Search

Purpose: Quality rating and improvement systems (QRIS) are systems approaches to assist states in providing high quality early childhood education. Texas Rising Star (TRS), a voluntary QRIS, exceeds state licensing standards and meets some obesity prevention guidelines. This study examines differences in physical activity, screen time, and outdoor policies and practices by QRIS certification.Design: Cross-sectional.Setting: Online.Sample: After exclusion criteria, respondents were 431 Texas childcare centers.Measures: 2016 survey of policies and Go NAPSACC best practices.Analysis: Chi-square and t-tests indicated differences in 1) practices and 2) policies by QRIS status.Results: TRS-certified centers reported more policies for physical activity (M= 4.57 ± 3.07 vs. 3.61 ± 2.95, p= 0.009) and screen time (M= 1.91 ± 1.84 vs. 1.28 ± 1.56, p< 0.001) than non-certified centers. TRS-certified centers reported significantly higher frequencies for 7 of 14 physical activity practices, however no significant differences for screen time practices were found. Additionally, TRS-certified centers reported more outdoor practices, including more classrooms/storage (p< 0.001) and vegetable gardens (p= 0.025).Conclusion: TRS-certified centers reported more physical activity policies and practices, more screen time policies, and more outdoor practices. TRS certification was not associated with screen time practices. QRIS can be a practical way to insert obesity prevention in early care and education. Using items from a widely used survey enables comparisons, however future research is needed in larger-scale studies. Some COVID-19 implications are discussed.

AbstractBackground:This study presents the impact of a 2-year implementation of Coordinated Approach to Child Health Early Childhood (CATCH EC), a preschool-based healthy nutrition and physical activity program, on child BMI z-scores, BMI percentiles, diet, physical activity, and sedentary behaviors among 3- to 5-year old children across Head Start centers in Houston and Austin, Texas.Methods:We used a quasi-experimental study design with serial cross-sectional data collection (Intervention catchment area: n= 12 centers, 353 parent-child dyads in Year 1; n= 12 centers, 365 parent-child dyads; Comparison catchment area: n= 13 centers in year 1, 319 parent child dyads; and n= 12 centers, 483 parent-child dyads in year 2). Child height and weight were measured and parent self-report surveys were conducted at year 1 (fall 2012) and year 2 (spring 2014).Results:In year 1, 34.8% of the children were overweight or obese, 74% were Hispanic, and >80% reported an annual household income of <$25,000. In year 2, 32.2% were overweight or obese, 72% were Hispanic, and 82.3% reported an annual income of <$25,000. Results demonstrated significantly lower child BMI z-scores [β = −0.26 (95% confidence interval, CI: −0.50 to −0.01), p= 0.041] and BMI percentiles [β = −6.5 (95% CI: −12.4 to −0.69), p= 0.028] from year 1 to 2 follow-up among those in intervention Head Start centers, compared to those in the comparison centers. There were no significant between-group changes in child dietary, physical activity, or screen time behaviors.Conclusion:Implementation of a preschool-based obesity prevention program can be modestly effective in lowering the prevalence of child overweight in low-income populations.

abstractBackground: U.S. preschool children consume inadequate amounts of key nutrients. Understanding the contents of lunches packed by parents and consumed by their children can help identify areas of opportunity for the development of healthy food preferences.Objective: To evaluate the nutrient adequacy of lunches packed by parents and consumed by children attending early care and education (ECE) centers.Methods: Baseline data from 607 parent–child dyads in the “Lunch Is in the Bag” cluster-randomized controlled trial in Central Texas were examined. Foods packed by parents and consumed by children in sack lunches were observed at 30 ECE centers on 2 nonconsecutive days. Mean levels of energy, macronutrients, vitamins, and minerals were estimated with covariate-adjusted multilevel regression models that accounted for center-level clustering and repeated within-child measures.Results: Energy (kilocalories) was 602.48 for packed lunches compared to 374.40 for consumed lunches. In packed lunches, percentage of energy as macronutrients for protein (14.8%), carbohydrate (55.9%), and total fat (31.2%) were within the acceptable macronutrient distribution range (AMDR) for the children's ages. Sugar (28.9% of energy) was above the AMDR recommendation. Only a quarter of parents packed 33% or more of the child's dietary reference intake (DRI) for dietary fiber. Over half the parents packed 33% or more of the DRI for vitamin A and calcium, and less than one in 8 packed 33% of the DRI for potassium. Children consistently consumed between 60 and 80% of the nutrients that were packed.Conclusions: Preschool children rely on parents to present them with healthy food choices, but lunches packed by parents for their preschool children do not consistently provide adequate nutrients. These data and the relationships between the dietary quality of packed and consumed lunches can be useful information to guide nutrition behavior change through targeted interventions.

