Process and impact evaluation of the romp & chomp obesity prevention intervention in early childhood settings : lessons learned from implementation in preschools and long day care settings

Background: The Romp & Chomp controlled trial, which aimed to prevent obesity in preschool Australian children, was recently found to reduce the prevalence of childhood overweight and obesity and improve children’s dietary patterns. The intervention focused on capacity building and policy implementation within various early childhood settings. This paper reports on the process and impact evaluation of this trial and the lessons learned from this complex community intervention.
Methods: Process data was collected throughout and audits capturing nutrition and physical activity-related environments and practices were completed postintervention by directors of Long Day Care (LDC) centers (n = 10) and preschools (n = 41) in intervention and comparison (n = 161 LDC and n = 347 preschool) groups.
Results: The environmental audits demonstrated positive impacts in both settings on policy, nutrition, physical activity opportunities, and staff capacity and practices, although results varied across settings and were more substantial in the preschool settings. Important lessons were learned in relation to implementation of such community-based interventions, including the significant barriers to implementing health-promotion interventions in early childhood settings, lack of engagement of for-profit LDC centers in the evaluation, and an inability to attribute direct intervention impacts when the intervention components were delivered as part of a health-promotion package integrated with other programs.
Conclusions: These results provide confidence that obesity prevention interventions in children’s settings can be effective; however, significant efforts must be directed toward developing context-specific strategies that invest in policies, capacity building, staff support, and parent engagement. Recognition by funders and reviewers of the difficulties involved in implementing and evaluating such complex interventions is also critical to strengthening the evidence base on the effectiveness of such public health approaches to obesity prevention.

Obesity prevention interventions in early childhood education and care settings with parental involvement: a systematic review

Partnering early childhood education and care (ECEC) and the home together may be more effective in combating obesogenic risk factors in preschool children. Thus, an evaluation of ECEC obesity prevention interventions with a parental component was conducted, exploring parental engagement and its effect on obesity and healthy lifestyle outcomes. A search revealed 15 peer-reviewed papers. Some studies demonstrated positive weight changes, and secondary outcomes of changes in physical activity and healthy eating were reported in most studies; study quality ranged from fair to good. Four findings were linked to weight changes: (1) when educational material is consistent across settings; (2) capacity building of parents; (3) parents encouraging their children to drink water and (4) parental satisfaction and participation. A partnership between parents and ECEC may be a powerful force in the prevention of paediatric obesity. A better understanding of collaborative parental engagement is needed.

Using the Safe Schools Hub as a Tool for School Improvement

The Safe Schools Hub is an online portal created by the Australian Government to support the National Safe Schools Framework. The Hub contains an extensive collection of resources for leaders, teachers, specialist staff, parents and students. This interactive workshop will explore a variety of ways in which school leaders and teachers can use selected resources from the Hub to facilitate positive school change in areas such as student wellbeing, teacher wellbeing, student safety and parent engagement. These resources include practical activities that can be used in staff meetings, the use of Appreciative Inquiry, a whole-school audit tool and parent surveys.

A preventative approach to oral health for children in a regional/rural community in south-west Victoria Australia

Abstract Dental caries is a major health problem in most industrialised countries. Childhood dental disease can cause acute pain, difficulty eating resulting in reduced self-esteem and sleep deprivation. The treatment of oral disease using traditional methods is costly and in industrialized countries currently rates the fourth most expensive disease to treat. Dental professionals are currently facing an unfathomable task of how to manage the large burden of consequences associated with caries progression across the world. The Barwon South-West Region of Victoria, Australia is a diverse regional/rural area. Some communities are quite remote. Barwon Health and Colac Area Health Oral Health Services developed an outreach program to improve access to dental services for children. A Minimal Intervention Dentistry approach was incorporated and includes early diagnosis, risk assessment, early detection of mineral loss, non-surgical treatment and preservation of the tooth structure. Kindergartens throughout the region and children in the first year of Primary School are visited by Oral Health Therapists. Teeth are scored according to the International Caries Detection Assessment System and any early 'white spot' lesions identified have fluoride varnish applied. Children receive up to three dental check-ups during the year and given a toothbrush and toothpaste at each visit. Parent engagement sessions are conducted during Visit 2. Examinations and fluoride application take only 3 - 6 minutes for each child, compared with the usual 30 minute appointments in dental clinics. Two virtual chairs have been created as two dental teams visit Kindergartens throughout the Barwon Region, significantly easing pressure at Community dental clinics. The Kinder Wide Smiles program successfully intervened in the oral health of 5,305 children in the region. Most importantly, one of the barriers for children not presenting to static dental clinics for screening has been eliminated.

