Identifying Food Parenting Practices From Comprehensive Home Environment Survey.

OBJECTIVE: Conducting exploratory factor analysis (EFA) with the existing home environment assessment-the Comprehensive Home Environment Survey (CHES), to identify scales related to food parenting practices. METHODS: Parents of 3- to 5-year-old children (n = 172) completed the CHES surveys. After selected items from CHES were categorized into food parenting practice constructs, EFA was used to identify potential subconstructs. Internal consistency and Spearman correlation analysis were also conducted. RESULTS: The EFAs identified 4 factors within the structure, 4 within coercive control, and 2 within autonomy support. CONCLUSIONS AND IMPLICATIONS: The results provided preliminary evidence and support that the CHES can be used to measure food parenting practices. The study was limited to a small sample of non-Hispanic White and highly educated participants, less identified items within autonomy support, and lower internal consistency for several identified factors. Confirmatory factor analysis in a larger and more diverse sample is needed for future research.

Dyadic Analysis of a Self-report Physical Activity Measure for Adult-Youth Dyads.

Adult physical activity levels influence youth physical activity levels, but the nature of this relationship is still unknown. Most research focusing on this topic has been conducted with accelerometers, which are ideal since self-report physical activity measures can be biased. However, self-report measures for physical activity are useful to include in studies to gather information at low-cost. The purpose of this study was to further develop a self-report adult-youth dyad measure of physical activity. This study was conducted using secondary data analysis of the physical activity measures used in an intervention on behavioral nutrition (iCook 4-H). Participants were a sample of 214 adults (M = 39.0, SD = 8.0 years) and youth (M = 9.4, SD = 0.7 years) pairs. Accelerometer data was collected for a subset of youth (n = 122). There was dependency between the adult-youth physical activity data, and a dyadic confirmatory factor analysis model showed good fit to the data and achieved metric invariance, a measure to determine if the same construct was being measured in both youth and adults. Invariance was confirmed across matched versus unmatched sex pairs and some evidence of invariance with youth accelerometer data. Based on study findings, when using self-report measures of physical activity, researchers should measure both members of the adult-youth dyad to get more accurate measurements. Further validation of these findings is needed using an objective physical activity measure, like accelerometers, with all participants and more diverse samples.

Parenting Styles, Food Parenting Practices and Dietary Intakes of Preschoolers.

Previous evidence suggests that children's eating behaviors were largely influenced by the parent and home eating structure. This study examined the relationship between parenting styles (including authoritative, authoritarian, indulgent, and uninvolved), food parenting practices (within Structure, Coercive Control, and Autonomy Support constructs) and dietary intakes of preschoolers. Children aged 3-5 years and their parents were recruited from preschools/daycare centers and parents completed the surveys (n = 166). Dietary intakes were collected using the Harvard Service Food Frequency Questionnaire (HSFFQ), parenting style was assessed using the Parenting Dimensions Inventory-Short Version (PDI-S), and food parenting practices were measured using Comprehensive Home Environment Survey (CHES). The results showed that food parenting practices had a higher number of specific significant findings on children's nutrient and food group intakes than parenting styles. Correlation analyses showed positive parenting practices within Structure were significantly related to healthier children's intakes (e.g., vegetables, iron, and folate) and less unhealthy dietary intakes (e.g., sweets and total fats). Regression models show that children with authoritative parents consumed more fruits compared to children with authoritarian parents and indulgent parents. The results addressed the importance of parental influences for preschoolers' healthy dietary intakes, which suggested that future interventions and educational programs could enhance parenting practices to impact child diet.

A Community-Based Cultural Adaptation Process: Developing a Relevant Cooking Curriculum to Address Food Security for Burundian and Congolese Refugee Families.

Refugee-specific nutrition and cooking curricula addressing dietary acculturation barriers to food security are limited. A cooking curriculum was culturally adapted for Burundian and Congolese refugees to address their unique dietary acculturation experiences. A four-phase curriculum adaptation process (information gathering [literature review, researcher informed, and formative interviews; n = 18], preliminary adaptation design [data incorporation and steering committee; n = 5], pilot testing [n = 10 youth/adult dyads], and refinement) was applied to the existing evidence-based iCook 4-H curriculum using a five-strategy (peripheral, evidential, linguistic, constituent-involving, and sociocultural) cultural adaptation framework. A multiphase, two-cycle coding analytic process was completed within NVivo 12, followed by direct content analysis. Seventeen adaptations were made to the iCook curriculum, derived from varying combinations of four data sources (literature review, researcher informed, priority population, and steering committee), applying all five cultural adaptation strategies. A majority of the curriculum adaptations were derived from two or more data sources (71%) and were categorized within multiple adaptation strategies (88%). This study provided a community-based cultural adaptation process that could be used with various populations to address unique barriers and facilitators to food security. This innovative model addresses cultural needs while simultaneously aiming to improve health habits of refugee communities.

