With the development of technology, using photographs to measure plate waste is an increasing
trend. These photographs are later analyzed when the data is being entered into a form or
system. Previously, these forms or systems have not been assessed for usability. This research
study looks at three iterations of a digital plate waste observation system developed for the
School Lunch Study at Arizona State University. The System Usability Scale was used to
understand the functionality of the digital plate waste observation system. An area for free
responses was used to understand aspects of the system that were liked by research assistants
and what technical difficulties the research assistants encountered. These responses were used to
develop the next version of the digital plate waste observation system. Time to complete a task
was calculated to see the trends across all versions of the system. With each version, the System
Usability Scale scores increased along with the time to complete a task. This study found that
following the workflow of research assistants, being able to manipulate a photograph, having
menu items populated, and decreasing the amount of typing performed by adding selections to be
useful design aspects. Future digital plate waste observation systems can implement the
successful design aspects of this system, be aware of errors experienced, and implement helpful
features not found in this system. Future studies can look at the effect proctored training sessions
have on the time to complete a task and the relation of System Usability Scale scores with the
success of data entry.

College students are a niche of young adults, characterized by abnormal sleeping habits and inactive lifestyles. Many students entering college are as young as 18 years old and graduate by 22 years old, a window of time in which their bones are still accruing mineral. The purpose of this cross-sectional study was to determine whether sleep patterns and physical activity observed in college students (N= 52) 18-25 years old at Arizona State University influenced bone biomarkers, osteocalcin (OC) and N-terminal telopeptide of type 1 collagen (NTX-1) concentrations. Students completed various dietary and health history questionnaires including the International Physical Activity Questionnaire short form. Students wore an actigraphy watch for 7 consecutive nights to record sleep events including total sleep time, sleep onset latency and wake after sleep onset. Total sleep time had a significant, negative correlation with OC (r = -0.298, p-value =0.036) while sleep onset latency had a significant, positive correlation with NTX-1 serum concentration (r = 0.293, p-value = 0.037). Despite correlational findings, only sleep percent was found to be significant (beta coefficient = 0.271 p-value = 0.788) among all the sleep components assessed, after adjusting for gender, race, BMI and calcium intake in multivariate regression models. Physical activity alone was not associated with either bone biomarker. Physical activity*sleep onset latency interactions were significantly correlated with osteocalcin (r = 0.308, p-value =0.006) and NTX-1 (r = 0.286, p-value = 0.042) serum concentrations. Sleep percent*physical activity interactions were significantly correlated with osteocalcin (r = 0.280, p-value = 0.049) but not with NTX-1 serum concentrations. Interaction effects were no longer significant after adjusting for covariates in the regression models. While sleep percent was a significant component in the regression model for NTX-1, it was not clinically significant. Overall, sleep patterns and physical activity did not explain OC and NTX-1 serum concentrations in college students 18-25 years old. Future studies may need to consider objective physical activity devices including accelerometers to measure activity levels. At this time, college students should review sleep and physical activity recommendations to ensure optimal healthy habits are practiced.

Objective: It’s not well understood how youth perceive existing fruit and vegetable (FV) marketing materials available in schools. This ancillary study sought to assess the acceptability of FV marketing materials freely available to schools among adolescents in grades 6-12.

Methods: Middle and high school adolescents (n=40; 50% female; 52.5% Hispanic) in the Phoenix, AZ area were asked to rank marketing materials (n=35) from favorite to least favorite in four categories: table tents, medium posters, large posters and announcements. Favorites were determined by showing participants two items at a time and having them choose which they preferred; items were displayed to each adolescent in a random order. Adolescents participated in a 20-30 minute interview on their favorite items in each category based on acceptance/attractiveness, comprehension, relevance, motivation and uniqueness of the materials. A content analysis was performed on top rated marketing materials. Top rated marketing materials were determined by the number of times the advertisement was ranked first in its category.

Results: An analysis of the design features of the items indicated that most participants (84%) preferred marketing materials with more than 4 color groups. Participant preference of advertisement length and word count was varied. A total of 5 themes and 20 subthemes emerged when participants discussed their favorite FV advertisements. Themes included: likes (e.g., colors, length, FV shown), dislikes (e.g., length, FV shown), health information (e.g., vitamin shown), comprehension (e.g., doesn’t recognize FV), and social aspects (e.g., peer opinion). Peer opinion often influenced participant opinion on marketing materials. Participants often said peers wouldn’t like the advertisements shown: “…kids my age think that vegetables are not good, and they like food more than vegetables.” Fruits and vegetable pictured as well as the information in the marketing materials also influenced adolescent preference.

Conclusion: Students preferred advertisements with more color and strong visual aspects. Word count had minimal influence on their opinions of the marketing materials, while information mentioned and peer opinion did have a positive effect. Further research needs to be done to determine if there is a link between adolescent preferences on FV marketing materials and FV consumption habits.

Background In the United States (US), first-year university students typically live on campus and purchase a meal plan. In general, meal plans allow the student a set number of meals per week or semester, or unlimited meals. Understanding how students’ use their meal plan, and barriers and facilitators to meal plan use, may help decrease nutrition-related issues.

