Research Original Research| Volume 116, ISSUE 6, P949-956, June 2016

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Comparative Evaluation of a South Carolina Policy to Improve Nutrition in Child Care

Published:January 06, 2016DOI:



      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.


      This study evaluated consistency with the standards before and after the policy took effect.


      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.


      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.


      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.


      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.


      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.


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      S. E. Benjamin Neelon is an associate professor, Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, MD.


      M. Mayhew is a research project manager, Department of Community and Family Medicine, Duke University Medical Center, Durham, NC.


      F. Li is a graduate student, Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC.


      J. R. O’Neill is a research assistant professor, Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia.


      R. R. Pate is a professor, Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia.


      B. Neelon is an associate professor, Department of Public Health Sciences, Medical University of South Carolina, Charleston.