INVESTIGATION OF FOODS, FOOD SYSTEMS, AND DIETARY AND EXERCISE BEHAVIOR FOR CULTURALLY DIVERSE POPULATIONS

• Sponsoring Institution: National Institute of Food and Agriculture
• Project Status: COMPLETE
• Funding Source: HATCH
• Reporting Frequency: Annual
• Accession No.: 1003249
• Project Start Date: Oct 1, 2014
• Project End Date: Sep 30, 2019
• Program Code: [(N/A)]- (N/A)

Recipient Organization
UNIV OF MINNESOTA
(N/A)
ST PAUL,MN 55108

Performing Department
Food Science & Nutrition

Non Technical Summary
The demographic composition of the American population is changing as baby boomers age, and more people migrate to the USA in search of refuge, new homelands, and employment. It is estimated that during 2010, approximately 1.1 million legal immigrants and 730,000 illegal immigrants came into the United States (US) from various regions of the world including Asia, Africa, and Central America. Minnesota is also diversifying and is now home to Hmong, Bhutanese, Somali, Indian, Mexican, and Ethopian immigrants. These changes necessitate research on issues influencing these individuals' health. Immigrants, as well as the general population, tend to gain weight in our obesogenic environment. Poor diets, inactivity, and changes in lifestyles have contributed to increased prevalence of obesity and associated chronic diseases. Diseases such as diabetes, heart disease, and hypertension are disproportionally higher among minority groups and are increasing in the immigrant segments of the population. It is important to learn more about what they eat and how they feed their children, how their growth patterns look, how body adiposity changes with the aging process, what are their perceptions about food, how they access the food and health systems, and what chronic diseases they are susceptible to so that we can create healthy people and communities. Also, because of globalization, what we produce, process, and consume is often shared with people living in other nations, as a result nutrition transition is rapidly occurring in many regions of the world. My research efforts will focus on food access issues and how environmental and personal factors impact food choices and eating and exercise behavior, ultimately influencing their nutritional status. Building on my previous work, I plan to work with the general population, focusing on minority and low-income populations, migrants to Minnesota, and globally, particularly with Asian populations (Nepalese, Chinese, and Indian) at various stages of the life cycle.

Animal Health Component

80%

Research Effort Categories

Basic

20%

Applied

80%

Developmental

(N/A)

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
704	6010	1010	100%

Knowledge Area
704 - Nutrition and Hunger in the Population;

Subject Of Investigation
6010 - Individuals;

Field Of Science
1010 - Nutrition and metabolism;

Keywords

environment

low income

minority populations

dietary behavior

food choice

food systems

Goals / Objectives
Goals/ObjectivesThe overall goal of the AES project will be to examine the environmental and personal influencers of nutritional status, particularly obesity, for populations experiencing changes in economic status, environment, age, or migration. Factors influencing food choices, dietary and exercise behavior, and food access issues will be assessed among the general population, including various minority, low-income, and migrant groups. Over the next five years, I plan to work with both urban and rural domestic (Native American, African Americans, Hmong, Bhutanese refugees, Asian Indians, Chinese, and the general Minnesota population and international (focusing on Asian groups of people-Asian Indians, Chinese, and Nepalese) populations. The following objectives will guide my AES projects:Qualitative (photo-voice, focus groups, and oral interviews) and quantitative (surveys, interventions, and dietary and nutritional status assessments) methods will be used to investigate how people make food choices and access the food system, what they perceive as barriers and promoters to achieving good health and a healthy lifestyle, and how they acculturate to new environments, and how these impact their nutritional status. This will include urban and rural and aging populations, including low-income, minority/migrant groups, and global populations.To examine obesity in terms of dietary acculturation of migrants and food security in low-income populations. Furthermore, the characteristics of specific populations make them vulnerable in terms of health as to how agricultural and food systems are organized and as such may also result in obesity.To investigate nutrition transition with international populations undergoing globalization because of changing food and economic systems. Changes in the food and economic systems appear to be changing cultural dietary patterns, resulting in changes in health and nutritional status. As with the American population, obesity is now a worldwide problem, affecting people in many countries that traditionally have not had this problem. Technology, transitions in diet and lifestyle, and the easy exchange of ideology have contributed to this problem.

