Duration: 10/01/2013 to 09/30/2014

Administrative Advisor(s):

NIFA Reps:

Non-Technical Summary

Statement of Issues and Justification

NEED AND IMPORTANCE

While obesity prevalence continues to rise among all children, the 2009-2010 rate was higher for 6-11 and 12-19 year olds than for those aged 2-5 (CDC, 2012). There is an increasing need for parents to be motivated and use practical approaches to encourage preadolescent children (10-13 y.) to make healthy food choices at all eating occasions. Behaviors by parents and caregivers are a dominant influence on preadolescents eating behaviors and therefore play an essential role in preventing obesity. Our preliminary work on calcium rich food and beverages (CRF/B) has revealed that when parents have expectations or rules about healthy beverages, make CRF/B available and practice or role model CRF/B consumption, childrens intakes are higher. Making foods available and role modeling are pre-requisite to creating rules and expectations for healthy habits. Preadolescents are becoming independent in their eating choices at school and at home, and this is a critical time period for parental influences that might promote healthy eating. If parents are successful in developing good habits and choices among their children now, it may avert the associated poor outcomes of unhealthy eating including obesity. Family habits influence healthy eating among adolescents (Berge et al, 2010) as well as among college students who also reported that healthier eating was facilitated by having healthy family eating habits as a child (Cluskey & Grobe, 2009).


Many benefits that support the prevention of childhood obesity have been associated with family or regular meals, such as higher intakes of fruits, vegetables, dairy and other nutrients (Neumark-Sztainer, et al., 2003). We will operationally define consumption patterns as being two-fold: 1) regular, family or planned eating occasions and 2) non-meal eating occasions. The term, snack may imply a sanctioned or planned eating occasion, but not a regular meal. It may be important when studying eating occasions to be cautious in referring to non-meal eating only as snackas random eating occasions might be overlooked. The focus of this proposal involves identifying both the child and parental behaviors relative to the food/beverage choices that preadolescents make in all snack and non-meal eating occasions.


Recent evidence from the Department of Labor Statistics Time Use Studies (USDL Bureau of Labor, 2012) reported that trends in consumption behavior in the U.S. are undergoing an interesting and potentially hazardous shift. Over the past 30 years, the frequency of family meals has decreased by 33%. The frequency of primary eating (focused eating/drinking without engaging in another activity) is also decreasing while frequency of secondary eating and especially drinking (eating while engaging in another activity) is increasing (USDA ERS, 2008). Snacking, or non-meal eating makes up 27% of caloric intake for 7-12 year olds, exceeding 500 kcals/day (Piernas & Popkin, 2010). Snacks are made up largely of salty snacks and sweets and sweetened beverages. Meal frequency was associated with increased total kcal intake and eating beyond 3 times/day was associated with higher BMI in adults (Howarth et al, 2007). However, Huang et al (2012) could not link increased BMI to snacking among adolescents. Instead, these authors suggested that choice of snack rather than frequency was related to total kcal intake among children (Huang et al, 2012). This evidence justifies the need to investigate adolescent non-meal eating behavior, and how parental behaviors may impact their choices. Understanding the behavior of non-meal eating occasions among adolescents is necessary to reduce the consumption of high energy density snacks.


Social marketing approaches utilize research methodology and marketing techniques to create behavior change in a target audience. That methodology focuses on clearly examining all of the circumstances surrounding the behavior, which then can be used to develop approaches to change that behavior. It relies on creating, communicating, delivering, and exchanging offerings that have positive value for the target audience and changes in behavior that benefit society at large (Lee and Kotler, 2011). It is clearly beneficial to control the development of chronic diseases among those who are obese both for their own well-being as well as the economic costs associated with developing or managing chronic diseases. There are general benefits for all of us if we can decrease the societal externalities or costs of accelerating health care demands and expenditures that are associated with obesity. The behavior of non-meal eating is influenced by our changing lifestyles as well as the varied contexts in which we eat, the people with whom we interact and environmental factors. Exploring the childs perception about what influences their own behavior gives a perspective of the costs and rewards of the behavior that need to be addressed to influence parental behaviors. With a broader understanding of the behavior, we can attempt to provide products (programs, knowledge, and/or messages) that may serve as realistic strategies and motivators for parents to promote better habits. All of this requires a thorough analysis and approach which we think is well suited for social marketing techniques.


