Brief Summary of Minutes of Annual Meeting

DAY ONE The interim chair, Madeleine Sigman-Grant, began the meeting by welcoming all attendees. The first order of business was to request a volunteer to record the minutes. Robin Orr volunteered. Administrative Reports ECOP Madeleine presented a report from Linda Fox (representing ECOP) regarding the state of CREATE-21 and new information ABOUT the integration component of NRI grants. CSREES " Susan Welsh (representing CSREES) reported on another new multistate project  NC1028, which is focused on preventing excessive weight gain among college students. It will be using a participatory research approach. " The Presidents budget has called for moving research funds distributed by formula to a more competitive process. The Congress has not been in favor of this change. Support for Multistate Research Fund projects, such as this one, comes through formula funds provided to AES. The impact of a change on these projects is uncertain. " Most multi-state projects involve working together using similar methods to reach the project goals. However, in some projects, individuals and small groups work independently of the entire group and thus, contribute to the project. Part of the intent of these projects is to provide leverage for external funding. Support for a project varies by university. At some universities, Tthe only money athe multistate projects may have is for funding travel. Susan concluded by thanking Madeleine, Beth and Britt Burton-Freeman for helping in the November 2006 writing of W1005 and making this project manageable in the allotted 5-year time frame. " Pleased to have such a diverse group in attendance as many different approaches are needed to address the goals emphasized in the 31.5 NRI  multi-disciplinary behavioral research related to obesity by focusing on family relations; food; and physical activity. AES " Ron Pardini presented a history of this project that emanated from a USDA Western Region summer meeting about ways to integrate research and Extension. " Water quality and obesity were identified as possible integrated topics. " Writing process started in DC with lots of interested research and extension folks attending. An initial proposal was drafted and submitted to RCIC Western region. After being rejected because it was too broad, the proposal was revised and received final approval as a multi- state, multi-disciplinary project that integrates research and extension. " One of the requirements of the project is to file an annual report on NIMSS and to report impact. " Reported on another ECOP activity related to CREATE 21, which is to develop a strategic marketing program for Ag Experiment Stations. This will be done by a subcommittee to reach the goal of increased funding for USDA. " As a follow-up to strategic marketing, Robin made a suggestion to prepare a one-page slick for W-1005 to be used to educate legislators and potential funders about the W1005 project. Review of Underpinnings to W-1005 " Madeleine presented two changes to approaching childhood overweight that support this current project. o One was that a change in our approach from the traditional research informs practice model to one where practice (e.g. Extension) helps to inform research. In particular, Extension is best positioned to help researchers learn which messages families accept or reject regarding feeding and physical activity and why they accept or reject specific messages. Extension educators know about behavior change and can inform research about how to do a better job. o The second concept relates to the whole issue of resilience. There are many ways to define resilience. What we want to learn is if 30% of children are overweight or at risk for overweight, why 70% arent. What do families do that protects their children? One example is family meals. How and why do some families preserve family meals and others not? How do families decide what gets eaten and what doesnt? " There are behaviors in resilient families (where children avoid risky choices such as drugs and alcohol). It is not known if these are the same behaviors that prevent overweight. " Kate added that previous work on positive deviance  very popular in International research  also uses the approach of going to families to learn about how they face adversity. This is an asset-based approach and the direction this project wants to move. " Beth then related that Jim Hill and Rena Wing have gone to those who have lost weight and maintained that loss long term. They asked what these people did, what works, and what doesnt work. This information now is used with others trying to lose weight. " Madeleine then reviewed the W1005 objectives and suggested methodology. o Amy asked for the rationale behind the 4 to 10 year old age-group? o Madeleine shared the following: The writing committee didnt want to get into adolescents, tweens or the toddlers and infant age groups. Children around 4-5 years old are mostly past a lot of picky eating behaviors and are also entering into the adiposity (BMI) rebound stage. o The group then discussed other issues related to the target population. It was decided that the age range should not be too small. " Prior to designing the project, the following need to be considered: o childrens age range; o multiple children in a household; o ethnicity; o school environment; o parent-child interaction; o weight status within families; o situations of adopted and foster children. " We agreed that the study doesnt have to represent the population; rather it needs to focus on results we want to achieve. As we go through eligibility criteria, we will try to think about potential variables and selection criteria and why or why not to include them. " As a multi-state project are we going to find some common measures and methods that all states will use? This is a decision the