Dietetics and Clinical Nutrition Commons^™

Impact Of Community-Driven Interventions On Dietary And Physical Activity Outcomes Among A Cohort Of Adults In A Rural Appalachian County In Eastern Kentucky, 2019–2022, Heather Norman-Burgdolf, Emily M. Dewitt, Rachel Gillespie, Kathryn Cardarelli, Stacey Slone, Alison Gustafson

Dietetics and Human Nutrition Faculty Publications

Several environmental level factors exacerbate poor health outcomes in rural populations in the United States, such as lack of access to healthy food and locations to be physically active, which support healthy choices at the individual level. Thus, utilizing innovative place-based approaches in rural locations is essential to improve health outcomes. Leveraging community assets, like Cooperative Extension, is a novel strategy for implementing community-driven interventions. This prospective cohort study (n = 152), recruited in 2019 and surveyed again in 2020 and 2021, examined individual level changes in diet and physical activity in one rural Appalachian county. During this time, multiple …

Development Of A Community-Based Plan For An Effective Behavioral Intervention To Reduce Childhood Obesity In A Rural Appalachian Community, Jennifer Stacy Wells

Theses and Dissertations--Nutrition and Food Systems

Rural children experience increased rates of obesity and reduced access to specialized weight management facilities, which makes receiving the recommended frequency of care difficult. Clinical-community partnerships, recommended by the American Academy of Pediatrics (AAP) to expand access, have been shown to be a feasible strategy of care delivery. Examination of literature and stakeholder interviews were used to inform the development of a collaborative pediatric weight management program in a rural, Appalachian community. Screening articles as well as intervention articles were reviewed. Outcomes of screening articles reviewed included BMI measures (3), screening practices (7), and referral practices (4). Common outcomes of …

Exploring Extension Agent Capacity And Readiness To Adopt Policy, Systems And Environmental Change Approaches, Lisa T. Washburn, Heather Norman-Burgdolf, Natalie Jones, Lauren E. Kennedy, Soghra Jarvandi

Dietetics and Human Nutrition Faculty Publications

Introduction: Enhanced Extension outreach strategies combine traditional direct education programs with public health approaches like policy, systems, and environmental (PSE) change. However, the Cooperative Extension system and county-based Family and Consumer Sciences (FCS) Extension agents have historically prioritized direct education programming and diffusion of enhanced outreach strategies has varied. Extension personnel may lack capacity and readiness for successful PSE change implementation. This study explored perceived acceptability, capacity, and readiness for PSE change work among FCS Extension agents in two states.

Method: A survey was developed framed by selected domains from the Consolidated Framework for Implementation Research: Intervention Characteristics, Inner Setting, …

Examining The Perspectives And Experiences Of Nutrition Educators Working With Clients In Substance Use Recovery Settings, Cora Teets, Paula Plonski, Omolola Adedokun, Heather Norman-Burgdolf

Dietetics and Human Nutrition Faculty Publications

Substance use disorder (SUD) is one of the most detrimental health, social, and economic problems in the United States. Limited studies suggest providing tailored nutrition education during SUD treatment correlates with positive recovery outcomes. The University of Kentucky Nutrition Education Program conducted two focus group sessions to explore and determine educators’ instructional and programmatic needs who deliver nutrition education to clients in substance use recovery throughout Kentucky. The study team identified four emerging themes and several subthemes related to Nutrition Education Program educators working with clientele in recovery. The four emerging themes included: (1) current experiences working with the audience, …

Unifying Multi-State Efforts Through A Nationally Coordinated Extension Diabetes Program, Laura Balis, Shari Gallup, Heather Norman-Burgdolf, Julie Buck, Pam Daniels, Dan Remley, Lisa Graves, Margaret Jenkins, Gayle Price

Dietetics and Human Nutrition Faculty Publications

The Cooperative Extension System translates research to practice and “brings the University to the people” throughout the U.S. However, the system suffers from program duplication and is challenged to scale-out effective programs. One program, Dining with Diabetes (DWD), stands out for its dissemination to multiple states. DWD is a community-based program aimed at improving diabetes management, nutrition, and physical activity behaviors. DWD was coordinated through a national working group and implemented by state Extension systems. A pragmatic, quasi-experimental study was conducted to determine the effectiveness of the national coordination model and the overall impact of DWD. Four states reported data …

