Family Child Care Homes Research Articles

Associations Between Community Nutrition Environments and Early Care and Education Classroom Nutrition Practices

ObjectivesPoor child diet is influenced by nutrition environments surrounding schools and homes; influence of these environments on Early Care and Education (ECE) settings is not understood. The purpose of this study was to determine associations between community nutrition environments and ECE classroom nutrition practices, by ECE context [Head Starts, community-based childcare (CBCs), and family child care homes (FCCHs)]. MethodsCross-sectional study including licensed Oklahoma ECEs. Locations of 457 grocery stores were determined in-person. Locations of participating ECEs and grocery stores were geocoded and analyzed in ArcMap 10.6. ECEs were considered located within a “Food Desert” if no grocery stores were available within a 0.25-mile radius for urban ECEs, or 10-mile radius for rural ECEs. ECE directors completed the Nutrition and Physical Activity Self-Assessment tool (i.e., NAP SACC); items were reported on a Likert-type scale and subscores were calculated for nutrition practices. Wilcoxon Rank Sum test was performed to compare practice scores among those located within a Food Desert versus Non-Desert. Benjamini Hochberg calculations for False Discovery Rate were applied (α< 0.004). Results54 Head Starts, 159 CBCs, and 160 FCCHs participated with 24%, 27% and 37%- respectively- being located within a Food Desert. ECE descriptive characteristics including food purchasing and meal planning strategies varied by ECE context. Head Starts demonstrated the highest classroom nutrition scores for mealtime practices, and nutrition education and policy. Food Desert status was not related to classroom nutrition practice scores for any ECE context (P > 0.004). ConclusionsContrary to studies in residential areas and schools, nutrition environments were not related to nutrition practices in ECEs. This suggests that ECEs may serve as protective micro-environments supporting health for children more vulnerable to the health environments of their nearby residing communities. Supporting health practices for ECEs may be achieved most effectively through within-center intervention and policy. Funding SourcesThis study was funded by the Early Care and Research Scholars: Head Start Graduate Student Research Grant (HHS2017-ACF-OPRE-YR-1219), OUHSC College of Allied Health Student Research and Creativity Grant, and Department of Nutritional Sciences.

Physical Activity Levels among Preschool-Aged Children in Family Child Care Homes: A Comparison between Hispanic and Non-Hispanic Children Using Accelerometry.

Obesity prevalence among Hispanic children is twice that of non-Hispanic white children; Hispanic children may also engage in less physical activity (PA) compared to non-Hispanic white children. A large number of U.S. preschool-aged children are cared for in Family Child Care Homes (FCCH), yet few studies have examined PA levels and ethnicity differences in PA levels among these children. We examine baseline data from a cluster-randomized trial (Healthy Start/Comienzos Sanos) to improve food and PA environments in FCCHs. Children aged 2-to-5-years (n = 342) wore triaxial accelerometers for two days in FCCHs. Variables examined include percentage of time (%) spent in sedentary, and light, moderate, and vigorous PA. The full dataset (n = 342) indicated sedentary behavior 62% ± 11% of the time and only 10% ± 5% of the time spent in moderate-to-vigorous PA. Among children in the upper-median half of wear-time (n = 176), Hispanic children had significantly greater % sedentary time vs. Non-Hispanic children (66.2% ± 8.3% vs. 62.6% ± 6.9%, p = 0.007), and lower % light PA (25.4% ± 6.3% vs. 27.7% ± 4.9%, p = 0.008) and moderate PA (5.5% ± 2.1% vs. 6.4% ± 2.2%, p = 0.018). Our results highlight that PA levels were lower among our sample compared to previous studies, and that Hispanic children were more sedentary and less active compared to non-Hispanic white children.

