A Path Analysis Examination of Factors Affecting Early Childhood Educators’ Health, Burnout, and Turnover

A Path Analysis Examination of Factors Affecting Early Childhood Educators’ Health, Burnout, and Turnover | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Path Analysis Examination of Factors Affecting Early Childhood Educators’ Health, Burnout, and Turnover Beatriz Carmona, Ligia Reyes, Meghan Orman, Laura Bellows This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8544453/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 11 You are reading this latest preprint version Abstract Background Early Childhood Education (ECE) educators experience high levels of stress, burnout, and job turnover, contributing to workforce instability. Efforts to better understand how interpersonal and environmental work-related factors contribute to burnout and job turnover intentions are essential to improving ECE educator wellbeing. Grounded in the social ecological model, this study quantitatively examined how stress, the social climate (social support and social strain), and health behaviors contribute to burnout and job turnover intentions in ECE educators. Methods The StayWell ECE ( St aff and Y outh Well ness for E arly C hildhood E ducators) projectadministered two online surveys to licensed ECE educators in New York: the Health Behaviors Survey (n= 1,423), assessing burnout, stress, turnover intentions, and health behaviors (diet, physical activity, and sleep), and the Social Environment Survey (n= 263), assessing workplace social climate (social support and social strain). Multiple linear regression analyses examined associations between burnout, the social climate, and health behaviors. Path analysis was conducted to test relationships among stress, the social climate, burnout, and turnover intentions, controlling for age, income, and education; model fit was evaluated using chi-square, comparative fit index, root mean square error of approximation, and standardized root mean square residual. Results Higher burnout was significantly associated with poorer diet quality and lower physical activity and sleep. Lower workplace social support was also associated with poorer diet quality and sleep. Path analysis demonstrated adequate model fit and showed that stress was associated with lower social support, higher social strain, and higher levels of burnout. Social strain was strongly associated with two burnout subdomains (lower emotional exhaustion and depersonalization; p<0.01 and p<0.01), while social support was associated with one (greater personal accomplishment; p<0.01). All burnout subdomains were associated with higher turnover intentions. Conclusions Findings highlight burnout as a key mechanism linking stress and workplace social climate to health behaviors and turnover intentions among ECE educators. Interventions that reduce stress and address both social support and social strain may improve wellbeing, support healthier behaviors, and reduce job turnover in this workforce. Trial registration Not applicable. Figures Figure 1 Figure 2 INTRODUCTION The fields of caregiving and education have long faced disproportionate burdens, including low wages and excessive demands, resulting in high prevalence and risk for chronic disease. 1–3 A population at the intersection of caregiving and education is that of the Early Childhood Education (ECE) workforce, which contains the highest proportion of women (97.1%) of all professions and is disproportionately women of color. 4 ECE educators, representing approximately 2 million U.S. workers, earn low wages, have limited benefits, and face workplace conditions marked by high occupational stress and burnout 5,6 . These conditions contribute to vulnerabilities in their health, including elevated depression, stress, and chronic disease risk compared to other professions 7 . In recent years, these challenges have been compounded by widespread staffing shortages and unprecedented levels of turnover. Some programs have experienced annual turnover rates as high as 40%, threatening program viability and decreasing access to childcare for families 8 . High turnover disrupts classroom stability and imposes financial and emotional strain on remaining staff, increasing burnout risk and job instability 9–11 . Understanding workforce wellbeing and identifying strategies to reduce turnover are, therefore, essential not only for improving the health and quality of life of a predominantly female workforce, but also for maintaining stable and equitable access to child care – a foundational need for working parents to maintain economic productivity. Burnout has been identified as a precedent to heightened turnover intentions across many professions 12 . Reflecting the cumulative toll of prolonged stress and overwork, burnout is defined as high emotional exhaustion (e.g., depletion of energy and emotional resources), high depersonalization (e.g., feelings of cynicism and detachment from one’s work), and diminished personal accomplishment (e.g., low perceptions of achievement and self-satisfaction from work) 13 . Recognition of burnout as a public health concern has sparked efforts to understand how to mitigate its impact, particularly in caregiving fields where emotional labor, role ambiguity, and demanding interpersonal environments are common 14 . Reducing burnout has been identified as integral to workforce retention, service quality, and individual wellbeing in several caregiving sectors, including nursing and social work. 15,16 Responsive to growing national concerns surrounding the health and turnover crisis among ECE educators, burnout has been a long-time focus of researchers studying this workforce. Findings here highlight stark issues: ECE educators experience disproportionately high burnout levels compared to many occupations 17 and report higher emotional exhaustion than even their K–12 teacher counterparts 18,19 . Such efforts to examine and improve burnout in ECE have kindled a strong interest to better understand how burnout develops through more holistic lenses that consider multiple individual, social, and environmental factors, as opposed to more unidimensional analyses of the ECE workplace 20 . This more holistic approach is responsive to emergent findings in ECE workplace interventions, which highlight gaps in understanding how more nuanced aspects of ECE educators’ lives, such as their health status and quality of professional relationships, impact their burnout risk 21 . Such gaps result in fragmented efforts to support ECE educators, with limited guidance regarding which factors are most influential or modifiable towards reducing burnout and turnover. Approaches to better understand the manifestation of burnout in the ECE workforce require a comprehensive focus on educators’ daily experiences, including factors affecting their health and wellbeing. In this regard, educators’ health behaviors are an important factor; parallel to poor health outcomes, ECE educators have been found to struggle with poor diet, low physical activity, and inadequate sleep 22–24 . In other professions characterized by high stress and high demands, these health behaviors play a role in the development and sustainment of burnout 25,26 . Emerging research from other caregiving sectors further suggests that poor diet, reduced physical activity, and disrupted sleep may both contribute to and result from burnout, producing feedback loops in which chronic stress impairs health behaviors that in turn exacerbate psychological strain 27 . If similar patterns emerge in ECE, health behaviors may serve as modifiable components that can serve to reduce burnout, with significant implications for workforce support initiatives. Alongside educators’ individual health circumstances, their social experiences within the workplace likely play an influential role in burnout development. The workplace social climate can be understood as a dynamic system of interpersonal interactions that includes both social support (e.g., encouragement, shared problem-solving, and collegial collaboration) and social strain (e.g., conflict, exclusion, or emotional disregard) 28,29 . The social climate is particularly relevant in the ECE profession, as relational work is central to the teaching role, and burgeoning evidence suggests that educators lack institutional resources that buffer interpersonal stress 19 . Social support has been shown to protect employees from burnout in several caregiving fields 30,31 . Evidence from emerging studies suggests that strain may exert particularly detrimental effects, potentially outweighing the benefits of support. Yet, research has historically emphasized support while giving less attention to social strain 32 . For ECE educators, both positive and negative social experiences may substantially shape wellbeing. Thus, considering both forms of the social climate, as support and strain, offers a more holistic picture of the workplace experience. While individual health behaviors and interpersonal dynamics are important, they exist within broader structural and environmental conditions that also shape burnout risk. Current literature on ECE workforce wellbeing has highlighted the multitude of stressors embedded within educators’ work environments. These include low wages, limited health and retirement benefits, inadequate staffing levels, high teacher-child ratios, challenging classroom dynamics, resource scarcity, and unstable schedules 3,33,34 . Many of these environmental stressors reflect systemic undervaluation of ECE caregiving labor. Such conditions heighten educators’ stress, undermine their physical and emotional health, and hinder their ability to engage in healthy behaviors and sustain collaborative workplace relationships 19,35 . Stressors embedded in the work environment, and the subsequent stress resulting from them, may therefore become a driving force shaping both educators’ interpersonal interactions and individual wellbeing. The Social Ecological Model (SEM) provides a valuable framework for understanding how burnout may emerge from the complex interplay of these individual, interpersonal, and environmental pressures. The SEM emphasizes that health is shaped