Morris et al. Having the knowledge to prepare and cook food is also a valuable skill to possess and could affect dietary patterns. If a person has insufficient skills to prepare food, this could limit types of food consumed, and thus could result in a poor-quality diet Research has shown that preschool-aged children who are actively involved in grocery shopping and simple food preparation are more likely to eat fresh fruits and vegetables Hands-on cooking activities can be a successful way to improve eating habits in youth Larson et al.
They found that adolescents who prepared food at home had lower intakes of fat and higher consumption of fruits and vegetables Middle-school youth who participated in a Cooking Camp program demonstrated increased confidence and mastery in food skills, vegetable consumption, and enjoyment in preparing food Providing children with the ability to understand where food comes from, as well as teaching them skills to prepare their food early on, could be beneficial in making healthy dietary choices throughout life.
Establishing a healthy lifestyle does not only refer to following appropriate dietary patterns, but also includes energy balance. Energy balance is defined as the balance between energy intake and expenditure, which plays an important role in maintaining a healthy lifestyle. Time allocated to both physical activity and screen time can influence the expenditure aspect of energy balance. Janssen et al. Television viewing among children is at an all-time high with children in front of a screen approximately 4.
The amount of time children spend looking at a screen, including televisions, computers, and other electronic devices, has increased dramatically and taken over children's free play time, once used for physically active play. Additionally, watching television during mealtimes is shown to be related to dietary patterns of children, specifically an increased amount of salty snacks and soda intake, and decreased amount of fruits and vegetables being consumed The numerous studies that have found links between childhood obesity and increased television viewing, coupled with the alarming amount of hours children spend in front of a screen, further supports a need to address screentime patterns with children 22 , Energy balance-related behaviors are contributors to the childhood obesity epidemic, and thus are important to include in prevention programs.
Research has shown that not only do dietary patterns and amounts of physical activity impact the likelihood of children becoming overweight or obese, but there is also an association with sleep patterns and childhood obesity. In addition, children who slept less or had poor sleep continuity were more likely to increase their food and SSBs consumption 9 , Sekine et al. Numerous factors play a role in the childhood obesity epidemic, and to address just one in a prevention strategy would not do the effort justice.
In an attempt to overcome the lack of obesity intervention programs focusing on multiple factors during early childhood, the Sprouts: Growing Healthy Habits curriculum was developed by researchers at the University of Illinois at Urbana-Champaign to provide a holistic approach to adopting a healthy lifestyle for children, with an emphasis on incorporating not only dietary patterns i. The goal of this study is to explore the Sprouts curriculum's impact on children's knowledge in healthy habit areas. The current study being reported is the controlled intervention examining changes in knowledge related to the Sprouts curriculum.
Prior to the controlled intervention phase, lessons and assessment tools were piloted and informally tested for feasibility. Teachers who reviewed the lessons reported that the lessons would be age-appropriate, meet educational goals, and fit into existing curriculum Additionally, pilot testing of the lessons and assessments indicated they were feasible for use in kindergarten classrooms and held children's attention.
After modifying the curriculum lessons and assessment tools based on feedback, the current pilot study was conducted. This study employed a nonrandomized controlled experimental design and was conducted during the — school year in six kindergarten classrooms of two elementary schools. Prior to curriculum implementation, undergraduate students enrolled in a two-semester transdisciplinary applied research course were trained by project coordinators on either the curriculum intervention or the assessment measures.
Different students were assigned to assessing the children and facilitating the curriculum to avoid any leading or biases during the evaluation process. Students who taught the curriculum were from a variety of disciplines at the University of Illinois. Classroom teachers were present during the curriculum implementation but not involved in teaching the lessons. They were asked to not make any changes to their planned curriculum nor to reinforce topics covered in the Sprouts curriculum facilitation phase.
We wanted to try to make sure lesson topics were not discussed any more than they normally would, to minimize differences between the intervention and control schools. Classroom teachers were asked to fill out a brief survey after each lesson to provide feedback. Additionally, a student was assigned to complete a curriculum facilitation checklist during every lesson to ensure fidelity of program implementation. These checklists confirmed that all lessons were consistently delivered based on instructions provided. The control school did not receive any type of alternative education in place of Sprouts curriculum.
The control group only participated in the pre- and post- assessments. Signed informed consent was obtained from the participants' parents; assent was provided verbally by children before each assessment. Consent letters were sent home with the kindergarten students at the beginning of the school-year, and parents mailed them back and included their home address to send payment and future surveys.
