Source: NORTH CAROLINA STATE UNIV submitted to
CHILDCARE OUTDOORS AS ACTIVE FOOD SYSTEM: EFFECTIVENESS OF POD GARDENING COMPONENT
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
NEW
Funding Source
Reporting Frequency
Annual
Accession No.
1011964
Grant No.
2017-68001-26354
Project No.
NC.W-2016-11068
Proposal No.
2016-11068
Multistate No.
(N/A)
Program Code
A2111
Project Start Date
Jun 1, 2017
Project End Date
May 31, 2022
Grant Year
2017
Project Director
Cosco, N. G.
Recipient Organization
NORTH CAROLINA STATE UNIV
(N/A)
RALEIGH,NC 27695
Performing Department
College of Design
Non Technical Summary
Aim: Measure effectiveness of the Preventing Obesity by Design (POD) hands-on fruit and vegetable (FV) gardening component to increase physical activity, FV liking, knowledge, and consumption in vulnerable 4 & 5 year old children attending childcare. Promising integrated strategy with potential to reach to 76% approx. US population living in regions with a growing season >200 days/year, where 77% US regulated childcare centers are located with potential exposure to FV gardening.Supporting objectives: 1) Contribute scientific evidence to the currently under-researched area of hands-on FV gardening in childcare centers through a randomized, controlled trial at 15 childcare centers (300 preschoolers engaged in standardized gardening); 2) Engage community college instructors by adding gardening component to standardized educational modules used in early childhood education/other fields to highlight the impact of preschool FV gardening on physical activity and FV consumption as a long-term health promotion strategy; 3) Translate and disseminate research findings via eXtension, informing extension agents, parents (via EFNEP), educators, and others about the potential for increasing FV consumption for vulnerable preschoolers through FV gardening interventions at childcare centers.Partners: NC State University: Landscape Architecture; Food, Bioprocessing, and Nutrition; Youth, Family, and Community Sciences; Horticultural Sciences; Statistics. Wake Co. Smart Start. Cornell University: Design and Environmental Analysis.Project addresses AFRI generating new knowledge priority "to develop and implement effective early care and education settings" as a critical factor for influencing new policies and regulations with the potential for reducing barriers to good health for millions of vulnerable children attending childcare.
Animal Health Component
0%
Research Effort Categories
Basic
(N/A)
Applied
100%
Developmental
(N/A)
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
72450103111100%
Knowledge Area
724 - Healthy Lifestyle;

Subject Of Investigation
5010 - Food;

Field Of Science
3111 - Landscape architecture;
Goals / Objectives
Long-term project goals: 1) Improve the health of vulnerable preschool children attending U.S. childcare centers by increasing physical activity (PA) and consumption of fresh fruit and vegetables (FV); 2) Influence childcare regulations to include hands-on FV gardening as health promotion policy, potentially impacting regulated U.S. childcare centers; 3) Increase awareness and understanding of early childhood physical activity and healthy eating through hands-on FV gardening for educators, parents, extension agents, and Quality Improvement Rating Systems (QIRS, operating in 25 states).Because childcare centers are policy-sensitive institutions, evidence underscoring the benefits of FV gardening may encourage regulators to adopt supportive rules (Tandon, Walters et al. 2016). With 76% approx. of the U.S. population living in areas with an annual growing season >200 days (IIASA 2013), a gardening component may be a promising obesity prevention strategy for young children in these regions, where 77% of total (120,000 approx.) U.S. regulated childcare centers are located (CCAA 2012).Supporting Objectives of Integrated Proposal1) Research. a) Contribute scientific evidence to the currently under-researched area of hands-on FV gardening in childcare centers; b) Assess the impact of a Gardening Component on 300, 4-5 year olds, enrolled in 15 childcare centers in Wake Co, NC; c) Using a waitlist/control group, randomized controlled trial (RCT) research design, assess the impact of FV gardening intervention on children's physical activity, FV liking, FV knowledge, and FV consumption;d) Translate research findings for Education and Extension Functions.2. Education. a) Highlight the impact of preschool FV gardening on physical activity and FV consumption as a long-term health promotion strategy by adding an evidence-based gardening component to the standardized POD Higher Education Modules; b) Engage pre-professional instructors by disseminating modules through community college course library systems to courses in early childhood, culinary arts, movement education, horticulture, landscape design and construction; c) Transfer knowledge to these fields by including evidence-based gardening component in post-professional certificate programs; d) Promote replication of gardening component by professional networks in North and South Carolina, Texas (see letters of support), and other states; e) Identify early adopters and provide technical assistance for implementation.3. Extension. a) Disseminate information, tools, and resources to support parents, community leaders, technical assistance providers, extension agents, community college instructors, and public health professionals to implement evidence-based, children's FV gardening; b) Develop online resources for delivery via eXtension and other distance/higher education systems, professional and collaborators' networks, Farm-to-Childcare, and related state level and national organizations; c) Train extension agents, technical assistance providers, and early childhood educators to deliver children's FV gardening/micro-farming technical assistance and training to create an evidence-based community of practice; d) Offer Expanded Food and Nutrition Education Program (EFNEP) cooking series for parents and teachers in Years 4 & 5.
