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A Case Study of the Transferability of the EPODE Model for Community-Based Childhood Obesity Prevention Programs

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The purpose of this research was to analyze the EPODE Model for the development community-based interventions against childhood obesity and its transferability on a global scale. The Ensemble, Prevenons L'Obesite des Enfant (EPODE: Together Let's Prevent Childhood Obesity) Model was

The purpose of this research was to analyze the EPODE Model for the development community-based interventions against childhood obesity and its transferability on a global scale. The Ensemble, Prevenons L'Obesite des Enfant (EPODE: Together Let's Prevent Childhood Obesity) Model was developed in France following the successful results of a community-based intervention there. The Model is illustrated by four pillars that are essential to program implementation and positive results. These pillars are: political support, research & evaluation, social marketing principles and public/private partnerships. Using these four pillars, the model has been transferred to diverse countries around the globe and has shown results in these diverse locations. In order to understand what makes this model so transferrable to so many diverse locations, this researcher traveled to the Netherlands, Belgium and France visiting program locations and interviewing professionals who have been involved in the development of the model, its modification and implementation. These interviews addressed specific modifications to the model that were made for implementation in the Netherlands and Belgium. This paper outlines the key transferrable components of this model and outlines a proposed model to be used in the United States.

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2014-05

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The relationship between food insecurity and weight status, eating behaviors, the home food environment, meal planning and preparation, and perceived stress in parents living in the Phoenix Metropolitan Area

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Objectives Through a cross-sectional observational study, this thesis evaluates the relationship between food insecurity and weight status, eating behaviors, the home food environment, meal planning and preparation, and perceived stress as it relates to predominantly Hispanic/Latino parents in Phoenix, Arizona.

Objectives Through a cross-sectional observational study, this thesis evaluates the relationship between food insecurity and weight status, eating behaviors, the home food environment, meal planning and preparation, and perceived stress as it relates to predominantly Hispanic/Latino parents in Phoenix, Arizona. The purpose of this study was to address gaps in the literature by examining differences in "healthy" and "unhealthy" eating behaviors, foods available in the home, how time and low energy impact meal preparation, and the level of stress between food security groups. Methods Parents, 18 years or older, were recruited during two pre-scheduled health fairs, from English as a second language classes, or from the Women, Infants, and Children's clinic at a local community center, Golden Gate Community Center, in Phoenix, Arizona. An interview, electronic, or paper survey were offered in either Spanish or English to collect data on the variables described above. In addition to the survey, height and weight were collected for all participants to determine BMI and weight status. One hundred and sixty participants were recruited. Multivariate linear and logistic regression models, adjusting for weight status, education, race/ethnicity, income level, and years residing in the U.S., were used to assess the relationship between food security status and weight status, eating behaviors, the home food environment, meal planning and preparation, and perceived stress. Results Results concluded that food insecurity was more prevalent among parents reporting lower income levels compared to higher income levels (p=0.017). In adjusted models, higher perceived cost of fruits (p=0.004) and higher perceived level of stress (p=0.001) were associated with food insecurity. Given that the sample population was predominately women, a post-hoc analysis was completed on women only. In addition to the two significant results noted in the adjusted analyses, the women-only analysis revealed that food insecure mothers reported lower amounts of vegetables served with meals (p=0.019) and higher use of fast-food when tired or running late (p=0.043), compared to food secure mothers. Conclusion Additional studies are needed to further assess differences in stress levels between food insecure parents and food insecure parents, with special consideration for directionality and its relationship to weight status.

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2014

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Arizona foodshed: estimating capacity to meet fresh fruit and vegetable consumption needs of the Arizona population

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Fruit and vegetable (FV) consumption continues to lag far behind US Department of Agriculture (USDA) recommendations. Interventions targeting individuals' dietary behaviors address only a small fraction of dietary influences. Changing the food environment by increasing availability of and excitement for

Fruit and vegetable (FV) consumption continues to lag far behind US Department of Agriculture (USDA) recommendations. Interventions targeting individuals' dietary behaviors address only a small fraction of dietary influences. Changing the food environment by increasing availability of and excitement for FV through local food production has shown promise as a method for enhancing intake. However, the extent to which local production is sufficient to meet recommended FV intakes, or actual intakes, of specific populations remains largely unconsidered. This study was the first of its kind to evaluate the capacity to support FV intake of Arizona's population with statewide production of FV. We created a model to evaluate what percentage of Dietary Guidelines for Americans (DGA) recommendations, as well as actual consumption, state-level FV production could meet in a given year. Intake and production figures were amended to include estimates of only fresh, non-tropical FV. Production was then estimated by month and season to illustrate fluctuations in availability of FV. Based on our algorithm, Arizona production met 184.5% of aggregate fresh vegetable recommendations, as well as 351.9% of estimated intakes of Arizonans, but met only 29.7% of recommended and 47.8% of estimated intake of fresh, non-tropical fruit. Much of the excess vegetable production can be attributed to the dark-green vegetable sub-group category, which could meet 3204.6% and 3160% of Arizonans' aggregated recommendations and estimated intakes, respectively. Only minimal seasonal variations in the total fruit and total vegetable categories were found, but production of the five vegetable sub-groups varied between the warm and cool seasons by 19-98%. For example, in the starchy vegetable group, cool season (October to March) production met only 3.6% of recommendations, but warm season (April to November) production supplied 196.5% of recommendations. Results indicate that Arizona agricultural production has the capacity to meet a large proportion of the population's FV needs throughout much of the year, while at the same time remaining a major producer of dark-green vegetables for out-of-state markets.

