Research Articles

Selected Relevant Publications

  1. Alkon A, Genevro J, Kaiser P, Tschann J, Chesney M, Boyce WT. Injuries in child care centers: Rates, severity and etiology. Pediatrics Supplement, 94(6), 1043-1045, 1994.
  2. Boyce WT, Chesney M, Alkon A, Tschann J, Adams S, Chesterman E, Cohen F, Kaiser P, Folkman S, Wara D. Psychobiologic reactivity to stress and childhood respiratory illnesses; Results of two prospective studies. (1995) J. of Psychosomatic Medicine, 57, 411-422, 1995.
  3. Alkon A, Boyce J. Health assessment in 4 child care centers: Parent and staff perceptions. Pediatric Nursing, 25(4), 439-442, 1999.
  4. Alkon A, Genevro J, Kaiser P, Tschann J, Chesney M, Boyce WT. The epidemiology of injuries in 4 child care centers. Archives of Pediatric and Adolescent Medicine, 153:1248-1254, 1999.
  5. Alkon A, Ragland DR, Tschann J, Genevro J, Kaiser, PJ, Boyce WT. Injuries in child care centers: gender-environment interactions. Injury Prevention, 6, 214-218, 2000.
  6. Alkon A, Tschann JM, Ruane SH, Wolff M, Hittner A. A violence prevention and evaluation project with ethnically diverse populations. American Journal of Preventive Medicine, 20(1S), 48-55, 2001.
  7. Boyce WT, Quas J, Alkon A, Smider NA, Essex MJ, Kupfer DJ. Autonomic Reactivity and Psychopathology in Middle Childhood. British Journal of Psychiatry, 179,144-150, 2001.
  8. Alkon A, Sokal-Gutierrez K, Wolff, M. Child Care Health Consultation Improves Health Knowledge and Compliance. Pediatric Nursing, 28(1), 61-65, 2002.
  9. Alkon A, Ramler M., MacLennan K. Evaluation of mental health consultation in child care centers. Early Childhood Education Journal, 31(2), 91-99, 2003.
  10. Alkon A, Goldstein LH, Smider N, Essex M, Kupfer D, Boyce WT. Developmental and contextual influences on autonomic reactivity in young children. Developmental Psychobiology, 42(1), 64-78, 2003.
  11. Alkon A, Boyer-Chu L. Oral health care starts early. Young Children, 59(2): 47, 2004.
  12. Alkon A, Farrer, J., Bernzweig, J. Roles and responsibilities of child care health consultants: Focus group findings. Pediatric Nursing, 30(4): 315-321, 2004.
  13. Farrer J, Alkon, A, To, K. Child care health consultation programs: Barriers and opportunities. Maternal Child Health Journal. 11(2):111-8, 2007.
  14. Ward, T, Gay, C, Anders, TF, Alkon, A, Lee, KA. Sleep and napping patterns in 3-to 5-year old children attending full-day childcare centers. Journal of Pediatric Psychology. 33(6):666-672, 2008.
  15. Wayne, W, Alkon, A, Buchanan, E. Creating a State Strategic Plan for Integrating Services for Children Using Multiple Qualitative Methods. Maternal Child Health Journal. 12:15-23, 2008.
  16. Alkon, A, Bernzweig, J, To, K, Mackie, J, Wolff, M, Elman, J. Child Care Health Consultation Programs in California: Models, Services and Facilitators. Public Health Nursing. 25(2):126-139, 2008.
  17. Ward, T, Gay, C, Alkon, A, Anders, TF, Lee, KA. Nocturnal sleep and daytime nap behaviors in relation to salivary cortisol levels and temperament in preschool-age children attending child care. Biological Research for Nursing. 9(3):244-253, 2008.
  18. Alkon, A, To, K, Wolff, M, Mackie, J, Bernzweig, J. Assessing health and safety in early care and education programs: Development of the CCHP Health and Safety Checklist. Journal of Pediatric Health Care. 22(6):368-377, 2008.
  19. Bernzweig, J, Ramler, M, Alkon, A. Mental health consultation in early childhood classrooms. Zero to Three. 30(1): 47-51, 2009.
  20. Alkon A, Bernzweig J, To K, Wolff M, Mackie, JF. Child care health consultation improves health and safety policies and practices. Academic Pediatrics. 9(5): 366-370, 2009.