Self-Efficacy for Healthy Eating Moderates the Impact of Stress on Diet Quality Among Family Child Care Home Providers

ObjectiveTo examine associations of stress and sleep with diet quality of family child care home (FCCH) providers, and whether self-efficacy for healthy eating influences these associations. DesignA cross-sectional analysis was performed using baseline data (2013–2015) from a randomized control trial with FCCH providers. ParticipantsThe study included 166 licensed FCCH providers, aged >18 years, from central North Carolina. Main Outcome Measure(s)Diet quality was assessed with a food frequency questionnaire, used to calculate a modified 2010-Healthy Eating Index score. Stress, sleep quality, and diet self-efficacy were measured via self-administered questionnaires. AnalysisUsing observations from 158 participants with complete data, multiple linear regression models were created to assess whether stress, sleep quality, and diet self-efficacy were associated with diet quality and whether diet self-efficacy moderated these associations (significance set at P < 0.05). ResultsIn the initial model, only diet self-efficacy was significantly associated with diet quality (β = 0.32; P < 0.001). Moderation analyses showed that higher stress was associated with lower diet quality, but only when diet self-efficacy was low. ConclusionsBuilding FCCH providers’ self-efficacy for healthy eating is an important component of health promotion and can buffer the impact of stress on their diet quality.

The effect of the food environment on fresh produce served in family child care homes.

Higher produce consumption in childhood decreases risks of short- and long-term malnutrition, obesity, and disease. Children in early care programs, including family child care homes (FCCHs), receive 50-67% of daily nutrition while in care. Procuring nutritious foods requires grocer access, which is absent in food deserts (FDs). To determine if FCCH food environment (FE) impacted distance to grocers and amount of fresh produce served. Using a cross-sectional design, Modified Retail Food Environment Index scores determined census tract FD status. FCCH and grocer addresses were geocoded and distance to the nearest grocers was calculated. Fresh produce was observed during two lunches. FE did not influence distance to grocers or fresh produce served. Non-desert FCCHs tended to serve fresh produce more frequently. The amount of fresh produce served was overall low. Further studies are warranted to inform policies aimed to reduce provider barriers regarding service of fresh produce.

Improving Breastfeeding Environments and Feeding Practices in Family Child Care Homes with the Go NAP SACC Program.

Breastfeeding and responsive feeding are important practices that support the health of infants and women. In the United States, breastfeeding continuation rates remain lower than recommended, and working women face additional challenges with breastfeeding continuation. Providers in a family child care setting are uniquely positioned to support and provide important resources to families in their breastfeeding and infant feeding practices. The Go NAP SACC program was designed to improve the nutrition and physical activity environments and practices in child care settings serving infants and young children. This evaluation focuses on Breastfeeding and Infant Feeding in Nebraska Family Child Care Homes (FCCH). Paired-sample t-tests were used to examine differences in pre-post evaluation scores. A repeated measure ANCOVA was used to examine differences between rural-urban settings. Nebraska FCCH met recommendations at pre-test, and exceeded recommendations at post-test (p<.05). Rural and urban FCCH performed equally well in 18 of 22 items, indicating little difference in the ability to provide supportive environments and adhere to best practices in both settings. Improvement in family engagement items were significant at the p<.001 level. Family engagement in FCCH is an important area for intervention that was well-received by provider participants. This evaluation shows that the Go NAP SACC program improves breastfeeding and infant feeding environments and practices in rural and urban FCCH. Interventions should continue to focus on basic and practical education and professional development for FCCH providers, with emphasis on intentional family engagement and support.

Nutrition Standards For Infants and Young Children can be Implemented by Family Child Care Home Providers.

The study evaluated an educational intervention with family child care home (FCCH) providers to implement nutrition standards. A convenience sample of licensed California FCCH providers (n = 30) attended a 2-hour, in-person group training in English or Spanish on nutrition standards for infants and children aged 1 to 5 years. Provider surveys and researcher observations during meals/snacks were conducted pre- and 3 months post-intervention. Providers rated the training as excellent (average score of 4.9 on a scale of 1-5). Adherence, assessed by survey and observation and compared over time using paired t-tests, increased from an average of 36% pre-intervention to 44% post-intervention (P = .06) of providers (n = 12) for infant standards and from 59% to 68% (P < .001) of providers (n = 30) for child standards. One-third (39%) of providers rated infant standards and 19% of providers rated child standards as difficult to implement. Nutrition standards can be implemented by FCCH providers after an educational intervention; a larger study is warranted with a representative group of providers.

