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Original Investigation

Comparison of Physical Activity Environments in Michigan Home-Based and Licensed Childcare Programs

Clevenger, Kimberly A.; Pfeiffer, Karin A.

Author Information
Translational Journal of the ACSM: Spring 2022 - Volume 7 - Issue 2 - e000198
doi: 10.1249/TJX.0000000000000198

Abstract

INTRODUCTION

Children younger than 5 yr should be active at least 3 h·d−1, including moderate-to-vigorous physical activity (PA), to attain the numerous short- and long-term benefits of being active, like reduced adiposity and improved motor or cognitive development (1). Because a third of children younger than 5 yr spend their days in a regularly scheduled, nonrelative childcare arrangement (2), this is an important setting for daily PA participation. The childcare attended is often the strongest predictor of a child’s daily PA (3). Dissimilarities in daily PA between children who attend different childcares support that environmental or contextual factors affect this behavior. For example, teacher PA training (4), program quality (3,5), active opportunities (4), and amount (4,5) or variety (6) of fixed or portable play equipment have been related to PA attainment. Aspects of the PA or play environment have also been related to early learning outcomes (7).

In the United States, the childcare PA environment has been characterized using state-specific surveys in Washington, Oklahoma, and Delaware (8–10). Similar studies in other states are necessary because licensing guidelines, weather, beliefs, and practices vary (11,12). Furthermore, studies have often only included licensed centers that are larger, are typically classroom based, and care for more children, whereas little research focuses on family or home-based programs in which care is provided to a smaller number of children in a nonrelative’s private home (13). Although 24% of children attend center-based childcare, 8% of children primarily receive nonrelative, home-based care (2). This accounts for over a million children across the United States who spend, on average, 33 h·wk−1 in childcare (2). In addition, attending home-based childcare has been associated with increased risk for overweight (14), less outdoor time compared with center-based care (15), and high levels of screen time (16). Home-based programs may face greater barriers regarding space, staff, or finances that could impact their ability to provide equipment (15) and promote PA. Understanding the home-based childcare environment and how this relates to center-based care has implications for future policy and allocation of educational and financial resources, and can inform future activity-promoting interventions for children in all forms of nonrelative childcare.

Although there has been some recent interest in the PA environment of home-based programs (17,18), few studies have directly compared licensed centers and home-based programs (15,18), which limits our understanding of differences by type of childcare. A notable exception is a recent survey conducted in Nebraska (18). However, standards relating to PA in Nebraskan home-based programs are less well regulated than licensed centers, as in most states (11). In contrast, Michigan is part of the minority of states with stricter guidance regarding PA and screen time for home-based childcare programs (11). Comparing the PA environment by program type in a policy environment with more strict guidance for home-based programs is of interest to assess if similarities or differences by program type are consistent with prior research. The present study compared characteristics of the PA environment in home-based childcare programs and licensed centers across the state of Michigan (United States).

METHODS

Participants and Setting

In Michigan, all childcare programs must be registered or licensed, including home-based programs (family (1–6 nonrelative children) or group (≤12 nonrelative children)) and licensed centers (not in a residence). The state of Michigan has separate licensing rules for home-based and center-based programs, but both address outdoor time, space and equipment for indoor and outdoor activities, nap time, and screen time (19). For example, licensed centers must provide an outdoor play area of at least 1200 ft2, whereas home-based programs require 400–600 ft2 of space. Both program types require at least 35 ft2 of indoor space per child (19).

