Browsing by Author "You, Wen"

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    Access for Whom? Examining Poor and Ethnic-minority Student Access at the Public Flagships
    Durodoye Jr, Raifu (Virginia Tech, 2015-06-17)
    As a result of increasing college costs and diminishing organizational support, poor and ethnic-minority students are finding it increasingly difficult to attend large public research universities. To investigate the potential relationship that exists between market-oriented practices in higher education and access for poor and ethnic-minority students, the Institutional Logics Perspective is employed as a theoretical frame to contextualize the precursors, content, and consequences of the market logic in the public higher education system. Hypotheses drawing out linkages between the mechanisms of the market logic and decreased student access are offered. A fixed-effect model is then constructed to evaluate proposed connections between university practices undergirded by the logic and access for both poor and ethnic-minority student populations. Results are discussed and the ramifications of the market logic for the future of accessible public higher education are explored in the context of social justice.
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    Application of The Theory of Planned Behavior in a Randomized Control Trial Targeting Sugar-Sweetened Beverage Intake and Physical Activity in Southwest Virginia
    Tyhurst, Maja (Virginia Tech, 2015-06-07)
    BACKGROUND: Health-related interventions informed by behavioral theory have been shown to be more effective in changing behaviors as compared to those that are not. The Theory of Planned Behavior (TPB) has been used to successfully predict and explain a variety of health related behaviors, including sugar-sweetened beverage (SSB) intake and physical activity (PA). The TPB assumes that behavioral intentions are the most important determinant of behavior. Intentions are the function of individual's attitudes toward the behavior (these evaluations can be positive or negative), subjective norms (social standards and expectations surrounding the behavior), and perceived behavioral control (perception of the ease with which the behavior can be performed). According to literature, behavioral intentions predict 20% - 40% of the variance in health behaviors with attitudes beings the strongest predictor of diet, and perceived behavioral control being the strongest predictor of physical activity related intentions. Excessive SSB consumption and inadequate PA have been highly associated with the obesity epidemic, and related comorbidities such as cardiovascular disease and type-2 diabetes. Understanding and targeting these behaviors through application of health behavior theories, such as the TPB, is important. PRIMARY AIMS: This research is embedded within a larger 2-arm randomized-control trial, Talking Health, which targets residents in rural southwest Virginia. Guided by the TPB, the overall goal of the Talking Health trial is to determine the effectiveness of a 6-month intervention aimed at decreasing SSB intake (SIPsmartER) compared to a matched contact control aimed at increasing PA (MoveMore). Each condition includes three classes, one teach-back call, and 11 interactive voice response (IVR) calls. The primary aims of this secondary analysis of Talking Health are to 1) determine if single-item TPB indicators are correlated with multi-item TPB scales for SSB and PA; 2) examine how baseline TPB variables predict participation in the SIPsmartER and MoveMore; 3) determine how the IVR TPB variables assessed during IVR calls predict future SSB and PA behaviors reported in a subsequent IVR call; and 4) explore how TPB variables change over the course of the teach back and 11 IVR calls. METHODS: Eligibility requirements included being 18 years of age or older, having reliable access to a telephone, drinking 200 kilocalories of SSB per day, and having no contraindications for moderate-intensity physical activity. The present research utilizes data from the baseline health assessment, class attendance and IVR and teach back calls completion data, as well as data collected in teach-back and 11 IVR calls. Multi-item TPB constructs for both SSB and PA behaviors were assessed at baseline (measured on a 7-point Likert scale). Each IVR call assessed self-reported past week behavior (ounces of SSB or minutes of PA) and four single-item TPB constructs including behavioral intentions, perceived behavioral control, instrumental attitudes, affective attitudes, and subjective norms. Participation was measured as the number out of 15 activities completed by participants (three classes, one teach back call, and 11 IVR calls). Statistical analysis included descriptive statistics, Chi square tests, independent T-tests, Pearson's correlations, Cronbach's α, and sequential multi-step regression models. Multiple data imputations were used to account for missing data. RESULTS: Of the 301 participants, 81% were female and 93% were Caucasian. The mean age of participants was 48.8 ± 13.5. Additionally, 32% of participants completed high school education, 55% earned < $20,000 per year, 32% had a full time or part time job, and 33% were classified as low health literate. Single-item indicators for both SSB-TPB questions (r > 0.60) and PA-TPB questions (r > 0.69) were highly correlated with their multi-item scales. Baseline TPB variables did not predict the participation rates in either SIPsmartER (F=1.763, R2=0.057, P=0.124) or