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Abstract
Background: Early childhood education (ECE) teachers have integral roles in communities as caretakers and educators of young children. Food served in the ECE setting can account for over two-thirds of the diet of children in full-time care, and evidence-based best practices related to nutrition are recommended to establish healthy eating behaviors in children. For these reasons, the nutrition culture in ECE is of increasing interest for public health research and intervention. There is less evidence, however, regarding whether and how teachers’ dietary intake may influence their nutrition- and food-related interactions with children. We hypothesized that healthier teacher dietary intake may be positively associated with increased adherence to best feeding practices in the centers at which they work.
Methods: In this cross-sectional study, 366 ECE teachers from 49 ECE centers located in Seattle, WA, South King County, WA and Austin, TX were surveyed. Teachers completed the National Cancer Institute’s Dietary Screener Questionnaire to measure dietary intake and the six-item short form of the United States Department of Agriculture (USDA) Food Security Survey Module to assess food security. Center directors filled out a questionnaire gathering basic information about their center, as well as the Nutrition and Physical Activity Self-Assessment for Child Care (NAPSACC), which measures the degree to which centers follow best practices in regards to food and nutrition. Spearman rank correlation and Kruskal-Wallis with post-hoc Dunn tests were performed to examine associations between teacher dietary intake and nutrition-related practices in their employing ECE centers.
Results: Thirty-nine percent of teachers self-reported being food insecure. Food insecurity was associated with several differences in teachers’ dietary intake: lower fruit and vegetable intake (-0.14 cup and -0.19 cup respectively), higher added sugar intake (+1.0 tsp. per day), and only slightly lower meat intake (-0.03 time per day). Teacher intake of fruits, vegetables, and whole grains were lower than national recommendations, and added sugar intake above national recommendations. However, teacher dietary intake of most food groups was comparable to national averages. There was considerable heterogeneity in the NAPSACC scores and sub-scores of centers. NAPSACC scores and sub-scores were high (74% to 89% of maximum possible scores), indicating center practices were close to recommended best practices. Spearman rank correlation tests revealed five weak associations between: fruit intake and the NAPSACC feeding environment sub-score (ρ=0.1209, p=0.0308); combined fruit and vegetable intake and the feeding environment sub-score (ρ=0.1356, p= 0.0154); fruit intake and the feeding practices sub-score (ρ=0.1330, p=0.0249); added sugar intake from SSBs and the professional development sub-score (ρ=0.1408, p=0.0132); and, red and processed meat intake and the menu sub-score (ρ=0.1556, p=0.0055). Kruskal-Wallis tests of differences in NAPSACC scores by quintile of teacher intake of individual food groups with a post-hoc Dunn test found that two of these associations remained significant: fruit intake and the feeding environment (Z=2.90 p=0.0018), and meat intake and the menu sub-score (Z=2.27, p=0.005).
Conclusion: Our findings showed limited weak associations between ECE teacher dietary intake and ECE center best practices. However, the fact that teacher intake of most food groups was not associated with any difference in NAPSACC total score or sub-scores suggests our limited findings may be spurious and not indicative of a true association between teachers’ dietary quality and ECE best practices In our findings, the high rate of food insecurity and low dietary quality of teachers is in stark contrast to the high frequencies of best practices regarding food served to children. This strongly suggests that quality of care related to nutrition in ECE is determined by center-level and external policies and not teacher intake. It also suggests that policies which more directly promote teacher nutrition may be beneficial, and future interventional research should attempt to identify supportive policies or practices, such as providing free or low-cost meals, which may benefit teachers. Further research should also investigate if teacher food insecurity is related to quality of care indicators not measured here, and if children’s actual dietary intake (versus the quality of food served to children) is associated with teacher intake or food security status.
