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Comprehensive changes in
school environment, health
education, and teacher
modeling led to healthier
obesity-related diet and
physical activity behaviors
in preschool children
Allison A. Parsons1, Christine E Blake1, Scotty M. Buff2
1Arnold School of Public Health, University of South Carolina, Columbia, SC,
2Medical University of South Carolina, Charleston, South Carolina
Acknowledgements:
This evaluation was supported with a grant from Sherman Financial Group
Kerry McIver, PhD, for guidance and assistance with accelerometer data collection and analysis
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Introduction
•
MSA is a rigorous, college-preparatory
school serving low-income children
•
MSA’s holistic approach includes:
• extended school day and year
• intensive academic program
• mandatory family involvement
• healthy diet and PA environments
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
Introduction
Comprehensive Childhood Obesity
program
 Taught by MUSC health
professional and biomedical
science students
 Three modules throughout school
year
 Nutrition
 Physical Activity
 Healthy Lifestyle
 Incorporates Parents and Teachers
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Purpose
Assess the impact of the Meeting Street
Academy (MSA)/Junior Doctors of
Health© (JDOH) collaboration on
preschool children’s nutrition knowledge,
diet and physical activity (PA) behaviors,
and BMI.
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Data were collected at three time points:
•
Baseline (BL) in August 2012
•
Midyear (MY) in January 2013
•
Follow-up (FU) in May 2013
Table 1 Measures completed by wave
Study Design
Measure
Wave 1
Wave 2 Wave 3
Child demographics
✔
✔
Teacher report of physical
activity environment
✔
✔
School physical activity and
nutrition environment
✔
✔
Child nutrition knowledge
and preferences
✔
✔
✔
Child physical activity
✔
✔
✔
Child dietary intake
✔
✔
✔
Child BMI*
✔
✔
✔
* The second measure of BMI was taken in August 2013
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Data Analyses

We used paired t-tests to determine changes in

Child nutrition knowledge and preference



Child PA: accelerometers

Boys and girls separately

3’s and 4’s combined

Instructional and afterschool hours

Minutes spent in sedentary, light/moderate, and vigorous PA
Child dietary intake


All participants combined
Each nutrient – all participants combined except kilocalories
Child BMI percentile

Boys and girls separately
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Results: Child Participants
In all waves the children were approximately evenly split between the 3
and 4 year old classrooms, there were more females than males, and
the majority of children were Black.
Table 2 Child demographics, 3 and 4 year olds, BL, MY, FU
Classroom
BLa
MYb and FUb
a: n = 33
b: n = 32
Sex
Race
3s
4s
M
F
B
W
16 (48.5%) 17 (51.5%) 15 (45.5%) 18 (54.5%) 29 (87.8%) 4 (12.1%)
17 (53.1%) 15 (46.9%) 14 (43.8%) 18 (56.3%) 28 (87.1%) 4 (12.5%)
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Results: School environment and
teacher modeling
SHAPES and NAPSACC (PA)
Scores
NAPSACC (NUTRITION) scores

Scoring range: 25 - 86

Scoring range: 36 - 144

BL: 79.25

BL: 108

FU: 84

FU: 119

Increase in:


Number of times and
duration of outdoor play
provided
Number of times and
duration of teacher-led PA
in regular, daily lessons

Increase in:


Staff eating the same food
as the children
Decrease in:

