Physical activity, screen time, and outdoor learning environment practices and policy implementation: a cross sectional study of Texas child care centers

Implementation of healthy eating and physical activity practices in Australian early childhood education and care services: A cross-sectional study

Background

The monitoring of healthy eating and physical activity environments is recommended to support population health. Early childhood education and care (ECEC) services are a key setting to deliver obesity prevention strategies as they reach the majority of children aged under five years and have existing supporting infrastructure.

Objectives

The aim of this study was to i) describe the prevalence of implementation of evidence-based healthy eating and physical activity practices in an Australian sample of ECEC services, and ii) examine associations between implementation of practices and service characteristics.

Methods

A random sample of 2,100 centre-based ECEC services across Australia were invited to participate in a cross-sectional survey online or via telephone (August 2021-April 2022). Service characteristics and implementation of 18 evidence-based healthy eating and physical activity practices were assessed. Descriptive statistics and linear mixed regression analyses were performed.

Results

A total of 1,028 (51.8%) eligible services participated. The healthy eating and physical activity practices with the lowest prevalence of implementation were related to encouraging children to consume age-appropriate beverages (17.9%) and providing families with child physical activity education via workshops or meetings (14.6%), respectively. There was a statistically significant difference in the implementation of healthy eating practices by service characteristics, with long day care services implementing significantly more practices than preschools (p < 0.01).

Conclusion

There is room to improve the implementation of evidence-based healthy eating and physical activity practices ECEC services. Implementation efforts should be directed towards preschools.

¡Míranos! a Comprehensive Preschool Obesity Prevention Program in Low-Income Latino Children: One-year Results of a Clustered Randomized Controlled Trial

OBJECTIVE

Test a culturally tailored obesity prevention intervention in low-income, minority preschool-age children.

DESIGN

A three-group clustered randomized controlled trial.

SETTING

Twelve Head Start Centers were randomly assigned to a center-based intervention, a combined center- and home-based intervention, or control using a 1:1:1 ratio. The center-based intervention modified center physical activity and nutrition policies, staff practices, and child behaviors, while the home-based intervention supported parents for obesity prevention at home.

STUDY OUTCOMES

The primary endpoint was change in children's body mass index (BMI; kg/m2) at posttest immediately following completion of the 8-month intervention. Secondary endpoints included standardized scores for BMI (BMIz) and body weight (WAZ), and BMI percentiles (BMI pctl).

PARTICIPANTS

Three-year-old children enrolled in Head Start in San Antonio, Texas, with written parent consent (N=325), 87% Latino; 57% female with mean age (SD) of 3.58 years (0.29).

RESULTS

Change in BMI at posttest was 1.28 (0.97), 1.28 (0.87), and 1.41 (0.71) in the center+home-based intervention, center-based intervention, and control, respectively. There was no significant difference in BMI change between center+home-based intervention and control or center-based intervention and control at posttest. BMIz (adjusted difference -0.12 [95% CI, -0.24 to 0.01], p = .06) and WAZ (adjusted difference, -0.09 [-0.17 to -0.002], p = .04) were reduced for children in center+home-based intervention compared to control group.

CONCLUSIONS

There was no reduction in BMI at posttest in children who received the intervention. Findings shed light on methodological challenges in childhood obesity research and offer future directions to explore health equity-oriented obesity prevention.

Obesity prevention practices in early care and education settings: an adaptive implementation trial

Background

Despite the potential for Early Care and Education (ECE) settings to promote healthy habits, a gap exists between current practices and evidence-based practices (EBPs) for obesity prevention in childhood.

