Research Evidence

NAP SACC (Nutrition and Physical Activity Self-Assessment for Child Care) is an evidence-based program for improving the health of young children through better nutrition and physical activity in early care and education programs. Evidence for NAP SACC’s impact on the health of child care settings is well documented. Please see below for a list of publications.


Ammerman A, Ward DS, Benjamin SE, Ball SC, Sommers J, Malloy M, Dodds J. An intervention to promote healthy weight: Nutrition and Physical Activity Self-assessment for Child Care (NAP SACC) theory and design. Prev Chronic Dis (serial online). 2007;4(3).
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This paper describes the 2001–2002 design and development of NAP SACC. It considers NAP SACC’s unique focus on nutrition and physical activity in both the physical and social environments of the child care setting. The theory and research behind the intervention are discussed. The paper also details the development of the self-assessment and other key parts of NAP SACC, and future directions for the program.

NAP SACC Pilot Study

Benjamin SE, Ammerman A, Sommers J, Dodds J, Neelon B, Ward DS. Nutrition and Physical Activity Self-assessment for Child Care (NAP SACC): Results from a pilot intervention. J Nutr Educ Behav. 2007;39(3):142–149.
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This paper discusses the 2003 NAP SACC pilot project. NAP SACC was tested in 19 child care centers in 8 counties in North Carolina. The 15 intervention centers selected and worked on 3 environmental improvements with assistance from a trained NAP SACC consultant. To assess their baseline nutrition and physical activity environments and improvements, centers completed the NAP SACC self-assessment before and after the 6-month intervention. Results showed intervention centers made more improvements than the comparison centers, which indicates that NAP SACC is a promising approach for promoting healthy weight in preschool settings.

NAP SACC Self-Assessment

Benjamin SE, Neelon B, Ball S, Bangdiwala SI, Ammerman AS, Ward DS. Reliability and validity of a nutrition and physical activity environmental self-assessment for child care. Int J Behav Nutr Phys Act. 2007;4:29.
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This paper outlines the reliability and validity testing performed on the NAP SACC self-assessment tool. Results of test-retest and inter-rater reliability showed that it is an accurate and stable measure of the child care environment.

NAP SACC Evaluation

Ward DS, Benjamin SE, Ammerman AS, Ball SC, Neelon B, Bangdiwala SI. Nutrition and physical activity in child care: Results from an environmental intervention. Am J Prev Med. 2008;35(4):352–356.
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This paper discusses the 2005–2006 evaluation of the NAP SACC intervention using a randomized controlled trial with 82 child care centers. Outcomes were measured by trained, blinded research staff using the Environment and Policy Assessment and Observation instrument. After eliminating centers that were assigned to the intervention but did not implement the program, significant pre-post differences were found between intervention and control centers for nutrition. A trend for improvement in physical activity was also observed, but it was not statistically significant.

Drummond RL, Staten LK, Sanford MR, Davidson CL, Magda Ciocazan M, Khor KN, Kaplan F. A pebble in the pond: The ripple effect of an obesity prevention intervention targeting the child care environment. Health Promot Pract. 2009 Apr;10(2 Suppl):156S–167S.
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This paper discusses implementation and evaluation of the NAP SACC intervention in Arizona during 2005–2008. Based on the NAP SACC self-assessment, centers showed a significant increase in the number of nutrition and physical activity best practices being met.

Related Publications:

Ball SC, Benjamin SE, Ward DS. Development and reliability of an observation method to assess food intake of young children in child care. J Am Diet Assoc. 2007;107(4):656–661.

Bower JK, Hales DP, Tate DF, Rubin DA, Benjamin SE, Ward DS. The childcare environment and children's physical activity. Am J Prev Med. 2008;34(1):23–29.

Ball SC, Benjamin SE, Ward DS. Dietary intakes in North Carolina child-care centers: Are children meeting current recommendations? J Am Diet Assoc. 2008;108(4):718–721.

Ward DS, Hales D, Haverly K, Marks J, Benjamin SE, Ball SC, Trost S. An instrument to assess the obesogenic environment of child care centers. Am J Health Behav. 2008;32(4):380–86.

McWilliams C, Ball SC, Benjamin SE, Hales D, Vaughn A, Ward DS. Best-practice guidelines for physical activity at child care. Pediatrics. 2009;124(6):1650–1659.

Benjamin Neelon SE, Vaughn A, Ball SC, McWilliams C, Ward DS. Nutrition practices and mealtime environments of North Carolina child care centers. Child Obes. 2012;8(3):216–223.