Mountain Scholar
Mountain Scholar is an open access repository service that collects, preserves, and provides access to digitized library collections and other scholarly and creative works from Colorado State University and the University Press of Colorado. It also serves as a dark archive for the Open Textbook Library.
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Recent Submissions
Assessment of nutrition education strategies to reduce cardiovascular disease in U.S. Army hospitals
(Colorado State University. Libraries, 2007) Bukhari, Asma Sultana; Jennifer Anderson, advisor; Kaminski, Karen, committee member; Gould, Susan, committee member
Cardiovascular disease (CVD) continues to be the leading cause of death in the United States with an estimated 79,400,000 adults diagnosed with this disease in 2004 and costs of $431.8 billion projected this year. As a result there is an increased emphasis on early detection and treatment of risk factors. Military personnel are vulnerable to this killer disease due to indulgence in unhealthy behaviors such as cigarette smoking, physical inactivity, poor nutrition, and increased stress. These behaviors can have a profound impact on the military readiness and mission accomplishment. The purpose of this study was to identify strategies to enhance nutrition education provided to the military personnel at US Anny hospitals to manage CVD. The results will be used to identify weaknesses and gaps in an existing program and facilitate improvement of CVD nutrition education. It was hypothesized that nutrition education can be enhanced by aligning the existing CVD management programs with evidenced based guidelines that will provide program consistency. The target audience for this study was Registered Dietitians in clinical leadership positions at U.S Anny hospitals and outpatient clinics. The study was approved by the Colorado State University Human Research Committee and the U.S Anny Medical Research and Material Command Human Research Protection Office. Survey validity was established by obtaining information from a review of literature and feedback from expert Army dietitians and CSU faculty. Survey reliability was established by a test and re-test during a pilot test on a subset of Army dietitians. The responses were analyzed using computer software and reported as mean, standard deviations and frequencies. The survey response rate was 70% (n=21). The primary educators of CVD risk reduction were dietitian. Sixty-two percent of the hospitals provided nutrition education based on current guidelines. The current program was rated either "very good" or "good" by 67% of the dietitians. Eighty-one percent of dietitians experienced variation in the program at their hospitals. Only 24% of the dietitians indicated a mechanism to reach deployed soldiers with hypercholesterolemia. A web-based resource center was selected by 43% of the dietitians followed by 23% who suggested development of a self-paced web-based education program for deployed or remotely located soldiers. Caution is advised while interpreting the results because the findings are based on dietitians' knowledge and opinions and may not have captured all the services offered to the patients. The survey provided insight into current program and suggestions for future program improvements. Cost effectiveness and improved patient satisfaction of medical nutrition therapy by Registered Dietitians is already established. Army dietitians need to take the lead in designing and implementing programs to reduce the CVD risks among military personnel. Such interventions will improve the quality of life of soldiers by providing long term health benefits; and that, in tum, will save resources from reduction in mortality and morbidity associated with CVD events. It is important to explore various communication media for information dissemination.
Development and evaluation of Food friends get movin' with mighty moves™ : a physical activity program to prevent obesity in low-income preschoolers
(Colorado State University. Libraries, 2007) Bellows, Laura Leigh; Jennifer Anderson, advisor; Auld, Garry, committee member; Kennedy, Catherine, committee member; Davies, Patricia, committee member
The prevalence of overweight among preschool-aged children in the United States is increasing at an alarming rate. The preschool years provide an opportunity to establish healthful eating and physical activity behaviors which can lessen the growth of obesity. Unfortunately, preschoolers have been largely ignored when it comes to obesity prevention efforts. The overall objective of this project was to design, develop, and evaluate a physical activity program to compliment the Food Friends ® nutrition program in an effort to prevent overweight in young children. Food Friends Get Movin' with Mighty Moves™ is an 18 week program focusing on gross motor development, physical fitness, and physical activity in the classroom environment. This project utilized the steps of social marketing to develop the Mighty Moves™ program. Further, to enhance the likelihood that behavior change would occur, the Social Learning Theory was embedded within the social marketing framework. The Food Friends Get Movin' with Mighty Moves™ study was a randomized controlled trial of 3- to 5-year old children (n=201) enrolled in 8 Head Start centers in Colorado. On-site measures included height, weight, physical fitness (sit-ups, sit-n-reach, shuttle run, 3-minute run), and gross motor skill (Peabody Developmental Motor Scales) assessments. BMI, BMI z-score and BMI percentiles were calculated. Additionally, physical activity was assessed by pedometers over a 6-day timeframe (4 weekdays and 2 weekend days), and daily step counts were recorded by parents. Characteristics of the study population indicated a high prevalence of overweight, low physical activity levels, and average to below-average motor skills. The intervention did not have an effect on weight status but did improve gross motor skills and fitness levels. Lastly, no difference was found for physical activity by treatment. The success of Mighty Moves™ at increasing gross motor skills and physical fitness in preschoolers, in concert with the Food Friends® program's demonstrated ability to increase children's willingness to try new foods, has contributed to the establishment of healthful behaviors for proper growth and development in the early years. These behaviors serve as foundations to building healthy lifestyles, which may decrease the risk of overweight later in life.
