Graduation Year

2021

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Public Health

Major Professor

Russell Kirby, Ph.D.

Committee Member

Abbey Alkon, Ph.D., RN

Committee Member

Heewon Gray, Ph.D., RD

Committee Member

David Himmelgreen, Ph.D.

Committee Member

Jennifer Marshall, Ph.D., MPH

Keywords

child health, healthy eating, healthy weight, obesity prevention

Abstract

Background: Childhood obesity is a public health problem associated with many co-morbidities. The majority of young children in the United States (U.S.) attend formal early childhood education (ECE) programs, often consuming the majority of daily calories and engaging with teachers during mealtimes. Mealtime best practices support children’s development of healthy eating habits. This dissertation aimed to understand how COVID-19 has influenced mealtimes in ECE centers, including (1) the division of responsibility between adults and children during mealtimes, (2) the child feeding dynamic, and (3) how mealtime best practices have been included during COVID-19.

Methods: This dissertation used a concurrent mixed-methods design to describe and understand changes in mealtime responsibilities, feeding behaviors, and best practices in ECE centers during COVID-19. A theory-based survey for directors and teachers was distributed to more than 7000 ECE centers, and in-depth interviews with teachers were completed. Survey and interview questions were developed based on The Trust Model and Social Cognitive Theory. Analyses were conducted in SPSS and MAX QDA.

Results: Surveys were completed by 759 directors and 431 teachers, and 29 teachers participated in interviews. Surveys showed that teachers’ mealtime responsibilities increased, especially in terms of cleaning and health & safety, while children’s responsibilities decreased, particularly around food handling and serving. Even so, many teachers reported engaging in autonomy-supportive feeding behaviors, such as letting children eat until they are finished and talking about food at the table. Controlling behaviors included praising children for cleaning their plates and requiring children to try one bite of a new food. Recommended mealtime best practices changed from pre-COVID to during-COVID, and centers varied in how they implemented mealtimes during COVID. Interviews revealed three explanatory models of mealtime practices during COVID-19: (1) modification: centers incorporated best practices into new routines, such as eating together but sitting farther away, (2) elimination: centers changed routines in ways that prevented best practices, e.g. teachers wearing masks and standing during meals, (3) minimal change: routines did not change due to COVID-19 and therefore, mealtime practices did not change.

Conclusion: These findings have implications for modifying mealtime routines both during COVID and as COVID restrictions are lifted. ECE centers that have successfully integrated COVID-19 modifications and maintained pre-COVID mealtime best practices (e.g., supporting children’s autonomy and learning to eat when they are hungry and stop when they are full) can serve as examples for others. Additionally, these findings raise further questions as to whether specific best practices are essential or if modified best practices are sufficient for supporting children’s healthy eating in general. Findings are generalizable to ECE centers in Florida and could be compared with other states.

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