Source: UNIVERSITY OF CALIFORNIA, DAVIS submitted to NRP
IDENTIFICATION OF EFFECTIVE STRATEGIES TO INCREASE FRUIT AND VEGETABLE CONSUMPTION IN LOW-INCOME POPULATIONS
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
COMPLETE
Funding Source
HATCH
Reporting Frequency
Annual
Accession No.
0224084
Grant No.
(N/A)
Cumulative Award Amt.
(N/A)
Proposal No.
(N/A)
Multistate No.
(N/A)
Project Start Date
Oct 1, 2010
Project End Date
Sep 30, 2015
Grant Year
(N/A)
Program Code
[(N/A)]- (N/A)
Recipient Organization
UNIVERSITY OF CALIFORNIA, DAVIS
410 MRAK HALL
DAVIS,CA 95616-8671
Performing Department
Nutrition
Non Technical Summary
With more than one-third of US adults now obese, promotion of a healthy lifestyle that includes an energy-balanced, nutrient- dense diet and physical activity is more urgent than ever. Many Americans consume too much energy from saturated fats and added sugar; cholesterol; sodium; and refined grains. At the same time, both adults and children do not consume enough fruit, vegetables, whole grains, milk and milk products, and oils. Based on a review of the evidence, the Dietary Guideline Advisory Committee (DGAC) concludes that the driving force behind the obesity epidemic is over-consumption of total calories, combined with too little physical activity. To support Americans in adopting healthy lifestyles, the DGAC report calls for many changes in the food environment. This proposed project is highly relevant to several of these recommended changes.The US Dietary Guidelines 2010 will continue to emphasize the importance of consuming more fruit and vegetables in the context of an overall healthful total diet, as a key strategy to optimize health. Fruits and vegetables provide many nutrients, including potassium and dietary fiber, and also tend to be less energy dense than foods with added sugars and solid fats. National studies have found associations between low fruit and vegetable consumption and greater abdominal fat in adolescent boys and obesity in adults. A national longitudinal cohort study also found an association between higher intakes of fruit and vegetables and lower incidence of and mortality from cardiovascular disease over the 19-year follow-up period. California is a major producer of vegetables and fruits but these foods are underconsumed both within California and in other states. In particular, low-income populations confront many barriers to consuming more fruit and vegetables. Recent changes in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) have attempted to remove some barriers by providing cash vouchers to low-income families to purchase fruit and vegetables. This policy change will provide an economic incentive to millions of low-income families nationwide to purchase more fruit and vegetables. Thus, identification and implementation of complementary strategies to maximize utilization of the vouchers and increase consumption of fruit and vegetables in low-income, high-risk populations is very timely. The long-term goal of this project-prevention of obesity and chronic disease-and its focus on identification of effective strategies to increase fruit and vegetable consumption is highly relevant to high-risk, low-income populations in California. The information generated through this research will be disseminated to US Department of Agriculture food assistance and nutrition education programs to guide local and state efforts to increase consumption of fruit and vegetables, especially in high-risk, low-income populations.
Animal Health Component
(N/A)
Research Effort Categories
Basic
(N/A)
Applied
(N/A)
Developmental
(N/A)
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
7036020101090%
6046299301010%
Knowledge Area
703 - Nutrition Education and Behavior; 604 - Marketing and Distribution Practices;

Subject Of Investigation
6020 - The family and its members; 6299 - Marketing, general/other;

Field Of Science
1010 - Nutrition and metabolism; 3010 - Economics;
Goals / Objectives
Goal: To prevent obesity and nutrition-related chronic diseases in low-income, high-risk populations Specific Objectives: 1) Design and validate instruments to measure youth preferences for and consumption of fruit and vegetables; 2) Develop and evaluate community-based programs (for example, family, school, afterschool, summer camp) to increase preferences for and consumption of fruits and vegetables in low-income youth; 3) Develop and evaluate the feasibility of a Farm-to-WIC intervention to increase local access to fresh, good-quality, culturally-preferred produce in low-income families; and 4) Determine the impact of a Farm-to-WIC intervention on voucher redemption rates and the variety and amount of fruit and vegetables consumed by WIC participants. Expected Outputs: 1) Validated tools for the evaluation of youth nutrition education programs delivered through the UC Food Stamp Nutrition Education Program (UC FSNEP in California or SNAP-Ed in other states); 2) Low-literacy (English and Spanish) nutrition factsheets on selecting and using fruit and vegetables (designed primarily for WIC clientele but also useful for UC FSNEP); 3) WIC vendor training on safe handling of fruit and vegetables; 4) Papers and presentations with guidance to USDA and other policy-makers on strategies to increase local access to and quality of produce in low-income communities, particularly those serving a WIC clientele; and 5) Papers and presentations with guidance to USDA and other policy-makers on appropriate messages to prevent childhood obesity in low-income Mexican American populations.
Project Methods
Objective 1: In two California counties, 100 low-income youth who participate in a summer fitness and FSNEP nutrition education program will complete pre-post taste testing of selected fruit and vegetables to document their food preferences. Staff will conduct pre-post interviews among their parents to determine how often the youth consume these foods. During nutrition classes, the teachers will also record the student responses to taste testing of each new fruit or vegetable. The students will complete a log to record their liking of the food at each session. Correlations between the teacher reports, parent surveys, and youth food preferences and logs will be analyzed. Objective 2: In Fresno County, we will conduct 3-4 focus group discussions among Latino parents to identify key messages and strategies for family-based nutrition education programs. This information will be used to adapt FSNEP adult and youth nutrition curricula for use in the Spanish-speaking audiences. We will then design a randomized, controlled intervention comparing three groups in Fresno County: 1) youth summer camp only (control); 2) youth summer camp plus nutrition education; and 3) youth summer camp plus nutrition education and family-based parent education. Youth eligible to participate will be low-income and either overweight or at risk of overweight (due to parent obesity). The nutrition education will include interactive activities, suitable for FSNEP, emphasizing repeated exposure to a variety of fruit and vegetables. Evaluation tools from objective #1 will be used to evaluate outcomes. Using analysis of covariance, we will examine the impact of the intervention on youth preference for fruit and vegetables, youth frequency of consumption of fruit and vegetables, and household availability of fruit and vegetables. Objective 3: In Tulare, Riverside, and Alameda Counties, we will identify at least 2-3 WIC vendors per county and 1 or more local growers who are willing to participate in this project. In each store, we will conduct a baseline and follow-up store survey 6-12 months later to record the variety and quality of fruit and vegetables. Between baseline and follow-up, we will implement the Farm-to-WIC program, providing locally-grown produce, point-of purchase consumer materials, and, vendor training on handling fruit and vegetables. We will also document process outcomes through in-depth individual interviews with the growers and vendors. Objective 4: In conjunction with activities described under Objective #3, we will partner with the California WIC Branch to obtain the cash voucher redemption rates for those clinics located in closest proximity to the vendors in the study. We will also recruit and follow a group of 300 WIC participants (with at least one adult and child 12 months or older). At baseline and 6-12 months later, we will interview the WIC adult regarding the variety of fruit and vegetables purchased with WIC vouchers and consumed by WIC participants. We will use a previously validated an English and Spanish Fruit and Vegetable Behavior Checklist in low-income multiethnic groups

