Supporting Healthy Weight in Statewide Quality Rating and Improvement Systems: A Review of 2020 Standards and Comparison to 2015 Standards.

Background: Quality Rating and Improvement Systems (QRISs) are used to assess, improve, and communicate quality in early care and education (ECE) programs. One strategy for supporting healthy growth in early childhood is embedding nutrition, physical activity, infant feeding, and screen time content into state QRIS standards, using the Caring for Our Children high-impact obesity prevention standards (HIOPS) and the CDC Spectrum of Opportunities framework (CDC Spectrum). We assessed the number of obesity prevention standards in QRISs in 2020 and compared results to an analysis published in 2015. Methods: We collected state QRIS standards for ECE centers from March to April 2020. Two analysts coded documents for standards related to 47 HIOPS and 6 Spectrum areas. Results: Thirty-nine states and the District of Columbia had statewide QRISs in early 2020. Of these, 21 QRISs (53%) embedded 1 or more HIOPS, and 26 (65%) embedded 1 or more Spectrum components. On average, 6.9% of HIOPS were embedded in QRIS standards in 2020, an increase from 4.6% in 2015. Nine QRISs included more HIOPS in 2020 than in 2015. Five QRISs added 10% or more of the 47 HIOPS between 2015 and 2020. Physical activity and screen time standards continued to be most often included; infant feeding standards were least included. Conclusion: Obesity prevention components were embedded in three-quarters of state QRISs, and more were embedded in 2020 than in 2015, suggesting that QRISs can be levers for supporting healthy weight in ECE settings.

A Healthy Start: National Trends in Child Care Regulations and Uptake of Obesity Prevention Standards (2010-2018).

Background: Obesity remains a significant public health issue in the United States. Each week, millions of infants and children are cared for in early care and education (ECE) programs, making it an important setting for building healthy habits. Since 2010, 39 states promulgated licensing regulations impacting infant feeding, nutrition, physical activity, or screen time practices. We assessed trends in ECE regulations across all 50 states and the District of Columbia (D.C.) and hypothesized that states included more obesity prevention standards over time. Methods: We analyzed published ratings of state licensing regulations (2010-2018) and describe trends in uptake of 47 high-impact standards derived from Caring for Our Children's, Preventing Childhood Obesity special collection. National trends are described by (1) care type (Centers, Large Care Homes, and Small Care Homes); (2) state and U.S. region; and (3) most and least supported standards. Results: Center regulations included the most obesity prevention standards (∼13% in 2010 vs. ∼29% in 2018) compared with other care types, and infant feeding and nutrition standards were most often included, while physical activity and screen time were least supported. Some states saw significant improvements in uptake, with six states and D.C. having a 30%-point increase 2010-2018. Conclusions: Nationally, there were consistent increases in the percentage of obesity prevention standards included in ECE licensing regulations. Future studies may examine facilitators and barriers to the uptake of obesity prevention standards and identify pathways by which public health and health care professionals can act as a resource and promote obesity prevention in ECE.

Supporting Obesity Prevention in Statewide Quality Rating and Improvement Systems: A Review of State Standards.

INTRODUCTION: A quality rating and improvement system (QRIS) is a fundamental component of most states' early care and education infrastructures. States can use a QRIS to set standards that define high-quality care and award child care providers with a quality rating designation based on how well they meet these standards. The objective of this review was to describe the extent to which states' QRIS standards include obesity prevention content. METHODS: We collected publicly available data on states' QRIS standards. We compared states' QRIS standards with 47 high-impact obesity prevention components in Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs, 3rd Edition, and 6 additional topics based on the Centers for Disease Control and Prevention's Spectrum of Opportunities for Obesity Prevention in the Early Care and Education Setting. RESULTS: Thirty-eight states operated a state-wide QRIS in early 2015. Of those, 27 states' QRIS included obesity prevention standards; 20 states had at least one QRIS standard that aligned with the high-impact obesity prevention components, and 21 states had at least one QRIS standard that aligned with at least one of the 6 additional topics. QRIS standards related to the physical activity high-impact obesity prevention components were the most common, followed by components for screen time, nutrition, and infant feeding. CONCLUSION: The high proportion of states operating a QRIS that included obesity prevention standards, combined with the widespread use of QRISs among states, suggests that a QRIS is a viable way to embed obesity prevention standards into state early care and education systems.

