ACCESSION NO: 0195001  SUBFILE: HNRIMS; CRIS 

PROJ NO: IND030462R AGENCY: NIFA IND 

PROJ TYPE: HATCH PROJ STATUS: TERMINATED  MULTISTATE PROJ NO: W-1003 
START: 01 OCT 2002 TERM: 30 SEP 2008 FY: 2008

INVESTIGATOR: Boushey, C. J.

PERFORMING INSTITUTION: 
PURDUE UNIVERSITY 
WEST LAFAYETTE, INDIANA 47907

PARENT AND HOUSEHOLD INFLUENCES ON CALCIUM INTAKE AMONG PREADOLESCENTS

NARRATIVE: During adolescence, calcium requirements increase but calcium intakes drop dramatically. Less than
optimal calcium intakes prevent maximal bone growth which is a major risk factor for osteoporosis. This project will
identify and contrast parental and household influences on preadolescent calcium intakes in four ethnic groups,
providing information necessary to design more effective education programs.

OBJECTIVES: 1. Identify factors (knowledge, attitudes, behavior and environment) associated with total calcium
intake among the parents of preadolescent children using qualitative methods. 2. Identify parental factors
(knowledge, attitudes, behavior and environment) related to total calcium intake of their preadolescent children using
qualitative methods. 3. Quantify the salient parental and preadolescent factors (attitudes, knowledge, behaviors, and
environment) that predict total calcium intake of the preadolescent using quantitative methods. 4. Develop and test
potential messages and dietary strategies among parents and preadolescents based on the salient factors related to
preadolescent calcium intake.

APPROACH: The study population will consist of parents and preadolescents (11-12 years); both genders and four
ethnic groups (Hispanic, White, Asian American, and mixed) will be included. Both qualitative (open-ended
interviews) and quantitative (motivator/barrier (MBQ) and food frequency (FFQ) questionnaires) will be used to
address the objectives. Parent (n=160) of preadolescents most responsible for food preparation will be interviewed to
determine the influences on calcium intake of the child and parent using tenets from the Social learning Theory. A
parent MBQ will be developed and validated, based on interview responses. Parent/child pairs (n=1600) pairs will be
surveyed using the parent MBQ and previously developed child MBQ and calcium based FFQ. Based on results from
above, five or more nutrition strategies to improve calcium intakes of parents and preadolescents will be developed
and tested.

PROGRESS: 2002/10 TO 2008/09
OUTPUTS: The Indiana site completed double-data entry on the 80 questionnaires rejected from the optical scanner.
The data from the double entry were checked using the SAS compare procedure. In addition, the Indiana site finished
the responsibility of compiling, cleaning, recoding, and formatting the data from questionnaires completed by a
sample of 695 parents and their early adolescent children (one parent-one child pairs) recruited by sites outside of
Indiana. The parents completed the parent questionnaire newly developed and evaluated as part of the W1003 multi-
state project. The children completed the What You Eat and Drink questionnaire that was created and evaluated
under the W191 multi-state project. Data sets were provided to the current chair of the W1003 multi-state project.
Summaries of the data were organized for presentation to the other investigators. The Indiana site continues to work
with investigators to create data sets to address research questions. Information regarding characteristics of the
sample, e.g., ethnicity, ages, was summarized, as well as results related to the specific aims of the project.
PARTICIPANTS: Nothing significant to report during this reporting period. TARGET AUDIENCES: The information
from this project may be used to design more effective osteoporosis prevention programs, tailored to Asian, Hispanic,
and non-Hispanic White families with early adolescents. Early adolescents in these racial/ethnic groups are at higher
risk for osteoporosis especially during the critical period of the lifecycle for bone growth. The data from this project will
serve as the basis for future research, which as proposed will seek to explore methods to influence and motivate
families in encouraging, role modeling and providing access to healthy foods for adolescents. Plus the tools
developed will available to researchers examining questions regarding calcium intakes. PROJECT MODIFICATIONS:
The only major change was a year extension.

