Structured interviews and focus groups were conducted with CCC professionals and state agency personnel to develop a survey to assess perceptions, practices, and training needs of child care professionals creating and maintaining a wellness environment in CCCs. The surveys were mailed to a national sample of 700 CCC directors stratified by seven USDA regions.
A total of 363 surveys were returned (52%) and proportional representation was achieved from CCC directors in all seven USDA regions. The majority of respondents were women (99%) operating CCCs eight hours or more per day (99%), preparing meals and snacks onsite (86%), serving mostly children ages 3 to 5 years (98%). Findings from the data indicate that CCC professionals perceived wellness in CCCs as a comprehensive approach that includes nutrition, safety, and physical activity for children. Exploratory factor analysis produced two factors from the practice statements accounting for 50.0% of the variance: Resources and Partnerships (13 items, alpha = 0.94) and Healthy Environment (13 items, alpha = 0.90). Respondents indicated that “I need” and “my staff” need training to secure resources to support wellness practices. CCC staff need additional training to address issues related to teaching and modeling wellness practices to children and addressing communication issues with parents about their children’s wellness needs.
Applications to Child Nutrition Professionals
The child care wellness perceptions, practices, and training needs identified in this study could be used to develop best practices or quality indicators for CCC professionals creating and maintaining a wellness environment in CCCs participating in the CACFP.
Please note that this study was published before the implementation of Healthy, Hunger-Free Kids Act of 2010, which went into effect during the 2012-13 school year, and its provision for Smart Snacks Nutrition Standards for Competitive Food in Schools, implemented during the 2014-15 school year. As such, certain research may not be relevant today.
Changes in the economy and demographic structures have increased the need for nonparental care for children in the U.S. By 2005, 61% of the nation’s children under the age of six received nonparental care on a regular basis (Federal Interagency Forum on Child and Family Statistics, 2007). As women with children under the age of six continue to participate in the labor force, the need for child care arrangements will continue to increase.
The Child and Adult Care Food Program (CACFP) functions as a federal nutrition assistance program that operates through state education sponsors and plays a vital role in the nutritional care of those served (United States Department of Agriculture, Food and Nutrition Service [USDA, FNS], n.d.). For many child care programs, the CACFP serves as a key source of financial support, providing subsidized reimbursement for food and meal preparation costs for qualified meals served. The child care segment of the program serves approximately 2.9 million nutritious meals and snacks to children daily (USDA, FNS, n.d.).
Since many children attend child care facilities during their formative years, child care center (CCC) professionals have an important responsibility for influencing the health and development of children in their care. Health care and child care agencies have developed guidelines and standards to ensure the food and care of children in the CCC environment are safe and support the welfare of children (American Dietetic Association [ADA], 2005). It is recognized that quality child care contributes to the positive development of children’s sense of identity, trust of others, and opportunities to acquire successful learning characteristics (Dodge, 1995; Fontaine, Torre, Grafwallner, & Underhill, 2006).
It is important that CCCs promote a wellness environment that influences early childhood experiences and supports the overall development of the child. As the demand for child care services increases, quality services and facilities have become a concern for parents and families (Campbell & Milbourne, 2005). Providing nutritious meals, establishing provisions for physical activity, ensuring safety and sanitation, and providing staff training are focus areas recognized in the literature as components for establishing a healthy environment in child care (ADA, 2005; Carr & Conklin, 2002; Fleischhacker, Cason, & Achterberg, 2006; Knoche, Peterson, Edwards, & Jeon, 2006; Kuratko, Martin, William, Chappell, & Ahmad, 2000). However, the research findings suggest non-compliance among child care CACFP participants for most of these focus areas (Fleischhacker, et al., 2006; Gupta, Shuman, Taveras, Kulldorff, & Finkelstein, 2005; Kuratko, et al., 2000). Additionally, high staff turnover rates among child care staff stipulate the need for continuous training regarding basic care, nutrition, and safety practices (Whitebook & Sakai, 2003). There is limited research addressing the role CCC professionals may play in reducing the trends of childhood obesity and practices related to CCC wellness. Therefore, the purpose of this study was to identify the perceptions, practices, and training needs of CCC professionals creating and maintaining a wellness environment in the CCCs participating in the CACFP.
