Understanding rural social networks addressing adverse childhood experiences: A case study of the San Luis Valley.

INTRODUCTION: The purpose of this study is to assess a cross-sector, interorganizational network addressing adverse childhood experiences (ACEs) in a rural Colorado community. We characterize the organizations in the network, assess their awareness of ACEs, and evaluate how they participate in the network. We also assess the network health. METHOD: Employing a social network analysis approach, we collected survey data from 45 organizations that support young children and their families, including nonprofits, health care clinics, and early childhood education centers, among others. RESULTS: On average, nonprofit organizations had relationships with a greater percentage of network members than other types of organizations. Network members engaged in relationships focused on a wide range of activities (e.g., client assessments, sharing information, providing services), with some organizational types leading the network in certain activities. Scores across all dimensions of trust and value were above 3 (range: 2.1-3.8), which is advantageous for a network and network relationships existed across a range of relational intensities (from awareness to organizational integration). DISCUSSION: Nonprofit organizations that reported high levels of connectedness in the network were able to effectively mobilize the ACEs network. Health clinics participated in a greater share of relationships involving assessment, service provision, and tool sharing than other types of organizations. As such, health care clinics may serve as leaders in directly serving children and families experiencing ACEs in rural communities. The rural context may also explain high levels of trust and value, which can serve as assets for future network development and mobilization. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Relationship between Chronic Health Conditions and Occupational Burnout in the Early Care and Education Workforce.

OBJECTIVE: The early care and education (ECE) workforce experiences high rates of poor mental and physical health outcomes which impact staff well-being and burnout. This study aimed to assess the relationship between chronic health conditions and occupational burnout in ECE Head Start staff working in low-resourced locations. METHODS: This study administered an 89-item cross-sectional survey to 332 ECE staff employed in 42 Head Start centers in the United States. Staff self-reported on 10 chronic health conditions: arthritis, asthma, cancer, depression, diabetes, heart disease, high blood pressure, insomnia, lung disease, and musculoskeletal disorders. RESULTS: We found that multimorbidity of chronic conditions significantly predicted overall burnout (B = 2.39, p < .01), particularly related to emotional exhaustion (B = 2.04, p < .01). CONCLUSIONS: Workplace interventions targeting emotional exhaustion related to chronic health conditions are recommended to effectively address occupational burnout among ECE staff.

Investigation of key domains associated with worker well-being and burnout and turnover in the early care and education workforce.

PURPOSE: The early care and education (ECE) workforce provides care for children aged zero to five. This critical segment of the workforce experiences significant burnout and turnover rates resulting from extensive demands, including job stress and poor overall well-being. Factors associated with well-being in these settings and the resulting impacts on burnout and turnover are understudied. The purpose of this study was to investigate associations between five well-being domains and burnout and turnover outcomes among a large sample of Head Start ECE staff in the United States. METHODS: An 89-item survey based off the National Institutes of Occupational Safety and Health Worker Wellbeing Questionnaire (NIOSH WellBQ) was administered to ECE staff employed in five large urban and rural Head Start agencies. The WellBQ is made up of five domains intended to measure worker well-being as a holistic construct. We utilized linear mixed-effect modeling with random intercepts to investigate associations between sociodemographic characteristics, well-being domain sum scores and burnout and turnover. RESULTS: After controlling for sociodemographic variables, the well-being Domain 1 (Work Evaluation and Experience) (ß = - .73, p < .05) and Domain 4 (Health Status) (ß = - .30, p < .05) were significantly and negatively associated with burnout; the well-being Domain 1 (Work Evaluation and Experience) (ß = - .21, p < .01) was significantly and negatively associated with turnover intent. CONCLUSIONS: These findings suggest that multi-level well-being promotion programs could be critical to mitigate ECE teacher stress and address individual-, interpersonal-, and organizational-level predictors of overall ECE workforce well-being.

First Analysis of Nationwide Trends in the Use of the SNAP-Ed Evaluation Framework.

