March 2010

Grant Results

SUMMARY

Researchers at the University of Washington's Daniel J. Evans School of Public Affairs in Seattle used data from U.S. Department of Education's Early Childhood Longitudinal Study—Kindergarten Cohort to examine associations between children's child-care arrangements in the year prior to kindergarten and their likelihood of being obese at the beginning of kindergarten. They also looked at whether changes in obesity or overweight status were related to child-care arrangements or type of kindergarten (full versus part day) during the kindergarten year.

The Early Childhood Longitudinal Study program examines child development, school readiness and early school experiences. The Kindergarten Cohort gathered information from a nationally representative sample of children who entered kindergarten during the 1998–1999 school year and followed them through 8th grade.

Key Findings

The researchers published these findings in an article in Pediatrics (122: 322–330, 2008):

  • Children in family, friend and neighbor care the year before kindergarten were more likely to be obese at the start of kindergarten than children in parent care in the year before kindergarten.
  • Non-Latino children in Head Start during the year before kindergarten were more likely to be obese at the start of kindergarten than non-Latino children in parent care, even after controlling for differences in household income.
  • Latino children in family, friend and neighbor care and in Head Start during the year before kindergarten were significantly less likely to be obese at the start of kindergarten than Latino children in parent care.

Funding

The Robert Wood Johnson Foundation (RWJF) supported the project with an unsolicited grant in the amount of $190,323 between July 2006 and June 2009.

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The Problem

Childhood overweight and obesity in the United States has more than tripled since the 1960s, according to a 2005 report of the Centers for Disease Control and Prevention.

Nearly 19 percent of children ages 6 to 11 and nearly 14 percent of children ages 2 to 5 are obese—they have body mass indexes (BMI) at or above the 95th percentile for their age and gender—according to researchers at the University of Washington's School of Public Health. BMI is a measure of a person's weight in relation to height.

Obesity during the preschool years predicts overweight and obesity in later years, according to literature reviewed by these researchers in an article in Pediatrics (122: 322–330, 2008). The literature review shows that factors such as a parent being overweight, low socioeconomic status and high birthweight are the strongest predictors of overweight and obesity at ages 5 to 7, but it is possible that time spent away from home during the preschool years might mitigate some of the demographic and family factors associated with childhood obesity.

The preschool years may be crucial because between the ages of 3 and 7, children experience the "adiposity rebound," or the point in maturation at which BMI starts to increase after reaching its low point. Studies have shown that adiposity rebound before kindergarten is a strong and consistent predictor of adult obesity, according to the researchers.

According to the researchers in their Pediatrics article, more than 80 percent of children spend time in child care during the year before kindergarten. As preschool children spend more time away from parental settings, maternal influence on their diets diminishes, and other caregivers play a more critical role. This transition is most striking when children start eating a significant number of meals away from home, as many do in child-care settings.

Despite the large percentage of children who attend child care, few studies have examined the influence of child care on children's weight.

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RWJF Strategy

RWJF seeks to help all children and families eat well and move more—especially those in communities at highest risk for obesity. The Foundation's goal is to reverse the childhood obesity epidemic by 2015 by improving access to affordable healthy foods and increasing opportunities for physical activity in schools and communities across the nation.

RWJF's strategy in preventing childhood obesity is on the RWJF Web site.

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The Project

This project examined four questions:

  • Is there a significant association between:
    • The type of child-care setting in the year prior to kindergarten and children's obesity when they start kindergarten?
    • The type of child-care setting during the kindergarten year and changes in children's obesity and overweight during kindergarten? (The researchers have not yet published their findings, and they are only partially reported here.)
    • Full-day versus part-day kindergarten and changes in children's obesity and overweight during the kindergarten year? (As with the previous question, the researchers findings have not been published.) Do these associations vary for different subgroups of children?

Project staff also convened a forum of experts and practitioners in the area of nutrition and food subsidies in early childhood settings. The goals of the forum were to share findings, discuss the state of evidence-based practice regarding food policy and childhood overweight and develop recommendations for future research and practice.

Erin J. Maher, Ph.D., a research scientist at the Daniel J. Evans School of Public Affairs, University of Washington, Seattle, was the first project director. Louise Carter, Ph.D., and then Donna B. Johnson, Ph.D., directed the project after Maher left the university.