In September 2016, a list of all childcares (N = 9379) registered or licensed in the state was retrieved from the Michigan Department of Licensing and Regulatory Affair’s Great Start to Quality (GSQ) Web site (20), including 4961 home-based programs and 4418 licensed centers. How frequently this information is updated is unknown. Because the survey used in the present study was distributed electronically (described in Instrumentation), we used three approaches to gather email addresses for as many programs as possible. First, 3101 programs provided their email address on the GSQ Web site (for the purpose of recruiting children/families), of which 2826 were unique. Duplicate email addresses could exist for school systems or childcares with multiple programs at the same or different locations (none of these programs participated although they were eligible). Second, 928 potential email addresses were found by searching online (i.e., using a search engine to find the program Web site based on available information like address), of which 842 were unique. Third, of the remaining programs for which we did not have an email address (n = 5350), approximately half (n = 2759) were randomly selected to be sent a postcard advertising the study and requesting the program contact the research team to participate (all programs were not contacted because of monetary limitations). A direct link to the survey was not included on the postcard to prevent erroneous submissions. Only 61 postcards resulted in additional emails being acquired, and some postcards (n = 66) were returned as undeliverable at the address provided on the GSQ Web site.

In total, 3729 programs were sent the survey electronically (Qualtrics, Provo, UT) between April 13 and June 18, 2018 (2333 licensed centers). Data were downloaded in mid-July 2018. Of note, some surveys were returned as nondeliverable at the provided email address (n = 200). In addition, a number of programs contacted us to indicate they no longer or never operated a childcare program, although the exact number is not available. Of the 203 respondents who started the survey (113 from licensed centers), 124 finished the survey (54 from licensed centers). Flow charts depicting the number of programs at each stage are found in Supplemental Content 1 (figure, https://links.lww.com/TJACSM/A162; home-based programs) and Supplemental Content 2 (figure, https://links.lww.com/TJACSM/A163; licensed centers). We ensured there was only one respondent from each program through use of unique survey links.

Because of the nature of home-based programs, surveys were completed by program owners who were responsible for both directing the program and teaching. At licensed centers, however, survey respondents could be a program director, teacher, or both. For this analysis, respondents from licensed centers who only served in a director role were not eligible to participate, as personal characteristics and understanding of children’s behavior and daily schedule are likely not comparable to those with a teaching role. Excluding those at licensed centers who only serve in a director role also improves comparability in role and responsibilities between respondents from different program types.

Instrumentation

The Institutional Review Board at Michigan State University approved the study’s methodology (protocol no. i054858). Before participation, all respondents completed an informed consent document. Survey questions were derived from the Environment and Policy Evaluation and Observation Self Report (EPAO-SR), and outcomes are described in Supplemental Content 3 (table, https://links.lww.com/TJACSM/A164). Briefly, the survey included items on respondent and program characteristics, the outdoor and indoor environment and opportunities for activities (e.g., PA, naps), estimated PA, and barriers to promoting PA (21).

The availability of indoor and outdoor space for activity was rated on 5-point and 4-point scales, respectively. Four individual types of screen time equipment were reported (yes/no present) and then summed. Respondents also reported the availability of portable and fixed equipment (30 yes/no items); the availability of this equipment was summed as one variable and also analyzed using the subcategories described by Neshteruk et al. (17): portable equipment variety (6 items; e.g., push-pull toys), activity-promoting fixed equipment (11 items; e.g., tricycle track), and creativity-promoting fixed equipment (5 items; e.g., sandbox). The number of natural elements was reported overall (10 yes/no items) and also using the categories described by Neshteruk et al. (17): activity-promoting landscape features (5 items; e.g., trees children can climb) and attractive landscape features (4 items; e.g., flowering plants).

Time for indoor and outdoor PA, nap, or television and instances and duration of indoor and outdoor teacher-led activity were reported (all numerical free responses). Outdoor and indoor time for PA and television and nap time were also corrected for the average amount of time children attended that program per day (in minutes per hour). Estimated indoor and outdoor activity levels were rated on a scale from mostly sitting, 1, to mostly vigorous activities, 7. Eleven individual barriers to promoting PA were also reported, with possible responses of “not a barrier or not applicable,” “somewhat of a barrier,” or “a major barrier.” Two sets of questions—purchasing of new equipment and barriers to promoting activity—were not asked of teachers at licensed centers who had no director role (n = 13) to make responses more comparable between groups (teachers in center-based programs are likely not responsible for purchasing new equipment or toys).

