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Mozaffarian RS, Carter S, Bovenzi MC, Kenney EL. Comparison of foods and beverages served and consumed in Child and Adult Care Food Program-participating childcare centres to national guidelines. Public Health Nutr 2023; 26:1862-1870. [PMID: 37288521 PMCID: PMC10478045 DOI: 10.1017/s136898002300109x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 02/02/2023] [Accepted: 05/22/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The federal Child and Adult Care Food Program (CACFP) sets minimum nutrition and portion size standards for meals served in participating childcare programs. CACFP has been associated with more nutritious meals served. It is unclear, however, whether CACFP results in children's dietary intake being aligned with national recommendations. We assess whether children's dietary intake in CACFP-participating childcare centres meets benchmarks set by the Dietary Guidelines for Americans (DGA). DESIGN This is a cross-sectional study. We used direct observation to estimate quantities of foods/beverages served and consumed per child. Mean amounts served per child per day were compared with CACFP portion size requirements for each component (fruits, vegetables, milk and meat/meat alternate). Mean amounts of foods/beverages consumed were compared with DGA recommendations (energy content, fruits, vegetables, whole/refined grains, dairy, protein and added sugars). One sample t-tests evaluated if quantities served and consumed were different from CACFP and DGA standards, respectively. SETTING Six CACFP-participating childcare centres. PARTICIPANTS 2-5 year-old children attending childcare. RESULTS We observed forty-six children across 166 child meals. Most meals served met CACFP nutrition standards. Compared with CACFP portion size standards, children were served more grains at breakfast and lunch; more fruits/vegetables at lunch but less at breakfast and snack and less dairy at all eating occasions. Compared with DGA recommendations, children under-consumed every food/beverage category except grains during at least one eating occasion. CONCLUSIONS Children were served quantities of foods/beverages mostly consistent with CACFP portion size requirements, but had sub-optimal intake relative to DGA. More research is needed to help children consume healthy diets in childcare.
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Affiliation(s)
- Rebecca S Mozaffarian
- Department of Nutrition, Harvard TH Chan School of Public Health, 665 Huntington Ave, Boston, MA02115, USA
| | - Sonia Carter
- Boston Public Health Commission, Boston, MA02118, USA
| | | | - Erica L Kenney
- Department of Nutrition, Harvard TH Chan School of Public Health, 665 Huntington Ave, Boston, MA02115, USA
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA02115, USA
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Patel D, Sisson SB, Sleet K, Rickman R, Love C, Taniguchi T, Sisk M, Jernigan VBB. Changes in Meal and Menu Quality at Early Care and Education Programs after Training with Food Service Staff: the FRESH Study. Curr Dev Nutr 2023; 7:100040. [PMID: 37181935 PMCID: PMC10111590 DOI: 10.1016/j.cdnut.2023.100040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 02/22/2023] Open
Abstract
Background Prevalence of obesity in Native American (NA) children is disproportionately high, indicating a higher risk of health disparities. Many children attend early care and education (ECE) programs, presenting an opportune environment to improve meal and menu quality as the intake of healthy foods is associated with lowered risk of childhood obesity. Objectives We aimed to examine the effectiveness of food service staff training on meals and menu quality across NA ECEs. Methods Food service staff from 9 participating ECE programs attended a 3-h training focused on Child and Adult Care Food Program (CACFP) best practices, and received a tailored, best-practice menu, and healthy recipes. Meals and menus prepared across 1 wk were examined per CACFP serving size assumptions at baseline, 4 mos, 6 mos, and 12 mos for all 9 programs. Healthy Eating Index (HEI), CACFP requirements and best practices achievement, and food substitutions quality (classified into superior, equivalent, and inferior based on the nutritional quality) were calculated. A repeated measures ANOVA model was used to determine the differences across time points. Results The total meal HEI score increased significantly from baseline to 4 mos (71.1 ± 2.1; 78.6 ± 5.0; P = 0.004), but did not differ from baseline to 12 mos. Menu CACFP requirements and best practices achievement did not differ across time points, although achievement with CACFP requirements was already high at baseline. Superior nutrition quality substitutions declined from baseline to 6 mos (32.4 ± 8.9; 19.5 ± 10.9; P = 0.007); however, it did not differ from baseline to 12 mos. Equivalent and inferior quality substitutions did not differ across time points. Conclusions Implementing a best-practice menu with healthy recipes showed immediate improvements in meal quality. Although the change did not sustain, this study showed evidence of an opportunity to educate and train food service staff. Robust efforts are needed for improving both meals and menus.This trial was registered ClinicalTrials.gov as NCT03251950 (https://clinicaltrials.gov/ct2/show/NCT03251950?cond=food+resource+equity&draw=2&rank=1).
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Affiliation(s)
- Divya Patel
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Susan B. Sisson
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kaysha Sleet
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- University Medical Center, Lubbock, TX, USA
| | - Rachel Rickman
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, USA
| | - Charlotte Love
- School of Health Care Administration, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Tori Taniguchi
- Center for Indigenous Health Research and Policy, Oklahoma State University, Tulsa, OK, USA
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Wang X, Wu L, Liu Q, Wu Y. Dietary Environment in Early Care and Education Settings and Young Children's Eating Behavior: A Systematic Review of Literature. Am J Health Behav 2022; 46:541-557. [PMID: 36333831 DOI: 10.5993/ajhb.46.5.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES An increasing number of young children spend time and eat at least one meal per day in childcare programs, highlighting the significance of early care and education (ECE) settings in promoting children's healthy dietary behaviors. The purpose of this review was to summarize quantitative studies on the relationship between the dietary environment in ECE settings and the eating behaviors of children aged 0-6 years. METHODS We consulted Web of Science, PsycInfo, ProQuest, and Emerald electronic databases, searching for empirical studies from 2000 to 2022. RESULTS Ultimately, we included 38 studies. Measures of the dietary environment varied considerably across studies. Following healthy diet regulations and nutrition-related activities were positively correlated with children's intake of healthy foods. Strategies such as serving fruits and vegetables in advance, serving small portion sizes, and providing children a variety of vegetables increased children's intake of healthy foods. Results on caregivers' feeding practices remained mixed. CONCLUSIONS These findings reveal the necessity and importance of paying attention to different aspects of the dietary environment and to take a comprehensive approach to understanding the role that environment plays in cultivating children's dietary behaviors.
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Affiliation(s)
- Xinghua Wang
- Institute of Early Childhood Education, Faculty of Education, Beijing Normal University, Beijing, China
| | - Lili Wu
- Institute of Early Childhood Education, Faculty of Education, Beijing Normal University, Beijing, China
| | - Qi Liu
- Institute of Early Childhood Education, Faculty of Education, Beijing Normal University, Beijing, China
| | - Yang Wu
- Department of Sociology, School of Humanities, Jiangxi University of Finance and Economics, Nanchang China
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The Nutritional Adequacy and Diet Quality of Vegetarian Menu Substitutions in Urban Kansas Childcare Centers. Nutrients 2022; 14:nu14173464. [PMID: 36079723 PMCID: PMC9458114 DOI: 10.3390/nu14173464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
While plant-based eating has become increasingly popular, little is known of how this trend has impacted childcare center meals. The purpose of this study was to measure the nutrient content and diet quality of vegetarian alternative lunches and compare these measures to those of standard childcare lunches and nutrient benchmarks representing one-third of the Dietary Reference Intake for 3-year-olds and 4–5-year-olds. Menu data were obtained from seven urban Kansas childcare centers participating in the Child and Adult Care Food Program and regularly providing a vegetarian alternative lunch. The centers provided detailed menu information for 27 days’ worth of meals. The most common vegetarian substitution was cheese, which was used to fulfill all or part of the meat/meat alternative requirement in over three-quarters of the vegetarian alternative meals (n = 22). Compared to the standard meals, the vegetarian alternative meals were higher in calories, fat, saturated fat, calcium, and sodium and lower in protein, choline, and diet quality (p = 0.05). Both lunch options met the benchmarks for vitamin A, vitamin D, vitamin B12, calcium, and protein. Iron content for both (95% CI: standard 1.61–2.17 mg; vegetarian 1.37–2.7 mg) was below the benchmark. Although additional research is needed to better understand how vegetarianism has impacted childcare meals in the U.S., important differences in the nutrient contents were observed between the standard and vegetarian alternative meals. In addition, the results suggest vegetarian alternative meals that rely heavily on cheese may be of lower diet quality.
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Kempler JV, Love P, Bolton KA, Rozman M, Spence AC. Exploring the Use of a Web-Based Menu Planning Tool in Childcare Services: Qualitative Cross-sectional Survey Study. JMIR Form Res 2022; 6:e35553. [PMID: 35849438 PMCID: PMC9345012 DOI: 10.2196/35553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/25/2022] Open
Abstract
Background Early childhood is a critical period for supporting the development of healthy eating habits, which may affect lifelong health. Childcare services are important settings for promoting early childhood nutrition; however, food provision in childcare frequently does not align with dietary guidelines. Web-based menu planning tools are well suited to support healthy food provision in childcare, although little is known about their use. Research is needed to understand how web-based menu planning tools are used in the childcare setting and how they can effectively support healthy menu planning and food provision for children in childcare. Objective We aimed to explore the use of a web-based menu planning tool called FoodChecker, which is available to childcare services in Victoria, Australia. We also aimed to gain insights and perspectives from childcare staff involved in menu planning about their use of the tool to plan healthy menus and guide healthy food provision for children. Methods We conducted a qualitative descriptive study using a cross-sectional web-based survey completed by the staff involved in menu planning in childcare services. Thematic analysis was performed using NVivo software. Emergent themes were mapped against constructs of the Technology Acceptance Model regarding perceived usefulness, perceived ease of use, and external variables influencing perceptions and use. Results The participants included 30 cooks and 34 directors from 53 childcare services. Participants perceived the web-based menu planning tool as useful for supporting child nutrition and health, improving organizational processes, and aiding the menu planner role. Perceptions regarding ease of use were mixed. External variables influencing perceptions and use included awareness of the tool, perceived need, time, resources, organizational support, and the food budget. Participants made recommendations to improve the tool, particularly the need to integrate functionality to make it easier and faster to use or to include more links to resources to support healthy menu planning. Conclusions The web-based menu planning tool was perceived as useful for cooks and directors in childcare services. Areas for improvement were identified; for example, the need for integrated digital features to make the tool easier and faster to use. As the first qualitative study to explore childcare staff experiences with a web-based menu planning tool, these findings inform future research and development of such tools to aid scalable and sustainable support for healthier food provision in the childcare sector.
