Results of caring and reaching for health (CARE): a cluster-randomized controlled trial assessing a worksite wellness intervention for child care staff.

BACKGROUND: Child care workers are among the lowest paid US workers and experience a wide array of health concerns. The physical and mental demands of their job and the lack of employer-provided health-insurance increase health risks. The Caring and Reaching for Health (CARE) study evaluated a 6-month Healthy Lifestyles intervention targeting child care workers' physical activity (primary outcome), other health behaviors, and their workplace health environment. METHODS: Eligible child care centers, defined as being in operation for at least 2 years and employing at least four staff, were enrolled into CARE's cluster-randomized trial. Centers and their child care staff were randomly assigned to either the Healthy Lifestyles (HL) intervention arm or the Healthy Finances (HF) attention control arm using a block randomization approach. Intervention components were delivered through in-person workshops, center-level displays, informational magazines, director coaching, electronic messaging, and an interactive website. Outcome measures were collected during center visits at baseline and immediately post-intervention by trained data collectors blinded to center arm assignment. Workers' physical activity was assessed with accelerometers, worn for 7 days. Secondary outcome measures included biometric assessments of health and fitness, web-based surveys about health behaviors, and an environmental audit of workplace supports for health. Multi-level linear mixed models assessed worker- and center-level changes in these outcomes. RESULTS: Participants included 553 child care workers representing 56 centers (HL = 250 staff/28 centers, HF = 303 staff/28 centers). At 6 months, moderate-to-vigorous physical activity declined slightly in both arms (- 1.3 min/day, 95% CI: - 3.0, 0.3 in HL; - 1.9 min/day, 95% CI: - 3.3, - 0.5 in HF), but there was no significant group by time interaction. Several secondary outcomes for other health behaviors and workplace health environment showed improvements in favor of the intervention arm, yet differences did not remain statistically significant after adjustment for multiple comparisons. CONCLUSIONS: While the Healthy Lifestyles intervention did not improve health behaviors or the workplace health environment, results confirmed the pressing need to focus on the health of child care workers. Future interventions should focus on prevalent health issues (e.g., weight, stress), include both high-tech and high-touch intervention strategies, and address work conditions or other social determinants of health (e.g. wages) as a means of improving the health of these essential workers. TRIAL REGISTRATION: Care2BWell: Worksite Wellness for Child Care (NCT02381938).

Development of a Workplace Intervention for Child Care Staff: Caring and Reaching for Health's (CARE) Healthy Lifestyles Intervention.

Child care staff are among the lowest wage workers, a group at increased risk for a wide array of chronic diseases. To date, the health of child care staff has been largely ignored, and there have been very few interventions designed for child care staff. This article describes the development of the Caring and Reaching for Health (CARE) Healthy Lifestyles intervention, a workplace intervention aimed at improving physical activity and health behaviors among child care staff. Theory and evidence-based behavior change techniques informed the development of intervention components with targets at multiple social ecological levels. Final intervention components included an educational workshop held at a kick-off event, followed by three 8-week campaigns. Intervention components within each campaign included (1) an informational magazine, (2) goal setting and weekly behavior self-monitoring, (3) weekly tailored feedback, (4) e-mail/text prompts, (5) center-level displays that encouraged team-based goals and activities, and (6) coaching for center directors. This multilevel, theory-driven intervention is currently being evaluated as part of a larger randomized controlled trial. Process evaluation efforts will assess the extent to which child care staff participated in, engaged with, and were satisfied with the intervention. Lessons learned will guide future intervention research engaging child care workers.

Current Status of Healthy Aging and Dementia Research: A Symposium Summary.

The purpose of the 'First Regional Healthy Aging and Dementia Research Symposium' was to discuss the latest research in healthy aging and dementia research, public health trends related to neurodegenerative diseases of aging, and community-based programs and research studying health, nutrition, and cognition. This symposium was organized by the Garrison Institute on Aging (GIA) of the Texas Tech University Health Sciences Center (TTUHSC), and was held in Lubbock, Texas, October 24-25, 2018. The Symposium joined experts from educational and research institutions across the United States. The two-day Symposium included all GIA staff and researchers. Students, postdoctoral fellows, and faculty members involved in dementia research presented at the Symposium. Healthcare professionals, from geriatricians to social workers working with patients with neurodegenerative diseases, also presented. In addition, experts traveled from across the United States to participate. This event was comprised of multiple sessions, each with several oral presentations, followed by questions and answers, and discussion.

Associations between acculturation, ethnic identity, and diet quality among U.S. Hispanic/Latino Youth: Findings from the HCHS/SOL Youth Study.

