ABSTRACT
Background: The Early Years (defined as ages from birth to -5) are the most critical life stage for developing important physical, motor, social and cognitive skills. Knowledge about how children’s movement behaviours - physical activity (PA), sedentary behaviour (SB), and sleep (S) influence one another and relate to healthy growth and development are not well known. In 2019, the WHO released the first global guidelines for movement behaviours for children birth to 5 years after identifying prevention of obesity in young children as one of its key priorities for the 21st Century and the key roles movement behaviours play in this. Nigeria lacks nationally representative data to formulate its own guidelines.
Objective: The primary aim of the SUNRISE study is to determine the proportion of 3- and 4- year- old children sampled in participating countries, who meet the WHO Global guidelines for PA, SB and S and to determine if these proportions differ by gender, parental education level, urban/rural location and country income level.
Methods: In Nigeria, preschool children and their parents (n = 150) were equally recruited from urban and rural settings. Height and weight were measured to assess adiposity. PA, SB and S were assessed using accelerometers and parent questionnaire. Fine and gross motor skills were measured using the NIH Toolbox, and executive functions (EF) assessed using the Early Years Toolbox.
Results: The proportion of children meeting the WHO guideline of 60 minutes/day, MVPA was 93.1%, 77.5% met the 180 minutes of total PA/day guideline, 77.5% children met the MVPA and TPA guidelines. 26% of children met the screen time guideline <1 hour/day, 54% of children met the sleep guideline (10-13 hours/day), 99% met the restrained time guideline, and 10% met all the 3 guidelines. Low-income setting children had higher inhibition scores than their high-income counterparts but no difference between the groups for working memory scores (cognition flexibility).
Conclusion: The study shows directions for policy actions to promote more walking, cycling, sport, and active recreation in Nigerian children contributing to achieving 13 of the 2030 Sustainable Development Goals and formulation of the country’s own movement behaviour guidelines.

Purpose: Developing healthy sleep habits is especially important when children transition from variable preschool environments to a more structured elementary school setting. However, few studies have harnessed the unique partnerships between teachers and parents in preventing suboptimal child sleep. The primary aim of this study was to engage key community partners (i.e., 4K & 5K teachers) in developing a combined school- and home-based sleep promotion program for young children (4-6 years old).

Methods: Teachers (n=34, 100% female, 82% White, 12.4±9.0 years’ experience) from two school districts participated in semi-structured focus groups or phone interviews (n=26 teachers in 3 focus groups; n=8 interviews) to inform the development of a sleep promotion program. Prompts addressed the influence of children’s sleep on school-day activities, barriers to optimal sleep, strategies to engage with parents, and preferences for future delivery of school-based intervention components. Transcripts were independently coded by two trained staff members using an inductive approach in NVivo (v14). Consensus coding was used with a third coder to resolve discrepancies. Themes were generated using constant-comparison methods.

Results: Teachers reported suboptimal child sleep manifested in two primary domains during the school day: classroom participation and learning (e.g., inability to focus, sleeping during classroom activities), and social-emotional influence (e.g., self-regulation, prosocial behavior). Teachers perceived parents’ lack of knowledge about appropriate bedtime routines, excessive screen time, family activity schedules, and sleep-inhibiting home environments were barriers to children’s healthy sleep. Teachers expressed interest in helping children sleep better by incorporating classroom activities about sleep, and noted leveraging the parent-teacher relationship may increase parent buy-in. To best engage parents, teachers recommended program information targeted towards the end of 4K leading up to the start of 5K that is accessible on parents’ smartphones, short and engaging, and consists of videos and infographic-style messages. In-person seminars, one-time events, and print materials were discouraged.

Conclusions: Teachers are concerned about suboptimal child sleep and are invested in working with parents to support healthy sleep habits. Findings will inform content, engagement strategies, and mode of delivery for a sleep promotion program targeting young children during the kindergarten transition.

Purpose: Step-based physical activity (PA) recommendations for preschool children vary widely. The purpose of this study was to use a data-driven approach to 1) identify the optimal number of steps/day to meet the current PA guideline and 2) examine if differences exist based on age and sex.

