Progress 10/01/06 to 09/30/07
Outputs
Progress Report Objectives (from AD-416) The objective of this cooperative research project is to evaluate the nutritional health in the Lower Mississippi Delta, to identify nutritionally responsive problems, and to design and evaluate interventions that may be sustained at the community level and implemented on a larger scale in similar areas of the United States. Approach (from AD-416) Developing capacity as necessary, the Lower Mississippi Delta Nutrition Intervention Research Initiative (Delta NIRI) Consortium will identify environmental and community characteristics related to nutritional status; measure dietary intake; assess nutritional risk factors; and design, conduct, and evaluate interventions in the Lower Mississippi Delta. The University of Southern Mississippi specifically will support community- based participatory research activities in Hollendale, MS, and other sites as mutually agreed upon. In addition, USM will maintain a Behavioral Research Center, to conduct telephone, mail, internet surveys and qualitative data collection including focus groups; take a lead role within the Delta NIRI in data management for community assessments; initiate efforts to secure external funding for food security research and graduate fellowships; obtain statistical consulting expertise related to use of large national datasets; and conduct research in food and health behavior change and evaluation. Significant Activities that Support Special Target Populations Monitoring of cooperator�s performance and adherence to conditions of the agreement was by: a strategic planning session; two site visits (one for data collection and one for technical assistance); quarterly reports consisting of budgetary material, progress towards goals and objectives, and review of publications and manuscripts in progress; community visits to determine progress at research sites and numerous conference calls and emails. Ndirangu, M., Yadrick, K., Bogle, M.L., Graham-Kresge, S. 2007. Community-academia partnerships to promote nutrition in the Lower Mississippi Delta: Community members� perceptions of effectiveness, barriers and factors related to success. Journal of Health Promotion Practice. In press. Lofton, K. 2007. Examining relationships among obesity, food insecurity, stress, and emotional eating among low-income African American women [dissertation]. University of Southern Mississippi. 102 p. Yadrick, K., Threadgill, P., Kennedy, B., Strickland, E., McCabe-Sellers, B., Prewitt, T., McGee, B., Bogle, M. 2007. Capacity building for health through community based participatory nutrition intervention research in rural communities. Progress in community Health Partnerships: Research Education and Action. In press. Zoellner, J., Powers, A., Williams, A., Ndirangu, M., Strickland, E., Rowser, M., Lucas, G.D., Connell, C., Yadrick, K., Bogle, M.L. Adherence and effects of maintaining a 6-month pedometer diary in a rural African American community-based walking intervention. Submitted to Journal of Health Care for the Poor and Underserved. Zoellner, J., Connell, C., Santell, R., Fungwe, T. Community health advisor awareness, knowledge and insights regarding the 2004 Dietary Guidelines and MyPyramid. Submitted to the Journal of the American Dietetic Association. Accomplishments Comprehensive Process Evaluation of Fit for Life Steps: Understanding the factors that contribute to making nutrition and physical activity interventions effective and sustainable is critical in small, rural communities, where declining population and limited resources present formidable challenges to community health status. Lower Mississippi Delta NIRI researchers from the University of Southern Mississippi completed a comprehensive process evaluation of the Hollandale Fit for Life Steps walking intervention. Our team conducted focus groups and interviews with participants and staff, and reviewed many types of records kept during the intervention. The process evaluation confirmed that trained volunteer leaders from the community can effectively recruit and support their overweight and obese community peers in increasing their level of physical activity and improving their blood pressure and other health outcomes. (NP 107, Human Nutrition Action Plan 2004-2008: Component 7: Health Promoting Intervention Strategies for Targeted Populations: ARS Strategic Plan Objective 4.l: Promote Healthier Individual Food Choices and Lifestyles and Prevent Obesity: and Performance Measure 4.1.1: Execute and report on two completed Delta NIRI projects) Addressing Dimensions of Community Capacity in a Rural Mississippi Delta Community: Rural lower Mississippi Delta communities have among the highest rates in the nation for obesity and other chronic health conditions, but may be among the most poorly equipped to address health problems because of lack of human and physical resources. Lower Mississippi Delta NIRI researchers from the University of Southern Mississippi evaluated capacity-building activities in a rural, predominantly African American community in the Delta of Mississippi to determine how they contributed to building community capacity for health promotion. Our team evaluated capacity-building activities conducted in Hollandale as part of the Delta NIRI using an accepted framework for dimensions of community capacity, which is understood to be necessary to successfully address the health disparities that face rural LMD communities. Capacity-building activities in Hollandale strengthened dimensions of community capacity that included leadership, skills, resources, critical reflection, problem assessment and community health values, preparing