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Abstract Objective: To evaluate the impact of a menu box delivery service tailored to the long-day care (LDC) setting on improving menu compliance with recommendations, children’s diet quality and dietary intake while in care. Design: A cluster randomised controlled trial in LDC centres randomly assigned to an intervention (menu box delivery) or comparison (menu planning training) group. The primary outcome was child food provision and dietary intake. Secondary outcomes include menu compliance and process evaluation, including acceptability, fidelity and menu cost (per child, per day). Setting: South Australian LDC centres. Participants: Eight LDC centres (n 224 children) provided data. Results: No differences were observed in serves/d between intervention and comparison centres, for provision (intervention, 0·9 inter-quartile range (IQR) 0·7–1·2; comparison, 0·8 IQR 0·5–1·3) or consumption (intervention, 0·5 IQR 0·2–0·8; comparison, 0·5 IQR 0·3–0·9) of vegetables. Child food provision and dietary intake were similar across both groups for all food groups (P < 0·05). At follow-up, all intervention centres met menu planning guidelines for vegetables, whereas only one comparison centre met guidelines. Intervention centre directors found the menu box delivery more acceptable than cooks. Cost of the intervention was AUD$2·34 greater than comparison centres (intervention, AUD$4·62 (95 % CI ($4·58, $4·67)); comparison, AUD$2·28 (95 % CI ($2·27, $2·30)) per child, per day). Conclusions: Menu compliance can be improved via a menu delivery service, delivering equivalent impacts on child food provision and dietary intake compared with an online training programme. Further exploration of cooks acceptability and cost is essential before scaling up to implementation.

Abstract Objective: To describe environmentally sustainable (ES) and healthy food provision practices in childcare services in Victoria, Australia. Design: Cross-sectional study. Setting: Childcare services providing food onsite. Participants: Staff completed an online survey that explored ES food provision practices including purchasing seasonal/local food, food waste awareness/management, and food cost/child/d. A purposively sampled subgroup conducted weighed audits to determine compliance with guidelines and total waste, serving waste (prepared, not served) and plate waste. Results: Survey results found 8 % of services (n 129) had previously conducted food waste audits. Service audits (n 12) found 27 % total food waste (range: 9 % - 64 %). Statistically significant differences in plate waste were found between services who had previously conducted food waste audits (7 %) and those who had not (17 %) (P = 0·04). The most common ES practice was ‘providing seasonal food’; the least common was ‘maintaining a compost system’ and ‘less packaged foods’. Most services (95 %) purchased foods from supermarkets with 23 % purchasing from farmers’ markets. This was statistically lower for regional/rural services (8 %), compared to metropolitan services (27 %) (P = 0·04). Twenty-seven per cent of services spent AUD2·50 or less per child per day on food. Only one audited service provided a menu compliant with childcare food provision guidelines. Conclusions: Childcare settings procure and provide large volumes of food; however, food waste awareness appears limited, and environmentally sustainable food procurement practices may be less affordable and difficult to achieve. Understanding the impact of food waste awareness on food waste practices and food costs across time merits further research.

Objective: To evaluate the impact of a menu box delivery service tailored to the long-day care (LDC) setting on improving menu compliance with recommendations, children's diet quality and dietary intake while in care. Design: A cluster randomised controlled trial in LDC centres randomly assigned to an intervention (menu box delivery) or comparison (menu planning training) group. The primary outcome was child food provision and dietary intake. Secondary outcomes include menu compliance and process evaluation, including acceptability, fidelity and menu cost (per child, per day). Setting: South Australian LDC centres. Participants: Eight LDC centres (n 224 children) provided data. Results: No differences were observed in serves/d between intervention and comparison centres, for provision (intervention, 0·9 inter-quartile range (IQR) 0·7–1·2; comparison, 0·8 IQR 0·5–1·3) or consumption (intervention, 0·5 IQR 0·2–0·8; comparison, 0·5 IQR 0·3–0·9) of vegetables. Child food provision and dietary intake were similar across both groups for all food groups (P < 0·05). At follow-up, all intervention centres met menu planning guidelines for vegetables, whereas only one comparison centre met guidelines. Intervention centre directors found the menu box delivery more acceptable than cooks. Cost of the intervention was AUD$2·34 greater than comparison centres (intervention, AUD$4·62 (95 % CI ($4·58, $4·67)); comparison, AUD$2·28 (95 % CI ($2·27, $2·30)) per child, per day). Conclusions: Menu compliance can be improved via a menu delivery service, delivering equivalent impacts on child food provision and dietary intake compared with an online training programme. Further exploration of cooks acceptability and cost is essential before scaling up to implementation. [ABSTRACT FROM AUTHOR]

