Building a Diverse Workforce and Thinkforce to Reduce Health Disparities

The Research Centers in Minority Institutions (RCMI) Program was congressionally mandated in 1985 to build research capacity at institutions that currently and historically recruit, train, and award doctorate degrees in the health professions and health-related sciences, primarily to individuals from underrepresented and minority populations. RCMI grantees share similar infrastructure needs and institutional goals. Of particular importance is the professional development of multidisciplinary teams of academic and community scholars (the "workforce") and the harnessing of the heterogeneity of thought (the "thinkforce") to reduce health disparities. The purpose of this report is to summarize the presentations and discussion at the RCMI Investigator Development Core (IDC) Workshop, held in conjunction with the RCMI Program National Conference in Bethesda, Maryland, in December 2019. The RCMI IDC Directors provided information about their professional development activities and Pilot Projects Programs and discussed barriers identified by new and early-stage investigators that limit effective career development, as well as potential solutions to overcome such obstacles. This report also proposes potential alignments of professional development activities, targeted goals and common metrics to track productivity and success.

What Happens When Parents and Children Go Grocery Shopping? An Observational Study of Latino Dyads in Southern California, USA

The objective of this study was to observe parent-child interactions in tiendas, limited assortment food stores catering to Latinos in the United States, and to examine the extent to which child involvement influenced these interactions and their purchase outcomes. Two confederates, one posing as a tienda employee and one posing as a customer, observed the entire shopping trip of 100 Latino parent-child (mean age = 8 years) dyads and coded the following: number and type of parent- and child-initiated request interactions, types of purchase influence attempts used by children and how parents responded, and whether the product was purchased. Level of child involvement was examined as a potential influencing factor on purchasing. The observations were relatively short (mean duration of 10 minutes), reflecting the "quick trip" nature of the observed shopping trips. From the 100 parent-child dyads, 144 request interactions were observed, and among dyads with at least 1 request interaction during the shopping trip, the average number of request interactions per dyad was 2. Children initiated most of the request interactions by asking for a product or simply placing it in the basket; parents initiated 24% of the request interactions. Child involvement in shopping and checkout were associated with spending and purchase outcomes. These results indicate that children and parents influence each other during grocery shopping, and children who are more involved have greater influence over purchases. Furthermore, this study identified a number of targets for future family/parent and consumer food environment interventions.

Energy balance in adolescent girls: the trial of activity for adolescent girls cohort

OBJECTIVES

To study correlates of change in BMI percentile and body fat among adolescent girls.

METHODS

A longitudinal prospective study following 265 girls from the Trial of Activity for Adolescent Girls (TAAG) cohort measured in 8th grade and during 10 and 11th grade or 11th and 12th grade. Twice during 2009-2011 girls wore an accelerometer and completed a food frequency questionnaire and 7-day diary documenting trips and food eaten away from home and school. Physical activity, BMI, and percent body fat were objectively measured at each time point.

RESULTS

Moderate to vigorous physical activity (MVPA) declined, but the change was not independently associated with changes in BMI percentile. Increased vigorous physical activity was associated with reductions in body fat. Diet was associated with both changes in BMI percentile and body fat. Girls who increased the percentage of caloric intake from snacks and desserts reduced their BMI percentile and body fat.

CONCLUSIONS

Some relationships between energy balance behaviors and BMI and body composition were counter-intuitive. While it is plausible that vigorous physical activity would result in reductions of body fat, until more accurate methods are devised to measure diet, the precise contribution of dietary composition to health will be difficult to assess.