THE TECHNICAL FEASIBILITY OF THE WORK

The project has significant potential to develop and implement an evidenced-based social marketing plan to develop parental strategies that positively influence eating behaviors among preadolescent children. Social marketing recognizes the need to carefully identify the uniqueness and best approaches for a specific target market, their needs and wants, as well as facilitators (rewards) and barriers (costs) regarding the behavior. It uses marketing research methods to identify how best to bring about behavior change in an audience by considering the willingness, ability and motivation to change as well as the context and rewards for the current behaviors (Kotler and Lee, 1997). A campaign results in the development of a target-based marketing mix by examining the behavior in broad context and exploring the many influences on what the child chooses to eat at non-meal occasions. A marketing mix includes a product (what is offered to influence or change the behavior, e.g., messages, educational programming, tools or strategies), place (the delivery or distribution method for accessing the products), price (rewards and costs of adopting the behavior) and promotion (channels of outreach that promote the product).


The phases of social marketing include: 1) problem description, 2) formative research, 3) strategy development, 4) campaign or intervention design, 5) evaluation plan, and 6) implementation (Andreason, 1994). The problem description phase includes conducting research, literature reviews, and discussion and analysis of the problem, in order to identify the specific purpose and focus of the plan. This approach recognizes the reality of what it takes to get a target audience to attempt to make that behavior change. Social marketing recognizes that behavior change is complicated and does not occur without understanding the environment of how the behavior is perceived to be beneficial to them. In the case of this research effort, we have to find strategies that convince parents that practicing the behavior provides some immediate value or benefits (challenged by the long-term nature of their eating-related behavior changes); to convince them that the costs of behavior change are low (parents might find that the time and effort to exercise the desired behaviors are too challenging or difficult); recognizing that behaviors are supported or obstructed by others (spouses, siblings, friends, teachers, coaches, etc. as well as the child, who may create barriers that need to be considered). Addressing this with up-front analysis will enhance the feasibility for success and may improve the likelihood of identifying the most effective way to get parents to achieve success related to their childrens making healthy eating and food choices at all eating occasions. The problem description and formative research occurring in phases one and two drive the remaining phases and all involve careful planning.


An endeavor of this kind requires much expertise and experience. Many of the team of researchers for this project have worked together on two or more AES-funded multi-state projects, building some of the justification for this research effort. There is diversity of expertise, experience and a collaborative spirit that is very functional for this team. The multi-state approach spreads the data collection efforts and allows for a wide representation of geographic areas and regions. In addition, several of the multi-state researchers have been involved with social marketing efforts including a social marketing campaign, called the Food Hero program offered through Oregon State University Family and Community Health Extension Service. Others have been involved in teaching a college level social marketing course to nutrition students. We will potentially seek guidance from marketing experts for input, as we have found that to be useful on our current project.


LIKELY IMPACTS AND CONSEQUENCES IF NOT DONE

While social marketing for obesity prevention is becoming more popular, what has not been evaluated is how an evidence-based social marketing campaign can help parents directly and indirectly influence 10-13 year-old preadolescents in making food choices in their non-meal or snacking occasions. A search in the USDA Current Research Information System, using the keywords/phrases of parental influence, preadolescent and/or snacking, did not result in similar objectives of the proposed W-3003 study. The closest match was the Childhood Eating Behaviors: Prevention of Childhood Obesity and Chronic Disease study led by Onstad et al (CRIS Project #6250-51000-038-01A; 1999-2004). The research project studied how environmental, personal and parental factors influence 3-15 year-old, multiethnic childrens fruit, juice and vegetable intakes. W-3003 will build from past multistate collaborative experience and findings in W-1003 and W-2003 to continue targeting multiethnic parents/primary caregivers of 10-13 year-old preadolescent children. Currently, there is no published social marketing campaign that has been conducted to determine how to encourage and motivate parents to utilize the three parental influencing behavior factors (i.e., having rules and expectations for healthy intakes, role modeling and availability of healthy foods) that may result in developing positive food and beverage choices and habits among pre-adolescents. The development and implementation of this campaign using social marketing methods uses a new approach to influence behaviors that considers the unique needs and wants of the target audience. The groups history with this audience and the intent to carry on this project utilizing outcomes from the previous projects will substantially fill the research gap about how to encourage parental behaviors that result in children choosing healthy foods. If the proposed work in W-3003 is not done, not only will our society miss the window of teachable moments among parents of preadolescent children, we will also risk facing more adverse consequences with respect to health, psychosocial, and economical issues in the near future.


