Multi-State Implementation of Go NAPSACC to Support Healthy Practices in the Early Care and Education Setting.

Childhood obesity in the United States is a serious problem that puts children at risk for poor health. Effective state-wide interventions are needed to address childhood obesity risk factors. Embedding evidence-based initiatives into state-level Early Care and Education (ECE) systems has the potential to improve health environments and promote healthy habits for the 12.5 million children attending ECE programs. Go NAPSACC, an online program that was adapted from an earlier paper version of Nutrition and Physical Activity Self-Assessment for Child Care (NAPSACC or NAP SACC), provides an evidence-based approach that aligns with national guidance from Caring for Our Children and the Centers for Disease Control and Prevention. This study describes approaches undertaken across 22 states from May 2017 to May 2022 to implement and integrate Go NAPSACC into state-level systems. This study describes challenges encountered, strategies employed, and lessoned learned while implementing Go NAPSACC state-wide. To date, 22 states have successfully trained 1,324 Go NAPSACC consultants, enrolled 7,152 ECE programs, and aimed to impact 344,750 children in care. By implementing evidence-based programs, such as Go NAPSACC, ECE programs state-wide can make changes and monitor progress on meeting healthy best practice standards, increasing opportunities for all children to have a healthy start.

Satisfacción laboral del personal de guarderías del IMSS y participativas en Ciudad Juárez, Chihuahua / Job satisfaction of IMSS and participatory nursing staff in Ciudad Juárez, Chihuahua

Introducción: la satisfacción laboral es la sensación positiva de sentirse satisfecho y se encuentra relacionada con la experiencia de trabajo, esto es alcanzado de manera plena cuando el trabajador satisface sus necesidades. El objetivo de la investigación es identificar la satisfacción laboral del personal de guarderías del IMSS y participativas de Ciudad Juárez, Chihuahua. Material y métodos: estudio descriptivo transversal, se aplicó el cuestionario de Meliá y Peiró S21/26 a 270 trabajadores de guarderías de Ciudad Juárez, Chihuahua, México. Resultados: se identificó que los trabajadores declararon nivel de satisfacción alta cuando reportaron antigüedad laboral menor a 1 año. La guardería IMSS reportó satisfacción con un valor de p = 0.05. Conclusión: el grado de satisfacción laboral de los trabajadores de las guarderías, reflejan un mejor ambiente laboral y una mayor calidad en el servicio prestado, lo que de manera positiva impacta en la calidad de los servicios que se ofrecen.

Introduction: Job satisfaction is the positive sensation of feeling satisfied and is related to the work experience, this is fully achieved when the worker satisfies his needs. The objective of the research is to identify the job satisfaction of the staff of IMSS and participatory day care centers in Ciudad Juárez, Chihuahua. Material and methods: A cross-sectional descriptive study, the Meliá and Peiró S21/26 Questionnaire was applied to 270 nursery workers in Ciudad Juárez, Chihuahua, Mexico. Results: It was identified that the workers declared a high level of satisfaction when they reported employment seniority of less than 1 year. The IMSS nursery reported satisfaction with a value of p = 0.05. Conclusion: The degree of job satisfaction of nurseries workers reflects a better work environment and a higher quality of service provided, which positively impacts the quality of services offered.

Independent Early Childhood Education Centers' Experiences Implementing the Revised Child and Adult Care Food Program Meal Pattern Standards: A Qualitative Exploratory Study.

