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NC219: Using Stage Based Interventions to Increase Fruit and Vegetable Intake in Young Adults

Annual/Termination Reports (SAES-422): [01/29/2003] [02/20/2004] [05/01/2005] [10/13/2005] [11/07/2006]

Date of Annual Report: 01/29/2003

Report Information:
  • Annual Meeting Dates: 07/24/02 to 07/26/02
  • Period the Report Covers: 10/2001 to 10/2002

    • Participants:
    Brief Summary of Minutes of Annual Meeting:
    The members of NC 219 held their annual meeting in St. Paul, Minnesota for three days prior to the beginning of the annual meeting of the Society of Nutrition Education. The meeting began with reports from Dean Savaiano about multi-state research groups and Susan Walsh from the USDA perspective. Both of them talked about new and upcoming opportunities for programming and research in the area of health/nutrition behaviors. These reports were followed by state reports from each participating institution.

    There are two-funded projects related to NC 219. Nancy Betts reported on NRI, and Susan Nitzke, reported on IFAFS progress to date. Details of these reports are included within the section on progress of work and principal accomplishments related to the NC 219 objectives.

    On the second day of the meeting, the Extension partners, associated and funded through the IFAFS grant, joined the group for the next day and a half working together to accomplish the work for beginning the intervention in early, 2003.

    Accomplishments:
    This report covers the first year of renewal for NC219, Using Stage Based Interventions to Increase Fruit and Vegetable Intake in Young Adults, October 1, 2001 through September 30, 2006, (writing team: RI lead, KS, ME, WI), and the first year activities for two grants: 1) USDA/NRICGP Using Stages of Change to increase fruit and vegetable intake, $400,000, September 1, 2001 through September 30, 2004, (NE lead, AL, KS, IA, MI, ME, NY, OR, RI, SD, WI) and 2) USDA/IFAFS A Staged-Based Intervention to Increase Fruit and Vegetable Intakes of Young Adults, $2,000,000, October 1, 2001 through September 30, 2005, (WI, lead, AL, KS, IA, MI, ME, NE, NY, OR, RI). A bridging subcommittee integrated the activities of the three projects, NC219, NRI, and IFAFS (KS, NE, ME, RI, WI).

    Objective 1: Qualitatively assess the preferred delivery method, as well as the acceptability stage tailored newslettes in young adults in diverse populations. A great deal of work was accomplished during this year to design print materials a magazine, newsletters, and individualized computer-generated letter reports that are appropriate and communicate effectively for the intended study group of young adults. A guidebook and videotape demonstrating interviewing techniques for use with focus groups and individual interviews were developed by NE. Using this standardized method focus groups and indepth interviews were conducted with 246 subjects in AL, IA, KS, ME, MI, NE, NY, OR, RI, SD, and WI. These sessions were audiotaped in the individual states, transcribed using qualitative analysis software and analyzed in NE. The common wording patterns have guided wording for instruments, and the subjects gave us much feed back to improve the look, feel, and wording for the print interventions (stage-based magazine and newsletters). Based on this qualitative research, RI has developed and revised 20 color newsletters for fruits and 20 color newsletter for vegetables for use in the intervention.

    Objective 2: Develop a sustained, 6-month stage-tailored intervention for young adults designed to increase consumption of vegetables and fruits tailored for diverse populations of young adults. The term economically disadvantaged was operationalized to provide the following screening criteria for subjects in the study: subject recruited through a verifiable program serving limited income, or if subject or family live in subsidized housing, receive aid to dependent children, temporary assistance for needy families, free/reduced price school lunch, or Food Stamps/elctronic benefits card, eligible for earned income credit or not required to file income taxes, participate in WIC, Medicaid, Welfare to Work, or a personal income less than $16,000/yr. In addition a recruitment committee led by NY, AL, and ME developed a recruiting manual to be used in all states to standardize procedures for recruiting and enrolling subjects. Materials developed include screening survey form to use in person or by telephone, electronic and print templates for recording subjects and recruiting sites, posters for attracting subjects that could be individualized with phone numbers for each state. Instrument Development committee led by OR and ME starting with instruments developed through earlier research in NC219 were adapted to meet the time limits for each assessment phone call to the subjects from WI survey research center. Modifying the Food Frequency Questionnaire for fruits and vegetables validated in earlier NC219 research from a pencil and paper to telephone administered instrument was accomplished. Timed comparisons were made between the NIH/NCI SCAN instrument and the NC219 FFQ. The Educational Phone Calls committee headed by NE, RI, and KS designed a training manual and stage-based scripts for guiding the two intervention educational phone calls which each subject will receive. The Mailed Materials subcommittee headed by RI and OR worked with the final revisions of newsletters and computer generated stage-based letters that will be received by each subject. The Data Generation and Analysis Committee headed by KS, ME, MI, and WI worked to develop guiding principles and the main hypotheses for the IFAFS project which implements this second NC219 objective. Reports were made by all of these working committees for total group input and revision.

