Coordinated School Health Program Research Articles

Design, protocol and baseline data of Nurturing Healthy Teachers, a cluster non-randomized controlled trial to improve the health, well-being, and food security of preschool and elementary school teachers in Houston, Texas

BackgroundWe present the conceptual framework, design, and study measures of Nurturing Healthy Teachers, a quasi-experimental study to examine the short- and long-term effectiveness of the Nurturing Healthy Teachers (NHT) nutrition intervention on food insecurity, dietary behaviors, mental health and cardiometabolic health among preschool and elementary school teachers. MethodsA convenience sample of 28 elementary schools with pre-kindergarten and elementary classrooms were recruited in Houston, Texas. Nurturing Healthy Teacher intervention includes Brighter Bites, an evidence-based coordinated school health program that combines access to fresh produce and nutrition education, and Create Healthy Futures, a web-based nutrition education program that targets nutrition knowledge, self-efficacy, mindfulness, and social support to create healthy habits among teachers. The primary outcome is food insecurity. Secondary outcomes include diet quality, mental health, and cardiometabolic health. Metabolic markers and skin carotenoid levels were assessed using in-person assessments, while all other measures were obtained via questionnaire. ResultsAt baseline, most of the participants were female, 63 % identified as Hispanic, were highly educated, and had a mean age of 42.6 years. Overall, 50 % of teachers were classified as being obese and 20 % had high cholesterol. At baseline teachers had a mean HbA1c (%) of 5.6 %.Moderate to severe depression was experienced by 18 % of teachers and 23 % of teachers experienced moderate to severe anxiety. ConclusionsThe results of this study will inform next steps towards future implementation and evaluation of teacher-focused interventions.

The Relationship Between Food Insecurity and Food Assistance Program Participation in Families of Preschool Children in the Rio Grande Valley

ABSTRACT The South Texas Early Prevention Study-PreK, a cluster randomized trial, explored the Bienestar Coordinated School Health Program’s influence on health variables in South Texas children. Factors associated with food insecurity (FI) were analyzed. Income-to-poverty ratio, income, and food assistance (FA) program participation were all associated with FI. Forty percent of families (257/643) reporting FI did not utilize FA. Of those families with FI, but who reported no FA participation, 31.8% were FA eligible. Families experiencing FI may underutilize FA programs, despite eligibility. Curtailing obstacles preventing FA program participation and matching those who are eligible with FA programs are crucial.

Design for a cluster randomized controlled trial to evaluate the effects of the CATCH Healthy Smiles school-based oral health promotion intervention among elementary school children

BackgroundThe top two oral diseases (tooth decay and gum disease) are preventable, yet dental caries is the most common childhood disease with 68% of children entering kindergarten having tooth decay. CATCH Healthy Smiles is a coordinated school health program to prevent cavities for students in kindergarten, 1st, and 2nd grade, and is based on the framework of Coordinated Approach to Child Health (CATCH), an evidence-based coordinated school health program. CATCH has undergone several cluster-randomized controlled trials (CRCT) demonstrating sustainable long-term effectiveness in incorporating the factors surrounding children, in improving eating and physical activity behaviors, and reductions in obesity prevalence among low-income, ethnically diverse children. The aim of this paper is to describe the design of the CATCH Healthy Smiles CRCT to determine the effectiveness of an oral health school-based behavioral intervention in reducing incidence of dental caries among children. MethodsIn this CRCT, 30 schools serving low-income, ethnically-diverse children in greater Houston area are recruited and randomized into intervention and comparison groups. From which, 1020 kindergarten children (n = 510 children from 15 schools for each group) will be recruited and followed through 2nd grade. The intervention consists of four components (classroom curriculum, toothbrushing routine, family outreach, and schoolwide coordinated activities) will be implemented for three years in the intervention schools, whereas the control schools will be offered free trainings and materials to implement a sun safety curriculum in the meantime. Outcome evaluation will be conducted at four time points throughout the study period, each consists of three components: dental assessment, child anthropometric measures, and parent survey. The dental assessment will use International Caries Detection and Assessment System (ICDAS) to measures the primary outcome of this study: incidence of dental caries in primary teeth as measured at the tooth surface level (dfs). The parent self-report survey measures secondary outcomes of this study, such as oral health related behavioral and psychosocial factors. A modified crude caries increment (mCCI) will be used to calculate the primary outcome of the CATCH Healthy Smiles CRCT, and a two-tailed test of the null hypothesis will be conducted to evaluate the intervention effect, while considering between- and within-cluster variances through computing the weighted-average of the mCCI ratios by cluster. ConclusionIf found to be effective, a platform for scalability, sustainability and dissemination of CATCH already exists, and opens a new line of research in school oral health. Clinical trials identifierAt ClinicalTrials.gov - NCT04632667.

