Progress 10/01/06 to 09/30/07
Outputs
Progress Report Objectives (from AD-416) A primary objective of the Lower Mississippi Delta Nutrition Intervention Research Initiative (Delta NIRI) Consortium mission being conducted in part under this cooperative agreement is to develop sustainable nutrition intervention strategies in the Lower Mississippi Delta (LMD) through community-based participatory research. The specific objective of this cooperative research project is to establish and support a cooperative partnership between the United States Department of Agriculture (USDA), Agricultural Research Service (ARS) and Baylor College of Medicine (BCM) which will work with ARS and other Delta NIRI partners to assist, organize, interpret, and evaluate community participatory-based nutritional interventions established within the LMD to evaluate nutritional health, identify nutritionally responsive problems, and develop and evaluate interventions that are sustainable at the community level. Approach (from AD-416) The Delta NIRI will identify environmental and community characteristics related to nutritional status; measure dietary intake; assess nutritional risk factors; design, conduct, and evaluate interventions in the Lower Mississippi Delta. Cooperator's representative will participate in the Delta NIRI research activities, provide technical expertise in the analysis of Initiatives, and provide assistance and support for capacity building and related research activities as identified by the ADODR, and are mutually agreed to. 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. Stuff, J.E., Casey, P.H., Connell, C.L., Champagne, C.M., Gossett, J.M., Harsha, D., McCabe-Sellers, B., Robbins, J.M., Simpson, P.M., Szeto, K.L., Weber, J.L., Bogle, M.L. 2007. Household food insecurity, obesity, chronic disease, and chronic disease risk factors. Journal of Hunger and Environmental Nutrition. 1(2):43-62. Stuff, J., Yadrick, K., Connell, C., McGee, B., Champagne, C.M., Zaghoul, S., McCabe-Sellers, B. 2007. Awareness of hypertension, fruit and vegetable intake, and their relationship by Key Informants in the Lower Mississippi Delta. Submitted to Journal of Nutrition Education and Behavior. Stuff, J., Bogle, M., Champagne, C., Zaghoul, S., Forsythe, W., Mitra, A., Fomby, B. 2007. Beliefs and dietary behaviors related to hypertension of adults in the Lower Mississippi Delta. Submitted to Journal of Ethnicity and Disease. Accomplishments Association of Food Insecurity to Obesity and Suboptimal Food Patterns: Obesity is a nationwide problem, increasing in all age groups, with potential for adverse health and economic consequences. In the Lower Mississippi Delta the unique concern is whether food-insecure households unable to purchase and consume healthy diets are at greater risk of obesity, an association shown in other studies. The Lower Mississippi Delta NIRI and Baylor College of Medicine scientists analyzed a national survey of 6,900 children and found that children in food-insecure households were at risk for being overweight or obese. It was evident that food-insecure adults in the Delta region consumed diets with a lower healthy eating index--a metric for a healthy diet--and diets were lower in Vitamin A, Copper, and Zinc. Long-term consumption of this unhealthy food pattern may contribute to obesity and chronic disease. These findings are important since the Lower Mississippi Delta NIRI has made significant contributions to understanding the role of food insecurity in children on obesity and health, as well as developing new methodology to measure children�s food insecurity. Collectively these results demonstrate the Delta NIRI�s role in understanding the role of food insecurity to obesity, and the specific issues that must be addressed in interventions and policy to prevent obesity in this and other high risk populations. (NP 107, Human Nutrition Action Plan 2004-2008: Component 3: Nutrition Monitoring and 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)
Impacts
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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 educational 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, including 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 Services; the College of Public Health at the University of Arkansas for Medical Sciences, Little Rock, AR; a private researcher from 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 and includes: 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 in 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 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 by year the currently approved milestones (indicators of research progress) Year 2005: Objective 1. Develop nutrition interventions in the Lower Mississippi Delta (LMD) through community-based participatory research. Milestone a) The Community Groups and a community-based research team will be in place in three communities in AR, LA, MS. Milestone b) The research worksite will provide a neutral site in each community and enhance visibility of the Delta NIRI. Milestone c) An assessment of community resources and environmental conditions relevant to nutrition interventions will be complete. Objective 2. Design the nutrition
