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Robertson E, Leyland A, Pearce A. The potential of early years' childcare to reduce mental health inequalities of school age children in Scotland. SSM Popul Health 2024; 26:101682. [PMID: 38952743 PMCID: PMC11216001 DOI: 10.1016/j.ssmph.2024.101682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 04/23/2024] [Accepted: 05/21/2024] [Indexed: 07/03/2024] Open
Abstract
Preschool childcare is considered an important policy for reducing inequalities in children's cognitive and socio-emotional development, although the population-level benefits for children under three years, is less clear. We examined the potential for childcare across the whole early years' period to benefit mental health and reduce inequalities, under different hypothetical policy scenarios, in the Growing Up in Scotland study. Marginal structural logistic regression models estimated odds ratios (ORs) to quantify inequalities in mental health and consider how these would be altered under different hypothetical scenarios. Mental health (the outcome) was measured using the total Strengths and Difficulties Questionnaire score at the start of primary school. Socioeconomic circumstances (the exposure) were represented by maternal educational measured in infancy. Sequence analysis identified common patterns of childcare usage from 10 months to four years (the mediator). Confounders were adjusted for using inverse probability of treatment weights and analyses accounted for sampling design and attrition (complete case sample, n = 3205). With virtually universal uptake of government-funded childcare at 3-4 years, most variation was seen before age three. Four groups were identified: 'Parents, family & friends' (35.8%), 'Grandparents' (32.7%), 'Private group childcare' (e.g. nurseries 23.5%), 'Single professional care' (e.g. childminders 8.1%). Children whose mothers had low, compared to high, educational qualifications were 3.18 times more likely to have mental health problems (95% CI: 1.88-5.37). In a hypothetical scenario where everyone received private group childcare, inequalities increased slightly to 3.78 (95%CI: 1.46-9.76). In an alternative scenario, where everyone received single professional childcare, inequalities in mental health reduced to 2.42 (95% CI: 0.20-28.76), albeit with wide confidence intervals. Universal childcare provision before three years may widen or narrow socioeconomic inequalities in children's mental health, depending on the childcare type provided. Further research is required to understand the role of childcare quality, which we were unable to account for.
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Affiliation(s)
- Elaine Robertson
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Clarice Pears, Building, 90 Byres Road, Glasgow, G12 8TB, UK
| | - Alastair Leyland
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Clarice Pears, Building, 90 Byres Road, Glasgow, G12 8TB, UK
| | - Anna Pearce
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Clarice Pears, Building, 90 Byres Road, Glasgow, G12 8TB, UK
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Barton JM, Lundquist A, Fisher MC, Fiese BH, McBride BA. Identifying elevated child weight from 3 to 24 months: Early transitions into nonparental care and to solid foods. Pediatr Obes 2024; 19:e13115. [PMID: 38520256 PMCID: PMC11081828 DOI: 10.1111/ijpo.13115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/15/2024] [Accepted: 03/07/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Early entry into nonparental care (NPC) and introduction to solid foods (ITS) have been linked to elevated weight, however, little research exists on the combined influence of these transitions on child weight over time. OBJECTIVES Identify groups of children based on early NPC and ITS timing and examine whether NPC-ITS groups differentially affect child weight over time. METHOD Data were drawn from STRONG Kids2 (n = 468). Primary predictors include NPC (by 3M)-ITS (< or ≥6M) groups; outcome variables include child weight-for-length/height z-scores (WFL/WFHz) (3, 12, 18, and 24 months). Multilevel regression was used to examine the NPC-ITS groups as predictors of child WFL/WFHz. RESULTS Six groups were identified: 27% Parental Care-ITS before 6M, 31% Parental Care-ITS after 6M, 12% Daycare-ITS before 6M, 14% Daycare-ITS after 6M, 10% Kincare-ITS before 6M, and 7% Kincare-ITS after 6M. Children who were in daycare (regardless of ITS) or kincare-ITS before 6M demonstrated the highest WFL/WFHz over time, compared to their parental care counterparts. CONCLUSIONS NPC-ITS combinations on child WFL/WFHz across the first 2 years of life highlight the need for a partnership approach among parental and nonparental caregivers to support the feeding of infants throughout the transition to solid foods.
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Affiliation(s)
- Jennifer M. Barton
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, USA
- Family Resiliency Center, University of Illinois, Urbana-Champaign, Urbana, IL, USA
| | - Alexandra Lundquist
- Division of Nutritional Sciences, University of Illinois, Urbana-Champaign, Urbana, IL, USA
| | - Meghan C. Fisher
- Department of Human Development and Family Studies, University of Illinois, Urbana-Champaign, Urbana, IL, USA
- Child Development Laboratory, University of Illinois, Urbana-Champaign, Urbana, IL, USA
| | - Barbara H. Fiese
- Department of Human Development and Family Studies, University of Illinois, Urbana-Champaign, Urbana, IL, USA
| | - Brent A. McBride
- Division of Nutritional Sciences, University of Illinois, Urbana-Champaign, Urbana, IL, USA
- Department of Human Development and Family Studies, University of Illinois, Urbana-Champaign, Urbana, IL, USA
- Child Development Laboratory, University of Illinois, Urbana-Champaign, Urbana, IL, USA
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Pate RR, Zaltz DA, Neelon B, Liu T, Bucko A, Benjamin-Neelon SE. Policies, Practices, and Environmental Characteristics Among Family Child Care Homes in South Carolina. Child Obes 2024. [PMID: 38197857 DOI: 10.1089/chi.2023.0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Background: Child care program requirements have adopted nutrition and physical activity standards to address childhood obesity, but few studies have examined the effects of these standards in family child care homes (FCCHs). Methods: In a cross-sectional study (2017-2019), the Childcare Home Eating and Exercise study examined self-reported provider characteristics and observed policies and practices related to physical activity and nutrition in FCCHs in South Carolina. Two-sample t-tests were used to compare observed nutrition and physical activity policy, practice, and environment scores in child care homes that participated in versus did not participate in the state's ABC Quality program, which is designed to improve child care and includes policies and practices intended to increase physical activity levels and improve diet quality. Results: Environment and Policy Assessment and Observation results for nutrition and physical activity were 7.5 out of 21 and 11.8 out of 30, respectively, indicating much room for improvement in nutrition and physical activity policies, practices, and environment in South Carolina FCCHs. The study found one difference between FCCHs that did and did not participate in the ABC Quality program; non-ABC homes provided more time for physical activity. Conclusions: Future research should develop ways to strengthen the guidelines and improve the implementation of obesity prevention standards in FCCHs.
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Affiliation(s)
- Russell R Pate
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Daniel A Zaltz
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Brian Neelon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Tiange Liu
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Agnes Bucko
- College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Sara E Benjamin-Neelon
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Chaturvedi S, Swaminathan S, Makkar S, John AT, Thomas T. Assessing association of household diet diversity with mother's time use on productive and reproductive activities: a case for gender sensitive social safety nets. Public Health Nutr 2024; 27:e33. [PMID: 38171547 PMCID: PMC10897577 DOI: 10.1017/s1368980023002963] [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] [Indexed: 01/05/2024]
Abstract
OBJECTIVE In South Asia, while women make substantial economic contributions through their participation in agricultural sector, these contributions are undercounted as most of their work is underpaid or unpaid. This paper examines how mothers allocate their time to productive and reproductive activities and its association with a household's ability to achieve high household diet diversity score. DESIGN The analysis uses data on household consumption and expenditure including food during the kharif (June to October) season (seeds are sown) and a modular time-use survey. SETTING Two districts of rural Bihar, India. PARTICIPANTS Mothers with children less than 5 years of age and supported by the head of the household from 2026 households. RESULTS The estimates indicate that the high household diet diversity (High HDDS ≥ 10) is associated with greater time spent in reproductive activities by all women (OR = 1·12, 95 % CI: 1·06, 1·18). However, with increasing time spent in productive activities by the women the odds of achieving 'High HDDS' reduced (OR = 0·83, 95 % CI: 0·77, 0·89) in adjusted logistic regression analysis. CONCLUSION The findings highlight propensity to achieve 'High HDDS' in Bihar increased with mothers allocating time towards reproductive activities, while it had an opposing effect with mothers allocating time on productive activities. Our study highlights that the policies that encourage women's participation in agriculture or livestock should acknowledge the unpaid nature of some of the productive activities and design programs to improve economic agency of women to actuate the true potential of agriculture-nutrition pathways.