Objective: To describe environmentally sustainable (ES) and healthy food provision practices in childcare services in Victoria, Australia. Design: Cross-sectional study. Setting: Childcare services providing food onsite. Participants: Staff completed an online survey that explored ES food provision practices including purchasing seasonal/local food, food waste awareness/management, and food cost/child/d. A purposively sampled subgroup conducted weighed audits to determine compliance with guidelines and total waste, serving waste (prepared, not served) and plate waste. Results: Survey results found 8 % of services (n 129) had previously conducted food waste audits. Service audits (n 12) found 27 % total food waste (range: 9 % - 64 %). Statistically significant differences in plate waste were found between services who had previously conducted food waste audits (7 %) and those who had not (17 %) (P = 0·04). The most common ES practice was 'providing seasonal food'; the least common was 'maintaining a compost system' and 'less packaged foods'. Most services (95 %) purchased foods from supermarkets with 23 % purchasing from farmers' markets. This was statistically lower for regional/rural services (8 %), compared to metropolitan services (27 %) (P = 0·04). Twenty-seven per cent of services spent AUD2·50 or less per child per day on food. Only one audited service provided a menu compliant with childcare food provision guidelines. Conclusions: Childcare settings procure and provide large volumes of food; however, food waste awareness appears limited, and environmentally sustainable food procurement practices may be less affordable and difficult to achieve. Understanding the impact of food waste awareness on food waste practices and food costs across time merits further research. [ABSTRACT FROM AUTHOR]

Abstract Objective: The federal Child and Adult Care Food Program (CACFP) sets minimum nutrition and portion size standards for meals served in participating childcare programs. CACFP has been associated with more nutritious meals served. It is unclear, however, whether CACFP results in children’s dietary intake being aligned with national recommendations. We assess whether children’s dietary intake in CACFP-participating childcare centres meets benchmarks set by the Dietary Guidelines for Americans (DGA). Design: This is a cross-sectional study. We used direct observation to estimate quantities of foods/beverages served and consumed per child. Mean amounts served per child per day were compared with CACFP portion size requirements for each component (fruits, vegetables, milk and meat/meat alternate). Mean amounts of foods/beverages consumed were compared with DGA recommendations (energy content, fruits, vegetables, whole/refined grains, dairy, protein and added sugars). One sample t-tests evaluated if quantities served and consumed were different from CACFP and DGA standards, respectively. Setting: Six CACFP-participating childcare centres. Participants: 2–5 year-old children attending childcare. Results: We observed forty-six children across 166 child meals. Most meals served met CACFP nutrition standards. Compared with CACFP portion size standards, children were served more grains at breakfast and lunch; more fruits/vegetables at lunch but less at breakfast and snack and less dairy at all eating occasions. Compared with DGA recommendations, children under-consumed every food/beverage category except grains during at least one eating occasion. Conclusions: Children were served quantities of foods/beverages mostly consistent with CACFP portion size requirements, but had sub-optimal intake relative to DGA. More research is needed to help children consume healthy diets in childcare.

Objective: The federal Child and Adult Care Food Program (CACFP) sets minimum nutrition and portion size standards for meals served in participating childcare programs. CACFP has been associated with more nutritious meals served. It is unclear, however, whether CACFP results in children's dietary intake being aligned with national recommendations. We assess whether children's dietary intake in CACFP-participating childcare centres meets benchmarks set by the Dietary Guidelines for Americans (DGA). Design: This is a cross-sectional study. We used direct observation to estimate quantities of foods/beverages served and consumed per child. Mean amounts served per child per day were compared with CACFP portion size requirements for each component (fruits, vegetables, milk and meat/meat alternate). Mean amounts of foods/beverages consumed were compared with DGA recommendations (energy content, fruits, vegetables, whole/refined grains, dairy, protein and added sugars). One sample t-tests evaluated if quantities served and consumed were different from CACFP and DGA standards, respectively. Setting: Six CACFP-participating childcare centres. Participants: 2–5 year-old children attending childcare. Results: We observed forty-six children across 166 child meals. Most meals served met CACFP nutrition standards. Compared with CACFP portion size standards, children were served more grains at breakfast and lunch; more fruits/vegetables at lunch but less at breakfast and snack and less dairy at all eating occasions. Compared with DGA recommendations, children under-consumed every food/beverage category except grains during at least one eating occasion. Conclusions: Children were served quantities of foods/beverages mostly consistent with CACFP portion size requirements, but had sub-optimal intake relative to DGA. More research is needed to help children consume healthy diets in childcare. [ABSTRACT FROM AUTHOR]

