Family Child Care Homes Research Articles

Foods Served in Child Care Programs Participating in the Child and Adult Care Food Program and Alignment with Program Meal Patterns

ObjectiveAssess Child and Adult Care Food Program (CACFP) program compliance with meal component requirements for children aged 3-5 years by program type, and describe foods and beverages most commonly served. DesignCross-sectional analysis of 1-week menu surveys during winter/spring 2017. SettingUS CACFP-participating child care programs. ParticipantsNationally representative multistage cluster sample of 664 programs: 222 child care centers, 247 Head Start programs, 195 family child care homes. Main Outcome Measure(s)Percentage of meals including required components; frequently served foods and beverages. AnalysisMean percentages; 2-tailed t tests; alpha = 0.05 significance level. ResultsMost breakfasts (97%), lunches (88%), and afternoon snacks (97%) included all required CACFP meal components. Most breakfasts included fruits (96%), but not vegetables; 16% included a meat/meat alternate. Most lunches (81%) included both fruits and vegetables. Afternoon snacks were mostly grains/breads (80%) and fruits (57%). Most frequently served foods included 1% unflavored milk and fresh fruits such as apples and bananas. Most menus limited juice, offered low-sugar cereal, and did not include flavored milk; very few menus included noncreditable foods with added sugar. Conclusions and ImplicationsMost CACFP meals provided required components, but there is room for improvement, particularly for increasing vegetables served and limiting foods high in added sugar and fat.

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.

Cleaning Products Commonly Used in Oklahoma Family Child Care Homes: Implications for Respiratory Risk and Children's Health.

Little is known about the cleaning products used by early care and education programs that contribute to childhood asthma, particularly in Oklahoma where rates of uncontrolled asthma are higher than national rates (60.0% vs. 50.3%, respectively). We conducted a cross-sectional study of cleaning products used by Oklahoma-licensed family child care homes (FCCHs) (n = 50) to characterize and identify potential respiratory-health risks associated with chemical contents. Overall, 386 chemicals were abstracted from the 132 reported products. Of these, 100 unique chemicals were identified. Four percent (4.2%) of providers used a product with a sensitizer that may cause allergy or asthma symptoms if inhaled and 35.4% used a product with an irritant that may cause irritation to the respiratory tract. Most (62.5%) reported using a product with a chemical that had a C=C double bond in its molecular structure that may make it highly reactive with other substances in the air and produce secondary air pollutants and 83.3% reported using a sodium hypochlorite containing product. Twenty-three percent reported products that contain carcinogens. Policy, educational, and technical assistance interventions are needed to promote the use of safer products and reduce respiratory and other health risks posed by chemicals in Oklahoma FCCHs.

Food Waste, Preference, and Cost: Perceived Barriers and Self-Reported Food Service Best Practices in Family Child Care Homes.

Background: Family Child Care Homes (FCCHs) are a setting where providers care for children at their own residence. FCCHs face unique challenges and children may not always receive optimal nutrition and have higher risk of obesity compared to other programs. The objective of this study was to determine differences in food service best practices scores between FCCHs who did/did not perceive barriers to serving healthy meals. Methods: FCCHs (n = 167) self-reported demographics, and perceived barriers to serving healthy foods. Nutrition and Physical Activity Self-Assessment for Child Care was used to assess food served with 1 (indicating poor practice) to 4 (indicating best practice). Means, standard deviations, and t-tests were conducted to determine differences in scores between FCCHs with and without perceived barriers. Adjusted alpha was 0.013. Results: FCCHs perceiving food waste as a barrier had significantly lower scores for total food and beverage (p = 0.006, 3.2 ± 0.3 vs. 3.4 ± 0.3); fruits and vegetables (p = 0.003, 3.1 ± 0.5 vs. 3.3 ± 0.5), whole fruits (p = 0.048, 3.1 ± 1.2 vs. 3.4 ± 0.9), and nonstarchy vegetables (p = 0.007, 2.8 ± 0.9 vs. 3.2 ± 0.9). Providers perceiving food preferences as a barrier had significantly lower scores compared to those who did not (p = 0.008, 2.9 ± 0.9 vs. 3.3 ± 0.9). No significant differences found in best practices among providers with vs. without perceived barrier of food costs. Conclusion: Food waste is an understudied barrier in FCCHs to serve healthy meals. Research is needed to explore these perceived barriers in FCCHs to improve best practices around meals.

