3rd Annual

Children Eating Well (CHEW) for Health Symposium


The Center for Prevention Research (CPR), directed by Dr. Jan Emerson, organized and planned the third annual Children Eating Well (CHEW) for Health conference held on Friday, November 15, 2013.  A total of 192 registered for the conference and a total of 141 attended.  The attendees included approximately 40 students along with community members and faculty/researchers.


Participants during Exercise Break at the Annual Chew Conference, 2013

Dr. Jan Emerson, the TSU CHEW Co-PI, moderated the program. Dr. Latif Lighari and Dr. Baqar Husaini welcomed the attendees on behalf of Tennessee State University, the College of Agriculture, Human, and Natural Sciences (CAHNS), and the Center for Prevention Research, respectively.  Dr. Lighari, filling in for Dean Reddy who was at another conference, reported on the TSU Extension efforts to address family and consumer needs as relates to health and nutrition. Dr. Husaini, CHEW Principal Investigator, reported on pre-school children’s obesity trends according to the Centers for Disease Control (CDC).

Next, Dr. Emerson presented an overview of the CHEW project followed by reports on the progress and findings of each CHEW component. Dr. Robert Levine (Meharry CHEW Co-PI) presented that the CHEW Education component team has logged, as of conference date, 4,083 trainee hours instructing students and medical personnel (i.e., TSU nutrition undergraduates; Meharry physicians in training; practicing physicians and nurses; and Meharry medical students) in childhood obesity prevention.  Further, the Education component has collaborated with the Tennessee Department of Health in developing and disseminating a Nutrition and Physical Activity Toolkit designed to help educator, healthcare providers, hospital administrators, community outreach workers, and researchers find needed resources to encourage healthy eating and active living.  The link to the Toolkit can be found on www.NashvilleCHEW.org.

Dr. Chiquita Briley, the new CHEW Extension component leader, updated the audience on Extension activities. The Extension team has recruited 19 WIC-approved small to medium grocery stores and are helping them expand fresh produce sales.  Two healthy food tastings have been done at each of the 19 stores with an average of 25 shoppers served with positive feedback. Finally, Dr. Pamela Hull (Vanderbilt CHEW Co-PI) highlighted that the CHEW Research component team had completed analysis of the CHEW Phase One data of dietary purchasing, preferences, and consumption among Caucasians, African Americans, and Hispanics. Based on this analysis, CHEW Phase Two is developing a smartphone shopping application to assist WIC participants shop healthier and wiser, which Dr. Hull previewed with a video. CHEW Phase Three will test the mobile app with 100 WIC participants beginning in early 2014.

Following CHEW updates, there were nine presenters, including the Director of the Metro Nashville Public Health Department (Dr. Bill Paul) and Former Mayor of Nashville (Bill Purcell), along with seven researchers from TSU, Vanderbilt University, University of Mississippi Medical Center, University of Missouri, Middle Tennessee State University, and LiveWell NorthWest Colorado. Speakers presented on the following topics: family nutrition programs, obesity prevention policies, childhood obesity prevention for young Hispanic children, advantages of community gardens (TSU gardeners gave experiences), how the Institute of Medicine (IOM) contributes to childhood obesity prevention, helping early childcare centers to prevent childhood obesity, and fighting obesity through community participatory strategies. Lively question and answer sessions followed presentations.

Additionally, to evaluate the impact of the conference, CPR had attendees fill out a pre- and a post-conference evaluation to determine whether the attendees increased their knowledge of topics presented. We received 112 completed pre-conference and 85 post-conference evaluations. Of the 85 matching evaluations, the average pre-conference score was 64.7 ± 13.2% (min: 25%, max: 92.5%) while the average post-conference score was 77.2 ± 13.4% (min: 37.5%, max: 100%) This was a statistically significant (p<0.001) increase in knowledge from pre-conference to post-conference.

Impact of the conference has been further demonstrated by the very positive feedback we have received from many who attended. One community member who attended wrote: “This was one of the most dynamic conferences I have attended in a long time. All the presenters were excellent. Keep up the great work.”  We have been asked to put a summary of our conference on the Tennessee Obesity Task Force website and will be posting this summary along with conference presentations on our www.NashvilleCHEW.org website.

CHEW Symposium 2013 Program Abstracts

Janice S. Emerson, PhD; Robert S. Levine, MD; Chiquita A. Briley, PhD; Pamela C. Hull, PhD  “Nashville CHEW for Health: Progress and Findings

Education Component: To date, we have conducted over 4,100 trainee-hours of nutrition education to a variety of audiences from undergraduate students to practicing physicians.  Our Nutrition and Physical Activity Toolkit has been disseminated through ten Tennessee Department of Health-funded workshops in Memphis, Nashville, Johnson City, Kingsport, and Chattanooga.  It is available electronically at www.eatwellplaymoretn.org/state-initiatives/grantees.html, and in a four month period was accessed 543 times, with the average duration of a visit to the site lasting three minutes and fourteen seconds, indicating that when individuals visit the site, they spend time perusing the content. 

Extension Component: Assessments were conducted in 19 small to medium sized grocery stores that are WIC-authorized vendors.  At each store, social marketing events were held using recipes, and food tastings focusing on improving the usage of WIC foods by participants and community members that may live in WIC-based households. To expand outreach efforts a total of 10 peer educators from the Hispanic and African-American communities were trained to provide informal information sessions to WIC participants and other community members.  Progress and findings related to these projects will be presented.

Research Component: The goal of the CHEW Research Component is to develop and test nutrition consumer education materials that are culturally-appropriate for African American and Hispanic WIC participants with children ages 2-4, using a community-based participatory research approach.  In Phase 1, the team conducted the CHEW Nutrition Survey to inform Phase 2, intervention development.  Based on survey findings and input from the CHEW Community Advisory Board and WIC program, the team is currently developing a smartphone application that includes two components: (1) a WIC shopping tool to assist mothers with using their WIC vouchers, and (2) a nutrition education component focused on healthy snacks and beverages.  The research team will present an overview of the development of the app and provide a demonstration of the current prototype.  In Phase 3 (2014-2016), the intervention app will be tested using a randomized controlled design.

Jo Britt-Rankin, PhD                                                                                                           “University of Missouri Family Nutrition Education Programs: 1998-2013”

This presentation provides a 15-year history chronicling the University of Missouri's Family Nutrition Program, from a small regional program to the large statewide program it is today. The presentation will share the process used to expand the program, as well as maturation of the curriculum and evaluation strategies.

David G. Schlundt, PhD                                                                                                      “Tennessee Obesity Taskforce: Update on Obesity in Tennessee”

Tennessee continues to make some progress in addressing the obesity epidemic. Data from the Behavioral Risk Factor Surveillance System (BRFSS) from 1997-2012 will be examined to look at obesity trends over time, health disparities, and urban-rural differences. Recently released data from the Tennessee Coordinated School Health program will be presented to examine obesity in the children of Tennessee and to demonstrate progress that is being made in schools around the state. The presentation will end with an update on the Tennessee Obesity Taskforce and a description of how Tennessee will continue to address the obesity epidemic.

Bettina M. Beech, PhD                                                                                                              “Obesity Prevention Policies in Action: Playpens to Preschools”

National trend data indicates that overweight and obesity in infancy and early childhood is a pervasive public health problem. Addressing obesity prevention for 0-5 year olds necessitates influencing the behaviors and environments of those who care for infants and young children.  Decision makers, caregivers, and parents of young children are critical partners in creating environments and shaping local, state, and national policies to address obesity prevention for early childhood.  An overview of the framing of obesity, the current obesity policy environment, and recommendations from the IOM Committee on early childhood obesity prevention will be discussed in this presentation.

