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Prev Chronic Dis. 2009 Jan;6(1):A11. Epub 2008 Dec 15.

Child care as an untapped setting for obesity prevention: state child care licensing regulations related to nutrition, physical activity, and media use for preschool-aged children in the United States.

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Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S 2nd St, Ste 300, Minneapolis, MN 55454, USA.



Child care is a potential setting for obesity prevention; 8.6 million preschool-aged children participated in child care in 2001. Each US state creates and enforces its own child care licensing regulations. We analyzed obesity-related child care licensing regulations of US states.


We downloaded state licensing regulations for children in child care centers (CCCs), small family child care homes (SFHs), and large family or group child care homes (LFGHs) in each state and the District of Columbia (collectively referred to as "states") in 2006 from national and state Web sites. We conducted a quantitative content analysis to identify 13 coding dimensions related to nutrition, physical activity, and media use.


We found variability among and within states. CCCs were the most heavily regulated and had the most specific regulations, followed by LFGHs. SFHs had the fewest and most general regulations. Just 2 states, Michigan and West Virginia, specified that CCC menus should be consistent with the Dietary Guidelines for Americans. Only 12 states had regulations that limited foods of low nutritional value in CCCs. Thirty-six states required that children have daily outdoor activity time in CCCs; only 9 states set specific minimum lengths of time that children should be outdoors each day. Eight states set quantified time limits on screen time per day or per week in SFHs.


Opportunities exist for strengthening state licensing regulations to prevent childhood obesity. The increasing prevalence of childhood obesity underscores the urgency for state policy efforts to create child care environments that foster healthful eating and participation in physical activity.

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