Abstract Objective: This study assessed the level of fathers’ involvement in childcare activities and its association with the diet quality of their children in Northern Ghana. Setting: The study was carried out in the Northern, Upper East and Upper West regions of Ghana. The people in the study area mostly depend on agriculture as their main occupation. Design: A community-based comparative analytical cross-sectional study. Participants: A sample of 422 rural mother–father pairs who had at least one child aged 6–36 months. Results: The overall level of fathers’ involvement in childcare and feeding activities was high among 63·5 % of the respondents in the 6 months prior to the study. The most common childcare activity men were involved in was providing money for the purchase of food for the child. Minimum acceptable diet was higher for children with a higher level of paternal involvement in childcare activities (adjusted OR = 3·33 (95 % CI: 1·41, 7·90)), compared to their counterparts whose father’s involvement was poor. Fathers who had a positive attitude to childcare and feeding were 2·9 more likely to get involved in childcare activities (adjusted OR = 2·90 (95 % CI: 1·87, 4·48)). Conclusions: The findings confirm earlier studies that show that fathers’ involvement in childcare activities including feeding is positively associated with improved child feeding practices. The findings point to the need to have a policy shift in which both men and women are key actors in interventions designed to improve child nutritional status in rural settings of Northern Ghana.

Abstract Objective: To test a culturally tailored obesity prevention intervention in low-income, minority preschool age children. Design: A three-group clustered randomised controlled trial. Setting: Twelve Head Start centres were randomly assigned to a centre-based intervention, a combined centre- and home-based intervention, or control using a 1:1:1 ratio. The centre-based intervention modified centre physical activity and nutrition policies, staff practices, and child behaviours, while the home-based intervention supported parents for obesity prevention at home. Study outcomes: The primary end point was change in children’s BMI (kg/m2) at post-test immediately following completion of the 8-month intervention. Secondary end points included standardised scores for BMI (BMIz) and body weight (WAZ), and BMI percentiles (BMI pctl). Participants: Three-year-old children enrolled in Head Start in San Antonio, Texas, with written parent consent (n 325), 87 % Latino, 57 % female with mean age (sd) of 3·58 years (0·29). Results: Change in BMI at post-test was 1·28 (0·97), 1·28 (0·87) and 1·41 (0·71) in the centre + home-based intervention, centre-based intervention and control, respectively. There was no significant difference in BMI change between centre + home-based intervention and control or centre-based intervention and control at post-test. BMIz (adjusted difference –0·12 (95 % CI, –0·24, 0·01), P = 0·06) and WAZ (adjusted difference, –0·09 (–0·17, –0·002), P = 0·04) were reduced for children in centre + home-based intervention compared with control group. Conclusions: There was no reduction in BMI at post-test in children who received the intervention. Findings shed light on methodological challenges in childhood obesity research and offer future directions to explore health equity-oriented obesity prevention.

Objective: This study assessed the level of fathers' involvement in childcare activities and its association with the diet quality of their children in Northern Ghana. Setting: The study was carried out in the Northern, Upper East and Upper West regions of Ghana. The people in the study area mostly depend on agriculture as their main occupation. Design: A community-based comparative analytical cross-sectional study. Participants: A sample of 422 rural mother–father pairs who had at least one child aged 6–36 months. Results: The overall level of fathers' involvement in childcare and feeding activities was high among 63·5 % of the respondents in the 6 months prior to the study. The most common childcare activity men were involved in was providing money for the purchase of food for the child. Minimum acceptable diet was higher for children with a higher level of paternal involvement in childcare activities (adjusted OR = 3·33 (95 % CI: 1·41, 7·90)), compared to their counterparts whose father's involvement was poor. Fathers who had a positive attitude to childcare and feeding were 2·9 more likely to get involved in childcare activities (adjusted OR = 2·90 (95 % CI: 1·87, 4·48)). Conclusions: The findings confirm earlier studies that show that fathers' involvement in childcare activities including feeding is positively associated with improved child feeding practices. The findings point to the need to have a policy shift in which both men and women are key actors in interventions designed to improve child nutritional status in rural settings of Northern Ghana. [ABSTRACT FROM AUTHOR]

