Creating healthy eating and active environments in early learning settings: protocol of the CHEERS eHealth intervention study.

Background: Early childhood educators through their daily interactions with children, play a central role in shaping young children's health behaviors. Given their influential role, early childhood educators are often targeted in interventions aiming at enhancing their nutrition and physical activity practices. Methods: This paper presents the design of the CHEERS eHealth program to improve nutrition and physical activity practices within Early Childhood Education and Care (ECEC) centers. The study has a longitudinal quasi-experimental design with recruitment of ECECs across Alberta Canada. ECEC intervention group educators complete 12 weekly online nutrition and physical activity modules and participate in weekly communities of practice sessions to discuss practical applications within their centers. Outcome assessments are scheduled at baseline (T1), mid-point at 5 months (T2), and end of program after 10 months (T3). Outcome measures include the Creating Healthy Eating and Active Environments survey (CHEERS), Mindful Eating Questionnaire (MEQ), Canadian Behavior, Attitude and Nutrition Knowledge Survey (C-BANKS 2.0), Physical Literacy Knowledge, Attitude, Self-Efficacy, and Behavior (PLKASB-ECE), the Environment and Policy Assessment and Observation (EPAO) derived variables, and an objective measure of children's physical activity using ActiGraph GT3X accelerometers. Linear mixed model analyses will be used to evaluate the effectiveness of the intervention. Qualitative assessments comprise exit interviews and open-response questions embedded within the educational modules. Results: Preliminary baseline data from the 2019 cohort indicate no statistically significant differences between the intervention and control groups for the primary outcome variables, except age. Educators' personal nutrition-related knowledge, attitude and behaviors were positively associated with their self-assessments of the nutrition environment and practices in ECECs. A significant correlation was observed between educators' self-reported physical activity practices and observed activity practices. The CHEERS survey Food Served subscale showed a positive correlation with the objective measures of EPAO-Foods Provided and Nutrition Policy subdomains. Discussion: We propose that this eHealth intervention would be an effective scaling up approach to enhancing the nutrition and physical activity environments of ECECs by fostering improved nutrition and physical activity-related knowledge, attitudes, and adherence to best practices which will potentially lead to improved outcomes for children in their care.

eHealth Tools Supporting Early Childhood Education and Care Centers to Assess and Enhance Nutrition and Physical Activity Environments: Protocol for a Scoping Review.

BACKGROUND: Many children today are growing up in environments that predispose them to develop noncommunicable diseases. While no single preventive solution exists, evidence supports interventions in childcare settings for establishing good nutrition and physical activity behaviors as a "critical window" that could reduce the risk of developing noncommunicable diseases later in life. Emerging eHealth tools have shown potential in promoting best practices for nutrition and physical activity environments in early childhood education and care (ECEC) settings. OBJECTIVE: The primary objective of this review is to map the breadth of available evidence on eHealth tools currently available to assess and support best practices for nutrition, physical activity, or both in ECEC settings and to highlight potential research directions. METHODS: This scoping review will be conducted in accordance with the Joanna Briggs Institute Manual for Scoping Reviews with adherence to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist guidelines. Eligibility is based on the Population, Concept, and Context criteria as follows: (1) early childhood educators (population); (2) eHealth (digital) technology, such as websites, smartphone apps, email, and social media (concept); and (3) measurement and intervention tools to support best practices for nutrition, physical activity, or both in ECEC settings (context). The information sources for this review are the bibliographic databases PubMed, Scopus, CINAHL Plus, ERIC, and Embase in English and French with no date restrictions. Following this, a scan of gray literature will be undertaken. The electronic search strategy was developed in collaboration with two librarians. Two independent reviewers will screen the titles and abstracts of all relevant publications against inclusion criteria, followed by a full-text review using a data extraction tool developed by the reviewers. A synthesis of included papers will describe the publication, assessment, and intervention tool details. A summary of the findings will describe the types of eHealth assessment tools available, psychometric properties, eHealth intervention components, and theoretical frameworks used for development. RESULTS: Preliminary searches of bibliographic databases to test and calibrate the search were carried out in May 2023. Study selection based on titles and abstracts was started in August 2023. The developed search strategy will guide our search for gray literature. The findings will be presented in visualized data map format, waffle chart, or tabular format accompanied by a narrative discussion. The scoping review is planned for completion in 2024. CONCLUSIONS: A structured review of the literature will provide a summary of the range and type of eHealth tools available for ECEC programs to assess and improve nutrition environments, physical activity environments, or both in order to identify gaps in the current evidence base and provide insights to guide future intervention research. TRIAL REGISTRATION: Open Science Framework XTRNZ; https://osf.io/xtrnz. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/52252.

Update and validation of the Canadian Behavior, Attitude and Nutrition Knowledge Survey (C-BANKS 2.0).

Aim: Understanding knowledge, attitudes and behaviors related to nutrition is crucial in developing effective intervention strategies to promote healthy eating habits. This study revised and updated the Canadian Behavior, Attitude and Nutrition Knowledge Survey (C-BANKS) to align with the current Canada's Food Guide and dietary guidance and report on its reliability and validity with a new population. Method: Data from 167 early childhood educators were recruited to test the revised C-BANKS' reliability and validity. Reliability, as measured by internal consistency, was assessed using Cronbach's alpha, while concurrent validity was determined by correlating the C-BANKS 2.0 scores with the CHEERS (Creating Healthy Eating and Active Environments Survey) and Mindful Eating Questionnaire (MEQ). Responsiveness was assessed by comparing a baseline C-BANKS 2.0 score to a post-test score after completing an online healthy eating and physical activity educational intervention. Results: The adapted C-BANKS 2.0 questionnaire demonstrated good internal consistency (Cronbach's alpha >0.70) and construct validity with related measures CHEERS and MEQ (p < 0.05). The C-BANKS 2.0 demonstrated strong responsiveness. Specifically, C-BANKS 2.0 scores increased after the nutrition education intervention (p < 0.001). Additionally, there were no signs of floor or ceiling effects. Conclusion: The adapted C-BANKS 2.0 demonstrated satisfactory internal consistency, construct validity, and responsiveness to measure of nutrition knowledge, attitudes, and behaviors in an early childhood educator population. The revised C-BANKS 2.0 provides insight into the key factors that influence dietary habits thereby informing the design and evaluation of effective nutrition community intervention programs.