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2013

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Factors associated with the accuracy of parental perception of their child's body weight status: the New Jersey Childhood Obesity Study

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Objectives: Although childhood obesity has received growing attention, parents still fail to recognize overweight and obesity in their children. Accurate identification of overweight or obesity in their child is associated with the parent's responsiveness to interventions aimed at preventing weight-related

Objectives: Although childhood obesity has received growing attention, parents still fail to recognize overweight and obesity in their children. Accurate identification of overweight or obesity in their child is associated with the parent's responsiveness to interventions aimed at preventing weight-related health issues. Recent research shows that a child's age and gender are associated with parental misperception of their child's weight status, but little is known about the interaction of these factors across various age groups. This study examined the association between a wide range of parent, child, and household factors and the accuracy of parental perception of their child's body weight status compared to parent-measured body weight status. Methods: Data were collected from a random-digit-dial telephone survey of 1708 households located in five low-income New Jersey cities with large minority populations. A subset of 548 children whose parents completed the survey and returned a worksheet of parent-measured heights and weights were the focus of the analysis. Bivariate and multivariate analyses were performed to determine the factors significantly associated with parental perception of their child's body weight status. Results: Based on parent-measure heights and weights, 36% of the children were overweight or obese (OWOB). Only 21% of OWOB children were perceived by their parents as OWOB. Child gender, child body mass index (BMI) and parent BMI were significant independent predictors of parents' accuracy at perceiving their child's body weight status. Conclusion: Boys, OWOB children, and children of OWOB parents had significantly greater odds of parental underestimation of their body weight status. Parents had better recognition of OWOB in their daughters, especially older daughters, than in their sons, suggesting parental gender bias in identifying OWOB in children. Further research is needed regarding parental gender bias and its implications in OWOB identification in children.

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2013

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Meat consumption, moral foundations and ecological behaviors among college students

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In recent years, overall consumption of meat products has been decreasing, and at the same time vegetarianism is on the rise. A variety of factors are likely driving changes in consumers' attitudes towards, and consumption of, meat products. Although concern

In recent years, overall consumption of meat products has been decreasing, and at the same time vegetarianism is on the rise. A variety of factors are likely driving changes in consumers' attitudes towards, and consumption of, meat products. Although concern regarding animal welfare may contribute to these trends, growing consumer interest in the roles that production and processing of meat play in terms of environmental degradation could also impact individuals' decisions about the inclusion of meat in their diets. Because these factors could be related to moral attitudes as well, the purpose of this study was to explore the relations among meat consumption, general environmental attitudes, and moral `foundations' of decision-making, including concern about minimizing `harm' and maximizing `care,' as well as issues of `purity' and `sanctity.' A survey was conducted among current college students using the New Ecological Paradigm scale and the Moral Foundations Questionnaire to assess environmental and moral attitudes. A food frequency questionnaire was used to assess meat consumption. Multiple linear regression analyses explored the relations of environmental and moral attitudes with meat consumption, controlling for potential confounding variables. The results showed no significant correlations among meat consumption, environmental attitudes or moral foundations of harm/care and purity/sanctity.

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2013

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The associations among emotions and food choices in college freshmen: a cross-sectional study using ecological momentary assessment

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While literature has examined the associations between emotions and overeating, rarely is the relationship between emotions and food choices included. The purpose of this secondary data analysis was to utilize mobile-based ecological momentary assessment (EMA) surveys to determine the associations