BACKGROUND: Acculturation among Hispanic/Latinos has been linked to deteriorating dietary quality that may contribute to obesity risks. This study examined the relationship between acculturation, ethnic identity, and dietary quality in U.S. Hispanic/Latino youth. METHODS: This cross-sectional study included 1298 Hispanic/Latino youth ages 8-16 from the Hispanic Community Health Study/Study of Latino Youth (HCHS/SOL Youth), an ancillary study of offspring of participants in the adult HCHS/SOL cohort. Multivariable regression analyses assessed relationships between acculturation and ethnic identity with dietary quality as measured by Healthy Eating Index (HEI) scores, accounting for covariates, design effects, and sample weights. We also compared HEI scores by immigrant generation and language of interview. RESULTS: Youth were 12 ±â€¯2.5 -years and 49.3% female. They were placed into five acculturation categories-including 48% integrated (bicultural orientation), 32.7% assimilated (high U.S. and low Latino orientation), 5.9% separated (high Latino and low U.S. orientation) or marginalized (neither U.S. nor Latino orientation), and 13.3% unclassified. Mean HEI was 53.8; there were no differences in HEI scores by acculturation category, but integrated youth had higher whole grains scores, lower sodium scores, and lower empty calories scores compared to assimilated youth. There were no differences in HEI scores by ethnic identity scores, and no consistent trend between dietary quality and ethnic identity. First- and second-generation youth had higher HEI scores, compared to third-generation youth, and, Spanish-speaking youth had higher HEI scores compared to English-speaking youth. CONCLUSION: Results suggest that integrated youth in the U.S. may engage in healthier eating behaviors than those who are assimilated. Additional research on Hispanic/Latino youths' acculturation and diet can inform health promotion efforts to improve eating habits and health outcomes among this population.

Workplace health and safety intervention for child care staff: Rationale, design, and baseline results from the CARE cluster randomized control trial.

BACKGROUND: Low-wage workers suffer disproportionately high rates of chronic disease and are important targets for workplace health and safety interventions. Child care centers offer an ideal opportunity to reach some of the lowest paid workers, but these settings have been ignored in workplace intervention studies. METHODS: Caring and Reaching for Health (CARE) is a cluster-randomized controlled trial evaluating efficacy of a multi-level, workplace-based intervention set in child care centers that promotes physical activity and other health behaviors among staff. Centers are randomized (1:1) into the Healthy Lifestyles (intervention) or the Healthy Finances (attention control) program. Healthy Lifestyles is delivered over six months including a kick-off event and three 8-week health campaigns (magazines, goal setting, behavior monitoring, tailored feedback, prompts, center displays, director coaching). The primary outcome is minutes of moderate and vigorous physical activity (MVPA); secondary outcomes are health behaviors (diet, smoking, sleep, stress), physical assessments (body mass index (BMI), waist circumference, blood pressure, fitness), and workplace supports for health and safety. RESULTS: In total, 56 centers and 553 participants have been recruited and randomized. Participants are predominately female (96.7%) and either Non-Hispanic African American (51.6%) or Non-Hispanic White (36.7%). Most participants (63.4%) are obese. They accumulate 17.4 (±14.2) minutes/day of MVPA and consume 1.3 (±1.4) and 1.3 (±0.8) servings/day of fruits and vegetables, respectively. Also, 14.2% are smokers; they report 6.4 (±1.4) hours/night of sleep; and 34.9% are high risk for depression. CONCLUSIONS: Baseline data demonstrate several serious health risks, confirming the importance of workplace interventions in child care.

Assessing Opportunities to Enhance Comprehensive Health Promotion and Wellness Programming in a State Community College System.

BACKGROUND North Carolina has the third largest community college system in the nation and reaches residents in all 100 counties. Few studies have focused on the health of employees who work at these institutions. We assessed the current status of and interest in supporting health promotion efforts among North Carolina Community College System members.METHODS North Carolina Community College System presidents completed a brief 15-item survey assessing support for and interest in offering health promotion programs. Wellness coordinators completed a 60-item questionnaire assessing current health promotion programming and organizational, environmental, and policy supports for health promotion efforts. Onsite interviews with a sub-sample of Wellness coordinators offered insights into important implementation considerations. We examined differences by campus size with Fisher's exact test.RESULTS All 58 presidents (100%) and 51 wellness coordinators (88%) completed surveys. Ten percent of colleges offered comprehensive employee health promotion programming. Most offered physical activity (70.6%), tobacco cessation (51.0%), weight loss/management (49.0%), and/or nutrition counseling (47.1%). Larger colleges were more likely to offer programming and environmental support. Nearly all presidents (89.7%) believed it is "very" or "extremely" important to offer health promotion programs to employees, and most (84%) were interested in promoting health through a university partnership.LIMITATIONS Despite very high survey response rates from presidents and wellness coordinators at each community college, onsite interviews were only done at select campuses, limiting the generalizability and scope of conclusions derived from interview data.CONCLUSION Community colleges in North Carolina are promising settings for promoting employee health. Findings identify resources, barriers, and technical assistance that could facilitate greater adoption and implementation of programs.

