Browsing by Author "Duffey, Kiyah J."

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    Adult Cranberry Beverage Consumers Have Healthier Macronutrient Intakes and Measures of Body Composition Compared to Non-Consumers: National Health and Nutrition Examination Survey (NHANES) 2005–2008
    Duffey, Kiyah J.; Sutherland, Lisa A. (MDPI, 2013-12-04)
    Flavonoids, present in high levels in cranberries, are potent bioactives known for their health-promoting benefits, but cranberry beverages (CB) are not typically recommended as part of a healthy diet. We examine the association between CB consumption with macronutrient intake and weight status. Data for US adults (≥19 years, n = 10,891) were taken from the National Health and Nutrition Examination Survey (NHANES) Survey 2005–2008. Total CB consumption was measured over two non-consecutive 24-h dietary recalls. Linear and logistic regression models adjusting for important covariates were used to examine predicted differences between CB consumers and non-consumers on macronutrient and anthropometric outcomes. Results are weighted to be nationally representative. CB consumers (n = 581) were older (>50 year) non-Hispanic black females. They consumed an average 221 mL (7.5 oz) CB per day. In fully adjusted models CB consumers (vs. non-consumers) had higher carbohydrates and total sugars and lower percent energy from protein and total fat (all p < 0.001), but no difference in total energy. A significantly higher proportion of CB consumers were predicted to be normal weight (BMI < 25 kg/m2; p = 0.001) and had to have lower waist circumferences (p = 0.001). Although there was not a significant trend across level of CB intake, low and middle level CB consumers compared to non-consumers were more likely to be normal weight (p < 0.001) and less likely to be overweight/obese (BMI ≥ 25 kg/m2, p < 0.001). Despite having slightly higher daily macronutrient intakes, CB consumers have more desirable anthropometric measures compared to non-consumers.
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    Branded Marketing and Media Campaigns to Support a Healthy Diet in the United States, 1999-2016: Insights to Inform the Partnership for a Healthier America’s Fruits & Veggies (FNV) Campaign
    Kraak, Vivica; Englund, Tessa R.; Zhou, Mi; Duffey, Kiyah J. (2017-03)
    Introduction Obesity and diet-related non-communicable diseases (NCD) are serious public health challenges that have created an enormous financial burden on the United States (U.S) health care system. The United States spends an estimated $190 billion annually on obesity-related costs, representing about 20 percent of all medical spending. Childhood obesity is responsible for more than $14 billion dollars in direct medical costs...
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    The Development and Evaluation of the Healthy Beverage Index for U.S. Children and Adolescents
    Parker, Molly Kathryn (Virginia Tech, 2019-07-15)
    Childhood (ages 2-9 years) and adolescence (ages 10-19 years) make up important periods of human life. Food preferences and dietary behaviors are developing during this time, and health status can impact noncommunicable disease (NCD) risk in adulthood. Many of the behaviors associated with developing NCD are modifiable and include dietary behaviors. Globally, children and adolescents are impacted by NCD, and obesity prevalence is growing among this population. One of the recommendations for combating obesity is to promote the consumption of healthy foods and beverages and the reduction of sugar-sweetened beverage intake. In order to assess beverage patterns, the Healthy Beverage Index (HBI) was created for adults. This tool provides a score from 0-100, with higher scores indicating better adherence to evidence-based beverage recommendations. Because many beverage recommendations for children and adolescents differ from those for adults, the purpose of this thesis was to develop the HBI for U.S. Children and Adolescents (HBI-CA). National Health and Nutrition Examination Survey (NHANES) data was used to calculate HBI-CA scores among a sample of U.S. children and adolescents. The HBI-CA resulted in scores similar to the adult HBI and provides a reference of beverage pattern quality in this population. Significant differences in scores were found among males and females and certain races. Evaluation of the HBI-CA demonstrated its construct validity and reliability. The HBI-CA still needs to undergo predictive validity tests. Overall, the HBI-CA provides a method to assess beverage pattern quality in clinical, public health, and research settings for this important population.
