VTechWorks Repository :: Browsing by Author "Hill, Jennie L."

Browsing by Author "Hill, Jennie L."

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Assessing Children\'s Restaurant Menus in a Health Disparate Region
Olive, Nicole Christine (Virginia Tech, 2013-06-05)
Obesity is an increasing problem in the United States with 17% of youth currently classified as obese and an even higher prevalence of obesity among disadvantaged populations. The food environment may be contributing to these high rates as there has been a well documented association among increased away from home food consumption and excess adiposity, as well as evidence to support that children\'s diets are composed of a large portion of restaurant foods. The main purpose of this study is to describe the quality of restaurant food offered to children in a rural health disparate region. Two trained research assistants conducted systematic audits of all food outlets offering a children\'s menu in the Dan River region using the Children\'s Menu Assessment (CMA) tool. A composite score for each outlet for was calculated from the 29 scored items on the CMA. The total sample consisted of 137 outlets with CMA scores ranging from -4 to 9 with a mean score of 1.6+2.7. Scores were lowest in the predominantly Black block groups (0.2+0.4) when compared to the predominately White block groups (1.4+1.6) and Mixed block groups (2.6+2.4) with significantly lower scores in the predominantly Black block group than the Mixed block groups (F=4.3; p<0.05). The results of this study reveal a lack of few healthy food options available for children in this region. These findings have the potential to contribute to public health efforts in developing public policy changes or environmental interventions for the children\'s food environment in the Dan River Region.
Assessing the Internal and External Validity of Mobile Health Physical Activity Promotion Interventions: A Systematic Literature Review Using the RE-AIM Framework
Blackman, Kacie C. A.; Zoellner, Jamie M.; Berrey, Leanna M.; Alexander, Ramine C.; Fanning, Jason; Hill, Jennie L.; Estabrooks, Paul A. (JMIR Publications, 2013)
Background: Mobile health (mHealth) interventions are effective in promoting physical activity (PA); however, the degree to which external validity indicators are reported is unclear. Objective: The purpose of this systematic review was to use the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to determine the extent to which mHealth intervention research for promoting PA reports on factors that inform generalizability across settings and populations and to provide recommendations for investigators planning to conduct this type of research. Methods: Twenty articles reflecting 15 trials published between 2000 and 2012 were identified through a systematic review process (ie, queries of three online databases and reference lists of eligible articles) and met inclusion criteria (ie, implementation of mobile technologies, target physical activity, and provide original data). Two researchers coded each article using a validated RE-AIM data extraction tool (reach, efficacy/effectiveness, adoption, implementation, maintenance). Two members of the study team independently abstracted information from each article (inter-rater reliability >90%) and group meetings were used to gain consensus on discrepancies. Results: The majority of studies were randomized controlled trials (n=14). The average reporting across RE-AIM indicators varied by dimension (reach=53.3%, 2.67/5; effectiveness/efficacy=60.0%, 2.4/4; adoption=11.1%, 0.7/6; implementation=24.4%, 0.7/3; maintenance=0%, 0/3). While most studies described changes in the primary outcome (effectiveness), few addressed the representativeness of participants (reach) or settings (adoption) and few reported on issues related to maintenance and degree of implementation fidelity. Conclusions: This review suggests that more focus is needed on research designs that highlight and report on both internal and external validity indicators. Specific recommendations are provided to encourage future mHealth interventionists and investigators to report on representativeness, settings, delivery agents for planned interventions, the extent to which protocol is delivered as intended, and maintenance of effects at the individual or organizational level.
Creating Healthy Schools: An Analysis of the Federal School Wellness Mandate
Smith, Erin M. (Virginia Tech, 2013-04-11)
Childhood obesity has become a growing problem in America; rates have tripled over the past 30 years, and more than 17 percent of America's children are classified as overweight or obese. To combat the rise in childhood obesity, the federal government mandated in 2004 that all public school districts adopt a local school wellness policy that incorporates goals to improve the wellness environments of these public schools. Previous research has indicated that the success of these policies is mixed; however, there has been no comprehensive research evaluating the quality of school wellness policies in Virginia, Maryland and the District of Columbia. The purpose of this research is to evaluate local wellness policies within the Mid-Atlantic region. These evaluations include a preliminary wellness policy evaluation based on locale (rural and urban school districts), an evaluation of the strength and comprehensiveness of template-based policies versus locally developed policies, and a comprehensive evaluation of physical activity policies within Virginia, Maryland and DC. The last study included is an evaluation of the association between physical activity policy quality and physical activity rates within selected middle schools. The results of this research show that wellness policy quality across the Mid-Atlantic region is weak and moderately comprehensive, and that the adoption process may impact the quality of a local policy. Furthermore, physical activity policy within the region is also weak and moderately comprehensive, and the results show that school districts that have adopted stronger and more comprehensive polices may be associated with higher local physical activity rates.