Project Methods
Research methods. Independent Variable Garden Fidelity - measured using the Garden Fidelity Tool (GaFT) - to capture unavoidable variations between gardens at centers includes: 11 garden-related experiences with 12 types of designated summer FVs in three sections: PREPARING: 1) examining seeds, 2) examining plant parts, sprouting seeds, 3) preparing beds, 4) planting; CARING 5) watering, 6) weeding, 7) observing plant growth, 8) observing garden bugs; HARVESTING & EATING: 9) harvesting, 10) preparing, 11) snacking).Dependent VariablesPhysical Activity - measured using Yamax pedometers. Reliable and valid objective measure Step counts. Time outdoors. Pre/post. Two weeks of data gathering.Fruit & Vegetable Liking - measured using modified electronic method for assessing children's fruit and vegetable (FV) liking. Auto-recorded. Pre/post.Fruit & Vegetable F&V Knowledge - measured simultaneously with F&V liking, using the same FV photographs. Pre/post.Fruit & Vegetable Consumption -Fruit & Vegetable Snack Tool (F&VST) modified version. Store-bought, standard pieces of six fruit types (week one), six vegetable types (week two). Weighted on scale in grams in kitchen (before) and in classroom (after eating). As a back up measure, a standard tray will be photographed before and individual trays after to measure consumption by FV type. Data entered by RA. Uneaten food composted. Pre/post.Control VariablesGlobal Outdoor Learning Environment Quality - will be measured using Preschool Outdoor Environment Measurement Scale - POEMS (DeBord, et al, 2005). Five Domains (Physical Environment, Interactions, Play and Learning Settings, Program, Teacher/Caregiver Role), 56 items, dichotomous scale.Outdoor Physical Environment Quality - will be measured using Best Practice Indicator Scale (BPIS) as an expansion of POEMS Domain 3 (Play and Learning Settings) for increased accuracy. Twelve item, four-point Likert scale. Pre/post. Inter-rater reliability checks will be performed before each data gathering period.Qualitative component: gathered using Garden Anecdote Box (GAB). Garden-related classroom activity (drawings, models, dramatics, music and movement, story time, etc., directly connected to FV gardening), garden anecdotes (children) and home-related stories (children and adults),. Together with teacher-taken smart phone photographs, uploaded weekly by RA to GAB server folder and archived.Statistical Analysis Approach. Continuous variables such as physical activities and environment quality measures will be summarized by mean and standard deviation or median and inter-quartile range; categorical variables such as children's fruit/vegetable liking will be summarized by frequency or percentage. In formal statistical analyses assessing the effects of childcare center fruit/vegetable garden intervention and other factors on children's physical activities and fruit/vegetable consumption/liking, we will recognize and take into account for valid statistical inference the fact that the analysis unit is centers and each child's longitudinal data is nested within each center.Education efforts include an educational module for community college instructors. Includes a specific Gardening Component that will be developed and added to current POD Education Modules for Community Colleges and Higher Education Systems. Aligned with NAEYC Standards for Early Childhood Associate Degree Accreditation and with early learning standards (e.g. NC Foundations for Early Learning, South Carolina Early Learning Standards, Texas Prekindergarten Guidelines).Extension efforts will apply the principles of translational research to convert and disseminate research findings via eXtension webinars/digital resources to inform extension agents, parents and educators about the potential for increasing FV consumption in vulnerable preschoolers through FV gardening interventions at childcare centers. "Cooking from the Garden" series will be offered through the Expanded Food and Nutrition Education Program (EFNEP) for teachers and parents. Policy strategy recommendations for change in center, local, and state policy regarding health benefits of gardening and outdoor activities of children 4-5 years old will be added to the Local and Regional Food Systems (CLRFS) Community of Practice. Development of a new niche market will be supported by defined benchmarks for multidisciplinary pre-professional education in early childhood, nutrition, culinary arts, and landscape construction/horticulture. Potential new job creation.Key networks to increase reach include: 1) eXtension Community, Local and Regional Food Systems (CLRFS) Community of Practice; 2) North Carolina Cooperative Extension (NCCE) Local Foods portal; 3) Center for Environmental Farming System (CEFS) academic/governmental/community networks, including NC State University, NC A&T (Historic Black Land Grant University), NC Department of Agriculture and Consumer Services, farmers and citizens.Project Evaluation. Surveys will be disseminated annually to participating centers (directors, owners, teachers), and technical assistance providers with questions related to the research and extension functions of the proposal.Annual documentation will include on-site FV garden activity photography (uploaded to the project server folder) to demonstrate physical progress and community engagement. Data will inform the general progress and success of the project. Improvement in childcare outdoor quality will be assessed using the validated Preschool Outdoor Environment Measurement Scale (POEMS) and the Best Practice Indicators Scale (BPIS). Intervention activities will be evaluated using surveys with attitude and knowledge questions. Responses processed using QualtricsTM will be summarized annually.Education modules will be evaluated using instructor and student surveys to capture changes in attitudes and knowledge regarding FV gardening, OLE quality enhancement, and child outcomes. Results from annual evaluations will be used to guide modifications of all project activities.Feedback collected through surveys will be analyzed using the concept of "diffusion of innovation" (Rogers, 2004), to understand adoption of the FV gardening component by intervention and waitlist centers. Survey questions will gauge the stage of adoption, including: 1) Awareness (first contact with topic); 2) Interest (participants actively seeking information); 3) Evaluation (participants assessing the possibility of adopting the practice); 4) Trial (participants preparing to implement the initiative or partially implementing it). Indicator: The POD gardening component will be considered successful if more than 50% participant centers reach level 3 or 4 (i.e. most participants are evaluating the possibility of implementing FV gardening by themselves after interventions are completed).