Feasibility of Assessing Falls Risk and Promoting Falls Prevention in Beauty Salons.

Falls are a major public health risk and a leading cause of emergency room visits for people of all ages. Finding ways to increase access to information and evidence-based falls prevention strategies is critically important across the lifespan. We tested the feasibility of conducting a falls risk assessment and awareness program among customers who attend beauty salons. We enrolled 78 customers from 2 beauty salons who completed a written questionnaire as well as several biometric and functional balance tests designed to assess falls risk. On average, enrolled participants were 56 years of age (range: 19-90), female (n = 70, 91%), and Black (n = 47, 62%). Eleven percent of enrolled customers were classified as at high risk of falls because they had reported two or more falls in the last 6 months. We found that younger age, higher education, employment, moderate physical activity, and decreased frequency of salon visits were associated with fewer falls. Results demonstrated initial interest in, and the feasibility of recruiting and enrolling customers into a beauty salon-based falls risk assessment and awareness program. Beauty salons, which are in all communities, represent an innovative setting for reaching people of all ages with life-saving falls prevention information and services.

The Health and Working Conditions of Women Employed in Child Care.

Over one million women are employed in child care and are among the lowest wage workers in the US. The health and working conditions of 674 child care workers (118 administrators and 556 staff) from 74 centers is described using baseline data from a larger intervention trial. Participants were 39.9 (±13.0) years old; 55.4% African American, 37.1% Caucasian, and 5.3% of Hispanic ethnicity. Seventy-six percent reported having an Associate's degree or less; 42% were classified as at or below poverty (<$20,000); and exhibited many health risks such as excess weight, insufficient activity, poor diet, and inadequate sleep. We investigated potential differences by income and job category. Lower income participants were significantly more likely to be current smokers (19.9% vs. 11.7%), drink more sweetened beverages (1.9 vs. 1.5), and report higher depressive symptoms (15.5 vs. 12.6). Administrators worked more hours weekly compared to staff (46.4 vs. 40.6), are less active (100 vs. 126 min/week), more sedentary (501 vs. 477 min/day), and reported higher job demands (13.3 vs. 12.5). Given the numerous health issues and challenging work conditions, we hope our results serve as a call to action for addressing low wages and the work environment as a means of influencing the health and well-being of child care workers.

Empowerment of promotoras as promotora-researchers in the Comidas Saludables & Gente Sana en las Colonias del Sur de Tejas (Healthy Food and Healthy People in South Texas Colonias) program.

Promotoras are trusted members of underserved, at-risk Hispanic communities experiencing social and health inequities. As promotora-researchers, promotoras have the unique ability and opportunity not only to provide outreach and education but also to be actively engaged in conducting research in their communities and serve as a cultural bridge between the community and researchers. In this article, we present a case study of personal and collective empowerment of six promotora-researchers who participated in seven community-based participatory research projects. Data sources included debriefing interviews with the promotora-researchers, milestone tracking and documentation completed during and after each study, and observations by the principal investigator and project managers regarding the role of the promotora-researchers in these studies. We qualitatively analyzed the data to identify the processes and decisions that were developed and implemented in a series of projects, which resulted in promotora-researcher empowerment. We found that active engagement empowered promotora-researchers personally and collectively in all phases of the research study. Common elements that contributed to the empowerment of promotora-researchers were valuing promotora-researchers' input, enabling promotora-researchers to acquire and utilize new skills, and allowing promotora-researchers to serve as both researchers and traditional promotoras. Together, these elements enabled them to more fully participate in research projects, while allowing them to identify and address needs within their own communities.

Diet and acculturation among Hispanic/Latino older adults in the United States: a review of literature and recommendations.

Among U.S. and foreign-born Hispanic/Latino older adults living in the United States, associations of dietary acculturation and health outcomes have yielded no consistent findings. The purpose of this review was to present current knowledge and research disparities on acculturation, dietary intake, and health outcomes among the fastest growing minority group in the United States. Fifteen peer-reviewed studies that measured dietary acculturation among Mexican, Puerto Rican, and Dominican older adults living in the United States were identified and examined. This literature review divulged contradictory associations between dietary acculturation and dietary intake, along with nutritional and general health outcomes. Conclusive evidence has yet to be attained due to use of cross-sectional study designs and numerous acculturation measures as well as unique cultural and dietary patterns across diverse Hispanic/Latino populations. Further research is needed to ascertain dietary acculturation among U.S. and foreign-born Hispanic/Latino older adults in the United States and should strive to develop instruments that consider the social, economic, and political environments that influence the dietary acculturation process. Furthermore, longitudinal study designs and qualitative methodologies are warranted.