ABSTRACT
Mental, emotional, and behavioral (MEB) disorders begin in early childhood, with one in six US preschoolers
aged 3-5 years diagnosed with a MEB disorder. Children from low income and economically marginalized
(LIEM) backgrounds have a higher risk of being diagnosed with MEB disorders than those from higher income
families. To address the mental and physical health disparities based on socioeconomic status, ethnicity/race,
and urban/rural residency, the proposed study will target Head Start racially/ethnically diverse preschoolers
from LIEM backgrounds in both urban and rural areas. Guided by the Actor-Partner Interdependence Model,
the Allostatic Load Model, and the Transactional Theory of Stress and Coping, the proposed 16-week Food-
Body-Mind intervention includes: 1) a school-based mindfulness component delivered to equip preschoolers
with knowledge and skills in mindful eating and movement (e.g., yoga, deep breathing exercises); 2) a home-
based mindfulness component to increase caregivers’ skills in practicing mindful eating, movement, and
parenting behaviors at home to foster a more positive, mindful, and healthy home environment; and 3) a school
learning and home practice connection component to improve caregiver-preschooler relationships. The
purpose of this 5-year cluster randomized controlled trial is to evaluate the effects of the 16-week school- and
home-based, multi-component, Food-Body-Mind intervention on improving both preschoolers’ and caregivers’
MEB and physical health. The long-term goal is to achieve optimal whole child health in early childhood to
foster a healthier generation in the US. Fifty Head Start daycare centers will be randomized into the
intervention (n=25: 8 urban [16 classrooms] and 17 rural [17 classrooms] daycare centers) or usual care
control group (n=25: 8 urban and 17 rural daycare centers). Five caregiver-preschooler dyads will be recruited
from each daycare classroom (total 330 dyads: 160 urban dyads and 170 rural dyads). Analyses will be based
on the intention-to-treat principle. The three aims are to: 1) determine effects of the intervention on improving
preschoolers’ primary outcomes including mental (chronic stress), emotional (sadness, fear, anger, positive
affect), and behavioral (problem behaviors, social skills) health as well as physical health (BMI z-score, % body
fat; secondary outcomes) from baseline (0 month) to 4 months (immediate post-intervention) and to 12-month
follow-up compared to control; 2) examine the effects of the intervention on improving caregivers’ physical
(BMI, % body fat, blood pressure) and mental (stress, anxiety, depression) health from 0 to 4 months and to
12-month follow-up compared to control; and 3) explore how the intervention will modify both preschoolers’ and
caregivers’ MEB and physical health via the mediating mechanisms of mindfulness, emotional eating,
fruit/vegetable intake, physical activity, caregiver-preschooler relationship, and caregiver coping from 0 to 4
months and to 12-month follow-up. Results from this study will improve the evidence base of complementary
and integrative health approaches that can be delivered in geographically diverse daycare settings.