Design of an educational strategy based on Intervention Mapping for nutritional health promotion in Child Care Centers

Early childhood is a critical period for instilling healthy habits to prevent overweight and obesity. This paper describes the development of an educational intervention for the promotion of healthy eating and physical activity among two-to-four-year-old children in public child care centers (CCCs) in Mexico City. Following the Intervention Mapping (IM) protocol, we developed the Bright Futures multidisciplinary intervention. First, a formative research process to identify the personal and environmental determinants of childhood overweight and obesity, behavioral outcomes and performance objectives was conducted. Then, a matrix of change objectives by intersecting the performance objectives with the determinants was integrated. Bright Futures lasted six months and included 24 weekly sessions, each composed of five phases: warm-up, theory, active movements, relaxation, and hydration. Ad hoc interactive teaching materials focused on recreational activities, and formulated plans for the adoption, implementation and process/impact evaluation of the intervention was developed. IM successfully guided the design of a theory-driven and evidence-based intervention for children in CCCs within a socio-ecological and participatory planning framework. This is one of the first studies in Mexico to use IM in the context of CCCs.     

Promoting fruit,vegetable and simple water consumption among mothers and teachers of preschool children: An Intervention Mapping initiative

For preschool children, mothers and teachers are the principal models and promoters of fruit, vegetable and simple water consumption at home and school, respectively. However, the daily intake of these food and drink items falls below recommended standards among Mexican adults, posing a high risk of non-communicable diseases such as overweight and obesity across all age groups in the country. The objective of this article is to describe the design, implementation and evaluation of an educational initiative conducted in a Mexican locality with the aim of promoting the consumption of fruits, vegetables (FVs) and simple water (SW) among preschoolers through the influence of their mothers and teachers. We used the Intervention Mapping methodology with qualitative and quantitative components. Mothers attended eight theoretical and practical sessions and two school meetings, while teachers were offered two workshops. Our results revealed positive changes among both groups: participants took greater interest in healthy nutrition, increased their purchase, preparation and intake of FVs and SW and promoted their consumption. This confirms that it is possible to achieve favorable changes in eating habits among those who participate in educational initiatives in Mexico.     

Effectiveness of a multi-faceted,school-based health intervention program with 4th graders in Alabama

Childhood obesity is considered one of the most prevalent, chronic disorders in the U.S. with Alabama among the states with the highest incidence. Schools have the opportunity to play a vital role in educating children about healthy nutritional, physical, and psychological choices. The purpose of this multi-faceted, school-based health intervention was to educate children about healthy nutrition, promote physical activity, and use avatars as an educational and motivational tool for understanding and developing healthy bodies. Six fourth-grade classrooms in rural Alabama participated. The intervention group consisted of 25 males and 26 females (43% African-American, 57% European-American; 26% obese, 14% overweight) who received a 10-week nutrition education program that incorporated classroom physical activity and exposure to avatars. The control group consisted of 30 males and 24 females (41% African-American, 59% European-American; 28% obese, 15% overweight) who received no intervention or initial avatar exposure. Repeated Measures Analysis of Variance determined that only intervention children significantly improved their healthy food choice intentions, ability to identify fatty foods, and general nutrition knowledge at posttest. Additionally, most intervention students reported that manipulating their avatar's body size helped them think about healthy weight (86%-helpful, 12%-somewhat helpful) and their own best, healthy body size (76%-yes, 22%-maybe). Intervention children picked healthier avatars as their ideal/desired body size at posttest. This intervention improved nutrition knowledge and attitudes and provided preliminary evidence that avatars can be a useful tool in childhood health interventions to help elementary school students think about healthy weight and body size.     

Emigration and Schooling among Second‐Generation Mexican‐American Children1

In this Research Note, we investigate the prevalence and patterns of second‐generation Mexican‐American children's migration to and return from Mexico during childhood and consider the consequences of this migration for their schooling. Around one in ten second‐generation Mexican‐American children live in Mexico for some of their childhood. Strong patterns of return to the U.S. through childhood argue for their being considered as part of the Mexican‐American second generation even when in Mexico. Their rates of school enrollment in Mexico are much lower than for second‐generation Mexican‐American children remaining in the U.S. and cannot be explained by their weakly negative selection into emigration. We conclude that country of residence is a far more important determinant of schooling outcome than is migrant status in that country.     