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.

Examining Foods and Beverages Served and Child Food Insecurity across Early Care and Education (ECE) Programs in Communities with High Rates of Obesity and Food Insecurity

ABSTRACT The purpose of this study was to examine implementation of serving food and beverage evidence-based practices (nutrition EBPs) across CACFP participating licensed childcare centers (CCCs, n = 51) and family childcare homes (FCCHs, n = 49) in central California. Results indicated that FCCHs reported significantly higher (p < .05) implementation of nutrition EBPs and barriers than CCCs. Both CCCs and FCCHs refer families to WIC/SNAP when they observe child food insecurity and control how much food is served to children. It is important to consider organizational structure (CCCs, FCCHs) and child food insecurity when developing policies/interventions for improving implementation of nutrition EBPs in ECEs.

Impacts of COVID-19 on the early care and education sector in California: Variations across program types

The COVID-19 crisis has overwhelmed and weakened the United States early care and education (ECE) sector, jeopardizing a system that was already precariously situated atop a weak foundation. While multiple national- and state-level studies have highlighted the overwhelming impacts of the pandemic on the ECE sector, little has been reported about how much variation in impacts exists, and in what forms, within the ECE sector. Based on a statewide survey of 953 licensed care providers in California conducted in June 2020, this paper examines the impact of COVID-19 experienced by ECE providers, focusing on the variations between centers and family child care homes (FCCs) and among center-based programs. Results indicate that the challenges programs face differ greatly depending on program type and funding source. Compared to center-based programs, FCCs fared worse in most measures of economic hardship that directly impact individual providers with medium to large effect sizes. Centers were more likely than FCCs to struggle with reduced attendance and changes in program operations by medium to large effect sizes and report staffing challenges by small to medium effect sizes. Among the center-based programs, subsidized programs holding contracts with Head Start or the California Department of Education (such as state preschool programs) were more stable and better able to financially support their staff during the pandemic, with effect sizes ranging from medium to large. Centers receiving government subsidies in the form of vouchers were more likely to be negatively impacted by the pandemic compared to unsubsidized centers and Head Start and state-contracted centers. Implications for future research and policy are discussed in the context of addressing the complex delivery system of ECE services and supporting outcomes that are effective and equitable for children, families, and the ECE workforce.

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.

Quality of Nutrition Environments, Menus and Foods Served, and Food Program Achievement in Oklahoma Family Child Care Homes.

Child care environments foster children’s healthy eating habits by providing exposure to healthy foods and feeding practices. We assessed the healthfulness of nutrition environments, menu/meal quality, and the achievement of Child and Adult Care Food Program (CACFP) guidelines and best practices in Oklahoma CACFP-enrolled family child care homes (FCCHs) (n = 51). Two-day classroom observations were conducted. Healthfulness of classroom nutrition environments was assessed using the Environment and Policy Assessment and Observation (EPAO). Foods served to and consumed by children were quantified using the Dietary Observations in Child Care (DOCC) tool. Nutrient analysis was performed to determine total energy for foods listed on menus, served to, and consumed by children. Menu and meal food variety and CACFP Guideline Achievement Scores were determined. Average nutrition environment score was 11.7 ± 1.2 (61.5% of maximum possible score). Energy (kcals) from menus and consumed by children was insufficient to meet two-thirds of their daily reference intake. Children were exposed to 1.7 vegetables and 1.3 fruits per meal. CACFP Guideline Achievement Scores were 66.3% ± 7.8 for menus and 59.3% ± 7.6 for mealtimes. Similar to previous research, our findings indicate a need for improved FCCH nutrition practices. Tailored interventions for FCCHs are needed.

Physical Activity and Screen Time Practices of Family Child Care Providers: Do They Meet Best Practice Guidelines?

