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      Impact of school-based vegetable garden and physical activity coordinated health interventions on weight status and weight-related behaviors of ethnically diverse, low-income students: Study design and baseline data of the Texas, Grow! Eat! Go! (TGEG) cluster-randomized controlled trial

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          Abstract

          Background

          Coordinated, multi-component school-based interventions can improve health behaviors in children, as well as parents, and impact the weight status of students. By leveraging a unique collaboration between Texas AgriLife Extension (a federal, state and county funded educational outreach organization) and the University of Texas School of Public Health, the Texas Grow! Eat! Go! Study (TGEG) modeled the effectiveness of utilizing existing programs and volunteer infrastructure to disseminate an enhanced Coordinated School Health program. The five-year TGEG study was developed to assess the independent and combined impact of gardening, nutrition and physical activity intervention(s) on the prevalence of healthy eating, physical activity and weight status among low-income elementary students. The purpose of this paper is to report on study design, baseline characteristics, intervention approaches, data collection and baseline data.

          Methods

          The study design for the TGEG study consisted of a factorial group randomized controlled trial (RCT) in which 28 schools were randomly assigned to one of 4 treatment groups: (1) Coordinated Approach to Child Health (CATCH) only (Comparison), (2) CATCH plus school garden intervention [Learn, Grow, Eat & Go! (LGEG)], (3) CATCH plus physical activity intervention [Walk Across Texas (WAT)], and (4) CATCH plus LGEG plus WAT (Combined). The outcome variables include student’s weight status, vegetable and sugar sweetened beverage consumption, physical activity, and sedentary behavior. Parents were assessed for home environmental variables including availability of certain foods, social support of student health behaviors, parent engagement and behavior modeling.

          Results

          Descriptive data are presented for students ( n = 1369) and parents ( n = 1206) at baseline. The sample consisted primarily of Hispanic and African American (53 % and 18 %, respectively) and low-income (i.e., 78 % eligible for Free and Reduced Price School Meals program and 43 % food insecure) students. On average, students did not meet national guidelines for vegetable consumption or physical activity. At baseline, no statistical differences for demographic or key outcome variables among the 4 treatment groups were observed.

          Conclusions

          The TGEG study targets a population of students and parents at high risk of obesity and related chronic conditions, utilizing a novel and collaborative approach to program formulation and delivery, and a rigorous, randomized study design.

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          Most cited references47

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          A review of correlates of physical activity of children and adolescents.

          Understanding the factors that influence physical activity can aid the design of more effective interventions. Previous reviews of correlates of youth physical activity have produced conflicting results. A comprehensive review of correlates of physical activity was conducted, and semiquantitative results were summarized separately for children (ages 3-12) and adolescents (ages 13-18). The 108 studies evaluated 40 variables for children and 48 variables for adolescents. About 60% of all reported associations with physical activity were statistically significant. Variables that were consistently associated with children's physical activity were sex (male), parental overweight status, physical activity preferences, intention to be active, perceived barriers (inverse), previous physical activity, healthy diet, program/facility access, and time spent outdoors. Variables that were consistently associated with adolescents' physical activity were sex (male), ethnicity (white), age (inverse), perceived activity competence, intentions, depression (inverse), previous physical activity, community sports, sensation seeking, sedentary after school and on weekends (inverse), parent support, support from others, sibling physical activity, direct help from parents, and opportunities to exercise. These consistently related variables should be confirmed in prospective studies, and interventions to improve the modifiable variables should be developed and evaluated.
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            Reducing children's television viewing to prevent obesity: a randomized controlled trial.

            Some observational studies have found an association between television viewing and child and adolescent adiposity. To assess the effects of reducing television, videotape, and video game use on changes in adiposity, physical activity, and dietary intake. Randomized controlled school-based trial conducted from September 1996 to April 1997. Two sociodemographically and scholastically matched public elementary schools in San Jose, Calif. Of 198 third- and fourth-grade students, who were given parental consent to participate, 192 students (mean age, 8.9 years) completed the study. Children in 1 elementary school received an 18-lesson, 6-month classroom curriculum to reduce television, videotape, and video game use. Changes in measures of height, weight, triceps skinfold thickness, waist and hip circumferences, and cardiorespiratory fitness; self-reported media use, physical activity, and dietary behaviors; and parental report of child and family behaviors. The primary outcome measure was body mass index, calculated as weight in kilograms divided by the square of height in meters. Compared with controls, children in the intervention group had statistically significant relative decreases in body mass index (intervention vs control change: 18.38 to 18.67 kg/m2 vs 18.10 to 18.81 kg/m2, respectively; adjusted difference -0.45 kg/m2 [95% confidence interval [CI], -0.73 to -0.17]; P = .002), triceps skinfold thickness (intervention vs control change: 14.55 to 15.47 mm vs 13.97 to 16.46 mm, respectively; adjusted difference, -1.47 mm [95% CI, -2.41 to -0.54]; P=.002), waist circumference (intervention vs control change: 60.48 to 63.57 cm vs 59.51 to 64.73 cm, respectively; adjusted difference, -2.30 cm [95% CI, -3.27 to -1.33]; P<.001), and waist-to-hip ratio (intervention vs control change: 0.83 to 0.83 vs 0.82 to 0.84, respectively; adjusted difference, -0.02 [95% CI, -0.03 to -0.01]; P<.001). Relative to controls, intervention group changes were accompanied by statistically significant decreases in children's reported television viewing and meals eaten in front of the television. There were no statistically significant differences between groups for changes in high-fat food intake, moderate-to-vigorous physical activity, and cardiorespiratory fitness. Reducing television, videotape, and video game use may be a promising, population-based approach to prevent childhood obesity.
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              Family dinner and diet quality among older children and adolescents.

