Progress 04/01/15 to 03/31/22
Outputs
Target Audience:The Healthy Bodies Project is a childhood obesity preventive intervention project that was designed using the multiphase optimization strategy (MOST) framework. The overall purpose of the research study was to select and optimize candidate components for a randomized controlled trial to reduce preschool children's obesity risk. The components that were tested were designed to improve preschool children's healthy eating knowledge, physical activity patterns, and behavioral self-regulation skills. Recruitment was targeted at center-based childcare programs serving predominately low-income families in rural/semi-rural counties in Pennsylvania. Preferred characteristics of enrolled classrooms and preschools/childcare centers included being open for full-day care, providing meals and snacks in the classroom, serving at least 50% of families that were considered Head-Start eligible (185% of the federal poverty level), and having a rating of 3 or less on the 4-point Keystone Stars rating of performance standards indicating high-quality care. Preschools/childcare centers were randomly assigned to one of 16 experimental conditions, with all classrooms within a center in conditions that varied only based on whether or not parental education was provided. Children were required to be ages 2-5 years at the start of the trial. They were excluded if they were younger than 3 years by January of the academic year, did not attend preschool during days/times that intervention lessons were taught, or if they had medical or developmental conditions that affected their ability to complete the research assessments. Parents/caregivers were excluded if they were not responsible for feeding their preschool child at least 50% of the time or if they were not fluent in English. To avoid nesting within families, data from one randomly-selected child per family was included. Because randomization occurs at the center level, all children participate in classroom activities, but data were only collected from children with consent to participate. Data have been collected and processed on a total of 1,681 preschool children;1,397 children have some data collect at pre- and post-test. Teacher-reported data (on child outcomes) is available from 107 out of a total of 113 teachersnested within 63 childcare centers (~12 children per classroom and 87 children per condition).A total of 799 parents/caregivers provided survey data, and 373 parents/caregivers completed online education modules. In response to childcare-related shutdowns as a result of COVID-19,we also conducted an ancillary survey study to examine the impact of childcare and school closures due to COVID-19 on (a) household and child food insecurity, (b) child diet quality and household food availability, and (c) child activity patterns. A total of297 parents completedthis survey. Changes/Problems:Due to COVID-19 school closures, our lead data manager was on family leave for a total of 12 weeks during 2020, which halted data cleaning and preparation, and delayed data analyses. A data analyst increased effort on the project in 2021, assisted with data cleaning and began data analyses and manuscript preparation. We currently have 1 manuscript published, 1 under review and 2 nearing submission, one of which describes the main study findings. We are hopeful that 2 additional papers will be published or accepted in 2022 and multiple papers will be published in 2023. Our rich dataset will lead to several papers over the next few years. What opportunities for training and professional development has the project provided?
Nothing Reported
How have the results been disseminated to communities of interest?A project website (healthybodiesproject.com) was developed to provide information on the study to caregivers and early childhood educators. The website houses all materials that were developed as a part of the study, although experimental curricula are available upon request. Materials will be shared when requested. In addition to publications, findings will be shared with stakeholders, including Head Start and Early Head Startagencies, Women, Infants and Children (WIC) programs, Supplemental Nutrition Assistant Program-Education (SNAP-Ed) partner agencies and programs, among others. We intendto continue to submit manuscripts for publications, as well as presentations for scientific meetings. To the extent possible, we will share study with other agencies devoted to child health and well-being, including the Academy of PediatricsandSesame Street. We will also share study findings with the Healthy Eating Research Program of the Robert Wood Johnson Foundation. The curriculum will be shared broadly with local and national agricultural extension agencies and programs. What do you plan to do during the next reporting period to accomplish the goals?
Nothing Reported
Impacts
What was accomplished under these goals?
Progress towards goal 1 ("to identify efficacious behavioral targets for obesity prevention..."): As noted in earlier progress reports, there were a two significant changes to the project goals, mainlydue to issues with feasibility and cost: The focus on food acceptance shifted given the difficulty we experienced with transporting foods to childcare centers. Rather than test Sesame Street curricula and characters, we developed new curricula. Findings are presented for outcomes related to our 3 experimental curricula: Healthy Eating, Active Play and Self-Regulation. Given that the majority of pre-post findings are based on data from 2 of the 3 cohorts, significance levels were set to p<.20 to indicate potential efficacy of the intervention components. HEALTHY EATING CURRICULUM Snack Selection. Children's nutrition knowledge and ability to identify healthy foods for a snack was measured using the "Snack Selection Testing Protocol" designed by Sigman-Grant et al. (2014). Children exposed to theHealthy Eating (HE)classroom curriculum (M= 1.6,SE= 0.1) showed slightly larger increases in the number of nutrient-dense foods chosen for a snack in Round 1 than children who were not in HE classrooms (M= 1.6,SE= 0.1); this difference did not reach significance (p<.20).Similarly, children in HE classrooms showed significantly greater increases in their ability to identify nutrient-dense foods as a "healthy snack" (M= 1.9,SE= 0.2) than children who were not in HE classrooms (M= 1.3,SE= 0.2). Food Knowledge. Children's ability to differentiate between energy-dense and nutrient-dense foods, and their ability to build a "healthy plate" was measured using the Food Knowledge Procedure. This measure was developed in our laboratory, and was closely based on the Placemat Protocol developed by Harrison and colleagues (2016). Children who were in HE classrooms (M =9.2, SE = 1.0) showed a greater increase in choosing nutrient-dense foods as "favorite foods" compared to children who were not in HE classrooms (M= 4.7,SE= 1.0). Likewise, compared to children who were not in HE classrooms (M= 11.8,SE= 1.4), children in HE classrooms (M= 16.3, SE = 1.4) showed a greater pre-post increase in choosing nutrient-dense foods as the "healthy lunch." ACTIVE PLAY CURRICULUM Children's activity level was measured objectively using Actigraph monitors worn during one morning (9am-12pm) at 3 timepoints: baseline, mid-intervention (on a day that AP lessons were being implemented) and at post-intervention. There were no significant