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Affiliation(s)
- Surabhi Chaturvedi
- Division of Epidemiology and Biostatistics, St. John's Research Institute, Bangalore, India
| | | | - Sanchit Makkar
- Division of Nutrition, St. John's Research Institute, Bangalore, India
| | - Anjaly Teresa John
- Division of Epidemiology and Biostatistics, St. John's Research Institute, Bangalore, India
| | - Tinku Thomas
- Department of Biostatistics, St. John's Medical College, Bangalore560034, India
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Fiese BH, Barton JM, Sahin E. Longitudinal changes in home food availability across the first 3 years of life and associations with family context predictors. Front Nutr 2023; 10:1215894. [PMID: 37841403 PMCID: PMC10569424 DOI: 10.3389/fnut.2023.1215894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/31/2023] [Indexed: 10/17/2023] Open
Abstract
Background There is limited research tracking changes in home food availability during the first 3 years of life and whether the family context influences these changes. Objective This study examined changes in and predictors of home food availability across the first 3 years of life. Design This study utilized longitudinal data from the STRONG Kids2 birth cohort from the target child at 6 weeks to 36 months postpartum. Participants Mothers of 468 children were surveyed at 6 weeks, 3, 12, 24, and 36 months postpartum. Methods Home observations were completed by trained research assistants to complete the presence of foods in the home. The primary outcomes were the availability of 10 food groups and scores from the Home Food Inventory (HFI), including dairy (regular fat), dairy (reduced fat), processed meats, other meats and non-dairy protein, savory snacks, vegetables, vegetables (no potatoes), and three obesogenic scores. Repeated measures ANOVA were used to examine changes in the HFI food groups and obesogenic scores over time. Multilevel regressions were conducted to examine whether the presence of an older sibling, entry into childcare, and mother's return to full-time work were associated with the HFI. Results Significant changes were detected for dairy (regular fat), other meats and non-dairy protein, savory snacks, vegetables, vegetables (no potatoes), and all obesogenic scores across time. A linear trend occurred for most HFI groups, however, the third obesogenic score (without milk and cheese) was highest at 3 months, declined at 12 months, and then slowly increased from 12 to 36 months years. The presence of an older sibling was a consistent predictor of the HFI groups over time. Entry into childcare was only associated with the availability of processed meats. Conclusion The availability of food types shift as children age and their dietary needs alter. It is important to consider the whole family context such as the presence of older siblings whose dietary needs may differ from younger children. Future efforts are warranted to consider changes in food availability among diverse samples and different family structures.
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Affiliation(s)
- Barbara H. Fiese
- Family Resiliency Center, University of Illinois Urbana-Champaign, Urbana, IL, United States
- Department of Human Development and Family Studies, University of Illinois Urbana-Champaign, Urbana, IL, United States
| | - Jennifer M. Barton
- Family Resiliency Center, University of Illinois Urbana-Champaign, Urbana, IL, United States
| | - Esra Sahin
- Department of Human Development and Family Studies, University of Illinois Urbana-Champaign, Urbana, IL, United States
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Hu Y, Qian X, Chen J, Huang D. The status and childcare management of overweight and obesity among preschool children in Hangzhou. J Pediatr Endocrinol Metab 2023; 36:859-864. [PMID: 37553860 DOI: 10.1515/jpem-2023-0248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/25/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVES This study aims to investigate the prevalence of overweight and obesity in preschool children in Hangzhou and assess the impact of childcare management. By examining the characteristics and predicting the trends of overweight and obesity, we hope to emphasize the significance of childcare management in primary community health service centers and the use of Electronic Health-care System in kindergartens. This study also seeks to provide evidence for intervention measures and effective prevention and control management of childhood obesity. METHODS From 2020 to 2022, kindergarten children aged 3-6 years old were selected as the research objects in kindergartens in Hangzhou. The Electronic Health-care System will be utilized to facilitate the management of childhood obesity and provide guidance and training to pediatricians and Primary Care Physicians. RESULTS The overall detection rates of overweight and obesity were 7.27 % and 3.55 %, respectively, among children aged 3-6 years in Hangzhou. The rates of simple obesity in Hangzhou preschool children aged 3-6 years were 4.25 , 3.42, and 3.04 % from 2020 to 2022, respectively; the overweight detection rates of children were 8.27 , 7.28, and 6.34 %, respectively, and the difference was statistically significant (p<0.05). The detection rates of overweight and obesity in 2022 were significantly lower than those in 2020 (p<0.05). The prevalence of obesity in children increased with age. Boys had a significantly higher incidence rate of obesity than girls (p<0.05). The proportion of children with moderate and severe obesity showed a downward trend. Intervention measures for childhood obesity in primary community health service centers and kindergartens are constantly being implemented. CONCLUSIONS The prevalence of obesity in preschool children aged 3-6 years in Hangzhou exhibited a decreasing tendency. This research has identified that child care administration, particularly the implementation of the Electronic Health-care System, demonstrates effectiveness in handling overweight and obesity amongst children.
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Affiliation(s)
- Ye Hu
- Department of Child Health Care, Hangzhou Women's Hospital (Hangzhou Maternity and Child Care Hospital), Hangzhou, P.R. China
| | - Xia Qian
- Department of Child Health Care, Hangzhou Women's Hospital (Hangzhou Maternity and Child Care Hospital), Hangzhou, P.R. China
| | - Jinqing Chen
- Department of Child Health Care, Hangzhou Women's Hospital (Hangzhou Maternity and Child Care Hospital), Hangzhou, P.R. China
| | - Dan Huang
- Department of Child Health Care, Hangzhou Women's Hospital (Hangzhou Maternity and Child Care Hospital), Hangzhou, P.R. China
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Zaltz DA, Pate RR, Liu T, McIver KL, Neelon B, Benjamin-Neelon SE. Young Children's Dietary Quality in Family Child Care and in Their Own Home. J Acad Nutr Diet 2023; 123:1197-1206. [PMID: 37479379 PMCID: PMC10851279 DOI: 10.1016/j.jand.2022.10.014] [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: 10/26/2021] [Revised: 09/29/2022] [Accepted: 10/25/2022] [Indexed: 07/23/2023]
Abstract
BACKGROUND Some evidence suggests that children may have higher quality dietary intake in early care and education settings, compared with their respective homes, but no studies have explored these differences among children in less formal family child care. OBJECTIVE The purpose of this study was to compare dietary quality via the Healthy Eating Index 2015 among children in family child care and in their own home. DESIGN This was a cross-sectional analysis of baseline dietary intake data from the Childcare Home Eating and Exercise Research study, a natural experiment, using directly observed dietary data in child care and 24-hour recall data in homes among children in South Carolina. PARTICIPANTS/SETTING Participants were 123 children in 52 family child-care homes between 2018 and 2019. MAIN OUTCOME MEASURE The main outcome was total and component Healthy Eating Index 2015 scores. STATISTICAL ANALYSIS The analysis was a hierarchical linear regression of children nested within family child care homes adjusting for child, provider, facility, and parent characteristics, including sex, age, race, ethnicity, and income, with parameters and SEs estimated via bootstrap sampling. RESULTS Children had a mean ± SD Healthy Eating Index 2015 score of 60.3 ± 12.1 in family child-care homes and 54.3 ± 12.9 in their own home (P < 0.001). In adjusted analysis and after accounting for clustering of children in family child care homes, total HEI-2015 scores were lower at home than in care (β = -5.18 ± 1.47; 95% CI -8.05 to -2.30; P = 0.003). CONCLUSIONS Children had healthier dietary intake in family child-care homes vs their respective homes.
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Affiliation(s)
- Daniel A Zaltz
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Russell R Pate
- Department of Exercise Science, University of South Carolina Arnold School of Public Health, Columbia, South Carolina
| | - Tiange Liu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kerry L McIver
- Department of Exercise Science, University of South Carolina Arnold School of Public Health, Columbia, South Carolina
| | - Brian Neelon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Sara E Benjamin-Neelon
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Kucab MD, Keown-Stoneman CDG, Birken CS, Perlman M, Maguire JL. Centre-based childcare in early childhood and growth in later childhood: a prospective cohort study. Int J Obes (Lond) 2023:10.1038/s41366-023-01316-2. [PMID: 37106078 DOI: 10.1038/s41366-023-01316-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Attending government-regulated centre-based childcare may influence important health behaviours including dietary quality, physical activity and routines related to child growth. However, the relationship between centre-based childcare and childhood obesity remains unclear. OBJECTIVES The primary objective was to evaluate the association between centre-based childcare attendance in early childhood and body mass index z-score (zBMI) in later childhood. Secondary objectives included exploring whether family income, child sex, or non-centre-based setting modified these relationships. METHODS A prospective cohort study of children aged 1 to 10 years who participated in the TARGet Kids! cohort was conducted. Linear mixed-effect modelling was used to evaluate the relationship between centre-based childcare attendance (in hours/week) compared to non-centre-based childcare between 1-4 years of age and zBMI between 4 and 10 years of age. Generalised estimating equation modelling was used to explore weight status categories. Models were adjusted for confounders and effect modification was explored. RESULTS A total of 3503 children were included. Children who attended centre-based childcare full-time (40 h/week) had 0.11 (95% CI: -0.19, -0.03; p = 0.01) lower zBMI at 4 and 7 years of age and lower odds of overweight and obesity at 4 years (OR 0.78; 95% CI: 0.62, 0.97; p = 0.03), but no evidence of an association was found at 10 years of age. Children from families with income < $50,000CDN who attended centre-based childcare full-time had 0.32 (95% CI: -0.50, -0.14; p = 0.001) lower zBMI and lower odds of overweight and obesity (OR 0.52; 95% CI: 0.28, 0.99; p = 0.05) at 10 years of age. CONCLUSIONS Attending centre-based childcare in early childhood was associated with a lower zBMI and odds of overweight and obesity in later childhood. These associations were stronger for children from lower income families. Centre-based childcare may be an early intervention for the prevention of childhood obesity. CLINICAL TRIAL Clinical Trial Registry Number: NCT01869530 (clinicaltrials.gov).
