Article

Pilot-testing CATCH Early Childhood: A Preschool-based Healthy Nutrition and Physical Activity Program

American Journal of Health Education

January 2011
42(1):12-23

DOI:10.1080/19325037.2011.10599169

Authors:

Ru-Jye Chuang

The University of Texas Health Science Center at Houston

Background: The literature on theoretically-based programs targeting healthy nutrition and physical activity in preschools is scarce. Purpose: To pilot test CATCH Early Childhood (CEC), a preschool-based nutrition and physical activity program among children ages three to five in Head Start. Methods: The study was conducted in two Head Start centers (N=75 children, their parents; 9 teachers). CEC was implemented by trained teachers over six weeks in fall 2008. Qualitative data on feasibility and acceptability was collected using post-intervention parent and teacher focus groups and lesson plan evaluation forms. Pre-to-post intervention changes in children's fruit and vegetable intake and physical activity at school were evaluated. Results: Results showed good feasibility and acceptability for the classroom curriculum, activity box and parent tip-sheets. There was a trend towards an increase in children's fruit, 100% fruit juice and vegetable intake and mean minutes of physical activity at school pre-to-post intervention. However, this increase was not significant. Discussion: The CEC program showed good feasibility and acceptability in the study population. Further evaluation of behavioral outcomes using a larger sample and a prospective design is needed. Translation to Health Education Practice: These results provide information important for developing and implementing evidence-based programs in preschools.

Systematic review of parental influences on Hispanic children's nutritional and physical health

Article

Full-text available

May 2022
J Publ Health

Background Obesity affects racial/ethnic groups at disproportionate rates. As within other minority populations, obesity rates are increasing in Hispanic individuals. Parental and cultural influences play important roles in determining children’s health-related lifestyle behaviors. Thus, it is important to understand how Hispanic parents are incorporated in behavioral interventions. Methods The inclusion criteria for this systematic review included being part of a human study published in a peer-reviewed, English language journal between 2009 and 2021, targeting school-age children, featuring a parent-based nutritional intervention, having at least a 50% Hispanic population, and including a nutritional, parental, and (optional) physical activity outcome. The search included terms such as “feeding behavior”, “pediatric obesity”, and “parenting”. Parent involvement within the intervention was scored as either active or passive. Results The search yielded 6567 articles. After removing 2847 duplicates, 4433 titles and abstracts were reviewed and 359 full text articles were reviewed. Of the 359 full text articles reviewed, 34 articles met inclusion criteria and 23 articles were not available for review. Thirty-four articles spanning 32 studies were included in this review. Twenty-three studies were classified as using active strategies with regard to parental components. Conclusion Interventions aimed at preventing childhood obesity among Hispanic children with parental components are actively involving parents through tailoring, active learning, modeling, and goal-setting. Studies using a combination of these change methods reported positive behavioral changes among the children participants.

Trends in the Number of Behavioural Theory-Based Healthy Eating Interventions Inclusive of Dietitians/Nutritionists in 2000–2020

Article

Full-text available

Nov 2021

Nutrition interventions developed using behaviour theory may be more effective than those without theoretical underpinnings. This study aimed to document the number of theory-based healthy eating interventions, the involvement of dietitians/nutritionists and the behaviour theories employed from 2000 to 2020. We conducted a review of publications related to healthy eating interventions that used behaviour change theories. Interventional studies published in English between 2000 and 2020 were retrieved from searching Medline, Cinahl, Embase, Psycinfo and Cochrane Central. Citation, country of origin, presence or absence of dietitian/nutritionist authors, participants, dietary behaviours, outcomes, theories and any behaviour change techniques (BCTs) stated were extracted. The publication trends on a yearly basis were recorded. A total of 266 articles were included. The number of theory-based interventions increased over the two decades. The number of studies conducted by dietitians/nutritionists increased, but since 2012, increases have been driven by other researchers. Social cognitive theory was the most used behaviour theory. Dietitians/nutritionists contributed to growth in publication of theory-based healthy eating interventions, but the proportion of researchers from other professions engaged in this field increased markedly. The reasons for this growth in publications from other professions is unknown but conjectured to result from greater prominence of dietary behaviours within the context of an obesity epidemic.

Preschoolers distinguish between healthy and unhealthy snack foods

Article

Apr 2011

Nutrition Education Resources in North Carolina–Based Head Start Preschool Programs: Administrator and Teacher Perceptions of Availability and Use

Article

Full-text available

Oct 2016

Objective: The purpose of this study was to provide new insight into common barriers to the availability and use of nutrition education (NE) resources in Head Start preschool programs based on administrator and teacher perceptions. Methods: In-depth, semistructured phone interviews (n = 63) were conducted with administrators (n = 31) and teachers (n = 32) from North Carolina-based Head Start programs. Interviews were audio-recorded and transcribed verbatim. Data were analyzed qualitatively using content analysis to identify common themes. Results: Five emergent themes were identified within the areas of NE resource availability and use and barriers to NE resource availability and use. Participants expressed desire for greater organization of existing NE material resources, increased community support, and professional development opportunities for teachers specific to NE. Funding and time constraints were reported as affecting NE resources. Conclusions and implications: Creative strategies for addressing NE resource availability and use and barriers (eg, NE integration with educational standards) in Head Start are needed.

Interventions for Improving Young Children’s Dietary Intake through Early Childhood Settings: A Systematic Review

Article

Full-text available

Feb 2015

Early childhood settings (ECS) offer a unique opportunity to intervene to improve children's nutrition. This paper reviews the literature on early childhood setting interventions that aim to improve children's dietary intake. Environmental and individual determinants of children's dietary intakes were also investigated. Prospective intervention studies targeting centres, staff, parents/caregivers or children, were reviewed. Methodological quality was assessed. Twenty six studies (14 weak, 12 moderate quality) were included. Interventions were delivered primarily via training workshops and/or written materials. Study findings favoured intervention effectiveness in 23 studies. Improvements were seen in children's intake for 8 out of 11 studies assessing dietary intake outcomes. Small increases in fruit and vegetable consumption were observed in five studies. Most studies measuring parental or centre food provision observed post-intervention improvements across a number of food groups, including fruit, vegetables, whole grains and sweetened beverages. Significant improvements in child, parent and/or staff knowledge, attitudes or behaviours were observed consistently across studies. For those studies that included a comparison group, these improvements were observed only in the intervention group. ECS interventions can achieve changes in children's dietary intake and associated socio-environmental-determinants, although the quality of current research limits confidence in study findings. Future intervention development needs to carefully consider the behavioural targets, modifiable determinants and utilise age-appropriate and effective behaviour change theory, in addition to inclusion of dietary intake outcomes.

Feasibility and acceptability of a gardening-based nutrition education program in preschoolers from low-income, minority populations

Article

Jan 2014

Garden-based lessons are gaining popularity as a means of increasing fruit and vegetable intake among children. The study objective was to pilot test a garden-based preschool curriculum for feasibility and acceptability in Harris County Department of Education Head Start using qualitative and quantitative methods. A total of 103, 3- to 5-year-old children at two Head Start centers in Harris County, Texas participated. PLANT Gardens (Preschoolers Learn About Nutrition Through Gardens), a theoretically grounded, teacher-led, garden-based nutrition education program for preschoolers was implemented over 8 weeks in spring 2008. Heights and weights were measured on participating children. Data regarding program feasibility and acceptability were obtained through post-intervention focus groups with teachers and parents, weekly lesson plan evaluation forms completed by project staff, and post intervention teacher surveys. Pre−post self-reported parent surveys were used to evaluate the effects of the program on their preschooler’s fruit and vegetable preferences and willingness. The results showed that, overall, 28.4 percent of the Head Start preschooler’s population were overweight or obese, yet only 3 percent of parents perceived their preschooler as overweight. This pilot test revealed strong acceptability and feasibility of the PLANT Gardens program in this Head Start population. Results of the parent surveys (n= 25) indicated a significant increase in their preschooler’s willingness to try new fruits and vegetables (67% at baseline vs 84% post-intervention; p = 0.026). Data were used to further refine the program components. In conclusion, the PLANT Gardens program showed good initial feasibility and acceptability and is a promising program to increase preference and intake of fruits and vegetables in a preschool population. Further evaluation of behavioral outcomes using a larger sample size and a prospective design is needed.

A socio-ecological approach to physical activity interventions in childcare: A systematic review

Article

Full-text available

Feb 2014
INT J BEHAV NUTR PHY

The promotion of physical activity (PA) in young children requires effective interventions. This article reviews the evidence on PA interventions in childcare by applying a socio-ecological approach. A computer-based literature search for intervention studies aimed at increasing children's PA levels was run across four databases: SPORTDiscus, ISI Web of Science, PsycINFO and ERIC. The participants had to be in childcare, aged 2-6-year-old, and their pre- and post- intervention PA levels measured. Selection was restricted to peer-reviewed publications and to studies conducted in childcare settings. Twenty-three studies met the inclusion criteria and their methodological quality was assessed. Seven studies exhibited high methodological quality; twelve were rated as moderate and four low. The effectiveness of the interventions was determined according to the post-intervention behavioral changes reported in children's PA. Fourteen studies found increases in PA levels or reductions in sedentary time, although the changes were modest. The data remain too limited to allow firm conclusions to be drawn on the effectiveness of the components mediating PA interventions, although PA-specific in-service teacher training seems a potential strategy. The findings of this review indicate that children's PA remained low and did not approach the 180 min/day criteria. It may be that more intensive multilevel and multicomponent interventions based on a comprehensive model are needed.

Preschoolers Can Distinguish Between Healthy and Unhealthy Foods: The All 4 Kids Study

Article

Mar 2014
J NUTR EDUC BEHAV

To determine changes in preschoolers' ability to distinguish between healthy and unhealthy foods and stated food preferences after participation in a nutrition education program. Pre-post comparison/intervention study with sites clustered based on center size and language. Preschool classrooms. A total of 191 preschoolers from Nevada and 128 from Connecticut, New Jersey, and Oklahoma. All 4 Kids, a 24-lesson program taught by trained instructors. Pre- and post-assessment sum scores for identifying 18 foods; stated preference for, and distinguishing between, healthy vs unhealthy choice from 9 food pairs using a newly designed tool. t tests; multiple linear and logistic regression models. There was a statistically significant improvement in identification scores from pre- to post-study for both groups from Nevada (P < .001). For preference and distinguishing between healthy and unhealthy foods, no differences were noted at pretest. At posttest, significantly more intervention than comparison preschoolers indicated a preference for healthier foods (P < .006) and an ability to distinguish them (P < .03). Outcome comparison between Nevada and 3 states demonstrated generalizability of the study tool. Participation in All 4 Kids resulted in preschoolers' increased understanding of healthy foods and changed their stated food preferences.

The Effect of Nutrition Educational Programs on the Composition of Home Prepared Children’s Breakfasts

Article

Full-text available

Oct 2022

The study aimed to examine the effectiveness of two intervention programs in improving dietary habits in two groups of preschool and fifth-grade students. The programs were tailored to the target age group. The composition of each of the children’s breakfasts that were brought from home was recorded both before and after the intervention program. Every food item received a score according to its nutritional quality, and each meal was summed accordingly. T-tests were performed in order to determine the significance of differences between the nutritional quality of the children’s breakfast items before and after the intervention. It was found that the nutritional quality of all breakfast components and its overall health quality improved significantly in both age groups. The study’s results indicate that the intervention program is effective for a range of young ages. It is recommended to conduct such programs starting in preschools, and subsequently in schools. Keywords: nutrition educational program, health education, meal components

Examining the Effects of Movement Activities of Coordinated Approach to Child Health (CATCH) Program on Locomotor and Manipulative Skills of 4-5 Years Old Children

Article

Full-text available

Jan 2022

The main objective of the research is to examine the impact of regular implementation of Education Program made of CATCH Program Movement Activities on the locomotor and manipulative skills of preschool children. Implementation of Education Program made of CATCH Program Movement Activities was carried out in an independent preschool located in Kadıköy District in Anatolian Side of İstanbul Province, Turkey. Purposeful sampling method was used to determine the school where the experimental designed study will be conducted. The study group of the research consists of 64 children, 32 in experiment group and 32 in control group. To determine the efficiency of Education Program made of CATCH Program Movement Activities, education program was implemented with experiment groups for two days a week during 9 weeks. According to the results of pre-test and post-test measurements of experiment and control groups, no significant difference was determined between the locomotor subdimension, manipulative subdimension of the measurement instrument and measurement instrument total scores in pre-test measurements of the children (p>.05). According to the analysis results of post-test measurements following movement program, it was determined that there is a significant difference in locomotor subdimension, manipulative subdimension of the measurement instrument and measurement instrument total scores of both 4 and 5 years old children in favour of the experiment group (p<.05).

The Effect of Family Participation in Nutrition Education Intervention on the Nutritional Status of Preschool Age Children

Article

Full-text available

Jul 2019
EGIT BILIM

To evaluate the effectiveness of family participation in nutrition education intervention on the nutritional status of preschool age children, a 10-week nutrition education program was implemented in 74 children in a public kindergarten. Children were assigned to one of three groups, namely the family participation group (FPG), the education group (EG), and the control group (CG). Interventions included school-based nutrition education, family nutrition education documents and family-child take-home activities and monthly meetings with families in the FPG, school-based nutrition education in the EG, and no intervention in the CG. Anthropometric measurements and a 3-day food record and food group consumption assessment were completed before and after intervention. Intervention led to positive changes in food availability, offering and consumption patterns in FPG and EG, with greater changes in FPG, along with lower obesity prevalence (p < 0.05). Our results show that family participation in a preschool nutrition education program can increase the effectiveness of nutrition education.

Developing Healthy Food Preferences in Preschool Children Through Taste Exposure, Sensory Learning, and Nutrition Education

Article

Full-text available

Mar 2018

Purpose of review: The present review was undertaken in order to summarize and evaluate recent research investigating taste exposure, sensory learning, and nutrition education interventions for promoting vegetable intake in preschool children. Recent findings: Overall, taste exposure interventions yielded the best outcomes for increasing vegetable intake in early childhood. Evidence from sensory learning strategies such as visual exposure and experiential learning also show some success. While nutrition education remains the most common approach used in preschool settings, additional elements are needed to strengthen the educational program for increasing vegetable intake. There is a substantial gap in the evidence base to promote vegetable intake in food fussy children. The present review reveals the relative importance of different intervention strategies for promoting vegetable intake. To strengthen intervention effects for improving vegetable intake in preschool children, future research could consider integrating taste exposure and sensory learning strategies with nutrition education within the preschool curriculum.

