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Project Title: Grow it, Try it, Like it!

Funds Requested: $100,000 Proposal Start Date: July 3, 2014 Proposal End Date: August 31, 2015 Project Director: Julia Findley, RD Certified Nutrition Educator for Head Start 12020 Kimberly Rd. Marysville, CA Phone: 530-XXX-XXXX Email: jfindley@calpoly.edu This award should be made to: Yuba-Sutter Head Start Program Funding Organization: Coalition for Healthy Communities ABSTRACT This intervention will create and use a multifaceted garden-based program to increase exposure to and knowledge of vegetables in preschool-aged Latino children in Yuba County. Twenty-five preschoolers will participate in weekly, 90 minute, farm field trips* (1st half of school year) and school garden activities (2nd half of school year) with integrated taste-testing of vegetables. A control group of 25 Latino preschoolers at the same school will not participate in any of the multifaceted garden-based activities. Data collections, before and after the study, will include anthropometric measures, food frequency records, and psychosocial factor questionnaires for all 50 students. This intervention will take place over 1 school year. Desired outcomes at the end of this study include increased willingness to try, preference for and intake of vegetables in participants of Grow It, Try It, Like It. *The farm field trips are meant to substitute garden activities until the school garden is up and going. Ideally, if the program was continued, it would consist of year-long activities in the school garden with a few farm field trips.

1 NEEDS STATEMENT: Over the past few decades inadequate intake of vegetables has become important in the context of rising childhood obesity rates. Inadequate intake is a major risk factor for pediatric obesity which is associated with unfavorable conditions such as increased occurrence of diabetes mellitus, asthma, and psychological or psychiatric problems that likely continue into adulthood.1 Long-term implications include decreased life expectancy, increased national financial burden and decreased overall quality of life. Healthy People 2020 addresses this concern in section 15.1 of their objectives.2 Their goal is to increase the mean daily intake of vegetables in the population aged 2 years and older from .8 cup equivalents to 1 cup equivalents of total vegetables per 1,000 calories. In 2012, the Latino population had the 2nd highest age-adjusted obesity rates in the US with 1 in 6 Latino children aged 2-5 being classified as obese.3 This makes preschool-aged Latino children in the U.S. a high needs population that would benefit greatly from a dietary intervention related to vegetable intake. Latino children aged 2-5 within the Yuba County in California may especially benefit from a dietary intervention. Latinos are a significant part of this community making up 25% of the population.4 Traditionally Yuba County has been an agriculture area with many of its farm workers emigrating from Mexico. The current Latino population is the remnants or descendants of a ten-year influx of immigrants from 1990 to 2000. Nearly 50% of foreign-born Mexicans entered the US during this period.5 Already 31% of this communitys adult population (all races) is obese, which is 7% above the state average.6 Heart disease mortality rates too are the sixth

2 highest in the state for Latino populations.7 This is significant because BMI is positively associated with risk of heart disease.8 It is also known that in Yuba County the low-income preschool obesity rate is 16.4% and that 1 in 5 Latinos are below the poverty level.6 These values are important because low socioeconomic status is correlated with reduced vegetable intake due to barriers of affordability, access, as well as other factors.9 Reduced vegetable intake is also seen in children with mothers with lower educational levels.9 This is especially pertinent to Yuba County where in 2010 only 78% of the population had graduated from high school and 12 .7% had a bachelor degree or higher.4 On the national level, childhood obesity prevalence rates almost tripled from 1970 to 2000.8 Only as recent as 2010 have we seen childhood obesity rates plateau at 14.94%.8 Although adult obesity rates in the U.S are still higher than child obesity rates , in relative terms the U.S. has seen obesity levels escalate faster in children than in adults.10 Yuba County has paralleled state prevalence rates of overweight and obese children , from 2005 to 2010, with only a slight 3.2% increase above national rates in 2010.11 This change is commonly attributed to a nationwide reduction in child physical activity and an increase in unhealthy eating patterns, in combination with some social and physical environment factors (e.g., cultural norms, family structure, advertising and marketing).10 The multifactorial nature of obesity onset is the main barrier to producing an appropriate and effective intervention. Researchers have identified many of the root causes of

