Source: Teachers College, Columbia University submitted to NRP
REDUCING CHILDHOOD OBESITY: AN INNOVATIVE CURRICULUM WITH WELLNESS POLICY SUPPORT
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
COMPLETE
Funding Source
AFRI COMPETITIVE GRANT
Reporting Frequency
Annual
Accession No.
0221421
Grant No.
2010-85215-20661
Cumulative Award Amt.
$1,497,055.00
Proposal No.
2009-05056
Multistate No.
(N/A)
Project Start Date
Mar 15, 2010
Project End Date
Mar 14, 2015
Grant Year
2010
Program Code
[93330]- Human Nutrition and Obesity
Recipient Organization
Teachers College, Columbia University
525 West 120th Street
New York,NY 10027-6670
Performing Department
(N/A)
Non Technical Summary
We are experiencing the linked epidemics of childhood obesity and type 2 diabetes. Rates are especially high among racial/ethnic minority children. These diseases lead to decreased quality of life and high health costs. At schools students can learn about why healthful eating and regular physical activity are important and how to enact these behaviors in their lives. Additionally, schools can be a model environment where mostly healthful foods are offered in appropriate sized portions, and opportunities to be physically active are offered everyday. This study improves our understanding of how to intervene in schools by providing us with information on the relative effectiveness of two innovative interventions for upper-elementary students. The first intervention focuses on a curriculum for fifth grade students, called: Food, Health & Choices. In these lessons, students first learn that humans biologically like sweet taste and also naturally seek out foods high in fat. Then, they learn that the foods that are readily available to us are often high in sugar and fat and served in large portions. Next, they learn about the concept of energy balance - balancing the energy from food with the energy we use, along with eating the right combination of food to get all the nutrients we need. This helps them understand the benefits of healthful eating and getting regular physical activity. Next, they set personal goals and make specific action plans for making change. They learn practical how-to tips for: - eating more fruits and vegetables, - drinking beverages that quench thirst and keep them healthy, - eating less often at fast food places and choosing healthy options and smaller portions, - eating processed, packaged, high-calorie snacks less often and in smaller portions, and - incorporating more movement into their lives. The students share what they learned with their family and school community through conducting a health expo. Throughout the rest of the school year the students receive additional lessons to help them maintain their healthful food and activity choices. The other intervention involves implementation of Wellness Policy school-wide and in the fifth grade classroom. This policy creates a school and classroom environment that models healthful eating and regular physical activity. When students have snacks or celebrations in the classrooms, healthful foods will are served. They will also do physical activity daily in the classroom and get other opportunities for physical activity. Our research will collect data that will help us determine how both of these interventions, separately and combined, affect: - what students know about healthful eating. - what the students eat and how active they are, and - students' weight in relation to their height and the amount of fat in their bodies. If one or both of these interventions are effective at moving the students toward healthful choices that will help them maintain health and a healthy weight, we will disseminate the interventions nation-wide so that more students can benefit from learning why and how to make food and activity choices that will maintain health.
Animal Health Component
100%
Research Effort Categories
Basic
(N/A)
Applied
100%
Developmental
(N/A)
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
7036010101015%
7036010302015%
7036010303010%
7036020302015%
7036020303010%
7036099101010%
7036099302015%
7036099303010%
Knowledge Area
703 - Nutrition Education and Behavior;

Subject Of Investigation
6010 - Individuals; 6020 - The family and its members; 6099 - People and communities, general/other;

Field Of Science
3020 - Education; 1010 - Nutrition and metabolism; 3030 - Information and communication;
Goals / Objectives
EDUCATIONAL OBJECTIVE 1. Develop and implement an innovative approach to reduce childhood obesity risk in fifth grade students that involves: a. CURRICULUM, combining inquiry-based science education with behavioral nutrition strategies-to be named Food, Health, & Choices (FHC). The outputs of the development and implementation of FHC are activities and products. Activities: providing professional development to teachers, workshops for families, newsletters, and family nights. Products: teacher curriculum guide, materials and supports for the teachers while implementing the curriculum, activity sheets and readings for students, and take-home materials for families. b. SCHOOL WELLNESS POLICY IMPLEMENTATION, combining school-level wellness policy activities with a novel classroom-level approach - to be named Positively Healthful Classrooms (PHC). The outputs of the development and implementation of school wellness policy and PHC will include activities and products. Activities: For school-level policy activities - assist schools to implement policy, conduct school-wide food and fitness activities. For PHC - provide professional development, materials and supports to the teachers implementing the classroom wellness policy, and work with families. Products: For school-wide policy, wellness policy guide and event planning materials. For PHC, teacher policy manual and take-home materials for families. DISSEMINATION. After the research, described below, is completed, the program will be disseminated through publishing the curriculum and wellness policy manual for distribution nation-wide. We will seek dissemination partners such as Extension Service and State Nutrition Education Network Coordinators. RESEARCH OBJECTIVE 2. Conduct an evaluation of the effectiveness of the Curriculum Intervention and Wellness Policy Intervention separately and combined. The research component will take place over all three years, with pilot-testing of outcome instruments in year 1, followed by formative evaluation in year 2 and outcome evaluation in year 3. The final outcome evaluation will use a cluster-randomized, intervention-control group, pretest-posttest design. Elementary schools that have agreed to participate in the program will be randomized within matched pairs into one of our 4 research conditions: 1) Curriculum Intervention [Food, Health, & Choices Curriculum]; 2) Wellness Policy Intervention [School-level and Positively Healthful Classrooms Policy]; 3) Curriculum and Wellness Policy Interventions; and 4) delayed controls, which will receive the complete intervention in year 3. The activities will include administering questionnaires to the students to measure our behavioral outcomes [actions] and theory mediators [knowledge], collecting anthropometric data on the students [conditions/physiological outcomes], and analyzing data to link intervention to outcomes. The product will be the databases from the students' answers to the questionnaires and from the anthropometric data and results of the statistical analyses. The research component will be disseminated through presentations at conferences and articles in peer-reviewed journals.
Project Methods
EFFORTS - Achievement of Educational Objective We will design the materials for the Curriculum and Wellness Interventions, using our theoretical framework. Based on our pilot and formative evaluation, we will finalize all materials for our outcome evaluation. During all rounds of implementation of the Curriculum and Wellness Interventions, we will work closely with the school administrators, teachers, and families. We will assure high fidelity to the 24 main lessons and the eight booster sessions through professional development and process implementation. We will also assure that the family materials are distributed, the family workshops are fully implemented, and that the family nights are promoted, engaging, and fun. We will achieve full implementation of the school-wide policies along with the classroom-level food policies and daily physical activity bouts. We will collect process data to be able to assess the level of implementation for both interventions. EVALUATION - Achievement of Research Objective We will develop, extensively pilot, and revise our outcome measurements that will be used for our final outcome evaluation. Key milestones: YEAR 1: Several rounds of pilot testing. YEAR 2: Pre-post formative evaluation. Knowledge: final products are scales to accurately measure: relevant food and nutrition knowledge, outcome expectations, self-efficacy, self-determined motivation, competence, autonomy or sense of choice and control, importance, and goal-setting/ self-regulation skills. Actions: final products are validated instruments to measure intake of: sweetened beverages, processed, packaged snacks, fast food, fruit and vegetables, leisure screen-time, and moderate and vigorous physical activity. Conditions (anthropometric parameters): final product - protocol for efficiently and accurately measuring height, weight, and percent body fat. IN YEAR 3, the final outcome study will span 8 months. The research plan is described above. Outcome measures will be taken for students in all four conditions twice: pre-intervention, and after the booster sessions have occurred for intervention students. We will analyze the data based on five hypotheses: Indicators of success: Hypothesis 1: Outcome effects. We will use a general linear mixed-model analysis to test the effects of the Curriculum and Wellness Policy interventions (separately and combined) on the primary outcomes mean BMI and percent body fat and on the students' actions and knowledge. Hypothesis 2: Mediation analysis. We will test whether changes in our theory variables (knowledge) are associated with improvements in BMI, percent body fat, and diet and physical activity actions. Hypothesis 3: Dose-response effect. Although we intend for the interventions to be fully implemented, we will also develop a "dose" composite score in case varying exposures occur and examine its effect using general linear mixed-model analysis. Hypothesis 4: Moderator effect. We will test whether students' gender and ethnic-racial group membership moderate intervention effects. Hypothesis 5: Process evaluation. We will examine satisfaction ratings from feedback forms completed by students and teachers.

