The Western Maternal and Child Health (MCH) Nutrition Leadership Network (NLN) is an annual conference of public health and nutrition professionals among 13 western states. In February 2019, as part of our training, the trainees of Arizona State University, including myself, had the pleasure of attending the 11th NLN meeting in Redondo Beach, California. Over two days, we attended sessions including updates of federal programs such as SNAP, utilizing PSE (policy, system, environment) concepts in rural communities, a leadership workshop, and more. We also had several networking opportunities in which state leaders discussed accomplishments and challenges specific in their respective states. Five trainees (three from ASU) also had the opportunity to share their research work with conference members.
Throughout these sessions, we discussed topics such as understanding your journey map and ‘why’ for the work you do, building coalitions and partnerships, and how rural and tribal communities experience challenges that might not be experienced among urban communities. For me, discussing my ‘why’ for the work I do has helped to reaffirm my passion for both nutrition and maternal/child health. While we know our fellow trainees and coworkers have a shared goal in our current positions, this activity was the first time I had discussed this topic with my fellow trainees. Understanding unique perspectives will help strengthen our team and identify unprecedented partnerships. I look forward to being able to continue these conversations and begin new ones with trainees from other states at our MCH Nutrition Grantee meeting later in March.
I highly encourage everyone to take a few minutes to ask yourself or someone you work with: what journey has brought you to where you are now? Why do you do the work you do? How might your passion shape your future?
Most, if not all, scientists are familiar with the Nuremberg Code, the Belmont Report, and the famously inhumane experiments that made ethical guidelines for conduct of research necessary (for background information on these topics, please see links at the end of the post). And most, if not all, researchers are familiar with the process of submitting the plan for a study to their local Institutional Review Board (IRB) for approval of ethical treatment of study subjects. However, what about situations in which the ethical course of action is unclear?
One of our most recent discussions as trainees in the ASU program was on research ethics. Our group discussed several case studies with a wide variety of ethical dilemmas, including the best way to obtain parental consent in research involving adolescents; working with populations involved in risky health behaviors; what exactly constitutes appropriate incentives for participating in research; and conducting research with participants that may be untrustworthy of researchers.
Each of the situations we discussed was uniquely complex, with many different angles, yet with each case, there was a point where a decision had to be made. Whether it was to intervene with adolescents taking serious health risks (even though it was an observational study) or allow an incentive to remain unchanged (even though some researchers may argue that it is high enough to be coercive), researchers in each of these situations had to pick a course of action and deal with the consequences. Discussion among the group allowed class members to see issues from various angles and brainstorm solutions that would not have been apparent if a single person was trying to make that decision on their own.
Researchers have the opportunity to work with a wide variety of populations. It is their responsibility to those populations to be not only good scientists, but good ethicists as well. This includes not just ensuring that literature searches, methods, analyses, and conclusions are of high quality, but that reasoning, motives, and contingency plans are also sound. In nearly every case we considered, the ethical dilemma faced would have been greatly reduced by involving someone with relevant expertise in the research process—such as a consulting psychologist or a respected community member who understood local customs. Including the right people in a study can help improve the design and ensure that ethics are sound.
What are some of the ethical dilemmas you have faced in research? How have you overcome them?
Sydney is currently a first year Master’s student in Nutrition and a MCH trainee at Arizona State University’s College of Health Solutions. She received her Bachelor’s in Nutrition (Dietetics) in 2018, also from Arizona State University. In the past, she was a Nutrition Instructor for the City of Tempe, where she taught Nutrition classes to people of all ages, from preschool to retirement age. Currently, she is a research assistant for the School Lunch Study at ASU, where salad bars and marketing materials are put in schools to see if fruit and vegetable consumption are affected. In this blog post, she will describe her thesis research on nutrition marketing and how marketing affects children.
