Associations Between the Child Care Environment and Children’s In-Care Physical Activity and Sedentary Time

Abstract

Background

Child care centers are important for children’s behaviors.

Aims

To examine the cross-sectional associations between child care environmental characteristics and physical activity and sedentary time in children.

Methods

Participants were 124 toddlers and 118 preschoolers from 19 centers in Alberta and Ontario, Canada, in the supporting Healthy physical AcTive CHildcare setting (HATCH) study. In-care physical activity and sedentary time were assessed using Actigraph accelerometers. Child care environments, including structure (e.g., resources) and process (e.g., activities) quality, were measured using three instruments: (1) the Environment and Policy Assessment and Observation and (2) the Children’s Physical Environments Rating Scale, and (iii) the Movement Environment Rating Scale. Mixed models were performed to examine the associations between environmental characteristics and children’s sedentary time, light physical activity, and moderate-to-vigorous physical activity.

Results

A few structure quality characteristics related to child care policy and indoor environment were associated with higher physical activity and lower sedentary time in toddlers. The overall structure quality (B = 0.04; 95% CI [0.003, 0.08]) and process quality (B = 0.08; 95% CI [0.02, 0.15]) of the child care environment were associated with log moderate-to-vigorous physical activity in preschoolers. Specifically, structure quality characteristics of the outdoor environment and physical activity time, and process quality characteristics relevant to curriculum and pedagogy, were associated with higher physical activity and lower sedentary time in preschoolers.

Discussion and Conclusion

The child care structure quality characteristics that are important for children’ physical activity and sedentary behavior may vary by age group. Improving the overall process quality, in particular curriculum and pedagogy, of the child care environment, may promote more physical activity in preschoolers.

Keywords

child care ECEC environment movement behavior preschoolers toddlers

Being physically active in early childhood is important for healthy growth and development. Evidence suggests that physical activity in children younger than 5 years is positively associated with motor and cognitive development, psychosocial and cardiometabolic health, fitness, and bone and skeletal health (Carson et al., 2017). Conversely, young children’s prolonged sedentary behavior, particularly screen-based sedentary behavior, may be detrimental to motor and cognitive development, psychosocial health, and fitness (Poitras et al., 2017). As levels of physical activity and sedentary behavior in early childhood can be tracked during childhood (Jones et al., 2013), and even into adulthood (Tammelin et al., 2014), it is crucial to help young children establish a habitually physically active and less sedentary lifestyle.

Settings where children frequently spend time influence their physical activity and sedentary behavior (Kurka et al., 2015). More than 90% of preschoolers (3–5 years) regularly attend child care in a majority of Organisation for Economic Co-operation and Development (OECD) countries (OECD, 2019). Although younger children aged 0 to 2 years have lower attendance rates (~32%), those who attend child care spend an average of 30 hours per week in these settings (OECD, 2019). Given this high attendance rate and the fact that young children spend a significant amount of time in child care centers, these settings are an important environment for promoting physical activity and reducing sedentary behavior in young children.

It has been suggested that up to 43% of the variation in young children’s physical activity levels can be explained by the child care environment (Pate et al., 2004). It is therefore important to assess the quality of the child care environment with regard to young children’s physical activity. The quality of the child care environment is multidimensional (Siraj et al., 2017; Slot, 2018). One dimension that has frequently been examined regarding physical activity and sedentary time is structure quality. This includes the resources used in the provision of care and is partly determined by legislation, policy, and funding (Siraj et al., 2017; Slot, 2018). For example, presence of play equipment, presence of sedentary items (e.g., television, computer), features of indoor spaces (e.g., size, suitability of the play space) and outdoor spaces (e.g., size, surface, shade), physical activity time, outdoor playtime and screen time, educator qualification and training, and written policies have previously been examined (Tonge et al., 2016). Findings for most of these environmental characteristics were null or inconsistent, with the exception of outdoor space (presence and larger size), which has consistently been associated with more physical activity and less sedentary time in preschoolers (Hesketh & van Sluijs, 2016; Tonge et al., 2016).

Another dimension of the child care environment is process quality. This includes the social, emotional, physical, and instructional aspects of the educator-child and peer-child interactions while being involved in play, activities, and routines (Siraj et al., 2017; Slot, 2018). Although these environmental characteristics play an integral role in children’s behaviors and development, they have been examined to a lesser extent than characteristics of structure quality, with regard to physical activity and sedentary behavior (Zhang et al., 2019). Therefore, a comprehensive measure of both structure and process quality of the child care environment is needed to further explore their associations with physical activity and sedentary behaviors in young children.

A number of studies have assessed the child care environment using the Environment and Policy Assessment and Observation (EPAO) instrument (Bower et al., 2008; Brown et al., 2009; Dowda et al., 2009; Hesketh & van Sluijs, 2016; Peden et al., 2017; Vanderloo et al., 2014). Although this instrument provides a comprehensive measure of the physical environment, practices, and policies of child care settings, the evaluations primarily focus on structure quality (Ward et al., 2008). Using complementary tools that focus on the structure quality related to the built environment and the process quality to simultaneously evaluate the child care environment would provide a comprehensive understanding of environmental associations with young children’s physical activity and sedentary behavior. Moreover, previous findings in this area have been mostly derived from preschoolers (Tonge et al., 2016); these associations in toddlers are relatively unknown. Given the developmental differences between toddlers and preschoolers (Cliff et al., 2009; Fees et al., 2015), it is likely appropriate to examine these associations separately for each age group.