    Objective 3: Test the efficacy of the intervention compared to a non-treatment control and compare the efficacy across diverse populations. Preparation of intervention materials, data collection instruments, and subject and data tracking forms, training manuals for recruitors and educators were all prepared during 2002 for implementation in early 2003.

    Other related work: A Latino interest subcommittee was formed of KS, WI, NE, IA, RI, SD to gather information that might be helpful in applying for funding to extend this stage-based TTM work for dietary change within the Latino communities. A questionnaire was developed for use with key informants and interviews were conducted in three states: WI, KS, and IA. The Latino population in these states was primarily from Mexico, followed by Guatemala, Costa Rica, and Puerto Rico, with smaller numbers from South America. One of the key observations was that few of the adults read English because most Mexican immigrants have only a primary school education before beginning to work. Therefore, educational strategies involving mainly a print basis will have limited use and effectiveness.

    WORK PLANNED FOR NEXT YEAR:
    The Stage Based intervention with young adults will begin in early 2003. Instrument development will continue to produce a finalized data-gathering instrument for research project. Manuals and materials for educators who will be recruiting and making educational phone calls will be completed for training in the states in early 2003. Electronic templates for communicating subject information after recruitment will be completed. And, all intervention materials will be completed for use in the project. This is the year when all of the development work of this year will go live in the intervention project.

    Impact Statements:
    1. Through our research, we are providing a rigorous application and evaluation of a theory-based model of behavior change to address a fundamental gap in our knowledge of how to effectively intervene to improve food choice behavior.
    2. Increasing consumption of fruits and vegetables among young adults can result in both short- and long-term health benefits for themselves, as well as, for current and future children who may follow the health habits of their parents.
    3. Producers could receive an economic benefit due to increased consumption of fruits and vegetables.
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    Date of Annual Report: 02/20/2004

    Report Information:
  • Annual Meeting Dates: 10/09/03 to 10/11/03
  • Period the Report Covers: 10/2002 to 10/2003

    • Participants:
    Brief Summary of Minutes of Annual Meeting:
    NC219 serves as an umbrella for two federally-funded projects. These projects are underway. Based on the status of data collection, data management questions were resolved and initial plans for analysis, interpretation and dissemination were determined. The representatives determined general publication guidelines and procedures. Eight manuscripts regarding the previous two years of data collections and development of novel methodology are in various stages of completion. Initial discussions of additional manuscripts were held. Ways to disseminate products from the study (ie training video, manuals, newsletters) were discussed. Plans for a developing a new five-year project proposal (2006-2011) with an increased focus on combating obesity and increasing nutritional literacy and plans for seeking competitive funding were made.

    Accomplishments:
    Objective 1, to qualitatively assess the preferred delivery method, as well as the acceptability of stage tailored newsletters in young adults in diverse populations, is completed. Manuscripts for scientific peer review are in process. Methods for distributing products of interest to stakeholders (training materials, manuals and newsletter) have been determined.
    Objective 2, to develop a sustained, 6-month stage-tailored intervention designed to increase consumption of vegetables and fruits tailored for diverse populations of young adults has been completed.
    Objective 3, to test the efficacy of the intervention compared to a non-treatment control and compare the efficacy across diverse population is underway.

    During 2003-2004, we will complete data collection and begin analysis. Data collection results from waves one and two from both funded studies will be ready for decisions on dissemination by the October 2004 meeting. The final wave of results for one of the funded studies should also be ready for examination and dissemination. The group will use preliminary results to shape the direction for a new multistate project.

    Impact Statements:
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    Date of Annual Report: 05/01/2005

    Report Information:
  • Annual Meeting Dates: 02/22/05 to 02/27/05
  • Period the Report Covers: 10/2003 to 03/2005

    • Participants:

    URL: Copy of participant list
    Brief Summary of Minutes of Annual Meeting:

    URL: Copy of minutes
    Accomplishments:
    NC 219 has four main objectives. This year objective3 was targeted:

    To determine the effectiveness of stage-tailored intervention modalities by testing the efficacy of the intervention compared to a non-treated control across diverse low-income populations [of 18-24 year olds].

