Brief Summary of Minutes of Annual Meeting

Brief summary of minutes from 2016 annual meeting:

• Welcome, agenda review, and introductions: the meeting started with a general welcome to the group as well as reviewing the agenda. Introductions were done with the whole group, which included not only NC-1193 members but also students who were in attendance.
• State report highlights: Group members provided pertinent updates regarding changes or new developments at the individual, department, college, and/or university level as well as information regarding new hires and position announcements.
• Review of past 5 years and termination report items: Objectives, milestones, and timelines were reviewed for objectives related to 2011-2016. Discussed sections of the 5-year termination report and identified areas for which additional information/clarification was needed. Group members were reminded to send missing annual reports to the secretary. A complete participant list was compiled so those members who were not part of the entire 5-year period were still represented. Accomplishments, outputs, and activities were discussed. The secretary compiled a cumulative list of publications, presentations, and students on the project and requested members review and make adjustments as needed. The chair requested team members provide information related to awards and grants within the 5 year period.
• Review 5-year renewal plan (2017-2021): An overview of the renewal plan was provided by the policies and procedures committee chair, with other individuals leading specific renewal objectives providing next steps in the areas of environment, behavior, policy, systems and environment approaches, and evaluation of dissemination and documenting best practices.
• Review group organizational chart: Group organization was reviewed, as well as committee membership and term length. Individuals indicated which committees they wanted to continue serving on and if they wanted to take a leadership role for the following year. Each member must serve on 1 Administrative Support and 1 Research Support committee.
• Policies and procedures manual – proposed updates: New member rules and regulations were updated to reflect the needs of the renewal project. Discussed whether or not we can have more than one voting representative per university; chair and secretary drafted options for voting on this policy change, which will be discussed and voted on at a future monthly meeting. Details were added regarding voting procedures, a majority vote will be a 2/3 vote of total membership; if a member does not vote it is considered an abstention and counts as a no. Updates to responsibilities/expectations of members were included and terms for membership resignation/termination and voting procedures.
• Elections: The following positions were discussed and voted on for Chair, Chair-Elect, Secretary, and Secretary-Elect with service from October 1, 2016- September 30, 2017.
• Scheduled monthly conference calls and 2017 annual meeting: Monthly conference calls were scheduled from March – August 2016, with fall meeting dates/times to be established at one of the monthly calls to accommodate fall teaching schedules. The 2017 annual meeting date and location was tentatively set.

Excessive weight gain is associated with increased risk of developing many serious diseases, including cardiovascular disease, hypertension, and type 2 diabetes. Young adults are at a uniquely increased risk for weight gain because of rapidly changing social situations that influence eating and exercise behaviors. Despite efforts to promote weight management, only a small proportion of the population at risk is reached and even effective programs promoting behavior change may have limited value in environments that promote weight gain. Participants in this multi-state research group have applied theory-based behavioral constructs to design intervention programs to promote healthful eating and exercise behaviors in young adults with a goal of preventing unhealthy weight gain. Although these programs have been effective in improving dietary behavior, they did not prevent weight gain. These past five years of the multi-state research project were devoted to building community relationships with young adults using principles of community-based participatory research (CBPR). The results of this work have led to the identification of environmental and behavioral barriers and facilitators, and to the development of instruments for assessing environmental and individual factors associated with health outcomes. In the next five years, we will work as a collaborative group to refine and validate these instruments and define the relationship between environmental and behavioral factors with a goal of quantifying these to create a Healthy Campus Index.

Short-term Outcomes: The research impacts from this group have the potential for extensive health care cost savings. The research outcomes target pre-symptom behaviors and those items supporting pre-symptom behaviors. Consumption of adequate amounts of fruits and vegetables is positively correlated with prevention of cancer, obesity and cardiovascular disease. A stage-tailored intervention was found to be successful in increasing fruit and vegetable intakes and advancing stage of change parameters for young adults through two modes of intervention. The findings will enable nutrition educators to more successfully reach this age group with effective nutrition education messages. Economically disadvantaged young adults, a vulnerable group for food insecurity due to limited physical and economic access to food and inadequate availability to education and health care, were impacted with this research, as measured by the sustained improvement in fruit and vegetable intake among the intervention versus control group. Application of findings will contribute to reduced health disparities among limited resource subgroups. Anticipated impacts include: a) researchers and Extension educators will develop skills in using community-based participatory research to enhance sustainability of interventions, b) the usefulness of a novel non-diet, web-based approach for healthy weight management will be determined in young adult college students focusing on eating, physical activity and a healthy body image; and c) usefulness of a non-calorically restrictive, weight gain prevention intervention with both college and non-college young adults will be established. Success of these new approaches to weight gain prevention could have an important impact on current and future weight gain prevention programs, resulting in young adults with lowered risk for obesity and associated chronic diseases. Additionally, this work has increased awareness regarding the importance of environmental supports needed for healthier choices with stakeholders such as university administrators, faculty, staff, and students.

