Master of Public Health / Public Health Interdepartmental Program / Tandalayo Kidd / Heart disease, cancer, stroke, and diabetes are the leading causes of death in the United States. In addition, the prevalence of obesity has significantly increased since the 1970s. In Kansas, 37% of adults are overweight and 24% are obese. These chronic diseases and conditions tend to be prevented by and/or managed with both adequate physical activity and a healthy diet rich in fruits, vegetables, and whole grains. In Kansas 48.5% of adults meet the current recommendations for physical activity set by the American Heart Association, while 20% of adults consume the recommended amounts of fruits and vegetables. Public health officials need to work together to encourage Kansas adults to increase their participation in physical activity and consumption of fruits and vegetables to help prevent future health problems or manage current chronic diseases. To help address these health issues in Kansas, Kansas State University Research and Extension developed the 8-week Kansans Move into Health nutrition and physical activity program, building its framework around the Theory of Planned Behavior (TPB). Using TPB, participants address attitudes and perceived norms as well as perform specific behaviors associated with healthy eating and physical activity. The purpose of this study was to evaluate the effectiveness of condensing the 8-week nutrition and physical activity program into four one-hour classes using a pre- and post-survey. Nineteen participants from the Johnson County community signed up to participate with 63% (n=12) completing the program. Results indicated that participants changed their belief that nutritious foods are more expensive (p≤0.05). Furthermore, participants gained knowledge in how to prepare healthy snacks that are quick and easy. All other measures did not change (n=19; p>0.05). Future research evaluating longer program interventions could better assess attitudes and perceived norms associated with healthy behaviors and determine whether the increase in knowledge leads to behavior change.

Doctor of Philosophy / Department of Human Nutrition / David A. Dzewaltowski / Consumption of fruits and vegetables (FV) contributes to healthy growth and development among youth. For effective intervention development, an understanding of the underlying casual influences on consumption is needed. The current dissertation is intended to identify whether influences on youth fruit and vegetable consumption (FVC) vary by age, gender, ethnicity and socioeconomic status (SES). The series of four chapters focus on self-efficacy for FVC and proxy efficacy to influence other adults to provide supportive FV environments. Chapter One reviews studies examining the influences on youth FVC. Consistently across studies, FV preferences and FV availability influenced youth FVC. Chapter Two and Chapter Three report studies documenting that children's confidence (proxy efficacy) to influence parents to make FV available and to influence other adults (after-school staff) to make FV available are independent but related constructs to self-efficacy to eat fruits and self-efficacy to eat vegetables. Differences were found in these constructs according to school demographic variables and youth demographic variables. Chapter Two reports that youth attending elementary schools with lower concentrations of racial/ethnic diversity and higher concentrations of high SES were more confident in influencing their parents to make FV available than youth attending schools with higher concentrations of racial/ethnic diversity and higher concentrations of low SES. Although analyses of cross sectional data collected on elementary-aged youth presented in Chapter 3 showed no demographic differences at the school level, Chapter Four examined longitudinal data across sixth-, seventh- and eighth-grade and found demographic differences using youth level variables. Across the middle school years, youth declined in proxy efficacy and racial/ethnic minority youth declined at a significantly faster rate than white youth. Each year, male and lower SES youth were significantly lower in proxy efficacy than females and higher SES youth, respectively. Thus, school or youth demographic differences in self-efficacy and proxy efficacy may contribute to the understanding of why males and lower SES youth eat less FV than females and higher SES youth.