Non-profit Coordinated School Health Program Achieves Student Outcomes in Both Beginning and Experienced Schools

Objective: The purpose of this study was to determine the efficacy of an ongoing health promotion program to sustain student outcomes over an extended period, and to determine if student outcomes are affected by the schools’ duration of program participation. Methods: The repeatmeasures study used secondary data from Healthy Schools Oklahoma for School Years 2016-2019. FITNESSGRAM assessed changes in student fitness levels (N = 12,219); an electronic health survey assessed changes in knowledge and behaviors (N = 6840). McNemar tests examined change in the proportion of students reaching the healthy fitness zone (HFZ) for 6 FITNESSGRAM tests, and the proportion of students with accurate knowledge or meeting dietary and physical activity recommendations. Poisson regression tested for change in student outcomes based on duration of program participation. Results: The proportion of students reaching HFZ increased for 5 of 6 fitness tests (p ≤ .004) and with accurate nutrition and physical education knowledge (p ≤ .009). We found statistically significant main effects for outcomes (p ≤ .016) and duration (p ≤ .030); there was no effect for the interaction. Conclusion: Students achieved similar gains in outcomes regardless of the schools’ duration of program participation.

REL Healthy School: Health Innovation Through Coordinated School Health Program in YWKA Elementary School

Schools as places for teaching and learning to take place are expected to become Health Promotion Schools. This can be maximally pursued by planning innovative health program activities in schools. The implementation of this community service activity provides solutions through health innovation in Trias UKS using Coordinated School Health Program. The method of activity is community empowerment, which is accomplished through a series of outreach, training, education, and coaching activities. Dokcil Students in SD YWKA improved their cognitive, attitude, and behavior as a result of the practice.

Social and Health Risk Factor Levels of Preschool Children Living Along the Texas-Mexico Border.

Childhood obesity is a public health concern that disproportionately affects populations from low socioeconomic status (SES) and minority groups. Evaluation of social and health risk factors of preschool children living along the Texas-Mexico border provides feedback to design health interventions. South Texas Early Prevention Study-PreK (STEPS-PreK) is a cluster randomized trial designed to assess the effect of the Bienestar coordinated school health program on children's health outcomes. Family characteristics, dietary intake, fitness, and anthropometric data were collected from 1277 preschool students enrolled in 28 preschools. The response rate was 67%. Overall, 57% of families lived in poverty. The mean age of students was 4.7 years, 95% were Hispanic, and 51% were male. The average serving of fruits and vegetables per day were 1 and 1/3, respectively. Of these, students consumed 39.7% of fruits and 18.9% of vegetables. Obesity prevalence for boys was 19.2% and for girls 16.8%. Nearly one-half reported some form of food insecurity. Children living in low-income areas are affected by high levels of social and health risk factors. It is these families who should be targeted with early-age and culturally appropriate health programs.

Parent Perspectives on Health and Functioning of School-Aged Adolescents With Disabilities.

Youth living with disabilities are at risk of experiencing poor health outcomes. Coordinated school health programs have an opportunity to help youth with disabilities and their families through health education, health services, and community engagement. The World Health Organization developed the International Classification of Functioning, Disability, and Health (ICF) as a framework to analyze factors related to health conditions. We used the ICF to examine parental perceptions of health and function among students with disabilities living in rural and urban areas. We surveyed parents (N = 71) using the parent-report versions of the Pediatric Outcomes Data Collection Instrument and Child Health and Illness Profile. From this group, parents were asked to volunteer to participate in in-depth, individual interviews (N = 18). The interviews were audio-recorded and transcribed verbatim. Researchers used the ICF linking rules to analyze and code the transcriptions. Emergent themes were assigned numerical ICF codes. There were more similarities than differences among rural and urban families. Children living with disabilities face significant environmental barriers regardless of context. Schools can facilitate education to improve the quality of life of parents and families of children with disabilities. School authorities should consider the many environmental barriers both urban and rural these families face in the community. The ICF can be used as a framework for program planning for community-based, health education for this population.

