Source: UNIVERSITY OF CALIFORNIA, DAVIS submitted to
NINOS SANOS, FAMILIA SANA (HEALTHY CHILDREN, HEALTHY FAMILY):PREVENTING CHILDHOOD OBESITY IN MEXICAN-HERITAGE CHILDREN IN RURAL CALIFORNIA
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
TERMINATED
Funding Source
Reporting Frequency
Annual
Accession No.
0224401
Grant No.
2011-68001-30167
Project No.
CALR-2010-04641
Proposal No.
2010-04641
Multistate No.
(N/A)
Program Code
A2101
Project Start Date
Apr 1, 2011
Project End Date
Mar 31, 2017
Grant Year
2011
Project Director
de la Torre, A.
Recipient Organization
UNIVERSITY OF CALIFORNIA, DAVIS
410 MRAK HALL
DAVIS,CA 95616-8671
Performing Department
Chicana/o Studies
Non Technical Summary
Latino children experience higher overweight prevalence compared to non-Latino white children. Little research focuses on this population, and educators lack adequate training for effective prevention. This project responds to gaps in knowledge and field training to address this epidemic. The project has four goals: (1) Slow the rate of weight gain among Mexican-heritage intervention children compared with control children; (2) Identify mediating factors influencing the effect of economic and educational interventions on child weight gain; (3) Culturally adapt, incorporate, and implement nutrition and physical activity curricula proven to counter childhood overweight/obesity; (4) Increase the number of culturally attuned undergraduate, graduate and professional degree students in nutrition, agricultural economics, education and allied health. The project employs a multi-faceted intervention approach targeting Mexican-heritage children ages 3-8 in a community and elementary school setting. The investigator team has partnered with the local community and UC Cooperative Extension to develop and implement economic and educational interventions. The economic intervention includes monthly distribution of produce vouchers to all intervention participants. The education interventions include: Family Nights with learner-centered UCCE nutrition education for parents; Pre-School Nutrition Education and Physical Education provided during Family Nights; School-based Nutrition Education and Physical Activity; semi-annual health screenings for both intervention and control groups. Graduate and medical students will participate in interventions, data collection, and analysis. Doctoral students will enroll in the International and Community Nutrition Designated Emphasis, which will be newly enriched through coursework enabling candidates to graduate with culturally-nuanced intervention support and research capacity to work with this underserved population. Expected outcomes / benefits include: Parents, teachers, students, and community members will increase knowledge of healthy nutrition and physical activity practices and the link to weight gain; Parents will develop cooking skills in using fresh produce in family meals; UCCE curriculum will be tailored to cultural values; Researchers and students will have a better understanding of appropriate sample design, methods and interventions used for this population. Families will increase purchases/consumption of fresh produce and decrease purchases/ consumption of unhealthy foods; Children will increase frequency and intensity of physical activity; UCCE will expand implementation of evidence based curriculum for target group; Graduate, medical and undergraduate students will demonstrate increased cultural sensitivity; There will be a slower rate of weight gain among intervention children compared with control children; The community will have greater access to fresh produce due to market effects and greater awareness; UCCE will achieve more effective outcomes through interventions; A higher number of students will be prepared to work with Mexican heritage populations.
Animal Health Component
(N/A)
Research Effort Categories
Basic
(N/A)
Applied
70%
Developmental
30%
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
6076020301020%
7036020302010%
7036020307010%
7246010307010%
8016020301010%
8026020302010%
8056020302010%
8056020307010%
9036020307010%
Goals / Objectives
Goal 1 (Research): Slow the rate of weight gain among intervention children compared with that of control children as follows: a) The proportion of overweight children (greater than 85th percentile) will not increase among the intervention group compared to an expected increase of 10% among the control group; and b) Among the intervention children, slow the rate of increase in BMI, whereas in the control group children are expected to either maintain or increase BMI growth. Goal 2 (Research via Extension-Based Activity): Identify mediating factors influencing the effect of economic (market) and educational interventions on child weight gain. Goal 3 (Extension via Undergraduate and Graduate Student Field Studies): Refine, integrate, and evaluate UCCE science-based nutrition and physical activity curricula for cultural propriety so they effectively target the Mexican-heritage community to counter the childhood overweight/obesity epidemic. Goal 4 (Education): To strengthen and increase the number of culturally sensitive UC Davis undergraduate, graduate and professional degree students in the areas of nutrition, agricultural economics, medicine, and education. Objectives: 1. Change in knowledge: Parents, teachers, students, and community members increase knowledge of healthy nutrition and physical activity practices and the link between these practices and weight gain. Parents increase cooking skills in using fruits and vegetables in family meals. Institution implements culturally nuanced UCCE curriculum. Researchers and students achieve better understanding of appropriate sample design, methods and interventions used for this population. 2. Change in behavior: Families increase purchases and consumption of fruits and vegetables and decrease purchases and consumption of unhealthy foods. Children increase frequency and intensity of physical activity. UCCE expands implementation of evidence based curriculum for target group Graduate, medical and undergraduate students increase cultural sensitivity 3. Change in condition: Slow rate of weight gain among intervention children compared with control children. Community has greater access to fresh fruits and vegetables due to both market effects and greater awareness. UCCE achieves more effective outcomes through interventions. Higher number of students prepared to work with Mexican Heritage population. Expected Outputs: Number of participants who successfully complete the intervention. Data Analysis. Evaluation of UCCE curriculum. Scientific Publication of study results. Research papers on best practices. Graduated students in Program in Community and International Nutrition. Number of students as research assistants. Knowledge for policy makers on the effectiveness of targeted food vouchers. Taller Arte del Nuevo Amanacer (TANA) posters and murals. Timeline for Significant Project Phases: Year 1: Recruitment, Community Input, Baseline Health Data Collection. Year 2: Intervention, Semi-Annual Health Data Collection. Year 3: Intervention, Semi-Annual Health Data Collection. Year 4: Intervention, Semi-Annual Health Data Collection. Year 5: No Intervention, Semi-Annual Health Data Collection.
Project Methods
The targeted population is Mexican-heritage children ages 3-8 in a small rural California community. The design integrates Social Cognitive Theory with an economic behavioral approach within the Health Belief Model to focus on behavior change through multiple levels of influence, such as individual, interpersonal, and community levels. The model uses a community-based-participatory-research approach that requires input at all stages of school and community engagement, and in the development and implementation of the proposed interventions based in the local schools, community centers, food markets and health clinics. This is a five-year multi-faceted intervention, controlled, community-based trial. The set-up phase (Year 1) will include establishing an advisory council; tailoring interventions based on stakeholder input; training teachers and promotoras; collecting baseline information from children and their parents; and assessing purchasing behavior of the targeted population to establish fruit and vegetable voucher system. The evidence-based structured intervention (Years 2-4) includes: (1) nutrition education, physical activity and social marketing components: school-based curriculum in nutrition and physical education for children in K-3; structured-play education during family cooking nights for pre-school children; nutrition and physical activities programs for parents, to be delivered during 10 family education nights. A community art campaign will use murals and posters to emphasize healthy eating and active lifestyles. (2) Voucher component: parents will receive a voucher to purchase fruits and vegetables in their community markets, similar to the WIC voucher system. The follow-up phase (Year 5) will consist only of data collection, analysis and results publication. (3) Graduate-level education: Chicana/o Studies,nutrition, agricultural economics and medical faculty willl develop curriculum to deepen student awareness of the cultural contexts impacting research, health-related and education programs targeting Mexican-heritage populations. Curriculum enrichment will be embedded into the Program in Community and International Nutrition curriculum (Designated Emphasis for doctoral degree students). Data collection tools include: Children: Height and Weight Scales; tape measures to measure waist circumference. Food Behavior Checklist (FBC); Food knowledge / attitude surveys; Adults: On the Go/De Prisa; NHANES; physical activity section; and participant evaluations. Child preferences for and consumption of fruits and vegetables (parent-reported); Assessment Activity Survey, Children; Activity Survey; Child knowledge quiz/ Child preferences for and consumption of fruits and vegetables. Focus group Interviews; Market food purchase scanners. Data variables include: Change in weight over time; Knowledge, Engagement, and Participation in food-related behavior; food nutrients; available foods in the home; health benefit; self-efficacy; stage of change related to fruit and vegetable consumption variables; Knowledge/ fitness activity variables; time watching TV, playing video/computer games, playing active games; food purchase choices.

Progress 04/01/11 to 03/31/17

Outputs
Target Audience:This reporting period consisted of data analysis and preparation of publications and curriculum materials. The target audience was not involved in activity during this period. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?Over the past six years, NSFS has provided 29 undergraduate students with human subjects (IRB- social and behavioral studies) certification training and field research, teaching and extension experience. The course developed through NSFS, International and Community Nutrition, has been integrated into the UC Davis graduate nutrition curriculum as an annually scheduled course offering through a collaboration between the Nutrition Graduate Group and the Chicana/o Studies department at UC Davis. This course provides approximately 8-10 graduate students annually with the knowledge and skills to plan and implement public health and nutrition projects that highlight the intersection of social determinants of health within a community empowerment framework. The first undergraduate student supervisor graduated in 2013 and is entering his final year of medical school at UCLA - Charles Drew School of Medicine. A significant outcome from NSFS' education goal has been the graduation of five doctoral degree recipients in the past two years with their PhD in nutrition (1), agricultural and resource economics (1), nursing science (1) and education (2 ). NSFS post-doctoral fellow, Dr. Rosa Manzo, graduated in 2014 with her PhD in education and has taught the Program in International and Community Nutrition (PICN) course over the past two years with oversight from the Chicana/o Studies Instructor of Record, Associate Professor Natalia Deep-Sosa. Dr. Manzo is from the community of San Joaquin (control) and is the first member of her family to graduate from college. Dr. Manzo co-facilitated the community engagement program in Golden Plains Unified School District with UC Davis Co-investigator Yvette Flores. Dr. Flores and Dr. Manzo developed and implemented a parent engagement and empowerment curriculum for mono-lingual Spanish-speaking parents to learn how to support their children's academic success. Participation in community engagement forums developed community / parental trust with the research group and led to the community's ongoing participation over the past five years in semi-annual data collection activity needed for the comparison study. The CE program led to the procurement of a two-year grant from the Fresno Regional Foundation (FRF), which Dr. Manzo co-authored with the Center for Transnational Health's Director of External Grants. The purpose of the FRF grant was to establish a parent literacy program that would build the capacity of parents in the control community to support their children's educational pathway. Through a train-the-trainer model, the parent literacy program has sustained its activity beyond the two-year grant, with volunteer parent facilitators leading the program for other parents after the grant ended. The second education doctoral student, Dr. Rosa Gomez-Camacho, graduated in 2015 with her PhD in education and a master's degree in economics. Dr. Gomez-Camacho is currently Associate Director of Institutional Research and Analysis at Florida Gulf Coast University and continues to provide data analysis services for NSFS via a sub-award / consulting agreement. Dr. Lisa Martinez, who received her PhD in nursing in 2014, is completing her certification as a nurse practitioner. Her dissertation research conducted through the NSFS study focused on investigating the correlation of healthy nutrition and physical activity practices among elementary school children to academic performance. Dr. Albert Aguilera completed his doctoral degree in nutrition in December 2015 and is completing a tertiary study in the NSFS intervention community on impact of the intervention on carotenoid levels in comparison with participant levels in the control community. Three additional graduate students completed their master's degrees in nutrition (2) and nursing science (1). Michele Byrnes, who graduated with a MS in nutrition, is now employed as a nutrition cooperative extension specialist with CalFresh in the State office; the other nutrition master's degree recipient, Mayra Munoz Gomez, is in the doctoral program in nutrition at UC Davis. Christy Solorio, who graduated with a MS in nursing in 2012, is a lecturer on clinical placement advising at California State University Sacramento School of Nursing. Current doctoral student in epidemiology, Erik Tseregounis, recently passed his qualifying exam and continues to work with NSFS on statistical analysis as a Graduate Student Researcher while completing his dissertation. Araceli Gonzalez entered the UC Davis doctoral program in education in fall 2014 after working with NSFS as a representative of the community-based organization Proteus, Inc., which provides promotoras (project liaisons) from the local communities to assist in participant recruitment and data collection for the NSFS project in the participating communities. Ms. Gonzalez is preparing for her qualifying exam. As a Graduate Student Researcher, Ms. Gonzalez has coordinated the community engagement activity for the NSFS project in the control communities during the past two years and is now embarking on her dissertation research in the control community of San Joaquin. Ms. Gonzalez's research examines the impact of parent engagement on first-generation Mexican-American student academic performance in elementary school. Ms. Gonzalez is a first-generation naturalized citizen of the US from Mexico. She has received a full fellowship from the Mexican government to support her work on NSFS and completion of her dissertation research. A number of Proteus promotoras have also been trained and certified under the UC Davis IRB as recruiters, consenters and data collectors. The IRB training and certification will enable these local community members to gain future higher-paying employment on studies conducted in the region through UC and CSU research programs. Another important professional development outcome from the employment of community members for the project is the recent acceptance of the NSFS Firebaugh site coordinator, Maria Rangel, into UC Berkeley School of Public Health's Masters in Public Health (MPH) program. Also the first in her family to complete an undergraduate degree, Ms. Rangel received her BS in microbiology from UCLA in 2010 before joining the NSFS team as site coordinator for the Firebaugh field office in Spring 2011. Principal investigators from NSFS mentored Ms. Rangel through the process of identifying and applying to graduate programs in public health. In addition to being accepted at UC Berkeley, Ms. Rangel was admitted to Johns Hopkins School of Public Health's MPH program. The accomplishments of UC Davis graduate students and undergraduates in the NSFS project highlighted in this report are critical markers of the project's success in generating a new generation of culturally competent research, teaching and extension professionals. However, the return of two community members to graduate programs in public health and education as a result of their exposure to the project reflects the ability of NIFA-funded programs to build local capacity for creating sustainable change to community infrastructure. A spreadsheet detailing a list of undergraduates who have been trained in research and data collection through NSFS has been submitted to the program officer. How have the results been disseminated to communities of interest?During the final year the two main vehicles for disseminating results to our community partners have been through quarterly community advisory council meetings (one per quarter in each of the treatment and control communities of Firebaugh and San Joaquin) and the quarterly newsletter that was published in English and in Spanish and tailored to each community. At the final community advisory council meetings in May 2016, we presented the prototype binders of the nutrition education curriculum for parent education programs. These binders included curriculum summaries, lesson plans, recipes, and other resources. The final products are currently under review through the UC Cooperative Extension peer review process. This review will enable the products developed through this NIFA-funded project to be made available nationally through USDA and throughout California through the state cooperative extension network. Periodic updates between quarterly meetings and newsletter publications were sent via email to community and district leadership in English and Spanish from the Firebaugh site coordinator. Parents involved in the parent nutrition education program prepared refreshments for each meeting using recipes for healthy snacks they had developed with the nutrition educator. The final community advisory council meetings included a slide presentation of study results to-date, delivered in English and Spanish. Results were presented in language appropriate to the literacy level of the community participants. The cooperative extension and research team attended each meeting, and project leaders in economics, nutrition, physical activity, medical measurement and community engagement reported on their team's activity and findings. Each presentation was followed by a community discussion that included soliciting feedback for development of a continuation grant application. The project team then presented certificates of recognition to community members whose leadership contributed to the success of the project and to all community volunteers. Each recipient also received a framed poster developed as part of the community art project that depicted the theme of community empowerment promoting a healthy lifestyle and the linkages between health literacy and community prosperity. Follow-up meetings in each community have continued these discussions for the purpose of planning additional collaborative work. The remaining nine months of the project term focused on analysis of final results for development of peer-reviewed publications and follow-up presentations at town-hall-style meetings in the participant communities. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? Goal 1: SUMMERIZED RESULTS The multifaceted intervention in this study successfully reduced the BMI in boys in the intervention community relative to the comparison. Empirical analysis resulted in consistent findings across all the three age groups as well as normal, overweight and obese boys. Although girls in our study did not show similar results across all weight statuses, obese girls responded to the intervention significantly. Intervention boys who were six years or older at baseline also experienced slower BMI gains than their counterparts. Boys also exhibited a decrease in Waist Circumference to Height Ratio (WCHTR), another measure of adiposity, in the intervention group relative to the comparison. Girls in the intervention site did not show any significant changes in their WCHTR. RESULTS Throughout the study, 782 children met eligibility for enrollment with parental / guardian consent, including 430 in the intervention group and 352 in the comparison group. 76.3% (n=328) of intervention-group children and 78.1% (n=275) of comparison-group children were retained through the period comprising this analysis. The sample for analysis includes all children with at least one set of anthropometric measurements, including those who exited prior to the end of the study: 387 children in the intervention group and 313 in the comparison group. Children who exited after at least one measurement had younger and less acculturated mothers than children who completed the study. There was no difference in zBMI or BMI percentile between those who exited and those who remained. The cohort's baseline characteristics were somewhat different between the two communities. Comparison-community mothers were significantly younger, less educated, and more likely to have been born in Mexico than intervention-community mothers. There were no statistically significant differences between intervention and comparison participants in any other baseline characteristics. The intervention significantly reduced BMI in obese boys in all age groups and normal boys only in the oldest age group. In girls, the intervention resulted in significantly lower BMI in obese girls in all three age groups compared with their counterparts in the comparison group. We examined the CDC-expected BMI (50th percentile by age in months) along with the observed BMI in our participants, stratified by intervention site, gender, and obesity status at baseline. Among boys in all three categories of obesity status at baseline, the BMI line in the comparison group crosses the line of the intervention group toward higher BMI ranges. Although on average obese girls in the comparison community have a higher BMI compared with that of obese girls in the intervention site, the projection of older obese girls in the intervention group clearly deviates from the projection of comparison participants. When modeling the Waist Circumference to Height Ratio (WCHTR) ratio in boys using the same predictors as BMI, we found similar findings as in BMI. There was no significant impact of the intervention on girls' WCHTR ratio. Exploration of the three-way interaction of age group, intervention and obesity at baseline yielded insignificant associations of terms with outcomes. Goal 2: Participating families completed a fourth installment of the Household Survey (HHS 4) and an exit survey in spring 2016. Results: Fruit accounted for the majority of purchases (54% of spending) in the intervention community. Dark green and red/orange vegetables comprised small percentages of spending (7% and 9%, respectively). The top five items purchased were bananas, apples, tomatoes, avocadoes, and strawberries. Twenty-two percent of spending was on foods with high potassium content and 33% was on foods with high fiber content. Outcomes suggest that the voucher was a critical component of the household food budget. Furthermore, the most frequently purchased items contributed important nutrients to participants' diets. Goal 3 -- Nutrition: Our findings show that food patterns among the children did not differ at baseline between the two communities but that overweight and obese children consumed fruit and vegetables less often than normal weight children. These findings point to the need to continue working with participants as they age into adolescence to counter the food intake trends that tend to accompany children as they become more independent and are less influenced by parental controls over meals and snacks. A continuation study with the same cohort should shift to obesity prevention among children in normal weight categories to ensure that children currently in the healthy weight range remain healthy as they enter adolescence while children who are overweight and obese continue on a trajectory of controlling weight gain. Goal 3: Physical Activity. Descriptive statistics from survey completion revealed that the students in the treatment community tended to have physical activity on a playground (84.6%). A higher percentage of teachers in the control group (68.4%) reported they used the classroom for daily physical activity. Furthermore, teachers in the control group indicated that spending physical activity time in the classroom was a high barrier to daily physical activity. Both treatment and control teachers rated "time spent teaching academic subjects" as the highest barrier to PE time. By understanding the barriers for delivering physical activity in elementary schools, we can gain a stronger understanding of the development and implementation of physical activity interventions for low-income rural communities. Minutes of moderate to vigorous physical activity (MVPA) was the main outcome variable for physical activity throughout this study. Data analyses of the change in MVPA from baseline and the first two intervention years revealed that obese girls in the intervention group showed significant increase in MVPA, in a longitudinal regression model, after controlling for socioeconomic and demographic variables. This data was presented in a poster at the 2016 Society of Nutrition Education and Behavior conference and this paper is currently being completed and submitted for publication. Goal 4 - Education: Our goal with respect to "education" has been to strengthen and increase the number of culturally sensitive UC Davis undergraduate, graduate and professional degree students in the areas of nutrition, agricultural economics, health sciences, and education. See next section for full disclosure.

