Optimizing health services for young children in poverty: enhanced collaboration between Early Head Start and pediatric health care.

Given the importance of health to educational outcomes, and education to concurrent and future health, cross-systems approaches, such as the Whole School, Whole Community, Whole Child (WSCC) framework, seek to enhance services typically in K-12 settings. A major gap exists in cross-systems links with early care and education serving children birth to age 5. Both pediatric health systems and early family and child support programs, such as Early Head Start (EHS) and Head Start (HS), seek to promote and optimize the health and wellbeing of infants, toddlers, preschoolers, and their families. Despite shared goals, both EHS/HS and pediatric health providers often experience challenges in reaching and serving the children most in need, and in addressing existing disparities and inequities in services. This paper focuses on infant/toddler services because high-quality services in the earliest years yield large and lasting developmental impacts. Stronger partnerships among pedicatric health systems and EHS programs serving infants and toddlers could better facilitate the health and wellbeing of young children and enhance family strengths and resilience through increased, more intentional collaboration. Specific strategies recommended include strengthening training and professional development across service platforms to increase shared knowledge and terminology, increasing access to screening and services, strengthening infrastructure and shared information, enhancing integration of services, acknowledging and disrupting racism, and accessing available funding and resources. Recommendations, including research-based examples, are offered to prompt innovations best fitting community needs and resources.

Resilience: supporting children's self-regulation in infant and toddler classrooms.

Introduction: Resilience is a process that develops as a complex transaction as children experience and shape their social-ecological contexts. The dynamic development of self-regulation is an aspect of resilience that has received increased attention as a key mechanism predicting a variety of important short- and long-term outcomes. The current study examined how the self-regulation skills of infants and toddlers in a classroom could potentially shape classroom interactions and quality which, in turn, could potentially shape the development of self-regulation skills of the individual infants and toddlers enrolled in the classroom across an early childhood program year. The unique contribution of this study is the focus on a critical component of resilience, self-regulation, in an understudied age group, infants and toddlers, in an important and understudied context, the infant-toddler early childhood classroom. Methods: Data are from a statewide evaluation of early childhood programs serving children birth to age 3 growing up in low-income contexts. Multi-level mediation models were employed to examine the mediation effect of classroom quality between classroom-level self-regulation and individual children's gain in self-regulation over a year. Results: We found a significant indirect path. The results showed that classroom-level self-regulation skills demonstrated by infants and toddlers in the fall predicted higher levels of teachers' implementation of three important aspects of classroom quality - support for social-emotional, cognitive, and language development - in the winter. We also found that higher levels of teachers' support for social-emotional, cognitive, and language development associated with children's increased growth in self-regulation skills from fall to spring. The direct path from classroom-level self-regulation demonstrated in the fall to individual children's gain in self-regulation was not significant. Discussion: These findings, unique due to the focus on infants and toddlers in a classroom context, are discussed within the larger body of existing self-regulation research conducted with older children and prevalent theories outlining developmental mechanisms. Implications for both infant-toddler classroom practices and future research are addressed. Relative to practice, our findings have implications for informing how the development of self-regulation, an important component of resilience, can be supported in the youngest children, infants and toddlers, specifically those enrolled in center-based classrooms serving young children growing up in families with low incomes. We focus on the need to improve the support and professional development of infant-toddler teachers which, in turn, can improve classroom quality and foster resilience in infants and toddlers. Relative to research, our use of a relatively new measure of infant-toddler classroom quality, the Quality of Care for Infants and Toddlers (QCIT), shows how this tool can expand infant-toddler research, a need in the current literature. Future research using different measures, designs, analytical strategies, and diverse samples and contexts is needed to further explain very young children's development of self-regulation, a critical component of resilience.

A deeper dive, a wider pool: Preschool benefits sustain to first grade on a broader set of outcomes.

The current study provides new evidence on the sustained benefits of preschool attendance on a broader range of skills-both academic and executive functioning (EF)-than many prior studies have examined. Using propensity score methods, we predicted children's (N = 920, M age at 1st = 6.5 years) literacy, language, math, and EF skills in kindergarten and again at first-grade (2020-2021) based on whether they had attended public preschool (school-based pre-k; Head Start) versus no preschool. In our race-ethnically diverse sample of children (48% Hispanic/Latinx; 21% Black; 14% White; 9% Native American; 9% multiracial) from low-income families, preschool attenders showed advantages on English literacy, English language, and math in kindergarten, which mostly persisted into first-grade. Preschool did not boost EF in kindergarten or first-grade.