3 obesity, but establishing which are the most essential determinants is an on-going endeavor. Often many of these factors are intertwined making it even harder to identify which one would be the most effective and modifiable.12 Recently research has shown that garden-based programs, targeting younger school populations, represents promising interventions. Targeting preschool-aged Latino children is important not only because they are a highrisk, high-impacted population but also because this is an age group that has high interventionimpact potential. According to Rajalakshmi Lakshman of the Cambridge Institute of Public Health, the preschool years are a period of rapid growth and habit formation.8 This makes creating an effective preschool nutrition-education intervention an important public health issue. Developing a program that exposes children to vegetables and creates a positive attitude toward vegetables could be essential to combating the obesity epidemic. A review of the scientific literature related to school gardens shows a positive association between these intervention programs and increased vegetable intake .1 13 A review article by Ramona Robinson-OBrien looked at eleven studies done from 1990-2007, in kids from five to fifteen years. Five of these intervention programs were done on school grounds in conjunction with classes, three were part of an after school program and three were done in the community. She reported that three garden-based programs were associated with increased vegetable intake while one was not. There was also a correlation between gardenbased nutrition education and psychological factors related to vegetable consumption such as changed perception of vegetables, increased vegetable preference and increased willingness to
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4 try new foods.1 13 In a quasi-experimental study researchers examined Latino youths in the Los Angeles Unified School District to see if garden-based nutrition education influenced their vegetable consumption. The program was based on social cognitive theory and the relationship between person, environment and behavior. The study looked at psychological aspects of the students diets (i.e. efficacy, preference and perceptions) as well their changes in vegetable intake. Components of the program included gardening, visits to local farmers markets and cooking and nutrition. They concluded that garden-based nutrition in combination with cooking and nutrition components could be an effective intervention; influencing attitudes , perceptions and preferences for vegetables. Another example is the Growing Healthy Kids Program. It conducted a community garden intervention among low-income families with kids aged 2-15 years (60% Latino). 15 It included a weekly gardening session, a 7-week cooking nutrition workshop, and social events for parents and children. The childrens BMI data was collected pre- and post-program and families reported on the availability and consumption of fruits and vegetables at the beginning and end of the familys participation. Results showed that by the end of the program 17% of obese or overweight children had improved their BMI classification , there was a 146% increase in the availability of fruits and vegetables and a 33% increase in the consumption of vegetables. Another recent review article looked at the best models for implementing school gardens in California.16 Researchers interviewed key school members or those who had direct involvement with the program, such as principals or community volunteers from ten schools whose programs were deemed exemplary. From these interviews they determined four
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5 factors fundamental to the success of school gardens: People, funds, materials and instruction. Committed people, and more importantly a collaborative team were essential for the continued maintenance and use of the gardens. When too much responsibility was laid on one or a few people the common result them becoming burned out. Success was also based on continued funding and supply of material. Schools who applied for grants and utilized committee members (i.e. parents, staff, etc.) to find discounted materials were more likely to have sustained programs. Lastly quality instruction was listed as being instrumental in the success of school gardens. Using a part-time or full-time garden collaborator who could work with teachers to develop appropriate and beneficial curricula was just one of the methods suggested for creating a quality program. 16 The results of all of these articles suggest that garden-based nutrition education can be an effective program and should be used as an intervention to help meet the Healthy People 2020 objective to increase vegetable intake from

.8 cup equivalents to 1.1 cup equivalents.


GOALS & OBJECTIVES:

The goal of this project is to decrease the prevalence of obese preschool-aged Latino children in the Grow It, Try It, Like It program. To increase intake of vegetables in Latino children at Olivehurst Preschool by exposing them to school vegetable gardens and local farms. To increase positive attitudes towards vegetables including (1) preference for vegetables and (2) willingness to try vegetables, (as measured by a psychosocial questionnaire).