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    Evaluation For Buying and Eating Fruits and Vegetables Among Teens and Moms Exposed to the Fruits & Veggies (FNV) Campaign in California and Virginia, 2015-2017
    Duffey, Kiyah J.; Kennedy, Lauren E.; Englund, Tessa R.; Rincón-Gallardo Patiño, Sofía; Hedrick, Valisa E.; Kraak, Vivica (2017-12)
    In 2015, the PHA launched the branded FNV (Fruits & Veggies) Campaign in California and Virginia to increase sales and consumption of fruits and vegetables among millennial moms (21-34 years) and Generation Z teens (15-20 years). This study summarizes trends in U.S. fruit and vegetable consumption behaviors. We also describe the survey results that examined the familiarity of the FNV Campaign among Generation Z teens and Millennial moms in the two lead cities or test locations—Fresno in the Central Valley region of California and the Hampton Roads region of southeastern Virginia. Methods: A 35-item Qualtrics survey was administered either in person or online to Millennial moms and Generation Z teens in the two lead cities (n= 1604; Fresno, California: n= 746; Hampton Roads, Virginia: n=858) between February 1, 2017 and June 31, 2017. Data were analyzed using SPSS version 24 for Windows (IBM Corporation, USA, 2016). We analyzed differences in cognitive, affective, and behavioral outcomes by each test location. Differences within each city were compared between those who were familiar versus unfamiliar with the FNV Campaign. Results: About a quarter (25%) of respondents in each lead city (25.2% in Fresno, California and 25.8% in Hampton Roads, Virginia) were familiar with the FNV Campaign. In Hampton Roads, Virginia, a larger percentage of respondents reported having seen the FNV logo, while in Fresno, California, respondents reported an equal distribution between seeing the logo online or in the community, or just having heard of FNV. Apples, bananas and carrots were the most commonly recognized foods by participants surveyed who recalled seeing the FNV Campaign. There were no statistically significant differences between respondents familiar with the FNV Campaign and their awareness of previous campaigns that encouraged fruits and vegetables (e.g., Five a Day and Fruits and Veggies—More Matters). Respondents familiar with the FNV Campaign were not more knowledgeable about U.S. government-recommended servings of fruits and vegetables (e.g., 4.5 cup equivalents/day), compared to those who were unfamiliar with FNV Campaign. Respon¬dents in both test locations were significantly more likely to agree that they found it hard to purchase fruits and vegetables in their neighborhood and that eating fruits and vegetables affected their health. In Fresno, California but not Hampton Roads, Virginia, respondents familiar with FNV were significantly more confident in their ability to purchase but not prepare fruits and vegetables. There were statistically significant differences between respondents in Fresno, California who were familiar with the FNV Campaign. These respondents reported more daily servings of 100% vegetable juice, dark-green leafy vegetables and orange-colored vegetables compared to those who were unfamiliar with FNV, although the latter differences were not significant. No differences were observed between respondents who were familiar or unfamiliar with the FNV Campaign in Hampton Roads, Virginia. We found no differences in the fruit and vegetable purchasing behaviors of those familiar versus unfamiliar with the FNV Campaign in either test location. Large supermarkets and farmers’ markets were the two most common locations where respondents’ reported always or mostly shopping for food. Conclusions: While a quarter of respondents interviewed were familiar with the FNV brand, more work is needed to influence the target populations’ awareness about the FNV Campaign. There is also a need to understand how to use IMC to promote actionable and memorable messages to encourage target groups to purchase and consume more fruits and vegetables regularly that align with the DGA. We offer six recommendations to inform future research, evaluation and marketing of the FNV Campaign.
