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To examine associations of stress and sleep with diet quality of family child care home (FCCH) providers, and whether self-efficacy for healthy eating influences these associations.A cross-sectional analysis was performed using baseline data (2013-2015) from a randomized control trial with FCCH providers.The study included 166 licensed FCCH providers, aged18 years, from central North Carolina.Diet quality was assessed with a food frequency questionnaire, used to calculate a modified 2010-Healthy Eating Index score. Stress, sleep quality, and diet self-efficacy were measured via self-administered questionnaires.Using observations from 158 participants with complete data, multiple linear regression models were created to assess whether stress, sleep quality, and diet self-efficacy were associated with diet quality and whether diet self-efficacy moderated these associations (significance set at P0.05).In the initial model, only diet self-efficacy was significantly associated with diet quality (β = 0.32; P0.001). Moderation analyses showed that higher stress was associated with lower diet quality, but only when diet self-efficacy was low.Building FCCH providers' self-efficacy for healthy eating is an important component of health promotion and can buffer the impact of stress on their diet quality.

Child care-based interventions offer an opportunity to reach children at a young and impressionable age to support healthy eating and physical activity behaviors. Ideally, these interventions engage caregivers, including both childcare providers and parents, in united effort. This study evaluated the impact of the Healthy Me, Healthy We intervention on children’s diet quality and physical activity. A sample of 853 three- to four-year-old children from 92 childcare centers were enrolled in this cluster-randomized control trial. Healthy Me, Healthy We was an 8-month, social marketing intervention delivered through childcare that encouraged caregivers (childcare providers and parents) to use practices that supported children’s healthy eating and physical activity behaviors. Outcome measures, collected at baseline and post-intervention, assessed children’s diet quality, physical activity, and BMI as well as caregivers’ feeding and physical activity practices. Generalized Linear Mixed Models were used to assess change from baseline to post-intervention between intervention and control arms. No significant changes were noted in any of the outcome measures except for small improvements in children’s sodium intake and select parent practices. Despite the negative findings, this study offers many lessons about the importance and challenges of effective parent engagement which is critical for meaningful changes in children’s health behaviors.

Wearables that include a color light sensor are a promising measure of electronic screen use in adults. However, to extend this approach to children, we need to understand feasibility of wear placement. The purpose of this study was to examine parent perceptions of children's acceptability of different sensor placements and feasibility of free-living 3- to 7-day wear protocols.This study was conducted in three phases. In phase 1, caregivers (n=161) of 3- to 8-year-old children completed an online survey to rate aspects of fitting and likelihood of wear for seven methods (headband, eyeglasses, skin adhesive patch, shirt clip/badge, mask, necklace, and vest). In phase 2, children (n=31) were recruited to wear one of the top five prototypes for three days (n=6 per method). In phase 3, children (n=23) were recruited to wear prototypes of the top three prototypes from phase 2 (n=8 per method) for 7 days. In phases 2 and 3, parents completed wear logs and surveys about their experiences. Parents scored each wearable on three domains (ease of use, likelihood of wear, and child enjoyment). Scores were averaged to compute an everyday "usability" score (0, worst, to 200, best).Phase 1 results suggested that the headband, eyeglasses, patch, clip/badge, and vest had the best potential for long-term wear. In phase 2, time spent wearing prototypes and usability scores were highest for the eyeglasses (10.4 hours/day, score=155.4), clip/badge (9.8 hours/day, score=145.8), and vest (7.1 hours/day, score=141.7). In phase 3, wearing time and usability scores were higher for the clip/badge (9.4 hours/day, score=169.6) and eyeglasses (6.5 hours/day, score=145.3) compared to the vest (4.8 hours/day, score=112.5).Results indicate that wearable sensors clipped to a child's shirt or embedded into eyeglasses are feasible and acceptable wear methods in free-living settings. The next step is to asses the quality, validity, and reliability of data captured using these wear methods.

