Nutrient intake of Head Start children: home vs. school

OBJECTIVE: To determine mean intake of energy and protein, total fat, saturated fat, percent energy from total and saturated fat, cholesterol, carbohydrate, calcium, iron, zinc, folate, vitamins A, C, E, B-6 and B-12, thiamin, niacin, riboflavin, magnesium, sodium and fiber of preschool Head Start children at school and away from school. DESIGN: Twenty-four-hour food intakes for 358 Head Start children were obtained by observing food intake at school and acquiring intake recalls from parents or guardians specifying food their children consumed for the balance of the day. After determining group estimates of energy and nutrient intake, mean intake was compared to standard nutrient recommendations for the entire 24-hour day, i.e., for the time the children were in school and for the remaining hours away from school ("home" intake). SUBJECTS: The 358 Head Start children attended school either half-day (2- to 3-hour AM and PM sessions) or all-day (5 to 6 hours). STATISTICAL ANALYSES: Differences in nutrient intake among class times were analyzed using one-way analysis of variance (ANOVA) followed by Tukey's multiple comparison test. Differences with a p-value <0.05 (two-tailed) were considered to be statistically significant. Total energy, protein, calcium, iron, zinc, vitamins A, C, E, B6, and B12, thiamin, niacin, riboflavin as well as folate and magnesium were compared to the Recommended Dietary Allowances for the 4- to 6-year-old age group. Other standards that were used for comparisons included the National Cholesterol Education Program (fat, saturated fat and cholesterol), the 1989 National Research Council's Diet and Health Report (carbohydrate and sodium) and the recommendation for fiber proposed by the American Health Foundation. RESULTS: At school, half-day children consumed up to 25% of the daily recommendation for energy and nutrients, while all-day children achieved at least a third of the recommended intakes. When intakes at home and school were combined, all three groups of children (AM, PM and all-day) exceeded dietary recommendations for protein, vitamins and minerals. Energy intake remained below 100% of the recommendation, while intake of total fat, saturated fat and cholesterol exceeded recommendations. APPLICATION: Further research is required to explore energy needs and determine nutritional status and nutrient needs of minority and low-income preschool children. Strategies are required to increase nutrient density, but not fat density, of meals and snacks served to children who attend day care for part of the day. Finally, school meals and nutrition education programs such as Team Nutrition should broaden their base to include healthful eating habits for all school children, including the very youngest children in preschool programs.     

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.     

Nutritional status of Head Start and nursery school children. I. Food intake and anthropometric measurements.

Food intakes and anthropometric measurements of Head Start and nursery school children were compared in the fall and spring. Meals consumed at Head Start improved low calcium and ascorbic acid intakes. Iron intakes were low among both groups of children during both seasons. All children had high protein intakes in the fall and spring. Nursery school children consumed high levels of calcium and ascorbic acid and received more vitamin and mineral supplements. Anthropometric measurements indicated adequate and similar growth for all children during each season. Dietary intakes of mothers were less satisfactory than those of their children. Head Start mothers had the poorest diets, with frequent low intakes of energy, calcium, iron, vitamin A, ascorbic acid, riboflavin, and thiamin. Iron was the nutrient needed most by both groups of mothers. Nursery school mothers had especially high intakes of ascorbic acid, and consumed more vitamin and mineral supplements than Head Start mothers.     

Body mass index and dietary intake among Head Start children and caregivers

Background

The US Head Start program serves low-income preschoolers and their caregivers and provides an opportunity for assessment and intervention on obesity. We sought to determine the prevalence of obesity among children and their caregivers and to identify variables that are associated with child body mass index (BMI) z scores and caregiver BMI.

Design/setting

Cross-sectional data on diet and BMI from 770 caregiver–child dyads recruited from 57 Head Start centers in Alabama and Texas.

Methods

Height and weight of each caregiver and child were measured using standardized protocols. Dietary intakes of caregiver–child dyads were collected using three 24-hour dietary recalls and Block food frequency questionnaires. Data were collected between September 2004 and November 2005. The larger Food Pyramid categories were divided into 17 food consumption groups and tested for their association with child BMI z scores. Analysis of variance was used to test if food groups were significantly associated with child BMI z score.

