Family Child Care Homes Research Articles

The Quality of Nutrition and Physical Activity Environments of Family Child-Care Homes in a State in the Southern United States

BackgroundFamily child-care homes (FCCHs) are an important provider of nonparental child care for low-income families. Little is known about the quality of nutrition and physical activity environments of FCCHs in the southern United States, where child obesity and child poverty levels are high. ObjectivesTo assess the quality of the nutrition and physical activity environments of a sample of FCCHs in Mississippi and examine the differences by urban vs rural location. DesignCross-sectional study. Participants/settingData were from a random sample of 134 FCCHs that enroll children aged 3 to 5 years. The sample was stratified by urban vs rural location and participation in the Child and Adult Care Food Program. Providers completed a modified version of the Environment and Policy Assessment and Observation-Self Report tool by mail and reported on provisions, practices, policies, and the general FCCH nutrition and physical activity environment. Main outcome measuresA nutrition environment score (range=0 to18), physical activity environment score (range=0 to 24), and a combined nutrition and physical activity environment score (range=0 to 42) were calculated from Environment and Policy Assessment and Observation-Self Report tool data. Statistical analyses performedDescriptive statistics and t tests were computed, with statistical significance set at P≤0.05. ResultsAverage scores for the nutrition, physical activity, and combined nutrition and physical activity environment were 9.4, 11.1, and 20.5, respectively. The average nutrition environment score (9.6 vs 9.2; P=0.39) and physical activity environment score (11.3 vs 11.0; P=0.62) did not differ between urban and rural homes. The combined nutrition and physical activity scores (20.8 vs 20.2; P=0.50) also did not differ between urban and rural homes. ConclusionsFindings highlight the need to improve the nutrition and physical activity environments of FCCHs, regardless of geographic location. Further research is needed to understand barriers to providing higher-quality nutrition and physical activity environments.

Exploring rural and urban Go NAP SACC trained child care providers perceptions and needs regarding the promotion of physical activity and healthy eating

Introduction: Early childhood is an optimal time to support the development of physical activity and healthy eating behaviors. As over half of children are cared for in family child care homes and ...

Nutritional Quality of Meals and Snacks Served and Consumed in Family Child Care

BackgroundImproving the nutritional quality of food, including beverages, served in early care and education settings should enhance children’s diet quality. However, few studies have explored the relationship between what is served and consumed in family child-care homes (FCCHs). ObjectiveTo describe the nutritional quality of food served to children in FCCHs and to assess the extent to which children eat what is served. DesignThis study was a cross-sectional analysis using baseline data (n=166) from a cluster-randomized controlled trial (2013-2016). Participants/settingEligible FCCHs in central North Carolina had to have at least two children between 18 months and 4 years, have been in business for at least 2 years, and serve at least one meal and one snack. Main outcome measuresFood was captured using the Diet Observation at Child Care protocol. Statistical analysesFrequencies, means, and multivariate analysis were used to examine the relationship between food served and consumed by food groups and by Healthy Eating Index (HEI-2010). ResultsChildren consumed between 61% and 80% of what was served, with vegetables having the lowest percent consumed (61.0%). Total HEI-2010 score for food served was 63.6 (10.4) and for food consumed was 61.7 (11.5) out of a 100-point maximum. With regards to food served, FCCH providers came close to meeting HEI-2010 standards for dairy, whole fruit, total fruit, and empty calories. However, providers appeared to fall short when it came to greens and beans, seafood and plant proteins, total vegetables, whole grains, and fatty acids. They also exceeded recommended limits for sodium and refined grains. ConclusionsAlthough FCCHs are serving some healthy food, mainly fruit, dairy, and few empty calories, there is room for improvement with regards to vegetables, grains, seafood and plant protein, fatty acids, and sodium. Future trainings should help providers find ways to increase the serving and consumption of these foods.

Modifying the Environment and Policy Assessment and Observation (EPAO) to better capture feeding practices of family childcare home providers.

