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Group 5, Angela Cho, Emily Cornell, Enya Meng, Julia Feygelman

Assignment 8

TABLE OF CONTENTS
GLOSSARY OF ABBREVIATIONS ........................................................................................... iv
ABSTRACT .....................................................................................................................................v
I. PROBLEM STATEMENT ......................................................................................................... 1
Overview ................................................................................................................................. 1
Who is Affected? ..................................................................................................................... 1
Relative Disparity in Low-income Latino Children ................................................................ 2
Target Population .................................................................................................................... 2
Past Interventions .................................................................................................................... 3
Needs Assessment ................................................................................................................... 3
Long Term Impact and Significance ....................................................................................... 4
II. PROGRAM DESCRIPTION .................................................................................................... 4
PROGRAM GOAL ................................................................................................................... 4
PROGRAM OBJECTIVES ..................................................................................................... 4
1a. Behavior Objective ............................................................................................................ 4
1b. Behavior Objective ............................................................................................................ 4
2. Behavior Objective .............................................................................................................. 5
3. Knowledge Objective .......................................................................................................... 5
4. Process Objective ................................................................................................................ 6
STRATEGIES ........................................................................................................................... 6
Recruitment Strategy ............................................................................................................... 7
Resource Strategy .................................................................................................................... 8
Education Strategy................................................................................................................... 9
Interpersonal Processes Strategy ........................................................................................... 10
Access Strategy...................................................................................................................... 11
IMPLEMENTATION PLAN ................................................................................................. 12
III. PROCESS EVALUATION ................................................................................................... 14
IV. IMPACT EVALUATION ...................................................................................................... 15
Research Questions................................................................................................................ 15
Research Strategy .................................................................................................................. 16
Research Design .................................................................................................................... 16
Hypotheses............................................................................................................................. 18
Unit Of Analysis .................................................................................................................... 20
Sampling Strategy.................................................................................................................. 20
Analytical Plan ...................................................................................................................... 25
Ethical Issues ......................................................................................................................... 26
V. DISCUSSION .......................................................................................................................... 27
REFERENCES ............................................................................................................................ 31

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APPENDIX A: TIMELINE......................................................................................................... 41
APPENDIX B: LESSON PLAN.................................................................................................. 42
APPENDIX C: LOGIC MODEL ................................................................................................ 43
APPENDIX D: BUDGET ............................................................................................................ 44
APPENDIX E: BUDGET JUSTIFICATION ............................................................................ 47
APPENDIX F: BIOSTATISTICIAN CONSULTANT REPORT .............................................. 53

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GLOSSARY OF ABBREVIATIONS
BMI: Body Mass Index

FFT: Family Fun Time

FV: Fruits and Vegetables

HBM: Health Belief Model

HE: Health Educator

LA: Los Angeles

LAUSD: Los Angeles Unified School District

PM: Program Manager

SES: Socioeconomic Status

SCT: Social Cognitive Theory

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ABSTRACT
Childhood obesity is one of the most serious global public health challenges of the twenty

first century and its prevalence has increased at an alarming rate. Over the past three decades, the

rate of childhood obesity has nearly tripled nationwide. While its determinants are complex, a

major risk factor for childhood obesity is poor nutrition and imbalance of caloric intake with

caloric output. The highest prevalence of childhood obesity is among Latinos and data from the

Los Angeles (LA) County reports a large disparity, showing that children from low

socioeconomic status (SES) suffer from higher obesity rates than those from affluent

backgrounds.

Our program Keep It Up Beet will consist of a series of nutrition education workshops,

with a cooking demonstration and gardening component, hosted throughout the 2018-19

academic year. The curricula incorporate lessons such as tasting a variety of health recipes,

reducing the consumption of sugar-sweetened beverages (SSB), and learning how to harvest

several fruits and vegetables (FV). Our target population is 5th grade children at Fishburn

located in Maywood, East LA as it is comprised of low-income Latino children who are

especially vulnerable to risk factors for obesity.

We based our strategies around components of the Social Cognitive Theory (SCT) and

Health Belief Model (HBM), as incorporating these theories into intervention programs have

shown to be the most successful in fostering positive behavior changes related to dietary choices

and weight status for youth and for Latino populations. Through increasing nutrition knowledge

and through parental modeling, the projected impact of our intervention is to ultimately reduce

community prevalence of childhood and adult obesity, along with associated health risks.

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I. PROBLEM STATEMENT
Overview: Childhood obesity is a global and national epidemic that is a growing public

health concern. Children who have a Body Mass Index (BMI), a measurement determined by

height to weight ratio, greater than or equal to the 95th percentile for their age and gender are

considered to be obese.1 According to the National Health and Nutrition Examination Survey,

the prevalence of obesity in children ages 6-11 almost tripled since 1980 to 2015 (6.5% vs

18.4%).2,3 Obesity in children is associated with a number of serious physical health issues

including high blood pressure,4,5 asthma,4,6 and an increased risk of developing life-threatening

conditions such as type 2 diabetes mellitus and cardiovascular disease, which are major leading

causes of death in the country.2,7-10 Obese children also face serious mental health issues like

anxiety and depression,4,11,12 along with social consequences such as increased feelings of social

isolation and poor self-image due to negative social stigma and discrimination by their peers.2,13

Obese children show poor academic performance compared to normal weight children, and it has

been predicted to continue throughout future grade levels.2,13,14 Because childhood obesity is a

predictor for severe chronic diseases in adulthood, it implies significant negative economic

impacts through dramatic increases in direct medical spending and loss of productivity in the

workplace.2,13,15

Genetic factors and individual behaviors influence but cannot fully explain the rising

prevalence and scale of the obesity epidemic. While its determinants are complex, a major risk

factor for childhood obesity is poor nutrition and imbalance of caloric intake with caloric

output.2,13 Low physical activity with increased consumption of high energy dense, low nutrient

foods, and sugar sweetened beverages (SSB) lead to the extreme weight gain linked to obesity.4

Who is Affected? Individuals in low-income communities in America have shown to be

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more vulnerable to poor nutrition than those in higher income communities, with almost double

the prevalence in childhood obesity (26.9% vs 12.5%).16 Low-income areas tend to have limited

access to healthier food options and greater access to low cost, energy dense, and nutrient poor

foods due to a high density of convenience stores.2,10,17,18 These factors cause unhealthy eating

behaviors and promote weight gain, evidenced by higher prevalence in obesity for children in

low-income neighborhoods.19,20

Relative Disparity in Low-income Latino Children: Nationally, the highest prevalence

of childhood obesity is among Latinos (21.9%), followed by African Americans (19.5%),

Caucasians (14.7%), and Asians (8.6%).21 According to a health survey administered by the LA

County Department of Public Health in 2009, East LA had the highest percent of Latino

residents (70.5%) in all of LA, with 14% of them living below the Federal Poverty Level,

making them an important target for intervention. Further, the rate of obese children in grades 5,

7, and 9 in East LA (26%) was higher than the rate reported for the LAUSD school system as a

whole (23%).9,22 Latino children in East LA experience obesity at a rate 1.52 times that of the

national average (17%).2 Obesity in children has been linked to obesity in adulthood, and

intervening on the earlier stages of life poses as a priority.23-26

Target Population: The direct target population of this intervention is 5th grade children

at Fishburn Avenue Elementary School located in Maywood, East LA. This is located in the

lowest income area of East LA with 544 total students attending and 97% of them identifying as

Latino, making it a suitable choice for our intervention as low-income Latino children are

especially vulnerable to risk factors for obesity.27 We are targeting 5th grade children because

nutrition education and healthy-eating programs integrated into a school curriculum in this age

group have shown to be highly effective in shaping food choices and preferences.28,29 Families of

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obese children are indirect targets of this intervention, as they may be burdened by the

substantial economic costs of managing obesity and its associated complications.30 Additionally,

improved parental eating behaviors31 and parental involvement in school programs have shown

to be effective in reducing the risk of obesity in low-income Latino children.32

Past Interventions: Successful interventions in highly impacted communities were

characterized by having multiple components that promoted both healthy eating and physical

activity in settings children spend most of their time (home and school) and involved

participation from community or family members.18,29,30,33 Government agencies and initiatives

have worked to address issues of obesity, poor eating habits, and physical inactivity in children

through a larger public health approach while the state of California also created federally funded

programs to successfully promote healthy lifestyle changes.9 Interventions for weight loss in

children show greater long-term efficacy than in adults34 helping to lay the foundation for

lifelong healthy behaviors that reduce morbidity in adulthood.35 Garden and education

interventions in Latino communities have been successful in promoting consumption, choice,

and availability of FV, self-efficacy in preparation of healthy meals, and community

engagement, organization, and empowerment.36

Needs Assessment: An extensive literature review of studies will provide statistics

regarding the prevalence of obese Latino children and estimate the levels of nutrition knowledge

and the environmental and societal barriers to improved nutrition in the community. To

determine the needs of the target population, a series of focus groups interviews will be

conducted in English and Spanish with parents from Fishburn. Topics discussed in focus groups

will include ways we could make our program more relevant, interesting, and helpful to the

Latino population.37 These recommendation inputs will provide a basic framework for the

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content and structure our program curricula.

