Publications by authors named "Julianna M Jayne"

11 Publications

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Development and Validation of the Military Eating Behavior Survey.

J Nutr Educ Behav 2021 Jun 29. Epub 2021 Jun 29.

Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA.

Objective: To describe the Military Eating Behavior Survey (MEBS), developed, and validated for use in military populations.

Design: Questionnaire development using a 6-phase approach that included item generation, subject matter expert review, cognitive interviewing, factor analysis, test-retest reliability testing, and parallel forms testing.

Setting: US Army soldiers were surveyed at 8 military bases from 2016 to 2019 (n = 1,561).

Main Outcome Measure: Content, face, and construct validity and reliability of the MEBS.

Analysis: Item variability, internal consistency, and exploratory factor analysis using principal coordinates analysis, orthogonal varimax rotation, and scree test (correlation coefficient and Cronbach alpha), as well as consistency and agreement (intraclass correlation coefficient) of test-retest reliability and parallel forms reliability.

Results: Over 6 phases of testing, a comprehensive tool to examine military eating habits and mediators of eating behavior was developed. Questionnaire length was reduced from 277 items to 133 items (43 eating habits; 90 mediating behaviors). Factor analysis identified 14 eating habit scales (hunger, satiety, food craving, meal pattern, restraint, diet rigidity, emotional eating, fast/slow eating rate, environmental triggers, situational eating, supplement use, and food choice) and 8 mediating factor scales (body composition strategy, perceived stress, food access, sleep habits, military fitness, physical activity, military body image, and nutrition knowledge).

Conclusions And Implications: The MEBS provides a new approach for assessing eating behavior in military personnel and may be used to inform and evaluate health promotion interventions related to weight management, performance optimization, and military readiness and resiliency.
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June 2021

Exceeding body composition standards is associated with a more negative body image and increased weight cycling in active duty U.S. soldiers.

Eat Behav 2021 May 24;42:101532. Epub 2021 May 24.

Medical Center of Excellence, U.S. Military-Baylor University Graduate Program in Nutrition, 3599 Winfield-Scott Rd, Building 2841, Fort Sam Houston, TX 78234, USA. Electronic address:

Negative body image is more often identified in individuals with overweight or obesity. More than 65% of U.S. soldiers have a body mass index (BMI) that classifies them with overweight or obesity. Additionally, all soldiers must meet body composition and physical fitness standards which may increase the risk of negative body image. This cross-sectional study aimed to identify associations between compliance with body composition standards, body image, and weight cycling through surveying 969 active-duty soldiers (86% male, 24.0 ± 5.5 years of age, BMI 26.0 ± 3.6 kg/m). Compliance with body composition standards was measured by whether a soldier had ever taken and failed the circumference-based body fat assessment. Weight cycling was self-reported as ≥3 weight fluctuations of ≥5% of body weight during their military career. Multivariate linear and logistic regression models were used to examine the relationship between compliance with body composition standards, body image, weight cycling, and sociodemographic characteristics while controlling for BMI. Failing the circumference-based body fat assessment was associated with increased concern with conforming to military image. Negative body image was associated with higher odds of weight cycling. Further examination is warranted to understand the effects of body composition standards on soldiers' body image and weight cycling.
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May 2021

Eating Behaviors Are Associated With Physical Fitness and Body Composition Among US Army Soldiers.

J Nutr Educ Behav 2021 Jun 3;53(6):480-488. Epub 2021 Mar 3.

US Military-Baylor University Graduate Program in Nutrition, Joint Base San Antonio-Fort Sam Houston, San Antonio, TX.

Objective: Examine associations between soldiers' eating behaviors, compliance with body composition and fitness standards, and physical performance.

Design: Cross-sectional study.

Setting: Eight Army installations.

Participants: US Army Soldiers (n = 1,591; 84% male).

Main Outcome Measures: Characteristics, eating behaviors, compliance with body composition and physical fitness standards, and fitness level were assessed via questionnaire.

Analysis: Bivariate and multivariable logistic regression.

