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American Journal of Public Health Dec 2023
Topics: Child; Adult; Humans; Child Care; Food; Child Day Care Centers; Nutrition Policy; Child Nutritional Physiological Phenomena
PubMed: 38118100
DOI: 10.2105/AJPH.2023.307497 -
American Journal of Public Health Dec 2023
Topics: Child; Adult; Humans; Child Day Care Centers; Food; Child Care
PubMed: 38118090
DOI: 10.2105/AJPH.2023.307516 -
Journal of Nutrition Education and... Jul 2023To 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...
OBJECTIVE
To 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.
DESIGN
Cross-sectional analysis.
PARTICIPANTS
Family 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 MEASURES
Data 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.
ANALYSIS
Multilevel 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.
RESULTS
Children 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 IMPLICATIONS
Future 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.
Topics: Humans; Female; Child; Male; Child Care; Child Day Care Centers; Cross-Sectional Studies; Diet; Nutritional Status
PubMed: 37245146
DOI: 10.1016/j.jneb.2023.03.005 -
Developmental Medicine and Child... Mar 2012
Topics: Child; Child Care; Children with Disabilities; Family Health; Humans
PubMed: 22324640
DOI: 10.1111/j.1469-8749.2012.04220.x -
Appetite Jul 2018Developing healthy eating behaviors and food preferences in early childhood may help establish future healthy diets. Large numbers of children spend time in child care,...
BACKGROUND
Developing 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.
METHODS
We 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.
RESULTS
Family 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.
CONCLUSIONS
Foods 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.
Topics: Child Care; Child Day Care Centers; Child, Preschool; Diet, Healthy; Feeding Behavior; Female; Food Preferences; Humans; Infant; Male; Multivariate Analysis; North Carolina; Nutrition Policy; Nutrition Surveys; Nutritive Value
PubMed: 29601921
DOI: 10.1016/j.appet.2018.03.024 -
Maternal and Child Health Journal Jun 2023To use scoping review methods to construct a conceptual framework based on current evidence of group well-child care to guide future practice and research. (Review)
Review
OBJECTIVE
To use scoping review methods to construct a conceptual framework based on current evidence of group well-child care to guide future practice and research.
METHODS
We conducted a scoping review using Arksey and O'Malley's (2005) six stages. We used constructs from the Consolidated Framework for Implementation Research and the quadruple aim of health care improvement to guide the construction of the conceptual framework.
RESULTS
The resulting conceptual framework is a synthesis of the key concepts of group well-child care, beginning with a call for a system redesign of well-child care to improve outcomes while acknowledging the theoretical antecedents structuring the rationale that supports the model. Inputs of group well-child care include health systems contexts; administration/logistics; clinical setting; group care clinic team; community/patient population; and curriculum development and training. The core components of group well-child care included structure (e.g., group size, facilitators), content (e.g., health assessments, service linkages). and process (e.g., interactive learning and community building). We found clinical outcomes in all four dimensions of the quadruple aim of healthcare.
CONCLUSION
Our conceptual framework can guide model implementation and identifies several outcomes that can be used to harmonize model evaluation and research. Future research and practice can use the conceptual framework as a tool to standardize model implementation and evaluation and generate evidence to inform future healthcare policy and practice.
Topics: Humans; Child; Child Care; Delivery of Health Care; Child Health
PubMed: 37014564
DOI: 10.1007/s10995-023-03641-4 -
PloS One 2018Our knowledge of the role of parental and child-care staff behavior in the development and prevention of obesity is rapidly increasing. Potential interaction between...
BACKGROUND
Our knowledge of the role of parental and child-care staff behavior in the development and prevention of obesity is rapidly increasing. Potential interaction between both settings in so-called meso-systems, as hypothesized by the ecological systems perspective, is however often ignored. Specifically, inconsistency between home and child-care is hypothesized to have negative effects on child outcomes.
METHODS
Participants were recruited through 23 child-care centers in the Netherlands. Data regarding 161 child-parent-child-care staff triads were available. Parenting and child care practices were assessed using validated questionnaires for parents (Child Feeding Practices Questionnaire, Preschooler Physical Activity Parenting Practices instrument) and child-care staff (Child-care Food and Activity Practices Questionnaire), using similar items in both settings. Absolute difference scores between parents and child-care staff were calculated for each triad as a measure of meso-system consistency. Child outcomes were physical activity (as assessed by accelerometry), dietary intake (from the parental questionnaire), and measured BMI z-scores. Paired t-tests were used to examine consistency between practices in both settings. Linear regression analyses were used to explore the association of parenting practices, child-care practices and difference scores on the one hand, and child outcomes on the other.
RESULTS
Significant differences between settings were found for almost all practices, and in most cases child-care staff scores more favorable on the practices than parents. Inconsistencies were mostly associated with unhealthy dietary intake and lower physical activity levels, but not with BMI.