Long Term Impact and Significance: It is vital that individuals, especially low-income

Latino children who are especially vulnerable to poor nutrition, develop healthy dietary

behaviors to decrease the risk for developing obesity and additional associated negative

consequences. By focusing on 5th graders in a primarily Latino, low-income school community,

we aim to ultimately reduce community prevalence of childhood and adult obesity and improve

health outcomes in East LA.

II. PROGRAM DESCRIPTION

PROGRAM GOAL: The goal of our school-based nutrition and gardening education

intervention is to reduce the dietary risk factors of childhood obesity among 5th graders at

Fishburn located in East LA.

PROGRAM OBJECTIVES:
1a. Behavior Objective: By June 15th, 2019, self-reported average daily consumption of

fruit among 5th graders at Fishburn will increase by 28% from 3.2 servings to 4.1 servings.

1b. Behavior Objective: By June 15th, 2019, self-reported average daily consumption of

vegetables among 5th graders at Fishburn will increase by 33% from 2.1 servings to 2.8 servings.

Rationale: According to the Centers for Disease Control and Prevention4,38 and the

World Health Organization1,7,8 best practices for childhood obesity prevention interventions

include increasing FV consumption. Replacing energy-dense foods with lower-calorie, high-

volume foods has shown to be a successful tool for weight management.8 By increasing intake of

FV, conversely, the consumption of energy dense foods that contribute to obesity may diminish.9

Consumption of FV increased, respectively, by 28% and 33%, in an obesity prevention program

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similar to ours’ for Latino children in North Carolina,10 leading us to project similar increases at

Fishburn.

2. Behavior Objective: By June 15th, 2019, the proportion of 5th graders at Fishburn

who self-report consumption of 1 or more servings of sugar-sweetened beverages (SSB) a day

will decrease by 57%, from 35% (23/65 students) to 15% (10/65 students).

Rationale: Many studies provide evidence for the positive association between the

frequency of SSB consumption and increased weight gain, higher BMI scores, and rising obesity

rates.13,17 In 2016, about 35.2% of Latino children ages 2-11 living in East LA reported drinking

1 or more servings of SSB per day, higher than the rates throughout LA County (26.6%).16 A

study that reviewed changes in rates of SSB consumption among children ages 6-11 in LA

County showed a 12.4% decrease from 45.2% (827/1830) in 2007 to 39.6% (725/1830) in

2011.18 This study along with a meta-analysis of global studies in 2017 showed school-based

intervention programs to be the most successful in decreasing SSB intake in children.19 We

estimated a greater percent decrease of 53% by averaging the results of studies based on similar

target populations. One study that utilized parental involvement in nutrition education in Latino

kids aged 2-5 showed an 82% reduction39 and classroom-based interventions in Latino kids aged

12-17 showed a 66% reduction in SSB intake.

3. Knowledge Objective: By June 15th, 2019, 5th graders at Fishburn will increase their

nutrition knowledge by 11% on a systematized questionnaire compared to baseline scores (from

14.6/26 to 16.2/26 points).

Rationale: In a school lunch initiative study done in a low-income school district with

13.5% Latino children, nutrition education programming for 4th and 5th graders increased

nutrition knowledge by 11% and led to healthier eating behaviors and attitudes.40 Scores from a

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student nutrition knowledge evaluation in this study showed 14.6 out of 26 total possible points

for only 5th graders.40 Multiple studies conducted with Latino youth from low-income schools in

LA have shown increased self-efficacy of healthy food choices and significantly decreased BMI,

providing support for our target population and evidencing a link between nutrition knowledge

and its impact on obesity.32,41

4. Process Objective: By June 15th, 2019, parent recruitment at Fishburn will yield at

least a 75% participation rate. As there are 60 children, and we aim to have 75% of parental

participation, we aim to have an average of 45 students with a parental attendance at FFT.

Rationale: Recruiting parents to FFT is an essential pillar of the intervention, crucial to

the sustainability of newly-acquired healthy eating behaviors in the target youth population. One

of the ways children learn about food is by observing the eating behavior of others.31 Several

studies provide evidence for the role of social modeling in eating behavior, such as the increased

consumption of calcium in girls who reported seeing their fathers drink milk and an associated

greater fruit juice and vegetable intake among school age children with parental modeling.42,43

We chose a parental participation rate of 75% as it was the average of participation rates reported

from previous studies with similar recruitment and retention strategies.44,45

STRATEGIES:
Introduction: To achieve our program goal and objectives related to reducing the dietary

risk factors of childhood obesity at Fishburn by June 15th, 2019, we will implement recruitment,

resource, and education strategies. We based our strategies around components of the SCT and

HBM as incorporating these theories into intervention programs have shown to be the most

successful in fostering positive behavior changes related to dietary choices and weight status for

youth and for Latino populations.46,47 In regards to SCT, we aim to increase behavioral

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capabilities of children by teaching them how to grow and prepare food from the garden, then

promote observational learning through the involvement of trained bilingual educators and

parents. In regard to HBM, we plan to identify the families’ perceived barriers through a needs

assessment, and decrease perceived barriers to fruit and vegetable consumption by supplying

participants with free, quality, fresh FV. We aim to increase the perceived benefits of parent

participation through rewarding incentives. Through nutrition education and gardening lessons

and providing FV, we intend to increase the self-efficacy and nutrition knowledge among parents

and children to aid them in choosing healthier food options.

RECRUITMENT STRATEGY: To encourage and recruit parent involvement in

intervention, aiding in sustainment of healthier dietary behaviors at both school and home

environments.

Activities: (1) Create flyers written in English and Spanish to advertise parent

involvement activities and distribute them through mail, the school listserv, a posting on the

school website, and phone calls; (2) Develop a relationship with key school staff that interact

with parents on a regular basis; (3) Utilize contingency management: offer both monetary and

non-monetary incentives for initial buy in and sustained parental engagement, during both FFT

and an awards celebration at the end of the year. Incentives will include (a) raffle prizes for

attending FFT, (b) take-home boxes of FV for each family attending FFT (c) giving certificates

to participants and (d) awarding prizes during the awards celebration event. The recruitment

strategy corresponds with objective 4.

Rationale: Research has shown higher recruitment and retention rates of Latino adults

for community interventions when utilizing flyers written in Spanish, having bilingual staff, and

having referrals made by trusted members of the community.48,49 Being able to identify and form

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relationships with trusted members within the social network of the parent population, be it a

teacher or a member of the Parent Committee at Fishburn, and having them aid in publicity and

referral efforts would likely contribute to the improvement of recruitment and retention of

parents.37 Research has emphasized the disparity between underserved community members,

focused on the present, and intervention programs, often focused on the future.50 Community

members are focused on meeting day to day needs, which takes up their limited resources and

attentional bandwidth. Programs focused on building the foundation for a better future often take

away from this finite amount of resources, so it is crucial that programs offer incentives that

overshadow the costs of attending. Receiving incentives can help foster a sense of

accomplishment and self-efficacy in participants, which can build intrinsic motivation over time

as the individual increases their knowledge and skills.51 Contingency management is the positive,

systematic reinforcement of desired behaviors by utilizing small incentives on a regular basis.52

Raffles and take home boxes provide immediate incentives to encourage participation.