    NC219 participants collectively recruited 2042 low income young adults, staged their fruit and vegetable intakes, randomized them to control and intervention groups, then proceded with the study protocol to meet the project goals. For the intervention group this included sending stage-tailored newsletters, individualized progress reports, and making educational phone calls. More specific procedures are delineated in the Journal of Extension publication listed in the publication section. 1255 subjects completed the study, data analyses are underway and interpretation of findings are forthcoming as noted in the meeting minutes.

    Activities in the coming year will include completion of data analysis, manuscript development, and addressing the Objective 4 of NC219: To extend findings to a specific set of recommendations for community-based practitioners.

    Impact Statements:
    1. Nutrition educators will be able to provide more effective programs to promote nutrition-related lifestyle behaviors.
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    Date of Annual Report: 10/13/2005

    Report Information:
  • Annual Meeting Dates: 09/15/05 to 09/17/05
  • Period the Report Covers: 10/2004 to 10/2005

    • Participants:
    Brief Summary of Minutes of Annual Meeting:
    NC219 serves as an umbrella for three federally-funded projects. Two of the projects are now completed with data analyses and manuscript preparation in process by the group. The group worked on a preparing a manuscript describing the main outcomes from one of the major funded projects. Additional manuscripts from the federally funded projects were presented and discussed by they main author of each manuscript. Dissemination of products from the study were discussed and implemented. University of Wisconsin has developed an interactive website with the materials. University of Nebraska updated the magazine and provided copies of via CD to each participant. The representatives worked on implementation plans for the third project. The proposal for the five-year renewal of NC219 was completed.

    Accomplishments:
    Objective 1, to qualitatively assess the preferred delivery method, as well as, the acceptability of stage tailored newsletters in young adults in diverse populations, is completed. Manuscripts for scientific review have been completed and submitted for publication. Materials have been distributed to via CD to major participants for use in individual states. Website with training materials has been established by University of Wisconsin.

    Objective 2, to develop a sustained, 6-month stage-tailored intervention designed to increase consumption of vegetables and fruits tailored for diverse populations of young adults has been completed and educational materials have been distributed via CD to each major participant to use in nutrition education to young adult audiences.

    Objective 3, to test the efficacy of the intervention compared to a non-treatment control and compare the efficacy across diverse populations, has been completed. Manuscripts are being prepared for dissemination of results.

    Impact Statements:
    1. The written materials tested in the intervention have been distributed to each principle investigator to use in their state nutrition education programs. A website with the stage-based materials has been developed and is maintained by University of Wisconsin-Madison and is available for use by the investigators.
    2. Educational materials targeting young adults in different stages of readiness to increase fruit and vegetable consumption have been developed and tested and found to be effective. The stage-based newsletters increased fruit and vegetable consumption in the 18-24 year old limited-income audience.
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    Date of Annual Report: 11/07/2006

    Report Information:
  • Annual Meeting Dates: 09/28/06 to 09/30/06
  • Period the Report Covers: 10/2001 to 09/2006

    • Participants:
    Brief Summary of Minutes of Annual Meeting:
    9/28/2006 NC219 Annual Meeting September 28-30, 2006 Fayetteville, NY Host: Syracuse University

