Community Partnering to Encourage Healthy Beverage Intake Through Child Care

Inappropriate intake of whole milk, fruit juice, and sugar-sweetened beverages is associated
with childhood obesity, obesity-related co morbidities, and dental caries, yet there are few
proven interventions to promote child intake of healthy beverages consistent with national
guidelines. Child care facilities provide a potential venue for influencing healthy beverage
intake in children and families. The overall objective of this study is to use principles of
community-based participatory research (CBPR; an approach in which researchers partner with
community members to conduct research) to develop, pilot test, and examine the acceptability,
feasibility, sustainability, and preliminary outcomes of a child care-based intervention to
encourage child intake of age-appropriate, guideline-recommended beverages. The central
hypothesis is that a multi-level intervention consisting of educational strategies to
encourage intake of guideline-recommended beverages; increased accessibility of lead-free,
fluoridated, drinking water in child care and at home; and evidence-based child care and home
beverage policies will lead to healthier beverage intake and reduced childhood obesity. This
hypothesis was tested through a quasi-experimental trial in four child care centers. Centers
were randomized to a control (delayed-intervention) condition or to receive a 12-week
intervention that promoted consumption of healthy beverages (water, unsweetened low-fat milk)
and discouraged consumption of unhealthy beverages (juice, sugar-sweetened beverages,
high-fat or sweetened milk). The multi-pronged intervention was delivered via child care
centers, targeted children, parents, and child care staff, and included education,
environmental changes, and policies. Outcomes were measured at baseline and immediately
post-intervention and included children's (n =154) at-home beverage consumption (assessed via
parental report) and overweight/obese weight status (assessed via objectively measured height
and weight).

Inclusion Criteria:

1. Child care centers were eligible if they were in San Mateo County, CA, were licensed,
had enrolled at least ten children ages 2-5 years, participated in the Child and Adult
Care Food Program (CACFP: a federal nutrition assistance program providing funding for
meals and snacks), had English or Spanish-speaking staff, and served primarily English
or Spanish-speaking families.

2. Two to five-year-old children were eligible if they were enrolled in participating
child care facilities.

3. Parents of eligible children were able to participate in beverage intake surveys if
they spoke English or Spanish.

Exclusion Criteria:

1. Non-center, unlicensed, and higher-income child care facilities were ineligible to
participate.

2. Parents unable to speak Spanish/English were excluded.