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Browsing by Author "Hedrick, Valisa E."

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    Application of The Theory of Planned Behavior in a Randomized Control Trial Targeting Sugar-Sweetened Beverage Intake and Physical Activity in Southwest Virginia
    Tyhurst, Maja (Virginia Tech, 2015-06-07)
    BACKGROUND: Health-related interventions informed by behavioral theory have been shown to be more effective in changing behaviors as compared to those that are not. The Theory of Planned Behavior (TPB) has been used to successfully predict and explain a variety of health related behaviors, including sugar-sweetened beverage (SSB) intake and physical activity (PA). The TPB assumes that behavioral intentions are the most important determinant of behavior. Intentions are the function of individual's attitudes toward the behavior (these evaluations can be positive or negative), subjective norms (social standards and expectations surrounding the behavior), and perceived behavioral control (perception of the ease with which the behavior can be performed). According to literature, behavioral intentions predict 20% - 40% of the variance in health behaviors with attitudes beings the strongest predictor of diet, and perceived behavioral control being the strongest predictor of physical activity related intentions. Excessive SSB consumption and inadequate PA have been highly associated with the obesity epidemic, and related comorbidities such as cardiovascular disease and type-2 diabetes. Understanding and targeting these behaviors through application of health behavior theories, such as the TPB, is important. PRIMARY AIMS: This research is embedded within a larger 2-arm randomized-control trial, Talking Health, which targets residents in rural southwest Virginia. Guided by the TPB, the overall goal of the Talking Health trial is to determine the effectiveness of a 6-month intervention aimed at decreasing SSB intake (SIPsmartER) compared to a matched contact control aimed at increasing PA (MoveMore). Each condition includes three classes, one teach-back call, and 11 interactive voice response (IVR) calls. The primary aims of this secondary analysis of Talking Health are to 1) determine if single-item TPB indicators are correlated with multi-item TPB scales for SSB and PA; 2) examine how baseline TPB variables predict participation in the SIPsmartER and MoveMore; 3) determine how the IVR TPB variables assessed during IVR calls predict future SSB and PA behaviors reported in a subsequent IVR call; and 4) explore how TPB variables change over the course of the teach back and 11 IVR calls. METHODS: Eligibility requirements included being 18 years of age or older, having reliable access to a telephone, drinking 200 kilocalories of SSB per day, and having no contraindications for moderate-intensity physical activity. The present research utilizes data from the baseline health assessment, class attendance and IVR and teach back calls completion data, as well as data collected in teach-back and 11 IVR calls. Multi-item TPB constructs for both SSB and PA behaviors were assessed at baseline (measured on a 7-point Likert scale). Each IVR call assessed self-reported past week behavior (ounces of SSB or minutes of PA) and four single-item TPB constructs including behavioral intentions, perceived behavioral control, instrumental attitudes, affective attitudes, and subjective norms. Participation was measured as the number out of 15 activities completed by participants (three classes, one teach back call, and 11 IVR calls). Statistical analysis included descriptive statistics, Chi square tests, independent T-tests, Pearson's correlations, Cronbach's α, and sequential multi-step regression models. Multiple data imputations were used to account for missing data. RESULTS: Of the 301 participants, 81% were female and 93% were Caucasian. The mean age of participants was 48.8 ± 13.5. Additionally, 32% of participants completed high school education, 55% earned < $20,000 per year, 32% had a full time or part time job, and 33% were classified as low health literate. Single-item indicators for both SSB-TPB questions (r > 0.60) and PA-TPB questions (r > 0.69) were highly correlated with their multi-item scales. Baseline TPB variables did not predict the participation rates in either SIPsmartER (F=1.763, R2=0.057, P=0.124) or MoveMore (F=0.815, R2=0.028, P=0.541) conditions. Of the nine SIPsmartER IVR regression models, eight were significant, and the SSB-TPB variables predicted about 30% of the variance in SSB behavior. Of the nine MoveMore IVR regression models, all were significant, and the PA-TPB variables predicted about 20% of the variance in SSB behavior. In both conditions, the majority of variance was explained by behavioral intentions and the addition of other TPB variables (perceived behavioral control, instrumental attitudes, affective attitudes, and subjective norms) explained substantially less variance in the behaviors. There were no notable patterns of change in TPB variables over 11 IVR calls for either SIPsmartER or MoveMore participants. DISCUSSION: Our findings show that single-item indicators can be used as reliable measures of the TPB constructs. The TPB model did not show significant predictive value when it comes to participation in SIPsmartER or MoveMore. On the other hand, our findings show that TPB model explained about 30% (SSB) and about 20% (PA) of variance in behavior. Although significant changes in IVR TPB variables were found between the two time points in several instances for both SSB and PA behavior, there were no patterns of change over time. Based on our findings, assessing behavioral intentions as the goal behavior in each IVR call may be the most useful application of the TPB. Other TPB variables can be assessed using single-item indicators.
