Improving Nutrition and Physical Activity Environments in Home-Based Child Care

Co-Principal Investigators
Kim M. Gans, PhD, MPH, LDN
Patricia Risica, DrPH

National Institutes of Health (NIH) / National Heart, Lung and Blood Institute (NHLBI)

Grant Number

Improving nutrition and physical activity environments in home-based child care 

Child care facilities are prime settings for healthy eating and physical activity (PA) interventions with preschoolers because over 70% of U. S. children under the age of six attend out-of-home child care averaging 35 hours per week and consuming 50-75% of their daily calories there. Preschool years are critical times when dietary and PA behaviors are established. Unhealthy food and PA behaviors contribute to the high prevalence rates of childhood obesity and associated chronic diseases that disproportionately affect low-income and racial and ethnic minority children. Improving child care environments is a recommended strategy for improving children’s diets, PA and for preventing obesity; and childcare intervention studies have been shown to be effective. However these studies have predominantly used expensive experts to deliver the intervention and were time and labor-intensive. Moreover, almost all of these studies were conducted in childcare centers and not in family child care homes (FCCHs), which provide care for 25% of U.S. and 28% of R.I. preschoolers. FCCHs are less regulated than centers and most do not meet national nutrition or PA diet or PA recommendations and, family child care providers (FCCPs). They also have limited access to ‘best practices’ training or technical assistance. RI is in particular need of such interventions due to its recent C+ national childcare report card rating for its nutrition and PA regulations, and a recent state-wide survey of RI FCCPs also supports the need for, and interest in, childhood obesity prevention. Through the proposed research, our team will adapt components of previous evidence-based interventions to create a new innovative intervention in both English and Spanish to improve food and PA environments of FCCH. The intervention will integrate: a) support from peer counselors with child care experience who will serve as team leaders for groups of FCCPs; b) tailored print and video materials; and c) a set of portable active toys.  A cluster-randomized trial with 132 FCCHs will evaluate the effectiveness of the intervention with a Steering Committee and Community Advisory Board guiding all aspects. The Specific Aims of the study are to: 1) Conduct formative research to inform the development and adaptation of the FCCH intervention. 2) Conduct a cluster-randomized trial of the intervention’s efficacy with 66 FCCPs and a control intervention with 66 demographically-matched FCCPs to evaluate its impact on: a) Children’s overall dietary quality at FCCHs; b) Children’s PA and sedentary behaviors at FCCHs; and c) the physical and social food and PA environments of FCCHs. We will also conduct extensive mixed-methods process evaluation to determine fidelity, dose, acceptability, context, and unintended consequences; explore the relationship between outcome measures and intervention dose as well as with mediating/moderating variables, and explore the intervention effect on child BMI. If proven effective, this intervention has the potential to be replicated and widely disseminated throughout RI and the US, where improvements in the childcare environment are a high priority.