Predictors of Overweight and Obesity in Early Care and Education Teachers during COVID-19.

The purpose of this cross-sectional study was to determine individual, sociocultural, policy, and economic predictors of overweight/obesity in early care and education (ECE) teachers to identify modifiable opportunities to enhance the health of this critical workforce. ECE teachers (n = 1434) in the U.S. completed an online survey in late spring to mid-summer 2020. Teachers self-reported height and weight; body mass index (BMI) and weight status were calculated. Teachers reported micro-environment variables including age, race, gender, obesogenic lifestyle behaviors, well-being, food security, personal health, stress, job stress, type of ECE, COVID-19 teaching modality, and age of children in the classroom. Logistic regression predicting overweight/obesity and linear regression predicting BMI were conducted. Teachers with more years of teaching experience (OR: 1.022: 95% CI 1.005, 1.039) and higher consumption of fast food (2.038: 1.310, 3.169) had higher odds of overweight/obesity. Teachers with higher levels of education (0.58: 0.407, 0.828) and higher physical health (0.836: 0.775, 0.902) had lower odds of overweight/obesity. Other variables were not associated with overweight/obesity. Variables significant in logistic regression were also associated with higher BMI. Additionally, Native American race (ß = 2.467 SE = 1.206) and sedentary hours/day (ß = 0.152 SE = 0.075) were associated with higher BMI. Implications for enhancing workplace health for these ECE teachers are emerging.

Relationships between proximity to grocery stores and Oklahoma Early Care and Education classroom nutrition practices.

The study purpose was to determine associations between proximity to grocery stores and Early Care and Education programs' (i.e., ECEs) classroom nutrition practices and barriers, by ECE context (Head Start, community-based childcare [CBC], and family child care homes [FCCHs]). A statewide cross-sectional survey was implemented in Oklahoma ECEs. Directors reported classroom nutrition practices with the Nutrition and Physical Activity Self-Assessment tool, and barriers to implementation. Locations of 457 grocery stores statewide were determined by in-person audit. Geocoded ECEs were considered within a "low proximity" area if no grocery stores were available within a 0.25-mile radius for urban, or 10-mile radius for rural, ECEs. From November 2019 to February 2020, 54 Head Starts, 159 CBCs, and 160 FCCHs participated. 31.0 % were considered as low proximity. Head Starts demonstrated the highest classroom nutrition scores for mealtime practices, and nutrition education and policy. While proximity to grocery stores was not related to classroom nutrition practices for any ECE context (p > 0.05), FCCHs located within a low proximity area reported barriers to implementing those practices more often compared to FCCHs in an area within accessible proximity of grocery store. Thus, proximity to grocery stores was related to barriers in FCCHs only; those provider's experiences and perceptions may be most susceptible to influence of the community nutrition environment, compared to other ECE contexts. Contrary to studies in residential areas and schools, nutrition environments were not related to nutrition practices in ECEs. ECEs may serve as protective micro-environments supporting health for children residing in nearby low-access communities.

When does 1 + 1 not equal 2? The relative advantage of public school-based pre-k versus head start for low-income children's kindergarten cognitive and self-regulatory skills.

