The Food, Feelings, and Family Study: comparison of the efficacy of traditional methods, social media, and broadcast email to recruit pregnant women to an observational, longitudinal nutrition study.

BACKGROUND: It is well known that recruitment is a challenging aspect of any study involving human subjects. This challenge is exacerbated when the population sought is reticent to participate in research as is the case with pregnant women and individuals with depression. This paper compares recruitment methods used for the Food, Feelings, and Family Study, an observational, longitudinal pilot study concerning how diet and bisphenol A exposure affect maternal mood and cognitive function during and after pregnancy. METHODS: Pregnant women were recruited to this study over a period of 15 months using traditional methods, social media including paid and unpaid posts, and emails broadcast to the university community. Contingency analysis using the Pearson's Chi-square test was used to determine if recruitment method was associated with likelihood of participation. T-tests were used to analyze Facebook advertisement success. ANOVAs and Fisher exact tests were used to determine if recruitment method was related to continuous and categorical demographics, respectively. RESULTS: Social media resulted in the largest number of recruits, followed by traditional methods and broadcast email. Women recruited through social media were less likely to participate. In contrast, use of broadcast email resulted in a smaller pool of recruits but these recruits were more likely to be eligible for and complete the study. Most women recruited via social media were the result of unpaid posts to the study's Facebook page. Paid posts lasting at least 4 days were the most successful. Recruitment method was not associated with participant demographics. CONCLUSIONS: Social media has the potential to recruit a large pool of potential subjects; however, when studies require a large time investment such as the case here, women recruited through social media are less likely to participate and complete the study than women recruited through other means. TRIAL REGISTRATION: N/A. This study does not describe a health care intervention.

High Protein Intake Among Preschoolers in Childcare in a Region at Elevated Risk for Obesity.

OBJECTIVES: To compare diet quality of convenience samples of children 2-3 and 4-5 years attending 11 of 75 childcare centers in Hays County, Texas to a nationally representative sample, as part of a needs assessment to inform a childcare center-based intervention. METHODS: Parents completed 24-h recalls of their child's diet in 2014. Usual dietary intake of the regional and age-matched sample from the National Health and Nutrition Examination Survey (2011-2014) was estimated using the National Cancer Institute method. Diet quality was assessed using the Healthy Eating Index. Quantile regression and t-tests compared nutrient intake and Healthy Eating Index scores between the two samples. RESULTS: Children ages 2-3 and 4-5 years in the regional sample (n = 124) consumed a higher percent of calories from protein (19%) than children in the national sample (n = 1613; 14%, P < .0.0001). In the regional sample, 21% of children 2-3 years consumed protein in excess of the AMDR compared to fewer than 1% of children in the national sample. CONCLUSIONS FOR PRACTICE: Assessing regional diet while planning health outreach is important. Among children in childcare in this community, high protein intake may contribute to weight disparity. Workshops with childcare center staff to address center policies, environments, and parent outreach could address replacing some high-protein foods with other nutrient-rich foods.

Influences on Catered Event Ordering in a University Workplace: Development and Validation of the Understanding Food Ordering Survey.

PURPOSE: To develop and validate an instrument to identify factors that influence what is ordered for catered events for employees at a large university. DESIGN: Themes derived from focus groups were used to develop a survey. SETTING: A large public university in central Texas. SUBJECTS: Twenty-seven administrative assistants who order food participated in focus groups, 138 completed the survey, and 31 completed the survey a second time. MEASURES: One hundred fourteen-question, 5-point Likert scale survey. ANALYSIS: Principal component analyses explored constructs. Confirmatory factor analysis confirmed structure validity. Test -retest analyses assessed reliability. RESULTS: The final survey, the Understanding Food Ordering Survey (UFO), included 19 items within 3 factors; all factor loadings were above 0.3, with no cross-loadings. Three factors explained 55.5% of the variance. Cronbach α values of .846 for social influences from supervisors/coworkers, .838 for restrictions on ordering due to policies/vendors/attendee feedback, .893 for personal views about nutrition, and .831 for the total affirmed reliability. Test-retest reliability was acceptable ( r = 0.780), and paired samples t test indicated no differences between assessments, mean difference = -0.062, standard deviation = 0.29, t (30) = -1.18, P = .247. Structure equation modeling indicated a good fit between the proposed 3-factor model and observed data, with comparative fit index = 0.921 and root means square error of approximation = 0.074. CONCLUSION: Interventions to improve the nutritional quality of foods selected for catering may benefit from addressing contributory factors while considering a top-down approach to changing the workplace culture.

