Promoting Nutrition and Physical Activity in Family Child Care

Study Overview
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Brief Summary
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The CHEER study takes advantage of a natural experiment happening in South Carolina (SC). The South Carolina Department of Social Services implemented new healthy eating and physical activity standards through a state-wide policy for family child care homes that participate in the ABC Grow Healthy program. Thus, CHEER is a quasi-experimental, two-group, pre-test/post-test design study.

Detailed Description
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The overall goal of the study is to evaluate new healthy eating and physical activity standards targeting family child care homes in South Carolina. To accomplish this goal, we are assessing the effects of the standards on the dietary intake and physical activity levels of racially diverse low-income children in family child care homes. The specific aims of the CHEER study are as follows: Aim 1. Evaluate the extent to which the new regulatory standards impact children's dietary intake assessed via direct observation in homes and 24-hour recalls with parents, and physical activity and sedentary behavior assessed via accelerometry. Aim 2. Evaluate the extent to which the new regulatory standards impact children's body mass index computed from researcher-measured height and weight. Secondary Aim. Evaluate the extent to which family child care homes in the SC ABC Child Care Program comply with the new healthy eating and physical activity regulatory standards, compared to family child care homes not participating in the program. We hypothesize that most homes will comply with the new standards, yielding improvements in children's healthy eating and physical activity levels. As an exploratory aim, we will examine the effects of the standards on children's weight status.

Official Title
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Promoting Nutrition and Physical Activity in Family Child Care

Conditions
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Diet, Healthy, Physical Activity, Obesity, Childhood

Intervention / Treatment
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* Behavioral: Policy/program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Having a child in care between the ages 2 and 4 years at recruitment The family is planning to stay in the same care arrangement for the next few years Exclusion Criteria: Family planning to leave the care arrangement in next few years

Ages Eligible for Study
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Minimum Age: 2 Years
Maximum Age: 4 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Comparison<br>Comparison children within family child care homes not exposed to policy/program | |
| Intervention<br>Intervention children within family child care homes exposed to policy/program | Behavioral: Policy/program<br>* Policy/program to improve nutrition and increase physical activity<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Diet | Healthy Eating Index score - The Healthy Eating Index is a calorie-adjusted comparison of individual or group-level dietary intake to current dietary guidelines. The Healthy Eating Index was last updated in 2015 and represents the sum of thirteen component scores. Higher scores are awarded for healthier intake within each component. Each component of the Healthy Eating Index has a standard for receiving the minimum or maximum points possible. The HEI components and maximum scores include: total fruit (5), whole fruit (5), total vegetables (5), greens and beans (5), whole grains (10), dairy (10), total proteins (5), seafood/plant (lean) proteins (5), fatty acids (10), refined grains (10), sodium (10), added sugars (10), and saturated fats (10). | Approx 1 year | 
| Physical activity | Accelerometer measured minutes of moderate to vigorous physical activity | Approx every year for 2 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Body mass index | Child body mass index z-score | Approx every year for 2 years | 
| Family child care home environment | Environment and Policy Assessment and Observation | Approx every year for 2 years |