this community to sustain positive health processes and outcomes achieved through nutrition and physical activity interventions. Specific capacity-building strategies used in Hollandale were shared with U.S. and Canadian community and academia representatives in a well-attended session at the Community Campus Partnerships for Health annual meeting. (NP 107, Human Nutrition Action Plan 2004-2008: Component 7: Health Promoting Intervention Strategies for Targeted Populations: ARS Strategic Plan Objective 4.l: Promote Healthier Individual Food Choices and Lifestyles and Prevent Obesity: and Performance Measure 4.1.1: Execute and report on two completed Delta NIRI projects) Stress Contributes to Obesity in Low-Income African American Women: Obesity rates of African American populations in the rural delta region are among the highest in the US, leading to many negative health consequences for this group. Lower Mississippi Delta NIRI researchers from the University of Southern Mississippi developed a better understanding of factors that contribute to obesity in limited income African American women in Mississippi. Researchers evaluated weight perceptions and the roles of stress, food insecurity, and emotional eating in contributing to obesity in this population. Perceived stress was a predictor of obesity for these women, but food insecurity and emotional eating were not. Most women perceived themselves to be in a lower weight category than they were actually in. Policymakers and educators must consider these factors as they plan approaches to prevent obesity in this population. (NP 107, Human Nutrition Action Plan 2004- 2008: Component 7: Health Promoting Intervention Strategies for Targeted Populations: ARS Strategic Plan Objective 4.l: Promote Healthier Individual Food Choices and Lifestyles and Prevent Obesity: and Performance Measure 4.1.1: Execute and report on two completed Delta NIRI projects) Technology Transfer Number of Non-Peer Reviewed Presentations and Proceedings: 1 Number of Newspaper Articles,Presentations for NonScience Audiences: 3
Impacts
(N/A)
Publications
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Progress 10/01/05 to 09/30/06
Outputs
Progress Report 1. What major problem or issue is being resolved and how are you resolving it (summarize project aims and objectives)? How serious is the problem? Why does it matter? The Lower Mississippi Delta (LMD) area of Arkansas, Louisiana, and Mississippi is characterized by high rates of poverty, low education attainment, and food insecurity. There is a high prevalence of hypertension, diabetes, obesity, anemia, and heart disease, all of which are influenced by nutrition. We are attempting to resolve these problems through the efforts of the Lower Mississippi Delta Nutrition Intervention Research Initiative (Delta NIRI). The Delta NIRI Consortium consists of the original partners: scientists from Alcorn State University, Alcorn State, MS (ASU); Arkansas Children's Hospital Research Institute, Little Rock, AR (ACHRI); Pennington Biomedical Research Center, Baton Rouge, LA (PBRC); Southern University and A&M College, Baton Rouge, LA (SU); The University of
Arkansas at Pine Bluff, Pine Bluff, AR (UAPB); The University of Southern Mississippi, Hattiesburg, MS (USM); and the Agricultural Research Service (ARS) of USDA, Little Rock, AR. The Delta NIRI Consortium also now includes representatives from the Arkansas, Louisiana, and Mississippi Cooperative Extension Service; the College of Public Health of the University of Arkansas for Medical Sciences, Little Rock, AR; a private researcher, Jackson, MS; and members from the Delta communities of Marvell, AR; Hollandale, MS; and Franklin Parish, LA. The ARS has initiated agreements with other scientists with needed expertise for specific research requirements. For example, the Children's Nutrition Research Center (CNRC) in Houston is collaborating with a Baylor College of Medicine scientist that has nutrition epidemiology skills, and the Human Nutrition Research Center on Aging (HNRCA) at Tufts University in Boston is providing expertise on the development of an original adult food frequency
questionnaire. These scientists, Extension, and community members participate fully in the Delta NIRI Consortium. The Consortium is diverse in its composition: including minorities, many research disciplines (nutrition, food science, family economics, sociology, medicine, community development, community grass root, agriculture, etc.), and a variety of professionals (nutritionists, pediatricians, nurses, food scientists, sociologists, agriculture economists, etc.). This diversity is necessary because of the complexity of the food concerns, poverty, isolation, and low educational attainment in parts of the Delta region. The Delta NIRI Consortium is evaluating the nutritional health in the LMD, to identify nutritionally responsive problems, and to design and evaluate interventions using a community participatory research model. Use of this model will promote capacity- building and sustainability at the community level. Lessons learned about successful intervention approaches will be
disseminated in order to facilitate implementation on a larger scale in similar areas of the United States. Rates of rural poverty and nutrition-related chronic diseases in the LMD are among the Nation's highest. Arkansas, Mississippi, and Louisiana traditionally rank at or near the bottom in health rankings of the United States and continue to worsen compared with other states. Food insecurity, adult and child obesity, and high blood pressure and diabetes among adults are higher in each of these states than for the national average. The area is underserved by food and nutrition and other health professionals, thus the burden of food-related health problems is carried by minority, low-income, and educationally disadvantaged individuals and families in the Delta communities. The presence of these problems severely limits the quality of life, productivity, and the future of this rural, at-risk population, while propelling them into the high-user category for nutrition assistance
