Healthy hearts in family child care: what is the current state of provider health?

Family child care providers (FCCPs) are an important source of child care for close to 1.5 million children under the age of five (Laughlin, 2013). FCCPs provide care to children in their own homes and tend to be a source of care for lower income children. As child care has been identified as a risk factor for childhood obesity (Geoffroy et al., 2013), there have been a few efforts to create quality interventions targeting children in family child care (Mann et al., 2015; Trost, Messner, Fitzgerald, & Roths, 2011). However, little is known about the health of these providers (Gratz & Claffey, 1996). This is the first set of studies to look specifically at FCCP self-reported and objectively measured health. A modified double ABC-X model (McCubbin & Patterson, 1983) was used to examine FCCP cardiovascular risk and resilience processes. Study 1. FCCP health was compared to a matched sample from the same state using data from the Center for Disease Control (2014). Online and paper-based surveys were utilized to form an analytic sample of 165 FCCPs. SPSS v23 was used to calculate descriptives, chi-square tests, multiple imputation and logistic regression. FCCPs were less healthy compared to the matched sample on multiple indicators including general health, emotional support, satisfaction with life, likelihood of not seeing a doctor due to cost or for another reason, consumption of one or more fruits per day, overweight or obese body mass index (BMI), fewer than 7 hours of sleep per night, high blood pressure, diabetes, and asthma. The likelihood of FCCPS being classified as overweight or obese was significantly increased with unhealthy eating, lack of physical activity, and higher than average perceived stress. Study 2. Due to the high levels of overweight and obesity in the first study, the second study was conducted to determine how these high levels might affect the cardiovascular health of FCCPs. This in-person study collected anthropometric and physiological measures in addition to more in-depth survey questions about cardiovascular health on 67 FCCPs. SPSS v23 was again used for descriptives, correlations, multiple imputation, and multiple regression. Two different Framingham Cardiovascular Risk Scores predicting risk for the next 30-years (FRS30) were calculated using BMI (FRS30B) and lipid (FRS30L) measures. The FRS30B was a better assessment in this population than the FRS30L. On average using the FRS30B, FCCPs had a 21.85% chance of having a cardiovascular event in the next 30 years, with 73.13% of over the normal risk and 86.57% over the optimal risk based on FCCP age and sex. Cumulative risk factors (not physically active, unhealthy eating, not seeing a doctor due to cost, arthritis, and depression diagnosis) and cumulative protective factors (low stress, very satisfied with life and would choose child care as career again) were determined based on correlations of over 0.10 with the FRS30B. Cumulative protective factors were found to significantly moderate cumulative risk factors. This finding supports the adapted double ABC-X model for FCCP cardiovascular risk and resilience processes. These studies are the first to provide evidence that, in addition to higher rates of overweight and obesity, FCCPs may also have poorer cardiovascular health. Given the centrality of this setting in the lives of over 1.5 million small children, these results have important implications for intervention work with FCCPs and for further exploring resilience in the context of cardiovascular health