Piecing together the puzzle: A mixed methods study of the Abecedarian Intervention.

Who calls for help? Assessing the reach of the Ohio preschool expulsion prevention partnership

Adverse childhood experiences and children's development in early care and education programs

Contribution of Meals and Snacks Provided Through the Child and Adult Care Food Program on Young Children's Total Dietary Intake.

The Development of Child and Adult Care Food Program Best-Practice Menu and Training for Native American Head Start Programs: The FRESH Study (P04-026-19)

This chapter discusses brief history of early education and child study in the United States (US) and describes important curricular approaches and programs. It covers early care and education (ECE) research and evaluation, teacher preparation and professional development, and future directions. The Creative Curriculum and Tools of the Mind models are also commonly employed in Head Start and other kinds of ECE classrooms. Compared to other ECE programs in the US, childcare programs are likely to be challenged by insufficient resources for adequate teacher compensation and other program needs. These institutional and fiscal challenges in turn lead to unsettling compromises in the key areas of caregiver qualifications, validated curriculum, parental outreach, and regular assessment. In the course of their career ECE teachers benefit from considerable support and encouragement; in-service or professional development opportunities are commonplace and differentiated by type of ECE setting and age/grade level served, and sometimes by content area.

ABSTRACTThe Special Issue on Early Care and Education (ECE) collaboration presents seven articles – followed by a commentary – that describe collaborations among different ECE programs. The articles present conceptual frameworks of ECE collaboration, explore the ways that organizations form and sustain ECE collaborations, and share findings regarding the outcomes of the collaborations. The studies employ a range of methods, including qualitative approaches, descriptive statistical analyses, regression analyses of survey data, network analysis, and mixed methods analyses. The articles and commentary in this special issue describe specific implications for policy and practice.

Numerous studies have examined the processes parents use in accessing early care and education (ECE) for their children and the barriers parents face to enroll. To our knowledge, previous studies have not engaged both parents and frontline ECE enrollment staff as co-investigators to examine family perspectives and a systems perspective simultaneously. This qualitative study compiled a research team of diverse (family, provider, academic) perspectives combining principles of community-based participatory research (CBPR) and human-centered design in peer-led qualitative interviews (n = 20), focus groups (n = 5) with local ECE staff and managers, and several community synthesis and design sessions (n = 6) with caregivers, ECE staff, and local thought leaders in Cincinnati, Ohio. The goals of the study were to: 1) identify policy-relevant and system-level barriers that keep families with low incomes or families of color from enrolling in high-quality ECE programs and 2) co-design potential policy- and system-interventions or prototypes with parents and local ECE agency partners to overcome these barriers. Nine types of barriers in three categories were elucidated by parents and ECE staff: 1) enrollment barriers such as parents’ lack of awareness of options, excessive and redundant paperwork, outdated technologies used, and lack of transparency paired with poor follow-up communication from ECE staff; 2) practical and logistical barriers such as cost, transportation, and concerns about COVID; and 3) human-factors concerns related to safety, trust, and diversity of ECE environment. Peer researchers co-created eight policy- or system- prototypes or interventions to address these barriers. While our findings suggest that access challenges remain ubiquitous locally, they also demonstrate what is possible when researchers and policymakers intentionally involve targeted users of ECE policy in the designs of those policies and systems.

Position of the Academy of Nutrition and Dietetics: Benchmarks for Nutrition in Child Care

Sixty percent of US children 5 years old and under receive up to two-thirds of their daily nutrition in early care and education (ECE) settings. Although participation in the federal Child and Adult Care Food Program (CACFP) is shown to improve nutrition, little is known about the relationship between procurement practices (where and how child care programs purchase food) and nutrition in ECE settings or whether these practices differ depending on participation in CACFP. We assessed self-reported nutrition practices and procurement practices by CACFP participation using a 2013 cross-sectional survey of 690 Washington ECE centers ("Centers") and 1260 family homes (family home child care [FHCCs]) serving children aged 2-5 years old using validated survey tools. We examined the relationship between procurement variables (i.e., main store and main mode) and nutrition scores using multinomial logistic regression models that adjusted for sociodemographic and program characteristics. In-person shopping was the primary mode of shopping for all programs, regardless of CACFP participation. Some Centers but very few FHCCs reported online shopping as their primary mode. Centers and non-CACFP FHCCs shopped primarily at megastores (Costco, Target, etc.). CACFP FHCCs used both megastores and grocery stores (Albertsons, QFC, etc.) at similar rates. Adjusted multinomial models found that shopping online or at two or more stores was associated with higher nutritional quality of foods served by programs. Understanding the procurement behaviors of ECE programs helps to illuminate and prioritize potential interventions that would support healthy food purchases.

