Effectiveness of Home Gardening in Improving Food Security and Health in Chacraseca, Nicaragua: A Pilot Study.

We studied the usefulness of home gardening in improving food security and health. One hundred participants were randomized into the control and intervention group of which the intervention group received training in home gardening. Results showed that the percentage of participants with normal body mass index decreased from 24.4% to 20% in the control group whereas it remained unchanged in the intervention group. The number of participants in the very low food security category decreased from 66% (n=33) to 54% (n=27) in the intervention group whereas it increased from 68.8% (n=33) to 70.8% (n=34) in the control group. Results from the present study may be used to guide policymakers in designing or modifying home gardening interventions.

Effectiveness of Home Gardening in Improving Food Security and Health in Chacraseca, Nicaragua: A Pilot Study.

We studied the usefulness of home gardening in improving food security and health. One hundred participants were randomized into the control and intervention group of which the intervention group received training in home gardening. Results showed that the percentage of participants with normal body mass index decreased from 24.4% to 20% in the control group whereas it remained unchanged in the intervention group. The number of participants in the very low food security category decreased from 66% (n=33) to 54% (n=27) in the intervention group whereas it increased from 68.8% (n=33) to 70.8% (n=34) in the control group. Results from the present study may be used to guide policymakers in designing or modifying home gardening interventions.

Development and Validation of the Short Healthy Eating Index Survey with a College Population to Assess Dietary Quality and Intake.

Because diet quality (DQ) is associated with risk of chronic disease and is a common construct assessed in health-related research, validated tools to assess DQ are needed that have low respondent and researcher burden. Thus, content experts develop the Short Healthy Eating Index (sHEI) tool and an associated scoring system. The sHEI scoring system was then refined using a classification and regression tree (CRT) algorithm methodology with an iterative feedback process with expert review and input. The sHEI scoring system was then validated using a concurrent criterion validation process that included the sHEI DQ scores (calculated from responses from 50 participants) being compared to the participants' Healthy Eating Index scores derived from 24 h recalls. The total HEI score from the CRT algorithm highly correlated with the 24 h recall HEI score (0.79). For individual food group items, the correlation between the CRT algorithm scoring and the 24 h recall data scoring ranged from 0.44 for refined grains to 0.64 for whole fruits. The sHEI appears to be a valid tool for estimating overall dietary quality and individual items (with correlations > 0.49) for fruits, vegetables, dairy, added sugar, sugar from sugar-sweetened beverages, and calcium.

eB4CAST Approach Improves Science Communication With Stakeholders in a College-Based Health Program.

Communicating scientific results with community partners is often lacking in intervention programs, thus eB4CAST was developed to facilitate impact sharing. This article investigated using the eB4CAST dissemination tool to communicate impact from a campus-based obesity prevention program. Data from Get Fruved RCT university sites collected at baseline were used to generate eB4CAST reports. Experts (n = 13) and RCT sites (n = 15) were asked to provide feedback on eB4CAST reports based on appeal, understanding, and clarity. On all Likert items, participants rated above 7 on each (out of 10). Positive responses from open-ended questions included eB4CAST reports being clear, visually appealing, and aid in program understanding. Overall, eB4CAST was successful in relaying data and information for the Get Fruved program, thus a means for science communication that could be used in interventions. Utilizing infographics to report data and information is a feasible way to disseminate and communicate in a cost-effective, timely manner.

Development of an Instrument Measuring Perceived Environmental Healthfulness: Behavior Environment Perception Survey (BEPS).

OBJECTIVE: To create a tool to measure college students' perception of the healthfulness of their environment. DESIGN: (1) Item generation, (2) cognitive interview testing and exploratory factor analysis, (3) item refinement/modification, (4) factor structure validation, and (5) criterion validation. SETTING: Ten college campuses. PARTICIPANTS: Time point 1 (n = 120 cognitive interviews; n = 922 factor analysis); time point 2 (n = 2,676), convenience sample of undergraduate students. MAIN OUTCOME MEASURES: Cognitive interviews and survey data were used to assess perceptions about the environment. ANALYSIS: Exploratory factor analysis, structural equation confirmatory factor analysis, correlations, and regressions. RESULTS: Item generation resulted in 93 items. Items were eliminated based on cognitive interviews, exploratory factor analysis of pilot data, and elimination of cross-loading or weak loading items. In confirmatory analyses, a 21-item, 5-factor structure was the best fit for the data (χ2 = 3,286.77, degrees of freedom = 189; comparative fit index = 0.840; root-mean-square error of approximation = 0.078). Environmental factors include physical activity (α = 0.68, 4 items), healthful eating (α = 0.86, 5 items), mental health (α = 0.85, 5 items), barriers to healthful eating (α = 0.70, 4 items), and peer influences (α = 0.73, 3 items). There were significant associations between scales and validation criteria (P < .05). CONCLUSIONS AND IMPLICATIONS: The Behavior Environment Perception Survey is a novel instrument measuring perceptions of the healthfulness of the campus environment. Strengths include a development process involving 10 different universities, strong psychometric properties, and breadth of constructs.

