Public Health Nutrition

Health Economy

Improving nutrition in home child care: are food costs a barrier?

Pablo Monsivaisa1 c1 and Donna B Johnsona1

a1 Center for Public Health Nutrition, School of Public Health, University of Washington, 305 Raitt Hall, Box 353410, Seattle, WA 98195, USA


Objective Child-care providers have a key role to play in promoting child nutrition, but the higher cost of nutritious foods may pose a barrier. The present study tested the hypothesis that higher nutritional quality of foods served was associated with higher food expenditures in child care homes participating in the Child and Adult Care Food Program (CACFP).

Design In this cross-sectional study, nutritional quality of foods served to children and food expenditures were analysed based on 5 d menus and food shopping receipts. Nutritional quality was based on servings of whole grains, fresh whole fruits and vegetables, energy density (kJ/g) and mean nutrient adequacy (mean percentage of dietary reference intake) for seven nutrients of concern for child health. Food expenditures were calculated by linking receipt and menu data. Associations between food expenditures and menu quality were examined using bivariate statistics and multiple linear regression models.

Setting USA in 2008–2009.

Subjects Sixty child-care providers participating in CACFP in King County, Washington State.

Results In bivariate analyses, higher daily food expenditures were associated with higher total food energy and higher nutritional quality of menus. Controlling for energy and other covariates, higher food expenditures were strongly and positively associated with number of portions of whole grains and fresh produce served (P = 0·001 and 0·005, respectively), with lower energy density and with higher mean nutrient adequacy of menus overall (P = 0·003 and 0·032, respectively).

Conclusions The results indicate that improving the nutritional quality of foods in child care may require higher food spending.

(Received February 28 2011)

(Accepted August 22 2011)

(Online publication September 29 2011)


c1 Corresponding author: Email