BACKGROUND: Nationally, approximately one-third of early childhood education centers participating in the Child and Adult Care Food Program (CACFP) are independently owned and operated (ie, not owned by a corporation, not affiliated with Head Start, and with no food program sponsor). Independent providers are less likely to meet CACFP standards and best practices and would benefit from additional support and technical assistance. OBJECTIVE: To explore independent early childhood education center key informants' (KIs) (ie, directors or relevant staff) perspectives on implementing the revised CACFP standards. DESIGN: Following qualitative exploratory design, semistructured, in-depth, telephone interviews were conducted with KIs individually. PARTICIPANTS/SETTING: In summer 2018, 30 randomly sampled KIs from independent CACFP-participating early childhood education centers serving children ages 2 to 5 years nationwide were interviewed. Participants were sampled from respondents to a previously completed nationwide survey of providers. MAIN OUTCOMES: KIs' perspectives on the CACFP program and revised meal pattern standard implementation. ANALYSIS PERFORMED: After audio recordings were professionally transcribed and reviewed, constant comparative analysis was conducted using Atlas.ti v8 qualitative software (Atlas.ti. version 8 for Windows, 2018, Scientific Software Development GmbH). RESULTS: KIs indicated that program benefits (eg, health and nutrition benefits, reimbursement, guidelines, and training) outweighed challenges experienced. Challenges associated with revised CACFP standards implementation (eg, availability or acceptability of new, creditable foods) were impacted by enhanced CACFP standards status, reported revised standards, and availability or utilization of outside support. KIs desired more contact with their state representative. KIs found the training and technical assistance on the revised standards useful and suggestions to enhance future training and technical assistance (eg, increasing accessibility, training resources, and audience-specific training). CONCLUSIONS: Overall, KIs desired additional resources, training, and increased communication from CACFP state representatives specific to CACFP-approved and reimbursable products, menu ideas, recipes, and cooking demonstrations. The present study suggests that a more tailored training and technical assistance approach is necessary as reported benefits, challenges, and program needs varied based on state-enhanced CACFP standards, reported familiarity with the revised meal pattern, and reported outside support.

Barriers and Enablers to Adoption of Digital Health Interventions to Support the Implementation of Dietary Guidelines in Early Childhood Education and Care: Cross-Sectional Study.

BACKGROUND: Few Australian childcare centers provide foods consistent with sector dietary guidelines. Digital health technologies are a promising medium to improve the implementation of evidence-based guidelines in the setting. Despite being widely accessible, the population-level impact of such technologies has been limited due to the lack of adoption by end users. OBJECTIVE: This study aimed to assess in a national sample of Australian childcare centers (1) intentions to adopt digital health interventions to support the implementation of dietary guidelines, (2) reported barriers and enablers to the adoption of digital health interventions in the setting, and (3) barriers and enablers associated with high intentions to adopt digital health interventions. METHODS: A cross-sectional telephone or online survey was undertaken with 407 childcare centers randomly sampled from a publicly available national register in 2018. Center intentions to adopt new digital health interventions to support dietary guideline implementation in the sector were assessed, in addition to perceived individual, organizational, and contextual factors that may influence adoption based on seven subdomains within the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) of health and care technologies framework. A multiple-variable linear model was used to identify factors associated with high intentions to adopt digital health interventions. RESULTS: Findings indicate that 58.9% (229/389) of childcare centers have high intentions to adopt a digital health intervention to support guideline implementation. The changes needed in team interactions subdomain scored lowest, which is indicative of a potential barrier (mean 3.52, SD 1.30), with organization's capacity to innovate scoring highest, which is indicative of a potential enabler (mean 5.25, SD 1.00). The two NASSS subdomains of ease of the adoption decision (P<.001) and identifying work and individuals involved in implementation (P=.001) were significantly associated with high intentions to adopt digital health interventions. CONCLUSIONS: A substantial proportion of Australian childcare centers have high intentions to adopt new digital health interventions to support dietary guideline implementation. Given evidence of the effectiveness of digital health interventions, these findings suggest that such an intervention may make an important contribution to improving public health nutrition in early childhood.

Determining eLearning Preferences to Inform Beverage Policy Training for Early Care and Education Teachers.

OBJECTIVE: To determine the eLearning preferences of early care and education (ECE) teachers for an effective beverage policy training. METHODS: Mixed methods study conducted with ECE directors and teachers in 6 regions throughout Georgia. Researchers used an eLearning survey (n = 646) along with focus groups (n = 6) and interviews (n = 24) to determine eLearning preferences and preferred eLearning format. Descriptive statistics and qualitative content analysis were used for data analysis. RESULTS: Most ECE teachers in Georgia (85%) have never had a beverage policy training. Participants (48%) reported they would definitely use the Internet for training. Qualitative analysis revealed key themes; training should be engaging, concise, hold the trainees accountable, and be interactive. Interactive video is the preferred eLearning format. CONCLUSIONS AND IMPLICATIONS: Interventions that promote national beverage recommended in the ECE setting are critically needed. Study findings may inform other states about the feasibility of using eLearning to provide beverage policy training for ECE providers in other states.

