title: Child Care Center Characteristics Associated With Preschoolers' Physical Activity.
abstract: BACKGROUND
  Despite children spending long hours in child care centers, it is unknown what center characteristics are associated with children's moderate to vigorous physical activity (MVPA) at the center and over the 24-hour day.
  
  
  METHODS
  Mixed model ANOVA evaluated associations between 23 center characteristics (e.g., policies, facilities, practices, and staff training) and time in MVPA, measured with accelerometers, at the child care center and over the 24-hour day among 388 preschoolers from 30 randomly selected child care centers in Cincinnati, Ohio. Data collection occurred from November 2009 through January 2011; data analyses occurred in 2012-2014.
  
  
  RESULTS
  Ninety percent of centers reported scheduling two or more outdoor sessions daily, yet only 40% of children had two or more outdoor sessions; 32% had no time outdoors. Eighty-three percent of centers reported scheduling ≥60 minutes outdoors; 28% of children experienced this during observation. Children spent a mean (SE) of 2.0 (0.06) minutes/hour in MVPA. Children with ≥60 minutes outdoor time had 0.6 minutes/hour more MVPA in child care (p=0.001), and 0.5 minutes/hour over the 24-hour day (p=0.001) than those who did not. Presence of an indoor play space, large outdoor playground, portable or fixed play equipment, staff PA training, weather and clothing policies, and TV/computer use were not related to children's MVPA.
  
  
  CONCLUSIONS
  Outdoor time occurred less frequently than scheduled. Children with ≥60 minutes of outdoor time at the center were more active than children without. Centers may increase preschoolers' PA by adhering to the scheduled ≥60 minutes of outdoor time daily.
authors.affiliation: Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio. Electronic address: kristen.copeland@cchmc.org.
authors.forename: Kristen A
authors.initials: KA
authors.lastname: Copeland
authors.affiliation: Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Jane C
authors.initials: JC
authors.lastname: Khoury
authors.affiliation: Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Heidi J
authors.initials: HJ
authors.lastname: Kalkwarf
mesh_terms: D061725:Accelerometry; D002656:Child Day Care Centers; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D009043:Motor Activity / Q000502:physiology*; D009820:Ohio; D010988:Play and Playthings; D013997:Time Factors; D014887:Weather