Progress 03/01/11 to 02/29/16

Outputs
Target Audience:The target audiences for this final year of the project included: In Texas - Texas A&M AgriLife Extension County Agents, Regional Program Leaders and District Extension Administrators; Educational, Health and Youth Serving organizations in Texas. Nationally - Extension, public health and educational partners across the 16 southern US counties; Extension specialists in JMG, FCS and Health and 4-H and Youth, and County educators from other states; Research faculty from universities interested in school focused garden, nutrition and physical activity interventions, research studies and findings. These audiences were reached through dissemination trainings, professional conference presentations, teacher workshops, and published articles. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?Extension Goal 4: Dissemination of intervention through Extension, schools and public health partners within Texas, across the southern US and nation through making presentations supporting student dissertations and writing articles. The TGEG study was transitioned to the "Learn, Grow, Eat & Go" Program, with a community engagement guide, the LGEG classroom curriculum, and a WAT Starter Kit. Two statewide and 16 regional Extension one-day trainings have been conducted in Texas involving 1024 participants: 278 county educators/agents; 59 Extension specialists, administrators and program assistants; 135 Master Wellness and Master Gardener volunteers; 434 local teachers, parent support specialists and school administrators and 118 community partners. How have the results been disseminated to communities of interest?Obj. 4:2: THI conducts conference for key Extension, Texas Education Agency & state decision-makers to plan for statewide diffusion & training. The Texas Health Institute and Texas A&M AgriLife Extension Service collaborated on a 5 hour dissemination training to share a new evidence-based program for elementary schools and communities: Learn, Grow, Eat & Go. A recent randomized controlled trial study with the UTSPH - Michael and Susan Dell Center for Healthy Living found both significant child BMI reductions and health and physical activity child and parent behavior changes resulting from this program. LGEG combines a school curriculum with school gardens, fresh vegetable exposures and physical activity components in a year-long school-community partnership. Forty five participants from 13 of the 16 southern States and 6 additional states represented Extension Services, University research partners, elementary schools, hospitals, public health and non-profit organizations. The training promoted environmental changes to improve the culture of health in elementary schools. 31 participants responded to the evaluation with 29 rating the session Extremely or Very Helpful. A second session on "Little p Policy Changes" attracted more than 50 participants with 36 responding to the evaluation survey. Twenty-five found the session to be Extremely or Very Helpful. The framework in the hands-on session challenged participants to identify little "p" changes that could be made individually, at home, at work and in civic and religious group settings. Dissemination in US. JMG Coordinators from 21 states were trained at the National Youth Gardening Symposium; 45 Extension and University faculty were trained at the National Health Outreach Conference. Presentations and pre conferences through the Extension Agent's professional associations- NEAFCS, NAE4-HA and Tenessee Master Gardener's State Conference provided 160 county educators and 104 volunteers with the tools to implement LGEG. volunteers, Extension educators, teachers and community partners in 35 states received training on the LGEG programs in 2015-2016. These included: 21 Junior Master Gardener State coordinators at the American Horticulture Society- National Youth Gardening symposium (AHS-NYGS); 55 community leaders, volunteers, teachers and Extension staff at 4 concurrent sessions at the AHS-NYGS; 50 FCS Educators at the national Extension Association of Family and Consumer Science Agents; 18 4-H Youth Educators at the NAE4-HA preconference and 50 4-H agents at the National Association of Extension 4-H agents; 45 Extension educators or specialists and 50 community members at the Southern Obesity Summit pre-conference; 45 Extension specialsits and agents at the national health outreach Conference; and 100 Master Gardeners and Extension Agents at the Tennessee Master Gardener State Conference. Obj.4:3: Present results regionally & nationally. Three publications have been resubmitted with revisions, one is under review. Six additional articles are in draft stages. 29 state and national peer reviewed presentations have been accepted, presented or will be presented by the end of 2016. These are provided in products section of this report. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? Research Goal 2 & 3 The goal of the Texas GROW! EAT! GO!(TGEG) study was to measure the impact of different combinations of two existing family focused garden, nutrition and physical activity interventions on key outcome variables related to healthy eating and physical activity and child obesity status among 1600 low-income 3rd grade students and parents. Few, if any, trials of this scale that have focused on the synergistic effects of garden-nutrition-physical activity based interventions related to child BMI. The family-focused, school-based and Master Volunteer supported Extension educational interventions of JMG/LGEG and WAT were focused on health behaviors known to be associated with reducing obesity: increasing vegetable preference, consumption and home availability, reducing sugar sweetened beverages, increasing physical activity and reducing sedentary activity, increasing family meal preparation and eating together, gardening together, and parent support of healthy behaviors. The team recruited 28 Title 1 schools and 145 3rd grade teachers in five counties for the full study, enrolling 1,326 3rd grade students and 1,206 parents in two cohorts (2012-2013, 2013-2014 with a one year follow-up in each cohort). The full study used a 4-way factorial design (randomized controlled trial) with CATCH (control or usual treatment); CATCH + WAT; CATCH + JMG; and CATCH + WAT + JMG as the intervention combinations. This 5-year randomized controlled trial with 4 treatment groups involved twenty-eight low-income schools. Child and parent measures developed included behavioral outcomes (i.e. diet, physical activity, and gardening), psychosocial variables related to these three behaviors, and demographic data. Pre- post-intervention and one year follow-up data was collected from children and parents, included child BMI. Process evaluation data included teacher implementation data, teacher and administrator attitudes. Treatment effects were estimated as the difference in the magnitude of pre-post change in the each of the three intervention groups, net of the estimated pre-post change in the comparison group. The test of treatment effects was a two- tailed test with significance threshold at 0.05. The primary outcome variable was BMI percentile between baseline and the 4th measurement period. Changes in the child, parent and child-parent interaction outcome variables are modeled as secondary outcomes. Population Characteristics. Student enrollment included 652 boys and 674 girls with similar student characteristics (age, race, ethnicity and gender) across treatment groups. Student race/ethnicity included 42.5% Hispanic or Latino; 19.9% Caucasian, 18% Black and 19.6% other. Selected Parent/Guardian demographics: 1206 Parents enrolled: 52% Hispanic, 18% African American, 16 Caucasian and 14% other. Educational Range: 34% parents had their High school/GED diploma; 4% had an advanced degree Employment Status: Although 51% worked full time; 34% did not work outside the home Marital Status: Almost 25% were single, never married; 15% were separated or divorced and 58.7% were married Spanish was the main language spoken at home for more than 25% of the participating parents Parent/Guardian level of assistance and food insecurity: 78% reported children receiving "free & reduced meals" at school 43.6% reported either sometimes or always running out of food before the end of the month 51% received some type of food assistance (WIC or SNAP) with 49% reporting no benefits Intervention Effects: Effects were estimated as difference-indifference scores (delta) to determine within-group effects and pre-post differences for each condition examined. For each outcome, pre-post differences in each treatment condition were compared against the pre-post differences in the control/comparison group. Combined treatment effects on students indicated significant increases (p<0.0001) on vegetable exposure and preference; increased moderate (p<0.0007) and vigorous physical activity (p<0.001); and selection of fruit juice over soda (p<0.01). Child BMI significantly decreased for single treatments: CATCH+ JMG and CATCH + WAT. Parent behavior changes with significant post program increases were parental support for child physical activity, reduced home availability of sugar sweetened beverages. Significant changes for student/parent interaction included gardening together, preparing food together, eating meals together and being physically active together. The programs also demonstrated strong reach into the homes of children in the combined intervention of CATCH + WAT + JMG: 56% of parents indicated receipt of TGEG materials, 41% learned about "Go, Slow and Whoa" foods, 81% learned about their child's classroom garden, 60% read the TGEG vegetable recipes, 30% prepared those recipes, 16% read the family stories, and 27% walked Bonus Miles for their child's class. Documenting this "reach" into the family home demonstrated the benefits of working collaboratively with the school to improve health behaviors. Conclusions: Data indicated that the combined treatment: CATCH + JMG + WAT resulted in slightly more positive changes in vegetable exposure & preference, physical activity behaviors in children and with parent engagement than the single treatments alone. The single treatments resulted in significant decreases in child BMI compared to the control and combined treatments. Documented variation in classroom implementation (fidelity) across treatments may explain results. Goal 4 Implementation analysis related to behavioral outcomes A team of researchers and Extension faculty have been working on the implementation analysis in cohort 1 schools. Data was collected from 88 teachers using a daily activity log during Cohort 1 for each treatment - WAT and LGEG; CATCH implementation was assessed by administering the CATCH checklist with CATCH champion at each school. Implementation scores were constructed for each classroom on a 1-3 scale using the activity logs and additional process data from teachers and school administrators. Patterns of implementation differed by school and treatment. Program implementation was affected by a number of interacting programmatic and organizational factors. Our examination of actual implementation is important in understanding the outcomes of school programs promoting children's health and can be used as a model to improve similar implementation efforts in the future. The team is working on three articles related 1) implementation measurement; 2) implementation levels and child & parent outcomes; implementation level and reach into the home. Next Steps: Future collaborations with UTSPH are in process (NIH RO1 proposal for 6/5/16 deadline) to further evaluate the effects of a fresh vegetable bag sent home with children having LGEG in their classroom. In addition, there is interest from the project team to further develop the Master Wellness/Master Gardener leadership in supporting sustainable school environment change - equipping schools and school districts with volunteer development and engagement for greater sustainability. Determining strategies to address eating and activity behaviors in Title 1 school populations can increase environmental strategies and integration of sound educational programs with high efficacy for improving health behaviors and health outcomes.