Best Practices and Barriers to Obesity Prevention in Head Start: Differences Between Director and Teacher Perceptions

Article

Full-text available

Dec 2017

Introduction: Practices and barriers to promoting healthy eating and physical activity at Head Start centers may influence children's energy balance behaviors. We examined differences between directors' and teachers' perspectives on best practices and barriers to promoting healthy eating and physical activity in Head Start centers. Methods: We conducted a cross-sectional study of directors (n = 23) and teachers (n = 113) at 23 Head Start centers participating in the baseline assessment of the Texas Childhood Obesity Research Demonstration study. Participants completed surveys about practices and barriers to promoting healthy eating and physical activity. Multilevel regression models examined differences between director and teacher responses. Results: More than half of directors and teachers reported meeting most best practices related to nutrition and physical activity; few directors or teachers (<25%) reported conducting physical activity for more than 60 minutes a day, and less than 40% of teachers helped children attend to satiety cues. Significantly more directors than teachers reported meeting 2 nutrition-related best practices: "Teachers rarely eat less healthy foods (especially sweets, salty snacks, and sugary drinks) in front of children" and "Teachers talk to children about trying/enjoying new foods" (P < .05). No barrier to healthy eating or physical activity was reported by more than 25% of directors or teachers. Significantly more teachers than directors reported barriers to healthy eating, citing lack of food service staff support, limited time, and insufficient funds (P < .05). Conclusion: More barriers to healthy eating were reported than were barriers to physical activity indicating that more support may be needed for healthy eating. Differences between responses of directors and teachers may have implications for future assessments of implementation of best practices and barriers to implementation related to nutrition and physical activity in early care and education centers.

Does the CATCH Early Childhood Program Increase Physical Activity Among Low-Income Preschoolers?—Results From a Pilot Study

Article

Full-text available

Feb 2018
AM J HEALTH PROMOT

Purpose To explore whether the physical activity (PA) component of the Coordinated Approach to Child Health Early Childhood (CATCH EC) program helps increasing preschoolers’ PA during active times at preschool. Design Nonrandomized controlled experimental study. Setting Head Start centers in Houston, Texas, 2009 to 2010 school year. Participants A total of 439 preschoolers aged 3 to 5 years (3 intervention centers, n = 220; 3 comparison centers, n = 219). Intervention The CATCH EC preschool-based teacher-led nutrition and PA program. Measures Preschoolers’ PA was measured at baseline and postintervention using the System for Observing Fitness Instruction Time–Preschool version, a direct observation method measuring PA at the classroom level. Parent surveys provided demographic data. Analysis Pre-to-post changes in preschoolers’ PA were examined using the Mann-Whitney U test. Results Results show a significant decrease in the percentage time preschoolers spent in level 2 PA (low activity) at intervention (P = .005) and comparison (P = .041) centers. Indoor vigorous activity increased significantly on an average by +6.04% pre-to-post intervention among preschoolers in the intervention group (P = .049); no significant change was found in the comparison group. Conclusion The CATCH EC favorably increased indoor vigorous PA level among low-income children attending Head Start.

Project ReFresh: Testing the Efficacy of a School-Based Classroom and Cafeteria Intervention in Elementary School Children

Article

Jul 2016

Background: The purpose of this study was to assess the effect of a school-based nutrition program using a cafeteria environment intervention and classroom nutrition education on self-reported fruit and vegetable (FV) consumption, self-efficacy to select FV, and preference for healthy foods. Methods: Using quasi-experimental pre-post design with 3 study conditions, a total of 665 fourth- and fifth-grade students participated in the study. The comprehensive intervention included a behavioral economics cafeteria intervention and weekly classroom nutrition education for 1 academic year. The intervention was designed and delivered by the extension system. Results: The comprehensive group showed significant improvement in some indicators including eating vegetables for lunch (p = .007), number of days eating vegetables (p < .001) and fruits (p < .001) in the last week, and self-efficacy in preparing FV at home (p = .034) compared to the control and cafeteria groups. Food preference of some food items, including oatmeal (p = .036 for cafeteria group, p < .001 for comprehensive group), whole grain noodles (p = .011 for comprehensive group), and vegetables (p = .003 for comprehensive group), significantly improved in the cafeteria and/or comprehensive group. Conclusions: Classroom nutrition education combined with cafeteria improvement has the potential to improve diet-related behavior of elementary school children. Also, collaborative partnership between schools and extension can enhance program sustainability.

Examination of Obesity Prevention Programs Using the ANGELO (the ANalysis Grid for Elements Linked to Obesity) Framework.

Technical Report

Apr 2011

A blended professional learning intervention for early childhood educators to target the promotion of physical activity and healthy eating: the HOPPEL cluster randomized stepped-wedge trial

Article

Full-text available

Jul 2022
BMC PUBLIC HEALTH

Background Childcare centres are important environments for promoting physical activity and healthy eating. Blended approaches to professional learning may help overcome existing challenges for educators in promoting these behaviours. This study aimed to test the effect of a blended professional learning program on healthy eating and physical activity in childcare. Methods Cluster randomized stepped-wedge trial in 15 childcare centres in Tasmania, Australia. Children aged 2-5y who attended at least two days per week were eligible to participate. Random assignment occurred at the centre level. Centre names were drawn out of a hat and then subsequently allocated to one of the three steps. The intervention comprised a 12-week blended professional learning program for educators. The main outcome was centre-level physical activity and healthy eating, assessed using the Environment and Policy Assessment Observation System (EPAO). All data collectors were blinded to step allocation. Analyses were according to intention to treat. The trial was registered with the Australian New Zealand Clinical Trial Registry (ACTRN12618000346279, date registered: 07/03/2018). Results Centres were recruited between January 2016 and February 2016. All centres were retained for the duration of the study. A total of 313 children were recruited with 291 analysed at the completion of the study (93%). The difference between groups for the EPAO total score was significant at the end of the maintenance period (adjusted difference = 14.63, 95% CI [1.33, 27.92], p = 0.03). Significant differences were found for the percentage of time children spent in light-intensity physical activity at the end of the intervention (adjusted difference = 0.01, 95% CI [0.00,0.01], p = 0.02) and maintenance periods (adjusted difference = 0.01, 95% CI [0.00,0.02], p = 0.04). To the best of the authors knowledge, there were no adverse events. Conclusion This intervention achieved a sustained improvement in physical activity and healthy eating in childcare centres. Further, it can be easily integrated into existing service provision, especially among centres with limited access to professional learning. Trial registration The study was registered with the Australian and New Zealand Clinical Trials Registry ( ACTRN12618000346279 , date registered: 07/03/2018).

ÜSKÜDAR İLÇESİ ANAOKULU MENÜLERİNİN DEĞERLENDİRİLMESİ

Article

Full-text available

Jan 2021

Elvan YILMAZ AKYÜZ1 , Esin SEZGİN2 ÖZET Amaç: Bu çalışma, İstanbul ili Milli Eğitim Müdürlüğü'ne bağlı Üsküdar İlçesi'ndeki resmi anaokullarındaki menülerin günlük beslenme referanslarına uygunluğunun değerlendirilmesi amacı ile yürütülmüştür. Çalışma Planı: Çalışmaya Üsküdar ilçesindeki beş resmi ana okulu dahil edilmiş ancak bir okulun menüsü internet sitesinde yayınlanmamış olduğu için çalışmaya dört anaokulu dahil edilmiştir. Anaokullarındaki bir aylık (20 gün) menülerin değerlendirilmesinde; besin grubu içerikleri ve çocukların enerji, makro besin ögesi gereksinmelerini karşılama oranları hesaplanmıştır. Enerji ve makro besin ögesi içerikleri Beslenme Bilgi Sistemi (BEBİS) yazılımı ile hesaplanmıştır. Bulgular: Çalışmadaki anaokulu menülerinin yağ oranları ve doymuş yağ miktarı okulların hepsinde (sırasıyla; %42, %40, %41, %37 ve %17.9, %13.6, %13.4, %14.3), enerjinin sükrozdan gelen miktarı (%7, %17, %14) üç okulda referans aralığın üzerinde bulunmuştur. Ayrıca menü içerikleri besin gruplarına göre değerlendirildiğinde tahıl grubunun yeterli düzeyde olduğu ve yüksek; ancak süt grubu, et grubu, meyve ve sebze grubunun yetersiz düzeyde bulunduğu saptanmıştır. Sonuç: Okul öncesi dönemde çocuklara doğru beslenme alışkanlıklarının kazandırılması, büyüme ve gelişimlerinin sürdürülebilmesi için oldukça önemlidir. Bu yüzden günlerinin önemli bir kısmını geçirdikleri anaokullarında çocuklara verilen menülerin yeterli ve dengeli beslenme ilkelerine uygun olarak hazırlanması gereklidir. Çalışma sonucunda anaokullarında öğrencilere sunulan menülerin beslenme ilkelerine uygun olmadığı belirlenmiştir. Menülerin diyetisyenler kontrolünde hazırlanması ve anaokullarındaki yetkili kişilerin menü hazırlama konusunda eğitilmesi önerilmektedir. Anahtar Kelimeler: Anaokulu, diyetisyen, okul öncesi çocuk, menü. EVALUATION OF PRESCHOOL MENUS IN USKUDAR ABSTRACT Objective: This study was carried out in order to evaluate the menus of formal preschools in Uskudar District of Istanbul Provincial Directorate of National Education. Study Design: The study included five formal preschools in Uskudar, but four schools were included in the study because a school's menu was not published on the website. In the evaluation of one month (20 days) menus in preschool; energy, macro nutrient requirements of children and nutrient group contents of menus were calculated. The contents of energy and macro nutrients were calculated with the Nutrition Information System (NIS) software. Results: The fat ratios and saturated fat content of the preschool menus in the study were found in all schools (42%,40%,41%,37% and 17.9%, 13.6%, 13.4%, 14.3% respectively), and the ratio of energy from sucrose was above the reference range in three schools (7%,17%,14%). In addition, when the contents of the menu were evaluated according to the food groups, the cereal group was adequate and high; however, the milk group, meat group, fruit and vegetable group were found to be insufficient. Conclusion: Achieveing appropriate eating habits in preschool children are very important for the sustainability of growth and development. Therefore, the menus served to children in preschool, where they spend a significant part of their days, should be prepared in accordance with adequate and balanced nutrition principles. As a result of the study, it was determined that the menus of preschools were not suitable for children's requirements. It is recommended that the menus should be prepared under the control of dietitians and trained and authorized/ experienced persons in the preparation of menus in preschool are required.

Assessments of Healthy Diet and Obesity Services on Primary Health Care Centers in Turkey

Article

Full-text available

Sep 2020

Amaç: Dünyada beslenme ilişkili sağlık sorunları önde gelen problemler arasında yer almaktadır. Çalışmamızın amacı birinci basamak sağlık hizmet birimi olan sağlıklı hayat merkezi diyabet ve obezite biriminde verilen diyetisyenlik hizmetlerinin obezitenin kontrolündeki etkinliğini araştırmaktır. Gereç ve Yöntemler: Bu çalışma 01/01/2017–30/06/2018 tarihleri arasında İstanbul’un bir ilçesinde son yıllarda popülerleşen sağlıklı hayat merkezi diyabet ve obezite danışma biriminde çalışan diyetisyene başvuran kişilerin verileri üzerinden yapılmıştır. Başvuru esnasında diyetisyen tarafından kişilerin demografik bilgileri, aile öyküsü, beslenme takviyesi alma durumları, hastalık ve ilaç bilgileri kaydedilmiştir. Ayrıca kişilerin vücut ağırlığı, boy uzunluğu, vücut yağ ölçümü yapılmış ve vücut-kitle indeksi (VKİ) hesaplanarak veri tabanına girilmiştir. Ölçümler her başvuru sırasında tekrarlanmış ve kaydedilmiştir. Araştırma evrenini, kilo vermek amacıyla birime başvuran, en az bir kontrolüne gelmiş, VKİ normal düzeyin üzerinde olan yetişkin bireyler oluşturmaktadır. Bulgular: Diyetisyen hizmetini kullanan 904 danışandan, 310’u (%34,3) kontrol randevularına gelmemiştir. Araştırmada değerlendirilen 446 danışandan 422’si (%94,6) kadındır. Birinci derece akrabada obezite olma durumu %75,8’dir. Danışanların ilk durumları VKİ’lerine göre sınıflandırıldığında; %31,4’ü kilolu, %58,7’si obez ve %9,9’u morbid obezdir. Kronik hastalık durumları sorgulandığında 244 kişinin (%54,7) eşlik eden kronik hastalığı olduğu bilgisi edinilmiştir. Ortalama yağ kaybı 2,6 (±4,0) ve ortalama kilo kaybı 3,1 (±3,6)’dir. Sonuç: Diyabet ve obezite danışma birimlerinden kadınlar daha yüksek oranla yararlanmaktadır. Literatür incelendiğinde koruyucu sağlık hizmetlerinin kullanımında kadınların ön plana çıktığı görülmüştür. Danışanların bir kısmının tanılı olup, ilaç kullanmadıkları anlaşılmaktadır. Bu durumla ilgili diyetisyenlerin danışanlarını uyarmaları ve hatırlatmaları yönünde telkine tabi tutulmaları yerinde olacaktır. Danışanların yaşı büyüdükçe, kilo verme başarılarının anlamlı derecede artmış olduğu tespit edilmiştir. Kilolu bireylerin aile hekimleri takiplerinde diyetisyenlere yönlendirilmesi periyodik olarak hekimlere hatırlatılmalıdır. Herhangi bir kronik hastalık tanısı almış bireyin muhakkak diyetisyene yönlendirilmesi, uzman hekim tarafından kontrollerde ilaç uyumunun ve diğer sorgulanan konuların yanında muhakkak diyet ve egzersiz uyumlarının da sorgulanması önem arz etmektedir. Sunulan sağlık hizmeti, kilo verdirme açısından başarılı bulunmuştur.

Barriers to Implementing a Healthy Habits Curriculum in Early Childhood Education: Perspectives from Childcare Providers and Teachers

Article

Full-text available

Jul 2021
Early Child Educ J

With increasing rates of childhood obesity in the United States, it is important to develop effective curricula that helps children learn and practice healthy habits. Given the large percentage of children who spend time in away-from-home care, childcare centers are opportune contexts to implement such curricula. We sought insight from 35 teachers and childcare providers to identify barriers to implementing an already established healthy habits curriculum (Sprouts: Growing Healthy Habits). Of the 35 participants, 9 identified as teachers (preschool, kindergarten, first grade) while the other 26 identified as childcare providers or working in childcare (i.e., program directors). Each participant completed a semi-structured phone interview after reviewing the curriculum to examine their perspective on: (a) curriculum appeal, (b) barriers to implementing the lessons, and (c) adaptations that would be needed. Interviews were recorded then transcribed verbatim. Three researchers developed a codebook and reached reliability coding (Cohen’s kappa > .70). Themes from initial codes were then used to interpret data. The results indicate that there is great appeal for implementing a healthy habits curriculum in childcare contexts. The barriers providers thought they might face were: behavioral management, parental connections, preparation time, and lack of resources. Additional recommendations suggested a need to incorporate more diversity into lessons. Differences in responses were also noted by participant demographics and childcare/school neighborhood demographics. Despite noted barriers, most providers expressed enthusiasm for using a healthy habits curriculum. This helpful feedback provided useful adaptions to the Sprouts curriculum for children 4–6 years old.