Scaling up a community-led health promotion initiative: Lessons learned and promising practices from the Healthy Weights for Children Project

The increase in overweight and obesity among children has emerged as an important public health issue. This trend has highlighted the need for accessible and novel approaches to support healthy weights for children and their families to prevent childhood obesity. The purpose of this article is to describe the iterative development and scale-up of a community-led, national-level project to promote healthy weights among Canadian children and families who may be experiencing vulnerabilities. In this project, the Healthy Together program was designed to engage families in an interactive program to support healthy lifestyles. The program also provides a platform for creating supportive environments for healthful lifestyles through practice and policy change. Based on a process evaluation, we describe the iterative development of Healthy Together from Phase 1 through 3 to shed light on processes shaping implementation and scale-up of the program. Lessons learned during each phase were used to refine the program and further expansion. Indicators of successful scale-up include the Healthy Together program’s cross-jurisdictional reach and promising evaluation results in real-world conditions. The practice-based program scaling approach provides practical guidance for planning and implementing similar health promotion programs in diverse communities.     

Becoming Overweight without Gaining a Pound: Weight Evaluations and the Social Integration of Mexicans in the United States

Mexican women gain weight with increasing duration in the United States. In the United States, body dissatisfaction tends to be associated with depression, disordered eating, and incongruent weight evaluations, particularly among white women and women of higher socioeconomic status. However, it remains unclear how being overweight and obesity are interpreted by Mexican women. Using comparable data of women aged 20–64 from both Mexico (the 2006 Encuesta Nacional de Salud y Nutricion; N = 17,012) and the United States (the 1999–2009 National Health and Nutrition Examination Surveys; N = 8,487), we compare weight status evaluations among Mexican nationals, Mexican immigrants, US‐born Mexicans, US‐born non‐Hispanic whites, and US‐born non‐Hispanic blacks. Logistic regression analyses, which control for demographic and socioeconomic variables and measured body mass index and adjust for the likelihood of migration for Mexican nationals, indicate that the tendency to self‐evaluate as overweight among Mexicans converges with levels among non‐Hispanic whites and diverges from blacks over time in the United States. Overall, the results suggest a US integration process in which Mexican‐American women's less critical self‐evaluations originate in Mexico but fade with time in the United States as they gradually adopt US white norms for thinner body sizes. These results are discussed in light of prior research about social comparison and negative health assimilation.     

Mexican American birthweight and child overweight: unraveling a possible early life course health transition

Mexican American children have a weight distribution that categorizes them as relatively healthy at birth but relatively unhealthy by age 3. This early life course transition in health based on weight raises the question of whether Mexican American children "outgrow" the epidemiologic paradox of favorable birth outcomes despite social disadvantage or whether their birthweight distribution places them on trajectory for overweight in childhood. We address this question using newly available 9-year follow-up data from the Fragile Families and Child Wellbeing birth cohort study linked to pre-natal medical records. We systematically investigate the roles of birthweight, pre-natal factors, and childhood factors in explaining racial/ethnic differences in childhood overweight. Our main finding is that Mexican American children do outgrow the paradox: Their rates of childhood overweight are higher than expected given their birthweight distribution. Observed pre-natal and childhood factors do not explain the elevated rates of overweight among Mexican American children.     

Development and psychometric testing of the childhood obesity perceptions (COP) survey among African American caregivers: A tool for obesity prevention program planning

Currently, public health practitioners are analyzing the role that caregivers play in childhood obesity efforts. Assessing African American caregiver’s perceptions of childhood obesity in rural communities is an important prevention effort. This article’s objective is to describe the development and psychometric testing of a survey tool to assess childhood obesity perceptions among African American caregivers in a rural setting, which can be used for obesity prevention program development or evaluation. The Childhood Obesity Perceptions (COP) survey was developed to reflect the multidimensional nature of childhood obesity including risk factors, health complications, weight status, built environment, and obesity prevention strategies. A 97-item survey was pretested and piloted with the priority population. After pretesting and piloting, the survey was reduced to 59-items and administered to 135 African American caregivers. An exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) was conducted to test how well the survey items represented the number of Social Cognitive Theory constructs. Twenty items were removed from the original 59-item survey and acceptable internal consistency of the six factors (α = 0.70–0.85) was documented for all scales in the final COP instrument. CFA resulted in a less than adequate fit; however, a multivariate Lagrange multiplier test identified modifications to improve the model fit. The COP survey represents a promising approach as a potentially comprehensive assessment for implementation or evaluation of childhood obesity programs.     