Outputs: Our work over the past several years includes building on previously acquired knowledge and developed tools, including:

• A validated Behavior, Environment, and Changeability survey (BECS) to identify the importance and changeability of nutrition, exercise, and stress management behavior and related aspects of the environment.
• A validated College Environment Perceptions and Behaviors Survey (CEPBS) incorporating aspects of the BECS to evaluate student perceptions of the healthfulness of their campuses and current health behaviors.
• A validated Environmental Audit to be used by campus residential life and foodservice administrators, health promotion specialists, and researchers to benchmark the degree the campus environment supports obesity prevention. The CEPBS and the Environmental Audit will be used to create the Healthy Campus Index that can be used for planning and evaluation at both the personal and environmental levels of the socio-ecological model.
• Results from current and previous North Central Multistate projects were presented at national and international conferences including (but not limited to) the: Academy of Nutrition and Dietetics (AND); American Association for Advancement of Science; American Public Health Association; Experimental Biology; International Congress of Behavioral Medicine; International Congress of Obesity; International Society for Behavioral Nutrition and Physical Activity; National Association of State Universities and Land-Grant Colleges; and Society for Nutrition Education and Behavior (SNEB).
• Materials, electronic files, and educational websites from studies with college and economically-disadvantaged young adults have been made available to health and nutrition educators nationwide via such mechanisms as the Supplemental Nutrition Assistance Program and the University of Wisconsin-Madison Department of Nutritional Sciences websites.
• In-service education/training on the Transtheoretical Model for Behavior Change (Stages of Change) and Community Based Participatory Research approach was provided for personnel in participating states.
• Manuals for conducting online, multi-state focus groups and for conducting physical assessments are available.
• A web-based, non-diet approach curriculum for weight management for college students is accessible for participating states.
• Cumulative students supported, mentored, and that gained research experience through this 5 year project period total 182. Students included on the project spanned from undergraduate to graduate to post-doctoral research assistants.
• Over 200 publications (peer-reviewed journal articles and published abstracts) and presentations directly related and complimentary to the work of the technical committee have been published/presented over the last 5 years.

Activities:     