Based on previous work completed by this multi-state group, we believe that parental behaviors should be explored that include establishing habits or creating expectations for healthful intakes and making healthful foods/beverages available for snacking occasions among early adolescents. Those parental behaviors were associated with greater intakes of calcium among Asian, Hispanic and non-Hispanic White pre-adolescents (Edlefsen et al, 2008, Reicks et al. 2011). Beverages consumed by children at meals and snacks are of concern for healthy eating in general and for the prevention of obesity in youth. Since snacks for children at this age are typically unsupervised non-meal eating occasions that occur at home and away, at school and with friends; children are able to be independent in their snack choices. How parental behavior, including habits and expectations may impact childs food choices is an unknown area of investigation; research to reveal how parents behave and children react may provide insight into shaping eating habits among pre-adolescent children. These parent practices will result in an overall improvement in intakes of CRF/B, whole grain foods, fruits and vegetables and decreased consumption of high fat and sugar foods, energy-dense foods/beverages among children. Nutrient density of non-meal eating occasions will also be improved among children. Parent outcomes will include an increased frequency of supportive parental behaviors (setting expectations and making healthful foods available).

Related, Current and Previous Work

OBESITY

Between 1980 and 2008, prevalence of childhood obesity in the U.S. tripled to nearly 20% among children aged 6-11 years and 18% among adolescents aged 12-19 years, with even greater prevalence among Hispanic and African American children (CDC, 2012). It is well-established that an imbalance between energy intake and energy expenditure accounts for excess weight gain. However, food consumption behavior in the U.S. is undergoing an interesting and potentially hazardous shift. Childrens energy intake increased by 197 kilocalories/day from 1977 to 2006, with contributing factors including more foods being consumed away from home (at fast-food and restaurant establishments), larger portion sizes, and changes in childrens eating habits such as skipping breakfast and consuming increased amounts of sugar-sweetened beverages and other snack-foods (Robin, 2007; St-Onge, 2003; Affenito et al, 2005; Poti & Popkin, 2011; Hiz et al, in press; ADA, 2008).


MEAL AND SNACKING BEHAVIORS

Recent evidence also suggests that the frequency of primary eating (focused eating/drinking without engaging in another activity) is decreasing while frequency of secondary eating (eating while engaging in another activity) is increasing (USDA Bureau of Labor, 2012). In 2008, Americans aged 15 and older spent an average of 67 minutes per day in primary eating and drinking, 25 minutes in secondary eating, and 75 minutes in secondary drinking (excluding water). Overweight and obese Americans spent more time than underweight and normal-weight Americans in secondary drinking and TV/movie watching (USDA Bureau of labor, 2012). While 42% of Americans ate or drank at lunchtime, 40% at dinner, and 22% at breakfast, 52% ate and 36% drank (excluding water) while engaging in another activity (USDA Bureau of labor, 2012). Between 1977 and 2006, snacking frequency among children aged 2-18 has increased from one snack a day to three snacks a day, contributing to approximately 168 calories per day (Piernas & Popkin, 2010). In the U.S., 1 in 5 school-age children has up to six snacks a day (Piernas & Popkin, 2010) with the top three snack choices being desserts, salty snacks, and sweetened beverages including fruit drinks, sports drinks, and fruit juice. Other studies have noted both favorable and less favorable nutrient intakes in youths snacking patterns (Sebastian et al, 2008; Keast et al, 2010; Gregori et al, 2011; Piernas & Popkin, 2010). Specifically, increased snacking frequency has been associated with increased intake of vitamins A, C, and E, magnesium, and foods from the fruit and milk food groups (Sebastian et al, 2008). However, it has also been found that more frequent snacking results in increased energy intake and added sugars including fruit drinks (Sebastian et al, 2008; Keast et al, 2010). Studies have also shown a positive association between screen time (TV, computers, and video games) and snacking behaviors which has resulted in increased caloric intake, higher consumption of candy and sodas, eating at fast-food restaurants, skipping breakfast, and lower intakes of fruit and vegetables among youth (Lipsky & Lannotti, 2012; Keast eat al, 2010; Vader, 2009). Further, research has suggested the influence of media advertisements on parental food purchasing behaviors as a result of childrens request of the advertised products, which behavior has been shown to increase childrens snacking (Ayala et al, 2007).


