The first is the ANGELO-ANalysis Grid for Environments Linked to Obesity-framework, which we used to classify the obesogenic attributes within the physical (what's available in and outside the FCCH, including education and training opportunities), sociocultural (i.e., culture around feeding practices, mealtime environment), and policy (child care policies to ensure best practices and to prevent obesity in the FCCH) environment .
Table 1 displays the policy, physical, and sociocultural FCCH environment assessment results.
FCCH providers have the opportunity to have written nutrition and physical activity policies.
Only three studies examined the sociocultural environment in the FCCH setting [17, 27, 29].
Overall, two studies showed that there were poor attitudes among providers regarding parents and parents' role in fostering a healthy environment in the FCCH setting [18,24].
There were inconsistent perceptions of what was considered normal weight among FCCH providers [16,18].
However, FCCH providers also believed that both the center-based providers and FCCH providers have an equal share of influence on physical activity behavior .
Three studies addressed providers' perceived strategies to improve the FCCH environment [18, 24, 28].
FCCH providers knew more of the rules on best nutrition practices than center-based providers in the State of Delaware (18 versus 14.7, p < 0.001) .
Although not directly tested for their moderation effects, this review suggests that there are certain neighborhood, FCCH/facility level, provider, and child-level characteristics that may confound relationships between the environment and EBRBs within the FCCH context.
When adjusting for the income zone of the neighborhood in which centers and FCCHs are located, indoor and outdoor physical activity and television-use practices remained significantly different between FCCHs and centers, with fewer FCCH providers providing best practices in these areas (p < 0.05) .