Marsha Spence

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Dr. Marsha Spence, MPH, RDN, LDN is a professor at the University of Tennessee where she is the director of the Public Health Nutrition Program and the Maternal and Child Health (MCH) Nutrition Leadership Education and Training Program. Her research includes evaluation of after school obesity prevention, nutrition and physical activity programs for school-aged children, positive youth development and peer leadership strategies to improve nutrition and physical activity environments, and parent engagement.

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Development of a Data Visualization Tool to Evaluate the Impact of a Maternal and Child Health (MCH) Nutrition Training Program on MCH Populations

Maternal and Child Health Journal

Using research to drive policy development: A school‐based nutrition intervention

The FASEB Journal, 2006

The objective of this intervention study was to use teacher generated themes from a qualitative s... more

Use of digital messages to increase parental engagement in an after‐school obesity prevention program

The FASEB Journal, 2013

A Cross‐sectional Survey of Intermediate School Teachers: Predictive Factors Associated with Teachers' Classroom Food‐related Practices

The FASEB Journal, 2007

Food intake, physical activity and BMI status of youth enrolled in a competitive, creative, problem solving program

The FASEB Journal, 2009

Dietary supplement use among college students

The FASEB Journal, 2009

Home food availability, dietary intake and child weight status

The FASEB Journal, 2011

Background: Childhood obesity is a critical public health problem. There is a crucial need to ide... more Background: Childhood obesity is a critical public health problem. There is a crucial need to identify environmental factors that either encourage or prevent obesogenic behaviors. The home food environment is one of the primary environments in which children are exposed to food. Therefore, it is crucial to study how the home food availability influences dietary intake and weight status. Objective: This study examines parental report of household food availability of fruits, vegetables, and milk, and its association with child weight status and child dietary intake of these foods. Methods: This is a cross-sectional study, based on surveys from 489 students in grades 3-12 their parents in 2009. Child participants were Destination ImagiNation® finalists. Child data collection included surveys based on the Youth Risk Surveillance Survey and anthropometric measurements of height and weight used to calculate child z-BMI. Parents self-reported their heights and weights and home food availability. Descriptive statistics were conducted and multiple linear regression was used to predict whether or not a relationship existed between home food availability, child weight status, and dietary intake of fruits, vegetables, and milk. Results: Overall, 12.5% of participants were overweight and 6.7% were obese. Approximately26% of participants consumed 5 or more servings of fruits and vegetables per day and 17% consumed 3 or more glasses of milk per day. However, a no significant relationship was found between home availability of fruits, vegetables, and milk and the reported intake of these foods. Although a significant association was also found between parent and child weight status, no significant association was found between home food availability and child weight status. Conclusions: Compared to national data, a larger proportion of this sample was classified as normal weight and consumed the recommended intake of fruits and vegetables and milk. Parents reported high availability of fruits, vegetables, and milk products. However, no significance was found between the reported availability of these foods and weight status or dietary intake of fruits, vegetables, or milk. v

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Impact of Nutrition and Culinary In‐service Training on School Food Service Employee Knowledge and Efficacy

The FASEB Journal, 2009

As part of a Coordinated School Health Program project to improve the nutrition quality of school... more

Cardiac Kids Club: A Childhood Obesity Prevention Afterschool Intervention for Elementary School Students

The FASEB Journal, 2015

Parents’ attitudes about a healthful school nutrition environment

The FASEB Journal, 2008

Eat the rainbow! Evaluation of a short‐term school‐based nutrition intervention

The FASEB Journal, 2011

After‐school obesity prevention programs: Are engaged parents a myth or reality?

The FASEB Journal, 2013

College student sleep quality and mental and physical health are associated with food insecurity in a multi-campus study

Public Health Nutrition, 2021

Objective:To assess the relationship between food insecurity, sleep quality, and days with mental... more 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 ten-item Adult Food Security Survey Module. Sleep was measured using the nineteen-item Pittsburgh Sleep Quality Index (PSQI). Mental health and physical health were measured using three items from the Healthy Days Core Module. Multivariate logistic regression was conducted to assess the relationship between food insecurity, sleep quality, and days with poor mental and physical health.Setting:Twenty-two higher education institutions.Participants:College students (n 17 686) enrolled at one of twenty-two participating universities.Results:Compared with food-secure students, those classified as food insecure (43·4 %) had higher PSQI scores indicating poorer sleep quality (P < 0·0001) and reported more days with poor mental (P < 0·0001) and physical (P <...