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Affiliation(s)
- Jessica V Kempler
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Penelope Love
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Australia
| | - Kristy A Bolton
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Australia
| | - Margaret Rozman
- Healthy Eating Advisory Service, Nutrition Australia Victorian Division, Docklands, Australia
| | - Alison C Spence
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Australia
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Elford A, Gwee C, Veal M, Jani R, Sambell R, Kashef S, Love P. Identification and Evaluation of Tools Utilised for Measuring Food Provision in Childcare Centres and Primary Schools: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4096. [PMID: 35409781 PMCID: PMC8998327 DOI: 10.3390/ijerph19074096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Children aged 2-11 years spend significant hours per week in early childhood education and care (ECEC) and primary schools. Whilst considered important environments to influence children's food intake, there is heterogeneity in the tools utilised to assess food provision in these settings. This systematic review aimed to identify and evaluate tools used to measure food provision in ECEC and primary schools. METHODS The Preferred Reporting Items for Systematic Reviews (PRISMA) was followed. Publications (2003-2020) that implemented, validated, or developed measurement tools to assess food provision within ECEC or primary schools were included. Two reviewers extracted and evaluated studies, cross checked by a third reviewer and verified by all authors. The Academy of Nutrition and Dietetics Quality Criteria Checklist (QCC) was used to critically appraise each study. RESULTS Eighty-two studies were included in the review. Seven measurement tools were identified, namely, Menu review; Observation; Weighed food protocol; Questionnaire/survey; Digital photography; Quick menu audit; and Web-based menu assessment. An evidence-based evaluation was conducted for each tool. CONCLUSIONS The weighed food protocol was found to be the most popular and accurate measurement tool to assess individual-level intake. Future research is recommended to develop and validate a tool to assess service-level food provision.
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Affiliation(s)
- Audrey Elford
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3216, Australia;
| | - Cherice Gwee
- Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia; (C.G.); (M.V.)
| | - Maliney Veal
- Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia; (C.G.); (M.V.)
| | - Rati Jani
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD 4222, Australia;
| | - Ros Sambell
- School of Medical and Health Sciences, Nutrition and Health Innovation Research Institute, Edith Cowan University, Perth, WA 6027, Australia;
| | - Shabnam Kashef
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia;
| | - Penelope Love
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3216, Australia;
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Rasmussen RA, Sisson SB, Campbell JE, DeGrace B, Baldwin JD. Home food access and children's heart healthy dietary intake at home and child care. Nutr Health 2022:2601060221090695. [PMID: 35350911 PMCID: PMC10434760 DOI: 10.1177/02601060221090695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: About 12 million children under 5 years of age attend early care and education centers (ECEs). Child intake at home can be impacted by food insecurity, which is higher among low income, rural, and racially diverse families. Aim: Determine whether greater access to fruits, vegetables, and snacks at home was associated with heart-healthy diet score at home and at ECEs in preschool-age children, and to determine whether there is a difference in heart-healthy diet score between home and ECEs. Methods: Cross-sectional study involving children (3-to-5-year-old, n = 88) who attended 16 licensed ECEs across Oklahoma. Caregivers completed the Healthy Home Survey and 3-Dinner Dietary recall to report children's home food access and home dinner dietary intake, respectively. Researchers recorded children's ECE lunch consumption using the Dietary Observation for Child Care. Heart-healthy diet score was derived from composite scores for six variables: consumption of fish, fruits, vegetables, sodium, fiber, and sugary drinks. Results: Home access to total fruits and vegetables (16.2 ± 6.3) outnumbered snacks (5.5 ± 3.0). No difference in composite heart-healthy diet score between ECEs (1.50 ± 0.8) and home (1.27 ± 0.9, P = 0.0851). Children within neither environment met recommendations for most variables (vegetables [18-24%], fruit [6-10%], fish [5-10%], fiber [1%], sodium [22-39%]). No relationship between home food access variables and the heart-healthy diet scores at home or ECEs. Conclusion: Dietary intake of children at home and ECEs does not meet heart-healthy diet score recommendations. Interventions should support preschool aged children from families that are located rurally, low-income, racial minorities, and whose primary caregivers work outside the home.
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Affiliation(s)
- Ruth A. Rasmussen
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Susan B. Sisson
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Janis E. Campbell
- University of Oklahoma Health Sciences Center, College of Public Health, Oklahoma City, OK, USA
| | - Beth DeGrace
- University of Oklahoma Health Sciences Center, College of Allied Health, Oklahoma City, OK, USA
| | - Jonathan D. Baldwin
- University of Oklahoma Health Sciences Center, College of Allied Health, Oklahoma City, OK, USA
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Cupertino A, Ginani V, Cupertino AP, Botelho RBA. School Feeding Programs: What Happens Globally? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042265. [PMID: 35206451 PMCID: PMC8871860 DOI: 10.3390/ijerph19042265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 12/04/2022]
Abstract
School feeding programs (SFPs) are an important effort to address food insecurity, improve nutritional education, and ultimately improve health outcomes. The objective of this research was to describe the nutritional, cultural, food safety, and agro-family participation of SFPs in different countries and observe the SFP in low-middle and high-income countries to establish disparities. The study followed documentary research of SFP official online resources complemented by a literature review. The programs were assessed in four criteria: (1) nutritional aspects, (2) cultural aspects, (3) food safety, and (4) agro-family participation. Out of 192 countries registered, 117 countries (60.93%) have an SFP, and only 8 (4.16%) do not have SFPs. A total of 67 countries (34.89%) did not have an official online resource and did not respond to follow-up emails. Out of the 117 countries with SFP, all of them had a detailed description of their nutritional aspects, cultural aspects (11.96%), food safety (16.23%), and agro-family participation (23.93%). Europe and Central Asia were the continents with the most comprehensive SFP. While most countries incorporate nutritional aspects and healthy food, cultural, food safety, and agro-family participation must be incorporated in their SPF to optimize children and adolescent development. Moreover, the study identified disparities across countries where the SFPs were identified in low-middle countries compared to middle- and high-income countries.
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Affiliation(s)
- Alessandra Cupertino
- Department of Nutrition, College of Health Sciences, University of Brasilia, Brasilia 70910-900, Brazil
- Correspondence:
| | - Veronica Ginani
- Master’s Programs Public Health, Department of Nutrition, College of Health Sciences, University of Brasilia, Brasilia 70910-900, Brazil;
| | - Ana Paula Cupertino
- Medical Center Wilmot Cancer, Wilmot Cancer Institute, University of Rochester, Rochester, NY 14627, USA;
| | - Raquel Braz Assunção Botelho
- Master’s Programs Nutrition, Department of Nutrition, College of Health Sciences, University of Brasilia, Brasilia 70910-900, Brazil;
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Barnes C, Yoong SL, Nathan N, Wolfenden L, Wedesweiler T, Kerr J, Ward DS, Grady A. Feasibility of a Web-Based Implementation Intervention to Improve Child Dietary Intake in Early Childhood Education and Care: Pilot Randomized Controlled Trial. J Med Internet Res 2021; 23:e25902. [PMID: 34914617 PMCID: PMC8717135 DOI: 10.2196/25902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/08/2021] [Accepted: 11/05/2021] [Indexed: 01/20/2023] Open
Abstract
Background Internationally, the implementation of evidence-based healthy eating policies and practices within early childhood education and care (ECEC) settings that encourage children’s healthy diet is recommended. Despite the existence of evidence-based healthy eating practices, research indicates that current implementation rates are inadequate. Web-based approaches provide a potentially effective and less costly approach to support ECEC staff with implementing nutrition policies and practices. Objective The broad aim of this pilot randomized controlled trial is to assess the feasibility of assessing the impact of a web-based program together with health promotion officer (HPO) support on ECEC center implementation of healthy eating policies and practices. Specifically, we seek to describe the completion rate of study evaluation processes (participant consent and data collection rates); examine ECEC center uptake, acceptability, and appropriateness of the intervention and implementation strategies; understand the potential cost of delivering and receiving implementation support strategies; and describe the potential impact of the web-based intervention on the implementation of targeted healthy eating practices among centers in the intervention group. Methods A 6-month pilot implementation trial using a cluster-randomized controlled trial design was conducted in 22 ECEC centers within the Hunter New England region of New South Wales, Australia. Potentially eligible centers were distributed a recruitment package and telephoned by the research team to assess eligibility and obtain consent. Centers randomly allocated to the intervention group received access to a web-based program, together with HPO support (eg, educational outreach visit and local technical assistance) to implement 5 healthy eating practices. The web-based program incorporated audit with feedback, development of formal implementation blueprints, and educational materials to facilitate improvement in implementation. The centers allocated to the control group received the usual care. Results Of the 57 centers approached for the study, 22 (47%) provided consent to participate. Data collection components were completed by 100% (22/22) of the centers. High uptake for implementation strategies provided by HPOs (10/11, 91% to 11/11, 100%) and the web-based program (11/11, 100%) was observed. At follow-up, intervention centers had logged on to the program at an average of 5.18 (SD 2.52) times. The web-based program and implementation support strategies were highly acceptable (10/11, 91% to 11/11, 100%). Implementation of 4 healthy eating practices improved in the intervention group, ranging from 19% (2/11) to 64% (7/11). Conclusions This study provides promising pilot data to warrant the conduct of a fully powered implementation trial to assess the impact of the program on ECEC healthy eating practice implementation. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001158156; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378099 International Registered Report Identifier (IRRID) RR2-10.1186/s40814-020-00707-w
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Affiliation(s)
- Courtney Barnes
- Hunter New England Population Health, Newcastle, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
| | - Sze Lin Yoong
- Hunter New England Population Health, Newcastle, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Nicole Nathan
- Hunter New England Population Health, Newcastle, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Newcastle, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
| | | | - Jayde Kerr
- Hunter New England Population Health, Newcastle, Australia
| | - Dianne S Ward
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States.,Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC, United States
| | - Alice Grady
- Hunter New England Population Health, Newcastle, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
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10
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Glenn ME, Patlan K, Connor P, Stidsen C, Ball S, Peterson KE, Olsho LEW, Gola AAH, Copeland KA. Dietary Intakes of Children Enrolled in US Early Child-Care Programs During Child-Care and Non-Child-Care Days. J Acad Nutr Diet 2021; 122:1141-1157.e3. [PMID: 34455104 DOI: 10.1016/j.jand.2021.08.108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/19/2021] [Accepted: 08/22/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Early-child-care (ECE) programs may substantially influence child diet quality. OBJECTIVE The Study of Nutrition and Activity in Child Care Settings describes the usual food group intake of preschool-aged children attending ECE programs relative to Dietary Guidelines for Americans (DGA) recommendations, comparing intakes during child-care and non-child-care days. DESIGN Meal observations and parent-completed food diaries in a cross-sectional nationally representative multistage cluster sample of Child and Adult Care Food Program-participating ECE programs. PARTICIPANTS/SETTING One thousand four hundred sixty-eight children aged 3 to 5 years attending 217 Child and Adult Care Food Program-participating ECE programs (eg, child-care centers and Head Start) during 2017. MAIN OUTCOME MEASURES Daily energy intake, daily US Department of Agriculture Food Pattern Food Group intakes, and percentage of daily intakes meeting 2015-2020 DGA Food Pattern recommendations. STATISTICAL ANALYSES PERFORMED Regression-adjusted usual intakes and percentage of children meeting recommendations were estimated using the National Cancer Institute method. Single-day mean intakes were used to test for statistical differences between child-care and non-child-care days. RESULTS Mean usual energy intake was 1,524 ± 19.3 kcal during child-care days and exceeded the recommended range at 1,702 ± 30.2 kcal during non-child-care days; single-day means indicated significantly lower energy intake on child-care days (P < 0.001). The percent of children meeting DGA recommendations on a child-care day varied by DGA food group: fruits (51.4%), grains (50.1%), dairy (42.5%), vegetables (6.5%), whole grains (4.6%), and protein foods (0.1%). Recommended limits on calories from added sugar and solid fats were met by 28.2% and 14.6% of children, respectively. Compared with mean food group intakes during a single child-care day, non-child-care day intakes were similar for fruits and vegetables, lower for dairy and whole grains, and higher for total grains, protein foods, and calories from added sugars and solid fats. CONCLUSIONS Although there is room to increase nutrient density inside and outside of child care, intakes on child-care days more closely align to DGAs.