Project Methods
MethodsI will incorporate both qualitative and quantitative methodologies into my research. Qualitative data collection will include the use of focus groups, in-person interviewing, observational learning, elicitation surveys, photo-voice (use of photography), and oral histories. Quantitative data collection will include the development and use of theory based surveys; the assessment of nutritional status through dietary and anthropometric measurements; the assessment of activity levels and behaviors through the use of activity monitors; and assessment of community environments through the use of mapping systems such as GIS software.Qualitative Data collection:Focus groups and personal interviews will be conducted according to standard protocol and questions will be developed based on a theoretical framework, a review of the literature, and from discussions experts in the appropriate area. The purpose of formatting questions with a theoretical framework is that information obtained from the focus groups can be used as formative information in the development of a survey. Focus groups will be used to examine dietary and exercise habits, and factors influencing food choices including ethnicity, physical and social environment, and participation in community programs. Focus groups will be conducted until data collection no longer generated a new understanding or new information, otherwise known as the point of saturation (Morgan and Krueger, 1997). In addition to focus group methodology, I plan to incorporate photo-voice and oral histories as additional qualitative methods. Oral histories will be used to collect food stories and photo-voice will be used with children to further our understanding of a child's viewpoint through the use of photography.Quantitative Data collection:Surveys: Surveys will be developed with formative qualitative data collected in the focus groups, in-person interviews, ovservational learning, and elicitation surveys. Surveys will be evaluated for content validity, and experts in the field will evaluated it for face validity and breadth of coverage. They will be pilot-tested with a subset of the group and examined for internal consistency using Cronbach-a scores prior to use. Behavior will be measured using a combination of behavioral questions on surveys, along with dietary intake and anthropometric data (heights, weights, skinfold thickness, waist-hip ratios).Dietary Intake: Many factors influence dietary intake including cultural and family norms, economic status, environment and availability of foods, individual taste preferences, social setting, presence of disease and medication usage, and appetite and hunger levels. However, obtaining dietary information can be problematic. I have found that the USDA's multiple pass 24-hour recall dietary intake works well. Generally, to achieve the best possible information for groups, we will conduct two 24-hour recalls with each participant and averaging these intakes for calories, macronutrients, and major micronutrients. The 24-hour recall methodology provides information on the type of food consumed, preparation style, how food is distributed throughout the day, where it is eaten, and an approximation of the quantity consumed. McPherson et al. examined 38 validity and 9 reliability studies to evaluate dietary assessment methods and found that correlations between the dietary method and the validation standard were higher for 24-hour recalls and food records methodologies than for food frequency questionnaires. To increase accuracy, the USDA multiple pass method will be used with culturally appropriate food models. The 24-hour recall method has been used with adults and children (Dressler and Smith, 2013; Frank, 1991; Mulasi-Pokhriyal and Smith, 2013; Mulasi-Pokhriyal et al., 2012; Smith et al., 2010; Smith and Franzen-Castle, 2012).Anthropometric Measures: Depending on the research at hand, height, weight, skinfold thicknesses (triceps, biceps, subscapular, suprailiac, etc), and body circumferences (mid upper arm, waist, and hip) measurement techniques may be used measures of nutritional status in combination with dietary and activity data. Stature will be measured to the nearest tenth of a centimeter using a portable GPM Anthropometer following standard procedures (Frisancho, 2011). Weights will be taken using a high quality, calibrated, electonic scale (a Seca scale). All measurements will be taken in lightweight clothing and subjects will be asked to wear tee shirts under sweaters. Subjects will be asked to remove outer clothing (sweaters/ jackets) and shoes, and to empty their pockets. The measurements for height and weight will be used to calculate the Body Mass Index (BMI=weight (kg)/height (m)2) for each individual. The measurements for waist and hip circumferences will be calculated into waist/hip ratios.Physical activity: Physical activity is a challenge to measure in both children and adults, but an approximation of energy expeditures and activity patterns can improve our understanding of a person's nutritional status. In order to understand the relationship between food insecurity and obesity we need to learn more about activity patterns of low-income populations and can do this by monitoring energy expenditure levels using tools such as an Actiwatch activity monitor. Most activity monitors record sleep and activity patterns to calculate approximate amounts of energy expended each day. The Actiware-sleep software is a complete actigraphy-based sleep/wake scoring program and measures for sleep/wake activities in terms of minutes, mean lengths of immobility, mean wake bout time, mean sleep bout time, total activity scores broken down by time of day, mean activity scores, and other functions.Behavioral DataUnderstanding why people behave as they do may assist efforts to change behavior. More behavior research is utilizing the systematic organizing power of psychosocial theories to discern individuals' health behavior. Theories are helpful in organizing related behavioral concepts in a systematic fashion, allowing for explanation and prediction of behavior and providing information useful for health promotion. I believe that the Theory of Planned Behavior (TPB) and the Social Cognitive Theory (SCT) are both most promising for the type of work that I do. The TPB has been used to study health related decision making behavior by a number of researchers, including myself (Kearney and O'Sullivan, 2003; Ajzen, 1991; Armitage and Conner, 1999, 2001; Robinson and Smith, 2002; Robinson and Smith, 2003a; Robinson and Smith, 2003b; Fila and Smith, 2006; Lautenschlager and Smith, under review). The intention to change a behavior such as dietary intake, exercise, or weight loss can in turn be predicted from the aforementioned three main psychosocial factors related to that behavior. The predictive power of the TPB has been established in many health behavioral studies (Backman et al., 2002; Fila and Smith, 2006; Kassem and Lee, 2004; Kassem et al., 2003; Lautenschlager and Smith, 2007a; Mesters and Oostveen, 1994; Robinson and Smith, 2002; Robinson and Smith, 2003; Sheeran et al., 2001).