Background: Child care settings significantly influence children's physical activity (PA) and screen time (ST) behaviors, yet less research has been conducted in family child care homes (FCCHs) than in child care centers. While a few studies have measured family child care providers' (FCCPs') PA practices, none have used observation to assess which specific evidence-based, best practice guidelines FCCPs met or did not meet, and no previous studies have included Latinx providers. This article examines FCCPs' adherence to PA and ST best practice guidelines using primarily observational methods with diverse FCCPs (including Latinx). Methods: We examined baseline data from a cluster randomized trial including surveys and observational data collected at the FCCH to assess whether providers met specific PA and ST best practices from the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) and the American Academy of Pediatrics. Results: Providers completed a telephone survey and participated in two full-day observations (n = 127; 72% Hispanic). Overall, only 4 of 14 PA and ST best practices were met by >50% of providers including: leading a planned PA class more than once a week; no ST during meal or snack; not modeling sedentary behavior; and providing families with information about children's ST. Best practices least likely to be met (<20% of providers) include: providing children with >60 minutes of outdoor play daily; providing children with >45 minutes of adult-led PA each day; participating in outdoor PA with children; participating in indoor PA with children; prompting and praising children for being active; and talking with children informally about the importance of PA. Conclusions: While FCCPs engage in some positive PA and ST practices, many providers do not meet best practice guidelines. There is a need for more research about how to overcome providers' personal and environmental barriers for meeting these guidelines as well as interventions and supports to overcome these barriers. Clinical Trial Registration Number NCT0245645.

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.

Ethnic Differences in Family Childcare Providers' Nutrition- and Activity-Related Attitudes and Barriers.

Objective The aim of the study is to examine family childcare providers' (FCCPs) attitudes and perceived barriers related to nutrition, physical activity (PA), and screen time (ST) behaviors of preschool children, exploring differences by provider ethnicity. Design Baseline survey data from a cluster-randomized trial. Participants. Around 168 FCCPs completed a telephone survey, and 126 completed both telephone and in-person surveys. Main Outcome Measures. Phone and in-person surveys include 44 questions to assess FCCPs attitudes and perceived barriers regarding nutrition, PA, and ST in the family childcare home. Analysis. Associations by ethnicity (Latinx vs. non-Latinx) were assessed by ANOVA, adjusting for provider education and Bonferroni correction. Results Some FCCP attitudes were consistent with national obesity prevention guidelines; for example, most FCCPs agreed that they have an important role in shaping children's eating and PA habits. However, many FCCPs agreed with allowing children to watch educational TV and did not agree that children should serve themselves at meals. Adjusting for education, there were statistically significant differences in attitude and perceived barrier scores by provider ethnicity. For example, Latinx FCCPs were more likely to agree that they should eat the same foods as children(p < .001) but less likely to agree that serving the food at meal and snack time is the adult's responsibility (p < .001). Latinx FCCPs were more like to perceive barriers related to children's safety playing outside (p < .001). Conclusions and Implications. While FCCPs hold some nutrition-, PA-, and ST-related attitudes consistent with national guidelines, training opportunities are needed for FCCPs to improve knowledge and skills and overcome perceived barriers related to nutrition and PA. Latinx FCCPs, in particular, may need culturally tailored training and support to overcome misperceptions and barriers.

A qualitative comparison of parent and childcare provider perceptions of communication and family engagement in children's healthy eating and physical activity

Parents and childcare providers play a substantial role in the development of health behaviours among the children they care for. In order to ensure the optimal growth and development of children, communication and family engagement in childcare is critical. Previous studies examining parent or provider perceptions about healthy eating or physical activity have explored these concepts individually and/or have only included only parents or providers. Therefore, the purpose of this study was to compare childcare provider and parent perceptions of communication regarding healthy eating and physical activity as well as use of best practice strategies on family engagement for these topics. Childcare providers (n = 12) in childcare centres or a family childcare home and a parent (n = 12) of a child they provide care for participated in a semi-structured interview guided by the Social Ecological Model. Interviews were transcribed verbatim and uploaded to NVivo for data analysis. Data were analysed using a directed content analysis. Three trained qualitative researchers developed a codebook and then compared responses between parents and providers. Similarities in provider and parent responses included agreement on healthy eating; influences on child development; parents being the most influential on children's healthy eating; how they identified physical activity opportunities; and the use of family engagement principles. Differences that arose included parents' roles in promoting children's physical activity; challenges for parents in promoting healthy eating and physical activity; and providers' encouragement of physical activity. Importantly, few parents mentioned providers were top influences on their child's healthy eating or physical activity. Providers also mentioned having difficult conversations with parents was challenging. Future efforts are needed to (1) help parents understand the providers' role in the development of their child's health behaviours and (2) strengthen efforts to engage families in healthy behaviours outside of childcare facilities.