Developing and Testing Smartphone Game Applications for Physical Activity Promotion in Adolescents
Allen, Kacie C. (Virginia Tech, 2013-05-14)
Though the benefits of physical activity are numerous and well-known, very few adolescents are meeting physical activity recommendations. Moreover, past research shows that physical activity declines with increasing age with this decline beginning in adolescence. One approach to promote physical activity is through mobile technology such as a mobile phone. Since mobile phone ownership is relatively high (77%) and there is no digital divide by race/ethnicity or socioeconomic status, mobile phones may be suitable for physical activity promotion. Few studies have promoted PA using a mobile phone and those studies showed increased physical activity outcomes. However, more research is needed to explore the effectiveness of mobile phone physical activity promotion especially in more health disparate populations. The purpose of this research was to develop and test smartphone game application for physical activity promotion in adolescents. The first study included various user-centered approaches (e.g. qualitative data, idea sessions) to get feedback on what was desired from the adolescents in terms of game development and design. The second study examined the degree to which mobile health studies reported on internal and external validity indicators. The last study evaluated the smartphone game applications through a mixed-methods approach. The results of this research showed that physical activity while playing smartphone game applications can yield moderate physical activity intensity. Moreover, adolescents had moderate perceptions of the games and recommended specific changes to the games. Likewise, the data suggest that smartphone physical activity game applications can be enjoyable if they are aesthetically appealing, easy to use, and foster social peer interactions. Overall, this research demonstrated that smartphone games that were developed and designed based on adolescents\' preferences and persuasive technology design principles could increase physical activity in adolescents and provides a tool for further exploration.
Development and Advancement of the Dan River Partnership for a Healthy Community (DRPHC)
Zoellner, Jamie M.; Hill, Jennie L.; Price, Bryan; Motley, Monica; Corsi, Terri; Jones, Lillie Mai (Dan River Partnership for a Healthy Community, 2013-08)
The DRPHC is an academic-community partnership who meets collectively to address obesity in the Dan River Region.
Disparities in obesity among rural and urban residents in a health disparate region
Hill, Jennie L.; You, Wen; Zoellner, Jamie M. (2014-10-08)
Background The burden of obesity and obesity-related conditions is not borne equally and disparities in prevalence are well documented for low-income, minority and rural adults in the United States. The current literature on rural versus urban disparities is largely derived from national surveillance data which may not reflect regional nuances. There is little practical research that supports the reality of local service providers such as county health departments that may serve both urban and rural residents in a given area. Conducted through a community-academic partnership, the primary aim of this study is to quantify the current levels of obesity (BMI), fruit and vegetable (FV) intake and physical activity (PA) in a predominately rural health disparate region. Secondary aims are to determine if a gradient exists within the region in which rural residents have poorer outcomes on these indicators compared to urban residents. Methods Conducted as part of a larger ongoing community-based participatory research (CBPR) initiative, data were gathered through a random digit dial telephone survey using previously validated measures (n = 784). Linear, logistic and quantile regression models are used to determine if residency (i.e. rural, urban) predicts outcomes of FV intake, PA and BMI. Results The majority (72%) of respondents were overweight (BMI = 29 ± 6-kg/m2), with 29% being obese. Only 9% of residents met recommendations for FV intake and 38% met recommendations for PA. Statistically significant gradients between urban and rural and race exist at the upper end of the BMI distribution. In other words, the severity of obesity is worse among black compared to white and for urban residents compared to rural residents. Conclusions These results will be used by the community-academic partnership to guide the development of culturally relevant and sustainable interventions to increase PA, increase FV intake and reduce obesity within this health disparate region. In particular, local stakeholders may wish to address disparities in BMI by allocating resources to the vulnerable groups identified.
Does Adoption of the Healthy Eating Standards Impact Snack Quality in Local After-School Programs?