To describe the modification and validation of an existing instrument, the Environment and Policy Assessment and Observation (EPAO), to better capture provider feeding practices. Modifications to the EPAO were made, validity assessed through expert review, pilot tested and then used to collect follow-up data during a two-day home visit from an ongoing cluster-randomized trial. Exploratory factor analysis investigated the underlying factor structure of the feeding practices. To test predictive validity of the factors, multilevel mixed models examined associations between factors and child's diet quality as captured by the Healthy Eating Index-2010 (HEI-2010) score (measured via the Dietary Observation in Childcare Protocol). Family childcare homes (FCCH) in Rhode Island and North Carolina, USA.ParticipantsThe modified EPAO was pilot tested with fifty-three FCCH and then used to collect data in 133 FCCH. The final three-factor solution ('coercive control and indulgent feeding practices', 'autonomy support practices', 'negative role modelling') captured 43 % of total variance. In multilevel mixed models adjusted for covariates, 'autonomy support practices' was positively associated with children's diet quality. A 1-unit increase in the use of 'autonomy support practices' was associated with a 9·4-unit increase in child HEI-2010 score (P=0·001). Similar to the parenting literature, constructs which describe coercive controlling practices and those which describe autonomy-supportive practices emerged. Given that diets of pre-schoolers in the USA remain suboptimal, teaching childcare providers about supportive feeding practices may help improve children's diet quality.

Beverage Policy Implementation by Child and Adult Care Food Program Participation and Program Type: A Statewide Examination in Georgia.

The child care setting is a promising venue to establish healthy habits and promote obesity prevention. One major contributor to weight gain among young children is high intake of sugar-sweetened beverages (SSBs). Increasing access to water and other healthy beverages is a viable strategy to reduce childhood obesity. The goal of our study was to investigate implementation of the beverage policies in child care programs in Georgia (GA) by Child and Adult Care Food Program (CACFP) participation and program type. The study employed a cross-sectional design. A statewide survey was conducted using the GA Child Care Wellness Survey. A random sample of 3054 child care programs was obtained. Programs were stratified by six state regions to acquire a representative sample. A total of 974 surveys were returned. Sixty-seven percent of the respondents were enrolled in CACFP. Programs participating in CACFP (96%) were less likely to serve SSBs (x2(2) = 15.309, p < 0.001), than non-CACFP programs (90%). CACFP programs were more likely to serve low-fat or fat-free milk to 2-5-year olds than non-CACFP programs (87% vs. 35%, p < 0.001). Family child care homes were significantly more likely to comply with serving only whole milk to 1 year olds (66%; p < 0.001) than other program types. All program types had low compliance with implementing water policies. Study outcomes provide vital information on the implementation of beverage policies that can inform beverage policy training, with the ultimate goal of reducing obesity risk and promoting healthier diets among preschool children in GA.

Physical Activity and Sedentary Behaviors of Children in Family Child Care Homes: Are There Opportunities for Improvement?

Many children attend family child care homes (FCCHs), an important setting to influence children's physical activity (PA) and sedentary behavior (SB). This study assessed children's PA and SB while in FCCHs, characteristics of the FCCH PA environment, and relationships between the environment and child PA and SB. Children ages 1.5-4.0 years (n = 495) were recruited from 165 FCCHs in North Carolina. Children's moderate to vigorous PA and SB were measured via accelerometry for 3 days. FCCH PA environments were assessed over 2 days using the Environment and Policy Assessment and Observation for FCCHs. Ten subscores and an overall PA environment score (possible range: 0-30) were calculated; higher scores indicate better quality. Children accumulated 30 (13)minutes of moderate to vigorous PA and 143 (42)minutes of SB in FCCHs daily. FCCHs scored low on the Environment and Policy Assessment and Observation for FCCHs, with an average overall score of 13 (2). FCCHs scored highest on screen time and screen time practices subscores, and lowest on PA education/professional development and PA policy subscores. Although no statistically significant associations were observed, some large Cohen d effect sizes were noted (eg,outdoor playtime subscore and moderate to vigorous PA). This study highlights opportunities to improve FCCHs and increase children's behaviors (eg,providing adequate time and outdoor play spaces).

State Regulations Promoting Infant Physical Activity in Early Care and Education

State policies have the potential to improve early care and education (ECE) settings, but little is known about the extent to which states are updating their licensing and administrative regulations, especially in response to national calls to action. In 2013, we assessed state regulations promoting infant physical activity in ECE and compared them with national recommendations. To assess change over time, we conducted this review again in 2018. We reviewed regulations for all US states for child care centers (centers) and family child care homes (homes) and compared them with three national recommendations: (1) provide daily tummy time; (2) use cribs, car seats, and high chairs for their primary purpose; and (3) limit the use of restrictive equipment (e.g., strollers). We performed exact McNemar's tests to compare the number of states meeting recommendations from 2013 to 2018 to evaluate whether states had made changes over this period. From 2013 to 2018, we observed significant improvement in one recommendation for homes-to use cribs, car seats, and high chairs for their primary purpose (odds ratio 11.0; 95% CI 1.6-47.3; p = 0.006). We did not observe any other significant difference between 2013 and 2018 regulations. Despite increased awareness of the importance of early-life physical activity, we observed only modest improvement in the number of states meeting infant physical activity recommendations over the past 5 years. In practice, ECE programs may be promoting infant physical activity, but may not be required to do so through state regulations.

