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Agurs-Collins T, Alvidrez J, ElShourbagy Ferreira S, Evans M, Gibbs K, Kowtha B, Pratt C, Reedy J, Shams-White M, Brown AG. Perspective: Nutrition Health Disparities Framework: A Model to Advance Health Equity. Adv Nutr 2024; 15:100194. [PMID: 38616067 PMCID: PMC11031378 DOI: 10.1016/j.advnut.2024.100194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 04/16/2024] Open
Abstract
Disparities in nutrition, such as poor diet quality and inadequate nutrient intake, arise from multiple factors and are related to adverse health outcomes such as obesity, diabetes, cardiovascular disease, and some cancers. The aim of the current perspective is to present a nutrition-centric socioecological framework that delineates determinants and factors that contribute to diet and nutrition-related disparities among disadvantaged populations. The Nutrition Health Disparities Framework (NHDF) describes the domains (biological, behavioral, physical/built environment, sociocultural environment, and healthcare system) that influence nutrition-related health disparities through the lens of each level of influence (that is, individual, interpersonal, community, and societal). On the basis of the scientific literature, the authors engaged in consensus decision making in selecting nutrition-related determinants of health within each domain and socioecological level when creating the NHDF. The framework identifies how neighborhood food availability and access (individual/built environment) intersect with cultural norms and practices (interpersonal/sociocultural environment) to influence dietary behaviors, exposures, and risk of diet-related diseases. In addition, the NHDF shows how factors such as genetic predisposition (individual/biology), family dietary practices (interpersonal/behavioral), and food marketing policies (societal) may impact the consumption of unhealthy foods and beverages and increase chronic disease risk. Family and peer norms (interpersonal/behavior) related to breastfeeding and early childhood nutrition interact with resource-poor environments such as lack of access to preventive healthcare settings (societal/healthcare system) and low usage of federal nutrition programs (societal/behavioral), which may increase risk of poor nutrition during childhood and food insecurity. The NHDF describes the synergistic interrelationships among factors at different levels of the socioecological model that influence nutrition-related outcomes and exacerbate health disparities. The framework is a useful resource for nutrition researchers, practitioners, food industry leaders, and policymakers interested in improving diet-related health outcomes and promoting health equity in diverse populations.
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Affiliation(s)
- Tanya Agurs-Collins
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States.
| | | | - Sanae ElShourbagy Ferreira
- National Center for Advancing Translational Sciences, Division of Clinical Innovation, Bethesda, MD, United States
| | - Mary Evans
- National Institute of Diabetes and Digestive and Kidney Diseases, Division of Digestive Diseases and Nutrition, Bethesda, MD, United States
| | - Kimberlea Gibbs
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Extramural Research, Pediatric Growth and Nutrition Branch, Bethesda, MD, United States
| | | | - Charlotte Pratt
- National Heart, Lung, and Blood Institute, Division of Cardiovascular Sciences, Bethesda, MD, United States
| | - Jill Reedy
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States
| | - Marissa Shams-White
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States
| | - Alison Gm Brown
- National Heart, Lung, and Blood Institute, Division of Cardiovascular Sciences, Bethesda, MD, United States
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Jiang Q, Risica PM, Tovar A, Cooksey Stowers K, Schwartz MB, Lombardi C, Gans K. Nutrition Practices of Family Child Care Home Providers and Children's Diet Quality. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:480-492. [PMID: 37245146 PMCID: PMC10426435 DOI: 10.1016/j.jneb.2023.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To examine the relationship between the diet quality of children aged 2-5 years cared for in family child care homes (FCCHs) with provider adherence to nutrition best practices. DESIGN Cross-sectional analysis. PARTICIPANTS Family child care home providers (n = 120, 100% female, 67.5% Latinx) and children (n = 370, 51% female, 58% Latinx) enrolled in a cluster-randomized trial. MAIN OUTCOME MEASURES Data were collected over 2 days at each FCCH. The Environment and Policy Assessment and Observation tool was used to document whether providers exhibited nutrition practices on the basis of the Nutrition and Physical Activity Self-Assessment for Child Care. Each practice was scored as either present or absent. Children's food intake was observed using Diet Observation at Child Care and analyzed with the Healthy Eating Index-2015. ANALYSIS Multilevel linear regression models assessed the association between providers exhibiting best practices regarding nutrition and children's diet quality. The model accounted for clustering by FCCH and controlled for provider ethnicity, income level, and multiple comparisons. RESULTS Children in FCCHs in which more of the best practices were implemented had higher diet quality (B = 1.05; 95% confidence interval [CI], 0.12-1.99; P = 0.03). Specifically, children whose providers promoted autonomous feeding (B = 27.52; 95% CI, 21.02-34.02; P < 0.001) and provided nutrition education (B = 7.76; 95% CI, 3.29-12.23; P = 0.001) had higher total Healthy Eating Index scores. CONCLUSIONS AND IMPLICATIONS Future interventions and policies could support FCCH providers in implementing important practices such as autonomy feeding practices, talking informally to children about nutrition, and providing healthful foods and beverages.
