Conclusions
Child care centers are being utilized more frequently by many families. While centers are increasing in the numbers of children attending they are also being forced to comply with many state and federal guidelines. These guidelines often involve variables related to the nutrition and physical activity environment (e.g., foods served, time spent being active). Similar to schools, centers play an important role in the development of the child. The idea that the school environment is likely to influence childhood obesity is well accepted (Story et al., 2006). However, only recently have child care centers and their environments received similar consideration. With the relatively recent development and implementation of the NAP SACC Program, it may be too early to determine the long term impacts on child obesity. However, the continued significant improvements that are being made to child care centers have promise in addressing childhood obesity. Considering the NAP SACC was developed, based in part on the Social Cognitive Theory (Glanz et al., 2002) which emphasizes the environment and its influence on behavior, we are encouraged by the positive changes seen at the center level. Additionally, this study has shown that rural child care centers, particularly those unaffiliated with school districts, have room for improvement in the areas of physical activity and nutrition. In addition, our results support the need for resources to assist rural child care centers in making these improvements. These resources may be financial to allow equipment purchases or support providing consultants or workshops and may work best for centers not associated with schools as they tend to just meet recommendations versus more exceed or far exceed. Nonetheless, future research should focus on ways to continue to provide support for meeting recommended standards, such as providing staff training and parent educational opportunities. In addition, long term evaluation of the impact of the environment in the child care center on childhood obesity is warranted.