Progress 06/01/19 to 05/31/20

Outputs
Target Audience:During this reporting period, the full sample increased to 288 children enrolled in 15 childcare centers located in Wake County, North Carolina. The 15 participating centers have an average 52% subsidized enrollment which suggests that more than half of the sample reached during the current reporting period included children socially, economically, and/or educationally disadvantaged. As in previous years, parents signed informed consent forms and received project flyers including evidence-based information about the importance of healthy eating behaviors and physical activity for preventing early onset of obesity. In the Spring of 2020, recruitment of new children to the project was halted due to COVID-19. Fifteen center directors and 55 teachers/caregivers were also reached by the project during the current reporting period. As in the past year, directors completed an online application containing information regarding the importance of children's healthy eating behaviors and physical activity for preventing obesity. Teachers received similar information through consent forms and face-to-face information along with educational guidance on gardening activities with children. Additionally, teachers at intervention sites (n=5) received a hard copy of the Gardening Activity Guide. During this reporting period, 38 volunteers (34 undergraduate and 4 graduate students) at NC State University received online and face-to-training for data collection during the current reporting period. Since the beginning of the study, a total of 100 NC State University undergraduate and graduate students have received trainings on the importance of healthy eating behaviors for preventing early onset obesity, as well as exposure to scientific procedures for collecting data on children's liking of fruit and vegetables, physical activity monitoring, and technical knowledge regarding food safety. The 23 volunteers trained in Spring 2020 did not participate in the project as data gathering was suspended due to COVID-19. Changes/Problems:1. The data-gathering session scheduled for the second week of September 2019 was rescheduled due to hurricane Dorian that affected North Carolina on September 4-6, 2019. 2. During Summer 2019, some centers had issues with fire ants, and yellow jackets at or near the garden, causing the children to not go outdoors. Squash bug infestation was also an issue at all centers with gardens. Preventive measures were transmitted to individual centers. Challenges at center level: a. During Fall 2019, all upper management at one center resigned (Director and Assistant Director). Temporary director was put in place. b. The outdoor environment at another center was closed off due to fence repair, and the research team was unable to gather on environmental measures. c. A third center closed multiple days due to power outage caused by the Dorian hurricane. 3. Only two children participated in data collection at one center due to lack of signed consent forms by parents, absences, and others graduating to Kindergarten. 4. On March 16, 2020, Wake County Public School System closed all public schools due to the COVID-19 pandemic. On March 17, 2020, NC State University recommended all non-essential employees should work remotely. On March 27, 2020, NC Governor issued a "stay-at-home" order for all non-essential workers. As a result, data gathering was suspended, and all centers, volunteer research assistants, research partners (UNC-Chapel Hill, NCSU Food Science Dept., etc.), and community helpers (Food Lion) were notified. Data gathering is postponed until "stay at home" order is lifted. What opportunities for training and professional development has the project provided?As in the previous year, training was provided to Lead and Volunteer Research Assistants (RAs) prior to data collection in September 2019 and March 2020. These sessions were attended by the five lead research assistants and 38 volunteer research assistants. All RAs were required to take online and in-person training sessions prior to data collection. Online Training sessions. The online training, AFRI Preventing Obesity by Design Nutrition Research Training Program was delivered via Moodle (NC State University distance education platform). Topics: 1) Hygiene; 2) Food Handling; 3) Knife Skills; 4) Collaborative Institutional Training Initiative's Human Subjects Research course In-Person Training sessions Instructors: Nilda Cosco, PhD, Natural Learning Initiative, NCSU, Principal Investigator; Bria Sledge, MA, Early Childhood Program Associate, Natural Learning Initiative, NCSU, Lead Research Assistant; Laura Lloyd, BS, Prof. Development Program Associate, Natural Learning Initiative, NCSU, Lead Research Assistant; Latasha Williams, MS, RD, LDN, Ph.D. Candidate, Department of Food, Bioprocessing, and Nutrition Sciences, NC State University.; Derek Hales, PhD, UNC Center for Health Promotion and Disease Prevention, UNC-Chapel Hill. 1) Study Introduction. 2) Accelerometer monitoring. Topics: overview of measuring physical activity methods; proper accelerometer fitting, interacting with children, and daily routine for accelerometer usage and storage. The following in-person training sessions were held to accommodate class schedules of all research assistants for training on different data gathering protocols. 3) Fruit and Vegetable Liking. Topics: "Plucky the Pea" story and activity, use of survey instrument, and how to interact with children. 4) Fruit and Vegetable Preparation and Consumption. Topics: Food preparation: food and kitchen safety, proper food cutting and handling of different fruits and vegetables, and food weighing and packaging. Consumption portion covered the standardized script to read to the children, how to present the food trays, how to record observations, packing of food waste, and weighing and recording food waste data. How to interact with children is also covered, including how not to positively or negatively reinforce eating behaviors. 5) Personal Boundaries for Working with Minors (new section). Topics: Appropriate and Inappropriate physical boundaries with minors. Appropriate and Inappropriate behaviors, language, dress, etc. while working with minors. 6) Early Education Garden Trainer Research Assistant In house training conducted by the Natural Learning Initiative team, College of Design, NCSU. Topics: The importance of healthy eating and physical activity, gardening with children, introduction to randomized controlled trial methods and ethical issues, gathering research data in the field, processing data systematically. How have the results been disseminated to communities of interest?Conferences presentations to public health, early childhood education, and landscape design audiences. What do you plan to do during the next reporting period to accomplish the goals?Continue with the approved plan of activities as soon as "stay at home" orders are lifted.