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Affiliation(s)
- Qianxia Jiang
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, Kansas City, MO.
| | - Patricia Markham Risica
- Department of Behavioral and Social Health Sciences, School of Public Health, Brown University, Providence, RI; Center for Health Promotion and Health Equity, School of Public Health, Brown University, Providence, RI
| | - Alison Tovar
- Department of Behavioral and Social Health Sciences, School of Public Health, Brown University, Providence, RI; Center for Health Promotion and Health Equity, School of Public Health, Brown University, Providence, RI
| | | | - Marlene B Schwartz
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT; Rudd Center for Food Policy and Health, University of Connecticut, Hartford, CT
| | - Caitlin Lombardi
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT
| | - Kim Gans
- Department of Behavioral and Social Health Sciences, School of Public Health, Brown University, Providence, RI; Center for Health Promotion and Health Equity, School of Public Health, Brown University, Providence, RI; Department of Allied Health Sciences, University of Connecticut, Storrs, CT
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Kracht CL, Burkart S, Flanagan EW, Melnick E, Luecking C, Neshteruk C. Policy, system, and environmental interventions addressing obesity and diet-related outcomes in early childhood education settings: A systematic review. Obes Rev 2023; 24:e13547. [PMID: 36601716 PMCID: PMC10214414 DOI: 10.1111/obr.13547] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/06/2022] [Indexed: 01/06/2023]
Abstract
Early childhood education (ECE) settings play an important role in child dietary intake and excess weight gain. Policy, systems, and environment (PSE) approaches have potential to reduce disparities in children at higher risk for obesity. The purpose of this review was to (1) characterize the inclusion of populations at higher risk for obesity in ECE interventions and (2) identify effective ECE interventions in these populations. Seven databases were searched for ECE interventions. Intervention characteristics and methodological quality were assessed in 35 articles representing 34 interventions. Interventions identified were mainly a combination of ECE and parent interventions (41%) or stand-alone ECE intervention (29%), with few multisector efforts (23%) or government regulations assessed (5%). Many included policy (70%) or social environment components (61%). For Aim 1, two thirds were conducted in primarily populations at higher risk for obesity (67%). Studies were rated as fair or good methodological quality. For Aim 2, 10 studies demonstrated effectiveness at improving diet or reducing obesity in populations at higher risk for obesity. Most included a longer intervention (i.e., >6 months), multiple PSE components, and formative work. Opportunities to incorporate more PSE components in ECE-based interventions and collaborate with parents and communities are warranted to improve child health.
