Henna Muzaffar

Background: Nutrition, cooking, and gardening lessons individually and together have been shown to increase fruit and vegetable (FV) consumption in school-aged children. The CATCH Rainbow program incorporated nutrition education, cooking, and gardening lessons aimed at increasing FV consumption in elementary school-aged children and assessed changes in participants’ BMI, self-reported FV consumption, and skin carotenoid levels at baseline and post-intervention. Methods: Two-hundred and twenty-five 4th and 5th graders (mean age: 9.8 years and 52% male participants) at Genoa Elementary School participated in six cooking and six gardening sessions between September 2021 and May 2022. Each nutrition education session was 25 min long, paired with either hands-on cooking activities or gardening skills. At baseline and post-intervention, participants’ height and weight were assessed with a stadiometer/scale, and skin carotenoid measurement was taken by a Veggie Meter^® (Longevity Link Corporation (Salt Lake City, UT, USA)). Students also completed the Block Food Frequency Questionnaire to self-report FV consumption at both time points. Focus groups were conducted with children at the end of the program for qualitative feedback. Results: paired samples T-test and regression analysis results indicate no significant decrease in BMI or significant increase in skin carotenoid scores from pre- to post-intervention. However, though not significant, there was an increase in self-reported FV intake by 0.4 servings. Additionally, the qualitative feedback was positive, as children mentioned benefits of healthy eating and expressed enjoyment for growing, cooking, and tasting fruits and vegetables. Conclusions: Results from this study can be used to guide future cooking and gardening programs for elementary school children. Time of the year when implementing these programs and collecting data may impact study outcomes due to seasonal variations in fruit and vegetable intake.

Aim: The purpose of this systematic review was to evaluate robust interventions across seven eating practice outcomes and to consider potential modifiers, including parental involvement, intervention setting, and quality of food practice evaluation. Methods: The search procedure reflected Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Web of Science, PsychInfo, PubMed, and Elton B. Stephens Company (EBSCO) (2004–2019) were searched for studies that aimed to change children’s (2 to 12 years old) diet (one or more eating practice components: fruit, vegetables, whole grains, lower saturated fat, lower sugar-sweetened beverages (SSBs), intake of dairy, diet quality). Of 2316 papers, 22 met inclusion criteria. Results: Fruits ( n = 12) and vegetables ( n = 15) were the most frequent outcomes. Half of fruit-targeted, two-thirds of vegetable-targeted, half of fruit/vegetable-targeted, eight of nine SSB-targeted, and one of two whole grain-targeted outcomes showed significant improvements. The actual food intake change was modest in most cases. Eighteen interventions included parents, although the four that did not also reported significant outcomes. Most studies were conducted in schools, early childcare, or after-school programs ( n = 13) with significant improvements in most settings. Only about half of the studies involving children < 10 years used proxy reporting/direct observation. Eight studies included no reliability, validity, or citation for the method of dietary measurement. Conclusion: Robust studies continue to focus on one or two foods, parental involvement may be beneficial depending on the intervention, and more research is needed to establish best practices across all settings.

The objective is to compare the gardening, cooking, and combined cooking and gardening programs in elementary schools from the past decade (2011–2022) in improving six psychosocial and behavioral outcomes related to fruit and vegetable intake. This review was conducted following the PRISMA guidelines. Five scientific databases were searched to identify 4763 potential articles, 44 articles were retained after screening the studies’ abstract, and 36 articles were included after further investigation into each intervention. This review included 9 gardening-only programs, 8 cooking-only programs, and 19 combined cooking and gardening programs. The included studies were from 14 different countries with half of these studies took place in the United States (n = 18). Of the outcomes assessed, 100% (10/10) of the studies were effective in improving knowledge/skills, 90% effective in improving attitudes and self-efficacy to consume F and V (9/10), 80% produced significant results for gardening and cooking attitudes/behaviors (8/10) and willingness to try F and V (4/5), 68% (11/16) programs resulted in increase in F and V intake, and 62% (10/16) programs improved F and V preference. This review suggests that gardening-only programs (89%) and cooking-only programs (88%) were slightly more effective in producing significant findings compared to combined programs (84%), but more high-quality interventions are needed to confirm these findings.

