Early Care And Education Centers Research Articles

Center-based early care and education programs and quality indicators: A latent class analysis

High quality early educational experiences are essential for young children's academic and social-emotional development. Although there is no one set of quality indicators that exists at a national level to assess center-based early care and education (ECE) program quality, researchers at the National Institute of Early Education Research (NIEER) have developed a set of quality benchmarks for state pre-kindergarten programs. However, patterns in the types of quality indicators ECE programs meet and how program, community, and policy features might be related to which indicators are met is not well understood. In the present study, we conducted a latent class analysis using nationally representative data from the 2012 National Survey of Early Care and Education (NSECE; n = 5,076 ECE centers) to identify subgroups of centers on the basis of the combinations of quality indicators met, which are similar to those developed by NIEER. Descriptive results show the mean number of NIEER benchmarks met was 5.74 out of 9 possible in the NSECE data. Our latent class analysis results reveal five distinct classes: (1) most quality indicators met; (2) smaller classroom ratios, but fewer teacher education and workforce support indicators met; (3) less screening support, but more teacher education and workforce support indicators met; (4) fewest indicators met; and (5) larger classroom ratios. Predictors of class membership were also examined. Findings of this exploratory study reveal heterogeneity in the specific combinations of quality indicators ECE programs meet.

Sustainability via Active Garden Education: The Sustainability Action Plan Model and Process.

Sustainability of intervention programming is challenging to achieve under real world conditions, since few models exist and many studies do not plan far beyond the funding period. Programming content in early care and education centers (ECECs) is often driven by guidelines. However, implementation is very sensitive to contextual factors, such as the setting and implementer (teacher) characteristics. This paper presents the model, definitions, and methodology used for the sustainability action plan capitalizing on a community-based participatory research (CBPR) approach, developed for a multi-site, multi-level garden-based childhood obesity prevention study, Sustainability via Active Garden Education (SAGE). The Ecologic Model of Obesity is applied to develop a sustainability action plan (SAP) and accompanying measures to link early care and education (ECE) environment, the community, policies, and classroom practices to an early childhood obesity prevention program. The SAGE SAP provides an example of how to iteratively evaluate and refine sustainability processes for an obesity prevention intervention utilizing CBPR approaches and will be applied to assess the sustainability of SAGE in a cluster randomized controlled trial. This SAP model can also help inform intervention delivery and scalability within ECECs.

Early Care and Education Center Environmental Factors Associated with Product- and Process-Based Locomotor Outcomes in Preschool-Age Children.

Environmental characteristics of early care and education centers (ECECs) are an important context for preschool-aged children’s development, but few studies have examined their relationship with children’s locomotor skills. We examined the association between characteristics of the ECEC environment with quantitatively (i.e., product-based) and qualitatively (i.e., process-based) measured locomotor skills, using the Progressive Aerobic Cardiovascular Endurance Run (PACER) and the locomotor portion of the Children’s Activity and Movement in Preschool Study (CHAMPS) motor skills protocol (CMSP), respectively. ECEC characteristics included outdoor and indoor play environment quality, outdoor and indoor play equipment, screen-time environment quality, and policy environment quality. Mean (SD) scores for the PACER (n = 142) and CSMP (n = 91) were 3.7 ± 2.3 laps and 19.0 ± 5.5 criteria, respectively, which were moderately correlated with each other (Pearson r = 0.5; p < 0.001). Linear regression models revelated that a better policy environment score was associated with fewer PACER laps. Better outdoor play and screen-time environment quality scores and more outdoor play equipment were positively associated with higher CMSP scores. ECEC environments that reflect best practice guidelines may be opportunities for locomotor skills development in preschool-aged children. ClinicalTrials.gov Identifier: NCT03261492 (8/25/17).

Food Insecurity Is Associated with Depression among a Vulnerable Workforce: Early Care and Education Workers.