Impacts
What was accomplished under these goals? Impact. Every day over 11 million US children younger than five attend some type of child care arrangement where they spend the majority of their waking hours, learn, eat, and exercise. This project aims to influence policies to improve healthy eating and active living of children 4 and 5 years old by creating evidence supporting the critical importance of gardening in early childhood. Although the study sample is composed of 288 children, the installation of fruit and vegetable (FV) gardens is already benefitting all children attending intervention sites estimated at more than 1,000 children to date. This promising, integrated strategy has the potential to reach approximately 76% US population living in regions with a growing season >200 days/year, where 77% US regulated childcare centers are located. During COVID-19 the need and urgency for the creation of local food sources and training of teachers and parents about gardening is clear. The installation of gardens for control sites (Y3) and maintenance assistance of past years fruit/vegetable gardens at participating centers are priorities. Phone contact was established with all 15 centers and a horticulture science contractor was secured to provide services to 12 (out of the 15 participating centers). Three centers were not ready for the task or were closed due to the pandemic. Note. Results from Y2 data gathering (2019-2020) will be reported at a later time. NC State University has been working remotely since March 17due to COVID-19, delaying cooperative work of the research team. Preliminary results (2018-2019) confirm the impact of gardening on children's behavior: 1) increased children's knowledge of selected fruits (cantaloupe and blackberry) and vegetables (red pepper, yellow squash, tomato, and zucchini); and 2) statistically significant steps per day increase (1.9%, P=.02) and 20 outdoor minutes/week increase (non-significant, P=.10). The latter is a considerable amount of time for children that, in some cases, spend one hour or less outside every day. The Gardening Activity Guide, created by this study to support teachers is now a peer reviewed publication included in the Extension Publications Catalog. URL https://content.ces.ncsu.edu/natural-learning-initiative-gardening-activity-guide.The Guide is also widely disseminated via the Natural Learning Initiative website, reaching thousands of child care providers. The Guide has been shared with the NC Community College System and nationally via their network partner organization named ACCESS. RESEARCH a) Contribute scientific evidence on hands-on FV gardening in childcare. The data gathering session (9/19) was executed and preliminary results are being analyzed. The second data collection session (during this reporting period) was postponed due to COVID-19 and will be rescheduled once the "stay-at-home" order has been lifted. b) Assess the impact of a Gardening Component on 300, 4-5 year old, enrolled in 15 childcare centers in Wake Co, NC. Posttest data for the Year 2 RCT (September 2019) was collected from 15 centers, 288 children. Pretest Year 3 RCT (April 2020) was not collected due to COVID-19. c) Using a waitlist/control group, randomized controlled trial (RCT), assess the impact of FV gardening intervention on children's PA, FV liking, FV knowledge, and FV consumption. Activities. Fruit and Vegetable (FV) gardens were installed in 15 participating centers: 5 at intervention centers (Y1), May 2018; five at Waitlist centers, May 2019; and 5 are being installed at control sites (Y3) May 2020. Data. Y2 post intervention data was gathered in August 2019. Data gathering scheduled for April 2020 was canceled due to COVID 10. Results will be shared as stay-at-home order is lifted, data is gathered, and the university resumes normal activity. EDUCATION a) Highlight the impact of preschool FV gardening on PA and FV consumption as a long-term health promotion strategy by adding an evidence-based gardening component to the POD Higher Education Modules. The Gardening Activity Guide was created to support intervention sites. The Guide recently completed is included in the POD Higher Education Modules. Outcomes. Included in foundational courses the Guide contributes to the delivery of skills training for implementation to support change in knowledge, action, and conditions. Due to COVID-19 the Gardening Activity Guide along with other resources is part of a suite created by NLI to aid teachers, parents, and college instructors in early childhood. b) Engage pre-professional instructors by disseminating modules through community college courses in early childhood, culinary arts, horticulture, landscape design and construction. Activities. NC Community College System instructors received the Gardening Activity Guide and special package of resources to support their online teaching during COVID. Outcomes. Materials shared. c) Transfer knowledge to these fields by including evidence-based gardening component in post-professional certificate programs. Activities. 2019 Extension Master Gardener College. NC State University Fox Hall. June 7th, 2019. Outcomes: Gardening Activity Guide sections were successfully shared with Master Gardeners. d) Promote replication of gardening component by professional networks in NC, SC, Texas, and other venues. Delayed due to COVID-19 restrictions. e) Identify early adopters and provide technical assistance for implementation. Delayed due to COVID-19 restrictions. EXTENSION a) Disseminate information, tools, and resources to support parents, community leaders, TA providers, extension agents, community college instructors, and public health professionals. Activities. Dissemination of information, tools and resources is being discussed with Extension partners as materials are developed and tested. Outcomes. A presentation was given on June 7, 2019 at the Extension Master Gardener Gathering, NCSU. The Gardening Activity Guide has been peer reviewed by NC Cooperative Extension. b) Develop online resources for delivery via eXtension and other distance/higher education systems, other. Activities. To identify resources needed and define best channels for disseminating findings and resources, a coordination meeting (6/3/19) was conducted with: NCSU EFNET Coordinator; Local Foods Ext Specialist; Urban Horticulture Ext Faculty; and Regional Nutrition Extension Association, EFNEP and SNAP-Ed. Outcomes. Recognition of the lack of resources is shown along with strong support and desire to collaborate. c) Train extension agents, TA providers, and EC educators [...]. Ongoing, with delays due to COVID 19. d) Offer Expanded Food and Nutrition Education Program (EFNEP) cooking in Years 4 & 5. N/A

Publications

  • Type: Conference Papers and Presentations Status: Accepted Year Published: 2019 Citation: Cosco, N., Moore. R. USDA National Institute of Food Administration (NIFA) Annual Program Directors Meeting. Poster presentation. Outdoor Learning Environments as Active Food Systems: Effectiveness of the Preventing Obesity by Design Gardening Component. July 29-30, 2020. Orlando, Florida.
  • Type: Journal Articles Status: Other Year Published: 2020 Citation: Cosco, N., Monsur, M., Wells, N., Moore, R., & Goodell, L. COLEAFS: Design of a Randomized Controlled Trial (RCT) for a Hands-On Fruit and Vegetable (FV) Intervention to Promote Healthy Eating and Physical Activity in Preschool Children Attending Childcare Centers. To be submitted to Journal of Nutrition Education and Behavior, Research Methods. Submission dated June 15, 2020.
  • Type: Journal Articles Status: Other Year Published: 2020 Citation: Cosco, N., Sledge, B., Monsur, M., Babb, M., & Moore, R. Hands-on Gardening Activities for Healthy Behavioral Outcomes: A Guide for Teachers to Engage Preschool Children in Gardening Opportunities in Childcare Centers. To be submitted to Journal of Nutrition Education and Behavior, Great Educational Materials (GEM section).


