Engaging Parents to Promote Children’s Nutrition and Health: Providers’ Barriers and Strategies in Head Start and Child Care Centers

Purpose: Using the Academy of Nutrition and Dietetics benchmarks as a framework, this study examined childcare providers’ (Head Start [HS], Child and Adult Care Food Program [CACFP] funded, and non-CACFP) perspectives regarding communicating with parents about nutrition to promote children’s health. Design: Qualitative. Setting: State-licensed center-based childcare programs. Participants: Full-time childcare providers (n ¼ 18) caring for children 2 to 5 years old from varying childcare contexts (HS, CACFP funded, and non-CACFP), race, education, and years of experience. Methods: In-person interviews using semi-structured interview protocol until saturation were achieved. Thematic analysis was conducted. Results: Two overarching themes were barriers and strategies to communicate with parents about children’s nutrition. Barriers to communication included—(a) parents are too busy to talk with providers, (b) parents offer unhealthy foods, (c) parents prioritize talking about child food issues over nutrition, (d) providers are unsure of how to communicate about nutrition without offending parents, and (e) providers are concerned if parents are receptive to nutrition education materials. Strategies for communication included—(a) recognize the benefits of communicating with parents about nutrition to support child health, (b) build a partnership with parents through education, (c) leverage policy (federal and state) to communicate positively and avoid conflict, (d) implement center-level practices to reinforce policy, and (e) foster a respectful relationship between providers and parents. Conclusion: Policy and environmental changes were recommended for fostering a respectful relationship and building a bridge between providers and parents to improve communication about children’s nutrition and health

Summer effects on body mass index (BMI) gain and growth patterns of American Indian children from kindergarten to first grade: a prospective study

<p>Abstract</p> <p>Background</p> <p>Overweight and obesity are highly prevalent among American Indian children, especially those living on reservations. There is little scientific evidence about the effects of summer vacation on obesity development in children. The purpose of this study was to investigate the effects of summer vacation between kindergarten and first grade on growth in height, weight, and body mass index (BMI) for a sample of American Indian children.</p> <p>Methods</p> <p>Children had their height and weight measured in four rounds of data collection (yielded three intervals: kindergarten, summer vacation, and first grade) as part of a school-based obesity prevention trial (Bright Start) in a Northern Plains Indian Reservation. Demographic variables were collected at baseline from parent surveys. Growth velocities (Z-score units/year) for BMI, weight, and height were estimated and compared for each interval using generalized linear mixed models.</p> <p>Results</p> <p>The children were taller and heavier than median of same age counterparts. Height Z-scores were positively associated with increasing weight status category. The mean weight velocity during summer was significantly less than during the school year. More rapid growth velocity in height during summer than during school year was observed. Obese children gained less adjusted-BMI in the first grade after gaining more than their counterparts during the previous two intervals. No statistically significant interval effects were found for height and BMI velocities.</p> <p>Conclusions</p> <p>There was no indication of a significant summer effect on children's BMI. Rather than seasonal or school-related patterns, the predominant pattern indicated by weight-Z and BMI-Z velocities might be related to age or maturation.</p> <p>Trial registration</p> <p>Bright Start: Obesity Prevention in American Indian Children Clinical Trial Govt ID# <a href="http://www.clinicaltrials.gov/ct2/show/NCT00123032">NCT00123032</a></p

Substance use and dietary practices among students attending alternative high schools: results from a pilot study