Cooking and Meal Planning as Predictors of Fruit and Vegetable Intake and BMI in First-Year College Students.

The objective was to determine if cooking skills and meal planning behaviors are associated with greater fruit and vegetable intake and lower body mass index (BMI) in first-year college students who are at risk for excessive weight gain. A cross-sectional analysis was conducted using baseline data from a multi-state research project aimed at preventing weight gain in first-year college students. Cooking type, frequency and confidence, self-instruction for healthful mealtime behavior intention, self-regulation of healthful mealtime behavior, and cup equivalents of fruits and vegetables (FV) were measured using validated surveys. BMI was calculated from measured height and weight. First-year students (n = 1108) considered at risk for weight gain from eight universities completed baseline assessments within the first month of entering college. Multiple linear regression was used to determine associations among independent variables of cooking patterns, meal planning behaviors, and dependent variables of fruit and vegetable intake and BMI, after controlling for the influence of sex. Cooking more frequently, cooking with greater skills, and practicing meal planning behaviors are associated with greater fruit and vegetable intake and lower BMI in first-year college students. Interventions aimed at improving health in college students may be enhanced by incorporating cooking and meal planning components.

Development and Validation of the Policies, Opportunities, Initiatives and Notable Topics (POINTS) Audit for Campuses and Worksites.

Background: Workplace or campus wellness/obesity-prevention policies and initiatives can improve health. Research tools to assess worksite or campus policies/initiatives are scarce. Thus, the aim of this research is to develop and validate the policies, opportunities, initiatives, and notable topics (POINTS) audit. Methods: POINTS was developed and refined via expert review, pilot-testing, and field testing. Trained researchers completed a web-based review from a student-focus or employee-focus regarding 34 health-promoting topics for colleges. Each topic was evaluated on a 0⁻2 scale: 0 = no policy/initiative, 1 = initiatives, 2 = written policy. When a written policy was detected, additional policy support questions (administered, monitored, reviewed) were completed. Results: Cronbach's Alpha for the student-focused POINTS audit was α = 0.787 (34 items, possible points = 65), and for the employee-focused POINTS audit was α = 0.807 (26 items, possible points = 50). A total of 115 student-focused and 33 employee-focused audits were completed. Although there was little evidence of policy presence beyond stimulant standards (smoking and alcohol), there were extensive examples of health initiatives. The student-focused POINTS audit was validated using the Healthier Campus Initiative's survey. Conclusions: POINTS is a web-based audit tool that is valid and useful for pre-assessment, advocacy, benchmarking, and tracking policies for health and well-being for students (campus) and employees (worksite).

Development and Validation of a Simple Convenience Store SHELF Audit.

Background This paper describes the development, reliability, and convergent validity of a practical tool-the Convenience Store Supportive Healthy Environment for Life-Promoting Food (SHELF) Audit. Methods Audit items included: a variety of fresh, processed, and frozen fruits and vegetables; low-fat dairy products; healthy staples and frozen meals; healthy food incentive programs; items sold in check-out areas; portion/cup sizes; and pricing. Each audit item was scored using a five-point semantic-differential scale (1 = provides little or no support for healthful foods to 5 = provides high support for healthful foods). Convergent validity was examined by comparing the SHELF audit to Ghirardelli et al. and Laska et al. store audits. Statistical analysis included: Factor analysis, ANOVA, and Spearman correlations. Results SHELF included three factors: a Fruits/Vegetables scale (eight items, α = 0.79; total potential points = 34); a Healthy Foods scale (four items, α = 0.72; total potential points = 16); and a Supports scale (four items, α = 0.685; total potential points = 16). Only 6% of the 124 convenience stores assessed scored in the most healthful range (46⁻66). The assessed drug stores (n = 15) scored higher than convenience stores (n = 81) on the Healthy Foods and Supports scales but not the Fruits/Vegetables scale. The SHELF sub-scores were highly correlated with other audit tools indicating convergent validity. Conclusion The SHELF convenience store audit is a valid, reliable tool for assessing the degree to which convenience stores support healthfulness regarding Fruits/Vegetables, Healthy Foods, and Supports for choosing healthy.

