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CDC Seed Projects - Abstracts

Lisa Casanova, PhD (GSU), and Montreka Dansby, PhD (GSU) and Christine E. Prue, MSPH, Ph.D. (CDC)

Communicating the Risks & Benefits of Raw Produce: Research with Consumers

This project aims to develop qualitative and quantitative information about the health risks and benefits of raw produce, foods that are healthy from a nutrition perspective but also high risk from a food safety perspective. Researchers will engage consumers in a three-step process that will: (1) Determine what the science/evidence says about the risks and benefits of consuming raw produce (from expert elicitation and literature); (2) Characterize audience beliefs about the risks and benefits of consuming raw produce and comparing these beliefs with the findings from the expert elicitation; and (3) Design, evaluate, refine, and re-evaluate communications that bridge critical knowledge gaps and consumer needs. If successful, information will help consumers understand the risks and benefits of consuming raw produce in a manner that develops their mastery of relevant aspects of nutrition and food safety issues and enables them to make effective decisions on their own as well as to evaluate recommendations made by others. A combination of in-depth interviews and focus group discussions will be the primary means for engaging up to 174 consumers living in urban, suburban, and rural communities within a 3-hour driving radius of Atlanta, Georgia. The interviews and focus groups will discuss specific foods identified by CDC as both nutritious but also as high risk from a food safety perspective (e.g., the food-pathogen pairs causing high burden of foodborne illnesses). Two audience segments that are particularly vulnerable to foodborne illnesses according to FoodNet data, have been selected: (1) Mothers of children under 5 years old who purchase and prepare meals for in-home consumption; and (2) Older adults who purchase and prepare meals for in-home consumption. All interactions will be recorded and transcribed for thematic analysis by the research team. Insights gained will be used for message development which will occur iteratively (e.g., audience insights gathered, materials formed and presented to audience, additional insights gathered, materials refined based on insights, etc.). Two rounds of research, development, and refinement are proposed with each audience segment in three types of community settings. The ultimate goal is to effectively communicate the risks and benefits of produce that is typically consumed raw in a manner that encourages Americans to eat healthy foods while also protecting them from foodborne illnesses that these foods can cause when they are contaminated. This project aims to address CDC’s Winnable Battle which promotes policies and behaviors that support healthy food choices and food safety by filling a critical knowledge gap surrounding consumer perceptions and behaviors of the risk and benefits of produce.

Michael Metzler, PhD (GSU) and Seraphine Pitts-Barnes, PhD (CDC)

Establishing a Comprehensive School Physical Activity Program

The prevalence of childhood obesity is well documented in the scientific literature, with 16.9% (Ogden, et al., 2012) of 2-19 year olds being categorized as obese and placing them at increased risk for a number of intermediate and long-term risks for chronic diseases. Healthy eating and regular physical activity are known to play a substantial role in preventing obesity and associated chronic diseases. Many sectors of society have a role to play in addressing physical activity behaviors of youth, but schools have a pivotal role. Schools are essential venues for young people to participate in a significant amount of the recommended 60 minutes of physical activity a day. However, school physical education programs are not adequately designed or resourced to meet that goal for the majority of children. To complement the physical activity provided in physical education, NASPE has developed and promotes the concept of a Comprehensive School Physical Activity Program (CSPAP) that includes: physical education as the cornerstone, physical activity during school, physical activity in before- or after-school programs, staff involvement, and parent and community involvement. The purpose of this study is to establish a two-year pilot CSPAP in an urban middle school and conduct in-depth analysis of its design, implementation, feasibility and efficacy in achieving a series of outcomes such as expanded teacher expertise, increased youth physical activity, increased parental knowledge and involvement, and an overall improved school environment.

Julie Swann, Ph.D. (Georgia Tech) and Stephen Onufrak, Ph.D. (CDC)

Approaches for Estimating Small-Area Prevalence of Pediatric Obesity for Improved Interventions

Goals and objectives:
Pediatric obesity has tripled in the last three decades in the United States. Targeted interventions could help, but traditional survey and surveillance approaches to map baseline prevalence are costly and inefficient. Our goals are first, to compare small-area estimation models for pediatric obesity that CDC and Georgia Tech (GT) have recently developed, to each other, to state level data from other sources, and county data from school examinations in Arkansas. Second, to improve approaches by the addition of geocoded data on correlated conditions or environmental factors. Third, to use the best models and small-area estimates to guide recommendations on targeted interventions for pediatric obesity.

Collaborative nature of the project:
Previously, a team from the CDC developed multilevel models for estimating prevalence of pediatric at the census block group level based on survey data from the National Survey of Children’s Health (NSCH). A team from Georgia Tech developed an alternative approach using logistic regression, examination data in the National Health and Nutrition Examination Survey (NHANES), and simulation of virtual populations from the Census. We combine the knowledge developed by both teams, validating and improving approaches for small-area prevalence estimation. The collaboration is based in statistics, epidemiology, public health, and engineering, and will be enabled by a student internship at the CDC.

Projected outcome:
A validated small-area estimation model for pediatric obesity that can be used across the U.S. to guide interventions. Research will result in publications and submissions for external funding from NIH, foundations, or others, and it can be potentially extended to other diseases.

Cushing Weigle, Ph.D. (GSU) and Judith A. McDivitt, Ph.D (CDC)

Identifying and Reducing Linguistic Barriers to Comprehension among Limited English Proficient Diabetes Patients in Healthcare Interactions

The goal of this research is to identify specific oral and written linguistic barriers in effectively communicating to limited-English proficient (LEP) diabetes patients and to reduce those barriers through improving written health-related materials and materials for training health care professionals who interact with LEP patients. Results of the study will provide information to the Grady Diabetes Clinic for improving written and oral health communication to patients and to the National Diabetes Education Program for increasing the usability of its nationally-available resources. This study addresses the Winnable Battle area of Nutrition, Physical Activity, and Obesity. LEP patients make up a significant and rising percentage of the population with limited health literacy, particularly in urban areas such as Atlanta. Addressing the communication needs of this population is a critical component of increasing health literacy and thus improving health outcomes in the general population. We propose to collect two language datasets (one from written materials and one from audiotaped oral interactions) to allow for analysis, identification and generalization from real world linguistic interactions. Additionally, health care professionals and LEP diabetes patients will participate in individual and focus group research to identify perceptions of challenges and difficulty of materials used. Based on this information, patient materials will be revised and training materials for health care professionals will be drafted. These revised materials will be evaluated for ease of communication by health care providers and patients. The researchers intend to seek additional funding to evaluate the impact of these revised materials on patient weight loss, average blood glucose control levels (A1C), and self-efficacy in an inner city diabetes clinic with a significant LEP population.

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