Medicine and Health Sciences Commons^™

“We’Re, Like, The Most Unhealthy People In The Country”: Employing An Equity Lens To Reduce Barriers To Healthy Food Access In Rural Appalachia, Kathryn Cardarelli, Emily M. Dewitt, Rachel Gillespie, Heather Norman-Burgdolf, Natalie Jones, Janet Tietyen Mullins

Dietetics and Human Nutrition Faculty Publications

Introduction

Obesity disproportionately affects rural communities, and Appalachia has some of the highest obesity rates in the nation. Successful policy, systems, and environmental (PSE) interventions to reduce obesity must reflect the circumstances of the population. We used a health equity lens to identify barriers and facilitators for healthy food access in Martin County, Kentucky, to design interventions responsive to social, cultural, and historical contexts.

Methods

We conducted 5 focus groups in Martin County, Kentucky, in fall 2019 to obtain perspectives on the local food system and gauge acceptability of PSE interventions. We used grounded theory to identify perceived barriers and …

Exercise For Weight Loss: Further Evaluating Energy Compensation With Exercise, Kyle D. Flack, Harry M. Hays, Jack Moreland, Douglas E. Long

Dietetics and Human Nutrition Faculty Publications

PURPOSE: This study assessed how individuals compensate for energy expended during a 12-wk aerobic exercise intervention, elucidating potential mechanisms and the role exercise dose plays in the compensatory response.

PARTICIPANTS AND DESIGN: Three-arm, randomized controlled trial among sedentary adults age 18 to 40 yr, body mass index of 25 to 35. Groups included six exercise sessions per week, two sessions per week, and sedentary control.

METHODS: Rate of exercise energy expenditure was calculated from a graded exercise test averaged across five heart rate zones. Energy compensation was calculated as the difference between expected weight loss (based on exercise energy expenditure) …

The Effect Of Dietary Nitrate And Vitamin C On Endothelial Function, Oxidative Stress And Blood Lipids In Untreated Hypercholesterolemic Subjects: A Randomized Double-Blind Crossover Study, Reem Basaqr, Michealia Skleres, Rani Jayswal, D. Travis Thomas

Athletic Training and Clinical Nutrition Faculty Publications

BACKGROUND: Vitamin C may enhance nitric oxide (NO) production through stepwise reduction of dietary nitrate (NO₃) to nitrite (NO₂) to NO. The combined effect of vitamin C and NO₃ supplementation is relatively unexplored in untreated hypercholesterolemia.

AIMS: We aimed to examine whether co-administration of vitamin C and nitrate for 4-weeks would improve endothelial function (primary outcome), plasma NO metabolites, oxidative stress, and blood lipids (secondary outcomes).

METHODS: Subjects 50–70 years of age with low density lipoprotein (LDL) > 130 mg/dL and RHI ≤ 2 were enrolled in this randomized double-blind crossover study. Subjects were assigned to …

Barriers And Facilitators Of Parent Engagement With Health Promotion In Child Care: A Mixed-Methods Evaluation, Courtney T. Luecking, Phillip Dobson, Dianne S. Ward

Dietetics and Human Nutrition Faculty Publications

BACKGROUND: Early care and education providers cite lack of parent engagement as a central barrier to promoting healthy behaviors among young children. However, little research exists about factors influencing parent engagement with promoting healthy eating and activity behaviors in the this setting.

AIMS: This study aimed to address this gap by examining low and high parent engagement with the Healthy Me, Healthy We campaign to identify barriers and facilitators of parent engagement with the intervention.