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Affiliation(s)
- Michaela D Kucab
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Paediatrics, St. Michael's Hospital, Toronto, ON, Canada
| | - Charles D G Keown-Stoneman
- Applied Health Research Centre, Unity Health Toronto, Toronto, ON, Canada
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Catherine S Birken
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Nutritional Sciences, Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, ON, Canada
| | - Michal Perlman
- Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada
| | - Jonathon L Maguire
- Department of Paediatrics, St. Michael's Hospital, Toronto, ON, Canada.
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
- Department of Nutritional Sciences, Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, ON, Canada.
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
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Williams BD, Sisson SB, Bhattacharya S, Merchant C, Slawinski M, Hildebrand D, Stoner JA, Fortin-Miller S, Patel SM, Salvatore AL. Process Evaluation of Two Interventions to Improve Health Environments in Family Child Care Homes. HEALTH EDUCATION & BEHAVIOR 2023; 50:211-223. [PMID: 34963346 DOI: 10.1177/10901981211057537] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Early care and education (ECE) environments influence children's lifelong health behaviors, growth, and development. Although the number of interventions to improve health in ECE environments is increasing, few have been designed for and tested in family child care homes (FCCHs). This study reports the process evaluation of two interventions to improve FCCH health environments, both part of Happy Healthy Homes, a matched-attention randomized-controlled intervention trial conducted in Oklahoma FCCHs. Participating child care providers received one of two multicomponent interventions: (a) an intervention focused on enhancing the quality of the nutrition environment, self-efficacy, and practices or (b) an intervention focused on improving providers' environmental health literacy, self-efficacy, and practices. Guided by "Implementation" constructs of the RE-AIM framework (i.e., reach, effectiveness, adoption, implementation, maintenance), intervention report forms and participant tracking were used to assess intervention dose delivered and interventionist-perceived challenges and successes to implementation. Interviews were conducted to obtain participant feedback after the intervention. Dose delivered was high for both interventions overall and across individual sessions, and provider feedback was positive. Implementation challenges and strengths identified for both interventions may be useful for further enhancing intervention appropriateness and success, particularly for interventions with FCCHs. Process evaluation findings indicate that the two Happy Healthy Home interventions can be conducted with high delivery and are well attended and considered to be valuable to FCCH providers.
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Affiliation(s)
- Bethany D Williams
- The University of Oklahoma Health Sciences Center, USA.,Washington State University Health Sciences Spokane, USA
| | | | | | - Cady Merchant
- The University of Oklahoma Health Sciences Center, USA
| | | | | | | | | | - Sarah M Patel
- The University of Oklahoma Health Sciences Center, USA
| | - Alicia L Salvatore
- The University of Oklahoma Health Sciences Center, USA.,Christiana Care Health System Value Institute, Newark, DE, USA
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Sello M, Adedini SA, Odimegwu C, Petlele R, Tapera T. The Relationship between Childcare-Giving Arrangements and Children's Malnutrition Status in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2572. [PMID: 36767937 PMCID: PMC9915111 DOI: 10.3390/ijerph20032572] [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: 10/12/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
Multiple caregiving arrangements have become common for childcare globally, and South Africa is no exception. Previous childcare studies mainly focused on the caregiver and household characteristics. Evidence on the influence of childcare on malnutrition is sparse. This study aimed to examine the relationship between exposure to secondary and multiple forms of care and child malnutrition, with a particular focus on child stunting and overweight among children. A cross-sectional study of a sample of 2966 dyads of mothers and children under five were analysed from the 2017 National Income Dynamics Study (NIDS) Wave 5. Descriptive and inferential statistics were used to analyse the data. The results indicated that 22.16% of the children were stunted and that 16.40% were overweight. Most children were mainly cared for at home (67.16%) during the day. Some results of the obtained multivariable analyses show that lack of being cared for in a crèche or school during the day was significantly associated with stunting (odds ratio (OR) 2; confidence interval (CI) 1.10-3.62, p < 0.05) and overweight (OR) 3.82; (CI) 1.60-9.08, p < 0.05). Furthermore, in this study, 69.88% of children who were cared for at home by the primary caregiver had no other forms of multiple care arrangements. The results showing high stunting and overweight rates among children cared for at home suggest that the government needs to look into supporting caregiver parenting. The high unemployment rates in the country highlight the importance of socioeconomic status in childcare and its implication for children's nutritional outcomes. The study's findings suggest the need for innovative strategies to address the challenges associated with multi-caregiving which negatively affects children's nutritional outcomes.
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Affiliation(s)
- Matshidiso Sello
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
- Centre for Social Development in Africa, University of Johannesburg, Johannesburg 2092, South Africa
| | - Sunday A. Adedini
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
- Department of Demography and Social Statistics, Faculty of Social Sciences, Federal University Oye-Ekiti, Oye-Ekiti 371104, Nigeria
| | - Clifford Odimegwu
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Rebaone Petlele
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Talent Tapera
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
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Zhang Q, Sauval M, Jenkins JM. Impacts of the COVID-19 pandemic on the child care sector: Evidence from North Carolina. EARLY CHILDHOOD RESEARCH QUARTERLY 2022; 62:17-30. [PMID: 35999900 PMCID: PMC9389921 DOI: 10.1016/j.ecresq.2022.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 02/25/2022] [Accepted: 07/20/2022] [Indexed: 06/01/2023]
Abstract
This study provides a comprehensive, census-level evaluation of the impacts of the COVID-19 pandemic on the county child care market in a large and diverse state, North Carolina, and the disproportionate impacts of the pandemic on different types of providers and communities. We use county-level panel data from 2016 to 2020 and a difference-in-differences design to isolate the effects of the pandemic from unobservable seasonal trends in enrollments and closures. We found that the COVID-19 pandemic reduced county-level child care enrollment by 40% and the number of providers by 2% as of December 2020. Heterogeneity analyses revealed that the family child care sector experienced not only less severe reductions in enrollment and closure than center providers, but also a small growth in the number of family providers. Declines in enrollment were most substantial for preschool-aged children. There was a significant drop in the number of 5-star providers and an increase in the number of lower-quality providers. Provider closures were more concentrated in communities with a higher percentage of Hispanic residents. Higher-SES communities experienced larger drops in enrollment as well as provider closures. Implications for child development and future research and policies are discussed.
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Affiliation(s)
- Qing Zhang
- School of Education, University of California, Irvine, Irvine, CA, 92697, United States
| | - Maria Sauval
- School of Education, University of California, Irvine, Irvine, CA, 92697, United States
| | - Jade Marcus Jenkins
- School of Education, University of California, Irvine, Irvine, CA, 92697, United States
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Lou Y, Zhu Y, You Q, Jiang Q, Meng X, Di H, Xu H, Gan Y, Lu Z, Cao S. Maternal long working hours and offspring's weight-related outcomes: A systematic review and meta-analysis. Obes Rev 2022; 23:e13439. [PMID: 35293115 DOI: 10.1111/obr.13439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/13/2022] [Accepted: 01/13/2022] [Indexed: 11/28/2022]
Abstract
It is unclear whether maternal working time has an impact on offspring's weight-related outcomes especially obesity; the objective of this study is to conduct the first meta-analysis to focus on this topic. We searched PubMed, Ovid, and Web of Science databases through August 2021. A random-effect model was used to assess the pooled odds ratios (ORs) and regression coefficients (β) with their corresponding 95% confidence intervals (95% CIs). Subgroup analyses were conducted to explore sources of heterogeneity. Publication bias was evaluated by the Egger's tests. Twenty-two observational studies were included with a total of 191,420 participants. Compared with children whose mothers worked less than 35 h/week, we found that children whose mothers worked more than 35 to 40 h/week had a 2.24-fold increased risk of childhood overweight/obesity (OR = 2.24, 95% CI: 1.61-3.11). An increment of 10 h/week in maternal working was associated with an approximately 1.0 percentage points in the probability of childhood overweight/obesity (β = 0.008, 95% CI: 0.004-0.012). The pooled OR also indicated a similar result (OR = 1.09, 95% CI: 1.04-1.15). In addition, an increment of 10 h/week in maternal working was associated with 0.029 units increase in offspring's BMI z score (β = 0.029, 95% CI: 0.016-0.042). Maternal long working hours is a potential risk factor for offspring's weight-related outcomes. Measures should be taken to protect the work welfare of females, thus facilitating the positive interaction of individual-family-society.
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Affiliation(s)
- Yiling Lou
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yi Zhu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qiqi You
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qingqing Jiang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xin Meng
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hongkun Di
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hongbin Xu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zuxun Lu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shiyi Cao
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Associations of Childcare Arrangements with Adiposity Measures in a Multi-Ethnic Asian Cohort: The GUSTO Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212178. [PMID: 34831933 PMCID: PMC8622483 DOI: 10.3390/ijerph182212178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 01/02/2023]
Abstract
Childcare arrangements shape behavioural patterns that influence the risk of childhood obesity. However, little is known of its influence on childhood obesity in Singapore. We aim to examine the associations between childcare arrangements at the age of 5 years and childhood adiposity at age 6 years. Children from the GUSTO study were grouped into three childcare arrangements at age 5: full-time centre-based childcare (FC), partial centre-based with parental care (PCP), and partial centre-based with non-parents (grandparents and domestic helpers) as caregivers (PCN). Diet, physical activity and sedentary behaviour information were collected at age 5, while anthropometric measurements were collected at age 6. Associations were analysed using multivariable regression models. Among 540 children, those in PCN had higher BMI z-scores (β: 0.34; 95% CI: 0.01, 0.66), greater sum of skinfold thicknesses (mm) (β: 3.75; 95% CI: 0.53, 6.97) and were 3.55 times (95% CI: 1.78, 7.05) more likely to be overweight/obese than those in FC. Adiposity measures in PCP children did not differ from those in FC. PCN children were reported to have more screen time and greater fast-food intake. Children in PCN tended to have higher adiposity measures. Greater engagement of non-parental caregivers should be considered in interventions targeting child obesity.
