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Campbell JE, McIsaac JLD, Young M, Dickson E, Caldwell S, Barich R, Rossiter M. Advancing assessment of responsive feeding environments and practices in child care. J Nutr Sci 2024; 13:e14. [PMID: 38572372 PMCID: PMC10988165 DOI: 10.1017/jns.2024.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/03/2024] [Accepted: 02/09/2024] [Indexed: 04/05/2024] Open
Abstract
Child care environments offer an ideal setting for feeding interventions. CELEBRATE Feeding is an approach implemented in child care environments in two Maritime Provinces in Canada to support responsive feeding (RF) to foster children's self-efficacy, self-regulation, and healthy relationships with food. This study aimed to describe RF in child care using established and enhanced scoring frameworks. The Environment and Policy Assessment and Observation (EPAO) was modified to reflect RF environments and practices, resulting in our modified EPAO and a CELEBRATE scale. Observations were conducted in 18 child care rooms. Behaviours and environments were scored on both scales, creating 21 RF scores, with a score of '3' indicating the most responsiveness. Descriptive analyses of the scores were conducted. The overall room averages were Mean (M) = 41.00, Standard Deviation (SD) = 7.07 (EPAO), and M = 37.92 SD = 6.50 (CELEBRATE). Most responsive scores among rooms within our EPAO and CELEBRATE scales, respectively, were 'educators not using food to calm or encourage behaviour' (M = 2.94, SD = 0.24; M = 2.98, SD = 0.06) and 'not requiring children to sit at the table until finished' (M = 2.89, SD = 0.47; M = 2.97, SD = 0.12). The least responsive scores within the EPAO were 'educator prompts for children to drink water' (M = 0.78, SD = 0.94) and 'children self-serving' (M = 0.83, SD = 0.38). The least responsive in the CELEBRATE scale were 'enthusiastic role modelling during mealtime' (M = 0.70, SD = 0.68) and 'praise of mealtime behaviour unrelated to food intake' (M = 0.74, SD = 0.55). The CELEBRATE scale captured unique observation information about RF to allow documenting change over time with detailed measurement to inform and support nutrition interventions within child care environments.
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Affiliation(s)
- Julie E. Campbell
- Early Childhood Collaborative Research Centre, Mount Saint Vincent University, Halifax, Canada
- School of Health and Human Performance, Dalhousie University, Halifax, Canada
| | - Jessie-Lee D. McIsaac
- Early Childhood Collaborative Research Centre, Mount Saint Vincent University, Halifax, Canada
- Faculty of Education and Department of Child and Youth Study, Mount Saint Vincent University, Halifax, Canada
| | - Margaret Young
- Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, Canada
| | - Elizabeth Dickson
- Early Childhood Collaborative Research Centre, Mount Saint Vincent University, Halifax, Canada
| | - Sarah Caldwell
- Early Childhood Collaborative Research Centre, Mount Saint Vincent University, Halifax, Canada
| | - Rachel Barich
- Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, Canada
| | - Misty Rossiter
- Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, Canada
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Jiang Q, Risica PM, Tovar A, Cooksey Stowers K, Schwartz MB, Lombardi C, Gans KM. Mediation of the association between social environmental characteristics of family childcare home and weight status in children by diet quality. BMC Public Health 2023; 23:2301. [PMID: 37990180 PMCID: PMC10664465 DOI: 10.1186/s12889-023-17179-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND The food and beverages served in family childcare homes (FCCHs) may play an important role in the development of childhood overweight and obesity. This analysis examines whether children's diet quality mediates the relationship between foods and beverages served in FCCHs and preschool-aged children's weight status. METHODS Trained and certified staff conducted observations for two days in each FCCH, using the Environment and Policy Assessment and Observation (EPAO) measure to determine the foods and beverages served to children (N = 370) in FCCHs (N = 120). They also used the Dietary Observation in Child Care (DOCC) protocol to assess children's food and beverage intake during childcare, from which we calculated the Healthy Eating Index-2015 (HEI), a measure of diet quality. Height and weight were measured for each child with parent consent from which the child's body mass index (BMI) z-scores were calculated. A multilevel mediation analysis was conducted to indicate whether children's diet quality mediates the relations between food and beverage served in FCCHs and preschool-aged children's weight status. RESULTS Children's total HEI scores significantly mediated the relationship between the EPAO subscale Food Provided and children's BMI z-scores (B=-0.01, p < .05, 95% CI = [-0.03, - 0.002]). Further, the EPAO subscale Food Provided was positively associated with the total HEI score (B = 0.75, p < .01, 95% CI = [0.32, 1.18]). Total HEI scores were negatively associated with BMI z-score (B=-0.01, p < .05, 95% CI = [-0.02, - 0.001]). CONCLUSION Children's diet quality did significantly mediate the relationship between the food served in FCCHs and children's weight status. More longitudinal studies with longer follow-up periods need to be conducted to confirm these relationships. Further, future studies need to examine the relationships between a broader spectrum of FCCH environmental characteristics and home environment with children's weight status, as well as other mediators including physical activity.