CONCLUSION
The current study showed that inconsistencies in parenting and child-care practices exist, and that these inconsistencies seem to be associated with unhealthy behavior in children. The results underline the importance of studying meso-system influences on behavior in general, and children's energy balance-related behavior specifically.
Topics: Child; Child Behavior; Child Care; Child, Preschool; Female; Humans; Male; Parenting
PubMed: 30192864
DOI: 10.1371/journal.pone.0203689 -
Progress in Community Health... 2023Regular consumption of produce is a challenge for families with young children in low food access areas.
BACKGROUND
Regular consumption of produce is a challenge for families with young children in low food access areas.
OBJECTIVE
A community partnership formed to evaluate feasibility of and interest in a child care center-based program for produce delivery from an online grocery vendor.
METHODS
Surveys were collected from caregivers across three child care centers, including produce program participants. Descriptive statistics summarize household characteristics and participants' experience with the program.
RESULTS
Challenges related to online payment and difficulty planning delivery times led to implementation of a modified intervention. Survey results revealed factors related to food access and storage that may impact interest and feasibility of online grocery in some communities.
CONCLUSIONS
Online grocery vendors may increase accessibility to fresh produce for families, but barriers to their use still exist. Trusted community partners such as child care centers may offer some of the resources needed for success.
Topics: Humans; Child; Child, Preschool; Child Care; Community-Based Participatory Research; Child Day Care Centers; Food; Trust
PubMed: 38286779
DOI: No ID Found -
Academic Pediatrics 2021Racism and poverty are intertwined throughout American society as a result of historic and current systemic oppression based on class and race. As the processes of...
Racism and poverty are intertwined throughout American society as a result of historic and current systemic oppression based on class and race. As the processes of pediatric preventive care, or well-child care, have evolved to better acknowledge and address health disparities due to racism and poverty, the structures of care have remained mostly stagnant. To cultivate long-term health and wellness of Black and Brown children, we must adopt an explicitly antiracist structure for well-child care. The pediatric medical home model is touted as the gold standard for addressing a host of health, developmental, and social needs for children and their families. However, the medical home model has not resulted in more equitable care for Black and Brown families living in poverty; there are ample data to demonstrate that these families often do not receive care that aligns with the principles of the medical home. This inequity may be most salient in the context of well-child care, as our preventive care services in pediatrics have the potential to impact population health. To appropriately address the vast array of preventive care needs of families living at the intersection of racism and poverty, a structural redesign of preventive care in the pediatric medical home is needed. In this paper, we propose a re-imagined framework for the structure of well-child care, with a focus on care for children in families living at the intersection of racism and poverty. This framework includes a team-based approach to care in which families build trusting primary care relationships with providers, as well as nonclinical members of a care team who have shared lived experiences with the community being served, and relies on primary care connections with community organizations that support the preventive health, social health, and emotional health needs of families of young children. Without a structural redesign of preventive care in the pediatric medical home, stand-alone revisions or expansions to processes of care cannot appropriately address the effects of racism and poverty on child preventive health outcomes.
Topics: Child; Child Care; Child Health Services; Child, Preschool; Family; Humans; Poverty; Racism; United States
PubMed: 34740416
DOI: 10.1016/j.acap.2021.08.004 -
Journal of the Academy of Nutrition and... Aug 2023Some evidence suggests that children may have higher quality dietary intake in early care and education settings, compared with their respective homes, but no studies...
BACKGROUND
Some evidence suggests that children may have higher quality dietary intake in early care and education settings, compared with their respective homes, but no studies have explored these differences among children in less formal family child care.
OBJECTIVE
The purpose of this study was to compare dietary quality via the Healthy Eating Index 2015 among children in family child care and in their own home.
DESIGN
This was a cross-sectional analysis of baseline dietary intake data from the Childcare Home Eating and Exercise Research study, a natural experiment, using directly observed dietary data in child care and 24-hour recall data in homes among children in South Carolina.
PARTICIPANTS/SETTING
Participants were 123 children in 52 family child-care homes between 2018 and 2019.
MAIN OUTCOME MEASURE
The main outcome was total and component Healthy Eating Index 2015 scores.
STATISTICAL ANALYSIS
The analysis was a hierarchical linear regression of children nested within family child care homes adjusting for child, provider, facility, and parent characteristics, including sex, age, race, ethnicity, and income, with parameters and SEs estimated via bootstrap sampling.
RESULTS
Children had a mean ± SD Healthy Eating Index 2015 score of 60.3 ± 12.1 in family child-care homes and 54.3 ± 12.9 in their own home (P < 0.001). In adjusted analysis and after accounting for clustering of children in family child care homes, total HEI-2015 scores were lower at home than in care (β = -5.18 ± 1.47; 95% CI -8.05 to -2.30; P = 0.003).
CONCLUSIONS
Children had healthier dietary intake in family child-care homes vs their respective homes.
Topics: Humans; Child; Child, Preschool; Child Care; Cross-Sectional Studies; Diet; Child Health; Cluster Analysis
PubMed: 37479379
DOI: 10.1016/j.jand.2022.10.014