Adoption of Comprehensive School Physical Activity Programs: A Literature Review

P-12 physical education (PE) has evolved significantly over the last several decades, with one of the most important changes occurring recently with the inclusion of PE as a core academic subject (Society of Health and Educators [SHAPE America], 2015c). Well-designed PE programs have been acknowledged as having the unique potential to address student learning in all three of Bloom's domains (psychomotor, cognitive, and affective; National Association for Sport and Education [NASPE], 2011; SHAPE America, 2015a), but PE did not become a validated core subject until the recent 2015 revision of the federally legislated Elementary and Secondary Education Act (ESEA), a designation long since desired in the field (SHAPE America, 2015c).The advancement of a holistic approach emphasizing the education and health of students began in the late 1980s with the promotion of the Coordinated School Health Program model by the Centers for Disease Control and Prevention (CDC). The model identifies schools as essential agencies of change in youth health behaviors (Wechsler, McKenna, Lee, & Dietz, 2004) and includes eight components known to strongly influence student health, with PE serving as one of the components (Allensworth & Kolbe, 1987). In 1991, Sallis and McKenzie published the seminal paper Physical Education's Role in Public Health, highlighting the vital potential contribution of schools and PE in addressing the nationwide concerns related to childhood obesity and physical inactivity.In response to this critical national concern, the U.S. Department of Health and Human Services (USDHHS, 2008) introduced the first set of approved guidelines addressing physical activity (PA): the 2008 Activity Guidelines for Americans. The guidelines recommend that children and adolescents engage in at least 60 min of moderate to vigorous physical activity (MVPA) daily. To further convey the importance of increasing PA opportunities, NASPE (2008) released a position statement recommending that all P-12 schools implement a Comprehensive School Activity Program (CSPAP). A CSPAP should include (a) quality PE (QPE), (b) PA during school, (c) PA before and after school, (d) school employee wellness and involvement, and (e) family and community involvement.The National Activity Plan (NPAP Alliance, 2010) includes comprehensive strategies to promote PA by eight sectors of society. The education sector is responsible for outlining strategies and tactics that could be implemented in and around the school setting (NPAP, 2010), with the first of seven strategies specifically targeting the comprehensive approach of the CSPAP. The goal of Strategy 1 is to access to and opportunities for high-quality, comprehensive physical activity programs, anchored by physical education, in Pre-kindergarten through grade 12 educational (Education section, para. 4). In line with this strategy and the NASPE (2008) recommendation, schools have been identified as one of the most appropriate settings for increasing PA (Institute of Medicine [IOM], 2013; Kelder, Karp, Scruggs, & Brown, 2014; NPAP Alliance, 2010; USDHHS, 2008), and national initiatives such as Let's Move! Active Schools (n.d.) have been established to provide schools and teachers with the necessary resources and tools to increase PA opportunities for students.Most recently, in The Essential Components of Education, SHAPE America (2015a) outlines four components that establish a more direct path for attaining QPE programs: (a) policy and environment, (b) curriculum, (c) appropriate instruction, and (d) student assessment. SHAPE America (2015a) identifies these as foundational components designed to guide schools and physical educators in making PE a more validated subject area. In addition to emphasizing more rigorous policies and higher accountability in the field, SHAPE America (2015a) also strongly endorses the use of the CSPAP framework to increase overall PA opportunities for students. …

Impact of school-based vegetable garden and physical activity coordinated health interventions on weight status and weight-related behaviors of ethnically diverse, low-income students: Study design and baseline data of the Texas, Grow! Eat! Go! (TGEG) cluster-randomized controlled trial.

