GROW HEALTHY KIDS AND COMMUNITIES: GENERATING RURAL OPPORTUNITIES FOR WEIGHT-HEALTHY KIDS AND COMMUNITIES

• Sponsoring Institution: National Institute of Food and Agriculture
• Project Status: COMPLETE
• Funding Source: AFRI COMPETITIVE GRANT
• Reporting Frequency: Annual
• Accession No.: 0224323
• Grant No.: 2011-68001-30020
• Cumulative Award Amt.: $4,878,865.00
• Proposal No.: 2010-04614
• Project Start Date: Feb 1, 2011
• Project End Date: Jan 31, 2017
• Grant Year: 2011
• Program Code: [A2101]- Childhood Obesity Prevention: Integrated Research, Education, and Extension to Prevent Childhood Obesity

Recipient Organization
OREGON STATE UNIVERSITY
(N/A)
CORVALLIS,OR 97331

Performing Department
Extension Family and Community Health

Non Technical Summary
The problem of obesity in children is in the forefront of research efforts across disciplines. A plethora of data support that physical health outcomes such as metabolic, orthopedic, pulmonary and endocrine conditions and mental health outcomes such as sleep disorders, social exclusion, and depression are associated with obesity, and data are emerging that suggest childhood obesity is associated with poor academic performance. Many risk factors have been associated with children being overweight or obese, including rural residency. Attributes of the rural environment make it difficult for children to access and eat healthy foods, walk or bike to destinations and participate in physical activity and recreational sport programs. Furthermore, features of rural schools, particularly those in under-resourced communities, are such that students often face long bus commutes, minimal/no provision of health and physical education by certified teachers, and few resources to support health and/or enrich the academic environment. Rural community features pose unique challenges for rural residents that differ from those faced by individuals residing in more metropolitan regions. Nevertheless most evidence-based strategies to combat obesity have been developed and tested in non-rural settings. The overarching goal of the Generating Rural Options for Weight-Healthy Kids & Communities (GROW HKC) project is to prevent obesity in rural children. Toward this end, we will take a solution-focused, two-pronged approach. Our first aim is to understand the rural obesogenic environment. To do so Oregon State University (OSU) will partner with Extension Services in six Western States to engage rural people in community-based participatory research efforts to (1) assess features of rural communities that are viewed as obesity preventing/promoting, community resources and readiness to implement and support environmentally-based obesity prevention efforts, (2) create a database to aggregate the data from community assessments, and (3) develop a new eXtension Community of Practice as a vehicle to help practitioners and the public learn from our research findings. Our second aim is to plan, implement, and evaluate a multi-level intervention targeting rural home, school, and community behavioral settings to promote healthful eating and increase physical activity, and thus improve body mass index among rural children aged 5-8 years old (grades K-3). Toward this end, we will develop and test the GROW HKC obesity prevention program in rural communities from three counties in Oregon. Applying a "people and places" framework, our intervention will utilize evidence-based strategies to affect positive changes in person-level attributes and in family home, school, and community environments related to healthful eating and physical activity.

Animal Health Component

38%

Research Effort Categories

Basic

25%

Applied

38%

Developmental

37%

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
724	6050	3000	40%
724	6010	1020	20%
724	6020	3070	20%
724	6099	3020	20%

Knowledge Area
724 - Healthy Lifestyle;

Subject Of Investigation
6010 - Individuals; 6020 - The family and its members; 6099 - People and communities, general/other; 6050 - Communities, areas, and regions;

Field Of Science
3000 - Anthropology; 3070 - Psychology; 3020 - Education; 1020 - Physiology;

Keywords

childhood obesity

rural communities

cbpr

obesogenic environment

healthy eating

physical activity

body mass index (bmi)

Goals / Objectives
The goal of the Generating Rural Opportunities for Weight-Healthy Kids & Communities (GROW HKC) project is to prevent obesity in rural children. We will take a two pronged approach. Our first aim is to understand the rural obesogenic environment. To do so Oregon State University (OSU) will partner with Extension Services in six Western States to engage rural people in community-based participatory research efforts to: (Objective 1) assess features of rural communities that are viewed as obesity preventing/promoting, measure community resources and readiness to implement and support environmentally-based obesity prevention efforts, create a database to model the data from community assessments, and (Objective 2) develop a new eXtension Community of Practice as a vehicle to help practitioners and the public learn from our research findings. OUTPUTS: Initial outputs of Aim One activities will be addressed during project years 1-2 and will include: GROW HKC community-campus teams and trainers in Oregon and partnering Western states, community profile and plan inventory including narrative maps and environmental attributes, and an eXtension CoP interested in rural obesity prevention. Our second aim is to plan, implement, and evaluate a multi-level intervention targeting rural home, school, and community behavioral settings to promote healthful eating and increase physical activity, and thus improve body mass index among rural children aged 5-8 years old (grades K-3). Toward this end, we will develop and test the GROW HKC obesity prevention program in rural communities from three geographically diverse counties in Oregon. Our intervention will employ a "people and places" framework and utilize evidence-based strategies to affect positive changes in person-level attributes and in family home, school, and community environments related to healthful eating and physical activity. Aim 2 objectives include implementing and evaluating a comprehensive multi-level intervention (Objective 3) to promote healthy eating and increase physical activity on obesity (change in BMI) among rural kindergarten through 3rd grade children, and (Objective 4) to increase supports and remove barriers in home, school, and community food and physical activity environments. OUTPUTS: Outputs of Aim Two activities include: 1) improved children's knowledge, skills, dispositions, and healthful eating and physical activity behaviors; and 2) families, schools, and communities use GROW HKC strategies to improve home, school, and community food and physical activity environment. Long-term outcome of Aim Two is no change or improved BMI scores in rural children grades K-3.

Project Methods
Our approach to meeting the stated project objectives is detailed below: Aim 1: We (Oregon) will partner with Extension Services in several Western States (Arizona, Colorado, Idaho, Nevada, Texas, and Washington) to engage rural people in community-based participatory research (CBPR) efforts to (1) document attributes of the rural environment that are perceived to be obesity preventing or promoting and establish a data-driven (grounded) model of the rural obesogenic environment, (2) assess resources and readiness to implement community level childhood obesity prevention strategies and support local obesity prevention efforts, and (3) inform a broader understanding of the rural obesogenic environment and disseminate our findings through the development of a new eXtension Community of Practice (CoP). A required element of CBPR is that there must be established and ongoing relationships between key community stakeholders and the research entity. We (OSU) and our Extension colleagues in partnering Western states have such relationships across and within rural communities as a function of our land-grant missions. Rural communities across Oregon and partnering Western states will be recruited to participate in the study by county-based Extension faculty in each state. Rural communities eligible for recruitment and participation will be determined using four criteria: population (US census), region, poverty, and proximity to an urban area. Communities will be grouped into 16 types, representing the social, economic, geographic, and political diversity of partnering states and a list of all eligible communities will be generated. Communities will be recruited to represent the diverse geographic and demographic rural landscapes found within the Western U.S. region. Aim 2: We will plan, implement, and evaluate a multi-level intervention targeting rural home, school, and community behavioral settings to promote healthful eating and increase physical activity, and thus improve body mass index among rural children aged 5-8 years old (grades K-3). We will develop and test the GROW HKC obesity prevention program in rural communities from three counties in Oregon. We will randomly select two schools from each of the identified partner rural school Districts in Clackamas, Columbia, and Klamath Counties (Table 1). One school in each District (n=3) will be randomized to the treatment condition (GROW HKC); the other schools (n=3) will serve as controls and receive standard SNAP-Ed programming. The GROW HKC intervention will use evidence-based home-, school-, and community-level strategies to promote healthful eating and increase physical activity among rural children aged 5-8 years old enrolled in grades K-3. Applying Maibach and colleagues "people and places framework for public health planning and action" our intervention will focus on concurrent positive changes in children's knowledge, skills, dispositions, and behaviors and family home, school, and community environments related to healthful eating and physical activity in order to prevent childhood obesity (i.e., prevent a rise in children's body mass index; (BMI).

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

Outputs
Target Audience:We have facilitated and delivered trainings to Oregon State U Extension educators (n=128), and workshops and community meetings to school teachers and administrators (n=88), and children, parents and other adult stakeholders in 6 rural communities in 3 Oregon counties. Our GROW Extension collaborators facilitated school and community events reaching/engaging over 5,000 youth targeted for this intervention. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?HEAL MAPPS, SPAN-ET and BEPA Toolkit were adopted for inclusion in the USDA SNAP-Ed Obesity and Evaluation Toolkit 2016. HEAL MAPPS and SPAN-ET online courses are being developed and beta tested for publication in Fall 2017 to support and sustainnational adoption and diffusion of innovation. BEPA Toolkit, SPAN-ET, and HEAL MAPPS trainings and professional development workshops have been provided by project staff, graduate students and postdocs, and collaborators in state and national venues. HEAL MAPPS will receive a Jeanne E. Priester award in the innovation category at the 2017 National Health Outreach Conference. How have the results been disseminated to communities of interest?John, DH, Gunter, K, Armington, A. with Winfield, T & Hicks, J (webmasters) (2012-present). The project team developed and maintains the GROW Healthy Kids & Communities website (funded by USDA NIFA grant #2011-68001-30020). The website provides information and resources about the project and rural childhood obesity prevention, including family newsletters, media articles, tools, and links to partners and public resources. Oregon Community Reports John, DH, Winfield, T, Hicks, J, & Gunter, K. (2016) Oregon Impacts Infographic Report. Community John, DH, Winfield, T, & Gunter, K. (2016). Molalla; Estacada; Clatskanie; Rainier; Bonanza; Chiloquin (n=6) Community Food and Physical Activity Environmental Resource Spatial Audit Report. John, DH, Winfield, T, Halverson, B, Devlin, E, & Gunter, K. (2016). Estacada; Molalla (n=2) HEAL MAPPS Community Report. Report was prepared using data collected by residents during HEAL MAPPS. John, DH, Winfield, T, Rudolph, J, Harden, L, & Gunter, K. (2016). Rainier; Clatskanie (n=2) HEAL MAPPS Community Report. Report was prepared using data collected by residents during HEAL MAPPS. John, DH, Winfield, T, Case, P, Rojina, J, & Gunter, K. (2016). Chiloquin; Bonanza (n=2) HEAL MAPPS Community Report. Report was prepared using data collected by residents during HEAL MAPPS. School Jackson, J., Rudolph, J, Gunter, K, & John, D (2016). School Physical Activity and Nutrition Environmental Assessment (SPAN-ET) Final Report: Clatskanie Elementary; Hudson Park Elementary (Rainier) Halverson, B, Devlin, E, Gunter, K, & John, D (2016). School Physical Activity and Nutrition Environmental Assessment (SPAN-ET) Final Report: Molalla Elementary; Clackamas River Elementary (Estacada) Case, P, Gunter, K, & John, D (2016). School Physical Activity and Nutrition Environmental Assessment (SPAN-ET) Final Report: Bonanza Elementary; Chiloquin Elementary. School-Student Gunter, K., Abi-Nader, P., Jackson, J., Armington, A.,John, D. (2016). Promoting Healthy Active Schools: Molalla Elementary School Physical Activity and Nutrition Report; Clackamas River Elementary School Physical Activity and Nutrition Report. Gunter, K., Abi-Nader, P., Jackson, J., Armington, A.,John, D. (2016). Promoting Healthy Active Schools: Hudson Park Elementary School Physical Activity and Nutrition Report; Clatskanie Elementary School Physical Activity and Nutrition Report. Gunter, K., Abi-Nader, P., Jackson, J., Armington, A., John, D. (2016). Promoting Healthy Active Schools: Bonanza Elementary School Physical Activity and Nutrition Report; Chiloquin Elementary School Physical Activity and Nutrition 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? We met aim one goals through partnerships with Cooperative Extension in Oregon and our 5 original partnering LGUs in WA, ID, CO, NV, NM, and new LGU partners in OH and SD. Our partnerships engaged rural populations in participatory research that (Objective 1) assessed features of rural communities experienced by residents as obesity preventing/promoting, measured community resources and readiness to implement and supported environmentally-based obesity prevention efforts. From these data, we have created a database and developed a model the data of the rural obesogenic context to support future interventions. We have developed online resources, webinars, interactive maps, and adopter trainings, (Objective 2) that will be available via eXtension as a vehicle to help practitioners and the public learn from our research findings. Our second aim was to plan, implement, and evaluate a multi-level intervention targeting rural home, school, and community behavioral settings to promote healthful eating and increase physical activity, and thus improve body mass index among rural children aged 5-8 years old (grades K-3). Toward this end, we developed an environmentally based, GROW HKC obesity prevention program, and tested the effectiveness of the program in rural communities (intervention n=3; comparison n=3) from three geographically diverse counties in Oregon. GROW HKC participatory research approach was effective in promoting sustainable policy, systems, and environmental changes in both intervention and comparision communities (estimated economic impact >$700,000 of new healthy eating and physical activity resources) with greatest environmental changes occuring in intervention communities. However, changing the obesogenic context takes considerable time to occur even in communities that are ready for change, which most rural communities are not. And, measurable weight health impacts in a target population requires the audience be repeatedly and strongly exposed to new healthy eating and physical activity supports over sufficient time to maintain a balanced energy. Despite our significant accomplishments, and modest healthy eating and physical activity behavior improvements among subsets of children exposed to new environmental interventions, sustained, long term exposures to behavioral supports in all rural children's microenvironments (home, school, community) are needed to habitualize behavioral patterns that lead to measurable population-level weight health impacts.