IMPACT: 2002/10 TO 2008/09
Inadequate calcium intake is the single most recognizable health issue identified with osteoporosis. Hip fractures are
more likely than heart attacks, stroke or cancer to lead to functional impairment and related morbidities. The
economic burden of these fractures exceeds $20 billion annually. Early adolescence (ages 10-13 y) is a critical period
in the lifecycle for bone mineralization. Adequate calcium intake during this time of growth is crucial to ensure bone
health in later life. However, studies indicate that early adolescent children consume less than the 1300 mg Adequate
Intake level of calcium recommended by the Institute of Medicine. These data suggest that American children are at
risk for osteoporosis later in life, with its associated health risks. Asian, Hispanic and non-Hispanic White populations
face a higher risk of developing osteoporosis, and thus prevention is key for these groups. The W-1003 project is
focused on developing tools to identify how parental and household factors,e.g., parental knowledge, attitudes,
behaviors, and environment, influence calcium intake in early adolescents from race/ethnic groups most at risk for
osteoporosis. The project also uses a questionnaire developed by a previous multi-state research project (W-191),
looking specifically at perceptions of calcium-rich foods among adolescents. Both survey tools provide a more
complete picture of factors affecting the calcium intake of early adolescents and their families. In addition, the
questionnaire developed as part of W-191 and also being used in the W-1003 project has been requested for use by
more than 15 research groups in the US and the UK. The questionnaire was also adapted for use as a multi-media
computer data collection tool and used to measure calcium intake in a federally funded intervention study. It is
anticipated that the questionnaire developed in the W-1003 project for parents will also be considered a valuable tool
by other research groups. Data are being collected on parental and household factors that potentially influence
calcium intake of Asian, Hispanic and non-Hispanic White early adolescents and their parents. These factors may
also be applicable to other health-related behaviors, such as overweight and obesity, and fruit and vegetable intakes.
Most studies have overlooked race/ethnic differences in calcium intake among youth and their families. This study
seeks to more accurately assess factors influencing calcium intake among these three racial/ethnic groups. The
information from this project may be used to design more effective osteoporosis prevention programs, tailored to
Asian, Hispanic, and non-Hispanic White families with early adolescents. The data from this project will serve as the
basis for future research, to explore methods to influence and motivate families in encouraging, role modeling and
providing access to healthy foods for adolescents. In Indiana, the W-1003 project has aided in the development of
future practitioners and researchers in dietetics and nutrition. An undergraduate Honors student in the Department of
Foods and Nutrition is completing her undergraduate thesis using data from the W-1003 project.

PUBLICATIONS (not previously reported): 2002/10 TO 2008/09

1. Edlefsen M, Reicks M, Goldberg DL, Auld, GW, Bock A, Boushey CJ, Bruhn CM, Cluskey M, Misner SL, Olson BH,
Wang C, Zaghloul S. Strategies of Asian, Hispanic, and non-Hispanic White parents to influence young adolescents'
intake of calcium-rich foods, 2004 and 2005. Preventing Chronic Disease 2008;5(4) October.
2. Cluskey M, Edlefsen M, Olson B, Reicks M, Goldberg DL, Auld, GW, Bock A, Boushey CJ, Bruhn CM, Misner SL,
Olson BH, Wang C, Zaghloul S. At home and away-from-home eating patterns influencing preadolescents' intake of
calcium rich foods as perceived by Asian, Hispanic and non-Hispanic White parents. J Nutr Educ Behav. 2008;40:72-
79
3. Reicks M, Edlefsen M, Goldberg D, Auld G, Bock MA, Boushey CJ, Bruhn C, Cluskey M, Misner S, Olson B, Wang
C, Zaghloul S. Strategies of Asian, Hispanic, and non-Hispanic white parents to influence young adolescents' intake
of calcium-rich foods, 2004 and 2005. Prev Chronic Dis 2008; 5(4):A119.
4. Cluskey M, Edlefsen M, Olson B, Reicks M, Auld G, Bock A, Boushey C, Bruhn C, Goldberg D, Misner S, Yang C,
Zaghoul S. At home and away from home eating patterns influencing pre-adolescents' intake of calcium rich foods as
perceived by Asian, Hispanic, and non-Hispanic parents. J Nutr Educ Behav 2008; 40(2):72-9.
5. Wong SS, Boushey CJ, Novotny R, Gustafson DR. Evaluation of a computerized food frequency questionnaire to
estimate calcium intake of Asian, Hispanic, and non-Hispanic white youth. J Am Diet Assoc 2008; 108(3):539-43.
6. Yang, YJ, Boushey CJ. Evaluation of a Brief Calcium Assessment Tool (BCAT) for adolescents. Experimental
Biology, Washington DC, April 30, 2007, Number 676.3
7. Yang J, Boushey CJ. Participants' omission may lead to the difference between estimated energy requirement and
intakes derived from food records. Experimental Biology, Washington DC, April 30, 2007, Number 676.2