Impact of the Physical Activity Environment on Change in Body Mass Index Percentile in Child Care Centers Serving Children with Disabilities.

Childcare centers (CCCs) can provide opportunities to implement physical activity (PA) via health promotion interventions to prevent obesity and associated chronic disease risk factors in young children. This study evaluated the impact of the Healthy Caregivers-Healthy Children (HC2) intervention on body mass index percentile (PBMI) and the PA environment in CCCs serving children with disabilities (CWD) over one school year. Ten CCCs were cluster-randomized to either (1) an intervention arm that received the HC2 curriculum adapted for CWD or (2) an attention control arm. Mixed-effect linear regression models analyzed the relationship between change in child PBMI and CCC childcare center PA environment by experimental condition and child disability status over one school year. Findings showed a significant decrease in PBMI among children in the HC2 centers (-6.74, p = 0.007) versus those in control centers (-1.35, p = 0.74) over one school year. Increased PA staff behaviors (mean change 3.66, p < 0.001) and PA policies (mean change 6.12, p < 0.001) were shown in intervention centers during the same period. Conversely, there was a significant increase in sedentary opportunities (mean change 4.45, p < 0.001) and a decrease in the portable play environment (mean change -3.16, p = 0.03) and fixed play environment (mean change -2.59, p = 0.04) in control centers. No significant differences were found in PBMI changes between CWD and children without disabilities (beta = 1.62, 95% CI [-7.52, 10.76], p = 0.73), suggesting the intervention's efficacy does not differ by disability status. These results underscore the importance of (1) including young CWD and (2) PA and the supporting environment in CCC health promotion and obesity prevention interventions.

A Randomized Controlled Cluster Trial of an Obesity Prevention Program for Children with Special Health Care Needs: Methods and Implications.

Children with disabilities have higher prevalence estimates of obesity than typically developing children. The Healthy Caregivers-Healthy Children Phase 3 (HC3) project implemented an obesity prevention program adapted for children with special health care needs (CSHCN) that includes dietary intake and physical activity (PA) components. The primary outcome was a change in dietary intake, PA, and the body mass index (BMI) percentile. Ten childcare centers (CCCs) serving low-resource families with ≥30 2- to 5-year-olds attending were randomized to either the intervention (n = 5) or control (n = 5). The HC3 CCCs received (1) snack, beverage, PA, and screen time policies via weekly technical assistance; (2) adapted lesson plans for CSHCN; and (3) parent curricula. The control CCCs received a behavioral health attention curriculum. HC3 was delivered over three school years, with data collected at five different timepoints. It was delivered weekly for six months in year one. To ensure capacity building, the HC3 tasks were scaled back, with quarterly intervention delivery in year 2 and annually in year 3. Adaptations were made to the curriculum to ensure appropriate access for CSHCN. Given that the program was being delivered during the COVID-19 pandemic, special modifications were made to follow CDC safety standards. The primary outcome measures included the Environment and Policy Assessment and Observation (EPAO) tool, standardized dietary intake and PA assessments, and the child BMI percentile. CCCs are an ideal setting for targeting CSHCN for obesity prevention efforts as they provide an opportunity to address modifiable risk factors.

Infant Nutrition and Other Early Life Risk Factors for Childhood Obesity According to Disability Status.

One in five preschool-aged children in the United States is obese, and children with disabilities are significantly impacted. This study aimed to determine the association between age at solid food initiation and obesity prevalence in preschool-aged children while considering disability status, ethnicity, gestational age, and birth weight. Analysis was conducted on a sample of 145 children aged 2 to 5 years who were enrolled in ten childcare centers. Parents completed a survey assessing disability status, race and ethnicity, birth weight, gestational age, and age of solid food initiation. Height and weight were collected concurrently. Multivariable logistic regression models generated the odds of developing obesity based on age at solid food initiation, disability status, ethnicity, gestational age, and birth weight. There was no significant difference in the odds of being obese based on age at solid food introduction. Children with disabilities (OR = 0.17, 95% CI 0.04-0.6, p = 0.01) and children born preterm (OR = 0.28, 95% CI 0.08-0.79, p = 0.03) had significantly lower odds of being obese. Hispanic children (OR = 4.93, 95% CI 1.91-15.32, p = 0.002) and children with higher birth weights (OR = 1.47, 95% CI 1.17-1.92, p = 0.002) were more likely to be obese. With pediatric obesity rates continuing to rise, these findings can inform future intervention efforts.

Social Challenges as a Consequence of the COVID-19 Pandemic among South Florida Preschool Children with Disability and Obesity.

The COVID-19 pandemic has negatively impacted the childcare industry over the past two years. This study examined how pandemic-related challenges impacted preschool-aged children by disability and obesity status. Participants were 216 children (80% Hispanic, 14% non-Hispanic Black) aged 2 to 5 years in 10 South Florida childcare centers. In November/December 2021, parents completed a COVID-19 Risk and Resiliency Questionnaire, and body mass index percentile (BMI) was collected. Multivariable logistic regression models examined the association of COVID-19 pandemic-related social challenges (transportation, employment) and child BMI and disability status. As compared to normal-weight children, those families with a child who was obese were more likely to report pandemic-related transportation (OR: 2.51, 95% CI: 1.03-6.28) challenges and food insecurity (OR: 2.56, 95% CI: 1.05-6.43). Parents of children with disabilities were less likely to report that food did not last (OR: 0.19, 95% CI: 0.07-0.48) and that they could not afford balanced meals (OR: 0.33, 95% CI: 0.13-0.85). Spanish-speaking caregivers were more likely to have a child who was obese (OR: 3.04, 95% CI: 1.19-8.52). The results suggest that COVID-19 impacts obese preschool children from Hispanic backgrounds, while disability was a protective factor.

Healthy caregivers-healthy children (HC2) phase 2: Integrating culturally sensitive childhood obesity prevention strategies into childcare center policies.

OBJECTIVE: Despite the high prevalence of obesity among preschool-aged children, most states lack childcare center (CCC) nutrition and physical activity policies. The Healthy Caregivers, Healthy Children (HC) Phase 2 project is examining the relationship between the CCC nutrition and physical activity environment and child dietary intake/physical activity patterns and body mass index (BMI). PARTICIPANTS: A total of 24 "Quality Counts" (Miami Dade County, Florida's Quality Rating Improvement System [QRIS)]) CCCs serving low resource families with ≥50 2-to-5year olds attending have been randomized to either intervention (n=12) or control (n=12). INTERVENTION: The HC2 intervention arm CCCs receive implementation of a daily curricula for (1) teachers/parents; (2) children; (3) snack, beverage, physical activity, and screen time policies; and (4) technical assistance with menu modifications. Control arm schools receive an attention control safety curriculum. HC2 is delivered once a month in year 1, quarterly in year 2 and will be disseminated throughout the Quality Counts network in year 3. MAIN OUTCOME MEASURES: Primary outcome measures include the Environment and Policy Assessment and Observation tool (EPAO), standardized dietary intake and physical activity patterns surveys, and child BMI. The 'Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM)' framework will guide the interpretation of outcome measures. CONCLUSIONS: CCCs are in need of evidence-based standardized nutrition and physical activity policies. The intersection of RE-AIM and early childhood obesity prevention in the childcare setting could generate robust and new information to the field about potential barriers, facilitators, adoption, and sustainability in this setting.