Brief Summary of Minutes of Annual Meeting

2008 W-1003/2003 Meeting-November 5-7 How to motivate parents to promote intake of calcium rich foods among early adolescents Holiday Inn Metrodome, 1500 Washington Ave S., Minneapolis, Minnesota 55454 Phone: (612) 333-4646 Fax: (612) 333-7910 Nov 5 Wednesday Avalon meeting room at the Holiday Inn. Room- 6-8 pm. Welcome and introductions-present: Marla, Scottie, Carolyn, Carol, April, Christine, Mary, Paul, and Susie. Thanks to Marla for developing our new proposal-W-2003. Each member provided a brief review of their research activities. Christine gave new members a brief history and background on previous projects. Our current project looks at the findings from previous project and focuses on those factors that led to effective parenting. Marla-briefly discussed segmentation analysis and how our data can be used for analysis. Carol-reviewed project rules: how we contribute to the project, authorship, on publications. " Review of 2007 minutes-the minutes were previously approved. " Registration fee for the meeting is $60 made out to the University of Minnesota. " State reports: Send papers to Scottie to be sure our records are complete. All members please update as to MS and PhD degrees completed and posters presented at professional societies. " Christine-stressed- Adherence to Timelines and how to use new research tools in suitable manner. " New members: NIMSS 1. Paul Johnston-BYU-has interests in international nutrition with projects in Bolivia-calcium (in grains) in cookies, increase vegetable intake and has another project in Ecuador-milk 2. Carolyn Gunther- The Ohio State University-Research and Administrative appointment with interests in calcium and body weight and nutrition education 3. Susie Goodell-NC State University-a newbie-interested in eating behavior-caregivers and preschool children relationships 4. Latha Devareddy-University of Arkansas " Appointed Carol Boushey and Mary Cluskey as a subcommittee to nominate next years chair and secretary Nov 6 Thursday Room 364, West Bank Office Building (WBOB), U of MN Walking directions were provided with a map. 8:00 Continental breakfast 8:30 Welcome to additional members who were introduced-Laltha-U of Ark, Osteoporosis & bench scientist, Leslie Cradler-new honors student with Carol Boushey. Paul Johnston was introduced, a special guest from BYU. He has an Agricultural background in animal nutrition and now also works in human international nutrition. He has guided students from Latin America and Africa toidentify a nutrition problem within their own country, then design and carry out a plan to reduce the problem. Calcium intake in these countries is only about 10% of daily requirement. Paul presented several examples of international interventions. " One such example explored the potential of using indigenous the grains: Canahua, Quinoa, Amaranth. These grains have high lysine, protein and fatty acid content compared with wheat and corn. The thought that perhaps high calcium content grains could be used in products (cookies) for use in school or breakfast program in developing countries. The cookies were tested at different levels of calcium fortification with children in Bolivia. Acceptance topped out at 300 mg of calcium. Their usual dietary intake consisted of potatoes and dehydrated potatoes. Malnutrition and stunting is common. Anemia is endemic. " When families move to the cities, they reject their previous native foods. In order to increase vegetable intake, BYU researchers have started subterranean gardens with the children. " Ecuador: Anemia occurs with animal ownership. Animals are raised for income not for intake. Calcium intake is low and milk is not shared with the children. There is no tradition of drinking milk. Shelf life is poor. Beverage intake consists of coca cola and water. Pictures of chicks illustrate the effect of diet (coca cola, water and milk) on growth. Paul would like to join the W 2003 research group. Another colleague at BYU interested in community nutrition research in low income populations is Dr. Rickelle Richards. The group enthusiastically welcomed Paul and his colleague. Status of W 20003 Project objectives as stated in the approved proposal were reviewed. The previous project (W 1003) has not been terminated but renewed. The title is different, but the goal to