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Affiliation(s)
- Qianxia Jiang
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, Kansas City, MO, USA.
| | - Patricia Markham Risica
- Department of Behavioral and Social Health Sciences, School of Public Health, Brown University, Providence, RI, USA
- Center for Health Promotion and Health Equity, School of Public Health, Brown University, Providence, RI, USA
| | - Alison Tovar
- Department of Behavioral and Social Health Sciences, School of Public Health, Brown University, Providence, RI, USA
- Center for Health Promotion and Health Equity, School of Public Health, Brown University, Providence, RI, USA
| | | | - Marlene B Schwartz
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
- Rudd Center for Food Policy and Health, University of Connecticut, Hartford, CT, USA
| | - Caitlin Lombardi
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Kim M Gans
- Department of Behavioral and Social Health Sciences, School of Public Health, Brown University, Providence, RI, USA
- Center for Health Promotion and Health Equity, School of Public Health, Brown University, Providence, RI, USA
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
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Jiang Q, Risica PM, Tovar A, Stowers KC, Schwartz MB, Lombardi C, Gans KM. Mediation of the Association between Social Environmental Characteristics of Family Childcare Home and Weight Status in Children by Diet Quality. RESEARCH SQUARE 2023:rs.3.rs-3147729. [PMID: 37645722 PMCID: PMC10462247 DOI: 10.21203/rs.3.rs-3147729/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Background The food and beverages served in family childcare homes (FCCHs) may play an important role in the development of childhood overweight and obesity. This analysis examines whether children's diet quality mediates the relationship between foods and beverages served in FCCHs and preschool-aged children's weight status. Methods Trained and certified staff conducted observations for two days in each FCCH, using the Environment and Policy Assessment and Observation (EPAO) measure to determine the foods and beverages served to children (N=370) in FCCHs (N=120). They also used the Dietary Observation in Child Care (DOCC) protocol to assess children's food and beverage intake during childcare, from which we calculated the Healthy Eating Index-2015 (HEI), a measure of diet quality. Height and weight were measured for each child with parent consent from which the child's body mass index (BMI) z-scores were calculated from. A multilevel mediation analysis was conducted to indicate whether children's diet quality mediates the relations between food and beverage served in FCCHs and preschool-aged children's weight status. Results Children's total HEI scores significantly mediated the relationship between the EPAO subscale "Food provided" and children's BMI z-scores (B=-.01, p<.05, 95% CI = [-.03, -.002]). Further, the EPAO subscale "Food provided" was positively associated with the total HEI score (B=.75, p<.01, 95% CI = [.32, 1.18]). Total HEI scores were negatively associated with BMI z-score (B=-.01, p<.05, 95% CI = [-.02, -.001]). Conclusion Children's diet quality did significantly mediate the relationship between the food served in FCCHs and children's weight status. More longitudinal studies with longer follow-up periods need to be conducted to confirm these relationships. Further, future studies need to examine the relationships between a broader spectrum of FCCH environmental characteristics and home environment with children's weight status, as well as other mediators including physical activity.
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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: 0] [Impact Index Per Article: 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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Kerr EM, Hewitt L, Ryan ST, Norman J, Kelly B, Hammersley ML, Lum M, Okely AD. Correlates of children's dietary intake, physical activity and sedentary behavior in home-based childcare: A systematic review. Prev Med Rep 2022; 30:101999. [PMID: 36237835 PMCID: PMC9551212 DOI: 10.1016/j.pmedr.2022.101999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 09/20/2022] [Accepted: 09/24/2022] [Indexed: 11/30/2022] Open
Abstract
This systematic review assessed the correlates of children's dietary intake, physical activity and sedentary behavior in home-based childcare. A systematic search of five databases with articles published between January 2000 and July 2021 was conducted. Articles were included if they contained data from a home-based childcare (birth-5 years) setting; were a quantitative study that reported children's dietary intake, physical activity or sedentary behavior; included variables associated with children's dietary intake, physical activity or sedentary behavior; and were published in English. Correlates were categorized using McLeroy’s social ecological framework. Risk of bias was assessed using the Office of Health Assessment and Translation (OHAT) Risk of Bias Rating Tool. Fifteen studies met the inclusion criteria; six assessed children's dietary intake, and nine assessed physical activity and/or sedentary behaviors. Studies were conducted in the USA (n = 12) and Canada (n = 3). Seventy-three correlates were identified, for children's dietary intake (n = 11), physical activity (n = 35) and sedentary behavior (n = 27). Ethnicity and the food provided to children were associated with children's dietary intake in two studies; both from the same study sample. Indoor play space was positively associated with physical activity in two separate studies. No consistent associations for children's dietary intake, physical activity, or sedentary behavior outcomes were found between studies, however few studies assessed the same correlates. High-quality studies conducted in different countries that assess the nutrition and physical activity environments in home-based childcare using reliable and consistent methods are needed. This review was registered with PROSPERO, no. CRD42019103429.
