Can a preschool health intervention improve preschoolers' lifestyle behaviors and home food environment?.

Chan, Yun Kwan.Accompanying CD-ROM contains appendix H, I, J, and K.Thesis (M.Phil.)--Chinese University of Hong Kong, 2008.Includes bibliographical references (leaves 161-170).Abstracts in English and Chinese; three appendixes in Chinese only.Library's copy: lacks accompanying CD-ROM.Acknowledgement --- p.iAbstract --- p.iiAbstract (Chinese) --- p.ivList of publications --- p.viTable of Contents --- p.viiiList of Figures --- p.xviList of Tables --- p.xviiList of Abbreviations --- p.xxvChapter CHAPTER ONE: --- INTRODUCTION --- p.1Chapter 1.1 --- Global prevalence of childhood overweight --- p.1Chapter 1.2 --- Preschool health situation in HK --- p.2Chapter 1.2.1 --- Breastfeeding --- p.2Chapter 1.2.2 --- Diet and physical activity patterns --- p.3Chapter 1.2.3 --- Prevalence of childhood overweight --- p.5Chapter 1.2.3.1 --- Definition of childhood overweight --- p.5Chapter 1.2.3.2 --- Local prevalence of childhood overweight --- p.6Chapter 1.3 --- Consequences of childhood overweight --- p.7Chapter 1.3.1 --- Health consequences of childhood overweight --- p.7Chapter 1.3.2 --- Economic consequences of childhood overweight --- p.9Chapter 1.4 --- Risk factors of childhood overweight and obesity --- p.11Chapter 1.4.1 --- Family Socioeconomic status --- p.11Chapter 1.4.2 --- Parental overweight --- p.11Chapter 1.4.3 --- Breastfeeding --- p.12Chapter 1.4.4 --- Birth order --- p.13Chapter 1.4.5 --- Breakfast consumption --- p.13Chapter 1.4.6 --- Beverage consumption --- p.14Chapter 1.4.7 --- High calcium intake --- p.15Chapter 1.4.8 --- Fruit and vegetable consumption --- p.15Chapter 1.4.9 --- Physical inactivity --- p.15Chapter 1.4.9.1 --- Physical activity recommendations for preschoolers --- p.17Chapter 1.4.9.2 --- Screentime recommendations for preschoolers --- p.18Chapter 1.5 --- Child development --- p.18Chapter 1.5.1 --- Onset of overweight --- p.18Chapter 1.5.2 --- Early establishment of lifelong habits at preschool age --- p.19Chapter 1.5.3 --- Interaction with parents --- p.20Chapter 1.6 --- Justification of preschool multi-component health intervention in Hong Kong --- p.22Chapter 1.6.1 --- Local health promotion initiative at preschool --- p.22Chapter 1.6.2 --- Justification for DRAGON2006 modifications --- p.23Chapter 1.6.2.1 --- Inclusion of family-home component in school- based health intervention --- p.24Chapter 1.6.2.2 --- Child BMI monitoring and health report to parents --- p.24Chapter 1.7 --- Present school-based preschool health intervention --- p.25Chapter 1.8 --- Summary --- p.27Chapter 1.9 --- Aims and objectives --- p.27Chapter CHAPTER TWO: --- METHODOLOGY --- p.28Chapter 2.1 --- Recruitment of preschools and preschoolers --- p.28Chapter 2.2 --- Development of DRAGON2006 --- p.33Chapter 2.2.1 --- Ethics approval --- p.35Chapter 2.2.2 --- Focus groups with parents --- p.35Chapter 2.2.3 --- Amendment and pretest of the questionnaires --- p.35Chapter 2.2.4 --- Health lessons --- p.36Chapter 2.2.4.1 --- Development and adaptation of the health lessons --- p.36Chapter 2.2.4.2 --- Improvement of the teaching materials --- p.37Chapter 2.2.4.3 --- Lyrics reproduction and CD production --- p.37Chapter 2.2.4.4 --- Worksheets --- p.38Chapter 2.2.4.5 --- Process evaluation --- p.38Chapter 2.2.5 --- Teachers´ة training --- p.38Chapter 2.3 --- Intervention Activities and Components --- p.39Chapter 2.3.1 --- Opening ceremony --- p.39Chapter 2.3.2 --- Health Talks --- p.40Chapter 2.3.3 --- Health report --- p.40Chapter 2.3.4 --- Parental newsletters --- p.41Chapter 2.4 --- Outcome evaluation --- p.42Chapter 2.5 --- Data collection --- p.43Chapter 2.5.1 --- Recruitment of subjects --- p.43Chapter 2.5.2 --- Anthropometric measurements --- p.43Chapter 2.5.3 --- Parental baseline and evaluation questionnaire administration --- p.44Chapter 2.5.4 --- Teachers´ة pre- and post-intervention evaluation and process evaluation --- p.44Chapter 2.6 --- Data management --- p.44Chapter 2.6.1 --- Verification of data from the questionnaires --- p.44Chapter 2.6.2 --- Data coding --- p.45Chapter 2.6.3 --- Data entry and verification --- p.45Chapter 2.6.4 --- Data analysis --- p.45Chapter 2.5.4.1 --- Descriptive and association analysis --- p.45Chapter 2.5.4.2 --- Construction of BMI-for-age percentile and z- score curves --- p.46Chapter 2.5.4.3 --- Evaluation of the effectiveness of the program --- p.47Chapter CHAPTER THREE: --- RESULTS --- p.48Chapter 3.1 --- Organization