However, more important than the actual

change in the amount of training available to staff was the development of a relationship between the child care centers and the local area health department. The NAP SACC materials were supplied to the child care centers through check details the local area health department and the child care centers worked closely with their consultants throughout the six month long process. Child care centers in rural areas often have difficulty in finding appropriate resources for training and education in nutrition and physical activity due to lack of available funding and geographical location. Therefore, discovering low cost ways to disseminate new information to child care centers regarding nutrition and physical activity or determining potential local collaborations with health agencies may be warranted. In addition, this relationship has the potential to impact the ability of these child care centers to meet nutrition and physical activity standards well beyond this intervention and the ability to assess it. Supplying centers with equipment and educational support may improve the center physical

environment however implementing written policies may assist in sustaining further desired behaviors. A focus on policy creates a supportive environment and provides incentives for positive behaviors (Sallis et al., 1998). The NAP SACC provides insights into current policy as well as environmental influences ROCK inhibitor on behavior (e.g., staff food choices, staff training, staff utilization of activity related equipment). As such, centers were also asked to focus on policies regarding nutrition and physical activity. While overall, child care centers in our study “exceeded recommendations” regarding nutrition and physical activity policies, unaffiliated centers significantly almost improved their nutrition

and physical activity policies and moved towards “far exceeding recommendations” regarding their physical activity policy. Seo and Lee (2012) indicated writing and following policies is important because sites that do not have strict policies regarding children’s eating and physical activity habits were more likely to have overweight/obese children. While no information was collected in our study regarding weight status of children, perhaps offering more detailed policies (e.g., children will spend at least 60 min outdoors) will provide an adequate stimulus to alter later physical activity behavior. While it may seem some of these changes detected are relatively small, a shift in how well a center accomplished a practice (e.g., scored 2 at the pre-test and 4 at post-test) improves the overall center environment and encourages healthy behaviors.