OBJECTIVE: To understand Supplemental Nutrition Assistance Program-Education (SNAP-Ed) Implementing Agencies'(SIAs) use of the SNAP-Ed Evaluation Framework (Framework), which is a tool that includes 51 indicators that SNAP-Ed programs can use to measure the success of their programs in the first 5 years after its release. METHODS: A repeated cross-sectional study design was utilized to administer electronic surveys to between 124 and 154 SIAs who received SNAP-Ed funding in fiscal years 2017, 2019, and 2021. Analyses included descriptive statistics and tests of proportions. RESULTS: Most SIAs indicated that they used the Framework to inform both data collection instruments and program planning decisions and the rates remained relatively constant over the 3 time points (> 80%). The most common specific use of the Framework across all 3 time points was to define, count, or measure the work accomplished, but this statistically decreased from 2017 (76%) to 2021 (57%) (z-score = 3.31; P < 0.001). CONCLUSIONS AND IMPLICATIONS: The results of this analysis confirmed that 5 years after its introduction, uptake and use of the Framework was high and that, as a whole, SIAs focused on priority indicators set by the US Department of Agriculture, with no notable increases in addressing and measuring longer-term, multisector, and population-wide outcomes. The systematic study of the Framework's usability over time has a broader application to other national health promotion initiatives with shared frameworks.

Application of an Implementation Framework Using Mixed Methods in Preschool Settings.

Research Findings. Application of mixed methods in a dissemination and implementation framework can give researchers a better understanding of the reach and delivery of early childhood obesity prevention programs in preschool settings, as well as potential facilitators and barriers related to implementation and sustainability. This study utilized a simultaneous, exploratory, mixed-methods design to investigate individual-, organizational-, and intervention-level factors that were related to the implementation and sustainability of policy, system, and environment (PSE) changes as part of a larger obesity prevention program in a randomly selected sample of preschool centers (n = 20). Individual-level factors, and specifically the attitudes and skills of preschool providers, were identified in both the qualitative and quantitative data as important factors related to the sustainability of PSE changes (r = .56, p < .01). Staff and leadership engagement and adaptability of the program were also identified as important factors related to the implementation and sustainability of PSE changes. Practice or Policy. These findings highlight the complexity of implementation success and suggest PSE obesity prevention interventions in preschool centers require the consideration of numerous, multilevel factors to ensure programming is impactful and sustained over time.

Changes in demands and resources faced by the early childhood education workforce due to COVID-19.

The primary purpose of this study was to investigate the impacts of the COVID-19 pandemic on demands, resources, and job satisfaction among a convenience sample of early childhood education (ECE) staff employed in Head Start preschools in a large metro area of Colorado. A survey was administered to a sample of Head Start staff at two timepoints: Time 1 (pre-COVID-19 pandemic) in October of 2019 (n = 137) and Time 2 (during the COVID-19 pandemic) in November of 2020 (n = 86). The survey consisted of a combination of validated measures to assess personal and external demands and resources and work satisfaction. Workload is a perceived external demand that significantly improved from pre- to mid-pandemic in this sample (z = -3.3, p < 0.01). Many personal and external resources changed pre- to mid-pandemic, though none were statistically significant. Overall job satisfaction in this sample increased, though it was not statistically significant (z = -1.04, p = 0.3). Mitigating demands, such as minimizing workload, and increasing job-related resources, such as bolstering management supports, may lead to improved job satisfaction of the ECE workforce employed in Head Start settings. Although the COVID-19 pandemic has amplified poor mental health and numerous job demands, some of the pandemic-related regulations may have also decreased the workload for some subgroups of the ECE workforce, potentially translating to improved job satisfaction. However, significant disparities remain with respect to personal and external demands among this sample of the ECE workforce compared to the national workforce suggesting multi-level resources and supports are critical to further buffer these stressors.

Rural parents' attitudes and beliefs on the COVID-19 pediatric vaccine: An explanatory study.