Publications

• Type: Journal Articles Status: Published Year Published: 2015 Citation: Spears-Lanoix, E., McKyer, E.L.J., Evans, A, McIntosh, W., Ory, M., Whittlesey, L., Kirk, A., Hoelscher, D., Warren, J.L. (2015, December) Using family focused garden, nutrition and physical activity programs to reduce childhood obesity: The Texas GROW! EAT! GO! pilot study. Childhood Obesity, 11(6), 707-714.
• Type: Journal Articles Status: Under Review Year Published: 2015 Citation: Evans, A., Ranjit, N., Jennings, R., Heredia, N., Warren, J.L. (2015) Previous gardening experience and gardening enjoyment is related to vegetable preferences and consumption among low-income elementary school children Journal of Nutrition Education and Behavior (under review - returned for corrections)
• Type: Journal Articles Status: Awaiting Publication Year Published: 2015 Citation: Li, Y, Palma, M.A., Towne, S.D., Warren, J.L. and Ory, M.Peer Effects on Childhood Obesity from an Intervention Program. Health Behavior and Policy Review Submitted 12.15.15
• Type: Journal Articles Status: Under Review Year Published: 2016 Citation: Evans, A.,Ranjit,N.,Hoelscher,D., Jovanovic,C.,Lopez,M., McIntosh, A., Ory, M., Whittlesey,L., McKyer,ELJ, Kirk,A., Smith, C., Walton, C., Heredia,N.,Warren,J.L. 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(PUBH-D-16-00713) BMC Public Health
• Type: Journal Articles Status: Submitted Year Published: 2016 Citation: Heredia, N., Ranjit, N., Evans, A.,Warren, J. Association of parental social support with energy balance in low-income and ethnically diverse children (HER-04-16-0108) Health Education Research.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2015 Citation: Warren, J.L., Evans, A., Smith, C., Lopez, M.L., Li, Y.,(2015, May 7) Texas GROW! EAT! GO! Partnering for Program Design, Evaluation and Impact, National Health Outreach Conference, Atlanta, GA.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2015 Citation: Holt, R., Lopez, M., Smith, C. & Warren, J. (2015, May 7). Texas GROW! EAT! GO! Implementation. National Health Outreach Conference, Atlanta, GA.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2015 Citation: Warren, J.L., Evans, A., Hoelscher, D., Ranjit, N., Smith, C., Nemic, C., Whittlesey, L. & Walton,C. (2015, June 4). Texas GROW! EAT! GO! Using family-focused garden, nutrition and physical activities to prevent childhood obesity: Cohort 1 child and parent results. International Society for Behavioral Nutrition and Physical Activity Annual Meeting. Edinburgh, Scotland.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2016 Citation: Lopez, M., Kirk, A., Ranjit, N., Warren, J., & Evans, A. (2015, June 5). Level of Teacher Implementation Determines Behavior Change: Results from the Walk Across Texas Program as part of the Texas Grow! Eat! Go! Intervention Study. International Society for Behavioral Nutrition and Physical Activity Annual Meeting. Edinburgh, Scotland.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2015 Citation: Evans, A., Warren, J. & Ranjit, N. (2015, June 5) Orals: Texas GROW! EAT! GO! Using Family-focused Garden, Nutrition and Physical Activities to Prevent Childhood Obesity: Cohort 1 results; Children and Families. International Society for Behavioral Nutrition and Physical Activity Annual Meeting. Edinburgh, Scotland.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2015 Citation: McIntosh, A., Rico, B., McCown, C, Evans, A. Warren, J.(2015). Parent Modeling of Healthy Eating and Physical Activities and Children engaging in these Activities. Rural sociological Society, Madison, WI.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2015 Citation: Warren, J.L., Evans, A., Ranjit, N., McIntosh, W. (2015). Texas Grow! Eat! Go! Preliminary findings of garden, nutrition and physical activity interventions on childhood behaviors and obesity. Society of Nutrition Education and Behavior, Pittsburg, PA, July 28, 2015
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2015 Citation: Li Y, Towne SD Jr, Ory MG, Warren J. (2015). Program Effectiveness on Medical Cost Savings of TGEG Intervention Program. Accepted for oral presentation at the 2015 National Health Outreach Conference. May 6-8, 2015. Atlanta, GA,
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2015 Citation: Towne SD Jr, Li H, Smith ML, Lopez M, Warren J, Ory MG. (2016). The Role of Social Determinants of Health: Income Inequality and obesity among Low-income Adults. Accepted for poster presentation at the American Academy of Health Behavior Annual Conference. February, 2016. Ponte Vedra Beach, FL, USA.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2015 Citation: Kellstedt D, Li Y, Towne SD Jr, Lopez M, Walton C, Ranjit N, Smith C, Warren J, & Ory M. (2016). Program Implementation Effects: An Evaluation of the Texas Grow! Eat! Go! Intervention Study. Accepted for poster presentation at the Texas Public Health Association Annual Meeting, April 2015, Galveston, TX, USA.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2016 Citation: Warren, J.L., Evans, A., McKyer, L., Mahadevan, L., Kirk, A., Whittlesey, L., Seagraves, R., Walton, C., Lopez, M. Multidisciplinary Arts and Humanities Education Connects Schools to Families. Hawaii International Conference on Arts and Humanities, Honolulu, Hawaii, January 9, 2016.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2016 Citation: Warren, J.L., Evans.A., Ranjit, N., Mahadevan, L. Texas GROW! EAT! GO! A Garden, Nutrition and Physical Activity Intervention Reaches Families. American Association of Family & Consumer Sciences-Texas, February 19, 2016.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2016 Citation: Warren, J.L., Evans, A., McKyer, L., Mahadevan, L., Kirk, A., Whittlesey, L., Walton, C., Lopez, M. Texas GROW! EAT! GO! Family Reach by Obesity Prevention Components. National Health Outreach Conference, Roanoke, Virginia, April 7, 2016
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2016 Citation: Warren, J., Evans, A., Ranjit, N., McKyer,ELJ, Ishdorf, A., Whittlesey, L., Seagraves, R. The Texas GROW! EAT! GO! Study: Increasing Vegetable Preference through Gardening and Nutrition Activities with Low-income, Elementary School Children. American Association of Family and Consumer Sciences, Bellevue, Washington, June 24, 2016
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2016 Citation: Warren, J., Evans,A., Ranjit, N., Whittlesey, L., Walton, C., Seagraves, R., Hohlt, R., Robinson, S. Texas GROW! EAT! GO! Can a School-Based Intervention Affect Child Obesity? American Association of Family and Consumer Sciences, Bellevue, Washington, June 23, 2016
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2016 Citation: Warren, J., Evans, A., Ranjit, N., McIntosh, W.A. Texas GROW! EAT! GO! Using Family-focused Garden, Nutrition and Physical Activities to Prevent Childhood Obesity: Combined Cohort Preliminary Results. International Society of Behavioral Nutrition and Physical Activity (ISBNPA), June 10, 2016
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2016 Citation: Warren, J. Evans, A., Ranjit, N., McIntosh, W.A. Texas GROW! EAT! GO! Using Family-focused Garden, Nutrition and Physical Activities to Prevent Childhood Obesity: Cohort 1 Results. International Federation of Home Economics, Seoul, Korea, August 3, 2016.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2015 Citation: McIntosh, A., Rico, B., Warren, J., Evans, A., Ory, M. (2015) The Relationship between Home Gardening and the Availability of Fruits and Vegetables at Home. Association for the Study of Food and Society, Pittsburg, PA.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2015 Citation: Lopez, M.L. & Kirk, A (2015). Walk Across Texas! (WAT!) Implementation in Texas Grow! Eat! Go! Schools: Increasing Physical Activity in Students and Parents. Oral Presentation at the 2015 National Health Outreach Conference in Atlanta, Georgia
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2015 Citation: Lopez, M.L. (2015). Effective Implementation of Learn, Grow, Eat & GO! In Schools  An Interdiscplinary Youth Gardening and Classroom Program. Oral Presentation at the WCCHD Health Education Summit in Round Rock, Texas.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2015 Citation: Kirk A & Lopez, M.L. (2015). Programs to Engage Families. Oral Presentation at the Out-of-School-Time Initiatives Conference in Dallas, Texas.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2015 Citation: Kirk, A & Lopez, M.L. (2015). Integrating the Walk Across Texas! Program and School Gardens for Increased Physical Activity. Oral Presentation at the Its Time Texas Summit in Austin, Texas.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2015 Citation: Kirk, A & Lopez, M.L. (2015. July 11). Learn, Grow, Eat & GO!  Health and Nutrition Components. Oral Presentation at the National Children & Youth Garden Symposium in Austin, Texas.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2015 Citation: Kirk, A & Lopez, M.L. (2015, July 11). Learn, Grow, Eat & GO!  Building Community Coalitions. Oral Presentation at the National Children & Youth Garden Symposium in Austin, Texas.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2015 Citation: Kirk, A & Lopez, M.L. (2015, July 15). Building School and Community Collaborations. Oral Presentation at the Its Time Texas Summit in Austin, Texas
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2016 Citation: McIntosh, A, Rico, B., McKyer, L., Warren, J., Evans, A., Ory, M., McCown, C. (2016). Parental confidence in cooking skills and its influence on their confidence in planning and serving vegetables at meals Rural Sociological Society Toronto Canada. August 10.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2016 Citation: Invited) Lopez, M.L. (2016, August 16). Utilizing the School Setting to Ensure Students and Families have Access to Healthy Food. Panel Discussant at the 2016 ITS TIME TEXAS Summit in San Antonio, Texas.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2014 Citation: McIntosh, A, Rico, B, Evans, A., McKyer, L.,( 2014, June 25) Confidence in Cooking Skills and Childrens Involvement in Food Acquisition and Preparation. Association for the Study of Food and Society in Burlington Vermont.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2014 Citation: McIntosh A., Rico, B., Warren, J. Ory, M., Evans, A. (2014, August 1) Confidence in Cooking Skills and Ability to Include Vegetables in Meals and Childrens Vegetable Preferences. Rural Sociological Society in New Orleans.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2014 Citation: Rico, B., McIntosh, A., Evans, A., Warren, J., McKyer, L. (2014, August 2). Determinants of Fruit & Vegetable Availability & Accessibility in the Home at the annual meeting of the Rural Sociological Society in New Orleans.

