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To capture Child and Adult Care Food Program (CACFP) state directors' experiences implementing federal waivers for feeding children in early care and education (ECE) settings during coronavirus disease 2019.Qualitative semistructured interviews.Virtual interviews with state CACFP directors.Child and Adult Care Food Program directors from 21 states from December 2020 to May 2021.Implementation of state-level waivers.Qualitative thematic analysis.State directors reported that the coronavirus disease 2019 waivers allowed ECE programs to continue feeding children despite being closed or having limited enrollment. The meal pattern, noncongregate feeding, parent/guardian meal pick-up, and monitoring waivers were most frequently used by states. Challenges included maintaining integrity to CACFP meal pattern requirements, addressing the limited capacity of ECE to produce and distribute noncongregate meals, and adapting technology for virtual reviews. Suggested improvements included streamlined communication from the US Department of Agriculture, standing waivers for emergencies, ongoing flexibilities for feeding children, and strategies to increase CACFP enrollment and reduce financial viability requirements for ECE.Results indicate the need for the US Department of Agriculture to consider issuing and extending waivers, increasing ECE participation in CACFP, and ensuring timely communication and guidance on waiver tracking.

Context Children consume up to two-thirds of their daily dietary requirements in full-time childcare, making the setting a critical vector for preventing childhood obesity. Objective To summarize the ecological correlates of children’s dietary intake in childcare settings that were identified and categorized using the Six-Cs developmental ecological model of contributors to overweight and obesity in childhood. Data Sources A literature search was conducted in 4 electronic databases. Study Selection English-language, peer-reviewed publications that investigated at least 1 correlate of children’s (ages 2–6 years) dietary intake in childcare settings and measured children’s actual consumption of foods and beverages from food groups were included. Data Extraction Correlates were categorized into child, clan, community, and country groups. Results A total of 55 studies, which examined 29 correlates, were reviewed. Correlates identified included child’s age, sex, characteristics of food provision (namely, food composition, foods and beverages served, portion sizes), repeated exposure, nutrition education, book reading, peer influence, meal service type, and childcare teachers’ responsive feeding practices. Policies and participation in Head Start and the Child and Adult Care Food Program could not be determined as correlates of children’s dietary intake, owing to a lack of evidence. Conclusion This review produced a list of correlates to consider in designing interventions to improve children’s dietary intake in childcare settings. The correlates could contribute to development of lifelong healthy eating habits, thereby preventing childhood obesity.

Family engagement in childcare is important to ensure the optimal growth, development, and safety of children. Previous research has explored family engagement practices, but limited research is av...

To determine differences by Child and Adult Care Food Program (CACFP) participation on nutrition requirements and best practices and barriers to implementing both in early care and education programs (ECEs) stratified by context (centers vs home-based ECEs).Cross-sectional survey.Three-thousand and fourteen licensed Nebraska ECEs in 2017.One-thousand three hundred forty-five ECEs.Director-reported nutrition practices in classrooms serving children aged 2-5 years (8 requirements for foods served, 5 best practices for foods served, and 14 best practices for mealtime behaviors).Chi-square analysis adjusted for multiple comparisons.Of the sample, 86.8% participated in CACFP, 21.7% were center-based, and 78.3% were home-based. Overall, CACFP participation was related to the higher implementation of CACFP requirements for foods served (P0.004 for all) and receiving professional development on nutrition (P0.012). In home-based ECEs only, CACFP participation was related to a higher prevalence of serving meals family-style (P = 0.002); however, these practices had low implementation overall.Findings suggest strengthening of requirements to include staff mealtime behaviors beyond service of healthful foods. Improving CACFP enrollment and including CACFP standards in state licensing requirements may be key strategies for improving nutrition practices in ECEs.

Background: The Nutrition and Physical activity Self-Assessment in Child Care (Go NAP SACC) is an evidence-based intervention developed to positively impact childhood obesity in early childhood education (ECE) facilities. One focus of Go NAP SACC is the development of physical activity best practices. However, little research has examined differences in achievement of best practices based on age of child and geographic location. Purpose: To examine differences in the achievement of physical activity best practices between urban and rural childcare facilities by age-specific recommendations (infants, toddlers, and preschoolers) and in the overall physical activity environment. Urban (n=207) and rural (n=218) ECE facilities completed the Go NAP SACC process. Scores of the post intervention self- assessment were used for comparison. Data were analyzed using an ANCOVA. Results: A majority of facilities reported exceeding best practices (79.5%). Of the 45 items assessed, significant differences were found for 18 best practices with urban facilities outscoring their rural counterparts on 17 of these items. A comparison by age found that urban facilities reported higher achievement of best practices among infants (60%) in comparison to toddlers (40%) or preschoolers (30%). Discussion: Urban ECE facilities scored significantly higher than their rural counterparts on 40% of the items assessed. Thus, there is a need to develop and identify relevant resources for continued improvement of best practices based on geographical location. Future studies should continue to explore the rural-urban context of physical activity practices across the early childhood age groups to ensure healthy physical development of children. Funding: This project was supported by the Cooperative Agreement Number NU58DP004819, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services. This work was also supported by a Nebraska Department of Health and Human Services Child Care and Development Fund, USDA Nebraska Team Nutrition, and a Title V Maternal and Child Health Block Grant., The Health & Fitness Journal of Canada, Vol. 14 No. 3 (2021): Proceedings from the 8th International Society for Physical Activity and Health Congress

The purpose of this study was to examine the frequency of and relationship between responsive feeding practices used during early childhood education (ECE) mealtimes and high-quality teaching practices and teacher characteristics. We found variation in teachers’ use of responsive feeding practices. Teachers were more often observed using role modeling than supporting eating self-regulation. Programs that implemented family style meal service had a generally higher use of responsive feeding practices. Overall, we found positive associations between high-quality teaching practices and responsive feeding practices. Teachers’ Head Start status was associated with teaching practices and role modeling during mealtime. Teachers’ education and salary were associated with high-quality teaching practices. This study highlights the possible training needs for teachers related to responsive feeding practices and the need to expand classroom quality assessment to incorporate classroom routines. Finally, this study sheds light on the importance of building better interdisciplinary partnerships to support teachers during mealtimes and to improve ECE mealtime practices in order to help promote optimal outcomes for children in all areas of development.

