The 5 A Day POWER PLUS PRESCHOOL Program will assess the effects of a childcare center focused intervention for promoting increased consumption of fruits and vegetables among preschool aged children to reduce their future risk of cancer. This will be accomplished through a program in childcare centers that provides increased opportunities to taste and eat a wide variety of fruit and vegetables, provides role models for eating fruit and vegetables, changes the social norms so that eating fruits and vegetables is expected and acceptable, and creates childcare center and home environments that foster increased fruit and vegetable consumption. The childcare center-based intervention will include three components: food service environmental change, taste-testing and food-related classroom type activities as part of the childcare center program, and provider and parent training, education and support. The hypothesis is that an intensive, multi-component childcare center-based program will significantly increase fruit and vegetable consumption in preschool children at lunch and snack. This will be assessed through a trial in which 20 urban daycare centers from within one large midwestern metropolitan area are randomly assigned to intervention and control conditions. The primary endpoint will be the number of servings of fruits and vegetables consumed during lunch and afternoon snack measured in a cohort of children who are 15 to 30 months old at baseline and 39 to 54 months old at follow-up. Specifically, the study will evaluate the hypothesis that preschoolers at the intervention sites, following two years of intervention, will consume .5 more servings of fruits and vegetables a day than preschoolers at the control sites. The data will be adjusted for baseline values and recorded based on observed combined intake for lunch and afternoon snack. A secondary outcome will be self-reported child preferences for fruits and vegetables, measured at follow-up with the food preferences card sorting task (CST) developed previously in POWER PLUS. Several moderating variables that may effect consumption in toddlers and preschoolers will also be assessed. Childcare provider practices will be observed and parental practices assessed through a parent survey. The major goal of the study is to achieve a total effect, similar to previous multi-component school based programs, but with a preschool population in a period of development where food preferences, meal patterns, and eating behaviors are being newly established.