Objective: Test a culturally tailored obesity prevention intervention in low-income, minority preschool-age children.Design: A three-group clustered randomized controlled trial.Setting: Twelve Head Start Centers were randomly assigned to a center-based intervention, a combined center- and home-based intervention, or control using a 1:1:1 ratio. The center-based intervention modified center physical activity and nutrition policies, staff practices, and child behaviors, while the home-based intervention supported parents for obesity prevention at home.Study Outcomes: The primary endpoint was change in children's body mass index (BMI; kg/m2) at posttest immediately following completion of the 8-month intervention. Secondary endpoints included standardized scores for BMI (BMIz) and body weight (WAZ), and BMI percentiles (BMI pctl).Participants: Three-year-old children enrolled in Head Start in San Antonio, Texas, with written parent consent (N=325), 87% Latino; 57% female with mean age (SD) of 3.58 years (0.29).Results: Change in BMI at posttest was 1.28 (0.97), 1.28 (0.87), and 1.41 (0.71) in the center+home-based intervention, center-based intervention, and control, respectively. There was no significant difference in BMI change between center+home-based intervention and control or center-based intervention and control at posttest. BMIz (adjusted difference -0.12 [95% CI, -0.24 to 0.01], p = .06) and WAZ (adjusted difference, -0.09 [-0.17 to -0.002], p = .04) were reduced for children in center+home-based intervention compared to control group.Conclusions: There was no reduction in BMI at posttest in children who received the intervention. Findings shed light on methodological challenges in childhood obesity research and offer future directions to explore health equity-oriented obesity prevention. [ABSTRACT FROM AUTHOR]

Objective: To explore government support service access, perceived barriers/enablers to menu planning and menu compliance in long day care (LDC) centres in Victoria, Australia, where the Victorian Government-funded Healthy Eating Advisory Service (HEAS) is available to provide free LDC menu planning support. Design: This is a cross-sectional study design. Data were collected from online surveys with the option of uploading 2 weeks of menus and recipes. Menu compliance was scored for quantity, quality and variety. Barriers/enablers to menu planning guideline implementation were determined using the Theoretical Domains Framework (TDF). Independent t tests, one-way ANOVA and chi-square tests assessed relationships between characteristics, barriers/enablers and menu scores. Setting: Eighty-nine LDC centres that prepare food onsite. Participants: LDC staff responsible for menu planning (n 89) and menus from eighteen centres. Results: Fifty-five per cent of centres had accessed HEAS. Of eighteen provided menus, only one menu was compliant with menu planning guidelines. HEAS access was associated with higher average scores in four of seven TDF domains, namely knowledge/awareness, skills/role, reinforcement/influence and optimism/intent. There were no correlations between menu score and barriers/enablers; however, menu quality scores were higher for those accessing HEAS. Conclusions: Childcare-specific government support services may be an important public health nutrition strategy and may improve menu planning guideline implementation as well as menu quality; however, this does not necessarily translate into menu compliance. Research should confirm these findings in larger studies to ascertain uptake of these services. Public health efforts should focus on exploring barriers and enablers to uptake of government support services to increase reach and acceptability. [ABSTRACT FROM AUTHOR]

Objective: To determine whether the 'Read for Nutrition' programme would increase liking and consumption of broccoli (a target vegetable) in preschool children and test acceptability and practicality of the programme. Design: Pilot pre-post intervention study, where childcare teachers received training and coaching followed by reading the book 'Monsters Don't Eat Broccoli' multiple times with the children during a three-week intervention. Setting: Five classrooms of Educare, Lincoln, Nebraska in 2018. Participants: Sixty-nine (11 to 16 children per classroom) preschool-aged children and sixteen teachers (minimum, three per classroom). Results: Average total consumption of broccoli increased 35 % (0·14 ounces or 0·05th cup) after the 'Read for Nutrition' programme (t = 2·66; P = 0·01; 95 % CIs (0·035, 0·246)) for all children. Proportional consumption increased for children who received ≥ five exposures to the book (t46 = 2·77; P = 0·008). Exposures to the book predicted proportional consumption (β = 0·365; P = 0·002). Liking of broccoli increased (W69 = 2·2, P = 0·03) as well. Teachers rated the programme as acceptable, practical and enjoyable to children and to themselves. Conclusions: Programmes such as 'Read for Nutrition' have the potential to improve children's vegetable liking and consumption in early care and education settings with only book readings and no exposure to a real vegetable. [ABSTRACT FROM AUTHOR]