Publications

  • Type: Conference Papers and Presentations Status: Accepted Year Published: 2016 Citation: de la Torre, A., Kaiser, L.L., Sadeghi, B., Flores, Y., Green, R., Shaikh, U., Whent, L. (2016). Ni�os Sanos, Familia Sana: Healthy Children, Healthy Family: A Multi-Component Intervention to Prevent Obesity in Mexican-Heritage Children in Rural California. SNEB Annual Conference, San Diego, CA, July30-August 2, 2016.
  • Type: Conference Papers and Presentations Status: Accepted Year Published: 2016 Citation: Condor, J.L., Manzo, R.D., Whent, L., de la Torre, A. (2016). Barriers to the Delivery of Childrens Physical Activity in Californias Central Valley. SNEB Annual Conference, San Diego, CA, July 30- August 2, 2016.
  • Type: Conference Papers and Presentations Status: Accepted Year Published: 2016 Citation: Schaefer SE, Sadeghi B, Whent L, de la Torre A. Ninos Sanos Familia Sana Impact on Childrens Physical Activity. SNEB Annual Conference, San Diego, CA, July 30- August 2, 2016.
  • Type: Conference Papers and Presentations Status: Accepted Year Published: 2016 Citation: Whent, L.S., Martinez, L., Gomez-Camacho, R., de la Torre, A. Classroom Teacher Impact on Student Physical Activity. SNEB Annual Conference, San Diego, CA, July 30- August 2, 2016.
  • Type: Journal Articles Status: Awaiting Publication Year Published: 2017 Citation: Kaiser L, Aguilera A, Martinez J, Horowitz M, Lamp CL, Johns M, Espinoza D, Byrnes M, Diaz Rios K. Ni�os Sanos Familia Sana Family Nutrition Education. UC ANR
  • Type: Conference Papers and Presentations Status: Accepted Year Published: 2016 Citation: Manzo, R.D., Sadeghi, B., Flores, Y., Ontai, L., Rangel, M., Gomez-Camacho, R. de la Torre, A. Demographic and Parenting Differences in the Ni�os Sanos, Familia Sana Communities. SNEB Annual Conference, San Diego, CA, July30-August 2, 2016.
  • Type: Conference Papers and Presentations Status: Accepted Year Published: 2016 Citation: Condor, J.L., Sadeghi, B. Barriers to Childrens Physical Activity in Two Rural Towns From Californias Central Valley. April 8, 2016. 27th Annual Undergraduate Research, Scholarship and Creative Activities Conference. University of California, Davis.
  • Type: Journal Articles Status: Published Year Published: 2016 Citation: Aguilera A, de la Torre A, Kaiser L. Use of Skin Carotenoids as a Biomarker for Fruit and Vegetable Intake Among Mexican-Origin Children in a Community Setting The FASEB Journal. April 1, 2016. 30:43.4.
  • Type: Journal Articles Status: Published Year Published: 2017 Citation: Manzo, R.D., Rangel, M., and Flores, Y.G, and de la Torre, A. (2017). Tapping into Our Assets: A Community Cultural Wealth Model to Train Promotoras as Research Collaborators. Health Promotion and Practice.
  • Type: Book Chapters Status: Under Review Year Published: 2017 Citation: Manzo, R.D., Flores, Y.G., Rangel, M., and Hernandez, G. (Under Review). From the Field to the Academy: Experiences of Chicana Feminist Conducting Community-Based Participatory Research in Californias Central Valley. In Deeb-Sossa, N. and de la Torre, A. (Eds.). From the Field and the Trenches: Community Empowerment, Sustainability and Community Based Research in Chicana/o Studies.
  • Type: Book Chapters Status: Under Review Year Published: 2017 Citation: Manzo, R.D. (Under Review). Negotiating Tensions: A Community-Based Approach to Document the Challenges Parent Face in Advocating for their Childrens Education. In Deeb-Sossa, N. and de la Torre, A. (Eds.). From the Field and the Trenches: Community Empowerment, Sustainability and Community Based Research in Chicana/o Studies.
  • Type: Journal Articles Status: Under Review Year Published: 2017 Citation: Manzo, R.D., Sadeghi, B., Ontai, L., Gomez-Camacho, R., Flores, Y.G., Rangel, M., and de la Torre, A. (Under Review). Examining Sociodemographic Variations and Predictors of Parenting Dimensions within Mexican Origin Communities in California. Journal of Family Relations.
  • Type: Journal Articles Status: Under Review Year Published: 2017 Citation: Aguilera, A., Manzo, R.D., Vera-Becerra, L.E., de la Torre, A., and Kaiser, L. L. (Under Review). Perceptions of Childhood Obesity and Nutrition Messages among Mexican-origin Mothers in Rural California. Journal of Immigrant and Minority Health.
  • Type: Journal Articles Status: Under Review Year Published: 2017 Citation: Sadeghi, B., de la Torre, A., Kaiser, L., Hanbury, M., Tseregounis, E., Shaikh, U., Gomez-Camacho, R., Aguilera, A., Whent, L. (Under Review). A Three-Year Multifaceted Intervention to Prevent Obesity in Children of Mexican-Heritage. International Journal of Obesity.
  • Type: Journal Articles Status: Published Year Published: 2016 Citation: Sadeghi B, Kaiser LL, Schaefer S, Tseregounis IE, Martinez L, Gomez-Camacho R, de la Torre A. Multifaceted community-based intervention reduces rate of BMI growth in obese Mexican-origin boys. Pediatric Obesity 2016 doi: 10.1111/ijpo.12135
  • Type: Journal Articles Status: Published Year Published: 2016 Citation: Schaefer SE, Gomez-Camacho R, Martinez L, Sadeghi B, German JB, de la Torre A. Social and environmental determinants of child physical activity in a rural Mexican-origin community. J Community Health 2016 41(2): 409-16.