Background Improving the nutritional quality of food, including beverages, served in early care and education settings should enhance children's diet quality. However, few studies have explored the relationship between what is served and consumed in family child-care homes (FCCHs). Objective To describe the nutritional quality of food served to children in FCCHs and to assess the extent to which children eat what is served. Design This study was a cross-sectional analysis using baseline data (n=166) from a cluster-randomized controlled trial (2013-2016). Participants/setting Eligible FCCHs in central North Carolina had to have at least two children between 18 months and 4 years, have been in business for at least 2 years, and serve at least one meal and one snack. Main outcome measures Food was captured using the Diet Observation at Child Care protocol. Statistical analyses Frequencies, means, and multivariate analysis were used to examine the relationship between food served and consumed by food groups and by Healthy Eating Index (HEI-2010). Results Children consumed between 61% and 80% of what was served, with vegetables having the lowest percent consumed (61.0%). Total HEI-2010 score for food served was 63.6 (10.4) and for food consumed was 61.7 (11.5) out of a 100-point maximum. With regards to food served, FCCH providers came close to meeting HEI-2010 standards for dairy, whole fruit, total fruit, and empty calories. However, providers appeared to fall short when it came to greens and beans, seafood and plant proteins, total vegetables, whole grains, and fatty acids. They also exceeded recommended limits for sodium and refined grains. Conclusions Although FCCHs are serving some healthy food, mainly fruit, dairy, and few empty calories, there is room for improvement with regards to vegetables, grains, seafood and plant protein, fatty acids, and sodium. Future trainings should help providers find ways to increase the serving and consumption of these foods.

Health behaviors associated with chronic disease, particularly healthy eating and regular physical activity, are important role modeling opportunities for individuals working in child care programs. Prior studies have not explored these risk factors in family child care home (FCCH) providers which care for vulnerable and at-risk populations. To address this gap, we describe the socio-demographic and health risk behavior profiles in a sample of providers (n = 166 FCCH) taken from baseline data of an ongoing cluster-randomized controlled intervention (2011–2016) in North Carolina. Data were collected during on-site visits where providers completed self-administered questionnaires (socio-demographics, physical activity, fruit and vegetable consumption, number of hours of sleep per night and perceived stress) and had their height and weight measured. A risk score (range: 0–6; 0 no risk to 6 high risk) was calculated based on how many of the following were present: not having health insurance, being overweight/obese, not meeting physical activity, fruit and vegetable, and sleep recommendations, and having high stress. Mean and frequency distributions of participant and FCCH characteristics were calculated. Close to one third (29.3%) of providers reported not having health insurance. Almost all providers (89.8%) were overweight or obese with approximately half not meeting guidelines for physical activity, fruit and vegetable consumption, and sleep. Over half reported a “high” stress score. The mean risk score was 3.39 (± 1.2), with close to half of the providers having a risk score of 4, 5 or 6 (45.7%). These results stress the need to promote the health of these important care providers., Highlights • Nearly one quarter of family child care home providers had a high risk score. • A high risk score indicates multiple health behavior risks. • A high risk score may suggest elevated risk of chronic disease. • Improving providers' health behaviors can help reduce their own health risk. • Healthier providers could be better role models of healthy habits for young children.

Objective Critical to the success of any intervention study is successful recruitment. The aim of this paper was to examine the recruitment process of a randomized controlled trial evaluating an intervention conducted with family child care home providers. Specifically, the recruitment challenges, the efforts employed to address the challenges, and their impact on participant recruitment are discussed. Methods The study’s original recruitment protocol was employed during waves 1 and 2 (out of 5). However, recruitment tracking showed a failure to meet enrollment targets, particularly in wave 2. Low enrollment prompted an all-day retreat to discuss potential revisions and enhancements to recruitment strategies. Four strategies to enhance the recruitment protocol emerged from the retreat: improving recruitment materials to enhance communication, increasing engagement with community partners, addressing provider concerns about participation and study burden, and facilitating parent engagement. Results The study successfully recruited 166 family child care home providers across the 5 waves. There was a significant impact on the recruitment of waves 3–5 versus waves 1–2 using the enhanced recruitment protocol. There was a dramatic increase in those who “consented” (43% vs. 60%, respectively) and a corresponding decrease in the percent of “interested and eligible” who then “failed to consent” (57% vs. 40%, respectively). Conclusion Results of these enhanced recruitment strategies demonstrate the many lessons learned about successful recruitment of a difficult-to-reach population, family child care homes; specifically, the importance of building relationships, communicating clearly, and identifying key motivators.

