Screen Time Parenting Practices and Associations with Preschool Children's TV Viewing and Weight-Related Outcomes.

The purpose of this study was to examine associations between screen time (ST) parenting practices and 2-5-year-old children's TV viewing and weight status. Data were collected from 252 parent-child dyads enrolled in a randomized parent-focused childhood obesity prevention trial from 2009-2012. ST parenting practices were assessed at baseline using a validated parent-reported survey. Parent-reported child TV viewing and objectively measured anthropometrics were assessed at baseline, post-intervention (35 weeks), and follow-up (59 weeks). Marginal effect models were developed to test the association between baseline ST parenting practices and children's TV viewing, BMI z-score, and waist circumference across all time points. Limiting/monitoring ST was associated with decreased weekly TV viewing (ß = -1.79, 95% CI: -2.61; -0.95), while exposure to TV was associated with more weekly TV viewing over 59 weeks (ß = 1.23, 95% CI: 0.71; 1.75). Greater parent use of ST as a reward was associated with increased child BMI z-score (ß = 0.15, 95% CI: 0.03; 0.27), while limiting/monitoring ST was associated with decreased BMI z-score (ß = -0.16, 95% CI: -0.30; -0.01) and smaller waist circumference (ß = -0.55, 95% CI: -1.04; -0.06) over the study period. These findings suggest that modifying parent ST practices may be an important strategy to reduce ST and promote healthy weight in young children.

Implementation of a workplace physical activity intervention in child care: process evaluation results from the Care2BWell trial.

Care2BWell was designed to evaluate the efficacy of Healthy Lifestyles (HL), a worksite health promotion intervention to increase child care workers' physical activity. The purpose of this study was to use process evaluation to describe the implementation of HL and determine if different levels of implementation are associated with changes in workers' physical activity. Data were collected from 250 workers randomized to HL, a 6 month, multilevel intervention that included an educational workshop followed by three 8 week campaigns that included self-monitoring and feedback, raffle incentive, social support, and center director coaching. Process evaluation data collection included direct observation, self-reported evaluation surveys, website analytics and user test account data, tracking databases and semi-structured interviews. Implementation scores were calculated for each intervention component and compared at the center and individual levels. Nearly a third of workers never self-monitored and few (16%) met self-monitoring goals. Only 39% of centers engaged with the social support component as intended. Raffle and social support components were perceived as the least useful. Implementation varied widely by center (25%-76%) and individual workers (0%-94%). No within- or between-group differences for high compared to low implementation groups for change in physical activity were evident. Interview themes included limited sustainability, competing priorities, importance of social support, and desire for a more intensive, personalized intervention. Wide variation in implementation may explain limited effects on intervention outcomes. Future worksite interventions designed for child care workers can use these findings to optimize health promotion in this setting.

Fidelity and factors influencing implementation of Healthy Me, Healthy: process evaluation of a social marketing campaign for diet and physical activity behaviors of children in childcare.

The effectiveness of interventions targeting children's eating and physical activity behaviors through childcare settings is inconsistent. To enhance public health impact, it is imperative to evaluate fidelity of implementing complex interventions in real-world settings. This study evaluated fidelity and contextual factors influencing implementation of Healthy Me, Healthy We (HMHW). HMHW was an 8-month social marketing campaign delivered through childcare to support children's healthy eating and physical activity. HMHW required two levels of implementation support (research team and childcare providers) and two levels of campaign delivery (childcare providers and parents). Process evaluation was conducted among childcare centers in the intervention group (n=48) of the cluster-randomized control trial. Measures included attendance logs, self-report surveys, observation checklists, field notes, and semi-structured interviews. A 35-item fidelity index was created to assess fidelity of implementation support and campaign delivery. The fidelity with which HMHW was implemented by childcare providers and parents was low (mean 17.4 out of 35) and decreased between childcare providers and parents. Childcare providers had high acceptability of the program and individual components (80 - 93%). Only half of parents felt intervention components were acceptable. Frequently cited barriers to implementation by childcare providers included time constraints, parent engagement, staff turnover, and restrictive policies. The lack of observable effect of HMHW on children's dietary or physical activity behaviors may be due to inadequate implementation at multiple levels. Different or additional strategies are necessary to support implementation of multilevel interventions, particularly when individuals are expected to deliver intervention components and support others in doing so.

