VTechWorks Repository :: Browsing by Author "Serrano, Elena L."

Browsing by Author "Serrano, Elena L."

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Adopting Plant-rich Dietary Patterns and Reducing Red and Processed Meat Intake: Examining How Diverse U.S. Food and Health Systems Actors May Support Sustainable Diet Transitions for American Adults
Stanley, Katherine Ellen (Virginia Tech, 2024-12-19)
Expert bodies recommend that populations adopt plant-rich dietary patterns and consume less red and processed meats (RPM) as a high-impact climate action. This PhD dissertation describes three studies that examined how diverse food and health systems actors may encourage sustainable diet transitions for Americans to support human and planetary health. Study one examined U.S. adults' perceptions, beliefs, and behaviors toward plant-rich dietary patterns. The International Food Information Council's Food and Health Surveys (2012–2022) were analyzed using crosstabulation and chi-square analyses. Consumers' recent RPM intake trends were mixed. Despite interest in sustainable products and principles, few U.S. adults followed plant-rich dietary patterns or purchasing practices. Leadership and coordinated action are needed to incentivize Americans to adopt plant-rich dietary behaviors. Study two conducted a systematic scoping review of media campaigns that promoted plant-rich dietary patterns and traditional and novel plant-based proteins, and that encouraged or discouraged RPM products to Americans (1917-2023). Of 84 media campaigns identified, corporate marketing (58.6%) campaigns were most prevalent compared to public information (13.8%), corporate sustainability (12.6%), countermarketing (5.7%), social marketing (4.6%), and public policy (4.6%). Civil society campaigns promoted plant-rich dietary patterns, but only one campaign was evaluated. U.S. government, academia, businesses, and civil society should commit adequate resources and evaluate media campaigns to support a sustainable diet transition for Americans that prioritizes traditional and novel plant-based proteins. Study three explored U.S. Food is Medicine (FIM) experts' views on how plant-rich dietary patterns and other sustainable diet practices could be incorporated into FIM interventions. Twenty semi-structured interviews were conducted among U.S. food and health systems actors and analyzed using inductive and deductive thematic analysis. Results indicated that many FIM actions support human and planetary health, but the co-benefits are not often discussed. The FIM movement is a unique opportunity to promote food and health systems changes that support human and planetary health, but key challenges require coordinated action across sectors. The three studies in this PhD dissertation collectively addressed knowledge gaps, used novel conceptual frameworks, and offered recommendations to inform U.S. food and nutrition policies, programs, and research to encourage sustainable diet transitions for American adults.
Analysis of the Stakeholder Derived Conceptual Models and Exploration of Lung Cancer Screening Barriers in a Medically Underserved Area
Zarghami, Fatemeh (Virginia Tech, 2018-06-13)
The number of new cases of lung and bronchus cancer was 55.8 per 100,000 men and women per year. The number of deaths was 44.7 per 100,000 men and women per year. These rates are age-adjusted and based on 2010-2014 cases and deaths. Each year, more people die of lung cancer than of colon, breast, and prostate cancers combined. The knowledge that lung cancer can be successfully treated if caught early has driven a decades-long search to find an accurate and reliable screening test. National Cancer Institute's National Lung Screening Trial (NLST) found that annual screening with Low-Dose CT (LDCT) for asymptomatic patients aged 55 to 74, with a smoking history of at least 30 pack-years, and smokers who quit less than 15 years ago, had a 20% reduction in risk of death from lung cancer. Findings of this trial resulted in that LDCT becoming the gold standard of screening for lung cancer. The SEED method is a community-engaged research approach to develop conceptual models and generate patient-centered research questions. This method has been used to engage community stakeholders of Martinsville, Virginia to develop conceptual models of the factors contributing to lung cancer outcomes. In the first manuscript of this dissertation, these models which were produced by 3 different groups of stakeholders have been examined closely to explore the complexity, similarities, and differences. The models were used to produce a research agenda on the topic of factors impacting lung cancer outcomes for future researchers. A literature review was conducted by the study team on the final research agenda. The goal of this literature review was to avoid duplication of research and to focus future research on the identified gaps. The knowledge and attitudes of the health care providers and patients about lung cancer screening and the barriers in the uptake of LDCT were identified as a research gap. The design of the Martinsville lung cancer study described in the second manuscript of this dissertation responds to this identified research gap. These studies and their results shed light on the factors that impact lung cancer outcomes using a community based participatory approach.
