Natasha Frost

Obesity Prevention in Early Child Care Settings A Bistate (Minnesota and Wisconsin) Assessment of Best Practices, Implementation Difficulty, and Barriers

Background. Long-term evaluation studies reveal that high-quality early care and education (ECE) programs that include a lifestyle component predict later adult health outcomes. The purpose of this article is to characterize the nutrition and physical activity (PA) practices, including implementation difficulty and barriers, of licensed center- and family home-based ECE programs serving 2- to 5-year-old children in Minnesota (MN) and Wisconsin (WI). Method. A stratified random sampling procedure was used to select representative cross sections of licensed ECE providers in MN and WI. A total of 2,000 providers (1,000 center-based, 1,000 family home-based) were randomly selected and invited to respond to a 97-item survey with questions representing (1) nutrition and PA practices, (2) barriers to meeting nutrition and PA best practices, and (3) written and implemented nutrition and PA policies. Summated scales were constructed for nutrition-related (range 0-15; Cronbach’s α = .86) and for PA-related best practices (range 0-10; Cronbach’s α = .82). Results. A total of 823 providers returned surveys between August 2010 and March 2011, resulting in a 44% bistate participation rate. Across all programs an average (SD) of 7.0 (4.1) nutrition best practices were already implemented. Center-based providers reported on average 0.8 additional nutrition best practice (7.4 vs. 6.6, p = .01). Across all programs an average (SD) of 5.2 (3.1) PA best practices were already implemented. Center-based providers reported on average one more PA best practice (5.3 vs. 4.3, p < .01). The cost of healthy food and the weather were identified as barriers by 80% of providers, regardless of program type.

What Can Be Learned from Existing Investigations of Weight-Related Practices and Policies with the Potential to Impact Disparities in US Child-Care Settings? A Narrative Review and Call for Surveillance and Evaluation Efforts

Child-care settings and the combination of policies and regulations under which they operate may reduce or perpetuate disparities in weight-related health, depending on the environmental supports they provide for healthy eating and activity. The objectives of this review are to summarize research on state and local policies germane to weight-related health equity among young children in the United States and on how federal policies and regulations may provide supports for child-care providers serving families with the most limited resources. In addition, a third objective is to comprehensively review studies of whether there are differences in practices and policies within US child-care facilities according to the location or demographics of providers and children. The review found there is growing evidence addressing disparities in the social and physical child-care environments provided for young children, but scientific gaps are present in the current understanding of how resources should best be allocated and policies designed to promote health equity. Additional research is needed to address limitations of prior studies relating to the measurement of supports for weight-related health; complexities of categorizing socioeconomic position, ethnicity/race, and urban and rural areas; exclusion of legally nonlicensed care settings from most research; and the cross-sectional nature of most study designs. There is a particularly great need for the development of strong surveillance systems to allow for better monitoring and evaluation of state policies that may impact weight-related aspects of child-care environments, implementation at the program level, and needed implementation supports.

Change in the implementation of healthy nutrition and physical activity best practices in Minnesota early care settings: A longitudinal cohort study (2010–2016)

The goal of the ‘Healthy Start, Healthy State’ study was to describe changes in the implementation of healthy nutrition and physical activity (PA) best practices in early child care and education (ECE) settings from 2010 to 2016. A cohort of 215 Minnesota licensed center- and family/home-based providers completed a survey describing 15 nutrition and 8 PA best practices that they “already do” in 2010 and again in 2016 were analyzed in 2016. There was a significant net implementation rate increase for 15 best practices (10 nutrition, 5 PA) in centers and 12 best practices (8 nutrition, 4 PA) in family/home-based programs. The 2010 nutrition and PA scores were negatively associated with mean change in 2016 indicating the decreased potential for improvement among sites with more best practices already implemented in 2010. Adjusted for 2010 nutrition score and other factors, centers implemented, on average, 1.45 more nutrition best practices from 2010 to 2016 than family/home based programs, and CACFP participating programs implemented, on average, 1.7 more nutrition best practices from 2010 to 2016 than non-CACFP participants. Urbanicity, provider education, and provider years of experience were not significantly associated with 2010–2016 change in nutrition score. The mean PA score change had a small but significant increase for each additional year of provider ECE experience after adjusting for the 2010 score. State-level surveillance of implemented best practices in ECE settings is useful. Findings identify opportunities for stakeholders to respond with targeted technical support and training and to consider potential future policy levers.

