Research brief
Nutrition and Physical Activity Self-assessment for Child Care (NAP SACC): Results from a Pilot Intervention

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Abstract

Objective

To determine the feasibility, acceptability, and reported impact of a nutrition and physical activity environmental intervention in child care.

Design

Self-assessment instrument completed pre- and post-intervention by randomly assigned intervention and comparison child care centers.

Setting

Child care centers in 8 counties across North Carolina.

Participants

A convenience sample of 19 child care centers (15 intervention and 4 comparison).

Intervention

Intervention centers completed the self-assessment instrument at baseline and then selected 3 environmental improvements to make over the 6-month intervention period with assistance from a trained NAP SACC Consultant.

Main Outcome Measure

Changes in pre- and post-intervention self-assesment of the nutrition and physical activity child care environment with additional process measures to evaluate project implementation, feasibility and acceptability.

Analysis

Comparison of pre- and post-test scores for the intervention group using a Wilcoxon signed-rank test and descriptions of environmental changes.

Results

Intervention centers rated themselves higher at follow-up than at baseline, and relative to comparison centers, reported a variety of environmental nutrition and physical activity improvements confirmed by research staff.

Conclusions and Implications

The NAP SACC pilot intervention shows promise as an approach to promote healthy weight environments in preschool settings. Additional evaluation of the project is needed using a greater number of centers and a more objective outcome measure.

Introduction

The prevalence of overweight among young children has risen at a steady and disconcerting pace, creating a serious public health concern.1, 2 Data from the 2003-2004 National Health and Nutrition Examination Surveys (NHANES) reported that 26.2% of 2-5 year olds were considered overweight or at risk for overweight.3 Even in childhood, overweight is associated with a myriad of deleterious health consequences that can include type 2 diabetes mellitus,4, 5 hypertension and hyperlipidemia,5, 6 early maturation, orthopedic problems, sleep apnea,7 and psychosocial stress.8 Overweight in youth tends to track into adulthood, causing overweight children to become overweight or obese adults.9 It is evident that overweight is a problem among preschool-age children, and intervention efforts are needed to mitigate this trend.

The association between nutrition, physical activity, and healthy weight among young children is well documented, although exact causes of childhood overweight are not known. Low levels of physical activity have been observed in children 3-5 years old, and sedentary activity (measured by TV time) and having a TV in the bedroom have been associated with risk of overweight.10, 11 Consumption of sugar-sweetened beverages and high-fructose corn syrup12, 13 may be contributors to the childhood overweight epidemic, as the increase in consumption shows a pattern consistent with the rise in overweight and obesity.14, 15, 16 In addition, maternal employment may increase the probability of a child being overweight.17

A greater proportion of children are now spending time in child care, and duration of time in care has increased, as well.18 Environmental influences are thought to be contributors to the recent increase in childhood overweight,19 and only a handful of studies have examined this issue in the child care environment. Healthy Start, a program designed to decrease cardiovascular risk in Head Start children, produced a significant decrease in the saturated fat content of menu items, as well as a decreased intake of saturated fat.20, 21 Another preschool intervention, focused on decreasing television viewing, found that educational sessions significantly reduced TV and video viewing in the intervention group.22 Hip-Hop to Health, Jr. evaluated an overweight prevention program in African American and Latino children in Chicago Head Start centers23 and found that 1 year postintervention, participants in the 14-week weight control intervention had a lower increase in mean body mass index (BMI) than children who received the general health intervention.24 This intervention, however, focused on delivery of a curriculum and was not an environmental intervention.

Although these studies provide guidance for future interventions, they also highlight the need to examine environmental influences on child weight. Child care has recently been cited as an important site for promoting healthy weight in children. The American Heart Association suggests that multicomponent preschool programs can be effective in promoting healthful behaviors and reducing heart disease risk.25 In addition, the American Dietetic Association’s recent position statement on nutrition standards for child care highlights 4 main areas of quality nutrition practices in child care, including meal plans, food preparation and food service, physical and emotional environment, and nutrition consultation and training.26 Child care centers are in a unique position to support and facilitate healthful eating and regular physical activity for young children and, as such, provide an opportunity for intervention.

This paper presents initial findings from an intervention, Nutrition and Physical Activity Self-assessment for Child Care (NAP SACC). The NAP SACC pilot study was designed to test the feasibility, acceptability, and self-reported environmental change of an intervention to improve the nutrition and physical activity environments in child care settings.

Section snippets

The NAP SACC Program

The goals of the NAP SACC program were to improve nutrition and physical activity policies and practices at the child care center and to enhance the overall center environment. The NAP SACC program was designed to allow child care centers to self-assess their nutrition and physical activity environments, select areas for improvement, and make environmental changes with the help of a local health consultant.

NAP SACC is a theory-based program that employs components of social cognitive theory

Self-assessment Results

Overall, the intervention group (n=13) increased an average of 12.84 points, whereas the comparison group (n=4) increased an average of 7.75 points on the pre- to post-self-assessment instrument (Table 3). The intervention group median (SD) total self-assessment score was 105.31 (5.25), which improved to 118.15 (6.03) after the intervention period (P < .001). The intervention group median baseline nutrition score was 70.08 (4.77), which improved to 77.15 (4.76) after the intervention period (P

Discussion

Although the prevalence of overweight is rising in preschool-age children, few interventions exist that currently address this important issue. The NAP SACC intervention was designed to improve the nutrition and physical activity environment through enhanced policies and practices at the child care center. Results of this pilot study suggest that the intervention centers improved their scores on the self-assessment instrument and made tangible nutrition and physical activity environmental

Implications for Research and Practice

Child care centers provide a unique opportunity for interventions to address and promote healthy weight in children, but environmental intervention efforts that target both nutrition and physical activity policies and practices are needed to support individual-level change. The NAP SACC program shows promise as a unique approach to address this issue and makes a valuable contribution to the growing body of literature on child healthy weight environments.

Ongoing NAP SACC research efforts include

Acknowledgments

This project was funded by the Division of Public Health, North Carolina Department of Health and Human Services. The authors would like to express thanks to research assistants Katie Giles and Kelly Buono for their assistance with data collection for this project.

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    This project was funded by the Division of Public Health, North Carolina Department of Health and Human Services.

    Continuing Education Questionnaire available at www.sne.org/ Meets Learning Need Codes for RDs and DTRs 8010, 9070, 3020, and 4150.

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