Child And Adult Care Food Program Research Articles

Contextual Factors Influence Professional Development Attendance Among Child Care Providers in Nebraska

ObjectiveTo examine contextual factors that may influence child care providers’ motivators for attending nutrition-related training and their preferences and barriers to attending professional development training. DesignCross-sectional survey completed between January and April 2017. SettingLicensed child care programs (n = 1,490) across urban and rural Nebraska. ParticipantsChild care center directors (n = 336) and family child care home providers (n = 1,154). Main Outcome Measure(s)Motivators, preferences, and barriers of child care providers for attending professional development. AnalysisDescriptive statistics and multiple logistic regression analyses were conducted. ResultsTop motivators for attending nutrition-related training included meeting licensure requirements and improving job performance. Child care providers most commonly selected preferences for receiving training included in-person and online delivery. Top barriers to obtaining training were schedule conflicts, accessibility, and cost. Child care centers and participants in the Child and Adult Care Food Program (CACFP) and Nutrition and Physical Activity Self-Assessment in Child Care (Go NAP SACC) were more likely to be motivated by licensure requirements. Rural providers were also more likely to report barriers such as inability to travel and limited access to training. Results revealed that child care type, geographic location, CACFP and Go NAP SACC participation can influence child care providers’ motivators, preferences, and barriers to attending training. Conclusions And ImplicationsResults highlight the importance of offering professional development training that best fits child care providers’ needs and preferences.

Impact of the 2017 Child and Adult Care Food Program Meal Pattern Requirement Change on Menu Quality in Tribal Early Care Environments: The Food Resource Equity and Sustainability for Health Study.

ABSTRACTBackgroundNative American (NA) children have a high prevalence of obesity contributing to lifespan health disparities. Dietary intake is important to promote healthy weight gain, growth, and development. In 2017, the USDA enforced changes to the Child and Adult Care Food Program (CACFP). The CACFP provides reimbursement to qualifying Early Care and Education (ECE) programs that serve foods that uphold the program's nutrition requirements.ObjectiveThis study had the following 2 objectives: 1) Describe a novel index to evaluate ECE menus based on revised CACFP requirements (accounting for food substitutions) and best practices for 3- to-5-y-old children, and 2) analyze CACFP requirement and best practice compliance and nutrient changes in 9 NA ECE programs before and after enforcement of the revised CACFP requirements.MethodsThis longitudinal study is within a larger community-based participatory research study. Menus and meals served were evaluated for 1 wk at each of 9 programs before and after enforcement of the revised meal patterns. Nutrient analysis, CACFP requirement and best practice compliance, and substitution quality were evaluated. Differences were determined using a paired t-test or Wilcoxon matched test. This trial was registered at clinicaltrials.gov as NCT03251950.ResultsTotal grams of fiber consumed increased (5.0 ± 1.2 compared with 5.9 ± 0.8 g, P = 0.04) and total grams of sugar consumed decreased (53.8 ± 12.6 compared with 48.4 ± 7.9 g, P = 0.024), although room for further improvement exists. Although total grams of fat remained unchanged, grams of saturated fat significantly increased (7.8 ± 1.4 compared with 10.5 ± 3.4, P = 0.041). Other nutrients remained unchanged. Overall CACFP requirement and best practice compliance scores improved, although this finding was not statistically significant. No significant changes in food quality associated with substitutions occurred.ConclusionsThis study provides early evidence to support the beneficial impact of the revised CACFP requirements. Understanding barriers to compliance within rural NA communities would be an important next step in enhancing the health of vulnerable children.

Licensed Family Child Care Providers’ Participation in the Child and Adult Care Food Program (CACFP): Greater Benefits and Fewer Burdens in Highly Urban Areas?

ABSTRACTResearch Findings: Family child care providers widely participate in the Child and Adult Care Food Program (CACFP), yet their participation experiences have not been studied. To fill this gap, we used a mixed methods approach that combined survey data collected from a random sample of 224 CACFP-participating licensed family child care providers and in-depth qualitative interviews (n = 40 survey respondents). Working within a cost-benefit framework, we sampled from Chicago and small cities and towns in central Illinois in order to compare providers’ perceptions of the benefits and burdens of CACFP participation by reimbursement level and urban/rural location. Reimbursement rate was related to providers’ perceptions of the adequacy of the reimbursement and how difficult it was to purchase food that met program requirements. Location was related to providers’ perceptions of how difficult it was to prepare meals that met program requirements. Practice or Policy: Our findings suggest modifications to reduce inequities in who has access to the higher reimbursement rate. How providers qualify for the higher reimbursement rate could be reconsidered to ensure that providers outside of urban areas are not disadvantaged. Sponsoring organizations could expand efforts to provide technical assistance and nutrition education, especially for providers outside of urban areas.

