Right from the Start: Assessing Child Care Settings for Obesity Prevention Multnomah County, Oregon Burdon, R., MPH; Bellanca, H., MD, MPH; McFarlan, K., MPH; Hennrich, M., RN, MSN Tomorrow’s health today Methodology Project 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 %!! 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 Learned Survey 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 & Context Obesity 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 home A 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 Prevention What are the practices & policies in childcare setting that support obesity prevention?  Breastfeeding  Nutrition  Physical activity  Screen time 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 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: Federal Interagency Forum on Child and Family Statistics: America’s Children: Key National Indicators of Well-Being, Washington, DC: U.S. Government Printing Office; 2002 For more information or questions visit: