Childhood Obesity最新文献

Background: Early childhood education (ECE) educators play an instrumental role in children's health and development but unfortunately have poor health themselves. This project examined the physical and psychological health of New York licensed ECE educators. Methods: A sequential, explanatory mixed methods design (quan→QUAL) consisted of a 110-item survey and semi-structured interviews to examine physical (diet, physical activity [PA], sleep, and body mass index [BMI]) and psychological health (stress and burnout). Quantitatively, multiple linear regressions tested associations between physical and psychological health, controlling for age and income, using R (v4.3.2, 2023); α < 0.05. Qualitatively, content analysis with pattern recognition for pragmatic synthesis was performed. Results: Survey respondents (n = 1423) and interview participants (n = 36) worked in a variety of ECE settings; 74% had overweight/obesity and 24% deemed themselves "unhealthy." Many had poor health behaviors-low diet quality (74%), limited regular PA (28%), poor sleep quality (34%), and moderate/high stress levels (74%). Most desired changes to health behaviors but were challenged due to work environments and job demands. Work-based factors impacted both their physical and mental health and influenced their personal life. Burnout and stress were high, and feelings of underappreciation were prevalent. Higher burnout (emotional exhaustion) was significantly associated with higher BMI (β = 0.18, p < 0.01) and stress (β = 1.09, p < 0.01) and lower PA (β = 2.62, p < 0.01) and sleep (β = 0.94, p < 0.01). Conclusion: ECE educators are experiencing high stress/burnout, have poor health behaviors, and have high prevalence of obesity. Workplace health promotion efforts are needed to improve educators' health and potentially that of the children in their care.

The importance of establishing national surveillance systems to monitor physical activity promotion is well recognized. This article outlines the methodological process undertaken to develop an evaluation rubric for assessing state licensing regulations alignment with the National Physical Activity Plan Education Sector Early Childhood Education (ECE) strategy. This tool offers a cost-effective mechanism for ongoing surveillance of ECE physical activity policies, with the potential to inform modifications that promote uniform standards and establish consistent, high-quality opportunities for the nation's youngest children.

Background: Although racial, ethnic minorities, and immigrants are more likely to have poor diet-related health outcomes, few studies have compared children's dietary quality across diverse households, which is the formative step to designing targeted interventions. The current study evaluates and compares the dietary quality of young children from diverse racial, ethnic, and immigrant households in Nebraska. Methods: Cross-sectional survey data were collected from adults living in Nebraska with at least one 2-6-year-old child residing in their household via an online survey regarding their federal assistance program participation and dietary quality of child(ren) residing in their household, measured using the short Healthy Eating Index (sHEI). Results: With nearly two-third participating in a federal assistance program, the sample includes respondents from diverse households (n = 1,277) including first-generation immigrant (n = 61), non-immigrant Hispanic (n = 538), non-immigrant non-Hispanic White (n = 509), non-immigrant non-Hispanic Black or African American (n = 120), and non-Hispanic American Indian or Native Hawaiian (n = 49). Based on analysis of covariance controlling for demographic variables, children from immigrant households had lower mean sHEI score 43.9 as compared to non-immigrant Hispanic 46.4, non-immigrant non-Hispanic White 47.1, non-immigrant non-Hispanic Black or African American 50.2, and non-Hispanic American Indian or Native Hawaiian 48.9. Racial/ethnic/immigrant household group differences were also observed for some sHEI component scores. Conclusions: Children from immigrant and non-immigrant Hispanic households had significantly lower sHEI scores on some subcomponents compared with other groups. Findings emphasize the need for additional research and culturally responsive multilevel nutrition interventions.

Background: There is need to identify evidence-based early childhood obesity prevention programs that are feasible and demonstrate cost-effectiveness for a broader health impact. This scale-out study leveraged community-engaged principles to compare the feasibility and cost-effectiveness of three delivery modes of a childhood obesity prevention family meals program (Simple Suppers) that demonstrated positive impacts on child and caregiver diet/nutritional health-related outcomes in a previous experimental trial tested among elementary-aged children. Methods: This three-arm (in-person, online, hybrid) pre-(T0) and post-(T1)-test study included families recruited from Head Start. Forty-five families (45 caregivers; 55 children) completed the study. The program was adapted to families with younger children (3-5 years). During the 8-week program, participants received weekly group education and meals through in-person, online, or hybrid format. Feasibility outcomes were attendance, acceptability (post-test survey; focus groups), fidelity, and cost (food; staff). Participant outcomes were related to diet/nutritional health. Kruskal-Wallis test was used to compare T0 to T1 differences in participant outcomes across delivery modes. Qualitative data were analyzed using thematic analysis. Cost-effectiveness was calculated as the net-cost of the program by changes in outcomes. Results: Overall attendance was 51.2%, and higher for in-person (72.0%) and hybrid (59.7%). Program satisfaction rate was highest for hybrid (93.0%), as well as program fidelity (96.7%). Focus group results revealed areas of program improvement, behavior change, and program approval. Cost was lowest for hybrid ($17.09/family). Children in the hybrid group had a reduced waist circumference (p = 0.02) versus in-person and online groups. Conclusion: The hybrid mode of Simple Suppers demonstrated the greatest scaling potential for a broader public health impact.

Background: Early childhood education and care (ECEC) settings are key for improving health behaviors, including physical activity (PA) and nutrition. In 2017, the province of British Columbia (BC) implemented a provincial-level Active Play policy supported by a capacity-building intervention. Significant improvements in all PA policies and practices and the majority of nutrition policies were observed post-implementation. The purpose of this study was to understand if PA and nutrition policies and practices were maintained at 5+ years post-provincial policy implementation. Methods: This study employed a repeated cross-sectional design to distribute surveys querying about PA and nutrition policies and practices to ECEC centers across BC at three time points: time 1, prior to implementation of the Active Play standard (2016-2017) and capacity-building intervention, time 2, 1-2 years post-implementation (2018-2019), and time 3, 5+ years post-implementation (2022-2023). Results: The majority of PA and all nutrition policies were maintained from time 2 (n = 378) to time 3 (n = 639). Prevalence of policies related to the provision of activities that address fundamental movement skills (odds ratio [OR] = 0.30) and total amount of active play (OR = 0.56) significantly decreased from time 2 to time 3. All reported PA practice prevalence levels decreased to time 1 levels. Conclusions: Center-level health behavior policies were largely maintained 5 years post-implementation, except some PA policies and practices returned to pre-implementation levels. Staff capacity and turnover as well as change in implementation support may explain these changes. Ongoing implementation support is needed to ensure maintenance of health promoting policies and practices in ECEC.

Background: Although positive coparenting, or how parents relate during childrearing, is known to support children's socioemotional development, the role of coparenting in supporting children's healthy eating and growth is poorly understood. This study examined associations between coparenting quality, the home food environment, and young children's body mass index (BMI). Methods: Cross-sectional data were obtained from 290 mothers and their 3-year-old children who participated in the Sprout study. Mothers who indicated they had a coparent in their household completed surveys to assess coparenting quality, food parenting practices, family mealtime routines and structure, and home food availability. Mothers also reported the foods served at two typical meals, and a healthy meal index (HMI) score was calculated to assess the nutritional quality of meals. Children's height and weight were measured and used to calculate BMI z-scores (BMIz). Results: Mothers who reported more positive coparenting also reported providing children more guidance for healthy eating (β = 0.15, p < 0.001), less use of food to control children's emotions (β = -0.15, p < 0.01), less use of food as a reward (β = -0.27, p < 0.01), more structured mealtimes (β = 0.22, p < 0.001), and more household availability of fruits and vegetables (β = 0.11, p < 0.01). Mothers who reported greater coparent agreement on childrearing also had children with lower BMIz (β = -0.11, p = 0.03). Mothers who reported greater endorsement of their partner's childrearing competency had a higher mean HMI score (β = 1.82, p < 0.01). Conclusion: Among dual-parent, highly resourced families with young children, stronger coparenting practices were associated with several food-related parenting practices that support healthy eating and weight among young children.

Background: During summer, children may meet fewer 24 hours Movement Guidelines (24 hr-MGs) [moderate-vigorous physical activity (PA): ≥60 minutes/day, screen time: ≤2 hours/day, sleep: 9-11 hours/day) compared with the school year. Structured environments within community settings (e.g., summer programs) support guideline adherence. Information about the relationship between structured home environments and 24 hr-MGs is needed. This mixed-methods study examined which features of the family, home, and community environment supported children in meeting 24 hr-MGs during the school year and summer. Methods: Children's PA and sleep data were estimated from wrist-worn accelerometry, and screen time was assessed via parent-reported nightly surveys (14 days) at two time points [school year: (March-April) and summer (July-August) of 2021]. Parents completed a survey at each time point with 13 measures of the family (e.g., screen time rules), home (e.g., bed sharing), and community (e.g., summer program enrollment) environment. Multilevel mixed effect logistic regression estimated the odds of meeting 24 hr-MGs at each time point. Parents (n = 20) completed a qualitative interview and thematic analysis revealed parents perceived facilitators and barriers to guideline adherence. Results: Summer program enrollment and bedtime rules were associated with greater odds of meeting the PA [odds ratios (ORs): 4.9, 95% confidence intervals (CIs): (1.4, 17.1)] and ≥two 24 hr-MGs [OR: 2.2, 95 CI: (1.2, 4.0)] during summer, respectively. Parents perceived family rules/routines supported guideline adherence and lack of access to summer programs was a barrier. Conclusions: Structured environments at home and in the community can support children in meeting 24 hr-MGs guidelines. Interventions that expand access to summer programming and encourage implementation of structured home routines may support meeting multiple 24 hr-MGs during summer.