State legislators' sources and use of information: bridging the gap between research and policy.

Research can inform policymakers of public health issues and shape policy decisions, hopefully benefiting public health; thus, improving dissemination of research to policymakers is important for developing effective public health policies that improve health and health equity. However, the utilization of research among policymakers is often not fully realized. This study builds upon current knowledge about what types of information legislators seek when working on health issues and where they go for information. Further, it explores what kinds of information legislators find most helpful and if there are ways researchers could better provide this evidence. Key-informant interviews were conducted with 25 U.S. state legislators holding health committee leadership positions between July and November, 2010. Regarding types of information sought, most legislators discussed their desire for data and statistics when working on health-related issues. When asked about their most trusted sources of information, participants mentioned government sources as well as advocacy, lobby and industry groups. A few mentioned universities and healthcare professionals. Results from this study offer public health researchers and practitioners' insights into the types of information that may be most helpful to policymakers. Insights gathered may improve the dissemination of research and bridge the gap between knowledge users and knowledge producers.

"Hearing from all sides" How legislative testimony influences state level policy-makers in the United States.

BACKGROUND: This paper investigates whether state legislators find testimony influential, to what extent testimony influences policy-makers' decisions, and defines the features of testimony important in affecting policy-makers' decisions. METHODS: We used a mixed method approach to analyze responses from 862 state-level legislators in the United States (U.S.). Data were collected via a phone survey from January-October, 2012. Qualitative data were analyzed using a general inductive approach and codes were designed to capture the most prevalent themes. Descriptive statistics and cross tabulations were also completed on thematic and demographic data to identify additional themes. RESULTS: Most legislators, regardless of political party and other common demographics, find testimony influential, albeit with various definitions of influence. While legislators reported that testimony influenced their awareness or encouraged them to take action like conducting additional research, only 6% reported that testimony changes their vote. Among those legislators who found testimony influential, characteristics of the presenter (e.g., credibility, knowledge of the subject) were the most important aspects of testimony. Legislators also noted several characteristics of testimony content as important, including use of credible, unbiased information and data. CONCLUSION: Findings from this study can be used by health advocates, researchers, and individuals to fine tune the delivery of materials and messages to influence policy-makers during legislative testimony. Increasing the likelihood that information from scholars will be used by policy-makers may lead to the adoption of more health policies that are informed by scientific and practice-based evidence.

Racial differences in parental perceptions of the neighborhood as predictors of children's physical activity and sedentary behavior.

OBJECTIVE: Most U.S. children engage in insufficient physical activity (PA) and spend too much time in sedentary behaviors (SBs), leading to increased risk of obesity and chronic disease. Evidence remains inconsistent on relationships between parental perceptions of the neighborhood and children's PA and SB. This study examines parental neighborhood perceptions, stratified by race, as predictors of children's PA and SB. METHODS: Relationships were tested with regressions stratified by parental race. The sample included 196 parents, residing in St. Louis, Missouri with a child at home. Participants responded to a mailed survey in 2012. Parental neighborhood perceptions were examined by mean composite scores and individual items. RESULTS: For parents of all races, perceived barriers negatively predicted the number of days in a week children engaged in ≥ 60 min of PA. Examining parental neighborhood perceptions by individual item, the perception that drivers exceed neighborhood speed limits was a positive predictor of their children's SB only among white parents. Only among minority-race parents was perceived neighborhood crime rate a positive predictor of their children's SB. CONCLUSIONS: While predictors of children's PA did not differ widely, several distinct predictors of children's SB by parental race lend support toward further examination of this topic.