While literature has examined the associations between emotions and overeating, rarely is the relationship between emotions and food choices included. The purpose of this secondary data analysis was to utilize mobile-based ecological momentary assessment (EMA) surveys to determine the associations among negative, positive, apathetic, and mixed emotions and a variety of food choices in college freshmen living in residence halls. A total of 2142 survey responses from 647 college freshmen were included in this analysis (70.3% female, 51.5% non-white). Mixed model logistic regression assessed the cross-sectional association between emotions and food choices adjusting for gender, race/ethnicity, Pell grant status, highest parental education, and the clustering of repeated measures within person and of students within residence hall. There were no significant associations between negative emotions and food choices. Positive emotions were significantly and inversely associated with eating pizza/fast food (OR=0.6; 95% CI=0.5, 0.8) and cereals (OR=0.6; 95% CI=0.4, 1.0), while apathetic emotions were significantly and positively associated with consuming salty snacks/fried foods (OR=1.6; 95% CI=1.1, 2.5) and inversely associated with consuming sandwiches/wraps (OR=0.5; 95% CI=0.3, 0.8) and meats/proteins (OR=0.6; 95% CI=0.4, 1.0). It was also found that there were several instances of surveys with mixed emotions, in which participants reported feeling two conflicting emotions at once (i.e. positive and negative). Mixed emotions were significantly associated with consuming sweets (OR=1.6; 95% CI=1.2, 2.1), meats/proteins (OR=1.6; 95% CI=1.2, 2.0), and cereals (OR=1.9; 95% CI=1.2, 2.9). Understanding the relationships between different types of emotions and food choices is helpful in understanding the motivation behind healthy versus unhealthy food choices. These findings can be used to develop interventions that encourage positive emotions in college freshmen to better promote healthy food choices and ultimately reduce the risk of weight gain and other health disparities. Future research should examine how college freshmen differ from other college students (i.e. upper classmen and graduate students), particularly related to their emotions and food choices, so that dietary interventions can be better suited to those who are vulnerable.

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2016

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An exploration of attitudes and perceptions of cash value vouchers in the Arizona Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

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In October, 2009, participants of the Arizona Special Supplemental Nutrition Program for Women, Infants and Children (WIC) began receiving monthly Cash Value Vouchers (CVV) worth between six and 10 dollars towards the purchase of fresh fruits and vegetables. Data from

In October, 2009, participants of the Arizona Special Supplemental Nutrition Program for Women, Infants and Children (WIC) began receiving monthly Cash Value Vouchers (CVV) worth between six and 10 dollars towards the purchase of fresh fruits and vegetables. Data from the Arizona Department of Health Services (ADHS) showed CVV redemption rates in the first two years of the program were lower than the national average of 77% redemption. In response, the ADHS WIC Food List was expanded to also include canned and frozen fruits and vegetables. More recent data from ADHS suggest that redemption rates are improving, but variably exist among different WIC sub-populations. The purpose of this project was to identify themes related to the ease or difficulty of WIC CVV use amongst different categories of low-redeeming WIC participants. A total of 8 focus groups were conducted, four at a clinic in each of two Valley cities: Surprise and Mesa. Each of the four focus groups comprised one of four targeted WIC participant categories: pregnant, postpartum, breastfeeding, and children with participation ranging from 3-9 participants per group. Using the general inductive approach, recordings of the focus groups were transcribed, hand-coded and uploaded into qualitative analysis software resulting in four emergent themes including: interactions and shopping strategies, maximizing WIC value, redemption issues, and effect of rule change. Researchers identified twelve different subthemes related to the emergent theme of interactions and strategies to improve their experience, including economic considerations during redemption. Barriers related to interactions existed that made their purchase difficult, most notably anger from the cashier and other shoppers. However, participants made use of a number of strategies to facilitate WIC purchases or extract more value out of WIC benefits, such as pooling their CVV. Finally, it appears that the fruit and vegetable rule change was well received by those who were aware of the change. These data suggest a number of important avenues for future research, including verifying these themes are important within a larger, representative sample of Arizona WIC participants, and exploring strategies to minimize barriers identified by participants, such as use of electronic benefits transfer-style cards (EBT).

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2013

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Food environment around school and students' weight status: a study of four New Jersey low-income communities

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Childhood obesity has been on the rise for the past decade, and it has been hypothesized that students' food choices may be influenced by easy access to food outlets near their schools that provide unhealthful options. But the results of

