title: Obesogenic environments in tribally-affiliated childcare centers and corresponding obesity rates in preschool children.
abstract: BACKGROUND
  Determine the relationship between obesogenic characteristics of childcare and child adiposity in tribally-affiliated centers in Oklahoma.
  
  
  METHODS
  The two-day Environment and Policy Assessment and Observation (EPAO) included a total environment (TE), nutrition (N), and physical activity (PA) score and took place in 11 centers across Oklahoma. Eighty-two preschool children (3-5 years) participated. Child height and weight were measured and overweight status (≥ 85th percentile for age and sex) was determined. Regression models, fit using Generalized Estimating Equations methodology to account for clustering by center were used and adjusted for center characteristics.
  
  
  RESULTS
  Participants were 3.8 (0.8) years old, 55% male, 67% American Indian (AI) and 38% overweight. A healthier TE and PA was associated with a reduced odds of overweight, which remained significant after adjusting for some center characteristics, but not all. A healthier TE, N, and PA was associated with lower BMI percentile, which remained significant after some center-level adjustments, but not all. Lower sedentary opportunity and sedentary time were no longer associated with reduced odds of overweight following adjustment. Lower opportunity for high sugar and high fat foods and minutes of active play were associated with reduced odds of overweight in some adjusted models.
  
  
  CONCLUSIONS
  Collectively unadjusted and adjusted models demonstrate that some aspects of a healthier childcare center environment are associated with reduced odds of overweight and lower BMI percentile in preschool children attending tribally-affiliated childcare in Oklahoma. Future research should examine the association of childcare and health behaviors and further explore the role of potential confounders.
authors.affiliation: Department of Nutritional Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
authors.forename: Susan B
authors.initials: SB
authors.lastname: Sisson
authors.affiliation: Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
authors.forename: Ji
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States; Oklahoma Shared Clinical and Translational Resources, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Stoner
authors.affiliation: Department of Nutritional Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
authors.forename: Karina R
authors.initials: KR
authors.lastname: Lora
authors.affiliation: Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
authors.forename: Janis E
authors.initials: JE
authors.lastname: Campbell
authors.affiliation: Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
authors.forename: Sandra H
authors.initials: SH
authors.lastname: Arnold
authors.affiliation: Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
authors.forename: Beth
authors.initials: B
authors.lastname: DeGrace
authors.affiliation: Early Chyildhood Education Institute, University of Oklahoma, Tulsa, OK, United States.
authors.forename: Diane
authors.initials: D
authors.lastname: Horm
authors.affiliation: Oklahoma Shared Clinical and Translational Resources, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States; Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States; American Indian Diabetes Prevention Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
authors.forename: Lancer
authors.initials: L
authors.lastname: Stephens
keywords: American Indian; Day care; Obesity; Preschool; Young children