Doctor of Philosophy, The Ohio State University, 2021, Health and Rehabilitation Sciences

A plant-based dietary pattern is associated with improved health outcomes and is integrated within guidelines to promote public and individual health, such as the Dietary Guidelines for Americans (DGA) and the WCRF/AICR Cancer Prevention Guidelines. The number of cancer survivors has increased dramatically, and efforts are focusing upon promoting healthy survivorship free of cancer and enhancing longevity. Data suggests that diets of cancer survivors are inadequate in plant foods including fruits, vegetables, and whole grains. There is a critical need for studies focusing upon improving survivor dietary patterns. The development and validation of tools to assess the complex dietary intake of humans and biomarkers of exposure are crucial to this effort. Further, assessment of individual response to dietary intake remains complex and impacted by interacting components in the diet as well as genetic influences on digestion, absorption, and metabolism. Aligning dietary intake data with biomarkers of individual exposure and metabolism is critical for advancing knowledge. The goals of these studies were to explore select phytochemicals as biomarkers of dietary exposure within human trials by: (a) Defining changes in carotenoid status as an indicator of overall exposure to fruits and vegetables following an intervention with a healthy dietary pattern in free living cancer survivors; (b) Developing, evaluating, and validating a targeted LCMS flavonoid profile in 24-hour urine that is reflective of human intake and exposure to (poly)phenol-rich fruits and vegetables; and (c) Examining the relationships between a targeted (poly)phenol profile in the urine and/or dietary patterns and indicators of cardiometabolic health in a clinical trial of a healthy dietary pattern in cancer survivors. To achieve these goals, we conducted a clinical trial in cancer survivors (n=80) with overweight/obesity. Individuals enrolled in a lifestyle intervention with a primary goal of improving mod (open full item for complete abstract)

Committee: Colleen Spees PhD, MEd, RDN, LD, FAND (Advisor); Steven Clinton MD, PhD (Committee Member); Fred Tabung PhD, MSPH (Committee Member); Xiaokui Mo PhD, MAS (Committee Member); Ken Riedl PhD (Committee Member) Subjects: Behavioral Sciences; Food Science; Health Sciences; Nutrition; Oncology

MS, Kent State University, 2020, College of Education, Health and Human Services / School of Health Sciences

Adolescence is a significant period of life with considerable physical and emotional growth during the transition from childhood to adulthood. It is estimated that 13.3% of the U.S. population of adolescents between the ages of 12-17 have had at least one major depressive episode, and an estimated 31.9% of those aged 13-18 have had an anxiety disorder (Koplewicz, H., 2017). The relationship between dietary intake and anxiety and depression may be bidirectional. One's mood may affect dietary choices, and dietary choices may affect one's mood. The purpose of this study is to evaluate the differences in dietary intake in adolescents who have different levels of PROMIS scale scores, a measurement used by the American Psychiatric Association for use in clinical and research settings. Participants were recruited through a convenience sample during a health or food study course at Kent Roosevelt High School in Kent, Ohio. Twenty-four students (N=24) were included in the study and were between 14-18 years old, consisting of 8 females and 16 males. Participants received paper-based surveys measuring anxiety and depression through the PROMIS scale and completed a web-based 24-hour recall using the Automated Self-Administered 24-hour Dietary Assessment Tool. A Univariate ANOVA was run to examine dietary intake of saturated fat (percentage), added sugar (percentage), and fruit and vegetable (servings) based on anxiety and depression levels. There was a significant difference between anxiety and depression levels and fruit and vegetable intake, and no difference with added sugar or saturated fat intake. Additionally, the study provided insight into the dietary intake and anxiety and depression levels of adolescents.

