The effects of school gardens on fruit and vegetable consumption at school: A randomized controlled trial with low-income elementary schools in four U.S. states.

This randomized controlled trial examines the effects of a school garden intervention on children's fruit and vegetable (FV) consumption at school over two years. We randomly assigned schools to the intervention group that received gardens and related curriculum (n = 24) or to the waitlist control group that received gardens and curriculum at the conclusion of the study (n = 22). Children in second, fourth, and fifth grade at baseline (n = 2767) in low-income schools (n = 46) in four U.S. States (Arkansas, Iowa, New York, and Washington) participated. The intervention comprised gardens for each classroom; a curriculum focused on nutrition, plant science, and horticulture, including activities and FV tasting sessions; resources for the school that addressed topics such as soil contamination and food safety; an implementation guide focused on issues related to planning, planting, and maintaining the garden through the year, engaging volunteers, summer gardening, building community capacity, and sustaining the gardening program. FV consumption was measured by photographing lunches before and after children ate, for 2-3 days, at baseline and at each of 3 subsequent periods of data collection during the intervention. FV consumption was calculated using Digital Food Image Analysis. Among children in the intervention, fruit consumption and low-fat vegetable consumption increased from pre-garden baseline to post-garden more than among control group children. Garden intervention fidelity (GIF) also predicted changes in dietary intake, with more robust interventions showing a stronger effect than weaker interventions. GIF-lessons was a particularly potent predictor of change in dietary intake. School gardens modestly increase children's FV consumption at school.

The experiences of Hispanic families of children with autism spectrum disorder regarding physical activity.

BACKGROUND: Researchers seldom focus on the services needed for Hispanic children with ASD, especially in regard to physical activity (PA). PURPOSE: The purpose of this study was: (a) to explore why Hispanic families with children with ASD seek out and participate in PA, and (b) to describe the strategies and supports needed by Hispanic families of children with ASD to improve PA participation. METHODS: Participants in this descriptive-qualitative study were Hispanic parents of children with ASD (n = 9) who participated in one-on-one semi-structured telephone interviews. Interviews were transcribed and then analyzed using thematic line-by-line analysis. RESULTS: Two major themes emerged from the data: 1) Personal Responsibility and 2) "Every Day is a Different Challenge". Parents were motivated to engage in PA because of perceived health benefits for themselves and their children. Parents faced famililal and external barriers that impacted their participation. Participants commented on the role of culture (e.g., customs, lack of family support after immigration) in the context of these barriers. IMPLICATIONS: Further research is needed regarding culturally responsive PA interventions for Hispanic families with children with ASD.

Parents' intentions toward including their children with visual impairments in physical activities.

Purpose: Physical activity participation is essential for the healthy development of basic locomotor skills and for the overall wellbeing of children. Unfortunately, for children with visual impairments the opportunities to engage in physical activity are limited compared with their peers without disabilities. The purpose of this study was to determine and analyze the intentions of parents to include their children with visual impairments, as well as their entire family in physical activities after participating in a physical activity intervention.Methods: This descriptive-qualitative study was situated in the theory of planned behavior. On completion of a series of workshops, 10 parents took part in individual semi-structured interviews that were subsequently transcribed and analyzed using a thematic line-by-line analysis.Results: Through the data analysis three major themes emerged: (a) increased confidence, (b) influence on future intentions, and (c) conditional intentions.Conclusions: Results revealed that the physical activity intervention provided parents with an opportunity to engage their child in physical activities and to gain a deeper understanding of their child's disability. Consequently, the intervention enhanced parent's perceived teaching abilities and skills regarding physical activity.Implications for rehabilitationResults of this study demonstrated that a physical activity intervention have the potential to enhance intentions to engage in physical activity among children with visual impairments and their parents.As a result of this study, parents acquired the skills necessary to confidently engage their children in physical activity.The current physical activity intervention provided parents with an opportunity to engage their child in physical activities and to gain a deeper understanding of their child's disability.Physical activity interventions targeting children with visual impairments and their parents should consider the inclusion of oral presentations combined with written supplements or written manuals, and physical activity equipment.

Physical activity participation among families of children with visual impairments and blindness.