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.

Accuracy of self-reported BMI using objective measurement in high school students.

Self-reported measures for body mass index (BMI) are considered a limitation in research design, especially when they are a primary outcome. Studies have found some populations to be quite accurate when self-reporting BMI; however, there is mixed research on the accuracy of self-reported measurements in adolescents. The aim of this study is to examine the accuracy of self-reported BMI by comparing it with measured BMI in a sample of U.S. adolescents and to understand gender differences. This cross-sectional study collected self-reported height and weight measurements of students from five high schools in four states (Tennessee, South Dakota, Kansas and Florida). Trained researchers took height and weight of students for an objective measurement. BMI was calculated from both sources and categorized (underweight, normal, overweight and obese) using the Centers for Disease Control and Prevention's BMI-for-age percentiles. Participants (n 425; 51⋅0 % female) had a mean age of 16⋅3 years old, and the majority were White (47⋅5 %). Limits of agreement (LOA) analysis revealed that BMI and weight were underreported, and height was overreported in the overall sample, in females, and in males. LOA analysis was fair for BMI in all three groups. Overall agreement in BMI categorisation was considered substantial (Κ 0⋅71, P < 0⋅001). As BMI increased, more height and weight inaccuracies led to decreased accuracy in BMI categorisation, and the specificity of obese participants was low (50⋅0 %). This study's findings suggest that using self-reported values to categorize BMI is more accurate than using continuous BMI values when self-reported measures are used in health-related interventions.

Relationship of Weight-Related Eating Behaviors and Weight Loss of Participants Enrolled in a Proprietary Weight Loss Program.

Background: There is a need for improving long-term success in meal replacement programs and identifying the variables that affect weight loss and maintenance in a proprietary weight loss program that includes health coaching. Objective: The aim of this study is to evaluate weight-related eating behaviors of participants with clinically significant weight loss (CSWL) in a proprietary weight loss program. Study Design, Setting, and Participants: A cross-sectional sample of participants (n=1,454) enrolled in a proprietary weight-loss program that includes meal replacements and health coaching were queried via an on-line survey for weight-related eating behaviors and weight history. Main Outcome Measures and Analysis: Weight-related eating behaviors of routine restraint (RR), compensatory restraint (CR), susceptibility to external cues (SEC), and emotional eating (EE) were assessed using the Weight Related Eating Questionnaire. CSWL was defined as having achieved a weight loss greater than 10% of starting weight. Participants were dichotomized into those with CSWL (n=973) and with no CSWL (n=481). The relationship between CSWL (controlling for age and sex) as the dependent variable and weight-related eating behaviors (RR, CR, SEC, and EE) as the independent variables was assessed using logistic regression (Stata/SE 14). Results: Those with CSWL have higher odds of having RR (OR: 1.3, p<0.05) and CR (OR: 1.1, p<0.05) and lower odds of SEC (OR: 0.7, p<0.05) and EE (OR: 0.8, p<0.05) eating behaviors than those without CSWL. Conclusions: Weight-related eating behaviors of participants in proprietary meal replacement weight-loss programs who have successfully lost weight differ compared to those who have not. Knowledge of the relationship between CSWL and weight-related eating behaviors can be used by coaches to assist participants in reinforcing those behaviors that support weight-loss. These results are limited to participants who self-select for proprietary meal-replacement weight-loss programs and cannot be generalized to other weight-loss or maintenance programs.

Feasibility and Acceptability of Implementing a Culturally Adapted Cooking Curriculum for Burundian and Congolese Refugee Families.

Pika Pamoja (Cook Together) is an eight-session cooking curriculum for Burundian and Congolese refugee families, culturally adapted from the evidence-based iCook 4-H curriculum to address dietary acculturation barriers to and facilitators of food security. The goal of this study was to determine the feasibility and acceptability of implementing Pika Pamoja. Researchers and a multilingual community aid implemented Pika Pamoja in a pre-post pilot intervention with randomized control (n = 5)/treatment (n = 5) dyads (youth/mother). Feasibility (recruitment/retention, implementation, fidelity testing, and assessment procedures) and acceptability (process and program evaluations) measures were collected. All 10 dyads (control and treatment) were retained throughout the study. All fidelity measures were 91% or above. The final youth assessment instrument included scales for cooking skills (α = 0.93), cooking self-efficacy (α = 0.90), openness to new foods (α = 0.81), and eating (α = 0.68), playing (α = 0.90), and setting healthful goals (α = 0.88) together as a family. The final adult instrument included scales for cooking, eating, and playing together (α = 0.68), kitchen proficiency (α = 0.89), and food security (α = 0.79). Participant feedback was uniformly positive. Based on these results, Pika Pamoja was feasible to implement and was accepted by the priority population. Larger scale studies to measure the effectiveness of Pika Pamoja to increase food security among refugee families are needed.