The coronavirus disease 2019 (COVID-19) first came to the Unites States in January 2020. Though adult and pediatric vaccines became available to the public, vaccine uptake among youth and particularly younger children has been gradual. This explanatory study aimed to better understand parents' attitudes and beliefs of the pediatric COVID-19 vaccine and the barriers and facilitators to vaccine uptake in a rural community through a brief, online demographic survey, and in-depth qualitative interviews. Forty-one in depth interviews were conducted with parents (31-English and 10-Spanish-speaking) residing in rural and frontier counties in Colorado between September 2021 and February 2022. Six emergent themes related to COVID-19 pediatric vaccine uptake were identified among the population. These themes spanned the three levels of influence in the Social Ecological Model (individual, interpersonal, and community levels). The six themes were identified as such; 1) Vaccine accessibility was associated with pediatric COVID vaccine uptake in rural communities, 2) Previous pediatric vaccine behaviors were not associated with COVID-19 pediatric vaccine uptake, 3) Perceived health status of a child or family member influenced pediatric COVID-19 vaccine uptake, 4) COVID-19 health seeking behaviors, like COVID pediatric vaccine uptake, are influenced by an individual's prosocial or individualistic perspectives, 5) Child autonomy and "age of consent" frames vaccine decision making behaviors in parents, and lastly 6) Social networks impacted COVID-19 pediatric vaccine decision making. These findings inform next steps for COVID-19 pediatric vaccine uptake including targeted and tailored messaging for communities (cues to actions), engaging youth stakeholders, and identifying trusted sources to build rapport and trust between health professionals and community members. The growing vaccine hesitancy among parents has serious implications for disease eradication and future viral outbreaks. Understanding the perceived barriers and facilitators to pediatric vaccine uptake is important to maintain the health of our youth and communities.

Implementation Factors and Teacher Experience of the Integrated Nutrition Education Program: A Mixed Methods Program Evaluation.

BACKGROUND: School-based programs are widely implemented to address childhood obesity. Despite the promise of these programs, evidence on their effectiveness is mixed. Adopting a dissemination and implementation (D&I) science focus utilizing mixed methods can provide a broader understanding and more robust details about these programs. The goal of this evaluation is to understand how implementation factors and teacher experience influence implementation success and outcomes of the Integrated Nutrition Education Program (INEP), an elementary school-based nutrition program, using a mixed-methods design. METHODS: Reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework guided the development of the evaluation and multiple methods were deployed. Hierarchical linear regression was used to assess the association between D&I construct variables within levels of influence and teacher perception of INEP impact from a quantitative end-of-year teacher survey. Follow-up qualitative interviews with teachers were analyzed using constant comparison analysis. RESULTS: Workload and burden emerged as significant factors related to implementation in the quantitative analysis. The follow-up qualitative data collection identified other factors teachers found important to the adoption, implementation, and maintenance of INEP. CONCLUSION: Results of this evaluation can be used to inform program improvement efforts for INEP and provide information on ways to promote reach, effectiveness, adoption, implementation, and maintenance of similar school-based health promotion programs.

Understanding the experience of the implementer: teachers' perspectives on implementing a classroom-based nutrition education program.

School-based programs are widely implemented to combat childhood obesity, but these programs have mixed results. Dissemination and implementation science approaches to evaluation using qualitative methods can provide more robust details about program functioning that may be able to help explain the variation in the impact of these programs. Fourteen in-depth interviews were conducted with classroom teachers implementing a school-based program, the Integrated Nutrition Education Program (INEP), to explore their experience. Factors related to organization, individual and intervention levels emerged as facilitators and barriers to program implementation. Key factors were school culture at the organization level, individual perception and belief in the intervention at the individual level and program content, perceived complexity and adaptability at the intervention level. Socioeconomic status of the community and family involvement were contextual factors identified across all levels. Findings from this qualitative evaluation can be used for the quality improvement of INEP, but beyond this these can also be informative for other school-based programs to promote adoption, implementation and maintenance.

Job Demands and Resources Experienced by the Early Childhood Education Workforce Serving High-Need Populations.

