The Evidence

NAPSACC is an evidence-based program for improving the health of young children by enhancing child care programs’ practices, policies, and environments. Below are select publications.

NAPSACC’s Impact

Ward DS et al. (2008) Nutrition and physical activity in child care: Results from an environmental intervention. Am J Prev Med. 35(4):352–356.

This paper details the original 2005–2006 evaluation of NAPSACC using a randomized controlled trial with 82 child care centers in North Carolina. Results showed that centers implementing NAPSACC made significant improvements to their nutrition environments as a result of the program. A trend for improvement in physical activity was also observed, but it was not statistically significant.

Alkon A et al. (2014) Nutrition and Physical Activity Randomized Control Trial in Child Care Centers Improves Knowledge, Policies, and Children’s Body Mass Index. BMC Public Health. 14:215. Access full article

This paper describes the 2009-2010 evaluation of NAPSACC in 17 child care centers in California, Connecticut, and North Carolina. Results showed significant improvements in children’s BMI. In addition, significant increases were also noted in providers’ and parents’ knowledge of nutrition and physical activity recommendations and centers’ policies. A detailed description of the technical assistance provided, including the strategies used and hours required, is included.

Ward DS et al. (2017) Translating a child care-based intervention for online delivery: development and randomized pilot study of Go NAPSACC. BM Public Health. 17(1): 891. Access full article

This paper details the 2015-2016 pilot of Go NAPSACC with 31 child care centers in North Carolina. For the pilot, centers used the new online tools and were encouraged to focus on Child Nutrition content. Results showed that intervention centers made notable improvements to the nutrition environment, but changes were not statistically significant given the pilot nature of the study.

Similar findings of NAPSACC's positive impact are also documented in the following papers:

  • Drummond RL et al. (2009) A pebble in the pond: The ripple effect of an obesity prevention intervention targeting the child care environment. Health Promot Pract. 10(2 Suppl):156S–167S.

  • Battista RA et al. (2014) Improving the physical activity and nutrition environment through self-assessment (NAPSACC) in rural area child care centers in North Carolina. Prev Med. 67:S10-S16. Access full article

  • Bonis M et al. (2014) Improving Physical Activity in Daycare Interventions. Child Obes. 10(4):334-341.

  • Martin SL et al. (2015) Notes from the field: The evaluation of Maine Nutrition and Physical Activity Self-Assessment for Child Care (NAPSACC) Experience. Eval Health Prof. 38(1): 140-145.

  • Dev DA et al. (2018) Improving the nutrition and screen time environment through self-assessment in family child care homes in Nebraska. Public Health Nutr. 21(13): 2351-2359.

  • Dinkel D et al. (2018) Improving the physical activity and outdoor play environment of family child care homes in Nebraska through go nutrition and physical activity self-assessment for child care. J Phys Activ Health. 9: 1-7.


NAPSACC’s Development

Ammerman A et al. (2007) An intervention to promote healthy weight: Nutrition and Physical Activity Self-assessment for Child Care (NAPSACC) theory and design. Prev Chronic Dis. 4(3). Access full article

This paper describes the design of the original NAPSACC program in 2001–2002. It documents NAPSACC’s strategy of intervening on the physical and social environment to impact children’s nutrition and physical activity. Development of the self-assessment and other key parts of NAPSACC are also discussed.

Benjamin SE et al. (2007) Nutrition and Physical Activity Self-assessment for Child Care (NAPSACC): Results from a pilot intervention. J Nutr Educ Behav. 39(3):142–149.

This paper details the 2003 pilot of NAPSACC with North Carolina child care centers. The 15 intervention centers selected 3 goals for environmental improvements and worked toward those goals with assistance from a trained NAPSACC consultant. NAPSACC self-assessments completed before and after the 6-month intervention showed that intervention centers made more environmental improvements than comparison centers.

Benjamin SE et al. (2007) Reliability and validity of a nutrition and physical activity environmental self-assessment for child care. Int J Behav Nutr Phys Act. 4:29. Access full article

This paper outlines the reliability and validity testing of the NAPSACC self-assessment tool, demonstrating that it is an accurate and stable measure of the child care environment.

McWilliams C et al. (2009) Best-practice guidelines for physical activity at child care. Pediatrics. 124(6):1650–1659.

This paper describes the rigorous development process used to create the NAPSACC’s original best practices for physical activity.
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