Study of Nutrition and Activity in Child Care Settings II (SNACS II)

When in the care of providers participating in CACFP, children have better overall diets on days when they are in child care than on days when they are not.

With the help of parents and study staff, SNACS-II collected data on everything kids ate over the course of a day, both at child care and at home. We found that in program year 2022-23, 3- to 5-year-old children had better overall diets on days when they attended child care than on days when they did not attend. On days in child care, 3- to 5-year-olds consumed more vegetables, fruit, whole grains, and dairy compared to days not in child care. They also consumed fewer calories from saturated fats and added sugars. These differences contributed to their higher HEI total score on days when they were in child care.

The meals and snacks CACFP providers served in 2022-23 aligned with the Dietary Guidelines for Americans.

SNACS-II measured how the meals and snacks served by CACFP child care providers aligned with the DGA in three ways:

1. USDA meal pattern requirements
   • USDA requires CACFP providers to serve different meal patterns for breakfast, lunch, and snacks. Meal patterns are combinations of meal components (fruits, vegetables, grains, meats/meat alternates, and fluid milk) served in portions that vary by age. Our study found that CACFP meal patterns align with the DGA.
   • In this study, most early child care programs served all the required meal components to 3- to 5-year-olds at breakfast (96%), lunch (82%), and snacks (85%). Nearly all early child care programs (99%) also met the requirement to limit fruit juice. About half (55%) met the requirement to serve whole grain-rich foods every day.
   • In this study, most before and afterschool programs served all the required meal components at snack (85%) and supper (78%).
2. HEI-2015 total scores over time
   • HEI total scores measure how well a set of foods aligns with the DGA, with scores ranging from 0 (does not align) to 100 (aligns). People should aim to meet the dietary guidelines with their overall diet-not with every single meal-so we do not expect HEI total scores to be 100 for every single CACFP meal either. Instead, we can compare HEI total scores for CACFP meals over time to see if they are improving. We expected HEI total scores to improve from SNACS-I (collected in 2016-17) to SNACS-II (collected in 2022-23) because USDA updated the CACFP meal patterns shortly after SNACS-I to align them with the DGA.
   • Note that these HEI scores for meals and snacks refer to the quality of the food served to children through CACFP, while the HEI scores in the section above refer to the food children consumed over the course of the full day.
   • For children ages 3 to 5 years in early child care programs, HEI scores for breakfasts and lunches increased from SNACS-I to SNACS-II. The HEI total score for all meals and snacks combined for this age group rose from 72 in SNACS-I to 77 in SNACS-II.
   • For children ages 6 to 12 years in before and afterschool programs, HEI total scores for snacks and suppers increased from 75 in SNACS-I to 82 in SNACS-II.

1. HEI-2015 component scores
   • When total HEI scores are broken down into their component parts (e.g. fruits, added sugars, etc.) for breakfast and lunch, most components scored high. Because a component may have a total of 5 or 10 points, we show component scores as a percentage of their maximum score. High component scores are good. In this study, they indicate that CACFP meals align with DGA recommendations to serve enough of some foods and nutrients ("adequacy components") and limit others ("moderation components"). Low component scores indicate room for improvement.
   • Note that the meal pattern for breakfast requires providers to serve fluid milk, a fruit or vegetable, and a grain; therefore, we expect vegetable and protein-related components to have lower scores at breakfast because they are not served as often.
   • Below, we share the main findings from early child care centers in the figure and findings from before and afterschool programs in the text that follows.

• Snacks served in before and afterschool programs received high HEI component scores for total fruits (94%), saturated fats (95%), sodium (91%), and added sugars (89%), meaning snacks were consistent with DGA recommendations for those components. Scores were lower for dairy (63%) and whole grains (68%), indicating that these components are not often served as snacks since only two of five meal components are required (e.g., choice of two from fluid milk, meats/meat alternates, vegetables, fruits, and/or grains).
• Suppers served in before and afterschool programs received high HEI component scores for total fruits (98%), whole fruits (100%), dairy (100%), and added sugars (90%). The lower scores for fatty acids (42%) and sodium (50%) indicate room for improvement.

Meal reimbursement rates covered providers' food costs but fell below total meal costs for all meal types.

USDA provides participating CACFP providers with funding (per-meal reimbursements) for meals and snacks to help offset the cost. Most of the cost to produce meals in child care centers was for labor costs rather than food costs. On average, labor costs accounted for 77% of total breakfast costs, 67% of total lunch costs, and 81% of total snack costs.

Some providers faced challenges related to CACFP.

CACFP participation: Providers reported the same top challenges to participating in CACFP in SNACS-II as they did in SNACS-I, including insufficient meal reimbursement and paperwork requirements. Although data from SNACS II indicates that CACFP reimbursements are sufficient to cover food costs, they are insufficient to cover food and labor costs. This is expected as USDA reimbursements for CACFP meals and snacks are intended to offset costs, not necessarily cover them completely.

Among SNACS-II early child care providers, 36% reported insufficient meal reimbursement as a major challenge to participation in CACFP, 31% reported it to be a minor challenge, while 33% reported it not to be a challenge. Among before and afterschool programs, 27% reported insufficient reimbursement to be a major challenge to participation, 21% reported it to be a minor challenge, while 52% reported it not to be a challenge. Paperwork requirements to receive meal reimbursement were reported as a major or minor challenge by 36% of early child care providers and 40% of before and afterschool programs, while the majority of providers reported paperwork requirements were not a challenge to participation.

Menu planning: Nearly half of providers in SNACS-II reported having no challenges planning menus that meet the CACFP meal patterns (44% of early child care programs and 48% of before and afterschool programs). Limited access to foods that fit the requirements was the most reported challenge to meeting nutritional requirements (24% of early child care programs and 27% of before and afterschool programs).