by interactions between a person and their environment, whereby individual behaviors, social relationships, and structural conditions are interdependent 36 . Applying this framework to ECE suggests that burnout cannot be sufficiently understood when examined at only one level. Instead, burnout likely reflects cascading influences in which environmental stressors shape interpersonal climates, which then interact with educators’ individual health behaviors. Although research has described individual, interpersonal, and environmental challenges independently within ECE settings, incomplete understanding of how these dimensions collectively drive burnout hampers the development of effective solutions 21 . In practice, this may lead to ineffective solutions that target only unidimensional aspects of educators’ lives. Examining burnout holistically is therefore essential not only for understanding the wellbeing of ECE educators but also for maintaining a stable and equitable childcare system. The StayWell ECE ( St aff and Y outh Well ness for E arly C hildhood E ducators) project aims to understand the health and wellbeing outcomes of New York (NY) licensed ECE educators, and to examine how individual, interpersonal, and environmental influences contribute to these outcomes. The project uses a sequential explanatory mixed methods approach (quan à QUAL) to gain a comprehensive understanding of NY ECE educators’ health and wellbeing to inform future intervention efforts. This study seeks to identify modifiable variables that are associated with burnout in ECE educators, focusing on the innermost layers of the SEM relating to individual behaviors and the interpersonal ECE social climate. Specifically, this study explored (1) how burnout and the social climate are associated with health behaviors, and (2) how the social climate (social support and strain), and stress are related to burnout and turnover intentions (Figure 1). METHODS Participants and Procedures Two surveys were distributed electronically to NY State licensed ECE programs via listservs using the Research Electronic Data Capture (REDCap) platform. The StayWell ECE Health Behaviors Survey was administered in spring 2023 with all respondents invited to complete a subsequent StayWell ECE Social Environment Survey in fall 2023. All study procedures were approved by the Cornell University Institutional Review Board (protocol #IRB0144439). By initiating each survey, all respondents provided informed consent. The StayWell ECE Health Behaviors survey contained 110 items inquiring about demographic and socioeconomic characteristics, as well as job turnover intentions, burnout (emotional exhaustion, depersonalization, and personal accomplishment), the social climate, health behaviors (diet, physical activity, and sleep), and stress. 22 The StayWell ECE Social Environment Survey contained 60 items inquiring about educators’ social support and social strain at work (social climate). Both surveys were prepared by a team of researchers and stakeholders with expertise in public health, survey development, and ECE. The surveys were developed using existing scales and items where possible. Measures Sociodemographic characteristics Key demographic characteristics consisted of age, gender, race, ethnicity, education (highest level of education completed), and annual household income using the 2023 federal poverty guidelines (Department of Health and Human Services, 2023). Turnover Intentions Turnover intentions were measured using 3 items that evaluated, respectively, likelihood to leave one’s job, center, or their ECE career within the next year (Job Satisfaction and Retention Survey; α = 0.89). Burnout Burnout used the Maslach Burnout Inventory, which consists of three subdomains: low personal accomplishment (e.g., “I have [not] achieved many rewarding objectives in my work”; 8 items), depersonalization (e.g., “I have become more callous to people since I have started doing this job”; 5 items), and emotional exhaustion (e.g., “I feel worn out at the end of a working day”; 9 items). Low personal accomplishment, high emotional exhaustion, and high depersonalization make up high overall burnout. This inventory had a total of 22 items with 7-point Likert scales. A higher score in emotional exhaustion (α = 0.92) or depersonalization (α = 0.88) equates to higher burnout, and a lower score in personal accomplishment (α = 0.91) equates to higher burnout (Maslach & Leiter, 1997). Social climate To examine workplace social climate, social support and social strain were both assessed using an adapted version of the Family Support and Strain Scale (Cohen & Wills, 1985). This scale has a total of 10 items (5 each for support and strain) with 5-point Likert scales. A lower score in social support (α = 0.89) equates to higher strain, and a higher score in social strain (α = 0.93) equates to lower support. Health Behaviors Health behaviors - diet, physical activity, and sleep - were assessed using a battery of different assessments. Diet behaviors were assessed with three items from the Rapid Eating Assessment for Participants – Shortened Version (Segal-Isaacson 2004; 3 items, α = 0.77). These included the frequency of consuming fewer than two servings of: 1) whole grains, 2) fruits, and 3) vegetables per day, based on a 3-point Likert scale (usually/ often; sometimes; rarely/never). Responses to all four items were summed into a continuous diet quality variable (score range of 3–9), where a higher score equated to a lower diet quality score. Physical activity was examined with two items. The first from the Behavioral Risk Factor Surveillance System (CDC, 2023) asked one’s self-reported participation in PA over the past month (responses of yes; no; not sure). Item 2, originated from the National Health Institute Survey (Thomas, 1990) and inquired whether the respondent felt they were more, less, or about as active as other people their age (responses of more; less; as active). Responses to both items were summed into a continuous PA variable (score range of 2–4), where a higher score equated to lower approximated physical activity levels. Sleep was examined with one item from the Pittsburgh Sleep Quality Index (Buysse, 1989) inquiring about self-reported nightly sleep time, on average, in hours and minutes. Stress Stress was examined with the Perceived Stress Scale (α = 0.85), which contains 10 items and a 5-point Likert scale (Cohen & Williamson, 1983). A higher score equates to a higher level of stress. Data Analysis The final sample size was determined using an a-priori threshold of > 80% completion for inclusion (Booker 2021). R studio version 4.3.2 (R Core Team; 2024) was used to test for normality (skewness and kurtosis), and to calculate descriptive statistics (frequencies, means, medians and standard deviation scores). Multiple linear regressions were used to examine our first analytical research question (how burnout and one’s social climate are associated with health behaviors (diet, physical activity, and sleep). Path analysis was used to examine the second research question (effects across stress, the social climate, burnout, and turnover intentions), controlling for age, income, and education. The lavaan package in R studio was used to assess model fit and significance of tested relationships. Model fit used chi-square, comparative fit index (CFI), root mean square error of approximation (RMSEA), and standardized root mean square residual (SRMR). 37,38 In evaluating the goodness of fit, the following criteria indicated an adequate fit: a non-significant chi-square value, CFI values ≥ .90, and RMSEA and SRMR values ≤ .08 39 . Significance of relationships was set at α < 0.05. RESULTS The surveys, StayWell ECE Health Behaviors survey and StayWell ECE Social Environment Survey, received 1,423 and 263 completed responses, respectively. Where possible the full sample size is reported (e.g., demographics, burnout, health behaviors). The smaller sample size (n=263) was found to be demographically representative of the full sample (n=1,423). Survey respondents were primarily women (95%), identified as White (70%), and had an average age of 43.6 ± 12.6 years. One-third were considered low income (32.5%), and half (49.5%) had a bachelor’s degree or higher (Table 1). For burnout, 56% had high emotional exhaustion, 38% had high depersonalization, and 80% had reduced personal accomplishment. Further, 22% planned to leave their position, center, or the ECE profession within the next year (turnover intentions). Within the workplace social climate, educators experienced mid-range scores of coworker social support (2.0 ± 0.76 out of 5) and coworker social strain (2.5 ± 0.70 out of 5). Regarding health behaviors, 72% consumed fewer than 2 daily servings of whole grains, vegetables, and/or fruit, 28% had not exercised in the past month, and 31% slept less than 7 hours per night. (Table 2). Multiple linear regressions addressing research question 1 identified that burnout and social support were both significantly associated with health behaviors. For burnout, lower personal accomplishment (high burnout) was positively associated with lower physical activity (β = 1.38, p < 0.01) and lower diet quality (β = 0.74, p < 0.01). Higher depersonalization and emotional exhaustion (high burnout) were also both positively associated with lower physical activity (depersonalization: β = 0.83, p < 0.01; emotional exhaustion: β = 2.62, p < 0.01). Higher depersonalization was associated with lower diet quality (β = 0.19, p < 0.01), and higher emotional exhaustion was associated with less sleep (β = 0.94, p < 0.01). Regarding the social climate, less social support was associated with lower diet quality (β = -0.28, p < 0.001) and sleep (β = -0.36, p < 0.01). A path analysis model was fit to examine broader environmental associations with burnout and the social climate, namely, how stress is associated with social support and strain and burnout, and how, in turn, they influence turnover intentions. The model, with standardized path coefficients, had an adequate fit, with a CFI of 0.994, a TLI of 0.992, and an RSMEA of 0.008. Path analysis results (Figure 2) indicated that stress was significantly