Accumulation of raffle tickets over time that reflect repetitive attendance and allow opportunities

for larger prizes at the awards ceremony encourage ongoing, sustained participation.

RESOURCE STRATEGY: Utilizing the six existing raised garden beds in the

Fishburn’s recess area, grow FV for use in educational workshops and for consumption.

Activities: (1) Engage parents through a discussion during an existing School Site

Council Meeting53 to determine what FV are culturally relevant and desired by the school

community; (2) Select seeds from the LAUSD approved plant list54 by seasonality and based

upon School Site Council Meeting outcomes; (3) Acquire seeds, soil, water cans, shears, trowels,

wood, hammers, and nails from the Garden Center at The Home Depot and The Home Depot at

3040 Slauson Ave, Huntington Park, CA 90255; (4) Engage students and parents in a kick-off

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FFT to create the garden resource alongside intervention staff by: (a) Cleaning up existing

garden bed, (b) filling beds with new soil, (c) planting and watering first seeds, and (d)

constructing a picnic table for use in nutrition education workshops and as a general gathering

site near the beds.

Rationale: By growing FV on school grounds, we are providing the FV, and thus, the

resources for the intervention programming. Engaging the students and parents in determining

what will go in the garden and building the garden increases community participation and

ensures that the intervention is appropriately tailored to the intervention group. Community

consultation and participation, and culturally tailored components have been shown to be

effective in improving health behaviors among the intervention group.55 The resource strategy

corresponds with objectives 1 and 3.

EDUCATION STRATEGY: Implement nutrition education and gardening sessions for

the 5th graders at Fishburn.

Activities: (1) Hire two qualified graduate student Health Educators (HE) and a gardener

who are bilingual (English/Spanish); (2) (a) Adapt the nutrition education and cooking

curriculum from “Cooking with Kids” to and (b) implement in 45-minute nutrition education

sessions, taught by the HEs; (3) (a) Adapt a garden education curriculum from the LA Sprouts

study and (b) implement in 45-minute gardening sessions taught by the gardener.

Rationale: Nutrition education geared towards children has shown to be a vital

component for obesity interventions.56-58 The positive effects attributed to including an education

component include improved results on nutrition knowledge tests, healthier eating behaviors and

attitudes,40 increased daily intake of FV, increased self-efficacy of healthy food preparation and

choices,41 and long-term reduction of overweight status.59 Self-efficacy for diet-related behaviors

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in elementary school-aged children has been shown to be a useful instrument in evaluating

nutrition interventions.60 The goal of “Cooking with Kids” is to provide hands-on education for

children and their families, a goal that aligns well with our intervention’s mission.61 The guide

contains teaching tools and tips designed for 5th graders, with bilingual student materials in

Spanish and English, which is ideal as our target population is primarily Latino. The lessons are

aligned with Common Core State Standards in Language Arts and Mathematics and National

Health Education Standards, allowing for easy integration into a public-school system. These

sessions are intended to foster an appreciation of and deeper relationship with the foods the kids

will be using during the nutrition education portion. We plan to adapt the garden curriculum

from the LA Sprouts intervention,41 which was a nutrition education intervention with a

gardening component, implemented among 4th and 5th grade students in East LA, with a similar

goal and population to Keep It Up Beet. LA Sprouts was successful in increasing preference for

FV, increasing positive perceptions of the taste of FV, and increasing total intake of FV.41 The

education strategy corresponds with objectives 1, 2, and 3.

INTERPERSONAL PROCESSES STRATEGY: Host FFT once per month to

encourage family participation in nutrition education.

Activities: (1) Plan a nutrition and gardening activity session adapted for participation of

both children and their parental figures; (2) Distribute take-home recipes and tips for healthy

cooking and snack ideas, as well as any food prepared during the session.62

Rationale: Parents/guardians are important indirect targets in the reduction of childhood

obesity risk factors as studies show that nutrition knowledge, attitudes, and behaviors related to

food are transmitted from parent to child.63-67 Through Keep It Up Beet we expect to improve

nutrition knowledge, attitudes, and behaviors in the parents, making community collaboration an

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essential component.37 The interpersonal processes strategy corresponds with objectives 1, 2, and

3.

ACCESS STRATEGY: Promote fruit and vegetable consumption by providing students

with fresh FV from school garden to minimize barriers to consumption.

Activities: (1) Provide take-home boxes of harvested fresh FV after each FFT to (a)

increase opportunities for consumption immediately after gardening, (b) allow children and

parents to act on what they have learned in the session, and further develop self-efficacy in

preparing FV after leaving the session, and (c) act as an incentive for families to attend FFT as

discussed in the recruitment strategy; (2) Between sessions, gardener will place excess harvested

FV from the garden in 5th grade classrooms to increase opportunities for consumption. The

access strategy corresponds with objectives 1 and 4.

Rationale: While providing students and their families with produce from the garden will

not provide students with a consistent supply, this will increase overall access to fresh FV.

Providing access to free, quality FV in a place where children spend most of their time provides

them with the environmental and financial capacity to increase knowledge and consumption. An

assessment in low-income communities has shown that inadequate access to healthy foods due to

high prices and geographical location, as well as low quality of available foods, were significant

barriers to healthy eating behaviors.68 Further, changes in accessibility of fresh produce are a

direct predictor for consumption of fresh produce.69 Per the HBM, to induce behavioral change,

it is necessary to address perceived barriers so that an individual believes that the benefits of

action outweigh the barriers.70 In East LA, 31% of households are food insecure, defined as

having “limited or uncertain availability of nutritionally adequate and safe foods or limited or

uncertain ability to acquire acceptable foods in socially acceptable ways,” suggesting that lack of

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access to fresh and healthy food is a barrier to healthy eating behavior in East LA.71 By growing

and placing freshly harvested FV in 5th grade classrooms and directly giving families take-home

boxes of produce from the garden, we lessen the access barrier for fruit and vegetable

consumption and provide opportunity to utilize lessons learned in the education programming.

IMPLEMENTATION PLAN:
Program Team: a) A Program Manager (PM) will work as full-time staff and oversee

and run a majority of the program and its activities by maintaining close communication with the

entire team, being responsible for administrative tasks, hosting and planning FFT, fostering good

relationships with parent participants, and meeting with the Parent Committee and school

principal once a month. The PM will establish a partnership with Fishburn’s principal and

parents, establish expected attendance, and recruit the rest of the staff team. b) A gardener will

use the gardening education curricula from LA Sprouts to prepare and teach the gardening

sessions). The gardener will maintain the 6 garden beds on school grounds throughout the

duration of the program, obtain necessary materials and tools for gardening, and keep in contact

with partners who provide resources. c) Two graduate student Health Educators (HE) will

teach and lead interactive nutrition education and cooking sessions for 5th grade students. The

staff team will select the location for workshops, purchase supplies, plan, and deliver workshops.

Nutrition Education: “Cooking with Kids” curriculum guide will be adapted by the

graduate HEs to create a full year-long lesson plan that also incorporates SSB lessons and

includes ethnically variable ingredients and dishes. The general outline of a 45-minute nutrition

education lesson plan using “Cooking with Kids” is pictured in Appendix B.

Gardening Education: The gardener will design components of interactive gardening

workshops for the first trimester of the school year, adapting lesson plans from LA Sprouts. The

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remaining workshops will be developed as the program rolls out, because these workshops will

depend on the success and growth of the garden beds.

Delivery of Workshops: The HEs will teach the weekly nutrition education and cooking

demonstrations, while the gardener will lead the gardening portion. An estimate of 60 5th grade

student participants will be divided into two groups of 30 students. These two groups will receive

the workshop sequentially, for 45 minutes each. Within each group, 15 students will start with

the nutrition portion and 15 with gardening, then interchange sessions for the second half of the

workshop.