Results

The prevalence of obesity among children was 18.4%, 24.3%, and 37.3% among black, Hispanic, and white children, respectively (P<0.0001), whereas it was 58.3%, 41.4%, and 41.6% among black, Hispanic, and white caregivers, respectively (P<0.0001). Child BMI z scores and caregiver BMIs were correlated (r=0.16, P<0.0001). In multivariable models, children were 1.90 (95% confidence interval 1.31-2.74) times more likely to have BMI ≥95th percentile if their caregiver was obese. Five variables (fruits, unsweetened beverages, low-fat dairy, race, and caregiver's BMI) were significantly associated with child BMI z scores. Fruits were inversely related, whereas unsweetened beverages, low-fat dairy, and caregiver's BMI were positively associated with child BMI z score (P<0.03). Compared to whites, black and Hispanic children had lower BMI z scores (P<0.05).

Conclusions

The high prevalence of obesity in this population together with the observed inverse association between fruit consumption and BMI, if replicated in other studies, suggests that interventions that promote fruit consumption could have beneficial effects on child BMI.     

Oral Health of Early Head Start Children: A Qualitative Study of Staff,Parents, and Pregnant Women

Objectives.We explored the oral health knowledge, attitudes, and activities of Early Head Start (EHS) staff members, parents, and pregnant women, along with their suggestions related to future oral health educational interventions targeting EHS children.Methods. Nine focus groups were conducted with EHS staff, parents, and pregnant women. Audiotapes of sessions were transcribed and entered into ATLAS.ti 5.0 for coding and analysis.Results. Attitudes about the importance of children''s oral health among parents and pregnant women were mixed. Staff members voiced responsibility for children''s oral health but frustration in their inability to communicate effectively with parents. Parents in turn perceived staff criticism regarding how they cared for their children''s oral health. Gaps were noted in the oral health activities of EHS programs. Participants expressed confusion regarding the application of Head Start oral health performance standards to EHS. The need for culturally sensitive, hands-on oral health education was highlighted.Conclusions. Tailored, theory-based interventions are needed to improve communication between EHS staff and families. Clear policies on the application of Head Start oral health performance standards to EHS are warranted. Educational activities should address the needs and suggestions of EHS participants.Early childhood caries has emerged as a concern over the past few years because of its widespread and increasing prevalence, its inequitable distribution among preschool-aged children, and its negative consequences for children, their families, and public health programs.^1–4 Many barriers to obtaining dental care exist for young children in most parts of the United States, particularly children in low-income families, and treatment failure rates can be high for those with elevated risk factors.^5,6 Recent initiatives have explored innovative approaches to providing preventive and treatment services for these high-risk young children.^7,8The Head Start and Early Head Start (EHS) programs provide an excellent setting in which to develop and test oral health interventions for young children who are at high risk for early childhood caries.^9–11 Built on 30 years of Head Start experience, the EHS program began in 1995 and now consists of approximately 650 local programs serving more than 60 000 children.¹² Although EHS programs reach only about 10% of eligible children, they can play an important role in promoting the oral health of young children and families.EHS programs operate under a set of performance standards adopted from the long-standing Head Start program requiring that the oral health needs of children and their families be addressed.^5,13 Several of these standards relate to oral health activities and components such as oral examinations, access to oral health care, and preventive services provided directly to children.^5,14 Because EHS programs offer services for pregnant women and infants soon after birth, they can intervene at an opportune time to help reduce risk factors for oral disease and promote good oral health practices before the onset of disease. By the time children are old enough to enroll in Head Start, many are already on a trajectory of poor oral health that is difficult to change.⁵Creating a foundation for a lifetime of good oral health among EHS children requires a number of strategies.^11,15 Among others, these strategies include (1) delivering effective oral health promotion services in the classroom to instill healthy habits, (2) educating and motivating parents to take an active role in their children''s oral health, and (3) developing collaborative relationships within communities to ensure that EHS children have access to oral health care.Although EHS is well positioned to have an impact on the oral health of young children and families, little is known about the oral health activities of EHS staff. Most of the small number of dental studies that have been conducted have focused on Head Start, which targets children 3 to 5 years of age (EHS includes children up to the age of 3 years). Even in the case of the Head Start program, however, relatively little is known about program effectiveness.For example, the Task Force on Community Preventive Services, in an evaluation of the impact of early childhood development programs on health, concluded that there was insufficient evidence to determine the effectiveness of these programs in improving dental outcomes.¹⁶ Therefore, a large gap exists in our understanding of the oral health activities of EHS staff and the barriers that affect these activities, including characteristics of parents of enrolled children and pregnant women. We explored the oral health knowledge, attitudes, and activities of EHS staff members, parents, and pregnant women in relation to the oral health of EHS children, as well as their suggestions regarding future oral health educational interventions targeting EHS children.     