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    Evaluation of integrated marketing communication strategies used for the Fruits & Veggies Campaign in California and Virginia
    Englund, Tessa R.; Hedrick, Valisa E.; Duffey, Kiyah J.; Kraak, Vivica (Elsevier, 2020-02-11)
    In 2015, the Partnership for a Healthier America launched the branded Fruits & Veggies (FNV) Campaign to promote fruit and vegetable sales and intake to moms and teens in two California and Virginia pilot markets. The FNV Campaign used a novel, creative approach to promote fruits and vegetables through integrated marketing communication (IMC) strategies. Findings from a mixed-methods process evaluation conducted between 2016 and 2017 were used to explore congruence between stakeholders’ expectations of IMC strategy potential and FNV brand awareness and reach among target audiences. Awareness and recall of IMC strategies were assessed through a cross-sectional survey of target audience respondents (n = 1604) from the pilot markets. Qualitative data regarding IMC strategy potential and influential factors were gathered from stakeholder interviews (n = 22). Approximately 19.6% (n = 315) of respondents were aware of the FNV Campaign. Stakeholders’ perspectives regarding IMC potential aligned with findings that the proportion of aware respondents was significantly (p = 0.008) higher among teens (22%) than moms (17%). Qualitative results also converged with higher proportions of survey respondents recalling brand exposure through social media (46%) and retail settings (30%) than community activities (18%), word of mouth (17.5%), and traditional media advertisements (9.5%). IMC recall did not differ between mom and teen respondents except for significantly (p = 0.02) higher word of mouth recall among teen respondents. Findings support using selected IMC strategies and future involvement of diverse stakeholders. Evaluation results can inform future research and practice to improve IMC strategy reach and influence as the FNV Campaign expands to new markets nationwide.
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    Evaluation Summary. Four Studies Conducted for the Partnership for a Healthier America's Fruits & Veggies (FNV) Campaign in California and Virginia, 2015-2017
    Kraak, Vivica; Englund, Tessa R.; Zhou, Mi; Duffey, Kiyah J. (Department Of Human Nutrition, Foods, And Exercise, 2018-02)
    This evaluation summary provides brief descriptions of four studies funded by the Robert Wood Johnson Foundation to evaluate the Partnership for a Healthier America’s (PHA’s) branded FNV (Fruits & Veggies) Campaign that was launched in two pilot cities or test locations—Fresno in the Central Valley region of California and the Hampton Roads region of southeastern Virginia in 2015. The PHA designed the FNV Campaign as a new brand to increase the sales and consumption of all forms of fruits and vegetables (e.g., fresh, canned, dried and frozen) to reach Millennial moms, ages 21 to 34 years, and Generation Z teens, ages 15 to 20 years, in the two test locations. The PHA also explored how the FNV Campaign could reach racially, ethnically and culturally diverse populations. During phase one of the FNV Campaign (May 2015 to September 2016), the PHA reported the Campaign as a $5 million dollar/year that used commercial and behavioral branding principles and integrated marketing communication (IMC) strategies to raise awareness and encourage fruit and vegetable sales and intake among targeted populations in the two test locations. Commercial businesses often use IMC strategies in campaigns that combine advertising, public relations, sales promotion, direct marketing, sponsorships, celebrity endorsement, and point-of-purchase in retail settings across different communication platforms to build brand awareness and loyalty among targeted groups for products, services and ideas. In September 2015, the Robert Wood Johnson Foundation provided a grant to a research team in the Department of Human Nutrition, Foods, and Exercise at Virginia Tech in Blacksburg, Virginia to conduct a multi-faceted and independent evaluation of the FNV Campaign in the two pilot locations of Fresno, California and Hampton Roads, Virginia during phase one. This report summarizes the results of four studies that comprise an independent evaluation of the FNV Campaign conducted between September 2015 and December 2017. During phase two of the FNV Campaign (October 2016 to the present), the PHA announced the FNV Campaign’s expansion to 13 states and cities. These locations included: Fresno, Los Angeles and San Francisco, California; Boise, Idaho; Dallas, Texas; Chicago, Illinois; Mason City, Iowa; Syracuse, New York; Washington, DC; Boston and Springfield, Massachusetts; Norfolk/Hampton Roads, Virginia; Raleigh, North Carolina; Atlanta, Georgia; Miami, Florida; and Madison, Wisconsin. By May 2017, the PHA had reported more than 25 public- and private-sector partners who supported the FNV Campaign. These included partnerships with state health departments and USDA Cooperative Extension offices in California, Colorado, Georgia and Wisconsin to reach participants in Supplemental Nutrition Assistance Program (SNAP) and SNAP-Education (SNAP-Ed) to encourage fruits and vegetables. We anticipate that the collective findings from this evaluation will be useful as the PHA and partners aim to expand, scale up and sustain the FNV Campaign in other states and nationwide.
