ArticleBMC public health2020
Participation in the Child and Adult Care Food Program is associated with fewer barriers to serving healthier foods in early care and education.
Article in BMC public health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 42 citations in OpenAlex.
- Identifying barriers and facilitators in the development and implementation of government-led food environment policies: a systematic review.Nutrition reviews · 2022Pooled it
- Beyond Local Champions: Contextual Factors Shaping the Implementation of Healthy Eating Interventions in Centre-Based Care - A Qualitative Study With Educators and Cooks.Health promotion journal of Australia : official journal of Australian Association of Health Promotion Professionals · 2025Article
- Implementation strategies used in policy, systems, and environmental interventions addressing obesity-related outcomes in early childhood education settings: a systematic review.Implementation science communications · 2025Review
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- Federal Nutrition Assistance for Young Children: Underutilized and Unequally Accessed.American journal of preventive medicine · 2024Article
- Leveraging the Child and Adult Care Food Program to Facilitate Healthy Behaviors and Environments in Early Care and Education Settings.American journal of public health · 2023Article
- Supporting Healthy Weight in Statewide Quality Rating and Improvement Systems: A Review of 2020 Standards and Comparison to 2015 Standards.Childhood obesity (Print) · 2023Review
- Opportunities to Improve Access to and Retention in the Child and Adult Care Food Program: Key Recommendations From Early Childcare Providers in Illinois, December 2020-July 2021.American journal of public health · 2023Article
- Implementation of Federal Waivers for Feeding Children in Early Care and Education During the COVID-19 Pandemic.Journal of nutrition education and behavior · 2022Article
- Leveraging Federal, State, and Facility-Level Early Care and Education Systems and Providers Toward Optimal Child Nutrition in the First 1000 Days.American journal of public health · 2022Article
- Mealtime Environment and Feeding Practices in Urban Family Child Care Homes in the United States.Childhood obesity (Print) · 2022Article
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- A Safety Net Unraveling: Feeding Young Children During COVID-19.American journal of public health · 2021Article
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- Article
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundEarly 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.
methodsWe 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.
resultsWe 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.
conclusionsCACFP 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.
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