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Methodology

Researchers analyzed data collected by the U.S. Department of Education's Early Childhood Longitudinal Study—Kindergarten Cohort. The Kindergarten Cohort includes information from a nationally representative sample of children who entered kindergarten during the 1998–1999 school year. It follows them through 8th grade, collecting information on factors such as their transition to non-parental care, early childhood education and school.

Using height and weight information on 15,691 children who entered kindergarten in the fall of 1998, researchers:

  • Calculated children's BMI at two points: when they entered kindergarten and at the end of kindergarten (not yet published)
  • Identified the primary (at least 10 hours a week) child-care setting for children in child care:
    • Family, friend and neighbor care (other than parental care)
    • Family child care (paid care by nonrelatives outside the child's home)
    • Head Start
    • Center care, including day care, nursery school, preschool or prekindergarten
  • Determined whether children attended kindergarten on a full-day or part-day basis (not yet published)
  • Statistically controlled for other factors that research has shown might influence parental choice of child care and children's weight status:
    • Child's age, race and gender
    • Family income and mother's education, employment and marital status
    • Child's birthweight, number of weeks premature, impairments in mobility, activity level and mother's use of federal Supplemental Nutrition Program for Women, Infants and Children (WIC) benefits when the child was an infant

Communications

Project Director Johnson contracted with Laura Streichert, Ph.D., MPH, to write three issue briefs:

  • "Why Child Care Matters for Obesity Prevention"
  • "Best Practices for Nutrition, Physical Activity & Screen Media Time in Child Care Settings"
  • "Child Care and Obesity Prevention: What Policymakers Can Do"

The briefs are available online. See the Bibliography for details.

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Results

Project staff convened a forum entitled Child Care and Obesity Policy Forum in Seattle on October 26, 2007. Some 150 researchers, federal and state agency representatives and child-care providers attended the forum.

The forum agenda and presentations of all sessions are available online.

Findings

Researchers reported findings from the study in a 2008 article published Pediatrics (122: 322–330, 2008; available online). See the Bibliography for information about the publication.

Findings Regarding Demographic Characteristics and Preschool Arrangements

  • At the start of kindergarten in the 1998–1999 school year, 11.6 percent of children were obese.
  • Asian, Latino and Native American children were more likely than White children to be obese at the start of kindergarten.
  • Males, children with a mobility impairment and children who participated in the Women, Infant and Children's (WIC) program were more likely to be obese at the start of kindergarten.
  • As family income increases, the likelihood of obesity decreases for children at the start of kindergarten.
  • Children in families with fewer children under age 18 were less likely to be obese at the start of kindergarten.
  • During the year prior to kindergarten, children had the following primary child-care arrangements:
    • 16.9 percent were in family, friend or neighbor care.
    • 8.4 percent were in paid family child care.
    • 9.2 percent were in Head Start.
    • 32.7 percent were in day-care centers.
    • Almost 33 percent were not in regular care away from their parents.

Findings Regarding Associations Between Child-Care Arrangement Prior to Kindergarten and Obesity at the Start of Kindergarten

  • Children in family, friend and neighbor care during the year before kindergarten were more likely to be obese than children in parent care that year, when holding other factors constant.
    • Some 20.2 percent of obese children were in family, friend and neighbor care, compared with 16.5 percent of non-obese children in this care.
    • Some 29.9 percent of obese children were likely to be in parent care, compared with 33.1 percent of non-obese children in this care.
    The likelihood of obesity among children in family, friend and neighbor care increased slightly with additional hours in care.
  • There were no significant differences in obesity between children in family, friend and neighbor care the year before kindergarten and children in Head Start or child-care centers that year. There also was no difference in obesity between children in Head Start or child-care centers and children in parent care.
  • Non-Latino children in Head Start during the year before kindergarten were more likely to be obese than non-Latino children in parent care, even after controlling for differences in household income.
  • Latino children in family, friend and neighbor care and Latino children attending Head Start in the year before kindergarten were significantly less likely to be obese than Latino children in parent care in that year:
    • Latino children in parent care had a 15.7 percent chance of being obese.
    • Latino children in family, friend or neighbor care had a 14.9 chance of being obese.
    • Latino children in Head Start had an 11.4 percent chance of being obese.