Family Fun Time: a) Lesson plan: FFT will follow the same series of activities

delivered to the students, with the addition of take-home activities and recipes, provided by the

Cooking with Kids curriculum. The PM will be in charge of administering these workshops with

the aid of HEs. b) Promotion: Flyers will be distributed in English and Spanish to promote FFT.

c) Incentives: For every FFT attended, the parent will receive a free box of FV to take home and

a raffle ticket for a chance to win one of four $20 gift cards for a local grocery store which will

be chosen at the end of each session. He or she will also receive a special raffle ticket for each

attendance, for a maximum of 8 total (1 each month, for 8 months) which will be used to enter a

raffle to win the grand prize at the end of the year.

Awards Event: This 1-hour event will be held in the last week of May 2019 and serve as

a celebration for student completion of the program as well as an incentive for parents to

increased feelings of accomplishment and being proud for their child. Every student will have

their name be announced and receive a printed certification from the principal. A slideshow will

display progress photos of the garden and workshop participation. Outstanding student awards

will be distributed to five nominated participants. A raffle will be held at the end for choosing the

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two recipients of the grand prize, a steel cooking ware set.

III. PROCESS EVALUATION


Purpose: We will evaluate the key aspects of Keep It Up Beet’s performance through a

systematic examination and documentation of service utilization and program delivery. Tools

that will be utilized include satisfaction surveys, meeting minutes, registration and sign-in sheets,

attendance sheets, contact logs, adherence checklists, marketing and publicity flyers, and other

administrative tools.

Recruitment Attendance: We will track the attendance of 5th grade students at Fishburn

at the weekly interactive nutrition and gardening education sessions with an attendance sheet.

The engagement of the 5th graders will be assessed with an activities checklist to check whether

all the students had a chance to engage in the hands-on activities. Parent participation will be

measured via a sign-in sheet at every FFT event where parents will mark their attendance next to

their child’s name. We anticipate 75% attendance rate for parents at FFT. It is expected that more

than one parent per child may attend, a caregiver (i.e. grandparent, aunt, uncle) other than a

parent may attend, or parents may bring additional children to FFT. We will take attendance of

additional guests, but for the purposes of recruitment, we will measure the number of children

who have a parental figure in attendance. If fewer than 75% of children have a parental figure in

attendance at FFT events, then further recruitment efforts may be needed. An output percentage

(number of parents attending/number of anticipated parents attending) can be calculated to

quantitatively measure the success rate of parental recruitment.

Participant Satisfaction: A survey will be distributed to families to survey how the

family heard, if at all, of the program, measure satisfaction with the event FFT and ask for any

feedback for future improvement. The Program Manager will pass out the quick survey at the

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end of the final FFT, or Awards Ceremony, to be completed on paper by the program

participants. The survey will consist of a few questions graded on a Likert scale, assessing the

parents’ opinions of the effectiveness of the taught curriculum. An additional section for free

commentary will be included to ensure that qualitative data will be captured, to better understand

potential participant complaints.

Resource Utilization: The Program Manager will log marketing and publicity materials,

such as number of flyers dispersed as well as keeping track of telephone and email logs

(including families contacted, mode of outreach, and responses). The type, cost, and number of

incentives awarded to families will be tracked in a log. An inventory of all the gardening tools

and education materials will be marked off before and after each session to insure all supplies are

present.

Program Delivery: We will assess the adherence of planned activities to the actual

activities. The Health Educator leading each session will oversee completing a checklist. The

adherence checklist will confirm which lessons are covered and which activities have occurred.

A log of the garden crops will also be recorded, documenting what was planted, when it was

planted, when it was watered, and when it was harvested. We will track the number of take-home

boxes of harvested fresh FV are taken, keep a record of the FV in each box, and keep record of

the FV taken from the garden and put in the classroom.

IV. IMPACT EVALUATION


RESEARCH QUESTIONS (RQ):
RQ1: Is participation in Keep It Up Beet associated with improved dietary habits among

target participants?

RQ2: Does participation in Keep It Up Beet improve nutrition/food knowledge among

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target participants?

RESEARCH STRATEGY: We are using an explanatory research strategy in the

evaluation of Keep It Up Beet. This approach is appropriate as we are seeking to explain an

association between program participation and dietary risk factors for obesity. Descriptive

research will come into play when we evaluate baselines of fruit, vegetable, and SSB

consumption and nutrition/food knowledge among participants and the comparison group, with

the goal of generalizing to the greater population Latino youth of low SES. Exploratory research

was utilized previously in the needs assessment, program planning, and development stages.

RESEARCH DESIGN: We will conduct a quasi-experimental, pretest-posttest

nonequivalent comparison group design to assess the impact of Keep It Up Beet. A pretest will

examine comparability of the two groups by controlling for the testing effect, and posttests

(immediate, 6-month, and 12-month follow-ups) will be used to assess short and long-term

effects.72 By giving both groups a test at the beginning, we can void any improvement effect that

may arise from learning from taking the test itself. Posttests ensure prolonged knowledge

retention and behavior change in case the improvement immediately post intervention arises by

chance.

A cross-sectional study was ruled out as we are seeking to ascertain effects of our

intervention over time. A retrospective cohort study would not be possible since the intervention

must occur before the evaluation of outcomes. A prospective cohort study would not be feasible

as we are looking at a specific subgroup of the population which would not have been

represented by a cohort. Since we are “treating” the participants with an intervention, any

observational research design is not fitting. A true experiment is not feasible given the small

scale of this pilot study. If randomization were at the individual level, then contamination within

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the school would pose a threat to internal validity. Health-related behaviors tend to spread

throughout social networks. In other words, if some children received the intervention and others

did not, the latter may pick up on new behaviors and knowledge spread by the children who do

receive program components during day to day interactions.

To increase equivalence of the treatment and “control” groups, we are using a

comparison group that is demographically similar to our intervention group with regard to

characteristics that are most related to the study’s dependent variables.72 Our comparison group

will be 5th graders at Huntington Park Elementary School in East LA. This school has a garden

onsite and is primarily comprised of low SES Latino students (97.5%) but is not receiving an

intervention related to nutrition or gardening.

We assume that students in both schools receive a comparable level of education and

enrichment programs, other than the presence of the Keep It Up Beet program. This assumption

reduces the threat posed by the Hawthorne effect, given that both groups will be receiving

attention through various school programs. Maturation will not be an issue because our treatment

and comparison groups are of the same age. The history effect should be minimized, as both

groups would experience major world events simultaneously. They could still, however,

experience local events differently. For example, one school might have a plumbing issue and

cancel school for a week. In our analysis, we will take such incidences into consideration.

Regression to the mean is unlikely, as dietary habits do not usually spontaneously improve. If

they did, this would occur in both groups and would not affect the analysis. Attrition is unlikely

because the intervention is integrated into the school curriculum, and both groups will be

attending school normally. We plan to use the same methods for measuring consumption,

participation, and knowledge at the pretest and posttest stages for both groups, so

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instrumentation is unlikely to pose a threat to validity.

Lack of randomization in this study design presents a few weaknesses, or threats to

internal validity. Differences between schools that may introduce selection bias cannot all be

controlled for, such as school lunch quality, built environment, level of care from school

administration, and parental attitudes. Additionally, contamination could pose a problem because

students from the two groups may interact given the proximity of the two schools (0.6 miles

apart).

HYPOTHESES:
Attributive Hypothesis 1a: At baseline, target participants consume on average 3.2

servings of fruit daily.

Associative Hypothesis 1b: Participation in Keep It Up Beet is associated with a 28%

increase in daily fruit consumption among target participants compared to the baseline.

A serving of fruit is defined by the USDA guidelines for each type of fruit including

fresh, frozen, canned, dried fruits, and fruit juices that are unsweetened.73 For example, one

serving is equal to 1 medium apple or ¾ cup of unsweetened orange juice. Fruit consumption is

a ratio variable defined as the number of servings of fruit consumed daily and its measurements

will be obtained from administering the 2005 National Health Interview Survey (NHIS) Diet and

Nutrition Questionnaire (DNQ) composed of 9 questions to estimate an individual’s fruit and

vegetable intake.74 Program participation is a ratio variable defined as student attendance of at

least 40% (15/36) in the Keep It Up Beet workshops over the duration of the program.75

Attendance will be tracked with an attendance sheet, in which the Health Educators will mark

present students. Participation is the IV and fruit consumption is the DV.