understanding motivators and barriers within parent child relationships remains the same. Christine presented a list of journals to consider for manuscripts describing our findings. See Journals for Calcium Rich Food Articles  (see attachment) Policy & Procedures of W-1003: The Policy and Procedures used in W 1003 were updated. (See P&P attachment). All publications should be sent to Christine/Scottie for the end-of-year Annual Report. Objectives of W 2003 - - " Segment parents into homogenous subgroups based on promotion of CRF to early adolescents. " Explore motivations and/or perceived benefits and barriers underlying parental factors which include making CRF available, encouraging intake of CRF, setting expectations for beverage consumption, and role modeling intake of CRF to early adolescents. " Identify relevant messages and delivery methods that will motivate parents to promote CRF to early adolescents. 10:30- Segmentation/Cluster Analysis presentation. Dennis Degeneffe Research Fellow-specializes in segmentation The Food Industry Center MySurvey-Food and Beverage Occasion Questionnaire - handout Dennis Degeneffe illustrated Cluster Analysis using an example data he prepared several years ago for Pillsbury. The analysis usually takes about 40 weeks The analysis uses demographics, life stage, lifecycle and attitudes-to place people into group that reflect their response to specific practices, such as meal choice and eating behavior. Using a battery of questions with 30% agreement respondents can be segmented into meaningful groups that can then be targeted with marketing or educational information. His analysis uses Cluster Analysis and Conical Factor Analysis-to identify a linear relationship between set of attitudinal questions. Best solutions profound stable (80% accurate) actionable Uses: targeting depth of understanding developing products crafting communication messages, delivering messages Pillsbury Study-How We Eat Food Segment Summary-Clusters food attitudes-Each has a distinct different approach to eating Mainstream Nurturing Cooks=love Healthy Traditional Cooks-balanced foods, lower fat, and traditional Healthful Explorers- Organic, creative experimental cooks Weary Providers-compromise-Stressful, meals are balancing, harmony at mealtime Food on Demand-other things get in the way but enjoy food Mobile Munchers-grazers, busy on the go Traditional Recipients-catered-want someone else to prepare to fix How to Shop-contains many of the same categories as food segments Born to shop-Love it Savvy game playing-competitive shoppers Budget weary-frustrated Practical and systemic-planners It's just groceries-has a pantry of food Haven't a plan-haphazard shoppers Want out of it-annoyed-internet shopping Intervention Need State-Consumer needs Emotional Connections Higher needs Nurture Family Convenience Hunger lower needs Nutritional Taste experience % Eating total eating occasions Healthy Express-21%- Breakfast & Lunch-High attention to health Comforting Interludes-14% eaten as a child, enjoyment-Med/high Indulgent Escapes-snacks-low Nurturing Family meals-18%-dinner-medium Sensible meals-16%-high Fast fueling-15%-low (see Appetite-pdf online for segment classifications or groups) Implications for Intervention: Need themes Attention to healthful eating Receptivity to improving nutrition ( for better clarification-see attachment of Dennis's ppt) Decision for the group-should we try to segment our data find different groups? i.e. find parental groups who want to provide for their children. Do factor analysis on our data? then find the segments. Encourage parents who are doing right and how can we reach those that aren't? Three Concerns of Dennis on our data: range of statements, we have too many questions with missing data. Allowing respondents to reply don't knows also limits suitability of our data for cluster analysis. Factor analysis-don't have to have all the data but you do need all data for cluster analysis. Focus on W 2003 Review of Time line (see p.15 of new proposal): Objectives 1-segment and Objective 2-motivators and barriers-perhaps both objectives 1 & 2 can be done in concert. In W-2003 we'll do focus groups to determine calcium intakes. We discussed techniques to obtain information: use card sorts, pictures with bubbles, story telling, word association, refrigerator, 3 restaurant