Environment And Policy Assessment And Observation Research Articles

Prevalence and influences of preschoolers' sedentary behaviors in early learning centers: a cross-sectional study.

BackgroundRecent research has highlighted the need for increased evidence regarding the sedentary activity levels of preschoolers. Given the large proportion of time this population spends in various early learning facilities, the exploration of sedentary behaviors within this particular environment should be a priority. The purpose of the study was two-fold: (1) to compare sedentary time of preschoolers in three different early learning environments (i.e., full-day kindergarten [FDK], center-, and home-based childcare); and (2) to assess which characteristics (i.e., staff behaviors, sedentary environment, fixed play environment, portable play environment, sedentary opportunities) of these early learning environments influence preschoolers’ sedentary time.MethodsData collection occurred between September 2011 and June 2012. Preschoolers’ sedentary time was measured using Actical™ accelerometers at a 15 s epoch. The Environment and Policy Assessment and Observation (EPAO) tool was used to assess the sedentary environment of participating early learning classrooms, and those subscales (n = 5) that were evidence-informed as potentially influencing sedentary time in early learning centers were explored in the current study. A linear mixed model ANCOVA was carried out to determine the differences in sedentary time based on type of early learning environment while direct entry regression analyses were performed to describe the relationships between sedentary time and the five sedentary-specific EPAO subscale.ResultsPreschoolers (n = 218) from 28 early learning programs (i.e., 8 FDK, 9 centre-, and 8 home-based childcare facilities) participated. Accelerometry data revealed that preschoolers attending centre-based childcare engaged in the highest rate of sedentary time (41.62 mins/hr, SD = 3.78) compared to preschoolers in home-based childcare (40.72 mins/hr, SD = 6.34) and FDK (39.68 mins/hr, SD = 3.43). The models for FDK, center-based childcare, and home-based childcare, comprised each of the five EPAO subscales accounted for 10.5 %, 5.9 %, and 40.78 % of the variability in sedentary time, respectively. Only the models for FDK and home-based childcare were found to be statistically significant (p < .05).ConclusionsThis is the first exploration of differences in sedentary time among preschoolers in different early learning arrangements. Findings highlight the substantial portion of the day preschoolers spend in sedentary pursuits, and subsequently, the ongoing need to reduce preschoolers’ sedentary time in early learning programs, particularly among those attending centre-based childcare facilities.

Environmental Influences on Preschoolers' Physical Activity Levels in Various Early-Learning Facilities

Purpose: This study aimed to: (a) compare the physical activity (PA) levels (i.e., moderate-to-vigorous PA [MVPA] and total PA [TPA]) of preschoolers in 3 different early-learning environments (center-based childcare, home-based childcare, and full-day kindergarten [FDK]); and (b) assess which characteristics (e.g., play equipment, policies, etc.) of these settings influenced preschoolers' PA. Method: Twenty-seven facilities (9 centers, 10 homes, and 8 FDK) participated in this study. Participants (aged 2.5–5 years; n = 297) were fitted with Actical™ accelerometers for 5 consecutive days during childcare/school hours to assess their PA. The Environment and Policy Assessment and Observation (EPAO) tool was used to objectively examine the PA environment of all participating facilities. Finally, demographic questionnaires were administered to preschoolers' parents/guardians. Results: Preschoolers in FDK accumulated significantly more MVPA (p < .05; 3.33 min/hr) than those in center- (1.58 min/hr) and home-based (1.75 min/hr) childcare, and they accumulated significantly more TPA (p < .05; 20.31 min/hr) than those in center-based childcare (18.36 min/hr). For FDK, the Active Opportunities, Sedentary Opportunities, Sedentary Environment, and Fixed Play Environment subscales of the EPAO significantly impacted both MVPA and TPA. For center-based childcare, only the Sedentary Environment subscale was found to impact MVPA and TPA. No subscales influenced children's MVPA or TPA in home-based childcare. Conclusions: This research underscores the need to encourage/support preschoolers' active behaviors in early-learning settings, particularly for those in center- and home-based childcare. Furthermore, this article highlights environmental and staff characteristics on which future PA programming should focus.

Preventing obesity in infants and toddlers in child care: results from a pilot randomized controlled trial.

Few interventions have focused on very young children for obesity prevention. This study evaluated a pilot intervention to improve the nutrition and physical activity environments of child care centers serving infants and toddlers. This randomized controlled trial took place in 32 centers in Boston, Massachusetts. The intervention aimed to improve policies and practices related to nutrition and physical activity within the center. For the outcome, observers assessed center environments using the Environment and Policy Assessment and Observation (EPAO) instrument (range 0-320 points) at baseline and the 6-month follow-up. We fit linear regression models with change in EPAO score from baseline to follow-up, controlling for potential confounders for total score, nutrition sub-score, and physical activity sub-score. Intervention centers had a mean (SD) of 98.2 (144.8) children enrolled, while control centers had 59.2 (34.5). In intervention centers, 47.5% of children were white, compared to 46.2% in controls. Fewer intervention centers had outdoor play areas on site (75 vs. 100%) but more had indoor play space (67 vs. 25%). At baseline, intervention centers had a mean (SD) EPAO score of 134.5 (7.0) points and controls had 146.8 (4.8) points. Compared with controls, intervention centers improved their EPAO scores at follow-up by 18.5 points (95% CI 0.1, 37.0; p = 0.049), chiefly through greater improvement in physical activity (12.2; 95% CI -1.6, 26.0; p = 0.075) and not nutrition (6.4; 95% CI -7.1, 19.8; p = 0.385). The pilot showed promise as an intervention to improve center environments, but future studies should include child-level outcomes.