In the US today, 70-90% of students are exposed to some form of food marketing in schools.1 Under the Healthy-Hunger Free Kids Act of 2010 and the “Smart Snacks in School” policy of 2014, participating schools were limited in what they could serve and market to children.2,3 This combined with local district nutrition policies, helped decrease the exposure of high sugar and high calorie foods at schools.2,3 However, current research shows that there has not been a large increase in the consumption of fruits and vegetables even with these new policies enacted.4
While schools are having trouble trying to get children to eat their meals, fast food companies are putting billions of dollars a year into marketing their products.5 When fast food companies market specifically to children, they increase their sales.5 They use bright colors, fun characters and prizes to influence children to want their product.5 One way that fast food companies develop their marketing materials is through interviews and focus groups with their target population.5 By doing this, they can determine exactly what appeals to children and then have their company develop products based on that. Although many successful companies utilize focus groups to help increase their sales, there is currently very little research on how children perceive school nutrition marketing materials
For her thesis, Sydney will be conducting interviews with children in grades 3-12 and determining their opinions on different nutrition marketing materials. The primary goal of her thesis is to determine what children like or dislike about the various marketing materials and if they motivate them to increase their consumption of fruits and vegetables.
Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of Obesity Among Adults and Youth: United States, 2015-2016 Key Findings Data from the National Health and Nutrition Examination Survey.; 2015.
Johnson DB, Podrabsky M, Rocha A, Otten JJ. Effect of the Healthy Hunger-Free Kids Act on the Nutritional Quality of Meals Selected by Students and School Lunch Participation Rates. JAMA Pediatr. 2016;170(1):e153918.
Bourke M, Whittaker PJ, Verma A. Are dietary interventions effective at increasing fruit and vegetable consumption among overweight children? A systematic review. J Epidemiol Community Heal. 2014;68(5):485-490. doi:10.1136/JECH-2013-203238
Harris JL, Marlene Schwartz MB, Munsell CR, et al. Measuring Progress in Nutrition and Marketing to Children and Teens Fast Food FACTS 2013: Measuring Progress in Nutrition and Marketing to Children and Teens.; 2013.
Nestled between businesses and bars around every corner, The Obesity Society’s Annual Meeting took place right in the heart of downtown Nashville, TN. The conference was four-days long with scientists and clinicians from all over the world in attendance. The lecture topics ranged from bariatric surgery and pharmacokinetics to basic science and community- or school-based research. With such diverse experts gathered in one place, it was easy to feel like you didn’t belong. However, the common theme, treatment and prevention of obesity, that brought all of these unique individuals together was apparent. The conference demonstrated that innovations and breakthroughs in obesity science is only the tip of the iceberg if we do not share our ideas and collaborate on projects.
There was a whole section devoted to perinatal and infant obesity research where three speakers presented on early life influences of the infant gut microbiome, the utility of a novel measure of body composition in infants, and behavioral aspects of food preferences impact on child growth. These presentations really stood out to two ASU TRANSCEND trainees who attended the conference. As the trainees continue to learn about maternal child health outcomes, it is critical for them to understand where the field is currently and, perhaps, where the field is going in order to become experts. These trainees also had the opportunity to attend the meeting this year. Here is a little bit about the posters they both presented.
Armando Peña, MS
I presented my poster entitled, Evaluating a Novel Measure of Insulin Sensitivity in Latino Youth. The Matsuda Index is a measure of insulin sensitivity that is formulated from insulin and glucose values collected during an OGTT at 0-, 30-, 60-, 90-, and 120-minutes post-glucose stimulus. The originators of this index came out with a later study deeming it appropriate to estimate the Matsuda Index by only using samples collected at 0- and 120-min. However, this measure has not been compared to the Matsuda Index in a sample of obese Latino youth, which was the objective of the study. In brief, the data suggests that it is an acceptable measure for use in obese Latino youth with prediabetes (defined by a 2-hour OGTT glucose ≥ 140 mg/dl) compared to those without prediabetes. In addition, it is approximately one-third the cost of the Matsuda Index, making it a measure of interest for researchers with funding limitations or those looking to generate preliminary data. Overall, I had a good turnout of visitors to my poster session, with about 8-10 visitors. A majority were pediatric physicians that were interested in the measure since it already follows clinical diabetes screening practice guidelines. It was gratifying to know that most of those who stopped by had seen the program ahead of time and found interest in my poster.
