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Tribally Affiliated Child-Care Center Environment and Obesogenic Behaviors in Young Children

Published:December 04, 2016DOI:



      Child-care centers are an integral part of life for many families with young children. American Indian children are at elevated health risk because of higher levels of obesity and associated health behaviors.


      Our aim was to assess the child-care environment and children’s physical activity (PA) and dietary intake in young children attending tribally affiliated child care.


      We conducted a cross-sectional study.


      Participants were from 11 tribally affiliated child-care centers across Oklahoma and included 82 children aged 3 to 5 years old.

      Main outcome measures

      Classroom observations were conducted using the Environmental and Policy Assessment Observation to measure PA and nutrition environments. Children wore an ActiGraph GT3X accelerometer and lunchtime plate waste was observed.

      Statistical analyses

      Descriptive statistics, including mean±standard deviation and frequencies, were calculated for the children’s behaviors and environment.


      The total environment score was 23.9±5.2 (maximum=43). The nutrition score was 12.5±3.1 (maximum=21). The PA score was 11.7±2.2 (maximum=22). The participants were 3.8±0.1 years old, 55% were male, 67% were American Indian, and 38% were overweight or obese. Accelerometers were worn for 5.9±1.7 hours, excluding naptime. Children accumulated 4.3±2.2 min/h of moderate to vigorous PA, 4,294±1,883 steps/day, and 12.1±3.7 steps/min. At lunch, children were served 510±241 kcal, and consumed 387±239 kcal. Lunches consisted of 47% carbohydrate, 20% protein, and 33% fat. Total number of F/V served was 2.9±1.9 and consumed was 2.3±1.8, while whole grains served and consumed were 0.3±0.4 and 0.2±0.4, respectively, and lean proteins served and consumed were 0.3±0.4 and 0.2±0.4, respectively.


      This study describes obesogenic aspects of the child-care environment and identifies areas for improvement. Children did not accumulate adequate PA or consume calories or fat excessively. Children consumed multiple F/V; however, more whole grains and lean proteins could be provided. Future research might investigate how the healthfulness of the child-care environment can be improved by counseling providers on nutrition and PA strategies to prevent obesity.


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      S. B. Sisson is an associate professor, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City.


      S. H. Arnold is an associate professor, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City.


      B. DeGrace is an associate professor, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City.


      J. Stoner is a professor, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City.


      J. Li is a research biostatistician, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City.


      L. Stephens is an associate professor, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City.


      J. E. Campbell is an associate professor, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City.


      K. R. Lora is an assistant professor, Center for Public Health and Health Policy, University of Connecticut Health, Farmington.


      D. Horm is a professor, Early Childhood Education Institute, College of Education, University of Oklahoma-Tulsa.