Objective: To examine the association between the amount of time spent at childcare and diet quality in 668 Japanese children aged 1·5–6 years. Design: A cross-sectional design was used. Dietary information was collected using dietary records (1 d for children aged 1·5–2 years and 2 d for children aged 3–6 years). Diet quality was assessed by counting the number of nutrients not meeting the Japanese Dietary Reference Intakes (DRI). Each child's guardian reported the average amount of time spent at childcare per d for the previous 1 month. Setting: In total, 315 childcare centres located in twenty-four areas in Japan. Participants: In total, 753 children aged 1·5–6 years who attend childcare facilities. Results: After adjustment for potential confounders, OR for the low diet quality (≥ 5 of twenty nutrients not meeting DRI) in long (≥10 h/d) v. medium (8–10 h/d) childcare hours was 4·81 (95 % CI 1·96, 11·8) among children aged 5–6 years. There was no significant association in children aged 1·5–2 and 3–4 years. Conclusion: This study showed that long time spent at childcare was strongly associated with low diet quality among children aged 5–6 years, but not those aged 1·5–2 and 3–4 years. More research is needed to clarify different associations in each age group. [ABSTRACT FROM AUTHOR]

Objective: To examine associations between childcare type and nutrition and oral health indicators.Design: Cross-sectional data extracted from a longitudinal birth cohort. Parent-completed FFQ and questions regarding oral health and childcare use. The associations between childcare type, classified into four groups: parent care only (PCO), formal childcare only (FCO), informal childcare only (ICO) or combination of care (F&I), and nutrition and oral health indicators were examined.Setting: Home and childcare.Participants: Families with children aged 3 years (n 273) and 4 years (n 249) in Victoria, Australia.Results: No associations were observed between childcare type and core food/beverage consumption or oral health indicators. For discretionary beverages, compared with children receiving PCO at age 3 years, children in FCO or F&I were less likely to frequently consume fruit juice/drinks (FCO: adjusted OR (AOR) 0·41, 95 % CI 0·17, 0·96, P = 0·04; F&I: AOR 0·32, 95 % CI 0·14, 0·74, P = 0·008). At age 4 years, children receiving FCO or ICO were less likely to consume sweet beverages frequently compared with children receiving PCO: fruit juice/drink (ICO: AOR 0·42, 95 % CI 0·19, 0·94, P = 0·03; FCO: AOR 0·35, 95 % CI 0·14, 0·88, P = 0·03) and soft drink (ICO: AOR 0·23, 95 % CI 0·07, 0·74, P = 0·01; FCO: AOR 0·14, 95 % CI 0·03, 0·76, P = 0·02).Conclusions: Associations between childcare type and discretionary beverage intake were observed. Investigation into knowledge, attitudes and activities in formal and informal childcare settings is required to explore different health promotion practices that may influence nutrition and oral health. [ABSTRACT FROM AUTHOR]

Objective: To examine the association between the amount of time spent at childcare and diet quality in 668 Japanese children aged 1·5-6 years.Design: A cross-sectional design was used. Dietary information was collected using dietary records (1 d for children aged 1·5-2 years and 2 d for children aged 3-6 years). Diet quality was assessed by counting the number of nutrients not meeting the Japanese Dietary Reference Intakes (DRI). Each child's guardian reported the average amount of time spent at childcare per d for the previous 1 month.Setting: In total, 315 childcare centres located in twenty-four areas in Japan.Participants: In total, 753 children aged 1·5-6 years who attend childcare facilities.Results: After adjustment for potential confounders, OR for the low diet quality (≥ 5 of twenty nutrients not meeting DRI) in long (≥10 h/d) v. medium (8-10 h/d) childcare hours was 4·81 (95 % CI 1·96, 11·8) among children aged 5-6 years. There was no significant association in children aged 1·5-2 and 3-4 years.Conclusion: This study showed that long time spent at childcare was strongly associated with low diet quality among children aged 5-6 years, but not those aged 1·5-2 and 3-4 years. More research is needed to clarify different associations in each age group. [ABSTRACT FROM AUTHOR]