Changes in Obesity During Kindergarten
In a report to RWJF, researchers noted the following findings regarding the associations between changes in obesity and overweight during kindergarten and child-care arrangements during kindergarten and attending full-day versus part-day kindergarten. These findings have not yet been published:

  • The type of child care children attended during their kindergarten year was not associated with changes in obesity during that year.
  • Kindergarteners attending school full day were less likely to become obese during the school year than were those attending part day.
  • For two high-risk groups, low-income children and Black children, attending full-day kindergarten protected against becoming overweight during kindergarten.
  • After controlling for other factors, Black children who started kindergarten at normal weight were more likely to become overweight or obese during kindergarten than were White children who started kindergarten at normal weight.

Limitations

Researchers reported the following limitations of the study in the article published in Pediatrics:

  • The study could not establish cause-and-effect relationships between child-care participation and obesity or the mechanisms by which child-care settings contribute to or protect against obesity.
  • The data did not include information regarding children's body mass index before preschool, so researchers could not control for earlier influences on childhood obesity.

Conclusions

Researchers drew these conclusions of the study in the article published in Pediatrics:

Primary type of child care is associated with children's obesity. For Latino children, who are at a greater risk of being obese, participation in nonparental child care seems to have a protective effect. These results suggest that child-care settings may be an important site for policy intervention during a crucial developmental period. Efforts to help family, friend and neighbor caregivers support children's physical health may be warranted.

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Lessons Learned

  1. Ask people from diverse backgrounds to review communications products. Project staff wanted the policy briefs to provide recommendations for federal, state and local action and sought input from people with expertise at each of these levels. This allowed staff to understand the needs of different groups, identify potential barriers to implementation and create realistic strategies. (Project Director/Johnson)

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Afterward

The project ended with this grant. Project staff made two presentations of study findings after the grant period:

  • "Child Care Matters: Building Healthy Habits & Reducing Childhood Obesity" at the national conference of the Child and Adult Care Food Program (CACFP) Sponsor's Association, Bellevue, Wash., September 2009. PowerPoint® available online.
  • "Nourished, Active & Engaged" at the Washington Association for the Education of Young Children conference, Spokane, Wash., October 2009.

Former project director Louise Carter is taking the lead on an article regarding findings from the analyses of full-day versus part-day kindergarten on childhood obesity.

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GRANT DETAILS & CONTACT INFORMATION

Project

Studying the impact of the child-care setting on childhood obesity

Grantee

University of Washington, Office of Sponsored Programs (Seattle,  WA)

  • Amount: $ 190,323
    Dates: July 2006 to June 2009
    ID#:  056478

Contact

Donna B. Johnson, Ph.D., R.D., M.S.
(206) 685-1068
DJohn@u.washington.edu

Web Site

http://depts.washington.edu/uwcphn/about_us/aboutus.html

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Articles

Maher EJ, Li G, Carter L and Johnson DB. "Preschool Child Care Participation and Obesity at the Start of Kindergarten." Pediatrics, 122(2): 322–330, 2008. Available online.

Reports

Why Child Care Matters for Obesity Prevention: Issue Brief #1. Seattle: University of Washington, Center for Public Health Nutrition, 2009. Available online.

Best Practices for Nutrition, Physical Activity & Screen Media in Child Care Settings: Issue Brief #2. Seattle: University of Washington, Center for Public Health Nutrition, 2009. Available online.

Child Care and Obesity Prevention: What Policymakers Can Do: Issue Brief #3. Seattle: University of Washington, Center for Public Health Nutrition, 2009. Available online.

Presentations and Testimony

Johnson D. "Movement = Learning for Preschoolers & Their Families." (Presented at the Child Care and Obesity Policy Forum, Seattle, Oct. 26, 2007.) Presentation available online.

Maher E. "Child Care and Children's Obesity in the Preschool Year." (Presented at the Child Care and Obesity Policy Forum, Seattle, Oct. 26, 2007.) Presentation available online.

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Report prepared by: Mary Nakashian
Reviewed by: Kelsey Menehan
Reviewed by: Molly McKaughan
Program Officer: C. Tracy Orleans

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