Doctor of Philosophy / Department of Human Nutrition / David A. Dzewaltowski / The prevalence of obesity within the U.S. has risen dramatically in the past thirty years. Recent changes in food and physical activity environments may contribute to increased obesity prevalence, suggesting that disparities in these environments may be linked to the increased risk of obesity observed in low-income, and racial/ethnic minority women. This dissertation characterizes the local food environment experienced by low-income women who participate in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Kansas, evaluates whether characteristics of the local food environment contribute to obesity risk, and examines how these relationships vary across the urban-rural continuum. Chapter One reviews the relevant literature examining the association between obesity and local food environments, and identifies three testable hypotheses that serve as the framework for later chapters. Chapter Two characterizes the local food environment and examines geographic, racial, ethnic, and socioeconomic disparities in the availability of small grocery stores and supermarkets. Chapter Three examines the association between store availability and obesity risk at an individual level among participants in the WIC Program, while Chapter Four utilizes multi-level modeling to examine the relationships between tract deprivation, tract store availability and body mass index (BMI). Significant geographic disparities were observed in the availability of small grocery and supermarkets. Racial and ethnic disparities observed within tracts were not observed when examining store availability in a 1-mile radius around the residence of WIC mothers. The majority of women participating in the WIC program resided within a 1-mile radius of a small grocery store, and micropolitan and metropolitan WIC mothers had a multiplicity of food stores available within a 3-mile radius of residence. Food store availability was associated with increased obesity risk only in micropolitan areas. The availability of food stores did not mediate the association between tract deprivation and BMI, which varied across the urban-rural continuum. Overall, these results suggest that the relationship between local food environments and eating behaviors is complex, that limited store availability does not contribute to increased obesity risk in vulnerable populations, and that the association between local food environments and obesity risk varies across the urban-rural continuum.

Doctor of Philosophy / Department of Human Nutrition / Craig A. Harms / The overall aim of this dissertation was to ascertain the influences of lifestyle factors on airway health in children and young adults. In Study 1 (Chapter 2) the effect of a high-fat meal on airway inflammation and hyper-responsiveness was examined. Results revealed a post-prandial increase (p<0.05) in total cholesterol (~4%), triglycerides (~93%), and exhaled nitric oxide (a marker of airway inflammation, ~19%) two-hours following a high-fat meal (74.2±4.1g fat). These novel findings suggest that a high-fat meal may contribute to impaired airway function. In study 2 (Chapter 3) we assessed the role of body fat and physical activity (PA) on airway health in prepubescent children. This study revealed that children with higher-body-fat levels (>21%), who were not meeting current PA recommendations, experienced greater (p<0.05) amounts of post-exercise airway narrowing (FEV1, forced expiratory volume in 1-second, ~11%), as compared to children with lower-body-fat (<21%), who were meeting PA guidelines. These findings suggest that elevated adiposity and low PA levels may place children at risk for development of asthma and asthma-like symptoms. In study 3 (Chapter 4), based on study 2 results, we assessed the impact of 8 weeks of high-intensity interval training on airway health in children who were not meeting PA guidelines. We determined that high-intensity training significantly increased V02max (~24%), and decreased total cholesterol (~11%) and LDL cholesterol (~35%). Additionally, we found improvements (p<0.05) in ∆FEV1 both post-exercise (pre: -7.6±2.2%, post: -1.3±1.8%) and post-eucapnic voluntary hyperventilation (pre: -6.7±2.2%, post: -1.4±1.5%) with training. Further, Lower-body-fat and higher V02max subjects experienced significantly greater improvement in ∆FEV1 following training than higher-body-fat and lower V02max subjects (r=-0.80, r=0.73, respectively). These results suggest that in children, high-intensity training can ameliorate the negative health consequences of inactivity. However, increased body fat, and low V02max levels may constrain these improvements. This series of studies underscores the importance of dietary habits, body composition, and PA for airway health in children and young adults. These findings may be useful in determining policies and practices impacting children’s health, and could facilitate protocol development for prevention of asthma-like symptoms.