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Assessing Cardiometabolic Health Risk Among U.S. Children Living in Grandparent-Headed Households. J Pediatr Nurs 2021; 61:331-339. [PMID: 34543828 DOI: 10.1016/j.pedn.2021.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE We evaluated children's cardiometabolic health (CMH) risk indicators and adverse childhood experiences (ACEs) stratified by family structure type (grandparent-headed, two-parent headed, and single-parent headed households). Separately, we assessed whether family structure type and number of ACEs were independently associated with the CMH risk indicators. DESIGN AND METHODS Utilizing data from the 2017-2018 National Survey of Children's Health, we evaluated five CMH risk indicators (obesity, physical activity, secondhand smoke exposure, sleep, and sports participation). We used multivariable logistic regressions to assess the association of CMH risk indicators with family structure type and ACEs. We controlled for sex, age, race/ethnicity, health insurance, household poverty level, and overall health status. RESULTS Among children aged 10-17 years (n = 24,885), we found the number of ACEs differed by family structure type (P < 0.001) and was independently associated with obesity, secondhand smoke exposure, sleep, and sports participation. Adjusting for all covariates except ACEs, family structure type was significantly associated with children's CMH risk; but after controlling for ACEs that association was attenuated - except for sleep (less adequate sleep in grandparent-headed households) and exposure to secondhand smoke (less exposure in single-parent headed households). CONCLUSIONS ACEs were highest among children living in grandparent-headed households and independently associated with a majority of the CMH risk indicators. Findings suggest that children living in grandparent-headed households may be at elevated risk for poor CMH, potentially due to higher risk for ACEs. PRACTICE IMPLICATIONS It is recommended to consider ACEs and family structure type when assessing CMH risk in children.
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Murphy TJ, Kaufman JS, Li P, Steele R, Yang S. Effect of preschool childcare on school-aged children's adiposity in Quebec, Canada. Paediatr Perinat Epidemiol 2021; 35:736-747. [PMID: 34164836 DOI: 10.1111/ppe.12790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Regulated public childcare must follow nutrition and physical activity guidelines, but the impact of public childcare on childhood adiposity is unclear. OBJECTIVES To estimate the effects of universal preschool childcare on children's BMI in elementary school in Quebec, Canada, and whether the effects differed in children from more or less advantaged families. METHODS For 1657 children enrolled in the Quebec Longitudinal Study of Child Development (1998-2010), BMI z-scores (BMIz) from 6 to 13 years were regressed on the childcare used from 2 to 5 years, adjusted for pre-childcare variables. Average treatment effects were estimated using the Bayesian multilevel linear regression and g-computation for four childcare profiles: 1) parental care or full-time care (35 hours/week) in a 2) centre-based, 3) regulated home-based or 4) unregulated home-based arrangement. RESULTS Had all participants attended centre-based care, mean BMIz in kindergarten would have been 0.38 (95% credible interval [CrI] 0.23, 0.52), which was 0.40 (95% CrI 0.14, 0.65) SD higher than regulated home-based, 0.20 (95% CrI -0.04, 0.43) SD higher than unregulated home-based and 0.36 (95% CrI 0.11, 0.60) SD higher than parental care. By 12 years, mean BMIz had increased for all childcare profiles, but differences between childcare profiles had diminished. CONCLUSIONS Although centre-based childcare was associated with an earlier rise in BMI, compared with informal care, it had no large, enduring effect, overall, or for less advantaged children, in particular.
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Affiliation(s)
- Tanya J Murphy
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Jay S Kaufman
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Patricia Li
- CORE, McGill University Health Centre, Pediatrics and the Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Russell Steele
- Department of Mathematics and Statistics, McGill University, Montreal, QC, Canada
| | - Seungmi Yang
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
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16
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Bessette H, Song M, Lyons KS, Stoyles S, Lee CS, Hansen L, Winters-Stone K. Enrolling Caregivers in Obesity Interventions to Improve Obesity-Related Outcomes in Children. West J Nurs Res 2021; 44:966-971. [PMID: 34353179 DOI: 10.1177/01939459211037057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this study, we assessed the influences of change in moderate-to-vigorous physical activity (MVPA)/sedentary time (ST) of caregivers participating in a commercial weight-loss program on their children's change in MVPA/ST. Data from 29 caregivers and their children were collected over 8 weeks. We used multivariable linear regression to assess associations of changes in caregiver's percent of time spent in MVPA/ST and changes in their child's percent of time spent in MVPA/ST. For caregivers that decreased body mass index (BMI) over 8 weeks, changes in caregivers' MVPA was strongly associated with the change in children's MVPA (β = 2.61 [95% CI: 0.45, 4.77]) compared to caregivers who maintained/increased BMI (β = 0.24 [-2.16, 2.64]). Changes in caregivers' ST was strongly associated with changes in children's ST (β = 2.42 [1.02, 3.81]) compared to caregivers who maintained/increased BMI (β = 0.35 [-0.45, 1.14]). Findings reinforce encouraging caregivers to enroll in weight-loss programs for the benefit of their children as well as for themselves.
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Affiliation(s)
- Hannah Bessette
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - MinKyoung Song
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Karen S Lyons
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Sydnee Stoyles
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Christopher S Lee
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Lissi Hansen
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
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17
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Cancelier ACL, V Dhurandhar N, Peddibhotla S, Atkinson RL, Silva HCG, Trevisol DJ, Schuelter-Trevisol F. Adenovirus 36 infection and daycare starting age are associated with adiposity in children and adolescents. J Pediatr (Rio J) 2021; 97:420-425. [PMID: 32910885 PMCID: PMC9432260 DOI: 10.1016/j.jped.2020.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE This study aimed to investigate human adenovirus 36 (Adv36) as an associated factor for adiposity in children and adolescents aged 9-12 years. METHODS This was a case-control study comparing overweight (cases) and eutrophic (controls) children and adolescents aged 9-12 years based on their body mass index in relation to human adenovirus 36 serology. Human adenovirus 36-specific neutralizing antibodies were assessed using the serum neutralization assay, and a questionnaire regarding the subjects' personal backgrounds, breastfeed history, age of starting daycare, and eating and exercise habits was also applied. RESULTS A total of 101 (51, eutrophic; 50, overweight) children were included in the study. The Adv36 seropositivity rate was of 15.8%, which increased the chance of being overweight by 3.17 times (p=0.049). Enrollment in a full-time daycare center before the age of 24 months increased the chance of being overweight by 2.78 times (p=0.027). Metabolic parameters (total cholesterol and blood glucose) were insignificantly different among children who were seropositive or seronegative for human adenovirus 36. CONCLUSION This study concluded that excessive weight was positively associated with seropositivity for human adenovirus 36. Early enrollment in a full-time daycare was also an associated factor for obesity. Such data, confirmed in new studies, reinforces the role of human adenovirus 36 in the increase of childhood adiposity.
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Affiliation(s)
| | - Nikhil V Dhurandhar
- Texas Tech University, Department of Nutritional Sciences, Lubbock, United States
| | - Swetha Peddibhotla
- Texas Tech University, Department of Nutritional Sciences, Lubbock, United States
| | | | - Helena C G Silva
- Universidade do Sul de Santa Catarina, Programa de Pós-Graduação em Ciências da Saúde, Tubarão, SC, Brazil
| | - Daisson J Trevisol
- Universidade do Sul de Santa Catarina, Programa de Pós-Graduação em Ciências da Saúde, Tubarão, SC, Brazil; Clinical Research Center Hospital Nossa Senhora da Conceição, Tubarão, SC, Brazil
| | - Fabiana Schuelter-Trevisol
- Universidade do Sul de Santa Catarina, Programa de Pós-Graduação em Ciências da Saúde, Tubarão, SC, Brazil; Clinical Research Center Hospital Nossa Senhora da Conceição, Tubarão, SC, Brazil
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Green MJ, Pearce A, Parkes A, Robertson E, Katikireddi S. Pre-school childcare and inequalities in child development. SSM Popul Health 2021; 14:100776. [PMID: 33768138 PMCID: PMC7980060 DOI: 10.1016/j.ssmph.2021.100776] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/12/2021] [Accepted: 03/06/2021] [Indexed: 01/21/2023] Open
Abstract
Centre-based childcare may benefit pre-school children and alleviate inequalities in early childhood development, but evidence on socio-emotional and physical health outcomes is limited. Data were from the UK Millennium Cohort Study (n = 14,376). Inverse-probability weighting was used to estimate confounder-adjusted population-average effects of centre and non-centre-based childcare (compared to parental care only) between ages 26-31 months on (age 3): internalising and externalising symptoms, pro-social behaviour, independence, emotional dysregulation, vocabulary, school readiness, and body mass index. To assess impacts on inequalities, controlled direct effects of low parental education and lone parenthood on all outcomes were estimated under two hypothetical scenarios: 1) universal take-up of centre-based childcare; and 2) parental care only. On average, non-centre based childcare improved vocabulary and centre-based care improved school readiness, with little evidence of other benefits. However, socio-economic inequalities were observed for all outcomes and were attenuated in scenario 1 (universal take-up). For example, inequalities in externalising symptoms (according to low parental education) were reduced from a confounder-adjusted standard deviation difference of 7.8 (95% confidence intervals: 6.7-8.8), to 1.7 (0.6-2.7). Inequalities by parental education in scenario 2 (parental care only) were wider than in scenario 1 for externalising symptoms (at 3.4; 2.4-4.4), and for emotional dysregulation and school readiness. Inequalities by lone parenthood, which were smaller, fell in scenario 1, and fell further in scenario 2. Universal access to centre-based pre-school care may alleviate inequalities, while restricted access (e.g. during lockdown for a pandemic such as Covid-19) may widen some inequalities in socioemotional and cognitive development.
