Improving the physical activity and nutrition environment through self-assessment (NAP SACC) in rural area child care centers in North Carolina.
OBJECTIVE
To determine if child care centers in rural, Western North Carolina met recommendations for nutrition and physical activity, if focusing on nutrition and physical activity practices and policies was effective in improving the center environment, and if differences existed between centers affiliated or unaffiliated with schools.


METHODS
Of 33 child care centers in three counties, 29 submitted mini-grant requests and participated in a pre-post evaluation using Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC). NAP SACC assesses compliance for nutrition and physical activity recommendations and standards. Between October 2011 and April 2012, centers participated in workshops and goal setting specific to nutrition and physical activity.


RESULTS
At baseline, over 95% of the centers met all recommendations. However, post-intervention, Wilcoxon Signed Ranks Test (p<0.05) indicated significant improvement across center types in five out of 37 nutrition and seven out of 17 physical activity standards following the intervention. Centers unaffiliated with schools made significant changes in ten nutrition standards, while those affiliated with schools improved in only two standards and decreased on one standard.


CONCLUSIONS
Overall, rural child care centers in Western North Carolina were meeting standards, they were still able to strengthen policies and practices by following NAP SACC. This was especially true for centers unaffiliated with schools. Continued financial support may assist centers in sustaining increased physical activity in children.
Appalachian State University, Department of Health, Leisure and Exercise Science, 111 Rivers Street, Boone, NC 28608, USA. Electronic address: battistara@appstate.edu.
Rebecca A
RA
Battista
Appalachian State University, Department of Health, Leisure and Exercise Science, 111 Rivers Street, Boone, NC 28608, USA.
Hillary
H
Oakley
Appalachian State University, Department of Health, Leisure and Exercise Science, 111 Rivers Street, Boone, NC 28608, USA.
Melissa S
MS
Weddell
Michigan State University, Department of Kinesiology, 308 W. Circle Drive, East Lansing, MI 48824, USA.
Lanay M
LM
Mudd
Appalachian District Health Department, 126 Poplar Grove Connector, Boone, NC 28607, USA.
J B
JB
Greene
Appalachian State University, Department of Health, Leisure and Exercise Science, 111 Rivers Street, Boone, NC 28608, USA.
Stephanie T
ST
West
D000818:Animals; D002654:Child Care / Q000592:standards*; D002656:Child Day Care Centers; D002675:Child, Preschool; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D009043:Motor Activity; D009657:North Carolina; D018673:Nutrition Policy; D009765:Obesity / Q000517:prevention & control*; D015397:Program Evaluation; D012424:Rural Population; D012574:Schools; D012647:Self-Assessment
Child care; Nutrition; Obesity; Physical activity; Rural health