associated with social support (0.019), social strain (0.023), and all three subdomains of burnout -emotional exhaustion (1.083), depersonalization (0.238) and personal accomplishment (-0.505). Social support was associated only with higher personal accomplishment (-0.171), and higher social strain was associated with higher emotional exhaustion (5.360) and higher depersonalization (2.433). All three subdomains of burnout were associated with turnover intentions. In summary, high stress was associated with lower social support, higher social strain, and higher burnout across all three subdomains. High social support was linked to higher personal accomplishment, and high social strain was linked to higher depersonalization and emotional exhaustion. DISCUSSION This study advances our understanding of how burnout, stress, and the workplace social climate intersect to shape health and job turnover intentions among ECE educators – a female-dominated workforce sector that, like other predominantly-female sectors, has long struggled with high job demands, limited pay, and increased chronic disease risk 1 , 6 . Regression results identified burnout as a key mechanism linking the workplace social climate to health behaviors, while the path model positioned stress as an upstream driver that amplifies burnout, social strain, and job turnover intentions. Together, these results illustrate that high stress is associated with high burnout and social strain, which in turn are associated with poorer health behaviors and higher job turnover intentions among ECE educators. These downstream effects underscore the critical need for strategies that effectively reduce stress and burnout in ECE settings. While prior studies have documented high stress and burnout in the ECE workforce, the present findings delineate how these experiences unfold across individual and social domains, and how health behaviors play a role in ECE educator wellbeing, offering a more mechanistic explanation for how burnout manifests in this profession. These results align with prior research positing stress as a precursor to burnout 13 and extend findings from caregiving professions, where nursing and social work have similarly identified that workplace stress predicts burnout. 15,40 The present study adds to this literature by showing that in ECE educators, stress not only exerts direct effects on burnout, but also indirectly shapes it through the influence of educators’ social climate. This supports emerging ecological models suggesting that burnout in ECE is not solely an intrapersonal condition but one that is continually reinforced by workplace dynamics. 6,18 In the ECE context, these findings emphasize that the social environment may modulate the effects of stress on burnout. The regression and path analysis findings together build a clearer understanding of how stress, burnout, and the social climate relate to educators’ health and turnover intentions. Regression findings showed that higher burnout was associated with poorer diet quality, lower physical activity, and shorter sleep duration, which are consistent with evidence linking chronic work-related stress to maladaptive coping behaviors. 41,42 These health behaviors, in turn, can reinforce burnout: disruptions in sleep, diet, and physical activity can amplify stress, making burnout harder to disrupt. 27,43 Health behaviors may therefore function both as outcomes of burnout and as factors that reinforce it, underscoring the need for workplace conditions that support educators’ ability to engage in health-promoting routines. The path model contextualizes these relationships by illustrating how stress and the social climate interact as antecedents to burnout, which then influences turnover intentions. This structure advances prior ECE research by clarifying the mechanisms through which individual and social experiences and factors translate into workforce instability. 6,11 Rather than documenting burnout as an independent concept, findings demonstrate how stress acts as an upstream driver that shapes both the social climate and burnout, which then influence educators’ likelihood of leaving the field. Addressing burnout amongst ECE educators may entail multilevel strategies that target workplace conditions. Stress management interventions may have a dual benefit through directly improving educators’ mental health while also enhancing the quality of the social climate that protect against burnout. For example, mindfulness-based programs, peer recognition systems, and conflict resolution training may reduce stress and foster social support in the workplace that, in turn, bolster personal accomplishment and mitigate emotional exhaustion. 44 Prior research in adjacent caregiving fields supports this multilevel approach, demonstrating that organizational and social support interventions can meaningfully reduce burnout and improve job satisfaction. 45,46 The current findings reinforce the need for similar models tailored to the ECE setting, particularly regarding those that enhance social support and reduce social strain as pathways to improve health and job turnover intentions. Findings further deepen how the ECE social climate may be understood by illustrating that social support and social strain operate as distinct predictors of burnout rather than opposite ends of the same continuum. While social support was tied specifically to the personal accomplishment subdomain of burnout, social strain was strongly associated with the other subdomains of emotional exhaustion and depersonalization. These differentiated pathways align with recent research suggesting that negative social interactions may exert stronger influence than positive ones in high-demand caregiving environments. 47 This distinction adds important nuance, as many interventions have prioritized social support alone as an amendment to employee wellbeing 48 , 49 and prior studies in caregiving professions emphasized the protective role of social support. 30,50,51 This study builds on emerging research suggesting that social strain can exacerbate emotional exhaustion and depersonalization even in otherwise cohesive workplaces. 47 Thus, it is important to consider both social support and social strain in the design of workplace interventions to foster supportive environments to mitigate social conflict and relational burdens. It is worth noting, however, that despite this distinction, social support was also found to be associated with social strain itself. This positions efforts to improve support (or reduce strain) alone as promising enhancements of the ECE climate and educator wellbeing. These insights also have direct implications for turnover. Job turnover intentions were consistently linked to burnout subdomains in this study’s path model, reinforcing burnout’s role as a proximal determinant of educators’ decisions to leave their jobs or the profession. Prior research has shown that burnout not only diminishes job satisfaction but also undermines commitment and stability across caregiving sectors. 6 By situating turnover within a broader ecological framework that includes stress and social climate, these findings highlight multiple potential intervention points. A study by Jin et al (2021) found that social support and resilience were associated with reduced job stress. 52 Reducing stress and improving the workplace social climate may therefore be pivotal for retaining qualified educators, which could contribute to stabilization of the ECE field. The strengths of this study include its large, demographically representative sample of ECE educators across New York State and its exploration of how burnout integrates with educators’ health and wellbeing. The use of path analysis allowed for the simultaneous assessment of multiple direct and indirect effects, advancing prior research that has largely relied on bivariate associations. By situating burnout within a path model linking stress, the social climate, and turnover intentions, this work offers a more comprehensive depiction of the ECE workforce’s wellbeing. The study’s limitations include its cross-sectional design, which precludes causal inference, and discrepancies in sample sizes between surveys (e.g., n = 263 for social climate measures vs. n = 1,423 overall). Additionally, the path model’s stability is limited by this smaller analytic sample, which constrains statistical power and increases the likelihood that some parameter estimates are less precise than they would be in a larger sample. Although the smaller subsample was demographically representative of the full cohort, replication in larger and longitudinal samples is warranted. Such replication can both improve precision of statistical analyses, and assist in evaluating potential longitudinal changes across time (e.g., the beginning of the year and the end of the year may have different characteristics). Finally, the study is vulnerable to selection bias, as participation in both surveys was voluntary and may reflect a subset of ECE educators who are more motivated to share their experiences due to frustrations compared with the broader workforce. Educators experiencing the lowest levels of stress or burnout may have been less likely to complete the surveys, potentially resulting in an overestimation of true strain within ECE settings. Implications of ECE workforce burnout-driven turnover goes beyond the educators’ themselves. It jeopardizes stable classroom quality, undermines continuity of care, and restricts childcare accessibility. 