Kiley Vander Wyst, MPH
I presented my poster entitled, Comparison of Prenatal Health Parameters & Nutrition Counseling Among Macrosomic Deliveries. The prevalence of obesity in Arizona is 25.7% among women of childbearing age. Although prenatal nutrition counseling has demonstrated a reduction in gestational weight gain, weight retention, and decrease in pregnancy complications it is seldom done by clinicians due to lack of knowledge and insufficient time. The aim of these retrospective chart review was to evaluate the type of nutritional counseling provided to women who delivered a fetal macrosomic (>4000 grams) infant and compare differences in health outcomes by pre-pregnancy BMI category. Of 2,689 deliveries, 225 resulted in fetal macrosomia, of which 188 were included in the study. Regardless of pre-pregnancy BMI, 59% of women received nutritional counseling (NC). Although, 97% of diabetic women received NC of which 80% met with a Registered Dietitian (RD), only 49% of non-diabetic women received NC, with only 3% meeting with a RD. Of the 41% of women that did not receive NC, 20% were normal weight, 33% were overweight, and 48% were obese prior to pregnancy. Nutrition topics discussed during prenatal visits varied based on pre-pregnancy BMI category; however, healthy foods and snacks, general pregnancy diet information, and carbohydrate counting were the three common topics across all BMI categories. There were no differences in weight-related outcomes among women who received NC. The prevalence of c-sections, diabetes, and hypertension were highest among OB pregnant women. However, OB women had the lowest GWG and smallest 3rd trimester fetal AC but the highest one-hour glucose. Presenting my poster was really fun with several visitors ranging from physician assistants and nurses to physician-scientists and dietitians. It was such a unique experience to talk about my poster to such a diverse group of people!
Despite the weather being wet and cold, the barbecue was delicious and the live music was plentiful. The ASU TRANSCEND trainees had a great time at the Obesity Week conference and plan to attend again next year. Hopefully, we will see the sun at least once in Vegas, unlike in Nashville!
The United States government continues to pour trillions of dollars into the treatment of lifestyle-related diseases while spending only a fraction on programs designed to improve health. Annual spending on nutrition research averages to only $1.5 billion annually, which may like plenty but is almost nothing compared to the over $1 trillion in direct and indirect costs of diet-related diseases in the U.S. each year. To put it into an even smaller context, the U.S. also spends over $5 billion on marketing for candy products.
At the same time, the fate of the USDA’s 2020-2025 Dietary Guidelines for Americans, which will aim to include nutrition needs for pregnant women and young children, hangs in the balance of unpredictable funding and competing industry interests. The Dietary Guidelines Committee is experiencing an onslaught of commentary from entities like the American Beverage Association and the Peanut Institute, who each wish to have their agendas addressed within the Guidelines. While outside funding certainly plays an important role in fueling national nutrition efforts, it is often insufficient and may also come at the cost of a balanced and neutral approach to national nutrition recommendations.
Of the 27 agencies within the National Institutes of Health, not one is focused primarily on nutrition or diet quality. While the U.S. Department of Agriculture (USDA) has been at the forefront of all nutrition-related efforts within the federal agencies, its primary focus continues to be agricultural science and farming practices, and is influenced disproportionately by industry interests as a result. The lack of emphasis on the nutritional factors of health is helping to perpetuate the health consequences of poor diet and health disparities among communities prone to adverse dietary choices due to food insecurity and other socioeconomic factors.
Will a National Institute of Nutrition help to resolve these issues?
