Marsha Spence

University of Tennessee at Knoxville | UTK · Department of Nutrition

Background: Despite limited clinical consensus regarding surgery for tethered oral tissues ("tongue-tie") for resolving breastfeeding-related issues, the procedure has been increasing in the United States. Greater understanding of maternal experiences with obtaining surgical release may help to improve breastfeeding outcomes. Research aim: To ex...

Introduction: Maternal and Child Health (MCH) Nutrition Training Programs aim to train graduate-level registered dietitian/nutritionists (RDNs) to improve the health of MCH populations. Metrics exist to evaluate the production and success of skilled graduates; however, metrics are needed regarding the reach of MCH professionals. This study aimed t...

Background: There is increasing evidence of problematic rates of food insecurity among college students, yet few studies have gone beyond this to examine housing insecurity rates or rates of basic need insecurity (BNI), which is defined as having both food and housing insecurity, among the postsecondary population. BNI may have significant impacts...

Objectives To quantify the number and type of students failing to secure basic needs. Participants Students attending 22 postsecondary schools in the United States in Fall 2019. Methods The Adult Food Security Module and part of the #RealCollege Survey were used to measure food and housing insecurity, respectively. Logistic and linear regression...

Objectives The objective was to explore mothers’ experiences breastfeeding/chestfeeding an infant diagnosed with an issue with tethered oral tissue(s), for which surgical intervention was performed (i.e., tissue was “released”). Methods This was a cross sectional, observational survey conducted online from August to September 2020. Recruitment occ...

Objective To assess the relationship between food insecurity, sleep quality, and days with mental and physical health issues among college students. Design An online survey was administered. Food insecurity was assessed using the 10-item Adult Food Security Survey Module. Sleep was measured using the 19-item Pittsburgh Sleep Quality Index (PSQI)....

Rates of food insecurity vary highly across and within regions in the U.S., with rural Appalachia having higher rates compared to the rest of the country, leading parts of the population to rely on food pantries as a source of food. This article explores how food pantries fit into a broader scope of food acquisition strategies of rural Appalachian...

Objectives Postpartum anxiety is associated with failure to meet breastfeeding (BF) goals. While BF self-efficacy is a potential moderator of this relationship, the relationship between postpartum anxiety, BF self-efficacy, and exclusive breastfeeding (EBF) has not yet been assessed. The objective was to assess relationships between EBF, anxiety, d...

Refugee-specific nutrition and cooking curricula addressing dietary acculturation barriers to food security are limited. A cooking curriculum was culturally adapted for Burundian and Congolese refugees to address their unique dietary acculturation experiences. A four-phase curriculum adaptation process (information gathering [literature review, res...

Pika Pamoja (Cook Together) is an eight-session cooking curriculum for Burundian and Congolese refugee families, culturally adapted from the evidence-based iCook 4-H curriculum to address dietary acculturation barriers to and facilitators of food security. The goal of this study was to determine the feasibility and acceptability of implementing Pik...

Background Sub-Saharan African refugees in the United States have reported low food security related to dietary acculturation issues. However, there is no existing evidence-based or culturally-tailored cooking programs to address the unique barriers to food security for this population. Objective To culturally adapt a cooking curriculum for Burund...

Background A number of studies have measured college student food insecurity prevalence higher than the national average; however, no multicampus regional study among students at 4-y institutions has been undertaken in the Appalachian and Southeast regions of the United States. Objectives The aims of this study were to determine the prevalence of...

Sub-Saharan African refugees in the US have reported food security rates seven times below the national average. Dietary acculturation issues may be a contributing factor. Criterion-specific sample (n = 18) was recruited using network then snowball sampling methods. Semi-structured interviews were facilitated with the aid of a culturally and lingui...

Purpose The purpose of this paper is to describe a collaborative service learning experience (SLE) which was part of the degree requirements of the Public Health Nutrition Graduate Program at the University of Tennessee. The SLE was collaboratively developed by the University of Tennessee’s maternal and child health (MCH) nutrition leadership educa...

The purpose of this convergent, multiphase, mixed methods study was to better understand the perceptions of adolescents’ food environments and related food behaviors using grounded visualization and story mapping. Adolescents from one high school (13–16 years) in the southeastern United States were evaluated via data from health behavior surveys (n...

Objective To assess rates of food insecurity (FI) among college students enrolled at a large public university system across one US state and identify factors associated with experiencing FI. Design Cross-sectional online survey administered to eligible, enrolled students ( n 38 614) across three campuses within the university system, with 5593 st...

Introduction The US Department of Agriculture sets nutrition standards for childcare centers and schools to ensure the nutritional quality of foods served to children. Recently, the nutrition standards for the Child and Adult Care Food Program (CACFP), which provides monetary support for low‐income childcare and preschool centers, were updated to r...

Background: Suboptimal breastfeeding duration and exclusivity rates are a public health concern. Therefore, there is a need for identifying effective tools for use in interventions targeting specific barriers to optimal breastfeeding outcomes. Research aim: This study aimed to assess the relationship between acceptance of remote lactation consulta...