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    Are Cooking Interventions Effective at Improving Dietary Intake and Health Outcomes? A Systematic Review
    Wunderlich, Kayla Marie (Virginia Tech, 2022-09-14)
    Existing systematic reviews have suggested that cooking interventions can be beneficial for improving dietary intake and health outcomes, with research indicating that the ability to prepare meals at home may prove to be more complex, and involve influencing factors (i.e., cooking self-efficacy, food agency [i.e., one's ability to procure and prepare food with the considerations of their physical, social and economic environment], and nutritional literacy/knowledge) for improving health outcomes. With the average American's diet consisting of about 60% of total energy coming from the consumption of ultra-processed foods, interventions that target increasing cooking skills and the frequency of consuming home-cooked meals may help to reduce reliance on processed foods, improve dietary intake quality, and reduce risk of weight gain, obesity, and related conditions. To date, there are no systematic reviews that have addressed the impact of cooking interventions on processed or ultra-processed food consumption. Therefore, this research systematically reviewed the body of literature focused on cooking interventions and dietary intake including processed food consumption and evaluated intervention's effectiveness at improving dietary intake and physical and mental health outcomes. English and full-text research articles published through January 2021 were obtained through PubMed, CINAHL using EBSCO, Web of Science from Clarivate, Scopus and PsycInfo. Overall, 55 articles were obtained after meeting the inclusion criteria and going through the data extraction process. Outcomes of interests to measure included fruit and vegetable consumption, body mass index (BMI), body weight, waist circumference, blood pressure, physical activity, and if the study measured psychosocial outcomes or processed food consumption. Results indicate that when analyzing the effect sizes for studies that reported mean data for each group (eg, intervention and control/comparison groups), 86% of studies measuring fruit intake found a positive effect size (Average: Cohen's d: 0.65, 95% CI: 0.30, 0.99); 90% of studies measuring vegetable intake found a positive effect size (Average: Cohen's d: 0.80, 95% CI: 0.37, 1.09); 82% of studies measuring BMI found a negative effect size (Average: Cohen's d: -0.20, 95% CI: -0.58, 0.17); 100% of studies measuring body weight had a negative effect size (Average: Cohen's d: -0.27, 95% CI: -0.77, 0.23); and 100% of studies measuring waist circumference had a negative effect size (Cohen's d: -0.16, 95% CI: -0.60,0.24). This systematic review will provide information on recently published studies that were not incorporated in prior reviews that can be utilized in future interventions that aim to improve health outcomes and reduce processed food consumption.
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    An Assessment of Government Capacity Building to Restrict the Marketing of Unhealthy Food and Non-Alcoholic Beverage Products to Children in the Region of the Americas
    Rincón-Gallardo Patiño, Sofía; da Silva Gomes, Fabio; Constantinou, Steven; Lemaire, Robin Hargroder; Hedrick, Valisa E.; Serrano, Elena L.; Kraak, Vivica (MDPI, 2021-08-06)
    The Pan American Health Organization (PAHO) Strategic Plan 2020–2025 committed to reduce children’s consumption of energy-dense nutrient-poor food and beverage products high in fat, sugar and salt (HFSS) and promote healthy eating patterns to reduce malnutrition in all forms. This paper describes the capacity-building needs in PAHO’s Member States to restrict the marketing of HFSS food and beverages to children. We asked Ministries of Health officials or national institutes/departmental representatives (n = 35) to complete a 28-item web-based survey (January to July 2020). Capacity-building needs were assessed using an adapted version of the World Health Organization’s government capacity-building framework with three modules: public health infrastructure, policies and information systems. Notable achievements for the PAHO’s Plan of Action were identified. State representatives reported strong infrastructure and information systems; however, policy improvements are needed to increase comprehensive national responses. These include using a constitutional health and human rights approach within the policies, policies that document conflict of interest from non-state actors, and strengthening regulatory oversight for digital media platforms. These findings provide baseline data and we suggest priorities for further action to strengthen national governments’ capacity-building and to accelerate the development, implementation, and monitoring systems to restrict the marketing of HFSS food and non-alcoholic beverages to children in the region of the Americas.