Pre and post-tests were exactly the same and consisted of six different assessments measuring healthy habit knowledge associated with the Sprouts lessons. Assessments were conducted across two testing periods with each child due to the amount of time it took to complete all assessments. The Sprouts curriculum was taught in three kindergarten classrooms in a small metropolitan public STEM academy, during normal school hours by undergraduate students from the University of Illinois. STEM schools focus on educating students in four specific areas: science, technology, engineering, and mathematics, through an interdisciplinary and applied approach.
The curriculum consists of eight lessons see Table 1 , taught weekly to individual classrooms for approximately 45—60 min, focusing on children's daily routines to instill the fundamental knowledge of healthy habits in various components of everyday life. The goals of the curriculum are to increase students' knowledge on topic areas, with the long-term goal of impacting behavioral change and reducing rates of childhood obesity. Topic areas include positive family interactions centered around mealtimes, healthy eating habits, understanding where food comes from, managing energy balance, healthy screen time and healthy sleep routines.
Each lesson has a specific focus that incorporates a discussion, activity, and a book to keep children engaged while offering a comprehensive approach to teaching healthy habits to this age group. The teacher then teaches the children about the five food groups, the importance of each group, and food examples for each group. During the activity portion of the lesson, children have the opportunity to go down pretend food aisles at a mock store to choose food paper pictures from each of the five food groups to make their own meal.
Cultivating relationships, connecting kids and schools back to real food
The teacher then reads a selected book to the children as a group, and asks them questions from the book related to the lesson. Materials and a lesson outline, that includes discussion questions are included in the curriculum for each lesson. The lesson is concluded by a short recap. All lessons follow this same format. Newsletters were also sent home weekly to inform parents of the healthy habits that their children were learning in school. These newsletters provided parents with strategies on how to integrate healthy habits at a family level.
Children 69 total in the intervention group from three kindergarten classrooms were taught the Sprouts curriculum, and had the opportunity to participate in the evaluation piece. However, only the children who assented and had parent consent participated in the pre- and post-intervention assessments 36 children. The low response rate was likely due to the passive recruitment tactics used i.
Thus, 57 children were included in the analyses. Children engaged in evaluation activities individually with researchers in a separate room from the classroom. Researchers administering the evaluation pieces were trained undergraduate students who were trained and observed for implementation fidelity by a research coordinator overseeing the project. They were not part of the curriculum implementation.
During training, the undergraduate students had the opportunity to practice implementing the activities either in groups or with children at a local early childhood school prior to working with the children who participated in this project. All measures were created to assess knowledge change in curriculum topic areas. Items involved in the assessments, such as pictures of specific foods, were the exact pictures that were shown during the curriculum implementation. This was done to prevent any issues with children not being able to recognize items, such as certain foods or activities, based on differences in backgrounds or access to varieties of foods and activities at home.
To assess children's knowledge of where food comes from, children were provided with six steps corresponding to the journey a seed takes to become food that is ready to eat at your table and asked to use sequence cards to put these steps in order. Each card had a picture of the action and was labeled with the word. The measure required a child to place the sequence cards in order from first step to the sixth step.
For each sequence assessment, research staff laid out the six steps and then identified what each card step was, by reading the label on the card, before the children began. The children were asked to place the cards on a board that had designated squares labeled 1 through 6 to assess their knowledge on the process of how food reaches one's table. Each of the six steps was scored on the distance between the child's answer and the correct answer, and then the absolute value was calculated for each item's score.
For example, if a child put the second step as the first step, the child would receive a score of one i. For example, if a child put the third step as the fourth step, the child would receive a score of one also i. The six-item scores were then summed, with a lower score indicating the child performed better, and a score of zero indicating the child identified each step correctly. The possibility of scores ranged from 0 to A similar sequence assessment scoring was used for the SSBs and energy expenditure assessments described below.
Knowledge of SSBs was also assessed through a card sequence task. Children were provided with six cards of different types of beverages. Each card had a picture of the beverage and was labeled with the type of beverage. The measure required a child to place the cards in order from the least amount of added sugar to the most amount of added sugar in a beverage. This assessment was conducted and scored based on the previously described sequence assessment see Farm to Table Knowledge description.
