Abstract
Since food preferences develop during early childhood and contribute to dietary patterns that can track into adulthood, it is critical to support healthy food environments in places where children spend significant amounts of time in, such as childcare. It is important to understand what factors influence the diet quality of children cared for in family childcare homes (FCCH). Methods: This study used baseline data from a cluster-randomized trial in FCCH, Healthy Start/Comienzos Sanos. Surveys capturing providers’ socio-demographic characteristics were completed. Food and beverage consumptions were estimated using the Dietary Observation in Childcare protocol, and diet quality was calculated using the Healthy Eating Index (HEI)-2015. Comparison of mean HEI scores by provider socio-demographic variables were completed using ANOVAs, followed by multiple linear regression models for significant variables. Post-hoc ANOVA models compared mean HEI-2015 sub-components by income and ethnicity. Results: Significant differences in mean HEI-2015 scores were found for provider income level (less than $25,000, HEI: 64.8 vs. $25,001–$50,000: 62.9 vs. $75,001 or more: 56.2; p = 0.03), ethnicity (Non-Latinx: 56.6 vs. Latinx: 64.4; p = 0.002), language spoken outside of childcare (English: 58.6 vs. Spanish: 64.3, p = 0.005), and language spoken in childcare (English: 59.6 vs. Spanish: 64.4; p = 0.02). In linear regression models, a higher provider income ($75,001 or more) was negatively and significantly associated with the total HEI-2015 scores (β = −9.8, SE = 3.7; p = 0.009) vs. lower income (less than $25,000). When entering provider income and ethnicity to the same model, adjusting for Child and Adult Food Program (CACFP), only ethnicity was significant, with Latinx being positively associated with total HEI-2015 scores vs. non-Latinx (β = 6.5, SE = 2.4; p = 0.007). Statistically significant differences were found by ethnicity and language for greens/beans, total protein, and seafood and plant protein HEI-2015 component scores. Discussion: Lower income, and Latinx providers cared-for children had higher diet quality in FCCH compared to the other providers. Future studies should better understand what specific foods contribute to each of the HEI-2015 components in order to better tailor trainings and interventions.
Highlights
Suboptimal diet is the leading risk factor for death and disability in the US [1,2]
We found that provider income, ethnicity, and the primary language spoken both outside and within the childcare setting were associated with the total Healthy Eating Index (HEI)-2015 scores
A higher family childcare provider (FCCP) income level was associated with the lower diet quality of higher family childcare provider (FCCP) income level was associated with the lower diet quality of the the children they cared for in their family childcare homes (FCCH), while the FCCP being Latinx was associated with the higher children they cared for in their FCCH, while the FCCP being Latinx was associated with the higher diet diet quality of children in their care
Summary
Suboptimal diet is the leading risk factor for death and disability in the US [1,2]. The diet quality of U.S children is generally poor, with an inadequate intake of fruits, vegetables, and whole grains, and over-consumption of energy-dense snacks and beverages [3,4,5,6], especially among low-income and ethnic minorities [7,8]. Poor diets contribute substantially to increased risk of chronic conditions including obesity, cardiovascular disease, specific cancers, and diabetes [9,10,11,12]. Since food preferences develop during early childhood [13,14] and contribute to dietary patterns that can track into adulthood [15], it is critical to support healthy food environments in places where children spend their time. The childcare environment is an ideal setting to promote children’s eating behaviors, given that. Children under five spend on average over 27 h a week in childcare settings [17], and it is recommended that they obtain 1/2 to
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