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What effect does food insecurity and barriers to physical activity have on body mass index of low income-women?Shawn E. Kise, MS student, BSN, RNNUR 707Wright State UniversityCollege of Nursing and Health March 8th 2010

Problem StatementPrevalence and trend reports have continuously shown an increase in obesity in women over the past several decades and remains a major threat among lower-income women.

Purpose StatementThe purpose of this quantitative research study is to examine the influence of food security using the U.S. Household Food Security Survey Module, and barriers to physical activity level affects body mass index among low-income women.

Research Questions and VariablesWhat is the relationship between food insecurity and BMI in low-income adult females in the Dayton, Ohio area?What is the relationship between barriers to physical activity and BMI in low-income adult females in the Dayton, Ohio area? Independent Variables Food insecurity and barriers to physical activity.Dependent Variable BMI Potential funding sourcesNIH Small Grant Program

Sigma Theta TauInternational Small GrantZeta Phi Chapter Awards and Grants

Background and significanceM.S. Townsend, J. Peerson, B. Love, C. Achterberg, and S.P. Murpy (2001)

C.F. Bove and C.M. Olson (2006)

K.C. Jordan, J.H. Freeland-Graves, D.M. Klohe-Lehman, G. Cai, V.S. Voruganti, J.M. Profit, H.J. Nuss, T.J. Milani, and T.M. Bohman (2008)Examined food insecurity related to BMI in low-income individuals that were food stamp recipients. No significance in men but there was a significance in women with higher BMIs in the women that reported mild and moderate food insecurity .

2. Evaluated the perspective of overweight of low-income mothers in rural New York State. Study revealed that transportation, having young children, and limited mobility were barriers to physical activity and two thirds of there participants were food insecure at one or more of the three interview sessions. And participants both food secure and food insecure ate more food in response emotional stressors.

3. Evaluated a nutrition and physical activity program for reducing weight and improving nutrition attitudes. An 8 week program showed significant results in lowering body fat percentage and waist circumference. And more than 90% of the participants stated learning a great deal from the intervention. 5Background and significanceV.J. Cleland, K. Ball, J. Salmon, A.F. Timperio, and D.A. Crawford (2010)

S. Ahn, C. Huber, M.L. Smith, M.G Ory, and C.D. Phillips (2011)

R. Miles and L. Panton (2006)1. Examined correlates of achieving recommended levels of physical activity among women of low socio-economic position. Study reported that the attitudes and enjoyment of walking and physical activity was significant in achieving the recommended levels of physical activities. Also having social support and participation, having a set routine, and sports club memberships were also significant in achieving RLOPA. The only environmental barrier noted was having busy roads to cross when walking.

Investigated demographic, behavioral, and functional predictors of overweight in participants aged 65 years or older that received or were applying for Medicare services. The study reported that women were more likely to be overweight and have higher BMIs. Also reported that being more cognitively impaired and smokers were less likely to be obese in participant 75 years of age or older.

(Pilot Study) Assessed whether low-income women who participated in an intervention to increase physical activity would gain health benefits and also investigated what differences the perceived community environment made in supporting or constraining their efforts to increase physical activity. The findings suggested that even small increases among overweigh or obese low-income women can lead to significant weight loss. 6Background and significanceP.B. Ford and D.A. Dzewaltowski (2011)

S.B. Jilcott, E.D. Wall-Basset, S.C. Burke, and J.B. Moore (2011)

To determine whether the association between neighborhood deprivation and BMI is mediated by the availability of retail food stores, and whether this relationship varied across the urban rural continuum. This study used WIC participants in the state of Kansas. The findings suggest that the level of urbanity influenced the effect of the neighborhood conditions and BMI among low-income women and availability of supermarkets and other food stores does not directly influence BMI among low-income women.

2. This studys purpose was to examine cross-sectional associations between food insecurity, Supplemental Nutrition Assistance Program (SNAP), benefits per household member, perceived stress, and body mass index (BMI) among female SNAP participants in eastern North Carolina. This study reported perceived stress was associated with higher food insecurity and food insecurity was positively related to BMI. Also reported that perceived stress was not directly associated with BMI.