6 Instability in the childcare workforce extends beyond educators to affect families: when ECE centers close due to staff turnover, many parents are forced to reduce or leave employment. As childcare access increasingly influences labor-force participation, ECE workforce instability emerges as a broader public health and economic concern. This also compounds as an issue affecting women’s health given the predominantly female aspect of this workforce. Altogether, there is a great need to investigate burnout within the ECE workforce through a comprehensive, ecological lens. Understanding how individual health behaviors, the workplace social climate, and environmental stressors interact to shape burnout and turnover could support the development of targeted, multilevel strategies to improve educator wellbeing and stabilize the childcare system. Interventions to address the health and wellbeing of the ECE workforce are critical, especially those that include behavioral and policy intervention strategies tailored to the ECE setting to address both individual and environmental contributors to burnout. In this vein, further research should include exploring organizational factors such as leadership practices, resource availability, and policy environments, which could further elucidate the contextual drivers of burnout and inform scalable, system-level interventions. Future longitudinal studies can help clarify causal pathways and assess whether improvements in stress and social climate translate to sustained reductions in burnout and turnover. In summary, this study identifies burnout as a pivotal link between ECE educators’ stress, social climate, and health-related outcomes. Stress and the social climate operate as modulators that influence both educators’ burnout and their intentions to remain in the field. Burnout marks the point where chronic stress and strained social environments begin to erode educators’ health, wellbeing, and professional commitment. Recognizing burnout as the result of these overlapping pressures is key to understanding ongoing workforce instability in ECE and shows why the conditions causing it must be addressed. Addressing these aspects of the ECE work environment represents a critical step toward supporting not only the educators themselves but also the families. Declarations Acknowledgments The authors wish to thank the New York State (NYS) ECE educators who participated in the study along with our partners at the NYS Department of Children and Families, NYS Department of Health, and Cornell Cooperative Extension in New York City and Oneida Counties. Funding was provided by the Cornell Center for Health Equity, USDA NIFA (NYC-199404); Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD 2T32HD087137-06) supporting B.C Ethics approval and consent to participate This study was conducted in accordance with the principles of the Declaration of Helsinki. All study procedures were approved by the Cornell University Institutional Review Board (protocol #IRB0144439). By initiating each survey, all respondents provided informed consent. Declaration of Interest The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Consent for publication Not applicable. Author Contribution B.C. and L.B. contributed to the design and implementation of the study, to the analysis of results, and to the writing of the manuscript. B.C. took the lead in result analysis and writing. All authors discussed the results and commented on the manuscript. Data Availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. References Stein R, Garay M, Nguyen A. It Matters: Early Childhood Mental Health, Educator Stress, and Burnout. Early Child Educ J. 2024;52(2):333–44. 10.1007/s10643-022-01438-8 . 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Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equation Modeling: Multidisciplinary J. 1999;6(1):1–55. 10.1080/10705519909540118 . Shah MK, Gandrakota N, Cimiotti JP, Ghose N, Moore M, Ali MK. Prevalence of and Factors Associated With Nurse Burnout in the US. JAMA Netw Open. 2021;4(2):e2036469. 10.1001/jamanetworkopen.2020.36469 . Nevanperä NJ, Hopsu L, Kuosma E, Ukkola O, Uitti J, Laitinen JH. Occupational burnout, eating behavior, and weight among working women. Am J Clin Nutr. 2012;95(4):934–43. 10.3945/ajcn.111.014191 . Padilla HM, Wilson M, Vandenberg RJ, Davis M, Clark MA. Health behavior among working adults: Workload and exhaustion are associated with nutrition and physical activity behaviors that lead to weight gain. J Health Psychol. 2021;26(6):892–904. 10.1177/1359105319851205 . Balatoni I, Szépné HV, Kiss T, Adamu UG, Szulc AM, Csernoch L. The Importance of Physical Activity in Preventing Fatigue and Burnout in Healthcare Workers. Healthcare. 2023;11(13):1915. 10.3390/healthcare11131915 . Kriakous SA, Elliott KA, Lamers C, Owen R. The Effectiveness of Mindfulness-Based Stress Reduction on the Psychological Functioning of Healthcare Professionals: a Systematic Review. Mindfulness. 2021;12(1):1–28. 10.1007/s12671-020-01500-9 . Cao Y, Gao L, Fan L, Jiao M, Li Y, Ma Y. The Influence of Emotional Intelligence on Job Burnout of Healthcare Workers and Mediating Role of Workplace Violence: A Cross Sectional Study. Front Public Health. 2022;10:892421. 10.3389/fpubh.2022.892421 . Bagdžiūnienė D, Kazlauskienė A, Nasvytienė D, Sakadolskis E. Resources of emotional resilience and its mediating role in teachers’ well-being and intention to leave. Front Psychol. 2023;14:1305979. 10.3389/fpsyg.2023.1305979 . Powers K, Brandon J, Chen F. Teaming Up for Community Health Simulation Intervention: A Quasi-Experimental Study. Nurs Educ Perspect. 2025;46(1):30–6. 10.1097/01.NEP.0000000000001253 . Tondokoro T, Nakata A, Otsuka Y, et al. Effects of participatory workplace improvement program on stress-related biomarkers and self-reported stress among university hospital nurses: a preliminary study. Ind Health. 2021;59(2):128–41. 10.2486/indhealth.2020-0176 . Wagner U, Galli L, Schott BH, et al. Beautiful friendship: Social sharing of emotions improves subjective feelings and activates the neural reward circuitry. Soc Cognit Affect Neurosci. 2015;10(6):801–8. 10.1093/scan/nsu121 . Velando-Soriano A, Ortega‐Campos E, Gómez‐Urquiza JL, Ramírez‐Baena L, De La Fuente EI, La Cañadas‐De GA. Impact of social support in preventing burnout syndrome in nurses: A systematic review. Japan J Nurs Sci. 2020;17(1):e12269. 10.1111/jjns.12269 . Ruisoto P, Ramírez MR, García PA, Paladines-Costa B, Vaca SL, Clemente-Suárez VJ. Social Support Mediates the Effect of Burnout on Health in Health Care Professionals. Front Psychol. 2021;11:623587. 10.3389/fpsyg.2020.623587 . Jin J, Tang J. Exploring the effect of perceived organizational support and resilience on Chinese pharmacists’ engagement in stressful and competitive pharmaceutical work at hospitals. Saudi Pharm J. 2021;29(9):931–8. 10.1016/j.jsps.2021.08.003 . Tables Table 1 and 2 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files MaslachLicenseStayWell.pdf Tables.docx Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 18 Mar, 2026 Reviews received at journal 11 Mar, 2026 Reviews received at journal 09 Mar, 2026 Reviewers agreed at journal 03 Mar, 2026 Reviewers agreed at journal 01 Mar, 2026 Reviewers agreed at journal 27 Feb, 2026 Reviewers invited by journal 20 Feb, 2026 Editor invited by journal 18 Feb, 2026 Editor assigned by journal 02 Feb, 2026 Submission checks completed at journal 02 Feb, 2026 First submitted to journal 02 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8544453","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":595533472,"identity":"db60dd53-0ec8-4b57-abbf-ee00019e85a5","order_by":0,"name":"Beatriz Carmona","email":"","orcid":"","institution":"Cornell University","correspondingAuthor":false,"prefix":"","firstName":"Beatriz","middleName":"","lastName":"Carmona","suffix":""},{"id":595533473,"identity":"8ef1e585-cd84-4224-8e30-afbfd096669d","order_by":1,"name":"Ligia Reyes","email":"","orcid":"","institution":"Pennsylvania State University","correspondingAuthor":false,"prefix":"","firstName":"Ligia","middleName":"","lastName":"Reyes","suffix":""},{"id":595533474,"identity":"a7a50de0-ee62-4b36-8e17-dc694f133698","order_by":2,"name":"Meghan Orman","email":"","orcid":"","institution":"Bezos Family Foundation","correspondingAuthor":false,"prefix":"","firstName":"Meghan","middleName":"","lastName":"Orman","suffix":""},{"id":595533475,"identity":"76920490-5353-4148-8feb-708977fd7866","order_by":3,"name":"Laura Bellows","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAUlEQVRIiWNgGAWjYBACPgh1gIGPHURXgHmMBx4AiQYcWthgWtiYQfQZKDeBaC2MbcRoYT9j9uEHwx05NmbmY5I/59nJmc9uPgDUYiO74QAOLTw5xjN7GJ4ZszGzpUnzbks2lrlzLAGoJc0YpxaGHGMGHobDiW3MPGa3GbcdSJwhkWMA1HI4EacW/jfGjH8YDteDtNz8OQekJf8DUMt/3FokcoyZgbYksAG13OBtANsC8v4BPFqeFTPLGDwzbGNmS//NcyzZWEIiDegwg2TjmTi08PMnb2Z8U3FHnp+9+bDhjxo7OQmJ5IcPPlTYyfbh0AIBBkSIjIJRMApGwSggAQAACPFYOmQx7V8AAAAASUVORK5CYII=","orcid":"","institution":"Cornell University","correspondingAuthor":true,"prefix":"","firstName":"Laura","middleName":"","lastName":"Bellows","suffix":""}],"badges":[],"createdAt":"2026-01-07 18:23:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8544453/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8544453/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103442800,"identity":"8490ff9d-0a12-46b8-b504-03121c2685bb","added_by":"auto","created_at":"2026-02-25 17:44:56","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":29355,"visible":true,"origin":"","legend":"\u003cp\u003eConceptual Model by Research Question Exploring Factors Affecting Early Childhood Educators’ Health and Wellbeing\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8544453/v1/24353885812ae5c1513891e4.png"},{"id":103442801,"identity":"4b2c4f22-c360-43f7-960d-cc8688cadfc3","added_by":"auto","created_at":"2026-02-25 17:44:56","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":54321,"visible":true,"origin":"","legend":"\u003cp\u003eFinal model with standardized path coefficients of pathways linking stress, social support and strain, burnout, and turnover intentions.\u003c/p\u003e\n\u003cp\u003eNote: Non-significant relationships are not shown. Solid lines indicate predictive relationships between variables and that changes in the predictor variable are associated with changes in the outcome variable. Significance is indicated as follows: * = p \u0026lt;0.05, ** = p \u0026lt;0.01, *** = p \u0026lt;0.001. Analyses were conducted with n=263 survey respondents.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8544453/v1/c20831e54c594e6b36d5a004.png"},{"id":103507519,"identity":"dfc1823a-11c9-4237-8957-4545d62f30dc","added_by":"auto","created_at":"2026-02-26 13:41:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":611446,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8544453/v1/0cf38cdb-6804-4a63-b7c7-93e3448d33a1.pdf"},{"id":103442802,"identity":"89fe9785-35a3-4632-9077-d194215d44ad","added_by":"auto","created_at":"2026-02-25 17:44:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":147347,"visible":true,"origin":"","legend":"","description":"","filename":"MaslachLicenseStayWell.