ArticlePublic health nutrition2019
Modifying the Environment and Policy Assessment and Observation (EPAO) to better capture feeding practices of family childcare home providers.
Article in Public health nutrition, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 4 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
20 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Interventions for increasing fruit and vegetable consumption in children aged five years and under.The Cochrane database of systematic reviews · 2024Pooled it
- A Systematic Review of Research on Non-Maternal Caregivers' Feeding of Children 0-3 Years.International journal of environmental research and public health · 2022Pooled it
- Interventions for increasing fruit and vegetable consumption in children aged five years and under.The Cochrane database of systematic reviews · 2020Pooled it
- Interventions for increasing fruit and vegetable consumption in children aged five years and under.The Cochrane database of systematic reviews · 2019Pooled it
- Cluster-randomised trial of the impact of an obesity prevention intervention on childcare centre nutrition and physical activity environment over 2 years.Public health nutrition · 2022Trial
- A multi-component tailored intervention in family childcare homes improves diet quality and sedentary behavior of preschool children compared to an attention control: results from the Healthy Start-Comienzos Sanos cluster randomized trial.The international journal of behavioral nutrition and physical activity · 2022Trial
- "A few more bites?": Manifestation of pressure-to-eat in child care.Nutrition & dietetics : the journal of the Dietitians Association of Australia · 2026Article
- CELEBRATE Feeding: Impacts of a responsive feeding behaviour change coaching intervention in child care settings.Journal of nutritional science · 2026Article
- Exploring barriers and facilitators to water availability and accessibility, and potential strategies for improving water accessibility and children's intake in family childcare homes: a qualitative study.Frontiers in nutrition · 2025Article
- Family child care home providers' perceived difficulty in serving vegetables to children: findings from a multi-method study.Journal of nutritional science · 2025Article
- Advancing assessment of responsive feeding environments and practices in child care.Journal of nutritional science · 2024Article
- Mediation of the association between social environmental characteristics of family childcare home and weight status in children by diet quality.BMC public health · 2023Article
- Nutrition Practices of Family Child Care Home Providers and Children's Diet Quality.Journal of nutrition education and behavior · 2023Article
- Correlates of children's dietary intake, physical activity and sedentary behavior in home-based childcare: A systematic review.Preventive medicine reports · 2022Review
- ResponsiveInternational journal of environmental research and public health · 2022Article
- Feeding and Activity Environments for Infants and Toddlers in Childcare Centers and Family Childcare Homes in Southeastern New England.International journal of environmental research and public health · 2022Article
- Feeding practices in Australian early childhood education and care settings.Public health nutrition · 2022Article
- Quality of Nutrition Environments, Menus and Foods Served, and Food Program Achievement in Oklahoma Family Child Care Homes.Nutrients · 2021Article
- Hungry is not safe: A mixed methods study to explore food insecurity in early care and education.Appetite · 2021Article
- The Impact of Responsive Feeding Practice Training on Teacher Feeding Behaviors in Tribal Early Care and Education: The Food Resource Equity and Sustainability for Health (FRESH) Study.Current developments in nutrition · 2020Article
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
objectiveTo describe the modification and validation of an existing instrument, the Environment and Policy Assessment and Observation (EPAO), to better capture provider feeding practices.
designModifications to the EPAO were made, validity assessed through expert review, pilot tested and then used to collect follow-up data during a two-day home visit from an ongoing cluster-randomized trial. Exploratory factor analysis investigated the underlying factor structure of the feeding practices. To test predictive validity of the factors, multilevel mixed models examined associations between factors and child's diet quality as captured by the Healthy Eating Index-2010 (HEI-2010) score (measured via the Dietary Observation in Childcare Protocol).
settingFamily childcare homes (FCCH) in Rhode Island and North Carolina, USA.ParticipantsThe modified EPAO was pilot tested with fifty-three FCCH and then used to collect data in 133 FCCH.
resultsThe final three-factor solution ('coercive control and indulgent feeding practices', 'autonomy support practices', 'negative role modelling') captured 43 % of total variance. In multilevel mixed models adjusted for covariates, 'autonomy support practices' was positively associated with children's diet quality. A 1-unit increase in the use of 'autonomy support practices' was associated with a 9·4-unit increase in child HEI-2010 score (P=0·001).
conclusionsSimilar to the parenting literature, constructs which describe coercive controlling practices and those which describe autonomy-supportive practices emerged. Given that diets of pre-schoolers in the USA remain suboptimal, teaching childcare providers about supportive feeding practices may help improve children's diet quality.
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