Workplace health and safety intervention for child care staff: Rationale, design, and baseline results from the CARE cluster randomized control trial

Abstract

Background Low-wage workers suffer disproportionately high rates of chronic disease and are important targets for workplace health and safety interventions. Child care centers offer an ideal opportunity to reach some of the lowest paid workers, but these settings have been ignored in workplace intervention studies. Methods Caring and Reaching for Health (CARE) is a cluster-randomized controlled trial evaluating efficacy of a multi-level, workplace-based intervention set in child care centers that promotes physical activity and other health behaviors among staff. Centers are randomized (1:1) into the Healthy Lifestyles (intervention) or the Healthy Finances (attention control) program. Healthy Lifestyles is delivered over six months including a kick-off event and three 8-week health campaigns (magazines, goal setting, behavior monitoring, tailored feedback, prompts, center displays, director coaching). The primary outcome is minutes of moderate and vigorous physical activity (MVPA); secondary outcomes are health behaviors (diet, smoking, sleep, stress), physical assessments (body mass index (BMI), waist circumference, blood pressure, fitness), and workplace supports for health and safety. Results In total, 56 centers and 553 participants have been recruited and randomized. Participants are predominately female (96.7%) and either Non-Hispanic African American (51.6%) or Non-Hispanic White (36.7%). Most participants (63.4%) are obese. They accumulate 17.4 ( ± 14.2) minutes/day of MVPA and consume 1.3 ( ± 1.4) and 1.3 ( ± 0.8) servings/day of fruits and vegetables, respectively. Also, 14.2% are smokers; they report 6.4 ( ± 1.4) hours/night of sleep; and 34.9% are high risk for depression. Conclusions Baseline data demonstrate several serious health risks, confirming the importance of workplace interventions in child care.

The health status of the early care and education workforce in the USA: a scoping review of the evidence and current practice

“…The proportion of providers meeting recommendations for fruit and vegetable consumption (3.5 cups or 5 servings per day) varied from 22.5% of Head Start staff [17] to 50% of family child care (FCC) providers [32]. Mean fruit and vegetable consumption exceeded recommendations in one study of Head Start teachers [16] but were below recommendations in one study of child care center (CCC) directors and staff [9].…”

“…Five studies explored the proportion of providers meeting national physical activity requirements (e.g., 150 min per week of moderate to vigorous physical activity); the results included 27% of CCC employees [23], 29.4% of CCC directors and staff [9], and 55% of Head Start teachers [22] met these recommendations. Approximately 40-50% of FCC providers in two studies reported meeting guidelines [24,32].…”

“…Approximately 40-50% of FCC providers in two studies reported meeting guidelines [24,32]. Providers across four studies reported large quantities of sedentary time; one study of Head Start (HS) teachers found they spent 291.69 min (4.9 h) per weekday sitting [22]; two studies of CCC employees found a mean of 481 and 513.6 min (8-8.6 h) of sedentary time per day, respectively [9,23]. One study of FCC providers found that nearly one third (32.8%) reported nine or more hours of sedentary time per day [24].…”

“…Seven studies assessed height and weight and converted to BMI; high levels of overweight and obesity (defined as BMI > 25) were reported. Rates of overweight and obesity included between 73.5 and 80.1% for HS staff [22,28,30], 71% and 89.9% for FCC providers, and 88.5% and 87.2% of CCC staff [9,23]. Nationally, 71.6% of adults are overweight or obese [38].…”

“…These programs typically focus on modifiable health behaviors such as smoking, diet, physical activity, and receiving cardiovascular disease screenings. However, worksite wellness programs are not widely available to the ECE workforce [8,9]. Most ECE settings operate independently or within small organizations that may not have the resources to offer worksite wellness programs.…”