Relationship Between Chronic Health Conditions and Occupational Burnout in the Early Care and Education Workforce.

OBJECTIVE: The early care and education (ECE) workforce experiences high rates of poor mental and physical health outcomes, which impact staff well-being and burnout. This study aimed to assess the relationship between chronic health conditions and occupational burnout in ECE Head Start staff working in low-resourced locations. METHODS: This study administered an 89-item cross-sectional survey to 332 ECE staff employed in 42 Head Start centers in the United States. Staff self-reported on the following 10 chronic health conditions: arthritis, asthma, cancer, depression, diabetes, heart disease, high blood pressure, insomnia, lung disease, and musculoskeletal disorders. RESULTS: We found that multimorbidity of chronic conditions significantly predicted overall burnout ( B = 2.39, P < 0.01), particularly related to emotional exhaustion ( B = 2.04, P < 0.01). CONCLUSIONS: Workplace interventions targeting emotional exhaustion related to chronic health conditions are recommended to effectively address occupational burnout among ECE staff.

Investigation of key domains associated with worker well-being and burnout and turnover in the early care and education workforce.

PURPOSE: The early care and education (ECE) workforce provides care for children aged zero to five. This critical segment of the workforce experiences significant burnout and turnover rates resulting from extensive demands, including job stress and poor overall well-being. Factors associated with well-being in these settings and the resulting impacts on burnout and turnover are understudied. The purpose of this study was to investigate associations between five well-being domains and burnout and turnover outcomes among a large sample of Head Start ECE staff in the United States. METHODS: An 89-item survey based off the National Institutes of Occupational Safety and Health Worker Wellbeing Questionnaire (NIOSH WellBQ) was administered to ECE staff employed in five large urban and rural Head Start agencies. The WellBQ is made up of five domains intended to measure worker well-being as a holistic construct. We utilized linear mixed-effect modeling with random intercepts to investigate associations between sociodemographic characteristics, well-being domain sum scores and burnout and turnover. RESULTS: After controlling for sociodemographic variables, the well-being Domain 1 (Work Evaluation and Experience) (ß = - .73, p < .05) and Domain 4 (Health Status) (ß = - .30, p < .05) were significantly and negatively associated with burnout; the well-being Domain 1 (Work Evaluation and Experience) (ß = - .21, p < .01) was significantly and negatively associated with turnover intent. CONCLUSIONS: These findings suggest that multi-level well-being promotion programs could be critical to mitigate ECE teacher stress and address individual-, interpersonal-, and organizational-level predictors of overall ECE workforce well-being.

First Analysis of Nationwide Trends in the Use of the SNAP-Ed Evaluation Framework.

OBJECTIVE: To understand Supplemental Nutrition Assistance Program-Education (SNAP-Ed) Implementing Agencies'(SIAs) use of the SNAP-Ed Evaluation Framework (Framework), which is a tool that includes 51 indicators that SNAP-Ed programs can use to measure the success of their programs in the first 5 years after its release. METHODS: A repeated cross-sectional study design was utilized to administer electronic surveys to between 124 and 154 SIAs who received SNAP-Ed funding in fiscal years 2017, 2019, and 2021. Analyses included descriptive statistics and tests of proportions. RESULTS: Most SIAs indicated that they used the Framework to inform both data collection instruments and program planning decisions and the rates remained relatively constant over the 3 time points (> 80%). The most common specific use of the Framework across all 3 time points was to define, count, or measure the work accomplished, but this statistically decreased from 2017 (76%) to 2021 (57%) (z-score = 3.31; P < 0.001). CONCLUSIONS AND IMPLICATIONS: The results of this analysis confirmed that 5 years after its introduction, uptake and use of the Framework was high and that, as a whole, SIAs focused on priority indicators set by the US Department of Agriculture, with no notable increases in addressing and measuring longer-term, multisector, and population-wide outcomes. The systematic study of the Framework's usability over time has a broader application to other national health promotion initiatives with shared frameworks.

Outcomes of a Multi-Component School-Based Nutrition Program.