Applying a Multi-Dimensional Digital Food and Nutrition Literacy Model to Inform Research and Policies to Enable Adults in the U.S. Supplemental Nutrition Assistance Program to Make Healthy Purchases in the Online Food Retail Ecosystem
Consavage Stanley, Katherine; Harrigan, Paige B.; Serrano, Elena L.; Kraak, Vivica (MDPI, 2021-08-06)
The United States (U.S.) Department of Agriculture (USDA)-administered Supplemental Nutrition Assistance Program (SNAP) made substantial changes in response to the coronavirus disease 2019 (COVID-19) pandemic. These changes highlight the need to identify the digital literacy skills and capacities of SNAP adults to purchase healthy groceries online. We conducted a scoping review of four electronic databases, Google and Google Scholar to identify studies that measured food and nutrition literacy outcomes for U.S. adults. We applied a multi-dimensional digital food and nutrition literacy (MDFNL) model to assess six literacy levels and components. Of 18 studies published from 2006–2021, all measured functional and interactive literacy but no study measured communicative, critical, translational, or digital literacy. Six studies examined SNAP or SNAP-Education outcomes. Adults with higher food or nutrition literacy scores had better cognitive, behavioral, food security and health outcomes. We suggest how these findings may inform research, policies, and actions to strengthen the multi-dimensional literacy skills of SNAP participants and SNAP-eligible adults to support healthy purchases in the online food retail ecosystem.
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.
Assessment of Physical Activity in Latina Mothers in the WIC Population
Killen, Kelleigh Dawn (Virginia Tech, 2006-03-24)
In 2000, the U.S. Census Bureau reported that Latinos represented 12.6% of the total population in the United States. It is projected that by 2010 Latinos will account for 15.5% of the population (1,2). Latinos account for 32% of the population in Texas, and specifically in Corpus Christi, Latinos represent 54% of the population (3). The purpose of this study was to compare reported versus actual physical activity among limited resource Latina mothers. This study also aimed to explore the validity of the existing Behavioral Risk Factor Surveillance System (BRFSS) and Seven-Day Physical Activity Recall (PAR) physical activity assessment tools. Fifty-five Latina mothers from a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinic in Corpus Christi, Texas were recruited to participate in this study. Data were collected through a combined (BRFSS and PAR) physical activity questionnaire as well as through step counts using pedometers. BRFSS and PAR reported significantly different levels of moderate physical activity (p=0.0312) using Chi Square tests when appropriate. The response rate in PAR for all levels of activity intensity was higher than BRFSS. There were significant trends between the number of steps reported and BRFSS and PAR moderate physical activity. Further, the majority of subjects who averaged greater than 5,000 steps per day did not perceive themselves to be moderately active in either BRFSS or PAR. These findings question the validity of these physical activity assessment tools with this population.
Authoritative Mothers Exhibit More Permissive Feeding Practices Eating Away from Home with their Children
Kasparian, Michelle Marie (Virginia Tech, 2012-06-25)
Eating away from home has been identified as one possible contributor to childhood obesity, with links to poor diet quality and higher weight status due to dietary quality of meals at restaurants and consumers' attitudes. Parenting style has been associated with children's weight status and overall attitudes toward food, with authoritative parenting being shown to help protect against childhood obesity. The current study aimed to compare and contrast parenting and feeding practices at home and in the restaurant. Twenty-five mothers with children, ages five to eight, who ate at restaurants at least two times per week participated in facilitated, individual interviews. Interviews topics included: parenting, child input in choosing restaurants and restaurant meal selection, and food rules and practices at restaurants versus at home. Socio-demographic information, parenting style, and the mothers' heights and weights were gathered, with descriptive statistics computed. Interview data were transcribed, then thematically coded using NVivo software. All mothers scored highest on authoritative parenting styles. Participating mothers were Caucasian, well-educated, with above-average family incomes. Mothers had an average of 2.2 children and a BMI of 27.9 kg/m². Mothers described more stringent behavioral expectations and more permissive food rules at restaurants. Parents had greater influence in determining whether to eat away from home and where, whereas children had greater responsibility for meal selections at restaurants. The results suggest that practices may differ at restaurants than at home, highlighting the importance of further research, along with educational and behavioral strategies directed toward mothers when eating away from home.