Progress 10/01/10 to 09/30/15

Outputs
Target Audience:Mexican-heritage families with young children; low-income (SNAP or SNAP-eligible) families with youth 9-17 yrs; low-income (SNAP or SNAP-eligible) adults Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?From 2010-2015, six nutrition graduate students (LE Vera Becerra, G. George, A. Aguilera, M. Muñoz, L Rodrigues, C. French) and two graduate student in public health (M. Byrnes, K. Sheldon) participated in the related research studies, gaining experience in nutrition curriculum development; dietary assessment and anthropometry; program evaluation; and policy. Three undergraduate students (G Zavala, R Cabrera, E Frandsen) also participated in related community-based research, presenting posters at an undergraduate research. How have the results been disseminated to communities of interest?Results have been disseminated at state, national and international conferences and workshops for professionals and academics; local advisory and supervisor board meetings; Cooperative extension staff training events, evaluation taskforce meetings, and webinars; media interviews for radio, print, and television, and local continuing education seminars for health professionals. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? 1) Design and validate instruments to measure youth preferences for and consumption of fruit and vegetables; Accomplishments have been previously reported but briefly include development, validation, and adoption of a taste-test tool for evaluation of youth outcomes in the UC CalFresh program. In the past year, further adaptation of this tool was elaborated for a preschool setting. A dissertation was published (Aguilera) reporting the validity of a limited literacy, food frequency questionnaire (FFQ), administered to Spanish-speaking Mexican-origin parents. The results showed a significant positive correlation between FFQ vegetable consumption and dietary recall assessed vegetable servings (n=51, r=+0.41, p=0.005). 2) Develop and evaluate community-based programs (for example, family, school, afterschool, summer camp) to increase preferences for and consumption of fruits and vegetables in low-income youth; Accomplishments have been previously reported but briefly include evaluation of a fitness summer camp program for overweight or obese youth and a five-year community-based intervention targeting Mexican-origin families with young children (NSFS: Niños Sanos, Familia Sana, Healthy Children, Healthy Family). In Press (George, JNEB) is a paper reporting positive outcomes of the summer camp in reducing abdominal obesity, as measured by waist-to-height ratio in the intervention youth (n=126), compared to a control group (29). A second paper from that study (George, California Agriculture) is under review and reports a significant increase in fruit and vegetable consumption of the intervention youth only. The final end of study data collection for the NSFS is currently under way. However, interim findings (baseline to end of year two) have reported reductions in BMI and consumption of fast and convenience food items in the intervention children, compared to controls. No significant differences among the groups have been observed in fruit and vegetable intakes. Reasons for this finding are still being explored. 3) Develop and evaluate the feasibility of a Farm-to-WIC intervention to increase local access to fresh, good-quality, culturally-preferred produce in low-income families; and 4) Determine the impact of a Farm-to-WIC intervention on voucher redemption rates and the variety and amount of fruit and vegetables consumed by WIC participants. Accomplishments for these two objectives have been previously reported. This year, the papers were published in the California Agriculture journal (Hardesty et al; Kaiser et al). Findings were shared with the Institute of Medicine Committee, charged with revision of the WIC food packages.

