5/2/2017 1 Influence of teachers personal health behaviors on - PDF document

5/2/2017 1 Influence of teachers’ personal health behaviors on operationalizing obesity prevention policy in Head Start preschools: A project of the Children’s Healthy Living Program (CHL). Esquivel MK, Nigg C, Fialkowski JK, Braun K, Li F , Novotny R. Journal for Nutrition Education and Behavior. 2016; 48 (5) 2 Objectives 1. To review the literature on factors that affect the efficacy of child care center wellness policy implementation on the obesogenic environment within preschool settings. 2. To discuss how the Children's Healthy Living Program child care wellness policy intervention was designed to address multiple levels of the socioecological model to positively influence the nutrition and physical activity environments in Head Start classrooms. 3. To identify key strategies and lessons learned from this program that could support effective wellness policy implementation in child care centers to address childhood obesity. 3 Introduction • State of Emergency Declared in Pacific Region 1 • High prevalence obesity-related non-communicable diseases • High prevalence of adult obesity • Childhood overweight/obesity (ow/ob) is a risk factor for ow/ob in adults 2 • Childhood prevalence ow/ob in Pacific & Hawai‘i: US Affiliated Pacific: 21% to 39% in 2-8 yr olds 3 • Hawaii: 28% children entering kindergarten 2007 4 • • Unchanged from 2003 5 • US Mainland: Recent national study showed decline in obesity in 3-5 year olds Hawai‘i data not included 6 1

5/2/2017 4 Children’s Healthy Living Program (CHL) • USDA grant for childhood obesity prevention in US Affiliated Pacific 7 • Training program • Community randomized controlled intervention trial based on social ecologic model and focused on the environment • 5 jurisdictions and 18 communities • >25% Native Hawaiian Pacific Islander per US Census • Target Population: 2-8 year olds children in selected communities • Data collected (baseline and follow-up) CHL Partnership • Socio-demographics • Anthropometry • Dietary intake • Physical activity • Sleep • Screen time 5 Determining Childhood Ow/Ob • Body Mass Index (BMI) compared against reference data • Classification • CDC BMI percentile cut points for ow/ob 8 • 0 to <5 th = underweight, 5 th to <85 th = healthy weight, ≥ 85 th to <95 th = overweight, ≥ 95 th = obese • Continuous Child BMI – Avg BMI from Reference Population • BMI z-scores (zBMI)= SD of Reference Population 50 th % tile 19 th % tile 84 th % tile 6 th % tile 95 th % tile Mean 0 SD -2 SD - 1SD + 1 SD + 2SD 6 Policy Causes of Obesity Community Organizational • Energy imbalance Interpersonal • Socio-Ecologic Model 12 • Individual/environment interaction Individual • Obesogenic Environments 13 • Physical- availability & access • Economic- food cost & income level • Political- policies or access • Socio-Cultural- beliefs, traditions 2

5/2/2017 7 Head Start (HS) and Childhood Obesity • HS: Federally funded free preschool for children from low- income families 20 • Emphasis on education and health • Health Requirements: annual physical exam, bi-annual growth assessment • Meal Requirements: mandatory participation in Child and Adult Care Food Program (CACFP) • CACFP 22 • Outlines minimum requirements for reimbursable meal components • HS or similar Early Childhood Education (ECE) delivered throughout US Affiliated Pacific Islands & Territories • HS has shown positive effect on childhood obesity in Michigan • Decline in BMI z-score of obese children after 1 st year of HS participation greater than comparison samples, p<0.001 21 8 Current HS Nutrition/Health Policy • Policies from the Office of Administration for Children and Families- Office of Head Start 20 • Identify individual child nutritional needs • Measure height/weight • Questionnaires about family eating pattern/cultural food preferences • Special dietary requirements • Meal and Snack Provision • Meals/snacks meet 1/3 to ½ of daily nutrition needs • Follow USDA child nutrition meal patterns • Foods are high in nutrients, low in fat, sugar, salt • Serve a variety of foods to broaden child’s food experiences • No outside foods/beverages allowed • Meal Time • Food is not a punishment/reward • Staff/volunteers eat the same food, family style to the extent possible 9 Current HS Nutrition/Health Policy • Policies from the Office of Administration for Children and Families- Office of Head Start 20 • Identify individual child nutritional needs • Measure height/weight • Questionnaires about family eating pattern/cultural food preferences • Special dietary requirements Opportunities for • Meal and Snack Provision Improvement • Meals/snacks meet 1/3 to ½ of daily nutrition needs - Strengthen policy • Follow USDA child nutrition meal patterns statements • Foods are high in nutrients, low in fat, sugar, salt - Additional policies to • Serve a variety of foods to broaden child’s food experiences improve implementation • No outside foods/beverages allowed • Meal Time • Food is not a punishment/reward • Staff/volunteers eat the same food, family style to the extent possible 3