of the results --- p.48Chapter 3.2 --- Baseline comparability between the EG and CG --- p.48Chapter 3.2.1 --- General sociodemographic characteristics --- p.48Chapter 3.2.2 --- Preschoolers' diet and meal behaviors --- p.54Chapter 3.2.3 --- Preschoolers´ة dental health --- p.61Chapter 3.2.4 --- Parental child feeding behaviors --- p.62Chapter 3.2.5 --- Preschoolers´ة physical activity and sedentary behaviors --- p.66Chapter 3.2.6 --- Summary --- p.67Chapter 3.3 --- Baseline comparability between the completes and dropouts --- p.69Chapter 3.3.1 --- Participant flow in the EG and CG --- p.69Chapter 3.3.2 --- General sociodemographic characteristics --- p.70Chapter 3.3.3 --- "Preschoolers´ة diet, meal and physical and sedentary activity behaviors and parental child feeding behaviors" --- p.74Chapter 3.3.4 --- Summary --- p.75Chapter 3.4. --- Evaluation of the effectiveness of the DRAGON2006 --- p.76Chapter 3.4.1 --- General demographic characteristics --- p.76Chapter 3.4.2 --- Effects on preschoolers´ة anthropometry and weight status --- p.77Chapter 3.4.3 --- Effects on preschoolers' diet and meal behaviors --- p.79Chapter 3.4.4 --- Effects on parental child feeding behaviors --- p.89Chapter 3.4.5 --- Effects on preschoolers´ة physical and sedentary activities --- p.92Chapter 3.4.6 --- Summary --- p.94Chapter 3.5 --- "Teaching staff members´ة attitudes, perceptions and practices with respect to addressing childhood overweight" --- p.95Chapter 3.5.1 --- General demographic characteristics --- p.95Chapter 3.5.2 --- Teachers' attitude toward addressing childhood overweight --- p.98Chapter 3.5.3 --- Teachers' behaviors toward addressing childhood overweight --- p.99Chapter 3.5.4 --- Teachers' perceived abilities to deal with some childhood overweight topics --- p.100Chapter 3.5.5 --- Teachers´ة reported helpful factors to implementing a new preschool health program --- p.101Chapter 3.5.6 --- Teachers´ة reported helpful factors for and barriers to parents´ة participation --- p.102Chapter 3.5.7 --- Comparisons between staff with and without self-reported weight and height --- p.103Chapter 3.5.8 --- Summary --- p.105Chapter 3.6 --- EG teachers´ة evaluation of the program --- p.106Chapter 3.6.1 --- Teachers' perception of DRAGON2006 program before the intervention --- p.106Chapter 3.6.2 --- DRAGON teachers´ة process evaluation of the DRAGON2006 curriculum --- p.113Chapter 3.6.3 --- DRAGON teachers´ة evaluation of DRAGON2006 program after the intervention --- p.118Chapter CHAPTER FOUR: --- DISCUSSION --- p.127Chapter 4.1 --- "Baseline findings about the preschoolers' weight status, diet, meal and physical and sedentary activity situation" --- p.127Chapter 4.1.1 --- Preschooler and parental overweight and obesity --- p.127Chapter 4.1.2 --- Preschoolers´ة diet and meal behaviors --- p.128Chapter 4.1.3 --- Preschoolers´ة physical and sedentary activity behaviors --- p.130Chapter 4.2 --- "Gender associations with preschoolers´ة diet, meal and physical and sedentary activity behaviors and parental child feeding behaviors" --- p.131Chapter 4.2.1 --- Gender associations with preschoolers´ة diet and meal behaviors --- p.132Chapter 4.2.2 --- Gender associations with parental child feeding behaviors --- p.134Chapter 4.2.3 --- Gender associations with preschoolers´ة physical and sedentary activity behaviors --- p.135Chapter 4.3 --- "Age associations with preschooler diet, meal and physical and sedentary activity behaviors and parental child feeding behaviors" --- p.136Chapter 4.3.1 --- Preschoolers' age associations with their anthropometry --- p.137Chapter 4.3.2 --- Preschoolers´ة age associations with their diet and meal behaviors --- p.137Chapter 4.3.3 --- Preschoolers' age associations with their dental health --- p.139Chapter 4.3.4 --- Preschoolers´ة age associations with parental child feeding behaviors --- p.139Chapter 4.3.5 --- Preschoolers´ة age associations with their physical and sedentary activity behaviors --- p.140Chapter 4.4 --- "Family income associations with preschooler diet, meal and physical and sedentary activity behaviors and parental child feeding behaviors" --- p.141Chapter 4.4.1 --- Family income associations with some general demographic characteristics of the sample --- p.143Chapter 4.4.2 --- Family income associations with preschoolers´ة diet and meal behaviors --- p.144Chapter 4.4.3 --- Family income associations with parental child feeding behaviors --- p.147Chapter 4.4.4 --- Family income associations with preschoolers' physical and sedentary