There are approximately 1.3 million US child care workers, most of who are hourly employees and classified as low-wage earners. In North Carolina, half of these workers are African American or Hispanic. Many have no health insurance, putting them at increased risk for many serious and chronic health conditions such as obesity, diabetes, and hypertension. Regular physical activity (PA) is known to decrease risk of many chronic diseases;unfortunately, most Americans, especially low-income individuals and minorities, fail to meet PA recommendations. A multi-level worksite-based PA intervention offered in child care is an innovative strategy to reach these low wage workers and address health disparities among this high-risk population. While the primary target of our intervention is worker PA, we expect that healthier and more physically active workers will be better role models and promoters of healthy lifestyles for children in their care. This two-arm, cluster RCT (n=104 centers, with 4 workers/center) will test the efficacy of a 6-month Care2bWell (CARE) intervention in increasing workers'PA compared to a Financial Empowerment (FE) control arm. The CARE intervention will include a kick-off workshop, where participants get tailored feedback about their health risks and set behavioral goals, followed by three 2-month long wellness campaigns, during which workers monitor PA, receive tailored feedback, and compete in teams for prizes. Center directors will take part in monthly webinars focused on improving the work environment to support PA and wellness. Within a social ecological framework, Perceptual Control, Social Support, and Diffusion of Innovation theories guide intrapersonal, interpersonal, and center- level intervention components. Participants in the FE arm will receive a parallel intervention to enhance financial health at the individual and center levels. The primary outcome will be accelerometer-measured minutes of moderate to vigorous PA. Primary and secondary outcomes (diet, anthropometrics, psychosocial variables, ¢er wellness environments) will be assessed at baseline, follow-up (6 mo), and maintenance (18 mo). Detailed process evaluation, cost-effectiveness, and meditational analysis will be used to assess mechanisms of behavior change at the individual and center levels.

Public Health Relevance

People who work in lower paying jobs without health insurance, such as child care workers, are at increased risk for many chronic diseases (obesity, heart disease, diabetes). Physical activity can help reduce risk for most of these conditions. A multi-level, child care-based, worksite wellness intervention could be an effective strategy for reaching this high risk population of low-wage workers. Improving workers'health and physical activity is a direct benefit to workers, and helps them become healthy role models for children in their care.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Psychosocial Risk and Disease Prevention Study Section (PRDP)
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Pratt, Charlotte
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University of North Carolina Chapel Hill
Schools of Public Health
Chapel Hill
United States
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Ward, Dianne S; Vaughn, Amber E; Hales, Derek et al. (2018) Workplace health and safety intervention for child care staff: Rationale, design, and baseline results from the CARE cluster randomized control trial. Contemp Clin Trials 68:116-126
Linnan, Laura; Arandia, Gabriela; Bateman, Lori A et al. (2017) The Health and Working Conditions of Women Employed in Child Care. Int J Environ Res Public Health 14: