title: Nutritional health attitudes and behaviors and their associations with the risk of overweight/obesity among child care providers in Michigan Migrant and Seasonal Head Start centers.
abstract: Children enrolled in Migrant and Seasonal Head Start (MSHS) programs are at high risks of health problems. Although non-family child care providers play important roles on children's health status as role models, educators, program deliverers, and information mediators, little is known about their nutritional health attitudes and behaviors, and weight status. Therefore, we investigated nutritional health attitudes and behaviors and their associations with overweight/obesity among child care providers in Michigan MSHS centers.
  
  
  
  A total of 307 child care providers aged ≥ 18 years working in 17 Michigan MSHS centers were included in this cross-sectional study conducted in 2013. An online survey questionnaire was used to collect data on nutritional health attitudes and behaviors of child care providers. Weight status was categorized into normal weight (18.5 ≤ BMI < 25 kg/m(2)), overweight (25 ≤ BMI < 30 kg/m(2)), and obese (BMI ≥ 30 kg/m(2)) based on child care providers' self-reported height and weight. Factor analysis was performed to investigate patterns of nutritional health attitudes and behaviors. Multivariate logistic regression was conducted to estimate the odds ratios (ORs) and 95 % confidence intervals (CIs) of overweight/obesity across tertiles of pattern scores taking the lowest tertile group as the reference group after adjustment for potential confounding variables.
  
  
  
  Three patterns of nutritional health attitudes and behaviors were identified: pattern 1) "weight loss practices with weight dissatisfaction", pattern 2) "healthy eating behaviors", and pattern 3) "better knowledge of nutrition and health". The pattern 1 scores were positively associated with overweight/obesity (Tertile 2 vs. Tertile 1: OR = 5.81, 95 % CI = 2.81-12.05; Tertile 3 vs. Tertile 1: OR = 14.89, 95 % CI = 6.18-35.92). Within the pattern 2, the OR for overweight/obesity in individuals with the highest scores was 0.37 (95 % CI = 0.19-0.75) compared with those with the lowest scores. However, the pattern 3 was not associated with the risk of overweight/obesity.
  
  
  
  Our findings support that nutrition education or health interventions targeting MSHS child care providers are urgently necessary. These efforts might be an efficient and effective approach for improving the nutritional health status of young children enrolled in MSHS programs.
authors.affiliation: Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, 48824, USA. song@anr.msu.edu.
authors.forename: Won O
authors.initials: WO
authors.lastname: Song
authors.affiliation: Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, 48824, USA.
authors.forename: SuJin
authors.initials: S
authors.lastname: Song
authors.affiliation: Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, 48824, USA.
authors.forename: Violeta
authors.initials: V
authors.lastname: Nieves
authors.affiliation: Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, 48824, USA.
authors.forename: Andie
authors.initials: A
authors.lastname: Gonzalez
authors.affiliation: Department of Medicine-College of Human Medicine, Michigan State University, East Lansing, MI, 48824, USA.
authors.forename: Elahé T
authors.initials: ET
authors.lastname: Crockett
mesh_terms: D000293:Adolescent; D001294:Attitude to Health; D001835:Body Weight; D017028:Caregivers / Q000523:psychology*; D002648:Child; D002656:Child Day Care Centers; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008824:Michigan; D009752:Nutritional Status; D009765:Obesity / Q000523:psychology*; D016017:Odds Ratio; D050177:Overweight / Q000523:psychology*; D012307:Risk Factors; D012621:Seasons; D011795:Surveys and Questionnaires; D014171:Transients and Migrants
keywords: Child care provider; Childhood obesity; Migrant and Seasonal Head Start; Nutritional health behavior; Obesity; Overweight