Progress 03/15/10 to 03/14/15

Outputs
Target Audience: The main audience for this project were 5th grade students (mostly 10-11 years old) from public elementary schools in New York City. Also reached by this project were the fifth grade teachers at the school and the families of the fifth grade students. The majority of the population reached were racial and ethnic minorities and those who are socially, economically, and educationally disadvantaged. Preparation and pilot period from 2010 to 2011: we have developed the intervention components and instruments, and pilot tested them with two public elementary schools in New York City. Approximately 100 students participated in 24-hour food recalls or food frequency questionnaire pilot studies. Height / weight and body fat measurement procedure was also pilot-tested with two 5th grade classes from one school. Students were predominantly Black or Hispanic and high percentages of students were eligible for free or reduced price lunch. Formative evaluation period, from 2011 to 2012: two schools where the pilot tests were completed participated in the intervention implementation, but with new 5th grade students. The first versions of the curriculum and wellness protocol were implemented throughout the school year in seven 5th grade classes (about 180 students). Again, students were mostly Black or Hispanic and high percentages of students were eligible for free or reduced price lunch. Summative evaluation period, from September 2012 to June 2013: the refined curriculum and wellness intervention were implemented and evaluated in 15 school and 5 schools received regular science curriculum as a delayed-control group. 1387 5th grade students and about 80 teachers where 85.3% of students qualify for free or reduced price lunch enrolled the study. A mean of 32.1% of students are Black/African are 59.0% of students are of Hispanic ethnicity. The mean percentage of students who are proficient (at grade level) on the state English Language Literacy and Mathematics test were 33.9% and 47.6% respectively. Delyaed control intervention implementation period, from September 2013 through June 2014: five public elementary schools that were in the control condition in the previous year were targeted. Four schools in 2013-2014 school year (September 2013 to June 2014) participated and implemented the Food, Health & Choices intervention. Fourteen 5th grade classes received the Food, Health & Choices curriculum and wellness policy intervention. Data collections were conducted at pre- and post-intervention conditions. The pre-intervention data were collected from 281fifth grade students, and 247 students completed the post-intervention surveys. The schools were located in underserved neighborhood and students were predominantly Black and Hispanic from the low-income families. The curriculum and wellness policy intervention included 23 lessons and classroom wellness policy materials (snack guidelines and dance breaks in classroom). Graduate school level nutrition and wellness instructors implemented the program in each 5th grade class. Teachers of participating classes assisted with classroom management. Several parents participated in 3 focus group discussion meetings on food environment and students' eating habits around the schools. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? 1) Training graduate level student professionals: We have provided extensive training to at least 10 master's degree and doctoral students so that they are learning about how to develop interventions, evaluation tools and how to deliver educational interventions in school classrooms. This was done through a half-day training at the beginning of the intervention and weekly meetings throughout the intervention. We have also trained an additional 6 master's degree students on how to collect anthropometric, behavioral, and psycho-social data in school settings through a full day of training before data collection and on-going training during data collection. During the entire reporting period, three doctoral students completed their dissertations as part of this grant, one on the formative evaluation, one on an analysis of the baseline data and one on the process evaluation of the outcome study. 2) Professional development opportunities for teachers and shcools Pilot studies from September 2010 through June 2011: nine fifth grade classes from two public elementary schools in New York City participated in the pilot study. We provided professional development to teachers and school staff. Professional development in August 2011 for the formative evaluation: Formative evaluation study was planned and professional development session was conducted with two NYC public elementary schools. Professional development in August 2012 for the summative evaluation: Twenty schools were recruited for the summative evaluation study, and three professional development sessions were held at Teachers College Columbia University for teachers and school administrative staff (mostly assistant principals). How have the results been disseminated to communities of interest? The results have been published or currently submitted in peer-reivewed journals, and presented in academic professional conferences. Ongoing as of March 2015 1) Systematically reviewed the Food, Health & Choices curriculum with instructors who taught the lessons during the 2012-13 school year for changes for publication in 2013. Currently working with copy editor to prepare curriculum for publication. 2) Participating in Extension Service and State Nutrition Education Network conference call meetings, especially as part of the Healthy Food Choice in Schools Community of Practice. 3) Writing manuscripts for peer-reviewed academic and professional journal publication. 4) Resources and Take a Dance Break videos are available through our website. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? We have accomplished educational and research goals over 5 years (March 2010 to March 2015). Development of intervention components and instruments, from March 2010 through August 2010: a curriculum intervention and a wellness policy manual were developed during this year. Height, weight, and body fat measure protocol and survey instruments were also developed. Pilot studies from September 2010 through June 2011: nine fifth grade classes from two public elementary schools in New York City participated in the pilot study. We provided professional development to teachers, and newsletters and events for families. Intervention revision from June 2011 to August 2011: Based on the results and feedbacks from the pilot study, we revised the intervention protocols and materials as well as outcome measurement instruments. Formative evaluation study from September 2011 through June 2012: Formative intervention materials and protocols were implemented in two public schools. 19.5% of study participants were African American and about 68.5% were Hispanic. 78.5% were eligible for free lunch, suggesting lower-income families. The purpose of evaluating the formative stage of research was to learn about ways to strengthen and improve the quality of program implementation and the appropriateness of study instruments in anticipation of the full intervention year. Results from the process evaluation revealed key factors to include in formative studies for school-based interventions, particularly for maximizing a program's ability to change behavior and the ability for evaluation instruments to detect any changes. Results from the outcome evaluation demonstrated that students successfully made changes in some of the targeted behaviors that were sufficiently promising to proceed with the full trial contingent upon program improvements being made. Finalizing intervention and measurement manual and materials from June 2012 through August 2012: To conduct an efficacy study (summative evaluation) using a cluster randomized controlled design in fall 2012, all materials and protocols/manuals were revised and finalized during the summer of 2012. Twenty schools were recruited for the summative evaluation study. A study design was a 2 x 2 factorial, cluster randomized controlled trial: a curriculum and a wellness intervention as two factors, yielding total 4 study arms (curriculum only, wellness only, both curriculum and wellness, and control condition). Schools were stratified by percentage of students eligible for free and reduced price lunch program, ethnicity, and achievement test scores, and randomly assigned into one of four study conditions. Summative evaluation study from September 2012 through June 2013: Educational materials were implemented in all intervention schools. Intervention and control schools were evaluated with final measurement protocols and instruments. The evaluation consisted of process evaluation and outcome evaluation. The results of the outcome data analyses indicated that the curriculum intervention significantly reduced the prevalence of overweight and obesity, without the Wellness intervention. Male students in the five Curriculum schools became 83% less likely to be overweight or obese after the intervention, compared to the control. It significantly increased the portion size of vegetables (by about a quarter cup), with or without the Wellness intervention. The curriculum significantly increased students' behavioral intentions with respect to physical activity. The Wellness Intervention significantly decreased the frequency of sports drinks, candy, and packaged baked goods (cookies, brownies, and pies). It significantly decreased the overall size (across different kinds of snacks) of processed packaged snacks, and significantly decreased the frequency and size of fast foods and also significantly decreased combo meals (fast food sandwich or entrée with fries and a soda). In addition, the Wellness intervention significantly improved outcome expectations for physical activity. The significant impacts of the Curriculum or Wellness interventions were independent, meaning that schools that received either or both interventions obtained all significant impacts from the Curriculum and Wellness components without synergy or suppressing each other. These components can thus be used separately, each with some effectiveness. As a secondary analysis, we also compared schools (n=5) who received Curriculum+Wellness to Control schools (n=5) on state test scores for English Language Literacy (ELA) and Math, to see whether or not the intervention had any impact on students' achievement scores. Due to test reformatting related to Common Core standards, all 10 schools saw a decrease in test scores from the previous school year. A mean decrease was calculated. For each school, we compared deviations from this mean decrease. Overall, students in schools who received the intervention had lower mean decreases, with Math 0.8 vs. -0.64 and ELA 0.2 vs. -0.43. This findings are promising to show that nutrition education could improve test scores. Lastly, we evaluated the cost-effectiveness of implementing FHC for all fifth-grade public school students in New York City (NYC) (n=76,778). The cost was $104/students. 1264 fewer males and 131 fewer females would be considered obese as adults, averting over $16M in medical costs. For process evaluation components, a Comprehensive Approach to Process Evaluation (CAPE) framework was developed and used for the project. CAPE was designed to provide a program improvement-oriented, paradigmatic and methodological compliment to randomized controlled trials. Analyses based on this systematic framework yielded insight into how the intervention implementation and context influenced results and might improve future interventions, highlighting the value of a well-received program, trained nutrition educators providing instruction, and the overwhelming power of neighborhood environment on behavioral outcomes. A purposeful sample of students (n=18) from all active intervention arms were selected to represent a range of engagement with FHC. Two 30-minute interviews were conducted with each participant. Data were descriptively coded and case-ordered descriptive meta-matrices were used to examine target energy balance related behavior adoption and supports and barriers. This yielded four patterns of behavior adoption with corresponding interpersonal and external contextual factors that facilitated and hindered behavior adoption in each group: (1) Activated; (2) Inspired; (3) Reinforced; and (4) Indifferent. Implementing intervention in delayed control schools and on-going data analyses, from June 2013 - March 2015: a) (Completed June, 2013): Implemented the Food, Health & Choices Curriculum and Positively Healthful Classroom Wellness Policy interventions in the 15 intervention schools as planned and collected post-data from all 20 schools. b) (Completed June 2013) Video-taped 18 Take a Dance Break songs (Physical activity bouts used in the Positively Healthful Classroom Wellness Policy intervention). c) (Completed June 2014) Implementing our Food, Health & Choices Curriculum and Positively Healthful Classrooms Wellness Policy (both Dance Breaks and Think Before you Bring Food Policy) in four schools 13 classes (started September 2013 through June 2014). d) (Completed June 2014) Using Take A Dance Break videos in the delayed control classes and for dissemination. e) (Completed June 2014) Editing Take A Dance Break video (8 songs edited and in classroom use, 10 still being edited). f) (Completed June 2014) Working closely with parents and active members of a nutrition committee at one school to change foods served at school functions, school food and food in the community. g) (Completed June 2014) Analyzing process and outcome data.

