Designing Video Games for Nutrition Education: A Participatory Approach

ObjectiveTo describe the participatory approach used to inform the development of a video game designed to increase children's nutrition knowledge. The objectives were to (1) assess children's nutrition areas of focus, (2) explore parents’ and children's perceptions of video games for nutrition education, and (3) collect information on children's video game preferences.DesignQualitative research design using 10 focus group interviews and 5 workshops. Children's nutrition knowledge and game player type were assessed by questionnaires.SettingSouth Island, New Zealand.ParticipantsSixty-two primary school children, aged 7–11 years. Ten parents completed an online questionnaire.Phenomenon of InterestParticipatory approach in designing digital nutrition education resources.AnalysisA general inductive approach was used to develop the themes.ResultsThe following 3 themes were identified through thematic analysis: (1) positive impacts associated with video games for nutrition education, (2) factors for engagement, and (3) barriers for sustained use.Conclusions and ImplicationsBoth children and parents perceived that video games offered an avenue to increase nutrition knowledge. However, negative views such as screen time usage need to be addressed before widespread adoption. The participatory design approach provided information about game mechanics that will inspire the game design and enhance engagement of video games for nutrition education.     

Nutrition socialization experiences of children in the Head Start program

Some preschoolers may be at risk for overweight and obesity. To gain greater insight into children's early nutrition socialization experiences, the association of adult nutrition attitudes and mealtime behaviors to young children's eating behaviors and weight-for-height was investigated. Forty-six parent-child pairs and 8 Head Start teachers participated. Children were weighed and measured; parents completed measures of child eating behaviors, nutrition attitudes, and family mealtimes; teachers reported their own nutrition attitudes and were observed during mealtimes. Correlational findings indicated that parents' negative mealtime practices were associated with higher child weight-for-height and that parents' positive nutrition-attitudes were related to more pleasant family mealtimes, fewer negative mealtime practices, and less troublesome child eating behaviors. The Head Start mealtime environment was developmentally appropriate and predictable for children. Although teachers engaged in some nutrition teaching during meals, a number of opportunities were missed for promoting children's nutrition socialization. In sum, these results identified potential opportunities for improving children's early nutrition socialization experiences.     

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

ObjectiveUsing 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).MethodsIndividual, semi-structured interviews with 28 Head Start teachers in central North Carolina.ResultsParticipants 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).Conclusions and ImplicationsNutrition 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.     

The Wellness Child Care Assessment Tool: a measure to assess the quality of written nutrition and physical activity policies

BackgroundThere is a growing interest in studying the influence of child-care center policies on the health of preschool-aged children.ObjectiveTo develop a reliable and valid instrument to quantitatively evaluate the quality of written nutrition and physical activity policies at child-care centers.DesignReliability and validation study. A 65-item measure was created to evaluate five areas of child-care center policies: nutrition education, nutrition standards for foods and beverages, promoting healthy eating in the child-care setting, physical activity, and communication and evaluation. The total scale and each subscale were scored on comprehensiveness and strength.SettingAnalyses were conducted on 94 independent policies from Connecticut child-care centers participating in the Child and Adult Care Food Program.Statistical analyses performedIntraclass correlation coefficient was calculated to measure inter-rater reliability, and Cronbach's α was used to estimate internal consistency. To test construct validity, t tests were used to assess differences in scores between Head Start and non–Head Start centers and between National Association for the Education of Young Children–accredited and nonaccredited centers.ResultsInter-rater reliability was high for total comprehensiveness and strength scores (intraclass correlation coefficient=0.98 and 0.94, respectively) and subscale scores (intraclass correlation coefficient=0.84 to 0.99). Subscales were adequately internally reliable (Cronbach's α=.53 to .83). Comprehensiveness and strength scores were higher for Head Start centers than non–Head Start centers across most domains and higher for National Association for the Education of Young Children–accredited centers than nonaccredited centers across some but not all domains, providing evidence of construct validity.ConclusionsThis instrument provides a standardized method to analyze and compare the comprehensiveness and strength of written nutrition and physical activity policies in child-care centers.     