The present study aimed to address current gaps in the literature by comprehensively examining the associations between environmental characteristics and physical activity and sedentary time in toddlers and preschoolers. To assess both structure and processes quality of the child care environment, three validated environmental tools were used, including the EPAO instrument (2017 version), and two other early-childhood environment rating scales: the Children’s Physical Environments Rating Scale (revised version 5; CPERS5; Moore, 2008; Moore & Sugiyama, 2007) and Movement Environment Rating Scale (MOVERS; Kazmierska-Kowalewska et al., 2020; Siraj & Archer, 2017).

Methods

Study Design and Participants

Baseline data from the supporting Healthy physical AcTive CHildcare setting (HATCH) study were analyzed in the present study. HATCH is a 6-month quasi-experimental pre–post design study, which aimed to determine the immediate physical activity, sedentary time, and health benefits of the new Alberta Childcare Accreditation Program Quality Standard. Eligible child care centers were those licensed with full-time toddler and preschooler programs and located in or around Edmonton, Alberta, and Ottawa, Ontario, Canada. Centers in Alberta were also required to be starting the accreditation process. Twelve (out of 18) accreditation centers in Alberta and eight (out of 42) control centers in Ontario, respectively, agreed to participate. All centers were located in urban areas. A higher participation rate for accreditation centers compared with control centers could be due to the fact that participation in the study may be helpful when working through the accreditation process. One center in Edmonton dropped out after baseline data collection for unknown reasons, and their data were excluded.

Children aged 19 to 60 months at baseline were eligible to participate in the study if they attended the child care centers full-time and were not expecting to change child care arrangements during the HATCH study. Children less than 19 months of age were ineligible as they usually attend infant programs in Canada. A total of 269 children’s parents agreed to participate (Edmonton: 141; Ottawa: 128), resulting in a participation rate of 47% (Edmonton: 67%; Ottawa: 36%). Of these, 16 children were ineligible due to age (n = 7), part-time attendance (n = 7), or because they were leaving the center (n = 2). The remaining 253 children were eligible. Baseline data used in this study were collected between October and December in 2017 (nine centers) and 2018 (10 centers), respectively. For child care centers in Edmonton, baseline data collection occurred before the implementation of the new accreditation standard (Carson et al., 2020; Government of Alberta, 2017). Ethics approval was obtained from a review committee on the protection of human participants. Written informed consent were provided by parents/guardians of all participants and all child care center directors.

Measures

Outcome Variables

Levels of physical activity and sedentary time were objectively assessed using ActiGraph WGT3X-BT accelerometers (Pensacola, FL, USA), which have established validity and reliability in toddlers and preschoolers (Janssen et al., 2013; Trost et al., 2012). For 6 consecutive weekdays (excluding the weekend), children wore the accelerometer on their right hip on their arrival at the child care centers until it was removed before their daily departure. After the accelerometers were collected, data were downloaded in 15-second epochs to capture the sporadic and intermittent activity pattern of young children (Janssen et al., 2013). Nonwear time was flagged as ≥20 minutes of consecutive minutes of zero counts and removed from analyses (Esliger et al., 2005). Daytime naps were assumed to be removed with nonwear time. In line with previous child care studies (Carson et al., 2015; Pate et al., 2004; Trost et al., 2003), participants needed to have at least ≥1 hour of wear time on ≥3 days to be considered as having valid data for the present study. The following cut-points validated in this age-group were used: sedentary time (≤25 counts/15 seconds), light physical activity (LPA, 26–419 counts/15 seconds), and moderate-to-vigorous physical activity (MVPA, ≥420 counts/15 seconds; Janssen et al., 2013; Trost et al., 2012). The average minute per hour for each of these behaviors was calculated to account for the variability in daily child care attendance.

Exposure Variables

Due to logistical reasons, environmental observations occurred simultaneously with accelerometer data collection in nine centers in Edmonton and surrounding areas but only one center in Ottawa and surrounding areas. Child care environment, including structure and process quality, were objectively assessed using three validated environmental rating instruments: EPAO (Ward et al., 2008), CPERS5 (Moore, 2008; Moore & Sugiyama, 2007), and MOVERS (Kazmierska-Kowalewska et al., 2020; Siraj & Archer, 2017). The completion of EPAO requires a full-day observation in the child care center as well as document review (Ward et al., 2008), while the completion of CPERS5 requires around 1 hour (Moore, 2008), and the completion of MOVERS requires one session (a morning or afternoon) lasting 3 to 4 hours (Siraj & Archer, 2017). Following these requirements, two independent researchers assessed two child care centers using these three instruments in the prestudy training, until each inter-rater agreement was above 85% for all instruments (85.2% for EPAO and MOVERS, 96.2% for CPERS5). Then, in the present study, one of the trained researchers concurrently completed 1-day observations (a typical day at the center with regular daily routines and program schedules) using these instruments within each center. Since the EPAO instrument has only been validated in preschool-aged children (Ward et al., 2008; Ward et al., 2015), a decision was made that observations using the three instruments would be focused on rooms and areas used by preschoolers. If there was more than one preschool room (n = 5), the one with the oldest children was selected.