Decades of research suggest that both Head Start and public pre-kindergarten (pre-k) programs boost low-income preschoolers' kindergarten skills. What is not yet well understood is whether there are relative advantages of transitioning from Head Start after 1 year into a school-based public pre-k program for the year immediately before kindergarten for children's developing cognitive and self-regulation skills. This is an important question, because in many communities Head Start and school-based pre-k programs provide competing early education options for low-income 4-year-olds, leaving policymakers, educators, and parents wondering which pathway best promotes the mix of skills predictive of success in elementary school. Only one study-conducted prior to significant recent demographic and policy changes affecting early education and focused exclusively on cognitive outcomes-has addressed this question. We extend that work with contemporary data on 362 low-income children to assess the relative advantages for both kindergarten cognitive and self-regulatory skills of 2 years of Head Start before kindergarten versus transitioning from Head Start to school-based pre-k at age 4. The child sample was evenly split by gender and diverse in race/ethnicity (50% Hispanic/Latinx; 36% Black; 7% White). Results showed that children who transitioned after 1 year of Head Start to school-based pre-k at age 4 showed marginally higher kindergarten literacy (d = .13) and significantly greater math (d = .18) skills than children who remained in Head Start for a second year, but there were no significant differences in kindergarten self-regulatory skills. Implications for contemporary, pressing policy issues are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Food Waste, Preference, and Cost: Perceived Barriers and Self-Reported Food Service Best Practices in Family Child Care Homes.

Background: Family Child Care Homes (FCCHs) are a setting where providers care for children at their own residence. FCCHs face unique challenges and children may not always receive optimal nutrition and have higher risk of obesity compared to other programs. The objective of this study was to determine differences in food service best practices scores between FCCHs who did/did not perceive barriers to serving healthy meals. Methods: FCCHs (n = 167) self-reported demographics, and perceived barriers to serving healthy foods. Nutrition and Physical Activity Self-Assessment for Child Care was used to assess food served with 1 (indicating poor practice) to 4 (indicating best practice). Means, standard deviations, and t-tests were conducted to determine differences in scores between FCCHs with and without perceived barriers. Adjusted alpha was 0.013. Results: FCCHs perceiving food waste as a barrier had significantly lower scores for total food and beverage (p = 0.006, 3.2 ± 0.3 vs. 3.4 ± 0.3); fruits and vegetables (p = 0.003, 3.1 ± 0.5 vs. 3.3 ± 0.5), whole fruits (p = 0.048, 3.1 ± 1.2 vs. 3.4 ± 0.9), and nonstarchy vegetables (p = 0.007, 2.8 ± 0.9 vs. 3.2 ± 0.9). Providers perceiving food preferences as a barrier had significantly lower scores compared to those who did not (p = 0.008, 2.9 ± 0.9 vs. 3.3 ± 0.9). No significant differences found in best practices among providers with vs. without perceived barrier of food costs. Conclusion: Food waste is an understudied barrier in FCCHs to serve healthy meals. Research is needed to explore these perceived barriers in FCCHs to improve best practices around meals.

Both sides of the screen: Predictors of parents' and teachers' depression and food insecurity during COVID-19-related distance learning.

The COVID-19 pandemic has placed unprecedented strains on both parents and teachers, both of whose mental and financial hardships have serious implications for young children's wellbeing. We drew on an existing cohort study of families with low incomes in Tulsa, OK when children were in their Spring of first grade in 2020. We surveyed parents and teachers - children's caregivers on both sides of the screen during distance learning - before and after the COVID-19 pandemic hit and schools were closed. We first compared the proportion of parents and teachers who were depressed and food-insecure before and after the pandemic struck. We then used pre-pandemic characteristics of parents and teachers in separate models to predict their depression and food insecurity during the pandemic. Results showed that rates of depression among both parents and teachers spiked after COVID-19, and food insecurity rates also increased among parents. For both parents and teachers, the strongest predictor of depression during COVID-19 was having experienced depression before the pandemic. Similarly, the strongest predictor of food insecurity during COVID-19 was having experienced food insecurity beforehand. These results point intervention efforts towards identifying the caregivers of children in low-income contexts whose mental and financial wellbeing are likely to be most compromised during this and perhaps future disasters.

Associations between Community Built Environments with Early Care and Education Classroom Physical Activity Practices and Barriers.