Objective: We aimed to explore the association between food insecurity and depression among early care and education (ECE) workers, a vulnerable population often working in precarious conditions. Design: We utilized cross-sectional data from a study exploring the effects of wage on ECE centers. Participants were enrolled between August 2017 and December 2018. Food insecurity was measured using the validated six-item U.S. Household Food Security Survey Module and participants were categorized as food secure (score = 0–1), low food security (score = 2–4), and very low food security (score = 5–6). Depression (defined as a score ≥ 16) was measured using the 20-item Center for Epidemiologic Studies Depression Scale-Revised. We employed a logistic regression model to examine the relationship between food insecurity and depression. All models controlled for marital status, nativity, race/ethnicity, number of children in the household, job title, weekly hours of work, education, income, and study site. Setting: Participants were from Seattle (40%) and South King County (26%), Washington, and Austin, Texas (34%). Participants: Participants included 313 ECE workers from 49 ECE centers. Results: A majority of participants were female, non-Hispanic White, born in the U.S., and did not have children. Compared to being food secure, very low and low food insecurities were associated with a 4.95 (95% confidence interval (CI): 2.29, 10.67) and 2.69 (95% CI: 1.29, 5.63) higher odds of depression, respectively. Conclusions: Policies and center-level interventions that address both food insecurity and depression may be warranted, in order to protect and improve the health of this valuable, yet vulnerable, segment of the U.S. workforce.

Evaluation of \u201cHealthy Way to Grow\u201d: An Obesity Prevention Program in Early Care and Education Centers

The aim of this study was to test a training and technical assistance program in early care and education (ECE) center-based programs focused on obesity prevention – Healthy Way to Grow (HWTG). After completing a self-assessment, ECE programs develop actionable policies to improve the wellness environment. Then, they receive individualized one-on-one support from a local, trained Child Care Specialist to develop, implement, and monitor policies. Three hundred and sixty ECE programs participated in HWTG for at least one year. Center-level outcomes were examined pre- and post-intervention, including the number of policies, wellness educational opportunities offered (to staff, families, and children), and monitoring wellness practices. A subset of centers was followed for five years to determine if the program results were sustained over time. Study findings revealed that after participating in HWTG for one year, centers developed more policies, provided more educational opportunities, and more frequently monitored wellness practices at ECE centers. Even with reduced training and technical assistance in years two through five of the program, centers were able to maintain gains in improvements to wellness environments. These findings provide evidence for the effectiveness of the HWTG wellness program and offer insights into how to support ECE programs to improve wellness environments.

Healthy Eating Policy Improves Children's Diet Quality in Early Care and Education in South Carolina.

Policies to promote healthy foods in early care and education (ECE) in the United States exist, but few have been prospectively evaluated. In South Carolina, a statewide program serving low-income children in ECE enacted new policies promoting healthy foods. We conducted an evaluation to measure changes in dietary intake among children in ECE exposed and not exposed to the new policy. Using direct observation, we assessed dietary intake in 112 children from 34 ECE centers in South Carolina and 90 children from 30 ECE centers in North Carolina (a state with no policy). We calculated Healthy Eating Index-2015 (HEI) scores to measure diet quality consumed before and after the policy was enacted. We fit mixed-effects linear models to estimate differences in HEI scores by state from baseline to post-policy, adjusting for child race, number of children enrolled, director education, center years in operation, participation in the Child and Adult Care Food Program (CACFP), and center profit status. The policy increased HEI scores for whole fruits, total fruits, and lean proteins, but decreased scores for dairy. Thus, the policy was associated with some enhancements in dietary intake, but additional support may help improve other components of diet.

Food Insecurity Is Associated with Depression Among a Vulnerable Workforce: Early Care and Education Workers

Abstract Objectives The primary objective of this analysis was to explore the association between food insecurity and depression among early care and education (ECE) workers. Methods We conducted a cross-sectional analysis of baseline data collected from a study exploring the effects of wage on ECE centers and workers in Seattle and South King County, WA, and Austin, TX. We employed a logistic regression model to investigate the relationship between food insecurity (i.e., six-item U.S. Household Food Security Survey Module) and depression (i.e., Center for Epidemiologic Studies Depression Scale-Revised). Models controlled for age, marital status, birth country, race/ethnicity, number of children in the household, job title, average paid hours of work per week, highest level of education, total household income, and study site. In two separate models, an interaction term was used to assess whether food assistance participation and wage modified the association between food insecurity and depression. Results Our primary model included 313 ECE workers from 49 ECE centers in Seattle (40%), South King County (26%), and Austin (34%). Majority of participants were female, non-Hispanic White, born in the US, and did not have children. In our primary model, low and very low food insecurity, compared to normal food security, was associated with a 2.69 (95% Confidence Interval [CI]: 1.29, 5.63) and 4.95 (95% CI: 2.29, 10.67) higher odds of depression, respectively. The association between food insecurity and depression did not vary by participation in food assistance program(s) or median site wage. Conclusions Results suggest a dose-response relation between food insecurity and depression among a sample of predominantly female, non-Hispanic white, and low-wage ECE workers. Policies and center-level interventions that address both food insecurity and depression warrant consideration in order to improve the health vulnerable workforce, which ultimately is vital to delivering quality childcare. Funding Sources This research study was supported by a Robert Wood Johnson Foundation Evidence for Action grant, as well as a Eunice Kennedy Shriver National Institute of Child Health and Human Development research infrastructure grant awarded to the Center for Studies in Demography and Ecology at the University of Washington.

