a Head Start Bulletin a Head Start Bulletin a

HeadStart

ENHANCING HEAD START COMMUNICATION

Adult Health

Government Initiatives in Health

Important Screenings for Your Health

Peer Health Educators Teachback

Issue Pull-out in 

English & Spanish: 

Head Start Self-Change Contract

Contracto de Head Start de Cambio Personal

bulletin

2003

U.S. Department of Health and Human Services 

■ Administration for Children and Families 

■ Administration on Children, Youth and Families

www.acf.hhs.gov/programs/hsb

Issue 75
The Head Start Bulletin is published six times a year by the Head Start Bureau,

Administration on Children, Youth and Families, Department of Health and 

Human Services.

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Tommy Thompson, Secretary

ADMINISTRATION FOR CHILDREN AND FAMILIES

Wade F. Horn, Assistant Secretary

OFFICE OF PUBLIC AFFAIRS

John C. Allen, Director

ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES

Joan E. Ohl, Commissioner

HEAD START BUREAU

Windy M. Hill, Associate Commissioner

The BULLETIN is a service of the Head Start Bureau’s Training and Technical Assistance

Branch. Its purpose is to enhance communication among the Head Start Bureau, Head

Start programs, and interested national, regional, and state organizations and agencies.

HEAD START BUREAU

Carmen Bovell-Chester, Division of Program Management 

JoAn Knight Herren, Chief, T/TA Branch

Robin Brocato, Guest Editor

Guylaine L. Richard, Guest Editor

Jeff Fredericks, Managing Editor 

Head Start Bulletin

The Head Start Bulletin is prepared under Contract No. 233-02-0002 with PaL-Tech, Inc.

Judy David, Co-Editor

Deb Kremer, Co-Editor

Shannon Lewis, Junior Writer

Aisha Mahy, Publications Assistant

Head Start Bulletin

Adult Health

Issue No. 75

For more copies of the Head Start Bulletin or to be put on the mailing list, contact the Head Start

Information and Publication Center. Toll free: 1-866-763-6481; www.headstartinfo.org.

CORRECTION: Judith Jerald’s name was misspelled in the article “Guiding Principles” in the Child

Mental Health Bulletin.
Head Start Bulletin 1

FEATURES

2 Health Begins With You

5 Screening Your Health: A Safe Start

7 Government Initiatives in Health

8 The Mind-Body Connection

10 Preventing Work-Related Musculoskeletal Injuries

14 Stress Reduction and Yoga

16 Diabetes and Obesity Prevention: 

An Exciting Initiative

18 Oral Health—It’s Not Just a Kid Thing

20 Are You Ready For a Healthier Me?

23 Finally Say Goodbye to Smoking

RESOURCES

21 PULL-OUT: Head Start Self-Change Contract

22 PULL-OUT: Contracto de Head Start de Cambio 

Personal

25 Is the Web a Reliable Source of Information?

42 A Useful Guide to Health in the Head Start 

Workplace

43 Resources and Webliography

ARTICLES

24 Peer Health Educators Teachback to Other 

Head Start Parents

26 Play and Stay Healthy: All It Takes is 30 Minutes a Day

27 Do Your Workout Anytime, Anyplace

29 Pyramid Power: The Building Blocks of Healthy Eating

32 Label Lingo: What Does It Mean?

33 Easy Steps to Feeling Fine

34 A Mother’s Success Story: Early Head Start 

Provides Support

36 Family Support Activities Contribute to the

Health of Families of Children with Disabilities

39 The Best for Your Employees: What an EAP Can Do

40 Addressing Pesticide Exposure in the MSHS Community

page 2:

Stay healthy and have fun

2003 Issue 75

HeadStart

bulletin

page 14: How

yoga can reduce

stress

page 24: Peer

Health Educators in

Head Start

page 40: Pesticide

exposure in the

farmworker community 

Cover photo of Sharon Yandian, Program Director of the Migrant and Seasonal HSQIC, Region XII.

Page 2 photo courtesy of Head Start Bureau.
During the course of a day, how much of what

we do promotes our health and keeps us well? 

If we take care of ourselves, we set an example

for children to follow. by Windy M. Hill

2 2003/Issue 75
Head Start Bulletin 3

WE ALL KNOW HOW CLOSELY children’s

health and their ability to learn are

linked. Every day in our Head Start

programs, we take measures to

insure that children are healthy—by making sure they

are connected to a medical home, by protecting them

from injury and disease, and by serving them healthy

foods. However, we may not always invest the same

amount of energy in promoting and protecting the

health of adults. Common sense tells us that in order to

care for, nurture, and teach our children, we must first

take care of ourselves. 

The Head Start Program Performance Standards

recognize the importance of keeping staff well. They

require grantee and delegate agencies to make mental

health and wellness information available to staff who

have concerns that may affect their job performance

(1304.52(j)(3)). Full implementation of the Program

Performance Standards includes having management

systems that support staff health.

Just as Head Start has a comprehensive vision of

health for children, we also hold a broad vision for

adults. Health includes physical, mental, social, and

spiritual aspects. It is more than the absence of disease.

What we are really talking about is wellness, which the

National Wellness Institute defines as “an active process

of becoming aware of and making choices toward a

more successful existence” (2002). In other words, we

want to live up to our full potential and regularly experience energy, vigor, and joy. 

During the course of a day, did you ever stop to

think about how much of what we do promotes our

health and keeps us well? We brush our teeth, obey 

traffic laws, dress appropriately, clean house, apply 

sunscreen, store and cook food properly, exercise,

relax, and talk with friends and family. These daily

tasks—often mundane and routine—are essential to 

our well-being. But they take on greater importance

when we realize that they set an example for our children to follow. By taking care of ourselves, we promote

our children’s health and teach them lifelong lessons

about wellness. 

All over the country, people are realizing the importance of making lifestyle changes in order to improve

health. In June 2002, President Bush launched the

HealthierUS initiative. This initiative is intended to help

Americans live longer, better, and healthier lives. It

focuses on four priorities:

Physical Fitness

Be physically active each day. Learn how to make

regular physical activity part of your daily routine.

HEALTH BEGINS WITH YOU

online...For more information on Head Start, visit our site at www.acf.hhs.gov/programs/hsb/.

Health Adult
4 2003/Issue 75

Nutrition

Eat a nutritious diet. Healthy eating is not a 

fad—it’s a lifestyle. Learn what the experts say 

you need for a healthy diet.

Prevention

Get preventive screening. Find out how screening 

can protect you and your family.

Avoiding Risky Behaviors

Make healthy choices. Avoid tobacco, drugs, and 

the abuse of alcohol. 

In this Bulletin, you will find articles on a wide

range of health issues affecting adults. Many articles

highlight one or more health priorities; some are indicated by one of the symbols, mentioned above, from the

HealthierUS initiative. Most of this information is about

lifestyle changes that we can make to maintain and

improve our health. A consistent theme is assuming personal responsibility. Every day, we make choices about

whether to engage in behaviors that may put our health

at risk. Some choices are easy for us to make alone.

Others require support from family, friends, co-workers,

and/or health care professionals. Most of these choices

cost nothing or are relatively inexpensive. Check out the

Head Start Self-Change Contract on pages 21-22 and

use it!

Many times, we make changes in our lives for 

the sake of children. But by making changes for our

own sake, we recognize, honor, and celebrate ourselves

just for who we are! The Head Start Bureau is pleased

to devote this issue of the Bulletin to you and your 

wellness. ■

REFERENCE

National Wellness Institute, Inc. June 2002.

<www.nationalwellness.org/nwi_Home>.

Windy M. Hill is the Associate Commissioner of the Head

Start Bureau, Administration for Children and Families,

U.S. Department of Health and Human Services.

HEALTH BEGINS WITH YOU

Windy M. Hill was named Associate Commissioner of the 

Head Start Bureau on January 7, 2002.

Photo courtesy of ACF.

By taking care of ourselves, we promote our

children’s health and

teach them lifelong

lessons about wellness.
THE SUDDEN DEATH OF A HEALTHY INDIVIDUAL can trigger

in us a sensation of doubt, disbelief, and even a true sense of

defeat. We think: “She was exercising. He was eating well.

She never abused any substances. What happened? I don’t

understand. Why bother then? Why not live for today and

forget about tomorrow?” 

Those reactions occur frequently when we face the challenges of practicing good health habits as a way to prevent

diseases and even death. Is there something else we need to

know? Sure. Good health and hygiene practices are not the

only ways of prevention. Screening is another necessary prevention. Even if an illness cannot be prevented, its early recognition and treatment usually lead to a more favorable outcome. But you might object, “I am healthy. I don’t need to go

to the doctor. I am not sick.” But how do you know? Have

you had any health screening done?

What is Screening?

SCREENING TESTS ARE NOT AN ASSUMPTION of illness. They

can serve two purposes. First, they are a means of catching an

illness in the silent phase, therefore minimizing its unfavorable

effects. Because many illnesses have an asymptomatic phase

(the period where the disease is present but you do not show

any signs or symptoms), your doctor may recommend screening tests. Second, they can uncover

potential risk factors for disease. When considering a

screening test, the doctor weighs several factors, such as your

age, sex, ethnicity, genetic predisposition, environmental exposure, past medical history, family history, clinical status, and

life style preference. An example of risk screening would be

testing for diabetes, high blood pressure, and high cholesterol

levels in order to prevent heart disease. Another example is a

mammogram as a way to prevent or detect early breast cancer. 

Where Do You Start? 

THE DECISION TO BE SCREENED for certain diseases needs to

be made by you and your physician. When ordering screening

tests, many doctors follow prescribed guidelines developed by

well-known and respected medical organizations. Those

guidelines are based on research conducted on large populations regarding the incidence and prevalence of diseases. They

take into account the risk factors. Your physician needs to

explain the risks and benefits of the recommended screening

and answer your questions. Based on all the information, you

can then decide whether to go ahead with the test. 

Are There Any Drawbacks?

YES, THERE ARE DRAWBACKS TO SCREENING TESTS.

• They are not 100 percent accurate. 

• They can be costly. 

• They may not be covered by health insurance.

• They may even present a degree of risk to the patient. 

Furthermore, there is some controversy in the medical

community regarding the value and frequency of certain tests,

such as routine mammography for women aged 40 to 49.

This is all the more reason for you and your doctor to decide

together how best to prevent disease. 

What Are the Recommended Screening Tests?

MEDICAL EXPERTS have made recommendations for 

preventive care for adults who have no symptoms and are

low-risk, as presented in Table 1 (Schroeder et al. 1997).

Head Start Bulletin 5

SCREENING YOUR HEALTH: A SAFE START

Good health and hygiene practices are not the only means of prevention.

Screening tests are important too. by Dr. Guylaine L. Richard Photo by K. Sanjari.
Most of the screening tests can usually be performed at a

clinic or doctor’s office. As you get older, you will need to

undergo more screening in order to detect the early onset

of a disease. ■

REFERENCES

Schroeder, S.A, L.M. Tierney, Jr., S.J. McPhee, M.A.

Papadakis, & M.A. Krupp. 1997. Current medical diagnosis & treatment: A Lange medical book. Stanford, CT:

Appleton & Lange.

Guylaine L. Richard, M.D., Guest Editor, is the Director of the

Prince George’s County Public Schools Head Start.

T: 301-408-7100; E: guylain.richard@pgcps.org.

6 2003/Issue 75

SCREENING YOUR HEALTH

Screenings What is it? How often do you need it?

TABLE 1: RECOMMENDED SCHEDULE FOR ADULT SCREENINGS

To screen for anemia

To screen for tuberculosis

To screen for hypertension/hyperextension

To prevent contraction of illness

To screen for colon cancer

To screen for colon cancer

To screen for breast cancer

To screen for breast cancer

To screen for high cholesterol, which can

be a cause for heart attack

To screen for diabetes

To screen for oral health problems (teeth,

gums, tongue, mouth)

To screen for general health status

To screen for vision problems

To screen for cervical cancer

To screen for prostate cancer

To screen for mental wellness

As part of routine physical exam

Every 2 years and based on your doctor's

recommendation

Every 2 years

Tetanus-diphtheria booster every 10 years 

and influenza shot every year and based on 

your doctor's recommendation

Every 3 years if 50 years or older

Annually if 50 or older

Monthly

Every 3 years if 20-40 years of age

Annually if 40 years or older

Based on your doctor's recommendation

Based on your doctor's recommendation

Once a year and based on your dentist's

recommendation

Every 2-3 years if 18-49 years

Annually if over 50

Every year and based on your doctor's

recommendation

Every 1-3 years if 20-40 years of age

Annually if over 40 years old

Annually if over 50 years

As part of routine physical exam

Hemoglobin/Hemacrit

Tuberculosis

Blood Pressure 

Immunizations

Colon Cancer (sigmoidoscopy)

Colon Cancer (occult blood)

Self-Breast Exam (for women)

Mammogram (for women)

Cholesterol

Diabetes (blood sugar)

Dental Exam

Physical Exam

Eye Exam

Pelvic Exam/Pap Smear (for women)

Prostate Exam (for men)

Counseling
7 2003/Issue 75 Head Start Bulletin 7

“Individuals have the power to protect their health, and

prevention is the key. Through adoption of healthy behaviors, we

can reduce the risk of illness and disease,” said Health and

Human Services (HHS) Secretary Tommy Thompson.

These government initiatives regarding health are underway.

Closing the Gap: This program, part of the Bush

administration's initiative to eliminate racial and ethnic disparities

in health, focuses on providing information to African-American

communities to help people in those communities take charge of

their health. The signature event of the program, "Take a Loved

One to the Doctor Day," took place on September 24 and

encourage members of minority communities to take a family

member or loved one to see (or schedule an appointment with) a

health care professional. For more information, see

www.healthgap.omhrc.gov. 

Healthier U.S.: Launched June 20, 2002, this initiative

encourages physical activity as essential in promoting good

health and preventing chronic diseases. For more information,

see www.HealthierUS.gov and page 50 in the Bulletin.

Healthy People 2010: As the nation’s broad-based national

health agenda, the initiative targets obesity, lack of physical

activity, and other health issues related to diabetes. For more

information, see www.health.gov/healthypeople/.

Micro-Grants for Communities: In September 2001, 

HHS launched a new program to award hundreds of “microgrants” to community organizations for activities that support

disease prevention and health promotion. Worth up to $2010

each, the micro-grants will represent a new, low-cost approach to

foster effective prevention efforts at the community level. Each

grant will support local efforts to promote health education,

quality care, access to care, and other projects that support the

national health goals of “Healthy People 2010.” Two

organizations have been awarded cooperative agreements to

administer the micro-grants.

National Breast and Cervical Cancer Early Detection

Program: This initiative provides screening services, including

clinical breast examinations, mammograms, pelvic examinations,

and Pap tests, to underserved women. It also funds post-screening

diagnostic services, such as surgical consultation and biopsy, to

ensure that women with abnormal results receive timely and

adequate referrals. For more information, see

www.cdc.gov/cancer/nbccedp/.

National Diabetes Prevention Campaign: In November

2002, HHS launched the first national diabetes prevention

campaign in an effort to stem the explosion of diabetes and to

help millions of Americans live longer and healthier lives. The

campaign, "Small Steps, Big Rewards," emphasizes that modest

lifestyle changes, including healthier diets and physical activity,

can help prevent the onset of type 2 diabetes, the most common

form of the disease. This campaign is part of the National

Diabetes Education Program, co-sponsored by NIH and CDC.

For more information, see www.ndep.nih.gov/.