Menu planning practices in early childhood education and care - factors associated with menu compliance with sector dietary guidelines.

ISSUE ADDRESSED: Despite recommendations, early childhood education and care services do not plan menus in accordance with sector dietary guidelines. This study aimed to examine the following among Australian long day care services: (a) menu planning practices; (b) prevalence of menu compliance with sector dietary guidelines; and (c) menu planning practices associated with higher menu compliance with sector dietary guidelines. METHODS: Long day care services within Hunter New England, NSW participated in a pen and paper survey assessing menu planning practices and socio-demographic and service characteristics. Two-week menus were assessed for compliance with sector dietary guidelines, based on the number of servings of food groups and discretionary foods provided per child, per day. RESULTS: Staff from 72 services completed the survey and 69 provided their menu. Results indicated the service cook was fully responsible for planning the menu in 43% of services, and 57% had received written support to assist with menu planning. Service menus were compliant with an average of 0.68 out of six food groups and discretionary foods. In poisson regression models, a shorter menu cycle length (P = .04) and the receipt of training opportunities to support menu planning (P < .01) were significantly associated with higher menu compliance. CONCLUSIONS: Menu compliance with sector dietary guidelines is low among participating long day care services. SO WHAT?: The implementation of practices such as shortening of the menu cycle and the provision of training opportunities may assist in the planning of menus that are more compliant with dietary guidelines in this setting.

Children's use of interactive media in early childhood - an epidemiological study / A utilização de mídias interativas por crianças na primeira infância - um estudo epidemiológico

ABSTRACT Objective: To describe the prevalence of interactive media (tablets and smartphones) use by children aged two to four years old, as well as to characterize this use, and investigate habits, practices, parents' participation and opinion about their child's interactive media use. Methods: A cross-sectional study with 244 parents or legal guardians of children enrolled in daycare centers in a small Brazilian municipality was conducted. A questionnaire based on interactive media use and related habits were applied, and economic level was assessed. Children were divided into three different groups according to media use: Group 1 did not use (n=81); Group 2 uses up to 45 min/day (n=83) and Group 3 uses more than 45 min/day (n=80). Then, they were compared with regard to the sociodemographic variables and media use by the Chi-square test and Student's t-test. Results: The prevalence of interactive media use was 67.2%, with a mean time of use of 69.2 minutes/day (confidence interval of 95% - 95%CI 57.1-81.2). The activities most performed were watching videos (55%), listening to music (33%) and playing games (28%). Most parents reported allowing media use in order to stimulate their child's development (58.4%), accompanying them during use (75.2%), and limiting media time (86.4%). Conclusions: We observed high interactive media use prevalence. The predominant way of using these devices was marked by parent-child participation. Most parents reported believing in the benefits of interactive media. Passive activities were more frequent, with restricted time of use.

RESUMO Objetivo: Descrever a prevalência do uso de mídias interativas (tablets e smartphones) pelas crianças de dois a quatro anos de idade, assim como caracterizar esse uso, investigar hábitos, práticas, participação e opinião dos pais acerca da sua utilização. Métodos: Estudo transversal com 244 pais ou responsáveis de crianças matriculadas em creches de um município brasileiro de pequeno porte. Foi aplicado um questionário sobre hábitos de utilização de mídias interativas e investigação do nível econômico. As crianças foram divididas em 3 grupos de acordo com o uso das mídias: grupo 1 - não utiliza; grupo 2 - utiliza até 45 minutos por dia; e grupo 3 - utiliza mais do que 45 minutos por dia. Os grupos foram comparados quanto às variáveis sociodemográficas e de caracterização do uso das mídias por meio dos testes do qui-quadrado e t de Student. Resultados: A prevalência do uso de mídias interativas foi de 67,2%, com tempo médio de utilização de 69,2 minutos por dia (intervalo de confiança de 95% - IC95% 57,1-81,2). As atividades mais realizadas foram: ver vídeos (55%), escutar músicas (33%) e jogar games (28%). A maioria dos pais relatou permitir a utilização da mídia para estimular o desenvolvimento do seu filho (58,4%), acompanhá-lo durante o uso (75,2%) e limitar o tempo com a mídia (86,4%). Conclusões: Observou-se elevada prevalência do uso de mídias interativas. A forma predominante de utilização das mídias envolve conjuntamente crianças e pais, os quais acreditam nos seus efeitos benéficos. Atividades passivas são as mais realizadas, com restrição do tempo de uso.

