Ohio Healthy Programs:

Building Evidence Towards Healthy Development in Early Childhood

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Early Ages Healthy Stages
(EAHS), works to ensure that all early care and education programs are healthy in Cuyahoga County. EAHS’ multi-sector partnerships have been working to prioritize early childhood health and wellbeing issues since 2016.

Childhood obesity remains a public health crisis. Rates of childhood obesity continue to increase, especially among children ages 2-5. Early Care and Education (ECE) programs have been targeted as a key intervention setting to address this growing concern. Use of high-impact nutrition and physical activity policies within ECEs has been demonstrated to reduce childhood obesity.

Despite the identification of evidence-based practices, there has been limited improvement uptake of these polices within the ECE setting. This lack of improvement has been documented in several national reports from the Centers for Disease Control and Prevention (CDC), Robert Wood Johnson Foundation (RWJ), and the National Resource Center for Health and Safety in Child Care and Early Education (NRC).

This is a call to action! States and communities need to act now to prioritize the health of young children. EAHS is uniquely positioned to maximize opportunities and provide leadership on early childhood prevention efforts.


CDC Report Card Grade for Ohio:

Ohio received an “F” on the 2020 Licensing Scorecard from the Center for Disease Control. This scorecard was first released in 2010 and since that time there has been minimal progress in improving nutritional and physical activity standards for ECE programs across the state.

In 2019, 85% of high-impact obesity prevention standards were unmet by Ohio licensing regulations for child care centers.

There was a decrease in overall score on the CDC’s Scorecard between 2010 and 2019 — from 55/100 to 49/100

In 2019, Ohio received an overall score of 49/100 in licensing regulations among ECE programs for policies and practices that support healthy eating and physical activity.

This is below the national average score of 64/100.

The most glaring challenges were related to high-impact nutritional standards, which include nutrition and healthy meal-time practices.

In 2019, only 14% of national nutritional standards were met for regulations associated with all child care types.

In 2010, 19% of these same standards were met.

Between 2010 and 2019, 38% of the nutritional standards decreased in quality rating for all child care types.


of OHP (Ohio Healthy Program) Creates Broader ECE Support in Cuyahoga County

Participation in OHP Increases the Number of Healthy Policies!
To measure how well OHP is addressing the nutritional standard gap, EAHS tracked the number of healthy policies before and after participation in OHP. These healthy policies are in alignment with high-impact strategies for nutrition and physical activity.

OHP is a statewide program designed to reduce and prevent childhood obesity through the adoption of high-impact strategies for nutrition and physical activity within ECE programs.

Between 2017 and 2019 there were 80 ECE programs participating in OHP for the first time.

These ECE programs were a combination of:

  • Home-based. . . . . . 57.5%
  • Center-based.. . . . 42.5%

ECE program capacity varied greatly from large centers to small home-based care in this program.

On average, each ECE received two in-person technical assistance (TA) visits. Remote TA communication (phone calls, emails, etc.) were also recorded. On average, each ECE program had five remote TA communications in addition to the two in-person visits.

Table I. Change in Number of Healthy Policies

Overall Number of Healthy Policies Mean
PreTest 10.9
PostTest 15.0
Change 4.1***
Number of Nutrition Policies Mean
PreTest 4.1
PostTest 7.2
Change 3.0***
*** p < 0.001

DETERMINATION: OHP significantly increases ECE use of high-impact nutrition standards.

On average, ECE programs adopted four healthy policies.

Of those policies,
an average of 3/4 were nutritional policies.


Makes Written Healthy Policies More Comprehensive!

Knowing the importance of evidence-based tools, EAHS has also collected data using the WellCCAT, an established measure that explores the quality of written physical activity and nutrition policies within ECE programs.

Comprehensiveness refers to the extent to which an ECE handbook mentions elements of policy in five broad categories:

  1. Nutritional Education
  2. Food and Beverage
  3. Promoting Healthy Eating
  4. Physical Activity
  5. Communication and Evaluation

Over 60% of ECE programs improved policies in Food and Beverage or Promoting Healthy Eating

WellCCAT scores in all five categories were significantly higher after OHP participation. WellCCAT stands for Wellness Child Care Assessment.