programs and high-cost health care and treatment of nutrition-related disease. The Lower Mississippi Delta Nutrition Intervention Research Initiative falls under the National Program 107 - Human Nutrition, and addresses ARS Strategic Plan performance goal 4.1.1 through developing and transferring effective nutrition intervention strategies. 2. List by year the currently approved milestones (indicators of research progress) Year 2005: Objective 1. Develop nutrition interventions in Hollandale, MS, through community-based participatory research. Milestone a) The Hollandale NIRI community-based research team will be in place in MS. Milestone b) The Hollandale research worksite will provide a neutral site in Hollandale, MS, and enhance visibility of the Delta NIRI. Milestone c) An assessment of community resources and environmental conditions in Hollandale, MS, relevant to nutrition interventions will be complete. Objective 2. Design the nutrition intervention research for Hollandale, MS,
using a Comprehensive Participatory Planning and Evaluation (CPPE) process. Milestone a) Potential interventions and strategies will be identified and evaluated. Milestone b) A research protocol for each of the selected interventions in Hollandale, MS, will be written. Milestone c) New and modified data collection instruments will be developed as needed for each intervention. Milestone d) Manuscripts will be completed by USM scientists describing the CBPR/CPPE processes, development of the Hollandale NIRI research worksite, community readiness, resource assessment, and other elements of the pilot testing and preparation for each intervention. Milestone e) USM will participate in the planning and implementation of one regional conference of scientific and lay communities. Objective 3A. Implement nutrition intervention strategies in Hollandale, MS. Milestone a) A well-written research protocol for a nutrition intervention in Hollandale, MS, will be finalized. Milestone b) Appropriate
data collection instruments and procedures necessary for the intervention research will be pre-tested if necessary. Milestone c) Hollandale residents and individuals from USM will be trained to collect data and to monitor data collection. Milestone d) A detailed operational plan for the implementation process for the intervention in Hollandale, MS, will be completed. Milestone e) Appropriate institutional review board approval for human subject's participation will be in place for USM. Milestone f) Manuscripts describing pilot testing intervention strategies, data collection procedures, and training of data collectors will be completed for peer reviewed journals by USM scientists. Year 2006 Objective 3A. Implement nutrition intervention strategies in Hollandale, MS. Milestone a) Implement nutrition intervention strategies specific to Hollandale, MS. Milestone b) Monitor data collection and progress of intervention strategies. Milestone c) Evaluate process variables associated with
nutrition interventions Hollandale, MS. Milestone d) USM will prepare and submit manuscripts to peer reviewed journals for publication. Year 2007 Objective 3B. Evaluate nutrition intervention strategies implemented in Hollandale, MS. Milestone a) Evaluate nutrition intervention strategies in place in Hollandale, MS. Milestone b) Develop measures to evaluate the impact of the CBPR/CPPE processes on the community of Hollandale, MS. Milestone c) Monitor the effects of other activities within Hollandale on the nutrition intervention. Milestone d) Utilize appropriate qualitative and quantitative statistical techniques to evaluate objectives and test hypotheses of the interventions in Hollandale, MS. Milestone e) The participation of the Hollandale NIRI (community group) in the analytical process will be documented. Milestone f) A data monitoring and evaluation system will be in place for continuous monitoring of data collection and quality of processes used. Milestone g) Manuscripts
describing the status of interventions in Hollandale, MS, with regards to process and outcome variables will be completed by USM scientists and submitted to peer reviewed journals for publication. Milestone h) USM will participate in the convening of a nationa Delta NIRI symposia for scientific and lay communities on CBPR/CPPE, and nutrition intervention strategies for at-risk populations in rural communities. Year 2008 Objective 4. Initiate the process of adapting the successful nutrition intervention strategies from Hollandale, MS to other Lower Mississippi Delta communities. Milestone a) At least one additional community in MS will be targeted and recruited for community-based nutrition intervention research to duplicate the successful strategies and interventions. Milestone b) Manuscripts describing the research process and intervention outcomes will be prepared by USM scientists and submitted to peer reviewed journals for publication. Milestone c) USM will participate in the