Progress 06/01/18 to 05/31/19

Outputs
Target Audience:In 2019, Group 3 (five centers non-intervention, control) was added to the sample composed of 273 children enrolled in 15 childcare centers located in Wake County, North Carolina. The 15 participating centers have an average 52% subsidized enrollment which suggests that more than half of the sample reached during the current reporting period include children socially, economically, or educationally disadvantaged. Parents signed informed consent forms and received project flyers which included evidence-based information regarding the importance of healthy eating behaviors and physical activity in children for preventing early onset of obesity. Fifteen center directors and 42 teachers/caregivers were also reached by the project during the current reporting period. As in the past year, directors completed an online application containing information regarding the importance of children's healthy eating behaviors and physical activity for preventing obesity. Teachers received similar information through consent forms. Teachers received face-to-face information and educational guidance for conducting hands-on gardening activities with children. Additionally, teachers at intervention sites (n=5) received a hard copy of the Gardening Guide. During this reporting period, 29 volunteers (28 undergraduates and 1 graduate student from NC State University) received online and face-to-training for data collection. Since the beginning of the study, a total of 62 NC State University undergraduate and graduate students have received trainings, which include science-based knowledge regarding the importance of healthy eating behaviors for preventing early onset obesity, scientific procedures for collecting data on children's liking of fruit and vegetables, physical activity monitoring, and technical/hands-on knowledge regarding food safety. Changes/Problems:Challenges 1) Because of lack of adequate preparation space, fruit and vegetables were store-bought, pre-cut, after detailed briefing of the vendor. Careful measuring of individual cups and preparation of trays was executed by trained RAs following proper food safety measures. 2) The data-gathering session scheduled for the second week of September 2018 was rescheduled due to hurricane Florence that hit North Carolina September 12-15, 2018. Changes A control center had to be replaced due to lack of approval by parents. Unknown to the researchers, the center had been part of another research project for the last three years, which may have felt like an over burden and provoked parents not to accept the invitation to join the study. A comparable center was added to the sample. What opportunities for training and professional development has the project provided?As in the previous year, training was provided to Lead and Volunteer Research Assistants (RAs) prior to data collection in April 2019. These sessions were attended by the 5 lead research assistants and 29 volunteer research assistants. All RAs were required to take online and in-person training sessions prior to data collection. Online Training sessions The online training, AFRI Preventing Obesity by Design Nutrition Research Training Program was delivered via Moodle (NC State University distance education platform). Topics: 1) Hygiene 2) Food Handling 3) Knife Skills 4) Collaborative Institutional Training Initiative's Human Subjects Research course. In-Person Training sessions The following in-person training sessions were held to accommodate class schedules of all research assistants for training on different data gathering protocols: 1) Study Introduction Muntazar Monsur, PhD, Natural Learning Initiative, NCSU, Study Coordinator. 2) Accelerometer monitoring. Derek Hales, PhD, UNC Center for Health Promotion and Disease Prevention, UNC-Chape Hill. Topic: overview of measuring physical activity methods; proper accelerometer fitting, interacting with children, and daily routine for accelerometer usage and storage. 3) Fruit and Vegetable Liking. Latasha Williams, MS, RD,LDN, Ph.D. Candidate, Departmentof Food, Bioprocessing, and Nutrition Sciences, NCSU. Muntazar Monsur, PhD, Natural Learning Initiative, College of Design, NCSU Topic: "Plucky the Pea" story and activity, use of survey instrument, and how to interact with children. 4) Fruit and Vegetable Preparation and Consumption. Latasha Williams, MS, RD,LDN, Ph.D. Candidate, Departmentof Food, Bioprocessing, and Nutrition Sciences, NCSU. Topic: Food preparation: food and kitchen safety, proper food cutting and handling of different fruits and vegetables, and food weighing and packaging. Consumption portion covered the standardized script to read to the children, how to present the food trays, how to record observations, packing of food waste, and weighing and recording food waste data. The narrative script lets children know what to expect during the snack time and what to do when they have finished eating what they wanted. How to interact with children is also covered, including how not to positively or negatively reinforce eating behaviors. 5) Early Education Garden Trainer Research Assistant In house training conducted by the Natural Learning Initiative team, College of Design, NCSU. Topic: The importance of healthy eating and physical activity, gardening with children, introduction to randomized controlled trial methods and ethical issues, gathering research data in the field, processing data systematically. How have the results been disseminated to communities of interest?Conferences presentations to public health, early childhood education, and landscape design audiences. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? Impact. Every day over 11 million US children younger than five attend some type of child care arrangement where they spend the majority of their waking hours, learn, eat, and exercise. This project aims to influence policies to improve healthy eating and active living of children 4 and 5 years old by creating evidence to support the critical importance of gardening in early childhood. In addition to the study sample of 273 children, the installation of fruit and vegetable (FV) gardens is already benefitting all children attending intervention sites estimated at more than 1,000 children to date. This promising, integrated gardening strategy has the potential to reach approximately 76% US population living in regions with a growing season >200 days/year, where 77% US regulated childcare centers are located. Results will guide innovative child care policies recognizing the outdoors in childcare facilities as salutogenic and supporting the installation of FV gardens, especially in vulnerable communities. Preliminary results confirm the impact of gardening on children's behavior: 1) increased children's knowledge of selected fruits (cantaloupe, blackberry) and vegetables (red pepper, yellow squash, tomato, and zucchini); and 2) statistically significant steps per day increase (1.9%, P=.02) and 20 outdoor minutes/week increase (non-significant, P=.10). The latter is a considerable amount of time for children that, in some cases, spend one hour or less outside every day. Coupled with director and teacher enthusiasm (documented by interviews and visits), we have already seen changes in attitudes showing motivation to continue gardening after the Year One intervention ended (October 2018): four/five (80%) intervention centers continued gardening over the cool season and started independently caring for the garden in Spring 2019. The project will continue to monitor this intervention "carryover effect." The Gardening Guide, created by this study to support teachers at intervention sites, was positively received and serves to coach teachers over the growing season. Distribution has been extended to early childhood providers participating in Preventing Obesity by Design (POD) projects, thus expanding reach to 40 child care centers and approx. 