Dialog, 16(3), 160-164 Copyright © 2013, ISSN: 1930-9325 RESEARCH-TO-PRACTICE SUMMARY Influencing Head Start Families Thoughts and Beliefs about Health, Nutrition, and Physical Activity Teresa A. Byington and Anne R. Lindsay University of Nevada Reno Deborah Loesch-Griffin Turning Point, Inc. Susi Brumett and Madeleine Sigman-Grant University of Nevada Reno The results of an intervention comparison research study indicated that preschoolers can have an influence on their families’ food selection and physical activity habits. Intervention families participated in an educational program focused on healthy eating and physical activity. Following the intervention, in-depth interviews were conducted with intervention and comparison families. Intervention families reported higher consumption of healthy snacks and buying fruits and vegetables based on preschooler requests. Families in the intervention group had a more positive concept about health and stated that ideas from the educational program had helped them overcome barriers to healthy eating and being active. Keywords: health, nutrition, physical activity, eating, preschooler, Head Start Families, caregivers, environments, and experiences combine to influence a child's eating and physical activity habits (Cooke, 2007; Lanigan, 2010; Roblin, 2007). The preschool years are a prime time for children to learn healthy eating habits and basic fundamental gross motor movement skills. Unhealthy eating and lack of physical activity can play a role in future health concerns, such as obesity (Roblin, 2007). Bronfenbrenner's ecological model provides a framework to guide educational efforts (Bronfenbrenner, 1979). It is assumed that families and communities share their thoughts and beliefs about health, nutrition, and physical activity with their children. Therefore, educational efforts targeting young children should focus on helping families develop healthy eating and physical activity habits. To promote the early development of healthy habits, the All 4 Kids ©: Healthy, Happy, Active, Fit program was created. All 4 Kids © targets overweight prevention in children ages 3 to INFLUENCING HEAD START FAMILIES 161 5 years old by involving preschoolers, their primary caregivers, and preschool teachers in educational programming. The main objectives of the All 4 Kids © program are to improve the physical movement skills of preschoolers; promote the consumption of healthy snacks (e.g., fruits and vegetables); and teach children they can be active and eat healthy at any size or shape. The program engages preschoolers and significant others (e.g., families, caregivers, and preschool teachers) through direct (e.g., classroom and family events at the Head Start site) and indirect teaching (e.g. take-home activities, family and teacher newsletters). Three major units taught in 24 lessons address the following themes: Be Active, Eat Smart, and Live Healthy at Any Size. Each thematic unit contains eight 30-minute lessons, delivered by trained teachers three times weekly. Classroom components include movement skill practice and dancing, along with interactive and purposeful nutrition and health messaging. The program concepts are taught through stories, games, food tasting, and other activities. In addition to the classroom components, parents are invited to attend three family events, and children take home activities to share with their families. Following program implementation, a study was conducted to assess All 4 Kids © impact on the thoughts and beliefs of Head Start families in relationship to health, nutrition, and physical activity. Head Start families participating in the program (intervention) and Head Start families who did not receive the program (comparison) were interviewed. PARTICIPANTS AND PROCEDURES Sixty-three in-depth interviews were conducted at 12 Head Start sites (30 intervention, 33 comparison) in the families preferred language, either English or Spanish. Using a structured format, both qualitative and quantitative responses were solicited during the 30 to 40 minute interview. Participants communicated detailed information about food consumption (e.g., healthy snacks, fruits and vegetables), activity choices, and their perceptions of what it means to be healthy. They also shared thoughts and beliefs about food purchasing and eating habits. The interviews were audio-recorded. Differences between groups were determined with a descriptive and comparative design using content analysis of individual questions. RESEARCH FINDINGS Consumption of Healthy Snacks Parents in the intervention group had a more comprehensive understanding of the concept of healthy snacks and reported their children had higher consumption of healthy snacks than parents in the comparison group. While both groups introduced new snacks to their children, 27% of those in the intervention group specifically mentioned foods preschoolers tasted during the All 4 Kids © program. Furthermore, intervention families had a more diverse set of reasons for describing how healthy snacks were part of an overall healthy lifestyle. Both groups mentioned similar barriers to serving preschoolers healthy snacks, including money, food preferences, dietary restrictions, and unhealthy snacking by adults. 