5/2/2017 10 Table 2.1 Literature review: summary of effective early childhood education policy intervention outcomes measured and intervention activities. Outcomes Measured Intervention Activities Significant Results Class Author, Location, Child CBPR EW T/TA Study Ob SR Lanigan, US x x x x Classroom feeding practices EHNAHCE 23 Gosliner, California, Teacher-parent communication Contra Costa County x x Classroom FV availability Child Care 24 Benjamin, North Obesity prevention best Carolina, NAP x x practices implemented SACC 25 Drummond, Arizona, Obesity prevention best x x NAP SACC 26 practices implemented Lyn, Georgia, Environment and Policy Assessment x x DECAL 27 and Observation score De Silva-Sanigorski, Obesity prevalence Australia, Romp N x x x Juice consumption Chomp 28 Alkon, US, NAP BMI z score x x x x SACC 29 Ob= Observed, SR= Self-Report, CBPR=Community Based Participatory Research, EW= Employee Wellness, T/TA= Training and Technical Assistance 11 Summary/Problem Statements • Multi-level interventions are needed for childhood ow/ob prevention and treatment within preschool settings • ECE-based policy interventions have the potential to support prevention efforts but have not been tested on Native Hawaiian and Pacific Islander populations • Increased ow/ob in HI and Pacific but lack of system to monitor progress • HS may be a potential partner for monitoring young child growth but validation of program measurements is needed • Child growth assessments differ by reference data (CDC vs WHO), both are used in US Affiliated Pacific and difference has not been assessed in NHPI sample 12 Conceptual Framework for Head Start Policy Intervention in Hawai‘i Mediator Wellness Policy Teacher Classroom Child Long-term Intervention Implementation Assessment 1 Outcomes 2 Outcomes 3, 4 Outcomes Development BMI HS teacher Teacher nutrition Evaluating PA & focus groups misconceptions, Fruit & Nutrition HS data for efficacy, vegetable to inform Environment child BMI intervention priorities, & intake monitoring Esquivel MK, Esquivel MK, knowledge et al. in Pacific et al. J Family Childhood Med Obesity . Community 2016 Health. 2016 Implementation Fidelity & Teacher reported health behaviors, indicators, skills, & knowledge related to nutrition & PA 5 Esquivel MK, et al. Journal for Nutrition Education and Behavior. 2016 Moderator Assessment Tools: 1 Child Care Provider Healthy Eating and Activity Survey, 2 Environment and Policy Assessment and Observation Tool a. Nutrition and b. Physical Activity, 3 Observed Plate Waste, 4 CDC 2000 Growth Charts, 5 Monthly Implementation Survey 4

5/2/2017 13 Background • Policy interventions have made positive effects on CCC environments • Policy goals: create classroom environments that support energy balance (calories in=calories out) • Few studies have assessed effect on child outcomes • BMI: 2 studies found positive effect on child BMI 28, 29 • Diet: Improved F/V availability 24 , decreased juice consumption 29 • Interventions that included teacher/staff activities: • Correlation between center staff and classroom meal time feeding practices, classroom nutrition education and parent-family communication 23 • Positive effect of teachers’ self-efficacy on communicating nutrition information to parents and frequency of fruits and vegetables served at centers 23 14 Hypotheses Classroom Child • Improved nutrition & • Decrease child zBMI & physical activity (PA) increase child fruit/veg classroom environment consumption • Mediated by teachers’ • Mediated by teachers’ beliefs, misconceptions, beliefs, misconceptions, knowledge, and priorities knowledge, and priorities • Moderated by • Moderated by implementation fidelity & implementation fidelity & teacher behaviors and status teacher behaviors and status 15 Methods: Design, Participants • 7 month intervention within CHL randomized community trial • Pre- Post Assessment • Monthly intervention activities • Dissertation Study Sample • HS clusters containing CHL randomized communities • Intervention: 11 HS classrooms • 220 children sampled • Control:12 HS classrooms CHL randomized community • 240 children sampled HS cluster • Ages: 3-5 years • Low-income 5