To date, there is limited published literature on process evaluation of adolescent health promotion programs. In this paper, we describe the methods and results of PAWS Club process evaluation over 2 years of implementation to compare the effectiveness of delivery by peer and adult leaders. PAWS (Peer-education About Weight Steadiness) Club was a 12-week healthy lifestyle program, delivered to 6th and 7th graders by peer and adult educators, using cluster randomized controlled design. Peer educators were 8th graders in the program schools and adult educators were staff/teachers in the program schools. Trained university students filled out fidelity logs at each session led by peer and adult educators to assess program delivery. The fidelity logs included questions to collect information about the number of participants, duration of the session, percent of activities completed, and if lessons started on time, lesson objectives were clearly stated, lesson objectives were emphasized, demonstrations were visible to participants, all activities were completed, the leader was familiar with lessons, the leader maintained an appropriate pace, the leader kept participants on track, and the leader asked if participants had any questions. Adult educators had a higher mean performance for all questions compared to peer leaders. Significant differences were observed for emphasizing lesson objectives (p = 0.005), making demonstrations visible to participants (p = 0.031), being familiar with the lesson plan (p = 0.000), maintaining an appropriate pace (p = 0.000), keeping participants on track (p = 0.000), and asking if participants had any questions (p = 0.000). Significance was set at p < 0.05. Findings from the current study have implications for designing and conducting a process evaluation of complex healthy lifestyle programs with adolescents in schools. Additional training of peer educators may be needed to enhance program delivery.

Parents substantially influence children’s diet and physical activity behaviors, which consequently impact childhood obesity risk. Given this influence of parents, the objective of this umbrella review was to synthesize evidence on effects of parent involvement in diet and physical activity treatment and prevention interventions on obesity risk among children aged 3–12 years old. Ovid/MEDLINE, Elsevier/Embase, Wiley/Cochrane Library, Clarivate/Web of Science, EBSCO/CINAHL, EBSCO/PsycInfo, and Epistemonikos.org were searched from their inception through January 2020. Abstract screening, full-text review, quality assessment, and data extraction were conducted independently by at least two authors. Systematic reviews and meta-analyses of diet and physical activity interventions that described parent involvement, included a comparator/control, and measured child weight/weight status as a primary outcome among children aged 3–12 years old were included. Data were extracted at the level of the systematic review/meta-analysis, and findings were narratively synthesized. Of 4158 references identified, 14 systematic reviews and/or meta-analyses (eight treatment focused and six prevention focused) were included and ranged in quality from very low to very high. Our findings support the inclusion of a parent component in both treatment and prevention interventions to improve child weight/weight status outcomes. Of note, all prevention-focused reviews included a school-based component. Evidence to define optimal parent involvement type and duration and to define the best methods of involving parents across multiple environments (e.g., home, preschool, school) was inadequate and warrants further research. PROSPERO registration: CRD42018095360.

Overview. Experiential learning has become a common pedagogical approach to provide university students an opportunity to apply classroom-acquired knowledge and skills in real-world settings. Evaluation of such experiences from a student perspective is needed to improve experiential learning opportunities offered in higher education settings. Purpose. The purpose of this qualitative study was to evaluate the experience of 13 university students who rotated with a healthy lifestyle program for middle schoolers. Method. The Peer-education About Weight Steadiness Club program was implemented by peer or adult educators, as a healthy lifestyle after-school intervention. Trainees participated in a learning rotation with the program for 16 weeks and were exposed to research coordination and implementation of the nutrition and healthy lifestyles program. After finishing their rotation, trainees completed a structured elicitation interview conducted by a faculty member and a graduate assistant. The 11-question individual elicitation interview, ranging from 16 to 40 minutes, queried trainees on elements of the learning experience. A grounded theory approach was used to guide data coding and analyses, which led to formulation of themes. Results. Forty codes were assigned to segments of the interview responses, which were then coalesced to formulate six themes and 16 subthemes. Identified themes include (1) program context, (2) roles and responsibilities of trainees, (3) professional development of trainees, (4) overall program implementation, (5) factors influencing implementation, and (6) health and behavioral outcomes. Conclusions. Student trainees gained program content knowledge, acquired skills transferable to their careers, valued this learning experience, and planned to apply lessons learned.