activity behaviors --- p.148Chapter 4.5 --- Factors associated with preschool overweight and obesity --- p.148Chapter 4.5.1 --- Preschooler overweight and obesity associations with some general demographic characteristics of the baseline participants --- p.149Chapter 4.5.2 --- Preschooler overweight and obesity associations with parental overweight and obesity --- p.150Chapter 4.5.3 --- Preschooler overweight and obesity associations with preschoolers' meal behaviors --- p.150Chapter 4.5.4 --- Preschooler overweight and obesity associations with their physical and sedentary activity behaviors --- p.150Chapter 4.6 --- The evaluation of the effectiveness of DRAGON2006 --- p.151Chapter 4.6.1 --- Baseline comparison between the education (EG) and control group (CG) --- p.151Chapter 4.6.2 --- Baseline comparison between completers and dropouts --- p.151Chapter 4.6.3 --- Follow up comparison between the education (EG) and control groups (CG) --- p.152Chapter 4.6.3.1 --- The changes in preschooler anthropometry --- p.153Chapter 4.6.3.2 --- The changes in preschooler diet and meal behaviors --- p.154Chapter 4.6.3.3 --- The changes in preschooler physical and sedentary activity behaviors --- p.155Chapter 4.6.3.4 --- Parental child feeding behaviors --- p.156Chapter 4.7 --- The teachers´ة evaluation results of DRAGON2006 and of Color Me Healthy --- p.156Chapter 4.7 --- Strengths and limitations of the study --- p.157Chapter 4.8 --- Suggestions for improvement of DRAGON --- p.159Chapter CHAPTER FIVE: --- CONCLUSION --- p.160References --- p.161AppendicesChapter AI --- Invitation letter for preschool (English) --- p.171Chapter AIII --- Invitation letter for preschool (Chinese) --- p.172Chapter AIII --- Invitation letter for CG preschool (Chinese only) --- p.173Chapter BI --- Research proposal (English) --- p.174Chapter BII --- Research proposal (Chinese) --- p.178Chapter CI --- Purpose and structure of DRAGON2006 health lessons (English) --- p.181Chapter CII --- Purpose and structure of DRAGON2006 health lessons (Chinese) --- p.185Chapter DI --- Teacher evaluation Part A (pre-intervention) (English) --- p.189Chapter DII --- Teacher evaluation Part A (pre-intervention) (Chinese) --- p.191Chapter EI --- Teacher evaluation Part B (process evaluation) (English) --- p.193Chapter EII --- Teacher evaluation Part B (process evaluation) (Chinese) --- p.205Chapter FI --- Teacher evaluation Part C (post-intervention) (English) --- p.218Chapter FII --- Teacher evaluation Part C (post-intervention) (Chinese) --- p.222Chapter GI --- Child health report (English) --- p.224Chapter GII --- Child health report (Chinese) --- p.226Chapter H --- Teaching kit --- p.228Chapter I --- Music sound track --- p.228Chapter J --- Curriculum worksheets (Chinese only) --- p.228Chapter K --- Parents´ة newsletters (Chinese only) --- p.228Chapter LI --- Focus group study questions (English) --- p.229Chapter LII --- Focus group study questions (Chinese) --- p.231Chapter MI --- Consent form for EG parents (English) --- p.233Chapter MII --- Consent form for EG parents (Chinese) --- p.235Chapter MII --- Consent form for CG parents (English) --- p.237Chapter MI --- Consent form for CG parents (Chinese) --- p.238Chapter NI --- Pre-internvetion parental questionnaire (English) --- p.239Chapter NII --- Pre-intervention parental questionnaire (Chinese) --- p.245Chapter OI --- Post-intervention parental questionnaire (English) --- p.250Chapter OII --- Post-internvetion parental questionnaire (Chinese) --- p.256Chapter PI --- Post-intervention staff survey (English) --- p.262Chapter PII --- Post-intervention staff survey (Chinese) --- p.264Chapter Q --- "Gender differences in preschoolers´ة diet, meal, physical and sedentary behaviors and parental child feeding behaviors" --- p.266Chapter R --- "Age differences in preschoolers´ة diet, meal, physical and sedentary behaviors and parental child feeding behaviors" --- p.296Chapter S --- "Income differences in preschoolers' diet, meal, physical and sedentary behaviors and parental child feeding behaviors" --- p.313Chapter T --- Factors associated with preschooler weight status --- p.334Chapter U --- "Maternal education level differences in preschoolers´ة diet, meal, physical and sedentary behaviors and parental child feeding behaviors" --- p.352Chapter V --- "Maternal birth place differences in preschoolers´ة diet, meal, physical and sedentary behaviors and parental child feeding behaviors" --- p.374Chapter W --- Test-retest reliability of DRAGON2006 questionnaire --- p.39