A subset of programs (n = 61) had been rated for quality by the statewide GSQ program, which includes an in-person, unscheduled evaluation by a GSQ assessor (not affiliated with the research team) of over 40 items on staff quality, family and community partnerships, administration and management, environment, and curriculum and instruction. Each program then received a score out of a total possible 50 points.

Data Analysis

Although 90 respondents from home-based programs started the survey, only 70 completed the entire survey. For licensed centers, 113 respondents started the survey, but 54 completed the survey (13 of which only had a teaching role and therefore were not asked about purchasing of new equipment and barriers to promoting activity). Only respondents who completed the survey (reached the last question) were included in our analysis. Normality of all outcome variables was confirmed using histograms and Q-Q plots, whereas homogeneity of variance was assessed using Levene’s test. Independent-samples t-tests were used to compare continuous variables (Welsh’s test when variance was not homogeneous), whereas Fisher’s exact test was used to compare categorical variables between home-based and licensed centers (significance P < 0.05). When Fisher’s exact test indicated a significant difference between home-based and licensed centers and the variable was not dichotomous, Fisher’s exact test was used on 2 × 2 tables to identify specific differences between groups, with the P value adjusted using a Bonferroni correction (post hoc analysis). As exploratory analysis, correlation coefficients (Pearson’s r) for the relationship between the GSQ quality score and continuous outcomes were calculated by program type. Analyses were conducted in RStudio (version 1.3.1056; R Foundation for Statistical Computing, Vienna, Austria).

RESULTS

Figure 1 illustrates the approximate locations of participating childcare programs, of which 70 were home based and 54 were licensed centers (only respondents who completed the survey were included in the analysis). This represents 3.3% of programs that were sent the survey electronically. Of the licensed centers that completed the survey, 22.2% were faith based, 3.7% were Montessori schools, and 31.5% were Great Start to Readiness (a state-funded program) and/or Head Start programs, compared with 10.4%, 3.0%, and 32.6%, respectively, statewide (20).

F1
Figure 1:
Map of participating childcare programs.

Respondents are described in Supplemental Content 4 (table, https://links.lww.com/TJACSM/A165) and were mostly White (91.9%) and female (96.0%). Respondents from home-based programs reported lower levels of education than those from licensed programs (P < 0.001), with the largest portion of respondents from home-based programs reporting some college or other certificate (38.6%), whereas respondents from licensed centers most commonly reported a bachelor’s degree (42.6%). Respondents reported similar levels of experience working in early childcare (19.0–19.4 yr; P = 0.89) and PA-related training (P = 0.08).

Program characteristics are reported in Table 1. Home-based programs more frequently purchased new equipment every 6 months (P = 0.005), and there was a trend toward more frequently taking weekly field trips, although post hoc tests were not significant after adjustment for multiple comparisons (P = 0.01). Home-based programs had more overall, active, and attractive natural elements (P < 0.001, 0.03, and 0.009, respectively), portable and fixed equipment overall (P = 0.02), creative fixed equipment (P < 0.001), and screen time equipment (P = 0.006). Percent of programs that had specific pieces of equipment is found in Supplemental Content 5 (table, https://links.lww.com/TJACSM/A166). The most common types of equipment included balls (98.6%), riding toys (90.0%), and picnic tables (85.7%) for home-based programs and balls (96.3%), sand and water toys (94.4%), and parachutes (90.7%) for licensed centers. There were no differences in outdoor or indoor space for activity, availability of portable equipment, or activity-promoting fixed equipment (Table 1).

