THE HOME AND CHILD-CARE: ARE PRESCHOOLAGED CHILDREN GETTING MIXED FOOD-RELATED MESSAGES?

Statement of the Problem: In the United States, nearly 14% of preschool-aged children (ages 2 to 5) are obese. Additionally, disparities persist, with the highest prevalence of obesity among Hispanic preschool-aged children (17% vs. 11% non-Hispanic Black and 3.5% non- Hispanic White preschool-aged children). Establishing healthy eating habits in early childhood is critical and providing children with similar opportunities to practice healthy eating habits independently at home and in child care is thought to reinforce the development of healthy eating habits early in life. However, there is limited information regarding how parents and childcare providers communicate about child-nutrition, including promoting healthy eating habits. Further, there is a need to examine how and what children are fed both at home and in child care. The purpose of this dissertation was to understand child-nutrition related communication between parents and family child care providers (FCCP) how and what parents and family child care providers (FCCP) feed preschool-aged children at home and in child care. The aims of this paper are to 1) describe parent-FCCP child nutrition-related communication, 2) describe how and what parents and FCCP feed preschool-aged children at home and in childcare, and 3) identify with parents and FCCP strategies to promote healthy eating habits in preschool-aged children. Methods: A total of three separate research projects (n = 83) were conducted between December 2016 – October 2018. For study 1, five focus groups (n = 25) were conducted with parents of preschool-aged children attending family child care homes (FCCH) to explore how and what parents communicate about with family child FCCPs, and influences on how parents feed their children at home. Inductive and deductive content analysis approach was utilized for data analysis of the focus group data. For study 2, 33 parent interviews were conducted to collect parent feeding practices and child dietary intake at home. The data collected was subsequently merged with a matching dataset containing FCCP feeding practices and child dietary intake at the FCCH. Parent/FCCP feeding practices scores were calculated and compared for differences. Healthy Eating Index (HEI – 2015) scores were calculated for dietary intake at home and in the FCCH and compared for differences. For study 3, four nominal group technique focus groups (two with parents, (n = 8) and two with FCCPs (n = 17)) were conducted to identify facilitators and barriers to parents and FCCPs working together to support healthy eating habits in Hispanic preschool-aged children. Responses were ranked from greatest to least facilitator/barrier. Summary of results: Most parents/FCCPs were non-US born Hispanic, female, and primarily Spanish-speaking. Parents reported child food preferences and ensuring that children eat enough food influenced how they fed children at home. Communication with FCCPs occurred primarily in-person; childnutrition related communication was infrequent. Compared to FCCPs, parents reported greater frequency of controlling feeding practices, and diet quality was higher at the FCCH compared to the home. In general, caregivers recognize the shared feeding responsibility and indicate that intercommunication (or a reciprocal interaction between caregivers) is important to work together to support healthy eating habits in young children, however barriers remain. Increasing communication of child-nutrition related topics between parents and FCCPs may lead to improvements in child dietary intake. Future efforts should include identifying effective communication modalities to facilitate transfer of nutrition information between parents and FCCPs to support healthy eating habits in young children