Family Child Care Homes Research Articles

Impact of changes to the Child and Adult Care Food Program on children's dietary intake in family child care homes.

To estimate the impact of recent changes to the Child and Adult Care Food Program (CACFP) meal pattern on young children's diets in family child care homes (FCCHs) serving racially/ethnically diverse children. In a natural experimental study of thirteen CACFP-participating FCCHs, we used digital photographs taken of children's plates before and after meals matched with menus to measure children's dietary intake both prior to implementation of the new meal patterns (summer/fall of 2017) and again 1 year later (summer/fall of 2018). Generalised estimating equations tested for change in intake of fruits, vegetables, whole grains, 100 % juice, grain-based desserts, meat/meat alternates and milk, adjusting for clustering of observations within providers. FCCHs in Boston, MA, USA. Three- to 5-year-old children attending FCCHs. We observed 107 meals consumed by twenty-eight children at the thirteen FCCHs across an average of 2·5 (sd 1·3) d before the CACFP policy change, and 239 meals consumed by thirty-nine children across 3·8 d (sd 1·4) 1 year later. During lunch, fruit intake increased by about a third of a serving (+0·38 serving, 95 % CI 0·04, 0·73, P = 0·03), and whole grain intake increased by a half serving (+0·50 serving, 95 % CI 0·19, 0·82, P = 0·002). No changes were seen in other meal components. Young children's dietary intake in CACFP-participating FCCHs improved following the CACFP meal pattern change, particularly for fruits and whole grains, which were targets of the new policy. Additional research should examine impacts of the changes in other child care settings, age groups and locales.

Parent adoption and implementation of obesity prevention practices through building children's asking skills at family child care homes

BackgroundEarly childhood education programs provide a setting to reach children and parents to modify home environments to prevent obesity. The Healthy Opportunities for Physical Activity and Nutrition Home (HOP’N) Home project was a novel approach that linked Family Child Care Homes (FCCH) to home environments by developing children’s asking skills for healthful home environmental change through curricular activities. ObjectiveTo evaluate the feasibility of engaging parents in obesity prevention practices through building children's asking skills at FCCH. MethodsFCCHs (n = 5 settings) and children (n = 25; aged 3−5 years; female = 36 %; non-Hispanic white = 91 %; low socioeconomic status = 28 %; overweight/obese = 52 %) and parents (n = 25) participated in a pre-post cohort design. We assessed children's body mass index and self-report variables at three time points. HOP'N Home included continuous staff training, group time, dramatic play, meal prompts, songs, and home activities. ResultsFCCH providers implemented 83%–100% of intervention activities. All parents (100 %) adopted the program, most (87 %) returned completed homework activities to FCCHs, and over 90 % implemented changes in the home. Percent of overweight/obese children decreased from pre-intervention (50 %) to post-intervention (29 %,p = 0.06) and follow-up (38 %,p = 0.06). ConclusionsIt is feasible to build children's asking skills and pair this strategy with home activities to engage parents to prevent obesity.

Patterns and Correlates of Sedentary Behavior in Children Attending Family Child Care.

Public health authorities recommend young children should not be sedentary for more than one hour at a time. This study assessed the frequency and duration of sedentary bouts in children attending family child care homes (FCCHs); and examined associations with FCCH provider practices related to sedentary behaviors. Overall, 127 children (aged 3.5 ± 1.1 years) from 41 FCCHs participated in the study. Sedentary bouts were measured using an accelerometer worn for the duration of FCCHs attendance over a randomly selected week. Provider practices were assessed using the Nutrition and Physical Activity Self-Assessment for Child Care self-assessment instrument. Children attending FCCHs mostly accumulated short sedentary bouts (<5 min) with very few lasting more than 10 min. Boys exhibited significantly fewer sedentary bouts, and significantly less sedentary time in bouts than girls. Children attending FCCHs that met or exceeded childcare standards for outdoor active play, had portable play equipment, offered a variety of fixed play equipment, and/or adequate indoor play space exhibited significantly fewer sedentary bouts and significantly less sedentary time accumulated in short and medium length bouts. Programs encouraging FCCHs to adopt physical activity promoting practices could potentially reduce child sedentary time while in care.