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8544453/v1/831c69fa86cd5fdb12010faf.pdf"},{"id":103442803,"identity":"b3750331-4afe-46fb-b65c-fd684e55dfab","added_by":"auto","created_at":"2026-02-25 17:44:56","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":25588,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-8544453/v1/905ea5d0e87a0b16b6ce5f8f.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Path Analysis Examination of Factors Affecting Early Childhood Educators’ Health, Burnout, and Turnover ","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe fields of caregiving and education have long faced disproportionate burdens, including low wages and excessive demands, resulting in high prevalence and risk for chronic disease.\u0026nbsp;\u003csup\u003e1\u0026ndash;3\u003c/sup\u003e A population at the intersection of caregiving and education is that of the Early Childhood Education (ECE) workforce, which contains the highest proportion of women (97.1%) of all professions and is disproportionately women of color.\u0026nbsp;\u003csup\u003e4\u003c/sup\u003eECE educators, representing approximately 2 million U.S. workers, earn low wages, have limited benefits, and face workplace conditions marked by high occupational stress and burnout\u0026nbsp;\u003csup\u003e5,6\u003c/sup\u003e. These conditions contribute to vulnerabilities in their health, including elevated depression, stress, and chronic disease risk compared to other professions\u0026nbsp;\u003csup\u003e7\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn recent years, these challenges have been compounded by widespread staffing shortages and unprecedented levels of turnover. Some programs have experienced annual turnover rates as high as 40%, threatening program viability and decreasing access to childcare for families\u0026nbsp;\u003csup\u003e8\u003c/sup\u003e. High turnover disrupts classroom stability and imposes financial and emotional strain on remaining staff, increasing burnout risk and job instability\u0026nbsp;\u003csup\u003e9\u0026ndash;11\u003c/sup\u003e. Understanding workforce wellbeing and identifying strategies to reduce turnover are, therefore, essential not only for improving the health and quality of life of a predominantly female workforce, but also for maintaining stable and equitable access to child care \u0026ndash; a foundational need for working parents to maintain economic productivity.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBurnout has been identified as a precedent to heightened turnover intentions across many professions\u0026nbsp;\u003csup\u003e12\u003c/sup\u003e. Reflecting the cumulative toll of prolonged stress and overwork, burnout is defined as high emotional exhaustion (e.g., depletion of energy and emotional resources), high depersonalization (e.g., feelings of cynicism and detachment from one\u0026rsquo;s work), and diminished personal accomplishment (e.g., low perceptions of achievement and self-satisfaction from work)\u0026nbsp;\u003csup\u003e13\u003c/sup\u003e. Recognition of burnout as a public health concern has sparked efforts to understand how to mitigate its impact, particularly in caregiving fields where emotional labor, role ambiguity, and demanding interpersonal environments are common\u0026nbsp;\u003csup\u003e14\u003c/sup\u003e. Reducing burnout has been identified as integral to workforce retention, service quality, and individual wellbeing in several caregiving sectors, including nursing and social work.\u0026nbsp;\u003csup\u003e15,16\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResponsive to growing national concerns surrounding the health and turnover crisis among ECE educators, burnout has been a long-time focus of researchers studying this workforce. Findings here highlight stark issues: ECE educators experience disproportionately high burnout levels compared to many occupations\u0026nbsp;\u003csup\u003e17\u003c/sup\u003e and report higher emotional exhaustion than even their K\u0026ndash;12 teacher counterparts\u0026nbsp;\u003csup\u003e18,19\u003c/sup\u003e. Such efforts to examine and improve burnout in ECE have kindled a strong interest to better understand how burnout develops through more holistic lenses that consider multiple individual, social, and environmental factors, as opposed to more unidimensional analyses of the ECE workplace\u0026nbsp;\u003csup\u003e20\u003c/sup\u003e. This more holistic approach is responsive to emergent findings in ECE workplace interventions, which highlight gaps in understanding how more nuanced aspects of ECE educators\u0026rsquo; lives, such as their health status and quality of professional relationships, impact their burnout risk\u0026nbsp;\u003csup\u003e21\u003c/sup\u003e. Such gaps result in fragmented efforts to support ECE educators, with limited guidance regarding which factors are most influential or modifiable towards reducing burnout and turnover.\u003c/p\u003e\n\u003cp\u003eApproaches to better understand the manifestation of burnout in the ECE workforce require a comprehensive focus on educators\u0026rsquo; daily experiences, including factors affecting their health and wellbeing. In this regard, educators\u0026rsquo; health behaviors are an important factor; parallel to poor health outcomes, ECE educators have been found to struggle with poor diet, low physical activity, and inadequate sleep\u0026nbsp;\u003csup\u003e22\u0026ndash;24\u003c/sup\u003e. In other professions characterized by high stress and high demands, these health behaviors play a role in the development and sustainment of burnout\u0026nbsp;\u003csup\u003e25,26\u003c/sup\u003e. Emerging research from other caregiving sectors further suggests that poor diet, reduced physical activity, and disrupted sleep may both contribute to and result from burnout, producing feedback loops in which chronic stress impairs health behaviors that in turn exacerbate psychological strain\u0026nbsp;\u003csup\u003e27\u003c/sup\u003e. If similar patterns emerge in ECE, health behaviors may serve as modifiable components that can serve to reduce burnout, with significant implications for workforce support initiatives.\u003c/p\u003e\n\u003cp\u003eAlongside educators\u0026rsquo; individual health circumstances, their social experiences within the workplace likely play an influential role in burnout development. The workplace social climate can be understood as a dynamic system of interpersonal interactions that includes both social support (e.g., encouragement, shared problem-solving, and collegial collaboration) and social strain (e.g., conflict, exclusion, or emotional disregard)\u0026nbsp;\u003csup\u003e28,29\u003c/sup\u003e. The social climate is particularly relevant in the ECE profession, as relational work is central to the teaching role, and burgeoning evidence suggests that educators lack institutional resources that buffer interpersonal stress\u0026nbsp;\u003csup\u003e19\u003c/sup\u003e. Social support has been shown to protect employees from burnout in several caregiving fields\u0026nbsp;\u003csup\u003e30,31\u003c/sup\u003e. Evidence from emerging studies suggests that strain may exert particularly detrimental effects, potentially outweighing the benefits of support. Yet, research has historically emphasized support while giving less attention to social strain\u0026nbsp;\u003csup\u003e32\u003c/sup\u003e. For ECE educators, both positive and negative social experiences may substantially shape wellbeing. Thus, considering both forms of the social climate, as support and strain, offers a more holistic picture of the workplace experience.\u003c/p\u003e\n\u003cp\u003eWhile individual health behaviors and interpersonal dynamics are important, they exist within broader structural and environmental conditions that also shape burnout risk. Current literature on ECE workforce wellbeing has highlighted the multitude of stressors embedded within educators\u0026rsquo; work environments. These include low wages, limited health and retirement benefits, inadequate staffing levels, high teacher-child ratios, challenging classroom dynamics, resource scarcity, and unstable schedules\u0026nbsp;\u003csup\u003e3,33,34\u003c/sup\u003e. Many of these environmental stressors reflect systemic undervaluation of ECE caregiving labor. Such conditions heighten educators\u0026rsquo; stress, undermine their physical and emotional health, and hinder their ability to engage in healthy behaviors and sustain collaborative workplace relationships\u0026nbsp;\u003csup\u003e19,35\u003c/sup\u003e. Stressors embedded in the work environment, and the subsequent stress resulting from them, may therefore become a driving force shaping both educators\u0026rsquo; interpersonal interactions and individual wellbeing.\u003c/p\u003e\n\u003cp\u003eThe Social Ecological Model (SEM) provides a valuable framework for understanding how burnout may emerge from the complex interplay of these individual, interpersonal, and environmental pressures. The SEM emphasizes that health is shaped by interactions between a person and their environment, whereby individual behaviors, social relationships, and structural conditions are interdependent\u0026nbsp;\u003csup\u003e36\u003c/sup\u003e. Applying this framework to ECE suggests that burnout cannot be sufficiently understood when examined at only one level. Instead, burnout likely reflects cascading influences in which environmental stressors shape interpersonal climates, which then interact with educators\u0026rsquo; individual health behaviors. Although research has described individual, interpersonal, and environmental challenges independently within ECE settings, incomplete understanding of how these dimensions collectively drive burnout hampers the development of effective solutions\u0026nbsp;\u003csup\u003e21\u003c/sup\u003e. In practice, this may lead to ineffective solutions that target only unidimensional aspects of educators\u0026rsquo; lives.