Maximal Strength Training Increases Metabolic Energy Expenditure In Sedentary Adults Classified As Obese, Robert E. Anderson Iii

Theses and Dissertations--Nutrition and Food Systems

Background: Metabolic adaptations reduce resting and non-resting energy expenditure to account for approximately 120 kcal/day. Weight loss promotes greater skeletal muscle efficiency, reducing the energy cost of physical activity and is correlated with declines in skeletal muscle glucose oxidation. Maximal Strength Training (MST) has the potential to upregulate glucose utilization and may offset these metabolic adaptations. Objective: To determine if MST offsets markers of metabolic adaptation by increasing resting and non-resting energy expenditure in sedentary individuals classified as obese. Methods: Five (5) participants (2 females, 3 males), ages 18-35 years, with obesity (BMI 30–45 kg/m2) were enrolled in an 8-week …

Efficacy Of An Enhanced Implementation Strategy To Increase Parent Engagement With A Health Promotion Program In Childcare, Courtney T. Luecking, Cody D. Neshteruk, Stephanie Mazzucca, Dianne S. Ward

Dietetics and Human Nutrition Faculty Publications

Previous efforts to involve parents in implementation of childcare-based health promotion interventions have yielded limited success, suggesting a need for different implementation strategies. This study evaluated the efficacy of an enhanced implementation strategy to increase parent engagement with Healthy Me, Healthy We. This quasi-experimental study included childcare centers from the second of two waves of a cluster-randomized trial. The standard approach (giving parents intervention materials, prompting participation at home, inviting participation with classroom events) was delivered in 2016–2017 (29 centers, 116 providers, and 199 parents). The enhanced approach (standard plus seeking feedback, identifying and addressing barriers to parent participation) …

Policy Implications Of The Covid-19 Pandemic On Food Security In Rural America: Evidence From Appalachia, Kathryn M. Cardarelli, Emily M. Dewitt, Rachel Gillespie, Rachel Hogg-Graham, Heather Norman-Burgdolf, Janet T. Mullins

Dietetics and Human Nutrition Faculty Publications

Rural communities are disproportionally affected by food insecurity, making them vulnerable to the consequences of supply disruptions caused by the COVID-19 pandemic. While access to food was initially diminished due to food supply disruptions, little is known about the mechanisms through which federal emergency assistance programs impacted food access in rural populations. Through a series of five focus groups in spring 2021, we examined the impact of the COVID-19 pandemic on food access in a rural Appalachian community in Kentucky. Data were analyzed using a Grounded Theory Approach. Findings revealed the following four primary themes: food scarcity in grocery stores; …

Sugar-Sweetened Beverage Consumption Among Adults In Rural Appalachia, Heather Norman-Burgdolf, Emily M. Dewitt, Kathryn M. Cardarelli, Rachel Gillespie, Stacey A. Slone, Alison A. Gustafson

Dietetics and Human Nutrition Faculty Publications

Sugar-sweetened beverage (SSB) consumption is decreasing nationally, yet intakes remain high in certain sub-populations as new varieties of SSBs are introduced. This study aims to expand on SSB intake patterns among adults living in Appalachia to develop policy, systems, and environmental (PSE) interventions to reduce consumption. Baseline cohort surveys were conducted to examine beverage consumption patterns of adults in one rural Appalachian county in Kentucky using a validated BEVQ-15 instrument. Ages were collapsed into three generational groups – Millennials (22–38 years), Generation X (39–54 years), and Boomers/Silents (≥55 years). Over half (n = 81; 54%) of the sample (n = …

Losses, Gains, And Changes To The Food Environment In A Rural Kentucky County During The Covid-19 Pandemic, Makenzie L. Barr, Courtney Martin, Courtney T. Luecking, Kathryn M. Cardarelli