Esmond, Abigail Christine (Virginia Tech, 2016-01-19)
Background: Childhood obesity is a pressing public health concern; the prevalence of childhood obesity is 15.5% in Virginia. About 15% of Virginia's K-12 population participates in after-school programs (ASPs), identified as appropriate venues in which to promote healthy eating. In 2011, the National Afterschool Association (NAA) adopted the evidence-based Healthy Eating and Physical Activity Quality Standards (HEPAQS) to address snack quality and physical activity in ASPs. Although research has indicated promise in implementation of such policies in after-school programs, a need for assessment of effectiveness still exists. Are the quality standards being implemented effective in increasing positive nutritional habits among children in ASPs? In 2014, Danville Parks and Recreation (PandR), a key partner in the Dan River Partnership for a Healthy Community (DRPHC), adopted the HEPAQS policies to improve the nutrition and physical activity of attending students. Objective: The primary purpose of this study was to determine the effectiveness of the adopted HEPAQS Healthy Eating standards by comparing the quality of snacks served at the ASP sites before and after the HEPAQS policies were implemented. A secondary purpose of this study was to describe the quality of snacks among both policy-adoption and comparison sites. The tertiary purpose of this study was to compare the quality of program versus non-program snacks in the ASPs. Methods: To meet the objective, a natural experiment followed a pre-post evaluation design to determine the impact of adoption of the Healthy Eating standards at three policy-adoption ASPs. Applying an interrupted time series design, a total of 531 children's snack observations were performed across all sites during a five-week pre-policy adoption data collection period and 412 total snack observations were performed during a six-week post-policy data collection period. Direct observation methods including a modified quarter-waste method for dietary observations and the HAAND tool were conducted by trained research staff to collect snack quantity, type, brand, and amount consumed. Observational data was entered into statistical software for hypothesis testing. Data were also analyzed using Nutrition Data System for Research (NDSR) software to determine the mean servings, fluid ounces, or grams of each nutrient specified in the adopted Healthy Eating standards. Results: Adoption of the Healthy Eating standards among the three policy-adoption sites did not result in better snack quality based on adherence to the Healthy Eating standards. Policy-adoption sites were only meeting four of the nine adopted Healthy Eating standards post-policy, almost all of which were also being met pre-policy: serving foods without trans-fats, serving no sugar-sweetened beverages (SSBs), limiting fruit juice to one 8 oz. serving, and avoiding artificially sweetened beverages. By post-policy data collection, policy-adoption sites were not meeting five of the nine adopted standards: weekly serving a fruit or vegetable, offering water at all times, serving no candy or sugar-based snacks, emphasizing whole grains, and serving no snack chips. Although no significant changes were expected among comparison sites, they saw a significant increase in 100% fruit juice consumption and a decrease in grams of trans-fat from pre- to post-policy data collection. Across all five sites, program snacks were generally healthier than non-program snacks, as program snacks contained less SSBs, sweets, and snack chips. Conclusion: Adoption of the Healthy Eating standards among the three policy-adoption sites did not result in better snack quality. Pursuing additional HEPAQS regarding implementation, staff training, and social and program support may be necessary to impact snack quality. ASPs may improve non-program snack quality by addressing HEPAQS for vending machines and guidelines provided to parents regarding non-program snacks. The PandR partners of the Dan River Partnership for a Healthy Community should continue to seek support as they implement the Healthy Eating standards in their ASPs.
Does availability of physical activity and food outlets differ by race and income? Findings from an enumeration study in a health disparate region
Hill, Jennie L.; Chau, Clarice; Luebbering, Candice R.; Kolivras, Korine N.; Zoellner, Jamie M. (2012-09-06)
Background Low-income, ethnic/racial minorities and rural populations are at increased risk for obesity and related chronic health conditions when compared to white, urban and higher-socio-economic status (SES) peers. Recent systematic reviews highlight the influence of the built environment on obesity, yet very few of these studies consider rural areas or populations. Utilizing a CBPR process, this study advances community-driven causal models to address obesity by exploring the difference in resources for physical activity and food outlets by block group race and income in a small regional city that anchors a rural health disparate region. To guide this inquiry we hypothesized that lower income and racially diverse block groups would have fewer food outlets, including fewer grocery stores and fewer physical activity outlets. We further hypothesized that walkability, as defined by a computed walkability index, would be lower in the lower income block groups. Methods Using census data and GIS, base maps of the region were created and block groups categorized by income and race. All food outlets and physical activity resources were enumerated and geocoded and a walkability index computed. Analyses included one-way MANOVA and spatial autocorrelation. Results In total, 49 stores, 160 restaurants and 79 physical activity outlets were enumerated. There were no differences in the number of outlets by block group income or race. Further, spatial analyses suggest that the distribution of outlets is dispersed across all block groups. Conclusions Under the larger CPBR process, this enumeration study advances the causal models set forth by the community members to address obesity by providing an overview of the food and physical activity environment in this region. This data reflects the food and physical activity resources available to residents in the region and will aid many of the community-academic partners as they pursue intervention strategies targeting obesity.