Progress 10/01/14 to 09/30/19

Outputs
Target Audience:During this five year project I have been very busy conducting research, monitoring students and publishing findings. My target audiences have been the general Minnesota population, including the minority groups of Hmong, African American, Native American, and Chinese Asian Student migrants; health care professionals; students through education and monitoring; and other academics. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?I trained 1 doctoral student, 2 masters' students, and three undergraduate researchers (Wu, Knezic, Mueller, Joseph) during this project. How have the results been disseminated to communities of interest?Yes, through talks, publications, dissertations, and thesis. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? The overall goal of the AES project will be to examine the environmental and personal influencers of nutritional status, particularly obesity, for populations experiencing changes in economic status, environment, age, or migration. Factors influencing food choices, dietary and exercise behavior, and food access issues will be assessed among the general population, including various minority, low-income, and migrant groups. During the past five years I have published 14 papers, presented 5 papers at national, state, or international meetings, and completed one doctoral student and 2 masters' students. I will highlight key findings from a few projects. Objective 1: The Jamaican Project: Supported by grants from I on E and The Global Programs and Strategy Alliance (GPS Alliance) at the University of Minnesota, a faculty team from the University of Minnesota which includes, Mr. Wayne Martin, Alternative Livestock Systems Specialist, UMN Extension, myself, Dr. Chery Smith, Department of Food Science and Nutrition, and Dr. Petrona Lee, Environmental Health Sciences travelled to Jamaica between November 3 - 17, 2017, for the first phase of an investigative research to meet with stakeholders and determine the feasibility of establishing a schoolyard farming project. Our first task was to conduct site visits to each of the schools that we had on our list to determine their willingness to participate in the project. Then to assess the nutritional status of students, schools were asked to find a few children who would be willing to meet with me (Dr. Smith). I took 4 site skinfold measures and a 24 hour dietary recall to provide us with an idea of what the children were consuming and to see if undernutrition was a problem in these schools. All children volunteering took home informational letters and parental consent forms for their parents to review and sign. They returned these signed notices before meeting with Dr. Smith. The sample size was small, but provided us with some preliminary findings. We completed assessments on 21 children in total (18 at the primary schools and only 3 at Muschette High School). In regard to the 24-hour dietary recall, I assessed the food group intake for the children and found 18 of the 21 students consumed no dairy products, while 2 students had only 1 serving of dairy and one student had 2 servings. Primary school children should be consuming 2-3 servings of dairy daily, while high school children should be consuming 3 servings of dairy daily. However, the children assessed consumed very little dairy and are of concern because dairy products provide important nutrients to the diet including calcium, potassium, protein, and other micronutrients that are important for bone and dental growth, and help regulate blood pressure, protecting against hypertension. Fruit and vegetable consumption was also very low. Five children had no vegetables, while 10 had one, 2 children had 2 servings, and 4 children consumed 3 or more servings of vegetables. The children should be consuming 1.5 to 2.5 servings daily depending on age and only a few met their requirements. In regards to fruit, 8 children had no fruit the previous day, while 8 had one piece of fruit and 5 had 2 pieces of fruit. Children should be consuming 3 servings daily. Diets were high in protein and fat because children are currently being provided fried chicken at school most days. Some children also consumed a great deal of fat and sugar because all of the schools sold junk food (chips, candy, soda pop, and fruit drinks) to children or children could buy those items from nearby vendors. About 20% of the children ate only the breakfast and the lunch provided because they were poorer and had no money to waste on junk food. We also had the opportunity to look at kitchens and visit with the kitchen staff about the foods that were provided. During this timeframe my research group also completed a Photovoice Project which became the focus for my doctoral student. We used Photovoice methodology with low-income, urban 9- to 13-year-olds to gain insight about their food environment and to determine whether this methodology was engaging and acceptable to them. Quantitative photograph analysis included quantity taken and usable internal/external and social environment and healthfulness categorizations. Qualitative analysis was conducted through open coding of interview transcripts. A total of 345 usable photos were taken by the children (n ¼ 29), depicting both healthy and unhealthy foods. Four themes were identified (1) food characteristics; (2) social environment; (3) kitchen, cooking, and dining environments; and (4) food insecurity. Unhealthy food was most readily available to children. Children reported a lack of functioning kitchen equipment and multiple physical and environmental challenges to consuming a healthy diet. Food insecurity was prevalent. Food stamps and food pantries were used to fill gaps in the home food supply. These data were published in several articles and a podcast. 2. The Dietary Acculturation of Chinese Migrant Students: Focus groups (n =7) were conducted with Chinese students (n = 43) studying in the USA to determine how acculturation and environmental factors influence dietary behavior and body mass index (BMI). This study used mixed methodology, collecting both qualitative (focus groups) and quantitative (24-h dietary recalls, food adoption scores, degree of acculturation, and height and weight measures) data. Themes emerging from focus group discussions were: a) dietary and social acculturation, b) factors influencing food intake, c) cultural importance of food, and d) changes in weight and BMI status. Environmental, behavioral, and cultural factors appear to have impacted the eating behaviors of the students. Because of the nature of the study, self-reported heights and weights were used to calculate BMI while living in China and actual heights and weights were taken for each student at the focus group to calculate current BMI after living in the USA. The majority of Chinese students (69% males; 85% females) experienced weight gain, resulting in an increased BMI based on weight/height data and as reported in focus group discussions. As a result, if students continue to gain weight, they may be at higher risk of developing chronic diseases in the future. Further, implemented dietary change may be transferred to other family members if students return to China. Results suggest that nutrition education should be provided to incoming foreign students during their orientation. 3. The Nepal Project: I went to Nepal to begin collecting stories with women around issues of food. I conducted in-depth interviews with 27 women about a variety of food related issues, meeting a second time with several women. I used qualitative methodology (face-to-face interviews). All interviews were conducted by me in Nepali with a Nepalese research assistant present. Interviews were audio-taped. Some women had lots of knowledge and they were interviewed a second, and in one case a third, time. While each interview had specific interview questions, the conservation flow was set by the woman, what she seemed knowledgeable about, and interested in. we talked about food, food memories as a child, food in their household and shopping, feeding ancestral spirits and use of foods in traditional festivals such as tej, rato matsyendranth, dumji, mani rimdu, dasai, gai jatra, weddings, naming ceremonies, and funerals; and discussed any food memories they might have, including stories about rice and water. I will return to Nepal once I retire and complete this project. These interviews will be transported in a series of short stories.