  21. Alkon, A, To, K, Mackie, JF, Wolff, M, Bernzweig, J. Health and safety needs in early care and education programs: What do directors, child health records, and national standards tell us? Public Health Nursing, 27(1), 3-16, 2010.
  22. Treadwell, M, Alkon, A, Quirolo, KC, Boyce WT. Stress reactivity as a moderator of family stress, physical and mental health, and functional impairment for children with sickle cell disease. Journal of Developmental and Behavioral Pediatrics, 31(6): 491-497, 2010.
  23. Alkon A, Davis NV, Boyce WT, Eskenazi B. Developmental Changes in Autonomic Nervous System Resting and Reactivity Measures in Latino Children from Six to Sixty Months of Age. Journal of Developmental and Behavioral Pediatrics. 32:668-677, 2011.
  24. Alkon, A, Cole, P. Health and safety assessment in early care and education programs in Indiana. Maternal Child Health Journal. 16: 555-563, 2012.
  25. Alkon, A, Kalmar, E., Leonard, V, Flint, ML, Kuo, D, Davidson, N, Bradman A. Development and Evaluation of an Integrated Pest Management Toolkit for Child Care Providers, Early Childhood Research and Practice (ECRP), 14(2), 2013;
  26. Alkon, A, Boyce WT, Tran L, Harley, K, Eskenazi, B. Prenatal Adversities Predict Children’s Autonomic Nervous System Reactivity Trajectories from 6 to 60 Months of Age. PLOS ONE. 9(1), e86283, 2014. PMCID: 3897676. e86283.
  27. Kalmar, E, Ivey, S, Bradman, A, Leonard, V, Alkon A. Implementing an integrated pest management (IPM) program in child care centers: A qualitative study. Early Childhood Research Quarterly. 29, 2014: 245-254.
  28. Alkon A, Harley KG, Neilands, TB, Tambellini K, Boyce WT, Eskenazi B. Latino children's body mass index at 2 - 3.5 years predicts autonomic nervous system activity at 5 years. Childhood Obesity. 10(3): 1-11, 2014. PMCID: PMC4038992. doi: 10.1089/chi.2013.0063
  29. Alkon, A, Crowley, AA, Benjamin Neelon, SE, Hill, S, Pan, Y, Nguyen, V, Rose, R, Savage, E, Shipman, L, Kotch, J. Nutrition and physical activity intervention in child care improves knowledge, policies, and children's body mass index. BMC Public Health. 14: 215, 2014. doi:10.1186/1471-2458-14-215
  30. Alkon, A, Rose, R, Wolff, M, Kotch, JB, Aronson, SS. Health and safety checklist for early care and education programs to assess National Health and Safety Standards. Maternal and Child Health Journal. Jan;20(1):114-27, 2016. doi: 10.1007/s10995-015-1809-8
  31. Waters SF, Boyce WT, Eskenazi B, Alkon A. The impact of maternal depression and overcrowded housing on associations between autonomic nervous system reactivity and externalizing behavior problems in vulnerable Latino children. Psychophysiology, 53(1), 97-104, 2016. doi: 10.1111/psyp.12539.
  32. Alkon A, Waters SF, Boyce WT, Johnson MM, Harley KG, Eskenazi B. Latino children's autonomic nervous system reactivity moderates the relations between cumulative socioeconomic adversity in the first five years and externalizing behavior problems at seven years. Advances in Pediatric Research. 3:6, 2016. doi: 10.12715/apr.2016.3.6
  33. Bush NR, Caron ZK, Blackburn KS, Alkon A. Measuring cardiac autonomic nervous system (ANS) activity in toddlers - resting and developmental challenges. J Vis Exp.  (JoVE). 25;(108):53652, 2016. doi: 10.3791/53652.
  34. Stastny PF, Keens TG, Alkon A. Supporting SIDS families and caregivers: The public health nurse SIDS home visit. Public Health Nursing. 33(3):242-248, 2016. doi: 10.1111/phn.12251.
  35. Alkon A, Nouredini S, Swartz A, Sutherland AS, Stephens M, Davidson N, Rose R. Integrated pest management intervention in child care centers improves knowledge, pest control, and practices. Journal of Pediatric Health Care. Nov-Dec.; 30(6): e27-e41, 2016. doi: 10.1016/j.pedhc.2016.07.004.