Publications

• Type: Book Chapters Status: Awaiting Publication Year Published: 2017 Citation: John, D. and Gunter, K. Chapter 10. Physical activity among rural populations. In M. Bopp, (Ed.), Physical Activity and Diverse Populations: Evidence and Practice. Taylor and Francis (Routledge): New York, NY.
• Type: Journal Articles Status: Awaiting Publication Year Published: 2017 Citation: 1. Gunter, K.B., Abi Nader, P*., Armington, A., Hicks, JC., John, D. Evaluation of an Extension-Delivered Resource to Accelerate Progress in Childhood Obesity Prevention: The BEPA-Toolkit. Journal of Extension. Accepted Nov 14, 2016; in press Jan 11, 2017.
• Type: Journal Articles Status: Awaiting Publication Year Published: 2017 Citation: 2. Jackson, J.A.*, Smit, E., Branscum, A., Harvey, S.M., John, D., Manore, M.M., Gunter, K.B. The family-home environment, body mass index, and food insecurity in rural children. Health Education and Behavior. Accepted Nov 9, 2016.
• Type: Journal Articles Status: Awaiting Publication Year Published: 2017 Citation: 3. John, D., Langellotto, G., Winfield, T., Hystad, P., Gunter, KB. Community-Engaged Attribute Mapping: Exploring Resources and Readiness to Change the Rural Context for Obesity Prevention. Progress in Community Health Partnerships: Research, Education, and Action. Accepted Aug 29, 2016.
• Type: Conference Papers and Presentations Status: Published Year Published: 2016 Citation: 1. John, DH, Winfield, W, Hystad, P. Gunter, K. Mapping resident experiences of active living resources: Developing a data-driven model of availability and accessibility of affordable physical activity supports in rural Oregon communities. American Public Health Association National Conference, Denver, CO. November 2016.
• Type: Conference Papers and Presentations Status: Published Year Published: 2016 Citation: 3. John, DH, Jackson, J*, Gramlow, L, Gunter, K. Evaluating the Feasibility and Utility of the School Physical Activity and Nutrition Environment Tool (SPAN-ET) for SNAP-Ed Adoption and National Dissemination. American Public Health Association National Conference, Denver, CO. November 2016.
• Type: Conference Papers and Presentations Status: Published Year Published: 2016 Citation: 4. Stulka, S, Shafrath, T, Winfield, T. John, DH. Creating healthy eating and active living rural communities: Utilizing local food and activity asset mapping to inform coalition work. American Public Health Association National Conference, Denver, CO. November 2016.
• Type: Conference Papers and Presentations Status: Published Year Published: 2016 Citation: 5. John, DH., Gunter, K., Hystad, P., Langellotto, G., Manore, M. (July 2016). Generating Rural Options for Weight Healthy Kids and Communities  Outcomes and Impacts. Journal of Nutrition Education and Behavior, 48(7), S122.
• Type: Conference Papers and Presentations Status: Published Year Published: 2016 Citation: 6. Gunter KB, Nader PA*, Hicks J*, John D. Setting the Context for Obesity Prevention in Rural Oregon Elementary Schools: Weight Status of Elementary-Age Children. Med Sci Sports Exerc. 2016 May;48(5 Suppl 1):1065-6. doi: 10.1249/01.mss.0000488207.57984.7d.
• Type: Conference Papers and Presentations Status: Awaiting Publication Year Published: 2017 Citation: Abi Nader, P, Hilberg, E, Schuna, JM Jr., John, D, Gunter, KB, FACSM. Comparison Of Accelerometer And Pedometer Measured Physical Activity In Rural Elementary Schools. 2017 Annual Meeting, World Congress on Exercise is Medicine�, and World Congress on the Basic Science of Exercise and the Brain of the American College of Sports Medicine being held at the Denver Convention Center and Hyatt Regency Denver at Colorado Convention Center Hotel in Denver, Colorado, May 30-June 3, 2017.
• Type: Journal Articles Status: Under Review Year Published: 2016 Citation: Gunter, KB, Jackson, JA*, Abi Nader, P*, John, DH. The association of rural elementary school environmental characteristics with childrens physical activity levels at school. Journal of School Health, revised, in review. Submitted August 18, 2016.
• Type: Journal Articles Status: Under Review Year Published: 2016 Citation: Abi-Nader P*., Hilberg, E*., Schuna, J, John, D., Gunter, KB. Association of Teacher-Level Factors with Implementation of Classroom-Based Physical Activity Breaks. Journal of School Health, in review (submitted October 21, 2016).
• Type: Journal Articles Status: Under Review Year Published: 2017 Citation: Gunter, KB., Jackson, JA, Tomayko, E, John, DH, Food Insecurity and Physical Activity Insufficiency among Rural Oregon Children. In review. Submitted, February 25, 2017.
• Type: Conference Papers and Presentations Status: Under Review Year Published: 2017 Citation: John, DH, Winfield, T, Gunter, KB, Mapping communities experiences of the rural context: Developing a data-driven model of obesogenic attributes for rural Oregon. 2017 Annual Meeting and Expo of the American Public Health Association, Nov 4-8, Atlanta, GA.
• Type: Conference Papers and Presentations Status: Published Year Published: 2016 Citation: 7. Nader PA*, Hilberg E*, John DH, Gunter K. Balanced Energy Physical Activity (BEPA) Toolkit Implementation and Children's Physical Activity at School. Med Sci Sports Exerc. 2016 May;48(5 Suppl 1):762. doi: 10.1249/01.mss.0000487288.88422.3b.
• Type: Conference Papers and Presentations Status: Awaiting Publication Year Published: 2017 Citation: Gunter, KB, Jackson, JJ, Tomayko, E, John, D. Food Insecurity and Physical Activity Insecurity among Rural Oregon Families. 2017 Annual Meeting, World Congress on Exercise is Medicine�, and World Congress on the Basic Science of Exercise and the Brain of the American College of Sports Medicine being held at the Denver Convention Center and Hyatt Regency Denver at Colorado Convention Center Hotel in Denver, Colorado, May 30-June 3, 2017.

