Exploring the Provider-Level Socio-Demographic Determinants of Diet Quality of Preschool-Aged Children Attending Family Childcare Homes

Abstract

Since food preferences develop during early childhood and contribute to dietary patterns that can track into adulthood, it is critical to support healthy food environments in places where children spend significant amounts of time in, such as childcare. It is important to understand what factors influence the diet quality of children cared for in family childcare homes (FCCH). Methods: This study used baseline data from a cluster-randomized trial in FCCH, Healthy Start/Comienzos Sanos. Surveys capturing providers’ socio-demographic characteristics were completed. Food and beverage consumptions were estimated using the Dietary Observation in Childcare protocol, and diet quality was calculated using the Healthy Eating Index (HEI)-2015. Comparison of mean HEI scores by provider socio-demographic variables were completed using ANOVAs, followed by multiple linear regression models for significant variables. Post-hoc ANOVA models compared mean HEI-2015 sub-components by income and ethnicity. Results: Significant differences in mean HEI-2015 scores were found for provider income level (less than $25,000, HEI: 64.8 vs. $25,001–$50,000: 62.9 vs. $75,001 or more: 56.2; p = 0.03), ethnicity (Non-Latinx: 56.6 vs. Latinx: 64.4; p = 0.002), language spoken outside of childcare (English: 58.6 vs. Spanish: 64.3, p = 0.005), and language spoken in childcare (English: 59.6 vs. Spanish: 64.4; p = 0.02). In linear regression models, a higher provider income ($75,001 or more) was negatively and significantly associated with the total HEI-2015 scores (β = −9.8, SE = 3.7; p = 0.009) vs. lower income (less than $25,000). When entering provider income and ethnicity to the same model, adjusting for Child and Adult Food Program (CACFP), only ethnicity was significant, with Latinx being positively associated with total HEI-2015 scores vs. non-Latinx (β = 6.5, SE = 2.4; p = 0.007). Statistically significant differences were found by ethnicity and language for greens/beans, total protein, and seafood and plant protein HEI-2015 component scores. Discussion: Lower income, and Latinx providers cared-for children had higher diet quality in FCCH compared to the other providers. Future studies should better understand what specific foods contribute to each of the HEI-2015 components in order to better tailor trainings and interventions.

Appetitive Traits in a Population-Based Study of Polish Adolescents within the PLACE-19 Study: Validation of the Adult Eating Behavior Questionnaire

“…Dietary behaviors are developed rapidly from infancy to adolescence, and they are influenced not only by individual factors and household characteristics [ 1 ], but also by parent–child interactions and social interactions [ 2 ]. In the adolescence period, dietary behaviors may be crucial, as they contribute to further behaviors in adulthood and to the resultant health risks [ 3 ] associated with body mass [ 4 ] and dieting [ 5 ].…”

“…A number of studies conducted during the COVID-19 pandemic have revealed important determinants that might influence the dietary behaviors of adults [ 19 , 20 , 21 ], but thus far, no such studies in a population of adolescents have been published. Despite the fact that the determinants of dietary behaviors are generally numerous and complex [ 1 , 2 ], such dietary behaviors in adults during the COVID-19 pandemic can be explained by two major determinants: lockdown and stockpiling food at home [ 20 ]. Both determinants were also experienced by children and adolescents in this period, and may have also influenced their dietary behaviors.…”

Dietary Contributors to Food Group Intake in Preschool Children Attending Family Childcare Homes: Differences between Latino and Non-Latino Providers

“…A previous analysis of data from the Healthy Start study, found that children under the care of Latino FCCPs had higher diet quality (Healthy Eating Index: 64.4) compared to non-Latino FCCPs (Healthy Eating Index: 56.6). While this study found that children under the care of Latino FCCPs had higher component diet quality scores for greens/beans, total protein, and seafood and plant protein, this analysis did not take into account the specific types of foods offered and the ethnic differences in the foods provided [24]. While the CACFP is a very important predictor of the nutritional quality of foods served in childcare [30][31][32][33], exploring other factors among FCCHs that care for underserved children is needed.…”

“…In addition to participating in the CACFP, FCCH providers (FCCPs) are ethnically diverse [22], and their ethnicity has been related to different dietary practices in childcare settings [23,24]. Research also suggests that cultural and social differences play a role in the foods offered to children [22,25,26].…”

Foods provided to children in family day care: an observational study

“…Most research exploring the nutrition environment in ECEC services has been conducted with centre-based services, with little on FDC (10,11) . Studies involving direct observation in Family Child Care Homes (equivalent to FDC) in the USA have found children's diet quality has been associated with the food provided (12,13) , nutrition education (12) , nutrition policy (12) , educator income (14) , ethnicity (14) and main language spoken at home (14) . Additionally, children were not being provided with, or consuming, adequate amounts of vegetables, total protein foods, seafood and plant-based proteins and wholegrains (13) .…”