Progress 02/01/16 to 01/31/17

Outputs
Target Audience:The no cost extension period of 2/1/2016 to 1/31/2017 focused on three target audiences: 1) parents and children who were enrolled in the Choose to Change Project to complete their final elementary school check-in assessment for anthropometrics; 2) community representatives in Kanawha and Monongalia Counties who would participate in a survey about attitudes toward childhood obesity and health programming; and 3) dietetic internship administrators and students who would consider translating study materials into a curriculum to be used in future efforts to train new generations of interventionists. Changes/Problems:Two major challenges were experienced during the no cost extension. First, extreme flooding conditions impacted the Kanawha County region leaving many without homes and schools. This had a significant effect on the study assessment goals. To combat this challenge, team members worked closely with schools and individual families to schedule home visits (or common community sites) where the anthropometric assessment could be completed. When possible, these assessments were completed at the school. the second challenge was the anticipated attrition experienced from being enrolled in a study for two years. Several families had moved and were no longer available to participate in the final assessment. Where possible, we completed the assessment if the family maintained contact with the study team. What opportunities for training and professional development has the project provided?In this reporting period, the Choose to Change Project worked closely with dietetic administrators to translate study materials into a curriculum and quick guide for interns to use when conducting community training with children. These guides specifically include bullets that highlight instructional points shown to be effective for young children with regards to increasing their healthy eating and physical activity simultaneously. Additional professional development opportunities were taken over the reporting period at national and international conferences. Graduate students and our project manager (Viggiano) presented study findings at various professional meetings. How have the results been disseminated to communities of interest?As noted earlier, our Choose to Change Team has been actively analyzing data collected over the past four years. Quickly, our team has analyzed findings pertinent to our proposed study aims. These findings have been presented at national and international conferences across disciplines including: USExtension, public health, social work, interdisciplinary obesity meetings, and early child development. We have also had great success within the area of geospatial analyses with our newest team members (Harris, Lafone) and will be presenting GIS work in spring and summer 2017. What do you plan to do during the next reporting period to accomplish the goals?The project funding is now finalized; however, our team is committed to work together to analyze more study data over the next year. We plan to disseminate these findings across annual meetings and to use the information as pilot data for future grant applications pertinent to childhood obesity efforts.

Impacts
What was accomplished under these goals? The main focus of the 2/1/16 to 1/31/17 no cost extension period was to complete three remaining activities originally proposed related to the overall goals and objectives of the proposed study. Specifically, we completed the final elementary school assessments of the last cohort (Cohort 2.0). Completing these final assessments increased our sample size and completed the cohort based on the student's final height, weight, and waist circumference measures, which served as dependent variables in models developed to identify environmental and behavioral factors that act as barriers to a healthy diet andphysical activity PA (Obective 1. Research 1.1). This final assessment was also used in analyses to test the effectiveness of the Choose to Change intervention, which included various WVU Extension-based activities including the Family Fun Nights (Objective 2.1-2.3; Objective 3.1-3.2). A final survey was also distributed across various community representatives was also conducted to obtain a final attitudinal assessment of childhood obesity and available programming. Community representative groups mirrored those who had participated in focus groups in year 1 of this study to obtain information that was incorporated into the intervention activities. These groups included: community leaders, advisory board members, parents of preschool students, and parents who had participated in the Choose to Change intervention directly. This information also contributed to a data point that will be used to note possible differences before and after the Choose to Change Project was implemented in the Kanawha and Monongalia County regions. The final activity in the no cost extension period included administrators and students involved in the dietetic programs at Marshall University and West Virginia University. These programs serve the state and would continue to develop the next generation of dieteticians. Our efforts in this area were to translate study materials and findings into teaching materials used with dietetic interns in local communities. These materials would continue to review the elements of Choose to Change and attempt to increase healthy eating and physical activity among the preschool populations throughout the state. In this area, study materials were translated into quick guides for interns and administrators to use when conducting community trainings.

Publications

• Type: Conference Papers and Presentations Status: Accepted Year Published: 2016 Citation: Bennett K, Bowen E, Sayago-Gomez J, Murphy E, Viggiano K, Cottrell L. Family and food purchasing patterns based on accessibility and environmental and geographic factors. Selected for poster presentation at the APHA annual meeting, November 2016, Denver, CO.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2016 Citation: Morris K, Viggiano K, Murphy E, Bowen E, Cottrell LA, Atkins M, Gray T, Scott A. Choose to change: A school and family based obesity prevention intervention amongst Preschoolers and Kindergarteners and their families. Poster presentation presented at the APHA annual meeting. Chicago, IL. 2016.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2016 Citation: Viggiano K, Bennett, K, Bowen E, Murphy E, Cottrell L. Its all about the base: Helping parents in creating a healthier home. Selected for poster presentation at the APHA annual meeting, November 2016, Denver, CO.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2016 Citation: Viggiano, K. (2016, October). Healthy Families Choose to Change: An Early Childhood Obesity Research Project in West Virginia. Poster session presented at the Eat Smart, Move More South Carolina Obesity Summit, Columbia, SC.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2016 Citation: Viggiano, K. (2016, November). Choose to Change: An Early Childhood Obesity Intervention Project in West Virginia with Focus on Healthy Lifestyle Modification. PowerPoint presentation at the Annual Southern Obesity Summit, Houston, TX.