Other environmental factors influencing childrens snacking choices have included peers, siblings, and food stores near schools (Wouters et al, 2010; Borradaile et al, 2009; Smith et al, 2011; Salvy et al, 2008). Wouters et al (2010) found that youths snack and soda consumption was associated with peers who engaged in these behaviors and with the availability of these foods in the school environment. Siblings have also been shown to influence youths dietary behaviors, including the consumption of snack foods such as chips, grain products, and desserts (Smith et al, 2011; Salvy eat al, 2008; Diaz et al, 2009; Backman et al, 2002). Borradaile et al (2009) reported that approximately 75% of 4th to 6th grade youth purchased chips, candy, and sugar-sweetened beverages at food stores neighboring their schools at least 2 to 4 times per week, with an average of 356 kilocalories for each purchase. Although mixed results exist in the literature regarding an association between snacking and childhood obesity (Keast et al, 2010; Johnson & Anderson, 2010; Vader, 2009; Gregori et al, 2011), collectively, the studies cited above suggest that snacking behaviors, especially when combined with secondary activities such as media use or consumption with peers or siblings, can result in less healthy food and beverage choices among youth.


PARENTAL BEHAVIORS

Parental role modeling of eating behaviors, rules or expectations about food consumption patterns, and availability of foods in the home environment can promote both healthy - fruits, vegetables, and milk - and less healthy - soft drinks, sweet and salty snacks, convenience foods, and high-energy drinks  food choices among children (Grimm et al, 2004; Hanseon et al, 2005; Cullen et al, 2001; Pearson et al, 2008; Campbell et al, 2007; Hang et al, 2007; Scaglioni et al, 2011; Wyse et al, 2011). Having a parent who provides more rules and expectations, structure and warmth in the home environment (an authoritarian parenting style) may create a protective environment where family meals and healthier eating patterns are more likely to occur (Berge et al, 2010; Pearson et al, 2009). In contrast, having a parent who is more rigid, has less structure, and provides less warmth may create a home environment that is less likely to have frequent family meals and less likely to promote healthy food choices (Berge et al, 2010; Pearson et al, 2009). Research has shown that children who perceive having parents with an authoritative parenting style were more likely to consume breakfast and fruit and less likely to eat salty and sweet snack foods compared to those who perceived parental behaviors as neglectful (Pearson et al, 2009). Presence of family meals has also been positively associated with youths intake of fruits, vegetables, and milk products, eating breakfast, having fruit available in the home environment, and the perception of parental encouragement to consume healthy foods (Videon & Manning, 2003; Utter et al, 2008). Further, youth reported in a qualitative study that positive parental role modeling behaviors can assist them in making healthy food choices, and conversely, the ease of availability of sweet and salty snack foods, makes it challenging to resist consuming such foods (Gellar et al, 2007).