Online Preschool Teacher Training to Promote Physical Activity in Young Children: A Pilot Cluster Randomized Controlled Trial

Article

Full-text available

Jan 2020

This study tested the Wellness Enhancing Physical Activity in Young Children (WE PLAY) program, a 4-week online preschool teacher training, on children's moderate-to-vigorous physical activity (MVPA). In this cluster RCT, six Head Start preschools were randomized to an intervention and comparison group. Children's MVPA was measured using accelerometers at pre- and posttest. The magnitude of the difference in MVPA between groups at posttest was small, but in the expected direction: Δ min/hour = 1.60, 95% CI [-0.97, 4.18], p = .22, Cohen's d = 0.32. We observed a pre/post within group increase in average minutes per hour of MVPA in school with a medium effect size for the intervention group: Δ mean min/hour = 2.09, 95% CI [0.51, 3.67], p = .0096, Cohen's d = 0.42. An increase was not seen for the comparison group: Δ mean min/hour = 0.44, 95% CI [-0.70, 1.59], p = .45, Cohen's d = 0.07. WE PLAY children in 6 hr/day programs gained 63 min of MVPA per week in school, providing preliminary evidence of the benefits of WE PLAY on children's physical activity levels. WE PLAY deserves further testing with larger groups of children and teachers. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

A systematic review of practices to promote vegetable acceptance in the first three years of life

Article

Full-text available

Feb 2019

Background: Although most children do not meet vegetable intake recommendations no clear universal guidelines exist on the best method of introducing and promoting vegetables in infants. Objective: To identify strategies to promote vegetable acceptance in children from the start of complementary feeding until 3 years of age. Design: A comprehensive search strategy was performed using the databases Scopus and Pubmed. Articles published before March 2018 measuring vegetable intake and/or liking were included. Results: 46 papers, 25 experimental (intervention) studies, and 21 observational studies were included. Intervention studies revealed that repeated exposure increased acceptance of the target vegetable, whereas exposure to variety was found to be particularly effective in increasing acceptance of a new vegetable. Starting complementary feeding with vegetables increased vegetable acceptance, whereas starting with fruits did not. Visual exposure to an unfamiliar vegetable increased the acceptance of that vegetable even without consuming it, while visual exposure to a familiar vegetable did not. A stepwise introduction of vegetables resulted in better initial acceptance of vegetables than introducing vegetables directly. Observational studies showed that vegetable consumption was associated with frequency of exposure, exposure to variety, and modelling. A majority of studies found a positive association between breastfeeding and vegetable acceptance, but only two out of seven studies found an association between age of vegetable introduction and their acceptance. Conclusions: Based on the papers reviewed, we conclude that introducing vegetables at the beginning of complementary feeding, giving a different type of vegetable every day and ensuring repeated exposure to the same vegetable following an interval of a few days are the most promising strategies to promote vegetable intake in children starting complementary feeding until they are 3 years of age.

Promoting Fitness and Safety in Elementary Students: A Randomized Control Study of the Michigan Model for Health

Article

Jul 2016

Systematic review and meta-analysis of strategies to increase vegetable consumption in preschool children aged 2–5 years

Article

Full-text available

Apr 2018

Background: Most children do not meet daily recommendations for fruit and vegetable intake, and consumption of vegetables remains especially low. Eating habits track from childhood to adulthood hence establishing liking and intake of vegetables is important. Objective: To identify the most successful strategies to enhance vegetable intake in preschool children aged 2-5 years. Design: The research was a systematic review and a meta-analysis of published studies. A comprehensive search strategy was performed using key databases such as Medline, Embase, PsychINFO, EBSCO and CENTRAL. Articles published between 2005-January 2016, specifically with measured vegetable consumption were included. Results: 30 articles and 44 intervention arms were identified for inclusion (n = 4017). Nine dominant intervention strategies emerged to promote vegetable intake in preschool children. These included; choice, pairing (stealth), education, food service, modelling, reward, taste exposure, variety and visual presentation. The meta-analysis revealed that interventions implementing repeated taste exposure had better pooled effects than those which did not. Intake increased with number of taste exposures and intake was greater when vegetables offered were in their plain form rather than paired with a flavor, dip or added energy (e.g. oil). Moreover, intake of vegetables which were unfamiliar/disliked increased more than those which were familiar/liked. Conclusions: Repeated taste exposure is a simple technique that could be implemented in childcare settings and at home by parents. Health policy could specifically target the use of novel and disliked vegetables in childcare settings with emphasis on a minimum 8-10 exposures.

A multilevel intervention to increase physical activity and improve healthy eating and physical literacy among young children (ages 3-5) attending early childcare centres: The Healthy Start-Départ Santé cluster randomised controlled trial study protocol

Article

Full-text available

Apr 2016
BMC PUBLIC HEALTH

Hassanali Vatanparast

Background: Childhood obesity is a growing concern for public health. Given a majority of children in many countries spend approximately 30 h per week in early childcare centers, this environment represents a promising setting for implementing strategies to foster healthy behaviours for preventing and controlling childhood obesity. Healthy Start-Départ Santé was designed to promote physical activity, physical literacy, and healthy eating among preschoolers. The objectives of this study are to assess the effectiveness of the Healthy Start-Départ Santé intervention in improving physical activity levels, physical literacy, and healthy eating among preschoolers attending early childcare centers. Methods/design: This study follows a cluster randomized controlled trial design in which the childcare centers are randomly assigned to receive the intervention or serve as usual care controls. The Healthy Start-Départ Santé intervention is comprised of interlinked components aiming to enable families and educators to integrate physical activity and healthy eating in the daily lives of young children by influencing factors at the intrapersonal, interpersonal, organizational, community, physical environment and policy levels. The intervention period, spanning 6-8 months, is preceded and followed by data collections. Participants are recruited from 61 childcare centers in two Canadian provinces, New Brunswick and Saskatchewan. Centers eligible for this study have to prepare and provide meals for lunch and have at least 20 children between the ages of 3 and 5. Centers are excluded if they have previously received a physical activity or nutrition promoting intervention. Eligible centers are stratified by province, geographical location (urban or rural) and language (English or French), then recruited and randomized using a one to one protocol for each stratum. Data collection is ongoing. The primary study outcomes are assessed using accelerometers (physical activity levels), the Test of Gross Motor Development-II (physical literacy), and digital photography-assisted weighted plate waste (food intake). Discussion: The multifaceted approach of Healthy Start-Départ Santé positions it well to improve the physical literacy and both dietary and physical activity behaviors of children attending early childcare centers. The results of this study will be of relevance given the overwhelming prevalence of overweight and obesity in children worldwide. Trial registration: NCT02375490 (ClinicalTrials.gov registry).

INCREASING PHYSICAL ACTIVITY OF PRESCHOOL STUDENTS

Article

Jul 2011

margaret Dunn-Carver

Evaluation of a teacher-led physical activity curriculum to increase preschooler physical activity

Article

Full-text available

Jan 2013

margaret Dunn-Carver

Preschool students are generally sedentary at school, and few interventions have addressed whether teacher-led activities can increase physical activity at preschools. The current study aimed to increase physical activity in preschool children enrolled in childcare centers by training childcare providers to deliver a physical activity curriculum. A within-group pre-test/post-test design was used including 32 children at 4 preschools. A teacher-led physical activity curriculum, the Coordinated Approach to Child Health Early Childhood Education Curriculum (CEC) was implemented in each childcare center for six weeks. Activity levels of participants were monitored through the use of accelerometers and direct observation for approximately five hours pre- and post-intervention. Time spent in moderate/vigorous physical activity in preschoolers in three of the four preschools suggested a positive trend increasing from 34.5% ± 13.2% baseline to 39.3% ± 15.4% at follow-up (p = 0.10). Teachers from all four centers reported spending 24.6 ± 13.0 minutes per activity session with up to two activity sessions completed per day. These results justify larger trials to determine the impact of a teacher-led physical activity curriculum on the intensity and duration of preschool students’ physical activity at school.

Incorporating Primary and Secondary Prevention Approaches To Address Childhood Obesity Prevention and Treatment in a Low-Income, Ethnically Diverse Population: Study Design and Demographic Data from the Texas Childhood Obesity Research Demonstration (TX CORD) Study

Article

Full-text available

Jan 2015

Background: There is consensus that development and evaluation of a systems-oriented approach for child obesity prevention and treatment that includes both primary and secondary prevention efforts is needed. This article describes the study design and baseline data from the Texas Childhood Obesity Research Demonstration (TX CORD) project, which addresses child obesity among low-income, ethnically diverse overweight and obese children, ages 2-12 years; a two-tiered systems-oriented approach is hypothesized to reduce BMI z-scores, compared to primary prevention alone. Methods: Our study aims are to: (1) implement and evaluate a primary obesity prevention program; (2) implement and evaluate efficacy of a 12-month family-centered secondary obesity prevention program embedded within primary prevention; and (3) quantify the incremental cost-effectiveness of the secondary prevention program. Baseline demographic and behavioral data for the primary prevention community areas are presented. Results: Baseline data from preschool centers, elementary schools, and clinics indicate that most demographic variables are similar between intervention and comparison communities. Most families are low income (≤$25,000) and Hispanic/Latino (73.3-83.8%). The majority of parents were born outside of the United States. Child obesity rates exceed national values, ranging from 19.0% in preschool to 35.2% in fifth-grade children. Most parents report that their children consume sugary beverages, have a television in the bedroom, and do not consume adequate amounts of fruits and vegetables. Conclusions: Interventions to address childhood obesity are warranted in low-income, ethnically diverse communities. Integrating primary and secondary approaches is anticipated to provide sufficient exposure that will lead to significant decreases in childhood obesity.

A qualitative study of parents' perceptions and use of portion size strategies for preschool children's snacks

Article

Nov 2014

Objective: Increases in childhood obesity correspond with shifts in children's snacking behaviors and food portion sizes. This study examined parents' conceptualizations of portion size and the strategies they use to portion snacks in the context of preschool-aged children's snacking. Methods: Semi-structured qualitative interviews were conducted with non-Hispanic white (W), African American (AA), and Hispanic (H) low-income parents (n = 60) of preschool-aged children living in Philadelphia and Boston. The interview examined parents' child snacking definitions, purposes, contexts, and frequency. Verbatim transcripts were analyzed using a grounded theory approach. Coding matrices compared responses by race/ethnicity, parent education, and household food security status. Results: Parents' commonly referenced portion sizes when describing children's snacks with phrases like "something small." Snack portion sizes were guided by considerations including healthfulness, location, hunger, and timing. Six strategies for portioning snacks were presented including use of small containers, subdividing large portions, buying prepackaged snacks, use of hand measurement, measuring cups, scales, and letting children determine portion size. Differences in considerations and strategies were seen between race/ethnic groups and by household food security status. Conclusions: Low-income parents of preschool-aged children described a diverse set of considerations and strategies related to portion sizes of snack foods offered to their children. Future studies should examine how these considerations and strategies influence child dietary quality. Copyright © 2014 Elsevier Ltd. All rights reserved.

A Pilot Study Analyzing Grocery Purchases of Families With Head Start Preschoolers

Article

Apr 2013

This study describes the foods and beverages available in the homes of low-income, minority preschoolers. In all, 42 families who represented 43 preschoolers from 2 Head Start centers submitted grocery receipts over a 6-week period in Fall 2008. Descriptive statistics were used to estimate the distribution of purchases of various foods for the families, and correlations were used to associate purchases between food groups. Results showed that a majority of families purchased animal proteins, desserts/chips, and sugar-sweetened beverages at least once during the study. Conversely, less than one third of families purchased green leafy vegetables and water. Purchases of vegetarian proteins were moderately associated with purchases of other plant-based foods. Results indicate that a large percentage of the participating preschoolers reside in homes where high-sugar, high-fat foods and beverages are readily available. These preliminary findings, which were obtained using an objective approach, provide important insight into consumer purchasing trends among low-income families.

Views of parents, teachers, and school administrators on health education in preschool

Article

Apr 2025
EUR EARLY CHILD EDUC

Health education from an early age is one of the most effective means for addressing the increasing prevalence of diseases and rising health care costs. Despite the unique benefits of preschool health education, its global prevalence is not at the desired level. To explore the reasons behind this, we aimed to thoroughly identify the needs, demands, and knowledge of parents, teachers, and school administrators. The findings revealed that stakeholders are highly concerned about children’s health and strongly motivated to demand health education. Parents primarily seek health education when their child is ill. The most commonly reported areas for health education include nutrition, food, hygiene, first aid, and issues related to abuse and neglect. On the other hand, areas perceived as less significant by stakeholders include diabetes, sexual health, sleep education, technology addiction, mental health, and school health. Teachers and school administrators expressed several requests from official institutions and non-governmental organizations.

Okul Öncesi Eğitimde Okul İçi Beslenme Süreçlerine İlişkin Öğretmen Görüşleri

Article

Sep 2023

Adapting a Preschool Physical Activity Intervention to Be Inclusive of Children on the Autism Spectrum

Article

Dec 2023

An Experiential Learning Program to Promote Healthy Eating and Physical Activity at an Australian Children’s Museum: Formative Research with Caregivers and Staff

Article

Aug 2023

The Need for a More Inclusive Definition of 'Childcare' in Efforts Aimed at Improving the Dietary Quality of Young Children

Article

Apr 2023

Alexis C Wood

Hispanic caregivers' preferences for content, delivery methods, and sources of nutrition education from their child's preschool: Qualitative research findings

Article

Jan 2023

Background: With the obesity epidemic disproportionately affecting Hispanic children and preschool being a critical period when interventions may be effective to prevent it, nutrition education interventions in the preschool setting have the potential to stem obesity's spread. However, the nutrition education needs of low-income Hispanic populations and methods of delivery of that information require further exploration as culturally tailored approaches have seen limited reach to the target audience. Aim: To explore content, delivery methods, and sources of nutrition education that Hispanic caregivers prefer to receive from their child's preschool. Methods: Qualitative interviews with 25 self-identified Hispanic caregivers (≥18 years of age) of 3- to 5-year-old children at Head Start centers in the Washington, D.C., area. Caregivers were interviewed about preferred nutrition education topics, how nutrition education should be delivered, and by whom. Audio-recorded interviews were transcribed verbatim. Transcripts were analyzed using thematic analysis in NVivo v12. Results: Caregivers wanted to know about healthy foods and appropriate portion sizes to feed their children, fruit and vegetable feeding strategies, and how to incorporate Hispanic foods in healthy meals. Preferred delivery methods included receiving nutrition education and recipes in print and digital formats and in-person nutrition classes. Special Supplemental Nutrition Program for Women, Infants, and Children educators were regarded as trusted nutrition education sources. Conclusion: Tailored nutrition education messages combined with multiple delivery methods could be an effective way to reach Hispanic caregivers of preschoolers to increase their nutrition knowledge.