Progress 02/01/11 to 01/31/17

Outputs
Target Audience:The Choose to Change Project examined factors associated with early childhood obesity (i.e., preschool years) in two counties of West Virginia (WV): Kanawha and Monongalia Counties from 2/1/2011 to 1/31/2017. This project not only focused on preschool children (3- to 4-year-olds) but their parents, siblings, community leaders and other providers in their local communities, and preschool teachers and administrators. Subsequent assessments of enrolled families also incorporated elementary school facilities and teaching staff (kindergarten and 2nd grade). Changes/Problems:Over the course of the program period, we have faced many challenges. Some challenges have created delays in program implementation, data collection, and/or dissemination. Other challenges have been easily overcome. Personnel Challenges Team member loss:In Years 1-4, the Choose to Change team lost several key members (e.g., changed institutions, passed away). These losses led to gaps in personnel expertise. In most instances, the team was able to identify faculty, staff, and students who had the expertise and ability to begin to work on the project to complete the noted goals and objectives. Communication:The Choose to Change Project team was unique due to the fact that it represented multiple disciplines andspanned the majority of the WVU campus. The size and scope of the team required close communication and management, which was limited in Years 1-4 of the project. Management assistance was provided in Years 3-5 of the project to help navigate the large team through the various activities proposed. Additionally, team members held a retreat to review completed activities, note next steps, and map out needs for Year 5 and a no cost extension period. These activities and subsequent regular meetings, minutes, and updates were helpful in making the team more cohesive in their efforts. Natural Challenges:Several natural events occured that challenged intervention implementation and data collection. In Year 2, Kanawha County experienced a polluted water supply from a leak in a major tributary. This public health event led to increased concern among families about their water source and overall health. In Year 5, the same region experienced intense flooding, which led to a loss of homes, schools, and larger community spaces. During these times, the team communicated with families as often as possible to check in on their needs, to see if they had to relocate, and to attempt to sustain the programming as much as possible. What opportunities for training and professional development has the project provided?The Choose to Change Project has incorporated a large team of undergraduate and graduate students throughout the program period. These students represent a wide variety of disciplines including: public health, social work, nutritional sciences, child development, exercise physiology, and psychology. Students have gathered experiences developing research elements, implementing early childhood health programming like Choose to Change, and trouble shooting research challenges in a rural environment. Additionally, the Choose to Change Project has employed individuals early in their careers. The effort and products from the Choose to Change have offered professional development to all team members via a wide range of scholarly products. How have the results been disseminated to communities of interest?To date, most of the study findings have been disseminated through national and international conference presentations. Five manuscripts have been published; at least four are in progress at this time. As noted earlier, data collection and entry issues needed to be resolved prior to analyzing much of the data. These and project team changes, led to delays to data analysis and dissemination for this project. What do you plan to do during the next reporting period to accomplish the goals?The funding for the Choose to Change Project is complete at this time. The team has chosen to continue to work on the study findings to disseminate more scholarly work in this area. This information will be used to seek additional external funding and to disseminate best practices on childhood obesity prevention in WV.

Impacts
What was accomplished under these goals? Overview: At the conclusion of the Choose to Change Project, our study team has accomplished all of the originally proposed goals and objectives. We requested a no cost extension period to obtain the final assessment of the last cohort of children enrolled in the study. This time was also used to analyze data that had not been analyzed over the course of the project period due to various challenges and team changes. The Choose to Change team also took the no cost extension opportunity to collect post-intervention attitudinal information about early childhood obesity in the same regions where focus groups had been conducted in year 1 of the grant. This information was collected from the same groups (e.g., community leaders, parents, Choose to Change parents, teachers) to compare and note potential improvements in areas where the Choose to Change intervention had taken place. We also took this opportunity to begin to translate study materials into lasting teaching tools/ guides. These guides will be used by dietetic programs throughout the state (Marshall University and West Virginia University). Specific summaries for each objective are provided below. Objective 1. Research A randomized control trial was implemented in years 2-5 of this study across three cohorts of preschool children and their families in Kanawha and Monongalia counties of WV. Overall, 158 families were enrolled in cohort 1, 131 families in cohort 1.5, and 190 families were enrolled in cohort 2.0. Based on the randomization results in cohorts 1 and 1.5 and attrition loss in those years, all families were randomized to the intervention in the last cohort (2.0). Across all cohorts, the attrition rate was 52.6%. This rate was much higher than anticipated and occured near the one-year anniversary of their participation. As a result, assessing the impact of the program at 1- and 2-years post will be difficult with this sample size. Families who participated in the study were rmore diverse thanstate demographics but representative of the socioeconomic and geographic experiences of families living in rural WV. More than ten presentations at national and international conferences and five manuscriptshave disseminated initial findings about the intervention and process. The team plans to continue to disseminate work from the project into the next year. Objective 2. Extension Over the proposed project period, WVU Extension team members have consistently utilized toolkits and guides focused on healthy eating and physical activity to educate community members, health profession clubs, 4-H clubs, and other audiences. In the first year of the project, members trained community representatives on processes for conducting environmental audits. This process using the EPAO was successful but often took a considerable amount of time to complete. NEMS training and evaluations were also available to different students and professionals throughout the course of the project. Similarly, these took a considerable amount of time but were successful in raising awarness about limitations to select foods and physical activity opportunities in the target areas. Extension team members were also key in implementing portions of the Choose to Change intervention. At least four family fun events were scheduled each year for each cohort. These events were scheduled at times (usually in early evening) that were more conducive to family schedules. Events incorporated at least one healthy eating and physical activity lesson for the entire family. Participants received information and materials to take home with them to immediately apply what they had learned at the family fun event. Those who were not able to attend received information from the event via mail. Lastly, Extension team members coordinated mini-grant opportunities to intervene at the community level within the targeted counties of WV. At least 20 mini-grants were awarded during the course of the program period. Each mini-grant had select activities and outcomes to achieve. Once completed, mini-grants were reviewed andtheir results disseminated to others for potential replication. Objective 3. Education One portion of the Choose to Change intervention program included educational lessons that were implemented within the preschool/daycare setting by trained teachers. The I Am Moving, I Am Learning (IMIL)curriculum assumed a large piece of this educational portion of the intervention. Teacher workshops were held on a regular basis. As new teachers were hired for this age group, additional workshops were provided. In addition to the Family Fun Nights, families also received educational lessons from the school and project team directly. These materials focused on healthy eating and proper physical activity for this age group. Objective 4. Education The final piece of the Choose to Change process was the dietetic rotation for dietetic interns. This component was delayed in Monongalia due to challenges the Dietetic Internship was having. Marshall University interns started rotating with the project early (Year 2/3). Dietetic students at West Virginia were hired as graduate students in Years 3-5. While our goals were completed in Year 5 of the project for this component, much work is needed given the dearth of dieticians in WV. Translation of study materials is the first step (completed this year) to provide evidence-based information to interns to disseminate to families of young children living in WV.

