Evaluating an Integrated Nutrition and Parenting Education Program for Preschoolers and Their Parents.
The main purpose of the study described in this article was to test the effectiveness of Little Books and Little Cooks, a 7 week integrated nutrition and parenting education intervention designed to improve eating habits of families, strengthen relationships between parents and their children, and improve preschoolers' cooking skills. Participant families showed promising change related to enhancing children's cooking skills, along with improved parent child interactions, eating behaviors among children, and feeding practices of parents. These findings suggest that a multidisciplinary, integrated approach addressing both nutrition and parenting is an effective way to help parents guide their children toward healthful eating behaviors. Introduction According to the ecological systems theory (Bronfenbrenner Morris, 1998) human development occurs as a result of interaction within and among contexts. Many of Bronfenbrenner's early writings recognized the family itself as a more appropriate context for intervention than the individual child (e.g. Bronfenbrenner, 1974) Additionally, group based parenting education programs have appeared to be effective and potentially cost effective options for families (London Economics, 2007) It stands to reason that researchand practicebased Extension parenting education programs can make a considerable difference in the lives of families all around a community. Previous parenting research supports the importance of the parent child relationship and its impact on healthful development of the child (Bornstein, 2002; Brooks Gunn Markman, 2005; Karoly, Kilburn, Cannon, 2005; Powell, 2005) Nutrition studies in the 1980s began demonstrating that a person's overall parenting style can determine his or her feeding behaviors with a child (Birch, McPhee, Shoba, Steinberg, Krehbiel, 1987) Contemporary nutrition work continues to demonstrate the potentially positive relationship between parenting styles (including feeding practices and style) or parent child interaction and young children's eating behaviors, food preferences, dietary patterns, and weight statuses (Rhee, 2008; Ventura Birch, 2008; Wake, Nicholson, Hardy, Smith, 2007) YaeBin Kim Assistant Professor and Extension Specialist University of Nevada Cooperative Extension Las Vegas, Nevada yaek@unr.edu Findings from these studies suggest that parents with competent parenting skills are able to provide a supportive environment for children's healthful eating. However, most nutrition education programs have not addressed parenting skills. According to a focus group study involving parent and family life educators (Ontai, Williams, Lamp, Smith, 2007) parents lack skills necessary to implement new nutrition practices with their children, but educators do not have the understanding of parenting and child development required to address these issues with parents. Therefore, a multidisciplinary, integrated approach that can speak to both nutrition information and parenting education is needed to help parents foster children's healthful eating behaviors. Extension professionals have been trying this multidisciplinary approach (Thering, 2009) and the U.S. Department of Agriculture's National Institute of Food and Agriculture (2011) has fostered this concept by grouping programs by content expertise and discipline, rather than function. One way of addressing the challenge of helping parents implement positive nutrition practices with their children is through engaging and fun family practices. Nutrition studies have shown that reading children's books with healthful eating messages encourages children to try new foods and make healthful choices (Drozd, Romaniello, Wearner, Carter, Auld, 2006; Flood, Murphy, Hammerschmidt, 2008) and that involving young children in planned cooking experiences is the best way to teach them about good eating habits (Dodge Colker, 1996) The healthful eating habits children practice early in life affect their health and nutrition throughout youth, including relative to issues with weight gain and obesity (Clark, Goyder, Bissell, Blank, Peters, 2007) and beyond into adulthood (Campbell Crawford, 2001; Savage, Fisher, Birch, 2007) Cooking together is one of a few activities that can help increase children's abilities across all areas of development and help parents learn about healthful eating and their own feeding styles (Spears, 2000) The Little Books and Little Cooks parenting education program was developed from prior nutrition and parenting education research by an Extension specialist in Nevada, using the family as the primary contextual unit. Based on interaction inherent among family members, it was designed to foster and sustain the child's healthful development by providing engaging, hands on activities for caregivers and children. The main purpose of the research described here was to evaluate the effectiveness of Little