Evaluating a child care-based social marketing approach for improving children's diet and physical activity: results from the Healthy Me, Healthy We cluster-randomized controlled trial.

Child care-based interventions offer an opportunity to reach children at a young and impressionable age to support healthy eating and physical activity behaviors. Ideally, these interventions engage caregivers, including both childcare providers and parents, in united effort. This study evaluated the impact of the Healthy Me, Healthy We intervention on children's diet quality and physical activity. A sample of 853 three- to four-year-old children from 92 childcare centers were enrolled in this cluster-randomized control trial. Healthy Me, Healthy We was an 8-month, social marketing intervention delivered through childcare that encouraged caregivers (childcare providers and parents) to use practices that supported children's healthy eating and physical activity behaviors. Outcome measures, collected at baseline and post-intervention, assessed children's diet quality, physical activity, and BMI as well as caregivers' feeding and physical activity practices. Generalized Linear Mixed Models were used to assess change from baseline to post-intervention between intervention and control arms. No significant changes were noted in any of the outcome measures except for small improvements in children's sodium intake and select parent practices. Despite the negative findings, this study offers many lessons about the importance and challenges of effective parent engagement which is critical for meaningful changes in children's health behaviors.

A pilot randomised controlled trial of a web-based implementation intervention to increase child intake of fruit and vegetables within childcare centres.

BACKGROUND: As dietary behaviours developed during early childhood are known to track into adulthood, interventions that aim to improve child nutrition at a population level are recommended. Whilst early childhood education and care (ECEC) is a promising setting for interventions targeting children's nutrition behaviours, previous interventions have largely used high intensity, face-to-face approaches, limiting their reach, implementation and potential impact at a population level. Web-based modalities represent a promising means of supporting the delivery of childcare-based interventions whilst overcoming challenges of previous approaches; however, the feasibility of using such modalities to support implementation is largely unknown. As such, this study sought to collect feasibility and pilot data to inform the design of a web-based intervention together with health promotion officer support within childcare centres. Child dietary intake will also be assessed to provide an estimate of the impact of the implementation intervention. METHODS: A superiority cluster randomised controlled trial with repeat cross-sectional data collection employing an effectiveness-implementation type-II hybrid design will be conducted with childcare centres within the Hunter New England region of New South Wales, Australia. Type-II hybrid designs provide the opportunity to assess intervention efficacy whilst piloting the feasibility of the implementation strategies. Centres allocated to the intervention group will receive access to a web-based program together with health promotion officer support to implement targeted healthy eating practices to improve child diet in care. A number of outcomes will be assessed to inform the feasibility to conduct a larger trial, including childcare centre and parent recruitment and consent rates for each component of data collection, uptake of the implementation strategies, acceptability of the intervention and implementation strategies, appropriateness of the implementation strategies and the contextual factors influencing implementation. DISCUSSION: This study will provide high-quality evidence regarding the potential feasibility of a web-based intervention and the impact of healthy eating practices on child diet in care. Web-based modalities provide a promising approach for population-wide implementation support to childcare centres given their potential reach and consistency with existing infrastructure. TRIAL REGISTRATION: Prospectively registered with Australian New Zealand Clinical Trial Registry ( ACTRN12619001158156 ).

Workplace-based opportunities to support child care workers' health and safety.