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Affiliation(s)
- Chelsea L. Kracht
- Clinical Science Department, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Sarah Burkart
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Emily W. Flanagan
- Clinical Science Department, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Emily Melnick
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | - Courtney Luecking
- Department of Dietetics and Human Nutrition, College of Agriculture, Food and Environment, University of Kentucky, Lexington, Kentucky, USA
| | - Cody Neshteruk
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
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Asada Y, Lin S, Siegel L, Kong A. Facilitators and Barriers to Implementation and Sustainability of Nutrition and Physical Activity Interventions in Early Childcare Settings: a Systematic Review. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:64-83. [PMID: 36198924 DOI: 10.1007/s11121-022-01436-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 02/01/2023]
Abstract
A stronger understanding of the factors influencing implementation of interventions in community-based early childcare settings is needed. The purpose of this systematic review was to synthesize existing research on facilitators and barriers to implementation and sustainability of nutrition and physical activity interventions in early childcare settings targeting 2-5-year-old children, including considerations for equitable implementation. This review adhered to PRISMA 2020 guidelines. Peer-reviewed literature was searched in PubMed, EMBASE, CINAHL, ERIC, and PsycINFO databases up to September 2020. Primary research studies that examined facilitators and barriers (or related synonyms) to the implementation and sustainability of nutrition and physical activity interventions in early childcare settings were eligible for inclusion. The search yielded 8092 records that were screened by four analysts in Covidence software with a final review of 24 studies. Two independent reviewers conducted study selection, data extraction, and quality appraisal (Mixed Methods Appraisal Tool). A "best fit" framework was applied using the Consolidated Framework for Implementation Research (CFIR) constructs to code barriers and facilitators. The most salient constructs were (1) "Available Resources," which was composed of time, staffing, space, and staff trainings; (2) adaptability; and (3) compatibility, the latter two indicating that easily modifiable interventions facilitated a smoother "fit" and were more likely to be successful, given adequate site-level resources. Only nine (28%) reported the use of a theory, model, or framework to guide evaluation; six studies (24%) included factors related to sustainability; and nine studies (38%) conducted their interventions with low-income or minoritized groups. The findings point to the need for intervention evaluations examining nutrition and physical activity to more consistently consider (a) sustainability factors early on in design and adoption phases; (b) use of theory, model, or framework to guide evaluation; and (c) equity-related frameworks and considerations for how equitable implementation.
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Affiliation(s)
- Yuka Asada
- School of Public Health, Community Health Sciences, University of Illinois Chicago, 1603 W Taylor St, Chicago, IL, 60612, USA.
| | - Shuhao Lin
- College of Applied Health Science, Department of Kinesiology and Nutrition, University of Illinois Chicago, 1919 W Taylor St, Chicago, IL, 60612, USA
| | - Leilah Siegel
- 4-H Youth Development, University of Illinois Extension, 535 S. Randall Road, St., Charles, IL, 60174, USA
| | - Angela Kong
- Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois Chicago, 833 S. Wood St., Chicago, IL, 60612, USA
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McKee SL, Cooksey-Stowers K, St Louis R, Schwartz MB. Understanding the process of implementing nutrition and physical activity policies in a large national child care organization: a mixed-methods study. Transl Behav Med 2021; 10:801-811. [PMID: 31330005 DOI: 10.1093/tbm/ibz045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Learning Care Group made a three-year commitment with the Partnership for a Healthier America to implement several evidence-based nutrition and physical activity policies in over 900 child care centers. New practices included serving more fruits and vegetables; eliminating sugary drinks and juice; family-style dining; healthier celebrations; limiting screen time; increasing outdoor play time; and supporting breastfeeding. A sequential convergent mixed-methods design was used to describe changes in center practices over time; organizational support for changes; and center director perceptions of the implementation process. Data were collected through an interview with organizational leadership; document review; and online center director surveys at 6, 18, and 36 months. The final center director survey included open-ended questions about policy implementation. Written responses were coded and overall themes were extracted by integrating the qualitative and quantitative data. The five overall themes were to: take a comprehensive approach; build the initiative over time; provide structural supports; replace old practices with new ones; and communicate thoroughly. Center leaders reported primarily positive reactions to healthier menus, juice removal, and increased physical activity. The most controversial policy concerned healthier celebrations. Center directors reported that the staff and children adapted quickly to changes, while some families required more assistance. The experience of this large child care organization can inform other efforts to implement early care and education wellness policies.
