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Dev DA, Hillburn C, Luxa J, Bauer KW, Lessard L, Cotwright C, Tovar A. Illuminating Child and Adult Care Food Program Partnerships That Improved Food Access and Waiver Utilization for Feeding Young Children in Early Care and Education Programs During COVID-19: A Qualitative Study. J Acad Nutr Diet 2024; 124:453-465. [PMID: 37832642 DOI: 10.1016/j.jand.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 09/27/2023] [Accepted: 10/05/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Little is known about the partnerships formed between early care and education (ECE) programs and the Child and Adult Care Food Program (CACFP) and other organizations to continue to feed young children during the COVID-19 pandemic. Such information can provide important lessons to build ECE capacity for feeding children during future emergencies and has the potential strengthen the ECE food systems. OBJECTIVE This study aimed to identify the unique partnerships that CACFP state agencies established to provide nutrition to young children during the COVID-19 pandemic DESIGN: Qualitative semi-structured interviews with 24 participants representing 21 states across the United States. PARTICIPANTS/SETTING Virtual interviews with CACFP directors from December 2020 through May 2021. ANALYSIS Following the realist method, transcripts were analyzed using thematic analysis. Codes were developed inductively and grouped to identify themes and subthemes. RESULTS Four themes were identified: (1) CACFP partnerships that supported children and families directly; (2) CACFP partnerships that built the capacity of ECE providers to provide food to children in their own settings; (3) CACFP systems-level partnerships that improved coordination of efforts to continue to feed children in ECE; and (4) CACFP directors encouraged other CACFP state agencies to build nontraditional, diverse partnerships that can be leveraged during pandemics and other natural disasters. Within these themes (subthemes), the purpose of the partnerships focused on improving waiver utilization (eg, Department of Transportation, state health departments), improving food access (eg, Summer Food Service Program [SFSP], food banks, grocery stores, dairy councils), supporting ECE programs to participate in food reimbursement programs (eg, SFSP, CACFP sponsors), and resource sharing (eg, coalitions, CACFP sponsors). CONCLUSIONS The CACFP state directors reported that existing and new partnerships between CACFP state agencies and external entities successfully facilitated feeding young children in ECE during the COVID-19 pandemic. States may consider developing a road map to proactively explore potential partners in their state to meet specific needs such as accessibility, availability, and affordability for feeding young children in ECE.
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Andreyeva T, Moore TE, Godoy LDC, Kenney EL. Federal Nutrition Assistance for Young Children: Underutilized and Unequally Accessed. Am J Prev Med 2024; 66:18-26. [PMID: 37709155 PMCID: PMC11000260 DOI: 10.1016/j.amepre.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION The federal Child and Adult Care Food Program (CACFP) improves nutrition and reduces food insecurity among young children by helping cover the food costs for child care providers and families. This nationwide study evaluated the extent and predictors of the CACFP's utilization among licensed child care centers to identify opportunities for expanding CACFP nutrition support. METHODS Administrative data from the CACFP and child care licensing agencies in 47 states and District of Columbia were compiled and geocoded for 93,227 licensed child care centers. CACFP participation was predicted using a multivariable Bayesian spatial logistic regression model in the sample of low-income areas to target CACFP eligible child care centers. Data were collected in 2020-2021 and analyzed in 2022. RESULTS Of all licensed child care centers, 36.5% participated in the CACFP, ranging from 15.2% to 65.3% across states; when restricted to low-income areas, 57.5% participated (range, 15.7%-85.7%). Income differences did not explain the large variation in CACFP participation rates across states. Having at least three CACFP sponsoring agencies per state predicted a 38% higher probability of CACFP participation (OR=1.38; 95% Credible Interval=1.08-1.78). CONCLUSIONS Currently CACFP participation rates among licensed child care centers point to program underutilization and unequal access, particularly in some states and regions. Work at the federal and state levels is warranted to expand participation in the program, above all in low-income areas, so that more young children could eat healthfully with the CACFP.
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Affiliation(s)
- Tatiana Andreyeva
- Department of Agricultural and Resource Economics, Rudd Center for Food Policy and Health, University of Connecticut, Storrs, Connecticut.
| | - Timothy E Moore
- Statistical Consulting Services, Center for Open Research Resources and Equipment, University of Connecticut, Storrs, Connecticut
| | | | - Erica L Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Zaltz DA. Leveraging the Child and Adult Care Food Program to Facilitate Healthy Behaviors and Environments in Early Care and Education Settings. Am J Public Health 2023; 113:S198-S201. [PMID: 38118093 PMCID: PMC10733884 DOI: 10.2105/ajph.2023.307482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 12/22/2023]
Affiliation(s)
- Daniel A Zaltz
- The author is with the Department of Nutritional Sciences, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
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Asada Y, Schermbeck R, Thiede K, Chriqui JF. Opportunities to Improve Access to and Retention in the Child and Adult Care Food Program: Key Recommendations From Early Childcare Providers in Illinois, December 2020-July 2021. Am J Public Health 2023; 113:S231-S239. [PMID: 38118081 PMCID: PMC10733880 DOI: 10.2105/ajph.2023.307433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 12/22/2023]
Abstract
Objectives. To identify recommendations to improve access to and retention in the Child and Adult Care Food Program (CACFP) as critical strategies to address health equity for low-income children. Methods. We conducted a qualitative key informant study of early childcare center and home providers (n = 35) in low-income urban and rural census tracts in Illinois between December 2020 and July 2021. Interviews with providers were organized and analyzed by the study team in MAXQDA Qualitative Data Analysis software. Themes were refined and finalized via member checking with an expert panel of providers and advocates. Results. Overall, providers spoke positively of the benefits of CACFP participation. Themes that centered around strategies to improve awareness of and access to CACFP included (1) conducting systematic statewide outreach, (2) improving technical assistance for enrollment, and (3) supporting positive sponsor-provider relationships. Themes related to retention included (1) alleviating procurement burdens, (2) extending reimbursement rates, and (3) expanding flexibilities. Conclusions. Policymakers looking to increase access to and retention in CACFP could consider state-level strategies such as systematic outreach and more targeted technical assistance. (Am J Public Health. 2024;113(S3):S231-S239. https://doi.org/10.2105/AJPH.2023.307433).