Effectiveness of a Worksite-Based Weight Loss Randomized Controlled Trial: The Worksite Study
Almeida, Fabio A.; You, Wen; Harden, Samantha M.; Blackman, Kacie C. A.; Davy, Brenda M.; Glasgow, Russell E.; Hill, Jennie L.; Linnan, Laura A.; Wall, Sarah S.; Yenerall, Jackie; Zoellner, Jamie M.; Estabrooks, Paul A. (Wiley-Blackwell, 2015-04-01)
Environmental perceptions and objective walking trail audits inform a community-based participatory research walking intervention
Zoellner, Jamie M.; Hill, Jennie L.; Zynda, Karen; Sample, Alicia D.; Yadrick, Kathleen (2012-01-30)
Background Given the documented physical activity disparities that exist among low-income minority communities and the increased focused on socio-ecological approaches to address physical inactivity, efforts aimed at understanding the built environment to support physical activity are needed. This community-based participatory research (CBPR) project investigates walking trails perceptions in a high minority southern community and objectively examines walking trails. The primary aim is to explore if perceived and objective audit variables predict meeting recommendations for walking and physical activity, MET/minutes/week of physical activity, and frequency of trail use. Methods A proportional sampling plan was used to survey community residents in this cross-sectional study. Previously validated instruments were pilot tested and appropriately adapted and included the short version of the validated International Physical Activity Questionnaire, trail use, and perceptions of walking trails. Walking trails were assessed using the valid and reliable Path Environmental Audit Tool which assesses four content areas including: design features, amenities, maintenance, and pedestrian safety from traffic. Analyses included Chi-square, one-way ANOVA's, multiple linear regression, and multiple logistic models. Results Numerous (n = 21) high quality walking trails were available. Across trails, there were very few indicators of incivilities and safety features rated relatively high. Among the 372 respondents, trail use significantly predicted meeting recommendations for walking and physical activity, and MET/minutes/week. While controlling for other variables, significant predictors of trail use included proximity to trails, as well as perceptions of walking trail safety, trail amenities, and neighborhood pedestrian safety. Furthermore, while controlling for education, gender, and income; for every one time per week increase in using walking trails, the odds for meeting walking recommendations increased 1.27 times, and the odds for meeting PA recommendation increased 3.54 times. Perceived and objective audit variables did not predict meeting physical activity recommendations. Conclusions To improve physical activity levels, intervention efforts are needed to maximize the use of existing trails, as well as improve residents' perceptions related to incivilities, safety, conditions of trail, and amenities of the walking trails. This study provides important insights for informing development of the CBPR walking intervention and informing local recreational and environmental policies in this southern community.
Evaluating the Potential Public Health Impact of Community Gardens in a Health Disparate Region: A case study approach
Zanko, Ashley Lee (Virginia Tech, 2012-03-29)
While community gardens (CG) have emerged as a popular public health strategy to improve fruit and vegetable access and consumption, few studies provide evidence-based principles to inform the initiation and maintenance of CG. Grounded in Community-based Participatory Research and guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, this mixed methods case study explores the potential public health impact of CG in the DRR. Six CG completed harvest logs during the 2011 season. Following the growing season, CG leader key informant interviews (N=6) and CG participant focus groups were conducted (N=21) using a semi-structured script, guided by RE-AIM dimensions. The five RE-AIM dimensions and associated components were used to develop a coding matrix and identify emerging themes. Three researchers coded the transcribed interviews using a deductive approach, which included coding raw data into meaning units. The six CG yielded 811 pounds of produce. The majority of focus group participants (95%) stated they would continue CG participation. From qualitative analysis, themes emerged such as increased the number of residents participating in CG, increased consumption of produce, key characteristics of successful CG leaders and locations, programs associated with CG, and adequate funding and resources necessary for maintenance. This study provides important insights to promote the potential public health impacts of CG in the DRR. Findings provide best-practice opportunities to promote the successful adoption, implementation, and maintenance of CG in similar communities.
