Residential Segregation, Neighborhood Social and Physical Context in Obesity Disparities in Hispanic Preschoolers: A Conceptual Model

During the last decade, there has been a significant inclusion in obesity prevention studies from individual characteristics to household factors then neighborhood factors. The study of place in the context of early childhood obesity studies has been limited to the food and physical built environment. With the persistent disparities in the prevalence of childhood obesity, and Hispanic minorities being increasingly affected, there is a need to reexamine existing models and develop new model conceptual frameworks to examine the role of place and residential segregation in the context of race, ethnicity, social position, and socioeconomic disparities. In the context of place as a relational space linked to where young children live, play and learn, this paper conceptualizes the role of the neighborhood social and physical factors as well as organizational, household and/or individual factors as mediators of the correlation between residential segregation and obesity in Hispanic preschoolers. In the model, we also attempted to include the role of policies and programs in moderating the negative effects of racial residential segregation and resource inequalities and their interactions with the multiple factors that may contribute to childhood obesity. Recommendations for future research need are identified

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Utilizing the RE-AIM framework to determine effectiveness of a preschool intervention program on social-emotional outcomes

Social-emotional issues in preschoolers continue to be an area of concern across the nation. Models to determine effective implementation practices are needed. The Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework is one model that can be used to evaluate program implementation in preschool settings. The Jump Start program provided short-term intervention to children in low-income preschools from multiethnic backgrounds. The goal was to promote prosocial behaviors while minimizing problem behaviors. Various evidenced-based practices (i.e., I Can Problem Solve, play therapy, Pyramid Model) were utilized. 305 children from 73 childcare centers participated in the program. The majority of participants were from ethnic minority backgrounds and resided in high-poverty areas of the county. The RE-AIM framework was utilized to determine program outcomes. Results showed successes on each level of RE-AIM with an at-risk population. The Jump Start program significantly increased positive behaviors and decreased challenging behaviors in preschool-aged children. Results indicated medium to large effect sizes. One year following program participation, the majority of children who participated in the program were at decreased risk of special education services and expulsion

State-Mandated Nutrition, Physical Activity, and Screen Time Policies in Child Care Centers

The child care center (CCC) environment presents opportunities for healthy weight promotion in preschoolers. Our study examined the current state of CCC adherence to nutrition, physical activity, and screen time legislative regulations and the differences in their adherence by center socioeconomic position (SEP: low, middle, high) in Miami-Dade County. In 34 CCC, we used the Environment and Policy Assessment and Observation tool to evaluate nutrition, physical activity, and screen time practices during 1-school day. Twenty-five of the centers (73.5%) were participants of the Child and Adult Care Food Program. Almost 80% of the centers adhered to serving low-fat/fat-free milk to children older than 2 years. Only 34.5% served vegetables and 75.9% served whole fruits during meals/snacks. Ninety-four percent of the centers had quiet and active play incorporated into their daily routines. All centers adhered to the 2-hour screen time limit for children older than 2 years. Low- and middle-SEP centers fared better in the serving of fruits, vegetables, and low-fat/fat-free milk. The centers averaged 1 hour in outdoor play regardless of SEP. High-SEP centers had no TV or screen time during day of observation. CCC practices highlight opportunities for improvement in nutrition, physical activity, and screen time practices in the prevention of overweight in early childhood

Effect of a child care center-based obesity prevention program on body mass index and nutrition practices among preschool-aged children

This study examined the effect of an early childhood obesity prevention program on changes in Body Mass Index (BMI) z-score and nutrition practices. Eight child care centers were randomly assigned to an intervention or attention control arm. Participants were a multiethnic sample of children aged 2 to 5 years old (N = 307). Intervention centers received healthy menu changes and family-based education focused on increased physical activity and fresh produce intake, decreased intake of simple carbohydrate snacks, and decreased screen time. Control centers received an attention control program. Height, weight, and nutrition data were collected at baseline and at 3, 6, and 12 months. Analysis examined height, weight, and BMI z-score change by intervention condition (at baseline and at 3, 6, and 12 months). Pearson correlation analysis examined relationships among BMI z-scores and home activities and nutrition patterns in the intervention group. Child BMI z-score was significantly negatively correlated with the number of home activities completed at 6-month post intervention among intervention participants. Similarly, intervention children consumed less junk food, ate more fresh fruits and vegetables, drank less juice, and drank more 1% milk compared to children at control sites at 6 months post baseline. Ninety-seven percent of those children who were normal weight at baseline were still normal weight 12 months later. Findings support child care centers as a promising setting to implement childhood obesity prevention programs in this age group

Relationship between teacher fidelity to an early childhood obesity prevention program and the Child care center nutrition and physical activity environment

Background: Child care centers (CCC) can be strategic settings to establish healthy lifestyle behaviors through obesity prevention programs. Fidelity to the implementation of such programs is a vital evaluation component, but is often not measured. This study assessed CCC teacher fidelity to the implementation of "Healthy Caregivers, Healthy Children (HC2)", a CCC-based obesity prevention intervention.Methods: CCCs serving low-resource, ethnically diverse families with >= 50 children ages 2-to-5 years old that were randomized to the HC2 intervention and that had teacher fidelity data collected (n = 9 CCC) were included in this analysis. The Environment and Policy Assessment and Observation (EPAO) tool assessed the CCC nutrition and physical activity (PA) environment at the beginning/end of the school year. Fidelity assessments were conducted in CCCs randomized to HC2 in Spring 2016 (n = 33 teachers) and 2017 (n = 39 teachers) by a trained observer. The relationship between teacher fidelity and EPAO was assessed via mixed models.Results: For every-one unit rise in teacher fidelity, EPAO nutrition increased 0.055 points (p =.006). No signif-icant relationship was shown between teacher fidelity and EPAO PA score (p =.14). Conclusion: Teacher fidelity to obesity prevention program implementation may support a healthy CCC obesity prevention and nutrition environment but might require continued support for all components

Role modeling as an early childhood obesity prevention strategy: effect of parents and teachers on preschool children's healthy lifestyle habits

To assess the effectiveness of a child care center-based parent and teacher healthy lifestyle role-modeling program on child nutrition and physical activity outcomes. Child care centers (N = 28) serving low-income families were randomized to intervention or control arms. Intervention centers (N = 12) implemented (1) menu modifications, (2) a child's healthy lifestyle curriculum, and (3) an adult (teacher- and parent-focused) healthy lifestyle role-modeling curriculum. Control centers (N = 16) received an attention control safety curriculum. Nutrition and physical activity data were collected at the beginning (T1) and at the end (T2) of the school year. Exploratory factor analysis identified positive and negative nutrition and physical activity practices by children, parents, and teachers. Intervention parents' baseline (β = .52, p < .0001) and school year consumption (β = .47, p < .0001) of fruits/vegetables significantly increased their children's consumption of fruits/vegetables from T1 to T2. Intervention parents significantly influenced a decrease in children's junk food consumption (β = -.04, p < .05), whereas control parents significantly influenced an increase in their children's junk food consumption (β = .60, p < .001) from T1 to T2. Control children showed a significant increase in junk food consumption (β = .11, p = .01) and sedentary behavior (β = .09, p < .005) from T1 to T2. Teachers did not significantly influence preschool-age children's nutrition or physical activity patterns from T1 to T2. Parent nutrition and physical activity patterns significantly influence their preschool-age children's consumption of fruits/vegetables, junk food, and level of sedentary behavior. Future obesity prevention intervention efforts targeting this age group should include parents as healthy lifestyle role models for their children