{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:04:07Z","timestamp":1791378247255,"version":"4.3.2"},"reference-count":62,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2017,3,9]],"date-time":"2017-03-09T00:00:00Z","timestamp":1489017600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Heart, Lung, And Blood Institute of the National Institutes of Health (NIH)","award":["R01HL119568"],"award-info":[{"award-number":["R01HL119568"]}]},{"name":"Center for Health Promotion and Disease Prevention, a Prevention Research Center funded through a cooperative agreement with the Center for Disease Control and Prevention (CDC)","award":["U48DP001944"],"award-info":[{"award-number":["U48DP001944"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Over one million women are employed in child care and are among the lowest wage workers in the US. The health and working conditions of 674 child care workers (118 administrators and 556 staff) from 74 centers is described using baseline data from a larger intervention trial. Participants were 39.9 (\u00b113.0) years old; 55.4% African American, 37.1% Caucasian, and 5.3% of Hispanic ethnicity. Seventy-six percent reported having an Associate\u2019s degree or less; 42% were classified as at or below poverty (&lt;$20,000); and exhibited many health risks such as excess weight, insufficient activity, poor diet, and inadequate sleep. We investigated potential differences by income and job category. Lower income participants were significantly more likely to be current smokers (19.9% vs. 11.7%), drink more sweetened beverages (1.9 vs. 1.5), and report higher depressive symptoms (15.5 vs. 12.6). Administrators worked more hours weekly compared to staff (46.4 vs. 40.6), are less active (100 vs. 126 min\/week), more sedentary (501 vs. 477 min\/day), and reported higher job demands (13.3 vs. 12.5). Given the numerous health issues and challenging work conditions, we hope our results serve as a call to action for addressing low wages and the work environment as a means of influencing the health and well-being of child care workers.<\/jats:p>","DOI":"10.3390\/ijerph14030283","type":"journal-article","created":{"date-parts":[[2017,3,9]],"date-time":"2017-03-09T11:12:17Z","timestamp":1489057937000},"page":"283","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":101,"title":["The Health and Working Conditions of Women Employed in Child Care"],"prefix":"10.3390","volume":"14","author":[{"given":"Laura","family":"Linnan","sequence":"first","affiliation":[{"name":"Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA"},{"name":"Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela","family":"Arandia","sequence":"additional","affiliation":[{"name":"Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lori","family":"Bateman","sequence":"additional","affiliation":[{"name":"Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amber","family":"Vaughn","sequence":"additional","affiliation":[{"name":"Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dianne","family":"Ward","sequence":"additional","affiliation":[{"name":"Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA"},{"name":"Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2017,3,9]]},"reference":[{"key":"ref_1","unstructured":"Occupational Outlook Handbook, 2016\u20132017 Edition, Childcare Workers, Available online: http:\/\/www.bls.gov\/ooh\/personal-care-and-service\/childcare-workers.htm."},{"key":"ref_2","unstructured":"Bureau of Labor Statistics (2015). Women in the Labor Force: A Databook."},{"key":"ref_3","unstructured":"National Survey of Early Care (2013). Number and Characteristics of Early Care and Education (ECE) Teachers and Caregivers: Initial Findings from the National Survey of Early Care and Education (NSECE), OPRE Report #2013-38."},{"key":"ref_4","unstructured":"Whitebook, M., McLean, C., and Austin, L.J.E. (2016). Early Childhood Workforce Index\u20142016, Center for the Study of Child Care Employment, University of California."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1016\/j.rmed.2011.03.008","article-title":"Low socioeconomic status is associated with chronic obstructive airway diseases","volume":"105","author":"Kanervisto","year":"2011","journal-title":"Respir. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2348","DOI":"10.1001\/archinte.166.21.2348","article-title":"Socioeconomic status and trends in disparities in 4 major risk factors for cardiovascular disease among U.S. adults, 1971\u20132002","volume":"166","author":"Kanjilal","year":"2006","journal-title":"Arch. Intern. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1093\/ije\/dyl083","article-title":"Widening socioeconomic inequalities in U.S. life expectancy, 1980\u20132000","volume":"35","author":"Singh","year":"2006","journal-title":"Int. J. Epidemiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1002\/ajim.22126","article-title":"Work organization, job insecurity, and occupational health disparities","volume":"57","author":"Landsbergis","year":"2014","journal-title":"Am. J. Ind. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"E181","DOI":"10.5888\/pcd10.130171","article-title":"The physical and mental health of head start staff: The Pennsylvania head start staff wellness survey, 2012","volume":"10","author":"Whitaker","year":"2013","journal-title":"Prev. Chronic Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/07370010709336582","article-title":"The health of female child care providers: Implications for quality of care","volume":"24","author":"Baldwin","year":"2007","journal-title":"J. Community Health Nurs."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Tovar, A., Vaughn, A., Grummon, A., Burney, R., Erinosho, T., \u00d8stbye, T., and Ward, D. (2016). Family child care home providers as role models for children: Cause for concern?. Prev. Med. Rep.","DOI":"10.1016\/j.pmedr.2016.11.010"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1016\/j.jand.2013.01.003","article-title":"Nutrition-related knowledge, attitudes, and dietary behaviors among head start teachers in Texas: A cross-sectional study","volume":"113","author":"Sharma","year":"2013","journal-title":"J. Acad. Nutr. Diet."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Cumming, T. (2016). Early childhood educators\u2019 well-being: An updated review of the literature. Early Child. Educ. J.","DOI":"10.1007\/s10643-016-0818-6"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1093\/occmed\/49.7.427","article-title":"Child care workers and workplace hazards in the United States: Overview of research and implications for occupational health professionals","volume":"49","author":"Bright","year":"1999","journal-title":"Occup. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1080\/03004430215109","article-title":"The physical demands and ergonomics of working with young children","volume":"172","author":"Gratz","year":"2002","journal-title":"Early Child Dev. Care"},{"key":"ref_16","first-page":"13","article-title":"Ergonomic recommendations and their impact on child care workers\u2019 health","volume":"26","author":"King","year":"2006","journal-title":"Work"},{"key":"ref_17","unstructured":"North Carolina Division of Child Development and Early Education. Available online: http:\/\/ncchildcaresearch.dhhs.state.nc.us\/."},{"key":"ref_18","first-page":"3","article-title":"International launch of the PAR-Q+ and EPARMED-X+ the physical activity readiness questionnaire (PAR-Q+) and electronic physical activity readiness medical examination (EPARMED-X+)","volume":"4","author":"Warburton","year":"2011","journal-title":"Health Fit. J. Can."},{"key":"ref_19","unstructured":"National Health and Nutrition Examination Survey (NHANES): Anthropometry Procedures Manual, Available online: https:\/\/www.cdc.gov\/nchs\/data\/nhanes\/nhanes_07_08\/manual_an.pdf."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1161\/01.HYP.0000150859.47929.8e","article-title":"Recommendations for blood pressure measurement in humans and experimental animals: Part 1: Blood pressure measurement in humans: A statement for professionals from the subcommittee of professional and public education of the American heart association council on high blood pressure research","volume":"45","author":"Pickering","year":"2005","journal-title":"Hypertension"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1093\/aje\/kwm390","article-title":"Amount of time spent in sedentary behaviors in the United States, 2003\u20132004","volume":"167","author":"Matthews","year":"2008","journal-title":"Am. J. Epidemiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1249\/mss.0b013e31815a51b3","article-title":"Physical activity in the United States measured by accelerometer","volume":"40","author":"Troiano","year":"2008","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_23","unstructured":"UNC Chai Core Carolina Health Assessment and Research Tool (CHART). Available online: http:\/\/chaicore.com\/home."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1016\/j.jada.2004.12.032","article-title":"Dietary intake estimates in the national health interview survey, 2000: Methodology, results, and interpretation","volume":"105","author":"Thompson","year":"2005","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1079\/PHN2004642","article-title":"Performance of a short tool to assess dietary intakes of fruits and vegetables, percentage energy from fat and fibre","volume":"7","author":"Thompson","year":"2004","journal-title":"Public Health Nutr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1016\/0895-4356(90)90099-B","article-title":"Validation of a self-administered diet history questionnaire using multiple diet records","volume":"43","author":"Block","year":"1990","journal-title":"J. Clin. Epidemiol."