Nutrition and physical activity randomized control trial in child care centers improves knowledge, policies, and children's body mass index

Abbey Alkon, Angela A Crowley, Sara E Benjamin Neelon, Sherika Hill, Yi Pan, Viet Nguyen, Roberta Rose, Eric Savage, Nina Forestieri, Linda Shipman, Jonathan B Kotch, Abbey Alkon, Angela A Crowley, Sara E Benjamin Neelon, Sherika Hill, Yi Pan, Viet Nguyen, Roberta Rose, Eric Savage, Nina Forestieri, Linda Shipman, Jonathan B Kotch

Abstract

Background: To address the public health crisis of overweight and obese preschool-age children, the Nutrition And Physical Activity Self Assessment for Child Care (NAP SACC) intervention was delivered by nurse child care health consultants with the objective of improving child care provider and parent nutrition and physical activity knowledge, center-level nutrition and physical activity policies and practices, and children's body mass index (BMI).

Methods: A seven-month randomized control trial was conducted in 17 licensed child care centers serving predominantly low income families in California, Connecticut, and North Carolina, including 137 child care providers and 552 families with racially and ethnically diverse children three to five years old. The NAP SACC intervention included educational workshops for child care providers and parents on nutrition and physical activity and consultation visits provided by trained nurse child care health consultants. Demographic characteristics and pre - and post-workshop knowledge surveys were completed by providers and parents. Blinded research assistants reviewed each center's written health and safety policies, observed nutrition and physical activity practices, and measured randomly selected children's nutritional intake, physical activity, and height and weight pre- and post-intervention.

Results: Hierarchical linear models and multiple regression models assessed individual- and center-level changes in knowledge, policies, practices and age- and sex-specific standardized body mass index (zBMI), controlling for state, parent education, and poverty level. Results showed significant increases in providers' and parents' knowledge of nutrition and physical activity, center-level improvements in policies, and child-level changes in children's zBMI based on 209 children in the intervention and control centers at both pre- and post-intervention time points.

Conclusions: The NAP SACC intervention, as delivered by trained child health professionals such as child care health consultants, increases provider knowledge, improves center policies, and lowers BMI for children in child care centers. More health professionals specifically trained in a nutrition and physical activity intervention in child care are needed to help reverse the obesity epidemic.

Trial registration: National Clinical Trials Number NCT01921842.

Figures

Figure 1
Figure 1
CONSORT flow diagram.