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Affiliation(s)
- Yuka Asada
- Yuka Asada is with the School of Public Health, University of Illinois, Chicago. Rebecca Schermbeck and Kendall Thiede are with the Institute for Health Research and Policy, University of Illinois, Chicago. Jamie F. Chriqui is with the Division of Health Policy Research, Institute for Health Research and Policy, and Department of Health Policy and Administration, School of Public Health, University of Illinois, Chicago. Yuka Asada is also a Guest Editor for this supplement issue
| | - Rebecca Schermbeck
- Yuka Asada is with the School of Public Health, University of Illinois, Chicago. Rebecca Schermbeck and Kendall Thiede are with the Institute for Health Research and Policy, University of Illinois, Chicago. Jamie F. Chriqui is with the Division of Health Policy Research, Institute for Health Research and Policy, and Department of Health Policy and Administration, School of Public Health, University of Illinois, Chicago. Yuka Asada is also a Guest Editor for this supplement issue
| | - Kendall Thiede
- Yuka Asada is with the School of Public Health, University of Illinois, Chicago. Rebecca Schermbeck and Kendall Thiede are with the Institute for Health Research and Policy, University of Illinois, Chicago. Jamie F. Chriqui is with the Division of Health Policy Research, Institute for Health Research and Policy, and Department of Health Policy and Administration, School of Public Health, University of Illinois, Chicago. Yuka Asada is also a Guest Editor for this supplement issue
| | - Jamie F Chriqui
- Yuka Asada is with the School of Public Health, University of Illinois, Chicago. Rebecca Schermbeck and Kendall Thiede are with the Institute for Health Research and Policy, University of Illinois, Chicago. Jamie F. Chriqui is with the Division of Health Policy Research, Institute for Health Research and Policy, and Department of Health Policy and Administration, School of Public Health, University of Illinois, Chicago. Yuka Asada is also a Guest Editor for this supplement issue
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Hall K, Geary N, Warnock AL, Dooyema C. Supporting Healthy Weight in Statewide Quality Rating and Improvement Systems: A Review of 2020 Standards and Comparison to 2015 Standards. Child Obes 2023; 19:541-551. [PMID: 36472466 PMCID: PMC10235206 DOI: 10.1089/chi.2022.0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Quality Rating and Improvement Systems (QRISs) are used to assess, improve, and communicate quality in early care and education (ECE) programs. One strategy for supporting healthy growth in early childhood is embedding nutrition, physical activity, infant feeding, and screen time content into state QRIS standards, using the Caring for Our Children high-impact obesity prevention standards (HIOPS) and the CDC Spectrum of Opportunities framework (CDC Spectrum). We assessed the number of obesity prevention standards in QRISs in 2020 and compared results to an analysis published in 2015. Methods: We collected state QRIS standards for ECE centers from March to April 2020. Two analysts coded documents for standards related to 47 HIOPS and 6 Spectrum areas. Results: Thirty-nine states and the District of Columbia had statewide QRISs in early 2020. Of these, 21 QRISs (53%) embedded 1 or more HIOPS, and 26 (65%) embedded 1 or more Spectrum components. On average, 6.9% of HIOPS were embedded in QRIS standards in 2020, an increase from 4.6% in 2015. Nine QRISs included more HIOPS in 2020 than in 2015. Five QRISs added 10% or more of the 47 HIOPS between 2015 and 2020. Physical activity and screen time standards continued to be most often included; infant feeding standards were least included. Conclusion: Obesity prevention components were embedded in three-quarters of state QRISs, and more were embedded in 2020 than in 2015, suggesting that QRISs can be levers for supporting healthy weight in ECE settings.
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Affiliation(s)
- Kelly Hall
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education (ORISE) Research Participation Program, Oak Ridge, TN, USA
| | - Nora Geary
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
- McKing Consulting Corporation, Atlanta, GA, USA
| | - Amy Lowry Warnock
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carrie Dooyema
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Ettinger de Cuba S, Bovell-Ammon A, Ahmad N, Bruce C, Poblacion A, Rateau LJ, Coleman SM, Black MM, Frank DA, Lê-Scherban F, Henchy G, Ochoa E, Sandel M, Cutts DB. Child Care Feeding Programs Associated With Food Security and Health for Young Children From Families With Low Incomes. J Acad Nutr Diet 2023; 123:1429-1439. [PMID: 37302653 DOI: 10.1016/j.jand.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 05/30/2023] [Accepted: 06/06/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND The Child and Adult Care Food Program is the primary national program that enables child-care settings to provide healthy meals for children. Associations between Child and Adult Care Food Program participation and child health and development and health care utilization are understudied. OBJECTIVE To assess associations between children's health, development, health care utilization and food security by meal source (child-care-provided vs parent-provided) among children from low-income families with a child care subsidy attending child-care in settings likely eligible to participate in Child and Adult Care Food Programs. DESIGN The study used repeat cross-sectional surveys (new sample at successive time points) conducted year-round. PARTICIPANTS AND SETTING Primary caregivers of 3,084 young children accessing emergency departments or primary care in Baltimore, MD; Boston, MA; Little Rock, AR; Minneapolis, MN; and Philadelphia, PA, were interviewed between 2010 and 2020. The sample was limited to children aged 13 to 48 months, receiving a child care subsidy and attending child-care centers or family child-care homes ≥20 hours per week. MAIN OUTCOME MEASURES Outcomes included household and child food security; child health, growth, and developmental risk; and admission to the hospital on the day of the emergency department visit. STATISTICAL ANALYSES Meal source and participant characteristics were analyzed using χ2 tests; associations of outcomes with parent-provided meals were analyzed with adjusted logistic regression. RESULTS The majority of children had child-care-provided meals (87.2% child-care-provided vs 12.8% parent-provided). Compared with children with parent-provided meals, children with child-care-provided meals had lower adjusted odds of living in a food-insecure household (adjusted odds ratio 0.70, 95% CI 0.55 to 0.88), being in fair or poor health (adjusted odds ratio 0.61, 95% CI 0.46 to 0.81), or hospital admission from the emergency department (adjusted odds ratio 0.59, 95% CI 0.41 to 0.83), with no differences in growth or developmental risk. CONCLUSIONS Compared with meals provided from home, child-care-provided meals likely supported by the Child and Adult Care Food Program are related to food security, early childhood health, and reduced hospital admissions from an emergency department among low-income families with young children.
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Affiliation(s)
- Stephanie Ettinger de Cuba
- Children's HealthWatch, Boston Medical Center, Boston, Massachusetts; Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts; Department of Pediatrics, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts.
| | | | - Nayab Ahmad
- Children's HealthWatch, Boston Medical Center, Boston, Massachusetts
| | - Charlotte Bruce
- Children's HealthWatch, Boston Medical Center, Boston, Massachusetts
| | - Ana Poblacion
- Children's HealthWatch, Boston Medical Center, Boston, Massachusetts
| | - Lindsey J Rateau
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Sharon M Coleman
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, (6)RTI International, Research Triangle Park, North Carolina
| | - Deborah A Frank
- Department of Pediatrics, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Félice Lê-Scherban
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania; Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | | | - Eduardo Ochoa
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Megan Sandel
- Department of Pediatrics, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Diana B Cutts
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Hennepin County Medical Center, Minneapolis, Minnesota
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Patel D, Sisson SB, Sleet K, Rickman R, Love C, Taniguchi T, Sisk M, Jernigan VBB. Changes in Meal and Menu Quality at Early Care and Education Programs after Training with Food Service Staff: the FRESH Study. Curr Dev Nutr 2023; 7:100040. [PMID: 37181935 PMCID: PMC10111590 DOI: 10.1016/j.cdnut.2023.100040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 02/22/2023] Open
Abstract
Background Prevalence of obesity in Native American (NA) children is disproportionately high, indicating a higher risk of health disparities. Many children attend early care and education (ECE) programs, presenting an opportune environment to improve meal and menu quality as the intake of healthy foods is associated with lowered risk of childhood obesity. Objectives We aimed to examine the effectiveness of food service staff training on meals and menu quality across NA ECEs. Methods Food service staff from 9 participating ECE programs attended a 3-h training focused on Child and Adult Care Food Program (CACFP) best practices, and received a tailored, best-practice menu, and healthy recipes. Meals and menus prepared across 1 wk were examined per CACFP serving size assumptions at baseline, 4 mos, 6 mos, and 12 mos for all 9 programs. Healthy Eating Index (HEI), CACFP requirements and best practices achievement, and food substitutions quality (classified into superior, equivalent, and inferior based on the nutritional quality) were calculated. A repeated measures ANOVA model was used to determine the differences across time points. Results The total meal HEI score increased significantly from baseline to 4 mos (71.1 ± 2.1; 78.6 ± 5.0; P = 0.004), but did not differ from baseline to 12 mos. Menu CACFP requirements and best practices achievement did not differ across time points, although achievement with CACFP requirements was already high at baseline. Superior nutrition quality substitutions declined from baseline to 6 mos (32.4 ± 8.9; 19.5 ± 10.9; P = 0.007); however, it did not differ from baseline to 12 mos. Equivalent and inferior quality substitutions did not differ across time points. Conclusions Implementing a best-practice menu with healthy recipes showed immediate improvements in meal quality. Although the change did not sustain, this study showed evidence of an opportunity to educate and train food service staff. Robust efforts are needed for improving both meals and menus.This trial was registered ClinicalTrials.gov as NCT03251950 (https://clinicaltrials.gov/ct2/show/NCT03251950?cond=food+resource+equity&draw=2&rank=1).