  36. Johnson MM, Deardorff J, Martinez W, Eskenazi B, Alkon A. The relationship between maternal responsivity, socioeconomic status, and resting autonomic nervous system functioning in Mexican American children. Int J Psychophysiol. 116: 45-52, 2017. doi: 10.1016/j.ijpsycho.2017.02.010.
  37. Alkon A, Boyce WT, Neilands TB, Eskenazi B. Children's autonomic nervous system reactivity moderates the relations between family adversity and sleep problems in Latino 5-year olds in the CHAMACOS study. Frontiers in Public Health. 5:155, 2017. doi: 10.3389/fpubh.2017.00155.
  38. Stephens M, Hazard K, Moser D, Cox D, Rose R, Alkon A. An integrated pest management intervention improves knowledge, pest control, and practices in family child care homes. International Journal of Environmental Research and Public Health. 14: 1299, 2017. doi: 10.3390/ijerph141112999.
  39. Bush NR, Jones-Mason K, Coccia M, Caron Z, Alkon A, Thomas M, Coleman-Phox K, Wadhwa PD, Laraia BA, Adler NE, Epel ES. Effects of pre- and postnatal maternal stress on infant temperament and autonomic nervous system reactivity and regulation in a diverse, low-income population. Dev Psychopathol. Dec;29(5):1553-1571, 2017. doi: 10.1017/S0954579417001237.
  40. Swartz A, Collier T, Young CA, Cruz E, Bekmezian A, Coffman J, Celedon J, Alkon A, Cabana MD. The effect of early child care attendance on childhood asthma and wheezing: A meta-analysis. J Asthma.2018.Apr 9:1-11, 2018. doi: 10.1080/02770903.2018.1445268.
  41. Alkon A, Boyce WT, Shulman A, Rehm RS. An exploratory qualitative study of life trajectories from preschool-age to young adulthood: Identifying early biologic sensitivity, facing challenges, and moving forward. Adv Pediatr Res, 5(2), 2018. doi:10.24105/apr.2018.5.8.
  42. Grummon, AH, Cabana, MD, Hecht, AA, Alkon, A, McCulloch, CE, Brindis, CD, and Patel, AI. Effects of a multipronged beverage intervention on young children's beverage intake and weight: A cluster-randomized pilot study. Public Health Nutrition, 2019.
  43. Alkon A, Rose R, Hazard K, Moser D. National health and safety standards: Family child care homes compared to child care centers. Journal of Pediatric Health Care. 35(1): 5-15.
  44. Stephens M, Coccia M, Koget K, Weiss S, Bush N, Alkon A. Autonomic nervous system reactivity in early childhood: developmental patterns from 18- to 36-months of age. Biological Research for Nursing. doi:10.1177/1099800420943957
  45. Roubinov D, Tien, J-Y, Kogut K, Gunier R, Eskenazi B, Alkon A. Latent profiles of children's autonomic nervous system reactivity early in life predicts externalizing behavior problems. Developmental Psychobiology. In Press.
  46. Hazard K, Lee D, Ritchie L, Rose R, Diaz Rios LK, Plank K, Alkon A. Development of an online curriculum for California early care and education providers on healthy beverages. Early Childhood Education Journal. In Press.
  47. Ritchie LD, Keeton V, Lee DL, Gurzo K, Homel Vitale E, Au LE, Alkon A. Nutrition Standards For Infants and Young Children can be Implemented by Family Child Care Home Providers. Global Pediatric Health, Volume 8, 25 January 2021. DOI:
  48. Lee DL, Alkon A, Plank K, Neelon M, Diaz Rios LK, Hecht CE, Ritchie LD. Self-paced online training on healthy beverage policy for child care providers. Journal of Nutrition Education and Behavior, In Press.
  49. Hashikawa AN, Sells JM, DeJonge PM, Alkon A, Martin ET, Shope TR. Child care in the time of Coronavirus disease-19: A period of challenge and opportunity. J of Pediatrics, 225:239-245. DOI:10.1016/j.jpeds.2020.07.042
  50. Rudd K, Alkon A, Abrams B, Bush N. Infant weight-for-length gain associated with autonomic nervous system reactivity. Pediatric Research. https:/