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Affiliation(s)
| | | | - Patricia Connor
- Abt Associates, Cambridge, Massachusetts; Independent Child Nutrition Research Consultant, Massachusetts
| | - Chantal Stidsen
- Abt Associates, Cambridge, Massachusetts; Mathematica, Cambridge, Massachusetts
| | - Sarah Ball
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Karen E Peterson
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
| | | | - Alice Ann H Gola
- US Department of Agriculture Food and Nutrition Service, Alexandria, Virginia; Westat, Rockville, Maryland
| | - Kristen A Copeland
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Abobakar L, Engler-Stringer R, Leis A, Vatanparast H. Evaluation of the impact of the Healthy Start/Départ Santé intervention on improving menu planning practices and improving the congruence between planned menus and actual food served in Saskatchewan childcare centres. Prev Med Rep 2021; 23:101403. [PMID: 34136337 PMCID: PMC8181209 DOI: 10.1016/j.pmedr.2021.101403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 05/07/2021] [Accepted: 05/12/2021] [Indexed: 12/04/2022] Open
Abstract
The majority of centres did not comply with the recommended nutrition guidelines. More than 50% of centres listed processed foods in amounts exceeding recommendations. The interventions may effectively improve the accuracy and reliability of menus.
The objective of this study was to evaluate the impact of the Healthy Start/Départ Santé (HS/DS) intervention program on improving menu planning practices and improving the congruence between planned menus and actual food served in licensed childcare centres in Saskatchewan. Overall, 39 licensed childcare centres in the province of Saskatchewan, Canada, were selected through a cluster randomized control trial to evaluate the impact of the HS/DS intervention. The pre and post intervention food menus of these centres were analyzed and compared to the Saskatchewan Childcare Nutrition Guidelines (SCNG). The food and beverages served at lunch were observed and digitally recorded using digital plate-waste measures. The congruence between the planned menus and the actual food served was assessed. Descriptive analyses and non-parametric tests were performed to determine the impact of the intervention. The results of this study indicated that there was no significant difference between the groups regarding the distribution and proportion of centres that adhered to the SCNG. The centres that received the intervention demonstrated significant improvements in adherence to their written menus, with the proportions of match between the items that served and listed (p-value = 0.029), and additional items served (p-value = 0.014). Within each group, intervention and usual practice, there were significant differences in centres that met the foods to limit guideline among the usual practice centres (p-value = 0.035). Findings from this study indicated that the HS/DS intervention had a positive impact on improving the adherence of the participating centres to the centres’ planned menus. HS/DS trial registration number: NCT02375490.
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Affiliation(s)
- Lila Abobakar
- College of Pharmacy and Nutrition, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada
| | - Rachel Engler-Stringer
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada
| | - Anne Leis
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada
| | - Hassan Vatanparast
- College of Pharmacy and Nutrition, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada
- School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada
- Corresponding author at: College of Pharmacy and Nutrition and School of Public Health, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada.
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12
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Dietary Contributors to Food Group Intake in Preschool Children Attending Family Childcare Homes: Differences between Latino and Non-Latino Providers. Nutrients 2020; 12:nu12123686. [PMID: 33260442 PMCID: PMC7761496 DOI: 10.3390/nu12123686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 11/17/2022] Open
Abstract
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.
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13
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Yen CE. Food and nutrient provision in preschools: Comparison of public and private preschools. Nutr Health 2020; 27:9-15. [PMID: 33040682 DOI: 10.1177/0260106020942430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND A balanced diet is important for ensuring health and development in childhood. As preschool is the main place of childcare, the meals that they provide have a critical influence on children's dietary intake. AIM The objectives of this study were to evaluate the nutrition status of preschool meals and to compare the food and nutrient content in public and private preschool meals. METHODS This was a cross-sectional study of 12 randomly sampled, public and private preschools in Taichung City, Taiwan. The background questionnaires, which included the meal budget and provision status of preschool meals, were completed either by the principals or supervisors of the preschools. The food and nutrition levels of preschool meals were assessed by weighing the actual food provided to the preschool children. In addition, preschool menus were collected to evaluate the meals and food served. RESULTS Overall, the mean calcium provision of preschools was lower than half the daily dietary reference intake (DRI), and the mean sodium was higher than half the DRI. The mean energy, carbohydrate, protein, fat, iron and vitamins B1, B2 and C supplied by the public preschools were significantly higher than those in the private preschools. In addition, the whole grains, meat, vegetables, fruits, oil and nuts supplied in public preschools were significantly higher than those found in private preschools. CONCLUSIONS The mean energy and macronutrient provision of public preschools were significantly higher than those found in private preschools. Meal quality and nutrient levels offered in public preschools were generally higher than those found in private preschools.
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Affiliation(s)
- Chin-En Yen
- 63114Chaoyang University of Technology, Taichung
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14
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Hasnin S, Dev DA, Tovar A. Participation in the CACFP Ensures Availability but not Intake of Nutritious Foods at Lunch in Preschool Children in Child-Care Centers. J Acad Nutr Diet 2020; 120:1722-1729.e1. [PMID: 32586746 DOI: 10.1016/j.jand.2020.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 03/12/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The US Department of Agriculture Child and Adult Care Food program (CACFP) recently (October 2017) updated requirements for meal reimbursement and best practice recommendations for serving nutritious meals and beverages, and minimum age-specific serving sizes for five food groups. It is not known whether CACFP-funded child-care centers are meeting the updated meal pattern requirements and best practice recommendations, and whether children are meeting nutrition recommendations based on the current 2015-2020 Dietary Guidelines for Americans (DGA). OBJECTIVE This study assessed whether the recruited CACFP-funded child-care centers in this study were meeting the updated (2017) CACFP requirements regarding foods served for lunch and whether children attending these child-care centers were meeting age- and sex-specific DGA recommendations regarding foods consumed. DESIGN This was a cross-sectional study using the Dietary Observation for Child Care method. PARTICIPANTS AND SETTINGS: Children aged 3 to 5 years (n=108) from 10 classrooms in three CACFP-funded child-care centers in Lincoln, NE, were recruited by convenience sampling during spring 2018. MEASURABLE OUTCOMES Food served and consumed during observed lunches in comparison with updated CACFP requirements and DGA, respectively. STATISTICAL ANALYSIS Adjusted mean amounts of foods served from each food group were compared with age specific minimum CACFP serving size requirements. Adjusted mean amounts of foods consumed from each food group were then compared with age- and sex-specific DGA recommendations. RESULTS The recruited child-care centers were meeting the updated CACFP requirements regarding foods served but showed limited adherence to the best practice recommendations during the observed lunches. However, the overall mean intake for grains, fruits, and vegetables was significantly lower (P<0.01) than DGA recommendations. In addition, approximately 25% of the children did not consume any vegetables during their meal. CONCLUSIONS: Although child-care centers were meeting the updated CACFP requirements by serving the recommended amounts of foods, children were not meeting DGA-recommended intakes. Future studies are needed to explore ways to improve adherence to best practice recommendations to improve children's consumption of healthy foods in child-care centers.
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Eyler AA, Valko CR, Curoe KA, Ramadas R, Chriqui JF. Adherence to Updated Childcare Nutrition Regulations in Colorado, United States. Front Public Health 2020; 8:102. [PMID: 32322568 PMCID: PMC7156549 DOI: 10.3389/fpubh.2020.00102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 03/16/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Preschool years are an important time for shaping healthy eating behaviors. Childcare centers can be a venue for policy change for broad and sustained positive impact on healthy eating environment. The objectives of this study were to assess how self-reported current practices align with updated statewide childcare center licensing regulations in Colorado, US, and to explore correlates of adherence. Methods: Using a post-test only study design, a survey was sent to all full-day, licensed childcare centers in Colorado (N = 1,398) with a valid street or email address. The survey included questions on allowable food and beverages, mealtime practices, and perceptions of the updated regulations. Frequencies were calculated and logistic regression models computed for a composite score of each of these factors. Results: Respondents (N = 344) were mostly center directors, with over 8 years of experience, from urban areas. Compliance was high for most food and beverage criteria (over 90%) and all meal practices. One third participated in the federal Child and Adult Care Food Program (CACFP), and were more likely to comply with the state meal regulations than non-CACFP centers. Conclusion: Although our results show high self-reported compliance, a more thorough study of the policy process would provide comprehensive evidence on effective development, enactment, and implementation of these regulations.
