Examining Nutrition and Physical Activity Policies and Practices in Maryland's Child Care Centers.

Background: Child care settings provide opportunities for obesity prevention by implementing nutrition/physical activity best practices. This study examines how center policies, provider training, family education, and center demographics relate to best practices for nutrition/physical activity in Maryland's child care centers. Methods: A survey, including minor modifications to The Nutrition and Physical Activity Self-Assessment for Child Care (Go NAP SACC), was sent by e-mail to center directors statewide. Best practice sum scores (dependent variable) were calculated, including physical activity (17 items), feeding environment (18 items), and food served (19 items). Adjusted regression models analyzed the number of nutrition/physical activity policies, provider training topics, and family education opportunities related to best practice scores. Results: Response rate was 40% (n=610/1506) with 69% independent centers (vs. organization sponsored), 19% with Child and Adult Care Food Program (CACFP enrolled), and 50.2% centers with majority (>= 70%) Caucasian children and 16.8% centers with majority African American children. Centers reported 40.8% of physical activity best practices, 52.0% of feeding environment best practices, and 51.6% of food served best practices. Centers reported (mean) 7.9 of 16 nutrition/physical activity-relevant policies, 6.9 of 13 provider training topics, and 4.4 of 8 family education opportunities. Regression models yielded associations with best practices: policies and provider training with feeding environment (B=0.26, p<0.001; B=0.26, p=0.001, respectively); policies with foods served (B=0.22, p=0.002); and policies, provider training, and feeding environment with physical activity (B=0.19, p=0.001; B=0.24, p=0.010; B=0.38, p<0.001). Conclusions: Nutrition/physical activity best practices in child care are supported by specific policies, provider training, and family education activities.