Browsing by Author "Myers, Emily A."
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- Advancing Food as Medicine in the Retail SettingHollis, Sarah (Virginia Tech, 2024)Over half of the American population, over 117 million individuals, have at least one or more preventable chronic diseases that are related to poor eating and exercise habits. This includes cardiovascular disease, type II diabetes, and poor bone health (Schap, 2016). The expansion of Food as Medicine programming in grocery stores is predicted to impact consumer food choices. Food retailers are trailing nutrition-related programs to understand how they can provide solutions to change eating habits (FMI, 2019) as more consumers shift their dietary habits and mindsets to be more focused on how food choices can affect health status. This project aimed to evaluate whether placing nutrition educational materials in ten Food City pharmacies in southwest Virginia and eastern Tennessee would provide consumer guidance in making food choices in the grocery store, specifically for populations looking to follow a low-carbohydrate diet or a heart-healthy diet. A pilot passive quasi-experimental design was created to determine if there was a product lift of the promoted products on the nutrition educational materials. Stores with both the resource racks and bag stuffers at the counters saw a 13.38% increase in carbohydrate-aware items and 1.04% in heart-healthy items. Stores that had bag stuffers only at the pharmacy counters saw a 10.55% increase in carbohydrate-aware items and a -0.11% decrease in heart-healthy items. Comparison stores saw a 11.19% increase in carbohydrate-aware items and a -0.48% decrease in heart-healthy items. This intervention was successful as it provided real world significance in product lift as well as it provided insight into future program development and modifications for future resources.
- 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 TrialHedrick, 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.
- The Impact of Health Literacy Status on the Comparative Validity and Sensitivity of an Interactive Multimedia Beverage Intake QuestionnaireHooper, Lucy P.; Myers, Emily A.; Zoellner, Jamie M.; Davy, Brenda M.; Hedrick, Valisa E. (MDPI, 2016-12-23)Self-reported dietary assessment methods can be challenging to validate, and reporting errors for those with lower health literacy (HL) may be augmented. Interactive multimedia (IMM) based questionnaires could help overcome these limitations. The objectives of this investigation are to assess the comparative validity and sensitivity to change of an IMM beverage intake questionnaire (IMM-BEVQ) as compared to dietary recalls and determine the impact of HL. Adults completed three 24-h dietary recalls and the IMM-BEVQ at baseline and after a six-month intervention targeting either sugar-sweetened beverages (SSB) or physical activity. Correlations and paired-samples t-tests are presented. For validity (n = 273), intake of SSB (mean difference = 10.6 fl oz) and total beverage consumption (mean difference = 16.0 fl oz) were significantly different (p ≤ 0.001) at baseline between the IMM-BEVQ and dietary recalls for all participants. However, the differences in intake were generally greater in low HL participants than in adequate HL participants. For sensitivity (n = 162), change in SSB intake (mean difference = 7.2 fl oz) was significantly different (p ≤ 0.01) between pre-/post-IMM-BEVQ and pre-/post-dietary recalls, but not total beverage intake (mean difference = 7.6 fl oz) for all participants. Changes in SSB and total beverage intake were not significantly different for those with adequate HL. The IMM-BEVQ is a valid dietary assessment tool that is as responsive to detecting changes in beverage intake as dietary recalls. However, adults with lower HL may need additional guidance when completing the IMM-BEVQ.
- Improving Non-nutritive Sweetener Study Design MethodologyMyers, Emily A. (Virginia Tech, 2018-11-13)Non-nutritive sweeteners (NNS) are frequently used as substitutes for added sugars. NNS are difficult to study due to the inability to accurately measure the amounts individuals consume, as well as limitations in study design and methods, including reliance on observational study designs, the use of diet soda as a proxy of total NNS intake, and the grouping of NNS into a single category rather than studying NNS as individual products. New dietary assessment methods and improved study design and methods are needed to advance researchers' abilities to study NNS and their impact on consumers' health. The objectives of this dissertation were to 1) determine validity and reproducibility of a novel NNS food frequency questionnaire (NNS-FFQ), 2) develop methodology for an objective NNS urinary biomarker, 3) identify an appropriate carrier for NNS intake in studies, and 4) examine the literature on the relationship between NNS and weight-related outcomes based on study design and methods. Objectives 1 and 2: participants (n=125) completed three 24-hr dietary recalls, the NNS-FFQ, and 2 24-hr urine samples. NNS intake via NNS-FFQ and recalls were compared using Bland-Altman analyses, with agreement levels ranging from 92.7-99.2% for individual NNS types and total intake. The NNS biomarker methodology was developed using ultra performance liquid chromatography (UPLC-MS/MS), which analyzes each sample for the presence of NNS and related metabolites. This method observed a range from very strong presence of NNS to not detectable, indicating that this biomarker could identify specific NNS consumption (n=9). Objective 3: a sensory evaluation (n=67) was conducted to identify if applesauce or water was a more appropriate carrier for NNS for future interventions. Applesauce was preferred (sucralose=83.6%; aspartame=79.1%; stevia=74.6%) significantly more than water (p≤0.001), indicating that applesauce could be used as an acceptable carrier of NNS in research studies. Objective 4: a systematic literature review focusing on study design and methods used in investigations on NNS and weight-related outcomes found that 81% of RCT had improved weight outcomes, while 76% of observational studies had higher weight outcomes. Improving NNS study design and methods will increase the quality of research conducted on NNS and related health outcomes.
