How local and state regulations affect the child care food environment: A qualitative study of child care center directors' perspectives.

Almost one-third of preschoolers spend regular time in child care centers where they can consume the majority of their daily dietary intake. The child care setting influences children's dietary intake. Thus, it is important to examine factors, such as local and state regulations, that influence the food environment at the center. This qualitative study explored directors' perceptions of how regulations influence the foods available at child care centers. Ten directors of centers in Travis County, Texas completed semi-structured interviews. Directors reported that changes in local health department regulations (e.g., kitchen specifications) result in less-healthful foods being served (e.g., more prepackaged foods). Directors of centers that do not participate in the federal Child and Adult Care Food Program (CACFP) said the state licensing regulations clarify the portion size and nutritional requirements for preschoolers thereby improving the nutritional quality of the food served. Directors of centers participating in CACFP said they are not affected by state mandates, because the CACFP regulations are more stringent. These findings suggest that state regulations that specify and quantify nutritional standards may beneficially impact preschoolers' diets. However, local health department regulations enacted to improve food safety may negatively influence the nutritional value of food served in centers.

Dietary intake at child-care centers and away: are parents and care providers working as partners or at cross-purposes?

OBJECTIVE: To examine how meals and snacks children consume before and after their time at a child-care facility complement the menu at the facility. DESIGN: Dietary intake of children at and away from the child-care center was compared with recommended standards for child nutrition. Registered dietitians observed foods consumed at the center during 3 consecutive days. Parents reported foods consumed away from the center during the same 3 days. SUBJECTS/SETTING: Six nonprofit child-care centers with strong menus (i.e., menus that come close to meeting dietary recommendations) and 6 with menus supplying less than 50% of the Recommended Dietary Allowance were selected for study. Five families at each center were invited to participate. Complete data sets were obtained for 51 children aged 3 to 6 years. STATISTICAL ANALYSES PERFORMED: Descriptive and inferential statistics were calculated to compare the children's dietary intake during center time and family time and over a full day with recommended standards. Energy and nutrient profiles and food frequencies were included in the analysis. RESULTS: Children consumed plenty of foods at the center and away from the following groups: meat, poultry, fish, dry beans, eggs, nuts; milk, yogurt, cheese; and fruit, fruit juice. Most children failed to consume enough vegetables. Nearly all the children failed to consume enough bread, cereal, pasta, and rice, especially while at the center. The majority ate more than sparing amounts of fats, oils, and sweets, especially during family time. Average percentage of energy from fat was 33 +/- 4. Intakes of concern for the full day were energy, iron, sodium, and zinc. APPLICATIONS: Child-care menus are an appropriate target for increasing iron and zinc by serving more cereal and whole grains. Families are an appropriate target for reducing young children's consumption of fats, oils, and sweets. Nutrition education and advocacy are needed to strengthen the partnership between parents and caregivers.

Identification of factors that influence the menu at child care centers: a grounded theory approach.

OBJECTIVE: This study was conducted to identify factors that influence what is on the menu at child care centers. DESIGN: Quantitative and qualitative data on menus, food preparation, and foodservice were collected during site visits to child care centers. Grounded theory methods were used to develop an explanation of child care menu planning that is "grounded" in data. SAMPLE AND SETTING: Three child care centers were selected in each of three communities representing different ethnic cultures in Texas. MAIN OUTCOME MEASURE: Quality of child care menus, as measured by nutrient content and variety and amount of food served, constituted the core category or main phenomenon. ANALYSES: Open and axial coding of the qualitative data were performed to identify significant themes and concepts and to explore their interrelationships in order to produce an explanation of the quality of child care menus. RESULTS: The patterns of strengths and weaknesses in the menus were similar in all three ethnic/geographic regions that were visited and were similar to findings in other states. The factors that have the most direct influence on the menus are food program requirements, staff perceptions of children's food preferences, history of the food program at the center, and cost. APPLICATIONS/CONCLUSIONS: The data and theory support three broad conclusions: (a) child care menus need to be improved; (b) training for child care staff needs to be sensitive to the missions and cultures of different kinds of child care centers; and (c) because lack of staff knowledge has only an indirect influence on the menus, changes in program requirements and strategies for assisting and monitoring food programs in child care centers may also be needed.

What can children learn from the menu at the child care center?

As a result of studies in Texas that indicated menus in child care centers may be depriving children of nutrients, a study was conducted to determine the prevalence of similar problems in 7 states. Menus for breakfast or morning snack, lunch, and afternoon snack for 10 consecutive program days were obtained from 171 child care centers. Results of nutrient analysis of the menus were compared against the Recommended Dietary Allowances (RDA) for children aged 1 to 3 and 4 to 6. Menus typically provided at least 100 percent of the RDA for protein and the vitamins A, ascorbic acid, B12, and riboflavin. The menus offered an average of only 42 percent of the iron needed by both the younger and older children. In all 7 states the menus provided less than 56 percent of the kilocalories recommended and less than 64 percent of niacin for the 1 to 3 year olds. Mean value for kilocalories for the 3-5 year old averaged 40 percent of recommendation while niacin averaged 48 percent. These findings indicate that attention should be directed toward careful assessment of nutritional adequacy of meals and snacks actually served at child care centers, the children's nutritional intake at the center, and the nutritional content of meals and snacks eaten away from the center.