Publications

Progress 02/01/15 to 01/31/16

Outputs
Target Audience:The Choose To Change (C2C) Project team continued to work closely with our partners to improve modifiable lifestyle behaviors of young children and their families. Originally beginning the project as preschool students, C2C children were followed as they entered Kindergarten and, for earlier cohorts, the First Grade. Additionally, the team worked closely with communities working with groups on mini-grants, business owners for increasing awareness of food accessibility, and community leaders on additional built environment opportunities. Changes/Problems:To date, the Choose to Change Project team has made no significant changes to the goals, objectives, or activities of the project in 2015. We have experienced leadership changes. Dr. Partington's departure from the University also required the team to re-evaluate the condition of the study database. Upon review, additional organization and cleaning has been required to ensure all team members have appropriate access to the complete study data. These additional processes have delayed our intended schedule for disseminating study findings limiting our publication and presentation rate for 2015. At this time, we believe we now have access to all data and have started to implement a timeline of data cleaning and analyses to increase our dissemination both to scholarly audiences and our community partners. What opportunities for training and professional development has the project provided?Marshall University and West Virginia University Dietetic Interns continued to work with the Choose to Change team to receive supervised practicum hours with early childhood populations. How have the results been disseminated to communities of interest?Aggregate data and descriptive information from study findings have been shared withour Community Advisory Board members on March 9, 2015 and March 16, 2015 in this reporting period. The first meeting was with school partners; the second withcommunity partners in Kanawha County. Select study findings have been disseminated to scholarly audiences at various international and national meetings. What do you plan to do during the next reporting period to accomplish the goals?We have submitted a request for a no cost extension. This request includes activities that would allow us to complete, and expand upon, our noted goals and objectives. Specifically, our request included the following activities: First, the final biometric assessments of our third and final cohort will be due in the early spring of 2016. These biometrics are scheduled in the school setting as our enrolled child participants enroll in kindergarten, first, and second grades and will be necessary to evaluate the long-term impact of the intervention. A second task in the no-cost extension pertains to the final NEMS evaluation of our two counties. As reported, a full NEMS evaluation was completed in the early portion of the project. Conducting a similar NEMS evaluation of all vendors of food in our target areas will allow us to evaluate what environmental changes might have taken place as a result of our intervention as well as what contextual factors are found that might explain any changes in our family choices. For the third task we would replicate the ethnographic research we conducted in the first year of the project. Focus groups and key informant sessions were conducted to capture the community-based perceptions of childhood obesity and the factors that may contribute to obesity. Parents, teachers, and community leaders were asked to provide their perceptions of who was responsible for the rising obesity and what strategies were already successfully implemented in their area. Capturing similar information after the intervention is complete will not only allow us to explore potential community-based changes but also look at changes to social determinants of obesity in our program areas. The fourth and final task included in the no-cost extension is related to our developing partnership with the dietetic programs at West Virginia University and Marshall University. As proposed, lesson plans have been developed that could be used by dietetic interns even after the grant is complete. These lessons would specifically target childhood obesity and are suitable to the Pre-K and Kindergarten populations. To date, we have not yet had the opportunity to test the feasibility of implementing these lessons within the existing dietetic intern infrastructure. In our proposal, one of our goals in this area is to provide efficient and effective information to teachers and to sustain these efforts over time. While we will not be able to adequately test the sustainability of these lessons, we strongly feel it is important to identify strengths and challenges to implementing these lessons through an existing program that reaches the state. As noted in the challenges section of this report, we have noted the departure of Dr. Partington from WVU. We have already made great strides to ensure all team members have access to the study data to improve team collaboration and to increase dissemination of study findings to many audiences in the short-term. Our team has provided a significant amount of effort to clean the data and prep it for analyses. We have regular data meetings and are focused to utilize the current time (and any additional time if awarded a no cost extension) to publish this work.

