Family Child Care Homes Providers Research Articles

Nutrition Practices of Family Child Care Home Providers and Children's Diet Quality

ObjectiveTo examine the relationship between the diet quality of children aged 2–5 years cared for in family child care homes (FCCHs) with provider adherence to nutrition best practices. DesignCross-sectional analysis. ParticipantsFamily child care home providers (n = 120, 100% female, 67.5% Latinx) and children (n = 370, 51% female, 58% Latinx) enrolled in a cluster-randomized trial. Main Outcome MeasuresData were collected over 2 days at each FCCH. The Environment and Policy Assessment and Observation tool was used to document whether providers exhibited nutrition practices on the basis of the Nutrition and Physical Activity Self-Assessment for Child Care. Each practice was scored as either present or absent. Children's food intake was observed using Diet Observation at Child Care and analyzed with the Healthy Eating Index–2015. AnalysisMultilevel linear regression models assessed the association between providers exhibiting best practices regarding nutrition and children's diet quality. The model accounted for clustering by FCCH and controlled for provider ethnicity, income level, and multiple comparisons. ResultsChildren in FCCHs in which more of the best practices were implemented had higher diet quality (B = 1.05; 95% confidence interval [CI], 0.12–1.99; P = 0.03). Specifically, children whose providers promoted autonomous feeding (B = 27.52; 95% CI, 21.02–34.02; P < 0.001) and provided nutrition education (B = 7.76; 95% CI, 3.29–12.23; P = 0.001) had higher total Healthy Eating Index scores. Conclusions and ImplicationsFuture interventions and policies could support FCCH providers in implementing important practices such as autonomy feeding practices, talking informally to children about nutrition, and providing healthful foods and beverages.

Online training for child care providers teaches child nutrition in English and Spanish

Poor nutrition among young children is a national health crisis which contributes to obesity and chronic disease later in life. Since children spend so much time in child care, child care providers can help improve the quality of young children's nutrition and foster lifelong healthy eating habits. However, California's family child care home (FCCH) providers receive little training on what and how to feed young children. To address this problem, we developed a self-paced online training on child nutrition in English and Spanish for FCCH providers. Our feasibility study evaluated providers’ satisfaction with the training and ease of use, using an online survey and a 45-minute interview upon completing the training. Providers rated their training experience as excellent, easy to enroll in, and complete. Most providers reported they were somewhat likely to make changes to what and how they feed infants and toddlers. Many recommended adding printed resources and culturally relevant material for future trainings.

Facilitators and barriers to family child care home participation in the U.S. Child and Adult Care Food Program (CACFP)

This paper describes facilitators, barriers, and potential strategies to promote participation in the Child and Adult Care Food Program (CACFP) by family child care homes (FCCHs). This descriptive study occurred from January-May 2022 in Arizona and New York, two states with varying levels of CACFP participation. Stakeholders from three state-level CACFP-administering agencies, representatives of six sponsor organizations, and 23 FCCH providers (70% CACFP, 30% non-CACFP) participated in interviews. Facilitators of CACFP participation included the simple enrollment, technical assistance from sponsors, software provided by sponsors, and incentives from state agencies. Barriers included perceptions that CACFP paperwork would be burdensome, lack of access to sponsors, and challenges with meal pattern requirements. Recommended strategies to promote CACFP uptake included educating providers about CACFP, expanding outreach, and additional funding. Efforts to address state-level disparities in FCCH participation in CACFP are needed. This study provides some insight into policy and systems changes that could be beneficial.

P065 Using Diffusion of Innovations Theory Explore Family Child Care Home Providers Perspectives on Responsive Feeding Practices

<h3>Background</h3> Early Care and Education (ECE) programs offer ideal settings for young children to develop healthy dietary intake. Implementation of responsive feeding evidence-based practices (EBPs) are a promising avenue to promote healthy eating in young children while supporting children's autonomy and self-regulation. However, implementation of responsive feeding EBPs is low, especially in rural family childcare homes (FCCH). Little is known about how organizational structure in FCCH impact implementation of responsive feeding EBPs in this unique setting. <h3>Objective</h3> To determine FCCH providers' perspectives for implementing evidence-based responsive feeding practices using the Diffusion of Innovations Theory's innovation-decision process. <h3>Study Design, Setting, Participants</h3> Six qualitative, semi-structured focus group interviews were conducted with 19 rural FCCH providers. <h3>Measurable Outcome/Analysis</h3> Interviews were analyzed using thematic analysis. <h3>Results</h3> Providers reported having knowledge regarding responsive feeding EBPs and had learned about them through various communication channels such as the Child and Adult Care Food Program, Go Nutrition and Physical Activity Self-Assessment for Child Care, and Step Up to Quality (Knowledge). Providers reported perceived challenges to implementing responsive feeding related to the organizational structure of the FCCH settings, such as the mixed age groups of children and balancing multiple roles such as administrator, cook and teacher during mealtimes (Persuasion and Decision). Additionally, providers who were implementing responsive feeding EBPs provided strategies used to overcome these challenges (Implementation). Finally, providers reported the benefits of using responsive feeding EBPs, such as supporting children's healthful development and more pleasant mealtimes, as reasons for their continued use of responsive feeding EBPs (Confirmation). <h3>Conclusions</h3> Results indicate that organizational structure impacts successful implementation of responsive feeding EBPs in ECE programs. Programming and policy efforts should consider these factors when targeting children's healthful dietary needs. <h3>Funding</h3> USDA