Initiative on Rural Communities: This initiative aims to

improve access to health care and social services for the 65

million Americans who live in rural areas. Health care and social

service programs in rural communities provide needed support of

communities' well-being and represent a significant segment of

local economies. In October 2002, over $25 million in grants

were assigned to rural communities to improve health care in

rural hospitals and speed help to heart attack victims in rural

America. For more information, see

www.ruralhealth.hrsa.gov/initiative.htm.

Health Care Safety Net: Part of President Bush's five-year

plan to add or expand health centers in 1,200 communities by

2006 and to increase the number of patients served annually to

more than 16 million, the Health Care Safety Net was

strengthened by an award of $13 million in December 2002. In

fiscal year 2002, the first full year of the initiative, HHS funded

171 new health center sites and awarded 131 grants to existing

centers to help them build capacity and expand services.

GOVERNMENT INITIATIVES IN HEALTH

Head Start Bulletin 7
8 2003/Issue 75

“A cheerful face is nearly as good for the individual as

healthy weather,” said Benjamin Franklin (1706-1790).

“True enjoyment comes from activity of the mind and

exercise of the body; the two are ever united,” stated

Alexander von Humboldt (1769-1959).

OVER 200 YEARS AGO, Benjamin Franklin and Alexander

von Humboldt noticed the connection between our state

of mind and our physical health. Whether we are aware

of it or not, many of us frequently experience this connection. For example, have you ever found yourself feeling

that you were on the verge of becoming sick or tired—

and decided to fight it? Probably, you kept telling yourself

over and over, “I don’t feel sick” or “I don’t have time

to be tired.” 

What happened next? My guess is that some of you

went on to become sick or tired and others did not. While

there are physical factors such as genetics, our immune system, and overall physical health that can account for this

difference, other factors, including our emotional state and

beliefs about health and illness, come into play as well. 

For many years, scientists have noted the “placebo

effect.” A placebo is defined as any treatment that does

nothing to alleviate symptoms or disease, but somehow

causes an effect. The effect results from the patient’s belief

in the medicine’s efficacy, not from the medicine itself.

What happens is this: While testing the effectiveness of a

certain drug, one group of patients is given the drug, the

other a placebo, which is often a sugar pill. At the end of

the trial period, the group receiving the placebo experiences an improvement in symptoms or, on the other hand,

feels worse or suffers side effects. 

Studies show that between 60 to 90 percent of all

physician visits are for stress-related complaints.

For over 30 years, Dr. Herbert Benson, the

founder of the Mind/Body Medical Institute in

Boston and author of The Relaxation Response

(2000), has studied how mind/body medicine can

help treat stress-related conditions, including joint pain,

hypertension, diabetes, migraine headaches, asthma, and

allergies. Dr. Benson explains that stressful thoughts lead

to the secretion of stress hormones that impede our natural

healing capabilities. These hormones send the body into a

state of arousal, causing metabolism, heart rate, blood

pressure, breathing rate, and muscle tension to increase.

The relaxation response—which produces a physical state

of deep rest—is a simple breathing and concentration technique that is practiced for only 10 - 20 minutes a day. Dr.

Benson’s research shows that it reduces the harmful effects

of the stress hormones. 

What are some other ways to combat stress? Regular

physical exercise helps. Yoga and meditation do, too (see

pages 14-15). Although these methods are effective, they

can take time and money for instruction and often may

not be practical in the midst of a stressful situation.

8 2003/Issue 75

THE MIND-BODY CONNECTION

Many of us frequently experience the connection between our state of

mind and our physical health. Often, that comes in the form of mental

stress impacting how we feel. by Robin Brocato

Children can teach us a lot

about living in the moment

Photo by C. Dyer. Higher Horizons EHS-HS.
Head Start Bulletin 9

So what else can we do? First, stop and take a deep

breath—or two or even three! Turn your focus toward

using the mind-body connection to produce a positive

effect. For example, try using affirmations on a regular

basis. Or, practice mindfulness. 

Affirmations are a way of turning negative selftalk, which leads to stress, into positive, life-affirming

statements. They are always stated in the present tense—

I am, I have, I choose—and they reflect what we wish

to experience. Think back to what we say when we

might be getting sick or feeling tired: “I don’t feel sick”

or “I don’t have time to be sick.” What do both of

these statements have in common? They are negative

and focus on what we do not want to happen. 

More positive and effective statements are, “I feel

energetic and healthy,” or “I am relaxed and have

plenty of time to do what needs to be done.” At first it

may feel silly to state over and over the exact opposite

of what you are feeling. But with regular practice, you

will notice a change. The inner world of your thoughts

and feelings will be in line with the outer world of your

experience. Your mind and body will work together to

produce a positive result.

In her book Emotional Alchemy, Tara BennettGoleman (2001) describes mindfulness as a “meditative

awareness that cultivates the capacity to see things just

as they are from moment to moment.” In other words,

we become fully aware, in a nonjudgmental way, of

our thoughts, body sensations, and feelings as we

experience them. For example, when you are showering,

instead of allowing your mind to wander and worry

about the busy day ahead, focus on the sensation of

the water and the smell of the soap. When walking from

the parking lot to your office, instead of anticipating the

piles of paperwork you must wade through, listen to the

sounds of your feet touching the pavement, smell the air,

and feel the warmth of the sun. By practicing mindfulness

regularly, we can live in the moment, feel content and

peaceful, and experience joy in the process of doing all that

we do. We use our minds to produce the positive results

that we want.

Children can teach us a lot about living in the moment

and practicing affirmations. Time and time again, in a

classroom or on a playground, I have noticed how children

approach whatever they are doing with joy and how they

focus intently on their involvement. When they feel ready

to do something else, they turn their attention and energy

to that. Take a moment or two to watch young children

during the day, and see if you notice this as well.

A while ago, my 13-year-old niece, Melanie, was visiting me. I was having a particularly stressful day. I found

myself saying to her over and over, “This is ending up to

be a really bad day.” Finally, she turned to me and said,

“Whenever I wake up and think it is going to be a bad day,

I tell myself over and over it is a good day. And before you

know it, it really is.” I learned an important lesson from

Melanie that day. ■

REFERENCES

Bennett-Goleman, T. 2001. Emotional alchemy: How

the mind can heal the heart. Nevada City, CA:

Harmony Books.

Benson, H. & M.Z. Klippur. 2000. The relaxation

response. Rev. ed. New York: Harper Torch.

Robin Brocato, Guest Editor, is a Health Specialist at the

Head Start Bureau. T: 202-205-9903; 

E: rbrocato@acf.hhs.gov.

Have you noticed how children

at play approach what they 

are doing with joy and how 

they focus intently? Unlike us,

they are not preoccupied with

other matters.
10 2003/Issue 75

COMMON SENSE TELLS US that happy healthy employees

are more productive in the workplace. In the child care

environment, employee productivity directly affects our

children. Although researchers have studied the health and

epidemiology of illness among children in out-of-home day

care, few have examined the occupational health of caregivers. Just like any workplace, there are environmental

and occupational hazards in a child care center. Ideally, we

want to minimize the hazards and maximize the opportunities to ensure the health and safety of the employees.

Ergonomics for Child Care

ERGONOMICS IS THE SCIENTIFIC STUDY of fitting a job to

an individual. This science can, and should, be applied to

the child care setting. Musculoskeletal injuries are relatively high among child care providers. The Bureau of

Labor Statistics reported that one of every 100 child care

workers suffered a nonfatal occupational injury in 1999

(Bureau of Labor Statistics). Working as a child care

provider can be a physically demanding job. It requires

constant interaction with active (sometimes hyperactive),

spontaneous, impulsive, heavy (sometimes very heavy) children. Lifting, stooping, bending, climbing, crawling, reaching, pulling, and pushing are just some of the strenuous

activities required. According to the Center for Disease

Control and Prevention, back injury is the most common

cause of occupational injury for child care providers (U.S.

Public Health Service). Aches, pains, muscle strains, and

sprains are also commonplace. Many of these musculoskeletal injuries can be prevented.

Phyllis M. King noted the paucity of documented

research regarding the health and safety of the child care

provider in a child care setting (King, Gratz, Scheuer, &

Claffey). However, research in other workplace settings can

be applied to the child care setting. Child care providers

need to be educated about what to do, and what

resources to use, so they can improve the efficiency and safety of their working environment.

The medical literature reports that most back pain

is not the result of a single injury. Even though pain may

be felt suddenly, the problem is almost always due to a

combination of several factors. These factors include poor

posture, faulty body mechanics, stressful living or work

habits, loss of flexibility, and a general decline of physical

fitness (Saunders). The good news is that we have control

over these factors. We can improve our posture and body

mechanics. We can work with our co-workers to improve

the ergonomic set-up of our workplace. And, we can exercise regularly to improve our flexibility and general fitness.

Education is Key

THE CHILD CARE PROVIDER MUST LEARN about these

issues as part of employment orientation. However, the

education should not stop here. Education of employees

should be an ongoing process with regular in-service, provision of written brochures and literature, and reminders

that help staff incorporate the behaviors into the daily routine. For instance, pictures of proper lifting techniques and

written reminders [can be] posted on the wall.

Sit with a pillow to

support your back

Back injury is the most common cause of occupational injury for people

who work with young children—but preventative measures are effective

and can be easily learned. by Alicia M. Wortman

PREVENTING WORK-RELATED MUSCULOSKELETAL INJURIES

Reprinted with permission from the Child Care Information Exchange; P.O. Box 3249; Redmond, WA 98073; (800) 221-2864 Photo by J. Swift.
Head Start Bulletin 11

Education on use of proper body mechanics must

begin with a basic understanding of the anatomy and physiology of the spine. The spine is a unique set of joints

which serve many vital functions. Not only does the spine

serve as the foundation for our skeleton, providing us with

both stability and mobility, but it also houses our spinal

cord, which is an extension of our brain—receiving and

providing sensorimotor input/output. The spine has a natural inward curve (or lordosis) in the lumbar and cervical

spine and a natural outward (or kyphosis) in the thoracic

spine. These curves exist to provide necessary shock

absorption, stability, and mobility needed for normal biomechanical function. We must support and maintain these

natural curvatures, or what has been termed as a neutral

spine. Find your neutral spine by standing erect and gently

tightening your abdominal (stomach) muscles. Perform this

exercise in various positions: sitting, standing, and lying.

With continued practice there will be carry-over to retrain

these muscles to naturally support the lumbar spine without conscious effort.

The spine is not supported when you sit in a slumped

position. This can be avoided by sitting with low-back support. If you must sit on the floor, sit against a wall or with

a large husband-style pillow for your back. Adults should

use adult furniture whenever possible. When the situation

requires using child-sized chairs, tables, or desks, be sure

to sit with as much back support as possible. Stand up as if

rising from a squat position, keeping your back straight,

pelvis level, and abdomen tight while you use your thigh

muscles to raise your body to standing.

Getting to Child Level

AVOID LEANING FORWARD OR DOWNWARD to reach or

assist children. Instead, assume a squatting position or

kneeling position to bring your body closer to the 

children. Use small kneeling pads (similar to the type used

for gardening) to allow more comfortable kneeling when

working with children who are sitting at child-sized tables.

Do not sit for prolonged periods of time. When you must

sit, use comfortable chairs with back support (rockers,

gliders, etc.).

Stretching

BREAK UP BOUTS OF SITTING with gentle stretching exercises. When you sit, your spine naturally flexes (or

rounds). It is important to counterbalance this with some

gentle extension exercises. For instance, each time you rise

from a seated position, place your hands in the small of

your back and gently lean backward. Hold for a few seconds and return to the natural upright position. Repeat

several times throughout the day. Another useful technique

involves simply reaching your arms towards the ceiling, in

order to stretch and extend the trunk and neck.

Standing

PROPER POSTURE SHOULD BE USED while standing as well.

Education on use of proper body mechanics must begin

with a basic understanding of anatomy and physiology

of the spine. The spine is a unique set of joints. It serves

as the foundation for our skeleton and houses our spinal

cord, which is an extension of our brain. 
12 2003/Issue 75

When standing for a prolonged period of time, shift your

weight from side to side and change positions. Adjust the

height of changing tables so that the child you are changing

is at your waist level. Use step stools for accessing high-toreach places. Reorganize areas so that the most commonly

used items are at an accessible level while standing.

A Buddy System

IF POSSIBLE, INSTALL LARGE MIRRORS (shatter-resistant, of

course) throughout the child care center. This will help to

provide constant reminders to improve your posture and

body mechanics. Also, use a buddy system so co- workers

remind each other when faulty body mechanics are

observed.

Footwear

BE SURE THAT YOU WEAR COMFORTABLE SHOES with good

shock-absorption. With every step, your foot must absorb

one-and-a-half times your body weight. You can purchase

over-the-counter shoe inserts to increase the shock-absorption of your shoe. This will help divert unnecessary stress

to your weight bearing joints. Avoid wearing high heels or

hard-heeled shoes.

Lifting

ANOTHER WAY TO REDUCE STRESS TO THE SPINE is by

reducing the amount of lifting. This may be a difficult task

in the child care environment. When lifting, use proper lifting techniques. Tighten your stomach musculature as you

lift. This helps the muscles to provide a corset-like support

to the spine. Bend at your knees and hips and bring the

item or child close to your body before lifting. Do not

twist or turn when lifting. Twisting stresses the muscles,

ligaments, and joints of the spine complex.

Avoid repetitive lifting from the floor. Have the children pick up toys and other items from the floor.

Incorporate this into daily clean-up time. Always lower the

crib side before lifting a child out. Utilize a ramp or small,

stable step ladders, or stairs to allow children, with close

and continuous supervision, to climb up to change tables

or other places to which they would ordinarily be lifted.

Use convenient equipment, like a multi-seat stroller, for

moving children, reducing the necessity for carrying them

long distances.

Exercise

FINALLY, INCORPORATE EXERCISE into daily routines.

Maintaining general fitness and flexibility is essential to

maintaining musculoskeletal health. Incorporating some of

the gentle stretches mentioned above is a good way of

ensuring that you maintain your flexibility. Institute walking programs and other fitness programs for the staff to

encourage overall physical fitness. Work together as a team

by developing an ergonomics mission statement that supports the mission of the organization. For example: “The

mission of the XYZ Ergonomics Program is to support

quality child care through the safe and innovative use of

ergonomics, maximizing productivity, and protecting the

health of the workforce” (Worrell). Use a team approach

to develop ideas to improve the ergonomics of your child

care center. ■

REFERENCES

Bureau of Labor Statistics. (December 2000). U.S.

Department of Labor.

U.S. Public Health Service. (1996). The ABCs of safe and

healthy child care: a handbook for child care

providers.

King, P.M., Gratz, R., Scheuer, G., & Claffey, A. (1996).

The ergonomics of child care: conducting worksite

analyses. Work, 6:25-32.

Saunders, H. (1992). Self help manual: for your back.

Chaska, MN: Saunders Group, 6.

Worrell, G. (2001). Revitalizing your ergonomics program.

Occupational Health & Safety, 70:93-4,7.

Alicia M. Wortman, is a physical therapist at the Hospital

of the University of Pennsylvania in Philadelphia. 

PREVENTING WORK-RELATED BACK INJURIES
Challenge Wise Moves

Lifting children, toys, supplies,

etc.

Avoid lifting by having children climb steps with help. Pull child or object to be lifted

as close as possible directly in front of you; squat and wrap your arms around

whatever you are lifting. Then tighten stomach muscles and use thigh muscles to raise

yourself and your load. Lower objects and children by sliding them down your body to

the level where you can squat or kneel to lower whatever you are putting down to its

destination.