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    An Examination of Celebrity Endorsement Used to Promote Branded Food and Beverage Products to American Children, Adolescents and Young Adults to Inform Policies to Promote Healthy Food Environments
    Zhou, Mi (Virginia Tech, 2020-04-09)
    Celebrity endorsement is a global billion-dollar business used by food, beverage and restaurant companies to influence dietary behaviors that may contribute to overweight and obesity. Evidence suggests that existing government policies and industry self-regulatory programs in the United States (US) do not adequately protect young Americans from celebrity endorsement that promotes energy-dense and nutrient-poor food and beverage products. This PhD dissertation describes four studies that examine the nature, extent, and perceived influence of celebrity endorsement used by business firms and non-profit organizations to promote branded food and beverage products or branded campaigns to American children, adolescents and millennial young adults to inform future research and policies to promote healthy food environments. Study one created a database of US celebrities (n=732) involved with food and beverage group, brand or product endorsements (1990-2017) to examine celebrity profiles and their endorsement relationships, company partnerships, the nutritional profile of products and brands. Evidence was analyzed using Python version 3.5.5 and SPSS version 24. Study two examined celebrities associated with the Partnership for a Healthier America's Fruits and Veggies (FNV) Campaign (2015-2016). Evidence was analyzed using data visualization tools supported by Python and SPSS, and results informed the FNV Campaign. Study three used Q methodology to explore the views of Millennials, born 1981-1994 (n=40) at Virginia Tech about celebrity endorsement of food and beverage products and brands. Participants sorted 48 celebrity images depicting brand and product endorsements on a normal distribution (+4 to -4) based on celebrity trustworthiness and complete a post Q-sort questionnaire. Data analysis used PQMethod 2.35 statistical software program, centroid factor analysis, and qualitative interpretation of unique factor arrays for sorters. Study four identified relevant evidence about US celebrity endorsement of food and beverage products (2000-2019), used an accountability framework to evaluate the adequacy of accountability structures, and suggested future policies and action needed for diverse stakeholders to use celebrity endorsement to promote healthy food environments. Future research should explore the trend of celebrity endorsement used in the US marketplace and examine the influence of this marketing strategy on young people's food preferences and choices based on more representative experimental research.
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    The Examination of Mindfulness, Stress, and Eating Behaviors in Mothers of Young Children
    Kennedy, Lauren E. (Virginia Tech, 2016-05-03)
    With the alarming prevalence of overweight and obesity, it is important to explore new approaches and strategies to improve dietary quality and weight status. Recently, a neuropsychological model of obesity was proposed. This new model illustrates an evidencebased relationship between a chronically activated hypothalamic-pituitary-adrenal (HPA) axis, due to chronic psychological stress and mood disturbance, and the food reward-related mechanisms within the brain. Intensive mindfulness-based training programs, such as Jon Kabat-Zinn's Mindfulness-Based Stress Reduction have demonstrated impressive results with a variety of populations. Given the relationship of stress to eating behavior and the capacity of mindfulness in managing stress, a relationship between mindfulness and eating is expected. The goal of this dissertation research was to help understand the concept of mindful eating and the relationship between stress and eating behavior for mothers of young children in order to inform the development of a mindfulness-based stress management and dietary intervention. The research consisted of three components: 1) an informative photo-elicitation study with working mothers of young children aiming to understand how mothers define, perceive, and experience mindful eating; 2) a crosssectional study investigating the relationship between mindful eating, dietary quality, and stress; and 3) the development and mixed-methods pilot intervention of the Slow Down Program, a mindfulness-based stress management and nutrition program for mothers of young children. Results from these studies give further evidence on how mindfulness can be utilized in nutrition research and they further confirm the success of mindfulness-based training on health and dietary outcomes. This research can inform public health programs and practice to encourage mindfulness, as it relates to dietary behavior, for families and other audiences, as well as future research studies that explore the interaction between mindfulness and eating behaviors.