differences in the amount of time spent in physical or sedentary activity at post-test by exposure to the AP curriculum. However, compared to children in non-AP classrooms (M= 0%,SE= 0.01), there was a significant increase in moderate-vigorous physical activity (from pre-test to mid-intervention) in children in AP classrooms (M= 3%,SE= 0.01).Likewise, children in AP classrooms (M= -4%,SE= 0.01) showed a significant reduction in time spent in sedentary activity than children in non-AP classrooms (M= 2%,SE= 0.01) from pre-test to mid-intervention, when AP lessons were being implemented. SELF-REGULATION CURRICULUM Teacher Report of Child Inhibitory Control. Children in SR classrooms (M= 9%,SE= 0.02) were rated by their teachers as showing a greater pre-post increases in inhibitory control than children in non-SR classrooms (M= 4%,SE= 0.02). Walk a Line Slowly. Children were asked to walk across a 6-foot ribbon on the floor 3 times. On each round, they were asked to walk even slower. Slower walk times reflect greater inhibitory control. Children in SR classrooms (M= 3.9,SE= 0.5) had slightly greater pre-post increases in walk time on the Walk a Line Slowly task, compared to children in non-SR classrooms (M= 3.1,SE= 0.5), but this difference failed to reach significance. Progress towards goal 2 ("to design and evaluate novel, multimedia approaches to providing parenting education to low-literacy parents."):A total of 18 racially- and ethnically-diverse, web-based lessons (nested within 5 education units) were designed to be delivered to caregivers who were assigned to our parent enhanced education condition (8 of 16 conditions). The lessons cover topics that are the focus of the main classroom intervention curricula (active play, healthy eating and self-regulation).A total of 956 families were in classrooms that were randomized into conditions that included enhanced parent education. Of those 956 potential parents, 541 consented to participate (57% participation rate), of which 373 completed educational units (69% completion rate). Cohen'sdwas used to assess the effects of parent education on parenting and child behavioral outcomes. Effects on Food Parenting Practices.Using parent-reported data on the Comprehensive Feeding Practices Questionnaire, the parent education component resulted in reduced parents' reported use of controlling food parenting practices (d= -.20, p<.05), reduced reports of use of coercive pressure in child feeding (d= -.35, p< .001), increased reports of parents encouraging children to be involved in meal planning and preparation(d= .20, p<.05), and increased reports of parents making healthy food available in the home (d= .27, p<.05). Effects on Child Outcomes.No effects of enhanced parent education on children's outcomes were noted, althoughchildren in parent education classrooms showed a 4% increase inteacher-reported inhibitory control while children who were not in parent education classrooms showed a 3% decrease from pre- to post-test. Progress towards Goal 3 ("to evaluate factors that boost...program fidelity..."): Classroom Observations:Trained and certified research staff (coaches) observed childcare centers, classrooms and teachers in the beginning of the school year (August and September), before the intervention began. Characteristics of (1) the physical activity environment, and (2) the food environment were assessed. Data collected from 123 classrooms showed that classrooms rated high in overall characteristics that support active play were also rated high on teacher support for and involvement in active play (r=.35,p<.001) and space and equipment to support active play (r=.93,p<.001). Classrooms rated high in availability of healthy foods, were also rated high in the quality of the mealtime space (r=.23,p<.05) and a positive mealtime environment (r=.41,p<.001); there was no association with food safety (r=.15,p=.12). Classroom Chaos:During classroom assessments with children, research staff rated the level of classroom organization and disorder using an adapted CHAOS scale (Matheny et al., 1995). Example items include, "The classroom appears to be neat and organized" and "It's a real zoo." Findings from data collected with 91 teachers show that classroom chaos was not significantly associated with ratings of the classroom food or activity environment. There was a trend toward greater classroom chaos being associated with lower implementation fidelity (r=-.23,p<.06). Progress towards Goal 4 (dissemination and translation of research findings): PI Francis is in the process of submitting an application to have curriculum materials included as a part of the national SNAP-Ed Toolkit. The toolkit is a repository of evidence-based nutrition education curricula and educational materials. Additional opportunities to share products developed from this project will be considered as they arise.
Publications
- Type:
Journal Articles
Status:
Published
Year Published:
2022
Citation:
Francis, L. A., Rollins, B. Y., Keller, K. L., Nix, R. L., & Savage, J. S. (2022). Profiles of Behavioral Self-Regulation and Appetitive Traits in Preschool Children: Associations With BMI and Food Parenting Practices. Frontiers in nutrition, 9, 796580. https://doi.org/10.3389/fnut.2022.796580
- Type:
Journal Articles
Status:
Under Review
Year Published:
2022
Citation:
Francis, L. A., Nix, R. L., BeLue, R., Keller, K. L., Kugler, K. C., Rollins, B. Y. and Savage, J. S. The Healthy Bodies Project: An engineering-inspired approach to optimizing a childhood obesity preventive intervention.
- Type:
Journal Articles
Status:
Other
Year Published:
2022
Citation:
Improving preschool childrens healthy eating knowledge, physical activity and behavioral self-regulation: Formative Evaluation of the Healthy Bodies Project. (nearing submission)
|
Progress 04/01/20 to 03/31/21
Outputs
Target Audience:We have completed theoptimizationphase of the study.In this phase, we completed testing of our refined and finalized curricula and research protocols that were prepared at the end of the first reporting period (preparation phase).The optimization phase was conducted with 3 cohorts of preschool children. We were preparing to conduct classroom post-test assessments with the last cohort of children in March 2020, but were unable to complete them due to COVID-19 school/center closures. Datasets have all been cleaned and are currently being analyzed. Data have been collected and processed on a total of 1,632 children; we also have teacher-reported data (on child outcomes) from 107 teachers.A total of 799 parents/caregivers provided survey data, and 373 parents/caregivers completed online education modules. Changes/Problems:
Nothing Reported
What opportunities for training and professional development has the project provided?
Nothing Reported
How have the results been disseminated to communities of interest?There have been multiple opportunities to disseminate project materials. Dr. Francis and her team will work to broadly disseminate project materials once they have been thoroughly evaluated and proven efficacious. What do you plan to do during the next reporting period to accomplish the goals?During the next period, we will focus on extensive data cleaning, data analysis and preparing/submission of manuscripts for publication. We will also begin contacting stakeholders for dissemination of the products that resulted from the study.
Impacts
What was accomplished under these goals?
