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Searle B, Staton S, Littlewood R, Thorpe K. Mealtimes in the context of poverty: Comparison of ECEC services providing food and those requiring food provided from home. Child Care Health Dev 2023; 49:995-1005. [PMID: 36843189 DOI: 10.1111/cch.13109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/10/2023] [Accepted: 02/17/2023] [Indexed: 02/28/2023]
Abstract
BACKGROUND In developed economies, most children attend Early Childhood Education and Care (ECEC) services before school entry, many from early life and across long days. For this reason, ECEC services present significant potential to provide food environments that positively influence eating behaviours and food preferences with attendant effect on life course trajectories of health and wellbeing. Yet there is evidence that feeding practices that limit optimal ongoing nutrition, such as pressure and restriction, are amplified in ECEC services serving disadvantaged communities. We sought to identify underlying explanatory mechanisms through observation of children's feeding experiences and educator explanations comparing, family-provided and service-provided meals. METHOD This study used qualitative analyses of educator interviews and observation records from 55 mealtimes in 10 ECEC services: 5 providing food and 5 requiring family food provision. RESULTS High levels of concern drove educator's controlling feeding practices at mealtimes but presented differently across meal provision modes. In centres that provided food, educators' concern focused on food variety, manifesting in pressure to 'try' foods. In centres requiring family-provided food, concern focused on nutrition quantity and quality and manifested as control of order of food consumption and pacing of intake to ensure food lasted across the day. Interview data suggested that conflict aversion limited optimal nutrition. In centres providing food, this was seen in menus that prioritized child food preferences. In centres requiring family meal provision, conflict aversion was seen as reticence to discuss lunchbox contents with families. CONCLUSION The findings direct attention to public health intervention. Currently, ECEC face significant barriers to realizing their potential to support child nutrition and establish positive life course trajectories of nutrition. To do so requires targeted supports that enable sufficient supply and quality of food in the context of poverty.
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Affiliation(s)
- Bonnie Searle
- Australian Centre of Excellence for Children and Families across the Life Course, Brisbane, Queensland, Australia
- Institute for Social Science Research, University of Queensland, Brisbane, Queensland, Australia
| | - Sally Staton
- Australian Centre of Excellence for Children and Families across the Life Course, Brisbane, Queensland, Australia
| | - Robyn Littlewood
- Health and Wellbeing Queensland, Brisbane, Queensland, Australia
| | - Karen Thorpe
- Australian Centre of Excellence for Children and Families across the Life Course, Brisbane, Queensland, Australia
- Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia
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2
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Sisson SB, Malek-Lasater A, Ford TG, Horm D, Kwon KA. Predictors of Overweight and Obesity in Early Care and Education Teachers during COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2763. [PMID: 36768129 PMCID: PMC9915895 DOI: 10.3390/ijerph20032763] [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: 12/13/2022] [Revised: 01/23/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
The purpose of this cross-sectional study was to determine individual, sociocultural, policy, and economic predictors of overweight/obesity in early care and education (ECE) teachers to identify modifiable opportunities to enhance the health of this critical workforce. ECE teachers (n = 1434) in the U.S. completed an online survey in late spring to mid-summer 2020. Teachers self-reported height and weight; body mass index (BMI) and weight status were calculated. Teachers reported micro-environment variables including age, race, gender, obesogenic lifestyle behaviors, well-being, food security, personal health, stress, job stress, type of ECE, COVID-19 teaching modality, and age of children in the classroom. Logistic regression predicting overweight/obesity and linear regression predicting BMI were conducted. Teachers with more years of teaching experience (OR: 1.022: 95% CI 1.005, 1.039) and higher consumption of fast food (2.038: 1.310, 3.169) had higher odds of overweight/obesity. Teachers with higher levels of education (0.58: 0.407, 0.828) and higher physical health (0.836: 0.775, 0.902) had lower odds of overweight/obesity. Other variables were not associated with overweight/obesity. Variables significant in logistic regression were also associated with higher BMI. Additionally, Native American race (β = 2.467 SE = 1.206) and sedentary hours/day (β = 0.152 SE = 0.075) were associated with higher BMI. Implications for enhancing workplace health for these ECE teachers are emerging.