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Affiliation(s)
- Sarah L McKee
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | | | - Rebecca St Louis
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Marlene B Schwartz
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA.,Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, CT, USA
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Vaughn AE, Hennink-Kaminski H, Moore R, Burney R, Chittams JL, Parker P, Luecking CT, Hales D, Ward DS. 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. Transl Behav Med 2021; 11:775-784. [PMID: 33231679 DOI: 10.1093/tbm/ibaa113] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Amber E Vaughn
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Heidi Hennink-Kaminski
- School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Renee Moore
- Biostats Collaboration Core, Emory University, Atlanta, GA
| | - Regan Burney
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jesse L Chittams
- Biostatistics Consulting Unit, Office of Nursing Research, School of Nursing, University of Pennsylvania, Philadelphia, PA
| | | | - Courtney T Luecking
- Department of Dietetics and Human Nutrition, College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY
| | - Derek Hales
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Dianne S Ward
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Lee DL, Traseira R, Navarro S, Frost N, Benjamin-Neelon SE, Cradock AL, Hecht K, Ritchie LD. Alignment of State Regulations With Breastfeeding and Beverage Best Practices for Childcare Centers and Family Childcare Homes, United States. Public Health Rep 2020; 136:79-87. [PMID: 33166484 PMCID: PMC7856380 DOI: 10.1177/0033354920964156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Childcare is an important setting for nutrition; nearly half of young children in the United States participate in licensed childcare, where they consume up to two-thirds of their daily dietary intake. We compared state regulations for childcare with best practices to support breastfeeding and healthy beverage provision. METHODS We reviewed regulations for childcare centers (centers) and family childcare homes (homes) in effect May-July 2016 and rated all 50 states for inclusion (1 = not included, 2 = partially included, 3 = fully included) of 12 breastfeeding and beverage best practices. We calculated average ratings for 6 practices specific to infants aged 0-11 months, 6 practices specific to children aged 1-6 years, and all 12 practices, by state and across all states. We assessed significant differences between centers and homes for each best practice by using McNemar-Bowker tests for symmetry, and we assessed differences across states by using paired student t tests. RESULTS States included best practices in regulations for centers more often than for homes. Average ratings (standard deviations) in regulations across all states were significantly higher in centers than in homes for infant best practices (2.1 [0.5] vs 1.8 [0.5], P < .001), child best practices (2.1 [0.6] vs 1.8 [0.6], P = .002), and all 12 best practices combined (2.1 [0.5] vs 1.8 [0.6], P < .001). CONCLUSIONS Although best practices were more consistently included in regulations for centers than for homes, many state childcare regulations did not include best practices to support breastfeeding and the provision of healthy beverages. Findings can be used to inform efforts to improve regulations and to reduce differences between centers and homes.