convening of a Delta NIRI national symposia for scientific and lay communities on CBPR, CPPE, and nutrition intervention strategies in rural communities. 4a List the single most significant research accomplishment during FY 2006. This accomplishment is aligned with National Program 107 Human Nutrition: Component 7. Health Promoting Intervention Strategies for Targeted Populations. Action Plan Problem Statements: Identify, implement and test nutrition and physical activity interventions in low- income communities. Fit for Life Steps Walking Intervention: Rates of obesity, hypertension, and heart disease in Delta residents are among the highest in the U.S. Partners in the Hollandale MS Nutrition Intervention Research Initiative conducted a 6-month intervention in which community residents attended monthly nutrition education sessions and participated in one of eight walking groups led by trained community volunteer 'coaches'. Participants lost an average of 1.5 inches from their
waist, lowered their systolic blood pressure by an average of 4 points, and raised their "good" (HDL) cholesterol by almost 8 points. These physical changes will directly benefit the health of these Delta residents, while lifestyle behaviors learned through the intervention will contribute to better health in the participants and their families in the future. 4b List other significant research accomplishment(s), if any. Delta high school students prepared for careers in nutrition: The Lower Mississippi Delta experiences a shortage of professionals in nutrition, as well as in other agricultural- and health-related professions, which is particularly acute with regard to representation of minority populations. The Hollandale Nutrition Intervention Research Initiative recruited and trained approximately 35 African American high school youth in food and nutrition careers over a three-year period. Youth participated in self-improvement enrichment sessions focusing on healthy food choices,
physical activity, and job skills, and acquired on- the-job training from community mentors engaged in food and nutrition- related careers. Exposing high school students nearing graduation to careers in food, nutrition and related disciplines will increase the number of students choosing to pursue such fields in college, and ultimately help to increase the number and diversity of professionals in these disciplines in the Delta region. African American moms perceive their overweight children to be of normal weight: Rates of obesity among Mississippi African American children are among the highest in the U.S. University of Southern Mississippi researchers studied child feeding practices and perceptions of African American mothers whose children were enrolled in Headstart about their preschool children's weight status. Mothers perceived their overweight children to be of normal weight, and encouraged their normal weight children, whom they perceived to be underweight, to eat more.
Obesity prevention programs and policies targeted towards this group must consider their beliefs about appropriate weights for children as well as their child feeding practices. Accurate estimates of obesity in Mississippi school children determined by measuring heights and weights: Most information on rates of obesity in Mississippi school children is based on estimates from heights and weights self-reported in surveys of middle and high school children, which tend to underestimate rates. University of Southern Mississippi scientists determined obesity rates of Mississippi children in grades 1-8 by training school personnel to measure heights and weights. Twenty-four percent of school children were classified as overweight, another 15% were at risk of overweight, and rates of overweight increased steadily from grade 1 to 5. An understanding of when obesity begins in Mississippi children is critical for developing prevention programs that target children at an age when such programs
have more likelihood of success. 5. Describe the major accomplishments to date and their predicted or actual impact. Much of the recent focus of Delta NIRI collaborators in Mississippi has been on building an effective community research collaboration in Hollandale, MS, to plan and implement nutrition interventions to address the health problems of Hollandale residents. We have established an effective research partnership that includes community, university, state extension, and ARS partners. This research collaboration has implemented its first formal research intervention, Fit for Life Steps. Outcome evaluation has been completed, and analysis of process evaluation data is ongoing. The impact of these accomplishments is that this Delta community, with its high rates of poverty and chronic diseases including obesity, has built capacity through this collaboration to engage in programs and interventions that can prevent obesity and promote healthy dietary behaviors. All
accomplishments made under this project are fully consistent with relevant milestones listed in the Delta NIRI Project Plan, and with the relevant research components as defined in the National Program 107 Action Plan. Accomplishments under this project contribute to the achievement of ARS Strategic Plan Goal 4, Objective 1, Performance Measure 1, in that project accomplishments contribute substantially to attainment of the Agency FY 2007 target of developing, testing, and evaluating effective clinical and community dietary intervention strategies and programs for modifying diet, eating behavior, and food choices to improve the nutritional status of targeted populations. A special emphasis is to prevent obesity and promote healthy dietary behaviors. 6. What science and/or technologies have been transferred and to whom? When is the science and/or technology likely to become available to the end- user (industry, farmer, other scientists)? What are the constraints, if known, to the