\u003c/p\u003e\n\u003cp\u003eExamining burnout holistically is therefore essential not only for understanding the wellbeing of ECE educators but also for maintaining a stable and equitable childcare system. The StayWell ECE (\u003cstrong\u003e\u003cu\u003eSt\u003c/u\u003e\u003c/strong\u003eaff and \u003cstrong\u003e\u003cu\u003eY\u003c/u\u003e\u003c/strong\u003eouth \u003cstrong\u003e\u003cu\u003eWell\u003c/u\u003e\u003c/strong\u003eness for \u003cstrong\u003e\u003cu\u003eE\u003c/u\u003e\u003c/strong\u003early \u003cstrong\u003e\u003cu\u003eC\u003c/u\u003e\u003c/strong\u003ehildhood \u003cstrong\u003e\u003cu\u003eE\u003c/u\u003e\u003c/strong\u003educators) project aims to understand the health and wellbeing outcomes of New York (NY) licensed ECE educators, and to examine how individual, interpersonal, and environmental influences contribute to these outcomes. The project uses a sequential explanatory mixed methods approach (quan \u0026agrave; QUAL) to gain a comprehensive understanding of NY ECE educators\u0026rsquo; health and wellbeing to inform future intervention efforts. This study seeks to identify modifiable variables that are associated with burnout in ECE educators, focusing on the innermost layers of the SEM relating to individual behaviors and the interpersonal ECE social climate. Specifically, this study explored (1) how burnout and the social climate are associated with health behaviors, and (2) how the social climate (social support and strain), and stress are related to burnout and turnover intentions (Figure 1).\u0026nbsp;\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants and Procedures\u003c/h2\u003e \u003cp\u003eTwo surveys were distributed electronically to NY State licensed ECE programs via listservs using the Research Electronic Data Capture (REDCap) platform. The StayWell ECE Health Behaviors Survey was administered in spring 2023 with all respondents invited to complete a subsequent StayWell ECE Social Environment Survey in fall 2023. All study procedures were approved by the Cornell University Institutional Review Board (protocol #IRB0144439). By initiating each survey, all respondents provided informed consent.\u003c/p\u003e \u003cp\u003eThe StayWell ECE Health Behaviors survey contained 110 items inquiring about demographic and socioeconomic characteristics, as well as job turnover intentions, burnout (emotional exhaustion, depersonalization, and personal accomplishment), the social climate, health behaviors (diet, physical activity, and sleep), and stress. \u003csup\u003e22\u003c/sup\u003e The StayWell ECE Social Environment Survey contained 60 items inquiring about educators\u0026rsquo; social support and social strain at work (social climate). Both surveys were prepared by a team of researchers and stakeholders with expertise in public health, survey development, and ECE. The surveys were developed using existing scales and items where possible.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSociodemographic characteristics\u003c/h2\u003e \u003cp\u003e Key demographic characteristics consisted of age, gender, race, ethnicity, education (highest level of education completed), and annual household income using the 2023 federal poverty guidelines (Department of Health and Human Services, 2023).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTurnover Intentions\u003c/h3\u003e\n\u003cp\u003eTurnover intentions were measured using 3 items that evaluated, respectively, likelihood to leave one\u0026rsquo;s job, center, or their ECE career within the next year (Job Satisfaction and Retention Survey; α\u0026thinsp;=\u0026thinsp;0.89).\u003c/p\u003e\n\u003ch3\u003eBurnout\u003c/h3\u003e\n\u003cp\u003eBurnout used the Maslach Burnout Inventory, which consists of three subdomains: low personal accomplishment (e.g., \u0026ldquo;I have [not] achieved many rewarding objectives in my work\u0026rdquo;; 8 items), depersonalization (e.g., \u0026ldquo;I have become more callous to people since I have started doing this job\u0026rdquo;; 5 items), and emotional exhaustion (e.g., \u0026ldquo;I feel worn out at the end of a working day\u0026rdquo;; 9 items). Low personal accomplishment, high emotional exhaustion, and high depersonalization make up high overall burnout. This inventory had a total of 22 items with 7-point Likert scales. A higher score in emotional exhaustion (α\u0026thinsp;=\u0026thinsp;0.92) or depersonalization (α\u0026thinsp;=\u0026thinsp;0.88) equates to higher burnout, and a lower score in personal accomplishment (α\u0026thinsp;=\u0026thinsp;0.91) equates to higher burnout (Maslach \u0026amp; Leiter, 1997).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSocial climate\u003c/h2\u003e \u003cp\u003eTo examine workplace social climate, social support and social strain were both assessed using an adapted version of the Family Support and Strain Scale (Cohen \u0026amp; Wills, 1985). This scale has a total of 10 items (5 each for support and strain) with 5-point Likert scales. A lower score in social support (α\u0026thinsp;=\u0026thinsp;0.89) equates to higher strain, and a higher score in social strain (α\u0026thinsp;=\u0026thinsp;0.93) equates to lower support.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eHealth Behaviors\u003c/h3\u003e\n\u003cp\u003eHealth behaviors - diet, physical activity, and sleep - were assessed using a battery of different assessments. Diet behaviors were assessed with three items from the Rapid Eating Assessment for Participants \u0026ndash; Shortened Version (Segal-Isaacson 2004; 3 items, α\u0026thinsp;=\u0026thinsp;0.77). These included the frequency of consuming fewer than two servings of: 1) whole grains, 2) fruits, and 3) vegetables per day, based on a 3-point Likert scale (usually/ often; sometimes; rarely/never). Responses to all four items were summed into a continuous diet quality variable (score range of 3\u0026ndash;9), where a higher score equated to a lower diet quality score.\u003c/p\u003e \u003cp\u003ePhysical activity was examined with two items. The first from the Behavioral Risk Factor Surveillance System (CDC, 2023) asked one\u0026rsquo;s self-reported participation in PA over the past month (responses of yes; no; not sure). Item 2, originated from the National Health Institute Survey (Thomas, 1990) and inquired whether the respondent felt they were more, less, or about as active as other people their age (responses of more; less; as active). Responses to both items were summed into a continuous PA variable (score range of 2\u0026ndash;4), where a higher score equated to lower approximated physical activity levels.\u003c/p\u003e \u003cp\u003eSleep was examined with one item from the Pittsburgh Sleep Quality Index (Buysse, 1989) inquiring about self-reported nightly sleep time, on average, in hours and minutes.\u003c/p\u003e\n\u003ch3\u003eStress\u003c/h3\u003e\n\u003cp\u003eStress was examined with the Perceived Stress Scale (α\u0026thinsp;=\u0026thinsp;0.85), which contains 10 items and a 5-point Likert scale (Cohen \u0026amp; Williamson, 1983). A higher score equates to a higher level of stress.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eThe final sample size was determined using an a-priori threshold of \u0026gt;\u0026thinsp;80% completion for inclusion (Booker 2021). R studio version 4.3.2 (R Core Team; 2024) was used to test for normality (skewness and kurtosis), and to calculate descriptive statistics (frequencies, means, medians and standard deviation scores). Multiple linear regressions were used to examine our first analytical research question (how burnout and one\u0026rsquo;s social climate are associated with health behaviors (diet, physical activity, and sleep). Path analysis was used to examine the second research question (effects across stress, the social climate, burnout, and turnover intentions), controlling for age, income, and education. The lavaan package in R studio was used to assess model fit and significance of tested relationships. Model fit used chi-square, comparative fit index (CFI), root mean square error of approximation (RMSEA), and standardized root mean square residual (SRMR). \u003csup\u003e37,38\u003c/sup\u003e In evaluating the goodness of fit, the following criteria indicated an adequate fit: a non-significant chi-square value, CFI values \u0026ge;\u0026thinsp;.90, and RMSEA and SRMR values \u0026le;\u0026thinsp;.08 \u003csup\u003e39\u003c/sup\u003e. Significance of relationships was set at α\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe surveys, StayWell ECE Health Behaviors survey and StayWell ECE Social Environment Survey, received 1,423 and 263 completed responses, respectively. Where possible the full sample size is reported (e.g., demographics, burnout, health behaviors). The smaller sample size (n=263) was found to be demographically representative of the full sample (n=1,423). Survey respondents were primarily women (95%), identified as White (70%), and had an average age of 43.6 ± 12.6 years. One-third were considered low income (32.5%), and half (49.5%) had a bachelor’s degree or higher (Table 1).\u003c/p\u003e\n\u003cp\u003eFor burnout, 56% had high emotional exhaustion, 38% had high depersonalization, and 80% had reduced personal accomplishment. Further, 22% planned to leave their position, center, or the ECE profession within the next year (turnover intentions). Within the workplace social climate, educators experienced mid-range scores of coworker social support (2.0 ± 0.76 out of 5) and coworker social strain (2.5 ± 0.70 out of 5). Regarding health behaviors, 72% consumed fewer than 2 daily servings of whole grains, vegetables, and/or fruit, 28% had not exercised in the past month, and 31% slept less than 7 hours per night. (Table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMultiple linear regressions addressing research question 1 identified that burnout and social support were both significantly associated with health behaviors. For burnout, lower personal accomplishment (high burnout) was positively associated with lower physical activity (β = 1.38, p \u0026lt; 0.01) and lower diet quality (β = 0.74, p \u0026lt; 0.01). Higher depersonalization and emotional exhaustion (high burnout) were also both positively associated with lower physical activity (depersonalization: β = 0.83, p \u0026lt; 0.01; emotional exhaustion: β = 2.62, p \u0026lt; 0.01). Higher depersonalization was associated with lower diet quality (β = 0.19, p \u0026lt; 0.01), and higher emotional exhaustion was associated with less sleep (β = 0.94, p \u0026lt; 0.01). Regarding the social climate, less social support was associated with lower diet quality (β = -0.28, p \u0026lt; 0.001) and sleep (β = -0.36, p \u0026lt; 0.01).