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Background: Whole grain (WG) options are often limited in schools, which may impact rural, low-income students who rely on school meals for a substantial portion of their food intake. This study examined the changes in the availability and quantity of WG and refined grain foods offered in schools participating in the Creating Healthy, Active and Nurturing Growing-up Environments (CHANGE) study, a randomized, controlled intervention among rural communities (4 intervention and 4 control)., Methods: Foods were assessed using production records, recipes, and nutrition labels from breakfast and lunch over 1 week during fall 2008 and spring 2009. Key informant interviews were conducted with school food service directors in the spring 2009., Results: The CHANGE intervention schools significantly increased the average percent of school days WGs were offered (p = .047) and the amount of WGs offered/food item (ounces) at lunch compared with control schools (p = .02). There was a significant decrease in the percent of students with access to refined grains at lunch compared with control schools (p = .049), although there were no significant differences in WG availability during breakfast., Conclusions: The CHANGE schools improved WG availability, enabling student's WG consumption to be closer to national recommendations., (© 2014, American School Health Association.)

Background: Despite the high rates of overweight and obesity among rural children, there have been limited interventions reported to improve the diet quality of rural, low-income children in the United States., Objective: Our aim was to evaluate students' diet quality at baseline and after implementing the CHANGE (Creating Healthy, Active and Nurturing Growing-Up Environments) study, a 2-year (2007-2009) randomized, controlled, community- and school-based intervention to prevent unhealthy weight gain among rural school-aged children., Design: We used a school and community-based group randomized, controlled design., Participants/setting: Data were collected in eight rural communities in California, Kentucky, Mississippi, and South Carolina (one elementary school per community). Children in grades 1 to 6 participated in the study (n=432; mean age=8.65 years ± 1.6 years). Students' diets were assessed at baseline (spring or early fall 2008) and post intervention (spring 2009) using the Block Food Screener for ages 2 to 17 years., Statistical Analyses: Mixed-model analysis of variance was used to examine the effect of the CHANGE study intervention on students' diets. Results were adjusted for corresponding baseline dietary values, sex, age, grade, race/ethnicity, and state, with school included as a random effect nested within condition., Results: At the end of 1 year, students enrolled in the CHANGE study intervention schools consumed significantly more vegetables (0.08 cups/1,000 kcal/day; P=0.03) and combined fruits and vegetables (0.22 cups/1,000 kcal/day; P<0.05) compared with students in control schools. Students in the intervention schools also showed a reduction in the average daily dietary glycemic index (GI=-1.22; P<0.05) and a trend toward more fruit consumption (0.15 cups/1,000 kcal/day; P=0.07). There were no significant differences in students' consumption of whole grains, legumes, dairy, potatoes/potato products, saturated fat, added sugars, or dietary fiber consumption., Conclusions: The CHANGE study enhanced some aspects of rural students' dietary intake. Implementing similar interventions in rural America can be promising to support vegetable consumption., (Copyright © 2014 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: Evidence supports the role of physical and social environments in active living, including perception of environment. However, measurement of perceived environments in rural settings is lacking. This study describes the development of the Rural Active Living Perceived Environmental Support Scale (RALPESS)., Methods: Premised on social ecological and cognitive perspectives, 85 initial items were generated through a literature review and a mixed-methods investigation of "activity-friendly" environments. Items were organized by resource areas--town center, indoor and outdoor physical activity areas, schools, churches, and areas around the home/neighborhood--and submitted for expert panel review. In 2009, a revised questionnaire was disseminated to adolescents, parents, public school staff, and older adults in 2 rural southeastern United States counties. Principal component analysis with varimax rotation was used to explore factor structure (n = 542)., Results: The final analysis yielded 33 items with 7 factors: 1) church facilities, 2) town center connectivity, 3) indoor areas, 4) around the home/neighborhood, 5) town center physical activity resources, 6) school grounds, and 7) outdoor areas., Conclusions: The RALPESS is a valid, internally consistent, and practically useful instrument to measure perceptions of rural environments in the context of physical activity across the lifespan. Confirmatory factor analysis is recommended to validate factor structure.