The physical activity component of the EPAO instrument (version 2017) was used in the present study to assess the structure quality of the child care environment. This component is composed of 13 subcomponents, distributed into three areas (1) physical activity, (2) screen time, and (3) outdoor play and learning (Table 1). As recommended by the instrument manual for data processing, all item responses were converted to several variables assessing compliance with physical activity best practice. Each best practice variable is scored on a 4-point scale (0–3), with higher scores indicating closer compliance with best practice. Relevant best practice variables were then aggregated to produce an average score for each subcomponent, ranging from 0 to 3. These subcomponent scores were combined to produce an overall physical activity score, with a possible maximum of 39 points. The 2017 version of the EPAO is a slightly modified version of the original EPAO. The mean agreement between observer pairs has been reported as 87.3% and 79.3% for the observation and document review, respectively, in child care centers within a 3- to 5-year-old classroom for the original EPAO (Ward et al., 2008).

Table 1.

Descriptive Characteristics at the Center Level (n = 19).

Characteristics	Description	M ± SD
Weather
Temperature (°C)	—	−2.74 ± 5.35
Precipitation (mm)	—	1.27 ± 1.49
EPAO instrument subscales scores
Physical activity
1. Time provided for physical activity	Total amount of indoor, outdoor physical activity playtime, teacher-led physical activity time, and length of seated time at one time	2.07 ± 0.52
2. Indoor play equipment	Space for indoor play, availability of portable paly equipment, teacher offer portable play equipment during indoor free play, and posters and books to promote physical activity	2.41 ± 0.33
3. Daily physical activity practices	Physical activity withheld for longer than 5 minutes, teacher role during playtime, teachers incorporate physical activity in classroom routines, and transitions	1.98 ± 0.58
4. Physical activity education and professional development	Formal child physical activity education, teachers talk with children about the importance of physical activity, teacher training on physical activity, and parent education on physical activity	0.68 ± 0.46
5. Physical activity policy	Physical activity policy	1.63 ± 0.50
Screen time
6. Screen time	Availability of televisions, amount of screen time, television/video program is educational and commercial free, and alternate activity offered during screen time	2.76 ± 0.54
7. Daily screen time practices	Screen time used as a reward and teachers engage with children during screen time	2.92 ± 0.34
8. Screen time education and professional development	Teacher training on screen time and parent education on screen time	0.50 ± 0.62
9. Screen time policy	Screen time policy	0.42 ± 0.69
Outdoor play and learning
10. Outdoor playtime	Occasions of outdoor playtime, amount of outdoor playtime, and types of activities outdoors	1.26 ± 0.65
11. Outdoor play environment	Amount of shaded space, open, outdoor area available, number of outdoor play spaces, garden present, path for wheeled toys, shape of path for wheeled toys, connectivity of path for wheeled toys, outdoor portable play equipment, portable play equipment offered to children during outside play, and amount of portable play equipment available outdoors	1.71 ± 0.18
12. Outdoor play education and professional development	Teacher training on outdoor play and learning and parent education on outdoor play and learning	0.92 ± 0.53
13. Outdoor paly policy	Outdoor play and learning policy	2.00 ± 0.58
Overall physical activity scores	Overall score of the physical activity component.	21.28 ± 1.88
MOVERS subscale scores
Curriculum, environment, and resources for physical development	(1) arranging environmental space to promote physical activity, (2) providing resource including portable and /or fixed equipment, (3) gross motor skill, and (4) body movement to support fine motor skills	4.11 ± 1.17
Pedagogy for physical development	(5) staff engaging in movement with children indoors and outdoors, (6) observation and assessment of children’s physical development indoor, and (7) planning for physical development indoors and outdoors	3.30 ± 1.31
Supporting physical activity and critical thinking	(8) supporting and extending children’s movement vocabulary, (9) encouraging sustained shared thinking by communicating and interacting through physical activity, and (10) supporting children’s curiosity and problem-solving indoors and outdoors	2.74 ± 1.06
Parents/carers and staff	(11) staff inform families about children’s physical development and the benefits to their learning, development, and health	2.74 ± 1.52
Total mean score	Mean score of the MOVERS subscales	3.39 ± 1.07
CPERS5 subscale scores
Part C: Indoor spaces
Modified open-plan space	Protection from noise distractions; easy modification, visibility for other activities, separation between noisy activities and quiet activities, separation between messy activities and clean activities, and connections between indoor children’s spaces	2.28 ± 0.54
Home bases	Area for children’s personal belongings, eating area, quiet sleeping area, diapering area, toilet-training area, toilet area, facilities location, and facilities connection to indoor spaces	2.52 ± 0.38
Quite activity areas	Reading area, manipulative (fine motor) play area, computer area	0.51 ± 0.22
Physical activity areas	Physical (gross motor) area, music area, and dramatic/fantasy play area	2.19 ± 0.44
Messy activity areas	Arts and crafts studio, water play area, and science and nature area	2.41 ± 0.47
Part D: Outdoor areas
Play yards (functional needs)	Sunny and shady areas, mobility for children using wheelchair or crutches, open and largely flat areas, accessible storage room for outdoor equipment, sandpit, and roofed outdoor areas	2.04 ± 0.63
Play yards (developmental need)	Provision of enough diversity (variety of surfaces for different types of play), provision of both large and small areas for play, space for social and fantasy play, smaller areas with friendly feelings, safe and challenging contours to play on, secret or retreat places, gardens that children help maintain, and outdoor water play area	1.96 ± 0.70
Location and site	Visible location, entrances that are easy to find, far away from noxious elements, easy access to public transportation, within–walking distance park and other natural features, safe access to the parent parking area, accessibility to wheelchairs and strollers, adequate fencing, natural features, natural light, and outdoor area noise	2.14 ± 0.46

Note. MOVERS = Movement Environment Rating Scale; EPAO, Environment and Policy Assessment and Observation (2017 version); CPERS5 = Children’s Physical Environments Rating Scale (revised version 5).