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Affiliation(s)
- Danielle L. Lee
- Nutrition Policy Institute, University of California Division of Agriculture and Natural Resources, Oakland, CA, USA
| | - Raquel Traseira
- Nutrition Policy Institute, University of California Division of Agriculture and Natural Resources, Oakland, CA, USA
- University College London Medical School, London, England
- Children’s Hospital Oakland Research Institute, Oakland, CA, USA
| | - Sophia Navarro
- Nutrition Policy Institute, University of California Division of Agriculture and Natural Resources, Oakland, CA, USA
- School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Natasha Frost
- Public Health Law Center, Mitchell Hamline School of Law, St Paul, MN, USA
| | - Sara E. Benjamin-Neelon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Ken Hecht
- Nutrition Policy Institute, University of California Division of Agriculture and Natural Resources, Oakland, CA, USA
| | - Lorrene D. Ritchie
- Nutrition Policy Institute, University of California Division of Agriculture and Natural Resources, Oakland, CA, USA
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Arcan C, Davey C, LaRowe TL, Nanney MS. Provider-Selected Training Needs and Associations With Related Practices in Childcare Settings in Minnesota and Wisconsin. THE JOURNAL OF SCHOOL HEALTH 2020; 90:869-877. [PMID: 32954497 DOI: 10.1111/josh.12952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/30/2020] [Accepted: 06/29/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Early care and education settings (ECE) are potential venues for young children to develop healthy lifestyle habits. The study assesses training needs and associations with relevant practices of licensed ECE providers across Minnesota and Wisconsin. METHODS A random sample of 823 providers completed a 97-item survey assessing nutrition and physical activity (PA) practices and training needs. Logistic regression, adjusted for program type (center- and family home-based), and location (urban/rural) examined associations between the top 3 selected training needs and provider practices. RESULTS Top training needs: (1) ways to effectively engage parents about healthy eating and PA, (2) low-cost ways to serve healthy foods, and (3) fun and easy nutrition education curricula. Providers who reported being not happy/somewhat happy vs happy/very happy with parent communication were more likely to need training to engage parents. Among providers who prepared food on-site, shopping at Farmer's Market had lower odds of needing training for serving healthy meals on a budget. Not having completed nutrition training in the past year providers were more likely to need training for fun and easy nutrition education curricula. CONCLUSIONS Providers need additional training to improve communication with parents, healthy food shopping practices, and nutrition-related games.
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Affiliation(s)
- Chrisa Arcan
- Assistant Professor, , Family, Population, and Preventive Medicine, Stony Brook University, HSC Level 3, Suite 086, Stony Brook, NY 11794-8036
| | - Cynthia Davey
- Senior Biostatistician, , Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, 717 Delaware St. SE, Minneapolis MN 55414
| | - Tara L LaRowe
- Faculty Associate, , Coordinator-Didactic Program in Dietetics, Department of Nutritional Sciences, University of Wisconsin-Madison, 1415 Linden Drive, Madison, WI 53706
| | - Marilyn S Nanney
- Associate Professor, , University of Minnesota, 717 Delaware Street SE, Suite 166, Minneapolis, MN 55414
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Lebron CN, Ofori A, Sardinas K, Luaces M, Natale R, Messiah SE. Barriers and facilitators to obesity prevention dissemination and implementation efforts in the childcare centre setting from the provider perspective. Child Care Health Dev 2020; 46:352-359. [PMID: 32017189 DOI: 10.1111/cch.12752] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 01/07/2020] [Accepted: 01/21/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND It has been established that the childcare centre (CCC) is a setting suitable for healthy weight promotion efforts. As the field advances, it is important to understand the barriers and facilitators to early childhood obesity prevention implementation and dissemination efforts from the CCC providers' perspective. This is especially true among those who serve low-income and diverse populations to maximize scalability success. METHODS Focus groups were held in English or Spanish with CCC providers across six CCCs who implemented healthy caregivers-healthy children (HC2), an early childhood healthy weight promotion programme targeting 2- to 5-year-olds from low-resource backgrounds. Centres represented both rural and urban environments. Focus groups were audio recorded, transcribed, and coded. A thematic analysis that combined a deductive and inductive approach was conducted. Codes were analysed using Dedoose to identify general themes and subthemes. RESULTS CCC providers stated that (a) children understood the nutritional benefits of healthy foods; (b) improved cognitive development as a result of HC2; (c) parents were barriers to HC2 implementation efforts, particularly in terms of cooperative healthy lifestyle efforts; and (d) modelling healthy eating and making healthy CCC environmental changes facilitated HC2 implementation. Overall, HC2 was well received by CCC teachers, and they shared creative classroom HC2 adaptions and improvements. CONCLUSIONS CCC providers can provide valuable insight to guide early childhood healthy weight promotion programme dissemination and implementation efforts. Although they value the implementation of HC2 programme in their classroom settings, they perceive parents as somewhat obstructive. This information is critical to informing future healthy weight promotion efforts in this setting, especially among low-resource families. It is important to continue to include the CCC provider viewpoint in future obesity prevention efforts to maximize scalability and sustainability efforts.