Transition from Breastfeeding and Complementary Feeding to Toddler Nutrition in Child Care Settings.

Child care has broad reach to young children. Yet, not all child care settings have nutrition standards for what and how foods and beverages should be served to infants as they transition to toddlerhood. The purpose of this paper is to describe the development of nutrition recommendations to guide feeding young children in licensed child care settings in the USA, a process that could be adapted in other countries. Nutrition standards were designed by nutrition and child care experts to address what and how to feed young children, also including the transition from infants to toddlers. Nutrition standards are important for health and can be feasibly implemented in child care settings. Feasibility considerations focused on family child care homes, which typically have fewer resources than child care centers or preschools. Infant standards include recommendations for vegetables, fruits, proteins, grains, and breast milk and other beverages. Also included are recommendations for supporting breastfeeding, introducing complementary foods, and promoting self-regulation in response to hunger and satiety. Toddler standards are expanded to address the frequency as well as types of food groups, and recommendations on beverages, sugar, sodium, and fat. Feeding practice recommendations include meal and snack frequency and style, as well as the promotion of self-regulation among older children.

Communication With Family Child Care Providers and Feeding Preschool-Aged Children: Parental Perspectives

To describe parent communication about child nutrition-related topics with family child care providers (FCCPs). Five focus groups conducted from December, 2016 to July, 2017. Parents (n = 25) of 2- to 5-year-old children attending family child care homes in Rhode Island. How and what parents communicate about with FCCPs related to feeding young children. Recordings were transcribed verbatim. Two independent coders employed content analysis to analyze transcripts. Reflections, emerging themes, and final themes were discussed. Participants were recruited through FCCPs and were mostly Hispanic and female. Parents mainly communicated with FCCPs in person. Communication with FCCPs related to how and what children were fed did not occur frequently, and parents usually inquired about how much children ate. Parents did not engage in frequent child nutrition-related communication with their FCCP. However, parents trusted FCCPs to provide healthy and sufficient food to children. More research is needed to identify effective strategies that facilitate child nutrition communication between parents and FCCPs.

Keys to healthy family child care homes: Results from a cluster randomized trial

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.

Provider reported implementation of nutrition-related practices in childcare centers and family childcare homes in rural and urban Nebraska.

Approximately 15 million children under age 6 are in childcare settings, offering childcare providers an opportunity to influence children’s dietary intake. Childcare settings vary in organizational structure – childcare centers (CCCs) vs. family childcare homes (FCCHs) – and in geographical location – urban vs. rural. Research on the nutrition-related best practices across these childcare settings is scarce. The objective of this study is to compare nutrition-related best practices of CCCs and FCCHs that participate in the Child and Adult Care Food Program (CACFP) in rural and urban Nebraska. Nebraska providers (urban n = 591; rural n = 579) reported implementation level, implementation difficulty and barriers to implementing evidence-informed food served and mealtime practices. Chi-square tests comparing CCCs and FCCHs in urban Nebraska and CCCs and FCCHs in rural Nebraska showed sub-optimal implementation for some practices across all groups, including limiting fried meats and high sugar/ high fat foods, using healthier foods or non-food treats for celebrations and serving meals family style. Significant differences (p < .05) between CCCs and FCCHs also emerged, especially with regard to perceived barriers to implementing best practices. For example, CCCs reported not having enough money to cover the cost of meals for providers, lack of control over foods served and storage problems, whereas FCCHs reported lack of time to prepare healthier foods and sit with children during mealtimes. Findings suggest that policy and public health interventions may need to be targeted to address the unique challenges of implementing evidence-informed practices within different organizational structures and geographic locations.