Children were provided with 10 cards, given one at a time. Each card had a picture of either a snack or meal portion size of food. The measure required a child to indicate whether the picture was one of a snack or meal. Research staff identified what each card was, by identifying the items on the picture. For example, a snack card would include items such as a banana, granola, fruit, and cheese, while a meal card would include items such as spaghetti and meatballs with a side plate of salad or eggs, toast, bacon, and fruit.
The 10 items were scored with 0 incorrect or 1 correct. The 10 items were then summed and higher scores indicated that the child performed better Cronbachs alpha pre-test: 0. Knowledge of energy balance was assessed by providing children with six cards of different types of activities. The measure required a child to place the cards in order from the least amount of energy expenditure to the most amount of energy expenditure.
To assess knowledge of bedtime routines, children were provided with 17 cards, given one at a time. Each card had a picture of an activity that is commonly done before bedtime e. The measure required a child to indicate whether the picture was something that would help people get a good night's sleep or not. There were a total of 9 healthy routine cards, that would help a person get a good night's sleep and a total of 7 unhealthy routine cards that have been found to impair quality sleep. The 16 items were scored with 0 incorrect or 1 correct.
The 16 items were then summed and higher scores indicated that the child performed better Cronbach's alpha pre-test: 0. Change in knowledge was assessed as post- minus pre-assessment score for each healthy habits content area. For the portion size and bedtime routine knowledge change scores, higher numbers indicated increases in knowledge. Since knowledge scores for the farm to table, energy expenditure, and SSBs were coded such that values closer to zero indicate the child performed better, negative values for the post minus pre change score indicated increases in knowledge.
To ensure that all change scores could be evaluated in the same way, these change scores were recoded as the inverse value such that higher scores also indicated increases in knowledge. Shapiro-Wilk tests indicated that the outcome variables were not normally distributed, and as such non-parametric tests were examined.
Differences between pre- and post-intervention scores were examined separately for the intervention and control school using the Signed Rank test Mann-Whiney U-test. Wilcoxon Two-Sample tests were used to examine change in assessment scores between the schools. Differences in demographic characteristics of participants were examined between the intervention and control schools using Fischer's Exact Tests see Table 2. Significant differences were found between participants in the two schools in relation to parent education and household income.
Parents in the intervention school reported higher education levels Demographic information compared between control and intervention schools using Fisher's exact test. Table 3 shows the difference in the assessment scores within-schools. Differences from pre- to post-intervention in the intervention school for farm to table, SSBs, and bedtime routine knowledge were significant and in the expected direction. On average, farm to table knowledge scores and knowledge of sugar content of beverages increased by about 2.
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Change in portion size knowledge was also significant within the control school, with on average 1 point increases in knowledge. Change in child knowledge in control and intervention schools compared within-school using signed rank tests and between-school using wilcoxon two-sample test. When considering changes in knowledge from pre to post between the intervention and control schools, there was only a significant difference for bedtime routines knowledge see Table 3.
Differences in changes in knowledge from pre- to post-intervention between the intervention and control schools were also examined using separate Generalized Linear Mixed Models for each outcome in order to adjust for household income and parental education. As such the Wilcoxon two-sample inter-school comparison models are presented for the sake of parsimony and ease of interpretation.
Don't make children eat their greens
This evaluation provides promising results for the impact of the Sprouts curriculum in kindergarten classrooms. The curriculum was significantly associated with increased knowledge of farm to table, SSBs, and bedtime routines in the intervention school. Activities and lessons in the control school were not monitored during the study period, so it may be the case that children in this school learned about these topics.
The Sprouts curriculum related to portion sizes is currently being reexamined and updated to focus more specifically on knowledge of snacks vs. Furthermore, when looking at the change in outcome across intervention and control schools within the same model, the increase in knowledge remained significant only for bedtime routines. It may be that topics children experience every day, such as bedtime routines, are easy to absorb and remember while newer topics such as farm to table that children may be learning for this first time could require repeated exposure in order to see significant increases in knowledge.
Sprouts: Growing Healthy Habits can provide a basis for introducing healthy habit topics to children, and future research will need to examine whether multiple lessons can increase knowledge over time.
- Early Childhood Activities for a Greener Earth (NONE).
- Lizzy (Italian Edition).
This curriculum can be a helpful tool in teaching children healthy habits that have not been traditionally taught in schools. Furthermore, this curriculum, which implemented lessons once a week that took less than an hour, still made an impact on knowledge, suggesting that with continued reinforcement and emphasis in the classroom and at home, children's knowledge could have continual improvements. Lack of observed increases in knowledge in all measures could be attributed to factors other than the effectiveness of the curriculum. For example, in the current study, significant demographic differences were noted between the intervention and control school, making it difficult to determine if increases in knowledge are generalizable to other contexts.
