Abstract
BackgroundChild care workers are among the lowest paid US workers and experience a wide array of health concerns. The physical and mental demands of their job and the lack of employer-provided health-insurance increase health risks. The Caring and Reaching for Health (CARE) study evaluated a 6-month Healthy Lifestyles intervention targeting child care workers’ physical activity (primary outcome), other health behaviors, and their workplace health environment.MethodsEligible child care centers, defined as being in operation for at least 2 years and employing at least four staff, were enrolled into CARE’s cluster-randomized trial. Centers and their child care staff were randomly assigned to either the Healthy Lifestyles (HL) intervention arm or the Healthy Finances (HF) attention control arm using a block randomization approach. Intervention components were delivered through in-person workshops, center-level displays, informational magazines, director coaching, electronic messaging, and an interactive website. Outcome measures were collected during center visits at baseline and immediately post-intervention by trained data collectors blinded to center arm assignment. Workers’ physical activity was assessed with accelerometers, worn for 7 days. Secondary outcome measures included biometric assessments of health and fitness, web-based surveys about health behaviors, and an environmental audit of workplace supports for health. Multi-level linear mixed models assessed worker- and center-level changes in these outcomes.ResultsParticipants included 553 child care workers representing 56 centers (HL = 250 staff/28 centers, HF = 303 staff/28 centers). At 6 months, moderate-to-vigorous physical activity declined slightly in both arms (− 1.3 min/day, 95% CI: − 3.0, 0.3 in HL; − 1.9 min/day, 95% CI: − 3.3, − 0.5 in HF), but there was no significant group by time interaction. Several secondary outcomes for other health behaviors and workplace health environment showed improvements in favor of the intervention arm, yet differences did not remain statistically significant after adjustment for multiple comparisons.ConclusionsWhile the Healthy Lifestyles intervention did not improve health behaviors or the workplace health environment, results confirmed the pressing need to focus on the health of child care workers. Future interventions should focus on prevalent health issues (e.g., weight, stress), include both high-tech and high-touch intervention strategies, and address work conditions or other social determinants of health (e.g. wages) as a means of improving the health of these essential workers.Trial registrationCare2BWell: Worksite Wellness for Child Care (NCT02381938).
Highlights
Low-wage workers are among the fastest growing segments in the United States workforce [1], and they suffer disproportionately from both health behavioral risks factors and chronic diseases that are the leading causes of premature death and disability [2, 3]
While the Healthy Lifestyles intervention did not improve health behaviors or the workplace health environment, results confirmed the pressing need to focus on the health of child care workers
While workplace health promotion interventions have achieved some encouraging results on a wide array of behavioral risk factor outcomes such as physical activity, diet, and weight management [4,5,6,7]; there is a critical need to develop effective interventions to address the health of low-wage workers [8]
Summary
Low-wage workers are among the fastest growing segments in the United States workforce [1], and they suffer disproportionately from both health behavioral risks factors and chronic diseases that are the leading causes of premature death and disability [2, 3]. While workplace health promotion interventions have achieved some encouraging results on a wide array of behavioral risk factor outcomes such as physical activity, diet, and weight management [4,5,6,7]; there is a critical need to develop effective interventions to address the health of low-wage workers [8]. In 2012, Child Care Aware published “Paths to a Healthier Child Care Workforce,” which reported on child care workers’ poor physical activity and dietary habits, identified critical barriers to health and wellness, and suggested health-supportive improvements to the workplace [15]. The Caring and Reaching for Health (CARE) study evaluated a 6-month Healthy Lifestyles intervention targeting child care workers’ physical activity (primary outcome), other health behaviors, and their workplace health environment
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