Results: Eating mostly at a dining facility was associated with lower odds of body composition failure (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.26-0.73); whereas, eating at a fast rate (OR, 1.51; 95% CI, 1.05-2.17) or often/always ignoring satiety cues (OR, 2.12; 95% CI, 1.06-4.27) was associated with higher odds of body composition failure. Eating mostly fast-food/convenience meals (OR, 1.75; 95% CI, 1.19-2.59) and eating at a fast rate (OR, 1.42; 95% CI, 1.04-1.93) was associated with higher odds of physical fitness failure. Skipping breakfast was associated with lower odds of high physical performance (OR, 0.41; 95% CI, 0.23-0.74); whereas, nutrition education was associated with higher odds of high physical performance (OR, 1.02; 95% CI, 1.01-1.04).

Conclusions And Implications: As eating behaviors are modifiable, findings suggest opportunities for improving the specificity of Army health promotion and education programs.
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June 2021

Barriers to Nutrition Interventions in Army Dining Facilities: A Qualitative Study.

Mil Med 2020 Nov 30. Epub 2020 Nov 30.

Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA 01760, USA.

Introduction: Interventions that encourage good nutrition-related behaviors in the dining environment can potentially influence the health of large numbers of military personnel. Thus, the Army has studied the effectiveness of implementing nutrition education and dining facility (DFAC) changes that included healthier recipes, revised menus, and population-specific point-of-choice labeling, but successful intervention implementation largely depends on the foodservice employees' understanding, knowledge, and desire to sustain changes. This phenomenological, qualitative study aimed to better understand common barriers to the implementation and sustainment of DFAC-based nutrition interventions at two U.S. Army DFACs.

Materials And Methods: Focus group sessions (n = 168 participants) ranging from 60 to 90 minutes in length were conducted at two large DFACs on three separate occasions every 4 months from May 2015 to January 2016 among the foodservice staff during intervention implementation. Focus group transcripts were analyzed using NVivo 11 software. Researchers conducted multiple rounds of coding following an iterative process until four principal themes emerged.

Results: Principal themes related to the foodservice employees' experience during the nutrition intervention revealed barriers to a successful implementation related to (1) nutrition knowledge deficits, (2) inadequate culinary training, (3) poor management practices, and (4) low staff morale.

Conclusion: A lack of foodservice staff training and education is a significant contributor to implementation barriers. Future interventions should increase engagement with foodservice employees during intervention planning and implementation phases with a structured and tailored nutrition education and culinary skill training program. Addressing these barriers may enhance staff morale and promote intervention adherence.
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November 2020

Targeting Nutritional Fitness by Creating a Culture of Health in the Military.

Mil Med 2021 02;186(3-4):83-86

Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.

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February 2021

Stressful Life Changes and Their Relationship to Nutrition-Related Health Outcomes Among US Army Soldiers.

J Prim Prev 2020 04;41(2):171-189

Robbins College of Health and Human Sciences, Baylor University, One Bear Place #97346, Waco, TX, 76798, USA.

Stressful life changes may tax people's adaptive capacity. We sought to determine if and when experiences of stressful life changes were associated with increased odds of adverse nutrition-related health outcomes among US Army soldiers relative to those who did not experience the same stressful life change. An additional aim was to determine which stressful life changes had the greatest association with these outcomes and if there were gender differences in the magnitude of the associations. Stressful life changes studied included: changes in marital status, combat deployment or return from deployment, relocation, adding a child, change in rank, change in occupation, and development of a physical limitation to duty. Using longitudinal data from the Stanford Military Data Repository, which represents all active-duty soldiers aged 17-62 between 2011 and 2014 (n = 827,126), we employed an event history analysis to examine associations between stressful life changes and a subsequent diagnosis of hyperlipidemia, substantial weight gain, and weight-related separation from the Army. Marriage was associated with an increase in the odds of substantial weight gain 3 months later for both men and women. Developing a physical duty limitation was associated with an increase in the odds of a hyperlipidemia diagnosis 2 months later for both men and women, as was substantial weight gain 2 months later. Stressful life changes were also associated with increased odds of nutrition-related health outcomes, although we found gender differences in the magnitude of the associations. Findings could be used to mitigate the effects of stress on health by health professionals.
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April 2020

Body weight status, perceived stress, and emotional eating among US Army Soldiers: A mediator model.