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    Assessment of the Validity, Reliability, and Sensitivity of Fingerstick δ¹³C as an Added Sugar Biomarker in Adolescents: A Controlled Feeding Study Approach
    Liu, Sarah Victoria (Virginia Tech, 2017-05-22)
    An estimated 20.5% of adolescents ages 12 – 19 years were obese (≥95th percentile of BMI-for-age) in 2011 – 2014. Consumption of added sugars (AS) has been linked with adverse effects on weight and cardiovascular disease risk factors. Approximately 16% of adolescents’ calories come from AS, of which sugar-sweetened beverages (SSB) are a major contributor. However, the relationship between AS/SSB intake and obesity is controversial, partly due to limitations in self-reported dietary data. Objective dietary intake biomarkers may circumvent this problem. The δ13C biomarker for AS intake is based upon the fact that C4 plants– major source for sugar production in the United States – have elevated δ¹³C values compared to C3 plants, which includes most fruits and vegetables. The δ¹³C value of blood, which is influenced by diet, has been established as a valid, reliable, and sensitive biomarker, but when compared to selfreported AS intake. This investigation evaluated the sensitivity and reliability of the δ13C biomarker, assessed with fingerstick blood samples, in adolescents using a controlled feeding, crossover design. Fingerstick δ¹³C values significantly changed by -0.05‰ and +0.03‰ after subjects completed the 5% and 25% AS diets, respectively (F(1, 30) = 18.828, p < 0.001). High reliability was found between two consecutive fingerstick δ¹³C values on the low (ICC = 0.996) and high (ICC = 0.997) AS diets. Thus, fingerstick δ¹³C may be a sensitive and reliable indicator of AS intake in adolescents. Future investigations should develop an equation to estimate AS intake based on fingerstick δ¹³C
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    The Association between Non-Nutritive Sweetener Intake and Metabolic Syndrome in Adults
    Hess, Erica Lynn (Virginia Tech, 2017-06-06)
    Non-nutritive sweeteners (NNS) have been used to replace added sugars in foods/beverages. Research related to NNS consumption and metabolic syndrome (MetS) is of great importance as NNS are often used by individuals who are looking to improve their health. The objectives of this investigation were to determine whether an association between NNS consumption (total and individual types) and MetS exists, and if any of the five risk factors for MetS were more significantly impacted by NNS consumption. Four NNS were included in this study: saccharin, sucralose, aspartame, and acesulfame potassium. Adult participants (n = 125) from Southwest Virginia were recruited for a cross-sectional investigation. Demographics, three 24-hour dietary recalls, and values for MetS (blood pressure, waist circumference, and glucose, triglyceride, and HDL levels) were collected. Statistical analyses included descriptives and multiple linear regressions models. Of the 125 participants, 63 were classified as NNS consumers and 18 met the criteria for MetS. There was a significant positive relationship between MetS and total NNS consumption (p=0.007) and MetS and aspartame (p=0.012). When looking at individual MetS risk factors, waist circumference, triglyceride and glucose values were significantly positively associated with NNS consumption (p≤0.001) and aspartame, sucralose, and saccharin (all p≤0.027). Some limitations to current NNS research were addressed, such as, examining associations between individual NNS types and not using diet soda as a proxy for NNS consumption. More research is needed to address the bias of self-reported data and the lack of randomized controlled trials to inferentially test the impact of NNS consumption.
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    Awareness and outcomes of the fruits and veggies (FNV) campaign to promote fruit and vegetable consumption among targeted audiences in California and Virginia: a cross-sectional study
    Englund, Tessa R.; Hedrick, Valisa E.; Patiño, Sofía R.; Kennedy, Lauren E.; Hosig, Kathryn W.; Serrano, Elena L.; Kraak, Vivica (2021-06-09)
    Background In 2015, the Partnership for a Healthier America launched the branded Fruits & Veggies (FNV) Campaign to apply a unique industry-inspired marketing approach to promote fruit and vegetable sales and intake to moms and teens in two US pilot markets: Fresno, California and Hampton Roads, Virginia. The aims of this cross-sectional study were to: 1) assess brand awareness and fruit- and vegetable-related outcomes among FNV Campaign target audiences in the California and Virginia market locations; and 2) examine whether reported awareness of the FNV Campaign was associated with differences in fruit- and vegetable-related cognitive and behavioral outcomes. Methods Data for this cross-sectional study were collected using an online survey administered to a non-probability convenience sample (n = 1604; February–July 2017) of youth aged 14–20 years (n = 744) and moms aged 21–36 years (n = 860) in the two pilot markets. Descriptive statistics were computed and outcomes compared between unaware and aware respondents, controlling for sociodemographic covariates. Multivariate analysis of covariance (MANCOVA) was conducted to assess whether fruit- and vegetable-related attitude, belief, and encouragement outcomes differed by FNV Campaign awareness; logistic regression was used to examine associations between FNV brand awareness and dichotomous variables (fruit- and vegetable-related behavioral intentions, trying new fruits and vegetables); and ANCOVA was used to assess associations with daily fruit and vegetable intake frequency. Results Approximately 20% (n = 315/1604) of respondents reported awareness of the FNV Campaign. Youth that reported awareness of the FNV Campaign (n = 167, 22.4%) had higher intentions to buy (p = 0.003) and eat (p = 0.009) fruits and vegetables than unaware respondents. Mothers that reported awareness of the FNV Campaign (n = 148, 17.2%) reported greater encouragement for friends and family to eat fruits and vegetables (p = 0.013) and were approximately 1.5 times more likely to report trying a new fruit or vegetable (p = 0.04) than mothers unaware of the Campaign. Daily fruit and vegetable intake frequency did not differ by Campaign awareness. Conclusions FNV Campaign awareness was associated with limited but positive short- and intermediate-term cognitive and behavioral outcomes among target audience respondents. These findings can inform future research to enhance understanding and improve the FNV Campaign as it is expanded to new markets nationwide.
