Right from the Start: Assessing Child Care Settings for Obesity PreventionMultnomah County, Oregon

Burdon, R., MPH; Bellanca, H., MD, MPH; McFarlan, K., MPH; Hennrich, M., RN, MSN

Tomorrow’s health today

MethodologyProject Objectives Objective 1: Prepare to conduct assessment of child care settings in Multnomah County, Oregon regarding practices for the prevention of childhood obesity. Objective 2: Conduct assessment of a universal sample of child care settings in Multnomah County that care for children age 0-5 years. Objective 3: Translate assessment results into recommendations for training and support of child care providers and possible environmental or policy change, prepare for statewide assessment.

Survey Development

Initial plan to adapt NAP SACC and other validated surveys (e.g. BMER, ENHANCE) Input & review from project advisory committee (child care providers, child health & child care experts) Development of a novel survey tool - 59 question; 16 page booklet survey - Contains both quantitative/qualitative questions IRB approval from Oregon Public Health Division for study instruments and protocol

Survey Testing Conducted 2 focus groups of registered home child care providers (16 participants) Child care providers completed survey and provided structured feedback about survey questions, design, and opinions about 4 topic areas Results of focus group informed revisions to final survey tool for implementation Focus group data is currently being analyzed

Survey Implementation – English Dillman Method: creates a social exchange relationship w/ structured, sequenced, and timed contacts to yield high response rate

Targeted outreach via multiple childcare networks - electronic, paper and word of mouth Mailed paper surveys to a universal sample of all licensed child care settings in Multnomah County (approximately 750) Option to complete survey on-line - Less than 10% responded on-line IRB approval from Oregon Public Health Division for study protocol

***Current response rate 60 - 65%!!

Survey Implementation - Russian Russian-speaking childcare providers are the largest language group after English, providing 25% of home-based care Key informant interviews with Russian-speaking child care consultants & experts Revised Dillman method: - Day 1: Survey w/ $2 bill and cover letter - Day 21-28: Replacement survey and cover letter to non-responders - Targeted outreach via Russian language child care networks IRB approval for revisions to protocol

***Current response rate - approx. 60%!

Lessons LearnedSurvey Development: There is no existing comprehensive tool to assess the four key areas of obesity prevention in a childcare setting.

Implementation: Following the well-tested Dillman method yields an amazingly high response rate.

*** The $2 bill offered w/ the survey vs. gift card/monetary gift post creates different relationship and exchange

Survey Response: Child care providers responded well to a paper survey as predicted by the Dillman method and offered rich qualitative responses in addition to the requested quantitative responses.

Special Population: Russian-speaking childcare providers responded well to a revised version of the Dillman method; this revised survey implementation method was based on key informant interviews with Russian-speaking childcare experts.

Overall: This survey-based assessment project is intended to be a pilot with plans to expand the project throughout Oregon, applying project findings and lessons learned to a broader state-wide assessment of childcare practices and policies related to obesity prevention.

Next Steps

Project Objective 3

Translate assessment results into recommendations for training and support of child care providers and possible environmental or policy change, prepare for statewide assessment

Background & ContextObesity Prevention in Childcare

Nationally, 24.4% of children ages two through five years are classified as either obese or overweight.1

The preschool period is a critical time for growth and development, and healthy eating and active play can help prevent later obesity.2-4

In the US, nearly 74% of children ages 3 to 6 are in some form of non-parental care and just over half are in center-based child care.5

*** With such large numbers of children in child care, child care providers are in a unique position to support and facilitate healthful eating and promote physical

activity in young children.____________

*** There is potential to raise the status of child care providers by improving training/education, increasing wages, and strengthening licensing requirements

Licensed Childcare in Oregon

Child care center A designated facility for care of children; can care for unlimited number of children - must meet ratios; 30% are exempt from regulation

Certified family child care homeA single family dwelling; run by homeowner; can care for up to 16 children; none are exempt from regulation

Registered family child care home Located in a person’s home; can care for up to 10 children; minimally regulated

***Most child care unregulated in Oregon (type = “family, friend, and neighbor”)

Four Areas of Assessment for Obesity PreventionWhat are the practices & policies in childcare setting that support obesity prevention?

Breastfeeding Nutrition Physical activity Screen time

Implementation Timing Day 1 Pre-notice letter Day 5-7 Survey w/ $2 bill and cover letter

Day 14-17 Reminder post card

Day 28-34 Replacement survey & cover letter to non-responders

Project Activities – going forward Late fall/winter, 2010 Review and interpret survey results Winter/early spring, 2011 Develop recommendations for

trainings and support, highlight best practices, and identify most prevalent missed opportunities

Late spring/early summer, 2011 Disseminate findings and recommendations

Late spring/early summer, 2011 Identify future funding opportunities

Types of childcare setting in Multnomah County

Capacity of each setting in Multnomah County

References 1.Ogden C, Carroll M and Flegal K. “High Body Mass Index for Age Among US Children and Adolescents, 2003–2006.” Journal of the American Medical Association, 299(20): 2401–2405, May 20082. Whitaker RC, Pepe MS, Wright JA, Seidel KD, Dietz WH: Early adiposity rebound and the risk of adult obesity. Pediatrics 1998, 101:E5.3. Dietz WH: Periods of risk in childhood for the development of adult obesity--what do we need to learn? J Nutr 1997, 127:1884S-1886S.4. Dietz WH: “Adiposity rebound”: reality or epiphenomenon? Lancet 2000, 356:2027-2028.5. Federal Interagency Forum on Child and Family Statistics: America’s Children: Key National Indicators of Well-Being, 2002. Washington, DC: U.S. Government Printing Office; 2002

For more information or questions visit:

www.orphi.org