Child care workers earn among the lowest wages in the United States and they struggle with many health issues. The purpose of this study was to describe workplace supports for nutrition, physical activity, other health behaviors (e.g., smoking cessation, stress management), and occupational health and safety available to child care workers, and thereby inform the development of future workplace-based interventions to improve worker well-being. Between 2015 and 2016, 74 North Carolina child care centers (and directors), participating in a larger randomized controlled trial, completed a Workplace Health and Safety Assessment (interview and observation) measuring four domains: Infrastructure, Organizational Policies and Procedures, Programs and Promotions, and Internal Physical Environment. This study used baseline data to report means and standard deviations. Participating child care centers employed, on average, 12.7 ± 8.4 employees. Total scores from the Workplace Health and Safety Assessment averaged 41.3 ± 12.6 out of a possible 154, demonstrating many missed opportunities for supporting health/safety. More specifically, centers scored on average 9.5 ± 3.9 on Infrastructure (35% of potential points), 11.1 ± 3.9 on Organizational Policies and Procedures (32% of potential), 7.6 ± 5.4 on Programs and Promotions (12% of potential), and 13.1 ± 2.2 on Internal Physical Environment (49% of potential). The most frequent supports available were for occupational health and safety issues, while fewer supports were available for physical activity and other health behaviors. Child care workers could benefit greatly from more comprehensive workplace health and safety interventions; however, strategies must overcome centers' limited capacity and resources.

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

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

Identifying patterns of physical activity and screen time parenting practices and associations with preschool children's physical activity and adiposity.

Although physical activity and screen time parenting practices influence children's behaviors, little work has examined how these practices work in combination. The purpose of this study was to identify patterns of physical activity and screen time parenting practices, and examine differences in preschool children's physical activity, sedentary behavior, and adiposity among the identified patterns. Data were collected in 2009-2012 from 319 parent-child dyads enrolled in a randomized trial testing a parent-focused obesity prevention intervention. At baseline, physical activity and screen time parenting practices were assessed using a validated self-report survey. Children's physical activity and sedentary behavior were measured using accelerometers and child anthropometrics were objectively measured. Latent profile analyses identified patterns of physical activity and screen time parenting practices. Differences in child outcomes were tested among the identified classes. Three parent classes were identified: Rewarders (n = 165), Activity Supportive (n = 98), and Screen Time Permissive (n = 56). Rewarder parents were characterized by the highest scores on using physical activity and screen time to reward or control children's behavior. Activity Supportive parents generally had the highest scores on practices to promote physical activity, while Screen Time Permissive parents had the highest scores on practices facilitating screen time. There were no differences in the mean child physical activity, sedentary behavior or BMI z-score among the three classes. Findings revealed distinct classes of parents that could provide modifiable targets for family-based physical activity promotion, but more work is needed examining the influence of these patterns longitudinally and in different populations.

Keys to healthy family child care homes: Results from a cluster randomized trial.

Early care and education settings, such as family child care homes (FCCHs), are important venues for children's health promotion. Keys to Healthy Family Child Care Homes evaluated a FCCH-based intervention's impact on children's diet and physical activity. This study enrolled 496 children aged 1.5-4 years and 166 FCCH providers into a cluster-randomized control trial (intervention = 242 children/83 FCCHs, control = 254 children/83 FCCHs) conducted during 2013-2016. The 9-month intervention addressed provider health, health of the FCCH environment, and business practices, and was delivered through three workshops, three home visits, and nine phone calls. The attention control arm received a business-focused intervention. Primary outcomes were children's diet quality (2 days of observed intakes summarized into Healthy Eating Index scores) and moderate to vigorous physical activity (3 days of accelerometry) at the FCCH. Secondary outcomes were child body mass index (BMI), FCCH provider health behaviors, and FCCH nutrition and physical activity environments and business practices. Repeated measures analysis, using an intent-to-treat approach, accounting for clustering of children within FCCHs and adjusting for child age, sex, and BMI, was used to evaluate change (completed in 2018). Compared to controls, intervention children significantly improved their diet quality (5.39, p = .0002, CI = 2.53, 8.26) but not MVPA (0.31, p = .195, CI = -0.16, 0.79). Intervention FCCH providers significantly improved their diet quality and several components of their FCCH environment (i.e., time provided for physical activity, use of supportive physical activity practices, and engagement in nutrition and physical activity education/professional development). FCCHs are malleable settings for health promotion, especially diet quality. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.govNCT01814215.

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

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

Contributions of Early Care and Education Programs to Diet Quality in Children Aged 3 to 4 Years in Central North Carolina.

