Early childhood overweight and obesity are a growing concern worldwide. In the US, nearly 23% of young children aged 2-5 are overweight or obese. Although recent reports have shown a decrease in obesity for this age group, overweight and obesity continue to be high, especially for young children from low income and ethnic minority families. Much attention needs to be paid in addressing overweight and obesity in early childhood since it presents great risk for many chronic health conditions such as adolescent and adult obesity, diabetes, hypertension and obstructive sleep apnea. Since more than 30% of 2-5 year olds are enrolled in non- relative early child care where they consume meals, snacks and beverages each day, non-relative early child care is an ideal setting to examine the food environment and provider feeding behaviors with the goal of identifying intervention areas to promote healthy feeding practices. Previous research has shown that children placed in non-relative early child-care, especially Family Child Care Homes (FCCHs) are at increased risk of becoming overweight and/or obese. To help foster healthy feeding environments in child care and prevent obesity, the United States Department of Agriculture administers a program entitled the Child and Adult Care Food Program (CACFP). Through this program, eligible child-care providers are reimbursed for purchase of nutritious foods. There is limited research, however, on how effective this program is in meeting its intended goal. The purpose of this proposed study is to describe and determine the association between the food environment including CACFP subsidy and provider feeding behaviors in FCCHs of Baltimore City, Maryland. The proposed study is guided by the ANGELO framework, short for Analysis Grid for Environments Linked to Obesity, which conceptualizes, identifies and measures obesity-promoting environmental attributes within the physical, socio-cultural, economic and political environment.
The specific aims of this study are to 1. Describe the physical, socio-cultural, political/economic food environment and family child-care providers'feeding behavior in FCCHs, 2. Compare the physical, socio-cultural food environment and family child-care providers'feeding behavior in non-CACFP and CACFP participating FCCHs and 3. Evaluate the relationship between the food environment (physical and socio-cultural food environment) and the feeding behaviors of family child care providers of 2-5 year olds, while adjusting for selected covariates. To achieve these aims, 92 licensed family child-care providers will be randomly selected in this cross-sectional survey design to obtain information on the food environment and provider feeding behaviors using the NAP SACC Child Nutrition Assessment tool (Family Child Care Edition). Proportionate random sampling technique will be used to reflect proportion of CACFP participating FCCHs in Baltimore's FCCH population. This study is important, as it will lead to inform interventions targeting FCCHS that will help prevent early childhood overweight and obesity.

Public Health Relevance

It is essential to examine the early food environments of young children with the goal of identifying intervention areas to ensure healthy feeding practices and prevent obesity. The purpose of this study is to describe and determine the association between the food environment and provider feeding behaviors in FCCHs.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Predoctoral Individual National Research Service Award (F31)
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Nursing Science Review Committee (NRRC)
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Banks, David
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Johns Hopkins University
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United States
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