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Affiliation(s)
- Erin M. Kerr
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia
- Corresponding author.
| | - Lyndel Hewitt
- Illawarra Health Medical Research Institute, Wollongong, NSW, Australia
- Illawarra Shoalhaven Local Health District, Wollongong Hospital, New South Wales 2500, Australia
| | - Sarah T. Ryan
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia
| | - Jennifer Norman
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
- Illawarra Health Medical Research Institute, Wollongong, NSW, Australia
| | - Bridget Kelly
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia
| | - Megan L. Hammersley
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia
| | - Melanie Lum
- Hunter New England Population Health, Wallsend, New South Wales 2287, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales 2300, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales 2308, Australia
| | - Anthony D. Okely
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia
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Nieri T, Zimmer A, Vaca JM, Tovar A, Cheney A. A Systematic Review of Research on Non-Maternal Caregivers' Feeding of Children 0-3 Years. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14463. [PMID: 36361342 PMCID: PMC9658782 DOI: 10.3390/ijerph192114463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/29/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
Although people other than mothers participate in feeding, few interventions include non-maternal caregivers, especially those promoting healthy development among children aged 0-3 years. Understanding the role and influence of non-maternal caregivers is essential for the development and effectiveness of early childhood feeding interventions; yet, no reviews have examined non-maternal caregivers of children aged 0-3 years. This study assessed what is known about non-maternal caregivers' feeding of children aged 0-3. We systematically reviewed 38 empirical quantitative, qualitative, and mixed methods studies, cataloged in PubMed and Web of Science and published between 1/2000-6/2021. The studies showed that non-maternal caregivers engage in child feeding and their attitudes and behaviors affect child outcomes. Like mothers, non-maternal caregivers vary in the extent to which their knowledge and attitudes support recommended feeding practices and the extent to which they exhibit responsive feeding styles and practices. Children of broad ages were included in the studies; future research should include infant/toddler-only samples to allow for better assessment of age-specific feeding constructs. The studies also revealed issues specific to non-maternal caregivers that are unlikely to be addressed in interventions developed for mothers. Thus, the review highlighted features of non-maternal caregiving of children 0-3 years that could be addressed to support feeding and child outcomes.
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Affiliation(s)
- Tanya Nieri
- Department of Sociology, University of California Riverside, Riverside, CA 92521, USA
| | - Arianna Zimmer
- Center for Health Disparities Research, School of Medicine, University of California Riverside, Riverside, CA 92521, USA
| | - Jai Mica Vaca
- Department of Justice Studies, San Jose State University, San Jose, CA 95192, USA
| | - Alison Tovar
- Department of Behavioral and Social Sciences, Brown University, Providence, RI 02912, USA
| | - Ann Cheney
- Department of Social Medicine, Population and Public Health, School of Medicine, University of California Riverside, Riverside, CA 92521, USA
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Cluster-randomised trial of the impact of an obesity prevention intervention on childcare centre nutrition and physical activity environment over 2 years. Public Health Nutr 2022; 25:3172-3181. [PMID: 34593076 PMCID: PMC9991736 DOI: 10.1017/s1368980021004109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The prevalence of obesity among pre-school-aged children in the USA remains unacceptably high. Here, we examine the impact of Healthy Caregivers-Healthy Children (HC2) Phase 2, a childcare centre (CCC)-based obesity prevention intervention on changes in the CCC nutrition and physical activity environment over 2 school years. DESIGN This was a cluster-randomised trial with twelve CCC receiving the HC2 intervention arm and twelve in the control arm. The primary outcome was change in the Environment and Policy Assessment and Observation (EPAO) tool over 2 school years (Fall 2015, Spring 2016 and Spring 2017). Changes in EPAO physical activity and nutrition score were analysed via a: (1) random effects mixed models and (2) mixed models to determine the effect of HC2 v. control. SETTING The study was conducted in twenty-four CCC serving low-income, ethnically diverse families in Miami-Dade County. PARTICIPANTS Intervention CCC received (1) teachers/parents/children curriculum, (2) snack, beverage, physical activity, and screen time policies, and (3) menu modifications. RESULTS Two-year EPAO nutrition score changes in intervention CCC were almost twice that of control CCC. The EPAO physical activity environment scores only slightly improved in intervention CCC v. control CCC. Intervention CCC showed higher combined EPAO physical activity and nutrition scores compared to control CCC over the 2-year study period (β = 0·09, P = 0·05). CONCLUSIONS Obesity prevention programmes can have a positive impact on the CCC nutrition environment and can promote healthy weight in early childhood. CCC may need consistent support to improve the physical activity environment to ensure the policies remain intact.
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McIsaac JLD, MacQuarrie M, Barich R, Morris S, Turner JC, Rossiter MD. Responsive Feeding Environments in Childcare Settings: A Scoping Review of the Factors Influencing Implementation and Sustainability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11870. [PMID: 36231167 PMCID: PMC9564844 DOI: 10.3390/ijerph191911870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
Children benefit from responsive feeding environments, where their internal signals of hunger and satiety are recognized and met with prompt, emotionally supportive and developmentally appropriate responses. Although there is existing research on responsive feeding environments in childcare, there is little synthesized literature on the implementation practices using a behavior change framework. This scoping review sought to explore the factors influencing the implementation and sustainability of responsive feeding interventions in the childcare environment, using the behavior change wheel (BCW). A total of 3197 articles were independently reviewed and 39 met the inclusion criteria. A thematic analysis identified the factors influencing the implementation and sustainability of responsive feeding, including the following: (1) pre-existing nutrition policies, (2) education and training, (3) provider beliefs and confidence, (4) partnership development and stakeholder engagement and (5) resource availability. The most common BCW intervention functions were education (n = 39), training (n = 38), environmental restructuring (n = 38) and enablement (n = 36). The most common policy categories included guidelines (n = 39), service provision (n = 38) and environmental/social planning (n = 38). The current literature suggests that broader policies are important for responsive feeding, along with local partnerships, training and resources, to increase confidence and efficacy among educators. Future research should consider how the use of a BCW framework may help to address the barriers to implementation and sustainability.