Attributive Hypothesis 2a: At baseline, target participants consume on average 2.1

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servings of vegetables daily.

Associative Hypothesis 2b: Participation in Keep It Up Beet is associated with a 33%

increase in daily vegetable consumption among target participants compared to the baseline.

A serving of vegetables is defined by the USDA guidelines for each type of vegetable.73

For example, one serving is equal to ½ cup green beans or ½ cup of broccoli. Vegetable

consumption is a dependent ratio variable defined as the number of servings of vegetables

consumed daily. Vegetable consumption measurements will be obtained from administering the

2005 NHIS DNQ.74

Attributive Hypothesis 3a: At baseline, 35% of target participants consume 1 or more

servings SSB per day.

Associative Hypothesis 3b: Participation in Keep It Up Beet is associated with a 53%

decrease in the number of target participants consuming 1 or more SSB per day compared to

baseline.

One SSB serving is defined as 12 ounces of any beverage with added sugar, including

but not limited to sodas, sweetened fruit juices, and sweetened teas.73 SSB consumption is a

dependent categorical variable defined in this context as whether or not 1 or more servings of

SSB are consumed throughout the day (consumed less than 1 serving of SSB daily vs. consumed

1 or more servings of SSB daily). SSB consumption will be measured using a 12-item beverage

consumption questionnaire.74

Attributive Hypothesis 4a: At baseline, target participants will have an average baseline

score of 56% on a nutrition/food knowledge questionnaire (meaning, 56% correct answers).

Associative Hypothesis 4b: Participation in Keep It Up Beet is associated with an 11%

increase on the nutrition/food knowledge questionnaire among target participants, increasing

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from a baseline score of 56% to 62%.

Nutrition/food knowledge is a dependent ratio variable defined by a numerical score on

a 21-item questionnaire about nutrition and food knowledge. The questionnaire is adapted from a

2010 study evaluating a school lunch initiative, modified to fit our specific research needs.40

Nutrition/food knowledge also has a conceptual definition and refers to a basic awareness and

understanding of the relationship between diet and health, the understanding that diet has short-

and long-term effects on health, and the knowledge necessary to make healthful dietary

decisions.

UNIT OF ANALYSIS:
Throughout Keep It Up Beet we will collect data at the individual level. This is the most

befitting unit of analysis for our study design since we are measuring fruit, vegetable, and SSB

consumption and nutrition/food knowledge for each individual student in order to capture their

personal progress. Keep It Up Beet will enlist the aid of biostatisticians to analyze pre- and

posttest scores to check for meaningful findings and determine whether the program successfully

fulfilled its intended goals and outcomes. The biostatisticians will determine the effects of

independent program variables on their related outcome variables (fruit, vegetable, and SSB

consumption and nutrition/food knowledge). Outcome variables will be operationalized by

nutrition knowledge test scores along with fruit, vegetable, and SSB consumption scores.

SAMPLING STRATEGY:
Our program Keep It Up Beet will use non-probability purposive sampling to obtain the

sample population. We will distribute questionnaires measuring fruit, vegetable, and SSB

consumption as well as nutrition knowledge surveys to all 5th grade students in the school. A

sample size of at least 60 students (30 5th-graders at Fishburn along with another 30 5th-graders at

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Huntington Park) will be sufficient to detect effect sizes at a 5% α-level, 80% power, and 95%

confidence interval for our dependent variables. A sample size of 60 students total should be

sufficient to detect statistically significant differences from baselines using 2 sample t-tests and

paired t-tests. To insure potential attrition, we will oversample by surveying all 5th grade

students (60 students) from Fishburn, and another 60 5th grade students from Huntington Park.

Oversampling (n=120) will ensure that we will have sufficient data, given that some students

may not participate, participate only partially, or not fit characteristics for the data we aim to

capture (for example, if they are not Latino).

Eligibility Criteria: All 5th grade students enrolled in Fishburn for the 2018-19

academic year will be our sampling frame recruited to participate in our program. Eligibility

criteria for students from the comparison school will be that they are enrolled in 5th grade during

the 2018-19 school year. Participants will be involved in our program from August 2018 to June

2019. We will gather attendance data at weekly workshops and consider pre- and posttest data

for children who attend 75% or more of the time throughout the entire program duration. All

students will proceed to participation in our program through passive consent, also assuming

consent from parents or guardians unless otherwise stated through a non-consent form.76

Response Rate: We anticipate a response rate over 92% based on a similar intervention

in East LA targeting primarily Latino children in 4th and 5th grades.77 Since their intervention

was an after school program which required students to stay beyond regular class hours, we

anticipate an even higher response rate for Keep It Up Beet seeing as our program is integrated

into the curriculum.

Recruitment Concerns: According to the biostatisticians’ report, a minimum of 30

students in each group would be sufficient to detect a significant result. We will be

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oversampling, with 60 students from each school to ensure that at least 30 kids from each school

will meet criteria for data inclusion. Our program does not pose significant recruitment barriers

because it is incorporated into the 5th grade curriculum during usual class hours. However, there

may be barriers to getting the school to agree to sacrificing class time and resources for the

program; therefore, it is imperative to address these concerns with the schools before the start of

the intervention. Another concern is inconsistent participation of students who may be absent

more than 25% of the time from our weekly gardening and nutrition workshops. If frequent

absence occurs, based on attendance sheets, we will disregard those data from the analysis.

Data Collection: Data collection will be carried out through administered questionnaires

regarding self-reported fruit, vegetable, and SSB consumption and nutrition/food knowledge.

These will be completed on paper-and-pencil forms under the supervision of trained Health

Educators as 5th grade students may require supervision with staying focused and completing the

survey. The Health Educators will be trained beforehand on administering these surveys. In-class

questionnaires, as opposed to take-home or emailed, minimize non-response and decrease errors

or misunderstandings about the questions since participants can ask for clarification while filling

out the forms.

Data will be collected before the first session, upon completion of the last session, and at

6-month and 12-month follow-up points. The same questionnaires will be delivered at each data

collection period, in both the intervention and comparison groups. The questionnaires will be

pretested for length, appropriateness to this group, intelligibility, and any other potential

oversights that could be detected by a small random sample of 5th graders at Fishburn prior to

the start of the intervention.

Fruit, Vegetable, and SSB Consumption Questionnaires: Fruit, vegetable, and SSB

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consumption will be measured using an adaptation of the Block Food Screeners for Ages 2-17,

2007 (BFS).78 Given that children at age 10 have the cognitive capacity to recall dietary

information, a self-report questionnaire is appropriate.79 Given that children in Keep It Up Beet

are at school most of the day, their parents are unable to minutely track their consumption

behavior, so asking the children to self-report directly will provide the most accurate

information.

The 41-item BFS is validated specifically for children between ages 2 and 17 and takes

only about 10-12 minutes. The BFS measures outcome variables by servings but also asks for

individual portion sizes, which allows us to calculate and standardize servings according to the

USDA guidelines.78 The questionnaire will ask children to recall what they ate the day before.

We will modify the existing BFS screener to utilize only the fruit, vegetable, and SSB related

questions from the BFS screener, since we are only interested in these variables. This includes

questions about consumption of fruits, vegetables, fruit juices, potatoes (including French fries),

and SSB.78 This survey has been validated and used effectively in LA Sprouts, another nutrition

and garden intervention targeting primarily Latino, 4th and 5th grade children in East LA.41 It

has also been validated in a separate study specifically measuring the validity of the screener in

children 10-17 years old.80

Nutrition/Food Knowledge Questionnaire: To measure nutrition knowledge before

intervention, upon termination of the intervention, and at 6-month and 1-year follow ups, the

Keep It Up Beet team will use a nutrition knowledge questionnaire adapted from a report by the

Dr. Robert C. and Veronica Atkins Center for Weight and Health, University of California at

Berkeley.40 Questionnaires or knowledge tests are the standard method in research studies

seeking to operationalize a nutrition knowledge change among youth.81 This specific

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questionnaire was selected because it originates from a large-scale study with goals similar to our

own. Both our current study and the 2010 report are measuring an improvement in nutrition

knowledge in 5th graders through the same modalities of gardening, integrated nutrition

education, and cooking.40 The report the Keep It Up Beet team is drawing from found

meaningful nutrition knowledge improvement after 1 year, which suggests that the Keep It Up

Beet team is likely to see a difference in our program’s scores being the same length of study.

