FCCH>Centers cooking foods children liked (63 versus 39%, ns) allowed children to eat less than they think they should (47 versus 29%, ns) Rarely/never allowed children to eat more than they thought they should (55 versus 27%, ns)
Ethnicity Hispanics less likely to eat meals with children (diff: 0.24, ; ); more likely to force children to eat what is “good for them” (). 3x more likely to cook foods they knew children liked () 50% insisted children finish food before leaving the table
Liu et al. [19], Maternal and Child Health Journal/2016/OH/cross-sectional survey
child care settings; 44% FCCHs; 56% centers
Modified NAPSACC and EPAO
FCCHs<Centers re policies Beverages only milk, water, and 100% fruit juice served; (47 versus 77%, ) <6 oz of 100% fruit juice/day served to ≥age 12 months (22 versus 43%, ) skim, 1 or 2% milk served >age 2 years (28 versus 50%, ) No eating/drinking outside foods (12 versus 31%, ) Use of food as punishment/reward cannot withhold/delay food/drinks as punishment; (44 versus 83%, ) cannot give food/drinks as a reward or an incentive (30 versus 48%, ) Authoritarian/controlling feeding interactions No forcing children to eat certain foods or quantities; (33 versus 55%, ) allowing children to decide how much to eat (25 versus 38%, ) Encouraged (not forced) to eat/taste food (30 versus 45%, )
FCCHs>Centers teach about food ≥1x/mos. (44 versus 27%, )
FCCHs<Centers not offering fried foods (38% versus 59%, )
Natale et al. [20], Early Childhood Education Journal/2014/FL/cross-sectional survey of baseline data
FCCHs; 842 center-based Provider/home b,cSES: Facilities’ zip code = 18.1% > 40% of household income <25K Children Race/ethnicity Enrollment 8.3% FCCHs predominantly black 45.8% FCCHs predominantly Hispanic
Modified HSFFQ
FCCHs>Centers provided more lessons with a basis in health and nutrition/week ()
FCCHs<Centers provided 1% milk >1x/day (45.2 versus 55%, ) FCCHs>Centers provided more fresh fruit (), limited servings of rolls/bread (28.1 versus 18.6%, )
Income zone of facility Adjusting for income zone: (ns associations between facility type and all other nutritional/dietary outcomes ()
Ritchie et al. [22], Childhood Obesity/2012/Multi-state/cross-sectional survey
FCCHs<state preschools, centers Used dietitian in menu planning (0% versus 19.1%, 4.2%, )
CACFP status CACFP and non-CACFP FCCHs>Centers served whole milk (). non-CACFP FCCHs>CACFP FCCHs served candy day before survey (15.8% versus 6.2, ) served sweetened drinks day before the survey (18.4% versus 7.7%, )
Ritchie et al. [23], Preventing Chronic Disease/2015/CA/cross-sectional survey in 2008 and 2012
child care sites (2008); 435 child care sites (2012); 65 CACFP homes; 38 non-CACFP homes
Adapted NAPSACC
FCCHs<Centers made water easily available to children for self-service indoors and outside (44.8% versus 73.1%, ) provided tap water ()
Tandon et al. [26], Journal of Nutrition Education and Behavior/2012/FL, MA, MI, WA/cross-sectional surveys
FCCHs; 74 center-based Provider Level of education: 28% HS grad, 21% some college, 51% 2 or 4 year college
NAPSACC
FCCHs + Centers = follow best practice recommendations for serving water at least daily + sugar sweetened beverages 66% FCCHs and centers offered 100% juice 3-4 times weekly
Tovar et al. [27], Appetite/2016/RI/Observational study
FCCHs; 214 observed meals and snack times; 227 child-provider interactions captured Provider Race/ethnicity: 75% African-American 19% white Gender: 100% female Level of education: 57% HS or associates, 40% Bachelors BMI: 77% obese 18% overweight Children BMI 67% normal weight 13% overweight 20% obese