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    Challenges and Opportunities for Member States to Implement Resolution WHA63.14 to Restrict the Marketing of Unhealthy Food and Non-alcoholic Beverage Products to Children to Decrease Global Obesity and Non-Communicable Disease Risks by 2025
    Rincon Gallardo Patino, Sofia (Virginia Tech, 2020-11-05)
    The widespread marketing of food and beverage products high in fat, sugar and salt (HFSS) es is a significant driver of obesity and diet-related non-communicable diseases (NCDs). This PhD dissertation examined the factors related to Member States' capacity and actions to fully implement the 2010 World Health Assembly's Resolution WHA63.14 to restrict the marketing of HFSS food and non-alcoholic beverage products to children up to 18 years by 2025. The first study describes the capacity-building needs of Ministries of Health (MoH) to implement the Resolution WHA63.14. The research used a 28-item web-based survey administered to representatives of MoH from the Pan American Health Organization (PAHO) region (n= 35). A government capacity-building and integrated marketing communications (IMC) frameworks guided this research. The second study examined the government policies to restrict the marketing of HFSS food and beverage products in a purposive sample of countries in the PAHO region (n=14). The WHO policy and IMC frameworks were used to develop a responsible policy index (RESPI). A web-based platform was developed that uses data visualization tools to depict the results. The third study explored the dimensions of power in the Mexican social networks of stakeholders that influenced the policy-making process that enabled the government to enact front-of-pack (FOP) warning labels on HFSS food and beverage products marketed to children and adults in 2020. The study followed a case study approach, using semi-structured interviews with stakeholders, and guided by the Gaventa's power cube framework. Social Network Analyses were conducted using the UCINET software (version 6) that measured centrality, factions and quadratic assignment procedures (QAP). These PhD studies applied several theoretically grounded conceptual frameworks related to nutrition governance that allowed me to draw conclusions from empirical and published evidence to develop and implement comprehensive policies to restrict the marketing of HFSS food and beverage products to children. Results may inform government agencies, civil society organizations, academic researchers, private foundations and industry actors about the areas needed for policy improvement and promising or best practices that should be adopted to implement Resolution WHA63.14 to reduce children's future risks of obesity and diet-related NCDs by 2025.
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    Changes in Non-Nutritive Sweetener Consumption Patterns in Response to a Sugar-Sweetened Beverage Reduction Intervention
    Acero, Darlene; Zoellner, Jamie M.; Davy, Brenda M.; Hedrick, Valisa E. (MDPI, 2020-11-08)
    Data are lacking on whether non-nutritive sweeteners (NNS) can be used as a strategy to support decreases in sugar-sweetened beverage (SSB) consumption. The purpose of this secondary analysis of a 6-month SSB-reduction intervention was to explore changes in NNS consumption patterns in Talking Health participants within the SIPsmartER (n = 101) intervention. Additionally, participant characteristics were compared for three SSB-NNS change groups (decrease SSB/increase NNS; decrease SSB/no increase in NNS; increase/no change in SSB/regardless of NNS). There was a significant increase in aspartame and total NNS intake for participants (mean daily mg increases of 37.2 ± 13.9 and 63.7 ± 18.5, respectively). With the exception of sex, no differences in participant characteristics were found between the three SSB-NNS change groups. Furthermore, no significant changes in weight or body mass index (BMI) were demonstrated between SSB-NNS change groups over time. Diet soda was the most commonly consumed source of NNS; however, other dietary sources of NNS also contributed to intake. At 6 months, intake of sucralose and saccharin were primarily from dietary sources other than diet sodas (94% and 100%, respectively). These findings suggest that NNS may be a feasible strategy to help reduce SSB consumption. This study supports the need to consistently quantify and identify NNS intake, beyond using diet soda intake as a proxy for NNS intake and grouping all NNS types into one variable, to more accurately address the potential health effects of NNS.
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    Changes in the Healthy Beverage Index in Response to an Intervention Targeting a Reduction in Sugar-Sweetened Beverage Consumption as Compared to an Intervention Targeting Improvements in Physical Activity: Results from the Talking Health Trial
    Hedrick, Valisa E.; Davy, Brenda M.; Myers, Emily A.; You, Wen; Zoellner, Jamie M. (MDPI, 2015-12-04)
    The recently developed Healthy Beverage Index (HBI) was designed to evaluate overall beverage intake quality (including total fluid consumption and beverage calories), yet no known intervention studies have assessed longitudinal changes to the HBI. The objective of this investigation was to assess changes in HBI scores in response to a sugar-sweetened beverage (SSB) reduction trial as compared to a physical activity comparison group. Participants were enrolled into a six-month, community-based, controlled behavioral trial and randomized into either a SSB reduction group (SIPsmartER) or a physical activity group (MoveMore). Correlations and multilevel mixed-effects linear regression with intention-to-treat analyses are presented. Total HBI score significantly increased for SIPsmartER (n = 149) (mean increase = 7.5 points (5.4, 9.7), p ≤ 0.001) and MoveMore (n = 143) (mean increase = 3.4 points (1.6, 5.2), p ≤ 0.001) participants, with a significant between group effect (p ≤ 0.05), over the six-month intervention. Other significant changes in HBI components for SIPsmartER included increased SSB and total beverage calorie scores, and decreased low-fat milk and diet soda scores. Changes in total HBI scores were significantly correlated with changes in total Healthy Eating Index-2010 scores (r = 0.15, p ≤ 0.01). Our findings suggest that individual HBI component scores, beyond the SSB component, are influenced by intervention strategies that primarily focus on SSB reduction.