Okul Öncesi Eğitim Kurumlarında Uygulanan Beslenme Menülerinin Sağlıklı Beslenme Açısından Değerlendirilmesi

Article

Dec 2021

A nutrition intervention to promote the consumption of pulse-based foods in childcare centers: Protocol (Preprint)

Article

Full-text available

Jul 2020

Background Plant-based foods, including pulses (dry beans, lentils, chickpeas, and peas), have gained worldwide attention owing to their health and environmental benefits. Despite high production, the consumption of pulses is low in Canada. Behavior change interventions systematically designed to promote the consumption of pulse-based foods are scarce. Objective We describe the utilization of intervention mapping (IM) in the development of a multicomponent nutrition intervention aimed at promoting consumption of pulse-based foods among preschool children in childcare centers in Saskatchewan, Canada. Methods The Pulse Discovery Toolkit intervention was developed following the six steps of the IM protocol. Decisions at each step were either based upon literature review, expert consultation, pretesting, or a combination of these. Following the initial phase of the study, which focused on intervention development, phases II and III of the study were concerned with pilot testing and roll-out of the intervention, respectively. In total, one, two, and four childcare centers participated in phases I, II, and III, respectively. A multimethod approach was designed to evaluate the intervention during pilot testing and roll-out. Results The application of IM steps 1 to 3 in phase I resulted in the creation of performance objectives at different levels, including at the individual level (preschool children), and the social and environmental levels (parents, early childhood educators, and cooks). These objectives were then used to create a matrix of objectives matching the constructs of the social cognitive theory while taking Piaget cognitive development into consideration. This step was followed by defining program components, implementation, adoption, and evaluation strategies, which were utilized in phases II and III. Data have been collected from 2015 to 2018 and analyzed. The results will be reported elsewhere. Conclusions The IM protocol provided a rigorous framework for the development of a multicomponent evidence-based intervention to promote pulse-based foods in childcare centers. International Registered Report Identifier (IRRID) RR1-10.2196/22775

Monitoring BMI Trends in a Midwest Regional Head Start Population: The Results of a Healthy Lifestyle Intervention

Article

Full-text available

Sep 2020

Background: Childhood obesity represents a public health crisis in the United States. Thus, focusing on early childhood is crucial to modify the consequences associated with obesity. The Food and Fitness Initiative (FFI) is a community-based wellness program implemented in Northeast Iowa since 2009. FFI focuses on healthy eating and physical activity. Our aim is to describe the impact on body mass index (BMI) after implementing FFI in a Northeast Iowa Community Action Head Start (HS) population. Methods: Retrospective BMI data was collected from all children attending 14 HS sites from 2012 to 2018. Children with BMI measurements during July to December of the first year in HS were included in the study. Follow-up data the second year in HS was obtained. Overweight and obesity prevalence, as well as, BMI changes between year 1 and 2 in HS were analyzed. Results: Data from 1013 children were collected, 850 (84%) had qualifying BMI measurements during their first year in HS and 352 of those children (41%) had follow-up data in their second year. There was a decrease in BMI between years 1 and 2 in HS that approached statistical significance (t = 1.83, P = .07, d = .10). There were no statistically significant changes in the percent of overweight (Wald χ2 = .50, P = .48) or obese (Wald χ2 = 1.71, P = .19) children between the first and second year. Conclusion: The FFI wellness program can be feasibly integrated into the HS curriculum and shows promising short-term results in improving BMI, but not to a statistically significant level when evaluated over 1 year.

10.1177 2150132720962866

Article

Sep 2020

Background: Childhood obesity represents a public health crisis in the United States. Thus, focusing on early childhood is crucial to modify the consequences associated with obesity. The Food and Fitness Initiative (FFI) is a community-based wellness program implemented in Northeast Iowa since 2009. FFI focuses on healthy eating and physical activity. Our aim is to describe the impact on body mass index (BMI) after implementing FFI in a Northeast Iowa Community Action Head Start (HS) population. Methods: Retrospective BMI data was collected from all children attending 14 HS sites from 2012 to 2018. Children with BMI measurements during July to December of the first year in HS were included in the study. Follow-up data the second year in HS was obtained. Overweight and obesity prevalence, as well as, BMI changes between year 1 and 2 in HS were analyzed. Results: Data from 1013 children were collected, 850 (84%) had qualifying BMI measurements during their first year in HS and 352 of those children (41%) had follow-up data in their second year. There was a decrease in BMI between years 1 and 2 in HS that approached statistical significance (t=1.83, P=.07, d=.10). There were no statistically significant changes in the percent of overweight (Wald χ2=.50, P=.48) or obese (Wald χ2=1.71, P=.19) children between the first and second year. Conclusion: The FFI wellness program can be feasibly integrated into the HS curriculum and shows promising short-term results in improving BMI, but not to a statistically significant level when evaluated over 1 year.

Using Process Evaluation for Implementation Success of Preschool‐Based Programs for Obesity Prevention: The TX Childhood Obesity Research Demonstration Study

Article

May 2019

BACKGROUND Through the Texas Childhood Obesity Research Demonstration study, we implemented and evaluated a system‐oriented model of primary and secondary prevention approaches to mitigate obesity among low‐income Texas children aged 2 to 12 years. Primary prevention included implementing the Coordinated Approach To Child Health Early Childhood (CATCH EC) program in Head Start preschools. In this paper, we describe the methods and results of CATCH EC program process evaluation over 2 years of implementation. METHODS We used a quasi‐experimental design with serial cross‐sectional data collected from Head Start centers across intervention and comparison catchment areas in Houston and Austin, Texas (intervention: N = 12 centers in 2012‐2013 [Year 1], N = 12 in 2013‐2014 [Year 2]; comparison: N = 13 centers in Year 1, N = 12 in Year 2). Process evaluation included center director and teacher surveys conducted in both years of implementation. We developed indices for implementation of CATCH EC and non‐CATCH health events at the centers. RESULTS Implementation scores were higher among intervention centers as compared to comparison centers across both years of implementation, and these differences were statistically significant (p < .01). There was also high variability in program implementation in intervention centers across both years ranging from 55% to 95%. CONCLUSION These implementation index strategies may inform future evaluation of preschool‐based obesity prevention program implementation.

The Role of Pre-School Education Institutions in Children's Nutritional Habit ---------------------------- ÇOCUĞUN BESLENME ALIŞKANLIĞINI KAZANMASINDA OKUL ÖNCESİ EĞİTİM KURUMLARININ YERİ

Article

Full-text available

Jan 2015

Türkiye’de ve dünyada okul öncesi eğitim kurumlarında beslenme üzerine yapılan çalışmaları genel olarak incelemek ve kurumlarda konuya ilişkin verilen eğitimlerin etkilerini genel olarak değerlendirmek çalışmanın amacını oluşturmaktadır. Türkiye ve dünyadaki mevcut literatür taranarak, okullarda uygulanan beslenme programları ve beslenme araştırmaları ve bu çalışmaların etkililikleri derlenmiştir. Eğitim kurumlarında sağlıklı beslenme üzerine yapılan uygulama ve araştırmalara bakıldığında tüm bu çalışmalar doğrultusunda çocuklarda ve ailelerde verilen eğitimin istendik yönde bir etki yarattığı görülmektedir.

Preschool-Based Physical Activity Interventions in African American and Latino Preschoolers: A Literature Review

Article

Jun 2018

The purpose of this review was to assess the effectiveness of physical activity (PA) interventions in African American and Latino/ Hispanic preschool children. A systematic search was conducted for English-language printed research articles published between January 1980 and December 2017. The inclusion criteria for studies in this review were that they were experimental PA studies conducted in the preschool setting in the United States that targeted African American/Black or Latino/Hispanic children between the ages of 2.9 and 5 years. A total of 1,533 articles were located, of which 10 met the inclusion criteria. Overall, studies reported positive changes in preschool-day PA levels, yet only 2 reported significant improvements in total daily PA. Limited scientific literature suggests that preschool-based interventions are effective in improving aspects of PA during the preschool day for children of color. However, minimal evidence exists on the effectiveness of these interventions in changing total daily PA.

Strength of obesity prevention interventions in early care and education settings: A systematic review

Article

Sep 2016

Time and place of study: 2010-2015; INTERNATIONAL: Given the high levels of obesity in young children, numbers of children in out-of-home care, and data suggesting a link between early care and education (ECE) participation and overweight/obesity, obesity prevention in ECE settings is critical. As the field has progressed, a number of interventions have been reviewed yet there is a need to summarize the data using more sophisticated analyses to answer questions on the effectiveness of interventions. We conducted a systematic review of obesity prevention interventions in center-based ECE settings published between 2010 and 2015. Our goal was to identify promising intervention characteristics associated with successful behavioral and anthropometric outcomes. A rigorous search strategy resulted in 43 interventions that met inclusion criteria. We developed a coding strategy to assess intervention strength, used a validated study quality assessment tool, and presented detailed descriptive information about interventions (e.g., target behaviors, intervention strategies, and mode of delivery). Intervention strength was positively correlated with reporting of positive anthropometric outcomes for physical activity, diet, and combined interventions, and parent engagement components increased the strength of these relationships. Study quality was modestly related to percent successful healthy eating outcomes. Relationships between intervention strength and behavioral outcomes demonstrated negative relationships for all behavioral outcomes. Specific components of intervention strength (number of intervention strategies, potential impact of strategies, frequency of use, and duration of intervention) were correlated with some of the anthropometric and parent engagement outcomes. The review provided tentative evidence that multi-component, multi-level ECE interventions with parental engagement are most likely to be effective with anthropometric outcomes.

An Evaluation of a Program to Increase Physical Activity for Young Children in Child Care

Article

Jan 2015

Research Findings: In the past 20 years, obesity rates among U.S. children have skyrocketed. In fact, 15.4% of 2- to 4-year-olds in North Carolina, where this study takes place, are obese, making it the 5th worst obesity rate in the nation. Research indicates that young children in preschool settings largely engage in sedentary activities, demonstrating the need for programs that encourage physical activity. Starting physical activity early helps children set patterns for lifelong learning and participation. In this article we describe the development and evaluation of a program of physical activities, Be Active Kids, designed to increase the level of physical activity of children birth to age 5 in child care settings in North Carolina. Using a single case study, multiple baseline design, we introduced the intervention in 6 classrooms in 3 child care centers. Teachers received a standardized training, and children in each classroom were observed for their level of physical activity during the baseline and treatment phases. Results demonstrated that teacher training and implementation of physical activities increased light and moderate/vigorous physical activity and was particularly effective when activities were teacher directed. Practice or Policy: This study provides evidence that a program of physical activity can help even the youngest children to be more physically active.

Understanding the State of Nutrition Education in the Head Start Classroom: A Qualitative Approach

Article

Jan 2014

Early education is important for establishing healthy eating behaviors among young children; however, the literature describing nutrition education in the preschool environment is limited. Purpose The purpose of this study was to explore teacher experiences related to the incorporation of nutrition education in Head Start preschool classrooms. Methods Between September 2011 and May 2012, investigators conducted 74 in-depth, structured interviews (31 health/nutrition coordinators, 11 center directors, and 32 teachers). Participant interviews were recorded in digital audio format and transcribed verbatim. Results Researchers condensed identified interrelated themes into 4 categories within a substantive-level model. Outcomes revealed that teacher training/education, funding, and policies/regulations were the core factors influencing the quality and quantity of nutrition-related instruction. Discussion The proposed model establishes a framework for understanding the state of nutrition education in the preschool environment. Teachers need more opportunities for training/education in instructional methods and nutrition content; financial support for materials; and clear, supportive policies/regulations. Translation to Health Education Practice Teachers and administrators can use the proposed framework as an objective guide to identify the presence of these barriers in their organizations and to facilitate their ability to work together to improve the quality of nutrition education in the preschool environment.

Effectiveness of a Child’s Fable on the Cognition of Preschools When Used to Address Chldhood Obesity

Article

Nov 2014
J Pediatr Nurs

The study investigated the effectiveness of a child's fable on the cognition of preschoolers when used to address childhood obesity. A single group, pretest/posttest design was used with 57 preschool children. Analysis of variance compared pre-existing differences between the four classes with respect to pre-test scores. A repeated measures t-test analyzed changes in scores as a result of the intervention. Following the fable intervention, students showed a significant difference (0.5) between their pre- and post-test scores, indicating this method to an effective learning strategy in this setting and age population.

What Proportion of Preschool‐Aged Children Consume Sweetened Beverages?

Article

Mar 2014
J SCHOOL HEALTH

Obesity affects nearly 17% of US children and youth 2-19 years old and 10% of infants and toddlers under the age of 2 years. One strategy for addressing obesity is to discourage sugar-sweetened beverage (SSB) consumption. Compared with their older school-aged counterparts, children ≤5 years depend largely on parents for the purchase and serving of SSBs. Therefore, recognizing parental factors associated with children's intake of SSBs is important. This study used cross-sectional data from parents of children ≤5 years old to examine SSB consumption and associated factors. Elements of the Health Belief Model and Theory of Reasoned Action facilitated data analysis and interpretation. The most consistent predictor of SSB intake was child age. Nearly 94% of children aged 3-5 years consumed sweetened milk products, 88% consumed fruity drinks, 63% consumed sodas, and 56% consumed sports drinks and sweet tea. Adjusting for all other factors, the only parental psychosocial factor associated with SSB intake was self-efficacy (predicting fruity drinks consumption). More children drink SSBs as they get older. Interventions designed to prevent SSB consumption should occur early, before children reach preschool age. Additional study of parental factors influencing SSB intake in early childhood is recommended.

Short Tools to Assess Young Children's Dietary Intake: A Systematic Review Focusing on Application to Dietary Index Research

Article

Full-text available

Jan 2013
J Obes

Dietary indices evaluate diet quality, usually based on current dietary guidelines. Indices can therefore contribute to our understanding of early-life obesity-risk dietary behaviours. Yet indices are commonly applied to dietary data collected by onerous methods (e.g., recalls or records). Short dietary assessment instruments are an attractive alternative to collect data from which to derive an index score. A systematic review of studies published before April 2013 was conducted to identify short (≤50 items) tools that measure whole-of-diet intake of young children (birth-five years) and are applicable to dietary indices, in particular screening obesogenic dietary behaviours. The search identified 3686 papers of which 16, reporting on 15 tools (n = 7, infants and toddlers birth-24 months; n = 8, preschoolers 2-5 years), met the inclusion criteria. Most tools were food frequency questionnaires (n = 14), with one innovative dietary questionnaire identified. Seven were tested for validity or reliability, and one was tested for both. Six tools (n = 2, infants and toddlers; n = 4, preschoolers) are applicable for use with current dietary indices, five of which screen obesogenic dietary behaviours. Given the limited number of brief, valid and reliable dietary assessment tools for young children to which an index can be applied, future short tool development is warranted, particularly for screening obesogenic dietary behaviours.