              The proportion of children eating dinner with their families declines with age and has decreased over time. Few data exist concerning the nutritional effect of eating family dinner. To examine the associations between frequency of eating dinner with family and measures of diet quality. Cross-sectional. A national convenience sample. There were 8677 girls and 7525 boys in the study, aged 9 to 14 years, who were children of the participants in the ongoing Nurses' Health Study II. We collected data from a self-administered mailed survey, including food and nutrient intakes from a validated semiquantitative food frequency questionnaire. Main outcome measures included servings per day of selected foods and food groups, daily intakes of selected macronutrients and micronutrients, and frequency of multivitamin use. Approximately 17% of participants ate dinner with members of their family never or some days, 40% on most days, and 43% every day. More than half of the 9-year-olds ate family dinner every day, whereas only about one third of 14-year-olds did so. In age- and sex-adjusted logistic regression models, the odds ratios associated with a frequency of family dinner of most days compared with never or some days, or every day compared with most days, were as follows: for eating at least 5 servings per day of fruits and vegetables, 1.45 (95% confidence interval [CI], 1.37-1.53); for eating any fried foods away from home, 0.67 (95% CI, 0.64-0.70); and for drinking any soda, 0.73 (95% CI, 0.66-0.80). Multiple linear regression showed that an increased frequency of family dinner was also associated with substantially higher intake of several nutrients, including fiber, calcium, folate, iron, vitamins B6, B12, C, and E; lower glycemic load; and lower intake of saturated and trans fat as a percentage of energy. We observed little or no effect on intakes of whole dairy products, red meat, or snack foods. Patterns were similar for boys and girls. Eating family dinner was associated with healthful dietary intake patterns, including more fruits and vegetables, less fried food and soda, less saturated and trans fat, lower glycemic load, more fiber and micronutrients from food, and no material differences in red meat or snack foods.
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                Author and article information

                Contributors
                Alexandra.e.evans@uth.tmc.edu
                Nalini.Ranjit@uth.tmc.edu
                Deanna.M.Hoelscher@uth.tmc.edu
                Christine.E.Jovanovic@uth.tmc.edu
                MLLopez@ag.tamu.edu
                w-mcintosh@tamu.edu
                mory@tamu.edu
                l-whittlesey@tamu.edu
                eljmckyer@tamu.edu
                AKirk@ag.tamu.edu
                Carolyn.L.Smith@uth.tmc.edu
                ccwalton@tamu.edu
                natalia.i.heredia@uth.tmc.edu
                Jl-warren@tamu.edu
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                13 September 2016
                13 September 2016
                2016
                : 16
                : 1
                : 973
                Affiliations
                [1 ]Michael & Susan Dell Center for Healthy Living - Division of Health Promotion and Behavioral Sciences - University of Texas Health (UTHealth) Science Center, Austin Regional Campus, Austin, USA
                [2 ]Division of Behavioral Science and Health Promotion, University of Texas Health Science Center (UTHealth) School of Public Health, Houston, USA
                [3 ]Family Development & Resource Management, Texas A&M AgriLife Extension Service, College Station, USA
                [4 ]Recreation, Park and Tourism Sciences & Sociology, Texas A&M University, College Station, USA
                [5 ]Health Promotion and Community Health Sciences, Texas A&M Health Science Center School of Public Health, College Station, USA
                [6 ]Department of Horticultural Sciences, Texas A&M AgriLife Extension Service, College Station, USA
                [7 ]College of Education and Human Development, Transdisciplinary Center for Health Equity Research, Texas A&M University, College Station, USA
                [8 ]Center for Health Promotion and Prevention Research, University of Texas Health Science Center (UTHealth) School of Public Health, Houston, USA
                Article
                3453
                10.1186/s12889-016-3453-7
                5022204
                27624139
                2e059529-692e-4879-a42e-b7cdc6c272af
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 9 March 2016
                : 5 August 2016
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100005825, National Institute of Food and Agriculture;
                Award ID: 2011-68001-30138
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/http://dx.doi.org/10.13039/100000880, Michael and Susan Dell Foundation;
                Funded by: FundRef http://dx.doi.org/10.13039/100008746, National Cancer Center;
                Award ID: R25 CA57712
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                Public health
                school garden intervention,physical activity intervention,jmg,lgeg,wat,randomized controlled trial,low-income children,hispanic,african american

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