Background
Childhood obesity and energy balance-related behaviors
Development of ¡Míranos! Look at us, we are healthy! (¡Míranos!)
Methods and design
Design and study aims
Study setting, recruitment, and randomization
Center eligibility | 1. A full-day center (offering ≥7 h of care/day) |
2. At least one classroom enrolling children aged 3 | |
3. Agreement to modify center physical activity and nutrition policies | |
4. Agree not to participate in other health-related studies. | |
Child eligibility | 1. Enrollment in a study center |
2. Age 3 years at baseline | |
3. One child per family | |
4. Parental consent |
Intervention and control condition
PA and Nutrition Policies | 1. Educate children to develop healthy habits for life |
2. Offer 90-min free, teacher-led physical activity to children at the center everyday | |
3. Offer balanced healthy meals and snacks utilizing the USDA Child and Adult Care Food Program best practice recommendations | |
Staff | 1. Be part of children’s play |
2. Role-model healthy behaviors to children at all times | |
3. Be physically active 30 min everyday | |
4. Eat healthy MyPlate meals everyday | |
Parents | 1. Help your child get 30 to 60 min physical activity at home everyday |
2. Serve fruits and vegetables to your child at every meal | |
3. Limit your child’s TV watching to less than 2 h everyday | |
4. Avoid offering sugar-added beverages to your child | |
5. Turn TV off during meals | |
6. Help your child get at least 10 h of sleep everyday |
¡Míranos! Center-based intervention
Policy Area: Active Play and Inactive Time | |
Policy #1 | Children will have at least of 90 min of structured and unstructured playtime each school day. |
Policy #2 | Children will participate in outdoor active play two times or more each school day. |
Policy #3 | Children will participate in morning outdoor play (structured activity 15 min and free play 15 min) each school day. |
Policy #4 | Children will participate in active learning classroom activities during center time, transition, and breaks (30 min) each school day. |
Policy #5 | Children will participate in afternoon outdoor play (structured activity 15 min and free play 15 min) each school day. |
Policy #6 | Screen time for entertainment at the center will be limited to 30 min per week. |
Policy #7 | Children’s sitting time will be < 15 min in any setting except nap and meal time. |
Policy Area: Play Environment | |
Policy #8 | Each child will have a piece of play equipment during structured play. |
Policy #9 | A variety of portable play equipment will be available for children to use at the same time during free play. |
Policy #10 | Heat Start teachers and teaching aids will lead and participate in physical activity with children. |
Policy #11 | Play area will be safe for children to play. |
Policy Area: Supporting Physical Activity | |
Policy #12 | Head Start staff will encourage children to engage in active play without pressure. |
Policy #13 | Head Start staff will not withhold playtime as punishment for children’s misbehaviors. |
Policy #14 | All Head Start center staff will complete a mandatory, paid training on obesity prevention, physical activity and nutrition. |
Policy Area: Mealtime Environment | |
Policy #1 | New fruits and vegetables will be introduced through structured food tastings. Non-food rewards will be given for participation. |
Policy #2 | Children will never be forced to eat or try new foods. Children will decide how much to eat at every meal and snack. |
Policy #3 | Food will not be given as a reward or taken away as punishment. |
Policy #4 | Staff members will sit at the table with children during meals and snacks. |
Policy #5 | Staff members will model healthy behavior by consuming the same food and drinks as the children and will not consume other foods and drinks in front of the children. |
Policy #6 | Meals will be served family style. |
Policy Area: Nutrition Education | |
Policy #7 | Teachers will incorporate Healthy Habits for Life into current curriculum and deliver lessons to children. |
Policy #8 | Staff will have the opportunity to participate in a free staff wellness program. |
Policy #9 | Healthy contests coordinated with the Healthy Habits for Life curriculum and staff wellness program will encourage children and staff to participate in healthy behaviors. Non-food rewards will be given for student and staff participation. |
Policy Area: Foods from Outside the Facility | |
Policy #10 | The center will have guidelines for foods or nonfood items brought into the facility and served for holidays and celebrations. |
Policy #11 | Holidays will be celebrated with mostly healthy foods and nonfood treats. |
Outdoor play sessions (morning and afternoon): | 1. 60 min of physical activities |
a. 15-min teacher led activities using Miranos! Activity Cards | |
b. 15-min free play | |
c. Join the children in play | |
d. Have play equipment out for free play | |
Health education activities from Healthy Habits for Life: | 1. Read/sing HHL poem at the beginning of the day |
2. Display HHL “Did You Know” poster at entrance for parents to read | |
3. Teach each HHL activity at least 2 times a week | |
4. Watch The Get Healthy Now Show 2–3 times a week (5–10 min at a time; do not watch the whole show in one setting) | |
5. Read Miranos! storybook for the week at least twice a week | |
6. Install YouTube version of all Miranos! storybooks on Learning Center computers | |
Transition activities that will keep children physically active: | 1. 15 min of physical activities |
a. Using GoNoodle | |
b. Using music on tablet | |
c. Active learning activities during Learn Centers | |
d. Goal: 15 min of physical activities | |
e. Not sitting longer than 15 min | |
f. Use Learning Ladder | |
g. Use Miranos! activity cards | |
Health contest: | 1. Track each child’s participation daily |
2. Post the contest results | |
Staff wellness: | 1. Complete weekly activity for each week |
2. Participate in health challenges | |
Evaluation survey: | 1. Complete the evaluation survey of all Miranos! activities by Friday |
¡Míranos! Staff wellness program
Home-based intervention
Session # | Topic |
---|---|
1 | Overview of ¡Míranos! |
2 | Physical Activity Benefits and Recommendations |
3 | Limiting Screen Time at Home |
4 | Balanced Diet and Expert Recommendations |
5 | Keeping Healthy Foods in the Home |
6 | Promoting a Balanced Diet and Healthy Eating Habits |
7 | Promoting Physical Activity Indoors and Outdoors |
8 | Sleep, Bedtime Routine, and Expert Recommendations |
Staff development and training
Comparison condition
Trial flow
Study measures
Primary outcomes | Baseline | Posttest | Follow-up |
Height, weight, Body Mass Index (BMI; kg/m2); BMI z-score [59] | C | C | C |
Secondary outcomes | |||
7-day accelerometry for PA, sedentary time and sleep [60] | C | C | C |
The Test of Gross Motor Skills | C | C | C |
Aggregated plate waste test, (241) | C | C | C |
National Health and Nutrition Examination Survey (NHANES) Dietary Screener | |||
7-day logs for child screening and sleep time (min/d) [61] | P | P | P |
Computer-assisted pictorial test for food preferences [62] | C | C | C |
Mediator/moderator measures | |||
The Home Self-administered Tool for Environmental Assessment of Activity and Diet [63] | |||
The Parenting Strategies for Eating and Activity Scale [56] | P | P | P |
Parent health knowledge test [43] | P | P | P |
Parental confidence/self-efficacy scale [64] | P | P | P |
Food Behavior Checklist [65] | P | P | P |
P | |||
Parent weight and physical activity [69] | P | P | P |
Family socio-demographics/health history | P |