BACKGROUND: This paper presents the effectiveness of a multi-component elementary school-based nutrition education program, the Integrated Nutrition Education Program (INEP), which has been in existence for over 25 years. INEP includes components to address multiple layers of influence: hands-on nutrition education lessons in the classroom (student-level), parent education, and outreach (home-level), and facilitation of a planning process to implement policy, system, and environmental (PSE) school changes (school-level). METHODS: Three evaluation tools assessed the effectiveness of the program: (1) classroom plate waste measurement in intervention (N = 149 students) and demographically-matched comparison schools (N = 131 students), (2) pre/post classroom surveys completed by students who participated in INEP (N = 204), and (3) PSE change data from participating schools (N = 47 schools). RESULTS: Students who participated in the nutrition education program were more likely to consume vegetable-based recipes and vegetables included in classroom nutrition lessons compared to students in comparison classrooms (Chinese vegetable salad: p < .001; couscous salad: p < .001; snap peas: p = .001). Classroom survey analyses showed improvements in student self-efficacy (p < .001), preference for vegetables (p = .005), and knowledge (p < .001). In addition, through a wellness planning process, schools implemented an average of 3.7 PSE changes per school. CONCLUSIONS: Results demonstrate a multi-component school-based nutrition education program improves student nutrition-related outcomes.

The SNAP-Ed Evaluation Framework: Nationwide Uptake and Implications for Nutrition Education Practice, Policy, and Research.

OBJECTIVE: Provide the first baseline census of Supplemental Nutrition Assistance Program Education (SNAP-Ed) state implementing agencies' (SIAs) intent to use and evaluate 51 indicators described in the SNAP-Ed Evaluation Framework. METHODS: A cross-sectional study design was used to administer electronic surveys to 124 SIAs who received SNAP-Ed funding in 2017. Descriptive statistics were used to analyze the results. RESULTS: Of 51 indicators, SIAs reported their intent to impact an average of 19 indicators and evaluate an average of 12. More SIAs reported the intention to impact indicators at the individual (59%) and environmental levels (48%), compared with the sectors of influence (20%) and population levels (30%) of the framework. In addition, more SIAs intended to impact and evaluate short- or medium-term indicators, compared with long-term indicators. CONCLUSIONS AND IMPLICATIONS: These findings illustrate the progress made toward aggregating metrics to measure the collective impact of SNAP-Ed.

Impact of a nutrition education programme on preschool children's willingness to consume fruits and vegetables.

OBJECTIVE: To evaluate the impact of a preschool-based nutrition education programme consisting of twelve 'hands on' nutrition education lessons delivered during the school year on young children's willingness to consume fruits and vegetables. DESIGN: Quasi-experimental, pre-post design including the collection of plate waste evaluation data at the start and end of the 2015-2016 school year within two groups: (1) randomly selected classrooms receiving the intervention and (2) within conveniently sampled preschool classrooms not receiving the intervention serving as a comparison group. SETTING: Centre-based preschool programmes serving low-income families in the Denver metro area. PARTICIPANTS: Three- to five-year-old children in preschool classrooms participating in the intervention during the 2015-2016 school year (n 308) and children enrolled in comparison classrooms (n 215). RESULTS: Repeated-measures logit models assessed whether increases in the odds of consuming small samples of fruits and vegetables between Time 1 (pre-intervention) and Time 2 (post-intervention) were different for children within the intervention group compared with the comparison group. Analyses showed that the change over time in consumption of the three vegetable samples varied by intervention status with greater change occurring among children within the intervention group (edamame: P = 0·001; cauliflower: P ≤ 0·0001 and red pepper: P ≤ 0·0001). Unlike vegetables, the change over time in consumption of the two fruit samples was not different between children within the intervention and comparison groups. CONCLUSIONS: An experiential-learning nutrition education programme can positively influence eating behaviours of low-income preschoolers in a centre-based setting by increasing willingness to consume vegetables.

Self-Reported and Diagnosed Depression in Rural Colorado: Findings from the San Luis Valley Community Health Survey.