Publications

• Type: Journal Articles Status: Published Year Published: 2019 Citation: Opichka K., Smith C., Levine A. Problematic Eating Behaviors Are More Prevalent in African American Women Who Are Overweight or Obese Than African American Women Who Are Lean or Normal Weight. Journal of Family and Community Health, 2019, 42(2-April/June):81-98.
• Type: Journal Articles Status: Published Year Published: 2019 Citation: Opichka K., Smith C. Accuracy of self-report heights and weights in a predominately low-income, diverse adult population. Am J Hum Bio, 2018, 1-9. DOI 10.10021ajhb.23184.
• Type: Journal Articles Status: Published Year Published: 2018 Citation: Heidelberger L., Smith C. Low-income, African American and Native American childrens viewpoints on body image assessment tools and body satisfaction. Maternal Child Health, Maternal and Child Health Journal, 2018, 22:13271338.
• Type: Journal Articles Status: Published Year Published: 2018 Citation: Heidelberger L., Smith C. Factors that influence physical activity from the perspective of inner city minority youth: a qualitative study. JHEN. Journal of hunger & environmental nutrition. 2018, (13): 1: p.70-83. DOI: 10.1080/19320248.2016.1227745.
• Type: Journal Articles Status: Published Year Published: 2017 Citation: Smith C., Heidelberger L., Robinson-OBrien R., Earthman C., Rubien K., Letter to the editor regarding A Dietitians perspectives on integrating food and water system issues into professional practice. JAND, 2017, 117 (7):dx.doi.org/10/1016/j.jand.2017.05.016.
• Type: Journal Articles Status: Published Year Published: 2017 Citation: Heidelberger L., Smith C., Robinson-OBrien R., Earthman C., Rubien K. Dietitians perspectives on integrating food and water system issues into professional practice. JAND, 2017, 117 (2): 271-277.
• Type: Journal Articles Status: Published Year Published: 2016 Citation: Wu B., Smith C. Dietary acculturation and eating behavior of Chinese students studying in the United States. Appetite. 2016, 103 (1): 324-335.
• Type: Journal Articles Status: Published Year Published: 2016 Citation: Skoro R., Smith C., Jin Y., Feng Q., Foodways and the Floating Population: Diet and Rural-to-Urban Migration in Nanjing, China. Ecology of Food and Nutrition Research. 2016,2:4):353-361.
• Type: Journal Articles Status: Published Year Published: 2016 Citation: Oemichen M., Smith C., Investigation of the food choice, promoters and barriers to food access issues, and food insecurity among free living Minnesotan seniors living in low income neighborhoods. Journal of Nutrition Education and Behavior, 2016, 48: 397-404.
• Type: Journal Articles Status: Published Year Published: 2016 Citation: Heidelberger L., Smith C., Low-income, Urban Childrens Perspectives on Physical Activity: A Photovoice Project. Maternal and Child Health, 2016, 20 (6):1124-1132.
• Type: Journal Articles Status: Published Year Published: 2014 Citation: Heidelberger L, Smith C. A Childs Viewpoint: Determinants of food choice and definition of health in low-income 8-13year old children in Urban Minnesota Communities. J Hunger Environmental Nutrition, 2014, 9:388-408.
• Type: Journal Articles Status: Published Year Published: 2014 Citation: Franzen-Castle L, Smith C. Environmental, personal, and behavioral influences on BMI and acculturation of second generation Hmong children. Maternal Child Health Journal. 2014; 18:73-89. At: https://doi.org/10.1007/s10995-013-1235-8
• Type: Theses/Dissertations Status: Other Year Published: 2018 Citation: Katelyn Opechka, MS. RD. Problematic eating behaviors are more prevalent in low-income African women with obesity/overweight than low-income African American women who are lean or normal weight and the accuracy of self-report versus actual heights and weights among a low-income, ethnical diverse sample. Masters thesis. P. 113.
• Type: Theses/Dissertations Status: Published Year Published: 2016 Citation: Lindsay Heidelberger, PhD, RD Qualitative analysis of diet, physical activity, and body image of children using focus groups and Photovoice and quantitative analysis of dietitians perspectives on integrating sustainable agriculture into professional practice using survey methodology. Funded by SNAP ED- USDA. Doctoral dissertation, p. 267.
• Type: Journal Articles Status: Published Year Published: 2015 Citation: Heidelberger L., Smith C,. The food environment through the camera lenses of 9-13 year olds living in urban, low-income, Midwestern households: A Photovoice Project. Journal of Nutrition Education and Behavior, 2015, 47:437-445.
• Type: Journal Articles Status: Published Year Published: 2015 Citation: Dressler H., Smith C., Depression affects emotional eating and dietary intake, and is related to food insecurity, in a group of multi-ethnic, low-income women. J Hunger Environmental Nutrition, 23 Sept 2015. DOI: 10.1080/19320248.2015.1045666
• Type: Theses/Dissertations Status: Published Year Published: 2015 Citation: Megan Oemichen, MS, RD Barriers to food access and fodd security among seniors and the association between hypertension and dietary intake patterns in post-menopausal, African American women. Masters Thesis, p. 135.
• Type: Conference Papers and Presentations Status: Published Year Published: 2018 Citation: Smith C: Talking with low-income, food insecure American children about their urban food environment using PhotoVoice methodology. URBIO 2018: Urban Biodiversity and Food Security Conference in Cape Town, South Africa.
• Type: Conference Papers and Presentations Status: Published Year Published: 2017 Citation: 2017 Smith C: Immigration to America: Environmental Change Impacts Dietary Intake and BMI Status; at Middle Tennessee State University. Distinguished Speaker Series.
• Type: Conference Papers and Presentations Status: Published Year Published: 2016 Citation: Smith C: Effects of Depression on Nutrition and Weight in Low-Income, non-pregnant women. National Maternal Nutrition Intensive Course @ School of Public Health, University of Minnesota.
• Type: Conference Papers and Presentations Status: Published Year Published: 2015 Citation: Smith C: The Hunger/Obesity Paradox Found among Low-Income Minnesotans @ Meeting: Food and Consumer Science Professionals, Minneapolis Home Economist group.
• Type: Conference Papers and Presentations Status: Published Year Published: 2015 Citation: Smith C: Investigation of the food choice, promoters and barriers to food access issues, and food insecurity among low-income, free living Minnesotan seniors @ Northeast Regional Meeting on Seniors in Rhode Island.