Inadequate work heights Reorganize to store frequently used objects where you can reach them easily. Store

heavy objects at waist height so you don’t have to lift them. Adjust diapering and

similar work surfaces to waist height; use adult-sized chairs whenever you can; squat

or kneel on a kneepad if you can’t sit down next to children to help. Use step stools to

reach high places.

Lifting infants in and out of cribs Do not use cribs with floor level mattresses or those that do not have a side you can

drop when putting children in or out. Get you and the child as close to the crib side

as possible before you lift.

Frequent sitting on the floor

without back support

When possible, sit against a wall or furniture that supports your back. Sit with a little

pillow in the small of your back when you can. Stretch when you get up.

Carrying children or heavy

objects

Use carts and strollers. Let children climb up with a step stool. If possible, divide

heavy loads into several smaller loads and use carts that can be slid under the load

and then tilt the load onto the cart.

Awkward posture to open

windows or adjust objects

Move objects away from the window to get as close as possible to it. Put one foot on

a step stool for better leverage. Lubricate the window mechanism to make opening

easier. Ask for help from a co-worker when the job is hard.

Sweeping/picking up crumbs and

small toys from the floor

Use a long-handled dustpan and broom. Keep a separate clean one for toys and one

for things going into the trash.

Caring for children with special

needs

Get specific training from the child’s physical therapist about how to move and carry

the child.

Caring for children during active

play when sudden moves may be

needed

Avoid twisting. Practice turning and bending to intercept a running or falling child so

the move becomes natural. Bend knees when pushing children in swings. Use good

body mechanics to help children on and off equipment.

WISE MOVES

Head Start Bulletin 13

Source: Work, 6:25-32: The ergonomics of child care: conducting worksite analyses (King, Gratz, Scheuer, & Claffey).
14 2003/Issue 75

UNTIL RECENTLY, when most people thought about yoga,

they had images of being bent into a pretzel. However, the

ancient practice of yoga, with a history of 5,000 years, is

more than convoluted exercises. It improves our physical

and emotional health. Movie stars, models, athletes, politicians, as well as everyday people, attest to its benefits.

Furthermore, research affirms that yoga is a stress reducer. 

Stress is our reaction to something in the environment or

a social situation that poses a real or perceived threat. In

order to ward off the threat, the individual has to mount a

physiological, physical, or psychological response. Some stress

can be positive, useful, and even necessary as motivation in

everyday life and emergency situations. 

The danger comes when stress is chronic or unmanageable because a person's responses may be inadequate. Intense

stress can lead to physical illness, emotional problems, or

interpersonal difficulties. Many Head Start staff and families

experience challenging and overwhelming stress, including

financial pressures, community and domestic violence, divorce and other losses, substance abuse,

physical illness, and homelessness. Yoga is an effective way to resolve stress because it works on both the mind

and body, reducing the feeling of being overwhelmed and

burned out by life's circumstances. Yoga stimulates the natural healing resources of the mind and body so that the individual is better able to cope with stress.

What is Yoga

YOGA IS A COMBINATION OF EXERCISE POSTURES, breathing exercises, and a philosophy about the way one lives life.

The different yoga postures, called asanas, are specifically

designed to stretch and relax certain muscles and stimulate

various organs and glands to balance them for optimal health.

Stephen Cope (1999), psychotherapist and yogi, states that

the body records and holds the memories of how we were

touched, held, soothed, or traumatized and frightened from

birth. When tension becomes locked within the fascia, or connective tissue of the body, emotional and physical reactions to

stress can cause painful symptoms. 

Muscles that are tightly held can result in shortened or

chronically contracted muscles. Stress is then put on the opposition muscle groups. They may become weak and flaccid

from under-use. With regular practice, the stretching, relaxing,

and stimulating yoga postures bring a sense of well-being, a

feeling of ease within the body and the emotions. 

In conjunction with the asanas, one needs to practice

breathing exercises. Yogis believe that breath is life—the life

force that exists between the boundary of the body and the

mind. The breathing exercises, called pranayama, induce

relaxation in the parasympathetic nervous system. Prana

means the breath; yama means to pause. When we bring our

awareness to our breathing, we may notice that the breath is

chronically held in a shallow and restricted way. Pranayama is

the practice of regulating irregular and hurried respiratory

processes without using excessive restraint or force. Breath

that is fully open, deep, relaxed, and slow without constriction in the lungs, in the diaphragm, or in the muscles of the

14 2003/Issue 75

STRESS REDUCTION AND YOGA

Yoga is an effective way to release stress because it stimulates both the

mind and the body. by Beverly Gould

Yoga postures

bring a sense of

well-being

Photo by A. Mahy.
Head Start Bulletin 15

chest and rib cage, allows for a full emotional experience.

The third component of yoga is its philosophy. The central principle is ahimsa, meaning nonviolence in attitude as

well as behavior. This principle is applied to the way one performs the asanas as well as the way that one lives one's life.

There is no competition among yoga students; we only strive

to be the best we can be on any given day, listening to the sensations, messages, and wisdom of the body. We are also

charged with looking at how we make life difficult for ourselves, push ourselves, judge ourselves, and create an inner

environment of violence against ourselves. 

How Does Yoga Promote Wellness?

THE PHILOSOPHY AND PRACTICE OF YOGA offer many

insights about the way that the mind and body work. In

1982, the National Institute of Health established the Office

of Alternative Medicine (OAM). In 1998, this became the

National Center for Complementary and Alternative Medicine

(NCCAM). The Center is funding research about yoga and its

role in promoting wellness. Preliminary findings suggest that

yoga helps to prevent, heal, or alleviate conditions such as

heart disease, carpal tunnel syndrome, asthma, diabetes, high

blood pressure, symptoms of menopause and many chronic

disabilities (Lipson 1999). Yoga is also becoming increasingly

popular as an adjunct therapy for HIV/AIDS (Kaiser 1998).

Yoga's focus on the correct alignment of the body is useful in assisting with musculoskeletal and joint problems. In a

small, controlled study, Professor Steven Hawkins from the

Department of Kinesiology and Physical Education at

California State University, Los Angeles (Sparrowe 2001 )

found that women who did certain yoga postures in class

twice a week and practiced on their own three times a week

showed notable increases in the bone density of their spine.

His findings support the notion that women of all ages can

enhance their bone health through yoga. 

Yoga also aids in weight loss. The breathing exercises

oxygenate the body, increase lung capacity and help the

metabolism to function at a higher level. The postures bring

increased body awareness and an inner quiet that allow a

greater exploration of the emotional issues buried by overeating. Yoga increases the energy level and improves circulation.

More and more insurance companies are willing to reimburse

for yoga treatment because they recognize that yoga is a relatively inexpensive, but effective form of treatment and rehabilitation for some chronic illnesses (Lipson 1999). 

Yoga can benefit most of us. Yoga exercises are helpful

during pregnancy (Teasdill 2000). Gentle yoga is offered to

the geriatric population and the chronically ill. Recently, yoga

has been used with and without traditional therapy to

improve the attention, respiration, and motor capacities of

children with Down’s syndrome, cerebral palsy, and learning

disabilities (Sumar 1998). At all ages and under many different health conditions, the ancient science of yoga helps to

quiet the mind, focus attention, and relax the body. 

For more information, see the National Center for

Complementary and Alternative Medicine (NCCAM) Web

site at http://nccam.nih.gov. ■

REFERENCES

Cope, S. 1999. Yoga and the quest for the true self. New

York: Bantam Books.

Kaiser, J.D. 1998. Healing HIV: How to rebuild your immune

system. Mill Valley, CA: Health First Press.

Lipson, E. 1999. Medical proof yoga works. Yoga Journal,

149: 6-12.

Sparrowe, L. May 2001. Good to the bone. Yoga Journal,

160: 106-171.

Sumar, S. 1998. Yoga for the special child: A therapeutic

approach for infants and children with Down’s syndrome, cerebral palsy and learning disabilities.

Buckingham, VA: Special Yoga Publications.

Teasdill, W. 2000. Step by step yoga for pregnancy: Essential

exercises for the childbearing years. New York:

Contemporary Books, McGraw Hill Professionals.

Beverly Gould is working on her Post Doctorate in neuropsychology at Emory University and was a 2000-2001 Head

Start Fellow. T: 404-712-9825; E: priyadarsa@aol.com. 
16 2003/Issue 75

AN ESTIMATED 17 MILLION AMERICANS currently have it,

but over a third are not even aware they have it. What is it? It

is Type 2 diabetes, a disease whose prevalence is increasing

rapidly in the United States. Type 2 diabetes is on the increase

primarily due to our lifestyle—poor eating habits and lack of

exercise are the main culprits. An unhealthy lifestyle can lead

to obesity—a condition occurring in epidemic proportions in

America—which can pose many health risks, including Type 2

diabetes. Most at risk for diabetes are certain population

groups including, African Americans, Hispanic Americans,

Asian Americans, Pacific Islanders, and American Indians. 

Diabetes is dangerous. It is the main cause of kidney failure, limb amputations, blindness in adults, and a major contributor to heart disease and stroke (National Institute of

Diabetes & Digestive & Kidney Diseases 2002). Other health

concerns related to the occurrence of Type 2 diabetes include

high blood pressure, nervous system disease, periodontal or

gum disease, and complications of pregnancy (Centers for

Disease Control and Prevention 2002). 

The American Diabetes Association (ADA) defines Type 2

diabetes as “a metabolic disorder resulting from the body’s

inability to make enough, or properly use, insulin” (2002).

Insulin is a hormone that is needed to convert sugar, starches,

and other foods into energy necessary for daily life. 

What Head Start is Doing

HEAD START PROGRAMS offer a unique opportunity to

implement obesity and diabetes prevention programs that are

culturally oriented, family-centered, and community-based.

“Healthy Children, Healthy Families, and Healthy

Communities” is a program created by the Indian Health

Service (IHS) Head Start Obesity and Diabetes Prevention

Initiative. The initiative promotes healthy habits, physical

activity, healthful eating behaviors, and self-esteem among

American Indian/Alaskan Native Head Start children, families, staff, and communities. The goal is to prevent or delay

Type 2 diabetes and obesity. 

In 2000, the initiative began with five tribal

Head Start pilot sites:

• Eastern Band of Cherokee Indians–Cherokee, NC 

• Northern Cheyenne Head Start–Lame Deer, UT

• Red Cliff Early Head Start–Bayfield, WI 

• San Felipe Pueblo Head Start–Pueblo of San Felipe, NM

• Winnebago Head Start–Winnebago, NE 

The sites receive training and technical assistance, including the latest scientific information, through quarterly meetings and on-site consultation visits by health experts. Each site

has developed specific initiatives based on their respective

community needs. The pilot models are shared with the wider

Head Start community and health professionals through public presentations, workshops, and other dissemination activities. Evaluation is ongoing, allowing for continuous program

improvement. 

According to Cheryl Wilson, Diabetes Prevention

Consultant for IHS, the initiative is progressing beautifully.

She attributes much of the success to the programs’ roots in

the communities they serve. Each pilot site is required to work

with a community health partner that is committed to the initiative for its duration and provides consistent support. Most

sites selected their local Special Diabetes Program for Indians

grant program as their partner. Other partners include

Women, Infants, and Children (WIC), and Residential Energy

Assistance Challenge Option Program (REACH). New

Head Start and the Indian Health Service have launched an initiative to

promote healthy habits and lifestyle changes.

DIABETES AND OBESITY PREVENTION

AN EXCITING INITIATIVE

Northern Cheyenne Head

Start created the “Eat

Healthy Campaign”—the

tribal symbol “morning star”

is placed on the labels of

healthy foods in local

grocery stores.
Head Start Bulletin 17

resources for the Head Start community can and do develop

out of these community partnerships.

The pilot sites are conducting many exciting and innovative interventions that reflect the needs of the community— 

• San Felipe Pueblo Head Start, in conjunction with the

local Health and Wellness Department, has a diabetes

prevention program that emphasizes physical activity

for Head Start children, parents, and staff. The program offers free aerobics classes for community

women, Alpha Fit (weekly classroom exercise sessions

for children set to music), and monthly fun runs and

walks for families. 

• The Northern Cheyenne Head Start Program has created the “Eat Healthy Campaign” in which the tribal

symbol “morning star” is placed on the labels of

healthy foods in local grocery stores. 

• At the Winnebago Head Start in Nebraska, monthly

family fun nights include a healthy meal, education for

parents, fun fitness and reading games for children, and

door prizes and books for those attending. The staff

are involved in weekly fitness activities with a theme:

March Madness (basketball), Up with the Birds (early

morning exercise), Tae-Bo (kick-boxing aerobics),

Husker (for Nebraska) football, country line-dancing,

and many more. 

• At the Red Cliff Early Head Start, a registered 

dietician makes presentations about nutrition for 

staff and parents.

Success Already

THOSE INVOLVED in the Diabetes Prevention Initiative are

enthusiastic about its successes and future possibilities. Pam

Potter, Program Director for Winnebago Head Start, reports

that the staff has felt results in their overall well-being, herself

included. Cynthia Cheykaychi, Director of the San Felipe

Head Start, believes their program has been especially

successful in creating awareness of how dangerous diabetes is

and the complications that can result. She says the program

really makes a difference by helping to create healthy lifestyle

habits and awareness of the dangers of diabetes in young

children. The result is a “continuum of prevention,” the

effects of which will be apparent in years to come. 

Although results of the pilot program will not be disseminated until the program’s end in 2004, the number of

participants is growing fast. The Eastern Band of Cherokee

Indians Tribal Care Healthy Journeys Initiative reports a

“ripple effect” in its 50-mile walking club, which started

with only a handful of members. Family members of the

staff and Head Start children and parents, as well as others

in the community, are getting active. But this does not

happen overnight. Virginia Johnson-Shell, Health Services

Manager for the Cherokee Indians Initiative, advises

programs “to have patience” in gaining participation for

their activities. 

Wilson hopes that other Head Start and Early Head

Start programs will follow the examples of the pilot sites—

they, too, can become involved in the fight to prevent Type

2 diabetes, especially with the help of a community partner.

Interested programs can start their own diabetes and obesity prevention activities at any time without extra funding—it is as easy as planning a regular walking program! ■

REFERENCES

American Diabetes Association. 26 June 2002 <www.diabetes.org/>. 

Centers for Disease Control and Prevention. 26 June 2002

<www.cdc.gov/>. 

National Institute of Diabetes & Digestive & Kidney

Diseases. “Diet and Exercise Dramatically Delay Type 2

Diabetes: Diabetes Medication Metformin Also

Effective.” 26 June 2002

<www.niddk.nih.gov/welcome/releases/8_8_01.htm>. 

Special thanks to Cheryl Wilson, Diabetes Prevention

Consultant for the IHS National Diabetes Program, for

contributing to this article. The Head Start Bureau also

extends its appreciation to all the programs for sharing

their experiences.
18 2003/Issue 75

HEAD START PROGRAMS spend a great deal of time and

energy on children’s oral health. All children in a Head Start

program receive a dental examination and any necessary

follow-up treatment. They are taught about the dentist, oral

health, and oral hygiene. In Head Start programs, they also

brush their teeth every day and are not allowed to eat

sugar between meals. Why do the programs go to all this

trouble? Because healthy teeth are important to children’s

overall health!

But what about your teeth? They are important, too!