PURPOSE: To gain a better understanding of depression in a rural community, survey results were used to compare differences in self-reported depressive symptoms and medical professional diagnosed depression among demographic groups. METHODS: A chi-square test of independence was performed to examine relationships among the depression-related variables. Logistic regression analyses were also performed to ascertain the effects of demographic characteristics and social support on depression. FINDINGS: A statistically significant association was found between the two depression-related variables (X2=145.17, P <.001). Income was significantly associated with both depression-related variables. Hispanic ethnicity, higher income, and some high school education were associated with decreased odds of self-reported medically diagnosed depression. Those reporting no or some social support had increased odds of both depression-related variables compared with those who reported always having social support. CONCLUSIONS: These findings provide a better understanding of depression in a rural community and may inform future public health interventions.

Enhancing Periconceptional Health by Targeting Postpartum Mothers at Rural WIC Clinics.

The overall goal of this pilot quality improvement (QI) intervention was to (1) assess the feasibility of making a WIC (Women, Infants, and Children) systems-level change that added measurement of maternal weight and discussion of maternal health habits into each postpartum maternal and offspring visit in rural clinics in Colorado and (2) assess the impacts of the intervention on maternal diet, physical activity, and weight status. A mixed-method evaluation approach was used involving the collection of quantitative data (HeartSmartMoms usage reports, manual WIC chart reviews [to calculate screening rates], pre-/postsurveys, and weight status [body mass index]) and qualitative data (focus groups and project team meeting minutes). It was determined it is feasible to make a short-term systems-level change; however, many barriers were encountered in doing so, and the results were not sustained. The QI intervention did decrease participants' daily consumption of sugar-sweetened beverages and maternal weight status (controlling for maternal age and language), but did not improve any other eating/physical activity behaviors. Lessons learned and recommendations to improve the implementation of health promotion interventions aimed at improving postpartum maternal health, which can increase health during the periconceptional phase, and in turn, improve the health outcomes for a child, are discussed.

Assess, Identify, Make it Happen (AIM) for Preschools: A Tool to Decrease Early Childhood Obesity.

Early childhood obesity is at epidemic proportions and is a major risk factor for the development of chronic diseases in adulthood. Since the majority of preschoolers are placed in center-based care, best practice policy, system, and environment (PSE) changes in early child care settings plays an important role in defining early development of obesogenic behaviors. However, implementation of best practice PSE changes is often a challenge in low resource settings due to staff turnover, time constraints, cultural beliefs, and lack of health-related knowledge. Assess, Identify, Make it Happen for Preschools (AIM-P) is a strategic planning process that was used with wellness teams in early child care centers to implement PSE changes that support adoption of health behaviors. AIM-P uses key change-making strategies based on intervention mapping including assets and needs assessments, prioritization of changes based on importance and feasibility, development of action steps and action plans, and identification of dissemination and sustainability plans. The AIM-P process resulted in implementation of 6.5 best practice PSE changes per site. Qualitative findings highlight lessons learned and the facilitators and barriers associated with using AIM-P to implement PSEs.

A Community-Engaged Approach to Collecting Rural Health Surveillance Data.

PURPOSE: In order for communities to make health-related, data-driven decisions concerning resource allocation, needed services, and intervention priorities, they need an accurate picture of the health status of residents. While state and national health surveillance systems exist to help local communities make data-driven health decisions, rural communities face unique challenges including: (1) limited county-level data; (2) underrepresented segments of the population; and (3) a lack of survey items to address local health concerns. The purpose of this study was to take a community-engaged approach to collecting population-based health status data in a rural area in an effort to address some of these unique challenges. METHODS: Using a community-based participatory research (CBPR) approach, over 1,500 residents from 6 rural and frontier counties were randomly selected with a stratified, multistage cluster study design. Surveys were primarily completed over the phone. FINDINGS: Response rates by county ranged from 59% to 80% (overall = 66%). Males and younger adults (18-24 year olds) were underrepresented in the sample, but Hispanics, low-income residents, and cell phone-only users were adequately represented. Prevalence rates for chronic disease and health behavior varied by county. CONCLUSIONS: The implications of this project are that engaging stakeholders in community surveillance efforts increases the quality, relevance and utility of the information collected and can help reach otherwise difficult-to-reach populations. This can result in a more accurate picture of the health status of residents, which can lead to making health-related, data-driven decisions concerning resource allocation, needed services, and intervention priorities.