Methods: Baseline and follow-up data from preschoolers (n=881; 3-5 years) who participated in a childcare-based healthy eating and PA intervention were used for analysis. PA data was collected in 5-second epochs using ActiGraph GT3x+ accelerometers worn on the right hip for 7-days. Age-appropriate cut-points were applied to calculate minutes of total physical activity (TPA) (i.e., sum of non-sedentary time) and moderate to vigorous physical activity (MVPA). Meeting the PA guideline was defined as ≥180 minutes/day of TPA of which ≥60 minutes/day were MVPA. To identify the optimal number of steps/day, a SAS macro was used to compare steps/days with meeting the guideline in one step increments. Three criteria, percent agreement, maximizing sensitivity and specificity, and balanced false positive/negative rates were estimated to identify optimal step/day cut-offs. Subgroup analysis were conducted based on age (3, 4, 5 years) and sex (boys/girls).

Findings: Preschoolers (50% boys, 40% White, 31% Black) contributed 7113 days of valid wear, averaging 720±125 minutes/day. Preschoolers met the PA guideline on 55% of days. In the total sample, an optimal cutoff of 6970 steps/day (CI: 6775-7145) was identified based on agreement (82%), sensitivity (0.84), specificity (0.80), and balanced false positive/negative rate (9%). Boys had a slightly higher step/day cutoffs compared to girls (7045 vs 6685 steps/day). Minimal differences in step/day cutoffs were observed based on age: 3y olds (6830 steps/day), 4y olds (6945 steps/day), and 5y olds (6945 steps/day). When combined and weighted by sample size, estimates were similar for boys and girls (6865 steps/day; CI: 6745-6975) and age groups (6930 steps/day; CI: 6765-7110) as the total sample step/day cutoff value.

Conclusions: Step cutoffs were similar among the total sample and in subgroup analyses, indicating that a cutoff between 6800-7000 steps/day shows high agreement with meeting the PA guideline. Future studies should explore the

Purpose: To report the results of the Drink Well study, which aimed to increase water availability, accessibility and children’s water consumption in family childcare homes (FCCH), which care for over two million U.S. children.

Methods: 67 FCCH providers (FCCPs) from under-resourced communities in RI, MA and CT (63% Latina) completed baseline surveys that determined practices and barriers/strategies to improving water availability/accessibility. Then an intervention package was delivered to FCCH, including water filters, self-serve stations, pitchers, water bottles and educational materials. Post-surveys were conducted 2-3 months later. Pre-post changes in FCCPs’ attitudes, barriers and practices re. water access/availability, and use/acceptability of intervention strategies were assessed. FCCPs also completed post-intervention qualitative interviews.

Results: 61 FCCP completed the post survey (91%). The intervention package was well utilized and liked. The percentage of FCCHs with self-serve water easily available indoors increased from 41.5% to 71.7%, and outdoors from 44.6% to 75%. Always providing water at snack-time increased from 62.0% to 76.7%; always providing water at meals increased from 83.3% to 88.3%. Prompting children to drink water at least 5 times daily increased from 29.2% to 58.3%. At posttest, 60% of FCCPs reported that children's access to water increased a lot; 61.7% reported that child water intake increased a lot; and 43% reported their own water consumption increased a lot because of the intervention. Only 25% of FCCPs reported that having parental support for child water intake increased a lot. When asked how much the intervention helped them to serve more water to children, and get children to drink more water, 88.3% and 85% of FCCPs, respectively reported “very much”. Qualitative interview data supported the quantitative results. Final statistical analyses/testing will be completed before May 2024.

Conclusions: Drink Well/Bebe Bien was feasible and acceptable to FCCP and shows promise in increasing water accessibility and children’s intake in FCCHs. These results indicate the importance of training and support to promote drinking water for FCCPs and the need to involve parents in order to also influence children’s intake in the home setting. A larger scale RCT that will measure children’s actual pre-post water consumption is warranted.

