Background
The NAP SACC pilot projectThe NAP SACC project was piloted May through December of 2003. The pilot intervention took place in eight counties across North Carolina (6 intervention and 2 control counties). The intervention counties were chosen based on their participation in the North Carolina Six-County Cardiovascular Health Survey. Two additional counties were included due to their partnership with one of the six target counties.History of the NAP SACC projectThe North Carolina Healthy Weight Initiative was created in October of 2000 through an obesity prevention grant to address childhood overweight by the Centers for Disease Control and Prevention. The Healthy Weight Initiative had three major components: 1) Planning for comprehensive nutrition and physical activity programs to prevent overweight and related chronic diseases in children and youth, 2) Implementation of a multi-level pilot intervention that targets preschool children and their families (NAP SACC), and 3) Enhancement of a statewide nutrition and physical activity surveillance system. In the Fall of 2002, the North Carolina Department of Health and Human Services released the state plan ‘Moving Our Children Toward a Healthy Weight—Finding the Will and the Way’. This state plan was a joint effort between NC DHHS, The Center for Health Promotion and Disease Prevention, the UNC-CH Institute of Nutrition, Wake Forest University Sch! ool of Medicine, North Carolina’s Turning Point, NC Department of Public Instruction, and North Carolina State University Cooperative Extension Service. The state plan, as well as the three major components of the Healthy Weight Initiative have played a pivotal role in North Carolina’s collaborative response to childhood overweight.Development of the NAP SACC self assessment instrumentThe NAP SACC self-assessment instrument was developed using the UNC-Chapel Hill Frank Porter Graham Child Development Center Early Childhood Environmental Rating System (ECERS) and Infant/Toddler Environmental Rating System (ITERS) child care center environmental assessment tools and the School Health Index as models. The research team evaluated and researched state and national nutrition and physical activity standards and recommendations for young children and child care. These recommendations and standards formed the basis of the NAP SACC self-assessment instrument. The research team also searched the literature to develop a list of key nutrition and physical activity indicators related to childhood overweight. In the absence of a recommendation or standard, the research team sought outside expert opinion. Prior to the pilot intervention, North Carolina experts in the fields of nutrition, physical activity, child care and child devel! opment reviewed the tool for accuracy, consistency and usability. An Advisory Group of local child care center staff and child health professionals also reviewed the tool and assisted researchers with the development of intervention materials. |
Inclusion and Exclusion Criteria
Child care centers in target counties had to meet eligibility requirements for participation. The centers needed to serve more than twenty but less than 150 children, participate in the Child and Adult Care Food Program (CACFP) (reimbursement program for meals that meet CACFP guidelines for low-income children in the center), and have 3, 4 or 5 stars on the North Carolina star rating system. For the pilot intervention, a convenience sample of child care centers (n=15) or control (n=4) group was chosen. Two to five child care centers per county were selected for the project. The child care center director and key center staff completed the NAP SACC self-assessment instrument at pre and post intervention periods. The Child Care Health Consultant (CCHC) then met with the center director to review the tool and select at least three areas for improvement over the course of the intervention. Together, the CCHC and center director developed an action plan to address nutrition and physical activity policies and practices in the center. CCHC worked with the centers over the next six months to improve and enhance the child care center environment. During the first two months of the intervention period, the CCHC facilitated three workshops for the child care center: Childhood Overweight, Healthy Eating, and Physical Activity. Each workshop was 30 minutes long and provided the center staff with continuing education credits from the North Carolina Division of Child Development. Data from the initial NAP SACC assessment instrument show insignificant differences between the intervention and control centers at baseline for overall score, nutrition score, and physical activity score. Both intervention and control centers improved on their NAP-SACC score at the end of the pilot intervention, however, greater change was observed in the intervention centers. Intervention centers increased an average of 13 points, while the control centers improved by an average of 8 points on the NAP-SACC instrument at follow-up. The NAP-SACC pilot intervention shows promise as an approach to improving nutrition and physical activity |