Fortunately, many of the things that Head Start does for the

children’s teeth can also help yours. 

The key to good oral health is prevention. Most dental

problems can be prevented with just a little bit of work each

day. Unfortunately, many people wait until they have a problem and then try to do something about it. Once a problem

has occurred, however, it can often be difficult and expensive

to fix.

When I talk to Head Start parents about their children’s

teeth, I tell them there are three things they can do to insure

that their child will have a healthy mouth—

1. Help the child brush each day with a fluoride

toothpaste.

2. Make sure the child does not eat a lot of sweets

between meals or go to bed with a bottle

containing sugar.

3. Take the child to the dentist at least once a year so that

little problems do not become big problems.

These same rules apply to adult teeth. However, there is

one additional rule for adults—

4. Floss the teeth every day to insure that the gums and

the bone that supports the teeth remain healthy.

Let’s take these rules and apply them to adults.

Brush your teeth each day with a fluoride toothpaste.

THE MOST COMMON PROBLEM with teeth is decay.

Decay begins when a film of bacteria and fibers

builds up on the teeth. This is called plaque. The bacteria in the plaque take sugar from the foods that

people eat and produce acid. The acid eating away at the

tooth is called decay; the hole is called a cavity.

While decay is more commonly found in children, it does

occur in adults. Toothbrushing alone will not prevent all

decay, but it will help. Dentists usually recommend that teeth

be thoroughly brushed several times a day, using a soft brush

in a circular motion. This will remove most of the plaque,

especially that which builds up near the gums and on the

smooth, outer surfaces of the teeth.

Using a fluoride toothpaste is important for two reasons.

The toothpaste itself is a mild abrasive, so it makes it easier

for the brush to remove the plaque. Also, the fluoride in the

toothpaste is deposited on the surfaces of the teeth and makes

them more resistant to the acid created by the plaque. If there

is fluoride in the water supply you drink, this will also help

prevent decay. Used properly, fluoride is one of the best ways

of preventing tooth decay.

Eat sweets with meals, not between meals.

THE BACTERIA IN THE PLAQUE take the sugar from the food

and turn it into acid. If the bacteria do not have the sugar,

they cannot produce the acid. Unfortunately, people in this

country eat a lot of sugar—more than a hundred pounds per

Most dental problems in adults can be prevented with just a little bit of

work each day. by Dr. Harry W. Bickel, Jr.

ORAL HEALTH—IT’S NOT JUST A KID THING

Tooth brushing alone

does not prevent all

decay, but it helps

Photo by A. Mahy.
Head Start Bulletin 19

person each year. That is a lot of sugar! The good news is that

people do not have to stop eating sugar entirely to reduce the

amount of decay they get.

Most people eat three meals a day. When they do, the

bacteria feed on the sugar in the food, and the acid level in

the mouth goes up. Normally, this process stops soon after the

meal is finished and the acid level goes back down. But if the

person begins drinking a soft drink or snacking on a candy

bar between the meals, the process starts all over again. When

this happens, the teeth are constantly exposed to the acid.

These eating habits can destroy a person’s teeth in a short

period of time. The most important thing to remember here is

to eat sweets with meals, not between meals.

Visit the dentist at least once a year so that little problems do not become big problems.

A SIMPLE FACT OF LIFE is that decayed teeth do not get better. They either stay the same or, more likely, get worse. As

more and more acid is produced, the cavity gets bigger and

bigger. It also gets deeper. The center of each tooth is a hollow

cavity known as the pulp chamber. It contains the blood and

nerve supply to the tooth. When the decay reaches the pulp

cavity, the tooth dies. If this happens, the only thing that can

save the tooth is a root canal and a crown. If nothing is done,

it is highly likely that an infection will begin in the pulp chamber and spread to the bone surrounding the tooth. This is

called an abscess and it can be very painful. It usually requires

treatment with antibiotics.

Little problems are much easier and less expensive to fix

than big ones. The longer a person waits, the more difficult

the problem is to fix and the more it costs. If a person waits

too long, it may not be possible to fix the problem at all.

When this happens, the tooth is lost and the situation

becomes even more serious. All of this can be avoided if the

dentist finds the problem early and fixes it.

Floss teeth every day to insure that the gums and the

bone that support the teeth remain healthy.

I ONCE WORKED IN A DENTAL OFFICE that had a sign on

the wall that read, “You don’t have to floss all of your

teeth, just the ones you want to keep.” It’s true! Adults

who don’t brush and floss their teeth regularly are likely

to lose them because of gum disease. Most people are

taught to brush their teeth to prevent tooth decay. That

is fine, but as one gets older, decay becomes less of a

problem and gum disease becomes more of one. The bacteria

found in the plaque, in addition to causing decay, also cause

gum disease. 

The plaque first builds up next to the gum tissue, both on

the outer surfaces and between the teeth. If left there, it begins

to irritate the gums. As the gums become more irritated and

inflamed, they appear red and bleed easily. A person whose

gums bleed easily when they brush and floss has at least some

gum disease. There usually is no need to panic, since there

should still be time to do something about it. If nothing is

done, the inflamed gum tissue will begin to affect the underlying bone that supports the teeth. Over a long period of time,

the bone will erode, and the teeth will become loose in their

sockets. This is what many people call Pyorrhea. Dentists call

it Periodontal Disease. Unless treated, it eventually leads to

tooth loss.

Fortunately, the brushing that is done to prevent tooth

decay also helps to prevent gum disease. It does not do the

whole job. To prevent gum disease, the teeth also need to be

flossed every day. Brushing only removes the plaque on the

outer surfaces of the teeth. The plaque between the teeth must

be removed with dental floss. If it is not, gum disease will

occur in this area. 

So what does this tell us? The key to good oral health in

adults is the same as that in children: prevention! The more

people do for themselves, and the earlier they do it, the better

off they will be. If adults follow a few simple rules, they can

have a lifetime of healthy smiles. If they do not, they will

probably pay the price. ■

Harry W. Bickel, Jr., D.M.D., is a Health Specialist at the Head

Start Region IV QIC at Western Kentucky University. T: 270-

745-4041; E: hbickel@insightbb.com.
20 2003/Issue 75

In April 2003, Head Start and Early Head Start Directors, Health Service Managers, and others involved in health services in Head

Start are attending the National Head Start Health Services Institute in Washington, D.C. This marks the first time since 1990 that the

Head Start health community has come together. One day will be devoted to examining ways that programs can support staff in their

efforts to improve their health. During the Institute, daily fitness activities, along with healthy snacks, will be offered.

The Head Start Bureau staff has decided to improve their own health (and to serve as an example for local staff) by working toward the

Presidential Adult Active Lifestyle Award (PAAL). This is a new award to recognize adults for committing to regular physical activity and

is offered as part of the President’s Challenge, a program designed to motivate all Americans to be active. Adult participants can do

many different types of activity (from aerobics to dancing to yoga) but the minimum is 30 minutes of activity or 10,000 pedometer steps

each day for at least five days per week over a six-week period. Daily activity is recorded on a form. Adults can achieve the award

independently or with a child or adolescent. At the end, participants receive an emblem and a certificate to acknowledge their

accomplishments.

We at the Head Start Bureau are sharing our accomplishments at an evening reception at the Institute. At that time, the Head Start

Bureau is formally launching its Healthier Me campaign—a challenge to Head Start staff nationwide to commit to improving their

health. We look forward to supporting you as you take that first step to becoming a healthier you!

ARE YOU READY FOR A HEALTHIER ME? Photo by D. Mentzer.

In support of a healthy Head Start community, the Head Start Bureau is inviting you to join the

Healthier Me Campaign. We’re challenging everyone in the Head Start community (including us at

the Head Start Bureau!) to commit to one lifestyle change that will result in a Healthier Me. 
A

Head Start Bulletin 21 ■■

21 2003/Issue 75 Head Start Self-Change Contract

I, , DO HEREBY AGREE TO BEGIN MY CHANGE

AS OF , AND TO CONTINUE IT FOR A MINIMUM PERIOD OF

WHAT I PLAN TO DO IS: 

THE BARRIERS I ANTICIPATE ARE:

MY SUPPORT PERSONS AND WHAT I WANT OF THEM ARE:

SHORT-TERM (DAILY) REWARDS ARE:

LONG-TERM REWARDS WILL BE:

Month/Day/Year

Signature Witness

The Head Start Training Guide Enhancing Health in the Head Start Workplace (1996).

A HEAD START BULLETIN PULL- OUTI SSUE 75
■

22 2003/Issue 75

■

HOJA DESPRENDIBLE DEL BOLETÍN DE HEAD START Número 75 CONTRACTO DE HEAD START DE Cambio Personal YO , , POR LA PRESENTE ACCEDO A COMENZAR MI CAMBIO A PARTIR DE , Y CONTINUARLO POR UN PERÍODO MÍNIMO DE LO QUE PIENSO HACER ES: LOS OBSTÁCULOS QUE ANTICIPO SON: LAS PERSONAS QUE ME APOYARÁN SON LAS SIGUIENTES Y LO QUE DESEO DE ELLAS ES: LAS RECOMPENSAS A CORTO PLAZO (DIARIAS) SON: LAS RECOMPENSAS A LARGO PLAZO: Fecha Firma Testigo La Guía de Capacitación de Head Start Mejoremos la salud en el ambiente laboral de Head Start (Enhancing Health in the Head Start Workplace, 1996).
Head Start Bulletin 23

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FINALLY SAY GOODBYE TO SMOKING

The information in this article is excerpted from the Washington Post, Tuesday 19 February, 2002, Section F, HEO1 “The

Butt Stops Here,” by Sally Squires

IN AMERICA, OVER 50 MILLION PEOPLE SMOKE. According

to the Federal Centers for Disease Control (CDC), about 40

percent will try to quit at least once in 2002. Unfortunately,

fewer than 1 out of 10 will be successful. Many smokers

will try to quit 5 to 7 times before they finally succeed, and

in most cases this is only after taking proper steps, which

today include different medications and smoking cessation

programs. With the new kinds of assistance available,

experts agree there has never been a better time to quit.

Today, there are many scientifically validated drug

treatment choices that can reduce withdrawal and cravings.

Four nicotine replacement methods are safe and have been

proven effective: gum, a patch, an inhaler, and a nasal

spray. They have minimal side effects, extremely low risk of

addiction, and are free of approximately 4,000 of the harmful

substances that are found in cigarettes. The drug Bupropion

(also known as Wellbutrin) has proven effective in reducing

the dose of nicotine the body receives and in taking the edge

off cravings and withdrawal. Drug treatments work best when

combined with organized cessation and support programs

and/or individual counseling.

Tobacco experts believe that smokers should keep trying to quit. There are a lot of options out there to help

you. Keep trying. Many give up too soon. And keep in

mind, even if you have tried and only stopped smoking for

days or weeks at a time, you still have a good chance of

succeeding in the end. ■

Do you need help quitting? Assistance is available, including drug

treatments and organized cessation and support programs.

Here are ways to help make the quitting process

smoother and more effective—

• Set a date to quit. The sooner, the better. Try within 2 weeks.

• Talk with your doctor about medication to help while you quit. 

• Involve your friends, family, and co-workers. Social support combined with drug treatment can boost success rates to 30%.

• Avoid alcohol for at least the first two months while quitting. 

• Do not diet. Expect to gain a couple pounds. 

• Exercise. It will help limit weight gain, can ease cravings

for nicotine, improve sleep, and elevate mood. 

• Drink fluids. They help flush nicotine from the body.

• Gradually reduce the amount of each cigarette smoked until

you are only smoking a quarter of each cigarette. 

• Cut back on the number of cigarettes smoked daily. Reduce

the number of cigarettes smoked daily by two each day

until you are not smoking any. 

• Make a list of why you want to quit smoking. Keep the list

with your cigarettes as a reminder.

• Develop a list of triggers. Plan in advance to avoid them.

• Find a phone buddy or Internet friend. Live assistance can be a

valuable source of support and guidance. See box on right.

WAYS TO HELP YOU KICK THE HABIT

American Cancer Society

1599 Clifton Rd., NE; Atlanta, GA 30329 

Quit Hotline: 877-937-7848 (24 hours a day everyday)

American Lung Association

1740 Broadway; 14th Floor; New York, NY 10019 

Quit Hotline: 800-LUNG-USA (24 hours a day everyday)

Freedom From Smoking, the free online smoking cessation

program, is available at www.lungusa.org. (24 hours a day

everyday)

National Cancer Institute

Quit Hotline: 800-4-CANCER

Live Help available at cis.nci.nih.gov. (M-F, 9:00 a.m.-4:30 p.m.)

QuitNet

Assistance available at www.quitnet.com. (M-F, 9 a.m.-7:30 p.m.)

NATIONAL QUIT LINES AND ONLINE SUPPORT

For more resources see page 44

As I was working on this article, I found a reborn force inside

me, pushing me to attempt to quit smoking yet another time.

I am ready to live a healthier life. I hope this article helps

convince you that there are ways to make that change. If you

do choose to quit, unlike some situations in life, there will be

no negative repercussions. Your family and friends will support you, and in the end, they will thank you. 

—Aisha Mahy, Publications Assistant
24 2003/Issue 75

PEER HEALTH EDUCATORS

TEACHBACK TO OTHER HEAD START PARENTS

B Y S HANNON BLAS

parents must complete a 12-hour

training in which they learn how to

partner with doctors and navigate

through the managed care system.

They learn how to use the Healthwise

Handbook, a self-care manual describing over 180 different health care

problems and their treatment. Advice

about when to call a doctor is

included. Many local organizations

use the Handbook in their health

education programs. 

The Peer Health Education

Program focuses on specific topics.

Oral health and the prevention of

tooth decay were emphasized last year;

asthma education will be the next

topic. Parents and health professionals

serve on a Peer Health Advisory subcommittee that provides guidance and

supports the program’s efforts.

The Teachback

THE PEER HEALTH EDUCATORS

teachback to other Head Start parents

what they have learned. The Educators

are given a training “script” to follow

but are encouraged to add their own

personal touches. These teachback sessions take place at parent meetings,

health fairs, and end-of-the-year celebrations. They vary from a one-hour

group meeting to a shorter one-on-one

session. Each parent who attends

a teachback receives a Healthwise

Handbook, which is a contribution to

the local Head Start programs. 

Other teachback activities

include— 

• “Ask the Doctor Checklist.”

Parents learn how to use a tool

to help them prepare for doctor

visits. They are encouraged to

write down their questions.

• First aid kits. Parents learn

about home safety and make

kits to keep on hand.

• Health care record keeping.

Parents learn about how to keep

and store information from children’s medical appointments

over the years. This task is

important when families move,

and medical records are difficult

to transfer.

Materials are available in

Spanish. Teachbacks are conducted in different languages. 

Benefits of the Peer Health

Educators Program

THE PROGRAM is a great success and continues to grow.

During 2000-2001, 22 Peer

Health Educators were trained;

they offered nearly 50 teachbacks. They distributed over 700

Healthwise Handbooks to families. The Peer Educators note

how the program has made a

difference in their own lives: 

• “Giving me more confidence in

myself.”

• “Decreasing my visits to the

emergency room.”

• “Showing me what I really love

to do—teach others.”

The Future of the Program

THE PEER HEALTH Education

program was funded by the

Maternal & Child Health Bureau’s

Healthy Tomorrow program. The

grant will end in 2002. However, the

program has been well integrated

with other Head Start health services

so that training for the Peer Health

IN 1997, PUGET SOUND EDUCATION SERVICE DISTRICT (PSESD) Head Start

launched a Peer Health Education Program in the Seattle area. The Peer Educators

are Head Start parents who are trained to teach other parents how to navigate

health care systems and advocate for their families’ health. 