Progress 10/01/17 to 09/30/18

Outputs
Target Audience:Target audience included college students, researchers in anthropology and nutrition, health care workers, general public, and low-income, minority children. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?One graduate student was trained in photovoice and focus group methodology, how to transcribe and analyze these data through open-coding method, and write up and publish data. One undergraduate student learned how to complete a literature review, how to do short survey work, recruit participants. This next year she will learn how to set up a data file, and enter and analyze data, and write-up findings. Our goal is to publish a manuscript next year. How have the results been disseminated to communities of interest?Yes, from the first project 3 manuscript were published (already cited 14, 6, and 3 times) and 2 presentations (1 national and 1 international), were completed. Reports have been made back to the multi-state project involved. Furthermore, I have included several manuscripts as required reading in my courses. Lastly, the podcast apparently was well-received. What do you plan to do during the next reporting period to accomplish the goals?We will continue surveying university students, having a goal of 150 students, including the ethnic breakdown of Euro-American, Asian, and African American students. Set up a data file, analyze the data, and write a manuscript. I will be continuing to work with the Nepalese women data. Transcription/translations will hopefully be completed and publications will be written. Over the past 5 years, I have used a 5-minute working assignment, "Food as medicine...what does this phrase mean to you?" to students in one of my courses as a segway into the lesson. I am now working with an undergraduate student to use data collection for a paper. It has been given to 570 undergraduate students taking a course about the social-cultural aspects of food, nutrition and health; 113 subjects were male and 457 subjects were female. Responses have been coded and entered into the computer and we are in the process of working with these data and will continue through 2019. We plan to submit the resulting manuscript to an education journal.

Impacts
What was accomplished under these goals? 1. This past year we finished up the Photovoice Project, a qualitative project, which investigated how low-income minority children experience their environment and how it influences their food choice, food assess, activity patterns and their body image. Since the start of this project, we have published 3 peer-reviewed papers, were the focus of a pod cast, and made a national presentation. In 2018, we completed a fourth manuscript from these data and published it. Limited research has been conducted with African American and Native American children to understand their opinions on body image assessment tools created primarily for Caucasians. This part of the project investigated pediatric obesity, low-income environments, and their influence on body satisfaction. Body image assessment tools were used with children to measure their acceptance of their body shape or image. This study investigated: a) children's perception about body image and b) differences between two body image instruments among low-income, multi-ethnic children using data previously collected by my lab using mixed methodology including focus groups (qualitative) and body image assessment instruments (quantitative). Fifty-one children participated (25 girls, 26 boys); 53% of children identified as African American and 47% as Native American. The average age was 10.4 years. Open coding methods were used by identify themes from focus group data. SPSS was used for quantitative analysis. Results showed that children preferred the Figure Rating Scale (FRS/silhouette) instrument over the Children's Body Image Scale (CBIS/photo) because their body parts and facial features were more detailed. Children formed their body image perception with influence from their parents, their environment, and the media. Children verbalized that they have experienced negative consequences related to poor body image including disordered eating habits, depression, and bullying. Healthy weight children were also aware of weight-related bullying that obese and overweight children faced. Children preferred that the images on a body image assessment tool that was clothed and had detailed facial features. Another important finding from this project was that the obese/overweight children in our study viewed themselves as having a healthy weight. In terms of having a positive body image this is important, but in terms of trying to have the children obtain a healthful weight, this may be problematic. This may explain why some children who are heavier than the norm do not try to curb their appetite, for them the weight may be a "non-issue." Further research into body image assessment tools for use with minority children is needed. Furthermore, care must be taken not to destroy their positive body issue when working on health intervention projects. These results have been published. 2. We have began investigation of food security among college students. Food security continues to a major concern in America. The USDA found that 12.3 percent of U.S households had been food insecure at some point during 2016 as measured by the USDA food insecurity tool (ERS, 2016). Households with children are about 6% more likely to be food insecure than households without children. Even though households with children showed to have the highest percent of food insecurity, little research has been done regarding food insecurity amongst children once they get to college and little is known about food insecurity among Asia and African American students; most data is regarding Caucasian students. We are currently surveying university students, having completed 30 of 150 students . The groups will be broken into 50 African Americans, 50 Asians, and 50 Caucasians. According to the University enrollment data, the ethnic breakdown of the student population is: 65.3% White, 9.2% Asian, and 4.3% Black. Students in these groups can be any age as long as they are an undergraduate. We will try to have 25 females and 25 males in each group to allow sample sizes large enough to complete statistical analyses. We selected African American and Asia students because there is little data on these groups and White students because there is comparative data. The USDA Food Security tool will be used to measure the food insecurity among student, a Coping Strategies form, along with a few additional questions. This project will continue into 2019. 3. I am continuing to work with a Nepalese group of women and conducted extensive interviews during the fall of 2017 and earlier. Forty-four women were included and transcripts are being translated from Nepali to English, slowly by me, and coded. This project will continue into 2019.