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    Exploring Progress, Barriers and Opportunities for the Branded FNV Marketing Campaign to Impact Fruit and Vegetable Consumption: A Mixed-Methods Evaluation
    Englund, Tessa R. (Virginia Tech, 2020-01-16)
    Unhealthy food and beverage products marketed through diverse media platforms contribute to poor diet quality, obesity, and chronic diseases in the United States (US). Limited empirical research is available on the effectiveness of integrated marketing communications (IMC) and branded media campaigns used to positively influence Americans' diet-related cognitive, behavioral and health outcomes. The purpose of this research was to assess and inform the Partnership for a Healthier America's Fruits and Veggies (FNV) Campaign to increase fruit and vegetable purchases and intake among targeted teen and mom populations. This PhD research evaluated the use, outcomes, and perspectives on branded food marketing campaigns to inform the FNV Campaign through four studies. Study 1 used a mixed-methods research approach that included a scoping review; comprehensive review of peer-reviewed articles, gray literature and media sources; and key-informant interviews (n=11) to identify 13 national branded marketing campaigns that used health-branding strategies to encourage healthy dietary purchases and consumption in the US between 1990-2016. Study 2 explored views of diverse stakeholders (n=22) regarding the FNV Campaign using semi-structured interviews that were thematically analyzed using a conceptual framework with eight constructs (i.e., campaign design, reach, adoption, effectiveness, impact, expansion, scaling up and sustainability). Study 3 assessed FNV Campaign awareness, cognitions and behaviors for buying and eating fruits and vegetables through a survey of targeted teen and millennial mom audiences (n=1,604) in Hampton Roads, Virginia and Fresno, California where the FNV Campaign pilot was launched. Study 4 encompassed a mixed-methods evaluation using data from the second and third studies that assessed and explored congruence between FNV brand awareness and recall of IMC strategies among survey respondents with stakeholders' perspectives regarding IMC strategy contexts and potential. This body of research expands knowledge about the effectiveness of diet-related IMC and media campaigns and provides a foundation for future FNV Campaign evaluations. Taken together, findings across the four studies identified significant opportunities for large-scale IMC campaigns to improve evaluation designs and outcome reporting. These results can inform evidence-based strategies and policies to improve the design of the FNV Campaign and other IMC initiatives to improve dietary patterns and population health.
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    Modeling the Effect of Replacing Sugar-Sweetened Beverage Consumption with Water on Energy Intake, HBI Score, and Obesity Prevalence
    Duffey, Kiyah J.; Poti, Jennifer (MDPI, 2016-06-28)
    Sugar-sweetened beverages (SSB) contribute to excessive weight gain through added energy intake. Replacing SSB with water is one strategy that has shown promise in helping lower excessive energy intake. Using nationally representative data from US adults (n = 19,718) from NHANES 2007–2012 we examine the impact of replacing SSB with water on Healthy Beverage Index (HBI) scores and obesity prevalence. Replacing an 8-ounce serving of SSB with water lowered the percent of energy from beverages from 17% to 11% (among those consuming 1 serving SSB/day). Reductions in the percent energy from beverages were observed across all SSB consumption groups (1–2 servings/day and >2 servings/day). Among adults there was a 9% to 21% improvement in HBI score when one serving of water replaced one serving of SSB. Using previously published randomized controlled trials (RCT) and meta-analyses of measured weight loss we also predicted a reduction in the prevalence of obesity (observed: 35.2%; predicted 33.5%–34.9%, p < 0.05) and increase in the prevalence of normal weight (observed: 29.7%; high weight loss: 31.3%, p < 0.05). Our findings provide further epidemiologic evidence that water in the place of SSB can be used as a strategy to limit energy intake and help individuals meet beverage intake recommendations.