The early childhood education (ECE) workforce plays a key role in promoting early childhood development by their interactions with young children during formative years. However, the inherent demands of the profession and the work conditions within ECE settings affect job satisfaction and overall health and well-being. This study applied the Job Demands-Resources Model (JD-R) and administered a cross-sectional survey (n = 137) to examine disparities in personal and external demands and resources that may impact job satisfaction and turnover rates among ECE staff who provide care for preschool children (3-5 years of age). ECE staff reported higher levels of personal demands, including depression and perceived stress, and external demands, including workload and staffing concerns, compared to the national workforce (all p < .01). The data also illustrated disparities related to resource access; ECE staff reported lower levels of personal resources, including mindfulness, and less access to external resources including safety climate, resource adequacy, role clarity, respect, and management relationships (all p < .01). Only 34% of ECE staff reported being very satisfied with their work compared to 49% of the national workforce (p < .01). External resources were significantly and positively associated with job satisfaction (B = .09, p < .01). These findings suggest that ECE staff experience significantly higher demands and have access to significantly fewer resources in the workplace, and that bolstering job-related resources may translate to increased job satisfaction.

Outcomes of a Multi-Component School-Based Nutrition Program.

BACKGROUND: This paper presents the effectiveness of a multi-component elementary school-based nutrition education program, the Integrated Nutrition Education Program (INEP), which has been in existence for over 25 years. INEP includes components to address multiple layers of influence: hands-on nutrition education lessons in the classroom (student-level), parent education, and outreach (home-level), and facilitation of a planning process to implement policy, system, and environmental (PSE) school changes (school-level). METHODS: Three evaluation tools assessed the effectiveness of the program: (1) classroom plate waste measurement in intervention (N = 149 students) and demographically-matched comparison schools (N = 131 students), (2) pre/post classroom surveys completed by students who participated in INEP (N = 204), and (3) PSE change data from participating schools (N = 47 schools). RESULTS: Students who participated in the nutrition education program were more likely to consume vegetable-based recipes and vegetables included in classroom nutrition lessons compared to students in comparison classrooms (Chinese vegetable salad: p < .001; couscous salad: p < .001; snap peas: p = .001). Classroom survey analyses showed improvements in student self-efficacy (p < .001), preference for vegetables (p = .005), and knowledge (p < .001). In addition, through a wellness planning process, schools implemented an average of 3.7 PSE changes per school. CONCLUSIONS: Results demonstrate a multi-component school-based nutrition education program improves student nutrition-related outcomes.

Prenatal Stress and Early Childhood Body Mass Index: A Path Analysis Approach.

OBJECTIVES: Stress experienced by mothers during the prenatal period can have negative impacts on offspring development. Elevated BMI in childhood in response to early stress experience is a particularly critical outcome of interest since high BMI in childhood is associated with diabetes, heart disease and stroke in later life. The primary objective of this study was to analyze pathways between prenatal stress and early childhood BMI at 54-months of age and to begin to explore ethnic variations in these pathways. METHODS: This study used the Growing Up in New Zealand (GUiNZ) dataset, which is a longitudinal, representative birth cohort study that began with recruiting pregnant women in 2009 and 2010 in Auckland, New Zealand. Path analysis modeling was used to explore risk and protective pathways between prenatal maternal stress and early childhood body mass index (BMI) at 54-months of age and differences by ethnicity (n = 5510). RESULTS: Prenatal stress was positively associated with early childhood BMI at 54-months and maternal nutrition behaviors and length of exclusive breastfeeding mediated this direct relationship (χ2 (1) = 0.83, p = 0.36; AIC = 50,496). Mediation and moderation paths varied by ethnicity. CONCLUSIONS FOR PRACTICE: These findings contribute to the understanding of the intergenerational transmission of stress with respect to early childhood obesity. Reducing early stress exposure and/or addressing mediating and moderating factors linking stress experience with obesity development may prove to be more effective than attempting to alter health behaviors and trajectories in adulthood.

Systematic review of cost-effectiveness analysis of behavior change communication apps: Assessment of key methods.