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

Outputs
Target Audience:We have facilitated and delivered trainings, workshops and community meetings to OSU Extension educators (n=40), teachers (n=88)and school administrators, parents and children and other community members. Our GROW County Extension teams have provided local education and outreach events (n=87) in participating communities and schools reaching/engaging 5,079youth participantscounts. Some counts are repeated exposures though multiple events or sessions. The number is relevant in that it reflects population exposure - the frequency with which rural residents (adults and youth) were exposed to strategies (see ENVIRONMENTAL IMPACTS ) and engaged in activities aimed at increasing obesity prevention readiness, capacity, and resources. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?John, D. & Winfield, T. Participatory Environmental Assessments Using MAPPSTM. 4H/FCH Spring Staff Meeting, Portland, OR. March 2015 (20 Participants/6 hours) John, D. & Winfield, T. Participatory Environmental Assessments Using HEAL MAPPSTM. Train the trainer event for South Dakota State University Extension personnel. April 2015 (20 Participants/18 hours) Case, P., Rojina, J., Rudolph, J., Harden, L., Halverson, B., Devlin, E., John, D., Gunter, K. (March 2015). School Wellness:Moving Toward Action to Prevent Childhood Obesity in Rural Communities. Oregon State University 4-H & Family and Community Health Spring Conference, Portland, OR. 1 session of 1:15 hours, 143 Extension educators. Halverson, B. K., Devlin, E. (Author & Presenter), Whole Grains Summit 2015, "Community Wellness: Moving Toward Action to Prevent Obesity in Rural Communities, StoryWalk as a Community Health and Physical Activity Intervention," Moore Family Center for Whole Grain Foods, Nutrition and Preventive Health at Oregon State University and the Grains for Health Foundation, Portland Oregon. (June 24, 2015). 1 session of 45 minutes, 124 participants. Jepson-Sullivan-NOUSE, R. (Coordinator/Organizer), Dodge Vera, T., Rudolph, J. (Author & Presenter), Devlin, E. (Author & Presenter), Halverson, B. K. (Author & Presenter), John, D. (Author), Case, P. (Author), Hoisington, A. (Author), FCH 4-H Spring Conference, "Policies, Systems and Environment Workshop," Portland, OR. (March 2015). 1 session of 6 hours, 111 Extension SNAP-Ed staff. Harden, L. (Author & Presenter), "Capacity Building, Engagement, and Sustainability," Oregon Farm to School and School Garden Network Regional Conference, Tillamook, OR. (November 6, 2015). 1 session of 30 minutes, 40 participants Harden, L. (Author & Presenter), "School Garden Education," Oregon Farm to School and School Garden Network School Garden Summit, Silverton, OR. (January 29, 2016).1 session of 30 minutes,53 participants Harden, L. (Author & Presenter), "Methods for Designing Inclusive Food-based Education Programs," Oregon Farm to School and School Garden Network Farm to School Summit, Silverton, OR. (January 30, 2016).1 session of 30 minutes,37 participants Winfield, T., Caldwell-Kan, S., John, D., Langelloto, G., Hystad, P., Manore, M., & Gunter, K.Determining Environmental Assets in Six Oregon Communities to Explain the Rural Obesogenic Context. Annual Occupational, Environmental, and Public Health Conference, Semiahmoo, WA. January 2015. Baggett, A., Rudolph, J., & Caldwell- Kahn, S. Using Health Impact Assessment to Inform Local Land Use and Transportation Decisions. Oregon Public Health Association Annual Conference, Corvallis, OR. October 2015. Gunter, K. School-Based Physical Activity Policies: Best Practice Recommendations.Lessons learned from the GROW Healthy Kids & Communities Project. Presented at the Good Samaritan Hospital Foundation Obesity Summit in Lebanon, Oregon,April 2015. Local (community) opportunties for training and community capacity building/professional development (list includesopportunities provided inone (Columbia)of three countiesengaged inGROW HKC research, education, and Extension: Rudolph, J., Harden, L. (February 19, 2015). School Physical Activity and Nutrition Environmental Tool (SPAN-ET) Assessment in Clatskanie. 1 session of 8 hours, 5 participants. Rudolph, J., Harden, L. (February 26, 2015). School Physical Activity and Nutrition Environmental Tool (SPAN-ET) Assessment in Clatskanie. 1 session of 8 hours, 5 participants. Rudolph, J., Harden, L. (April 27-29, 2015). Height and Weight Assessment in Rainier. 3 sessions of 6 hours. Rudolph, J., Harden, L. (April 30-May 1, 2015). Height and Weight Assessment in Clatskanie. 2 sessions of 6 hours. Harden, L. (July 22, 2015). Presentation of Clatskanie Trails & Playground project to Clatskanie Boosters Club. 1 session of 20 minutes, 9 participants. Harden, L. (July 22, 2015). Presentation of Clatskanie Trails & Playground project to Clatskanie Planning Commission. 1 session of 1 hour, 27 participants. Harden, L. (July 23, 2015). Rainier Community Audit training and implementation with Rainier School District Administration. 1 session of 2 hours, 2 participants. Harden, L. (July 24, 2015). Clatskanie Community Audit training and implementation with Head Start and Clatskanie School District Administration. 1 session of 2 hours, 2 participants. Harden, L. (July 28, 2015). Rainier Community Audit training and implementation with City of Rainier Administration. 1 session of 2 hours, 1 participant. Harden, L. (July 30, 2015). Clatskanie Community Audit training and implementation with Farmers Market Administration. 1 session of 2 hours, 3 participants. Harden, L. (August 5, 2015). Presentation of Clatskanie Trails & Playground project to City of Clatskanie. 1 session of 1 hour, 12 participants. Harden, L. (August 22, 2015). Presentation of Clatskanie Trails & Playground project to Clatskanie School Board. 1 session of 45 minutes, 11 participants. Rudolph, J. (September 21, 2015). Presentation of Health Impact Assessment project to City of Rainier. 1 session of 45 minutes, 19 participants. Rudolph, J., Harden, L. (September 24, 2015). Healthy Eating Active Living Mapping Attributes using Participatory Photographic Surveys (HEAL MAPPS) Training in Clatskanie. 1 session of 120 minutes, 7 participants. Rudolph, J., Harden, L. (October 2, 2015). Healthy Eating Active Living Mapping Attributes using Participatory Photographic Surveys (HEAL MAPPS) Photo Selection Committee in Clatskanie. 1 session of 90 minutes, 5 participants. Rudolph, J., Harden, L. (October 5-7, 2015). Height and Weight Assessment and Physical Activity Assessment in Rainier. 3 sessions of 6 hours. Rudolph, J., Harden, L. (October 15, 2015). Healthy Eating Active Living Mapping Attributes using Participatory Photographic Surveys (HEAL MAPPS) Training in Rainier. 1 session of 120 minutes, 8 participants. Rudolph, J., Harden, L. (October 19-21, 2015). Height and Weight Assessment and Physical Activity Assessment in Clatskanie. 3 sessions of 6 hours. Rudolph, J., Harden, L. (October 28, 2015). Healthy Eating Active Living Mapping Attributes using Participatory Photographic Surveys (HEAL MAPPS) Photo Selection Committee in Rainier. 1 session of 90 minutes, 4 participants. Rudolph, J. (October 29, 2015). Balanced Energy Physical Activity (BEPA) Toolkit Training in Rainier. 1 session of 30 minutes, 28 participants. Rudolph, J., Harden, L. (November 5, 2015). Healthy Eating Active Living Mapping Attributes using Participatory Photographic Surveys (HEAL MAPPS) Community Conversation in Clatskanie. 1 session of 3 hours, 33 participants. Rudolph, J., Harden, L. (November 19, 2015). Healthy Eating Active Living Mapping Attributes using Participatory Photographic Surveys (HEAL MAPPS) Community Conversation in Rainier. 1 session of 3 hours, 18 participants. Rudolph, J., Harden, L. (December 1, 2015). School Physical Activity and Nutrition Environmental Tool (SPAN-ET) Assessment in Rainier. 1 session of 8 hours, 5 participants. Rudolph, J., Harden, L. (December 4, 2015). School Physical Activity and Nutrition Environmental Tool (SPAN-ET) Assessment in Clatskanie. 1 session of 8 hours, 2 hours of school staff training, 5 participants. Harden, L. (January 12, 2016). Presentation of Clatskanie Trails & Playground project to Clatskanie Kiwanis Club. 1 session of 45 minutes, 23 participants. How have the results been disseminated to communities of interest? Let's Move! Molalla social media websites (https://www.facebook.com/letsmovemolalla?ref=hl) and (https://www.facebook.com/groups/230816293709041/) were created and maintained by personnel supported on this grant. Jensen, K. (2015). GROW healthy kids, communities. Idaho County Free Press. Retrieved from http://www.idahocountyfreepress.com/news/2015/sep/02/grow-healthy-kids-communities/. Palmer, J. (2015). 10 INNOVATORS IN RURAL HEALTH. Oregon Business. Retrieved from http://www.oregonbusiness.com/article/the-magazine/july-august-2015/item/15129-10-innovators-in-rural-health. Kolff, K. (2015). Step On IT! Promote Walking and Biking. (2015). Indiegogo. Retrieved from https://www.indiegogo.com/projects/step-on-it-promote-walking-and-biking#/. Savage, P. (2015). Take a Story Walk. Molalla Pioneer. Retrieved from http://portlandtribune.com/mop/157-news/260862-133004-take-a-storywalk. The Public Health Foundation of Columbia County. (August 2015). Connecting Rural Communities: U.S. 30 & Rainier Veterans Way Crossing. GROW directly contributed to this publication. Jackson, J., John, D., Gunter, K. (2015). School Physical Activity and Nutrition Report: (n=6; Estacada, Molalla, Clatskanie, Rainier, Bonanza, Chiloquin) Elementary. This report includes both height/weight and general SPAN-ET results. Jackson, J., John, D., Gunter, K. (2015). School Physical Activity and Nutrition Environmental Assessment (SPAN-ET) Report: (n=6; Estacada, Molalla, Clatskanie, Rainier, Bonanza, Chiloquin) Elementary. Hicks, J., John, D., Gunter, K. (2015). Summary of child weight status. (n=3; Clackamas County, Columbia County, Klamath County) What do you plan to do during the next reporting period to accomplish the goals?Aim 1 - We will host and convene adopters (GROW HKC LGU partnersfrom 6 Western U.S. states; new HEAL MAPPSTMadopters fromOhio State U Extension& SDSU Extension;Oregon GROW HKC county partnersand OR SNAP-Ed partners, scientists and community stakeholdersfor a best practice symposium (virtually or in-person) to share accomplishments and inform dissemination of results, expand development of data-informed, theoretical model of rural obesogenic contexts to guide obesity prevention interventions and promote a culture of weight healthin landscapes similar to the Western U.S. Aim 2 - We will continue to analyze data, generate anddisseminatenew knowledge andstrategiesat the local (school and community), state, and nationallevel, and to target audiences/populations (rural community residents and stakeholders), county and state cross-sector partners, and the scientific community. We will host media events to broadly communicate impacts resulting from the efforts and resourcing. We will pursue additional funding to maintain surveillance of the population currently being studied longitudinally to confirm weight health protective factors for rural populations,translate weight healthy community development approaches, partnerships,and PSE strategies to new ruralcommunities and at risk rural populations, and contribute to the knowledge base specific to effective solutions for addressing rural weight health disparities and achieving weight health equity.