Reducing Childhood Obesity by Eliminating 100% Fruit Juice

The Healthy Hunger-Free Kids Act of 2010 presents an opportunity to change the nutritional quality of foods served in low-income childcare centers, including Head Start centers.Excessive fruit juice consumption is associated with increased risk for obesity. Moreover, there is recent scientific evidence that sucrose consumption without the corresponding fiber, as is commonly present in fruit juice, is associated with the metabolic syndrome, liver injury, and obesity.Given the increasing risk of obesity among preschool children, we recommend that the US Department of Agriculture’s Child and Adult Food Care Program, which manages the meal patterns in childcare centers such as Head Start, promote the elimination of fruit juice in favor of whole fruit for children.CHILDHOOD OBESITY HAS reached epidemic proportions in the United States. By age four, 18.4% of all children are obese, with a body mass index (BMI; defined as weight in kilograms divided by height in meters squared) in the 95th percentile or greater for age and gender. There is an even greater prevalence among Hispanic (22.0%), American Indian or Alaska Native (31.2%), and non-Hispanic Black children (20.8%) than among non-Hispanic White children.1 Among older children, the greatest increase in the prevalence of obesity has been in those in low-education, -income, and -employment households that have sustained increases from 22% to 33% from 2003 to 2008.2 Per capita daily caloric intake increases in beverages, particularly sugar-sweetened beverages and 100% fruit juices, parallel the surge in childhood obesity in the United States.3 Additionally, studies document the association between excessive consumption of fruit juice and an increased risk for childhood obesity and short stature.4To address the obesity epidemic in children and the simultaneous increase in caloric intake from beverages, the Special Supplemental Program for Women, Infants, and Children changed the food package in 2009 for the high-risk children who the program serves to eliminate fruit juice for infants younger than 12 months and to limit juice consumption to less than four ounces a day for children older than one year.5 In this article, we have argued that the rapid increase in obesity among American children necessitates a more aggressive approach, for example, to limit high caloric beverages such as 100% fruit juice, particularly among young children, who are first developing eating behaviors and practices.A unique opportunity to reshape the eating and drinking habits of high-risk US children presents itself in the forms of the Child Nutrition and WIC Reauthorization Act and the Healthy, Hunger-Free Kids Act.6 The Healthy, Hunger-Free Kids Act is designed to target the nutritional health of high-risk, low-income children younger than five years, including those participating in the Child and Adult Food Care Program (CAFCP), which includes Head Start and other low-income daycare centers. The US Department of Agriculture (USDA) is mandated to develop, as early as fall 2013, updated meal patterns and nutrition standards for CAFCP meals and snacks that reflect current relevant science.7 Additionally, the secretary of agriculture is required to provide nutrition guidance to childcare centers and states by January 1, 2012, to ensure increased consumption of such foods as fresh, canned, and frozen fruits.7We recommend that the CAFCP meal patterns and nutrition standards include the removal of 100% fruit juice from the CAFCP programs to counter increases in fruit juice consumption among US preschool children and in line with recent science that underscores the danger of fructose consumption without concurrent fiber in contributing to childhood obesity. Our recommendations also parallel the act’s mandate that only low-fat milk options be served to children older than two years, that water be made readily available and accessible,7 and that CAFCP programs adhere to the limits placed on 100% fruit juice by professional organizations and institutes in the past 10 years.     

Redefining parent involvement in Head Start: a two-generation approach

The present review of the literature aims to look at two-generation programs and their effects on children and parents as a potential strategy to improve parent involvement in Head Start while responding to the self-sufficiency needs of families. This paper reviews several two-generation program evaluations: Comprehensive Child Development Program, Even Start Family Literacy Program, Head Start Family Service Centers, New Chance and New Hope. Lessons learned from the evaluation of these programs are used to suggest options for enhancing Head Start program's ability to respond to the needs of low-income families and maintain a high level of parent involvement.     