    1. Introductions and State Reports; AL, PA, ME, SD, WI, NE, CSREES, NY, RI, MI CSREES Report. o An agency wide review was held this year. There were 14 portfolio reviews. Some panelists involved were Laura Sims; Margery Caldwell; Larry Jones; Tammy Bray; Judy Wilson; Roger Clemens, Susan Nitzke (IPA); o Welsh will do several CSREES department-wide reviews this year. o National program leaders have been assigned to states, not areas of expertise. Welsh has OH and WV. o Welsh is the liaison to the nutrition department chairs who will meet in WDC November 13-15. A goal is to establish more research between food science and human nutrition, e.g., bioactive food components. Other topics include: § Tailoring functional foods to promote energy balance. § Linda Myers will talk about the new DRI process. § NASs ranking of FS & HN nutrition doctoral programs. § ADA will discuss the new MS required for dietetics. § Possibility of new credentialing program for community nutrition from SNE. § Initiate discussion on integrated programs between nutrition and sports medicine " The USDA budget hasnt passed yet; funding levels are about the same as in former years. o The Farm Bill specifically mentions obesity. NC1028-Promtoing healthful eating to prevent excessive weight gain in young adults is one of two Multi state research funded projects addressing obesity. o The federal administration is still interested in making formula funding (HATCH) more competitive with investigators submitting proposals to be reviewed nationally. " CSREES is interested in working with NASLGUC to identify model campuses for healthy living, especially to reduce obesity. " The NRI was just released with section on obesity 31.5. Proposals are due June 5th. Panels will have expertise on physical activity, economics, and human development, as well as in human nutrition. " There will be a session at EB, 2007 Obesity prevention: integrating research and outreach to consumers. The Nutrition Education RIS recommended this program. It is intended to attract researchers with NRI funding for integrated projects. " Cindy Tuttle is the new nutrition person at CSREES and Director of Nutrition Family/Consumer Sciences.

    2. PRECEDE-PROCEED 4 hr workshop. Tanya Horacek & Maria Erdman. " Green & Krueter. (4th ed) Health Program Planning: an Educational and Ecological Approach. McGraw Hill, 2005. " This is a planning model incorporating aspects from several disciplines and behavioral theories. It is a rigorous, iterative application of all four types of evaluation (formative, process, outcome, impact) throughout that involves the community participants at each step and addresses policy and environmental factors as well as individual qualities. " The first step of social diagnosis incorporates assessment of the target groups values, attitudes, lifestyle, etc. " Advantage and limitations of this model are that it features the differences between groups, rather than suppressing differences as does a national level intervention that would use one standardized evaluation form, for example.

    3. IFAFS Sprouts (subprojects) update " Progress on projects were reviewed. " Research partners worked in small groups on IFAFS manuscripts in process.

    Friday, September 29, 2006 1. Subcommittees worked on Webhealth projects and IFAFS manuscripts.

    2. Webhealth conference call. Attendees: § Adrienne reported that the online survey has been completed and four focus groups were completed last week for Lesson Exercise #1. § Sue Schembre reported that one student went to the wrong lesson. This problem can be avoided in the future by being sure that students type in the full correct address.

    A. Adrienne reported for Brian Rahill about updating the Web design and timing for when the lessons will be pilot tested. § SD starts a focus group next week. § The second lesson is set for October 16th and was ready by Sept 29th. Comments must be returned by October 6th. § Each state should get an outside person to provide an outside review; there is a short time line for this. § Lessons 1 and10 will need to be pilot tested informally, but not through the focus group procedures. § Suzanne Shoff and Sue Schembre offered technical assistance to review the lessons.

    B. Sarah Dayton reported on the systematic approach to incorporate instructional and motivational design models into the curriculum process. She will evaluate the entire curriculum for both internal and external consistency with objectives. This is a two step process: 1) technical-immediate; 2) Sarahs lesson evaluation-in November. " Technical changes will likely be those that can be incorporated in October. " Each lesson will be evaluated using Sarahs lesson evaluation model (incorporating the Dick and Carey model and the ARCs model). This comprehensive assessment tests for lesson consistency as well as ability to motivate the audience. " Volunteers to do this were SD, NY, WI, MI, AL, RI. Sarah will be the organizer of this assessment.

    C. Barbara reported for the instrument committee (Suzanne, Kendra, Barb). 1. Instruments to be used this fall: " For this set of focus groups, we have the 12-item GHQ-12 Quality of life, BMSLSS instruments to be able to control for other life stressors. " Two other items: course credit load, work load outside of school " F/V intake 2 item self assessment; perceived F/V goal. " Self assessed physical activity from myPyramid. 2. Sue Schembre reported on the training DVD for the step test. " There are four measuresHeight, weight, waist circumference, step test. " There also needs to be written instructions and a paper reporting form for these test. " All states need to use a wall mounted stadiometer and a digital or balance beam scale for the anthropometric measurements. " Suzanne Shoff will send the reporting form to Sue Schembre. 3. Barb reminded us that states wishing to collect additional data must submit a SPIDER and the instruments for prior approval. § Barb will do cheek swabs for a genetic marker test in her states pilot for 25 subjects. § Michigan wants to do parenting style (and possibly feeding style). § Adrienne pointed out that the incentive for the pilot test was only $20, so additional measures must be limited to only one. 4. Other points related to instruments. " The directions to subjects must provide the time for measurements, proper attire, to arrive fasted, etc. " The step test is from Queens College and Deb Reibe will send us the reference on its validity and reliability to predict VO2Max. " Students will be able to see their results on the website. There needs to be some explanatory text. Each states IRB will need to approve this. " Each state should also include a paper IRB form when the physical assessment is done. Susan Shoff will modify the on-line consent form for the pen and paper form used in the intervention.