Formative evaluation of a motivational intervention for increasing physical activity in underserved youth

The present study was designed to develop an innovative motivational intervention (based on Self-Determination Theory and Social Cognitive Theory) to increase physical activity (PA) in underserved adolescents. Sixty-four adolescents (35 females, 29 males; 50% minority; 65% on reduced lunch program; ages 11-13 yr) participated in either an 8-week motivational intervention after-school (n = 32) or a typical after-school program (n = 32). The conceptual framework for the intervention targeted the social environment (perceived autonomy, perceived social support, participation, fun), cognitive mediators (perceived choice, self-efficacy, and relatedness/belongingness), and motivational orientation (intrinsic motivation, commitment, positive self-concept). Formative evaluation data was collected by staff through daily forms throughout the 8-week program and through observational data completed by independent objective observers during 2 weeks of the program. The major themes that were identified addressed theoretical concepts regarding the intervention and logistical issues in delivering the intervention. The data revealed information regarding the importance of the cognitive appropriateness of the PA and motivational activities, the environmental climate for promoting nurturing relationships, developing specific strategies for increasing intrinsic rather than extrinsic reinforcement, and developing methods for preventing social "cliques" and gender conflicts to maintain an appropriate level of support in the social climate. Themes for training staff included focusing on team building, leadership, and nurturing. This formative evaluation is being used to formalize a randomized trial to test the effects of a student-centered motivational intervention on increasing PA in underserved 6th graders.     

Parent adoption and implementation of obesity prevention practices through building children's asking skills at family child care homes

BackgroundEarly childhood education programs provide a setting to reach children and parents to modify home environments to prevent obesity. The Healthy Opportunities for Physical Activity and Nutrition Home (HOP’N) Home project was a novel approach that linked Family Child Care Homes (FCCH) to home environments by developing children’s asking skills for healthful home environmental change through curricular activities.ObjectiveTo evaluate the feasibility of engaging parents in obesity prevention practices through building children's asking skills at FCCH.MethodsFCCHs (n = 5 settings) and children (n = 25; aged 3−5 years; female = 36 %; non-Hispanic white = 91 %; low socioeconomic status = 28 %; overweight/obese = 52 %) and parents (n = 25) participated in a pre-post cohort design. We assessed children's body mass index and self-report variables at three time points. HOP'N Home included continuous staff training, group time, dramatic play, meal prompts, songs, and home activities.ResultsFCCH providers implemented 83%–100% of intervention activities. All parents (100 %) adopted the program, most (87 %) returned completed homework activities to FCCHs, and over 90 % implemented changes in the home. Percent of overweight/obese children decreased from pre-intervention (50 %) to post-intervention (29 %,p = 0.06) and follow-up (38 %,p = 0.06).ConclusionsIt is feasible to build children's asking skills and pair this strategy with home activities to engage parents to prevent obesity.     

Goodness of fit assessment of an alcohol intervention program and the underlying theories of change

The authors conducted an investigation of The Pennsylvania State University's Alcohol Intervention Program Level 2 (AIP2) to determine goodness of fit of the program components and its underpinning theories. They determined that the Health Belief Model, Social Norms Theory, Social Learning Theory, and the Transtheoretical Model Stages of Change and Process of Change are associated with AIP2's program elements. Although elements of AIP2 fit with these theories, gaps did exist within the program. The authors put forth recommendations for additional program elements that would strengthen the fit with these theories and enhance the program. In addition, upon examining the Transtheoretical Model Stages of Change and Process of Change in terms of sequence, the authors found that information from the readiness to change assessment was not being used to tailor the program elements to individual participant needs. Moreover, the postreadiness-to-change measure adapted by a prereadiness-to-change assessment was not useful in determining behavior change.     

Traumatic Responding in Children Exposed to Domestic Violence

Abstract

The present cross-cultural study summarizes the traumatic responses of Mexican, Mexican American, and non-Mexican American children who were residents of three shelters for battered women in Monterrey Mexico, McAllen Texas, and Ft. Worth Texas. Sixty-eight mothers reported on their children's (n = 90) individual and total traumatic symptoms. Findings revealed very slight differences in individual responses with no overall trauma symptom differences. Multiple regression analyses revealed that mothers' experiences of physical, and sexual abuse predicted greater trauma responses in children. Implications for practice with children and mothers in shelters for battered women are highlighted.     