Examining Access to Recreational Facilities in Danville, Virginia
Sams, Lauren Kimbrell (Virginia Tech, 2012-04-26)
Obesity is a growing issue in the United States, and it affects millions of people. Obesity-related illness accounts for billions of dollars in medical expenses each year, heightening the need for prevention and intervention strategies. Physical activity is essential in maintaining a healthy weight, yet population groups have unequal access to physical activity opportunities. This research utilizes an environmental justice framework to examine variations in access and quality of recreational facilities among different socio-demographic groups in Danville, VA. Data for this research include secondary and primary sources. Race data were obtained from the 2010 U.S. Census. The Physical Activity Resource Assessment (PARA) tool was utilized to audit all recreational facilities within the City of Danville for features, amenities, and incivilities. Telephone survey data provided individual level-BMI, physical activity minutes per week, and variables of socioeconomic status, including income, education attainment, employment status, and gender. Analysis included ANOVAs, linear, and bivariate logistic regression. Predominant block group race was a significant predictor of incivilities at physical activity outlets. Proximity to recreational facilities was not a predictor of physical activity or BMI. Interventions must be made to improve the quality of recreational facilities in black or African American block groups.
Exploring Community Gardens in a Health Disparate Population: Findings from a Mixed Methods Pilot Study
Zanko, Ashley; Price, Bryan; Bonner, Jennifer; Hill, Jennie L.; Zoellner, Jamie M. (Johns Hopkins Univ Press, 2012)
Background: Despite recommendations, there have been few efforts to apply the community-based participatory research (CBPR) approach in the development, implementation, and evaluation of community gardens. Objectives: As guided by the CBPR approach and grounded in a social-ecological model and behavioral theory, the purpose of this mixed methods study was to understand opinions and interests in developing and implementing a community garden and to understand factors impacting fruit, vegetable, and gardening behaviors. Methods: Community and academic members collaborated to develop and execute this study. The qualitative phase- targeting regional key informants-was designed to elicit perceived benefits and challenges of community gardens at the environmental, community, and individual levels. The quantitative phase targeted low resourced youth and parents and included a variety of validated theory-based questionnaires to understand factors impacting fruit, vegetable, and gardening behaviors. Results: Major benefits of community gardens that emerged from the 10 qualitative interviews included increasing community cohesion and improving nutrition and physical activity factors. The quantitative phase included 87 youth and 67 parents. Across 16 items for fruits and vegetables, the average willingness to try was 1.32 (standard deviation [SD] = 0.40) on a 2-point scale. The majority of youth indicated they would work in a garden (n = 59; 68%) and eat food grown in their garden (n = 71; 82%). Among parents, gardening attitude, belief, and self-efficacy scores were all above average; however, gardening intentions were neutral. Conclusion: This research illustrates the successful partnering a community-academic team and has provided the partnership with a clearer lens to conceptualize and launch future regional community garden efforts.
Exploring health disparities in rural regions of Virginia: The impact of health literacy and social capital
Bailey, Angela (Virginia Tech, 2016-01-14)
In the United States, low-income, ethnic/racial minorities and rural populations are at increased risk for poorer health outcomes compared to higher income, non-minorities, and urban populations. Two key determinants that influence rural health disparities are health literacy and social capital. Health literacy can be described as an individual-level factor and defined as, "the degree to which individuals have the capacity to obtain, process, and understand the basic health information and services needed to make appropriate health decisions." Social capital is a concept that accounts for the role of collective social functioning and has been defined as, "the features of social structures, such as levels of interpersonal trust and norms of reciprocity and mutual aid" which act as resources for individuals to facilitate collective action." The overarching goal of this research is to explore factors influencing health disparities, including health literacy, social capital in two rural regions of Virginia. The first study is embedded in Talking Health, a larger 2-arm RCT targeting adults in rural Southwest Virginia and examined participants' perceptions of and satisfaction with components of a behavioral intervention designed using health literacy concepts to decrease sugary beverage intake in rural, low-health literacy participants. The second study is also embedded in the Talking Health trial, yet focused on the maintenance of behavior 12-months after the intervention concluded. Guided by RE-AIM, this study examined the reach, effectiveness and implementation of a 12-month randomized extended care intervention aimed at enhancing long-term maintenance of behavior change and study retention when compared to a control condition. The last study is part of a larger telephone surveillance survey conducted in the Dan River Region located in south central Virginia. This study described current levels of social capital in the Dan River Region and examined the influence of social capital on FV consumption, physical activity, sugary beverage intake and BMI on a sample of rural and urban adults.