Roger Zoorob, MD and Pamela C. Hull, PhD                                                                         “Healthy Families Study: Childhood Obesity Prevention Trial for Young Hispanic Children“

The Healthy Families Study is an ongoing randomized controlled trial testing the efficacy of a community-based, behavioral family intervention to prevent excessive weight gain in Hispanic children using a community-based participatory research approach. The study enrolled 272 Hispanic families with 319 children ages 5-7 residing in greater Nashville, Tennessee, United States, who are being followed for one year. Preliminary analysis of selected outcomes at 4-month follow-up will be presented.

William S. Paul, MD, MPH, FACP                                                                                          “Nashville Putting Prevention to Work: Policy, Systems and Environmental Change to Promote Healthy Eating and Active Living”

In 2009, Nashville was awarded a two-year, 7.5 million grant, Communities Putting Prevention to Work, to create policy systems and environmental changes as an effort to reduce obesity community-wide.  The achievements of the program are many and diverse resulting in changes in the school and neighborhood food environment and workplace policies and practices. Such impacts will be discussed.

Arvazena E. Clardy, PhD                                                                                                                “TSU Community Gardens – Impact”

Tennessee State University implemented a Community Garden in March 2011, where TSU employees and students can grow their own fruits and vegetables. We believe by allowing people to grow their own produce, Community Gardeners will make better food choices, working in their gardens will provide exercise and individuals will develop friendships through their garden contacts. Gardeners were able to grow their own fruits and vegetables from April to December of each year. At the beginning of each year, Community Gardeners attend three workshops: Beginning Gardening, Weed Control, and Irrigation.  Over the past two years we have had more than 270 people working individually or in groups to plant, grow, and maintain their own garden plots.  Evaluation of how much produce was grown and the amount of saving to each gardener is being evaluated by surveying each Community Gardener.

Bill P. Purcell, JD                                                                                                             “Accelerating Progress and the Work of the Institute of Medicine”

This session will provide a look back and look ahead at the contributions of the Institute of Medicine to reducing the weight of the nation. The retrospective will review with broad strokes what was achieved in the last decade and the practical implementations of its work. In looking ahead, the recommendations from the recent IOM committee report, “Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation,” will be highlighted. Information about how the Institute is moving to a new phase with its new Roundtable on Obesity Solutions will be discussed.

 Don W. Morgan, PhD                                                                                                                    “A-B-C-1-2-3, Healthy Kids in Tennessee: Let’s Eat Well, Play, and Be Aware Every Day”

Let’s Eat Well, Play, and Be Aware Every Day” is a 12-week, hands-on, health education initiative targeting childcare providers, the children they care for, and their families. This collaborative project has received national recognition from the Centers for Disease Control and Prevention and was a 2012 National Comprehensive Cancer Control “Success Story.”   Components of the “A-B-C-1-2-3” program include curriculum modules promoting active play, healthy eating, smoke-free living, and cancer awareness in 3- to 5-year-old children.  Teacher and staff training and educational materials are available online and daycare facilities implementing “A-B-C-1-2-3” can receive training credits from the Tennessee Department of Human Services. Results and impacts of this program will be presented.

Barb Parnell, PhD                                                                                                                      “HEAL in LiveWell Northwest Colorado: Fighting Obesity through Community Participatory Strategies”

The nonprofit organization LiveWell Colorado (LWC) funds community coalitions throughout the state to design and implement multi-sector approaches to reduce obesity, focusing on policy and environmental change.  LWC provides community funding for up to 9 years with the intent of building momentum for a Healthy Eating and Active Living (HEAL) movement that will become a self-sustaining, permanent part of the community landscape. This presentation will highlight experiences and lessons learned from LiveWell Northwest Colorado (LWNWCO), a rural county initiative. Session topics will include LWNWCO coordinated school health strategy and evaluation efforts.

CHEW Symposium 2012 Program Abstracts

Roberts S. Levine, MD, Meharry Medical College; Veronica J. Oates, PhD RD, LDN, Tennessee State University; Pamela C. Hull, PhD, Vanderbilt University School of Medicine 

“Nashville CHEW for Health: Progress and Findings”    

Education Component: The first objective is to implement curriculum for Meharry medical students, residents and practicing physicians on child obesity prevention.  The second objective is to implement curriculum for TSU students and post-doctoral fellows on obesity prevention, nutrition-related chronic diseases and non-pharmacologic approaches to their prevention and management.  Overview of the curricula and implementation progress will be presented.

Extension Component: The first objective is to provide technical assistance to WIC-authorized vendors to expand the availability and marketing of healthy foods, with the goal of expanding shelf space for fruits, vegetables, low-fat dairy and whole grains.  The second objective is to conduct consumer education outreach to improve dietary practices, through in-store healthy recipe demonstrations in participating stores, and training African American and Hispanic peer educators (current or former WIC participants) to promote healthy eating to others in the community.  Progress and findings related to these objectives will be presented.

Research Component: The objective is to develop and test nutrition consumer education materials that are culturally-targeted for African American and Hispanic WIC participants with children ages 2-4. In Phase 1 of the study, the team implemented the CHEW Nutrition Survey (N=150 families with a WIC-enrolled child ages 2-4) to gather quantitative and qualitative formative data and to examine racial/ethnic differences in attitudes and behaviors related to nutrition. Preliminary findings will be presented from the survey, which will guide development of the culturally-targeted intervention in Phase 2 of the study.

Shari Barkin, PhD, MSHS, Vanderbilt University School of Medicin

“Family-based Community Centered Childhood Prevention Research: Results from the Field”   Objective: To test the effect of a culturally-tailored, family-centered, short-term behavioral intervention on Body Mass Index (BMI) in Latino American preschool-aged children. Patients and Methods: In a randomized controlled trial, 54 parent-child dyads were allocated to the intervention, and 52 dyads were allocated to an alternative school-readiness program as the control condition. Parent-child dyads were eligible if the parent self-defined Latino/a, was at least 18 years old, had a 2-6 year old child not currently enrolled in another healthy lifestyle program, had a valid phone number and planned on remaining in the city for the next 6 months. Salud Con La Familia (Health with the Family) consisted of 12 weekly 90-minute skills-building sessions designed to improve family nutritional habits and increase physical activity. Both programs were conducted in a community recreation center serving an urban neighborhood of mostly Spanish-speaking residents. Results: Forty-two percent of participating preschool children were overweight or obese. Controlling for child age, gender and baseline BMI, the effect of the treatment condition on post-intervention absolute BMI was B = -0.59 (p< 0.001). The intervention effect appeared strongest for obese children. Conclusion: A skills-building, culturally-tailored intervention involving parent-child dyads changed short-term early growth patterns in Latino American preschoolers. Examining long-term effects would be a prudent next step. Trial Registration: ClinicalTrials.gov Identifier - NCT00808431

Janice S. Emerson, PhD, Center for Prevention Research, Tennessee State University  

“Empowering Youth to Choose a Healthier Diet and More Physical Activity.”    Obesity prevention programs that are tailored for adolescents, who are at risk of obesity, are critical for African American (AA) youth, especially those from very low-income communities. Yet only insufficient data are available on effectiveness of these obesity prevention programs. The “Empowering Youth to Choose a Healthier Diet and More Physical Activity” project was designed to encourage better nutrition and physical activity choices during a summer camp held four days a week for five weeks by Tennessee State University’s Youth Empowerment Program (YEP) in June/July 2012. The project followed USDA’s “ChooseMyPlate 10 Tips Nutrition Education Series” guidelines and includes baseline, interim, and 3-month follow-up surveys of nutrition knowledge and behavior. Among the 23 participants, 45.8% were overweight or obese at baseline. Interim data showed significantly higher proportions of students compared to baseline answered correctly that light ranch was lowest in calories out of a list of 6 salad dressings and correctly chose the two meals of out a list of five not containing high amounts of protein, vitamins, minerals and fiber (p<.05). More importantly, analysis of behavior revealed a significantly higher proportion of students reported having for lunch during past week:  lower fat salad dressing (p<.05); a baked potato (p<.05); and water for their beverage (p<.01). Preliminary results suggest that even among this adolescent, low SES, and high-risk population positive changes in diet are possible with intensive education and experience eating healthy snacks and lunches. A three-month follow up survey will determine if positive changes in nutrition knowledge and dietary behavior were maintained. 