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Affiliation(s)
- Susan B. Sisson
- Department of Nutrition Sciences, University of Oklahoma Health Sciences Center, 1200 N. Stonewall Ave, Oklahoma City, OK 73117, USA
| | - Adrien Malek-Lasater
- Department of Teaching, Learning, and Curriculum, College of Education and Human Services, University of North Florida, 1 UNF Drive, Jacksonville, FL 32224, USA
| | - Timothy G. Ford
- Department of Educational Leadership and Policy Studies, The University of Oklahoma, 4502 E. 41st Street, 4W101, Tulsa, OK 74135, USA
| | - Diane Horm
- Early Childhood Education Institute, The University of Oklahoma-Tulsa, 4502 E. 41st Street, Tulsa, OK 74135, USA
- Department of Instructional Leadership and Academic Curriculum, University of Oklahoma, 820 Van Vleet, Norman, OK 73019, USA
| | - Kyong-Ah Kwon
- Department of Instructional Leadership and Academic Curriculum, University of Oklahoma, 820 Van Vleet, Norman, OK 73019, USA
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He Y. Impact of coronavirus disease 2019 on food security in early childhood. Curr Opin Pediatr 2023; 35:22-27. [PMID: 36101522 PMCID: PMC9803345 DOI: 10.1097/mop.0000000000001179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW To summarize the impact of the COVID-19 pandemic on food insecurity during early childhood, with a focus on challenges and strategies to improve access to and consumption of nutritious food in early childcare and education settings. RECENT FINDINGS The COVID-19 pandemic exacerbated existing gaps and inequities in the early childcare and education system, resulting in closures and decreased access to healthy foods that disproportionately impacted black, indigenous, and people of color, as well as rural and low-income communities. SUMMARY Closures and changes in operational capacity not only stressed the early childcare and education system and its workforce but also contributed to financial strain and food insecurity among families with young children. Increased public investment and cross-sector partnerships can support and strengthen both early childcare and education and food systems, increasing equitable access to quality care and reducing food insecurity in early childhood.
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Affiliation(s)
- Yuan He
- National Clinician Scholars Program, University of Pennsylvania School of Medicine
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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4
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Markowitz AJ, Bassok D. Understanding the wellbeing of early educators in the wake of the coronavirus pandemic: Lessons from Louisiana. EARLY CHILDHOOD RESEARCH QUARTERLY 2022; 61:1-14. [PMID: 35571571 PMCID: PMC9085453 DOI: 10.1016/j.ecresq.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Anna J Markowitz
- Human Development and Psychology, Department of Education, School of Education and Information Studies, University of California, Los Angeles, United States
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5
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Searle BRE, Staton SS, Littlewood R, Thorpe K. Associations between food provision and feeding practices in socially disadvantaged childcare centres. Appetite 2021; 169:105811. [PMID: 34798225 DOI: 10.1016/j.appet.2021.105811] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/24/2021] [Accepted: 11/14/2021] [Indexed: 12/17/2022]
Abstract
Preschool children consume a large proportion of their daily food intake in their childcare settings. These settings, therefore, provide important opportunities for children to experience food socialisation, and related positive nutrition. Yet, the extent to which these opportunities are taken, particularly in socioeconomically disadvantaged areas where risk of poor nutrition is high, is not well documented. This study focused on 10 childcare centres in socially disadvantaged locations and examined daily feeding practices via direct in-situ observation (n = 189 children observed). Centres were randomly selected based on type of food provision: centre-provided (n = 5 centres) or family-provided (n = 5 centres). Analyses showed that where food was family-provided, educators were significantly more likely to use controlling feeding practices, including pressuring children to eat, restricting food choices and rushing children into finishing meals. These practices were particularly evident during mid-morning meals, where pressuring children to eat healthy foods first, was more often observed. Further research and interventions that target feeding practices in childcare are indicated and should consider how source of food provision impacts upon these practices.
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Affiliation(s)
- Bonnie-Ria E Searle
- Institute for Social Science Research, The University of Queensland, 80 Meiers Rd, Indooroopilly, QLD, 4068, Australia.
| | - Sally S Staton
- Institute for Social Science Research, The University of Queensland, 80 Meiers Rd, Indooroopilly, QLD, 4068, Australia.
| | - Robyn Littlewood
- Health and Wellbeing Queensland, Queensland Government, 139 Coronation Drive, Milton, QLD, 4064, Australia.
| | - Karen Thorpe
- Institute for Social Science Research, The University of Queensland, 80 Meiers Rd, Indooroopilly, QLD, 4068, Australia.