The Availability of Competitive Foods and Beverages to Middle School Students in Appalachian Virginia Before Implementation of the 2014 Smart Snacks in School Standards
Mann, Georgianna Rhodes; Kraak, Vivica; Serrano, Elena L. (Centers for Disease Control and Prevention, 2015-09)
The study objective was to examine the nutritional quality of competitive foods and beverages (foods and beverages from vending machines and à la carte foods) available to rural middle school students, before implementation of the US Department of Agriculture’s Smart Snacks in School standards in July 2014. In spring 2014, we audited vending machines and à la carte cafeteria foods and beverages in 8 rural Appalachian middle schools in Virginia. Few schools had vending machines. Few à la carte and vending machine foods met Smart Snacks in School standards (36.5%); however, most beverages did (78.2%). The major challenges to meeting standards were fat and sodium content of foods. Most competitive foods (62.2%) did not meet new standards, and rural schools with limited resources will likely require assistance to fully comply.
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.
The benefits, challenges, and strategies of adults following a local food diet
Byker Shanks, Carmen; Rose, Nick; Serrano, Elena L. (2010)
Supported in part by a variety of popular books, websites, and other media, the interest in local food is building dramatically, and a growing number of people are increasing their purchases of local food. This paper describes a study that explored the perceived benefits and challenges of following a diet consisting exclusively of local food in southwestern Virginia, as well as the strategies for coping with its limitations. Nineteen individuals participated in a four-week Local Food Diet Challenge, which included eating only foods produced from within 100 miles of the participants' homes. Part of a larger study looking at the nutritional impacts of a local food diet, this study included a pre-diet questionnaire that gathered participants' demographic characteristics, shopping patterns, eating behaviors, and attitudes toward local foods; consumption-reporting forms during the diet period; and a post-diet focus-group discussion for participants to share their experiences in following the local food diet. In this paper we report the major themes that emerged in the focus groups and offer recommendations for locavores and organizations attempting to maximize local food consumption.
Beverage Vending Purchasing Patterns and Attitudes in Southwest Virginia High School Students
Spangler, Jennifer Anne LaBarge (Virginia Tech, 2006-03-17)
Purpose: This article examines changes in attitude and beverage consumption after a school-wide policy change replacing sweetened beverages in vending machines with 100% juice and bottled water. Methods: Written questionnaires were administered three times to high school students (n = 278) in an ethnically-diverse, southwest Virginia school district. X Â² analysis was utilized and test-retest reliability was assessed with intra-class correlation coefficients. Results: Pearson correlation coefficients for reliability between test and re-test displayed a range from r =0.53 to r =0.73. There were no significant differences in demographics (gender and ethnicity) between time periods. X Â² analysis revealed students were significantly more likely to choose healthier beverage vending options after one year compared to baseline (P<0.01). Although beverage vending purchases declined to near significance immediately following the change, there were no significant changes observed between baseline and follow-up (P<0.05). X Â² analysis revealed no significant (P<0.05) changes in outside purchase patterns. Students also indicated that the top reasons for snack/beverage choices were hunger, taste, and price. Conclusion: This suggests that students purchase what is convenient and available, regardless of choices. Therefore, environmental changes may be beneficial to promote healthier beverage choices among adolescents.
Build a Bone Bank with 3-A-Day After-School Education Program for Elementary Students
Cox, Heather K. (Virginia Tech, 2008-06-02)
Objective: To determine whether a social cognitive theory guided nutrition educational intervention in an after-school program is associated with improved nutrition and physical activity knowledge, attitudes, beliefs and behaviors for fourth and fifth grade participants. Design: A prospective comparative study with a quasi-experimental design over a six month period. Questionnaires were collected at baseline and at the end of the program for students at the intervention and comparison schools. Follow-up questionnaires were collected at the intervention school three months post program. Subjects/Setting: Fourth and fifth grade students enrolled in an after-school program targeted to reach students performing below grade level and/or living below the poverty level at an elementary school in southwest Virginia. Fourth and fifth grade students at another county elementary school with similar demographics served as comparison participants. Main Outcome Measures: Daily food intake, dairy intake, physical activity, sedentary behaviors, environment, self-efficacy for consuming dairy products, and food and activity beliefs. Statistical Analysis: Measures of central tendency (mean, median, and variance) were performed to describe participants. Independent t-tests (p<0.05) were used to compare changes from pre to post-questionnaire by treatment group. Paired t-tests (p<0.05) were used to test for differences from pre to post-questionnaire within group. Chi square analysis (p<0.05) was conducted to further investigate changes between groups. Results: Intervention participants significantly increased previous day's milk consumption (p=.006) and plans to drink low-fat milk instead of regular milk (p =.047) from pre to post-program. Significant change was also observed in previous day's milk consumption change from pre to post between groups (p=.004). Conclusion: Participation in an after-school program with nutrition education could change daily milk consumption and plans to drink low-fat over regular milk. Applications: After-school nutrition interventions can be effective in changing milk intake and plans to consume low-fat milk.
