The Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) program is an environmental intervention that aims to affect change in the nutrition and physical activity practices, policies, and physical environments of child care facilities in support of healthy weight for young children.
Topic area(s): Obesity Prevention and Control; Women, Children and Minorities


NAP SACC’s goal is to promote healthy eating and physical activity in young children in child care and preschool settings.

Project Description

The NAP SACC program contains a number of components including a self-assessment instrument, continuing education workshops, collaborative action planning and technical assistance materials, and an extensive resource manual which includes copy ready materials. The NAP SACC intervention was designed for implementation through an existing infrastructure of public health professionals, typically registered nurses and health educators, trained as NAP SACC Consultants. Key steps in the intervention, which typically takes place over 6 months, include the following:

  1. Child care center directors and key staff complete the self-assessment instrument to assess center nutrition and physical activity policies, practices, and overall environment.
  2. NAP SACC Consultants work with center directors to develop an action plan to improve at least three target areas of concern identified from the self-assessment instrument.
  3. NAP SACC Consultants deliver five NAP SACC continuing education workshops to center staff on: 1) Childhood Overweight, 2) Healthy Eating for Children, 3) Physical Activity for Children, 4) Personal Health and Wellness for Staff, and 5) Working with Families.
  4. NAP SACC Consultants provide on-going targeted technical assistance, through in-person visits and telephone follow-up, to support implementation of planned policy, practice, and environmental changes.
  5. Centers complete a follow-up self-assessment instrument to evaluate changes made to the center during the six-month intervention period.

Additional projects using the NAP SACC intervention are an intensive NAP SACC that lasts 1 year and encourages the centers to choose more areas for improvement and NAP SACC Family, which links the child care center to the home by offering parenting workshops and providing parents with the opportunity to make targeted nutrition and physical activity improvements in their home.

Currently, NAPSACC is being disseminated through an online training, which can be found at


  • North Carolina DHHS – Evaluation of Healthy Weight Initiative (HWI), 01/01/01 – 06/30/05
  • American Schools of Public Health/CDC cooperative agreement S3407-2323 – A Evaluation of the NAP SACC: An Intervention in Child Care, 10/01/04 – 09/30/06
  • CDC SIP 16-05 – Promoting Healthy Weight Through Child Care: The NAP SACC Program, 10/1/05 – 09/30/07
  • NIDDKDK073044-02 – Healthy Weight: Linking Child Care Centers with the Home, 09/30/05 – 08/31/07
  • Current Status: Disseminated

Key Contacts

Principal Investigator: Dianne Ward

Project Director/Manager: Christina McWilliams 919-966-8648



Benjamin SE, Ammerman A, Sommers J, Dodds J, Neelon B, Ward DS. Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC): Results from a Pilot Program. J Nutr Edu Behav 2007;39:142-149.

Ball SC, Benjamin SE, Ward DS. Development and Reliability of an Observation Method to Assess Food Intake of Young Children in Child Care. J Am Diet Assoc 2007;107:656-661.

Ammerman A, Ward DS, Benjamin SE, Ball SC, Sommers J, Malloy M, Dodds J. An Intervention to Promote Healthy Weight: Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) Theory and Design. Prev Chron Dis (serial online) 2007 July. Available from:

Benjamin SE, Neelon B, Ball S, Bangdiwala SI, Ammerman AS, and Ward DS. Reliability and Validity of a Nutrition and Physical Activity Self-Assessment for Child Care. International Journal of Behavioral Nutrition and Physical Activity 2007, 4:29 (5 July 2007). Available from:

Bower JK, Hales DP, Tate DF, Rubin DA, Benjamin SE, Ward DS. The childcare environment and children’s physical activity. Am J Prev Med, 2008;34(1); 23-29.

Ball SC, Benjamin SE, Ward DS. Dietary intakes in North Carolina child-care centers: are children meeting current recommendations? J Am Diet Assoc 2008;108:718-721.

Ward DS, Hales D, Haverly K, Marks J, Benjamin SE, BallSC, Trost S. An instrument to assess the obesogenic environment of child care centers. Am J Health Behav, 2008 Jul-Aug;32(4):380-6.

Ward DS, Benjamin SE, Ammerman AS, Ball SC, Neelon B, Bangdiwala SI. Nutrition and Physical Activity in Child Care: Results from an Environmental Intervention. Am J Prev Med 2008 (In press).