The complete CPERS5 assesses the structure quality of the child care environment, specifically the architecture and built environment (Moore, 2008; Moore & Sugiyama, 2007). The scale can be divided into four parts—in the present study, only Part C (assessing each module and spaces in which children spend most of their time) and Part D (evaluating the outdoor activity areas around the building and surrounding conditions) were used (Table 1). Each of these subscales is composed of several items or descriptors of environmental characteristics. Each item was scored on a 5-point scale (0–4), and an average score was computed for each subscale, which can be interpreted as 0.00–1.00 = poor, 1.01–2.00 = fair, 2.01–3.00 = good, and 3.01–4.00 = excellent. Previous research has reported that the inter-rater reliability for each subscale in Part C and Part D ranges between a Cronbach’s generalizability coefficient G of 0.74 and 0.96. Additionally, experts’ assessment for content validity indicate a very high degree of expert support for the subscales and for the individual items (Moore & Sugiyama, 2007).

The MOVERS assesses environment supporting children’s physical development and movement, with focuses on process quality, including pedagogy, children’s physical experience, and educators’ practices (Siraj & Archer, 2017). The scale is composed of 11 items, which are distributed into four subscales (Table 1). Each item consists of several indicators and is rated on a 7-point scale: 1 = inadequate, 3 = minimal, 5 = good, and 7 = excellent, with midpoint scores of 2, 4, and 6. Achieving a score for an item requires meeting all indicators at this level and lower levels. The score of each item were computed to an average score for each subscale and a total mean score. The MOVERS has good test–retest reliability (intraclass correlation coefficient = 0.96; weighted Kappa = 0.91; percentage agreement = 69%–100%) and internal consistency (Cronbach’s α = .94), as well as good concurrent validity (Spearman’s ρ = 0.57–0.87; Kazmierska-Kowalewska et al., 2020).

Covariates

Age and sex

Child’s age and sex were assessed using the HATCH parental questionnaire. Age was calculated in months based on the reported birth date and the first accelerometer data collection date.

Weather

Since evidence suggests that young children in Canada may be more physically active in warmer months (Carson et al., 2010), weather variables were considered as covariates. Based on information recorded from the Environment Canada website, for each center, daily temperature was calculated as an average of maximum and minimum temperature during the day, and a mean daily temperature during the 6 accelerometers-wearing days were calculated. Mean precipitation was also calculated as an average of daily total precipitation during the 6 days.

Center location

In the present study, since child care centers were in two sites (Alberta, Ontario), center location was considered as a covariate.

Statistical Analysis

Statistical analyses were performed using SPSS version 24.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics, including means and standard deviations or percentages, were calculated at the individual and center level.

Although children are typically chronologically classified as toddlers (19–35 months) and preschoolers (36–60 months) in Canadian child care settings, child care centers can separate children based on individual developmental differences. In the participating child care centers, the center’s decision to assign a child to toddler room or preschooler room can also be based on the child’s biological and cognitive maturity level. For instance, a toddler-aged child may have been brought to a preschool room if they exhibited an equivalent level of maturity to the children in the older age-group. Considering that the exposure variable was child care environment in the current study, children were grouped as toddlers or preschoolers, according to the main room (i.e., toddler room or preschooler room) where they primarily stayed in the child care center.

The differences in individual descriptive characteristics between toddlers and preschoolers were assessed using two-tail Student t test, Mann–Whitney U test, or chi-square test. The average minute per hour that toddlers and preschoolers spent in sedentary time, LPA, and MVPA were checked for outliers according to prespecified criteria (Hoaglin & Iglewicz, 1987); two outliers were found in preschoolers’ MVPA. The assumptions of the mixed models for sedentary time, LPA, and MVPA in toddlers and preschoolers were assessed by visual examination of residuals. Data of MVPA in preschoolers were log transformed to meet assumptions of normality. No outliers existed after this transformation. The associations between child care centers environmental characteristics and children’s sedentary time, LPA, and MVPA were examined using linear mixed models, for toddlers and preschoolers, respectively. Models were adjusted for center clustering effects and covariates including age, sex, mean temperature, mean precipitation, and center location. Sensitivity analyses were further performed for chronologically aged toddlers (19–35 months) and preschoolers (36–60 months). Significance was set at p < .05.

Results

Of the 253 eligible children, 242 (toddler: n = 88; preschooler: n = 154) had valid accelerometer data and were included in the analytic models. There were no significant differences in age and sex between included children (n = 242) and excluded children due to invalid wear time (n = 11). Descriptive characteristics at the center level and the individual level are presented in Tables 1 and 2, respectively. In the sensitivity analysis of the chronologically aged sample, there were 124 toddlers (37 in preschooler rooms) and 118 preschoolers (1 in toddler room), and similar individual-level descriptive characteristics were found (Supplemental Table S1).