Predictors of Parent Engagement Based on Child Care Providers’ Perspectives

ObjectiveDetermine the predictors of child care providers’ parent engagement regarding child nutrition in child care centers (CCCs) and family child care homes (FCCHs). DesignCross-sectional. SettingChild care centers and FCCHs. ParticipantsChild care center directors (n = 337) and FCCH providers (n = 1,153) completed a self-administered survey. Main Outcome MeasuresFifteen variables were examined as predictors for parent engagement: providers’ perceived barriers to communication, participation in Go Nutrition and Physical Self- Assessment in Child Care, National Association for the Education of Young Children accreditation, participation in Quality Ratings and Improvement Systems, feeding practices, and professional development. AnalysisStructural equation modeling examined the relation between variables for CCCs and for FCCHs. ResultsFor CCCs, NAEYC accreditation, providers’ perceived barriers regarding parents’ cultural beliefs about food, parents not liking the taste of healthy foods, and parents prioritizing other food-related topics over healthy eating significantly predicted parent engagement. For FCCHs, participation in Go Nutrition and Physical Self- Assessment in Child Care, perceiving parents to be busy, not wanting to offend parents, and practicing family-style dining were significantly related to parent engagement. For both CCCs and FCCHs, professional development regarding child nutrition was related to parent engagement. Conclusions and ImplicationsFocusing professional development on child care contexts and addressing providers’ perceived barriers may improve parent engagement.

NP16 - Development of an Intervention to Enhance Children's Nutrient Quality in Family Child Care Homes

Objective: Describe Happy Healthy Homes, an interdisciplinary, community-based study in Oklahoma, to improve FCCH environments and children's health through the development and testing of two interventions: a nutrition intervention to increase quality of foods served and promote compliance with Child and Adult Care Food Program (CACFP) best-practices and a healthy environment intervention to reduce children's exposure to toxins. Description: Early childhood is a critical developmental period that largely determines health throughout the life course. Over 60% of U.S. children spend time in weekly early care and education (ECE) environments away from home. The physical and social environments of ECEs influence children's health in multiple ways and, as such, ECEs are important settings for health promotion interventions. Family Child Care Homes (FCCH), ECE that provide care for children in the provider's own home, serve over one million children in the U.S. Matched attention intervention trials offer an opportunity to test nutrition interventions in FCCHs along with other intervention to promote children's health. Evaluation: Cluster randomized controlled trial with matched attention design. Fifty-two FCCH providers in and around Oklahoma City were randomly assigned into either of the two interventions, where each serves as an attention control for the other. Interventions were based on existing evidence base for health promotion interventions in ECE, Public Health Ecological Model, Social Cognitive Theory, Social Support, Self-Determination Theory, and Adult Learning Practices. Both interventions were completed over three months and consists of two 90-minute home visits with interactive activities, reflection, and goal setting, and a three-hour small group class. The aims include determining the effectiveness, over a 12-month follow-up period, of a pilot community-based intervention to enhance meeting (CACFP) best practices. Multiple observed and self-reported measures were collected at baseline and at 3 and 12 months post-baseline. Conclusions and Implications: Implementation of this intervention will enhance the quality of nutrition provided to young children in FCCH and can be used to scale to rural environments and other states. Funding: 2017-68001-26355. The following is the supplementary data to this article: Download .pdf (.5 MB) Help with pdf files Poster

P65 - Factors Influencing Childcare Providers' Engagement of Parents Regarding Child Nutrition