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Affiliation(s)
- Divya Patel
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Susan B. Sisson
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kaysha Sleet
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- University Medical Center, Lubbock, TX, USA
| | - Rachel Rickman
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, USA
| | - Charlotte Love
- School of Health Care Administration, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Tori Taniguchi
- Center for Indigenous Health Research and Policy, Oklahoma State University, Tulsa, OK, USA
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Payes RM, Chong C, Botsko C. Improving child care through healthy eating and physical activity. Curr Opin Pediatr 2023; 35:2-7. [PMID: 36301264 DOI: 10.1097/mop.0000000000001188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW Most young children in the United States spend a significant portion of their time in early care and education (ECE) settings, commonly known as child care. This review highlights recent literature to support a continued focus and increased investment in embedding nutrition and physical activity standards within ECE settings and systems as a critical strategy for child obesity prevention. Pediatricians can support the promotion of these standards by understanding their local child care settings and sharing information with families about the importance of healthy eating and physical activity in early childhood. RECENT FINDINGS The child care sector is fragile and complex, but quality improvement efforts have been successful in improving healthy eating and physical activity. Diverse child care providers, including family child care homes, can effectively embed nutrition and physical activity standards in their environments to promote healthy eating and active play, limit screen time, and support breastfeeding families. A small but growing body of evidence also demonstrates how these standards can be embedded in broader state systems to stimulate change across a state. SUMMARY The literature demonstrates progress supporting diverse child care settings to embed high-impact standards into their environments. There is a small but growing body of evidence around systems-change efforts as well. Greater attention is needed on embedding physical activity standards in facilities, especially family child care homes, and state systems.
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He Y. Impact of coronavirus disease 2019 on food security in early childhood. Curr Opin Pediatr 2023; 35:22-27. [PMID: 36101522 PMCID: PMC9803345 DOI: 10.1097/mop.0000000000001179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW To summarize the impact of the COVID-19 pandemic on food insecurity during early childhood, with a focus on challenges and strategies to improve access to and consumption of nutritious food in early childcare and education settings. RECENT FINDINGS The COVID-19 pandemic exacerbated existing gaps and inequities in the early childcare and education system, resulting in closures and decreased access to healthy foods that disproportionately impacted black, indigenous, and people of color, as well as rural and low-income communities. SUMMARY Closures and changes in operational capacity not only stressed the early childcare and education system and its workforce but also contributed to financial strain and food insecurity among families with young children. Increased public investment and cross-sector partnerships can support and strengthen both early childcare and education and food systems, increasing equitable access to quality care and reducing food insecurity in early childhood.
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Affiliation(s)
- Yuan He
- National Clinician Scholars Program, University of Pennsylvania School of Medicine
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Patel D, Butzer D, Williams BD, Dev DA, Horm D, Finneran D, Lowery B, Campbell JE, Sisson SB. Food Waste, Preference, and Cost: Perceived Barriers and Self-Reported Food Service Best Practices in Family Child Care Homes. Child Obes 2022; 18:548-555. [PMID: 35333611 DOI: 10.1089/chi.2021.0251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background: Family Child Care Homes (FCCHs) are a setting where providers care for children at their own residence. FCCHs face unique challenges and children may not always receive optimal nutrition and have higher risk of obesity compared to other programs. The objective of this study was to determine differences in food service best practices scores between FCCHs who did/did not perceive barriers to serving healthy meals. Methods: FCCHs (n = 167) self-reported demographics, and perceived barriers to serving healthy foods. Nutrition and Physical Activity Self-Assessment for Child Care was used to assess food served with 1 (indicating poor practice) to 4 (indicating best practice). Means, standard deviations, and t-tests were conducted to determine differences in scores between FCCHs with and without perceived barriers. Adjusted alpha was 0.013. Results: FCCHs perceiving food waste as a barrier had significantly lower scores for total food and beverage (p = 0.006, 3.2 ± 0.3 vs. 3.4 ± 0.3); fruits and vegetables (p = 0.003, 3.1 ± 0.5 vs. 3.3 ± 0.5), whole fruits (p = 0.048, 3.1 ± 1.2 vs. 3.4 ± 0.9), and nonstarchy vegetables (p = 0.007, 2.8 ± 0.9 vs. 3.2 ± 0.9). Providers perceiving food preferences as a barrier had significantly lower scores compared to those who did not (p = 0.008, 2.9 ± 0.9 vs. 3.3 ± 0.9). No significant differences found in best practices among providers with vs. without perceived barrier of food costs. Conclusion: Food waste is an understudied barrier in FCCHs to serve healthy meals. Research is needed to explore these perceived barriers in FCCHs to improve best practices around meals.
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Affiliation(s)
- Divya Patel
- Department Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Daisy Butzer
- Department Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Bethany D Williams
- Department Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Department of Nutrition and Exercise Physiology, Washington State University Health Sciences Spokane, Spokane, WA, USA
| | - Dipti A Dev
- Department of Child, Youth, and Family studies, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Diane Horm
- Instructional Leadership and Academic Curriculum, and University of Oklahoma, Norman, OK, USA
| | - Denise Finneran
- Department Speech Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Bryce Lowery
- Department of Regional and City Planning, University of Oklahoma, Norman, OK, USA
| | - Janis E Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Susan B Sisson
- Department Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Heinz H, Bell D, Martinez J, Cunningham M, Maunders B, Jimenez EY. New Mexico Sponsors Identify Time and Money as Factors Affecting Home-Based Provider Child and Adult Care Food Program Engagement. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:947-956. [PMID: 35989109 DOI: 10.1016/j.jneb.2022.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 05/11/2022] [Accepted: 05/15/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Describe Child and Adult Care Food Program (CACFP) sponsor perspectives on barriers and facilitators to home-based provider CACFP eligibility, enrollment, and participation and ways to improve provider support. METHODS Semistructured interviews were conducted with 11 New Mexico CACFP sponsor staff representing 9 out of 13 agencies (69% response rate) from August to September, 2020. Interviews were analyzed using thematic analysis with an essentialist/realist epistemological approach. RESULTS Sponsor-perceived barriers to provider CACFP: eligibility (costs, background checks, fear/stigma, and delays in becoming state-approved providers); enrollment (lack of translated/low-literacy materials and cumulative systems requirements); and participation (challenges maintaining qualifying menus and documentation and accessing qualifying food, inadequate reimbursements, and unannounced visits). Sponsors suggested systems changes to improve provider support (eg, more assistance with becoming state-approved and for start-up costs and accessible, progressive nutrition training opportunities). CONCLUSIONS AND IMPLICATIONS Sponsors noted CACFP barriers for home-based providers and identified corresponding systems changes that could be tested.