Purpose: The Go Nutrition and Physical Activity Self-Assessment in Child Care (Go NAP SACC) intervention aims to improve the health of young children through policy, system, and environmental changes in childcare settings. Several studies reported the effectiveness of this intervention; however, few studies have examined the differential effectiveness. This study compares the Go NAP SACC intervention outcomes between family childcare homes (FCCH) and center-based childcare settings (CCC) in Nebraska.

Methods: The current study used pre- and post-intervention evaluation data collected between 2014 and 2023 in the Nebraska Go NAP SACC program. The analysis included 604 (n) licensed childcare settings (336 FCCH and 268 CCC) that had completed the program and were included in the analysis. Nebraska Go NAP SACC utilizes five instruments from the Go NAP SACC self-assessment: Child Nutrition, Breastfeeding and Infant Feeding, Infant and Child Physical Activity, Outdoor Play and Learning, and Screen Time.

Data Analysis: Using SPSS v.29.0.1.0, multiple linear regression analyses were conducted to determine the association between childcare providers’ total improvement at post-intervention with the type of childcare settings while controlling for the pre-intervention score, geographical location (rural vs. urban), and CACFP-participation. Six separate models were run for the Breastfeeding, Infant Feeding, Child Nutrition, Outdoor Playtime, Indoor Physical Activity, and Screen Time outcomes. Benjamini Hochberg (B-H) correction was done with a 5% false discovery rate for conducting multiple analyses.

Results: The CACFP participation rate was 71% for FCCH and 90.5% for CCC. About 18.6% of FCCH and 36.9% of CCC were in rural Nebraska. All six regression models were significant at p <.001. FCCH setting type was negatively associated with the total improvement at the post-intervention for each of the six Go NAP SACC intervention components.

Discussion: FCCH providers have complete authority over the childcare policy and environment, but they may lack resources to bring more changes to the setting. Differential effectiveness in this study emphasizes future research on implementation strategies for increasing Go NAP SACC intervention effectiveness across different settings.

Background: The purpose of this study was to compare nutrition and physical activity (PA) knowledge and confidence scores between parents and Early Care and Education (ECE) providers.

Methods: Three- to five-year-old children’s (n=72) parent-ECE provider dyads completed The Confidence in Activity and Nutrition-Teach questionnaire to measure nutrition and PA knowledge related to preschool children and confidence in implementing optimal nutrition and PA activities. Knowledge items were multiple-choice with one correct answer (1 point per question) and confidence items used a 7-point Likert scale (1=no confidence, 4=moderate confidence, and 7=high confidence) to measure three constructs (best practices, nutrition and PA curriculum, and daily activities). Independent t-tests were used to compare differences in mean scores between parents and providers and alpha was set at 0.05.

Results: Parents scored significantly lower than providers on total nutrition and PA knowledge score (12.9 ± 2.6 out of 19 vs 14.3 ± 2.9; p=0.003), nutrition knowledge (8.8 ± 1.8 out of 13 vs 9.7 ± 2.0; p=0.004) and PA knowledge (4.1 ± 1.3 out of 6 vs 4.6 ± 1.3; p=0.04). Parents felt significantly higher confidence than providers in implementing nutrition and PA best practices at home (6.0 ± 1.1 vs 5.2 ± 1.1; p=0.03) and significantly lower confidence than providers in conducting daily activities like encouraging social interactions, healthy mealtimes, modeling, and creating a healthy PA environment (5.8 ± 1.0 vs 6.2 ± 0.8; p=0.003).

Conclusion: ECE providers consistently had higher scores on nutrition and PA knowledge than parents and this may be due to the policy regulations and guidelines available to them as opposed to parents who do not receive mandatory trainings related to child nutrition and PA. Interestingly, parents felt more confident than providers in implementing optimal nutrition and PA practices at home despite having lower knowledge. This indicates that with optimal training and education, parents become positive influences in establishing their children’s nutrition and PA practices. Further, parents can benefit from collaborating with their ECE providers to work together to ensure a thriving environment for children at their households and ECE.