Academic journal article Childhood Obesity

Evaluation of a Physical Activity Regulation for Child Care in Massachusetts

Academic journal article Childhood Obesity

Evaluation of a Physical Activity Regulation for Child Care in Massachusetts

Article excerpt

[Author Affiliation]

Sara E. Benjamin Neelon. 1 Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

Jonathan Finkelstein. 2 Division of General Pediatrics, Boston Children's Hospital, Boston, MA.

Brian Neelon. 3 Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC.

Matthew W. Gillman. 4 Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.

Address correspondence to: Sara E. Benjamin Neelon, PhD, MPH, RD, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, E-mail:


Preschool-aged children are largely inactive in child care.1-5 Research shows that children engage in less than the recommended 120 minutes of light, moderate, and vigorous physical activity (LMVPA) daily6 and that insufficient physical activity in child care settings may be a missed opportunity.7,8 Recommendations put forth by the Institute of Medicine (IOM) in Early Childhood Obesity Prevention Policies9 suggest that children should be provided with opportunities for 15 minutes per hour of LMVPA daily while in child care. This is equivalent to 120 minutes over an 8-hour day of care. A study of children in South Carolina, however, found that about half of child care centers met this IOM recommendation.4

In response, researchers and national organizations have proposed policy-based approaches to increase children's physical activity in child care.9-11 Child care programs are required by law to meet specific minimum health and safety standards of care unless they are legally exempt from state licensing. In the United States, regulation of child care programs is the responsibility of the individual state, and each has an agency responsible for oversight and enforcement. Cities and other municipalities also have the authority to regulate child care within their jurisdiction, unless preempted by the state. A number of states and cities have enacted new physical activity regulations for child care programs and 4 states and one city currently have regulations specifying a specific amount of physical activity for children daily.12 Despite this growing interest in establishing such policies, few have been formally evaluated to determine whether they increase children's physical activity or bring physical activity levels up to standards.

New York City implemented regulations for licensed group child care centers that required 60 minutes of LMVPA, with 30 minutes of those as structured physical activity each day, and limited screen time to no more than 60 minutes per day.13,14 The regulations were implemented in 2007 and researchers conducted a post-only (no baseline) assessment in 2009. Stephens et al.13 measured physical activity in a sample of 1352 preschool-aged children from 110 centers and found that 87% of the centers were compliant with the 60-minute physical activity regulation, 86% were compliant with the structured physical activity regulation, and 30% were compliant with the screen time regulation.13,14 Additionally, center compliance with the 60-minute physical activity regulation was positively associated with moderate to vigorous physical activity (MVPA) in children.13 Compliance with the structured physical activity or the screen time regulation was not associated with children's MVPA.13 Delaware also implemented a new physical activity rule requiring 20 minutes of MVPA for every 3 hours of care and less than 1 hour per day of screen time.15 After the rules took effect, Van Stan et al.16 assessed changes in provider knowledge before and after a state-sponsored training to facilitate compliance. …

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