A program based on Social Cognitive Theory and Smith's model of health and illness and its effect on maternal self-efficacy and child behavior

PurposeThis study was conducted in order to determine the effect of a program based on Social Cognitive Theory and Smith's Model of Health and Illness on the self-efficacy, self-esteem and attitudes of mothers and on the emotional and behavioral problems and competence levels of their children.MethodThis quasi-experimental study used a control group and a pretest-posttest design. The sample was composed of 77 mothers (experimental group, n = 39; control group, n = 38) who had low self-efficacy and self-esteem and whose children had problematic behavior. The mothers in the experimental group underwent a 10-session program over a period of 10 weeks. This program included activities to help them build trust in themselves and their surroundings, induce positive thinking, increase their childcare knowledge and skills, establish an effective interaction with their children, set realistic and positive goals, cope with stress, experience the feeling of success and become motivated. Data were collected by using the Demographic Information Form, the self-efficacy for Parenting Task Index-Toddler Scale, the Rosenberg Self-Esteem Scale, the Parent Attitude Scale and the Brief Infant-Toddler Social & Emotional Assessment. Data were collected before the start of the program, immediately after its completion and three months afterwards.ResultsIt was found that, at the end of the program and after the following three months, the self-efficacy, self-esteem and democratic attitude scores of the experimental group mothers and the competency scores of their children had significantly increased compared to their pre-program scores. The problem domain scores of their children had decreased and a statistically significant difference was detected in favor of the experimental group. In both the experimental and the control group, a weak negative correlation was found between the self-efficacy and democratic attitude scores of the mothers and the problem domain scores of their children.ConclusionThe total 12-hour program created a positive change, even among the mothers with low self-efficacy, low self-esteem and low education and income levels who had problematic children. Therefore, healthcare professionals may find it beneficial to offer this program to all mothers having 2- and 3-year-old children.     

Humor Your Way to Good Health

ABSTRACT

Although humor has been used in many ways, humor practices have not been fully conceptualized or utilized as a means to impact major concerns on a societal level. In this intergenerational model demonstration, humor practices were re-conceptualized and used as an effective vehicle for communicating messages to impact a societal issue, overweight and obesity among children. This objective was operationalized through an intergenerational project of the Legacy Leadership Institute on Humor Communication and Health (LLIHCH). Legacy Leaders were trained to use humor practices to convey messages about healthy eating and physical activity to children. They participated in interactive instruction on key topics (nutrition, humor practices, intergenerational relationships, children and schools, leadership, and instructional methods. Legacy Leaders used this training to conduct the Humor Your Way to Good Health program in two public elementary schools. Assessments indicate the children benefit significantly from the Humor Your Way to Good Health intergenerational program in terms of the knowledge acquired and its application to making choices that support healthy behaviors. The unique humor approach captures the attention and imagination of children. The intergenerational approach unites children and adults in a joint quest for healthier lifestyles. Together, they are addressing the epidemic of overweight and obesity among children.     

The adaptive nature of implementation practice: Case study of a school-based nutrition education intervention

ObjectiveTo describe how and why nutritionists implement and strategize particular program operations across school contexts.DesignInstrumental case study with empirical propositions from Actor-Network Theory (ANT). Data derived from interviews with interventionists and observations of their practices.SettingSeven primary schools from disadvantaged Montreal neighborhoods.ParticipantsSix nutritionists implementing the nutrition intervention in grades 4 and 5. From 133 nutrition workshops held in 2005/06, 31 workshops were observed with audio-recordings.Intervention(s)Little Cooks – Parental Networks aims to promote healthy eating behaviors through engagement in food preparation and promotion of nutrition knowledge.Phenomenon of interestThe program-context interface where interventionists’ practices form interactively within a given social context.AnalysisCoding inspired by ANT. Interview analysis involved construction of collective implementation strategies. Observations and audio-recordings were used to qualify and quantify nutritionists’ practices against variations in implementation.ResultsNutritionists privileged intervention strategies according to particularities of the setting. Some such variation was accounted for by school-level social conditions, individual preferences and nutritionists’ past experiences.Conclusions and implicationsImplementation practices are strategic and aim to engage educational actors to achieve intervention goals. These results challenge implementation frameworks centered on purely technical considerations that exclude the social and interpretive nature of practice.     