group needs to make. It will be helpful to use the experiences of other multi-state projects to look at commonalities and differences. Issues of ethnicity and recruitment cant always be controlled. We need to retain overarching protocols while being responsive to individual state needs. Getting Acquainted Activity " Sheets were distributed listing all participants signed into NIMSS and the objectives for which they signed up. Each attendee identified to the group their selected objective(s), which methodologies they have used and a little bit about their past experiences related to the goals, methods and outcomes of W1005. " The group focused on the first four project objectives. A sheet is attached that lists the objective number and the names of those interested in working on them. Furthermore, work experiences and expertise are listed in the roster of participants. Break out groups In order to determine milestones and next steps, two groups were formed to meet the afternoon of Day 1: one for Objectives 1 and 3 (as they are closely tied together) and one for Objective 2. As most of the group was interested in Objective 4, all agreed that we would discuss this objective on Day 2. Prior to breaking, we decided that what we need to leave the meeting with knowing was the yearly milestones for each objective over the 5 year timeline; when and where next meeting will be; and identify potential funding sources. Notes were to be taken for presentation in the morning of Day 2. DAY TWO Defining resiliency " The definition of resiliency was revisited. " The group decided that for now we would leave the term resiliency as undefined, since it can be an outcome measurement, a behavioral process or a framework. We need to learn how different communities define resilient behaviors. Madeleine suggested everyone read Ginsbergs book: Building Resilience: Giving Your Child Roots and Wings; published by the American Academy of Pediatrics. Lily and Shiyong presented a graphic depicting how resilience could be mathematically defined. Table 1. Table 1. Definition of Obesity Resilience 1. Obesity resilience can be viewed as a degree. Its relationship with obesity can be defined as shown in the following figure. 2. While obesity can be defined by a few variables, for example, BMI and fitness, the previous figure looks like as follows 3. When obesity is defined by more than two variables, resilience can still be defined the same way, even though it would be hard to visualize. Note: 1) The value of each variable can be weighted, before being aggregated, to reflect level of importance. 2) These variables can be relative indices, for example, relative BMI (ratio of the child BMI to the average BMI of his family) " Our short-term goal is to build healthy resilient children. " The long-term goal is for these children to become healthy resilient adults. Since this concept is new, it might be beneficial to begin to use it to promote this project, along with overweight and obesity as key words to getting grants. " Robin suggested Introducing the word resiliency into the logo/marketing materials and volunteered to find someone to help with the design. The group came up with the idea that resiliency is a familys abilities to bounce forward in times of crisis. Perhaps we could use the concept of families bouncing forward towards resilient communities as part of the logo. Elections The following were selected by the group as the three members of the coordinating committee for W-1005 for 2006-2007. Terms can be extended to two years. Chair  Madeleine Sigman-Grant Vice-Chair  Beth Olson Recording Secretary  Robin Orr Leaders for each Objective were identified. Karen volunteered to lead Objective 2, Mariah volunteered to lead Objective 4, and Madeleine will be temporary lead on Objective 3. Therefore, volunteers to lead Objectives 1 and 3 are needed. Notes from Objective 1 Group 2007-2009 Objective 1: Conduct an expert field review of key behavioral measures purported to contribute to excessive weight gain in children aged 4-10 years old Members in Attendance NOTE: Shared leadership Madeleine Kaye Kate Leslie Mariah Caroline Amy Robin Beth Kari Steve " The conversation began with the exploration of who would be considered experts to provide a reality check of what works and doesnt work in regards to messages about obesity prevention as well as what is taught or not taught. " A long list was generated that included not only extension personnel, but public health nutritionists, health care providers, WIC, parenting educators and others. After an in-depth discussion, it was decided to accommodate the integrated portion of W1005. " Frontline experts will be EFNEP and FSNE educators, and extension educators at all levels. " Experts will be asked to develop key informants in communities, involved with disseminating overweight prevention messages " Experts will use the card sort (similar to that in Objective 3) listing targeted behaviors " Card sort with directions will be developed by Madeline for objective 3 Output  Validate the targeted behavior list by asking field experts Decisions regarding how this is to be done were not completed. Consideration was given whether we would use a survey or leave to more open-ended. The consensus seemed to be the use of focus group. It was determined that we might recruit for volunteers at SNE (July 2007 or 2008) and ADA (Oct 2007 or 2008) national meetings, as well as during state meeting and trainings. Milestones for Objective 1 " Similar to, and contingent upon, some of the results of the pilot study to be conducted for Objective 3. Notes from Objective 2 (2007-2009) Objective 2: Identify anthropometric and physiological (A/P) measures that could be used to differentiate families within the target population in the community setting Members in Attendance Leader: Karen Bret Annie Karen Kay Rafida Lily Shiyong