title: Health and Safety in Family Day Care Homes: Association Between Regulatory Non-compliance and Lower Median Income.
abstract: OBJECTIVE
  To determine frequency of non-compliance with child care regulations among family day care homes (FDCH) and identify the role of income in compliance.
  
  
  METHODS
  We analyzed non-compliance in 746 routine, unannounced inspection and re-inspection reports of FDCH collected by the Connecticut Department of Public Health licensing specialists in 2007-2008 and linked results to median income of zip code data. We grouped the 83 state regulations into 12 regulation categories, analyzed 11 categories, and used latent class analysis to classify each FDCH as high or low compliance for each category. We used logistic regression analysis to estimate the odds ratios of low compliance.
  
  
  RESULTS
  Among the 746 FDCH inspections (594 first inspections and 152 re-inspections), we found high rates of non-compliance in inspection regulations in immunizations (32.9 %), water temperature (35.6 %) and hazards (30.0 %). Among the 11 regulation categories, 4 categories (indoor safety, emergency preparedness, child/family/staff documentation, and qualifications of provider) had regulations with high non-compliance. Median household income of FDCH zip code was lower for re-inspection sites than for inspection sites ($34,715 vs. $57,118, p < 0.0001) and FDCH in the lowest quartile of income had greater odds of low compliance in indoor safety (OR 1.86, 95 % CI 1.04, 3.35, p < 0.05).
  
  
  CONCLUSIONS
  The majority of FDCH were in compliance with the majority of regulations, yet there are glaring non-compliance issues in inspections and re-inspections and there are income-based inequities that place children at higher risk who are already at high risk for suboptimal health outcomes.
authors.affiliation: Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA. marjorie.rosenthal@yale.edu.|Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, CT, USA. marjorie.rosenthal@yale.edu.
authors.forename: Marjorie S
authors.initials: MS
authors.lastname: Rosenthal
authors.affiliation: Yale School of Nursing, Orange, CT, USA.
authors.forename: Sangchoon
authors.initials: S
authors.lastname: Jeon
authors.affiliation: Yale School of Nursing, Orange, CT, USA.
authors.forename: Angela A
authors.initials: AA
authors.lastname: Crowley
mesh_terms: D002656:Child Day Care Centers / Q000331:legislation & jurisprudence / Q000592:standards*; D002675:Child, Preschool; D003237:Connecticut; D005161:Facility Regulation and Control / Q000331:legislation & jurisprudence*; D033161:Government Regulation; D019983:Guideline Adherence; D006801:Humans; D007182:Income; D008004:Licensure; D012044:Regression Analysis; D017751:Safety Management / Q000592:standards*
keywords: Child care; Family child care homes; Income inequity; Regulation compliance