PURPOSE: Physical activity (PA) provides multiple benefits to children with visual impairments (VI) and their families. However, the empirical literature base is underdeveloped on how family PA experiences impact participation for children with VI. The purpose of this study was two-fold; that is: (a) to explore why families with children with VI seek out and participate in PA, and (b) to describe the strategies and supports needed by families of children with VI to improve PA participation. METHOD: The research method was descriptive-qualitative positioned in the theoretical framework of the theory of planned behavior. Participants were parents of children with VI (n = 10) who took part in one-on-one semi-structured telephone interviews. Interview recordings were transcribed and analyzed using a thematic line-by-line analysis. RESULTS: Three salient, recurrent, and interrelated themes emerged from the data analyses. These themes were: (a) committed, (b) challenged, and (c) access. CONCLUSIONS: Findings revealed that parents valued PA, but they lacked the skills to teach and advocate for their children regarding PA. As a consequence, parents voiced the need for a support system that would allow their families to be more physically active. Implications for Rehabilitation Results of this study demonstrated that parents valued physical activity, but they lacked the skills necessary to confidently engage their children in physical activity. Physical activity interventions are needed to enhance the quality of life of children with visual impairments and their families. Physical activity programs and interventions are most likely to enhance intentions to engage in physical activity among children with visual impairments and their parents. Results demonstrated that parents of children with visual impairments were interested to work side-by-side with physical activity professionals to enhance recreational physical activity opportunities available to their children.

Parents' Beliefs About Physical Activity for Their Children With Visual Impairments.

Despite having the desire to become physically active as a family, parents of children with visual impairments often lack the skills and resources needed to provide appropriate physical activities (PAs) for their children. The purpose of this study was to explore the intentions of parents of children with visual impairments toward including their children in PAs after participating in a PA program. In this descriptive qualitative study, the participants were 10 parents of children with visual impairments. A series of workshops were designed to provide parents with the skills and resources needed to promote PA for their family. Upon completion of the workshops, parents took part in one-on-one semistructured interviews that were subsequently transcribed and analyzed using a thematic line-by-line process. Two interdependent themes emerged from the data analyses: (a) eye-opening experiences and (b) transformed, more hopeful, and optimistic outlook. The results revealed that through the PA intervention, parents learned teaching strategies that were intended to increase their PA opportunities and garnered resources that allowed them to teach their children to participate in PA.

Brief Report: Physical Activity, Body Mass Index and Arterial Stiffness in Children with Autism Spectrum Disorder: Preliminary Findings.

We examined the association between physical activity (PA), body mass index (BMI) and novel measures of subclinical cardiovascular disease (CVD) in 15 children with autism spectrum disorder (ASD) (mean age 7 ± 2 years, 2 girls). PA was objectively assessed using accelerometry as time spent in moderate-vigorous physical activity (MVPA). Arterial stiffness was measured via aortic pulse wave velocity (PWV) and taken as a marker of subclinical CVD risk. MVPA was inversely associated with aortic PWV (r = - 0.46, p < 0.05). BMI percentile was positively associated with aortic PWV (r = 0.61, p < 0.05). Overall findings suggest that reduced PA and higher body mass in children with ASD are associated with increased arterial stiffness which may have a detrimental impact on overall cardiovascular health.

Impacts of active school design on school-time sedentary behavior and physical activity: A pilot natural experiment.

BACKGROUND: Children spend a significant portion of their days in sedentary behavior (SB) and on average fail to engage in adequate physical activity (PA). The school built environment may influence SB and PA, but research is limited. This natural experiment evaluated whether an elementary school designed to promote movement impacted students' school-time SB and PA. METHODS: Accelerometers measured SB and PA at pre and post time-points in an intervention group who moved to the new school (n = 21) and in a comparison group experiencing no school environmental change (n = 20). Difference-in-difference (DD) analysis examined SB and PA outcomes in these groups. Measures were also collected post-intervention from an independent, grade-matched group of students in the new school (n = 21). RESULTS: As expected, maturational increases in SB were observed. However, DD analysis estimated that the intervention attenuated increase in SB by 81.2 ± 11.4 minutes/day (p<0.001), controlling for time in moderate to vigorous physical activity (MVPA). The intervention was also estimated to increase daily number of breaks from SB by 23.4 ± 2.6 (p < .001) and to increase light physical activity (LPA) by 67.7 ± 10.7 minutes/day (p<0.001). However, the intervention decreased MVPA by 10.3 ± 2.3 minutes/day (p<0.001). Results of grade-matched independent samples analysis were similar, with students in the new vs. old school spending 90.5 ± 16.1 fewer minutes/day in SB, taking 21.1 ± 2.7 more breaks from SB (p<0.001), and spending 64.5 ± 14.8 more minutes in LPA (p<0.001), controlling for time in MVPA. Students in the new school spent 13.1 ± 2.7 fewer minutes in MVPA (p<0.001) than their counterparts in the old school. CONCLUSIONS: This pilot study found that active school design had beneficial effects on SB and LPA, but not on MVPA. Mixed results point to a need for active classroom design strategies to mitigate SB, and quick access from classrooms to areas permissive of high-intensity activities to promote MVPA. Integrating active design with programs/policies to promote PA may yield greatest impact on PA of all intensities.