One study from 2002 suggests that a carefully designed, validated questionnaire that

involves simply adding up correct answers can, in fact, be used to assess nutrition knowledge.40

However, they cautioned that unidimensional test scores do not illustrate a full picture of one’s

entire understanding of nutrition. Our measurement is somewhat restricted but given the time and

resource constraints of our small pilot study, using a short-adapted questionnaire is the most

feasible option.

While the questionnaire for the UC Berkeley study included a broad range of questions

related to food, the Keep It Up Beet team has narrowed it down to include questions which

pertain specifically to measuring nutrition knowledge, which together make up 21 questions in

total. Answers are either in the form of answering free response questions (i.e. “How many

servings of FV are healthy to eat each day?”) or multiple-choice questions (i.e. “Which food has

the most sugar?”). Total points earned (1 point per correct answer) will be translated to a

percentage score for analysis. Six-month and 1-year post-intervention follow-up questionnaires

will be mailed to the student’s home with postage for the return envelope. Follow-up

questionnaires will be incentivized by a raffle entry per each completed posttest, to win a

cookware or baking set.

The original questionnaire that we have modified was developed in collaboration with

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school staff and project partners in the Berkeley Unified School District School Lunch Initiative.

Curricular learning objectives provided the basis for the knowledge questions, which fit our

study as well seen as we are implementing a comparable curriculum. A minor limitation of using

their questionnaire is that their target population consisted of 12.8% Latino children, while ours

is 97% Latino, which may or may not undermine its applicability to our group, which will be

determined after pretesting the questionnaire with our target population. However, the

questionnaire was reviewed by school staff and pre-tested for wording among students of similar

age as the participants, making it a pertinent tool to use in our program.

ANALYTICAL PLAN:
The Program Manager and Health Educators will be responsible for data entry, data

cleaning, and analysis. A statistical analyst consultant will provide their input, run statistical

tests, and present analyses and results to the staff team. In order to increase generalizability to

our study population, results will be controlled by ethnicity to determine if there is an effect

among Latino children specifically.

Data Entry and Management: Health Educators will enter questionnaire data into a

password protected Microsoft Excel 2017 spreadsheet. The analyst will quantify and recode all

outcome ratio variables (fruit consumption, vegetable consumption, nutrition knowledge, SSB

consumption) for analysis using Stata, version 14.

Univariate Descriptive Analysis: The univariate analysis will summarize data (mean,

median, standard deviation, etc.) for each moderating variable for both intervention and

comparison group. Variables include fruit consumption, vegetable consumption, SSB

consumption, and nutrition knowledge scores. The analysis will address assertive hypotheses by

testing descriptive baseline data and address associative hypotheses by analyzing the association

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between the percentage of participants and the magnitude of the desired outcomes.

Statistical Tests: To analyze changes in outcome variables within the target participants,

the analysts will use a paired t-test to compare the change in fruit consumption, vegetable

consumption, and nutrition knowledge from baseline to follow-up. To analyze the changes in

consumption and nutrition knowledge compared to the comparison group, the analysts will use a

2-sample t-test. For our primary outcome, we will use multiple logistic regression to assess

whether exposure is associated with consumption of fruit and vegetables, consumption of SSB,

and score on a nutrition knowledge test.

Economic Cost Analysis: Keep It Up Beet’s total budget requires $48,803.55 for its one-

year program and the total number of 5th grade students at Fishburn is 60. The cost-per-student-

served analysis for Keep It Up Beet’s one-year program assumes that the number of students at

Fishburn stays constant during the academic year and concludes that the cost to deliver the Keep

It Up Beet program is approximately $813.39 per student receiving the intervention.

ETHICAL ISSUES:
The implementation and evaluation plan of Keep It Up Beet will be reviewed and

approved by the UCLA Institutional Review Board (IRB) and the LAUSD IRB. To protect

participant confidentiality, each individual will be given a non-identifiable alias in place of their

name on all evaluation documents. Only program staff members and data analysts will have

access to questionnaire and answers, despite anonymous responses. Attendance sheets, study

notes, and survey response sheets will be kept in a locked, private office file cabinet, accessible

only by the Health Educators, gardener, and Program Manager. Electronic data will be password

protected and accessible only by these relevant program staff.

Consent will be acquired passively, by participation. Incentives for participation are not

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so valuable or desirable that they should alter behavior nor lead to coercion. The study purpose,

timeline, and activities will be explained in layman’s terms to students and their families to

provide transparency to participants. Information will be provided regarding where and when

participants can expect to read about the results of the study and further implications. The

proposed activities and questions will not pose psychological or physical harm to any participant,

so the benefits outweigh any potential risk. Keep It Up Beet is a small-scale pilot study that aims

to test the efficacy of food education and workshops, therefore it would not be unethical to

withhold the intervention in the comparison group.

V. DISCUSSION
Implications: The success of Keep It Up Beet is determined by immediate outcomes of

increased fruit and vegetable consumption, increased nutrition/food knowledge, and decreased

SSB consumption among target participants. In the long term, target participants will benefit

from decreased risk of obesity, a condition associated with negative health outcomes such as

cardiovascular disease, diabetes, asthma, and mental health issues. Additionally, providing

nutrition, food, and gardening knowledge to youth grants them the opportunity to become

advocates for their health as they grow up, to fuel demand for and creation of a healthier food

environment. If Keep It Up Beet is successful, it should become a permanent course in the 5th

grade curriculum at Fishburn. It could also be expanded to other elementary schools in the

LAUSD system. If Keep It Up Beet fails, this may be due either to implementation failure or

theory failure, which we can determine based on the results of process evaluation. If all aspects

of the program run as intended, this would implicate theory failure, and the concepts forming the

basis of Keep It Up Beet would need to be reevaluated. If there is implementation failure, the

process evaluation will point to the activities within the program requiring adjustment.

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Limitations: Potential challenges in implementation failure include the possibility that

FV in the garden will not sufficiently grow, whether due to lapses in care, pests, weather, or

other unpredictable factors. Additionally, FV will not be ready to be harvested on schedule with

each FFT. To prepare for this, we have included in the budget funding to purchase FV for

produce boxes to be given away on those days when the garden will not produce enough FV. In

these situations, we will discuss with students the risks and fickle nature of produce cultivation

as part of the lesson. Another possible issue is if the school were to choose to cease integration of

the workshops in the curriculum. In this case, we would have to deliver workshops after school

hours, which would negatively impact recruitment and attendance, in turn impacting exposure to

the intervention. To avoid this, we will create a contract with Fishburn regarding agreement on

and cooperation with our intervention from the beginning. Additionally, we will be receptive to

feedback from teachers, administrators, and staff at Fishburn so that our program is in line with

their expectations and does not disrupt the students’ academic goals. The curriculum is designed

to take into account holidays and testing days that may require cancellation of our sessions. If the

workshop must be canceled for unexpected reasons, that week will simply be skipped, and the

resulting loss will be taken into account in the data analysis phase.

One major challenge of our intervention will be recruitment and continuing attendance of

both parents and students at FFT. If certain students are unable to attend these sessions,

occurring outside school hours, they will have less exposure to the intervention than their peers

who attend both in-school sessions and FFT sessions. Future studies should examine more

specifically the association between level of participation and desired outcomes. To address

parent recruitment and participation, we could change the type or increase the value of

incentives, change the time and location of the event to better accommodate parents’ schedules

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and connect with a trusted community member who has frequent contact with parents to better

spread the word about these events. Additionally, behavior change takes time, and immediate

evaluation may not adequately capture progressive changes in behavior. To address this, we are

delivering posttests at 6 and 12 months out to evaluate the effects of Keep It Up Beet beyond the

program's completion. The sample size (n=120) is too small to generalize results of this

intervention to the greater population. Additional studies, preferably with larger samples, would

be beneficial to increasing reliability of the intervention. It is important to note that any result of

this study will be associative and will not indicate causality. Therefore, further testing is crucial

to determining if improvements in the target group can be directly attributed to components of

the intervention. While we hope that this program can be used as a blueprint for similar

programs, it is important to note that its effects will not be directly applicable to other schools

due to the varying demographics of the LAUSD student body. Additional evaluation and

adjustment of the program will be necessary before Keep It Up Beet can be successful in other

LAUSD schools.