Committee: Natalie Caine-Bish (Committee Chair); Eun-Jeong Ha (Committee Member); Amy Miracle (Committee Member) Subjects: Nutrition

Doctor of Philosophy, The Ohio State University, 2017, Agricultural and Extension Education

Abstract Inadequate fruit and vegetable (F &V) intake is associated with obesity and untoward health outcomes in children, particularly those from low resourced communities. The aim of this study was to investigate the impact of novel implementation and assessment methods for increasing access and intake of fruits and vegetables (F&V) in children and to determine if supplemental nutrition education (SNAP- Ed) can augment the effects of increased access. A cluster randomized control method was used to randomize 209 Head Start preschool children by classrooms into 1 of 3 groups: Treatment A (control), Treatment B (produce/access), and Treatment C (produce/access and child nutrition education). Produce was provided weekly at each Head Start site to treatment B and C classrooms. Nutrition education, which was done for 30 minutes, was provided in treatment C classrooms weekly by SNAP-Ed personnel. Outcomes measured, done at baseline and at the study end included carotenoid levels as performed using a BioPhotonic™ Scanner/ Ramen Spectroscopy and validated self-report questionnaires. The questionnaire included questions on the fruit and vegetable intake of the subjects, availability, and use of the fruits and vegetables provided. Final scan numbers consisted of 209 children. Treatment C (access/education) had 82 subjects, Treatment B (access) contained 61 subjects, and Cluster A (Control) had 66 subjects. Average cluster carotenoid change scores (Ramen Units – RU) were positive for all groups: Cluster C = 7837 RU; Cluster B = 5050 RU; Control = 2622 RU. Differences in change scores were significant (p < .000) between Cluster C (produce/access with education) and Control. Using novel intervention and assessment techniques, fruit and vegetable access plus nutrition education significantly improved carotenoid levels among children compared to those who received access only or neither access or education. This study demonstrated a relationship between self-repor (open full item for complete abstract)

Committee: Jamie Cano (Advisor); Gail Kaye (Committee Member) Subjects: Health Education; Nutrition; Public Health Education

Doctor of Philosophy, The Ohio State University, 2016, Agricultural, Environmental and Developmental Economics

Most Americans do not consume the recommended amount of fruits and vegetables (FV). We explore the potential for the retail food environment to push Americans toward healthier dietary habits. First, we conduct a hedonic analysis to test whether households value access to farmers markets, a key source of fresh produce. The results suggest that a one-mile increase in distance to the closest farmers market yields a 1.1% decline in housing prices, with the effect being strongest for low-cost housing and areas with poor-quality food environments. Second, we use a county-level, modified retail food environment index to examine the impact of the food environment on the quantity of FV purchases of U.S. households. We find that merely increasing the proportion of food retailers that are healthy does not impact FV purchases overall but may help to reduce racial disparities in FV purchases among black households in urban counties and Hispanic households in rural counties. Lastly, we identify three homogenous groups of the U.S. population based on FV purchasing patterns using a latent class model that accounts for both the quantity and frequency of purchases. We test whether residing in a food desert affects FV purchasing patterns using multinomial logistic regression and find that residing in a food desert does not independently affect FV purchasing patterns, though the effects of income and race do depend on whether a household resides in a food desert. Overall, the findings provide insight to policy makers aiming to improve dietary outcomes by modifying the food environment.

Committee: Elena Irwin (Advisor); Joyce Chen (Committee Member); Brian Roe (Committee Member) Subjects: Agricultural Economics; Economics

Master of Science, The Ohio State University, 2014, Human Ecology: Human Nutrition

Abstract Background: Many low-income children do not consume the recommended amounts of fruits and vegetables (FV). For this reason, a primary objective of the Supplemental Nutrition Assistance Program Education (SNAP-Ed) is to increase children's consumption of FV. To accurately measure dietary changes related to FV intake, validated assessment tools that are quick and easy to administer are needed; however, few such tools exist. Objective: To test a 10-item fruit and vegetable questionnaire (10-item FVQ) for criterion and convergent validity, sensitivity, test-re-test reliability, and internal consistency. Participants: The study took place among 9-11 year old children attending a SNAP-Ed-eligible elementary school. Four 3rd grade and four 4th grade classrooms were invited to participate. The study included 3rd (n=46) and 4th grade (n=40) participants, with the majority being white (93%). Main Outcome Measures: Criterion validity was assessed by comparing the total score on the 10-item FVQ to total servings of FV as reported on a single 24-hour dietary recall (24-HDR). Convergent validity analyzed the “variety” and “snack” constructs from the 10-item FVQ compared to variety and snack reference scores generated from the matched 24-HDR. Sensitivity of the 10-item FVQ was assessed by comparing scores pre- and post- a 4 lesson FV intervention to FV servings reported on the 24-HDR. Reliability was evaluated by administering the 10-item FVQ at two time points one week apart, pre-intervention, and internal consistency by analyzing scores on a single 10-item FVQ. Pearson correlation was used to assess criterion and convergent validity, and sensitivity. Reliability was measured using a pairwise t-test, intraclass correlation coefficient, and Cronbach's alpha. Results: Correlation between the total scores on the 10-item FVQ and 24-HDR was significant (r = 0.36, p < 0.005), in addition to the total variety (r = 0.306, p < 0.01) and total snack score (open full item for complete abstract)