TABLE 1 - Characteristics of Home-Based and Licensed Programs.
Home-Based (n = 70) Licensed Center (n = 54) P
Program characteristics
 Years in operation, mean ± SD 16.6 ± 12.1 21.3 ± 15.0 0.08
 Average hours per day children attend, mean ± SD 10.5 ± 3.9 6.7 ± 2.8 <0.001*
 How often new equipment is purchased a 0.005*
  Every 6 months, n (%) 38 (54.3) 10 (25.0) 0.005**
  Every year, n (%) 22 (31.4) 20 (50.0) 0.07
  Every 2–3 yr, n (%) 6 (8.6) 6 (15.0) 0.35
  Every 5 yr, n (%) 3 (4.3) 0 (0.0) 0.55
  Less frequently than every 5 yr, n (%) 1 (1.4) 4 (10.0) 0.06
 How often planned field trips are taken 0.003*
  Weekly, n (%) 8 (11.4) 0 (0.0) 0.01
  Monthly, n (%) 11 (15.7) 11 (20.8) 0.49
  Quarterly, n (%) 9 (12.9) 12 (22.6) 0.23
  Yearly, n (%) 7 (10.0) 14 (26.4) 0.03
  Less than yearly, n (%) 6 (8.9) 1 (1.9) 0.24
  Never, n (%) 29 (41.4) 15 (28.3) 0.18
Outdoor and indoor environment
 Outdoor space for activity (range, 1–4), mean ± SD 4.0 ± 0.0 3.9 ± 0.4 0.15
 No. natural elements (max 10), mean ± SD 6.2 ± 2.3 4.7 ± 1.9 0.001*
  Active landscape features (max 5), mean ± SD 2.5 ± 1.3 2.0 ± 1.0 0.02*
  Attractive landscape features (max 4), mean ± SD 2.7 ± 1.3 2.1 ± 1.3 0.01*
 Portable or fixed equipment (max 30), mean ± SD 18.2 ± 4.3 16.3 ± 4.6 0.02*
  Variety of portable equipment (max 6), mean ± SD 4.5 ± 1.2 4.8 ± 1.3 0.19
  Activity-promoting fixed equipment (max 11), mean ± SD 5.2 ± 2.1 4.7 ± 2.0 0.21
  Creative fixed equipment (max 5), mean ± SD 3.5 ± 1.1 2.4 ± 1.4 <0.001*
 Indoor space for activity (range, 1–5), mean ± SD 3.8 ± 0.9 3.5 ± 0.9 0.06
 Television, computers, DVD, video games (max 3), mean ± SD 2.5 ± 1.0 1.8 ± 0.7 0.006*
 Quality (max 50), mean ± SD 30.6 ± 11.0 39.5 ± 7.6 0.001*
*P < 0.05 for overall tests.
**P < 0.01 for post hoc tests.
aA subset of 13 respondents from licensed centers did not receive this question because they were only a teacher at a licensed center with no director role.

Licensed centers were rated higher by the GSQ quality program than home-based programs (39.5 vs 30.6 out of 50; P < 0.001). Across all programs, quality was significantly and positively related to number of pieces of portable or fixed equipment (P = 0.02; r = 0.23), but inversely related to indoor time for PA (P = 0.01; r = −0.37), duration of teacher-led activity (P < 0.001; r = −0.52), and television time (P = 0.01; r = −0.64). For home-based programs, quality was significantly and positively related to portable or fixed equipment (P = 0.02; r = 0.36), but inversely related to indoor time for PA (P = 0.01; r = −0.28), duration of teacher-led activity (P < 0.001; r = −0.48), and television time (P = 0.01; r = −0.61). For licensed centers, quality was significantly and positively related to active landscape features (P = 0.04; r = 0.47), but inversely related to nap time (P = 0.03; r = −0.48). Full correlation matrices for all programs, home-based programs, and licensed centers are found in Supplemental Contents 6–8 (tables, https://links.lww.com/TJACSM/A167; https://links.lww.com/TJACSM/A168; https://links.lww.com/TJACSM/A169).

Children attended home-based programs for more hours per day (+3.8; P < 0.001), so analysis corrected for this difference (Table 2). Despite this correction, home-based programs provided more indoor time for PA (P = 0.04) and nap (P = 0.02), but similar outdoor and television time compared with licensed centers. Home-based programs reported longer bouts of indoor, teacher-led activity (P < 0.001), and higher levels of PA while indoors compared with licensed centers (4.5 vs 4.0 out of 7; P = 0.03), with no differences in the amount of time, teacher-led activity, or PA levels while outdoors.