Genesis of an Employee Wellness Program at a Large University.

University employee wellness programs have potential to support positive changes in employee health, thereby improving productivity and mitigating the rise in health care costs. The purpose of this article is to describe a theory-driven approach to systematically planning, developing, and implementing a comprehensive university employee wellness program. Long-term program goals were to improve employee health, well-being, and productivity by focusing on decreasing sedentary behavior, increasing physical activity, improving dietary habits, and reducing stress. An ecological approach was taken to identify levels of influence specific to a university setting: intrapersonal, interpersonal, department/college/division, and university. This framework guided the development of program components and strategies, which were grounded in several health behavior change theories. Input from supervisors and employees was incorporated throughout program development. A 15-week trial run, involving 514 employees, was evaluated to fine-tune services. Participation and feedback were positive, demonstrating that the program was valued. Support from upper administration is evidenced by continued funding. Critical factors to the successful launch of the program included a supportive administration, leverage of existing facilities and equipment, leadership provided by faculty, and service delivery by students.

Staff Workshop Improves Child Care Center Menus in South Central Texas: A Best Food for Families, Infants, and Toddlers (Best Food FITS) Intervention.

OBJECTIVE: To assess the efficacy of an educational workshop for child care center staff to improve menus. METHODS: Staff from 18 centers attended a nutrition educational workshop that included an activity that compared center menus to MyPlate standards. Four weeks of menus collected before and after the workshop were imported into SuperTracker; the Food Details report produced menu data clustered by day and center. Changes in pre-post menus were assessed using Healthy Eating Index scores and the SAS software macro, MIXCORR. RESULTS: After the workshop, there was a lower probability that fruit juice (P = .03) and starchy vegetables (P = .004) and a higher probability that non-starchy vegetables (P < .001) and whole grains (P = .004) were on menus; amounts of refined grains (P = .004), savory snacks (P < .001), and cheese (P = .004) were significantly lower. Total Healthy Eating Index scores improved after the workshop (P = .009). CONCLUSIONS AND IMPLICATIONS: Comparing 4 weeks of menus revealed menu changes. Workshop interventions show promise for improving children's health.

User-centered Design of a Texas WIC App: A Focus Group Investigation.

OBJECTIVE: The purpose of this research was to conduct the first stages of a user-centered design of a smartphone app designed to improve health behaviors among participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Texas. METHODS: Focus groups explored facilitators and barriers to health behaviors, current use of apps, and desired features in a WIC app. RESULTS: Facilitators to improve health behaviors included access to information, support from healthcare practitioners and family, and implementation of strategies. Current app use themes included texting/chatting, accessing information, tracking/locating, planning/scheduling, sharing, and gaming. Frequencies of key themes within and across groups were used to inform app prototype design. Mock-ups of 15 prototype features were developed based on themes of facilitators and currently used app features. Participants agreed that having all features combined into a single WIC app would be convenient and provide trustworthy information from WIC. CONCLUSIONS: The enthusiasm of focus group participants for a comprehensive WIC app suggests that this initiative is timely, and that an app has potential to improve health behaviors. Future research should continue the user-centered design process through further evaluation of prototype features, incorporating cultural preferences at every step.

Comparison of Food Intake Among Infants and Toddlers Participating in a South Central Texas WIC Program Reveals Some Improvements After WIC Package Changes.

In 2009, WIC began issuing revised food packages with the intent of improving dietary practices such as breastfeeding, delaying the introduction of complementary foods until about 6 months, limiting juice intake, and increasing intake of fruits, vegetables, whole grains, and baby food meats as appropriate for age. This observational study investigated whether dietary intake and feeding practices of a sample of majority-Hispanic infants and toddlers participating in a WIC clinic in south central Texas improved after the package changes. Feeding practices data and 24-h recalls were collected during telephone interviews with 84 caregivers of infants (4-12 months) and toddlers (1-2 years) in 2009 before the package change and with 112 caregivers in 2011 after the package change. The Nutrition Data System for Research was used to collect 24-h recalls. Outcomes for the two study years were compared using Chi square analysis for categorical and Mann-Whitney U analysis for continuous variables. Breastfeeding initiation, breastfeeding duration, age of introduction of complementary foods, and exposures to baby food fruits, vegetables, and meats among infants did not improve after the package changes. Significantly fewer infants received cereal in their bottles and fewer toddlers consumed vegetables and eggs after the package changes. The observed feeding practices of infants and toddlers among this sample did not reflect the WIC package changes. Strategic and comprehensive breastfeeding and nutrition education are recommended. Package modifications such as adding eggs back to the toddler package and allowing more flexibility for purchasing fresh produce and baby foods may be warranted.