Progress 02/28/14 to 02/27/15

Outputs
Target Audience: Texas GROW! EAT! GO! PROJECT The target audiences for this project have been parents and children in Title 1 school in five Texas counties: Dallas, Harris, Nueces, Walker, and Montgomery. These geographical areas represent the diverse population of Texas and the nation including Hispanic, African American, Asian and Caucasian populations as well as urban and rural settings. The Texas GROW! EAT! GO! Project is assessing the efficacy of a coordinated school health (CSH) program enhanced with family-focused, experiential garden, nutrition and physical activity programs on the prevalence of child overweight and obesity in third grade students in 28 Title 1 schools with a projected sample size of 1,600 student/parent pairs. Developing a working model that can be easily disseminated and institutionalized through connecting Extension personnel and volunteers such as Master Gardeners or Master Wellness volunteers with local elementary schools is the goal of this project. Third grade teachers, school CSH coordinators, parent volunteers, school administrators and local county Extension educators are another target audience in terms of adopting and implementing a coordinated strategy integrating horticulture, nutrition, and physical activity programs to address child obesity through experiential learning activities. Full Study Cohort 1: students enrolling and continuing: 734 (T1); 783 (T2); 583 (T3); Cohort 1 parents enrolled and continuing: 560 (T1); 405 (T2); teachers enrolled and continuing: 84 (T1); 75 (T2). Cohort 1 demographics previously reported. Cohort 2: students enrolled and continuing: 671 (T1); 635(T2); 468 (T3); parents enrolled and continuaing: 640 (T1); teachers enrolled and continuing:52 (T1). Cohort 2 Demographics reported in Accomplishment section. Demographic summary for C1 and C2 non-matched, students with consents: 1,508 students; 1,169 parents Intermediate school pilot 4th and 5th grade pilot focused on one intermediate school. T1 Data collection in Fall 2013: N= 97 students; 78 parents; 12 teachers; 4 volunteers; T2 Data collection in Spring 2014: N= 99 students; 67 parents; 11 teachers; 4 volunteers. Matched T1 & T2 surveys for 90 students and 67 parents. Student Demographics: Male-53%; Female-47%; Ethnicity/Race: Caucasian-33.3%; Black- 12.6%; Hispanic-9.2%; American Indian-3.4%; multiracial-34.5; other-6.9%; Data entry has been completed and analysis is in process. Parent, teacher and volunteer data is being entered. There were 10 female and one male teacher enrolling with ethnic identity: 9 Caucasian and 2 African American. After school pilot A small study was conducted in one after school program at a Title 1 school in Conroe,TX in cooperation with the City of Conroe Parks Department. All Title 1 schools have a high percentage of students who are low income status. T1 & T2 Data collection in Spring of 2014: 19 students completed surveys at T1 and 16 continued through T2; 12 parents completed surveys at T1 and 2 continued through T2. There were no volunteers. 8 teachers completed the pre and post program surveys. Student demographics: Male 63%; Female 37%. Ethnicity/Race: Caucasian-9%; Black- 29%; Hispanic-62%; Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? Extension: Goal 4: Dissemination; Obj. 4.1 & Obj. 4.2: 1) Summer 2014 training for two school districts teachers in control and non-intervention groups on all interventions. 2) 2 1/2 day Conference for Extension held Fall of 2014 with 39 counties and 112 participants which included regional program leaders, administrators, county educators and volunteers. Director of Extension funded $15,000 in start up funds for counties who implement the program. 3) Conducted information sessions at four regional Health and Human Service Snap-Ed Conferences in Texas Objective 4.3: Present results regionally for dissemination. two meetings-one at Prairie view A&M University with the Cooperative Extension Program health team to share the development process related to social cognitive and behavior oriented intervention development; a second meeting with local Houston area community to engage city wide partners-organized by local Extension educator who is involved in research project as one site. Objective 4.4: Publish in relevant journals. Graduate students have been involved in writing journal articles with Faculty including one submitted to Childhood Obesity on pilot program results. In addition, multiple graduate students are now on teams working on data analysis interpretation and publications. Research: Multiple graduate students have been involved in data processing which has included much training and faculty support. How have the results been disseminated to communities of interest? Extension: Objective 4.1: 1) Local dissemination efforts in one ISD show financial support secured through a local non-profit for school gardens at every elementary school in district as a result of the TGEG project success in Cohort 1; 21 schools in that ISD committed to implementing the Walk Across Texas program; 2) Collaboration with Farm 2 School in another ISD have resulted in LGEG being included in Implementation Grant for 2015. Objective 4.3: Present results regionally for dissemination. Objective 4.4: Present findings at professional conferences. PI invited as presenter at SouthEast Conference on Obesity; faculty presented at International Society for Behavioral Nutrition and Physical Activity; Southern Obesity Summit; National Farm to Cafeteria Conference; American Public Health Association and Society for nutrition Education and Behavior. Objective 4.4: Publish in relevant journals. One article was submitted to Childhood Obesity on pilot program results and three articles are in process. What do you plan to do during the next reporting period to accomplish the goals? Extension: Goals 3.1: Complete data collection with Cohort 2 participants; Goal 3.2-3.5: Collect data from teachers, volunteers, school leaders and other school district champions related to outcomes and process. Goal 4: Disseminate Project Results (4.1-3). Conduct 6 regional full day dissemination trainings in Texas; conduct brief dissemination & information sessions at Texas After School conference, and many other venues involving health systems and community health workers, Master Gardeners, Health and Human Service regional SNAP-ED conferences, Pre conference and 4 sessions at the American Horticulture Society Youth Garden Symposium for State JMG coordinators, National Extension Association for Family & Consumer Sciences, National 4-H Youth Development Conference, Environmental Health Science Conference, and the Dallas Obesity Prevention Coalition. Partner with Dallas and Bexar Counties Farm 2 School Implementation Projects related to implementing LGEG program as component of efforts related to improved fruit and vegetable consumption by children. Research Goals 3-4: Teams formed to focus on various topics for publications (analyzing data and writing). Team also focused on future grant opportunities.

