In the 1990s, states began developing Quality Rating and Improvement Systems (QRIS) as a structural approach to improve the quality of early care and education (ECE) programs. Nemours’ experience implementing obesity prevention efforts in nine states has demonstrated that QRIS systems may be leveraged to promote childhood obesity prevention in addition to school readiness and other child outcomes. The goal of this project is to examine opportunities to promote best practices for healthy eating, breastfeeding, and physical activity (HEPA) in state QRIS implementation. The Institute of Medicine Roundtable on Obesity Solutions, Early Childhood Innovation Collaborative serves as the Advisory Committee and expert consultants provide guidance to the project team. A survey of the 44 states and the District of Columbia that are implementing a QRIS will be conducted to gather information on implementation strategies (i.e., training, technical assistance, professional development) that promote HEPA best practices in ECE settings. Survey results will be analyzed to identify 10-15 states with promising strategies, and key informant interviews will provide data for the development of detailed case profiles. A final report will provide aggregated and disaggregated survey findings, state case studies, policy implications, and recommendations for the field.