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    Characterization of Non-Nutritive Sweetener Intake in Rural Southwest Virginian Adults Living in a Health-Disparate Region
    Hedrick, Valisa E.; Passaro, Erin M.; Davy, Brenda M.; You, Wen; Zoellner, Jamie M. (MDPI, 2017-07-01)
    Few data assessing non-nutritive sweetener (NNS) intake are available, especially within rural, health-disparate populations, where obesity and related co-morbidities are prevalent. The objective of this study is to characterize NNS intake for this population and examine the variance in demographics, cardio-metabolic outcomes, and dietary intake between NNS consumers and non-consumers. A cross-sectional sample (n = 301) of Virginian adults from a randomized controlled trial (data collected from 2012 to 2014) targeting sugar-sweetened beverage (SSB) intake completed three 24-h dietary recalls, and demographics and cardio-metabolic measures were assessed. The frequency, types, and sources of NNS consumption were identified. Thirty-three percent of participants reported consuming NNS (n = 100). Sucralose was the largest contributor of mean daily NNS intake by weight (mg), followed by aspartame, acesulfame potassium, and saccharin. NNS in tabletop sweeteners, diet tea, and diet soda were the top contributors to absolute NNS intake. The most frequently consumed NNS sources were diet sodas, juice drinks, and tabletop sweeteners. Although mean body mass index (BMI) was greater for NNS consumers, they demonstrated significantly lower food, beverage, and SSB caloric intake and energy density, and higher overall dietary quality. It remains unclear whether NNS use plays a role in exacerbating weight gain. NNS consumers in this sample may have switched from drinking predominantly SSB to drinking some NNS beverages in an effort to cope with weight gain. Future studies should explore motivations for NNS use across a variety of weight and health categories.
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    Characterization of Non-nutritive Sweetener Intake Patterns in a Sample of Rural Southwest Virginian Adults
    Passaro, Erin Marie (Virginia Tech, 2016-06-03)
    Controversy surrounds the use of artificial sweeteners (non-nutritive sweeteners [NNS]) as an effective weight-loss and/or maintenance strategy. This controversy is especially important as obesity is an epidemic in the United States. Excessive added sugar intake, primarily from sugar-sweetened beverages, has been linked to increased risk of overweight and obesity, as well as type 2 diabetes and cardiovascular disease. NNS provide minimal to no calories and thus, they have been suggested as a method to reduce added sugar intake, and consequently decrease energy intake, weight, and cardiometabolic risk. However, NNS intake has been associated with various health outcomes in observational studies and randomized controlled trials, including cancer, weight gain and loss, physiological and intestinal changes, cardiovascular disease, and diabetes. The uncertainties around the effect of NNS on health outcomes stem from a variety of limitations, one of which is inadequate dietary assessment methodology. Accuracy of dietary intake assessment methods is limited by the inability to distinguish between different types of NNS and lack of information about consumer use of NNS in a variety of beverages and foods. The purpose of this investigation is to explore NNS consumer characteristics and to characterize NNS intake in a sample of rural Southwest Virginian adults. This characterization is especially important for rural populations, as they are known to be high sugar-sweetened beverage consumers and are at an increased risk of obesity and chronic disease; thus, NNS could serve as a replacement method to facilitate cardiometabolic health. Cross-sectional data from a large randomized controlled trial, Talking Health (n=301), was utilized in this investigation to compare demographic characteristics, anthropometrics, biochemical markers, dietary quality, and dietary factors between NNS consumers and NNS non-consumers. This data was also used to characterize NNS intake (frequency, type, and source of sweetener). Of this rural sample, 33% consumed NNS, with sucralose being the most prevalent type of NNS and diet soda being the most frequently consumed source of NNS. NNS consumers had a higher BMI status than NNS non-consumers. However, NNS consumers had better overall dietary quality than NNS non-consumers. The characteristics of these NNS consumers and their intake patterns can be used to develop well-designed dietary intake assessment tools that accurately measure NNS intake, which can facilitate a better understanding of the associations of NNS with health outcomes.
