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Thompson HG, Brady P, Delger P, Kersten S, Evans S, Daly E, Boudreau H, Baymon E, Kim Y, Askelson NM. How Home Child Care Providers Purchase, Prepare, and Serve Healthy Foods: In-Depth Interviews with Child and Adult Care Food Program Participants. Child Obes 2022; 18:507-513. [PMID: 35213249 DOI: 10.1089/chi.2021.0302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Child care settings can enhance children's access and exposure to healthy foods through participation in The Child and Adult Care Food Program (CACFP), which reimburses child care providers for purchasing healthy foods. To identify challenges and facilitators to CACFP participation, we carried out in-depth interviews with CACFP-participating home child care providers to discuss purchasing, preparing, and serving food under CACFP guidelines. Methods: We carried out 20 in-depth telephone interviews with CACFP-participating home child care providers. Transcribed interviews were coded to develop themes using a deductive approach. Results: Interviews indicated that food costs still burden CACFP-participating child care providers despite reimbursements. CACFP-participating providers who described prioritizing healthy foods and nutrition showed a greater inclination toward purchasing, preparing, and serving healthy foods to children. Conclusions: We offer recommendations for how to effectively support CACFP-participating providers in offering healthy food to their children within a food choice framework, a multilevel categorization of factors that influence food choice. Recommendations include increased reimbursement rates for food purchases under CACFP and support for peer-to-peer mentoring and health promotion programs targeting child care provider health.
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Affiliation(s)
- Helaina G Thompson
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Patrick Brady
- Division of Epidemiology and Community Health at the University of Minnesota, MN, USA
| | - Patti Delger
- Team Nutrition, Iowa Department of Education, Des Moines, Des Moines, IA, USA
| | - Sarah Kersten
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Sydney Evans
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Eliza Daly
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Hailey Boudreau
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Essence Baymon
- Winship Discovery Team in Clinical Research, Emory Winship Cancer Institute, Atlanta, GA, USA
| | - Yeaseul Kim
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Natoshia M Askelson
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA.,Health Policy Research Program, University of Iowa Public Policy Center, Iowa City, IA, USA
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Neshteruk CD, Willis E, Smith F, Vaughn AE, Grummon AH, Vu MB, Ward DS, Linnan L. Implementation of a workplace physical activity intervention in child care: process evaluation results from the Care2BWell trial. Transl Behav Med 2021; 11:1430-1440. [PMID: 33864466 DOI: 10.1093/tbm/ibab034] [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: 01/01/2023] Open
Abstract
Care2BWell was designed to evaluate the efficacy of Healthy Lifestyles (HL), a worksite health promotion intervention to increase child care workers' physical activity. The purpose of this study was to use process evaluation to describe the implementation of HL and determine if different levels of implementation are associated with changes in workers' physical activity. Data were collected from 250 workers randomized to HL, a 6 month, multilevel intervention that included an educational workshop followed by three 8 week campaigns that included self-monitoring and feedback, raffle incentive, social support, and center director coaching. Process evaluation data collection included direct observation, self-reported evaluation surveys, website analytics and user test account data, tracking databases and semi-structured interviews. Implementation scores were calculated for each intervention component and compared at the center and individual levels. Nearly a third of workers never self-monitored and few (16%) met self-monitoring goals. Only 39% of centers engaged with the social support component as intended. Raffle and social support components were perceived as the least useful. Implementation varied widely by center (25%-76%) and individual workers (0%-94%). No within- or between-group differences for high compared to low implementation groups for change in physical activity were evident. Interview themes included limited sustainability, competing priorities, importance of social support, and desire for a more intensive, personalized intervention. Wide variation in implementation may explain limited effects on intervention outcomes. Future worksite interventions designed for child care workers can use these findings to optimize health promotion in this setting.
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Affiliation(s)
- Cody D Neshteruk
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Erik Willis
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Falon Smith
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amber E Vaughn
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anna H Grummon
- Center for Population and Development Studies, Harvard University, Cambridge, MA, USA.,Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Maihan B Vu
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dianne S Ward
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura Linnan
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Linnan LA, Vaughn AE, Smith FT, Westgate P, Hales D, Arandia G, Neshteruk C, Willis E, Ward DS. Results of caring and reaching for health (CARE): a cluster-randomized controlled trial assessing a worksite wellness intervention for child care staff. Int J Behav Nutr Phys Act 2020; 17:64. [PMID: 32414381 PMCID: PMC7227251 DOI: 10.1186/s12966-020-00968-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 05/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Child care workers are among the lowest paid US workers and experience a wide array of health concerns. The physical and mental demands of their job and the lack of employer-provided health-insurance increase health risks. The Caring and Reaching for Health (CARE) study evaluated a 6-month Healthy Lifestyles intervention targeting child care workers' physical activity (primary outcome), other health behaviors, and their workplace health environment. METHODS Eligible child care centers, defined as being in operation for at least 2 years and employing at least four staff, were enrolled into CARE's cluster-randomized trial. Centers and their child care staff were randomly assigned to either the Healthy Lifestyles (HL) intervention arm or the Healthy Finances (HF) attention control arm using a block randomization approach. Intervention components were delivered through in-person workshops, center-level displays, informational magazines, director coaching, electronic messaging, and an interactive website. Outcome measures were collected during center visits at baseline and immediately post-intervention by trained data collectors blinded to center arm assignment. Workers' physical activity was assessed with accelerometers, worn for 7 days. Secondary outcome measures included biometric assessments of health and fitness, web-based surveys about health behaviors, and an environmental audit of workplace supports for health. Multi-level linear mixed models assessed worker- and center-level changes in these outcomes. RESULTS Participants included 553 child care workers representing 56 centers (HL = 250 staff/28 centers, HF = 303 staff/28 centers). At 6 months, moderate-to-vigorous physical activity declined slightly in both arms (- 1.3 min/day, 95% CI: - 3.0, 0.3 in HL; - 1.9 min/day, 95% CI: - 3.3, - 0.5 in HF), but there was no significant group by time interaction. Several secondary outcomes for other health behaviors and workplace health environment showed improvements in favor of the intervention arm, yet differences did not remain statistically significant after adjustment for multiple comparisons. CONCLUSIONS While the Healthy Lifestyles intervention did not improve health behaviors or the workplace health environment, results confirmed the pressing need to focus on the health of child care workers. Future interventions should focus on prevalent health issues (e.g., weight, stress), include both high-tech and high-touch intervention strategies, and address work conditions or other social determinants of health (e.g. wages) as a means of improving the health of these essential workers. TRIAL REGISTRATION Care2BWell: Worksite Wellness for Child Care (NCT02381938).
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Affiliation(s)
- Laura A Linnan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB 7440, Chapel Hill, North Carolina, 27599-7440, USA.
| | - Amber E Vaughn
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Falon T Smith
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Philip Westgate
- Department of Biostatistics, College of Public Heath, University of Kentucky, Lexington, Kentucky, USA
| | - Derek Hales
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Gabriela Arandia
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB 7440, Chapel Hill, North Carolina, 27599-7440, USA
| | - Cody Neshteruk
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Erik Willis
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dianne S Ward
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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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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