In total, 26 articles met the inclusion criteria for health status (Table 2). Two articles were excluded from the health status analysis because they involved qualitative methods and did not present prevalence estimates [36, 37]. The themes from these papers were, however, integrated within the results section.
Thirteen studies described some component of physical health including diet quality (11 studies), physical activity (8 studies), and height/weight/BMI (7 studies). Five studies each measured sleep and smoking and four studies measured chronic disease status.
Ten studies measured fruit and/or vegetable consumption. The proportion of providers meeting recommendations for fruit and vegetable consumption (3.5 cups or 5 servings per day) varied from 22.5% of Head Start staff  to 50% of family child care (FCC) providers . Mean fruit and vegetable consumption exceeded recommendations in one study of Head Start teachers  but were below recommendations in one study of child care center (CCC) directors and staff .
Five studies explored the proportion of providers meeting national physical activity requirements (e.g., 150 min per week of moderate to vigorous physical activity); the results included 27% of CCC employees , 29.4% of CCC directors and staff , and 55% of Head Start teachers  met these recommendations. Approximately 40–50% of FCC providers in two studies reported meeting guidelines [24, 32]. Providers across four studies reported large quantities of sedentary time; one study of Head Start (HS) teachers found they spent 291.69 min (4.9 h) per weekday sitting ; two studies of CCC employees found a mean of 481 and 513.6 min (8–8.6 h) of sedentary time per day, respectively [9, 23]. One study of FCC providers found that nearly one third (32.8%) reported nine or more hours of sedentary time per day .
Seven studies assessed height and weight and converted to BMI; high levels of overweight and obesity (defined as BMI > 25) were reported. Rates of overweight and obesity included between 73.5 and 80.1% for HS staff [22, 28, 30], 71% and 89.9% for FCC providers, and 88.5% and 87.2% of CCC staff [9, 23]. Nationally, 71.6% of adults are overweight or obese .
Three studies explored whether FCC providers were meeting sleep recommendations (7 or more hours of sleep per night); between 43.4 and 56.7% were regularly meeting these goals [24, 32].
A small proportion of providers reported being current smokers; from 15.6% of CCC staff  to just 7.5% of FCC providers .
Chronic disease status
Three studies assessed diabetes prevalence and found similar rates (10.6% for FCC, 10.4% for FCC, 11.9% for HS) [24, 33] compared to just 7.8% of a comparable national sample . Rates of diagnosed high blood pressure included 22.3% of HS staff and 36% of FCC providers [24, 33]. One study of HS staff found higher rates of four additional chronic diseases and conditions (severe headache/migraine, lower back pain, obesity and asthma) as compared to a similar national sample .
In total, we found 21 studies that included measurement of mental health including depression (15 studies), stress (8 studies), and mindfulness (3 studies).
Fifteen studies explored depression levels of ECE providers; from two samples of FCC, approximately 23% reported a depressive disorder or diagnosis . Among the five analyses of HS staff, one study found an average Center for Epidemiologic Studies—Depression (Scale) (CES-D) of 10.8 (at or above 16 is considered screening positive for depression) ; another found 35% of respondents with at least moderate depression at two time points during the year ; and Ling found that 31% of HS teachers were experiencing depressive symptoms . In two analyses from the Pennsylvania Head Start Survey [33, 34], approximately 24% of respondents had a CES-D score at or above 16. This contrasts with only 17.6% of a national comparison sample with similar demographics. The eight studies that included CCC staff generally found lower rates of depressive symptoms; fewer than 19% of respondents in one study of CCC staff scored above 16 on the CES-D  and only 8.9% of respondents in another study had clinically significant depression . Two analyses of data from CCC providers in North Carolina found higher rates of depression (34.9–36% with a CES-D at or above 16), compared to the national average of 12.3% of women ages 40–59 [9, 23].
While only one of the eight studies that explored stress levels of providers included prevalence data on high stress, several explored the impact that stress levels have on performance. One study of 39 providers (CCC staff and FCC providers) found that higher levels of provider stress were associated with lower child engagement in the classroom . Another study found that stress levels were associated with a greater intention for teachers to leave rather than stay in their positions . In a survey of FCC providers conducted by Tovar and colleagues (2017), 62% of respondents had a high stress score on the Perceived Stress Scale .
Three studies measured mindfulness traits among ECE providers, each with a different measure (CAMS-R, FFMQ, MAAS), which makes comparisons across samples difficult.
Following the literature and practice searches, seven published and four unpublished programs were identified. Details on the audience, target behaviors/outcomes, activities/components, and evaluation results (if available) are included in Table 3.
The majority of the programs were delivered to center-based teachers and staff, with only one developed specifically for family child care providers [44, 46]. Others focused on Head Start staff [39, 42] or a broader audience of providers including FCC (33, Building Well-Being Resilient).
Target behaviors and program components
All but one program included nutrition/healthy eating components; most included physical activity and five included stress or other mental health-related targets. The majority of the published interventions were larger, multi-component interventions that included some staff wellness component (as opposed to a stand-alone staff intervention). Most were also conducted over a long period of time ranging from 6 to 12 months with multiple pedagogical techniques (e.g., workshops, print materials, individual or group coaching). Only one identified program (YMCA child care) described ongoing efforts that are always available to employees. All others represented one-time interventions, with the majority sponsored by outside organizations and/or researchers working in conjunction with providers.
Limited evidence on the effectiveness of these interventions is available. Among the published interventions, only four included participant-level impact data. The CARE Intervention has shown preliminary evidence of impact; a pilot study showed positive impact on BMI, physical activity, fruit and vegetable intake, and smoking . Another intervention, offered over 9 months as part of a larger intervention targeting center-based providers in California, showed positive impact on only sugar sweetened beverage consumption . The Eat Healthy, Stay Active! program has been shown to positively impact provider BMI, diet, physical activity, and health-related knowledge . A one-time mindfulness workshop did not show significant impact on provider mindfulness or workplace stress . Among the unpublished programs, only one has evaluation results available. The Create Healthy Futures program, a 4-hour online program, showed improvements in nutrition knowledge and perceived barriers to promoting wellness in the classroom .