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    Nutritional Comparison of Packed and School Lunches for Elementary Children
    Farris, Alisha (Virginia Tech, 2015-04-21)
    Over 50 million children attend public elementary and secondary schools in the United States each day. Children spend a substantial portion of their waking hours in school and consume one-third to one-half of their daily calories there, making schools a promising site to influence dietary quality and potentially the risk of childhood obesity. Important policy revisions have been implemented in the National School Lunch Program (NSLP) to improve the nutritional quality of school meals. In 2010, the Healthy, and Hunger-Free Kids Act updated the NSLP standards. The revised nutrition standards required schools to increase the availability of fruits, vegetables, whole grains, and fat-free and low-fat fluid milk in school meals; reduce the level of sodium, saturated fat and trans fat; and meet the nutritional needs of school children within their calorie requirements. About 60% of elementary children participate in the NSLP at least once per week, with the remaining 40% of children bringing a packed lunch from home. While school lunches are guided by national standards and regularly monitored to ensure standards are maintained, the remaining 40% are not guided by national standards. The ultimate purpose of this research was to assess the current school lunch environment and increase the overall nutritional quality of elementary lunches. Data collection procedures included school and packed lunch observations, elementary parent questionnaires, and a pilot intervention to assist elementary parents in providing healthier packed lunches. Results from these studies provide insight on the nutritional differences in school and packed lunches, provide knowledge concerning the parental motivations and barriers to participating in the NSLP or packing lunch for a child, and contribute to the limited research on effective modalities for assisting parents in providing healthier lunches. This research has significant implications public policy and provides valuable information for health professionals, researchers, food service directors, parents, and elementary school administrators to encourage NLSP participation and/or develop interventions which assist parents in packing healthier lunches. Interventions can take the form of marketing strategies to potentially influence NSLP participation, interventions to increase the nutritional value of packed lunches, and/or improvements in school wellness policies.
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    A Profile of Celebrities Involved in the Partnership for a Healthier America’s Fruits & Veggies (FNV) Campaign
    Kraak, Vivica; Zhou, Mi; Duffey, Kiyah J.; Williams, Jerome D. (2017-01)
    Most Americans do not consume the minimum daily 4.5-cup equivalent servings of fruits and vegetables recommended by the Dietary Guidelines for Americans 2015-2020 (DGA). In 2015, the Partnership for a Healthier America (PHA) launched a $5 million dollar branded marketing campaign called FNV (Fruits & Veggies) in Fresno, California and Hampton Roads Virginia to increase sales and consumption of fruits and vegetables among ethnically and racially diverse millennial moms (21-34 years) and Generation Z teens (15-20 years). Pro bono celebrity endorsement is a feature of the FNV Campaign’s IMC strategy, complemented by the use of print, broadcast and social media; sponsored community events; and in-store food retail marketing. A Virginia Tech evaluation team examined the FNV Campaign celebrities’ demographic profile (i.e., race, ethnicity, sex and age); food category and brand endorsements; and company or organization partnerships between April 2015 and December 2016. Methods: The FNV Campaign celebrity names (n=82) were obtained from the FNV website, verified by PHA staff, and entered into a larger Excel database of celebrities (n=552) associated with food and beverage group, brand or product endorsements in the United States between 1990 and 2016. We collaborated with computer scientists to use a python-based scripting engine and data visualization tools to