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 registrationThis study is registered at www.clinicaltrials.govNCT01814215.
Highlights
A high-quality diet and regular physical activity improves young children’s weight, cardiometabolic health, skeletal/bone health, psychosocial health, and cognitive development.[1,2,3,4] young children are not meeting diet and physical activity recommendations.[5]
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 family child care homes (FCCHs)
To address this research gap, we developed Keys to a Healthy Family Child Care Home (Keys), an intervention to improve FCCH environments and positively impact children’s diet quality and physical activity
Summary
A high-quality diet and regular physical activity improves young children’s weight, cardiometabolic health, skeletal/bone health, psychosocial health, and cognitive development.[1,2,3,4] young children are not meeting diet and physical activity recommendations.[5]. Care and education (ECE) offers important opportunities to improve young children’s diet and physical activity.[7] In Australia and the United States (US), 60–64% of children aged 3–5 years are enrolled in some type of ECE program.[8,9] Many countries in Europe have enrollment rates above 90%.10. FCCHs have fewer regulations compared to center-based programs, including limited nutrition and physical activity requirements.[12,13] FCCHs are an important target for intervention as they have poor nutrition and physical activity practices,[14] and the children enrolled have poor diet quality, low physical activity, and increased risk of obesity.[15,16,17]. To address this research gap, we developed Keys to a Healthy Family Child Care Home (Keys), an intervention to improve FCCH environments and positively impact children’s diet quality and physical activity. This paper describes primary and secondary outcomes from this intervention
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