Assessing dinner meals offered at home among preschoolers from low-income families with the Remote Food Photography Method.

The high prevalence of obesity among preschoolers may be partially explained by the type and quantity of foods offered by parents and left unconsumed by preschoolers. (a) To compare foods offered and consumed at dinner to the Dietary Guidelines for Americans (DGAs) and the Child and Adult Care Food Program (CACFP) standards and (b) to examine the types, quantities, and nutrient composition of foods offered to and consumed by preschoolers and their plate waste. Participants were recruited from six Head Start/preschool centres. The Remote Food Photography Method was used to document dinner meals over 1 week (n = 153 meals). Energy and nutrients for foods offered, consumed, and plate waste were calculated. Foods offered and consumed were compared with the DGAs and CACFP standards. Foods and beverages offered at dinner equaled 506 kcal, which is 36% of the DGA-recommended total daily energy intake. Meals offered and consumed were high in fat and sodium and low in fibre. Adherence to CACFP standards was low for fruits (25%) and milk (2%) and moderate for vegetables (63%). Mean plate waste (29%) was similar across food types. Opportunities exist to improve preschoolers' adherence to the DGAs and CACFP standards by enhancing the quality of dinner meals offered to them.

O2 Participation in the Food Program Ensures Availability of Nutritious Foods but not Intake in Children Attending Childcare

Background Childcare programs participating in the federal Child and Adult Care Food Program (CACFP) serve nutritious foods and beverages to children. Most of these studies however, report on food served but not in comparison with the updated 2017 CACFP meal pattern and foods consumed. Objective The purpose of this study is to assess if CACFP-funded childcare centers are meeting the updated CACFP meal pattern and age-specific Dietary Guidelines for Americans (DGA) 2015-2020 regarding foods served and consumed by children, respectively. Study Design, Settings, Participants Cross-sectional study using dietary observation in childcare method. Children ages three to five years old (n = 108) from three CACFP childcare centers were recruited by convenience sampling. Measurable Outcome/Analysis Food served and food consumed were measured for five food groups during observed lunch. Amounts of food served from each food group were compared with age-specific minimum serving size requirement by CACFP using one-sample t-test. Amounts of food consumed from each food group were compared with age-specific recommendations by DGA using one-sample t-test. Proportions of foods consumed from the served amounts were calculated using descriptive statistics. Results Foods were served and portioned by the childcare providers for 81.5% (n = 88) of the children. Foods served were consistent with CACFP recommendations. Children were over-served whole grains, milk, fruits and vegetables (FV) than the CACFP requirement (P Conclusion Although childcare centers are serving foods based on CACFP requirements, children are not meeting DGA recommendations. CACFP childcare programs may benefit from training regarding best practices related to encouraging children's healthier food choices and managing food refusal. Funding USDA Hatch Project 1011204; Nebraska Agricultural Experiment Station.

P17 Participation in the Child and Adult Care Food Program (CACFP) Influences Nutrition-Related Practices of Child Care Settings in Nebraska

Background Federal food assistance programs such as the Child and Adult Care Food program (CACFP) are designed to promote healthy dietary habits for young children. Objective Determine how CACFP participation influences implementation of nutrition-related best practices and barriers in childcare settings. Study Design, Settings, Participants Cross-sectional surveys were distributed to 3,014 licensed childcare facilities in Nebraska in 2017 to collect provider-reported information on facility demographics, CACFP participation, and practices implemented in childcare settings serving children aged 2-5 years. Measureable Outcome/Analysis Chi-square analysis was performed in SPSS to determine differences in best practice implementation, barriers, and difficulty level between those who do versus do not participate in the CACFP, stratified by childcare context (center-based versus family childcare home-based). Results The sample included 1,345 childcare programs (54.6% response rate); 86.8% participated in the CACFP, 21.7% were center-based, and 78.3% were home-based. Childcare programs who participated in the CACFP were more likely to serve foods and beverages according to best practices across both contexts; practices included serving fruit at least one time, serving vegetables at least one time, and serving skim or 1% milk (P Conclusion While participation in the CACFP was related to higher prevalence of serving healthier food and beverages, few mealtime practices were affected. This could be attributed to CACFP regulations requiring participating childcare programs to serve nutritious food and beverages to children, but only recommending mealtime-related best practices. These findings could suggest that CACFP-related trainings should emphasize the importance of these practices with consideration of known provider-reported barriers. Funding USDA.