Table 2.

Descriptive Characteristics at the Individual Level.

Characteristics	Toddlers (n = 88)	Preschoolers (n = 154)	p
Age (months)	26.70 ± 4.87	40.52 ± 7.68	<.001
Sex (% boys)	50	51.9	.771
Sedentary time (min/h)	32.30 ± 5.13	31.72 ± 4.45	.088
LPA (min/h)	22.03 ± 3.96	21.38 ± 2.96	.003
MVPA (min/h)	5.67 ± 1.95	6.89 ± 2.47	<.001
Accelerometer wear time (h)	6.28 ± 1.49	6.59 ± 1.51	.121
The number of valid days	5.01 ± 1.05	5.52 ± 0.86	<.001

Note. Continuous data (age, sedentary time, LPA, MVPA, and accelerometer wear time) are presented as mean ± standard deviation. The differences between toddlers and preschoolers in age, sedentary time, and LPA were examined using Student t test, the difference in MVPA were examined using Mann–Whitney U test, and the difference in sex percentage were examined using Pearson chi-square test. Bold font denotes statistical significance (p < .05). LPA = light physical activity; MVPA = moderate-to-vigorous physical activity.

The associations between EPAO-, CPERS5-, and MOVERS-assessed environmental characteristics and physical activity and sedentary time in toddlers and preschoolers are presented in Tables 3, 4, and 5, respectively. Similar results were found in the sensitivity analysis in chronologically aged children (Supplemental Tables S2–S4). Despite many null results, structure quality characteristics relevant to child care policy, including “screen time policy” and “outdoor play and learning policy” (Table 3), and an indoor environmental characteristic “modified open-plan space” (Table 4), were positively associated with physical activity and/or negatively associated with sedentary time in toddlers. Conversely, “daily physical activity practices” was negatively associated with LPA (Table 3).

Table 3.

Associations Between Child Care Environment Characteristics (EPAO Instrument) and Physical Activity and Sedentary Time in Young Children.

EPAO instrument subscale scores	Toddlers (n = 88)						Preschoolers (n = 154)
	Sedentary time		LPA		MVPA		Sedentary time		LPA		MVPA
	B [95% CI]	p	B [95% CI]	p	B [95% CI]	p	B [95% CI]	p	B [95% CI]	p	B [95% CI]	p
Physical activity
Time provided for physical activity	1.04 [−2.91, 4.99]	.572	−0.58 [−3.52, 2.35]	.667	−0.08 [−0.35, 0.19]	.531	−1.58 [−3.93, 0.77]	.168	0.64 [−1.28, 2.56]	.483	0.13 [0.03, 0.24]	.011
Indoor play equipment	−0.54 [−7.04, 5.96]	.857	0.66 [−4.12, 5.44]	.766	−0.06 [−0.51, 0.40]	.786	0.28 [−3.92, 4.48]	.890	−1.14 [−4.30, 2.03]	.453	.11 [−0.13, 0.35]	.338
Daily physical activity practices	2.71 [−0.10, 5.53]	.057	−2.54 [−4.28, −0.80]	.009	0.005 [−0.23, 0.24]	.964	−0.76 [−3.04, 1.53]	.491	0.60 [−1.14, 2.35]	.471	0.05 [−0.09, 0.19]	.443
Physical activity education and professional development	0.36 [−4.73, 5.45]	.880	0.62 [−3.13, 4.37]	.724	−0.27 [−0.57, 0.03]	.074	−1.38 [−4.61, 1.86]	.378	1.00 [−1.49, 3.49]	.404	0.06 [−0.13, 0.26]	.501
Physical activity policy	−2.15 [−7.40, 3.09]	.392	0.67 [−3.33, 4.68]	.722	0.26 [−0.08, 0.60]	.123	0.28 [−2.79, 3.35]	.849	−0.24 [−2.59, 2.10]	.827	0.02 [−0.17, 0.20]	.837
Screen time
Screen time	2.02 [−1.49, 5.54]	.221	−1.05 [−3.75, 1.66]	.400	−0.18 [−0.41, 0.05]	.114	1.62 [−0.72, 3.95]	.161	−1.25 [−3.03, 0.52]	.153	−0.05 [−0.20, 0.10]	.493
Daily screen time practices	0.06 [−6.36, 6.48]	.984	−0.04 [−4.84, 4.77]	.987	−0.03 [−0.48, 0.42]	.897	1.26 [−3.59, 6.11]	.603	−1.65 [−5.06, 1.76]	.332	0.02 [−0.32, 0.36]	.908
Screen time education and professional development	−0.27 [−4.67, 4.12]	.895	0.93 [−2.27, 4.14]	.536	−0.17 [−0.45, 0.11]	.211	−0.09 [−2.66, 2.48]	.942	0.48 [−1.47, 2.43]	.605	−0.06 [−0.21, 0.10]	.455
Screen time policy	−3.18 [−6.08, −0.28]	.034	2.69 [0.69, 4.69]	.012	.08 [−0.16, 0.31]	.507	1.18 [−0.73, 3.10]	.206	−0.85 [−2.34, 0.63]	.239	−0.07 [−0.19, 0.04]	.172
Outdoor play and learning
Outdoor playtime	2.40 [−0.97, 5.78]	.146	−2.03 [−4.43, 0.37]	.089	−0.06 [−0.32, 0.20]	.618	−2.42 [−4.05, −0.80]	.007	1.52 [0.11, 2.93]	.036	0.14 [0.04, 0.24]	.005
Outdoor play environment	0.30 [−5.63, 6.20]	.916	−0.56 [−4.91, 3.79]	.784	0.10 [−0.31, 0.51]	.612	0.08 [−3.51, 3.68]	.961	−0.34 [−3.08, 2.40]	.794	0.07 [−0.14, 0.28]	.507
Outdoor play and learning education and professional development	0.66 [−3.31, 4.64]	.719	−0.33 [−3.27, 2.61]	.807	−0.10 [−0.37, 0.16]	.407	−2.10 [−4.30, 0.11]	.060	1.93 [0.35, 3.50]	.020	0.02 [−0.13, 0.17]	.764
Outdoor play and learning policy	−2.48 [−5.91, 0.95]	.134	1.15 [−1.58, 3.88]	.361	0.24 [0.03, 0.44]	.030	0.05 [−2.43, 2.54]	.963	−0.27 [−2.17, 1.63]	.762	−0.001 [−0.15, 0.15]	.989
Overall physical activity scores	0.37 [−1.07, 1.82]	.580	−0.28 [−1.34, 0.79]	.582	−0.03 [−0.13, 0.07]	.488	−0.56 [−1.40, 0.37]	.167	0.28 [−0.39, 0.96]	.383	0.04 [0.003, 0.08]	.036