Progress 04/01/15 to 03/31/16

Outputs
Target Audience:The target audiences include the following: Primary: Mexican-heritage female and male children ages 2-8: 553 Active Children 305 Firebaugh (intervention - data collection only) 248 San Joaquin (comparison - communty engagement activity and data collection) Secondary: Parents / Guardians of child participants: 428 Active Households 238 Firebaugh (Intervention ) 190 San Joaquin (Comparison) 57 teachers 36 Firebaugh (Intervention) 21 San Joaquin (Control) This period consisted of data collection only. Changes/Problems:No changes have been made in the past year. What opportunities for training and professional development has the project provided?Over the past five years, NSFS has provided 43 undergraduate students with human subjects (IRB- social and behavioral studies) certification training and field research, teaching and extension experience. The course developed through NSFS, International and Community Nutrition, has been integrated into the UC Davis graduate nutrition curriculum as an annually scheduled course offering through a collaboration between the Nutrition Graduate Group and the Chicana/o Studies department at UC Davis. This course provided students the knowledge and skills to plan and implement public health and nutrition projects that highlight the intersection of social determinants of health within a community empowerment framework. The first undergraduate student supervisor graduated in 2013 and is entering his final year of medical school at UCLA - Charles Drew School of Medicine. A significant outcome from NSFS' education goal has been the graduation of five doctoral degree recipients in the past two years with their PhD in nutrition (1), agricultural and resource economics (1), nursing science (1) and education (2 ). NSFS post-doctoral fellow, Dr. Rosa Manzo, graduated in 2014 with her PhD in education and has taught the Program in International and Community Nutrition (PICN) course over the past two years with oversight from the Chicana/o Studies Instructor of Record, Associate Professor Natalia Deep-Sosa. Dr. Manzo is from the community of San Joaquin (control) and is the first member of her family to graduate from college. Dr. Manzo co-facilitated the community engagement program in Golden Plains Unified School District with UC Davis Co-investigator Yvette Flores. Dr. Flores and Dr. Manzo developed and implemented a parent engagement and empowerment curriculum for mono-lingual Spanish-speaking parents to learn how to support their children's academic success. Participation in community engagement forums developed community / parental trust with the research group and led to the community's ongoing participation over the past five years in semi-annual data collection activity needed for the comparison study. The CE program led to the procurement of a two-year grant from the Fresno Regional Foundation (FRF), which Dr. Manzo co-authored with the Center for Transnational Health's Director of External Grants. The purpose of the FRF grant was to establish a parent literacy program that would build the capacity of parents in the control community to support their children's educational pathway. Through a train-the-trainer model, the parent literacy program has sustained its activity beyond the two-year grant, with volunteer parent facilitators leading the program for other parents after the grant ended. The second education doctoral student, Dr. Rosa Gomez-Camacho, graduated in 2015 with her PhD in education and a master's degree in economics. Dr. Gomez-Camacho is currently Associate Director of Institutional Research and Analysis at Florida Gulf Coast University and continues to provide data analysis services for NSFS via a sub-award / consulting agreement. Dr. Lisa Martinez, who received her PhD in nursing in 2014, is completing her certification as a nurse practitioner. Her dissertation research conducted through the NSFS study focused on investigating the correlation of healthy nutrition and physical activity practices among elementary school children to academic performance. Dr. Albert Aguilera completed his doctoral degree in nutrition in December 2015 and is completing a tertiary study in the NSFS intervention community on impact of the intervention on carotenoid levels in comparison with participant levels in the control community. Three additional graduate students completed their master's degrees in nutrition (2) and nursing science (1). Michele Byrnes, who graduated with a MS in nutrition, is now employed as a nutrition cooperative extension specialist with CalFresh in the State office; the other nutrition master's degree recipient, Mayra Munoz Gomez, is in the doctoral program in nutrition at UC Davis. Christy Solorio, who graduated with a MS in nursing in 2012, is a lecturer on clinical placement advising at California State University Sacramento School of Nursing. Current doctoral student in epidemiology, Erik Tseregounis, continues to work with NSFS on statistical analysis as a Graduate Student Researcher. Araceli Gonzalez entered the UC Davis doctoral program in education in fall 2014 after working with NSFS as a representative of the community-based organization Proteus, Inc., which provides promotoras (project liaisons) from the local communities to assist in participant recruitment and data collection for the NSFS project in the participating communities. A number of Proteus promotoras have also been trained and certified under the UC Davis IRB as recruiters, consenters and data collectors. The IRB training and certification will enable these local community members to gain future higher-paying employment on studies conducted in the region through UC and CSU research programs. As a Graduate Student Researcher, Ms. Gonzalez has coordinated the community engagement activity for the NSFS project in the control communities during the past two years and is now embarking on her dissertation research in the control community of San Joaquin. Ms. Gonzalez's research examines the impact of parent engagement on first-generation Mexican-American student academic performance in elementary school. Ms. Gonzalez is a first-generation naturalized citizen of the US from Mexico. She has received a full fellowship from the Mexican government to support her work on NSFS and completion of her dissertation research. Another important professional development outcome from the employment of community members for the project is the recent acceptance of the NSFS Firebaugh site coordinator, Maria Rangel, into UC Berkeley School of Public Health's Masters in Public Health (MPH) program. Also the first in her family to complete an undergraduate degree, Ms. Rangel received her BS in microbiology from UCLA in 2010 before joining the NSFS team as site coordinator for the Firebaugh field office in Spring 2011. Principal investigators from NSFS mentored Ms. Rangel through the process of identifying and applying to graduate programs in public health. In addition to being accepted at UC Berkeley, Ms. Rangel was admitted to Johns Hopkins School of Public Health's MPH program. The accomplishments of UC Davis graduate students and undergraduates in the NSFS project highlighted in this report are critical markers of the project's success in generating a new generation of culturally competent research, teaching and extension professionals. However, the return of two community members to graduate programs in public health and education as a result of their exposure to the project reflects the ability of NIFA-funded programs to build local capacity for creating sustainable change to community infrastructure. How have the results been disseminated to communities of interest?During the past year the two main vehicles for disseminating results to our community partners have been through quarterly community advisory council meetings (one per quarter in each of the treatment and control communities of Firebaugh and San Joaquin) and the quarterly newsletter that was published in English and in Spanish and tailored to each community. At the final community advisory council meetings in May 2016, we presented the prototype binders of the nutrition education curriculum for parent education programs. These binders included curriculum summaries, lesson plans, recipes, and other resources. The final products are currently under review through the UC Cooperative Extension peer review process. This review will enable the products developed through this NIFA-funded project to be made available nationally through USDA and throughout California through the state cooperative extension network. Periodic updates between quarterly meetings and newsletter publications were sent via email to community and district leadership in English and Spanish from the Firebaugh site coordinator. Parents involved in the parent nutrition education program prepared refreshments for each meeting using recipes for healthy snacks they had developed with the nutrition educator. The final community advisory council meetings included a slide presentation of study results to-date, delivered in English and Spanish. Results were presented in language appropriate to the literacy level of the community participants. The cooperative extension and research team attended each meeting, and project leaders in economics, nutrition, physical activity, medical measurement and community engagement reported on their team's activity and findings. Each presentation was followed by a community discussion that included soliciting feedback for development of a continuation grant application. The project team then presented certificates of recognition to community members whose leadership contributed to the success of the project and to all community volunteers. Each recipient also received a framed poster developed as part of the community art project that depicted the theme of community empowerment promoting a healthy lifestyle and the linkages between health literacy and community prosperity. Follow-up meetings in each community have continued these discussions for the purpose of planning the continuation grant. The remaining nine months of the project term are focusing on analysis of final results for development of peer-reviewed publications and follow-up presentations at town-hall-style meetings in the participant communities. What do you plan to do during the next reporting period to accomplish the goals?This project has now entered a no-cost extension year to allow for final data analysis and completion of additional publications. Our findings suggest that rather than focus on one mode of intervention, cooperative extension specialists in nutrition and physical activity should partner with the K-12 community, community/civic leaders, health care providers, and parents to establish, implement and evaluate effective multi-approach childhood-obesity-prevention programs. We noted that statistically significant results require a minimum of two intervention years to observe in boys and three intervention years to observe in girls. Pediatric obesity prevention and treatment requires a longitudinal, multidisciplinary approach in which health-care providers partner with whole communities, including parents, schools, and policy makers, and target children beginning in pre-school. Assuming the same rate of growth observed during the intervention period, it would take one-to- five additional years for average BMI to fall below the 95th percentile in the obese group, transitioning these children to the overweight category by ages 8-14. Using estimates of direct medical costs, the shift in weight category represents a potential lifetime savings of $16,600 - $28,300 per participant, depending on age and gender. Based on these findings, the team is developing final publications for dissemination through peer-reviewed journals targeting the extension profession, as well as health sciences communities. The team is planning a continuation project that builds upon the knowledge gained to-date in the current program. The NSFS nutrition extension team has finalized the parent nutrition education curriculum materials in English and Spanish and is awaiting review feedback from UC Cooperative Extension peer review. The team will finalize the materials based on reviewers' feedback and then produce hard copies of the materials for the participating school districts and community libraries. Web-based curricular materials will be uploaded on the UCCE web site and submitted to the USDA NIFA Resources website. An announcement of the on-line availability of the materials will go to school districts and community leaders as well as CE Nutrition Advisors throughout California. The economics team is currently analyzing voucher and receipt data to determine if consumers changed their consumption behavior based on the fruits-vegetable voucher they received on a monthly basis. For example, did they increase their consumption of fruits and vegetables or did they substitute other commodities with their savings from their monthly stipends? We are combining food-purchasing receipts with the voucher information to examine how consumers change their food purchasing patterns given a monthly voucher. Data from the final data collection year (Year 5) are currently being analyzed and will be disseminated to the participating communities via town-hall style meetings. Dissemination to the professional community will occur through publication in peer-reviewed journals.

Impacts
What was accomplished under these goals? Goal 1: During study conception, we hypothesized that rate of BMI growth would be lower in the intervention than comparison community after three years of intervention. During the most recent grant period April 1, 2015-March 31, 2016, we conducted final data collection at the participating school sites in the intervention and control communities. Weight/ Height and waist circumference data informed the findings. Results: We found that this multifaceted intervention over three years was effective at slowing the rate of weight gain in obese boys and girls in the intervention community, in comparison with obese participants in the control community.At baseline, mean (SD) BMI was 17.39 (2.21) in the intervention group (n=387) and 17.61 (2.85) in the comparison group (n=313) (NS). The intervention was inversely associated with log-transformed BMI in obese boys (β = -0.063, P = 0.003) and girls (β = -0.046, P = 0.028). Goal 2: The produce voucher program provided $25 per month to each family of child participants in the intervention community during the three intervention years. The third intervention year ended in July 2015. 272 vouchers were distributed and used regularly each month over the three-year intervention period. On average, each participating household received $700 over the intervention period. Participating families who received a voucher submitted food-shopping receipts for a one-month period per year, with the final collection occurring in October 2015. Data on voucher purchases was collected via grocery store scanners through July 2015. Participating families completed a fourth installment of the Household Survey (HHS 4) and an exit survey in spring 2016. Results: Fruit accounted for the majority of purchases (54% of spending) in the intervention community. Dark green and red/orange vegetables comprised small percentages of spending (7% and 9%, respectively). The top five items purchased were bananas, apples, tomatoes, avocadoes, and strawberries. Twenty-two percent of spending was on foods with high potassium content and 33% was on foods with high fiber content. Outcomes suggest that the voucher was a critical component of the household food budget. Furthermore, the most frequently purchased items contributed important nutrients to participants' diets. Goal 3 -- Nutrition: By the end of February, the family nights in the intervention community had covered all of key obesity prevention messages. Thus, from March through the end of June, the classes transitioned to a hands-on cooking class, involving parents and the children. Taught by our Spanish-speaking promotoras (lay-workers), each class presented a 15 minute discussion on key parenting topics, such as how to cook with children, strategies to encourage children to taste new foods, and ways to reinforce good behaviors in children without using food rewards. We also convened a monthly support group for parents of children with body mass index above the 90th percentiles. A bilingual nutrition specialist led each session which was geared to problem-solving in implementing healthy diets and physical activity. A highlight of the year was an end-of-study Halloween party where intervention parents and children engaged in active games and sampled healthy foods (fruit kabobs). We also conducted four focus groups in both communities (2 in May and 2 in October) to explore how the drought in 2015 had affected food choices and posed barriers to change. Results: Our findings show that food patterns among the children did not differ at baseline between the two communities but that overweight and obese children consumed fruit and vegetables less often than normal weight children. From baseline to the end of year 2, the intervention children did not increase their intake of these foods, compared to the control children. However, by the end of year 2, intake of high-fat or high sugar fast and convenience foods had declined in the intervention community and was significantly different from intake in control children. These findings point to the need to continue working with participants as they age into adolescence to counter the food intake trends that tend to accompany children as they become more independent and are less influenced by parental controls over meals and snacks. A continuation study with the same cohort should shift to obesity prevention among children in normal weight categories to ensure that children currently in the healthy weight range remain healthy as they enter adolescence while children who are overweight and obese continue on a trajectory of controlling weight gain. Goal 3: Physical Activity - elementary schools in both treatment and intervention school districts continued to participate during the final data-collection year of the project. Measurements of participants in the cohort took place during two time-points, April, 2014 and November, 2015. Teachers were again asked to complete weekly surveys regarding the number of PE minutes, the types of activities they offered, and the intensity of the activities. During the period under review, the treatment community hired a 4th PE teacher and provided site-based supervision of a PE student teacher from Fresno State. Thus, since beginning the grant term in 2011, five professional PE specialists have joined the district to teach PE in the intervention elementary schools, while classroom teachers have continued to teach PE in the control community's elementary schools. During the 2015-2016 school year, 32 preschool-through-3rd-grade teachers from the intervention and control communities completed a Classroom Barriers to Physical Activity survey. The physical activity team completed the final assessment of child physical activity during the final data-collection year. Measurement took place in November 2015 and February 2016. Accelerometer distribution took place at the schools by UC Davis and local field staff. A total of 185 children were targeted overall for assessment in the last year, and a total of 157 were successfully measured using the accelerometer, including 94 children in schools in the Firebaugh-Las Deltas district and 63 children in elementary schools in Golden Plains. Accelerometer data are currently being entered and cleaned prior to analysis. Results to-date: Descriptive statistics from survey completion revealed that the students in the treatment community tended to have physical activity on a playground (84.6%). A higher percentage of teachers in the control group (68.4%) reported they use the classroom for daily physical activity. Furthermore, teachers in the control group indicated that spending physical activity time in the classroom was a high barrier to daily physical activity. Both treatment and control teachers rated "time spent teaching academic subjects" as the highest barrier to PE time. By understanding the barriers for delivering physical activity in elementary schools, we can gain a stronger understanding of the development and implementation of physical activity interventions for low-income rural communities. Goal 4 - Education: Our goal with respect to "education" has been to strengthen and increase the number of culturally sensitive UC Davis undergraduate, graduate and professional degree students in the areas of nutrition, agricultural economics, health sciences, and education. Through the PICN class in international and community nutrition we have developed this capacity in dozens of graduate students across these disciplines. But through direct participation in the research and extension components of the NSFS project, we have developed this capacity in masters and doctoral degree recipients who are now entering extension and research fields across nutrition, education, health sciences, and economics disciplines (see next section on training and professional development opportunities).