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.

A Multi-Year Examination of Gardening Experience and Fruit and Vegetable Intake During College.

Gardening has been positively associated with fruit and vegetable (FV) consumption based on short-term studies among children, but long-term data among adolescents and young adults are lacking. This investigation sought to elucidate the association between gardening experience and FV intake among college students over a two-year period. Students (N = 593) from eight universities were assessed at the end of their freshman (Y1) and sophomore (Y2) years during the springs of 2016 and 2017, respectively. At each time point, participants completed the NCI FV Screener and questions related to gardening experience and FV-related attitudes and behaviors. Students were then categorized into four groups based on gardening experience: Gardened only during the first or second year (Y1 only and Y2 only gardeners), gardened both years (Y1+Y2 gardeners), and non-gardeners. While both Y1 only and Y1+Y2 gardeners reported significantly higher FV intake relative to non-gardeners at Y1 (2.3 ± 0.9 and 2.6 ± 0.7 versus 1.9 ± 0.6 cup equivalents (CE)/day, respectively; p < 0.01), only Y1+Y2 gardeners differed from non-gardeners at Y2 (2.4 ± 0.6 versus 1.8 ± 0.5 CE/day; p < 0.001). Additionally, Y1+Y2 gardeners reported more frequent engagement of several FV-related behaviors, including shopping at farmers' markets, eating locally grown foods, and cooking from basic ingredients; and were five times more likely to have gardened during childhood (OR: 5.2, 95%, CI: 3.5-8.8; p < 0.001). Findings suggest that while isolated gardening experiences during college are associated with FV intake, reoccurring experience may be essential for sustained benefit.

Incorporating Technology Into the iCook 4-H Program, a Cooking Intervention for Adults and Children: Randomized Controlled Trial.

BACKGROUND: Families who cook, eat, and play together have been found to have more positive health outcomes. Interventions are needed that effectively increase these health-related behaviors. Technology is often incorporated in health-related interventions but is not always independently assessed. OBJECTIVE: The objective of this study was to describe challenges and facilitators to incorporating technology into the iCook 4-H intervention program. METHODS: Dyads (n=228) composed of children (mean 9.4, SD 0.7 years old) and an adult primary meal preparer (mean 39.0, SD 8 years) were randomly assigned to a control (n=77) or treatment group (n=151). All treatment group dyads participated in 6 in-person sessions designed to increase families cooking, eating, and playing together. We incorporated Web-based between-session technological components related to the curriculum content throughout the intervention. Assessments were completed by both groups at baseline and at 4, 12, and 24 months; they included measured anthropometrics for children, and online surveys about camera and website skill and use for dyads. Session leaders and participants completed open-ended process evaluations after each session about technological components. We computed chi-square analysis for sex differences in technological variables. We tested relationships between video posting frequency and outcomes of interest (cooking frequency, self-efficacy, and skills; dietary intake; and body mass index) with Spearman correlations. Process evaluations and open-ended survey responses were thematically analyzed for beneficial and inhibiting factors, including technological components in the curriculum. RESULTS: Only 78.6% (81/103) of children and 68.3% (71/104) of adults reported always being comfortable accessing the internet postintervention. Boys reported being more comfortable than girls with technological tasks (P<.05). Children who posted more videos had a higher level of cooking skills at 4 months postintervention (r=.189, P=.05). Barriers to website usage reported most frequently by children were lack of accessibility, remembering, interactivity, motivation, time, and lack of parental encouragement. CONCLUSIONS: Incorporating technological supports, such as cameras and websites, into children's programs may help produce improved outcomes. Identifying barriers to and patterns of technology usage need to be considered when developing future child health promotion interventions. TRIAL REGISTRATION: ISRCTN Registry ISRCTN54135351; https://www.isrctn.com/ISRCTN54135351.

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.

Cooking Frequency Associated With Dietary Quality in iCook-4H Youth Participants at Baseline.