Contributions of Early Care and Education Programs to Diet Quality in Children Aged 3 to 4 Years in Central North Carolina

BackgroundParents and early care and education (ECE) are the key influencers of young children’s diets, but there is limited information about how each contribute to children’s overall diet quality. ObjectiveThis study aimed to determine what proportion of children’s dietary intake occurs within the ECE setting and whether diet quality is higher at ECE centers and, consequently, on weekdays than weekends. DesignThis cross-sectional analysis of a larger cluster randomized controlled trial used multiple 24-hour dietary intakes measured through a combination of the Dietary Observation in Child Care protocol and parent-reported food diaries. Participants/settingParticipants (N=840) included children aged 3 to 4 years enrolled in ECE centers in central North Carolina for whom 24-hour dietary intake was captured via observation of meals and snacks consumed at ECE and parent-report of all remaining meals and snacks. Data were collected from 2015 to 2016. Main outcome measuresDiet quality at ECE and elsewhere was evaluated using the Healthy Eating Index 2015. Statistical analyses performedMixed-effects models were used to determine differences in mean Healthy Eating Index 2015 component and total scores. Models were adjusted for children’s age and sex and accounted for clustering within ECE centers and families. ResultsChildren consumed approximately 40% of daily energy, nutrients, and food groups at ECE centers. The mean total Healthy Eating Index 2015 score was higher for foods and beverages consumed at ECE centers (58.3±0.6) than elsewhere (52.5±0.6) (P<0.0001). The mean total Healthy Eating Index 2015 score was also higher on weekdays (58.5±0.5) than on weekends (51.3±0.5) (P<0.0001). ConclusionsChildren consume a majority of dietary intake away from ECE centers. Overall, diet quality is low, but the quality of foods consumed by children at ECE centers is higher than that consumed elsewhere. ECE centers remain an important source of nutrition and further investigation is warranted to identify ways to support both ECE centers and families to provide healthier eating environments.

Diet Quality in Early Care and Education Centers: A Comparison of Menu, Served, and Consumed Lunch Measures

ObjectiveAssess if diet quality (DQ) differs among 3 lunch measures commonly used to assess DQ in early care and education (ECE) centers, which include what is listed on the menu, served, and consumed. DesignThis quantitative observational study measured DQ of food and beverage items listed on the menu, what children were served, and what they consumed during one lunch meal. SettingAlabama ECE centers. ParticipantsECE centers (n = 28) with attendance of ≥10 children ages 3 to 5 years and provided lunch daily. Main Outcome Measure(s)DQ measured through Healthy Eating Index–2015 (HEI) scores, which were calculated for the menu, served, and consumed lunch measures. AnalysisMenu, served, and consumed HEI scores compared using either Kruskal-Wallis or ANOVA. Dunn Bonferroni or Duncan post hoc tests identified which group differed. ResultsTotal HEI scores were significantly higher among menus, compared with served and consumed (P = .001). Served and consumed total HEI scores were not different. Conclusions and ImplicationsMenu DQ differed from both the served and consumed lunch measures. These findings support the need for nutrition education on the importance of menu adherence in ECE centers.