Findings are presented for outcomes related to our 3 experimental curricula: Healthy Eating, Active Play and Self-Regulation. Given that the majority of findings are based on data from 2 of the 3 cohorts, significance levels were set to p<.20 to indicate potential efficacy of the intervention components. HEALTHY EATING CURRICULUM Snack Selection. Children's nutrition knowledge and ability to identify healthy foods for a snack was measured using the "Snack Selection Testing Protocol" designed by Sigman-Grant et al. (2014). Children exposed to the Healthy Eating (HE) classroom curriculum (M = 1.6, SE = 0.1) showed slightly larger increases in the number of nutrient-dense foods chosen for a snack in Round 1 than children who were not in HE classrooms (M = 1.6, SE = 0.1); this difference did not reach significance (p<.20). Similarly, children in HE classrooms showed significantly greater increases in their ability to identify nutrient-dense foods as a "healthy snack" (M = 1.9, SE = 0.2) than children who were not in HE classrooms (M = 1.3, SE = 0.2). Food Knowledge. Children's ability to differentiate between energy-dense and nutrient-dense foods, and their ability to build a "healthy plate" was measured using the Food Knowledge Procedure. This measure was developed in our laboratory, and was closely based on the Placemat Protocol developed by Harrison and colleagues (2016). Children who were in HE classrooms (M =9.2, SE = 1.0) showed a greater increase in choosing nutrient-dense foods as "favorite foods" compared to children who were not in HE classrooms (M = 4.7, SE = 1.0). Likewise, compared to children who were not in HE classrooms (M =11.8, SE = 1.4), children in HE classrooms (M = 16.3, SE = 1.4) showed a greater pre-post increase in choosing nutrient- dense foods as the "healthy lunch." ACTIVE PLAY CURRICULUM Children's activity level was measured objectively using Actigraph monitors worn during one morning (9am-12pm) at 3 timepoints: baseline, mid-intervention (on a day that AP lessons were being implemented) and at post-intervention. There were no significant differences in the amount of time spent in physical or sedentary activity at post-test by exposure to the AP curriculum. However, compared to children in non-AP classrooms (M = 0%, SE = 0.01), there was a significant increase in moderate-vigorous physical activity (from pre-test to mid-intervention) in children in AP classrooms (M = 3%, SE = 0.01). Likewise, children in AP classrooms (M = -4%, SE = 0.01) showed a significant reduction in time spent in sedentary activity than children in non-AP classrooms (M = 2%, SE = 0.01) from pre-test to mid-intervention, when AP lessons were being implemented. SELF-REGULATION CURRICULUM Teacher Report of Child Inhibitory Control. Children in SR classrooms (M = 9%, SE = 0.02) were rated by their teachers as showing a greater pre-post increases in inhibitory control than children in non-SR classrooms (M = 4%, SE = 0.02). Walk a Line Slowly. Children were asked to walk across a 6-foot ribbon on the floor 3 times. On each round, they were asked to walk even slower. Slower walk times reflect greater inhibitory control. Children in SR classrooms (M = 3.9, SE = 0.5) had slightly greater pre-post increases in walk time on the Walk a Line Slowly task, compared to children in non-SR classrooms (M = 3.1, SE= 0.5), but this difference failed to reach significance. Progress towards goal 2 ("to design and evaluate novel, multimedia approaches to providing parenting education to low-literacy parents."): A total of 18 racially- and ethnically-diverse, web-based lessons (nested within 5 education units) were designed to be delivered to caregivers who were assigned to our parent enhanced education condition (8 of 16 conditions). The lessons cover topics that are the focus of the main classroom intervention curricula (active play, healthy eating and self-regulation). A total of 956 families were in classrooms that were randomized into conditions that included enhanced parent education. Of those 956 potential parents, 541 consented to participate (57% participation rate), of which 373 completed educational units (69% completion rate). Findings will be shared in the final report. Progress towards Goal 3 ("to evaluate factors that boost...program fidelity..."): Classroom Observations: Trained and certified research staff (coaches) observed childcare centers, classrooms and teachers in the beginning of the school year (August and September), before the intervention began. Characteristics of (1) the physical activity environment, and (2) the food environment were assessed. Data collected from 123 classrooms showed that classrooms rated high in overall characteristics that support active play were also rated high on teacher support for and involvement in active play (r=.35, p<.001) and space and equipment to support active play (r=.93, p<.001). Classrooms rated high in availability of healthy foods, were also rated high in the quality of the mealtime space (r=.23, p<.05) and a positive mealtime environment (r=.41, p<.001); there was no association with food safety (r=.15, p=.12). Classroom Chaos: During classroom assessments with children, research staff rated the level of classroom organization and disorder using an adapted CHAOS scale (Matheny et al., 1995). Example items include, "The classroom appears to be neat and organized" and "It's a real zoo." Findings from data collected with 91 teachers show that classroom chaos was not significantly associated with ratings of the classroom food or activity environment. There was a trend toward greater classroom chaos being associated with lower implementation fidelity (r=-.23, p<.06). Teacher Enthusiasm: Beginning in cohort 2, staff rated teachers' enthusiasm with regard to participating in the study, which we use an indicator of intervention uptake. In Cohorts 2 and 3 of the study, teachers' perceived enthusiasm for participation in the intervention was rated by research staff during study recruitment. Based on data from 90 teachers, greater enthusiasm for participating at baseline was associated with greater implementation fidelity (r=.23, p<.05). Teacher enthusiasm rated at post-test (n=87) was also associated with greater implementation fidelity (r=.53, p<.001). We also examined correlations among classroom environment factors and implementation fidelity for teachers higher vs. lower levels of enthusiasm for participation at baseline. Findings revealed that for teachers with high enthusiasm at baseline, higher implementation fidelity was associated with a more high-quality food environment (r=.29, p<.05, n=66), greater classroom food safety (r=.34, p<.01, n=74), a more supportive activity environment (r=.27, p<.05, n=74) and better space and equipment for physical activity (r=.28, p<.05, n=74). Progress towards Goal 4 (dissemination and translation of research findings): Progress towards Goal 4 will be included in the final progress report, once all data to examine the efficacy of the study have been analyzed, and once products have been refined based on study findings and teacher feedback. The long-term goal is to select and package the most efficacious components of the project for a randomized control trial. Products (videos, curricula) developed for the study will be disseminated at the end of the project.
Publications
|
Progress 04/01/19 to 03/31/20
Outputs
Target Audience:We have completed theoptimizationphase of the study.In this phase, we completed testing of our refined and finalized curricula and research protocols that were prepared at the end of the first reporting period (preparation phase).The optimization phase was conducted with 3 cohorts of preschool children. We were preparing to conduct classroom post-test assessments with the last cohort of children in March 2020, but were unable to complete them due to COVID-19 school/center closures. All datasets have all been cleaned and are currently being analyzed.Data have been collected and processed on a total of 1,632 children; we also have teacher-reported data (on child outcomes) from 107 teachers.A total of 799 parents/caregivers provided survey data, and 373 parents/caregivers completed online education modules. Changes/Problems:The major challengeexperienced in this grant period was a halt in our ability to complete data collection with our third and final cohortdue to childcare center closures as a result of COVID-19. We were able to complete survey data collection with Cohort 3 teachers and parents, and a small fraction of post-test data collection (remotely) with children. We will continue to clean and analyze existing data, and pivot to collect new survey data on the effects of COVID-related childcare center closures onfamilies' ability to access food resources. What opportunities for training and professional development has the project provided?