Multilevel Structural Equation Modeling of Students' Dietary Intentions/Behaviors, BMI, and the Healthfulness of Convenience Stores.

BACKGROUND: When dietary behaviors are habitual, intentions are low, and environmental cues, such as the consumer food environment, might guide behavior. How might intentions to eat healthily and ultimately actual dietary behaviors, be influenced by the consumer food environment (including the availability and affordability of healthy foods) in convenience stores? This study will determine pathways between the healthfulness of convenience stores and college students' dietary intentions/behaviors, and body mass index (BMI). METHODS: Through multilevel structural equation modeling, a comparison was made of students' healthful meal intentions (HMI); intake (fruits/vegetables, %kcal/fat, sugar-sweetened beverages (SSBs) and whole-grains); and measured BMI; as well as the healthfulness of convenience stores (fruits/vegetables availability/quality, healthy food availability/affordability). Data was collected on 1401 students and 41 convenience stores across 13 US college campuses. RESULTS: Controlling for gender, HMI was negatively associated with SSBs (ß = -0.859) and %kcal/fat (ß = -1.057) and positively with whole-grains (ß = 0.186) and fruits/vegetables intake (ß = 0.267); %Kcal/fat was positively (ß = 0.098) and fruits/vegetables intake (ß = -0.055) negatively associated with BMI. Campus level, fruits/vegetables availability were positively associated to HMI (ß = 0.214, ß = 0.129) and directly/negatively to BMI (ß = -2.657, ß = -1.124). CONCLUSIONS: HMI modifies dietary behaviors, with energy from fat and fruit/vegetable intake the most predictive of weight. Availability of fruit/vegetables in convenience stores make it easier for young adults to eat well.

Survey Development to Assess College Students' Perceptions of the Campus Environment.

OBJECTIVE: We developed and tested a College Environmental Perceptions Survey (CEPS) to assess college students' perceptions of the healthfulness of their campus. METHODS: CEPS was developed in 3 stages: questionnaire development, validity testing, and reliability testing. Questionnaire development was based on an extensive literature review and input from an expert panel to establish content validity. Face validity was established with the target population using cognitive interviews with 100 college students. Concurrent-criterion validity was established with in-depth interviews (N = 30) of college students compared to surveys completed by the same 30 students. Surveys completed by college students from 8 universities (N = 1147) were used to test internal structure (factor analysis) and internal consistency (Cronbach's alpha). RESULTS: After development and testing, 15 items remained from the original 48 items. A 5-factor solution emerged: physical activity (4 items, α = .635), water (3 items, α = .773), vending (2 items, α = .680), healthy food (2 items, α = .631), and policy (2 items, α = .573). The mean total score for all universities was 62.71 (±11.16) on a 100-point scale. CONCLUSION: CEPS appears to be a valid and reliable tool for assessing college students' perceptions of their health-related campus environment.

College Students' Health Behavior Clusters: Differences by Sex.

OBJECTIVE: The study purpose was to identify clusters of weight-related behaviors by sex in a college student populations. METHODS: We conducted secondary data analysis from online surveys and physical assessments collected in Project Young Adults Eating and Active for Health (YEAH) with a convenience sample of students on 13 college campuses in the United States. We performed 2-step cluster analysis by sex to identify subgroups with homogeneous characteristics and behaviors. We used 8 derivation variables: healthy eating; eating restraints; external cues; stress; fruit/vegetable intake; calories from fat; calories from sugar-sweetened beverages; and physical activity. Contribution of derivation variables to clusters was analyzed with a MANOVA test. RESULTS: Data from 1594 students were included. Cluster analysis revealed 2-clusters labeled "Healthful Behavior" and "At-risk" for males and females with an additional "Laid Back" cluster for males. "At-risk" clusters had the highest BMI, waist circumference, elevated health risk, and stress and least healthy dietary intake and physical activity. The "Laid Back" cluster had normal weights and the lowest restrained eating, external cues sensitivity, and stress. CONCLUSION: Identified differences in characteristics and attitudes towards weight-related behaviors between males and females can be used to tailor weight management programs.

Relationships of Sleep Duration With Weight-Related Behaviors of U.S. College Students.

