Abstract
Objective
To assess the impact of a multilevel nutrition intervention for low-income child care
environments, staff, and center-enrolled children.
Design
A cluster-randomized, controlled trial conducted among eligible centers. Staff and
parent self-report surveys and objective field observations at baseline and follow-up
were conducted.
Setting
A total of 22 low-income child care centers (enrolling ≥ 25 2- to 5-year-old children).
Participants
Children aged 18–71 months; 408 children and 97 staff were randomized into intervention
(208 children and 50 staff) and waitlist-control groups (200 children and 45 staff).
Retention rates were high (87% for children and 93% for staff).
Intervention(s)
A 6-session, 6-month director's child nutrition course with on-site technical support
for center teachers.
Main Outcome Measure(s)
Center nutrition/physical activity environment; staff feeding styles, dietary patterns,
and attitudes about food; child food preferences and dietary patterns.
Analysis
Covariance regression analyses to assess the intervention effect, adjusting for clustering
within centers.
Results
Significant intervention effects were found for the center nutrition training/education
environment (b = 3.01; P = .03), nutrition total scores (b = 1.29; P = .04), and staff-level prompting/encouraging feeding styles (b = 0.38; P = .04). No significant intervention effects were found for child-level measures.
Conclusions and Implications
Curriculum-driven training and implementation support improved nutritional policies
and practices and staff–child interactions during meals. Future research could extend
the intervention to families and the evaluation to children's dietary behaviors and
weight changes.
Key Words
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Article info
Publication history
Published online: June 19, 2019
Accepted:
April 16,
2019
Footnotes
Conflict of Interest Disclosure: The authors have not stated any conflicts of interest.
Identification
Copyright
© 2019 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.