Books and Little Cooks as an integrated nutrition and parenting education program, specifically examining its ability to enhance parent child interaction skills and parents' feeding practices and to improve children's cooking skills and eating habits. Methods Program Description Little Books and Little Cooks is a 7 week interdisciplinary parenting education program for preschool age children and their parents that incorporates both nutrition education and parenting education (including parenting related content specific to nutrition and overall parenting information) During the program, children and parents learn about healthful eating and nutrition information together, apply positive parentchild interaction techniques, and practice school readiness skills through mini lessons, nutrition related activities, reading children's books about healthful eating/nutrition, and cooking and eating. After the introductory week, each weekly session features a new topic, a new book about healthful eating, and a new recipe (see Table 1) Table 1. Research in Brief Evaluating an Integrated Nutrition and Parenting Education Program for Preschoolers and Their Parents JOE 54(5) (c) 2016 Extension Journal Inc 1 Little Books and Little Cooks Curriculum Overview Week Topic Book Recipe 1 Safety rules and equipment use demonstration 2 Five food groups according to the U.S. Department of Agriculture MyPlate guide MyPlate and You Five foodgroup pasta 3 Benefits of cooking with kids Pumpkin Soup Pumpkin pancake smiles 4 Introducing cultural foods Bee Bim Bop Rice ball 5 Parents' feeding styles and child's hunger and fullness cues Mealtime Grilled cheese sandwich shapes 6 Child's picky eating behaviors I Will Never Not Ever Eat a Tomato Cucumber yogurt dip 7 More fruits and vegetables Growing Vegetable Soup Vegetable soup Program Sites and Participants Thirty one program sites in Clark County, Nevada, were selected for participation in the study (conducted January December 2014) on the basis of staff interest, evidence of community collaboration, population in need, and variations in program characteristics. The selected program sites included community recreation centers, libraries, and parent centers. Program participants were children aged 3 5 and their primary caregivers (referred to herein as parents or caregivers) For the purposes of the study, 349 caregivers completed preprogram questionnaires, and 232 parents completed postprogram questionnaires. The majority of the caregivers who participated (93% were mothers, and 53% of the participating children were girls. The average caregiver age was approximately 33 years, and the average child age was 4.3 years. More than half of the families (58% were involved with at least one social service (e.g. Women, Infants, and Children program; Temporary Assistance for Needy Families; Medicaid; Supplemental Nutrition Assistance Program) The parents and children attending the classes were ethnically diverse: 52% were Hispanic, 29% were Caucasian, 8% were Asian, 4% were African American, and 7% were other ethnicities. Fifty one percent of the parents held a high school degree or less. The program reached diverse audiences in Clark County who are in need. Outcome Evaluation and Data Analysis The effectiveness of Little Books and Little Cooks was evaluated through the use of a self report survey instrument completed by parents and an observation checklist completed by trained observers. The survey Research in Brief Evaluating an Integrated Nutrition and Parenting Education Program for Preschoolers and Their Parents JOE 54(5) (c) 2016 Extension Journal Inc 2 consisted of 27 questions related to parents' feeding styles (Wardle, Sanderson, Guthrie, Rapoport, Plomin, 2002) and 24 questions related to children's eating behaviors (Wardle, Guthrie, Sanderson, Rapoport, 2001) all having Likert scale response options ranging from 1 (never) to 5 (always) seven demographic questions; a question related to frequency of cooking, with scaled response options ranging from 1 (never) to 6 (every day) and a question related to frequency of fruit and vegetable consumption for parents and children, with scaled response options ranging from 1 (0) to 5 (5+ The observation checklist was created for the program and designed to be completed by trained researchers different from the program providers. The observation checklist addressed child cooking skills (13 items) parent child interaction during cooking (10 items) and mealtime behavior (four items) scales for all items ranged from 1 (not observed) to 3 (consistently observed) Rater reliability training was conducted at the investigator meetings and five pilot program sites before the start of the study .91 reliability) Both assessments the parent survey and the observation were administered at the start and end of each 7 week cycle. The preprogram and postprogram mean scores for each subscale and individual item were compared through the use of paired ttests (N 228) Findings Parent Outcom