Menu options with added
fats

Unhealthy celebratory foods
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Results: Child diet behavior
Nutrient Intake: K calories
600.00!
)
500.00!
400.00!
300.00!
200.00!
100.00!
0.00!
Boys
Girls
Results: Child diet behavior
Nutritient Intake: Protein, Carbohydrates, Fat, Saturated
Fat !
60.00!
))
50.00!
Percentage!
+
40.00!
30.00!
20.00!
))
))
)))
10.00!
0.00!
Calories from
protein!
*= p" 0.05
**= p" 0.01
***= p" 0.000
Calories from Calories from
carbohydrates!
fat!
Calories from
saturated fat!
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baseline to follow-up (p" 0.00 ).
Results: Child diet behavior
Nutrient Intake: Sugar, Fiber
Figure 7.4
grams/100 kcal
C
ugar decreased from
*=
**=
***=
calcium decreased
.
0
5.00
4.50
4.00
3.50
3.00
2.50
2.00
1.50
1.00
0.50
0.00
**
***
Sugar
Fiber
ron intake
calcium de
follow-upcalcium decreased
.
follow-up
.
Results:
Child diet behavior
Figure 7.5
Nutrient Intake: Sodium
Nutrient Intake: Sodium
180.00
160.00
140.00
120.00
100.00
80.00
60.00
40.00
0.00
*=
**=
***=
*=
**=
0***=
0
180.00
160.00
140.00
120.00
100.00
80.00
60.00
40.00
***
Figur
Figure 7.6
***
6.0
5.0
mg/100 kcal
mg/100 kcal
Figure 7.5
mg/100 kcal
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sodium intake increased
sodium intake increased
4.0
3.0
2.0
1.0
0.00
0.0
*=
**=
***=
p
m
+
calcium decreased
.
ron intake
Results: Child diet behavior
Figure 7.6
Nutrient Intake: Calcium, Iron
6.00
***
mg/100 kcal
5.00
4.00
***
3.00
2.00
1.00
***
0.00
Calcium
*=
**=
***=
0
Iron
Results: Child physical activity
behavior
· Boys morning sedentary time decreased from baseline to follow-up (p "0.00 ) while light/moderate activity and vigorous
activity increased (p"0.00 and p"0.01, respectively) (Figure 8.1).
· Girls morning sedentary time decreased from baseline to follow- up (p"0.00) while light/moderate physical activity and vigorous
physical activity increased (p"0.00) (Figure 8.2).
Figure 8.1
Figure 8.2
Morning (8am-11am) Boys!
50!
50!
40!
40!
30!
Sedentary!
20!
10!
Minutes!
Minutes!
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: Instructional (8am – 11am) and Afterschool (3pm – 6pm). The vertical axis shows
the number of minutes spent in sedentary, light, moderate, or vigorous physical activity.
Light/ Mod
Vigorous!
Morning (8am-11am) Girls!
30!
Sedentary!
20!
10!
0!
0!
*=
*=
*=
*=
* =
* =
Light/ Mod
Vigorous!
8. Changes in child physical activity in school
Results: Child physical activity
behavior
Figure 8.3
Figure 8.4
Afterschool (3pm-6pm) Boys!
40!
40!
35!
35!
30!
30!
25!
25!
20!
Sedentary!
15!
Light/Mod
10!
Minutes!
Minutes!
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· Boys’ afterschool sedentary activity increased at midyear (p" 0.01) and decreased at follow-up. Light/Moderate physical activity
decreased at midyear and then increased at follow -up. Vigorous physical activity increased slightly from baseline to midyear and
decreased slightly at follow-up (Figure 8.3).
· Girls’ afterschool sedentary activity increased at midyear (p " 0.05) then decreased at follow-up. Light/Moderate physical activity was
the same at midyear then increased at follow- up. There is an increase in vigorous physical activity at baseline to midyear (p " 0.05) and
a slight decrease at follow-up.
Vigorous!
20!
Sedentary!
15!
Light/Mod
10!
5!
5!
0!
0!
*=
*=
*=
*=
* =
* =
Afterschool (3pm-6pm) Girls!
Vigorous!
Results: Child BMI

BMI data was measured at two time points: September 9,
2012 (baseline) and August 8, 2013 (follow-up).
BMI - All 3's and 4s Pre and Post
18
16
Number of Children
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14
12
Under
10
8
Normal
6
Overweight
4
Obese
2
0
Baseline
Follow-up
Waves
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Limitations

No control group so unable to determine causality

Small sample size (n=32) could have limited our ability to
detect changes, particularly in nutrition knowledge and
preferences scores

School environment scores were high at baseline leaving very
little room for score improvement
+ Discussion
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Increased teacher modeling and improvements to the
school environment may have led to positive dietary and
PA changes
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Significant increases in dietary fiber and iron and a
decrease in added sugars
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Increases in morning physical activity
Future efforts
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Continued improvements to the school menu
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Modifications in afterschool programming
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MSA/JDOH should continue to focus their efforts on
providing nutrition and physical activity education
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Encourage and supports parents and teachers to
promote and model health lifestyle behaviors
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Questions?