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Affiliation(s)
- Jessie-Lee D. McIsaac
- Department of Child and Youth Study, Faculty of Education, Mount Saint Vincent University, Halifax, NS B3M 2J6, Canada
| | - Madison MacQuarrie
- Department of Child and Youth Study, Faculty of Education, Mount Saint Vincent University, Halifax, NS B3M 2J6, Canada
| | - Rachel Barich
- Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, PE C1A 4P3, Canada
| | - Sarah Morris
- Department of Child and Youth Study, Faculty of Education, Mount Saint Vincent University, Halifax, NS B3M 2J6, Canada
| | - Joan C. Turner
- Department of Child and Youth Study, Faculty of Education, Mount Saint Vincent University, Halifax, NS B3M 2J6, Canada
| | - Melissa D. Rossiter
- Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, PE C1A 4P3, Canada
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Risica PM, Karpowicz JM, von Ash T, Gans KM, Stowers KC, Tovar A. Feeding and Activity Environments for Infants and Toddlers in Childcare Centers and Family Childcare Homes in Southeastern New England. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159702. [PMID: 35955058 PMCID: PMC9367851 DOI: 10.3390/ijerph19159702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/30/2022] [Accepted: 08/03/2022] [Indexed: 06/01/2023]
Abstract
Few studies have documented the food and physical activity (PA) environments of childcare settings caring for children <24 months of age, although they may be key contributors to developing child PA and diet patterns. We used an adapted Environment and Policy Assessment and Observation tool to assess the food and activity environments for infants and toddlers in childcare centers (n = 21) and family childcare homes (FCCH) (n = 20) and explored differences by childcare type. Many similarities were found between childcare site types; however, centers used more recommended feeding practices than FCCH (e.g., 100% of center providers talked with toddlers about feelings of hunger or fullness compared to 18% of family childcare providers (FCCP), p < 0.01). Differences in non-recommended feeding practices (e.g., spoon feeding, bottle propping and encouraging unhealthy foods) were mixed between childcare types. Toddlers in centers spent more time playing at higher PA levels than those in FCCH (61 vs. 13 min, p < 0.001). Screen time was observed in FCCH, but not in centers. Differences between childcare types may indicate differential influences on infant and toddler feeding and PA behaviors, which could predict disparate obesity risk. Future research should further observe these behaviors in a larger sample of centers and FCCH to inform childcare interventions and policies.
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Affiliation(s)
- Patricia Markham Risica
- Brown University School of Public Health, Providence, RI 02912, USA
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI 02912, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
| | | | - Tayla von Ash
- Brown University School of Public Health, Providence, RI 02912, USA
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI 02912, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
| | - Kim M. Gans
- Brown University School of Public Health, Providence, RI 02912, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT 06269, USA
- Institute for Collaboration in Health, Interventions and Policy, University of Connecticut, Storrs, CT 06269, USA
| | - Kristen Cooksey Stowers
- Institute for Collaboration in Health, Interventions and Policy, University of Connecticut, Storrs, CT 06269, USA
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
- Rudd Center for Food Policy and Health, University of Connecticut, Hartford, CT 06103, USA
| | - Alison Tovar
- Brown University School of Public Health, Providence, RI 02912, USA
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI 02912, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
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Kerr EM, Kelly B, Hammersley ML, Norman J, Hernandez L, Furber S, Vuong C, Wardle K, Ryan S, Okely AD. Assessment of Feeding Practices and Mealtime Environments in Australian Family Daycare Services. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:442-448. [PMID: 35027307 DOI: 10.1016/j.jneb.2021.10.006] [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: 02/07/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Assess educators' feeding practices and mealtime environments in family daycare services and examine the factors associated with educators' feeding practices and mealtime environments. METHODS Cross-sectional observational study of family daycare services (n = 33) in Australia. Best practices for mealtime environments and educator feeding practices were assessed during each mealtime using the Environment Policy Assessment and Observation instrument. Correlates assessed via survey included: socioeconomic status, main language spoken at home, early childhood career experience, and nutrition professional development. Descriptive statistics and independent t tests were calculated. RESULTS Educators typically had higher scores, indicating better practices, for (the absence of) negative practices compared with positive practices. The only positive practice meeting best-practice standards was educators sitting with children during the meal. There were no significant correlations for educators' feeding practices or mealtime environment. CONCLUSIONS AND IMPLICATIONS Educators may benefit from professional development targeting positive feeding practices and supportive mealtime environments.