<p>Abstract</p> <p>Background</p> <p>Substance use and poor dietary practices are prevalent among adolescents. The purpose of this study was to examine frequency of substance use and associations between cigarette, alcohol and marijuana use and selected dietary practices, such as sugar-sweetened beverages, high-fat foods, fruits and vegetables, and frequency of fast food restaurant use among alternative high school students. Associations between multi-substance use and the same dietary practices were also examined.</p> <p>Methods</p> <p>A convenience sample of adolescents (n = 145; 61% minority, 52% male) attending six alternative high schools in the St Paul/Minneapolis metropolitan area completed baseline surveys. Students were participants in the Team COOL (Controlling Overweight and Obesity for Life) pilot study, a group randomized obesity prevention pilot trial. Mixed model multivariate analyses procedures were used to assess associations of interest.</p> <p>Results</p> <p>Daily cigarette smoking was reported by 36% of students. Cigarette smoking was positively associated with consumption of regular soda (p = 0.019), high-fat foods (p = 0.037), and fast food restaurant use (p = 0.002). Alcohol (p = 0.005) and marijuana use (p = 0.035) were positively associated with high-fat food intake. With increasing numbers of substances, a positive trend was observed in high-fat food intake (p = 0.0003). There were no significant associations between substance use and fruit and vegetable intake.</p> <p>Conclusions</p> <p>Alternative high school students who use individual substances as well as multiple substances may be at high risk of unhealthful dietary practices. Comprehensive health interventions in alternative high schools have the potential of reducing health-compromising behaviors that are prevalent among this group of students. This study adds to the limited research examining substance use and diet among at-risk youth.</p> <p>Trial registration number</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01315743">NCT01315743</a></p

Objectively Measured Physical Activity in Urban Alternative High School Students

Introduction—Alternative high school students are an underserved population of youth at greater risk for poor health behaviors and outcomes. Little is known about their physical activity patterns. Purpose—The purpose of this study was to describe 1) physical activity levels of students attending alternative high schools (AHS) in St. Paul/Minneapolis, MN and 2) compliance with wearing a physical activity accelerometer. Methods—Sixty-five students (59% male, 65% \u3c18 years\u3eold, 51% African-American, 17% Caucasian, 32% mixed and other) wore an accelerometer during all waking hours for seven days as part of the baseline assessment for a school-based physical activity and dietary behavior intervention. Accelerometer data was reduced to summary variables using a custom software program. Compliance with wearing the accelerometer was assessed by the number of days with ≥10-hours of data. Accelerometer counts/min, and minutes spent in moderate to-vigorous physical activity (MVPA) were calculated. Results—Students averaged 323±143.0 counts.min-1 and 51±25.5 min.d-1 of MVPA. Minutes of MVPA.d-1 were greater on weekdays compared to the weekend (52±27.3 vs. 43±39.7 min.d-1, respectively; p=0.05). However, students wore the accelerometer less on the weekends (weekdays=17.2±3.0, weekend=14.9±6.8 hrs.d-1). Expressing minutes of MVPA as a percentage of the number of minutes of available data, students spent approximately 5% of their time in MVPA on weekdays and weekends. Forty-five percent of students had 7-days of data, 51% had 4-6 days, and 5% had fewer than four days. On average, students wore the accelerometer for 17±3.2 hrs.d-1 (range 12.0-23.8 hrs.d-1). Conclusion—Compliance was high (95% of students provided at least four days of data) and physical activity was relatively low representing a vulnerable population in need of further study and intervention

‘Let’s Work Together Towards Children’s Nutrition’: Building Bridge Between Child Care Providers and Parents for Promoting Child Health

Objective: To investigate childcare providers’ perspectives for communicating with parents to promote children’s nutrition and health. Design, Setting, and Participants: In-person, semistructured interviews. Licensed center-based child care. Eighteenfull- time childcareproviders caring for children2-5 years old, 67% caring for children who pay with federal subsidy. Outcome Measures and Analysis: Participants were selected using maximum variation purposive sampling. Interviews were conducted until saturation was achieved. NVivo, thematic analysis used to code and identify themes and meta-themes regarding providers\u27 perspectives for parent communication. Results: Two meta-themes emerged from providers’ responses: barriers to communication, and strategies to communication. Barriers to communication include: parents are too busy to talk, parents prioritize food concerns over nutrition, parents allow unhealthy foods, providers are unsure about communicating, and providers weren’t sure parents were receptive to nutrition education materials. Five strategies were identified for communication and building bridges between providers and parents: ecognize the benefits of engaging and educating parents about nutrition to promote health; everage policy to communicate positively and avoid conflict with parents; implement center-level practices to reinforce policy; build partnerships with parents through education; foster a respectful relationship between providers and parents. Conclusions and Implications: Policy and center strategies were identified for fostering a respectful relationship and building bridges between providers and parents to promote child health and nutrition. Funding: Administration for Children and Families Office of Planning and Evaluation Research, Illinois Transdisciplinary Obesity Prevention Program (I-TOPP