title: The CHANGE study: a healthy-lifestyles intervention to improve rural children's diet quality.
abstract: 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.
  
  
  METHODS
  We used a school and community-based group randomized, controlled design.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.forename: Juliana F W
authors.initials: JF
authors.lastname: Cohen
authors.forename: Vivica I
authors.initials: VI
authors.lastname: Kraak
authors.forename: Silvina F
authors.initials: SF
authors.lastname: Choumenkovitch
authors.forename: Raymond R
authors.initials: RR
authors.lastname: Hyatt
authors.forename: Christina D
authors.initials: CD
authors.lastname: Economos
mesh_terms: D000293:Adolescent; D002140:California; D002648:Child; D002675:Child, Preschool; D004032:Diet; D004043:Dietary Fiber / Q000008:administration & dosage; D002523:Edible Grain; D002149:Energy Intake; D005247:Feeding Behavior; D005260:Female; D005638:Fruit; D006293:Health Promotion; D006801:Humans; D007629:Kentucky; D008019:Life Style; D008297:Male; D008922:Mississippi; D009765:Obesity / Q000517:prevention & control; D050177:Overweight / Q000517:prevention & control; D012424:Rural Population; D012574:Schools; D013022:South Carolina; D014675:Vegetables
keywords: Children; Diet; Healthy-lifestyle behaviors; Rural; Vulnerable populations