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Affiliation(s)
- Erin M Kerr
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, New South Wales, Australia.
| | - Bridget Kelly
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, New South Wales, Australia
| | - Megan L Hammersley
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, New South Wales, Australia; Illawarra Health Medical Research Institute, Wollongong, New South Wales, Australia
| | - Jennifer Norman
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, New South Wales, Australia; Illawarra Health Medical Research Institute, Wollongong, New South Wales, Australia; Health Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, New South Wales, Australia
| | - Lara Hernandez
- Centre for Population Health, NSW Ministry of Health, St Leonards, New South Wales, Australia
| | - Susan Furber
- Illawarra Health Medical Research Institute, Wollongong, New South Wales, Australia; Health Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, New South Wales, Australia; School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Australia
| | - Cecilia Vuong
- Health Promotion Service, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Karen Wardle
- Health Promotion Service, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Sarah Ryan
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, New South Wales, Australia
| | - Anthony D Okely
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, New South Wales, Australia; Illawarra Health Medical Research Institute, Wollongong, New South Wales, Australia
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Gans KM, Tovar A, Kang A, Ward DS, Stowers KC, von Ash T, Dionne L, Papandonatos GD, Mena N, Jiang Q, Risica PM. A multi-component tailored intervention in family childcare homes improves diet quality and sedentary behavior of preschool children compared to an attention control: results from the Healthy Start-Comienzos Sanos cluster randomized trial. Int J Behav Nutr Phys Act 2022; 19:45. [PMID: 35428298 PMCID: PMC9013065 DOI: 10.1186/s12966-022-01272-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 03/09/2022] [Indexed: 11/24/2022] Open
Abstract
Background Childcare settings are important environments for influencing child eating and physical activity (PA). Family childcare homes (FCCH) care for many children of low-income and diverse racial/ethnic backgrounds who are at greater risk for poor diet quality, low PA, and obesity, but few interventions have targeted this setting. The aim of this study was to assess the efficacy of a multicomponent intervention conducted in FCCH on the diet quality and PA of 2–5 year old children in their care. Trial design Cluster randomized trial. Methods The cluster-randomized trial, Healthy Start/Comienzos Sanos (2015–2019) evaluated an 8-month nutrition and PA intervention that included four components: (1) monthly telephone calls from a support coach using brief motivational interviewing, (2) tailored reports, newsletters and videos, (3) group support meetings, and (4) active play toys. After completing baseline measurement, FCCH were randomized into intervention or comparison groups in matched pairs. Both groups received the same intervention components but on different topics (intervention: nutrition/PA vs. comparison: reading readiness/literacy). Evaluation staff were blinded to group assignment. Child primary outcome measures collected at baseline and 8-months included: 1) Healthy Eating Index (HEI-2015) scores calculated from diet observation, and 2) accelerometer measurement of PA. Process measures were collected from field data and provider surveys. Generalized Estimating Equation Models assessed changes in HEI-2015 scores and PA over time by experimental condition. Results Ethnically diverse FCCH providers (n = 119) and 2-to-5-year-old children in their care (n = 377) were included in the final analysis. Process evaluation showed high participation in all intervention components except for group meetings. Compared to children in comparison group FCCH, children in intervention FCCH increased total HEI-2015 scores by 7.2 points (p < .001) including improvement in component scores for vegetables (0.84 points, p = .025) and added sugar (0.94 points, p = .025). For PA, compared to children in the comparison group, children in intervention FCCH decreased sedentary time by 5.7% (p = .021). Conclusions The multicomponent Healthy Start intervention was effective in improving diet quality and sedentary behavior of children in FCCH, which demonstrates the promise of obesity prevention interventions in this setting. Future research could include enhancing the Healthy Start intervention to strengthen the PA component, considering virtual peer support, and determining how to best translate and disseminate the intervention into FCCH nationally. Trial registration National Institutes of Health, NCT02452645. Registered 5 May 2015. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-022-01272-6.
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12
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OUP accepted manuscript. Nutr Rev 2022; 80:1247-1273. [DOI: 10.1093/nutrit/nuab123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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13
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Williams BD, Sisson SB, Stinner EL, Hetrick HN, Dunlap M, Graef-Downard J, Eliot K, Finnell K, Salvatore AL. Quality of Nutrition Environments, Menus and Foods Served, and Food Program Achievement in Oklahoma Family Child Care Homes. Nutrients 2021; 13:4483. [PMID: 34960034 PMCID: PMC8704456 DOI: 10.3390/nu13124483] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 02/02/2023] Open
Abstract
Child care environments foster children's healthy eating habits by providing exposure to healthy foods and feeding practices. We assessed the healthfulness of nutrition environments, menu/meal quality, and the achievement of Child and Adult Care Food Program (CACFP) guidelines and best practices in Oklahoma CACFP-enrolled family child care homes (FCCHs) (n = 51). Two-day classroom observations were conducted. Healthfulness of classroom nutrition environments was assessed using the Environment and Policy Assessment and Observation (EPAO). Foods served to and consumed by children were quantified using the Dietary Observations in Child Care (DOCC) tool. Nutrient analysis was performed to determine total energy for foods listed on menus, served to, and consumed by children. Menu and meal food variety and CACFP Guideline Achievement Scores were determined. Average nutrition environment score was 11.7 ± 1.2 (61.5% of maximum possible score). Energy (kcals) from menus and consumed by children was insufficient to meet two-thirds of their daily reference intake. Children were exposed to 1.7 vegetables and 1.3 fruits per meal. CACFP Guideline Achievement Scores were 66.3% ± 7.8 for menus and 59.3% ± 7.6 for mealtimes. Similar to previous research, our findings indicate a need for improved FCCH nutrition practices. Tailored interventions for FCCHs are needed.
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Affiliation(s)
- Bethany D. Williams
- Department of Nutritional Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, 1200 N. Stonewall Ave., AHB 3068, Oklahoma City, OK 73117, USA; (B.D.W.); (E.L.S.); (H.N.H.); (J.G.-D.); (K.E.)