Impacts
What was accomplished under these goals? AIM 1 activities accomplished outputs in PY5 including HEAL MAPPS™ train-the-trainer workshops for new Extension adopters in OR and SD and CBPR-related community events. Approximately 40 Oregon State and South Dakota State Extension personnel were trained to implement HEAL MAPPS™ on March 11-12, 2015 (OR) and March 30-April 1, 2015 (SD) supported by grant funds external to GROW HKC funding. GROW HKC-supported HEAL MAPPS™ was implemented by LGU partners and trained Extension facilitators in 4 rural communities in Colorado and Idaho. Funds ($2500 per community) were distributed to HEAL MAPPS™ communities that completed CBPR, used results to target HEAL environmental change, and submitted HEAL improvement plans in four partnering states (ID, NV, NM and WA). Outcomes and Impacts: HEAL MAPPS™ implemented and results report provided to 4 GROW HKC-supported communities (Ignacio, Leadville CO; Fruitland, Preston ID) and 11 communities supported by funds external to GROW HKC (Elk Point, McLaughlin, Parmalee, Pine Ridge, Rapid City-Lakota Homes, Dupree-Cheyenne River, Martin, Herreid, Wagner, Lower Brule, and Crow Creek SD). L. Bellows, CSU GROW HKC Lead and CSU County Extension Facilitator, in cooperation with OSU GROW HKC Winfield, Gunter, & John (2015). GROW HKC HEAL MAPPS™ Community Report (n=2) M. Raidl, UI GROW Lead and UI County Extension Facilitator, in cooperation with OSU GROW HKC Winfield, Gunter, & John (2015). GROW HKC HEAL MAPPS™ Community Report (n=2) S. Stluka, SDSU Extension Good and Healthy South Dakota Lead and SDSU County Extension Facilitator, in cooperation with OSU GROW HKC Winfield & John (2015). Good and Healthy SD HEAL MAPPS™ Community Report (n=11) AIM 2 activities conducted in Oregon in PY5 include environmental, informational, and behavioral interventions, formative and summative evaluations. OUTPUTS: Proposed outputs of Aim Two activities include: 1) communities, schools, and families use GROW HKC PSE strategies to improve home, school, and community food and physical activity contexts; and 2) children exposed to GROW HKC PSE strategies demonstrate improved knowledge, skills, dispositions, and healthful eating and physical activity behaviors. Long-term outcome of Aim Two is no change or improved BMI scores in the population of rural children, elementary grades K-5, in intervention (n=3) vs. comparison (n=3) communities. HEAL MAPPS™ t2 were Extension facilitated by trained staff in six GROW HKC communities (Estacada, Molalla, Rainier, Clatskanie, Bonanza and Chiloquin) in OR. Environmental scans t2 (using our GROW HKC-developed Rural community food and PA photomapping audit tool) were also conducted by trained Extension staff in four OR communities (Clatskanie, Estacada, Molalla, and Rainier) and initiated in a further two communities (Bonanza and Chiloquin). Community-based PSE actions, including coalition-led efforts in partnership with GROW HKC Extension and sector stakeholders, were planned, developed, resourced/initiated, and/or completed. Throughout the spring and fall of 2015, multi-level school-based assessments including the SPAN-ET (school environmental scan), Physical Activity (PA) assessments, and an evaluation of the Balanced Energy Physical Activity (BEPA) Toolkit were conducted in each of the GROW HKC elementary schools (n=6). For each SPAN-ET, a report was developed and shared with the school's health stakeholders (e.g. principal, wellness committee, etc.). GROW HKC intervention schools utilized data and tools to prioritize and implement PSE changes that would increase students' exposure/access to healthy behavioral options at school. School-based PSE actions, including wellness committee-led efforts in partnership with GROW HKC Extension and school stakeholders, were planned, developed, resourced/initiated, and/or completed. PA assessments measured the daily school-based activity level of each assenting elementary student over the span of four school days. BEPA Toolkit evaluation data were collected and analyzed through implementation of a survey developed by GROW HKC scientists, which was distributed to teachers (n=88) in each participating elementary school (n=6).

Publications

• Type: Conference Papers and Presentations Status: Published Year Published: 2015 Citation: John, D., Gunter, K., Hystad, P., Langellotto, G., & Manore, M. Generating Rural Options for Weight Healthy Kids and Communities Year 4 Outcomes and Impacts. Society for Nutrition Education and Behavior Annual Conference, Pittsburg, PA. July 2015.
• Type: Conference Papers and Presentations Status: Published Year Published: 2015 Citation: Jackson, J., Harvey, M., John, J., Finneran, K., Manore, M. & Gunter, K. Rural Perspectives on Family Nutrition and Physical Activity: Results from Focus Groups with Parents of Elementary School-Age Children. American Public Health Association Annual Conference, Chicago, IL and Oregon Public Health Association Annual Conference, Corvallis, OR. October 2015.
• Type: Conference Papers and Presentations Status: Published Year Published: 2015 Citation: Gunter, K., Abi Nader, P., Hicks, J., & John, D. Physical Activity Levels and Obesity Status of Oregon Rural Elementary School Children. American College of Sports Medicine Annual Meeting and World Congress, San Diego, CA. May- June 2015.
• Type: Conference Papers and Presentations Status: Published Year Published: 2015 Citation: Gramlow, L., Chappuis, C., Kunkle, D., Gunter, K., John, D. Evaluating the Feasibility and Utility of the School Physical Activity and Nutrition Environment Tool (SPAN-ET) for adoption and implementation by Extensions SNAP-Ed Program. Oregon Public Health Association Annual Conference, Corvallis, OR. October 2015.
• Type: Conference Papers and Presentations Status: Published Year Published: 2015 Citation: Winfield, T., Caldwell-Kan, S., John, D., Langelloto, G., Hystad, P., Manore, M., & Gunter, K. Determining Environmental Assets in Six Oregon Communities to Explain the Rural Obesogenic Context. Annual Occupational, Environmental, and Public Health Conference, Semiahmoo, WA. January 2015.
• Type: Conference Papers and Presentations Status: Published Year Published: 2015 Citation: John, D., Gunter, K., Langellotto, G., Hystad, P., & Manore, M. Engaging Extension to Build Community Capacity to Improve Healthy Eating and Active Living Resources and Readiness to Address the Rural Obesogenic Context and Weight Health Disparities. Linn County Obesity Prevention Task Force Meeting and Oregon Public Health Association Annual Conference, Corvallis, OR. 2015.
• Type: Conference Papers and Presentations Status: Published Year Published: 2015 Citation: Abi Nader, P., Hilberg, E., John, D., & Gunter, K. The Balanced Energy Physical Activity Toolkit and Elementary Children's Physical Activity at School. Oregon Public Health Association Annual Conference, Corvallis, OR. October 2015.
• Type: Conference Papers and Presentations Status: Published Year Published: 2015 Citation: Case, P., Rojina, J., Rudolph, J., Harden, L., Halverson, B., Devlin, E., John, D., Gunter, K. (May 2015). Building Capacity of Rural Schools to Take Action to Prevent Childhood Obesity. National Health Outreach Conference, Atlanta, Georgia.
• Type: Websites Status: Published Year Published: 2015 Citation: Generating Rural Options for Weight Healthy Kids and Communities. Available at: http://extension.oregonstate.edu/growhkc/
• Type: Websites Status: Published Year Published: 2015 Citation: Balanced Energy Physical Activity Toolkit. Available at: http://extension.oregonstate.edu/growhkc/tools/bepa
• Type: Journal Articles Status: Published Year Published: 2015 Citation: Jackson, J., Branscum, A., John, D., Smit, E., & Gunter, K. (2015). Healthy Eating, Physical Activity, and Learning Behaviors. Health Behavior and Policy Review, 2(1), 24-34. DOI: http://dx.doi.org/10.14485/HBPR.2.1.3
• Type: Journal Articles Status: Published Year Published: 2015 Citation: Jackson, J., Smit, E., Manore, M., John, D., & Gunter, K. (2015). The Family- Home Nutrition Environment and Dietary Intake in Rural Children. Nutrients, 7(12), 9707-9720. DOI:10.3390/nu70x000x
• Type: Journal Articles Status: Published Year Published: 2016 Citation: John, D., Gunter, K., Jackson, J., & Manore, M. (2016). Developing the School Physical Activity and Nutrition Environment Tool to Measure Qualities of the Obesogenic Context. Journal of School Health, 86(1):39-47. DOI: 10.1111/josh.12348.