Impacts
What was accomplished under these goals? Extension: Goal 2. Implement the educational program: Cohort 2 schools (n= 12) continued implementing the program through spring of 2014. Goal 3.Evaluation for process, behavioral and obesity related outcomes: Objective 3.1: Data was collected for Cohort 1 participants(students, parents) for time 4 completing data collection for that cohort. Data was collected for Cohort 2 participants for times 2 & 3. Objective 3.2: Assess Master Volunteer Activities: volunteer surveys were administered to project volunteers. Objective 3.3: Determine teacher activities, etc.: Teacher surveys were administered at T2 for post program evaluation. Objective 3.4: Track program fidelity. Teacher Match Logs were completed for Cohort 2 implementation year; Objective 3.5: Track program sustainability: interviews conducted with Cohort 1 and 2 district champions related to program implementation and continuation. Research: Goal 1, 2 & 3: Cohort 1 child and parent survey data analyzed; Cohort 1 teacher data analyzed; Cohort 1 Implementation data analyzed. Cohort 1& 2 student-parent demographics (non-matched, student with consent) : Students: 18% African American; 43% Hispanic; 20% white; 19% other. 51% female; 49% male. Student BMI changes(overweight and obese): CATCH-no change - weight stability; WAT-.slight,non-significant reduction; JMG-slight, non-significant reduction; CATCH+ WAT+ JMG-slight, non-significant increase. Parents: 18% African American; 52% Hispanic; 24% white and 6% other. 88% female; 12% male. 12% under age 29, 25% ages 30-34, 29% ages 35-39, 22% ages 40-44, 11% over 44 ( data missing from 45 respondants). 66% were married; 13% divorced or separated, 20% never married/single; 1% widowed (data missing from 7 respondants). 76% of the parents spoke English at home; 22% spoke Spanish at home and 2% spoke another language at home(data missing from 27 respondants).51% of parents were employed full time, 17% part time, 30% did not work outside the home and 2% were retired (data from 14 respondants was missing). 59% had high school or less educational level; 30% had some college or were college graduates. Food security: 12% of parents were enrolled in WIC; 36% in SNAP; 5% in other benefit programs and 47% in no programs. Parents reported running out of food before the end of the month: Never-55%; sometimes-31%; almost always aor always-13% (8 did not respond). Cohort 1 child/ parent behavior change reported by treatment below (CATCH only- control; CATCH + WAT; CATCH + JMG; CATCH + WAT & JMG) Child Behaviors Parent/Adult Behaviors Child & Parent/Adult Interaction Behaviors Increasing F&V consumption Veg preference: [WAT and JMG and WAT groups] Knowledge: [all 3 groups] Increasing access and availability of F&V in the home [WAT group] Gardening together [WAT and JMG group] [WAT group] Decreasing SSB consumption [WAT and JMG group] Self efficacy to consume healthy beverages:[WAT and JMG group] Limiting availability of SSB [WAT group] Preparing snacks and meals together Increasing physical activity (PA) [WAT and JMG group] Providing PA opportunities for children [WAT group] Engaging in PA together [WAT group][JMG group] Decreasing sedentary activity [WAT and JMG group] Limiting children's sedentary activity [WAT group] Eating snacks and meals together [WAT and JMG group] Significant parent changes found for "parent cooking skills" and "eating meals together" in WAT+JMG (p-<.054); "gardening with children" (p <.005); "parent encourages eating vegetables" (p<.002); and parents being physically active with their children (p<.05) Significant student changes were found for: F&Vegetable preference (p<.005); increased in time spent in moderate to vigorous physical activity (p<.005); preference for healthy beverages (p<.005); and student self efficacy (p<.005). Student knowledge in nutrition and plant science also increased significantly (p<.005)

Publications

• Type: Conference Papers and Presentations Status: Accepted Year Published: 2014 Citation: Kirk, A. and Lopez, M.L., Walk Across Texas: Increasing Physical Activity in Parents and Children. Presented at the Out of School Time Initiatives Conference, Austin, TX, July 24, 2014
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2014 Citation: Rico, Brittany and Alex McIntosh. 2014. "What Predicts Fruit and Vegetable Availability and Accessibility in the Home? Confidence in Cooking Skills and Challenges in Vegetable Preparation/Purchases Among Parents. Presented at the Annual Meeting of the Rural Sociological Society. New Orleans, LA, August 1, 2014.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2014 Citation: Warren, J.L., Evans, A., Ranjit, N., McIntosh, W., McKyer, E.L.J., Using Family Focused Garden, Nutrition & Physical Activities to Prevent Childhood Obesity: Cohort 1 Preliminary Results. Invited presentation at the Southeastern Conference Symposium: Prevention of Obesity: Overcoming a 21st Century Public Health Challenge, Atlanta, Georgia, September 23, 2014.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2014 Citation: Warren, J.L. and Evans, A., Texas GROW! EAT! GO! Addressing Obesity Through School-Extension Collaboration-Cohort 1 Outcomes. Presented at the Southern Obesity Summit, Lexington, Kentucky, November 18, 2014.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2014 Citation: Omolola, A., Warren, J., Evans, A., Li, L., Ory., M.G. Texas Grow! Eat! Go!: A Promising Child Obesity Prevention Effort. AcademyHealth Meeting, Child Health Services Research Interest Group, San Diego, CA, June 7, 2014.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2015 Citation: Warren, J.L., Applying Multidisciplinary Arts and Humanities Education to Obesity Prevention. Oral Presentation at the Hawaii International Conference on Arts and Humanities, Honolulu, Hawaii, January 13, 2015.
• Type: Journal Articles Status: Accepted Year Published: 2015 Citation: Spears-Lanoix, E., McKyer, E.L.J., Evans, A, McIntosh, W., Ory, M., Whittlesey, L., Kirk, A., Hoelscher, D., Warren, J.L. Using Family Focused Garden, Nutrition and Physical Activity Programs to Reduce Childhood Obesity: The Texas GROW! EAT! GO! Pilot Study. Childhood Obesity, accepted with revisions
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2014 Citation: Warren, J.L., Evans, A., Ranjit, N., McIntosh, W. A., and Smith, C., Texas GROW! EAT! GO! Addressing Child Obesity and Related Health Behaviors Through Garden, Nutrition and Physical Activity Programs: Cohort 1 Findings. Presented at National Farm to Cafeteria Conference, Austin, TX, April 17, 2014.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2014 Citation: Evans, A., Ranjit, N, Powell, K, and Warren, J.L., Is Childrens Gardening Experience Associated with Their Vegetable Consumption? Presented at National Farm to Cafeteria Conference, Austin, TX, April 17, 2014.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2014 Citation: Warren, J.L., Evans, A., Ranjit, N., Wilson, A.D., Lopez, M., Walton, C., Rico, B., and McIntosh, W., Preliminary Results of the Texas GROW! EAT! GO Intervention Study on Childrens Weight related Behaviors and Weight Status: Cohort 1. Presented at the International Society for Behavioral Nutrition and Physical Activity Conference, San Diego, CA., May 22, 2014.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2014 Citation: Lopez, M., Ranjit, N., Kirk, A., Warren, J., and Evans, A., Walk Across Texas Program Implementation in Texas Grow! Eat! Go! Schools: Increasing Physical Activity in Students and Parents. Presented at the International Society for Behavioral Nutrition and Physical Activity Conference, San Diego, CA., May 22, 2014
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2014 Citation: Rico, Brittany and Alex McIntosh. 2014. "Predicting Teachers' Continued Use of a Gardening, Nutrition, and Physical Activity Program to Reduce Childhood Obesity. Presented at the Annual Meeting of the Association for the Study of Food and Society. Burlington, VT, June 14, 2014
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2014 Citation: Warren, J.L., Evans, A., McIntosh, W.A, Ranjit, N., Texas GROW! EAT! GO!: Cohort 1 Student Outcomes. Presented at the Society for Nutrition Education and Behavior Annual Conference, Milwaukee, WI, July 1, 2014.
• Type: Journal Articles Status: Published Year Published: 2014 Citation: Warren, J.L., Evans, A., McIntosh, W.A, Ranjit, N., Texas GROW! EAT! GO!: Cohort 1 Student Outcomes. Journal of Nutrition Education and Behavior, Vol. 46, Number 4S, 2014, p. S200.

