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Abstract
Background: Early care and education (ECE) settings serve as primary eating environments for young children. Approximately 60% of U.S. children aged 5 years old and under are enrolled in some form of ECE and receive up to two-thirds of their daily nutrition in these settings. Many factors impact nutrition in ECE settings. While most studies have focused on the association between Child and Adult Care Food Program (CACFP) and nutrition, little is known about the relationship between procurement practices (where and how childcare providers purchase food) and nutrition in ECE settings. This information may guide purposeful interventions that promote healthy procurement and improve access to healthy foods, ultimately improving the nutritional quality of meals children receive in ECE settings.
Objective: The purpose of this analysis is to characterize the food procurement practices of licensed center (Centers)- and family home-based (FHCCs) ECE programs in Washington State and to explore the relationships of these practices with the nutritional quality of meals served to children in their care.
Methods: In 2013, the University of Washington Center for Public Health Nutrition invited all Washington State licensed Centers and FHCCs (1,522 Centers; 4,013 FHCCs) serving children aged 2-5 years old to participate in a 152-item survey. This analysis focuses on 48 questions from these topic areas: 1) Socio-Demographics, 2) Nutrition Best Practices and, 3) Procurement Characteristics. Chi-square tests were used to test for difference in response distributions for categorical responses, while two-sample t-tests were used to test for mean differences in the continuous responses. Linear regressions examined the bivariate associations of Composite Nutrition Scores with key socio-demographic, child care program characteristics, and procurement variables. A series of multivariable linear regression models explored the relationship between each procurement variable (i.e., Main Store and Main Mode, the primary independent variables) and the Composite Nutrition Score (i.e., the dependent variable).
Results: Centers had a 46% response rate (692 out of 1,522 Centers) and FHCCs had a 32% response rate (1,281 out of 4,013 FHCCs). In terms of food procurement mode, most programs prefer in-person shopping compared to phone and online shopping modes, regardless of CACFP participation (91% CACFP vs. 92% non-CACFP from the full sample). Both CACFP and non-CACFP centers shop primarily at Megastores (Costco, Target, Walmart, Sam's Club) (41% CACFP Centers vs. 53% non-CACFP Centers). CACFP FHCCs use both Megastores as well as grocery stores (Albertsons, QFC, Safeway, Trader Joes etc.) at similar rates (31% Megastores vs. 34% Grocery Stores), while non-CACFP FHCCs primarily use Megastores (40%). Race/ethnicity, education, and years employed in the childcare field are associated with the nutritional quality of foods served to children. CACFP enrollment is also positively associated with the quality of nutrition in childcare. Multivariate analysis models found that in this sample, after taking into account key socio-demographic variables and child care program characteristics, food procurement characteristics were not predictors of nutritional quality of foods offered to children.
Conclusion: Although food procurement characteristics were not significantly associated with the nutritional quality of foods in ECE settings, this paper identifies where and how meals are purchased for childcare programs in Washington State, thus illuminating potential points of interventions to improve access to healthy and affordable foods for ECE settings.