METHOD: This comparative case study used an explanatory sequential mixed-methods approach. We created center-level parent engagement scores using process evaluation data from the effectiveness trial …

Rural Snap Participants And Food Insecurity: How Can Communities Leverage Resources To Meet The Growing Food Insecurity Status Of Rural And Low-Income Residents?, Emily M. Dewitt, Rachel Gillespie, Heather Norman-Burgdolf, Kathryn Cardarelli, Stacey A. Slone, Alison A. Gustafson

Dietetics and Human Nutrition Faculty Publications

The burden of obesity disproportionately influences poor health outcomes in rural communities in the United States. Various social and environmental factors contribute to inadequate food access and availability in rural areas, influencing dietary intakes and food insecurity rates. This study aims to identify patterns related to food insecurity and fruit and vegetable consumption within a SNAP-eligible and low-income, highly obese rural Appalachian community. A prospective cohort was implemented to identify gaps in resources addressing obesity and food insecurity challenges. SAS 9.4 software was used to examine differences in dietary intakes and shopping practices among SNAP participants. Among participants (n …

Policy, Systems, And Environmental Change: A Planning Tool For Community Health Implementation, Lauren E. Kennedy, Christopher T. Sneed, Karen L. Franck, Heather Norman, Lisa Washburn, Soghra Jarvandi, Janet Mullins

Dietetics and Human Nutrition Faculty Publications

Extension educators across the United States are being asked to expand their direct education efforts to include policy, systems, and environmental (PSE) changes. However, professional development opportunities and tools are needed to familiarize Extension professionals with PSE change approaches, build their capacity to implement PSE change, and make the process relevant to their work. We describe a planning tool developed for a unique multistate PSE change intervention training and designed to facilitate the process of PSE change implementation at the local level. An example of the tool and recommendations for others wishing to use it are included.

Two States, One Mission: Building Policy, Systems, And Environmental Change Capacity Of County Extension Educators, Christopher T. Sneed, Karen L. Franck, Heather Norman, Lisa Washburn, Lauren E. Kennedy, Soghra Jarvandi, Janet Mullins

Dietetics and Human Nutrition Faculty Publications

Policy, systems, and environmental (PSE) change interventions are a key part of comprehensive nutrition and health education. Although Extension educators find value in PSE approaches and report being involved in PSE work, many still indicate a lack of understanding regarding PSE approaches. We describe a unique multistate training designed to increase Extension educators' understanding, skills, and capacity related to implementing PSE change interventions. Data demonstrating success of the training are presented. Additionally, best practices for others wishing to create similar multistate programs conclude the article.

Consumption Of Added Sugars By Rural Residents Of Southwest Virginia, Maryam Yuhas, Valisa Hedrick, Jamie Zoellner

Journal of Appalachian Health

Introduction: Nationally, rural residents have high consumption of added sugars, yet the top sources have not been explored. Characterizing added-sugar intake in high sugar-sweetened beverage (SSB) consumers in rural areas is an important step to help inform interventions and policies.

Purpose: The objective of this study was to explore the top food and beverage sources of added sugar and to examine variations by sociodemographic characteristics.

Methods: This cross-sectional study analyzed data from a randomized-controlled trial to reduce SSB in eight rural Appalachian counties. Data were obtained from baseline demographic surveys and three 24-hour dietary recalls. Dietary analyses included deriving AS …

The Consequences Of Exercise-Induced Weight Loss On Food Reinforcement. A Randomized Controlled Trial, Kyle D. Flack, Harry M. Hays, Jack Moreland

Dietetics and Human Nutrition Faculty Publications

BACKGROUND: Obesity remains a primary threat to the health of most Americans, with over 66% considered overweight or obese with a body mass index (BMI) of 25 kg/m2 or greater. A common treatment option many believe to be effective, and therefore turn to, is exercise. However, the amount of weight loss from exercise training is often disappointingly less than expected with greater amounts of exercise not always promoting greater weight loss. Increases in energy intake have been prescribed as the primary reason for this lack of weight loss success with exercise. Research has mostly focused on alterations in hormonal mediators …

Incentive Sensitization For Exercise Reinforcement To Increase Exercise Behaviors, Kyle D. Flack, Harry M. Hays, Jack Moreland

Dietetics and Human Nutrition Faculty Publications

Individuals can be sensitized to the reinforcing effects of exercise, although it is unknown if this process increases habitual exercise behavior. Sedentary men and women (body mass index: 25–35 kg/m², N = 52) participated in a 12-week aerobic exercise intervention. Exercise reinforcement was determined by how much work was performed for exercise relative to a sedentary alternative in a progressive ratio schedule task. Habitual physical activity was assessed via accelerometry. Post-intervention increases in exercise reinforcement predicted increases in physical activity bouts among those who expended over 2000 kcal per week in exercise and who compensated for less than …

Food Insecurity Among College Students With And Without Medical Disorders At A University In Appalachia, Laura Mcarthur, Melissa D. Gutschall, Kimberly Fasczewski, Anna Jackson

Journal of Appalachian Health

Objective: This study compared severity of food insecurity, characteristics, and behaviors of college students with and without diagnosed medical disorders.

