Participation in the Child and Adult Care Food Program is associated with fewer barriers to serving healthier foods in early care and education

Abstract

Background Early care and education (ECE) is an important setting for influencing young children’s dietary intake. There are several factors associated with barriers to healthy eating in ECE, and recent evidence suggests that participation in the Child and Adult Care Food Program (CACFP), the primary national food assistance program in ECE, may be associated with fewer barriers to serving healthier foods. However, no prior studies have examined differences between CACFP participants and non-participants across a large, multi-state sample. This is the first study to examine the association between CACFP participation and barriers to serving healthier foods in ECE using a random sample of directors from two regions across the country. Methods We conducted a cross-sectional survey among a random sample of child care center directors from four states (Massachusetts, North Carolina, Rhode Island, and South Carolina). We conducted logistic and Poisson regression to calculate the odds and incidence rate ratios of reporting 1) no barriers, 2) specific barriers (e.g., cost), and 3) the total number of barriers, by CACFP status, adjusting for covariates of interest. Results We received 713 surveys (36% response rate). About half (55%) of centers participated in CACFP. The most prevalent reported barriers to serving healthier foods were cost (42%) and children’s food preferences (19%). Directors from CACFP centers were twice as likely to report no barriers, compared to directors from non-CACFP centers (OR 2.03; 95% CI [1.36, 3.04]; p < 0.01). Directors from CACFP centers were less likely to report cost as a barrier (OR = 0.46; 95% [CI 0.31, 0.67]; p < 0.001), and reported fewer barriers overall (IRR = 0.77; 95% CI [0.64, 0.92]; p < 0.01), compared to directors from non-CACFP centers. Conclusions CACFP directors reported fewer barriers to serving healthier foods in child care centers. Still, cost and children’s food preferences are persistent barriers to serving healthier foods in ECE. Future research should evaluate characteristics of CACFP participation that may alleviate these barriers, and whether barriers emerge or persist following 2017 rule changes to CACFP nutrition standards.

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

“…However, and contrary to our hypothesis, we found that centers reported more challenges with needing more time, money, and staff to support implementation of the standards from baseline to follow-up. While these challenges are consistent with reported challenges that ECE centers face with CACFP generally [7,8,21], it is possible that, at the time of the baseline survey (which occurred immediately prior to the implementation effective date), centers did not yet have a sense of the resources that would be required for implementation. Once they began implementation, however, they may have realized that they needed more resources to support implementation.…”

Dietary Contributors to Food Group Intake in Preschool Children Attending Family Childcare Homes: Differences between Latino and Non-Latino Providers

“…While this study found that children under the care of Latino FCCPs had higher component diet quality scores for greens/beans, total protein, and seafood and plant protein, this analysis did not take into account the specific types of foods offered and the ethnic differences in the foods provided [24]. While the CACFP is a very important predictor of the nutritional quality of foods served in childcare [30][31][32][33], exploring other factors among FCCHs that care for underserved children is needed. This is particularly important given that children still do not meet recommendations for fruits, vegetables, whole grains and low-fat milk, and are consuming too many sugar-sweetened beverages (SSBs), fruit juice and snacks, with excess sugars, saturated fat and sodium [34][35][36][37][38][39][40][41].…”

A Market in Mealtimes: Social and Economic Factors Associated With Meal Provision in Early Care and Education (ECE) Services

“…Studies of the Child and Adult Care Food Program (CACFP) in the USA provide the most robust population-level evidence of the potential for ECE services to address food insecurity (e.g. (Copeland & Johnson, 2016;Heflin, Arteaga, & Gable, 2015;Korenman, Abner, Kaestner, & Gordon, 2013;Zaltz et al, 2020)). This program, unlike many that provide foods directly to families, provides cash reimbursements to services, including Headstart programs and non-Headstart childcare centres, to supply high quality foods to children.…”

“…First, the program has been shown to directly improve the adequacy and quality of child nutrition. Both Heflin, Arteaga and Gable (2015) and Zaltz et al (2020) report that centres participating in the CACFP provide higher quality food than those not participating. Specifically, Zaltz et al (2020) identify that CACFP reduces cost to the centre, the greatest barrier to provision of high quality food.…”

“…Both Heflin, Arteaga and Gable (2015) and Zaltz et al (2020) report that centres participating in the CACFP provide higher quality food than those not participating. Specifically, Zaltz et al (2020) identify that CACFP reduces cost to the centre, the greatest barrier to provision of high quality food. Copeland and Johnson (2016) compared the food consumption of children when attending Head Start services participating in CACFP with food consumption at home.…”