Fruits and Vegetables in an Inner-City Head Start Center.

Open Access
Fleischhacker, Sheila Erin
Graduate Program:
Integrative Biosciences
Doctor of Philosophy
Document Type:
Date of Defense:
June 16, 2004
Committee Members:
  • Cheryl Achterberg, Committee Chair
  • Leann L Birch, Committee Member
  • Linda Burton, Committee Member
  • Terryl Johnson Hartman, Committee Member
  • Carla Miller, Committee Member
  • Head Start
  • childcare
  • fruits and vegetables
  • nutrition education
  • preschoolers
  • inner-city
  • African Americans
  • low-income
Early intervention is one of the most effective methods of creating or changing dietary patterns; yet, evidence on intervening efforts targeted toward low-income and African American preschoolers is limited. These two groups, from the fetus through adulthood, endure a disproportionate risk of developing diet-related diseases and have a low intake of fruits and vegetables. Head Start offers one avenue to assist low-income and African American populations in improving their dietary intake and it may, thereby, help reduce their disproportionate health burden. The purpose of this exploratory, qualitative study is to: 1) explore the concepts, preference, availability, and dietary intake of fruits and vegetables in low-income, African American preschoolers who participate in an inner-city Head Start childcare center; 2) explore the concepts, preference, availability, and dietary intake of fruits and vegetables of the primary care providers (i.e. parents, grandparents, etc.) of the children studied under the first aim; and, 3) determine the level of shared meaning, preference, availability, and dietary intake of fruits and vegetables between the children studied under the first aim and both their primary care providers (studied under the second aim) and their childcare providers. Design and methods were informed by the Theory for the Ecology of Human Development, the Theory of Meaningful Learning, hypotheses generated by Achterberg, and the Ecological Model of Predictors of Childhood Overweight. The study methodology involved direct observations from January—August, 2002 of over six inner-city Head Start centers. Methods included: qualitative interviews (n=24 children, n=22 primary care providers, and n=2 childcare providers), preference ratings, descriptions of household availability, direct observations of the food served at the primary Head Start study center (n=77 days), mealtime observations, menu to actual food served comparisons, a child-feeding practices survey, and the National Cancer Institute Fruit and Vegetable Screener. Concept maps were used to analyze the interview transcripts. Statistical analyses aided in differentiating study participants and determining the correlation between concepts, preference, availability, and intake of fruits and vegetables within the sample. Some of the results indicate: the children’s average score for naming the foods was 73-75%. The children’s concepts varied tremendously—from almost none to some and often involved misconceptions such as “vegetables do bad things to the body.” The children who were able to express their concepts of fruits and vegetables primarily discussed where, when, and how they ate fruits and vegetables, where fruits and vegetables came from, what fruits and vegetables could do for their body, and their preference for fruits and vegetables. Preference ratings were positive with 80% of fruits and vegetables being rated as “yummy.” Fruits were preferred. The availability of fruits and vegetables in a child’s household varied, especially for fresh produce. Only six primary care providers reported having all the selected fruits and vegetables in their homes on a regular basis. The estimated median daily servings of fruits and vegetables were 7.03 and ranged from 13.87 to 1.86. Primary care providers also had a limited and varied understanding of fruits and vegetables with some misconceptions. Preference ratings were positive (82%) and the estimated median daily servings of fruits and vegetables were 8.69 and ranged from 15.97 to 0.85. Shared meaning and preference between children, primary care providers, and childcare providers in this study were minimal. Availability and intake were related among children and also between children and primary care providers. Child-feeding practices by both primary care providers and childcare providers included using food as a reward and portioning the children’s food. These results demonstrate that an inner-city Head Start center’s children and primary care providers both had: a varied understanding of fruits and vegetables with little meaning behind the concepts, a positive preference for fruits and vegetables, limited access to fruits and vegetables, and an intake of fruits and vegetables that varied. Nonetheless, between these children, primary care providers, and childcare providers minimal common meaning occurred. These findings indicate that nutrition communication, education, and intervening efforts for populations like this low-income, inner-city, African American sample should focus on developing methods and mediums to increase nutrition knowledge on fruits and vegetables in children, primary care providers, and childcare providers. Efforts should design mediums to facilitate similar dialogue and activities around fruits and vegetables in the home and childcare settings between these three groups. Potential topics and aims about fruits and vegetables can include expressing preference; improving household, childcare center, and community availability; along with targeting messages to increase dietary intake. Future research and theory should validate these findings in other samples and then should build off this work in order to learn how to effectively utilize Head Start—its meals, educational curriculum, and interaction with primary care providers—to promote healthy eating in at-risk populations and, in doing so, help reduce the risk of diet-related diseases prevalent in this population.