TABLE 2 - Indoor and Outdoor physical activity (PA), Television and Nap Time, and Teacher-Led Activity.
Home-Based (n = 70) Licensed Center (n = 54) P
Indoor time today
 Indoor activity level (range, 1–7) 4.5 ± 1.3 4.0 ± 0.9 0.03*
 Time for PA (min·d−1) 48.4 ± 45.0 18.1 ± 11.6 <0.001*
 Corrected activity time (min·h−1) 5.0 ± 5.1 2.9 ± 2.9 0.04*
 Teacher-led activity (instances per day) 2.5 ± 1.5 2.3 ± 1.5 0.57
 Teacher-led activity (minutes per instance) 16.1 ± 9.5 10.0 ± 5.7 <0.001*
 Television time (min·d−1) 36.1 ± 20.4 16.7 ± 2.9 <0.001*
 Corrected television time (min·h−1) 3.9 ± 2.5 2.9 ± 1.8 0.51
 Nap time (h·d−1) 1.8 ± 0.6 1.0 ± 0.8 <0.001*
 Corrected nap time (min·h−1) 10.7 ± 3.9 7.6 ± 7.2 0.02*
Outdoor time today
 Outdoor activity level (range, 1–7) 6.2 ± 1.0 6.4 ± 0.9 0.26
 Time for PA (min·d−1) 98.3 ± 64.3 67.8 ± 47.7 0.008*
 Corrected time (min·h−1) 9.9 ± 6.6 11.8 ± 11.4 0.30
 Teacher-led activity (instances per day) 2.0 ± 0.9 2.3 ± 1.1 0.29
 Teacher-led activity (minutes per instance) 15.1 ± 7.5 12.8 ± 10.0 0.34
*P < 0.05.
Data are shown as mean ± SD.

Barriers to promoting PA are reported in Table 3. The most commonly reported barrier to promoting PA in both program types was the cost of new equipment (82.9%–87.8% reported that it was somewhat of or a major barrier). More respondents from home-based programs reported that space to do activities was not a barrier compared with licensed centers (P < 0.001), whose respondents more frequently reported that this was a major barrier (P < 0.001).

TABLE 3 - Reported Barriers to Promoting physical activity (PA) in Home-Based and Licensed Programs.
Barriers to Promoting PA Home-Based, n (%) Licensed Center, n (%) P
Learning about new activities 0.18
 Not a barrier or not applicable 63 (90.0) 32 (78.0)
 Somewhat of a barrier 6 (8.6) 9 (22.0)
 Major barrier 1 (1.4) 0 (0.0)
Space to do all activities you would like to do <0.001*
 Not a barrier or not applicable 50 (71.4) 12 (29.3) <0.001**
 Somewhat of a barrier 17 (24.3) 18 (43.9) 0.06
 Major barrier 2 (2.9) 11 (26.8) <0.001**
Time spent reviewing PA information 0.12
 Not a barrier or not applicable 52 (74.3) 24 (58.5)
 Somewhat of a barrier 15 (21.4) 15 (36.6)
 Major barrier 2 (2.9) 2 (4.9)
Fitting new physical activities into existing schedule 0.09
 Not a barrier or not applicable 51 (72.8) 23 (56.1)
 Somewhat of a barrier 16 (22.9) 13 (31.7)
 Major barrier 2 (2.9) 5 (12.2)
Cost of new materials and equipment used in activities 0.45
 Not a barrier or not applicable 10 (14.3) 5 (12.2)
 Somewhat of a barrier 31 (44.3) 16 (39.0)
 Major barrier 27 (38.6) 20 (48.8)
Children’s preferences to not participate 0.80
 Not a barrier or not applicable 41 (58.5) 26 (63.4)
 Somewhat of a barrier 25 (35.7) 14 (34.1)
 Major barrier 3 (4.3) 1 (2.4)
Parent preferences about child’s participation in activities 0.11
 Not a barrier or not applicable 54 (77.1) 33 (80.5)
 Somewhat of a barrier 16 (22.9) 7 (17.1)
 Major barrier 0 (0.0) 1 (2.4)
My own physical limitations 0.16
 Not a barrier or not applicable 58 (82.8) 39 (95.1)
 Somewhat of a barrier 11 (15.7) 2 (4.9)
 Major barrier 1 (1.4) 0 (0.0)
Licensing requirements regarding supervision 0.28
 Not a barrier or not applicable 39 (55.7) 29 (70.7)
 Somewhat of a barrier 24 (34.3) 11 (26.8)
 Major barrier 5 (7.1) 1 (2.4)
The weather 0.57
 Not a barrier or not applicable 12 (17.1) 6 (14.6)
 Somewhat of a barrier 43 (61.4) 28 (68.3)
 Major barrier 14 (20.0) 7 (17.1)
Safety concerns or considerations 0.21
 Not a barrier or not applicable 37 (52.9) 20 (48.8)
 Somewhat of a barrier 26 (37.1) 19 (46.3)
 Major barrier 6 (8.6) 2 (4.9)
A subset of 13 respondents from licensed centers did not receive this question because they were only a teacher at a licensed center with no director role.
*P < 0.05 for overall tests.
**P < 0.017 for post hoc tests.