    5. Recruitment (Linda) Committee reported that states should send names recruitment coordinators to her by October 15. " By November15, each state should have made connections on campus for the recruitment process. IRB approval will be necessary for this recruitment and assessment. " Linda will resend the recruitment manuals.

    D. Tanya led the discussion on SPIDERS and asked each state to discuss theirs. Directions to the minutes on the web are: http://www.nutritionlearning.com/minutes/ username:webhealth; password: webhealth All manuscripts and theses or dissertations must go through this process. Each PI should communicate directly with Tanya regarding joining a spider. § Barb discussed her spiders a. Cheek swabs for genotype testing. N=25 mostly for the lab techs time ~$2500. PPARS. b. Examination to see if the 4 eating competence lessons are applicable to FSNEP audience and funding. Barb will need additional copies of these 4 lessons. c. Examination of the eating competence outcome status of this group in the focus group data and how it relates to the other data collected. § Megumi and Sharon discussed the idea related to childs parenting style and health status of young adults. § Adrienne reported on her use of online focus groups with young adults § Geoff reported on 2 manuscripts related to the fall focus 2005 groups. We will need apportion investigators to various papers to avoid too many authors on one paper a. Seung yeon reported on one paper about body image and body acceptance, eating and regulation. b. Molly has a paper on the barriers and benefits to maintaining healthy weight. § Sue Schembre will restructure the TFEQ and examine predictive validity with weight change. Her instrument development will result in a new instrument. § Sarahs spider was reprised on curriculum evaluation.

    E. Adrienne updated the schedule for the spring pilot testing that states should modify based on their semester schedule. " Jan 16-26 recruitment and assessment " Jan 29-Apr 20 intervention " Apr 23-24 post assessment

    F. Next Web Health conference call October 10, 2pm EST, 1pm CST. 207-581-3555.

    3. NC 1028 and IFAFS conference call Sept. 29, 2006 1-3pm Attendees: Tanda Kidd; Adrienne White; Sharon Hoerr; Beatrice Phillips; Linda Boeckner; Sarah Colby; Tanya Horaeck; Susan Nitzke; Geoff Greene; Kendra Kattelmann; Steve Hertzler until 2:20; Nancy Betts for Janice Hermann until 2:20 Absent: Kim Shafer; Janice Hermann. New NC1028 members: Steve Hertzler hertzler@iastate.edu Iowa state Sarah Colby scolby@gfhnrc.ars.usda.gov ARS Janet Hermann (not yet signed up) Oklahoma State Kimberly Schafer (not yet signed up) USDA, Grand Forks

    A. NC1028 Leadership " Tanda Kidd (Kansas) Secretary from 2006-07. (Sarah Colby  ARS/USDA volunteered to serve for 2007-2008.) Bea Phillips (Tuskegee)  Chair for 2006-07

    B. Annual Meeting: NC1028 and NRI: June 5-7, 2007 at URI, Spring Pine, RI.

    C. Timeline (NC1028) " Tanya reprised a brief overview of the PRECEDE-PROCEED Model to be used in NC1028 intervention. Discussion ensued on processes for involving key players on each campus as participants in the process (establishing relationships). Linda will e-mail reading materials on PRECEDE-PROCEED to those members on the phone call, but who missed the workshop the previous day. " Sarah Colby is holding focus groups with students on her campus dealing with barriers to weight management. Adrienne will send WebHealth focus group questions to Sarah. " Linda Boeckner led a discussion of the first year objectives of the NC1028 proposal. 1. Enhance participatory research skills: Sarah Colby, Tanya and Sharon. Sharon & Tanya will attend the Evaluating Nutrition Education and Health Promotion Conference, October 14-15 in Houston. 2. Establishing partnerships with outreach educators and young adult populations. Each state will do this on our own campuses. Geoff and Seung-Yeon will develop a reporting form to identify how we are doing each period. 3. Initiate epidemiology literature review: Sarah Colby; Susan Nitzke; Adrienne White; Maria Erdman will organize this. 4. Develop grant proposal due June 5th to NRI. Tanda, Linda, Kendra will comprise the writing team. Each state will address college students and some might reach out to other target groups. An NRI goal might be a model for creating healthy living on campus to prevent obesity. They will begin by reformatting the approved NC1028 proposal into the NRI proposal framework.