Nothing Reported
How have the results been disseminated to communities of interest?There have been multiple opportunities to disseminate project materials. However, Dr. Francis and her team will work to broadly disseminate project materials once they have been thoroughly evaluated and proven efficacious (based on ongoing analyses). What do you plan to do during the next reporting period to accomplish the goals?During the no-cost extension period, we will continue to analyze the complete study findings to examine whether there are subgroups of children for whom the intervention worked best (e.g., children with low baseline levels of self-regulation, or males vs. females). Manuscripts to (1) describe the study design and rationale, (2) describe the intervention effects, and (3) describe classroom- and teacher-level factors that impact intervention fidelity are underway. To date, we have performed analyses using baseline data from 720 children, parents, and teachers. For these analyses, we employed the mixture modeling technique of latent profile analysis to explore patterns in children's eating and behavioral regulation. Latent profile analysis is a person-specific, analytical approach used to identify sub-groups or profiles of individuals within a data set. Using the current dataset, we identified four profiles of children: High Eating Control (EC) + High Behavioral Regulation (BR) (35.1%), High EC + Low BR (16.4%), Low EC + Low BR (15.7%), Low EC + High BR (32.8%). Eating control measures included subscales such as food responsiveness ("Even if my child is full s/he finds room to eat his/her favorite food") and satiety responsiveness ("My child leaves food on his/her plate at the end of a meal"). We also found that children in the high EC profiles had similar, lower BMI scores than children in the low EC profiles (p's < 0.05). Our findings suggest that although behavioral regulation has been linked to eating behaviors, for some children, these processes may not be congruent. Our findings may also have implications for roles that BR and EC play on early growth.
Impacts
What was accomplished under these goals?
Findings are presented for outcomes related to our 3 experimental curricula: Healthy Eating, Active Play and Self-Regulation. Given that the majority of findings are based on data from 2 of the 3 cohorts, significance levels were set to p<.20 to indicate potential efficacy of the intervention components. HEALTHY EATING CURRICULUM Snack Selection. Children's nutrition knowledge and ability to identify healthy foods for a snack was measured using the "Snack Selection Testing Protocol" designed by Sigman-Grant et al. (2014). Children exposed to theHealthy Eating (HE)classroom curriculum (M= 1.6,SE= 0.1) showed slightly larger increases in the number of nutrient-dense foods chosen for a snack in Round 1 than children who were not in HE classrooms (M= 1.6,SE= 0.1); this difference did not reach significance (p<.20).Similarly, children in HE classrooms showed significantly greater increases in their ability to identify nutrient-dense foods as a "healthy snack" (M= 1.9,SE= 0.2) than children who were not in HE classrooms (M= 1.3,SE= 0.2). Food Knowledge. Children's ability to differentiate between energy-dense and nutrient-dense foods, and their ability to build a "healthy plate" was measured using the Food Knowledge Procedure. This measure was developed in our laboratory, and was closely based on the Placemat Protocol developed by Harrison and colleagues (2016). Children who were in HE classrooms (M =9.2, SE = 1.0) showed a greater increase in choosing nutrient-dense foods as "favorite foods" compared to children who were not in HE classrooms (M= 4.7,SE= 1.0). Likewise, compared to children who were not in HE classrooms (M= 11.8,SE= 1.4), children in HE classrooms (M= 16.3, SE = 1.4) showed a greater pre-post increase in choosing nutrient-dense foods as the "healthy lunch." ACTIVE PLAY CURRICULUM Children's activity level was measured objectively using Actigraph monitors worn during one morning (9am-12pm) at 3 timepoints: baseline, mid-intervention (on a day that AP lessons were being implemented) and at post-intervention. There were no significant differences in the amount of time spent in physical or sedentary activity at post-test by exposure to the AP curriculum. However, compared to children in non-AP classrooms (M= 0%,SE= 0.01), there was a significant increase in moderate-vigorous physical activity (from pre-test to mid-intervention) in children in AP classrooms (M= 3%,SE= 0.01).Likewise, children in AP classrooms (M= -4%,SE= 0.01) showed a significant reduction in time spent in sedentary activity than children in non-AP classrooms (M= 2%,SE= 0.01) from pre-test to mid-intervention, when AP lessons were being implemented. SELF-REGULATION CURRICULUM Teacher Report of Child Inhibitory Control. Children in SR classrooms (M= 9%,SE= 0.02) were rated by their teachers as showing a greater pre-post increases in inhibitory control than children in non-SR classrooms (M= 4%,SE= 0.02). Walk a Line Slowly. Children were asked to walk across a 6-foot ribbon on the floor 3 times. On each round, they were asked to walk even slower. Slower walk times reflect greater inhibitory control. Children in SR classrooms (M= 3.9,SE= 0.5) had slightly greater pre-post increases in walk time on the Walk a Line Slowly task, compared to children in non-SR classrooms (M= 3.1,SE= 0.5), but this difference failed to reach significance. Progress towards goal 2 ("to design and evaluate novel, multimedia approaches to providing parenting education to low-literacy parents."):A total of 18 racially- and ethnically-diverse, web-based lessons (nested within 5 education units) were designed to be delivered to caregivers who were assigned to our parent enhanced education condition (8 of 16 conditions). The lessons cover topics that are the focus of the main classroom intervention curricula (active play, healthy eating and self-regulation).A total of 956 families were in classrooms that were randomized into conditions that included enhanced parent education. Of those 956 potential parents, 541 consented to participate (57% participation rate), of which 373 completed educational units (69% completion rate). Findings will be shared in the final report. Progress towards Goal 3 ("to evaluate factors that boost...program fidelity..."): CLASSROOM OBSERVATIONS:Trained and certified research staff (coaches) observed childcare centers, classrooms and teachers in the beginning of the school year (August and September), before the intervention began. Characteristics of (1) the physical activity environment, and (2) the food environment were assessed. Data collected from 123 classrooms showed that classrooms rated high in overall characteristics that support active play were also rated high on teacher support for and involvement in active play (r=.35,p<.001) and space and equipment to support active play (r=.93,p<.001). Classrooms rated high in availability of healthy foods, were also rated high in the quality of the mealtime space (r=.23,p<.05) and a positive mealtime environment (r=.41,p<.001); there was no association with food safety (r=.15,p=.12). CLASSROOM CHAOS:During classroom assessments with children, research staff rated the level of classroom organization and disorder using an adapted CHAOS scale (Matheny et al., 1995). Example items include, "The classroom appears to be neat and organized" and "It's a real zoo." Findings from data collected with 91 teachers show that classroom chaos was not significantly associated with ratings of the classroom food or activity environment. There was a trend toward greater classroom chaos being associated with lower implementation fidelity (r=-.23,p<.06). TEACHER ENTHUSIASM:Beginning in cohort 2, staff rated teachers' enthusiasm with regard to participating in the study, which we use an indicator of intervention uptake. In Cohorts 2 and 3 of the study, teachers' perceived enthusiasm for participation in the intervention was rated by research staff during study recruitment. Based on data from 90 teachers, greater enthusiasm for participating atbaseline was associated with greater implementation fidelity (r=.23,p<.05). Teacher enthusiasm rated at post-test (n=87) was also associated with greater implementation fidelity (r=.53,p<.001). We also examined correlations among classroom environment factors and implementation fidelity for teachers higher vs. lower levels of enthusiasm for participation at baseline. Findings revealed that for teachers with high enthusiasm at baseline, higher implementation fidelity was associated with a more high-quality food environment (r=.29,p<.05, n=66), greater classroom food safety (r=.34,p<.01, n=74), a more supportive activity environment (r=.27,p<.05, n=74) and better space and equipment for physical activity (r=.28,p<.05, n=74). Progress towards Goal 4 (dissemination and translation of research findings): Progress towards Goal 4 will be included in the final progress report, once all data to examine the efficacy of the study have been analyzed, and once products have been refined based on study findings and teacher feedback. The long-term goal is to select and package the most efficacious components of the project for a randomized control trial. Products (videos, curricula) developed for the study will be disseminated at the end of the project.