Ann Ferris, PhD, RD, University of Connecticut

“Issues with Reducing Sugar-sweetened Beverage Consumption in Pre-school Children”   The city of Hartford, CT is located in the second wealthiest state in the U.S.   Hartford, with a predominantly minority population, is one of the poorest medium-sized cities in the nation. The dichotomy between rich and poor in Connecticut is reflected in major health disparities and high rates of preventable health problems, such as obesity.  Seventeen percent of the preschool children are classified as overweight and 20% as obese.  The presentation by Dr. Ann Ferris will describe the research and outreach programs at the Center for Public Health and Health Policy and its Urban Health Partnership developed in collaboration with the city and public and private agencies with both state and federal funding designed to understand and ultimately reduce the alarming rate of childhood obesity in the city.  Formative research on parents’ misperception of childhood obesity, their difficulty in interpreting the health value of beverages, and beverage consumption by caretakers and children led to the development of interventions designed to reduce sugar-sweetened beverage and 100% juice consumption among children in the city and to increase healthy foods in small corner markets.  She will briefly describe the UConn Husky Nutrition Program and the usefulness of undergraduate university students in effectively delivering nutrition education programs.  Funding sources that support or have supported her work are USDA/AFRI (Integrated Obesity and seed grant Programs), USDA/FNS (Supplemental Nutrition Assistance Nutrition Education), USDA/CSREES (Higher Education Challenge Grant), the Donaghue Foundation, the City of Hartford, the CT Department of Social Services, the University of Connecticut Health Center, and the Connecticut Center for Clinical and Translational Science. 

Michelle Garza, MAg, New Mexico State University

“Shake Your Groove Thing: Exergame Guidelines, Research and Recommendations”   You've heard of the Nintendo Wii, and maybe you've seen or played the newest "Kinect" for the xBox; but can these exergames (active video games) help you meet your program objectives? Michelle Garza, exergames outreach educator and research coordinator on the Exergames Unlocked project at New Mexico State University will share the latest research on the impacts of exergames, including ways in which they can burn calories, increase resting heart rate, and change sedentary patterns. She will also share latest work on how they are using exergames to increase academic performance in schools, and participation in after school programs. Expect to get up and move as you experiment with the latest exergames and learn how to best use them in your programs.

Kimberly Harrell, BS, Vanderbilt Children's Health

“Changing Habits Academically, Mentally, and Physically with Gardens (CHAMPS)”  Garden-based education and programming can be a successful approach to building environments conducive to good nutrition, active living, positive social and emotional development, academic achievement, and successful community partnerships.  Methods included a model developed for schools by Vanderbilt composed of the following: Organizing leadership committees for program development, implementation, and evaluation; Building strategic partnerships to provide necessary knowledge, resources and skills; Creating opportunities for student, family and community involvement; Integrating gardens into academics; Supplementing gardens with walking trails, staff wellness, and teaching kitchens; and Promoting policies to develop sustainability for garden programs. Results include: Improved knowledge and attitudes about healthy eating; Increased access to healthier foods and opportunities for physical activity; Social and emotional learning skills such as problem-solving, communication, collaboration, and appreciation for diversity; and Increased self-efficacy and empowerment for at-risk students. The implications are that gardens can empower at-risk youth, teach healthy behaviors, build healthy environments, and instill lifelong habits that promote physical, mental, social, emotional, intellectual, and spiritual health.

Susan Johnson, PhD, University of Colorado - Denver

“Be a Super Taster & a Mighty Mover: An update on the Colorado LEAP Study to Prevent Early Childhood Obesity”  It has been suggested that the preschool years are a critical time to begin obesity prevention efforts as they represent a time when young children establish healthy eating habits and physical activity patterns.  Child behaviors, such as dietary intake and physical activity, can place children at risk for overweight and are shaped by many characteristics, including individual (age, gender, and susceptibility to weight gain), school, family and societal environmental characteristics.  While many behaviors have been shown to influence dietary intake, physical activity and weight status, two potential predictive behaviors of food preference and motor performance need further exploration in young children. Two theory-based interventions - Food Friends- Making New Foods Fun for Kids® and Food Friends Get Movin’ with Mighty Moves™ - have successfully demonstrated increases in both children’s willingness to try new foods (food preference) and motor performance in preschool-aged children.  To further explore the efficacy of these two programs, and how they relate to child weight status, we are conducting a longitudinal study to see if the following questions can be addressed:  (1) What are the longer term impacts on children who participate in Food Friends® and Mighty Moves™?  That is, are improvements in willingness to try new foods and motor skills sustained through kindergarten and 1st grade? (2) Do improvements in willingness to try new foods and motor performance have impacts on children’s dietary intake and physical activity?  (3) Do the Food Friends® and Mighty Moves™ programs have an impact on reducing the percentage of children considered overweight and at risk for overweight in kindergarten and 1st grade?  To answer these questions a longitudinal cohort study is being conducted in rural Colorado.  Children and families will be recruited through Head Start programs in the mountains and eastern plains, will target limited income Hispanic and Non-Hispanic families, and will follow them over a 3-year timeframe.  

William S. Paul, MD, MPH, FACP, Metro Nashville Public Health Department

“Nashville Putting Prevention to Work: Policy, Systems and Environmental Change to Promote Healthy Eating and Active Living”  In 2009, Nashville was awarded a two-year, 7.5 million grant, Communities Putting Prevention to Work, to create policy systems and environmental changes as an effort to reduce obesity community-wide.  The achievements of the program are many and diverse, aimed at increasing healthy eating and active living, and include food environment policy changes, bike share, community gardens and lactation support. 

Joan A. Randall, MPH, Vanderbilt University/TN Obesity Taskforce

“Tennessee Obesity Task Force Update”  Representing nearly 700 individuals and organizations across the state, the Tennessee Obesity Taskforce (TOT) is unique in that it links scientists and clinicians with city planners, school officials, state agencies, policymakers, community advocates, transportation experts, nutritionists, parents, and representatives of our most vulnerable populations.  The TN Obesity Task Force created a comprehensive and cohesive state plan called Eat Well Play More Tennessee to reduce obesity and its related chronic diseases (such as diabetes, hypertension, heart disease, and some cancers). The plan was launched in September 2010. ( www.eatwellplaymoretn.org ).In partnership with the Tennessee Department of Health, the Tennessee Obesity Taskforce is working with multiple partners to address the following target areas: Increased physical activity; Increased consumption of fruits and vegetables; Decreased consumption of sugar-sweetened beverages; Increased breastfeeding initiation and duration; Reduced consumption of high-energy-dense foods; and Decreased screen (TV/Video) time. TOT has 11 Action Teams implementing the plan across the state in the following focus areas - with an emphasis on policy and environmental change: Advocacy, Breastfeeding, Built Environment and Transportation, Early Childcare, Evaluation, Food Systems, Health Systems, Parks & Recreation, Schools, Vulnerable Populations, Worksite Wellness. TOT is closely aligned with scientists and academic institutions across Tennessee and nationally to integrate evidence-based strategies into the efforts of each action team.

