Head Start Wellness Policy Intervention in Hawaii: A Project of the Children's Healthy Living Program (CHL)

Esquivel, Monica
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[Honolulu] : [University of Hawaii at Manoa], [May 2015]
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Head Start (HS) preschools present an opportunity for obesity prevention efforts, and their presence throughout the Pacific makes them a potential source of data for monitoring body mass index (BMI) in the region. This dissertation is embedded within the Children’s Healthy Living (CHL) Program for Remote Underserved Minority Populations in the Pacific Region, which worked with HS preschools. It includes four manuscripts; 1) identifying HS teacher recommendations for policies to prevent childhood obesity in HS; 2) testing the effect of a HS teacher-informed wellness policy intervention on the HS classroom environment and childhood diet intake and obesity; 3) quantifying the relative validity of HS teachers’ anthropometric measurements for potential child BMI monitoring in the Pacific; and 4) quantifying the differences between child BMI assessment with World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) BMI reference data. Findings suggest that HS teachers (n=17) value being role models of healthy eating and nutrition to children and families, but voiced discomfort in sharing BMI information with parents. The intervention had positive effects on the classroom physical activity environment, as measured by the Environment and Policy Assessment and Observation (EPAO) tool (n= 23 classrooms, p=0.002). HS teachers’ priorities related to child nutrition mediated the intervention effect on the environment, and improvements in teachers’ personal health behaviors and status moderated the intervention effect on the classroom environment. In comparing height and weight assessments, HS measures were not significantly different from the researcher collected data (n=195, difference in height= 0.66cm, p =0.3458, difference in weight 0.09kg, p=0.8522). Kappa statistics showed good agreement; however, percent agreement varied by weight category (weight kappa=0.50, percent agreement= 94%, 87%, 75% and 50% for healthy weight, overweight, obese and underweight). In a sample of 941 Native Hawaiian and Pacific Islander children, CDC growth reference data significantly underestimated BMI z-scores compared to WHO reference data (zBMI difference=-0.31, p<0.001) with age and sex affecting the relationship, and significant differences in BMI classification were observed (chi square=8.95, p=0.03). Findings confirmed that HS teachers can be champions for childhood obesity prevention in Head Start, from policy planning to evaluation of intervention efforts.
Ph.D. University of Hawaii at Manoa 2015.
Includes bibliographical references.
Childhood Obesity, Head Start, Nutrition
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Theses for the degree of Doctor of Philosophy (University of Hawaii at Manoa). Human Nutrition,Food & Animal Sciences
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