Building Healthy Meals Together
Farris, Alisha; Serrano, Elena L. (Virginia Cooperative Extension, 2014-07-07)
This publication helps teach you and your kids the building blocks of a balanced meal and a healthy life with food and physical activity.
Calcium : build strong bones
Serrano, Elena L.; Sablik, Anna (Virginia Cooperative Extension, 2003)
Calcium: Build Strong Bones
Serrano, Elena L.; Sablik, Anna (Virginia Cooperative Extension, 2009-05-01)
Tips for ways to choose foods higher in calcium for maintaining and building stronger bones.
A Case Study Exploring Lunchtimes: Implications for Equitable Access to the National School Lunch Program
Smith, Jeanell (Virginia Tech, 2023-09-25)
It is recommended that 20 minutes be provided for students to eat lunch at school. Research has shown that adequate seated lunchtime can ensure that children consume enough food, which may help address child food insecurity concerns. It may also improve dietary quality. The school that is the focus of this case study is located in Lynchburg, Virginia, in a community with relatively high rates of food insecurity. The school participates in CEP, with all students eligible for free school meals. The goal of this study was to assess the current school lunch environment in the cafeteria, using the Strengths, Opportunities, Aspirations, and Results (SOAR) framework, to help inform strategies to increase seated lunch time and ultimately address food insecurity and dietary quality. The study involved 12 one-on-one interviews with cafeteria stakeholders, including cafeteria monitors, cafeteria staff, teachers, and administration. The interview results answered the four research questions and utilizing the asset-based SOAR framework, revealed what is going well in the cafeteria, what opportunities are available for improvement, the collective goals of the stakeholders, and how the stakeholders would define success. The strengths included mandatory quiet time at the start of each lunch period to focus on eating and verbal cues during lunch to provide structure and time management for the students. The opportunities included cafeteria staff providing quality images, detailed descriptions, and tastings of menu items for students and staff. The aspirations of the stakeholders include a deep passion for creating a safe and nurturing environment in the cafeteria. The goals are to increase the amount of time students have to eat lunch and build on the current strengths to continue to improve the cafeteria environment. Recommendations to achieve these goals are offered in a tiered approach and include uniform cafeteria monitor training, expanding nutrition education, and increasing time allotments for lunch.
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.
Childhood Obesity and the Home Environment
Robert, Courtney Adele (Virginia Tech, 2010-07-22)
The prevalence and severity of childhood overweight has climbed dramatically in the past three decades and is recognized as a serious public health concern that requires urgent action. The home environment has been identified as a key influence on the diet and physical activity of children. Furthermore, low-income families experience obesity at higher rates and current interventions have not been translated from research to practice settings. Therefore, there is a need to evaluate the potential for evidence-based obesity treatment strategies to be translated into community or clinical delivery settings that reach broadly into the population of low-income families. In addition, while the home environment has successfully been targeted to treat childhood obesity, there is a paucity of measurement tools available to provide a comprehensive assessment of the home physical and social environment as it pertains to physical activity and dietary intake. This dissertation includes: (1) a mixed-methods study to determine the feasibility and effectiveness of a childhood obesity treatment intervention based on a partnership with a Health Care Organization and delivered through Cooperative Extension, (2) a systematic review of home environmental measures related to physical activity and dietary intake, and (3) a home environment measure development and validation study. Smart Choices for Healthy Families (SC) was developed through a research-practice partnership that included a local healthcare provider (Carilion Clinic), Virginia Cooperative Extension (VCE), and an interdisciplinary research team. The aim of this study was to assess the reach, implementation, and effectiveness of SC to reduce the BMI z-scores of overweight and obese children from low-income families. The resultant intervention, based on an evidence-based social-ecological model, included brief physician counseling and referral, six-biweekly group sessions taught by VCE lay leaders, and six automated telephone counseling calls on alternate weeks. Twenty-six of 264 eligible children (50% boys; mean age=10.5 years) were recruited and 78% completed baseline and 3-month assessments. Over the 6 class sessions, there was an average 65% attendance rate and an average 58% completion rate for the automated telephone calls. Results revealed a significant reduction in children's BMI z-score (p<0.01), an increase in lean muscle mass (p<0.001) and weight (p<0.05), and an increase in Health Related Quality of Life (HRQL; p<0.0001). The participating group had a higher income (p<0.05) and also participated in fewer food assistance programs (p<0.05). Despite this small difference, Smart Choices reached a sample that was representative of the larger target population and was effective in reducing BMI z-score, increasing lean muscle mass, and improving HRQL of low-income obese children. A systematic review was conducted of the measures of the home environment in order to collect and synthesize