Design For a Cluster Randomized Controlled Trial to Evaluate the Effects of the Catch Healthy Smiles School-Based oral Health Promotion intervention among Elementary School Children

BACKGROUND: The top two oral diseases (tooth decay and gum disease) are preventable, yet dental caries is the most common childhood disease with 68% of children entering kindergarten having tooth decay. CATCH Healthy Smiles is a coordinated school health program to prevent cavities for students in kindergarten, 1st, and 2nd grade, and is based on the framework of Coordinated Approach to Child Health (CATCH), an evidence-based coordinated school health program. CATCH has undergone several cluster-randomized controlled trials (CRCT) demonstrating sustainable long-term effectiveness in incorporating the factors surrounding children, in improving eating and physical activity behaviors, and reductions in obesity prevalence among low-income, ethnically diverse children. The aim of this paper is to describe the design of the CATCH Healthy Smiles CRCT to determine the effectiveness of an oral health school-based behavioral intervention in reducing incidence of dental caries among children. METHODS: In this CRCT, 30 schools serving low-income, ethnically-diverse children in greater Houston area are recruited and randomized into intervention and comparison groups. From which, 1020 kindergarten children (n = 510 children from 15 schools for each group) will be recruited and followed through 2nd grade. The intervention consists of four components (classroom curriculum, toothbrushing routine, family outreach, and schoolwide coordinated activities) will be implemented for three years in the intervention schools, whereas the control schools will be offered free trainings and materials to implement a sun safety curriculum in the meantime. Outcome evaluation will be conducted at four time points throughout the study period, each consists of three components: dental assessment, child anthropometric measures, and parent survey. The dental assessment will use International Caries Detection and Assessment System (ICDAS) to measures the primary outcome of this study: incidence of dental caries in primary teeth as measured at the tooth surface level (dfs). The parent self-report survey measures secondary outcomes of this study, such as oral health related behavioral and psychosocial factors. A modified crude caries increment (mCCI) will be used to calculate the primary outcome of the CATCH Healthy Smiles CRCT, and a two-tailed test of the null hypothesis will be conducted to evaluate the intervention effect, while considering between- and within-cluster variances through computing the weighted-average of the mCCI ratios by cluster. CONCLUSION: If found to be effective, a platform for scalability, sustainability and dissemination of CATCH already exists, and opens a new line of research in school oral health. CLINICAL TRIALS IDENTIFIER: At ClinicalTrials.gov - NCT04632667

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

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

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 ( \u3c $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

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

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 ( \u3c $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

Miscellany

Art Writings I Believe Roy F. Powell Awardshttps://digitalcommons.georgiasouthern.edu/miscell/1002/thumbnail.jp

‘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

Physical activity, screen time, and outdoor learning environment practices and policy implementation: a cross sectional study of Texas child care centers

Abstract Background Early care and education (ECE) centers are important for combating childhood obesity. Understanding policies and practices of ECE centers is necessary for promotion of healthy behaviors. The purpose of this study is to describe self-reported practices, outdoor environment aspects, and center policies for physical activity and screen time in a statewide convenience sample of non-Head Start Texas ECE centers. Methods Licensed home and child care centers in Texas with email addresses publicly available on the Department of Family and Protective Services website (N = 6568) were invited to participate in an online survey. Descriptive statistics of self-reported practices, policies, and outdoor learning environment are described. Results 827 surveys were collected (response rate = 12.6%). Exclusion criteria yielded a cross-sectional sample of 481 center-only respondents. > 80% of centers meet best practice recommendations for screen time practices for infants and toddlers, although written policies were low (M = 1.4 policies, SD = 1.65, range = 0–6). For physical activity, < 30% meet best practice recommendations with M = 3.9 policies (SD = 3.0, range = 0–10) policies reported. Outdoor learning environment indicators (M = 5.7 policies, SD = 2.5, range = 0–12) and adequate play settings, storage (< 40%), and greenery (< 20%) were reported. Conclusions This statewide convenience sample of non-Head Start Texas ECE centers shows numerous opportunities for improvement in practices and policies surrounding outdoor environments, physical activity, and screen time. With less than half of centers meeting the recommendations for physical activity and outdoor learning environments, dedicating resources to help centers enact and modify written policies and to implement programs to improve their outdoor learning environments could promote physical activity and reduce sedentary time of children