Breastfeeding and responsive feeding are important practices that support the health of infants and women. In the United States, breastfeeding continuation rates remain lower than recommended, and working women face additional challenges with breastfeeding continuation. Providers in a family child care setting are uniquely positioned to support and provide important resources to families in their breastfeeding and infant feeding practices. The Go NAP SACC program was designed to improve the nutrition and physical activity environments and practices in child care settings serving infants and young children. This evaluation focuses on Breastfeeding and Infant Feeding in Nebraska Family Child Care Homes (FCCH). Paired-sample t-tests were used to examine differences in pre-post evaluation scores. A repeated measure ANCOVA was used to examine differences between rural–urban settings. Nebraska FCCH met recommendations at pre-test, and exceeded recommendations at post-test (p

To determine how demographic, socioeconomic, and neighborhood characteristics are associated with bedtimes among US kindergarteners.Parents reported bedtimes of their children as well as personal, household, and residential characteristics via interviews in the Early Childhood Longitudinal Study-Kindergarten (ECLS-K) Class of 1998-1999. The ECLS-K links individual households to US Census tracts.A random selection of 1,280 schools and surrounding communities in the US.A random selection of 16,936 kindergarteners and their parents.The 2 outcomes were regular and latest weekday bedtimes of kindergarteners. Through a series of nested multilevel regression models, these outcomes were regressed on individual- and neighborhood-level variables, including race/ethnicity, sex, family type, household income, mother's educational attainment, neighborhood disorder, and several additional neighborhood characteristics.Models showed significant (P.05) bedtime disparities by race/ethnicity, sex, family income, and mother's educational attainment. Additionally, models tended to indicate that kindergarteners from disadvantaged neighborhoods experienced later bedtimes than children from more advantaged areas. Neighborhood characteristics accounted for a portion of racial/ethnic differences, suggesting that bedtime disparities are partly rooted in disparate environmental conditions.Reducing disparities in childhood sleep may require programs that target not only children and their parents, but also the communities in which they reside.

Assessing children’s skin carotenoid score (SCS) using reflection spectroscopy (RS) is a non-invasive, widely used method to approximate fruit and vegetable consumption (FVC). The aims for the current review were to (1) identify distributions of SCS across demographic groups, (2) identify potential non-dietary correlates for RS-based SCS, (3) summarize the validity and reliability of RS-based SCS assessment, and (4) conduct meta-analyses of studies examining the correlation between RS-based SCS with FVC. A literature search in eight databases in June 2021 resulted in 4880 citations and peer-reviewed publications written in English that investigated children’s (2–10 years old) SCS using RS. We included 11 studies (intervention = 3, observational = 8). Potential covariates included weight status, ethnicity, seasonal variation, age, sex, and income. Studies reported criterion validity with children’s FVC but not with plasma carotenoid. Additionally, no studies reported the reliability of RS-based SCS in children. Among the 726 children included in the meta-analysis, the correlation between RS-based SCS and FVC was r = 0.2 (p < 0.0001). RS-based SCS is a valid method to quantify skin carotenoids for children’s FVC estimation with the potential for evaluating nutrition policies and interventions. However, future research should use standardized protocol for using RS and establish how RS-based SCS can translate to the amount of daily FVC in children.

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.

The study purpose was to determine associations between proximity to grocery stores and Early Care and Education programs' (i.e., ECEs) classroom nutrition practices and barriers, by ECE context (Head Start, community-based childcare [CBC], and family child care homes [FCCHs]). A statewide cross-sectional survey was implemented in Oklahoma ECEs. Directors reported classroom nutrition practices with the Nutrition and Physical Activity Self-Assessment tool, and barriers to implementation. Locations of 457 grocery stores statewide were determined by in-person audit. Geocoded ECEs were considered within a "low proximity" area if no grocery stores were available within a 0.25-mile radius for urban, or 10-mile radius for rural, ECEs. From November 2019 to February 2020, 54 Head Starts, 159 CBCs, and 160 FCCHs participated. 31.0 % were considered as low proximity. Head Starts demonstrated the highest classroom nutrition scores for mealtime practices, and nutrition education and policy. While proximity to grocery stores was not related to classroom nutrition practices for any ECE context (p 0.05), FCCHs located within a low proximity area reported barriers to implementing those practices more often compared to FCCHs in an area within accessible proximity of grocery store. Thus, proximity to grocery stores was related to barriers in FCCHs only; those provider's experiences and perceptions may be most susceptible to influence of the community nutrition environment, compared to other ECE contexts. Contrary to studies in residential areas and schools, nutrition environments were not related to nutrition practices in ECEs. ECEs may serve as protective micro-environments supporting health for children residing in nearby low-access communities.

Background: Parent feeding practices play a critical role in children’s eating behaviors. Limited research has explored child-level correlates of parent feeding practices. Aim: To identify correlates of feeding practices (responsive and controlling) among parents of preschoolers US. Methods: Participants included parents (n = 273) of preschoolers (3–5 years), recruited from Early Care and Education settings (n = 24) located in a metropolitan city in the US. Analysis included descriptives, correlations, and multiple regression. Results: For responsive feeding practices, positive associations included child's weight with unintentional modeling ( β = .17, 95% CI [0.12, 0.53]), child vegetable consumption with behavioral role modeling ( β = 0.22, 95% CI [0.17, 0.44]), and parent monitoring with verbal modeling ( β = 0.21, 95% CI [0.12, 0.34]). For controlling feeding practices, parent restriction was positively associated with child weight concern ( β = 0.22, 95% CI [0.13, 0.39]) and parent monitoring ( β = 0.13, 95% CI [0.01, 0.19]), whereas child vegetable consumption was negatively associated ( β = −0.16, 95% CI [−0.27, −0.05]). Pressure to eat was negatively associated with child weight concern ( β = −0.18, 95% CI [−0.45, −0.09]), child fruit consumption ( β = −0.12, 95% CI [−0.37, −0.01]), household income ( β = −0.13, 95% CI [−0.30, −0.02]), and parent weight ( β = −0.14, 95% CI [−0.60, −0.05]), Conclusions: Findings highlight the importance of child characteristics when examining correlates of parent feeding practices, demonstrating bidirectional interactions between parent feeding practices and children’s eating behaviors. Considering child-level correlates may improve the implementation of responsive feeding practices and reduce controlling feeding practices.

Conduct formative evaluation of Ecological Approach to Family-Style Dining (EAT) Intervention.Qualitative semistructured interviews and demographic surveys.Early care and education (ECE) centers in Nebraska.Cooperative Extension coaches (n = 9), ECE administrators (n = 8), and teachers (n = 17) caring for children aged 3-5 years.The EAT intervention (a 16-week, 7-lesson, evidence-based online responsive feeding ECE model) uses a multilevel improvement system of 5 implementation strategies. Early care and education administrators and teachers completed 1 lesson/wk followed by a coaching session.The Reach, Effectiveness, Adoption, Implementation, and Maintenance framework includes 5 evaluative dimensions.Thematic analysis.Overall, 77% of children aged 3-5 years (n = 216) participated from targeted Child and Adult Care Food Program ECEs (Reach). All perceived EAT improved children's nutritional and developmental outcomes and encouraged a positive mealtime environment (Effectiveness). Coaches found professional development incentives important, whereas administrators/teachers valued inservice hours (Adoption). Teachers reported successful implementation of responsive feeding, and administrators supported the teachers (Implementation). All reported they intended to continue using EAT, and administrators and teachers discussed incorporating EAT practices into the handbook/school policy (Maintenance).The EAT was valued by all stakeholders for its perceived effectiveness to positively impact children's nutritional outcomes. Furthermore, stakeholders valued the provided incentives and multilevel design with coaching, ECE administrators, and teachers. Future research is needed on how to use Extension coaches in ECE interventions.

