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Objectives: We sought to determine the extent to which child care centers in South Carolina improved physical activity practices after a new policy took effect., Methods: In 2012, South Carolina adopted new mandatory physical activity standards within its child care quality enhancement program. This quasi-experimental study used North Carolina, a state not making policy changes, as the comparison. Participants were 34 child care centers in South Carolina and 30 centers in North Carolina. Researchers used the Environment and Policy Assessment and Observation (EPAO) tool to conduct center observations before and after policy implementation and then conducted repeated-measures linear regression with interaction between state and time for the Physical Activity Environment Total Score and the 8 subscale scores., Results: Compared with centers in North Carolina, EPAO subscale scores in South Carolina centers increased significantly for the Fixed Play Environment (P < .001) and Physical Activity Training and Education (P = .015). The state-by-time interaction of Physical Activity Environment Total Score approached statistical significance (P = .06)., Conclusions: Adoption of new physical activity standards in South Carolina child care centers was associated with improvements in practices aimed at increasing children's physical activity.

Despite the well-known benefits of youths engaging in 60 or more minutes of daily physical activity, physical inactivity remains a significant public health concern. The 2008 Physical Activity Guidelines for Americans (PAG) provides recommendations on the amount of physical activity needed for overall health; the PAG Midcourse Report (2013) describes effective strategies to help youths meet these recommendations. Public health professionals can be dynamic change agents where youths live, learn, and play by changing environments and policies to empower youths to develop regular physical activity habits to maintain throughout life. We have summarized key findings from the PAG Midcourse Report and outlined actions that public health professionals can take to ensure that all youths regularly engage in health-enhancing physical activity.

Objectives: We assessed the prevalence of regulatory noncompliance of licensed child care centers and identified factors associated with improved compliance., Methods: We analyzed 676 routine, unannounced reports of child care centers collected by the Connecticut Department of Public Health licensing specialists over a 2-year time period, included characteristics of centers, and created categories of regulations., Results: The sample included 41% of licensed child care centers. Of the 13 categories of regulations in the analyses, 7 categories (outdoor safety, indoor safety, indoor health, child and staff documentation, emergency preparedness, infant-toddler indoor health, and infant-toddler indoor safety) had regulations with center noncompliance greater than 10%. Playground hazard-free was the regulation with the highest frequency (48.4%) of noncompliance. Compliance with the regulation for 20 hours of continuing education per year for child care providers was the characteristic most frequently associated with regulations compliance., Conclusions: Efforts to support continuing education of child care providers are essential to improve and sustain healthy and safe early-care and education programs. Analyses of state child care licensing inspection reports provide valuable data and findings for strategic planning efforts.

Objectives: This study assessed outcomes for children when child care centers meet recommended care standards., Methods: Data from the NICHD Study of Early Child Care were used to examine the association between meeting standards for child-staff ratios, group sizes, caregiver training, and caregiver education and children's development at 24 and 36 months of age., Results: There were 5 major findings: (1) most classes observed did not meet all 4 recommended standards (compliance ranged from 10% at 6 months of age to 34% at 36 months of age); (2) linear associations were found between number of standards met and child outcomes, and this was more the case at 36 months than at 24 months of age: (3) there was no evidence of threshold effects; (4) children in classes that met more standards had better school readiness and language comprehension scores as well as fewer behavior problems at 36 months of age; and (5) child outcomes were predicted by child-staff ratio at 24 months and caregiver training and education at 36 months of age., Conclusions: Outcomes were better when children attended classes that met recommended child-staff ratios and recommended levels of caregiver training and education.

The American Public Health Association and the American Academy of Pediatrics recently published health and safety guidelines for child care centers. A survey was conducted to determine the extent to which practices in US child care centers are reflective of these guidelines. Compliance with 16 guidelines ranged from 19.5% to 98.6%, varied considerably by state, and was not consistently associated with selected center characteristics. Prevention efforts should focus on practices for which compliance is low and on those that have the greatest disease- and injury-reducing potential.

In 1988, we identified playground hazards at 58 child-care centers (CCCs) and intervened by showing the director the hazards and distributing safety information. In 1990, we evaluated the 58 intervention CCCs as well as 71 randomly selected control CCCs. Intervention centers had 9.4 hazards per playground; control centers had 8.0. We conclude that the intervention was ineffective.

Background: With 1.9 million US children cared for in organized group child care, the safety of these children is a public health concern. In the absence of federal policy, each state has developed its own day care safety regulations., Methods: After creating a set of 36 criteria from three sets of national guidelines, we assessed the safety regulations of 45 states. With a mailed survey of state day care regulatory personnel, we examined the processes of formulating and implementing safety policy in 47 states., Results: For 24 of the 36 items, more than half the states' regulations were below the criteria or failed to mention the topic. Most notable is the inattention to playground safety, choking hazards, and firearms., Conclusion: The uneven quality of regulations may be a reflection of a regulatory process that is fragmented, with many different groups sharing authority and with limited involvement of injury prevention specialists.

We identified 684 playground hazards in 66 child care centers despite regulations mandating that the grounds be hazard-free. Of 21 centers with less than or equal to 5 hazards, 42.9 percent reported a playground-related injury in the previous year; of 25 centers with 6-11 hazards, 52.0 percent reported a playground-related injury; and of 20 centers with greater than or equal to 12 hazards, 60.0 percent reported a playground-related injury. Climbing equipment greater than or equal to 6 feet tall generally had inadequate impact-absorbing undersurfacing and had over twice the rate of fall injuries as climbing equipment less than 6 feet.