Dietary Contributors to Food Group Intake in Preschool Children Attending Family Childcare Homes: Differences between Latino and Non-Latino Providers

While there are several factors that contribute to the diet quality of children in childcare, one contributing factor in Family Childcare Homes (FCCHs) is the provider’s ethnicity. However, research examining the food items provided in this setting is limited; in particular, with regards to differences between FCCHs of Latino and non-Latino providers. The aim of this study was to identify and describe the food items that contribute to food group intake in preschool-aged children attending FCCHs, and to examine differences by provider ethnicity. This secondary data analysis used baseline data from Healthy Start/Comienzos Sanos: a cluster-randomized trial. Children’s dietary intake was collected using the Dietary Observation in Child Care method and entered into Nutrition Data System for Research software. Food groups were based on the Nutrition Coordinating Center classification. Contribution of food items to their respective food group was calculated as a proportion, using ratio of means and presented as a percentage. Ethnic differences were tested with ANCOVA (p < 0.05) with Bonferroni adjustments for multiple comparisons. All providers (n = 120) were female and 67.5% were Latino. Most fruit consumed by children was in the form of juice (85%), three-fourths of the grains consumed were refined (75%), and half of the sweets consumed were syrup/honey/jelly (50%). Most of the vegetables consumed were non-starchy (61%), nearly three-fourths of dairy consumed was low-fat (71%), and vegetable oils contributed the most to the fats group (89%). Food items differed by provider’s ethnicity, with children cared for by non-Latino providers consuming a higher proportion of fruit juice, animal fats and a lower proportion of legumes (p < 0.001 for all). Children with Latino providers consumed a lower proportion of non-starchy vegetables, low-fat dairy, and nuts/seeds (p < 0.001 for all). FCCH providers could offer more whole fruits and grains and a greater variety of vegetables. Differences by ethnicity suggest providers could benefit from culturally tailored recommendations.

Alignment of State Regulations With Breastfeeding and Beverage Best Practices for Childcare Centers and Family Childcare Homes, United States.

Childcare is an important setting for nutrition; nearly half of young children in the United States participate in licensed childcare, where they consume up to two-thirds of their daily dietary intake. We compared state regulations for childcare with best practices to support breastfeeding and healthy beverage provision. We reviewed regulations for childcare centers (centers) and family childcare homes (homes) in effect May-July 2016 and rated all 50 states for inclusion (1 = not included, 2 = partially included, 3 = fully included) of 12 breastfeeding and beverage best practices. We calculated average ratings for 6 practices specific to infants aged 0-11 months, 6 practices specific to children aged 1-6 years, and all 12 practices, by state and across all states. We assessed significant differences between centers and homes for each best practice by using McNemar-Bowker tests for symmetry, and we assessed differences across states by using paired student t tests. States included best practices in regulations for centers more often than for homes. Average ratings (standard deviations) in regulations across all states were significantly higher in centers than in homes for infant best practices (2.1 [0.5] vs 1.8 [0.5], P < .001), child best practices (2.1 [0.6] vs 1.8 [0.6], P = .002), and all 12 best practices combined (2.1 [0.5] vs 1.8 [0.6], P < .001). Although best practices were more consistently included in regulations for centers than for homes, many state childcare regulations did not include best practices to support breastfeeding and the provision of healthy beverages. Findings can be used to inform efforts to improve regulations and to reduce differences between centers and homes.

Changes in Foods Served and Meal Costs in Boston Family Child Care Homes after One Year of Implementing the New Child and Adult Care Food Program Nutrition Standards.