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University Health Sciences Spokane, 412 E Spokane Falls Blvd, Spokane, WA 99202, USA
| | - Susan B. Sisson
- Department of Nutritional Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, 1200 N. Stonewall Ave., AHB 3068, Oklahoma City, OK 73117, USA; (B.D.W.); (E.L.S.); (H.N.H.); (J.G.-D.); (K.E.)
| | - Emily L. Stinner
- Department of Nutritional Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, 1200 N. Stonewall Ave., AHB 3068, Oklahoma City, OK 73117, USA; (B.D.W.); (E.L.S.); (H.N.H.); (J.G.-D.); (K.E.)
| | - Hope N. Hetrick
- Department of Nutritional Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, 1200 N. Stonewall Ave., AHB 3068, Oklahoma City, OK 73117, USA; (B.D.W.); (E.L.S.); (H.N.H.); (J.G.-D.); (K.E.)
| | - Marny Dunlap
- Department of Pediatrics, Section of General and Community Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, 1200 Children’s Ave., Oklahoma City, OK 73104, USA;
| | - Jennifer Graef-Downard
- Department of Nutritional Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, 1200 N. Stonewall Ave., AHB 3068, Oklahoma City, OK 73117, USA; (B.D.W.); (E.L.S.); (H.N.H.); (J.G.-D.); (K.E.)
| | - Kathrin Eliot
- Department of Nutritional Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, 1200 N. Stonewall Ave., AHB 3068, Oklahoma City, OK 73117, USA; (B.D.W.); (E.L.S.); (H.N.H.); (J.G.-D.); (K.E.)
| | - Karla Finnell
- Department of Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, OK 73104, USA; (K.F.); (A.L.S.)
| | - Alicia L. Salvatore
- Department of Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, OK 73104, USA; (K.F.); (A.L.S.)
- Institute for Research on Equity and Community Health, ChristianaCare, Wilmington, DE 19803, USA
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE 19706, USA
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14
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Abstract
Objective: Feeding practices used by educators in Early Childhood Education and Care (ECEC) settings can influence the diet quality of young children. However, Australian data is scarce and limited to describing barriers to responsive feeding. This study describes the use of feeding practices amongst a group of Australian educators. Design: Direct observation of feeding practices and assessment of centre policy were conducted using the ‘Environment and Policy Assessment and Observation’ tool. Self-reported feeding practices and demographic data were collected via online survey using the Childcare Food and Activity Practices Questionnaire. Setting: Ten centre-based ECEC services in South East Queensland, Australia. Participants: Educators working in ECEC. Results: A total of 120 meals were observed and 88 educators provided self-report data (n 84 female). Centre policy supported the use of responsive feeding practices, and this was reflected in the high frequency with which children could decide what and how much to eat, across both observed and self-report data as well as low levels of pressure to eat and use of food as a reward (observed at 19·9 % and 0 % of meals). The only apparent discrepancy was regarding modelling. Median score for self-reported role-modelling was 5·0 (4·3–5·0) and educators were observed to sit with children at 75 % of meals, however observed occasions of enthusiastic role modelling was only 22 % (0–33·3) of meals. Conclusions: Research addressing how educators conceptualise feeding practices, as well under what circumstances they are used, particularly in centres with different models of food provision, may shed light on why modelling is rarely implemented in practice.
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Swindle T, Phelps J, Schrick B, Johnson SL. Hungry is not safe: A mixed methods study to explore food insecurity in early care and education. Appetite 2021; 167:105626. [PMID: 34389375 DOI: 10.1016/j.appet.2021.105626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 06/09/2021] [Accepted: 08/04/2021] [Indexed: 11/25/2022]
Abstract
The early care and education (ECE) environment has the potential to affect both children and their families. Food insecurity in ECE and its management may be an important influence. Objectives of this mixed methods study were to (1) elicit prominent themes relating to teacher experiences with food insecurity (in the classroom) through qualitative interviews; (2) translate interview themes into survey items and analyze survey data to explore generalizability of the qualitative findings; and (3) provide preliminary data on properties of a new tool to study the influence of food insecurity in the ECE setting. An exploratory sequential mixed methods design (QUAL → quant) was used. Twenty-eight interviews about teacher experiences with food insecurity were followed by 781 surveys to assess generalizability of interview findings. Qualitative themes highlighted that ECE teachers are concerned about children's food insecurity in their classroom; ECE teachers have developed their own set of strategies to manage their concern; and teachers often struggle with what to do. Quantitative results demonstrated many teachers had the same concerns and used the strategies described in the interviews. Further, in exploratory analyses, ECE teachers with Food Insecurity scored significantly higher on all scales (e.g., Food Insecurity Concerns, Struggle with Addressing Food Security) in both adjusted and unadjusted analyses. ECE teachers with Food Acquisition Stress had higher scores on Strategies to Address Food Insecurity with Families in adjusted analyses.