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Affiliation(s)
- Amy A. Eyler
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Cheryl R. Valko
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Katherine A. Curoe
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Ramya Ramadas
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Jamie F. Chriqui
- Division of Health Policy and Administration and Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States
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16
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Dev DA, Garcia AS, Dzewaltowski DA, Sisson S, Franzen-Castle L, Rida Z, Williams NA, Hillburn C, Dinkel D, Srivastava D, Burger C, Hulse E, Behrends D, Frost N. Provider reported implementation of nutrition-related practices in childcare centers and family childcare homes in rural and urban Nebraska. Prev Med Rep 2020; 17:101021. [PMID: 31908908 PMCID: PMC6939097 DOI: 10.1016/j.pmedr.2019.101021] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 11/01/2019] [Accepted: 11/13/2019] [Indexed: 12/13/2022] Open
Abstract
Approximately 15 million children under age 6 are in childcare settings, offering childcare providers an opportunity to influence children's dietary intake. Childcare settings vary in organizational structure - childcare centers (CCCs) vs. family childcare homes (FCCHs) - and in geographical location - urban vs. rural. Research on the nutrition-related best practices across these childcare settings is scarce. The objective of this study is to compare nutrition-related best practices of CCCs and FCCHs that participate in the Child and Adult Care Food Program (CACFP) in rural and urban Nebraska. Nebraska providers (urban n = 591; rural n = 579) reported implementation level, implementation difficulty and barriers to implementing evidence-informed food served and mealtime practices. Chi-square tests comparing CCCs and FCCHs in urban Nebraska and CCCs and FCCHs in rural Nebraska showed sub-optimal implementation for some practices across all groups, including limiting fried meats and high sugar/ high fat foods, using healthier foods or non-food treats for celebrations and serving meals family style. Significant differences (p < .05) between CCCs and FCCHs also emerged, especially with regard to perceived barriers to implementing best practices. For example, CCCs reported not having enough money to cover the cost of meals for providers, lack of control over foods served and storage problems, whereas FCCHs reported lack of time to prepare healthier foods and sit with children during mealtimes. Findings suggest that policy and public health interventions may need to be targeted to address the unique challenges of implementing evidence-informed practices within different organizational structures and geographic locations.
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Affiliation(s)
- Dipti A. Dev
- Department of Child Youth and Family Studies, Louise Pound Hall, University of Nebraska-Lincoln, 512 N 12th St, Lincoln NE, 68588-0366, USA
| | - Aileen S. Garcia
- Department of Child Youth and Family Studies, Louise Pound Hall, University of Nebraska-Lincoln, 512 N 12th St, Lincoln NE, 68588-0366, USA
- Department of Counseling and Human Development, South Dakota State University, Brookings, SD, USA
| | - David A. Dzewaltowski
- Buffett Early Childhood Institute, Department of Health Promotion, University of Nebraska Medical Center, 986075 Nebraska Medical Center, Omaha, NE 68198-4365, USA
| | - Susan Sisson
- Department of Nutritional Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, 1200 N Stonewall, Suite 3057, Oklahoma City, OK 73117-1215, USA
| | - Lisa Franzen-Castle
- Department of Nutrition and Health Sciences, Ruth Leverton Hall, University of Nebraska-Lincoln, 1700 N 35th St, Lincoln, NE 68583-0806, USA
| | - Zainab Rida
- Nebraska Department of Education, 301 Centennial Mall South, P.O. Box 94987, Lincoln, NE 68509-4987, USA
| | - Natalie A. Williams
- Department of Child Youth and Family Studies, Louise Pound Hall, University of Nebraska-Lincoln, 512 N 12th St, Lincoln NE, 68588-0366, USA
| | - Carly Hillburn
- Department of Nutrition and Health Sciences, Ruth Leverton Hall, University of Nebraska-Lincoln, 1700 N 35th St, Lincoln, NE 68583-0806, USA
| | - Danae Dinkel
- School of Health and Kinesiology, H&K Building, University of Nebraska, Omaha, 6001 Dodge Street, Omaha, NE 68182, USA
| | - Deepa Srivastava
- Cooperative Extension, University of California Agriculture & Natural Resources, 4437-B South Laspina Street, Tulare, CA 93274, USA
| | - Christina Burger
- Nebraska Department of Education, 301 Centennial Mall South, P.O. Box 94987, Lincoln, NE 68509-4987, USA
| | - Emily Hulse
- Children’s Hospital & Medical Center, 2021 Transformation Drive, Suite 1250, Lincoln, NE 68508, 402.955.6887, USA
| | - Donnia Behrends
- Department of Nutrition and Health Sciences, Ruth Leverton Hall, University of Nebraska-Lincoln, 1700 N 35th St, Lincoln, NE 68583-0806, USA
| | - Natasha Frost
- Senior Staff Attorney, Public Health Law Center, USA
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17
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Wolfenden L, Barnes C, Jones J, Finch M, Wyse RJ, Kingsland M, Tzelepis F, Grady A, Hodder RK, Booth D, Yoong SL. Strategies to improve the implementation of healthy eating, physical activity and obesity prevention policies, practices or programmes within childcare services. Cochrane Database Syst Rev 2020; 2:CD011779. [PMID: 32036618 PMCID: PMC7008062 DOI: 10.1002/14651858.cd011779.pub3] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite the existence of effective interventions and best-practice guideline recommendations for childcare services to implement evidence-based policies, practices and programmes to promote child healthy eating, physical activity and prevent unhealthy weight gain, many services fail to do so. OBJECTIVES The primary aim of the review was to examine the effectiveness of strategies aimed at improving the implementation of policies, practices or programmes by childcare services that promote child healthy eating, physical activity and/or obesity prevention. The secondary aims of the review were to: 1. Examine the cost or cost-effectiveness of such strategies; 2. Examine any adverse effects of such strategies on childcare services, service staff or children; 3. Examine the effect of such strategies on child diet, physical activity or weight status. 4. Describe the acceptability, adoption, penetration, sustainability and appropriateness of such implementation strategies. SEARCH METHODS We searched the following electronic databases on February 22 2019: Cochrane Central Register of Controlled trials (CENTRAL), MEDLINE, MEDLINE In Process, Embase, PsycINFO, ERIC, CINAHL and SCOPUS for relevant studies. We searched reference lists of included studies, handsearched two international implementation science journals, the World Health Organization International Clinical Trials Registry Platform (www.who.int/ictrp/) and ClinicalTrials.gov (www.clinicaltrials.gov). SELECTION CRITERIA We included any study (randomised or nonrandomised) with a parallel control group that compared any strategy to improve the implementation of a healthy eating, physical activity or obesity prevention policy, practice or programme by staff of centre-based childcare services to no intervention, 'usual' practice or an alternative strategy. Centre-based childcare services included preschools, nurseries, long daycare services and kindergartens catering for children prior to compulsory schooling (typically up to the age of five to six years). DATA COLLECTION AND ANALYSIS Two review authors independently screened study titles and abstracts, extracted study data and assessed risk of bias; we resolved discrepancies via consensus. We performed meta-analysis using a random-effects model where studies with suitable data and homogeneity were identified; otherwise, findings were described narratively. MAIN RESULTS Twenty-one studies, including 16 randomised and five nonrandomised, were included in the review. The studies sought to improve the implementation of policies, practices or programmes targeting healthy eating (six studies), physical activity (three studies) or both healthy eating and physical activity (12 studies). Studies were conducted in the United States (n = 12), Australia (n = 8) and Ireland (n = 1). Collectively, the 21 studies included a total of 1945 childcare services examining a range of implementation strategies including educational materials, educational meetings, audit and feedback, opinion leaders, small incentives or grants, educational outreach visits or academic detailing, reminders and tailored interventions. Most studies (n = 19) examined implementation strategies versus usual practice or minimal support control, and two compared alternative implementation strategies. For implementation outcomes, six studies (one RCT) were judged to be at high risk of bias overall. The review findings suggest that implementation strategies probably improve the implementation of policies, practices or programmes that promote child healthy eating, physical activity and/or obesity prevention in childcare services. Of the 19 studies that compared a strategy to usual practice or minimal support control, 11 studies (nine RCTs) used score-based measures of implementation (e.g. childcare service nutrition environment score). Nine of these studies were included in pooled analysis, which found an improvement in implementation outcomes (SMD 0.49; 95% CI 0.19 to 0.79; participants = 495; moderate-certainty evidence). Ten studies (seven RCTs) used dichotomous measures of implementation (e.g. proportion of childcare services implementing a policy or specific practice), with seven of these included in pooled analysis (OR 1.83; 95% CI 0.81 to 4.11; participants = 391; low-certainty evidence). Findings suggest that such interventions probably lead to little or no difference in child physical activity (four RCTs; moderate-certainty evidence) or weight status (three RCTs; moderate-certainty evidence), and may lead to little or no difference in child diet (two RCTs; low-certainty evidence). None of the studies reported the cost or cost-effectiveness of the intervention. Three studies assessed the adverse effects of the intervention on childcare service staff, children and parents, with all studies suggesting they have little to no difference in adverse effects (e.g. child injury) between groups (three RCTs; low-certainty evidence). Inconsistent quality of the evidence was identified across review outcomes and study designs, ranging from very low to moderate. The primary limitation of the review was the lack of conventional terminology in implementation science, which may have resulted in potentially relevant studies failing to be identified based on the search terms used. AUTHORS' CONCLUSIONS Current research suggests that implementation strategies probably improve the implementation of policies, practices or programmes by childcare services, and may have little or no effect on measures of adverse effects. However such strategies appear to have little to no impact on measures of child diet, physical activity or weight status.
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Affiliation(s)
- Luke Wolfenden
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Courtney Barnes
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Jannah Jones
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Meghan Finch
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Melanie Kingsland
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
| | - Alice Grady
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
| | - Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Debbie Booth
- University of NewcastleAuchmuty LibraryUniversity DriveCallaghanNSWAustralia2308
| | - Sze Lin Yoong
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
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18
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The impact of replacing breakfast grains with meat/meat alternatives: an evaluation of child nutrition policy. Public Health Nutr 2020; 23:1136-1141. [PMID: 32014068 DOI: 10.1017/s136898001900377x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the Child and Adult Care Food Program (CACFP) rule that allows a meat/meat alternative to replace the breakfast grain requirement three times per week. DESIGN A 5-week menu including breakfast, lunch and snack was developed with meat/meat alternative replacing the breakfast grain requirement three times per week. Menu nutrients based on the minimum requirements were compared with reference values representing the Acceptable Macronutrient Distribution Range for fat and a range of reference values representing two-thirds the Dietary Reference Intake for 3-year-olds and 4-5-year-olds. The meal pattern minimum requirements were compared with two-thirds of those recommended by the Dietary Guidelines for Americans (DGA). SETTING Evaluation took place between April and June 2019. PARTICIPANTS Human subjects were not utilized. RESULTS The CACFP minimum grain requirement is well below the DGA reference value (0·5-1·5 v. 3·33 ounce-equivalents). Energy (2208·52 kJ) was below the reference values (3126·83-4362·53 kJ). Protein (34·43 g) was above the reference values (9·87-10·81 g). Carbohydrate (76·65 g), fibre (7·46 g) and vitamin E (1·69 mg) were below their reference values of 86·67 g, 10·46-14·60 g and 4-4·76 mg, respectively. Fat (22·57 %) was below the reference range (25-40 %). CONCLUSIONS The CACFP rule which allows a meat/meat alternative to replace the breakfast grain requirement three times per week may result in meal patterns low in energy, carbohydrate, fat, fibre and vitamin E, while providing an excessive amount of protein.