analyze and display the relationships among each FNV Campaign celebrity; company, organization or campaign association; and brand or product category endorsements. We created a scatterplot for each celebrity’s food and beverage category or product endorsement to assess whether it met the U.S. DGA 2015-2020 and USDA’s Smart Snacks in School Standards. Two interactive dedrograms illustrated the FNV celebrity endorsement relationships between products, brands and companies. Results: The 552 unique celebrities were associated with 745 endorsements representing 159 brands across 13 food and beverage categories. The 82 FNV Campaign celebrities represented 15% of the entire database. Two thirds were male (68%; n=56) and they are primarily white (46%; n=38) or African American (43%; n=35). FNV Campaign celebrities were associated with a quarter (23%; n=37) of brands promoting fruits and vegetables; water, low- or no-calorie beverages (LCB or NCB) ≤60 calories/12 ounce-serving; and dairy or milk. The FNV Campaign celebrities were involved with 121 endorsements across 12 food and beverages categories. Three quarters (76%; n=62) endorsed only FNV; 12% (n=10) endorsed FNV and another brand; and 10% (n=8) endorsed FNV and 2-3 other brands. Apolo Ohno and Serena Williams endorsed FNV and 5-8 other brands. More than two thirds (70%; n=14) of FNV celebrities endorsed associated with products high in fat, sugar and sodium. Conclusions: Empirical evidence is needed to evaluate whether the target populations recognize the FNV Campaign celebrities, and how they view multiple endorsers for fruits and vegetables versus sugar-sweetened beverages, restaurant meals, salty and sweet snacks and desserts. We offer six recommendations to build an evidence base that will reveal whether the FNV Campaign’s celebrity endorsement is effective to encourage Americans to buy and consume more fruits and vegetables.
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    A review of state regulations to promote infant physical activity in child care
    Slining, Meghan M.; Benjamin Neelon, Sara E.; Duffey, Kiyah J. (2014-11-22)
    Background The purpose of this study was to review state regulations promoting increased physical activity and decreased sedentary behaviors in infants in child care and to assess consistency with recent Institute of Medicine (IOM) recommendations. Methods We compared existing state and territory licensing and administrative regulations to recent IOM recommendations to promote physical activity and decrease sedentary time in very young children attending out-of-home child care (both child care centers and family child care homes). Three independent reviewers searched two sources (a publicly available website and WestlawNext™) and compared regulations with five IOM recommendations: 1) providing daily opportunities for infants to move, 2) engaging with infants on the ground, 3) providing daily tummy time for infants less than six months of age, 4) using cribs, car seats and high chairs for their primary purpose, and 5) limiting the use of restrictive equipment for holding infants while they are awake. We used Pearson chi-square tests to assess associations between geographic region, year of last update, and number of state regulations consistent with the IOM recommendations. Results The mean (SD) number of regulations for states was 1.9 (1.3) for centers and 1.6 (1.2) for homes out of a possible 5.0. Two states had regulations for all five recommendations, Arizona for centers and Virginia for homes. Six states and territories had zero regulations for child care centers and seven states and territories had zero regulations for family child care homes. There were no significant associations between geographic region and number of regulations consistent with IOM recommendations. Conclusions Out-of-home child care settings are important targets for optimal early child health interventions. While most states had some regulations related to the promotion of physical activity among infants, few states had regulations for more than three of the five IOM recommendations. Enhancing state regulations in child care facilities could aid in early childhood obesity prevention efforts.