the current body of literature. It was found that some authors choose to use non-validated measures and that there is an inconsistent use of measures across the field, making comparisons between studies difficult and conclusions regarding parental influence on childhood obesity difficult to discern. The psychometric properties that were reported on these studies are reported in this review. Through the systematic review of literature a number of measures were identified that assessed different aspects of the home environment. These measures were compiled and combined to generate a comprehensive tool to assess the physical and social aspects of the home environment that could influence eating and physical activity. This measure plus a social-ecological framework for the measure were provided to experts in the field who provided information on potential areas that had been overlooked and advice on additions or contractions of items and scales. The modified measure, the Comprehensive Home Environment Survey (CHES), was then tested for reliability and validity in a low-income audience. Parent-child dyads (n=132; Children 47% girls, age range 5 to 17; Parent 82% mothers; mean age=36) were recruited through a pediatric clinic in Roanoke, Virginia, that serves a primarily low-income audience (i.e., 95% eligible for Medicaid). Each of these parents completed the assessment tool and additional surveys to assess concurrent and predictive validity. Height and weight was assessed in each child, and children between the ages of 9 and 17 also completed nutrition and physical activity self-report surveys. Test-retest reliability was assessed in 43 parents who complete the survey a second time one-to-two-weeks following the initial assessment. Inter-rater reliability was assessed in 36 cases by having a spouse or second care-giver complete the assessment tool. Internal consistency, test-retest, inter-rater reliability, and predictive validity all showed promising results. Across the scales internal consistency was adequate to high with Cronbach's Alphas ranging from 0.67-0.92, test-retest reliability was high with Pearson Correlations ranging from 0.73-0.97 and inter-rater reliability was higher with Pearson Correlations ranging from 0.42-0.92. Finally, the CHES displayed predictive validity with subscale scores predicting outcome behaviors (e.g., parents who modeling more physical activity had children who were more active). This dissertation demonstrated that the home environment is a key factor in the treatment of childhood obesity and provides avenues for both intervention and measurement in this field of study.
Community Matters: The Exploration of Overweight and Obesity within the Lesbian Population
Thayer, Amy Nichole (Virginia Tech, 2010-10-29)
Obesity in the United States has increased dramatically during the past 40 years. Women are more at risk than men to be obese; and, a lesbian sexual identity further increases a woman's likelihood of being overweight or obese. This dissertation includes the following components: 1) a review of factors influencing overweight and obesity in lesbians, 2) an ethnographic inquiry examining how lesbian culture and a lesbian sexual identity contribute to a woman's body weight, and 3) the development of a lesbian-specific tool based on factors identified during the ethnography that predicts eating, physical activity, and weight status. The literature review, informed by the Social Ecological Model, investigated potentially contributing factors of overweight and obesity in lesbians. This review revealed a small body of literature dedicated to lesbians' physical activity and eating behaviors; additionally, weight-influencing social-cultural elements of lesbian communities were identified. This body of literature suggests that specific personal, social, and environmental factors negatively influence lesbians' weight, although there is not much known about this community's PA and eating behaviors, as overall behavior-specific findings, were equivocal. However, the following gaps in the literature were identified: lesbians' self-efficacy in PA and healthy eating, and effects on these behaviors as determined by their membership in lesbian subcultures. An ethnographic inquiry examined how a lesbian sexual identity contributes to body weight, attempted to fill a need in the current literature, and was driven by the following questions: 1) How does this lesbian social community serve as a context for its lesbian members to understand body weight? 2) What is the relationship between women's lesbian identities and their body weight? 3) What sub-cultural customs exist that permit or prohibit healthy eating and physical activity by women in this lesbian community? Participant observation, the primary method of data collection, uncovered the following themes: 1) Valuing Weight, 2) Coping and Socializing Behavior, and 3) Living within an Inconsistent Environment. Social Cognitive Theory assisted in interpreting how and why lesbians create innovative ways to appreciate diverse body weights and provided directives for measurement domains when investigating overweight in this community. Informed by the previous projects, the Lesbian Overweight and Obesity Questionnaire (The LOOQ) was developed as a tool to measure potential influences on PA, fat intake, and dietary consumption, which assist in predicting body mass index (BMI) within the lesbian community. Internal consistency, test-retest reliability, and predictive validity demonstrated encouraging results; all but two (i.e., 2/27) subscales demonstrated adequate to high internal consistency (Cronbach's Alphas= 0.61-0.97) and reliable test-retest scores (r=0.61-0.92). The LOOQ displayed predictive validity with subscale scores predicting outcome behaviors, which predicted BMI scores.