Food Desert Status of Family Child Care Homes: Relationship to Young Children's Food Quality.

Family child care homes (FCCHs) are a favored child care choice for parents of young children in the U.S. Most FCCH providers purchase and prepare foods for the children in their care. Although FCCH providers can receive monetary support from the Child and Adult Care Food Program (CACFP), a federal subsidy program, to purchase nutritious foods, little is known about FCCH providers’ access to nutritious foods, especially among FCCH providers serving children from communities that have been historically disinvested and predominantly Black. This study aims to describe the food desert status of FCCHs in Baltimore City, Maryland, and examine the relationship between food desert status and the quality of foods and beverages purchased and provided to children. A proportionate stratified random sample of 91 FCCH providers by CACFP participation status consented. Geographic information system mapping (GIS) was used to determine the food desert status of each participating FCCH. Participants reported on their access to food and beverages through telephone-based surveys. Nearly three-quarters (66/91) of FCCHs were located in a food desert. FCCH providers working and living in a food desert had lower mean sum scores M (SD) for the quality of beverages provided than FCCH providers outside a food desert (2.53 ± 0.81 vs. 2.92 ± 0.70, p = 0.036, respectively). Although the significant difference in scores for beverages provided is small, FCCH providers working in food deserts may need support in providing healthy beverages to the children in their care. More research is needed to understand food purchases among FCCH providers working in neighborhoods situated in food deserts.

A multi-component tailored intervention in family childcare homes improves diet quality and sedentary behavior of preschool children compared to an attention control: results from the Healthy Start-Comienzos Sanos cluster randomized trial

BackgroundChildcare settings are important environments for influencing child eating and physical activity (PA). Family childcare homes (FCCH) care for many children of low-income and diverse racial/ethnic backgrounds who are at greater risk for poor diet quality, low PA, and obesity, but few interventions have targeted this setting. The aim of this study was to assess the efficacy of a multicomponent intervention conducted in FCCH on the diet quality and PA of 2–5 year old children in their care.Trial designCluster randomized trial.MethodsThe cluster-randomized trial, Healthy Start/Comienzos Sanos (2015–2019) evaluated an 8-month nutrition and PA intervention that included four components: (1) monthly telephone calls from a support coach using brief motivational interviewing, (2) tailored reports, newsletters and videos, (3) group support meetings, and (4) active play toys. After completing baseline measurement, FCCH were randomized into intervention or comparison groups in matched pairs. Both groups received the same intervention components but on different topics (intervention: nutrition/PA vs. comparison: reading readiness/literacy). Evaluation staff were blinded to group assignment. Child primary outcome measures collected at baseline and 8-months included: 1) Healthy Eating Index (HEI-2015) scores calculated from diet observation, and 2) accelerometer measurement of PA. Process measures were collected from field data and provider surveys. Generalized Estimating Equation Models assessed changes in HEI-2015 scores and PA over time by experimental condition.ResultsEthnically diverse FCCH providers (n = 119) and 2-to-5-year-old children in their care (n = 377) were included in the final analysis. Process evaluation showed high participation in all intervention components except for group meetings. Compared to children in comparison group FCCH, children in intervention FCCH increased total HEI-2015 scores by 7.2 points (p < .001) including improvement in component scores for vegetables (0.84 points, p = .025) and added sugar (0.94 points, p = .025). For PA, compared to children in the comparison group, children in intervention FCCH decreased sedentary time by 5.7% (p = .021).ConclusionsThe multicomponent Healthy Start intervention was effective in improving diet quality and sedentary behavior of children in FCCH, which demonstrates the promise of obesity prevention interventions in this setting. Future research could include enhancing the Healthy Start intervention to strengthen the PA component, considering virtual peer support, and determining how to best translate and disseminate the intervention into FCCH nationally.Trial registrationNational Institutes of Health, NCT02452645. Registered 5 May 2015.

