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      Physical activity, screen time, and outdoor learning environment practices and policy implementation: a cross sectional study of Texas child care centers

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          Abstract

          Background

          Early care and education (ECE) centers are important for combating childhood obesity. Understanding policies and practices of ECE centers is necessary for promotion of healthy behaviors. The purpose of this study is to describe self-reported practices, outdoor environment aspects, and center policies for physical activity and screen time in a statewide convenience sample of non-Head Start Texas ECE centers.

          Methods

          Licensed home and child care centers in Texas with email addresses publicly available on the Department of Family and Protective Services website ( N = 6568) were invited to participate in an online survey. Descriptive statistics of self-reported practices, policies, and outdoor learning environment are described.

          Results

          827 surveys were collected (response rate = 12.6%). Exclusion criteria yielded a cross-sectional sample of 481 center-only respondents. > 80% of centers meet best practice recommendations for screen time practices for infants and toddlers, although written policies were low (M = 1.4 policies, SD = 1.65, range = 0–6). For physical activity, < 30% meet best practice recommendations with M = 3.9 policies (SD = 3.0, range = 0–10) policies reported. Outdoor learning environment indicators (M = 5.7 policies, SD = 2.5, range = 0–12) and adequate play settings, storage (< 40%), and greenery (< 20%) were reported.

          Conclusions

          This statewide convenience sample of non-Head Start Texas ECE centers shows numerous opportunities for improvement in practices and policies surrounding outdoor environments, physical activity, and screen time. With less than half of centers meeting the recommendations for physical activity and outdoor learning environments, dedicating resources to help centers enact and modify written policies and to implement programs to improve their outdoor learning environments could promote physical activity and reduce sedentary time of children.

          Electronic supplementary material

          The online version of this article (10.1186/s12889-019-6588-5) contains supplementary material, which is available to authorized users.

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          Most cited references16

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          The relative influence of individual, social and physical environment determinants of physical activity

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            Physical activity, sedentary behaviour and energy balance in the preschool child: opportunities for early obesity prevention.

            Prevalence of obesity in preschool children has increased dramatically in recent years. The preschool years (age 3-6 years) have been regarded as critical for the programming of energy balance, via the concept of early 'adiposity rebound'. Children who undergo early adiposity rebound are at increased risk of later obesity. Recent evidence suggests that associations between timing of adiposity rebound and later obesity may not reflect programming, but might denote that 'obesogenic' growth trajectories are often established by the preschool period. Studies of objectively-measured physical activity and sedentary behaviour in preschool children show that levels of physical activity are typically low and sedentary behaviour high. The review of evidence presented here is supportive of the hypothesis that physical activity is protective against obesity in the preschool period, and that sedentary behaviour, particularly television viewing, is obesogenic. Definitive evidence on dose-response relationships between physical activity, sedentary behaviour and obesity remain unclear. Dose-response evidence could be obtained fairly readily by intervention and longitudinal observational studies that use accelerometry in preschool children. The generalisability of much of the evidence base is limited and there is a need for research on the influence of physical activity and sedentary behaviour in the preschool years in the aetiology of obesity in the developing world.
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              Nutrition and physical activity in child care: results from an environmental intervention.

              With evidence of increased levels of obesity in younger children, the child-care setting is an important intervention target. Few environmental interventions exist, and none target both diet and physical activity. The Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) intervention was developed to fill this research and practice gap. Randomized controlled. Health professionals (child-care health consultants) serving child-care centers in North Carolina were recruited (n=30), randomly assigned into intervention or delayed-intervention control groups, and trained to implement the NAP SACC program. Up to three child-care centers were recruited (n=84) from each consultant's existing caseload. Implemented in 2005, the NAP SACC intervention includes an environmental self-assessment, selection of areas for change, continuing education workshops, targeted technical assistance, and re-evaluation. Implementation occurred over a 6-month period. An observational instrument, Environment and Policy Assessment and Observation (EPAO), provided objective evidence of intervention impact and was completed by trained research staff blinded to study assignment. Data were collected in 2005 and 2006. Statistical analyses were conducted in 2006. Intention-to-treat analysis results were nonsignificant. Exploratory analyses using only centers that completed most of the NAP SACC program suggest an intervention effect. Factors in the intervention design, the fidelity of implementation, the selection of outcome measure, or a combination of these may have contributed to the lack of intervention effect observed. Because of this study's use of existing public health infrastructure and its potential for implementation, future studies should address strategies for improving effectiveness.
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                Author and article information

                Contributors
                courtney.e.byrdwilliams@uth.tmc.edu
                erin.dooley@uth.tmc.edu
                Christina.Thi@dshs.texas.gov
                Cari.Browning@dshs.texas.gov
                Deanna.M.Hoelscher@uth.tmc.edu
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                7 March 2019
                7 March 2019
                2019
                : 19
                : 274
                Affiliations
                [1 ]GRID grid.468222.8, Michael & Susan Dell Center for Healthy Living at The University of Texas Health Science Center (UTHealth) School of Public Health in Austin, ; 1616 Guadalupe, Suite 6.300, Austin, TX 78701 USA
                [2 ]Department of State Health Services, Obesity Prevention Program, Health Promotion and Chronic Disease Prevention Section, MC 1965, PO Box 149347, Austin, TX USA
                Author information
                http://orcid.org/0000-0002-3942-8595
                Article
                6588
                10.1186/s12889-019-6588-5
                6407214
                30845946
                99965995-6dce-4d7c-b9c2-8172e2a7b85d
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 10 May 2018
                : 25 February 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000030, Centers for Disease Control and Prevention;
                Award ID: DP13-1305
                Funded by: Michael & Susan Dell Center for Healthy Living at the University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Public health
                pediatrics,physical activity,environment,guidelines and recommendations,public health

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