Train-the-Trainer (TTT) methodology uses an expert to train a non-expert on how to implement an intervention and is often used by Cooperative Extension personnel for delivery of programs in the natural setting. In these interventions using multiple educators and/or non-experts, a measure of implementation (fidelity of implementation) is necessary…

Background: Long-term evaluation studies reveal that high-quality early care and education (ECE) programs that include a lifestyle component predict later adult health outcomes. The purpose of this article is to characterize the nutrition and physical activity (PA) practices, including implementation difficulty and barriers, of licensed center-…