Evaluation of a nutrition education program for head start parents

This study investigated the effects of a parent education program on the nutrition-related behavior of Head Start parents and the dietary intake of their preschool children. Six New York City and five Maryland Head Start centers were assigned to either the treatment (nutrition education) or control group. Treatment group mothers received 13 weekly nutrition newsletters and were encouraged to attend four nutrition workshops addressing child nutrition, meal planning, food preparation, and food shopping. A total of 89 mothers in the treatment group and 82 mothers in the control group completed pre- and post-program interviews examining their children's food consumption and their nutrition-related behaviors. One to two months after the nutrition education program, Maryland treatment group parents reported that their children were consuming a significantly more diverse and high quality diet, and were consuming significantly more servings of selected nutritious foods than were children in the control group. There were no significant differences in the food consumption of New York treatment and control group children following the program. Treatment group parents from both Maryland and New York reported making more positive changes in their meal planning, food shopping, food preparation, and cooking practices than did their control group counterparts. Findings indicate that nutrition education programs can have a positive effect on Head Start parents' nutrition-related behaviors and can lead to improvements in the diets of children who have been eating fewer than the recommended number of servings of nutritious foods.     

Communicating With Head Start Families About Children's Weight Status: A Phenomenological Approach

BackgroundTo support the early identification of childhood obesity, Head Start (HS) implemented a body mass index screening program. This program provides opportunities for HS to communicate with families about children's weight status. Limited research is available describing the methods used to communicate this information.ObjectiveExplore common experiences of HS health/nutrition managers (HNM) when communicating information to families about children's weight status.Study Design, Settings, and ParticipantsTwenty-eight in-depth telephone interviews with HNM across North Carolina (n = 15) and Ohio (n = 13).Study Design/AnalysisPhenomenology guided the study design and analysis. The themes focused on HNM's lived experiences with their body mass index screening program. Interviews were recorded and transcribed verbatim.ResultsFour emergent themes identified: (1) strategies for communicating weight status to families; (2) family response to communication strategies; (3) educational, staff support, and counseling opportunities for families; and (4) challenges engaging families in childhood obesity prevention efforts.Conclusions and ImplicationsHead Start programs acknowledged the importance of communicating children's weight status; however, there are inconsistencies in methods used and information communicated across programs. Head Start programs have community partners who support obesity prevention efforts; however, these partnerships may be underused. More research is needed to explore effective and sensitive communication methods for HS families regarding children's weight status.     

Peer Reviewed: Reaching Staff,Parents, and Community Partners to Prevent Childhood Obesity in Head Start, 2008

Introduction

Lowering the prevalence of childhood obesity requires a multilevel approach that targets the home, school, and community. Head Start, the largest federally funded early childhood education program in the United States, reaches nearly 1 million low-income children, and it provides an ideal opportunity for implementing such an approach. Our objective was to describe obesity prevention activities in Head Start that are directed at staff, parents, and community partners.

Methods

We mailed a survey in 2008 to all 1,810 Head Start programs in the United States.

Results

Among the 1,583 (87%) responding programs, 60% held workshops to train new staff about children''s feeding and 63% held workshops to train new staff about children''s gross motor activity. Parent workshops on preparing or shopping for healthy foods were offered by 84% of programs and on encouraging children''s gross motor activity by 43% of programs. Ninety-seven percent of programs reported having at least 1 community partnership to encourage children''s healthy eating, and 75% reported at least 1 to encourage children''s gross motor activity.

Conclusion

Head Start programs reported using a multilevel approach to childhood obesity prevention that included staff, parents, and community partners. More information is needed about the content and effectiveness of these efforts.     

Academy of Nutrition and Dietetics Benchmarks for Nutrition in Child Care 2011: Are Child-Care Providers across Contexts Meeting Recommendations?

The Academy of Nutrition and Dietetics (Academy) recommends feeding practices for child-care providers to establish nutrition habits in early childhood to prevent obesity. With >12 million US children in child care, little is known about child-care providers’ feeding practices. The purpose of this study was to examine child-care providers’ feeding practices to assess whether providers met the Academy’s benchmarks and whether attainment of benchmarks varied across child-care contexts (Head Start, Child and Adult Care Food Program [CACFP], and non-CACFP). Cross-sectional data was collected in 2011 and 2012 from 118 child-care providers who completed self-administered surveys regarding their feeding practices for 2- to 5-year-old children. χ² tests and analysis of variance were used to determine variation across contexts. Head Start providers sat more frequently with children during meals (P=0.01), ate the same foods as children (P=0.001), and served meals family style (P<0.0001) more often compared with CACFP and non-CACFP providers. Head Start providers (P=0.002), parents (P=0.001), and children (P=0.01) received more nutrition-education opportunities compared with CACFP and non-CACFP. Head Start providers encouraged more balance and variety of foods (P<0.05), offered healthier foods (P<0.05), modeled healthy eating (P<0.001), and taught children about nutrition (P<0.001) compared with CACFP and non-CACFP providers. Providers across all three contexts used significantly more non-internal than internal mealtime verbal comments (P<0.0001). Head Start providers had greater compliance with the Academy’s benchmarks compared with CACFP and non-CACFP providers. Possible reasons for this compliance might be attributed to Head Start nutrition performance standards and increased nutrition-training opportunities for Head Start staff. Head Start programs can serve as a model in implementing the Academy’s benchmarks.     

