title: Healthy caregivers-healthy children (HC2) phase 2: Integrating culturally sensitive childhood obesity prevention strategies into childcare center policies.
abstract: Despite the high prevalence of obesity among preschool-aged children, most states lack childcare center (CCC) nutrition and physical activity policies. The Healthy Caregivers, Healthy Children (HC) Phase 2 project is examining the relationship between the CCC nutrition and physical activity environment and child dietary intake/physical activity patterns and body mass index (BMI).
  
  
  
  A total of 24 "Quality Counts" (Miami Dade County, Florida's Quality Rating Improvement System [QRIS)]) CCCs serving low resource families with ≥50 2-to-5year olds attending have been randomized to either intervention (n=12) or control (n=12).
  
  
  
  The HC2 intervention arm CCCs receive implementation of a daily curricula for (1) teachers/parents; (2) children; (3) snack, beverage, physical activity, and screen time policies; and (4) technical assistance with menu modifications. Control arm schools receive an attention control safety curriculum. HC2 is delivered once a month in year 1, quarterly in year 2 and will be disseminated throughout the Quality Counts network in year 3.
  
  
  
  Primary outcome measures include the Environment and Policy Assessment and Observation tool (EPAO), standardized dietary intake and physical activity patterns surveys, and child BMI. The 'Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM)' framework will guide the interpretation of outcome measures.
  
  
  
  CCCs are in need of evidence-based standardized nutrition and physical activity policies. The intersection of RE-AIM and early childhood obesity prevention in the childcare setting could generate robust and new information to the field about potential barriers, facilitators, adoption, and sustainability in this setting.
authors.affiliation: Department of Pediatrics, University of Miami Miller School of Medicine, United States; Department of Public Health Sciences, University of Miami Miller School of Medicine, United States. Electronic address: smessiah@med.miami.edu.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Messiah
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, United States.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Lebron
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, United States.
authors.forename: Rhoda
authors.initials: R
authors.lastname: Moise
authors.affiliation: Department of Pediatrics, University of Miami Miller School of Medicine, United States.
authors.forename: M
authors.initials: M
authors.lastname: Sunil Mathew
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, United States.
authors.forename: Krystal
authors.initials: K
authors.lastname: Sardinas
authors.affiliation: College of Public Health, Florida International University, Miami, FL, United States.
authors.forename: Catherina
authors.initials: C
authors.lastname: Chang
authors.affiliation: Department of Pediatrics, University of Miami Miller School of Medicine, United States.
authors.forename: Joanne
authors.initials: J
authors.lastname: Palenzuela
authors.affiliation: Department of Health Sciences, James Madison University, Harrisonburg, VA, United States.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Walsh
authors.affiliation: Department of Family, Youth and Community Sciences, University of Florida, Gainesville, FL, United States.
authors.forename: Karla P
authors.initials: KP
authors.lastname: Shelnutt
authors.affiliation: The Children's Trust, Miami, FL, United States.
authors.forename: Rachel
authors.initials: R
authors.lastname: Spector
authors.affiliation: Early Learning Coalition, Miami, FL, United States.
authors.forename: Fiorella
authors.initials: F
authors.lastname: Altare
authors.affiliation: Department of Pediatrics, University of Miami Miller School of Medicine, United States.
authors.forename: Ruby
authors.initials: R
authors.lastname: Natale
mesh_terms: D017028:Caregivers; D002656:Child Day Care Centers; D002675:Child, Preschool; D065246:Culturally Competent Care; D015444:Exercise; D005260:Female; D005431:Florida; D006291:Health Policy; D006293:Health Promotion; D006801:Humans; D008297:Male; D018673:Nutrition Policy; D010290:Parents; D063766:Pediatric Obesity / Q000517:prevention & control*; D011203:Poverty; D000070777:School Teachers
keywords: Body mass index; Child care; Early childhood; Environment; Healthy; Policy; Prevention; Weight