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Affiliation(s)
- Cynthia N Lebron
- Department of Public Health, University of Miami Miller School of Medicine, Miami, Florida
| | - Ashley Ofori
- School of Public Health, University of Texas Health Science Center at Houston, Dallas Regional Campus, Dallas, Texas
| | - Krystal Sardinas
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, Florida
| | - Maria Luaces
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, Florida
| | - Ruby Natale
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, Florida
| | - Sarah E Messiah
- School of Public Health, University of Texas Health Science Center at Houston, Dallas Regional Campus, Dallas, Texas.,Department of Epidemiology, Human Genetics & Environmental Sciences, UTHealth School of Public Health, Dallas Regional Campus, Dallas, Texas.,Center for Pediatric Population Health, UTHealth School of Public Health and Children's Health System of Texas, Dallas, Texas
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Brazendale K, Beets MW, Weaver RG, Turner-McGrievy B, Brazendale AB, Chandler JL, Moore JB, Huberty JL, Lemley J, Brownson RC. The application of mHealth to monitor implementation of best practices to support healthy eating and physical activity in afterschool programs. Glob Health Promot 2020; 27:33-40. [PMID: 29809105 PMCID: PMC11467714 DOI: 10.1177/1757975918768442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Childhood obesity continues to be a global epidemic and many child-based settings (e.g. school, afterschool programs) have great potential to make a positive impact on children's health behaviors. Innovative and time-sensitive methods of gathering health behavior information for the purpose of evaluation and strategically deploying support are needed in these settings. PURPOSE The aim is to (1) demonstrate the feasibility of mobile health (mHealth) for monitoring implementation of healthy eating and physical activity (HEPA) standards and, (2) illustrate the utility of mHealth for identifying areas where support is needed, within the afterschool setting. METHODS Site leaders (N = 175) of afterschool programs (ASPs) were invited to complete an online observation checklist via a mobile web app (Healthy Eating and Physical Activity Mobile, HEPAm) once per week during ASP operating hours. Auto-generated weekly text reminders were sent to site leaders' mobile devices during spring and fall 2015 and 2016 and spring 2017 school semesters. Data from HEPAm was separated into HEPA variables, and expressed as a percent of checklists where an item was present. A higher percentage for a given item would indicate an afterschool has higher compliance with current HEPA standards. RESULTS A total of 141 site leaders of ASPs completed 13,960 HEPAm checklists. The average number of checklists completed per ASP was 43 (range 1-220) for healthy eating and 50 (range 1-230) for physical activity. For healthy eating, the most common challenge for ASPs was 'Staff educating children about healthy eating', and for physical activity checklists, 'Girls only physical activity is provided at ASP'. CONCLUSION HEPAm was widely used and provided valuable information that can be used to strategically deploy HEPA support to ASPs. This study gives confidence to the adoption of mHealth strategies as a means for public health practitioners to monitor compliance of an initiative or intervention.
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Tovar A, Benjamin-Neelon SE, Vaughn AE, Tsai M, Burney R, Østbye T, Ward DS. Nutritional Quality of Meals and Snacks Served and Consumed in Family Child Care. J Acad Nutr Diet 2019; 118:2280-2286. [PMID: 30497638 DOI: 10.1016/j.jand.2018.08.154] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 08/23/2018] [Indexed: 01/25/2023]
Abstract
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.