Impacts
What was accomplished under these goals? 1. Research 1.1 Identify environmental and behavioral factors that act as barriers to unhealthy diet and sedentary behavior. We have consistently identified environmental and behavioral factors associated with unhealthy diet and sedentary behavior throughout the project period. As previously reported, our Year 1 ethnography work involving individual interviews and focus group sessions with community leaders, parents, and school personnel identified a variety of factors that were considered when developing the study intervention and individual activities. Our community partners continued to identify factors in their environment and personal lives that received attention (and will receive attention analytically later this year). Preliminary environmental analyses using the NEMS data identified additional environmental factors and methodological approach considerations when examining environmental factors (accessibility) related to diet and healthy food consumption in the target areas. This year, the NEMS analyses continued under the supervision of Dr. Partington in late 2014/early 2015. Continued analyses of these factors before and after the developed intervention will be conducted in January/February 2016. 1.2 Implement and evaluate obesity prevention strategies Our obesity prevention program completed mid-2015. Our team implemented ongoing IMIL trainings to preschool teachers as proposed, implemented community strategies directly to families via Family Fun Nights, and provide on-line resources using social media as proposed. One quarter of participants, on average, attended at least oneFamily Fun Night (FFN). Three FFN's were implemented in both Kanawha and Monongalia counties in 2015 (the initial FFN for cohort 2.0 was held in 2014). Each FFN was met with great anticipation and satisfaction (65-78% satisfied) with most participants intending to modify their behaviors based on the lessons they had learned in the FFN (observations and responses from each FFN available upon request). Finally, our team conducted environmental audits inparticipating preschool facilities in 2015 (15 classroom observations in Kanawha; 46 in Monongalia in 2015). 2. Extension 2.1 - 2.3 Increase community knowledge and awareness of healthy food and physical environments, develop & implement strategies, and engage community stakeholders. The WVU Extension Service has been a study partner in this project from inception providing direct development, onsite supervision, and logistical oversight for activities includingeach Family Fun Night (see activities for this year above) and the IMIL trainings for preschool personnel (also noted above). Team members (Drs. Bowen and Murphy)also coordinated the community advisory boardmeetings and mini-grant opportunities for this project. During this reporting period, five community organizations were funded for mini-grant projects with the remaining budgeted mini-grant funds. In total, we have supported 19 initiatives designed to improve healthy environments for young families. InMarch 2015, the Monongalia County Community Advisory Board (CAB) met with the mini-grant organization representativesto discuss Choose to Change accomplishments and to identify additional steps for sustainability. In October 2015, all Kanawha and Monongalia County CAB partners and mini-grant organization representatives received an on-line survey to documen the social networks resulting from Choose to Change activities as well as their perceptions about the project. Results showed that the majority of community partners agreed that Choose to Change was successful in exchanging knowledge and informationthrough community collaboration. Final reports from all mini-grant projects will be due January 2016 and available for review. Finally, our Extensionpartners are involved in theenvironmental audits (described above). 3. Education 3.1 Conduct pediatric obesity prevention educational events We have provided a detailed description of our pediatric obesity prevention project in prior annual reports. In this reporting period, we continued to provide the program directly to children enrolled as the cohort 2.0 (third cohort enrolled) through I am Moving, I am Learning on-site at participating preschools and to their parents via Family Fun Nights, social media, and other direct contact (mailing, texts, etc). Cohort 2.0 included 38 families in Kanawha County and 126 families in Monongalia County. 3.2 Train and support Pre-K teachers in IMIL As noted earlier, we continued to train preschool teachers on the IMIL curriculum this reporting period. However, the majority of the training for cohort 2.0 had occured prior to the reporting period. Trainings for new teachers due to changing teaching assignments were the primary responsibility in this reporting period. 3.3 Nutrition rotation for dietetic interns This obesity prevention project continued to be a significant source of training for two dietetic programs in West Virginia - West Virginia University and Marshall University. Once trained on the responsibilities of ethical research (CITI training), interns played a crucial part conducting baseline and follow up assessments, home visits, and environmental audits. Weekly reviews of these activities were essential for reviewing processes and challenges. During this reporting period, 12 interns from Marshall University and 3 interns from WVU were rounding with the program. Related Activities Completed in Reporting Period Baseline and follow up assessments were essential pieces of the research for this project. During the reporting period, 28 of 38 home visits (74%) were completed in Kanawha County. Eleven of 38 (29%) on-line surveys were completed for Cohort 2.0. Cohorts 1.0 and 1.5 follow up biometrics were also completed on 68 of 96 participants (70%) durng the reporting period for Kanawha County. In Monongalia County, 106 of 126 home visits for Cohort 2.0 were completed (84%); 55 of 126 (44%) of cohort 2.0 completed on-line surveys. Biometrics for cohorts 1.0 and 1.5 were also conducted and completed for 81 of 147 (55%) participants during this reporting period.

