Implementing Color Me Healthy in Jackson County Mississippi Head Start Centers: Successes, Struggles, and Future Implications (Year Two Results) Danielle Fastring, PhD, MS, MPH University of Southern Mississippi College of Health Department of Public Health

Introduction and Background Initiative of the MS Gulf Coast Youth Health Coalition Color Me Healthy: Intervention used to teach healthy eating and physical activity habits to 3-5 year old children 12 circle time activities Rated according to activity level Incorporate original songs Encourage imagination and physical activity Teach about healthy snacks and TV substitutes Parent newsletters Colorful posters and picture cards for reinforcement Healthy People 2020 Reduce the proportion of children aged 2 to 5 years who are considered obese Prevent inappropriate weight gain in children aged 2 to 5 years Increase the variety and contribution of fruits and vegetables to the diets of the population aged 2 years and older MS has one of the highest rates of childhood obesity in the nation, with 40% of school aged children and youth classified as overweight or obese.

Methods Partnered with Jackson County Head Start Centers (n=23) Control Site: Taconi (5) Intervention Sites : Gautier (7), Pascagoula (7), and Vancleave (4) Quasi-Experimental Study Design Two group pre-test / post-test O1 O2 O1 X O2 Utilized a “Train the Trainer” Model All teachers in Jackson County Head Start Centers (n=130 over 2 years) Program delivery training Fruit and Vegetable Consumption Data Collection Tool

Data Collection Demographic Information: Anthropometric Data: Age, Race, Sex Anthropometric Data: Height, Weight, Waist Circumference, Calculated BMI Knowledge Items: Recognition of Fruits and Vegetables Intervention Fidelity Teacher’s report of activities Behavioral Data for Children: One week of fruit and vegetable consumption Parent Survey Child’s fruit and vegetable consumption patterns at home Screen time Physical activity time Sugary snacks and beverages Child’s Satisfaction with the Program Teachers’ Readiness to Change

Results: BMI Baseline BMI: control Group BMI: Intervention Group Underweight: < 5th, Healthy weight: 5th – 85th, Overweight: >85th - < 95th, Obese: 95th +

Results: Fruit and Vegetable Recognition   Taconi (Control Site) Gautier (Intervention Site) Pascagoula (Intervention Site) Vancleave (Intervention Site) Mean (sd) Pre Post Fruit Recognition 4.58 (1.33) 5.56 (0.97) 4.18 (1.54) 5.13 (1.06) 4.05 (1.53) 5.50 (1.02) 4.30 (1.41) 5.65 (1.22) Vegetable Recognition 2.13 (1.36) 3.66 (1.42) 1.81 (1.48) 3.30 (1.58) 1.70 (1.46) 3.85 (1.36) 1.93 (1.36) 4.14 (1.77) There was a significant increase in fruit and vegetable recognition across all intervention group sites from pre-test to post test and when compared to results in the control group (p < 0.001).

Fruit &Vegetable Consumption Teachers in the classroom used direct observation to record whether a child ate “all, some, or none” of their fruit and vegetable servings at breakfast, lunch, and two snacks daily for one week pre- and post-intervention.

Results: Parent Survey Asked for each CMH food: What is your child’s experience with the following foods? Ex. Apples My child has tried this food and enjoys eating it My child has tried this food but does not enjoy eating it My child has been introduced to this food but would not try it My child has never been introduced to this food Parents in the intervention groups reported a significantly greater number of “tried” and “tried and enjoyed” fruits and vegetables than did the control group post-intervention (p<0.001). Screen Time Parents in the intervention groups reported that their children were significantly less likely to engage in screen time than were control children post-intervention (p<0.005) Sugary Snacks and Beverages Parents in the intervention groups were significantly more likely to report that their child “always or often” chose a fruit or vegetable for snack than did control group parents post-intervention (p<0.005). Physical Activity No significant difference in physical activity between groups.

Results: Child and Teacher Satisfaction Child Satisfaction Teacher Satisfaction Which picture shows how you feel about the Color Me Healthy Program? 95.2% of children reported they “liked it” or “liked it very much” 94% of teachers reported that the circle time activities were “easy” or “very easy” to complete 100% of teachers characterized children’s responses to circle time activities and color me active activities as “happy” or “very happy” 94% of teachers reported that they would be “interested” or “very interested” in continuing the CMH program in their classroom

Future Implications The Color Me Healthy curriculum was effective in improving the knowledge and behaviors of children in our study. Research shows that beliefs and attitudes adopted in early life carry over into adulthood. Mississippi’s adult obesity rate continues to be the highest in the nation. Further longitudinal studies are needed to determine if healthy attitudes and behaviors toward nutrition and physical activity adopted in early childhood are maintained into adulthood.