Flora A. M. Ukoli, MD, MPH, Meharry Medical College

“Preventing Overweight In African-American Infants: The Baby-Friendly Initiative Model”    Up to 25% pre-school children in the U.S. are overweight, and low-income minority children are disproportionately affected. Rapid weight gain in the 1st year of life is an important predictor of childhood obesity that can be prevented by healthy infant feeding practices that include exclusive breastfeeding for the first 6 months of life, delayed weaning till the 2nd birthday, and restriction of high-calorie sweetened beverages. The prevalence of breastfeeding at birth of 70.9% overall and 51.1% in African-Americans with respective exclusive breastfeeding rates of 36.2% and 21.9% must be improved to control rapid weight gain in infancy. In order to develop an education intervention to prepare mothers to make healthy infant feeding choices we conducted a cross-sectional survey to assess the childhood obesity and breastfeeding knowledge, attitude, and practices among African American mothers. The 75 participants were aged 18-52 years, 53% had a high school diploma or less, 47% were unemployed, and 56% earned less than $10,000 annually and overall 56% were single-mothers. We observed that the level of awareness and concern about overweight in young children was very high. Mothers knew what the average birth weight should be but exaggerated the size of a baby at 6 months and older. Half of the mothers have a fairly good idea how to prevent overweight in children, but over half of them did not know the effect of breast milk, formula, ice cream, desserts and high-calorie beverages such as milk, juice, and soda on weight gain. They were familiar with the advantages of breastfeeding, but did not realize that breast milk was superior to formula, or that it protects against overweight. They had not heard the term ‘exclusive breastfeeding’ and they also did not know any of the strategies for successful breastfeeding.  A culturally appropriate education intervention based on the principles of the Baby-Friendly Hospital Initiative has been developed in partnership with these mothers to promote breastfeeding and prevent overweight in infants and toddlers.


CHEW Symposium 2012 Poster Abstracts

Husaini Oates and Nissa

Baqar Husaini, Ph.D.,  Veronica J. Oates, Ph.D RD, LDN, and Nerissa Aquino

Scottie Bussell, MD, MPH, Courtney Kihlberg, MD, MSPH, Meharry Medical College

“Meeting Accreditation Council for Graduate Medical Education (ACGME) Competencies through a Multi-Institutional Nutrition Practicum Experience: An Analysis of Resident Participation in Children Eating Well for Health (CHEW) Nashville”  The objectives were to enhance existing academic and practicum training on childhood obesity prevention, the Meharry Medical College Preventive Medicine Residency Program provided experiential learning activities to its occupational and preventive medicine residents through CHEW, a USDA-AFRI funded multi-institutional program with the goals of (1) improving nutrition education across multiple levels of training and practice and (2) analyzing and enhancing WIC participants’ use of nutritious supplemental food to reduce the rate of childhood obesity.   The objective of this study was to assess the degree to which residents participating in CHEW activities were able to fulfill ACGME competencies. Residents’ activities were classified under CHEW focus areas: research, education, extension, and grant leadership/ administration.  Activities were categorized using ACGME Program Requirements for Graduate Medical Education in Preventive Medicine, 2011 to determine which competencies each activity satisfied. Resident records were reviewed between July 2011 and July 2012 (N=7).   Residents were compared by rotation type (partial, two weeks; full, one month) to evaluate differences in ACGME requirement attainment.  The median number of times residents met ACGME requirements across focus areas (an indication of practice) were: medical knowledge (4x), interpersonal & communication skills (4x), practice-based learning & improvement (3x), systems-based practice (3x), professionalism (2x), and patient care (4x). Eighty-three percent of residents met all six ACGME requirements by conducting research; 69% through educating others; 76% through extension activities; 71% by acting in a grant leadership/administrative role. There were no significant differences in the portion of residents fulfilling ACGME requirements by rotation type. Without an extensive time commitment (≤ one month), the majority of residents fulfilled all six ACGME competency requirements while acquiring training in childhood obesity prevention and control.

Cynthia Chafin, MEd, TN Cancer Coalition/Middle Tennessee State University

“A Big Feat for Little Feet: A-B-C-1-2-3 Healthy Kids in Tennessee – Let’s Eat Well, Play, and Be Aware Every Day”  Objectives were: 1) To reach children ages 3-5 in a childcare setting, their parents and caregivers, and childcare providers with important information on healthy lifestyles, which may prevent cancer, obesity, and other chronic diseases and health conditions; 2) To facilitate interactive learning activities for children related to healthy lifestyles; 3) To facilitate educational opportunities for parents and caregivers and childcare providers related to healthy lifestyles and cancer prevention; 4) To build lifetime healthy habits in children ages 3-5 and their families, ultimately reducing the burden of cancer in Tennessee. A multi-year project, onsite training for childcare centers began in 2007 and continued through 2012 with 991 children and 198 childcare teachers and staff participating.  An online training component was added in 2012.  The Tennessee Cancer Coalition’s A-B-C-1-2-3 Healthy Kids in Tennessee program brings healthy living and disease prevention to childcare centers. Health education experts and coalition members have created a three-unit interactive curriculum, which has been field-tested and reviewed by the Vanderbilt Institute for Clinical and Translational Research.   Program materials are provided free to childcare centers, along with training and an on-going coalition volunteer mentor to help with implementation.  Curriculum modules include Active Play, Nutrition, and Awareness (which includes a childhood cancer component for adults, along with an emphasis on second-hand smoke).  Each module features activities for children, take-home materials for families and an evaluation component and is designed to be self-sustaining so that providers can continue to use the program as new staff and children join the childcare facility.  Program data is currently being compiled with a complete report anticipated 9/30/12.  One immediate outcome has been partnerships with Tennessee Department of Human Services, Extension Services, Children’s Services, Childcare Resource and Referral Program, and the Leukemia & Lymphoma Society.  Coalition volunteers facilitate meaningful and fun healthy living and disease prevention activities.   The program puts health messages in the little hands of the next generation of Tennesseans to take home to their families.