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Lima do Vale MR, Farmer A, Ball GDC, Gokiert R, Maximova K, Thorlakson J. Implementation of Healthy Eating Interventions in Center-Based Childcare: The Selection, Application, and Reporting of Theories, Models, and Frameworks. Am J Health Promot 2020; 34:402-417. [PMID: 31983219 DOI: 10.1177/0890117119895951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To explore the selection, use, and reporting of theories, models, and frameworks (TMFs) in implementation studies that promoted healthy eating in center-based childcare. DATA SOURCE We searched 11 databases for articles published between January 1990 and October 2018. We also conducted a hand search of studies and consulted subject matter experts. STUDY INCLUSION AND EXCLUSION CRITERIA We included studies in center-based settings for preschoolers that addressed the development, delivery, or evaluation of interventions or implementation strategies related to healthy eating and related subjects and that explicitly used TMF. Exclusion criteria include not peer reviewed or abstracts and not in English, French, German, and Korean. DATA EXTRACTION The first author extracted the data using extraction forms. A second reviewer verified data extraction. DATA SYNTHESIS Direct content analysis and narrative synthesis. RESULTS We identified 8222 references. We retained 38 studies. Study designs included quasi-experimental, randomized controlled trials, surveys, case studies, and others. The criteria used most often for selecting TMFs were description of a change process (n = 12; 23%) or process guidance (n = 8; 15%). Theories, models, and frameworks used targeted different socioecological levels and purposes. The application of TMF constructs (e.g., factors, steps, outcomes) was reported 69% (n = 34) of times. CONCLUSION Reliance on TMFs focused on individual-level, poor TMF selection, and application and reporting for the development of implementation strategies could limit TMF utility.
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Affiliation(s)
| | - Anna Farmer
- Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Geoff D C Ball
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Rebecca Gokiert
- Faculty of Extension, University of Alberta, Edmonton, Alberta, Canada
| | - Katerina Maximova
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jessica Thorlakson
- Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada
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20
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Dinkel D, Dev D, Guo Y, Sedani A, Hulse E, Rida Z, Abel K. Comparison of Urban and Rural Physical Activity and Outdoor Play Environments of Childcare Centers and Family Childcare Homes. FAMILY & COMMUNITY HEALTH 2020; 43:264-275. [PMID: 32658027 DOI: 10.1097/fch.0000000000000267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The purpose of this study was to examine the physical activity environment in childcare programs across type (childcare centers [CCCs] and family childcare homes [FCCHs]) and geographic location (urban and rural) as assessed by physical activity best practices according to the Go Nutrition and Physical Activity Self-assessment in Child Care. Results showed CCCs compared with FCCHs reported higher achievement of best practices. Further, urban childcare programs (CCCs and FCCHs) reported higher achievement of best practices in comparison to rural childcare programs. There is a need to deliver targeted interventions that promote children's physical activity in FCCHs and CCCs in rural areas.
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Affiliation(s)
- Danae Dinkel
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha (Dr Dinkel); Department of Child, Youth, and Family Studies, University of Nebraska, Lincoln (Dr Dev and Ms Guo); Nebraska Department of Health & Human Services, Lincoln (Mss Sedani and Abel); University of Oklahoma Health Sciences Center, Oklahoma City (Ms Sedani); Children's Hospital and Medical Center, Center for the Child & Community, Lincoln, Nebraska (Ms Hulse); Nebraska Department of Education, Lincoln (Dr Rida); and Family Service WIC, Lincoln, Nebraska (Ms Abel)
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21
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Sisson SB, Sleet K, Rickman R, Love C, Bledsoe A, Williams M, Jernigan VBB. Impact of the 2017 Child and Adult Care Food Program Meal Pattern Requirement Change on Menu Quality in Tribal Early Care Environments: The Food Resource Equity and Sustainability for Health Study. Curr Dev Nutr 2020; 4:12-22. [PMID: 32258995 PMCID: PMC7101482 DOI: 10.1093/cdn/nzz094] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/28/2019] [Accepted: 08/06/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Native American (NA) children have a high prevalence of obesity contributing to lifespan health disparities. Dietary intake is important to promote healthy weight gain, growth, and development. In 2017, the USDA enforced changes to the Child and Adult Care Food Program (CACFP). The CACFP provides reimbursement to qualifying Early Care and Education (ECE) programs that serve foods that uphold the program's nutrition requirements. OBJECTIVE This study had the following 2 objectives: 1) Describe a novel index to evaluate ECE menus based on revised CACFP requirements (accounting for food substitutions) and best practices for 3- to-5-y-old children, and 2) analyze CACFP requirement and best practice compliance and nutrient changes in 9 NA ECE programs before and after enforcement of the revised CACFP requirements. METHODS This longitudinal study is within a larger community-based participatory research study. Menus and meals served were evaluated for 1 wk at each of 9 programs before and after enforcement of the revised meal patterns. Nutrient analysis, CACFP requirement and best practice compliance, and substitution quality were evaluated. Differences were determined using a paired t-test or Wilcoxon matched test. This trial was registered at clinicaltrials.gov as NCT03251950. RESULTS Total grams of fiber consumed increased (5.0 ± 1.2 compared with 5.9 ± 0.8 g, P = 0.04) and total grams of sugar consumed decreased (53.8 ± 12.6 compared with 48.4 ± 7.9 g, P = 0.024), although room for further improvement exists. Although total grams of fat remained unchanged, grams of saturated fat significantly increased (7.8 ± 1.4 compared with 10.5 ± 3.4, P = 0.041). Other nutrients remained unchanged. Overall CACFP requirement and best practice compliance scores improved, although this finding was not statistically significant. No significant changes in food quality associated with substitutions occurred. CONCLUSIONS This study provides early evidence to support the beneficial impact of the revised CACFP requirements. Understanding barriers to compliance within rural NA communities would be an important next step in enhancing the health of vulnerable children.
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Affiliation(s)
- Susan B Sisson
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Kaysha Sleet
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Rachel Rickman
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Charlotte Love
- Center for Indigenous Health Research and Policy, Oklahoma State University, Tulsa, OK
| | - Alexandria Bledsoe
- Center for Indigenous Health Research and Policy, Oklahoma State University, Tulsa, OK
| | - Mary Williams
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Tulsa, OK
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Earnesty DS, Hourani M, Kerver JM, Weatherspoon LJ. Dietary Guidelines Are Not Met by In-Home Child Care Providers in Low-Income Areas. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:1150-1158. [PMID: 31492622 DOI: 10.1016/j.jneb.2019.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 08/05/2019] [Accepted: 08/07/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The goals of this study were to describe (1) the dietary quality of foods and beverages served by in-home child care providers in low-income areas in Michigan and (2) the extent to which they align with the Dietary Reference Intakes and food group recommendations. DESIGN Cross-sectional, observational. Food and beverages served were examined using direct diet observation. SETTING Child care provider homes. PARTICIPANTS In-home child care providers (n = 116) from rural and urban Michigan counties (n = 24) were recruited from the Great Start to Quality child care database. MAIN OUTCOME MEASURES Dietary quality (food groups and nutrients) of food and beverages served by 116 providers to 378 children, aged 2-5 years, for 1 lunch and a snack. ANALYSIS Average food group and nutrient scores were compared with Dietary Reference Intakes and food group thresholds using the Wilcoxon rank sum test (significance at <.05). RESULTS Findings indicate overserving of refined grains, protein, carbohydrates, added sugars, and sodium and underserving of whole grains and vegetables. Nutrients exceeding recommendations included vitamins A, C, and D, folate, calcium, zinc, and magnesium, whereas iron and potassium were underserved. CONCLUSIONS AND IMPLICATIONS Tailored efforts are needed to address shortcomings in meeting dietary recommendations among in-home child care providers to enhance child nutrition.
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Affiliation(s)
- Dawn S Earnesty
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI; Michigan State University Extension, Saginaw, MI.
| | - Miya Hourani
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI
| | - Jean M Kerver
- Department of Epidemiology and Biostatistics, Michigan State University, College of Human Medicine, Traverse City Campus, Traverse City, MI
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Souza CAND, Longo-Silva G, Menezes RCE, Araujo ADC, Toloni MHDA, Oliveira MADA. [Nutritional adequacy and food waste in Early Childhood Education Centers]. CIENCIA & SAUDE COLETIVA 2018; 23:4177-4188. [PMID: 30540001 DOI: 10.1590/1413-812320182312.30742016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 02/05/2017] [Indexed: 11/22/2022] Open
Abstract
Analyzing quantitative and qualitative aspects of school meals represents the initial stage to ensure that the National School Food Program (PNAE) is an effective space for the promotion of healthy eating habits and establishing individual rights. The objective of this study was to evaluate the nutritional adequacy of meals served and consumed, as well as quantifying food waste in Child Daycare Centers in Maceió, in the state of Alagoas. All meals served and consumed by 359 children (aged 17 to 63 months) were analyzed by the direct weighing method for three non-consecutive days in all institutions. Food waste was determined by the leftover factor and the nutritional value of meals served and consumed was compared to the PNAE reference values regarding energy, carbohydrates, protein, lipids, vitamins A and C, iron, calcium, zinc, magnesium and fiber. Of the 85 meals/preparations featured on the menu, 58 (68%) revealed a high leftover percentage; in excess of 10%. The meals served and consumed met approximately 50% of the recommended energy and macronutrient values. The difference between the averages of the nutrients offered and consumed was statistically significant (p < 0.05) for fiber, vitamin A, vitamin C, calcium, iron and zinc.
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Affiliation(s)
- Camila Alves Nogueira de Souza
- Faculdade de Nutrição, Universidade Federal de Alagoas. BR 104 Norte Km 97, Tabuleiro do Martins. 57072-900 Maceió AL Brasil.
| | - Giovana Longo-Silva
- Faculdade de Nutrição, Universidade Federal de Alagoas. BR 104 Norte Km 97, Tabuleiro do Martins. 57072-900 Maceió AL Brasil.
| | - Risia Cristina Egito Menezes
- Faculdade de Nutrição, Universidade Federal de Alagoas. BR 104 Norte Km 97, Tabuleiro do Martins. 57072-900 Maceió AL Brasil.
| | - Alyne da Costa Araujo
- Faculdade de Nutrição, Universidade Federal de Alagoas. BR 104 Norte Km 97, Tabuleiro do Martins. 57072-900 Maceió AL Brasil.
| | | | - Maria Alice de Araújo Oliveira
- Faculdade de Nutrição, Universidade Federal de Alagoas. BR 104 Norte Km 97, Tabuleiro do Martins. 57072-900 Maceió AL Brasil.