Design and methodology of a cluster-randomized trial in early care and education centers to meet physical activity guidelines: Sustainability via Active Garden Education (SAGE).

Strategies are needed to help early care and education centers (ECEC) comply with policies to meet daily physical activity and fruit and vegetable guidelines for young children. This manuscript describes the design and methodology of Sustainability via Active Garden Education (SAGE), a 12-session cluster-randomized controlled crossover design trial using community-based participatory research (CBPR) to test a garden-based ECEC physical activity and fruit and vegetables promotion intervention for young children aged 3-5 years in 20 sites. The SAGE curriculum uses the plant lifecycle as a metaphor for human development. Children learn how to plant, water, weed, harvest, and do simple food preparation involving washing, cleaning, and sampling fruit and vegetables along with active learning songs, games, science experiments, mindful eating exercises, and interactive discussions to reinforce various healthy lifestyle topics. Parents will receive newsletters and text messages linked to the curriculum, describing local resources and events, and to remind them about activities and assessments. Children will be measured on physical activity, height, and weight and observed during meal and snack times to document dietary habits. Parents will complete measures about dietary habits outside of the ECEC, parenting practices, home physical activity resources, and home fruit and vegetable availability. SAGE fills an important void in the policy literature by employing a participatory strategy to produce a carefully crafted and engaging curriculum with the goal of meeting health policy guidelines and educational accreditation standards. If successful, SAGE may inform and inspire widespread dissemination and implementation to reduce health disparities and improve health equity.

Early Childhood Education Centers' Reported Readiness to Implement the Updated Child and Adult Care Food Program Meal Pattern Standards in the United States, 2017.

BACKGROUND: The Child and Adult Care Food Program (CACFP) serves nutritious meals/snacks to >3.6 million children in early childhood education (ECE) centers. This study provides a nationwide assessment of nonhome-based CACFP-participating ECE centers' awareness of and reported readiness for implementing updated CACFP standards/best practices that took effect October 1, 2017. METHODS: A national frame of 38,760 centers serving children ages 0-5 was developed. A web-based survey of 5483 sampled centers, stratified by census division, was conducted between August 22 and September 30, 2017. One thousand three hundred forty-three centers (25%) located in 47 states and the District of Columbia responded. Surveys were primarily completed by center directors/assistant directors (71%). Nonresponse adjusted multivariate regressions were conducted, controlling for center/zip code-level characteristics. RESULTS: The majority of centers reported being "very" familiar with the updated standards and met specific standards/best practices. Centers that reported being "somewhat" (vs. "very") familiar with the standards were less prepared and likely to have begun implementation and more likely to need additional time, money, and staff. Centers that reported being "not"/"somewhat" familiar (vs. "very") with the updated standards were also less likely to meet specific standards/best practices. Center preparedness and standards/best practices varied by weekly rates/fees charged. Centers in the West (vs. South) were more likely to report meeting sugary cereal standards and fruits and vegetables as a snack component best practice. CONCLUSIONS: While most centers reported familiarity with and were prepared to implement the updated CACFP standards, readiness is not universal. Technical assistance and training should ensure that all centers are trained on the updated standards.

Barriers and Facilitators to Compliance with a State Healthy Eating Policy in Early Care and Education Centers.

BACKGROUND: Early care and education (ECE) policies can improve childhood obesity risk factors. We evaluated barriers and facilitators to implementing mandatory nutrition standards for foods provided in South Carolina ECE centers serving low-income children, comparing centers participating in the Child and Adult Care Food Program (CACFP) with non-CACFP centers. METHODS: We mailed 261 surveys (demographics, policies and practices, barriers and facilitators) to center directors after new state nutrition standards were implemented in South Carolina. We conducted univariate and bivariate analyses to explore relationships between barriers, facilitators, and center-level characteristics, by CACFP status. RESULTS: We received 163 surveys (62% response rate). Centers had a median [interquartile range (IQR)] of 5 (4-7) classrooms and 59 (37.5-89) total children enrolled. More than half (60.1%) of directors reported they were moderately or fully informed about the standards. The most common barriers were food costs (17.8%) and children's food preferences (17.8%). More non-CACFP directors reported food costs as a barrier (28.6% vs. 6.5%, p < 0.001), having to spend additional money on healthier foods (48.8% vs. 28.6%, p = 0.01), and having to provide additional nutrition education to parents (28.6% vs. 11.7%, p = 0.01), compared with CACFP directors. CONCLUSIONS: Center directors were generally well informed about the nutrition standards. The most common barriers to implementing the standards were food costs and children's food preferences. Centers participating in CACFP may be in a better position to adhere to new state nutrition standards, as they receive some federal reimbursement for serving healthy foods and may be more accustomed to regulation.