Design: Data were collected using a cross-sectional online questionnaire. Variables measured were food security status, disorders, coping strategies, and perceived barriers to food access. Descriptive and inferential statistics examined associations and compared groups. Statistical significance was p≤0.05.

Setting: Data were collected at Appalachian State University in North Carolina.

Participants: The sample was 247 food insecure students, of whom 60% were females, 50% 3rd- and 4th-year students, and 75% whites.

Results: Medical disorders were reported by 67.2% of food insecure students, …

A Brief Report On A Facilitated Approach To Connect Cooperative Extension Southern Region State-Level Health Specialists, Samantha M. Harden, Lisa Washburn, Alison Berg, Ninfa Pena-Purcell, Heather Norman-Burgdolf, Nancy Franz

Dietetics and Human Nutrition Faculty Publications

Improving the nation’s health will require collaboration among many stakeholders and systems, including representatives from Cooperative Extension Services (CES). This paper describes the process of establishing a multistate collaboration and discusses initial outcomes of a third-party facilitated participatory planning meeting. State-level specialists with expertise and responsibilities in “health” promotion participated. Satisfaction with meeting format; feasibility, acceptability, and appropriateness of the proposed approach to public health impact; and general meeting feedback were collected through a survey and cultural artifacts (e.g., notes, worksheets). Preparation and attendance costs were captured. Seventeen of the 20 attendees (85%) responded to the survey and reported the …

Contributions Of Early Care And Education Programs To Diet Quality In Children Aged 3 To 4 Years In Central North Carolina, Courtney T. Luecking, Stephanie Mazzucca, Amber E. Vaughn, Dianne S. Ward

Dietetics and Human Nutrition Faculty Publications

BACKGROUND: Parents and early care and education (ECE) are the key influencers of young children's diets, but there is limited information about how each contribute to children's overall diet quality.

OBJECTIVE: This study aimed to determine what proportion of children's dietary intake occurs within the ECE setting and whether diet quality is higher at ECE centers and, consequently, on weekdays than weekends.

DESIGN: This cross-sectional analysis of a larger cluster randomized controlled trial used multiple 24-hour dietary intakes measured through a combination of the Dietary Observation in Child Care protocol and parent-reported food diaries.

PARTICIPANTS/SETTING: Participants (N=840) included children aged …

Examining Cultural Influences On Dietary Behaviors Among Mexican Americans With Low Acculturation, Austyn Erickson

Theses and Dissertations--Nutrition and Food Systems

Mexican Americans represent approximately 63 percent of the total Hispanic population in the US and are disproportionately affected by health disparities related to poor nutrition status. With this community among the fastest growing populations in the US, it is critical to address the health disparities and the relationship between culture and diet to provide evidence-based nutrition interventions that are culturally sensitive to specific communities. The purpose of this cross-sectional exploratory study is to examine the relationship between cultural values and dietary behaviors among a low-income, urban, clinical sample of Mexican Americans using the Mexican American Cultural Values Scale, dietary assessment, …

Energy Compensation With Exercise Is Not Dependent On Dose, H. Michael Hays

Theses and Dissertations--Nutrition and Food Systems

Background: Exercise induced weight loss is often less than expected due to a coordinated set of compensatory mechanisms that serve to maintain energy homeostasis. The extent to which exercise frequency, duration, intensity and exercise energy expenditure (ExEE) influences the compensatory response to an exercise-induced energy deficit (energy compensation) is controversial. Determining how these variables impact energy compensation would help health care providers prescribe exercise with greater probability of creating a sustained negative energy balance and subsequent weight loss.

