title: Children's cortisol levels and quality of child care provision.
abstract: BACKGROUND
  Cortisol levels are increasingly being used as an indicator of stress levels. Research suggests that children who attend child care demonstrate higher cortisol levels than children in their homes, suggesting that child care acts as a risk factor for poor child outcomes. However, it is also suggested that quality influences outcomes.
  
  
  METHODS
  Cortisol levels were measured through samples of saliva taken from children (3-5 years of age) attending long-day care centres in Perth, Western Australia. Quality of the programme was measured using industry national quality assurance indicators designed for child care centres. The analysis employed a 2 (time of collection: average am cortisol, average pm cortisol) by 3 (centre quality: high, satisfactory, unsatisfactory) split plot ANOVA with repeated measures on the time factor.
  
  
  RESULTS
  Cortisol levels of children attending high-quality programmes demonstrated a decline across the child care day. Levels in children attending unsatisfactory programmes demonstrated an increase across the day.
  
  
  CONCLUSIONS
  Although we do not yet know how high, and for how long, cortisol levels need to be elevated for risk of undesirable outcomes to increase, this research signals the importance of emphasizing the need for high-quality care for young children.
authors.affiliation: School of International, Cultural and Community Studies Joondalup Campus, Edith Cowan University, Joondalup, WA, Australia. m.sims@ecu.edu.au
authors.forename: M
authors.initials: M
authors.lastname: Sims
authors.forename: A
authors.initials: A
authors.lastname: Guilfoyle
authors.forename: T S
authors.initials: TS
authors.lastname: Parry
mesh_terms: D000704:Analysis of Variance; D015415:Biomarkers / Q000032:analysis; D002648:Child; D002654:Child Care / Q000592:standards*; D002656:Child Day Care Centers; D002657:Child Development; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis*; D008297:Male; D012307:Risk Factors; D012463:Saliva / Q000737:chemistry*; D014904:Western Australia
chemical_list: D015415:Biomarkers; D006854:Hydrocortisone