Background: Family style meal service is a nationally endorsed best practice. However, implementation in family child care homes (FCCHs) is low because child care providers are worried that it could increase plate waste. To examine this perceived barrier, the study aims to investigate the association between family style meal service and plate waste in FCCHs in Nebraska. Methods: In this cross-sectional study, the participants included FCCH providers (n = 46) in Nebraska and 3-5-year-old children attending these FCCH settings (n = 146). Providers were given a family style meal service score using 11 items from the Mealtime Observation in Child Care tool. Children's plate waste data over the observed lunchtime were collected using the Dietary Observation in Child Care method. We conducted multivariate, multilevel regression analyses in SAS (v9.4) to assess the relationship between family style meal service score and children's plate waste, while controlling for child-level characteristics and accounting for FCCH setting-level effects (ICCs 11.3%-31.2%). Results: Increase in family style meal service score was associated with a decrease in vegetable waste (B = -4.7, p = 0.03), fruit waste (B = -3.6, p = 0.03), and protein waste (B = -4.2, p = 0.02). Dairy and grain waste were not associated with family style meal service score. Conclusions: A higher family style meal service score was associated with a 3%-5% reduction in plate waste for three food groups. These findings warrant further research examining the effect of interventions promoting family style meal service in child care on improving children's dietary intake and reducing plate waste.

Background: Early childhood interventions that support the development of healthy lifestyle behaviors are key to ensuring equitable health outcomes later in life. The aim of this article is to assess the extent to which early care and education (ECE) sites adopt best practices to support healthy diet and physical activity (PA) behaviors and whether adoption differs between centers and family child care homes (FCCHs). Methods: The study is a cross-sectional analysis of best practices at Supplemental Nutrition Assistance Program-Education (SNAP-Ed)-eligible child care centers (n = 76) and FCCHs (n = 47) in California. Generalized linear models were used to estimate associations of facility type with eight best practice index measures in the following three areas: dietary intake (nutrition education, food and beverage quality, staff training in nutrition), PA (quantity of PA opportunities, quality of PA opportunities, environmental support for PA), and parent engagement and wellness policies (comprehensive, active parent engagement and support for wellness policy implementation, monitoring, and feedback). Results: Overall, ECE sites scored an average of 64.8% of maximum points possible for best practices to improve dietary intake, 81.7% for best practices to improve PA, and 51.8% in comprehensive parent engagement and wellness policies. FCCHs adhered to fewer best practices for robust nutrition education, relative to centers (β = -0.41, 95% CI [-0.70, -0.12]). Differences were also observed in individual practices between settings. Conclusion: This study highlights opportunities for programs such as SNAP-Ed to support ECE providers in implementing nutrition and PA best practices to help children ages 0-5 develop healthy habits.

Background: Child overweight and obesity is a critical global health issue with substantial individual and societal impacts necessitating early intervention to establish healthy habits. Health promoting early childhood education (ECE) settings are important as most young children attend ECEs in high- and middle-income countries. Nutrition and Physical Activity Self-Assessment for Child Care (NAPSACC) is an evidence-based approach to support improvements to ECE environment for improving child health. While adapting proven child obesity prevention interventions from other countries offers efficiency, the process is frequently underreported and insufficiently documented. Methods: Guided by the ADAPT framework, this article describes the adaptation of NAPSACC in the United States (US), Australia (AU), and the United Kingdom (UK) from 2012 to 2023. Contextual differences in ECE systems in the US, AU, and UK and reflections on the process of adaptation were explored. Results: NAPSACC was successfully adapted, maintaining core theoretical components while allowing for implementation flexibility to meet varying contexts. The iterative adaptation process revealed that a flexible dynamic approach was essential for maintaining the relevance and effectiveness of the NAPSACC intervention in different contexts. Conclusions: Our experience highlights the importance of ongoing iteration, international collaboration, research, and responsiveness to evolving circumstances in adaptation processes. Strong and flexible leadership, such as that demonstrated by NAPSACC's founder, Dr. Dianne S. Ward, facilitates successful adaptation and continuous improvement of public health programs. Trial registration: This paper includes multiple registered trials - NCT02889198, ACTRN12619001158156, ISRCTN16287377, and ISRCTN33134697.