P113 Diet Quality Assessment in Early Care and Education Centers: A Comparison of Three Common Methods

Background Children in Early Care and Education (ECE) centers are not meeting Dietary Guidelines (DG), which could contribute to the onset of diet-related diseases. ECE center diet quality has been assessed using either what is listed on the menu, what children are served and/or what was consumed for the lunch meal. However, it is unclear whether diet quality differs among the three measures, which may be useful to understand patterns that inform nutrition education messaging. Objective Identify if diet quality differs among the menu, served and consumed lunch measures. Diet quality will be assessed using Healthy Eating Index-2015 (HEI) scores, which represent how closely DG are met. Study Design, Settings, Participants ECE centers were located within one southern state, and included rural and urban communities. For each center, three children from a 3-5 year old classroom, were randomly chosen and observed during one lunch meal, per a published protocol. The type and amount of food/beverage served to or by the child (SERVED) and the amount consumed (CONSUMED) was visually estimated and recorded. The menu from the observed lunch (MENU) was collected. For each center, a mean HEI score was calculated for SERVED, CONSUMED and MENU. Measurable Outcome/Analysis Non-parametric ANOVA and Duncan's post-hoc were used to identify statistically significant differences among SERVED, CONSUMED, and MENU HEI scores. Results Lunch observations were completed within 28 ECE centers. The total HEI score was significantly higher (χ2 = 11.7, P = .003) among MENUS, compared to SERVED and CONSUMED. Total HEI scores among SERVED and CONSUMED were not significantly different. Conclusion Diet quality was higher among menus, compared to served and consumed measures. Nutrition education messaging may encourage ECE employees to serve the food/beverage items listed on the lunch menu, in order to improve diet quality. Understanding why diet quality differences exist among lunch measures, is warranted. Funding Nestle S.A. Grant.

Acculturation Is Related to Diet Quality in Phoenix Preschoolers, Controlling for Food Insecurity (P04-048-19)

ObjectivesTo examine the relationship between acculturation and diet quality of preschoolers in the Phoenix area. There is little research on how the dietary intake of preschoolers outside of the home is impacted by parental acculturation in food secure and insecure households. MethodsThis study was a cross-sectional secondary data analysis of the SAGE (Sustainability via Active Garden Education) research project. SAGE provides education on gardening, physical activity, and nutrition to preschoolers in Phoenix, AZ. Preschoolers (Mean age 53.1 + 3.5 mos; n = 154) were recruited from early care and education centers (ECEC). Acculturation was evaluated using a parent-report validated survey on a scale of 1–5 (1 = low acculturation). Parents also reported sociodemographic variables (child sex, age, ethnicity, and family income) and household food security status (dichotomized as food secure or insecure). Meals were observed by trained research staff at the ECEC for one full day (breakfast, lunch, snack) and recorded using the Nutrition Data System for Research. Linear regressions examined the relationship between acculturation and diet quality (total kcal, fruits, vegetables, saturated fat, added sugar intake) adjusting for sociodemographics and household food security status. ResultsA total of 78.6% of preschoolers in this study were Hispanic. Of the 154 children, 52.6% and 47.4% were male and female, respectively. The mean acculturation score was 3.0 + 1.3 with 41.8% of the sample being food insecure. Higher acculturation was significantly associated with increased vegetable (β = 0.095, P = 0.028) and saturated fat intake (β = 1.001, P = 0.018). Acculturation trended an association with increased kcal intake (β = 47.475, P = 0.053). ConclusionsResults suggest parent acculturation is associated with healthy and unhealthy eating habits in preschoolers outside of the home regardless of food security status. When evaluating diet quality of preschoolers, acculturation needs to be assessed to promote improved health behaviors, especially in relation to saturated fat and vegetable intake. Funding SourcesThis study was funded by the Maternal Child Health Bureau and the National Institute of Minority Health and Health Disparities of the National Institutes of Health.

A Menu to Evaluate Factors Influencing Implementation of Obesity Prevention Early Care and Education Regulations.