Parental Work Schedules and Child Overweight or Obesity: Does Family Structure Matter?

The authors used longitudinal data from the Fragile Families and Child Wellbeing Study (N = 5,482) to investigate whether maternal and paternal work schedules affect child overweight or obesity. They took the novel step of examining whether this effect is consistent for children living in different family structures. Findings from child fixed effects models suggest that the probability of child overweight or obesity was higher for children living with mothers who worked standard shifts at a primary job and nonstandard shifts at a secondary job compared to children living with mothers who worked a standard shift at a primary job only. Fathers' work schedules were not associated with child overweight or obesity. Unexpectedly, maternal standard shift work at a primary job and nonstandard shift work at a secondary job was associated with overweight or obesity only among children living with married biological parents.     

Australian Social Work Reviewers 2010

Abstract

Children placed in out-of-home care are a particularly disadvantaged group in society, who have often been exposed to trauma and socioeconomic disadvantage. As a result, they experience poorer health outcomes than children in the general population, especially mental health outcomes. One health outcome that has yet to be researched thoroughly is overweight and obesity of children placed in out-of-home care. Hence, the overall goal of this paper was to review the extant literature over the last decade on weight-related issues for children in out-of-home care, with particular emphasis on overweight and obesity. The findings of the review revealed that there is a lack of rigorous Australian research in relation to prevalence rates of overweight and obesity in children in out-of-home care; there is a lack of strategies or interventions designed specifically to combat overweight and obesity in children in out-of-home care; and one of the major limitations of Australian research to date is the use of self-report measures to assess the weight status of children in out-of-home care. It was concluded that prevention and intervention strategies are needed that target children as they enter out-of-home care.     

Childhood Obesity: An Overview

This article reviews recent research evidence, largely from systematic reviews, on a number of aspects of childhood obesity: its definition and prevalence; consequences; causes and prevention. The basis of the body mass index (BMI) as a means of defining obesity in children and adolescents is discussed: a high BMI for age constitutes obesity. In recent years the prevalence of obesity has increased dramatically across most of the world, and in the UK obesity prevalence is high and continuing to increase. Despite a widespread perception that obesity in childhood or adolescence is a cosmetic issue, the research evidence shows that it does matter to physical and psychological health and that there are adverse health risks for both the obese child and the adult who was obese as a child. Few interventions aimed at preventing or treating childhood obesity have been successful. There is an urgent need for more research on better strategies that will enable children and adolescents to make long‐term changes to their dietary and physical activity behaviour in order to prevent obesity.     

Healthy eating and physical activity among low-income Hispanic adolescents and a school-based intervention

Hispanic and low-income adolescents have significantly higher overweight and obesity rates than others. This study described the nutrition and physical activity habits of a sample of 122 low-income, Hispanic adolescents and assessed the impact of their environment on their nutrition and physical activity. The study also assessed the outcomes of a pilot of a Farm to Table Chef Demonstration and Blender Bike intervention among a subsample of 16 participants. Family members' influence had a stronger positive correlation to healthy eating while friends' influence had a stronger positive correlation to exercise. The intervention piloted was statistically significantly associated with an increase in vegetable consumption.     

Problematic Eating and Food-related Behaviours and Excessive Weight Gain: Why Children in Out-of-home Care Are at Risk

Emerging evidence suggests that abuse and neglect in childhood may play a role in subsequent development of obesity. One population group particularly at risk is children and young people living in out-of-home care (OOHC). Given this population is already a vulnerable group, identifying potential mechanisms by which childhood abuse and neglect increases risk for obesity is essential. A possible explanation is that problematic eating and food-related behaviours (i.e., emotional eating, compulsive eating, overeating, binge eating, stealing or hoarding food) might mediate the association between adverse childhood experiences and obesity. Hence, the overall goal of this paper was to provide a narrative review of eating and food-related difficulties for children in care and their possible association with unhealthy and excessive weight gain. This review revealed a shortage of existing empirical papers and signalled particular need for further examination of the mediating effects of problematic eating.