This study was conducted in two phases and used two research design methods to identify issues associated with providing a wellness environment in CCCs. In Phase I, interviews and focus group discussions were conducted with CCC professionals, and the qualitative data was used to develop a survey for use in Phase II of the study. The survey was evaluated by a review panel of CCC professionals, revised by researchers, and formatted as a scannable survey. The survey was then mailed to a national sample of CCC directors across the US. The Human Subjects Protection Review Committee of the University of Southern Mississippi approved the protocol for this study.
Child Care Interviews and Focus Groups
In Phase I of the study, nine semi-structured, open-ended interview questions were developed from CCC literature and previous National Food Service Management Institute, Applied Research Division (NFSMI, ARD) research to gain insight into child care wellness environment issues. CCC professionals (a state agency director, a private child care consultant, and a child care operator) with diverse experiences and contributions to the child care profession were asked to participate in a telephone conference to discuss issues associated with creating a wellness environment in CCCs. Notes from the interviews were analyzed for themes and commonalities to develop the focus group protocol.
Focus group methodology by Krueger and Morgan (1998) was used to guide the focus group process. Twelve focus group questions were developed from the themes of the interviews to address the CCC directors’ perceptions, practices, and training issues/needs to maintain a wellness environment in CCCs participating in the CACFP. CACFP state agency directors representing the seven USDA regions were asked to provide contact information for one CACFP state agency representative and eight to ten CCC directors for this study. From the contact lists provided by the respondents, four focus group sites were selected representing states with diverse child care settings in the Southeast, Southwest, and Western USDA regions. CACFP state agency representatives in the four states agreed to host and participate in focus group discussions with CCC directors in their state. Six to eight directors in each of the four states were e-mailed a brief description of the study and an invitation to participate in the focus group sessions. Each focus group was audio-recorded and scheduled to last approximately 90 minutes. The discussions were moderated by a researcher while another researcher recorded participants’ comments. The first focus group served as the pilot to evaluate the focus group protocol and questions. Based on the pilot, no changes were made and the remaining focus group sessions were conducted as planned. Information collected from the four discussion sessions were reviewed and summarized by the primary researcher. Two researchers separately analyzed all four focus group summaries using traditional coding methodology and constant comparison techniques (Glaser & Strauss, 1967) to identify emergent patterns and themes. The two researchers then collaborated and the themes were revised and used to develop categories and survey statements to draft the survey.
A quantitative survey was developed from data collected from the focus group discussions. Additional survey statements were added based on child care standards of practice literature and the research objectives. All survey statements were evaluated by a panel of reviewers and the researchers for wording and content validity.
The draft survey, “Creating a Wellness Environment in Child Care Centers Participating in the Child and Adult Care Food Program (CACFP),” consisted of four sections related to the perceptions (16 statements), practices (32 statements), training issues/needs of the CCC director and staff (22 statements), and demographic questions (13 questions). The survey statements for perceptions and practices were anchored on a 4-point Likert scale ranging from 4 (strongly agree) to 1 (strongly disagree). To address training issues/needs, two 4-point Likert scales ranging from 4 (strongly agree) to 1 (strongly disagree) were used with 20 statements to rate participants’ level of agreement to training issues/needs of CCC directors and CCC staff. The last section addressed personal and CCC characteristics. The draft survey was converted into a scannable format so that the surveys could be transferred into a statistical program for analysis. A cover letter was drafted by the researchers to describe the purpose of the study and provide instructions to complete and return the survey.
A review panel was selected from the list of child care professionals who participated in interviews and focus groups, and CACFP state agency representatives and CCC directors who did not participate in Phase I of the study. An e-mail with the survey cover letter, draft survey, and survey evaluation form attached was sent to 35 potential review panel members describing the purpose of the study and requesting their participation in the review process. Reviewers were asked to assess the survey cover letter and draft survey for clarity and complete and return the survey evaluation form via e-mail within two weeks. Return of the completed survey evaluation served as consent to participate in the review process. Twenty-three (66%) review panel members returned completed evaluation forms. Minor changes were made to the cover letter and survey based on the reviewers’ suggestions in preparation for distribution.
Study Sample and Survey Distribution
State agency CACFP directors were contacted and asked to provide contact information for CCC directors in their state. Thirty state agency CACFP directors responded to the request. From the information provided, a database of CCC directors (n=13,307) was created to select the study sample. States were stratified into the seven USDA regions to obtain the sample of 700 potential participants. CCC directors were then selected by using a systematic sampling technique to obtain 100 participants per USDA region.