BackgroundCoordinated, multi-component school-based interventions can improve health behaviors in children, as well as parents, and impact the weight status of students. By leveraging a unique collaboration between Texas AgriLife Extension (a federal, state and county funded educational outreach organization) and the University of Texas School of Public Health, the Texas Grow! Eat! Go! Study (TGEG) modeled the effectiveness of utilizing existing programs and volunteer infrastructure to disseminate an enhanced Coordinated School Health program. The five-year TGEG study was developed to assess the independent and combined impact of gardening, nutrition and physical activity intervention(s) on the prevalence of healthy eating, physical activity and weight status among low-income elementary students. The purpose of this paper is to report on study design, baseline characteristics, intervention approaches, data collection and baseline data.MethodsThe study design for the TGEG study consisted of a factorial group randomized controlled trial (RCT) in which 28 schools were randomly assigned to one of 4 treatment groups: (1) Coordinated Approach to Child Health (CATCH) only (Comparison), (2) CATCH plus school garden intervention [Learn, Grow, Eat & Go! (LGEG)], (3) CATCH plus physical activity intervention [Walk Across Texas (WAT)], and (4) CATCH plus LGEG plus WAT (Combined). The outcome variables include student’s weight status, vegetable and sugar sweetened beverage consumption, physical activity, and sedentary behavior. Parents were assessed for home environmental variables including availability of certain foods, social support of student health behaviors, parent engagement and behavior modeling.ResultsDescriptive data are presented for students (n = 1369) and parents (n = 1206) at baseline. The sample consisted primarily of Hispanic and African American (53 % and 18 %, respectively) and low-income (i.e., 78 % eligible for Free and Reduced Price School Meals program and 43 % food insecure) students. On average, students did not meet national guidelines for vegetable consumption or physical activity. At baseline, no statistical differences for demographic or key outcome variables among the 4 treatment groups were observed.ConclusionsThe TGEG study targets a population of students and parents at high risk of obesity and related chronic conditions, utilizing a novel and collaborative approach to program formulation and delivery, and a rigorous, randomized study design.

School staff perceptions of factors influencing participation in a Whole-of-School initiative in an Indigenous community

Objectives: The purpose of this study was to investigate teachers’ perspectives on factors influencing their involvement in a Whole-of-School initiative. Methods: A survey was administered to participating teachers/school personnel ( N = 81) and 30 of the teachers/school personnel also participated in mostly individual interviews. The survey was informed by Lohrmann’s Ecological Model of Coordinated School Health Programs focusing on individual, interpersonal, community, organisation and policy factors. Category mean values were calculated for the survey data (along with t tests to explore differences by participant role in the schools), and interview data were analysed via analytic induction using several trustworthiness measures. Findings: Findings revealed that all survey categories ranked 3.5 or higher on a 5-point scale and there were significant differences by participant role. Interview data provided specific examples of each of the school health ecology factors. Conclusion: Results provide support for the model Whole-of-School programme efforts, insights into teacher and school personnel involvement and resistance to a school health change initiative. The project may serve as a model for other schools/districts interested in Whole-of-School health programming. The transformation that took place is especially important in this Indigenous community with significant health concerns.

Evaluating a school-based fruit and vegetable co-op in low-income children: A quasi-experimental study

The purpose of this study was to evaluate the effectiveness of a new school-based food co-op program, Brighter Bites (BB), to increase fruit and vegetable intake, and home nutrition environment among low-income 1st graders and their parents. This was a non-randomized controlled comparative effectiveness trial (2013–2015). Six schools received BB (n=407 parent-child dyads); six comparison schools implemented a coordinated school health program (n=310 parent-child dyads) in Houston, Texas, 2013–2015. Brighter Bites (BB) is a 16-week school-based food co-op comprising weekly distribution of fresh produce (50 servings); nutrition education in schools and for parents; and weekly recipe tastings. Measurements included parent-reported home nutrition environment surveys, and food frequency questionnaires for parent and child. Intervention effects were examined using multivariate analyses. At baseline, the sample was 71% Hispanic, 24% African American; 43% of 1st graders were overweight/obese. Children receiving BB had significant increases in intake of fruit servings (P=0.046), vegetable servings (P=0.049), and decreased intake of added sugars (P=0.014). Among parents, there were significant increases in fruit consumed (P=0.032); vegetable intake increased baseline to midpoint but not post-intervention. Among BB families, there were significant improvements in the home environment including understanding and usage of nutrition facts labels to make food purchases (P<0.05), frequency of cooking (P=0.007), rules and practices regarding eating family meals (P=0.022), serving fruits (P=0.005) and vegetables (P=0.028) at meals, and limiting portion sizes (P=0.016).In conclusion, a school-based food co-op model shows promising results in improving dietary habits and home nutrition environment among low-income families.

