Impact of implementing improved nutrition and physical activity standards alone or with training in licensed child care settings in a low-income area of Los Angeles County

Background: In Los Angeles County (LAC), approximately 20% of 3-4 year old children are obese. Low-income families have higher rates, with the County's highest rate of child obesity found in the predominantly low-income area of south Los Angeles. Approximately 40% of children in LAC spend most of their day in licensed childcare centers (CCC). Improving nutrition and physical activity standards (NPAS) in childcare centers (CCC) may reduce early child obesity, although successful implementation of improved NPAS might require training for providers. Methods: Representative CCC from south LAC will be enrolled in this intervention study. All participants will be provided with NPAS plus written guidance for implementation. Intervention CCC will also receive training on the guidelines. Validated assessment tools published in the Nutrition and Physical Activity Self-Assessments for Child-Care (NAP SACC) will evaluate the quality of CCC nutrition and physical activity environments. Baseline and nine-month assessments will include both observational and CCC director self-administered assessments. Changes in scores will be compared between groups to determine additional effects of training. Expected Results: Control and intervention CCC are expected to show improvements in key nutrition and physical activity measures over the study duration, with intervention CCC expected to have a greater improvement. Discussion: This work is significant because of the obesity crisis and potential for NPAS in CCC to improve current and future health of participants. Determining the effect of training in addition to distribution of NPAS will help determine the level of support that CCC need when implementing NPAS.