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

Outputs
Target Audience: Target audiences included demographically diverse residents from geographically diverse rural communities, andmulti-sectorial rural community stakeholdersinsix WesternU.S. states. In 2014, GROW activities took place in 16 communities in Oregon (n=6), Washington (n=6), New Mexico (n=1), Idaho (n=1), Colorado (n=2). A second target audience in Oregonincluded children and families from six elementary schools in three Oregon counties. All targeted schools were based on 50% or more of enrolled students were eligible for free and reduced price meals or free milk in rural communities of less than 10,000 population. Changes/Problems: Enrolling individual familiesin research has been problematic, resulting in lower enrollments and fewer returned family-level surveysthan proposed. We have adapted our methodology to collect de-identified data, which allows forimplied consent (return survey implies consent to participate)from families of students attending our participating schools. Additionally,distributing surveys (Family HEAL)in students' school materials,and providing a stamped, self-addressed envelope for adult family member to use to return completed survey, has been a successful evaluation methodin schools resulting in adequate response rates with previous surveys. What opportunities for training and professional development has the project provided? The project has provided opportunities for training of students, Extension personnel in Oregon, current partnering states, and new partnering states. HEAL MAPPS (Healthy Eating Active Living: Mapping Attributes using Participatory Photographic Surveys) train-the-trainer workshops, including workshops for UI Extension (grant funded) and The Ohio State U Extension (provided as contracted service). HEAL MAPPS was adapted for practitioner (non-research implementation), resulting in a HEAL MAPPS Toolkit - Practitioner. SPAN-ET (School Physical Activity and Nutrition Environmental Tool) training for SNAP-Ed personnel, NVivo workshops for students egaged in research apprenticeships, and community capacity-building events. The following graduate students have been learning through project activities and are conducting research toward the completion of their degrees relative to the project: Patrick Abi-Nader,Doctoral Candidate,Physical Activity and Public Health; Jennifer Jackson, MS, RD, Doctoral Candidate, Public Health; Alinna Ghavami, MPH, Health Behavior Health Promotion, Evan Hilberg,Doctoral Student,Physical Activity and Public Health. We have engaged undergraduate students (n=15) and masters level students (n=2) through internships and university research programs. We have facilitated and delivered trainings, workshops and community meetings to OSU Extension educators, teachers and school administrators, parents and children and other community members. In all, we have engaged 1,373 participant counts. Some counts are repeated exposures though multiple events or sessions. The number is relevant in that it reflects population exposure - the frequency with which rural residents (adults and youth) were exposed to strategies and engaged in activities aimed at increasing obesity prevention readiness, capacity, and resources. How have the results been disseminated to communities of interest? In PY 4, in addition to refereed scientific journal articles and publishedpresentation abstracts,and we disseminated information about our measures, approaches and findings at conferences, symposia and workshops and through web-based distribution of materials.Outcomes and impactshave been disseminated to communities of interest by oral presentations, written reports, website updates, social, print, and media. Peer-reviewed Presentations and Published Abstracts Halverson, B., Case, P., Rudolph, J., Devlin, E., Hardin, L., Rojina, J. (March 2014). GROW Healthy Kids and Communities Project Update from the Perspective of County Faculty and Faculty Research Assistants. 4-H & FCH Spring Conference, Portland, OR. March 2014. Abstract published in conference program. Gunter, K. and Booth, C. Generating Rural Options for Weight-Healthy Kids and Communities: Examining the rural family home nutrition and physical activity environment. Oregon State University, College of Public Health and Human Sciences Celebration of Excellence. May 2014. John, D. and Bridget Jamieson. Exploring Rural People's Perceptions of Weight-Healthy Attributes of Community Place. Oregon State University, College of Public Health and Human Sciences Celebration of Excellence. May 2014. John, D. and Bridget Jamieson. Examining Rural Resources and Readiness to Change the Context for Obesity Prevention. Oregon State University, College of Public Health and Human Sciences Celebration of Excellence. May 2014. Gunter, K. and VanMeter, E. Generating Rural Options for Weight-Healthy Kids and Communities: Examining the School Environment. Oregon State University, College of Public Health and Human Sciences Celebration of Excellence. May 2014. John, D. Winfield, T., Langellotto G., Ghavami, A., Gunter, K. Mapping Rural Food and Physical Activity Availability: Using Spatial Analysis to Explain Access an Obesogenic Factor. Oregon Public Health Association Annual Conference, Corvallis, OR. October 2014. Abstract published in conference program. Halverson, B., Devlin, E., Case, P., Rojina, J., Rudolph, J., Harden, L., John, D., Gunter, K. School Wellness: Moving Toward Action to Prevent Childhood Obesity in Rural Communities. Oregon Public Health Association Annual Conference, Corvallis, OR. October, 2014. Abstract published in conference program. Case, P., Rojina, J., Rudolph, J., Harden, L., Halverson, B., Devlin, E., John, D., Gunter, K. Using Participatory Approaches to Mobilize Community Action for Weight Healthy Youth in Three Rural Counties. Oregon State University Extension Annual Conference, Corvallis, OR, October, 2014. John, D., Langellotto, G., Winfield, T., Hystad, P., Manore, M., Gunter, K. Preventing Obesity in the Rural Populations: Visualizing the Need for Cross-Program Collaborations in Research, Education, and Extension to Address the Local Food and Physical Activity Systems. Oregon State University Extension Annual Conference, Corvallis, OR, October, 2014. Winfield, T., Caldwell-Kan, S. Determining environmental assets in six Oregon communities to explain the rural obesogenic context. Annual Occupational, Environmental and Public Health Conference, Semiahoo, WA, January 2015 Websites: GROW HKC http://extension.oregonstate.edu/growhkc/ website was maintained by personnel supported by this grant. BEPA website provides free access to the physical activity cards in the BEPA Toolkit as well as videos of select activities for families and teachers: http://extension.oregonstate.edu/physicalactivity/BEPA Let's Move! Molalla social media websites (https://www.facebook.com/letsmovemolalla?ref=hl) and (https://www.facebook.com/groups/230816293709041/) were created and maintained by personnel supported on this grant. Media: Hansen, S. (2014, September 9). Obesity solutions discussed. Quay County Sun. Retrieved from http://www.qcsunonline.com/2014/09/09/obesity-solutions-discussed/. WSU Extension Staff. (2014, September 9). A New Extension Collaborative Effort on Community Health and Growing Local Food Systems with Four Tribal Communities on the Olympic Peninsula. Peninsula Tribal Extension. Retrieved from http://native.wsu.edu/tribal-liaison/news/june2013/peninsula.html. Halverson, B. (2014). OSU - GROW Healthy Kids & Communities Receives Community Partner Award from Molalla River School District. FOCUS on Extension, 15(5), 1. Molalla River School District. (2014) OSU - Grow Healthy Kids. Molalla River School District Newsletter, 1(1). Retrieved from https://madmimi.com/p/9ec7c4?fe=1&pact=24964041383. Winfield, T. and John, D. (2014). GROW Healthy Food Environments for Oregon's Rural Communities. Oregon Small Farm News, 9(3). Retrieved from http://smallfarms.oregonstate.edu/sfn/su14grow. Child Obesity: Solving the Weighty Matter of Kids' Health http://oregonstate.edu/terra/2015/02/child-obesity-solving-the-weighty-matter-of-kids-health/ Reports: Hicks, J, Abi Nader, P, Gunter, K, John D. (2014). Family Physical Activity Summary Report.Reports were mailed to every child and parent/guardian who participated in the 2014 Physical Activity Assessment at the family level (n=66) .Gunter, K., Abi-Nader, P., Klein, B., Jackson, J., John, D. (2014). Promoting Healthy Active Schools: (n=6; Estacada, Molalla, Clatskanie, Rainier, Bonanza, Chiloquin) Elementary School Physical Activity and Nutrition Report. Jackson, J., John, D., Gunter, K.. (2014). School Physical Activity and Nutrition Environmental Assessment (SPAN-ET) Report: (n=6; Estacada, Molalla, Clatskanie, Rainier, Bonanza, Chiloquin) Elementary. John, D., Winfield, T., Ghavami, A., Devlin, E., Halverson, B., Gunter, K. (2014). Community Food and Physical Activity Environmental Resource Spatial Audit Report (n=6; Estacada, Molalla, Clatskanie, Rainier, Bonanza, Chiloquin). What do you plan to do during the next reporting period to accomplish the goals? Aim 1 - We will convene Western state partners, Oregon state and county partners, and community stakeholders for a summit to share accomplishments and inform dissemination of results, data-informed, theoretical model of rural Western USobesogenic community contexts to guide obesity prevention interventions. Aim 2 - We will collect community-level environmental data (HEAL MAPPS; R-CFPA audit)beginning summer 2015 - fall 2015. We will conduct school-level environmental (SPAN-ET) and PA data fall 2015. We will collect school family household level (Family HEAL Survey) data spring 2015. We will analyze data andshare results with rural community residents and stakeholders, county and state partners, and the scientific community. We will host media events to broadly communicate impacts resulting fromtheefforts andresourcing.

Impacts
What was accomplished under these goals? AIM 1 activitiesaccomplished in PY4 include train-the-trainer workshops and HEAL MAPPS (Healthy Eating Active Living: Mapping Attributes using Participatory Photographic Surveys) community events. We trained one Extension Western Region partner on the HEAL MAPPS process on March 26, 27 and 28 (ID). Each HEAL MAPPS trainingincludes instruction on delivering three distinct community-engaged processes: participatory photo mapping, focus group, and community conversation. HEAL MAPPS programs were conducted by trained Extension facilitators in six communities in Colorado, New Mexico, Idaho, and Washington, two of which are Native American communities. Contracts (n=5) were issued to land-grant partners (WSU, UI, UNR, NMS, CSU) tosupport AIM 1 activities and fundingfor improving rural environmentalcontextsidentified by ruralcommunities during HEAL MAPPS aspresenting barriers to HEAL for rural children and and families. Implementation funds were distributed to Extension partners (i.e. WSU) who have completed all HEAL MAPPS in their respective states. Outcomes and Impacts:HEAL MAPPS training for UI Extension personnel (n=10), 10 HEAL MAPPS programs implemented and report provided (Kalama, Connell, Fairfield - WA; Wells, Laughlin, Gardnerville, Caliente - NV; Tucumcari - NM; Fleming, Wray - CO. HEAL MAPPS webinar for The Ohio St U Cooperative Extension and invited guests. John, DH. Using MAPPS™ Assessments to Prioritize and Prompt Community Health Action. Invited webinar providedfor The Ohio State University Cooperative Extension; July 23, 2014 WSU County Extension Facilitator, S. Calodich, WSU Extension GROW Lead,in cooperation withOSU Winfield, T., K. Gunter, and John, D (2014). HEAL MAPPS Community Report. (n=3) UNRCounty Extension Facilitator,A. Lindsay, UNR Extension GROW Lead,in cooperation withOSU Winfield, T., K. Gunter, and John, D (2014). HEAL MAPPS Community Report. (n=4) NMS County Extension Facilitator,S. KoukelNMS Extension GROW Lead,in cooperation withOSU Winfield, T., K. Gunter, and John, D (2014). HEAL MAPPS Community Report. (n=1) CSUCountyExtension Facilitator,L. Bellows CSU Extension GROW Lead,in cooperation withOSU Winfield, T., K. Gunter, and John, D (2014). HEAL MAPPS Community Report. (n=2) AIM 2 activities conducted in PY4 includeenvironmental,informational, and behavioral interventions, and formative evaluations.School-wide height and weight (body mass index; BMI kg/m2)assessments were conductedat two time points(spring 2014; fall 2014) and PA (physical activity) assessments in fall 2014 in each of the participating GROW elementary schools (n=6). At present we havemeasured data on approximately 2000 rural elementary school children in grades K-5/6collectedover the listed time points (fall 2012, spring 2013, fall 2013, spring 2014, fall 2014). Focus groupswith parents from families enrolled in the GROW research were conducted in all six participating GROW communities. SPAN-ET (school environmental scans) were conducted in fall 2014in six elementary schools.Environmental (policy, system and environmental; PSE) strategies have been implemented in schools and communities to increase access to healthy eating and physical activities.Community Action Teams (CAT) in the six participating Oregon communities were fostered and supported by GROW staff. The CATs applied for GROW implementation funding in order to makePSE changes in their communities based on data from the community-level assessments (HEAL MAPPS and Community Food & PA Resource Audits). School wellness committees were formed and supported by GROW staff. These wellness committees worked with school stakeholders and GROW staff to apply for GROW implementation funding in order to make PSE changes based on data from the school-level assessment (SPAN-ET). Newsletters were distributed to to all families enrolled in the intervention group of the GROW study. An existing Extension-based newsletter, Food Hero, was distrubited to all families enrolled in the control group of the GROW study. GROW website is updated weekly and maintained to communicate findingsand program accomplishments. Outcomes and Impacts include: REACH: We have facilitated and delivered trainings, workshops and community meetings to OSU Extension educators, teachers and school administrators, parents and children and other community members. Our GROW County Extension teams have provided local education and outreach events (n=76) in participating communities and schoolsengaging 1,373 participant counts. Some counts are repeated exposures though multiple events or sessions. The number is relevant in that it reflects population exposure - the frequency with which rural residents (adults and youth) were exposed to strategies (see ENVIRONMENTAL IMPACTS below)and engaged in activities aimed at increasing obesity prevention readiness, capacity, and resources. ENVIRONMENTAL IMPACTS: GROW intervention funds have been given to the intervention and control (to a lessor degree) schools and intervention communities. Wellness committees (at the school level) and community action teams (at the community levels) were required to complete a Request for Funding Application and have (or will) followed up with mid- and final reports. Thus far, $14,142 in funding has been allocated to the projects, such as the following examples: Molalla Youth Football Club- PA pathways to fields ($1,800). Molalla River Academy - 2-Tier grow light school garden ($600). Mulino & Rural Dale Elementary Schools -BEPA Toolkits and banners ($3420). Scout Lake, Columbia County - Scouts improve trail access ($145). Clatskanie Parks & Rec and Action Team - Check-It-Out recreation equipment ($310). Clatskanie Farmer's Market -Produce scale and signage ($867). Molalla Resource Center - Refrigerator to store donated produce ($2,000). Bonanza Elementary School - Playground 40' rock wall. ($3,300). Hudson Park Elementary School - Water bottle refilling station ($1,000). ADDITIONAL ECONOMIC and ENVIRONMENTAL IMPACTS resulting fromGROW-supported activities/accomplishmentsinclude external grant fundingtotaling $63,656. Grants were submitted by school and community partners,with support from GROW project staff and based on information gained in the HEAL MAPPS and/or SPAN-ET. All listed grants were submitted and awarded between February 1, 2014 and January 30, 2015through GROW-enabled partnerships: The Molalla Library & OregonDOE -funding from Bob's Red Mill to implement a HEAL Storywalks, expand farm to school and HEto local businesses. ($25,000) Molalla Elementary School - Clackamas County HEAL Grant forrun/walk trail ($8,000) Molalla High School & 4-H Culture Club- Pacific Source funding for OSU YA4-H youth school garden microenterprise. ($5,000) Molalla High School & 4-H Culture Club - Clackamas County Small Grants for refrigerator to store garden produce distribution. ($2,500) Columbia County - Oregon Health Authority forHIA focusing on pedestrian/bicyclesafety ($15,000) Clatskanie Elementary School - Oregon 4-H Foundation, Community Pride Grant Program to create a healthy playscape. ($1,500) Chiloquin Elementary School - National Fuel Up to Play. ($950) Bonanza Elementary School - National Fuel Up to Play 60. ($1,000) Bonanza Elementary School-Run-A-Thon School Fundraiser for PE equipment and indoor climbing wall ($4,206). Chiloquin Elementary School and Klamath Master Gardeners - Tribal Food Security Fundingfor raised garden beds ($500).