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Affiliation(s)
- Hailey Heinz
- Cradle to Career Policy Institute, University of New Mexico, Albuquerque, NM.
| | - Dana Bell
- Cradle to Career Policy Institute, University of New Mexico, Albuquerque, NM
| | - Julia Martinez
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Margaret Cunningham
- Cradle to Career Policy Institute, University of New Mexico, Albuquerque, NM
| | - Blythe Maunders
- Nutrition Program, Department of Individual, Family, and Community Education, University of New Mexico, Albuquerque, NM
| | - Elizabeth Yakes Jimenez
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM; Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM; College of Population Health, University of New Mexico Health Sciences Center, Albuquerque, NM
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Dooyema CA, Hall K, Tovar A, Bauer KW, Lowry-Warnock A, Blanck HM. Leveraging Federal, State, and Facility-Level Early Care and Education Systems and Providers Toward Optimal Child Nutrition in the First 1000 Days. Am J Public Health 2022; 112:S779-S784. [PMID: 36288515 PMCID: PMC9612196 DOI: 10.2105/ajph.2022.307082] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Carrie A Dooyema
- Carrie A. Dooyema, Amy Lowry-Warnock, and Heidi M. Blanck are with the Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Kelly Hall is a fellow with the Oak Ridge Institute for Science and Education, Oak Ridge, TN, placed within the Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC. Alison Tovar is with the Department of Behavioral and Social Sciences and the Center for Health Promotion and Health Equity, School of Public Health, Brown University, Providence, RI. Katherine W. Bauer is with the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor
| | - Kelly Hall
- Carrie A. Dooyema, Amy Lowry-Warnock, and Heidi M. Blanck are with the Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Kelly Hall is a fellow with the Oak Ridge Institute for Science and Education, Oak Ridge, TN, placed within the Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC. Alison Tovar is with the Department of Behavioral and Social Sciences and the Center for Health Promotion and Health Equity, School of Public Health, Brown University, Providence, RI. Katherine W. Bauer is with the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor
| | - Alison Tovar
- Carrie A. Dooyema, Amy Lowry-Warnock, and Heidi M. Blanck are with the Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Kelly Hall is a fellow with the Oak Ridge Institute for Science and Education, Oak Ridge, TN, placed within the Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC. Alison Tovar is with the Department of Behavioral and Social Sciences and the Center for Health Promotion and Health Equity, School of Public Health, Brown University, Providence, RI. Katherine W. Bauer is with the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor
| | - Katherine W Bauer
- Carrie A. Dooyema, Amy Lowry-Warnock, and Heidi M. Blanck are with the Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Kelly Hall is a fellow with the Oak Ridge Institute for Science and Education, Oak Ridge, TN, placed within the Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC. Alison Tovar is with the Department of Behavioral and Social Sciences and the Center for Health Promotion and Health Equity, School of Public Health, Brown University, Providence, RI. Katherine W. Bauer is with the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor
| | - Amy Lowry-Warnock
- Carrie A. Dooyema, Amy Lowry-Warnock, and Heidi M. Blanck are with the Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Kelly Hall is a fellow with the Oak Ridge Institute for Science and Education, Oak Ridge, TN, placed within the Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC. Alison Tovar is with the Department of Behavioral and Social Sciences and the Center for Health Promotion and Health Equity, School of Public Health, Brown University, Providence, RI. Katherine W. Bauer is with the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor
| | - Heidi M Blanck
- Carrie A. Dooyema, Amy Lowry-Warnock, and Heidi M. Blanck are with the Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Kelly Hall is a fellow with the Oak Ridge Institute for Science and Education, Oak Ridge, TN, placed within the Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC. Alison Tovar is with the Department of Behavioral and Social Sciences and the Center for Health Promotion and Health Equity, School of Public Health, Brown University, Providence, RI. Katherine W. Bauer is with the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor
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13
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Thompson HG, Brady P, Delger P, Kersten S, Evans S, Daly E, Boudreau H, Baymon E, Kim Y, Askelson NM. How Home Child Care Providers Purchase, Prepare, and Serve Healthy Foods: In-Depth Interviews with Child and Adult Care Food Program Participants. Child Obes 2022; 18:507-513. [PMID: 35213249 DOI: 10.1089/chi.2021.0302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Child care settings can enhance children's access and exposure to healthy foods through participation in The Child and Adult Care Food Program (CACFP), which reimburses child care providers for purchasing healthy foods. To identify challenges and facilitators to CACFP participation, we carried out in-depth interviews with CACFP-participating home child care providers to discuss purchasing, preparing, and serving food under CACFP guidelines. Methods: We carried out 20 in-depth telephone interviews with CACFP-participating home child care providers. Transcribed interviews were coded to develop themes using a deductive approach. Results: Interviews indicated that food costs still burden CACFP-participating child care providers despite reimbursements. CACFP-participating providers who described prioritizing healthy foods and nutrition showed a greater inclination toward purchasing, preparing, and serving healthy foods to children. Conclusions: We offer recommendations for how to effectively support CACFP-participating providers in offering healthy food to their children within a food choice framework, a multilevel categorization of factors that influence food choice. Recommendations include increased reimbursement rates for food purchases under CACFP and support for peer-to-peer mentoring and health promotion programs targeting child care provider health.
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Affiliation(s)
- Helaina G Thompson
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Patrick Brady
- Division of Epidemiology and Community Health at the University of Minnesota, MN, USA
| | - Patti Delger
- Team Nutrition, Iowa Department of Education, Des Moines, Des Moines, IA, USA
| | - Sarah Kersten
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Sydney Evans
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Eliza Daly
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Hailey Boudreau
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Essence Baymon
- Winship Discovery Team in Clinical Research, Emory Winship Cancer Institute, Atlanta, GA, USA
| | - Yeaseul Kim
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Natoshia M Askelson
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA.,Health Policy Research Program, University of Iowa Public Policy Center, Iowa City, IA, USA
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14
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Dev DA, Hillburn C, Luxa J, Lessard L, Bauer KW, Cotwright C, Tovar A. Implementation of Federal Waivers for Feeding Children in Early Care and Education During the COVID-19 Pandemic. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:925-938. [PMID: 36216442 PMCID: PMC9537749 DOI: 10.1016/j.jneb.2022.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/13/2022] [Accepted: 07/17/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To capture Child and Adult Care Food Program (CACFP) state directors' experiences implementing federal waivers for feeding children in early care and education (ECE) settings during coronavirus disease 2019. DESIGN Qualitative semistructured interviews. SETTING Virtual interviews with state CACFP directors. PARTICIPANTS Child and Adult Care Food Program directors from 21 states from December 2020 to May 2021. PHENOMENON OF INTEREST Implementation of state-level waivers. ANALYSIS Qualitative thematic analysis. RESULTS State directors reported that the coronavirus disease 2019 waivers allowed ECE programs to continue feeding children despite being closed or having limited enrollment. The meal pattern, noncongregate feeding, parent/guardian meal pick-up, and monitoring waivers were most frequently used by states. Challenges included maintaining integrity to CACFP meal pattern requirements, addressing the limited capacity of ECE to produce and distribute noncongregate meals, and adapting technology for virtual reviews. Suggested improvements included streamlined communication from the US Department of Agriculture, standing waivers for emergencies, ongoing flexibilities for feeding children, and strategies to increase CACFP enrollment and reduce financial viability requirements for ECE. CONCLUSIONS AND IMPLICATIONS Results indicate the need for the US Department of Agriculture to consider issuing and extending waivers, increasing ECE participation in CACFP, and ensuring timely communication and guidance on waiver tracking.