    D. Conference Calls- will be every two months. First date: November 16 at 3:00 ET/ 2:00 CT / 1:00 MT Alternate date: November 20 at 9:00 ET/ 8:00 CT / 7:00 MT. Bea Phillips will set up this first conference call. The agenda is to schedule the remaining phone conferences. Susan Nitzke will check into transferring the IFAFS website into the NC1028 website. Username: grantme Password: 3wishes

    E. Ordering IFAFS materials. Susan Nitzke " " Susan ordered a printing of 10,000 copies of the F & V Connection, available to states. " " FV Express Bites WILL SOON BE available in Spanish as well as English. " " All the newsletters will be printed in English and two in Spanish. All THE UPDATED FILES WILL SOON BE available online. " An order form was sent to all the NC219 group members. Orders received by next week will be shipped free. AFTER THAT, A WAY TO COVER SHIPPING EXPENSES WILL HAVE TO BE IDENTIFIED. " IFAFS distribution committee: Susan, Geoff, Barb, Linda

    F. Reports " Linda Boeckner has a 5 year report for NC219. " Susan Nitzke must do a 5 year IFAFS report. " Kendra recommended checking with NIMMS to check the reporting formats. " We should be sure to indicate that there are additional publications in process and list the specific topics. " The list of NC219 publications was reviewed. o Under related publications there will be two subheadings: NRI & NC1028 o There are a high number of publications listed with collaborative authorship among NC 219 members.

    Meeting adjourned 5pm

    Submitted by Sharon L Hoerr and Beatrice Phillips

    Accomplishments:
    Accomplishments

    Objective 1: Qualitatively assess the preferred delivery method, as well as the acceptability of stage tailored newsletters in young adults in diverse populations. Print materials (magazine, newsletters, individualized computer-generated letter reports) were designed and field tested in year one of the project, with young adults in each of the participating states. A specialized guidebook and videotape demonstrating interview techniques was used to standardize collection of qualitative data for this phase of the research . 246 individuals were interviewed individually or in focus groups, with proceedings audiotaped, transcribed and analyzed in Nebraska. Information to improve the appearance and wording of the print materials were used by RI to revise a series of colorful theory-based newsletters and an F&V Connection magazine. Methods for distributing these materials (training materials, manuals and newsletters) to stakeholders were determined. Some of these educational materials and training manuals have also been placed on the Food Stamp Nutrition Connections database of reviewed and recommended materials. Manuscripts for scientific peer review were prepared, submitted, and published.

    Objective 2: Develop a sustained, 6-month stage-tailored intervention for young adults designed to increase consumption of vegetables and fruits tailored for diverse populations of young adults. Work groups were formed for instrument development (Lead: OR, ME), preparation of mailed educational print materials (Lead: RI, NE, OR), standardization of protocols for subject recruitment (Lead: NY, AL, ME, SD), training and procedures for the educational phone call component of the intervention (Lead: NE, KS, RI), and for planning and management of data analysis (Lead: (KS, ME, MI, WI). Materials developed included: screening survey form, recruiting manual and posters, electronic and print templates for subject records, educational phone call procedures manual and stage-based scripts. Instruments developed in previous NC219 research were revised, tested and adapted to meet the telephone time limits for each assessment phone call conducted by WI survey research center. Extension partners contributed to development and testing of many of these recruitment and assessment materials, and refinement of the educational materials. Manuscript about the extension-research partnership was prepared, submitted and published. Electronic files for educational materials were revised to reflect 2005 Dietary Guidelines and distributed via CD to each participating state.

    Objective 3: Test the efficacy of the intervention compared to a non-treatment control and compare the efficacy across diverse populations. Testing intervention efficacy began in 2003 and was completed in 2004. NC219 research and Extension partners collectively recruited 2042 low income young adults, determined their fruit and vegetable stage of change, administered consent procedures, and implemented the study protocol. The intervention group received stage-tailored newsletters, individualized progress reports and educational phone calls with a focus on improving fruit and vegetable intakes. The intervention was completed by 1255 subjects (61% completion). Manuscript about the intervention outcomes is currently under review.