Angela Chapman, Meharry Medical College

“Prevalence of Overweight and Obesity among Minority Children at Nashville General Hospital”  Obesity has become a major health concern around the world.  Over the past three decades, the prevalence of obesity in young children and adolescents (aged 2 – 19 years) has nearly tripled.  High prevalence of childhood obesity has been consistent in Tennessee for decades.   In 2010, Tennessee recorded the 6th highest rate for childhood obesity with Latino and African American children having about a 2-fold overweight & obesity rate compared to Caucasian children.  The objectives of this study were to estimate the prevalence of overweight and obesity for male and female children aged 6 months to 10 years and to demonstrate the association between early childhood overweight and subsequent overweight in minority children.  It is hypothesized that children who are overweight at age 0-2 years are likely to remain overweight at 5 years and older. This is a retrospective medical record analysis of 185 children aged 10 years and younger seen at Nashville General Hospital.  Body mass index (BMI), age- and sex-specific BMI percentiles, and weight-for-recumbent length percentiles were used to identify overweight and obesity status in children.  Associations between early childhood overweight and overweight after the age or 5 years were assessed using independent samples t-test and chi-square tests.  Data was analyzed using SPSS Version 20.0.  In children aged 0-12 months, 8% were overweight.  Approximately 17% of the children aged 2-10 years were overweight and 16% were obese.  Of the 7 age group cross tabulations, 22% of males that were normal weight became overweight, and 43% who were overweight remained overweight.  18% of females that were normal weight became overweight, whereas 80% who were overweight remained overweight.  The highest percentage of overweight occurred after age 5 in both males and females.  The rate of obesity increased in both males and females as age increased.  Children who are overweight in early childhood have a higher risk of remaining overweight in later childhood.  Overweight and obesity prevention methods should be established in early childhood to prevent the likelihood of overweight and obesity in later childhood.  Obesity interventions should be targeted at school-aged children.  Limitations of this study are small sample size and that the medical records are of children that presented to the clinic with possible illnesses that may have interfered with weight.  

Deanna Froeber, MDiv, Vanderbilt University

“Health Literacy: The Relationship Between Health Education and Healthy Behavior Choices: Evaluating the Community and Students Together for Learning Enhanced Service (CASTLES) Program”  Pediatric obesity disproportionately affects African American youth. According to BRFSS data, African Americans are more likely to not have exercised in the past month and less likely to consume five servings of fruits and/or vegetables per day. The goal was to contribute to the reduction of racial/ethic disparities in Type 2 Diabetes by implementing and evaluating a promising anti-obesity program.  This study was a community-engaged approach to obesity prevention and reduction in African American youth ages 6-14 living north Nashville. This program was delivered at low cost in an after-school program by college students with federally subsidized wages. Students delivered the 56-unit CASTLES nutrition and physical activity curriculum. We recruited from 8 area schools. We worked with Metro Transportation and a local minority-owned business to provide transportation. We tracked intake of sugar-sweetened beverages, physical activity, screen time, knowledge of nutrition and healthy behaviors, and BMI at three waves.  A total of thirty-three youth completed the study. There was a 40:60 percent ratio of female and male participants, respectively. We conducted a paired-samples t-test to compare the minutes of physical activity in wave 1 and wave 3. There was a significant difference in the scores for minutes of physical activity in wave 1 (M=30.6, SD=21.64) and wave 3 (M=44.2, SD=19.04) conditions; t (32)=2.77, p=0.009. Curriculum knowledge was defined as correct responses to five questions. There was significant difference in the scores for the wave 1 (M=2.21, SC=1.34) and wave 3 (M=4.09, SD=.947) conditions; t(32)=-8.50, p=0.001.  A sweet drink was defined as the reported number of sugar-sweetened beverages drunk each day. Although a paired-samples t-test was conducted to compare sweet drinks consumed in wave 1 and wave 3, there was no significance in the scores for the wave 1 (M=1.64, SD=1.52) and wave 3 (M=1.27, SD=1.28) conditions; t(32)=1.09, p=0.284.  However, when we conducted a paired-samples t-test to compare average daily consumption of 3 or more sweet drinks in waves 1 and 3, there was a significant difference for the wave 1 (M=3.8, SD=.441) and wave 3 (M=1.2, SD=1.48) conditions; t(8)=5.75, p=.001.  69.7% and 100.0% of youth indicated water consumption was important regardless of being thirsty during wave 1 and wave 3 respectively.  The results confirmed that developmentally appropriate after-school programs focused on nutrition, healthy behavior knowledge, and physical activity opportunity can contribute to the reduction of racial/ethnic disparities in obesity and risk of type 2 diabetes.

Leslie Hamlin, MS, Meharry Medical College

“Breastfeeding Knowledge, Attitude, and Practice of African American Mothers in Nashville, TN.”  The purpose of this study is to evaluate the breastfeeding knowledge, attitude, and practices of African American mothers with the goal of developing an education intervention for improved decision-making regarding breastfeeding in this population. Objectives were: 1) To evaluate African American women attitude and knowledge toward breastfeeding.  The data collected from this project will be analyzed to determine the women’s perception and knowledge of breastfeeding versus formula milk.  2) To evaluate African American women practice in breastfeeding.  Their mother or any other significant figures practice of breastfeeding will also be assessed to identify any factors that may influence their decision making in breastfeeding. 3) To recruit an additional sample of 20 African American women of childbearing age and allow them to complete a “Baby Friendly Initiative in Minority Women:  Knowledge, Attitude & Practice” survey.  African American women with at least one child under the age of 5 were recruited around Davidson County by distributing flyers.  The women were consented before they completed a ‘Baby-Friendly Initiative in Minority Women: Knowledge, Attitude, & Practice Survey’ by interview. Demographic characteristics were described by frequency distribution, and the Chi-Squared test was used to compare sub-group differences regarding breastfeeding level of knowledge, practice, influences and barriers, using SPSS version 19.  Mothers that were more aware of the advantages of breastfeeding were more likely to choose to breastfeed than the mothers that lacked this knowledge, 35 (77.8%) vs. 10 (22.2%), p<0.01. Mothers who had their babies in institutions who incorporated ‘Baby-Friendly’ Hospital Initiative practices were more likely to breastfeed compared to those who did not, 38 (84.4%) vs. 7 (15.6%), p<0.01. Thirty-two (42.7%) of mothers perceived breastfeeding as painful, however this barrier did not prevent them from breastfeeding. Positive consideration regarding breastfeeding was 30 (85.8%) among mothers with a college degree, 23 (82.1%) mothers with high school diploma, and 8 (66.7%) mothers with less than high school education, p=0.07.  A small sample size is a limitation that will be overcome in a fully funded larger study.   African-American mothers recorded a positive attitude to breastfeeding that can be improved through a culturally appropriate education intervention to improve their breastfeeding knowledge and skills. More hospitals need to adopt the ‘Baby-Friendly’ principles to sustain the breastfeeding promotion and support needs of the African-American mothers they serve.   

Pamela C. Hull, PhD, Vanderbilt University School of Medicine

“Cultural-tailoring of a childhood obesity prevention program for Hispanic families” Childhood obesity is a critical public health threat in the US due to the increasing prevalence of obesity among children and adults over the past three decades.  The rise in obesity parallels changes in the physical design of communities, changes in American dietary practices, decreases in physical activity, and increases in sedentary behavior.  While this epidemic affects all socioeconomic levels, certain racial/ethnic groups are disproportionately affected, including Hispanics. The objective of this paper is to report the process used to adapt the We Can! childhood obesity prevention program developed by National Heart, Lung and Blood Institute to be culturally-tailored for the Hispanic/Latino families, using a community-based participatory research (CBPR) approach. In the formative research phase, focus group data were collected to identify aspects of the We Can! program to modify to be culturally appropriate. In conclusion, the Healthy Families intervention is now being tested in an ongoing randomized controlled trial.