MoveMore (F=0.815, R2=0.028, P=0.541) conditions. Of the nine SIPsmartER IVR regression models, eight were significant, and the SSB-TPB variables predicted about 30% of the variance in SSB behavior. Of the nine MoveMore IVR regression models, all were significant, and the PA-TPB variables predicted about 20% of the variance in SSB behavior. In both conditions, the majority of variance was explained by behavioral intentions and the addition of other TPB variables (perceived behavioral control, instrumental attitudes, affective attitudes, and subjective norms) explained substantially less variance in the behaviors. There were no notable patterns of change in TPB variables over 11 IVR calls for either SIPsmartER or MoveMore participants. DISCUSSION: Our findings show that single-item indicators can be used as reliable measures of the TPB constructs. The TPB model did not show significant predictive value when it comes to participation in SIPsmartER or MoveMore. On the other hand, our findings show that TPB model explained about 30% (SSB) and about 20% (PA) of variance in behavior. Although significant changes in IVR TPB variables were found between the two time points in several instances for both SSB and PA behavior, there were no patterns of change over time. Based on our findings, assessing behavioral intentions as the goal behavior in each IVR call may be the most useful application of the TPB. Other TPB variables can be assessed using single-item indicators.
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    Applications of Applied Econometrics in the Food and Health Economic and Agribusiness Topics
    Shi, Ruoding (Virginia Tech, 2019-11-12)
    This dissertation consists of three essays in Applied Econometrics that seek a better understanding of different aspects of risk and risk management tools. The first essay is about mortality risk in Virginia coal regions. With a focus on the mortality of non-malignant respiratory diseases (NMRD), I estimate the impact of living in a coal county and find that coal-mining county residency significantly increases the probability of dying from NMRD. This statistical association is accentuated by surface coal mining, high smoking rates, lower health insurance coverage, and a shortage of doctors. The second essay evaluates the cost of a price risk management tool called futures hedging. A variety of measures illustrate considerable changes in hedging costs over time. Quantile regression results show that substantial price volatility and high margin requirements are the main factors driving high hedging costs from 2007 to 2013. The third paper investigates a health risk management tool, a public health insurance program in China called New Cooperative Medical Scheme (NCMS). I apply contract theory to characterize local governments' selective incentives in NCMS benefit designs. Empirical analysis of China Health and Nutrition Survey data indicate challenges of financial sustainability of this scheme in poor regions. The NCMS plan tends to under-cover the services that are moderately predictable and negatively correlated with plan profits, such as outpatient treatments. Preventive services are generally over-provided, perhaps due to the incentive to attract healthy participants.
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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.
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    Beginning A Patient-Centered Approach in the Design of A Diabetes Prevention Program
    Seidel, Richard W.; Pardo, Kimberlee A.; Estabrooks, Paul A.; You, Wen; Wall, Sarah S.; Davy, Brenda M.; Almeida, Fabio A. (MDPI, 2014-02-01)
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    Changes in the Healthy Beverage Index in Response to an Intervention Targeting a Reduction in Sugar-Sweetened Beverage Consumption as Compared to an Intervention Targeting Improvements in Physical Activity: Results from the Talking Health Trial
    Hedrick, Valisa E.; Davy, Brenda M.; Myers, Emily A.; You, Wen; Zoellner, Jamie M. (MDPI, 2015-12-04)
    The recently developed Healthy Beverage Index (HBI) was designed to evaluate overall beverage intake quality (including total fluid consumption and beverage calories), yet no known intervention studies have assessed longitudinal changes to the HBI. The objective of this investigation was to assess changes in HBI scores in response to a sugar-sweetened beverage (SSB) reduction trial as compared to a physical activity comparison group. Participants were enrolled into a six-month, community-based, controlled behavioral trial and randomized into either a SSB reduction group (SIPsmartER) or a physical activity group (MoveMore). Correlations and multilevel mixed-effects linear regression with intention-to-treat analyses are presented. Total HBI score significantly increased for SIPsmartER (n = 149) (mean increase = 7.5 points (5.4, 9.7), p ≤ 0.001) and MoveMore (n = 143) (mean increase = 3.4 points (1.6, 5.2), p ≤ 0.001) participants, with a significant between group effect (p ≤ 0.05), over the six-month intervention. Other significant changes in HBI components for SIPsmartER included increased SSB and total beverage calorie scores, and decreased low-fat milk and diet soda scores. Changes in total HBI scores were significantly correlated with changes in total Healthy Eating Index-2010 scores (r = 0.15, p ≤ 0.01). Our findings suggest that individual HBI component scores, beyond the SSB component, are influenced by intervention strategies that primarily focus on SSB reduction.