Publications

  • Type: Journal Articles Status: Accepted Year Published: 2016 Citation: George GG, Schneider C, Kaiser LL. Healthy Lifestyle Fitness Camp: A Summer Approach to Prevent Obesity in Low-income Youth. Journal Nutrition Education and Behavior
  • Type: Conference Papers and Presentations Status: Published Year Published: 2015 Citation: Aguilera A, de la Torre A, Kaiser L. Changes in food consumption patterns of Mexican-Heritage children during a nutrition intervention FASEB J 2015; 29:120.6.
  • Type: Journal Articles Status: Published Year Published: 2015 Citation: Kaiser LL, Lamp CL, Ganthavorn C, Farfan-Ramirez L, Behar M, Cantwell M, Hardesty S. UCCE efforts improve quality of and demand for fresh produce at WIC A-50 stores. California Agriculture 2015; 69(2): 105-109.
  • Type: Journal Articles Status: Published Year Published: 2015 Citation: Hardesty S, Leff P, Baameur A, Aguiar JL, Jimenez M, Zeltser Y, Kaiser L. WIC fruit and vegetable vouchers: small farms face barriers in supplying produce. California Agriculture 2015;69(2) 98-104
  • Type: Journal Articles Status: Published Year Published: 2015 Citation: Kaiser LL; Martinez J, Horowitz M, Lamp C, Johns M, Espinoza D, Byrnes M, Mu�oz Gomez M, Aguilera A, Adela de la Torre, Adaptation of a culturally-relevant nutrition and physical activity program for low-income, Mexican-origin parents with young children. Prev Chronic Dis 2015;12:140591. DOI: http://dx.doi.org/10.5888/pcd12.140591
  • Type: Journal Articles Status: Published Year Published: 2015 Citation: Kaiser LL, Chaidez V, Horowitz M, Martin AC, Mendoza C, Neelon M, Ginsburg D. Food resource management education with SNAP participation improves food security. J Nutr Educ Behav. Published online April 2015
  • Type: Journal Articles Status: Published Year Published: 2016 Citation: Vera Becerra LE, Lopez ML, Kaiser LL. Relative validity of a tool to measure food acculturation in children of Mexican descent. Appetite 2016;97:87-93.
  • Type: Theses/Dissertations Status: Published Year Published: 2013 Citation: Gretchen George. Reduction of obesity in low SES youth through summer camp interventions
  • Type: Theses/Dissertations Status: Published Year Published: 2015 Citation: Alberto Aguilera. Changes in Eating Patterns of Young Mexican-Origin Children
  • Type: Journal Articles Status: Under Review Year Published: 2016 Citation: George GG, Schneider C, Kaiser LL. Lessons learned: how summer camps reduce risk factors of childhood obesity. Under review in California Agriculture
  • Type: Theses/Dissertations Status: Published Year Published: 2012 Citation: Luz Vera Becerra. Childhood Obesity in Mexican-Origin Populations
  • Type: Journal Articles Status: Published Year Published: 2015 Citation: Kaiser LL, Aguilera A, Horowitz M, Lamp C, Johns M, Gomez-Camacho, Ontai, de la Torre. Correlates of food patterns in young Latino children at high-risk of obesity. Public Health Nutrition. 2015; 18(16):3042-3050.


Progress 10/01/13 to 09/30/14

Outputs
Target Audience: Mexican-heritage families with young children; low-income (SNAP or SNAP-eligible) families with youth 9-17 yrs; low-income (SNAP or SNAP-eligible) adults Changes/Problems: These food frequency data from the NSFS should be interpreted with caution because research staff faced more challenges in data collection from the control community than in the intervention group during the past year. However, we have intensified efforts to interview the hard-to-reach populations in both communities. What opportunities for training and professional development has the project provided? Four nutrition graduate students (A. Aguilera, M. Muñoz, L Rodrigues, C. French) and one graduate student in public health (M. Byrnes) participated in the Niños Sanos, Familia Sana study, gaining experience in nutrition curriculum development; dietary assessment and anthropometry; program evaluation; and policy. Three undergraduate students (G Zavala, R Cabrera, E Frandsent) also participated in related community-based research, presenting posters at an undergraduate research symposium. Other training and professional development activities included 3 guest lectures in a community-based participatory research methods (Nutr. 298) class; 1 guest lecture on a graduate qualitative methods (Nutr 258); 2 guest lectures to graduate students on dietary assessment and food security (MAS 260 & 261); and 5 webinars and in-service training events related to program evaluation for cooperative extension county and public health staff. How have the results been disseminated to communities of interest? Presentations at several scientific meetings (Society for Nutrition Education, Experimental Biology have disseminated results. Presentations have also been given at quarterly local advisory committee meetings in Fresno County and at California State University in Fullerton to a USDA-funded program training Hispanic undergraduate majors in Health Science. What do you plan to do during the next reporting period to accomplish the goals? Several publications are in preparation for the project and are to be submitted this year. We hope to publish our culturally-adapted nutrition education curriculum online. Third and final year of the three-year intervention will be completed in 2014-2015 for the Niños Sanos, Familia Sana project. We will analyze data from this project on skin carotenoids, as an indicator of fruit and vegetable consumption.