To become a Peer Health Educator,

Peer health educators learn

about well-baby care

Photo courtesy of Puget Sound Education Service District Head Start.
Head Start Bulletin 25

Educators will continue.

Programs do not need special funding to implement peer health activities.

The PSESD Head Start staff offers these

tips for starters—

• Involve parents, staff, and the

Health Services Advisory

Committee in planning and

implementing peer health 

education.

• Teach parents to teach other parents about health advocacy

and navigating health systems.

Specific information about

diagnoses, treatment, and medication are best left to health

professionals.

• Use Peer Health Educators to

offer health information to

families who have limited

English proficiency. 

Peer health education is an effective

way to increase the knowledge and

advocacy of Head Start parents around

health matters. Why not consider

beginning such an initiative in your

program? ■

Shannon Blas is the Peer Health

Manager for the Puget Sound

Educational Service District Head Start.

T: 206-439-6910 x4040; 

E: sblas@psesd.wednet.edu.

IS THE WEB A RELIABLE SOURCE OF INFORMATION?

PICTURE THIS. You have just found out

a family member or friend needs to

have surgery. What would you do? In

this age of technology, more than

likely you would turn to the Internet to

get more information. And you would

not be alone. In fact, a recent Harris

Interactive survey estimated that 97

million Americans used the Internet to

look for health-related materials.

Studies also show that consumers pay

attention to what they find on the

Internet—more than 70% say that

online health information has

influenced a health decision! But is

the information reliable and

accurate? Is it comprehensive and

understandable? These questions

prompted the California HealthCare

Foundation to ask the RAND

Corporation to design and conduct a

large study to evaluate medical

information on the Web. 

The researchers accessed 14 search

engines and numerous medical Web

sites in both English and Spanish.

They focused on four medical

conditions: breast cancer, childhood

asthma, depression, and obesity. At

each Web site, the researchers asked

consumer-oriented questions. The

main conclusions were—

• Search engines are not efficient

tools for locating health

information on a particular

health topic.

• Consumers often find incomplete

answers.

• Most Web-based health

information is difficult for the

average consumer to understand.

Although RAND found that the

information is generally accurate, is

searching for health information via

the Internet really worth it for the

average consumer? It is, as long as

you keep these guidelines in mind—

• The Internet health area is

infinite. It is not easy to find all

the information you seek on one

Web site. Go to multiple sites.

• Know that sites will not provide

all of the information you need.

They can give you information

about good questions to ask a

doctor and may help you

understand what a doctor says. 

• Many sites have been created

to sell products. This does not

mean that the information is

incorrect, but it may be

incomplete or biased.

The final message is—be an informed

consumer of health information on

the Internet. ■

REFERENCES

RAND Corporation. 2001. Evaluation

of English and Spanish Health

Information on the Internet. 29

August 2002

<www.rand.org/publications/do

cuments/Interneteval/>.
26 2003/Issue 75

from being more active. We want to

alert you to the community and personal barriers to your playing as well

and as much as you want.

First the basic information: If you

are an active person, the benefits are

endless. Physical activity, especially in

the form of PLAY, can—

• Reduce the risk of dying from

coronary heart disease and of

developing high blood pressure,

colon cancer, and diabetes;

• Help reduce blood pressure in

some people with hypertension;

• Help maintain healthy bones,

muscles, and joints;

• Reduce symptoms of anxiety

and depression and fosters

improvements in mood and feelings of well-being; and

• Help control weight, develop

lean muscle, and reduce body

fat (McGinnis & Foege 1993;

U.S. Department of Health and

Human Services 1996).

Most people know all of this.

However, most people—in fact, more

than 60% of American adults—do

not get out and play for the recommended 30 minutes each day. Why?

Perhaps it is because our society has

made it so easy for us to be inactive.

We are busy and cannot imagine getting up 45 minutes earlier everyday to

do something active. At the end of the

day, we are too tired. Our children

would rather use video games and

watch TV than play tag. We find it

easier to get in a car and drive everywhere than to walk. Sometimes it is

tough to find a safe place to walk, run,

or bike. However, things were not

always this way, and they do not have

to stay this way.

You will remember that in the

past, a lot of people smoked cigarettes.

As we learned more and more about

the health risks of cigarette smoking,

our society changed its attitude toward

smoking. It became harder for people

to smoke in public. Thirty years ago,

we would never have seen smokers

outside of buildings puffing in the

cold. We would not have been able to

fly across country on a smoke-free airplane. How times change!

Although there are still smokers

(and we will give them all possible

support as they try to quit), the

Centers for Disease Control and

Prevention (CDC) has found that

physical inactivity, in children and

adults, is fast approaching epidemic

proportions. CDC and the Surgeon

General have sounded the alarm—

there are serious consequences for

being inactive. However, it is better to

think of the benefits of activity, and to

understand that each one of us can

build a little bit of activity into our

lives. Bit by bit, we can reach the recommended 30 minutes each day. The

30 minutes do not need to happen all

at one time. 

You can climb a few stairs, dance

a few steps down the hallway, or get

out in the garden to water plants. Take

a walk with your toddler, move to

music with your preschooler, or toss a

ball with your older child. Choose to

get around by any method other than

the car, and you will add many minutes of physical activity to your day.

If you would like to begin a genuine program of PLAY, choose a playmate. Social support from family and

friends is consistently and positively

Continued on page 45

PLAY AND STAY HEALTHY

ALL IT TAKES IS 30 MINUTES A DAY

B Y P EGGY DA SILVA

HEAD START STAFF AND PARENTS ARE BUSY PEOPLE. They are committed to caring for children and sometimes neglect their own health and well-being. They do

not take time to eat well, relax, or get out to play. You notice that we said “play”

and not exercise! That is because we want you to keep reading. We want to

describe the benefits that adults can gain

Choose a favorite

activity

Photo by A. Mahy.
Head Start Bulletin 27

utes each day to try these exercises.

Some can be done while you are seated

at your desk. You will not even break

into a sweat if you pause at the end of

each contraction and hold the position

for a few seconds. Where possible, try

10-15 repetitions on each side. And

remember to breathe properly: Always

exhale on exertion or when lifting a

weight, and inhale as the weight is

being lowered. If you are a beginner to

exercise, please proceed with caution.

Consult with your health care professional before beginning any exercise

program.

• Side lifts – Stand with one hand

on your waist. In your other

hand, hold a book or other

weighted object. Raise the

weighted arm out to your side

with elbow extended but not

completely locked. Continue to

lift the weighted arm to shoulder height, hold, lower. This

move can also be done with

both arms at the same time

(bilaterally) or as described

here (unilaterally). 

• Arm curls – Stand with your

arms at your side. Hold a book

or other weighted object in one

hand at your side. Bend the

weighted arm at the elbow raising your palm toward your

chest. Hold, then lower. This

can also be done bilaterally or

unilaterally. 

• Desk pushups – Stand with

your hands on your desk, arms

straight, shoulder-width apart.

Keep your feet together, back

straight, slowly bend your

elbows, leaning toward the

desk. Straighten up. Remember

to keep your abdominal muscles contracted to prevent

strain on your lower back.

Repeat 10-15 times.

• Palms press – Press your palms

together in front of your face.

Slowly lift your elbows to chin

level, hold, lower. Be cautious

with this exercise if you have

hypertension, and avoid it altogether if you have known coronary artery disease. Repeat 10-

15 times. 

• Wall squats – Stand with your

back against a wall. Lower

yourself into a seated position

and hold to the count of 20.

Repeat 3 times. If you have

knee problems, only bend

about 60-75 degrees of flexion

so as not to elicit pain. 

• Leg curls – Hold onto a file

cabinet, shelf, or wall for support and stand parallel to it.

Bend one leg at the knee and

slowly curl it behind you, keeping your upper legs together.

Keep the knee of the opposite

leg slightly bent, to work the

quads and hamstrings, instead

of placing unnecessary stress on

your knee.

• Writing the alphabet – Sit and

rotate one foot to “write” each

letter of the alphabet. Repeat

with other foot.

• Foot lifts – Sit and press down

on the toes of one foot, lift up

your heel. Hold, lower. 

Build Flexibility

THERE IS NOTHING like easy stretching to reduce body tension that comes

from sitting in one place too long. Try

3-5 repetitions of each exercise several times throughout the day. Each

stretch should be held 15-30 seconds.

Before stretching, try taking a brief

five-minute walk around the office to

DO YOUR WORKOUT

ANYTIME, ANYPLACE

Here are a few tips about how to build in workout time during a busy day. 

Build Strength

SHORT SESSIONS OF UPPER AND LOWER BODY EXERCISES can increase your stamina, build and tone your muscles, and prevent back problems. Take a few minIt does not take much to

build up your strength

and flexibility. Set aside

a few minutes a day to

work out. You will end up

feeling so good.
28 2003/Issue 75

DO YOUR WORKOUT

stimulate increased blood flow. This

will slightly increase your core body

temperature and increase the effectiveness of your stretches. Remember

to hold each stretch just to the point

of mild discomfort. A stretch should

not be painful. Avoid any ballistic

(bouncing) type stretching. 

• Side to Side – Look ahead,

slowly turn your head to one

side, hold, return to center,

repeat on other side.

• Neck stretches – Slowly lower

each ear to the corresponding

shoulder, hold, return, repeat

on other side.

• Shoulder rolls – Rotate your

shoulders forward. Reverse

directions.

• Shoulder circles – Raise arms

out to your sides. Rotate arms

forward in small circles,

increasing to large circles.

Repeat, circling backward.

• Stretching up – Raise your

hands over your head and

reach for the ceiling. Let your

head drop back and look at the

ceiling. Keep your feet flat on

the floor. Hold this position.

Lower your arms slowly, reach

behind your back and clasp

your hands. Stretch your arms

behind you. ■

These exercises are adapted from yoga,

gym routines, and advice from medical

practioners. Consultation was provided by Chris Brophy, Program

Administrator for Research and

Professional Development for the

National Association for Sport and

Physical Education. T: 703-476-3413;

E: cbrophy@aahperd.org.

Back Stretch—Sit on the edge of a

stable chair. Extend your legs out straight

in front of you. Slowly bend forward from

your waist, head toward your knees while

reaching for your ankles. Hold. Slowly

rise, lifting your shoulders first and

keeping your head bent forward. This will

also stretch your hamstrings.

Leg extensions—Sit on a chair, feet

on the floor. Extend one leg from the

knee so that it is parallel to the floor.

This contracts the quadriceps. Hold,

then lower. 

Photos by D. Mentzer.

HERE ARE EXAMPLES OF POPULAR EXERCISES

Calf Stretch—Stand facing the wall.

Place one leg forward and the other leg

back. Bend the front leg, while keeping

the back leg straight, and be sure to keep

both heels flat on the floor. Lean forward,

keeping your palms on the wall for

balance. Switch leg positions and repeat. 
Head Start Bulletin 29

tion. Dietitians say that moderation is the key to making

all foods a part of healthful

eating. It means not having to

give up certain foods, but

instead setting limits on how

much and how often you

eat them.

Healthy eating habits are

not created or destroyed by

one food alone. There really

are no “good foods” or “bad

foods.” But there are bad

ways of eating foods—the

bad way is eating too much or

to excess.

Sometimes a bowl of

your favorite premium ice

cream or Aunt Mabel’s fried

chicken and gravy is just too

much to pass up. But remember, the key to healthy eating

and weight control involves moderation

and balance.

That means if you give in to temptation, and go a bit overboard with a

“not so good for you” food now and

then, balance out your diet over the

next day or two. Simply choose from a

variety of grains, fruits, and vegetables,

and other lower fat choices from the

base of the United States Department of

Agriculture’s Food Guide Pyramid

(Figure 1).

Think of the Pyramid as a tool or

visual guide to help you choose the

kinds of food to eat every day for good

nutrition. The five major food groups

are pictured as blocks. To no one’s surprise, they are stacked pyramid style. 

Food groups that should be eaten

more often are bigger and found at the

Pyramid’s base. Grains, breads, and

cereals are found there and should

form the bulk of our diet, especially

whole grains. Six to eleven servings a

day is ideal.

Fruits and vegetables come next,

emphasizing plant-based foods.

Naturally high in fiber and diseasefighting substances called phytochemicals, fruit (at least two servings) and

vegetables (at least three servings)

should be eaten each day. 

Smaller blocks near the Pyramid’s

top contain foods to be eaten in moderation. Fish, poultry, dried beans,

nuts, lean meats, and eggs—as well as

low-fat dairy products—are naturally

higher in fat than food groups found

lower on the Pyramid. That is why,

although they are a part of a balanced

eating plan, it is important to limit

PYRAMID POWER

THE BUILDING BLOCKS OF HEALTHY EATING

B Y PAULA MYDLENSKI

POP QUIZ. Ask your friends to name five foods that they can not live without. What

would they say? Maybe soft drinks, fast food burgers, and French fries are favorites.

Or perhaps, chocolate, ice cream, or chips score big.

Believe it or not, despite the oodles of sugar, salt, or fat in all of those foods,

they can still be included in a healthful diet—as long as they are eaten in moderaFat (naturally occurring and added)

Sugars (added)

These symbols show fats and added

sugars in foods.

Meat, Poultry, Fish, Dry Beans,

Eggs & Nuts Group

2 - 3 SERVINGS

Fruit Group

2 - 4 SERVINGS

Bread, Cereal,

Rice & Pasta

Group

6 - 11

SERVINGS

Fats, Oils & Sweets

USE SPARINGLY

Milk, Yogurt & Cheese Group

2 - 3 SERVINGS

Vegetable Group

3 - 5

SERVINGS

U.S. DEPARTMENT OF AGRICULTURE

CENTER FOR NUTRITION POLICY AND PROMOTION

THE FOOD PYRAMID

Recommended Daily Servings

Figure 1
30 2003/Issue 75

PYRAMID POWER

portion sizes for this group.

Fats, sugars, and salts make up the

pyramid’s top. These are the ingredients

of the foods that are often the most

loved but the least healthy. 

Youngsters and parents can encourage each other to make wise food

choices by playing the “Family Food

and Fitness Challenge.” Each day, score

1 point for each tier of the Pyramid represented at a meal and another point

for a daily session of physical activity.

At the end of the week, the family

member with the most points wins! ■

Paula Mydlenski is the Nutrition

Specialist for the Region IV Head

Start Quality Improvement Centers,

T/TAS at Western Kentucky

University. 

T: 270-745-4041; 

E: paulawku@aol.com.

PERFECT PYRAMID RECIPE

To get you on the path of healthy Pyramid eating, why not whip up some Black

Bean Chili With Oranges and Cornbread—count them—all tiers of the Food

Pyramid in only one dish!

BLACK BEAN CHILI WITH

ORANGES AND CORNBREAD

1 package cornbread mix

2 large onions, chopped

1 green bell pepper, chopped

1 red bell pepper, chopped

2 cloves of garlic, chopped

1 tablespoon vegetable oil

1⁄4 cup water

3 (15 oz) cans of black beans, 

drained and rinsed well

1 cup chicken or vegetable broth

1⁄2 teaspoon dried oregano

1⁄4 teaspoon chili powder

1⁄4 teaspoon ground allspice

dash hot pepper, or to taste

4 fresh oranges

1 cup nonfat sour cream

Bake cornbread in a 9x9 inch

(square) pan, as directed on package.