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Struggling with the basics: food and housing insecurity among college students across twenty-two colleges and universities

Journal of American College Health, 2021

OBJECTIVES To quantify the number and type of students failing to secure basic needs. PARTICIPANT... more 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 models were used to assess the relationship between selected factors and basic needs insecurities. RESULTS Participants (n = 22,153) were classified as 44.1% and 52.3% food insecure and housing insecure, respectively. Homeless students or those who experienced childhood food insecurity were at the greatest odds of college food insecurity. Year in school was the largest contributor to being housing insecure, with PhD or EdD students being 1,157% more likely to experience housing insecurity compared to freshmen. CONCLUSIONS High prevalence of basic needs insecurities remain. Current campus initiatives may be insufficient, calling for a more holistic approach at the campus, state, and national levels.

A Community-Based Cultural Adaptation Process: Developing a Relevant Cooking Curriculum to Address Food Security for Burundian and Congolese Refugee Families

Health Promotion Practice, 2020

Refugee-specific nutrition and cooking curricula addressing dietary acculturation barriers to foo... more 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, researcher informed, and formative interviews; n = 18], preliminary adaptation design [data incorporation and steering committee; n = 5], pilot testing [ n = 10 youth/adult dyads], and refinement) was applied to the existing evidence-based iCook 4-H curriculum using a five-strategy (peripheral, evidential, linguistic, constituent-involving, and sociocultural) cultural adaptation framework. A multiphase, two-cycle coding analytic process was completed within NVivo 12, followed by direct content analysis. Seventeen adaptations were made to the iCook curriculum, derived from varying combinations of four data sources (literature review, researche...

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Postpartum Anxiety, Breastfeeding Self-Efficacy & Breastfeeding Outcomes

Current Developments in Nutrition, 2020

Objectives Postpartum anxiety is associated with failure to meet breastfeeding (BF) goals. While ... more 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, depression, and BF self-efficacy scores. Methods An online survey using the State-Trait Anxiety Inventory (STAI), Edinburgh Postnatal Depression Scale (EPDS), and Breastfeeding Self-Efficacy Scale (BSES) was conducted. Eligible mothers were ³ 18 years old, had infants 4–24 weeks old, and had provided breastmilk in the prior 2 weeks. Screening stratified by anxiety across 4 groups (no, low, moderate, high) using the Generalized Anxiety Disorder-7 (GAD) tool to ensure sample variability. Possible score ranges for each scale were: GAD (0–21), STAI (20–80), EPDS (0–30), and BSES (14–70). Full sample correlations assessed relationships between S...

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Food Environments in the Classroom: Testing of an Experiential Learning Curriculum Intervention on Dietary Behavior

Journal of Nutrition Education and Behavior, 2018

Description: The 3-hour session covered taking and editing photos; making movies; Facebook live p... more Description: The 3-hour session covered taking and editing photos; making movies; Facebook live presentations; social media; and evaluation. Evaluations included pre-and post-workshop, process, and 3-month follow-up with a random gift card drawing incentive. Evaluation: Respondents represented 21 states, were female, and ranged from 26 to 69 years old. Pre-workshop surveys (n = 48) indicated top barriers to working with mobile devices included lacking knowledge (26%), time (24%), and institutional training (20%). Majority (75%) were very confident with taking photos, with few very confident in editing, movies, Facebook live, social media, and evaluation (average of 7%). Process and demonstrative evaluation techniques during the presentation included completing surveys with online survey software and interactive audience polls. Post-workshop participants (n = 38) rated the workshop as: good to excellent (95%); met expectations (86%); found material informative and useful (95%); and gained relevant knowledge/skills that could be used immediately (89%). Three-month follow-up results (n = 26) indicated 92% shared information with others (colleagues, staff, administrators). Top implemented items were creating photos and collages (25%), editing photos (20%), and social media posting (14%). Gains in feeling very confident were noted across taking (84%) and editing (38%) photos, social media (31%), and evaluation (23%). Conclusions and Implications: Using multiple forms of evaluation helped demonstrate workshop participants' change in confidence and skill attainment and showcased how they could use the various techniques demonstrated in future programming. Funding: None.