P176 In-Home Childcare Provider Perceived Barriers and Facilitators to Adherence to the New Child and Adult Care Food Program Nutrition Standards

Background Implementation of the new Child and Adult Care Food Program (CACFP) nutrition standards may present challenges, especially for in-home child care providers. Objective To elucidate perceived barriers and facilitators faced by in-home child care providers to following the changes in the CACFP food and beverage nutrition standards. Study Design, Settings, Participants Virtual, semi-structured individual interviews elicited qualitative data from a cross section of low-income in-home child care providers in Michigan. Stratified purposive sampling (race, ethnicity, urban and rural residence and licensure) was used to recruit 20 in-home child care providers. Measurable Outcome/Analysis Thematic coding analysis with NVivo (v10.0) was used to organize and interpret data. Results Primary barriers included: food received outside of child care, food preparation time, child food and beverage restrictions, the expense and availability of foods and beverages and child care provider and child preferences. Facilitators included: focus on health and behavior of children, child care provider encouragement and modeling, clear CACFP guidelines and examples, preparation ahead of time, giving children choices and serving the same food for all children. What the children are perceived as more likely to eat, CACFP, WIC, state child care licensing guidelines, what the child care provider chooses to serve and what the provider perceives as healthy help determined their feeding decisions. Perceived support was provided through CACFP program sponsors, social media outlets, and nutrition and early care education and training organizations. Conclusion Early care education and training organizations, such as Extension, should focus on if and how facilities, seasonality, child dietary restrictions as well as budget impact food purchase choices as well as preparation ability on a limited budget. Modeling and family-style meals education may also be beneficial in conjunction with partnering with CACFP program sponsors and using social media as an informational outlet.

FP10 In-Home Childcare Providers Participating in the Child and Adult Care Food Program (CACFP) Improve Knowledge and Nutritional Quality of Foods and Beverages Served with Nutrition Education Intervention

Objective To determine if a nutrition education intervention for in-home child care providers increased CACFP knowledge and menu adherence. Description Quasi-Experimental Study using the Healthier Childcare Environment Team Nutrition intervention group. Participants included 82 in-home child care providers from Michigan group and family day care home programs from 2016-2019. Evaluation A CACFP knowledge questionnaire and a weekly menu of foods and beverages served were collected pre and post intervention and compared with paired t-tests and Wilcoxon Signed Rank tests. Menus were coded for CACFP nutrition standard compliance by nutrition professionals. After the six-month nutrition education intervention, childcare providers’ knowledge (P = .055) of CACFP nutrition standards and motivation to improve eating and offer healthy choices increased (P = .03) from pre to post assessment. Adherence to CACFP nutrition standards for breakfast and snacks on the menu increased significantly (P Conclusions and Implications The results suggest that the Healthier Childcare Environment intervention improved the nutrition quality of foods being offered to children attending in-home childcare settings. Implementation of the Child and Adult Care Food Program nutrition standards may present challenges, especially for in home providers. Grant Year 2016

P89 The Impact of Digital Learning on Child Care Providers Regarding the Implementation of CACFP Meal Pattern