Improving children's menus in community restaurants: best food for families, infants, and toddlers (Best Food FITS) intervention, South Central Texas, 2010-2014.

BACKGROUND: Approximately 32% of US children are overweight or obese. Restaurant and fast food meals contribute 18% of daily calories for children and adolescents aged 2 to 18 years. Changing children's menus may improve their diets. This case study describes Best Food for Families, Infants, and Toddlers (Best Food FITS), a community-based intervention designed to address childhood obesity. The objective of this study was to improve San Marcos children's access to healthy diets through partnerships with local restaurants, removing sugar-sweetened beverages, decreasing the number of energy-dense entrées, and increasing fruit and vegetable offerings on restaurant menus. COMMUNITY CONTEXT: San Marcos, Texas, the fastest growing US city, has more restaurants and fewer grocery stores than other Texas cities. San Marcos's population is diverse; 37.8% of residents and 70.3% of children are Hispanic. Overweight and obesity rates among school children exceed 50%; 40.3% of children live below the poverty level. METHODS: This project received funding from the Texas Department of State Health Services Nutrition, Physical Activity, and Obesity Prevention Program to develop Best Food FITS. The case study consisted of developing a brand, engaging community stakeholders, reviewing existing children's menus in local restaurants, administering owner-manager surveys, collaborating with restaurants to improve menus, and assessing the process and outcomes of the intervention. OUTCOME: Best Food FITS regularly participated in citywide health events and funded the construction of a teaching kitchen in a new community building where regular nutrition classes are held. Sixteen independent restaurants and 1 chain restaurant implemented new menus. INTERPRETATION: Improving menus in restaurants can be a simple step toward changing children's food habits. The approach taken in this case study can be adapted to other communities. Minimal funding would be needed to facilitate development of promotional items to support brand recognition.

Differences in energy and micronutrient intakes among Central Texas WIC infants and toddlers after the package change.

OBJECTIVE: To assess nutrient intakes after the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) package changes within an at-risk, majority Hispanic population of WIC infants and toddlers in Central Texas. METHODS: For this cross-sectional observational study, Nutrition Data System for Research was used to collect 24-hour recalls of infants and toddlers from a sample of caregivers in 2009 and 2011. Usual nutrient intakes were estimated and compared with Dietary Reference Intakes using the National Cancer Institute method. Mean single-day nutrient intakes were compared using Mann-Whitney tests. RESULTS: Subjects were children ages 4-24 months (2009, n = 84; 2011, n = 120). After the package change, usual energy intakes exceeded recommended levels for infants (79% in excess of Estimated Energy Requirement), but fell below recommended levels for toddlers (88% below Estimated Energy Requirement). Also after the package change, mean usual intake of vitamin D was below the Estimated Average Requirement for toddlers (6.54 vs 10 µg), and mean usual intakes of vitamin A and zinc exceeded the Tolerable Upper Intake Level for all groups. CONCLUSIONS AND IMPLICATIONS: Whereas lower energy intake may reduce obesity risk, in toddlers, lower energy intake increases risk for micronutrient deficiencies. Recommendations include culturally appropriate education and reinstatement of previous milk allotment in the toddler package.

Is the Polar F6 heart rate monitor less accurate during aerobic bench stepping because of arm movements?