Abstract A56: The role of food distributors within small stores in San Diego, CA, and produce purchasing behavior among Latino grocery shoppers

Limited research has been conducted to examine the role and impact of produce and non-produce food distributors within small stores. Dietary intake is an important determinant of risk for obesity and cancer (American Cancer Society, 2009). Improving the food environment of small stores by incorporating fresh produce into their retail environment is an important step in creating an equitable food system. Lack of access to healthy food disproportionately impacts racially/ethnically diverse, low-income populations, such as Latinos, and lead to obesity disparities with the United States (Lindsay, Sussner, Greaney, & Peterson, 2008). Without access to healthy and affordable produce, residents cannot meet the recommended servings of fruits and vegetables a day set by the U.S. Department of Agriculture (Freuhaft & Karpyn, 2010). Understanding the role of food distributors within small stores may help to increase both the access and sales of affordable, fresh produce among Latinos in urban communities. As part of a larger NIH-funded study, El Valor de Nuestra Salud (The Value of Our Health), structured interviews were conducted with small store owners/managers, employees, and customers in San Diego, California. Interviews were coded to understand the marketing tactics of produce and non-produce distributors, their impact on food selection and display, as well as their overall relationship with and influence upon small stores. Interviews were also coded to determine how a food distributor's presence within a store affects the purchasing of fresh produce among Latino customers. Preliminary analyses revealed the use of strong tactics by distributors, such as store owner incentive programs and customer-directed marketing strategies, to encourage the sale of unhealthy, non-produce items within small stores. Preliminary analyses also documented the role food distributors play in developing a supportive relationship with small store owners while also portraying a negative view of farmers and other produce distributors, further preventing the development of additional food distribution relationships. Understanding the food distribution system in San Diego is critical for promoting fruit and vegetable consumption among Latinos. Food distributors play an important role in structuring the food system and that role needs to be considered in the creation of future interventions. Further research on the food distributor-small store relationship needs to be conducted in order to effectively change the food retail environment in urban communities.

Citation Format: Jennifer C. Sanchez, Julie Pickrel, Guadalupe X. Ayala. The role of food distributors within small stores in San Diego, CA, and produce purchasing behavior among Latino grocery shoppers. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A56.

Adolescent girls' most common source of junk food away from home

Contextual factors associated with adolescent girls' dietary behaviors could inform future interventions to improve diet. High school girls completed a 7-day diary, recording all trips made. In places other than home or school they recorded the food eaten. Girls made an average of 11.4 trips per week other than to home or school. Snacks high in solid oils, fats and added sugars (SOFAS) were frequently consumed. Girls reported eating an average of 3.5 servings per week of snacks high in SOFAS at someone else's house compared to 3.0 servings per week at retail food outlets. Findings demonstrate that low nutrient foods are ubiquitous and efforts should be made to reduce their availability in multiple settings.

Process evaluation results from a school- and community-linked intervention: the Trial of Activity for Adolescent Girls (TAAG)

Process evaluation is a component of intervention research that evaluates whether interventions are delivered and received as intended. Here, we describe the process evaluation results for the Trial of Activity for Adolescent Girls (TAAG) intervention. The intervention consisted of four synergistic components designed to provide supportive school- and community-linked environments to prevent the decline in physical activity in adolescent girls. Process evaluation results indicate that the intervention components were delivered from intervention staff to teachers with high fidelity (84-97%) to the protocol and with lower fidelity (range: 18-93%) from teachers to students. Physical activity programs for girls, a unique feature of the TAAG intervention, increased from a mean of 10 programs per school to a mean of 16 and 15 in years 1 and 2, respectively, in intervention schools, with no change in control schools. These findings suggest that a multicomponent school- and community-based physical activity intervention can be delivered with fidelity and result in a middle school environment that supports physical activity for girls.

Formative research in school and community-based health programs and studies: "state of the art" and the TAAG approach

Formative research uses qualitative and quantitative methods to provide information for researchers to plan intervention programs. Gaps in the formative research literature include how to define goals, implementation plans, and research questions; select methods; analyze data; and develop interventions. The National Heart, Lung, and Blood Institute funded the Trial of Activity for Adolescent Girls (TAAG), a randomized, multicenter field trial, to reduce the decline in physical activity in adolescent girls. The goals of the TAAG formative research are to (a) describe study communities and schools, (b) help design the trial's interventions, (c) develop effective recruitment and retention strategies, and (d) design evaluation instruments. To meet these goals, a variety of methods, including telephone interviews, surveys and checklists, semistructured interviews, and focus group discussions, are employed. The purpose, method of development, and analyses are explained for each method.