This study describes sleep behaviors of U.S. college students (N = 1,252; 18-24 years old; 59% female) and examines associations of sleep duration with weight-related behaviors. More than one quarter of participants slept < 7 hr/night and had mean Pittsburgh Sleep Quality Index (PSQI) scores indicating poor sleep quality. There were significant differences for all PSQI scales among sleep duration categories, < 7 hr (n = 344), 7-8 hr (n = 449), ≥ 8 hr (n = 459) sleep/night. Compared to those who slept ≥ 8 hr, those who slept < 8 hr had significantly more negative eating attitudes (2% higher), poorer internal regulation of food (4% lower), and greater binge eating (4% higher) scores. Findings advocate for health care professionals to evaluate sleep behaviors of college students during office visits and promote good sleep behaviors.

The effects of Young Adults Eating and Active for Health (YEAH): a theory-based Web-delivered intervention.

OBJECTIVE: To assess the effectiveness of a tailored theory-based, Web-delivered intervention (Young Adults Eating and Active for Health) developed using community-based participatory research process. DESIGN: A 15-month (10-week intensive intervention with a 12-month follow-up) randomized, controlled trial delivered via Internet and e-mail. SETTING: Thirteen college campuses. PARTICIPANTS: A total of 1,639 college students. INTERVENTION: Twenty-one mini-educational lessons and e-mail messages (called nudges) developed with the non-diet approach and focusing on eating behavior, physical activity, stress management, and healthy weight management. Nudges were short, frequent, entertaining, and stage-tailored to each behavior, and reinforced lesson content. MAIN OUTCOME MEASURE: All participants were assessed at baseline, postintervention (3 months from baseline), and follow-up (15 months from baseline) for primary outcomes of weight, body mass index (BMI), fruit and vegetable intake (FVI), physical activity (PA), and perceived stress; and secondary outcomes of waist circumference, percent dietary fat, energy from sugar-sweetened beverages, servings of whole grains, self-instruction and regulation for mealtime behavior, hours of sleep, and stage of readiness for change for consuming 5 cups of FVI, completing 150 minutes of PA/wk, and managing stress on most days of the week. Demographics were collected at baseline. ANALYSIS: Chi-square analysis and mixed-models repeated measures analysis were performed to determine differences between experimental and control outcomes. RESULTS: There were no differences between experimental and control participants in BMI, weight, and waist circumference. There were small improvements in FVI (P = .001), vigorous PA in females (P = .05), fat intake (P = .002), self-instruction (P = .001), and regulation (P = .004) for mealtime behavior, and hours of sleep (P = .05) at postintervention, but improvements were not maintained at follow-up. At postintervention, a greater proportion of experimental participants were in the action/maintenance stages for FVI (P = .019) and PA (P = .002) than control. CONCLUSIONS AND IMPLICATIONS: Young Adults Eating and Active for Health is one of the first studies to use the community-based participatory research process of PRECEDE-PROCEED to develop a non-diet approach intervention. Although there were no differences between experimental and control participants in weight change or BMI, the intervention supported positive change in behaviors that may mediate excessive weight gain, such as increasing FVI and more healthful self-regulation mealtime behaviors immediately postintervention. Additional strategies to maintain the behavior changes need to be explored.

Mobile MyPlate: a pilot study using text messaging to provide nutrition education and promote better dietary choices in college students.

OBJECTIVE: To evaluate the acceptance and effectiveness of repetitive nutrition-related text messages on college students' nutrition knowledge and fruit and vegetable consumption. PARTICIPANTS: One hundred fifty undergraduate (18-24 years old) non-health major students with a texting mobile phone. METHODS: The intervention group received biweekly text messages of the MyPlate icon and the United States Department of Agriculture's Dietary Guidelines (DGs) for 7 weeks. The control group received the same information in a mailed brochure. A pre and post online survey assessed the students' knowledge and behavior. RESULTS: The intervention resulted in greater MyPlate food group recognition (p <.05) compared with control and a trend toward improved knowledge of the DGs. In the intervention group, fruit consumption was elevated (p <.05) and a trend toward elevated vegetable consumption was determined. No gender differences in intervention effectiveness exist. CONCLUSION: Texting repeated messages appears to be an acceptable and effective way to increase nutrition knowledge and promote positive diet-related behaviors in college students.

Development of Young Adults Eating and Active for Health (YEAH) internet-based intervention via a community-based participatory research model.