Exploring the Food and Physical Activity Environments and Their Influence on Healthy Behaviors
Waters, Clarice Nhat-Hien (Virginia Tech, 2013-11-19)
Using a community-based participatory research (CBPR) approach, community members, community stakeholders, and academic researchers from Virginia Tech formed a community-academic partnership in 2009. In the formative months, the coalition decided to focus on reducing obesity in the region. The coalition adopted the name of The Dan River Partnership for a Healthy Community (DRPHC) with a mission to "foster community partnerships to combat obesity in the Dan River Region through healthy lifestyle initiative". During a planning workshop, the DRPHC created six causal models for the root causes of obesity in the region. Two causal models that focused on geographic and environmental influences for obesity are the foundation for this series of research. The focus of this dissertation is at the intersection of the food and physical activity environments and their characteristics that contribute to meeting fruit and vegetable intake and minutes of physical activity recommendations. The food environment is one aspect of built environment research that examines food locations for procurement and the variety, availability, and quality of different food options. To date, the vast majority of research on the food environment is based in urban, suburban, and metropolitan areas with high residential densities and populations. Rural areas are often understudied because of their dispersed and hard-to-reach populations; yet these individuals experience some of the worst health outcomes in the nation. This is due, in part, to the large overlaps of rural regions and food deserts, resulting in poor food choices and poor diets. The overall objective of this dissertation is to examine the associations of the food and physical activity environments with individual healthy behaviors. Three studies were conducted within the broader research plan to meet the overall objective. The first study systematically examined the food environment using the Nutrition Environment Measures Survey (NEMS) for all food outlets in Danville, VA, a small regional city within the health disparate region, to compare differences in healthy available food options by block group race and income. The second study expanded NEMS methodology to encompass all food outlets in the three-county Dan River region to examine if food environment and availability of healthy options was predictive of meeting fruit and vegetable intake recommendations. The last study examined the objective and perceived distance individuals must travel to reach a physical activity outlet and whether or not distance was a predictive factor of individual weekly minutes of moderate to vigorous physical activity and meeting physical activity recommendations.
Feasibility of an Experiential Community Garden and Nutrition Program for Youth Living in Public Housing:Exploring Outcomes from Youth, Parents and Site Leaders
Grier, Karissa Niphore (Virginia Tech, 2014-06-11)
Background: Community gardens have existed in America since the late 1800s and have served multiple purposes from food subsidies to neighborhood beautification. The use of community gardens has grown in popularity and has been recommended as a way to encourage healthy eating habits in youth. Though the health benefits of having a diet high in fruits and vegetables is well known, youth in the United States do not meet recommendations for fruit and vegetable intake. Under-consumption of fruits and vegetables is problematic in youth, as eating habits are established in childhood. Community gardens have been successfully used to improve access, self-efficacy, preference, and consumption of fruits and vegetables. However, few published community garden studies have focused on low socioeconomic youth. The Dan River Partnership for a Healthy Community (DRPHC) was developed according to community-based participatory research (CBPR) principles. With a mission to reduce obesity using healthy lifestyle initiatives, community gardens are an evolving DRPHC initiative. Objective: To evaluate the feasibility (i.e., demand, acceptability, implementation, and limited-effectiveness testing) of a 10-week experiential theory-based gardening and nutrition education program targeting youth living in two public housing sites in the Dan River Region. Methods: Using pre- and post-program questionnaires/interviews, demand and acceptability were measured among youth, parents and site leaders. Implementation was measures via field notes and attendance. Limited-effectiveness was measured among youth using a pre-post design. Three researchers independently coded the qualitative transcripts, met to resolve disagreements, and built consensus through discussion of the codes. Similarly, field notes were reviewed and evaluated for reoccurring themes regarding barriers, facilitators, and other observations. For the quantitative measures, descriptive statistics were used to summarize the variables and Cronbach's alphas used to assess the reliability of each scale at baseline. Overall effects were tested with repeated measures ANOVA. An intent-to-treat analysis using the last observation carried forward method was used. A critical value of .05 was used for significance testing. A standard equation for reporting effect sizes on a single-group, pre-post study design is also reported. Results: Program enrollment included 43 youth, primarily African American. The positive demand and acceptability findings indicate the potential of the program to be used and suitable for the youth, parents, and site leaders. Field notes revealed numerous implementation facilitators and barriers. Youth weekly attendance averaged 4.6 of 10 sessions. Significant improvements (p<0.05) were found for some (e.g., FV asking self-efficacy, overall gardening knowledge, knowledge of MyPlate recommendations), but not all limited-effectiveness measures (e.g., willingness to try FV, FV eating self-efficacy). Study Implications: This study addresses recommendations for utilizing CBPR in community garden efforts and builds on community identified research priorities of the DRPHC. Results demonstrate the feasibility of a gardening and nutrition program targeting youth in public housing. Lessons learned are being used to adapt and strengthen the program for future efforts targeting FV behaviors. Findings will be shared with local community stakeholders and used to adapt and strengthen the program for future efforts in the Dan River Region targeting of fruit and vegetable behaviors.