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Expenditure, Coping, and Academic Behaviors among Food-Insecure College Students at 10 Higher Education Institutes in the Appalachian and Southeastern Regions

Current Developments in Nutrition, 2019

Background: A number of studies have measured college student food insecurity prevalence higher t... more 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 food insecurity among college students in the Appalachian and Southeastern regions of the United States, and to determine the association between food-insecurity status and money expenditures, coping strategies, and academic performance among a regional sample of college students. Methods: This regional, cross-sectional, online survey study included 13,642 college students at 10 public universities. Food-insecurity status was measured through the use of the USDA Adult Food Security Survey. The outcomes were associations between food insecurity and behaviors determined with the use of the money expenditure scale (MES), the coping strategy scale (CSS), and the academic progress scale (APS). A forward-selection logistic regression model was used with all variables significant from individual Pearson chi-square and Wilcoxon analyses. The significance criterion α for all tests was 0.05. Results: The prevalence of food insecurity at the universities ranged from 22.4% to 51.8% with an average prevalence of 30.5% for the full sample. From the forward-selection logistic regression

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Barriers and Facilitators to Food Security among Adult Burundian and Congolese Refugee Females Resettled in the US

Ecology of Food and Nutrition, 2019

Sub-Saharan African refugees in the US have reported food security rates seven times below the na... more 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 linguistically appropriate interpreter. An iterative, two cycle coding analytic process was completed within NVivo 11 by two coders who sought inter-rater reliability. Codes were organized into hierarchical maps and coding matrices for direct content analysis, and pattern and theme detection. Saturation was achieved and validated with an additional two interviews. Participants were primarily Burundian (67% vs. 33% Congolese), married (72%), held no high school degree (72%), unemployed (56%) and reported limited English proficiency (72%). Barriers and facilitators to food security across all levels of the Socio-Ecological Model (SEM) were noted. Emerging themes included difficulty with language, cooking, and shopping; transportation; social network support; orientation services; reliance on nutrition assistance programs; limited culturally relevant food and land access; and program policy miscomprehension. The complex relationship between dietary acculturation barriers and facilitators at various SEM levels demonstrates the need for a multi-level intervention to improve food security among refugees.

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Maternal and Child Health Nutrition Faculty and Trainees Work Collaboratively with Community Partners to Assess Afterschool Nutrition Environments

Maternal and Child Health Journal, 2019

The purpose of this paper is to describe a collaborative service learning experience (SLE) which ... more 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 education and training (NLET) Program Director and the Knox County Health Department's healthy weight program manager. Description The SLE was a semester long project that included instructional time and fieldwork. Coursework focused on development of a community nutrition needs assessment, how to interpret and analyze assessment data, and how to use assessment data for program planning and policy development. Fieldwork consisted of interacting with an interprofessional team, assessing the nutrition environment at two afterschool sites, conducting a plate waste study to determine the amount of food consumed by children at the sites' dinner meals, interpreting and analyzing data, and developing and presenting recommendations for improvement. Assessment Trainees successfully completed all aspects of the SLE. They completed a community needs assessment of the neighborhoods surrounding the two afterschool program sites, conducted nutrition environment audits, including meal observations, and measured and analyzed plate waste from dinner meals served at the sites. Using the data gathered and collected, they prepared suggestions for nutrition environment improvements and policy development for community partners. Conclusion The SLE allowed trainees to develop MCH competencies and professional skills required in public health nutrition, while providing valuable data that subsequently was used to establish nutrition-related policies and interventions.

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