Date on Master's Thesis/Doctoral Dissertation


Document Type

Master's Thesis

Degree Name



Bioinformatics and Biostatistics

Committee Chair

Wu, Dongfeng

Author's Keywords

Healthy lifestyle; Nutrition; Rural children; Mixed-effects regression model; Physical activity


Health education (Elementary); Physical education for children; Nutrition--Study and teaching (Elementary); Rural children--Education


Introduction: Childhood obesity has become a national public health crisis in America. Physical inactivity and unhealthy eating behavior may contribute to childhood obesity. School-based programs focusing on healthy lifestyles play a promising role in preventing and controlling childhood obesity. Purpose: To assess the preliminary effects of a school-based program on physical activity and eating behavior among rural children. Methods: A quasi-experimental study design with repeated measures (intervention group only) was utilized. Children from kindergarten to fifth grade in four rural elementary schools in Kentucky participated in the study. A variety of strategies were implemented to obtain four goals: (1) improving physical activity level, (2) improving health and nutrition education, (3) promoting family/community involvement through Family Fitness Fun Nights, and (4) realigning school’s wellness policy with HealthierUS School Challenge. Physical activity was assessed by pedometer logs of step counts (4 consecutive days), while fruits and vegetables consumption were assessed by a previous day recall survey. Data were collected in January (baseline), February (t1), March (t2), April (t3) and May (t4) of 2010. Repeated measures ANOVA and mixed-effects regression models were used. Results: A total of 1,508 children, 814 boys and 679 girls (15 missing sex), participated in this study. The program had significant effects on increasing the percentage of children meeting nutrition (14.8% vs. 25.9%, p < 0.01) and physical activity recommendations (1.4% vs. 5.0%, p < 0.01). There were significant main effects of school, time, sex and grade on physical activity and eating behavior. The effects of the program on physical activity and eating behavior depended on school, grade and age of the children. Children’s physical activity level was positively correlated with their grade level. Generally, there was an increasing linear trend of physical activity and an increasing quadratic trend of eating behavior over time. Conclusions: The school-based healthy lifestyle program had beneficial effects on improving healthy behaviors among children. Further studies are needed to assess the long-term health effects and cost-effectiveness of this program.