BACKGROUND Parents and childcare providers play a substantial role in the development of health behaviours among the children they care for. In order to ensure the optimal growth and development of children, communication and family engagement in childcare is critical. Previous studies examining parent or provider perceptions about healthy eating or physical activity have explored these concepts individually and/or have only included only parents or providers. Therefore, the purpose of this study was to compare childcare provider and parent perceptions of communication regarding healthy eating and physical activity as well as use of best practice strategies on family engagement for these topics. METHODS Childcare providers (n = 12) in childcare centres or a family childcare home and a parent (n = 12) of a child they provide care for participated in a semi-structured interview guided by the Social Ecological Model. Interviews were transcribed verbatim and uploaded to NVivo for data analysis. Data were analysed using a directed content analysis. Three trained qualitative researchers developed a codebook and then compared responses between parents and providers. RESULTS Similarities in provider and parent responses included agreement on healthy eating; influences on child development; parents being the most influential on children's healthy eating; how they identified physical activity opportunities; and the use of family engagement principles. Differences that arose included parents' roles in promoting children's physical activity; challenges for parents in promoting healthy eating and physical activity; and providers' encouragement of physical activity. Importantly, few parents mentioned providers were top influences on their child's healthy eating or physical activity. Providers also mentioned having difficult conversations with parents was challenging. CONCLUSIONS Future efforts are needed to (1) help parents understand the providers' role in the development of their child's health behaviours and (2) strengthen efforts to engage families in healthy behaviours outside of childcare facilities.

This study examined the accuracy of parent-report child fruit/vegetable (FV) liking. Child/parent dyads (n = 24) were recruited from six Head Start preschools in North Carolina. Liking for 10 FVs was assessed using a validated pictorial tool for children; a similar scale was used for parents. Negative relationships were observed between parent/child for one fruit (grapes) and one vegetable (broccoli). Positive relationships were observed among oranges, grapes, and overall fruit rankings. Parents tended to rank children's liking of fruits higher than their children, while children ranked liking vegetables higher. Findings suggest parents may not be accurate respondents for preschool children's FV liking.

The Reggio Emilia approach is an international example of high-quality early care and education programs and this article offers innovative, practical strategies in which Reggio Emilia-inspired edu...

OBJECTIVES: Poor child diet is influenced by nutrition environments surrounding schools and homes; influence of these environments on Early Care and Education (ECE) settings is not understood. The purpose of this study was to determine associations between community nutrition environments and ECE classroom nutrition practices, by ECE context [Head Starts, community-based childcare (CBCs), and family child care homes (FCCHs)]. METHODS: Cross-sectional study including licensed Oklahoma ECEs. Locations of 457 grocery stores were determined in-person. Locations of participating ECEs and grocery stores were geocoded and analyzed in ArcMap 10.6. ECEs were considered located within a “Food Desert” if no grocery stores were available within a 0.25-mile radius for urban ECEs, or 10-mile radius for rural ECEs. ECE directors completed the Nutrition and Physical Activity Self-Assessment tool (i.e., NAP SACC); items were reported on a Likert-type scale and subscores were calculated for nutrition practices. Wilcoxon Rank Sum test was performed to compare practice scores among those located within a Food Desert versus Non-Desert. Benjamini Hochberg calculations for False Discovery Rate were applied (α< 0.004). RESULTS: 54 Head Starts, 159 CBCs, and 160 FCCHs participated with 24%, 27% and 37%- respectively- being located within a Food Desert. ECE descriptive characteristics including food purchasing and meal planning strategies varied by ECE context. Head Starts demonstrated the highest classroom nutrition scores for mealtime practices, and nutrition education and policy. Food Desert status was not related to classroom nutrition practice scores for any ECE context (P > 0.004). CONCLUSIONS: Contrary to studies in residential areas and schools, nutrition environments were not related to nutrition practices in ECEs. This suggests that ECEs may serve as protective micro-environments supporting health for children more vulnerable to the health environments of their nearby residing communities. Supporting health practices for ECEs may be achieved most effectively through within-center intervention and policy. FUNDING SOURCES: This study was funded by the Early Care and Research Scholars: Head Start Graduate Student Research Grant (HHS2017-ACF-OPRE-YR-1219), OUHSC College of Allied Health Student Research and Creativity Grant, and Department of Nutritional Sciences.

The influence of community-built environments on physical activity (PA) support in Early Childhood Education settings (ECEs) is unknown. The purpose of this cross-sectional study was to determine associations between community PA environments and ECE classroom PA practices. We included licensed Oklahoma ECE directors serving 3-to-5-year-old children. Parks and playground locations were exported from Google Earth. National Walkability Index was derived from 2010 US Census data. ArcMap 10.6 was used to geocode ECE locations, which were within an Activity Desert if no parks/playgrounds were located within a 1-mile radius or if Walkability Index was 10.5 or below. Classroom PA practices were determined by using the Nutrition and PA Self-Assessment tool (NAP SACC). Barriers to implementing practices were reported. Most Head Starts (n = 41, 80.3%), center-based childcare settings (CBC, n = 135, 87.0%), and family childcare homes (FCCHs, n = 153, 96.4%) were in an Activity Desert. Parks/playgrounds within a 10-mile buffer were correlated with classroom PA practices in FCCHs only (p &lt, 0.001). Activity Desert status was not related to classroom PA practices for any ECE context (p &gt, 0.029). While FCCHs may be the most vulnerable to lack of park and playground access, overall findings suggest ECEs provide a healthful micro-environment protective of the typical influence of community-built environments.

Childhood nutrition establishes consumption norms that affect an individual's health over the course of their lives. However, early nutrition interventions to establish such norms are uncommon owing to the various inefficiencies associated with current methods of measuring childhood nutrition. Here, we present an IoT measuring device, called the SensiTray, which accurately tracks mealtime intake in a child-friendly and cost-effective fashion. Principal technologies underlying the SensiTray (including mass-sensing technologies, microcontrollers) are identified and analyzed, along with other design choices. Operation of the SensiTray is explained with special attention given to SensiTray software peripherals and algorithms. Preliminary testing consisted of static and dynamic simulations (i.e. food weights constant and changing), with the SensiTray demonstrating a high degree of accuracy in both formats. Future development of the SensiTray may focus on design iteration, additional testing, and experimentation with various mealtime data visualizations to precipitate positive dietary changes.