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA path analysis model was fit to examine broader environmental associations with burnout and the social climate, namely, how stress is associated with social support and strain and burnout, and how, in turn, they influence turnover intentions. \u0026nbsp;The model, with standardized path coefficients, had an adequate fit, with a CFI of 0.994, a TLI of 0.992, and an RSMEA of 0.008. Path analysis results (Figure 2) indicated that stress was significantly associated with social support (0.019), social strain (0.023), and all three subdomains of burnout -emotional exhaustion (1.083), depersonalization (0.238) and personal accomplishment (-0.505). Social support was associated only with higher personal accomplishment (-0.171), and higher social strain was associated with higher emotional exhaustion (5.360) and higher depersonalization (2.433). All three subdomains of burnout were associated with turnover intentions. In summary, high stress was associated with lower social support, higher social strain, and higher burnout across all three subdomains. High social support was linked to higher personal accomplishment, and high social strain was linked to higher depersonalization and emotional exhaustion.\u0026nbsp;\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study advances our understanding of how burnout, stress, and the workplace social climate intersect to shape health and job turnover intentions among ECE educators \u0026ndash; a female-dominated workforce sector that, like other predominantly-female sectors, has long struggled with high job demands, limited pay, and increased chronic disease risk \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Regression results identified burnout as a key mechanism linking the workplace social climate to health behaviors, while the path model positioned stress as an upstream driver that amplifies burnout, social strain, and job turnover intentions. Together, these results illustrate that high stress is associated with high burnout and social strain, which in turn are associated with poorer health behaviors and higher job turnover intentions among ECE educators. These downstream effects underscore the critical need for strategies that effectively reduce stress and burnout in ECE settings. While prior studies have documented high stress and burnout in the ECE workforce, the present findings delineate how these experiences unfold across individual and social domains, and how health behaviors play a role in ECE educator wellbeing, offering a more mechanistic explanation for how burnout manifests in this profession. These results align with prior research positing stress as a precursor to burnout \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e and extend findings from caregiving professions, where nursing and social work have similarly identified that workplace stress predicts burnout. \u003csup\u003e15,40\u003c/sup\u003e The present study adds to this literature by showing that in ECE educators, stress not only exerts direct effects on burnout, but also indirectly shapes it through the influence of educators\u0026rsquo; social climate. This supports emerging ecological models suggesting that burnout in ECE is not solely an intrapersonal condition but one that is continually reinforced by workplace dynamics. \u003csup\u003e6,18\u003c/sup\u003e In the ECE context, these findings emphasize that the social environment may modulate the effects of stress on burnout.\u003c/p\u003e \u003cp\u003eThe regression and path analysis findings together build a clearer understanding of how stress, burnout, and the social climate relate to educators\u0026rsquo; health and turnover intentions. Regression findings showed that higher burnout was associated with poorer diet quality, lower physical activity, and shorter sleep duration, which are consistent with evidence linking chronic work-related stress to maladaptive coping behaviors. \u003csup\u003e41,42\u003c/sup\u003e These health behaviors, in turn, can reinforce burnout: disruptions in sleep, diet, and physical activity can amplify stress, making burnout harder to disrupt. \u003csup\u003e27,43\u003c/sup\u003e Health behaviors may therefore function both as outcomes of burnout and as factors that reinforce it, underscoring the need for workplace conditions that support educators\u0026rsquo; ability to engage in health-promoting routines. The path model contextualizes these relationships by illustrating how stress and the social climate interact as antecedents to burnout, which then influences turnover intentions. This structure advances prior ECE research by clarifying the mechanisms through which individual and social experiences and factors translate into workforce instability. \u003csup\u003e6,11\u003c/sup\u003e Rather than documenting burnout as an independent concept, findings demonstrate how stress acts as an upstream driver that shapes both the social climate and burnout, which then influence educators\u0026rsquo; likelihood of leaving the field.\u003c/p\u003e \u003cp\u003eAddressing burnout amongst ECE educators may entail multilevel strategies that target workplace conditions. Stress management interventions may have a dual benefit through directly improving educators\u0026rsquo; mental health while also enhancing the quality of the social climate that protect against burnout. For example, mindfulness-based programs, peer recognition systems, and conflict resolution training may reduce stress and foster social support in the workplace that, in turn, bolster personal accomplishment and mitigate emotional exhaustion. \u003csup\u003e44\u003c/sup\u003e Prior research in adjacent caregiving fields supports this multilevel approach, demonstrating that organizational and social support interventions can meaningfully reduce burnout and improve job satisfaction. \u003csup\u003e45,46\u003c/sup\u003e The current findings reinforce the need for similar models tailored to the ECE setting, particularly regarding those that enhance social support and reduce social strain as pathways to improve health and job turnover intentions.\u003c/p\u003e \u003cp\u003eFindings further deepen how the ECE social climate may be understood by illustrating that social support and social strain operate as distinct predictors of burnout rather than opposite ends of the same continuum. While social support was tied specifically to the personal accomplishment subdomain of burnout, social strain was strongly associated with the other subdomains of emotional exhaustion and depersonalization. These differentiated pathways align with recent research suggesting that negative social interactions may exert stronger influence than positive ones in high-demand caregiving environments. \u003csup\u003e47\u003c/sup\u003e This distinction adds important nuance, as many interventions have prioritized social support alone as an amendment to employee wellbeing \u003csup\u003e\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e,\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u003c/sup\u003e and prior studies in caregiving professions emphasized the protective role of social support. \u003csup\u003e30,50,51\u003c/sup\u003e This study builds on emerging research suggesting that social strain can exacerbate emotional exhaustion and depersonalization even in otherwise cohesive workplaces. \u003csup\u003e47\u003c/sup\u003e Thus, it is important to consider both social support and social strain in the design of workplace interventions to foster supportive environments to mitigate social conflict and relational burdens. It is worth noting, however, that despite this distinction, social support was also found to be associated with social strain itself. This positions efforts to improve support (or reduce strain) alone as promising enhancements of the ECE climate and educator wellbeing.\u003c/p\u003e \u003cp\u003eThese insights also have direct implications for turnover. Job turnover intentions were consistently linked to burnout subdomains in this study\u0026rsquo;s path model, reinforcing burnout\u0026rsquo;s role as a proximal determinant of educators\u0026rsquo; decisions to leave their jobs or the profession. Prior research has shown that burnout not only diminishes job satisfaction but also undermines commitment and stability across caregiving sectors. \u003csup\u003e6\u003c/sup\u003e By situating turnover within a broader ecological framework that includes stress and social climate, these findings highlight multiple potential intervention points. A study by Jin et al (2021) found that social support and resilience were associated with reduced job stress. \u003csup\u003e52\u003c/sup\u003e Reducing stress and improving the workplace social climate may therefore be pivotal for retaining qualified educators, which could contribute to stabilization of the ECE field.