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6
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Swindle T, Phelps J, Schrick B, Johnson SL. Hungry is not safe: A mixed methods study to explore food insecurity in early care and education. Appetite 2021; 167:105626. [PMID: 34389375 DOI: 10.1016/j.appet.2021.105626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 06/09/2021] [Accepted: 08/04/2021] [Indexed: 11/25/2022]
Abstract
The early care and education (ECE) environment has the potential to affect both children and their families. Food insecurity in ECE and its management may be an important influence. Objectives of this mixed methods study were to (1) elicit prominent themes relating to teacher experiences with food insecurity (in the classroom) through qualitative interviews; (2) translate interview themes into survey items and analyze survey data to explore generalizability of the qualitative findings; and (3) provide preliminary data on properties of a new tool to study the influence of food insecurity in the ECE setting. An exploratory sequential mixed methods design (QUAL → quant) was used. Twenty-eight interviews about teacher experiences with food insecurity were followed by 781 surveys to assess generalizability of interview findings. Qualitative themes highlighted that ECE teachers are concerned about children's food insecurity in their classroom; ECE teachers have developed their own set of strategies to manage their concern; and teachers often struggle with what to do. Quantitative results demonstrated many teachers had the same concerns and used the strategies described in the interviews. Further, in exploratory analyses, ECE teachers with Food Insecurity scored significantly higher on all scales (e.g., Food Insecurity Concerns, Struggle with Addressing Food Security) in both adjusted and unadjusted analyses. ECE teachers with Food Acquisition Stress had higher scores on Strategies to Address Food Insecurity with Families in adjusted analyses.
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Affiliation(s)
- Taren Swindle
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, #530, Little Rock, AR, 72205-7199, USA.
| | - Joshua Phelps
- Cooperative Extension, Division of Agriculture, University of Arkansas, 2301 S University Ave, Little Rock, AR, 72204, USA
| | - Britney Schrick
- Cooperative Extension, Division of Agriculture, University of Arkansas, 2301 S University Ave, Little Rock, AR, 72204, USA
| | - Susan L Johnson
- Department of Pediatrics, University of Colorado, 12631 East 17th Avenue, Mail Stop F-561 Academic Office Building, Aurora, CO, 80045, USA
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Mofleh D, Ranjit N, Chuang RJ, Cox JN, Anthony C, Sharma SV. Association Between Food Insecurity and Diet Quality Among Early Care and Education Providers in the Pennsylvania Head Start Program. Prev Chronic Dis 2021; 18:E60. [PMID: 34138698 PMCID: PMC8220947 DOI: 10.5888/pcd18.200602] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction Food insecurity affects dietary behaviors and diet quality in adults. This relationship is not widely studied among early care and education (ECE) providers, a unique population with important influences on children’s dietary habits. Our study’s objective was to explore how food insecurity affected diet quality and dietary behaviors among ECE providers. Methods We used baseline data from a cluster-randomized controlled trial (January 2019−December 2020) on 216 ECE providers under the Pennsylvania Head Start Association. We used radar plots to graph scores for the Healthy Eating Index 2015 and the Alternative Healthy Eating Index (AHEI) 2010 and fitted a multivariate regression model for diet quality measures, adjusting for covariates. Results Among the 216 participants, 31.5% were food insecure. ECE providers who were food insecure had a lower AHEI-2010 mean score (mean difference for food insecure vs food secure = −4.8; 95% CI, −7.8 to −1.7; P = .002). After adjusting for covariates, associations remained significant (mean difference = −3.9; 95% CI, −7.5 to −0.4; P = .03). Food insecure ECE providers were less likely to use nutrition labels (22.8% vs 39.1%; P = .046) and more likely to report cost as a perceived barrier to eating fruits and vegetables. Conclusion We found a significant inverse association between food insecurity and the AHEI-2010 diet quality score among ECE providers after adjusting for covariates. More studies are needed to examine the effects of food insecurity on dietary behaviors of ECE providers and their response to nutrition education programs targeting their health.
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Affiliation(s)
- Dania Mofleh
- Department of Epidemiology, Human Genetics and Environmental Sciences, Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston, School of Public Health, 1200 Pressler St, Houston, TX 77030.