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Affiliation(s)
- Michael J. Green
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, 99 Berkeley Street, Glasgow, G3 7HR, United Kingdom
| | - Anna Pearce
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, 99 Berkeley Street, Glasgow, G3 7HR, United Kingdom
| | - Alison Parkes
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, 99 Berkeley Street, Glasgow, G3 7HR, United Kingdom
| | - Elaine Robertson
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, 99 Berkeley Street, Glasgow, G3 7HR, United Kingdom
| | - S.Vittal Katikireddi
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, 99 Berkeley Street, Glasgow, G3 7HR, United Kingdom
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, United Kingdom
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De Buck E, Vanhove AC, O D, Veys K, Lang E, Vandekerckhove P. Day care as a strategy for drowning prevention in children under 6 years of age in low- and middle-income countries. Cochrane Database Syst Rev 2021; 4:CD014955. [PMID: 33884613 PMCID: PMC8406676 DOI: 10.1002/14651858.cd014955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Drowning is responsible for an estimated 320,000 deaths a year, and over 90% of drowning mortality occurs in low- to middle-income countries (LMICs), with peak drowning rates among children aged 1 to 4 years. In this age group, mortality due to drowning is particularly common in rural settings and about 75% of drowning accidents happen in natural bodies of water close to the home. Providing adequate child supervision can protect children from drowning, and organized formal day care programs could offer a way to achieve this. OBJECTIVES Primary objective • To assess the effects of day care programs for children under 6 years of age on drowning-related mortality or morbidity, or on total drowning accidents (fatal and non-fatal), in LMICs, compared to no day care programs or other drowning prevention interventions Secondary objectives • To assess the effects of day care programs in LMICs for children under 6 years of age on unsafe water exposure • To assess safety within these programs (e.g. transmission of infection within day care, physical or sexual abuse of children within day care) • To assess the incidence of unintentional injury within these programs • To describe the cost-effectiveness of such programs, in relation to averted drowning-related mortality or morbidity SEARCH METHODS: On November 23, 2019, and for an update on August 18, 2020, we searched MEDLINE (PubMed), Embase, CENTRAL, ERIC, and CINAHL, as well as two trial registries. On December 16, 2019, and for an update on February 9, 2021, we searched 12 other resources, including websites of organizations that develop programs targeted to children. SELECTION CRITERIA We included randomized, quasi-randomized, and non-randomized controlled studies (with explicitly listed specific study design features) that implemented formal day care programs as a single program or combined with additional out-of-day care components (such as educational activities aimed at preventing injury or drowning or early childhood development activities) for children of preschool age (below 6 years of age) in LMICs for comparison with no such programs or with other drowning prevention interventions. Studies had to report at least one outcome related to drowning or injury prevention for the children enrolled. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection and data extraction, as well as risk of bias and GRADE assessment. MAIN RESULTS Two non-randomized observational studies, conducted in rural Bangladesh, involving a total of 252,631 participants, met the inclusion criteria for this review. One of these studies compared a formal day care program combined with parent education, playpens provided to parents, and community-based activities as additional out-of-day care components versus no such program. Overall we assessed this study to be at moderate risk of bias (moderate risk of bias due to confounding, low risk of bias for other domains). This study showed that implementation of a formal day care program combined with parent education, provision of playpens to parents, and community-based activities, in a rural area with a high drowning incidence, likely reduces the risk of death from drowning over the study period of 4 years and 8 months compared to no day care program (hazard ratio 0.18, 95% confidence interval [CI] 0.06 to 0.58; 1 study, 136,577 participants; moderate-certainty evidence). Drowning morbidity (non-fatal drowning resulting in complications), total drowning (fatal and non-fatal), unsafe water exposure, and program safety (e.g. transmission of infection within day care, physical or sexual abuse of children within day care) were not reported, nor was the incidence of other unintentional injuries. Cost-effectiveness was reported as 812 USD (95% CI 589 to 1777) per disability-adjusted life-year averted as a consequence of drowning (moderate-certainty evidence). The second study compared day care programs with or without playpens provided to parents as an additional component versus only playpens provided to parents as an alternative drowning prevention intervention. Overall we assessed the study to be at critical risk of bias because we judged bias due to confounding to be at critical risk. As the certainty of evidence was very low, we are uncertain about the effects on drowning mortality rate of implementing a day care program compared to providing playpens (rate ratio 0.25, 95% CI 0.15 to 0.41; 1 study; 76,575 participants; very low-certainty evidence). Likewise, we are uncertain about the effects of a day care program with playpens provided as an additional component versus playpens provided alone (rate ratio 0.06, 95% CI 0.02 to 0.12; 1 study, 45,460 participants; very low-certainty evidence). The other outcomes of interest - drowning morbidity, total drowning, unsafe water exposure, program safety, incidence of other unintentional injuries, and cost-effectiveness - were not reported. AUTHORS' CONCLUSIONS This review provides evidence suggesting that a day care program with additional out-of-day care components such as community-based education, parent education, and playpens provided to parents likely reduces the drowning mortality risk in regions with a high burden of drowning compared to no intervention.
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Affiliation(s)
- Emmy De Buck
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
- Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Cochrane First Aid, Mechelen, Belgium
| | - Anne-Catherine Vanhove
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
- Belgian Centre for Evidence-Based Medicine - Cochrane Belgium, Leuven, Belgium
| | - Dorien O
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
| | - Koen Veys
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
| | - Eddy Lang
- Department of Emergency Medicine, University of Calgary, Calgary, Canada
| | - Philippe Vandekerckhove
- Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Belgian Red Cross, Mechelen, Belgium
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Butler ÉM, Fangupo LJ, Cutfield WS, Taylor RW. Systematic review of randomised controlled trials to improve dietary intake for the prevention of obesity in infants aged 0-24 months. Obes Rev 2021; 22:e13110. [PMID: 32776705 DOI: 10.1111/obr.13110] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 02/06/2023]
Abstract
Improving dietary intake early in life is a common behavioural target in obesity prevention trials. We undertook a systematic review of randomised controlled trials aiming to improve dietary intake of complementary foods during infancy (0-24 months). PubMed, Cochrane Library, EMBASE, Medline, and PsycInfo were searched for trials focussed on obesity prevention conducted between January 2000 and August 2019 where dietary intake was an outcome. Two reviewers screened studies and extracted data from selected articles. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias 2 tools. The protocol was registered on Open Science Framework (https://osf.io/6srg7/). Seventeen articles from 12 trials were selected for data extraction. Statistically significant group differences in outcomes were observed in 36 of 165 (21.8%) of dietary variables examined. Measurement and analysis of outcomes varied between studies. Overall risk of bias was rated as high, primarily due to missing outcome data. Improving dietary intake at this age appears challenging based on a relatively limited number of studies. Future research could consider dietary pattern analyses, which may provide more meaningful outcomes for this age group. Opportunities exist for further exploration of maternal-focussed interventions, responsive feeding interventions, and interventions delivered outside of homes.
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Affiliation(s)
- Éadaoin M Butler
- A Better Start - National Science Challenge, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Louise J Fangupo
- A Better Start - National Science Challenge, New Zealand.,Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Wayne S Cutfield
- A Better Start - National Science Challenge, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Rachael W Taylor
- A Better Start - National Science Challenge, New Zealand.,Department of Medicine, University of Otago, Dunedin, New Zealand
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Costa S, Bann D, Benjamin-Neelon SE, Adams J, Johnson W. Associations of childcare type, age at start, and intensity with body mass index trajectories from 10 to 42 years of age in the 1970 British Cohort Study. Pediatr Obes 2020; 15:e12644. [PMID: 32372562 DOI: 10.1111/ijpo.12644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 02/21/2020] [Accepted: 03/06/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Attending childcare is related to greater childhood obesity risk, but there are few long-term follow-up studies. We aimed to examine the associations of childcare type, age at start, and intensity with body mass index body mass index (BMI) trajectories from ages 10 to 42 years. METHODS The sample comprised 8234 individuals in the 1970 British Cohort Study, who had data on childcare attendance (no, yes), type (formal, informal), age at start (4-5, 3-3.99, 0-2.99 years old), and intensity (1, 2, 3, 4-5 days/week) reported at age 5 years and 32 563 BMI observations. Multilevel linear spline models were used to estimate the association of each exposure with the sample-average BMI trajectory, with covariate adjustment. A combined age at start and intensity exposure was also examined. RESULTS Attending vs not attending and the type of childcare (none vs formal/informal) were not strongly related to BMI trajectories. Among participants who attended childcare 1 to 2 days a week, those who started when 3 to 3.99 years old had a 0.197 (-0.004, 0.399) kg/m2 higher BMI at age 10 years than those who started when 4 to 5 years old, and those who started when 0 to 2.99 years old had a 0.289 (0.049, 0.529) kg/m2 higher BMI. A similar dose-response pattern for intensity was observed when holding age at start constant. By age 42 years, individuals who started childcare at age 0 to 2.99 years and attended 3 to 5 days/week had a 1.356 kg/m2 (0.637, 2.075) higher BMI than individuals who started at age 4 to 5 years and attended 1 to 2 days/week. CONCLUSIONS Children who start childcare earlier and/or attend more frequently may have greater long-term obesity risk.