Background With the release of 2017 United State Department of Agriculture (USDA)/Child and Adult Care Food Program (CACFP) meal pattern, states need to provide training and technical assistance to all Child Care Providers (CCPs) who participate in CACFP to ensure that healthy foods are served to children during mealtime in order to improve early childhood dietary quality and health outcomes. Objective To assess the effectiveness of CACFP Digital Learning (DL) in increasing the knowledge level of the Child Care Providers (CCPs) regarding the implementation of USDA/CACFP new meal pattern in Nebraska (NE). Study Design, Settings, Participants CCPs who participate in CACFP (N = 286) completed four digital learning modules regarding the new CACFP meal pattern. Pre-post knowledge questions were utilized before and after completing each module. Measurable Outcome/Analysis Paired sample t-tests were conducted using SPSS statistical software to examine the differences in CCPs knowledge scores from pre-test to post-test. Results Data shows a significant (P Conclusion It is a win-win result for the NE Department of Education (NDE) and CCPs. DL approach is effective for positively impacting CCPs knowledge level regarding the CACFP new meal pattern. At the same time, DL enables NDE to disseminate the training across the state and reach more CCPs. Although this study aimed to measure the knowledge level of the CCPs directly upon completion each module, future research should focus on the long-term knowledge of the CCPs who utilize DL. Funding USDA Team Nutrition.

FP14 Time-Series Assessment of Childcare Professionals’ Knowledge Regarding the Implementation of the Updated CACFP Meal Pattern

Objective Children's eating behaviors are formed early in life making it an optimal time period to promote healthy eating. Therefore, the United States Department of Agriculture (USDA) released a new meal pattern for the Child and Adult Care Food Program (CACFP) in 2017.There is a gap in the literature regarding CACFP provider's knowledge level of the updated guidelines. This study investigates the nutrition knowledge of CACFP providers after one year of implementing 2017 CACFP meal pattern. Description This is a matched pre-post longitudinal study with a convenience sampling; childcare professionals from CACFP-funded institutions participate in an annual training to maintain their USDA support. At the 2017 annual training, participants were given a “baseline” survey that included 27 knowledge questions. The follow-up survey was administered at the 2018 training. A total of 475 baseline surveys were turned in, and 420 follow-up surveys with 135 matched IDs. Evaluation Descriptive statistics, paired sample t-tests and linear regression analyses were used to determine differences in nutrition knowledge by geographical location, for-profit and non-profit and program settings. Conclusion and Implications The overall percentage of correct answers increased significantly from time one to time two, from 68% to 74% [t (135) = 5.48, P Grant Year 2016

FP6 Supporting Healthy Habits in Childcare with Online Trainings for CACFP Participants

Objective To develop interactive and engaging online trainings for CACFP (Child and Adult Care Food Program) participants, based on adult learning principles and instructional strategy, including audience analysis, and formative evaluation of knowledge gained. The modules support healthy habits in childcare homes and centers. Description A training needs assessment of CACFP participants, completed as part of the Iowa Team Nutrition 2017 grant, revealed menu planning and healthy food purchasing were topics of greatest interest. A Registered Dietitian Nutritionist wrote content for the modules and Iowa Public Television provided instructional design consultation on best practices for adult learners; online course template with discussion board; knowledge assessments; video production; and certification procedures. Healthy Menu Makeover and Healthy Food Purchasing modules were developed, including lesson content, assessments, graphics, links to resources, and certificates of completion. The modules were pilot tested by 10 CACFP participants who provided valuable feedback to make the modules relevant to users. The total budget for the project was $13,500. The modules are available at no cost, can be completed at the participant's own pace and accessed anywhere with an internet connection. Evaluation The modules were released in April 2018 and certificates earned through December 2018 included 516 for Healthy Menu Makeover and 288 for Healthy Food Purchasing. A participant is allowed to take a final quiz up to three times to reach a passing grade of at least 80% correct. Demographic survey results report 51% of users are from centers and 38% are home providers. Conclusions and Implications The online modules have been a popular and effective training option to meet CACFP training requirements in Iowa. Lessons learned include the value of a needs assessment to determine training topics, implementation of an instructional design process, use of an online learning platform, and use of discussion boards to engage learners.