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    Characterization of Non-Nutritive Sweetener Intake in Rural Southwest Virginian Adults Living in a Health-Disparate Region
    Hedrick, Valisa E.; Passaro, Erin M.; Davy, Brenda M.; You, Wen; Zoellner, Jamie M. (MDPI, 2017-07-01)
    Few data assessing non-nutritive sweetener (NNS) intake are available, especially within rural, health-disparate populations, where obesity and related co-morbidities are prevalent. The objective of this study is to characterize NNS intake for this population and examine the variance in demographics, cardio-metabolic outcomes, and dietary intake between NNS consumers and non-consumers. A cross-sectional sample (n = 301) of Virginian adults from a randomized controlled trial (data collected from 2012 to 2014) targeting sugar-sweetened beverage (SSB) intake completed three 24-h dietary recalls, and demographics and cardio-metabolic measures were assessed. The frequency, types, and sources of NNS consumption were identified. Thirty-three percent of participants reported consuming NNS (n = 100). Sucralose was the largest contributor of mean daily NNS intake by weight (mg), followed by aspartame, acesulfame potassium, and saccharin. NNS in tabletop sweeteners, diet tea, and diet soda were the top contributors to absolute NNS intake. The most frequently consumed NNS sources were diet sodas, juice drinks, and tabletop sweeteners. Although mean body mass index (BMI) was greater for NNS consumers, they demonstrated significantly lower food, beverage, and SSB caloric intake and energy density, and higher overall dietary quality. It remains unclear whether NNS use plays a role in exacerbating weight gain. NNS consumers in this sample may have switched from drinking predominantly SSB to drinking some NNS beverages in an effort to cope with weight gain. Future studies should explore motivations for NNS use across a variety of weight and health categories.
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    Characterization of Non-nutritive Sweetener Intake Patterns in a Sample of Rural Southwest Virginian Adults
    Passaro, Erin Marie (Virginia Tech, 2016-06-03)
    Controversy surrounds the use of artificial sweeteners (non-nutritive sweeteners [NNS]) as an effective weight-loss and/or maintenance strategy. This controversy is especially important as obesity is an epidemic in the United States. Excessive added sugar intake, primarily from sugar-sweetened beverages, has been linked to increased risk of overweight and obesity, as well as type 2 diabetes and cardiovascular disease. NNS provide minimal to no calories and thus, they have been suggested as a method to reduce added sugar intake, and consequently decrease energy intake, weight, and cardiometabolic risk. However, NNS intake has been associated with various health outcomes in observational studies and randomized controlled trials, including cancer, weight gain and loss, physiological and intestinal changes, cardiovascular disease, and diabetes. The uncertainties around the effect of NNS on health outcomes stem from a variety of limitations, one of which is inadequate dietary assessment methodology. Accuracy of dietary intake assessment methods is limited by the inability to distinguish between different types of NNS and lack of information about consumer use of NNS in a variety of beverages and foods. The purpose of this investigation is to explore NNS consumer characteristics and to characterize NNS intake in a sample of rural Southwest Virginian adults. This characterization is especially important for rural populations, as they are known to be high sugar-sweetened beverage consumers and are at an increased risk of obesity and chronic disease; thus, NNS could serve as a replacement method to facilitate cardiometabolic health. Cross-sectional data from a large randomized controlled trial, Talking Health (n=301), was utilized in this investigation to compare demographic characteristics, anthropometrics, biochemical markers, dietary quality, and dietary factors between NNS consumers and NNS non-consumers. This data was also used to characterize NNS intake (frequency, type, and source of sweetener). Of this rural sample, 33% consumed NNS, with sucralose being the most prevalent type of NNS and diet soda being the most frequently consumed source of NNS. NNS consumers had a higher BMI status than NNS non-consumers. However, NNS consumers had better overall dietary quality than NNS non-consumers. The characteristics of these NNS consumers and their intake patterns can be used to develop well-designed dietary intake assessment tools that accurately measure NNS intake, which can facilitate a better understanding of the associations of NNS with health outcomes.