BACKGROUND: Increased intakes of ready-made and fast foods paralleled with decreased homemade food consumption have been associated with increased rates of obesity. Researchers have shown associations between cooking self-efficacy (SE) and cooking frequency (CF) with dietary quality and weight status. Some cooking interventions have shown positive associations with dietary outcomes, such as increased fruit and vegetable intake and decreased fast food consumption. There is still much unknown about SE and CF, especially among youth. OBJECTIVE: Determine baseline SE and CF and the associations with dietary quality and body mass index (BMI) of youth enrolled in iCook 4H. METHODS: Youth (n = 228, ages 9-10 years) completed online surveys assessing SE, CF, dietary quality, and demographics. Anthropometrics were collected to calculate BMI-for-age percentiles and weight categories. Descriptive statistics were completed for CF, SE, BMI categories, and demographics. Differences in CF and SE by sex, race, and participation in government assistance programs were determined through independent-sample t tests. Pearson correlations were used to assess the association between dietary quality and CF and SE. Associations between CF and dietary quality were assessed further through 2-way analyses of variance (ANOVAs) that included CF and sex and CF and race as independent variables. Associations between SE and CF and BMI were assessed through ANOVAs. RESULTS: Thirty-seven percent of youth were overweight or obese. Females reported significantly higher CF than males (P = .042). Cooking frequency was positively associated with dietary quality (P < .001), but BMI was not associated with dietary quality. SE was not associated with dietary quality or BMI. CONCLUSION: Based on results, CF was positively associated with dietary quality among youth. More research is needed to assess how different types of cooking relate to diet and BMI. Interventions are needed to determine whether increasing CF leads to better diet outcomes.

Redesign, Field-Testing, and Validation of the Physical Activity Campus Environmental Supports (PACES) Audit.

This paper describes the redesign, field-testing, and convergent validity of a practical tool-Physical Activity Campus Environmental Supports (PACES) audit. Methods. The audit includes two parts: (1) PACES-Programs, which is comprised of questions regarding populations served, fees, programs (recreation/fitness classes and intramurals), proximity, adequacy of facilities, and marketing, and (2) PACES-Facilities, which is comprised of questions regarding built environment (aesthetics, bike racks, stairs, and universal design), recreation equipment, staff, amenities, and access. Each item criterion is specifically scored using a five-point, semantic-differential scale ranging from limited to extensive environmental support. A few questions utilize select all that apply for a summed score. PACES training, interrater reliability, and data collection are all accessible via an online portal. PACES was tested on 76 college campuses. Convergent validity was examined by comparing the PACES-Programs questions to Healthy Campus Initiatives-Programs questions (HCI-Programs) and comparing the PACES-Facilities questions to questions contained in the Physical Activity Resource Assessment (PARA) Instrument. Statistical analyses included Cronbach's alpha, ANOVA, latent profile analysis, and Spearman correlations. Results. The PACES-Programs audit includes 10 items for a potential total of 73 points (α = 0.72) and PACES-Facilities audit includes 15 items for a potential total of 77 points (α = 0.837). Most (77.8%) of the 153 facilities assessed scored in the most healthful range (20-42), which was mainly due to the extensiveness of the aerobic equipment/amenities and the competence/accessibility of staff. Significant differences in PACES-Total and PACES-Programs scores were associated with campus size and PACES-Facilities across regions. For the paired validation assessments, correlations were significant between PACES-Programs and HCI-Programs ((n=41) r=0.498, p < 0.001) and PACES-Facilities and PARA (n=29) for both features (r=0.417, p=0.024) and amenities (r=0.612, p < 0.001), indicating moderate convergent validity. Conclusion. The PACES audit is a valid, reliable tool for assessing the quality of recreation facilities and programs in a variety of college campus environments.

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).

The iCook 4-H Study: An Intervention and Dissemination Test of a Youth/Adult Out-of-School Program.

OBJECTIVE: To describe outcomes from intervention and dissemination of iCook 4-H. DESIGN: Five-state, community-based participatory research and a randomized, controlled trial followed by a 5-state, nonrandomized dissemination test of the iCook 4-H curriculum with control and treatment groups. SETTING: Community and university sites. PARTICIPANTS: Youths aged 9-10 years and their adult food preparer; 228 dyads in the intervention and 74 dyads in dissemination. INTERVENTION(S): Theoretical frameworks were Social Cognitive Theory and the experiential 4-H learning model. Six 2-hour, biweekly sessions on cooking, eating, and playing together followed by monthly newsletters and boosters until 24 months, expanded to 8 sessions for dissemination. MAIN OUTCOME MEASURE(S): Youth body mass index (BMI) z-scores, measured height and weight, and youth/adult program outcome evaluations surveys. ANALYSIS: Linear mixed models, group, time, and group × time interaction for BMI z-score and program outcomes changes. Significance levels = P ≤ .05; interaction term significance = P ≤ .10. RESULTS: In intervention, treatment BMI z-scores increased compared with controls based on significant interaction (P = .04). For odds of being overweight or obese at 24 months, there was no significant interaction (P = .18). In dissemination, based on significant interaction, treatment youths increased cooking skills (P = .03) and treatment adults increased cooking together (P = .08) and eating together (P = .08) compared with controls. CONCLUSIONS AND IMPLICATIONS: iCook 4-H program outcomes were positive for mealtime activities of cooking and eating together. The program can be successfully implemented by community educators. The increase in BMI z-scores needs further evaluation for youths in cooking programs.