A Qualitative Investigation of Teachers' Information, Motivation, and Behavioral Skills for Increasing Fruit and Vegetable Consumption in Preschoolers

Article

Jun 2013

Using the Information-Motivation-Behavioral Skills model as a framework, researchers qualitatively assessed preschool teachers' perceived motivation, facilitators, and barriers related to getting preschool children to eat fruits and vegetables (FV). Individual, semi-structured interviews with 28 Head Start teachers in central North Carolina. Participants reported the need for FV-related information (Information) to improve FV consumption in children, perceived themselves to be parents at school (Motivation), and reported using conditional rewards and punishment statements to get preschoolers to eat FV (Behavioral Skills). Nutrition educators may use the Information-Motivation-Behavioral Skills model to develop education materials targeting increases in preschoolers' FV consumption. To motivate preschool teachers who see themselves as parents at school (Motivation), nutrition educators can provide teachers with FV-related information that was reported as their needs (Information), and supportive feeding practices (Behavioral Skills) to get preschoolers to consume FV.

Validation of Sofit for Measuring Physical Activity of First- to Eighth-Grade Students

Article

Full-text available

May 1997

The purpose of this study was to assess the validity of the System for Observing Fitness Instruction Time (SOFIT) for measuring physical activity of elementary and middle school children. Students (N= 173, 92 boys and 81 girls) from Grades 1-8 completed a standardized protocol that included lying, sitting, standing, walking, running, curl-ups, and push-ups. Heart rates were used as a criterion for concurrent validity. The results confirm the validity of the physical activity codes of SOFIT for elementary and middle school children. Activity Categories 2-5 indicate different levels of energy expenditure, whereas Categories 1 (lying) and 2 (sitting) refer to the same energy expenditure level. The common distinction between SOFIT Levels 4 and 5 as MVPA (moderate to vigorous physical activity) and SOFIT Levels 1 to 3 as non-MVPA is valid. Curl-ups and push-ups should be coded as MVPA.

Distributing Free Fresh Fruit and Vegetables at School: Results of a Pilot Outcome Evaluation

Article

Full-text available

Sep 2009

Consumption of fruit and vegetables among children is generally below recommended levels. This evaluation addressed two questions: (1) To what extent did children's attitudes toward, familiarity with, and preferences for fruit and vegetables change during the school year? and (2) To what extent did children's consumption of fruit and vegetables change during the school year? During the 2004-2005 school year, the Mississippi Department of Education, Child Nutrition Programs initiated a pilot program to distribute free fruit and vegetables to students (kindergarten through 12th grade) during the school day. Data were collected in 2004-2005 within a one-group pretest/posttest design using a self-report questionnaire (n=725) and 24-hour dietary recalls (n=207) with a sample of students from five schools in Mississippi. Data were analyzed in 2006-2007. Results showed greater familiarity with fruit and vegetables at all grade levels (p<0.05) and increased preferences for fruit among eighth- and 10th-grade students (p<0.01). Eighth-grade students also reported more positive attitudes toward eating fruit and vegetables (p<0.01), increased perceived self-efficacy to eat more fruit (p<0.01), and increased willingness to try new fruit. Finally, results showed increased consumption of fruit, but not vegetables, among eighth- and 10th-grade students (p<0.001). Distributing free fruit and vegetables at school may be a viable component of a more comprehensive approach for improving students' nutrition attitudes and behaviors. More program emphasis is needed on ways to promote vegetable consumption.

Preliminary findings from an evaluation of the USDA Fresh Fruit and Vegetable Program in Wisconsin schools

Article

Full-text available

Aug 2008
Wis Med J

In 2002, the US Department of Agriculture (USDA) created the Fresh Fruit and Vegetable Program (FFVP) to improve nutrition and help reduce the prevalence of childhood overweight and obesity. The FFVP provides funding for students from selected schools in each participating state to receive a free fresh fruit or vegetable snack daily for an academic year. In November 2005, Wisconsin was added to this program. In this study, we evaluate whether the Wisconsin FFVP resulted in positive changes in children's attitudes and behavior related to eating fruits and vegetables. In 2006, 25 Wisconsin schools were selected by the Wisconsin Department of Public Instruction for FFVP participation. Study measures included a pre-test and post-test survey given to 4th, 7th, and 9th graders in the intervention and controls schools. Post-test data from all 25 intervention schools were not yet available for analysis. Our sample, therefore, consisted of 1127 participants: 784 students in 10 intervention schools and 343 students in 10 control schools. Independent samples t tests and multivariate probit regression analyses were used to examine attitudinal and behavioral program effects. Compared to controls, intervention students reported an increased willingness to try new fruits (24.8% versus 12.8%, P<0.01) and vegetables (25.1% versus 18.4%, P=0.01) at school. Findings indicate positive changes in attitudes and behavior among children participating in the Wisconsin FFVP.

Gimme 5 Fruit, Juice, And Vegetables for Fun And Health: Outcome Evaluation

Article

Full-text available

Mar 2000

A theory-based multicomponent intervention (Gimme 5) was designed and implemented to impact fourth- and fifth-grade children's fruit, juice, and vegetable (FJV) consumption and related psychosocial variables. Gimme 5 was a randomized controlled intervention trial with school (n = 16 elementary) as unit of random assignment and analysis. Participants included the cohort of students who were in the third grade in the winter of 1994 and students who joined them in the fourth and fifth grades. The intervention included a curriculum, newsletters, videotapes, and point-of-purchase education. Evaluation included 7-day food records and psychosocial measures from students, telephone interviews with parents, and observational assessments. Favorable results were observed for consumption of FJV combined, FJV consumed at weekday lunch, eating FJV self-efficacy, social norms, asking behaviors, and knowledge. A theory-based school nutrition education program can help change children's FJV consumption and impact factors at home that predispose to FJV consumption, but changes were small, and their persistence is unknown.

Prevention of obesity—more than an intention. Concept and first results of the Kiel Obesity Prevention Study (KOPS)

Article

Full-text available

Jun 2001

Obesity prevention is necessary to address the steady rise in the prevalence of obesity. Although all experts agree that obesity prevention has high priority there is almost no research in this area. The effectiveness of different intervention strategies is not well documented. There is also no structured framework for obesity prevention. Based on (i) our current and limited knowledge and (ii) the idea that prevention of childhood obesity is an effective treatment of adult obesity, the Kiel Obesity Prevention Study (KOPS) was started in 1996. Concept, intervention strategies and first results of KOPS are reported in this paper. KOPS is an ongoing 8 y follow-up study. We first enrolled a large scale cohort of 5 to 7-y-old children, providing sufficient baseline data. KOPS allows further analyses of the role of individual risk factors as well as of long-term effectiveness of different intervention strategies. From 1996 to 1999 a representative group of 2440 5 to 7-y-old children was recruited (ie 30.2% of the total population of 5 to 7-y-old children examined by the school physicians) and a full data set was obtained from 1640 children. Of the children, 340 (20.7%) were considered as overweight and obese, 1108 children (67.6%) were normal weight, and underweight was found in 192 children (11.7%). Of the normal-weight children, 31% or 346 (21.1% of the total population) were considered to have a risk of becoming obese. Cross-sectional data provided evidence that (i) there is an inverse social gradient in childhood overweight as well as health-related behaviours and (ii) parental fatness had a strong influence on childhood overweight. We observed considerable changes in health-related behaviours within 1 y after combined "school-" and "family-based" interventions. Interventions aimed to improve health-related behaviours had significant effects on the age-dependent increases in median triceps skinfolds of the whole group (from 10.9 to 11.3 mm in "intervention schools" vs from 10.7 to 13.0 mm in "control schools", P<0.01) as well as in percentage fat mass of overweight children (increase by 3.6 vs 0.4% per year without and with intervention, respectively; P<0.05). First results of KOPS are promising. Besides health promotion, a better school education and social support seem to be promising strategies for future interventions.

Parental Feeding Style and the Inter-generational Transmission of Obesity Risk

Article

Full-text available

Jul 2002

This study was designed to determine whether a community sample of obese mothers with young children used different feeding styles compared with a matched sample of normal-weight mothers. Four aspects of feeding style were assessed: emotional feeding, instrumental feeding (using food as a reward), prompting/encouragement to eat, and control over eating. Participants were from 214 families with same-sex twins; 100 families in which both parents were overweight or obese and 114 in which both parents were normal weight or lean. We found that obese mothers were no more likely than normal-weight mothers to offer food to deal with emotional distress, use food as a form of reward, or encourage the child to eat more than was wanted. The obese and normal-weight mothers did differ on "control"; obese mothers reported significantly less control over their children's intake, and this was seen for both first-born and second-born twins. Twin analyses showed that these differences were not in response to children's genetic propensities, because monozygotic correlations were no greater than dizygotic correlations for maternal feeding style. These results suggest that the stereotype of the obese mother, who uses food in nonnutritive ways so that her child also becomes obese, is more likely to be myth than fact. However, the results raise the possibility that lack of control of food intake might contribute to the emergence of differences in weight.

An Intervention to Reduce Television Viewing by Preschool Children

Article

Full-text available

Mar 2004
Arch Pediatr Adolesc Med

Television viewing has been associated with increased violence in play and higher rates of obesity. Although there are interventions to reduce television viewing by school-aged children, there are none for younger children. To develop and evaluate an intervention to reduce television viewing by preschool children. Randomized controlled trial conducted in 16 preschool and/or day care centers in rural upstate New York. Children aged 2.6 through 5.5 years. Children attending intervention centers received a 7-session program designed to reduce television viewing as part of a health promotion curriculum, whereas children attending the control centers received a safety and injury prevention program. Change in parent-reported child television/video viewing and measured growth variables. Before the intervention, the intervention and control groups viewed 11.9 and 14.0 h/wk of television/videos, respectively. Afterward, children in the intervention group decreased their television/video viewing 3.1 h/wk, whereas children in the control group increased their viewing by 1.6 h/wk, for an adjusted difference between the groups of -4.7 h/wk (95% confidence interval, -8.4 to -1.0 h/wk; P =.02). The percentage of children watching television/videos more than 2 h/d also decreased significantly from 33% to 18% among the intervention group, compared with an increase of 41% to 47% among the control group, for a difference of -21.5% (95% confidence interval, -42.5% to -0.5%; P =.046). There were no statistically significant differences in children's growth between groups. This study is the first to show that a preschool-based intervention can lead to reductions in young children's television/video viewing. Further research is needed to determine the long-term effects associated with reductions in young children's television viewing.

Determinants of fruit and vegetable consumption among children and adolescents: a review of the literature. Part I: quantitative studies

Article

Full-text available

Feb 2006
INT J BEHAV NUTR PHY

Background: In order to more effectively promote fruit and vegetable intake among children and adolescents, insight into determinants of intake is necessary. We conducted a review of the literature for potential determinants of fruit and vegetable intake in children and adolescents. Methods: Papers were identified from Medline and PsyclNFO by using all combinations of the search terms: "fruit(s) or vegetable(s)" and "children or adolescents". Quantitative research examining determinants of fruit and/or vegetable intake among children and adolescents aged 6-18 years were included. The selection and review process was conducted according to a four-step protocol resulting in information on country, population, design, methodology, theoretical basis, Instrument used for measuring intake, statistical analysis, included independent variables, and effect sizes. Results: Ninety-eight papers were included. A large number of potential determinants have been studied among children and adolescents. However, for many presumed determinants convincing evidence is lacking, mostly because of paucity of studies. The determinants best supported by evidence are: age, gender, socio-economic position, preferences, parental intake, and home availability/accessibility. Girls and younger children tend to have a higher or more frequent intake than boys and older children. Socio-ecconomic position, preferences, parental intake, and home availability/accessibility are all consistently positively associated with intake. Conclusion: The determinants most consistently supported by evidence are gender, age, socio-economic position, preferences, parental intake and home availability/accessibility. There is a need for internationally comparative, longitudinal, theory-based and multi-level studies taking both personal and environmental factors into account.

Does participation in a population-based dietary intervention scheme have a lasting impact on fruit intake in young children?

Article

Full-text available

Oct 2007

The National Schools Fruit Scheme (NSFS) is intended to improve fruit intake in young children by providing free daily fruit at school. We used a parentally completed questionnaire for three consecutive years to study fruit intake in young children before, during and after participation in the NSFS compared with a control region. In 2003, 2004 and 2005, a total of 224, 220 and 179 schools, respectively, were studied with responses from 5,606, 5,111 and 3,382 children for each survey. Between 2003 and 2004, individual fruit consumption in the intervention region increased by more (from a median of 7.5 to 14.0 pieces/week) than in the control region (from a median of 9.2-11.0 pieces/week), resulting in a difference (P < 0.001) between the two regions in 2004. However, after ceasing to be eligible for the NSFS, fruit intake in children in the intervention region fell to a median of 12 pieces per week, lower than that in the control region (median value of 14 pieces per week, P = 0.02). School-based fruit distribution schemes providing free fruit at school appear to be an effective means of increasing dietary fruit intake in young children, including those who live in relatively socio-economically deprived areas. However, this approach does not influence fruit intake after the provision of free fruit ends, so schemes may need to be sustained to provide the maximum benefit to young children.

Active commuting to school: How far is too far?

Article

Full-text available

Jan 2008
INT J BEHAV NUTR PHY

Walking and cycling to school provide a convenient opportunity to incorporate physical activity into an adolescent's daily routine. School proximity to residential homes has been identified as an important determinant of active commuting among children. The purpose of this study is to identify if distance is a barrier to active commuting among adolescents, and if there is a criterion distance above which adolescents choose not to walk or cycle. Data was collected in 2003-05 from a cross-sectional cohort of 15-17 yr old adolescents in 61 post primary schools in Ireland. Participants self-reported distance, mode of transport to school and barriers to active commuting. Trained researchers took physical measurements of height and weight. The relation between mode of transport, gender and population density was examined. Distance was entered into a bivariate logistic regression model to predict mode choice, controlling for gender, population density socio-economic status and school clusters. Of the 4013 adolescents who participated (48.1% female, mean age 16.02 +/- 0.661), one third walked or cycled to school. A higher proportion of males than females commuted actively (41.0 vs. 33.8%, chi2 (1) = 22.21, p < 0.001, r = -0.074). Adolescents living in more densely populated areas had greater odds of active commuting than those in the most sparsely populated areas (chi2 (df = 3) = 839.64, p < 0.001). In each density category, active commuters travelled shorter distances to school. After controlling for gender and population density, a 1-mile increase in distance decreased the odds of active commuting by 71% (chi2 (df = 1) = 2591.86, p < 0.001). The majority of walkers lived within 1.5 miles and cyclists within 2.5 miles. Over 90% of adolescents who perceived distance as a barrier to active commuting lived further than 2.5 miles from school. Distance is an important perceived barrier to active commuting and a predictor of mode choice among adolescents. Distances within 2.5 miles are achievable for adolescent walkers and cyclists. Alternative strategies for increasing physical activity are required for individuals living outside of this criterion.