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    Childhood Misnourishment, School Meal Programs and Academic Performance
    Capogrossi, Kristen Lynn (Virginia Tech, 2012-03-29)
    Both types of childhood misnourishment, overweight/obesity and underweight, are accompanied by serious health consequences and a heavy economic burden. In 2008, 19.6% of US children aged 6 to 11 and 18.1% of adolescents aged 12 to 19 were obese equating to 13 million children. Furthermore, in 2006, 2.7% of US children aged 6 to 11 and 3.9% of adolescents aged 12 to 19 were underweight translating to 2.4 million children. This dissertation contains three essays on the relationship between child weight, school meal program participation and academic performance. Chapter II examines how childrens' weight impacts their academic performance using a quantile analysis while controlling for potential simultaneity between weight and school outcomes. Results indicate that programs targeting child weight could potentially have positive spillover effects on academic performance leading to the question of what can be done to mitigate the problem. Since children consume one-third to one-half of their daily calories while in school each day, school level programs are natural policy instruments to tackle misnourishment. Specifically, the School Breakfast Program (SBP) and National School Lunch Program (NSLP) are two federally-funded programs providing meals to over 31.7 million children daily. Chapter III examines the impact that these programs have on child weight using a multiple simultaneous treatment analysis controlling for self-selection into the programs. Chapter IV then investigates whether these programs have spillover effects on academic performance through the mediator of child weight using structural equation modeling and multiple simultaneous equation methodologies. Each of these essays provides further insight to the relationship between child weight, school meal program participation and academic performance offering potential policy implications to tackle child misnourishment.
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    Conditional, Structural and Unobserved Heterogeneity: three essays on preference heterogeneity in the design of financial incentives to increase weight loss program reach
    Yuan, Yuan Clara (Virginia Tech, 2015-08-27)
    This dissertation consists of three essays on forms of preference heterogeneity in discrete choice models. The first essay uses a model of heterogeneity conditional on observed individual-specific characteristics to tailor financial incentives to enhance weight loss program participation among target demographics. Financial incentives in weight loss programs have received attention mostly with respect to effectiveness rather than participation and representativeness. This essay examines the impact of financial incentives on participation with respect to populations vulnerable to obesity and understudied in the weight loss literature. We found significant heterogeneity across target sub-populations and suggest a strategy of offering multiple incentive designs to counter the dispersive effects of preference heterogeneity. The second essay investigates the ability of a novel elicitation format to reveal decision strategy heterogeneity. Attribute non-attendance, the behaviour of ignoring some attributes when performing a choice task, violates fundamental assumptions of the random utility model. However, self-reported attendance behaviour on dichotomous attendance scales has been shown to be unreliable. In this essay, we assess the ability of a polytomous attendance scale to ameliorate self-report unreliability. We find that the lowest point on the attendance scale corresponds best to non-attendance, attendance scales need be no longer than two or three points, and that the polytomous attendance scale had limited success in producing theoretically consistent results. The third essay explores available approaches to model different features of unobserved heterogeneity. Unobserved heterogeneity is popularly modelled using the mixed logit model, so called because it is a mixture of standard conditional logit models. Although the mixed logit model can, in theory, approximate any random utility model with an appropriate mixing distribution, there is little guidance on how to select such a distribution. This essay contributes to suggestions on distribution selection by describing the heterogeneity features which can be captured by established parametric mixing distributions and more recently introduced nonparametric mixing distributions, both of a discrete and continuous nature. We provide empirical illustrations of each feature in turn using simple mixing distributions which focus on the feature at hand.