The Relationship Between Classroom Quality and Ratings of the Social Functioning of Head Start Children

Classroom quality throughout three Head Start programs in the southeastern United States was monitored. A random sample of classrooms was selected to represent high and low quality classrooms in urban and rural settings. Parents and teachers rated the social behaviors of 328 children who were nested within 40 classrooms. Maternal depression was associated with parent reports of fewer positive social behaviors and more problem behaviors. Parent-reported home violence was associated with fewer disruptive behaviors as reported by the teacher. Higher quality classrooms tended to have lower scores on a parent-reported measure of children's problem behaviors. Teachers who interacted less positively with children tended to rate the children in their classrooms as more compliant. The teacher's ability to individualize instruction tended to moderate the association between the child's age and prosocial behaviors while also moderating the association between maternal depression and parents' reports of their children's problem behaviors.     

High prevalence of overweight and short stature among Head Start children in Massachusetts.

The Head Start Program measures children''s heights and weights to screen for growth problems such as obesity, wasting, and short stature. At present, little public health use is made of these data. In this paper, the authors present serial cross-sectional nutrition surveillance data from Massachusetts Head Start Programs. Nonrandom samples of local Head Start Programs provided annual screening data from 1988 to 1991 on an average of 2,664 children per year. Height and weight measurements were compared with National Center for Health Statistics (NCHS) reference populations. On average, 87 percent of the children were 36 to 59 months of age and 51 percent were white. From 7.3 to 8.8 percent of children were below the 5th percentile of height for age each year, and from 1.2 to 3.3 percent were underweight, with weight below the 5th percentile for height (P < 0.05 compared with NCHS population). In each year overweight (weight for height above the 95th percentile) was most prevalent, ranging from 9.6 percent to 13.3 percent (P < 0.05 compared with NCHS) and demonstrating a statistically significant upward trend over the 4 years of study (chi-square = 9.21, P < 0.01). The prevalence of overweight and short stature varied by race and ethnicity. A statistically significant upward trend in overweight was seen among Hispanic children (chi-square = 5.99, P < 0.05). Also, children who were 48 months of age or older were more likely than younger children to be overweight (P < 0.05). The prevalence of short stature did not vary significantly by year, sex, or age.(ABSTRACT TRUNCATED AT 250 WORDS)     

Reducing Fat in Preschool Meals: Description of the Foodservice Intervention Component of Healthy Start

Healthy Start is a 3–year demonstration and education research project to evaluate the effectiveness of a coronary heart disease risk reduction program in Head Start centers in New York State. The primary goal of the program is to demonstrate that it is possible and safe to reduce young children's intake of fat to desirable levels. The development and initial implementation of the nutrition intervention component of the program are described in this report. Nutrition intervention includes nutrition education for the children's care givers and modifications in the foodservice operation in each of the study's six intervention sites. Recommendations are provided to guide educators in future research and practice.     

Feeding Style Differences in Food Parenting Practices Associated With Fruit and Vegetable Intake in Children From Low-income Families

ObjectiveTo examine the moderating effects of feeding styles on the relationship between food parenting practices and fruit and vegetable (F & V) intake in low-income families with preschool-aged children.DesignFocus group meetings with Head Start parents were conducted by using the nominal group technique. Parents completed information on food parenting practices and feeding styles. Three dietary recalls were collected on each child.SettingParents completed measures in Head Start centers and/or over the telephone.Participants667 parents of preschool-aged children participated.OutcomesFood parenting practices and F & V intake.AnalysisMean differences in the food parenting practices across the 4 feeding styles were established through multivariate general linear modeling using MANOVA. Moderated multiple regression analysis was conducted to examine the moderating role of feeding style on food parenting practices and child F & V intake.ResultsThe indulgent feeding style moderated the relationship between food parenting practices and child F & V intake.Conclusions and ImplicationsThis study indicates that parents' feeding styles have a moderating effect on the relationship between the food parenting practices and children's F & V intake. This finding can facilitate the development of interventions aimed at reducing childhood overweight.     