Siew Sun Susan Ron " This objective should view existing research, protocols, methods etc. through the eyes of educators, e.g. what could be useful as field measures by educators conducting interventions to use to measure impact. " Generated lists of tools to consider for measuring o anthropometrics, o physical fitness and o nutrient/dietary physiological parameters. " The impact of genetic influence was discussed, followed by the generation of assessment tools for behavior (although it was decided that these probably would be needed for use in Objective 3. Anthropometric Measurement Tools Height Weight BMI Somatotyping (body typing, silhouettes, etc.) Circumference (tape measures) Body Composition Skin folds (Subcutaneous Fat) Dexascan (Bone Density) Bio-Impedance Analysis (Bioelectrical Impedance through tissue) UW Weighing (Water Displacement) Bod Pod (Air Displacement) Physical Fitness Physiological Tools Presidents Council on Physical Fitness Test Fitness Tests (strength, endurance, cardio, flex..) Walk Test Step Test Mobile Indirect Calorimeter Direct Calorimeter Nutrient & Dietary Physiological Tools Glucose Test Lipid Panel Vitamin & Mineral Status Genetic Influence The role of genetics may also provide a better definition of the measurement being used to define the child. (For example, also testing the A/P parameters of the childs parents, such as BMI, may provide a clearer picture of the childs individually measured BMI. If both parents have elevated BMIs and are also found to be athletes or exercisers, the childs elevated BMI may not necessarily be an at-risk value.) There are many other similar scenarios. Therefore we are suggesting that not only should A/P measurements be used for the child, but that the mothers BMI might also be considered as part of the childs A/P equation. Additional studies might even suggest an algorithm that defines the entire Healthy Family as a unit, not just the child, through a number of A/P measurements taken on the child and the parents. However, this will require a paired data set. This may also include behavioral parameters as well as A/P parameters. Behavioral Parameters to consider that may Influence A/P Parameters Dietary Intake Assessment 24 Hour Recall (Interview-driven) FFQ (Self-reported) Food Diary Physical Activity Assessment Pedometers Accelerometers Indirect Calorimeter PA Questionnaire (Self-reported or Interview-driven) PA Diary Environmental Influence (family, community, etc&) Milestones & Timeline " MARCH 2007 Define resiliency (possibly even determine a scientific measurement); contact project collaborators not present; assign literature tasks and other experts to involve in the project " JULY 2007 Complete a literature review of widely accepted techniques in epidemiological studies TIMELINES TBD " Suggest recommendations based on the literature review regarding what parameters to use " Determine a parameter(s) or develop an equation of parameters to use within the family context " Develop a feasibility study for ease of use " Write a protocol " Pilot the study " Analyze the data " Write/publish the manuscript *POST SESSION NOTATION* " The need for a working definition of health has also been identified Notes from Objective 3 2007-2010 Objective 3: To assess parent-child interactions in the target population as they relate to key behaviors identified as being associated with resilience to overweight Members in Attendance Madeleine Kaye Kate Leslie Mariah Caroline Amy Robin Siew Sun Beth Kari Steve " Group members discussed milestones and action plans. Madeleine informed the group of an NRI proposal she (and several others in the room) had submitted to CSRESS based on resiliency. Although the proposal was not funded, it received a high rating and encouragement to resubmit. An ensuing conversation resulted in some members of W1005 volunteering to assist with pilot testing interview protocol that would be used for that NRI and for this study. " Discussion ensued around the specifics of the pilot study. This study will provide support for resubmission of above mentioned NRI. The group made the following decisions: " The purpose of the pilot project is to test the use of a card sort with a variety of audiences using an iterative list of suggested behaviors targeted to prevent or reduce childhood overweight. Thus, the outcome will be how well this technique worked. Secondary outcomes will be the caregiver responses. " The cards will contain those behaviors suggested in the current literature as ones to target. Parents will indicate which behaviors they use, why and relate their effectiveness. Start with an open question (What does your family do that works?). " Use of silhouettes will be tested to see how child and caregiver determine weight status of children. " Interview questions and probes will be tested " Madeleine will coordinate the pilot study o Design the cards for caregiver and child o Write the interview protocol o Develop a debriefing form for interviewers to record impressions of the protocol to determine what interviewer needed to do to get the activity effectively completed. Beth will get some forms out on the logistics of how interviews were conducted. o Develop a model IRB form o Train (via videoconferencing) others in using the protocol o Debrief interviewers Pilot study eligibility criteria o Low-income o Primary caregiver (one who makes decision about feeding) o English -speaking Pilot data to be collected o Income and cost of living assessment o Employment status o Weight status of child and caregiver (? Reported or measured) o Age 4-10 (so can determine at what age the child can handle the card sort) o Census track (rural or urban) o Race/Ethnicity  USDA definitions o Age o Family composition o Family health history based on AMA work on health literacy o Caregivers education level o Transportation o Acculturation (length of time