Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.
BMC Public Health. 2020 Jun 5;20(1):856. doi: 10.1186/s12889-020-08712-7.
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.
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.
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.
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.
早期儿童照护与教育（ECE）是影响幼儿饮食摄入的重要场所。ECE 中存在多种与健康饮食障碍相关的因素，近期证据表明，参与儿童与成人照护食品计划（CACFP）这一 ECE 中的主要国家食品援助计划，可能与提供更健康食品的障碍较少相关。然而，之前没有研究在大规模多州样本中比较过 CACFP 参与者和非参与者之间的差异。这是第一项使用全国两个地区的主任随机样本，研究 CACFP 参与情况与 ECE 中提供更健康食品的障碍之间关联的研究。
我们对来自四个州（马萨诸塞州、北卡罗来纳州、罗得岛州和南卡罗来纳州）的儿童护理中心主任进行了一项随机抽样的横断面调查。我们进行了逻辑回归和泊松回归，以计算报告 1）无障碍、2）特定障碍（例如，成本）和 3）按 CACFP 状况报告的总障碍数量的几率和发病率比，调整了感兴趣的协变量。
我们收到了 713 份调查（36%的回复率）。大约一半（55%）的中心参与了 CACFP。报告的最常见的提供更健康食品的障碍是成本（42%）和儿童的食物偏好（19%）。与非 CACFP 中心的主任相比，CACFP 中心的主任报告不存在障碍的可能性是其两倍（OR 2.03；95%CI [1.36, 3.04]；p<0.01）。CACFP 中心的主任报告成本为障碍的可能性较小（OR=0.46；95%CI [0.31, 0.67]；p<0.001），并且报告的总障碍数量较少（IRR=0.77；95%CI [0.64, 0.92]；p<0.01），与非 CACFP 中心的主任相比。
CACFP 主任报告在儿童保育中心提供更健康食品的障碍较少。尽管如此，成本和儿童的食物偏好仍然是 ECE 中提供更健康食品的持续障碍。未来的研究应该评估可能减轻这些障碍的 CACFP 参与特征，以及在 2017 年 CACFP 营养标准规则更改之后，这些障碍是否会出现或持续存在。