The influence of community-built environments on physical activity (PA) support in Early Childhood Education settings (ECEs) is unknown. The purpose of this cross-sectional study was to determine associations between community PA environments and ECE classroom PA practices. We included licensed Oklahoma ECE directors serving 3-to-5-year-old children. Parks and playground locations were exported from Google Earth. National Walkability Index was derived from 2010 US Census data. ArcMap 10.6 was used to geocode ECE locations, which were within an Activity Desert if no parks/playgrounds were located within a 1-mile radius or if Walkability Index was 10.5 or below. Classroom PA practices were determined by using the Nutrition and PA Self-Assessment tool (NAP SACC). Barriers to implementing practices were reported. Most Head Starts (n = 41; 80.3%), center-based childcare settings (CBC; n = 135; 87.0%), and family childcare homes (FCCHs; n = 153; 96.4%) were in an Activity Desert. Parks/playgrounds within a 10-mile buffer were correlated with classroom PA practices in FCCHs only (p < 0.001). Activity Desert status was not related to classroom PA practices for any ECE context (p > 0.029). While FCCHs may be the most vulnerable to lack of park and playground access, overall findings suggest ECEs provide a healthful micro-environment protective of the typical influence of community-built environments.

Caregiver-infant and toddler interactions during diapering: Caregiver responsiveness and child well-being and involvement.

The findings of this empirical research provide new information about the importance of caregiver interactions during care routines, specifically diaper changing, in supporting infant and toddler involvement and well-being. This correlational study involved observations of 144 separate diapering cycles by 31 caregivers with 74 infants and toddlers in 30 infant and toddler classrooms in a U.S. Midwest city. Based on these observations, caregiver responsiveness was found to be significantly related to both child involvement and child well-being. Another feature of caregivers' behavior, caregiver encouragement, was significantly associated with child well-being, but not child involvement. The study results suggest that caregivers' behaviors, specifically responsiveness and encouragement, during diapering are vital proximal processes in the moment-to-moment interactions between a caregiver and child. Thus, responsiveness and encouragement in care routines should be emphasized in infant care settings and be a focus for caregiver professional development, including pre- and in-service training. Although training related to diapering is often restricted to health concerns, the findings suggest that specific caregiver-child interactions during this care routine may support or hinder children's well-being and involvement in the moment. Caregiver responsiveness to children's cues in this context may enhance children's opportunities to practice involvement in bidirectional relationships and support children's well-being.

Los resultados de esta investigación empírica aportan información acerca de la importancia de las interacciones del cuidador durante las rutinas de prestar el cuidado, específicamente el cambio de los pañales, en cuanto a apoyar la participación y el bienestar del infante y el niño pequeñito. Este estudio correlativo incluyó las observaciones de 144 ciclos separados de cambios de pañales por parte de 31 cuidadores con 74 infantes y niños pequeñitos en 30 salas para infantes y niños pequeñitos en una ciudad del medio oeste de los Estados Unidos. Con base en estas observaciones, se encontró que la sensibilidad del cuidador estaba significativamente relacionada con la participación y el bienestar del niño. Otra característica del comportamiento del cuidador, la motivación del cuidador, se asoció significativamente con el bienestar del niño, pero no con la participación del niño. Los resultados del estudio sugieren que los comportamientos de los cuidadores, específicamente la sensibilidad y la motivación, durante el cambio de pañales son procesos vitales proximales en las interacciones de momento a momento entre un cuidador y el niño. Por tanto, la sensibilidad y la motivación en las rutinas de prestar cuidado deben enfatizarse en escenarios de cuidados a infantes y deben ser el enfoque para el desarrollo profesional del cuidador, incluyendo el entrenamiento previo y durante el servicio. Mientras que el entrenamiento relacionado con el cambio de pañales es a menudo restringido a las preocupaciones de salud, los resultados sugieren que interacciones específicas entre cuidador y niño durante la rutina de este cuidado pudieran apoyar o impedir el bienestar y la participación del niño en este momento. La sensibilidad del cuidador a las señales del niño en este contexto pudiera mejorar las oportunidades del niño para practicar la participación en relaciones bidireccionales y apoyar el bienestar de los niños.