Background Positive mealtime emotional climate (MEC) has been linked to better nutrition, psychosocial, literacy and academic outcomes, and fewer behavior problems. However, MEC has been defined in a variety of ways across studies, limiting the ability to synthesize findings and plan future research. Objective To identify which child characteristics are associated with MEC and to determine how previous studies have measured MEC. Methods We searched three databases (1980–2020) for peer-reviewed articles measuring MEC. Inclusion criteria required at least one child-level outcome related to physical, nutritional, or developmental health; children aged 0–18 years old; and quantitative data using cohort, case-control, intervention, or experimental designs. We used a previously published taxonomy to categorize child/adolescent characteristics as correlates, non-correlates, unclear, or as having insufficient evidence, according to the amount of evidence linking them to MEC. Additionally, we extracted data about the measures and definitions of MEC from each included article. Results Out of 668 unique studies identified in the initial search after duplicates removed, 14 met inclusion criteria, and only three used the same measure of MEC. Healthful dietary intake, disordered eating behaviors, and weight/BMI were categorized as correlates of MEC, but links to unhealthy dietary intake are unclear. Several characteristics (e.g. temperament, academic success) were examined in one study only. Conclusions Future research should examine the relationship between MEC and child psychosocial child outcomes and utilize a preschool age group. These findings aid in conceptualizing how MEC has been defined and measured and illuminate the importance of MEC on children's health.

The emergence of COVID-19 in the United States led most states to close or severely limit the capacity of their early child-care and education (ECE) programs. This loss affected millions of young children, including many of the 4.6 million low-income children who are provided free meals and snacks by their ECE programs through support from the federal Child and Adult Care Food Program (CACFP).Although Congress swiftly authorized waivers that would allow CACFP-participating ECE programs to continue distributing food to children, early evidence suggests that most ECE programs did not have the capacity to do so, leaving a fragmented system of federal, state, and local food programs to fill the gaps created by this loss.Critical steps are needed to repair our nation's fragile ECE system, including greater investment in CACFP, to ensure the nutrition, health, and development of young children during the COVID-19 pandemic and beyond. (Am J Public Health. Published online ahead of print November 19, 2020: e1-e4. https://doi.org/10.2105/AJPH.2020.305980).

Objective:Explore the interrelationship between teachers’ personal and professional socio-ecological structures while examining Head Start (HS) teachers’ experiences with (1) trying to eat healthy and engage in physical activity (PA) and (2) promote healthy eating and PA in their classrooms.Design:In-depth semi-structured interviews were collected from March through June 2017. Researchers designed the data collection and analysis methods using a phenomenological approach. All interviews were recorded using digital audio and transcribed verbatim.Setting:Seven HS centres in two rural eastern North Carolina counties.Participants:Teachers (n 15) who had recently participated in a healthy eating and physical activity intervention. Participants were 100 % female, an average age of 43 years (sd 9·6) and primarily Black/African American (93·3 %).Results:Eighteen primary themes were identified providing unique insight into individual, social and environmental determinants that may influence teachers’ personal health behaviours and professional health promotion practices. Findings indicated that teachers want to improve health behaviours personally (individual/family health) and professionally (children/families served); however, barriers exist at all levels impacting their ability to improve their own health and facilitate positive behaviours among the children/families they serve. Many teachers observed connections between their personal and professional experiences, but not beyond the individual level.Conclusions:Study findings highlight the importance of considering and emphasising the potential relationship between personal and professional determinants of health when working with early childhood teachers. Findings from this study may be useful for informing the development, implementation and evaluation of future health promotion interventions using teachers as implementers.

Background Ecological Approach To (EAT) Family Style is a 16-week responsive feeding Early Care and Education (ECE) intervention, utilizing a multilevel improvement system of 4 implementation strategies: (a) provision of a 7-lesson, on-line professional development training for administrators and teachers (b) administrative support; (c) performance monitoring, feedback, and assistance through follow-up coaching; and (d) use of incentives. The 7 lessons cover role modeling, peer modeling, sensory exploration, self-regulation, children serve themselves, praise and rewards, and family engagement, each relying on goal setting. The evidence-based practices and implementation system was delivered to ECE administrators and teachers completing one online lesson/week followed by a coaching session with a trained coach. EAT Family Style is guided by the self-determination theory. The objective of this study was to evaluate the EAT Family Style intervention through the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.Methods Center-based ECE administrators (n=8) and teachers (n=17) caring for preschool (3-5 years) children and coaches (n=9) who participated in the EAT Family Style intervention were recruited. Semi-structured interviews were conducted, transcribed verbatim, and coded deductively by 3 coders using RE-AIM dimensions as a priori codes and placed into themes and sub-themes using thematic analysis. Results All participants perceived that EAT Family Style improved children’s nutritional and developmental outcomes and encouraged a positive mealtime environment (Effectiveness). Coaches and administrators reported EAT Family Style aligned with their professional goals and beliefs. Coaches found professional development incentives important, whereas administrators/teachers specifically valued in-service training credit hours (Adoption). Teachers reported successful implementation of EAT Family Style practices in the classroom. Administrators and coaches supported the teachers through administrative and coaching strategies (Implementation). All participants reported they intended to continue using the intervention. Administrators and teachers discussed incorporating EAT Family Style practices into handbook/school policy (Maintenance).Conclusion(s) EAT Family Style was viewed as feasible by participants. Its 4-pronged implementation strategy has the potential to improve the uptake of evidence-informed feeding practices in ECEs.

The purpose of this study was to examine the physical activity environment in childcare programs across type (childcare centers [CCCs] and family childcare homes [FCCHs]) and geographic location (urban and rural) as assessed by physical activity best practices according to the Go Nutrition and Physical Activity Self-assessment in Child Care. Results showed CCCs compared with FCCHs reported higher achievement of best practices. Further, urban childcare programs (CCCs and FCCHs) reported higher achievement of best practices in comparison to rural childcare programs. There is a need to deliver targeted interventions that promote children's physical activity in FCCHs and CCCs in rural areas.

BACKGROUND Physical activity (PA) has long been acknowledged to contribute health benefits among children. However, research has consistently shown that PA declines as children grow older. Thus, this study examined the factors which are associated to children's PA in order to identify potential barriers to PA. METHODS Using data from the KidQuest Program, we conducted bivariate and multivariate analyses on survey data collected from fifth to seventh grade students in a small Midwestern city. RESULTS We found that food knowledge, eating breakfast, and talking with family about eating healthy foods, are positively related to PA. On the other hand, screen time is negatively related to PA. In addition, our results evinced differences between ethnicities and found that Latino children's screen time affects their PA levels more than their white counterpart. CONCLUSIONS There are different factors which can be tapped to increase PA among middle school-aged children. Given the differences between the Latino and white samples especially in screen time, schools should consider individualized intervention, rather than a "one size fits all" program, to increase PA participation.