This study aimed to determine the impact of 2017 revisions to the Child and Adult Care Food Program (CACFP) nutrition standards on foods and beverages served and meal costs in family child care homes (FCCHs). Our pre–post study utilized four weeks of menus and food receipts from 13 FCCH providers in Boston, MA prior to CACFP nutrition standards changes in 2017 and again one year later, resulting in n = 476 menu observation days. We compared daily servings of food and beverage items to the updated standards. Generalized estimating equation models tested for changes in adherence to the standards and meal costs. FCCHs offered more whole grains and less juice and refined grains from baseline to follow-up. FCCHs were more likely to meet the revised whole grain standard at follow-up (OR = 2.7, 95% CI: 1.4, 5.2, p = 0.002), but rarely met all selected standards together. Inflation-adjusted meal costs increased for lunch (+$0.27, p = 0.001) and afternoon snack (+$0.25, p = 0.048). FCCH providers may need assistance with meeting CACFP standards while ensuring that meal costs do not exceed reimbursement rates.

Child Care in the Time of Coronavirus Disease-19: A Period of Challenge and Opportunity

The early care and education of young children, more commonly known as child care, is a ubiquitous experience in the US across geographies and socioeconomic levels. Nationally, more than 12 million children—or nearly two-thirds of children under 5 years of age—regularly participate in out-of-home care, making early care and education a $47.2 billion industry with a workforce of more than 1.5 million child care providers.1-3 Early care and education involves children from birth through kindergarten entry, a time when organized, group care, including child care centers, family child care homes, preschool, and Head Start programs represent the majority of child care arrangements.

Comparison of Urban and Rural Physical Activity and Outdoor Play Environments of Childcare Centers and Family Childcare Homes.

The purpose of this study was to examine the physical activity environment in childcare programs across type (childcare centers [CCCs] and family childcare homes [FCCHs]) and geographic location (urban and rural) as assessed by physical activity best practices according to the Go Nutrition and Physical Activity Self-assessment in Child Care. Results showed CCCs compared with FCCHs reported higher achievement of best practices. Further, urban childcare programs (CCCs and FCCHs) reported higher achievement of best practices in comparison to rural childcare programs. There is a need to deliver targeted interventions that promote children's physical activity in FCCHs and CCCs in rural areas.

P44 Influences of Provider Nutrition Knowledge and Self-Efficacy on Nutrition Practices and Policies of Oklahoma Family Child Care Homes

<h3>Background</h3> Early child care and education (ECE) are favorable locations for early obesity prevention. Few studies include Family Child Care Homes (FCCH) compared to larger ECE settings. Several ECE interventions show that introducing or improving a written policy has positive effects on food environment and foods served. However, a gap exists on possible influences of policies and practices in FCCHs. <h3>Objective</h3> To determine impact of FCCH providers' nutrition knowledge and nutrition self-efficacy on program nutritional practices and policies. <h3>Study Design, Setting, Participants</h3> This cross-sectional study uses baseline data from an intervention study (Happy Healthy Homes) of FCCH providers caring for 2- to 5-year-old children within 60 miles of Oklahoma City. <h3>Measurable Outcome/Analysis</h3> From October 2017 to November 2018 providers completed surveys including demographics, nutrition knowledge, nutrition self-efficacy (confidence and barriers), and NAP SACC practices and policies. Spearman's rank-order correlation, linear regression, and logistic regression were used via SPSS version 25. <h3>Results</h3> Forty-nine FCCH providers participated (100% women, 45 ± 13 years old). Confidence self-efficacy is inversely correlated with barriers self-efficacy (rs(47) = −0.4, <i>P</i> = .004). Nutrition knowledge was not correlated with confidence or barriers self-efficacy. Multivariate linear regression indicates nutrition knowledge as the strongest predictor of nutrition practices (std β = 0.442, <i>P</i> = .001) followed by confidence self-efficacy (std β = 0.358, <i>P</i> = .001), while barriers self-efficacy does not (std β = −0.061, <i>P</i> = .651). There was no association between knowledge, self-efficacy, and nutrition policies. <h3>Conclusions</h3> As FCCH provider nutrition confidence increases, barriers to serving healthy foods decrease. However, nutrition knowledge was not related to either confidence or barriers self-efficacy. Collectively, knowledge and self-efficacy were associated with FCCH practices. Results suggest that increase in knowledge and confidence may have a positive effect on nutrition practices in the FCCH. However, they do not necessarily influence each other. Knowledge and self-efficacy each need to be included in provider training opportunities.