BACKGROUND: Parents and early care and education (ECE) are the key influencers of young children's diets, but there is limited information about how each contribute to children's overall diet quality. OBJECTIVE: This study aimed to determine what proportion of children's dietary intake occurs within the ECE setting and whether diet quality is higher at ECE centers and, consequently, on weekdays than weekends. DESIGN: This cross-sectional analysis of a larger cluster randomized controlled trial used multiple 24-hour dietary intakes measured through a combination of the Dietary Observation in Child Care protocol and parent-reported food diaries. PARTICIPANTS/SETTING: Participants (N=840) included children aged 3 to 4 years enrolled in ECE centers in central North Carolina for whom 24-hour dietary intake was captured via observation of meals and snacks consumed at ECE and parent-report of all remaining meals and snacks. Data were collected from 2015 to 2016. MAIN OUTCOME MEASURES: Diet quality at ECE and elsewhere was evaluated using the Healthy Eating Index 2015. STATISTICAL ANALYSES PERFORMED: Mixed-effects models were used to determine differences in mean Healthy Eating Index 2015 component and total scores. Models were adjusted for children's age and sex and accounted for clustering within ECE centers and families. RESULTS: Children consumed approximately 40% of daily energy, nutrients, and food groups at ECE centers. The mean total Healthy Eating Index 2015 score was higher for foods and beverages consumed at ECE centers (58.3±0.6) than elsewhere (52.5±0.6) (P<0.0001). The mean total Healthy Eating Index 2015 score was also higher on weekdays (58.5±0.5) than on weekends (51.3±0.5) (P<0.0001). CONCLUSIONS: Children consume a majority of dietary intake away from ECE centers. Overall, diet quality is low, but the quality of foods consumed by children at ECE centers is higher than that consumed elsewhere. ECE centers remain an important source of nutrition and further investigation is warranted to identify ways to support both ECE centers and families to provide healthier eating environments.

The impact of basic vs. enhanced Go NAPSACC on child care centers' healthy eating and physical activity practices: protocol for a type 3 hybrid effectiveness-implementation cluster-randomized trial.

BACKGROUND: To prevent childhood obesity and promote healthy development, health authorities recommend that child care programs use the evidence-based practices that foster healthy eating and physical habits in children. Go NAPSACC is an intervention shown to improve use of these recommended practices, but it is known to encounter barriers that limit its impact and widespread use. METHODS: This study will use a type 3 hybrid effectiveness-implementation cluster-randomized trial to compare effectiveness and implementation outcomes achieved from Go NAPSACC delivered with a basic or enhanced implementation approach. Participants will include approximately 25 coaches from Child Care Aware of Kentucky (serving four geographic regions), 97 child care centers with a director and teacher from each and two cross-sectional samples of 485 3-4-year-old children (one recruitment at baseline, another at follow-up). Coaches will be randomly assigned to deliver Go NAPSACC using either the basic or enhanced implementation approach. "Basic Go NAPSACC" represents the traditional way of delivering Go NAPSACC. "Enhanced Go NAPSACC" incorporates preparatory and support activities before and during their Go NAPSACC work, which are guided by the Quality Implementation Framework and the Consolidated Framework for Implementation Research. Data will be collected primarily at baseline and post-intervention, with select measures continuing through 6, 12, and 24 months post-intervention. Guided largely by RE-AIM, outcomes will assess change in centers' use of evidence-based nutrition and physical activity practices (primary, measured via observation); centers' adoption, implementation, and maintenance of the Go NAPSACC program (assessed via website use); center directors', teachers', and coaches' perceptions of contextual factors (assessed via self-report surveys); children's eating and physical activity behaviors at child care (measured via observation and accelerometers); and cost-effectiveness (assessed via logs and expense tracking). The hypotheses anticipate that "Enhanced Go NAPSACC" will have greater effects than "Basic Go NAPSACC." DISCUSSION: This study incorporates many lessons gleaned from the growing implementation science field, but also offers opportunities to address the field's research priorities, including applying a systematic method to tailor implementation strategies, examining the processes and mechanisms through which implementation strategies produce their effects, and conducting an economic evaluation of implementation strategies. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03938103, Registered April 8, 2019.