Purpose: To understand parental ethnotheories (ie, belief systems) and practices about preschoolers’ healthy eating guided by the developmental niche framework. Design: Qualitative hermeneutic phenomenology. Setting: Home. Participants: Participants were 20 parents of preschool-age children ages 3 to 5 years, recruited from a quantitative investigation. A majority of the participants were white, female, married, well educated, and working full time. Methods: Participants who completed the quantitative survey were asked to provide their contact information if they were willing to be interviewed. From the pool of participants who expressed their willingness to participate in the interviews, 20 participants were selected using a random number generator. In-person semistructured interviews were conducted until data saturation (n = 20). Thematic analysis was performed. Results: Three themes and 6 subthemes emerged: theme 1—parental ethnotheories about healthy eating included subthemes of knowledge about healthy eating, motivations to promote healthy child development through healthy eating, and sources of knowledge about healthy eating (eg, doctors, social media, government guidelines, positive family-of-origin experiences); theme 2—parental ethnotheories that supported organization of children’s physical and social settings included structured mealtime routines and food socialization influences (eg, grandparents, siblings, and childcare programs); and theme 3—parental ethnotheories that supported children’s learning about healthy eating included parent–child engagement, communication, and encouragement in food-related activities (eg, meal preparation, visiting farmer’s market, grocery shopping, gardening, cooking, baking). Conclusion: Findings advance the literature on parental practices about healthy eating. Parental ethnotheories (eg, beliefs, motivations, knowledge, and skills) matter. Developmental niche of preschoolers (ie, physical and social settings, childrearing practices, and parental ethnotheories) constitutes an interactive system in which ethnotheories serve as guides to parental practices. Fostering nutrition education and parent–child engagement, communication, and encouragement in food-related activities are recommended to promote children’s healthy eating in daily routines.

Background: With the release of 2017 Child and Adult Care Food Program (CACFP) meal pattern, states need to determine knowledge gaps in order to develop targeted training materials and resources to...

Background Practicing family style meal service in early care and education (ECE) settings supports children's autonomy and improves self-regulation of energy intake. However, during COVID-19, CDC passed a directive to ECE to pause family style meal service. Therefore, we conducted an ECE webinar focused on how to feed children responsively during plated meal service to help providers support children's autonomy and self-regulation. Objective To evaluate changes in the level of understanding, behavioral intention to implement knowledge, and confidence about how to feed children (2-5 years) responsively during plated meal service. Also, to determine need for future training opportunities. Study Design, Setting, Participants Retrospective pretest-posttest study. The webinar was advertised through an email newsletter disseminated by a national-level platform, Penn State Extension Better Kid Care. Participants attended the online webinar for 1 hour on August 11, 2020, had access to an Extension publication ( http://bit.ly/3pnJ71X ) and responded to a follow-up survey (Qualtrics Link: http://bit.ly/3jMWvvv ). Participants identified themselves as either ECE providers (n = 77) or other stakeholders (n = 30), who can offer opportunities or guidance to providers. Measurable Outcome/Analysis Change in self-reported evaluation score (range 1 = low to 7 = high) for understanding, behavioral intention to implement knowledge, and confidence about how to feed children responsively during plated meal service. Paired sample t tests (alpha = 0.05) followed by Sidak-Bonferroni correction (adjusted P = 0.007). Results Both providers and stakeholders reported significantly higher (P Conclusion Intentional mealtime conversations, giving children small tasks supporting their autonomy, and setting clear expectations while adjusting mealtime routines can offer a promising avenue for implementing responsive feeding during plated meal service.

Background Early Childhood Education (ECEs) directors and teachers experience substantial barriers to implementing childhood nutrition recommendations. Diet in older children is influenced by nutrition environments surrounding homes and schools; influence of the community environment on ECEs is not understood. Objective Determine associations between community nutrition environments and ECE barriers to classroom nutrition practices, by ECE context [Head Starts, community-based childcare (CBCs), and family child care homes (FCCHs)]. Study Design, Setting, Participants Cross-sectional study including licensed Oklahoma ECEs. Locations of 457 grocery stores were determined in-person. Locations of participating ECEs and grocery stores were geocoded and analyzed using ArcMap 10.6. Measurable Outcome/Analysis ECEs were considered located within a “Food Desert” if no grocery stores were available within a 0.25-mile radius for urban ECEs, or 10-mile radius for rural ECEs. Presence of barriers to serving healthier foods and beverages were reported. Fisher's exact test was used to compare differences in barriers among those within Food Deserts versus Non-Deserts. Benjamini Hochberg calculations for False Discovery Rate were applied (α Results Fifty-four Head Starts, 159 CBCs, and 160 FCCHs participated with 24%, 27% and 37%- respectively- being located within a Food Desert. ECE descriptive characteristics including food purchasing and meal planning strategies varied by ECE context. Among Head Starts and CBCs, barriers were not different by Food Desert status (P > 0.0004). In FCCHs only, those located within Food Deserts reported a 20% higher prevalence of concern for food waste compared to those within Non-Deserts (P Conclusion Food Desert status was related to reported barriers in FCCHs only; therefore, those provider's experiences and perceptions may be most susceptible to influence of the community nutrition environment, compared to other ECE contexts. Findings suggest a need for future research and policy implementation to support FCCHs residing in low-access areas and experiencing difficulty implementing classroom health practices. Funding Early Care and Research Scholars: Head Start Graduate Student Research Grant (HHS2017-ACF-OPRE-YR-1219), OUHSC College of Allied Health Student Research and Creativity Grant, and Department of Nutritional Sciences.