Les résultats de ces recherches empiriques offrent de nouvelles données sur l'important des interactions de la personne prenant soin de l'enfant durant les routines de soin, plus particulièrement le changement de couche, dans le soutien à l'implication et au bien-être du nourrisson et du petit enfant. Cette étude corrélationnelle a compris des observations de 144 cycles de changement de couche séparés, faits par 31 personnes prenant soin de 74 nourrissons et petits enfants dans 30 crèches dans une ville américaine du centre-nord des Etats-Unis. Basé sur ces observations on a établi que la réaction des personnes prenant soin des enfants était liée de manière importante à l'implication de l'enfant et au bien-être de l'enfant. Un autre trait du comportement des personnes prenant soin de l'enfant, leurs encouragements, était lié de manière important au bien-être de l'enfant, mais pas à l'implication de l'enfant. Les résultats de l'étude suggèrent que les comportements des personnes prenant soin de l'enfant, plus spécifiquement la réaction et l'encouragement, durant le changement de couche sont des processus de proximité essentiels dans les interactions moment-à-moment entre la personne prenant soin de l'enfant et l'enfant. Donc la réaction et l'encouragement dans les routines de soin devraient être soulignés dans les contextes de soin au nourrisson et leur nécessitée accentuée dans la formation professionnelle des personnes prenant soin d'enfant, y compris durant la formation pré-emploi et la formation continue. Bien que la formation au changement de couches soit souvent confinée aux préoccupations en matière de santé les résultats suggèrent que les interactions spécifiques personne prenant soin de l'enfant-enfant durant cette routine de soin peut soutenir ou entraver le bien-être et l'implication des enfants dans le moment. La réaction des personnes prenant soin de l'enfant aux signaux des enfants dans ce contexte peut accroître les opportunités qu'ont les enfants de s'impliquer dans des relations bidirectionnelles et soutenir le bien-être des enfants.

The Educare intervention: Outcomes at age 3.

The effectiveness of Educare, a center-based early education program, in improving child outcomes at age 3 was evaluated in a randomized clinical trial. Educare programs serve children from birth to age 5 and are designed to reduce the achievement gap between children from low-income families and their more advantaged peers. This study began following 239 children from low-income families who were randomly assigned as infants (<19 months) to Educare or a business-as-usual control group. At age 3, assessments of the skills of 202 children remaining in the study revealed significant differences in favor of children in the treatment group on auditory language skills, early math skills, and parent-reported problem behaviors. Effect sizes were in the modest range, although not as strong as the previously reported age 2 findings. No effects were found for observations of parent-child interactions, observer-rated child behaviors, or parent-rated social competence. For English-language skills, children who were dual language learners (DLLs) benefitted more from treatment than non-DLLs. Analyses of outcomes by child care type, regardless of treatment group assignment, showed that children in Educare had better language, math, and behavioral scores than children in less formal care, whereas children in other center-based care only had higher language scores than children in less formal care. Differences in outcomes between Educare and other center-based care were not significant.

Early Care and Education Teacher's Role in Obesity Prevention and Healthy Development of Young American Indian Children.

INTRODUCTION: The purpose of this study was to develop an understanding of how stakeholders, specifically early care and education (ECE) teachers, perceive their role in the development of young American Indian children, and envision working with health care providers and parents in order to enhance children's health. METHODOLOGY: Twenty tribally affiliated ECE teachers from Oklahoma participated in interviews. Thematic analysis was conducted, and three main themes, each with two to three subthemes, emerged. RESULTS: Teachers felt that nutrition and physical activity were important to children's health. Teachers had little professional interaction with health care providers but desired more. Parental empowerment was conveyed as essential to actualize positive changes in their child's behavior. DISCUSSION: Teachers of tribally affiliated ECE centers are important stakeholders in promoting the health and well-being of young American Indian children. Additional efforts are needed to more effectively integrate teachers and nurses in order to create effective interventions. We propose a stakeholder partnership to guide the development of future interventions.

Health Care Provider's Role in Obesity Prevention and Healthy Development of Young American Indian Children.

INTRODUCTION: Health care providers (HCPs) serving American Indian (AI) populations are critical stakeholders in promoting healthy weight-related behaviors of young AI children. The purpose of this study is to develop an understanding of how HCP perceive their role in the healthy development of young AI children, and how they envision working with early care and education teachers and parents to enhance children's health. METHOD: Twenty HCP that serve young AI children in Oklahoma participated in individual interviews. Thematic analysis was conducted on coded transcripts and three main themes, each with two to four subthemes were identified. RESULTS: HCP had limited contact with teachers, felt family health was equal or more important than child health, and parental empowerment and gradual change was essential for success. CONCLUSION: Creating ways to involve HCP, early care and education teachers, and parents together in multilevel and multisector interventions has the potential to improve the health of young AI children.