OBJECTIVE: To develop a tailored, theory-based, Web-delivered intervention to prevent excessive weight gain in young adults using a Community-Based Participatory Research model. DESIGN: Investigators from 14 universities developed the intervention and supporting administrative portal using the 4 phases of the PRECEDE model. Steering committees were composed of the target audience (aged 19-24 years) and key health/wellness personnel were formed at each institution and provided information during each phase that was used to guide development of the intervention, Project YEAH (Young Adults Eating and Active for Health). Piloting results were used to refine the curriculum and identify and avoid barriers to delivery. RESULTS: Qualitative and quantitative data collected at each phase informed Project YEAH development. In Phase 1, factors of highest priority to young adults were identified. In Phase 2, environmental supports for healthful lifestyles were elucidated. In Phase 3, behavior and environmental changes considered important and changeable were identified. In Phase 4, the 10-week, theory-based, stage-tailored, interactive-learning intervention with a 10-month reinforcement period was developed. CONCLUSIONS AND IMPLICATIONS: Applying the PRECEDE model with fidelity during development of Project YEAH resulted in an intervention that pilot participants found relevant and useful, gained attention, instilled confidence in the ability to apply the information, and provided a sense of satisfaction.

PACES: a Physical Activity Campus Environmental Supports Audit on university campuses.

PURPOSE: This study evaluated the policy and built and recreation environmental supports for physical activity on 13 university campuses. DESIGN: Environmental audit survey. SETTING: Thirteen U.S. universities, 2009. Subjects. University policies, recreation programs and facilities, and at least five additional buildings per campus. MEASURES: The Physical Activity Campus Environmental Supports Audit was developed for this study. ANALYSIS: Analysis of variance with post hoc Tukey's B and χ(2) assessed differences by institution and building type. RESULTS: The mean obesogenic policy score was significantly lower than the desired score, ≥7 (p = .002), with only one campus scoring 10. The mean built environment audit score (5.4 ± 1.7) was low, with significant differences between institutions (p < .001) and only three campuses scoring above the desired score, ≥7. Although generally stairwells were clean and well lighted, there was a lack of signage to encourage stair use (p < .001). Overall, recreation programs (7.1 ± .7) and facilities (7.1 ± 1.2) scored well, but amenities scores were lower for satellite (2.8 ± 1.6) versus main (4.1 ± 1.8) recreation facilities (p = .04). CONCLUSION: On these 13 university campuses, recreation programs and facilities were supportive of healthful lifestyles for obesity prevention, but policies and the built environment were not. This physical activity environmental audit survey requires testing in a wider sample of postsecondary institutions to corroborate its utility and provide evidence to support initiatives to improve campus environments for physical activity.

Eat, sleep, work, play: associations of weight status and health-related behaviors among young adult college students.

PURPOSE: To examine relationships of sleep, eating, and exercise behaviors; work time pressures; and sociodemographic characteristics by weight status (healthy weight [body mass index or BMI < 25] vs. overweight [BMI ≥ 25]) of young adults. DESIGN: Cross-sectional. SETTING: Nine U.S. universities. SUBJECTS: Enrolled college students (N = 1252; 18-24 years; 80% white; 59% female). MEASURES: Survey included the Pittsburgh Sleep Quality Index (PSQI), Three-Factor Eating Questionnaire (TFEQ), Satter Eating Competence Inventory (ecSI), National Cancer Institute Fruit/Vegetable Screener, International Physical Activity Questionnaire, Work Time Pressure items, and sociodemographic characteristics. ANALYSIS: Chi-square and t-tests determined significant bivariate associations of sociodemographics, sleep behaviors, eating behaviors, physical activity behavior, and work time pressures with weight status (i.e., healthy vs. overweight/obese). Statistically significant bivariate associations with weight status were then entered into a multivariate logistic regression model that estimated associations with being overweight/obese. RESULTS: Sex (female), race (nonwhite), older age, higher Global PSQI score, lower ecSI total score, and higher TFEQ Emotional Eating Scale score were significantly (p < .05) associated with overweight/obesity in bivariate analyses. Multivariate logistic regression analysis showed that sex (female; odds ratio [OR] = 2.05, confidence interval [CI] = 1.54-2.74), older age (OR = 1.35, CI = 1.21-1.50), higher Global PSQI score (OR = 1.07, CI = 1.01-1.13), and lower ecSI score (OR = .96, CI = .94-.98), were significantly (p < .05) associated with overweight/obesity. CONCLUSION: Findings suggest that obesity prevention interventions for college students should include an education component to emphasize the importance of overall sleep quality and improving eating competence.