Publications
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Progress 04/01/18 to 03/31/19
Outputs
Target Audience:In the last grant period, we concluded our first cohort of data collection on the project in June 2018 (optimization phase) and began running the cohort 2 intervention in August 2018. A total of 314 preschool children and 347 adult caregivers (parents) have been recruited for cohort 1 of the optimization phase of the study. Children's ages range from 2.8 to 5.5 years (mean = 4.1 years), and approximately 52% were female. Approximately 79% of caregivers are mothers, with the remaining 21% reported as fathers or another legal guardian (e.g., grandparent or aunt). Caregivers, on average, were approximately 33 years of age, 95% Caucasian, married (69%) and overweight (mean BMI = 29.2). Approximately 20% of caregivers completed high school or less, and 18% were either unemployed or working part time. Seventy-two (72) caregivers are in the parent enhanced education condition, and are in the process of receiving 18 web-based lessons, delivered in 5 educational units. The overall completion rate of the units was 58%. A total of 23 childcare providers (classroom teachers) are currently participating in the study. Teachers will receive a total of 2-8 coaching/mentoring visits from certified early education development specialists over the course of the study. The number of coaching visits vary based on the experimental condition teachers assigned to, and as such, the number of curricula they are assigned. Changes/Problems:Apart from the addition of new data collectors (Laubach and Mastovich) and an additional coach (Hengst), there have been no other major staffing changes to the project since the last reporting period. What opportunities for training and professional development has the project provided?Marlaina Laubach, B.S. (full-time, Data Collector) assists with recruitment, data collection in classrooms and data entry. She has been trained and certified on all study procedures and measures. This included training on data collection methods with young children, body composition assessments, administering executive function tests, and measuring emotional and eating regulation in young children. Ms. Laubach is also CITI trained and completed an additional child-abuse training, as mandated by the university. Kellie Mastovich, B.S. (part-time, Data Collector) assists with data collection in classrooms. She has been trained and certified on all study procedures and measures. This included training on data collection methods with young children, body composition assessments, administering executive function tests, and measuring emotional and eating regulation in young children. Mrs. Mastovich is also CITI trained and completed an additional child-abuse training, as mandated by the university. Kimberly Hengst, M.S. (part-time, Coach) assists with classroom observations, coaching and implementation fidelity. She received training on the procedures we use for classroom observations, coaching and implementation fidelity testing. She is also CITI trained and completed an additional child-abuse training, as mandated by the university. How have the results been disseminated to communities of interest?There have been multiple opportunities to disseminate project materials, however, funding for the projects was not secured (outlined in the last reporting period). Dr. Francis and her team will work to broadly disseminate project materials once they have been thoroughly evaluated and proven efficacious. What do you plan to do during the next reporting period to accomplish the goals?We are currently in the optimization phase of the study. No further changes will be made to the standard operating procedures, although outcome measures may continue to be refined. We are currently collecting data from cohort 2 of 3; data collection will end in July 2019. An updated study timeline appears, below.
Impacts
What was accomplished under these goals?
Progress towards goal 1 ("to identify efficacious behavioral targets for obesity prevention..."): Findings are presented for our 3 experimental curricula: Healthy Eating, Active Play and Self-Regulation. Preliminary findings (pre-post differences) show promise for the intervention in some areas: HEALTHY EATING CURRICULUM Children exposed to the Healthy Eating (HE) curriculum showed modest increases in nutrition knowledge and competence in selecting nutrient-dense snacks, and two-fold increases in their ability to select nutrient-dense foods for assembling a healthy plate. For example, in a snack selection assessment, children in the HE condition (M = 1.4, SD = 2.4) showed slightly larger increases in the ability to correctly identify nutrient-dense foods than children not in the HE condition (M = 1.2, SD = 1.7). Similarly, children in the HE condition showed slightly greater increases in their ability to identify nutrient-dense snack foods (M = 1.2, SD = 2.4) than children who were not in the HE condition (M = 0.9, SD = 2.0). Children in the HE condition also had an almost two-fold greater increase in the percentage of nutrient-dense foods chosen for a healthy plate (M = 16.0, SD = 23.4) than children who were not in the HE condition (M = 8.2, SD = 21.7). Although we did not expect children to have decreases in BMI from pre-intervention to post-intervention due to this short duration of time, we ran preliminary analyses to explore mean differences in BMI z-scores by HE condition. Children in the HE condition showed no change in BMI z-scores, whereas, BMI z-scores significantly increased among children who did not receive the HE curriculum (p = .02). ACTIVE PLAY CURRICULUM There were no meaningful differences in time spent in physical activity in children who participated in the Active Play (AP) curriculum, compared to children who were not exposed. Physical activity was measured via actigraphy at 3 time points during the pilot study: pre-intervention, mid-intervention, and post-intervention (Figure 5). Activity data have not yet been fully processed. Thus, the results may change once we examine more specific time points during the days that activity data were collected. Despite not seeing any changes in moderate-vigorous activities, we however did see decreased time spent in sedentary activities. Children in the AP condition showed decreased time spent in sedentary activities at post-test than children who were not in the AP condition. SELF-REGULATION CURRICULUM Children exposed to the Self-Regulation (SR) curriculum showed modest increases in behavioral self-regulation. Specifically, children in the SR condition showed greater increases in time spent while completing the walk a line task - a measure of inhibitory control - than children not in the SR condition. However, in the pencil-tapping task, another measure of inhibitory control, children in the SR condition showed improved performance, as did children who were not in the SR condition. Thus, changes may be solely due to developmental changes associated with age. Change in BMI z-scores did not differ by SR condition (data not shown). ANCILLARY STUDY TO ASSESS REGULATION As mentioned in previous reports, we have designed an ancillary study that will allow us to assess a number of gold-standard measures of emotional, behavioral and eating regulation in a controlled, laboratory-based setting. Study protocols were piloted in June 2018, and we are currently awaiting approval from the university's Institutional Review Board. We aim to collect data on a sample of ~200 families over the next 1.5 years. Families will be invited to visit the laboratory on 2 occasions after the intervention has ended in children's classrooms. Data will be collected on the first