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Affiliation(s)
- Silvia Costa
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - David Bann
- Centre for Longitudinal Studies, University College London (UCL) Institute of Education, London, UK
| | - Sara E Benjamin-Neelon
- UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jean Adams
- UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - William Johnson
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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The effects of intervening with physical activity in the early years (ages 3-5) on health-related quality of life: a secondary analysis of the Activity Begins in Childhood (ABC) trial. Qual Life Res 2020; 30:221-227. [PMID: 32700186 DOI: 10.1007/s11136-020-02587-2] [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: 07/10/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Limited research has measured the effect of physical activity (PA) interventions on health-related quality of life (HRQoL) among pre-school-aged children. This study evaluates the effect of the Activity Begins in Childhood (ABC) cluster-randomized controlled trial designed to increase PA in the ages 3-5 years on HRQoL. METHODS This was a cluster-randomized controlled trial where the intervention group included PA education delivered to daycare providers only, or daycare providers and parents. In the current study, the two PA intervention groups were combined. The comparator group received standard daycare curriculum (COM). A total of 215 children were included (PA n = 161, COM n = 54). Parents completed the proxy Pediatric Quality of Life Inventory Generic Core Scale (PedsQL™ 4.0) to measure HRQoL at baseline and the end of the 6-month trial. HRQoL scores were analyzed as physical, psychosocial, and total domains. Baseline and 6-months measurements were compared for PA and COM groups, and mean changes in scores (95% confidence intervals) were measured using absolute values. RESULTS No between-group differences were observed for the physical (p = 0.17), psychosocial (p = 0.95) or total scores (p = 0.20). Paired comparisons showed that only the PA group improved psychosocial- (PA mean difference = 2.18 (0.20, 4.15), p = 0.03; COM mean difference = 2.05 (- 1.03, 5.13), p = 0.19) and total-HRQoL scores (PA mean difference = 2.83 (1.83, 3.84), p < 0.001; COM mean difference = 0.19 (- 1.78, 2.16), p = 0.84) after 6 months. CONCLUSION Although the within-PA group analysis showed an improvement in psychosocial and total HRQoL scores from baseline, no between-group differences were observed in the HRQoL over time among children aged 3-5 years.
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Allel K, Narea M, Undurraga EA. Centre-based care is a significant predictor of lower body mass index in early childhood: Longitudinal evidence from Chile. J Glob Health 2020; 10:010419. [PMID: 32373335 PMCID: PMC7182360 DOI: 10.7189/jogh.10.010419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The prevalence of childhood overweight has increased by approximately 50% in the past three decades, becoming a major public health concern worldwide. In Chile, an upper middle-income country, about 38% of children between two and four years of age are overweight, almost double the average in Latin America and the Caribbean. Various environmental and individual factors, and their interactions, affect childhood weight. Emerging evidence suggests childcare may also matter. Because the public provision of centre-based care is growing, childcare may be a useful policy tool to help prevent childhood overweight. METHODS Using a nationally representative longitudinal survey of ~ 15 000 children in Chile (2010 and 2012), we estimated whether the type of child care (centre-based or maternal) a child attended at age 24 to 36 months was a significant predictor of the child's sex-and-age-specific body-mass-index (BMI) at age 36-48 months. We restricted our sample to children in full-time maternal care at baseline (12-24 months of age; n = 1273), but tested the robustness of results with the full sample. We compared children in centre-based care and in maternal care using difference-in-difference estimators and propensity score matching, and adjusted our estimates using child, family, and neighborhood characteristics. RESULTS Children attending centre-based care had 0.27 SD lower BMI than children in maternal care at follow-up (P < 0.05). We found suggestive evidence this association may be modulated by the child's socioeconomic status and by how frequently the child watched television: we found smaller BMI changes for children at the bottom 80% of socioeconomic status (P < 0.05) and also for children who frequently watched television (P < 0.10). Our results were robust to various model specifications. CONCLUSIONS Our findings suggest centre-based care programs, with adequate regulation and enforcement, may be a useful support to help curb the early childhood overweight epidemic, in addition to known effects in labor supply and child development.
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Affiliation(s)
- Kasim Allel
- Institute for Global Health, University College London, UK
- Millennium Nucleus for the Study of the Life Course and Vulnerability (MLIV), Chile
- Society and Health Research Centre, Facultad de Humanidades, Universidad Mayor, Santiago, Chile
| | - Marigen Narea
- Centre for Advanced Studies on Educational Justice (CJE), Pontificia Universidad Católica de Chile, Macul, Santiago, Chile
- School of Psychology, Pontificia Universidad Católica de Chile, Macul, Santiago, Chile
| | - Eduardo A Undurraga
- Millennium Nucleus for the Study of the Life Course and Vulnerability (MLIV), Chile
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Macul, Santiago, Chile
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24
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Ward DS, Vaughn AE, Burney RV, Hales D, Benjamin-Neelon SE, Tovar A, Østbye T. Keys to healthy family child care homes: Results from a cluster randomized trial. Prev Med 2020; 132:105974. [PMID: 31899253 PMCID: PMC8091030 DOI: 10.1016/j.ypmed.2019.105974] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/24/2019] [Accepted: 12/28/2019] [Indexed: 01/11/2023]
Abstract
Early care and education settings, such as family child care homes (FCCHs), are important venues for children's health promotion. Keys to Healthy Family Child Care Homes evaluated a FCCH-based intervention's impact on children's diet and physical activity. This study enrolled 496 children aged 1.5-4 years and 166 FCCH providers into a cluster-randomized control trial (intervention = 242 children/83 FCCHs, control = 254 children/83 FCCHs) conducted during 2013-2016. The 9-month intervention addressed provider health, health of the FCCH environment, and business practices, and was delivered through three workshops, three home visits, and nine phone calls. The attention control arm received a business-focused intervention. Primary outcomes were children's diet quality (2 days of observed intakes summarized into Healthy Eating Index scores) and moderate to vigorous physical activity (3 days of accelerometry) at the FCCH. Secondary outcomes were child body mass index (BMI), FCCH provider health behaviors, and FCCH nutrition and physical activity environments and business practices. Repeated measures analysis, using an intent-to-treat approach, accounting for clustering of children within FCCHs and adjusting for child age, sex, and BMI, was used to evaluate change (completed in 2018). Compared to controls, intervention children significantly improved their diet quality (5.39, p = .0002, CI = 2.53, 8.26) but not MVPA (0.31, p = .195, CI = -0.16, 0.79). Intervention FCCH providers significantly improved their diet quality and several components of their FCCH environment (i.e., time provided for physical activity, use of supportive physical activity practices, and engagement in nutrition and physical activity education/professional development). FCCHs are malleable settings for health promotion, especially diet quality. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.govNCT01814215.
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Affiliation(s)
- Dianne S Ward
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB # 7461, Chapel Hill, NC 27599-7461, USA; Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin L. King Jr. Blvd., CB 7426, Chapel Hill, NC 27599-7426, USA.
| | - Amber E Vaughn
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin L. King Jr. Blvd., CB 7426, Chapel Hill, NC 27599-7426, USA
| | - Regan V Burney
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin L. King Jr. Blvd., CB 7426, Chapel Hill, NC 27599-7426, USA
| | - Derek Hales
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB # 7461, Chapel Hill, NC 27599-7461, USA; Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin L. King Jr. Blvd., CB 7426, Chapel Hill, NC 27599-7426, USA
| | - Sara E Benjamin-Neelon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, 41 Lower College Road, Kingston, RI 02881, USA
| | - Truls Østbye
- Duke University Department of Family Medicine and Community Health, Duke University Medical Center, W Main St 2200, Suite 622, Durham, NC 27710, USA
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25
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Benjamin-Neelon SE, Iversen E, Clancy SM, Hoyo C, Bennett GG, Kravitz RM, Østbye T. Early Child Care and Weight Status in a Cohort of Predominantly Black Infants in the Southeastern United States. Child Obes 2020; 16:122-128. [PMID: 31618046 PMCID: PMC7047092 DOI: 10.1089/chi.2019.0127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Previous studies show inconsistent relations between child care and obesity, but few assessed longitudinal associations during infancy and even fewer included racially diverse children. We examined associations of time infants spent in child care, both overall and in different types of care, with weight status at 6 and 12 months. Methods: We examined 664 infants living in central North Carolina. We conducted adjusted multivariable linear regressions examining (1) child care from birth to 6 months and 6-month weight-for-length (WFL) z-score, and (2) child care from birth to 12 months and 12-month WFL z-score. We assessed any child care and child care by type, including relative care, informal care by a nonrelative, formal child care, and a combination of care (e.g., relative and informal care). Results: Nearly 70% of infants were black and 49% were female. After adjustment for potential confounders, any child care was not associated with WFL z-score at 6 months (0.07; 95% confidence intervals [CI] -0.02 to 0.16; p = 0.13) or 12 months (0.05; 95% CI -0.02 to 0.12; p = 0.19). However, greater combination care was associated with higher WFL z-score at 6 months (0.68; 95% CI 0.23-1.13; p = 0.003) and greater care by a relative was associated with higher WFL z-score at 12 months (0.16; 95% CI 0.05-0.26; p = 0.005). Conclusions: Although we did not observe associations with any child care, combination care and relative care during infancy were associated with higher weight. Interventions aimed at preventing excessive weight gain in early life may target relatives who provide regular care for infants.