Multi-Level Opportunities to Improve Nutrition in Child Care Settings.

Early care and education (ECE) programs can have a positive influence on children's nutrition by ensuring that they eat a healthful diet and develop a positive relationship with food during the early years, from birth to age 5 years. Dietary habits take root early in life, carry into adolescence and adulthood, and affect immediate and long-term disease risk, including cardiovascular disease and obesity. In the United States and most other countries, ECE programs serve large numbers of children, providing care for most of children's waking hours as well as 50-75% of daily calories. Nutrition education, defined broadly as education, environmental supports, and policy, can be highly influential on children's nutrition. The "4-Ps" is a useful mnemonic when describing the multiple opportunities within ECE programs to address child nutrition, referring to provisions, practices, planned education and outreach, and policy. ECE administrators and teachers need assistance and support to improve nutrition education within their programs. An effective strategy for achieving such improvements is Go NAPSACC, an on-line suite of tools that guides ECE programs through a system for continuous quality improvement. It is critical that nutrition experts and policy makers assume a leadership role in helping ECE programs and the children and families they serve.

Modifying the Environment and Policy Assessment and Observation (EPAO) to better capture feeding practices of family childcare home providers.

OBJECTIVE: To describe the modification and validation of an existing instrument, the Environment and Policy Assessment and Observation (EPAO), to better capture provider feeding practices. DESIGN: Modifications to the EPAO were made, validity assessed through expert review, pilot tested and then used to collect follow-up data during a two-day home visit from an ongoing cluster-randomized trial. Exploratory factor analysis investigated the underlying factor structure of the feeding practices. To test predictive validity of the factors, multilevel mixed models examined associations between factors and child's diet quality as captured by the Healthy Eating Index-2010 (HEI-2010) score (measured via the Dietary Observation in Childcare Protocol). SETTING: Family childcare homes (FCCH) in Rhode Island and North Carolina, USA.ParticipantsThe modified EPAO was pilot tested with fifty-three FCCH and then used to collect data in 133 FCCH. RESULTS: The final three-factor solution ('coercive control and indulgent feeding practices', 'autonomy support practices', 'negative role modelling') captured 43 % of total variance. In multilevel mixed models adjusted for covariates, 'autonomy support practices' was positively associated with children's diet quality. A 1-unit increase in the use of 'autonomy support practices' was associated with a 9·4-unit increase in child HEI-2010 score (P=0·001). CONCLUSIONS: Similar to the parenting literature, constructs which describe coercive controlling practices and those which describe autonomy-supportive practices emerged. Given that diets of pre-schoolers in the USA remain suboptimal, teaching childcare providers about supportive feeding practices may help improve children's diet quality.

Using a social marketing approach to develop Healthy Me, Healthy We: a nutrition and physical activity intervention in early care and education.

Although social marketing principles have been successfully employed in school-based interventions to prevent obesity, use in early care and education (ECE) settings has been limited. This paper describes the use of the social marketing approach to develop an ECE-based intervention that encourages an ECE provider-parent partnership to improve the quality of preschool children's diets and their level of physical activity. A six-step social marketing approach for public health interventions guided the development of this ECE-based intervention. These steps were as follows: (i) initial planning, (ii) formative research, (iii) strategy development, (iv) program development, (v) implementation, and (vi) monitoring and evaluation. During this process, we reviewed current literature, conducted focus groups with ECE providers and parents, developed a detailed conceptual model and content map, created and tested the campaign concept, and developed final campaign materials along with strategies for its implementation. The final intervention resulting from this process was an 8-month campaign known as Healthy Me, Healthy We. The campaign is delivered by the child care center and includes branded materials for use in the classroom and at home. The final campaign is being evaluated in a cluster-randomized trial. Healthy Me, Healthy We offers an innovative approach to promoting healthy eating and physical activity during early childhood, a key developmental period, that leverages partnership between ECE providers and parents to affect behavior change.

HomeSTEAD's physical activity and screen media practices and beliefs survey: Instrument development and integrated conceptual model.