Peer effects on low-income children's learning and development.

Using data from a large study of 78 high-quality Head Start classrooms in 12 sites across the U.S., this study examined whether peers' receptive vocabulary skills and teacher-reported social-emotional (S-E) functioning (i.e., behavior problems and self-regulation) measured at the beginning of the preschool year were related to children's gains in these three domains over a school year. Analyses included over 75% of the children in each classroom and produced three noteworthy findings. First, children in classrooms where average peers had higher behavior problems demonstrated increased teacher-reported behavior problems themselves at the end of the year. Second, children in classrooms where average peers had higher self-regulation skills demonstrated larger gains in teacher-reported self-regulation skills at the end of the school year. Third, peers' higher baseline self-regulation skills were found to be associated with children's higher self-regulation in spring, especially when children began the school year with higher levels of self-regulation. This finding indicates that children who have higher baseline self-regulation may be better positioned to benefit from their peers' high self-regulation in developing their own self-regulation skills. In contrast, no evidence was found that peers' baseline receptive vocabulary skills were related to children's receptive vocabulary gains over a school year. Additionally, no significant cross-domain peer effects were found between peers' baseline S-E functioning and children's receptive vocabulary gains nor peers' baseline receptive vocabulary skills and children's S-E development over a school year. Implications of these findings for classroom practice and further research are discussed.

Staff Food-Related Behaviors and Children's Tastes of Food Groups during Lunch at Child Care in Oklahoma.

BACKGROUND: Young children should consume a variety of nutrient-dense foods to support growth, while limiting added fat and sugar. A majority of children between the ages of 3 and 5 years attend child care in the United States, which makes this environment and the child-care staff influential at meals. OBJECTIVE: The aim was to determine the association between best-practice food-related behaviors and young children's tastes of fruit, vegetable, low-fat dairy, and high-fat/high-sugar foods at child care. DESIGN: This was a cross-sectional study. PARTICIPANTS: A community-based study with 201 children ages 3 to 5 years from 25 early care and education centers, including 11 tribally affiliated centers and two Head Start programs across Oklahoma. Data collection occurred from fall 2011 to spring 2014. MAIN OUTCOME MEASURES: Classroom observations used the Environmental Policy Assessment Observation tool to measure the staff behaviors and environment. Staff behavior was compared at three different levels: the composite score of staff nutrition behavior, each constituent staff behavior, and staff behaviors grouped into broader feeding behaviors. Tasted food was measured through the Dietary Observation in Child Care method. The children's meals were categorized into the following food groups: fruit, vegetable, low-fat dairy, fried vegetable, fried meat, high-fat meat, and high-fat/high-sugar food. STATISTICAL ANALYSIS PERFORMED: Descriptive statistics were calculated for relevant variables. Relationships between the constituent staff behaviors and food groups that children tasted were compared using multilevel mixed-model analysis. RESULTS: The mean number of tasted fruit or vegetable items was higher and the mean number of tasted high-fat/high-sugar food items was lower when staff: 1) determined fullness before plate removal when less than half of food was eaten, 2) ate with the children, 3) and talked about healthy food. CONCLUSIONS: The utilization of the three staff behaviors and their association with higher mean tastes of nutrient-dense items and lower mean tastes of high-fat/high-sugar food items among exposed children demonstrated support for the use of the best practices in early care and education centers.

Child and Parenting Outcomes After 1 Year of Educare.

Educare is a birth to age 5 early education program designed to reduce the achievement gap between children from low-income families and their more economically advantaged peers through high-quality center-based programming and strong school-family partnerships. This study randomly assigned 239 children (< 19 months) from low-income families to Educare or a business-as-usual control group. Assessments tracked children 1 year after randomization. Results revealed significant differences favoring treatment group children on auditory and expressive language skills, parent-reported problem behaviors, and positive parent-child interactions. Effect sizes were in the modest to medium range. No effects were evident for observer-rated child behaviors or parent-rated social competence. The overall results add to the evidence that intervening early can set low-income children on more positive developmental courses.