P13 Implementation of and Barriers to Nutrition Best Practices in Urban and Rural Nebraska Child Care Settings

Background Nebraska ranks fifth in the US for childhood obesity among children 2-4 years old. Children in rural areas are more likely to be classified as obese than children in urban areas. There is limited research on nutrition-related practices and barriers of childcare across urban and rural areas. Objective To examine the differences in implementation, barriers, and difficulty of nutrition practices including foods served and mealtime practices in childcare settings across urban-rural contexts in Nebraska. Study Design, Settings, Participants An exploratory cross-sectional study in 2017. Data were collected from 1,170 childcare providers (urban = 591; rural = 579) participating in the Child and Adult Care Food Program (CACFP), including 200 childcare centers (CCCs) and 970 family childcare homes (FCCHs) in Nebraska. Measurable Outcome/Analysis Childcare programs completed the self-administered ‘Healthy Children, Healthy State’ questionnaire. Descriptive statistics and chi-square tests were conducted to assess implementation, difficulty, and barriers to nutrition practices across urban-rural CCCs and FCCHs. Results For implementation of nutrition-related practices, CCCs in urban areas were significantly more likely to serve lean and low fat meat ( P P P P P P P Conclusion This study illuminates factors that may influence high rates of obesity in rural childcare settings.Future research should examine rural childcare programs and how local food systems may decrease costs and increase healthy food availability. Funding USDA National Institute of Food and Agriculture.

FP13 Nebraska Team Nutrition Pilots a Nutrition Education Intervention to Improve Childcare Providers Perceived Feasibility and Usability of the EatPlayGrow™ Curriculum

Objective There were two objectives: determine the impact of NE TN pilot project on childcare provider perceived feasibility and usability of the EPG curriculum and explore the effectiveness of NE TN pilot project on childcare provider's self-efficacy in providing nutrition and physical activity education to children in early childhood classrooms. Description NE TN adopted the EatPlayGrow™ curriculum to develop an interactive nutrition and physical activity (PA) education training program for childcare providers. Five (4 nutrition lessons, 1 PA lesson) out of 11 lessons of EPG curriculum were included in the training. An educational kit was developed including: lessons’ objectives, materials for the activities, and books suggested from the curriculum. Twenty (n = 20) childcare providers were recruited to participate in this pilot project. The recruited providers taught in (n = 5 classroom centers, n = 5 in-home day care). All participants participate in the Child and Adult Care Food Program (CACFP). Participants were provided with the educational kits to utilize for seven weeks and were instructed to provide nutrition and PA lessons to their children in their facilities. This project shows the majority of participants were either moderately or highly confident in their ability to incorporate nutrition and PA education. Data also indicates the majority of the participants plan on incorporating at least some activities from the curriculum in their regular lesson plans. Evaluation Quantitative and qualitative methods were used to assess childcare providers’ feasibility, usability and self-efficacy in providing nutrition and physical activity education to children in their care. A survey was distributed before the training and after seven weeks of completing the training. Conclusion and Implications Interactive training is a feasible method for increasing child care providers’ self-efficacy in delivering nutrition and PA education. Interactive and hands on nutrition and physical activity curriculum training needs to be further evaluated for to determine possible outcomes in childcare settings. Grant Year 2016

Participation in the Child and Adult Care Food Program Influences Nutrition-Related Practices of Child Care Settings in Nebraska (P04-172-19)

ObjectivesFederal food assistance programs such as the Child and Adult Care Food program (CACFP) are designed to promote healthy dietary habits for young children; the present study will aim to determine how CACFP participation influences implementation of nutrition-related best practices and barriers in childcare settings. MethodsCross-sectional surveys were distributed to 3014 licensed childcare facilities in Nebraska in 2017 to collect provider-reported information on facility demographics, CACFP participation, and practices implemented in childcare settings serving children aged 2–5 years. Chi-square analysis was performed in SPSS to determine differences in best practice implementation, barriers, and difficulty level between those who do versus do not participate in the CACFP, stratified by childcare context (center-based versus family childcare home-based). ResultsThe sample included 1345 childcare programs (54.6% response rate); 86.8% participated in the CACFP, 21.7% were center-based, and 78.3% were home-based. Childcare programs who participated in the CACFP were more likely to serve foods and beverages according to best practices across both contexts; practices included serving fruit at least one time, serving vegetables at least one time, and serving skim or 1% milk (P < 0.05 for all). In family childcare homes only, those who participated in the CACFP were more likely to role model eating healthy foods and serve meals family style (P < 0.05 for both). Across both contexts, those who participated in the CACFP were more likely to receive professional development on child nutrition (P < 0.01). ConclusionsWhile participation in the CACFP was related to higher prevalence of serving healthier food and beverages, few mealtime practices were affected. This could be attributed to CACFP regulations requiring participating childcare programs to serve nutritious food and beverages to children, but only recommend mealtime-related best practices. These findings could suggest that CACFP-related trainings should emphasize the importance of these practices with consideration of known provider-reported barriers. Funding SourcesThis work was supported by the US Department of Agriculture National Institute of Food and Agriculture and the Nebraska Agricultural Experiment Station.