Publications

• Type: Journal Articles Status: Published Year Published: 2015 Citation: Gunter, KB, Abi-Nader, P, John DH. Physical Activity Levels and Obesity Status of Oregon Rural Elementary School Children. Preventive Medicine Reports.Accepted manuscript (unedited version) available online: 26-APR-2015 DOI information: 10.1016/j.pmedr.2015.04.014
• Type: Conference Papers and Presentations Status: Published Year Published: 2014 Citation: Halverson, B, Devlin, E, Case, P, Rojina, J, Rudolph, J, Harden, L, John, D, Gunter, K. School Wellness: Moving Toward Action to Prevent Childhood Obesity in Rural Communities. Oregon Public Health Association Annual Conference, Corvallis, OR. October, 2014. Abstract published in conference program.
• Type: Conference Papers and Presentations Status: Published Year Published: 2014 Citation: Abi Nader, P., Klein, B. Hicks, J., John, D. Gunter, K. School Day Physical Activity Levels among Rural, Low Income, Elementary Age Students in Oregon. Medicine & Science in Sports & Exercise. 2014; 46(5S): p:22735. Presented at the American College of Sports Medicine Annual Conference, Orlando, FL, May 2014. Abstract published in conference program and special issue of the International Journal of Exercise Science.
• Type: Conference Papers and Presentations Status: Published Year Published: 2014 Citation: John, D., Abi Nader, P., Ghavami, A., Gunter, K. Using Mixed Methods to Explain Physical Activity Attributes of Older Residents and Their Community Place. Medicine & Science in Sports & Exercise. 2014; 46(5S): p:S96. Presented at the American College of Sports Medicine Annual Conference, Orlando, FL, May 2014. Abstract published in conference program and special issue of the International Journal of Exercise Science.
• Type: Conference Papers and Presentations Status: Published Year Published: 2014 Citation: John, D., Gunter, K., Etuk, L., Langellotto, G., and Manore, M. Generating Rural Options for Weight (GROW) Healthy Kids and Communities. Society for Nutrition Education and Behavioral Annual Conference, Milwaukee, WI, June-July 2014.
• Type: Conference Papers and Presentations Status: Published Year Published: 2014 Citation: John, D. Winfield, T., Langellotto G., Ghavami, A., Gunter, K. Mapping Rural Food and Physical Activity Availability: Using Spatial Analysis to Explain Access an Obesogenic Factor. Oregon Public Health Association Annual Conference, Corvallis, OR. October 2014. Abstract published in conference program.
• Type: Conference Papers and Presentations Status: Published Year Published: 2014 Citation: John, D. Langellotto, G., Winfield, T., Hystad, P., Manore, M., and Gunter, K. Mapping Local Food and Activity Assets to Visualize Spatial Relationships between Obesity and Attributes of Rural Place. American Public Health Association National Conference, New Orleans, LA. November 2014. Abstract published in conference program.
• Type: Conference Papers and Presentations Status: Published Year Published: 2014 Citation: Gunter, K., Abi Nader, P., Klein, B., Hicks, J., John, D. Setting the Context for Obesity Prevention in Rural Schools: GROW Healthy Kids & Communities. American Public Health Association National Conference, New Orleans, LA. November 2014. Abstract published in conference program.
• Type: Journal Articles Status: Published Year Published: 2014 Citation: Jackson, J, Branscum, A, John, D, Smit, E, & Gunter, K. Healthy Eating (2015). Physical Activity, and Learning Behaviors. Health Behavior and Policy Review, 2(1): 24-24.
• Type: Journal Articles Status: Published Year Published: 2014 Citation: Gunter, K., Abi-Nader, P., Klein, B., & John, D. (2014). Assessing family level behaviors for obesity prevention: development and preliminary validation of the family stage of change tool. Journal of Human Sciences and Extension, 2(3).
• Type: Journal Articles Status: Awaiting Publication Year Published: 2015 Citation: John, DH, Jackson, JJ, Manore, M, Gunter, KB. Developing the School Physical Activity and Nutrition-Environment Tool (SPAN-ET). In press: Journal of School Health, Accepted Apr 23, 2015.

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

Outputs
Target Audience: Target audiences included residents and sector stakeholders from geographically, economically, and ethnically diverse rural communities in the Western United States. In 2013, activities took place in 19 communities in Oregon (n=6), Washington (n=6), New Mexico (n=1), Nevada (n=4), Colorado (n=1), Arizona (n=1). A second target audience included children and families from rural elementary schools (n=6)in three Oregon Counties. All targeted schools were located in rural communities, andover 50% of enrolled students were eligible for free and reduced price meals or free milk. Changes/Problems: One multi-state partner, Arizona (University of Arizona Extension) has withdrawn from the research project. Extension educators who were trained to implement HEAL MAPPS as a research tool will utilize HEAL MAPPS Extension educator/practitioner version and participate in a program evaluation. Lena Etuk has left the project and has been replaced by Perry Hystad, PhD as Co-PD to oversee GIS analyses. What opportunities for training and professional development has the project provided? The following graduate students have been learning through project activities and are conducting research toward the completion of their degrees relative to the project: Patrick Abi-Nader, PhD, Physical Activity and Public Health; Jennifer Jackson, PhD, Public Health; Alinna Ghavami, MPH, Public Health. We have engaged undergraduate students (n=12) and MPH students (n=1) through internships and university research programs in physical activity assessment, BEPA toolkit implementation, We have delivered trainings to OSU Extension educators (n=35), and state health department partners about HEAL MAPPS, the Rural Community Food and Physical Activity Resource Audit and the application of the SPAN-ET in several training workshops. R-CFPAR (Rural Community Food and Physical Activity Resource) Auditserves as an engagement, assessment and intervention tool, documenting the geographic location of and conditions of access and cost for all available food and physical activity resources within a community. The R-CFPAR Audit establishes a baseline measure of system resource availability and spatial distribution, and features of access and costs, which can be used to identify and prioritize improvements the food and/or activity system and, when repeated, show how the community food and physical activity environment changes over time.One practitioner and6 communitytrainings were conducted. SPAN-ET (School Physical Activity and Nutrition Environment Tool) and HEAL MAPPS™ (Healthy Eating Active Living: Mapping Attributes using Participatory Photographic Surveys) training materials, presentations, and program tools were created for field-based practitioners with Oregon State University Extension Service. Three practitioner trainings were conducted. Physical Activity Assessment trainings and materials were developed, field based practitioners and school partners were trainedduring 3trainings. BEPA Toolkit trainings were conducted to train GROW field staff(one training)to train elementary school teachers (3 trainings)to use the toolkit to promote active learning. How have the results been disseminated to communities of interest? The study rationale, design, and results were disseminated via lectures and invited talks by the PIs to professional organizations, university graduate and undergraduate students, colleagues, and community groups. Methodologies and tools developed through the project were integrated into courses taught by the PIs, and shared through workshops delivered to Extension personnel. The HEAL MAPPS Manual and process has been shared with collaborators on other projects and written in to several successful grant applications as a mechanism to understand environmental factors contributing to healthy eating and physical activity across cultures (e.g. Latino and Native American populations). The SPAN-ET Manual and processes have been shared with OSU Extension and SNAP Ed partners and will be incorporated into the SNAP Ed 2014-2015 plan.Information about our measures, approaches and findings have been shared at conferences, symposia and workshops and through web-based distribution of materials. Presentations Gunter, K. Exercise is Preventive Medicine, The Community as the Clinic. Oregon State University, Corvallis, OR. March 2013. John, D, Gunter, K. Jackson, J. Using the School Nutrition and Physical Activity (SNPA) Tool too Assess Resources and Readiness for Changing the Environmental Context. Oregon State University Extension FCH-4H Joint Conference, Wilsonville, OR, March 2013. Abi Nader, P, Jackson, J. Generating Rural Options for Weight-Healthy Kids & Communities (GROW HKC). Oregon State University, May 2013. John, D. Preventing Obesity in the Rural West: Making Connections through Research, Education, and Extension. Western Region Extension Joint Summer Meeting, Coeur d’Alene, ID, July 2013. John, D, Jackson, J. Generating Rural Options for Weight-Healthy Kids & Communities. Wellness in School Environments (WISE), Portland, OR. July 2013. John, D, Gunter, K, Manore, M, Langellotto, G, Etuk, L. Generating Rural Options for Weight Healthy Kids & Communities. NIFA Project Directors Meeting, Society for Nutrition Education & Behavior Annual Conference, Portland, OR. August 2013. John, D, Gunter, K, Jackson, J. Preventing Obesity among Rural Children - Changing the Context is Key. Panel Discussion. Oregon Public Health Association Annual Conference, Corvallis, OR. October 2013. Gunter, KB, Abi-Nader, P, John, DH. Understanding Family Readiness for Behavior Change: Development of the Family Stage of Change Measure. Oregon Public Health Association Annual Conference, Corvallis, OR. October 2013. Jackson, J, Gunter, KB. Associations between Family Nutrition and Physical Activity Behaviors and Successful Learning Characteristics in Elementary School Children. Oregon Public Health Association Annual Conference, Corvallis, OR. October 2013. Dodge Vera, T., John, D. Using HEAL MAPPS to build community capacity among Latinos. Oregon Public Health Association Annual Conference, Corvallis, OR. October 2013. John D, Gunter, K. Jackson, J. Measuring the School Nutrition and Physical Activity Environment: A Case for Assessing School Resources and Readiness for Changing the Context to Address Child Obesity. American Public Health Association National Conference, Boston, MA. November 2013. John D, Gunter, K. Preventing Obesity among Rural Children: Improving School Nutrition and Physical Activity Options through Targeted Environmental Actions. USDA-Funded Projects Panel, American Public Health Association National Conference, Boston, MA. November 2013. John, D. Preventing Obesity in the Rural West: Connecting Research, Education, and Extension. Oregon State University, Corvallis, OR. June 2013 Websites GROW HKC http://extension.oregonstate.edu/growhkc/ website was created and is maintained by personnel supported by this grant. BEPA website provides free access to the physical activity cards in the BEPA Toolkit as well as videos of select activities for families and teachers: http://extension.oregonstate.edu/physicalactivity/BEPA What do you plan to do during the next reporting period to accomplish the goals? University of Idaho Extension has joined the project, identified rural communities who will participate in the CBPR HEAL MAPPS, and will participate in a HEAL MAPPS training for Extension faculty to facilitate CBPRwith/in 3-4 rural communities during 2014-2015 to accomplish Aim 1 goals. We have added Perry Hystad, PhD, Environmental Health and Safety/GIS Analyst as a Co-PD.