Methods

We will use an enhanced non-responder trial design to determine the effectiveness and incremental cost-effectiveness of an adaptive implementation strategy for Together, We Inspire Smart Eating (WISE), while examining moderators and mediators of the strategy effect. WISE is a curriculum that aims to increase children’s intake of carotenoid-rich fruits and vegetables through four evidence-based practices in the early care and education setting. In this trial, we will randomize sites that do not respond to low-intensity strategies to either (a) continue receiving low-intensity strategies or (b) receive high-intensity strategies. This design will determine the effect of an adaptive implementation strategy that adds high-intensity versus one that continues with low-intensity among non-responder sites. We will also apply explanatory, sequential mixed methods to provide a nuanced understanding of implementation mechanisms, contextual factors, and characteristics of sites that respond to differing intensities of implementation strategies. Finally, we will conduct a cost effectiveness analysis to estimate the incremental effect of augmenting implementation with high-intensity strategies compared to continuing low-intensity strategies on costs, fidelity, and child health outcomes.

Discussion

We expect our study to contribute to an evidence base for structuring implementation support in real-world ECE contexts, ultimately providing a guide for applying the adaptive implementation strategy in ECE for WISE scale-up. Our work will also provide data to guide implementation decisions of other interventions in ECE. Finally, we will provide the first estimate of relative value for different implementation strategies in this setting.

Trial registration

NCT05050539; 9/20/21.

Preschool environment and preschool teacher's physical activity and their association with children's activity levels at preschool

Objective

The aim of this study was to investigate the association between preschool playground size, formalized physical activity (PA) policies, time spent outdoors and preschool teacher’s levels of PA and children’s objectively assessed levels of PA and sedentary time (ST) during preschool hours.

Methods

In total, 369 children and 84 preschool teachers from 27 preschools in Södermalm municipally, Stockholm Sweden wore an Actigraph GT3X+ accelerometer during 7 consecutive days. Preschool environmental and structural characteristics were measured via the Environment and Policy Evaluation Self-Report (EPAO-SR) instrument and time in- and outdoors was recorded by preschool teachers during the PA measurements. Weight and height of children were measured via validated scales and parents filled out a questionnaire on demographical and descriptive variables. Linear mixed models, nested on preschool level, were used to assess the association between predictors and outcomes.

Results

The mean child age was 4.7 years (SD 0.8) and 45% were girls. We found that children were more active in preschools with a formalized PA policy, compared to preschools without such a policy, but not less sedentary. The association between policy and activity seemed to be more pronounced when accounting for other environmental factors. Similar associations were found in children spent most time outdoors (uppermost quartile) compared with children spent least time outdoors (Lowermost quartile). Preschool teachers’ light PA (LPA) (ß = 0.25, P = 0.004) and steps (ß = 0.52, P<0.001) were associated with children’s LPA and steps while the preschool playground size showed no association with PA in children, when accounting for other environmental factors.

Conclusion

The current study showed that preschool structural characteristics such as formalized PA policies and more time spent outdoors were positively associated with children’s PA. These findings suggest that formalized PA policies and time outdoors may be of importance for promoting children’s PA during preschool hours.

Examining physical activity policies to practice implementation: Results from the Texas Early Childhood Physical Activity Survey in non-Head Start childcare centers

Ensuring young children have adequate opportunities for physical activity (PA) is important, and policies at childcare centers may help to ensure children have adequate opportunities. The purpose of this study is to examine the associations between center policies and odds of meeting best practices for PA in non-Head Start Texas early care and education (ECE) centers. Licensed centers with publicly available email addresses on the Texas Department of Family and Protective Services website were invited to participate in an online survey in February 2016. A total of 10 PA-related policies and 11 best practices were assessed. Logistic regression models assessed the odds of meeting best practices with each written policy (vs. no written policy). Covariates included center enrollment size. Exclusion criteria yielded a cross-sectional sample of 481 center respondents. Centers reported, on average, 3.92 (SD = 3.00) policies and meeting 4.55 (SD = 1.99) best practices. Each policy was associated with higher odds of meeting at least one best practice. Education policies and structured, adult-led active play policies were associated with meeting most PA best practices. No policies were associated with meeting best practices for seated time or for providing preschoolers recommendation daily minutes of indoor and outdoor PA. Texas ECEs report a low number of written policies and best practice implementation. The findings suggest policies alone may not be enough for implementation of best practices. There are opportunities for enhancement in mandated licensing, policy development, and best practice implementation surrounding PA.