Recipient Organization
TUFTS UNIVERSITY
200 WESTBORO ROAD
N. GRAFTON,MA 01536
Performing Department
ChildObesity180
Non Technical Summary
Unhealthy dietary patterns and obesity are major causes of debilitating and common diseases, particularly cardiovascular disease and type 2 diabetes. Indicators of obesity are present as early as infancy. To promote the physical, social, and emotional health of children at the population level, strategies designed to improve the health and well-being of their caregivers are desperately needed. Most children under the age of 5 years spend over 35-hours per week receiving care outside their home at childcare centers, therefore, early childcare education (ECE) providers are influential role models who have an enormous impact on our nation's children. Yet, despite their crucial role in early childhood development, ECE providers are among the lowest paid in the country and have worse health than the general population. They face a disproportionately high risk of developing preventable chronic diseases. Interventions to improve health and well-being of this workforce are urgently needed.Head Start has longstanding bipartisan support as an effective and worthwhile child development program in the US. The goal of this proposal is to improve the health and well-being of ECE providers at diverse Head Start centers, the nation's largest federal early childhood program. We will examine whether healthy nutrition behaviors of ECE providers at Head Start spillover to impact nutrition behaviors of the children in their care. Head Start providers will be offered in-person group programs supported by a strong web application for healthy eating and weight management. The results of the project will have enormous direct relevance to public health policies encouraging government health plans and private health insurers to offer obesity prevention and treatment programs as a routine service. Ultimately, we aim to provide evidence for a successful workplace wellness program in the ECE field toward nationwide scaling to reduce health disparities and create sustainable behavior changes, leading to a healthier, more self-sufficient workforce.We will first identify opportunities and barriers to creating a worksite wellness and health promotion program for Head Start providers by conducting a nationwide survey. Using these insights, we will develop and test a novel worksite wellness initiative in diverse Head Start sites through a randomized controlled trial that determines if the program reduced the risk of ECE staff developing preventable cardiovascular disease risk factors. We will also explore whether the intervention improved the healthy nutrition behavior of children enrolled at Head Start. Finally, we will model whether the program can result in additional benefits to ECE providers and their employers as well as cost savings, such as reduced absenteeism. Throughout the process we will develop, deliver, and evaluate an experiential graduate-level (MS and PhD) trainee course, "Applied Implementation Research in Nutrition and Agriculture Interventions: Design, Delivery, and Assessment," to train a cohort of nutrition professionals to implement and continue this work. The goal of this novel graduate training course is to support future generations of researchers and stakeholders who promote equity, reduce disparities, and work with under-resourced populations, particularly children with low income and low wage workers, to improve the health and wellbeing of our country. Dissemination will occur via scientific publications and presentations, trainings, and online resources.
Animal Health Component
100%
Research Effort Categories
Basic
(N/A)
Applied
100%
Developmental
(N/A)
Goals / Objectives
The goal of this proposal is to improve the health and well-being of early childcare education (ECE) providers by developing, implementing, and evaluating an integrated workplace wellness randomized controlled trial (RCT) at diverse Head Start centers (research), the nation's largest federal early childhood program. The RCT will be designed, implemented, and evaluated by MS and PhD nutrition graduate students in collaboration with and supervised by PIs through a novel applied course (education). This study meets A1344's program goals, responding to needs of childcare providers, a low-income population with wide-ranging health disparities, to create sustainable behavior changes, leading to a healthier, more self-sufficient workforce. The proposal development was made possible by a strong collaboration between Tufts University and the National Head Start Association.The following objectives address opportunities and barriers to improve the childcare healthy eating environment and to train future nutrition and agriculture professionals.To develop, deliver, and evaluate an innovative, graduate-level (MS and PhD) trainee course, "Applied Implementation Research in Nutrition and Agriculture Interventions: Design, Delivery, and Assessment," with an experiential learning component to train nutrition and agriculture policy students in applied research.To develop a workplace wellness trial for diverse Head Start centers informed by a national needs assessment and in collaboration with graduate-level trainees that will identify the factors that influence childcare providers' health and weight management behaviors and engagement in worksite wellness and health promotion services.To implement and evaluate the impact of a workplace wellness trial at diverse Head Start centers, in collaboration with graduate-level trainees, on childcare providers' weight status and cardiometabolic risk factors, as well as to assess and model the potential cost savings associated with changes in absenteeism and diet-related chronic disease conditions compared to controls (intervention waitlist).
