Since more than a third of 2-5 year olds spend many hours in non-relative early child care settings, such as center-based child care and family child care homes (FCCHs) where they receive about 2-3 meals including snacks and beverages each day,9,10 coupled with recent evidence linking care in early child care settings with an increased risk of becoming overweight or obese, compared to children cared for by their parents,11-20 the early child care setting becomes an important venue to spearhead obesity prevention efforts.21 Studies that have included FCCHs as type of child care setting have shown that children placed in FCCHs are especially at increased risk for overweight or obesity.11,13,14,17 However, few studies have examined the obesity-promoting or obesogenic attributes of the mealtime environment in FCCHs. Since family child care home providers are the second largest provider of non-relative early child care, providing care to nearly 2 million children less than 5 years of age in a home environment outside the child’s home (FCCHs),10,22 it is important to understand its mealtime environment and the quality and frequency of foods offered to young children by FCCH providers.
To combat the problem of early childhood obesity, particularly in low-income communities, the United States Department of Agriculture instituted the Child and Adult Care Food Program (CACFP) which provides reimbursements to eligible childcare providers for the purchase of nutritious foods.23 FCCH providers participating in this program also receive essential supports for learning how to select nutritious food options and providing healthy food environments to low-income children. Few studies, however, have examined the impact of the CACFP on the mealtime environment and the quality and frequency of foods offered by child care providers.
The objectives of this study were to compare the mealtime environment and quality and frequency of foods offered to 2-5-year-old children in non-CACFP and CACFP FCCHs and to examine the association between the mealtime environment and the quality and frequency of foods offered to 2-5-year-old children in FCCHs. This research is the first step towards a long-term goal of partnering with early child care providers in ensuring that early child care settings, such as FCCHs provide optimal food environments for young children.
Using a cross-sectional telephone survey design, a proportionate stratified random sample of FCCH providers by the CACFP participation status was used. Demographic information on providers were collected. Additionally, data on the mealtime environment (i.e. provider role modeling behavior, prompting/feeding cues, encouragement of new foods, respect for satiety, and use of foods to control behavior, style of feeding) and the quality and frequency of foods offered were collected by phone using the items from the Nutrition and Physical Activity Self-Assessment for Child Care (NAPSACC) survey.24 NAPSACC consists of a 4-point Likert scale; the range signifies whether child care nutrition standards have been adequately met (1 = barely met, 2 = met, 3 = exceeded, 4 = far exceeded child care standards). Thirteen questions on the NAPSACC tool measure the mealtime environment, and fifteen questions measure the quality and frequency of foods offered- ranges of scores for the mealtime environment and the quality and quantity of foods offered are 13-52 and 15-60, respectively.
A total of 91 licensed FCCH providers (69 CACFP, 22 non-CACFP) participated. The majority of the FCCH providers (90 %) were Black or African American, the mean (SD) years of child care experience was 18 (9.5) years, and the mean (SD) years of education was 14.5 (1.7) years-14 years equals having had some college education. The majority of providers were obese with a mean (SD) Body Mass Index (BMI) of 30 (4.7) kg/m2. There were no significant differences in any of these covariates by CACFP status, p>0.05. Pearson’s Chi-square test shows that the percentage of providers who reported having had nutrition training within the past year differed by the CACFP participation status of the FCCH provider, with 37% more CACFP FCCH providers reporting having had nutrition training within the past year (χ2(1, N=91) =13.3, p<0.001). More CACFP than non-CACFP FCCHs exceeded child care nutrition standards in meal style delivery, encouragement of new foods, quality of vegetables served, and quality and frequency of whole grains served. Non-CACFP FCCHs had significantly lower mean mealtime environment scores (β=-0.18, p=0.04). Mealtime environment was positively associated with the frequency and quality of foods offered to children (β=0.26, p=0.008). These relationships persisted after adjusting for certain provider-level demographic characteristics.
Findings suggest that providers in CACFP FCCHs have more positive mealtime interactions that may be important to positive nutrition practices. More research on strengthening mealtime environments in FCCHs and the possible impact on childhood obesity is recommended.
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