In recent years, several states have adopted new regulations concerning nutrition, physical activity, and screen time in early care and education (ECE) settings to help prevent childhood obesity. To disseminate a menu of factors that facilitate and/or impede implementation of obesity prevention regulations in ECE settings. To create the menu, we condensed and categorized factors identified in the literature and through field work by placing them within domains. We applied the menu by conducting semistructured interviews during a pilot test assessing implementation of ECE regulations in Colorado. We first interviewed state and local government agency leaders responsible for policy oversight, and state employees and contractors who acted as intermediaries to direct implementers. We then interviewed directors at ECE centers in the Denver, Colorado, area. We selected 21 ECE centers for a site visit on the basis of feasibility, percentage of low-income families, and diversity in race and ethnicity at each center. Seven centers participated. Minor and major facilitators and impediments to implementation of childhood obesity prevention regulations in ECE settings. The resulting menu includes 7 domains and 39 factors influential for implementation of ECE regulations. Of these 39 factors, interviewees identified 7 facilitating factors (4 major and 3 minor) and 2 impeding factors (both major). Major facilitating factors were buy-in from parents/caregivers, training and communication provided by governing authority and their contractors, and low level of change required by the regulations themselves. Major impeding factors were timing of implementation and balancing the demands of the regulations against other priorities. The menu developed by our research team, combined with existing frameworks in dissemination and implementation research, can be used by researchers, practitioners, and policy makers to anticipate factors that facilitate and/or impede implementation of ECE policies to prevent childhood obesity.

Design and methodology of a cluster-randomized trial in early care and education centers to meet physical activity guidelines: Sustainability via Active Garden Education (SAGE)

Strategies are needed to help early care and education centers (ECEC) comply with policies to meet daily physical activity and fruit and vegetable guidelines for young children. This manuscript describes the design and methodology of Sustainability via Active Garden Education (SAGE), a 12-session cluster-randomized controlled crossover design trial using community-based participatory research (CBPR) to test a garden-based ECEC physical activity and fruit and vegetables promotion intervention for young children aged 3–5 years in 20 sites. The SAGE curriculum uses the plant lifecycle as a metaphor for human development. Children learn how to plant, water, weed, harvest, and do simple food preparation involving washing, cleaning, and sampling fruit and vegetables along with active learning songs, games, science experiments, mindful eating exercises, and interactive discussions to reinforce various healthy lifestyle topics. Parents will receive newsletters and text messages linked to the curriculum, describing local resources and events, and to remind them about activities and assessments. Children will be measured on physical activity, height, and weight and observed during meal and snack times to document dietary habits. Parents will complete measures about dietary habits outside of the ECEC, parenting practices, home physical activity resources, and home fruit and vegetable availability. SAGE fills an important void in the policy literature by employing a participatory strategy to produce a carefully crafted and engaging curriculum with the goal of meeting health policy guidelines and educational accreditation standards. If successful, SAGE may inform and inspire widespread dissemination and implementation to reduce health disparities and improve health equity.

About feeding children: factor structure and internal reliability of a survey to assess mealtime strategies and beliefs of early childhood education teachers

BackgroundChildren spend a substantial amount of time in early care and education (ECE) settings and may eat a majority of their diet in this setting. While there are several instruments focused on measuring factors of the ECE environment that may influence diet and weight outcomes, there are few comprehensive, valid, and reliable measures for collecting self-report of ECE providers’ feeding practices. The purpose of this study was to establish the factor structure and internal reliability of a survey developed to measure practices and beliefs of ECE providers relative to feeding children.MethodsLicensed ECE centers from CA, CO, ID and NV were included in this cross-sectional survey study. The sample was stratified by states and census regions to yield equal numbers of centers from each category. The total sample distribution included 1600 randomly selected centers and up to 8000 staff members (who represented teachers, aides, assistants, or cooks); 1178 surveys were completed. We conducted an exploratory, unrestricted factor analysis as well as parallel analyses to inform the number of factors to be extracted.ResultsFactors within Structural Mealtime Strategies included Adult Control of Foods Consumed (Kuder-Richardson [KR] = 0.67), Bribing with Sweet Foods (KR = 0.70), and Supportive Adult Roles at Mealtime (KR = 0.55). Factors in Verbal Mealtime Strategies included Supporting Children’s Eating Self-regulation (KR =0.61), Pressure to Eat (KR = 0.58), and Social Comparisons (KR = 0.59). Beliefs about Mealtime factors were Autonomy Promoting (α = 0.64), Coercive Beliefs (α = 0.77), and Concern-Based Control (α = 0.60).ConclusionsThe AFC Strategies and Beliefs Survey provides a promising self-report instrument with a strong factor structure consistent with the extant literature to measure practices and beliefs related to feeding and mealtimes in the ECE setting. Feeding young children in group settings differs in many ways from feeding in a family setting; hence it is important that measures such as the AFC Strategies and Beliefs Survey capture unique aspects of the ECE feeding environment.