},{"key":"ref_27","unstructured":"Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System (BRFSS), Available online: http:\/\/www.cdc.gov\/brfss\/."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/0165-1781(89)90047-4","article-title":"The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research","volume":"28","author":"Buysse","year":"1989","journal-title":"Psychiatry Res."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Society for Behavioral Medicine\u2019s Health Policy Committee (2011). The public health need for patient-reported measures and health behaviors in electronic health records: A policy statement of the society of behavioral medicine. Transl. Behav. Med., 1, 108\u2013109.","DOI":"10.1007\/s13142-011-0017-3"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1177\/014662167700100306","article-title":"The CES-D scale: A self-report depression scale for research in the general population","volume":"1","author":"Radloff","year":"1977","journal-title":"Appl. Psychol. Meas."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1037\/1076-8998.3.4.322","article-title":"The job content questionnaire (JCQ): An instrument for internationally comparative assessments of psychosocial job characteristics","volume":"3","author":"Karasek","year":"1998","journal-title":"J. Occup. Health Psychol."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Slopen, N., Glynn, R.J., Buring, J.E., Lewis, T.T., Williams, D.R., and Albert, M.A. (2012). Job strain, job insecurity, and incident cardiovascular disease in the women\u2019s health study: Results from a 10-year prospective study. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0040512"},{"key":"ref_33","unstructured":"2016 Federal Poverty Guidelines, Available online: https:\/\/aspe.hhs.gov\/poverty-guidelines."},{"key":"ref_34","unstructured":"North Carolina Quality Rating and Improvement System Profile, Available online: https:\/\/qrisguide.acf.hhs.gov\/files\/111109_NC_QRIS_Profile_0.pdf."},{"key":"ref_35","unstructured":"National Heart Lung and Blood Institute, and National Institutes of Health Classification of Overweight and Obesity by BMI, Waist Circumference, and Associated Disease Risks, Available online: https:\/\/www.nhlbi.nih.gov\/health\/educational\/lose_wt\/BMI\/bmi_dis.htm."},{"key":"ref_36","unstructured":"U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans."},{"key":"ref_37","unstructured":"United States Department of Agriculture, MyPlate, Available online: https:\/\/www.choosemyplate.gov\/MyPlate."},{"key":"ref_38","unstructured":"Centers for Disease Control and Prevention Are You Getting Enough Sleep?, Available online: https:\/\/www.cdc.gov\/features\/sleep\/."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2284","DOI":"10.1001\/jama.2016.6458","article-title":"Trends in obesity among adults in the United States, 2005 to 2014","volume":"315","author":"Flegal","year":"2016","journal-title":"JAMA"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Guh, D.P., Zhang, W., Bansback, N., Amarsi, Z., Birmingham, C.L., and Anis, A.H. (2009). The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis. BMC Public Health, 9.","DOI":"10.1186\/1471-2458-9-88"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1016\/j.ecl.2008.06.004","article-title":"Impact of obesity on cardiovascular disease","volume":"37","author":"Zalesin","year":"2008","journal-title":"Endocrinol. Metab. Clin. N. Am."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1001\/jama.2012.113905","article-title":"Association of all-cause mortality with overweight and obesity using standard body mass index categories: A systematic review and meta-analysis","volume":"309","author":"Flegal","year":"2013","journal-title":"JAMA"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1080\/02640414.2013.847278","article-title":"Comparison of accelerometer cut points to estimate physical activity in U.S. adults","volume":"32","author":"Watson","year":"2014","journal-title":"J. Sports Sci."},{"key":"ref_44","first-page":"709","article-title":"Adults meeting fruit and vegetable intake recommendations\u2014United States, 2013","volume":"64","author":"Moore","year":"2015","journal-title":"MMWR Morb. Mortal Wkly. Rep."},{"key":"ref_45","unstructured":"Pratt, L.A., and Brody, D.J. (2014). Depression in the U.S. Household Population, 2009\u20132012."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.ecresq.2014.08.008","article-title":"Workplace stress and the quality of teacher-children relationships in head start","volume":"30","author":"Whitaker","year":"2015","journal-title":"Early Child. Res. Quart."