Overweight and Obese Prevalence Rates in African American and Hispanic Children: An Analysis of Data from the 2003-2004 National Survey of Children's Health

Article

Full-text available

May 2008

The prevalence of overweight and obesity was examined in African-American and Hispanic children compared with white children. Multivariate analyses were performed on cross-sectional data from the National Survey of Children's Health collected in 2003 to 2004. Analyses found that overweight children were more likely to be African American and Hispanic than white, be male, live in households with incomes below 150% of the Federal poverty level, watch television 3 or more hours daily, and not have received preventive care in the past 12 months. Overweight children were less likely to get minimum levels of moderate physical activity or have participated on a sports team. Poverty impacts childhood body mass index in at least 2 specific ways: unsafe neighborhoods and the cost and accessibility of healthy foods in low income communities. Addressing these issues require the concerted efforts of policy makers. The same is true for resolving the issues of children not receiving preventive care. Increasing the number of well child check-ups mandated by the government and required by school systems may be a beneficial policy. Furthermore, policymakers concerned with issues of childhood obesity may pursue the creation of school-based health clinics in schools where at least 50% of the student body live in households with incomes <150% of the Federal poverty level.

High Body Mass Index for Age Among US Children and Adolescents, 2003-2006

Article

Full-text available

Jun 2008
J Am Med Assoc

The prevalence of overweight among US children and adolescents increased between 1980 and 2004. To estimate the prevalence of 3 measures of high body mass index (BMI) for age (calculated as weight in kilograms divided by height in meters squared) and to examine recent trends for US children and adolescents using national data with measured heights and weights. Height and weight measurements were obtained from 8165 children and adolescents as part of the 2003-2004 and 2005-2006 National Health and Nutrition Examination Survey (NHANES), nationally representative surveys of the US civilian, noninstitutionalized population. Prevalence of BMI for age at or above the 97th percentile, at or above the 95th percentile, and at or above the 85th percentile of the 2000 sex-specific Centers for Disease Control and Prevention (CDC) BMI-for-age growth charts among US children by age, sex, and racial/ethnic group. Because no statistically significant differences in the prevalence of high BMI for age were found between estimates for 2003-2004 and 2005-2006, data for the 4 years were combined to provide more stable estimates for the most recent time period. Overall, in 2003-2006, 11.3% (95% confidence interval [CI], 9.7%-12.9%) of children and adolescents aged 2 through 19 years were at or above the 97th percentile of the 2000 BMI-for-age growth charts, 16.3% (95% CI, 14.5%-18.1%) were at or above the 95th percentile, and 31.9% (95% CI, 29.4%-34.4%) were at or above the 85th percentile. Prevalence estimates varied by age and by racial/ethnic group. Analyses of the trends in high BMI for age showed no statistically significant trend over the 4 time periods (1999-2000, 2001-2002, 2003-2004, and 2005-2006) for either boys or girls (P values between .07 and .41). The prevalence of high BMI for age among children and adolescents showed no significant changes between 2003-2004 and 2005-2006 and no significant trends between 1999 and 2006.

Relationships between the home environment and physical activity and dietary patterns of preschool children: A cross-sectional study

Article

Full-text available

Feb 2008
INT J BEHAV NUTR PHY

To assess relationships between characteristics of the home environment and preschool children's physical activity and dietary patterns. Homes of 280 preschool children were visited and information obtained by direct observation and parent interview regarding physical and nutritional characteristics of the home environment. Children's physical activity, sedentary behaviour and dietary patterns were measured using standardised parent-report questionnaires. Associations were analysed using analysis of variance and correlation. Parental physical activity (p = 0.03-0.008), size of backyard (p = 0.001) and amount of outdoor play equipment (p = 0.003) were associated with more outdoor play. Fewer rules about television viewing (p < 0.001) and presence of playstation (p = 0.02) were associated with more indoor sedentary time. Higher fruit and vegetable intake was associated with restricting children's access to fruit juice (p = 0.02) and restricting high fat/sugar snacks (p = 0.009). Lower intake of non-core foods was associated with restricting children's access to fruit juice (p = 0.007), cordial/carbonated drinks (p < 0.001) and high fat/sugar snacks (p = 0.003). Lower fruit and vegetable intake was associated with reminding child to 'eat up' (p = 0.007) and offering food rewards to eat main meal (p = 0.04). Higher intake of non-core foods was associated with giving food 'treats' (p = 0.03) and offering food rewards to eat main meal (p = 0.04). The availability of food groups in the home was associated with children's intake of these foods (fruit and vegetables, p < 0.001; fat in dairy, p = <0.001; sweetened beverages, p = 0.004-<0.001; non-core foods, p = 0.01-<0.001). Physical attributes of the home environment and parental behaviours are associated with preschool children's physical activity, sedentary behaviour and dietary patterns. Many of these variables are modifiable and could be targeted in childhood obesity prevention and management.

Family correlates of fruit and vegetable consumption in children and adolescents: A systematic review

Article

Full-text available

Jul 2008

To review associations between the family environment and young people's fruit and vegetable consumption. A systematic review. Published English-language (n 60) papers were identified using electronic databases and manual searches of personal files and reference lists. Observational research reporting a measure of fruit/vegetable intake for children (aged 6-11 years) and/or adolescents (aged 12-18 years) and at least one potential family correlate of dietary intake was included. Parental modelling and parental intake were consistently and positively associated with children's fruit and fruit, juice and vegetable (FJV) consumption. There were also positive associations between home availability, family rules and parental encouragement and children's fruit and vegetable consumption. Parental intake was positively associated with adolescents' fruit and vegetable consumption. There were also positive associations between parental occupational status and adolescent fruit consumption and between parental education and adolescents' FJV consumption. Our findings highlight the importance of targeting the family environment for the promotion of healthy eating behaviours among children and adolescents. Future interventions should encourage parents to be positive role models by targeting parental intake and to create a supportive home environment through increased encouragement and availability of fruits and vegetables and employing rules to govern eating behaviours. For adolescents, indicators of family circumstances (e.g. parental education) should be used to identify target groups for interventions aimed at promoting healthy eating.

Social Cognitive Theory of Self-Regulation

Article

Full-text available

Dec 1991
ORGAN BEHAV HUM DEC

Albert Bandura

Self-control theories have focused on various aspects of the processes involved in exerting self-control. In the present paper, we intend to add to this literature by demonstrating that exerting self-control leads one to narrow one's attention and cognition, inducing a narrow mindset. We demonstrate this in three studies. Participants who exerted self-control applied a narrower view (Study 1), applied a narrower categorization (Study 2), and used more concrete language (Study 3) than participants who did not exert self-control. Results are discussed in light of the possibility that a narrow mindset enhances performance on the self-control task at hand at the cost of poorer performance on other tasks.

Health Consequences of Obesity in Youth: Childhood Predictors of Adult Disease

Article

Mar 1998

William H Dietz

Obesity now affects one in five children in the United States. Discrimination against overweight children begins early in childhood and becomes progressively institutionalized. Because obese children tend to be taller than their nonoverweight peers, they are apt to be viewed as more mature. The inappropriate expectations that result may have an adverse effect on their socialization. Many of the cardiovascular consequences that characterize adult-onset obesity are preceded by abnormalities that begin in childhood. Hyperlipidemia, hypertension, and abnormal glucose tolerance occur with increased frequency in obese children and adolescents. The relationship of cardiovascular risk factors to visceral fat independent of total body fat remains unclear. Sleep apnea, pseudotumor cerebri, and Blount's disease represent major sources of morbidity for which rapid and sustained weight reduction is essential. Although several periods of increased risk appear in childhood, it is not clear whether obesity with onset early in childhood carries a greater risk of adult morbidity and mortality. Obesity is now the most prevalent nutritional disease of children and adolescents in the United States. Although obesity-associated morbidities occur more frequently in adults, significant consequences of obesity as well as the antecedents of adult disease occur in obese children and adolescents. In this review, I consider the adverse effects of obesity in children and adolescents and attempt to outline areas for future research. I refer to obesity as a body mass index greater than the 95th percentile for children of the same age and gender.

Food intake measurements: Is there a “gold standard”?

Article

Dec 1992
J AM DIET ASSOC

WALTER MERTZ

A review of validations of dietary assessment methods

Article

Apr 1982
AM J EPIDEMIOL

Gladys Block

The theory of planned behavior, organizational behavior and human decision processes

Article

Jan 1991

Icek Ajzen

Outcomes of a Field Trial to Improve Children's Dietary Patterns and Physical Activity

Article

Mar 1996

Russell V Luepker

Objective. —To assess the outcomes of health behavior interventions, focusing on the elementary school environment, classroom curricula, and home programs, for the primary prevention of cardiovascular disease.Design. —A randomized, controlled field trial at four sites with 56 intervention and 40 control elementary schools. Outcomes were assessed using prerandomization measures (fall 1991) and follow-up measures (spring 1994).Participants. —A total of 5106 initially third-grade students from ethnically diverse backgrounds in public schools located in California, Louisiana, Minnesota, and Texas.Intervention. —Twenty-eight schools participated in a third-grade through fifth-grade intervention including school food service modifications, enhanced physical education (PE), and classroom health curricula. Twenty-eight additional schools received these components plus family education.Main Outcome Measures. —At the school level, the two primary end points were changes in the fat content of food service lunch offerings and the amount of moderate-to-vigorous physical activity in the PE programs. At the level of the individual student, serum cholesterol change was the primary end point and was used for power calculations for the study. Individual level secondary end points included psychosocial factors, recall measures of eating and physical activity patterns, and other physiologic measures.Results. —In intervention school lunches, the percentage of energy intake from fat fell significantly more (from 38.7% to 31.9%) than in control lunches (from 38.9% to 36.2%)(P<.001 ). The intensity of physical activity in PE classes during the Child and Adolescent Trial for Cardiovascular Health (CATCH) intervention increased significantly in the intervention schools compared with the control schools (P<.02). Self-reported daily energy intake from fat among students in the intervention schools was significantly reduced (from 32.7% to 30.3%) compared with that among students in the control schools (from 32.6% to 32.2%) (P<.001). Intervention students reported significantly more daily vigorous activity than controls (58.6 minutes vs 46.5 minutes; P<.003). Blood pressure, body size, and cholesterol measures did not differ significantly between treatment groups. No evidence of deleterious effects of this intervention on growth or development was observed.Conclusion. —The CATCH intervention was able to modify the fat content of school lunches, increase moderate-to-vigorous physical activity in PE, and improve eating and physical activity behaviors in children during 3 school years.(JAMA. 1996;275:768-776)

Social Foundations of Thought & Action: A Social Cognitive Theory

Book

Jan 1986

Albert Bandura

SOFIT: System for Observing Fitness Instruction Time

Article

Jan 1991
J TEACH PHYS EDUC

This paper describes SOFIT (System for Observing Fitness Instruction Time), an observation instrument designed to assess variables associated with students’ activity levels and opportunities to become physically fit in physical education. SOFIT involves the direct observation of classes while simultaneously recording student physical activity levels, curriculum context variables, and teacher behavior. The paper reports the reliability, validity, and feasibility of using the instrument, as well as data from using SOFIT to assess 88 third- and fourth-grade classes.

School‐Based Cardiovascular Health Promotion: The Child and Adolescent Trial for Cardiovascular Health (CATCH)

Article

Oct 1990
J SCHOOL HEALTH

The Child and Adolescent Trial for Cardiovascular Health (CATCH) is a multisite intervention research study that builds on significant progress made in school health education research in the 1980s. The study has three phases: Phase I deals with study design, intervention, and measurement development, Phase II involves the main trial in 96 school'; in four states, and Phase III focuses on analysis. The intervention program targets third-fifth grade students and focuses on multiple cardiovascular health behaviors, including eating habits, physical activity, and cigarette smoking. Classroom curricula, school environmental change, and family involvement programs are developed for each grade level and behavioral focus. This paper describes Phase II of CATCH with a rationale for cardiovascular health promotion with youth. The process of change that appears to be necessary for school-based health promotion and that will be tested in CATCH are presented as a framework to guide these efforts.

The Effects of Adults' Eating on Young Children's Acceptance of Unfamiliar Foods

Article

Oct 1975

Adults presented unfamiliar foods to 14- to 20- and 42- to 48-month-old children individually in their homes. More children put the food in their mouths when the adults also were eating than when the adults simply were offering the food. More children put food in their mouths when their mothers were the source than when the source was a friendly adult “visitor”. However, even when alone with a child, the visitor's eating elicited reliably more tasting. Analysis of requesting behavior indicated that the adults' eating aroused a desire to eat in the children. There were no consistent sex differences or interactions between sex of visitor and sex of child in children's food acceptance. There was a suggestion that younger children were more affected by repeated offerings than were older children. It is concluded that a relatively “low level” form of observational learning—“social facilitation”—can account for the data.

Reductions in Child Obesity Among Disadvantaged School Children With Community Involvement: The Travis County CATCH Trial

Article

Feb 2010
OBESITY

The objective of this study was to compare the impact of two intervention approaches on the prevalence of child overweight and obesity: (i) Coordinated Approach To Child Health BasicPlus (CATCH BP), in which schools were provided evidence-based coordinated school health program training, materials, and facilitator support visits, and (ii) CATCH BP and Community (BPC), in which BP schools received additional promotion of community partnerships with the aim of integrating community members and organizations into schools, local decision making and action, and best practices workshops. Schools (n = 97) in four central Texas districts were recruited to participate in the 4-year project. Of the low-income schools (n = 58), 15 schools were selected to receive the BPC intervention and matched with 15 schools in the BP condition. A serial cross-sectional design was used, in which 4th grade student BMI, physical activity, and diet were assessed in the 30 schools in spring 2007 and 2008. Measurements in spring 2007 included 1,107 students, with 53% female; 61% Hispanic, and 14% African American; and mean age of 9.9 years. Adjusted prevalence of overweight/obesity (>or=85th percentile) was 42.0 and 47.4% in spring 2007 for the BP and BPC students, respectively. From spring 2007 to spring 2008, the percent of students classified as overweight/obese decreased by 1.3 percentage points (P = 0.33) in BP schools, compared to a decrease of 8.3 percentage points (P < 0.005) in students from BPC schools; the difference between conditions was significant (P = 0.05). CATCH BPC students also reported more positive trends in related behaviors. Implementation of a community-enhanced school program can be effective in reducing the prevalence of child overweight in low-income student populations.