Purpose: Using the Academy of Nutrition and Dietetics benchmarks as a framework, this study examined childcare providers’ (Head Start [HS], Child and Adult Care Food Program [CACFP] funded, and non-CACFP) perspectives regarding communicating with parents about nutrition to promote children’s health.Design: Qualitative.Setting: State-licensed center-based childcare programs.Participants: Full-time childcare providers (n = 18) caring for children 2 to 5 years old from varying childcare contexts (HS, CACFP funded, and non-CACFP), race, education, and years of experience.Methods: In-person interviews using semi-structured interview protocol until saturation were achieved. Thematic analysis was conducted.Results: Two overarching themes were barriers and strategies to communicate with parents about children’s nutrition. Barriers to communication included—(a) parents are too busy to talk with providers, (b) parents offer unhealthy foods, (c) parents prioritize talking about child food issues over nutrition, (d) providers are unsure of how to communicate about nutrition without offending parents, and (e) providers are concerned if parents are receptive to nutrition education materials. Strategies for communication included—(a) recognize the benefits of communicating with parents about nutrition to support child health, (b) build a partnership with parents through education, (c) leverage policy (federal and state) to communicate positively and avoid conflict, (d) implement center-level practices to reinforce policy, and (e) foster a respectful relationship between providers and parents.Conclusion: Policy and environmental changes were recommended for fostering a respectful relationship and building a bridge between providers and parents to improve communication about children’s nutrition and health.

The top two oral diseases (tooth decay and gum disease) are preventable, yet dental caries is the most common childhood disease with 68% of children entering kindergarten having tooth decay. CATCH Healthy Smiles is a coordinated school health program to prevent cavities for students in kindergarten, 1st, and 2nd grade, and is based on the framework of Coordinated Approach to Child Health (CATCH), an evidence-based coordinated school health program. CATCH has undergone several cluster-randomized controlled trials (CRCT) demonstrating sustainable long-term effectiveness in incorporating the factors surrounding children, in improving eating and physical activity behaviors, and reductions in obesity prevalence among low-income, ethnically diverse children. The aim of this paper is to describe the design of the CATCH Healthy Smiles CRCT to determine the effectiveness of an oral health school-based behavioral intervention in reducing incidence of dental caries among children.

Almost one third of preschoolers spend regular time in child care centers where they can consume the majority of their daily dietary intake. The child care setting influences children’s dietary intake. Thus, it is important to examine factors, such as local and state regulations, that influence the food environment at the center. This qualitative study explored directors’ perceptions of how regulations influence the foods available at child care centers. Ten directors of centers in Travis County, Texas, completed semistructured interviews. Directors reported that changes in local health department regulations (eg, kitchen specifications) result in less healthful foods being served (eg, more prepackaged foods). Directors of centers that do not participate in the federal Child and Adult Care Food Program (CACFP) said the state licensing regulations clarify the portion size and nutritional requirements for preschoolers, thereby improving the nutritional quality of the food served. Directors of centers participating in CACFP said they are not affected by state mandates, because the CACFP regulations are more stringent. These findings suggest that state regulations that specify and quantify nutritional standards may beneficially influence preschoolers’ diets. However, local health department regulations enacted to improve food safety may negatively influence the nutritional value of food served in centers.

