Progress 12/09/13 to 09/30/17
Outputs
Target Audience:Childhood obesity, especially among low-income racial/ethnic minorities continues to be disproportionately high, especially in the state of Rhode Island. My research group focuses on these low-income racial/ethnic minority groups. Changes/Problems:As discussed under accomplishments, the overall goal and objectives of the initial grant were modified to reflect our initiial findings that other factors were impacting what young children were eating. To further explore this, we gathered data about what children were eating outside of the home (childcare) and also explored how other adult caregivers might be impacting what they eat. We also heard from parents that what their child eats is often out of their control and that greater environmental factors influence their choices. This brought us to better understand the larger community and its readiness to take on a community-wide intervention in the city of Providence. Our data suggestthat a multi-level interdisciplinary intervention is warranted- one that works with Extension but also other agencies to educate parents and also make the environments they live in healthier. What opportunities for training and professional development has the project provided?Undergraduate and graduate students have beentrained how to enter and manage data in NDSR software to be able to analyze what children are eating in family child care homes. Undegraduate students have also been trained on human subjects research and data quality management. How have the results been disseminated to communities of interest?We have written up a summary of our results from collecting data in Head Startcenters and we are finalizing a letter that will be sent out to all centers that participated in the research. We are in the process of convening a community advisory board to work towards early prevention of childhood obesity in Providence and hope to discuss findings from the key informant interviews here and discuss next steps. Other results have been disseminated via conferences. What do you plan to do during the next reporting period to accomplish the goals?
Nothing Reported
Impacts
What was accomplished under these goals?
In the first couple of years of this project and through some of our findings it became clear that when talking to parents that participated in ENFEP and educating them with regards to nutrition, the topic of eating outside the home, their broader community and in what they consumed in childcare came up. In response to what we found we explored what children were eating outside of the home and the feeding practices of child care providers. Findings from the previous yearsuggested that for children in Head Start classrooms and from family child care homes, they were not meeting the reccommendations for eating vegetables and whole grains. These results informed the next step of this resaerch- to explore the provider's feeding practices as well as starting to explore how greater community efforts could be harnessed to improve the environments for very young children. We used secondary data from 65 family child care homes in Rhode Island to explore the relationshipbetween providers feeding practices and their fruit and vegetable consumption. We found that mean whole fruit intake was 0.12±0.20 cups/day, mean total fruit intake was 1.35±1.07 cups/day, and mean vegetable intake was 0.54±0.41 cups/day. Provider encouragement and pressure to eat were both significantly positively correlated with child vegetable intake (r=0.27, p=0.03, and r=0.25, p=0.05, respectively). No other provider practices were significantly correlated with child whole fruit, total fruit, or vegetable intake. In order to inform a larger community wide effort to prevent childhood obesity among very young children in Rhode Island, we conducted 12 key informant interviews with key leaders in Providence, RI. Key informant interviews were with leaders working with 0-5-year-old children from the city of Providence using the community readiness model. The model was derived from the Trans-theoretical Model of Stages of Change and Community Development as a tool for addressing public health concerns. Participants were interviewed for approximately 60 minutesregarding the health and wellness efforts in Providence for 0-5 year-old children. Interviews were audio-recorded and transcribed. Descriptive statistics for eight questions regarding participant information were run in SPSS. Overall all key informant interviewees hold college degrees with 9-32 years of experience in the field. They represented the following sectors: department of health, health care, department of education, supplemental nutrition assistance program, child care, parks and recreation, and healthy community's office. The mean community readiness to change score was 7.2 (±3.4), which corresponds to a stabilization stage. Community knowledge of efforts received the lowest score (2.7) while leadership and resources ranked highest (11.1). Based on these results in the city of Providence, efforts to increase the community's knowledge of the causes, symptoms, and prevalence of childhood obesity may be warranted. The city appears to already be supporting activities related with prevention as reflected in a stabilization score. Given that childhood obesity continues to be a critical public health problem in the city, it will be important to capitalize on the city's leadership and resources to further support collaborative efforts
Publications
- Type:
Conference Papers and Presentations
Status:
Submitted
Year Published:
2018
Citation:
Boukarim, J. Leedal, S. Sebelia, L. Melanson, K. Tovar, A. Is the city of Providence, Rhode Island ready for an obesity prevention intervention? Submitted to American Society for Nutrition. Boston 2018.
- Type:
Conference Papers and Presentations
Status:
Submitted
Year Published:
2018
Citation:
Carter, T. Risica, P. , Gans,K. Vadiveloo, M. McCurdy,M., Tovar,A.Are Feeding Practices of Family Child Care Home Providers Associated with Child Fruit and Vegetable Intake? Submitted to American Society for Nutrition. Boston 2018.
