Preventing Chronic Disease | Insights and Implications for Health Departments From the Evaluation of New York City’s Regulations on Nutrition, Physical Activity, and Screen Time in Child Care Centers - CDC
Insights and Implications for Health Departments From the Evaluation of New York City’s Regulations on Nutrition, Physical Activity, and Screen Time in Child Care Centers
Cathy Nonas, MS, RD; Lynn D. Silver, MD; Laura Kettel Khan, PhD
Suggested citation for this article: Nonas C, Silver LD, Kettel Khan L. Insights and Implications for Health Departments From the Evaluation of New York City’s Regulations on Nutrition, Physical Activity, and Screen Time in Child Care Centers. Prev Chronic Dis 2014;11:130429. DOI: http://dx.doi.org/10.5888/pcd11.130429.
In 2006, the New York City Department of Health and Mental Hygiene, seeking to address the epidemic of childhood obesity, issued new regulations on beverages, physical activity, and screen time in group child care centers. An evaluation was conducted to identify characteristics of New York City child care centers that have implemented these regulations and to examine how varying degrees of implementation affected children’s behaviors. This article discusses results of this evaluation and how findings can be useful for other public health agencies. Knowing the characteristics of centers that are more likely to comply can help other jurisdictions identify centers that may need additional support and training. Results indicated that compliance may improve when rules established by governing agencies, national standards, and local regulatory bodies are complementary or additive. Therefore, the establishment of clear standards for obesity prevention for child care providers can be a significant public health achievement.
In 2006, New York City, seeking to address factors contributing to rising rates of childhood obesity, promulgated health code regulations for group child care centers on beverages, physical activity, and screen time. Although the regulations were grounded in scientific evidence, until now, no large-scale assessment of the effect of such regulations has been conducted.
It is interesting to examine the regulations, approved in 2006 and executed in 2007, from the vantage point of 2014. Much has changed. Since 2007, new Institute of Medicine guidelines were released that advocate similar guidelines for early child care centers (1). The federal Child and Adult Care Food Program (CACFP), in which 86% of the centers in our evaluation participated, adopted guidelines similar to the New York City regulations in 2009 (2). And Caring for Our Children, the 3rd edition of child care standards, released in 2010 by the American Academy of Pediatrics, the American Public Health Association, and the National Resource Center for Health and Safety in Child Care and Early Education (3), reduced the amount of juice per day to be given and recommended 1% or skim milk for children aged 2 years or older. This redundancy, in which a policy that is shown or expected to change behavior is reinforced by another, may be particularly important in health policy. Although one policy may help to improve health, greater consistency among the policies of regulators, payors, and expert bodies that affect the same population may have synergistic effects.
The articles in this collection present the findings of the multimethod evaluation of the impact of the 2006 regulations. The first data collection in late 2009 included 176 child care centers, and the second data collection included 110 of the original centers 6 months later. The centers were located in high-poverty neighborhoods in all 5 boroughs of the city. Most of the children were Hispanic or non-Hispanic black, aged 3 or 4 years. The first data collection (the Center Component) was for an evaluation at the center level and included interviews with the staff and direct observation of center-level characteristics, such as whether there was physical activity in the classroom curriculum plan or low-fat milk in the refrigerator. The second data collection (the Class Component) was for an evaluation at the classroom and child level and included direct observation of the classroom staff and child behavior, such as whether children drank water or were physically active for 60 minutes each day. A detailed description of the design and methods can be found elsewhere (3).
This project was funded by grant no. 65425 from the Robert Wood Johnson Foundation to the National Foundation for the Centers for Disease Control and Prevention (CDC). Technical assistance was provided by the CDC National Center for Chronic Disease Prevention and Health Promotion Division of Nutrition, Physical Activity, and Obesity. ICF International served as the lead contractor for the study in conjunction with the New York City DOHMH. Beth Dixon served as a consultant on the project. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC or any of the other project agencies.
Corresponding Author: Cathy Nonas, MS, RD, New York City Department of Health and Mental Hygiene, 42-09 28th St, CN-46, Queens, NY 11101-4132. Telephone: 347-396-4234. E-mail: firstname.lastname@example.org.
Author Affiliations: Lynn D. Silver, Public Health Institute, Oakland, California; Laura Kettel Khan, Centers for Disease Control and Prevention, Atlanta, Georgia.