Pamela C. Hull, PhD, Vanderbilt University School of Medicine

“Healthy Family Study: Design of a Childhood Obesity Prevention Trial for Hispanic Families” Hispanics are disproportionately affected by the childhood obesity epidemic. This paper reports on the design and baseline characteristics of the ongoing Healthy Families Study, a randomized controlled trial (RCT) testing the efficacy of a family-based behavioral intervention to prevent excessive weight gain in Hispanic children using a community-based participatory research approach. The study will enroll 270 Hispanic families with children ages 5-7 residing in Nashville/Davidson County, Tennessee.  Families are randomized to the active weight gain prevention intervention or an alternative intervention focused on oral health.  The active intervention is implemented by lay community health promoters in a community center.  This intervention was adapted from the We Can! parent program to be culturally-targeted for Hispanic families and for a younger age group. It promotes healthy eating behaviors, increased physical activity, and decreased sedentary behavior, with a strong emphasis on parental modeling as well as experiential learning for children.  The primary outcomes are change in body mass index of the children.  Secondary outcomes are waist-to-hip ration, changes in children’s behaviors related to healthy eating, preferences for fruits and vegetables, physical activity, and screen time. As of June 2012, 180 Hispanic families have enrolled, completed baseline assessment, and been randomized to study groups.  The sample is comprised of immigrant parents with relatively low education and income and mostly U.S.-born children. Approximately 82% of parents and 56% of children were overweight or obese at baseline. This study will contribute valuable evidence on the efficacy of a childhood obesity prevention intervention targeting Hispanic families.

Jessica Jones, MS, Tennessee State University

“Presence of a Television in Children’s (ages 2-4) Bedroom: A Risk Factor for Obesity”  Approximately 17% of 2-19 year olds in the US are considered obese. Among low-income children, 1 in 7 preschool-aged children are obese. Over 30% percent of children younger than 6 years of age have been found to have televisions in their bedrooms.  Many studies have noted that having a television in a child’s bedroom is associated with increased television viewing, which may have led to weight management issues. This study examines the association between the presence of a television in the child’s bedroom and body mass index (BMI) status among children 2-4 years old. The data used for this presentation were drawn from the CHEW Nutrition Survey, which were collected as part of the research project under the Nashville Children Eating Well (CHEW) for Health grant.  A stratified random sample was recruited of 50 each of non-Hispanic White, non-Hispanic Black and Hispanic families with at least one enrolled child 2-4 years old participating in the Nashville/Davidson County Women, Infant, Children’s supplemental food program (WIC). They were interviewed using a structured questionnaire with anthropometric measures of mother and child taken at time of interview. The analysis presented in this poster used the following variables: child’s BMI categories of underweight, normal and overweight/obese, ethnicity, and the presence of a television in child’s room.  A cross-tabular analysis was conducted and chi-square measured for significance. Results indicate a significant association (p<.05) between a child’s weight status and the presence of a television in the child’s bedroom. A higher proportion of overweight and obese children had a television the bedroom (81.3%) compared to normal weight children (76.8%) in this sample. Further breakdown by ethnicity reveals a significant association (p<.05) for non-Hispanic White children between weight status and the presence of a television in the bedroom, with 93.8% of the overweight or obese children compared to 72.4% of normal weight having a television in the bedroom; however, this association was not statistically significant for non-Hispanic Black or Hispanic children. Results from this study suggest the need to caution parents regarding the presence of a television in a child’s room. Removal of the television may be a possible strategy for parents and caregivers that are concerned about their child maintaining a healthy weight.

Rebecca Morris, BS, CLC, Metro Nashville Department of Public Health

“Changing a Communities Culture: Strategies to Promote and Support Breastfeeding in the Southeast”  Obesity is one of the most prevalent health issues facing US. In the “2010 F as in Fat Report,” Tennessee ranks 49th in obesity rates among adults and children. The United States Breastfeeding Committee recommends breastfeeding as a primary prevention strategy to reduce obesity and promote healthy weight throughout life. Nashville’s Communities Putting Prevention to Work (CPPW) campaign includes changing community culture working with institutions to create policy, systems and environmental changes (PSE) that promote and support breastfeeding. Objectives are grounded in evidence and target places most likely to impact initiation or maintenance of breastfeeding including workplaces, maternity hospitals, and community places.  Objectives enhance current work of Women Infant and Child (WIC) and Fatherhood Project resulting in cross bureau collaboration and a robust intervention.  Objectives include: 1) Minimum of 2 maternity hospitals serving greatest proportion of low-income mothers will adopt WHO/ UNICEF Baby-Friendly hospital criteria; 2) Ten largest employers will adopt and implement lactation policies and environmental supports; 3) Develop and implement city-wide media campaign to promote and support breastfeeding including workplaces, places of worship and community.  Community Breastfeeding Workgroup provided input on policy change within hospitals and fostered support in the community.  Workgroup included representatives of 2 local hospitals, WIC, Board of Health, community advocates and internal staff.  Nashville’s approach of encouraging hospitals to incrementally increase breastfeeding initiation rates uses evidence-based practices that demonstrate greater number of interventions new mother’s experience, greater likelihood of success. Steps that were chosen localized ‘Ten Steps to Successful Breastfeeding’ to specific climate within hospitals allowing celebration of success.  Five,  local hospitals were engaged and three accepted technical assistance improve policy and practice.  ‘Breastfeeding Welcomed Here’ initiative promotes social acceptance of breastfeeding. Initiative encourages businesses and community organizations to provide a welcoming environment for breastfeeding mothers and to educate staff on the law (TCA 68-58-101) protecting public breastfeeding rights.  Initiative aims to allow families to be at ease by displaying commitment through a pledge, and window decal.  Grassroot’s initiative was shared by community members interested in having more locations support breastfeeding.  Workplace team engaged ten largest local employers with “Prescription for a Healthier Workplace” promoting PSE for lactation impacting over 96,000 employees.  Nashville has taken significant strides implementing PSE to support breastfeeding mothers. Momentum seized by legislative efforts, policy implementations, and positive response from the community, ensures that Nashville is not only aligned with national agenda, but serves as a national leader in promoting breastfeeding awareness.

Veronica Oates, PhD, Tennessee State University

“Youth Active and Media Savvy (YAMS) 2012 Summer Camp Sessions: Preliminary Findings” African Americans disproportionately have higher rates of obesity and reportedly watch more television than other Americans. Although many social, cultural, and environmental factors influence childhood and adolescent risk for obesity, marketing may have an especially powerful impact on increasing food and beverage consumption. YAMS serves to launch a legacy of health empowerment for African American youth, age 8-14 years living in Davidson County, Tennessee. This interactive program aims to promote self-confidence and healthy behaviors as the participating youth engage in culturally relevant activities that increase: (1) media literacy; (2) healthy cooking skills; (3) food safety knowledge; (4) physical activity; and (5) self-esteem. Using an adoptive model, two 2-week long camps were held June 11-22 and July 16-27, with a total of 61 participants attending both camps. Each camper received a journal to record their thoughts regarding their awareness, attitudes and behaviors regarding the daily media, diet and physical activity lessons. Camp participants were instructed using activities adopted from the Media Smart Youth © curriculum. High school students, ages 16-8 years, paid as Peer Educators, served as role models. Recipes, nutrition lessons, and cooking were planned, prepared, and taught by a Registered Dietitian, Participants prepared their lunches after receiving food safety preparation lessons beforehand. Each day, campers were involved in 60-minutes of physical activity. Campers participated in cultural and self-esteem empowering activities in gender-specific social circles daily. Field trips taken include a trip to a grocery store, a local radio station, and the Challenge Course at the Agricultural Research and Education Center in Ashland City. Youth created and presented various forms of media and artistic expression (i.e. posters, songs, raps, poems, and videography) concerning deceitful food marketing, healthy habits, the YAMS camp, and positive self-images of their culture. Observations and self-reports from camp participants and their parents/guardians affirm that campers were motivated to implement and share healthier food alternatives at home. Negative outcomes include the camper’s initial hesitancy to embrace the menu, lack of enthusiasm for Media Smart lessons, and interpersonal conflict. Adaptation of Media Smart Media Lessons is not appropriate for delivering media literacy education to this population. Relevance to messages and images appears to hinder the transference of meaning and cognition of more persuasive techniques employed by marketing companies. Participant observations revealed that use of peer educators in delivering the camp requires revisiting.