SOCIAL MARKETING FOR BEHAVIOR CHANGE

Social marketing campaigns are becoming more prevalent. In 2008, a review of media related social marketing campaigns for children only included two related to nutrition. (Evans WD, 2008). The USDA Supplemental Nutrition Education Program website provides links to 14 social marketing programs relative to nutrition (http://snap.nal.usda.gov/professional-development-tools/social-marketing/campaigns). They reveal that such research-based target focused programs are necessary to foster campaigns with better potential for success. A community-based California Project Lean summary emphasizes that the challenge in social marketing is the comprehensiveness of the research. Some view it as a challenge for those who believe the time would be better spent on interventions. However, the success of the behavior change is tied to knowing what determines, undermines and supports the behaviors and the range of products that are developed to address these factors. Various target-based interventions and products from the SNAP-Ed campaigns include websites, on-line networking, a site for parent champions, tips for making behavior changes, tangibles such as recipes, menus, and shopping tips, lists of community resources relative to the behavior, coalitions and train-the-trainer materials to support behavior change. In some cases the social marketing campaign may influence behavior change by advocating for policy changes (offering healthier items at a subsidized cost) or organizational practices relative to the behavior (e.g., sufficient time to eat at lunch time).


Gracia-Marco et al (2012) evaluated the impact of existing social marketing efforts in childhood obesity prevention. The main focus of these childhood obesity campaigns or interventions has been to change parents and childrens knowledge and behaviors. Between 1990 and 2009, 25 of 27 social marketing interventions targeting behavior changes were effective. To date, although there is limited evidence of effectiveness in social marketing, it seems when applied conscientiously, its principles may be useful to change behaviors to result in better health outcomes.


Our current project has provided data indicating that parental behaviors including creating rules, habits and expectations for their childs eating and snacking have positive impacts on their childs intake of calcium. Parental role modeling and having calcium rich foods in the household are positively associated with calcium intake. Additionally, the qualitative results from W-2003 also suggest that role modeling and availability support the ability to have rules and expectations about food consumption and eating behavior for their children. Other literature supports that role modeling, availability and having rules and expectations for food intake are associated with better nutrient intakes among children (Eisenberg et al, 2012; Evans et al 2011,Lopez et al, 2012, Tibbs et al 2001). This project strives to identify the best social marketing campaign to encourage those positive parental behaviors regarding the food and beverage choices made at all non-meal eating occasions.


In our W-2003 project, we have found that many parents lack or have fewer rules and expectations about what children eat during the non-meal eating occasions, particularly in references to offering choice of beverages. While beverages contribute significant amounts of calories to childrens diets, (Piernas & Popkin, 2010) in our W-1003 interviews with parents about were rigid in beverages choices for meals or snacks or overly concerned about their childs calcium intakes (Cluskey et al, 2008). In our parental calcium motivator/barrier questionnaire (You and Your Food: A Questionnaire for Parents of Adolescent Children) implemented in W-1003 we asked about consumption of CRF food choices in relation to meals and snacks but did not extensively explore other high energy/low nutrient density food choices for non-meal eating among adolescents.


As a final component of W-2003, we implemented efforts to being using social marketing techniques. We recruited the help of a WSU student marketing group, who guided us in developing creative briefs based on our focus group data and nominal group techniques that we gathered from parents. These discussions addressed the motivations and approaches that they use to promote healthy eating and calcium rich foods among their pre-adolescent children. The creative briefs also helped to focus on identifying the pulse points which are the emotional rewards parents perceive from encouraging and being successful in getting from their children to eat calcium rich and/or healthy foods. The parent responses will be translated into messages reflecting the emotional components and motivations we asked parents to describe when they practice these behaviors. By the end of W-2003 (Sep 2013), we will have developed and tested messages and determined different delivery mediums to explore parental responses to these messages. Our final analysis for W-2003 will include the parental feedback about how the messages resonate or influence them to practice these behaviors.


The efforts of this group have focused on promoting the consumption of calcium-rich food or beverages (CRF/B) and we have gathered data during W-2003 and the past projects (W-191 and W-1003) that have revealed information about the parent child motivators and barriers to calcium rich food consumption. The relationship to calcium intake is related to both beverage consumption (milk vs. water and SSB) and total food intake. We believe that this serves as a basis for investigating how this translates into parental behaviors to promote healthy eating overall or when pre-adolescents are choosing their own non-meal snacks. Our data indicate that parental behaviors, including role modeling of CRF consumption, establishment of rules and expectations for CRF/B intake, and making CRF/B available in the household are associated with greater consumption of CRF/B among preadolescent children in Asian, Hispanic, and non-Hispanic white families (Reicks et al, 2011, 2008). Making CRF/B available and parental role modeling of CRF/B consumption support the W-3003 overarching approach to encourage healthy food choices through rules and expectations.


