Abstract
Background
Policies to promote healthy eating in young children appear promising, but are largely
untested. Recently, South Carolina implemented mandatory nutrition standards governing
child-care centers serving low-income children.
Objective
This study evaluated consistency with the standards before and after the policy took
effect.
Design
This study evaluated consistency with the nutrition standards in South Carolina, using
North Carolina—a state not making policy changes—as the comparison. The research team
conducted assessments in a longitudinal sample of centers and a cross-sectional sample
of children before and approximately 9 months after the standards took effect.
Participants/setting
Trained observers recorded foods and beverages served to 102 children from 34 centers
in South Carolina and 90 children from 30 centers in North Carolina at baseline. At
follow-up, the research team observed 99 children from 33 centers in South Carolina
and 78 children from 26 centers in North Carolina.
Intervention
The policy was implemented in April 2012 and included 13 standards governing the nutritional
quality of foods and beverages served to children, and staff behaviors related to
feeding children in care.
Main outcome measures
The outcome was consistency with each standard at follow-up in South Carolina compared
with North Carolina, controlling for baseline consistency and other covariates.
Statistical analyses performed
Logistic regressions were conducted to evaluate consistency with each standard, adjusting
for baseline and potential confounders.
Results
Compared with North Carolina, centers in South Carolina were more likely to be consistent
with the standard prohibiting the use of food as a reward or punishment (odds ratio=1.22;
95% CI 1.11 to 1.61; P=0.03). Two centers in South Carolina met all 13 standards at follow-up compared with
none in North Carolina. No other differences were observed.
Conclusions
New standards modestly improved nutrition practices in South Carolina child-care centers,
but additional support is needed to bring all centers into compliance with the current
policies.
Keywords
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Biography
S. E. Benjamin Neelon is an associate professor, Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, MD.
Biography
M. Mayhew is a research project manager, Department of Community and Family Medicine, Duke University Medical Center, Durham, NC.
Biography
F. Li is a graduate student, Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC.
Biography
J. R. O’Neill is a research assistant professor, Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia.
Biography
R. R. Pate is a professor, Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia.
Biography
B. Neelon is an associate professor, Department of Public Health Sciences, Medical University of South Carolina, Charleston.
Article info
Publication history
Published online: January 06, 2016
Accepted:
October 28,
2015
Received:
October 20,
2014
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT This study was supported, in part, by a grant from the Robert Wood Johnson Foundation (RWJF), Healthy Eating Research #69551. The content is solely the responsibility of the authors and does not necessarily represent the official views of the RWJF.
Identification
Copyright
© 2016 by the Academy of Nutrition and Dietetics.