| | - Nalini Ranjit
- Department of Epidemiology, Human Genetics and Environmental Sciences, Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston School of Public Health, Austin, Texas
| | - Ru-Jye Chuang
- Department of Epidemiology, Human Genetics and Environmental Sciences, Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas
| | - Jill N Cox
- Penn State Extension Better Kid Care, State College, Pennsylvania
| | | | - Shreela V Sharma
- Department of Epidemiology, Human Genetics and Environmental Sciences, Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas
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9
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Swindle T, Rutledge J. Measuring feeding practices among early care and education teachers and examining relations with food insecurity. Appetite 2020; 155:104806. [PMID: 32735955 DOI: 10.1016/j.appet.2020.104806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
Early care and education teachers' (ECETs) dietary and feeding behaviors have the potential to influence children's health outcomes. This study sought to: (1) gather data on the properties and performance of the CFQ and CFSQ in an ECET sample and compare properties to published parent samples and (2) examine relations between FI experiences by ECETs and reported feeding practices, and (3) examine relations between FI experiences by ECETs and reported feeding practices. ECETs completed 506 cross-sectional surveys. Mean patterns, ranges, and internal consistency values on the adapted instruments for ECETs were consistent with those published for parents. Significant mean differences between parents and ECETs on established scales using one-sample t-tests were prevalent with medium to large effect sizes despite small, relative differences. The majority of ECETs were authoritarian (35.6%), followed by indulgent (29.2%), authoritative (17.9%), and uninvolved (17.3%). T-tests indicated that ECETs who were currently food insecure were significantly higher than teachers who were currently food secure on scales of perceived responsibility, concern about child weight, restriction, pressure to eat, monitoring, demandingness, and responsiveness (all p < .001). Chi-square tests found that food insecurity was not independent from ECET feeding style, with a greater occurrence of authoritarian and less of indulgent feeding styles for ECETs who were food insecure. Overall, analyses support that two popular measures of feeding practices function similarly in ECETs as they do in parents. Additionally, results demonstrate associations between food insecurity and ECETs' feeding practices.
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Affiliation(s)
- Taren Swindle
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, #530, Little Rock, AR, 72205-7199; USA.
| | - Julie Rutledge
- School of Human Ecology; Louisiana Tech University, P.O. Box 3167, Ruston, LA, 71272, USA
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10
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Eastern North Carolina Head Start Teachers' personal and professional experiences with healthy eating and physical activity: a qualitative exploration. Public Health Nutr 2020; 24:3460-3476. [PMID: 33190662 DOI: 10.1017/s1368980020003687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Explore the interrelationship between teachers' personal and professional socio-ecological structures while examining Head Start (HS) teachers' experiences with (1) trying to eat healthy and engage in physical activity (PA) and (2) promote healthy eating and PA in their classrooms. DESIGN In-depth semi-structured interviews were collected from March through June 2017. Researchers designed the data collection and analysis methods using a phenomenological approach. All interviews were recorded using digital audio and transcribed verbatim. SETTING Seven HS centres in two rural eastern North Carolina counties. PARTICIPANTS Teachers (n 15) who had recently participated in a healthy eating and physical activity intervention. Participants were 100 % female, an average age of 43 years (sd 9·6) and primarily Black/African American (93·3 %). RESULTS Eighteen primary themes were identified providing unique insight into individual, social and environmental determinants that may influence teachers' personal health behaviours and professional health promotion practices. Findings indicated that teachers want to improve health behaviours personally (individual/family health) and professionally (children/families served); however, barriers exist at all levels impacting their ability to improve their own health and facilitate positive behaviours among the children/families they serve. Many teachers observed connections between their personal and professional experiences, but not beyond the individual level. CONCLUSIONS Study findings highlight the importance of considering and emphasising the potential relationship between personal and professional determinants of health when working with early childhood teachers. Findings from this study may be useful for informing the development, implementation and evaluation of future health promotion interventions using teachers as implementers.
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Warkentin S, Mais LA, Ranganath K, Jansen E, Carnell S. Controlling and less controlling feeding practices are differentially associated with child food intake and appetitive behaviors assessed in a school environment. Pediatr Obes 2020; 15:e12714. [PMID: 32893452 DOI: 10.1111/ijpo.12714] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 07/13/2020] [Accepted: 07/22/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Child food intake and appetitive behaviors show an inconsistent pattern of associations with parental feeding practices. Relationships likely vary depending on parent feeding style, and on the method by which child eating behaviors are measured. OBJECTIVES We tested relationships of controlling and less controlling forms of parental promotion and limitation of eating with food intake and appetitive behaviors assessed in preschoolers' normal school environments. METHODS As part of a 5-day protocol, preschoolers consumed standardized lunches, and caloric compensation, eating rate and eating in the absence of hunger were assessed. Feeding practices were measured using the Child Feeding Questionnaire (CFQ) and Parent Feeding Styles Questionnaire (PFSQ). CFQ-Pressure to eat and CFQ-Restriction were controlling forms of promotion/limitation of child intake, and CFQ-Monitoring and PFSQ-Prompting to eat were less controlling forms. RESULTS Children (3-5y, n = 70) of parents with higher CFQ-Pressure to eat scores showed lower total intake, consuming significantly fewer calories from bread, snacks and fruits and vegetables. Higher PFSQ-Prompting to eat was associated with lower fruit and vegetable intake only. CFQ-Restriction and CFQ-Monitoring scores were unassociated with food intake. Higher CFQ-Pressure to eat was associated with slower eating rate, while higher CFQ-Monitoring was associated with lower intake in absence of hunger. CONCLUSIONS Parental promotion and limitation of intake were associated with preschoolers' eating behaviors assessed in an ecologically valid setting, without parents present. Controlling and less controlling forms showed differential patterns of associations. Results were consistent with child-to-parent and parent-to-child effects, but research using longitudinal designs is needed to test bidirectional relationships.