adoption and durability of the technology products? Through the work of Delta NIRI partners in the Hollandale community, processes for community nutrition assessment, including community identification of its nutrition problems, root causes, and solutions, were developed. These processes have been adapted for use with community- based nutrition support programs for people living with HIV/AIDS in Kenya, developed under the auspices of the Columbia University Earth Institute Fellows program. Methodology and instruments used in the Delta NIRI food store survey of food availability in the Lower Mississippi Delta were shared with researchers from Texas A&M University engaged in a food audit of food establishments in the Lower Rio Grand Valley. The Hollandale Nutrition Intervention Research Initiative emphasizes building capacity and sustainability in Delta communities. These goals can only be accomplished by making community members full research partners. The Hollandale NIRI Fit for
Life STEPS intervention transferred skills to community members by training walking group volunteer leaders in leadership, motivation, and exercise techniques. Community members were also trained to be intervention data collectors, acquiring skills in interviewing and anthropometric and biological data collection. Such skills can be applied to sustain community activities targeted at obesity prevention as well as to increase employability of trained community residents. 7. List your most important publications in the popular press and presentations to organizations and articles written about your work. (NOTE: List your peer reviewed publications below). Bounds, W., Connell, C., Nettles, M.F., Lofton, K. 2005. The relationship of child body mass index to parental child feeding practices, weight perceptions, and personal eating behaviors among 3-5 year olds attending Head Start. Final grant report delivered in oral session at the USDA Economic Research Service 2005 Food Assistance
and Nutrition Research Small Grants Conference in Washington, DC. Connell, C.L., Simmerman, K.B., Stewart, R.K., Foy, J.E., Nettles, M.F. 2005. Assessment of college students' eating and exercise habits, barriers toward behavior change regarding physical activity, and perceptions of weight status. Presented at the Food and Nutrition Conference and Exhibition, American Dietetic Association, October 2005, St. Louis, Missouri. Connell, C.L., Nettles, M.F., Bounds, W., Lofton, K.L. 2005. Integrating applied research into the undergraduate curriculum: improving student knowledge, skills and confidence. Presented at the Food and Nutrition Conference and Exhibition, American Dietetic Association, October 2005, St. Louis, Missouri. Connell, C.L., Nettles, M.F., Bounds, W., Lofton, K.L. 2005. Integrating applied research into the undergraduate curriculum: improving student knowledge, skills, and confidence. Poster presented at: Food and Nutrition Conference and Exhibition, American Dietetic
Association, October 2005, St. Louis, Missouri. Lofton, K. 2005. Feeding Head Start Children: The mmportance of following policies and procedures. The Five County Head Start Training and Continuing Education Session, December 2005. Lofton, K.L., Bounds, W., Connell, C.L., Nettles, M.F. 2005. The accuracy of personal weight perceptions in African American women. Presented at the Food and Nutrition Conference and Exhibition, American Dietetic Association, October 2005, St. Louis, Missouri. Molaison, E.F., Connell, C.L. 2005. Assessing dietetics students' anxiety: the use of handheld computers for nutrition assessment. Presented at the Food and Nutrition Conference and Exhibition, American Dietetic Association, October 2005, St. Louis, Missouri. Wilkins, K.E., Bounds, W.E., Zoellner, J.M. 2005. Does weight locus of control predict body esteem in African American women? Presented at the Food and Nutrition Conference and Exhibition, American Dietetic Association, October 2005, St. Louis,
Missouri. Yadrick, K. 2006. Human subjects protection in research. University of Southern Mississippi, January 2006. Yadrick, K., Avis A. 2006. Community-based participatory research. University of Southern Mississippi, March 2006. Zoellner, J. 2006. A high performance diet: The athlete's pyramid. University of Southern Mississippi's Southern Fit Fest, Hattiesburg, Mississippi. Zoellner, J. 2006. Fad dieting. University of Southern Mississippi's Learn & Lose Program. Hattiesburg, Mississippi. Connell, C. 2006. Household food insecurity in the Lower Delta: Prevalence and association with self-reported general health, weight status, and chronic disease. Mississippi Association for Family and Consumer Sciences, February 16, 2006. Zoellner, J. 2006. Health literacy. Mississippi Dietetic Association annual meeting, March 2006, Vicksburg, Mississippi. Reece, L., Molaison, E.F. 2006. Barriers related to referring obese patients to registered dietitians. International Society of Behavioral
Nutrition and Physical Activity, July 2006, Boston Massachusetts. Yadrick, K. 2006. A healthier Mississippi, one city at a time. Mississippi Municipal League Annual Conference, July 2006. Nathan, T., Bounds, W. 2006. The relationship between weight-related attitudes and behaviors in African American males attending college. Poster presented at the 2006 American Dietetic Association Food and Nutrition Conference and Exhibition, September 2006, Honolulu, Hawaii. Davis, K.A., Brown, D.M., Azria-Evans, M., Connell, C., Yadrick, M.K. 2006. An assessment of self-efficacy and glucose control after attendance to a summer camp for children and adolescents with diabetes. Presented at the American Dietetic Association Food and Nutrition Conference and Exhibition, September 2006, Honolulu, Hawaii.
