The role of early care educators in increasing health literacy to prevent

adolescent obesity

Lila Cornelio- Master of Science in Dietetics

Faculty Advisor- Joanne Kouba, PhD, RD, LDN

American Journal of Preventive Medicine

Introduction

• 1 in 5 children overweight or obese1

• 32% overweight or obese

• Low health literacy strong predictor: • Poor health outcomes

• Increased body weight

• Early care educators

• Influence health literacy obesity related behaviors2

• Early years greatest risk for obesity & developmental problems negative long term effects7

• 80.6% of children enrolled some form of childcare Image:CDC.gov

Childhood Obesity Health Consequences

• 5x more likely to be overweight through adolescence

• $19,000 more on obesity related costs

• Increased risk for cardiovascular disease • 70% of obese children have at least 1 risk factor

• 39% have 2 or more1

• Socioemotional & behavioral issues

• Physical discomfort

• Decreased lifespan1

• Economic and public health issue: 16-18% of total U.S. health costs obesity related4

Images: www.naturalproductsinsider.com; http://health.lilithezine.com/images/American-Obesity-Rates-07.gif

Cardiovascular Disease (CVD)• High blood pressure• Tobacco use• Elevated blood glucose (diabetes)• Physical inactivity• Unhealthy diet• Elevated Cholesterol/lipids• Overweight and obesity

Health Literacy

“the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” 9 -

IoM-

Must be improved in order to “create a system based on

wellness and prevention”.-Former Surgeon General, 2010-

Socio-cognitive

skills obtain & interpret

Translate actions & behavior better health10

A framework for

empowerment in children9

Use of preventive health services More emergency visits & hospitalizations11

• Poor management: medication & health conditions 7,9,12

• Acceptable vs inacceptable eating habits unhealthy behaviors 13

80 million Americans have inadequate health literacy11

The early care setting• 12 million children <6 yrs • Avg: 30 up to 40 hours/wk 1,14

• Low literacy:• 2x overweight or obese +poorer school performance

14

Healthy People 2020 objectives for Early and Middle Childhood: cornerstone for physical, cognitive, and social-emotional growth that influences long term well-being7

CDC, 2015c

Center-based early childhood care and education programs: Day care centers, Head Start programs, nursery schools,

preschools, pre-kindergarten programs, and other early childhood programs

High-quality education programs: Promote Healthy Behaviors improved speech, cognitive, social development in children17

Health literacy and Early Care EducatorsHabits begin early life greater independence 2,15

90% brain growth easier to adapt behaviors 7,16

Early Care Educators (ECE)

A resources for families

Positively influence health behaviors/health literacy

Foundation improved health

(education/prevention)Nutrition Literacy Pilot StudyTeachers underwent specific training1. Insight: nutrition issues2. Navigate through online nutrition sites 3. Improved communication & engagement

strategies4. Improved education  

Effective Strategies

• Easy to understand material

• Child friendly print, and nutrition resources

(MyPlate and reading labels)

• Parent teacher conferences

• Easy to see: Display boards & printed

material

Socioecological Model• Childhood obesity multifactorial

• Genetic and behavioral factors• Physical and social environment 5

• Health literacy goes beyond knowledge on health environment, government, lifestyle

Address all levels for sustainable practices & efforts

Socioecological Model (SEM)Social & physical environment affects growth and development

health decisions & behaviors

Health Literacy: A Prescription to End Confusion Patient care

Health systemEducation system

CommunityFigure 1. SEM (Carter, 2011)

Community

The Patient and Health Systems

Early Care Educators

Parents & Caregivers

Individual

Implications for advance practice

• Preschool Policies- include health promoting activities• RD collaboration

• Improved health literacy measures

• Health literacy within workplace: interventions, educational sessions, training

Methods for incorporating health literacy• Parent/Child friendly content: Individual health

literacy capacity• Improved Communication: developmental stage,

ethnicity, individual needs • Culturally competent-

• Consider: cultural attitudes, practices influences health behaviors

• Eliminate health literacy barriers & other barriers to health information and services

“prevention efforts in early and middle childhood can have lasting benefits”

Other areas: Health professionals- bridge the

gap Communities- resources,

information, basic literacy, influences, and services initiatives and promotion

Acknowledgements

• Dr. Kouba

• Marcella Niehoff School of Nursing

• Loyola Faculty

• Preceptors

• Friends and Family

THANK YOU!