Development of the iCook 4-H Curriculum for Youth and Adults: Cooking, Eating, and Playing Together for Childhood Obesity Prevention.

The objective was to describe the development process of a curriculum (iCook 4-H) targeted to low-income, rural, and/or diverse youths and their adult primary meal preparer to promote cooking, eating, and playing together. Lessons learned highlighted the importance of grounding the curriculum in Social Cognitive Theory and applying the experiential 4-H learning model using a multiphased, community-based participatory approach with cyclical development and evaluation, and key modifications made for dissemination and distribution. Findings across 4 testing phases over 6 years and 5 states demonstrated the time-intensive, cyclical process that required flexibility with fidelity to form a hands-on, interactive curriculum.

Development and Validation of the Vending Evaluation for Nutrient-Density (VEND)ing Audit.

Background: This paper describes the development and validation of the Vending Evaluation for Nutrient-Density (VEND)ing audit to comprehensively evaluate vended products based upon healthfulness, price and promotion, and machine accessibility. Methods: A novel vending nutrient-density score was created to determine the healthfulness of vended snack/beverage products. Field tested in United States colleges, VENDing audit (∑nutrient-density + 10 × % healthy products) and Support sub-scores (price + promotion + accessibility) were calculated for snack/beverage machines. Higher scores indicate more healthful vending options and supports for choosing healthfully. Nutrition Environment Measures Survey-Vending (NEMS-V) was used to validate the nutrient-density score for a sub-sample of machines. Sensitivity and specificity were computed by comparing the number of healthy snacks/beverages determined by NEMS-V and the VENDing nutrient-density scores. Results: Researchers conducted the VENDing audit on 228 snack/beverage vending machines at 9 universities within the United States and used both VENDing and NEMS-V on 33 snack and 52 beverage vending machines. Mean VENDing audit scores were 4.5 ± 2.0 (2.6, 3.4) and 2.6 ± 2.0 (0, 12) for snack/beverage machines, respectively. The number of products considered healthy assessed with both the VENDing nutrient-density scores and the NEMS-V were positively correlated for beverages (r = 0.687, p < 0.001) and snacks (r = 0.366, p < 0.05). The sensitivity was excellent for beverages (0.83) and moderate for snacks (0.69); while the specificity was moderate for both beverages (0.66) and snacks (0.50). Conclusions: The VENDing audit uses unique, valid, and reliable nutrient-density scoring to evaluate snacks/beverages along a continuum of healthful criteria and comprehensively evaluates the full vending environment.

Ripple Effect Mapping Outcomes of a Childhood Obesity Prevention Program From Youth and Adult Dyads Using a Qualitative Approach: iCook 4-H.

OBJECTIVE: To describe the impact of the iCook 4-H intervention study based on data gathered through ripple effect mapping focus groups through an explorative approach. DESIGN: Youth-adult dyads responded about ways in which iCook had affected the individual, family, and community. Three questions were asked: (1) What were people doing differently as a result of iCook? (2) Who benefited from iCook and how? (3) Were there changes in the way community groups and institutions did things as a result of iCook? SETTING: Ripple effect mapping sessions took place across 5 states (Maine, Nebraska, South Dakota, Tennessee, and West Virginia). PARTICIPANTS: Seventy dyad participants (n = 35 youth, n = 35 adults) from the iCook 4-H intervention. MAIN OUTCOME MEASURE: Three core themes of iCook 4-H were assessed: cooking, eating, and playing together. ANALYSIS: Direct content analysis and word frequencies were used. RESULTS: Seven categories emerged: improved health, increased community involvement, increased knowledge, increased communication, changed motivation, financial mindfulness, and increased appreciation for family. An overarching theme that was determined was that learning new skills together through trying new things (cooking, eating, and playing) leads to positive individual family and community change. CONCLUSIONS AND IMPLICATIONS: Ripple effect mapping was effective in determining the perceived impact of iCook 4-H on oneself, family, and community.