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Affiliation(s)
- Sara E. Benjamin-Neelon
- Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, MD.,Address correspondence to: Sara E. Benjamin-Neelon, PhD, JD, Department of Health, Behavior and Society, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205
| | - Edwin Iversen
- Department of Statistical Science, Duke University, Durham, NC
| | - Shayna M. Clancy
- Department of Community and Family Medicine, Duke University Medical Center, Durham, NC
| | - Cathrine Hoyo
- Department of Biological Sciences, North Carolina State University, Raleigh, NC
| | - Gary G. Bennett
- Department of Psychology and Neuroscience, Duke University, Durham, NC
| | | | - Truls Østbye
- Department of Community and Family Medicine, Duke University Medical Center, Durham, NC
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26
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Matvienko-Sikar K, Cooney J, Flannery C, Murphy J, Khashan A, Huizink A. Maternal stress in the first 1000 days and risk of childhood obesity: a systematic review. J Reprod Infant Psychol 2020; 39:180-204. [PMID: 32046507 DOI: 10.1080/02646838.2020.1724917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective: Maternal stress is associated with adverse child outcomes. Conception to 2-years postpartum (the first 1000 days) is a developmentally sensitive period for stress exposure. The role of maternal stress in the first 1000 days on child obesity risk is unclear. This review systematically examines the relationship between maternal stress across the first 1000 days and child obesity risk. Methods: The Cochrane Library, MEDLINE, PsycINFO, EMBASE, CINAHL, and Maternity and Infant Care were searched from inception to June 2018. Eligible studies included women who experienced maternal stress in the first 1000 days; an included a measure of maternal stress and of child anthropometrics. Results: Sixteen studies met inclusion criteria, the majority of these examined prenatal stress exposure. Inconsistent effects were observed for psychological and physiological stress responses, on child weight outcomes. Environmental stress exposures, including natural disaster and bereavement, were more consistently associated with increased obesity risk. Conclusion: This review does not provide support for the effects of psychological or physiological maternal stress on child weight outcomes; there is some evidence of associations between environmental stress exposures and greater childhood adiposity. Variation in conceptualisation and measurement of stress, timing of stress exposure, and limited examination of stress-related behaviours were noted.
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Affiliation(s)
| | - Jennifer Cooney
- School of Applied Psychology, University College Cork , Cork, Ireland
| | - Caragh Flannery
- School of Public Health, University College Cork , Cork, Ireland
| | - Jennifer Murphy
- School of Public Health, University College Cork , Cork, Ireland
| | - Ali Khashan
- School of Public Health, University College Cork , Cork, Ireland.,Irish Centre for Fetal and Neonatal Transnational Research (INFANT) Centre, Cork University Maternity Hospital , Cork, Ireland
| | - Anja Huizink
- Department of Clinical, Neuro- and Developmental Psychology, VU University Amsterdam , Amsterdam, The Netherlands
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27
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Costa S, Benjamin-Neelon SE, Winpenny E, Phillips V, Adams J. Relationship Between Early Childhood Non-Parental Childcare and Diet, Physical Activity, Sedentary Behaviour, and Sleep: A Systematic Review of Longitudinal Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234652. [PMID: 31766666 PMCID: PMC6926528 DOI: 10.3390/ijerph16234652] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/05/2019] [Accepted: 11/07/2019] [Indexed: 12/19/2022]
Abstract
The rising prevalence of childhood obesity is a global public health concern. Evidence suggests that exposure to non-parental childcare before age six years is associated with development of obesity, diet, and activity behaviours (physical activity, sedentary behaviour, and sleep). However, findings are inconsistent and mostly from cross-sectional studies, making it difficult to identify the direction of causation in associations. This review identified and synthesised the published research on longitudinal associations between non-parental childcare during early childhood, diet, and activity behaviours. Seven databases were searched, and results were independently double-screened through title/abstract and full-text stages. Included studies were evaluated for risk of bias. Of the 18,793 references screened, 13 met eligibility criteria and were included in the review. These presented results on 89 tested childcare/outcome associations, 63 testing diet outcomes (59% null, remainder mixed), and 26 testing activity behaviour outcomes (85% null, remainder mixed). The scarce available literature indicates little and mixed evidence of a longitudinal association. This reflects a paucity of research, rather than clear evidence of no effect. There is an urgent need for studies investigating the longitudinal associations of non-parental childcare on diet and activity behaviours to assess potential lasting effects and mechanisms; whether and how effects vary by provider; and differences by intensity, duration, and population sub-groups.
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Affiliation(s)
- Silvia Costa
- UKCRC Centre for Diet and Activity Research, MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0QQ, UK; (S.E.B.-N.); (E.W.); (J.A.)
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
- Correspondence: ; Tel.: +44-(0)1509-226-304
| | - Sara E. Benjamin-Neelon
- UKCRC Centre for Diet and Activity Research, MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0QQ, UK; (S.E.B.-N.); (E.W.); (J.A.)
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Eleanor Winpenny
- UKCRC Centre for Diet and Activity Research, MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0QQ, UK; (S.E.B.-N.); (E.W.); (J.A.)
| | - Veronica Phillips
- Medical Library, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK;
| | - Jean Adams
- UKCRC Centre for Diet and Activity Research, MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0QQ, UK; (S.E.B.-N.); (E.W.); (J.A.)
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28
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McDonnell T, Doyle O. Maternal employment and childcare during infancy and childhood overweight. Soc Sci Med 2019; 243:112639. [PMID: 31698206 DOI: 10.1016/j.socscimed.2019.112639] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 10/01/2019] [Accepted: 10/19/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This paper examines the joint impact of maternal employment and childcare during infancy on childhood weight at ages three and five in the context of weak social support for early childhood care and education. METHOD Using three waves of longitudinal data from the Growing-Up in Ireland survey (n = 8,393 age three, n = 8,039 age five), propensity score matching is used to address the endogeneity of employment and childcare decisions. Selection on observables is used to assess potential bias arising from selection on unobservables whereby unobserved characteristics of the mother or child may jointly influence child weight and maternal employment and childcare. RESULTS Full-time maternal employment at nine months combined with either formal or informal childcare increases the likelihood of being overweight at three years by 8.1% and 5.9% respectively, but only for children of highly educated mothers. Similar results are observed for part-time employment coupled with informal (7.5%) or parental (8.0%) care. The results for mothers with lower levels of education are either not significant or favourable. While the majority of the effects dissipate by age five, there is some evidence that full-time maternal employment coupled with informal care increases the risk of being overweight at both ages three and five for children of higher-educated mothers. An assessment of selection bias finds that the estimates of full-time employment combined with formal childcare by well-educated mothers are a lower bound, such that the true effect on child weight may be understated. CONCLUSIONS The findings for Ireland are consistent with studies from the United States and the United Kingdom, and are in contrast to findings from the rest of Europe, suggesting the role of institutional factors, such as the lack of subsidised, universal, high-quality childcare.
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Affiliation(s)
- Thérèse McDonnell
- UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland.
| | - Orla Doyle
- UCD School of Economics & UCD Geary Institute for Public Policy, University College Dublin, Ireland
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29
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Fang K, Mu M, Liu K, He Y. Screen time and childhood overweight/obesity: A systematic review and meta-analysis. Child Care Health Dev 2019; 45:744-753. [PMID: 31270831 DOI: 10.1111/cch.12701] [Citation(s) in RCA: 160] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/24/2019] [Accepted: 06/30/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Controlling childhood overweight/obesity would help early prevention on children from getting chronic noncommunicable diseases, exposing to screen for long periods may increase the risk of overweight/obesity due to lack of physical activity and tend to intake too much energy, and the relationship between screen time and overweight/obesity is inconsistent. Thus, the object of the present study was to estimate the relationship between screen time and overweight/obesity in children (<18 years) by systematically review prevalence studies. METHODS We collected data from relevant studies published up to May 2019 using predefined inclusion/exclusion criteria. And all the literatures were searched in PubMed, ScienceDirect, Embase, and Web of Science. RESULTS A total of 16 studies met the criteria and were included in the meta-analysis. When compared with the screen time <2 hr/day, an increased overweight/obesity risk among children was shown in the screen time ≥2 hr/day (OR = 1.67; 95% CI [1.48, 1.88], P < .0001). The subgroup analysis showed a positive association between the different types of screen time and overweight/obesity among children. CONCLUSION Based on our study, increasing screen time could be a risk factor for being overweight/obesity in children and adolescents.