Table II. Change in the Comprehensiveness of Healthy Policy Based on WellCCAT Scores

Percentage of ECE programs with Change
Overall Scores.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96.3%

Nutritional Education 31%
Food and Beverage 68%
Promoting Healthy Eating 80%
Physical Activity 14%
Communication and Evaluation 15%
Overall Comprehensive Score Median
PreTest 21.6 PostTest   37.5
Change 6.6***
Nutritional Education
PreTest 0.0 PostTest   20.0
Change 20.0***
Food and Beverage
PreTest 10.0 PostTest   40.0
Change 25.0***
Promoting Healthy Eating
PreTest 19.4 PostTest   37.5
Change 12.5***
Physical Activity
PreTest 41.7 PostTest   45.8
Change 16.7***
Communication and Evaluation
PreTest 25.0 PostTest   25.0
Change 12.7***
** p < 0.01     *** p < 0.001

DETERMINATION: Participation in OHP significantly increases ECE written policies in all categories of
the evidence-based WellCCAT tool.



National recommendations, coupled with data related to the implementation of OHP, provide a roadmap for prioritizing nutrition and physical activity for young children.

National key policy recommendations include:

  1. Adopt healthy eating and physical activity standards in ECE.
  2. The Child and Adult Care Food Program (CACFP) should continue to fund nutrition and wellness education and program efforts.
  3. The Centers for Disease Control and Prevention’s (CDC) Division of Nutrition, Physical Activity, and Obesity should have adequate resources to support all 50 states to implement multi-sector campaigns to address obesity.

Local action must be taken to create alignment with these national recommendations.

  1. Adopt OHP recommendations in licensing and Step Up to Quality as Ohio’s nutrition and physical activity standards.
  2. Leverage existing OHP networks and grassroots efforts in statewide expansion.
  3. Encourage all OHP-designated programs to participate in CACFP.
  4. Work with state partners to ensure Ohio better aligns with the CDC high impact obesity prevention standards.
  5. Explore opportunities to leverage existing local and state CDC funding opportunities to support broad implementation of OHP.

EAHS recognizes these opportunities for improving Ohio’s approach to childhood obesity and is positioned to advocate for a strong foundation of health for our young children.



Advocate for Ohio Healthy Program! 

Promote the designation through your networks OR require the programs in your network to get

Join our coalition’s efforts

to address the health and well-being of young children in Cuyahoga County!

Advocate for change

through the adoption or nutrition and physical standards in Ohio’s Step Up to Quality Rating System.


Centers for Disease Control and Prevention. 2020. Ohio State Licensing Scorecard: Obesity Prevention in Center-Based Child Care. Retrieved from: https://www.cdc.gov/obesity/strategies/early-care-education/scorecards/2020/ohio.pdf

National Resource Center for Health and Safety in Child Care and Early Education. 2020. Achieving a State of Healthy Weight 2019 Supplement: State Profile Pages for Child Care Centers. Aurora, CO: University of Colorado Denver. Retrieved from: https://nrckids.org/files/Final.ASHW.2018.Supplement_8.19.19.pdf

Robert Wood Johnson Foundation. 2020. State of Childhood Obesity: Prioritizing Children’s Health During the Pandemic. Retrieved from: https://media.stateofobesity.org/wp-content/uploads/2020/10/13205332/State-of-Childhood-Obesity-10-14-20-Final-WEB.pdf

J. Song, A. Patrick, and K. Knight (February 2021). Data Brief: Ohio Healthy Programs: Building Evidence Towards Healthy Development in Early Childhood. Cleveland, Ohio: Cuyahoga County Board of Health.

This data brief is a product of collaboration between the Cuyahoga County Board of Health and researchers at the Kent State University College of Public Health. This work was supported in part by a grant from the Mt.Sinai Health Care Foundation. The funders were not involved in the study conception, research design, data collection, analysis, manuscript writing, or in the decision to submit the article for publication.

Ohio Healthy Programs:

Building Evidence Towards Healthy Development in Early Childhood