OBJECTIVE: Evidence backing the effectiveness of mobile health technology is growing, and behavior change communication applications (apps) are fast becoming a useful platform for behavioral health programs. However, data to support the cost-effectiveness of these interventions are limited. Suggestions for overcoming the low output of economic data include addressing the methodological challenges for conducting cost-effectiveness analysis of behavior change app programs. This study is a systematic review of cost-effectiveness analyses of behavior change communication apps and a documentation of the reported challenges for investigating their cost-effectiveness. MATERIALS AND METHODS: Four academic databases: Medline (Ovid), CINAHL, EMBASE and Google Scholar, were searched. Eligibility criteria included original articles that use a cost-effectiveness evaluation method, published between 2008 and 2018, and in the English language. RESULTS: Out of the 60 potentially eligible studies, 6 used cost-effectiveness analysis method and met the inclusion criteria. CONCLUSION: The evidence to support the cost-effectiveness of behavior change communication apps is insufficient, with all studies reporting significant study challenges for estimating program costs and outcomes. The main challenges included limited or lack of cost data, inappropriate cost measures, difficulty with identifying and quantifying app effectiveness, representing app effects as Quality-adjusted Life Years, and aggregating cost and effects into a single quantitative measure like Incremental Cost Effectiveness Ratio. These challenges highlight the need for comprehensive economic evaluation methods that balance app data quality issues with practical concerns. This would likely improve the usefulness of cost-effectiveness data for decisions on adoption, implementation, scalability, sustainability, and the benefits of broader healthcare investments.

The SNAP-Ed Evaluation Framework: Nationwide Uptake and Implications for Nutrition Education Practice, Policy, and Research.

OBJECTIVE: Provide the first baseline census of Supplemental Nutrition Assistance Program Education (SNAP-Ed) state implementing agencies' (SIAs) intent to use and evaluate 51 indicators described in the SNAP-Ed Evaluation Framework. METHODS: A cross-sectional study design was used to administer electronic surveys to 124 SIAs who received SNAP-Ed funding in 2017. Descriptive statistics were used to analyze the results. RESULTS: Of 51 indicators, SIAs reported their intent to impact an average of 19 indicators and evaluate an average of 12. More SIAs reported the intention to impact indicators at the individual (59%) and environmental levels (48%), compared with the sectors of influence (20%) and population levels (30%) of the framework. In addition, more SIAs intended to impact and evaluate short- or medium-term indicators, compared with long-term indicators. CONCLUSIONS AND IMPLICATIONS: These findings illustrate the progress made toward aggregating metrics to measure the collective impact of SNAP-Ed.

Development of a Dissemination and Implementation Framework for an Early Childhood Obesity Prevention Program.

Dissemination and implementation (D&I) science addresses the disconnect between evidence-based research and practical application in community settings. Early childhood education settings are ideal for the application of D&I research because of their widespread use for implementing health promotion interventions. A D&I framework was applied to the Culture of Wellness in Preschools program, a comprehensive early childhood obesity prevention program. The development and application of the Culture of Wellness in Preschools D&I framework can lead to a more comprehensive approach to program evaluation and quality improvement and can contribute more broadly to the body of evidence of nutrition-related health promotion programs.

An exploration of constructs related to dissemination and implementation of an early childhood systems-level intervention.

Obesity and overweight in early childhood have detrimental impacts on children's health and development. Changing policy, system and environmental features focused on physical activity and healthy eating behaviors as part of health promotion interventions can play a key role in prevention strategies in early childhood education settings. These types of changes can have broad reach and are often sustained over time, which allows for impact on children who enter the early childhood education setting year after year. However, there is currently a gap between the generation of evidence for health promotion programs and their application into practice. This study used qualitative methods to evaluate intervention-, organizational- and individual-level factors within a dissemination and implementation framework that may be related to the implementation of a health-promoting intervention in early childhood education settings. Intervention-level factors, including feasibility and adaptability, organizational-level factors, including staff and leadership engagement, and individual-level factors, including attitudes, skills and knowledge, were identified as constructs that impacted the successful implementation of the intervention. These findings provide insight into core dissemination and implementation constructs that should be targeted by obesity prevention interventions in early childhood education settings to ensure maximum impact on sustainable behavior change.

Impact of a nutrition education programme on preschool children's willingness to consume fruits and vegetables.