P27 Contextual Factors Influence Childcare Providers’ Barriers for Serving Healthy Meals to Preschool Children.

<h3>Background</h3> The Child and Adult Care Food Program (CACFP) and other national policies recommend serving healthy foods and beverages in childcare settings to promote healthy eating behaviors and prevent childhood obesity. However, childcare providers have reported several barriers to serving healthy foods and beverages to the children. To address the barriers, more evidence is needed regarding the contextual factors associated with the childcare providers' tendency to report specific barriers. <h3>Objectives</h3> To examine contextual factors (geographic location, participation in CACFP, type of childcare program, mealtime practices, and personnel responsible for menu planning) that are related to childcare providers' perceived barriers to serving healthy foods and beverages to preschool (2 to 5-year-old) children. <h3>Study Design, Setting, Participants</h3> Cross-sectional study with a self-reported survey completed by childcare center (CCC) directors (n = 336) and family childcare home (FCCH) providers (n = 1154) from licensed childcare settings (n = 1490) across urban and rural Nebraska. <h3>Analysis</h3> Descriptive statistics and multiple logistic regression analyses. <h3>Results</h3> Rural childcare providers were more likely to report not having enough money to purchase healthy foods and limited storage space as barriers as compared to their urban counterparts. CACFP-funded settings reported not having enough money, not knowing which recommendation to follow, unsure which foods can be reimbursed through CACFP, and lack of availability of healthy foods as compared to the non-CACFP settings. Participants reporting lower frequency of professional development on nutrition were more likely to report barriers of not having enough money and not knowing which recommendation to follow. Barrier regarding lack of availability of healthy foods was associated with providers' residing in food deserts, receiving less professional development and being CACFP-participants. Lack of time was reported as a barrier when FCCH providers and CCC owners or directors were responsible for menu planning. <h3>Conclusions</h3> Considering contextual factors influencing providers' barriers can improve healthy food availability in childcare.

Implementing the New Child and Adult Care Food Program's Nutrition Standards in Boston.

In 2017, the US Department of Agriculture’s Child and Adult Care Food Program’s (CACFP’s) nutrition standards were updated to improve nutrition and meal quality while remaining feasible for child care providers to implement. We conducted a pre–post study of 13 family child care home (FCCH) providers in Boston, Massachusetts, to compare reported opportunities for training and technical assistance and knowledge of new nutrition standards before the effective date of the updates (October 1, 2017) and 1 year later. The McNemar test was used to test for differences in provider responses. Few FCCH providers received training or technical assistance or had knowledge of most new standards at baseline or at follow-up; however, provider-reported knowledge of the whole-grain standard improved over time (from 6 providers to 12 providers) (P = .03). One year post implementation, FCCH providers still needed additional training, technical assistance, or other support to meet the new nutrition standards for meals served to children.