occasions: fast food-pizza, burger and regular restaurant, breakfast and lunches, grocery store, and after-school occasion (snacks), convenience store, and on-the-go eating. Use probes to get segments and do content analysis. (Volunteers to write questions for the above techniques include: Marla, Mary and Susie) Look at benefits or barriers 4 factors associated with CRF: such as availability, parental modeling, benefits barriers strategies distribution channels encouragement, and expectations. Goal: Why & How do they get these behaviors, determine answers to these questions. Objective 3- describe preferred messages, delivery methods and channels to get these messages. Ask parents: What could I do to get this parent to do it? Use probes-under each category Sample parents using: Diversity Race/ethnicity SES Choose parents: involved in low income programs after-school programs YMCAs boys, girls clubs religious groups W HA AS AA(bl) AR X X X AZ X X CA X X X HI X X IN X MN X X NC X X OH X X X OR X X UT X UT/BYU X X WA X X 3 focus groups/state with 9-12 per group Sub group characteristics of parental behaviors for message tailoring Have parents telling what they do or projecting what they think is happening in the picture. 36 focus groups-parents may be from each group. In the past we've not found any differences in race or ethnic group. With focus groups, you continue to do groups until you don't get any new information. Training on focus groups. Book by Krueger outlines focus group procedures. (Christine will provide reference). IRB approval: Christine will submit initially for IRB approval and will send information for others to use as a model. The procedure will include pre-testing the questions, holding focus groups, and finally message testing as specified in project objectives. The IRB approval will be submitted after the group developing the questions has submitted a draft. Nov 7 Friday Room 310 from 8-1, Room 364 from 1-5 WBOB, U of MN 8:00 Recap of previous day's decisions of the group: Each state will do 3 focus groups of parents of 10-13 year children. Groups will be mixed and include diverse ethnic groups. Additionally, we're seeking volunteers reflective of the SES of our state. One group will put together pictures and questions for the focus group (Marla, Mary, and Susie). Christine will put together the initial IRB for approval. Friday, we reviewed the results of the previous projects' data upon which we based the new project. Leslie Cradler from the Purdue's Honor's program, presentation: (see attachment of Leslies ppt) Are adolescents' attitudes toward calcium rich foods and intakes of dietary calcium related to the presence of grandparent(s) living in the household? (data presented are from funny box data, certain questions were routinely skipped possibly due to placement/or design of the FF Questionnaire) Justification: Statistics: Osteoporosis cost is estimated to $19 billion/yr Multi-component interventions are most effective. Girls who met adequate intake were most likely to be served milk by mothers and likewise by fathers. Family's structure can affect calcium intake. Single parent household was more likely to be more food insecure, more anemic. With good relationship with grandparents, grandparents do want to be part of child's choices and well-being. FFQ and YOU and YOUR FOOD survey calcium intake can predict CRF. Children with grandparents (8.5%) in the household had a higher calcium intake. Relate methods to total calcium intake Analysis relate to factors to primary exposure and total psychosocial factors. No adjustment was made for family composition. Gender-girls had lower calcium intake than boys. Children with no grandparents had a lower taste for CRF. Children's intake was reportedly higher than parent's intake. Discovery is part of the research experience. Beth Olson from Michigan State University was introduced. Beth has a PhD student doing work with Asian Indian parents with infants 0-1 year. Carol-data analysis (has all of the scans): sentinel child-survey referred to this child, parents=n695 age: early adolescent defined as age 10-14 gender relationship to child Q23 # children<18 yr age of adult gender-7.8% men total >18yr in house education-35% employment status-majority were FT spouse/partner race/ethnic group-(Re-look at this-double check-Asian numbers look