Worksite nutrition education can lower total cholesterol levels and promote weight loss among police department employees.

Individuals who work in law enforcement careers are often subjected to stress that can result in health and emotional disorders. Many police departments have begun to offer wellness programs to support their employees. This pilot study designed and implemented a nutrition education component for an existing police department wellness program. Twenty-eight subjects completed the 12-month study that included nutrition counseling, seminars on nutrition and eating behaviors, and monitoring of weight and blood lipid levels. There was a significant group trend for decreased weight and lower total cholesterol levels. Results of the study led to the development of health policy standards for the Austin (Tex) Police Department. Wellness programs that involve registered dietitians can result in weight loss and lower cholesterol levels for employees in high-stress occupations as well as changes in departmental policy.

Sous vide processed foods: are they safe for the elderly?

Demographic trends and market analyses indicate that Americans' interest in convenience foods that are nutritious, safe, and high quality will influence the food industry into the next century. The increase in individuals over 55 plus working women, and the changing family have caused the food industry to develop a new generation of foods. One of the processes, sous vide, is an advanced method where fresh foods are vacuum sealed in impermeable plastic, cooked at low temperature in circulating water, and chilled and held at refrigerator temperature for up to three weeks. Nutritionists and food scientists have concerns about the food safety of sous vide products and the possible increase in food borne illnesses. Continued research is needed for the food industry to deliver safe, nutritious foods, particularly to the elderly.

Dietary intakes of police department employees in a wellness program.

A 12-month nutrition program was developed and implemented as a project of the Wellness Department of the Austin Police Department (APD). Forty APD employees began the program; 24 completed the dietary portion of the study. A comparison of 7-day dietary intakes recorded before and after the program indicated a decrease in energy intake from a mean of 2,273 +/- 694 kcal/day to 1,379 +/- 364 kcal/day (p less than .001). Percentage of energy from protein increased from 16% to 21% (p less than .001), and energy from fat decreased from 42% to 36% (p less than .05). Percentages of energy from carbohydrate and alcohol were not significantly different from the beginning to the end of the study. Daily intakes of cholesterol decreased from 405 +/- 188 mg/day to 295 +/- 132 mg/day (p less than .05). Phosphorus and iron intakes decreased significantly (p less than .01 and p less than .001, respectively), while intakes of calcium remained constant. Mean consumption of thiamin, riboflavin, and niacin decreased significantly (p less than .01, p less than .05, and p less than .01, respectively). The changes in vitamin A and ascorbic acid intakes were not significant. Results indicated that a nutrition education program can effect positive changes toward better food choices. However, dietitians working with similar populations should stress eating patterns that include foods dense in micronutrients.

The determinants of food choices of the elderly.

The increase in individuals over 60 years of age in America must cause professionals from the fields of nutrition, food science, food systems management and the food industry to consider the determinants of food choices and the effects on the overall health and well-being of elderly citizens and those soon to be in their mature years. Income, household composition, food preferences, time, technology, education, good health, attitudes, physiological changes in vision, hearing, taste and smell, psychological and sociological factors all affect the food choices of the elderly.

Validated foodservice training manual for supervisors with limited experience.

The objective of this research project was to develop a useful, validated training manual to be used by supervisors in small foodservice operations and government-funded nutrition programs that do not have access to the services of a registered dietitian. The accuracy of the content was critiqued by an expert panel. The pilot phase was conducted at one congregate dining site to assess and revise problems involving evaluation design. The model phase evaluated the trainer's ability to use the manual and the worker's knowledge and performance as a result of training. Foodservice workers' scores after training were significantly higher than scores before training (p less than .01). Performance evaluations 4 weeks after training showed a significant positive change in work behavior (p less than .001) over evaluations before training. At 8 weeks a return to pretraining behavior was observed. The project showed that regular in-service training sessions conducted in short segments that are inexpensive and continuous would be valuable in any foodservice operation with limited access to dietitians. Benefits from such training include improved efficiency of food preparation and service, better quality of products produced, increased cost-effectiveness, and higher employee morale.

Validation and application of nutrition education objectives.

Nutrition education is more likely to be effective when nutrition and education professionals set goals in working with individuals. In an effort to assist such professionals with these goals, 24 objectives for nutrition education were identified and validated. Teachers, dietitians, and nutritionists can use these objectives in analyzing and targeting their nutrition efforts to influence behavior change in students, patients, employees, and clients. Ways to use the objectives and a process for behavior change to use with students are suggested.