Objective: To (i) describe the adaptation of the Short Food Survey (SFS) for assessing the dietary intake of children (2-5 years) during attendance at Early Childhood Education and Care (SFS-ECEC); (ii) determine the acceptability and feasibility of the SFS-ECEC; and (iii) compare the SFS-ECEC to direct observations for assessing dietary intake of children in care.Design: The adapted forty-seven-item SFS-ECEC was completed by childcare educators to capture individual child's usual intake over the past month. Acceptability and feasibility were assessed via educator self-report and completion rates. Mean servings of food groups consumed in accordance with dietary guidelines reported in the SFS-ECEC were compared to those obtained by a single-day direct observation via visual estimation conducted by trained personnel. Mean differences, intra-class correlations, Bland-Altman plots, percentage agreement and Cohen's κ were examined.Setting: Early Childhood Education and Care, NSW, Australia.Participants: Educators and children.Results: 213 (98·61 %) SFS-ECECs were returned. Acceptability was high with 86·54 % of educators reporting the tool as easy to understand. Mean differences in servings of food groups between the SFS-ECEC and direct observation were statistically significantly different for five out of six foods and ranged 0·08-1·07, with intra-class correlations ranging 0·00-0·21. Agreement between the methods in the classification of children meeting or not meeting dietary guidelines ranged 42·78-93·01 %, with Cohen's κ ranging -0·03 to 0·14.Conclusions: The SFS-ECEC is acceptable and feasible for completion by childcare educators. While tool refinement and further validation is warranted, small mean differences suggest the tool may be useful in estimating group-level intakes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the Child and Adult Care Food Program (CACFP) rule that allows a meat/meat alternative to replace the breakfast grain requirement three times per week. Design: A 5-week menu including breakfast, lunch and snack was developed with meat/meat alternative replacing the breakfast grain requirement three times per week. Menu nutrients based on the minimum requirements were compared with reference values representing the Acceptable Macronutrient Distribution Range for fat and a range of reference values representing two-thirds the Dietary Reference Intake for 3-year-olds and 4–5-year-olds. The meal pattern minimum requirements were compared with two-thirds of those recommended by the Dietary Guidelines for Americans (DGA). Setting: Evaluation took place between April and June 2019. Participants: Human subjects were not utilized. Results: The CACFP minimum grain requirement is well below the DGA reference value (0·5–1·5 v. 3·33 ounce-equivalents). Energy (2208·52 kJ) was below the reference values (3126·83–4362·53 kJ). Protein (34·43 g) was above the reference values (9·87–10·81 g). Carbohydrate (76·65 g), fibre (7·46 g) and vitamin E (1·69 mg) were below their reference values of 86·67 g, 10·46–14·60 g and 4–4·76 mg, respectively. Fat (22·57 %) was below the reference range (25–40 %). Conclusions: The CACFP rule which allows a meat/meat alternative to replace the breakfast grain requirement three times per week may result in meal patterns low in energy, carbohydrate, fat, fibre and vitamin E, while providing an excessive amount of protein. [ABSTRACT FROM AUTHOR]

Objective: To determine the acceptability, internal consistency and test-retest reliability of self-efficacy, motivation and knowledge scales relating to pre-school children's nutrition, oral health and physical activity.Design: An online questionnaire was completed twice with an interval of 7-11d.Setting: Online questionnaires were sent to participants via email from nursery managers. The parent questionnaire was also available on the parenting website www.netmums.com.ParticipantsEighty-two parents and sixty-nine nursery staff from Bristol, UK who had and worked with 2-4-year-olds, respectively.Results: Response rates were 86·3 and 86·0 % and missing data 15·9 and 14·5 % for the second administration of the parent and nursery staff questionnaires, respectively. Weighted κ coefficients for individual items mostly fell under the 'moderate' agreement category for the parental (75·0 %) and nursery staff (55·8 %) items. All self-efficacy and motivation scales had acceptable levels of internal consistency (Cronbach's α coefficients>0·7). The intraclass correlation coefficients for the self-efficacy, motivation and knowledge scales ranged between 0·48 and 0·82. Paired t tests found an increase between test and retest knowledge scores for the Nutrition Motivation (t=-2·91, df=81, P=0·00) and Knowledge (t=-3·22, df=81, P=0·00) scales in the parent questionnaire.Conclusions: Our findings demonstrate that the items and scales show good acceptability, internal consistency and test-retest reliability. [ABSTRACT FROM AUTHOR]

Objective: Mothers' return to work and childcare providers' support for feeding expressed human milk are associated with breast-feeding duration rates in the USA, where most infants are regularly under non-parental care. The objective of the present study was to explore Florida-based childcare centre administrators' awareness and perceptions of the Florida Breastfeeding Friendly Childcare Initiative.Design: Semi-structured interviews were based on the Consolidated Framework for Implementation Research and analysed using applied thematic analysis.Setting: Childcare centre administrators in Tampa Bay, FL, USA, interviewed in 2015.ParticipantsTwenty-eight childcare centre administrators: female (100 %) and Non-Hispanic White (61 %) with mean age of 50 years and 13 years of experience.Results: Most administrators perceived potential implementation of the Florida Breastfeeding Friendly Childcare Initiative as simple and beneficial. Tension for change and a related construct (perceived consumer need for the initiative) were low, seemingly due to formula-feeding being normative. Perceived financial costs and relative priority varied. Some centres had facilitating structural characteristics, but none had formal breast-feeding policies.Conclusions: A cultural shift, facilitated by state and national breast-feeding-friendly childcare policies and regulations, may be important for increasing tension for change and thereby increasing access to breast-feeding-friendly childcare. Similar to efforts surrounding the rapid growth of the Baby Friendly Hospital Initiative, national comprehensive evidence-based policies, regulations, metrics and technical assistance are needed to strengthen state-level breast-feeding-friendly childcare initiatives. [ABSTRACT FROM AUTHOR]