Contextual Factors Influence Professional Development Attendance Among Child Care Providers in Nebraska

ObjectiveTo examine contextual factors that may influence child care providers’ motivators for attending nutrition-related training and their preferences and barriers to attending professional development training. DesignCross-sectional survey completed between January and April 2017. SettingLicensed child care programs (n = 1,490) across urban and rural Nebraska. ParticipantsChild care center directors (n = 336) and family child care home providers (n = 1,154). Main Outcome Measure(s)Motivators, preferences, and barriers of child care providers for attending professional development. AnalysisDescriptive statistics and multiple logistic regression analyses were conducted. ResultsTop motivators for attending nutrition-related training included meeting licensure requirements and improving job performance. Child care providers most commonly selected preferences for receiving training included in-person and online delivery. Top barriers to obtaining training were schedule conflicts, accessibility, and cost. Child care centers and participants in the Child and Adult Care Food Program (CACFP) and Nutrition and Physical Activity Self-Assessment in Child Care (Go NAP SACC) were more likely to be motivated by licensure requirements. Rural providers were also more likely to report barriers such as inability to travel and limited access to training. Results revealed that child care type, geographic location, CACFP and Go NAP SACC participation can influence child care providers’ motivators, preferences, and barriers to attending training. Conclusions And ImplicationsResults highlight the importance of offering professional development training that best fits child care providers’ needs and preferences.

Strengthening children’s roots of resilience: Trauma-responsive early learning

With the majority of children in the United States attending early care and education (ECE) prior to kindergarten (National Survey of Early Care and Education, 2016), the opportunity to reach children early, and strengthen resilience in the context of everyday life, is profound. Yet, ECE teachers often lack professional supports to meet the needs of children impacted by trauma (Cummings, Addante, Swindell, & Meadan, 2017; Loomis, 2018). The Roots of Resilience program was designed to address this issue through an online course and video-based coaching. Recognizing the importance of feasibility and of balancing rigor with relevance to create wide-spread change (Glasgow & Chambers, 2012), this preliminary study of Roots of Resilience focuses on feasibility and examines teachers’ learning and application of practices consistent with trauma-responsive care. Seventeen ECE teachers from family child care homes, centers, and Head Start programs participated. The majority (69%) had less than a Bachelor’s-level education. Qualitative and quantitative data sources included teacher surveys, quizzes, discussion board entries, workbook entries, coach ratings, and observations. Findings indicate that the program is feasible for ECE teachers and offer preliminary evidence that it may help teachers strengthen their knowledge and application of practices to identify and respond to children’s needs. An iterative development process and a strengths-based approach were identified as critical program attributes.

Micronutrient Adequacy in Preschool Children Attending Family Child Care Homes

Limited data is available on the micronutrient intake and adequacy in preschool children enrolled in family child care homes (FCCH). The goal of this paper is to describe the micronutrient adequacy relative to age-specific recommendations of preschool-aged children (aged 2–5 years) attending FCCH in Rhode Island (RI). Dietary data among younger preschoolers (aged 2–3 years), n = 245) and older preschoolers (aged 4–5 years), n = 121) in 118 RI FCCH (N = 366 children) were analyzed. Nutrient adequacy was assessed as the amount of nutrient per 1000 kcal of the diet that would meet the Institute of Medicine nutrient requirements (critical nutrient density), and it was compared to the observed nutrient densities of the children. The sodium:potassium ratio was also calculated. For most micronutrients, the observed density met or exceeded the recommendation, meaning the children’s intake was adequate. However, a high proportion of children had nutrient densities under the recommendation for vitamins D, E, K, and potassium (86.1%, 89.1%, 70.8%, and 99.2% of children, respectively). The mean vitamin B12, potassium, and zinc densities were statistically higher in younger vs. older preschoolers (p < 0.05 for all). Low densities in calcium and vitamins K and B5 were more frequent in older children vs. younger children (p < 0.05). In addition, older preschoolers had a higher sodium:potassium ratio than younger children (p < 0.05). The micronutrient intake density was adequate for most nutrients. However, intake of some nutrients was of concern. Further attention to training and compliance in FCCH may improve the diet quality of those cared for in these settings.