Impacts
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Publications
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Progress 10/01/04 to 09/30/05
Outputs
1. What major problem or issue is being resolved and how are you resolving it (summarize project aims and objectives)? How serious is the problem? What does it matter? The Lower Mississippi Delta (LMD) area of Arkansas, Louisiana, and Mississippi is characterized by high rates of poverty, low education attainment, and food insecurity. There is a high prevalence of hypertension, diabetes, obesity, anemia, and heart disease, all of which are influenced by nutrition. We are attempting to resolve these problems through the efforts of the Lower Mississippi Delta Nutrition Intervention Research Initiative (Delta NIRI). The Delta NIRI Consortium consists of the original partners: scientists from Alcorn State University, Alcorn State, MS (ASU); Arkansas Children's Hospital Research Institute, Little Rock, AR (ACHRI); Pennington Biomedical Research Center, Baton Rouge, LA (PBRC); Southern University and A&M College, Baton Rouge, LA (SU); The University of Arkansas at Pine
Bluff, Pine Bluff, AR (UAPB); The University of Southern Mississippi, Hattiesburg, MS (USM); and the Agricultural Research Service (ARS) of USDA, Little Rock, AR. The Delta NIRI Consortium also now includes representatives from the Arkansas, Louisiana, and Mississippi Cooperative Extension Service; the College of Public Health of the University of Arkansas for Medical Sciences, Little Rock, AR; a private researcher, Jackson, MS; and members from the Delta communities of Marvell, AR; Hollandale, MS; and Franklin Parish, LA. The ARS has initiated agreements with other scientists with needed expertise for specific research requirements. For example, the Children's Nutrition Research Center (CNRC) in Houston is collaborating with a Baylor College of Medicine scientist that has nutrition epidemiology skills, and the Human Nutrition Research Center on Aging (HNRCA) at Tufts University in Boston is providing expertise on the development of an original adult food frequency questionnaire.
These scientists, Extension, and community members participate fully in the Delta NIRI Consortium. The Consortium is diverse in its composition: including minorities, many research disciplines (nutrition, food science, family economics, sociology, medicine, community development, community grass root, agriculture, etc.), and a variety of professionals (nutritionists, pediatricians, nurses, food scientists, sociologists, agriculture economists, etc.). This diversity is necessary because of the complexity of the food concerns, poverty, isolation, and low educational attainment in parts of the Delta region. The Delta NIRI Consortium is evaluating the nutritional health in the LMD, to identify nutritionally responsive problems, and to design and evaluate interventions using a community participatory research model. Use of this model will promote capacity- building and sustainability at the community level. Lessons learned about successful intervention approaches will be disseminated in
order to facilitate implementation on a larger scale in similar areas of the United States. Rates of rural poverty and nutrition-related chronic diseases in the LMD are among the Nation's highest. Arkansas, Mississippi, and Louisiana traditionally rank at or near the bottom in health rankings of the United States and continue to worsen compared with other states. Food insecurity, adult and child obesity, and high blood pressure and diabetes among adults are higher in each of these states than for the national average. The area is underserved by food and nutrition and other health professionals, thus the burden of food-related health problems is carried by minority, low-income, and educationally disadvantaged individuals and families in the Delta communities. The presence of these problems severely limits the quality of life, productivity, and the future of this rural, at-risk population, while propelling them into the high-user category for nutrition assistance programs and
high-cost health care and treatment of nutrition-related disease. The Lower Mississippi Delta Nutrition Intervention Research Initiative falls under the National Program 107 - Human Nutrition, and addresses established performance goals through developing and transferring effective nutrition intervention strategies. 2. List the milestones (indicators of progress) from your Project Plan. Year 2005 Develop nutrition interventions in Hollandale Community, through community-based participatory research (CBPR): 1) Establish Community Groups and Research Teams. 2) Identify community-specific nutritional problems/concerns. 3) Identify community resources/environmental conditions. Year 2006 Design the nutrition intervention research for Hollandale Community, using Comprehensive Participatory Planning and Evaluation (CPPE): 1) Evaluate proposed intervention strategies. 2) Develop community-specific research plans/protocols. 3) Modify and develop new data collection instruments. Year 2007
Initiate the implementation and evaluation of nutrition intervention strategies in Hollandale Community: 1) Complete training on data collection/intervention strategies. 2) Pre-test data collection instruments/procedures. 3) Complete operational plan/research protocol. 4) Implement community-specific nutrition interventions. Year 2008 Implement and evaluate nutrition intervention strategies in Hollandale Community: 1) Complete training on data collection/intervention strategies. 2) Pre-test data collection instruments/procedures. 3) Complete operational plan/research protocol. 4) Implement community-specific nutrition interventions. Year 2009 Initiate the process of adapting the successful nutrition intervention strategies to other Lower Mississippi Delta communities. 1) Evaluate interventions for adaptability 2) Identify potential communities for additional research 3) Prepare manuscripts and develop symposia 3a List the milestones that were scheduled to be addressed in FY