small) Q34 Questionnaire-look at data set V1=ID numbers Characteristics, dietary information, cross tabs of 11 states Child characteristics- check on these as MISSING kids-(Ask Miriam) The W-2003 meeting location for 2009 will be Nov. 18-21 at UC-Davis. Carol's analysis SPSS 16 continued: She presented testing of the tool, 2 pilot tests, scales, constructs and subscales. Everyone has an identifier. Either we can ask for these calculations from Carol (do duplicate fields) or have someone from our institution do analysis. Culture/tradition for parent concern-3 scales for this (look at # of missing fields) 1-5 scale higher score is more positive. Quantitative variables Parent role modeling 1-dairy only V122 Knowledge questions Q16 & Q17, Q22, V96 & V97 55% answered Ca correctly broccoli-3 ½ cups boys need more Ca than girls Vitamins can help obtain Ca cups of milk Eating out occasion V81 Family meal together-most eat dinner together FFQ review: Ca intake--how individuals respond to different foods. FFQ is designed to separate high end from low end intakes (W-191-Carol, Rachel, Keith, Deb used the means approach). FFQ was developed for adolescents. Convergent or (?) validity is associated with bone. Longitudinal data also tracks with bone. Implausible levels were set at less than 100 or over 2500. Parent outliers were around 2.6% while child outliers were 4.1%. FFQ Decisions: age for age-go with parent's decision on how old child is-age is significant. gender-no decision 0 is boy and 1 is girl education-NS employment-NS Parents expectation of beverage 0.02 significance Convenience .036 sig. Availability .032 sig. Parenting scale never did come out. Quartiles of intake-must transform data Probability plot-distributes normally Garry Auld joined the group via Skype after 1:45pm MST. Carol showed outliers. Knowledge manuscript-see p.7 child/parent pairs. (A whole analytical method exists for dyad analysis and is often done by human development or family studies professionals). Potential confounding factors respondent at home or not at home-Q32 keep in, Q33 throw out parent intake-dependent variable but sig. Writing groups: Paper 1: What predicts a child's calcium intake? Paper 2: Parent and child interrelationship Attitudinal, weight concerns-do they go together? Family influence and the child. Generational differences? What do you drink out of the restaurant? Do scales, gender-match? More discussion (Christine, Beth, Scottie) Paper 3: like NHANES, adjust for each individual state (AZ-reference state) sampling. Paper 4: Parental intake (Marla, Siew Sun, Miriam, Susie and others) need child intake (check to see where missing children questionnaires are >150 missing-AZ, MI, MN) Paper 5: Rank foods by ethnicity Describe variation, decide on one of four objectives and determine appropriate analysis i.e. Principle Components-along scale of a certain food-check for missing data (Garry, Siew Sun, Miriam, PhD student). Paper 6: Eating out Divide by frequency of eating out and calcium intake. The higher the score, the greater the parental expectations (Mary, Christine, Marla and Miriam-have had a conference call). Knowledge paper: Quantitative data: awareness of what child is eating, how important are foods, (Christine, Carol, Carolyn) Nov 8 Saturday 8-12 am Avalon room at the Holiday Inn 8:30.discussion of W 2003 continued. Changes in P & P: Include role of new people on the project, original intellectual contributions may participate in authorship, fees for abstracts, page charges, amounts over $100 will be negotiated. Acknowledgements should read: W-2003 is a multistate research project funded through the Agricultural Experiment Station at the participating land grant universities. W-2003 Tasks: IRB-Christine Timeline: February 1st & conference call to review draft of Pilot questions, then revise questions Mid Feb-IRB submitted Mid-March/April-Training on focus groups, highlight references, pilot testing with pictures May-revise pilot questions & pictures May-September-conduct focus groups Nov.19-complete focus groups & check on message development by experts for Davis meeting Next year-2010- start data analysis Carol: Check on missing children's data for W-1003 with Miriam and Wendy-are these scanning errors? This could be serious!! Asian (56) and Hispanic numbers seem to be incorrect check race/ethnic group check