Dietary Contributors to Food Group Intake in Preschool Children Attending Family Childcare Homes

Abstract Objectives To identify and describe the food sources that contribute to food group intake in preschool children attending family childcare homes (FCCH) in Rhode Island and to examine differences by provider ethnicity. Methods Baseline data (n = 120 FCCH and n = 370 children) from Healthy Start, an ongoing cluster-randomized trial, were used. Information about foods and beverages consumed by the children was collected using the Dietary Observation in Child Care. The Nutrition Data System for Research food group classification was used to define food groups, sources and servings. The contribution of food sources to major food groups was calculated using ratio of means. Differences in mean ratios between Latino and non-Latino providers were tested with ANOVA and ANCOVA (P &amp;lt; 0.05) and Bonferroni adjustments were made for multiple comparisons. Results The analysis included 120 FCCH providers, all female, 68% were Latino, mean age of 48.9 ± 9.0 years; and 370 preschool children, 57% were Latino, mean age of 3.4 ± 0.9 years. Across FCCH, juice contributed the highest proportion to the fruits consumed (0.85 ± 0.24), and most vegetables consumed were non-starchy (0.61 ± 0.34). Nearly, three-fourths of dairy was low-fat (0.71 ± 0.30) and most milk/yogurt was unsweetened (0.85 ± 0.20). Three fourths of the grain servings consumed were refined (0.75 ± 0.22). The majority of the fats were vegetable oils (0.89 ± 0.20), and syrup/honey/jelly contributed more than half (0.50 ± 0.41) to the total sweets consumed. Children in non-Latino vs Latino FCCH consumed a significantly higher proportion of nuts and seeds (0.21 ± 0.34 vs 0.05 ± 0.13) and animal fats (0.37 ± 0.36 vs 0.11 ± 0.20). Similarly, children attending non-Latino FCCH ate a significantly higher proportion of non-starchy vegetables (0.82 ± 0.24 vs 0.52 ± 0.34), but a significantly lower proportion of legumes (0.05 ± 0.19 vs 0.33 ± 0.31) compared to Latino FCCH. Conclusions FCCH providers should be encouraged to include more whole fruits and whole grains. Differences between the foods consumed in FCCH according to the ethnicity of the provider, highlights the importance of considering cultural differences when developing tailored interventions to improve children's dietary intake at these settings. Funding Sources National Institutes of Health- National Heart, Lung, Blood Institute, National Institutes of Health.

National Health and Safety Standards: Family Child Care Homes Compared With Child Care Centers.

The study objectives are to describe the national health and safety standards in family child care homes (FCCHs) and child care centers and compare them by child care type. Child care health consultants and research assistants completed the standardized Health and Safety Checklist, which comprised key national health and safety standards, in a convenience sample of 21 FCCHs and 31 child care centers enrolled in two larger studies conducted in CA. The checklist was completed in 1 or 2 hours in FCCHs and centers, respectively. The internal consistency of the overall checklist subscales was moderate to strong. Eight of 10 checklist subscales were not significantly different in FCCHs and centers, but outdoor facilities (p < .05) and supervision, interaction, and physical activity (p < .05) were different. The Health and Safety Checklist is valid in FCCHs and centers and identifies targeted interventions for nurses to improve child care quality.

Exploring Provider-Level Socio-Demographic Determinants of Diet Quality of Preschool Aged Children Attending Family Child Care Homes

Abstract Objectives To measure the dietary quality of meals and snacks consumed by preschool-aged children (2- to -5 years old) in family child care homes (FCCH) and explore whether dietary quality differs by sociodemographic characteristics and acculturation of FCCH providers. Methods This study used baseline data from a cluster-randomized trial, Healthy Start/Comienzos Sanos. Surveys including demographic characteristics were completed with FCCH providers. Food and beverage consumption was measured using the Dietary Observation in Child Care, then Healthy Eating Index (HEI) 2015 scores were calculated. Differences in mean HEI-2015 scores by sociodemographic characteristics were calculated using one-way ANOVAs. Multiple linear regression models were then fit for statistically significant variables. Post-hoc ANOVA's were run to explore mean differences by HEI sub-components. Results There were statistically significant differences in mean total HEI scores by income (&amp;lt;$25,000: HEI: 64.8 vs. $25,001-$50,000: 62.9 vs. $75,001 or more: 56.2, P = 0.03); ethnicity (Latinx: 64.4 vs. Non-Latinx: 56.6, P = 0.002); language spoken in childcare (Spanish: 64.4 vs. English: 59.6, P = 0.02); language spoken outside of childcare (Spanish: 64.3; vs. English: 58.6, P = 0.005). Results from multiple linear regression models revealed that higher provider income ($75,001 or more) was negatively and significantly associated with total HEI scores (b = −9.8, SE = 3.7, P = 0.009) vs. lower income (less than $25,000). There were also differences in the HEI greens/beans, total protein, and seafood/plant protein scores across ethnicity and language. Conclusions Provider income, ethnicity and language were important factors in what children consume in FCCH. Future studies should aim to better understand how these provider sociodemographic factors are related to meal and snack preparation/provision in order to better tailor interventions. Funding Sources National Institutes of Health- National Heart, Lung, Blood Institute, NationalInstitutes of Health, HL123016.