The Development of Child and Adult Care Food Program Best-Practice Menu and Training for Native American Head Start Programs: The FRESH Study (P04-026-19)

ObjectivesNew Child and Adult Care Food Program (CACFP) meal patterns and best-practices were implemented nationally in 2017 to address the need to prevent chronic diseases. Young Native American children have disproportionately higher risk of chronic disease. Some Native American tribes operate early care and education (ECE) programs and have the opportunity to participate in the CACFP. The purpose of this paper is to describe a CACFP best-practice menu and training developed and implemented as part of the Food Resource Equity and Sustainability for Health (FRESH) study. MethodsFRESH is a community-based participatory research (CBPR) intervention implemented within ECE programs in the Osage Nation of Oklahoma. Site managers and cooks from each of the nine ECE programs attended meetings and provided feedback to investigators which shaped the best-practice menu and training. Each site participated in a three-hour training in January 2018 to discuss the best-practice menu and ways to overcome implementation barriers. Goals of the menu aimed to increase intake of fruit and vegetables and whole grains and reduce pre-fried and processed foods without increasing cook burden. Training included application activities individually and in small and large groups. ResultsThough the project is still underway, lessons learned have emerged including the need for technical assistance, improved communication between ECE program staff and food supply vendors, and infrastructure barriers (e.g., limited space, lack of supplies) that challenge work-flow. ConclusionsEfforts to improve menus in rural and low-income ECE programs must consider these issues in developing feasible intervention strategies. Collaboration with the site manager and cook is essential to fully understand perceived and actual barriers to provide training that can provide necessary background rationale for nutrition recommendations as well as beneficial and productive activities and hands-on training to effect change outside the training. Funding SourcesThis study was funded by the National Institute on Minority Health and Health Disparities (R01MD011266). The funding agency did not participate in the study design, data collection, analysis, decision to publish, or preparation of the manuscript.

The development of child and adult care food program best-practice menu and training for Native American head start programs: The FRESH study.

New Child and Adult Care Food Program (CACFP) meal patterns and best practices were implemented nationally in 2017 to address the shift in dietary need from ensuring essential nutrient consumption to chronic disease prevention. Young American Indian (AI) children have disproportionately higher risk of chronic disease. Some AI tribes operate early care and education (ECE) programs and have the opportunity to participate in the CACFP. The purpose of this paper is to describe a CACFP best-practice menu and training developed and implemented as part of the Food Resource Equity and Sustainability for Health (FRESH) study, a community-based participatory research (CBPR) intervention implemented within ECE programs in the Osage Nation of Oklahoma. Site managers and cooks from each of the nine ECE programs attended meetings and provided investigators with feedback that shaped the best-practice menu and training. Each site participated in a three-hour training in January 2018 to discuss the best-practice menu and ways to overcome implementation barriers. Goals of the menu aimed to increase intake of fruit and vegetables and whole grains and reduce pre-fried and processed foods without increasing cook burden. Training included application activities individually and in small and large groups. Though the project is still underway, lessons learned, including the need for technical assistance, improved communication between ECE program staff and food supply vendors, and infrastructure barriers (e.g., limited space, lack of supplies) that challenge workflow, have emerged. Efforts to improve menus in rural and low-income ECE programs must consider these issues in developing feasible intervention strategies.

Sugary Cereals at Early Childhood Education Centers Participating in the Child and Adult Care Food Program, 2017.

The objective of this study was to describe the provision of sugary cereals by early childhood education (ECE) centers participating in the Child and Adult Care Food Program (CACFP) before required implementation of the updated CACFP meal pattern standards. We distributed a web-based survey, which included a question on breakfast cereals, to a random sample of 5,483 CACFP-participating ECE centers nationwide. Of the 1,343 centers that responded, 30% did not meet the updated requirement for cereal; 38% of independently owned or operated centers did not meet the requirement. Results indicate the need for additional training and technical assistance on the updated CACFP standards for sugar in cereal.