2005. For each milestone, indicate the status: fully met, substantially met, or not met. If not met, why. 1. Establish Community Groups and Research Teams. Milestone Substantially Met 2. Identify community-specific nutritional problems/concerns. Milestone Substantially Met 3. Identify community resources/environmental conditions. Milestone Substantially Met 3b List the milestones that you expect to address over the next 3 years (FY 2006, 2007, and 2008). What do you expect to accomplish, year by year, over the next 3 years under each milestone? Year 2006 Design the nutrition intervention research for Hollandale Community, using Comprehensive Participatory Planning and Evaluation (CPPE): 1) Evaluate proposed intervention strategies. ACCOMPLISH: a) Complete data collection and evaluate process and outcome data from the initial Hollandale Nutrition and Physical Activity intervention, Fit for Life Steps, to determine feasibility and effectiveness; b) Review specific intervention
strategies related to intake of unhealthy foods proposed in the CPPE workshops conducted in Hollandale; evaluate strategies for feasibility using the CPPE HIPPOPOC model, to determine additional nutrition intervention strategies to be implemented; c) Review current scientific literature on food choices to identify potential effective strategies for nutrition intervention; evaluate strategies proposed through CPPE in light of current scientific knowledge. d) Evaluate health and nutrition literacy of Hollandale residents and determine implications for effectiveness of nutrition intervention strategies. Each of these expected accomplishments will help to ensure that nutrition intervention strategies implemented in Hollandale a) consider local priorities and conditions and b) are designed using the most current scientific research. 2) Develop community-specific research plans/protocols. ACCOMPLISH: a) Modify and update research protocols developed for Fit for Life Steps intervention
based on process evaluation data; b) develop/adapt protocols to implement one or more intervention strategies to address intake of unhealthy foods. These expected accomplishments will ensure that interventions are implemented and evaluated systematically. 3) Modify and develop new data collection instruments. ACCOMPLISH: a) Evaluate performance of instruments used in Fit for Life Steps, including those measuring variables mediating behavior (e.g. social support, decisional balance), and those measuring physical activity (walking log, past week physical activity) and suitability for continued use in Hollandale nutrition interventions; b) Pilot test Delta NIRI Child Food Frequency Questionnaire (FFQ); c) evaluate new Food Stamp Nutrition Education program outcomes instrument for suitability for use in Hollandale nutrition interventions; d) evaluate existing instruments that measure community level environmental factors related to food and physical activity environments for suitability
for use in Hollandale and modify as needed. These expected accomplishments will ensure that interventions are evaluated appropriately, allowing us to understand and disseminate information about effective interventions to improve health and nutrition in at risk populations similar to Hollandale. Year 2007 Implement and evaluate nutrition intervention strategies in Hollandale Community: 1) Complete training on data collection/intervention strategies. ACCOMPLISH: Develop additional training protocols related to specific intervention strategies to be implemented in 2007 and 2008. Train appropriate staff for data collection and intervention implementation, to include university partners, graduate students, cooperative extension staff, full-time Hollandale NIRI staff, part-time community staff, and volunteers. 2) Pre-test data collection instruments/procedures. ACCOMPLISH: Pre-test any data collection instruments and administration procedures not previously used in community. 3)
Complete operational plan/research protocol. ACCOMPLISH: Develop additional research protocols as needed to implement and evaluate new intervention strategies. Update previously developed protocols based on process evaluation findings. 4) Implement community-specific nutrition interventions. ACCOMPLISH: Implement new intervention strategies including process and outcome evaluation. Collectively these expected accomplishments will allow us to implement and evaluate interventions systematically, in turn providing information about effective ways to improve the health and nutrition status of LMD residents and similar populations. Year 2008 1) Complete training on data collection/intervention strategies. ACCOMPLISH: Develop additional training protocols related to specific intervention strategies to be implemented in 2008. Train appropriate staff for data collection and intervention implementation, to include university partners, graduate students, cooperative extension staff, full-