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Affiliation(s)
- Taren Swindle
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, #530, Little Rock, AR, 72205-7199, USA.
| | - Joshua Phelps
- Cooperative Extension, Division of Agriculture, University of Arkansas, 2301 S University Ave, Little Rock, AR, 72204, USA
| | - Britney Schrick
- Cooperative Extension, Division of Agriculture, University of Arkansas, 2301 S University Ave, Little Rock, AR, 72204, USA
| | - Susan L Johnson
- Department of Pediatrics, University of Colorado, 12631 East 17th Avenue, Mail Stop F-561 Academic Office Building, Aurora, CO, 80045, USA
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Pallewaththa P, Agampodi TC, Agampodi SB, Pérez-Escamilla R, Siribaddana S. Measuring Responsive Feeding in Sri Lanka: Development of the Responsive Feeding Practices Assessment Tool. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:489-502. [PMID: 33775569 DOI: 10.1016/j.jneb.2021.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To develop and validate a tool focusing on responsive feeding (RF) practices among mothers and infants aged between 6 and 12 months in Sri Lanka. DESIGN A comprehensive review, an in-depth qualitative study, and a cross-sectional study were carried out. SETTING Anuradhapura District, Sri Lanka. PARTICIPANTS Sample of mother-infant pairs (n = 170). VARIABLES MEASURED Items were developed by extracting data from a previous in-depth qualitative study on RF, informed by currently available RF items. ANALYSIS Content validation was performed among experts using standard techniques, followed by cognitive interviews among mothers. Structural validity was assessed using principal component analysis. Test-retest reliability was done with a sample of 50 mothers. RESULTS Cognitive validation with mothers confirmed the applicability and comprehensiveness of the tool. The tool possessed good reliability with an intraclass correlation of 0.80 and internal consistency of 0.79. The principal component analysis showed a clear 3 factor solution. The 3 factors were interpreted as responsive communication during feeding, appropriate feeding, attentive to child's signals, and proactive preparation of the feeding environment. The final version of the tool consisted of 15 items. CONCLUSIONS AND IMPLICATIONS The 15-item Responsive Feeding Practices Assessment Tool is a valid tool to assess RF.
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Affiliation(s)
- Prabhath Pallewaththa
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka.
| | - Thilini C Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka
| | - Suneth B Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT
| | - Sisira Siribaddana
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka
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Hodder RK, O'Brien KM, Tzelepis F, Wyse RJ, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2020; 5:CD008552. [PMID: 32449203 PMCID: PMC7273132 DOI: 10.1002/14651858.cd008552.pub7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Testing the effects of interventions to increase consumption of fruit and vegetables, including those focused on specific child-feeding strategies or broader multicomponent interventions targeting the home or childcare environment is required to assess the potential to reduce this disease burden. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 January 2020. We searched Proquest Dissertations and Theses in November 2019. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included trials to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 80 trials with 218 trial arms and 12,965 participants. Fifty trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fifteen trials examined the impact of parent nutrition education only in increasing child fruit and vegetable intake. Fourteen trials examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake. One trial examined the impact of a child-focused mindfulness intervention in increasing vegetable intake. We judged 23 of the 80 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is low-quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption, equivalent to an increase of 5.30 grams as-desired consumption of vegetables (SMD 0.50, 95% CI 0.29 to 0.71; 19 trials, 2140 participants; mean post-intervention follow-up = 8.3 weeks). Multicomponent interventions versus no intervention has a small effect on child consumption of fruit and vegetables (SMD 0.32, 95% CI 0.09 to 0.55; 9 trials, 2961 participants; moderate-quality evidence; mean post-intervention follow-up = 5.4 weeks), equivalent to an increase of 0.34 cups of fruit and vegetables a day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.13, 95% CI -0.02 to 0.28; 11 trials, 3050 participants; very low-quality evidence; mean post-intervention follow-up = 13.2 weeks). We were unable to pool child nutrition education interventions in meta-analysis; both trials reported a positive intervention effect on child consumption of fruit and vegetables (low-quality evidence). Very few trials reported long-term effectiveness (6 trials), cost effectiveness (1 trial) or unintended adverse consequences of interventions (2 trials), limiting our ability to assess these outcomes. Trials reported receiving governmental or charitable funds, except for four trials reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 80 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited in terms of quality of evidence and magnitude of effect. Of the types of interventions identified, there was moderate-quality evidence that multicomponent interventions probably lead to, and low-quality evidence that child-feeding practice may lead to, only small increases in fruit and vegetable consumption in children aged five years and under. It is uncertain whether parent nutrition education or child nutrition education interventions alone are effective in increasing fruit and vegetable consumption in children aged five years and under. Our confidence in effect estimates for all intervention approaches, with the exception of multicomponent interventions, is limited on the basis of the very low to low-quality evidence. Long-term follow-up of at least 12 months is required and future research should adopt more rigorous methods to advance the field. This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Kate M O'Brien
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Rebecca J Wyse
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
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18