cohort of families in March/April 2019. Progress towards goal 2 ("to design and evaluate novel, multimedia approaches to providing parenting education to low-literacy parents."): Results from eHealth childhood obesity interventions that target parents are mixed, largely due to inconsistencies in methodology. Nevertheless, findings from several studies show promise for this approach to engage parents in prevention research (Hammersley, Jones and Oakley, 2016). A total of 18 racially- and ethnically-diverse, web-based lessons (nested within 5 education units) were developed for caregivers that cover the topics that are the focus of the main classroom intervention curricula (active play, healthy eating and self-regulation). Behaviors targeted in web-based lessons include: · Developing consistent daily family routines, including mealtime routines and bedtime/sleep routines · Building emotional intelligence in children by helping them to identify and manage emotions · Fostering children's behavioral self-regulation (e.g., waiting) · Increasing/improving responsive child-feeding behaviors · Fostering healthy eating environments and dietary patterns Increasing family and child time spent in active play In the last reporting period, we examined parent engagement with these web-based lessons in the first cohort of parents/caregivers (referred to as parents from here on). A total of 207 parents were randomized into conditions that included parent education. Of these 207 parents, 72 consented to participate (34.8% participation rate). Approximately 63% of participating parents completed some education units; 43% completed ALL education units. Progress towards Goal 3 ("to evaluate factors that boost...program fidelity..."): We continue to utilize a number of methods to measure classroom, center and teacher-level factors that may impact program fidelity. CLASSROOM OBSERVATIONS: Trained and certified research staff (coaches) observed childcare centers, classrooms and teachers before the intervention began. Assessments were made of (1) the physical activity environment, and (2) the food environment. Measures of the physical activity environment included information on space, equipment and planning of activities, and teacher participation during gross-motor activities. Measures of the food environment included provision of healthy foods for meals and snacks, books and posters with healthy eating messages, and food- and eating-related messages from teachers during lunch. PROGRAM FIDELITY: Fidelity was measured in 2 major ways. For each lesson in each curriculum, teachers completed a form to provide information on the various materials and activities they used. There is also space for teachers to indicate things that worked well, or didn't work well, and to explain why they may not have followed the script or used the curriculum as designed. In addition, coaches observed teachers twice for each curriculum assigned, and provide immediate verbal and written feedback with guidance on ways to better use the curriculum as designed. Fidelity data were being prepared at the time of submission of this report; new results are not yet available.
Publications
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Progress 04/01/17 to 03/31/18
Outputs
Target Audience:In the last grant period, we concluded pilot work on the project in May 2017 (preparation phase) and began running the full intervention in August 2017 (optimization phase). A total of 289 preschool children and 116 adult caregivers (parents) have been recruited for cohort 1 of the optimization phase of the study. At the time of submission of this report, approximately 11 weeks (out of a total of 27) of classroom lessons were delivered. Children's ages range from 3 to 5 years (mean = 3.7 years), and approximately 53% were female. Approximately 79% of caregivers are mothers, with the remaining 21% reported as fathers or another legal guardian (e.g., grandparent or aunt). Caregivers, on average, were approximately 33 years of age, 96% Caucasian, married (70%) and overweight (mean BMI = 29.2). Approximately 21% of caregivers completed high school or less, and 18% were either unemployed or working part time. Sixty-six (66) caregivers are in the parent enhanced education condition, and are in the process of receiving 18 web-based lessons, delivered in 5 educational units. At the time of submission, caregivers were beginning Unit 1 lessons. A total of 25 childcare providers (classroom teachers) are currently participating in the study. Teachers will receive a total of 2-8 coaching/mentoring visits from certified early education development specialists over the course of the study. The number of coaching visits vary based on the experimental condition teachers assigned to, and as such, the number of curricula they are assigned. At the time of submission, most teachers received 2 of their coaching visits. Changes/Problems:There have been some staffing changes to the project. Rhonda BeLue (co-Project Director) is no longer at the Pennsylvania State University. She has taken a position at St. Louis University and will continue on the project in the role of a consultant. In addition, Robert Nix has left the university; he will also be contributing as a consultant. Given the amount of time needed to refine and develop new project materials at the end of the preparation phase, we were unable to pilot the ancillary study as planned. Many of the protocols we are proposing to use have been previously used by the Project Director and a new Research Assistant Professor that is working on the project (Dr. Brandi Rollins). No other major changes have occured. What opportunities for training and professional development has the project provided?Training was provided to coaches on the CLASS assessment tool that was used to measure teacher quality and teacher-child interactions (www.teachstone.com). These data will be used to examine differential effects of the intervention by classroom. In addition, one staff member in a project management role completed training on effective strategies for supervisors. Lastly, several staff members completed training on the use of a survey development system that we use to deliver web-based lessons to parents, Qualtrics (www.qualtrics.com). How have the results been disseminated to communities of interest?
Nothing Reported
What do you plan to do during the next reporting period to accomplish the goals?During the preparation phase, we found that gold-standard measures of emotional, behavioral and eating regulation (key targets in the SR curriculum) were infeasible to collect in the preschool setting. Thus, we are designing an ancillary study that will allow us to assess a number of measures of emotional, behavioral and eating regulation in a controlled, laboratory-based setting. Families with children participating in the intervention will be invited to attend 2 laboratory-based data collection sessions at the end of the classroom curriculum schedule. Protocols will include measures designed to assess children's eating behavior, energy intake regulation, eating in the absence of hunger, emotion regulation and various indicators of self-regulation. The tentative start date is March 2018. We are currently in the optimization phase of the study. The previous preparation phase allowed us to systematically test and refine program components. No further changes will be made to the standard operating procedures, although outcome measures may continue to be refined. We are currenlty collecting data from cohort 1 of 3, and we will wrap up Cohort 1 data collection in July 2018. We will continue to work towards goals 1 through 3, as more data become available.
Impacts
What was accomplished under these goals?