Background In combination with healthy eating, physical activity is an essential component of a healthy lifestyle that can help prevent a range of chronic diseases among children. As role models and gatekeepers, parents can influence children's eating and physical activity behaviors through healthy practices, helping and teaching children to make healthy choices for themselves that will last a lifetime. Objective To investigate the associations between demographic characteristics, parental feeding practices, and child physical activity in preschool-age children. Study Design, Setting, Participants Participants of this cross-sectional study included parents (n = 273) of preschool-age children ages 3 to 5 years, recruited from early childhood education centers (n = 24). Measurable Outcome/Analysis Independent variables (IVs) included parent and child demographics, parent weight status, feeding practices, parent role modeling, home meal preparation, and child fruit and vegetable consumption. Binary dependent variables (DVs) included participation in moderate-to-vigorous physical activity (MVPA) and participation in physical activity for more than 60 minutes a day (TPA). Logistic regression models determined associations between IVs and DVs. Results The participant's married status (OR = 3.625, CI = 3.609-3.641), child weight (OR = 2.920, CI = 2.905-2.935), and less spousal meal preparation (OR = 0.450, CI = 0.448-0.451) were associated with MVPA. On the other hand, lower parent weight (OR = 0.366, CI = 0.364-0.368), less food restriction (OR = 0.509, CI = 0.508-0.511), and more food monitoring (OR = 1.618, CI = 1.615-1.622) were associated with TPA. Conclusion Overall, the results suggest that parent characteristics and feeding practices are associated with child physical activity. Addressing this interconnectedness between eating and physical activity will allow families and providers to better understand how to promote healthy behaviors in children.

Supporting children's self-regulation in eating through caregivers' practice of responsive feeding is paramount to obesity prevention, and while much attention has been given to supporting children's self-regulation in eating through parents' responsive feeding practices in the home setting, little attention has been given to this issue in childcare settings. This qualitative study examines childcare providers' perspectives on using responsive feeding practices with young children (2-5years). Individual semi-structured interviews were conducted with providers until saturation was reached. Data was analyzed using thematic analysis. The final sample included 18 providers who were employed full-time in Head Start or state-licensed center-based childcare programs, cared for children (2-5y), and were directly responsible for serving meals and snacks. Providers were primarily (67%) employed in childcare programs that served children from low-income families and received reimbursement for meals and snacks from the US Department of Agriculture's Child and Adult Care Food Program. Three factors emerged that shaped childcare providers' experiences using responsive feeding practices: the providers' perspectives about whether or not young children can self-regulate food intake, their understanding of Child and Adult Care Food Program (CACFP) portion size regulations, and the availability of food at the center where they worked. Future research should examine how childcare providers' understanding of children's ability to self-regulate their food intake, the appropriate use of the CACFP regulations in relationship to serving sizes, and having food available to offer seconds promotes providers' use of responsive feeding practices in center-based childcare programs and children's dietary behaviors.

Parental feeding practices reflecting coercive control are related to children's later eating behaviors, but the mechanisms underlying these effects remain poorly understood. This study examined the relationships between recalled childhood experiences of parental pressure to eat and restriction and current food preoccupation, dieting, and emotional eating in a racially diverse sample of college students (N = 711). Results revealed that parental restriction, but not pressure to eat, was associated with more emotional eating (r = 0.18, p

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.

Objective To evaluate a responsive feeding intervention ‘Ecological Approach to (EAT) Family Style’ through the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Use of Theory or Research EAT Family Style is guided by the self-determination theory and includes an evidence-informed implementation improvement system to enhance use of evidence-informed responsive feeding practices. Target Audience Center-based childcare directors (n = 8) and teachers (n = 17) caring for preschool (3-5 years) children and Cooperative Extension coaches (n = 9). Program Description EAT Family Style is a 14-week intervention and utilizes an improvement system of 3 implementation strategies: (a) online professional development and goal setting with 7 lessons: role modeling, peer modeling, sensory exploration, self-regulation, children serve themselves, praise and rewards, and family engagement; (b) administrative support; and (c) ongoing monitoring, feedback, and follow-up support through Extension. The evidence-informed practices and implementation system was delivered through childcare directors and teachers completing 1 online lesson/week followed by a coaching session with an Extension coach. Evaluation Methods Semi-structured interviews were conducted, transcribed verbatim, and coded deductively by 3 coders using RE-AIM dimensions as a priori codes and placed into sub-themes and themes using thematic analysis. Results All participants perceived EAT Family Style improved children's nutritional and developmental outcomes and encouraged a positive mealtime environment (Effectiveness). Coaches and directors reported EAT Family Style aligned with their professional goals and beliefs. Coaches found incentives to PD important, whereas directors/teachers valued in-service hours followed by other incentives (Adoption). Teachers reported successful implementation of EAT Family Style practices in the classroom. Directors and coaches supported the teachers through administrative and coaching strategies (Implementation). All participants reported they intended to continue using the intervention. Directors and teachers discussed incorporating EAT Family Style practices into handbook/school policy (Maintenance). Conclusions EAT Family Style was viewed as feasible by participants. Its implementation strategy has the potential to improve the uptake of evidence-informed feeding practices in childcare centers.

Background Current feeding practice measures are either not validated for use in childcare centers or do not include key constructs that influence children's eating. Objective To describe the development and validation of the ‘Mealtime Observation in Child Care’ (MOCC) toolkit (manual, coding checklist, scoring sheet, training videos) to measure teachers’ feeding practices with preschool (3-5 years) children. Study Design, Setting, Participants An observational measure to assess mealtime environment and feeding practices was developed based on existing literature and measures, expert collaboration, and external reviews. Trained observers coded 41 lunchtime videos in 10 childcare centers. Measurable Outcome/Analysis Face validity of the tool was assessed by sending the toolkit to 4 external expert reviewers for feedback. Four trained coders watched and coded a video separately in order to assess inter-rater reliability calculating a Kappa statistic. Convergent validity was evaluated by relating the MOCC items to previously validated measures including EPAO-Extended Feeding Practices (EPAO-EFP), Table Talks (TT), and Feeding Behavior Coding System (FBCS). The same videos were coded with TT, EPAO-EFP and FBCS and the scores for relevant items were used for comparison with MOCC score. Pearson's, bivariate correlations were calculated between MOCC items and items matched with other measures. Results Expert reviewers provided feedback related to including additional verbal examples, clarifying the difference between unable to observe and not applicable and improving the formatting of the checklist. Interrater reliability was high (Fleiss's Kappa, K = 0.85). The convergent validity of the MOCC tool was high, among 9 subscales 8 were significantly associated to previous measures (r = 0.40 [P 50 lunchtimes. Conclusions MOCC may be a comprehensive, valid and reliable tool to assess teacher feeding practices, informing professional development and evaluating intervention efforts.