Authoritative parenting stimulates academic achievement, also partly via self-efficacy and intention towards getting good grades.

BACKGROUND: The aim of this prospective study is to examine how parenting style relates to academic achievement of Lebanese adolescents and test the mediating effect of self-efficacy and intention towards getting good grades. Potential moderation by demographic factors (age, gender, school type, religion and parents' education) was also examined. METHODS: Students (n = 345) from private and public schools in Mount Lebanon and Beirut area, aged between 15 and 18, participated in a two-wave longitudinal study and completed a self-administered questionnaire based on the I-Change Model assessing socio-demographics (age, gender, school type, parents' education, family structure, religion), socio-cognitive factors (attitude, social norms, self-efficacy, intention), parenting styles and academic achievement. Adolescent were surveyed at two time points, six months apart. A multiple linear regression was carried out to identify baseline factors independently associated with academic achievement 6 months later. Moderation was examined using Hayes's SPSS macro PROCESS. A serial mediation model was employed to test for the sequential mediating effect of self-efficacy and intention between parenting style and academic achievement. RESULTS: Authoritative parenting was prospectively associated with better academic achievement and higher self-efficacy and intention at 6 months follow up. In addition, self-efficacy and intention towards getting good grades were found to mediate the relationship of parenting style to academic achievement. Adolescents who perceive their parents as authoritative are more likely to develop high efficacy beliefs and higher intention and subsequently are more likely to achieve better in school compared to peers of neglectful parents. Socio-demographics did not moderate the effect of parenting on academic achievement. CONCLUSION: Authoritative parenting influenced both directly and indirectly the academic achievement of their children. Interventions aiming at improving academic performance of adolescents should also encompass positive parenting style strategies.

Increased Adherence to the Mediterranean Diet and Higher Efficacy Beliefs Are Associated with Better Academic Achievement: A Longitudinal Study of High School Adolescents in Lebanon.

This longitudinal study aims to examine how changes in health behaviors and socio-cognitive factors influence the academic achievement of Lebanese adolescents over a period of 12 months. Adolescents (n = 563) from private and public schools in Mount Lebanon and the Beirut area, aged between 15 and 18, participated in a three-wave longitudinal study and completed a self-administered questionnaire assessing socio-demographics, health behaviors, socio-cognitive factors, parenting styles, and academic achievement. A linear mixed model was carried out to examine if changes in health behaviors and cognitive factors affect changes in academic achievement after 6 and 12 months from the baseline, adjusting for demographic variables and parenting style. Results show that improved adherence to the Mediterranean diet and an increase in self-efficacy were associated with an increase in academic achievement. An increase in adherence to the Mediterranean diet had the same effect on academic achievement 6 and 12 months from the baseline, whereas an increase in efficacy beliefs was only significantly associated with achievement at 12 months from the baseline. This study supports the longitudinal link between diet quality and efficacy beliefs with the academic achievement of adolescents. This relationship is independent of sex, age, religion, parents' education, and raising styles.

Parenting style as longitudinal predictor of adolescents' health behaviors in Lebanon.

This prospective study aimed to examine how parenting style relates to health behaviors and body mass index of Lebanese adolescents while checking for interactive effect of child characteristics (age and gender). About 341 students from private and public schools in Mount Lebanon and Beirut area, aged between 16 and 18 years, completed a self-administered survey assessing socio-demographics, parenting styles and health behaviors. Adolescents were surveyed at two time points, six months apart. Anthropometric measurements were also taken. Authoritative parenting was associated with better outcomes compared to the neglectful style. Adolescents raised with an authoritative style had higher adherence to the Mediterranean diet and lower consumption of alcohol intake. Parenting style was a significant predictor of eating behavior and alcohol intake of Lebanese adolescent. Interventions aiming at improving health behaviors should also encompass healthy parenting style strategies.

Is Academic Achievement Related to Mediterranean Diet, Substance Use and Social-Cognitive Factors: Findings from Lebanese Adolescents.

There is substantial evidence that good academic performance significantly enhances the prospects of success for adolescents in terms of employment, social status, quality of life and health. Identifying which factors are correlated to good academic achievement and which factors may need to be addressed by policies is crucial. Despite its importance, there is insufficient data concerning factors associated with academic achievement in the Middle East, particularly Lebanon. This study assessed the association of lifestyle, socio-demographics and motivational factors with academic achievement of Lebanese adolescents. Grade 10 and 11 Lebanese adolescents aged 15 to 18 years (n = 600), from private and public schools in Beirut and the Mount Lebanon area, completed a multi-component questionnaire assessing health behaviors, socio-demographic characteristics and motivational factors. Height and weight were physically measured and, subsequently, Body Mass Index was calculated. Academic achievement was assessed using self-reported grades and was categorized into high and low. Associations between all factors and academic achievement were tested using logistic regression models. Adherence to the Mediterranean diet, high self-efficacy and intention were positively associated with academic achievement, whereas smoking was associated with poor achievement. Our findings support the need for targeting adolescents with an unhealthier lifestyle and focusing on socio-cognitive determinants interventions aimed at enhancing academic achievement.