Publications

• Type: Journal Articles Status: Published Year Published: 2018 Citation: Heidelberger L, Smith C. Low-income, African American and Native American childrens viewpoints on body image assessment tools and body satisfaction. Maternal Child Health, Maternal and Child Health Journal, 2018, 22:13271338. https://doi.org/10.1007/s10995-018-2513-2
• Type: Conference Papers and Presentations Status: Published Year Published: 2018 Citation: Smith C: Talking with low-income, food insecure American children about their urban food environment using PhotoVoice methodology. URBIO Sept. 2018: Urban Biodiversity and Food Security Conference in Cape Town, South Africa.

Progress 10/01/16 to 09/30/17

Outputs
Target Audience:Target populations for this project during 2017 included both domestic and international populations of lay people, as well as academic and health care professionals. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?These projects have provided both undergraduate and graduate students with training on how to collect qualitative data through focus groups, how to recruit participants and find conveniently located sites to hold discussions in, how to conduct a literature review to identity gaps in the knowledge, how to code and analyze focus group data, how to write up these data and publish them, how to create survey questions and format surveys, how to enter data into SPSS software for analyses, and how to write up these data. The type of work that I do, also requires the development of people skills such as how to approach and work with people of different cultural backgrounds. I also share my findings with students in the class, as well as with students doing research. One of the undergraduate researchers enjoyed her project in Tanzania so much that she signed up for Peace Corps and is currently a health volunteer in a remote clinic in Botwana where the teaching continues to make an impact. Additionally, the Nepalese research assistant who I have worked,with and mentored, for the past several years will co-author one of my papers and will apply for graduate school in 2019; she too will make a long term impact. How have the results been disseminated to communities of interest?Yes, the results of much of the work has been published and currently much of it has been submitted for publication and hopefully will be out in the next year. The information has also been shared with the multistate project members who I work with and with students in my classes. What do you plan to do during the next reporting period to accomplish the goals?I plan to follow the manuscripts through to completion; try to obtain funding to work on the Jamaican Project; analyze and write up findings from my Nepalese data and return one more time to Nepal if necessary.