Methods: 44 Overweight/obese men and women (BMI=25-35kg/m²) aged 18 to 40 years were randomized to perform aerobic exercise 2 or 6 days/week …

Communication Of Professional Readiness In Dietetics And Human Nutrition Undergraduates: A Pilot Study, Heather Norman-Burgdolf, Emily M. Dewitt, Nathan L. Vanderford, Julie Plasencia

Dietetics and Human Nutrition Faculty Publications

Learning experiences within the dietetics and human nutrition undergraduate curricula develop knowledge and skills pertinent to student career goals. Core competency requirements are extensively assessed in these programs, yet the communication of transferable skills gained and student professional readiness are rarely examined. The purpose of this study was to evaluate undergraduate students' perceived professional readiness following six professional development workshops on transferable skills and career preparedness communicated through resumes and personal statements. In this pilot study, twelve upper-level dietetics and human nutrition students self-assessed their resumes and personal statements with rubrics and completed surveys before and after the intervention. Following …

An Educational Pilot Intervention To Increase Environmental Health Literacy Among Rural Kentucky Youth Attending Summer Camp, Ashley Rose Mattingly

Theses and Dissertations--Nutrition and Food Systems

Risk factors, including exposure to environmental pollutants, poor dietary and overall health outcomes, and low environmental health literacy (EHL), place the rural Appalachian youth population at increased risk for chronic diseases. Implementation of nutrition and pollution curriculum into two week-long summer day camps for youth ages 5-12 years that focus around healthy lifestyles and environmental stewardship has the potential to increase health protective action in this community. This research utilized qualitative interviews of 30 Kids on the Creek Camp attendees to determine the efficacy of the implementation of an active learning lesson to increase EHL by explaining the link between …

Appetite-Regulating Hormones In Energy Compensation With Exercise, Jack Moreland

Theses and Dissertations--Nutrition and Food Systems

Background: The appetite-regulating hormones may influence compensatory increases in energy intake with exercise, although this causal relationship has been difficult to prove in a longitudinal trial.

Methods: 37 participants (29 female) aged 18 to 40 years performed aerobic exercise 6 days (6d), 2 days (2d), or 0 days per week for 12-weeks. Concentrations of ghrelin, leptin, glucagon-like peptide 1 (GLP-1), and insulin were assessed before (fasting, minute 0) and after a standardized meal at minute 15, 30, 45, 60, 90, 120, 150, and 180. Linear mixed-effects models were used to model the relationships between time point (12 weeks vs. baseline) …

Cardiac Effects Of Obesity During Pregnancy In C57bl/6j Mice, Kayla Lynn Dudick

Theses and Dissertations--Nutrition and Food Systems

Objective: Pregnancy requires profound cardiac and metabolic adaptation. Left ventricular (LV) mass is increased in response to pregnancy, but is not associated with cardiac damage. In contrast, obesity-mediated cardiac hypertrophy is pathological. Data from animal studies indicate dietary fatty acid composition may have a protective effect during states of extreme cardiac physiological adaptation. In contrast, aberrant cardiac metabolism is a hallmark of disease. Over a third of reproductive-age women in the United States are obese, but there is a paucity of data describing the effect of obesity on maternal cardiac adaptation to pregnancy. The objective of this study was to …

The Effects Of Dietary Nitrate And Vitamin C On Endothelial Function And Oxidative Stress Biomarkers, Reem Basaqr

Theses and Dissertations--Pharmacology and Nutritional Sciences

Background: Endothelial dysfunction is associated with a decline in the vasodilator nitric oxide (NO) and presents alongside other cardiovascular risk factors in the early stages of atherosclerosis. Independently, inorganic nitrate and vitamin C supplementation have shown promise in providing some restoration of NO bioavailability, reduced oxidative stress, and improvements in endothelial function. Some preliminary evidence has suggested that vitamin C may augment the reduction of nitrite to further liberate NO and improve cardiovascular health. However, co-supplementation has not been adequately studied. Our objective was to compare the effect of inorganic nitrate in the form of concentrated beetroot juice (CBJ) with …