Methods First-year students’ meal plan and residence information was provided by a large, public, southwestern university for the 2015-2016 academic year. A subset of students (n=619) self-reported their food security status. Logistic generalized estimating equations (GEEs) were used to determine if meal plan purchase and use were associated with food insecurity. Linear GEEs were used to examine several potential reasons for lower meal plan use. Logistic and Linear GEEs were used to determine similarities in meal plan purchase and use for a total of 599 roommate pairs (n=1186 students), and 557 floormates.

Results Students did not use all of the meals available to them; 7% of students did not use their meal plan for an entire month. After controlling for socioeconomic factors, compared to students on unlimited meal plans, students on the cheapest meal plan were more likely to report food insecurity (OR=2.2, 95% CI=1.2, 4.1). In Fall, 26% of students on unlimited meal plans reported food insecurity. Students on the 180 meals/semester meal plan who used fewer meals were more likely to report food insecurity (OR=0.9, 95% CI=0.8, 1.0); after gender stratification this was only evident for males. Students’ meal plan use was lower if the student worked a job (β=-1.3, 95% CI=-2.3, -0.3) and higher when their roommate used their meal plan frequently (β=0.09, 99% CI=0.04, 0.14). Roommates on the same meal plan (OR=1.56, 99% CI=1.28, 1.89) were more likely to use their meals together.

Discussion This study suggests that determining why students are not using their meal plan may be key to minimizing the prevalence of food insecurity on college campuses, and that strategic roommate assignments may result in students’ using their meal plan more frequently. Students’ meal plan information provides objective insights into students’ university transition.

The objective of this study was to evaluate and compare the content of nutrition marketing materials within the cafeterias of schools in Central Arizona. By collecting photographs of marketing material from three elementary schools, one K-8 school, three middle schools and three high schools, 59 pieces of nutrition marketing were gathered. The schools chosen were a convenience sample and selected from schools that were already participating in ASU' s School Lunch Study. The photographs were sorted by grade level and then coded quantitatively and qualitatively for their purpose, visual components, strategies used and relevance. Results from this novel study provided insight into prevalence, size, textual content, educational content, strategies for fruit and vegetable marketing, messaging and overall design of existing nutrition marketing within the sample schools. This study found that the prevalence of nutrition marketing within all school cafeterias appeared to be low, particularly within elementary and middle schools. Diverse types of messaging were present among elementary, middle and high schools and a variety of appeals were utilized with little consistency. Many of the strategies used in the nutrition marketing appeared disconnected from the population it was intended to appeal to. Educational components were notably lacking within middle school cafeterias but were often effectively integrated into high school nutrition marketing. The results are unique to this population, and further research is required to evaluate the content of existing nutrition material on a larger scale, so efforts can be made to improve the persuasiveness of nutrition marketing in promoting fruit and vegetable consumption.

Chronic diseases are the leading causes of death in the United States. Dietary behaviors influence the risk of developing multiple chronic diseases. The U.S. population consumes too few fruits and vegetables and too much sugar sweetened beverages (SSB) and fast food. The Social Ecological Model (SEM) was created as a framework for health promotion interventions. The SEM organizes factors that can influence health into five layers: intrapersonal factors, interpersonal processes, institutional/organizational factors, community factors, and public policy. Each layer can influence dietary behaviors and other layers.

This work aims to understand how the community layer, represented by the food environment, moderates the association of two other layers and dietary behaviors: the interpersonal layer, represented by receiving health care provider’s (HCP) advice to lose weight, and the policy layer, represented by participation in the Supplemental Nutrition Assistance Program (SNAP), and a policy change within the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Participant data were obtained from a household telephone survey of 2,211 adults in four cities in New Jersey from two cross-sectional panels in 2009-10 and 2014. Community food data were purchased and classified according to previously established protocol. Interaction and stratified analyses determined the differences in the association between HCP advice, SNAP participation, and time (for WIC participants) and eating behaviors by the food environment.

Interaction and stratified analyses revealed that HCP advice was associated with a decrease in SSB consumption when participants lived near a small grocery store, or far from a supermarket, limited service restaurant (LSR), or convenience store. SNAP participation was associated with a higher SSB consumption when respondents lived close to a small grocery store, supermarket, and LSR. There were no differences in fruit and vegetable consumption between two time points among WIC participants, or by food outlet.

The food environment, part of the community layer of SEM, moderated the relationship between the interpersonal layer and dietary behaviors and the policy layer and dietary behaviors. The association between HCP advice and dietary behaviors and SNAP participation and dietary behaviors were both influenced by the food environment in which participants lived.