60 teachers working with 3,600 children across North Carolina. Additionally, the Guide is used as a resource tool for a Collaborative Teacher Network (16 centers serving ~1,100 children in Wake Co, NC). The Guide will be adopted by the NC Community College system next Fall, for use by Early Childhood Education students (Education). New role! The Garden Trainer / Research Assistant role brings together the fields of early childhood education and healthy living combined with expertise in horticulture, experiential learning, food production, and adult education (coaching teachers). The role focuses primarily on monitoring FV gardens (watering and weeding), using the Gardening Guide to coach teachers in weekly gardening activities, collecting weekly information about activities performed with children at intervention centers, and conducting a short interview at the end of the season. The garden trainer is an emerging professional area connecting indoor-outdoor healthy learning experiences in a seamless process. RESEARCH a) Contribute scientific evidence supporting hands-on FV gardening in childcare. Two data gathering sessions (9/18 and 4/19) were executed and preliminary results are being analyzed. b) Assess the impact of a Gardening Component on 300, 4-5 year olds, enrolled in 15 childcare centers in Wake Co, NC. Posttest data for Year 1 RCT (September 2018) and pretest Year 2 RCT (April 2019) were collected from 15 centers, 273 children. c) Using a waitlist/control group, randomized controlled trial (RCT), to assess the impact of FV gardening intervention on children's PA, FV liking, FV knowledge, and FV consumption. Activities. Intervention Fruit and Vegetable (FV) gardens were installed in 10 participating centers - 5 FV Year 1 (Y1) gardens, May 2018 and 5 FV gardens in Waitlist centers May 2019. Data. Y1 RCT posttest data were collected from 10 centers: 5 Intervention/5 Waitlist; 148 children September 2018. Y2 RCT Pretest data were collected from 10 centers: 5 Waitlist/5 Control centers; 160 children April-May 2019. Note: Y1 35 children continue to participate. Results Preliminary analyses show: 1) increased children's knowledge of selected fruits (cantaloupe, blackberry) and vegetables (red pepper, yellow squash, tomato, zucchini); and 2) PA statistically significant steps per day increase (1.9%, P=.02) and 20 min/week increase (non-significant, P=.10). Outcomes. Change in Condition: Creation of 10 FV gardens. Y2: 194 children and 42 teachers/caregivers in 10 intervention centers. Gardens are actively used by teachers and children and 4/5 (80%) intervention centers continued to use installed gardens during winter, after intervention ended October 2018. EDUCATION a) Highlighttheimpactofpreschool FVgardening on PAand FVconsumptionas a promotionstrategyby adding an evidence-based gardening componenttothePODHigher Education Modules.The Gardening Guide was created to support intervention sites. A pilot project at Piedmont Com College, EC Education program is scheduled for Spring 2019 (courses #157 Active Play and #153 Safety and Nutrition). At completion, the Gardening Guide will be included in the POD Higher Education Modules. Outcomes. Included in foundation courses the Guide contributes to delivery of skills training for implementation to support change in knowledge, action, and conditions. b) Engage pre-professional instructors by disseminating modules through community college course to courses in EC, culinary arts, horticulture, landscape design and construction. Activities. After the pilot is finalized in Spring 2019, NC Com College System instructors are invited to include the Gardening Guide as a teaching resource. Also invited are community college lab schools. An evaluation protocol will be created to assess resource utility. Outcomes: planning, timeline and strategy to engage community college instructors in place. c) Transfer knowledge to these fields by including evidence-based gardening component in post-professional certificate programs. Activities. Application is underway to present at the 2019 NC Community Colleges Conference, October 7-9, 2019, Raleigh. Outcomes: Gardening Guide sections were successfully used in the Early Childhood Garden Teacher Online Network, Spring 2019 (16 POD centers, Wake Co, NC). d) Promote replication of gardening component by professional networks in NC, SC, Texas, other. Years 4&5. e) Identify early adopters and provide technical assistance for implementation. Years 4&5. EXTENSION a) Disseminate information, tools, and resources to support parents, community leaders, TA providers, extension agents, community college instructors, and public health professionals. Activities. Dissemination of information, tools and resources is being discussed with Extension partners as materials are developed and tested. Outcomes. A presentation is scheduled for June 7, 2019 at the Extension Master Gardener Gathering, NCSU. Gardening Guide is currently under peer review by Extension. b) Develop online resources for delivery via eXtension and other distance/higher education systems, other. Activities. To identify resources needed and define best channels for disseminating findings and resources, a coordination meeting (6/3/19) is scheduled with NCSU EFNET Coordinator; Local Foods Ext Specialist; Urban Horticulture Ext Faculty; and Regional Nutrition Extension Assoc, EFNEP and SNAP-Ed. Outcomes. Recognition of the lack of resources along with strong support and desire to collaborate. c) Train extension agents, TA providers, and EC educators [...]. Year 3 Activity. d) Offer Expanded Food and Nutrition Education Program (EFNEP) cooking in Years 4 & 5. N/A

Publications

  • Type: Conference Papers and Presentations Status: Accepted Year Published: 2019 Citation: Cosco N, Monsur M. Effectiveness of the Preventing Obesity by Design Gardening Component. Environmental Design Research Conference EDRA-50, May 23-26, Brooklyn. Oral presentation.
  • Type: Journal Articles Status: Other Year Published: 2020 Citation: Cosco, N., Monsur, M., Wells, N., Moore, R., & Goodell, L. COLEAFS: Design of a Randomized Controlled Trial (RCT) for a Hands-On Fruit and Vegetable (FV) Intervention to Promote Healthy Eating and Physical Activity in Preschool Children Attending Childcare Centers. To be submitted to Journal of Nutrition Education and Behavior, Research Methods. In progress.