Publications

  • Type: Conference Papers and Presentations Status: Published Year Published: 2015 Citation: Gomez-Camacho, R., Sadeghi, B., Alexandrescu, B., Tseregounis, I., de la Torre, A. Lessons Learned from the Ni�os Sanos, Familia Sana Multiple-Digital Data Collection System. Creativity and Innovation in Nutrition Education. Society for Nutrition Education and Behavior. July 25-28. Pittsburgh, PA.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2015 Citation: Hanbury, M., Gomez-Camacho, R., De la Torre, A., , April 2-3rd, 2015. "Economic Mobility among Mexican-Origin Immigrants in Californias Central Valley: Age of Immigration Matters" 2015. Economic Mobility: Research and Ideas on Strengthening Families, Communities and the Economy. Federal Reserve: Community Development Research Conference. Washington, DC
  • Type: Conference Papers and Presentations Status: Published Year Published: 2015 Citation: Schaefer , S. Martinez, L., Whent, L., Gomez-Camacho, R. and de la Torre, A. Physical Activity and BMI of Children in Ni�os Sanos, Familia Sana Project. Creativity and Innovation in Nutrition Education. Society for Nutrition Education and Behavior. July 25-28. Pittsburgh, PA.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2015 Citation: Gomez-Camacho, R., Hanbury, M., Green, R., de la Torre, A. Food Purchasing Patterns Among Mexican-Origin Families in a Multi-Disciplinary Childhood Obesity Prevention Program. Creativity and Innovation in Nutrition Education. Society for Nutrition Education and Behavior. July 25-28. Pittsburgh, PA.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2015 Citation: Rodriguez L, Mu�oz Gomez M, Aguilera A, Kaiser L, Horowitz M, Johns M, Lamp C, de la Torre A. The droughts effect on food security among farmworkers SNEB Conference, Pittsburg PA July 28, 2015
  • Type: Conference Papers and Presentations Status: Published Year Published: 2015 Citation: Mu�oz Gomez M, Kaiser LL, Schaefer S, Horowitz M, Lamp C, de la Torre Association between sleep trends and obesity among Mexican-Heritage children, 8th Biennial Childhood Obesity Conference, San Diego, June 30, 2015
  • Type: Journal Articles Status: Published Year Published: 2015 Citation: Condor, J.L., Sadeghi, B. Barriers to Childrens Physical Activity in Aguilera A, de la Torre A, Kaiser L. Changes in Food Consumption Patterns of Mexican- Heritage Children during a Nutrition Intervention. The FASEB Journal. April 1, 2015 2015;29(1 Supplement).
  • Type: Journal Articles Status: Awaiting Publication Year Published: 2016 Citation: Kaiser LL, Martinez J, Horowitz M, et al. Adaptation of a culturally-relevant nutrition and physical activity program for low-income, Mexican-origin parents with young children. Preventing Chronic Disease.
  • Type: Journal Articles Status: Awaiting Publication Year Published: 2016 Citation: Manzo, R.D., Flores, Y.G., and de la Torre, A. (Forthcoming). Development of Culturally-Relevant Community-Based Workshops for a Manzo, R.D., Flores, Y.G., and de la Torre, A. (Forthcoming). Development of Culturally-Relevant Community-Based Workshops for a Mexican-Origin Rural, Low-Income Comparison Group in a USDA NIFA Childhood Obesity Study. Journal of Community Engagement and Higher Education, 8(2).
  • Type: Journal Articles Status: Published Year Published: 2016 Citation: Manzo, R.D. (2016). Parent Involvement Practices of Farmworking Immigrant Mothers in a Rural Community. The Association of Mexican-American Educators Journal, 10(1), 53-79.
  • Type: Journal Articles Status: Published Year Published: 2016 Citation: Manzo, R.D. (2016). Linking School and Community: A Community-Based Participatory Action Research (CBPAR) Approach in a Rural Community to Promote Education. In Slater, J.J., Ravid, R., Reardon, M.R., (Eds.). Building and Maintaining Collaborative Communities: Schools, University, and Community Organizations (pp. 117-132). Charlotte, NC: Information Age Publishing, Inc.
  • Type: Journal Articles Status: Published Year Published: 2015 Citation: Rodriguez L, Horowitz M, Espinoza D. Aguilera A, de la Torre A. Kaiser L. The Impact of the California Drought on Food Security among Rural Families of Mexican Origin> Journal of Applied Research in Children 2015: 6 (2). http://digitalcommons.library.tmc.edu/childrenatrisk/vol6/iss2/11?utm_source=digitalcommons.library.tmc.edu%2Fchildrenatrisk%2Fvol6%2Fiss2%2F11&utm_medium=PDF&utm_campaign=PDFCoverPages
  • Type: Journal Articles Status: Published Year Published: 2015 Citation: Green, R., A. Havenner, A. de la Torre, Obesity in Mexican-Origin Children, ARE Update, Vol. 19, no. 2., Nov/Dec. 2015.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2015 Citation: Economic Explanations of Obesity, R. Green, and N. Zhang, at the Agricultural Nutrition Science Session, World Congress of Agriculture, Nov. 13-15, 2015 in Qingdao, China.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2015 Citation: Manzo, R.D., Flores, Y.G., Gonzalez, A., de la Torre, A. Development of Culturally-Relevant Community-Based Workshops for a Mexican-Origin Rural, Low-Income Comparison Group. Creativity and Innovation in Nutrition Education. Society for Nutrition Education and Behavior. July 25-28. Pittsburgh, PA.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2015 Citation: Rangel, M.I., Garcia, I., Hernandez, G., de la Torre, A. Lessons Learned: Implementing a Multifaceted CBPR Intervention to Combat Childhood Obesity. Creativity and Innovation in Nutrition Education. Society for Nutrition Education and Behavior. July 25-28. Pittsburgh, PA.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2015 Citation: Sadeghi, B., de la Torre, A., Martinez, L., Mu�oz-Gomez, M., Tseregounis, I., Schaefer, S., Aguilera, A., Gomez-Camacho, R. Preliminary Results from the First Year of Intervention for the Ni�os Sanos, Familia Sana (NSFS) Study. Creativity and Innovation in Nutrition Education. Society for Nutrition Education and Behavior. July 25-28. Pittsburgh, PA.


Progress 04/01/14 to 03/31/15

Outputs
Target Audience:The target audiences include the following: Primary: Mexican-heritage female and male children ages 2-8: 688 Active Children 381 Firebaugh (intervention - received nutrition and physical education interventions) 307 San Joaquin (comparison - received usual school-site education) Secondary: Parents / Guardians of child participants: 446 Active Households 250 Firebaugh (Intervention - Received information /education on nutrition, exercise, meaning of BMI Report Card) 196 San Joaquin (Comparison - Receved non-nutrition/ physical activity community seminars on topics such as parenting, literacy, navigating the school system, etc. to maintain engaged, active status for collection of comparison data. Tertiary: Teachers of child participants, Grades Pre-K-3 57 teachers 36 Firebaugh (Intervention) 21 San Joaquin (Control) 36 teachers in the intervention community received SPARK physical education instruction from a SPARK-certified PE teacher in Firebaugh USD. 57 teachers in both communities completed personal physical activity surveys, describing their own physical fitness routine and self-perceptions of fitness level. Results of these surveys relative to time spent engaging classrooms in physical activity are discussed in this report. The participant table asks for staff count by FTE; The following table itemizes number of staff involved in the project: Roles Non Students or faculty Students with staffing roles Total Undergraduate Graduate Post-Doc Scientist 7.00 - 4.00 4.00 15.00 Professional - - - - - Technical 1.00 - - - 1.00 Administrative 5.00 16.00 - - 21.00 Other 12.00 - - - 12.00 Total 25.00 16.00 4.00 4.00 49.00 Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?In Spring 2015 we held the Nutrition 298 course, Program in International and Community Development. This 10-week graduate seminar included 5 students in health sciences and nutrition graduate programs. Products include a reading list and syllabus, which have been sent to the National Program Leader. (Goal 4, Education) NSFS PI Green (Agricultural and Resource Economics) taught two upper-division undergraduates courses (Econometric Theory and Applications, ARE106) during the fall quarter of 2014 (between 150-160 students) and winter quarter (2015 - 170 students). He frequently used the NSFS research in examples of how to use proper econometric techniques in working with diverse populations. His examples were designed to alert economics students to the need to understand demographic differentiation of sample populations, e.g., (1) A random sample is a set of independently, identically distributed random variables. Since we are interested in the BMI's of Mexican-origin children, we must select all of our observations from Mexican-origin children. If we select some, say, Chinese children whose mothers were not born in Mexico, we would violate the identical part of i.i.d. random variables. (2) Specification. It is important to include all relevant variables in a model in order for least squares estimators to be unbiased and consistent and for the tests to be valid. For example, if we are using children z-scores (adjusted BMIs) as our dependent variable, then we need to include all the relevant factors that influence children's z-scores. We need to include the mother's BMI, gender, physical activities, budget shares of various food items, acculturation factors, etc. (3) Functional form. If we include the mother's BMI as an explanatory variable, then we would expect the mother's BMI to have a positive effect on the child's z-score. However, we would also expect the child's z-score to increase at a decreasing rate with respect to the mother's BMI. In order to capture this potential effect, we need to add a quadratic term for the mother's BMI as an explanatory variable. (4) Autocorrelation. Since we are using cross-sectional data, we need to account for correlation among children from the same family. This is called clustering. (5) Heteroskedasticity. The variance of the error term (and dependent variable) may not be constant across observations. Thus, we need to use a heteroskedastic corrected model to account for this. The variability among z-scores may increase, for example, with the variability of some of the explanatory variables. There are various ways to model this, but we used an exponential heteroskedasticity scheme. (6) Measurement errors. We were very careful in collecting BMIs and other anthropometric measures from children and parents. The medical team took more than one measurement by different personnel in order to minimize measurement errors which cause least squares estimators to be biased and inconsistent. (Goal 4) Community Engagement: Training for Parents in Control Community. To keep families in the control community engaged for the purpose of consistent data collection, the research team held a number of family education workshops and events, designed to empower parents with knowledge they need to support their family's health and wellbeing and their children's education. This activity was funded by institutional cost-share. The community engagement team has facilitated a total of 14 workshops in the GPUSD communities, our comparison group. The workshops participants evaluate the content of the workshops, and the delivery of the content using a Likert scale (0=Disagree; 1=Slightly agree; 2=Agree; 3= Strongly Agree). The workshop evaluations for the three years demonstrate that the workshop content was useful for the participants learned something new from the material (average score=2.92). Furthermore, the participants perceived that the delivery method was appropriate (average score=2.93). The workshops in the comparison community are essential to our community engagement efforts and to ensuring visibility of the research team in the community. In June, the community engagement team will facilitate a debriefing and planning workshop to plan the next year's activities. Workshop Topics Early Literacy April 2014 Yoga and Stress Relief May 2014 Children's Mental Health May 2014 Debrief Year 3 Planning June 2014 Promoting Healthy Youth August 2014 Reading at Grade Level September 2014 Report Cards and Parent-Teacher Conferences October 2014 EL Reclassification November 2014 Men's Mental Health and Migration December 2014 Yoga January 2015 School Finance February 2015 Promoting Emotional Well-being in Children March 2015 Yoga April 2015 Youth Mental Health and Academic Stress May 2015 Training of Community Data Collectors (Promotoras and students) The Field Team worked collaboratively to train four new IRB-CITI-certified data collectors (two Promotoras and two students) to administer surveys, conduct outreach, and collect anthropometric measurements. The data collection process was streamlined as additional staff brought their personal networks, first-hand knowledge of the communities, and skills acquired from previous experiences. In comparison to previous years, a higher percentage of families participated in annual data collection in a shorter amount of time.Attesting to community engagement and sustainability aspects of the project, the Field Team continues to work collaboratively with the research team to build upon and introduce new skills to those who assist with the project. Two Promotoras in the intervention site were selected to lead the Nutrition Classes that focus on cooking healthy meals, the Lead Data Collector for the control site has been hired to coordinate a new research project focusing on teenage health, and the promotora who leads the Nutrition Classes also facilitates literacy workshops as part of a new early childhood literacy project. Graduate Student Success - Four graduate students received their doctoral degrees in the following disciplines: Agricultural and Resource Economics (1); Nursing Science (1); Education (2). Dissertation topics included (1) elucidating the relationship between safety-net (subsidized food program) participation and obesity among children and Mexican-heritage women; (20 the relationship between physical activity and academic achievement among the study population of children; (3) the impact of engaging parents in a research study using community-based participatory research and community empowerment models; and (4)Parental Investment in Children's Human Capital: Determinants of Bargaining Power, Decision-Making and Intra-Household Resource Allocation. All four post-doctoral fellows will continue with NSFS through the end of the grant period, focusing on final data collection and publication development (see products). A fifth graduate student is completing his dissertation on the impact of the interventions on caratenoid levels of participants; a sixth graduate student just completed her master of science degree in nutrition; her thesis was enitled "Development and Dissemination of Body Mass Index Health Report Cards in a Mexican-Heritage Community in California's Central Valley." Nutrition 190 - -The MS recipient taught a seminar class in Obesity and Under-nutrition to 10 undergraduate students who learned about community-based research in studying obesity and under-nutrition. The graduate student also served as a laboratory TA teaching undergraduate participants how to use anthropometric measurements in a community-based research setting. Dozens of undergraduates have been involved in NSFS this year as data collectors and analysts. All are IRB certified through UC Davis CITI course completed through an on-line course in the Office of Research / IRB Administration. How have the results been disseminated to communities of interest?Preliminary findings and other information pertinent to the project are shared at the quarterly meetings of the community advisory councils in Firebaugh and San Joaquin and through the quarterly newsletters. All communications are in English and Spanish. Results of anthropometric measures of the children in the intervention community (Firebaugh) were distributed as "BMI Report Cards" to parents during a BMI class and at the annual health fair. Parents received information on what BMI is, how it is calculated and the implications of a high or low BMI. Parents of children flagged for underweight or obesity were referred to Valley Health Team for low-cost medical intervention. BMI cards were printed and discussed in English with Spanish translation side-by-side. Dissemination of Nutrition Research Findings: Two peer-reviewed articles were prepared (Kaiser et al PHN2015; Kaiser et al. PCD In Press). Our findings show that food patterns among the children did not differ at baseline between the two communities but that overweight and obese children consumed fruit and vegetables less often than normal weight children. From baseline to the end of year 2, the intervention children did not increase their intake of these foods, compared to the control children. However, by the end of year 2, intake of high-fat or high sugar fast and convenience foods had declined in the intervention community and was significantly different from intake in control children. The findings on changes in food patterns were reported at the Experimental Biology meeting in Boston (March 2015) will be published in the dissertation of Albert Aguilera (expected date of completion, June 2015). Specialist Kaiser (Co-I / Lead Nutrition Scientist) and/or the nutrition educator (Judith Martinez) shared findings from this study at workshops, governmental committees and conferences [March 2015, Institute of Medicine Committee to Revise the WIC Food Packages; December 2014, Strategies to Reach Latino Families (SNAP-Ed training); November 2014, Solano County Board of Supervisors; October 2014, World Food Day; June 2014, Joint EFNEP/UC CalFresh nutrition educator training; May 2014, Continuing Education training for Physicians]. Dissemination of Physical Activity Research Findings: The Physical Activity team presented the following poster in 2014: Schaefer SE, Sadeghi B, Kaiser LL, de la Torre A. Impact of Niños Sanos, Familia Sana on the Physical Activity of Mexican-American Children in California's Central Valley. Society of Nutrition, Education & Behavior, Milwaukee, WI, June 2014 What do you plan to do during the next reporting period to accomplish the goals? The medical research team is working on further analysis of the second and third year of intervention data to explore the consistency of the results and whether the aforementioned findings regarding change to BMI would expand to other categories of children in the intervention arm over longer period of time. Anthropomorphic data will be collected two more times during the study over the next 9 months and results reported in the final report. The physical activity and economics research teams have collected additional data this spring and will be analyzing these data for publication in 2015-16. We are preparing a final exit survey for parents of child participants to complete in Fall 2015. Nutrition education curricula for families are being finalized for publication and distribution. UC Davis is exploring opportunities to expand implementation of the PICN course in community and international nutrition via collboration with additional UC and CSU campuses.