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    The Comparative Validity of Interactive Multimedia Questionnaires to Paper-Administered Questionnaires for Beverage Intake and Physical Activity: Pilot Study
    Riebl, Shaun K.; Paone, Allyson C.; Hedrick, Valisa E.; Zoellner, Jamie M.; Estabrooks, Paul A.; Davy, Brenda M. (JMIR Publications, 2013-10-22)
    Background: Brief, valid, and reliable dietary and physical activity assessment tools are needed, and interactive computerized assessments (ie, those with visual cues, pictures, sounds, and voiceovers) can reduce administration and scoring burdens commonly encountered with paper-based assessments. Objective: The purpose of this pilot investigation was to evaluate the comparative validity and reliability of interactive multimedia (IMM) versions (ie, IMM-1 and IMM-2) compared to validated paper-administered (PP) versions of the beverage intake questionnaire (BEVQ-15) and Stanford Leisure-Time Activity Categorical Item (L-Cat); a secondary purpose was to evaluate results across two education attainment levels. Methods: Adults 21 years or older (n=60) were recruited to complete three laboratory sessions, separated by three to seven days in a randomly assigned sequence, with the following assessments–demographic information, two IMM and one paper-based (PP) version of the BEVQ-15 and L-Cat, health literacy, and an IMM usability survey. Results: Responses across beverage categories from the IMM-1 and PP versions (validity; r=.34-.98) and the IMM-1 and IMM-2 administrations (reliability; r=.61-.94) (all P<.001) were significantly correlated. Paired t tests revealed significant differences in sugar-sweetened beverage (SSB) grams and kcal (P=.02 and P=.01, respectively) and total beverage kcal (P=.03), on IMM-1 and IMM-2; however, comparative validity was demonstrated between IMM-2 and the PP version suggesting familiarization with the IMM tool may influence participant responses (mean differences: SSB 63 grams, SEM 87; P=.52; SSB 21 kcal, SEM 33; P=.48; total beverage 65 kcal, SEM 49; P=.19). Overall mean scores between the PP and both IMM versions of the L-Cat were different (both P<.001); however, responses on all versions were correlated (P<.001). Differences between education categories were noted at each L-Cat administration (IMM-1: P=.008; IMM-2: P=.001; PP: P=.002). Major and minor themes from user feedback suggest that the IMM questionnaires were easy to complete, and relevant to participants' typical beverage choices and physical activity habits. Conclusions: In general, less educated participants consumed more total beverage and SSB energy, and reported less engagement in physical activity. The IMM BEVQ-15 appears to be a valid and reliable measure to assess habitual beverage intake, although software familiarization may increase response accuracy. The IMM-L-Cat can be considered reliable and may have permitted respondents to more freely disclose actual physical activity levels versus the paper-administered tool. Future larger-scale investigations are warranted to confirm these possibilities.
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    Consumer responses and willingness-to-pay for hibiscus products: A preliminary study
    Ndiaye, Oumoule; Hedrick, Valisa E.; Neill, Clinton L.; Carneiro, Renata C. V.; Huang, Haibo; Fernandez-Fraguas, Cristina; Guiro, Amadou Tidiane; O'Keefe, Sean F. (Frontiers, 2023-04)
    The rise in diseases like obesity and diabetes is a worldwide challenge. The consumption of functional products such as hibiscus, which has been proven to be high in bioactive compounds and dietary fiber, providing it with anticancer, antiaging, anti-inflammatory and satiety properties, should be promoted. In the U.S., promoting the consumption of hibiscus products can be a good approach to increase fiber consumption and to reduce risk of obesity, diabetes, and hypertension. However, information about knowledge of this functional product among consumers is still sparse and increasing consumption requires designing and marketing desired products made from hibiscus. Therefore in this preliminary study, we assessed consumer response to hibiscus products and investigated whether providing information about potential health benefits could impact consumer willingness-to-pay (WTP) for three types of non-alcoholic hibiscus beverages: ready-made tea, bottled juice, and kombucha. Our web-based survey was distributed through Qualtrics(XM) and a convenience sampling method was chosen. Most participants identified themselves as female, 18-34 years old, with a graduate degree. Most participants (81%) had consumed hibiscus products before and 57% had a weekly food budget lower than $60. Overall, tea and juices were the most liked hibiscus beverages, respectively. Although taste and health benefits were ranked as the main reasons to consume hibiscus beverages, additional information about hibiscus health benefits did not significantly affect WTP for these products. Without additional health benefit information, consumer WTP for non-alcoholic hibiscus beverages ranged from $2.9 to $3.60 for kombucha and $4.08-4.97 for Ready-made-tea. This study provides valuable insights that can support future research on hibiscus products and promote the development of novel hibiscus-based foods and beverages that are appealing to the U.S. market.
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    Cultivating a Healthy School Environment: Evaluation of a Virginia School Nutrition Training Program
    Nelson, Rachel A. (Virginia Tech, 2020-05-18)
    The Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework was used to evaluate the impact of the Virginia Department of Education's (VDOE) implementation of the USDA's Team Nutrition training program on Virginia elementary schools from 2017-2020. The VDOE provided training for school nutrition directors (SNDs) at workshops in June 2018 and September 2019 and continued technical assistance to help SNDs improve the school food environment within their divisions. SNDs' perceived support, self-efficacy, and intention to implement changes to the school food environment was measured through pre- and post-training surveys and quarterly check-ins. Implementation was measured using lunchroom environment observations and strategic plans created at the workshops. SNDs representing 83.9% of Virginia elementary students (512,953 students) in 111 divisions attended at least one of the workshops. Within effectiveness, perceived support from cafeteria staff was highest among all stakeholders for both the 2018 and 2019 trainings, though it significantly decreased from before to after the training for both workshops. Average perceived support did not significantly change over time. Self-efficacy was significantly higher following the 2018 training workshop only. The intervention was adopted by 84% of divisions and both intention to implement and actual implementation were highest for strategies related to Farm to School, a VDOE priority. Effectiveness and implementation are expected to improve as it takes up to years for changes to occur in schools. Despite RE-AIM not being part of the initial evaluation plan, 62% of indicators were assessed. With some adaptations to improve effectiveness, the intervention should continue and be expanded.