Note. Models were adjusted for age, sex, mean temperature, mean precipitation, whether belonging to the accreditation groups or not, and clustering effects of child care centers. MVPA for preschoolers were log transformed. Bold font denotes statistical significance (p < .05). EPAO = Environment and Policy Assessment and Observation (2017 version); LPA = light physical activity; MVPA = moderate-to-vigorous physical activity.

Table 4.

Associations Between Child Care Environmental Characteristics (CPERS5) and Physical Activity and Sedentary Time in Young Children.

CPERS5 subscale score	Toddlers (n = 88)						Preschoolers (n = 154)
	Sedentary time		LPA		MVPA		Sedentary time		LPA		MVPA
	B [95% CI]	p	B [95% CI]	p	B [95% CI]	p	B [95% CI]	p	B [95% CI]	p	B [95% CI]	p
Indoor spaces
Modified open-plan space	−4.54 [−9.15, 0.07]	.053	2.90 [−0.71, 6.51]	.108	0.32 [0.02, 0.63]	.041	0.64 [−1.92, 3.19]	.610	−0.42 [−2.29, 1.45]	.649	−0.02 [−0.19, 0.14]	.748
Home bases	−5.01 [−14.89, 4.87]	.286	3.63 [−3.62, 10.89]	.289	0.24 [−0.47, 0.95]	.471	1.30 [−5.38, 7.99]	.684	−0.44 [−5.50, 4.62]	.856	−0.19 [−0.59, 0.20]	.294
Quiet activity areas	−1.44 [−5.10, 2.21]	.434	1.14 [−1.69, 3.96]	.424	0.07 [−0.19, 0.33]	.570	0.35 [−1.72, 2.42]	.739	−0.43 [−1.81, 0.96]	.543	0.004 [−0.15, 0.15]	.952
Physical activity areas	2.75 [−3.46, 8.95]	.341	−2.52 [−6.98, 1.95]	.228	−0.02 [−0.47, 0.42]	.905	0.71 [−3.36, 4.78]	.713	−0.62 [−3.70, 2.46]	.674	0.01 [−0.23, 0.26]	.897
Messy activity areas	−1.33 [−6.13, 3.46]	.558	1.30 [−2.26, 4.86]	.441	0.005 [−0.33, 0.33]	.975	0.22 [−2.30, 2.75]	.855	−0.06 [−1.94, 1.82]	.947	−0.04 [−0.19, 0.12]	.622
Outdoor areas
Play yards (functional needs)	0.81 [−2.95, 4.56]	.643	−0.89 [−3.61, 1.83]	.477	−0.01 [−0.27, 0.25]	.922	−1.56 [−3.21, 0.09]	.062	0.62 [−0.71, 1.95]	.340	0.15 [0.05, 0.25]	.005
Play yards (developmental need)	2.79 [−2.36, 7.93]	.260	−1.94 [−5.77, 1.90]	.288	−0.18 [−0.54, 0.18]	.294	−3.13 [−5.07, −1.19]	.003	2.35 [0.87, 3.83]	.004	0.14 [0.01, 0.28]	.037
Location and site	−6.21 [−13.69, 1.27]	.096	4.54 [−1.08, 10.15]	.104	0.27 [−0.26, 0.81]	.289	−1.92 [−6.30, 2.45]	.373	0.53 [−2.71, 3.78]	.737	0.19 [−0.09, 0.47]	.181

Note. Models were adjusted for age, sex, mean temperature, mean precipitation, whether belonging to the accreditation groups or not, and clustering effects of child care centers. MVPA for preschoolers were log transformed. Bold font denotes statistical significance (p < .05). CPERS5 = Children’s Physical Environments Rating Scale (revised version 5); LPA = light physical activity; MVPA = moderate-to-vigorous physical activity.