DISCUSSION

We compared the PA environment and practices in home-based childcare programs and licensed centers across Michigan. Respondents from home-based programs reported having more provided/available equipment and natural elements, indoor time for PA, and indoor teacher-led activity compared with licensed centers. These key differences by program type may impact children’s opportunity for and participation in PA while in childcare.

Children in programs with more college-educated teachers have been shown to participate in more outdoor moderate-to-vigorous activity (22), so the higher levels of education reported by respondents from licensed centers in the present and prior (15) research could have implications for PA. However, we found no difference in respondents’ experience working in early childcare or prior PA training, which are alternative forms of education that may be important for promoting PA (4,23) that have not been compared between home-based and licensed centers (15,18). Best-practice guidelines recommend that staff receive PA training at least twice per year (23). A previous study in Delaware of family childcare providers reported that 86% had PA training in the last 12 months, compared with 43% of licensed childcare providers (8). In the present study, only 30% (home) and 21% (licensed) of respondents had this training in the last 12 months. Of note, participation in PA-related training in the Delaware study may have been high because of a statewide training program (24). Future research should explore if and why PA training is less common in Michigan and the potential impact of training or other prior noncollegiate experience on a provider’s promotion of PA.

There were several differences in the indoor and outdoor environment between home-based and licensed centers that may impact children’s PA levels. Provision of adequate space to be active has an important influence on children’s PA levels (6,23,25), and previous studies have concluded that home-based programs have inadequate indoor space for activity (6). However, we report no difference between home-based and licensed centers, with both types of programs reporting just above “room for limited movement activities.” Home-based programs were more likely than licensed centers to report that space to do activities was not a barrier to promoting PA. This may be because licensed centers are constrained to one classroom per group of children, whereas home-based programs could use their entire home. It would be of interest to conduct in-person audits to assess what spaces home-based programs are using for PA and determine if this space is indeed adequate for promoting PA, as suggested by our findings. Of note, our findings may not be replicated in other states that have fewer regulations for home-based programs regarding indoor and outdoor space (19).

Home-based programs also had more activity-promoting and attractive natural elements, a construct not previously studied in this setting. This warrants further investigation because exposure to natural environments has a host of benefits in young children, from reduced stress (26) to more complex play (e.g., group sociodramatic play with a sustained theme and/or symbolism) (27) and improved motor skill development (28). Studies should assess whether children in home-based programs have greater direct interaction with or exposure to natural environments, potentially using direct observation. All respondents in the present study completed the survey in the spring/summer of the same year, so differences in the presence of natural elements by program type are not likely to be attributable to varying environmental conditions.

