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Premature Birth

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Coupons or WIC vouchers ' ... Decrease barriers: coupons, recipes ... Nylon Pouch with dividers for coupons, stickers, recipes. Shopping Lists ... – PowerPoint PPT presentation

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Title: Premature Birth


1
Premature Birth DHA Enriched Functional Foods
  • Phase II - Nutrition Education Intervention
  • Garry Auld, PhD, RD
  • auld_at_cahs.colostate.edu

2
Funding
  • Premature birth and docosahexaenoic acid enriched
    functional foods USDA, Initiative for Future
    Agriculture and Food Systems Program (IFAFS)
    Grant 00-52102-9633
  • Omega Tech, Inc Martek, Inc
  • Hidden Villa Ranch

3
Phase II
  • Goal match effective clinic DHA intake
  • Formative Evaluation
  • Focus Groups with Target Audience
  • Education Materials (develop test)
  • WIC Implementation
  • Recruit, initial education messages materials
  • CSU monthly mail follow-up

4
Focus Group Objectives
  • Motivators/Barriers to eating during pregnancy
  • Customary (DHA) Foods
  • Information sources and preferences
  • Preferred format for education materials
  • 8 FG (2 in Spanish)
  • 47 participants
  • 66 Hispanic/Latina 28 African American

Marx and Auld, 2003
5
Healthy Foods to Eat During Pregnancy
  • In general, participants felt that eating a
    variety of foods, as a part of a balanced diet
    was healthy
  • In my house, we eat a variety of everything.
    Its all healthy because all foods have different
    things that are right for your body.
  • Fruits and vegetables
  • Protein foods

6
Motivators to Eating Healthy During Pregnancy
  • Primary
  • Nutrition and development of a healthy baby
  • Specific vitamins and minerals
  • Folic acid Calcium
  • No one mentioned DHA
  • Secondary
  • Healthy foods essential to weight gain
  • African-American women - avoidance of heartburn
  • Spanish Language women - disease prevention

7
Foods Avoided During Pregnancy
  • Food with a high fat content/fried foods
  • Fast food
  • Candy/sweets
  • (Fewer mentioned) Salty foods or Caffeine
  • Why avoid?
  • Excess weight gain
  • Increase disease risk (mom/baby)
  • Genl not healthy

8
Common Foods (DHA rich?)
  • Eggs
  • Canned tuna (7 out of 8 focus groups)
  • Sardines, salmon and mackerel (primarily
    African-American women)

9
Frequency of Consuming DHA Targeted Foods
  • 380 food frequency questionnaires completed
  • Obtained from FG and Clinical Trial participants
  • weeks
  • FFQ validated against initial RBC DHA from Phase
    I trial

Marx and Auld, 2003
10
Clinic staff verified frequency and amount
11
Validation of FFQ
n 380 p .000 r .39
12
Mean DHA Intake (from FFQ)
ISSFAL Recommendation 300 mg/day CSFII Average
Intake in US 100 mg/day
13
Proportion with Common DHA Sources
14
Primary Source of DHA
15
Intake of DHA Rich Foods
  • Motivators to consuming more
  • Knowledge of the benefits to baby
  • Yes, I will eat it. If they tell me that tuna
    is good and it will benefit the baby.
  • New and easy ways to prepare the foods
  • Barriers
  • Smell and taste
  • I love tuna fish, but if you put it in my face
    when I am pregnant, youre gonna get thrown up
    on.
  • Cost
  • Unfamiliar with foods, especially DHA eggs

16
Encouraging DHA Consumption
  • What would be a good way of providing
    information to encourage you to eat more of the
    foods that contain DHA?
  • Recipes
  • I think ways of preparing the foods maybe with
    sauces or something that would help them go down
    easier.
  • Cooking demonstrations
  • Coupons or WIC vouchers
  • Maybe if they (Gold CircleTM brand eggs) were on
    our WIC list we would try them because they would
    be there.
  • Planners/calendars, short readings, magnets