Early care and education settings, such as family child care homes (FCCHs), are important venues for children's health promotion. Keys to Healthy Family Child Care Homes evaluated a FCCH-based intervention's impact on children's diet and physical activity. This study enrolled 496 children aged 1.5–4 years and 166 FCCH providers into a cluster-randomized control trial (intervention = 242 children/83 FCCHs, control = 254 children/83 FCCHs) conducted during 2013–2016. The 9-month intervention addressed provider health, health of the FCCH environment, and business practices, and was delivered through three workshops, three home visits, and nine phone calls. The attention control arm received a business-focused intervention. Primary outcomes were children's diet quality (2 days of observed intakes summarized into Healthy Eating Index scores) and moderate to vigorous physical activity (3 days of accelerometry) at the FCCH. Secondary outcomes were child body mass index (BMI), FCCH provider health behaviors, and FCCH nutrition and physical activity environments and business practices. Repeated measures analysis, using an intent-to-treat approach, accounting for clustering of children within FCCHs and adjusting for child age, sex, and BMI, was used to evaluate change (completed in 2018). Compared to controls, intervention children significantly improved their diet quality (5.39, p = .0002, CI = 2.53, 8.26) but not MVPA (0.31, p = .195, CI = −0.16, 0.79). Intervention FCCH providers significantly improved their diet quality and several components of their FCCH environment (i.e., time provided for physical activity, use of supportive physical activity practices, and engagement in nutrition and physical activity education/professional development). FCCHs are malleable settings for health promotion, especially diet quality. Trial registration This study is registered at www.clinicaltrials.gov NCT01814215 .

Background As part of childhood obesity prevention initiatives, Early Care and Education (ECE) programs are being asked to implement evidence-based strategies that promote healthier eating and physical activity habits in children. Translation of evidence-based interventions into real world ECE settings often encounter barriers, including time constraints, lack of easy-to-use tools, and inflexible intervention content. This study describes translation of an evidence-based program (NAPSACC) into an online format (Go NAPSACC) and a randomized pilot study evaluating its impact on centers’ nutrition environments. Methods Go NAPSACC retained core elements and implementation strategies from the original program, but translated tools into an online, self-directed format using extensive input from the ECE community. For the pilot, local technical assistance (TA) agencies facilitated recruitment of 33 centers, which were randomized to immediate (intervention, n = 18) or delayed (control, n = 15) access groups. Center directors were oriented on Go NAPSACC tools by their local TA providers (after being trained by researchers), after which they implemented Go NAPSACC independently with minimal TA support. The Environment and Policy Assessment and Observation instrument (self-report), collected prior to and following the 4-month intervention period, was used to assess impact on centers’ nutrition environments. Process data were also collected from a sample of directors and all TA providers to evaluate program usability and implementation. Results Demographic characteristics of intervention and control centers were similar. Two centers did not complete follow-up measures, leaving 17 intervention and 14 control centers in the analytic sample. Between baseline and follow-up, intervention centers improved overall nutrition scores (Cohen’s d effect size = 0.73, p = 0.15), as well as scores for foods (effect size = 0.74, p = 0.16), beverages (effect size = 0.54, p = 0.06), and menus (effect size = 0.73, p = 0.08), but changes were not statistically significant. Conclusions Core elements of NAPSACC were effectively translated into online tools and successfully implemented by center directors. Results suggest that the online program may have retained its ability to drive change in centers’ nutrition environments using a streamlined, self-directed, and flexible implementation approach. Results need to be confirmed in a larger more definitive trial. Trial registration NCT02889198 (retrospectively registered). Electronic supplementary material The online version of this article (10.1186/s12889-017-4898-z) contains supplementary material, which is available to authorized users.