The study objectives were to determine if there was an association between intention to breastfeed and accuracy of body size estimation (BSE) among a sample of nulliparous undergraduate females, and to explore other potential explanatory factors, should such a relationship be detected. Female figure drawings from Gardner and Jappe's Body Image Asse...

This paper presents a formative evaluation of an afterschool program that combined positive youth development and school garden curricula. Novel approaches were used to teach elementary school children about gardening and nutrition, and to engage them in advocacy for healthy community physical activity and nutrition environments. The youth developm...

This study examined associations between youths' individual and family subjective social status (SSS), body mass index (BMI), and weight perceptions. Participants ranged in age from 11–18, 57.8% identified as female, and 85.5% as Caucasian. Regression analyses revealed that individual and family SSS were negatively associated with BMI and overweigh...

Purpose The purpose of Cardiac Kids Club, an afterschool obesity prevention program for 4 th and 5 th graders, is to create healthful nutrition behavior changes and increase fitness levels among participants. Methods Children from 7 schools in East Tennessee, which were selected due to high rates of overweight and obesity among students, participa...

Background Previous research has shown the potential of increasing fruit and vegetable (F&V) intake by incorporating the senses into interventions. However, little to no research has specifically looked at the impact that the use of the senses can have on intake of fruits and vegetables among preschool‐aged children. Purpose The objective was to e...

Introduction Most preschool‐aged children (3–5 years old) do not consume an adequate amount of fruits and vegetables. Accessibility and parent involvement are important factors in determining fruit and vegetable consumption in preschool‐aged children. Objective Increase access to and consumption of fruits and vegetables among preschool‐aged childr...

Objective The primary objective of this project was to evaluate if there were significant differences between pre‐ and post‐outcomes for physical fitness levels, nutrition knowledge, and physical activity self‐efficacy among conventional and experimental intervention groups. Methods This study was a convenience sample, pre‐and post‐test, quasi‐exp...

Use of videoconferencing (VC) as a strategy to reduce barriers to breastfeeding has been minimally explored among breastfeeding families. Because fathers/maternal partners (FMPs) are often a vital source of support and encouragement, it is important to explore their acceptance of use of VC. This was a cross-sectional research design using online su...

The objective of this study was to assess pre‐ and post‐intervention dietary intake measures, physical activity levels, and body mass index (BMI) of students enrolled in a 10‐week (2 sessions per week) afterschool obesity prevention program. This one group pretest‐posttest design used a validated dietary intake survey, fitness measures using Fitnes...

The objective of this study was to assess the relationship of acceptance of remote lactation consultation using videoconferencing (VC) with maternal learning styles and demographic factors among mothers of infants 蠄16 weeks old who also reported breastfeeding initiation. This cross‐sectional research design used an online survey methodology with mo...

The objective of this study was to assess the relationship of acceptance of remote lactation consultation using videoconferencing (VC) with maternal learning styles and demographic factors among mothers of infants 蠄16 weeks old who also reported breastfeeding initiation. This cross-sectional research design used an online survey methodology with mo...

Excessive, rapid weight gain in early infancy has been linked to risk of later overweight and obesity. Inappropriate infant feeding practices associated with this rapid weight gain are currently of great interest. Understanding the origin of these practices may increase the effectiveness of interventions. Low-income populations in the Southeastern...

Evidence suggests that parental involvement in school‐based obesity prevention programs for elementary school students may improve outcomes. However, parental engagement can be difficult to achieve and maintain, especially among low‐income and rural families. As part of a continuous quality improvement process for an afterschool obesity prevention...

Research shows that parental engagement in childhood obesity prevention programs is key for children's healthy eating and activity. However, parental participation is difficult to achieve. The aim of this study was to test if the use of personalized digital nutrition and physical activity messages delivered to parents via a digital home message cen...

Recent findings from our research indicate that children participating in a creative afterschool program exhibit overall healthier lifestyle practices compared to the average US pediatric population. This observation led us to investigate the prevalence of overweight/obesity and lifestyle practices of their parents. To determine the strongest predi...

Dietary goals specific for lowering energy density (ED) may promote a nutrient-dense diet and weight loss. This pilot study examined the effects of ED-based diet prescriptions on diet quality and weight loss during a 3-month behavior-based obesity intervention conducted in a research setting. Forty-four adults with overweight/obesity (age 52.1±7.6...

Objective To examine if dietary intake (DI), physical activity (PA), and school and family subjective social status (SSS) differed based on weight status (WS). Methods 2,438 students in grades 7–12, who were surveyed and measured at a national creative competition, met study criteria and were included in the analysis. BMI was calculated using stan...

Use of videoconferencing technology for healthcare intervention and support is an area of tremendous potential, especially in regard to application in rural or underserved communities. Potential for cost-savings, time-savings, and increased access to care are the ultimate driving force behind use of this technology, for both providers and recipient...