Impacts
What was accomplished under these goals? Goal 1: The medical team collected anthropometric measurements of the participants (Children ages 3-8 - primary; and their mothers - secondary), including body mass index, waist circumference, and subscapular and triceps skinfold thickness at 2 time points this year. The medical team also analyzed the baseline anthropometric data of children (N=594) in both communities. The team found that 45% of children and 82% of mothers were overweight or obese, and 26% of children were obese. 92% percent of children in the overweight group and 53% of children in the obese group according to BMI were perceived as having normal weight by their mothers. Waist circumference had a higher correlation with BMI-z score than skinfold thickness. Only in 33% of overweight or obese children, either triceps or subscapular skinfold thickness was higher than 85th percentile. In multivariate analyses, mothers' BMI and acculturation were predictors of children's BMI z-score. A multivariate analysis of changes in BMI z-score from baseline until after one year of intervention, showed a significant decrease in BMI growth in obese boys (B coefficient = -1.30, P-value = 0.013). Although the direction of changes were similar in obese girls, the change was not statistically significant. Consistently, we found similar effect of intervention in obese boys, when we modeled the change in waist circumference or change in waist circumference to height ratio. Obese boys in the intervention community significantly had a smaller increase in waist circumference (B coefficient = -5.2, p-value = 0.004), or waist circumference to height ratio (B coefficient = -0.03, P-value = 0.011) compared with the control community. We found that the multifaceted intervention significantly decreased the growth of BMI in obese boys over the first year of intervention. Goal 2: Over the past year the Economics team has continued distributing monthly vouchers to 280 families and collecting scanner data in the intervention community. As of March 2015 we had recorded 89,297 purchased items via the grocery store scanners. In October 2014 we collected food purchasing receipts from households in San Joaquin as a measure of food expenditure. The third installment of the Household Survey (HHS 3) was collected from 239 households in Firebaugh and 189 households in San Joaquin (94% of enrolled households). Analysis of scanner data shows the items that are most commonly purchased include: bananas, apples, tomatoes, carrots, avocados, chili/jalapeño peppers, cucumbers, iceberg lettuce, cilantro, and strawberries. By category, fruit purchases account for the highest dollar amount of produce spending--$14.39 per month per household. Orange vegetables are the lowest spending category--$1.57 per month per household. Household survey data has shown that mother's BMI is the largest factor in predicting child's BMI. Furthermore, mothers who were born in the United States and mothers who immigrated as a child have children with higher BMIs than mothers who immigrated as adults. Mothers who immigrated as adults are also in lower income households and have less education than mothers who immigrated as children or were born in the United States. Goal 3: Nutrition: During the grant period, family nights in the intervention community covered key obesity prevention messages related to decreasing screen time, increasing walking, reducing consumption of sugar-sweetened beverages, ensuring adequate sleep time, providing a healthy balanced breakfast. Each month, a different topic was covered, using learner-centered discussions and hands-on activities like role playing, food demonstrations and tastings, and fun physically active games. After offering the class on walking, the nutrition educator started a walking club, meeting once a week, for mothers and children. A highlight of the year was a healthy cook-off event that challenged participants to prepare traditional recipes, modified with the help of the nutrition team to include ingredients lower in salt, solid fats, and added sugars. Starting at the healthy cook-off event, the nutrition team began distributing the second individualized health reports to the parents with their children's BMI, physical activity, and fruit and vegetable intake data to the intervention families. County staff distributed the BMI data from the Sept wave of data collection to the families. We have conducted four focus groups (2 in June and 2 in March) to get feedback on our nutrition intervention and explore persisting barriers to change. The team has begun to develop a website, where the curriculum materials will eventually be posted for public dissemination. Outcomes: Of the 238 families enrolled during the first year of the intervention, 53% (125) attended a recommended minimum of five (out of 10) family nights. In the second year, parent attendance at five or more classes dropped to 40% (105) among 263 families enrolled. This decline was most likely due to lifting of a requirement to attend a minimum of five classes each year. Regardless of family night attendance, intervention families continued to receive the vouchers, school-based nutrition education, and physical activity components.Our findings show that food patterns among the children did not differ at baseline between the two communities but that overweight and obese children consumed fruit and vegetables less often than normal weight children. From baseline to the end of year 2, the intervention children did not increase their intake of these foods, compared to the control children. However, by the end of year 2, intake of high-fat or high sugar fast and convenience foods had declined in the intervention community and was significantly different from intake in control children. Physical Activity: Data were collected from 57 pre-school through 3rd grade teachers from the two school districts in our study during the 2013-2014 school year. Children in these classrooms were 93% Latino/Hispanic with 46% of these children overweight or obese. Teachers completed a classroom Physical Education Weekly Reporting Form for 8 weeks and a Teacher Physical Activity demographic survey. Teachers reported they averaged 204.54 minutes of self-physical activity per week. Teachers teaching pre-school and kindergarden reported the highest weekly averages of classroom minutes of physical activity. For every increase of .07 minutes of teacher weekly physical activity minutes there was an increase of 1 minute of classroom physical activity minutes (t = 2.01, p = .05). This finding shows that there maybe an opportunity to increase elementary school classroom physical activity time, where classroom teachers are leading PE time, via encouraging teachers to become more physically active themselves. In addition, we found that increased academic study time in grades 1 through 3 may be impacting class time for PE.In September 2014, the treatment community made the decision to hire 3 PE teachers to teach PE with the goal of improving PE at the elementary schools. PE specialists now teach PE in the intervention schools while classroom teachers continue to teach PE in the control schools. Accelerometers were used to collect physical activity data from 215 youth in the two participating school districts of Niños Sanos Familia Sana. Collections were planned to take place in November 2014 and February 2015 to avoid the winter holiday when many families are traveling. Accelerometer distribution took place at the schools and from promotores and field staff visiting homes.

Publications

  • Type: Journal Articles Status: Published Year Published: 2015 Citation: Aguilera A, de la Torre A, Kaiser L. Changes in Food Consumption Patterns of Mexican-Heritage Children during a Nutrition Intervention. The FASEB Journal. April 1,2015 2015;29(1 Supplement).
  • Type: Journal Articles Status: Awaiting Publication Year Published: 2015 Citation: Kaiser LL, Martinez J, Horowitz M, et al. Adaptation of a culturally-relevant nutrition and physical activity program for low-income, Mexican-origin parents with young children. Preventing Chronic Disease (In Press)
  • Type: Theses/Dissertations Status: Accepted Year Published: 2014 Citation: Manzo, R.D. (2014) Platicas de resistencia: An examination of the forms of parent involvement and negotiation of school-parent tensions in a farm working community in Californias Central Valley (Unpublished doctoral dissertation). University of California, Davis.
  • Type: Theses/Dissertations Status: Accepted Year Published: 2013 Citation: Hanbury, M.M. (2013). The U.S. Safety Net and Obesity (Doctoral dissertation). UMI 3614206.
  • Type: Theses/Dissertations Status: Accepted Year Published: 2014 Citation: Martinez, L. C. (2014). The relationship between physical activity and academic achievement in rural, low-income, mexican origin, elementary school aged children (Order No. 3637867). Available from Dissertations & Theses @ University of California; ProQuest Dissertations & Theses A&I. (1617976664). Retrieved from http://search.proquest.com/docview/1617976664?accountid=14505?
  • Type: Theses/Dissertations Status: Accepted Year Published: 2015 Citation: Gomez, M.M. (2015). Development and Dissemination of Body Mass Index Health Report Cards in a Mexican-Heritage Community in Californias Central Valley. Doctoral Dissertaion: University of California, Davis.
  • Type: Theses/Dissertations Status: Accepted Year Published: 2015 Citation: Gomez-Camacho, R.V. (2015). Parental Investment in Childrens Human Capital: Determinants of Bargaining Power, Decision-Making and Intra-Household Resource Allocation within a Mexican-Origin Immigrant Community. University of California, Davis.
  • Type: Conference Papers and Presentations Status: Other Year Published: 2014 Citation: Gomez-Camacho, R. Higher Education Aspirations: Family Characteristics and Parental Practices. American Educational Research Association Annual Meeting. The Power of Education Research for Innovation in Practice and Policy. April 3, 2014. Philadelphia, PA.
  • Type: Conference Papers and Presentations Status: Other Year Published: 2014 Citation: Manzo, R.D. Linking School and Community: An Examination of the Parental Practices in a Latino Farmworking Community. American Educational Research Association Annual Meeting. The Power of Education Research for Innovation in Practice and Policy. April 3, 2014. Philadelphia, PA.
  • Type: Conference Papers and Presentations Status: Other Year Published: 2014 Citation: Posada, G., Jackson, C.F., Manzo, R.D. Engagement Through a University-Campus Partnership, Chicana/o Studies Curriculum, and Community Art Projects. American Educational Research Association Annual Meeting. The Power of Education Research for Innovation in Practice and Policy. April 3, 2014. Philadelphia, PA.
  • Type: Conference Papers and Presentations Status: Other Year Published: 2014 Citation: Gomez-Camacho, R. Effects of Acculturation, Isolation, and Access on Gender Roles and Intra-Household Decision Making in Mexican-Origin Families. Fragmented Landscapes in Chicana and Chicano Studies: Deliberation, Innovation or Extinction. National Assocition For Chicana and Chicano Studies, April 9-12, 2014. Salt Lake City, Utah.
  • Type: Conference Papers and Presentations Status: Other Year Published: 2014 Citation: Posada, G., Toriche, G., Gutierrez, Manzo, R.D. Jackson, C.F., CulturArte: An Evaluation of Community-Based Art Projects in Rural Communities in California. Fragmented Landscapes in Chicana and Chicano Studies: Deliberation, Innovation or Extinction. National Assocition For Chicana and Chicano Studies, April 9-12, 2014. Salt Lake City, Utah.
  • Type: Conference Papers and Presentations Status: Other Year Published: 2014 Citation: Frandsen, E., Kaiser, L.L., De la Torre, A. April 25, 2014. RRS Skin Carotenoids as a Biomarker for Fruit and Vegetable Intake Among Children. 25th Annual Undergraduate Research, Scholarship and Creative Activities Conference. University of California, Davis.
  • Type: Conference Papers and Presentations Status: Other Year Published: 2014 Citation: Mercado-Rodas, D.R., Whent, L.S., Preventing Childhood Obesity in the Central Valley of California. April 25, 2014. 25th Annual Undergraduate Research, Scholarship and Creative Activities Conference. University of California, Davis.
  • Type: Conference Papers and Presentations Status: Other Year Published: 2014 Citation: Godinez, H. Green, R. Water and Sugared Beverages Purchasing Patterns Among Low Income Communities in the Central Valley of California. April 25, 2014. 25th Annual Undergraduate Research, Scholarship and Creative Activities Conference. University of California, Davis.
  • Type: Conference Papers and Presentations Status: Other Year Published: 2014 Citation: Zavala, R., Kaiser, L.L.. Effect of Children Entering the School System on Skin Carotenoid Levels and Fruit and Vegetable Intake in Mexican Origin Children in California. April 25, 2014. 25th Annual Undergraduate Research, Scholarship and Creative Activities Conference. University of California, Davis.
  • Type: Conference Papers and Presentations Status: Other Year Published: 2014 Citation: Zavala, G., Kaiser, L.L., Relationship Between Skin Carotenoid Levels, Feeding Patterns, and Gender Disparities Among Mexican Origin Children April 25, 2014. 25th Annual Undergraduate Research, Scholarship and Creative Activities Conference. University of California, Davis.
  • Type: Conference Papers and Presentations Status: Other Year Published: 2014 Citation: Cabrera, R., Kaiser, L.L. Association Between Maternal Prenatal Diabetes and BMI Amongst Mexican-Origin Children in Rural, Central California. April 25, 2014. 25th Annual Undergraduate Research, Scholarship and Creative Activities Conference. University of California, Davis.
  • Type: Conference Papers and Presentations Status: Other Year Published: 2014 Citation: Flores, Y.G., Manzo, R.D., de la Torre, A., Rangel, M.I., Gonzalez, A. Engaging Control Participants in a Childhood Obesity Prevention Study Targeting Mexican-Heritage Families. Nutrition Education Impact: Local to Global! Society for Nutrition Education and Behavior. June28-July1. Milwaukee, Wisconsin.
  • Type: Conference Papers and Presentations Status: Other Year Published: 2014 Citation: Whent, L.S., Gomez-Camacho, R., Mercado-Ruedas, D., de la Torre, A. Efficacy of School Based Physical Activity Curriculum in Intervention and Comparison Schools. Nutrition Education Impact: Local to Global! Society for Nutrition Education and Behavior. June28-July1. Milwaukee, Wisconsin.
  • Type: Conference Papers and Presentations Status: Other Year Published: 2014 Citation: Gomez-Camacho, R., Green, R., de la Torre, A., Hanbury, M. Effects of Socioeconomic and Other Demographic Factors on Mexican-Heritage Children, Ages 3-to 8-Years Old, In Rural California. Nutrition Education Impact: Local to Global! Society for Nutrition Education and Behavior. June28-July1. Milwaukee, Wisconsin.
  • Type: Conference Papers and Presentations Status: Other Year Published: 2014 Citation: Gomez-Camacho, R., Green, R., de la Torre, A., Hanbury, M. Pre- and Post-Implementation Food Expenditure Among Mexican-Heritage Families in an Obesity Prevention Program. Nutrition Education Impact: Local to Global! Society for Nutrition Education and Behavior. June28-July1. Milwaukee, Wisconsin.
  • Type: Conference Papers and Presentations Status: Other Year Published: 2014 Citation: Jackson, C.F., Posada, G., Manzo, R.D., Hernandez, O. An Evaluation of Community-Based Art Engagement Practices in Rural, Mexican-Heritage communities in California. Nutrition Education Impact: Local to Global! Society for Nutrition Education and Behavior. June28-July1. Milwaukee, Wisconsin.
  • Type: Conference Papers and Presentations Status: Other Year Published: 2014 Citation: Schaefer, S.E., Sadeghi, B., Gomez-Camacho, R., de la Torre, A. Ni�os Sanos, Familia Sana: Impact on physical activity of Mexican-American Children. Nutrition Education Impact: Local to Global! Society for Nutrition Education and Behavior. June28-July1. Milwaukee, Wisconsin.
  • Type: Conference Papers and Presentations Status: Other Year Published: 2014 Citation: Aguilera, A., Kaiser, L. Horowitz, M. Johns, M., Lamp, C., Stenger, K., de la Torre, A. Development of a Fruit and Vegetable Report Card for Mexican-Heritage Children. Nutrition Education Impact: Local to Global! Society for Nutrition Education and Behavior. June28-July1. Milwaukee, Wisconsin.
  • Type: Conference Papers and Presentations Status: Other Year Published: 2014 Citation: Mu�oz-Gomez, M., Kaiser, L., Lamp, C., Horwitz, M., Johns, M., Martinez, J., de la Torre, A. Parental Responses to Body Mass Index (BMI) Report Cards in a Childhood Obesity Intervention. Nutrition Education Impact: Local to Global! Society for Nutrition Education and Behavior. June28-July1. Milwaukee, Wisconsin.
  • Type: Conference Papers and Presentations Status: Other Year Published: 2014 Citation: Byrnes, M. Kaiser, L. Espinoza, D., Martinez, J., Whent, L., Schaefer, S., de la Torre, A., Evaluation of a Physical Activity Curriculum for Parents of Mexican-heritage Children in Californias Central Valley. Nutrition Education Impact: Local to Global! Society for Nutrition Education and Behavior. June28-July1. Milwaukee, Wisconsin.
  • Type: Conference Papers and Presentations Status: Other Year Published: 2014 Citation: Sadeghi, B. (Invited Presenter). Ni�os Sanos, Familia Sana: findings after one year of intervention, Oct 2014. Fourth CHEW Annual Conference: Nashville, Tennessee.
  • Type: Conference Papers and Presentations Status: Other Year Published: 2014 Citation: Gomez-Camacho, R., Green, R., De la Torre, A, Hanbury, M. November 15th-19th, 2014. "Pre- and Post-Implementation Food Expenditure among Mexican-Heritage Families in an Obesity Prevention Program" 2014. Annual Meeting American Public Health Association, New Orleans, LA
  • Type: Conference Papers and Presentations Status: Other Year Published: 2015 Citation: Hanbury, M., Gomez-Camacho, R., De la Torre, A., , April 2-3rd, 2015. "Economic Mobility among Mexican-Origin Immigrants in Californias Central Valley: Age of Immigration Matters" 2015. Economic Mobility: Research and Ideas on Strengthening Families, Communities and the Economy. Federal Reserve: Community Development Research Conference. Washington, DC
  • Type: Journal Articles Status: Published Year Published: 2015 Citation: Kaiser LL, Aguilera AL, Horowitz M, et al. (2015). Correlates of food patterns in young Latino children at high risk of obesity. Public health nutrition, 1-9. DOI: http://dx.doi.org/10.1017/S1368980014003309


