Establishment of "Smiles": an innovative inclusive program for the promotion of oral health among preschool children.

OBJECTIVES: To describe the planning stage and the first year of "Smiles," an innovative, inclusive oral health promotion program among preschool children, ages 3 to 5, encompassing the enhancement of daily toothbrushing skills, engagement of teaching staff and parents, and integration of a supportive environment of supervised toothbrushing in kindergartens. METHOD AND MATERIALS: The major components of the first year of the program included workshops with the teaching staff, working sessions with the preschool children, and workshops with the parents. Program participation, program cooperation, program satisfaction, and kindergarten teachers, kindergarten parents, and dental hygienists' attitudes towards this component of the program were recorded and evaluated. Minor components of the first year of the program included assimilation and integration of daily supervised toothbrushing in some of the kindergartens. Program participation, kindergarten teachers, kindergarten teachers' assistants, and kindergarten parents' attitudes towards this component of the program were recorded and evaluated. RESULTS: In total, 180 kindergartens, in nine locations across Israel, including 5,311 preschool children, their parents, and teaching staff, took part in the first year of the program. High levels of participation (80% and above), cooperation (9.55 to 9.78) and satisfaction (9.62 to 9.81) were recorded in the first year of the program. Kindergarten teachers, parents, and dental hygienists expressed high levels of support for continuing the program beyond its first year (9.86 to 10.00). Regarding the daily supervised toothbrushing model in the kindergartens, high levels of satisfaction (9.50 to 9.75) and willingness to continue the program (9.50-10.00) were recorded among kindergarten teachers, assistants, and parents. CONCLUSION: The "Smiles" program serves as an example of successful collaboration between many partners and stakeholders from different organizations, sectors, and government ministries, local authorities, kindergarten management and staff, parents, and the most important partners, the preschool children. Its adherence to the basic principles of health promotion, and its professional adjustment to early childhood with positive atmosphere of happiness, joy, and shared warmth, contributed to the success of the program.

Effect of a School-Based Intervention on Nutritional Knowledge and Habits of Low-Socioeconomic School Children in Israel: A Cluster-Randomized Controlled Trial.

Early social and economic deprivation, associated with poor nutrition and physical inactivity, may lead to adverse health trajectories. A cluster-randomized controlled-trial examining the effect of a school-based comprehensive intervention on nutrition knowledge, eating habits, and behaviors among low socioeconomic status (LSES) school-aged children was performed. LSES school-aged children (4-7 years) and their mothers were recruited from 11 schools, located in one town. The intervention was implemented on three levels: children, mothers, and teachers. The intervention (IArm) included nutrition classes for children, mothers, and teachers and physical activity (PA) classes for children; the control (CArm) received PA only. Interventions were conducted by professional personnel, who were trained during in a two-day session to deliver the specific program in schools. Family data were obtained by parental interviews. Food knowledge observations, packed lunch records, and anthropometric measurements were obtained in school at baseline, six months, and at the end of the school year. Of 258 children enrolled, 220 (87.6%) completed the six-month program. Only children in the IArm improved their nutrition knowledge and eating-habits and increased food variety and fruit and vegetable consumption, quality score of packed lunches (p < 0.001 for all), habitual water drinking increased (p = 0.02), and decreased sweet-drink consumption (p = 0.05). A school-based comprehensive nutrition intervention targeting LSES population improved eating habits, nutritional knowledge, and healthier packed lunches.

Factors associated with childhood overweight and obesity among acculturated and new immigrants.

OBJECTIVE: To examine the relationship between acculturation and obesity among low socioeconomic status (LSES) children. DESIGN: Cross-sectional study. SETTING: Children from 12 preschools in LSES neighborhoods were recruited. PARTICIPANTS: Anthropometric measurements were obtained from 238 children (aged 4-7 years) and 224 mothers. Sociodemographic characteristics and perceptions of child's weight were collected from mothers. We compared native Israelis and immigrants for risk factors for obesity, using a 9-year cut-off to define new and acculturated immigrants. RESULTS: The combined prevalence of overweight and obesity (OWOB) among children was 29.8% (71/238) using the World Health Organization (WHO) growth standard. Mean age, sleeping hours, sex distribution and poverty level were similar between immigrants and natives. Prevalence of OWOB and current parental smoking were significantly lower among children of new immigrants (P = .02). More than 82% of mothers underestimated their child's weight status, 74.2% of OWOB children were perceived as normal-weight (NW) and 8% as thin. In a multivariable logistic-regression analysis comparing NW to OWOB children, maternal underestimation of the child's weight status (OR = 7.5; 95%CI: 3.4-16.5, P < .0001) and being born to acculturated immigrants (OR = 2.3 95% CI: 1.1-4.7, P = .03) were associated with OWOB. Ethiopian children were at lower risk for obesity. Paternal smoking increased the risk for obesity by 2-fold in non-Ethiopian, and 5-fold in Ethiopian children (OR = 2.0 and 5.0, respectively; P for interaction = .026). CONCLUSIONS: Acculturation, perception of child's weight status and parental smoking are associated with childhood OWOB. Immigration status should be considered when programs to prevent childhood obesity are implemented in mixed populations.