front of questionnaire for state: Parents-normal P Plot Food-Calcium intake Female-256 mg less Ca- significant high school, some college not employed outside the home Asian women have even less calcium than children Calcium variables F calcium-per day Next years chair and secretary: Christine will continue as Chair (with reminders from Mary and Carol). Scottie will become secretary for 2009. Methods: Marla has begun with methods paper (with Jennie's paper) and how things were coded. Data: check on race/ethnic groups Scottie-check on V1-V171 Marla- check on V169-V262 Near the end of the meeting, we met by Paper group interest.: Marla, Mary, Susie, Laltha, Miriam (call):Important Foods and Eating Out Marla, Susie-Parental Influence-motivators Christine, Scottie, Beth- **((for further clarification of minutes, see the following attachments- Paul Johnstone's summary comments, Dennis deGeneffe's ppt, Leslie Cradler's ppt, dyad paper, W-2003 member list & others, P&P updates, Publications for Annual Report-Marla, journal review for CRFs ))

Adequate calcium intake as an adolescent is crucial for sufficient mineralization of the skeleton to ensure bone health later in life. Many early adolescent children in the United States do not consume enough calcium from food and beverages to meet the recommended intake, while intake varies based on the race/ethnicity of the child. Family environmental factors, both physical and social, have been implicated for their overall influence on eating patterns and diet quality of children and adolescents including adequate calcium intake. The purpose of the project was to identify these factors and their relationship to intake of calcium rich foods by early adolescents. This task was accomplished in several steps. Initial in depth interviews were conducted with about 200 parents of Asian, Hispanic and non-Hispanic white early adolescents across 12 states. Results were used to develop a parent motivator-barrier questionnaire (Parent MBQ). After establishing that the new instrument had acceptable psychometric properties, it was used with a previously developed Child MBQ to collect survey data from about 600 parent-child pairs across 8 states. Participants were recruited from 4-H, Scouts and church groups. Data analysis is currently underway to establish predictive models for the manner in which household characteristics and parental practices influence intake of calcium rich foods by early adolescent children as well as their parents. Additionally, some PIs completed projects specific to their state. These are detailed in individual state reports.

Cluskey M, Auld G, Edlefsen M, Zaghloul, S, Bock MA, Boushey CJ, Bruhn C, Goldberg D, Misner S, Olson B, Reicks M, Wang C. Calcium knowledge, concern, and expectations for intake among parents of Asian, Hispanic, and non-Hispanic white early adolescents. The Forum for Family and Consumer Issues. Winter 2008, 13(3). http://ncsu.edu/ffci/publications/ Edlefsen M, Reicks M, Goldberg DL, Auld, GW, Bock A, Boushey CJ, Bruhn CM, Cluskey M, Misner SL, Olson BH, Wang C, Zaghloul S. Strategies of Asian, Hispanic, and non-Hispanic White parents to influence young adolescents intake of calcium-rich foods, 2004 and 2005. Preventing Chronic Disease 2008;5(4) October. http://www2.cdc.gov/pcd/issues/2008/oct/07_0174.htm Cluskey M, Edlefsen M, Olson B, Reicks M, Goldberg DL, Auld, GW, Bock A, Boushey CJ, Bruhn CM, Misner SL, Olson BH, Wang C, Zaghloul S. At home and away-from-home eating patterns influencing preadolescents intake of calcium rich foods as perceived by Asian, Hispanic and non-Hispanic White parents. J Nutr Educ Behav. 2008;40:72-79. Yang J, Boushey CJ, Olson BH, Auld G, Bock MA, Boushey CJ, Bruhn C, Cluskey M, Edlefsen M, Goldberg D, Misner S, Olson B, Wang C, Zaghloul S. Intentional purchase of calcium-fortified foods observed among Asian, Hispanic, and non-Hispanic white parents of early adolescents. Submitted to Journal Am Diet Association 2008 (in review) Olson, BH, Chung, KR, Reckase, M, Schoemer, S. Parental Influences on Dairy Intake in Children, and their Role in Child Calcium Fortified Food Use," In press, Journal of Nutrition Education and Behavior. Abstracts Roth-Yousey L, Asche K, Schroeder M, Reicks M. Assessment of parent and child perceptions of rules and expectations regarding beverage intake. FASEB J. 2008 22:44.2.