- Type:
Conference Papers and Presentations
Status:
Submitted
Year Published:
2018
Citation:
Mena, N.,Risica, P. , Gans,K., Lofgren, I., Gorman, K., Tobar, F. Tovar, A. How Parents Communicate with their Family Child Care Home Provider Regarding Foods Young Children Are Eating. Submitted to American Society for Nutrition. Boston 2018.
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Progress 10/01/15 to 09/30/16
Outputs
Target Audience:Low-income parents in the Greater Providence area including Pawtucket and Central Falls. In addition, several of the target audience is predominantly Hispanic. Changes/Problems:There have been some changes to the original goals given the feedback we got from parents. As a result we decided to more broadly explore what influences healthy eating of young children including child care centers. This change still aligns with the outcomes and goals of improving healthy eating of parents of young children. What opportunities for training and professional development has the project provided?Student training related to data collection, dietary data management and analysis. How have the results been disseminated to communities of interest?We have yet to have the work published and upon publication we will dissseminate our findings. What do you plan to do during the next reporting period to accomplish the goals?We will publish the work from Megan Fallon, we will publish the work from Laura Otterbach (intervention with parents), we will completedata analysis for Maggie Tsai's work and publish the work for dissemination. We will also use the data to inform a future project.
Impacts
What was accomplished under these goals?
In the first couple of years of this project and through some of our findings it became clear that when talking to parents and educating them with regards to nutrition, the topic of eating outside the home and in childcare came up. In response to this we started to explore what children are eating outside of the home and exploring what children are eating outside of them home and the feeding practices of child care providers. As a result, Megan Fallon, one of the graduate students supported on this grant collected data of child care providers in 85 Head Start centers in Rhode Island. With another doctoral student, Megan found that participants were predominantly female (2 participants were male) and averaged 40 years (Range=19-63; SD = 11.37). On average, teachers had 14 years of experience and a little more than 7 years teaching at their current center. Head Start teachers reported consuming an average of 3.9 cups of fruit and vegetables per day and exercising an average of 3 to 4 days a week. More days of physical activity and lower self-reported 'other sugar sweetened beverage' consumption (i.e., sweetened coffee beverages, kool-aid, sports drinks, etc.) were both associated with increased nutrition knowledge. Overall, teacher's had high nutrition knowledge and nutrition attitude scores with head teachers scoring significantly higher than non-head teachers on both nutrition knowledge, and nutrition attitudes. Regarding observed mealtime behavior, total scores were relatively high as well. The model predicting observed support for autonomy found to be was significant. After controlling for age and experience, nutrition attitudes were found to be a significant predictor of observed support for autonomy. Regarding self-reported mealtime behavior, mean total scores were also relatively high. The model predicting self-reported self-efficacy was also found to be significant with nutrition knowledge and attitudes significantly predicting self-reported self-efficacy after controlling for age and experience. They also looked at how well observational measures compared to some of their self-report measures. Feeding practices are primarily assessed through self-report measures, but capturing these through self-report and observations may provide valuable information for future measures. Feeding practices were coded using a tool adapted from the Environmental Policy Assessment and Observation (EPAO) tool. Teachers completed a questionnaire adapted from the EPAO Self-Report to capture self-reported feeding practices. There was a higher level of agreement among self-reported and observed negative feeding practices (78.8-97.6% agreement) vs. positive feeding practices (11.8-20.0% agreement). Agreement among negative feeding practices were also found to occur in one direction (Never/Rarely) compared to positive feeding practices. Although self-report measures are typically used to capture feeding practices, inconsistencies between self-report and observation measures exist. The inconsistencies found among positive self-reported and observed feeding practices has implications for future research protocols, measurement refinement and training of child care teachers. Meanwhile, higher agreement among negative self-reported and observed practices suggest that Head Start policies and trainings that discourage their use are working. In another child care setting, family child care homes, Maggie Tsai, another graduate student is exploring what children are consuming. She is currently analyzing her data and in her primary findings. She is using secondary data from another study and has preschool-aged children (n = 104) (2-5 years old) enrolled in family child care homes (N = 34), that were observed during two meals and a snack over a two day, following a standardized protocol. Foods and beverages consumed were entered and analyzed in the Nutrition Data System for Research (NDSR) 2015. Portion sizes consumed were compared to 2/3 of the daily intake recommendations established by the DGA 2015 for a 1000 kcal diet. One-sample t-tests were run to test for differences between the averaged amounts of food groups consumed compared to the national guidelines for each food group. She found that children were not consuming the recommended amount of vegetables (40% of the recommended 2/3 cups of vegetables were consumed; M = 0.27, SD = 0.21), whole grains (37% of the recommended 1 ounce was consumed; M = 0.37, SD = 0.37), and fiber (40% of the recommended 14 grams a day for this age group; M = 5.60, SD = 2.14). A sensitivity analysis was conducted to account for single-day observations and showed no effect on results. Consistent with child care centers, children in FCCH are not meeting national recommendations for vegetables, whole grain, and fiber. Future programs and policies should continue to find strategies to increase fruit, vegetable and whole grain intake in early child care settings. These results are helping to further inform future materials and curriculums that can be used in EFNEP settings as they related to healthy eating and feeding practices. These results will also help inform future interventions for parents where both the home and the child care environment can be targeted.
