title: Head Start Wellness Policy Intervention in Hawaii: A Project of the Children's Healthy Living Program.
abstract: BACKGROUND
  The increased prevalence of childhood overweight and obesity across the United States and the Pacific has become a serious public health concern, with especially high prevalence among Native Hawaiian and Pacific Islander (NHPI) children. This study aimed to measure the effect of a Head Start (HS) policy intervention for childhood obesity prevention.
  
  
  METHODS
  Twenty-three HS classrooms located in Hawaii participated in the trial of a 7-month policy intervention with HS teachers. Classroom- and child-level outcome assessments were conducted, including: the Environment and Policy Assessment and Observations (EPAO) of the classroom environment; plate waste observations to assess child intake of fruit and vegetables; and child growth.
  
  
  RESULTS
  The intervention showed a positive and significant effect on classroom EPAO physical activity (PA) and EPAO total scores. Although mean BMI z-score (zBMI) increased at postintervention for both intervention (mean = 0.60; standard deviation [SD], 1.16; n = 114) and delayed-intervention groups (mean = 0.35; SD, 1.17; n = 132), change in zBMI was not significantly different between the groups (p = 0.50; p = 0.48).
  
  
  CONCLUSIONS
  These findings contribute evidence on the potential for HS wellness policy to improve the PA environment of HS classrooms. More research is needed to link these policy changes to other child outcomes.
authors.affiliation: 1 Department of Human Nutrition, Food, and Animal Sciences, University of Hawaii at Mānoa , Honolulu, HI.
authors.forename: Monica
authors.initials: M
authors.lastname: Esquivel
authors.affiliation: 2 Office of Public Health Studies, University of Hawaii at Mānoa , Honolulu, HI.
authors.forename: Claudio R
authors.initials: CR
authors.lastname: Nigg
authors.affiliation: 1 Department of Human Nutrition, Food, and Animal Sciences, University of Hawaii at Mānoa , Honolulu, HI.
authors.forename: Marie K
authors.initials: MK
authors.lastname: Fialkowski
authors.affiliation: 2 Office of Public Health Studies, University of Hawaii at Mānoa , Honolulu, HI.
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Braun
authors.affiliation: 1 Department of Human Nutrition, Food, and Animal Sciences, University of Hawaii at Mānoa , Honolulu, HI.
authors.forename: Fenfang
authors.initials: F
authors.lastname: Li
authors.affiliation: 1 Department of Human Nutrition, Food, and Animal Sciences, University of Hawaii at Mānoa , Honolulu, HI.
authors.forename: Rachel
authors.initials: R
authors.lastname: Novotny
mesh_terms: D002675:Child, Preschool; D005247:Feeding Behavior; D005260:Female; D006254:Hawaii / Q000453:epidemiology; D006291:Health Policy; D040361:Healthy People Programs; D006801:Humans; D008297:Male; D009043:Motor Activity; D044468:Native Hawaiian or Pacific Islander; D063766:Pediatric Obesity / Q000453:epidemiology / Q000517:prevention & control*; D015397:Program Evaluation; D011634:Public Health