Using school-level interviews to develop a Multisite PE intervention program

The Trial of Activity for Adolescent Girls (TAAG) is a randomized, multicenter field trial in middle schools that aims to reduce the decline of physical activity in adolescent girls. To inform the development of the TAAG intervention, two phases of formative research are conducted to gain information on school structure and environment and on the conduct of physical education classes. Principals and designated staff at 64 eligible middle schools were interviewed using the School Survey during Phase 1. The following year (Phase 2), physical education department heads of the 36 schools selected into TAAG were interviewed. Responses were examined to design a standardized, multicomponent physical activity intervention for six regions of the United States. This article describes the contribution of formative research to the development of the physical education intervention component and summarizes the alignment of current school policies and practices with national and state standards.

Validation of bioelectrical impedance analysis (BIA) for estimation of body composition in Black, White and Hispanic adolescent girls

AIM: Equations for estimating % fat mass (%BF) and fat-free mass (FFM) from bioelectrical impedance analysis (BIA) that work in adolescent girls from different racial/ethnic backgrounds are not available. We investigated whether race/ethnicity influences estimation of body composition in adolescent girls. PRINCIPAL PROCEDURES: Prediction equations were developed for estimating FFM and %BF from BIA in 166 girls, 10-15 years old, consisting of 51 Black (B), 45 non-Black Hispanic (H), 55 non-Hispanic White (W) and 15 mixed (M) race/ethnicity girls, using dual energy x-ray absorptiometry (DXA) as the criterion method. FINDINGS: Black girls had similar %BF compared to other groups, yet were heavier per unit of height according to body mass index (BMI: kg.m(-2)) due to significantly greater FFM. BIA resistance index, age, weight and race/ethnicity were all significant predictors of FFM (R(2) = 0.92, SEE = 1.81 kg). Standardized regression coefficients showed resistance index (0.63) and weight (0.34) were the most important predictors of FFM. Errors in %BF (~2%) and FFM (~1.0 kg) were greater when race/ethnicity was not included in the equation, particularly in Black girls. We conclude the BIA-composition relationship in adolescent girls is influenced by race, and consequently have developed new BIA equations for adolescent girls for predicting FFM and %BF.

Comparison of two bioelectrical impedance analysis instruments for determining body composition in adolescent girls

The purpose of this study was to compare fat-free mass (FFM) and percent body fat determined by two bio-electrical impedance analysis (BIA) instruments against criterion estimates determined by dual-energy x-ray absorptiometry (DXA) in a multi-racial/ethnic sample of adolescent girls. BIA was assessed in 151 girls (n=51 African-American; n=45 Hispanic; n=55 Caucasian; age 12.2 +/- 1.2 yr) using the RJL Quantum II and the American Weights and Measures Body-Comp Scale (BCS). Percent body fat determined by BIA was significantly related to that determined by DXA (R(2)=0.87, SEE=2.8% for RJL vs DXA, P<0.0001; R(2)=0.71, SEE=4.4% for BCS vs DXA, P<0.0001). The agreement between DXA and BIA for FFM was also significant (R(2)=0.91, SEE=0.03 kg for RJL, P <0.0001; R(2)=0.79, SEE=0.04 kg for BCS, P <0.0001). The BCS overestimated FFM by 2.7 kg (P<0.0001) and underestimated percent body fat by over 4% (P<0.001). There were no differences in percent body fat between DXA and the RJL, and although the RJL significantly overestimated FFM, the absolute difference was <1 kg. Within each ethnic group, the RJL instrument more closely estimated FFM and percent body fat than did the BCS. Although both BIA instruments compared favorably with DXA, the RJL had better stability and accuracy than the BCS, for both the total sample and for the three ethnic groups. Considering its relatively low cost and minimal time required for technical training, BIA is a useful and appropriate technique for assessing body composition in adolescent girls.