Tribally Affiliated Child-Care Center Environment and Obesogenic Behaviors in Young Children.

BACKGROUND: Child-care centers are an integral part of life for many families with young children. American Indian children are at elevated health risk because of higher levels of obesity and associated health behaviors. OBJECTIVE: Our aim was to assess the child-care environment and children's physical activity (PA) and dietary intake in young children attending tribally affiliated child care. DESIGN: We conducted a cross-sectional study. PARTICIPANTS/SETTING: Participants were from 11 tribally affiliated child-care centers across Oklahoma and included 82 children aged 3 to 5 years old. MAIN OUTCOME MEASURES: Classroom observations were conducted using the Environmental and Policy Assessment Observation to measure PA and nutrition environments. Children wore an ActiGraph GT3X accelerometer and lunchtime plate waste was observed. STATISTICAL ANALYSES: Descriptive statistics, including mean±standard deviation and frequencies, were calculated for the children's behaviors and environment. RESULTS: The total environment score was 23.9±5.2 (maximum=43). The nutrition score was 12.5±3.1 (maximum=21). The PA score was 11.7±2.2 (maximum=22). The participants were 3.8±0.1 years old, 55% were male, 67% were American Indian, and 38% were overweight or obese. Accelerometers were worn for 5.9±1.7 hours, excluding naptime. Children accumulated 4.3±2.2 min/h of moderate to vigorous PA, 4,294±1,883 steps/day, and 12.1±3.7 steps/min. At lunch, children were served 510±241 kcal, and consumed 387±239 kcal. Lunches consisted of 47% carbohydrate, 20% protein, and 33% fat. Total number of F/V served was 2.9±1.9 and consumed was 2.3±1.8, while whole grains served and consumed were 0.3±0.4 and 0.2±0.4, respectively, and lean proteins served and consumed were 0.3±0.4 and 0.2±0.4, respectively. CONCLUSIONS: This study describes obesogenic aspects of the child-care environment and identifies areas for improvement. Children did not accumulate adequate PA or consume calories or fat excessively. Children consumed multiple F/V; however, more whole grains and lean proteins could be provided. Future research might investigate how the healthfulness of the child-care environment can be improved by counseling providers on nutrition and PA strategies to prevent obesity.

Obesogenic environments in tribally-affiliated childcare centers and corresponding obesity rates in preschool children.

BACKGROUND: Determine the relationship between obesogenic characteristics of childcare and child adiposity in tribally-affiliated centers in Oklahoma. METHODS: The two-day Environment and Policy Assessment and Observation (EPAO) included a total environment (TE), nutrition (N), and physical activity (PA) score and took place in 11 centers across Oklahoma. Eighty-two preschool children (3-5 years) participated. Child height and weight were measured and overweight status (≥ 85th percentile for age and sex) was determined. Regression models, fit using Generalized Estimating Equations methodology to account for clustering by center were used and adjusted for center characteristics. RESULTS: Participants were 3.8 (0.8) years old, 55% male, 67% American Indian (AI) and 38% overweight. A healthier TE and PA was associated with a reduced odds of overweight, which remained significant after adjusting for some center characteristics, but not all. A healthier TE, N, and PA was associated with lower BMI percentile, which remained significant after some center-level adjustments, but not all. Lower sedentary opportunity and sedentary time were no longer associated with reduced odds of overweight following adjustment. Lower opportunity for high sugar and high fat foods and minutes of active play were associated with reduced odds of overweight in some adjusted models. CONCLUSIONS: Collectively unadjusted and adjusted models demonstrate that some aspects of a healthier childcare center environment are associated with reduced odds of overweight and lower BMI percentile in preschool children attending tribally-affiliated childcare in Oklahoma. Future research should examine the association of childcare and health behaviors and further explore the role of potential confounders.

Macronutrient and micronutrient intakes of children in Oklahoma child-care centres, USA.