There is need to explore how parents can be influenced to utilize behaviors that are associated with establishing and encouraging healthy eating at non-meal or snacking occasions among their preadolescent children. We will use social marketing methods to analyze the audience and consider their needs in our efforts to determine the effectiveness of various behavioral change approaches (motivating messages, educational or awareness or materials offering suggested strategies or skills) for parents to use in promoting healthy eating among their preadolescent children. W-3003 aims to continue addressing those same parental behaviors identified in W-2003 and apply them to a broader scope of eating and meal behaviors via a social marketing campaign that addresses obesity prevention in preadolescent children.

Objectives

1. Conduct a literature review and interview experts to choose a specific purpose and focus behavior that will impact outcomes. Explore a situation analysis to describe the factors and forces in the environment that impact outcomes.
   
2. 2. Conduct formative research to identify potential target audience (tentatively multi-ethnic parents of preadolescents) and strategies to support desired and discourage undesirable parental behaviors. Identify the barriers, costs, competition and potential support and obstacles to the desired parental behaviors.
   
3. Develop the strategic marketing mix (products, distribution mediums, promotional strategies, costs/rewards associated with behavior) and outline a plan for evaluation and monitoring the campaign.
   
4. Implement campaign plan and evaluate the impact of campaign on primary outcomes.
   

Methods

GOAL: The overall goal of this project is to develop, implement, and evaluate the effectiveness of a social marketing campaign to increase the supportive parental behaviors that encourage healthy snack consumption among preadolescent children. RESEARCH QUESTION: Can strategies to promote parental behaviors impact their early adolescent childs non-meal or snacking food choices? This social marketing campaign will strive to focus on the most appropriate strategies or interventions to impact the targets positive eating behavior among early adolescents. It is necessary to explore the potential target market responses to promotional and educational messages which might motivate or create greater awareness and value for establishing positive habits versus providing a message campaign that provide tips or strategies to develop positive eating habits. The first phase of a social marketing campaign involves the problem description, which includes analysis to identify a purpose and focus for the project. A purpose reflects the benefit of the intended campaign, which we are proposing may be to impact preadolescents healthy food choice behaviors at snacking or non-meal eating occasions. The focus narrows the scope of the plan, and we believe that the focus will include exploring approaches for parents to establish and utilize behaviors that may influence their childs choices. Our preliminary work has included some of the necessary analysis allowing us to propose a tentative purpose and focus for this proposed project using data about parental behaviors and childrens intakes. Further analysis will allow us to narrow to a specific target audience to see if a particular ethnic group, parent/child group or parental behavior is most critical or most likely to result in positive outcomes. The project will unfold with the following objectives: Objective 1: Conduct a literature review and interview nutrition, child and parent behavior and social marketing experts to fine tune the purpose and focus. Explore a situation analysis to describe the factors and forces in the environment that impact outcomes and impact planning decisions relative to the project. 1.1. Forecast Strategy Feasibility. Survey experts using forecasting methodology such as the Delphi Technique to determine the feasibility of the proposed social marketing campaign strategy. For example, determining whether social media is a feasible way to reach parents, what are the merits or risks associated with this project, if some ethnic groups are more appropriate targets, if the formative research should explore elements of good versus poor eating, and food choice behavior in families of adolescents, or both. Steps for Delphi Technique: 1) Determine an area of expertise needed for the panel, e.g., marketing, social marketing, family behavior, nutrition 2) Select a panel of 8-10 experts. Panelists have in-depth knowledge of or experience in the project. 3) Develop an open-ended instrument asking about various aspects of this project in relation to social marketing and behavior change and feasibility of various options 4) Gather input, rank and evaluate the input. Strive to reach a consensus with the outcome. A complete agreement is not required. 5) Identify project constraints and preferences. Set boundaries on the project ranking by first considering the hard constraints (e.g., budget, mandatory requirements), then the preferences. 6) Rank projects by constraints and preferences. 7) Gather input from appropriate members of the Delphi panel as needed. Finalize decision. 