Impacts
What was accomplished under these goals? This has been a busy year with many accomplishments and these are as follows: Qualitative focus groups were conducted with Native American and African American women to investigate eating behavior related to BMI status (lean/normal weight versus overweight/obesity) during 2016 and this project continued into 2017. During 2017, we analyzed the data and submitted a publication which is currently under review at the Journal for the Academy of Nutrition and Dietetics. It is: Opichka K, Levine AS, Smith C. Problematic eating behaviors are more prevalent in low-income minority women who are overweight or obese than low-income minority women who are lean or normal weight. JAND, Under review. We found that lean/normal weight women ate in response to hunger, did not overeat or think of food often. In contrast, women who were overweight or obese reported more problematic eating behaviors including eating in the absence of hunger, frequent overeating, and increased food thoughts. Differences were found between weight categories regarding exercise, coping mechanisms, and views on weight. Eating behaviors associated with neuronal control of food intake could explain why weight loss attempts are often unsuccessful, indicating the need for either behavioral or drug-therapy, targeting the brain's reward system. We also continued working with our child data previously collected (mixed data including both qualitative and quantative data) which investigated: a) children's perception about body image and b) differences between two body image instruments among low-income, multi-ethnic children. Children preferred the Figure Rating Scale (FRS/silhouette) instrument over the Children's Body Image Scale (CBIS/photo) because their body parts and facial features were more detailed. Children formed their body image perception with influence from their social environment including their parents and the media. Children verbalized that they have experienced negative consequences related to poor body image including disordered eating habits, depression, and bullying. Healthy weight children are also aware of weight-related bullying that obese and overweight children faced. Children prefer that the images on a body image assessment tool has detailed facial features and is clothed. This manuscript is currently been reviewed and will hopefully be accepted soon. It is: Heidelberger L, Smith C. Low-income, African American and Native American children's viewpoints on body image assessment tools and body satisfaction. Maternal Child Health, Under reveiw. We have also spent time combining 18 data sets to investigate how accurate self-reported heights and weights are in prodominately low-income adult and children Minnesotans. Through the years, I have asked study participants about what they thought they weighed and how tall they thought they were, then later in that session I would take actual heights and weights. With a sample consisting of 3004 adults (from previous NIFA projects) of primarily African American (approximately 38%), Caucasians (approximately 37%), and Native Americans (approximately 16%), and also included Asians (3%), and mixed ethnicities (4%), we found that that self-reported height and weight values significantly differed from actual values and resulted in an underestimation of BMI. This underestimation of BMI led to misclassifications of BMI categories. Furthermore, these results showed a surprisingly number of individuals who were overweight or obese still view their health as very good or excellent despite repercussions of being overweight or obese. These results also indicated that certain factors influenced the extent of self-report biases such as age, race, and sex for adults, education level for women, and income level for men. The manuscript regarding the adult data is currently under review and the citation is: Opichka K, Smith C. Accuracy of self-report heights and weights in a predominately low-income, diverse adult population. Am J Hum Bio, Under review. The manuscript regarding the child data will be submitted shortly. Globally I have been working on two projects, one in Nepal and the other in Jamaica. In Nepal, I continued collecting qualitative data with 44 Nepalese women reguarding the impact of globalization on eating behavior and important cultural rituals. I also photographed rituals and food usage in these rituals for follow-up interviews. I plan to transcribe these interviews during the next year and write up the results for publication. I believe that globalization is making a profound change in many cultural practices. I have also started another international project in Jamaica. It has taken over a year to get our foot in the door, but in November of 2017, a team of three researchers (me, Dr. Lee, and Mr. Martin) traveled to Jamaica where we met with primary and high school teaching faculty, important government officials, and Jamaican Broilers (a poultry firm), who are all interested in this project to increase food security among Jamaican children. One of the downsides to globalization is the increased cost of living to local populations, in this case traditional foods such as seafood are now sold to hotels for tourism, making seafood very expensive. This project would work through schools to introduce aquaponics (growing fresh vegetables and fruits), poultry production (using broilers at one school and layers at another), and surrounding the structures with fruit trees and vegetation to provide both shade and food. I assessed a small group of children (21) and found evidence of both undernutrition and overnutrition, a dual nutrition burden for this small country, and diets lacking in dairy, fruits, vegetables and fiber. A third global project was also written up and has been submitted for publication. I had an undergraduate student complete her research project in Tanzania which a) investigated the prevalence of obesity, b) examined dietary intake and eating behavior and c) identified whether adoption of Western foods is associated with higher body mass index (BMI), income, urbanity, and education in both urban Bantu-speaking dwellers and rural Maasai women. This is under review: Moe C, Smith C. Dual Burden of Nutrition Transition among Tanzanian Women. Under review. I have also been mentoring a Hmong doctoral student (I am on her committee, but not her advisor) who is investigating the hypotheses that immigration to the US from developing countries induces loss of important microbial organisms in the native gut microbiome, predisposing the host to obesity. She is comparing the dietary intake and gut microbial organisms of Hmong and Karon living in Thailand to those living in the US, both are populations that I am familar with. I have spent time with this student teaching her how to collect dietary information using the USDA Multiple Pass Method and how to analyze it. We have also discussed dietary acculturation among the Hmong and went through research that I conducted with the Minnesota Hmong regarding their acculturation process. Lastly, I was invited to Middle Tennessee State University as Distinguished Lecturer and presented, Immigration to America: How Environmental Change Impacts Dietary Intake and Body Mass Index Status, to a general audience of lay and academic people. Afterwards, I received several email messages about the talk.

Publications

• Type: Journal Articles Status: Published Year Published: 2017 Citation: Heidelberger L, Smith C. Factors that influence physical activity from the perspective of inner city minority youth: a qualitative study. JHEN. Journal of hunger & environmental nutrition. DOI: 10.1080/19320248.2016.1227745, 2017, (1), p.1-14. Journal for the Academy of Nutrition and Dietetics: Opichka K, Levine AS, Smith C. Problematic eating behaviors are more prevalent in low-income minority women who are overweight or obese than low-income minority women who are lean or normal weight. JAND, Under review. The manuscript regarding the adult data is currently under review and the citation is: Opichka K, Smith C. Accuracy of self-report heights and weights in a predominately low-income, diverse adult population. Am J Hum Bio, Under review. Bantu-speaking dwellers and rural Maasai women: Moe C, Smith C. Dual Burden of Nutrition Transition among Tanzanian Women. Under review.

Progress 10/01/15 to 09/30/16

Outputs
Target Audience:This year target audiences included African American, Nation American, Nepalese, and Chinese adults and childern, and academic and health professional members of the community . Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?Under objectives 1 and 2, graduate students were trained, including one doctoral student who has just finished her PhD and a masters' student who is just completing her first year. How have the results been disseminated to communities of interest?Three manuscripts have been submitted, accepted and are online and we have just started writing a fourth manuscript. What do you plan to do during the next reporting period to accomplish the goals?I plan to continue to work on objectives 1 and 3. We need to analyze focus group and interview data and work on reporting our findings. Also, i hope that the 2 submitted grant proposals get funded so that I can move forward on those projects.