Eat Behav 2020 01 16;36:101367. Epub 2020 Jan 16.

US Military-Baylor University Graduate Program in Nutrition, Joint Base San Antonio, Fort Sam Houston, TX 78234, United States of America.

Background: In civilians, overweight and obesity are associated with emotional eating behaviors such as eating in response to stress, but this association has not been examined in Soldiers, a population with unique stressors. This cross-sectional study examined the relationship between perceived stress (PS), emotional eating (EE), and outcomes of body mass index (BMI), and failing Army body composition (BC) standards among Soldiers.

Methods: Soldiers (N = 1460, 83% male, 23.5 ± 5.2 years old) completed validated surveys on PS, EE, and adherence with military BC standards. Conditional process models and mediation models tested gender as a moderator and EE as a mediator of associations between PS and BMI and PS and BC failure, respectively.

Results: Higher PS was associated with more frequent self-reported EE behaviors (p < 0.001), higher BMI (p < 0.001), and BC failure (p < 0.001). BMI significantly increased with frequency of reported EE behaviors (p < 0.001). Gender was not a statistically significant moderator in the relationship between PS, EE, and, BMI (p = 0.83) or BC failure (p = 0.57). PS appears to affect BMI indirectly through EE behaviors (c' = 0.03, 95% CI: 0.02, 0.04). PS may affect BC failure directly (c' = 1.04, 95% CI: 1.01, 1.08) and indirectly (ab = 1.02, 95% CI: 1.01, 1.03) through EE as a mediator.

Conclusions: EE behaviors may mediate the positive association between PS, BMI, and BC failure. Prospective investigation is warranted to better understand the role of EE in health-related outcomes among Soldiers and populations in high stress professions.
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January 2020

Validity of Digital and Manual Refractometers for Measuring Urine Specific Gravity During Field Operations: A Brief Report.

Mil Med 2019 12;184(11-12):e632-e636

Military Nutrition Division, US Army Research Institute of Environmental Medicine, 10 General Greene Ave., Natick, MA 01760.

Introduction: Dehydration can have an immediate negative impact on the performance of Soldiers in training or combat environments. Field expedient methods for assessing hydration status may be valuable for service members. Measurement of urine-specific gravity (USG) via refractometer is inexpensive, simple, fast, and a validated indicator of hydration status. Manual (MAN) and digital (DIG) refractometers are commonly used in laboratory settings however, digital (DIG) devices have not been validated in the field against MAN devices. The purpose of this study was to determine the validity and feasibility of using a DIG refractometer to assess USG compared to a MAN refractometer during a military field training exercise.

Materials And Methods: Fifty-six military service members provided 672 urine samples during two 10-day field training exercises in central Texas. USG was assessed using a MAN and a DIG refractometer with cutoff value of ≥1.020 indicating hypohydration. The study received a non-human research determination.

Results: The MAN measurements were strongly correlated with the DIG (r = 0.91, p < 0.0001) measurements. Bland-Altman analysis demonstrated agreement between the refractometers. The DIG displayed good sensitivity (93.9%) and specificity (85.8%) compared to the MAN.

Conclusion: The DIG refractometer used in this study was reliable and valid compared with a MAN device and was feasible for use in a field environment; however, the DIG refractometer tended to over overestimate hypohydration.
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December 2019

Trajectories of body mass index among active-duty U.S. Army soldiers, 2011-2014.

Prev Med Rep 2019 Jun 5;14:100818. Epub 2019 Feb 5.

Robbins College of Health and Human Sciences, Baylor University, One Bear Place #97346, Waco, TX 76798, USA.