Progress towards goal 1 ("to identify efficacious behavioral targets for obesity prevention..."): Data from the preparation phase (pilot study) are currently being cleaned and analyzed. Given that measures and protocols were revised after the pilot, only descriptive findings will be shared. Children exposed to the Healthy Eating (HE) curriculum exhibited pre-post increases in nutrition knowledge, and greater competence in making healthy snack and meal choices. Children in the HE condition showed a slightly larger increase in the ability to correctly identify healthy foods than children who were not in the HE condition. Children in the HE condition also showed more than a twofold greater increase in their ability to identify healthy snack foods than children who were not in the HE condition. Lastly, children in the HE condition had an almost twofold greater increase in the percentage of foods chosen to build a "healthy plate" than children who were not in the HE condition. There were no meaningful differences in time spent in physical activity in children exposed to the Active Play (AP) curriculum, compared to children who were not exposed. Physical activity was measured via actigraphy at 3 time points during the pilot study: pre-intervention, mid-intervention, and post-intervention. It is important to note that we intentionally did not measure physical activity on AP intervention days in the preparation phase because we were interested in testing whether the AP curriculum made changes to the preschool environment in ways that increased time spent in moderate-vigorous physical activity outside of the AP lessons. In the current, refined research protocols, physical activity will be measured in children in the AP condition on days they are participating in AP lessons. Lastly, there were no meaningful differences in behavioral self-regulation in children exposed to the Self-Regulation (SR) curriculum. Children in the SR condition showed improvements in measures of inhibitory control pre-post, as did children who were not in the SR condition. Thus, changes may solely be due to developmentally-expected improvements associated with age. We have refined and added behavioral self-regulation measures for the optimization phase. Progress towards goal 2 ("to design and evaluate novel, multimedia approaches to providing parenting education to low-literacy parents."): In the last reporting period, we developed 18 web-based lessons for caregivers that cover the topics that are the focus of the main classroom intervention curricula (active play, healthy eating and self-regulation). Parents of preschool children were recruited to provide feedback on a subset of the videos using cognitive interviews; parents were not participants in the pilot study. A total of 20 parents participated in cognitive interviews designed to elicit feelings, beliefs, sense of homophily, perceived utility of the information featured in the videos, and overall satisfaction with the videos. After parents viewed the videos, a phone survey was conducted to assess parents' perceptions. Specifically, parents were asked to provide feedback on the timing, sound quality, images and ease of use of the videos. In addition, parents were asked to comment on the degree to which they identified with the images, and the degree to which the messages were clear and helpful. All parents liked the videos from a visual, informational, time and content perspective. All identified with the images presented in the videos and felt that the graphics that were chosen were representative of their family life. Parents used a variety of technology to view the videos including tablets, phones, and laptop computers. There was no reported difficulty in getting the videos to load or play. A total of 3 additional parents were recruited for cognitive interviews to review diverse videos (developed during this reporting period), and the results were identical to those described above. Progress towards Goal 3 ("to evaluate factors that boost...program fidelity..."): To address this goal, we have a number of methods to measure classroom, center and teacher-level factors that may impact program fidelity. CLASSROOM OBSERVATIONS: Trained and certified research staff (coaches) observed childcare centers, classrooms and teachers before the intervention began. Assessments were made of (1) teacher-child interactions, (2) the physical activity environment, and (3) the food environment. PROGRAM FIDELITY: Fidelity was measured in 2 major ways. For each lesson in each curriculum, teachers completed a form to provide information on the various materials and activities they used during the lesson. In addition, coaches observed teachers twice for each curriculum assigned, and provide immediate verbal and written feedback with guidance on ways to better use the curriculum as designed. Preliminary results from the pilot year with 16 classrooms showed that providers were generally rated high in quality by coaches, with coaches indicating that teachers "often" showed the positive behaviors we were measuring (mean = 2.03 + 0.83 on a 1-3 response scale, with 3 being the most positive display of behaviors). The food environment for most centers was rated high, but there was more variability with respect to the activity environment. Most centers received the highest rating for having physical activity in the daily schedule (mean = 2.6 on a scale of 1-3), but most had the lowest rating for intentional planning of physical activity (mean = 1.0 on a scale of 1-3); a 3 on both scales indicating evidence of a high frequency of the event. Just over 40% of the 16 schools had appropriate equipment for physical activity. With respect to program fidelity, teacher-rated fidelity was higher than coach-observed fidelity, which is not surprising. Teacher-rated fidelity ranged from 85-100%, indicating that teachers stated that they used the curricula as intended 85-100% of the time over the course of the intervention. However, coach-observed fidelity ranged from 58%-98%. The Active Play curriculum had the lowest rating of fidelity for both teachers and coaches, and ratings for both Healthy Eating and Self-Regulation were similar, and high (near 100%). Likewise, increases in fidelity were evident over the course of the intervention in teachers using the Healthy Eating and Self-Regulation curricula, but there were no increases in fidelity ratings for Active Play. Follow-up feedback surveys from teachers showed that while teachers reported a high degree of satisfaction with the program, lack of time and space were common barriers to delivering the curricula as intended. The issue of space may explain why fidelity for the Active Play curriculum was low. Progress towards Goal 4 (dissemination and translation of research findings): Progress towards Goal 4 will not be evident until data has been collected and analyzed from 3 cohorts of participants in the optimization phase of the project. The long-term goal is to select and package the most efficacious components of the project for a randomized control trial. Products (videos, curricula) developed for the study will be widely shared at the end of the project.
Publications
- Type:
Conference Papers and Presentations
Status:
Published
Year Published:
2016
Citation:
Francis, L. A., BeLue, R. and Kugler, K. (2016). Optimizing a Childhood Obesity Prevention Program Using an Engineering-Inspired Framework. Journal of Nutrition Education and Behavior, 48(7), S118-S119
- Type:
Conference Papers and Presentations
Status:
Published
Year Published:
2017
Citation:
Francis, L. A., BeLue, R. and Kugler, K. (2017). Childcare Center and Provider Factors Impacting Implementation Fidelity in a Childhood Obesity Prevention Program. Journal of Nutrition Education and Behavior, 49(7), Supplement 1, S114
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Progress 04/01/16 to 03/31/17
Outputs
Target Audience:A total of 247 preschool children and 73 caregivers have been recruited for this piloting phase of the study. At the time of submission of this report, approximately 16 weeks (out of a total of 28) of classroom lessons were delivered. Children's ages range from 3 to 5 years (mean = 3.8 years), and approximately 52% were female. A total of 73 caregivers were recruited for the preparation phase. Approximately 91% of caregivers are mothers, with the remaining 9% reported as fathers or another legal guardian (e.g., grandparent, aunt, foster parent). Caregivers, on average, were approximately 32 years of age, Caucasian (100%), married (62%) and overweight (mean BMI = 28.2). Approximately 38% of caregivers completed high school or less, and 44% were either unemployed or working part time. All 73 caregivers have received newsletters with basic fruit and vegetable literacy information (e.g., growing and harvesting information and ways to prepare). Thirty-four (34) caregivers are in a parent enhanced condition, and are in the process of receiving 18 web-based lessons, delivered in 5 educational units. At the time of submission, caregivers were beginning Unit 4 lessons. A total of 16 classroom teachers are currently participating in the study. Teachers will receive a total of 5 coaching/mentoring visits from certified early education development specialists over the course of the study. At the time of submission, most teachers received 4 of their 5 visits. Teacher data, including their response to the intervention, will be gathered at the conclusion of the classroom education for this phase of the study (May 2016). Changes/Problems:During the last reporting period, we addressed concern regarding the complexity of the study. We proposed to use a planned missingness approach to collect data from children and caregivers using gold-standard measures to assess study outcomes. We have determined through piloting that one of the major goals of the study, to examine the effects of repeated exposure on children's vegetable intake, is not feasible in this field study. When this proposal was submitted, we were hoping to take lessons learned from laboratory-based studies into the field. Some protocols transferred quite well, however, the need to pre-weigh and deliver study food to classrooms as far as 2 hours away from the university has proven to be quite a challenge. As such, we propose to conduct a smaller, laboratory-based ancillary study with a subset of children in each study condition to address the goal of examining the effects of the classroom curricula and caregiver education on children's vegetable intake and self-regulation of intake. Caregivers will be invited to visit our laboratory space on campus for a 2-hour evening visit. Dinner will be served, and children will complete a number of behavioral procedures that measure outcomes of interest to the study. Procedures for the ancillary study are in the process of being refined for piloting in May/June 2017. What opportunities for training and professional development has the project provided?