Master of Public Health / Department of Human Nutrition / Sandra B. Procter / HIV/AIDS is one of the most devastating health concerns of the developing world, especially in sub-Saharan Africa (SSA). To address individual food insecurity and malnutrition, numerous small-scale nutrition and agriculture interventions have been implemented. This study compared the CTC Community Garden Project in Maai Mahiu, Kenya (n=15) and the HelpMercy Nutrition and Food Security Project (seed distribution) in Macha, Zambia (n=64), after one year. Study objectives included assessing food security in Maai Mahiu, determining beneficiaries' perceived usefulness of the interventions, comparing and evaluating the interventions, determining the importance of education in the interventions, and making recommendations for improvement. A survey in Maai Mahiu used a modified FAST tool to determine food security for beneficiaries (n=15) and non-participants (n=50). The majority of respondents were determined food insecure (without hunger), indicating a need for improved access to food/land. To determine outcomes and make comparisons, intervention outcome and beneficiary 'perceived usefulness' were measured using two verbally administered surveys, two focus groups, and two interviews with translation. Qualitative and quantitative results demonstrated differences between beneficiary perceptions of the interventions. No association was observed between perceived usefulness of the two studies (χ2). A backward elimination logistic regression model of the HelpMercy intervention showed that attendance at community-based nutrition and agriculture education sessions (CBES), household size, and number of seed types planted were predictors of perceived usefulness. Households who attended at least one CBES were more likely to perceive the intervention as useful (χ2 for trend, p=0.007), and there was a linear relationship between number of CBES attended and perceived usefulness (Mann-Whitney, p=0.008). Results may support research that agriculture interventions are more effective when combined with nutrition education. Perceived barriers and benefits differed significantly between the two programs. 60.3% of HelpMercy beneficiaries and 40.0% of CTC beneficiaries perceived the interventions as useful. Program improvements are possible, and further research is needed to better understand the impact and potential benefits of small-scale nutrition and agriculture interventions for HIV-affected populations in SSA.

Master of Public Health / Department of Human Nutrition / Mary L. Higgins / Nutrition education programs strive to help low-income people make optimal food choices while living on a limited budget. This study addressed perceived understanding, acceptance, and usability of Food and Nutrition Bytes, a set of 12 eight- to eleven-minute online Expanded Food and Nutrition Education Program (EFNEP) lessons. Clients in EFNEP during 2005-2006 were surveyed on internet usage and interest in online nutrition lessons. Lessons were developed and assessed for reading levels using two formulas. Clients and professionals in six Kansas counties completed a Likert scale survey and gave comments after they viewed one online lesson. Fifty-five percent of 75 EFNEP clients who had internet access indicated they were interested in taking nutrition lessons online. The new lessons averaged a 6.64 grade reading level. Two lessons had content that was rated too general to be useful. For the remaining lessons, both groups ranked their perceived understanding, helpfulness of graphics and audio, and usefulness of information at the first or second most-desirable rating. They rated length and amount of information as “Just Right.” The only difference found between the groups was when clients rated one lesson as having a little too much information and professionals rated it as having not quite enough (Mann-Whitney U = 35.0, p = 0.039). Within-sample associations were measured for two lessons. Clients older than 30 years of age found the Grains lesson’s pictures and graphics to be more helpful than did younger clients (Kendall tau-b = 0.593, p = 0.002). White clients evaluated the Cooking lesson as being easier to understand than did non-white clients (Kendall tau-b = -0.477, p = 0.020). The most frequent comments pertained to the importance of portion sizes and appropriate pictures and graphics. Overall, Food and Nutrition Bytes lessons were easy to read, and perceived by both clients and professionals to be easy to understand, helpful and useful, and also optimal in length and amount of information. Despite low numbers of EFNEP clients who had internet access, over half were interested in taking lessons online. Limitations of this study include small samples, convenience samples, subjects’ time constraints, and interviewer bias.