While cornbread is baking, make chili

by combining onion, green and red bell

peppers, garlic, oil and water in a large

saucepan. Cook, stirring often, for 10

minutes, or until vegetables are soft.

Add beans, broth, oregano, chili

powder, allspice, and hot pepper, if

desired. Bring to a boil. Reduce heat,

cover, and simmer for 10 minutes more.

While chili is simmering, shred 2

teaspoons orange peel. Squeeze juice

from enough oranges to make 1⁄2 cup.

Set shredded peel and juice aside. Peel

and remove all white membrane from

remaining oranges, then slice fruit

crosswise. Cover oranges and set aside.

Uncover chili and bring back to a

boil. Continue boiling for 15 to 20

minutes, until chili thickens. Stir in 1

teaspoon orange peel and add in all of

the juice. Ladle chili into bowls. Top with

orange slices and a dollop of sour

cream. Garnish with one remaining

teaspoon of orange peel. Serve

cornbread slice on side of chili. Enjoy!

Makes 4 Servings: Per serving (with one

2-by-2 inch cornbread square): 490

calories; 10 grams fat, 0 mg cholesterol. 

Prep. Time: Approximately 1 hour.

GRAIN GROUP

1 slice of bread

1⁄2 cup of cooked rice or pasta

1⁄2 cup of cooked cereal

VEGETABLE GROUP

1⁄2 cup of chopped raw or 

cooked vegetables

1 cup of raw leafy vegetables

FRUIT GROUP

1 piece of fruit or melon wedge

3⁄4 cup of juice

1⁄2 cup of canned fruit

MILK GROUP

1 cup of milk or yogurt

2 ounces of cheese

MEAT GROUP

2 to 3 ounces of cooked lean 

meat, poultry, or fish.

1⁄2 cup of cooked dry beans 

1 egg counts as 1 ounce of 

lean meat. 

FATS AND SWEETS

Limit servings from these.

What Counts as 1 Serving?
A LITTLE SOMETHING FOR HEALTHY SNACKING

TRY THESE RECIPES FOR YOUR NEXT STAFF GET-TOGETHER OR PARENT MEETING

Curried Veggie Dip

8 oz. carton plain, low fat yogurt

1⁄4 cup shredded carrots

2 teaspoons minced green onions

1 tablespoon low fat mayonnaise-type salad dressing

1⁄4 teaspoon curry powder

dash pepper (to taste)

1. Mix all ingredients in a bowl. 

2. Chill. 

3. Serve with crisp, raw vegetable pieces, such as summer

squash sticks, celery, carrot, and cucumber.

Makes: 1 cup; 15 calories and 1 gram of fat per tablespoon. 

Prep. time: 15 minutes

Chill time: 30 minutes

Total time: 45 minutes

Tempting Tortilla Chips 

Non stick cooking spray

2 tablespoons oil (optional)

1 package of flour or corn tortillas

1 cookie sheet baking pan

1. Preheat your oven to 350 degrees F.

2. Stack the tortillas into one pile, and using a sharp knife,

cut the pile in half, then into quarters, then cut the quarters

in half again (this will make the triangle shapes).

3. Spray cookie sheet with non stick spray or coat with the

oil.

4. Separate tortilla pieces, and arrange them on the cookie

sheet. Toast in the oven until the chips are crisp and

beginning to brown (approximately 10 minutes).

Makes approximately 80 chips from 10 tortillas, and

approximately 98 calories per 10 chips.

Black Bean and Cilantro Spread

1 15- or 16-ounce can of black beans, rinsed and drained

2 teaspoons fresh lime juice

1 teaspoon olive oil

1⁄4 to 1⁄2 teaspoon hot pepper sauce

1⁄4 cups of fresh cilantro (coriander) leaves

2 tablespoons of finely diced red onion

1. Puree the beans, lime juice, oil, and pepper sauce in a

food processor or blender, scraping down the sides once

or twice.

2. Add the cilantro. Process just until the leaves are coarsely

chopped and well mixed. Stir in the red onion.

3. Serve at room temperature (if chilled, the mixture will be

difficult to spread).

4. Use as a dip for whole wheat crackers, carrot or other

fresh vegetable sticks, baked tortilla chips, rice cakes, or

pita chips.

Makes 11⁄4 cups (10 servings). Per serving: 44 calories; 

1 gram of fat; 0 mg cholesterol.

Cheesy Carrot Spread

1⁄2 cup grated raw carrots

1⁄2 cup grated low fat cheddar cheese

Low fat or fat-free mayonnaise to taste

Pepper to taste

Lemon juice to taste

Salt (optional) to taste

1. In a food processor or by hand, grate cheese and carrots. 

2. Add enough fat free or low fat mayonnaise to moisten. 

3. Season with pepper, lemon juice, and salt, if desired. 

4. Spread on tempting tortillas (above), whole wheat

crackers, or bread.

Makes 1 cup (approximately 8 servings); 98 calories per serving. 

Prep time: approximately 5 minutes if a food processor is used;

10 minutes if using a hand grater.

Head Start Bulletin 31
32 2003/Issue 75

nutrition information. Today’s food

labels display up to four different

types of health and nutrition information, all designed to help you decide

which foods fit best into your overall

eating style and nutritional goals. 

Nutrition Descriptions

FROM “LEAN,” “low fat,” and

“light,” to “reduced calorie” or “high

calcium,” these nutrition descriptions

are truthful, because they are now

strictly regulated. Usually found on the

front of food labels, they can be seen

for quick comparisons of products (see

“Nutrition Descriptions” on page 33).

Health Claims

FOUND FREQUENTLY on the front of

food packages, health claims are

optional. They truthfully state a food’s

nutritional qualities may help reduce

the risk of a specific long-term

disease, such as osteoporosis, cancer,

or heart disease. For example, “This

is a high calcium food, and calcium

has been shown to lower the risk of

osteoporosis.”

Nutrition Facts

USUALLY LOCATED ON THE SIDE or

back of a food package, the nutrition

facts panel offers much more detailed

nutrition information than the nutrition description or a health claim. The

nutrition facts panel provides information about the specific nutrient and

caloric content of one serving. The

nutrition facts panel includes serving

size, calories, percent daily nutritional

value, and specific amounts of nutrients that relate to today’s most important health issues (fat, saturated fat,

cholesterol, fiber, Vitamins A and C,

calcium, and iron).

Ingredient List

IF A FOOD CONTAINS more than one

ingredient, the label must include an

ingredient list. Like a recipe, the ingredient list tells you what is in the package. By law, food manufacturers must

list all ingredients in descending order

of weight. This means that the food

ingredient in the largest amount must

be listed first. The food ingredient present in the least amount is listed last.

Take chicken soup. If the first

ingredient listed is water, then the soup

contains more water by weight, than

anything else. The ingredient list is

especially useful for persons with allergies to specific ingredients or with

dietary restrictions.

In addition, check out the product’s weight. Sometimes packaging

can fool the eye. When you want to

compare size, look at the weight of

the product.

And last, but not least, check

out the manufacturer’s name and

address. This information is useful

if you would like additional information regarding the food, or if you

would like to contact them with

product complaints.

Whether it is cutting calories,

boosting fiber, lowering dietary fat, or

making a myriad of other, more nutritious personal food choices, food

labels can help. Read the food

label...eat healthy at the table! ■

Paula Mydlenski is the Nutrition

Specialist for the Region IV Head Start

Quality Improvement Centers, T/TAS

at Western Kentucky University. T: 270-

745-4041; E: paulawku@aol.com.

Example of a food label.

LABEL LINGO

WHAT DOES IT MEAN?

B Y PAULA MYDLENSKI

MORE AND MORE PEOPLE ARE CONCERNED about what they are eating. If you

are one of them, you probably want to know what is REALLY in your food—

and what has been added, such as fat, chemicals, salt, and sugar. Food labels can

help you! 

Wrapped around almost every packaged food, you will find a wealth of 
Free An amount so small that it probably will not affect your body; for example, “calorie free,” “fat free,” 

or “sodium free.” Other terms: no, zero, without, trivial source of, and negligible source of...

Low An amount specifically defined for each term, such as “low calorie,” “low fat,” or “low cholesterol.” 

Other terms: few, contains a small amount of, low source of, low in, little, a little...

Reduced An amount used to describe a food with at least 25 percent fewer calories, fat, saturated fat, 

cholesterol, or sodium than a comparable food. Look for information about the food it is being 

compared to. Other terms: reduced in, ___ percent reduced, fewer, lower, lower in, less...

High An amount 20 percent or more of the Daily Value* for a nutrient, for example, “high in vitamin C”

or “high calcium.” Other terms: excellent source of, rich in...

More An amount that is 10 percent or more of the Daily Value*, for example, “more fiber” or “more

iron.” Not found on meat or poultry products. Other terms: enriched, fortified, added...

Light A food with one-third fewer calories or 50 percent less fat than the traditional version. A “lowcalorie” or “low-fat” food with 50 percent less sodium might also be called “light.” Other terms: lite...

Healthy A food low in fat and saturated fat, 480 milligrams or less sodium per serving, and at least 10 percent 

Daily Value* of vitamin A, vitamin C, calcium, iron, protein, and fiber.

NUTRITION DESCRIPTIONS

What do they mean?

Want to look and feel fine? Who doesn’t?

Here are some simple steps to help you

achieve your goal:

1. Avoid becoming obsessed with your

weight. We all know that weight

control is important for well-being and

health. Still, remember that your

worth cannot be measured on a

bathroom scale!

2. Always shop with a grocery list and

do not deviate from it. That way, you

will not be tempted to buy high-calorie

junk food.

3. Guard against a monotonous diet. It is

easier to stay on a fitness or weightcontrol program if it is filled with an

assortment of food.

4. Eat fresh fruits and vegetables daily.

Loaded with fiber, vitamins, and

minerals, these foods fill you up and

help prevent overeating.

5. Eat fish several times a week. It is low

in calories. Research is showing that

some fish oils are good for the heart.

6. Limit fatty, fried foods as much as

possible. Fats have twice as many

calories as protein and carbohydrate

foods. By now, we all know that they

clog up our arteries too.

7. Eat slowly. Concentrate on the taste

and texture of food.

8. Drink lots of water and very little

alcohol. It is best to drink six to eight

glasses of water per day. On the other

hand, alcohol has no nutrient value

and many calories.

9. Exercise daily. Do something you

enjoy—like walking, dancing,

swimming, or playing ball. It will

put you in a more positive frame of

mind too.

10. Laugh often and smile a lot. At an

American Heart Association’s meeting,

University of Maryland researchers

reported that healthy people are more

likely to laugh often and use humor to

get out of uncomfortable situations. It

is good for your heart. 

11. Finally, be your own “stress-buster.”

When the tensions and anxieties of

daily life get to you, take three very

deep breaths. Next, put things into

perspective by asking yourself, “Will

this really matter one year from

today?” In most cases, the answer is

that it will not even matter one week

from today.

Paula Mydlenski is the Nutrition

Specialist for the Region IV Head Start

Quality Improvement Centers, T/TAS at

Western Kentucky University. T: 270-745-

4041; E: paulawku@aol.com.

EASY STEPS TO FEELING FINE

by Paula Mydlenski

Head Start Bulletin 33
34 2003/Issue 75

including Somerville Early Head Start

(EHS). Important enough that Patricia

strives daily to ensure that both she

and Michael will have a better future

than she once believed possible.

Patricia had already lost one

pregnancy to her cocaine addiction

when she became pregnant with

Michael. Fearful of losing a second

baby, but still in the grips of her addiction, she was referred to the EHS and

began receiving home visits. The doctor providing her prenatal care had

been performing regular drug screens.

Unable to deter her drug use, he

reported her case to the Department of

Social Services (DSS). Finally, facing

the choice between entering a residential drug treatment program or losing

custody of her soon-to-be born child,

Patricia began to see that she needed

to deal with her addiction. 

Raised by her grandmother,

Patricia knew the pain of growing up

wondering where her mother—an

alcoholic unable to raise any of her

nine children—was, what had happened to her, and why she could not

take care of or be with her children.

Patricia became determined not to

allow her own child to experience

those same feelings of rejection and

loss. In her seventh month of pregnancy, Patricia found the strength to

stop using drugs.

Michael was born at seven-and-ahalf months, weighing just three

pounds and six ounces. As a newborn

he evidenced the respiratory, muscular,

and sensory problems typically caused

by prenatal drug abuse, in addition to

the challenges associated with premature birth. While Michael remained in

the neonatal intensive care unit,

Patricia entered a treatment program.

She visited him daily until his weight

reached five pounds. Then he was

transferred to her care at the drug

treatment facility. Patricia was making

good progress in her recovery. Yet, she

was concerned that her schedule kept

her separated from Michael for too

much of the day and was interfering

with their bonding. She asked her case

manager to move her into an outpatient treatment program so that she

and Michael could go home.

When her request was granted,

Patricia and Michael moved back into

the community where she had previously been enrolled in EHS. The program staff had maintained contact

with Patricia during her inpatient

treatment, calling frequently to see

how she was doing and to offer their

support. As a result, Patricia felt

respected and cared about. She was

eager to return to the program, recognizing that both she and Michael were

going to need a lot of help—help that

EHS could provide.

EHS and the Early Intervention

program (funded by the state of

Massachusetts) began intensive work

with Michael and Patricia to overcome

the developmental challenges resulting

from his early exposure to cocaine.

Patricia also set to work on her own

plan of action, assisted by her DSS

case manager and her EHS home visitor. Cynthia Vivian, a family support

worker with EHS, worked with

Patricia to develop a Family

Partnership Agreement designed to

assist her in reaching self-sufficiency,

self-care, and developmental goals. 

Cynthia helped educate Patricia

A MOTHER’S SUCCESS STORY

EARLY HEAD START PROVIDES SUPPORT

B Y LARISSA Z OOT

YOUNG MICHAEL DOWNEY will grow up knowing that he is important.

Important enough that his mother, Patricia Zecchilli, found the strength and motivation to overcome a ten-year cocaine addiction and begin taking better care of

them both. Important enough that Patricia learned how to ask for, and accept,

help from agencies in her community—

Michael and his mother are happy and healthy

Photo courtesy of Somerville Early Head Start.
Head Start Bulletin 35

about the variety of resources available

in the community and how to access

those resources. With Cynthia’s support, Patricia was able to complete the

paperwork and keep appointments

which led to energy assistance, furniture donations, a Section 8 housing

voucher, and even Christmas presents

for Michael. Patricia found it difficult

to believe that help was there for the

asking. She found it even more difficult to ask in the first place. After a

lifetime of keeping her fears and feelings inside and not wanting anyone to

feel sorry for her, Patricia discovered

that taking action to care for herself

and Michael increased her confidence

and self-respect. “I had no selfesteem,” Patricia says, “but now I love

myself and I love Michael. I thank

God every single day for letting me

have my son. And I deserve a lot of

the credit too.”

As a result of therapies implemented via the Early Intervention program and individualized home visit

activities via EHS, Michael’s development has progressed to the point

where there are few remaining traces

of his initial delays. A child care

voucher facilitated by DSS made it

possible for Michael to attend a centerbased child care program in the community and required Patricia to seek

employment. It had been ten years

since she last held a job. Initially the

search was both scary and frustrating.

During her job search, Patricia began

volunteering at Michael’s child care

center. It was not long before the

center director noticed her skill and

comfort with the children and

asked Patricia to consider working

in the center.