Publications

  • Type: Conference Papers and Presentations Status: Published Year Published: 2014 Citation: Burgermaster, M., Lee, H., Graziose, M., Koch, P., Contento, I. R., & DiNoia, J. (2014, July). Food, Health & Choices (FHC): Fifth-graders Post-Intervention Meal and Beverage Patterns. [Abstract] Journal of Nutrition Education and Behavior, 46 (Suppl. 4), S109. Presented at the Annual Meeting of Society for Nutrition Education and Behavior, Milwaukee, WI.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2014 Citation: Burgermaster, M., Lee, H., Contento, I. R., & Koch, P. (2014, July). Food, Health & Choices (FHC): Parent Awareness of the Program, Beliefs about Nutrition Education, and Family Behaviors. [Abstract] Journal of Nutrition Education and Behavior, 46 (Suppl. 4), S175. Presented at the Annual Meeting of Society for Nutrition Education and Behavior, Milwaukee, WI.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2014 Citation: Abrams, E., Burgermaster, M., Koch, P., Contento, I. R., & Lee, H. (2014, July). Food, Health & Choices (FHC): Importance of Formative Evaluation to Create a Well-delivered and Well-received Intervention. [Abstract] Journal of Nutrition Education and Behavior, 46 (Suppl. 4), S137. Presented at the Annual Meeting of Society for Nutrition Education and Behavior, Milwaukee, WI.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2014 Citation: Burgermaster, M., Koch, P., Lee, H., Mull, L., Contento, I. R., & Paul, R. (2014, July). Food, Health & Choices (FHC): Teacher engagement related to student reception in curriculum intervention, but not wellness. [Abstract] Journal of Nutrition Education and Behavior, 46 (Suppl. 4), S175. Presented at the Annual Meeting of Society for Nutrition Education and Behavior, Milwaukee, WI.
  • Type: Conference Papers and Presentations Status: Other Year Published: 2014 Citation: Burgermaster, M., Koch, P., Contento, I. R. & Lee, H. (2014, May). Food health & choices, obesity prevention curriculum: Classroom teacher engagement related to student reception when trained instructors facilitated lessons. Presented at the Annual Meeting of International Society for Behavioral Nutrition & Physical Activity, San Diego, CA.
  • Type: Conference Papers and Presentations Status: Other Year Published: 2014 Citation: Burgermaster, M., Koch, P., Contento, I. R. & Lee, H. (2014, May). Effortful Control and Energy-Balance Related Behaviors in Fifth Graders Participating in Food Health & Choices Obesity Prevention Intervention. Presented at the Annual Meeting of International Society for Behavioral Nutrition & Physical Activity, San Diego, CA.
  • Type: Conference Papers and Presentations Status: Other Year Published: 2014 Citation: Paul, R., Graziose, M., Burgermaster, M., Koch, P., Contento, I. R. & Lee, H. (2014, May). Understanding Perception of Peer and Maternal Eating and Physical Activity Behaviors of Urban Elementary School Students Participating in Food, Health & Choices: A Childhood Obesity Prevention Program. Presented at the Annual Meeting of International Society for Behavioral Nutrition & Physical Activity, San Diego, CA.
  • Type: Conference Papers and Presentations Status: Other Year Published: 2014 Citation: Lee, H., Burgermaster, M., Tipton, E., Contento, I.R., Koch, P., DiNoia, J., & Islas, A. (2014, May). Food, Health & Choices (FHC): Are We Underpowering School-Based Nutrition Intervention Studies? Investigating Intraclass Correlation Coefficients (ICC) In a Cluster-Randomized Trial of a School-Based Obesity Prevention Intervention. Presented at the Annual Meeting of International Society for Behavioral Nutrition & Physical Activity, San Diego, CA.
  • Type: Journal Articles Status: Accepted Year Published: 2015 Citation: Gray, H.L., Burgermaster, M., Tipton, E., Contento, I.R., Koch, P., DiNoia, J., & Islas, A. (2015). Intraclass correlation coefficients for obesity indicators and energy balance related behaviors among New York City public elementary schools. Heath Education & Behavior, Manuscript accepted for publication.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2014 Citation: Contento, I. R., Koch, P.A., & Lee, H. (2014, July). Reducing Childhood Obesity: An Innovative Curriculum with Wellness Policy Support. [Abstract] Journal of Nutrition Education and Behavior, 46 (Suppl. 4), S190. Presented at the Annual Meeting of Society for Nutrition Education and Behavior, Milwaukee, WI.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2014 Citation: Bhana, H., Islas, A., Contento, I. R., Lee, H., DiNoia, J., Koch, P. (2014, July). Food, Health & Choices (FHC): Using Focus Group Data to Determine Effective Family Supports. [Abstract] Journal of Nutrition Education and Behavior, 46 (Suppl. 4), S134. Presented at the Annual Meeting of Society for Nutrition Education and Behavior, Milwaukee, WI.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2014 Citation: Koch, P., Lee, H., Contento, I. R., Graziose, M., Burgermaster, M. & DiNoia, J. (2014, July). Food, Health & Choices (FHC): a Retrospective Evaluation of Changes in Energy Balance Related Behaviors (EBRBs). [Abstract] Journal of Nutrition Education and Behavior, 46 (Suppl. 4), S147. Presented at the Annual Meeting of Society for Nutrition Education and Behavior, Milwaukee, WI.