Approximately 15 million children under age 6 are in childcare settings, offering childcare providers an opportunity to influence children’s dietary intake. Childcare settings vary in organizational structure – childcare centers (CCCs) vs. family childcare homes (FCCHs) – and in geographical location – urban vs. rural. Research on the nutrition-related best practices across these childcare settings is scarce. The objective of this study is to compare nutrition-related best practices of CCCs and FCCHs that participate in the Child and Adult Care Food Program (CACFP) in rural and urban Nebraska. Nebraska providers (urban n = 591; rural n = 579) reported implementation level, implementation difficulty and barriers to implementing evidence-informed food served and mealtime practices. Chi-square tests comparing CCCs and FCCHs in urban Nebraska and CCCs and FCCHs in rural Nebraska showed sub-optimal implementation for some practices across all groups, including limiting fried meats and high sugar/ high fat foods, using healthier foods or non-food treats for celebrations and serving meals family style. Significant differences (p

The US Department of Agriculture Child and Adult Care Food program (CACFP) recently (October 2017) updated requirements for meal reimbursement and best practice recommendations for serving nutritious meals and beverages, and minimum age-specific serving sizes for five food groups. It is not known whether CACFP-funded child-care centers are meeting the updated meal pattern requirements and best practice recommendations, and whether children are meeting nutrition recommendations based on the current 2015-2020 Dietary Guidelines for Americans (DGA).This study assessed whether the recruited CACFP-funded child-care centers in this study were meeting the updated (2017) CACFP requirements regarding foods served for lunch and whether children attending these child-care centers were meeting age- and sex-specific DGA recommendations regarding foods consumed.This was a cross-sectional study using the Dietary Observation for Child Care method. PARTICIPANTS AND SETTINGS: Children aged 3 to 5 years (n=108) from 10 classrooms in three CACFP-funded child-care centers in Lincoln, NE, were recruited by convenience sampling during spring 2018.Food served and consumed during observed lunches in comparison with updated CACFP requirements and DGA, respectively.Adjusted mean amounts of foods served from each food group were compared with age specific minimum CACFP serving size requirements. Adjusted mean amounts of foods consumed from each food group were then compared with age- and sex-specific DGA recommendations.The recruited child-care centers were meeting the updated CACFP requirements regarding foods served but showed limited adherence to the best practice recommendations during the observed lunches. However, the overall mean intake for grains, fruits, and vegetables was significantly lower (P0.01) than DGA recommendations. In addition, approximately 25% of the children did not consume any vegetables during their meal. CONCLUSIONS: Although child-care centers were meeting the updated CACFP requirements by serving the recommended amounts of foods, children were not meeting DGA-recommended intakes. Future studies are needed to explore ways to improve adherence to best practice recommendations to improve children's consumption of healthy foods in child-care centers.

Objective To examine contextual factors that may influence child care providers’ motivators for attending nutrition-related training and their preferences and barriers to attending professional development training. Design Cross-sectional survey completed between January and April 2017. Setting Licensed child care programs (n = 1,490) across urban and rural Nebraska. Participants Child care center directors (n = 336) and family child care home providers (n = 1,154). Main Outcome Measure(s) Motivators, preferences, and barriers of child care providers for attending professional development. Analysis Descriptive statistics and multiple logistic regression analyses were conducted. Results Top motivators for attending nutrition-related training included meeting licensure requirements and improving job performance. Child care providers most commonly selected preferences for receiving training included in-person and online delivery. Top barriers to obtaining training were schedule conflicts, accessibility, and cost. Child care centers and participants in the Child and Adult Care Food Program (CACFP) and Nutrition and Physical Activity Self-Assessment in Child Care (Go NAP SACC) were more likely to be motivated by licensure requirements. Rural providers were also more likely to report barriers such as inability to travel and limited access to training. Results revealed that child care type, geographic location, CACFP and Go NAP SACC participation can influence child care providers’ motivators, preferences, and barriers to attending training. Conclusions And Implications Results highlight the importance of offering professional development training that best fits child care providers’ needs and preferences.

Introduction: Early childhood is an optimal time to support the development of physical activity and healthy eating behaviors. As over half of children are cared for in family child care homes and child care centers it is crucial to ensure these behaviors are being supported in the childcare setting. One such process that supports provider’s education and implementation of healthy behaviors in the childcare setting is the Nutrition and Physical Activity Assessment in Child Care (Go NAP SACC). However, after participation in Go NAP SACC, little is known regarding how to further support providers in their promotion of healthy behaviors. More research is needed in the United States (U.S.), especially in rural populations, to understand providers’ reported perceptions of health behavior promotion after receiving Go NAP SACC training and implementing best practices. Purpose: The purpose of this study was to assess the nutrition and physical activity reported practices and perceptions of U.S. rural and urban providers who had received Go NAP SACC training and implemented Go NAP SACC best practices within the last two years. Methods: Semi-structured interviews were completed with 12 providers (6 rural, 6 urban) in the Midwestern U.S. based on constructs of the Social Cognitive Theory (i.e., personal behaviors, cognitive factors, and socioenvironmental factors). Data were analyzed via immersion and crystallization and validated with reflexivity and peer debriefing. Results: Findings indicated Go NAP SACC trained providers in both rural and urban areas felt they had the resources and knowledge needed to promote physical activity and healthy eating. However, they still struggled with barriers related to adequate space for activity, funding for equipment, parent engagement, and health promotion among staff and parents. Conclusion: Incorporating opportunities for follow-up interactions after initial training may help reduce the barriers that persist after Go NAP SACC training. In addition, future interventions should consider the factors of parent engagement and staff wellness during intervention development and execution.

Background National early childhood obesity prevention policies recommend that child-care providers avoid controlling feeding practices (CFP) (eg, pressure-to-eat, food as reward, and praising children for cleaning their plates) with children to prevent unhealthy child eating behaviors and childhood obesity. However, evidence suggests that providers frequently use CFP during mealtimes. Objective Using the Academy of Nutrition and Dietetics (2011) benchmarks for nutrition in child care as a framework, researchers assessed child-care providers' perspectives regarding their use of mealtime CFP with young children (aged 2 to 5 years). Design Using a qualitative design, individual, face-to-face, semi-structured interviews were conducted with providers until saturation was reached. Participants/setting Providers were selected using maximum variation purposive sampling from varying child-care contexts (Head Start, Child and Adult Care Food Program [CACFP]–funded centers, non-CACFP programs). All providers were employed full-time in Head Start or state-licensed center-based child-care programs, cared for children (aged 2 to 5 years), and were directly responsible for serving meals and snacks. Main outcome measure Child-care providers' perspectives regarding CFP. Statistical analyses performed Thematic analysis using NVivo (version 9, 2010, QSR International Pty Ltd) to derive themes. Results Providers' perspectives showed barriers, motivators, and facilitators regarding their use of mealtime CFP. Providers reported barriers to avoiding CFP such as CFP were effective for encouraging desired behaviors, misconceptions that providers were encouraging but not controlling children's eating, and fear of parents' negative reaction if their child did not eat. Providers who did not practice CFP were motivated to avoid CFP because they were unnecessary for encouraging children to eat, and they resulted in negative child outcomes and obesity. Facilitators as an alternative to CFP included practicing healthful feeding practices such as role modeling, peer modeling, and sensory exploration of foods. Conclusions Training providers about negative child outcomes associated with CFP, children's ability to self-regulate energy intake, and differentiating between controlling and healthful feeding strategies may help providers to avoid CFP.