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    Determination of the Capacity Building Framework that Support a Collaborative Fruit and Vegetable Prescription Program
    Schwartz, Olivia Rae (Virginia Tech, 2017-05-22)
    Over half of U.S. adults, roughly 117 million individuals, suffer from at least one preventable chronic disease, such as obesity, hypertension, coronary heart disease, and certain types of cancer. Epidemiological studies suggest that fruit and vegetable intake may be protective against these diseases, yet it is estimated that less than one-quarter of the population meets current fruit and vegetable recommendations. Low consumption rates may be attributed to lower income, food insecurity, and poor access and availability to fruits and vegetables. As a result, access to affordable and nutritious foods and beverages, particularly in underserved communities, such as “food deserts,” has become a national priority. An emerging strategy to address this is prescription programs, whereby physicians provide prescriptions or vouchers for fruit and vegetables to clients to encourage increased consumption, implemented in the form of the Farmacy Garden, which was the result of collaboration between multiple agencies. For collaborative efforts to be able to implement and sustain their shared goals, partnering individuals, agencies, and organizations need to first have the capacity or the potential to build capacity as a ‘unit.’ The purpose of this study was to concretely examine different factors and domains within Matachi’s Capacity Building Framework related to the Farmacy Garden in order to replicate the program in other locations. This framework conceptualizes organizational capacity building as dependent (and interdependent) on three different domains - individual, organizational, and environment. The study utilized semi-structured, openended interviews to ascertain concrete factors of organizational capacity building present at each level among Farmacy Garden collaborative project stakeholders (n=7). Interviews with six stakeholders (85.7% response rate) ranged in length from thirty-two minutes to one hour and twenty minutes. Common themes were coded separately by two members of the research team, first for overall recurring themes and second, to reveal connections between themes. Relevant quotes were identified and any discrepancies between researchers were resolved. Common themes often crossed over different levels, such as time, beliefs, values, and attitudes and inter-organizational linkages/partnerships, attitudes, and relationships, highlighting the inter-dependence of various factors across domains of capacity building. In addition to identifying specific factors that were necessary for the creation and sustainability of the Farmacy Program, the analysis revealed the importance of a “shared belief and value system.” In other words, individuals and organizations “valorized” this project in different ways than more traditional programs and/or interventions. The findings of this study can help guide leadership in cultivating relationships and new benchmarks to ensure transparency in project goals, in addition to time and physical resources, as well as inform the organizational capacity research area within nutrition and food systems fields.
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    Development and Evaluation of a Brief Questionnaire to Assess Habitual Beverage Intake (BEVQ-15): Sugar-Sweetened Beverages and Total Beverage Energy Intake
    Hedrick, Valisa E. (Virginia Tech, 2011-09-23)
    Attention on beverage intake, specifically sugar-sweetened beverages (SSB), has increased in recent years (1). Energy-containing beverages do not provide the same satiety as solid foods, and intake of solid food is not spontaneously reduced when energy-containing beverages are consumed (2,3). This may contribute to positive energy balance (1). Conversely, a reduction in energy intake occurs by replacing SSB with water and may facilitate weight loss (4,5). A valid, reliable and sensitive assessment tool for quantifying beverage consumption and determining its influence on weight status could help advance research on this topic. Three studies were conducted to develop the BEVQ, a self-administered quantitative beverage intake questionnaire. First study (n=105): the 19-item BEVQ's validity was examined by comparing participant's beverage intake to the "gold standard" of dietary intake assessment, food intake records; reliability was assessed by comparing two BEVQ's, administered two weeks apart. The BEVQ demonstrated acceptable validity (R2=0.53, water g; 0.46, 0.61 total beverage g, kcal; 0.49, 0.59 SSB g, kcal) as well as reliability (all correlations P<0.001) (6). Second study (n=1,596): the BEVQ underwent exploratory factor analyses (EFA) to identify the potential to reduce items. Three beverage items, which contributed <10% to total beverage intake g, kcal, were eliminated; EFA identified beer and light beer as a combined category. The refinement led to the 15-item BEVQ, which produced a lower readability score of 4.8 and shorter administration time (~2 min) (7). Third study (n=70): the ability of the BEVQ-15 to detect changes in beverage intake was evaluated by increasing participant water and fruit juice consumption and evaluating BEVQ-15 outcomes before and after the feeding period. Increases in water, juice and total beverage (g) were detected during the intervention period (P<0.001) (8). This rapid, valid, reliable and sensitive beverage intake assessment tool may determine the habitual intake of SSB and other beverages, and evaluate the effectiveness of clinical and public health interventions which aim to address national SSB recommendations. Future work is needed to evaluate the validity and reliability of the BEVQ-15 in children, as well as develop cost-effective noninvasive biomarkers that can objectively estimate intake of specific foods/dietary components (9).