Sustainability: Long-term sustainability of the program beyond the 1-year intervention

period poses a challenge. Financially, program costs are $48,803.55 and as education funding is

sparse, these funds will need to continue to flow from an outside source. It is uncertain whether

there would be enough qualified volunteers to continue to lead these educational workshops

when considering time commitment and required skill level. Building partnerships with the

school principal, teachers, and community members who participate is essential so that the

existing garden may continue to be harnessed as a source of fresh FV for students and their

families. Gathering input from stakeholders, including parents, teachers, staff, and the principal,

is crucial for the development and maintenance of the program in the future.82 Involving parents,

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kids, and creating a space for discussion about the curriculum may encourage sustained

engagement and foster a sense of excitement in parents to continue to support the activities

initiated by the program. The garden beds will remain on the Fishburn campus, making the

continuation of the program more feasible.

Dissemination of Findings: Our findings will be disseminated to teachers, parents,

students, and administrators of Fishburn at School Site Council, Parental Involvement Policy

(PIP), Open House nights, and board meetings. Since other schools in the LAUSD system would

also benefit from these findings, study results will be presented to the LAUSD Board of

Education. As knowledge of the efficacy of the intervention could contribute to the literature on

preventing childhood obesity, our findings will be made available to other researchers through

peer-reviewed publications and relevant conferences.

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64. Gibson EL, Wardle J, Watts CJ. Fruit And Vegetable Consumption, Nutritional

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74. Hamilton EA. The Phenx Toolkit: Get The Most From Your Measures. In. Vol 174.

March 14, 2018, Ver. 22.2 Ed: American Journal Of Epidemiology; 2011:253-260.

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Activity And Fitness: A Meta-Analysis. Am J Prev Med. 2009;36(6):527-537.

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Participants. School Ment Health. 2009;1(1):3-15.

77. Martinez LC, Gatto NM, Spruijt-Metz D, Davis JN. Design And Methodology Of The

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Randomized Controlled Intervention. Contemp Clin Trials. 2015;42:219-227.

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For Dietary Assessment In Children And Adolescents. Maternal And Child Nutrition.

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82. Davis J, Spaniol M, Somerset S. Sustenance And Sustainability: Maximizing The Impact

Of School Gardens On Health Outcomes. Public Health Nutrition. 2018;18(13):2358-

2367.

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APPENDIX A: TIMELINE

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APPENDIX B: LESSON PLAN

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APPENDIX C: LOGIC MODEL

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APPENDIX D: BUDGET
Line-Item Budget

Organization Name: UCLA

Proposal Title: Keep it Up Beet

Project Period: June 15, 2018 – June 15, 2019

Proposed Expenses Annual Salary % FTE Amount

Personnel

Full Time Personnel

Program Manager $ 75,000.00 0.3 $ 22,500.00

Benefits and Taxes @

35% $ 7,875.00

Total Personnel $ 30,375.00

Non-Personnel

Contracted Personnel

Garden Educator $ 3,700.00

Statistician $ 3,200.00

Stipends

Health Educator (2) $ 6,000.00

Program Costs

Nutrition Workshop

Materials $ 1,414.71

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Ingredients $ 6,240.00

Garden Workshop

Materials $ 444.19

Fruits and Vegetables $ 720.00

Recruitment

Materials

Incentives $ 995.40

Flyers $ 16.20

Operating Expenses

Local Travel $ 2,490.65

Site Compensation $ 1,000.00

Office Supplies $ 150.00

ServSafe

Certification $ 45.00

Evaluation Expenses

Questionnaire - paper $ 129.60

Pencils $ 10.35

Envelopes $ 47.96

Stamps $ 112.80

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Posttest Incentives $ 175.00

Total Non-Personnel $ 13,991.86

SUBTOTAL: Direct

Costs $ 44,366.86

Indirect Costs @ 10

% $ 4,436.69

GRAND TOTAL $ 48,803.55

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APPENDIX E: BUDGET JUSTIFICATION


Personnel Expenses:

Program Manager (PM): The PM will be a Full-Time UCLA affiliate and will oversee and run a

majority of the program and its activities. Duties will include hiring and managing program

team, curriculum design, program management, budget management, report writing and

additional administrative tasks. The PM will also host monthly FFT sessions, meet with the

Parent Committee and school principal once a month, and is expected to foster good

relationships with parent participants (i.e. in person, emails, phone calls).

Qualifications: MPH; minimum years of experience in community health education and

program planning for the Latino population; bilingual (English/Spanish).

Salary: The average public health program manager salary is $75,000. The project

manager will work 30% FTE on this project for 1 full year. ($75,000 x 30%) = $22,500

Employee Benefits and Taxes: Benefits and taxes have been calculated at 35% for full

time employees which includes FICA and federal withholding, SDI, state withholding,

workers’ compensation, and health and dental benefits. The benefits for this project total

$7,875.

Non-personnel expenses:

Gardener: The gardener will create the gardening education curricula by adapting the LA Sprouts

gardening curricula and using their own horticultural knowledge. The gardener will teach weekly

gardening sessions, maintain the 6 garden beds on school grounds throughout the duration of the

program, obtain necessary materials and tools for gardening, and keep in contact with partners

who provide resources.

Qualifications: Master Gardener certification (or pursuing certification), as this

certification provides complete horticultural training as well as ensuring prior community


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engagement experience; bilingual (English/Spanish).

Rate: Gardener will be hired as a contractor (3 hours/week during school year x 36

weeks) + 40 hours curriculum planning = 148 hours @ $25.00/hr = $3,700

Health Educators (HE): HEs will work with program manager to develop nutrition education

curriculum. Health Educators will lead interactive nutrition education and cooking sessions, and

assist at FFT, as well as assist program manager with recruitment and outreach activities as

needed, and perform evaluation activities such as data collection, data entry, data cleaning, and

preparation and delivery of data analysis.

Qualifications: Current enrollment in an MPH program; BS degree in Nutrition; bilingual

(English/Spanish).

Stipend: Educators will be paid a stipend based upon expected 1.5-3 hours per week for

11 months at $3,000 each ($3,000 x 2 educators = $6,000).

Statistical Analyst: A statistical analyst will be hired as a consultant to provide input, run

statistical tests, and prepare statistical analyses for program staff.

Qualifications: Minimum Master’s degree in biostatistics or related; minimum 3 years

related experience.

Rate: Statistical analyst will be hired as a contractor. We estimate analysis will take up to

a total of 80 hours over the course of the evaluation process. According to the Bureau for

Labor Statistics, the average rate for a statistician is $40/hr. ($40/hr x 80 hours = $3200)

Program Costs

Nutrition Materials

Materials totaling $1,414.71 necessary for nutrition education workshops include:

Rolling cart to store and transport materials, and utilize as a demonstration table during

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education sessions $500.00

Hot plate for use as cooktop in demonstrations $30.00

Cookware (4 mixing bowls, 4 whisks, 4 measuring cups, 4 measuring set, 2 mortar &

pestle, 2 spatula set) $272.00

Eating sets (60 students x 36 sessions = 2160 sets) + (120 caregivers x 8 FFT = 960 sets)

= 3120 sets

Utensils (2 boxes of 1800 utensil sets x $73.96) = $147.92

Plates (7 boxes of 480 plates x $22.57) = $157.99

Napkins (8 boxes of 400 napkins x $6.55) = $52.40

Curriculum that meets common core standards to be adapted for intervention; purchased

online $60.00

Worksheets for nutrition education workshops (1 worksheet at $0.09/sheet x 60 students

x 36 sessions) = $194.40

Ingredients

Ingredients for use in all cooking workshops (produce, grains, beans, oil, etc) at