A1 Introduction to the 8th Annual Conference on the Science of Dissemination and Implementation: Optimizing Personal and Population Health David Chambers1, Lisa Simpson2 1Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, 20850, USA; 2AcademyHealth, Washington, DC, 20036, USA For the second year in a row, we are pleased to be able to share the proceedings of the Annual Conference on the Science of Dissemination and Implementation in Health, a large meeting reflecting the expanding and evolving research field that seeks to optimize the use of evidence, interventions, and tools from health research within the myriad of settings where people receive health care, make health-related decisions, and increase knowledge of influences on the health of the population. We once again benefitted from a strong partnership, co-led by AcademyHealth and the National Institutes of Health (NIH), with co-sponsorship from the Agency for Healthcare Research and Quality (AHRQ), the Patient Centered Outcomes Research Institute (PCORI), the Robert Wood Johnson Foundation (RWJF), the US Department of Veterans Affairs (VA), and the WT Grant Foundation. In addition, we benefitted from the collaboration of staff from the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). NIH and AcademyHealth again co-led the program planning committee, which focused on the development of the plenary sessions, and convened a scientific advisory panel to suggest speakers and advise on the overall conference development. The planning committee identified four key areas around which to focus the plenary panels and keynote address. Dr. America Bracho, M.D., M.P.H., Executive Director of Latino Health Access in Orange County, California, spoke about the opportunities for implementation science to inform efforts to improve community health and engage underserved populations. The three plenary panels each focused on a significant future direction for dissemination and implementation (D & I) research: the interface between D&I science and population health, emerging opportunities for global implementation science, and the challenges around implementation of precision medicine. The plenary sessions were complemented by facilitated lunchtime discussions on the same three topics, which offered participants an opportunity to identify key research questions for each and brainstorm next steps. Synopses of the lunchtime discussions are included in this supplement. Given the overwhelming success of the 2014 conference and the large number of abstracts received in 2014 (660), the program planning committee identified eight program tracks for abstract submitters to respond to, and through which the concurrent sessions of the conference would be organized. These tracks—Behavioral Health, Big Data and Technology for Dissemination and Implementation Research, Clinical Care Settings, Global Dissemination and Implementation, Promoting Health Equity and Eliminating Disparities, Health Policy Dissemination and Implementation, Prevention and Public Health, and Models, Measures and Methods— were designed to enable conference participants to follow a consistent theme across the multiple sessions of the conference and form the structure of this supplement. The call for abstracts, including individual paper presentations, individual posters and panel presentations, resulted in 515 submissions, spread across the eight thematic tracks. Over one hundred reviewers devoted their time to ensuring a comprehensive and expert review, and reviews were conducted within each track and coordinated by the track leads. For the final program, 64 oral presentations, 12 panels, and 263 posters were presented over the two-day meeting. Slides for the oral presentations and panels (with the agreement of the authors) were posted on the conference website (http://diconference.academyhealth.org/archives/2015archives) and all abstracts were included on the conference webapp (https://academyhealth.confex.com/academyhealth/2015di/meetingapp.cgi). This supplement has compiled the abstracts for presented papers, panel sessions, and lunchtime discussions from the 8th Annual Meeting on the Science of Dissemination and Implementation in Health: Optimizing Personal and Population Health. We are pleased to have the abstracts from the conference together in one volume once again, and look forward to the 9th Annual meeting, scheduled for December in Washington, D.C.

Child care providers play an important role in feeding young children, yet little is known about children’s influence on providers’ feeding practices. This qualitative study examines provider and child (18 months −4 years) feeding interactions. Trained data collectors observed 200 eating occasions in 48 family child care homes and recorded providers’ responses to children’s meal and snack time behaviors. Child behaviors initiating provider feeding practices were identified and practices were coded according to higher order constructs identified in a recent feeding practices content map. Analysis examined the most common feeding practices providers used to respond to each child behavior. Providers were predominately female (100%), African-American (75%), and obese (77%) and a third of children were overweight/obese (33%). Commonly observed child behaviors were: verbal and non-verbal refusals, verbal and non-verbal acceptance, being “all done”, attempts for praise/attention, and asking for seconds. Children’s acceptance of food elicited more autonomy supportive practices vs. coercive controlling. Requests for seconds was the most common behavior, resulting in coercive controlling practices (e.g., insisting child eat certain food or clean plate). Future interventions should train providers on responding to children’s behaviors and helping children become more aware of internal satiety and hunger cues.