Impacts
What was accomplished under these goals? Objective 1: We conducted focus groups with children last year and during this year completed analyses and wrote up findings for publication. The objective of this study was to use qualitative methodology to understand low-income, urban children's beliefs about physical activity. Children (n=52) who were 8-12 years old, lived in an urban, low-income household participated in eight focus groups. Children were predominantly Native American or African American. Focus group questions were based on the Social Cognitive Theory. Open coding methods were used for focus group analysis. Three major themes were identified: (a) community programs and school impact physical activity, (b) physical environment effects activity level, and (c) social factors influence physical activity. Changes at the policy level should be considered to improve accessibility to safe venues for physical activity, such as recreation centers and community programs. Also as part of this objective, we conducted focus groups to qualitatively explore food addiction perceptions and eating behaviors. Specifically, this research is investigating how lean/normal weight women perceive food, exercise and body size differently from overweight/obese women and to explore the existence of food addiction in women. To fulfill these objectives, focus group discussions are being used to examine different perceptions of food and exercise and the existence of food addiction among low-income African American and Native American women of various body sizes. The Palatable Eating Motives Scales is being used to further assess motives for consuming palatable foods. Taste testing was also conducted to look for differences in food preference between lean/ normal weight and overweight/obese women. To date, 69 women have participated. Objective 2: We conducted focus groups with Chinese students (n=43) studying in the USA to determine how acculturation and environmental factors influence dietary behavior and body mass index (BMI). This study used mixed methodology, collecting both qualitative (focus groups) and quantitative methodology and found that Chinese students living in the USA are undergoing the process of dietary acculturation. Breakfast and lunch were the first meal to become more American than Chinese, along with snacks. Furthermore, weight gain was common among the students with 69% of the males and 85% of the females experiencing weight gain. This is a concern because the Chinese are at higher risk for chronic diseases even at lower BMIs. Several factors contributed to changes in eating behaviors, including cultural values, degree of acculturation, perception of weight status, living situation, cooking knowledge, class schedule, cost, exercise, and access to transportation. More research should be done and steps should be taken to work with incoming students, so that living in the USA will not negatively influence their health. These findings were written up and published this year in Appetite. Objective 3: For this objective, I am working on data collected last year in Nepal. Priliminary findings show that the nutrition transition has impacted the well to do and high caste Nepalese on a much greater scale than low income and low caste Nepalese.

Publications

• Type: Journal Articles Status: Awaiting Publication Year Published: 2016 Citation: Heidelberger L, Smith C. Factors that influence physical activity from the perspective of inner city minority youth: a qualitative study. Journal of Hunger & Environmental Nutrition, 2016, p.1-14 Online 24/Oct/2016.
• Type: Journal Articles Status: Published Year Published: 2016 Citation: Skoro R, Smith C, Jin Y, Feng Q. Foodways and the Floating Population: Diet and Rural-to-Urban Migration in Nanjing, China. Ecology of Food and Nutrition Research. 2016, 2 (4): 353-361. Published online.
• Type: Journal Articles Status: Published Year Published: 2016 Citation: Beiwen W, Smith C. Dietary acculturation and eating behavior of Chinese students studying in the United States. Appetite. 2016, 103 (1): 324-335.

Progress 10/01/14 to 09/30/15

Outputs
Target Audience:This project focused on three target audiences this past year, low-income women, Chinese students attending the University of Minnesota, and Minnesotans who practice mindfulness based activities such as yoga, meditation, and tai chi. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?This year I trained two graduate students how to analyze and write up research findings, along with 2 undergraduates students who learned about community research, how to conduct and analyze focus groups, and how to write up their findings. How have the results been disseminated to communities of interest?One manuscript was published, thus disseminating results among researchers. What do you plan to do during the next reporting period to accomplish the goals?During this next year, I will focus on analyzing and publishing findings from the studies investigating dietary acculturation among Chinese students and dietary and mindful eating practices among Minnesota who practice mindful behaviors such as yoga, meditation, and tai chi. Also during this period, we plan to conduct focus groups among lean and obesity Minnesotans about food addictions.

Impacts
What was accomplished under these goals? This year I worked on several projects including a) analyzed and wrote up data from focus groups (n=43) conducted with Chinese students to investigate their dietary acculturation since coming to America, b) analyzed and published findings from our project that investigated food insecurity among 330 low income women and associations with obesity and depression, c) conducted 9 focus groups (n=40 people) which investigated the eating and exercise behavior of people who have participated in mindfulness based practices, such as yoga, tai chi, karate, meditation and mindful eating, and d) analyzed data for a survey completed earlier which investigated dietitian's behavior to incorporate issues relating to sustainable agriculture into professional practice using the Theory of Planned Behavior, and to compare the results from this survey to those from a survey completed in 2002. Our project regarding low-income women and food security findings were published. We found both obesity and depression to be prevalent among low-income, food insecure women. This study found that women suffering from depression in low income communities were more food insecure, consumed more calories including high fat discretionary foods, and exhibited more emotional eating than low-income women who were not depressed. We are currently in the process of writing up our findings regarding dietary acculturation among Chinese students and eating behavior among Minnesotans who practice yoga or other mindfulness activities.

Publications

• Type: Journal Articles Status: Published Year Published: 2015 Citation: Dressler H*, Smith C. Depression affects emotional eating and dietary intake, and is related to food insecurity, in a group of multi-ethnic, low-income women. J Hunger Environmental Nutrition, 23 Sept 2015. DOI: 10.1080/19320248.2015.1045666.