Children's Physical Activity While Gardening: Development of a Valid and Reliable Direct Observation Tool.

BACKGROUND: Gardens are a promising intervention to promote physical activity (PA) and foster health. However, because of the unique characteristics of gardening, no extant tool can capture PA, postures, and motions that take place in a garden. METHODS: The Physical Activity Research and Assessment tool for Garden Observation (PARAGON) was developed to assess children's PA levels, tasks, postures, and motions, associations, and interactions while gardening. PARAGON uses momentary time sampling in which a trained observer watches a focal child for 15 seconds and then records behavior for 15 seconds. Sixty-five children (38 girls, 27 boys) at 4 elementary schools in New York State were observed over 8 days. During the observation, children simultaneously wore Actigraph GT3X+ accelerometers. RESULTS: The overall interrater reliability was 88% agreement, and Ebel was .97. Percent agreement values for activity level (93%), garden tasks (93%), motions (80%), associations (95%), and interactions (91%) also met acceptable criteria. Validity was established by previously validated PA codes and by expected convergent validity with accelerometry. CONCLUSIONS: PARAGON is a valid and reliable observation tool for assessing children's PA in the context of gardening.

School gardens and physical activity: a randomized controlled trial of low-income elementary schools.

OBJECTIVE: This study examines effects of a school garden intervention on elementary school children's physical activity (PA). METHOD: Twelve schools in New York were randomly assigned to receive the school garden intervention (n=6) or to the waitlist control group that later received gardens (n=6). PA was measured by self-report survey (Girls Health Enrichment Multi-site Study Activity Questionnaire) (N=227) and accelerometry (N=124, 8 schools) at baseline (Fall 2011) and follow-up (Spring 2012, Fall 2012, Spring 2013). Direct observation (N=117, 4 schools) was employed to compare indoor (classroom) and outdoor (garden) PA. Analysis was by general linear mixed models. RESULTS: Survey data indicate garden intervention children's reports of usual sedentary activity decreased from pre-garden baseline to post-garden more than the control group children's (Δ=-.19, p=.001). Accelerometry data reveal that during the school day, children in the garden intervention showed a greater increase in percent of time spent in moderate and moderate-to-vigorous PA from baseline to follow-up than the control group children (Δ=+.58, p=.010; Δ=+1.0, p=.044). Direct observation within-group comparison of children at schools with gardens revealed that children move more and sit less during an outdoor garden-based lesson than during an indoor, classroom-based lesson. CONCLUSION: School gardens show some promise to promote children's PA. CLINICAL TRIALS REGISTRATION: clinicaltrials.gov # NCT02148315.

Study protocol: effects of school gardens on children's physical activity.

BACKGROUND: Childhood obesity is an epidemic. Strategies are needed to promote children's healthy habits related to diet and physical activity. School gardens have the potential to bolster children's physical activity and reduce time spent in sedentary activity; however little research has examined the effect of gardens on children's physical activity. This randomized controlled trial (RCT) examines the effect of school gardens on children's overall physical activity and sedentary behavior; and on children's physical activity during the school day. In addition, physical activity levels and postures are compared using direct observation, outdoors, in the garden and indoors, in the classroom. METHODS/DESIGN: Twelve New York State schools are randomly assigned to receive the school garden intervention or to serve in the wait-list control group that receives gardens and lessons at the end of the study. The intervention consists of a raised bed garden; access to a curriculum focused on nutrition, horticulture, and plant science and including activities and snack suggestions; resources for the school including information about food safety in the garden and related topics; a garden implementation guide provided guidance regarding planning, planting and maintaining the garden throughout the year; gardening during the summer; engaging volunteers; building community capacity, and sustaining the program. Data are collected at baseline and 3 post-intervention follow-up waves at 6, 12, and 18 months. Physical activity (PA) "usually" and "yesterday" is measured using surveys at each wave. In addition, at-school PA is measured using accelerometry for 3 days at each wave. Direct observation (PARAGON) is used to compare PA during an indoor classroom lesson versus outdoor, garden-based lesson. DISCUSSION: Results of this study will provide insight regarding the potential for school gardens to increase children's physical activity and decrease sedentary behaviors. TRIAL REGISTRATION: Clinicaltrial.gov # NCT02148315.