Modified EPAO
Only plated meals served Response to verbal refuses of food 55% best feeding practices in response to verbal refuses 45% coercive controlling practices Response to nonverbal refuses of food both best practices and coercive controlling practices equally Response to verbal and non-verbal acceptance of food reacted to food acceptance with autonomy supportive practices > coercive controlling practices (43 versus 5 interactions) Response for seconds 85% responded with coercive controlling practices, esp. during lunch pressured children to clean their plates first to get seconds of certain foods some simply complied/offered bribes Being “all done” responded equally with coercive and best practices Pressuring children to eat more frequently observed Attempts for praise or attention frequently praised for trying new foods and eating certain foods
Trost et al. [30], American Journal of Preventive Medicine/2011/KS/cross-sectional survey
FCCHs; 85.3% CACFP participation Provider Level of education: 40.8% HS diploma or GED, 42.9% some college or Associate’s, 14.3% Bachelor degree
Foods served Fruits and vegetables 3.20 ± 0.4 Fried foods and high-fat meats 3.10 ± 0.3 Beverages 2.90 ± 0.5 Meals and snacks 3.70 ± 0.3 Foods outside of regular meals and snacks 2.00 ± 0.7 Supporting healthy eating 3.00 ± 0.5
Trost et al. [29], American Journal of Preventive Medicine/2009/KS/cross-sectional survey
FCCHs
NAPSACC
Written guidelines concerning type of foods brought for celebrations 18.6% (95% CI: 13.7, 23.4) comprehensive written policy on nutrition and food services 53.7% (95% CI: 47.6, 59.7)
Received nutrition training ≥1x/yr 47.5% (95% CI: 41.2, 53.8) offered nutrition education for children 46.9% (95% CI: 40.6, 53.2) offered nutrition education to parents 45.3% (95% CI: 39.1, 51.5)
Family-style meals 23% (95% CI: 17.7, 28.4)
Served lean meats >4x/wk 41.7% (95% CI: 35.4, 48) served 100% fruit juice >1x/day 55.8% (95% CI: 49.6, 62) Served 1% milk 13.9% (95% CI 9.7, 18.1) Infrequent use of healthy foods for celebrations 43.9% (95% CI: 37.6, 50.2)
Physical activity
Liu et al. [19], Maternal and Child Health Journal/2016/OH/cross-sectional survey
FCCHs; 56% centers
Modified NAPSACC and EPAO
FCCHs>Centers preschoolers engaged in 60 min of adult-led physical activity/day (33 versus 18%, ) required training on how to help children be physically active (78 versus 56%, ).
Natale et al. [20], Early Childhood Education Journal/2014/FL/cross-sectional survey of baseline data
FCCHs; 842 center-based child care Provider/home b,cSES: Facilities’ zip code = 18.1% > 40% of household income <25K Children Race/ethnicity: Enrollment: 8.3% FCCHs predominantly black 45.8% FCCHs predominantly Hispanic
ePAFQ
FCCHs<Centers provided outside PA for 30 min + /3x/wk. (92.9% versus 96.5%, ) rated excellent in amount of limiting TV/video (39.2%, 59.5 %, ) FCCHs>Centers reported higher levels of limiting computer time (63.9 versus 51.8%, )
Income zone of Facility Adjusting for income zone: sig. Differences remained b/t indoor physical activity, outdoor physical activity, and television-use practices ()
Rice and Trost [21], Journal of Nutrition Education and Behavior/2014/OR/accelerometer readings
FCCHs, 114 children (60 boys, 54 girls), 70% CACFP Provider Age: 2% less than 30, 44% 30–39, 54% greater than 40 Provider race 90% white, Mean yrs. of operation: 10 (IQR 5–15) Level of education 66% HS diploma or GED, 20% some college or associate degree, 15% Bachelor’s degree Children Avg. BMI 16.8 ± 202% overweight or obese: 29%
