Instrument Questionnaire - WORD

Attachment E—Instrument: Word Version

Form Approved

OMB No. 0920-0879

Expiration Date 03/31/2018

ECE State Indicator Report

Instructions

Welcome! Improving the health of Americans through proper nutrition, physical activity and obesity prevention is a primary goal of the CDC’s Division of Nutrition Physical Activity and Obesity (DNPAO). A priority area within DNPAO is obesity prevention in the early care and education setting (ECE; e.g. child care centers and homes, Head start, pre-k).

To learn more about what states are doing related to this areas we are conducting a short assessment with:

• State Health Department ECE coordinators who support CDC’s 1305 grant program and implement obesity prevention activities in the ECE setting;

• State Child and Adult Care Food Program (CACFP) Directors who support the federal CACFP program, which provides reimbursement for meals/snacks served in ECEs

Information collected through this request will be used to develop CDC’s first State Indicator Report on the Early Care and Education setting (ECE SIR). The primary purpose of the ECE SIR report is to describe state level obesity prevention efforts occurring through 6 avenues that are included in DNPAO’s Spectrum of Opportunities, which is CDC’s framework for obesity prevention in the ECE setting. The ECE SIR will thus provide a partial snapshot describing how states have embedded obesity prevention into components of their state ECE systems or in state programs such as CACFP. Your feedback is very important to us and will be combined with other publically available data to create the ECE SIR.

CDC’s State Indicator Reports are reports produced and published by CDC and can be used by state and national government officials to describe how obesity prevention has been included in states, guide state health department obesity prevention work in the ECE setting and highlight successful state efforts.

Completing the data collection instrument is voluntary and takes approximately 5 minutes for State CACFP directors and approximately 30 minutes for state 1305 ECE respondents. CDC will not publish or share any personal identifying information about you as an individual respondent. Data will be reported at the state level and we ask that you complete this data collection instrument as it pertains to your job duties at your state agency. There are no known risks or direct benefits to you from participating or choosing not to participate, but your answers will help CDC describe how obesity prevention is being incorporated into state ECE systems to create and publish the first ECE SIR.

If you have any questions or concerns about this assessment, please contact Carrie Dooyema at [email protected].

If you agree to participate, please click next to begin. The data collection instrument does not have to be completed in one session. The data collection instrument will be open until x date. [a 3 week window TBD after OMB approval granted]

CDC estimates the average public reporting burden for this collection of information as 30 minutes per response for ECE state coordinators and 5 minutes per response for CACFP directors, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0879).

1. In which U.S. state do you work? [DROP DOWN MENU for states and DC]

2. Which best describes your job duties:

   1. I am a state health department staff person who is responsible for obesity prevention efforts in the Early Care and Education (ECE) setting

   2. I am a state child and adult care food program (CACFP) director who is responsible for our state’s CACFP program (Skip to question 20)

QUESTIONS 3-19 ARE FOR STATE HEALTH DEPARTMENT 1305 COORDINATOR ONLY

3. Does your state have a state-wide ECE Quality Rating and Improvement System (QRIS) in place?

   1. YES, we have a system in place

   2. NO, we do not have a system in place (skip to question 7)

   3. In progress, my state is piloting a system

   4. I don’t know if we have a QRIS system (skip to question 7)

4. Does your state’s current QRIS system include standards related to obesity prevention such as: nutrition, physical activity, breastfeeding or screen time?

   1. Yes

   2. No (skip to question 6)

c. I don’t know (skip to question 6)

5. Which obesity prevention components are included in your state’s QRIS standards? Please check all that apply.

   1. Nutrition

   2. Physical activity

   3. Breastfeeding

   4. Screen time

   5. I don’t know which ones

6. (Optional) Provide any additional comments related to your state’s QRIS system and obesity prevention in the text box below. [open text box]

7. In which of the following ways do state agencies (such as the Department of Health, Department of Agriculture, Department of Education, Department of Child Care) support Farm to Preschool initiatives? Please check all that apply.

   1. _____Through a statewide farm to preschool coalition

   2. _____By dedicating state agency staff time to Farm to Preschool activities

   3. _____By including farm to preschool in our state’s Food Policy Council

   4. _____Through inclusion of Farm to Preschool activities in my state’s nutrition/physical activity/obesity or chronic disease plan

   5. _____ By state agency funding for farm to preschool promotion or support activities

   6. _____ Local level Farm to Preschool initiatives exist, but they are not coordinated by a state agency

   7. _____ Other [text box]

   8. _____ None of these are occurring in my state

   9. _____ I do not know if any of these are occurring in my state

8. Does your State Health Department or another State Agency promote or provide a specific ECE obesity prevention intervention to ECE providers within your state?