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Stanhope KK, Bettermann E, Stevenson ECH, Julius SD, Kafi A, Kay C, Gazmararian JA. Feasibility of a Multicomponent Program to Promote Physical Activity and Nutrition in Georgia Low-Income Early Care and Education Settings. Child Obes 2019; 14:358-367. [PMID: 30199294 DOI: 10.1089/chi.2018.0088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND This article describes the process and intermediate outcomes from a program implemented in 65 Early Care and Education (ECE) centers serving low-income families throughout Georgia during the 2014-2017 school years. METHODS The HealthMPowers' Empowering Healthy Choices in Schools, Homes, and Communities ECE program was based on the organization's previously successful elementary school program and aligns with current early childhood nutrition and physical activity recommendations. Participating centers worked with HealthMPowers for up to 3 years. A team from each center led changes by conducting annual self-assessments, creating and implementing improvement plans, and implementing nutrition and physical activity programs using educational resources and environmental cues. A monitoring and evaluation plan provided ongoing feedback to HealthMPowers and centers. Family and staff surveys provided insights into behaviors of children, families, and staff. Process measures included specific benchmarks (e.g., center leadership team formation, improvement plan implementation). Annual self-assessment results served as intermediate outcome measures. RESULTS As of 2017, 65 centers had enrolled in the program. All centers formed a health team and completed the baseline self-assessment and most implemented an improvement plan (88%). At the 1-year follow-up self-assessment, centers reported improvements from baseline including never offering food incentives for good behavior (75%-86%), conducting taste testing at least once a month (61%-79%), and rarely/never serving sugar-sweetened beverages (93%-96%). CONCLUSIONS Initial process measures from a multicomponent health promotion program in ECE were promising. An integrated continuous improvement approach to working with child care settings is feasible and likely effective.
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Affiliation(s)
- Kaitlyn K Stanhope
- 1 Department of Epidemiology, Rollins School of Public Health, Emory University , Atlanta, GA
| | - Erika Bettermann
- 1 Department of Epidemiology, Rollins School of Public Health, Emory University , Atlanta, GA
| | | | - Samantha D Julius
- 3 Hubert Department of Global Health, Rollins School of Public Health, Emory University , Atlanta, GA
| | - Anusheh Kafi
- 4 Mailman School of Public Health, Columbia University , New York, NY
| | | | - Julie A Gazmararian
- 1 Department of Epidemiology, Rollins School of Public Health, Emory University , Atlanta, GA
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Gans KM, Tovar A, Jiang Q, Mello J, Dionne L, Kang A, Mena NZ, Palomo V, Risica PM. Nutrition-Related Practices of Family Child Care Providers and Differences by Ethnicity. Child Obes 2019; 15:167-184. [PMID: 30707598 PMCID: PMC6909752 DOI: 10.1089/chi.2018.0083] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Child care settings play an important role in shaping children's eating behaviors; yet few studies have included family child care homes (FCCHs). We examined provider-reported nutrition-related practices in FCCHs and observed adherence to nutrition guidelines from the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC), exploring differences by provider ethnicity. METHODS We assessed baseline data from a cluster-randomized trial, including surveys with FCCH providers and observational data collected at the FCCH. We examined provider-reported nutrition-related practices and if providers met NAP SACC guidelines using observational data. Differences by ethnicity were assessed using chi-square and multivariate log-linear analysis adjusting for education. RESULTS Providers completed a telephone survey (n = 166, 100% female and 72% Hispanic) and participated in 2 full-day observations (n = 119). Many providers reported engaging in positive nutrition-related practices. Significant differences by ethnicity included the following: Hispanic providers less likely to report feeding practices that were responsive to children's self-regulation, but also less likely to report eating and drinking unhealthy foods/beverages in front of children and having screens on during meals and more likely to report seeking nutrition trainings. Using observational data, only 10 of 26 NAP SACC practices were met by >60% of providers. Few ethnic differences in meeting guidelines were found (7 of 26 practices). CONCLUSIONS While providers engage in some positive nutrition practices, improvement is needed to ensure that all providers actually meet evidence-based guidelines. Ethnic differences in certain practices underscore the need for culturally relevant trainings. TRIAL REGISTRATION NUMBER NCT02452645.
