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      Best Practices and Barriers to Obesity Prevention in Head Start: Differences Between Director and Teacher Perceptions

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          Abstract

          Introduction

          Practices and barriers to promoting healthy eating and physical activity at Head Start centers may influence children’s energy balance behaviors. We examined differences between directors’ and teachers’ perspectives on best practices and barriers to promoting healthy eating and physical activity in Head Start centers.

          Methods

          We conducted a cross-sectional study of directors (n = 23) and teachers (n = 113) at 23 Head Start centers participating in the baseline assessment of the Texas Childhood Obesity Research Demonstration study. Participants completed surveys about practices and barriers to promoting healthy eating and physical activity. Multilevel regression models examined differences between director and teacher responses.

          Results

          More than half of directors and teachers reported meeting most best practices related to nutrition and physical activity; few directors or teachers (<25%) reported conducting physical activity for more than 60 minutes a day, and less than 40% of teachers helped children attend to satiety cues. Significantly more directors than teachers reported meeting 2 nutrition-related best practices: “Teachers rarely eat less healthy foods (especially sweets, salty snacks, and sugary drinks) in front of children” and “Teachers talk to children about trying/enjoying new foods” ( P < .05). No barrier to healthy eating or physical activity was reported by more than 25% of directors or teachers. Significantly more teachers than directors reported barriers to healthy eating, citing lack of food service staff support, limited time, and insufficient funds ( P < .05).

          Conclusion

          More barriers to healthy eating were reported than were barriers to physical activity indicating that more support may be needed for healthy eating. Differences between responses of directors and teachers may have implications for future assessments of implementation of best practices and barriers to implementation related to nutrition and physical activity in early care and education centers.

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          Most cited references11

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          Nutrition and physical activity in child care: results from an environmental intervention.

          With evidence of increased levels of obesity in younger children, the child-care setting is an important intervention target. Few environmental interventions exist, and none target both diet and physical activity. The Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) intervention was developed to fill this research and practice gap. Randomized controlled. Health professionals (child-care health consultants) serving child-care centers in North Carolina were recruited (n=30), randomly assigned into intervention or delayed-intervention control groups, and trained to implement the NAP SACC program. Up to three child-care centers were recruited (n=84) from each consultant's existing caseload. Implemented in 2005, the NAP SACC intervention includes an environmental self-assessment, selection of areas for change, continuing education workshops, targeted technical assistance, and re-evaluation. Implementation occurred over a 6-month period. An observational instrument, Environment and Policy Assessment and Observation (EPAO), provided objective evidence of intervention impact and was completed by trained research staff blinded to study assignment. Data were collected in 2005 and 2006. Statistical analyses were conducted in 2006. Intention-to-treat analysis results were nonsignificant. Exploratory analyses using only centers that completed most of the NAP SACC program suggest an intervention effect. Factors in the intervention design, the fidelity of implementation, the selection of outcome measure, or a combination of these may have contributed to the lack of intervention effect observed. Because of this study's use of existing public health infrastructure and its potential for implementation, future studies should address strategies for improving effectiveness.
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            Systematic review of the relationship between childcare educators' practices and preschoolers' physical activity and eating behaviours.

            The role of childcare educators is important given that 81% of preschoolers living in developed countries receive childcare outside their home. Since children learn by observing and imitating others, childcare educators may play a role in promoting healthy eating behaviours and physical activity in young children. Six databases were searched for quantitative peer-reviewed, English or French primary studies reporting the correlates, predictors or effectiveness of childcare educators' practices on preschoolers' healthy eating and physical activity behaviours. Risk of bias was assessed using the Quality Assessment Tool for Quantitative Studies. Fifteen articles were included in this review: 10 measured physical activity levels and five assessed eating behaviours. The quality score was rated as low for eight of these articles, and as moderate for the remaining seven. Two of four cross-sectional studies reported a positive relationship between educators and children's behaviours. Eleven intervention studies reported significant favourable effects of interventions. Educators may play a positive role in promoting healthy behaviours in children, but this is mainly based on a small number of intervention type studies of low or moderate quality. The influence of specific components of educators' practices on children's healthy eating and physical activity behaviours remains inconclusive.
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              Use of the Environment and Policy Evaluation and Observation as a Self-Report Instrument (EPAO-SR) to measure nutrition and physical activity environments in child care settings: validity and reliability evidence

              Background Early care and education (ECE) centers are important settings influencing young children’s diet and physical activity (PA) behaviors. To better understand their impact on diet and PA behaviors as well as to evaluate public health programs aimed at ECE settings, we developed and tested the Environment and Policy Assessment and Observation – Self-Report (EPAO-SR), a self-administered version of the previously validated, researcher-administered EPAO. Methods Development of the EPAO-SR instrument included modification of items from the EPAO, community advisory group and expert review, and cognitive interviews with center directors and classroom teachers. Reliability and validity data were collected across 4 days in 3–5 year old classrooms in 50 ECE centers in North Carolina. Center teachers and directors completed relevant portions of the EPAO-SR on multiple days according to a standardized protocol, and trained data collectors completed the EPAO for 4 days in the centers. Reliability and validity statistics calculated included percent agreement, kappa, correlation coefficients, coefficients of variation, deviations, mean differences, and intraclass correlation coefficients (ICC), depending on the response option of the item. Results Data demonstrated a range of reliability and validity evidence for the EPAO-SR instrument. Reporting from directors and classroom teachers was consistent and similar to the observational data. Items that produced strongest reliability and validity estimates included beverages served, outside time, and physical activity equipment, while items such as whole grains served and amount of teacher-led PA had lower reliability (observation and self-report) and validity estimates. To overcome lower reliability and validity estimates, some items need administration on multiple days. Conclusions This study demonstrated appropriate reliability and validity evidence for use of the EPAO-SR in the field. The self-administered EPAO-SR is an advancement of the measurement of ECE settings and can be used by researchers and practitioners to assess the nutrition and physical activity environments of ECE settings.
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                Author and article information

                Journal
                Prev Chronic Dis
                Prev Chronic Dis
                PCD
                Preventing Chronic Disease
                Centers for Disease Control and Prevention
                1545-1151
                2017
                21 December 2017
                : 14
                : E139
                Affiliations
                [1 ]Michael & Susan Dell Center for Healthy Living at The University of Texas Health Science Center at Houston (UTHealth), School of Public Health in Austin, Austin, Texas
                [2 ]Michael & Susan Dell Center for Healthy Living at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Houston, Houston, Texas
                [3 ]US Department of Agriculture, Agricultural Research Service Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
                Author notes
                Corresponding Author: Courtney Byrd-Williams, PhD, Michael & Susan Dell Center for Healthy Living at UTHealth, School of Public Health in Austin, 1616 Guadalupe St, Ste 6.300, Austin, TX, 78701. Telephone: 512-391-2508. Email: courtney.e.byrdwilliams@ 123456uth.tmc.edu .
                Article
                17_0297
                10.5888/pcd14.170297
                5743025
                29267155
                3ae18667-f384-4fcc-be85-c19e6c28b3c8
                History
                Categories
                Original Research
                Peer Reviewed

                Health & Social care
                Health & Social care

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