Impacts
What was accomplished under these goals? AIM 1 Outcomes in PY 3 include Community and School environmental assessment reports that have been provided to communities to support community- and school-based initiatives to prevent childhood obesity. John, D, Winfield, T, Ghavami, A, Gunter, K. (2014). Molalla Community Food and Physical Activity Environmental Resource Spatial Audit Report. John, D, Winfield, T, Ghavami, A, Gunter, K. (2014). Estacada Community Food and Physical Activity Environmental Resource Spatial Audit Report. John, D, Winfield, T, Ghavami, A, Gunter, K. (2014). Clatskanie Community Food and Physical Activity Environmental Resource Spatial Audit Report. John, D, Winfield, T, Ghavami, A, Gunter, K. (2014). Rainier Community Food and Physical Activity Environmental Resource Spatial Audit Report. John, D, Winfield, T, Ghavami, A, Gunter, K. (2014). Bonanza Community Food and Physical Activity Environmental Resource Spatial Audit Report. John, D, Winfield, T, Ghavami, A, Gunter, K. (2014). Chiloquin Community Food and Physical Activity Environmental Resource Spatial Audit Report. Jackson, J, John, D, Gunter, K. (2013). School Physical Activity and Nutrition Environmental Assessment (SPAN-ET) Report: Molalla Elementary Jackson, J, John, D, Gunter, K. (2013). School Physical Activity and Nutrition Environmental Assessment (SPAN-ET) Report: Clackamas River Elementary (Estacada) Jackson, J, John, D, Gunter, K. (2013). School Physical Activity and Nutrition Environmental Assessment (SPAN-ET) Report: Clatskanie Elementary Jackson, J, John, D, Gunter, K. (2013). School Physical Activity and Nutrition Environmental Assessment (SPAN-ET) Report: Hudson Park Elementary (Rainier) Jackson, J, John, D, Gunter, K. (2013). School Physical Activity and Nutrition Environmental Assessment (SPAN-ET) Report: Bonanza Elementary Jackson, J, John, D, Gunter, K. (2013). School Physical Activity and Nutrition Environmental Assessment (SPAN-ET) Report: Chiloquin Elementary Gunter, K, Abi-Nader, P, Klein, B, John, D. (2013). Promoting Healthy Active Schools: Molalla Elementary School Physical Activity and Nutrition Baseline Report. Gunter, K, Abi-Nader, P, Klein, B, John, D. (2013). Promoting Healthy Active Schools: Clackamas River Elementary School Physical Activity and Nutrition Baseline Report. Gunter, K, Abi-Nader, P, Klein, B, John, D. (2013). Promoting Healthy Active Schools: Hudson Park Elementary School Physical Activity and Nutrition Baseline Report. Gunter, K, Abi-Nader, P, Klein, B, John, D. (2013). Promoting Healthy Active Schools: Clatskanie Elementary School Physical Activity and Nutrition Baseline Report. Gunter, K, Abi-Nader, P, Klein, B, John, D. (2013). Promoting Healthy Active Schools: Bonanza Elementary School Physical Activity and Nutrition Baseline Report. Gunter, K, Abi-Nader, P, Klein, B, John, D. (2013). Promoting Healthy Active Schools: Chiloquin Elementary School Physical Activity and Nutrition Baseline Report. SIGNIFICANT IMPACTS resulting from these outcomes include grants totaling $124, 205 that were submitted by communities with support from GROW project staff and based on information gained in the HEAL MAPPS and/or SPAN-ET. All listed grants were submitted and awarded between January 2013 and January 30, 2014. Molalla Community; General Mills Champions Grant, January 2013, $10,000 Trail Project http://www.generalmills.com/Responsibility/Community_Engagement/Grants/Champions_for_healthy_kids.aspx Molalla Elementary School; Playworks (April of 2013). $2500 (Title 1 25%; Kaiser Permanente grant 75%) Molalla Elementary School; Fuel up and Play 60 Oregon Dairy Council $4,000 Molalla Elementary School;, Active Schools Acceleration Project $1000 Molalla Community; Bear Creek Byway project (Safe way to Safeway walking route)-$8000 HEAL grant (Project of the Ford Leadership Group, but the community recognized the need during the HEAL Mapps process) Molalla Community; Molalla River Academy HEAL grant $8000, awarded to charter school for a new fitness trail. Clatskanie School District – Farm-to-School $20,400 Molalla River School District – Farm-to-School $70, 305

Publications

• Type: Other Status: Published Year Published: 2013 Citation: John D, Gunter, K, Jackson, J (2013). SPAN-ET" Training Manual. Oregon State University. Corvallis, OR.
• Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: John, D, Gunter, K, Manore, M, Langellotto, G, Etuk, L. Generating Rural Options for Weight Healthy Kids & Communities. Published Abstract. Society for Nutrition Education & Behavior Annual Conference, Portland, OR. August 2013.
• Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: John, D, Gunter, K, Jackson, J. Preventing Obesity among Rural Children - Changing the Context is Key. Published Abstract. Oregon Public Health Association Annual Conference, Corvallis, OR. October 2013.
• Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Gunter, KB, Abi-Nader, P, John, DH. Understanding Family Readiness for Behavior Change: Development of the Family Stage of Change Measure. Published Abstract. Oregon Public Health Association Annual Conference, Corvallis, OR. October 2013.
• Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Jackson, J, Gunter, KB, John, DH. Associations between Family Nutrition and Physical Activity Behaviors and Successful Learning Characteristics in Elementary School Children. Published Abstract. Oregon Public Health Association Annual Conference, Corvallis, OR. October 2013.
• Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: John, D, Gunter, K. Jackson, J. Measuring the School Nutrition and Physical Activity Environment: A Case for Assessing School Resources and Readiness for Changing the Context to Address Child Obesity. Published Abstract. American Public Health Association National Conference, Boston, MA. November 2013.
• Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: John D, Gunter, K. Preventing Obesity among Rural Children: Improving School Nutrition and Physical Activity Options through Targeted Environmental Actions. Published Abstract. American Public Health Association National Conference, Boston, MA. November 2013.
• Type: Journal Articles Status: Under Review Year Published: 2013 Citation: John, D, Jackson, J, Manore, M, Gunter, K. Developing the School Physical Activity and Nutrition-Environment Tool (SPAN-ET) to Measure the School Context for Obesity Prevention. In Review, Journal of School Health.
• Type: Journal Articles Status: Under Review Year Published: 2013 Citation: Jackson, J, Branscum, A, John, D, Smit, E, Gunter, K. Associations between Family Nutrition and Physical Activity and School Performance. In Review, Journal of School Health.
• Type: Journal Articles Status: Under Review Year Published: 2013 Citation: Gunter, K, Abi-Nader, P, Klein, B, and John, D. Assessing Family Level Behaviors for Obesity Prevention: Development and Preliminary Validation of the Family Stage of Change Tool. In Review, Journal of Human Sciences and Extension.
• Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Dodge Vera, T., John, D. Using HEAL MAPPS to build community capacity among Latinos. Published Abstract. Oregon Public Health Association Annual Conference, Corvallis, OR. October 2013.

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

Outputs
Target Audience: Extensionlead research partnersfrom AZ, CO, NM, NV, TX, WA (n=6) and Oregon (n=6) and Washington (n=4) Extension educators completed train-the-trainer workshops (June 18-20, July 30-Aug 3, and Nov 15-16, respectively)to conduct HEAL MAPPS (Healthy Eating Active Living: Mapping Attributes using Participatory Photographic Surveys; developed with this funding) community-engaged participatory research. Trained Extension educatorsimplemented HEAL MAPPS in Oregon (n=7)and Washington (n=1) ruralcommunities, engaging rural residents and community stakeholders in issues of weight health and rural place in five distinct community events: stakeholder engagement, MAPPS training, focus group, community conversation, and results reporting. Trained Extension educators (n=6) engaged schooladministrators and staff(n=24)in rural elementary schools (n=3) in participatory assessments of the school nutrition and physical activity environments using the School Nutrition and Physical Activity (SNPA) Environmental Assessment Tool (developed with this funding). Trained Extension scientists and educators (n=9) collected whole school height and weight data inOregon elementary schools (n=6) on 1,920 children in kindergarten through grade 6 (n=1061 boys; n=859 girls) usingassessment methods developed with this funding. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? Major collaborators and partners have participated in training and professional development, including those from: University of Nevada, Extension; University of Arizona Extension; Washington State University Extension; Texas A&M Extension; New Mexico State University Extension; Colorado State University Extension; Oregon State University SNAP Ed Program; Oregon Department of Health - Health Authority; Oregon State University Extension Family & Community Health and 4H Programs; Clatskanie and Rainier Elementary School Teachers, Columbia County; Molalla and Estacada Elementary School Teachers, Clackamas County; Chiloquin and Bonanza Elementary SchoolTeachers, Klamath County; GeoMobile Innovations Inc. technicians. Graduatestudents have been learning through project activities and are conducting research toward the completion of their degrees relative to the project: Patrick Abi-Nader, PhD, Physical Activity and Public Health; Jennifer Jackson, PhD, Public Health. We have engaged undergraduate students (n=2) and MPH students (n=2) in internships. How have the results been disseminated to communities of interest? The study rationale, design, and results were disseminated via lectures and invited talks by the PIs to university graduate and undergraduate students, colleagues, and community groups. Methodologies and tools developed through the project were integrated into courses taught by the PIs, and shared through workshops delivered to Extension personnel. The HEAL MAPPS Manual and process has been shared with collaborators on other projects and written in to several successful grant applications as a mechanism to understand environmental factors contributing to healthy eating and physical activity across cultures (e.g. Latino and Native American populations). Results from HEAL MAPPS and SPAN-ET assessments as well as school-level HWA results providing overweight and obesity prevalence were shared via written reports and oral presentationsto community stakeholders and/orschool stakeholders. Community-based project activities and events were communicated via media publications, including newpaper, websites, and social media. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? AIM 1 Outcomes in PY 2 include five HEAL MAPPS reports that have been provided to communities to support community-based initiatives to prevent childhood obesity. John, DH & Gunter, KB (2012). Philomath, OR HEAL MAPPS Community Report.Soda vending machines were removed from Boys and GIrls club. Rudolph, J, Etuk, L , John, DJ, Gunter, KB, (2012). Clatskanie, OR HEAL MAPPS Community Report.Clatskanie, OR secured a $5,000 Youth Advocates for Health (YA4-H!) grant to promote youth involvement in healthy eating, active living (HEAL) through community gardens. Case, P, Wayne, L, Etuk, L, John, DJ, Gunter, KB, (2012). Bonanza, OR HEAL MAPPS Community Report.Bonanza, OR received $500 to supplement healthy foods at the elementary school food services Halverson, B, Sterrett, K, Etuk, L, John, DJ, Gunter, KB, (2012). Molalla, OR HEAL MAPPS Community Report.Molalla was the recipient of an $8,000 HEAL grant from Clackamas County DHHS to support the development of a walking/running trail on Molalla elementary property. The project includes a joint use agreement to allow community access to the trail. Calodich, S, Etuk, L, John, DJ, Gunter, KB, (2012). Port Townsend, WA HEAL MAPPS Community Report. Washington State University submitted and was awarded a 2-year, $50,000 grant to deliver HEAL MAPPS in rural tribal communities on the Olympia peninsula to improve community health and enhance the local food systems. Aim 2 Outcomes in PY 2Baseline data reportingoverweight an obesity prevalence in the elementary schools enrolled in the GROW intervention programs. Of the 1920 children assessed in grades k-6, 36% were overweight (having BMI values for their age and gender > the 85th percentile); 19% were obese (having BMI values for their age and gender > the 95th percentile). Prevalence did not differ by age, but a greater proportion of children in older grades (3rd-6th) were classified as overweight and obese. Reports were generated and shared with each participating school justifying the need to improve the school context for obesity prevention.