Progress 04/01/13 to 03/31/14

Outputs
Target Audience: Target audiences: Primary participants this year were Mexican heretige children ages 5 - 7 in two rural agricultural comunities in the California Central Valley. During this 2nd-intervention-year (Year 3 of grant term) measurements were collected from 238 children in San Joaquin (control community) and 303 children from Firebaugh (intervention community). Collection of skin carotenoid measures were added to data collection procedures for both treatment and control groups. Secondary participants included: parents and legal guardians of children enrolled in the study. Tertiary participants: other family members of enrolled children; community stakeholders (city and school district officials, market owners, health practitioners, teachers, health coaches (promotoras). Activity reported in 2013 continued. New Intervention Highlights: School-based nutrition education: work continued with teachers of grades K-3 to adapt, deliver and evaluate the impact of grade-level, standards-based nutrition curriculum in the schools. The team conducted 16 family education nights for 10 months for parents and families of intervention children. Lessons included integrated explanation of BMI report card into family education nights in intervention community and community engagement nights in control community. An additional mural was completed in the control community, promoting community engagement and education, as a way of continuing to engage participants in data collection. The art team is completing artwork to support final deliverables of nutrition education materials geared toward parents/guardians and teachers of children ages 3-8. Teachers in intervention and control communities received training on accelerometer watches to promote use of devices by their students, via distribution and collection in classroom over established time period. Physical activity logs have been maintained by participating pre-school and elementary school teachers in both communities. College students from local community college continue to participate as trained data collectors. Community engagement has included development of 2 multi-district collaborative grant applications to the Department of Education for sustained K-12 academic enrichment to support a college-going culture in these communities (funded by UC Davis). Changes/Problems: No major changes or problems in approach have taken place. We made one modification to our methodology and received IRB approval for this modification: anthropometric data are now being collected at the school sites and no longer require parental presence. We re-consented parents/legal guardians of all participants on this change and are collecting data only on those children whose parents/ legal guardian were re-consented. Data collectin of children is more consistently achieved and we have a larger participant sample in both communities without having to schedule measurements through parent visits. Schools worked with our research team to ensure that FERPA policies were observed. What opportunities for training and professional development has the project provided? 1. Parents are being trained to become trainers of other parents on nutrition education so the project becomes sustainable beyond the grant term. Parents have approached the nutrition educator to volunteer to become facilitators. Parents continue to receive nutrition education from project staff. 2. Teachers have received training in physical activity (SPARK) and nutrition curricula, as well as the use of the accelerometer. Training in the use of the accelerometer helps teachers to guide parents and children in the importance of following the instructions during the measurement periods. 3. Undergraduates from West Hills Community College and UC Davis continue to be trained in IRB protocol and data collection for the project. 4. Upper level undergraduates and graduate students have participated in the education courses developed as part of the project's education goals. How have the results been disseminated to communities of interest? The project staff hold quarterly community advisory council meetings in Firebaugh and San Joaquin. In preparation for each meeting, the team publishes a newsletter so community members can come to the meeting with background information on the past quarter's activity and engage in a discussion with the research team. What do you plan to do during the next reporting period to accomplish the goals? The year ending March 31, 2014 is the second intervention year. Data from the second intervention year are under analysis at this time. We are able to report on findings of baseline data but consider the timing premature for meaningful comparison with only Year-one intervention data available. The next year will include more intensive analysis of anthropometric and economic data from the second intervention year, which should begin to show intervention impact; and collection of data for the third and final intervention year. Thus, in the coming year we expect to continue reporting on outputs and begin reporting on outcome predicitions.

Impacts
What was accomplished under these goals? 1. Economics team: Professor Richard Green taught Econometric Theory and Applications to approximately 300 undergraduate students at the University of California, Davis during the 2013-14 school year. Numerous econometric illustrations were provided related to the obesity research project of Mexican-origin children in California’s Central Valley. For example, if a relevant variable such as an acculturation score is omitted in the obesity model explaining children’s z-scores, then the least squares estimators will be biased and inconsistent. Furthermore, hypothesis tests will be invalid. Using cross-sectional data, researchers need to be aware of correlation. In the obesity project it is called clustering. The family unit is the cluster and observations of children within a family will be correlated due to similar eating patterns, exercise routines, etc. Ignoring clustering will produce invalid standard errors and consequently erroneous hypothesis test results. Many other econometric examples were provided that are encountered in the obesity project. For examples, measurement errors (food purchase vs food consumption); limitation of using BMI as a measurement of obesity since it does not distinguish between fat from fat-free mass such as muscle and bone; spillover effects from the control and treatment groups, etc. The students were very much interested with a real-world and important research project and how econometric concepts were important in better understanding how to produce useful and accurate research results. Many of the students actually wanted to assist in the project. Goal 1 (Research): UPC codes were matched with products or food items and receipts were obtained in both the control and treatment communities to better determine if the fruit and vegetable voucher incentive program results in families in Firebaugh (treatment community) purchasing more fruits and vegetables relative to families in San Joaquin (control community). This program should lead to a reduction in obesity of children in Firebaugh, although this will take time. Economic data were collected for another year on food consumption patterns relative to the baseline data collected the first year. Goal 3 (Extension via Undergraduate and Graduate Student Field Studies): Meagan Hanbury completed her Ph.D. dissertation, “The U.S. Safety Net and Obesity” at the University of California, Davis. The empirical results show that while Head Start has limited effect on weight outcomes within the general population, the program is associated with reduction in overweight and obesity among white and Hispanic children. A second finding is that low-income Mexican-origin families with children have a high participation rate in child-focused programs. Stigma, however, may be a deterrent for families entering certain “welfare” programs. Thirdly, the SNAP and TANF programs do not make a statistically significant difference in BMI of low-income Mexican-origin women. 2. Nutrition Team: In an analysis of baseline data, the UC Cooperative Extension specialist and advisors and graduate students have examined factors associated with food patterns in Mexican-American children. Of interest, children eat more vegetables when their parents sit and eat with them and are able to maintain a regular schedule for dinner and snacks. Although children tend to eat more fast foods (like pizza, hamburgers, and hot dogs) as they grow older, allowing children to skip meals seems to be more important than child’s age in explaining this behavior. Acculturation is positively associated with fast food intake but is unrelated to vegetable intake. UC Cooperative Extension specialist and nutrition advisors, in collaboration with local staff and graduate students, developed ten family night lessons (one topic offered each month). The lessons focused on three key messages: increasing physical activity, reducing screen time, and reducing sugar sweetened beverages. Each lesson delivered to small groups of parents (9-12) at Family Nights throughout the month. Attendance was between 100-150 families per month, depending on the work season. The specialist shared insights from this study at the California statewide training for Cooperative Extension educators in January 2014. The local nutrition educator, along with the PI and Co-PI, provided a workshop to physicians on culturally-effective strategies for preventing childhood obesity in immigrant families (May 2014). The specialist and nutrition educator will give two more extension presentations on culturally-nuanced education and effective outreach in June 2014. The nutrition team is currently planning the design elements and format for the lessons developed in the first and second year. The plan is to make the curriculum lesson plans, recipes, and handouts available for free-download from the UC Agricultural and Natural Resources online catalog. Four graduate students (three in Nutrition, one in public health) participated in research and curriculum-development activities related to this project. Albert Aguilera, a doctoral student in Nutrition, has introduced a method to measure skin carotenoid levels as a biomarker of fruit and vegetable intake and is developing a Nutrition Report Card to provide personalized feedback to the parents on their children’s intake. Michele Byrnes, as part of her Public Health Masters practicum, did the background research for the physical activity lessons, drafted the first version of the curriculum, and worked with Dr. Linda Whent to design and present a two-day teacher training at Bailey Elementary School. Mayra Muñoz Gomez, a Nutrition Masters student, conducted two focus groups with parents to find out what changes families have made since receiving their child's BMI report card last September. Mayra has also served as the nutrition lead for coordinating the health fair in Firebaugh in June 2014. Caitlin French, also a Nutrition Masters student, explored issues related to water quality in the region and developed lesson plans related to the reduction of sugar-sweetened beverages and promotion of water at family nights. Four undergraduate students worked with the graduate students on special projects and presented posters with their research at the Undergraduate Research symposium in April 2014.

Publications

  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Sadeghi, B., Aguilera, A., Griffin, K., Gomez-Camacho, R. Use of a Digital Data Collection in a Multi-year, Family-Centered Nutrition Intervention to Prevent Obesity in Mexican-Heritage Children: Lessons Learned. Moving from Good to Great! Society for Nutrition Education and Behavior. August 9-12, 2013. Portland, Oregon.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Hanbury, M., Gomez-Camacho, R. de la torre, A. Fruit and Vegetable Vouchers in a Rural Community: Implementation and Outcomes. American Public Health Association Annual Meeting, November 6, 2013. Boston, MA.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Manzo, R.D. Lessons from the Community: A Conceptualization of the Policy and Practice Implications of Community-Based Research within a Latino context. Association for the Study of Higher Education. November 14-16, 2013. St. Louis, MO.
  • Type: Journal Articles Status: Published Year Published: 2013 Citation: de la Torre, A., Sadeghi, B., Green, R.D., Kaiser, L.L., Flores, Y.G., Jackson, C.F., Schaefer, S.E. (2013). Ni�os Sanos, Familia Sana: Mexican immigrant study protocol for a multifaceted CBPR intervention to combat childhood obesity in two rural California towns. BMC Public Health, 13, 1033. doi: 10.1186/1471-2458-13-1033
  • Type: Journal Articles Status: Published Year Published: 2014 Citation: de la Torre, A. (2014). Benevolent Paradox: Integrating Community-Based Empowerment and Transdisciplinary Research Approaches Into Traditional Frameworks to Increase Funding and Long-Term Sustainability of Chicano-Community Research Programs. Journal of Hispanic Higher Education, 1538192713515909.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Vera-Becerra, L.V., Aguilera, A., Kaiser, L., Manzo, R., de la Torre, A .Perceptions of factors and messages related to childhood obesity among Mexican-origin parents. FASEB J April 9, 2013 27:1063.13. Boston, MS.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Solorio, C. Maternal Food Insecurity, Child Feeding Practices, Weight Perceptions and BMI in a Rural, Mexican-Origin Population. Western Institute of Nursing Conference. April 12, 2013. Anaheim, CA.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Manzo, R.D., Gomez-Camacho, R. Martinez, L., Aguilera, A. Implementation of a Community-Based, Multi-Year, Multifaceted Program in Mexican-Origin, Rural Communities in Californias Central Valley. Interdisciplinary Graduate and Professional Symposium. April 5, 2013. University of California, Davis.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Aguilera, A., Kaiser, L. Food insecurity and food patterns in Mexican-heritage children. FASEB J April 9, 2013 27:1054.9. Boston, MS.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Gomez-Camacho, R. Revisiting Theories of Parental Investment in Childrens Human Capital. American Educational Research Association Annual Meeting: Edcuation and Poverty. Theory, Research, Policy, and Praxis. April 27-May 1, 2013. San Francisco, CA.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Manzo, R.D. Fostering Partnerships: A Community-Based Approach to Engagement in a Mexican-American Rural Community. American Educational Research Association Annual Meeting: Edcuation and Poverty. Theory, Research, Policy, and Praxis. April 27-May 1, 2013. San Francisco, CA.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Mu�oz Gomez, M., Schaefer, S., de la Torre, A. Association between Sleep Duration and BMI Among Mexican-American Children in Californias Central Valley. UC Davis Undergraduate Research Conference. May 26, 2013. Davis, California.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Kaiser, L.L., Lamp, C., Johns, M., Horowitz, M., Schneider, C.,Mu�oz-Gomez, M., Aguilera, A., and de la Torre, A. June 18-20, 2013. Development of a Health Report Card for a Mexican-Origin Audience. 7th Biannual Childhood Obesity Conference. Long Beach, California.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Kaiser, L.L., Martinez, J., Lamp, C., Johns, M., Horowitz, M., Schneider, C., Aguilera, A., and de la Torre, A. June 18-20, 2013. Cultural Adaptation of Obesity Prevention Messages and Programs for a Mexican-Origin Audience. 7th Biannual Childhood Obesity Conference. Long Beach, California.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Posada, G., Hernandez, O., Manzo, R.D., Jackson, C.F. Youth Engagement Through Community-Based Participatory Action Research (CBPAR), Chicana/o Studies Curriculum, and Community Art Projects. �Aqu� Estamos!/ We Are Here! : Movements, Migrations, Pilgrimage and Belonging. Mujeres Activas en Letras y Cambio Social. July 18-20, 2013. Ohio State University.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Kaiser, L.L., Horowitz, M., Schneider, C., Johns, M., Lamp, C., Aguilera, A., Martinez, J., and de la Torre, A. Use Of An Environmental Scan For Planning In A Multi-Year, Family-Centered Nutrition Intervention To Prevent Obesity In Mexican-Heritage Children. Society of Nutrition Education and Behavior. August 10-13, 2013. Portland, Oregon.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Jackson, C.F., Posada, G., Manzo, R.D., Flores, Y.G. Deloping and Assessing a Community-Based Art Project in a Control Group. Moving from Good to Great! Society for Nutrition Education and Behavior. August 9-12, 2013. Portland, Oregon.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Flores, Y.G., Manzo, R.D., de la Torre, A. Engaging control group low-income Mexican origin families in a federally funded USDA NINFA study of childhood overweight and obesity: CBPR Methodology and lessons learned. Moving from Good to Great! Society for Nutrition Education and Behavior. August 9-12, 2013. Portland, Oregon.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Schaefer, S.E., et. al. Physical activity and health of Mexican American Children in Californias Central Valley. Moving from Good to Great! Society for Nutrition Education and Behavior. August 9-12, 2013. Portland, Oregon.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Hanbury, M., Gomez-Camacho, R., de la Torre, A., Green, R. Implementing a Fruit and Vegetable Voucher. Moving from Good to Great! Society for Nutrition Education and Behavior. August 9-12, 2013. Portland, Oregon.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2013 Citation: Gomez-Camacho, R., Hanbury, M., de la Torre, A., Green, R. Using Digital Data Collection in a Multi-year, Family-centered Nutrition Intervention to Prevent Obesity in Mexican-heritage Children: Lessons Learned. Moving from Good to Great! Society for Nutrition Education and Behavior. August 9-12, 2013. Portland, Oregon.