Examining Nutrition and Physical Activity Policies and Practices in Maryland's Child Care Centers.

BACKGROUND: Child care settings provide opportunities for obesity prevention by implementing nutrition/physical activity best practices. This study examines how center policies, provider training, family education, and center demographics relate to best practices for nutrition/physical activity in Maryland's child care centers. METHODS: A survey, including minor modifications to The Nutrition and Physical Activity Self-Assessment for Child Care (Go NAP SACC), was sent by e-mail to center directors statewide. Best practice sum scores (dependent variable) were calculated, including physical activity (17 items), feeding environment (18 items), and food served (19 items). Adjusted regression models analyzed the number of nutrition/physical activity policies, provider training topics, and family education opportunities related to best practice scores. RESULTS: Response rate was 40% (n = 610/1506) with 69% independent centers (vs. organization sponsored), 19% with Child and Adult Care Food Program (CACFP enrolled), and 50.2% centers with majority (≥70%) Caucasian children and 16.8% centers with majority African American children. Centers reported 40.8% of physical activity best practices, 52.0% of feeding environment best practices, and 51.6% of food served best practices. Centers reported (mean) 7.9 of 16 nutrition/physical activity-relevant policies, 6.9 of 13 provider training topics, and 4.4 of 8 family education opportunities. Regression models yielded associations with best practices: policies and provider training with feeding environment (B = 0.26, p < 0.001; B = 0.26, p = 0.001, respectively); policies with foods served (B = 0.22, p = 0.002); and policies, provider training, and feeding environment with physical activity (B = 0.19, p = 0.001; B = 0.24, p = 0.010; B = 0.38, p < 0.001). CONCLUSIONS: Nutrition/physical activity best practices in child care are supported by specific policies, provider training, and family education activities.

Feasibility of a Multicomponent Program to Promote Physical Activity and Nutrition in Georgia Low-Income Early Care and Education Settings.

BACKGROUND: This article describes the process and intermediate outcomes from a program implemented in 65 Early Care and Education (ECE) centers serving low-income families throughout Georgia during the 2014-2017 school years. METHODS: The HealthMPowers' Empowering Healthy Choices in Schools, Homes, and Communities ECE program was based on the organization's previously successful elementary school program and aligns with current early childhood nutrition and physical activity recommendations. Participating centers worked with HealthMPowers for up to 3 years. A team from each center led changes by conducting annual self-assessments, creating and implementing improvement plans, and implementing nutrition and physical activity programs using educational resources and environmental cues. A monitoring and evaluation plan provided ongoing feedback to HealthMPowers and centers. Family and staff surveys provided insights into behaviors of children, families, and staff. Process measures included specific benchmarks (e.g., center leadership team formation, improvement plan implementation). Annual self-assessment results served as intermediate outcome measures. RESULTS: As of 2017, 65 centers had enrolled in the program. All centers formed a health team and completed the baseline self-assessment and most implemented an improvement plan (88%). At the 1-year follow-up self-assessment, centers reported improvements from baseline including never offering food incentives for good behavior (75%-86%), conducting taste testing at least once a month (61%-79%), and rarely/never serving sugar-sweetened beverages (93%-96%). CONCLUSIONS: Initial process measures from a multicomponent health promotion program in ECE were promising. An integrated continuous improvement approach to working with child care settings is feasible and likely effective.

The quality of nutrition and physical activity environments of child-care centers across three states in the southern U.S.