  • Type: Journal Articles Status: Other Year Published: 2020 Citation: Cosco, N., Sledge, B., Monsur, M., Babb, M., & Moore, R. Hands-on Gardening Activities for Healthy Behavioral Outcomes: A Guide for Teachers to Engage Preschool Children in Gardening Opportunities in Childcare Centers. To be submitted to Journal of Nutrition Education and Behavior, Great Educational Materials (GEM section). In progress.
  • Type: Conference Papers and Presentations Status: Accepted Year Published: 2019 Citation: Wells, N. School Gardens & Physical Activity: Among the mechanisms linking green space to health? Green Infrastructure and Public Health Conference,Beijing Forestry University, Beijing, China. May, 2019
  • Type: Conference Papers and Presentations Status: Accepted Year Published: 2019 Citation: Cosco N, Monsur M, Moore R. Fruit and vegetable (FV) garden for preventing obesity: Hands-on gardening to increase physical activity and FV liking among preschool age children. Active Living Conference, February 17-20, 2019. Charleston, SC. Poster presentation.


Progress 06/01/17 to 05/31/18

Outputs
Target Audience:A total of 136 children attending 10 childcare centers located in Wake County, North Carolina were recruited. Parents signed informed consent forms and received project flyers which included evidence based information regarding the importance of healthy eating behaviors and physical activity in children for preventing early onset of obesity. The ten participating centers have an average of 49% subsidized enrollment which suggests that almost half of the audience reached during the current reporting period are socially, economically, or educationally disadvantaged. Ten center directors and 22 teachers/caregivers were also reached by the project efforts during the current reporting period. Directors completed an online application containing information regarding the importance of children's healthy eating behaviors and physical activity for preventing obesity. Teachers also received similar information through consent forms. Additionally, teachers received face-to-face trainings and educational guidance for conducting hands-on gardening activities with children. Four volunteer graduate students and 12 volunteer undergraduate students of NC State University received online and face-to-training for data collection during the current reporting period. Trainings included science-based knowledge regarding the importance of healthy eating behaviors in children for preventing early onset obesity, scientific procedures for collecting data on children's liking of fruit and vegetables, physical activity monitoring, and technical/hands-on knowledge regarding food safety. Changes/Problems:Changes and Challenges Accelerometers are being used to measure physical activity instead of pedometers. After further review and refinement of methods we concluded that using accelerometers would be most appropriate to meet the goals of the study. Accelerometers allow determination of the exact time of activity that, linked to teacher journaling, will help identify the location of children at any given time. Accelerometers will be set at a 5-second epoch, thus providing accurate information about bouts of activity. Accelerometer source is the Department of Nutrition, UNC Gillings School of Global Public Health, including support for processing and reporting results. This is a no cost revision. Instead of store-bought, fruits and vegetable snacks were prepared at the Department of Food, Bioprocessing and Nutrition Sciences, NC State University Store-bought pre-cut fruits and vegetables were not readily available. Whole fruits and vegetables were purchased and snacks were prepared at a NC State University industrial kitchen facility. All food safety measures were followed during the process. Challenge: Lower number of children subjects The original research goal was to recruit approximately 20 children per classroom. However, most of the classrooms have fewer children. Also, children are sometimes moved between classrooms, which creates additional challenges for data collection. Additional classroom groups were invited to join the study. What opportunities for training and professional development has the project provided?Training was provided to Lead and Volunteer Research Assistants (RAs) prior to the data collection in April 2018. These sessions were attended by the 5 lead research assistants and 16 volunteer research assistants. All RAs were required to take online and in-person training sessions prior to data collection. Online Training sessions The online training, AFRI Preventing Obesity by Design Nutrition Research Training Program was delivered via Moodle (NC State University distance education platform). Topics included: 1) Hygiene, 2) Food Handling 3) Knife Skills 4) Collaborative Institutional Training Initiative's Human Subjects Research course. In-Person Training sessions Following, three in-person training sessions were held to accommodate class schedules of all research assistants for training on different data gathering protocols: 1) Introduction to the Study Nilda Cosco, PhD, Natural Learning Initiative, College of Design, Program Director 2) Accelerometer monitoring. Derek Hales, PhD, UNC Center for Health Promotion and Disease Prevention, UNC. Topics: overview of measuring physical activity methods; proper accelerometer fitting, interacting with children, and daily routine for accelerometer usage and storage. 2) Fruit and Vegetable Liking. Lora Suzie Goodell, PhD, NCSU, Dept. of Food, Bioprocessing, and Nutrition Sciences. Muntazar Monsur, PhD, NCSU, Natural Learning Initiative, College of Design Topics: "Plucky the Pea" story and activity, use of survey instrument, and how to interact with the children. 3) Fruit and Vegetable Preparation and Consumption. Lora Suzie Goodell, PhD, NCSU, Dept. of Food, Bioprocessing, and Nutrition Sciences. Topics: Food preparation: food and kitchen safety, proper food cutting and handling of the different fruits and vegetables, and food weighing and packaging. Consumption portion covered the standardized script to read to the children, how to present the food trays, how to record observations, packing of food waste, and weighing and recording food waste data. The script let the children know what to expect during the snack time and what to do when they finished eating what they wanted. How to interact with the children was covered including how not to positively or negatively reinforce eating behaviors. How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? The aim of this randomized, controlled trial (RCT) project is to influence childcare policies by creating evidence of the critical importance of gardening in early childhood (EC) to acquire healthy eating behaviors and active lifestyles, and thus, counteract the early onset of obesity. The RESEARCH function measures the effectiveness of the Preventing Obesity by Design (POD) active fruit and vegetable gardening component to increase physical activity and fresh produce liking, knowledge, and consumption in vulnerable preschoolers attending childcare. Three groups of 5 Wake County, NC, childcare centers (N=15) were randomly assigned from a pool meeting