time Hollandale NIRI staff, part-time community staff, and volunteers. 2) Pre-test data collection instruments/procedures. ACCOMPLISH: Pre-test any data collection instruments and administration procedures not previously used in community. 3) Complete operational plan/research protocol. ACCOMPLISH: Develop additional research protocols as needed to implement and evaluate new intervention strategies. Update previously developed protocols based on process evaluation findings. 4) Implement community-specific nutrition interventions. ACCOMPLISH: Implement new intervention strategies including process and outcome evaluation. Collectively these expected accomplishments will allow us to implement and evaluate interventions systematically, in turn providing information about effective ways to improve the health and nutrition status of LMD residents and similar populations. 4a What was the single most significant accomplishment this past year? Assessment of Community Members' Perceptions
of Community-Academia Partnerships' Effectiveness. To establish and maintain an effective community-academic research partnership, it is necessary to understand the community's perspective regarding facilitators and barriers to accomplishing this goal. Researchers at University of Southern Mississippi, supported by the Lower Mississippi Delta NIRI, evaluated the effectiveness of the three Delta NIRI community partnerships from the community partners perspectives, using process evaluation techniques and a theoretical framework of empowerment and sustainability. USM researchers conducted 6 focus groups with a total of 33 community committee members, conducted a document review of community committee minutes and events' records since the inception of the committees, and analyzed data by coding, identifying themes, and categorizing themes according to the theoretical framework. It was found that factors perceived by the communities as important are maintaining community interest and
momentum during a lengthy intervention protocol development and testing period, and are likely to occur in other community participatory intervention initiatives. The understanding of the communities' perceptions of benefits and barriers associated with the community-academia partnership facilitates the understanding of benefits and addresses perceived barriers, and in turn possibly increases the present and future effectiveness of the nutrition intervention research. 5. Describe the major accomplishments over the life of the project, including their predicted or actual impact. Much of our recent focus has been on building an effective community research collaboration in Hollandale, MS, to plan and implement nutrition interventions to address the health problems of Hollandale residents. The community of Hollandale and its residents are our customers, but they are also our research partners. We have established an effective research partnership that includes community, university,
state extension, and ARS partners. This research collaboration has planned its first intervention, Fit for Life Steps, which is currently in progress. We have also completed an evaluation of the research partnerships' effectiveness from the community perspective, described above. These accomplishments address the challenge of bringing together diverse partners with different backgrounds, perspectives, and experiences to solve complex nutrition and health problems in the Lower Mississippi Delta. All accomplishments made under this project are fully consistent with relevant milestones listed in the Project Plan, and with the relevant research components as defined in the National Program 107 Action Plans performance goals through developing and transferring effective nutrition intervention strategies. Accomplishments under this project contribute to the achievement of ARS Strategic Plan Goal 4, Objective 1, Performance Measure 1, in that project accomplishments contribute
substantially to attainment of the Agency FY 2007 target of executing and reporting nutritional interventions. 7. List your most important publications in the popular press and presentations to organizations and articles written about your work. (NOTE: List your peer reviewed publications below). Connell, C. 2004. Food insecurity in children. Mississippi State University Cooperative Extension southeast region nutrition program assistants, October 2004. Ndirangu, M., Yadrick, K., Strickland, E., Santell, R., Perkins, H., Lucas, G., Bogle, M. 2004. Development of an evaluation framework for a community-academia partnership intervention to encourage physical activity in a rural community in the Mississippi Delta community. Campus- Community Partnerships for Health annual meeting, October, 2004, Atlanta, Georgia. Avis, M., Lofton, K., Lucas, G., Vassel, K., Strickland, E., Perkins, H. 2004. Using service learning to encourage nutrition and physical activity among high school students
participating in a summer work program. Community Partnerships for Health annual meeting, October 2004, Atlanta, Georgia. Lofton, K., Davis, K., Connell, C., Yadrick, K., Forsythe, W., Champagne, C., Sutff, J., Bogle, M. 2004. Food and nutrient intake of Southern African-American children participating in a summer sports and food assistance program. The American Dietetic Association annual Food and Nutrition Conference and Exhibition, October, 2004, Anaheim, California. Connell, C. 2005. Development of the child food security module. USDA Economic Research Service Food and Nutrition Assistance Research Program Conference, February 16, 2005, Washington, D.C. Connell, C. 2005. Food insecurity among children: does it exist and how do we measure it? Mississippi Association of Family & Consumer Sciences annual conference, February 24, 2005. Zoellner, J. 2005. Incorporating health literacy training into dietetics curriculum. Institute for Healthcare Advancement's 4th Annual Health Literacy
Conference, May, 2005, Irvine, California. Yadrick, K. 2005. Creating healthy Mississippi communities. Mississippi Municipal League annual conference, August 2005.
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