OBJECTIVE: To determine macronutrients and micronutrients in foods served to and consumed by children at child-care centres in Oklahoma, USA and compare them with Dietary Reference Intakes (DRI). DESIGN: Observed lunch nutrients compared with one-third of the age-based DRI (for 1-3 years-olds and 4-8-year-olds). Settings Oklahoma child-care centres (n 25), USA. SUBJECTS: Children aged 3-5 years (n 415). RESULTS: Regarding macronutrients, children were served 1782 (sd 686) kJ (426 (sd 164) kcal), 22·0 (sd 9·0) g protein, 51·5 (sd 20·4) g carbohydrate and 30·7 (sd 8·7) % total fat; they consumed 1305 (sd 669) kJ (312 (sd 160 kcal), 16·0 (sd 9·1) g protein, 37·6 (sd 18·5) g carbohydrate and 28·9 (sd 10·6) % total fat. For both age-based DRI: served energy (22-33 % of children), protein and carbohydrate exceeded; consumed energy (7-13 % of children) and protein exceeded, while carbohydrate was inadequate. Regarding micronutrients, for both age-based DRI: served Mg (65·9 (sd 24·7) mg), Zn (3·8 (sd 11·8) mg), vitamin A (249·9 (sd 228·3) µg) and folate (71·9 (sd 40·1) µg) exceeded; vitamin E (1·4 (sd 2·1) mg) was inadequate; served Fe (2·8 (sd 1·8) mg) exceeded only in 1-3-year-olds. Consumed folate (48·3 (sd 38·4) µg) met; Ca (259·4 (sd 146·2) mg) and Zn (2·3 (sd 3·0) mg) exceeded for 1-3-year-olds, but were inadequate for 4-8-year-olds. For both age-based DRI: consumed Fe (1·9 (sd 1·2) mg) and vitamin E (1·0 (sd 1·7) mg) were inadequate; Mg (47·2 (sd 21·8) mg) and vitamin A (155·0 (sd 126·5) µg) exceeded. CONCLUSIONS: Lunch at child-care centres was twice the age-based DRI for consumed protein, while energy and carbohydrate were inadequate. Areas of improvement for micronutrients pertain to Fe and vitamin E for all children; Ca, Zn, vitamin E and folate for older pre-schoolers. Adequate nutrients are essential for development and the study reveals where public health nutrition experts, policy makers and care providers should focus to improve the nutrient density of foods.

What's for lunch? An analysis of lunch menus in 83 urban and rural Oklahoma child-care centers providing all-day care to preschool children.

BACKGROUND: More than half of 3- to 6-year-old children attend child-care centers. Dietary intakes of children attending child-care centers tend to fall short of Dietary Reference Intakes (DRIs). OBJECTIVE: Our aim was to examine macro-/micronutrient content of child-care center menus, compare menus to one third of DRIs, and determine menu differences by population density. METHODS: A stratified, random, geographically proportionate sample of Oklahoma child-care centers was obtained. Child-care centers providing all-day care for 2- to 5-year-old children were contacted to complete a telephone questionnaire and asked to send in that month's menus for the 3- to 4-year-old children. Overall means and standard deviations of the nutrient content of 5 days of lunch menus were calculated. Comparisons were made to both the 1- to 3-year-old and 4- to 8-year-old DRIs. One-sample t tests compared mean nutrient content of lunches to one third of the DRIs for the overall sample and urban/rural classification. Independent t tests compared nutrient content of urban and rural lunches. PARTICIPANTS/SETTING: One hundred sixty-seven child-care centers were contacted; 83 completed the study (50% response). RESULTS: Menus provided statistically significantly insufficient carbohydrate, dietary fiber, iron, vitamin D, and vitamin E. Calcium was higher than the 1- to 3-year-old DRI, but lower than the 4- to 8-year-old DRI. Folate was higher than the 1- to 3-year-old DRI, but not different from the 4- to 8-year-old DRI. Sodium was higher than the DRI for both age groups. Thirty-four child-care centers (41%) were classified as urban and 49 (59%) as rural. Urban menus provided less than the 4- to 8-year-old DRI for folate, but rural child-care center menus did not. CONCLUSIONS: Oklahoma child-care center menus appear to provide adequate protein, magnesium, zinc, vitamin A, and vitamin C, but may be deficient in key nutrients required for good health and proper development in preschool-aged children. These issues can be addressed by including food and nutrition practitioners in the process to ensure child-care center menus are a useful resource and nutritionally appropriate for preschool children.