This cross-sectional study assessed the quality of nutrition and physical activity environments of child-care centers in three southern states and examined differences by rural versus urban location, participation in the Child and Adult Care Food Program, and Head Start status. The sample included 354 centers that enroll children aged 2-5: 154 centers from Georgia, 103 from Kentucky, and 97 centers from Mississippi. Directors and 1-2 teachers per center completed the Environment and Policy Assessment and Observation Self-Report (EPAO-SR) tool that assesses nutrition and physical activity environments of child-care centers. The EPAO-SR items were scored to capture six nutrition domains and six physical activity domains that were averaged and then summed to create a combined nutrition and physical activity environment score (range = 0-36); higher scores indicated that centers met more best practices, which translated to higher-quality environments. Overall, the centers had an average combined nutrition and physical activity environment score of 20.2 out of 36. The scores did not differ between rural and urban centers (mean = 20.3 versus 20.2, p = 0.98). Centers in the Child and Adult Care Food Program had higher combined nutrition and physical activity environment scores than non-participating centers (mean = 20.6 versus 19.1, p < 0.01). Head Start centers also had higher combined environment scores than non-Head Start centers (mean = 22.3 versus 19.6, p < 0.01). Findings highlight the vital role of federal programs in supporting healthy child-care environments. Providing technical assistance and training to centers that are not enrolled in well-regulated, federally-funded programs might help to enhance the quality of their nutrition and physical activity environments.

Promoting physical activity, healthy eating and gross motor skills development among preschoolers attending childcare centers: Process evaluation of the Healthy Start-Départ Santé intervention using the RE-AIM framework.

BACKGROUND: The Healthy Start-Départ Santé intervention was developed to promote physical activity, gross motor skills and healthy eating among preschoolers attending childcare centers. This process evaluation aimed to report the reach, effectiveness, adoption, implementation and maintenance of the Healthy Start-Départ Santé intervention. METHODS: The RE-AIM framework was used to guide this process evaluation. Data were collected across 140 childcare centers who received the Healthy Start-Départ Santé intervention in the provinces of Saskatchewan and New Brunswick, Canada. Quantitative data were collected through director questionnaires at 10 months and 2 years after the initial training and analyzed using descriptive statistics. Qualitative data were collected throughout the intervention. RESULTS: The intervention was successful in reaching a large number of childcare centres and engaging both rural and urban communities across Saskatchewan and New Brunswick. Centres reported increasing opportunities for physical activity and healthy eating, which were generally low-cost, easy and quick to implement. However, these changes were rarely transformed into formal written policies. A total of 87% of centers reported using the physical activity resource and 68% using the nutrition resource on a weekly basis. Implementation fidelity of the initial training was high. Of those centers who received the initial training, 75% participated in the mid-point booster session training. Two year post-implementation questionnaires indicated that 47% of centers were still using the Active Play Equipment kit, while 42% were still using the physical activity resource and 37% were still using the nutrition resource. Key challenges to implementation and sustainability identified during the evaluation were consistent among all of the REAIM elements. These challenges included lack of time, lack of support from childcare staff and low parental engagement. CONCLUSIONS: Findings from this study suggest the implementation of Healthy Start-Départ Santé may be improved further by addressing resistance to change and varied levels of engagement among childcare staff. In addition, further work is needed to provide parents with opportunities to engage in HSDS with their children.

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.

Does the CATCH Early Childhood Program Increase Physical Activity Among Low-Income Preschoolers?-Results From a Pilot Study.

PURPOSE: To explore whether the physical activity (PA) component of the Coordinated Approach to Child Health Early Childhood (CATCH EC) program helps increasing preschoolers' PA during active times at preschool. DESIGN: Nonrandomized controlled experimental study. SETTING: Head Start centers in Houston, Texas, 2009 to 2010 school year. PARTICIPANTS: A total of 439 preschoolers aged 3 to 5 years (3 intervention centers, n = 220; 3 comparison centers, n = 219). INTERVENTION: The CATCH EC preschool-based teacher-led nutrition and PA program. MEASURES: Preschoolers' PA was measured at baseline and postintervention using the System for Observing Fitness Instruction Time-Preschool version, a direct observation method measuring PA at the classroom level. Parent surveys provided demographic data. ANALYSIS: Pre-to-post changes in preschoolers' PA were examined using the Mann-Whitney U test. RESULTS: Results show a significant decrease in the percentage time preschoolers spent in level 2 PA (low activity) at intervention ( P = .005) and comparison ( P = .041) centers. Indoor vigorous activity increased significantly on an average by +6.04% pre-to-post intervention among preschoolers in the intervention group ( P = .049); no significant change was found in the comparison group. CONCLUSION: The CATCH EC favorably increased indoor vigorous PA level among low-income children attending Head Start.