The home environment has a significant influence on children's physical activity and obesity risk. Our understanding of this environment is limited by current measurement tools. The Home Self-administered Tool for Environmental assessment of Activity and Diet addresses this gap. This paper describes the development and psychometric testing of its family physical activity and screen media practices and beliefs survey. METHODS: Survey development was guided by the Analysis Grid for Environments Linked to Obesity (ANGELO) framework and informed by a literature review, expert opinion, and cognitive interviews. Parents of children ages 3-12 years (n = 129) completed the HomeSTEAD survey three times over 12-18 days. Additionally, parents reported on child behaviors and trained staff measured parent and child height and weight. Five exploratory factor analyses were conducted after categorizing items into: control of physical activity, control of screen media, explicit modeling, implicit modeling, and perceived barriers and facilitators. Scales with 3 or more items underwent scale reduction. Psychometric testing evaluated internal consistency (Chronbach's alphas), test-retest reliability (analysis of variance and intraclass correlations (ICC)), and construct validity (correlations with child BMI, physical activity, screen time). An integrated conceptual model of parent physical activity and screen media practices and beliefs was developed based on recent literature to aid in the identification and naming of constructs. RESULTS: Final scales demonstrated good internal consistency (median Cronbach's alpha = 0.81, IQR = 0.74-0.85), test-retest reliability (median ICC = 0.70, IQR = 0.66-0.78), and construct validity (with correlations between scale score and children's behaviors generally in the expected direction). Comparison with the integrated conceptual model showed that most identified constructs were captured. CONCLUSIONS: The family physical activity and screen media practices survey advances the measurement of the home environment related to children's physical activity, screen time, and weight. The integrated conceptual model provides a useful framework for researchers studying both physical activity and screen media parenting practices.

Nutritional Quality of Meals and Snacks Served and Consumed in Family Child Care.

BACKGROUND: Improving the nutritional quality of food, including beverages, served in early care and education settings should enhance children's diet quality. However, few studies have explored the relationship between what is served and consumed in family child-care homes (FCCHs). OBJECTIVE: To describe the nutritional quality of food served to children in FCCHs and to assess the extent to which children eat what is served. DESIGN: This study was a cross-sectional analysis using baseline data (n=166) from a cluster-randomized controlled trial (2013-2016). PARTICIPANTS/SETTING: Eligible FCCHs in central North Carolina had to have at least two children between 18 months and 4 years, have been in business for at least 2 years, and serve at least one meal and one snack. MAIN OUTCOME MEASURES: Food was captured using the Diet Observation at Child Care protocol. STATISTICAL ANALYSES: Frequencies, means, and multivariate analysis were used to examine the relationship between food served and consumed by food groups and by Healthy Eating Index (HEI-2010). RESULTS: Children consumed between 61% and 80% of what was served, with vegetables having the lowest percent consumed (61.0%). Total HEI-2010 score for food served was 63.6 (10.4) and for food consumed was 61.7 (11.5) out of a 100-point maximum. With regards to food served, FCCH providers came close to meeting HEI-2010 standards for dairy, whole fruit, total fruit, and empty calories. However, providers appeared to fall short when it came to greens and beans, seafood and plant proteins, total vegetables, whole grains, and fatty acids. They also exceeded recommended limits for sodium and refined grains. CONCLUSIONS: Although FCCHs are serving some healthy food, mainly fruit, dairy, and few empty calories, there is room for improvement with regards to vegetables, grains, seafood and plant protein, fatty acids, and sodium. Future trainings should help providers find ways to increase the serving and consumption of these foods.

Physical Activity and Sedentary Behaviors of Children in Family Child Care Homes: Are There Opportunities for Improvement?