Life course perspective, social determinants of health, and health equity have been combined into one comprehensive model, the life course model (LCM), for strategic planning by US Health Resources and Services Administration's Maternal and Child Health Bureau. The purpose of this project was to describe a faculty development process; identify stra...

This study evaluated the potential of youth partnerships to improve the school environment and child nutrition. A quasi-experimental trial was conducted with 2 intervention and 3 control schools. Intervention schools selected student leaders to participate in youth-led interventions in their schools. Students (n = 104) were included in the evaluati...

The aim of this study was to increase understanding of how college students perceive dietary supplements, including their experiences with and attitudes about these substances. This study used a qualitative case study design and content analysis of web log (blog) posts completed as an assignment in an undergraduate nutrition course. Students were a...

Objective To test if differences existed among 3 modes of intervention on fruit (F) & vegetable (V) liking, the mean number of Fs & Vs ever eaten, FV preference, & self‐efficacy to consume Fs & Vs using a short‐term intervention (3 weeks). Methods This study used a convenience sample, pre‐ & post‐test, quasi‐experimental design with 3 study school...

Blogs have the potential to increase reflection, sense of community and collaboration in undergraduate classrooms. Studies of their effectiveness are still limited. The purpose of this study was to investigate whether the use of blogs in a large lecture class would enhance students' perceived learning. Students in an undergraduate nutrition course...

The purpose of this presentation is to describe an after-school, positive youth development and gardening program, which used youth-led participatory action research with a Photovoice methodology to assess the community's food and physical activity environments. This novel pilot project targeted young adolescents to advocate for healthier community...

The aim of this project was to collect data from focus-group participants to inform the future development of region-specific educational strategies to modify infant-feeding practices that may predispose children to obesity. Infant-feeding perceptions and practices were collected from participants of the Special Supplemental Nutrition Program for W...

We describe two iterations of the design, development, implementation and evaluation of small online activity and reflection blogging groups into a large undergraduate lecture course in nutrition. Our goal was to promote student learning and conceptual change through reflection and interaction in blog conversations. We found the blog conversations...

Introduction of solid foods before the recommended age of 4-6 months is a common practice in the USA, and appears to be especially prevalent among infants who are enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Currently, little is known about how fathers influence early infant feeding decisions, outsi...

The purpose of this study was to evaluate the impact of the MyPyramid Color-bar Signage System, which is a unique, targeted environmental change for school cafeterias paired with nutrition education, designed to increase fruit and vegetable consumption among Kindergarteners in an inner city school. The color-bar system is an educational tool to ass...

Dietary supplement use is common among adults. However, little is known about the supplement intake among college students. The purpose of this project was to describe dietary supplement use among college students enrolled in an introductory nutrition course. Of 355 students enrolled in the course at a large southeastern university, 310 students co...

As part of a Coordinated School Health Program project to improve the nutrition quality of school meals, a series of nutrition education and culinary training in‐service workshops were conducted. The objective of this study was to determine the effect of the training on food service employees' nutrition knowledge and self‐efficacy scores. The subje...

The objective of this study was to determine if children who participate in a competitive, creative, problem‐solving program differ in BMI, food intake, and physical activity levels when compared to a nationally representative sample. Participants were a sample of high school‐aged youth that competed in the 2008 Destination ImagiNation® (DI) Global...

This paper explores how discourse analysis in social psychology (DASP) can provide CSCL researchers with insights regarding how students perform knowing and learning. We investigated what counted as knowledge and learning as students in a large undergraduate lecture course shared their understandings of dietary supplements through blog conversation...

This paper explores how discourse analysis in social psychology (DASP) can provide CSCL researchers with insights regarding how students perform knowing and learning. We investigated what counted as knowledge and learning as students in a large undergraduate lecture course shared their understandings of dietary supplements through blog conversation...

The objective of this project is to inform the development of educational strategies to modify infant feeding practices that may predispose the child to obesity. Data pertaining to caregiver’s infant feeding perceptions and practices were collected through focus groups with participants of the Special Supplemental Nutrition Program for Women, Infan...

In collaboration with a Coordinated School Health Program in rural East Tennessee, researchers piloted a survey with a convenience sample of 450 parents of students in grades K‐8 to determine their attitudes about the school nutrition environment (SNE) and changes that were made to improve the dietary quality of school meals. Of 108 returned survey...

The objective of this project is to inform the development of educational strategies to modify infant feeding practices that may predispose the child to obesity. Data pertaining to caregiver's infant feeding perceptions and practices were collected through focus groups with participants of the Special Supplemental Nutrition Program for Women, Infan...

Objective: A consistent definition for snacks has not been developed in dietary research despite snacking's significant contribution to overall dietary intake. The purpose of this research was to examine self‐reported definitions of a snack. Methods: 663 18–19yo entering freshman responded to the question, “How would you define the word “snack”?” Q...

Blogs have the potential to increase reflection, sense of community and collaboration in undergraduate classrooms. Studies of their effectiveness are still limited. The purpose of this study was to investigate whether the use of blogs in a large lecture class would enhance students' perceived learning. Students in an undergraduate nutrition course...