Family child care home providers' self-reported nutrition and physical activity practices, self-efficacy, barriers and knowledge: baseline findings from happy healthy homes.

Describe nutrition and physical activity practices, nutrition self-efficacy and barriers and food programme knowledge within Family Child Care Homes (FCCH) and differences by staffing. Baseline, cross-sectional analyses of the Happy Healthy Homes randomised trial (NCT03560050). FCCH in Oklahoma, USA. FCCH providers (n 49, 100 % women, 30·6 % Non-Hispanic Black, 2·0 % Hispanic, 4·1 % American Indian/Alaska Native, 51·0 % Non-Hispanic white, 44·2 ± 14·2 years of age. 53·1 % had additional staff) self-reported nutrition and physical activity practices and policies, nutrition self-efficacy and barriers and food programme knowledge. Differences between providers with and without additional staff were adjusted for multiple comparisons (P < 0·01). The prevalence of meeting all nutrition and physical activity best practices ranged from 0·0-43·8 % to 4·1-16·7 %, respectively. Average nutrition and physical activity scores were 3·2 ± 0·3 and 3·0 ± 0·5 (max 4·0), respectively. Sum nutrition and physical activity scores were 137·5 ± 12·6 (max 172·0) and 48·4 ± 7·5 (max 64·0), respectively. Providers reported high nutrition self-efficacy and few barriers. The majority of providers (73·9-84·7 %) felt that they could meet food programme best practices; however, knowledge of food programme best practices was lower than anticipated (median 63-67 % accuracy). More providers with additional staff had higher self-efficacy in family-style meal service than did those who did not (P = 0·006). Providers had high self-efficacy in meeting nutrition best practices and reported few barriers. While providers were successfully meeting some individual best practices, few met all. Few differences were observed between FCCH providers with and without additional staff. FCCH providers need additional nutrition training on implementation of best practices.

Food Outlet Density, Distance, and Food Quality Offered to Preschool-Aged Children at Family Child Care Homes

ObjectiveTo examine how food environments around family child care homes (FCCHs) are associated with the healthfulness of foods served to children. DesignCross-sectional data from a mail survey of FCCH providers, InfoUSA. ParticipantsThe study included 132 Mississippi FCCHs (26% response). Main Outcome MeasuresDependent: compliance with nutrition best practices for 9 food categories; composite healthfulness score. Independent: counts of supermarkets, small-medium grocery stores, produce stores, convenience stores within 5 miles; distance to supermarket. AnalysisLogistic regression estimated associations between best-practice compliance and food environment. Linear regression estimated associations between composite food healthfulness and food environment. Models stratified by rural/urban location. ResultsRural FCCHs with higher counts of supermarkets, convenience stores, and produce stores had lower compliance with selected best practices (fried/prefried potatoes, high-sugar/high-fat foods). Urban FCCHs with more supermarkets had higher compliance with fruit not canned in syrup; those with more small-medium grocery stores and convenience stores had lower compliance with selected best practices (fried/prefried potatoes, vegetables, low-fat meats). Conclusions and ImplicationsFood environment measures were associated with some nutrition best practices, though not consistently in the expected direction. Future research could examine food quality at stores near rural FCCHs. Programs that improve local food environments may improve foods served at FCCHs.

Family Child Care Providers’ Nutrition Practices and Policies: Happy Healthy Homes

ObjectiveDetermine the impact of family child care home providers’ nutrition knowledge, confidence, and perceived barriers on program nutrition best practices and written nutrition policies. MethodsCross-sectional analysis of self-reported surveys of 49 female providers in Oklahoma City analyzed with Spearman correlation, multivariate linear and logistic regression (α < 0.05). ResultsConfidence and barriers were significantly correlated (rs(47) = −0.4, P = 0.004). Independent variables explained 36% of practices (r2 = 0.357). Nutrition knowledge (standard β = 0.442, P = 0.001) and confidence (standard β = 0.358, P = 0.008) were significantly associated with practices; barriers were not. No significant association between independent variables and written policies resulted. Conclusions and ImplicationsProvider nutrition knowledge and confidence appear to be suitable targets to improve nutrition practices. Further research can evaluate possible influences on the presence and quality of family child care home written nutrition policies and specific nutrition policy topics associated with healthier nutrition practices.

Mealtime Environment and Feeding Practices in Urban Family Child Care Homes in the United States.