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Rida Z, Burger C, Dev D, Smith J, Hasnin S. Assessment of Nutrition Knowledge of Childcare Providers Regarding the Implementation of the 2017 CACFP Meal Pattern Update. AMERICAN JOURNAL OF HEALTH EDUCATION 2018. [DOI: 10.1080/19325037.2018.1527734] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Improving the Physical Activity and Outdoor Play Environment of Family Child Care Homes in Nebraska Through Go Nutrition and Physical Activity Self-Assessment for Child Care. J Phys Act Health 2018; 15:730-736. [DOI: 10.1123/jpah.2017-0411] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: The purpose of this study was to determine if the Go Nutrition and Physical Activity Self-Assessment in Child Care (Go NAP SACC) intervention was effective in improving best practices in the areas of infant and child physical activity and outdoor play and learning in family child care homes (FCCHs) in Nebraska. Methods: FCCHs (n = 201) participated in a pre–post evaluation using the Infant and Child Physical Activity and Outdoor Play and Learning assessments from the Go NAP SACC validated measure to assess compliance with best practices. Results: At post, FCCHs demonstrated significant differences in 85% of the Infant and Child Physical Activity items (17 of 20) and 80% of the Outdoor Play and Learning items (12 of 15). Significant differences in best practices between urban and rural FCCH providers were also found. Conclusion: Go NAP SACC appears to be an effective intervention in Nebraska as, after participation in the initiative, providers were improving child care physical activity best practices. Additional research is needed to objectively determine if these changes resulted in objective improvements in children’s physical activity levels. Further, efforts are needed to develop and/or identify geographic-specific resources for continued improvement.
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Erinosho T, Vaughn A, Hales D, Mazzucca S, Gizlice Z, Treadway C, Kelly A, Ward D. The quality of nutrition and physical activity environments of child-care centers across three states in the southern U.S. Prev Med 2018; 113:95-101. [PMID: 29719221 DOI: 10.1016/j.ypmed.2018.04.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 04/16/2018] [Accepted: 04/28/2018] [Indexed: 11/29/2022]
Abstract
This cross-sectional study assessed the quality of nutrition and physical activity environments of child-care centers in three southern states and examined differences by rural versus urban location, participation in the Child and Adult Care Food Program, and Head Start status. The sample included 354 centers that enroll children aged 2-5: 154 centers from Georgia, 103 from Kentucky, and 97 centers from Mississippi. Directors and 1-2 teachers per center completed the Environment and Policy Assessment and Observation Self-Report (EPAO-SR) tool that assesses nutrition and physical activity environments of child-care centers. The EPAO-SR items were scored to capture six nutrition domains and six physical activity domains that were averaged and then summed to create a combined nutrition and physical activity environment score (range = 0-36); higher scores indicated that centers met more best practices, which translated to higher-quality environments. Overall, the centers had an average combined nutrition and physical activity environment score of 20.2 out of 36. The scores did not differ between rural and urban centers (mean = 20.3 versus 20.2, p = 0.98). Centers in the Child and Adult Care Food Program had higher combined nutrition and physical activity environment scores than non-participating centers (mean = 20.6 versus 19.1, p < 0.01). Head Start centers also had higher combined environment scores than non-Head Start centers (mean = 22.3 versus 19.6, p < 0.01). Findings highlight the vital role of federal programs in supporting healthy child-care environments. Providing technical assistance and training to centers that are not enrolled in well-regulated, federally-funded programs might help to enhance the quality of their nutrition and physical activity environments.
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Affiliation(s)
- Temitope Erinosho
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Amber Vaughn
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Derek Hales
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephanie Mazzucca
- Prevention Research Center, Washington University in St. Louis, St. Louis, MO, USA
| | - Ziya Gizlice
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Cayla Treadway
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alexandra Kelly
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dianne Ward
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Finch M, Seward K, Wedesweiler T, Stacey F, Grady A, Jones J, Wolfenden L, Yoong SL. Challenges of Increasing Childcare Center Compliance With Nutrition Guidelines: A Randomized Controlled Trial of an Intervention Providing Training, Written Menu Feedback, and Printed Resources. Am J Health Promot 2018; 33:399-411. [PMID: 30004247 DOI: 10.1177/0890117118786859] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the effectiveness of an intervention including training, provision of written menu feedback, and printed resources on increasing childcare compliance with nutrition guidelines. DESIGN Parallel group randomized controlled trial. SETTING Hunter New England region, New South Wales, Australia. PARTICIPANTS Forty-four childcare centers that prepare and provide food on-site to children while in care. INTERVENTION The intervention was designed using the Theoretical Domains Framework, targeted managers, and cooks and included implementation strategies that addressed identified barriers. MEASURES Outcomes included the proportion of menus providing food servings (per child) compliant with overall nutrition guideline recommendations and each individual food group assessed via menu assessments. Cook knowledge of recommendations, intervention acceptability, adverse events, and barriers were also assessed via questionnaires with cooks and managers. ANALYSIS Logistic regression models, adjusted for baseline values of the outcome. RESULTS At baseline and follow-up, zero centers in the intervention and control groups were compliant with the overall menu guidelines or for the vegetable and meat food groups. Follow-up between-group differences in compliance for discretionary (33.3 vs 5, P = .18), dairy (41.7 vs 15, P = .16), breads and cereals (8.3 vs 10 P = 1.00), and fruit (16.7 vs 10, P = .48) were all nonsignificant. Relative to the control group, intervention centers showed a significantly greater increase in percentage of cooks with correct knowledge for vegetable servings (93.3 vs 36.4, P = .008). CONCLUSION Although the application of the theoretical framework produced a broader understanding of the determinants of menu compliance, due to the complexity of guidelines, limited follow-up support, lower training uptake, and low intervention dose, the intervention was not effective in supporting the practice change required.
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Affiliation(s)
- Meghan Finch
- 1 Hunter New England Population Health, Wallsend, New South Wales, Australia.,2 School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,3 Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,4 Priority Research Center for Health Behaviour, University of Newcastle, Newcastle, New South Wales, Australia
| | - Kirsty Seward
- 2 School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,4 Priority Research Center for Health Behaviour, University of Newcastle, Newcastle, New South Wales, Australia
| | - Taya Wedesweiler
- 1 Hunter New England Population Health, Wallsend, New South Wales, Australia
| | - Fiona Stacey
- 1 Hunter New England Population Health, Wallsend, New South Wales, Australia.,2 School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,3 Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,4 Priority Research Center for Health Behaviour, University of Newcastle, Newcastle, New South Wales, Australia
| | - Alice Grady
- 1 Hunter New England Population Health, Wallsend, New South Wales, Australia.,2 School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,3 Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,4 Priority Research Center for Health Behaviour, University of Newcastle, Newcastle, New South Wales, Australia
| | - Jannah Jones
- 1 Hunter New England Population Health, Wallsend, New South Wales, Australia.,2 School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,3 Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,4 Priority Research Center for Health Behaviour, University of Newcastle, Newcastle, New South Wales, Australia
| | - Luke Wolfenden
- 1 Hunter New England Population Health, Wallsend, New South Wales, Australia.,2 School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,3 Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,4 Priority Research Center for Health Behaviour, University of Newcastle, Newcastle, New South Wales, Australia
| | - Sze Lin Yoong
- 1 Hunter New England Population Health, Wallsend, New South Wales, Australia.,2 School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,3 Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,4 Priority Research Center for Health Behaviour, University of Newcastle, Newcastle, New South Wales, Australia
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Myszkowska-Ryciak J, Harton A. Implementation of Dietary Reference Intake Standards in Preschool Menus in Poland. Nutrients 2018; 10:nu10050592. [PMID: 29748511 PMCID: PMC5986472 DOI: 10.3390/nu10050592] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 12/28/2022] Open
Abstract
Although the nutritional value of preschool menus largely determines the proper nutrition of attending children, their nutrient composition often does not meet the standards. The purpose of the study was to assess the nutritional value of menus served in preschools throughout Poland. We analyzed a sample of 10 daily menus and inventory reports reflecting foods and beverages served in 270 full-board government-sponsored preschools. Nutrient content was calculated per child per day, and compared with 70% of dietary reference intake (DRI) for children aged 1–3 and 4–6. The content of energy, protein, fat, and carbohydrates generally exceeded 70% of DRI. The amount of vitamins was correct, with the exception of vitamin D (100% of daycare centers (DCCs) were below the recommendations); in ≤3% of preschools vitamin E, folate, and niacin were below DRI. Calcium was too low in 63% of preschools for children aged 1–3 years and in 99% for 4–6-year-olds. A shortage of iodine, iron, and potassium (especially for 4–6-year-olds) was observed in a small number of preschools. Our study highlights the need for uniform legal standards of nutrition in childcare centers, based on the current recommendations for the age group.
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Affiliation(s)
- Joanna Myszkowska-Ryciak
- Department of Dietetics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences (WULS), 159C Nowoursynowska Str, 02-776 Warsaw, Poland.
| | - Anna Harton
- Department of Dietetics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences (WULS), 159C Nowoursynowska Str, 02-776 Warsaw, Poland.
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Benjamin-Neelon SE, Vaughn AE, Tovar A, Østbye T, Mazzucca S, Ward DS. The family child care home environment and children's diet quality. Appetite 2018; 126:108-113. [PMID: 29601921 DOI: 10.1016/j.appet.2018.03.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 02/27/2018] [Accepted: 03/26/2018] [Indexed: 12/22/2022]
Abstract
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.
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Affiliation(s)
- Sara E Benjamin-Neelon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Amber E Vaughn
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, NC, USA.
| | - Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI 02881, USA.
| | - Truls Østbye
- Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA.
| | - Stephanie Mazzucca
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, NC, USA; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA.
| | - Dianne S Ward
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, NC, USA; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA.
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Seward K, Finch M, Yoong SL, Wyse R, Jones J, Grady A, Wiggers J, Nathan N, Conte K, Wolfenden L. Factors that influence the implementation of dietary guidelines regarding food provision in centre based childcare services: A systematic review. Prev Med 2017; 105:197-205. [PMID: 28965755 DOI: 10.1016/j.ypmed.2017.09.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 09/20/2017] [Accepted: 09/24/2017] [Indexed: 10/18/2022]
Abstract
Children attending centre based childcare services consume as much as two thirds of their daily dietary requirements while in care. However, such services often fail to provide foods that are consistent with guideline recommendations. Developing strategies to improve childcare service adherence to menu dietary guidelines requires a comprehensive understanding of factors that may impede or promote implementation. The primary aim of this systematic review is to describe factors (barriers and facilitators) that may influence the implementation of menu dietary guidelines regarding food provision in centre-based childcare services and to map these factors to a theoretical framework. Over 7000 citations were identified from all sources. Duplicate abstracts were removed and selection criteria applied. Twelve studies (1994-2015) were included in the review. Dual data extraction was conducted and the reported factors were synthesised using the theoretical domains framework (TDF). Barriers and facilitators identified in qualitative studies were classified into 8 and 10 of the 14 TDF domains. Barriers and facilitators reported in quantitative studies covered 6 and 3 TDF domains respectively. The most common domain of which both barriers and facilitators to the implementation of menu dietary guidelines were identified was 'environmental context and resources'. This is the first study that comprehensively assesses literature to identify factors that influence the implementation of menu dietary guidelines in childcare services utilising a theoretical framework. Findings provide guidance to support researchers and policy makers design strategies to improve menu dietary guideline implementation and, as such have the potential to improve food provision in care.
