Why Go NAPSACC

NAPSACC is an evidence-based program that promotes the implementation of health promoting policies, practices, and environments in early care and education (ECE) programs. Below are select publications documenting its development and impact.

NAPSACC’s Impact

Key Studies

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. Read abstract

  • Evaluated NAPSACC in 82 North Carolina ECE programs (2005–2006, randomized controlled trial).

  • ECE programs implementing NAPSACC showed significant improvements in nutrition environments; trends in physical activity also improved.

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. Read abstract

  • Evaluated 17 ECE programs across California, Connecticut, and North Carolina (2009–2010).

  • Results showed significant improvements in children’s BMI, educators’ and parents’ nutrition and physical activity knowledge, and ECE program policies.

  • Includes detailed description of technical assistance strategies.

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

  • Pilot of web-based, Go NAPSACC Child Nutrition module in 31 North Carolina ECE programs (2015–2016).

  • Intervention ECE programs improved nutrition environments using online tools; but changes were not statistically significant given the pilot nature of the study.

Additional Evidence

  • Center for Training and Research Translation at the UNC Center for Health Promotion and Disease Prevention. (2008) Nutrition and Physical Activity Self-Assessment for Child-Care (NAP SACC): Potential public health impact.

  • 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. Read abstract

  • White House Task Force on Childhood Obesity. (2010) Solving the Problem of Childhood Obesity Within a Generation. Washington, DC: Executive Office of the President of the United States.

  • 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. Read abstract

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

  • 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. Read abstract

  • Lessard L, Breck A. (2015) Childhood Obesity Prevention in Childcare Settings: the Potential of Policy and Environmental Change Interventions. Curr Obes Rep. 4(2):191-197. Read abstract

  • Gortmaker SL et al. (2015) Three interventions that reduce childhood obesity are projected to save more than they cost to implement. Health Aff (Millwood). 34(11): 1932-1939. Read abstract

  • Kenney E et al. (2019) The cost-effectiveness of interventions for reducing obesity among young children through healthy eating, physical activity, and screen time. Durham, NC: Healthy Eating Research. Read abstract

  • Barrett JL et al. (2023) CHOICES National Action Kit: Creating Healthier Early Care and Education Environments Strategy Report. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA. Read summary

  • West M et al. (2023) Multi-state Implementation of Go NAPSACC to Support Healthy Practices in the Early Care and Education Setting. Health Promot Pract. 24 (1_suppl):145S-151S. Read abstract

  • Smith FT†, Kipping R†, Yoong SL† et al. (2025) (2025) Adapting the Nutrition and Physical Activity Self-Assessment: a cross-country case study of improving early childhood health environments in the United States, Australia, and the United Kingdom. Child Obes. 21(3). Read abstract

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). Read abstract

  • Details the 2001–2002 design strategy targeting physical and social environments to improve nutrition and activity.

  • Discusses development of the self-assessment tool and other key program components.

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. Read abstract

  • 2003 pilot in North Carolina ECE programs: 15 intervention ECE programs selected 3 environmental goals and worked towards goals with assistance from a trained NAPSACC consultant.

  • Results showed that intervention ECE programs made more environmental improvements than comparison ECE programs after 6 months.

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. Read abstract

  • Details the reliability and validity testing of the NAPSACC self-assessment, demonstrating accuracy and stability as a measure of ECE environments.

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

  • Describes the rigorous development process used to create NAPSACC’s original evidence-based practices for physical activity.