Impacts
What was accomplished under these goals? Objective 1: Design and validate instruments to measure youth outcomes related to fruit and vegetables. In 2013-14, a paper was submitted and accepted for publication (Public Health Nutrition) with our previously reported findings on the factors associated with food patterns in Mexican-origin children. This paper reports construct validity and internal reliability of a 26-item, limited literacy food frequency questionnaire (FFQ), developed and administered at baseline to 217 Mexican-origin families in the Niños Sanos, Familia Sana (Healthy Children, Healthy Families) childhood obesity intervention in Fresno County, CA. This paper also identified several child feeding practices, including eating with an adult and having a regular routine for meals and snacks, that were related to higher consumption of vegetables in this population. Objective 2: Develop and evaluate community-based programs (for example, family, school, afterschool, summer camp) to increase preferences for and consumption of fruits and vegetables in low-income youth. The Niños Sanos, Familia Sana (NSFS, Healthy Children, Healthy Families) childhood obesity prevention study in Fresno County, CA completed its second intervention year (of three planned) delivering a culturally adapted nutrition curriculum, to Mexican-origin parents of children among whom about half were obese or overweight at baseline. The intervention families attended monthly nutrition education classes featuring key obesity prevention messages and received a monthly voucher worth $25 to purchase fruit and vegetables. The control community parents received other parent education, unrelated to nutrition. Using the tool validated above (objective #1), we interviewed Mexican-origin parents of the children to collect data on their child's frequency of consuming 26 food and beverage items during the past month at baseline and 1 year follow-up. Analysis of covariance, controlling for baseline consumption, mother's acculturation, and child's age, revealed no significant differences between the intervention (n=116) and control groups (n=54) in vegetable or fast food consumption. However, based on preliminary results, a trend has been detected in lowering the rate of Body Mass Index (BMI) growth in obese children in the intervention arm compared to the control arm. As we collect more data in the final year of this project (2015-2016), this preliminary finding will also be explored to see if these differences can be sustained.

Publications

  • Type: Other Status: Published Year Published: 2014 Citation: Kaiser LL and Campbell C. Practice Paper: Nutrition and lifestyle for a. healthy pregnancy outcome, J Acad Nutr Diet. 2014; 114 (7). Full text available at: http://www.eatright.org/Members/content.aspx?id=6442481526
  • Type: Conference Papers and Presentations Status: Published Year Published: 2014 Citation: Aguilera A, Kaiser LL, Horowitz M, Johns M, Lamp C, Stenger K, de la Torre A. Development of a Fruit and Vegetable Report Card for Mexican-Heritage Children. 2014 SNEB Conference, Milwaukee MI, June 28-July 1, 2014
  • Type: Conference Papers and Presentations Status: Published Year Published: 2014 Citation: Byrnes M, Kaiser L, Espinoza D, Martinez J, Whent L, Schaefer S, de la Torre A. Evaluation of a Physical Activity Curriculum for Parents of Mexican-heritage Children in California's Central Valley. 2014 SNEB Conference, Milwaukee MI, June 28-July 1, 2014
  • Type: Conference Papers and Presentations Status: Published Year Published: 2014 Citation: French C, Kaiser L, Lamp C, Stenger K, and de la Torre A. Navigating Murky Waters: Addressing Challenges to Reducing Sugar-Sweetened Beverages in Immigrant Communities. 2014 SNEB Conference, Milwaukee MI, June 28-July 1, 2014
  • Type: Conference Papers and Presentations Status: Published Year Published: 2014 Citation: Mu�oz Gomez M, Kaiser L, Lamp C, Horowitz M, Johns M, Martinez J, de la Torre. Parental response to Body Mass Index (BMI) report cards in a childhood obesity prevention. 2014 SNEB Conference, Milwaukee MI, June 28-July 1, 2014
  • Type: Journal Articles Status: Accepted Year Published: 2014 Citation: Kaiser LL, Aguilera A, Horowitz M, Lamp C, Johns M, Gomez-Camacho, Ontai, de la Torre. Correlates of food patterns in young Latino children at high-risk of obesity. Public Health Nutrition.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2014 Citation: Kaiser L and Ganthavorn C. Evaluating intent-to-change among SNAP-Ed participants. FASEB J April 2014 28:626.14
  • Type: Conference Papers and Presentations Status: Published Year Published: 2014 Citation: Kaiser L, Aguilera A, Schaefer S, Camacho Gomez R, de la Torre. Effect of infant feeding practices on fruit and vegetable intake in a Mexican-heritage population. 2014 Nutrition and Growth conference, Barcelona Spain, January 30-February 1, 2014.
  • Type: Other Status: Published Year Published: 2014 Citation: French C, Kaiser L, Gomez-Camacho R, Lamp C, de la Torre. Improve water quality in rural immigrant communities http://poverty.ucdavis.edu/policybriefs


Progress 01/01/13 to 09/30/13

Outputs
Target Audience: Mexican-heritage families with young children; low-income (SNAP or SNAP-eligible) families with youth 9-17 yrs; low-income (SNAP or SNAP-eligible) adults; Agencies serving these populations Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? One doctoral nutrition student completed her dissertation (G. George); two other nutrition graduate students (A. Aguilera, M. Muñoz) participated in the Niños Sanos, Familia Sana study. Several undergraduate students also participated in related community-based research (R. & G. Zavala; E. Figueroa; L. Rodriguez). How have the results been disseminated to communities of interest? Presentations at several scientific meetings (Childhood Obesity conference, Society for Nutrition Education, Experimental Biology have disseminated results. Presentations have also been given at local advisory committee meetings in Fresno County and at California State University in Fullerton to a USDA-funded program training Hispanic undergraduate majors in Health Science. What do you plan to do during the next reporting period to accomplish the goals? Second year of the three-year intervention will be completed in 2013-14 for the Niños Sanos, Familia Sana project. Several publications are in preparation for the HLFC projects and are to be submitted this year.