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Affiliation(s)
- Sarah Warkentin
- EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal
| | | | | | - Elena Jansen
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Susan Carnell
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Love P, Walsh M, Campbell KJ. Knowledge, Attitudes and Practices of Australian Trainee Childcare Educators Regarding Their Role in the Feeding Behaviours of Young Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103712. [PMID: 32466111 PMCID: PMC7277710 DOI: 10.3390/ijerph17103712] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 02/08/2023]
Abstract
Background: Early childhood (2-5 years) is acknowledged as a critical time for the establishment of healthy behaviours. The increasing number of children and amount of time spent in childcare provides strong rationale to explore the important role that childcare services and childcare educators play in influencing healthy eating behaviours of young children in their care. Methods: This study used a qualitative exploratory approach to describe the knowledge, attitudes and practices of Australian childcare trainee educators' regarding their role in the feeding of young children. Results: All participants agreed that feeding of young children was an important part of their role, but described challenges to the promotion of healthy eating and the adoption of responsive child feeding practices. These included personal beliefs and experiences with food, the bi-directional nature of child feeding, conflicting parental requests and/or unsupportive centre-based policies and procedures. Conclusion: Training about responsive child feeding practices within the childcare sector should include all childcare staff; aim to enhance relational efficacy and communication skills with parents; and empower childcare staff to lead organisational change. To support this, childcare centres need to provide coherent centre-based healthy eating policies inclusive of healthy food provision and desirable feeding practices.
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Affiliation(s)
- Penelope Love
- Institute for Physical Activity and Nutrition, Deakin University, Geelong 3216, Australia;
- Centre of Research Excellence, Early Prevention of Obesity in Childhood (EPOCH), Sydney 2007, Australia
- School of Exercise and Nutrition Sciences, Deakin University, Geelong 3216, Australia;
- Correspondence:
| | - Melissa Walsh
- School of Exercise and Nutrition Sciences, Deakin University, Geelong 3216, Australia;
| | - Karen J. Campbell
- Institute for Physical Activity and Nutrition, Deakin University, Geelong 3216, Australia;
- Centre of Research Excellence, Early Prevention of Obesity in Childhood (EPOCH), Sydney 2007, Australia
- School of Exercise and Nutrition Sciences, Deakin University, Geelong 3216, Australia;
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Prusaczyk B, Swindle T, Curran G. Defining and conceptualizing outcomes for de-implementation: key distinctions from implementation outcomes. Implement Sci Commun 2020; 1:43. [PMID: 32885200 PMCID: PMC7427870 DOI: 10.1186/s43058-020-00035-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 04/22/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Increasingly, scholars argue that de-implementation is a distinct concept from implementation; factors contributing to stopping a current practice might be distinct from those that encourage adoption of a new one. One such distinction is related to de-implementation outcomes. We offer preliminary analysis and guidance on de-implementation outcomes, including how they may differ from or overlap with implementation outcomes, how they may be conceptualized and measured, and how they could be measured in different settings such as clinical care vs. community programs. CONCEPTUALIZATION OF OUTCOMES We conceptualize each of the outcomes from Proctor and colleagues' taxonomy of implementation outcomes for de-implementation research. First, we suggest key considerations for researchers assessing de-implementation outcomes, such as considering how the cultural or historical significance to the practice may impact de-implementation success and, as others have stated, the importance of the patient in driving healthcare overuse. Second, we conceptualize de-implementation outcomes, paying attention to a number of factors such as the importance of measuring outcomes not only of the targeted practice but of the de-implementation process as well. Also, the degree to which a practice should be de-implemented must be distinguished, as well as if there are thresholds that certain outcomes must reach before action is taken. We include a number of examples across all outcomes, both from clinical and community settings, to demonstrate the importance of these considerations. We also discuss how the concepts of health disparities, cultural or community relevance, and altruism impact the assessment of de-implementation outcomes. CONCLUSION We conceptualized existing implementation outcomes within the context of de-implementation, noted where there are similarities and differences to implementation research, and recommended a clear distinction between the target for de-implementation and the strategies used to promote de-implementation. This critical analysis can serve as a building block for others working to understand de-implementation processes and de-implement practices in real-world settings.