Effectiveness of a Web-based nutrition education program to reduce cardiovascular disease risk among U.S. Army personnel and their families ("Defend your heart" study)
(Colorado State University. Libraries, 2009) Bukhari, Asma Sultana; Jennifer Anderson, advisor; Kaminski, Karen, committee member; Harris, Mary, committee member; Gould, Susa Martin, committee member
Cardiovascular disease (CVD) continues to be the leading cause of mortality and morbidity in the United States. Military personnel are also vulnerable to this killer disease due to indulgence in unhealthy behaviors such as cigarette smoking, physical inactivity, poor nutrition, and high stress. Formative assessment identified a need for web-based resources for the Army registered dietitians (RDs) and for deployed or remotely located military beneficiaries. The purpose of the current study was to create and assess the effectiveness of a web-site "Defend Your Heart". This web-site was targeted to two audiences: RDs and a self care program for the military beneficiaries. This self care program was created using the framework of Rosenstock's Expanded Health Belief Model (EHBM). The effectiveness of a web-based self care program was evaluated using a randomized 4-month study with participants either in the web-based group (n=17) or the usual care (n=13) at a U.S. Army hospital. Data were collected at baseline, two months and four months. Variables measured were anthropometric, blood pressure, lipid profile, fasting glucose, C-reactive protein, nutrient intake, physical activity, and EHBM constructs. Data were analyzed using analysis of covariance and using baseline means to adjust the two and four month data. Results indicated a significant reduction of total blood cholesterol, LDL-cholesterol, predicted body fat percent, and estimated body mass index (P<0.05) in the web-based group. The usual group demonstrated a significant increase in self-efficacy score at month four (p<0.05). Significant within group changes for both groups were demonstrated for the reduction in waist circumference and serum triglycerides (p<0.05). Due to a smaller sample size caution is required while interpreting the results. The results of the web-site usability showed that a majority of the RDs (n=34) and web-based participants (n=8) were satisfied with the content and ease of navigation. RDs and web-based groups suggested enhancing web-site eye appeal, interactivity, and printing capability. Web-based programs may serve as an effective alternate mechanism of delivering CVD risk reduction education. The U.S Army needs to invest in further research to launch an effective web-based program for military beneficiaries to reduce CVD risk factors.
Development and evaluation of a bilingual interactive multimedia computerized food recall
(Colorado State University. Libraries, 2004) Zoellner, Jamie Marie; Jennifer Anderson, advisor; Adams, Liz, committee member; Auld, Gerry, committee member; Middlemist, Dennis, committee member
The objective of this research was to utilize advancements in computer technology to develop and test a bilingual interactive multimedia (IMM) dietary assessment tool. During developmental testing 25 peer-reviewers rated characteristics of the program on a 5-point Likert scale. The mean score of each question received high ratings including introduction/directions helpful (M = 4.5), meal times understandable (M = 4.6), foods easy to identify (M = 3.9), portions easy to identify (M = 4.5), and computer food recall easy to use (M = 4.5). In the final format, the bilingual IMM recall represents a multiple-pass method in which users first report food choices from 167 graphically represented foods. After the development and formative evaluation, the IMM recall underwent comparative validity testing against an interview-administered dietary recall. This study was a two-period cross over design study with repeated measures. Subjects were randomly assigned to complete an IMM recall or interview-administered 24-hour recall first. The interview-administered recall was analyzed using the Food Intake Analysis System (FIRS) and the EFNEP Reporting System (ERS). The effect of substituting standardized portion sizes for reported portion sizes was examined. Of 80 adult Coloradoan participants, 71 (91%) were female, 45 (56%) had ≤12th grade education, 65 (81%) had ≤$15,000 annual income, and 21 (26%) completed the IMM recall in Spanish. Analysis of variance and unadjusted and energy-adjusted correlations were used for analysis. No significant group differences were found for order of administration or demographic characteristics. The only significant method effect found was between the IMM recall and FIRS for vitamin C (P = 0.025). The unadjusted correlations between the IMM recalls and interview-administered recalls analyzed using both FIRS and ERS were generally around 0.6. Energy-adjusted correlations consistently decreased. Substituting standardized portion sizes resulted in significant differences for six nutrients and caused all correlations to drop. Overall, the IMM recall was found to be valid for assessing dietary intake by groups of individuals. This IMM recall has been well received in the peer-review process and attracted the interest of nutrition educators. The results of comparative validity testing and positive reactions received from participants and nutrition educators indicate diet assessment utilizing IMM holds tremendous potential.
Developing and evaluating a website on infant feeding, specifically breastfeeding, for child care providers
(Colorado State University. Libraries, 2006) Clark, Alena Michelle; Jennifer Anderson, advisor; Adams, Elizabeth, committee member; Baker, Susan, committee member; Barrett, Karen, committee member
Research studies have shown that breastfeeding provides a multitude of benefits to infants, mothers and communities. Yet, many women cease breastfeeding before the recommended times. A common reason women cease breastfeeding is because of returning to work or school. Because child care providers often provide care to these infants, further research on the role of child care providers on infant feeding practices, specifically breastfeeding, is warranted. This research project occurred in three phases. First, a needs assessment survey was conducted to determine the knowledge, attitudes, behaviors and training needs of child care providers on infant feeding, specifically breastfeeding, in child care centers. The most appropriate medium to integrate best practice information and provide educational tools to child care providers was also examined. Based on the first phase of this project, a website for child care providers on infant feeding, specifically breastfeeding, was determined to be the desired medium for child care providers. Because no other infant feeding website for child care providers was available, InfaNET Nutrition for Child Care Providers website was developed during the second phase of this project based upon the needs assessment results and facilitated group discussions' feedback. The Social Learning Theory was used as the theoretical framework for the development of the content information on the website. A process evaluation with infant feeding experts, child care providers and web design experts deemed the website ready to be tested. Thirdly, a quasi-experimental research design with a control and intervention group was completed. The target population viewed the website as a well-liked and effective means to provide infant feeding information. Results also showed that between the pre- and post-test intervention, the intervention group had more statistically significant positive changes in attitude and behaviors than the control group. Child care providers already possessed a desirable level of knowledge in regards to storing, preparing and feeding infants' breastmilk and formula, but not in distinguishing hunger cues or introducing solid foods. The behavior and attitude changes were not sustained at follow-up, but results showed there was a non-significant positive trend in knowledge for the intervention group.