Building equitable staff-parent communication in early childhood settings : an Australian case study

International research has consistently found that good staff-parent relationships in early childhood centers benefit children, staff, and parents. Given these findings, the Australian federal government's Quality Improvement and Accreditation Scheme (QIAS) requires centers to involve parents in their programs. However, international research has also found that early childhood staff are anxious about their relationships with parents. This article describes a study in which early childhood staff in Australia were asked about their experiences with parent involvement. It draws on those interviews to consider communication strategies to create equitable relationships between staff and parents.

Parent, peer and media influences on body image and strategies to both increase and decrease body size among adolescent boys and girls

This study investigated the nature of body image and body change strategies, as well as the sociocultural influences on these variables, among a group of 1,266 adolescents (622 males, 644 females). In particular, it investigated weight gain and increased muscle, as well as weight loss. It was found that females were less satisfied with their bodies and were more likely to adopt strategies to lose weight, whereas males were more likely to adopt strategies to increase weight and muscle tone. Respondents with higher body mass index (BMI) evidenced greater body dissatisfaction and more weight loss strategies, but there were no differences between BMI groups in weight gain or strategies to increase muscles. Weight gain and strategies to increase muscles were more likely to be undertaken by older adolescents, but there were no grade level differences in weight loss. Media influences to alter weight, as well as feedback from mother, father, and both male and female peers, were greater for females. There were few grade level or BMI differences in regard to any of the sociocultural influences. The importance of these findings in terms of providing a better understanding of factors which may lead to a disturbed body image and body change disorders, particularly among adolescent boys, is discussed.

The importance of first-time parent groups for new parents

First-time parent groups are offered to all new parents in Victoria, Australia through the Maternal and Child Health Service, which is funded by state and local governments. Parents who join a group attend a series of eight sessions that emphasize parenting skills, relationship development and social support in order to increase confidence and skills in parenting. The present paper highlights the importance of first-time parent groups, claiming that these groups serve an important social support and health function amid a climate of early discharge policies and changing family structures. Although there are a number of challenges to the successful running of groups, it is argued that first-time parents benefit from participating in these groups in a number of ways: by developing social networks, gaining self confidence, and through access to relevant information on child health and parenting. Research indicates that first-time parent groups provide lasting benefits not only for families, but also for society as a whole. Maternal and child health nurses play a key role in facilitating groups for first-time parents.

Engagement and retention of participants in a physical activity website

Background: Websites have the potential to deliver enhanced versions of targeted and tailored physical activity programs to large numbers of participants. We describe participant engagement and retention with a stage-based physical activity website in a workplace setting. Methods:  We analyzed data from participants in the website condition of a randomized trial designed to test the efficacy of a print- vs. website-delivered intervention. They received four stage-targeted e-mails over 8 weeks, with hyperlinks to the website. Both objective and self-reported website use data were collected and analyzed. Results: Overall, 327 were randomized to the website condition and 250 (76%) completed the follow-up survey. Forty-six percent (n = 152) visited the website over the trial period. A total of 4,114 hits to the website were recorded. Participants who entered the site spent on average 9 min per visit and viewed 18 pages. Website use declined over time; 77% of all visits followed the first e-mail. Conclusions: Limited website engagement, despite the perceived usefulness of the materials, demonstrates possible constraints on the use of e-mails and websites in delivering health behavior change programs. In the often-cluttered information environment of workplaces, issues of engagement and retention in website-delivered programs require attention.

