Multistate Research Activity
Accomplishments Report
Project/ Activity Number: W1005
Project/ Activity Title:
An Integrated Approach to Prevention of Obesity in High
Risk Families
Period Covered:
October 2006-December 2006
Date of this Report:
January 11, 2007
Annual Meeting Date:
November 26, 2006
Dickin, Kate
Cornell University
Ehmke, Mariah Tanner
University of Wyoming
Garasky, Steve
Iowa State University
Hongu, Kay
The University of Arizona
Idris, Rafida
South Carolina State
University
Krogstrand, Kaye
Stanek
University of NebraskaLincoln
Liang, Lily
University of the District of
Columbia
Lindsay, Anne
University of Nevada
Cooperative Extension
Loesch-Griffin,
Deborah
Turning Point Inc.
Lu, Shiyong
Wayne State University
Luick, Bret
University of Alaska
Fairbanks CES
Mobley, Amy
Purdue University
Morgan, Kari
University of Wyoming
Olson, Beth
Michigan State University
Orr, Robin
University of Illinois
Pardini, Ron
University of Nevada Reno
Shallcross, Leslie
University of Alaska
Fairbanks CES
Sigman-Grant,
Madeleine
University of Nevada
Cooperative Extension
Spears, Karen
University of Nevada Reno
Washburn, Carolyn
Utah State University
Extension
Welsh, Susan
USDA CSREES
Wong, Siew Sun
Utah State University
Brief summary of minutes of annual meeting:
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.
Details for Group Discussion (from draft minutes)
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
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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 doesn’t 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
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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
Body Composition
Weight
Skin folds (Subcutaneous Fat)
BMI
Dexascan (Bone Density)
Somatotyping (body typing,
Bio-Impedance Analysis (Bioelectrical
silhouettes, etc.)
Impedance through tissue)
Circumference (tape measures)
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 child’s parents,
such as BMI, may provide a clearer picture of the child’s individually measured BMI. If
both parents have elevated BMI’s and are also found to be athletes or exercisers, the
child’s 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 mother’s BMI might also be considered as part of the child’s 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
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JULY 2007 Complete a literature review of widely accepted techniques in
epidemiological studies
TIMELINES TBD
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Suggest recommendations based on the literature review regarding what
parameters to use
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Determine a parameter(s) or develop an equation of parameters to use within the
family context
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Develop a feasibility study for ease of use
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Write a protocol
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Pilot the study
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Analyze the data
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Write/publish the manuscript
*POST SESSION NOTATION*
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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.
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Interview questions and probes will be tested
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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 Caregiver’s 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
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Mariah gave a report on a pilot being conducted at the University of Wyoming
with 45 families to measure parent’s 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
Publications:
NA