PURPOSE: Many children attend family child care homes (FCCHs), an important setting to influence children's physical activity (PA) and sedentary behavior (SB). This study assessed children's PA and SB while in FCCHs, characteristics of the FCCH PA environment, and relationships between the environment and child PA and SB. METHOD: Children ages 1.5-4.0 years (n = 495) were recruited from 165 FCCHs in North Carolina. Children's moderate to vigorous PA and SB were measured via accelerometry for 3 days. FCCH PA environments were assessed over 2 days using the Environment and Policy Assessment and Observation for FCCHs. Ten subscores and an overall PA environment score (possible range: 0-30) were calculated; higher scores indicate better quality. RESULTS: Children accumulated 30 (13) minutes of moderate to vigorous PA and 143 (42) minutes of SB in FCCHs daily. FCCHs scored low on the Environment and Policy Assessment and Observation for FCCHs, with an average overall score of 13 (2). FCCHs scored highest on screen time and screen time practices subscores, and lowest on PA education/professional development and PA policy subscores. Although no statistically significant associations were observed, some large Cohen d effect sizes were noted (eg, outdoor playtime subscore and moderate to vigorous PA). CONCLUSIONS: This study highlights opportunities to improve FCCHs and increase children's behaviors (eg, providing adequate time and outdoor play spaces).

What matters most - what parents model or what parents eat?

PURPOSE: Parents have a strong influence on their children's eating habits; however, researchers struggle to identify which food parenting practices to recommend. This study examined the influence of parents modeling of healthy eating ("parent role modeling") and parents' actual food intake ("parent dietary intake") on child diet quality, and explored whether these practices work together to influence children's diets. METHODS: Baseline data from a larger intervention trial were used for this analysis. The sample included parents of preschool-age children from households with at least one overweight parent. The Comprehensive Feeding Practices Questionnaire was used to assess parent modeling of healthy eating ("healthy modeling"). Three days of dietary recalls were used to collect parents' report of their own intake and their children's intake (excluding food at child care). Associations between parent healthy modeling and parent intake of healthy and unhealthy foods were explored using Pearson correlations. Associations between parent healthy modeling and parent Healthy Eating Index (HEI) score on child HEI score were examined with linear regression. Additionally, the interaction between parent healthy modeling and HEI score on child HEI score was tested. RESULTS: Parent healthy modeling was significantly correlated with parent intake of healthy foodsLinear regression showed a significant association between parent modeling and child HEI score, even after controlling for parent diet (ß = 3.08, SE = 0.87, p < 0.001). Children whose parents had high parent healthy modeling scores had higher HEI scores (mean = 61.5 ±â€¯10.4) regardless of parent HEI score. We did not find evidence that parent healthy modeling and diet quality interact to influence child diet quality. CONCLUSIONS: Parents' healthy modeling is an important practice in influencing children's diet quality, possibly more so than the quality of parents' diets.

The family child care home environment and children's diet quality.

BACKGROUND: Developing healthy eating behaviors and food preferences in early childhood may help establish future healthy diets. Large numbers of children spend time in child care, but little research has assessed the nutritional quality of meals and snacks in family child care homes. Therefore, it is important to assess foods and beverages provided, policies related to nutrition and feeding children, and interactions between providers and children during mealtimes. We examined associations between the nutrition environments of family child care homes and children's diet quality. METHODS: We assessed the nutrition environments of 166 family child care homes using the Environment and Policy Assessment and Observation (EPAO) (scores range: 0-21). We also recorded foods and beverages consumed by 496 children in care and calculated healthy eating index (HEI) (scores range: 0-100). We used a mixed effects linear regression model to examine the association between the EPAO nutrition environment (and EPAO sub-scales) and child HEI, controlling for potential confounders. RESULTS: Family child care homes had a mean (standard deviation, SD) of 7.2 (3.6) children in care, 74.1% of providers were black or African American, and children had a mean (SD) age of 35.7 (11.4) months. In adjusted multivariable models, higher EPAO nutrition score was associated with increased child HEI score (1.16; 95% CI: 0.34, 1.98; p = 0.006). Higher scores on EPAO sub-scales for foods provided (8.98; 95% CI: 3.94, 14.01; p = 0.0006), nutrition education (5.37; 95% CI: 0.80, 9.94; p = 0.02), and nutrition policy (2.36; 95% CI: 0.23, 4.49; p = 0.03) were all associated with greater child HEI score. CONCLUSIONS: Foods and beverages served, in addition to nutrition education and nutrition policies in family child care homes, may be promising intervention targets for improving child diet quality.