Assessment of Nutrition Knowledge of Childcare Providers Regarding the Implementation of the 2017 CACFP Meal Pattern Update

ABSTRACTBackground: With the release of 2017 Child and Adult Care Food Program (CACFP) meal pattern, states need to determine knowledge gaps in order to develop targeted training materials and resources to aid childcare providers in achieving new regulations. Purpose: To assess the nutrition knowledge of childcare providers in regards to the implementation of the 2017 CACFP meal pattern. Methods: Convenience sampling, where CACFP participants (n = 398) completed a self-reported survey at the annual mandatory trainings across the state of Nebraska, was employed in this study. Descriptive statistics including frequencies, means, standard deviations, independent sample t tests, and chi-square tests were used to determine differences in nutrition knowledge by geographical location, for-profit and nonprofit, and program settings. Results: Data obtained from this study indicate that CACFP participants scored low on questions regarding yogurt (30%), juice (35%), breakfast cereal (37%), and whole grain (43%) questions. Data also show that there was no significant difference in levels of knowledge among characteristics and demographics of programs, types of facilities, and geographic locations. Translation to Health Education Practice: The present study results underscore the importance for continued professional development for CACFP participating childcare providers to implement the new CACFP meal pattern for child nutrition standards.

Beverage Policy Implementation by Child and Adult Care Food Program Participation and Program Type: A Statewide Examination in Georgia.

The child care setting is a promising venue to establish healthy habits and promote obesity prevention. One major contributor to weight gain among young children is high intake of sugar-sweetened beverages (SSBs). Increasing access to water and other healthy beverages is a viable strategy to reduce childhood obesity. The goal of our study was to investigate implementation of the beverage policies in child care programs in Georgia (GA) by Child and Adult Care Food Program (CACFP) participation and program type. The study employed a cross-sectional design. A statewide survey was conducted using the GA Child Care Wellness Survey. A random sample of 3054 child care programs was obtained. Programs were stratified by six state regions to acquire a representative sample. A total of 974 surveys were returned. Sixty-seven percent of the respondents were enrolled in CACFP. Programs participating in CACFP (96%) were less likely to serve SSBs (x2(2) = 15.309, p < 0.001), than non-CACFP programs (90%). CACFP programs were more likely to serve low-fat or fat-free milk to 2-5-year olds than non-CACFP programs (87% vs. 35%, p < 0.001). Family child care homes were significantly more likely to comply with serving only whole milk to 1 year olds (66%; p < 0.001) than other program types. All program types had low compliance with implementing water policies. Study outcomes provide vital information on the implementation of beverage policies that can inform beverage policy training, with the ultimate goal of reducing obesity risk and promoting healthier diets among preschool children in GA.

Center-Reported Adherence to Nutrition Standards of the Child and Adult Care Food Program.

The Child and Adult Care Food Program (CACFP) sets nutrition standards for foods served in participating settings. Licensing regulations in many states, including Connecticut (CT), extend these rules to nonparticipating facilities. This study evaluates the food environment for preschool-age children in CT child care centers and describes center-reported adherence to the CACFP nutrition regulations. We surveyed directors of licensed CACFP-participating and non-CACFP centers that served meals and/or snacks. Food served, caregiver feeding behavior, nutrition practices and policies, and CACFP knowledge were reported by 256 non-CACFP and 87 CACFP centers. We conducted bivariate analyses to describe adherence to the CACFP regulations as reported by CACFP and nonparticipating centers. Data were collected in 2015-2016 and analyzed in 2017. CACFP centers reported more engagement in recommended feeding and nutrition practices than non-CACFP centers, including serving more fresh fruit and whole grains at snack time, serving low-fat milk for meals/snacks, and use of family style dining and positive caregiver behaviors. No center reported serving soda, only a few had fruit drinks, and the majority prohibited parents from sending in sugary drinks. Despite the licensing regulations about compliance with the CACFP nutrition standards, 52% of non-CACFP centers had never heard of CACFP and only 21% received information about following the CACFP standards and practices. CACFP participation is associated with better center-reported adherence to the CACFP nutrition standards and feeding practices. Poor awareness about CACFP among nonparticipating centers needs to be addressed to improve compliance with the CACFP nutrition standards.