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.

Environmental Health-Related Policies and Practices of Oklahoma Licensed Early Care and Education Programs: Implications for Childhood Asthma.

Little is known about the environmental health-related policies and practices of early care and education (ECE) programs that contribute to childhood asthma, particularly in Oklahoma where child asthma rates (9.8%) and rates of uncontrolled asthma among children with asthma (60.0%) surpass national rates (8.1% and 50.3%, respectively). We conducted a cross-sectional survey with directors of Oklahoma-licensed ECE programs to assess policies and practices related to asthma control and to evaluate potential differences between Centers and Family Childcare Homes (FCCHs). Surveyed ECEs (n = 476) included Centers (56.7%), FCCHs (40.6%), and other program types (2.7%). Almost half (47.2%) of directors reported never receiving any asthma training. More Center directors were asthma-trained than FCCH directors (61.0% versus 42.0%, p < 0.0001). Most ECEs used asthma triggers, including bleach (88.5%) and air fresheners (73.6%). Centers were more likely to use bleach daily than were FCCHs (75.6% versus 66.8%, p = 0.04). FCCHs used air fresheners more than did Centers (79.0% versus 61.0%, p < 0.0001). The majority of ECEs (74.8%) used pesticides indoors. Centers applied indoor pesticides more frequently (i.e., monthly or more often) than did FCCHs (86.0% versus 58.0%, p < 0.0001). Policy, educational, and technical assistance interventions are needed to reduce asthma triggers and improve asthma control in Oklahoma ECEs.

Development of an online curriculum for California early care and education providers on healthy beverages

BackgroundChildren’s consumption of sugar-sweetened beverages is associated with obesity, diabetes, and dental decay. California’s Healthy Beverages in Child Care Act (AB 2084) requires all licensed child care centers and family child care homes to comply with healthy beverages standards, however many licensed providers in California are unaware of the law and few are fully compliant with the law’s requirements. The aim of the current project is to describe the development of a self-paced online training on best practices and implementation of AB 2084 in English and Spanish for family child care home and child care center providers; and to evaluate the feasibility, defined as being accessible, acceptable, and satisfactory to providers, of this new online course.MethodsThe project was broken into two main stages: (1) development of the online course; and (2) evaluation of the final online course. The first stage was completed in five phases: (1) identify relevant course content and develop narration script; (2) conduct in-person focus groups with child care providers to review and edit the content; (3) adapt course content and translate for Spanish-speaking providers; (4) build the online course and resources; and (5) pilot online course and evaluate accessibility. The second stage, evaluation of the acceptability and satisfaction of the final course was rated on a Likert scale from 1 to 4; the evaluation was completed as part of a larger randomized control trial with 43 child care providers. The course features four key requirements of AB 2084 as the main sections of the course (milk, sweetened beverages, juice, and water), plus background information about beverages and children’s health, special topics including caring for children with special needs, family engagement, written policies, and child engagement.ResultsThe child care providers who completed the evaluation found the online training was easily understandable (median(Q1,Q3,IQR) = 4 (4,4,0)), included new information (3 (1, 3, 4)), provided useful resources (4(4,4,0)), and was rated with high overall satisfaction (3 (1, 3, 4)).ConclusionOnline training in English and Spanish designed for child care providers is a feasible medium to deliver important health messages to child care providers in an accessible, acceptable, and satisfactory manner.

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.