References

    1. Ogden C, Carroll M, Kit B, Flegal K. Prevalence of obesity and trends in Body Mass Index among US children and adolescents, 1999–2010. JAMA. 2012;307:483–490. doi: 10.1001/jama.2012.40.
    1. Nadar P, O'Brien M, Houts R, Bradley J, Belsky J, Crosnoe R, Friedman S, Mei Z, Susman E. Identifying risk for obesity in early childhood. Pediatrics. 2006;118:e594–e601. doi: 10.1542/peds.2005-2801.
    1. Barlow S. Expert Committee Recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007;120(Supplement 4):S164–S192.
    1. Natale R, Scott SH, Messiah SE, Schrack MM, Uhlhorn SB, Delamater A. Design and methods for evaluating an early childhood obesity prevention program in the childcare center setting. BMC Public Health. 2013;13:78. doi: 10.1186/1471-2458-13-78.
    1. Larson N, Ward D, Benjamin Neelon S, Story M. What role can child-care settings play in obesity prevention? A review of the evidence and call for research efforts. J Am Diet Assoc. 2011;111:1343–1362. doi: 10.1016/j.jada.2011.06.007.
    1. National Association of Child Care Resource and Referral Agencies (NACCRRA) Child Care in America: 2010 State Fact Sheets. Washington DC; 2010.
    1. Ward D, Benjamin SE, Ammerman AS, Ball SC, Neelon BH, Bangdiwala SI. Nutrition and physical activity in child care: results from an environmental intervention. Am J Prev Med. 2008;35(4):352–356. doi: 10.1016/j.amepre.2008.06.030.
    1. Wolfenden L, Neve M, Farrell L, Lecathelinais C, Bell C, Milat A, Wiggers J, Sutherland R. Physical activity policies and practices of childcare centers in Australia. J Paediatr Child Health. 2009;47:73–76.
    1. Trost S, Messner L, Fitzgerald K, Roths B. Nutrition and physical activity policies and practices in family child care homes. Am J Prev Med. 2009;37:537–540. doi: 10.1016/j.amepre.2009.09.020.
    1. Benjamin Neelon S, Vaughn A, Ball S, McWilliams C, Ward D. Nutrition practices and mealtime environments of North Carolina child care centers. Childhood Obesity. 2012;8:216–223.
    1. Ball SC, Benjamin SE, Ward DS. Development and reliability of an observation method to assess food intake of young children in child care. J Am Diet Assoc. 2007;107:656–661. doi: 10.1016/j.jada.2007.01.003.
    1. American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. Caring for our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs. 3. Elk Grove Village, IL; 2011.
    1. Glickman D, Parker L, Sim L, Del Valle Cook H, Miller E, editor. Institute of Medicine. Accelerating Progress on Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press; 2012.
    1. Erinosho T, Dixon L, Young C, Brotman L, Hayman L. Nutrition practices and children's dietary intakes at 40 child-care centers in New York City. J Am Diet Assoc. 2011;111:1391–1397. doi: 10.1016/j.jada.2011.06.001.
    1. Sigman-Grant M, Christiansen E, Fernandez G, Fletcher J, Johnson SL, Branen L, Price BA. Child care provider training and a supportive feeding environment in child care settings in 4 states, 2003. Prev Chronic Dis. 2011;8:A113.
    1. Benjamin S, Ammerman AS, Sommers JK, Dodds JM, Neelon BH, Ward D. Nutrition and physical activity self-assessment for child care (NAP SACC): results from a pilot intervention. J Nutr Educ Behav. 2007;39(3):142–149. doi: 10.1016/j.jneb.2006.08.027.
    1. Butte N, Fox MK, Briefel RR, Siega-Riz AM, Dwyer JT, Deming DM, Reidy KC. Nutrient intakes of US infants, toddlers, and preschoolers meet or exceed dietary reference intakes. J Am Diet Assoc. 2010;110(12 Suppl):S27–S37.
    1. Vernarelli J, Mitchell D, Hartman R, Rolls B. Dietary energy density is associated with body weight status and vegetable intake in U.S. children. J Nutr. 2011;141:2204–2210. doi: 10.3945/jn.111.146092.
    1. O'Connor T, Yang S, Nicklas T. Beverage intake among preschool children and its effect on weight status. Pediatrics. 2006;118:e1010–e1018. doi: 10.1542/peds.2005-2348.
    1. Oliver M, Schofield G, Kolt G. Physical activity in preschoolers: understanding prevalence and measurement issues. Sports Med. 2007;37:1045–1070. doi: 10.2165/00007256-200737120-00004.