Objective: Evidence suggests that improvements to the childcare nutrition environment can have a positive impact on child dietary intake. The primary aim of the present study was to assess, relative to usual care, the effectiveness of a multi-strategy implementation intervention in improving childcare compliance with nutrition guidelines. As a secondary aim, the impact on child dietary intake was assessed.Design: Parallel-group, randomised controlled trial design. The 6-month intervention was designed to overcome barriers to implementation of the nutrition guidelines that had been identified by applying the theoretical domains framework.Setting: Hunter New England region, New South Wales, Australia.Subjects: Forty-five centre-based childcare services.Results: There were no differences between groups in the proportion of services providing food servings (per child) compliant with nutrition guideline recommendations for all five (5/5) food groups at follow-up (i.e. full compliance). Relative to control services, intervention services were more likely to be compliant with guidelines (OR; 95 % CI) in provision of fruit (10·84; 1·19, 551·20; P=0·0024), meat and meat alternatives (8·83; 1·55, -; P=0·023), dairy (8·41; 1·60, 63·62; P=0·006) and discretionary foods (17·83; 2·15, 853·73; P=0·002). Children in intervention services consumed greater servings (adjusted difference; 95 % CI) of fruit (0·41; 0·09, 0·73; P=0·014) and vegetables (0·70; 0·33, 1·08; P<0·001).Conclusions: Findings indicate that service-level changes to menus in line with dietary guidelines can result in improvements to children's dietary intake. The study provides evidence to advance implementation research in the setting as a means of enhancing child public health nutrition. [ABSTRACT FROM AUTHOR]

Objective: Children's dietary intake impacts weight status and a range of short- and long-term health outcomes. Accurate measurement of factors that influence children's diet is critical to the development and evaluation of interventions designed to improve children's diets. The purpose of the current paper is to present the development of the Table Talk observational tool to measure early care and education teachers' (ECET) verbal feeding communications.Design: An observational tool to assess ECET verbal communication at mealtimes was deigned based on the extant literature. Trained observers conducted observations using the tool during lunch for both lead and assistant ECET. Descriptive statistics, test-retest for a subgroup, interclass correlations for each item, and comparisons between leads and assistants were conducted.Setting: Head Start centres, Southern USA.Subjects: Seventy-five Head Start educators.Results: On average, 17·2 total verbal feeding communications (sd 8·9) were observed per ECET. For lead ECET, the most prevalent Supportive Comment was Exploring Foods whereas for assistants Making Positive Comments was the most prevalent. Overall, lead ECET enacted more Supportive Comments than assistant ECET (F(2,72)=4·8, P=0·03). The most common Unsupportive Comment was Pressuring to Eat, with a mean of 3·8 (sd 4·3) and a maximum of 25. There was no difference in Unsupportive Comments between lead and assistant ECET.Conclusions: Table Talk may be a useful tool to assess verbal feeding communications of ECET, with potential applications such as informing ECET training and assessing intervention efforts. [ABSTRACT FROM AUTHOR]

Objective: The National Early Care and Education Learning Collaboratives (ECELC) Project aims to promote healthy physical activity and nutrition environments, policies and practices in early care and education (ECE) programmes across multiple states. The present pilot study sought to assess changes to the physical activity and nutrition practices in a sub-sample of ECE programmes participating in the ECELC using the Environment and Policy Assessment and Observation (EPAO). Additionally, it sought to compare results with the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC).Design: Quasi-experimental pre-post pilot study where paired-sample t tests examined changes to physical activity and nutrition practices from pre-assessment to post-assessment (P<0·05). Pearson correlation coefficients examined change scores from EPAO compared with NAP SACC with statistical significance set at a two-sided α level of P<0·10 to account for sample size.Setting: The study occurred among ECE programmes.Subjects: Pre-school classrooms in nineteen ECE programmes across four US states were observed.Results: EPAO data demonstrated an increase in total score from pre-assessment to post-assessment (150 (sd 30) to 176 (sd 35)). NAP SACC change scores demonstrated little relationship with EPAO domain change scores, with exceptions in Nutrition Policy and Physical Activity Policy (r=-0·4 and -0·6, respectively).Conclusions: The overall improvements reported through the EPAO suggest participation in the ECELC resulted in changes in critical nutrition- and physical activity-related practices. However, considerable differences in data reported using the NAP SACC compared with the EPAO suggest subjective data should be interpreted with caution and objective measurement should be used when feasible. [ABSTRACT FROM AUTHOR]

