Healthy Start, Healthy State

Healthy Start, Healthy State 

Healthy Start, Healthy State logo, with the state of MN and a hand holding a child

Principal Investigator

Marilyn "Susie" Nanney, PhD, MPH, RD 


Katie Loth, PhD, MPH


Funding for this project is provided by the 
Center for Prevention at Blue Cross and Blue Shield of Minnesota.

Project Description

The Healthy Start, Healthy State study explored nutrition and physical activity practices in a sample of child care centers and family homes across the state of Minnesota through a comprehensive survey. The survey was a follow-up to a study conducted in 2010, called "Supporting Early Child Care Food and Activity Environments" through a partnership between University of Minnesota and University of Wisconsin, Madison. For the current study respondents of the 2010 survey, who were still in business were invited to complete the current survey, as well as a random sample of licensed child care providers (family and center based) in Minnesota. The survey was adapted from the original 2010 survey, through intensive stakeholder review and discussion. The study aims to understand the landscape of nutrition and physical activity practices, training and support among child care providers in MN, as well as any change in these categories from 2010 to 2016. Additionally, disparities by provider and family level income, race and education characteristics were explored. 

Research Measurement and Supporting Documents

Provider Survey

Map of 2010-2016 cohort of providers who completed 2016 survey

Map of total sample of providers who completed 2016 survey

Publications and Presentations

Presentation to MN Dept. of Education Child Nutrition Staff

Blog Post "University study: Minnesota childcare providers are fostering healthier environments"

Final Study Report: On the Road to a Brighter Future

Change in the implementation of healthy nutrition and physical activity best practices in Minnesota USA early care settings: a longitudinal cohort study (2010-2016). 
Nanney MS, Davey C, Mosbrucker S, Shanafelt A, Frost N, Anfinson A, Zauner M, Loth K. Preventative Medicine Reports, 2018(10):234-24.

What can be learned from existing investigations of weight-related practices and policies with the potential to impact disparities in U.S. child care settings? A narrative review and call for surveillance and evaluation efforts. Larson N, Looby AA, Frost N, Nanney MS, Story M. Journal of the Academy of Nutrition and Dietetics. 2017; 117(10): 1554-1557. 

Provider adherence to nutrition and physical activity best practices within early care and education settings in Minnesota, helping to reduce childhood health disparities.
Loth KA, Shanafelt A, Davey C, Anfinson A, Zauner M, Looby A, Frost N, Nanney MS. Health Education and Behavior, in press. Accepted for publication on May 2, 2018.

Public Health Support for Weight-Related Practices in Child Care Settings in Minnesota.
Pelletier J, Hassan A, Zukoski A, Loth KA. Health Promotion Practice, in press. Accepted for publication on May 2, 2018. 

Study Dataset

With the goal of improving the quality of child care settings in Minnesota and throughout the United States, the Healthy Start, Healthy State study team is open to sharing the data collected as a part of the study with interested advocates, policy makers and researchers.  If you would like access to the data, please contact Katie Loth ( to make your request.

Link to 2010 Study