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About HALF

Healthy Active Living for Families (HALF) Program
What is HALF?
The Healthy Active Living for Families: Right From the Start program (HALF) is a project of the American Academy of Pediatrics to address early childhood obesity prevention that integrates the parent perspective and evidence-informed pediatric health guidance.
While there is pediatric expert consensus and recognition that early obesity prevention is a public health concern, AAP experts wanted to know what parents, as day-to-day experts of their children, thought about early obesity prevention. This knowledge would help create resources that parents would find engaging and relevant. AAP reached out to parents to learn more about motivators, barriers, and facilitators to healthy active living and to identify messages and content that resonated with parents.
The AAP spoke with over 200 parents of children up to 5 years old across the nation, to explore parents' attitudes, needs and experiences related to messaging for healthy nutrition and active living.  Simultaneously, the HALF Editorial Board, comprised of experts in pediatric primary care, obesity, early childhood, strength-based approaches and psychology, combed through the scientific evidence to identify a series of desired  behaviors that can foster healthy active living within families and help to mitigate obesity in early childhood.  Armed with the qualitative parent data and the evidence-informed desired behavior list, the HALF editorial board, in partnership with a health communication plain language firm, developed parent-friendly content to engage, inform, and motivate parents about healthy active living right from the start.
Taking parent and pediatrician feedback into account in terms of how they wanted to receive information, a number of web-based resources were created for parents and pediatricians. To learn more about the HALF resources and tools visit: Using HALF to Improve Your Care.
Research Highlights
Parent feedback was solicited through two rounds of focus groups. Parents were asked directly about their experiences, concerns, and challenges related to food, feeding, activity, and obesity prevention.
  • The purpose of the first round of focus groups, the formative focus groups, was to gather initial information and inform the development of positive and strength-based healthy active living messages. The formative focus groups occurred in the Fall 2010 and took place in Illinois and California.
  • A second round of focus groups, the evaluative focus groups, explored the developed messages and how parents would like to receive the messages from health care professionals. The evaluative groups occurred over the Spring and Summer of 2011. The English-speaking focus groups occurred in Alabama, Illinois, Louisiana, New Mexico, New York, and Pennsylvania. The Spanish-Speaking focus groups occurred in Pennsylvania and Texas.
Through these focus groups we learned a great deal to inform our HALF project. Overall most parents in our sample:
  • Believed that childhood obesity was a serious problem
  • Assessed their own child’s weight as just right, regardless of whether or not they have been told otherwise by a healthcare provider
  • Identified pediatricians as their primary source of well child care
With regard to obesity prevention messaging and content we found that some angles or content detracted from message endorsement by parents.  These include:
  • Use of obesity language especially as it relates to infancy – as a general concept parents did not like associating infancy with obesity.
  • Guidance focused on future outcomes – the now was much more important especially in the infancy and early toddler periods.
  • Parent perceptions and actions may often be incongruent with expert guidelines and guidance – parents cited numerous examples of how their personal experiences were not consistent with expert guidance or that the guidance was not realistic or attainable in their family environment.
On the flip side, certain angles, themes and content contributed to message endorsement by parents and these include:
  • Respect for parent’s expertise and family – parent’s valued information that acknowledged their expertise and recognized their child and family was unique. Parents valued information that can be individualized to meet their unique needs.
  • Easy to understand explanation of “why” – when the “why” was provided the message resonated more with parents.
  • Realistic action strategies to support desired behavior change – parents valued “how to” and “what works” ideas from other parents.
To learn more about the focus group findings review the following:
Target Behaviors
The HALF Editorial Board reviewed the evidence and identified a number of desired behaviors for parents and families with young children that could foster healthy active living and prevent obesity. The desired behavior targets are outlined below (note: the items with asterisks are specific to infancy):

Food and Feeding:

  • Understand hunger and satiety cues
  • Offer vegetables and/or fruits with every meal/snack
  • Foster self-feeding as much as possible (use of cups and utensils)
  • Establish a feeding routine with regular meal and snack times and eat these seated at a table
  • Offer water and non-flavored milk for beverages (whole milk or 2% milk for 12 months -2 years, low-fat milk after age 2)
  • Consider delaying juice introduction until 12 months and limit any juice to 4-6 ounces in a cup
  • Breastfeed exclusively for at least 6 months of age, ideally 12 months*
  • Use appropriate bottle feeding techniques if bottle feeding (no bottle propping, only breastmilk or formula in bottle unless otherwise instructed by doctor)*
  • Wait to introduce complimentary foods until around 6 months of age*
  • Offer new foods multiple times and in multiple ways (10-15 times for infants)*
Physical Activity and Sedentary Behavior:

  • Incorporate age-appropriate active play and physical activity into daily routine
  • Encourage free play and motor development
  • Limit screen time to 2 hours or less per day
  • Limit exposure to commercials 
  • Discourage eating in front of screens
  • Avoid placing TV in children’s bedrooms
  • Limit amount of time spent in devices that restrain movement (car seat, stroller, bouncy seat, and swing)*
General Parenting:

  • Establish household routines including consistent meal and snack times, regular daily physical activity and sleep.
  • Practice authoritative parenting and responsive feeding (avoid restrictive and/or permissive practices around food).
  • Role model healthy active living.
  • Engage extended family and care takers as part of their healthy active living team.
The HALF editorial board, plain language firm, and the researchers used this content to inform the evaluative focus groups, the themes for the HALF action oriented parent messages, and the HALF Physician Implementation Guide.
What Makes HALF Unique?
The HALF project is unique because it is:
  • Parent-informed
  • Evidence based
  • Plain language
  • Strength based
  • Consistent with Bright Futures, and 
  • Age-appropriate

The HALF program was generously supported by the Nestlé Nutrition Institute.

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