Preschool Teachers’ Child-Centered Beliefs: Direct and Indirect Associations with Work Climate and Job-Related Wellbeing

Background

Early childhood teachers’ child-centered beliefs, defined as teachers’ attitudes about how children learn, have been associated with teachers’ developmentally appropriate practices and positive child outcomes. The predictors of teachers’ child-centered beliefs, however, are less frequently explored.

Objective

This study tested whether teachers’ perceived work climate in child-care programs is associated with their child-centered beliefs, mediated by their job-related well-being.

Methods

The sample consisted of 522 preschool teachers (16 % Head Start, and 25 % nationally accredited programs). Path analysis was conducted to test the direct and indirect associations between teachers’ perceived work climate (i.e., collegiality and influence), job-related well-being (i.e., satisfaction and stress), and child-centered beliefs.

Results

The results of the path analysis showed that teachers’ perceived collegiality and influence had positive associations with job-related satisfaction, which in turn was positively associated with child-centered beliefs. On the other hand, teachers’ influence in the program was negatively associated with job-related stress, which was in turn, positively associated with child-centered beliefs. Test of mediation using bootstrapping technique showed significant mediation effects.

Conclusions

Work climate in child-care programs has important implications for teachers’ child-centered beliefs through job-related well-being. Teachers may need more support from the program directors and policy to create high levels of collegiality and influence, which will eventually be related with more developmentally appropriate philosophy.

     

Validating an asthma case detection instrument in a Head Start sample

Although specific tests screen children in preschool programs for vision, hearing, and dental conditions, there are no published validated instruments to detect preschool-age children with asthma, one of the most common pediatric chronic conditions affecting children in economically disadvantaged communities of color. As part of an asthma education intervention, a 15-item Brief Respiratory Questionnaire (BRQ) was developed to detect children with probable asthma in Head Start and subsidized preschool settings in communities with high asthma prevalence and associated morbidity. Preschool personnel administered the BRQ to consenting parents of 419 enrolled children. Trained interviewers administered validation interviews (VALs) to parents of 149 case-positive children and 51 case-negative children. Three physicians independently assessed deidentified summaries of the VALs that captured responses about signs and symptoms of asthma, diagnosis and treatment, and use of medical services. The physicians' assessments of the summarized VALs were the validated standard to which the BRQ classifications were compared. A simple algorithm of 4 items was identified that can be administered and scored by nonmedical preschool personnel in less than 5 minutes. The chance-corrected agreement between these 4 items of the BRQ and the VAL was good: kappa, .73 (95% confidence interval, 0.62-0.84); specificity, 96%; sensitivity, 73%; and positive predictive value, 97%. The BRQ appears to be a valid instrument for detecting children with probable asthma in Head Start and other subsidized preschool settings in communities with high prevalence of asthma.     

The Head Start Tobacco Cessation Initiative: Using Systems Change to Support Staff Identification and Intervention for Tobacco Use in Low-Income Families

Tobacco use continues to be the leading cause of preventable illness and death in the United States. Remarkably, more than nine million preschool-aged children are exposed to secondhand smoke, resulting in increased rates of morbidity and mortality. Even more disturbing is that tobacco use is highest among people with the lowest levels of income and education. Thus, reaching these populations is a challenge facing tobacco control programs. This report describes an innovative pilot project implementing a systems change model that involves multiple stakeholders in integrating evidence-based cessation strategies into federal Head Start programs, which serve low-income adults and their children. The Tobacco Cessation Initiative was developed through a partnership between the American Legacy Foundation, the Mailman School of Public Health at Columbia University, and the Louisiana State University Health Sciences Center School of Public Health. The partnership developed guidelines to fit into the overall mission of Head Start by enabling participating sites to incorporate tobacco cessation identification and referral protocols into their existing infrastructures. This program allowed Head Start sites to incorporate, into their existing family services, protocols for user identification and referral; build partnerships with groups supporting tobacco cessation; link families to cessation services; and educate families about risks associated with exposure to secondhand smoke. Applying system strategies in non-clinical settings such as Head Start offers a way to improve the health and quality of life of preschool children at the highest risk for exposure to secondhand smoke.     