6 To evaluate the effectiveness of the learning components (school garden , farm field trips, taste tasting) on the improvement of attitudes toward vegetables and overall vegetable intake at 1 year. To evaluate the effectiveness of Master Gardener and Project Director on the improvement of attitudes toward vegetables and overall vegetable intake at 1 year . PROJECT DESCRIPTION: Twenty-five Latino children at Olivehurst Preschool will act as intervention participants and meet once a week for 90 minute garden-based or farm-based learning activities. The first half of the school year will be dedicated to field trips to local farms with taste-testing activities at the off-site locations. The second half of the school year will be dedicated to school-garden activities and taste testing of harvested vegetables. Twenty-five non-intervention Latino preschoolers will act as controls. Time Frame The program will be broken into four phases. Phase 1: July 3, 2014-August 20, 2014 Phase 1 will consist of the recruitment of a Master Gardener/school garden activity coordinator, as well as a research assistant and two data collection interviewers. This phase will also consist of plan development for the school garden , including, garden location, dimensions, crop choices and volunteer recruitment. Planning of farm field trips will also take place in Phase 1. Arrangements will be made with local farms who agree to receive and work with the Grow it,

7 Try it, Like it program as well as with the school board or director to make sure field trips are sanctioned. A used school bus with 30+ capacity will also need to be purchased. Phase 2: August 21, 2014-December 10, 2014 Phase 2 will mark the beginning of the project. It will start in the beginning of the school year and continue tell Christmas break. During this period the garden beds will be constructed, soil brought in and seeds purchased and planted. Initial collection of data from the intervention and control group will take place. Following initial data collection the intervention group will start program activities. Phase one will consist of field trips to local farms and taste-testing of vegetables at the off-campus sites. Phase 3: January, 5 2015-June 13, 2015 Phase 3 will take place from the end of Christmas break to the end of the school year. During this period the intervention group will participate in the harvest of vegetables as well as taste testing of the vegetables. At the end of harvest or at the end of the school year (whichever comes first), final data collection will take place for both the control and intervention group .

Phase 4-June 13, 2015-August 31, 2015 Data evaluation by director and research assistant. Master Gardener will also continue to take care of gardens and ideally train staff, parents and/or volunteers, in order to preserve the care of gardens when funding is no longer is available.

8 Partners Partners will include the Olivehurst Preschool director, staff and school board to help develop the program and authorize the use of the school land and facilities. Volunteers will be recruited from the parent population, from the community and from local high schools and colleges to help build and maintain the gardens. Local schools include Marysville High School, Lindhurst High School, Yuba City High School, Sutter High School and Yuba College. Students may benefit from this work because of its applicability to community service requirements as well as field experience for those interested in childcare or agricultural fields. A research assistant and data collection interviewers will be recruited from this population. Possible community partners include the Rotary Club, Kiwanis Club, Lyons Club and 4-H. One trained Master Gardener from the local Yuba-Sutter Cooperative Extension Program will be hired to manage crop choices and garden construction in Phase 1, learning activities in Phase 2 and garden maintenance and training of other staff in both phases. Project director will oversee and work with Master Gardener to construct the garden, develop activities and recruit volunteers. Farms would benefit from this program because of the increased exposure to the community and to potential future customers. Farmers will be encouraged to develop simple, interactive activities related to vegetables for the children to participate in. During phase 1 the project director will lead the field trips to local farms. Parents and local high school and college students will be recruited to assist with garden activities and field trips.

9 EVALUATION: Measurements-Summative Evaluation Attitudes about, Preferences for, and Willingness to try Vegetables A questionnaire was created using or modifying questions from validated questionnaires for pediatric populations.1 Five questions asked about level of enjoyment of commonly eaten vegetables on a 5-point scale. Twelve questions assessed attitudes towards, preferences for and willingness to try vegetables. Data will be collected in the beginning of Phase 1 and at the end of Phase 2. Intake of Vegetables Food frequency questionnaires will be used to measure food intake. These function as dietary assessment tools, and will be used to determine parent reported frequency of child consumption and portion size of vegetables. Additional questions on food purchasing and preparation methods will be asked. Vegetable boxes will be purchased from local farms in beginning of the year to give to participant families (control and intervention) as incentive for participation. Anthropometrics Weight (kg) was measured with a Tanita digital scale. Body mass index (BMI) and Centers for Disease Control and Prevention age-and sex-specific BMI Percentiles were determined using EpiInfo (version 3.2, 2005). Students with a BMI at or more than the 95th percentile were classified as being obese.3