Background: Family Child Care Homes (FCCHs) are the second-largest childcare option in the US. Given that young children are increasingly becoming overweight and obese, it is vital to understand the FCCH mealtime environment. There is much interest in examining the impact of the Child and Adult Care Food Program (CACFP), a federal initiative to support healthy nutrition, by providing cash reimbursements to eligible childcare providers to purchase nutritious foods. This study examines the association among the FCCH provider characteristics, the mealtime environment, and the quality of foods offered to 2-5-year-old children in urban FCCHs and examines the quality of the mealtime environment and foods offered by CACFP participation. Methods: A cross-sectional design with a proportionate stratified random sample of urban FCCHs by the CACFP participation status was used. Data were collected by telephone using the Nutrition and Physical Activity Self-Assessment for Child Care survey. Results: A total of 91 licensed FCCHs (69 CACFP, 22 non-CACFP) participated. FCCH providers with formal nutrition training met significantly more of the quality standards for foods offered than providers without nutrition training (β = 0.22, p = 0.034). The mealtime environment was not related to any FCCH provider characteristics. CACFP-participating FCCH providers had a healthier mealtime environment (β = 0.326, p = 0.002) than non-CACFP FCCHs. Conclusions: Findings suggest that nutrition training and CACFP participation contribute to the quality of nutrition-related practices in the FCCH. We recommend more research on strengthening the quality of foods provided in FCCHs and the possible impact on childhood obesity.

O20 Family Child Care Home Menu Quality: Happy Healthy Homes Baseline

BackgroundThere is limited understanding of nutrition quality of food served in Family Child Care Homes (FCCH).ObjectiveDescribe FCCH menu quality by examining nutrients, variation in foods served, and compliance with Child and Adult Care Food program (CACFP) meal pattern requirements and best practices.Study Design, Setting, ParticipantsCross-sectional analyses of a randomized controlled baseline characteristics of FCCH providers caring for children ages 2-to-5 years, participating in the CACFP, and residing in and around the Oklahoma City metropolitan.Measurable Outcome/AnalysisDaily nutrients were calculated across 1 week's menu using Food Processor. Nutrients were compared to two thirds Dietary Reference Intakes (DRIs) values for key macro and micronutrients. Menu variety was quantified using frequencies of different exposures to fruits, vegetables, high sugar, and high fat foods across the week's menu. Compliance with 2017 CACFP meal pattern requirements and best practices was determined using a measurement index.ResultsThe majority of the 49 FCCHs menus’ nutrient exceeding two thirds of DRI. However, the energy, total fiber, vitamin D, and iron content of menus for children ages 4 to 8-years was less than two thirds of the DRIs. The average number of different exposures to fruit, vegetables, high sugar, and high fat food categories per week were 7.1, 5.5, 0.9, and 3.8, respectively. Average CACFP score percentages for meal pattern requirements, best practices, and total score were 65.9%, 66.8%, and 66.3%, respectively.ConclusionMenus met several nutrient recommendations, are high in variety, and met the majority of CACFP requirements and best practices, which is desirable for children's health. Menus indicated a variety of nutrient-dense and high-quality foods are served in these FCCHs. Quality of menus can be improved by reducing sodium and saturated fat and increasing total fiber, vitamin D, and iron; increasing fruit and vegetable variation; and increasing compliance with CACFP requirements and best practices. There is limited understanding of nutrition quality of food served in Family Child Care Homes (FCCH). Describe FCCH menu quality by examining nutrients, variation in foods served, and compliance with Child and Adult Care Food program (CACFP) meal pattern requirements and best practices. Cross-sectional analyses of a randomized controlled baseline characteristics of FCCH providers caring for children ages 2-to-5 years, participating in the CACFP, and residing in and around the Oklahoma City metropolitan. Daily nutrients were calculated across 1 week's menu using Food Processor. Nutrients were compared to two thirds Dietary Reference Intakes (DRIs) values for key macro and micronutrients. Menu variety was quantified using frequencies of different exposures to fruits, vegetables, high sugar, and high fat foods across the week's menu. Compliance with 2017 CACFP meal pattern requirements and best practices was determined using a measurement index. The majority of the 49 FCCHs menus’ nutrient exceeding two thirds of DRI. However, the energy, total fiber, vitamin D, and iron content of menus for children ages 4 to 8-years was less than two thirds of the DRIs. The average number of different exposures to fruit, vegetables, high sugar, and high fat food categories per week were 7.1, 5.5, 0.9, and 3.8, respectively. Average CACFP score percentages for meal pattern requirements, best practices, and total score were 65.9%, 66.8%, and 66.3%, respectively. Menus met several nutrient recommendations, are high in variety, and met the majority of CACFP requirements and best practices, which is desirable for children's health. Menus indicated a variety of nutrient-dense and high-quality foods are served in these FCCHs. Quality of menus can be improved by reducing sodium and saturated fat and increasing total fiber, vitamin D, and iron; increasing fruit and vegetable variation; and increasing compliance with CACFP requirements and best practices.

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.

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.

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.

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.

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.

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.

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.