Progress 03/15/13 to 03/14/14

Outputs
Target Audience: The main audience for this project are 5th grade students (mostly 10-11 years old) from public elementary schools in New York City. Also reached by this project are the fifth grade teachers at the school and the families of the fifth grade students. The first few months of this reporting year was the end of our student outcome evaluation where we worked with 20 schools (1387 5th grade students and about 80 teachers) where 85.3% of students qualify for free or reduced price lunch. A mean of 32.1% of students are Black/African are 59.0% of students are of Hispanic ethnicity. The mean percentage of students who are proficient (at grade level) on the state English Language Literacy and Mathematics test were 33.9% and 47.6% respectively. This indicates that the majority of the population reached are racial and ethnic minorities and those who are socially, economically, and educationally disadvantaged. From September 2013 through June 2014 we are working with four of the original schools (13 classrooms, 281 students). These four schools are the delayed control schools and their statistics are included in the above. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? During this reporting period, we have continued to provide extensive training to 10 master’s degree and doctoral students so that they are learning about how to develop interventions, evaluation tools and how to deliver educational interventions in school classrooms. This was done through a half-day training at the beginning of the intervention and weekly meetings throughout the intervention. We have also trained an additional 6 master’s degree students on how to collect anthropometric, behavioral, and psycho-social data in school settings through a full day of training before data collection and on-going training during data collection. We also provided professional development to the schoolteachers, during an all-day workshop in August, 2013. Our graduate students who taught the interventions continue to support the teachers as they visit their classrooms. How have the results been disseminated to communities of interest? We are currently working on dissemination through two routes. First, when the editing is complete (anticipated date March 2015) the Food, Health & Choices Curriculum and Positively Healthful Classroom Wellness Policy Manual will be published and marketed nationally by National Gardening Association. This will make it available across the country. Additionally, since our interventions are based on the Dietary Guidelines for Americans we will also make it known to Extension, SNAP-Ed, and other nutrition professionals. Additionally, we will put our 18 “Take A Dance Break” songs and instructional videos on a website so that they can be widely used. What do you plan to do during the next reporting period to accomplish the goals? Plans for Next Reporting Period Educational Objective 1: March - June 2014: Implement the Food, Health & Choices Curriculum and Positively Healthful Classrooms (both Dance Breaks and Think Before you Bring Food Policy) in four schools 13 classes March - June 2014: Edit the remaining 10 Take A Dance Break videos. March - June 2014: Work with one school with parents to change foods served at school functions, school food and food in the community. March 2014 - March 2015: Work with copy editor and publisher to prepare curriculum for publication and create marketing plan for dissemination. Research Objective 2: March 2014 - March 2015: Complete the analyses of the student outcome and process evaluation data from the Food Health & Choices curriculum and Positively Healthful Classrooms wellness intervention study with 1387 students. This includes analysis of the anthropometric, behavioral, psychosocial, and process data. March - June 2014: Collect post data from students from the 4 delayed control schools. September 2014 - March 2015: Prepare and submit articles to peer-reviewed journals.

