title: Child care provider training and a supportive feeding environment in child care settings in 4 states, 2003.
abstract: BACKGROUND
  Strategies to prevent adult chronic diseases, including obesity, must start in childhood. Because many preschool-aged children spend mealtimes in child care facilities, staff should be taught supportive feeding practices for childhood obesity prevention. Higher obesity rates among low-income children suggest that centers providing care to these children require special attention. We compared self-reported feeding practices at child care centers serving low-income children on the basis of whether they received funding and support from the Child and Adult Care Food Program (CACFP), which suggests supportive feeding practices. We also assessed training factors that could account for differences among centers.
  
  
  METHODS
  Eligible licensed child care centers (n = 1600) from California, Colorado, Idaho, and Nevada received surveys. Of the 568 responding centers, 203 enrolled low-income families and served meals. We analyzed the responses of 93 directors and 278 staff for CACFP-funded centers and 110 directors and 289 staff from nonfunded centers. Chi square analyses, pairwise comparisons, t tests, and multiple linear regressions were used to compare CACFP-funded and nonfunded centers.
  
  
  RESULTS
  Significant differences were noted in 10 of 26 feeding practices between CACFP-funded and nonfunded centers. In each case, CACFP-funded centers reported practices more consistent with a supportive feeding environment. Forty-one percent of the variance could be explained by training factors, including who was trained, the credentials of those providing training, and the type of training.
  
  
  CONCLUSIONS
  Our findings suggest that when trained by nutrition professionals, child care staff learn, adopt, and operationalize childhood obesity prevention feeding guidelines, thereby creating a supportive mealtime feeding environment.
authors.affiliation: University of Nevada Cooperative Extension, 8050 Paradise Rd, Las Vegas, NV 89123, USA. sigman-grantm@unce.unr.edu
authors.forename: Madeleine
authors.initials: M
authors.lastname: Sigman-Grant
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Christiansen
authors.forename: George
authors.initials: G
authors.lastname: Fernandez
authors.forename: Janice
authors.initials: J
authors.lastname: Fletcher
authors.forename: Susan L
authors.initials: SL
authors.lastname: Johnson
authors.forename: Laurel
authors.initials: L
authors.lastname: Branen
authors.forename: Beth A
authors.initials: BA
authors.lastname: Price
mesh_terms: D002648:Child; D002656:Child Day Care Centers / Q000592:standards*; D002657:Child Development; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D004032:Diet; D004493:Education; D005522:Food Services / Q000592:standards*; D006801:Humans; D009751:Nutritional Requirements; D009765:Obesity / Q000517:prevention & control*; D011203:Poverty; D014481:United States