Publications
- Type:
Conference Papers and Presentations
Status:
Accepted
Year Published:
2016
Citation:
Fallon M, Halloran K, Gorman, K, Tovar A. Exploring self-reported and observed feeding practices of Rhode Island Head Start teachers. Poster Presentation. Society for Behavioral Medicine. Washington DC.
- Type:
Conference Papers and Presentations
Status:
Under Review
Year Published:
2017
Citation:
Fallon M, Halloran K, Gorman, K, Tovar A.
Exploring self-reported and observed feeding practices of Rhode Island Head Start teachers. Manuscript Subited to Appetite Journal.
- Type:
Conference Papers and Presentations
Status:
Other
Year Published:
2016
Citation:
Otterbach L, Greene G, Redding C, Tovar A.
The Impact of the Healthy Children, Healthy Families Curriculum on Maternal Feeding Practices
Poster Presentation. Society for Behavioral Medicine. Washington DC.
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Progress 10/01/14 to 09/30/15
Outputs
Target Audience:Our target audience is low-income parents or caregivers (over the age of 18) with a child between the ages of 2-12 years of age. Changes/Problems:
Nothing Reported
What opportunities for training and professional development has the project provided?Parprofessionals that work with EFNEP were trained to deliver the modules and also trained with regards to importance of parental feeding, importance of physical activity and media awareness around food marketing to children. How have the results been disseminated to communities of interest?These data were presented to the EFNEP and SNAP-ed office. They also have access to the new materials and are using them as part of their outreach efforts. What do you plan to do during the next reporting period to accomplish the goals?We would like to learn more about parental feeding practices and what is working for parents and how they may be modified. A more in depth look at different mechanism on parental feeding practices is going to be explored this coming year. While the initial goal was to run an RCT trail to compare the modified curriculum to current EFNEP, it is unclear if there are enough EFNEP classes to do this at this time and to achieve sufficient power to test this design. If it is not possible to do this, we will continue to explore more novel ways in which parents can modify their parental feeding practices so that this information can be incorporated into existing systems such as EFNEP.
Impacts
What was accomplished under these goals?
Given the results from aim 1 we were able to develop the existing curriculum and test it, measure pre-post outcomes and capture process evaluation measures. Although the Expanded Food and Nutrition Education Program (EFNEP) is designed to reach low-income populations primarily through curricula addressing dietary intake, we found previously that including other target behaviors such as physical activity, screen time and child feeding practices may be beneficial. Three additional EFNEP modules were developed covering feeding practices areas. Parapfoessionals were trained to deliver the new modules. Five RI-EFNEP classes taught by paraprofessionals to parents of children ages 2-12 years (n=42) participated in this portion of the study. The process evaluation assessed fidelity, lesson observations, and participant feedback (surveys and focus groups). Analysis included frequencies and content analysis. Fidelity for all components of the modified curriculum was high (75-100%) except for goal setting, which occurred only 58.8% of the time. Observations show participants were attentive and open to discussion in 90-100% of the lessons. Participant feedback was positive for the new lessons and hands-on activities. However, participants expressed wanting more age specific information related to feeding together with hands-on activities, and information related to how food advertisements tailor to parents and children. With regards to other outcome data, there were significant with-in person improvements for 1 of 16 of the individual items on the behavior checklist which was used . There were within person improvement in parental consumption of soda (p=0.011) with a magnitude of change on the 5-point Likert style scale of -0.333. The post survey shows final parental soda consumption averaged was 3.96 on a 5 point Likert style scale which corresponded to"1-3 days each week" where the baseline score was 3.63 corresponding to "4-6 days each week". On average at baseline, home environment behaviors on the Likert scale scores ranged from 4.38 to 4.63 this corresponds to the participants eating meals as a family about "5-6 days each week", eating take out with their family "1-2 days each week", "more than half the time" fruit is available in their homes "and about half the time" did participants have energy dense snacks available to their children and did they let their child decide how much to eat about. Although non-significant, the largest magnitude of change was in parents letting a child's decide on how much to eat (change = -0.540, p=0.15) and having energy dense snack foods less available (change = -0.458, p=0.068). Of the participants 37.5% had at least 1-point for parent physical activity (37.5%). Furthermore, 33.3% of participants had at least a 1-point change for availability of energy dense foods and home fruit availability and 25% had a 2-point change. (See Figure). Overall, the curriculum was successful and will be revised to modify goal setting and include more age appropriate information as well as focus on the effects of advertising. Future studies can benefit from participant feedback to improve interventions that target obesity-related health behaviors in low-income families.