Patricia was surprised by the offer,

but excited and definitely interested in

the job. She now works as a teaching

assistant in the center’s infant room

and is beginning her Child

Development Associate training.

Patricia says the job helps keep her

motivated to maintain her sobriety and

to continue taking care of her health.

“It gives me a sense of responsibility

and somewhere to go. I work my eight

hours, and at the end of the day I feel

excellent.” Since beginning work,

Patricia has been paying off financial

debts accrued during her years of drug

use. She has begun thinking about

goals for the future. Her employer

will reimburse her educational

expenses, which means she will soon

be able to start saving money for

Michael’s education instead. “I want

him to have a good life and to be comfortable, and I want to give him all the

love I can give him.”

In meeting her own physical and

mental health needs, Patricia has also

learned a lot about how to support

Michael’s well-being. “You have to

take care of yourself in order to have

strength and be able to take care of

your child. Michael senses and reacts

to my feelings. If a parent is upset or

tense, a child feels the vibes and gets

worked up too. It affects their

appetite, their sleep, everything. You’d

be amazed what they can sense.”

Patricia admits that despite her

tremendous progress, it has not always

been easy. When she first returned

home from inpatient treatment, everyday items in her surroundings often

triggered her desire to numb her emotions with drugs. But she says that

having Michael to care for gave her

the will to change. According to

Patricia, each day of change is another

step on the road to recovery. “Each

day I wake up in the morning, and I’m

stronger than the last day.”

Michael continues to grow

stronger as well. His therapy continues

in order to support his fine motor

development, but his respiratory and

sensory problems have been eliminated. He is a joyful, friendly, and

energetic toddler, and his mother dotes

on him. Says Patricia, “When he was

born and I saw him, my love for him

was incredible. No drug in the world

could take priority over him.” ■

Larissa Zoot is an Early Head Start

Program Specialist for ACF Region I.

T: 617-565-1153; E: lzoot@acf.hhs.gov.

This story is written with special thanks

to Patricia Zecchilli for sharing her story,

and to JoAnn Thrasher, Patricia Elliott,

and Cynthia Vivian at Somerville Early

Head Start.
36 2003/Issue 75

ing, and after pregnancy as a way to

reduce the incidence of childhood disability. Disabilities services can promote parent education, community

partnerships, and advocacy activities,

including the reduction of developmental risks from exposure to environmental toxins such as lead poisoning and the harmful effects of alcohol,

smoking, and drugs. Working with

parents and community partners to

address these concerns should be part

of a comprehensive health education

effort in every Head Start program.

But there is more that falls under

the umbrella of disabilities services.

A core Head Start activity is broadly

described as “family support.” It can

make a steady and strong contribution to the wellness of families of

children with disabilities. This effort

has been a part of the Head Start

model from the beginning and is

reflected throughout the Head Start

Program Performance Standards (see

page 38). While family support activities contribute to the development of

children in all the families Head Start

serves, research suggests that families

of children with disabilities may benefit even more. 

Why is this? Parents of children

with disabilities are more likely to

have experiences that can put their

own health and wellness at risk.

These experiences include increased

isolation, marital conflict, financial

hardships, time and energy demands,

and a persistent feeling that they are

being ineffective in meeting their

child’s needs. Family support activities are often critical to the family’s

well-being and the parents’ capacity

to parent.

My first lesson on Head Start’s

contribution to supporting families of

children with disabilities came several

years ago. I was a psychologist in a

program serving children with developmental disabilities. I often had the

responsibility of presenting the assessment findings of the interdisciplinary

team and its recommendations at

Individualized Education Program

(IEP) meetings in the schools. One

such meeting was scheduled for

Maria, a five-year-old girl with multiple disabilities who would be entering

kindergarten that fall. A few weeks

before that meeting, I had met Maria,

her parents, and a coordinator from

the Head Start program she attended.

They had traveled almost 100 miles

from home to our university-based

center for multiple evaluations,

including neurological and orthopedic

exams recommended by her pediatrician and developmental assessments

requested by the local school system.

The results would help in planning

the most appropriate services for

Maria’s kindergarten year. 

The afternoon of the IEP meeting,

I arrived to find Maria’s parents and

the Head Start disabilities services

coordinator seated together on a

bench outside the local elementary

school. They had arranged to meet

early to prepare for the meeting. The

Head Start program had arranged

child care that afternoon for Maria

and her younger brother so that both

parents could attend. As the meeting

began, I soon recognized that these

parents were unusually well-prepared

and confident in their roles as advocates for their daughter. The Head

Start coordinator offered support and

suggestions, but she followed the 

FAMILY SUPPORT ACTIVITIES CONTRIBUTE TO

THE HEALTH OF FAMILIES OF CHILDREN WITH DISABILITIES

B Y JI M O’BRIEN

IS THERE A ROLE FOR HEAD START DISABILITIES SERVICES in promoting adult

health and wellness? The answer is a resounding YES. Although the disabilities

services usually target children, they can also support adults’ well-being. In

coordination with a Head Start program’s health promotion and prevention

efforts, disabilities services activities may focus on maternal health before, durFamily support activities benefit both parents 

and children

Photo courtesy of Head Start Bureau.
Head Start Bulletin 37

parents’ lead. The school staff and

Head Start coordinator shared reassuring stories of children with disabilities (and their parents) who had

made successful transitions from

Head Start to kindergarten. I was

pleased to learn that the kindergarten

teacher knew Maria and her parents

from her visit to the Head Start classroom; she made specific suggestions

based on those observations and discussions with the Head Start teachers.

It was clear that Maria’s transition

was on a sound foundation and that

her parents’ involvement in her new

school would be substantial. After the

meeting, the Head Start coordinator

congratulated the parents on their

performance and jokingly warned

them that she would be calling for

their help in supporting other Head

Start parents of children with disabilities. 

Looking back, I now know that

this Head Start coordinator’s wonderful support of Maria’s family was a

required feature of the Head Start

model of parent involvement. I also

understand that the parents’ “performance” in that IEP meeting was the

product of months of communication

between them and the Head Start

staff. It was grounded in a relationship of trust and mutual respect. And,

I realize that the partnership between

the Head Start program and the

school system, built over several 

Continued on page 45

The Beach Center at the University of Kansas (www.beachcenter.org) conducts

research and collects information on best practices for supporting families caring

for a family member with a disability. A primary focus is identifying what families

report as being helpful for their child and for themselves. Its message to service

providers is: While you may see your role as delivering a service, the family

measures your contribution on their own scale, based on their needs and dreams

for their child and family. Many of the lessons learned by the Beach Center and

other researchers are being implemented in a national network of parent training,

information, and support centers. 

Parent centers in each state provide training and information to parents of children

with disabilities from birth to 21 years of age. This assistance helps parents

participate more effectively with professionals in meeting their children’s

educational needs. To reach the parent center in your state, visit the Web site of

the Technical Assistance Alliance for Parent Centers at www.taalliance.org or call

1-800-537-2237. 

Services that Parent Centers provide include: **

Information:

✓ Helping parents find available and appropriate services 

✓ Helping parents understand their legal rights and responsibilities 

Support:

✓ Finding another parent to talk with and learn from

✓ Finding a parent to attend school conferences with you

✓ Meeting other parents with similar concerns

Training:

✓ Developing self-advocacy skills

✓ Improving communication with teachers and administrators

✓ Preparing for IEP meetings

Parent-to-Parent programs (over 600 nationwide):

✓ Finding trained parents to volunteer for a one-to-one relationship with a

parent seeking support

**Many of these activities correspond to requirements in the Head Start Performance

Standards listed on page 38.

Training and Information Centers and Community Groups
38 2003/Issue 75

FAMILY SUPPORT ACTIVITIES

1304.20(f)(2)(i) Services for infants and toddlers with disabilities and their families support the attainment of the expected outcomes

contained in the Individualized Family Service Plan (IFSP) 

1304.20(f)(2)(ii) ...support parent participation in the evaluation and IFSP development process for infants and toddlers enrolled in 

their program; 

1304.20(f)(2)(iii) ...support efforts for a smooth and effective transition for children who, at age three, will need to be considered for

services for preschool age children with disabilities; 

1304.40(a)(1) Family goal setting: ... engage in a process of collaborative partnership-building with parents to establish mutual trust 

and to identify family goals, strengths, and necessary services and other supports.

1304.40(a)(2) ...offer parents opportunities to develop and implement individualized family partnership agreements that describe 

family goals, responsibilities, timetables, and strategies for achieving these goals as well as progress in achieving them. 

1308.21(a)

(1) Support parents of children with disabilities entering from infant/toddler programs. 

(2) Provide information to parents on how to foster the development of their child with disabilities. 

(3) Provide opportunities for parents to observe large group, small group and individual activities described in their child’s IEP.

(4) Provide follow-up assistance and activities to reinforce program activities at home. 

(5) Refer parents to groups of parents of children with similar disabilities who can provide helpful peer support. 

(6) Inform parents of their rights under IDEA. 

(7) Inform parents of resources which may be

available to them from the Supplemental

Security Income (SSI) Program, the Early and

Periodic Screening, Diagnosis and Treatment

(EPSDT) 

(8) Identify needs (caused by the disability) of

siblings and other family members. 

(9) Provide information in order to prevent

disabilities among younger siblings. 

(10) Build parent confidence, skill and

knowledge in accessing resources and

advocating to meet the special needs of their

children.

1308.21(b) ...assist parents in the transition

of children from Head Start to public school or

other placement, beginning early in the

program year. 

Selected Head Start Program Performance Standards: Support for Families

Identifying Disability Prevention and Support Resources 

The March of Dimes has a comprehensive Web site on the

prevention of early childhood disabilities—MAMA, the online guide

to a healthy pregnancy mama.modimes.org. This site combines

expert advice in an easy-to-read format with lively graphics and a

humorous style (e.g., sorting out myth from the evidence in a section

entitled, “What the old wives say!”). A Spanish language version of

the March of Dimes Web site is available at www.nacersano.org.

For local resources and approaches to working with families, consult

with your Head Start program’s Health Services Advisory

Committee. And remember the training and technical assistance

resources available through the Head Start health and disabilities

services specialists at your Quality Improvement Centers (QICs and

QIC-DSs).
Head Start Bulletin 39

Employee assistance programs can

offer a variety of services to address

employees’ personal concerns, ranging

from assistance with legal matters to

referrals for health care. One Head

Start Director approached her EAP

when she went through a family crisis.

Employee assistance professionals not

only helped her understand the legal

and financial issues she had to deal

with, but also provided short-term

family counseling. EAPs can offer written materials, guest speakers, and

workshops to employees and their

families on topics such as health

promotion, conflict management, and

parenting. Some EAPs provide a

24-hour hotline for employee

emergencies. A Head Start program

with employees who have mostly

school-age children might have its EAP

run a homework hotline. 

An employee assistance program

is also a resource for managers. It can

provide training for supervisors to help

them identify personal and health

concerns among employees and make

referrals to EAP services when needed.

The goal is to help supervisors resolve

sensitive workplace problems in a

positive and caring way. As a result,

morale and job performance improve

and staff turnover diminishes.

An EAP can also work to prevent

or help with health and mental

health issues that manifest in the

workplace, such as substance abuse

and stress. EAPs can help create a

positive work environment. 

Grantees typically operate Head

Start employee assistance programs.

According to Jan Cox, Health

Resources Manager for Region VI-A

HSQIC, many Head Start EAPs offer

“resource and referral and support

services.” They contract with local

service providers, such as community

mental health agencies, to provide

direct services. A contact within

the Head Start grantee agency usually

makes the initial referral and provides

necessary support and follow-up to

the employee.

The particular design of an

employee assistance program can vary

greatly from program to program. One

Native American Head Start program

used the tribe’s EAP, which offered culturally relevant services. Sometimes

clients were referred to a sweat lodge

as a treatment option. Staff who used

the tribe’s EAP were usually referred

by the director or mental

health consultant on staff,

but occasionally they

approached the EAP on

their own. Because so

many factors are critical

in selecting an EAP, The

Resource Guide on Head

Start Employee

Assistance Programs, developed by the

Department of Health and Human

Services (DHHS 2001), recommends

using an outside, professional consultant for assistance. 

Employee assistance programs are

considered an employee benefit, with

employees paying a share of the cost.

Head Start staff members are given an

orientation to the EAP so that they

know what services are available and

how to access them. Some programs

offer their staff a designated number of

one-on-one sessions for use throughout the year. Employee contacts with

EAP professionals are confidential,

and successful programs in Head Start

ensure this. 

Employee assistance programs are

recognized by Head Start as “an

important partner in the creation of a

mentally healthy workplace” and as a

positive way to improve job performance (DHHS 2001). Speaking for 

Continued on page 45

THE BEST FOR YOUR EMPLOYEES

WHAT AN EAP CAN DO

THE PURPOSE OF AN EMPLOYEE ASSISTANCE PROGRAM (EAP) is to promote wellness in the workplace. For Head Start, this is especially important because of the

value we place on comprehensive support and care. By supporting the well-being

of employees and their families, Head Start supports the well-being of the children

and families in the program. Head Start recognizes that

Employee Assistance Programs

are important partners in

creating a positive work

environment and in improving

job performance.
40 2003/Issue 75

ing could be further from the truth.

—Eric Schlosser, In the Strawberry Fields

Concern About the Pesticides

THERE ARE AN ESTIMATED 4.2 million migrant and seasonal farmworkers and their families who live and

work in the United States (Arcury

1998). They are among the most disadvantaged and medically indigent in

the country. They have the poorest

health and lowest life expectancy of

any group in the United States.

Multiple factors undermine their

quality of life, but of particular

concern to migrant and seasonal

Head Start families is their exposure

to agricultural chemicals. 

They worry that this exposure

may be responsible for a variety of

health problems ranging from minor

illnesses to permanent disabilities,

chronic illnesses, and even death.

Contact with pesticides in the fields

during pregnancy has been linked to

the delivery of a premature child with

a disability or compromised immune

system. Understandably, many

migrant and seasonal farm workers

have questions: “Is it safe for me to

breastfeed when I am working? Is it

more dangerous for me to be working

in the fields early on or later in pregnancy? Should I take off my shoes

before I walk in my house? Am I having trouble with my eyes because I’ve

been picking fruit trees that have been

sprayed?” 

Many farm workers share the sentiment of this mother: 

Yet another woman here, whose

baby was born prematurely, told me

that throughout her pregnancy, men

dressed in protective suits were

unloading and applying chemicals

next door to her house at the nursery.

She said to me, “If the chemicals

aren’t dangerous, why are they wearing those suits? And if they are, why

aren’t they coming to warn me how to

protect my babies?” (Muir 1998)

Try as we might to connect the

farmworkers’ experiences with medical knowledge, there are no clear-cut

answers to pesticide exposure. No one

in the health and research community

is able to say with certainty that agricultural chemicals are or are not the

cause of some health problems that

affect the migrant and seasonal farmworkers community. Furthermore, it

has been difficult for many Migrant

and Seasonal Head Start programs to

develop pesticide prevention or intervention strategies that are culturally

and linguistically appropriate. 

Finding the Answers

IN AN EFFORT TO ADDRESS the concerns of the farmworker community,

the Oregon Child Development

Coalition (OCDC) Migrant and

Seasonal Head Start program has

engaged in “community based participatory research” with the Oregon

Health Sciences University Center for

Research on Occupational and

Environmental Toxicology (CROET).