Background (Background, Rationale, Prior Research, and/or Theory): The Academy of Nutrition and Dietetics, parents, childcare directors, and health consultants agree that nutrition education is instrumental to improving children's and families' nutrition knowledge and eating behavior (Benjamin Neelon & Briley, 2011; Gupta et al., 2005). More recent research, however, has demonstrated that childcare providers often report challenges to engaging parents in topics about their children's nutrition (Lyn et al., 2014; Stage et al., 2017). Objective: To determine the factors influencing childcare providers' engagement with parents regarding child nutrition in childcare centers (CCCs) and family childcare homes (FCCHs). Study Design, Setting, Participants, Intervention: This was a cross-sectional, quantitative study on CCCs and FCCHs in Nebraska. CCC directors (n = 337) and FCCH providers (n = 1,153) completed self-administered surveys. Outcome Measures and Analysis: The dependent variable was parent engagement. Fifteen variables were examined as predictors for parent engagement—barriers to communication, participation in Go Nutrition and Physical Self- Assessment in Child Care (Go NAP SACC), National Association for the Education of Young Children (NAEYC) accreditation, participation in Quality Ratings and Improvement Systems (QRIS), feeding practices, professional development regarding child nutrition, and child-provider ratio. Structural equation modeling was conducted to examine the relation between variables for CCCs and for FCCHs. Results: For CCC's, NAEYC accreditation, providers' barriers regarding parents' cultural beliefs about food that are not always consistent with healthy eating, parents not liking the taste of healthy foods, and parents prioritizing other food related topics (allergies or children's food intake) significantly predicted parent engagement. For FCCHs, participation in Go NAP SACC, perceiving parents as busy, not wanting to offend parents, and practicing family style dining were significantly related to parent engagement. For both CCCs and FCCHs, professional development regarding child nutrition was related to parent engagement. Conclusions and Implications: Focusing professional development on childcare contexts and addressing providers' barriers may improve parent engagement. Funding: USDA.

P34 - Family Child Care Home Provider Experiences with the Child and Adult Care Food Program

P34 - Family Child Care Home Provider Experiences with the Child and Adult Care Food Program

Examining the Obesogenic Attributes of the Family Child Care Home Environment: A Literature Review.

Childhood obesity is a major public health concern in the US. More than a third of young children 2–5 years old are placed in nonrelative child care for the majority of the day, making the child care setting an important venue to spearhead obesity prevention. Much of the obesity research in child care has focused on center-based facilities, with emerging research on Family Child Care Homes (FCCHs)—child care operated in a home setting outside the child's home. The purpose of this review was to assess the obesogenic attributes of the FCCH environment. A search of the PubMed, Embase, CINHAL, and PsycINFO electronic databases identified 3,281 citations; 35 eligible for full-text review, and 18 articles from 17 studies in the analysis. This review found a lack of comprehensive written nutrition and physical activity policies within FCCHs, lack of FCCH providers trained in nutrition and physical activity best practices, lack of adequate equipment and space for indoor and outdoor playtime activities in FCCHs, inaccurate nutrition-related beliefs and perceptions among FCCH providers, poor nutrition-related communication with families, and poor feeding practices. Future research focusing on interventions aimed at addressing these problem areas can contribute to obesity prevention.

The physical environment in family childcare homes and children's physical activity.

Family childcare homes (FCCHs) are the second largest provider of childcare in the United States, yet little is known about how this setting influences children's physical activity, particularly related to the physical environment. Thus, the purpose of this study was to determine what aspects of the FCCH physical environment facilitate or hinder children's physical activity. Data were collected from 166 FCCH providers and 496 preschool-aged children in 2013-2014 as part of the Keys to Healthy FCCHs study. Children's moderate-to-vigorous physical activity (MVPA) was measured using Actigraph GT3X+ accelerometers. Wear data from the childcare day were isolated, and cut-points were applied in order to calculate children's minutes of MVPA per hour. FCCH-level estimates of child MVPA per hour were calculated. Indoor and outdoor physical environment characteristics were assessed during a 2-day observation using the Environment and Policy Assessment and Observation modified for FCCHs. General linear models were used to examine the relationship between indoor, portable play equipment, and outdoor FCCH physical environment characteristics and children's MVPA per hour. Only indoor play space was significantly associated with children's MVPA (β=0.33; p=.034), indicating that when provided with more indoor space for active play, children were more physically active. No significant associations were noted between portable play equipment or the outdoor environment and children's MVPA. Indoor space was the only physical environment characteristic associated with children's MVPA, suggesting that teaching FCCH providers how to best utilize their indoor play space for active play may be a way to promote children's physical activity. Futures studies should explore the impact of other environmental characteristics of the FCCH (e.g., provider practices and policies) on children's physical activity.

