Healthy apple program to support child care centers to alter nutrition and physical activity practices and improve child weight: a cluster randomized trial

Abstract

Background: North Carolina Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) resources improve child body mass index (BMI) when the resources are introduced by nurses to child care providers, and offered with workshops and incentives. In San Francisco, public health and child care agencies partnered to adapt NAP SACC resources into an annual "Healthy Apple" quality improvement program (HAP). Methods: This cluster randomized controlled trial pilot-tested integration of the HAP with bi-annual public health screenings by nurses. All child care centers that participated in Child Care Health Program (CCHP) screenings in San Francisco in 2011-2012 were offered routine services plus HAP in 2012-2013 (CCHP + HAP, n = 19) or routine services with delayed HAP in 2014-2015 (CCHP + HAP Delayed, n = 24). Intention-to-treat analyses (robust SE or mixed models) used 4 years of screening data from 12 to 17 CCHP + HAP and 17 to 20 CCHP + HAP Delayed centers, regarding 791 to 945 children ages 2 to 5y, annually. Year-specific, child level models tested if children in CCHP + HAP centers had greater relative odds of exposure to 3 index best practices and smaller Autumn-to-Spring changes in BMI percentile and z-score than children in CCHP + HAP Delayed centers, controlling for age, sex, and Autumn status. Multi-year, child care center level models tested if HAP support modified year-to-year changes (2013-2014 and 2014-2015 vs 2011-2012) in child care center annual mean Autumn-to-Spring BMI changes.

Preventing and treating childhood overweight and obesity in children up to 5 years old: A systematic review by intervention setting

“…These reviews highlight that the most effective intervention strategies incorporate both family and the school/childcare environment. Our findings concur with this; we have also found that interventions including a policy-based change to improve the food environment are effective at improving outcomes (Hodgkinson et al, 2019;Natale et al, 2017;Stookey et al, 2017).…”

“…The studies were assessed using the T A B L E 4 (Continued) Daniels et al, 2013;Fisher et al, 2019;Fitzgibbon et al, 2011;Helle et al, 2019;Kim et al, 2019;Natale et al, 2014Natale et al, , 2017Nyström et al, 2017;Quattrin et al, 2014;Skouteris et al, 2016;Tomayko et al, 2016;Wall et al, 2019). | 23 of 31 et al, 2021;Bocca et al, 2012;Campbell et al, 2013;de la Haye et al, 2019;Fitzgibbon et al, 2011;Haines et al, 2018;Hodgkinson et al, 2019;Lumeng et al, 2017;Martínez-Andrade et al, 2014;Natale et al, 2014Natale et al, , 2017Nyström et al, 2017;Quattrin et al, 2014;Salazar et al, 2014;Sherwood et al, 2015;Skouteris et al, 2016;Stark et al, 2011;Stookey et al, 2017;Tomayko et al, 2016;Verbestel et al, 2014;Walton et al, 2015), four of which included policies to promote changes to the early years/childcare setting (Hodgkinson et al, 2019;Natale et al, 2014Natale et al, , 2017Stookey et al, 2017). Five studies focused on modifying diet only (Daniels et al, 2013;Fisher et al, 2019;…”

“…Three of these studies included a structured training programme for the staff delivering the interventions (Bellows et al, 2013;Fitzgibbon et al, 2011;Hodgkinson et al, 2019). Interventions were also delivered by master's level educators (Lumeng et al, 2017), trained programme facilitators/staff (Stookey et al, 2017;Walton et al, 2015), dietitians…”

“…Common sources of bias included no information on randomisation or high rates of attrition. Of the effective interventions, five were found to be at low risk of bias (Haines et al, 2018;Quattrin et al, 2014;Stark et al, 2011;Stookey et al, 2017;Wall et al, 2019), four were moderate (Bocca et al, 2012;Hodgkinson et al, 2019;Sherwood et al, 2015;Verbestel et al, 2014) and four were classified as high risk (Berry et al, 2011;Natale et al, 2017;Salazar et al, 2014;Tomayko et al, 2016). These reviews highlight that the most effective intervention strategies incorporate both family and the school/childcare environment.…”

Measuring Skin Carotenoids Using Reflection Spectroscopy in a Low-Income School Setting

“…While this cost may be insurmountable for small programs, it can be more feasible as part of state level budgets or as part of large public health initiatives. One such example is the San Francisco Department of Public Health, which uses the Veggie Meter ® to assess the Healthy Apple Program [54,55]. In the specific case of this group, the cost of the device was split across departmental funding and state funding through CFHL, UC.…”