7Background and significanceK.W. Dammann and C. Smith(2011)

H.A. Eicher-Miller, A.C. Mason, A.R. Abbott, G.P. McCabe, and C.J. Boushey (2009)

To examine racial/ethnic differences in relationships between food-related environmental, behavioral, and personal factors and low-income womens weight status. 72% of the participants report low to very low food security. 82% of the participants were overweight or obese. and food security was significantly associated with racial/ethnic identity but mean BMIs were not significantly different among racial/ethic groups .

Examine the effect of FSNE lessons on the food insecurity and food insufficiency in participants. This study used an intervention group that received the FSNE and a control group that did not receive FSNE. The results showed significant improvement in food insecurity and food insufficiency in the intervention group compared to the control group.

These last two studies used the social cognitive theory as a framework for their studies. 8Theoretical Frame workSocial Cognitive TheoryPosits that portions of an individual's knowledge acquisition can be directly related to observing others within the context of social interactions, experiences, and outside media influences.

Theoretical Frame workNola Penders Health Promotion ModelTo help increase the patients level of wellbeing and takes into account the multivariable nature of the person and the environment in which they live to gain better health.Research PlanResearch MethodsThis quantitative, descriptive correlational study will examine the correlation between food insecurity and barriers to physical activity to body mass index among low-income women in the Dayton area. Research PlanSettingThis study will take place in the Medicaid office located in the Job and Family Services agency building and the four WIC office locations in this county.

Accessible Population are all the low-income women in this county. Target Population are the low-income women that used the above offices during the collection period of this study.Research PlanSample and sampling planThe sampling plan is a purposive, convenience sample. Snowball sampling will also be used if the researcher is unable to obtain the projected number of participants into the study. The total number of participants in this study is 30. Oversampling will occur by 60% to account for attrition (N = 48). Oversampling by 60% was determined by the high attrition rates for mail surveys.The number of 30 participants is based on one group being evaluated.

13Research PlanInclusion/exclusion criteriaInclusion criteria for this study are as follows: (1) participants must be female; (2) be between the ages of 18 to 65 years of age; and (3) must have a total household income up to 185% of the Federal Poverty Income Guidelines. Exclusion criteria include: (1) anyone who is not female; (2) those who are < 18 and > 65 years of age; and (3) any female with a total household income of more than 185% of the Federal Poverty Income Guidelines. Research PlanRecruitment/procedure

Community flyers will be posted in the Job and Family Services building and the WIC offices.

Medicaid and WIC office staff will be instructed by the researcher to inform the women who meet the criteria of the study during their appointments.

Research PlanRecruitment/procedure cont.

Staff will administer the study material to the women that want to participate in a quite and private area at the offices.Women who do not have time to complete the study at the office but would like to participate will fill out an information card and will be contacted by the researcher via phone. Women that contact the researcher from the community flyer will be contacted by the researcher via phone.

Research planEthical consideration

Explanation of the procedure, risks, benefits, confidentiality, and the right not to participate will be in writing on the informed consent.

Approval will be obtained through the Wright State University IRB as well as from the directors overseeing the WIC and Medicaid programs. Research planEthical consideration cont.

Confidentiality and anonymity will be kept.

The researcher has recently completed the CITI training for Human Subjects.

Participants will receive a $10 VISA gift card.

Confidentiality will be maintained by keeping all study material and data locked and secure at all times and only available to the researcher and research team. All data will be assigned a security number so that the participants cannot be connected to the data and the researcher will be the only one to have access to the participants names.

Anonymity will be kept All participants identities will be protected and at no time will they be available to anyone other than the researcher. The list of participants will be destroyed on the completion of the study. Questionnaires will not contain any information that can connect the data to the participants.

The list of participants will be destroyed after the 5 year period required to keep all study material.18Research planData collection procedures

The United States Department of Agricultures 18-item Household Food Security Survey Module will be used to measure food security. A 15-item questionnaire to assess barriers to physical activity. The socio-demographic questionnaire will ask participants their age, race/ethnicity, height, weight, income, education level, marital status, number of total household members, and the number of children under 18 years of age living in the home.

Research planData analysis proceduresNon-parametric measures include: mean, median, range, standard deviation, percentage, and frequency. The most appropriate parametric measurements for this study are: Pearsons r correlation to test the relationships between two variables. Data entry and interpretation will be done by the Wright State University Statistical Consultation Center in consultation with the researcher and faculty advisor in the College of Nursing and Health. questions