Progress 04/01/12 to 03/31/13

Outputs
OUTPUTS: Goal 1: Slow rate of weight gain among intervention children compared with control children. Data collection for baseline BMI, skin-fold, height/weight, and waist circumferences begun in August 2012. Economic intervention (monthly $25 vouchers) begun in intervention community in November 2012 after test-piloting. Scanner equipment installed to collect purchasing data in intervention community store. Receipt collection provides back-up data and primary data in control community. The nutrition team implemented 16 monthly family nights for parents and school-based nutrition education for the children. The team developed limited-literacy health report cards to show childs weight status and guide the family to choose goals for improvement. Goals, based on American Academy of Pediatrics recommendations, emphasize simple minimal-cost steps to grow into a healthy weight. Goal 2: Identify mediating factors influencing the effect of economic and educational interventions on child weight gain. Economics team developed hedonic theoretical model to analyze changes in health as a consumption good - produces satisfaction and utility - and investment good -exercise more, change eating habits, obtain health care - to improve health. Data are regressed on acculturation index, food consumption patterns, and other variables to explain factors that increase BMI in Mexican-origin children. The team developed a field-based tracking system to examine implementation factors for analysis; an evaluation form will monitor program delivery at the family education nights to record the extent to which key nutrition messages are accurately communicated and the participants are actively engaged in the lesson. Goal 3: Refine, integrate, evaluate UCCE science-based nutrition and physical activity curricula for cultural propriety. The team adapted existing curricula to create a five-lesson Family Meals series emphasizing the parent/child division of responsibility around meals, MyPlate (what to serve), how much to serve, healthy snacks, and handling picky eaters. This series was used in combination with lessons on shopping, reading labels, and benefits of consuming a wide variety of fruits and vegetables, creating a year-one plan for parent education. A 30-item pictorial questionnaire to capture child food patterns and feeding practices evaluated the lessons. The nutrition PI has observed delivery of each newly adapted lesson and informally asked for participant feedback on the messages, activities, and recipes. The nutrition team will use data to tailor and refine the first implementation years lessons and develop a plan for next year. A family education team provided 8 monthly general education programs to families in the control community. Goal 4: Increase number of culturally sensitive UC Davis students. Students participate in all project activity, including recruitment, consenting, data collection, education programing. UCD Students worked on community art projects in San Joaquin and Firebaugh. Students learn community and youth engagement in a community-based participatory research model. Community Advisory Councils in both communities provide ongoing project feedback. PARTICIPANTS: The following staffing completed the same roles/ responsibilities as in Year 1. PI Adela de la Torre: 1.8 academic and summer months to lead all phases of project. Co-I Yvette Flores: 2.4 summer months: manages recruitment and retention of control group families. Co-I Richard Green: .6 academic months as economist and econometrician to address issues related to the economic interventions and data analysis. Co-I Carlos Jackson: .6 summer months to implement community arts education project that reinforces project messaging. Co-I Lucia Kaiser: 1.2 academic months as chief nutrition scientist. Co-I Banafsheh Sadeghi: 6 academic months as physician lead. Project Manager Linda Whent: 5 person months: oversee grant budget and administration. Director of External Grants (Mitloehner): 1.2 person months to manage IRB, reporting processes. Project Coordinator Maria Rangel: 12 person months to coordinate all local activity. Graduate Students: 6 person months (3) and 3 person months (2) to assist the investigator team in all aspects of the project. Changes to staffing: Business Assistant time split between two individuals: total: 4.8 person months to assist in all project-related transaction processing and travel. Judith Martinez was hired in June 2012 to provide 8.4 person months as health educator in the intervention community. Ivan Garcia was hired in October 2012 and allocates 12 person months to provide administrative support to the Firebaugh office. New Activity in 2013: The intervention community school district funded a PE teacher to work with 19 teachers at the elementary school site, coaching them on the use of the SPARK curriculum in their classrooms and training 127 K-2nd grade students 30 minutes each week in addition to their classroom physical activities. 12 teachers in six pre-school sites in the Firebaugh community have received SPARK Early Childhood curriculum binders and classroom sets of SPARK equipment for their classrooms. Teachers in the intervention and control districts are tracking weekly classroom physical activity. Participants in the control community participated in ten family education trainings to prepare them for project involvement by solidifying their relationship with project staff and teaching them about tools used in data collection (e.g., loyalty cards scanned at the local supermarket). The intervention district will apply for a 2013 PEP grant through the US Dept of Education to increase their physical education activity in these grades. Quarterly advisory council meetings take place to strengthen the partnership among the university, county-based university extension staff, merchants, school district personnel, city personnel, promotores, and parents. The research team has collaborated with community organizers to hold data collection events around community events, including health fairs, school events, and holiday celebrations. Participants in the intervention community have attended monthly parent nutrition trainings since August 2012. TARGET AUDIENCES: Target audiences included 649 children ages 3-7 and their parents or legal guardians and immediate family members (other children, grandparents, etc.); community stakeholders (city and school district officials, market owners, health practitioners, teachers, health coaches (promotoras). School-based nutrition education: Worked with teachers of grades K-2 to adapt and deliver grade-level, standards-based nutrition curriculum in the schools. See "Outputs" for detail. Family Education Intervention Community: 16 family education nights per month for parents and families of participants. See outputs for curriculum detail. Developed health report card for parents to monitor child weight and learn simple ways to maintain healthy weight in children. All materials developed in English and Spanish. Control Community: To engage the control community, we responded to community needs obtained through focus groups with stakeholders. The identified areas of need that our team could address included improving the knowledge of the U.S. educational system, promoting educational attainment, and increasing knowledge regarding mental health problems and solutions. We developed a series of workshops designed to increase the knowledge of participating families in these areas. Additional topics included how to raise bilingual/bicultural children, how to manage stress, the impact of migration on family mental health, and prevention of substance abuse and domestic violence. The workshops were evaluated highly by participants. Physical Activity Intervention school district funded a high school coach to teach SPARK curriculum to K- 3rd grade students. Teacher trained in SPARK program delivery. Teachers in grades K-2 in intervention and control communities trained in use of accelerometers. Year-2 Collection of data through the distribution of Accelerometers to both the FLDUSD and the GPUSD. Collection of weekly physical activity forms completed by pre-school and K-2nd grade teachers. Enrollment and Data Collection 400 intervention group children and 249 control group children enrolled. Baseline anthropomorphic data collected from 271 intervention children and 139 control children. Household survey completed by 247 intervention families; 143 control families. Art Project Community mural project completed in control community. Art team worked with local high school students and adults to design mural over three-month period and paint the mural over a period of 15 days. Community celebration in September 2012 commemorated completion of the project. Goal of art project: community engagement and youth development. Other Community Participants 1 market in intervention community trained in use of scanner - scanner activity currently active. College students from local community college certified through IRB course and participate in data collection activity. Quarterly advisory councils in both communities include: district, city, health clinic, and parent representatives. PROJECT MODIFICATIONS: While modifications in approach have consistently taken place to respond to the unique circumstances of these communities, no changes threaten rate of expenditure or adversely impact our ability to comply with all approved protocols and meet obligations on deliverables. Changes that have taken place included redesigning the delivery schedule for parent education programming to meet parent scheduling needs during the high-peak work seasons; redesigning surveys, questionnaires and other instruments so they are user-friendly for a low-literacy audience; changing methodology for data collection to increase yield, and recruiting local residents, such as community college students, to increase the local presence of this project and enable activity to occur daily. The hiring of additional local professional staff has enabled us to increase recruitment and consenting activity significantly in the last quarter. Ongoing meetings with the community advisory councils are supplemented with one-on-one personal meetings with individual members to ensure full committee feedback is ongoing. In November of year 2, our subcontractor Proteus Inc. stopped the work of the promotores for 30 days due to internal funding challenges. During this time, the study reached out to the local West Hills Community College to recruit and train students living in the served communities to continue the work of the program. Several of the students had skills to be IRB certified and were then qualified to take on higher level roles in the program. Since the promotores returned to work in December 2012, we have maintained a hybrid program, using both promotores and students for recruitment and family nights. Students have been conducting informed consent and assisting with data collection, medical measurement and supporting Family Night presentations. As the work of the program is changing from primarily a recruitment focus to data collection and treatment intervention, the work hours of the promotores is also changing, such that fewer promotores will work more hours (20 -25 hours per week), and students will work up to 19.5 hours per week. An unanticipated result of this change has been that the project is increasing our impact in Goal 4 by expanding our increase of the number of culturally sensitive students to a non-UC Davis student audience - and bringing this skill directly into the community in which we are working. This change has direct long-term, systemic impact on the availability of a culturally competent local workforce.

Impacts
SPARK PE curriculum training directly influenced teacher knowledge of and attitudes toward the importance of physical fitness for their students. Teachers are more engaged in the project and committed to project goals. Families whose children receive school-based nutrition curriculum have shown interest in learning about fresh produce introduced at the school site and ways to bring use of these foods into their home cooking. This exposure was reinforced by family nutrition education curriculum in the parent workshops. The participating supermarket has worked with the project team to increase the availability and quality of fresh produce in its market, showing a change in behavior likely owing to the economic incentive of having the monthly voucher income, which can only be used to purchase fruits and vegetables. Control Community: The art team project and the family education series in the control community have had perhaps the most significant change in knowledge and attitude on several levels. Recruitment and retention of control community participants are challenged by the lack of resources to use as incentives. Using art as a tool for community engagement has integrated participants in the project through visual culture. Participating undergraduates learn through experience that in a community where poverty and illiteracy are major hurdles in achieving self determination, visual culture can be a mechanism to outreach to families through symbols that are representative of the activities, goals, and aims of a project. Community muralism and socially engaged printmaking were employed by students as tools to advance the efforts of this project while providing outlets for the community to engage as active participants in their understanding of and relationship to the project goals and objectives. A parent education team focused on identifying and responding to parent needs obtained through focus groups with promoters and community residents and suggested by the advisory board members. The identified areas of need that our team could address, given the expertise of members of the research group, were improving the knowledge of the U.S. educational system, promoting educational attainment, and increasing knowledge regarding mental health problems and solutions. The family education team developed a series of workshops designed to engage parents in the project by delivering information sessions on the U.S. educational system and ways to support their childrens educational success. In addition, workshops were developed to address parenting and mental health needs, including how to raise bilingual/bicultural children, how to manage stress, the impact of migration on family mental health, and prevention of substance abuse and domestic violence. The workshops were well received, and recommendation of the workshops by parents who participate to others in the community increased attendance and therefore recruitment and retention in the project.

Publications

  • de la Torre, A., Flores, Y., Manzo, R.D. 2012. Ninos Sanos, Familia Sana: A Multi-Year, Multi-Intervention Program to Address Childhood Obesity Among Low-Income Mexican-Origin Children in Californias Central Valley. Nutrition Education: Energy from Synergy 2012 Conference. Society for Nutrition Education and Behavior. Washington, D.C., July, 2012.
  • Aguilera, A., Bosse, S., Bueno-Gutierrez, D., De la Torre, A., Horowitz, Johns, M., M., Kaiser, L., Lamp, C., Schneider, C. 2012. Development of a Multi-Year, Family-Centered Nutrition Intervention to Prevent Obesity in Mexican-Heritage Children. Nutrition Education: Energy from Synergy 2012 Conference. Society for Nutrition Education and Behavior. Washington, D.C. July, 2012.
  • Sadeghi, B., Aguilera, A., Griffin, K. Hanbury, M. 2012. A Low-Cost Solution For Securely Collecting, Managing, and Synchronizing data. Nutrition Education: Energy from Synergy 2012 Conference. Society for Nutrition Education and Behavior. Washington, D.C. July, 2012.
  • Green, R., Hanbury, M. 2012. An Examination of Factors Explaining Obesity in Mexican-Origin Families in California: A Hedonic Approach. World Congress of Agricultural Biotechnology. Dalian, China. September, 2012.
  • De la Torre, A., Green, R., Gomez-Camacho, R., Hanbury, M. 2012. Multi-facted intervention to reduce childhood obesity in Mexican-origin populations in the rural Central Valley of California. American Public Health Association Annual Meeting. San Francisco, CA. October, 2012.
  • De la Torre, A., R. Green, and L. Kaiser. 2012. "Identifying Factors That Contribute to High Rates of Obesity in Mexican Origin Children. ARE Update 16(2):5-7. University of California. Giannini Foundation of Agricultural Economics
  • De la Torre, A., Sadeghi, B., Flores, Y., Kaiser, L., Gomez-Camacho R. 2012. Implementation of a Community Based, Multi-Year, Multifaceted Obesity Prevention Program: Lessons Learned. Nutrition Education: Energy from Synergy 2012 Conference. Society for Nutrition Education and Behavior. Washington, D.C. July, 2012.