Barriers and Facilitators to Sustaining School Health Teams in Coordinated School Health Programs.

Coordinated school health (CSH) programs address multiple factors related to students' overall health, thereby increasing their physical and mental readiness to learn. A formative evaluation of three school districts in 2010-2011 examined strategies for sustaining the school health teams (SHTs) that lead CSH efforts. Qualitative data from 39 interviews and 13 focus groups revealed facilitators and barriers for sustaining SHTs. Quantitative data from 68 questionnaires completed by SHT members and school principals examined factors associated with having more active SHTs and district and school characteristics SHT members believed to be important to their schools' efforts to implement CSH. Facilitators of sustaining SHTs included administrative support, staff engagement in the SHT, and shared goals and responsibility. Barriers to sustaining SHTs included limited time and competing priorities, budget and funding constraints, and staff turnover. Findings provide valuable insight into challenges and potential solutions for improving the sustainability of SHTs to enable them to better support CSH efforts.

Quantifying collaboration using Himmelman ' s strategies for working together

Purpose– Coordinated school health programs (CSHPs), a type of health promoting school (HPS) program adopted by Canada and the USA, were developed to provide a comprehensive approach to school health in the USA. Community partnerships are central to CSHP and HPS efforts, yet the quality of collaboration efforts is rarely assessed. The purpose of this paper is to use Himmelman’s strategies for working together to assess the types of partnerships that are being formed by CSHPs and to explore the methodological usefulness of this framework. The Himmelman methodology describes four degrees of partnering interaction: networking, coordinating, cooperating, and collaborating, with each degree of interaction signifying a different level of partnership between organizations.Design/methodology/approach– Data were collected as part of the 2008-2009 and 2009-2010 CSHP annual Requests for Proposal from all 131 public school systems in Tennessee. Thematic analysis methods were used to assess partnerships in school systems. Descriptive analyses were completed to calculate individual collaboration scores for each of the eight CSHP components (comprehensive health education, physical education/activity, nutrition services, health services, mental health services, student, family, and community involvement, healthy school environment, and health promotion of staff) during the two data collection periods. The level of collaboration was assessed based on Himmelman’s methodology, with higher scores indicating a greater degree of collaboration. Scores were averaged to obtain a mean score and individual component scores were then averaged to obtain statewide collaboration index scores (CISs) for each CSHP component.Findings– The majority of CSHPs partnering activities can be described as coordination, level two in partnering interaction. The physical activity component had the highest CISs and scored in between coordinating and cooperating (2.42), while healthy school environment had the lowest score, scoring between networking and coordinating (1.93), CISs increased from Year 1 to Year 2 for all of the CSHP components. Applying the theoretical framework of Himmelman’s methodology provided a novel way to quantify levels of collaboration among school partners. This approach offered an opportunity to use qualitative and quantitative methods to explore levels of collaboration, determine current levels of collaboration, and assess changes in levels of collaboration over the study period.Research limitations/implications– This study provides a framework for using the Himmelman methodology to quantify partnerships in a HPS program in the USA. However, the case study nature of the enquiry means that changes may have been influenced by a range of contextual factors, and quantitative analyses are solely descriptive and therefore do not provide an opportunity for statistical comparisons.Practical implications– Quantifying collaboration efforts is useful for HPS programs. Community activities that link back to the classroom are important to the success of any HPS program. Himmelman’s methodology may be useful when applied to HPSs to assess the quality of existing partnerships and guide program implementation efforts.Originality/value– This research is the first of its kind and uses a theoretical framework to quantify partnership levels in school health programs. In the future, using this methodology could provide an opportunity to develop more effective partnerships in school health programs, health education, and public health.

