Healthy Caregivers-Healthy Children (HC2) Phase II



Status:Completed
Conditions:Obesity Weight Loss
Therapuetic Areas:Endocrinology
Healthy:No
Age Range:2 - 5
Updated:3/9/2019
Start Date:April 2015
End Date:March 2019

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Healthy Caregivers-Healthy Children (HC2) Phase II: Integrating Culturally Sensitive Childhood Obesity Prevention Strategies Into Policy

One in four U.S. children under the age of 5 years old are either overweight or obese with
ethnic-minority children being disproportionately affected. Low-income preschool children,
many from ethnic minority backgrounds, receive childcare in federal/state subsidized centers
where daily meals are provided. Nationally, the Quality Rating and Improvement Systems (QRIS)
organization is responsible for rating the quality of childcare centers. However, nutrition
and physical activity policy standards have not been incorporated into QRIS childcare center
policies. Therefore, the goal of this project is to address the 2014 AFRI program area
priority of Childhood Obesity Prevention by building on the phase I "Healthy Caregivers,
Healthy Children (HC2)" NRI/AFRI funded project (2010-2013), in partnership with the Miami
Dade County Cooperative Extension team, to evaluate the program via randomized-controlled
trial outcomes, and deliver an evidence-based effective childcare center-based
program/toolkit. This project (phase II) will expand HC2 Phase I findings by transferring the
evidence-based HC2 program/toolkit to QRIS childcare centers via a train-the-trainers (TTT)
model. The following specific aims are proposed; (1) to evaluate the TTT model of delivery
for the evidence-based HC2 toolkit's effectiveness versus an attention control on parent and
teacher adoption of healthy lifestyle role modeling behaviors, and policy integration; (2) to
evaluate the impact of a TTT delivery model versus an attention control on child body
composition and short- and long-term behavioral health outcomes, and (3) to disseminate the
HC2 early childhood obesity prevention toolkit TTT model within the QRIS early childhood
network at the Miami Dade County-level.

While all states are responsible for childcare licensing standards, 26 states serving over 1
million preschool-age children currently implement QRIS. In MDC, QRIS-affiliated childcare
facilities (collectively called Quality Counts or QC centers from this point forward) provide
care to 1/3 of MDC's preschool-age children (80% are ethnic minorities) in 417 centers. At
this time there are no nutrition policies included in the QRIS standards for childcare
centers. Therefore, in light of the current childhood obesity epidemic, this project will
address a major gap in knowledge and the disparities in access to healthy food consumption in
the childcare center setting through HC2 implementation.

This study builds on previously funded work and will maximize the initial 3-year (2010-2013)
investment the USDA made in phase I of the project to test effective obesity prevention
strategies in the early childhood setting utilizing both educators and parents as nutritional
gatekeeper, healthy lifestyle role models for 2-to-5 year-old children. The goal of this
proposed project (phase II) is to expand the phase I evidence-based HC2 findings by giving
ownership of the program/toolkit to the childcare centers via a train-the-trainers model and
by implementing nutrition and physical activity standards into the Quality Rating Improvement
System.

The proposed integrated project is responsive to the USDA's National Institute of Food and
Agriculture (formerly CSREES) functions by addressing all three areas of the agricultural
knowledge system, including (1) a scientifically-based and rigorous Research design that
assesses obesity prevention efforts with young children in a novel setting of childcare
facilities; (2) the development of an Educational tool kit to improve training and capacity
of teachers and parents/families. Extension and capacity building will be enhanced through
HC2 toolkits delivered to the centers and train-the-trainer program manuals for use
throughout the QRIS network and in cooperation with Florida FNP. Finally, by incorporating
HC2 practices into permanent QRIS policy, centers can sustain the project's benefits for
future children, teachers, and families. Additionally, the investigators will collaborate
with two community nutritionists to provide services to a large number of childcare centers
in the county therefore, extending project materials. Lastly, the toolkit will sustain
education and extension functions beyond the life of the project by giving ownership of HC2
to the childcare centers.

Inclusion Criteria:

- QC centers must meet the following criteria to be included: (1) have > 30 children
ages 2-5 enrolled; (2) Serve low income families; (3) be a part of the USDA food
program and Supplemental Nutrition Assistance Program (SNAP) eligible; (3) Reflect the
ethnic diversity of the MDC Public School System (63 percent Hispanic, 19 percent
African American, 18 percent white); and (4) Center directors agree to participate and
sign a letter of commitment (see Documents of Collaboration).

Exclusion Criteria:

- Centers with a high prevalence of special needs children.
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