Happy Family, Healthy Kids: An Intergenerational Program to Promote Healthy Eating Habits
Phase: NA
Conditions: Healthy Diet, Stress, Pediatric Obesity, Intergenerational Relations
Sponsor: Michigan State University

Happy Family, Healthy Kids: An Intergenerational Program to Promote Healthy Eating 
Habits 
NCT04183179 
Date: August 23, 2022

Theoretical Framework 
The “Happy Family, Healthy Kids” program was grounded in the Actor-Partner 
Interdependence Model (Cook & Kenny, 2005), the Allostatic Load Model (McEwen, 2000), and 
the Transactional Theory of Stress and Coping (Lazarus & Folkman, 1987). The Actor-Partner 
Interdependence Model has been used in lifestyle behavioral and mental health interventions to 
better understand the intergenerational interactions and relationships inside a family (Braithwaite 
& Fincham, 2011; Vedanthan et al., 2016). The Actor-Partner Interdependence Model 
demonstrates the bidirectional relationship between preschoolers and parents: 1) actor effects 
within preschoolers or parents and 2) partner effects between preschoolers and parents (Cook & 
Kenny, 2005).  
According to the Allostatic Load Model (McEwen, 2000) and the Transactional Theory 
of Stress and Coping (Lazarus & Folkman, 1987), to respond to stress, individuals first 
cognitively appraise external stressors according to their harm, threat, or challenge. Then, they 
respond to the appraised stressors with different coping strategies including problem-focused 
coping, emotion-focused coping, and avoidant coping. Problem-focused coping focuses on 
making cognitive and behavioral effort to change a stressful situation in a positive way (Lazarus 
& Folkman, 1987). Emotion-focused coping involves regulating difficult emotions such as anger, 
fear, anxiety, depression, frustration, and sadness that are associated with stress (Lazarus & 
Folkman, 1987). Avoidant coping is a maladaptive form of coping that includes denying or 
avoiding the stressful situations or feelings to temporarily reduce stress (Penley, 2002). When the 
selected coping strategies fail to manage the external stressors, the cumulative burden of chronic 
stress (allostatic load) can lead to poor health outcomes such as obesity, cardiovascular diseases, 
anxiety, and depression (Guidi et al., 2021; Lazarus & Folkman, 1987; McEwen, 2000). 

Fortunately, maintaining a healthy lifestyle, such as having healthy diet, is associated with lower 
allostatic load, resulting in improved physical and mental health (Forrester et al., 2019; Mattei et 
al., 2013). Based on information from the theory and models, the “Happy Family, Healthy Kids” 
program focused on the connections between F/V intake and mental health to strengthen both 
preschoolers’ and parents’ adaptive coping strategies (e.g., mindful eating) and reduce 
maladaptive coping strategies (e.g., emotional eating) to enhance their overall well-being.  
Methods 
Study Design, Setting, and Sample 
 
A one-group quasi-experimental study was conducted in 13 Michigan Head Start centers 
across two academic years. In Year 1, three urban Head Start centers (eight classrooms) and 
three rural Head Start centers (five classrooms) participated. In Year 2, four urban Head Start 
centers (five classrooms) and three rural Head Start centers (five classrooms) participated. The 
total enrollment from the 23 Head Start classrooms was 374 preschoolers, and 127 (34%) of the 
families were initially interested in participating in the study. Of the 127 families, 20 were 
excluded due to not meeting the inclusion criteria or declining to participate or for other reasons. 
A total of 107 parent-preschooler dyads were enrolled in the study, but four preschoolers did not 
receive the program due to being dropped out of the Head Start programs. The study flow 
diagram is presented in Figure 1.  
 
We recruited parent-preschooler dyads using the following two strategies: 1) Head Start 
teachers and family engagement specialists shared the recruitment flyer with their classroom 
families; and 2) at urban settings, the study project manager and trained research assistants 
recruited participants and answered questions in-person during daycare drop-offs and pick-ups. 

A $5 e-gift card was distributed to the families who completed the enrollment and screening 
survey.  
 
Sample size was estimated using the freely available G*Power software. With the study 
design being one-group quasi-experimental and a significance level of 0.05, a sample size of 90 
would achieve 80% study power to identify a small effect size of 0.30, and a sample size of 102 
would achieve 85% power. Inclusion criteria were: 1) child was 3-5 years old and enrolled in a 
participating Head Start program; 2) parent was the primary caregiver for the child, had at least 
weekly Internet access, and was willing to use Facebook to participate; 3) dyad was able to speak 
and understand English; and 4) parental consent and child assent (if child was five years old) 
were obtained. Preschoolers were excluded if they had any medical conditions preventing them 
from participating in dietary changes. University Institutional Review Board approved the 
project, and parents’ consent and 5-year-old preschoolers’ verbal assent were obtained.  
“Happy Family, Healthy Kids” Program 
 