Nothing Reported
How have the results been disseminated to communities of interest?
Nothing Reported
What do you plan to do during the next reporting period to accomplish the goals?Recruitment of new preschools/agencies will begin in April 2017. We are planning to move into areas of Pennsylvania that are more racially/ethnically diverse and predominantly low-income. Based on the information gathered during piloting, classroom materials, caregiver education materials and study protocols will be refined and finalized. Finalized materials and processes will be in place by July 2017. Preliminary data from piloting will be available by the next reporting period, and information on the Cohort 1 sample will also be available. Cohort 1 of the optimization phase will begin in August 2017 to address Goals 1 through 3.
Impacts
What was accomplished under these goals?
We are currently in the preparation phase of the multi-phase optimization strategy (MOST; Collins, 2011). In this phase, we have examined the feasibility of the major study components (classroom curricula, caregiver education and the teacher coaching plan) and we are more than halfway through piloting of the study components. The majority of the past fiscal year has been spent developing and refining our classroom curricula and materials, caregiver education materials and study protocols. Progress towards goal 1 The pilot intervention because in October 2016. At the time of submission of this report, we were through approximately 16 of 28 weeks. Pre-intervention was collected in September and October 2016, and we will begin post-intervention data collection in March 2017. Preliminary data to address Goal 1 will be available by summer 2017, once data entry and analysis are complete. Progress towards goal 2 We have developed 18 web-based lessons packaged in 5 education units for caregivers; lessons are in video format. We also are in the process of developing 2 brief animations on kitchen safety and choking hazards to supplement the caregiver educational units. At the time of submission of this report, caregivers were about to begin the 4th of 5 units. Data to address Goal 2 will be available by summer 2017, once data entry and analysis are complete. Progress towards goal 3 Trained research assistant (RA) observed each participating classroom and center before the study began. RAs made observations of (1) teacher-child interactions to get a measure of teacher quality, (2) the classroom and center food environment, and (3) the classroom and center activity environment. The food and activity environment instrument measures amenities, visuals and the built environment available to support healthy eating behaviors and activity patterns. At the conclusion of the study (April/May 2017) teachers and center directors will be interviewed to provide an understanding of factors that my have influenced intervention uptake and implementation fidelity. Data to address Goal 3 will be available by summer 2017, once data entry and analysis are complete. Progress towards goal 4 The next phase of the study, optimization, will begin in August 2017 and will run through March 2020. At the end of the optimization phase, components will be finalized based on study findings, and materials will be disseminated and tested on a larger scale in a randomized control trial (RCT).
Publications
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Progress 04/01/15 to 03/31/16
Outputs
Target Audience:Dr. Francis received a small, internal grant from Penn State University's Clinical and Translational Science Institute (CTSI) to build in a community-engaged perspective to this grant. Through this funding, we solicited information and feedback from community stakeholders (preschool teachers and administrators, local agencies serving low-income populations, and caregivers) on the needs and health priorities of our target audience. We have helda series of focus group meetings with the various stakeholders outlined above to (1) review our study Mission, Goals and Objectives, (2) determine various ways to meet family and community priorities around physical health, (3) review project materials to determine whether they are relevant for our target audience, and (4) review project materials to ensure that they can be understood bylow-literacy caregivers. Childhood obesity consistently emerged as a major priority for families. Apart from funds to support personnel, no other funds from the NIFA grant were used to support efforts to reach the target audience. Changes/Problems:Three significant changes were made in Year 1 that have impacted the direction of the project. In the original proposal, we outlined our intentions to use animations in the caregiver education component. We intended to invite caregivers to attend in-person, group education sessions, in which animations would be included as a part of the delivery of education. Through a small, internal grant from the Penn State Social Science Research Institute (SSRI), we developed and piloted an animation that was designed to provide guidance to caregivers on increasing vegetable intake in children who are picky eaters. As a result of this formative evaluationstudy, the following changes were made: We intially planned to work with our local PBS station (WPSU) to develop the animations. After working with them to develop the animation for the small SSRI study, we concluded that it would be cost-prohibitive to work with them for the NIFA-funded study. We decided to use the funds earmarked for WPSU to hire a MultiMedia Specialist to develop the animations for the project. To this end, we hired a MultiMedia Specialist with experience in media research, who has been instrumental in working with a company to develop animations for a very low cost. He has also been conductinginterviews with caregivers as a part of the formative evaluation efforts for the caregiver education media materials. We are in the process of refining and developing additional animations with his oversight. Rather than recruit caregivers for in-person education sessions, all interactions with caregiver will be web- or phone-based. Given the difficulty in recruiting and retaining low-income and low-literacy caregivers for multi-session educational programs, and based on feedback from caregivers and other stakeholders who work with this audience, we decided to develop online learning modules for the caregiver education component of the study. Education will be provided via the web, and surveys/assessments will be collected using phone calls. We initially planned to partner with Sesame Street to test materials from their existingHealthy Habits for Lifeclassroom guide. After spending a considerable amount of time working on classroom curricula, and aligning the materials with the study goals, we decided that it would be best to develop our own materials using evidence-based messages and materials (e.g., MyPlate and Eat Smart Now), and to simplydraw on inspiration from the Sesame Street materials. Revised study goals do not include an emphasis on Sesame Street materials or characters. What opportunities for training and professional development has the project provided?Apart from encouraging staff to attend various workshops, seminars and trainings as a part of their continuing education (e.g., media research, survey design, food safety, research integrity workshops), there have been no other opportunities for training and professional development. Starting in Year 2 of the grant, we will be working with interns from various disciplines, including Public Health,Nutrition, Agricultural Education andEarly Childhood Education. The goal of the internship training will be to provide undergraduate students with opportunities to learn about ecological approaches to preventing childhood obesity. Interns will contribute to all aspects of data collection and evaluation. How have the results been disseminated to communities of interest?
Nothing Reported
What do you plan to do during the next reporting period to accomplish the goals?A majority of the next reporting period will be spent piloting the study. All study materials will be refined after piloting. We will have preliminary results to share in the next progress report.
Impacts
What was accomplished under these goals?
The first year has been spent developing materials that will allow us to test the outlined study goals. We will begin a pilot study in Year 2 of the grant (August 2016), and will have preliminary results to share by the next reporting period.
Publications
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