Improvements in Physical Activity Opportunities: Results From a Community-Based Family Child Care Intervention

Reaching preschool-aged children to establish healthy lifestyle habits, including physical activity, is an important component of obesity prevention efforts. However, few studies have examined family child care homes where nearly 1 million children receive care. A pre- and post-intervention evaluation without a control group was conducted to evaluate what changes occurred in family child care homes that participated in the Healthy Eating and Active Living project, a multicomponent obesity prevention initiative, focused on community-driven policy and environmental change in neighborhoods within Kaiser Permanente service areas. From 2012 to 2014, a total of 17 family child care homes in Northern California participated in the intervention. A physical activity workshop for child care staff and technical assistance to develop a policy to promote physical activity and other healthy behaviors. Pre and post observations, questionnaires, and physical activity logs were completed to assess change in physical activity resources available in the family child care homes, the amount of child screen time offered, type and amount of physical activity offered to children, and implementation of physical activity best practices. Between baseline and follow-up, providers significantly increased both the number of structured, adult-led activities (2.6 vs 3.2 activities per day) and the number of structured, adult-led minutes of activity in which children participated (49 vs 83 minutes per day). Providers also improved screen time practices and made improvements to the physical activity environment. In this study, a community-based organization designed and implemented multicomponent strategies tailored for participating family child care homes. The successful implementation of the intervention likely contributed to implementation of practices that increased opportunities for physical activity for the young children attending these family child care homes. This article is part of a supplement entitled Building Thriving Communities Through Comprehensive Community Health Initiatives, which is sponsored by Kaiser Permanente, Community Health.

Changes in Nutrition Policies and Dietary Intake in Child Care Homes Participating in Healthy Eating and Active Living Initiative

From 2012 to 2014, a total of 17 family child care homes participated in a multisector, community-wide initiative to prevent obesity. Strategies included staff workshops, materials, site visits, and technical assistance regarding development and implementation of nutrition policies. The purpose of the evaluation was to examine the impact of the initiative on family child care home nutrition-related policies and practices and child dietary intake. Pre- and post-intervention without control group. Measures taken at baseline and follow-up included structured observations and questionnaires regarding nutrition policies, practices, and environments; documentation of lunch foods served on 5 days; and lunch plate waste observations on 2 days. Paired t-tests were used to determine the significance of change over time. Seventeen family child care homes in a low-income diverse community in Northern California; children aged 2-5 years who attended the family child care homes. Change in nutrition-related policies and practices, lunch foods served and consumed. Data was collected at 17 sites for an average of 5.2 children aged 2-5 years per site per day at baseline and 4.6 at follow-up for a total of 333 plate waste observations. There were significant increases in staff training, parental involvement, and several of the targeted nutrition-related practices; prevalence of most other practices either improved or was maintained over time. There were significant increases in the number of sites meeting Child and Adult Care Food Program meal guidelines, variety of fruit and frequency of vegetables offered, and reductions in frequency of juice and high-fat processed meats offered. Adequate portions of all food groups were consumed at both time points with no significant change over time. A simple, policy-focused intervention by a child care resource and referral agency was successful at reinforcing and improving upon nutrition-related practices at family child care homes. Children consumed adequate, but not excessive, portions of the balanced meals served to them, suggesting there is no reason to offer unhealthy options. This article is part of a supplement entitled Building Thriving Communities Through Comprehensive Community Health Initiatives, which is sponsored by Kaiser Permanente, Community Health.