Texas GROW! EAT! GO! Preliminary Findings of Garden, Nutrition and Physical Activity Interventions on Child Behaviors and Obesity

ObjectiveThe goal of the Texas GROW! EAT! GO! project is to assess the efficacy of a Coordinated School Health Program (CSH) enhanced with theory-based, family-focused, experiential garden, nutrition and physical activity programs on the prevalence of child obesity in third grade students.Description1,405 students, 1,200 parents, 128 teachers and 53 volunteers enrolled in Cohorts 1 & 2 of the study at five sites in Texas involving 80 classes of 3rd grade students. Title 1 schools at each site were randomly assigned to receive CHS alone or with Walk Across Texas (WAT), Junior Master Gardener (JMG) or both WAT and JMG over a one year period.EvaluationEvaluation included Child BMI and student surveys (four times over 2 years), parent surveys (3 times over 2 years), teacher and volunteer surveys (2 times over 1 year). Process evaluation included teacher records of implementation, school champion interviews, and weekly reports by on-site leaders.Conclusions and ImplicationsData from student and parent surveys (not matched) indicated increased self-efficacy to consume healthy beverages, reduced consumption of sugar sweetened beverages, increased healthy family meal practices and increased knowledge about nutrition and plant science. Combined treatment effects indicated significant increases in vegetable exposure and preference, decreased screen time, increased moderate to vigorous physical activity and selection of fruit juice over soda. Mixed effects were found related to obesity and overweight change.FundingUSDA Grant #2011-6800-30138, (USDA/NIFA Grant.gov # - 10950125). ObjectiveThe goal of the Texas GROW! EAT! GO! project is to assess the efficacy of a Coordinated School Health Program (CSH) enhanced with theory-based, family-focused, experiential garden, nutrition and physical activity programs on the prevalence of child obesity in third grade students. The goal of the Texas GROW! EAT! GO! project is to assess the efficacy of a Coordinated School Health Program (CSH) enhanced with theory-based, family-focused, experiential garden, nutrition and physical activity programs on the prevalence of child obesity in third grade students. Description1,405 students, 1,200 parents, 128 teachers and 53 volunteers enrolled in Cohorts 1 & 2 of the study at five sites in Texas involving 80 classes of 3rd grade students. Title 1 schools at each site were randomly assigned to receive CHS alone or with Walk Across Texas (WAT), Junior Master Gardener (JMG) or both WAT and JMG over a one year period. 1,405 students, 1,200 parents, 128 teachers and 53 volunteers enrolled in Cohorts 1 & 2 of the study at five sites in Texas involving 80 classes of 3rd grade students. Title 1 schools at each site were randomly assigned to receive CHS alone or with Walk Across Texas (WAT), Junior Master Gardener (JMG) or both WAT and JMG over a one year period. EvaluationEvaluation included Child BMI and student surveys (four times over 2 years), parent surveys (3 times over 2 years), teacher and volunteer surveys (2 times over 1 year). Process evaluation included teacher records of implementation, school champion interviews, and weekly reports by on-site leaders. Evaluation included Child BMI and student surveys (four times over 2 years), parent surveys (3 times over 2 years), teacher and volunteer surveys (2 times over 1 year). Process evaluation included teacher records of implementation, school champion interviews, and weekly reports by on-site leaders. Conclusions and ImplicationsData from student and parent surveys (not matched) indicated increased self-efficacy to consume healthy beverages, reduced consumption of sugar sweetened beverages, increased healthy family meal practices and increased knowledge about nutrition and plant science. Combined treatment effects indicated significant increases in vegetable exposure and preference, decreased screen time, increased moderate to vigorous physical activity and selection of fruit juice over soda. Mixed effects were found related to obesity and overweight change. Data from student and parent surveys (not matched) indicated increased self-efficacy to consume healthy beverages, reduced consumption of sugar sweetened beverages, increased healthy family meal practices and increased knowledge about nutrition and plant science. Combined treatment effects indicated significant increases in vegetable exposure and preference, decreased screen time, increased moderate to vigorous physical activity and selection of fruit juice over soda. Mixed effects were found related to obesity and overweight change.

Feasibility and Acceptability of Brighter Bites: A Food Co-Op in Schools to Increase Access, Continuity and Education of Fruits and Vegetables Among Low-Income Populations.