Potential for misclassification of micronutrient status in children participating in a Head Start program

OBJECTIVE: To evaluate relations among measures of iron and zinc status, C-reactive protein (CRP), and leukocytes in low-income children participating in the Head Start program. DESIGN: Cross-sectional correlational study with samples collected at Head Start centers in May 2003. SUBJECTS/SETTING: Forty-seven children (aged 3 to 5 years) attending Head Start centers in three rural communities. MEASURES: Zinc, ferritin, CRP, and complete blood count were analyzed in nonfasting blood samples. STATISTICAL ANALYSES: Correlations were computed among leukocyte levels, CRP levels, and measures of micronutrient status. Children having two abnormal measures (ie, leukocytes and CRP) were compared by univariate analysis of variance with children having zero or one abnormal measure. RESULTS: Most (72%) of the children had elevated CRP levels. Four percent were anemic (hemoglobin<11.0 g/dL [<110 g/L]); 11% had low iron stores (serum ferritin相似文献   

Do the contemporary dietary patterns of children align with national food and nutrient recommendations?

Background

Childhood nutrition is important in optimising growth, development and future health. The present study compared dietary intakes of Australian children aged 4–8 years with (i) Australian Guide to Healthy Eating (AGHE) food group recommendations and (ii) age‐specific Nutrient Reference Values (NRVs), in addition to (iii) describing food group intakes of children meeting key NRVs.

Methods

Data were obtained from a representative sample of children (n = 789) from the National Nutrition and Physical Activity Survey between May 2011 and June 2012. Parent‐reported 24‐h recall dietary data were disaggregated into five core food groups, along with energy‐dense, nutrient‐poor (EDNP) foods, with intakes being compared with AGHE recommendations. Food group intakes were compared for children meeting the NRVs for 10 nutrients used for the development of AGHE food groups. Chi‐squared and t ‐tests were performed to determine differences in food group intakes with P < 0.05 considered statistically significant.

Results

Only one child met the recommended daily servings for all AGHE core food groups and none met both core and energy‐dense, nutrient‐poor (EDNP) food group recommendations. The lowest level of alignment (percentage meeting recommendations) was for vegetables (4.6%) and the highest was for fruit (47.7%). Mean (SD) daily intake of EDNP foods [4.7 (3.2) serves day^?1] accounted for 38.4% of total energy intakes. Children meeting key NRVs (n = 395) consumed greater daily servings of fruit [2.2 (1.7)], dairy [2.2 (1.2)] and EDNP foods [5.0 (3.4)] compared to the total sample (n = 789).

Conclusions

Significant discrepancies exist between contemporary dietary patterns of Australian children and national recommendations. Future AGHE revisions should incorporate greater diversity of consumption patterns, including sub‐categories of EDNP foods.

     

Physical education for Head Start children: A field-based study

Although Head Start Programs provide preschool children with essential academic readiness skills and experiences, a critical missing link in the curriculum is motor skill instruction. The purpose of this study was to examine the effects of a motor development program taught by physical education majors on Head Start children's gross motor development. Participants were 53 preschool children #op2 classes from each of 2 centers#cp who were enrolled in Head Start programs and 28 physical education majors who were enrolled in two separate motor development classes. The Test of Gross Motor Development #opUlrich, 1985#cp was used for assessment and instruction. Prior to teaching the children, the university students received approximately 12 hours of practical training in motor skill analysis and assessment through laboratory experiences and videotapes. The two Head Start centers #opgroups A and B#cp were pretested in October prior to the start of the instructional program. Group A received the instructional program during the next 10 weeks and then both groups were retested. During the following 10 weeks. Group B received the same instructional program and then both groups were again tested. A 2 #opGender#cp x 2 #opGroup#cp x 3 #opTest#cp repeated measures design produced a significant Group x Test effect. Gender differences were not significant. Post-hoc analysis revealed significant differences between tests 1 and 2 for group A and between tests 2 and 3 for group B. Results suggest that a competency-based motor development program taught by physical education students can provide valuable benefits for both Head Start programs and undergraduate teacher preparation programs.     