10 SUSTAINABILITY: Once the garden is built and tools have been acquired expenses will be significantly less. Volunteers, parents, school staff or minimally incentivized gardeners from the cooperative extension could become familiarized with the school garden during the initial intervention year and take over management of field trips (with established farm partners) in Phase 1 and garden activities during Phase 2. Continuing expenses will include seeds and disposable items, like garbage bags and gloves and transportation fees to get kids to local farms. Fundraising efforts will include plant sales and a summer garden party and fundraiser. Other funding may be acquired from local farms, hardware stores, cooperative extensions and clubs (i.e. Lyons Club, 4-H, Key Club, etc). Additionally a 3 year post intervention data collection would be extremely valuable in measuring if positive outcomes are maintained long term . If the intervention shows positive outcomes then consideration should be taken to institute it county wide. This area is very agriculturally focused and would likely be receptive to county wide participation of preschools. Dissemination: In phase 4 the evaluation of data will take place. Project director and research assistant will analyze results for significant findings. Project director will then write a research paper and results will be disseminated by being published in a journal. Specifically a journal associated with Pediatric Obesity.

11 REFERENCES:
1. Gatto NM, Ventura EE, Cook LT, Gyllenhammer LE, Davis JN. LA Sprouts: A Garden-Based Nutrition Intervention Pilot Program Influences Motivation and Preferences for Fruits and Vegetables in Latino Youth. J. Acad. Nutr. Diet. 2012;112(6):913920. Available at: http://www.sciencedirect.com/science/article/pii/S2212267212001268. Accessed October 18, 2013. 2. Site HPW. Nutrition and Weight Status - Healthy People. http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=29#146172. Available at: http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=29#146172. 3. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA. 2012;307(5):4917. Available at: http://jama.jamanetwork.com/article.aspx?articleid=1104933. Accessed November 8, 2013. 4. Bureau USC. American FactFinder - Community Facts. Available at: http://factfinder2.census.gov/faces/nav/jsf/pages/community_facts.xhtml. Accessed November 18, 2013. 5. Derose KP, Escarce JJ, Lurie N. Immigrants and health care: sources of vulnerability. Health Aff. (Millwood). 2007;26(5):125868. Available at: http://content.healthaffairs.org/content/26/5/1258.full. Accessed November 18, 2013. 6. County Health Rankings & Roadmaps. Rankings Data. http://www.countyhealthrankings.org/rankings/data. Available at: http://www.countyhealthrankings.org/rankings/data. 7. Interactive Atlas of Heart Disease and Stroke Tables. Centers Dis. Control Prev. Available at: http://nccd.cdc.gov/DHDSPAtlas/reports.aspx?geographyType=county&themeSubClassId=1&filterIds=4, 3,2,7,10,9&filterOptions=1,1,4,1,1,1#report. Accessed November 18, 2013. 8. Lakshman R, Elks CE, Ong KK. Childhood obesity. Circulation. 2012;126(14):17709. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3785130&tool=pmcentrez&rendertype=ab stract. Accessed November 9, 2013. 9. Rasmussen M, Krlner R, Klepp K-I, et al. Determinants of fruit and vegetable consumption among children and adolescents: a review of the literature. Part I: Quantitative studies. Int. J. Behav. Nutr. Phys. Act. 2006;3:22. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1564033&tool=pmcentrez&rendertype=ab stract. Accessed November 8, 2013. 10. Jennifer Bishop, Rebecca Middendorf, Tori Babin WT. ASPE RESEARCH BRIEF: Childhood Obesity. Off. Assist. Secr. Plan. Eval. Available at: http://aspe.hhs.gov/health/reports/child_obesity/index.cfm. 11. Babey SH, Wolstein J, Diamant AL, Bloom A, Goldstein H. A Patchwork of Progress: Changes in Overweight and Obesity Among California 5th, 7th, and 9th Graders, 2005-2010. 2011. Available at: https://escholarship.org/uc/item/8wr3t0zc. Accessed November 18, 2013. 12. Santo Domingo L, Scheimann AO. Overview of the epidemiology and management of childhood obesity. Minerva Pediatr. 2012;64(6):60713. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23108322. Accessed November 9, 2013. 13. Robinson-OBrien R, Story M, Heim S. Impact of Garden-Based Youth Nutrition Intervention Programs: A Review. J. Am. Diet. Assoc. 2009;109(2):273280. Available at: http://www.sciencedirect.com/science/article/pii/S0002822308020440. Accessed October 19, 2013.