Objective: In this study, we evaluated the afterschool PAWS (Peer-education About Weight Steadiness) Club program delivered by peer or adult educators to improve food choices, physical activity, and psychosocial variables related to healthy eating. Methods: We had 109 adolescents (53 in adult-led group; 56 in peer-led group) participate in a cluster randomized controlled intervention. The 12-session curriculum framed within Social Cognitive Theory (SCT) and Stages of Change addressed mediators of behavior change related to cooking skills, food intake, and physical activity. Anthropometric, dietary intake, physical activity, and SCT mediators were assessed at baseline, post-intervention, and 6-months post-intervention. Results: Adolescents in the peer-led group significantly improved whole grain intake at post-intervention (p = .017) and 6-months post-intervention (p = .014). Both peer-led and adult-led groups had significant reductions in caloric intake at 6-months post-intervention (p = .047). Only the adult-led group improved self-efficacy (SE) and social/family support (SS) for healthy eating at post-intervention [p = .019 (SE); p = .048 (SS)] and 6-months post-intervention [p = .036 (SE); p = .022 (SS)]. Conclusions: The PAWS Club program promoted lower caloric intake by adolescents. Peer educators were effective at increasing whole grains in adolescents, and adult educators contributed to positive changes in SE and SS related to healthy eating.

Objective: The PAWS (Peer-education About Weight Steadiness) Club program, grounded in So- cial Cognitive Theory (SCT), is an adolescent healthy lifestyle afterschool program. In this study, our objective was to assess the feasibility and reliability of the modified version of the PAWS Club SCT questionnaire in adolescents, compared to its original version. Methods: Overall, 21 youth aged 11-14 years participated in this study for PAWS Club SCT questionnaire, assessing psychosocial mediators of healthy dietary behaviors. Adolescents were randomly assigned to completing the initial 18-page questionnaire first, followed by the modified 9-page question- naire or vice versa. At the end, participants completed a brief form indicating which survey they preferred and why. A paired sample t-test assessed the difference in completion time between the 2 tools. Cronbach's alpha and Spearman correlation coefficients were used to measure inter- nal and inter-survey reliability. Results: About 71.4% participants indicated preference for the newly formatted questionnaire. The new form reduced completion time by half (p < .05). An 85% concordance was achieved between the scores on the initial and modified tool. Conclusion: The revised questionnaire is a shorter, quicker, and reliable tool to assess psychosocial mediators of dietary behaviors.

Obesity prevalence is higher among Hispanic children (22.4%) compared with general U.S. children (17%). Children of migrant and seasonal farmworking families are at heightened risk for obesity and related conditions. Limited research, including needs assessments and health promotion programs, has been conducted in Latino migrant farm working communities. Our objective was to identify needs, opportunities, and barriers for designing health promotion programs for children attending a community agency in a small Midwestern town. As part of a community-based participatory research project, a needs assessment was undertaken with 38 children aged 5 to 12 years (74% Latino). Measures included demographics, dietary patterns, physical activity (PA), and anthropometrics. The study was approved by the university’s institutional review board and written parental consent, and child assent, was obtained. More than half of the sample had overweight (29%) or obesity (26%); 31% had elevated blood pressure levels. Participants did not meet the U.S. Department of Agriculture recommendations for most food groups and nutrients; 13% fell into the “poor” and 87% into the “needs improvement” category based on Healthy Eating Index scores. PA levels were low; only 34% of respondents engaged in sufficient exercise. Findings indicate the need for programs promoting improvements in dietary intake and increased PA.