17
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18
Omega-3 for Baby and Me
  • Health Belief Model
  • Increase motivation information, logo, reminders
  • Decrease barriers coupons, recipes
  • Perceived susceptibility recruitment, some
    calendar information
  • Recipe Development Criteria
  • 300 mg in one serving (2 Gold CircleTM eggs)
  • Quick and easy to prepare
  • Wide variety of inexpensive, widely accepted
    ethnic foods
  • Include breakfast, lunch and dinner recipes
  • Provide variety in fish preparation
  • Well pronounced flavor to disguise the
    taste/smell of fish

Troxell et al, 2005
19
  • Taste Testing
  • Recipes tested by CSU research team
  • Would tester would make the recipe?
  • Should recipe be included in intervention?
  • 3 recipes tested in target population in clinics
  • Used salmon, tuna, sardines
  • 90 thought recipes should be included in
    intervention
  • Kept 12 4 egg, 4 salmon, 2 sardine, 2 tuna

20
Nutrition Education Materials
  • WIC insert (1 page)
  • 9 month Calendar
  • Backbone of the nutrition education intervention
  • Explanation of what DHA is
  • Something relevant to mother AND baby
  • Nutrition/health tip of the month
  • Stickers
  • personalize calendar (events, appointments,
    delivery date etc)
  • Recipes
  • Magnetic Clip and Recipe Holder with Logo
  • Nylon Pouch with dividers for coupons, stickers,
    recipes
  • Shopping Lists

21
  • Store coupons for Gold CircleTM eggs
  • Canned fish provided at recruitment
  • salmon, tuna, sardines
  • CSU mailed egg coupons 2 recipes/mo

22
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23
EPA/FDA Advisory on Methyl Mercury in Fish
  • Pregnant Women
  • No More Than 6 oz (cooked) /week
  • AVOID Tile Fish, Shark. Sword Fish, King
    Mackerel, AlbacoreTuna
  • Pulled Tuna cans recipes

24
Results
25
WIC Participants
  • 178 women with complete delivery data
  • 136 Hispanic (76)
  • 25 White (14)
  • 14 African American (8)
  • 3 Other (2)

26
Gestational Length Nutrition Educ. vs
Supplementation
a,b
b
b
a
Model adjusted for Ethnicity, Prepregnancy
BMI Values with different superscripts are
significantly different (p.026)
27
Summary of ComparisonPhase I and Phase II DHA
Trials
  • Significant 4 day increase in gestational length
  • Nutrition education as effective as functional
    food supplements
  • 60 g (NS) increase in birth weight
  • Lower than expected fetal growth rate for 4 days
    ( 130 g)
  • No effect on head circumference, birth length
  • Compliance not confirmed with blood work in
    Phase II

28
Post-Delivery Follow-up
  • Tracked use of egg coupons
  • Phone Interviews

29
191 participants 2049 coupons redeemed 11
dozen per participant 6 eggs/wk
available
30
Interview Results
31
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32
Why such apparent success?
  • Straight forward behavior change
  • Foods already eating
  • Simply asked to eat more often and focus on
    omega-3 options
  • Stressed benefit to baby
  • The primary motivator from FG
  • Decreased obvious barriers
  • Coupons (cost) recipes (preparation)

33
Implications for WIC
  • Should WIC consider changes to food package?
    During which trimesters? Breastfeeding?
  • Omega-3 intervention potential to double WIC
    effectiveness
  • Currently WIC intervention results in 1 oz
    increase in birth weight
  • Primary complaint (from interviews) or barrier
    to eating more Gold CircleTM eggs was having too
    many WIC egg coupons

34
Colleagues and Graduate Students
  • Kenneth GD Allen. PhD
  • Jennifer Anderson, PhD, RD
  • Mary Harris, PhD, RD
  • John Wilson, MPh
  • Melanie Reece, PhD
  • Jan French, MS, CNM
  • James McGregor,MD
  • Marsha Wheeler, MD
  • Shannon Burke, MD
  • Robyn Foster, MS
  • Ruth Inglis-Widrick, MS
  • Nadia Marx, MS
  • Shannon Seal, MS RD
  • Heather Troxell, MS
  • Katy Warren, MS

35
Premature Birth DHA Enriched Functional Foods
  • Phase II - Nutrition Education Intervention
  • Garry Auld, PhD, RD
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