Progress 02/28/13 to 02/27/14

Outputs
Target Audience: Target Audiences: The target audiences for this project have been parents and children in Title 1 school in five Texas counties: Dallas, Harris, Nueces, Walker, and Montgomery. These geographical areas represent the diverse population of Texas and the nation including Hispanic, African American, Asian and Caucasian populations as well as urban and rural settings. The Texas GROW! EAT! GO! Project is assessing the efficacy of a coordinated school health (CSH) program enhanced with family-focused, experiential garden, nutrition and physical activity programs on the prevalence of child overweight and obesity in third grade students in 28 Title 1 schools with a projected sample size of 1,600 student/parent pairs. Developing a working model that can be easily disseminated and institutionalized through connecting Extension personnel and volunteers such as Master Gardeners or Master Wellness volunteers with local elementary schools is the goal of this project. Third grade teachers, school CSH coordinators, parent volunteers, school administrators and local county Extension educators are another target audience in terms of adopting and implementing a coordinated strategy integrating horticulture, nutrition, and physical activity programs to address child obesity through experiential learning activities. Baseline demographics for Cohort 1 students: 734 students-46% male; 54% female; 19% African American, 46% Hispanic, 16% Caucasian, 19% Other/multi-racial.Cohort 1 Teachers: Out of 82 possible participants, 70 teachers enrolled in the study and 65 completed both pre and post program intervention surveys. This data has been entered for T1 and T2 with analysis in process. 45% of teachers are Hispanic, 34% Caucasian, 16% African American and 5% Asian. or mixed. 97% were female and 3% were male. Cohort 1 Volunteers: 36 volunteers enrolled and completed pre and post program surveys.55% were Caucasian, 25% were Hispanic, 14% were African American and 6% were other. 81% were female and 9% male. Parent data from Cohort 1 shows 566 parent enrollees with data entry in process. Cohort 2 students: 671 students and 640 parent enrollees. Student survey data entry is in process. Parent surveys will be entered next. Cohort 2 Teachers: 56 teachers enrolled: 86% female; 14% male. Data entry is in process. 4th & 5th Grade Pilot: 160 students enrolled; 106 parents enrolled; 12 of 12 teachers enrolled. Changes/Problems: Addition to project: With the non-continuation of one school district for Cohort 2 of the study due to teacher and principal turnover, a request was made and approved by Dr. Chester at USDA to allow a second pilot study (requested by a school principal) of the combined intervention in one middle school with 160 4th and 5th grade students, parents, teachers and volunteers. This pilot will provide the opportunity to evaluate the curriculum components with older students. One of the project Co-I’s is starting a Ph.D. program and will conduct the evaluation of this pilot as part of her research class with training from the assistance of the research coordinator at the University of Texas and consultation with PI’s. What opportunities for training and professional development has the project provided? Goal 4: Cohort 2 schools (12) and 1 school in a 4th-5th grade pilot engaged teachers, county Extension agents, project specialists and volunteers in a one day training related to the specific treatment assignment( CATCH only; CATCH + JMG; CATCH + WAT; or CATCH + JMG + WAT). Co-I's, Graduate students and project specialists completed Institutional Review Board certifications, revised training on Project research protocol using Tanita scale and revised consents and surveys. County Extension agents participated in professional development training related to child offered within Texas. Co-I's and PI's participated in professional development conferences when they were presenting project outcomes (SNEB, ISBNPA, RSA, APHA, Southern Obesity Summit, AAFCS) Project outcomes were shared through 15 national or international conferences named above. In addition, presenations were made at the National Science Teacher's Association Conference held in Texas, the JMG State Coordinator's meeting and three Texas school districts interested in JMG, nutrition and gardening curriculum and activities. How have the results been disseminated to communities of interest? Extension Goal 4: Submitted project team for Texas AgriLife Extension Service's 2013 Superior Service Team Award – one of three teams in Texas to win. Award presented at the Centennial Extension Staff Conference in January 2014. Four site reports related to preliminary results from Cohort 1 were developed and disseminated to the four county Extension agent partners for interpretation. Collaborating with one site's USDA Farm 2 School Planning Grant - PI serving on Project Committee. Educational resources and research tools from the project have been shared with this committee. Goal 4.4: Publication/Presentation chart being completed for graduate student projects and research presentations/articles by PI’s and Co-I’s on the team. Currently 15 presentations were made in 2013 using project descriptive and outcome data. These have been made to professional conferences including SNEB, ISBNPA, APHA, Southern Obesity Summit, Rural Sociology Association, among others. These presentations are reported under Products in REEport. What do you plan to do during the next reporting period to accomplish the goals? Goal 2: Complete Cohort 2 implementation phase; Goal 4.2: Conduct dissemination training in summer 2014 for school districts in Cohort 1 which were Cohort 1 only districts. Develop report for Cohort 1 only Districts once Cohort 1 data analysis complete for child-parent pairs. Goal 3: Collect Time 4 survey data (students and parents) for Cohort 1 participants in four school districts; collect Time 2 & 3 survey data (students and parents) for Cohort 2 participants. Conduct teacher and administrator interviews for Cohort 2. Complete data entry for parent participants in Cohort 1; conduct data analysis on Cohort 1 paired child-parent pairs related to target behaviors and child BMI change. Complete process evaluation related to intervention fidelity/level of implementation Conduct analysis related to level of intervention implementation and child-parent behaviors and BMI. Goal 4: Complete and submit at least four articles for publication in 2014: Multidisciplinary curriculum development to Journal of Extension; Pilot study to Childhood Obesity; Survey development and methodology to SNEB; Implementation article to Implementation Science. Five presentations related to project processes and outcomes have been accepted for the Farm to Cafeteria national conference in Austin, TX to be presented 4/2014. Plan dissemination training for remaining school districts after Cohort 2 implementation phase is complete.