This article describes the process and intermediate outcomes from a program implemented in 65 Early Care and Education (ECE) centers serving low-income families throughout Georgia during the 2014-2017 school years. The HealthMPowers' Empowering Healthy Choices in Schools, Homes, and Communities ECE program was based on the organization's previously successful elementary school program and aligns with current early childhood nutrition and physical activity recommendations. Participating centers worked with HealthMPowers for up to 3 years. A team from each center led changes by conducting annual self-assessments, creating and implementing improvement plans, and implementing nutrition and physical activity programs using educational resources and environmental cues. A monitoring and evaluation plan provided ongoing feedback to HealthMPowers and centers. Family and staff surveys provided insights into behaviors of children, families, and staff. Process measures included specific benchmarks (e.g., center leadership team formation, improvement plan implementation). Annual self-assessment results served as intermediate outcome measures. As of 2017, 65 centers had enrolled in the program. All centers formed a health team and completed the baseline self-assessment and most implemented an improvement plan (88%). At the 1-year follow-up self-assessment, centers reported improvements from baseline including never offering food incentives for good behavior (75%-86%), conducting taste testing at least once a month (61%-79%), and rarely/never serving sugar-sweetened beverages (93%-96%). Initial process measures from a multicomponent health promotion program in ECE were promising. An integrated continuous improvement approach to working with child care settings is feasible and likely effective.

High-quality supervision for teachers in early care and education (ECE) is essential for building positive teacher-child relationships and enhancing ECE program quality, which in turn promotes healthy social-emotional and academic development in young children. Reflective supervision (RS) is a process-oriented and relationship-centered supervisory approach that has growing empirical evidence supporting its use. As the evidence base for RS continues to expand, and early childhood-serving settings-including ECE-increasingly consider this approach, understanding whether RS is likely to be routinely used in ECE settings and what helps or hinders use of this approach is critically important. Thus, the aims of this study were to assess the feasibility, acceptability, and appropriateness of RS in state-funded pre-Kindergarten (state pre-K) programs, as well as delineate the implementation determinants that either advanced or challenged the use of RS in state pre-K. This study was informed and guided by the updated Consolidated Framework for Implementation Research (CFIR) and the CFIR Outcomes Addendum. Participants included 11 state pre-K program supervisors who had been trained in RS. Participants completed brief measures of feasibility, acceptability, and appropriateness of RS, and semi-structured interviews. Descriptive analyses of quantitative measures revealed that participants perceived RS as feasible to implement in their programs, highly acceptable, and highly appropriate, thereby suggesting that RS is likely to be implemented successfully in this setting. Qualitative data obtained from interviews and coded using the updated CFIR lent greater nuance to these results by specifying the facilitators and barriers affecting implementation. All participants reported great need for RS at the supervisor, teacher, and child/family level, and identified numerous other facilitating factors within four CFIR domains (i.e., Innovation, Outer Setting, Inner Setting, and Individuals), ranging from the relative advantage of RS to individual supervisor motivation and capability. Participants also cited barriers to using RS, most notably staffing difficulties, competing demands, and lack of policy and leadership support. Through theory-driven implementation frameworks applied to a real-world ECE setting, these findings extend prior research suggesting that RS may be an effective supervisory approach by highlighting the contextual factors that make RS more or less likely to be adopted, used, and sustained in state pre-K.

ABSTRACTBackgroundNative American (NA) children have a high prevalence of obesity contributing to lifespan health disparities. Dietary intake is important to promote healthy weight gain, growth, and development. In 2017, the USDA enforced changes to the Child and Adult Care Food Program (CACFP). The CACFP provides reimbursement to qualifying Early Care and Education (ECE) programs that serve foods that uphold the program's nutrition requirements.ObjectiveThis study had the following 2 objectives: 1) Describe a novel index to evaluate ECE menus based on revised CACFP requirements (accounting for food substitutions) and best practices for 3- to-5-y-old children, and 2) analyze CACFP requirement and best practice compliance and nutrient changes in 9 NA ECE programs before and after enforcement of the revised CACFP requirements.MethodsThis longitudinal study is within a larger community-based participatory research study. Menus and meals served were evaluated for 1 wk at each of 9 programs before and after enforcement of the revised meal patterns. Nutrient analysis, CACFP requirement and best practice compliance, and substitution quality were evaluated. Differences were determined using a paired t-test or Wilcoxon matched test. This trial was registered at clinicaltrials.gov as NCT03251950.ResultsTotal grams of fiber consumed increased (5.0 ± 1.2 compared with 5.9 ± 0.8 g, P = 0.04) and total grams of sugar consumed decreased (53.8 ± 12.6 compared with 48.4 ± 7.9 g, P = 0.024), although room for further improvement exists. Although total grams of fat remained unchanged, grams of saturated fat significantly increased (7.8 ± 1.4 compared with 10.5 ± 3.4, P = 0.041). Other nutrients remained unchanged. Overall CACFP requirement and best practice compliance scores improved, although this finding was not statistically significant. No significant changes in food quality associated with substitutions occurred.ConclusionsThis study provides early evidence to support the beneficial impact of the revised CACFP requirements. Understanding barriers to compliance within rural NA communities would be an important next step in enhancing the health of vulnerable children.