Publications

• Type: Conference Papers and Presentations Status: Accepted Year Published: 2015 Citation: Morris K, Viggiano K, Murphy E, Bowen E, Cottrell LA, Atkins M, Gray T, Scott A. Choose to change: A school and family based obesity prevention intervention amongst Preschoolers and Kindergartners and their families. Poster presentation presented at the APHA annual meeting. Chicago, IL. 2015.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2015 Citation: Ackerman S, Bowen E, Atkins M, Gray T, Murphy E, Viggiano K. Choose to change: Communities collaborate for healthier weights. Poster presentation presented at the APHA annual meeting. Chicago, IL. 2015.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2015 Citation: Viggiano K, Atkins M, Gray T, Ackerman S, Scott A, Cottrell L. West Virginia early childhood obesity prevention project: EPAO methodology. Poster presentation presented at the APHA annual meeting. Chicago, IL. 2015.
• Type: Theses/Dissertations Status: Accepted Year Published: 2015 Citation: Scott AE, Dailey R, Giacobbi P, Lacombe D, Partington S. The influence of accelerometer cut points on determining the percent of preschool-age children meeting physical activity guidelines. Student master's thesis accepted as partial fulfillment of the requirements for the degree in Animal & Nutritional Sciences.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2015 Citation: Bowen E, Ackerman S, Fine-Clark B, Gray T, Murphy E, Murphy E. The more, the merrier: Engaging partners for healthier community environments. Research poster presentation at the Society for Nutrition Education and Behavior Annual Conference. Pittsburgh, PA.

Progress 02/01/14 to 01/31/15

Outputs
Target Audience: Pre-kindergarten teachers and aides in Monongalia and Kanawha Counties attended I am Moving, I am Learning (IMIL) Training. Pre-kindergarten subject children and families: attended Family Fun Events nutrition and physical activity educational events. West Virginia University Human Nutrition and Foods, Community Nutrition undergraduate students completed service learning experience. Community members in Kanawha and Monongalia counties attended project events. Community Advisory Boards Community group mini-grant awardees Changes/Problems: The project's began recruitment and collection from its third Cohort (2.0). Due to structural changes within the project and unexpected external factors, the overall number of participants in Kanawha County dropped and the overall number of participants in Monongalia County increased. Cohort 2.0 has total aggregate numbers ahead of Cohort 1.0 and Cohort 1.5. Although the project had originally planned on having only two offerings, a third round of community minigrants was decided upon when the first two rounds had not exhausted available funding. This money was distributed in late 2014. What opportunities for training and professional development has the project provided? Control school pre-kindergarten teachers and aides in Monongalia and Kanawha Counties attended I am Moving, I am Learning (IMIL) Training in August, September, and October of 2014. Experimental school pre-kindergarten teachers and aides attended IMIL refresher training in August, September, and October of 2014. Marshall University Dietetic Interns completed supervised practice hours. How have the results been disseminated to communities of interest? Selected information has been shared with members of the project's Community Advisory Board. Posters at Professional Conferences. Publications What do you plan to do during the next reporting period to accomplish the goals? 1. Objective 1 Research: 1. Cohort 1.0 1. Analyses and publication of pre- and post-intervention data 2. Second grade biometric screening 3. Follow-up surveys 2. Cohort 1.5 post-intervention data collection 1. Analyses and publication of pre- and post-intervention data 2. First grade biometric screening 3. Follow-up surveys 3. Cohort 2.0 Post-intervention data collection 1. Home visits - 1 per family 2. Online surveys - 11 per family 3. Kindergarten biometric screening 4. Data management and processing 1. Grocery-restaurant receipt collection 1. Data entry 2. Probabilistic data linkage to food/nutrient database 2. Pantry audit data 1. Barcode decode 2. Probabilistic data linkage to food/nutrient database 5. Data analyses, pre-post comparisons all cohorts. 2. Objective 2: Extension: 1. Community Advisory Board Meetings 3. Objective 4: Education 1. A Director for the WVU graduate dietetic internship was recently hired and will start July 1, 2014. 2. Develop and implement an obesity prevention education rotation for the dietetic internship.

Impacts
What was accomplished under these goals? Objective 1 Research: 1. Research: Continued ongoing data collection with 158 Cohort 1.0 families and 131 Cohort 1.5 families for participation. Recruitment and collection began with 190 Cohort 2.0 families. 1. Home visits - 1 per family 2. Online surveys - 11 per family 3. Objective physical activity assessment 1. Accelerometer monitoring (1 week) mid- and post-intervention 2. Activity log data entry 4. Kindergarten biometric screening 2. Cohort 1.5 Recruitment and post-intervention data collection 158 families 1. Home visits - 1 per family 2. Online surveys - 11 per family 3. Pre-kindergarten biometric screening 4. Objective physical activity assessment 1. Accelerometer monitoring (1 week) pre- and mid-intervention 2. Activity log data entry 3. Data Management and processing 1. Grocery-restaurant receipt collection 1. Data entry 2. Probabilistic data linkage to food/nutrient database 2. Pantry audit data 1. Barcode decode 2. Probabilistic data linkage to food/nutrient database 4. Community food audit 1. Stores (496) and restaurants (897) re-audited using the reduced NEMS. 5. School environment assessment (cohort 2.0) 1. EPAO (Environment and Policy Assessment and Observation System) 2. Administers in all project schools 1. Monongalia County: 44 classrooms 2. Kanawha County: 24 classrooms 3. Data entry and scoring Objective 2: Extension: 1. Five Community Group minigrants were distributed in 2014 to groups in Kanawha and Monongalia Counties. Objective 3. Education: 1. Pre-kindergarten teachers and aides in project schools received initial or refresher IMIL training. 2. Four Family Fun Events were held in each county for project families. Objective 4: Education 1. The WVU graduate dietetic internship will resume in Fall 2015. The planned pediatric obesity prevention rotation will be developed.

