The following project is under review for funding through the Harvey W. Peters Research Foundation:
This project will explore factors associated with overweight in school children in southwest Virginia. Specifically, the association between school environment as measured by the CDC School Health Index (SHI) and student outcomes (existing data for BMI and fitness; student behaviors measured for the project) will be measured. The School Health Index from the Centers for Disease Control and Prevention (CDC) is one tool available to schools for assessing the school health environment. It is recommended by the USDA as one way to help schools conduct self-assessment and monitor progress related to the Local Wellness Policy, now required of all school divisions that participate in the USDA National School Lunch Program. No studies have been conducted to measure the association between SHI scores and student health such as weight, nutrition and physical activity. School administrators responsible for decisions regarding needs assessment and use of resources for addressing nutrition and physical activity would benefit from such information. Schools in approximately seven school divisions (counties) in southwest Virginia will complete the CDC School Health Index, modified to target nutrition and physical activity. Existing data on student body mass index and fitness will be obtained from individual schools. Data on nutrition knowledge and nutrition/physical behaviors will be collected from 2 classes (4th, 7th or 10th grade) per school for half of the elementary, middle and high schools that participate in the study. The association between SHI scores and student weight, nutrition and physical activity outcomes will be measured. Pearson’s correlation (2-sided), independent samples t-test, and bivariate Chi-square analysis will be used to determine associations and to detect differences in student outcomes (p < 0.05) between schools with low versus high SHI scores. Results will be shared with participating schools. Results can be used to guide decisions regarding use of the SHI for addressing the Local Wellness Policy and targeting specific modules of the SHI for improvement to optimize student health outcomes.
According to the National Longitudinal Study of Adolescent Health, incidence of obesity increases significantly during the transition from older adolescence to early adulthood, and obesity during older adolescence is likely to be maintained into adulthood. Physical activity decreases during adolescence, and dietary habits associated with overall health and weight maintenance (e.g. sweetened beverage and milk consumption; fruit, vegetable and whole grain intake; overall nutrient density) worsen. Health habits established in older adolescence tend to persist into adulthood. As older adolescents transition to young adulthood, they experience increased autonomy and changes in social, physical and academic environments that may influence lifestyle choices and risk for obesity. Published studies and our preliminary results indicate poor nutrition and physical activity habits and risk of excess weight gain in college students. The School Health Index, developed by the Centers for Disease Control and Prevention, is designed to measure the comprehensive health environment for K-12 public schools. No such measure for the university health environment is currently available. One-third of persons aged 18-24 years in the United States are enrolled in a college or university; more than 50% of persons aged 20-24 years have attended some college. Thus, the university health environment could play a significant role in addressing the current obesity epidemic in the U.S. We are currently working to identify university factors most strongly associated with nutrition and physical activity habits and weight changes in college students.
Goals for several ongoing and related projects are to provide data on overall diet composition, calcium intake, breakfast habits, physical activity and body composition in college students and to follow changes in these measures over time. Students will be recruited from HNFE 1004, a freshman level nutrition course. Data to be collected include dietary intake, breakfast habits, physical activity, weight and height (BMI), waist-to-hip ratio (WHR) and body composition (lean mass, fat mass, and bone mineral density). Associations between diet and physical activity variables and changes in body composition will be measured to address limitations in published studies. Physical activity will be measured to assess its importance as an independent variable and its association with dietary habits. The longitudinal nature of the study will allow analysis of the relative effects of breakfast and physical activity on any observed changes in body weight and composition. Analysis of nutrient composition of the overall diet and breakfast itself will enhance the study by allowing analysis of the effect of nutrient composition of breakfast on overall diet composition as well as body composition. This information has not been reported in any previous longitudinal study.
The following project is under review for funding from NIH:
Total prevalence of diabetes in the US is estimated at 20.8 million currently and projected to be 39 million by 2050, with non-Hispanic blacks being 1.8 times as likely to have diabetes as non-Hispanic whites. Complications and comorbidities of diabetes are associated with increased medical expenses, disability and decreased quality of life. Maintaining HbA1c levels at or below 7% in patients with diabetes is associated with decreased medical expenses and lower rates of health complications, with more pronounced benefit for African Americans compared to Caucasians. Improving glycemic control through diabetes self-management is particularly important in African Americans to reduce risk of health complications from type 2 diabetes. Diabetes self-management education programs delivered in faith-based settings appear to be particularly effective for African Americans, should include spiritual leaders, and should address self-efficacy, social support and outcome expectations in addition to general education on diabetes and rationale for recommended self-care behaviors. The proposed study will implement a community-based diabetes education program guided by Social Cognitive Theory (SCT), Dining with Diabetes in Virginia (DwDVA), that is designed to be delivered in partnership with local Cooperative Extension Agents and healthcare professionals (registered dietitians/certified diabetes educators). In the proposed study, DwDVA will be delivered in partnership with the health ministry program of the statewide association of Baptist Churches that are predominantly African American and will target medically underserved areas of Virginia using a community-based participatory approach. Three churches in each of five geographic locations will be randomly assigned to one of three conditions: DwDVA, DwDV+ (plus monthly support groups) or delayed treatment control. The primary outcome variable will be glycosylated hemoglobin (HbA1c) as a marker of glycemic control. Secondary outcome measures will include blood pressure, body weight, nutrition and physical activity behaviors and SCT variables. Hypotheses include: 1) compared to the delayed treatment control condition at 3 months, DwDVA will be associated with improved HbA1c levels, body weight, nutrition and physical activity behaviors, and SCT variables; 2) compared to DwDVA, DwDVA+ will be associated with further improvement in outcome measures at 6 months; 3) change in SCT variables will mediate treatment effects on primary and secondary intervention outcomes. Both Cooperative Extension and the church-based health ministry are charged with delivering health education programs to communities across the state and have resources available to sustain and disseminate the program if it is found to be successful.
Future research projects will examine the association between nutrition and physical activity knowledge/attitudes/behavior of medical students and student comfort/skill in counseling patients regarding general nutrition and physical activity, especially as related to body weight and risk for type 2 diabetes. Several published studies have indicated that people prefer to receive information and counseling regarding lifestyle characteristics , including body weight, related to risk of chronic disease from their physicians. At the same time, physicians may not feel comfortable addressing these behaviors, related to their own personal habits or training. This research may be used to design educational curricula to address these factors.