\u003c/p\u003e \u003cp\u003eThe strengths of this study include its large, demographically representative sample of ECE educators across New York State and its exploration of how burnout integrates with educators\u0026rsquo; health and wellbeing. The use of path analysis allowed for the simultaneous assessment of multiple direct and indirect effects, advancing prior research that has largely relied on bivariate associations. By situating burnout within a path model linking stress, the social climate, and turnover intentions, this work offers a more comprehensive depiction of the ECE workforce\u0026rsquo;s wellbeing. The study\u0026rsquo;s limitations include its cross-sectional design, which precludes causal inference, and discrepancies in sample sizes between surveys (e.g., n\u0026thinsp;=\u0026thinsp;263 for social climate measures vs. n\u0026thinsp;=\u0026thinsp;1,423 overall). Additionally, the path model\u0026rsquo;s stability is limited by this smaller analytic sample, which constrains statistical power and increases the likelihood that some parameter estimates are less precise than they would be in a larger sample. Although the smaller subsample was demographically representative of the full cohort, replication in larger and longitudinal samples is warranted. Such replication can both improve precision of statistical analyses, and assist in evaluating potential longitudinal changes across time (e.g., the beginning of the year and the end of the year may have different characteristics). Finally, the study is vulnerable to selection bias, as participation in both surveys was voluntary and may reflect a subset of ECE educators who are more motivated to share their experiences due to frustrations compared with the broader workforce. Educators experiencing the lowest levels of stress or burnout may have been less likely to complete the surveys, potentially resulting in an overestimation of true strain within ECE settings.\u003c/p\u003e \u003cp\u003eImplications of ECE workforce burnout-driven turnover goes beyond the educators\u0026rsquo; themselves. It jeopardizes stable classroom quality, undermines continuity of care, and restricts childcare accessibility. \u003csup\u003e6\u003c/sup\u003e Instability in the childcare workforce extends beyond educators to affect families: when ECE centers close due to staff turnover, many parents are forced to reduce or leave employment. As childcare access increasingly influences labor-force participation, ECE workforce instability emerges as a broader public health and economic concern. This also compounds as an issue affecting women\u0026rsquo;s health given the predominantly female aspect of this workforce. Altogether, there is a great need to investigate burnout within the ECE workforce through a comprehensive, ecological lens. Understanding how individual health behaviors, the workplace social climate, and environmental stressors interact to shape burnout and turnover could support the development of targeted, multilevel strategies to improve educator wellbeing and stabilize the childcare system.\u003c/p\u003e \u003cp\u003eInterventions to address the health and wellbeing of the ECE workforce are critical, especially those that include behavioral and policy intervention strategies tailored to the ECE setting to address both individual and environmental contributors to burnout. In this vein, further research should include exploring organizational factors such as leadership practices, resource availability, and policy environments, which could further elucidate the contextual drivers of burnout and inform scalable, system-level interventions. Future longitudinal studies can help clarify causal pathways and assess whether improvements in stress and social climate translate to sustained reductions in burnout and turnover.\u003c/p\u003e \u003cp\u003eIn summary, this study identifies burnout as a pivotal link between ECE educators\u0026rsquo; stress, social climate, and health-related outcomes. Stress and the social climate operate as modulators that influence both educators\u0026rsquo; burnout and their intentions to remain in the field. Burnout marks the point where chronic stress and strained social environments begin to erode educators\u0026rsquo; health, wellbeing, and professional commitment. Recognizing burnout as the result of these overlapping pressures is key to understanding ongoing workforce instability in ECE and shows why the conditions causing it must be addressed. Addressing these aspects of the ECE work environment represents a critical step toward supporting not only the educators themselves but also the families.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors wish to thank the New York State (NYS) ECE educators who participated in the study along with our partners at the NYS Department of Children and Families, NYS Department of Health, and Cornell Cooperative Extension in New York City and Oneida Counties. Funding was provided by the Cornell Center for Health Equity, USDA NIFA (NYC-199404); Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD 2T32HD087137-06) supporting B.C\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the principles of the Declaration of Helsinki. All study procedures were approved by the Cornell University Institutional Review Board (protocol #IRB0144439). By initiating each survey, all respondents provided informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eB.C. and L.B. contributed to the design and implementation of the study, to the analysis of results, and to the writing of the manuscript. B.C. took the lead in result analysis and writing. All authors discussed the results and commented on the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eStein R, Garay M, Nguyen A. It Matters: Early Childhood Mental Health, Educator Stress, and Burnout. Early Child Educ J. 2024;52(2):333\u0026ndash;44. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10643-022-01438-8\u003c/span\u003e\u003cspan address=\"10.1007/s10643-022-01438-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTotenhagen CJ, Hawkins SA, Casper DM, Bosch LA, Hawkey KR, Borden LM. Retaining Early Childhood Education Workers: A Review of the Empirical Literature. 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Saudi Pharm J. 2021;29(9):931\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jsps.2021.08.003\u003c/span\u003e\u003cspan address=\"10.1016/j.jsps.2021.08.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 and 2 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8544453/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8544453/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEarly Childhood Education (ECE) educators experience high levels of stress, burnout, and job turnover, contributing to workforce instability. Efforts to better understand how interpersonal and environmental work-related factors contribute to burnout and job turnover intentions are essential to improving ECE educator wellbeing. Grounded in the social ecological model, this study quantitatively examined how stress, the social climate (social support and social strain), and health behaviors contribute to burnout and job turnover intentions in ECE educators.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe StayWell ECE (\u003cu\u003e\u003cstrong\u003eSt\u003c/strong\u003e\u003c/u\u003eaff and \u003cu\u003e\u003cstrong\u003eY\u003c/strong\u003e\u003c/u\u003eouth \u003cu\u003e\u003cstrong\u003eWell\u003c/strong\u003e\u003c/u\u003eness for \u003cu\u003e\u003cstrong\u003eE\u003c/strong\u003e\u003c/u\u003early \u003cu\u003e\u003cstrong\u003eC\u003c/strong\u003e\u003c/u\u003ehildhood \u003cu\u003e\u003cstrong\u003eE\u003c/strong\u003e\u003c/u\u003educators) projectadministered two online surveys to licensed ECE educators in New York: the Health Behaviors Survey (n= 1,423), assessing burnout, stress, turnover intentions, and health behaviors (diet, physical activity, and sleep), and the Social Environment Survey (n= 263), assessing workplace social climate (social support and social strain). Multiple linear regression analyses examined associations between burnout, the social climate, and health behaviors. Path analysis was conducted to test relationships among stress, the social climate, burnout, and turnover intentions, controlling for age, income, and education; model fit was evaluated using chi-square, comparative fit index, root mean square error of approximation, and standardized root mean square residual.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHigher burnout was significantly associated with poorer diet quality and lower physical activity and sleep. Lower workplace social support was also associated with poorer diet quality and sleep. Path analysis demonstrated adequate model fit and showed that stress was associated with lower social support, higher social strain, and higher levels of burnout. Social strain was strongly associated with two burnout subdomains (lower emotional exhaustion and depersonalization; p\u0026lt;0.01 and p\u0026lt;0.01), while social support was associated with one (greater personal accomplishment; p\u0026lt;0.01). All burnout subdomains were associated with higher turnover intentions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFindings highlight burnout as a key mechanism linking stress and workplace social climate to health behaviors and turnover intentions among ECE educators. Interventions that reduce stress and address both social support and social strain may improve wellbeing, support healthier behaviors, and reduce job turnover in this workforce.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"A Path Analysis Examination of Factors Affecting Early Childhood Educators’ Health, Burnout, and Turnover","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-25 17:44:51","doi":"10.21203/rs.3.rs-8544453/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-19T03:34:15+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-12T03:53:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-09T14:15:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"114013483787127365585286355374432773102","date":"2026-03-04T04:45:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"260194034275513275364005941539403810175","date":"2026-03-01T05:05:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"139356112854376458473909050278439194460","date":"2026-02-27T11:10:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-20T15:56:47+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-19T03:08:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-03T04:54:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-02T08:47:46+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2026-02-02T08:29:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"84530c49-5ed9-4ebd-8efc-9927101f8687","owner":[],"postedDate":"February 25th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-15T05:10:02+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-25 17:44:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8544453","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8544453","identity":"rs-8544453","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}