Design, Protocol and Baseline Data of Nurturing Healthy Teachers, a Cluster Non-Randomized Controlled Trial to Improve the Health, Well-Being, and Food Security Of Pre-Kindergarten And Elementary School Teachers

Background: We present the conceptual framework, design, and study measures of Nurturing Healthy Teachers, a quasi-experimental cluster, non- randomized controlled study to examine the short- and long-term effectiveness of the Nurturing Healthy Teachers (NHT) nutrition intervention on food insecurity, dietary behaviors, mental health and cardiometabolic health among pre-kindergarten and elementary school teachers.  Methods: A convenience sample of 28 elementary schools with pre-kindergarten and elementary classrooms meeting the eligibility criteria were recruited in Houston, Texas. Nurturing Healthy Teachers intervention included teachers receiving Brighter Bites, an evidence-based coordinated school health program that combines access to fresh produce and nutrition education, and Create Healthy Futures, a web-based nutrition education program that targets nutrition knowledge, self-efficacy, mindfulness, and social support to create healthy habits among teachers. The primary outcome is food insecurity. Secondary outcomes include diet quality, mental health, and cardiometabolic health. Metabolic markers and skin carotenoid levels were assessed using in person assessments, while all other measures were obtained via questionnaire.  Results: At baseline, most of the participants were female, 63% identified as Hispanic, were highly educated, and had a mean age of 42.6 years. Moderate to severe depression was experienced by 18% of teachers and 23% of teacher experienced moderate to severe anxiety. Overall, 50% of teachers were classified as being obese and 20% had high cholesterol. At baseline teachers had a mean HbA1c (%) of 5.6%.  Conclusions: The results of this study will inform next steps towards future implementation and evaluation of teacher-focused interventions.