Committee: Carolyn Gunther (Advisor); Ana Claudia Zubieta (Advisor); Julie Kennel (Committee Member); Tonya Orchard (Committee Member) Subjects: Nutrition; Public Health; Public Health Education

MS, University of Cincinnati, 2003, Allied Health Sciences : Nutrition

Objective: Analyze intakes of dietary nutrients, fruits and vegetables (F&V) of oral carcinoma survivors. Subjects: Twenty-four oral carcinoma survivors. Methods: Three 24-hour dietary recalls were obtained over fifteen-days by telephone interviews. A Formative Questionnaire was completed as part of the first interview. Results: Subjects had significantly lower daily dietary intake means (all p<0.05) of energy, niacin, vitamin C, B6, B12, phosphorous, iron, and zinc compared with data from the 1994-96 Continuing Survey of Food Intake by Individuals (CSFII). Compared to the Recommended Dietary Allowances/Dietary Reference Intakes (RDAs/DRIs) subjects had lower daily mean percentages of calcium, magnesium, vitamins D and E (<75% RDAs/DRIs). Significant correlation (p=0.01) was noted between F&V daily variety scores and dietary total carotenoids and vitamin C intakes. Conclusion: Subjects are deficient in energy and nutrients dietary sources when compared to the CSFII data and RDAs/DRIs. Cancer survivors may benefit from a diet rich in F&V variety.

Committee: Dr. Grace Falciglia (Advisor) Subjects: Health Sciences, Nutrition

Master of Science, The Ohio State University, 2012, Human Ecology: Human Nutrition

Underserved groups eat fewer vegetables and fruits compared to families who are not low-income; thus, a target message of low-income nutrition education programs is to increase vegetable and fruit consumption. Validated instruments for measuring behavioral outcomes are important for determining and documenting the effectiveness of these programs, yet many of the questionnaires used to gather behavioral outcome information in children have not been validated. The specific aims of the study were to: 1) develop a questionnaire measuring behavior changes in vegetable and fruit consumption for low-income 9-11 year olds, 2) assess the questionnaire for content validity via judgment of an expert panel and, 3) assess the questionnaire for face validity via focus groups with 9-11 year olds. A comprehensive review of child nutrition questionnaires was performed using a search on relevant databases (such as MEDLINE, ERIC, and WORLDCAT) as well as electronic sources through relevant journals and other documents. Forty-two questions were chosen based on the target audience, to measure behavior change, and relate to vegetable and fruit consumption. The research team in response to recommendations in the Dietary Guidelines for Americans 2010 also developed twelve questions. A total of 54 questions were assessed. An expert panel (n=95) was recruited through purposive sampling to evaluate the questions for content validity using 3 constructs: 1) students will understand the question, 2) students can answer the question, and 3) the question will assess behavior change. After the results of the expert panel were analyzed with α=0.1, questions that received 75% or greater agreement among the constructs and a power ≥.5 were considered to have content validity and were then assessed for face validity. Seven focus groups (FG) were performed with low-income 9-11 year olds and four major themes were identified. The results are 10 content and face validated questions assessing behavior c (open full item for complete abstract)

Committee: Joyce McDowell (Advisor); Diane Habash PhD (Committee Member); Julie Kennel PhD (Committee Member); Ana Claudia Zubieta PhD (Committee Member) Subjects: Nutrition