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Rhode Island childcare centers using federal nutrition subsidy served healthier food

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PROVIDENCE, R.I. [Brown University] — A new Brown University study suggests that in Rhode Island, the nutritional requirements imposed by a federal food subsidy program for daycare centers that serve low-income children have resulted in kids at those centers eating healthier food than kids at centers that do not participate in the program.

The analysis, based on the survey responses of more than 100 directors of centers around the state serving children aged 18 months to 5 years, suggest that if all daycare centers followed nutritional guidelines — such as the ones enforced by U.S. Department of Agriculture's Child and Adult Care Food Program (CACFP) — more kids might receive better nutrition.

"I encourage all childcare facilities to follow the CACFP guidelines voluntarily as a check on the nutritional quality of what is being served," said Patricia Risica, lead author of the study in BMC Nutrition and research assistant professor in the Brown University School of Public Health. "Alternatively, I would encourage the state regulations to include CACFP guidelines for all licensed childcare facilities."

Food findings

The detailed surveys, conducted in 2011, asked center directors questions about the food they serve, opportunities for physical activity and attitudes among staff and parents regarding health and nutrition. In all, 107 facility directors, including at 36 centers receiving CACFP subsidies and 71 centers outside the program, answered all the survey's questions.

Centers qualify for the CACFP reimbursements of two meals and one snack that meet nutrition guidelines if 25 percent or more of children meet measures of low income, SNAP assistance or Head Start enrollment.

Overall, the study found that nutrition could be considerably better in all centers, regardless of program participation, but that CACFP center directors reported significantly higher frequencies of providing healthy foods such as fruits and vegetables, beans, 100 percent juice and low-fat milk.

The nutritional differences were evident in the data, even though directors at non-CACFP centers were more likely to say they were capable of identifying healthy foods and had easy access to purchasing them. The difference seems to arise from the program enforcing requirements rather than depending on the abstract nutrition perceptions or knowledge of the staff, Risica said.

"CACFP recipients are required to serve food within very specific meal plan parameters, which are monitored," Risica said. "Also, CACFP providers and sponsors are required to have continuing education regarding nutrition. To us, the likelihood is that the requirements for meal plans and education make the difference."

Regulations or a voluntary commitment to guidelines may counteract the temptation to take an easier road on nutrition, Risica said.

"Less healthy food is often cheaper and consumed without complaint," Risica said. "Healthier foods might cost more, not taste as good if not prepared in an appetizing way, and children might need encouragement to eat something that is not part of their usual diet at home. I was not terribly surprised that those not monitored for nutritional quality do not serve a very healthy menu. The same pattern is seen with public — regulated and monitored — versus private schools."

CACFP does not make or enforce any requirements for physical activity, and there was no difference in the survey data in physical activity between centers in or out of the program.

Though the survey data is five years old, it is still relevant, Risica said. Rhode Island has not promulgated new rules for daycare centers since 2007. CACFP regulations have been revised, but many daycare centers remain outside state or federal programs entirely, meaning they remain without clear nutrition guidelines.

In the survey, center directors overwhelmingly said they would welcome standardized nutrition guidelines, though they were not asked specifically about CACFP's rules as that standard.

Risica said she hopes centers will begin to meet particular nutrition standards.

"Changing the childcare environment to expose children to healthy, tasty foods and fun, engaging physical activity will not only benefit their health, but also will hopefully instill in children a love of healthy foods and activity that will last into adulthood," she said.

In addition to Risica, the paper's other authors are Sarah Amin, Angela Ankoma and Eliza Lawson.

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The study was funded by a grant from the U.S. Centers for Disease Control and Prevention to the Rhode Island Department of Health (grant: CDC-RFA-DP13-1305).

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David Orenstein
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