Community-based lifestyle intervention for underserved Hispanics with pre-diabetes and type 2 diabetes in Southwest Virginia
Valenzuela, Ivette Guadalupe (Virginia Tech, 2015-10-16)
In the U.S., diabetes mellitus cases have been increasing, from 25 million in 2010 to 29 million in 2012. Healthy People 2020, the U.S. National Health Agenda, has established specific goals and objectives for diabetes. In the U.S., prevalence of pre-diabetes and diabetes for adult Hispanics was 38% and 12%, respectively, in 2012. The total estimated diabetes cost in the U.S. has been increasing, from $176 billion in 2007 to $245 billion in 2012. The current study had two research hypotheses; the formative phase was expected to demonstrate a need for a community-based Type 2 Diabetes Mellitus (T2DM) self-management intervention for Spanish-speaking Hispanics. Random Control Trial (RTC) was expected to demonstrate the potential impact in preventing and managing T2DM. Methods. A community-based lifestyle education curriculum was translated into Spanish, and adapted to Hispanic culture. This study includes three phases: 1) a formative phase; 2) a two-group pilot RCT with Hispanic Living with Diabetes (HBLD) and a delayed treatment condition; and 3) post-HBLD focus groups held with three participating groups of HBLD. Results. Of 60 participants screened in the formative phase, 62% had A1c > 5.7%, and 75% did not have medical insurance. Of 6 participants who completed the pilot, A1c decreased for all six participants. Of 67 participants screened in phase 2, 61% had A1c > 5.7%. Of 30 HBLD participants in the RCT, baseline versus 3-month mean A1c increased 0.2 for the delayed control group (n = 10) and did not experience any change for the intervention group (n = 11). The difference in A1c change from baseline to follow up between treatment groups was not statistically significant (Kruskal Wallis, p < 0.05). Diabetes knowledge and SCT variables change from baseline to follow-up between groups were not statistically significant. Major themes identified in focus group discussions included barriers to access to health and nutrition services, the value of having a Spanish-speaking Hispanic as a health educator, and barriers to recruiting community members as promotoras. Implications. HBLD has potential to reduce complications of diabetes among Hispanic participants by providing education to those who may not otherwise have access to it.
Contextual Factors Influencing the Adoption of Physical Activity Direct Education and Policy, Systems, and Environmental Change Initiatives by Virginia EFNEP and SNAP-Ed Staff
Brooks, Austin; Young, Gabrielle; Misyak, Sarah; Johnson, Meredith Ledlie; Serrano, Elena L. (Elsevier, 2023-11-28)
Objective: To explore factors influencing the adoption of direct education programs and policy, systems, and environmental (PSE) change initiatives focused on physical activity for Supplemental Nutrition Assistance Program-eligible audiences by Virginia Expanded Food and Nutrition Education Program and Supplemental Nutrition Assistance Program-Education (SNAP-Ed) staff. Methods: Online survey with Expanded Food and Nutrition Education Program and SNAP-Ed peer (paraprofessional) educators (n = 28) and SNAP-Ed agents (master of science level) (n = 9) in Virginia. Descriptive statistics were computed for sociodemographic characteristics and responses to questions on the basis of Likert-type scales. Exploratory factor analyses were run to identify the underlying structures of the different variables. Results: The main factors for peer educators were related to substituting nutrition programs or content for physical activity programs. Other factors included staff qualifications and expectations about leading vs teaching physical activities. For PSEs, the top factors were the capacity to reach many community members, attract new partners and stakeholders, and personal interest in the PSE. Conclusions and Implications: The results provide insight into potential barriers and motivators for adopting physical activity education and PSEs within community-based initiatives and can be used to inform program planning and staff training. Additional research is warranted to examine other factors influencing the adoption and implementation of physical activity programs and PSEs.

Browsing by Author "Serrano, Elena L."

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