title: A review of state regulations to promote physical activity and safety on playgrounds in child care centers and family child care homes.
abstract: BACKGROUND
  As interventions increasingly emphasize early child care settings, it is necessary to understand the state regulatory context that provides guidelines for outdoor physical activity and safety and sets standards for child care environments.
  
  
  METHODS
  Researchers reviewed regulations for child care facilities for 50 states, the District of Columbia and the Virgin Islands. We compared state regulations with national standards for 17 physical activity- and safety-related items for outdoor playground settings outlined in Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs (CFOC). State regulations were coded as fully, partially or not addressing the CFOC standard and state-level summary scores were calculated.
  
  
  RESULTS
  On average, state regulations fully addressed one-third of 17 CFOC standards in regulations for centers (34%) and family child care homes (27%). Data suggest insufficient attention to outdoor play area proximity and size, equipment height, surfacing, and inspections.
  
  
  CONCLUSIONS
  Considerable variation exists among state regulations related to physical activity promotion and injury prevention within outdoor play areas. Many states' regulations do not comply with published national health and safety standards. Enhancing regulations is one component of a policy approach to promoting safe, physically active child care settings.
authors.affiliation: Dept. of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Angie L I
authors.initials: AL
authors.lastname: Cradock
authors.forename: Emily M
authors.initials: EM
authors.lastname: O'Donnell
authors.forename: Sara E
authors.initials: SE
authors.lastname: Benjamin
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Walker
authors.forename: Meghan
authors.initials: M
authors.lastname: Slining
mesh_terms: D017028:Caregivers / Q000331:legislation & jurisprudence* / Q000592:standards; D002648:Child; D002654:Child Care / Q000331:legislation & jurisprudence* / Q000592:standards; D002669:Child Welfare; D004219:District of Columbia; D033161:Government Regulation; D006293:Health Promotion; D006801:Humans; D009043:Motor Activity; D010988:Play and Playthings; D012449:Safety / Q000706:statistics & numerical data*; D013219:State Government; D014481:United States; D014767:United States Virgin Islands; D014947:Wounds and Injuries / Q000517:prevention & control