Impacts
What was accomplished under these goals? Objective 1: Design and validate instruments to measure youth outcomes related to fruit and vegetables. A 26-item limited literacy food frequency questionnaire was developed and administered at baseline to 316 Mexican-origin families in the Niños Sanos, Familia Sana (Healthy Children, Healthy Families) childhood obesity intervention in Fresno County, CA. Analysis of the baseline data did not reveal any differences in intakes of fruit and vegetables and other foods among the intervention and control communities. However, greater acculturation and age of the children were positively related to intake of fast and convenience foods, high in solid fats and/or added sugars. None of the demographic variables were related to vegetable intake. Participation in the WIC program was positively related to fruit intake, as well a low-fat milk, instant cereal, and juice. Objective 2: Develop and evaluate community-based programs (for example, family, school, afterschool, summer camp) to increase preferences for and consumption of fruits and vegetables in low-income youth. Final data analysis was completed on a Healthy Lifestyles Fitness Camp (HLFC), held during the summers of 2011 and 2012. The HLFC evaluation included 135 campers, 78% of whom are Latino or African American, and 48 comparison youth (all either Latino or African American). Parents who participated in the nutrition education classes, offered through the Healthy Lifestyles Fitness Camp, reported a decrease in the availability at home of unhealthy foods at home and increase in fruit and vegetable consumption among their children. Based on acclerometers that measured physical activity over an entire week, campers in HLFC were significantly more physically active than the comparison group. These overweight and obese campers lost on average about 2 ½ lbs over the six-week period, compared to 1 lb in other youth, but the campers were heavier at the start of camp. The amount of belly fat, also known as abdominal fat and measured by waist circumference, decreased significantly only in the campers. The other youth actually showed increases in belly fat over the six-weeks. Based on focus group research previously conducted among Mexican-origin parents, the Niños Sanos, Familia Sana (Healthy Children, Healthy Families) childhood obesity prevention intervention in Fresno County, CA completed the first year (of three planned) delivering a culturally adapted nutrition curriculum, developed by Specialist Kaiser and a team of Cooperative Extension nutrition advisors. More than 300 families attended monthly nutrition education classes featuring key obesity prevention messages and received a monthly voucher worth $25 to purchase fruit and vegetables; about 200 families in the control community received other parent education, unrelated to nutrition. Baseline data, including anthropometry, food purchases, frequency of food consumption, were analyzed for 500 families. Prevalence of child overweight and obesity is 46% among the 3-8 yr olds enrolled in the study. Objective 3: Develop and evaluate the feasibility of a Farm-to-WIC intervention to increase local access to fresh, good-quality, culturally-preferred produce in low-income families. This study was completed in June 2012. Two peer-reviewed journal articles were prepared over this past year. One is In Press; the other, submitted.

Publications

  • Type: Journal Articles Status: Published Year Published: 2013 Citation: Vera-Becerra LE, Aguilera A, Manzo R, Kaiser LL, De la Torre A. Perceptions of factors and messages related to childhood obesity among Mexican-origin parents. FASEB J 2013;27:1063.13
  • Type: Journal Articles Status: Published Year Published: 2013 Citation: George G, Kaiser LL, Martin A, Schneider C, Ginsburg G. Individualized feedback during summer camp affects anthropometric changes in Californias Central Valley overweight youth. FASEB J 2013; 27:36.6
  • Type: Journal Articles Status: Awaiting Publication Year Published: 2013 Citation: Kaiser LL, Lamp CL, Ganthavorn C, Farfan-Ramirez L, Behar M, Cantwell M, Hardesty S. UC Cooperative Extension Supports Policy Change in the WIC Program. California Agriculture. In Press
  • Type: Journal Articles Status: Published Year Published: 2013 Citation: De la Torre A, Sadeghi B, Green R, Kaiser LL, Flores Y, Jackson CF, Shaikh U, Whent L, Schaefer S. Ni�os Sanos, Familia Sana: Mexican immigrant study protocol for a multifaceted CBPR intervention to combat childhood obesity in two rural California towns. BMC 2013Oct 31:13 1033 doi 10.1186/1471-2458-13-1033.
  • Type: Journal Articles Status: Awaiting Publication Year Published: 2013 Citation: Chaidez VC, McNiven S, Vosti S. Kaiser LL. Sweetened food purchases and indulgent feeding are associated with increased toddler anthropometry. JNEB 2013 published online. In Press
  • Type: Journal Articles Status: Published Year Published: 2013 Citation: Vera Becerra LE, Lopez ML, Kaiser LL. Child feeding practices and overweight status among Mexican immigrant families. J Immigrant and Minority Health 2013; published online DOI 10.1007/s10903-013-9879-4
  • Type: Conference Papers and Presentations Status: Other Year Published: 2013 Citation: Kaiser LL, Lamp C, Johns M, Horowitz M, Schneider C, Mu�oz-Gomez M, Aguilera A, De la Torre, A. Development of a health report card for a Mexican-origin audience. Childhood Obesity Conference, Long Beach, California, June 18-20, 2013
  • Type: Conference Papers and Presentations Status: Other Year Published: 2013 Citation: Kaiser LL, Martinez J, Lamp C, Johns M, Horowitz M, Schneider C, Aguilera A, De la Torre A. Cultural adaptation of obesity prevention messages and programs for a Mexican-origin audience. Childhood Obesity Conference, Long Beach, California, June 18-20, 2013
  • Type: Journal Articles Status: Published Year Published: 2013 Citation: Aguilera A, Kaiser L. Food insecurity and food patterns in Mexican-heritage children. FASEB J 2013; 27:1054.9