Intake of fruits and vegetables (F&V) continues to be low in children in the United States. The purpose of this study was to conduct a pilot feasibility evaluation of Brighter Bites, a school-based food co-op to provide access to fresh F&V and nutrition education to low-income children and their families. Brighter Bites is a 16-week school-based food co-op consisting of: (1) Weekly distribution of 50-60 servings of fresh F&V; (2) Weekly bilingual parent handouts and recipe demonstrations; and (3) implementing CATCH, a coordinated school health program in schools. Brighter Bites was pilot tested using a pre-post evaluation design in one charter school in Houston, TX, USA (n = 57 3rd grade parent-child dyads; 94.1 % Hispanic, 91 % low-income). Evaluation, at baseline, midpoint, and post-intervention, included self-reported child and parent surveys on psychosocial factors, dietary habits and mealtime practices. Pearson's Chi square test, Fisher's exact-test or paired t test were used to determine changes pre- to post-intervention (at p < 0.05). Process data using parent surveys, teacher surveys, attendance logs, and produce cost data were used to determine feasibility and acceptability of program. Participants received on average 61 servings of F&V weekly for 16 weeks at the cost of $4.31/family/week. Results showed significant increases in child reported self-efficacy, outcome expectations and attitudes towards consuming F&V (p < 0.05). We found significant increases in child exposure to F&V and child preference of various F&V from baseline to post-intervention (p < 0.05). Parent surveys showed significant improvements in mealtime practices at home: decrease in children eating while watching TV, increase in eating dinner with the family, less fast food, less sugary drinks with meals, more children asking for F&V as snacks. Process data showed 98 % retention rate and high parent acceptability of program components. Brighter Bites is a promising strategy to increase F&V access and education in low-income populations using existing infrastructure of schools and food banks.

Effect of a School-Based Intervention on Parents' Nutrition and Exercise Knowledge, Attitudes, and Behaviors

BackgroundParents exert a significant effect on children's eating behaviors and physical activity levels, so it is imperative to find successful obesity prevention programs that target whole families in underserved communities.PurposeTo investigate the effects of a Coordinated School Health Program (CSHP) on parents in the program over a 2-year period.MethodsParents of kindergarteners (n = 277) in 7 schools participating in a CSHP that served an underserved, predominantly minority community were surveyed at 3 time points regarding their nutrition and physical activity knowledge, attitudes, and behaviors (KABs). Results after years 1 and 2 were compared with pre-intervention results using t tests. Effects of socioeconomic variables were investigated using multivariate linear regression.ResultsReported unhealthy behaviors were lower at the end of both year 1 (P = .03) and year 2 (P = .04). Numerous factors were associated with changes in KABs in the parents, including parental gender.DiscussionA CSHP may have lasting effects on parental behaviors in an underserved, predominantly minority community.Translation to Health Education PracticeFuture studies should assess the effects of CSHPs in other populations and which factors most significantly affect parental attitude and behavioral changes so that program content may be tailored accordingly.

Exercise Strategies for Children

Exercise Strategies for Children

Health education: leading the way to a healthy future.

Formal health education occurs in the classroom, is guided by a well-designed lesson plan, and is aligned with the National Health Education Standards. Formal health education needs to be well thought out and planned in advance to achieve success. Health education is part of a coordinated school health program, and the school nurse plays an essential role in teaching students health knowledge and skills that will allow them to lead a healthy lifestyle.

Chapter 1 Setting the Stage: Coordinated Approaches to School Health and Physical Education

Is there anything more important than the health, well-being and education of a nation’s children? This paper takes the position that school is the most important place to educate children about health and to develop lifelong health promoting skills. We believe that health promotion programs and activities are integral to the school’s educational program, not as extracurricular, but as central to school’s educational mission. In this chapter, we highlight the importance of physical education and physical activity as key components of a well-designed coordinated school health program. We also outline the skills that PE teachers must learn to take a leadership role in the school health movement.

Texas GROW! EAT! GO! Cohort 1 Student Outcomes

The goal of the Texas GROW! EAT! GO! project is to assess the efficacy of a Coordinated School Health Program (CSH) enhanced with theory-based, family-focused, experiential garden, nutrition and physical activity programs on the prevalence of child obesity in third grade students. In Cohort 1 and 2, 1,600 students in 28 randomly assigned Title I schools received one of four treatments including Junior Master Gardener and/or Walk Across Texas over a one year period. Evaluation included student, parent surveys and child BMI. Data from 1405 students in Cohort 1 and 2 will document behavioral and BMI change related to treatment.