title: Nutrition and physical activity in child care centers: the impact of a wellness policy initiative on environment and policy assessment and observation outcomes, 2011.
abstract: BACKGROUND
  The child care environment has emerged as an ideal setting in which to implement policies that promote healthy body weight of children. The purpose of this study was to assess the effect of a wellness policy and training program on the physical activity and nutrition environment in 24 child care centers in Georgia.
  
  
  METHODS
  We used the Environment and Policy Assessment and Observation instrument to identify changes to foods served, staff behaviors, and physical activity opportunities. Observations were performed over 1 day, beginning with breakfast and concluding when the program ended for the day. Observations were conducted from February 2010 through April 2011 for a total of 2 observations in each center. Changes to nutrition and physical activity in centers were assessed on the basis of changes in scores related to the physical activity and nutrition environment documented in the observations. Paired t test analyses were performed to determine significance of changes.
  
  
  RESULTS
  Significant improvements to total nutrition (P < .001) and physical activity scores (P < .001) were observed. Results indicate that centers significantly improved the physical activity environments of centers by enhancing active play (P = .02), the sedentary environment (P = .005), the portable environment (P = .002), staff behavior (P = .004), and physical activity training and education (P < .001). Significant improvements were found for the nutrition environment (P < .001), and nutrition training and education (P < .001).
  
  
  CONCLUSIONS
  Findings from this study suggest that implementing wellness policies and training caregivers in best practices for physical activity and nutrition can promote healthy weight for young children in child care settings.
authors.affiliation: Institute of Public Health, Georgia State University, 856 Urban Life, Atlanta, GA 30303, USA. rlyn1@gsu.edu
authors.forename: Rodney
authors.initials: R
authors.lastname: Lyn
authors.forename: Joyce
authors.initials: J
authors.lastname: Maalouf
authors.forename: Sarah
authors.initials: S
authors.lastname: Evers
authors.forename: Justin
authors.initials: J
authors.lastname: Davis
authors.forename: Monica
authors.initials: M
authors.lastname: Griffin
mesh_terms: D002656:Child Day Care Centers / Q000592:standards* / Q000706:statistics & numerical data; D002675:Child, Preschool; D004032:Diet; D005260:Female; D005845:Georgia; D006291:Health Policy; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D009043:Motor Activity; D015588:Observer Variation; D017063:Outcome Assessment, Health Care