Effects of prior formal and informal caregiving experiences on undergraduates’ infant/toddler caregiving knowledge and beliefs

ABSTRACTWith growing emphasis on the development and use of competencies (knowledge, dispositions, skills) for training and evaluating the early childhood workforce, this study aimed to identify sources of variation in undergraduate students’ beliefs and knowledge related to competencies identified by the Collaborative for Understanding Pedagogy for Infant/toddler Development (CUPID). Specifically, we examined how prior work experience with children, formal and informal, was related to students’ knowledge of developmentally appropriate expectations of young children, beliefs regarding supporting parent–child relationships in center-based care, and endorsement of strict discipline and physical punishment. Results indicate that formal (i.e., in child care centers, family child care homes) and informal work experiences with children (e.g., babysitting) may relate to beliefs and knowledge in different ways. Students with formal experience indicated slightly more support for parent–child relationships than students with informal experience. Students with formal or informal experience reported less endorsement of strict discipline than students with no experience working with children. Implications for higher education programs that prepare students to work with infants and toddlers are discussed, including the importance of providing ample opportunities for undergraduates to work with children in formal settings, and to reflect on each of their caregiving experiences, early in the undergraduate program.

Interventions to promote healthy environments in family child care homes in Oklahoma\u2014Happy Healthy Homes: study protocol for a randomized controlled trial

BackgroundEarly childhood is a critical period of development. Caregivers, including providers of early care and education (ECE), have a substantial influence on the health of young children. Family child care homes (FCCHs), which are small, licensed ECE businesses operated out of the residences of providers, are important settings for promoting child health. However, to date, few interventions to promote the health of children have been developed for FCCHs. The purpose of this article is to describe the protocol for Happy Healthy Homes, a pilot interdisciplinary, community-based study to improve FCCH environments and the health of children in Oklahoma. We describe the development and evaluation of two interventions to be tested in a matched attention randomized controlled trial: 1) a nutrition intervention aimed at enhancing the nutritional quality of meals served to young children, incorporating the Child and Adult Care Food Program best practices, and improving nutritional self-efficacy of providers; and 2) an environmental intervention aimed at increasing providers’ environmental health literacy, self-efficacy for integrated pest management (IPM), and awareness of less toxic cleaning practices and FCCH provider cleaning behaviors.MethodsBoth interventions are informed by common theoretical principles and are matched in attention (i.e., 6 h), format (i.e., two individual 90-min educational home visits and a 3-h small group class) and materials (i.e., tool kit of educational materials and supplies tailored to the allocated intervention). A randomized trial of both interventions is currently underway with 52 FCCH providers in the Oklahoma City metropolitan area who participate in the Child and Adult Care Food Program. Observed and self-reported measures will be collected at baseline, and 3 months and 12 months after baseline measurements. Randomization to one of the two interventions will occur after baseline data collection.DiscussionThis study aims to support FCCH providers in creating healthier FCCH environments for nutrition and environmental health. Successful completion will provide critical information about the nutritional quality and the environmental health of children in FCCHs, as well as much needed evidence about the efficacy of two community-based interventions to improve the nutrition and environmental health of children in home-based ECE settings.Trial registrationClinicaltrials.gov, NCT03560050. Retrospectively registered on 23 May 2018.

Building blocks of infant-toddler conversation skills: using the Conversation Compass© to drive innovation in Early Head Start classroom conversations

ABSTRACT We collaborated with Early Head Start (EHS) coaches to qualitatively explore the feasibility delivering a professional development approach designed to enhance the quality of conversations in infant-toddler (I/T) classrooms and family child care homes. First, we reviewed empirical literature about oral language discourse skills in infants and toddlers. Second, we examined the frameworks and evaluation tools EHS practitioners and programmes used to guide conversations, e.g. the Head Start Early Learning Outcomes Framework and the Quality of Caregiver-Child Interaction for Infants and Toddlers (Q-CCIIT) Scale. Third, we adapted the Conversation Compass© approach for ages birth to 24 months. Lessons learned were (1) teachers report that the Conversation Compass approach was user-friendly, (2) due to teachers’ limitations with computer skills the online course was difficult for them to complete independently, and (3) the approach can be used to facilitate and model conversation in mixed-age group settings with infants and toddlers.