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Affiliation(s)
- Beth Prusaczyk
- Washington University School of Medicine in St. Louis, 660 S. Euclid Avenue, St. Louis, MO 63110 USA
| | - Taren Swindle
- University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 77205 USA
| | - Geoffrey Curran
- University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 77205 USA
- Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR 72114 USA
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14
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Lessard LM, Wilkins K, Rose-Malm J, Mazzocchi MC. The health status of the early care and education workforce in the USA: a scoping review of the evidence and current practice. Public Health Rev 2020; 41:2. [PMID: 31934495 PMCID: PMC6950818 DOI: 10.1186/s40985-019-0117-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 12/17/2019] [Indexed: 12/15/2022] Open
Abstract
Background More than two million early care and education (ECE) providers care for young children in the USA each day. These providers tend to earn low wages and many are enrolled in public assistance programs. Nearly all ECE providers are female and they are disproportionately women of color. Despite the fact that these attributes place the ECE workforce at greater risk of chronic disease, the health status of the workforce is not established and the availability and effectiveness of interventions to improve their health status is also not known. Methods We conducted a scoping review of both the published literature and current practice to identify all articles and interventions targeting the health status of the ECE workforce. Our search strategy identified scientific articles published in English within the past 10 years as well as any interventions targeting the ECE workforce that have been implemented within the past 3 years. Data from both scientific articles and practice were extracted using systematic methods and summarized. Results Thirteen studies described some component of physical health including diet quality (11 studies), physical activity (8 studies), and height/weight/body mass index (7 studies), and 21 studies assessed component(s) of mental health including depression (15 studies), stress (8 studies), and mindfulness (3 studies). ECE providers reported a high prevalence of overweight, obesity, and chronic disease diagnoses and spend significant time being sedentary, and some report low diet quality. Mental health concerns in this population include depression and high stress. Eleven interventions targeting ECE workforce wellness were also identified; most focused on nutrition, physical activity and/or stress. Conclusion The limited evidence available for review describes a workforce in need of health promotion interventions to address high levels of mental and physical health challenges, some above and beyond peers with comparable demographic characteristics. Several promising interventions were identified from both the published and unpublished literature; these interventions should be further implemented and evaluated to assess their impact on the workforce.
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Affiliation(s)
- Laura M Lessard
- 1University of Delaware, College of Health Sciences, Newark, DE 19716 USA
| | - Katilyn Wilkins
- Child Care Aware of America, 1515 N. Courthouse Rd-3rd Floor, Arlington, VA 22201 USA
| | - Jessica Rose-Malm
- Child Care Aware of America, 1515 N. Courthouse Rd-3rd Floor, Arlington, VA 22201 USA
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Swindle TM, Phelps J, Schrick B, Selig J, Hu Z, Kopparapu A, Johnson S. Identifying a Fine Line between Food Insecurity and Food Acquisition Stress: A Mixed Methods Exploration. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2019; 16:45-63. [PMID: 33868533 DOI: 10.1080/19320248.2019.1697407] [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: 10/25/2022]
Abstract
This study introduces the concept of Food Acquisition Stress (FAS), stress associated with food acquisition among those who do not necessarily screen positive for food insecurity.. This study used an exploratory sequential mixed methods approach among a sample of predominantly early childhood educators to develop a 7-item tool for measuring current and retrospective FAS. Using this tool, we identified that 61% of individuals who had FAS did not meet criteria for food insecurity. Capturing FAS, even among those categorized as food secure, has the potential to identify individuals who may need supportive interventions. Future research can explore how FAS is related to health behaviors.