Feasibility, effectiveness, and perceptions of an Internet- and incentive-based behavioral weight loss intervention for overweight and obese college freshmen: A mixed methods approach
Davy, Brenda M.; Potter, Kerry L.; Dennis, Elizabeth A.; Harden, Samantha M.; Hill, Jennie L.; Halliday, Tanya M.; Estabrooks, Paul A. (2013)
Challenges inherent with the transition to col- lege are often accompanied by weight gain among college freshmen. Weight gain and dura- tion of obesity increase metabolic syndrome and cardiovascular disease risk in young adulthood, which supports the need for weight loss inter- ventions tailored to college students. The pur- pose of this investigation was to conduct a mixed methods pilot trial to determine the effi- cacy and acceptability of a semester long Inter- net- and incentive-based weight loss interven- tion for overweight/obese college freshmen. Par- ticipants (n = 27, aged >18 yrs, BMI >25) were randomly assigned to a 12-week social cognitive theory (SCT)-based intervention (Fit Freshmen [FF]) or a health information control group. The FF intervention also included modest financial incentives for weight loss. Primary outcomes included body weight/composition, dietary and physical activity (PA) behaviors, and psychoso- cial measures (i.e. self-efficacy, self-regulation) associated with diet, PA, and weight loss. Stu- dents in the FF intervention participated in focus groups to provide qualitative feedback on pro- gram structure and design. FF participants demonstrated significant reductions (all group differences p < 0.10) in body weight (−1.2 kg), fat mass (−0.6 kg), dietary energy (−673 kcal/d), fat (−37 g/d) and added sugar intake (−41 g/d), and increases in diet and PA-related self-regulatory skills at week 12 compared to control partici- pants (+1.0 kg, +1.1 kg, −334 kcal/d, −15 g/d, −13 g/d, respectively). No changes in PA were noted, but FF participants demonstrated increases in self-efficacy to overcome barriers to PA relative to control participants. Themes for content im- provement from focus groups included reducing email contact and increasing in-person interac- tions. Program characteristics that were posi- tively evaluated included incentives for weight loss and access to an onsite weigh station kiosk. Overall, this efficacious SCT Internet- and incen- tive-based weight loss intervention was well received and can be adapted for larger-scale use in the college population.