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Affiliation(s)
- Dipti A Dev
- Department of Child Youth and Family Studies, University of Nebraska-Lincoln, Lincoln, NE.
| | - Carly Hillburn
- Department of Child Youth and Family Studies, University of Nebraska-Lincoln, Lincoln, NE
| | - Jordan Luxa
- Department of Food, Nutrition, and Health, University of Nebraska-Lincoln Extension, Lincoln, NE
| | - Laura Lessard
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE
| | - Katherine W Bauer
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI
| | - Caree Cotwright
- Department of Foods and Nutrition, University Of Georgia, Athens, GA
| | - Alison Tovar
- Department of Behavioral and Social Sciences, Brown University, Providence, RI
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15
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Meal provision in early childhood education and care programs: Association with geographic disadvantage, social disadvantage, cost, and market competition in an Australian population. Soc Sci Med 2022; 312:115317. [DOI: 10.1016/j.socscimed.2022.115317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 05/24/2022] [Accepted: 08/25/2022] [Indexed: 11/18/2022]
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16
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Patlan K, Glenn ME, Connor P, Stidsen C, Olsho LEW, Witt MB, Gola AAH, Copeland KA. Foods Served in Child Care Programs Participating in the Child and Adult Care Food Program and Alignment with Program Meal Patterns. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:610-620. [PMID: 35491380 DOI: 10.1016/j.jneb.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Assess Child and Adult Care Food Program (CACFP) program compliance with meal component requirements for children aged 3-5 years by program type, and describe foods and beverages most commonly served. DESIGN Cross-sectional analysis of 1-week menu surveys during winter/spring 2017. SETTING US CACFP-participating child care programs. PARTICIPANTS Nationally representative multistage cluster sample of 664 programs: 222 child care centers, 247 Head Start programs, 195 family child care homes. MAIN OUTCOME MEASURE(S) Percentage of meals including required components; frequently served foods and beverages. ANALYSIS Mean percentages; 2-tailed t tests; alpha = 0.05 significance level. RESULTS Most breakfasts (97%), lunches (88%), and afternoon snacks (97%) included all required CACFP meal components. Most breakfasts included fruits (96%), but not vegetables; 16% included a meat/meat alternate. Most lunches (81%) included both fruits and vegetables. Afternoon snacks were mostly grains/breads (80%) and fruits (57%). Most frequently served foods included 1% unflavored milk and fresh fruits such as apples and bananas. Most menus limited juice, offered low-sugar cereal, and did not include flavored milk; very few menus included noncreditable foods with added sugar. CONCLUSIONS AND IMPLICATIONS Most CACFP meals provided required components, but there is room for improvement, particularly for increasing vegetables served and limiting foods high in added sugar and fat.
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Affiliation(s)
| | | | | | | | | | | | - Alice Ann H Gola
- US Department of Agriculture Food and Nutrition Service, Alexandria, Virginia
| | - Kristen A Copeland
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH
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17
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Thorndike AN, Gardner CD, Kendrick KB, Seligman HK, Yaroch AL, Gomes AV, Ivy KN, Scarmo S, Cotwright CJ, Schwartz MB. Strengthening US Food Policies and Programs to Promote Equity in Nutrition Security: A Policy Statement From the American Heart Association. Circulation 2022; 145:e1077-e1093. [PMID: 35535604 DOI: 10.1161/cir.0000000000001072] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nutritionally inadequate dietary intake is a leading contributor to chronic cardiometabolic diseases. Differences in dietary quality contribute to socioeconomic and racial and ethnic health disparities. Food insecurity, a household-level social or economic condition of limited access to sufficient food, is a common cause of inadequate dietary intake. Although US food assistance policies and programs are designed to improve food security, there is growing consensus that they should have a broader focus on nutrition security. In this policy statement, we define nutrition security as an individual or household condition of having equitable and stable availability, access, affordability, and utilization of foods and beverages that promote well-being and prevent and treat disease. Despite existing policies and programs, significant gaps remain for achieving equity in nutrition security across the life span. We provide recommendations for expanding and improving current food assistance policies and programs to achieve nutrition security. These recommendations are guided by several overarching principles: emphasizing nutritional quality, improving reach, ensuring optimal utilization, improving coordination across programs, ensuring stability of access to programs across the life course, and ensuring equity and dignity for access and utilization. We suggest a critical next step will be to develop and implement national measures of nutrition security that can be added to the current US food security measures. Achieving equity in nutrition security will require coordinated and sustained efforts at the federal, state, and local levels. Future advocacy, innovation, and research will be needed to expand existing food assistance policies and programs and to develop and implement new policies and programs that will improve cardiovascular health and reduce disparities in chronic disease.
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18
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Ireland M, Bryant LM, Finders JK, Duncan RJ, Purpura DJ, Schmitt SA. Examining Associations Between Food Insecurity, Inhibitory Control, and Body Mass Index in Preschoolers. J Dev Behav Pediatr 2022; 43:e255-e262. [PMID: 34596102 DOI: 10.1097/dbp.0000000000001014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/20/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study examines relations between food insecurity, inhibitory control, and body mass index (BMI) in early childhood. METHOD The sample comes from an evaluation of a state-funded prekindergarten program and includes 126 children (mean age = 4.73 yrs, female = 42%) from families with low incomes. Parents reported on their child's food insecurity. Child inhibitory control was assessed using a performance-based task, and children's height and weight were objectively collected at the same time as the inhibitory control assessment. A regression model was used to test whether inhibitory control moderated the association between food insecurity and BMI. The model included a large battery of covariates and adjusted for clustering at the classroom level. Ad hoc analyses were conducted to examine the robustness of findings to different conceptualizations of food insecurity based on the US Department of Agriculture's categories for severity. RESULTS A significant interaction revealed that inhibitory control moderated the association between food insecurity and children's BMI percentile. Investigation of the simple slopes suggested that greater food insecurity was related to a higher BMI percentile among children who demonstrated stronger inhibitory control. In addition, results from ad hoc analyses examining categories of food insecurity indicated that experiencing very low food security was also related to a higher BMI among children with average and strong inhibitory control. CONCLUSION This study makes a unique contribution to the existing literature by examining relations among food insecurity, inhibitory control, and BMI during a critical period in children's physical and brain development. Findings have implications for public health efforts to address childhood obesity among populations with low incomes.