The call n for a National Institute of Nutrition and Food Health (NINFH) is spearheaded Dr. Joon Yun, a Salk Institute trustee and partner of a hedge fund who has helped fund millions of dollars into longevity science research. Dr. Yun argues that nutrition research should have a space to operate apart from agricultural research The NINFH would also be responsible for providing research-based, expert opinion to inform programs to improve nutrition and public health. Accomplishments that may be made by the NINFH include bridging the gap between diet and health outcomes, filling the funding gap for nutrition research and programs, keeping human nutrition science separate from agricultural science, and acting as a trusted authority for the public to seek information about optimal nutrition. Dr. Yoon suggests that the NINFH may be proposed in one of two ways: as an additional agency with the National Institutes of Health or as an independent entity, like the National Cancer Institute.
Plus, with the NINFH there is a chance that the Dietary Guidelines for Americans will no longer be in the hands of the USDA and may be more independently created in a more streamlined fashion. Implications for public health nutrition include better data and funding to support community programs like Head Start, WIC, and the Supplemental Nutrition Assistance Program (SNAP), providing better-quality nutrition support for communities in need.
What are your thoughts on a National Institute of Nutrition in the United States?
By: Emily Masek, ASU TRANSCEND Trainee
Emily is a first-year Master’s degree student and dietetic intern at Arizona State University’s College of Health Solutions. She began her nutrition studies at the University of Nevada, Las Vegas, earning a Bachelor’s in nutrition sciences with a minor in kinesiology, and has helped publish two papers about the role of dietary polyphenols in inflammatory diseases. Her current thesis research will involve a pilot study about the effects of a parenting education intervention on the diet quality of Hispanic and Latino adolescents in Phoenix, Arizona.
Kenzie is a first-year master student in Nutrition at the Arizona State University (ASU) College of Health Solutions. Kenzie received her undergraduate degree in Nutritional Sciences with a Dietetics Emphasis from the University of Arizona-Tucson. She began as an MCH Trainee in August 2018 through the ASU TRANSCEND Program. In this blog post she describes her thesis research and work with a family-focused intervention program in the Phoenix Metropolitan area.
Obesity is a major public health concern for adolescents in the United States. According to the CDC, 18.5% of youth in the United States were considered obese in 2015–2016 (NCHS Data Brief, 2017). Rates of adolescent obesity are even higher in many ethnic minority populations, including Hispanics and Non-Hispanic Blacks (NCHS Data Brief, 2017). Current programming for obesity prevention has been unsuccessful in reaching and preventing obesity in ethnic minority populations. In order to understand the complex factors leading to obesity in ethnic youth populations, we must determine links between physical health behaviors such as substance use, sleep, physical activity, and food choices and obesity, while also understanding the role of mental health in obesity prevention.
The Research and Education Advancing Children’s Health Institute at ASU is a multidisciplinary team that developed and implemented an interdisciplinary project called Family Check Up for Health. Family Check Up for Health is based on a previous evidenced-based model called Family Check Up, which focused on a “strengths-based, family-centered intervention” as a foundation to improve family management skills and address child and adolescent adjustment problems. Family Check Up has shown a variety of health benefits for children and adolescents, including lower rates of obesity among individuals receiving the intervention. The next step is to investigate how a similar intervention impacts health behaviors among an ethnically diverse population. Family Check Up for Health utilizes this foundational framework but also aims to address familial support of positive health behaviors to improve obesity among children and adolescents in the Phoenix Metropolitan area.
My thesis project will focus on data from the Family Check Up for Health intervention. The primary objective of my project is to determine whether there is an association between ethnicity and obesity in adolescents in the program. I will also determine the link between health behaviors in adolescents in the program, and their mental health markers including depression and perceived stress. Uncovering these relationships is the first step in developing evidenced-based interventions which will help bridge the gap of health disparities in ethnic minority populations, especially in obesity treatment and prevention. My work in Family Check Up for Health has been very rewarding thus far, as I really enjoy getting to see first-hand how an intervention can transform peoples’ lives. I hope to see this intervention continue to be adopted by healthcare practitioners around the country so that more lives can be improved.