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Affiliation(s)
- Kehong Fang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Min Mu
- School of Medicine, Department of Preventive Medicine, Anhui University of Science and Technology, Huainan, China
| | - Kai Liu
- National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuna He
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
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30
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Eagleton SG, Hohman EE, Verdiglione N, Birch LL, Paul IM, Savage JS. INSIGHT Study Maternal Return to Work and Infant Weight Outcomes. Acad Pediatr 2019; 19:67-73. [PMID: 30145361 PMCID: PMC6321792 DOI: 10.1016/j.acap.2018.08.008] [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] [Received: 01/04/2018] [Revised: 08/08/2018] [Accepted: 08/18/2018] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Maternal return to work within 12 weeks of delivery is associated with poor child health and development. However, little is known about the impact of return to work on the risk of child obesity. We examined whether timing of maternal return to work is associated with rapid infant weight gain from 0 to 6 months and weight-for-length at 1 year. METHODS Secondary data analysis of 279 mother-newborn dyads from the Intervention Nurses Start Infants Growing on Healthy Trajectories Study, a randomized controlled trial evaluating a responsive parenting (RP) intervention. Rapid infant weight gain from 0 to 6 months was assessed using conditional weight gain (CWG) scores. Infant weight-for-length was calculated using World Health Organization reference values. Analysis of variance (ANOVA) examined whether infant weight outcomes differed by timing of maternal return to work (≤12 weeks vs >12 weeks after delivery). Moderation by study group (RP intervention vs safety control) and mediation by breastmilk feeding were examined in ANOVA models. RESULTS Among 261 mothers, approximately one half (n = 130) returned to work within 12 weeks. Compared with infants of mothers who returned to work after 12 weeks, infants of mothers who returned to work within 12 weeks had greater CWG scores from 0 to 6 months (P = .006) and were heavier at 1 year (P = .05). These associations were not moderated by study group or mediated by breastmilk feeding. CONCLUSIONS Maternal return to work within 12 weeks was associated with rapid infant weight gain in the first 6 months and greater weight-for-length at 1 year, although the mechanisms to explain our findings are unclear.
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Affiliation(s)
- Sally G. Eagleton
- Center for Childhood Obesity Research, Penn State College of Health and Human Development, University Park, PA,Department of Nutritional Sciences, Penn State College of Health and Human Development, University Park, PA
| | - Emily E. Hohman
- Center for Childhood Obesity Research, Penn State College of Health and Human Development, University Park, PA
| | - Nicole Verdiglione
- Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Leann L. Birch
- Department of Foods and Nutrition, University of Georgia, Athens, GA
| | - Ian M. Paul
- Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Jennifer S. Savage
- Center for Childhood Obesity Research, Penn State College of Health and Human Development, University Park, PA,Department of Nutritional Sciences, Penn State College of Health and Human Development, University Park, PA
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31
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Lidgate ED, Li B, Lindenmeyer A. A qualitative insight into informal childcare and childhood obesity in children aged 0-5 years in the UK. BMC Public Health 2018; 18:1229. [PMID: 30400788 PMCID: PMC6219155 DOI: 10.1186/s12889-018-6131-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 10/19/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Previous studies in various countries have found that informal childcare (provided by relatives, friends etc.) was associated with an increased risk of obesity in children aged 0-5 years. However, no qualitative research has been done to explore possible reasons for such a relationship and potential interventions to tackle it. We conducted a qualitative study with both parents and informal carers to explore their 1) experiences in receiving or giving informal childcare for British children aged 0-5 years; 2) perceived explanations of the relationship between informal childcare and childhood obesity and 3) preferred intervention ideas and delivery strategies for preventing obesity among those children under informal care. METHODS Four in-depth focus groups with a total of 14 participants (7 parents, 7 informal caregivers) were conducted in Birmingham and Edinburgh (1 parent group and 1 informal caregiver group in each city). Data were audio recorded, transcribed verbatim and analysed using a thematic approach. RESULTS The significance of informal care to parents, carers, and society was recognised (theme one). Informal carers were identified to have practical and emotional support roles for the parents (theme two). Informal care was perceived to contribute to childhood obesity in four ways (theme three): cross-generation conflict preventing adoption of healthy practices; the trade-off for parents between receiving childcare and maintaining control; reduced energy capacity of carers; and increased snacking. Potential intervention ideas and delivery strategies (theme four) were identified. Examples of identified ideas included providing carers with up-to-date weaning advice, and suggestions of healthy snacks and ways to increase physical activity level in informal care. The suggestion of utilising existing primary care platforms (e.g. health visitor check-ups) to reach and deliver low-cost information based interventions, to all children aged 0-5 years who receive informal care, was highlighted. CONCLUSIONS This exploratory qualitative study provided novel insights into potential explanations for the evidenced link between informal care and childhood obesity in children aged 0-5 years, despite a small size and limited participants in each focus group. Our findings support the idea of and inform the development towards an information based and low-cost intervention delivered through existing primary care platforms.
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Affiliation(s)
- Eleanor Diana Lidgate
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, West Midlands UK
| | - Bai Li
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, West Midlands B15 2TT UK
| | - Antje Lindenmeyer
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, West Midlands B15 2TT UK
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Porter RM, Tindall A, Gaffka BJ, Kirk S, Santos M, Abraham-Pratt I, Gray J, Heckler D, Ward WL, Tucker JM, Sweeney B. A Review of Modifiable Risk Factors for Severe Obesity in Children Ages 5 and Under. Child Obes 2018; 14:468-476. [PMID: 30156438 DOI: 10.1089/chi.2017.0344] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Early-onset severe obesity in childhood presents a significant clinical challenge signaling an urgent need for effective and sustainable interventions. A large body of literature examines overweight and obesity, but little focuses specifically on the risk factors for severe obesity in children ages 5 and younger. This narrative review identified modifiable risk factors associated with severe obesity in children ages 5 and younger: nutrition (consuming sugar sweetened beverages and fast food), activity (low frequency of outdoor play and excessive screen time), behaviors (lower satiety responsiveness, sleeping with a bottle, lack of bedtime rules, and short sleep duration), and socio-environmental risk factors (informal child care setting, history of obesity in the mother, and gestational diabetes). The lack of literature on this topic highlights the need for additional research on potentially modifiable risk factors for early-onset severe obesity.
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Affiliation(s)
- Renee M Porter
- 1 Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine , Aurora, CO
| | | | - Bethany J Gaffka
- 3 Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan , Ann Arbor, MI
| | - Shelley Kirk
- 4 Cincinnati Children's Hospital Medical Center , Cincinnati, OH
| | | | - Indira Abraham-Pratt
- 6 Center for Child and Family Wellness, Florida Hospital for Children , Winter Park, FL
| | - Jane Gray
- 7 Department of Educational Psychology, Dell Children's Medical Center of Central Texas, University of Texas at Austin , Austin, TX
| | - David Heckler
- 7 Department of Educational Psychology, Dell Children's Medical Center of Central Texas, University of Texas at Austin , Austin, TX
| | - Wendy L Ward
- 8 Arkansas Children's Hospital/University of Arkansas for Medical Sciences , Little Rock, AR
| | | | - Brooke Sweeney
- 10 Department of General Academic Pediatrics, Children's Mercy Hospital Kansas City, University of Missouri Kansas City School of Medicine , Kansas City, MO
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Hesketh KR, Benjamin-Neelon SE, van Sluijs EMF. How does the UK childcare energy-balance environment influence anthropometry of children aged 3-4 years? A cross-sectional exploration. BMJ Open 2018; 8:e021520. [PMID: 30002012 PMCID: PMC6082453 DOI: 10.1136/bmjopen-2018-021520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To assess the association between time spent in care, the childcare energy-balance environment, and preschool-aged children's body mass index z-score (z-BMI), waist-to-height ratio (WHR) and sum of skinfold thickness (SST). DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Children aged 3-4 years were recruited from 30 childcare centres in Cambridgeshire (UK) in 2013. MAIN OUTCOME MEASURES Objectively measured height and weight was used to calculate z-BMI; waist circumference and height were used to generate WHR; subscapular and tricep skinfolds were used to calculate SST. Associations between childcare attendance, the nutrition, physical activity, and overall childcare environment, and three anthropometric outcomes were explored using two-level hierarchical regression models, adjusting for demographic and family based confounders. RESULTS Valid data were available for 196 children (49% female). Time spent in care, the nutrition, physical activity and overall childcare environment were not associated with children's z-BMI, WHR and SST. CONCLUSIONS Childcare environment and level of attendance were not associated with UK preschool-aged children's anthropometry. The childcare environment has been central to intervention efforts to prevent/reduce early childhood obesity, yet other factors, including child-level, family level, wider environmental and policy-level factors warrant substantial attention when considering obesity prevention strategies for young children.
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Affiliation(s)
- Kathryn R Hesketh
- Centre for Diet and Activity Research and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sara E Benjamin-Neelon
- Centre for Diet and Activity Research and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Esther M F van Sluijs
- Centre for Diet and Activity Research and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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