Because of the well-documented linear relationship between heart rate and oxygen consumption (VO2), heart rate is commonly used to estimate energy expenditure during exercise. However, previous research suggests that heart rate increases without a concomitant rise in VO2 when arm movements are added to exercise. If so, this could impact the accuracy of heart rate monitors in estimating energy expenditure during combined arm and leg exercise. This study compared the cardiorespiratory responses to a bench step aerobics routine performed with and without arm movements and evaluated whether the accuracy of the Polar F6 heart rate monitor in predicting energy expenditure was impacted by the inclusion of arm movements. Thirty-two women performed the same routine with and without arm movements while stepping up and down off of a 15.24-cm bench at a cadence of 128 b·min-1. Heart rate and VO2 increased, whereas oxygen pulse (VO2·heart rate-1) decreased when arm movements were added (p < 0.001). However, the differences between the energy expenditure estimated by the Polar F6 heart rate monitor and the energy expenditure measured by indirect calorimetry were similar during the same aerobic bench stepping routine performed with and without arms (Δ∼2 kCal·min-1, p ≥ 0.05). Results confirm that arm movements during aerobic bench stepping elicit a disproportionate rise in heart rate relative to V[Combining Dot Above]O2. However, results do not support that these movements increase the prediction error in energy expenditure, as the Polar F6 heart rate monitor over predicted energy expenditure when arm movements were involved and when they were not involved.

The effects of caffeine in women during aerobic-dance bench stepping.

People of all ages and fitness levels participate regularly in aerobic-dance bench stepping (ADBS) to increase fitness and control body weight. Any reasonable method for enhancing the experience or effectiveness of ADBS would be beneficial. This study examined the acute effects of a single dose of caffeine on physiological responses during ADBS in women. When compared with a placebo, neither a 3- nor a 6-mg/kg dose of caffeine altered physiological responses or rating of perceived exertion (RPE) in 20 women (age 19-28 y) of average fitness level, not habituated to caffeine, while they performed an ADBS routine. Since neither dose of caffeine had any effect on VO2, VCO2, minute ventilation, respiratory-exchange ratio, rate of energy expenditure, heart rate, or RPE during ADBS exercise, it would not be prudent for a group exercise leader to recommend caffeine to increase energy cost or decrease perception of effort in an ADBS session. Furthermore, caffeine ingestion should not interfere with monitoring intensity using heart rate or RPE during ADBS.

The physiological effects of caffeine in women during treadmill walking.

Although the effects of caffeine ingestion on athletic performance in men have been studied extensively, there is limited previous research examining caffeine's effects on women of average fitness levels participating in common modes of physical activity. The purpose of this study was to determine the effect of 2 levels of caffeine dosage on the metabolic and cardiorespiratory responses to treadmill walking in women. Subjects were 20 women (19-28 years of age) of average fitness, not habituated to caffeine. Each subject was assigned randomly a 3-mg x kg(-1) dose of caffeine, 6-mg x kg(-1) dose of caffeine, and placebo for 3 trials of moderate steady-state treadmill walking at 94 m x min(-1) (3.5 mph). Steady-state rating of perceived exertion (RPE), heart rate (HR), respiratory exchange ratio (RER), weight-relative VO2, %VO2max reserve (%VO2R), and rate of energy expenditure (REE) were measured during each trial. Repeated measures analysis of variance revealed that a 6-mg x kg(-1), but not a 3-mg x kg(-1) dose of caffeine increased VO2 (p = 0.04), REE (p = 0.03), and %VO2R (p = 0.03), when compared to the placebo. Caffeine had no effect on RPE, HR, or RER. No significant differences were observed between the placebo trials and the 3-mg x kg(-1) dose trials. Although a 6-mg x kg(-1) dose of caffeine significantly increased REE during exercise, the observed increase (approximately 0.23 kcal x min(-1)) would not noticeably affect weight loss. Because caffeine had no effect on RPE, it would not be prudent for a trainer to recommend caffeine in order to increase a woman's energy expenditure or to decrease perception of effort during mild exercise. These data also demonstrate that caffeine intake should not interfere with monitoring walking intensity by tracking exercise heart rate in women.

The effects of caffeine on athletic agility.

Caffeine has been shown to improve sprint time, anaerobic power, and reaction time, all integral aspects of agility. The purpose of this study was to determine whether an acute caffeine dose would enhance agility and anaerobic power. Sixteen subjects participated in a randomized, double-blind experiment and performed the proagility run and the 30-second Wingate test 60 minutes after ingestion of caffeine (6 mg.kg(-1)) or placebo. No significant change was observed in the proagility run after caffeine ingestion compared with placebo. Also, no significant change was observed in peak power, mean power, or percent power decrease. Agility is an integral component of athletic skill and any reasonable method for enhancing agility would benefit active individuals. However, results from this study indicate that a 6 mg.kg(-1) dose of caffeine does not impact agility as measured by the proagility run test or power output as measured by the 30-second Wingate test in recreationally active young adult males who are not habituated to caffeine.