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Affiliation(s)
- Mariah Ireland
- Health and Kinesiology, Purdue University, West Lafayette, IN
| | - Lindsey M Bryant
- Human Development and Family Studies, Purdue University, West Lafayette, IN
| | - Jennifer K Finders
- Human Development and Family Studies, Purdue University, West Lafayette, IN
| | - Robert J Duncan
- Human Development and Family Studies, Purdue University, West Lafayette, IN
| | - David J Purpura
- Human Development and Family Studies, Purdue University, West Lafayette, IN
| | - Sara A Schmitt
- Human Development and Family Studies, Purdue University, West Lafayette, IN
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19
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Francis L, Perrin N, Black MM, Allen JK. Mealtime Environment and Feeding Practices in Urban Family Child Care Homes in the United States. Child Obes 2022; 18:102-111. [PMID: 34415787 PMCID: PMC8892968 DOI: 10.1089/chi.2021.0042] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: Family Child Care Homes (FCCHs) are the second-largest childcare option in the US. Given that young children are increasingly becoming overweight and obese, it is vital to understand the FCCH mealtime environment. There is much interest in examining the impact of the Child and Adult Care Food Program (CACFP), a federal initiative to support healthy nutrition, by providing cash reimbursements to eligible childcare providers to purchase nutritious foods. This study examines the association among the FCCH provider characteristics, the mealtime environment, and the quality of foods offered to 2-5-year-old children in urban FCCHs and examines the quality of the mealtime environment and foods offered by CACFP participation. Methods: A cross-sectional design with a proportionate stratified random sample of urban FCCHs by the CACFP participation status was used. Data were collected by telephone using the Nutrition and Physical Activity Self-Assessment for Child Care survey. Results: A total of 91 licensed FCCHs (69 CACFP, 22 non-CACFP) participated. FCCH providers with formal nutrition training met significantly more of the quality standards for foods offered than providers without nutrition training (β = 0.22, p = 0.034). The mealtime environment was not related to any FCCH provider characteristics. CACFP-participating FCCH providers had a healthier mealtime environment (β = 0.326, p = 0.002) than non-CACFP FCCHs. Conclusions: Findings suggest that nutrition training and CACFP participation contribute to the quality of nutrition-related practices in the FCCH. We recommend more research on strengthening the quality of foods provided in FCCHs and the possible impact on childhood obesity.
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Affiliation(s)
- Lucine Francis
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.,Address correspondence to: Lucine Francis, PhD, RN, Johns Hopkins University School of Nursing, 525 Wolfe Street, Room 532, Baltimore, MD 21205, USA
| | - Nancy Perrin
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Maureen M. Black
- Division of Growth and Nutrition, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA.,RTI International, Research Triangle Park, NC, USA
| | - Jerilyn K. Allen
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.,Division of Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Department of Health, Behavior, and Society, Johns Hopkins School of Public Health, Baltimore, MD, USA
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20
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Abstract
Context Policy-specific actions to improve food environments will support healthy population diets. Objective To identify cited barriers and facilitators to food environment policy (FEP) processes reported in the literature, exploring these according to the nature of the policy (voluntary or mandatory) and country development status. Data sources A systematic search was conducted of 10 academic and 7 grey-literature databases, national websites, and manual searches of publication references. Data extraction Data on government-led FEPs, barriers, and facilitators from key informants were collected. Data synthesis The constant-comparison approach generated core themes for barriers and facilitators. The appraisal tool developed by Hawker et al. was adopted to determine the quality of qualitative and quantitative studies. Results A total of 142 eligible studies were identified. Industry resistance or disincentive was the most cited barrier in policy development. Technical challenges were most frequently a barrier for policy implementation. Frequently cited facilitators included resource availability or maximization, strategies in policy process, and stakeholder partnership or support. Conclusions The findings from this study will strategically inform health-reform stakeholders about key elements of public health policy processes. More evidence is required from countries with human development indices ranging from low to high and on voluntary policies. Systematic Review Registration PROSPERO registration no. CRD42018115034.
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Affiliation(s)
- SeeHoe Ng
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Heather Yeatman
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Bridget Kelly
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Sreelakshmi Sankaranarayanan
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Tilakavati Karupaiah
- T. Karupaiah, School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, 47500 Subang Jaya, Selangor, Malaysia. E-mail:
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21
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Stephens L, Rains C, Benjamin-Neelon SE. Connecting Families to Food Resources amid the COVID-19 Pandemic: A Cross-Sectional Survey of Early Care and Education Providers in Two U.S. States. Nutrients 2021; 13:3137. [PMID: 34579014 PMCID: PMC8465308 DOI: 10.3390/nu13093137] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/04/2021] [Accepted: 09/07/2021] [Indexed: 02/07/2023] Open
Abstract
Early care and education (ECE) settings are important avenues for reaching young children and their families with food and nutrition resources, including through the U.S. federally funded Child and Adult Care Food Program (CACFP). Researchers conducted a cross-sectional survey of ECE providers in two U.S. states in November 2020 to identify approaches used to connect families with food and nutrition resources amid the COVID-19 pandemic. Logistic regression models were used to estimate odds of sites reporting no approaches and adjusted Poisson models were used to estimate the incidence rate ratio of the mean number of approaches, comparing sites that participate in CACFP to those that did not. A total of 589 ECE sites provided responses. Of those, 43% (n = 255) participated in CACFP. CACFP participating sites were more likely to report using any approaches to connecting families to food resources and significantly more likely to report offering "grab and go" meals, providing meal delivery, distributing food boxes to families, and recommending community food resources than non-CACFP sites. This study suggests that CACFP sites may have greater capacity to connect families to food resources amid emergencies than non-CACFP participating sites.
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Affiliation(s)
- Lacy Stephens
- National Farm to School Network, P.M.B. #104, 8770 West Bryn Mawr Ave, Suite 1300, Chicago, IL 60631, USA
| | - Caroline Rains
- Research Triangle Institute International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709, USA;
| | - Sara E. Benjamin-Neelon
- Department of Health, Behavior and Society, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA;
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22
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Kear K, Stotz S, Love K, Cox GO, Birch LL, Cotwright CJ. Assessing health disparities in foods and beverages served in early care and education programs across Georgia. Pediatr Obes 2021; 16:e12787. [PMID: 33729706 DOI: 10.1111/ijpo.12787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 07/22/2020] [Accepted: 02/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Obesity disproportionately impacts children who are Black and Hispanic, those who live in rural communities and those who have low income. Predisposition to obesity early in life is profoundly impacted by feeding habits during the preschool years. The early care and education (ECE) setting impacts children's health by providing daily meals. OBJECTIVE The goal of this study was to identify whether or not health disparities in foods and beverages served in ECE programs in Georgia exist based on socioeconomic, demographic and geographic variables. METHODS A random sample was drawn from 3054 ECE programs across the state of Georgia. The likelihood of serving specific foods and beverages in ECE programs in the previous day was measured. Percentages and frequencies, logistic regressions, Spearman's rho and Odds ratio tests determined outcomes. RESULTS A total of 974 surveys were returned. Data were stratified based on the income level of the participant families, race of enrolled children and geographic location of the ECE program. Disparities existed between programs based on race of enrolled children and geographic location. For example, although the odds of providing sweets increased by 0.6% as the percentage of Black children enrolled increased, the provision of healthier foods, such as the odds of providing fruits (P = .001), vegetables (P = .001) and protein (P = .001) also increased. However, after results were adjusted for covariates findings did not remain significant. CONCLUSIONS Future research focused on evaluating the foods and beverages provided in ECE programs and the relationship of how income, race and location are related may provide further understanding about the disproportionate childhood obesity rates in America.