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Affiliation(s)
- Kirsty Seward
- Hunter New England Population Health, Longworth Avenue, Wallsend, New South Wales 2287, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, New Lambton, New South Wales 2308, Australia.
| | - Meghan Finch
- Hunter New England Population Health, Longworth Avenue, Wallsend, New South Wales 2287, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, New Lambton, New South Wales 2308, Australia.
| | - Sze Lin Yoong
- Hunter New England Population Health, Longworth Avenue, Wallsend, New South Wales 2287, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, New Lambton, New South Wales 2308, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia.
| | - Rebecca Wyse
- Hunter New England Population Health, Longworth Avenue, Wallsend, New South Wales 2287, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, New Lambton, New South Wales 2308, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia.
| | - Jannah Jones
- Hunter New England Population Health, Longworth Avenue, Wallsend, New South Wales 2287, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, New Lambton, New South Wales 2308, Australia.
| | - Alice Grady
- Hunter New England Population Health, Longworth Avenue, Wallsend, New South Wales 2287, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, New Lambton, New South Wales 2308, Australia.
| | - John Wiggers
- Hunter New England Population Health, Longworth Avenue, Wallsend, New South Wales 2287, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, New Lambton, New South Wales 2308, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia.
| | - Nicole Nathan
- Hunter New England Population Health, Longworth Avenue, Wallsend, New South Wales 2287, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, New Lambton, New South Wales 2308, Australia.
| | - Kathleen Conte
- Menzies Centre for Health Policy, The University of Sydney, Camperdown, New South Wales 2006, Australia.
| | - Luke Wolfenden
- Hunter New England Population Health, Longworth Avenue, Wallsend, New South Wales 2287, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, New Lambton, New South Wales 2308, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia.
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Larson N, Ayers Looby A, Frost N, Nanney MS, Story M. What Can Be Learned from Existing Investigations of Weight-Related Practices and Policies with the Potential to Impact Disparities in US Child-Care Settings? A Narrative Review and Call for Surveillance and Evaluation Efforts. J Acad Nutr Diet 2017; 117:1554-1577. [PMID: 28774504 DOI: 10.1016/j.jand.2017.06.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 06/12/2017] [Indexed: 01/30/2023]
Abstract
Child-care settings and the combination of policies and regulations under which they operate may reduce or perpetuate disparities in weight-related health, depending on the environmental supports they provide for healthy eating and activity. The objectives of this review are to summarize research on state and local policies germane to weight-related health equity among young children in the United States and on how federal policies and regulations may provide supports for child-care providers serving families with the most limited resources. In addition, a third objective is to comprehensively review studies of whether there are differences in practices and policies within US child-care facilities according to the location or demographics of providers and children. The review found there is growing evidence addressing disparities in the social and physical child-care environments provided for young children, but scientific gaps are present in the current understanding of how resources should best be allocated and policies designed to promote health equity. Additional research is needed to address limitations of prior studies relating to the measurement of supports for weight-related health; complexities of categorizing socioeconomic position, ethnicity/race, and urban and rural areas; exclusion of legally nonlicensed care settings from most research; and the cross-sectional nature of most study designs. There is a particularly great need for the development of strong surveillance systems to allow for better monitoring and evaluation of state policies that may impact weight-related aspects of child-care environments, implementation at the program level, and needed implementation supports.
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Gerritsen S, Dean B, Morton SMB, Wall CR. Do childcare menus meet nutrition guidelines? Quantity, variety and quality of food provided in New Zealand Early Childhood Education services. Aust N Z J Public Health 2017; 41:345-351. [PMID: 28616873 DOI: 10.1111/1753-6405.12667] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 11/01/2016] [Accepted: 01/01/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To describe food provision and evaluate menus in New Zealand childcare services, determining associations with service characteristics and/or cost of menu. METHODS Licensed services in three regions of New Zealand participated in an online survey, uploading a weekly menu where applicable. Menus were scored for compliance with guidelines on quantity, variety and quality of foods served. Bivariate and multivariate associations between menu score and service characteristics were analysed. RESULTS A total of 257 services participated (30% of 847 services invited). Food was provided daily in 56%, with 34% providing lunch and snacks daily. Of the 57 full menus analysed, only three (5%) met all 10 scoring criteria (mean score of 6.8/10). Higher menu scores were statistically associated with employing a cook, high and low (not medium) neighbourhood deprivation, the Heart Foundation's Healthy Heart Award program; there was no association with food costs. The Healthy Heart Award remained statistically associated with higher menu score after adjustment for other service characteristics. CONCLUSION Most menus did not meet current nutrition guidelines for quantity, variety, and limiting 'sometimes' and 'occasional' foods. Implications for public health: This study provides a baseline for monitoring menu compliance in New Zealand and evidence for nutrition promotion and menu improvement programmes in early education.
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Affiliation(s)
- Sarah Gerritsen
- School of Population Health, University of Auckland, New Zealand
| | - Brianna Dean
- Nutrition Department, University of Auckland, New Zealand
| | - Susan M B Morton
- Centre for Longitudinal Research, University of Auckland, New Zealand
| | - Clare R Wall
- Nutrition Department, University of Auckland, New Zealand
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Seward K, Wolfenden L, Wiggers J, Finch M, Wyse R, Oldmeadow C, Presseau J, Clinton-McHarg T, Yoong SL. Measuring implementation behaviour of menu guidelines in the childcare setting: confirmatory factor analysis of a theoretical domains framework questionnaire (TDFQ). Int J Behav Nutr Phys Act 2017; 14:45. [PMID: 28376892 PMCID: PMC5381057 DOI: 10.1186/s12966-017-0499-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 03/27/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND While there are number of frameworks which focus on supporting the implementation of evidence based approaches, few psychometrically valid measures exist to assess constructs within these frameworks. This study aimed to develop and psychometrically assess a scale measuring each domain of the Theoretical Domains Framework for use in assessing the implementation of dietary guidelines within a non-health care setting (childcare services). METHODS A 75 item 14-domain Theoretical Domains Framework Questionnaire (TDFQ) was developed and administered via telephone interview to 202 centre based childcare service cooks who had a role in planning the service menu. Confirmatory factor analysis (CFA) was undertaken to assess the reliability, discriminant validity and goodness of fit of the 14-domain theoretical domain framework measure. RESULTS For the CFA, five iterative processes of adjustment were undertaken where 14 items were removed, resulting in a final measure consisting of 14 domains and 61 items. For the final measure: the Chi-Square goodness of fit statistic was 3447.19; the Standardized Root Mean Square Residual (SRMR) was 0.070; the Root Mean Square Error of Approximation (RMSEA) was 0.072; and the Comparative Fit Index (CFI) had a value of 0.78. CONCLUSIONS While only one of the three indices support goodness of fit of the measurement model tested, a 14-domain model with 61 items showed good discriminant validity and internally consistent items. Future research should aim to assess the psychometric properties of the developed TDFQ in other community-based settings.
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Affiliation(s)
- Kirsty Seward
- Hunter New England Population Health, Wallsend, NSW 2287 Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308 Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Wallsend, NSW 2287 Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Newcastle, NSW 2300 Australia
| | - John Wiggers
- Hunter New England Population Health, Wallsend, NSW 2287 Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Newcastle, NSW 2300 Australia
| | - Meghan Finch
- Hunter New England Population Health, Wallsend, NSW 2287 Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308 Australia
| | - Rebecca Wyse
- Hunter New England Population Health, Wallsend, NSW 2287 Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Newcastle, NSW 2300 Australia
| | - Christopher Oldmeadow
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308 Australia
| | - Justin Presseau
- Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6 Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON K1H 8L6 Canada
| | - Tara Clinton-McHarg
- Hunter New England Population Health, Wallsend, NSW 2287 Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Newcastle, NSW 2300 Australia
| | - Sze Lin Yoong
- Hunter New England Population Health, Wallsend, NSW 2287 Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Newcastle, NSW 2300 Australia
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Benjamin Neelon SE, Østbye T, Bennett GG, Kravitz RM, Clancy SM, Stroo M, Iversen E, Hoyo C. Cohort profile for the Nurture Observational Study examining associations of multiple caregivers on infant growth in the Southeastern USA. BMJ Open 2017; 7:e013939. [PMID: 28179416 PMCID: PMC5306520 DOI: 10.1136/bmjopen-2016-013939] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Childcare has been associated with obesity in children in cross-sectional and longitudinal studies, although some observed no association. Few studies have focused on care during infancy, a period when children may be especially vulnerable. PARTICIPANTS The Nurture Study is an observational birth cohort designed to assess longitudinal associations of childcare and the presence of multiple caregivers on infant adiposity and weight trajectories throughout the first year of life. We examine as potential mediators feeding, physical activity, sleep and stress. We completed recruitment in 2015. Of the 860 women who enrolled during pregnancy, 799 delivered a single live infant who met our inclusion criteria. Of those, 666 mothers (77.4%) agreed to participate in the study for themselves and their infants. FINDINGS TO DATE Among the 666 women in the study, 472 (71%) identified as black, 127 (19%) as white, 7 (1%) as Asian or Asian American, 6 (1%) as Native American and 49 (7%) as other race or more than one race; 43 (7%) identified as Hispanic/Latina. Just under half (48%) had a high school diploma or less, 61% had household incomes <$20 000/year and 59% were married or living with a partner. The mean (SD) infant gestational age was 41.28 weeks (2.29) and birth weight for gestational age z-score was -0.31 (0.93). Just under half (49%) of infants were females, 69% received some human milk and 40% were exclusively breast fed at hospital discharge. Data collection began in 2013, is currently underway, and is scheduled to conclude in late 2016. FUTURE PLANS Results will help assess the magnitude of associations between childcare in infancy and subsequent obesity. Findings will also inform intervention and policy efforts to improve childcare environments and help prevent obesity in settings where many infants spend time. TRIAL REGISTRATION NUMBER Clinicaltrials.gov, NCT01788644.