Publications
- Type:
Conference Papers and Presentations
Status:
Accepted
Year Published:
2015
Citation:
S. Harper � A. Tovar � G. Greene � K. McCurdy � L. Sebelia
No preview � Article � Sep 2015 � Journal of the American Academy of Nutrition and Dietetics Process Evaluation of a Revised Nutrition Education Curriculum for Parents Targeting Obesogenic Behaviors
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Progress 12/09/13 to 09/30/14
Outputs
Target Audience: We are working with parents of 3-12 year old children who participate in the Expanded Food and Nutrition Education Program in Rhode Island. Changes/Problems: Although focus groups were initially proposed to gather feedback from parents, and two of them were able to be completed, logistically it was very difficult to recruit these parents to come together. Therefore, interviews were completed for the remaining participants. We believe the data collected through this method was not compromised as participants appeared to be candid about their responses. What opportunities for training and professional development has the project provided? Traning for one master level student as well as one undegraduate student who was involved with the project. Paraprofessionals who deliver the EFNEP curriculum to parents were trained on the new modules of the curriculum and learned more about feeding practices, marketing unhealthy foods to children and physical activity in children. How have the results been disseminated to communities of interest? The results of Part 1 were presented at Experimental Biology in San Diego and the manuscript is being revised for sumbission for peer-reviewed journal. What do you plan to do during the next reporting period to accomplish the goals? The new modified curriculum is currently being tested in a quasi-experimental study with 40 EFNEP participants. The data will then be analyzed and the curriculum further modified as needed.
Impacts
What was accomplished under these goals?
During this year two parts of the project were developed: 1) to explore attitudes, perceptions, beliefs, and barriers regarding obesity-related behaviors in EFNEP (Expanded Food and Nutrition Education Program) participants using qualitative research methods, and 2) to develop and adapt the existing EFNEP curriculum to incorporate obesity prevention topics for young children. Part 1 has been completed and a manuscript is being prepared for publication using this data. For part 2, the EFNEP curriculum has been modified and is currently being implented with four EFNEP parent groups in Rhode Island. Part 1: We completed 23 individual semi-structured interviews and two focus groups (n= 15) with parents who had participated in EFNEP and had a young child. The goal of conducting these interviews wsa to gather feedback on the current EFNEP program and to provide insight into what more the participants wanted out of the program. We focused questions on four main concepts 1) Participant satisfaction, 2) Cultural appropriateness, 3) Discussion of obesity-related behaviors, and 4) Current parenting practices to raising healthy children. Part 2: Using the data obtained from the interviews and focus groups, three new EFNEP lesson plans were created (parental feeding, media literacy, and physical activity & screen-time). Collaborating with the EFNEP program director, it was decided that the EFNEP program would be increased from 6 sessions to 8 sessions. The three new lessons have been incorporated into the EFNEP sessions and are being pilot tested through a quasi-experimental study this Fall 2014. Part 1: The feedback provided from past EFNEP participant parents was essential in revising the EFNEP curriculum to parents. We heard directly from parents about their needs and expectations (parents with young children) and created additional lesson plans, as indicated by the results/feedback. Part 2: The tailored curriculum is currently being tested. The goals of the newly tailored curriculum are 1) Parents will improve their confidence when feeding their child around mealtimes, 2) Improve parents’ media awareness around unhealthy food advertisements, and 3) Increase weekly hours of family physical activity and decrease daily family screen-time. If successful, EFNEP can have a curriculum specifically dedicated to parents of young children that target other obesity related behaviors besides diet composition. In addition, further work can be done to assess the impact/improvement in the health of this population with regards to obesity and chronic disease prevention.
Publications
- Type:
Conference Papers and Presentations
Status:
Published
Year Published:
2013
Citation:
VanAsch P, Melanson, K, Gorman K. Tovar A. Parental Perception of the Rhode Island Expanded Food and Nutrition Education Program. Experimental Biology, San Diego CA. April 2014
- Type:
Theses/Dissertations
Status:
Published
Year Published:
2013
Citation:
PARENTAL PERCEPTIONS OF THE RHODE ISLAND EXPANDED FOOD AND NUTRITION EDUCATION PROGRAM BY PATRICK COOPER VAN ASCH.A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NUTRITION AND FOOD SCIENCES UNIVERSITY OF RHODE ISLAND. 2014
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