The Impact of Health-Start-Depart-Sante Intervention on Improving Dietary Intake of 3-5 Year-old Children Attending Childcare Centres in Saskatchewan and New Brunswick

Principal Investigators: 
Vatanparast, Hassanali (University of Saskatchewan)
Leis, Anne

1. The Health Problem/Issue

Early childhood overweight and obesity rates continue to rise in Canada. Unfortunately research shows that childhood obesity increases the risk of obesity and cardiovascular issues in adulthood. Early childhood is thus a critical time for prevention. Given their reliance on adults (i.e. parents, caregivers and educators), young children have little control over the diet – and activity related opportunities they are given, which ultimately influences their physical activity and healthy eating behaviours. Current research also indicates that Canadian early years children spend a large proportion of their day being sedentary and they often have poor dietary patters. While parents, as primary caregivers, have a large influence on the development of children’s lifestyle patterns, over 54% of Canadian children six months to five years spend nearly 30 hours per week in licensed childcare centres. As such, childcare centre practices can have a large impact on children’s behaviours and are key settings for implementing physical activity and healthy eating interventions.

2. The Objectives 

The proposed research aims to evaluate the effectiveness of Healthy Start-Depart Sante, an intervention program designed to improve the dietary intake of children, aged 3-5 years in Saskatchewan and New Brunswick. This will be accomplished by comparing childcare centers with and without a Healthy Start-Depart Sante program within a lO-month time span. Through the following three objectives, the study will determine to what extent:
·Primary Objective: Children in Healthy Start-Depart Sante childcare centres have healthier eating patterns.
·Secondary Objective 1: Children in Healthy Start-Depart Sante childcare centres have healthier weight status.
·Secondary Objective 2: Educators and directors in Healthy Start-Depart Sante childcare centers have improved knowledge, attitudes, and self-efficacy, leading to a change in environment and practice related to the provision of healthy food.  

3. The Approach 

The implementation of the Healthy Start-Depart Sante population health intervention is funded by the Public Health Agency of Canada since early 2013 and includes a small evaluation component to assess change in physical activity in this population. Funds sought in this application will be utilized to implement a nutrition assessment of children 3 to 5. Intervention daycare centres will be compared to usual practice day centres. A randomized controlled intervention design with gradual implementation over 10 months is proposed to address the above research questions. Over the course of three years, we will recruit 20 intervention child care sites (12 in SK and 8 in NB) and 20 control sites (12 in SK and 8 in NB). Based on an average of 28 eligible children per centre and the anticipated response proportion of 70%, a sample of at least 785 participants will be engaged.

4. The Unique Factors

We propose to evaluate a promising population health, multi-level intervention aimed at improving the nutritional status of 3-5 years old children who attend childcare centres. Such data are virtually non-existent to date. In addition the evaluation is uniquely collaborative and brings together key stakeholders from various sectors including policy makers, service providers, academics, parents and caregivers. We will use innovative and rigorous tools such as digital plate waste measurement, menu analysis, and questionnaires to assess Healthy Start's efficacy and impact.

5. How the project is relevant to the objectives of the initiative

Heart disease and stroke are associated with being overweight or obese which often has its roots in childhood. The 2013 physical activity report card shows that the percentage of young Canadian children with healthy weights continues to decline. Young children who are overweight or obese have an increased risk of remaining overweight in later stages of childhood and during their adult years. These children may follow a trajectory of lifelong poor health or risk of ill-health.  
Establishing healthy dietary habits early in life can reduce the risk of unhealthy weight and cardiovascular diseases in adulthood. Since dietary habits developed in childhood are likely to be maintained in adulthood. Research shows that in addition to parents and the home environment, early childhood educators and childcare settings are another major influence on children's healthy eating behaviours and physical activity. A successful early years comprehensive nutrition intervention program which improves the children's environment can help reduce the risk of overweight/obesity in childhood and heart disease and stroke later in life.  

6. The Impact

This study aims to evaluate how the Healthy Start initiative improves food served in childcare centres as well as the eating behaviours of young children in those centers. It seeks to change the physical and social environment around healthy food availability and consumption. It is expected that findings will show that childcare centres can promote healthy eating and be agents of change for healthier children and adults to be. A successful health promotion initiative in childcare centres can reduce the risk of childhood overweight/obesity and the early onset of heart disease and stroke.