- The Reproducibility and Comparative Validity of a Non-Nutritive Sweetener Food Frequency QuestionnaireMyers, Emily A.; Passaro, Erin M.; Hedrick, Valisa E. (MDPI, 2018-03-10)In order to better assess non-nutritive sweetener (NNS) consumption, measurement tools with greater utility are needed. The objective of this investigation is to determine the reproducibility and validity of a newly developed NNS food frequency questionnaire (NNS-FFQ) that measures five types of NNS (saccharin, aspartame, acesulfame potassium, sucralose and erythritol). Adult participants (n = 123, 56% female, 75% Caucasian, mean age = 36.8 ± 16.6) completed the NNS-FFQ twice and had 24-h dietary recalls three times over a two-week study period. Reproducibility between two administrations of the NNS-FFQ was assessed via Bland–Altman plots, Spearman’s correlations (rs) and paired samples t-tests. Bland–Altman plots, Cohen’s κ, Spearman’s correlations (rs), and paired samples t-tests compared NNS intake between the two methods for validity. For reproducibility analyses, Bland–Altman analyses revealed agreement levels above the 95% acceptance level for total NNS (99.2%), erythritol (99.2%), and aspartame (96.7%). Agreement levels for acesulfame potassium (94.3%), saccharin (94.3%), and sucralose (94.3%) were slightly below the acceptable level. For validity analyses, Bland–Altman analyses revealed agreement levels above the 95% acceptance level for total NNS (95.1%), sucralose (95.9%), saccharin (95.9%), and erythritol (95.1%). Agreement levels for aspartame (94.3%) and acesulfame potassium (92.7%) were slightly below the acceptable level. Although less than desirable agreement was found between the methods for aspartame and acesulfame potassium, some variance was expected due to the habitual nature of the NNS-FFQ as compared to the recent intake reported by recalls. Within the context of this constraint, the NNS-FFQ demonstrates acceptable reproducibility and validity. The NNS-FFQ is a brief questionnaire that could be administered among diverse participants at the individual and population levels to measure habitual NNS intake.
- Validation of a Rapid Method to Assess Habitual Beverage Intake PatternsHedrick, Valisa E.; Myers, Emily A.; Zoellner, Jamie M.; Duffey, Kiyah J.; Davy, Brenda M. (MDPI, 2018-01-13)The Healthy Beverage Index (HBI) is an emerging approach to assess beverage pattern quality. HBI total scores range from 0 to 100, with higher scores indicating greater adherence to proposed beverage recommendations. However, assessing patterns is resource-intensive due to the need for extensive dietary data, typically 24-h dietary records or recalls. The BEVQ-15, a beverage intake questionnaire, may be used as an alternative method to rapidly measure HBI scores. The objective of this cross-sectional investigation is to assess the comparative validity of the HBI-Q, a method to rapidly assess HBI scores via the BEVQ-15, as compared to the traditional method of deriving HBI scores via dietary recalls/records. Between 2012 and 2016, a cross-sectional sample of adults in southwest Virginia completed three 24-h dietary recalls (30–60 min administration and analysis time per recall) and the BEVQ-15 (3–4 min administration time). HBI scores were generated by both methods, and compared via paired-samples t-tests, correlations, and Bland–Altman analysis. Among 404 adults (mean age = 40 years), total mean HBI scores were 63.7 from the HBI-Q and 67.3 from the recalls (mean difference = 3.6 out of 100; r = 0.63; both p ≤ 0.001). Agreement between the two methods for total HBI scores via Bland–Altman plots was 92%. Using the HBI-Q to rapidly assess HBI scores in adults will increase the utility of the HBI by decreasing the time and resources required, thus allowing researchers and practitioners to provide targeted feedback for improvement.