Selected References1. Center for Disease Control and Prevention. (2016a). Childhood obesity causes & consequences. Division of Nutrition, Physical Activity, and Obesity. Retrieved from http://www.cdc.gov/obesity/childhood/causes.html

2. Ward, S., Belanger, M., Donovan, D., Horsman, A., & Carrier, N. (2015). Correlates, determinants, and effectiveness of childcare educators’ practices and behaviors on preschoolers’ physical activity and eating behaviours: a systematic review protocol.

3. Arteaga, S., Loria, C., Crawford, L., Fawcett, S., Fishbein, H., Gregoriou, M. John, L… Strauss, W. (2015). The Healthy Communities Study: Its Rationale, Aims, and Approach. American Journal of Preventive Medicine, 49 (4), 615-623. doi:10.1016/j.amepre.2015.06.029

4. Karnik, S. & Kanekar, A. (2012). Childhood Obesity: A Global Public Health Crisis. International Journal of Preventive Medicine. 3 (1):1-7. Retrieved from http://www.hrsa.gov/publichealth/healthliteracy/

5. Zhou, N & Cheah, C. (2015). Ecological risk model of childhood obesity in Chinese immigrant children. Appetite, 90, 99-107. doi:10.1016/j.appet.2015.02.028

6. U.S. Health and Human Services. (2014). Early and Middle Childhood. Healthy People 2020. Office of Disease Prevention and Health Promotion. Washington, DC. Retrieved from http://www.cdc.gov/obesity/strategies/childcareece.html

7. . Abrams, M., Klass, P. & Dreyer, B. (2009a). Health literacy and children: Introduction. Pediatrics, 124 (Supple 3), S262-S264. doi: 10.1542/peds.2009-1162A

8. World Health Organization. (2016b). Track 2: Health literacy and health behavior. Retrieved from http://www.who.int/healthpromotion/conferences/7gchp/track2/en/

9. Berkman, N., Sheridan, S., Donahue, K., Halpern, D. & Crotty, K. (2011). Low health literacy and health outcomes: An updated systematic review. Annals of Internal Medicine, 155, 97-107. doi:10.7326/0003-4819-155-2-201107190-00005

10. Benjamin, R. (2010). Improving health by improving health literacy. Public Health Reports, 125(6), 784–785.

11. Ballance, D. & Webb, N. (2016). For the mouths of babes: nutrition literacy outreach to a child care center. Journal of Consumer Health on the Internet. Author manuscript. 19(1), 1–12. doi: 10.1080/15398285.2015.998054

12. Lam, T. & Yang, L. (2014). Is low health literacy associated with overweight and obesity in adolescents: an epidemiology study in a 12–16 years old population. Archives of Public Health 2014, 72 (11). Retrieved from http://www.archpublichealth.com/content/72/1/11

13. Natale, R, Scott, S., Messiah, S., Schrack, M., Uhlhorn, S. & Delamatar, A. (2013). Design and methods for evaluating an early childhood obesity prevention program in the childcare center setting. Study Protocol. BioMed Central Public Health, 13 (78)http://www.biomedcentral.com/1471-2458/13/78

14. Center for Disease Control and Prevention. (2015b). Early care and education. Division of Nutrition, Physical Activity, and Obesity. Retrieved http://www.cdc.gov/obesity/strategies/childcareece.html

15. Child Trends Databank. (2014). Early childhood program enrollment. Retrieved from http://www.childtrends.org/?indicators=early-childhood-program-enrollment

16. Sanders, L., Judith, S., Ghislaine, G, Cynthia, B., & Rima, R. (2009). Health literacy and child health promotion: Implications for research, clinical care, and public policy. Pediatrics, 124(3). doi: 10.1542/peds.2009-1162G

17. Abrams, M., Klass, P. & Dreyer, B. (2009b). Health literacy and children: Recommendations for action Pediatrics, 124 (Supple 3), S327-S331, doi:10.1542/peds.2009-1162I

Cater, M. (2011). Social ecological model. [Image]Retrieved from https://lsuagcenterode.wordpress.com/2011/07/12/individuals-exist-within-multiple-groups-how-does-this-impact-program-design/

Center for Disease Control and Prevention. (2015c). [Image]. Retrieved fromhttp://www.cdc.gov/healthliteracy/education-support/index.html

Questions?