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Sleet K, Sisson SB, Dev DA, Love C, Williams MB, Hoffman LA, Jernigan VBB. The Impact of Responsive Feeding Practice Training on Teacher Feeding Behaviors in Tribal Early Care and Education: The Food Resource Equity and Sustainability for Health (FRESH) Study. Curr Dev Nutr 2020; 4:23-32. [PMID: 32258996 PMCID: PMC7101487 DOI: 10.1093/cdn/nzz105] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/10/2019] [Accepted: 09/13/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Establishing healthy eating habits early affects lifelong dietary intake, which has implications for many health outcomes. With children spending time in early care and education (ECE) programs, teachers establish the daytime meal environment through their feeding practices. OBJECTIVE We aimed to determine the effect of a teacher-focused intervention to increase responsive feeding practices in 2 interventions, 1 focused exclusively on the teacher's feeding practices and the other focused on both the teacher's feeding practices and a nutrition classroom curriculum, in ECE teachers in a Native American (NA) community in Oklahoma. METHODS Nine tribally affiliated ECE programs were randomly assigned to 1 of 2 interventions: 1) a 1.5-h teacher-focused responsive feeding practice training (TEACHER; n = 4) and 2) TEACHER plus an additional 3-h training to implement a 15-wk classroom nutrition curriculum (TEACHER + CLASS; n = 5). Feeding practice observations were conducted during lunch at 1 table in 1 classroom for 2- to 5-y-olds at each program before and 1 mo after the intervention. The Mealtime Observation in Child Care (MOCC) organizes teacher behaviors into 8 subsections. Descriptive statistics and the Shapiro-Wilk test for normality were calculated. Paired t tests were calculated to determine change in each group. RESULTS A mean ± SD of 5.2 ± 2.0 (total n = 47) children and 1.7 ± 0.5 (total n = 14) teachers/center were observed at baseline, and 5.6 ± 1.7 (total n = 50) children and 1.7 ± 0.7 teachers (total n = 14) were observed/center postintervention. Total MOCC scores (max possible = 10) improved for TEACHER (6.1 ± 0.9 compared with 7.5 ± 0.3, t = 4.12, P = 0.026) but not for TEACHER + CLASS (6.5 ± 0.8 compared with 6.4 ± 1.0, t = -0.11, P = 0.915). No other changes were observed. CONCLUSIONS Teacher intervention-only programs demonstrated improvements in responsive feeding practices, whereas the programs receiving teacher and classroom training did not. Greater burden likely decreased capacity to make changes in multiple domains. We demonstrated the ability to implement interventions in NA ECE. Further research with larger communities is necessary. This trial was registered at clinicaltrials.gov as NCT03251950.
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Affiliation(s)
- Kaysha Sleet
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Susan B Sisson
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Dipti A Dev
- Department of Child, Youth and Family Studies, College of Education and Human Sciences, University of Nebraska Lincoln, Lincoln, NE, USA
| | - Charlotte Love
- Center for Indigenous Health Research and Policy, Oklahoma State University, Tulsa, OK, USA
| | - Mary B Williams
- Department of Biostatistics and Epidemiology, College of Public Health—Schusterman Center, University of Oklahoma Health Sciences Center, Tulsa, OK, USA
| | - Leah A Hoffman
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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19
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Hodder RK, O'Brien KM, Stacey FG, Tzelepis F, Wyse RJ, Bartlem KM, Sutherland R, James EL, Barnes C, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2019; 2019:CD008552. [PMID: 31697869 PMCID: PMC6837849 DOI: 10.1002/14651858.cd008552.pub6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Interventions to increase consumption of fruit and vegetables, such as those focused on specific child-feeding strategies and parent nutrition education interventions in early childhood may therefore be an effective strategy in reducing this disease burden. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 August 2019. We searched Proquest Dissertations and Theses in May 2019. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included trials to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 78 trials with 214 trial arms and 13,746 participants. Forty-eight trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fifteen trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Fourteen trials examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake. One trial examined the impact of a child-focused mindfulness intervention in increasing vegetable intake. We judged 20 of the 78 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is very low-quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption equivalent to an increase of 4.45 g as-desired consumption of vegetables (SMD 0.42, 95% CI 0.23 to 0.60; 18 trials, 2004 participants; mean post-intervention follow-up = 8.2 weeks). Multicomponent interventions versus no intervention has a small effect on child consumption of fruit and vegetables (SMD 0.34, 95% CI 0.10 to 0.57; 9 trials, 3022 participants; moderate-quality evidence; mean post-intervention follow-up = 5.4 weeks), equivalent to an increase of 0.36 cups of fruit and vegetables per day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.12, 95% CI -0.03 to 0.28; 11 trials, 3078 participants; very low-quality evidence; mean post-intervention follow-up = 13.2 weeks). We were unable to pool child nutrition education interventions in meta-analysis; both trials reported a positive intervention effect on child consumption of fruit and vegetables (low-quality evidence). Very few trials reported long-term effectiveness (6 trials), cost effectiveness (1 trial) and unintended adverse consequences of interventions (2 trials), limiting their assessment. Trials reported receiving governmental or charitable funds, except for four trials reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 78 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited. There was very low-quality evidence that child-feeding practice may lead to, and moderate-quality evidence that multicomponent interventions probably lead to small increases in fruit and vegetable consumption in children aged five years and younger. It is uncertain whether parent nutrition education interventions are effective in increasing fruit and vegetable consumption in children aged five years and younger. Given that the quality of the evidence is very low or low, future research will likely change estimates and conclusions. Long-term follow-up of at least 12 months is required and future research should adopt more rigorous methods to advance the field. This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Kate M O'Brien
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Fiona G Stacey
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
- University of NewcastlePriority Research Centre in Physical Activity and NutritionCallaghanAustralia
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Kate M Bartlem
- University of NewcastleSchool of PsychologyUniversity DriveCallaghanNew South WalesAustralia2308
| | - Rachel Sutherland
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Erica L James
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
| | - Courtney Barnes
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Luke Wolfenden
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
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