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Affiliation(s)
- Taren M Swindle
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences
| | - Josh Phelps
- College of Health Profession, University of Arkansas for Medical Sciences
| | - Brittney Schrick
- Cooperative Extension, Division of Agriculture, University of Arkansas
| | - James Selig
- College of Public Health, Department of Biostatistics, University of Arkansas for Medical Sciences
| | - Zhuopei Hu
- College of Public Health, Department of Biostatistics, University of Arkansas for Medical Sciences
| | - Anil Kopparapu
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences
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Johnson CM, Sharkey JR, Lackey MJ, Adair LS, Aiello AE, Bowen SK, Fang W, Flax VL, Ammerman AS. Relationship of food insecurity to women's dietary outcomes: a systematic review. Nutr Rev 2019; 76:910-928. [PMID: 30184168 PMCID: PMC6240001 DOI: 10.1093/nutrit/nuy042] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Context Food insecurity matters for women's nutrition and health. Objective This review sought to comprehensively evaluate how food insecurity relates to a full range of dietary outcomes (food groups, total energy, macronutrients, micronutrients, and overall dietary quality) among adult women living in Canada and the United States. Data sources Peer-reviewed databases (PubMed/MEDLINE, CINAHL, Scopus, Web of Science) and gray literature sources from 1995 to 2016 were searched. Data extraction Observational studies were used to calculate a percentage difference in dietary intake for food-insecure and food-secure groups. Results Of the 24 included studies, the majority found food-insecure women had lower food group frequencies (dairy, total fruits and vegetables, total grains, and meats/meat alternatives) and intakes of macro- and micronutrients relative to food-secure women. Methodological quality varied. Among high-quality studies, food insecurity was negatively associated with dairy, fruits and vegetables, grains, meats/meats alternatives, protein, total fat, calcium, iron, magnesium, vitamins A and C, and folate. Conclusions Results hold practical relevance for selecting nutritional targets in programs, particularly for nutrient-rich foods with iron and folate, which are more important for women's health.
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Affiliation(s)
- Cassandra M Johnson
- School of Family & Consumer Sciences, Texas State University, San Marcos, Texas, USA
| | - Joseph R Sharkey
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station, Texas, USA
| | - Mellanye J Lackey
- Spencer S. Eccles Health Sciences Library, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Linda S Adair
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Allison E Aiello
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sarah K Bowen
- Department of Sociology and Anthropology, College of Humanities and Social Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - Wei Fang
- Center for Population Health, University of Massachusetts-Lowell, Lowell, Massachusetts, USA
| | - Valerie L Flax
- RTI International, Research Triangle Park, North Carolina, USA
| | - Alice S Ammerman
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Swindle T, Sigman-Grant M, Branen LJ, Fletcher J, Johnson SL. About feeding children: factor structure and internal reliability of a survey to assess mealtime strategies and beliefs of early childhood education teachers. Int J Behav Nutr Phys Act 2018; 15:85. [PMID: 30200993 PMCID: PMC6131865 DOI: 10.1186/s12966-018-0717-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 08/27/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Children spend a substantial amount of time in early care and education (ECE) settings and may eat a majority of their diet in this setting. While there are several instruments focused on measuring factors of the ECE environment that may influence diet and weight outcomes, there are few comprehensive, valid, and reliable measures for collecting self-report of ECE providers' feeding practices. The purpose of this study was to establish the factor structure and internal reliability of a survey developed to measure practices and beliefs of ECE providers relative to feeding children. METHODS Licensed ECE centers from CA, CO, ID and NV were included in this cross-sectional survey study. The sample was stratified by states and census regions to yield equal numbers of centers from each category. The total sample distribution included 1600 randomly selected centers and up to 8000 staff members (who represented teachers, aides, assistants, or cooks); 1178 surveys were completed. We conducted an exploratory, unrestricted factor analysis as well as parallel analyses to inform the number of factors to be extracted. RESULTS Factors within Structural Mealtime Strategies included Adult Control of Foods Consumed (Kuder-Richardson [KR] = 0.67), Bribing with Sweet Foods (KR = 0.70), and Supportive Adult Roles at Mealtime (KR = 0.55). Factors in Verbal Mealtime Strategies included Supporting Children's Eating Self-regulation (KR =0.61), Pressure to Eat (KR = 0.58), and Social Comparisons (KR = 0.59). Beliefs about Mealtime factors were Autonomy Promoting (α = 0.64), Coercive Beliefs (α = 0.77), and Concern-Based Control (α = 0.60). CONCLUSIONS The AFC Strategies and Beliefs Survey provides a promising self-report instrument with a strong factor structure consistent with the extant literature to measure practices and beliefs related to feeding and mealtimes in the ECE setting. Feeding young children in group settings differs in many ways from feeding in a family setting; hence it is important that measures such as the AFC Strategies and Beliefs Survey capture unique aspects of the ECE feeding environment.