Project Methods
Objective 1:Our main education objective will be accomplished through the following steps: 1. To create a new course at the Friedman School:"Applied Implementation Research in Nutrition and Agriculture Interventions: Design, Delivery, and Assessment"and develop learning objectives and a training module with integrated experiential activities that align with the research phases of this proposal. 2. Offer, evaluate, and iteratively revise the course. Students will receive direct hands-on experience as they engage with the curriculum. Our goal is to enroll 6-10 students per semester for 6 semesters 3. Institutionalize the curriculum in the Friedman School and disseminate to other peer nutrition programs.Objective 2:In collaboration with the student trainees, we will design and conduct a national needs assessment between Jan 2022 and Apr 2022 by developing and administering a nationally representative survey. Qualitative data to inform the design of the national needs assessment survey will be obtained via focus groups Nov 2021- Dec 2021 at our partner ABCD Head Start in Massachusetts. Scripts will include questions to gain an understanding of both "deep structure" factors - psychological, cultural, social, historical, and environmental - considered critical for salience and effectiveness in wellness intervention implementation, as well as "surface structure" factors - look and feel of centers' current and available wellness related activities.Results will be analyzed and integrated into the development of the specific components of theHealthy Living! Program (May 2022 - Sep 2022) through an iterative and collaborative process with key stakeholders.Study Population and Sampling.Focus Groups.Five focus groups will be conducted from Nov 2021 - Dec 2021 to obtain qualitative data to inform development of the national Head Start survey, ensuring cultural adaptability for major ethnic groups employed and served by Head Start. We will work with ABCD Head Start and Children's Services in Boston using their usual communications channels to recruit a purposive, nonrandom sample of Head Start educators.National Needs Assessment.Eligible survey participants include Head Start directors, teachers, and teacher's aides in all 50 states, the District of Columbia, Puerto Rico, and the US territories. Our sampling plan leverages NHSA's extensive employee contact list, which includes email addresses of directors of the 1,600 funded Head Start programs. We aim to successfully recruit 20% of program directors (n=320) and will work with our NHSA partners to achieve a representative sample based on centers' demographic distribution (by sex, race, ethnicity), funded enrollment (e.g., program size), and geography. Survey response of 320 Head Start program directors will yield an employee population of approximately 48,000 employees (based on an average of 150 staff educators members per program); we aim for a ~5% response rate among these employees after sending three emails (initial plus 2 reminders) to yield a sample of 2300.Objective 3:We will conduct a 12-month randomized controlled trial beginning in October 2022 to examine the effect of the adaptedHealthy Weight for Livingprogram (tentatively titledHealthy Living!) on cardiometabolic risk factors. Secondary outcomes include dietary intake and patterns, physical activity levels, stress, health behaviors, and job satisfaction. Participants will be followed for an 18-month period from the time of enrollment (12-month intervention + 6-month follow-up. Five Head Start centers will be randomly assigned to receive the adapted HWL intervention and 5 to the control condition (intervention waitlist) and 10 participants per site will be enrolled.Study population:The study population includes Head Start directors and their employees in the Boston, MA area through collaboration with ABCD, which runs the largest Head Start program in Massachusetts. Study Recruitment:Together with partners at ABCD, we will recruit 10 diverse Head Start centers, and up to 10 participants per center (full-time staff educators and staff) in the greater Boston area. Once recruitment is complete, we will conduct the randomization by center: Intervention and intervention waitlist.Demographic measures:At the start of the study, we will distribute a survey to capture participant's self-reported age, gender, education, employment, family size and structure, and race/ethnicity. The following measures will be taken at 4 time points - baseline, 6-month, 12-month, and 18 months.Cardiovascular measures:Blood samples will be obtained using a non-fasting finger stick method and transferred into a cassette sample well for validated measures of HbA1c, fasting glucose, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) concentrations using our state-of-the-art equipment (Cholestech LDX System, Alere, Waltham MA).Blood pressure will be assessed using the OMRON HEM-907XL Digital Blood Pressure Monitor according to standard protocols).Anthropometric measures:We will assess participant weight to ±0.1 kg, height ±0.1 cm and waist circumference to ±0.3 cm according to our usual protocols and standardized methods. 18,19,45Dietary intake: Diet measures will be collected using the National Cancer Institute's validated Automated Self-Administered 24-Hour (ASA24®).Physical Activity:Time spent in light, moderate and vigorous physical activity will be measured using GTX ActiGraph accelerometers, owned by Tufts, which are validated and calibrated for adult use.Health behaviors:Perceived occupational stress, assessed by job strain and referred to throughout as "stress," will be measured by the commonly used, validated Job Content Questionnaire (JCQ). . Other lifestyle questions including sleep-related questions and other variables identified as important variables and predictors in Objective 1 will be drawn from validated tools using the National Collaborative on Childhood Obesity Research measures registry,NHANES, and BRFSS.Key Informant Interviews:Because we are interested in acceptability and feasibility of the intervention in other settings (i.e.: to scale to Head Start in other communities), as well as any indication of the spillover effect to children, each program director from the intervention sites will participate in key informant interviews regarding uptake and impact of program implementation, as well as health-promoting environmental changes due to the intervention.Environmental Health and Policy Assessment:At baseline and 12 months, an environmental assessment survey will be implemented at the 10 centers, and in the classrooms of intervention participants in particular using a validated tool for childcare centers. This survey will be comprised of validated environmental assessment questions.This environmental assessment will allow us to triangulate how the intervention may impact the broader Head Start field, as well as how environmental and policy changes may translate to added health promotion of children served.Child Behavior (spillover)will be assessed using an adapted tool that the graduate student trainees will identify and prepare for use in the field, and child behaviors of interest will include 1) quantity and quality of dietary intake, 2) nutrition attitudes and knowledge, and 3) total amount of active time at school.This mixed-methods assessmentmayutilize key informant interviews and/or focus groups with children, families, and Head Stareducators, as well as quantitative assessments of pre/post child behaviors.