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    Stakeholders’ Views About the FNV Campaign to Increase the Sales and Consumption of Fruits and Vegetables in Two U.S. Cities
    Kraak, Vivica; Englund, Tessa R.; Zhou, Mi; Duffey, Kiyah J. (2017-12)
    In 2015, the PHA launched the branded FNV (Fruits & Veggies) Campaign in California and Virginia to increase sales and consumption of fruits and vegetables among millennial moms (21-34 years) and Generation Z teens (15-20 years). This study explored diverse stakeholders’ views and expectations about the FNV Campaign’s design, implementation and effectiveness in the test locations—Fresno in the Central Valley region of California and the Hampton Roads region of southeastern Virginia (May 2015 to September 2016); and their views about future expansion, scaling up and sustainability. Methods: We used a purposive sampling strategy to recruit and interview diverse stakeholders (n=22) (i.e., government, business, trade associations, public-interest non-governmental organizations, private foundations, and academic institutions) by phone (n=18) or in-person (n=4) between July and October 2016. We used a 15-item interview guide to explore stakeholders’ views and expectations about eight constructs (i.e., design, reach, adoption, effectiveness, impact, expansion, scaling up and sustainability) for the FNV Campaign. The interviews were analyzed using qualitative research principles and NVivo 11 software. The written transcripts were coded and analyzed for emergent themes. The results were summarized as perceived opportunities and challenges for the eight constructs. Results: Stakeholders represented national, state or local government agencies (36.4%; n=8), private-sector businesses (18.2%; n=4), industry trade associations (9.1%; n=2), public-interest organizations (9.1%; n=2), academic researchers (13.6%; n=3) and private foundations (13.6%; n=3). Design opportunities included breadth of creative marketing strategies including celebrities. Challenges were inadequate formative research conducted and confusion about the FNV brand and message content. Reach opportunities were social media and in-store fruit and vegetable retail potential, whereas challenges were underutilization of food-retail partnerships and desire for objective and rigorous evaluation data. Adoption opportunities were diverse sponsorship, assistance of local partners, and community excitement generated by FNV association. Adoption challenges were lack of a clear long-term communication plan between PHA and partners, limited flexibility for local adaptation, and lack of evidence to show that FNV brand or messages had increased fruit and vegetable sales or intake. Effectiveness and impact opportunities were some positive sales data from Virginia and public relations impressions. Challenges were a lack of targeted outcomes, limited transparency to share sales data and Campaign results with funders, and one-year pilot was inadequate to show positive effects. Expansion opportunities included potential to expand partnerships with SNAP retailers and untapped community-based supporters. Perceived challenges were that FNV targeted high-income food retailers were SNAP participants did not shop, and more than a campaign is needed to reach low-income consumers. Sustainability opportunities were well-resourced national partners and community-based organizations that could play a central role, and potential for commodity produce groups to support the Campaign. Challenges were sustaining clear communication with partners over time, fundraising, and keeping FNV brand and messages resonating with diverse audiences. Conclusions: This qualitative evaluation can inform the design and PHA partnership engagement strategy as the FNV campaign expands to other locations to increase fruit and vegetable sales and consumption among ethnically, racially and culturally diverse Americans. We offer four recommendations for evaluating the FNV Campaign’s effectiveness, impact and sustainability in other locations.
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    Validation of a Rapid Method to Assess Habitual Beverage Intake Patterns
    Hedrick, Valisa E.; Myers, Emily A.; Zoellner, Jamie M.; Duffey, Kiyah J.; Davy, Brenda M. (MDPI, 2018-01-13)
    The Healthy Beverage Index (HBI) is an emerging approach to assess beverage pattern quality. HBI total scores range from 0 to 100, with higher scores indicating greater adherence to proposed beverage recommendations. However, assessing patterns is resource-intensive due to the need for extensive dietary data, typically 24-h dietary records or recalls. The BEVQ-15, a beverage intake questionnaire, may be used as an alternative method to rapidly measure HBI scores. The objective of this cross-sectional investigation is to assess the comparative validity of the HBI-Q, a method to rapidly assess HBI scores via the BEVQ-15, as compared to the traditional method of deriving HBI scores via dietary recalls/records. Between 2012 and 2016, a cross-sectional sample of adults in southwest Virginia completed three 24-h dietary recalls (30–60 min administration and analysis time per recall) and the BEVQ-15 (3–4 min administration time). HBI scores were generated by both methods, and compared via paired-samples t-tests, correlations, and Bland–Altman analysis. Among 404 adults (mean age = 40 years), total mean HBI scores were 63.7 from the HBI-Q and 67.3 from the recalls (mean difference = 3.6 out of 100; r = 0.63; both p ≤ 0.001). Agreement between the two methods for total HBI scores via Bland–Altman plots was 92%. Using the HBI-Q to rapidly assess HBI scores in adults will increase the utility of the HBI by decreasing the time and resources required, thus allowing researchers and practitioners to provide targeted feedback for improvement.