Childhood obesity has been on the rise for the past decade, and it has been hypothesized that students' food choices may be influenced by easy access to food outlets near their schools that provide unhealthful options. But the results of recent studies on the relationship between the food environment around schools and student weight status are mixed and often contradictory. Most studies have used measures of weight and height that were self-reported by students, or have relied on data from a relatively small sample of students. I examine the association between weight status among school students and the food environment surrounding their schools using professionally-measured, student-level data across the full school-age spectrum. De-identified data were obtained for over 30,000 K-12 students in 79 public schools located in four New Jersey cities. Locations of alternative food-outlets (specifically, supermarkets, convenience stores, small grocery stores, and limited-service restaurants) were obtained from commercial sources and geocoded to develop proximity measures. A simplified social-ecological framework was used to conceptualize the multi-level the association between students' BMI and school proximity to food outlets and multivariate analyses were used to estimate this relationship controlling for student- and school-level factors. Over twenty percent of the students were obese, compared to the national average at 17% (Ogden, Carroll, Kit, & Flegal, 2012). On average, students had 2.6 convenience stores, 2.9 limited-service restaurants, and 0.1 supermarkets within a quarter mile of their school. This study suggests that easy access to small grocery stores (which this study uniquely examines as a separate food outlet category) that offer healthy choices including five types of fresh vegetable, five types of fresh fruits, low-fat dairy, and lean meats is associated with lower BMI z score and lower probability of being obese for middle and high school students. This suggests that improving access to such small food outlets may be a promising area for future investigation in obesity mitigation research. Also, this study separates students of pre-schools, kindergartens and elementary schools (neighborhood schools) from that of the middle and high schools (non-neighborhood) schools because the two groups of schools have different neighborhood characteristics, as well as open-school and bussing policies that result in different levels of exposure that students have to the food outlets around the schools. The result of this study suggests that the relationship between students' weight outcomes and food environment around schools is different in the two groups of schools.

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2013

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Omega-3 supplementation and body weight in healthy young women

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Objective: The purpose of this randomized parallel arm trial was to demonstrate the effects of daily fish oil supplementation (600mg per day for eight weeks) on body composition and body mass in young healthy women, aged 18-38, at a large

Objective: The purpose of this randomized parallel arm trial was to demonstrate the effects of daily fish oil supplementation (600mg per day for eight weeks) on body composition and body mass in young healthy women, aged 18-38, at a large southwestern university. Design: 26 non-obese (mean BMI 23.7±0.6 kg/m2), healthy women (18-38y; mean, 23.5±1.1 y) from a southwestern Arizona university campus community completed the study. Subjects were healthy, non-smokers, consuming less than 3.5 oz of fish per week according to self-report. Participants were randomized to one of two groups: FISH (600 mg omega-3 fatty acids provided in one gel capsule per day), or CON (1000 mg coconut oil placebo provided in one gel capsule per day). Body weight, BMI, and percent body fat were measured using a stadiometer and bioelectrical impedance scale at the screening visit and intervention weeks 1, 4, and 8. 24-hour dietary recalls were also performed at weeks 1 and 8. Results: 8 weeks of omega-3 fatty acid supplementation did not significantly alter body weight (p=0.830), BMI (p=1.00), or body fat percentage (p=0.600) as compared to placebo. Although not statistically significant, 24-hour dietary recalls performed at the beginning and end of the intervention revealed a trend towards increased caloric intake in the FISH group and decreased caloric intake in the CON group throughout the course of the study (p=0.069). If maintained, this difference in caloric intake could have physiological relevance. Conclusions: Omega-3 fatty acids do not significantly alter body weight or body composition in healthy young females. These findings do not refute the current recommendations for Americans to consume at least 8 oz of omega-3-rich seafood per week, supplying 250 mg EPA and DHA per day. More research is needed to investigate the potential for omega-3 fatty acids to modulate daily caloric intake.

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2013

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The association between the moral foundations theory, ethical concern and fast food consumption

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Health knowledge alone does not appear to lead to sustained healthy behavior, suggesting the need for alternative methods for improving diet. Recent research shows a possible role of moral contexts of food production on diet related behaviors; however no studies

Health knowledge alone does not appear to lead to sustained healthy behavior, suggesting the need for alternative methods for improving diet. Recent research shows a possible role of moral contexts of food production on diet related behaviors; however no studies have been conducted to specifically explore the relationship between moral constructs and food consumption. This study examined the relationship between fast food consumption and two measures of morality, Moral Foundations Questionnaire (MFQ), specifically harm/care and purity/sanctity foundations, and the Ethical Concern in food choice (EC) questionnaire, which includes animal welfare, environment protection, political values, and religion subscales. The study also examined the association between the measures of morality. 739 participants, primarily female (71.4%) and non-Hispanic Whites (76.5%), completed an online survey that included the MFQ, the EC questionnaire, and a brief fast food screener. Participant's morality scores in relation to their fast food consumption were examined first using bivariate ANOVA analysis and then using logistic regression to control for covariates. The MFQ foundations were compared with the EC subscales using Pearson correlation coefficient. Significant bivariate relationships were seen between fast food consumption and the MFQ's purity/sanctity foundation and EC's religion subscales (p<0.05). However these significant bivariate relationships did not hold after controlling for gender, race, university education, and religion in the logistic regression analysis. The foundations of the MFQ were positively correlated with the subscales for the EC questionnaire (r values ranging from .233-.613 (p<0.01). MFQ's purity/sanctity foundation and EC's religion subscale were the two most highly correlated (r=.613, p<0.01) showing that moral intuitions may be associated with eating decision making. The study did not find significant associations between MFQ or EC scores and fast food consumption.

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2013