Examining the sociocultural, physical, and potical/economic food environments of family child care homes

Background: Nearly 23% of US-based young children aged 2-5 are overweight or obese. Since young children spend a majority of their time in child care where they consume most of the day’s meals, a better understanding of the child care food environment is warranted. Evidence shows that children placed especially in Family Child Care Homes (FCCHs) are at increased risk of becoming overweight and/or obese. Yet, there isn’t much research on examining the obesity promoting attributes of the FCCH environment. There is also limited research on how effective the United States Department of Agriculture’s program entitled the Child and Adult Care Food Program (CACFP) is in meeting its intended goal of ensuring healthy food environments in child care. Purpose: The purpose of this dissertation is to describe and examine the association between the sociocultural, physical and political/economic food environment and quality and frequency of foods offered to 2-5-year-old children in FCCHs. Design and Methods: A cross sectional design was employed. 91 licensed FCCHs (69 CACFP, 22 non-CACFP) were surveyed by phone using a proportionate random sampling technique to reflect the proportion of CACFP FCCHs in Baltimore City. Findings: CACFP participation status of FCCHs was associated with the sociocultural food environment. Additionally, the sociocultural food environment was positively associated with the frequency and quality of foods offered to children. These significant relationships persisted when adjusted for provider level characteristics. CACFP participation status of FCCHs was not associated with the quality and frequency of foods offered. Providers who reported not having had nutrition training within the past year had lower physical food environment mean scores, even when controlling for CACFP participation status. There were no significant associations between the food desert status of a FCCH and the CACFP status of FCCHs as well as the quality and frequency of foods offered. No significant associations were found between the micro physical food environment of the FCCH and the quality and frequency of foods offered to 2-5-year-old children. Conclusions: Non-CACFP FCCH providers should be targeted for enhanced training in fostering a positive mealtime environment and help to enhance what’s available in the FCCH. Advisor: Jerilyn K. Allen, Sc.D., R.N., FAAN Secondary Readers: Maureen M. Black, Ph.D., Deborah Gross, Sc.D., R.N., FAAN, Kelly Bower, Ph.D., MPH, R.N., Lawrence Cheskin, M.D