OBJECTIVE: To evaluate the impact of a preschool-based nutrition education programme consisting of twelve 'hands on' nutrition education lessons delivered during the school year on young children's willingness to consume fruits and vegetables. DESIGN: Quasi-experimental, pre-post design including the collection of plate waste evaluation data at the start and end of the 2015-2016 school year within two groups: (1) randomly selected classrooms receiving the intervention and (2) within conveniently sampled preschool classrooms not receiving the intervention serving as a comparison group. SETTING: Centre-based preschool programmes serving low-income families in the Denver metro area. PARTICIPANTS: Three- to five-year-old children in preschool classrooms participating in the intervention during the 2015-2016 school year (n 308) and children enrolled in comparison classrooms (n 215). RESULTS: Repeated-measures logit models assessed whether increases in the odds of consuming small samples of fruits and vegetables between Time 1 (pre-intervention) and Time 2 (post-intervention) were different for children within the intervention group compared with the comparison group. Analyses showed that the change over time in consumption of the three vegetable samples varied by intervention status with greater change occurring among children within the intervention group (edamame: P = 0·001; cauliflower: P ≤ 0·0001 and red pepper: P ≤ 0·0001). Unlike vegetables, the change over time in consumption of the two fruit samples was not different between children within the intervention and comparison groups. CONCLUSIONS: An experiential-learning nutrition education programme can positively influence eating behaviours of low-income preschoolers in a centre-based setting by increasing willingness to consume vegetables.

Safety and Health Innovation in Preschools: A Total Worker Health Pilot Project.

OBJECTIVE: The primary objective of this study was to evaluate quality of work life in early childhood education (ECE) centers and implement a total worker health (TWH) pilot project with a small sample of ECE teachers. METHODS: An evidence-based strategic planning process to make policy, system, and environmental (PSE) changes related to TWH was implemented with six ECE centers. A pre-post design with mixed-methods was used to evaluate the impact. RESULTS: Baseline findings suggest that there are significant disparities related to quality of work life among ECE teachers compared with the national population. After implementation of the pilot project, ECE centers averaged 4.7 PSE changes. Qualitative data informed facilitators and barriers to implementation of TWH-related changes. CONCLUSIONS: This pilot project reflects an evidence-based participatory approach to assessing and improving the well-being of ECE teachers.

Self-Reported and Diagnosed Depression in Rural Colorado: Findings from the San Luis Valley Community Health Survey.

PURPOSE: To gain a better understanding of depression in a rural community, survey results were used to compare differences in self-reported depressive symptoms and medical professional diagnosed depression among demographic groups. METHODS: A chi-square test of independence was performed to examine relationships among the depression-related variables. Logistic regression analyses were also performed to ascertain the effects of demographic characteristics and social support on depression. FINDINGS: A statistically significant association was found between the two depression-related variables (X2=145.17, P <.001). Income was significantly associated with both depression-related variables. Hispanic ethnicity, higher income, and some high school education were associated with decreased odds of self-reported medically diagnosed depression. Those reporting no or some social support had increased odds of both depression-related variables compared with those who reported always having social support. CONCLUSIONS: These findings provide a better understanding of depression in a rural community and may inform future public health interventions.

Training Child Care Inspectors to Deliver Health Messaging: A Quality Improvement Pilot Project.

Early childhood obesity is at epidemic proportions. Early child care providers have a unique opportunity to instill healthy eating and active living behaviors in children that can foster lifelong health. Academic-community partnerships that involve collaborations between child care centers, local public health departments, and universities provide one avenue to strengthening healthy eating and active living-related knowledge and skills among early child care providers. This quality improvement pilot intervention, titled Healthy Child Care Makes a Healthy Start, is one example of this type of collaboration. This quality improvement pilot project consisted of two complementary intervention components. Inspectors were trained to cofacilitate a strategic planning process with university researchers to help providers implement healthy eating and active living-related policy, system, and environment changes in their child care homes and centers. An average of five changes were implemented in participating child care locations. Inspectors also received training on health-related best practices and delivered 1-minute health messages to child care providers during routine inspection visits. This type of innovative partnership has the potential to leverage a currently existing relationship between child care providers and licensing and regulation inspectors and shift the relationship to include dissemination and implementation of health messaging in child care center and home settings.