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Affiliation(s)
- Sara E Benjamin Neelon
- Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, Maryland, USA
| | - Truls Østbye
- Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Gary G Bennett
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
| | - Richard M Kravitz
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Shayna M Clancy
- Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Marissa Stroo
- Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Edwin Iversen
- Department of Statistical Science, Duke University, Durham, North Carolina, USA
| | - Cathrine Hoyo
- Department of Biological Sciences, North Carolina State University, Raleigh, North Carolina, USA
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Romo-Palafox MJ, Ranjit N, Sweitzer SJ, Roberts-Gray C, Byrd-Williams CE, Briley ME, Hoelscher DM. Adequacy of Parent-Packed Lunches and Preschooler's Consumption Compared to Dietary Reference Intake Recommendations. J Am Coll Nutr 2017; 36:169-176. [DOI: 10.1080/07315724.2016.1240634] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Maria Jose Romo-Palafox
- Michael & Susan Dell Center for Health Living, University of Texas Health Science Center, School of Public Health, Austin Regional Campus, Austin, Texas
| | - Nalini Ranjit
- Department of Health Promotion/Behavioral Sciences Austin, Texas
| | - Sara J. Sweitzer
- Nutritional Sciences, School of Human Ecology, The University of Texas at Austin, Austin, Texas
| | | | | | - Margaret E. Briley
- Nutritional Sciences, School of Human Ecology, The University of Texas at Austin, Austin, Texas
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Merkiel S, Chalcarz W. Preschool diets in children from Piła, Poland, require urgent intervention as implied by high risk of nutrient inadequacies. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2016; 35:11. [PMID: 27093922 PMCID: PMC5025991 DOI: 10.1186/s41043-016-0050-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 04/12/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Among the studies published after the year 2000 which focused on nutrition at preschool, only three aimed to assess children's intake of energy and selected nutrients at preschool. The purpose of this study was to assess dietary intake in children during their stay at preschool. METHODS The studied population comprised 128 4-6-year-old children who attended preschools in Piła, Poland. Intakes of energy and macronutrients were estimated from a 5-day weighed food record completed by the preschool staff. Weight and height were measured, and BMI was calculated. Statistical analysis was carried out using the IBM SPSS Statistics 21.0 computer programme. The data were analysed according to gender. RESULTS Energy intake was the lowest in children with underweight, 2004 kJ (478 kcal), and the highest in obese children, 3388 kJ (809 kcal). Energy intake from lactose was statistically significantly higher in boys than in girls, 3.0 vs 2.6 %. Statistically significantly higher percentage of boys in comparison to girls had intakes of vitamin C below 70 % of EAR, 56.9 vs 38.1 %. It is important to highlight the excessive intake of energy from saturated fatty acids and energy from sucrose, along with inadequate intake of energy from polyunsaturated fatty acids. We also found excessive intake of sodium and inadequate intakes of dietary fibre, water, vitamin D, vitamin E, folate, niacin, calcium and potassium. CONCLUSIONS Preschool diets need urgent improvement to prevent diet-related diseases in the studied preschoolers in the future. The inadequacies observed in these diets are in accordance with the previously reported inadequacies in menus planned for preschoolers. More research is needed to investigate dietary intake of children during their stay at preschool. Common regulations worked out for all preschools in the European Union would be a good way to provide adequate nutrition to preschool children.
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Affiliation(s)
- Sylwia Merkiel
- Food and Nutrition Department, The Eugeniusz Piasecki University School of Physical Education in Poznan, Królowej Jadwigi 27/39 Street, 61-871 Poznan, Poland
| | - Wojciech Chalcarz
- Food and Nutrition Department, The Eugeniusz Piasecki University School of Physical Education in Poznan, Królowej Jadwigi 27/39 Street, 61-871 Poznan, Poland
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Vossenaar M, Hernández L, Montenegro-Bethancourt G, Soto-Méndez MJ, Bermudez OI, Solomons NW. The Nutritional Contribution of Foods and Beverages Provided by Government-Sponsored Day Care Centers in Guatemala. Food Nutr Bull 2015; 36:299-314. [PMID: 26385951 DOI: 10.1177/0379572115596634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Meals served at government-run day care centers must be nutritionally adequate to ensure good health and proper development of preschool-aged children. They can provide a controlled opportunity to complement the daily diet of children in vulnerable populations. OBJECTIVE To determine the nutrient adequacy and leading food sources of nutrients provided by the diet served in government-sponsored day care centers. METHODS Estimated daily energy and nutrient intakes of a theoretical 40-day day care center menu were calculated, and the nutrient adequacy was assessed. Nutrient densities and critical nutrient densities of the menu were computed to identify nutrient inadequacies. Furthermore, main sources of nutrients were identified, and energy and nutrient distributions were examined by meal time. RESULTS The menu provides approximately 90% of daily energy requirement and more than 100% of Recommended Nutrient Intakes (RNIs), with the exception of vitamin D and calcium. Sugar was the first leading source of energy, whereas milk was the first leading contributor of vitamin D. CONCLUSION Within an environment of budgetary constraints, the Guatemalan government developed and advocated an exemplary menu offering for children in the vulnerable preschool period. We have demonstrated that, if prepared and served as planned, the items from the official, standard menu would supply most of the nutrients needed. High vitamin A intake related to the mandated national fortification program is a potential problem. From the analysis, it was found that vitamin D emerges as the most prominent candidate for a problem nutrient of deficient intake.
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Affiliation(s)
- Marieke Vossenaar
- Center for Studies of Sensory Impairment, Aging and Metabolism, Guatemala City, Guatemala
| | - Liza Hernández
- Center for Studies of Sensory Impairment, Aging and Metabolism, Guatemala City, Guatemala
| | | | - María José Soto-Méndez
- Center for Studies of Sensory Impairment, Aging and Metabolism, Guatemala City, Guatemala
| | - Odilia I Bermudez
- Center for Studies of Sensory Impairment, Aging and Metabolism, Guatemala City, Guatemala Tufts University School of Medicine, Boston, MA, USA
| | - Noel W Solomons
- Center for Studies of Sensory Impairment, Aging and Metabolism, Guatemala City, Guatemala
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Macronutrient and micronutrient intakes of children in Oklahoma child-care centres, USA. Public Health Nutr 2015; 19:1498-505. [PMID: 26278280 DOI: 10.1017/s1368980015002372] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine macronutrients and micronutrients in foods served to and consumed by children at child-care centres in Oklahoma, USA and compare them with Dietary Reference Intakes (DRI). DESIGN Observed lunch nutrients compared with one-third of the age-based DRI (for 1-3 years-olds and 4-8-year-olds). Settings Oklahoma child-care centres (n 25), USA. SUBJECTS Children aged 3-5 years (n 415). RESULTS Regarding macronutrients, children were served 1782 (sd 686) kJ (426 (sd 164) kcal), 22·0 (sd 9·0) g protein, 51·5 (sd 20·4) g carbohydrate and 30·7 (sd 8·7) % total fat; they consumed 1305 (sd 669) kJ (312 (sd 160 kcal), 16·0 (sd 9·1) g protein, 37·6 (sd 18·5) g carbohydrate and 28·9 (sd 10·6) % total fat. For both age-based DRI: served energy (22-33 % of children), protein and carbohydrate exceeded; consumed energy (7-13 % of children) and protein exceeded, while carbohydrate was inadequate. Regarding micronutrients, for both age-based DRI: served Mg (65·9 (sd 24·7) mg), Zn (3·8 (sd 11·8) mg), vitamin A (249·9 (sd 228·3) μg) and folate (71·9 (sd 40·1) µg) exceeded; vitamin E (1·4 (sd 2·1) mg) was inadequate; served Fe (2·8 (sd 1·8) mg) exceeded only in 1-3-year-olds. Consumed folate (48·3 (sd 38·4) µg) met; Ca (259·4 (sd 146·2) mg) and Zn (2·3 (sd 3·0) mg) exceeded for 1-3-year-olds, but were inadequate for 4-8-year-olds. For both age-based DRI: consumed Fe (1·9 (sd 1·2) mg) and vitamin E (1·0 (sd 1·7) mg) were inadequate; Mg (47·2 (sd 21·8) mg) and vitamin A (155·0 (sd 126·5) µg) exceeded. CONCLUSIONS Lunch at child-care centres was twice the age-based DRI for consumed protein, while energy and carbohydrate were inadequate. Areas of improvement for micronutrients pertain to Fe and vitamin E for all children; Ca, Zn, vitamin E and folate for older pre-schoolers. Adequate nutrients are essential for development and the study reveals where public health nutrition experts, policy makers and care providers should focus to improve the nutrient density of foods.
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Larson N, Story M. Barriers to Equity in Nutritional Health for U.S. Children and Adolescents: A Review of the Literature. Curr Nutr Rep 2015. [DOI: 10.1007/s13668-014-0116-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Frndak SE. An ecological study of food desert prevalence and 4th grade academic achievement in new york state school districts. J Public Health Res 2014; 3:319. [PMID: 25553313 PMCID: PMC4274497 DOI: 10.4081/jphr.2014.319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 11/24/2014] [Indexed: 12/01/2022] Open
Abstract
Background This ecological study examines the relationship between food desert prevalence and academic achievement at the school district level. Design and methods Sample included 232 suburban and urban school districts in New York State. Multiple open-source databases were merged to obtain: 4th grade science, English and math scores, school district demographic composition (NYS Report Card), regional socioeconomic indicators (American Community Survey), school district quality (US Common Core of Data), and food desert data (USDA Food Desert Atlas). Multiple regression models assessed the percentage of variation in achievement scores explained by food desert variables, after controlling for additional predictors. Results The proportion of individuals living in food deserts significantly explained 4th grade achievement scores, after accounting for additional predictors. School districts with higher proportions of individuals living in food desert regions demonstrated lower 4th grade achievement across science, English and math. Conclusions Food deserts appear to be related to academic achievement at the school district level among urban and suburban regions. Further research is needed to better understand how food access is associated with academic achievement at the individual level. Significance for public health The prevalence of food deserts in the United States is of national concern. As poor nutrition in United States children continues to spark debate, food deserts are being evaluated as potential sources of low fruit and vegetable intake and high obesity rates. Cognitive development and IQ have been linked to nutrition patterns, suggesting that children in food desert regions may have a disadvantage academically. This research evaluates if an ecological relationship between food desert prevalence and academic achievement at the school district level can be demonstrated. Results suggest that food desert prevalence may relate to poor academic performance at the school district level. Significant variation in academic achievement among urban and suburban school districts is explained by food desert prevalence, above additional predictors. This research lays the groundwork for future studies at the individual level, with possible implications for community interventions in school districts containing food desert regions.
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Affiliation(s)
- Seth E Frndak
- Graduate School of Education, University at Buffalo-State, University of New York Buffalo , NY, USA
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