We reported that home-based programs had more fixed and portable equipment overall, which contrasts with Tandon et al. (15), who conducted telephone interviews with childcare programs and reported that fewer home-based programs had a variety of portable and fixed play equipment compared with licensed centers. However, in the present study, we used a list of 30+ types of portable and fixed equipment from the EPAO-SR, whereas prior research used a more limited list (15,17). Although we did not compare each piece of equipment statistically, there are some interesting results that warrant confirmation by future studies. For example, a similar proportion of home-based and licensed programs report having a tricycle track or paved area (67% vs 63%), which have been shown to promote PA (25), but a greater proportion of home-based programs had riding toys like tricycles, cars, or scooters (90% vs 65%). Thus, children in these programs may use these spaces differently, impacting PA participation.

Home-based programs also reported more frequently purchasing equipment in the last 6 months compared with licensed centers. Although there is no research to support this, it may be that home-based providers are more likely to purchase small items when they see them, whereas teachers at licensed centers must abide by more strict budgets or procedures. Interviews or audits would allow us to identify if response bias was present and would provide information about how, when, and what type of equipment is being purchased.

Regardless of program type, the cost of equipment was the biggest barrier to promoting activity, which is in line with previous research in licensed (29) and home-based (30) programs. A review by Larson et al. (31), called for more research on barriers to PA in home-based childcare programs, and our findings support that barriers may not be the same between different types of programs. There may also be barriers that were not captured by the present study. For example, home-based programs typically have a greater age range compared with centers, and this has been cited as a barrier to promoting PA in all children (30). A follow-up with a selection of programs would provide further insight into how these barriers are or could be overcome by programs.

Little research has directly compared indoor and outdoor PA by program type. In this study, home-based programs and licensed centers reported similar amounts of outdoor time when overall time was accounted for, in line with prior research (15) and state recommendations (30 min of outdoor time per 3 h of attendance) (19). Indoors, respondents from home-based programs reported higher levels of activity, more active play opportunities, and longer bouts of teacher-led activity. The greater amount of teacher-led activity in home-based programs compared with licensed centers is supported by a previous study, although their findings were not statistically significant (15). Researchers have also reported that few home-based childcares have adequate indoor space for activity (6), but it may be that these programs are compensating for this lack of space by providing more opportunities for and more directed activity. These differences could contribute to the higher levels of PA in home-based programs reported in prior research (32). More research should be done to verify these findings using direct observation or accelerometry, further characterize how children spend their time indoors at home-based and licensed centers, and explore how teachers are facilitating PA.

Although home-based programs reported more opportunity for indoor PA compared with licensed centers, they also incorporated more television time and have more screen-time equipment. This is unsurprising as state licensing policies allow home-based childcare programs to provide more screen time activities to children compared with licensed centers (2 h·d−1 vs 2 h·wk−1) (19). Compared with the present study, which only assessed television time, a study by Tandon et al. (16) reported even higher overall screen times in home-based programs (1.8 h) and even lower screen times in licensed centers (0.1 h). Another study reported that children in home-based programs participated in more television time compared with centers (15). Importantly, although we found that home-based programs reported twice as much television time overall, accounting for the fact that children attended home-based programs for, on average, 3.8 more hours per day eliminated this effect. This is supported by Christakis et al. (33), who reported that increased hours of operation was related to greater television time during childcare. Future studies should quantify multiple types of screen time and explore the impact of associated additional sedentary time on long-term health behaviors or outcomes.