in US) Volunteers for pilot study (each state listed below will interview 5 families) Michigan  African American Illinois  urban/rural Latino Alaska  Native Wyoming  rural white Utah  Asian Nebraska  Native American Nevada  rural white and rural Latino New York  whomever is interested South Carolina  Rural south POSTCONFERENCE: Indiana: White rural and black urban Actions for each volunteer state: " Make sure you understand your IRB process, especially in regard to multistate projects. We also could use an external IRB under which everyone works. Beth will share a low-literacy consent form. " Each state will be responsible for transcribing their tapes and collecting interviewer notes to send to Madeleine " Participate in a debriefing phone conference after data collection Milestones for Objectives 3 By February 1. Lit review Begin with the recent reviews: Pat Nelson  University of Delaware website and UC Berkeley  Center for Health & Weight website Establish a website where this can be available to all W1005 members All members will continually update this By February 2. Design website Ron volunteered Robert Morse (UNR) Steve will provide group an example of another multistate project site March 3. Assist with pilot study (see details above) September 4. Write paper describing the process Notes for Objective 4 2007-2010 Objective 4: Determine appropriate tools to effectively measure salient behavioral difference between low-income families in the parent-child relationships identified in Objectives 1 & 2 for the community setting. Leader: Mariah All members attended this discussion " Mariah gave a report on a pilot being conducted at the University of Wyoming with 45 families to measure parents time preference for short term or future rewards. " Researchers gradually increase the long term pay off, as they look at the time preference variable based on the amount of the incentive. They wish to correlate if this strategy works with long term vs. short term planning on food stamp usage. " Their next experiment is a risk assessment  starting with low and moving to high risk as it is associated with tradeoffs and linking with food choices. " Family composition effects how this plays out in really interesting ways. " They will link parenting styles around food and child weight outcomes with negotiation in households to see how different negotiations work for food and non-food items. " This is based on game theory about bargaining in economics - self-centered vs. altruism and social norms. They are working to learn power in relationships. " Mariah has begun to use various tools, including the o CFSQ (Caregivers Feeding Style) developed at Baylor which has questions around TV, physical activity and parenting style. " The term healthogenic was suggested as a positive approach rather than obesogenic which is negative. The question then becomes: How will we put together an interactive list of tools that can be ranked in terms of resiliency in measuring the healthogenic status of a community. Outcome of this objective A menu of tools that start to quantify and qualify resilience constructs, that fit a variety of audiences. Milestones 1. List of available tools, who has used them, and what rationale can be used to relate each tool to obesity prevention/resiliency a. Economics b. Families c. Fitness 2. Testing with audiences in the field 3. Selection of appropriate tools to measure impacts of future interventions Next Meeting The group decided to meet in DC in October 24-26, 2007 with legislative visits to be scheduled. Beth will be handling the meeting details. Since many attendees are planning on going to the SNE annual meeting July 328 through August 1, 2007 in Chicago, a suggestion was made that an ad hoc meeting of W1005 be arranged at the same time. Robin and Madeleine will pursue this. Membership in W1005. In addition to contacting those who signed up as participants for the proposal, we wish to recruit others. Karen will try personally recruiting folks from the ARS labs. Robin will call Jim McColl from Discovery. Kellogg, RWJF and Save The Children US were mentioned as organizations from which we might recruit members. Future Tasks Contact non-attendees to determine their continued interest Work out the dates for the next Annual Meeting Objective groups appoint a lead person Objective groups continue with their tasks Amy will look into setting up the list serve at Purdue Ron will investigate setting up a website at UNR

Accomplishments and Impacts: During this, the first meeting of the project, the leadership team was elected. Groups then formed around each of the first four objectives of the project. Construction of a list serve and web site will be completed by February to ensure project communication. A proposed marketing strategy will include design of a logo and a one-page brochure describing the project. Participants will investigate possible funding sources as the group projects progress. The next meeting was planned for October, 2007 in Washington DC so that participants can explain the project to legislative staff. Each group discussed their goals for the coming year. Focus groups of Cooperative Extension Food and Nutrition Educators will be conducted at the 2007 Society for Nutrition Education Meeting (Group 1). A complete literature review of anthropometric and physiological measures for children will be compiled (Group 2). A pilot test of protocols to help identify what families are currently doing in terms of food and activity decision will be conducted in Michigan; Illinois; Alaska; Wyoming; Utah; Nebraska; Nevada; New York; South Carolina; and Indiana (Group 3). A minimum of 5 families in each state representing multiple ethnicities and races will be interviewed. Results will be used to apply for USDA NRI funds. Group 4 will collect and assess current tools available for determining resiliency.