Master of Science / Food Science Institute / Delores H. Chambers / The challenge with reduced sodium foods is finding a suitable sodium replacement that delivers a salty flavor without extraneous off flavors. Potassium chloride (KCl), a commonly used salt replacer, when used in conjunction with sodium chloride, can be perceived as salty; however to some people, KCl tastes bitter or metallic. The hypothesis for this research was the belief that a majority of people do not describe the flavors associated with KCl as bitter, metallic, or other possible negative terms. The objectives were 1) To determine the impact of KCl addition on the saltiness, bitterness, and other sensory characteristics in model soup systems using a trained descriptive analysis panel and 2) To determine what words are most frequently chosen by consumers to describe flavors associated with KCl. There were two studies conducted; 1) The first study examined the basic taste intensities in samples with varying levels (19%-41%) of total sodium ions and samples with a set total sodium ion level (19%) and varying levels of KCl (0%-0.75%) in model soup systems in order to understand the potential interaction of KCl on the perceived saltiness of NaCl. The degree to which KCl can be used in reducing total sodium ion levels without adversely affecting the basic taste sensory properties was also examined. Panelists evaluated the samples using the Sensory Spectrum® method. Salt, sour, bitter, umami, and metallic attributes were rated for chicken broth. Salt, sweet, sour, and bitter attributes were rated for tomato soup. 2) The second study examined the consumer language used to describe the flavors associated with KCl when used in a reduced sodium model soup system. Focus group participants generated the initial list of flavor descriptors for high (0.75%) KCl levels in chicken broth. A larger consumer study was conducted with subjects pre-screened for sensitivity to KCl Consumers were given reduced sodium chicken broth or tomato soup without KCl and another sample with 0.45% KCl, labelled Flavor A. Subjects then chose all of the descriptors from a pre-selected list that describe Flavor A, the flavors associated with KCl. Comparisons in language descriptor selection were made among ethnic groups (African American, Hispanic, Caucasian, and Asian), gender, and age groups. As an example, among ethnic groups, for chicken broth, Hispanics chose the salty descriptor less frequently than the other ethnic groups, whereas Asians chose the salty descriptor more frequently than the other ethnic groups. The trained descriptive analysis panel did not find an increase in bitterness perception as KCl levels increased. Consumers frequently selected characterizing flavor terms to describe flavors associated with KCl and rarely selected bitterness, metallic or other potentially negative terms to describe KCl flavor. The significance of these findings is that there may be a higher potential for sodium reduction in the food industry using KCl as a sodium ion replacer.

Master of Science / Department of Human Nutrition / Denis M. Medeiros / Copper deficiency has been linked with many health problems, among them cardiac hypertrophy. Because of its potential for causing oxidative damage, copper within the cell must be bound to chaperone proteins. In this thesis, we examined the role of dietary copper deficiency in the regulation of select copper chaperone proteins in cardiac tissue of rats. Sixteen weanling male Long-Evans rats were randomized into treatment groups, one group receiving a copper deficient diet (< 1 mg Cu/kg diet) and one group receiving a diet containing adequate copper (6 mg Cu/kg diet) for 5 weeks. Rats were sacrificed and a small blood sample was removed to determine hematocrit. Also, heart and liver tissues were removed for subsequent analysis. Rats fed the copper deficient diet had lower body weights but greater heart weights and heart:body weight. Hematocrit levels and liver copper concentrations were markedly decreased in copper deficient rats. These variables indicated that the copper deficient diet did in fact induce a copper deficiency in these animals. Non-myofibrillar proteins from the hearts were removed and separated by SDS-PAGE. Western Blotting was used to determine the concentrations of CTR1, CCS, Cox17, SCO1, Cox1 and Cox4. No changes were observed in the concentrations of CTR1 and Cox17. CCS and SCO1 were up-regulated as a result of copper deficiency, while Cox1 and Cox4 were both down-regulated. However, use of another antibody against Cox subunits suggested that only the nuclear encoded subunits including subunit IV were decreased, but not subunits I and II. These data provide new insight into the cardiac hypertrophy observed in copper deficiency, which suggests that select chaperone proteins may be up-regulated by a dietary copper deficiency.

