Head Start Teacher Nutrition Knowledge, Attitudes and Diet as Predictors of Classroom Mealtime Behaviors with Children

Recent research has suggested that childcare settings can play an integral role in the prevention of childhood obesity. Childcare providers are in a unique position to influence the diets of children through a number of mealtime interactions including food and nutrition intake, observational learning and nutrition education (Hendy et al., 2000; Birch, Zimmerman, & Hind, 1980). However, there is little evidence on childcare provider’s own behavior, in particular how their own diet, attitudes and knowledge may influence their mealtime behaviors with children. The purpose of this study was to examine the association between childcare providers’ diet, nutrition knowledge, attitudes, and their classroom feeding practices. Participants were 85 Head Start teachers (i.e., head, assistant, special education and teacher’s aide) from 16 Head Start centers across Rhode Island. Teachers were predominantly female (2 participants were male), averaged 40 years of age (range: 19-63, SD = 11.37) and reported 14 years of experience as a childcare teacher. The study was a cross-sectional design involving a classroom mealtime observation of teachers during either a breakfast (n=19) or lunch (n=66). Teachers were rated on 48 items using the Mealtime Behavior Observation Scale, adapted from the Environmental Policy Assessment and Observation (EPAO) tool, designed to capture optimal feeding practices. Teachers also completed the EPAO Self-Report Children’s Eating Scale, the Nutrition Attitudes Inventory, the NCI Fruit and Vegetable Screener, and several other measures designed for this study including a nutrition knowledge survey and a demographics, health, and center practice survey. Principal Components Analysis of the observed and self-reported mealtime behaviors yielded six additional composite scores. Observed autonomy support and involvement composites were examined in addition to the Mealtime Behavior Observation total score. Self-reported autonomy support, self-efficacy, avoidance of reward, and structure composites were examined in addition to the EPAO Self-Report Children’s Eating Scale total score. Teachers scored relatively high on all measures. Head Start teachers reported higher than average fruit and vegetable consumption and had high levels of nutrition knowledge and positive nutrition attitudes. Both the direct observation and the self-reported mealtime behavior suggested that teachers were engaging in high levels of best practices. For example, teachers frequently engaged in talking to the children about the foods they were eating, ate fruits and vegetables at the meal with children, and encouraged pleasant conversation during mealtimes. There was no evidence of fast food, salty snacks or sugar-sweetened beverage consumption during the meal. Among Head Start teachers in this study, older and more experienced teachers demonstrated higher scores on the observed classroom behavior and on the self-reported mealtime behavior. Teachers observed during lunch scored significantly higher on observed mealtime behaviors than those observed during breakfast. Nutrition attitudes, but not diet or knowledge, were positively associated with higher teacher self-reported behavior and the self-efficacy composite. In contrast to hypotheses, knowledge, attitudes and diet were not significantly associated with the observed mealtime behavior total score. After controlling for age, experience, and meal type, nutrition attitudes were inversely associated with observed support for autonomy. After controlling for age and experience, nutrition knowledge was negatively associated with self-reported self-efficacy while nutrition attitudes were positively associated with self-reported self-efficacy. None of the other regression analyses were significant. In both models, controlling for the covariates resulted in significant associations between attitudes and observed autonomy support as well as knowledge and self-reported self-efficacy compared to what was observed in the bivariate analyses, though variables remained negatively associated with outcomes. Future research may need to examine how teacher experience may modify the associations between attitudes/knowledge and behavior. In conclusion, both reported and observed mealtime behavior total scores among this Head Start population indicate high adherence to best mealtime practices. Further, there was limited support for a significant association between teacher diets, knowledge and attitudes, and their classroom behavior. Lack of variability among teachers in this sample, on both the independent and dependent measures, may have restricted our ability to establish the hypothesized associations. It appears that age and experience of the teachers, as well as strong adherence to Head Start guidelines, were the strongest predictors of mealtime behaviors. Future research should examine similar associations among childcare provider populations with less strict regulations around meals. Multiple observations of the same mealtime might be more representative of individual teacher behavior. Examining the association between childcare provider characteristics and child outcomes is an important next step. Given that children learn about healthy eating from their families and teachers, it is important to continue to learn all we can about the best ways to support this process