Evaluation of a Nutrition Education Program Targeting Home-Based Child Care Centers

Background: The development of a highly obesogenic culture promoting sedentary behavior and the consumption of calorie-dense foods has led to increased levels of overweight and obesity globally. While children and adults are both at increased risk of developing obesity, the risk is even higher in minority and low socioeconomic populations. Changes in familial structure and an increase in mothers of younger children (below the age of 6) entering the workforce have created a new demand for child care services. Although some studies have researched the effectiveness of nutrition programs to increase healthy eating within the child care setting, few have examined to what extent a program is able to increase child proxy-efficacy. Proxy-efficacy is defined as a youth’s confidence in their ability to get others to act in one’s interests; in this case, to create a supportive home environment that produces healthier eating and increased physical activity beyond the child care center. Purpose: To evaluate the effectiveness of a nutrition education program targeting home-based child care centers to increase child proxy-efficacy related to asking behaviors for healthy foods and physical activity. Methods: Children of both genders across Doña Ana County participated in a longitudinal nonexperimental research study in which 23 home-based child care centers received the 12-week HOP’N Home program. The intervention included training of the child care providers who then taught lessons five days a week to the children in their care. Weekend home-connection activities were also provided to the families. Baseline and follow-up skin carotenoid measurements (a biomarker of total fruit and vegetable [F/V] intake) were collected using VEGGIE METER™ (VM), along with pretest and posttest parent survey data assessing the impact of HOP’N Home on parental practices and home environment. Statistical analyses were conducted using SPSS 22 predictive analytics software and included univariate descriptive analysis of all variables, paired-sample t-tests, bivariate linear regression, and correlations (both parametric and nonparametric). Results: The sample population consisted of 54 preschool aged children (mean age= 3.9; SD= 0.82 y; 97% Hispanic or Latino origin; 25.5% Male) and one parent or guardian (mean age=30.7 y.; SD= 8.0 y; 97.7% Hispanic or Latino origin; 84% Female caregiver; 60% Married or living with a partner). Due to attrition, time 2 data were collected on approximately half of the initial participants (n=26-31). Child VEGGIE METER™ (VM) scores were not significantly different (n=31; 0.101 vs. 0.104; p=0.48). Child proxy-efficacy to ask for F/V increased significantly only for vegetables (n=26; 2.32 servings/day vs. 3.50 servings/day; p=0.003). Parent-reported child consumption of 100% fruit juice, vegetables, and fruit did not change. Parental practices of tracking and limiting screen time did not change significantly. Regarding screen time, there was a significant decrease in TV and movie time (n=26; 2.02 h/day vs. 1.23 h/day; p=0.003). The decrease in video game time approached significance (n=26; 0.308 h/day vs. 0.058 h/day; p=0.091), but there was no difference in computer screen time. At time 1, there was a negative correlation between child VM score and parent-reported child intake of fruit (i.e. low child VEGGIE METER™ scores were associated with higher parent-reported child intake of fruit); r= -0.386; p=0.008), but no association with 100% fruit juice or vegetables (r= -0.178 and r= -0.122). At time 2, there was no association between VM score and intake (100% fruit juice, r=-0.139; vegetables, r=-0.202; or fruit, r=0.077). A correlation between child screen time of TV/movies and parental practices of limiting that type of screen time at time 2 was significant (i.e. higher parental practices of limiting child screen time was associated with children watching less TV and movies at time 2; r=0.426; p=0.012), and the association approached significance for video games (r=0.286; p=0.070). Conclusions: Given that Doña Ana County has a high population of youth that are overweight or obese, a program such as HOP’N Home that targets child nutrition knowledge and proxy-efficacy has potential for great impact. In this study, high attrition levels compromised statistical power and poor program implementation compromised impact. However, given that some outcomes were improved, this evidence-based tool does have promise for use in this region. A thorough process evaluation could be useful in addressing logistics and implementation barriers leading to improved program effectiveness