Impacts
What was accomplished under these goals? Extension Goal 2. Organizational support: School recruitment briefings held and memos of agreement/contracts developed with three districts for Cohort 2: Dallas, Corpus Christi, and Willis; and one for 4th-5th grade pilot in New Waverly. Executive Management Team revised and simplified consents and made slight modifications to surveys. Team conducted data collector training on survey administration and using Tanita scale for BMI measurement. Objective 2:1: 12 schools from 3 ISDs recruited for Cohort 2 of the study with 58 third grade classes. 16 schools continued in Cohort 1 with 78 classes through May 2013. Additional Pilot Study implemented in one school with combined treatment for 4th and 5th grade students. Programs implemented: LEARN! GROW! EAT! GO! (LGEG), Walk Across Texas(WAT) and Coordinated Approach to Child Health (CATCH). Cohort 2 training on program implementation conducted for involved personnel in schools and Extension; Objective 2.2: 12 schools implemented treatments with project specialists, Extension staff and Extension volunteer support for Cohort 2 starting September 2013. 1 school implemented combined treatment for 4th-5th grade pilot. Goal 3: Objectives 1,2,3,4, (Evaluate program for process, behavioral and obesity related outcomes): IRB continuation approval received through 1/24/14 and through 1/15/15. Student, parent, teacher & volunteer surveys implemented with 12 schools for Cohort 2 (T1) and 16 for Cohort 1(T2 & 3); Principal & teacher survey & weekly teacher SNAP-ED MATCH logs provided documentation of program component implementation. Implementation evaluation team developed rubric for determining high, medium and low implementation by teacher/school/treatment for Cohort 1 to enable analysis of student behavior outcomes and BMI compared to schools within treatment by level of implementation. Goal 3: Initial data analysis from Cohort 1 of the full study (Fall of 2012 - Spring 2013) was based on 734 student enrollees and 566 parent enrollees. Comparison of pre and post student surveys across treatments showed increased exposure and preference for a variety of vegetables, reduced soda consumption (18%), increased juice over soda, reduced screen time, and increased physical activity (moderate and vigorous) for participants in the CATCH + JMG + WAT treatment. Pre intervention Student weight status (Overweight and obese) in Fall 2012 were: CATCH 47.7%, CATCH + WAT 43.2%; CATCH + JMG 49.6% and CATCH+WAT+JMG 44.5%. Post intervention weights were: CATCH 45%; CATCH + WAT 42.7%; CATCH + JMG 49.2% and CATCH + WAT+ JMG 45.2%. Slight reductions in overweight and obese percentages were noted except for the CATCH+WAT+JMG treatment group. Variable implementation of the different interventions in the TGEG program across treatment groups and within treatment schools may explain some of this variance in weight. The program was effective in changing vegetable exposure and preference, screen time was reduced across all interventions and vigorous and moderate physical activity increased resulting in slight decreases in numbers of children classified as obese and overweight across most treatment groups. The purpose of one analysis presented by Evans, et. al. was to examine the relationship between children's gardening experience, vegetable preferences, variety of vegetables tasted, and vegetable intake. Methods: 843 3rd grade students (58% female; 11% Spanish speaking) enrolled at low-income schools completed a self-report survey which included items measuring vegetable intake (5 items), vegetable preference (20 items), whether or not he/she had tasted certain vegetables (n=20) and gardening experience (5 items). Gardening experience was divided into 3 categories [no experience; little experience (1-2 gardening activities in previous year), and lot of experience (3 or more)]. Random-effects regression models controlling for school-level clustering were run to estimate the mean of these outcome measures at each level of the main predictor, after controlling for gender and language. Results: 35% of children had no gardening experience, 26 % of children had little experience, and 39% had a lot of experience. Compared to children who had no gardening experience, children who engaged in 3 or more gardening activities liked significantly more vegetables (p<.001), tasted a greater variety of vegetables (p<.001) and consumed higher amounts of vegetables (p<.001). Conclusion: Findings confirm that using school gardens to teach children gardening skills is an effective strategy to increase children's vegetable consumption. 4th & 5th Grade pilot enrolled 160 students, 106 parents and 12 or 12 teachers. Objective 3.5: Economic analysis team in process on identifying education data for short and long term economic impacts.

Publications

• Type: Conference Papers and Presentations Status: Other Year Published: 2013 Citation: Warren, J.L., Evans A., McIntosh, W.A., McKyer, E. Lisako J., Smith, C. Texas GROW! EAT! GO-Addressing Childhood Obesity through School and Extension Collaborations: Cohort 1 Outcomes. Presented at the Southern Obesity Summit, Nashville, Tenn., November, 18, 2013.
• Type: Conference Papers and Presentations Status: Other Year Published: 2014 Citation: Warren, J.L., Evans, A., McKyer, E. L. J., Kirk, A., and Pena-Purcell, N., Using Children[s Literature to Target Health Behaviors. Presented at the Hawaii International conference on Arts and Humanities, Honolulu, Hawaii, January 13, 2014.
• Type: Conference Papers and Presentations Status: Other Year Published: 2013 Citation: Walton, C., Health and Nutrition In the Garden with Junior Master Gardener and the TEXAS GROW! EAT! GO! Project. Presented at the National Science Teachers Association Conference, San Antonio, Texas, April 13, 2013.
• Type: Conference Papers and Presentations Status: Other Year Published: 2013 Citation: Warren, J.L., Evans, A., Kirk, A., Lopez, M., Hoelscher, D., Implementation of Walk Across Texas to Increase Physical Activity in children and Families in Texas GROW! EAT! GO! Pilot Study. Poster at the International Society for Behavioral Nutrition and Physical Activity: Post-Conference, Cambridge, England, May 27, 2013.
• Type: Conference Papers and Presentations Status: Other Year Published: 2013 Citation: Evans, A., Warren, J., McIntosh, W.A., Smith, C., Jennings, R., McKyer, L., Hoelscher, D., Pilot Results of the Texas GROW! EAT! GO! Intervention Study on Childrens Weight-Related Behaviors and Weight Status, Presented at the International Society for Behavioral Nutrition and Physical Conference, Ghent, Belgium, May 26, 2013.
• Type: Conference Papers and Presentations Status: Other Year Published: 2013 Citation: Warren, J., Evans, A., McIntosh, W.A., Smith, C., Jennings, R., McKyer, L., Hoelscher, D., Pilot Results of the Texas GROW! EAT! GO! Intervention Study on Childrens Weight-Related Behaviors and Weight Status, Roundtable at American Association for Family and Consumer Sciences Annual Conference, Houston, TX., June 27, 2013.
• Type: Conference Papers and Presentations Status: Other Year Published: 2013 Citation: Rico, Brittany, W. A. McIntosh. Frequency of Parental Participation in the Family Meal and Confidence in Cooking Skills and Vegetable Preparation. Presented at the annual meeting of the Rural Sociological Society, East Lansing MI, July 24, 2013.
• Type: Conference Papers and Presentations Status: Other Year Published: 2013 Citation: Rico, Brittany and Alex McIntosh. Determinants of FV Availability and Accessibility. Presented at the Annual Meeting of the Rural Sociological Society, New York, August 8, 2013.
• Type: Conference Papers and Presentations Status: Other Year Published: 2013 Citation: Warren, J.L., Evans, A., McIntosh, A., Smith, C. Texas GROW! EAT! GO! Addressing Child Obesity and Related Health Behaviors through Garden, Nutrition and Physical Activity Programs-Cohort 1 Preliminary Findings. Poster presented at the Society for Nutrition Education and Behavior Annual Conference, Portland Oregon, August 12, 2013.
• Type: Journal Articles Status: Published Year Published: 2013 Citation: Warren, J.L., Evans, A., McIntosh, & Smith, C.L., Addressing Child Obesity and Related Health Behaviors through Garden, Nutrition and Physical Activity Programs Cohort 1 Preliminary Findings. Journal of Nutrition Education and Behavior, Vol. 45, Number 4S, 2013, p.S90.
• Type: Conference Papers and Presentations Status: Other Year Published: 2013 Citation: Walton, C., Seagrave, R., TEXAS GROW! EAT! GO! Curriculum Overview. Presented at the JMG State Coordinators Online Meeting, College Station, Texas, February 6, 2013.
• Type: Conference Papers and Presentations Status: Other Year Published: 2013 Citation: Walton, C., Growing Healthy Minds and Bodies with Junior Master Gardener and the TEXAS GROW! EAT! GO! Project. Presented at the International Master Gardener Conference, Sitka, Alaska, September 8, 2013.
• Type: Conference Papers and Presentations Status: Other Year Published: 2013 Citation: Evans, A., Ranjit, N., Nemec, C., Powell, K., Jennings, R., McIntosh, W.A., Walton, C., Whittlesey, L., Warren, J.L., Childrens Garden Experience is Associated with Higher Vegetable Preference and Fruit and Vegetable Intake. Presented at the 2013 American Public Health Association, Boston, MA, November 4, 2013.
• Type: Conference Papers and Presentations Status: Other Year Published: 2013 Citation: Lopez, M., Kirk, A., Walk Across Texas in Schools: Increasing Physical Activity in Students and their Parents. Presented at the Southern Obesity Summit, Nashville, Tenn., November, 18, 2013.
• Type: Conference Papers and Presentations Status: Other Year Published: 2013 Citation: Lopez, M., Ranjit, N., Kirk, A., Warren, J., Evans, A. Walk Across Texas Program Implementation in TGEG Schools. Poster presentation at the 19th Annual Multiracial and Multicultural Health Conference, San Antonio, December, 2013.