Objective Given the high prevalence of suboptimal nutrition and low activity levels in children, we systematically reviewed the literature on the relationship between physical activity and dietary patterns and cognitive development in early childhood (six months to five years). Methods In February 2016, we conducted two different searches of MEDLINE, PsycINFO, and ERIC. Each search included either physical activity (including gross motor skills) or diet terms, and neurocognitive development outcome terms. Included studies were in English, published since 2005, and of any study design in which the physical activity or diet measure occurred prior to age five. Results For physical activity, twelve studies (5 cross-sectional, 3 longitudinal and 4 experimental) were included. Eleven studies reported evidence suggesting that physical activity or gross motor skills are related to cognition or learning. Both acute bouts and longer term exposures showed benefit. For diet, eight studies were included consisting of secondary analyses from longitudinal cohort studies. A healthier dietary pattern was associated with better cognitive outcomes in all studies, although some of the reported associations were weak and the measures used varied across the studies. Conclusions Physical activity and healthy diets in early childhood are associated with better cognitive outcomes in young children. The paucity of literature and the variability in the type and quality of measures used highlight the need for more rigorous research. Given that the early childhood years are critical for both obesity prevention and neurocognitive development, evidence that the same healthy behaviors could promote both should inform future interventions., Highlights • There is evidence for cognitive benefits of physical activity in early childhood. • An association between diet in early childhood and later cognition is suggested. • Variability in study design and measurement tools limits comparisons. • Health behaviors that prevent obesity could also promote children's cognition.

Background Positive mealtime emotional climate (MEC) has been linked to better nutrition, psychosocial, literacy and academic outcomes, and fewer behavior problems. However, MEC has been defined in a variety of ways across studies, limiting the ability to synthesize findings and plan future research. Objective To determine how previous studies have measured MEC, and to identify which child characteristics are associated with MEC. Study Design, Setting, Participants We searched 3 databases (1980-2018) for peer-reviewed articles measuring MEC. Inclusion criteria required at least 1 child-level outcome related to physical, nutritional, or developmental health; children aged 0-18 years old; and quantitative data using cohort, case-control, intervention, or experimental designs. Measurable Outcome/Analysis To address the first objective, we extracted data about the measures and definitions of MEC from each included article. To address the second aim, we used a previously published taxonomy to categorize child/adolescent characteristics according to the amount of evidence linking them to MEC. A characteristic was categorized as a “correlate” (positive or negative association) or “non correlate” (no association) if >3 studies assessing that characteristic found consistent results. If >3 studies assessing a characteristic had inconsistent results, the construct was classified as “unclear.” If Results Out of 561 unique studies identified in the initial search, 13 met inclusion criteria, and only 3 used the same measure of MEC. Healthful dietary intake, disordered eating behaviors, and weight/BMI were categorized as correlates of MEC, but links to unhealthy dietary intake are unclear. Several characteristics (eg, temperament, academic success) were examined in only 1 study. Conclusions More research is needed to understand the relationship between MEC and child developmental outcomes and physical activity. These findings aid in conceptualizing how MEC has been defined and measured and illuminate the importance of MEC on children's health.

ObjectiveTo determine if family childcare homes (FCCH) in Nebraska meet best practices for nutrition and screen time, and if focusing on nutrition and screen time policies and practices improves the FCCH environment.DesignA pre–post evaluation was conducted using the Go Nutrition and Physical Activity Self-Assessment for Childcare (Go NAP SACC).SettingFCCH in Nebraska, USA.SubjectsFCCH enrolled in the Child and Adult Care Food Program (CACFP; n 208) participated in a pre–post evaluation using Go NAP SACC.ResultsAt baseline, all FCCH met the minimum childcare standards for fifty-four of fifty-six practices in nutrition and screen time. After the intervention, FCCH demonstrated significant improvement in fourteen of the forty-four Child Nutrition items and eleven of the twelve Screen Time items. However, FCCH providers did not meet best practices at post-intervention. Lowest scores were found in serving meals family-style, promoting visible support for healthy eating, planned nutrition education and written policy on child nutrition. For screen time, lowest scores were reported on the availability of television, offering families education on screen time and having a written policy on screen time.ConclusionsFCCH in Nebraska were able to strengthen their policies and practices after utilizing Go NAP SACC. Continued professional development and participation in targeted interventions may assist programmes in sustaining improved practices and policies. Considering the varying standards and policies surrounding FCCH, future studies comparing the current findings with childcare centres and non-CACFP programmes are warranted.

Background: The purpose of this study was to determine if the Go Nutrition and Physical Activity Self-Assessment in Child Care (Go NAP SACC) intervention was effective in improving best practices in the areas of infant and child physical activity and outdoor play and learning in family child care homes (FCCHs) in Nebraska.Methods: FCCHs (n = 201) participated in a pre–post evaluation using the Infant and Child Physical Activity and Outdoor Play and Learning assessments from the Go NAP SACC validated measure to assess compliance with best practices.Results: At post, FCCHs demonstrated significant differences in 85% of the Infant and Child Physical Activity items (17 of 20) and 80% of the Outdoor Play and Learning items (12 of 15). Significant differences in best practices between urban and rural FCCH providers were also found.Conclusion: Go NAP SACC appears to be an effective intervention in Nebraska as, after participation in the initiative, providers were improving child care physical activity best practices. Additional research is needed to objectively determine if these changes resulted in objective improvements in children’s physical activity levels. Further, efforts are needed to develop and/or identify geographic-specific resources for continued improvement.

Background Early childhood education (ECE) programs are important partners for childhood obesity prevention efforts. Despite signs of progress, racial and ethnic, socioeconomic, and geographic disparities in obesity rates still persist in California. Current understanding of obesity prevention strategies (e.g. nutrition practices) is limited across ECE programs in Tulare/ Kings counties of California. Objective To characterize nutrition practices of Child Care Centers (CCCs) and Family Child Care Homes (FCCHs). Study Design, Settings, Participants Study design was cross-sectional. Settings included licensed CCCs and FCCHs in Tulare/Kings counties. Participants included CCC Directors (N = 59) and FCCH Providers (N = 58). Measurable Outcome/Analysis Of the 701 nutrition practices surveys administered, 117 were completed and returned. Descriptive and chi-square analysis was conducted using SPSS. Results Results indicated statistically significant differences (P Conclusion Targeting nutrition interventions based on the childcare context (FCCH vs. CCC) is critical to the implementation of nutrition best practices. Overall, FCCH reported higher adherence to best practices as compared to CCC. This could be attributed to a higher participation of FCCHs in CACFP. A focus on nutrition education as well as participation in CACFP in ECE programs may help in obesity prevention efforts. Funding UC ANR.