This finding strongly suggests that the increases in bedtime routine knowledge are robust, but further research is needed with demographically diverse schools to determine whether the curriculum would increase knowledge for other concepts. Additionally, each site only had a small portion of families consent to the evaluation piece, resulting in a small, demographically limited sample size. As such, it is unknown how the results reported here might generalize to other populations with different demographics.
Replication on a larger scale is suggested to provide stronger support for implementing Sprouts to teach about topics including both risk and protective factors related to obesity, in hopes that children adopt a healthy lifestyle. It should also be noted that the assessment tools used to examine changes in knowledge related to curriculum implementation were developed specifically for the current study. This is both a strength and a limitation. Given that no measures appropriate to capture change in child knowledge in the healthy habit domains covered by the Sprouts curriculum were available at the time of measurement, this study provides a first step toward creating measurement tools for use in early childhood settings to evaluate changes in children's knowledge of healthy habits.
However, the current pilot study was limited in scope in terms of the ability to carry out extensive reliability and validity testing of the developed assessment tools. More work is needed to develop valid measurement tools in these areas. As such, changes in knowledge or lack thereof observed with these assessment tools, such as the portion size measure which had low internal consistency, should be interpreted with caution.
Another component that may impact measurement is the aptitude level of the child. We were unable to measure children's language comprehension and cognitive ability in order test whether the children fully comprehended the lesson topics or the measurement tools. Furthermore, the intervention would be best optimized if classroom teachers and parents reinforced health messages throughout the week or time period outside of when curriculum was being taught. Studies have shown that children learn best when material has been repeated and taught in multiple formats i.
Due to the many contributing factors to childhood obesity, there are many topic areas that need to be covered in a healthy habits curriculum. The curriculum's eight lessons are each focused on a different topic area that is part of what constitutes a healthy lifestyle. We measured knowledge change shortly after the entire curriculum was taught, and thus, we do not have a measure of sustained results over time.
About Karrie Kalich, PhD
There were significant changes seen from pre to post, even though there was limited dosage of each topic lesson, showing positive results at least for short-term knowledge gain. In future research, studies should measure behavior change in parallel with knowledge change, as in the current study the main objective was to first understand knowledge change.
Long-term follow-up is also necessary to build a better understanding of whether school-based curriculum is the best avenue to create sustainable interventions to make lasting knowledge and behavior changes for children and their families. It may be necessary to also target parents through outreach materials or involve parents in classroom lessons in order to establish healthy habits that extend across contexts.
Despite these limitations the results show promise for this curriculum. Considering that, the Sprouts program showed promise in increasing knowledge the next steps are to adapt the curriculum for broader audiences. We recognize that a properly tailored curriculum in other early childhood education settings, such as home-based or center-based childcare facilities require adaptation.
Therefore, it is necessary to expand on these limitations by connecting with childcare providers and teachers about the barriers and facilitators of incorporating and implementing this curriculum to their specific setting. These conditions are also ideal for the growth of bacteria, including Salmonella , Listeria , and E.
If just a few harmful bacteria are present in or on the seed, the bacteria can grow to high levels during sprouting, even if you are growing your own sprouts under sanitary conditions at home. When eating out, you can ask that raw sprouts not be added to your food. If you purchase a sandwich or salad at a restaurant or delicatessen, check to make sure that raw sprouts have not been added. What can consumers do to reduce the risk of illness if they want to eat sprouts?
As you enjoy fresh produce, follow these safe handling tips to help protect yourself and your family. Fruits and vegetables are an important part of a healthy diet. Your local markets carry a wide variety of nutritious fresh fruits and vegetables. However, harmful bacteria that may be in the soil or water where produce grows can come in contact with fruits and vegetables and contaminate them. Fresh produce may also become contaminated after it is harvested, such as during storage or preparation.
Keep fruits and vegetables that will be eaten raw separate from raw meat, poultry, and seafood — and from kitchen utensils used for those products. When preparing any fresh produce, begin with clean hands. Wash your hands for at least 20 seconds with soap and warm water before and after preparation.
Many pre-cut, bagged, or packaged produce items are pre-washed and ready-to-eat. If so, it will be stated on the packaging, and you can use the produce without further washing.
Related Early Sprouts: Cultivating Healthy Food Choices in Young Children (NONE)
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