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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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    Development and Evaluation of the Planetary Health Diet Index for the United States and Assessment of Dietary Constructs Associated with Sustainability
    Parker, Molly Kathryn (Virginia Tech, 2023-05-09)
    Dietary choices present an important avenue for promoting food system sustainability. Research suggests that plant-based dietary patterns can have positive health effects and reduce environmental impacts. The Planetary Health Diet was proposed by the EAT-Lancet Commission as a reference healthy and sustainable dietary pattern. A Planetary Health Diet Index (PHDI) was developed for Brazil to measure adherence to Planetary Health Diet recommendations; however, a PHDI has not been developed and evaluated for the United States (U.S.) population. Additionally, relatively few studies have assessed dietary constructs related to sustainability among U.S. adults, including the construct of meat attachment (i.e., a positive bond toward eating meat) and willingness to reduce meat intake. These gaps informed three primary research objectives. First, develop and evaluate the PHDI for the U.S. (PHDI-US). Second, use the PHDI-US to measure American adherence to the Planetary Health Diet. Third, analyze differences in meat attachment and willingness to reduce meat intake by sociodemographic and socioeconomic characteristics in a southern U.S. population. Cross-sectional data from 4,741 participants of the National Health and Nutrition Examination Survey 2017-2018 were used for analyses. Validity and reliability tests were acceptable, with total PHDI-US and Health Eating Index-2015 scores being positively associated; concurrent-criterion validity analyses identifying significantly lower scores among males, everyday smokers, and younger adults; and Cronbach's alpha equaling 0.51. The average PHDI-US score was 38.7 out of 150, indicating that American diets are far from meeting Planetary Health Diet recommendations. Using the Meat Attachment Questionnaire (MAQ), levels of meat attachment, meat intake frequency, and willingness to reduce meat intake and follow a more plant-based diet were compared by gender, educational attainment, income, and age among 328 American adults. The two characteristics most associated with differences in MAQ scores were age and educational attainment, with younger adults and those with higher educational attainment having lower MAQ scores and greater willingness to follow a more plant-based diet. The results of these studies can help improve the design of interventions by providing a tool to quantitatively measure American adherence to the Planetary Health Diet and identifying that younger adults and those with higher educational attainment may be more receptive to adopting sustainable dietary patterns.
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    Development of a Responsible Policy Index to Improve Statutory and Self-Regulatory Policies that Protect Children’s Diet and Health in the America’s Region
    Rincón-Gallardo Patiño, Sofía; Rajamohan, Srijith; Meaney, Kathleen; Coupey, Eloise; Serrano, Elena L.; Hedrick, Valisa E.; da Silva Gomes, Fabio; Polys, Nicholas F.; Kraak, Vivica (MDPI, 2020-01-13)
    In 2010, 193 Member States of the World Health Organization (WHO) endorsed World Health Assembly Resolution WHA63.14 to restrict the marketing of food and beverage products high in fat, sugar and salt (HFSS) to children to prevent obesity and non-communicable diseases (NCDs). No study has examined HFSS marketing policies across the WHO regional office countries in the Americas. Between 2018 and 2019, a transdisciplinary team examined policies to restrict HFSS food and beverage product marketing to children to develop a responsible policy index (RESPI) that provides a quality score based on policy characteristics and marketing techniques. After designing the RESPI, we conducted a comprehensive literature review through October 2019 to examine policies in 14 countries in the WHO Americans Region. We categorized policies (n = 38) as either self-regulatory or statutory and calculated the RESPI scores, ranked from 0 (lowest) to 10 (highest). Results showed Brazil, Canada, Chile, and Uruguay had the highest RESPI scores associated with statutory policies that restricted point of sale, cartoon, licensed media characters and celebrities; and HFSS products in schools and child care settings, and broadcast and print media. Policymakers can use the RESPI tool to evaluate marketing policies within and across geopolitical boundaries to protect children’s diet and health.
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    Dietary biomarkers: advances, limitations and future directions
    Hedrick, Valisa E.; Dietrich, Andrea M.; Estabrooks, Paul A.; Savla, Jyoti S.; Serrano, Elena L.; Davy, Brenda M. (Biomed Central, 2012-12-14)
    The subjective nature of self-reported dietary intake assessment methods presents numerous challenges to obtaining accurate dietary intake and nutritional status. This limitation can be overcome by the use of dietary biomarkers, which are able to objectively assess dietary consumption (or exposure) without the bias of self-reported dietary intake errors. The need for dietary biomarkers was addressed by the Institute of Medicine, who recognized the lack of nutritional biomarkers as a knowledge gap requiring future research. The purpose of this article is to review existing literature on currently available dietary biomarkers, including novel biomarkers of specific foods and dietary components, and assess the validity, reliability and sensitivity of the markers. This review revealed several biomarkers in need of additional validation research; research is also needed to produce sensitive, specific, cost-effective and noninvasive dietary biomarkers. The emerging field of metabolomics may help to advance the development of food/nutrient biomarkers, yet advances in food metabolome databases are needed. The availability of biomarkers that estimate intake of specific foods and dietary components could greatly enhance nutritional research targeting compliance to national recommendations as well as direct associations with disease outcomes. More research is necessary to refine existing biomarkers by accounting for confounding factors, to establish new indicators of specific food intake, and to develop techniques that are cost-effective, noninvasive, rapid and accurate measures of nutritional status.