Happy Healthy Homes: Content Analysis of Intervention Delivery and Participant Feedback

Abstract Objectives Describe intervention delivery and participant feedback for Happy Healthy Homes, a pilot interdisciplinary study to improve health environments for family childcare homes (FCCHs), a unique and understudied childcare setting. Methods Providers received continuing education focused on either (1) enhancing quality of the nutrition environment, self-efficacy, and practices or (2) improving providers’ environmental health (ECO) literacy, self-efficacy and practices. Detailed written post-intervention logs were completed following educational sessions. Content analysis was performed to summarize information on participant goals and challenges. Results Participants included 46 FCCH providers (25 nutrition, 21 environmental health, 100% female). Common nutrition goals related to family-style meal service (77%), and common ECO goals included increased use of microfiber (69%). The most prevalent challenges to meeting nutrition goals included catering to a varying composition/dynamic of children (50%) and having a lack of time (19%). The most prevalent challenges meeting ECO goals included a lack of time (47%) and parent and/or child resistance to practices (21%). Interventionist-reported challenges to delivery included having children or other potential distractions present during session (25%), providers’ tendencies to pull discussion off-topic (22%) and pressure from a strict time constraint or scheduling issue (20%). Conclusions Future intervention delivery in FCCHs should continue to promote goal-setting autonomy and provide resources to support implementation of best practices. However, efforts could improve by tailoring to multiple age groups, allowing ample time for discussion, and utilizing regular reminder calls/texts to avoid scheduling confusion. Funding Sources This study is supported by the Agriculture and Food Research Initiative grant from the USDA National Institute of Food and Agriculture and the National Institute of General Medical Sciences award.

Exploring the Provider-Level Socio-Demographic Determinants of Diet Quality of Preschool-Aged Children Attending Family Childcare Homes.

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.

A systematic review of interventions to improve the dietary intake, physical activity and weight status of children attending family day care services.

To (i) identify and synthesise findings from interventions to improve the dietary intake, physical activity and weight status of children aged 0-6 years attending family day care services; and (ii) assess the impact of interventions on family day care environments, intervention cost and adverse outcomes. Medline in Process, PsycINFO, ERIC, Embase, CINAHL, CENTRAL and Scopus databases were searched in March 2019. Studies were included if they (i) evaluated an intervention to improve the diet, physical activity and/or weight of children aged 0-6 years; (ii) were delivered in family day care services; (iii) targeted child diet, physical activity and/or weight; and (iv) used a parallel control group design. Screening was undertaken by two reviewers with disagreements resolved by a third reviewer. Family day care services, also known as family childcare homes. Children aged 0-6 years attending family day care services. In total, 8977 titles were retrieved, and 199 full-texts reviewed. No studies met the inclusion criteria for the primary outcome; however, two studies reporting on the secondary outcome of family day care environments were included. The 4-year community-wide obesity prevention programme and the 12-month train-the-trainer programme both reported statistically significant improvements in the healthy eating and physical activity environments of family day care, compared to cross-sectional state-average control groups. Findings highlight few existing interventions in family day care services and a need for high-quality controlled trials to identify effective interventions to improve children's diet, activity and weight in this setting.