Impacts
What was accomplished under these goals? Educational Objective 1 During this reporting period of March 2013 through February 2014 we completed our cluster-randomized student outcome evaluation, with 20 total schools as follows: Curriculum condition: Food, Health & Choices Curriculum (5 schools); Wellness condition: Positively Healthful Classroom Wellness Policy (5 schools); Curriculum+Wellness condition (5 schools) and Delayed Control condition (5 schools). (This intervention spanned from September, 2012 to June 2013). Accomplishments: a) (Completed June, 2013): Implemented the Food, Health & Choices Curriculum and Positively Healthful Classroom Wellness Policy interventions in the 15 intervention schools as planned. b) (Completed August, 2013) Systematically reviewed the Food, Health & Choices curriculum with instructors who taught the lessons during the 2012-13 school year for changes for publication. c) (Completed June 2013) Video-taped 18 Take a Dance Break songs (Physical activity bouts used in the Positively Healthful Classroom Wellness Policy intervention). For each song there is a short instructional video and the dance video that has a lead instructor who announces the moves and shows dancers (5th grade students and adults) performing the moves. d) (Ongoing) Implementing our Food, Health & Choices Curriculum and Positively Healthful Classrooms Wellness Policy (both Dance Breaks and Think Before you Bring Food Policy) in four schools 13 classes (started September 2013 through June 2014). e) (Ongoing) Using Take A Dance Break videos in the delayed control classes and for dissemination. f) (Ongoing) Editing Take A Dance Break video (8 songs edited and in classroom use, 10 still being edited). g) (Ongoing) Working with copy editor to prepare curriculum for publication. h) (Ongoing) Working closely with parents and active members of a nutrition committee at one school to change foods served at school functions, school food and food in the community. Research Objective 2 During the current reporting period our major activity for this objective was to complete our main student outcome evaluation. From March through June 2012 we recruited and randomized 20 schools, five to each of our four study conditions (Curriculum, Wellness, Curriculum+Wellness and Delayed Control) using a clustered randomization approach, with schools clustered by percentage eligible for free and reduced lunch, academic performance based on state tests, and racial/ethnic composition of the students. From September 2012 to June 2013 we conducted the student outcome evaluation research study. Accomplishements: a) (Completed June 2013) Collected our pre-test data in September 2012) and our post-test data (June, 2013) that consisted of weight, height, percent body fat, eating and physical activity behaviors and theory-based mediator of behavior change in our 20 schools: 5 Curriculum only, 5 Wellness only, 5 Curriculum + Wellness, and 5 Delayed Control. b) (Completed June 2013) Collected process evaluation data (September 2012 to June 2013) using the instruments and protocols developed during the pilot (2010-2011) and formative years (2011-2012). c) (Ongoing) Analyzing the student outcome and process evaluation data from the Food Health & Choices curriculum and Positively Healthful Classrooms wellness intervention study. d) (Ongoing) Collecting data from the 4 schools who are receiving the delayed intervention to help us understand how the interventions impact students. We are collecting data on student behaviors, students’ social networks, and students’ effortful control -- as experimental variables to see if the intervention changes these variables or how these variables influence effectiveness of the intervention (pre data collected September, 2013 and post data to be collected June, 2014). Knowledge and Psycho-social Mediators: Changes Based on the data we have collected and analyzed so far, our preliminary results show that after the one year intervention, students in curriculum+wellness condition compared to students in the control condition showed positive changes. They improved their knowledge on physical activity (48% vs. 32% correct), water (40% vs. 23%), processed packaged snacks (37% vs. 17%), fast food (37% vs. 19%), and screentime (39% vs. 22%) (all p<.001). There were also positively changes in beliefs about healthy behaviors combined (3.95 vs. 3.40 on a 5-point scale); fruit and vegetables (3.74 vs. 3.08) and physical activity (4.16 vs. 3.73) (all p<.05). Female students in the curriculum only condition increased their intention to drink fewer sweetened beverages compared to control students (3.27 vs. 2.69 on a 5-point scale, p<.05). Further data analyses are on-going. Actions (Eating and Physical Activity Behaviors): Changes Based on the data we have collected and analyzed so far, our preliminary results show that students in curriculum+wellness condition reported that they consumed sweetened beverages (fruit drinks and soda) less frequently (2.75 vs. 3.37 on a 5-point scale) and in smaller sizes (3.47 vs. 4.27 on a 6-point scale) than control school students (p<.01). Students in wellness only condition reported that they ate fast food combo meals less frequently than control students (2.36 vs. 2.85 on a 4-point scale, p<.05). In a retrospective survey more students in the curriculum+wellness self-reported that they decreased packaged snacks (p<0.05, 39% vs. 25%), fast food (p<0.01, 54% vs 27%), sweetened beverages (p<0.01, 45% vs. 20%) compared to control students. Students who received the wellness condition reported more physical activity in class (p<0.001, 63% vs. 37%), compared to control students. Further data analyses are on-going. Conditions (Prevalence of Obesity): Changes Based on the data we have collected and analyzed so far, our preliminary results show that between before and after intervention, students in the curriculum+wellness condition significantly decreased their BMI z-scores by .04 and BMI percentile for age and gender by 1.04% (both p<.05). Percent body fat was significantly decreased in curriculum condition (1.20%) and curriculum+wellness condition (.02%) ( both p<.001). However, there is no significant difference in BMI z-score and percent body fat when the intervention conditions were compared to the control condition in ANCOVA models or multi-level regression models. Considering the fact that there were great school level variances, we have analyzed the data by matching criteria cluster (by %free and reduced lunch, reading and math scores). Among the schools in matching criteria 3, students in curriculum only condition had significantly lower percent body fat than control school students (23% vs. 26%; p<.001), after our one year intervention.Further data analyses are on-going.

Publications

  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Contento IR, Koch PA, Lee H, DiNoia J. Reducing childhood obesity: An innovative curriculum with policy supports. Journal of Nutrition Education and Behavior 2013, 45 (4), Supplement: S80.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Lee H, Mull L, Contento IR, Abrams E, Koch PA, DiNoia J. Food, Health & Choices: Understanding Relationships Among Food and Activity Behaviors and Theory-Based Mediators. Journal of Nutrition Education and Behavior 2013, 45 (4), Supplement: S6.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Lee H, Koch PA, Contento IR, DiNoia J, Mull L, Abrams E. Food, Health & Choices: Validation of an Audience Response system (ARS)-Delivered Food and Activity Questionnaire for Youth. Journal of Nutrition Education and Behavior 2013, 45 (4), Supplement: S59.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Lee H, Mull L, Abrams E, Contento IR, Koch PA, DiNoia J, Gallagher D. Food, Health & Choices: Understanding Body Fatness in Urban Elementary School Youth. Journal of Nutrition Education and Behavior 2013, 45 (4), Supplement: S59-S60.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Abrams E, Koch PA, Contento IR, Mull L, Lee H, DiNoia J, Burgermaster M. Food, Health & Choices: Using the DESIGN Stepwise Procedure to Develop a Childhood Obesity Prevention Program. Journal of Nutrition Education and Behavior 2013, 45 (4), Supplement: S13-S14.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Mull L, Koch PA, Abrams E, Contento IR, Lee H. Food Health & Choices: Development and Implementation of a Classroom Wellness Intervention Positively Healthful Classrooms. Journal of Nutrition Education and Behavior 2013, 45 (4), Supplement: S60-S61.