• Effectiveness of a theory-based approach, based on the Transtheoretical Model, in accomplishing behavior change in economically-disadvantaged young adults (a high need, hard-to-reach audience) was established. As a result of the intervention, participants in the experimental group had higher consumptions of fruit and vegetables than controls.
• Project YEAH. Multi-state researchers collaborated on a NRI-funded project called project YEAH (Young adults Eating and Active for Health) to develop a web-based intervention for obesity prevention among college and non-college young adults. The PRECEDE-PROCEED process of CBPR was used to identify and prioritize the problems of significance (quality of life/health/and environmental & behavioral determinants and predisposing/enabling and reinforcing factors) to young adults that were then linked to factors influencing weight gain. Young adults (n=1639) recruited from samples in 14 states were randomized into experimental or control groups. Participants in the experimental group received targeted online education and stage-of-change tailored email messages that encouraged healthy dietary and physical activity choices and effective stress management techniques. The experimental participants had significant improvements in cups of fruit and vegetable intake, minutes of vigorous physical activity in females, reduction in percentage of energy from fat, self-instruction and regulation for mealtime behavior, and hours of sleep at 6 months (post intervention) than control participants. There were also a significantly greater proportion of experimental participants in the action/maintenance stages than control participants for fruit and vegetable intake and physical activity.
• College Environment Perception Survey (CEPS). The objective of this study was to develop and test a College Environmental Perceptions Survey (CEPS). CEPS was developed in 3 stages: questionnaire development, validity testing, and reliability testing. Questionnaire development was based on an extensive literature review and input from an expert panel to establish content validity. Face validity was established with the target population using cognitive interviews with 100 college students. Concurrent-criterion validity was established with in-depth interviews (n=30) of college students that were compared to surveys completed by the same 30 students. Internal structure using factor analysis from surveys (n=1,147) completed by college students from 8 universities. The survey data were also used to establish internal consistency (Cronbach alpha). After development and testing, 15 items remained from the original 48 items. Iterative factor analysis eliminated items that had low factor loadings (i.e., <0.50) or cross-loaded on more than one scale. A 5 factor solution emerged: physical activity (4 items, α =.649), water (3 items, α =.764), vending (2 items, α =.684), healthy food (2 items, α =.630), and policy (2 items, α =.572). The mean total score for all universities was 62.61±11.28SD on a 100-point scale. CEPS appears to be a valid and reliable tool for assessing college students’ perceptions of their health-related campus environment. These perceptions may be used to determine targets for college campus environment improvement efforts.
• Vending Machine Audits. The Health Density Vending Machine Audit Tool (HDVMAT) was developed to extensively evaluate and score vending machines based on machine accessibility/availability and product healthfulness, price, and promotion. The HDVMAT was implemented in 91 snack and 100 beverage vending machines in 11 states. Significant differences in scores were found between states and building types, with the healthiest machines found in recreation facilities. Comparing products by type and size, healthy products were equally-priced or less expensive for 83% and 13.2% of the machines respectively. The HDVMAT can be used to evaluate and compare vending machine environments. Average HDVMAT scores for evaluated buildings were relatively low, indicating significant improvements can be made to vending machine environments. Through investigating HDVMAT sub-scores, variables contributing to low HDVMAT scores can be identified. HDVMAT scores can be used to create interventions that can be targeted at improving aspects of the vending machine environment that are not conducive to an overall healthy vending machine environment. The nutrient-density scoring approach may allow for a more inclusive representation of vended product healthfulness.
• Dining Environment Audits. Full Restaurant Evaluation Supporting a Healthy (FRESH) Dining Environment Audit assessed dining halls/cafeterias (DH), fast food (FF), sit-down (SD) and delivery restaurants. Each item criterion was scored using a five-point semantic-differential scale, a score of "1" provided little or no support, and "5" provided high support for healthy food selection. Items included: menu descriptions; food preparation; healthy foods availability; nutrition information; substitutions; condiments; signage/posters; menu/board labeling; portion/cup sizes; pricing; accessibility; and sustainability. FRESH was pilot-tested with experts/users to improve conceptualization and wording. Data were analyzed using confirmatory factor analysis, inter-class correlations (ICC), and non-parametric statistics. There were 421 dining venues (11.6% DH, 45.8% FF, 36.3% SD, 6.2% delivery) evaluated. Healthfulness of foods subscale (HEFS) included 12 items (α=.813) (total potential points=60) and dining environment supports (DESS) included 10 items (α=.753) (total potential points=50). Five items were eliminated. Average HEFS scores for DH, FF, SD, and delivery; were 42.36±10.40, 20.97±7.33, 21.41±5.22, and 16.92±4.35, respectively. Average DESS scores for DH, FF, SD, and delivery; were 33.14±7.50, 24.44±5.83, 22.77±4.63, and 16.96±4.30, respectively. For high/medium/low healthfulness scores, there was a significant difference between venues for HEFS scores. Of note, 91.8% HEFS and 79.6% DESS of DH had higher scores, whereas SD and FF were more evenly distributed. For the final audit, six items (i.e. portion sizes, substitutions) were revised to an additive score of all applicable categories to better capture the reality/diversity of dining environments.
• The Convenience Store SHELF (Supporting Healthy Environment for Life-promoting Food) Audit. Assessed the supports and healthfulness of foods sold in corner/drug/bodegas/dollar stores. Stores (n=165) were evaluated in 14 states. Seventy percent of stores fell into the least healthy, 22% moderately healthy, and only 8% most healthy. SHELF distinguished the healthfulness of the convenience store environment with less than 10% scoring healthy. The healthiness of a convenience store was most influenced by fruit and vegetable availability. Researchers could suggest healthier options and simple supports for consumers to store owners. Future research should assess a broader range of convenience store locations.
• Awards and Recognition. Team members have received awards at the college, university, state, and national level. Examples of recognition include (but are not limited to) the following. At the college level, members have been recognized for their outstanding advising (Morrell), teaching (Shelnutt), and research (Colby, Kattelmann). Members have been acknowledged at the University level for excellence in research (Kattelmann) public engagement, scholarship and service (Horacek), and ADVANCE career recognition (White). At the state level Extension specialists were awarded for outstanding service and innovative programming (Franzen-Castle, Shelnutt), as well as recognized as an emerging dietetic leader (Franzen-Castle). On the national stage, members received awards from organizations such as: AND for excellence in research (Kattelmann) and innovation in dietetics education (Shelnutt); SNEB for early (Shelnutt) and mid-career (Colby) awards; the American Society for Nutrition for excellence in nutrition education (Byrd-Bredbenner); the National Extension Association of Family and Consumer Sciences for innovation in social networking and internet education technology (Franzen-Castle); the North American Colleges and Teachers of Agriculture for education (Shelnutt); USDA NIFA Partnership Award for Innovation (Shelnutt); and the Association for Communication Excellence in Agriculture, Natural Resources, and Life and Human Sciences for professional skill (Byrd-Bredbenner).
• Tenure, Promotions, and Leadership. The level of performance of the technical committee has resulted in tenure and promotion to associate (Horacek, Franzen-Castle, Shelnutt, Kidd, Laska, Colby), full professor (Kattelmann, Greene, White), and principal lecturer (Morrell). Members have moved into leadership positions, such as, Department Chair/Head (Greene), Assistant Department Chair (Kidd), Didactic Program Director (Kattelmann, Horacek, Phillips), Dietetic Internship Director (Olfert, White, Greene), Graduate Program director/co-director (Kattelmann, Byrd-Bredbenner), Extension Priority Work Group chair/co-chair (Shelnutt, Brown), Division Chair for SNEB (Olfert), and Undergraduate Program Director/Coordinator (Horacek, Morrell) as well as being on the board of editors for peer-reviewed journals (Horacek) in part due to their success with this multistate group.