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Affiliation(s)
- Taren Swindle
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, 521 Jack Stephens Drive, Little Rock, AR, 72205, USA.
| | - Madeleine Sigman-Grant
- University of Nevada Cooperative Extension, 2558 So Elizabeth Street, Salt Lake City, UT, 85406, USA
| | - Laurel J Branen
- Food and Nutrition, University of Idaho, Moscow, ID, 83844-3183, USA
| | - Janice Fletcher
- Child, Family and Consumer Studies, Center on Disabilities and Human Development, University of Idaho, 1187 Alturas Drive, Moscow, ID, 83844-1187, USA
| | - Susan L Johnson
- Department of Pediatrics, Anschutz Medical Campus, Section of Nutrition, F-561, University of Colorado-Denver, 12,631 E 17th Ave, Rm #2609, Aurora, CO, 80045, USA
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Whiteside-Mansell L, Swindle TM. Together We Inspire Smart Eating: A Preschool Curriculum for Obesity Prevention in Low-Income Families. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2017; 49:789-792.e1. [PMID: 28669691 PMCID: PMC5632587 DOI: 10.1016/j.jneb.2017.05.345] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 05/06/2017] [Accepted: 05/09/2017] [Indexed: 05/04/2023]
Affiliation(s)
- Leanne Whiteside-Mansell
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR.
| | - Taren M Swindle
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
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Table Talk: development of an observational tool to assess verbal feeding communications in early care and education settings. Public Health Nutr 2017; 20:2869-2877. [PMID: 28803584 DOI: 10.1017/s1368980017001896] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Children's dietary intake impacts weight status and a range of short- and long-term health outcomes. Accurate measurement of factors that influence children's diet is critical to the development and evaluation of interventions designed to improve children's diets. The purpose of the current paper is to present the development of the Table Talk observational tool to measure early care and education teachers' (ECET) verbal feeding communications. DESIGN An observational tool to assess ECET verbal communication at mealtimes was deigned based on the extant literature. Trained observers conducted observations using the tool during lunch for both lead and assistant ECET. Descriptive statistics, test-retest for a subgroup, interclass correlations for each item, and comparisons between leads and assistants were conducted. SETTING Head Start centres, Southern USA. SUBJECTS Seventy-five Head Start educators. RESULTS On average, 17·2 total verbal feeding communications (sd 8·9) were observed per ECET. For lead ECET, the most prevalent Supportive Comment was Exploring Foods whereas for assistants Making Positive Comments was the most prevalent. Overall, lead ECET enacted more Supportive Comments than assistant ECET (F(2,72)=4·8, P=0·03). The most common Unsupportive Comment was Pressuring to Eat, with a mean of 3·8 (sd 4·3) and a maximum of 25. There was no difference in Unsupportive Comments between lead and assistant ECET. CONCLUSIONS Table Talk may be a useful tool to assess verbal feeding communications of ECET, with potential applications such as informing ECET training and assessing intervention efforts.
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Swindle TM, Patterson Z, Boden CJ. A Qualitative Application of the Belsky Model to Explore Early Care and Education Teachers' Mealtime History, Beliefs, and Interactions. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2017; 49:568-578.e1. [PMID: 28689611 PMCID: PMC5518700 DOI: 10.1016/j.jneb.2017.04.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 04/28/2017] [Accepted: 04/30/2017] [Indexed: 05/08/2023]
Abstract
OBJECTIVE Studies on factors associated with nutrition practices in early care and education settings often focus on sociodemographic and programmatic characteristics. This qualitative study adapted and applied Belsky's determinants of parenting model to inform a broader exploration of Early Care and Education Teachers (ECETs) practices. DESIGN Qualitative cross-sectional study with ECETs. SETTING The researchers interviewed ECETs in their communities across a Southern state. PARTICIPANTS Purposive sampling was employed to recruit ECETs (n = 28) from Head Start or state-funded centers serving low-income families. PHENOMENON OF INTEREST Developmental histories of ECETs regarding food and nutrition, beliefs about child nutrition, and teaching interactions related to food. ANALYSIS Qualitative interviews were coded using a deductive content analysis approach. RESULTS Three distinct interrelationships were observed across the themes. First, rules and routines regarding food and mealtime in the educators' childhood often aligned with educator beliefs and behaviors at meals in their classroom. Second, some ECETs described motivations to leave a healthy food legacy for children in their class. Finally, an experience of food insecurity appeared in narratives that also emphasized making sure children got enough through various strategies. CONCLUSIONS AND IMPLICATIONS The influence of ECET developmental histories and their related beliefs can be addressed through professional development and ongoing support. Future study should quantify model constructs in a larger sample and study their relationships over time.
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Affiliation(s)
- Taren M Swindle
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR.
| | - Zachary Patterson
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Carrie J Boden
- Department of Occupational, Workforce, and Leadership Studies, Texas State University, San Marcos, TX
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