An outreach intervention increases bone densitometry testing in older women.

OBJECTIVES: To evaluate the performance of a patient recall intervention that relies on an outreach coordinator with a bachelor's degree to prompt women by mail and telephone about their eligibility for bone densitometry (dual-energy X-ray absorptiometry (DXA)) screening and allow them to schedule an examination without a medical provider visit ahead of time. DESIGN: Observational. SETTING: Academic general internal medicine practice. INTERVENTION: Mail- and telephone-based patient recall for DXA. PARTICIPANTS: Five hundred sixty-four women aged 65 to 79 at average risk for osteoporosis without a history of DXA. MEASUREMENTS: Rates of DXA completion and the change in proportion of screened women during a 7-month intervention period, case finding for clinically significant bone loss, frequency of appropriate clinical follow-up, DXA no-show rates compared with usual care, and clinician satisfaction. RESULTS: Through patient recall, rates of DXA screening rose significantly (P<.001), and the proportion of the eligible clinic population screened increased 13%. Thirty percent of patients had clinically significant bone loss, with almost all of these receiving follow-up. DXA no-show rates were comparable with usual care, and provider acceptance was high. CONCLUSION: A patient recall intervention substantially increased DXA screening, allowing pharmacological therapy to be started much earlier in some women with significant bone loss. It imposed minimal burden on providers and enhanced patient convenience. This type of program may have utility for additional preventive services.

A patient outreach program between visits improves diabetes care: a pilot study.

OBJECTIVE: Barriers to guideline-based diabetes care include poor patient activation, haphazard clinic appointments, poorly organized medical records and a lack of automated physician decision support. We developed a patient recall intervention to mitigate these barriers and improve diabetes care coordination. We evaluated this intervention in terms of operational feasibility, provider and patient acceptance and effects on process of care measures. METHODS: On the basis of the American Diabetes Association criteria, we identified patients with diabetes in a large internal medicine practice who were due for provider visits; hemoglobin A1c, lipid, microalbumin and serum creatinine laboratories; and retinal examinations. An outreach coordinator contacted patients to summarize this information and schedule recommended services. We assessed patient responsiveness to outreach and used medical chart review to compare diabetes care rendered before and after the intervention. Providers gave feedback about their satisfaction with the program. RESULTS: Over 3 months, 709 patients were overdue for diabetes-related services. Of 415 overdue for provider visits, a total of 125 (30.1%) completed such visits arranged by an outreach coordinator and, of these, 101 (80.8%) completed laboratories at least a day ahead of time. An additional 52 out of 415 patients (12.5%) bypassed the outreach coordinator to self-schedule diabetes visits within a 6-week period after the outreach letter was mailed. Among overdue patients, completion of recommended services and intensity of diabetes care were significantly greater through the outreach program compared with traditional care. Provider attitudes were favorable. CONCLUSIONS: An outreach intervention was associated with improved timeliness and intensity of diabetes care in an outpatient setting. The success of this pilot program in terms of process measures warrants additional evaluation focused on clinical outcomes.

Improving patient care through health-promotion outreach.

Patient receipt of recommended preventive and chronic disease care is suboptimal, partly because of poorly organized clinical information and time-limited and sporadic appointments with medical care providers. To overcome these problems, we describe the features of a novel health-promotion outreach system based on electronic data queries, active patient-centered outreach, and minimizing patient barriers to adherence. We describe advantages of this system over traditional preventive care delivery systems and chronic disease management programs, and explain how it complements and helps to promote the type of clinical practice change contemplated by the chronic care model.