162 BYINGTON ET AL. Consumption of Fresh Fruits and Vegetables Most respondent families fed their preschoolers more fruits than vegetables and offered a wide variety of options. A higher number of comparison families (18 %) indicated barriers to eating fruits and vegetables than intervention families (7 %), with economic reasons given as the primary barrier. Influences on Purchasing and Eating Habits The majority of intervention and comparison families indicated they were influenced by their preschooler's requests when shopping, with about one-fourth stating they "always" purchased items their child requested. However, a similar amount indicated that they "never" bought what their preschooler asked them to buy, with the remaining families “sometimes” buying requested foods. Additionally, most families reported eating outside of the home about once a week. The intervention families reported eating in family restaurants rather than at fast food establishments more often than comparison families. Intervention families were also twice as likely to report selecting healthy meal choices when eating out. Physical Activity Overwhelmingly, both groups responded that it was important for them and their preschoolers to be physically active for health reasons. Intervention families, however, cited additional reasons, such as increasing family time, avoiding illness, not being sedentary or bored, and gaining personal benefits. Intervention families reported fewer barriers to engaging in daily physical activity, although both groups related health restrictions or work schedules as the primary obstacles. Perceptions of What It Means to Be Healthy Families from both groups shared different aspects of healthy eating and physical activity habits when describing what it means to be healthy. Some families also mentioned long-term benefits. However, more comparison families considered not being ill as the main definition of healthy. This contrasted with intervention families, who appeared to have a more positive concept of health. IMPLICATIONS OF RESULTS AND LESSONS LEARNED Educational efforts focused on health and wellness need to start early. Teaching parents and preschoolers about healthy eating and physical activity habits is essential to the development of positive health outcomes. Programs such as All 4 Kids © can influence parents in helping them view the challenges of healthy living from a different perspective. Direct quotes from intervention families illustrate the lessons learned from this research study. INFLUENCING HEAD START FAMILIES 163 Lesson # 1: Preschoolers Can Have a Strong Influence on the Family Food Selection “Well my daughter used to like cookies. Now she has changed. Sometimes when we go buy food, she tells me that the program says that only “this” type of food is healthy. Her view has changed. She likes fruits. She now eats kiwis (which she used to not eat). The program is good. In our house we used to not eat fruit. But now, two days a week I fill the fruit basket. The family is starting to eat fruit.” As recognized by food advertisers, parents respond to preschoolers’ requests. Whether it is for a special meal pack or a sweetened cereal, preschoolers influence family purchases, even if these purchases are for unhealthy choices. This study demonstrates that families will respond in a similar fashion when their child requests healthy foods. All 4 Kids © program families reported specifically buying fruits and vegetables at the request of their preschooler. This is a powerful demonstration of positive messaging on both the child and the family. Lesson #2: Engaging Preschoolers and Their Families in Exploring a Variety of Healthy Foods and Physical Activity Can Help Them Gain a More Positive Concept of Health “Healthy means to me - we eat healthy, go out and play, not just sitting around or laying down all the time. Eating right and the right amount of exercise.” Many families consider health to be simply the absence of disease. This is a limited definition as health also encompasses both physical and mental wellness resulting from appropriate choices and practices. As the preschoolers in All 4 Kids © learned to eat smart and be active, they were able to articulate how positive habits influence their health and, in turn, were able to "teach" their families. Educating preschoolers using concrete language and intentional teaching techniques (along with reinforcing these messages with the parents) resulted in families having a more complete understanding of what it means to be healthy. Lesson # 3: Engaging Preschoolers and Their Families in an Educational Program Targeting Healthy Eating and Physical Activity May Enable Them to Overcome Barriers to Healthy Eating and Being Active “The money [is a barrier]. Sometimes vegetables and fruits are more expensive than meat. I look for specials. If coupons are available and things are on special, I look for food that is healthy and buy in bulk.” Low-income families face many obstacles in achieving a healthy lifestyle. Some obstacles are economic, others are physical, and still others are attitudinal. Families from both groups in this study reiterated these challenges—healthy foods are expensive and opportunities for being active as a family are often limited. However, the strikingly different thoughts expressed by the 164 BYINGTON ET AL. families in the intervention group indicated that ideas from an educational program (including overcoming these challenges) were being integrated into their lives. Head Start educators are in an ideal situation to provide low-income preschoolers and their families with specific strategies to assist them in engaging in a healthy lifestyle. As the Whitney Houston song, Greatest Love of All says, “Let the children lead the way”. REFERENCES Bronfenbrenner, U. (1979). The Ecology of Human Development. Cambridge MA: Harvard University Press. Cooke, L. (2007). The importance of exposure for healthy eating in childhood: A review. Journal of Human Nutrition and Dietetics, 20, 294-301. Lanigan, J. D. (2010). The substance and sources of young children’s healthy eating and physical activity knowledge: Implications for obesity prevention efforts. Child: Care, Health & Development, 37(3), 368- 376. Roblin, L. (2007). Childhood obesity: Food, nutrient, and eating-habit trends and influences. Applied Physiology Nutrition Metabolism, 32, 635-645.