Progress 01/01/12 to 12/31/12

Outputs
OUTPUTS: Objective 1: Design and validate instruments to measure youth outcomes. Work on this objective was completed this year. In Dec 2012, an article on validation of the Taste Test Tool (TTT) was published a peer-reviewed journal; an article on the Teacher Observation Tool (TOT) was published in an online book. Having completed the development phase, Specialist Kaiser worked with the UC CalFresh program (known nationwide as SNAP-Ed) to set SMART program objectives, based on use of the TTT and TOT evaluation tools for each of the youth curricula used in that program. Objective 2: Develop and evaluate community-based programs. In 2012, a second year of evaluation of the Healthy Lifestyles Summer Fitness (HLFC) in Fresno was completed. During this year, the study included 56 campers and 30 controls who were participants in another summer camp that did not include nutrition and physical activities. Another component of this years' study examined the effect of providing individualized feedback on dietary intake and physical activity on anthropometric and other outcomes. Two focus groups were conducted at the end of the study with parents. Findings from this study were shared at the Experimental Biology meeting (April 2012) in Anaheim. A second community-based program was initiated in 2012. The Ninos Sanos, Familia Sana (Healthy Children, Healthy Family) study, which will last 5 years, involves a multi-component intervention to prevent childhood obesity in Mexican-origin children, ages 3-8 yrs. The intervention community will receive a monthly voucher worth $25 for fruit and vegetables, parent nutrition education, and school-based nutrition education and physical activity. Outputs for this year included development of lesson plans for 10 Family Nights, focusing on childhood obesity prevention messages (increase family meals, eat more fruits and vegetables, healthy diets and kid-friendly portion sizes). About 280 families were enrolled in the intervention community. Two abstracts on the development of the intervention were presented at the Society for Nutrition Education meeting in July 2012. Objective 3: Develop and evaluate the feasibility of a Farm-to-WIC intervention. A qualitative study was conducted among 62 WIC participants in three counties to examine shopping practices and decision-making regarding use of the fruit and vegetable vouchers. In-depth interviews were also conducted in 2012 among five store owners or managers representing more than 230 California WIC-only stores. Specialist Kaiser and the nutrition advisors shared findings from this study with WIC clinic staff in workshops conducted in Alameda, Tulare and Riverside (April to May 2012) and at the WIC Annual Conference in Palm Springs May 2012. Two research articles summarizing the findings have been submitted to a journal. All extension materials (fact sheets and posters) have been posted on a website for free download. PARTICIPANTS: Individuals: Lucia Kaiser served as the PI or Co-PI on all these activities. Gretchen George, doctoral student in nutrition, designed and implemented the evaluation of the Fresno Summer Fitness Camp. The Ninos Sanos, Familia Sana, led by PI Adela de la Torre, involves a large team of academics from different departments and schools, including Nutrition, Agricultural Resource Economics, Chicano Studies, the School of Medicine, the School of Nursing, the School of Education, and UC Cooperative Extension. Partners: The Fresno County Park and Recreation Department played a pivotal role in running the Fresno Summer Fitness Camp. In the Ninos Sanos, Familia Sana project, important partners include various local organizations including West Hills Community College, the local school district, and the Firebaugh supermarket, and other Firebaugh community groups and leaders. Collaborators: UC CalFresh staff in Fresno County and the State Office facilitated activities conducted as part of objectives #1-2. UC Cooperative Extension nutrition advisors from Tulare, Yolo, and Kern Counties have participated in development of the curriculum for the Family Nights offered in the Ninos Sanos, Familia Sana project. The Early Childhood Development Specialist (L Ontai) also participated in this project. Professional development: Two doctoral students (G. George and A. Aguilera) have been actively involved in the activities. Several undergraduate interns have also participated. TARGET AUDIENCES: For all objectives, the primary groups reached include low-income youth and families with young children, including those served through the federal Supplemental Nutrition Program for Women, Infants, and Children. In the Fresno Summer Fitness project, most of the youth were Latino or African-American, and all were overweight or obese. The Ninos Sanos, Familia Sana project that is taking place in Fresno County includes Mexican-American immigrant families, which comprise the target group for the community-based fruit and vegetable intervention. A second target group is owners/managers of small stores and local farms (Objectives# 3 & 4). Efforts have included extension and outreach activities, parent nutrition classes, school-based nutrition classes, and point-of-purchase information. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.