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/j.ecresq.2004.04.006","article-title":"Self-reported depression in nonfamilial caregivers: Prevalence and associations with caregiver behavior in child-care settings","volume":"19","author":"Hamre","year":"2004","journal-title":"Early Child. Res. Quart."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"75","DOI":"10.3122\/jabfm.2011.01.100076","article-title":"Obesity and women\u2019s health: An evidence-based review","volume":"24","author":"Kulie","year":"2011","journal-title":"J. Am. Board Fam. Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1136\/bjsports-2016-h3576rep","article-title":"Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: Systematic review, meta-analysis, and estimation of population attributable fraction","volume":"50","author":"Imamura","year":"2016","journal-title":"Br. J. Sports Med."},{"key":"ref_50","unstructured":"U.S. Department of Health and Human Services (2014). The Health Consequences of Smoking\u201450 Years of Progress: A Report of the Surgeon General."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1111\/j.1749-6632.2011.06202.x","article-title":"Socioeconomic status and smoking: A review","volume":"1248","author":"Hiscock","year":"2012","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.jand.2012.09.016","article-title":"Consumption patterns of sugar-sweetened beverages in the United States","volume":"113","author":"Han","year":"2013","journal-title":"J. Acad. Nutr. Diet."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/j.jand.2012.08.011","article-title":"Diet quality of Americans differs by age, sex, race\/ethnicity, income, and education level","volume":"113","author":"Hiza","year":"2013","journal-title":"J. Acad. Nutr. Diet."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1177\/1476718X14552871","article-title":"Childcare providers: Work stress and personal well-being","volume":"14","author":"Faulkner","year":"2014","journal-title":"J. Early Child. Res."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1097\/JOM.0000000000000517","article-title":"Organizational characteristics influence implementation of worksite health protection and promotion programs: Evidence from smaller businesses","volume":"57","author":"McLellan","year":"2015","journal-title":"J. Occup. Environ. Med."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1146\/annurev-publhealth-032013-182416","article-title":"Health promotion in smaller workplaces in the United States","volume":"35","author":"Harris","year":"2014","journal-title":"Annu. Rev. Public Health"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1002\/ajim.22174","article-title":"Promoting an integrated approach to reducing health inequities among low-income workers: Applying a social ecological framework","volume":"57","author":"Baron","year":"2013","journal-title":"Am. J. Ind. Med."},{"key":"ref_58","unstructured":"North Carolina Child Care Workforce Study. Available online: http:\/\/www.childcareservices.org\/wp-content\/uploads\/2016\/01\/2015-Workforce-Report-FNL.pdf."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1177\/1534484310384958","article-title":"Constructs of the work\/life interface: A synthesis of the literature and introduction of the concept of work\/life harmony","volume":"10","author":"McMillan","year":"2011","journal-title":"Hum. Resour. Dev. Rev."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1097\/JOM.0b013e31818c308d","article-title":"Incorporating home demands into models of job strain: Findings from the work, family & health network","volume":"50","author":"Ertel","year":"2008","journal-title":"J. Occup. Environ. Med.\/Am. Coll. Occup. Environ. Med."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/j.ypmed.2016.08.005","article-title":"Integrating worksite health protection and health promotion: A conceptual model for intervention and research","volume":"91","author":"Sorensen","year":"2016","journal-title":"Prev. Med."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1177\/00333549091244S103","article-title":"A conceptual framework for integrating workplace health promotion and occupational ergonomics programs","volume":"124","author":"Punnett","year":"2009","journal-title":"Public Health Rep."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/3\/283\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T18:30:07Z","timestamp":1760207407000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/3\/283"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,3,9]]},"references-count":62,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2017,3]]}},"alternative-id":["ijerph14030283"],"URL":"https:\/\/doi.org\/10.3390\/ijerph14030283","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,3,9]]}}}