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    Consumer Economic Behavior and the Role of Information: Three Case Studies
    Vinoles Gomez, Maria V. (Virginia Tech, 2014-10-13)
    The economics of information is a relatively new and important field of economics. This dissertation analyzes the role of information in three case studies within three different branches of economics: health economics, environmental economics, and finance and banking. First I analyze parental nutritional label usage and its effect of children's dietary outcomes (i.e. Health Eating Index and Body Mass Index). I show that parental usage of nutritional labels is associated with a better quality of their children's diet as well as an overall improvement in their health as measured by their Body Mass Index. Secondly, I study the behavioral effect of length of residency on water demand in the arid cities of Reno and Sparks in Nevada. In this case, I observe that social interaction among households affects their water usage. In particular, newcomers' watering behaviors are influenced by the prevailing social norms among neighbors that have lived in the arid area for a longer period of time. Finally, I compare the performance of local versus larger national and regional lending institutions in the years leading to the 2007 mortgage crisis. I find that local or community lenders have a significantly lower foreclosure rate during these years. Local lenders presumably base their origination decisions on an interpersonal relationship with their customers. This provides them with information that is not contained within the standard risk metrics generally used in loan applications. I discuss the policy implications of these results for each case study.
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    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.
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    Demographic Factors and Beverage Consumption Patterns: Health Literacy, Education, and Income Level
    Ferguson, Katherine E. (Virginia Tech, 2011-04-26)
    Over the past several decades, the prevalence of overweight and obesity has increased to 68% of American adults1. During this same time period, there has been an increase in sugar-sweetened beverage consumption. This increase in added sugar consumption, particularly from sugar-sweetened beverages, has been theorized as a possible contributor to the obesity epidemic2,3,4. Sugar-sweetened beverages are the number one source of added sugars in the American diet and organizations such as the American Heart Association have addressed this issue of added sugar consumption due to its association with negative health outcomes5. A variety of demographic factors have been linked to increased added sugar consumption6. Health literacy is another variable which may influence beverage consumption patterns, specifically sugar-sweetened beverage consumption. To date only one study has investigated this association, and the authors reported an inverse relationship between health literacy scores and sugar-sweetened beverage consumption7. Therefore, the purpose of this investigation was to determine what demographic variables serve as predictors of consumption of sugar-sweetened beverages, water, milk, and total beverage calories. This could allow for appropriate interventions to be developed targeting healthier beverage consumption patterns in specific sub-populations.
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    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.
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    Development of the University Health Index to Examine the Interface between Campus Environment and Nutrition, Physical Activity, and Weight in College Students
    Goodwin, Stephanie Kay (Virginia Tech, 2011-09-02)
    Since many adolescents experience the transition to young adulthood in college, the university health environment could play a significant role in addressing the current rise in chronic disease and obesity epidemic. The University Health Index for Nutrition and Physical Activity (UHI) tool, guided by the Center for Disease Control and Prevention (CDC) K-12 School Health Index, was developed to evaluate the associations between the university health environment and student health outcomes related to nutrition, physical activity, and weight. Several studies were conducted to examine what university characteristics are most strongly associated with college student health habits related to weight, nutrition, and physical activity behaviors. These studies culminated in a study to develop and validate the UHI. A request soliciting participation in the completion of the UHI was posted on the American College Health Association (ACHA) listserve. The final dataset used for analysis included 13 universities (N = 19) with a total of 9,460 National College Health Assessment (NCHA) student participants. Data were analyzed using Mixed-effects REML regression model adjusting for clustering effects, with statistical significance set at p < 0.05 and trends set a p < 0.10. Data were analyzed to determine associations between the total UHI score, individual module scores, and individual components of each module with student outcomes from the NCHA data (fruit/vegetable intake per day, days per week of aerobic and strength physical activity, and body mass index: BMI; kg/m² calculated from self-reported height and weight). Total UHI score was not significantly associated with outcome variables related to BMI, nutrition, or physical activity. The total health promotion module, however, was associated with vigorous physical activity (coefficient = 0.095; SE = 0.048; p = 0.046) and the built environment was associated with moderate physical activity (coefficient = 0.029; SE = 0.017; p = 0.096) and with high fruit and vegetable intake (coefficient = 0.021; SE = 0.011; p = 0.061). Individual questions related to recreational sports and fitness and nutrition and/or weight management counseling were associated with outcome variables as well. Measures for physical activity are better developed than for nutrition as there was only one nutrition question available with limited utility in terms of data analysis to test the UHI. Studying the university health environment and college students' health habits related to weight, nutrition, and physical activity is multifaceted and challenging. Unlike the K-12 school system, there is not a central university entity with jurisdiction over health-related student issues. Instead, health-related student issues and services are the responsibility of a variety of departments at a university and it is difficult to realize the complete university health environment. Results of this research can be used to refine future versions of the UHI and to continue to investigate the university characteristics that are most strongly associated with specific student health behaviors and outcomes related to nutrition, physical activity, and weight.