1.2. Conduct Systematic Literature Review. For publication, the team will conduct systematic literature reviews of the impact of interventions (including social media campaigns) aimed at influencing parental behaviors that promote early adolescents healthful dietary intake including snacking. Objective 2: Conduct formative research to identify potential target audience (tentatively multi-ethnic parents of preadolescents) and strategies to support desired and discourage undesirable parental behaviors. Identify the barriers, costs, competition and potential support and obstacles to the desired parental behaviors. A mixed methods approach will be used to conduct formative research. This will involve focus groups and/or individual interviews using nominal-group technique, projective techniques, or survey methodology. We will pilot test survey instruments prior to implementation. Results of formative research will determine the campaigns target audience (e.g., race/ethnicity, age, and income level), and identify the barriers, benefits, competing behaviors, and influential others (e.g., siblings, peers, teachers, and coaches) for the target audience. Objective 3: Develop the strategic marketing mix and outline a plan for evaluation and monitoring the campaign. 3.1. Consult with marketing experts and consider data from Objective 2 to develop the strategic marketing mix. a. Product (tangible elements of campaign): Activities may include sites for presenting tips or suggestions on healthy snacking, healthy snacking recipes, testimonial blogs, and social interaction between parents (online support group). On-line activities for kids may support or validate parental behaviors. b. Place (distribution): Campaign-related activities may include social media outlets such as Facebook, Twitter, and Pinterest. Other outlets may be determined through the formative research process. c. Price (costs): Identify costs associated with practicing behaviors. Increase the value of the positive behavior and decrease the value of the competing behaviors. d. Promotion: Promote products to target audience and promote to others who may influence and support parental behaviors and/or assist to promote the campaign among parents as well (e.g., physicians, teachers, leaders at Boys and Girls Club, etc) 3.2. Develop a Logic Model to organize an evaluation and monitoring plan based on inputs, activities, outputs, and outcomes. Inputs may include resources such as our team, marketing consultants, relations with extension or personnel at universities, and material resources. Outputs may include campaign visibility and exposure to messages via social media and interaction with other parents and educators. Short-term outcomes include increased frequency of positive parental practices to enable healthy snacking behavior among preadolescent children. Long-term impacts include changes in overall dietary behaviors and within snacking occasions. Objective 4: Implement campaign plan and evaluate the impact of campaign on primary outcomes. 4.1. Recruitment and Enrollment. Upon approval by individual Institutional Review Boards (IRB), each site will recruit a convenience sample of parents or primary caregivers and their children aged 10 to 13 years. Inclusion criteria of the parents or primary caregivers are: 1) being the parent of a child 10 to 13 years, 2) being the adult responsible for food acquisition and preparation in the child's household, and 3) speaking English and being comfortable speaking English. A total of eight states will be participating in this campaign (Arizona, California, Hawaii, Minnesota, Ohio, Oregon, Utah, and Washington). Parental consent and youth assent will be collected. The type of IRB-approved incentive/compensation for participation may vary in different sites. 4.2. Data Collection and Data Entry. All data will be managed by a central location and shared at a secure member site at Basecamp (https://oardc.basecamphq.com/login) hosted by Ohio State University. Data collection among adult participants will include: Demographics (age, sex, height, weight, race/ethnicity, family size, number of children, income level, education level, number of main meals per day, number of snacks per day, physical activity level); dietary recall; (Automated Self-administered 24-hour dietary recall; ASA24 at baseline, post-intervention, and 6 months post-intervention); reach (number of parents or primary caregivers reached based on selected exposure); media habits (tracked using Google Analytics or software alike); feedback about social marketing (like, dislike; resonate best with which message/channel); self-efficacy towards the targeted behavior (pre-post); Impressionable Score (perceived positive parental influences through: 1. Rules & expectations for targeted behavior in other settings, e.g., away from home; 2. Availability of healthy foods in the home, pre-post checklist of healthy foods available at home); and other exposure (similar campaigns/entities; persons, products, and/or place). Data collection among youth participants will include: Demographics (age, sex, height, weight, race/ethnicity, grade, family size, number of siblings, number of main meals per day, number of snacks per day, physical activity level); dietary recall (including associated activity, eating with someone); perceived parental influences (behavioral checklist; parent-assisted ASA24 at baseline, post-intervention, and 6 months post-intervention); self-efficacy towards the targeted behavior (pre-post), and other exposure (persons, products, place, or price). 4.3. Data Analyses. Campaign impact will be measured by reach, cross-sectional frequencies of unhealthy vs. healthy snacking, daily calories and nutrients from snacks, and change in BMI among youth participants. The mechanism and process for campaign implementation will also be evaluated (e.g., timeline, cost, and feasibility). 4.4. Potential Pitfalls. Not all target audience members have access to computer and Internet, and/or use social media.

