Does an active play standard change childcare physical activity and healthy eating policies? A natural policy experiment.

Background: In 2017, the provincial government of British Columbia (BC) implemented a mandatory policy outlining Active Play Standards (AP Standards) to increase physical activity (PA) levels, sedentary and motor skills among children attending licensed childcare centers. Concurrently, a capacity-building initiative was launched to help implement policies and practices supporting both PA and healthy eating (HE) in the early years. This study evaluated differences in center-level PA and HE policies and practices before and after the enforcement of the new provincial AP Standards.

Methods: Using a repeat cross-sectional design, surveys were distributed to managers and staff of licensed childcare facilities serving children aged 2-5 years before (2016-2017 or 'time 1') and after (2018-2019 or 'time 2') implementation of the AP Standards across BC. The total sample included 1,459 respondents (910 and 549 respondents at time 1 and time 2, respectively). Hierarchical mixed effects models were used to examine differences in 9 and 7 PA/sedentary policies and practices, respectively, as well as 11 HE policies between time 1 and time 2. Models controlled for childcare size and area-level population size, education, and income.

Results: Compared to centers surveyed at time 1, centers at time 2 were more likely to report written policies related to: fundamental movement skills, total amount of Active Play (AP) time, staff-led AP, unfacilitated play/free play, total amount of outdoor AP time, limiting screen time, breaking up prolonged sitting, staff role modeling of PA, and training staff about PA (P < 0.01 for all 9 policies examined). Compared to time 1, centers at time 2 reported more frequent practices related to ensuring children engaged in at least 120 min of AP, 60 min of outdoor AP daily, and limiting screen time (P < 0.01 for 3 out of 7 practices examined). Despite no additional policy intervention related to HE, centers were more likely to report having written policies related to: HE education for children, encouraging new foods, having family-style meals, offering only milk or water, limiting the amount of juice served, staff role modeling of HE, limiting the types of foods at parties/celebrations and foods brought from home (P < 0.05 for 9 out of 11 HE policies).

Conclusion: Approximately a year after the implementation of a governmental policy targeting PA supported by a capacity-building initiative, childcare centers reported positive changes in all 9 PA/sedentary policies examined, all 3 out of 7 PA/sedentary practices and 9 out of 11 HE policies evaluated at the center-level.