Publications

• Type: Journal Articles Status: Published Year Published: 2014 Citation: Partington SN, Papakroni V, Menzies T. Optimizing data collection for public health decisions: a data mining approach. BMC Public Health. 2014; 14:593.
• Type: Journal Articles Status: Accepted Year Published: 2015 Citation: Partington S, Menzies TJ, Colburn TA, Saelens BE, Glanz K. Reduced Item Food Audits based on the Nutrition Environment Measures Surveys. Am J Prev Med. 2015.

Progress 02/01/13 to 01/31/14

Outputs
Target Audience: Pre-kindergarten teachers and aides in Monongalia and Kanawha Counties attended I am Moving, I am Learning (IMIL) refresher training. Pre-kindergarten subject children and families: attended Family Fun nutrition and physical activity educational events. West Virginia University Human Nutrition and Foods, Community Nutrition undergraduate students completed service learning experience. WVU ISPP (Individualized Supervised Practice Program) Dietetic Interns completed supervised practice hours. Community members in Kanawha and Monongalia counties attended project events. • Mini-grant training • Community Advisory Boards Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? WVU ISPP (Individualized Supervised Practice Program) Dietetic Interns completed supervised practice hours. Marshall University Dietetic Interns completed supervised practice hours. West Virginia University Human Nutrition and Foods, Community Nutrition undergraduate students completed service learning experience. How have the results been disseminated to communities of interest? Selected information has been shared with members of the project’s Community Advisory Board. This was limited because of the project’s ongoing data-collection. Posters at Professional Conferences. What do you plan to do during the next reporting period to accomplish the goals? Objective 1 Research: Cohort 1.0 Analyses and publication of pre- and post-intervention data First grade biometric screening Follow-up surveys Cohort 1.5 post-intervention data collection Home visits – 1 per family Online surveys – 11 per family Kindergarten biometric screening Objective physical activity assessment Accelerometer monitoring (1 week) post-intervention Activity log data entry Cohort 2.0 Recruitment and pre-intervention data collection Home visits – 1 per family Online surveys – 11 per family Kindergarten biometric screening Objective physical activity assessment Accelerometer monitoring (1 week) pre-intervention Activity log data entry Data management and processing Grocery-restaurant receipt collection Data entry Probabilistic data linkage to food/nutrient database Pantry audit data Barcode decode Probabilistic data linkage to food/nutrient database Community food audit Data collection Monongalia County: 842 stores and restaurants Kanawha County: 1,237 stores and restaurants Data analyses School environment assessment (cohort 1.5) EPAO (Environment and Policy Assessment and Observation System) Administered in all project schools Monongalia County: 44 classrooms Kanawha County: 24 classrooms Data entry and scoring Objective 2: Extension: Community Advisory Board Meetings Mini-grant assistance Objective 3. Education: Pre-kindergarten teachers in project schools received IMIL training. Four Family Fun Events were held in each county for experimental project families in experimental group. Objective 4: Education A Director for the WVU graduate dietetic internship was recently hired and will start July 1, 2014. Development of childhood obesity prevention internship rotation.

Impacts
What was accomplished under these goals? Objective 1 Research: Cohort 1.0 Post-intervention data collection 154 families. Home visits – 1 per family Online surveys – 11 per family Objective physical activity assessment Accelerometer monitoring (1 week) mid- and post-intervention Activity log data entry Kindergarten biometric screening Cohort 1.5 Recruitment and pre-intervention data collection 158 families. Home visits – 1 per family Online surveys – 11 per family Pre-kindergarten biometric screening Objective physical activity assessment Accelerometer monitoring (1 week) pre- and mid-intervention Activity log data entry Data management and processing Grocery-restaurant receipt collection Data entry Probabilistic data linkage to food/nutrient database Pantry audit data Barcode decode Probabilistic data linkage to food/nutrient database Community food audit Development and validation of reduced-item NEMS survey for stores and restaurants. Development of survey format for android smartphones and tablets. Server set-up for direct upload of food audit data. School environment assessment (cohort 1.0) EPAO (Environment and Policy Assessment and Observation System) Administered in all project schools Monongalia County: 44 classrooms Kanawha County: 24 classrooms Data entry and scoring Objective 2: Extension: 15 Community Group minigrants were distributed to applicants in Kanawha and Monongalia Counties. Objective 3. Education: Pre-kindergarten teachers in project schools received IMIL refresher training. Four Family Fun Events were held in each county for experimental project families in experimental group. Objective 4: Education: This WVU graduate dietetic internship is still temporarily suspended due to institutional understaffing.