Barriers and Facilitators to Compliance with a State Healthy Eating Policy in Early Care and Education Centers.

Early care and education (ECE) policies can improve childhood obesity risk factors. We evaluated barriers and facilitators to implementing mandatory nutrition standards for foods provided in South Carolina ECE centers serving low-income children, comparing centers participating in the Child and Adult Care Food Program (CACFP) with non-CACFP centers. We mailed 261 surveys (demographics, policies and practices, barriers and facilitators) to center directors after new state nutrition standards were implemented in South Carolina. We conducted univariate and bivariate analyses to explore relationships between barriers, facilitators, and center-level characteristics, by CACFP status. We received 163 surveys (62% response rate). Centers had a median [interquartile range (IQR)] of 5 (4-7) classrooms and 59 (37.5-89) total children enrolled. More than half (60.1%) of directors reported they were moderately or fully informed about the standards. The most common barriers were food costs (17.8%) and children's food preferences (17.8%). More non-CACFP directors reported food costs as a barrier (28.6% vs. 6.5%, p < 0.001), having to spend additional money on healthier foods (48.8% vs. 28.6%, p = 0.01), and having to provide additional nutrition education to parents (28.6% vs. 11.7%, p = 0.01), compared with CACFP directors. Center directors were generally well informed about the nutrition standards. The most common barriers to implementing the standards were food costs and children's food preferences. Centers participating in CACFP may be in a better position to adhere to new state nutrition standards, as they receive some federal reimbursement for serving healthy foods and may be more accustomed to regulation.

Examining Relationships between Food Procurement Characteristics and Nutritional Quality in Washington State Child Care Settings.

Sixty percent of US children 5 years old and under receive up to two-thirds of their daily nutrition in early care and education (ECE) settings. Although participation in the federal Child and Adult Care Food Program (CACFP) is shown to improve nutrition, little is known about the relationship between procurement practices (where and how child care programs purchase food) and nutrition in ECE settings or whether these practices differ depending on participation in CACFP. We assessed self-reported nutrition practices and procurement practices by CACFP participation using a 2013 cross-sectional survey of 690 Washington ECE centers ("Centers") and 1260 family homes (family home child care [FHCCs]) serving children aged 2-5 years old using validated survey tools. We examined the relationship between procurement variables (i.e., main store and main mode) and nutrition scores using multinomial logistic regression models that adjusted for sociodemographic and program characteristics. In-person shopping was the primary mode of shopping for all programs, regardless of CACFP participation. Some Centers but very few FHCCs reported online shopping as their primary mode. Centers and non-CACFP FHCCs shopped primarily at megastores (Costco, Target, etc.). CACFP FHCCs used both megastores and grocery stores (Albertsons, QFC, etc.) at similar rates. Adjusted multinomial models found that shopping online or at two or more stores was associated with higher nutritional quality of foods served by programs. Understanding the procurement behaviors of ECE programs helps to illuminate and prioritize potential interventions that would support healthy food purchases.

Screen-Time Policies and Practices in Early Care and Education Centers in Relationship to Child Physical Activity.

Few preschool children meet physical activity recommendations, whereas the majority exceeds screen-time recommendations. The purpose of this study was to examine the relationship of screen-time policies and practices with children's physical activity and sedentary time in early care and education (ECE) centers. We conducted a cross-sectional study of 104 children (3.3 ± 0.5 years; 50% girls) attending 10 ECE centers in the United States. Physical activity was measured by accelerometry. Screen-time practices were measured by classroom observation and director report. Mixed linear models were used to examine the relationship of screen-time practices with children's total physical activity (TPA) and moderate-to-vigorous physical activity (MVPA) and sedentary time, adjusting for child's age, sex, and BMI z-score and taking into account the clustering of children within each center. Models were repeated to include director-reported active play time as a covariate. More limited/supervised screen-time (by observation) was related to higher TPA (p = 0.0003) and lower sedentary time (p = 0.0003). More limited/supervised screen-time (by director report) was related to higher TPA (p < 0.0001) and MVPA (p = 0.021) and lower sedentary time (p < 0.0001). Associations remained significant when active play time was included as a covariate. TPA was inversely related to computer access (p = 0.0015) and positively related to the use of educational screen-time compared with noneducational screen-time (p = 0.04). Limiting computer usage and ensuring screen-time is educational, and integrated within the curriculum may benefit children's physical activity levels and reduce time spent sedentary.