Progress 03/01/12 to 02/27/13

Outputs
OUTPUTS: Integrated Extension and Research activities and metrics reported for March 1, 2012 - February 28, 2013. Organizational support: Project personnel hired; project support materials acquired/distributed. School recruitment briefings held and memos of agreement/contracts developed with four districts: Dallas, Corpus Christi, Klein and Huntsville. Article in Texas A&M Center for Health System Design newsletter. Executive Management Team conducted data collector training on survey and using Tanita scale for BMI measurement. Previous Tanita validation study reduced need for further testing. Objective 1:2 (refine JMG intervention): Pilot study conducted in one Title 1 school in Nueces County during the Spring of 2012 with three third-grade classes. Programs implemented included LEARN! GROW! EAT! GO! (LGEG), Walk Across Texas(WAT) and Coordinated Approach to Child Health (CATCH). Weekly teacher surveys provided usability data on pilot Junior Master Gardener Curriculum: LGEG. Based on teacher and expert reviewer feedback modifications were made and eight additional lessons were developed for curriculum with student journal, family stories and vegetable recipes in English and Spanish. Website developed to target intervention support. Teacher and Extension staff training materials developed and implemented. Teacher, principal and parent support specialist interviews were conducted. Test-Retest evaluation of child survey changes was conducted with sample of third-grade students in another elementary school. Survey protocol for Cohort 1 developed by research team. IRB approval for final consent forms and Student, parent, teacher and volunteer surveys and Spanish versions completed. Research materials printed and organized by treatment group and site. Objective 2.1: Cohort 1 training on program implementation conducted with 4 school districts (3 treatment schools in each district); 2.2: 16 schools implemented treatments with project specialists, Extension staff and Extension volunteer support for Cohort 1. Objective 3.1: Student, parent, teacher surveys implemented with 16 schools 2012-2013; Objectives 3.2,3,4: Process evaluation tools developed and implemented; Objective 3.5: collaboration with economic analysis team and state comptroller's office developed model related to variables that have potential for short and long term economic impacts. Goal 4.4: A chart of research articles/presentations was developed with graduate student projects and research topics from PI's and Co-I's on the team. PARTICIPANTS: Participants: Warren, PI, and Evans, Co-PI, coordinated with new project coordinator Caren Walton(replaced Jan Fernandez) to oversee overall project planning, reports, implementation and accountability. Program Assistant Gabriel Mayer coordinated budget management. Warren, Evans and Walton coordinated on development of research components with Ory, McKyer, McIntosh, McCorkle and Smith. Smith worked with four graduate students on child, adult and teacher survey test-retest evaluation; Ashley Wilson surveyed pilot teachers for curriculum usability, providing data to Robinson, Kirk, Whittlesey, and Seagraves for curriculum revisions. Wilson, Evans, Smith and Warren conduced process evaluation interviews. Graduate Students include Rose Jennings and Kerry Meath at UT; Michael Lopez and Brittany Rico at A&M who implemented the child and teacher surveys, and collected the returned parent surveys. Warren and Evans coordinated review of revised research instruments and protocol forms through TAMU and UT Institutional Review Boards. Field Staff- Rusty Hohlt, Connie Kelly (replaced Lavaughn Moseley), Jeff Raska (replaced Rebecca Welch), and Gail Warren participated in the Cornell University Obesity Prevention on-line course (Dollahite & Stark) and coordinated with Caren Walton on Cohort 1 study implementation and intervention support using volunteers. Susan Ballabina and Elaine Fries have coordinated with the four study sites. Jenna Anding, Ninfa Pena-Purcell, and Amanda Scott have reviewed materials and provided feedback. Jayla Fry has coordinated with the Master Gardener Association on local gardening guides and website needs to support gardening. Sharon Robinson developed and tested 12 vegetable recipes; Linda Madden wrote 14 family stories; Janet Peirce translated recipes and family stories into Spanish; Caren Walton developed lesson correlations with Texas Essential Knowledge and Skill and STAARs standards. Peter Cribb and Joey Walker of the Michael and Susan Dell Center for Healthy Living at University of Texas Health Science Center have contributed the CATCH coordination materials and training component. The Texas Health Institute hosted the Southern Obesity Summit where information on the project was shared in a poster session. Project advisors provided curriculum review feedback: Carolyn Dunn, North Carolina Extension; Jamie Dollahite, Cornell Cooperative Extension; Rose Hayden-Smith, University of California; Joy Casnovsky The Sustainable Food Center; The Oliver Foundation and Sharon McWhinney, Prairie View A&M University. Cohort 1 schools were trained on JMG, WAT or combined treatment by Seagraves, Kirk, Smith, Warren, and Evans at four sites with eighty four Elementary school teachers. Kirk, Warren, Evans, Wilson and Lopez participated in Southern Obesity Summit. Warren and Evans participated in the International Society for Behavioral Nutrition and Physical Activity conference and pre-conference on measurement of nutrition and physical activity behaviors. Warren participated in the Children's Environmental Health Conference at University of Texas related to school environments and nutrition and physical activity. TARGET AUDIENCES: Target Audiences: The target audiences for this project include parents and children in Title 1 school in four Texas counties: Dallas, Harris, Nueces and Walker. These geographical areas represent the diverse population of Texas and the nation including Hispanic, African American, Asian and Caucasian populations as well as urban and rural settings. The Texas GROW! EAT! GO! Project will assess the efficacy of a coordinated school health (CSH) program enhanced with family-focused, experiential garden, nutrition and physical activity programs on the prevalence of child overweight and obesity in third grade students in 32 Title 1 school with a total sample size of 1,600 student/parent pairs. Improving family and community involvement has been shown to increase the potential of CSH programs to have significant effects on child obesity. Developing a working model that can be easily disseminated and institutionalized through connecting Extension personnel and volunteers such as Master Gardeners with local elementary schools is the goal of this project. Third grade teachers, school CSH coordinators, parent volunteers, school administrators and local county Extension educators are another target audience in terms of adopting and implementing a coordinated strategy integrating horticulture, nutrition, and physical activity programs to address child obesity through experiential learning activities. The specific efforts of this project include the modified Junior Master Gardener: Health and Nutrition from the Garden curriculum, student journals, family stories, cultural traditions, & family celebrations activities, the integration of children's books, "Dinner Tonight," video clips of children selecting, cleaning and preparing the twelve featured vegetables in easy, child friendly recipes and Walk Across Texas' addition of Family Bonus Miles, Family physical activity BINGO and family newsletters. The incorporation of Social Cognitive Theory tenets into the program components has been shown to work well in school-based interventions. Expanded Food and Nutrition Agents and Assistants as well as external project advisers provide reviews and feedback of curriculum components for effectiveness with limited-resource families and youth during the pilot phase of the project PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.

Impacts
Goal 3: Pilot study outcomes reported for 3 third grade classes in Title 1 school. 122 students and parents enrolled. 62 students and 34 parents completed pre-post surveys: 95% low income, 63% Hispanic, 13% Black, 11% white and 13% other. 32% of parents were enrolled in SNAP; 10% in WIC. Students increased vegetable intake by 13%, and increased the number of vegetables tried and preferred. Physical activity level per child increased: 4 miles/week to 9.8 miles/week with an increase in variety and activity time with parents reported. Soda consumption was reduced by 18%; sugar drinks by 10%. Student weight status pre-intervention was: 57% obese, 10% overweight, 31% healthy weight and 2% underweight. Post-intervention weight status change was significant: 39% obese, 16% overweight and 45% healthy weight. 23.8% of boys and 13.3% of girls transitioned from an unhealthy to a healthy BMI status by end of pilot. Process evaluation determined teacher's success with the curriculum learning activities, journaling, vegetable tasting, recipe tasting, gardening and WAT activities within their classrooms. Process interviews with school administrators indicated feasibility of the combined intervention. Limited participation by parents was found. Extension and Master Gardeners provided primary support for implementation. Need to find successful parent recruitment strategies. Cohort 1 enrollment from 16 schools during Fall 2012: 730 parents returned surveys with consents. Statistics reported below pertain to 188 parents for whom data has been entered. These data are not representative. 91.5% of parents responding to the parent questionnaire were female. 56% of responding parents were Hispanic, nearly 10% White, 28% Black, and the remaining 6% other races, including mixed races. Two out of 5 parents (42%) reported some college, and nearly 25% reported <12 years of education. The mean age of parents was 34 years. 88% of parents reported that their child was eligible for free or reduced lunch. The self-reported mean BMI of parents was 30.36. 44% of parents were classified as obese (BMI>=30), 32% of parents were classified as overweight (BMI>25 and <30). Less than a quarter of parents were normal weight or less. 722 students returned usable surveys showing a mean age of 8.3 with 88% reporting English as the main language spoken at home; 11% Spanish. Student BMI showed the following distribution by gender. Boys: underweight, 2.7%; normal weight,48.3%; overweight,15.5%; obese,33.4%; Girls: underweight, 2.5%; normal weight,50.1%; overweight,19.4%; obese,28.1%. 70 of 84 teachers and 7 volunteers enrolled in the research project, completing the pre-survey. Data entry for all surveys is in process. Goal 4: Pilot findings presented at two conferences: Warren, J.L., Evans, A., McIntosh, A., McKyer, L.E., Ory, M., Whittlesey, L., Kirk, A., and Robinson, S. Journal of Nutrition Education and Behavior, Vol. 44, Number 4S, 2012, p.S92.; Evans, A. and Warren, J.L., Texas GROW! EAT! GO! (TGEG)-Using Family Focused Garden, Nutrition and Physical Activities to Prevent Childhood Obesity. Southern Obesity Summit, Charlotte, N.C., October 15, 2012.