Dietetics and Human Nutrition Faculty Publications

The COVID-19 pandemic has caused alterations to be made in the way many people access, prepare, and consume food. Rural communities are particularly impacted due to pre-existing structural vulnerabilities, i.e., poverty, lack of infrastructure, and limited fresh food options. This study aimed to characterize experiences of one rural Appalachian community’s changes to the food environment during the pandemic. In April 2021, six focus groups were conducted with residents of Laurel County, Kentucky. Using grounded theory, we identified losses, gains, and overall changes to the community food environment since the onset of COVID-19. Seventeen Laurel Countians (17 female; ages 30–74) participated …

Process Evaluation Of The Early Implementation Stages Of The National Diabetes Prevention Program Through Kentucky Cooperative Extension: Perceptions Of Adopters And Potential Adopters, Nicole Breazeale, Heather Norman-Burgdolf, Katherine Counts, Lovoria B. Williams

Dietetics and Human Nutrition Faculty Publications

With the growing demand for lifestyle change programs that prevent or delay Type 2 diabetes onset, community organizations with broad reach should be explored for national dissemination of the National Diabetes Prevention Program (NDPP). This study evaluates the early implementation of the NDPP through Cooperative Extension in four Kentucky counties and explores the feasibility of scaling up the program to additional counties. Using a qualitative approach, semi-structured telephone interviews were conducted with 12 Family and Consumer Sciences (FCS) Agents – four who were participating in the pilot (adopters) and eight who had no experience with the NDPP (potential adopters). Five …

Screen Time Parenting Practices And Associations With Preschool Children’S Tv Viewing And Weight-Related Outcomes, Cody D. Neshteruk, Gina L. Tripicchio, Stephanie Lobaugh, Amber E. Vaughn, Courtney T. Luecking, Stephanie Mazzucca, Dianne S. Ward

Dietetics and Human Nutrition Faculty Publications

The purpose of this study was to examine associations between screen time (ST) parenting practices and 2–5-year-old children’s TV viewing and weight status. Data were collected from 252 parent–child dyads enrolled in a randomized parent-focused childhood obesity prevention trial from 2009–2012. ST parenting practices were assessed at baseline using a validated parent-reported survey. Parent-reported child TV viewing and objectively measured anthropometrics were assessed at baseline, post-intervention (35 weeks), and follow-up (59 weeks). Marginal effect models were developed to test the association between baseline ST parenting practices and children’s TV viewing, BMI z-score, and waist circumference across all time points. Limiting/monitoring …

Healthy Trees – Healthy People: A Model For Engaging Citizen Scientists In Exotic Pest Detection In Urban Parks, Heather Norman-Burgdolf, Lynne K. Rieske

Dietetics and Human Nutrition Faculty Publications

Healthy Trees – Healthy People (HT-HP) is an outreach and education program created to enlist and train participants in exotic pest detection while providing them with structured opportunities to connect with urban nature and increase their physical and emotional health. HT- HP creates infrastructure to increase engagement by the urban populace in the urban tree canopy. The program solicits participants to engage in an 8-week intervention designed to expand capacity to detect non-native insect pests and pathogens, while increasing physical activity, raising awareness of healthy lifestyle choices, and improving the health of participants. Program participants were trained in tree and …

Dietary Assessments And Their Association With Psychological Factors, Inflammation, And Cardiovascular Health Outcomes, Junghee Kang

Theses and Dissertations--Nursing

Cardiovascular diseases (CVDs), a group of disorders of the heart and blood vessels, are the leading cause of death worldwide, causing one-third of deaths each year. Diet is one of the most important behavioral risk factors for CVD. The effects of behavioral risk factors, such as diet, may lead to increased blood pressure, increased blood glucose, raised blood lipids, and overweight and obesity. Inflammation contributes to the development of CVD and can be influenced by diet. Dietary assessment indices can measure diet quality from an individual's dietary intake by scoring food and nutrient intakes. However, the mediation effects of diet …

“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 …

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 …

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 …

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, …

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 …

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 …

Nutrition And Environmental Pollution Extension Curriculum Improved Diet-Related Behaviors And Environmental Health Literacy, Dawn Brewer, Hannah Bellamy, Anna Hoover, Annie Koempel, Lisa Gaetke