Objective: Test a culturally tailored obesity prevention intervention in low-income, minority preschool-age children., Design: A three-group clustered randomized controlled trial., Setting: Twelve Head Start Centers were randomly assigned to a center-based intervention, a combined center- and home-based intervention, or control using a 1:1:1 ratio. The center-based intervention modified center physical activity and nutrition policies, staff practices, and child behaviors, while the home-based intervention supported parents for obesity prevention at home., Study Outcomes: The primary endpoint was change in children's body mass index (BMI; kg/m 2 ) at posttest immediately following completion of the 8-month intervention. Secondary endpoints included standardized scores for BMI (BMIz) and body weight (WAZ), and BMI percentiles (BMI pctl)., Participants: Three-year-old children enrolled in Head Start in San Antonio, Texas, with written parent consent (N=325), 87% Latino; 57% female with mean age (SD) of 3.58 years (0.29)., Results: Change in BMI at posttest was 1.28 (0.97), 1.28 (0.87), and 1.41 (0.71) in the center+home-based intervention, center-based intervention, and control, respectively. There was no significant difference in BMI change between center+home-based intervention and control or center-based intervention and control at posttest. BMIz (adjusted difference -0.12 [95% CI, -0.24 to 0.01], p = .06) and WAZ (adjusted difference, -0.09 [-0.17 to -0.002], p = .04) were reduced for children in center+home-based intervention compared to control group., Conclusions: There was no reduction in BMI at posttest in children who received the intervention. Findings shed light on methodological challenges in childhood obesity research and offer future directions to explore health equity-oriented obesity prevention.

Objective: This study assessed the level of fathers' involvement in childcare activities and its association with the diet quality of their children in Northern Ghana., Setting: The study was carried out in the Northern, Upper East and Upper West regions of Ghana. The people in the study area mostly depend on agriculture as their main occupation., Design: A community-based comparative analytical cross-sectional study., Participants: A sample of 422 rural mother-father pairs who had at least one child aged 6-36 months., Results: The overall level of fathers' involvement in childcare and feeding activities was high among 63·5 % of the respondents in the 6 months prior to the study. The most common childcare activity men were involved in was providing money for the purchase of food for the child. Minimum acceptable diet was higher for children with a higher level of paternal involvement in childcare activities (adjusted OR = 3·33 (95 % CI: 1·41, 7·90)), compared to their counterparts whose father's involvement was poor. Fathers who had a positive attitude to childcare and feeding were 2·9 more likely to get involved in childcare activities (adjusted OR = 2·90 (95 % CI: 1·87, 4·48))., Conclusions: The findings confirm earlier studies that show that fathers' involvement in childcare activities including feeding is positively associated with improved child feeding practices. The findings point to the need to have a policy shift in which both men and women are key actors in interventions designed to improve child nutritional status in rural settings of Northern Ghana.

Objective: To determine whether the 'Read for Nutrition' programme would increase liking and consumption of broccoli (a target vegetable) in preschool children and test acceptability and practicality of the programme., Design: Pilot pre-post intervention study, where childcare teachers received training and coaching followed by reading the book 'Monsters Don't Eat Broccoli' multiple times with the children during a three-week intervention., Setting: Five classrooms of Educare, Lincoln, Nebraska in 2018., Participants: Sixty-nine (11 to 16 children per classroom) preschool-aged children and sixteen teachers (minimum, three per classroom)., Results: Average total consumption of broccoli increased 35 % (0·14 ounces or 0·05th cup) after the 'Read for Nutrition' programme (t = 2·66; P = 0·01; 95 % CIs (0·035, 0·246)) for all children. Proportional consumption increased for children who received ≥ five exposures to the book (t46 = 2·77; P = 0·008). Exposures to the book predicted proportional consumption (β = 0·365; P = 0·002). Liking of broccoli increased (W69 = 2·2, P = 0·03) as well. Teachers rated the programme as acceptable, practical and enjoyable to children and to themselves., Conclusions: Programmes such as 'Read for Nutrition' have the potential to improve children's vegetable liking and consumption in early care and education settings with only book readings and no exposure to a real vegetable.