Women`s satisfaction with life following marital separation : coping resources and adjustment of lone-parent women

This questionnaire study examined the adjustment of 245 lone-parenting women following marital separation. A composite model included intrapsychic variables as intervening between demographic and contextual variables and adjustment (life satisfaction). Regression analyses showed that the demographic and contextual variables were partially mediated by the intrapsychic variables. The path model indicated that the intrapsychic variables (sense of coherence, control, depression, and grief) had a direct impact on life satisfaction and that there was an indirect path for depression through sense of coherence (SOC) and control. It was concluded that the intrapsychic variables had a more powerful relationship with women's post-separation life satisfaction than did the demographic/contextual variables. Social implications and recommendations for future policy are considered.

Impact of an empowerment-based parent education program on the reduction of youth suicide risk factors

Purpose: To evaluate the impact of parent education groups on youth suicide risk factors. The potential for informal transmission of intervention impacts within school communities was assessed.

Methods: Parent education groups were offered to volunteers from 14 high schools that were closely matched to 14 comparison schools. The professionally led groups aimed to empower parents to assist one another to improve communication skills and relationships with adolescents. Australian 8th-grade students (aged 14 years) responded to classroom surveys repeated at baseline and after 3 months. Logistic regression was used to test for intervention impacts on adolescent substance use, deliquency, self-harm behavior, and depression. There were no differences between the intervention (n = 305) and comparison (n = 272) samples at baseline on the measures of depression, health behavior, or family relationships.

Results: Students in the intervention schools demonstrated increased maternal care (adjusted odds ratio [AOR] 1.9), reductions in conflict with parents (AOR .5), reduced substance use (AOR .5 to .6), and less delinquency (AOR .2). Parent education group participants were more likely to be sole parents and their children reported higher rates of substance use at baseline. Intervention impacts revealed a dose-response with the largest impacts associated with directly participating parents, but significant impacts were also evident for others in the intervention schools. Where best friend dyads were identified, the best friend’s positive family relationships reduced subsequent substance use among respondents. This and other social contagion processes were posited to explain the transfer of positive impacts beyond the minority of directly participating families.

Conclusions: A whole-school parent education intervention demonstrated promising impacts on a range of risk behaviors and protective factors relevant to youth self-harm and suicide.

An ecobehavioural analysis of interactive engagement of children with developmental disabilities with their peers in inclusive preschools

Ecobehavioural analysis procedures were used to examine the interactive engagement of children with developmental disabilities due to Down syndrome who attended inclusive preschools for 2 years. Compared with typical children, the children with disabilities displayed infrequent interactions with peers for the duration of the study. For the children with disabilities, interactive engagement was largely unrelated to the characteristics of class activities, while typical children responded positively to activities expected to promote peer interaction. The results are discussed in terms of the inadequacy of informal strategies commonly applied in inclusive preschool settings to promote interactive engagement in children with disabilities.

Body mass index and parent-reported self-estem in elementary school children: evidence for a causal relationship.

OBJECTIVE: To clarify relationships between body mass index (BMI) and self-esteem in young children at a population level. To assess whether low self-esteem precedes or follows development of overweight/obesity in children. DESIGN: Prospective cohort study in elementary schools throughout Victoria, Australia. Child BMI and self-esteem were measured in 1997 and 2000. SUBJECTS: Random sample of 1,157 children who were in the first 4 y of elementary school (aged 5-10 y) at baseline. MEASURES: BMI was calculated from measured height and weight, then transformed to z-scores. Children were classified as nonoverweight, overweight or obese based on international cut-points. Low child self-esteem was defined as a score below the 15th percentile on the self-esteem subscale of the parent-reported Child Health Questionnaire. RESULTS: Overweight/obese children had lower median self-esteem scores than nonoverweight children at both timepoints, especially at follow-up. After accounting for baseline self-esteem, higher baseline BMI z-score predicted poorer self-esteem at follow-up (P=0.008). After accounting for baseline BMI z-score, poorer baseline self-esteem did not predict higher BMI z-score at follow-up. While nonoverweight children with low baseline self-esteem were more likely to develop overweight/obesity (OR=2.1, 95% CI=1.2, 3.6), this accounted for only a small proportion of the incidence of overweight. CONCLUSIONS: Our data show an increasingly strong association between lower self-esteem and higher body mass across the elementary school years. Overweight/obesity precedes low self-esteem in many children, suggesting a causal relationship. This indicates that prevention and management strategies for childhood overweight/obesity need to begin early to minimise the impact on self-esteem.