Department of Agricultural and Resource Economics, Rudd Center for Food Policy and Health, University of Connecticut, Storrs, Connecticut.
Statistical Consulting Services, Center for Open Research Resources and Equipment, University of Connecticut, Storrs, Connecticut.
Am J Prev Med. 2024 Jan;66(1):18-26. doi: 10.1016/j.amepre.2023.09.008. Epub 2023 Sep 13.
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.
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.
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).
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.
联邦儿童和成人照顾食品计划（CACFP）通过帮助支付儿童照顾提供者和家庭的食品费用，改善了幼儿的营养状况并减少了他们的食物不安全感。本项全国性研究评估了 CACFP 在获得许可的儿童照顾中心中的使用程度和预测因素，以确定扩大 CACFP 营养支持的机会。
从 47 个州和哥伦比亚特区的 CACFP 和儿童照顾许可机构收集行政数据，并对 93,227 个获得许可的儿童照顾中心进行地理编码。在低收入地区的样本中，使用多变量贝叶斯空间逻辑回归模型预测 CACFP 的参与情况，以确定有资格获得 CACFP 的儿童照顾中心。数据收集于 2020-2021 年，并于 2022 年进行分析。
在所有获得许可的儿童照顾中心中，有 36.5%参与了 CACFP，各州的参与率从 15.2%到 65.3%不等；在限制为低收入地区的情况下，有 57.5%参与（范围为 15.7%-85.7%）。收入差异并不能解释各州 CACFP 参与率的巨大差异。每个州至少有三个 CACFP 赞助机构预测 CACFP 参与的可能性增加 38%（OR=1.38；95%可信区间=1.08-1.78）。
目前，获得许可的儿童照顾中心中 CACFP 的参与率表明该计划的利用率低且机会不平等，尤其是在某些州和地区。需要在联邦和州各级开展工作，以扩大该计划的参与度，尤其是在低收入地区，以便更多的幼儿可以通过 CACFP 健康饮食。