NP25 Nutrition and Physical Activity Practices and Policies of Family Child Care Home Providers in Oklahoma: Baseline Findings From Happy Healthy Homes

Objective Early obesity prevention in key environments where young children spend substantial time, such as early care and education (ECE) is essential. Children are not eating adequate amounts of whole grains, fruits, vegetables, and nutrients, or getting sufficient physical activity in ECE. Family Child Care Homes (FCCH) are licensed home-based ECEs. Few studies have examined nutrition and physical activity (PA) in FCCHs. Objective was to determine the nutrition and PA practices and policies in FCCH. Description Cross-sectional study with self-reported practices and policies conducted in Oklahoma from October 2017 to November 2018. Evaluation Forty-nine providers (44.2 ± 14.2 years, 100% women) participated. FCCH programs supervised 9.7 ± 4.2 children and had been in business for 10.8 ± 9.6 years (range 0.25-40 years). Providers spent 2.8 ± 6.2 hours/week preparing meals. Many (68.8%) providers had a degree in early childhood education or development. The majority prepared meals after children arrive (70%) and before children arrived (54%). Baking (98%) and slow cooker (70%) were the most common food preparation methods. Almost all (91.8%) believed the food program enhanced dietary quality for children. Frequencies of providers meeting all best practices in NAPSACC domains were foods provided (4.3%), beverages provided (2.2%), feeding environment (0%), feeding practices (40%), menus and variety (43.8%), nutrition education and professional development (4.3%), nutrition policy (20.8%), time provided for PA (0%), outdoor play environment (2.4%), daily PA practices (9.8%), PA education and professional development (6.4%), and PA policies (12.8%). Conclusions and Implications Few FCCH providers meet all best practices in nutrition and PA domains. Understanding current practices and procedures is necessary for intervention development and technical assistance training to meet FCCH provider needs and enhance ECE program quality. Funding 2017-68001-26355.

P143 Examining Nutrition Practices Across Early Childhood Education Programs in Two Rural Counties of California

Background Early childhood education (ECE) programs are important partners for childhood obesity prevention efforts. Despite signs of progress, racial and ethnic, socioeconomic, and geographic disparities in obesity rates still persist in California. Current understanding of obesity prevention strategies (e.g. nutrition practices) is limited across ECE programs in Tulare/ Kings counties of California. Objective To characterize nutrition practices of Child Care Centers (CCCs) and Family Child Care Homes (FCCHs). Study Design, Settings, Participants Study design was cross-sectional. Settings included licensed CCCs and FCCHs in Tulare/Kings counties. Participants included CCC Directors (N = 59) and FCCH Providers (N = 58). Measurable Outcome/Analysis Of the 701 nutrition practices surveys administered, 117 were completed and returned. Descriptive and chi-square analysis was conducted using SPSS. Results Results indicated statistically significant differences (P Conclusion Targeting nutrition interventions based on the childcare context (FCCH vs. CCC) is critical to the implementation of nutrition best practices. Overall, FCCH reported higher adherence to best practices as compared to CCC. This could be attributed to a higher participation of FCCHs in CACFP. A focus on nutrition education as well as participation in CACFP in ECE programs may help in obesity prevention efforts. Funding UC ANR.

P148 Parent and Family Childcare Home Provider Feeding Practices and Child Diet Quality at Home and in Childcare