Progress 03/15/12 to 03/14/13

Outputs
Target Audience: The main audience for this project are 5th grade students (mostly 10-11 years old) from public elementary schools in New York City. Also reached by this project are the fifth grade teachers at the school and the families of the fifth grade students. The first few months of this reporting year was the end of our formative year where we worked with about 150 students and about 10 teachers. During the 2012-13 school year, we conducted our main student outcome evaluation with a total of 20 schools (1382 5th grade students and about 80 teachers). Our project has four study conditions: Curriculum intervention; Wellness intervention; Curriculum and Wellness interventions; and Delayed control. There are five schools in each study condition. For the schools were are working with, a mean of 85.3% of students qualify for free or reduced price lunch. A mean of 32.1% of students are Black/African and 59.0% of students are of Hispanic ethnicity. The mean percentage of students who were proficient (at grade level) on the state English Language Literacy and Mathematics test were 33.9% and 47.6% respectively. This indicates that the majority of the population reached are racial and ethnic minorities and those who are socially, economically, and educationally disadvantaged. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? Training Activities. We provided extensive training to graduate students on developing curriculum, developing evaluation tools, how to deliver educational lessons in school classrooms, and how to collect anthropometric, behavioral and psycho-social data in school settings. This was done through one day of intensive training before the intervention began and weekly meetings during the entire intervention. Professional Development Activities. We also provided professional development through an all-day workshop to teachers from the schools before the intervention. How have the results been disseminated to communities of interest? Because the outcome study is still in progress, we have not yet disseminated the interventions and plan to do so in the future so that Food, Health & Choices Curriculum and Positively Healthful Classrooms Wellness Policy can be used by schools, as well as by Extension, SNAP-Ed and other nutrition professionals. What do you plan to do during the next reporting period to accomplish the goals? Education Objective 1: 1a Curriculum. During the next reporting period we will still be working on this objective by revising and refining the curriculum to prepare it for publication. We will also make plans for nationwide dissemination through marketing of the curriculum guide and web-based activities. 1b Wellness Policy. During the next period we will still be working on this objective by revising and refining the wellness policy intervention to prepare it for publication. This will include video-taping the Dance Breaks and posting the videos online for teachers to use. We will also make plans for nationwide dissemination through marketing of the wellness policy guide and website with the Dance Breaks videos. Research Objective 2: During the next reporting year we will complete the outcome evaluation study by collecting the post data in both the intervention and control schools. We will analyze the data and prepare manuscripts based on the data for publication in peer-reviewed journals. We will also conduct the combined curriculum and wellness interventions with the delayed control schools, throughout the 2013-14 school year.

Impacts
What was accomplished under these goals? Educational Objective 1 During this reporting period, our major activity for this objective was to develop and implement our two interventions: Curriculum condition (5 schools); Wellness Policy (5 schools); Both Curriculum and Wellness (5 schools) and Delayed Control (5 schools).These two intervention had been pilot tested during the first two years of our grant (2010-11 and 2011-12) in 2 schools. 1a Curriculum: We developed the the Food, Health & Choices Curriculum Guide as planned. This guide includes 23 full lesson plans for teachers as well as materials for students. As part of the curriculum, an innovation developed of a skit, called Adventures with S-Cubed (S-Cubed=Secrets to Success through Science) that provided students with a case study of a boy and girl who successfully changed their behaviors. Also, we developed a very clear method for student to go through the behavior change process. For our six behaviors (choose more fruits and vegetables and physical activity and choose less processed packaged snacks, sweetened beverages, fast food, and recreational screen time) we gave the students a general goal (choose more fruits and vegetables) a specific target (at least 4 cups a day), a plan with specific ideas for how they could meet the target in their daily lives, and tips to help them be successful at making change. We also developed take home materials for families. See the other products section of this report for details. 1b Wellness Policy Intervention: We develop the Positively Healthful Classrooms Wellness Policy Guide as planned. This guide provides background on why wellness policies are important and consists of two features, a framework for foods to bring into the classroom and a framework for incorporating physical activity bouts into the classroom. The latter involved an innovative approach that was called Dance Breaks, to get students up and moving to songs. They do dance moves that they thoroughly enjoy and also get their heart rates elevated. All classes were encouraged to do one or two Dance Breaks each day. Dance Breaks were very well received by teachers and students. See other product section of this report for details. These two interventions were implemented throughout the 2012-13 school year to all fifth grade classes in our 15 schools (45 classes) in our intervention study condition. This included our instructors going to the classrooms to teach all of the lessons in the curriculum, and our wellness coaches visiting the classroom weekly to discuss the food policy and to do a Dance Break with the class. Research Objective 2 During the current reporting period our major activity for this objective was to conduct our main student outcome evaluation. From March through June 2012 we recruited and randomized 20 schools, five to each of our four study conditions (Curriculum, Wellness, Curriculum and Wellness and Delayed Control) using a clustered randomization approach, with schools clustered by percentage eligible for free and reduced lunch, academic performance based on state tests, and racial/ethnic composition of the students. During the current project period, we completed the pre-test data collection. We also completed preliminary analyses of these data, which describe the baseline knowledge, actions, and conditions of our study population, which the the interventions are designed to change. Baseline Knowledge and Psycho-social Mediators The pre-test results for the mediators showed that students scored relatively high on these measures. Based on a five-point scale, for the general mediators that go across all behaviors the means were: goal setting skills 4.2, autonomy 3.5, and competence 3.9. For the mediators of specific behaviors results were: 3.6 outcome expectation, 3.3 behavioral intention, 3.5 habit strength, 3.5 self-efficacy. On the knowledge questions, however, students got a mean of only 20% correct. Baseline Actions (Eating and Physical Activity Behaviors) In terms of dietary intake data. The students were eating about 1 cup (recommendation at least 4 cups) of fruits and vegetables a day. They were drinking an average of 30 ounces of sweetened beverages a day (recommendation less than 8 ounces), they were having the equivalent of 4.3 medium sized processed packaged snacks [chips, candy, baked goods, and/or ice cream] a day (recommendation no more than 1 small a day), and they were having a mean of 1.6 medium sized fast food items a day (recommendation no more than 1 small item a day). In terms of physical activity they were doing an average of 132 minutes of physical activity a day (recommendation more than 60 minutes a day), and they had 257 minutes of recreational screen time a day (recommendation less than 60-120 minutes a day). Baseline Conditions (Prevalence of Obesity) From our pre-test measurements, 45.4% of children are classified as overweight or obese by BMI for age. The average body fat percentage was 24.7±9.2%. When compared to the NHANES data broken down by body fat percentage by age and gender, our study group was at or above the NHANES level in almost every category. The correlation between BMI and body fat percentage was high, .913 for boys and .955 for girls. Yet, within each BMI for age category (underweight, normal weight, overweight, obese) there was a wide range of percent body fat.

Publications

  • Type: Conference Papers and Presentations Status: Published Year Published: 2012 Citation: Contento IR, Koch P, Lee H, Abrams L, Mull L. (2012) Food, Health & Choices: Behaviorally based nutrition and science curriculum with wellness support obesity prevention program in fifth grade classes. Journal of Nutrition Education & Behavior;Jul/Aug 2012 Supplement, Vol. 44 Issue 4S1, pS94.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2012 Citation: Lee H, Contento IR, Koch P, Abrams, E, Mull L, DiNoia,J , & Gallagher D. Percent Body Fat by Age, Sex and Body Mass Index (BMI) in Minority Youth. Journal of Nutrition Education & Behavior;Jul/Aug 2012 Supplement, Vol. 44 Issue 4S1, pS45.
  • Type: Conference Papers and Presentations Status: Accepted Year Published: 2013 Citation: Contento, IR et al. Reducing childhood obesity: An innovative curriculum with policy supports. Society for Nutrition Education and Behavior 2013 Annual meeting (will be a published abstract after meeting in August 2013).
  • Type: Conference Papers and Presentations Status: Accepted Year Published: 2013 Citation: Lee, H, et al. Food, Health & Choices: Understanding Relationships Among Food and Activity Behaviors and Theory-Based Mediators. Society for Nutrition Education and Behavior 2013 Annual meeting (will be a published abstract after meeting in August 2013).
  • Type: Conference Papers and Presentations Status: Accepted Year Published: 2013 Citation: Lee H, et al. Food, Health & Choices: Validation of an Audience Response system (ARS)-Delivered Food and Activity Questionnaire for Youth Society for Nutrition Education and Behavior 2013 Annual meeting (will be a published abstract after meeting in August 2013).
  • Type: Conference Papers and Presentations Status: Accepted Year Published: 2013 Citation: Lee H, et al. Food, Health & Choices: Understanding Body Fatness in Urban Elementary School Youth. Society for Nutrition Education and Behavior 2013 Annual meeting (will be a published abstract after meeting in August 2013).
  • Type: Conference Papers and Presentations Status: Accepted Year Published: 2013 Citation: Abrams E, et al. Food, Health & Choices: Using the DESIGN Stepwise Procedure to Develop a Childhood Obesity Prevention Program Society for Nutrition Education and Behavior 2013 Annual meeting (will be a published abstract after meeting in August 2013).
  • Type: Conference Papers and Presentations Status: Accepted Year Published: 2013 Citation: Mull L, et al. Food Health & Choices: Development and Implementation of a Classroom Wellness Intervention Positively Healthful Classrooms Society for Nutrition Education and Behavior 2013 Annual meeting (will be a published abstract after meeting in August 2013).