It is well established that physical activity (PA) directly correlates with many health benefits, especially when active habits are formed during childhood and adolescence. PA practiced in adolescence has been seen to carry into adulthood, helping to combat a host of chronic diseases, such as obesity and diabetes. However, in recent years there has been a steady decline in PA among adolescents, followed by a resulting rise in sedentary behavior. Walking Intervention Through Texting for Adolescents, or WalkIT-A, was an 11.5-week intervention that built upon behavioral theory to provide an incentive-based, adaptive, physical activity intervention to inactive adolescents. The goal of this study was to investigate an intervention which combined walking with pointed behavior change strategies to incite a larger increase in PA. Using single-case, reversal (ABA) design, the study was aimed at shaping physical activity behavior in adolescents aged 12-17 through a mobile health intervention that paired adaptive goal setting with financial incentives to increase step count. The intervention was delivered using a semi-automated texting, mobile-Health (mHealth) platform, which incorporated FitBit tracking technology, adaptive goals, motivational messages, performance feedback, and points/incentives. It was hypothesized that during the adaptive intervention phase participants would increase both steps per day and active minutes compared to baseline values. Upon conclusion of the study, the three adolescent participants exhibited increased steps and active minutes during the intervention period compared to baseline and withdrawal phases. However, the specific trends identified suggest the need for future research to incorporate even stronger intervention components to overcome PA "drop-off" midway through the intervention, along with other external, environmental influencers. Despite this need, the use of adaptive goal setting combined with incentives can be an effective means to incite PA behavior change in adolescents.

An increasingly sedentary population in the United States, specifically with adolescents, is putting youth at risk of future health related trauma and disease. This single-case design study, Walking Intervention Through Text Messaging for Adolescents (WalkIT-A), was used to intervene with a 12-year old, physically inactive male, in an attempt to test the efficacy of a 12-week physical activity program that may help reduce health risks by increasing number of steps walked per day. The components of the intervention consisted of a FitBit Zip pedometer, physical activity education, text messages, monetary incentives, and goal setting that adapted personally to the participant. Mean step count increased by 30% from baseline (mean = 3603 [sd = 1983]) to intervention (mean = 4693 [sd = 2112]); then increased slightly by 6.7% from intervention to withdrawal (mean = 5009 [sd = 2152]). Mean "very active minutes" increased by 45% from baseline (mean = 8.8 [sd = 8.9]) to intervention (mean = 12.8 [sd = 9.6]); then increased by 61.7% from intervention to withdrawal (mean = 20.7 [sd = 8.4]). Weight, BMI, and blood pressure all increased modestly from pre to post. Cardiovascular fitness (estimated VO2 max) improved by 12.5% from pre (25.5ml*kg-1*min-1) to post (28.7ml*kg-1*min-1). The intervention appeared to have a delayed and residual effect on the participant's daily steps and very active minutes. Although the idealistic ABA pattern did not occur, and the participant did not meet the target of 11,500 daily steps, a positive trend toward that target behavior in the latter 1/3rd of the intervention was observed. Results suggest the need for an extended intervention over a longer period of time and customized even further to the participant.

The WalkIT Study is a mobile health study examining the efficacy of a four month text message-based intervention for increasing physical activity among 96 overweight adults. The purpose of this thesis is to examine the potency of the different types of motivational prompt-to-action text messages used in the WalkIT Study for increasing steps per day by examining the individual messages, creating qualitative themes and comparing themed groups, and evaluating the interaction between demographic subgroups and themed groups. A total of nine themes was created. The results found that Message 13, “It doesn't matter how old you are – it's never too early or too late to become physically active so start today; only then will you start to see results!”, had the highest median step count (7129 steps) and Message 71, “It's ok if you can't reach your goal today. Just push yourself more tomorrow.”, had the lowest median step count (5054 steps). For themes, the highest median step count (6640 steps) was found in Theme 6, Challenges, and the lowest median step count (5450 steps) was found in Theme 9, Unconditional Feedback. Theme 6 (Challenges) had the highest median step count for females, Theme 7 (Everyday Tips) had the highest median step count for males, Theme 4 (Nutrition) had the highest median step count for the 18-42 group, Theme 6 (Challenges) had the highest median step count for the 43-61 group, and Theme 9 (Unconditional Feedback) had the lowest median step count for both genders and both age groups. The results suggest the usefulness of analyzing the effectiveness of individual motivational text messages, themes, and the interaction between demographic groups and themes in physical activity interventions.

With an excessive amount of resources in the United States healthcare system being spent on the treatment of diseases that are largely preventable through lifestyle change, the need for successful physical activity interventions is apparent. Unfortunately an individual's physical activity and health goals are often not supported by the social context of their daily lives. This single-case design study, Walking Intervention through Text messaging for CoHabiting individuals (WalkIT CoHab), looks at the efficacy of a text based adaptive physical activity intervention to promote walking over a three month period and the effects of social support in intervention performance in three pairs of cohabiting pairs of individuals (n=6). Mean step increase from baseline to intervention ranged from 1300 to 3000 steps per day for all individuals, an average 45.87% increase in physical activity. Goal attainment during the intervention ranged from 43.96% to 71.43%, meaning all participants exceeded the 40% success rate predicted by 60th percentile goals. Social support scores for study partners, unlike social support scores for family and friends, were often in the high social support range and had a moderate increase from pre to post visits for most participants. Although there was variation amongst participants, there was a high correlation in physical activity trends and successful goal attainment in each pair of participants. Less ambitious percentile goals and more personalized motivational text messages might be beneficial to some participants. An extended intervention, something the majority of participants expressed interest in, would further support the efficacy of this behavioral intervention and allow for possible long term benefits of social support in the intervention to be investigated.