Intakes of whole grain in an Italian sample of children,adolescents and adults

Purpose

There is wide evidence that regular consumption of whole grain foods may reduce the risk of chronic diseases. The aim of this work was to quantify the intake of whole grains and identify main dietary sources in the Italian population.

Methods

Whole grain intakes were calculated in a sample of 2830 adults/older adults and of 440 children/adolescents from the last national survey INRAN-SCAI 2005–06. Food consumption was assessed from a 3-day food record. The whole grain content of foods was estimated mainly from quantitative ingredient declarations on labels.

Results

Mean whole grain intakes were 3.7 g/day in adults/older adults and 2.1 g/day in children/adolescents. Overall, 23 % of the sample reported consumption of whole grain foods during the survey, among which mean whole grain intakes ranged from 6.0 g/day in female children to 19.1 g/day in female older adults. The main sources of whole grains were breakfast cereals in children/adolescents (32 %) and bread in adults/older adults (46 %). Consumption of whole grain among adults was associated with significantly higher daily intakes and adequacy of dietary fibre, several vitamins (thiamine, riboflavin, vitamin B₆) and minerals (iron, calcium, potassium, phosphorus, zinc, magnesium) compared to non-consumption. Among children, whole grain intake was associated with significantly higher intakes of iron and magnesium.

Conclusions

The study reveals very low whole grain intakes across all age groups of the Italian population. Considering the positive association in consumers between whole grain intakes and fibre and micro-nutrient intakes, public health strategies to increase whole grain consumption should be considered.

     

Vaccination coverage among children enrolled in Head Start programs,licensed child care facilities,and entering school--United States, 2000-01 school year

The implementation of state and local requirements for vaccination before entry to Head Start programs, licensed child care facilities, and school has resulted in high vaccination levels among preschool and school children. One of the national health objectives for 2010 is to maintain > or = 95% vaccination coverage among children attending licensed child care centers and kindergarten through postsecondary school (objective 12-23). National estimates of vaccination coverage among children in Head Start programs, licensed child care facilities, and those entering school have been published each year since 1997 on the basis of reports from federally funded immunization programs (IPs) in the 50 states, five cities, eight territories, and the District of Columbia. This report summarizes data reported by states, cities, and the District of Columbia for the 2000-01 school year. Although vaccination coverage for 2000-01 appears similar to that for previous years, the number of programs reporting and the completeness of the reports are lower than in previous years and do not permit precise estimation of coverage at the national level. IPs use school data to identify undervaccinated children enrolled in Head Start programs, licensed child care facilities, and those entering school; evaluate the success of prevention programs targeting these children; and document the proportion of children whose parents claim exemptions from one or more vaccines. Plans are ongoing to assist IPs in applying successful strategies for collecting, reporting, and increasing the precision of coverage estimates for these populations.     

Root Shock Revisited: Perspectives of Early Head Start Mothers on Community and Policy Environments and Their Effects on Child Health,Development, and School Readiness

Racial differences in school readiness are a form of health disparity. By examining, from the perspective of low-income minority families participating in an Early Head Start study, community and policy environments as they shape and inform lived experiences, we identified several types of social and economic dislocation that undermine the efforts of parents to ready their children for school.The multiple dislocations of community triggered by housing and welfare reform and “urban renewal” are sources of stress for parents and children and affect the health and development of young children. Our findings suggest that racial differences in school readiness result not from race but from poverty and structural racism in American society.

It was more families there. Here it is pretty much individuals. They don''t interact as neighbors. They act as enemies. I don''t have very many friends here. So it''s hard, like, [I can''t ask] “What was it like when your daughter went to kindergarten?” You can''t do that here.—Mother involved in Early Head Start study who was relocated by HOPE VI

SCHOOL READINESS IS AT the heart of current debate on the health and development of young children. Policy discussions focus on the supposed lack of readiness of children in low-income and minority families and on racial and economic “readiness gaps.”¹ In a previous article, we addressed these issues by privileging the voices of low-income, predominantly African American parents to discern meanings of school readiness for them and their efforts to ready their children for school.² What remained unexamined were community and policy influences on school readiness as experienced by study families. In this article, we elaborate on this theme by suggesting new directions in public health research intended to eliminate health disparities.