For preschoolers, the EPAO-assessed overall structure quality for the physical activity environment was associated with log MVPA (B = 0.04; 95% CI:0.003,0.08; Table 3). In particular, “time provided for physical activity” and several outdoor environmental characteristics, including “outdoor playtime,” “outdoor play and learning education and professional development,” “play yard providing functional needs,” and “play yards providing developmental needs,” were generally shown to be associated with higher physical activity and lower sedentary time (Tables 3 and 4). In terms of the process quality, the MOVERS-assessed overall score was positively associated with log MVPA (B = 0.08; 95% CI [0.02, 0.15]; Table 5). Specifically, associations were observed for “curriculum, environment, and resources for physical development” and “pedagogy for physical development” (Table 5).

Table 5.

Associations Between Child Care Environmental Characteristics (MOVERS) and Physical Activity and Sedentary Time in Young Children.

MOVERS subscale scores	Toddlers (n = 88)						Preschoolers (n = 154)
	Sedentary time		LPA		MVPA		Sedentary time		LPA		MVPA
	B [95% CI]	p	B [95% CI]	p	B [95% CI]	p	B [95% CI]	p	B [95% CI]	p	B [95% CI]	p
Curriculum, environment, and resources for physical development	1.05 [−0.77, 2.87]	.229	−0.89 [−2.20, 0.41]	.158	−0.02 [−0.16, 0.12]	.746	−1.13 [−2.20, −0.07]	.038	0.078 [−0.05, 1.61]	.065	0.08 [0.01, 0.14]	.016
Pedagogy for physical development	0.19 [−1.48, 1.86]	.810	−0.28 [−1.50, 0.94]	.622	0.02 [−0.10, 0.13]	.776	−0.95 [−1.85, −0.05]	.040	0.53 [−0.22, 1.28]	.149	0.07 [0.03, 0.12]	.003
Supporting physical activity and critical thinking	−0.09 [−2.57, 2.40]	.940	−0.40 [−2.20, 1.41]	.638	0.09 [−0.07, 0.26]	.240	−0.44 [−1.80, 0.95]	.514	0.22 [−0.84, 1.29]	.663	0.04 [−0.04, 0.12]	.308
Parents/carers and staff	0.32 [−1.63, 2.26]	.723	−0.49 [−1.89, 0.92]	.458	0.04 [−0.09, 0.17]	.501	−0.84 [−1.87, 0.20]	.104	0.64 [−0.14, 1.43]	.101	0.03 [−0.03, 0.10]	.299
Total scores	0.60 [−1.57, 2.77]	.558	−0.70 [−2.26, 0.85]	.340	0.02 [−0.13, 0.18]	.748	−1.14 [−2.33, 0.06]	.060	0.71 [−0.23, 1.66]	.130	0.08 [0.02, 0.15]	.014

Notes. Models were adjusted for age, sex, mean temperature, mean precipitation, whether belonging to the accreditation groups or not, and clustering effects of child care centers. MVPA for preschoolers were log transformed. Bold font denotes statistical significance (p < .05). MOVERS = Movement Environment Rating Scale; LPA = light physical activity; MVPA = moderate-to-vigorous physical activity.

Discussion

The present study examined the associations between environmental characteristics of child care centers and in-care physical activity and sedentary time in young children. Though several associations were null, some patterns were observed. For instance, different associations were observed between toddlers and preschoolers. Regarding child care structure quality, associations for policy and indoor environment were observed in toddlers, while outdoor environment was more relevant to preschoolers’ behavior. In addition, child care process quality, particularly curriculum and pedagogy, appeared important to physical activity in preschoolers but not toddlers.

A novel aspect of the present study was the inclusion of toddlers, given that this age-group has not been studied as frequently as preschoolers in the child care setting (Tonge et al., 2016). Associations observed between child care policies related to screen time and outdoor play and physical activity and sedentary time in toddlers may be explained by center culture that supports less sedentary time and more physical activity. Findings for the indoor environment may be explained by the fact that a modified open-plan space can accommodate a variety of activities with minimal distractions and facilitate free movement between activities. Such spaces likely keep children engaged and active, as it has been reported that a large proportion of toddler’s indoor MVPA (66%) occurs in activity areas and transitions (Fees et al., 2015).

Our findings in preschoolers indicate that the overall structure quality of the child care physical activity environment may be important for supporting their MVPA. Specifically, the outdoor environment may play an integral role in promoting physical activity and reducing sedentary behavior in children of this age group. Though inconsistent findings have previously been observed for structure quality (Tonge et al., 2016), the outdoor space has consistently been observed as an important environmental characteristic (Henderson et al., 2015; Hesketh & van Sluijs, 2016; Tonge et al., 2016). A potential reason for this finding is that levels of stress may diminish in the outdoor environment (Bento & Dias, 2017). This is likely to facilitate positive educator–child interactions that are associated with increased physical activity in young children (Zhang et al., 2019). The outdoor environment may also offer stimuli that capture young children’s attention, curiosity, and interest (Bento & Dias, 2017; Morrissey et al., 2015), which may encourage children to actively explore the surrounding areas and engage in outdoor activities. This is further supported by our observed findings for the importance of the “play yards for developmental needs” subscale in CPERS5 on preschoolers’ physical activity and sedentary time.

