Wellness Policy and the Head Start Environment: The Moderating Role of Head Start Teachers in the Children's Healthy Living Program in Hawai'i

Abstract

School wellness policy intervention for childhood obesity prevention has shown mixed results in preschool environments, with teachers considered a contributing factor to the variation. This study's objective was to examine whether a wellness policy intervention influenced the physical activity (PA) and nutrition environment in preschool classrooms and whether the effect depends on teachers' skills, knowledge and behaviors related to nutrition and PA. The wellness policy intervention was conducted in 23 Head Start classes, of which 11 were assigned to the intervention and 12 served as control. Classroom environments were assessed by the Environment and Policy Assessment and Observations (EPAO). Monthly surveys were mailed to teachers, asking if they had experienced any improvements in their nutrition and PA skills or knowledge, and other health behaviors and indicators. Health behaviors and indicators assessed included: increased water consumption; decreased sugar‐sweetened beverage consumption; increased level of PA; and improved weight control, blood pressure control, or stress management. Among classes where teachers' improvements in monthly surveys were greater than or equal to the mean, average EPAO‐total scores in the intervention group were 2.2 points higher than the control group (p=0.01) and mean EPAO‐PA scores were 3.5 points higher than the control group (p=0.003). In contrast, in classes where teachers had lower than the mean improvements, no significant difference was observed in either the total or PA EPAO mean scores between the two intervention groups. Wellness activities targeted at teachers in the HS environment may increase the effectiveness of wellness policy initiatives.