selection criteria. A total of 136 children are participating in Year 1. Researchers, RAs, and staff successfully completed the Responsible Conduct of Research RCR Training. NC State University IRB approved the study. The project team conducted a project full review (protocols updated, tools refined, touch-enabled iPad interface created). Quarterly meetings are held. To secure sustainability, outreach, and knowledge transfer, research findings will be included in the EDUCATION function to create higher education modules. End-user resources on the potential for increasing fruit and vegetable consumption will be disseminated through the EXTENSION function via eXtension and EFNEP. Response of childcare directors and teachers in Group 1 ("intervention") and Group 2 ("waitlist") centers (N=10) has been enthusiastically positive with center directors and teachers expressing a strong desire to learn about gardening and outdoor learning. Groups 1 &2 centers were initially visited by PI/co-PI and garden locations verified March 2018. Baseline data was gathered mid-April 2018. Standardized gardens were installed in Group 1 centers, early May 2018. Impact. Improvement of childcare outdoor environmental quality and hands-on gardening (micro-farming) will increase preschool physical activity, fruit and vegetable liking, knowledge, and consumption. This promising strategy has potential to reach a large proportion of the US population living in regions with a growing season >200 days/year (approximately 76%), where a majority of US regulated childcare centers (77%) are located. RESEARCH a) Contribute scientific evidence to the currently under-researched area of hands-on FV gardening in childcare. Preliminary results available late 2018. b) Assess the impact of a Gardening Component on 300, 4-5 year olds, enrolled in 15 childcare centers in Wake Co, NC. A Pilot Project was conducted Nov. 20, 2018 at a non-participating childcare center (Childcare Network #61, Raleigh, NC) to test protocols, estimate amount of data gathering time, and confirm touch-enabled interface effectiveness. Accelerometers were substituted for pedometers. Baseline data were collected in Group 1 & 2 centers (Apr. 02-19, 2018), including: physical activity using accelerometers, three consecutive days; fruit/vegetable liking and knowledge via modified touch-enabled interface; vegetable/fruit tasting and consumption using well-established protocols; and outdoor physical/learning environment variables using POEMS & Best Practice Indicators. Research activities were documented photographically. Data is currently being prepared to perform statistical analyses. c) Using a waitlist/control group, randomized controlled trial (RCT) research design, assess the impact of FV gardening intervention on children's physical activity, FV liking, FV knowledge, and FV consumption. Eligibility: Wake Co. Smart Start collaborated to assess all 359 centers in Wake Co for eligibility. Criteria: 1) Hold a 4 or 5-NC Star Rated License; 2) Serve a majority of children under the Wake Co Child Care Subsidy Program; 3) Contain at least 2 preschool classrooms; 4) Enrollment size within the middle third for Wake Co; 5) Operate a regulated on-site kitchen; 6) Employ cooking staff; 7) Open year-round; 8) Own/lease space for at least 5 years into the future; and 9) Do not have on-site gardening but interested in implementing. Astringent eligibility criteria considerably reduced pool of centers. Consequently, centers with lower number of children with subsidies (30%) were included in the pool. Recruitment efforts: 1) Flyer distributed by Wake Co Smart Start; 2) Follow-up calls; 3) Information packet (summary, eligibility criteria, activities). All participating teachers signed consent forms. Five intervention centers received standardized, 6-bed garden installation and a Gardening Guide (fidelity tool). RAs visit intervention centers weekly to tend gardens and collect information from teachers using the Gardening Guide. d) Translate research findings for Education and Extension Functions. End of Project Year 2. EDUCATION a) Highlight the impact of preschool FV gardening on PA and FV consumption as a long-term health promotion strategy by adding an evidence-based gardening component to the POD Higher Education Modules. Opportunities to add a gardening component to the POD Higher Education Modules includes creation of an Early Childhood Gardening component in the required Community College class (#153 Health, Safety, and Nutrition, NC Community College System), to be developed in Year 2. b) Engage pre-professional instructors by disseminating modules through community college course library systems to courses in EC, culinary arts, movement education, horticulture, landscape design and construction. Project team members will confer with other higher education faculty in national conferences to assess the potential for disseminating of modules nationally. c) Transfer knowledge to these fields by including evidence-based gardening component in post-professional certificate programs. Developed project materials will be included in the Certificate Programs conducted by the Natural Learning Initiative for the Fall 2018 Section. d) Promote replication of gardening component by professional networks in North and South Carolina, Texas (see letters of support), and other states. Replication process planned in Year 2. e) Identify early adopters and provide technical assistance for implementation. Replication activities will contain evaluation surveys to identify early adopters. EXTENSION a) Disseminate information, tools, and resources to support parents, community leaders, TA providers, extension agents, community college instructors, and public health professionals to implement evidence-based, children's FV gardening. Dissemination of information, tools and resources will follow as soon as preliminary results are available. Several opportunities have been identified including presentations at conferences and meetings of: extension (local, state), Master Gardeners, green industry, and Youth, Family and Community Sciences. Presentations will be developed as soon as the resources are created. b) Develop online resources for delivery via eXtension and other distance/higher education systems, professional and collaborators' networks, Farm-to-Childcare, and related state level and national organizations. User needs assessment conducted (EC educators, regulators, Farm-to-Childcare, and newly created Food Master Volunteers) to start resource development. Year 2 Activities will include resource/dissemination assessment: 1) Potential gardening component for existing healthy eating program (Color Me Healthy); 2) Peer reviewed extension publications on early childhood gardening (planning, installing, managing); 3) Continuing education offering for Food Master Volunteers and Master Gardeners. c) Train extension agents, technical assistance providers, and EC educators to deliver children's gardening/micro-farming TA and training to create an evidence-based community of practice. Year 3 Activity. d) Offer Expanded Food and Nutrition Education Program (EFNEP) cooking series for parents and teachers in Years 4 & 5. N/A

Publications