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14. Evans A, Ranjit N, Rutledge R, et al. Exposure to multiple components of a garden-based intervention for middle school students increases fruit and vegetable consumption. Health Promot. Pract. 2012;13(5):60816. Available at: http://hpp.sagepub.com.ezproxy.lib.calpoly.edu/content/13/5/608. Accessed October 18, 2013. 15. Castro DC, Samuels M, Harman AE. Growing healthy kids: a community garden-based obesity prevention program. Am. J. Prev. Med. 2013;44(3 Suppl 3):S1939. Available at: http://www.ajpmonline.org/article/S0749-3797(12)00907-5/abstract. Accessed November 17, 2013. 16. Hazzard EL, Moreno E, Beall DL, Zidenberg-Cherr S. Best practices models for implementing, sustaining, and using instructional school gardens in California. J. Nutr. Educ. Behav. 2011;43(5):40913. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21906553. Accessed October 18, 2013.

13 Appendix 1: Time Frame


Task Year 2014 6 7 8 9 10 11 12 Year 2015 1 2 3 4 5 6 7 8

1. Develop plan for school garden & activities. 2. Recruit farms, partners, volunteers and participants 3. Buy equipment and materials 4. Plant garden 5. Initial data collection 6. Phase 1 of program 7. Phase 2 of program 8. Post-project data collection 9. Data evaluation

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Appendix 2

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15 Direct Costs I. Personnel Costs A. 1 Project Director (PD): $12,000 Julia Findley: structural design expert for all activity planning. Project director will oversee and work with Master Gardener to construct the garden, develop activities and recruit volunteers. She will also make contact with local farms and set up school district sanctioned field trips with those that agree to receive and work with the Grow It, Try It, Like It program. She will oversee summative evaluation of activities and data collection and identify any changes that need to be made. B. 1 Research Assistant: $6,000 Assists PD and MG. Responsible for taking calls and maintaining contact with partners and volunteers through email. Also responsible for managing volunteers. Assists with pre- and post-data collection. C. 2 Yuba College Interviewers: $100 Angie Picalow and Laura Fifer: Responsible for administering data collections including: food frequency questionnaires, psychosocial factor questionnaires, and weight and height measurements. D. Fringe Benefits: $4,632 Twenty-four percent for 1 Project Director, 1 Master Gardener and 1 Research Assistant II. Project Materials/Supplies A. Materials for garden $700: 3 garden boxes, organic seeds & plants, 60 bags of soil, etc. B. Materials for data collection $50: Paper and ink for questionnaires C. Education material $100-any additional pictures, or paper related activities for preschoolers III. Equipment A. Gardening Equipment: $395 i.e. 60 gloves (small and large), 3 spades, 2 shovels B. Data Collection Equipment: $0 i.e. borrowed weight scale C. Bus and operation costs: $28,560 Used 30+ capacity school bus to transport kids to and from farms for field trips. Also additional vehicle operation costs like maintenance and gas.

16 IV. Contracted Services A. 1 Master Gardener/ Health Teacher (MG/HT): $12,000 John Doe: Will help plan and lead the construction and maintenance of the school garden. Also will help develop activities for Phase 2 and help train volunteers, parents and staff how to maintain garden. V. Miscellaneous: $1000: For any unexpected costs that come up.

Total Cost: $65,537