Media and Young Minds: Comparing State Screen Media Use Regulations for Children Under 24 Months of Age in Early Care and Education to a National Standard

Introduction Excessive screen media use has been associated with a number of negative health outcomes in young children, including increased risk for obesity and comparatively lagging cognitive development. The purpose of this study was to assess state licensing regulations restricting screen media use for children under 24 months old in early care and education (ECE) and to compare regulations to a national standard. Methods We reviewed screen media use regulations for all US states for child care centers (“centers”) and family child care homes (“homes”) and compared these regulations to a national standard discouraging screen media use in children under 24xa0months of age. We assessed associations between state geographic region and year of last update with the presence of regulations consistent with the standard. In centers, 24 states had regulations limiting screen media use for children under 24xa0months of age and 19 states had regulations limiting screen media use in homes. Results More states in the South and fewer states in the Midwest had regulations limiting screen media use. The association between geographic region and regulations was not significant for centers (pu2009=u20090.06), but was for homes (pu2009=u20090.04). The year of last update (within the past 5xa0years versus older than 5xa0years) was not associated with regulations for centers (pu2009=u20090.18) or homes (pu2009=u20090.90). Discussionxa0Many states lacked screen media use regulations for ECE. States should consider adding screen media use restrictions for children under 24 months based on current research data and current recommendations in future regulations updates.

Provider Adherence to Nutrition and Physical Activity Best Practices Within Early Care and Education Settings in Minnesota, Helping to Reduce Early Childhood Health Disparities

Licensed child care providers, and the early care and education settings in which they operate, are uniquely situated to influence children’s healthy eating and physical activity through practices, attitudes, and supportive physical and social environments. However, preliminary research indicates that child-, family-, and provider-level characteristics affect adherence to best practices across early care and education settings. The current article used survey data (n = 618) to characterize differences in child care providers’ adherence to nutrition, physical activity, and mealtime best practices, based on child-, family- and provider-level characteristics, and to describe secular trends in adherence to nutrition and physical activity best practices between 2010 and 2016. Results indicate that differences exist across certain characteristics, including child race/ethnicity, family’s use of child care assistance, language spoken at home, and provider educational attainment; however, it is notable that in most cases providers serving children of minority race and children in low-income families have a higher rate of compliance with the nutrition and physical activity best practices studied. Additionally, the comparison of adherence to best practices from 2010 to 2016 suggests that, while there was an increase in mean adherence from 2010 to 2016, overall trends in adherence across child-, family- and provider-level characteristics have been consistent across time. Public health professionals should continue to advocate for opportunities for providers to learn how to best incorporate best practices within their setting (e.g., education and training opportunities) as well as for the development and adoption of systems-level changes (e.g., expansion of food assistance programs) to reduce barriers to adherence to best practices.

State Regulations Promoting Infant Physical Activity in Early Care and Education

BACKGROUNDnState policies have the potential to improve early care and education (ECE) settings, but little is known about the extent to which states are updating their licensing and administrative regulations, especially in response to national calls to action. In 2013, we assessed state regulations promoting infant physical activity in ECE and compared them with national recommendations. To assess change over time, we conducted this review again in 2018.nnnMETHODSnWe reviewed regulations for all US states for child care centers (centers) and family child care homes (homes) and compared them with three national recommendations: (1) provide daily tummy time; (2) use cribs, car seats, and high chairs for their primary purpose; and (3) limit the use of restrictive equipment (e.g., strollers). We performed exact McNemars tests to compare the number of states meeting recommendations from 2013 to 2018 to evaluate whether states had made changes over this period.nnnRESULTSnFrom 2013 to 2018, we observed significant improvement in one recommendation for homes-to use cribs, car seats, and high chairs for their primary purpose (odds ratio 11.0; 95% CI 1.6-47.3; pu2009=u20090.006). We did not observe any other significant difference between 2013 and 2018 regulations.nnnCONCLUSIONSnDespite increased awareness of the importance of early-life physical activity, we observed only modest improvement in the number of states meeting infant physical activity recommendations over the past 5 years. In practice, ECE programs may be promoting infant physical activity, but may not be required to do so through state regulations.