Publications

• No publications reported this period

Progress 03/01/11 to 02/28/12

Outputs
OUTPUTS: Integrated Extension and Research activities and metrics reported for March 1, 2011 - October 2011. Organizational Support: Project personnel hired; project support materials acquired/distributed. Briefings held with study site Extension staff, faculty and administrators. News articles/TV in Brazos (TAMU), Travis (UT) and Dallas. Executive Management Team established communication protocol, organizational work plan, curriculum and child/parent survey plans. Extension faculty from multiple disciplines addressed Goal 1 below to include social cognitive theory. Goal 1, Objective 1:1 Progress: Extension faculty gave input on approach, program modifications, volunteer development and support plans, intervention implementation plan, parental engagement, school and community events supporting the project and process evaluation strategies. External consultant contracts developed for product review on structure, scientific content and dosage. Teachers, parent volunteers, administrators and CATCH coordinators at a Evans Elementary School have been trained and are pilot testing the curriculum during the Fall of 2011/Spring 2012 (prior to Cohort 1 of the study in Fall of 2012). Implementation support developed locally. Objective 1:2: Refined/produced 12 JMG: "Learn, Grow, Eat, Go" lessons and components: "What's for Snack," student journals, cultural traditions, & family celebrations activities, the integration of children's books and "Dinner Tonight" videos based on stakeholder input. Vegetable growing guides developed with Master Gardeners. Objective 1:3: WAT school program refined: new in-school activities, family physical activity BINGO and family bonus miles based on stakeholder review. Objective 1:4: Developed resources for volunteer recruitment. Trained Master Wellness volunteers. CATCH training of Extension pilot planned. Research Progress to Date: Graduate Students, research coordinator and CATCH staff hired. Four study instruments were developed based on Logic Model constructs: Child, Parent, Teacher and Volunteer Surveys. Questions pretested by cognitive interviews with children and adults, revised to capture evaluation of both parent and child variables at different levels: home environment (meals, availability of foods), constructs consistent with the theoretical models (self-efficacy, motivation, role modeling), and behaviors (child walking, child F&V consumption) with Spanish translation. Surveys used with focus groups by the UT research partner for feedback. The use of Mid-Upper Arm Circumference replaced the waist circumference measurement on the BMI evaluation. The research team planned small validation study comparing the Tanita scale (body composition print out) to accepted BMI measurement protocol. The pilot includes three third grade classrooms with 66 children. The parents of the children, three teachers and parent volunteers completed the surveys during baseline data collection and will be post-tested in May. Process evaluation researchers developed four instruments related to teacher implementation, volunteer management, learning influence and economic impact. PARTICIPANTS: Judith Warren, PI, and Alexandra Evans, Co-PI, coordinated with project manager Jan Fernandez to oversee the overall project planning, budget management and reports, implementation and accountability. Warren, Evans and Fernandez coordinated with the following team members on development of both research and intervention components: Marcia Ory, Lysako McKyer, Christine Tisone, Alex McIntosh, Dean McCorkle and Carolyn Smith worked with four graduate students on child, adult and teacher survey development; Sharon Robinson, Alice Kirk, Lisa Whittlesey, and Randy Seagraves produced the curriculum revisions and provided target areas for process evaluation. Graduate Students include Rose Jennings and Kerry Meath at UT; Michael Lopez and Brittany Rico at A&M who helped develop the child, parent and teacher surveys. Limited income parents and children in Austin, Corpus Christi and Bryan have been involved in cognitive interviews and focus group evaluation of project surveys. Warren and Evans coordinated review of research instruments and protocol forms through TAMU and UT Institutional Review Boards. Field Staff- Rusty Hohlt, LaVaughn Moseley, Rebekah Welsh, and Caren Walton have developed video scripts and raw footage on 6 vegetables, gardening, kids preparing vegetables, physical activity, six "Dinner Tonight" videos and volunteer guidelines and the local implementation management framework. Susan Ballabina and Elaine Fries have coordinated with the four study sites. Jenna Anding, Ninfa Pena-Purcell, and Amanda Scott have reviewed materials and provided feedback. Jayla Fry has coordinated with the Master Gardener Association on local gardening guides and website needs to support gardening. Jackson Price, JMG artist, developed logo; Janet Peirce translated Walk Across Texas into Spanish; Terri Browning has written family stories; Rebecca Vore developed JMG lessons associated with Texas Essential Knowledge and Skill. Peter Cribb and Joey Walker of the Michael and Susan Dell Center for Healthy Living at University of Texas Health Science Center have contributed the CATCH coordination materials and training component. KAMU has aired a 15 minute segment on the project; Dallas Morning News, Bryan Eagle and Austin American Statesman did news articles about the project. The Texas Health Institute hosted the Southern Obesity Summit where information on the project was shared informally. Project advisors include Carolyn Dunn, North Carolina Extension; Jamie Dollahite, Cornell Cooperative Extension; Rose Hayden-Smith, University of California; Joy Casnovsky The Sustainable Food Center; The Oliver Foundation and Sharon McWhinney, Prairie View A&M University. A one day training was conducted by Seagraves, Kirk, Smith, Warren, Evans in Corpus Christi with the Evans Elementary pilot teachers. TARGET AUDIENCES: The target audiences for this project include parents and children in Title 1 school in four Texas counties: Dallas, Harris, Nueces and Brazos. These geographical areas represent the diverse population of Texas and the nation including Hispanic, African American, Asian and Caucasian populations. The Texas GROW! EAT! GO! Project will assess the efficacy of a coordinated school health (CSH) program enhanced with family-focused, experiential garden, nutrition and physical activity programs on the prevalence of child overweight and obesity in third grade students in 32 Title 1 school with a total sample size of 1,600 student/parent pairs. Improving family and community involvement has been shown to increase the potential of CSH programs to have significant effects on child obesity. Developing a working model that can be easily disseminated and institutionalized through connecting Extension personnel and volunteers such as Master Gardeners with local elementary schools is the goal of this project. Third grade teachers, school CSH coordinators, parent volunteers, school administrators and local county Extension educators are another target audience in terms of adopting and implementing a coordinated strategy integrating horticulture, nutrition, and physical activity programs to address child obesity through experiential learning activities. The specific efforts of this project include the modified Junior Master Gardener: Health and Nutrition from the Garden curriculum, adding "What's for Snack," student journals, family stories, cultural traditions, & family celebrations activities, the integration of children's books, "Dinner Tonight," You Tube clips of children selecting, cleaning and preparing the six featured vegetables in easy, child friendly recipes and Walk Across Texas' addition of Family Bonus Miles, Family physical activity BINGO and family newsletters. The incorporation of Social Cognitive Theory tenets into the program components has been shown to work well in school-based interventions. Expanded Food and Nutrition Agents and Assistants as well as external project advisers provide reviews and feedback of curriculum components for effectiveness with limited-resource families and youth during the pilot phase of the project. PROJECT MODIFICATIONS: Not relevant to this project.

Impacts
Year one of the Texas GROW! EAT! GO! project focused on using project resources to refine the inter disciplinary intervention for school and local Extension organization training, implementation and evaluation in Years two through five of the project. Project resources have been used to hire part-time local project specialists for project support and for coordination with faculty implementation and research teams at two universities: Texas A&M University System which includes Texas AgriLife Extension Service, Texas A&M University, Texas A&M Health Science Center School of Rural Public Health, Prairie View A&M University, an Historically Black College and University of Texas Health Sciences Center School of Public Health. Research and Extension faculty have coordinated efforts on curriculum modification; development and review of survey research tools-child, parent and teacher survey; and development of local implementation plans and actions. These activities have been described in the Output Section of this report.

Publications

• No publications reported this period