Milestones:

• October, 2011- September, 2012: New members of the project gained knowledge on the CBPR process of PRECEDE-PROCEED. States continued to work with their participatory research committees. Participating states completed objective 1 to refine the BECS instrument for the assessment of individualized factors associated with eating and exercise behavior. Participating states completed objective 2 to refine and validate the environmental instruments. Data was compiled, analyzed, and grant proposals were developed to fund assessment of additional individual factors as well as the assessment in Year 03. Abstract and manuscript preparation continued.
• October, 2012- September, 2013: States continued to work with their participatory research committees. BECS and environmental assessments reliability and validity studies were finalized. Data was compiled and analyzed, and funding proposals as well as manuscript preparation continued.
• October, 2013- September, 2014: All states participating in the multi-state project conducted an online assessment of individualized factors (n=200 per state) as well as an environmental assessment utilizing instruments for the assessment of individualized and environmental factors. States continued work with their participatory research committees. Data was compiled and analyzed (Objective 3). Results were reviewed and interpreted with community teams, and manuscript and abstract preparation continued. Two grant proposals were submitted, with one being funded through USDA/NIFA/AFRI.
• October, 2014- September, 2015: The Healthy Campus Environmental Audit (HCEA), a series of assessments to determine environmental supports for health promotion and obesity prevention, evaluated cafeteria/restaurants, convenience store, vending, recreation programs/facilities, walkability/bike-ability, and initiatives and policies. The extensiveness of audit implementation was decided by each participating state. The HCEA was used to document, monitor, and advocate for health-facilitating campus environmental and policy supports and changes. Each Audit was composed of approximately 15-25 items, with criterion scored using a five-point semantic-differential scale ranging from limited to extensive healthfulness or environmental support/evidence. Each audit was reviewed by experts, pilot-tested, and had acceptable Inter-rater reliability. Self-administered training tools were provided. Audits were administered via Qualtrics. Campus results and comparative feedback were provided to participating states.
• October, 2015- September, 2016: HCEA validation studies took place for the following areas of interest: cafeteria/restaurants, convenience store, vending, recreation programs/facilities, walkability/bike-ability, and initiatives and policies. The extensiveness of the implementation of this audit validation study was decided by each state participating in the project. Online audits were tested with mobile devices for dining, convenience stores, vending, and walkability/bike-ability. Also, an online survey was administered by 8 to 10 states in the project to assess college student perceptions and behavior. The survey administered was a developmental version of the perceptual dimension of the ongoing survey that will be administered on a regular basis. In addition, to ascertain student perceptions of selected questionnaire items being used in the developmental survey, each participating institution received 15 items for cognitive testing.