This project studied the extent to which a successful state-sponsored program to improve the activity and nutrition environments of schools can be adapted successfully for child care centers. Investigators evaluated the state-sponsored policy intervention that began in Montgomery County (Ohio) child care centers in April 2009. This natural experiment was timed such that investigators could evaluate the efficacy and effectiveness of the intervention in the pilot county, using a nearby, demographically-matched control county (slated for a later roll-out of the same intervention) for comparison. The target study population for this work included 162 licensed full-time child care centers in Montgomery County and 209 licensed full-time centers in demographically similar Hamilton County. The main outcome assessed was the six-month change in an overall Physical Activity and Nutrition Score that reflects 24 environment characteristics addressed by the intervention. The impact of key covariates, such as race, on intervention effectiveness and participation was also explored. In addition, investigators conducted qualitative one-on-one interviews with directors of non-participant centers serving primarily low-income clientele in Montgomery County to assess barriers to participation.This study is funded jointly by Active Living Research and Healthy Eating Research.