The family child care home environment and children's diet quality

BackgroundDeveloping healthy eating behaviors and food preferences in early childhood may help establish future healthy diets. Large numbers of children spend time in child care, but little research has assessed the nutritional quality of meals and snacks in family child care homes. Therefore, it is important to assess foods and beverages provided, policies related to nutrition and feeding children, and interactions between providers and children during mealtimes. We examined associations between the nutrition environments of family child care homes and children's diet quality. MethodsWe assessed the nutrition environments of 166 family child care homes using the Environment and Policy Assessment and Observation (EPAO) (scores range: 0–21). We also recorded foods and beverages consumed by 496 children in care and calculated healthy eating index (HEI) (scores range: 0–100). We used a mixed effects linear regression model to examine the association between the EPAO nutrition environment (and EPAO sub-scales) and child HEI, controlling for potential confounders. ResultsFamily child care homes had a mean (standard deviation, SD) of 7.2 (3.6) children in care, 74.1% of providers were black or African American, and children had a mean (SD) age of 35.7 (11.4) months. In adjusted multivariable models, higher EPAO nutrition score was associated with increased child HEI score (1.16; 95% CI: 0.34, 1.98; p = 0.006). Higher scores on EPAO sub-scales for foods provided (8.98; 95% CI: 3.94, 14.01; p = 0.0006), nutrition education (5.37; 95% CI: 0.80, 9.94; p = 0.02), and nutrition policy (2.36; 95% CI: 0.23, 4.49; p = 0.03) were all associated with greater child HEI score. ConclusionsFoods and beverages served, in addition to nutrition education and nutrition policies in family child care homes, may be promising intervention targets for improving child diet quality.

Participation in the Child and Adult Care Food Program Is Associated with Healthier Nutrition Environments at Family Child Care Homes in Mississippi

ObjectiveDescribe foods and beverages offered, nutrition practices, and nutrition policies of family child care homes in Mississippi and differences by participation in the Child and Adult Care Food Program (CACFP). DesignCross-sectional study conducted between fall, 2015 and spring, 2016. SettingMississippi. ParticipantsRandom, stratified sample of 134 family child care homes that enroll 3- to 5-year-olds. Providers completed a modified version of the Environment and Policy Assessment and Observation–self-report tool. Variables MeasuredFoods and beverages offered at lunch, provider practices regarding nutrition, and presence or absence of written nutrition policies. AnalysisDescriptive statistics, likelihood ratio chi-square, and t tests. ResultsMost homes (>75%) provided components from the fruit, vegetable, grain/bread, meat/meat alternative, and milk food groups at lunch. At some homes, the food and beverage selections offered were high in fat, sugar, and refined grains. Providers at CACFP-participating homes (P < .05) reported healthier beverage selections, more healthful nutrition practices, and more written nutrition policies compared with providers at non-CACFP homes. Conclusion and ImplicationsInterventions and regulatory standards are needed, particularly in non-CACFP homes, to ensure that food and beverage offerings, provider practices, and policies regarding nutrition support the development of healthful dietary behaviors in early childhood.

Links Between Patterns of Quality in Diverse Settings and Children’s Early Outcomes

Patterns of quality among approximately 1,400 center classrooms and 350 family child care homes based on measures of global quality, sensitive caregiving, and frequency of language/literacy and math/numeracy activities were examined. Four patterns of quality were identified. Provider education was predictive of higher quality care in both centers and family child care home arrangements. Associations between quality patterns and children’s preschool and kindergarten academic skills were found among children in family child care homes only. Policy and practice implications related to the varying patterns of quality are discussed.

State Variations in Infant Feeding Regulations for Child Care.

Early care and education (ECE) settings have become primary targets for policy change in recent years. In our 2008 study, we assessed state and regional variation in infant feeding regulations for ECE and compared them to national standards. We conducted the same regulatory review to assess change over time. Because all but 2 states have updated their regulations, we hypothesized that states would have made substantial improvements in the number of regulations supporting infant feeding in ECE. For this cross-sectional study, we reviewed infant feeding regulations for all US states for child care centers (centers) and family child care homes (homes). We compared regulations with 10 national standards and assessed the number of new regulations consistent with these standards since our previous review. Comparing results from 2008 and 2016, we observed significant improvements in 7 of the 10 standards for centers and 4 of the 10 standards for homes. Delaware was the only state with regulations meeting 9 of the 10 standards for centers in 2008. In 2016, Delaware and Michigan had regulations meeting 8 of the 10 standards. Previously, Arkansas, the District of Columbia, Minnesota, Mississippi, Ohio, and South Carolina had regulations consistent with 4 of the 10 standards for homes. In 2016, Delaware, Mississippi, and Vermont had regulations meeting 7 of the 10 standards. Evidence suggests that enacting new regulations may improve child health outcomes. Given that many states recently enacted regulations governing infant feeding, our findings point to the growing interest in this area.

Easier said than done: a qualitative study conducted in the USA exploring Latino family child care home providers as role models for healthy eating and physical activity behaviours

ObjectiveLatinos are the largest and most rapidly growing minority population group in the USA and are disproportionally affected by obesity and related chronic diseases. Child care providers likely influence the...