    Impacts In the IFAFS-funded research, follow-up interviews 6 months after the 6-month intervention period showed that positive results were achieved and maintained. Participants in the experimental group had higher intakes of fruit and vegetables than controls (perceived daily intakes of 4.90 vs. 4.60 servings per day, F=3.49, p<0.05 and 4.31 vs. 3.92 servings/day via 5-A-Day Screener, F=4.78, p<0.01) and greater progression to action or maintenance stages (66% progress in fruit for intervention vs. 55% progress in fruit for controls; 47% vs. 32% progress for vegetables, p=0.0080 and 0.0001, respectively).

    Education and supervision of graduate students have been an integral part of the NC219 activity. Graduate students have assisted in all aspects of the integrated projects that have been part of the NC219 multi-state project, have presented their work at national professional conferences, conducted ancillary data collection/analysis and, thus, gained professional experience to enhance their skills and expertise.

    The work of this group has been extended via Extension systems in the cooperating states. Printed educational materials have been made available to each state in the project, and inservice education on Transtheoretical Model for Behavior Change (Stages of Change) for Extension personnel has been conducted. A web-based educational tool, using the content of the stage-based newsletters and magazine and the adapted assessment instruments, was developed and evaluated for delivery to young adult audiences through the Web (F and V Express Bites, http://www.nutrisci.wisc.edu/fav/). Implications for the use of educational phone calls to support educational delivery leading to eating behavior changes have been identified. Plans to share that information via peer-reviewed research publication are in progress.

    The majority of work of this group was supported by a USDA IFAFS grant that was awarded in 2001 through 2005 with a no-cost extension until August 2006. A National Research Initiative grant funded a second project with young adults, using stage-based newsletters to enhance fruit and vegetable intake. In 2005, a National Research Initiative Integrated Projects grant was received to support additional work with young adults related to weight management and healthy food and physical activity choices. These additional funding sources are:

    2001-2005 A Stage-Based Intervention to Increase Fruit and Vegetable Intakes of Young Adults. USDA/IFAFS. Susan Nitzke, Principal Investigator with subcontracts to each of the states in the Multi-State Research Project. Total Award: $2 million. 2001-2005 Using the Stages of Change Model to Increase Fruit and Vegetable Intake. USDA/NRI. Nancy Betts, Principal Investigator. Total Award: $400,000. 2005-2009 Behavior Modification for Obesity Prevention in Young Adults. USDA/NRI Integrated Project. Geoffrey Greene, Principal Investigator with subcontracts to ME, NY, AL, MI, WI, SD, PA. Total Award: $1,127,707.

    The work of this research group is being continued through a recently approved Multi-State Research Project NC-1028: Promoting healthful eating to prevent excessive weight gain in young adults, 2006-2011. The NC219 project team was successful in developing theory-based education strategies for low-income young adults between the ages of 18-24. However, the researchers discovered that young adults were more likely to drop from the intervention study if they had very low incomes (< $800 per month), were of ethnic minority status and/or were parents. The new multi-state project will use principles of community based participatory research to further increase relevance and accessibility of nutrition education programs, and reduce the attrition found within harder-to-reach segments of young adult audiences.

    Impact Statements:
    1. In the IFAFS-funded research, follow-up interviews 6 months after the 6-month intervention period showed that positive results were achieved and maintained. Participants in the experimental group had higher intakes of fruit and vegetables than controls (perceived daily intakes of 4.90 vs. 4.60 servings per day, F=3.49, p<0.05 and 4.31 vs. 3.92 servings/day via 5-A-Day Screener, F=4.78, p<0.01) and greater progression to action or maintenance stages (66% progress in fruit for intervention vs. 55% progress in fruit for controls; 47% vs. 32% progress for vegetables, p=0.0080 and 0.0001, respectively).
    2. The work of this group has been extended via Extension systems in the cooperating states. Printed educational materials have been made available to each state in the project, and inservice education on Transtheoretical Model for Behavior Change (Stages of Change) for Extension personnel has been conducted. A web-based educational tool, using the content of the stage-based newsletters and magazine and the adapted assessment instruments, was developed and evaluated for delivery to young adult audiences through the Web (F and V Express Bites, http://www.nutrisci.wisc.edu/fav/). Implications for the use of educational phone calls to support educational delivery leading to eating behavior changes have been identified.
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