Chapters in Books  

  1. Alkon A. Wolff, B. Boyce, WT. Poverty, Stress and Autonomic Reactivity. Chapter 12. In The Oxford Handbook of Poverty and Child Development. Editors: Maholmes, V. & King, R.B. New York: Oxford University Press, 2012.
  2. Donahue, E.A. and Kraft, C.A. (Editors), Managing Chronic Health Needs in Child Care and Schools, Second Edition. Alkon A and Rose R (Contributors), American Academy of Pediatrics, Elk Grove, IL., 2018


Health and School Readiness Literature Review

The purpose of this literature review is to summarize the health components, initiatives, and outcomes of key School Readiness Programs in the United States, not including California. The intent of this review is to provide relevant information for county First 5 staff renewing their School Readiness Programs and developing health interventions and/ or outcomes to address the required 'health and social services' element of their programs. This literature review summarizes key findings of program components and outcomes related to health and School Readiness.


Advocate Daily Encounter Form

In California, CCHCs work with Child Care Health Advocates (CCHAs). The CCHAs use a form that was modified from the DEF and is similar to the DEF. The form is called the Advocate Daily Encounter Form (ADEF). The ADEF documents the health and safety activities of the CCHAs. The ADEF was developed by the Child Care Health Linkages Evaluation Project, of the University of California, San Francisco School of Nursing.

Advocate Daily Encounter Form (PDF; 57k)

The Child Health Record Review

Early Care and Education Program Health Assessment (Child Health Record Review) was developed to assess children's health status based on information in children's health records located on-site at early care and education (ECE) programs. They are based on the Child Care Evaluation Worksheet and Guidelines for Completion of form developed by the University of North Carolina of Chapel Hill Quality Enhancement Project for Infants and Toddlers Quality Enhancement Project for Infants and Toddlers, 2001; and researchers' and Child Care Health Consultants' experiences.

The Child Health Record Review (PDF; 11k)

back to top

CCHP Health and Safety Checklist--Revised

The CCHP Health and Safety Checklist-Revised is an 82-item observational measure that was developed to: 1) assess the health and safety status in early care and education (ECE) programs, 2) assess compliance with key National Health and Safety Performance Standards (American Academy of Pediatrics, American Public Health Association and National Resource Center for Health and Safety in Child Care, 2002), and 3) assist users to develop interventions to address the health and safety needs identified on the CCHP H&S Checklist.

The CCHP H&S Checklist was modified from the original CCHP Health and Safety Checklist based on several years of researchers' and Child Care Health Consultants' experiences using the measure. In addition, the new Health and Safety Checklist was modified to be more user-friendly, comprehensive and better organized than the original CCHP Health and Safety Checklist. An advisory group of experts met to review and prioritize the items.

back to top

CCHP Health and Safety Policies Checklist

The California Childcare Health Program Health and Safety Policies Checklist (2005) was developed to objectively assess written health and safety policies in early care and education programs. The Checklist can be used by child care providers or directors, child care health advocates, child care health consultants, health professionals, and researchers. It assesses the quality of written health and safety policies and helps child care and health professionals identify how to improve written policies and target interventions. The Checklist is based on the University of North Carolina of Chapel Hills's Quality Enhancement Project and the National Health and Safety Performance Standards (AAP, APHA, NRC, 2002).

CCHP Health and Safety Policies Checklist (PDF; 239k; 13pp)

Health and Physical Development Foundations for California’s Early Care and Education (Year of completion 2009)

This project supported the development of research-based foundations for the State of California Department of Education Child Development Division’s 4-5 year olds attending child care programs on their physical development and general health. The foundations were reviewed by a national panel of experts and California’s child care agencies and providers. The Foundations provide the guidelines for new state curricula for 4-5 year olds on physical development and general health. CCHP was funded by WestEd for the project.

Integrated Pest Management Checklist for Early Care and Education Programs

This Checklist was developed by an interdisciplinary team including epidemiologist, entomologist, child care providers and administrators, and nurses. It includes observable items to assess in the indoor and outdoor environment to identify possible places that pests may enter a building or find shelter, water, or food. It also includes an introduction with a suggestions for tools to use when conducting the assessment and a explanations for why certain items are included in the Checklist. It was administered in 10 child care programs before and after the integrated pest management workshops were provided for child care staff on the Integrated Pest Management Toolkit.  

back to top