Parents play an important role in shaping children's eating habits. Few studies have evaluated the influence of both parenting style and parenting practices on child outcomes such as dietary intake. During spring 2007, 99 parent-child dyads from four rural US areas participated in this cross-sectional study. Child food intake was reported during two interviewer-administered, parent-assisted 24-hour recalls. Diet quality was defined as the average number of low-nutrient-dense (LND) foods consumed. Validated questionnaires were used to assess parental feeding practices and feeding style. Pearson correlations identified relationships among child food intake, parental feeding style typologies, and covariates. Regression analyses were used to predict child diet quality. Sixty percent of children and 76% of parents were overweight or obese. A permissive feeding style, which is highly responsive to a child's requests and sets few demands on him or her, was the most common (n=37) parental feeding style. This feeding style was associated with child intake of LND foods (r=0.3; P<0.001) and moderated the relationship between parental feeding practices and child intake of LND foods. In the presence of a permissive feeding style, higher levels of monitoring were associated with child intake of LND foods (β=.69; P<0.05). Parental feeding style may alter the effectiveness of parental feeding practices on children's food intake. More research is needed to understand the parent-child feeding relationship in the context of parental feeding styles and practices., (Copyright © 2012 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: Active living integrates physical activity into one's daily routine. Current understanding of active living among children and their families living in rural communities is limited. A community perspective is critical to understand the contextual factors that influence children's physical activity in rural areas., Purpose: The purpose of this study was to identify the perceived environmental factors that support or hinder physical activity among rural children to develop testable hypotheses to inform future interventions for reducing unhealthy weight gain and preventing chronic diseases associated with physical inactivity., Methods: PhotoVOICE was used to explore active living opportunities and barriers for children living in four low-income, rural U.S. communities. In 2007, parents (n=99) and elementary school staff (n=17) received disposable cameras to document their perspective. Using their photographs and narratives, participants developed emergent themes during a facilitated group discussion. In 2008, study authors used the Analysis Grid for Environments Linked to Obesity (ANGELO) framework to categorize the themes., Results: Microenvironment themes include physical (e.g., natural features, topography); sociocultural (e.g., isolation); policy (e.g., time for school recess); and economic (e.g., funding for physical activity programs). Macroenvironmental themes related to the built and natural environments and transportation infrastructure., Conclusions: This study identified rural environment elements that community members perceived as influencing children's physical activity patterns. Certain aspects were unique to rural areas, whereas other urban and suburban factors may be generalizable to rural settings. PhotoVOICE was a useful participatory research method to gain insight into perceived factors affecting rural children's physical activity behaviors., (Copyright © 2010 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

The purpose of this study was threefold: to investigate the association between three parenting behaviors (parenting style, feeding style, and feeding practices), to evaluate whether these behaviors were associated with child weight, and to determine whether style (parenting and feeding) moderated the relationship between feeding practice and child weight. Ninety-nine parent-child dyads were recruited for a cross-sectional study where parents self-reported their parenting style, feeding style, and feeding practices along with demographic characteristics. Height and weight were measured for each dyad. The relationship between parenting style and feeding style showed modest agreement. Feeding style, but not parenting style, was associated with child BMI z-score while controlling for known covariates. An indulgent feeding style was associated with a higher child weight status. Multiple regression analysis demonstrated that feeding style moderated the association between restrictive feeding practices and child BMI z-score. No moderating relationship was found between feeding style and the practices of pressure to eat or monitoring and child weight. This research suggests that an indulgent feeding style may be predictive of higher child weight and that future studies should examine the possible moderating role of feeding style in the parent feeding practice-child weight relationship., (Copyright 2010 Elsevier Ltd. All rights reserved.)

Background: There are disproportionately higher rates of overweight and obesity in poor rural communities but studies exploring children’s health-related behaviors that may assist in designing effective interventions are limited. We examined the association between overweight and obesity prevalence of 401 ethnically/racially diverse, rural school-aged children and healthy-lifestyle behaviors: improving diet quality, obtaining adequate sleep, limiting screen-time viewing, and consulting a physician about a child’s weight. Methods: A cross-sectional analysis was conducted on a sample of school-aged children (6–11 years) in rural regions of California, Kentucky, Mississippi, and South Carolina participating in CHANGE (Creating Healthy, Active, and Nurturing Growing-up Environments) Program, created by Save the Children, an independent organization that works with communities to improve overall child health, with the objective to reduce unhealthy weight gain in these school-aged children (grades 1–6) in rural America. After measuring children’s height and weight, we17 assessed overweight and obesity (BMI ≥ 85th percentile) associations with these behaviors: improving diet quality18 (≥ 2 servings of fruits and vegetables/day), reducing whole milk, sweetened beverage consumption/day; obtaining19 adequate night-time sleep on weekdays (≥ 10 hours/night); limiting screen-time (i.e., television, video, computer,20 videogame) viewing on weekdays (≤ 2 hours/day); and consulting a physician about weight. Analyses were adjusted 21 for state of residence, children's race/ethnicity, gender, age, and government assistance. Results: Overweight or obesity prevalence was 37 percent in Mississippi and nearly 60 percent in Kentucky. Adjusting for covariates, obese children were twice as likely to eat ≥ 2 servings of vegetables per day (OR=2.0,95% CI 1.1-3.4), less likely to consume whole milk (OR=0.4,95% CI 0.2-0.70), Their parents are more likely to be told by their doctor that their child was obese (OR=108.0,95% CI 21.9-541.6), and less likely to report talking to their child about fruits and vegetables a lot/sometimes vs. not very much/never (OR=0.4, 95%CI 0.2-0.98) compared to the parents of healthy-weight children. Conclusions: Rural children are not meeting recommendations to improve diet, reduce screen time and obtain adequate sleep. Although we expected obese children to be more likely to engage in unhealthy behaviors, we found the opposite to be true. It is possible that these groups of respondent parents were highly aware of their weight status and have been advised to change their children’s health behaviors. Perhaps given the opportunity to participate in an intervention study in combination with a physician recommendation could have resulted in actual behavior change. [ABSTRACT FROM AUTHOR]