In addition to the outdoor environment, our findings suggest that educator professional development and parent education on outdoor play and learning may also encourage physical activity in preschoolers. Despite the potential benefits, evidence suggests that educators may be reluctant to organize outdoor activities, due to safety considerations or lack of confidence (Copeland et al., 2012; Dyment & Coleman, 2012). Parents may also be uncomfortable with their children engaging in outdoor play in child care centers (Tandon et al., 2017). Educator professional development and parent education on the importance of outdoor play for overall development could help diminish these concerns. This professional development could also prompt educators to lead organized activities, interact with children, and encourage children to discover surroundings, during their outdoor playtime (Bento & Dias, 2017; Waters & Maynard, 2010).

Findings in preschoolers suggest that both structure and process quality are important for promoting physical activity in child care centers. For example, in the MOVERS subscale “curriculum, environment, and resources for physical development,” meeting the few structure quality indicators (e.g., indoor space, portable and fixed resources, opportunities, or resources to develop motor skills) were the prerequisites for scores in each item. To achieve higher scores, however, it is required to observe higher process quality, such as more educators’ engagement, prompts, facilitate the use of the space and resource, and higher quality of pedagogy (Siraj & Archer, 2017). The positive associations observed between this subscale and MVPA in preschoolers suggest that higher structure quality of the child care environment may be an important precondition for improving their physical activity. However, enhancing process quality that facilitate and interact with the structure quality may be the key to promoting physical activity. Therefore, it is important for future research to determine the structure quality characteristics that matter the most for the process quality related to children’s physical activity.

Our findings suggest that the associations of child care environment with physical activity and sedentary time may be different between toddlers and preschoolers. This is consistent with a previous study supporting age as a moderator of such associations (Gubbels et al., 2011). The different pattern of associations observed in the present study may be due to the fact that our environmental observations were done in preschool rooms. Developmental differences may also explain the different associations between indoor and outdoor environments observed between the two age groups. For instance, toddlers’ physical activity is characterized by unstructured activities (Cliff et al., 2009), and they tend to spend considerable sedentary time observing other children during free play (Fees et al., 2015). In contrast, preschoolers are more physically, cognitively, and socially developed. Consequently, they tend to engage in more structured activities and modified sports (Cliff et al., 2009), which likely occurs in large open space, such as the outdoor environment. As a result, there may be greater variability in outdoor physical activity and sedentary time in preschoolers than that in toddlers.

Strengths and Limitations

The objective measures of physical activity and sedentary time in young children while at centers is a strength of the present study. The use of three validated environment rating instruments also provided a more comprehensive measure of the child care environment than has been assessed in previous studies. Furthermore, stratified analysis allowed us to compare the patterns of associations between toddlers and preschoolers. However, this study is not without limitations. First, the cross-sectional design precludes causal inferences. Second, observations in the main rooms within each center were only conducted in preschool rooms, as the environmental scales used were only validated in children of this age-group. Although shared areas (e.g., outdoor play yard) were the same for toddlers and preschoolers, there may be environmental differences between their main rooms. If that is the case, these unmeasured differences may affect the associations observed in toddlers. Third, while accelerometry is an objective measure of physical activity and sedentary time, there is no consensus on the optimal cut point for young children (Trost et al., 2018). It is possible that our choice of cut points may have over- or underestimated the amount of sedentary time and physical activity in young children. This, in turn, may have affected estimates of associations for the child care environmental characteristics. Fourth, although the child care environments were objectively observed by the same rater, for all centers, rater’s bias is still possible. Fifth, data were collected in only two cities, and thus, our results may not be generalizable to all child care centers in Canada. Finally, there may be unmeasured covariates leading to residual confounding.

Implications for Practice and Future Research

Enhancing structure quality related to child care policy and the indoor environment seems promising in promoting physical activity and less sedentary time in child care for toddlers. For preschoolers, overall structure quality of the environment, in particular the outdoor environment, and overall process quality of the environment, in particular curriculum and pedagogy, appear important for physical activity and sedentary time. Given the different pattern of associations observed between toddlers and preschoolers, stratified analysis is recommended for future research in this area.

Supplemental Material

Online_Supplementary_file – Supplemental material for Associations Between the Child Care Environment and Children’s In-Care Physical Activity and Sedentary Time

Supplemental material, Online_Supplementary_file for Associations Between the Child Care Environment and Children’s In-Care Physical Activity and Sedentary Time by Zhiguang Zhang, Nicholas Kuzik, Kristi B. Adamo, Nancy Ogden, Gary S. Goldfield, Anthony D. Okely, Mitchell Crozier, Stephen Hunter, Madison Predy and Valerie Carson in Health Education & Behavior

Footnotes

Acknowledgements

The authors appreciate all the children, parents, educators, and directors who participated in the study. The authors would also like to thank Nicole McLeod and April English for their help with project coordination and data collection, Dr. Eun-Young Lee for her help with training, as well as Rachel Sukman, William Howatt, Anne Leslie, Brody Flegal, and Alexandra Goudreau for their help with data collection.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was funded by the Canadian Institutes of Health Research. The sponsor had no role in the study design; collection, analysis, and interpretation of data; and in writing the manuscript. Valerie Carson is supported by a Canadian Institutes of Health Research New Investigator Salary Award. Anthony D. Okely is supported by a NHMRC Investigator Grant (Leadership Fellow, Level 2). No financial disclosures were reported by the authors.

ORCID iD

Valerie Carson

Supplemental Material

Supplemental material for this article is available online at .

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