Help statement: This could be an intervention such as the Nutrition And Physical Activity Assessment for Child Care (NAP SACC), a curriculum such as Color Me Healthy or a state branded program such as Minnesota’s LANA (Learning About Nutrition through Activities) program.

1. YES

2. NO (skip to question 12)

3. I don’t know (skip to question 12)

1. Please provide the name of the obesity prevention intervention [open text box]

10. The obesity prevention intervention is: _____________ [check all that apply]:

    1. Offered to ECE providers throughout my state

    2. Offered to ECE providers only in a select geographic area/region of my state

    3. Offered to ECE providers participating in a pilot program

    4. I don’t know

11. Which benefits does your state offer to ECE providers who participate in this intervention? Please check all that apply.

    1. Financial benefits or incentives

    2. Technical assistance benefits such as training or consultation

    3. Free or low cost materials or resources

    4. Other benefits (please specify)

    5. None

12. Are obesity prevention standards incorporated into your state’s Early Learning Standards (also known as Early Learning Guidelines)?

    1. Yes

    2. No

    3. I don’t know

13. Does your state have any online obesity prevention training(s) that count toward ECE providers’ continuing education or professional development credits?

    1. Yes

    2. No

    3. I don’t know

14. Please provide any additional comments or information about ECE provider professional development [text box]

15. Does your state have a recognition or designation program for child care providers that is based on obesity prevention, such as a “Healthy Child Care” or a “Breastfeeding Friendly Child Care” program?

    1. Yes

    2. No

    3. I don’t know

16. Is there a state level group that meets regularly that focuses on obesity prevention in the ECE setting? This could be a state level inter-agency workgroup, a state Childhood Obesity Task Force or other state level coalition that includes ECE.

    1. Yes

    2. No

    3. I don’t know

17. For approximately how many years has your state been working in the area of obesity prevention for the ECE setting?

    1. 2 years or less

    2. 3 to 5 years

    3. 6 – 10 years

    4. More than 10 years

18. Does your state have a current state health improvement plan, chronic disease plan or nutrition/physical activity/obesity state plan?

    1. Yes

    2. No [end of assessment for state health department respondent]

    3. I don’t know [end of assessment for health department respondent]

19. Is ECE included in your state’s health improvement, chronic disease, or nutrition/physical activity/obesity plan?

    1. Yes, ECE is in our state plan

    2. No, ECE is not included in our state plan

    3. I don’t know if ECE is included in our state plan

[Thank you for your time, this is the end of assessment for state health department 1305 ECE coordinator]

FOR STATE CACFP DIRECTOR

20. Does your state encourage ECE providers who participate in CACFP to meet specific standards that exceed federal CACFP meal pattern requirements? For example in 2008 New York State launched the “Healthy Infant and Healthy Child Meal Patterns” initiative, which among other things, mandates ECE providers who participate in CACFP serve only unflavored milk for children younger than 5 years, no more than one serving of juice per day, and sweetened grain products no more than twice a week and only at snack or breakfast.

    1. YES

    2. NO

21. Does your state CACFP program promote or provide a specific ECE obesity prevention intervention to ECE providers who participate in CACFP?

    1. YES

    2. NO (Skip to question 24)

    3. I don’t know (Skip to question 24)

22. Which content areas are included in the obesity prevention intervention? Please check all that apply

    1. Nutrition

    2. Physical activity

    3. Breastfeeding

    4. Screen time

    5. I don’t know which areas are included

23. What is the name of the obesity prevention intervention?

[open text field]

24. Does your state CACFP program offer training in obesity prevention to ECE providers who participate in CACFP?

    1. Yes

    2. No [END OF QUESTIONNAIRE FOR CACFP DIRECTOR]

    3. I don’t know [END OF QUESTIONNAIRE FOR CACFP DIRECTOR]

25. If yes, which areas of obesity prevention are covered in the training? Please check all that apply

    1. Nutrition

    2. Physical activity

    3. Breastfeeding

    4. Screen time

    5. I don’t know which areas are included

26. How is this training provided?

    1. It is provided as a part of required annual CACFP training

    2. It is provided outside of required annual CACFP training

    3. Both A and B

[Thank you for your time, this is the END OF QUESTIONANNAIRE FOR STATE CACFP DIRECTOR]

[Type here]