Impacts
Objective 2: Among the youth who participated in the six week Healthy Lifestyle Fitness Camp (HLFC), the effect of individualized feedback on cardiovascular risk factors was examined. A randomly selected subgroup of campers (HLFC+, n=11) wore accelerometer watches, provided diet information, and received individualized feedback pre, post and two month after camp. A control group (n = 30) was followed simultaneously without exposure to HLFC. Trained staff measured the youths' weights, heights, and waist circumferences. Significant differences were observed pre-post camp in waist circumference to height ratio (WCHtR) between HLFC (-0.03) and control (-0.01), determined by t-test (p=0.01). Significant WCHtR differences between HLFC (-0.04) and HLFC+ (-0.06) were observed at the two month follow- up (p=0.03). Nutrition and physical activity themed camps, coupled with individualized feedback, may achieve greater results in longer term risk reduction in overweight youth. Objective 3: The Farm-to-WIC project was completed in 2012. The following findings were reported to the funder and submitted to a journal for dissemination. First, smaller-scale farms face several barriers to entry when seeking access to the WIC fruit and vegetable voucher supply chain. These farms lack economies of scale in production; therefore, they cannot provide competitive pricing when selling direct to WIC-only stores or through produce distributors. The WIC-only stores are competing with established large retailers that operate with very small margins. Second, most WIC participants found the fact sheets useful, especially the nutrition information and the tips on how to choose, store, and prepare the produce. Most said they learned something new from the fact sheets. These fact sheets may useful either in the clinics or as point-of-purchase materials in WIC stores. Third, for many of the WIC-only store employees, store training is needed on topics such as temperature management with limited options, control of water loss, compatibility issues with focus on ethylene sensitive produce, minimizing decay, managing product turnover, and postharvest conditions to retain nutrients, among others.

Publications

  • Kaiser LL, Schneider CS, Mendoza C. Neelon M, Roche B, and Ganthavorn C. 2012. Evaluation of nutrition outcomes in youth: challenges and opportunities. In: Youth: Practices, Perspectives and Challenges Editor: Elizabeth Trejos NOVA Science Publishers: NY
  • George GG, Schneider C, Ginsburg D, and Kaiser L. Summer camp promotes anthropometric and lifestyle changes in overweight youth in Fresno, California FASEB J March 29, 2012 26:1011.9
  • Kaiser L, Horowitz M, Schneider C, Johns MC, Lamp C, Aguilera A. Bueno-Gutierrez D, de la Torre, A. Development of a Multi-Year, Family-Centered Nutrition Intervention to Prevent Obesity in Mexican-Heritage Children JNEB 2012; 44 (4): S90-91
  • Kaiser LL, Schneider CS, Mendoza C, George G, Neelon M, Roche B, and Ginsburg D. 2012. Development and use of an evaluation tool for taste testing activities in school-age children. Journal of the Academy of Nutrition and Dietetics 112: 2028-2034.
  • De la Torre A, Sandeghi B, Flores Y, Kaiser L, Camacho R. Implementation of a Community-based, Multiyear, Multifaceted Obesity Prevention Program: Lessons Learned JNEB 2012; 44 (4): S87.


Progress 01/01/11 to 12/31/11

Outputs
OUTPUTS: Objective 1: Design and validate instruments. One validation study was conducted in 10 counties participating in the UC CalFresh (formerly Food Stamp Nutrition Education Program). This study examined the validity of a retrospective Teacher Observation Tool (TOT), compared to pre-post student curriculum test scores and a traditional pre-post version of TOT. Data analysis was completed on the 2010 validation study of a Taste Test Tool in Fresno County. Findings from these studies have been shared at the 6th Childhood Obesity conference (national event) and at the annual UC CalFresh Conference. A UC CalFresh staff in-service webinar training was also conducted on use of the instruments. Several papers related to instrument validation were finalized and published in 2011. Objective 2: Develop and evaluate community-based programs. A graduate student (A. Aguilera) conducted two focus groups among Mexican-origin families to develop key messages for an obesity prevention intervention to promote fruit and vegetable consumption. A controlled intervention study was conducted by another graduate student (G. George) and two student interns among 108 low-income, overweight or obese youth (ages 9-17 yrs) who were in a six-week summer fitness camp in Fresno. This study examined the effects of a nutrition and physical activity program on dietary patterns, fruit and vegetable preferences, and anthropometric measurements. UC CalFresh staff attended two in-service trainings related to curriculum design and evaluation as part of the summer fitness camp study. Findings from the 2010 summer fitness camp were shared at the 6th Childhood Obesity conference (national event) and the annual UC CalFresh Conference. Objective 3: Develop and evaluate the feasibility of a Farm-to-WIC intervention. Eighteen point-of-purchase factsheets promoting fruit and vegetables and a poster were finalized and distributed to WIC stores in Tulare, Riverside, and Alameda counties. Findings from the 2010 survey were summarized in a peer-reviewed publication and shared at the 6th Childhood Obesity conference and at the American Dietetic Association meeting (both national events). Objective 4: Determine the impact of a Farm-to-WIC intervention on voucher redemption rates and the variety and amount of fruit and vegetables consumed by WIC participants. A Memorandum of Understanding was developed to obtain voucher redemption rate data from the California WIC Branch. PARTICIPANTS: Individuals: Lucia Kaiser served as the PI on all these activities. Gretchen George, doctoral student in nutrition, designed and implemented the evaluation of the Fresno Summer Fitness Camp. Partners: The Fresno County Park and Recreation Dept played a pivotal role in running the Fresno Summer Fitness Camp. Penny Leff and Tammy McMurdo were partially supported on a California Dept of Food and Agriculture grant to implement the Farm-to-WIC program. Teachers in 10 California school districts participated in the validation study. Collaborators: UC CalFresh staff in Fresno County and the State Office facilitated activities conducted as part of objectives #1-2. UC Cooperative Extension nutrition advisors from Tulare, Fresno, Riverside, Alameda, Riverside, Contra Costa, Shasta/Trinity, and Los Angeles were also key collaborators. Due to the receipt of a new grant, faculty from the UC Davis Chicano Studies Dept have begun working on a community-based fruit and vegetable intervention, along with Dr. Kaiser, in Fresno County. Professional development: Two doctoral students (G. George and A. Aguilera) have been actively involved in the activities. Two undergraduate interns have also participated. TARGET AUDIENCES: For all objectives, the primary groups reached include low-income youth and families with young children, especially those served through the federal Supplemental Nutrition Program for Women, Infants, and Children. In the Fresno Summer Fitness project, most of the participants were Latino or African-American, and all were overweight or obese. The focus groups that took place in Fresno included Mexican-American immigrant families, which will comprise the target group for the future community-based fruit and vegetable intervention. A second target group is owners/managers of small stores and local farms (Objectives# 3 & 4). Efforts have included extension and outreach activities, informal education, and point-of-purchase information. PROJECT MODIFICATIONS: Since the Farm-to-WIC intervention has not been able to sufficiently engage small farmers directly, activities under objective #4 will be altered to focus more on assessment of needs and opportunities and less on evaluation of the intervention. We are now planning a WIC participant, store, and grower interviews to determine additional strategies to improve local availability of fresh, affordable produce.