David Schlundt, PhD, Vanderbilt University

“Eat Well-Play More Tennessee: A State Plan of Action to Address the Obesity Epidemic”  The Tennessee Obesity Task Force (TOT) was formed in 2007 when a group of public health professionals from Tennessee attended the Southern Obesity Summit and realized Tennessee was not organized to address the obesity epidemic like other southern states.  The group expanded to include a broad statewide coalition then collaborated with the Tennessee Department of Health to compete for a CDC obesity planning grant, which was funded in 2008.  In 2010, the state plan, titled Eat Well-Play More Tennessee (http://www.eatwellplaymoretn.org/), was unveiled at the annual meeting of the Tennessee Public Health Association.  The plan is intended to focus on changing policies, environments, and systems in order to make it easier for the people of Tennessee to make healthy eating and activity choices.  The plan is organized around the following action teams: Advocacy, Breastfeeding, Built Environment / Transportation, Early Childcare, Evaluation, Food Access, Health Systems, Parks & Recreation, Schools, Vulnerable Populations, and Worksite Wellness.  This poster will present the highlights of the state plan, and describe how Tennessee is organized to implement the plan. Data from the annual Behavioral Risk Factor Surveillance System surveys will be presented to show how overweight and obesity in adults have declined since the implementation of the plan.  The Youth Risk Behavior Survey data, collected every other year, will also show improvements in high school aged children.  We will describe the mini-grant program, and our efforts to document success stories from communities all over Tennessee.

Leslie Speller-Henderson, MS, Tennessee State University

“Making Healthy Lifestyle Choices – Summer Feeding and Community Nutrition Education Programs Work Together to Feed and Teach Youth” Tennessee State University Cooperative Extension Program EFNEP Nutrition Educators work with children in diverse settings to encourage them to make healthy food and lifestyle choices using MyPlate and according to the Dietary Guidelines for Americans 2010.  A very successful nutrition education program was conducted in Dyer County, Tennessee in the summer of 2012 in conjunction with the USDA Summer Feeding Program. The seven-week community-based program, working with children ranging in age from 3 years to 14 years, was conducted in local community centers and churches.  The youth learned about the five major food groups, portion sizes, why physical activity is so important, the importance of drinking water and milk, the benefits of including whole grains in their diets, how fruits and vegetables are good for health and about basic food safety procedures, such as washing hands. This community nutrition education program was deemed a success based on feedback from the children and the implications for the future would be to include the parents in learning how to encourage and support their children in making the healthy food choices about which they learned.

Ying Wu, PhD, Tennessee State University

“Soybean dietary fiber: A functional ingredient for prevention of childhood obesity” High fiber diets are important in the prevention and management of obesity and chronic diseases, including type2 diabetes, heart disease and cancer (Kendall et al., 2010). North Americans consume less than 50% of the dietary fiber levels recommended for good health. In the preferred food choices of today's youth, this value may be as low as 20%. There are emerging needs for food products with higher dietary content which are readily available to consumers especially at younger ages. Soybean seeds are rich in dietary fiber and are abundant in State of Tennessee. So far, there are few publications presenting systematic analysis on soybean dietary fiber from the fractionation of dietary fiber with specific emphasis on investigating the chemical, physical and physiological properties of different fractions, and the application of these fractions into final products. In the current study, three soy dietary fiber fractions will be extracted, fractionated and incorporated into bread. This study’s objectives seek to examine the chemical, physical and physiological properties of the three fractions before and after being added to bread. Preparation of fiber fractions from soybean will follow the method described by Makamura et al. (2001) to extract total, soluble and insoluble fibers with slight modification. Incorporation of dietary fiber fractions into bread will adopt the basic recipe from Cadioli et al. (2011). Quantification of soluble and insoluble dietary fiber will be carried out using a commercial kit, Megazyme Total Dietary Fiber.  Examination of physical properties will be performed using an ARES rheometer (TA Instruments) for measurement of viscosity of samples/digesta; and a Zetasizer (Nano ZS, Malvern Instruments) for emulsification properties (particle size and zeta-potential). In vitro study of glucose/oil release will follow the procedure described by Roberts (2012). This research will bring more scientific evidence for the beneficial roles of different fractions of soybean polysaccharides to prevent obesity and other diseases. The outcome of the current research not only can be used as an industrial guide on soybean dietary fiber production, but also highlight how farmers and food processers can obtain increased profit from this crop. More fully developed dietary-fortified foods would be available to consumers at younger ages to achieve prevention-based health outcomes in finding new ways to reduce childhood obesity.

Yuan E. Zhou, PhD, Tennessee State University

“Breast-feeding/formula feeding among WIC toddlers from three ethnic groups and association with adiposity levels” Recent research suggests that breastfeeding could protect against the development of obesity. Evidence has been consistent on the age-appropriate body weight increase among breast-fed infants in comparison with formula-fed infants. However, there have been mixed findings on the protective effects of breastfeeding against the occurrence of obesity in childhood and later in life. Moreover, the majority of previous studies were conducted among Caucasian infants, leaving an evident knowledge gap regarding the effects of breastfeeding on early childhood growth among minority ethnic groups. The purpose of this study is to investigate the putative protective effects of breastfeeding on healthier body weight gain among African American, Hispanic and White toddlers. The data used for this presentation are drawn from the CHEW Nutrition Survey, which were collected as part of the research project under the Nashville Children Eating Well (CHEW) for Health grant led by Tennessee State University's Center for Prevention Research. Participants were 150 WIC families with children aged 2-4 years who are African American, Hispanic or White in the Nashville metropolitan area. Nearly half (47%) of the children in this study were exclusively bottle-fed during infancy. Among breast-fed children, 49 (63%) were fed breast milk and formula at the same time (mixed-feeding) in contrast to 29 (37%) toddlers being exclusively breast-fed. Mixed feeding was more prevalent among Hispanic toddlers (52.5%) than either White (21.3%) or African American children (26.3%) (p<0.0001). There were 22.4% obese toddlers in the mixed feeding group in comparison with 11.0% in the other two groups (p<0.05). Toddlers of exclusively bottle-feeding have higher BMI percentile (mean 48.3 [95% CI: 37.3 - 62.5]) than those of exclusive breast-feeding (mean 32.9 [95% CI: 23.0 - 47.0]) (p<0.1). Among African American and White children, children ≥ 4 months old exclusively breastfed have lower BMI% (mean 39.9 [95% CI: 29.2 - 54.5]) than those both ≤ 3 months (mean 61.8 [95% CI: 54.0 - 70.8]) and those exclusively bottle-fed (mean 68.2 [95% CI: 50.7 - 91.8]) (p<0.05). In comparison, breast-feeding for ≤ 3 months does not differ from exclusively bottle-feeding in children’s adiposity.  Overall, results from the current study suggest that breastfeeding promotion is important among WIC participants and in particular for the Hispanic population. Mixed-feeding and bottle-feeding were related to a higher risk of obesity among toddlers, whereas short term breast-feeding may not be sufficient to protect for age-appropriate weight gain in early childhood. 

