MCH Student:
Elissa Gross
Date of Defense:
2009
Abstract:
Background: The relationship between child care settings and the long term effects on a child’s body mass index (BMI) is unknown. Objective: To investigate the impact of parental and non-parental child care settings on children’s BMI.
Methods: Data were analyzed from Phase I (1991-94), II (1995-2000), and III (2000-05) of the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (SECCYD), a longitudinal study investigating the effects of early child care on a child’s development. In Phase I, 1,364 newborns and their families were recruited from 31 hospitals located near 10 SECCYD sites around the country. The analysis included the 256 children who spent a minimum of 15 hours/week in the same child care setting from 24-54 months of age. The outcome of interest was the change in BMI percentiles between age 24 months and several future time points: 54 months, grade 1, 3, 5 and 6. Outcomes were compared among parental, home, and center-based care. The impact of child care setting on BMI while controlling for demographic factors was assessed using a generalized linear models procedure to account for the cluster sampling design.
Results: Mean BMI percentiles at age 24 months for children in different care settings were: parental, 55.2 (SD 27.4); home care, 50.6 (SD 24.6); and center care, 58.6 (SD 27.6). Between 24 and 54 months of age, the increase in mean BMI percentile was significantly greater for children in parental and home care than in center care, with increases of 15.4, 10.6, and 2.7, respectively. Between 24 months and grades 1, 5, and 6, mean BMI percentile increases remained significantly greater for children who were in parental care (P_<_ .007 for all comparisons) and home care (P _<_ .001 for all comparisons) compared to children who attended center care as toddlers/preschoolers. Controlling for demographic factors (sex, race/ethnic group, poverty status, maternal marital status, maternal and partner education), parental (P<0.01) and home-based (P< 0.001) child care vs. center-based care were strong predictors of an increase in BMI percentile between 24 and 54 months of age. Previous attendance at center-based vs. parental or home-based care remained a significant protective factor against an increase in BMI at grades 1, 3, 5, and 6 (P _< _.003 in all adjusted models).
Conclusion: Children who attended child care centers from 24-54 months of age had a significantly lower increase in BMI percentile than children in home-based care or with their parents, a difference that persisted through 6^th grade. Defining the differences in diet and activity among children in these child care settings that account for the long-term protective effect of center-based care on changes in BMI may lead to the development of effective approaches to prevent childhood obesity.