Impacts
Obj1: Design and validate instruments. The teachers in the 10 counties completed the pre-TOT before delivering nutrition lessons and post-TOT after teaching all the lessons. They also completed the retrospective TOT a minimum of 2 weeks after the post TOT but before the start of the new school year. TOT youth scores were calculated by summing up the responses for the five student knowledge, attitude, and behavior items. A greater TOT score (regardless of pre-, post-, or retrospective TOT) always indicates more desirable outcomes. Matching sets of pre-post TOT and retrospective TOT were obtained for 52 classrooms. A significant improvement in TOT scores (n= 52) was observed in pre-post administration of TOT. For 5 student items, mean TOT scores were as follows: pre-TOT: 16.3 (ranges 6-23); post-TOT; 19.7 (ranges 13-25); and retrospective TOT: 20.7 (14-25). Significant differences were observed in the post v. pre TOT (p <0.0001) and in the retro v. pre TOT (p < 0.0001). However, post-TOT and retro-TOT are strongly correlated (r=0.47, p< 0.0002). These findings show that the teachers' perceptions of the students' nutrition knowledge, attitudes, and behaviors change during the course of the school year reflecting improvement related to the nutrition education and that their final perception at the end of the lessons remains consistent at two separate time points. Obj2: Develop and evaluate community-based programs. Using analysis of variance, significant differences were observed in weight change between Fitness Camp youth (-1.06 kg in 9-11 yr olds and -1.58 kg in 12-17 yr olds) and controls (+0.33 kg), after adjusting for baseline (body mass index for age) BMI (p= 0. 04). Waist circumference change was also significantly different among Fitness Camp and control groups, after controlling for baseline BMI (p=0.003). Effect of the intervention on the home food environment was also examined, specifically exploring if the fruit and vegetables tastings might influence youth requests for vegetables and if the education (to youth and parents) might increase the availability of healthy foods and reduce unhealthy foods in the home. The final sample size of control parents w/ both pre- and post-data was too small (n=8) for statistical analysis; no differences could be detected between the groups. However, intervention parents reported receiving more youth requests at the end of camp for the target vegetables, although that did not always prompt them to buy more food Improvements were also seen in the availability of healthy foods (increased) and unhealthy foods (decreased). Intervention parents also reported more frequent family meals and involvement of youth in food preparation. Participation in a summer fitness camp was associated with weight loss in overweight/obese youth and improvement in their home food environment. Obj3: Develop and evaluate the feasibility of a Farm-to-WIC intervention. Many barriers exist in direct marketing of produce from small local growers to the WIC stores. There appear to be other ways to improve local availability of fresh produce. Training related to postharvest handling to maintain product quality is critically needed.

Publications

  • Kaiser LL, Lamp C, Ganthavorn C, Farfan-Ramirez L, McMurdo T, Cantwell M, Hardesty S. 2012. UC Cooperative Extension explores a Farm-to-WIC program. California Agriculture 66 (1): 15-19.
  • Chaidez VC, Kaiser LL. 2011. Validation of an instrument to assess toddler feeding practices of Latinos mothers. Appetite 57(1): 229-236.
  • Chaidez VC, Townsend MS, and Kaiser LL. 2011. Toddler feeding practices among Mexican-American mothers: a qualitative study. Appetite 56(3): 629-632.
  • Matthiessen T, Steinberg FM, Kaiser LL. 2011. Convergent validity of a digital image-based food record to assess food group intake in youth Journal of the American Dietetic Association 111(5): 756-761.
  • Matthiessen T, Horowitz M, Neelon M, Smith D, Kaiser L. 2011. Insights from 4-H Healthy Living Project. In: Advances in Youth Development: Research and Evaluation from the University of California Cooperative Extension (2001 - 2010). Editor: Aarti Subramaniam. Available at http://www.ca4h.org/Research/CYD/Publications/, 2011.
  • Lamp C, McMurdo T, Ganthavorn C, Farfan-Ramirez L, Kaiser L. 2011. Development of a Farm-to-WIC extension program. Food and Nutrition Conference, Sept 24-27, 2011 San Diego JADA 2011; 111(9): A52 (abstract)