intervention research 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 will be written. Milestone c) New and modified data collection instruments will be developed. Milestone d) Manuscripts will be completed describing the CBPR process, research worksite development, community readiness, resource assessment, and other elements of the pilot testing and preparation for interventions. Milestone e) One regional conference of scientific and lay communities will be completed. Objective 3A. Implement nutrition intervention strategies in selected LMD communities. Milestone a) Well-written research protocols for nutrition interventions in each of three communities will be finalized. Milestone b) Data collection instruments and procedures will have been pre-tested. Milestone c) Community and university
individuals will be trained to collect data and monitor data collection. Milestone d) A detailed operational plan for the implementation process will be completed. Milestone e) Appropriate institutional review board approval for human subject's participation will be in place for each partner institution. Milestone f) Manuscripts describing pilot testing intervention strategies, data collection procedures, and training of data collectors will be completed for peer reviewed journals. Year 2006 Objective 1. Collaborate with Delta NIRI to increase manuscript productivity, develop and test research instruments and procedures. Milestone a) Participate in the development and validation of the Delta NIRI Child Food Frequency Questionnaire. Milestone b) Finalize and publish results on prevalence, attitude, and dietary behaviors of Delta residents related to hypertension. Milestone c) Evaluate the impact of food security status on obesity and chronic disease in adults of the Delta. Year 2007.
Objective 1. Collaborate with Delta NIRI to increase manuscript productivity, develop and test research instruments and procedures. Milestone a) Assist the Food Security Working group in writing manuscripts on food insecurity and other outcomes. Milestone b) Participate in the Food Store Survey Working group in data reviews and analysis and writing of manuscripts. Milestone c) Assist in designing process and outcomes evaluation procedures for nutrition intervention strategies in the communities. Year 2008 Objective 1. Collaborate with Delta NIRI to increase manuscript productivity, develop and test research instruments and procedures. Milestone a) Assist the Food Security Working group in writing manuscripts on food insecurity and other outcomes. Milestone b) Participate in the Food Store Survey Writing group to prepare and submit manuscripts to peer reviewed journals. Milestone c) Prepare manuscripts to describe the process and outcomes evaluation procedures for nutrition
intervention strategies in the three communities in the Lower Mississippi Delta of AR, LA, and MS. 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. Manuscript Identifies Awareness of Hypertension and Food Patterns: Lower Mississippi Delta residents are not aware that the high prevalence of hypertension in their region is linked to what they eat. Key Informants from 36 counties and parishes in the Lower Mississippi Delta were interviewed to determine their perceptions of health and well being. The Baylor cooperator analyzed data from this survey and found that 53% of respondents (total n=490) identified hypertension as a major health problem, and 67% agreed that people
do not eat enough fruits and vegetables. Each of these problems differed by respondents race, age, and their occupation. However, most respondents did not link the association of food patterns and hypertension. These findings suggest that general awareness of hypertension is adequate, yet residents do not have an understanding of this condition, nor the preventive role of high intakes of fruits and vegetables. 4b List other significant research accomplishment(s), if any. A manuscript on food security and chronic disease was completed and is under review by a peer reviewed journal. The Baylor Cooperator analyzed food security datasets for other Delta NIRI researchers and assisted in the completion and submission of two other manuscripts to peer reviewed journals. One, relating to food insecurity and child obesity, has been accepted for publication; the other, relating food insecurity to the Healthy Eating Index, is under review by a peer reviewed journal. 4d Progress report. Lower
Mississippi Delta residents need awareness of the high prevalence of hypertension in their region and foods patterns that can help control hypertension. In conjunction with the Lower Mississippi Delta NIRI, the Baylor cooperator analyzed data from the Key Informant Survey and found respondents (total n=490) identified hypertension as a major health problem, and agreed that people do not eat enough fruits and vegetables. However, the majority did not connect the two concepts. Agreement for each of these problems differed by respondents race, age, and their occupation. However, most respondents did not agree with both problems, or link the association of food patterns and hypertension. These findings suggest that general awareness of hypertension is adequate, yet respondents do not have a comprehensive understanding of this condition, i.e., the preventive role of high intakes of fruits and vegetables. A high prevalence of chronic disease exists in the context of food insecurity. In