ActiGraph GT1M accelerometer
Avg. participation in MVPA and total PA 5.8 ± 3.2 and 10.4 ± 4.4 min/h, respectively
BMI overweight and obese 4-5 yr olds < healthy 4-5 yr olds MVPA and TPA () Gender Girls < boys exhibited MVPA and TPA ()
Tandon et al. [26], Journal of Nutrition Education and Behavior/2012/FL, MA, MI, WA/cross-sectional surveys
FCCHs; 74 center-based Provider Level of education: 28% HS grad, 21% some college, 51% 2 or 4 year college
NAPSACC
FCCHs<Centers variety of fixed-play equipment (76 versus 89%, ) variety of portable play equipment (86 versus 95%, ) rarely or never showed TV (29 versus 68% )
50% of preschoolers in FCCHs <1 hr/day outdoor play time
Tandon et al. [25], Academic Pediatrics/2012/cross-sectional analyses on longitudinal data
N = Overall (1900); Nonrelative in Child’s home (); Nonrelative in another home () Provider (nonrelative in child’s home, nonrelative in another home) Race: 85%, 82% white, 6%, 13% Black, 26%, 14% Hispanic Level of education 34, 37% HS or less 35, 45% some college 26, 14% college graduate 6, 4% graduate degree
ECLS-B
50% of home-based providers take the child outside to walk or play ≥1x/day Nonrelatives in home-based > relatives in homes Increased odds of going outside daily for children (OR 1.5, 95% CI 1.36–1.64). Nonrelative care in another home ≠ relative care Odds of outdoor play did not differ
Trost et al. [30], American Journal of Preventive Medicine/2011/KS/cross-sectional survey
FCCHs: 85.3% CACFP participation Provider Level of education: 40.8% HS diploma or GED, 42.9% some college or Associate’s, 14.3% bachelor degree
Active play and inactive time 3.20 ± 0.4 TV use and TV viewing 2.90 ± 0.8
Trost et al. [29], American Journal of Preventive Medicine/2009/KS/cross-sectional survey
FCCH providers
NAPSACC
Existence of comprehensive written policy on PA 24.9% (95% CI: 19.5, 30.3)
Suitable space indoors when weather is bad 17.6% (95% CI: 12.8, 22.3) Displayed posters, pictures, or books about PA 21.9% (95% CI: 16.5, 27.2) Received training on PA ≥1x/per year 46.1% (95% CI: 39.8, 52.3): Provided PA education to parents 30.2% (95% CI: 24.3, 36)
Restricted active play time for misbehavior 62.7% (95% CI: 56.6, 68.7)
TV turned on every day for at least part of the day 64.6% (95% CI: 58.7, 70.5) 55.1% (95% CI: 48.7, 61.4) allowed children to watch TV/videos ≥1x/day
aIncluded results regarding ethnicity since a great percentage of homes were Hispanic; bsignificantly different from center based; cFCCHs more likely to care for children enrolled in federal subsidy programs; dScoring guide: 1 = marginally meeting child care standards, 2 = meeting child care standards, 3 = exceeding child care standards, and 4 = far exceeding child care standards and using best practice; edeveloped based on physical activity standards from Caring for Our Children National Health and Safety Performance Standards; SCFQ = Stanford Child Feeding Questionnaire; HCFSQ = Hughes Caregiver Feeding Styles Questionnaire; EPAO = Environment and Policy Assessment and Observation; HSFFQ = Harvard Service Food Frequency Questionnaire; PAFQ = Physical Activity Frequency Questionnaire; ECLS-B = Early Childhood Longitudinal Study-Birth Cohort; FCCHs = Family Child Care Homes; NAPSACC = Nutrition and Physical Activity Self-Assessment for Child Care; CACFP = Child and Adult Care Food Program; PA = physical activity; MVPA = moderate to vigorous physical activity; TPA = total physical activity; M = mean; SD = standard deviation; ns = not significant; mos. = months.