Table 1 demonstrates the three components of the 14-week healthy eating and stress 
management program. Each participating family received a crockpot and a program “Healthy 
Tasty Cookbook” to promote healthy family meals at home, an adult and a child MyPlate plates 
to encourage appropriate portion size and healthy eating habits, and a community resource 
booklet to share community resources on healthy eating (e.g., local farmers markets) and stress 
management (e.g., mindfulness classes, local trails for walking in nature).  
Measurements and Data Collection 
As demonstrated in Table 2, reliable and valid instruments were selected to assess 
program outcomes at two time points: baseline and post-program. Parents completed an online 
survey measuring their nutrition knowledge, self-efficacy, support, child feeding 

beliefs/attitudes/practices, food resource management behavior, perceived stress, coping 
strategies, dietary intake, home eating environment, emotional eating, and food insecurity via 
Qualtrics. A face-to-face appointment was scheduled with each parent-preschooler dyad to 
objectively measure their height to the nearest 0.1cm using the Shorr board, weight to the nearest 
0.1kg using the Seca 874 scale, % body fat to the nearest 0.1% using the BF-689 body fat/body 
water monitor for preschoolers and BC-533 InnerScan body composition monitor for parents, 
and parents’ BP to the nearest 1mmHg using the Omron HEM-705-CP digital BP monitor.  
For height, weight, and % body fat measurements, participants were asked to remove 
shoes, socks, or bulky clothes. To avoid interference with height measurements, participants 
were asked to remove their accessories or change hairstyles (no ponytail) when applicable. If a 
participant refused, trained data collectors would obtain the height measurment as well as 
measure hairdo height (using small, flexible plastic ruler) and record both types of information 
on the data collection form. Each participant’s biological sex, age, and height in cm were entered 
into the monitor for measuring % body fat. Trained data collectors then instructed participants to 
step onto the monitor surface and align feet with the four electrodes. The protocol by the 
American Heart Association (2020) was followed for BP measurement. Parents’ left arms were 
used for BP measurement unless having a prior surgery or injury. 
To increase reliability for measuring height, weight, % body fat, and BP, two 
measurements were taken. A third measurement was taken when the first two measurements 
differed by ≥0.5 cm for height, ≥0.5 kg for weight, ≥1% for % body fat, and ≥5 mmHg for BP. 
The data collection process was repeated by another data collector when the third mesurement 
was ≥0.5 cm, ≥0.5 kg, ≥1%, and ≥5 mmHg away from the first two measurements. The average 
of the two closest measurements was calculated as the final value. The online SAS program for 

Centers for Disease Control and Prevention Growth Charts (2021) was applied to calculate 
preschoolers’ BMI for age and sex. 
 
In Year 2, an instrument called the Veggie Meter® was utilized to assess skin carotenoids 
as an indicator for F/V intake. Biologically, carotenoid levels in serum/plasma have been used as 
a biomarker to estimate F/V intake (Ferrari et al., 2005). However, this invasive approach due to 
the drawing of blood can generate needle-related stress, anxiety, insecurity, and fear among 
participants (Soares da Silva, 2016). The skin carotenoid score measured by resonance Raman 
spectroscopy (the Veggie Meter®; Longevity Link, Salt Lake City, UT) was proposed as a non-
invasive biomarker for F/V intake given its high correlation (r=0.70-0.72) with carotenoid levels 
in blood plasma/serum (Aguilar et al., 2014; Jahns et al., 2014). To assess skin carotenoids in 
this study, each participant’s non-dominant index finger was used, and the average of three scans 
was recorded as the final score.   
 
 
 
 
 
 
 
 
 
 
 

Table 1. The 14-week “Happy Family, Healthy Kids” program 
 
Component  
Descriptions 
A 14-week parent 
component 
• A 14-week Facebook-based program with weekly videos and 
flyers providing life stress management and eating behavioral 
change strategies and 4 weekly habit-formation tasks to create a 
happier and healthier home environment for preschoolers. 
• 3 virtual meetings (weeks 1, 7, & 14) to establish personal 
connections and communication networks among parents, 
discuss strategies, and share community resources to support 
behavioral changes at home. 
• 3 motivational text messages (Monday, Wednesday, Friday) per 
week for 14 weeks to increase parents’ motivation for making 
healthy eating behavioral changes at home and encourage them 
to positively manage stress. 
A parent-preschooler 
learning component 
Sending weekly preschooler letters (total 13 letters) to each parent 
privately via Facebook messenger by the research team to share the 
preschooler’s experiences of learning at school and his/her stated 
interests for a healthy diet at home, and to ask parents to respond to 
the letters. 
A 14-week Head Start 
center-based 
preschooler component 
Helping preschoolers establish mindful healthy eating habits via 
weekly healthy diet participatory learning (e.g., food taste test 
activity) following the “Eat My ABCs” curriculum. 
 
 
 
 
 
 
 
 
 
 
 

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