Background Most US children under the age of 6 attend out-of-home care. This has led to a shared feeding responsibility between parents and child care providers, both influencing children's eating habits via feeding practices. However, little is known about caregiver feeding practices and child diet quality among children attending family child care homes (FCCHs). Objective To describe parent/provider (FCCP) feeding practices and child diet quality at home and in the FCCH, and examine associations between caregiver feeding practices and child diet quality. Study Design, Setting, Participants This was a cross-sectional mixed-methods study including 33 FCCPs-parent-child triads (87% and 64% Hispanic, respectively) from two northeastern states. Measurable Outcome/Analysis Caregiver feeding practices were collected via a self-report questionnaire. Child dietary intake at home was collected via telephone interviews, and via direct observation in the FCCH. Healthy Eating Index (HEI-2015) scores were calculated for dietary intake in both settings. Descriptive statistics were calculated for all variables. We used the Mann-Whitney U tests to examine differences between caregiver feeding practices, the Signed Rank Test to examine differences in child HEI-2015 between settings and Spearman correlations to examine associations between feeding practices and child diet quality in both settings. All analyses were conducted using SAS 9.4. Results Compared to FCCPs parents engaged in significantly greater frequency of controlling feeding practices (P Conclusion Findings suggest that the FCCH environment is more supportive of promoting healthy eating habits in preschool-aged children. However, there is a need for improvement in both settings to decrease the frequency of non-responsive feeding practices and increase child diet quality. Funding None.

P13 Implementation of and Barriers to Nutrition Best Practices in Urban and Rural Nebraska Child Care Settings

Background Nebraska ranks fifth in the US for childhood obesity among children 2-4 years old. Children in rural areas are more likely to be classified as obese than children in urban areas. There is limited research on nutrition-related practices and barriers of childcare across urban and rural areas. Objective To examine the differences in implementation, barriers, and difficulty of nutrition practices including foods served and mealtime practices in childcare settings across urban-rural contexts in Nebraska. Study Design, Settings, Participants An exploratory cross-sectional study in 2017. Data were collected from 1,170 childcare providers (urban = 591; rural = 579) participating in the Child and Adult Care Food Program (CACFP), including 200 childcare centers (CCCs) and 970 family childcare homes (FCCHs) in Nebraska. Measurable Outcome/Analysis Childcare programs completed the self-administered ‘Healthy Children, Healthy State’ questionnaire. Descriptive statistics and chi-square tests were conducted to assess implementation, difficulty, and barriers to nutrition practices across urban-rural CCCs and FCCHs. Results For implementation of nutrition-related practices, CCCs in urban areas were significantly more likely to serve lean and low fat meat ( P P P P P P P Conclusion This study illuminates factors that may influence high rates of obesity in rural childcare settings.Future research should examine rural childcare programs and how local food systems may decrease costs and increase healthy food availability. Funding USDA National Institute of Food and Agriculture.

Exploratory Factor Analysis of Observed Feeding Practices Among Family Child Care Home Providers (OR03-01-19)

ObjectivesFamily childcare homes (FCCH) are a commonly used form of childcare in the US, yet little is known about this setting, particularly the practices that Hispanic providers use when feeding children. Therefore, the goal was to examine the validity of the Environmental Policy Assessment Observation Tool (EPAO) to assess provider feeding practices. MethodsData from an ongoing cluster-randomized trial were used. FCCH provider feeding practices were assessed over 2 days using a modified version of the EPAO (adapted for use in FCCH with expanded assessment of feeding practices). The EPAO captures nutrition and physical activity environments in child-care (e.g., provisions, practices, policies); however, only the 44 feeding practices items recorded during meals were used in this study. For each meal and snack occasion, a weighted factor, which accounted for frequency and time spent in each meal for each feeding practice was created and then averaged across the two observation days to obtain a weighted average score. Exploratory factor analysis investigated the underlying factor structure of the feeding practices. ResultsAll FCCH providers were female (n = 119) and the majority (72%) were Hispanic. A final 3-factor solution, which captured 34% of the variance, was examined. Factor 1 appeared to capture autonomy support practices with 14 items (e.g., Enthusiastic role modeling, eating the same foods, talking about foods being served, reasoning with children) with loadings ranging from 0.455-0.875 (eigenvalue = 7.3). Factor 2 appeared to capture coercive control and indulgent feeding practices and emerged with 5 items (e.g., Insisting child eat foods on plate, pressuring child to eat, rushing child to eat) with loadings ranging from 0.410-0.817 (eigenvalue = 3.7). Factor 3 appeared to capture a mix of overt control and negative structure behaviors with 5 items (e.g., Enforcing table manners, encouraging children to sit at the table, removing the plate before child was done) with loadings ranging from 0.37-0.66 (eigenvalue = 3.2). ConclusionsThe emerging autonomy supportive and coercive controlling factors are consistent with recent research conducted with FCCH providers in North Carolina. Future research should continue to refine this model and explore associations with child diet. Funding SourcesNational Heart Lung and Blood Institute, Grant # R01 HL123016.