Progress 03/15/11 to 03/14/12

Outputs
OUTPUTS: The long-term goal of this integrated project is to reduce the risk of childhood obesity, particularly among urban, low-income racial/ethic minority children through an innovative educational approach and research on its effectiveness. This year, both the educational and research components of our project yielded activities, events, and products. ACTIVITIES: This was our formative evaluation year with a target population of fifth grade students in two schools. These schools implemented our draft curriculum and provided feedback information. Pre and post data were collected. Audience Response System (ARS), where students use remote-control style clickers to enter in their responses to our pre-post surveys, was pilot-tested with very favorable results. With this system, the questions are shown on a screen and students click a number on the remote control to choose their answer. Students eagerly participated. Initial analysis shows students might answer more honestly. Additionally, the data are very easy for us to manage. EVENTS: Our advisory board met once to review the work our pilot year and review plans for the formative evaluation year. Fifth grade teachers from our two schools attended four professional development workshops, one is school 1 and three in school 2, to become prepared to teach the draft curriculum and to provided focus group feedback data. Families attended one large parent night with a celebrity community chef who prepared culturally relevant dishes. During two parent-teacher conference days, parents and students participated in a health fair style table at school 2. PRODUCTS: Our first products was a generation of a theory model for the intervention. Which was based on an integration of social cognitive theory and self-determination theory. There are two educational-related products. First is the Food, Health & Choices Curriculum guide for teachers, complete with 23 lesson plans, lesson materials, and student activity sheets which addresses our target behaviors (more fruits and vegetables, fewer sweetened beverages, fewer processed packaged snacks, smaller sizes and healthier options when at fast food restaurants, more physical activity, and less recreational screen time) and theory-based mediators. Second is the Positively Healthful Classes classroom wellness guide that has guidelines on serving healthful foods for classroom snacks and events and mini-lessons for conducting 10-minute bouts of physical activity. This creates a classroom environment that supports our target behaviors. There are three products for the research component: 1) a protocol for measuring heights, weights, and percent body fat, 2) a two-part instrument to measure our targeted behaviors, and psychosocial factors related to the behaviors (outcome expectations, self-efficacy, behavioral intention, knowledge, and goal setting skills from social cognitive theory, and competence, and levels of motivation from self-determination theory), and 3) a data set with pre-post data on heights, weights, percent body fat, behaviors, and psychosocial variables. Analysis and interpretation of these data will inform our summative evaluation. PARTICIPANTS: Isobel Contento is the Principal Investigator provided oversight for all aspects of the educational and research components of the project. Pamela Koch is the Co-principal Investigator and she was the lead writer for the curriculum, worked extensively on the survey instrument development, and worked on recruiting schools for the summative evaluation. Heewon Lee is the Project Manager and coordinated communication among staff, managed the work plans for all staff, supervised all data entry, and conducted the data analyses. Jennifer DiNoia is a co-investigator who provides expertise in dietary assessment, survey methodology, research design, and statistical analysis of data. Emily Abrams and Lorraine Mull are implementation coordinators / research assistants and worked directly with the school administration, teachers, students, and family members on the implementation of the program throughout the entire school year. They also coordinated and administrated all data collection. The New York City Department of Education is a partner organization, as we work with all New York City Public schools on this project. The Office of School Wellness Programs is also a partner as is the YMCA afterschool program. We continue to work with Lori Benson who is now the Vice President, Healthy Lifestyles, YMCA of Greater New York and was previously the head of Wellness Programs for the Department of Education. The Body Composition Unit New York Obesity Nutrition Research Center at St. Luke's/Roosevelt Hospital is a partner that advises our project on body composition measurement protocols and data interpretation. TARGET AUDIENCES: Participants of the formative evaluation of the Food, Health & Choices Curriculum and Wellness Policy Intervention were 5th graders (mostly 10-11 years old) from two New York City public elementary schools. Male and female participants were evenly distributed (50% boys). Percent free lunch or reduced-price lunch eligible was used as a measure of the target audience's socioeconomic status: on average, 82.5% of the participating school children were eligible, indicating that our target audiences were those who are socially and economically disadvantaged. Ethnicity/race data showed that about 71% of the formative evaluation study population was Hispanic/Latino or Black/African American, indicating that majority of the study population was made up of ethnic minorities. PROJECT MODIFICATIONS: Not relevant to this project.

Impacts
Between March 2011 and May 2011, student surveys were developed and pilot tested. To ensure our study population understood each question, cognitive testing was conducted with two classes from two different schools. Based on this, questions were revised and finalized for the formative evaluation study. During fall 2011, baseline data were collected before our curriculum and wellness interventions were implemented. Nine classes from two schools participated in the study. Between October and November 2011, a total of 228 students from two schools in New York City completed height, weight, and % body fat measurement as well as the surveys. Post-intervention data collection is scheduled to be done in June, 2012. Baseline height, weight, and %BF (Tanita SC-331S Body Composition Analyzer) were measured, and then BMI was calculated using the CDC BMI-for-age growth charts for girls and boys. Mean %BF was calculated by age, sex, and weight status categorized by BMI-for-age. Pearson correlations were calculated to examine the association between BMI-for-age and %BF. As a result, students were distributed as follows according to the CDC BMI categories: 3.4% underweight, 50.0% healthy weight, 15.8% above 85%ile, and 30.8% above 95%ile. Mean %BF by weight status was as follows, for females: underweight: 10.4+/-1.6% BF, healthy weight: 20.4+/-4.9% BF, above 85%ile: 30.6+/-2.3% BF, and above 95%ile: 36.9+/-3.5% BF; and for males: (no males were underweight), healthy weight: 15.6+/-4.0% BF, above 85%ile: 24.5+/-4.1% BF, and above 95%ile: 33.7+/-5.1% BF. The correlation coefficients between BMI-for-age and %BF were .93 (p < .001) for girls and .81 (p < .001) for boys. Findings from this analysis advance our understanding of mean %BF by weight status categories for mostly Hispanic and African American urban children. As there are no standard reference ranges for %BF, these data may aid in the interpretation of %BF scores in other similar samples. The survey measured 5th graders' eating and physical activity behaviors as well as psychosocial variables that could be mediating factors for behavioral changes. Questions related to food included weekly frequency and size of fruit and vegetables; sweetened beverages; processed packaged snacks; fast foods. Activity questions included weekly frequency and duration of physical activity and sedentary behaviors. Theory-based psychosocial mediating variables in the survey included outcome expectations; self-efficacy; behavioral intention; habit strength; knowledge; parent modeling; goal setting skills; and motivation levels based on the self-determination theory (SDT). In addition, a social desirability scale was added to examine if students answer questions in a manner that will be viewed favorably by others. Internal consistency reliability Crobach's alpha levels ranged from .517 to .875. Two teacher focus groups were conducted to collect teachers' opinions on curriculum and wellness intervention components and to determine intervention implementation barriers that teachers identified during the formative evaluation phase. Feedback from teachers will be used to revise the intervention for the summative evaluation phase.