A pre-notice letter was sent to 700 CCC directors approximately one week before the survey packets were mailed to briefly describe the study and notify the study participants that they would be receiving a survey within a few days. The survey packet, which included a cover letter, the survey, and self-addressed, postage-paid envelope, was mailed one week later. The cover letter explained the purpose of the study and provided instructions for completing and returning the completed survey within three weeks of their receipt of the survey. A reminder postcard was sent to all recipients one week after sending the initial surveys to encourage participants to complete and return their survey if they had not already done so.
Returned surveys (n=363) were scanned and analyzed using the statistical package SPSS Version 15.0 for Windows. Descriptive statistics included means, standard deviations, and frequencies of total responses. Exploratory principal-component factor analysis was performed on the practice section of the survey to determine if the practice items could be factored into smaller groups. A two-factor solution was generated for the 32 CCC wellness practice statements. Cronbach’s alpha reliability coefficients were calculated to determine the reliability of each factor. For all statistical analysis, an alpha level of 0.05 was used for significance.
Results And Discussion
A total of 363 surveys were returned and included in the statistical analysis, for a response rate of 52%. Six surveys were not included in the final analysis because they arrived too late for inclusion. Proportional representation was achieved from respondents in all seven USDA regions (11.3% Mid-Atlantic, 15.2% Midwest, 13.2% Mountain Plains, 14.9% Northeast, 16.3% Southeast, 16.1% Southwest, and 13.0% in the Western region). Job title of study respondents included the CCC Director (78%), while some served as the owner and/or administrator. The majority of the respondents were women (99%) who operated 1 to 2 CCCs (92%) and had been in their current position for six years or longer (75%). When asked about their CCCs, respondents reported that they operated CCCs that were open eight hours or more per day (99%) and the CCCs cooked and prepared meals and snacks for the children (86%). All respondents reported serving children of variable ages, with children 3 to 5 years of age (98%) being the group most served.
The majority of respondents believed that training is an important component of CCC operations. Sixty-nine percent reported that they currently participate in child care related training three times or more per year. Respondents reported the following preferences for training times: they would prefer training during work hours (37%); 23% would attend training on the weekends; 23% would attend training when the center is closed; and 16% preferred training during scheduled conferences and meeting times. Respondents reported that their preferred methods of training were satellite seminars (40%) and participating in training groups away from the CCC site (35%).
Perceptions on Creating a Wellness Environment in Child Care Centers
Respondents rated their level of agreement with 15 statements on their perception of CCC wellness on a 4-point Likert scale ranging from 4 (strongly agree) to 1 (strongly disagree). Mean values of 3.0 and above indicated a high level of agreement for the survey statements. Table 1 presents the means and standard deviations for the perception statements in descending order of agreement. Providing children with nutritious meals and snacks, a safe environment, and opportunities to be physically active were the most agreed upon statements related to creating a wellness environment in CCCs. These findings matched those from focus group discussions that wellness in CCCs is a comprehensive approach that includes nutrition, safety, and physical activity for children. “Opportunities for active play” as part of the child care day was the most agreed upon statement (3.94 + .23). “Healthy food is served to children” was the second most agreed upon statement (3.92 + .31), followed by “children feel safe” (3.91 + .31), “meals and snacks meet CACFP meal pattern requirements” (3.89 + .36), and “indoor and outdoor active play areas are safe” (3.88 + .33). The perception statement with the lowest level of agreement was “parents participate in CCC events that promote health” (3.25 + .72). However, it should be noted that all mean values were above 3.0, indicating that respondents agreed that the statements were actions necessary for creating a healthy environment in CCCs. Factor analysis of the perception statements did not yield factors that would explain any plausible relations or factor groupings of the perception statements.
Table 1. Mean Agreement Ratings and Standard Deviations for Perceptions to Create a Wellness Environment in Children Care Centers
|Opportunities for active play are a part of the child care day.||361||3.94||0.23|
|Healthy food is served to children.||363||3.92||0.31|
|Children feel safe.||362||3.91||0.31|
|Meals and snacks meet CACFP meal pattern requirements||363||3.89||0.36|
|Indoor and outdoor active play areas are safe.||363||3.88||0.33|
|Children view the child care center as friendly.||362||3.88||0.37|
|Active play activities are age-appropriate.||362||3.85||0.35|
|Age-appropriate serving sizes are provided.||363||3.77||0.43|
|Staff engages in active play activities with children.||363||3.74||0.50|
|Staff model appropriate mealtime behaviors.||361||3.63||0.53|
|Nutrition education is provided to the children.||359||3.56||0.57|
Note. CACFP = Child and Adult Care Food Program.
aScale = 4 (strongly agree) to 1 (strongly disagree)
Practices to Create and Maintain a Wellness Environment in Child Care Centers
Respondents were asked to rate their level of agreement to 32 practice statements that contribute to creating and maintaining a wellness environment in CCCs. The practice statements were anchored on a 4-point Likert scale ranging from 4 (strongly agree) to 1 (strongly disagree). Mean values of 3.0 and above served as the primary indicator for high level of agreement to practice statements.