Establishing the shape and determinants of trajectories of body mass index (BMI) among Soldiers is critical given the importance of weight management to military service requirements. To establish the shape and determinants of BMI trajectories among Soldiers, we aimed to (1) model the overall BMI trajectory of Soldiers, (2) find the most common trajectory groups among Soldiers, (3) investigate the relationship between BMI trajectories and sociodemographic and military-specific characteristics, and (4) determine if there were Soldiers with large fluctuations in BMI. The study population included all US Army Soldiers on active-duty between 2011 and 2014 who were age 17-62 ( = 827,126). With longitudinal data from the Stanford Military Data Repository, we used group-based trajectory modeling to identify the BMI trajectories of Soldiers and multinomial logistic regression to estimate associations between Soldier characteristics and trajectory membership. Four distinct BMI trajectory groups were found: increasing, decreasing, constant, and inconstant. The constant, increasing, and decreasing trajectories were similar in shape and percentage between men and women. The constant trajectory had the fewest Soldiers who exceeded weight standards or had duty limitations. The increasing trajectory was associated with marriage and fewer service years. The decreasing trajectory was associated with more service years and higher educational attainment. The inconstant trajectory differed in shape between men and women. Over 6% of men and 12% of women had fluctuations in BMI indicative of weight cycling. Understanding the characteristics associated with BMI trends may assist the Army in targeting resources aimed to improve Soldier health and combat readiness.
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June 2019

Role of Drill Sergeants in Nutrition Behaviors of Soldiers in Basic Combat Training.

J Acad Nutr Diet 2019 01 27;119(1):69-75. Epub 2018 Jul 27.

Background: In the US Army, soldiers' nutrition behaviors have a direct impact on their performance. The emphasis in basic combat training is on "soldierization" (transforming a civilian into a soldier), and drill sergeants are instrumental in this process. Limited information about how drill sergeants use their influence to have an impact on nutrition behaviors of new soldiers is available.

Objective: This study aimed to determine nutrition attitudes, beliefs, and knowledge of drill sergeants; the ways drill sergeants instill new soldiers with an army identity (eg, warrior athlete, army strong); and how healthy eating is perceived to fit with this new identity.

Design: This qualitative, phenomenological study used in-depth interviews conducted with army drill sergeants at two southeast US Army posts between July and August 2011 (n=30).

Main Outcome Measures: Interviews emphasized drill sergeants' perceptions of the eating environment during basic training, the drill sergeant role, and drill sergeants' main duties.

Data Analysis: An iterative process of group coding using a constant comparative method was used to find distinct themes. Data were analyzed using qualitative data analysis software.

Results: Drill sergeants described their main duty as training new soldiers. Drill sergeants identified the ideal soldier as lean and physically fit but did not identify training soldiers how to eat to become the ideal soldier as part of their duties. Confusion about nutrition concepts was common. Overall, drill sergeants recognized that what soldiers eat affects their physical performance and appearance, but they did not see helping soldiers establish healthy eating behaviors as one of their duties or responsibilities during basic combat training.

Conclusions: Drill sergeants are key individuals in the process by which new recruits develop a soldier identity. Additional resources are necessary to help drill sergeants emphasize nutrition and health during basic combat training and help them guide soldiers toward adopting healthy eating as part of their soldier identity to improve weight management, health, and performance.
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January 2019

A Healthy Eating Identity is Associated with Healthier Food Choice Behaviors Among U.S. Army Soldiers.

Mil Med 2018 11;183(11-12):e666-e670

Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC.

Introduction: Promoting healthy eating among Soldiers is a priority to the Army due to the link between nutrition and performance. The Army typically uses nutrition education to encourage Soldiers to make healthier food choices with low emphasis on other psychosocial determinants of food choice behaviors.

Materials And Methods: Drill Sergeant Candidates (n = 575) completed surveys assessing nutrition knowledge, eating identity type, and food choice behaviors including fruit and vegetable intake, skipping meals, and eating out frequency. In multiple linear regression models using full-information maximum likelihood estimation while controlling for race/ethnicity, education, and marital status, we examined relationships between nutrition knowledge, a healthy eating identity, and Soldiers' food choice behaviors. The study was approved by the Department of Defense and University of South Carolina's Institutional Review Boards.

Results: A healthy eating identity was positively associated with greater fruit and vegetable consumption (p < 0.05), and negatively associated with skipping meals and eating out frequency (p < 0.05). Nutrition knowledge was negatively associated with skipping meals (p < 0.05).

Conclusions: Findings suggest that fostering a healthy eating identity may be more effective for promoting healthy food choice behaviors than nutrition education alone. Determining if various points in a Soldier's career could be leveraged to influence a healthy eating identity and behaviors could be an important strategy to improve compliance with health promotion programs.
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November 2018