In 2001, the 77th Texas legislature passed Senate Bill 19 requiring students in publicly funded elementary schools to participate in physical activity and schools to implement a coordinated school health program by September 1, 2007. We report on awareness of and adherence to Senate Bill 19 in a statewide sample of elementary schools and a subsample in two public health regions located along the Texas–Mexico border. Statewide, structured interviews with principals indicated high awareness of Senate Bill 19's requirements, but lower awareness of the need for parental involvement. Only 43% of Texas schools had adopted their coordinated program 1 year or less before the implementation deadline. Principals reported an average of 179 min of physical education per week, higher than the 135-min mandate. Among the subsample border schools, principals' physical activity reports were consistent with teacher records and student reports. Further, direct observation of physical education indicated that 50% of class time was spent in moderate and vigorous physical activity, meeting the level of physical activity intensity recommended by Healthy People 2010. The differences observed by public health regions included: more physical activity minutes in Region 10 (231 min compared to 217 min in Region 11); higher adoption of coordinated school health programs (92% compared to 75%); more district-level school health advisory committees (58% compared to 38%) and school-level school health advisory committees (83% compared to 25%); and a lower prevalence of obesity in 4th grade students (21% compared to 32%). Differences by region suggest that Senate Bill 19 is not being adhered to equally across the state, and some regions may require further support to increase implementation. Results underscore the importance of continued monitoring of enacted legislation, and that legislation for child health that focuses on school programs and policies requires funding and refinement to produce the intended effect.

Coordinated, multi-component school-based interventions can improve health behaviors in children, as well as parents, and impact the weight status of students. By leveraging a unique collaboration between Texas AgriLife Extension (a federal, state and county funded educational outreach organization) and the University of Texas School of Public Health, the Texas Grow! Eat! Go! Study (TGEG) modeled the effectiveness of utilizing existing programs and volunteer infrastructure to disseminate an enhanced Coordinated School Health program. The five-year TGEG study was developed to assess the independent and combined impact of gardening, nutrition and physical activity intervention(s) on the prevalence of healthy eating, physical activity and weight status among low-income elementary students. The purpose of this paper is to report on study design, baseline characteristics, intervention approaches, data collection and baseline data. The study design for the TGEG study consisted of a factorial group randomized controlled trial (RCT) in which 28 schools were randomly assigned to one of 4 treatment groups: (1) Coordinated Approach to Child Health (CATCH) only (Comparison), (2) CATCH plus school garden intervention [Learn, Grow, Eat & Go! (LGEG)], (3) CATCH plus physical activity intervention [Walk Across Texas (WAT)], and (4) CATCH plus LGEG plus WAT (Combined). The outcome variables include student’s weight status, vegetable and sugar sweetened beverage consumption, physical activity, and sedentary behavior. Parents were assessed for home environmental variables including availability of certain foods, social support of student health behaviors, parent engagement and behavior modeling. Descriptive data are presented for students (n = 1369) and parents (n = 1206) at baseline. The sample consisted primarily of Hispanic and African American (53 % and 18 %, respectively) and low-income (i.e., 78 % eligible for Free and Reduced Price School Meals program and 43 % food insecure) students. On average, students did not meet national guidelines for vegetable consumption or physical activity. At baseline, no statistical differences for demographic or key outcome variables among the 4 treatment groups were observed. The TGEG study targets a population of students and parents at high risk of obesity and related chronic conditions, utilizing a novel and collaborative approach to program formulation and delivery, and a rigorous, randomized study design.

Background: Nutrition labels are a tool to inform and encourage the public to make healthier food choices, but little information is available about use in multi-ethnic adolescent populations in the U.S. The purpose of this study was to examine associations between the level of nutrition label usage and healthy/unhealthy eating behaviors among a statewide representative sample of 8th and 11th-grade students in Texas. Methods: We analyzed cross-sectional associations between the Nutrition Facts label use and eating behaviors from a statewide sample of 8th and 11th-grade students in Texas, (n = 4730, weighted n = 710,731, mean age = 14.7 ± 1.6 years; 49% female, 51% Hispanic), who completed the 2019–2020 Texas School Physical Activity and Nutrition (TX SPAN) survey. Students self-reported their level of nutrition label usage to make food choices (5-point Likert scale from “Never” to “Always”) and previous day consumption of 26 food items (13 healthy, 13 unhealthy). The 26 food items were used to calculate a Healthy Eating Index (HEI) score (0–100), a Healthy Foods Index (HFI) score (0–100), and an Unhealthy Foods Index (UFI) score (0–100). Weighted linear regression models were employed to examine the associations between self-reported use of nutrition labels to make food choices and HEI, HFI, and UFI scores. Marginal predicted means of HEI, HFI, and UFI scores were calculated post hoc from linear regression models. The odds of consuming specific individual food items for nutrition label usage were also calculated from weighted logistic regression models. All linear and logistic regression models were adjusted for grade, sex, Body Mass Index (BMI), race/ethnicity, economic disadvantage, and percentage of English language learners by school. Results: A total of 11.0% of students reported always/almost always using nutrition labels to make food choices, 27.9% reported sometimes using them, while 61.0% indicated they never/almost never used nutrition labels to make food choices. The average HEI score among students in the sample was 47.7 ± 5.9. Nutrition Facts label usage was significantly and positively associated with HEI (b = 5.79, 95%CI: 4.45, 7.12) and HFI (b = 7.28, 95%CI:4.48, 10.07), and significantly and negatively associated with UFI (b = −4.30, 95%CI: −6.25, −2.34). A dose–response relationship was observed between nutrition label usage and HEI, HFI, and UFI scores, such that the strength of these associations increased with each one-point increase in nutrition label usage. Students who reported using nutrition labels always/almost always to make food choices had significantly higher odds of consuming healthy foods including baked meat, nuts, brown bread, vegetables, whole fruit, and yogurt (OR_range = 1.31–3.07), and significantly lower odds of consuming unhealthy foods including chips, cake, candy, and soda (OR_range = 0.48–0.68) compared to students who reported never/almost never using the Nutrition Facts label. Conclusions: Using the Nutrition Facts labels to make food choices is beneficially associated with healthy and unhealthy eating among 8th and 11th-grade students, although the proportion of students using nutrition labels to make their food choices was low. Public health efforts should be made to improve nutrition literacy and encourage nutrition label use among secondary students in the United States.