Interventions to Prevent Obesity in 0–5 Year Olds: An Updated Systematic Review of the Literature

Article

Feb 2010
OBESITY

Unlabelled: The small number and recency of the early childhood obesity-prevention literature identified in a previous review of interventions to prevent obesity, promote healthy eating, physical activity, and/or reduce sedentary behaviors in 0-5 year olds suggests this is a new and developing research area. The current review was conducted to provide an update of the rapidly emerging evidence in this area and to assess the quality of studies reported. Ten electronic databases were searched to identify literature published from January 1995 to August 2008. Inclusion criteria: interventions reporting child anthropometric, diet, physical activity, or sedentary behavior outcomes and focusing on children aged 0-5 years of age. Exclusion criteria: focusing on breastfeeding, eating disorders, obesity treatment, malnutrition, or school-based interventions. Two reviewers independently extracted data and assessed study quality. Twenty-three studies met all criteria. Most were conducted in preschool/childcare (n = 9) or home settings (n = 8). Approximately half targeted socioeconomically disadvantaged children (n = 12) and three quarters were published from 2003 onward (n = 17). The interventions varied widely although most were multifaceted in their approach. While study design and quality varied most studies reported their interventions were feasible and acceptable, although impact on behaviors that contribute to obesity were not achieved by all. Early childhood obesity-prevention interventions represent a rapidly growing research area. Current evidence suggests that behaviors that contribute to obesity can be positively impacted in a range of settings and provides important insights into the most effective strategies for promoting healthy weight from early childhood.

Schools and Obesity Prevention: Creating School Environments and Policies to Promote Healthy Eating and Physical Activity

Article

Apr 2009
MILBANK Q

Research consistently shows that the majority of American children do not consume diets that meet the recommendations of the Dietary Guidelines for Americans, nor do they achieve adequate levels of daily physical activity. As a result, more children are overweight today than at any other time in U.S. history. Schools offer many opportunities to develop strategies to prevent obesity by creating environments in which children eat healthfully and engage regularly in physical activity. This article discusses the role of schools in obesity prevention efforts. Current issues in schools' food and physical activity environments are examined, as well as federal, state, and local policies related to food and physical activity standards in schools. The article is organized around four key areas: (1) school food environments and policies, (2) school physical activity environments and policies, (3) school body mass index measurements, and (4) school wellness policies. Recommendations for accelerating change also are addressed. The article found that (1) competitive foods (foods sold outside of federally reimbursed school meals) are widely available in schools, especially secondary schools. Studies have related the availability of snacks and drinks sold in schools to students' high intake of total calories, soft drinks, total fat and saturated fat, and lower intake of fruits and vegetables; (2) physical activity can be added to the school curriculum without academic consequences and also can offer physical, emotional, and social benefits. Policy leadership has come predominantly from the districts, then the states, and, to a much lesser extent, the federal government; (3) few studies have examined the effectiveness or impact of school-based BMI measurement programs; and (4) early comparative analyses of local school wellness policies suggest that the strongest policies are found in larger school districts and districts with a greater number of students eligible for a free or reduced-price lunch. Studies show that schools have been making some progress in improving the school food and physical activity environments but that much more work is needed. Stronger policies are needed to provide healthier meals to students at schools; limit their access to low-nutrient, energy-dense foods during the school day; and increase the frequency, intensity, and duration of physical activity at school.

Correlates of Fruit and Vegetable Intakes in US Children

Article

Apr 2009

The objective of this study was to assess the quality of the current intakes of fruits and vegetables compared to the Dietary Guidelines for Americans in US children and adolescents and identify factors related to low fruit and vegetable intake. This descriptive study examined differences in fruit and vegetable intakes by age, sex, ethnicity, poverty level, body mass index, and food security status utilizing data from the 1999-2002 National Health and Nutrition Examination Survey. Six thousand five hundred thirteen children and adolescents ages 2 to 18 years, who were respondents to the 1999-2002 National Health and Nutrition Examination Survey. Mean fruit and vegetable intakes were computed using 24-hour recalls for individuals and compared using analysis of variance. Leading contributors to fruit and vegetable intake were identified using frequency analysis. Children aged 2 to 5 years had significantly higher total fruit and juice intakes than 6- to 11- and 12- to 18-year-olds. Total vegetable and french fry intake was significantly higher among 12- to 18-year-old adolescents. Regarding sex differences, boys consumed significantly more fruit juice and french fries than girls. In addition, non-Hispanic African-American children and adolescents consumed significantly more dark-green vegetables and fewer mean deep-yellow vegetables than Mexican-American and non-Hispanic white children and adolescents. Total fruit consumption also differed significantly among race/ethnicities and household income. Children and adolescents most at risk for higher intakes of energy-dense fruits and vegetables (fruit juice and french fries) were generally boys, and adolescents, at risk for overweight or overweight and living in households below 350% of the poverty level.

Social and Environmental Factors Associated With Preschoolers’ Nonsedentary Physical Activity

Article

Feb 2009
CHILD DEV

The twofold purposes of the investigation were (a) to describe with direct observation data the physical activity behaviors and the accompanying social and environmental events of those behaviors for children in preschools and (b) to determine which contextual conditions were predictors of moderate to vigorous physical activity (MVPA) and nonsedentary physical activity (i.e., light activity + MVPA) for 3-, 4-, and 5-year-old children during their outdoor play. The results indicate that preschoolers' physical activity is characterized as sedentary in nature throughout their preschool day (i.e., 89% sedentary, 8% light activity, and 3% MVPA). During outdoor play periods, when children are most likely to be physically active, some contextual and social circumstances better predict their physical activity. Implications for policy makers, practitioners, and researchers are discussed.

Validating the Food Behavior Questions from the Elementary School SPAN Questionnaire

Article

Sep 2008

The School Physical Activity and Nutrition (SPAN) questionnaire was developed as a surveillance instrument to measure physical activity, nutrition attitudes, and dietary and physical activity behaviors in children and adolescents. The SPAN questionnaire has 2 versions. This study was conducted to evaluate the validity of food consumption items from the elementary school version of the SPAN questionnaire. Validity was assessed by comparing food items selected on the questionnaire with food items reported from a single 24-hour recall covering the same reference period. 5 elementary schools in Indiana. Fourth-grade student volunteers (N = 121) from 5 elementary schools. Agreement between responses to SPAN questionnaire items and reference values obtained through 24-hour dietary recall. The agreement between the questionnaire and the 24-hour recall was measured using Spearman correlation, percentage agreement, and kappa statistic. Correlation between SPAN item responses and recall data ranged from .25 (bread and related products) to .67 (gravy). The percentage agreement ranged from 26% (bread and related products) to 90% (gravy). The kappa statistic varied from .06 (chocolate candy) to .60 (beans). Results from this study indicate that the SPAN questionnaire can be administered in the classroom quickly and easily to measure many previous day dietary behaviors of fourth graders. However, questions addressing consumption of "vegetables," "candy," and "snacks" need further investigation.

Mertz W. Food intake measurements: Is there a "gold standard"? J Am Diet Assoc 92, 1463-1465

Article

Jan 1993
J AM DIET ASSOC

W Mertz

Conditioned flavor preferences in children

Article

Apr 1990
PHYSIOL BEHAV

In this experiment 11 children participated in a series of 8 pairs of conditioning trials in order to investigate the hypothesis that children could form conditioned flavor preferences based on caloric density. Unfamiliar drink flavors were used in these trials, and the drinks were either high in caloric density (155 kcal/150 ml) or low (less than 5 kcal/150 ml). Caloric density was altered by the addition of low glucose maltodextrin. Each child always had the same caloric density/flavor pairing throughout the conditioning trials. Each trial pair included one high and one low density preload, followed by ad lib consumption. These conditioning trials substituted for the children's regularly scheduled morning snack four days per week, one trial per day. Conditioning trials were given as a series of two-part snacks, consisting of fixed volumes of initially unfamiliar drinks, followed by the opportunity to eat a variety of foods ad lib. Two measures, obtained before and after conditioning, provided evidence for the formation of conditioned flavor preferences: 1) preference assessments, and 2) two-flavor choice tests. In addition, the ad lib consumption data indicated that the children were responsive to the caloric density manipulation, by consistently eating more following the low than the high density drink. The potential contribution of such acquired flavor preferences to the reduction of neophobia is discussed.

Cardiovascular risk factors in children and early prevention of heart disease

Article

Feb 1988

Clinical and anatomical observations from the Bogalusa Heart Study over a 15-year span provide data on cardiovascular risk factors and the early natural history of arteriosclerosis. These studies established that: cardiovascular risk can be predicted in early life; interrelationships of risk factors in children are similar to those observed in adults; and concentrations of serum lipoproteins change during sexual maturation. Strategies involving the general population and high-risk groups should be considered to help reduce atherosclerosis and coronary artery disease. Active modification of risk factors in the general populace would include using such methods as screening, education, and mass-media campaigns. Educational promotion ("Heart Smart") has already been implemented in the New Orleans area, focusing on using the total school environment to teach cardiovascular health and to encourage children to adopt desirable lifestyles. Inclusion of cardiovascular health education into general educational studies of children should be a major objective of the future.

Effects of a Controlled Trial of a School-based Exercise Program on the Obesity Indexes of Pre-School Children

Article

Dec 1998

Exercise has been found to be effective for prevention of weight gain and maintenance of a stable weight in adults. The objective of this study was to evaluate the effect of a school-based aerobic exercise program on the obesity indexes of preschool children. Subjects were 292 second-year elementary school pupils from 2 kindergartens in Hat Yai municipality, Songkhla province, southern Thailand. A specially designed exercise program, including a 15-min walk before beginning the morning class and a 20-min aerobic dance session after the afternoon nap, 3 times a week, was conducted for 29.6 wk. Weight, height, and triceps skinfold thickness were measured 4 times. At the end of the study, the prevalence of obesity, using 95th percentile National Center for Health Statistics triceps-skinfold-thickness cutoffs, of both the exercise and control groups decreased. That of the exercise group decreased from 12.2% at baseline to 8.8% (Wilcoxon signed-rank test, P = 0.058), whereas that of the control group decreased from 11.7% to 9.7% (Wilcoxon signed-rank test, P = 0.179). A sex difference in the response of body mass index (BMI) to exercise was observed. Girls in the exercise group had a lower likelihood of having an increasing BMI slope than the control girls did (odds ratio: 0.32; 95% CI: 0.18, 0.56). In conclusion, our study suggests that a 29.6-wk school-based exercise program can prevent BMI gain in girls and may induce a remission of obesity in preschool-age children.

Three-Year Maintenance of Improved Diet and Physical Activity: The CATCH Cohort

Article

Jul 1999
Arch Pediatr Adolesc Med

To assess differences through grade 8 in diet, physical activity, and related health indicators of students who participated in the Child and Adolescent Trial for Cardiovascular Health (CATCH) school and family intervention from grades 3 through 5. Follow-up of the 4-center, randomized, controlled field trial with 56 intervention and 40 control elementary schools. We studied 3714 (73%) of the initial CATCH cohort of 5106 students from ethnically diverse backgrounds in California, Louisiana, Minnesota, and Texas at grades 6, 7, and 8. Self-reported daily energy intake from fat at baseline was virtually identical in the control (32.7%) and intervention (32.6%) groups. At grade 5, the intake for controls remained at 32.2%, while the intake for the intervention group declined to 30.3% (P<.001). At grade 8, the between-group differential was maintained (31.6% vs 30.6%, P = .01). Intervention students maintained significantly higher self-reported daily vigorous activity than control students (P = .001), although the difference declined from 13.6 minutes in grade 5 to 11.2, 10.8, and 8.8 minutes in grades 6, 7, and 8, respectively. Significant differences in favor of the intervention students also persisted at grade 8 for dietary knowledge and dietary intentions, but not for social support for physical activity. No impact on smoking behavior or stages of contemplating smoking was detected at grade 8. No significant differences were noted among physiologic indicators of body mass index, blood pressure, or serum lipid and cholesterol levels. The original CATCH results demonstrated that school-level interventions could modify school lunch and school physical education programs as well as influence student behaviors. This 3-year follow-up without further intervention suggests that the behavioral changes initiated during the elementary school years persisted to early adolescence for self-reported dietary and physical activity behaviors.

Birch LL. Development of food preferences. Annu Rev Nutr 19, 41-62

Article

Feb 1999

Leann L Birch

Using a developmental systems perspective, this review focuses on how genetic predispositions interact with aspects of the eating environment to produce phenotypic food preferences. Predispositions include the unlearned, reflexive reactions to basic tastes: the preference for sweet and salty tastes, and the rejection of sour and bitter tastes. Other predispositions are (a) the neophobic reaction to new foods and (b) the ability to learn food preferences based on associations with the contexts and consequences of eating various foods. Whether genetic predispositions are manifested in food preferences that foster healthy diets depends on the eating environment, including food availability and child-feeding practices of the adults. Unfortunately, in the United States today, the ready availability of energy-dense foods, high in sugar, fat, and salt, provides an eating environment that fosters food preferences inconsistent with dietary guidelines, which can promote excess weight gain and obesity.

Nutritional Intake Monitoring for Nursing Home Residents: A Comparison of Staff Documentation, Direct Observation, and Photography Methods

Article

Mar 2000

The current approach to assessing nutritional intake requires nursing home (NH) staff to document total percentage of food and fluid consumed at each meal. Because NH staff tend to significantly overestimate total food intake, methods need to be developed to improve the accuracy of food intake measurement. To compare three methods of assessing the nutritional intake of NH residents. Validation Study. Fifty-six NH residents in one facility. Total percentage of food and fluid intake of each resident for each of nine meals, or all three meals for 3 consecutive days, was assessed by: (1) Nursing home staff chart documentation, (2) Research staff documentation according to direct observations, and (3) Research staff documentation according to photographs of residents' trays before and after each meal. Research staff documentation of total intake and intake of all individual food and fluid items was similar for the direct observation and photography methods. In comparison with these two methods, NH staff documentation reflected a significant overestimate (22%) of residents' total intake levels. In addition, NH staff failed to identify the more than half (53%) of those residents whose intake levels were equal to or below 75% for most meals. The photography method of nutritional assessment yielded the same information as direct observations by research staff, and both of these methods showed the intake levels of NH residents to be significantly lower than the intake levels documented by NH staff. The photography method also has several advantages over a documentation system that relies on an observer to be present to record food and fluid intake levels.

A Community-Based Obesity Prevention Program for Minority Children: Rationale and Study Design for Hip-Hop to Health Jr.