Publications

• Type: Journal Articles Status: Accepted Year Published: 2014 Citation: Partington SN, Papakroni V, Menzies TJ: Optimizing data collection for public health decisions: a data mining approach. BMC Public Health, 2013, accepted pending response to reviewer comments.
• Type: Journal Articles Status: Under Review Year Published: 2014 Citation: Partington S, Lacombe D, Cottrell L & Menzies T. Associations between aspects of the home and community environments and BMI percentile in preschool aged children. Public Health Nutrition, 2014, under review.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2014 Citation: Partington S, Lacombe D, Cottrell L & Menzies T. Associations between the neighborhood and home environments and weight status in pre-kindergarten children. Experimental Biology 2014, San Diego, CA. April 26-30, 2014. Accepted
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2014 Citation: Middleton MG, Partington S & Lacombe D. Walking Score Matrix for Two Appalachian Communities in West Virginia. 37th Annual Appalachian Studies Conference, Marshall University, Huntington, WV. March 28-30, 2014. Accepted.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2104 Citation: Cottrell L, Murphy E, Partington S. If You Build It, Who Will Come? American College of Sports Medicine 2014 Annual Meeting, Orlando, FL. May 27 - 31, 2014. Accepted.
• Type: Conference Papers and Presentations Status: Under Review Year Published: 2104 Citation: Partington S. Panel Presentation. American Public Health Association 2014 Annual Meeting, New Orleans, LA, November 15-19, 2014. Submitted. Cottrell L, Bowen E, Wade K, Gray T, McCartney K, Atkins M, Partington S, Murphy E. Assessing and building capacity for a comprehensive obesity prevention program with families of young children. Bowen E, Fint-Clark B, Gray T, Murphy EJ, Partington S, Swint S, Murphy EC. Community engagement in childhood obesity prevention, methods used in the Choose to Change Project. Piras G, Partington S. Food outlet use and proximity to home and work. Gray T, Workman S, Partington S. Challenges and tips for recruiting and retaining families of pre-school children in a year-long obesity prevention study. Murphy EC, Atkins M, Cain A, Carson L, Cottrell L, Murphy EJ, Gray T, Partington S, Workman S, Yohn B, Bowen E. Choose to Change: A school- and family-based obesity prevention intervention amongst pre-kindergarteners and their families.

Progress 02/01/12 to 01/31/13

Outputs
Target Audience: Pre-kindergarten teachers and aides in Monongalia and Kanawha Counties attended I am Moving, I am Learning (IMIL) Training. Pre-kindergarten subject children and families: attended Family Fun Events nutrition and physical activity educational events. West Virginia University Human Nutrition and Foods, Community Nutrition undergraduate students completed service learning experience. WVU ISPP (Individualized Supervised Practice Program) Dietetic Interns completed supervised practice hours. Community members in Kanawha and Monongalia counties attended project events. Community Kick-Off Events Community Advisory Boards Changes/Problems: Initially 2 cohorts had been planned, one for the 2012-2013 school year and one for the 2013-2015 school year. Recruitment of families fell short of anticipated levels. An additional cohort was added for the 2013-2014 school year. The WVU Graduate dietetic Internship is currently on hiatus to reorganize the program and hire a new Director. The proposed internship rotation will be developed in next program year. What opportunities for training and professional development has the project provided? Pre-kindergarten teachers and aides in Monongalia and Kanawha Counties attended I am Moving, I am Learning (IMIL) Training. Academy of Nutrition and Dietetics Individualized Practice Program students completed supervised practice hours. Marshall University Dietetic Interns completed supervised practice hours. How have the results been disseminated to communities of interest? Community Kick-off Events were held in both counties. Posters at Professional Conferences. What do you plan to do during the next reporting period to accomplish the goals? Objective 1 Research: 1. Post-intervention assessments will be completed for cohort 1. Pre- and post-intervention assessments will be evaluated to assess intervention effectiveness. 2. Cohort 2 families wll be recruited and will complete pre-intervention assessments. 3.Assess community environments for physical activity and nutrition using GIS database and reduced item NEMS Surveys. Objective 2 Extension: 1. Results for cohort 1 will be disseminated to community advisory groups. Objectives 3 and 4: Education: 1. Family Fun Events for cohorts 1 and 2. 2. Implement a pediatric obesity prevention community nutrition rotation for dietetic interns. 3. Conduct workshops for community groups to assist them in writing mini-grant proposals.

Impacts
What was accomplished under these goals? Objective 1. 1. Research: Cohort one families (154) recruited pre-interventions assessment completed. Objective 2: Extension: 1. Advisory groups formed in each county. 2. Two Community group mini-grants were awarded to fund small projects addressing healthy lifestyle barriers. Objective 3. Education: 1. Pre-kindergarten teachers in project schools received IMIL training. 2. Two Family Fun Events were held in each county for project families.