Publications

  • Presentation: Lee, H., Contento, I.R., Koch, P., Abrams, E., Mull, L., DiNoia, J., & Gallgher, D. (2012, July). Percent Body Fat by Age, Sex, and Body Mass Index (BMI) in minority youth. (will be) Presented at the Annual Meeting of Society for Nutrition Education, Washington D.C.


Progress 03/15/10 to 03/14/11

Outputs
OUTPUTS: During the first year of our grant we had many outputs. ACTIVITIES: We conducted a full-team meeting to get input and suggestions form all members of the AFRI Food, Health & Choices team within one month of receiving funding. We collected and analyzed data on the food and activities choices and daily patterns from about 158 fifth grade students. We collected heights, weights, and percent body fat from 40 students. We mentored the nine teachers who piloted the draft Food, Health & Choices curriculum. We worked with students in the nine classes (from two schools) who pilot-tested our lessons, through helping the students understand the lesson content and also discussing with them what they thought about the lessons and how they could apply what they learned to their personal food and activity choices. We researched the overall wellness policy and implementation across New York City schools and investigated the specific wellness policy and implementation at the two schools that took part in our curriculum pilot. This included interviewing key wellness informants at each school. EVENTS: We provided professional development workshops and regular meetings with the teachers in the two schools who piloted our lessons. We conducted a family cooking night with a chef doing demonstrations for how to cook vegetable-based meals that was attended by over 50 family members at one of our pilot schools. SERVICES: We did not provide any services. PRODUCTS: We developed our theoretical framework that guides the development of our curriculum and wellness interventions as well as the outcome instruments. Based on this framework, we created the first draft of our Food, Health & Choices curriculum, complete with lesson plans, background information and resources for teachers, PowerPoint presentations for teachers to use for each lesson, and activity sheets for students. Using a Beverage and Snack Questionnaire (BSQ) instrument by Neuhouser et al. (2009) as a model, we developed our initial instrument for collecting behavioral data on our targeted food and activity behaviors [increasing fruit and vegetable intake, increasing eating healthful breakfast items, decreasing processed packaged snacks, decreasing sweetened beverages, choosing smaller sizes and healthier options at fast food restaurants, increasing physical activity, and decreasing leisure screen time]. We believe that taken together these behaviors have the potential to help students maintain energy balance through decreasing excessive energy intake and low energy output, thus reducing risk of obesity. This instrument contains photographs to aid the students in choosing accurate response. We developed the initial draft of an instrument that can measure our theory-based mediators of behavior change. We also developed a complete protocol for collecting anthropometrics (height, weight, and percent body fat). This protocol contains information on how to collect accurate, complete data, as well as policies and procedures for working with schools and students before, during and after the collection of these data. Additionally, we developed marketing materials for the program to aid in the recruitment of schools. PARTICIPANTS: In this pilot year, we hired two Teachers College Program in Nutrition doctoral students to work on this project, Emily Abrams and Lorraine Mull. We also worked closely with Dr. Jennifer DiNoia on the development of the outcome instrument and study design. These three individuals, along with Drs. Isobel Contento (PI), Pamela Koch (Co-PI), and Heewon Lee (Project Director) are the core team of individuals who worked on this project. We partnered with the New York City Department of Education, and specifically with two schools, PS 161 and PS 75. We also worked in collaboration with the New York City Department of Health and Mental Hygiene. The fifth grade teachers at these schools received professional development on the Food, Health & Choices curriculum. TARGET AUDIENCES: Nothing significant to report during this reporting period. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.

Impacts
This being our pilot year, we needed to understand our population and the baseline context in order to be able to measure changes in knowledge, actions and conditions during the evaluation of our intervention in the future. Our research objectives for this year were to develop instruments and protocols and collect pilot data. Thus we (1) piloted an anthropometric measurement procedures in order to understand our study population (minority urban 5th graders)'s Body Mass Index and overweight/obesity status; (2) used lunch observation checklists, 24 hr recalls, and Food frequency questionnaire to better understand the eating behaviors of our study population; (3) examined the current status of wellness policies in schools of our study population in order to understand the degree of implementation of wellness activities; and (4) conducted a parent workshop in order to learn how to more effectively engage parents. The results were as follows. (1) Of the 33 students who completed the anthropometric pilot testing, the mean percent BMI based on CDC growth chart was 60% and mean percent body fat was 21%. There were 39% students who are overweight or obese, based on %BMI. Based on the desirable range that the body composition analyzer defines (12.0% to 22.9%), 33% of students had %Body fat greater than the desirable range. (2) Through our three different methods to measure baseline eating and physical activity behaviors, we found that only 20% of participants ate any fruits or vegetables in 24 hours. 65% of students drank water and 70% of them drank sweetened beverages within 24 hours. Students usually drank sweetened beverages for afternoon snacks or at dinner. The amount of sweetened drinks they usually drank ranged from 4 ounces to 60 ounces per day. 36% of students who ate packaged snacks answered that they ate it for afternoon snacks and 27% said that they ate it for lunch, and 18% said that they ate it as evening snacks. 75% of participants consumed breakfast. The majority of breakfast eaters ate their foods either at home or at school, and the time of breakfast was between 6:00am and 8:32am. Popular processed packaged snacks that participants had were chips, cookies, and candies. In terms of physical activity, Kick-ball, running, walking, football, jump ropes, and watching TV were common. This information was used to develop our outcome instruments, as it provided guidance on food, drink, snack, and physical activity items in addition to appropriate ranges/intervals of response options for the items. (3) Both schools have wellness policy written and available. Using the Wellness School Assessment Tool (WellSAT), the total comprehensiveness of the wellness policy in schools were around 44 (out of 100) and total strength score was around 30 (out of 100). Interview with a school coordinator indicated that even though school wellness policy is established and available, many school staff, parents, and students do not know about the policy. (4) Fifty participants attended a parent workshop (about 26 families) and all participating parents said that they are interested in getting involved and agreed to be contacted via email/phone/letters.

Publications

  • [Announcement of grant and summary of project] TC Today, Testing Obesity with Fifth Graders. Spring 2010, Volume 34. Number 2 weblink: http://www.tc.columbia.edu/news/article.htmid=7537&pub=7