$2.00/child and $2.00/caregiver. ($2.00/child x 60 children x 36 workshops = 4,320) +

($2.00/caregiver x 120 caregivers x 8 FFT = 1,920) = $6,240.00

Garden Materials

Materials totaling $444.19 necessary for gardening workshops include:

Tools (20 Trowels, 6 watering cans) $178.88

Seeds (18 packs x $3/pack) = $54.00

Soil ($3.32/cu. ft x 90 cu. ft) = $299.10

Picnic table supplies (3 hammers, wood, nuts, bolts, screws, washers) $265.31

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Fruits and Vegetables

It is expected that take-home boxes will need to be supplemented with purchased FV, as

garden will not produce enough FV for all FFT events. This includes the first 2 FFT

events, as garden will not yet have produced sufficient FV, and 2 additional anticipated

FFT throughout the year. We anticipate these costs at ($3/box x 60 boxes x 4 FFT) =

$720.00

Recruitment Materials

Incentives are vital to participant recruitment and retention. Incentive costs totaling

$995.40 necessary for raffle prizes for FFT, and prizes for award celebration include:

Gift cards to Superior Grocery Store (4 cards/FFT x 8FFT x $20) = $640.00

Steel Cookware Set (2 sets x $130) = $260.00

Kitchenaid 11-piece Baking Set (2 sets x $45) = $90.00

Print paper certificates for award celebration (0.09/sheet x 60 students) = $5.40

Flyers: Print flyers for recruitment ($0.09/sheet x 180 sheets) = $16.20

Operating Expenses:

Local Travel: Travel has been calculated at $0.545 per mile per 2018 IRS standards; one

round trip between UCLA and Fishburn is 35 miles. It is estimated that the educators will travel

1260 miles in total each for nutrition education sessions, gardener will travel 1800 miles for

nutrition education and garden maintenance, and program manager will travel 875 miles for FFT,

networking, site visits, and outreach, for a total of 4,570 miles. (4,570 miles x $0.545/mile =

$2,490.65).

Site Compensation: Intervention will take place at Fishburn Elementary and will require

utilization of existing raised beds, shed space for gardening tools, and storage space for rolling

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cart. Additionally, presence on site may add to Fishburn Elementary School’s overhead costs. To

compensate for added burden to site and site expenses, will provide compensation to Fishburn

Elementary at $1000.

Office Supplies: Miscellaneous office supplies (pens, pencils, highlighters, notebooks,

post-its, paper clips, staples, etc.) have been estimated at $150.

ServSafe Certification: ServSafe Certification is required for all staff (2 health educators,

1 program manager) who will be handling food items to be served to participants, totaling

($15/certification x 3 staff) = $45.00.

Evaluation Expenses:

Print paper questionnaires for surveying 4 times, at baseline, immediate posttest, 6-month

posttest, and 12-month posttest (0.09/sheet x 3 sheets per questionnaire = $0.27 per

questionnaire; $0.27/questionnaire x 120 students = $32.40 per survey session;

$32.40/survey x 4 total survey sessions = $129.60)

Pencils, 96 pack = $10.35

Envelopes, 120 pack for posttests, includes one envelope to send and one return envelope

per participant (2 envelopes/participant x 120 participants = 240 envelopes; 240

packs/120 per pack = 2 packs; $11.99/pack x 2 packs = $23.98 per posttest;

$23.98 per posttest x 2 posttests = $47.96)

Stamps ($0.47/stamp x 240 envelopes = $112.80)

Raffle prizes, totaling $175.00:

Steel Cookware Set (1 set x $130) = $130.00

Kitchen aid 11-piece Baking Set (1 set x $45) = $45.00

Contractor (health educators, statistical analyst) time for delivering and analyzing

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evaluation included above.

Indirect Costs:

Indirect, administrative costs have been calculated at 10% of total direct costs

($44,366.86 x 10%) for a total of $4,436.99.

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APPENDIX F: BIOSTATISTICIAN CONSULTANT REPORT


Background:

“Keep it Up Beet: More Fruits and Veggies, Happier Kids” is a Community Health Sciences

project with the primary goal of reducing dietary risk factors for obesity in Latino 5th graders of

low socioeconomic status (SES) attending elementary school in East LA. Dietary risk factors for

obesity will be measured through fruit, vegetable and sugar sweet beverage (SSB) consumption

as well as knowledge of nutrition through a questionnaire designed by the researchers.

Objectives:

The objective of this study is to decrease dietary risk factors for obesity in school children. The

intervention consists of two main components: parental participation and workshops. The

workshops include educating students on good nutritional habits and teaching them gardening

with as much parental involvement as possible. The investigators will measure these risk factors

and compare results in the group that receives the intervention (through pre and posttests) as well

as compare results with the control group that receives no intervention. Ultimately, they hope

that the intervention will (1) increase fruit and vegetable consumption, knowledge of nutrition

and parental participation and (2) decrease SSB consumption.

Study Design:

The investigators describe the study design as a, “quasi-experimental, with a pre and posttest

nonequivalent comparison group, controlling for the testing effect and posttests.” The control

group will not receive the intervention and will consist of a 5th grade class at another elementary

school in East LA comprised primarily of Latinos of low SES that receive a comparable level of

education and enrichment programs. The researchers assume (1) dietary habits will not

spontaneously improve drastically, (2) students will consistently attend school (3) the control

group will have no interaction with the group that receives the intervention and (4) attrition is
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unlikely because the intervention will be integrated into the school curriculum. The investigators

plan to do 6-month and 12-month follow ups and measure parental participation, fruit, vegetable,

and SSB consumption and knowledge of nutrition through a questionnaire. The researchers

establish baselines for these variables and hope to see beneficial changes in pre and post

examinations within the group that receives the intervention as well as compared to the control

group.

Statistical Methods:

The researchers make baseline measurements for fruit, vegetable and SSB consumption and

questionnaire score based on nutrition questionnaire based on previous research/literature.

Measurements for fruit, vegetable and SSB consumption are measured in serving size, as defined

by the USDA guidelines. They hope to see a 28% increase, 33% increase and 53% decrease,

respectively in these consumption groups as well as an 11% increase in nutritional knowledge

score.

• Because the researchers want to see a percentage change in serving size, a t-test would be

used to analyze the results. Specifically, to analyze changes in consumption within the

group that receives the intervention, we would use a paired t-test and to study changes in

consumption compared to the control group, we would use a 2-sample t-test.

Sample Size and power considerations:

The researchers claim their study is a pilot study, so they will do this intervention on one 5th

grade class (n = 60 students). They also provide us with a desired effect size (a percentage

change) for fruit, vegetable and SSB consumption as well as knowledge score. The investigators

want to see a 28% increase in fruit consumption, a 33% increase in vegetable consumption, a

53% decrease in SSB consumption and an 11% increase in nutrition knowledge score.

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We consider the sample size calculation in the following way:

n=(Z1-α2+Z1-β)2*CVPC(1-PC)2

where

• CV=σμ≈sX , the coefficient of variation (a useful way to compare variation between two

groups). Because we do not have actual data, we must estimate σ and the CV. A typical

CV is 30%.

• PC represents the percentage change (the effect size).

• We assume α=0.05 and Power=1-β=0.8, so Z1-α2=1.96 and Z1-β=0.84.

The following table shows how the sample size changes for each consumption group as we vary
the CV.
CV N (Fruit N (Vegetable N (SSB Knowledge
Consumption) Consumption) Consumption) PC = 11%
PC = 28% PC = 33% PC = 53% increase
increase increase Decrease
10% 6 subjects 6 subjects 7 subjects 10 subjects
20% 11 subjects 11 subjects 14 subjects 19 subjects
30%* 16 subjects 16 subjects 21 subjects 28 subjects
40% 22 subjects 22 subjects 28 subjects 37 subjects
50% 28 subjects 27 subjects 35 subjects 46 subjects
60% 33 subjects 32 subjects 41 subjects 56 subjects
70% 39 subjects 38 subjects 48 subjects 65 subjects

*Typical values for CV are around 30%.


In short, to detect these effect sizes at a 5% α level and 80% power, a sample size of 60 for each
group should be sufficient (assuming all students in the class participate).

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