Progress 04/01/11 to 03/31/12

Outputs
OUTPUTS: April 1 startup continued meetings with: quarterly Community Advisory Councils in both communities; Proteus promotores (health coaches) weekly and monthly; informational meetings with target population parents weekly for feedback on all instrument designs and processes. Goal 1 Slow rate of weight gain among intervention children compared with control children. The medical team purchased scales for anthropometric baseline measurements; developed data collection manual for research staff and bilingual medical measurement manual; trained bilingual undergraduates to assist in medical measurements; developed, piloted and finalized medical questionnaires; initiated baseline data collection; designed health information education content. The data management team defined and created study variables data dictionary; designed, piloted and refined medical questionnaire (Lime Survey); designed data collection and management structure to maintain participant confidentiality and data security, and enable data merging. The nutrition team held focus groups to explore perceptions of obesity prevention messages; developed, pilot-tested, refined, trained staff and administered nutrition and food consumption surveys. Adapted lessons from UCCE curricula for first 10 family night sessions in Year 2. Prepped curriculum kits for preschool; hired community nutrition educator. Goal 2: Identify mediating factors influencing the effect of economic (market) and educational interventions on child weight gain. Developed theoretical model to explain BMI differences of ideal BMI's in Mexican-heritage children and mothers. Set up scanners in Firebaugh and San Joaquin to track food purchasing patterns and co-designed household survey. Goal 3: Refine, integrate, evaluate UCCE science-based nutrition and physical activity curricula for cultural propriety. Goal 4: Srengthen and increase number of culturally sensitive UC Davis students. Designed, taught and evaluated 10-week Program in International and Community Nutrition (PICN) course. See "Outcomes" for relevant detail. Staffing: Appointed full-time bilingual on-site program coordinator at project site Casa Sana in Firebaugh. Hired program representative to assist in data collection, outreach, informed consent and medical measurement. Goals 1-4: Taller Arte del Nuevo Amanacer (TANA) community art project. The art team worked with community stakeholders to design and create the first poster depicting the importance of nutrition for the intervention community and two posters emphasizing community identity and healthy living for the control community. A mural in the control community will be completed and unveiled in September. See Outcomes for more detail on impact. Output change: expanded enrollment eligibility cap from age 5 to age 7, to meet study enrollment target of 800 participants. We will identify relevant ages for purposes of data analyses. Investigators are well aware we will need to stratify by appropriate ages to meet stated goals objectives of the project. PARTICIPANTS: PI Adela de la Torre: 1.8 academic and summer months to lead all phases of project; provides leadership role in planning and implementing all biweekly co-Investigator, graduate student and site staff meetings; works closely with Firebaugh site staff, sub-contractor Proteus and collaborators; facilitates Community Advisory Council meetings and bi-weekly meetings with research team. Co-I Yvette Flores: 2.4 summer months: manages recruitment and retention of control group families: plans and gives mental health workshops and supervises educational workshops for families; ensures that instrument translations are accurate; trains student staff in proper administration of an oral interview; reviews project staff IRB certification credentials prior to their beginning project work. Co-I Richard Green: .6 academic months as economist and econometrician, meeting weekly with the Economics Team to address issues related to the household consumption survey; fruit and vegetable vouchers; economic data collection and analysis; and development of econometric models. Co-I Carlos Jackson: .6 summer months to implement community arts education project that reinforces project messaging. Co-I Lucia Kaiser: 1.2 academic months as chief nutrition scientist: convened UCCE nutrition advisors workgroup to oversee review and refinement of nutrition curriculum materials and program delivery options based on community stakeholder and advisory council input; reviews formative data collected from participants to ensure cultural appropriateness and scalability for dissemination. Co-I Banafsheh Sadeghi: 6 academic months as physician lead and data manager: design and development of surveys; data collection monitored for standardized protocol; proper coding, security and confidentiality, dataset cleaning and sharing data; led collection of medical history and anthropometric measures; provides health information education services to participating families. Project Manager Linda Whent: 6 person months: grant budget and administration: track voucher card use; SPARK physical education curriculum in classrooms; delivery of physical education components during Family Nights; supervise project staff in Davis and Firebaugh; serve as program liaison with school districts, Proteus, Head Start and University of California Cooperative Extension programs in Woodland and Fresno. Project Coordinator Maria Rangel: 12 person months to coordinate all local activity with advisory councils, school districts, and community stakeholders through the Firebaugh site, Casa Sana. Graduate Students: 6 person months (3) and 3 person months (2) to assist the investigator team in all aspects of nutrition, economics, behavioral, education and anthropometric research. Director of External Grants (Mitloehner): 1.2 person months to manage IRB, reporting processes. Business Assistant Leticia Quinana: 4.8 person months to assist in all business transaction processing for research staff activity and participant events. Proteus, Inc., subcontractor for Promotores for childcare and outreach. Community: Advisory Councils in San Joaquin and Firebaugh. Elementary schools: venues for meetings and data collection. TARGET AUDIENCES: Target audiences included children ages 3-7 and their parents or legal guardian and immediate family members (other children, grandparents, etc.) Decision-making in this community is a family concern, and there must be project buy-in by the family as a unit. The following activities were implemented: Nutrition Curriculum Informational meeting with the Firebaugh-Las Deltas Unified School District and UCCE to discuss the delivery of the Nutrition Curriculum and the training of teacher to deliver the curriculum Partnership with Los Promotores to purchase produce from the Firebaugh Community Garden for use at Family Fun Nights Review of voluntary certification of Good Agricultural Practices A calendar of family night education sessions has been planned for Year 2. Physical Activity Informational meeting with the Firebaugh-Las Deltas Unified School District to discuss the delivery of the SPARK curriculum Registration of Linda Whent, Sara Schaefer, Lisa Martinez to attend the SPARK Summer Institute for Preschool and Mr. Jim McCall, a FLDUSD High School teacher, for K-2 . Collection of baseline data through the distribution of Accelerometers to both the FLDUSD and the GPUSD Anthropometric Measurements Collection took place at 2 pilot and 3 large events in Firebaugh and 1 large event in San Joaquin Economic Team Household Survey piloted, refined and administered beginning in March Art Team Informational presentation to Tranquility High School students and community members regarding the overall process of creating a mural for San Joaquin in Summer 2012. Use of Art Posters throughout community and distributed to participants in Firebaugh to reinforce key project themes. Advisory Council Meetings Four Community Advisory Council meetings to gain feedback on recruitment and retention strategies and plans for baseline and plans for the start of intervention Meetings with the Promotores Three meetings to gain feedback and guidance on progress of the project, recruitment and retention, and overall organization West Hills Community College Partnership Discussion of collaboration with the West Hills Community College North District Center with the Director, including venue for Family Fun Nights and to hire WHCC students to work on the project Informational Meetings and Tables/Recruitment Informational presentations through the local elementary schools H.M. Bailey Elementary Tranquility Elementary Cantua Creek Elementary Informational table at Kindergarten registration, at general meetings, and at large community events GPUSD: 22nd Annual Migrant Parent Conference, Golden Plains Unified district-wide Cinco de Mayo Open House and School Readiness Parent Institute FLDUSD: Firebaugh Migrant Mini-Conference, Firebaugh Readiness Program Health Fair PROJECT MODIFICATIONS: The following change was made to the program in Year 1: Eligibility age range of participant children was expanded from an upper limit of age 5 to an upper limit of age 7 to fit the reality of the population: some of the children do not start Kindergarten until age 6, and some are held back a year, so they are 7 when they repeat Kindergarten. In addition, the children in the families are very close in age, and enrolling one but not both children caused family tension and reluctance to participate. Researchers will stratify data by age to retain fidelity to the design. The following change is being explored: The project was designed to follow the WIC policy of capping the monthly voucher at $25 and only adding the amount needed on the first of each month to bring the total voucher to that $25 limit. So if a family spends $18 in May, on June 1 they would receive $7 on their voucher card. To capture fluctuations in purchasing patterns that follow seasonality of agricultural work, we are exploring with the bank the ability to add $25 per month, regardless of unspent balance, to a cap of $300 in any project year. This design would enable participants to budget their spending so they have more voucher funds during times of the year when work is scarce. This also enables research staff to evaluate this design vs. the WIC method, to identify true purchasing patterns of participants -- if they know the funds will not disappear on the first of each month, are they inclined to save for leaner times; are they apt to make more appropriate food choices and/or are they wasting less food because they do not throw away unused produce they purchased only to use up the funds (use it or lose it syndrome) We will form hypotheses around this new design and submit to the national program leader for feedback prior to implementation. Year 1 includes partial baseline data collection because of the length of time it has taken to validate and administer the consent forms to this population. Most adults have very limited if any literacy in English or Spanish. Many have a sixth-grade education limit, and some participants, especially women, have not been to school at all and are have low literacy in both languages. This reality made consenting with visual presentations a necessity, and it has taken longer than predicted to reach the target goal for participants in both intervention and control communities. Baseline data collection began in late March rather than February, and is continuing through the early fall. We were originally scheduled to conduct a second anthropomorphic data collection in August, but we will still be collecting baseline at that time. Semi-annual data collection will initiate in Year 2 with February collection, and at the beginning of Year 3 with August collection, continuing every six months thereafter. We have added skin fold to the data collection methods, following IRB approvals.

Impacts
Early outcomes from Logic Model include: Changes in knowledge and behavior for researchers and students: 1. Community input leading to change in design: The original design of the voucher incentive followed the WIC policy of a monthly cap of $25. Stakeholder feedback revealed seasonal- worker income fluctuation common to agricultural economies. The economics team is investigating a rollover system wherein families can accumulate during higher income periods unspent funds on their voucher to spend during periods of economic stress that accompany lack of available agricultural work. Findings could have substantial policy implications for WIC and other federal consumer subsidies. The use of loyalty cards to track purchases will reveal food distribution patterns and the impact of project vs. WIC produce vouchers on produce consumption. We will examine the impact of seasonality, consumption, and increased level of funding for low-income families concerned with food security. Research findings will include data on pattern of use based on carry-over effects. 2. Graduate Curriculum: 1 geography, 1 community development, 1 public health, 2 nursing and 3 nutrition graduate students completed a new 10-week course. Students learned to apply CBPR methods in Latino communities, extending this knowledge into their research projects. Three students will continue their work to develop and conduct independent case studies in the field sites in Firebaugh and San Joaquin; a fourth student will assist in delivery of the community health interventions. PICN Course: Community Based Nutrition and Health Research: Lessons Learned from California's Communities: Students learned to plan and implement public health and nutrition projects that highlight the intersection of social determinants of health within a community empowerment framework. Content focused on existing literature and methods on community and international nutrition research, with special emphasis on California's growing Chicano/Latino communities. Topics included ethical concerns regarding human studies in cross-cultural settings; recruitment and retention of hard-to-reach and at-risk groups; application of culturally nuanced theoretical models and community-based research methods; sample design issues; methods of qualitative and quantitative data collection; data management; and program implementation issues that impact administration, personnel hiring and program integrity over time. Community Arts Project: Using art as a tool for community engagement integrates participants in the project through visual culture. Participating undergraduates learn through experience that in a community where poverty and illiteracy are major hurdles in achieving self determination, visual culture can be a mechanism to outreach to families through symbols that are representative of the activities, goals, and aims of a project. Community muralism and socially engaged printmaking were employed by students as tools to advance the efforts of this project while providing outlets for the community to engage as active participants in their understanding of and relationship to the project goals and objectives.

Publications

  • De la Torre, A., Aguilera, A., Gomez-Camacho, R., Manzo, R. D. 2012 Ninos Sanos, Familia Sana (Healthy Children, Healthy Family): A Multi-Intervention Study to Prevent Childhood Obesity in Mexican-Origin Children in Rural California. SIGLO XXI: Forging the Future of Latinos in a Time of Crisis. Fourth Biennial Conference of the Inter-University Program for Latino Research. City University of New York.
  • De la Torre, A., Flores, Y., Jackson, C.F., Manzo, R. D. 2012 Ninos Sanos, Familia Sana (Healthy Children, Healthy Family): A Multi-Intervention Study to Prevent Childhood Obesity in Mexican-Origin Children in Rural California. National Association for Chicana/Chicano Studies 40th Anniversary: Celebrating Scholarship and Activism. Chicago, Illinois.
  • De la Torre, A., Flores, Y., Manzo, R. D. 2012 Ninos Sanos, Familia Sana: A Multi-Year, Multi-Intervention Program to Address Childhood Obesity Among Low-Income Mexican-Origin Children in California's Central Valley. Nutrition Education: Energy from Synergy 2012 Conference. Society for Nutrition Education and Behavior. Washington, D.C.
  • Aguilera, A., Bosse, S., Bueno-Gutierrez, D., De la Torre, A., Horowitz, Johns, M., M., Kaiser, L., Lamp, C., Schneider, C. 2012 Development of a Multi-Year, Family-Centered Nutrition Intervention to Prevent Obesity in Mexican-Origin Children. Nutrition Education: Energy from Synergy 2012 Conference. Society for Nutrition Education and Behavior. Washington, D.C.
  • Sadeghi, B., Aguilera, A., Griffin, K. Hanbury, M. 2012 A Low-Cost Solution For Securely Collecting, Managing, and Synchronizing data. Nutrition Education: Energy from Synergy 2012 Conference. Society for Nutrition Education and Behavior. Washington, D.C.
  • De la Torre, A., Sadeghi, B., Flores, Y., Kaiser, L., Gomez-Camacho R.J. 2012 Implementation of a Community Based, Multi-Year, Multifaceted Obesity Prevention Program: Lessons Learned. Nutrition Education: Energy from Synergy 2012 Conference. Society for Nutrition Education and Behavior. Washington, D.C.
  • Green, R., Hanbury, M. 2012 An Examination of Factors Explaining Obesity in Mexican-Origin Families in California: A Hedonic Approach. World Congress of Agricultural Biotechnology. Dalian, China.
  • De la Torre, A., Green, R., Gomez-Camacho, R., Hanbuy, M. 2012 Multi-Faceted Intervention to Reduce Childhood Obesity in Mexican-Origin Populations in the Rural Central Valley of California. American Public Health Association Annual Meeting. San Francisco, CA.