High 5 for Kids: the impact of a home visiting program on fruit and vegetable intake of parents and their preschool children.

OBJECTIVE: The High 5 for Preschool Kids (H5-KIDS) program tested the effectiveness of a home based intervention to teach parents how to ensure a positive fruit-vegetable (FV) environment for their preschool child, and to examine whether changes in parent behavior were associated with improvements in child intake. METHODS: A group randomized nested cohort design was conducted (2001 to 2006) in rural, southeast Missouri with 1306 parents and their children participating in Parents As Teachers, a national parent education program. RESULTS: When compared to control parents, H5-KIDS parents reported an increase in FV servings (MN=0.20, p=0.05), knowledge and availability of FV within the home (p=0.01), and decreased their use of noncoercive feeding practices (p=0.02). Among preschoolers, FV servings increased in normal weight (MN=0.35, p=0.02) but not overweight children (MN=-0.10, p=0.48), relative to controls. The parent's change in FV servings was a significant predictor of child's change in FV in the H5-KIDS group (p=0.001). CONCLUSION: H5-KIDS suggests the need for, and promise of, early home intervention for childhood obesity prevention. It demonstrates the importance of participatory approaches in developing externally valid interventions, with the potential for dissemination across national parent education programs as a means for improving the intake of parents and young children.

Organizational capacity's effects on the delivery and outcomes of health education programs.

Community-based public health efforts to change health behaviors and health outcomes generally involve the implementation of complex, multipronged programs, which utilize many resources, both inside and outside a single community-based organization or agency. It is becoming more apparent that the organizational capacities of these agencies influence the implementation and success of health promotion programs. However, research is limited on the specific organizational capacities (e.g., resources, training, workload, trust, communication) that influence program implementation and, thus, the ultimate impact of these programs. This article seeks to address this gap in the literature by identifying organizational capacity variables that may have influenced the delivery of a dietary change program.

Improving dietary behavior in African Americans: the Parents As Teachers High 5, Low Fat Program.

BACKGROUND: The High 5, Low Fat Program (H5LF) for African American parents was developed in partnership with the Parents As Teachers program, and was designed to test a dietary intervention appropriate for national adoption. METHODS: H5LF used a group randomized, nested cohort design with 738 parents. Consistent with organizational goals and methods, parent educators delivered a dietary change program via personal visits, newsletters, and group meetings. Primary outcomes were reducing percentage calories from fat and increasing fruit and vegetable consumption among participating parents; intermediate aims included improving in nutrition-related skills and parental modeling of dietary behaviors. RESULTS: H5LF parents achieved a 0.53 increase in fruit and vegetable consumption (P = 0.03), and a higher proportion of H5LF parents reduced their intake to less than 30% calories from fat (chi(2) = 4.8, P < 0.03; -1.7% calories from fat, p = 0.07) and improved performance of dietary behaviors (F = 14.2, P = 0.004). Improvements in parental modeling were not statistically significant. CONCLUSIONS: H5LF is an effective intervention that is appropriate for national adoption by over 2000 Parents As Teachers sites with the potential to impact dietary intake of African American parents nationwide.

Prevention of overweight and obesity in children: influences on the food environment.

PURPOSE: There is an epidemic of pediatric overweight and obesity leading to type 2 diabetes in youth. The purpose of this review is to describe the multiple paths of influence on the food environment of youth and to identify diabetes education strategies focused on early prevention of overweight and obesity. METHODS: A review of relevant professional literature was conducted. RESULTS: Models of obesity prevention in youth need to address genetic factors that influence the development of food preferences in the young child, parenting influences on eating pattern development, and access and availability of foods in the physical environment of the child. CONCLUSIONS: Early intervention with parents of young children is required to prevent the development of eating patterns that lead to pediatric obesity and type 2 diabetes in youth. Diabetes educators need to be able to inform parents of the multiple paths of influence on the food environment of the child and suggest strategies to encourage the development of positive food preferences and intake.

The relationship between parental modeling, eating patterns, and dietary intake among African-American parents.

OBJECTIVE: This article examines the relationship between the frequency with which African-American parents report modeling healthful dietary behaviors for their children and parental dietary intake. DESIGN: Cross-sectional, baseline data from a community-based dietary change study to reduce fat intake and increase fruit and vegetable consumption among African-American parents was analyzed to identify role-modeling behaviors. SUBJECTS/SETTING: Subjects were 456 African-American parents who participated in a dietary change study as part of a national parent education group. Participants completed the Parental Dietary Modeling Scale, an eating patterns questionnaire and a food frequency questionnaire. STATISTICAL ANALYSES PERFORMED: Descriptive statistics and stepwise multiple linear regression analyses were conducted. RESULTS: Parental modeling of healthful dietary behavior was associated with the performance low-fat eating patterns (r = 0.48; P < .001), lower dietary fat intake (r = -0.30; P < .001), and higher consumption of fruits and vegetables (r = 0.18; P < .001). APPLICATIONS: The frequency with which parents model healthful dietary behaviors may be associated with parental dietary intake and may have long-term implications for the development of childhood eating patterns. Dietetics professionals need to carefully assess parents' current dietary modeling behaviors and inform parents about how performance of these general behaviors may affect their child's ultimate nutrition health.

A community research partnership to improve the diet of African Americans.

OBJECTIVE: To describe a community research partnership in which a national parent education organization collaborated with academic institutions to develop a dietary change program for underserved African American parents. METHODS: Qualitative methods were used to characterize issues that impacted partnership operations. RESULTS: Data are reported on partnership activities including program development and implementation with African American parents. Lessons learned and strategies for improving the partnership are presented. CONCLUSIONS: Ongoing assessment and evaluation of how a partnership operates, especially in the context of multiple sites, are important to sustaining successful functioning.