Physical activity policies at childcare centers and impact on children's physical activity and screen‐time behaviors

This study evaluated the association between childcare center policies about physical activity (PA) and children's PA and screen‐time behaviors at 50 childcare centers. Data were collected in 2008–2009 using the Environment and Policy Assessment and Observation (EPAO) tool. Directors reported center PA policies (written, unwritten but general practice, no policy). Preschool children's PA and screen‐time behaviors were assessed via 4‐day observation at each center. Time spent per day in outdoor play, teacher–led PA, sedentary activities, and screen‐time were 67.7±33.6, 16.5±11.3, 52.2±28.8, and 39.7±47.9 minutes, respectively. Children engaged in more minutes of outdoor play at centers with a written policy about amount of active playtime; and a written/unwritten policy about amount of time spent outdoors. Written policies about amount of active playtime and time spent outdoors were also associated with more minutes of sedentary activity. Children engaged in more minutes of teacher‐led PA at centers with written policy about amount of time in teacher‐led activities. Children spent fewer minutes watching television and using computers at centers with written policies about such behaviors and written policy about staff supervision of media use. Results suggest that written and unwritten policies may be effective at increasing PA, but may be insufficient to help children achieve recommended levels of PA.

Interaction between physical environment, social environment, and child characteristics in determining physical activity at child care.

To investigate the association between the child-care environment and physical activity of 2- and 3-year-olds. Based on an ecological view of environmental influences on health behavior, we hypothesized that the social and physical environment, as well as child characteristics (age and gender), would show independent and interactive effects on children's physical activity intensity. Observations of physical activity intensity were performed among children (N = 175) at 9 Dutch child-care centers. Aspects of the child-care environment were assessed using the validated Environment and Policy Assessment and Observation (EPAO) Instrument. Multilevel linear regression analyses examined the association of environment and child characteristics with children's activity intensity. Moderation was tested by including interaction terms in the analyses, with subsequent post hoc analyses for significant interaction terms. Observed child physical activity intensity, measured with the Observational System for Recording Physical Activity in Children-Preschool Version. A large proportion of the observed activities were classified as sedentary, while far fewer observations were classified as moderate or vigorous. Activity opportunities in the physical environment (assessed using EPAO) and prompts by staff and peers were significantly and positively related to physical activity intensity, while group size was negatively related to activity intensity. The influence of the physical environment was moderated by social environment (peer group size), while the social environment in turn interacted with child characteristics (age and gender) in determining activity intensity. Our findings are in line with the ecological perspective regarding environmental influences on behavior, and stress the importance of incorporating the child-care environment in efforts to prevent childhood overweight and obesity.

Nutrition and Physical Activity in Child Care: Results from an Environmental Intervention

With evidence of increased levels of obesity in younger children, the child-care setting is an important intervention target. Few environmental interventions exist, and none target both diet and physical activity. The Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) intervention was developed to fill this research and practice gap. Randomized controlled. Health professionals (child-care health consultants) serving child-care centers in North Carolina were recruited (n=30), randomly assigned into intervention or delayed-intervention control groups, and trained to implement the NAP SACC program. Up to three child-care centers were recruited (n=84) from each consultant's existing caseload. Implemented in 2005, the NAP SACC intervention includes an environmental self-assessment, selection of areas for change, continuing education workshops, targeted technical assistance, and re-evaluation. Implementation occurred over a 6-month period. An observational instrument, Environment and Policy Assessment and Observation (EPAO), provided objective evidence of intervention impact and was completed by trained research staff blinded to study assignment. Data were collected in 2005 and 2006. Statistical analyses were conducted in 2006. Intention-to-treat analysis results were nonsignificant. Exploratory analyses using only centers that completed most of the NAP SACC program suggest an intervention effect. Factors in the intervention design, the fidelity of implementation, the selection of outcome measure, or a combination of these may have contributed to the lack of intervention effect observed. Because of this study's use of existing public health infrastructure and its potential for implementation, future studies should address strategies for improving effectiveness.

The Childcare Environment and Children’s Physical Activity

With increased numbers of children attending child care, this setting presents an ideal opportunity to promote physical activity and the early development of healthy behaviors. The purpose of this study was to examine the relationships between the childcare environment and physical activity behavior of preschool children. Aspects of the environment hypothesized to influence children's physical activity were assessed in 20 childcare centers using the Environment and Policy Assessment and Observation (EPAO) instrument. Physical activity behavior was assessed over 2 days using direct observation. Children in centers with supportive environments achieved more moderate-to-vigorous physical activity (15% of observations vs 9%; effect size [ES]=1.17), spent less time in sedentary activities (50% vs 61%; ES=-1.52), and had higher mean physical activity levels (2.68 vs 2.43; ES=1.41) compared to centers with less supportive environments. Facets of the physical and social environment related to physical activity behavior included active opportunities, portable play equipment, fixed play equipment, sedentary environment, and physical activity training and education. Previous research indicates that the childcare center that children attend significantly affects physical activity behavior. The current findings extend this evidence by identifying aspects of the childcare environment that relate to the physical activity behavior of children. These factors should be considered when identifying determinants of physical activity and designing interventions.