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    Dietary Intake Changes in Response to a Sugar-Sweetened Beverage Reduction Trial for SNAP Participants and Nonparticipants
    Bremer, Molly Catherine (Virginia Tech, 2017-06-13)
    It is unknown if participation in the Supplemental Nutrition Assistance Program (SNAP) influences the magnitude of improvement in dietary intake in response to dietary interventions. Adults with low socioeconomic status (SES) tend to have lower overall dietary quality as compared to those with higher SES. However, low SES adults are more likely to receive benefits from SNAP, which gives nutrition assistance to millions of eligible Americans. The objective of this investigation is to examine differences in dietary intake between 1) SNAP participants, 2) those eligible for SNAP but not receiving (nonparticipants), and 3) those ineligible for SNAP, in response to an intervention targeting a reduction in sugar-sweetened beverage (SSB) consumption. Adult participants (n=146) from Southwest Virginia were enrolled in a 6-month, community-based trial, SIPsmartER. Participants provided SNAP enrollment status and 3 24-hour dietary recalls at baseline and 6-months. Dietary variables (SSB, macronutrients, etc.) and dietary quality data (Healthy Eating Index [HEI-2010]) were derived from nutritional analysis software (NDS-R 2011). Statistical analyses included descriptives and repeated-measures ANOVA. Although SNAP participation and eligibility status did not impact the overall effectiveness of this dietary intervention, the within group data suggests that those eligible for SNAP but not participating (n=30) may be at a disadvantage to improving their dietary intake as compared to those at a similar household income who receive SNAP benefits (n=56) or ineligible individuals at a higher income level (n=60). Future research is needed to explore if participant's ability to maintain long-term adherence to the dietary changes differs between groups.
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    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.
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    Dissemination of Health Promotion Information in Cooperative Extension:  A multi-study exploration of channels, sources, and characteristics that influence intervention uptake
    Strayer, Thomas Edward III (Virginia Tech, 2019-05-09)
    A translational gap exists between the development of an evidence-based health promotion intervention and its eventual implementation in the intended setting. This lack of translation impacts the uptake of health promotion interventions within delivery systems such as the Cooperative Extension Service (Extension). Within this system, Extension educators serve as the intermediaries addressing needs in the communities in which they are employed with support from Extension health specialists. Previous research has shown that educators utilize other peer educators and specialists to learn and adopt health promotion programming, but these studies are over two decades old (e.g., missing technological advances such as Internet and social media) and often focused on a single state Extension system. The purpose of this research was to understand how evidence-based health promotion intervention information is shared within Cooperative Extension by 1) identifying information sources and channels of Extension specialists and educators while 2) identifying the characteristics of an intervention that aid in the adoption and uptake of these health promotion interventions. The first mixed-methods study aimed to identify information sources and channels used by Extension educators from a national sample and learn their preferences for information delivery. Results of this study (Manuscript 1), identified specialists as the key information source Therefore, the second study (Manuscript 2) focused on Extension health specialists' preferences for information sources and channels while also 1) determine how specialists communicate with educators 2) preliminary thoughts on a dissemination intervention. The final study (Manuscript 3) explored the intervention characteristics that are both educator and specialists deemed most important to their adoption decision-making process. The results of this dissertation inform the development of a dissemination intervention to bridge the translational gap across Extension. The information sources and channels used and trusted by both Extension educators and specialists are highlighted in this work. Additionally, specialists have given insight for consideration for an online repository that can be used on demand to both facilitate the adoption and uptake of health promotion interventions as needed by Extension Educators.
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    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.
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    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)