Table 1.

Measuring Child Diet and Physical Activity and ECE Programs' Policies, Practices, and Environment

Measurement method and description	Strengths	Weaknesses
Assessment of Child Diet
Weighed/measured intakes: Trained data collectors measure all foods served to or taken by each child throughout the meal.	• Most precise assessment of child's intake	• Most intrusive method and greatest chance for subject reactivity
		• Particularly challenging for meals served family style
		• Staffing requirements make this one of the most costly methods
Meal observation: Calculation of foods eaten by each child is based on visual estimates by trained observers.	• Reasonably precise method • Trained observers can assess up to 3 children at a time, thus reducing cost	• Some subject reactivity, but less than weighed intakes
Plate waste: Foods provided to classroom are measured before and after meal to calculate average child consumption.	• Least subject reactivity • Least expensive method for diet assessment	• Does not provide individual estimate of intake
Assessment of Child Physical Activity
Proxy reports: Parent or child care provider is asked to estimate a child's past physical activity.	• Inexpensive	• Cruder method, less precision
	• Low participant burden
Direct observation: Trained observers rate and record children's physical activity during a designated period of time.	• Good reliability and adequate validity • Also able to capture contextual information	• Observation period is generally limited, therefore not able to capture habitual activity
Accelerometers	• Objective measure of physical activity • Considered to have good reliability and validity • Low subject burden • Able to assess habitual physical activity	• Captures large amount of data which must be reduced • Disagreements about cut points and interpretation of data • More costly than other methods
Measurement of ECE Policies and Environment
Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC): The NAP SACC self-assessment is a brief instrument that child care providers can use to evaluate their environment, policies, and practices.	• Quick and easy to use • Minimal participant burden • Inexpensive	• Designed as part of the NAP SACC program, intended primarily as a process measure not for evaluation of effectiveness.
Environment and Policy Assessment and Observation (EPAO): The EPAO protocol is a comprehensive measure of the child care environment, policies, and practices, and includes a document review (90 items) and onsite observation (102 items).	• This protocol was developed as an outcome measure to assess the impact of the NAP SACC intervention but has been used by other researchers. • It is the most comprehensive measure of its kind available. • It has demonstrated reliability and validity as a measure of nutrition and physical activity policies and environmental characteristics at child care.	• Expensive to implement • Requires special training and certification of data collectors
The Wellness Child Care Assessment Tool (WellCCAT): The WellCCAT focuses on assessing strength and comprehensiveness of policies using 65 items from a document review.	• It has demonstrated reliability and validity as a measure of nutrition and physical activity policies and environmental characteristics at child care.	• It is less comprehensive compared to the EPAO
	• Less expensive to implement