Early Care and Education Teacher's Role in Obesity Prevention and Healthy Development of Young American Indian Children.

The purpose of this study was to develop an understanding of how stakeholders, specifically early care and education (ECE) teachers, perceive their role in the development of young American Indian children, and envision working with health care providers and parents in order to enhance children's health. Twenty tribally affiliated ECE teachers from Oklahoma participated in interviews. Thematic analysis was conducted, and three main themes, each with two to three subthemes, emerged. Teachers felt that nutrition and physical activity were important to children's health. Teachers had little professional interaction with health care providers but desired more. Parental empowerment was conveyed as essential to actualize positive changes in their child's behavior. Teachers of tribally affiliated ECE centers are important stakeholders in promoting the health and well-being of young American Indian children. Additional efforts are needed to more effectively integrate teachers and nurses in order to create effective interventions. We propose a stakeholder partnership to guide the development of future interventions.

Parent packs, child eats: Surprising results of Lunch is in the Bag‘s efficacy trial

Early care and education (ECE) centers that require lunch brought from home provide an uncluttered view of parent-child dietary interactions in early childhood. Children's eating from parent-provided bag lunches was observed at 30 ECE centers in Texas, with 15 randomly assigned to the Lunch is in the Bag intervention to improve the lunch meal and 15 to a wait-list control condition. Study participants were parent and child aged 3–5 years (N = 633 dyads). Data were collected at baseline (pre-intervention) and follow-ups at weeks 6 (post-intervention), 22 (pre-booster), and 28 (post-booster). Changes effected in the children's lunch eating—e.g., increase of 14 percent in prevalence of children eating vegetables (SE = 5, P = 0.0063)—reciprocated changes in parent lunch-packing. Irrespective of intervention, however, the children consumed one-half to two-thirds of the amounts of whatever foods the parents packed, and the eat-to-pack ratio did not change across time. Thus, children's lunch eating at the ECE centers appeared to be regulated by perceptual cues of food availability rather than food preferences or internal cues of hunger and satiety.

Adequacy of Parent-Packed Lunches and Preschooler's Consumption Compared to Dietary Reference Intake Recommendations

abstractBackground: U.S. preschool children consume inadequate amounts of key nutrients. Understanding the contents of lunches packed by parents and consumed by their children can help identify areas of opportunity for the development of healthy food preferences.Objective: To evaluate the nutrient adequacy of lunches packed by parents and consumed by children attending early care and education (ECE) centers.Methods: Baseline data from 607 parent–child dyads in the “Lunch Is in the Bag” cluster-randomized controlled trial in Central Texas were examined. Foods packed by parents and consumed by children in sack lunches were observed at 30 ECE centers on 2 nonconsecutive days. Mean levels of energy, macronutrients, vitamins, and minerals were estimated with covariate-adjusted multilevel regression models that accounted for center-level clustering and repeated within-child measures.Results: Energy (kilocalories) was 602.48 for packed lunches compared to 374.40 for consumed lunches. In packed lunches, percentage of energy as macronutrients for protein (14.8%), carbohydrate (55.9%), and total fat (31.2%) were within the acceptable macronutrient distribution range (AMDR) for the children's ages. Sugar (28.9% of energy) was above the AMDR recommendation. Only a quarter of parents packed 33% or more of the child's dietary reference intake (DRI) for dietary fiber. Over half the parents packed 33% or more of the DRI for vitamin A and calcium, and less than one in 8 packed 33% of the DRI for potassium. Children consistently consumed between 60 and 80% of the nutrients that were packed.Conclusions: Preschool children rely on parents to present them with healthy food choices, but lunches packed by parents for their preschool children do not consistently provide adequate nutrients. These data and the relationships between the dietary quality of packed and consumed lunches can be useful information to guide nutrition behavior change through targeted interventions.