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Affiliation(s)
- Kathryn Kear
- Department of Foods and Nutrition, University of Georgia College of Family and Consumer Sciences, Athens, Georgia, USA
| | - Sarah Stotz
- Centers for American Indian and Alaska Native Health, University of Colorado Denver - Anschutz Medical Campus, Denver, Colorado, USA
| | - Kim Love
- K.R. Love Quantitative Consulting and Collaboration, Athens, Georgia, USA
| | - Ginnefer O Cox
- Department of Foods and Nutrition, University of Georgia College of Family and Consumer Sciences, Athens, Georgia, USA
| | - Leann L Birch
- Department of Foods and Nutrition, University of Georgia College of Family and Consumer Sciences, Athens, Georgia, USA
| | - Caree J Cotwright
- Department of Foods and Nutrition, University of Georgia College of Family and Consumer Sciences, Athens, Georgia, USA
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23
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Earnesty D, Mphwanthe G, Rau K, Weatherspoon L. A Qualitative Study: Perceived Barriers and Facilitators to Nutrition Standard Adherence by In-home Childcare Providers. J Acad Nutr Diet 2021; 122:786-796.e4. [PMID: 34411786 DOI: 10.1016/j.jand.2021.08.104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/04/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The Child and Adult Care Food Program (CACFP) nutrition standards may present food purchasing, preparation, and feeding challenges for caregivers of young children. OBJECTIVE To elucidate perceived barriers and facilitators faced by in-home childcare providers to following the CACFP food and beverage nutrition standards. DESIGN Virtual, semistructured individual interviews elicited perceptions from a cross section of low-income, in-home childcare providers in Michigan. PARTICIPANTS/SETTINGS Twenty childcare providers of various races, ethnicity, urban and rural residence, and licensure status. ANALYSIS Thematic coding analysis with NVivo (ver12.0) to organize and interpret data. RESULTS Four primary barriers to adhering to the CACFP nutrition standards emerged including (1) noncompliant food preferences of children and providers; (2) higher cost and lower availability of CACFP-approved items; (3) celebrations and food rewards; (4) excessive time and effort needed to prepare foods and beverages, especially with dietary restrictions for some children. Ten perceived facilitators included (1) using nutrition education available through community organizations; (2) finding convenient and easy ways to prepare foods and beverages; (3) using CACFP and Special Supplemental Nutrition Program for Women, Infants, and Children guidelines and funding; (4) increasing variety of foods and beverages by using a menu or recalling items recently served; (5) modeling eating healthful foods and encouraging sampling of new foods and beverages; (6) mixing preferred foods/beverages with less preferred; (7) using nutrition information available from social media and from peers; (8) allowing children to choose foods and beverages; (9) serving the same eligible food and beverages to all children; and (10) provider concern about impact of foods and beverages on children's health and behavior. CONCLUSIONS Results from this study can inform nutrition education from community organizations that occurs in tandem with CACFP sponsor organizations. In addition, they can be utilized to address state-level licensure regulations and quality improvement rating systems that include nutrition standards childcare providers are encouraged or required to follow.
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Affiliation(s)
- Dawn Earnesty
- Michigan State University Extension, East Lansing, Michigan.
| | - Getrude Mphwanthe
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, Michigan
| | - Kaitlyn Rau
- Michigan State University Extension, East Lansing, Michigan
| | - Lorraine Weatherspoon
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, Michigan
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24
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Bauer KW, Chriqui JF, Andreyeva T, Kenney EL, Stage VC, Dev D, Lessard L, Cotwright CJ, Tovar A. A Safety Net Unraveling: Feeding Young Children During COVID-19. Am J Public Health 2021; 111:116-120. [PMID: 33211589 PMCID: PMC7750580 DOI: 10.2105/ajph.2020.305980] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The emergence of COVID-19 in the United States led most states to close or severely limit the capacity of their early child-care and education (ECE) programs. This loss affected millions of young children, including many of the 4.6 million low-income children who are provided free meals and snacks by their ECE programs through support from the federal Child and Adult Care Food Program (CACFP).Although Congress swiftly authorized waivers that would allow CACFP-participating ECE programs to continue distributing food to children, early evidence suggests that most ECE programs did not have the capacity to do so, leaving a fragmented system of federal, state, and local food programs to fill the gaps created by this loss.Critical steps are needed to repair our nation's fragile ECE system, including greater investment in CACFP, to ensure the nutrition, health, and development of young children during the COVID-19 pandemic and beyond.
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Affiliation(s)
- Katherine W Bauer
- Katherine W. Bauer is with the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor. Jamie F. Chriqui is with the Division of Health Policy and Administration, School of Public Health, University of Illinois, Chicago. Tatiana Andreyeva is with the Department of Agricultural and Resource Economics, Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford. Erica L. Kenney is with the Departments of Nutrition and Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Virginia C. Stage is with the Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC. Dipti Dev is with the Department of Child, Youth and Family Studies, College of Education and Human Sciences, University of Nebraska, Lincoln. Laura Lessard is with the Department of Behavioral Health & Nutrition, University of Delaware, Newark. Caree J. Cotwright is with the Department of Foods and Nutrition, University of Georgia, Athens. Alison Tovar is with the Department of Nutrition and Food Sciences, University of Rhode Island, Kingston
| | - Jamie F Chriqui
- Katherine W. Bauer is with the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor. Jamie F. Chriqui is with the Division of Health Policy and Administration, School of Public Health, University of Illinois, Chicago. Tatiana Andreyeva is with the Department of Agricultural and Resource Economics, Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford. Erica L. Kenney is with the Departments of Nutrition and Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Virginia C. Stage is with the Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC. Dipti Dev is with the Department of Child, Youth and Family Studies, College of Education and Human Sciences, University of Nebraska, Lincoln. Laura Lessard is with the Department of Behavioral Health & Nutrition, University of Delaware, Newark. Caree J. Cotwright is with the Department of Foods and Nutrition, University of Georgia, Athens. Alison Tovar is with the Department of Nutrition and Food Sciences, University of Rhode Island, Kingston
| | - Tatiana Andreyeva
- Katherine W. Bauer is with the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor. Jamie F. Chriqui is with the Division of Health Policy and Administration, School of Public Health, University of Illinois, Chicago. Tatiana Andreyeva is with the Department of Agricultural and Resource Economics, Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford. Erica L. Kenney is with the Departments of Nutrition and Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Virginia C. Stage is with the Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC. Dipti Dev is with the Department of Child, Youth and Family Studies, College of Education and Human Sciences, University of Nebraska, Lincoln. Laura Lessard is with the Department of Behavioral Health & Nutrition, University of Delaware, Newark. Caree J. Cotwright is with the Department of Foods and Nutrition, University of Georgia, Athens. Alison Tovar is with the Department of Nutrition and Food Sciences, University of Rhode Island, Kingston
| | - Erica L Kenney
- Katherine W. Bauer is with the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor. Jamie F. Chriqui is with the Division of Health Policy and Administration, School of Public Health, University of Illinois, Chicago. Tatiana Andreyeva is with the Department of Agricultural and Resource Economics, Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford. Erica L. Kenney is with the Departments of Nutrition and Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Virginia C. Stage is with the Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC. Dipti Dev is with the Department of Child, Youth and Family Studies, College of Education and Human Sciences, University of Nebraska, Lincoln. Laura Lessard is with the Department of Behavioral Health & Nutrition, University of Delaware, Newark. Caree J. Cotwright is with the Department of Foods and Nutrition, University of Georgia, Athens. Alison Tovar is with the Department of Nutrition and Food Sciences, University of Rhode Island, Kingston
| | - Virginia C Stage