Publications

• Type: Websites Status: Published Year Published: 2012 Citation: John, DH, Gunter, KB, Hicks, J (2012) GROW Healthy Kids and Communities. Available at: http://extension.oregonstate.edu/growhkc/
• Type: Other Status: Published Year Published: 2012 Citation: John DH, Gunter, KB, Etuk, E (2012). HEAL MAPPS Toolkit Training Manual. Oregon State University: Corvallis, OR.

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

Outputs
OUTPUTS: AIM 1 OUTPUTS:Oregon HEAL MAPPS (Healthy Eating, Active Living, Mapping Attributes through Participatory Photographic Strategies)training was July 2012; Multi-state partner (AZ, CO, NM, NV, TX, WA) HEAL MAPPS training was June 2012. WA field partners HEAL MAPPS training took place in Wenatchee, WA in November 2012. OR (n=7) and WA (n=1)communities have completed HEAL MAPPS training, focus group, and community conversation activities. AIM 2 OUTPUTS:Whole school height and weight data were collected on 1,920 children in K through grade 6 (n=1061 boys; n=859 girls) in 6 schools participating in the AIM 2 intervention. School nutrition and physical activity environmental data were collected in our intervention schools (n=3) using the School Nutrition and Physical Activity (SNPA) Environmental Assessment Tool. PRODUCTS: A HEAL MAPPS Training Manual and tool kit was developed to support needs assessment and intervention activities. Also listed under publications; A Field Transfer Application for Garmin GPS units used in our community-based HEAL MAPPS processes, and a Processing Extension for ArcGIS. Both were developed by GeoMobile Innovations Inc. specifically for our project to support data transfer and analyses of GIS data; The Family Stage of Change (FSOC) Instrument was developed and pilot tested to assess families readiness to change behaviors and family home environmental characteristics; The SNPA Environmental Assessment tool was developed to assess school resources and readiness to improve nutrition and physical activity environments, suggest appropriate improvement strategies, and score impacts resulting from environmentally-based treatments. The SNPA was pilot tested in three elementary schools to obtain process and reliability data; The Balanced Energy Physical Activity (BEPA) Tool Kit was developed with grant funds from this project and funds from SNAP Ed of USDA to help nutrition educators, teachers, and caregivers provide physical activity into every direct education occasion with children pre-k-grade 6. DISSEMINATION via PRESENTATIONS: Gunter, KB & John, DH. Generating Rural Options for Weight Healthy Kids & Communities. Presented at the Northwest Environmental Health Conference, Portland, OR. February 2012; John, DH & Gunter KB. HEAL MAPPS (Healthy Eating Active Living, Mapping Attributes through Participatory Photographic Surveys. Oregon State University Extension In-Service Training, Wilsonville, OR. March 2012; John, D, Gunter, K, Manore, M, Langellotto, G, Etuk, L. Generating Rural Options for Weight Healthy Kids & Communities. Journal of Nutrition Education and Behavior, 2012; (44)4S:S84. Society for Nutrition Education and Behavior Annual Conference, Washington DC. July 2012; Etuk, L., Greenwald, C., John, D.H., & Gunter, K. Generating Rural Options for Weight-Healthy Kids & Communities: Preventing Obesity in Rural Children in Partnership with GeoMobile Innovations, Inc.,Willamette Valley GIS User Group, Corvallis, OR. November 2012. DISSEMINATION via WEBSITES: GROW HKC http://extension.oregonstate.edu/growhkc/, and HEAL MAPPS (not yet live) websites; The BEPA website: http://extension.oregonstate.edu/physicalactivity/BEPA PARTICIPANTS: GRANT SUPPORTED PERSONNEL with major contributions: Deborah John, PD/PI, provided overall project leadership, led the development of the HEAL MAPPS Training manual and all HEAL MAPPS activities and contributed significantly to all activities and outputs detailed in the progress report. Kathy Gunter, PD/PI, provided overall project leadership, led the development of the Family Stage of Change (FSOC) Tool and school-based height and weight data collection activities and contributed significantly to all activities and outputs detailed in the progress report. Lena Etuk, Co-I, contributed to the development of the HEAL MAPPS Training Manual and all HEAL MAPPS activities and was responsible for managing the GIS data resulting from HEAL MAPPS processes. Melinda Manore, Co-I, contributed to the development of the SNPA, the FSOC, HEAL MAPPS activities, and intervention curricula. Gail Langolotto, Co-I, contributed to HEAL MAPPS activities, the development of the SNPA, and supported field faculty in acquiring community-based ancillary funding related to garden education. Brendan Klein, Research Assistant, contributed to all aspects of the project related to individual, family, and school level activities. Patty Case, Beret Halverson, and Jenny Rudolph, Extension Field Faculty, led all Aim 1 & 2 community-based efforts in their respective Oregon Counties (Klamath, Clackamas, Columbia) and were supported by Field Educators Laurie Wayne, Kelsey Sterrett, and Allison OSullivan. Kristin Trost, Project Coordinator, has supported all aspects of the project as needed. Jenny Jackson, Graduate Assistant (Doctoral Trainee) contributed to the development of the SNPA, the FSOC, and to the HEAL MAPPS processes. Alinna Ghavami, Graduate Assistant (MPH Trainee) contributed to all aspects of the HEAL MAPPS processes. Multi-state partners Anne Lindsay (UN R), Shirley Calodich (WSU), Sonja Koukel (NMSU), and Kay Hongu (UA) have all made major strides to implement HEAL MAPPS in their respective states. COLLABORATORS and PARTNERS. Major collaborators and partners include: University of Nevada, Reno Extension; University of Arizona Extension; Washington State University Extension; Texas A&M Extension; New Mexico State University Extension; Colorado State University Extension; Oregon State University SNAP Ed Program; Oregon State University Extension Family & Community Health and 4H Programs; Clatskanie and Rainier Elementary Schools, Columbia County; Molalla and Estacada Elementary Schools, Clackamas County; Chiloquin and Bonanza Elementary Schools, Klamath County; GeoMobile Innovations Inc. TRAINING and PROFESSIONAL DEVELOPMENT ACTIVITIES not reported above: The following graduate students have been learning through project activities and are conducting research toward the completion of their degrees relative to the project: Patrick Abi-Nader, PhD, Physical Activity and Public Health; Jennifer Jackson, PhD, Public Health. We have engaged undergraduate students (n=2) and MPH students (n=2) in internships. We have delivered trainings to OSU Extension faculty, and state health department partners about HEAL MAPPS and the application of the SNPA in several training workshops. TARGET AUDIENCES: TARGET AUDIENCES Target audiences included residents from geographically, economically, and ethnically diverse rural communities in the Western United States. In 2012, activities took place in seven communities in Oregon and Washington. A second target audience included children from six elementary schools in three Oregon Counties. All targeted schools were in rural communities where over 50% of enrolled students were eligible for free and reduced price meals or free milk. EFFORTS The study rationale, design, and results were disseminated via lectures and invited talks by the PIs to university graduate and undergraduate students, colleagues, and community groups. Methodologies and tools developed through the project were integrated into courses taught by the PIs, and shared through workshops delivered to Extension personnel. The HEAL MAPPS Manual and process has been shared with collaborators on other projects and written in to several successful grant applications as a mechanism to understand environmental factors contributing to healthy eating and physical activity across cultures (e.g. Latino and Native American populations). PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.

Impacts
AIM 1 OOUTCOMES in PY 2 include five HEAL MAPPS reports that have been provided to communities to support community-based initiatives to prevent childhood obesity: John, DH & Gunter, KB (2012). Philomath, OR HEAL MAPPS Community Report; Rudolph, J, Etuk, L , John, DJ, Gunter, KB, (2012). Clatskanie, OR HEAL MAPPS Community Report; Case, P, Wayne, L, Etuk, L, John, DJ, Gunter, KB, (2012). Bonanza, OR HEAL MAPPS Community Report; Halverson, B, Sterrett, K, Etuk, L, John, DJ, Gunter, KB, (2012). Molalla, OR HEAL MAPPS Community Report; Calodich, S, Etuk, L, John, DJ, Gunter, KB, (2012). Port Townsend, WA HEAL MAPPS Community Report. SIGNIFICANT IMPACTS resulting from these outcomes include three grants that were submitted by communities with support from GROW project staff and based on information gained in the HEAL MAPPS processes and/or the SNPA assessment. Clatskanie, OR secured a $5,000 Youth Advocates for Health (YA4-H!) grant from OSU to promote youth involvement in healthy eating, active living (HEAL) through community gardens. Bonanza, OR received $500 to supplement healthy foods at the elementary school food services, and Molalla was the recipient of an $8,000 HEAL grant from Clackamas County DHHS to support the development of a walking/running trail on Molalla elementary property. The project includes a joint use agreement to allow community access to the trail. Additionally, one of our multi-state partners, after becoming trained to support HEAL MAPPS processes in Washington State, submitted and was awarded a 2-year, $50,000 grant to deliver HEAL MAPPS in rural tribal communities to improve community health and enhance local food systems. Thus this USDA NIFA grant was leveraged to secure a total of $63,500 additional dollars at the local level to support obesity prevention in rural communities in the Northwest region. AIM 2 OUTCOMES in PY 2 include an understanding of the overweight an obesity prevalence in the elementary schools enrolled in the GROW intervention programs. Of the 1920 children assessed in grades k-6, 36% were overweight (having BMI values for their age and gender > the 85th percentile); 19% were obese (having BMI values for their age and gender > the 95th percentile). Prevalence did not differ by age, but a greater proportion of children in older grades (3rd-6th) were classified as overweight and obese. Reports were generated and shared with each participating school.

Publications

• HEAL MAPPS Training Manual John DH, Gunter, KB, Etuk L.(2012). The purpose of this training manual is to introduce the Healthy Eating Active Living: Mapping Attributes through Participatory Photographic Surveys (HEAL MAPPS) program, and to train users to apply the HEAL MAPPS process and tools collaboratively with community-based research partners. This manual is a 105-page step-by-step resource intended to guide users through the entire HEAL MAPPS process, from planning to execution to dissemination of findings.