Maternal and Child Health Journal

, Volume 20, Issue 9, pp 1933–1939 | Cite as

Obesity Prevention Practices and Policies in Child Care Settings Enrolled and Not Enrolled in the Child and Adult Care Food Program

  • Sherry T. LiuEmail author
  • Cheryl L. Graffagino
  • Kendall A. Leser
  • Autumn L. Trombetta
  • Phyllis L. Pirie


Objectives The United States Department of Agriculture’s Child and Adult Care Food Program (CACFP) provides meals and snacks to low-income children in child care. This study compared nutrition and physical activity practices and policies as well as the overall nutrition and physical activity environments in a sample of CACFP and non-CACFP child care settings. Methods A random stratified sample of 350 child care settings in a large Midwestern city and its suburbs, was mailed a survey on obesity prevention practices and policies concerning menu offerings, feeding practices, nutrition and physical activity education, activity levels, training, and screen time. Completed surveys were obtained from 229 of 309 eligible child care settings (74.1 % response rate). Chi square tests were used to compare practices and policies in CACFP and non-CACFP sites. Poisson and negative binomial regression were used to examine associations between CACFP and total number of practices and policies. Results Sixty-nine percent of child care settings reported CACFP participation. A significantly higher proportion of CACFP sites reported offering whole grain foods daily and that providers always eat the same foods that are offered to the children. CACFP sites had 1.1 times as many supportive nutrition practices as non-CACFP sites. CACFP participation was not associated with written policies or physical activity practices. Conclusions for Practice There is room for improvement across nutrition and physical activity practices and policies. In addition to food reimbursement, CACFP participation may help promote child care environments that support healthy nutrition; however, additional training and education outreach activities may be needed.


Child and Adult Care Food Program Nutrition Physical activity Child care Practices Policies 



This work was supported by Cooperative Agreement No. U48-DP001912 from the Centers for Disease Control and Prevention. The findings and conclusions in this journal article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Supplementary material

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Supplementary material 1 (DOC 27 kb)


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Sherry T. Liu
    • 1
    • 3
    Email author
  • Cheryl L. Graffagino
    • 2
  • Kendall A. Leser
    • 1
  • Autumn L. Trombetta
    • 2
  • Phyllis L. Pirie
    • 1
  1. 1.Division of Health Behavior and Health PromotionThe Ohio State University College of Public HealthColumbusUSA
  2. 2.Columbus Public HealthColumbusUSA
  3. 3.U.S. Food and Drug AdministrationCollege ParkUSA

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