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Affiliation(s)
- Kim M. Gans
- Department of Human Development and Family Studies, University of Connecticut, Storrs, CT
- Institute for Collaboration on Health, Interventions and Policy, University of Connecticut, Storrs, CT
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI
| | - Qianxia Jiang
- Department of Human Development and Family Studies, University of Connecticut, Storrs, CT
- Institute for Collaboration on Health, Interventions and Policy, University of Connecticut, Storrs, CT
| | - Jennifer Mello
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI
| | - Laura Dionne
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI
| | - Augustine Kang
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Noereem Z. Mena
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI
| | - Vanessa Palomo
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI
| | - Patricia Markham Risica
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
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Loth K, Shanafelt A, Davey C, Anfinson A, Zauner M, Looby AA, Frost N, Nanney MS. Provider Adherence to Nutrition and Physical Activity Best Practices Within Early Care and Education Settings in Minnesota, Helping to Reduce Early Childhood Health Disparities. HEALTH EDUCATION & BEHAVIOR 2019; 46:213-223. [PMID: 30005577 PMCID: PMC6855601 DOI: 10.1177/1090198118780458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Licensed child care providers, and the early care and education settings in which they operate, are uniquely situated to influence children's healthy eating and physical activity through practices, attitudes, and supportive physical and social environments. However, preliminary research indicates that child-, family-, and provider-level characteristics affect adherence to best practices across early care and education settings. The current article used survey data ( n = 618) to characterize differences in child care providers' adherence to nutrition, physical activity, and mealtime best practices, based on child-, family- and provider-level characteristics, and to describe secular trends in adherence to nutrition and physical activity best practices between 2010 and 2016. Results indicate that differences exist across certain characteristics, including child race/ethnicity, family's use of child care assistance, language spoken at home, and provider educational attainment; however, it is notable that in most cases providers serving children of minority race and children in low-income families have a higher rate of compliance with the nutrition and physical activity best practices studied. Additionally, the comparison of adherence to best practices from 2010 to 2016 suggests that, while there was an increase in mean adherence from 2010 to 2016, overall trends in adherence across child-, family- and provider-level characteristics have been consistent across time. Public health professionals should continue to advocate for opportunities for providers to learn how to best incorporate best practices within their setting (e.g., education and training opportunities) as well as for the development and adoption of systems-level changes (e.g., expansion of food assistance programs) to reduce barriers to adherence to best practices.
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Affiliation(s)
- Katie Loth
- University of Minnesota, Minneapolis, MN, USA
| | | | | | - Allison Anfinson
- Center for Prevention at Blue Cross and Blue Shield of Minnesota, Eagan, MN, USA
| | - Marguerite Zauner
- Center for Prevention at Blue Cross and Blue Shield of Minnesota, Eagan, MN, USA
| | - Anna Ayers Looby
- Public Health Law Center at Mitchell Hamline School of Law, St. Paul, MN, USA
| | - Natasha Frost
- Public Health Law Center at Mitchell Hamline School of Law, St. Paul, MN, USA
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Larson N, Loth KA, Nanney MS. Staff Training Interests, Barriers, and Preferences in Rural and Urban Child Care Programs in Minnesota. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:335-341. [PMID: 30205928 DOI: 10.1016/j.jneb.2018.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 06/19/2018] [Accepted: 06/21/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To describe any rural-urban differences in child care providers' (1) past training on the facilitation of child healthy eating and physical activity and (2) views relevant to the design of trainings. METHODS Cross-sectional analysis of data from the 2016 Healthy Start, Healthy State survey of Minnesota child care providers (rural, n = 232; urban, n = 386). Licensed family home-based care providers and providers working at licensed centers responded online or by mail to measures of desired training content, barriers, and delivery mode preferences. RESULTS Training barriers that were more often a concern for rural compared with urban providers included scheduling outside work hours, difficulties finding trainings, and travel (all P < .001). Rural and urban providers identified similar preferences with regard to training content and delivery. CONCLUSIONS AND IMPLICATIONS The findings suggest it would be worthwhile for future research to examine whether rural providers' training participation is affected by uniquely relevant participation barriers.
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Affiliation(s)
- Nicole Larson
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN.
| | - Katie A Loth
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
| | - Marilyn S Nanney
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
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