Change in the implementation of healthy nutrition and physical activity best practices in Minnesota early care settings: A longitudinal cohort study (2010-2016).

The goal of the 'Healthy Start, Healthy State' study was to describe changes in the implementation of healthy nutrition and physical activity (PA) best practices in early child care and education (ECE) settings from 2010 to 2016. A cohort of 215 Minnesota licensed center- and family/home-based providers completed a survey describing 15 nutrition and 8 PA best practices that they "already do" in 2010 and again in 2016 were analyzed in 2016. There was a significant net implementation rate increase for 15 best practices (10 nutrition, 5 PA) in centers and 12 best practices (8 nutrition, 4 PA) in family/home-based programs. The 2010 nutrition and PA scores were negatively associated with mean change in 2016 indicating the decreased potential for improvement among sites with more best practices already implemented in 2010. Adjusted for 2010 nutrition score and other factors, centers implemented, on average, 1.45 more nutrition best practices from 2010 to 2016 than family/home based programs, and CACFP participating programs implemented, on average, 1.7 more nutrition best practices from 2010 to 2016 than non-CACFP participants. Urbanicity, provider education, and provider years of experience were not significantly associated with 2010-2016 change in nutrition score. The mean PA score change had a small but significant increase for each additional year of provider ECE experience after adjusting for the 2010 score. State-level surveillance of implemented best practices in ECE settings is useful. Findings identify opportunities for stakeholders to respond with targeted technical support and training and to consider potential future policy levers.