AbstractBackground:The Texas Childhood Obesity Research Demonstration project (TX CORD) uses a systems-oriented approach to address obesity that includes individual and family interventions, community-level action, as well as environmental and policy initiatives. Given that randomization is seldom possible in community-level intervention studies, TX CORD uses a quasi-experimental design. Comparable intervention and comparison study sites are needed to address internal validity bias.Methods:TX CORD was designed to be implemented in low-income, ethnically diverse communities in Austin and Houston, Texas. A three-stage Geographical Information System (GIS) methodology was used to establish and ascertain the comparability of the intervention and comparison study sites. Census tract (stage 1) and school (stage 2) data were used to identify spatially exclusive geographic areas that were comparable. In stage 3, study sites were compared on demographic characteristics, socioeconomic status (SES), food assets, and physical activity (PA) assets. Student's t-test was used to examine significant differences between the selected sites.Results:The methodology that was used resulted in the selection of catchment areas with demographic and socioeconomic characteristics that fit the target population: ethnically diverse population; lower-median household income; and lower home ownership rates. Additionally, the intervention and comparison sites were statistically comparable on demographic and SES variables, as well as food assets and PA assets.Conclusions:This GIS approach can provide researchers, program evaluators, and policy makers with useful tools for both research and practice. Area-level information that allows for robust understanding of communities can enhance analytical procedures in community health research and offer significant contributions in terms of community assessment and engagement.

AbstractBackground:There is consensus that development and evaluation of a systems-oriented approach for child obesity prevention and treatment that includes both primary and secondary prevention efforts is needed. This article describes the study design and baseline data from the Texas Childhood Obesity Research Demonstration (TX CORD) project, which addresses child obesity among low-income, ethnically diverse overweight and obese children, ages 2–12 years; a two-tiered systems-oriented approach is hypothesized to reduce BMI z-scores, compared to primary prevention alone.Methods:Our study aims are to: (1) implement and evaluate a primary obesity preventionprogram; (2) implement and evaluate efficacy of a 12-month family-centered secondary obesity preventionprogram embedded within primary prevention; and (3) quantify the incremental cost-effectiveness of the secondary prevention program. Baseline demographic and behavioral data for the primary prevention community areas are presented.Results:Baseline data from preschool centers, elementary schools, and clinics indicate that most demographic variables are similar between intervention and comparison communities. Most families are low income (≤$25,000) and Hispanic/Latino (73.3–83.8%). The majority of parents were born outside of the United States. Child obesity rates exceed national values, ranging from 19.0% in preschool to 35.2% in fifth-grade children. Most parents report that their children consume sugary beverages, have a television in the bedroom, and do not consume adequate amounts of fruits and vegetables.Conclusions:Interventions to address childhood obesity are warranted in low-income, ethnically diverse communities. Integrating primary and secondary approaches is anticipated to provide sufficient exposure that will lead to significant decreases in childhood obesity.

OBJECTIVE To examine if reductions in added sugar intake or increases in fiber intake in response to a 16-week intervention were related to improvements in metabolic outcomes related to type 2 diabetes mellitus risk. DESIGN Secondary analysis of a randomized control trial. SETTING Intervention classes at a lifestyle laboratory and metabolic measures at the General Clinical Research Center. PARTICIPANTS Fifty-four overweight Latino adolescents (mean [SD] age, 15.5 [1] years). INTERVENTION Sixteen-week study with 3 groups: control, nutrition, or nutrition plus strength training. MAIN OUTCOME MEASURES Body composition by dual-energy x-ray absorptiometry; visceral adipose tissue by magnetic resonance imaging; glucose and insulin incremental area under the curve by oral glucose tolerance test; insulin sensitivity, acute insulin response, and disposition index by intravenous glucose tolerance test; and dietary intake by 3-day records. RESULTS Fifty-five percent of all participants decreased added sugar intake (mean decrease, 47 g/d) and 59% increased fiber intake (mean increase, 5 g/d), and percentages were similar in all intervention groups, including controls. Those who decreased added sugar intake had an improvement in glucose incremental area under the curve (−15% vs +3%; P = .049) and insulin incremental area under the curve (−33% vs −9%; P = .02). Those who increased fiber intake had an improvement in body mass index (−2% vs +2%; P = .01) and visceral adipose tissue (−10% vs no change; P = .03). CONCLUSIONS Individuals who reduced added sugar intake by the equivalent of 1 can of soda per day or increased fiber intake by the equivalent of a cup of beans showed improvements in key risk factors for type 2 diabetes, specifically in insulin secretion and visceral fat. Improvements occurred independent of group assignment and were equally likely to occur in control group participants. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00697580Arch Pediatr Adolesc Med. 2009;163(4):320-327--