- Katherine W. Bauer is with the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor. Jamie F. Chriqui is with the Division of Health Policy and Administration, School of Public Health, University of Illinois, Chicago. Tatiana Andreyeva is with the Department of Agricultural and Resource Economics, Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford. Erica L. Kenney is with the Departments of Nutrition and Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Virginia C. Stage is with the Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC. Dipti Dev is with the Department of Child, Youth and Family Studies, College of Education and Human Sciences, University of Nebraska, Lincoln. Laura Lessard is with the Department of Behavioral Health & Nutrition, University of Delaware, Newark. Caree J. Cotwright is with the Department of Foods and Nutrition, University of Georgia, Athens. Alison Tovar is with the Department of Nutrition and Food Sciences, University of Rhode Island, Kingston
| | - Dipti Dev
- Katherine W. Bauer is with the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor. Jamie F. Chriqui is with the Division of Health Policy and Administration, School of Public Health, University of Illinois, Chicago. Tatiana Andreyeva is with the Department of Agricultural and Resource Economics, Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford. Erica L. Kenney is with the Departments of Nutrition and Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Virginia C. Stage is with the Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC. Dipti Dev is with the Department of Child, Youth and Family Studies, College of Education and Human Sciences, University of Nebraska, Lincoln. Laura Lessard is with the Department of Behavioral Health & Nutrition, University of Delaware, Newark. Caree J. Cotwright is with the Department of Foods and Nutrition, University of Georgia, Athens. Alison Tovar is with the Department of Nutrition and Food Sciences, University of Rhode Island, Kingston
| | - Laura Lessard
- Katherine W. Bauer is with the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor. Jamie F. Chriqui is with the Division of Health Policy and Administration, School of Public Health, University of Illinois, Chicago. Tatiana Andreyeva is with the Department of Agricultural and Resource Economics, Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford. Erica L. Kenney is with the Departments of Nutrition and Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Virginia C. Stage is with the Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC. Dipti Dev is with the Department of Child, Youth and Family Studies, College of Education and Human Sciences, University of Nebraska, Lincoln. Laura Lessard is with the Department of Behavioral Health & Nutrition, University of Delaware, Newark. Caree J. Cotwright is with the Department of Foods and Nutrition, University of Georgia, Athens. Alison Tovar is with the Department of Nutrition and Food Sciences, University of Rhode Island, Kingston
| | - Caree J Cotwright
- Katherine W. Bauer is with the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor. Jamie F. Chriqui is with the Division of Health Policy and Administration, School of Public Health, University of Illinois, Chicago. Tatiana Andreyeva is with the Department of Agricultural and Resource Economics, Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford. Erica L. Kenney is with the Departments of Nutrition and Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Virginia C. Stage is with the Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC. Dipti Dev is with the Department of Child, Youth and Family Studies, College of Education and Human Sciences, University of Nebraska, Lincoln. Laura Lessard is with the Department of Behavioral Health & Nutrition, University of Delaware, Newark. Caree J. Cotwright is with the Department of Foods and Nutrition, University of Georgia, Athens. Alison Tovar is with the Department of Nutrition and Food Sciences, University of Rhode Island, Kingston
| | - Alison Tovar
- Katherine W. Bauer is with the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor. Jamie F. Chriqui is with the Division of Health Policy and Administration, School of Public Health, University of Illinois, Chicago. Tatiana Andreyeva is with the Department of Agricultural and Resource Economics, Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford. Erica L. Kenney is with the Departments of Nutrition and Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Virginia C. Stage is with the Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC. Dipti Dev is with the Department of Child, Youth and Family Studies, College of Education and Human Sciences, University of Nebraska, Lincoln. Laura Lessard is with the Department of Behavioral Health & Nutrition, University of Delaware, Newark. Caree J. Cotwright is with the Department of Foods and Nutrition, University of Georgia, Athens. Alison Tovar is with the Department of Nutrition and Food Sciences, University of Rhode Island, Kingston
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Dietary Contributors to Food Group Intake in Preschool Children Attending Family Childcare Homes: Differences between Latino and Non-Latino Providers. Nutrients 2020; 12:nu12123686. [PMID: 33260442 PMCID: PMC7761496 DOI: 10.3390/nu12123686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 11/17/2022] Open
Abstract
While there are several factors that contribute to the diet quality of children in childcare, one contributing factor in Family Childcare Homes (FCCHs) is the provider's ethnicity. However, research examining the food items provided in this setting is limited; in particular, with regards to differences between FCCHs of Latino and non-Latino providers. The aim of this study was to identify and describe the food items that contribute to food group intake in preschool-aged children attending FCCHs, and to examine differences by provider ethnicity. This secondary data analysis used baseline data from Healthy Start/Comienzos Sanos: a cluster-randomized trial. Children's dietary intake was collected using the Dietary Observation in Child Care method and entered into Nutrition Data System for Research software. Food groups were based on the Nutrition Coordinating Center classification. Contribution of food items to their respective food group was calculated as a proportion, using ratio of means and presented as a percentage. Ethnic differences were tested with ANCOVA (p < 0.05) with Bonferroni adjustments for multiple comparisons. All providers (n = 120) were female and 67.5% were Latino. Most fruit consumed by children was in the form of juice (85%), three-fourths of the grains consumed were refined (75%), and half of the sweets consumed were syrup/honey/jelly (50%). Most of the vegetables consumed were non-starchy (61%), nearly three-fourths of dairy consumed was low-fat (71%), and vegetable oils contributed the most to the fats group (89%). Food items differed by provider's ethnicity, with children cared for by non-Latino providers consuming a higher proportion of fruit juice, animal fats and a lower proportion of legumes (p < 0.001 for all). Children with Latino providers consumed a lower proportion of non-starchy vegetables, low-fat dairy, and nuts/seeds (p < 0.001 for all). FCCH providers could offer more whole fruits and grains and a greater variety of vegetables. Differences by ethnicity suggest providers could benefit from culturally tailored recommendations.
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Chriqui JF, Leider J, Schermbeck RM, Sanghera A, Pugach O. Changes in Child and Adult Care Food Program (CACFP) Practices at Participating Childcare and Education Centers in the United States Following Updated National Standards, 2017-2019. Nutrients 2020; 12:E2818. [PMID: 32942598 PMCID: PMC7551123 DOI: 10.3390/nu12092818] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/04/2020] [Accepted: 09/11/2020] [Indexed: 11/22/2022] Open
Abstract
The U.S. Department of Agriculture's (USDA) Child and Adult Care Food Program (CACFP) updated meal pattern standards took effect in October 2017. The aim of this quasi-experimental, pre-post study is to identify changes in food and beverage practices of CACFP-participating centers due to implementation of updated CACFP meal patterns over a 21-month period. Eight hundred and fifty-eight centers located in 47 states and the District of Columbia completed a survey (primarily electronic) at both time points (67.6% follow-up response rate). Multivariable logistic regressions with robust standard errors assessed changes over time, accounting for repeated observations within each site. From baseline to follow-up, centers reported the increased familiarity and implementation, albeit with time, money, and staffing-related challenges. Significant improvements were seen in not serving sugary cereals or flavored milk, in serving 100% whole grains, and serving processed meats less than once a week. While CACFP-participating centers reported making significant progress in meeting the updated meal pattern standards and suggested best practices within 15-19 months of their effective date, reported compliance and adherence to the standards and best practices was not universal. USDA, state agencies, and technical assistance providers should work to provide centers with additional guidance to help them with implementation.
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Affiliation(s)
- Jamie F. Chriqui
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL 60608, USA
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (J.L.); (R.M.S.); (A.S.); (O.P.)
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (J.L.); (R.M.S.); (A.S.); (O.P.)
| | - Rebecca M. Schermbeck
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (J.L.); (R.M.S.); (A.S.); (O.P.)
| | - Anmol Sanghera
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (J.L.); (R.M.S.); (A.S.); (O.P.)
| | - Oksana Pugach
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (J.L.); (R.M.S.); (A.S.); (O.P.)
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