Dietetics and Human Nutrition Faculty Publications

Kentucky experiences some of the nation’s worst health outcomes related to obesity, diabetes, high blood pressure, and other age-related chronic diseases linked with oxidative stress and inflammation, which in turn are associated with poor diet, lack of physical activity, and exposure to certain environmental pollutants. In the Commonwealth, deteriorating infrastructure, inappropriate waste disposal, and potential occupational injury related to mining, agriculture, and other regionally important industries exacerbate the need for residents to have basic knowledge of potential environmental health threats. Unfortunately, community-level understanding of the complex connections between environmental exposures and health is limited, with many Kentuckians unaware that the …

A Mentor-Led Text-Messaging Intervention Increases Intake Of Fruits And Vegetables And Goal Setting For Healthier Dietary Consumption Among Rural Adolescents In Kentucky And North Carolina, 2017, Alison A. Gustafson, Stephanie B. Jilcott Pitts, Kristen Mcquerry, Oyinlola Babtunde, Janet Mullins

Dietetics and Human Nutrition Faculty Publications

Introduction—Text-messaging interventions hold promise for successful weight loss interventions. However, there is limited research on text-messaging interventions to improve dietary intake among rural adolescents, who are at greater risk for obesity and related risk factors. The goal of this study was to test an eight-week, mentor-led text-messaging intervention among 14–16-year-old rural adolescents: the “Go Big and Bring It Home” Project to improve fruit and vegetable and healthy beverage intake. Methods and Materials—Eight rural high schools in eastern Kentucky and eastern North Carolina participated (n = 4 were randomized as intervention schools and n = 4 were randomized as control …

The Impact Of A Fruit And Vegetable Farmers' Market Voucher Prescription Program On A Low-Income Rural Population, Kevin Anthony Richie

Theses and Dissertations--Nutrition and Food Systems

Objective: Measures the impact of the Farmers’ Market Voucher program on weight, body mass index, waist circumference, during the 2016 summer on a rural, low-income population residing in Appalachian Kentucky.

Background: Rural communities often have limited access to fresh fruits and vegetables (FV) which contributes to low levels of consumption. FV are calorie poor, nutrient dense and are inversely associated with inflammation markers, obesity, hypertension, and high blood glucose levels. Appalachian rural communities have a higher prevalence of obesity, diabetes, strokes, and death by heart attack when compared to the U.S. Farmers’ markets

Methods: Pre-experimental intervention design examining FV consumption …

Promotion Of Fruit And Vegetable Intake Through Recipe Card Distribution And Sampling At Farmers’ Markets Throughout Kentucky, Umaima Sidra Afsheen Syeda

Theses and Dissertations--Nutrition and Food Systems

The Center for Disease Control and Prevention (CDC) reports indicate that 8% and 6.3% of Kentuckians consume enough fruits and vegetables, respectively. The Plate It Up! Kentucky Proud (PIUKP) project is a recipe-development project that aims to boost produce consumption by incorporating local fruits and vegetables. The purpose of this study was to implement promotional strategies using PIUKP recipes at farmers’ markets and determine their effects on consumers’ intent of purchasing and preparing the produce. The study was conducted at nine farmers’ markets across Kentucky (n=300) in collaboration with Cooperative Extension agents/assistants.

The consumers’ impression of the sample was positively …

Factors That Influence Maternal Feeding Decisions For Toddlers: Extending The Theory Of Planned Behavior, Elizabeth Lucas Combs

Theses and Dissertations--Kinesiology and Health Promotion

Establishing healthy eating behaviors is vital in the early years to help combat the development of obesity and other chronic diseases. Mothers play an invaluable role in shaping their children's eating habits through controlling what and when children eat as well as the overall food environment, which is why a better understanding of what influences mothers’ decisions about these behaviors is important.