Parents’ Perceptions of 5210 Nutrition Messaging and Child Weight Status

ObjectiveTo explore parent perceptions of child weight status and 5210 nutrition messaging recommendations, including daily consumption of 5 fruits and vegetables, limiting child screen time to ≤2 hours, incorporating 1 hour of daily physical activity, and no consumption of sugary, sweetened beverages.MethodsUsing the Convergence Model of Communication as a framework, qualitative focus groups (n = 5) were conducted at 4 Head Start sites across 1 Ohio County. Twenty-eight parents aged 20–60 years comprised the groups. A deductive analysis technique with respondent validation was used.ResultsParents have limited understanding of 5210 messages delivered by the program. Parent food preferences, family finances, and children's picky eating were identified as barriers to integrating healthy eating habits at home. Parents prefer practical strategies regarding how to integrate healthy eating habits into the home environment. Participants expressed concern about children's psychological health and happiness vs weight status.Conclusions and ImplicationsUnderstanding parental perceptions of 5210 messaging and program-reported weight status may assist Head Start programs in addressing childhood obesity through focused parent education and support.     

Association of school nutrition policy and parental control with childhood overweight

BACKGROUND: Schools and parents may play important roles in preventing childhood obesity by affecting children's behaviors related to energy balance. This study examined how school nutrition policy and parental control over children's eating and physical activity habits are associated with the children's overweight/obesity (hereafter overweight) status. METHODS: Data were analyzed from a total of 246 pairs of children and parents who were recruited in the 2008‐2009 academic year from 10 randomly selected public secondary schools in Indiana (school response rate = 66.7%; participant response rate = 73.5%). Logistic regression analyses were performed to examine odds ratios of different levels of school nutrition policies and parental control with and without adjusting for sociodemographic characteristics. RESULTS: Children who attended schools where soda pop (OR = 3.79, p < .01) and non‐low‐fat salty snacks (OR = 2.46, p = .05) could be purchased were more likely to be obese than those at schools where such items were not sold. Children whose parents rarely or never ensured that their child was avoiding eating too many sweets (OR = 2.33, p = .08), avoiding spending too much time watching TV (OR = 2.24, p = .06), or engaging in physical activity (OR = 2.35, p = .09) were more likely to be obese than children whose parents did so always or most of the time. CONCLUSIONS: School nutrition policy and parental control over children's eating and physical activity habits are associated with the children's overweight status.     

Preschool teachers' use of music to scaffold children's learning and behaviour

This study investigated how and when teachers used music in preschool classrooms throughout the day. Direct classroom observations were conducted to determine preschool teachers' use of music in four Head Start classrooms and one private preschool classroom for a total of 24 hours of observation in each classroom. Music was observed to be used 6.5 times per hour on average. All teachers used music most frequently to scaffold children's learning both in academic skill and social skill areas, and second most frequently to scaffold routine activities such as cleaning up and transitions to new activities. All teachers used music most frequently during group time. Music was used most frequently at group times outside times specifically set aside for music and movement. Researchers, practitioners, parents and teacher preparation professionals need to be aware of these findings in order to fully appreciate the broad experience that teachers and children have with music on a daily basis in preschool.     

Teacher beliefs and practices relating to development in preschool: importance placed on social–emotional behaviours and skills

Preschool teachers' beliefs relating to the importance of social–emotional competence and teacher practices that support children's competence were investigated through surveys and focus groups. Survey results indicated that Head Start and public school pre-K teachers placed higher importance on social–emotional behaviours and skills than on early math and language and literacy behaviours and skills and reported a variety of practices to promote prosocial skills, pretend play, and friendships. Practices that support prosocial skills ranged from setting the tone of the social environment to responding to situations that arose. Similarly, practices that support pretend play focused on setting up pretend play scenarios and helping children play in those scenarios. Finally, practices to support friendships involved practices that may set the stage for friendship development, facilitating dyadic and small group interactions, and involving parents. Results are discussed in terms of connections with previous research and developmentally appropriate practice recommendations.     

Mississippi Elementary School Teachers' Perspectives on Providing Nutrition Competencies under the Framework of Their School Wellness Policy

ObjectiveIdentify elementary teachers' implementation of nutrition competencies as part of their school wellness policies (SWP) guided by Organizational Change Theory (OCT) constructs.MethodsA 32-item, cross-sectional survey was distributed through a Web link e-mailed to teachers in Mississippi public elementary schools. Response rate was 34% (n = 947) from 30 schools. Principal component factor analysis for inter-item correlations and theoretical fit to OCT was used with internal consistency reliability coefficients determined using Cronbach's α for Likert-type scales.ResultsA majority of teachers (85.5%) favors their SWPs and has transitioned through the unfreezing stage. Lack of teacher input, time, resources, and recognition for providing nutrition education reflects that teachers do not have support for transitioning through the moving stage.Conclusions and ImplicationsUse of evaluation tools to facilitate teachers' progress through the moving stage into the refreezing stage would be advantageous in supporting organizational change as school administrations implement SWPs.