Building a Collaboration Between a Children's Hospital and an Early Childhood Education and Social Services Center.

To address toxic stress among children growing up in poverty, an innovative collaboration was developed between a community center, Operation Breakthrough (OB), and a tertiary care children's hospital, Children's Mercy Hospital (CMH). OB started as a day care center but has expanded and developed ways to provide shelter, safety, food, employment, education and health care. CMH is a traditional academic children's hospital that, in recent years, has been looking for ways to better address the social determinants of health. This article describes how the two organizations found ways to work together to capitalize on each other's strengths. Although the two institutions shared some common goals, they had very different organizational structure. We describe how a series of complex negotiations and trust-building exercises eventually led to a robust and unique partnership.

Identifying Strategies Programs Adopt to Meet Healthy Eating and Physical Activity Standards in Afterschool Programs.

BACKGROUND: The YMCA of USA has adopted Healthy Eating and Physical Activity (HEPA) Standards for its afterschool programs (ASPs). Little is known about strategies YMCA ASPs are implementing to achieve Standards and these strategies' effectiveness. AIMS: (1) Identify strategies implemented in YMCA ASPs and (2) evaluate the relationship between strategy implementation and meeting Standards. METHOD: HEPA was measured via accelerometer (moderate-to-vigorous-physical-activity [MVPA]) and direct observation (snacks served) in 20 ASPs. Strategies were identified and mapped onto a capacity building framework ( Strategies To Enhance Practice [STEPs]). Mixed-effects regression estimated increases in HEPA outcomes as implementation increased. Model-implied estimates were calculated for high (i.e., highest implementation score achieved), moderate (median implementation score across programs), and low (lowest implementation score achieved) implementation for both HEPA separately. RESULTS: Programs implemented a variety of strategies identified in STEPs. For every 1-point increase in implementation score 1.45% (95% confidence interval = 0.33% to 2.55%, p ≤ .001) more girls accumulated 30 min/day of MVPA and fruits and/or vegetables were served on 0.11 more days (95% confidence interval = 0.11-0.45, p ≤ .01). Relationships between implementation and other HEPA outcomes did not reach statistical significance. Still regression estimates indicated that desserts are served on 1.94 fewer days (i.e., 0.40 vs. 2.34) in the highest implementing program than the lowest implementing program and water is served 0.73 more days (i.e., 2.37 vs. 1.64). CONCLUSIONS: Adopting HEPA Standards at the national level does not lead to changes in routine practice in all programs. Practical strategies that programs could adopt to more fully comply with the HEPA Standards are identified.

San Francisco childcare centers' preparedness in the prevention and management of asthma among preschool-aged children.

INTRODUCTION: Asthma is a common health condition for children in childcare. National recommendations for asthma in childcare exist. However, no studies have investigated the extent to which childcare centers adhere to these recommendations. We aimed to assess childcare center adherence to National Asthma Education and Prevention Program (NAEPP) recommendations for asthma care and preparedness and to identify characteristics associated with increased adherence to national asthma recommendations. METHODS: We developed a standardized instrument. Each childcare center received a score of 0 through 7 based on number of recommendations met. We conducted t-tests, chi square tests and linear regression to identify childcare center factors associated with increased asthma preparedness. RESULTS: 36 out of 40 eligible childcare centers (90%) participated. These sites served 1570 children primarily between the ages of 2 to 5 years. On average, centers met 3.8 out of 7 (SD = 1.3) recommendations. Staff familiarity caring for children with asthma (p < 0.001) and the center's asthma prevalence (p = 0.01) was positively associated with the center's asthma preparedness. The 3 areas most in need of improvement related to asthma medications, asthma action plans and asthma policies. None of the managers reported being familiar with the NAEPP recommendations. DISCUSSION: There is room for improvement in the asthma care and preparedness of childcare centers. The 3 areas in which centers performed poorly (appropriate asthma medication management, use of asthma action plans, and presence of appropriate asthma policies) suggest that closer collaboration between clinicians and childcare centers may be a key to improving asthma management for young children.