conjunction with the Delta NIRI working group on food insecurity, Baylor College of Medicine cooperator continued to make substantial contributions to writing manuscripts of other Delta NIRI investigators. Topics addressed food insecurity and childhood obesity; food insecurity and childhood health outcomes; and food insecurity and adult healthy eating index. Data were analyzed, and the Baylor College of Medicine cooperator and writing group synthesized the findings into coherent papers, with appropriate descriptions on methodology, and discussion supported by the literature. These findings show the dynamics of food insecurity and its interplay with health and nutrition of children and adults, which in turn provides direction for interventions. This is especially significant given the fact that the LMD has prevalence of food insecurity 2.5 times that of the U.S. Additional knowledge on planning sustainable nutritional interventions was needed by the Lower Mississippi Delta NIRI
Research Committee. In conjunction with the Delta NIRI working group on food insecurity, Baylor College of Medicine cooperator continued to update and expand the literature review on food insecurity, with implications for interventions. The topical areas that emerged were prevalence, measurement, health outcomes, obesity, and interventions. In addition, an extensive review of recent literature and internet information was developed on food store surveys, and creation of food baskets used in food store methodology. These findings will enable Delta NIRI to plan future research on food insecurity, and to plan future interventions taking into account food insecurity. There is little knowledge available on identifying and understanding food patterns in the Lower Mississippi Delta. Although emphasis has been placed on food patterns related to obesity and hypertension, the Baylor College of Medicine cooperator conducted an initial review of FOODS 2000 and NHANES datasets with respect to
cancer. Specifically, N-nitroso compounds present in high levels in processed meats, ham, bacon, sausage, and beer could be related to dietary exposures to cancer, and it appears Delta residents consume higher levels of these foods than those nationwide. The cooperator will continue to pursue these findings and develop appropriate manuscripts to further characterize this type of food pattern analysis. 5. Describe the major accomplishments to date and their predicted or actual impact. The prevalence of food insecurity and hunger in the Lower Mississippi Delta (LMD) was unknown. As part of Foods Of Our Delta Study 2000 (FOODS 2000), interviews were completed in 1652 households using the USDA Household Food Security Questionnaire. Household food insecurity is 2.5 times greater in the Lower Mississippi Delta than nationwide, which indicates a need for targeted nutrition interventions in this area. Our better understanding of the health outcomes of hunger and food insecurity enables
researchers and community leaders to collaborate on solutions, such as research used to identify community-based interventions and policy changes needed to prevent food insecurity and improve the health of LMD residents. 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 Human Nutrition 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 executing and reporting nutritional interventions. 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? Over the lifetime of the Lower Mississippi Delta Project, the Baylor cooperator has developed an expertise in the area of food security. As a result of this in-depth experience and knowledge gained from working on this project, the Baylor cooperator was recruited to help plan, train, and implement the Hunger Study in Houston, TX and surrounding counties. his study was part of the nationwide Second Harvest Hunger Study. After results were distributed, the Baylor cooperator helped summarize and interpret findings for lay audiences, including the business sectors that support non-profit organization to rescue and distribute high quality food. Another example technology transfer of food security expertise, is that the Baylor Cooperator was asked by the Research Investigators to analyze their large dataset collected on 740 children and mothers in Head Start programs in Texas and Alabama. Still another example of technology transfer of the cooperator's food security
expertise, the Delta NIRI Cooperator was asked to serve as a reviewer for manuscripts on food security. Editors from J. Nutrition, Public Health Nutrition, BMC Public Health, and an author writing a chapter, requested reviews (total of seven manuscripts).
Impacts
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