Article

Mar 2002

BACKGROUND; The increasing prevalence of overweight among children in the United States presents a national health priority. Higher rates of overweight/obesity among minority women place their children at increased risk. Although increased rates of overweight are observed in 4- to 5-year-old children, they are not observed in 2- to 3-year-old children. Therefore, early prevention efforts incorporating families are critical. The primary aim of Hip-Hop to Health Jr. is to alter the trajectory toward overweight/obesity among preschool African-American and Latino children. This 5-year randomized intervention is conducted in 24 Head Start programs, where each site is randomized to either a 14-week dietary/physical activity intervention or a general health intervention. This paper presents the rationale and design of the study. Efficacy of the intervention will be determined by weight change for the children and parent/caretaker. Secondary measures include reductions in dietary fat and increases in fiber, fruit/vegetable intake, and physical activity. Baseline data will be presented in future papers. The problem of overweight/obesity is epidemic in the United States. Behaviors related to diet and physical activity are established early in life and modeled by family members. Early intervention efforts addressing the child and family are needed to prevent obesity later in life. This paper describes a comprehensive, family-oriented obesity prevention program for minority preschool children.

Health Consequences of Obesity in Youth: Childhood Predictors of Adult Disease

Article

Apr 1998

William H Dietz

Availability, Accessibility, and Preferences for Fruit, 100% Fruit Juice, and Vegetables Influence Children's Dietary Behavior

Article

Nov 2003

The relationships among home fruit (F), 100% fruitjuice (J), and vegetable (V) availability and accessibility separately, as reported by 225 fourth- through sixth-grade children and their parents (n = 88), separately, and FJV preferences to child-reported FJV consumption were assessed. For girls, child-reported FJV availability and accessibility accounted for 35% of the variability in FJV consumption. Child-reported availability and parent-reported accessibility were significantly correlated with child FJV consumption in a combined model. For children with high FJV preferences, FJV availability was the only significant predictor, whereas both availability and accessibility were significantly related to consumption for children with low FJV preferences. Interventions targeting child dietary behaviors may need to tailor to the home environment, separately by gender. Extra efforts are necessary by parents to enhance accessibility among children who do not like FJV.

Cardiovascular Risk Reduction in Preschool Children: The "Healthy Start" Project

Article

May 2004

To evaluate the impact of a multicomponent cardiovascular health intervention ("Healthy Start") which included a food service modification in a largely minority Head Start preschool population. The primary outcome measure was the change in serum cholesterol from the beginning to the end of the school year. Nine Head Start centers in Upstate N.Y. were assigned to either food service modification or control conditions. In addition, half of the centers assigned to the food service modification received supplemental nutrition education (FS/NU--food service modification/nutritional education), while the remaining centers were provided with supplemental safety education materials (FS--food service modification only). The control preschool centers (CON) also received supplemental safety educational curricula for children but their food services remained unchanged. Children had serum cholesterol, as well as height and weight measured at the beginning and end of the school year. A generalized linear univariate procedure was used with percent change in total serum cholesterol as the outcome variable and intervention group as the primary independent variable. There was a significant decrease in total serum cholesterol among preschool children in food service intervention groups, (FS/NU and FS), compared to Controls (-6.0 versus -0.4 mg/dL). In addition to the significant difference in group means, children with elevated cholesterol at baseline were significantly more likely to have a cholesterol level in the normal range (<170 mg/dL) at follow-up if they attended a preschool in the food service modification group. There was a 30% reduction in risk of elevated cholesterol in the latter compared to controls. Participation in the dietary intervention did not affect short-term growth. A preschool heart health intervention, "Healthy Start," designed to reduce the total and saturated fat content of snacks and meals to recommended levels was effective in reducing serum cholesterol in the study population as a whole and specifically children 'at risk'; i.e., those with initial elevated serum cholesterol.

Influences of Preschool Policies and Practices on Children's Physical Activity

Article

Jul 2004

The objective of this study was to determine if moderate to vigorous physical activity (MVPA) of 3-5 year old preschool children varied with differences in policies/practices, and overall quality of preschools. A total of 266 children (47% males, 60% African American) from 9 preschools were observed for 1 hour on 3 different days. PA of children was observed twice per minute and scored as 1-5, with 1 for stationary/motionless and 5 for fast movement. Summary MVPA was calculated over the 3 days as percent of times observed at levels of 4 or 5, and percent of time at levels 1 or 2 as sedentary activity. A structured interview about PA policies was conducted with an administrator at each preschool and overall quality of the preschool was assessed using Early Childhood Environment Rating Scale-Revised Edition (ECERS-R). Preschools were divided into groups according to whether a specific policy/practice that would be logically hypothesized to promote PA was in place at the school. MVPA differences between groups of children was assessed using mixed ANOVA controlling for preschool. When preschools offered more field trips, and more college educated teachers, the children participated in more MVPA. Children who attended preschools with lower quality spent more time in sedentary activity. In conclusion, children in preschools which may have more resources and better quality appear to show both more sedentary behavior and more MVPA.

Physical Activity Among Children Attending Preschools

Article

Dec 2004
Pediatrics

Obesity rates are increasing among children of all ages, and reduced physical activity is a likely contributor to this trend. Little is known about the physical activity behavior of preschool-aged children or about the influence of preschool attendance on physical activity. The purpose of this study was to describe the physical activity levels of children while they attend preschools, to identify the demographic factors that might be associated with physical activity among those children, and to determine the extent to which children's physical activity varies among preschools. A total of 281 children from 9 preschools wore an Actigraph (Fort Walton Beach, FL) accelerometer for an average of 4.4 hours per day for an average of 6.6 days. Each child's height and weight were measured, and parents of participating children provided demographic and education data. The preschool that a child attended was a significant predictor of vigorous physical activity (VPA) and moderate-to-vigorous physical activity (MVPA). Boys participated in significantly more MVPA and VPA than did girls, and black children participated in more VPA than did white children. Age was not a significant predictor of MVPA or VPA. Children's physical activity levels were highly variable among preschools, which suggests that preschool policies and practices have an important influence on the overall activity levels of the children the preschools serve.

Prevention of the Epidemic Increase in Child Risk of Overweight in Low-Income Schools: The El Paso Coordinated Approach to Child Health

Article

Apr 2005
Arch Pediatr Adolesc Med

To assess the impact on children's health of translating an evidence-based national intervention trial (Child and Adolescent Trial for Cardiovascular Health [CATCH]) to low-income elementary schools with primarily Hispanic students. An untreated, matched control group design with repeated dependent pretest and posttest samples was used. Four El Paso CATCH and 4 control elementary schools in El Paso, Tex, along the US-Mexico border region. All had Title I status (most were low-income students). Participants were 896 third-grade children (473 control schools [224 girls and 249 boys] and 423 CATCH schools [199 girls and 224 boys]); 93% were Hispanic. Community-based implementation of the national CATCH program. Risk of overweight or overweight, body mass index, waist-to-hip ratio, yards run in 9 minutes, passing rates for Fitnessgram national mile standards, moderate to vigorous physical activity and vigorous physical activity in physical education class, and percentage of fat and sodium in school lunches. Girls in control schools had significant increases in percentage of risk of overweight or overweight from third (26%) to fifth (39%) grades, as did girls in CATCH schools (30%-32%); however, the rate of increase for girls in the CATCH schools was significantly lower (2%) compared with the rate for control girls (13%). A similar pattern was seen for boys, with a rate of increase for boys in CATCH schools of 1% (40%-41%), which was significantly less than the 9% increase (40% to 49%) for control boys. The translation of the national CATCH program to low-income schools with Hispanic students successfully slowed the epidemic increase in risk of overweight or overweight seen in control school children. An emphasis should be placed on community organizing and evaluation feedback when implementing evidence-based school health programs in low-income Hispanic communities.

Rapid growth in infancy and childhood and obesity in later life - A systematic review

Article

Jun 2005

The association between obesity and morbidity resulting from chronic diseases is well known. This systematic review addresses studies of the role of rapid growth in infancy and childhood as possible determinants of overweight and obesity later in the life course. We reviewed MEDLINE for studies reporting on growth in infancy and childhood, as well as measures of weight or adiposity in later childhood, adolescence or adulthood. The methodological quality of the papers was assessed using the criteria suggested by Downs and Black. Sixteen articles that fulfilled review criteria were located. There was wide variability in the indicators used for defining rapid growth as well as overweight or obesity. The age range in which weight or adiposity was measured ranged from 3 to 70 years. In spite of differences in definitions used, 13 articles that reported on early rapid growth found significant associations with later overweight or adiposity. Efforts should be made to standardize the definition of rapid growth, as well as that of overweight and obesity in children and adolescents. The most frequent definition for rapid growth in this review was a Z-score change greater than 0.67 in weight for age between two different ages in childhood. Regarding obesity, the definition proposed by the International Obesity Task Force also appears to be most appropriate. The present results indicate that early growth is indeed associated with the prevalence of obesity later in the life course.

Two-year follow-up results for Hip-Hop to Health Jr.: a randomized controlled trial

Article

Jun 2005
J Pediatr

To assess the impact of a culturally proficient dietary/physical activity intervention on changes in body mass index (BMI) (kg/m 2 ). Randomized controlled trial (Hip-Hop to Health Jr.) conducted between September 1999 and June 2002 in 12 Head Start preschool programs in Chicago, Illinois. Intervention children had significantly smaller increases in BMI compared with control children at 1-year follow-up, 0.06 vs 0.59 kg/m 2 ; difference -0.53 kg/m 2 (95% CI -0.91 to -0.14), P = .01; and at 2-year follow-up, 0.54 vs 1.08 kg/m 2 ; difference -0.54 kg/m 2 (95% CI -0.98 to -0.10), P = .02, with adjustment for baseline age and BMI. The only significant difference between intervention and control children in food intake/physical activity was the Year 1 difference in percent of calories from saturated fat, 11.6% vs 12.8% ( P = .002). Hip-Hop to Health Jr. was effective in reducing subsequent increases in BMI in preschool children. This represents a promising approach to prevention of overweight among minority children in the preschool years.

Determinants of fruit and vegetable consumption among 6-12-year-old children and effective interventions to increase consumption

Article

Jan 2006

To review the current literature about potential determinants of fruit and vegetable intakes and effective intervention strategies to increase the consumption of fruits and vegetables among 6-12-year-old children. A structured review of literature located in PubMed and Psychinfo electronic literature databases. Of all determinants, the availability and accessibility of fruit and vegetables and taste preferences were most consistently and most positively related to consumption. There was some evidence that parental fruit and vegetable intakes, knowledge of intake recommendations and skills had a positive association with children's intakes, whereas television viewing, exposure to television advertisement, and having a snack bar at school were associated with lower intakes of fruit and vegetables. Multi-component school-based interventions that combined classroom curriculum, parent and food service components showed the greatest promise for fruit and vegetable promotion among children. School fruit and vegetable subscription programmes, scout-based interventions, and fruit and vegetables education via computer multi-media channels also appear promising. Interventions should improve the availability and accessibility of fruit and vegetables to children, and should aim to improve their taste preferences for them. Such interventions should be of a multi-component nature, school-based or use other social channels and may include multi-media channels.

Diet and lifestyle recommendations revision 2006 - A scientific statement from the American Heart Association Nutrition Committee (vol 114, pg 82, 2006)

Article

Jul 2006
CIRCULATION

Improving diet and lifestyle is a critical component of the American Heart Association's strategy for cardiovascular disease risk reduction in the general population. This document presents recommendations designed to meet this objective. Specific goals are to consume an overall healthy diet; aim for a healthy body weight; aim for recommended levels of low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides; aim for normal blood pressure; aim for a normal blood glucose level; be physically active; and avoid use of and exposure to tobacco products. The recommendations are to balance caloric intake and physical activity to achieve and maintain a healthy body weight; consume a diet rich in vegetables and fruits; choose whole-grain, high-fiber foods; consume fish, especially oily fish, at least twice a week; limit intake of saturated fat to <7% of energy, trans fat to <1% of energy, and cholesterol to <300 mg/day by choosing lean meats and vegetable alternatives, fat-free (skim) or low-fat (1% fat) dairy products and minimize intake of partially hydrogenated fats; minimize intake of beverages and foods with added sugars; choose and prepare foods with little or no salt; if you consume alcohol, do so in moderation; and when you eat food prepared outside of the home, follow these Diet and Lifestyle Recommendations. By adhering to these diet and lifestyle recommendations, Americans can substantially reduce their risk of developing cardiovascular disease, which remains the leading cause of morbidity and mortality in the United States.

Hip-Hop to Health Jr. for Latino Preschool Children*

Article

Oct 2006

Hip-Hop to Health Jr. was a diet/physical activity intervention designed to reduce gains in BMI (kilograms per meter squared) in preschool minority children. Twelve predominantly Latino Head Start centers participated in a group-randomized trial conducted between Fall 2001 and Winter 2003. Six centers were randomized to a culturally proficient 14-week (three times weekly) diet/physical activity intervention. Parents participated by completing weekly homework assignments. The children in the other six centers received a general health intervention that did not address either diet or physical activity. The primary outcome was change in BMI, and secondary outcomes were changes in dietary intake and physical activity. Measures were collected at baseline, post-intervention, and at Years 1 and 2 follow-up. There were no significant differences between intervention and control schools in either primary or secondary outcomes at post-intervention, Year 1, or Year 2 follow-ups. When Hip-Hop to Health Jr. was conducted in predominantly black Head Start centers, it was effective in reducing subsequent increases in BMI in preschool children. In contrast, when the program was conducted in Latino centers, it was not effective. Although the intervention did not prevent excessive weight gain in Latino children, it was very well received. Future interventions with this population may require further cultural tailoring and a more robust parent intervention.

Interventions to Prevent or Treat Obesity in Preschool Children: A Review of Evaluated Programs*

Article

Jun 2007

To identify effective programs to prevent or treat overweight among 2- to <6-year-old children. We searched six databases to identify evaluated intervention programs assessing changes in weight status or body fat and systematically summarized study attributes and outcomes. Four of the seven studies (two intervention, two prevention) documented significant reductions in weight status or body fat. Among these, three sustained reductions at 1 or 2 years after program initiation, three incorporated a framework/theory, two actively and one passively involved parents, three included multicomponent strategies, and all four monitored behavioral changes. Of the three (prevention) studies that did not show reduction in weight or fat status, all performed assessments between 4 and 9 months after program initiation, and one used a multicomponent strategy. Other significant changes reported were reductions in television viewing, cholesterol, and parental restriction of child feeding. The paucity of studies limits our ability to generalize findings. Among the available studies, multicomponent programs with 1- to 2-year follow-up in clinics or child care settings were successful in their impact on weight; they were likely enhanced by parental involvement. Both treatment programs and two of five prevention programs reduced weight/fat status. Our review highlights the need to evaluate more programs, advocate for use of a framework/behavioral theory and objective behavioral measures, further examine the impact of involving parents and the impact of intervention duration and follow-up time, strengthen prevention programs, and further evaluate successful programs in other settings and among other racial/ethnic groups.

Pilot-testing CATCH Early Childhood: A Preschool-based Healthy Nutrition and Physical Activity Program

Abstract

No full-text available

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