Head Start and child care providers' feeding practices: a potential avenue for obesity prevention in young children

Dev, Dipti

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Description

Title

Head Start and child care providers' feeding practices: a potential avenue for obesity prevention in young children

Author(s)

Dev, Dipti

Issue Date

2014-01-16T18:26:19Z

Director of Research (if dissertation) or Advisor (if thesis)

• McBride, Brent A.
• Donovan, Sharon M.

Doctoral Committee Chair(s)

Chapman-Novakofski, Karen M.

Committee Member(s)

• McBride, Brent A.
• Donovan, Sharon M.
• Fiese, Barbara H.
• Teran-Garcia, Margarita D.

Department of Study

Nutritional Sciences

Discipline

Nutritional Sciences

Degree Granting Institution

University of Illinois at Urbana-Champaign

Degree Name

Ph.D.

Degree Level

Dissertation

Keyword(s)

• Head Start
• Child and Adult Care Food Program
• Child care providers' feeding practices
• self-regulation
• preschool children
• Academy of Nutrition and Dietetics benchmarks for nutrition in child care
• family style meal service
• qualitative research
• predictors
• ecological model
• childhood obesity prevention

Abstract

The Academy of Nutrition and Dietetics released a position statement in 2012 regarding benchmarks for nutrition in child care to establish healthful eating behaviors in early childhood and prevent obesity in young children. Further, recent publications by the Institute of Medicine and national organizations have recommended specific feeding practices for child care providers to be implemented at the state-level to prevent early childhood obesity in preschool children. Although over 12 million US children in child care consuming up to 5 meals and snacks per day in such settings, little is known about child care providers’ feeding practices. The purpose of this dissertation was to examine provider’s feeding practices in Head Start and child care programs with the following aims 1) To assess whether providers met the Academy’s benchmarks and if attainment of benchmarks varied across child care contexts (Head Start [HS], Child and Adult Care Food Program [CACFP] and non-CACFP). 2) To identify determinants of child care providers’ healthful and controlling feeding practices for 2-5y-old children. 3) To identify Head Start and child care provider’s motivators, barriers and facilitators for using family style meal service (FSMS) during child care mealtimes. Cross-sectional data was collected in 2011 and 2012 where 118 child care providers from 24 center-based programs (6 Head Start [HS], 11 Child and Adult Care Food Program [CACFP] funded, 7 non-CACFP) completed self-administered surveys regarding their feeding practices for 2-5-year-old children. Chi-square tests and Analysis of variance were used to determine variation in meeting benchmarks across contexts. Multi-level multivariate linear regression models were used to predict seven feeding practices- healthful (allowing children to control their food intake, role modeling healthy eating and teaching children about nutrition) and controlling (pressuring children to eat and restricting access to food for health or weight control). For aim 3, qualitative semi-structured interviews were conducted with a subset of providers based on maximum variation purposive sampling. The interviews were lead until saturation was reached and the data was coded using thematic analysis by NVivo qualitative software. It was found that HS providers had greater compliance with the Academy’s benchmarks compared to CACFP and non-CACFP providers. HS providers sat more frequently with children during meals (P=0.01), ate the same foods as children (P=0.001) and served meals family-style (P<0.0001) more often, compared to CACFP and non-CACFP providers. HS providers (P=0.002), parents (P=0.001) and children (P=0.01) received more nutrition education opportunities compared to CACFP and non-CACFP. HS providers encouraged more balance and variety of foods (P<0.05), offered healthier foods (P<0.05), modeled healthy eating (P<0.001), and taught children about nutrition (P<0.001) compared to CACFP and non-CACFP providers. Providers across all three contexts used significantly more non-internal than internal mealtime verbal comments (P<0.0001). Regarding predictors of provider’s feeding practices; working in a HS center predicted teaching children about nutrition and modeling healthy eating; that may be attributed to the HS performance standards which require HS providers to practice healthful feeding. Providers who reported being concerned about children’s weight, responsible for feeding children and had an authoritarian feeding style were more likely to pressure children to eat, restrict intake, and control food intake to decrease or maintain children’s weight. Providers with non-White race, who were trying to lose weight, perceived nutrition as important in their own diet, and had greater number of nutrition training opportunities were more likely to use restrictive feeding practices. Findings suggest that individual and child care level factors, particularly provider race, education, training, feeding attitudes and styles and the child care context may influence providers’ feeding practices with young children. A qualitative investigation of the motivators, barriers and facilitators for using family style meal service (FSMS) from the perspective of 18 child care providers revealed that HS and CACFP providers were motivated to use FSMS because it created pleasant mealtimes, opportunities to role model healthy eating, and healthful child development. CACFP and non-CACFP providers reported not using FSMS because it was resource intensive, messy, unhygienic, and seemed to violate CACFP policy. HS and CACFP providers recommended strategies to overcome these barriers. They suggested that FSMS becomes easier with practice and teaching children self-help skills during play time can avoid messes during mealtimes. Possible reasons for an increased compliance of HS providers to the Academy’s benchmarks may be attributed to HS federal performance standards for child nutrition and increased nutrition training opportunities for HS staff. HS programs can serve as a model in implementing the Academy’s benchmarks. Considering the predictors of providers feeding practices identified by this study when developing interventions, may add to the efficacy of childhood obesity prevention programs. The present research offers new insights not only regarding providers’ barriers to FSMS, but also strategies from providers to help overcome these barriers and allow for effective implementation of FSMS in child care settings. Providers should be encouraged to adopt FSMS, because the long-term health consequences and learning opportunities of FSMS outweigh any barriers related to its practical implementation. By strengthening policies and training that are more aligned with the Academy’s benchmarks, child care providers can be in a unique position to prevent childhood obesity by instilling positive eating behaviors related to self-regulation of the preschool-aged children in their care.

Graduation Semester

2013-12

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Copyright 2013 Dipti Ashok Dev

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