Issues in Rural HealthThe Winning With Wellness Pilot Project: Rural Appalachian Elementary Student Physical Activity and Eating Behaviors and Program Implementation 4 Years LaterSchetzina, Karen E. MD, MPH; Dalton, William T. III PhD; Pfortmiller, Deborah T. MA; Robinson, Hazel F. BA; Lowe, Elizabeth F. MS, RD; Stern, H. Patrick MDAuthor Information Department of Pediatrics (Drs Schetzina and Stern and Ms Robinson), Department of Psychology (Dr Dalton), Center for Nursing Research (Ms Pfortmiller), and Department of Allied Health Sciences (Ms Lowe), East Tennessee State University, Johnson City. Correspondence: Karen E. Schetzina, MD, MPH, Department of Pediatrics, East Tennessee State University, P.O. Box 70578, Johnson City, TN 37614 (email@example.com). The authors recognize and thank all coalition members, community partners, and the school community for their contributions in developing, implementing, and evaluating the Winning with Wellness project. This study was supported, in part, by an East Tennessee State University Appalachian Center for Translational Research Disparities (ACTRID) grant through funding from NCMHD Project EXPORT grant number 5 R24 MD001106-02 awarded to Dr Joellen Edwards. Dedicated to the memory of Connie Hall Givens, former Director of Tennessee Coordinated School Health and a lifelong champion for children. Family & Community Health: April/June 2011 - Volume 34 - Issue 2 - p 154-162 doi: 10.1097/FCH.0b013e31820e0dcb Buy Metrics Abstract School-based efforts to promote physical activity and healthier eating are a potentially effective approach to decreasing child obesity in rural populations. This article describes follow-up data on student activity and eating behaviors 4 years after implementation of the Winning with Wellness obesity prevention initiative. This project was based on the Centers for Disease Control and Prevention's coordinated school health model and used a community-based participatory research approach to address health behaviors in rural Appalachian elementary students. Results suggest significant increases in daily pedometer steps and healthier food selections by students as well as teacher support for continued health promotion efforts. © 2011 Lippincott Williams & Wilkins, Inc.