Publications

• Type: Conference Papers and Presentations Status: Accepted Year Published: 2013 Citation: Martin, R.G., Partington, S., Lacombe, D., and Waterland, N. (2013) Home food gardening, fruit and vegetable intake, and weight status in pre-kindergarten children. FASEB J 27, lb348

Progress 02/01/11 to 01/31/12

Outputs
OUTPUTS: Activities: Eighteen NEMS trainings of community groups were conducted in Kanawha County and 14 in Monongalia County. Community nutrition environment audit completed. Nutrition Environment Measures (NEMS) Surveys completed for 433 retail food outlets in Kanawha County and 445 in Monongalia County.NEMS survey scanning , verification, and data cleaning have been completed. Data reduction to produce NEMS scored for study area completed. Analyses of these data is ongoing. Focus group and key informant interviews completed and recordings have been transcribed, qualitative analyses of these data are being completed.Random sample of schools selected in each county, initial subject recruitment underway. Construction of online surveys for the collection of family and individual level data. Surveys include socio-demographic information, physical activity, consumer behavior, nutrition knowledge, health status and health history, home gardening, community walkability, family food habits, food security, and family food behavior. Pilot testing of online surveys. Project presentations have been made to 18 groups. Eighteen NEMS trainings were conducted, involving 19 community groups and three student groups. A total of 100 raters were trained. Six focus groups were conducted with 32 parents and school staff. Thirty community key informants have been interviewed. Events: Family Style meal Training conducted in both counties. I am Moving, I am Learning (IMIL) Training for PIs and Project Staff. Products: GIS database constructed to assess the physical activity environment. Project brand developed. PARTICIPANTS: Susan Partington, Project Manager: Overall project management, budget management, data management, survey development, develop specs and structure for data warehouse. Tammy Gray, Project Coordinator Kanawha County: NEMS training-auditing, community group networking, focus group recruiting-coordinating-facilitating, key informant interviews, communications, administrative tasks. Kristin McCartney, Project Coordinator, Monongalia: NEMS training-auditing, community group networking, focus group recruiting-coordinating-facilitating, key informant interview, communications, administrative tasks. Emily Murphy, Co-I: Conduct NEMS trainings, assist PI with project implementation, develop focus groups questions and format, oversee focus group and key informant interviews. Megan Atkins, GRA: Assist with NEMS audit, transcription of key informant and focus group recordings. Gianfranco Piras, Co-I: Assist PI in defining data specifications, assist PI in identifying data elements for outcomes analyses, assist PI in planning data analyses. Maryam Neghsh Nejad, GRA: Formatting and management of online surveys. Donald Lacombe, Co-I: Assist PI in defining data specifications, assist PI in identifying data elements for outcomes analyses, assist PI in planning data analyses. Mark Middleton, GRA: Development of GIS database to assess physical activity environment. GIS data management and integration, Jordan Bryant, GRA: Scanning NEMS Surveys, data verification. Roanna Martin, GRA: Scanning NEMS Surveys, data verification, development and testing of home gardening survey, data cleaning. Lesley Cottrell, Co-I: Qualitative analyses of key informant interview data and focus group data, assist in development of focus group format and questions. Elaine Bowen, Co-I: Community engagement, event planning, NEMS trainings, NEMS data collection, marketing materials development. Paige Dewhirst, GRA: Transcription of focus group and key informant interviews, NEMS auditing. Lindy Hoeft, GRA: Food retail outlet location GPS coordinates recording, focus group recording and transcription. Kerri Wade, WVU Extension: NEMS training, focus group facilitation. Partner Organizations West Virginia University WVU Davis College of Agriculture WVU Extension Service Regional Research Institute, WVU Monongalia County Schools Kanawha County Schools WV Headstart WVU Medical School, Pediatrics, Choosy Kids, LLC Daughters of the American Revolution, Friends of Deckers Creek Children's Home Society Boys and Girls Club, Jakes Run Church, WVU Women's Ultimate Frisbee Club, Arnettsville Community Center, Children's Discovery Museum, Senior Monongalians, Fairmont State University Nutrition Students, WVU Graduate Student Nutrition Association, WVU Exercise Physiology Club, St. Andrew Nursery School, Elk Valley 4-H, Shamrock Club, Kanawha County 4-H Leaders, Keys 4 Healthy Kids, Good Samaritan Foundation Charitable Fund of WV Inc. Manna Meal, East End Family Resource Center (EEFRC,) Community Educational Outreach Service Clubs, Greenmont Neighborhood Association, Children's Discovery Museum, WVU Collegiate 4-H Club Collaborators and contacts: Tim Menzies, WVU Computer Sciences TARGET AUDIENCES: Target audiences Community groups, Neighborhood Associations, 4H Clubs, Student Associations, Pre-kindergarten teachers and elementary school food service staff in Monongalia and Kanawha Counties. Efforts Support training for school personnel on related obesity prevention topics (family style meals). PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.

Impacts
None to report.

Publications

• Bryant, J., Partington, S., Straeger, M. Inskeep, K. & Neal, W. A. (2011), Targeting Community-based Interventions using Spatial Mapping, (abstract), 8th International Conference on Diet and Activity Methods, Rome, Italy. May, 2012 (accepted). Bryant, J., Partington, S., Straeger, M. Inskeep, K. & Neal, W. A. (2011), Targeting Community-based Interventions using Spatial Mapping, (abstract), Experimental Biology 2012, San Diego, California. April, 2012 (accepted). Partington, S., Menzies, T.,Lacombe, Bryant, J. & Neal, W. A. (2011), Measuring the Nutrition Environment: a Data Mining Approach, (abstract), 8th International Conference on Diet and Activity Methods, Rome, Italy. May, 2012 (accepted).