Breast cancer risk varies by socioeconomic status (SES), but it is unclear whether similar SES patterns exist for mammographic density, a strong intermediate marker of future breast cancer risk. Evidence on the associations between SES and mammographic density can further support the validity of mammographic density as an intermediate marker of breast cancer risk. Furthermore, given that breast cancer risk develops over the lifecourse, socioeconomic conditions in early life periods may be associated with density. We examined the associations between early life (infancy) and adult socioeconomic factors and mammographic density in 348 women from the Childhood Health and Development study, a birth cohort established in 1960–1967 in California. We further investigated the mediating role of adult SES, adult body mass index (BMI, Kg/m2) and age at first live birth in the associations between early life SES and density. Data on maternal education and family income were reported by participants’ mothers around the time of participants’ birth. Data on participants’ own education, and adult household income, ethnicity, BMI and reproductive events were collected directly from adult participants. We obtained participants’ most recent mammograms from the facilities where mammograms were performed and evaluated the proportion of dense area (dense area/breast area in percentage) and dense breast tissue (dense area in cm2) using Cumulus software (average age=43.0±2.1). We used linear regression analyses to investigate the associations between parental and own education and income and percent density and dense area. We also examined the associations of density with educational and income trajectories from early life to adulthood (persistent low, downward mobility, upward mobility vs. persistent high group). Maternal education, adult education and adult income had moderate to strong correlations (e.g., Spearman correlation coefficients for adult education with maternal education and adult income were 0.34 and 0.42, respectively), but early life family income had minimal correlation with other SES variables (range of 0.16 to 0.21). In separate models that adjusted for age and ethnicity, maternal education and adult education were each inversely associated with percent density (e.g., β=-10.4 95% confidence interval [CI]: −17.8, −3.0 & = −10.9, 95% CI: −17.7,−4.1 for lowest vs. highest groups for maternal education and adult education, respectively) and with dense area (e.g., β=−9.4, 95% CI: −18.0, −0.8 & β=−11.2, 95% CI: −19.7, −2.7 for lowest vs. highest groups for maternal education and adult education, respectively). Mutual adjustment for maternal and adult education attenuated the estimates of their associations with both percent density and dense area. The associations between maternal and adult education and percent density were substantially reduced by adjustment for BMI, with further small reduction from adjustment for age at first live birth. BMI and age at first live birth resulted in relatively small reductions in the associations between education and dense area but educational differences in dense area were no longer statistically significant in the final model. Results of social trajectory models suggested lower percent density and dense area for women with persistent low education and downward mobility that were substantially accounted for by adjustment for BMI and age at first birth for percent density, and to a lesser extent, for dense area. Early life and adult income, and income trajectories did not show any significant associations with either measure of density. In summary, the inverse educational patterns in mammographic density, observed for both maternal and own education, parallel SES variations in breast cancer risk. Educational differences in percent density, but not dense area, were mainly explained by adult BMI, which may be due to the inverse association between BMI and non-dense breast tissue. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B24.

Qualitative studies are gaining their credibility after a period of being misinterpreted as "not being quantitative." Qualitative method is a broad umbrella term for research methodologies that describe and explain individuals' experiences, behaviors, interactions, and social contexts. In-depth interview, focus groups, and participant observation are among the qualitative methods of inquiry commonly used in psychiatry. Researchers measure the frequency of occurring events using quantitative methods; however, qualitative methods provide a broader understanding and a more thorough reasoning behind the event. Hence, it is considered to be of special importance in psychiatry. Besides hypothesis generation in earlier phases of the research, qualitative methods can be employed in questionnaire design, diagnostic criteria establishment, feasibility studies, as well as studies of attitude and beliefs. Animal models are another area that qualitative methods can be employed, especially when naturalistic observation of animal behavior is important. However, since qualitative results can be researcher's own view, they need to be statistically confirmed, quantitative methods. The tendency to combine both qualitative and quantitative methods as complementary methods has emerged over recent years. By applying both methods of research, scientists can take advantage of interpretative characteristics of qualitative methods as well as experimental dimensions of quantitative methods.

In this prospective cohort study, we explored associations of childhood socioeconomic status (SES) with social connection in adulthood, and to which extent these associations can be explained by SES in adulthood. We used data from the longitudinal Young Finns Study (n = 1775, 3-18 years at baseline). Childhood SES was assessed through parental income and educational attainment in 1980, and participants’ own adult SES through income and educational attainment in 2007. The outcomes were 3 indicators of social connection measured in 2018-2020: (1) loneliness, (2) perceived social support, and (3) frequency of social contact. SES indicators were analyzed separately using regression models and causal mediation analysis via marginal structural models. In the mediation analyses, low parental income was associated with higher loneliness, lower perceived social support, and less frequent social contact in adulthood while adjusting for parental and own educational attainment. The associations with loneliness and perceived social support were partially mediated by participants’ income in adulthood. Conversely, the associations between parental educational attainment and social connection in adulthood were smaller, with confidence intervals including the null. These results emphasize that poor family financial conditions during childhood may have long-lasting implications for the development and maintenance of social connection throughout the lifespan.