     Yuan Zhou, Jessica Jones, & Kayla Vance

 Kayla Vance, Yuan Zhou,Ph.D. and Jessica Jones

2011 Abstracts

Russell L. Rothman, MD MPP,  Associate Professor and Chief of Internal Medicine & Pediatrics, Vanderbilt University School of Medicine  russell.rothman@vanderbilt.edu       

“Addressing Health Literacy and Health Communication in Pediatric Obesity Prevention” In 2003, Surgeon General Richard Carmona stated that low health literacy was “one of the largest contributors to our nation’s epidemic of overweight and obesity.” This assertion is supported by recent studies which have found that low health literacy or numeracy is associated with poorer caregiver breastfeeding knowledge, incorrect mixing of infant formula, difficulty understanding food labels and portion sizes, and higher Body Mass Index (BMI) in adults and children. Of particular concern is the impact of the obesity epidemic on our youngest children. Over 26% of preschool children are now overweight (BMI85%) or obese (BMI95%). Rates of obesity in preschool children have doubled over the past decade, with the highest increases among low income and minority children-- the same communities most affected by low health literacy. This presentation will discuss the importance of health literacy and health communication in pediatric obesity prevention, and will share the details of an ongoing multi-site randomized controlled trial addressing health communication to address pediatric obesity prevention in children 0-2 years of age.

Monica L. Baskin, Ph.D.,  Associate Professor Division of Preventive Medicine, University of Alabama School of Medicine     mbaskin@mail.dopm.uab.edu 
“The Influence of the Food Marketing Environment on Calorie Overconsumption Among African American Children and Their Families” Social and environmental inequities in food environments may contribute to a greater burden of obesity among African American children. Targeted marketing of high caloric foods to African Americans have been recognized by researchers, but perceptions of community members have yet to be explored. The purpose of our research was to assess caregivers’ perceptions of the food environments contributing to overconsumption of calories among African American children (ages 3-11). Using a communitybased participatory research (CBPR) framework, 30 community members participated in depth interviews and a Photovoice project to document community concerns. Content analysis was used to summarize qualitative data. Our findings suggest that an abundance of “junk food,” lack of healthy foods, and limited skills in preparing healthy foods were recognized by caregivers as primary contributors in the home environment. Outside of the home, high presence of marketing (in-store ads, billboards), limited products in food stores, and lack of full service grocers were implicated in the neighborhood environment. Actions to address these issues were proposed including social marketing, a moratorium on new fast food restaurants, and incentives for wholesale/discount stores to locate in these communities. Caregivers perceive their home and neighborhood environments as contributing to the overconsumption of calories among young African American children. As such, we believe that communities armed with local data and action strategies can help galvanize the demand for healthy food and eliminate environmental inequities.

Marilyn S. Townsend, Ph.D., Cooperative Extension Specialist, Department of Nutrition, University of California-Davis   mstownsend@ucdavis.edu 
“ Obesity Among Preschool Children: Research to Guide and Evaluate Community Prevention programs” This presentation will focus on recent research targeting obesity prevention among low-income families with young children. Results will be presented on two visually enhanced tools Healthy Kids and My Child at Meal Time designed for pediatric obesity risk assessment and program evaluation. Results of new behavior change strategy adapted for this parent audience will be hared. Funding for this research was provided by the University of California Cooperative Extension, NIFA NRI, and NIFA AFRI.

Veronica J. Oates, Ph.D., RD, LDN, Assistant Professor of Nutrition, Tennessee State University  voates@tnstate.edu 
“Youth Active and Media Savvy (YAMS) Pilot Camp: Process and Feasibility“ Using an integrated approach, Youth Active and Media Savvy (YAMS) aims to promote weight management behaviors by counteracting the harmful effects of negative cultural values on African American youth. The camp is designed to teach an appreciation of African culture and reinforce it on multiple levels (individual, interpersonal, organizational, and community). The goal of the intervention is to empower African American children ages 8 to 14 years to improve their dietary behaviors and practices regarding (1) media literacy knowledge; (2) healthy cooking and food preparation skills; and (3) daily physical activity. The pilot camp held July 2011 provided a methodical run-through of the proposed intervention as well as an existing media literacy curriculum to determine its cultural appropriateness. The pilot group of four males and four females attended the pilot camp for one week. Debriefing of the youth regarding their experiences allowed us to adapt the curriculum, materials, content, schedule and other aspects of the camp format. Pilot study participants received $30 for their time and effort. Eligible youth were deemed at risk for adulthood obesity as evidenced by any of the following: (1) A BMI at or above the 85th percentile for age and sex; (2) At least one obese parent (BMI 30); (3) Low family income as evidenced by eligibility to receive free or reduced lunch; and (4) Identify or classify themselves as Black /African American.

Maciej S. Buchowski, Ph.D., Research Professor of Medicine and Pediatrics, Director of Energy Balance Laboratory, Vanderbilt University Medical Center maciej.buchowski@vanderbilt.edu 
“Can We Balance Calories? Yes, We Can!” Childhood obesity is associated with various health-related consequences. Obese children and adolescents may experience immediate health consequences and may be at risk for weight-related health problems in adulthood. The goal for obesity prevention is to maintain a healthy weight in children. To achieve this goal energy from foods and beverages must be balanced with the energy used for physical activity and normal growth. The goal for intervention in overweight and obese youth is to reduce the rate of weight gain while allowing normal growth and development. This could be done by reducing energy from food or increasing energy for physical activity. Definite relationship between physical activity, nutrition, and obesity in children remains unclear and the knowledge gap is related, in part, to methods used to assess energy intake and expenditure.

Jennifer Anderson Ph.D., R.D., Professor and Extension Specialist, Colorado State University  Jennifer.Anderson@colostate.edu 
“Overcoming Picky Eating with Food Friends: Fun with New Foods®” The Food Friends® program (visit: foodfriends.org) is the most recent nutrition education program designed for the preschool age child, their teachers and parents. The Food Friends consists of two programs Food Friends: Fun with New Foods® and Food Friends: Get Movin’ with Mighty Moves ® to address obesity by overcoming picky eating and enhancing gross motor skills. Jennifer has served as President of the Society for Nutrition Education and two terms as President of the Rocky Mountain Affiliate of the American Heart Association. In addition she has served on the national board of American Heart Association. Food Friends: Fun With New Foods is a 12-week classroom program for pre-school aged children. The program introduces children to new foods through dynamic, tactile, and engaging activities. Through this fun, interactive journey with new foods, children become more willing to try other new foods, ultimately leading to improved diet quality. This presentation will present the 10 years of research and evaluation data that has been collected attesting to the success of this program.

David G. Schlundt, Ph.D., Associate Professor of Psychology, Vanderbilt University  d.schlundt@vanderbilt.edu 
“Obesity and Food Deserts in Tennessee: A Tale of Two Places   There has been much recent interest in the idea of food deserts. Food deserts are areas in which residents have little or no access to healthy foods. Food deserts are created by lack of food resources, poverty, and lack of access to affordable transportation. The idea of food deserts has been applied to urban areas, but little attention has been given to rural food deserts. I will explore food deserts in Nashville using data from the REACH 2010 project. Differences between food deserts and other areas on eating behavior, exercise, obesity, and chronic illness will be examined. For the entire state of Tennessee, food deserts will be identified at the zip code and county level. These data will be compared to the Behavioral Risk Factor Surveillance System (BRFSS) data and to Tennessee Mortality data from nutrition related disease. The presentation will use maps to illustrate relationships between food deserts and health indices at both levels (within Davidson County and Statewide). Different strategies may be needed to address urban and rural food deserts as a way to reduce the burden of obesity

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