Fidelity to and comparative results across behavioral interventions evaluated through the RE-AIM framework: a systematic review
Harden, Samantha M.; Gaglio, Bridget; Shoup, Jo A.; Kinney, Kimberlee A.; Johnson, Sallie B.; Brito, Fabiana A.; Blackman, Kacie C. A.; Zoellner, Jamie M.; Hill, Jennie L.; Almeida, Fabio A.; Glasgow, Russell E.; Estabrooks, Paul A. (2015-11-08)
Background The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework was developed to determine potential public health impact of interventions (i.e., programs, policy, and practice). The purpose of this systematic review was to determine (1) comparative results across accurately reported RE-AIM indicators, (2) relevant information when there remains under-reporting or misclassification of data across each dimension, (3) the degree to which authors intervened to improve outcomes related to each dimension, and (4) the number of articles reporting RE-AIM dimensions for a given study. Methods In April 2013, a systematic search of the RE-AIM framework was completed in PubMed, PSYCHInfo, EbscoHost, Web of Science, and Scopus. Evidence was analyzed until January 2015. Results Eighty-two interventions that included empirical data related to at least one of the RE-AIM dimensions were included in the review. Across these interventions, they reached a median sample size of 320 participants (M = 4894 ± 28,256). Summarizing the effectiveness indicators, we found that: the average participation rate was 45 % (±28 %), 89 % of the interventions reported positive changes in the primary outcome and 11 interventions reported broader outcomes (e.g., quality of life). As for individual-level maintenance, 11 % of studies showed effects ≥6 months post-program. Average setting and staff adoption rates were 75 % (±32 %) and 79 % (±28 %), respectively. Interventions reported being delivered as intended (82 % (±16 %)) and 22 % intervention reported adaptations to delivery. There were insufficient data to determine average maintenance at the organizational level. Data on costs associated with each dimension were infrequent and disparate: four studies reported costs of recruitment, two reported intervention costs per participant, and two reported adoption costs. Conclusions The RE-AIM framework has been employed in a variety of populations and settings for the planning, delivery, and evaluation of behavioral interventions. This review highlights inconsistencies in the degree to which authors reported each dimension in its entirety as well as inaccuracies in reporting indicators within each dimension. Further, there are few interventions that aim to improve outcomes related to reach, adoption, implementation, and maintenance.
Fit Freshmen: A mixed methods approach to developing weight control strategies for 1st year college students
Potter, Kerry L. (Virginia Tech, 2010-04-15)
College-age adults gain weight more rapidly than the general population, with a mean weight gain of ~1.8 to 4 kilograms during their first year at college. The purpose of this pilot RCT was to test the efficacy of a semester long internet weight-loss program based upon social cognitive theory for overweight college freshmen. Qualitative focus groups were used to provide feedback on content of the active intervention. Participants (n=27; mage=18.5±.6; mweight=90kg±18; 74% female) were randomly assigned to the active intervention (Fit Freshmen; FF) or a health information control group and completed baseline and 3 month follow-up measurements. When compared to controls FF participants experienced higher improvement in self-regulatory skills for portion control, fruit and vegetable consumption and physical activity (all p's<.05). Consumption of dietary fat and added sugar also decreased significantly for FF subjects when compared to controls (all p's<.05) while total energy intake differences were significant (p<.09). Trends in increased physical activity were present, but not significantly different between groups. Finally, FF lost significantly more weight than controls (mdifference=2.2kg; p<0.05) and more fat mass (mdifference=1kg; p<0.09). Themes for content improvement included providing a more detailed meal plan, reducing email contact, and increasing social activity opportunities. Program characteristics that were positively evaluated included the flexible exercise program, incentives for weight loss, and use of an onsite weigh station. This study provides promising outcomes for a scalable internet-based weight loss program for college freshmen and highlights features that could be improved to be more attractive to this population.
From Bright Bodies to iChoose: Using a CBPR Approach to Develop Childhood Obesity Intervention Materials for Rural Virginia
Brito, Fabiana A.; Zoellner, Jamie M.; Hill, Jennie L.; You, Wen; Alexander, Ramine C.; Hou, Xiaolu; Estabrooks, Paul A. (2019-03-21)
This community-based participatory research (CBPR) project used a collaborative process to develop a culturally relevant workbook for parents of overweight children. We followed a mixed methods iterative process to assess clear communication using a CBPR approach. Materials were evaluated using readability tests, the Clear Communication Index (CCI), and the Suitability Assessment of Materials (SAM). In addition, we used surveys and focus groups to investigate parents' perceptions and gather feedback from delivery staff using the workbook. While workbook materials maintained adequate grade reading levels, our iterative process and the use of CCI and SAM led to significant improvements in (a) clearly communicating the objectives of the program, (b) being culturally relevant, and (c) reaching a high satisfaction among users. These findings suggest that evaluative measures for written materials should move beyond readability and need to account for level of clarity and cultural appropriateness of messages. Furthermore, we found that that an iterative process to intervention's material development using clear communication strategies while involving community members, parents, and research partners can lead to workbook materials that are culturally relevant to the target audience, and better communicate program objectives. Finally, this is a potentially generalizable process for improving clear communication of written health information materials.

Browsing by Author "Hill, Jennie L."

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