    1. Reilly J. Low levels of objectively measured physical activity in preschoolers in child care. Med Sci Sports Exerc. 2010;42:502–507.
    1. Pate RR, McIver K, Dowda M, Brown W, Addy C. Directly observed physical activity levels in preschool children. J Sch Health. 2008;78:438–444. doi: 10.1111/j.1746-1561.2008.00327.x.
    1. Dowda M, Brown WH, McIver KL, Pfeiffer KA, O'Neill JR, Addy CL, Pate RR. Policies and characteristics of the preschool environment and physical activity of young children. Pediatrics. 2009;123(2):261–266. doi: 10.1542/peds.2008-2498.
    1. Herman A, Nelson B, Teutsch C, Chung P. "Eat Healthy, Stay Active!": a coordinated intervention to improve nutrition and physical activity among Head Start parents, staff, and children. Am J Health Promot. 2012;27(1):e27–e36. doi: 10.4278/ajhp.110412-QUAN-157.
    1. Fitzgibbon M, Stolley MR, Van Horn L, Kaufer-Christoffel K, Dyer A. Two-year follow-up results for Hip-Hop to Health Jr: a randomized controlled trial for overweight prevention in preschool minority children. J Pediatr. 2005;146:618–625. doi: 10.1016/j.jpeds.2004.12.019.
    1. Fitzgibbon M, Stolley MR, Schiffer LA, Braunschweig CL, Gomez SL, Van Horn L, Dyer A. Hip-Hop to Health Jr. obesity prevention effectiveness trial: postintervention results. Obesity. 2011;19:994–999. doi: 10.1038/oby.2010.314.
    1. Fitzgibbon M, Stolley MR, Schiffer L, Van Horn L, Kaufer-Christoffel K, Dyer A. Hip-Hop to Health Jr. for Latino preschool children. Obesity. 2006;14(9):1616–1625. doi: 10.1038/oby.2006.186.
    1. Yin Z, Parra-Medina D, Cordova A, He M, Trummer V, Sosa E, Gallion KJ, Sintes-Yallen A, Huang Y, Wu X, Acosta D, Kibbe D, Ramirez A. Miranos! Look at us, we are healthy! An environmental approach to early childhood obesity prevention. Childhood Obesity. 2012;8:429–439.
    1. Bruening K, Gilbride J, Passannante M, McClowry S. Dietary intake and health outcomes among young children attending 2 urban day-care centers. J Am Diet Assoc. 1999;99:1529–1535. doi: 10.1016/S0002-8223(99)00375-2.
    1. Winter S, Sass D. Healthy & Ready to Learn: examing the efficacy of an early approach to obesity prevention and school readiness. J Res Child Educ. 2011;25:304–325.
    1. Ammerman A, Ward DS, Benjamin SE, Ball SC, Sommers JK, Molloy M, Dodds JM. An intervention to promote healthy weight: nutrition and physical activity self-assessment for child care (NAP SACC) theory and design. Prev Chronic Dis. 2007;4:1–12.
    1. Drummond R, Staten LK, Sanford MR, Davidson CL, Ciocazan MM, Khor K-N, Kaplan F. Steps to a healthlier Arizona. A pebble in the pond: the ripple effect of an obesity prevention intervention targeting the child care environment. Health Promot Pract. 2009;10:156S–167S. doi: 10.1177/1524839908331267.
    1. Let’s Move: America’s move to raise a healthier generation of kids. [ ]
    1. Cianciolo S, Trueblood-Noll R, Allingham P. Health consultation in early childhood settings. Young Children. 2004;59:56–61.
    1. Crowley AA. Child care health consultation: an ecological model. J Soc Pediatr Nurs. 2001;6:170–181. doi: 10.1111/j.1744-6155.2001.tb00241.x.
    1. Isbell P, Kotch JB, Savage E, Gunn E, Lu LS, Weber DJ. Improvement of child care programs’ health and safety policies, and practices, and children’s access to health care linked to child care health consultation. NHSA Dialog: Res Pract J . 2013;16:34–52.
    1. Alkon A, Bernzweig J, To K, Wolff M, Mackie J. Child care health consultation improves health and safety policies and practices. Acad Pediat. 2009;9:366–370. doi: 10.1016/j.acap.2009.05.005.
    1. NAPSACC. Nutrition and Physical Activity Self Assessment for Child Care. [ ]
    1. Office of the Assistant Secretary for Planning and Evaluation. Prior HHS poverty guidelines and Federal Register references. [ ]
    1. American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care. Caring for our Children: National Health and Safety Performance Standards; Guidelines for Out-of-Home Child Care Programs. 2. Elk Grove Village, IL; 2002.