What is exciting about participatory research? It is structured to shift

decision-making and decision-taking

increasingly into the hands of the participants—in this case, the farmworker

community. The research process is

meant to be a medium for community

empowerment. 

The project is lead by an advisory

board with representatives from the

ADDRESSING PESTICIDE EXPOSURE 

IN THE MSHS COMMUNITY

B Y MARCO BELTRAN

Signs in agricultural fields warn workers and their

families about pesticide usage

Photo courtesy of Oregon Child Development Coalition.

WHEN THE SUN RISES from behind the coastal range, crews of thirty assemble at

the edges of huge fields and start picking strawberries, slowly making their way

down the long furrows, hundreds of men and women bent over at the waist,

grabbing fruit with both hands. In the early morning light it looks like a scene

out of the distant past, the last remnant of a vanishing way of life—and yet noth-
Head Start Bulletin 41

farmworker community, Migrant and

Seasonal Head Start programs, the

agricultural community, academic

institutions, and local family service

organizations. The migrant and seasonal farmworker community has collaborated in the process from the initial design of the project to its ongoing evaluation. 

The objectives of the study

are to—

1. Establish the relationship

between the levels of pesticides

in homes and these factors: the

crops household members work

in; the common pesticides used;

the proximity of housing to

fields; and household characteristics, including ventilation, size

and traffic patterns.

2. Evaluate pesticide overexposure

of workers and their children

by measuring associated biomarkers and neurobehavioral

markers.

3. Increase the effectiveness of

Migrant and Seasonal Head

Start programs n promoting

behaviors that avoid pesticide

exposure in the home and work

environment of farmworkers

and their children. 

What Is Known

SURVEYS WERE CONDUCTED of pesticide use and protective practices in the

fields. Results indicated that less than

one fifth of the farmworkers wore

protective clothing and equipment for

their jobs (McCauley et al 2001).

Most entered their homes with their

work clothes on. In fact, the study

revealed that workers have many misconceptions about proper protective

gear. Some workers believe that ineffective devices such as bandannas will

protect them against pesticide exposure. Dust samples were taken in

homes and in open areas where

migrant children play. High levels of

pesticides were found in both settings. 

Continuing research is needed to

document the effects of pesticide

exposure on farmworkers and their

families. Migrant and Seasonal Head

Start programs can play a critical role

in educating this population about

their health and safety and in advocating on their behalf. ■

REFERENCES

Arcury, T., & S. Quandt. 1998.

Chronic agricultural chemical

exposure among migrant and seasonal farmworkers. Society and

Natural Resources 11: 829-843.

McCauley, L.A., M.R. Lasarev, G.

Higgins, J. Rothlein, J. Muniz, C.

Ebbert, & J. Phillips. 2001. Work

characteristics and pesticide exposure among migrant agricultural

families: A community-based

research approach. Environmental

Health Perspectives 109 (5): 533-

538.

Muir, M. 1998. Migrant malaise.

Oregon Health, A Magazine of

Possibilities, Accomplishments,

People and Ideas 1 (1): 22-25.

Schlosser, E. 1995. In the strawberry

fields. The Atlantic Monthly

November: 276. Also available at

<www.theatlantic.com/issues/95no

v/strawber.htm>.

Marco Beltran is a Program Specialist

for the Migrant and Seasonal Head

Start Quality Improvement Center,

Academy for Educational

Development, Region XII. T: 202-

884-8958; E: mbeltran@aed.org. 

For more information regarding the

research project or for copies of the

Spanish language pesticides safety

video “Un Lugar Seguro para sus

Niños” (A Safe Place for Your

Children), contact Rachelle

Mann-Gaytan or Jacki Phillips, 

T: 503-570-1110 at the Oregon

Child Development Coalition.

Migrant and Seasonal

Head Start programs

can play a critical

role in educating the

migrant population

about their health

and safety.
42 2003/Issue 75

Are you interested in increasing health

awareness of your Head Start staff, maybe

even for yourself? Then one good place to go

for information is the

guide, Enhancing Health

in the Head Start

Workplace. This guide is

one in the series, Training

Guides for the Head Start

Learning Community. It is

full of information on

employee health and

suggestions for

“promoting both

individual health and

organizational health.”

Employee health is critical

if individuals are to do

their jobs well. This guide

is designed to help

programs develop ways to encourage

employees to improve their own health. The

four main goals of this guide are to:

• Identify the ways in which employee health

affects the organization’s effectiveness.

• Design training programs that encourage

employees to improve their own health.

• Understand how the organization contributes to

the overall health of its employees.

• Implement policies that allow employees to enjoy

the best health possible.

The target audience for the guide includes,

“Head Start directors, managers, and members

of the grantee and/or delegate board, Policy

Council, and Health Services Advisory

Committee.” The Head Start Program

Performance Standards require that staff be

instructed on principles of preventive health and

safety. Enhancing Health

in the Head Start

Workplace will help Head

Start programs put the

Performance Standards

into action. When

employee health is being

actively promoted, staff

will be better able to

educate Head Start

children and parents

about constructive health

behaviors.

Five training modules are

presented in this guide.

They “focus on building

managers’ skills in

applying the broad principles to the topics most

relevant to their own program.” The modules

are—

• Why Care About Health in the Workplace?

• What Does Wellness Mean for Our Staff

Members?

• Making Changes in Behavior for Better Health

• Creating a Healthy Organizational Climate

• Weight and Wellness—A Classic Worksite Issue

Enhancing Health in the Head Start Workplace

and other training guides can be ordered online

from the Head Start Information and

Publications Center (HSIPC) Web site at

www.headstartinfo.org/index.htm or call toll

free: 1-866-753-6481.

A USEFUL GUIDE

TO HEALTH IN THE HEAD START WORKPLACE
RESOURCES

BOOKS IN PRINT

THE WELLNESS BOOK: THE

COMPREHENSIVE GUIDE TO

MAINTAINING HEALTH AND TREATING

STRESS-RELATED ILLNESS.

Herbert Benson & E. M. Stuart.

1993. NY: Fireside Press.

This guide provides basic information on

how to combine personal behaviors and

scientific health care to enhance health

and wellness. Written in a self-help format

to help the reader make behavioral

changes, topics include the mind/body

connection, aging, exercise, nutrition, and

stress management.

THE NEW WELLNESS ENCYCLOPEDIA. 

Editors of the Wellness Letter, U.C.

Berkeley. 1995. Boston, MA:

Houghton Mifflin Co.

This volume is a thorough reference of

positive, practical guidelines to wellness.

Major topics are longevity, nutrition,

exercise, self-care, and environment/

safety. Excellent tips are given

about changing old habits for new,

healthier ones. 

CHANGING FOR GOOD: A

REVOLUTIONARY SIX-STAGE PROGRAM

FOR OVERCOMING BAD HABITS AND

MOVING YOUR LIFE POSITIVELY

FORWARD. 

James O. Prochaska, John. C.

Norcross, & Carlo C. Diclemente.

1995. NY: Avon Books.

To uncover the key to successful personal

change, the psychologist authors

WEBLIOGRAPHY

The following Web sites about adult health are recommended

as further resources for teachers, parents, and administrators.

www.healthierus.gov

HEALTHIERUS, the President’s initiative, encourages Americans to improve their

health. The Web site provides valuable information and links to other sites.

www.nccam.nih.gov 

NATIONAL CENTER FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE

(NCCAM) offers information about research projects and available

publications. Includes fact sheets on CAM procedures and evaluation of

cancer-related CAM. Toll free: 1-888-644-6226.

www.cdc.gov

CENTERS FOR DISEASE CONTROL AND PREVENTION is the lead Federal agency

for protecting the health and safety of people of the U. S. It offers a wealth of

information and a dictionary of health topics from A-Z. Toll free: 1-888-232-4674.

www.health.gov/nhic 

NATIONAL HEALTH INFORMATION CENTER (NHIC) provides a central health

information referral service for consumers and professionals using a database

of over 1,700 national organizations. Toll free: 1-800-336-4797.

www.acefitness.org

THE AMERICAN COUNCIL ON EXERCISE is a nonprofit organization

committed to promoting active, healthy lifestyles. “Fit Facts,“ is a monthly

online newsletter on a specific topic. 

www.ca5aday.com 

SPONSORED BY THE CALIFORNIA DEPT. OF HEALTH SERVICES, this Web site

promotes healthy behaviors that prevent cancer and other chronic diseases.

Nutritional information specific to children, Latinos, and women is provided.

www.odphp.osophs.dhhs.gov

OFFICE OF DISEASE PREVENTION AND HEALTH PROMOTION develops and

coordinates a wide range of national disease prevention and health promotion

strategies. It links to many other sites.

www.healthfinder.gov 

HEALTHFINDER is the Government’s premier gateway Web site for linking

consumers and professionals to over 6,000 health information resources from

the Federal government and its partners. Also available in Spanish.

Head Start Bulletin 43
44 2003/Issue 75

RESOURCES

interviewed more than 1000 people

who were able to positively and

permanently alter their lives. They

discovered that change does not

depend on luck or willpower. They

present a six- step approach for selfchange with many concrete examples. 

HEAD START RESOURCES

Available from the Head Start Information

and Publication Center (HSIPC) at

www.headstartinfo.org or 

Toll free: 866-763-6481.

ENHANCING HEALTH IN THE HEAD

START WORKPLACE

This technical guide will help to

increase the understanding and skills of

Head Start staff in identifying the

various ways in which employee health

affects the effectiveness of the

organization. The guide includes

training materials.

LAYING A FOUNDATION IN HEALTH

AND WELLNESS

This guide explains the importance

of health to Head Start’s mission,

describes health services, and

suggests ways to teach about and

promote health in children, families,

and Head Start staff.

PROMOTING MENTAL HEALTH 

This technical guide encourages

mental health promotion for all

members of the Head Start community.

Activities are included that will build

interpersonal skills with co-workers,

parents, and children.

SUSTAINING A HEALTHY

ENVIRONMENT

This technical guide offers information

and activities to broaden staff’s

understanding of the natural

environment and improve their

ability to incorporate environmental

enrichment and protection into their

Head Start programs. 

QUIT SMOKING HELP

Free smoking cessation materials are

available from a number of

organizations, including—

AGENCY FOR HEALTHCARE

RESEARCH AND QUALITY

Toll free: 800-358-9295

www.ahcpr.gov/consumer/helpsmok.htm

AMERICAN HEART ASSOCIATION

7272 Greenville Ave., Dallas, TX

75231; Toll Free: 800-AHA-USA1.

www.americanheart.org

CENTERS FOR DISEASE CONTROL

AND PREVENTION

Office of Smoking and Health

Toll free: 800-232-1311

www.cdc.gov/tobacco/

U.S. PUBLIC HEALTH SERVICE

www.surgeongeneral.gov/tobacco/

default.htm (information available in

English or Spanish).

AMERICAN LUNG ASSOCIATION

1740 Broadway; 14th Floor; 

New York, NY 10019 

Quit Hotline: 800-LUNG-USA 

(24 hours a day everyday)

Freedom From Smoking, the free online

smoking cessation program, is

available online at www.lungusa.org.

Wear gloves when handling food

Photo by C. Dyer. Higher Horizons EHS-HS.
Head Start Bulletin 45

Continued from page 26, Play and Stay Healthy

related to sticking with regular physical activity. Choose

something to do that you like. If you hate to sweat, do not

sign up for aerobics! Remember that your PLAY does not

have to be strenuous. It just needs to get you moving. We can

almost guarantee that you will feel happier when you are

done with your workout/PLAY. In fact, studies have shown

that exercise can help alleviate depression (Dimeo et al. 2001). 

Beyond our individual efforts, it is important to improve

our communities. Object to local policies that make it more

difficult for people to be active. For example, do not let your

leaders put in streets without sidewalks or ignore cars that

speed through crosswalks. Ask for longer hours at recreation

centers. Insist that parks be well-maintained and well-lit. Be

sure that workplaces support active people by providing

places for workout clothes, clean-up facilities and breaks that

allow people to get out and about. 

Thirty years from now, we hope that we will see changes

in our society that makes it easy for all of us to be active and

healthy. In the meantime, we all have to commit ourselves to

leading a more active—that is, a more playful—life! ■

REFERENCES

Dimeo, F., M. Bauer, I. Varahram, G. Proest, & U. Halter.

2001. Benefits from aerobic exercise in patients with

major depression: A pilot study. British Journal of Sports

Medicine 35: 114-117.

McGinnis, J. & W. Foege. 1993. Actual causes of death in the

United States. Journal of American Medical Association

270: 2207-2212.

U.S. Department of Health and Human Services: Centers for

Disease Control and Prevention, National Center for

Chronic Disease Prevention and Health Promotion. 1996.

Physical activity and health: A report of the Surgeon

General. Atlanta, GA: Author.

Peggy da Silva is a Project Director for James Bowman

Associates. T: 510-625-9303; E: dasilva@jba-cht.com.

Continued from page 37, Family Support

years, paid a real dividend for Maria and her family as they

began the new school year. 

As your program continuously assesses how it promotes

the health and wellness of the families it serves, consider

the resources, training, and support provided families of

children with disabilities. Learn more from your Head Start

families about the supports they value most and those they

find most lacking. Contact the Parent Centers for your

state (see page 37) to identify the parent-to-parent support

organizations available in your community or collaborate

with local parents and community partners to start a new

parent-to-parent organization. When the health and

well-being of parents are promoted, children and families

reap the benefits. ■

Jim O’Brien is a Program Specialist in the Health and

Disabilities Services Branch at the Head Start Bureau.

T: 202-205-8656; E: jobrien@acf.hhs.gov.

Continued from page 39, The Best for Your Employees

many in the Head Start community, Jan Cox hopes that

Head Start programs will continue to bolster their EAP

services. After all, she adds, “Head Start is a stafffriendly program, and we really care about our staff’s

well-being.” ■

REFERENCES

U.S. Department of Health and Human Services:

Administration for Children and Families, Head Start

Bureau. 1993. Resource guide on Head Start employee

assistance programs. Washington, D.C.: Author.

Thank you to Jan Cox, Health Resources Manager for

Region VI-A HSQIC, for contributing to this article.

Head Start Bulletin 45
U.S. Department of

Health and Human Services

ACF/ACYF/HSB

Washington, DC 20201

OFFICIAL BUSINESS

Penalty for private use $300

SUBMIT YOUR HEAD START PHOTO TODAY

The National Head Start Training and Technical Assistance Resource Center (NRC) would like YOUR PHOTO to be

part of the Head Start Bulletin and/or other Head Start publications such as Web sites, brochures, flyers,

meeting agendas, and more. It’s time to let your Head Start organization SHINE.

Photo tips—

! Limit one to three subjects per picture; have them engaged in an activity or interacting with each other.

! Fill the frame with the subject (i.e., do not take pictures from across the room).

! Make sure there is good lighting.

! Focus on Head Start-related activities—both indoor and outdoor.

! Take more than one photo of a particular event.

! Take pictures regularly. 

! If you are sending an electronic image, please use a resolution of 300 dpi.

FOR MORE INFORMATION OR TO REQUEST A PHOTO RELEASE FORM, CONTACT JUDY DAVID.

Mail photos to:

National Head Start T/TA Resource Center

Attn: Judy David

1000 Wilson Blvd., Suite 1000

Arlington, VA 22209

Phone# 703-243-0495 Fax# 703-243-0496

jdavid@pal-tech.com

Goodbye to Smoking ■ Food Pyramid Power ■ Exercise in the Office ■ Bilingual Parent/Teacher Pull-out: Self-Change Contract