Finally, we found that licensed centers tended to be rated as higher quality compared with home-based programs according to the state’s GSQ rating system, which is of interest because quality has been consistently related to children’s PA (4) and other outcomes, like school readiness (34). Importantly, GSQ uses separate standards for each program type (20), so differences in quality are not due to home-based programs being unable to meet the standards set for licensed centers. For example, all classrooms at a licensed center must have lead teachers with at least a bachelor’s degree in early childhood education or development to receive full points for that indicator. The lead provider at a home-based program can have a bachelor’s degree in any field as long as they have 30 h of courses in child development and 480 h of experience to receive full points for that indicator. Thus, the two types of programs are held to slightly different standards. Despite being rated as lower quality (according to GSQ), home-based programs have many attributes that are beneficial to PA, like more field trips (22), natural elements (35), equipment (4–6), indoor time for activity (4), and teacher-led activity (36). Further analysis indicated that the GSQ quality score was inversely related to some beneficial outcomes like indoor time for PA and teacher-led activity. Although the GSQ quality score is meant to be a general indication of overall program quality, future work could aim to improve this quality score to better reflect the PA environment.

The biggest limitations of this study were the reliance on teacher/director report and low response rate. The low response rate was unsurprising because the email addresses we used to send the survey were not provided for the purpose of research recruitment, so were often out of date or targeted the wrong audience. We downloaded the list of childcare programs at the end of 2016, so programs may have opened, closed, or changed their contact information before the survey was distributed in 2018. Email addresses may also have belonged to an administrative individual who did not forward the email to the appropriate person. For example, in licensed centers that are part of a larger group or school system, the email address could be the same for all individual programs or schools and would be for an administrative office instead of a specific director or teacher. Similarly, email addresses were often for individuals who only served as directors and could not be included because they are not directly involved in classroom activities.

This information is useful to consider for similar future studies; Web-only surveys distributed using email addresses readily available online may not be the ideal way to reach many childcare programs, particularly if one wants to include teachers. Our approach using postcards to solicit additional emails had a low return rate, so alternative approaches to reaching programs are needed (e.g., phone calls). A random sample stratified by variables like program type, size, and geographic location would be ideal. Prior studies with similar methodology were often conducted in conjunction with statewide licensing agencies. Although this has likely made response rates higher, there may be less social desirability bias in the present study because respondents knew we had no association with governing bodies (e.g., when reporting less than the required amount of outdoor time). Despite any response rate issues, we were able to include a variety of childcare program types (e.g., religious, Montessori) across the entire state (Fig. 1), which improves generalizability.

Differences between home-based and licensed programs should be confirmed with in-person observations, and this study should be replicated elsewhere, because licensing guidelines vary (11). Although some states have less strict or fewer regulations for home-based programs (12), Michigan’s regulations are fairly equitable by program type (19). Although it was not our purpose to assess the impact of state policy, this may be why so many home-based programs offered adequate outdoor and indoor time for activity in the present study, and there may be differences in home-based programs in other states. Adherence to state policy and implementation of policies at the childcare level should be further explored. Overall, more research that directly compares home-based and licensed centers in a variety of policy environments is needed, as differences in the environment and opportunity for activity will directly impact the millions of children who regularly attend nonrelative childcare programs.

It is well known that PA in young children has both short- and long-term benefits such as promoting PA across the life span, motor skill development, and reduced adiposity (1). Because young children attend a variety of childcare program types, including home-based programs and licensed centers, teachers or directors should consider the PA environment that is being cultivated at their school, and state officials should consider how resources could be allocated to ensure that all schooling types are receiving the information and materials they need to promote PA. Specifically, teachers in all types of programs may benefit from PA training for young children or equipment-free ways to promote PA. Although it can be difficult when children attend programs for many hours a day, teachers/directors in home-based programs should seek out alternatives to screen time. Teachers/directors at licensed centers should consider changes to their daily schedule to allow for more opportunities for indoor PA, in line with PA recommendations.

The authors wish to thank Shannon Bradley for her assistance with data collection. The results of the present study do not constitute endorsement by the American College of Sports Medicine.

The authors have no conflicts of interest to declare. This work was supported by a Student Award Program grant from the Blue Cross and Blue Shield of Michigan Foundation (2503.SAP).

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