The purpose of the dissertation was to gain a better understanding of what impacts maternal feeding decisions regarding toddler nutrition behaviors. This was a two-phased mixed methods study. The aim of the initial study was to explore, using …

Direct Effects Of The Home, School, And Consumer Food Environments On The Association Between Food Purchasing Patterns And Dietary Intake Among Rural Adolescents In Kentucky And North Carolina, 2017, Alison Gustafson, Stephanie Jilcott Pitts, Jordan Mcdonald, Hannah Ford, Paige Connelly, Rachel Gillespie, Emily Liu, Heather M. Bush, Candace Brancato, Toyin Babatande, Janet Mullins

Dietetics and Human Nutrition Faculty Publications

Background: Obesity rates are higher among rural versus urban adolescents. To examine possible mechanisms for the rural-urban adolescent obesity disparity, we examined the direct and indirect effects of food purchasing patterns, and the home, school, and consumer food environments on dietary intake among rural adolescents. Methods: A baseline survey was conducted among adolescents in eight rural high schools (four in Eastern Kentucky, and four in Eastern North Carolina). Participants answered questions about food purchasing patterns, dietary intake, home food availability, and demographics. The school and consumer food environments were assessed using validated measures from the School Meals Cost Study (United …

Marketing Strategies To Encourage Rural Residents Of High-Obesity Counties To Buy Fruits And Vegetables In Grocery Stores, Emily Liu, Tammy Stephenson, Jessica Houlihan, Alison Gustafson

Dietetics and Human Nutrition Faculty Publications

Introduction

Obesity rates in Appalachia are among the highest in the United States, and knowledge of upstream approaches to decrease prevalence among this vulnerable population is limited. The primary aim of this study was to examine the association between healthy, diet-based, social marketing interventions in grocery stores and frequency of fruit and vegetable intake.

Methods

A social marketing campaign was conducted among 17 grocery stores (N = 240 participant surveys) over 4 months in 5 rural Kentucky counties. Interventions included providing food samples, recipe cards, and promotional discounts on fruits and vegetables and moving high-calorie foods to side aisles.

Results …

A Community-Based Marketing Campaign At Farmers Markets To Encourage Fruit And Vegetable Purchases In Rural Counties With High Rates Of Obesity, Kentucky, 2015-2016, Emily M. Dewitt, Margaret Louise Mcgladrey, Emily Liu, Nicole Rachael Peritore, Kelly H. Webber, Brooke F. Butterworth, Ann Vail, Alison A. Gustafson

Dietetics and Human Nutrition Faculty Publications

Availability of farmers markets may increase fruit and vegetable consumption among rural residents of the United States. We conducted a community-based marketing campaign, Plate it Up Kentucky Proud (PIUKP), in 6 rural communities over 2 years to determine the association between exposure to the campaign and fruit and vegetable purchases, adjusted for Supplemental Nutrition Assistance Program recipient status. Logistic regression was used to examine the odds of the PIUKP campaign influencing purchases. Awareness of the PIUKP marketing campaign was significantly associated with a willingness to prepare fruits and vegetables at home. Using marketing strategies at farmers markets may be an …

Connecting Self-Efficacy Of Dietary Choices And The Association With Dietary Intake Among Rural Adolescents In North Carolina And Kentucky, Rachel Gillespie

Theses and Dissertations--Nutrition and Food Systems

Determining the level of belief one has in themselves, or their self-efficacy, can be a key factor to improve certain dietary patterns and choices in the rural youth population. Sugar sweetened food and beverage consumption continues to rise and fruit and vegetable intake remains a struggle in rural areas; addressing both the food environment and adolescents’ self-efficacy could have a lasting impact on changing the nature of a generation of rural student’s food and beverage choices. This study measured self-efficacy levels of (n=425) adolescents in rural Kentucky and North Carolina using the Youth Impact Questionnaire and dietary intake using the …

An Evaluation Of The Screening And Management Of Childhood Overweight And Obesity In The Primary Care Setting, Diane L. Crutcher

DNP Projects

Background: Worldwide, the World Health Organization (2016) estimates that forty-two million children from two to five years of age are overweight or obese. In the United States, Kentucky ranks sixth for the highest rate of overweight youth in the nation (Partnership for Fit Kentucky, 2009). The long term consequences of overweight and obesity are early onset of adult chronic diseases as well as social and psychological issues in childhood and adulthood.

Purpose: The objective of this gap analysis was to assess BMI screening and weight management of children ages two to five who presented for a well-child check …