O17 Associations Between Community Nutrition Environments and Early Care and Education Barriers to Classroom Nutrition Practices

<h3>Background</h3> Early Childhood Education (ECEs) directors and teachers experience substantial barriers to implementing childhood nutrition recommendations. Diet in older children is influenced by nutrition environments surrounding homes and schools; influence of the community environment on ECEs is not understood. <h3>Objective</h3> Determine associations between community nutrition environments and ECE barriers to classroom nutrition practices, by ECE context [Head Starts, community-based childcare (CBCs), and family child care homes (FCCHs)]. <h3>Study Design, Setting, Participants</h3> Cross-sectional study including licensed Oklahoma ECEs. Locations of 457 grocery stores were determined in-person. Locations of participating ECEs and grocery stores were geocoded and analyzed using ArcMap 10.6. <h3>Measurable Outcome/Analysis</h3> ECEs were considered located within a "Food Desert" if no grocery stores were available within a 0.25-mile radius for urban ECEs, or 10-mile radius for rural ECEs. Presence of barriers to serving healthier foods and beverages were reported. Fisher's exact test was used to compare differences in barriers among those within Food Deserts versus Non-Deserts. Benjamini Hochberg calculations for False Discovery Rate were applied (α<0.004). <h3>Results</h3> Fifty-four Head Starts, 159 CBCs, and 160 FCCHs participated with 24%, 27% and 37%- respectively- being located within a Food Desert. ECE descriptive characteristics including food purchasing and meal planning strategies varied by ECE context. Among Head Starts and CBCs, barriers were not different by Food Desert status (<i>P</i> > 0.0004). In FCCHs only, those located within Food Deserts reported a 20% higher prevalence of concern for food waste compared to those within Non-Deserts (<i>P</i> < 0.004). <h3>Conclusion</h3> Food Desert status was related to reported barriers in FCCHs only; therefore, those provider's experiences and perceptions may be most susceptible to influence of the community nutrition environment, compared to other ECE contexts. Findings suggest a need for future research and policy implementation to support FCCHs residing in low-access areas and experiencing difficulty implementing classroom health practices.

Associations between Community Built Environments with Early Care and Education Classroom Physical Activity Practices and Barriers.

The influence of community-built environments on physical activity (PA) support in Early Childhood Education settings (ECEs) is unknown. The purpose of this cross-sectional study was to determine associations between community PA environments and ECE classroom PA practices. We included licensed Oklahoma ECE directors serving 3-to-5-year-old children. Parks and playground locations were exported from Google Earth. National Walkability Index was derived from 2010 US Census data. ArcMap 10.6 was used to geocode ECE locations, which were within an Activity Desert if no parks/playgrounds were located within a 1-mile radius or if Walkability Index was 10.5 or below. Classroom PA practices were determined by using the Nutrition and PA Self-Assessment tool (NAP SACC). Barriers to implementing practices were reported. Most Head Starts (n = 41; 80.3%), center-based childcare settings (CBC; n = 135; 87.0%), and family childcare homes (FCCHs; n = 153; 96.4%) were in an Activity Desert. Parks/playgrounds within a 10-mile buffer were correlated with classroom PA practices in FCCHs only (p < 0.001). Activity Desert status was not related to classroom PA practices for any ECE context (p > 0.029). While FCCHs may be the most vulnerable to lack of park and playground access, overall findings suggest ECEs provide a healthful micro-environment protective of the typical influence of community-built environments.

Self-Paced Online Training on Healthy Beverage Policy for Child Care Providers

ObjectiveDetermine if online training for child care providers increases knowledge and awareness of and adherence to California's Healthy Beverages in Child Care Act (AB2084) policy. DesignCluster, randomized controlled trial with 2 intervention groups and 1 control group. SettingLicensed child care centers and family child care homes. ParticipantsChild care providers in 3 California regions. InterventionThirty-minute, self-paced online training in English or Spanish, with or without 6-months of ongoing technical assistance. Main outcomes measuredProviders’ self-reported knowledge and awareness of and adherence to AB2084 at baseline, after 1 and 6 months. AnalysisGeneralized estimating equations and generalized linear models, adjusted for the percentage of children on child care subsidies and region. ResultsOutcomes were similar between groups receiving and not receiving technical assistance. Providers receiving training (both intervention groups combined) experienced larger increases in knowledge (P = 0.002 and P = 0.003) and awareness (P = 0.004 and P = 0.001) of AB2084 compared with the control group after 1 and 6 months. All groups reported pre-post increases in adherence to AB2084. Conclusions and ImplicationsA brief online training supports increased knowledge and awareness of healthy beverage policy among child care providers. The training is available online and is free for California child care providers.