    1. Brown W, Pfeiffer KA, McIver KL, Dowda M, Almeida J, Pate RR. Assessing preschool children's physical activity: the observational system for recording physical activity in children - preschool version. Res Q Exerc Sport. 2006;77:167–176.
    1. Salomon K. Respiratory sinus arrhythmia during stress predicts resting respiratory sinus arrhythmia 3 years later in a pediatric sample. Health Psychol. 2005;24:68–76.
    1. Alkon A, Boyce WT, Davis NV, Eskenazi B. Developmental changes in autonomic nervous system resting and reactivity measures in Latino children from 6 to 60 months of age. J Dev Behav Pediatr. 2011;32:668–677. doi: 10.1097/DBP.0b013e3182331fa6.
    1. A SAS Program for the CDC Growth Charts. [ ]
    1. Kuczmarski F, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, Mei R, Curtin FL, Roche AF, Johnson CL. 2000 CDC Growth Charts for the Unisted States: methods and development. Vital and Health Statistics Series 11. 2002;246:1–190.
    1. SAS Institute, Inc. SAS/STAT 9.2 User’s Guide. 2. Cary, NC; 2009.
    1. Organizational Research Services. Pilot Evaluation Report, Executive Summary, Healthy Child Care Washington. Seattle, WA; 2003.
    1. Institute of Medicine. Early Childhood Obesity Prevention Policies. Washington, DC: The National Academies Press; 2011.
    1. Crowley A, Kulikowich J. Impact of training in child care health consultant knowledge and practice. Pediatr Nurs. 2009;35:93–100.
    1. Hanna H, Mathews F, Southward LH, Cross GW, Kotch J, Blanchard T, Cosby AG. Use of paid child care health care consultants in early care and education settings: results of a national study comparing provision of health screening services among Head Start and non-Head Start centers. J Pediatr Health Care. 2012;26:427–435. doi: 10.1016/j.pedhc.2011.05.008.
    1. Copeland K, Sherman S, Kendeigh C, Kalkwarf H, Saelens B. Societal values and policies may curtail preschool children's physical activity in child care centers. Pediatrics. 2012;129:265–274. doi: 10.1542/peds.2011-2102.
    1. Copeland K, Sherman SN, Khoury JC, Foster KE, Saelens BE, Kalkwarf HJ. Wide variability in physical activity environments and weather related outdoor play policies in child care centers within a single county of Ohio. Arch Pediat Adol Med. 2011;165:435–442.
    1. Brotman L, Dawson-McClure S, Huang K-Y, Theise R, Kamboukos D, Wang J, Petkova E, Ogedegbe G. Early childhood family intervention and long-term obesity prevention among high-risk minority youth. Pediatrics. 2012;129:e621–e628. doi: 10.1542/peds.2011-1568.
    1. Sisson S, Campbell JE, May KB, Brittain DR, Monroe LA, Guss SH, Ladner JL. Assessment of food, nutrition, and physical activity practices in Oklahoma child-care centers. J Acad Nutr Diet. 2012;112:1230–1240. doi: 10.1016/j.jand.2012.05.009.
    1. Whitaker R, Gooze R, Hughes C, Finkelstein D. A national survey of obesity prevention practices in Head Start. Arch Pediat Adol Med. 2009;163:1144–1150.
    1. Bower J, Hales DP, Tate DF, Rubin DA, Benjamin SE, Ward DS. The childcare environment and children's physical activity. Am J Prev Med. 2008;34:23–29. doi: 10.1016/j.amepre.2007.09.022.
    1. Waters E, de Silva-Sanigorski A, Burford BJ, Brown T, Campbell KJ, Gao Y, Armstrong R, Prosser L, Summerbell CD. Interventions for preventing obesity in children. Cochrane Database Syst Rev. 2011. Issue 12. Art. No.: CD001871. DOI:10.1002/14651858.CD001871.pub3.
    1. Benjamin S, Cradock A, Walker E, Slining M, Gillman M. Obesity prevention in child care: a review of U.S. state regulations. BMC Public Health. 2008;8:188. doi: 10.1186/1471-2458-8-188.
    1. Mendez J. How can parents get involved in preschool? Barriers and engagement in education by ethnic minority parents of children attending Head Start. Cult Divers Ethn Min. 2010;16:26–36.
    1. Ward D, Vaughn A, Story M. Expert and stakeholder consensus on priorities for obesity prevention research in early care and education settings. Childhood Obesity. 2013;9:116–124.

Source: PubMed

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