Childcare providers' possession or use of Marijuana, Tobacco, or alcohol while caring for children: A comparison of US state regulations

OBJECTIVESnTo evaluate US state regulations regarding marijuana, tobacco, and alcohol to determine the extent to which states attempt to govern these substances in early care and education (ECE) settings.nnnMETHODSnTwo independent reviewers assessed regulations enacted by December 2016 for all states and the District of Columbia. Reviewers compared regulations to national standards on the possession or use of marijuana, tobacco, and alcohol in ECE settings.nnnRESULTSnFewer states regulated marijuana than tobacco or alcohol in ECE settings. More states restricted the use of these 3 substances than they restricted the possession of them.nnnCONCLUSIONSnMost states address alcohol or tobacco possession or use in their regulations but should consider updating these provisions to align with national standards. Public Health Implications. Updating and strengthening state childcare regulations regarding marijuana, tobacco, and alcohol possession and use may help protect children in ECE settings, where many children spend a substantial portion of time. As more states legalize marijuana, they may consider updating their regulations and including precise language to better protect children from unintended pediatric marijuana exposure or impaired childcare providers.

Early feeding in child care in the United States: Are state regulations supporting breastfeeding?

Most women in the US are not meeting the recommendation of exclusively breastfeeding their infants for the first 6months of life. The child care environment can be especially influential in a mothers ability to continue breastfeeding after returning to employment. For this study, we reviewed child care regulations related to breastfeeding for centers and homes in all 50 states and the District of Colombia in late 2016, and compared them to 5 national standards. We coded regulations as either not meeting, partially meeting, or fully meeting each standard. We assessed correlations between number of regulations consistent with standards and 1) geographic census region and 2) last year of update. This study provides an update to a previous review conducted in 2012. No state met all 5 of the included standards, and only 2 states for centers and 1 state for homes at least partially met 4 of the 5 standards. More states had regulations consistent with standards encouraging general support for breastfeeding and requiring a designated place for mothers to breastfeed onsite. Number of regulations consistent with standards was associated with geographic census region, but not last year of update. States in the South had a greater number of regulations consistent with standards and states in the West had the fewest number of regulations consistent with standards. Overall support for breastfeeding at the state child care regulation level continues to be insufficient. States should improve child care regulations to include greater support for breastfeeding in child care facilities.

State Variations in Infant Feeding Regulations for Child Care

State regulations have the potential to improve child health. We conducted a state-by-state review to document regulations supporting appropriate infant feeding in child care. OBJECTIVES: Early care and education (ECE) settings have become primary targets for policy change in recent years. In our 2008 study, we assessed state and regional variation in infant feeding regulations for ECE and compared them to national standards. We conducted the same regulatory review to assess change over time. Because all but 2 states have updated their regulations, we hypothesized that states would have made substantial improvements in the number of regulations supporting infant feeding in ECE. METHODS: For this cross-sectional study, we reviewed infant feeding regulations for all US states for child care centers (centers) and family child care homes (homes). We compared regulations with 10 national standards and assessed the number of new regulations consistent with these standards since our previous review. RESULTS: Comparing results from 2008 and 2016, we observed significant improvements in 7 of the 10 standards for centers and 4 of the 10 standards for homes. Delaware was the only state with regulations meeting 9 of the 10 standards for centers in 2008. In 2016, Delaware and Michigan had regulations meeting 8 of the 10 standards. Previously, Arkansas, the District of Columbia, Minnesota, Mississippi, Ohio, and South Carolina had regulations consistent with 4 of the 10 standards for homes. In 2016, Delaware, Mississippi, and Vermont had regulations meeting 7 of the 10 standards. CONCLUSIONS: Evidence suggests that enacting new regulations may improve child health outcomes. Given that many states recently enacted regulations governing infant feeding, our findings point to the growing interest in this area.

Applying an Equity Lens to the Child Care Setting

In the current landscape, child care is increasingly being seen as a place for early education, and systems are largely bundling child care in the Early Care and Education sphere through funding and quality measures. As states define school readiness and quality, they often miss critical elements, such as equitable access to quality and cultural traditions. This article provides a summary of the various definitions and structures of child care. It also discusses how the current child care policy conversation can and ought to be infused with a framework grounded in the context of institutional racism and trauma. Models and examples will explore the differences between state government regulations, and how those differ than the regulation and structure of child care in Indian Country.