Master of Science / Department of Animal Sciences and Industry / Evan C. Titgemeyer / Two experiments analyzed effects of zilpaterol-HCl and nitrogen supplementation in the form of either dried distiller’s grains with solubles (DDGS) or urea fed to steers. In Experiment 1, steers were fed corn-based diets: control (CON; 10.2% CP), urea (UREA; 13.3% CP), or DDGS (14.9% CP). Nitrogen intake differed among treatments (99, 151, and 123 g/d for CON, DDGS, and UREA). Urea-N synthesis tended to be greater for DDGS (118 g/d) than for UREA (86 g/d), which tended to be greater than CON (52 g/d). Urinary urea-N excretion was greater ([italics]P[italics]<0.03) for DDGS (35.1 g/d) and UREA (28.6 g/d) than for CON (12.7 g/d). Gut entry of urea-N (GER) was numerically greatest for DDGS (83 g/d), intermediate for UREA (57 g/d), and least for CON (39 g/d). Urea-N returned to the ornithine cycle tended to be greater for DDGS (47 g/d) than for UREA (27 g/d) or CON (16 g/d). The percent of microbial N flow derived from recycled urea-N tended ([italics]P[italics]=0.10) to be greater for DDGS (35%) than for UREA (22%) or CON (17%). The percent of urea production captured by ruminal bacteria was greater ([italics]P[italics]<0.03) for CON (42%) than for DDGS (25%) or UREA (22%). Experiment 2 diets were identical to those used in Experiment 1. In addition, steers were also fed either 0 or 60 mg/d zilpaterol-HCl. Dietary CP was 9.6, 12.4, and 13.7% for CON, UREA, and DDGS, respectively. Zilpaterol increased ([italics]P[italics]<0.01) total DMI and N intake; however, zilpaterol did not affect urea entry rate ([italics]P[italics]=0.80) or GER ([italics]P[italics]=0.94). Urea entry rate and GER were numerically greater for DDGS than CON and UREA. In conclusion, zilpaterol did not influence urea entry rate or GER. This lack of response in the face of greater N intake was interpreted to suggest that zilpaterol may reduce urea production and GER at constant N intake.

Doctor of Philosophy / Department of Hospitality Management and Dietetics / Deborah D. Canter / The culture-change movement in skilled nursing facilities is challenging foodservices to consider their role in supporting the paradigm shift to person-centered care. Optimal nutrition for residents supports physical and emotional health of institutionalized older adults. The purpose of this study was to explore factors associated with resident dining in skilled nursing facilities that have transitioned from a traditional foodservice system to restaurant-style dining. The study investigated foodservice employee perceptions of resident satisfaction with foodservices, foodservice employee job satisfaction, and effect of the delivery system transition on employee intent to leave. The study was conducted in two phases. Phase I was a case study of one skilled nursing facility’s transition from the traditional foodservice to restaurant-style dining. Phase II consisted of a survey of residents and employees in seven skilled nursing facilities utilizing restaurant-style dining. Two questionnaires, addressing the constructs of food quality, service quality, and customization relating to resident satisfaction with foodservices, were developed and administered to residents and foodservice employees. The Phase 1 case study revealed differences in financial and unintended weight loss data from pre- to post-menu transitioning. Focus groups provided insight into resident satisfaction with food and foodservices. In both phases, residents were satisfied with restaurant-style dining. Statements regarding the ability to choose foods at meals times scored highly. Service statements such as “Being treated respectfully by employees” were rated high by the residents. Portion sizes and food quality consistency were rated lower by residents. Employee perceptions of resident satisfaction were consistent with the resident ratings of satisfaction. Foodservice employee job satisfaction was high and intent to leave was low. Job satisfaction mediated the relationship between the employee perception of resident service and their intent to leave. Overall, restaurant-style dining appears to be a positive alternative to the traditional foodservice system in skilled nursing facilities. Implications and future research are discussed.