“Monkey see, monkey do”: Peers' behaviors predict preschoolers' physical activity and dietary intake in childcare centers
Introduction
Establishing healthy eating and physical activity behaviors in childhood is important as these can persist into adulthood (Bélanger et al., 2015, Mikkilä et al., 2005) and could lead to better health outcomes later in life. Childcare centers have been identified as potential key locations for the promotion of healthy eating behaviors and physical activity as approximately 80% of preschoolers (2 to 5 years old) living in developed countries receive out-of-home care (Organisation for Economic Co-operation and Development, 2013), and spend a considerable amount of their waking hours in childcare centers. For example, 70% of Canadian parents who use childcare services for their children under the age of 4 report using them for at least 30 h a week (Sinha and Bleakney, 2014).
Childcare centers offer many opportunities for children to develop both healthy eating behaviors and physical activity. Children who attend childcare centers on a full-time basis are generally offered lunch and snacks, which can contribute to their daily nutritional requirements (Benjamin Neelon et al., 2011). United States benchmarks for nutrition have suggested that half to two-thirds of children's nutritional needs should be met while in childcare (Benjamin Neelon et al., 2011). However, many preschoolers consume low amounts of vegetables and fruit, and excessive amounts of saturated fat and added sugars while in childcare centers (Copeland et al., 2013, Erinosho et al., 2013, Gubbels et al., 2014). Furthermore, despite opportunities for children to be active inside and outside, studies have consistently shown that sedentary time within childcare centers is typically high, while physical activity levels are typically very low, accumulating < 20 min per day of moderate-to-vigorous physical activity (MVPA) during an 8-hour day (Kuzik et al., 2015).
Bandura's theory of observational learning suggests that children can learn new behaviors, or increase or decrease the frequency of a previous behavior by observing, remembering and replicating the behaviors of those around them (Bandura, 1977). Furthermore, it is suggested that children will be more likely to replicate the behavior of someone who they like, respect or who they perceive as similar to themselves (Bandura, 1977). Therefore, preschoolers' eating and physical activity behaviors may be shaped by imitating those of their peers while in childcare centers. However, a recent systematic review concluded that current evidence of a potential relationship between preschoolers' food intake or physical activity, and that of their peers is based on small controlled experimental research, cross sectional observations, and small pre-post studies (Ward et al., 2016). This review also highlighted the need for longitudinal population-based studies to examine how peers influence these behaviors over time, as recent data suggest that it can take up to 8 months for a health-related behavior to be adopted (Lally et al., 2010). Therefore, this study aimed to assess how peers' behaviors predict preschoolers' dietary intake and physical activity in childcare centers, over the course of 9 months.
Section snippets
Subjects
Participants in the Healthy Start – Départ Santé (HSDS) intervention, a clustered randomized controlled trial conducted over a 9-month period in New Brunswick and Saskatchewan, provided data for this longitudinal study (Bélanger et al., 2016). All preschoolers (3 to 5 years) attending the childcare center on a full-time basis were eligible to participate in the study. Of the 61 childcare centers that were recruited for the HSDS intervention, dietary data from children who attended 17 childcare
Dietary intake
Children's intake in calories, fiber, sugar, fat, sodium, and fruit and vegetables was assessed at lunch on two consecutive weekdays, at baseline (October 2013 and 2014) and endpoint (9 months later, i.e., June 2014 and 2015, respectively) of the same school year, using weighed plate waste and digital photography. These nutrients were chosen based on reports that Canadian children frequently consume foods and beverages that are high in calories, sugar, fat and sodium, and consume insufficient
Results
Of the 1205 children eligible to participate in the HSDS intervention in the first two years of the study, parents of 730 children (61%) provided consent. Of these children, 350 attended a childcare center that was randomized to the control group (203 children in New Brunswick and 147 children in Saskatchewan). An average of 23 children were enrolled in the preschool program in each of the childcare centers. A total of 238 children (mean age of 4.0 at the beginning of the study) provided data
Discussion
To our knowledge, this is the first study to objectively assess how peer behavior predict change in preschoolers' dietary intake and physical activity peers over time. Results suggest that peers' dietary intake and physical activity predict children's dietary intake and physical activity over a 9-month period. Specifically, the greater the deviation between children's intake or physical activity and those of their peers at the beginning of the year, the more their behavior changed to become
Conclusions
This study objectively assessed how peers' behaviors predicted change in preschoolers' dietary intake and physical activity over time. Specifically, our study suggests that the greater the deviation between children's dietary intake or physical activity level and those of their peers at the beginning of the year, the greater their change in dietary intake or physical activity will be over time. Our findings suggest that improving some children's eating behaviors and physical activity could
Declaration of conflict of interest
No conflicts of interest were reported by the authors of this paper.
Acknowledgements
Funding Support: The Healthy Start study is financially supported by a grant from the Public Health Agency of Canada (# 6282-15-2010/3381056-RSFS), a research grant from the Consortium national de formation en santé (# 2014-CFMF-01), and a grant from the Heart and Stroke Foundation of Canada (# 2015-PLNI). SW was supported by a Canadian Institutes of Health Research Charles Best Canada Graduate Scholarships Doctoral Award and by the Gérard-Eugène-Plante Doctoral Scholarship. The funders did not
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