Improving nutrition and physical activity environments of family child care homes: the rationale, design and study protocol of the \u2018Healthy Start/Comienzos Sanos\u2019 cluster randomized trial

BackgroundEarly childhood is a crucial time to foster healthy eating and physical activity (PA) habits, which are critical for optimal child health, growth and development. Child care facilities are important settings to promote healthy eating and PA and prevent childhood obesity; however, almost all prior intervention studies have focused on child care centers and not family child care homes (FCCH), which care for over 1.6 million U.S. children.MethodsThis paper describes Healthy Start/Comienzos Sanos, a cluster-randomized trial evaluating the efficacy of a multicomponent intervention to improve nutrition and PA environments in English and Spanish-speaking FCCH. Eligible child care providers complete baseline surveys and receive a two-day FCCH observation of the home environment and provider practices. Parent-consented 2–5 year-old children are measured (height, weight, waist circumference), wear accelerometers and have their dietary intake observed during child care using validated protocols. FCCH providers are then randomly assigned to receive an 8-month intervention including written materials tailored to the FCCH providers’ need and interest, videos, peer support coaching using brief motivational interviewing, and periodic group meetings focused on either nutrition and PA (Intervention) or reading readiness (Comparison). Intervention materials focus on evidence-based nutrition and physical activity best practices. The initial measures (surveys, two-day observation of the FCCH and provider practices, child diet observation, physical measures, and accelerometer) are assessed again 8 and 12 months after the intervention starts. Primary outcomes are children’s diet quality (Healthy Eating Index), time in moderate and vigorous PA and sedentary PA during child care. Secondary outcomes include FCCH provider practices and foods served, and PA environments and practices. Possible mediators (provider attitudes, self-efficacy, barriers and facilitators) are also being explored. Process evaluation measures to assess reach, fidelity and dose, and their relationship with dietary and PA outcomes are included.DiscussionHealthy Start/Comienzos Sanos fills an important gap in the field of childhood obesity prevention by rigorously evaluating an innovative multicomponent intervention to improve the nutrition and physical activity environments of FCCH.Trial registration(# NCT02452645) ClinicalTrials.gov Trial registered on May 22, 2015.

Nutrition-Related Practices of Family Child Care Providers and Differences by Ethnicity.

Child care settings play an important role in shaping children's eating behaviors; yet few studies have included family child care homes (FCCHs). We examined provider-reported nutrition-related practices in FCCHs and observed adherence to nutrition guidelines from the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC), exploring differences by provider ethnicity. We assessed baseline data from a cluster-randomized trial, including surveys with FCCH providers and observational data collected at the FCCH. We examined provider-reported nutrition-related practices and if providers met NAP SACC guidelines using observational data. Differences by ethnicity were assessed using chi-square and multivariate log-linear analysis adjusting for education. Providers completed a telephone survey (n = 166, 100% female and 72% Hispanic) and participated in 2 full-day observations (n = 119). Many providers reported engaging in positive nutrition-related practices. Significant differences by ethnicity included the following: Hispanic providers less likely to report feeding practices that were responsive to children's self-regulation, but also less likely to report eating and drinking unhealthy foods/beverages in front of children and having screens on during meals and more likely to report seeking nutrition trainings. Using observational data, only 10 of 26 NAP SACC practices were met by >60% of providers. Few ethnic differences in meeting guidelines were found (7 of 26 practices). While providers engage in some positive nutrition practices, improvement is needed to ensure that all providers actually meet evidence-based guidelines. Ethnic differences in certain practices underscore the need for culturally relevant trainings. NCT02452645.