Measurement of Progress and Results

Outputs

• Adapted the Parental Motivator Barrier Questionnaire developed as part of W-1003 to reflect healthy snacking outcomes.
• A retrospective pre-test questionnaire to assess parental self-efficacy and awareness, administered a month post-intervention.
• Social marketing campaign.
• Parent report of exposure to the messages via social media.
• Media habit reports on social media.

Outcomes or Projected Impacts

• Increased frequency of supportive parental behaviors (setting expectations and making healthful foods available).
• Overall improvement in intakes of CRF/B, whole grain foods, fruits and vegetables and decreased consumption of high fat and sugar foods, energy-dense foods/beverages among targeted early adolescent children.
• Improved nutrient density of non-meal eating occasions among targeted early adolescent children.

Milestones

(2014): Conduct a literature review and interview experts to choose a specific purpose and focus behavior that will impact outcomes. Explore a situation analysis to describe the factors and forces in the environment that impact outcomes.

(2015): Conduct formative research to identify target audience barriers, benefits, competition, with the desired behaviors. Craft a desired position and identify the influential others and for enhancing parental support of behaviors.

(2016): Develop the strategic marketing mix (products, distribution mediums, promotional strategies, costs/rewards associated with behavior) and outline a plan for evaluation and monitoring the campaign.

(2017): Implement campaign plan.

(2018): Complete campaign plan and evaluate the impact of campaign on primary outcomes.

Projected Participation

View Appendix E: Participation

Outreach Plan

We will make the results of the project available in an accessible manner to intended users of the information through refereed publications in nutrition and health journals and presentations made at annual meetings of nutrition, health and education societies, and eXtension Families, Food, and Fitness Community of Practice (FFF CoP).

Organization/Governance

An executive committee will be formed annually by group consensus methods with a Chair and Reporter. The Chair manages meetings, submits reports and plans the agenda for the annual meeting. The Reporter provides minutes describing the discussion and actions suggested during the meetings. Administrative guidance will be provided by an assigned Administrative Advisor and a CSREES Representative.


Each approved member will cooperate in the design of the project, collection and analysis of data and co-authoring of publications and presentations that result from this work. The research team will use common protocols for conducting focus group interviews, and developing and testing messages. Data will be collected in individual states and aggregated for analysis by a subgroup of researchers. Findings will be shared with the entire project team. Research team subgroups will develop several manuscripts, reports and presentations.

Literature Cited

Affenito SG, Thompson DR, Barton BA, Franko DL, Daniels SR, Obarzanek E, Schreiber GB, Striegel-Moore RH. Breakfast consumption by African-American and White adolescent girls correlates positively with calcium and fiber intake and negatively with body mass index. J Am Diet Assoc. 2005;105:938-945.

Andreasen AR. Social Marketing: Its Definition and Domain. Journal of Public Policy and Marketing. 1994 Spring; 13(4): 108-114.

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Attachments

Land Grant Participating States/Institutions

AZ, CA, HI, MN, OR

Non Land Grant Participating States/Institutions

Brigham Young University, Ohio State University, Washington State University