Exploratory factor analysis was performed on the practice section of the survey to identify meaningful dimensions or factors of the 32 child care practice statements. Principal component factor analysis was used as the extraction method and varimax rotation with Kaiser Normalization. Factors were retained if eigenvalues were greater than 1.0. Factor loadings were evaluated on two criteria: factor loadings of .40 or greater or double loading of statements on more than one factor. Two factors were produced explaining 50% of the variance. After the first analysis, one practice statement was eliminated because it contained a loading factor below .40 and was not cognitively associated with either factor. Five practice statements loading on both factors were omitted from the analysis. After three iterations, 26 practice statements loaded satisfactorily into the factor in which it loaded the highest. The final factor solution contained the two factors, which explained 53% of the variance. Internal consistency and reliability was calculated using Cronbach alpha for both factors and demonstrated adequate internal consistency.
The first factor, “Resources and Partnerships,” includes 13 practice statements with a Cronbach alpha of .94 (Table 2). The “Resources and Partnerships” factor refers to CCC professionals securing and maintaining partnerships and resources for wellness initiatives in CCCs. In this factor, CCC professionals seek resources to support physical activity, food and nutrition, and health and safety practices to create a wellness environment in CCCs. Child care professionals also network and seek assistance from CACFP sponsoring organizations, community organizations, and parents to promote wellness activities and health behaviors for children and staff in child care. Included are practice statements such as “partnerships are established with community organizations to promote health-related activities” and “resources are available to teach children about nutrition”. These practices are essential for long-term promotion of wellness activities in the CCC.
The second factor, “Healthy Environment,” includes 13 practice statements with a Cronbach alpha of .90 and relates to creating opportunities for active play for children and providing healthy food and nutrition practices. This factor also encompasses educational opportunities for children and training initiatives for staff (Table 2). Included are practice statements such as “the mealtime environment encourages healthy eating” and “center staff model healthy nutrition and physical activity behaviors”.
Table 2. Factor Loadings, Means, and Standard Deviations for Resources and Partnerships and Healthy Environment
|Resources and Partnerships Practice Statements|| Standardized
|M + SD b|
|Training is provided to staff on health-related issues.||.66||3.55 + .58|
|Resources are available to teach children about nutrition.||.61||3.49 + .59|
|Staff is trained on how to model healthy behaviors.||.74||3.47 + .63|
|Seek resources to support health-related activities.||.64||3.41 + .61|
|.70||3.35 + .66|
|A wellness plan is implemented for the child care center.||.76||3.32 + .70|
|.73||3.29 + .72|
|A wellness plan is developed for the child care center.||.75||3.29 + .70|
|.78||3.24 + .73|
|.80||3.24 + .71|
|Parents are involved in health-related activities.||.82||3.12 + .72|
|.83||3.10 + .74|
|.76||2.95 + .80|
|Healthy Environment Practice Statements||Standardized
|M + SD b|
|.67||3.90 + .31|
|.74||3.89 + .32|
|Children are encouraged to eat fruits and vegetables.||.76||3.86 + .34|
|Nutritious foods are purchased for all meals and snacks.||.65||3.85 + .38|
|Children receive healthy snacks.||.69||3.83 + .38|
|Children have adequate time for meals and snacks.||.78||3.82 + .39|
|Children are encouraged to try new food items.||.71||3.80 + .41|
|.66||3.79 + .43|
|.64||3.79 + .42|
|Play equipment is supplied for active play.||.53||3.76 + .45|
|Portions sizes are age-appropriate.||.67||3.76 + .45|
|.71||3.76 + .44|
|Staff is trained to prepare healthy meals.||.45||3.75 + .49|
Note. Total variance explained for both factors: R2=53%
aAll factor loadings were significant at .05
bScales (Min/Max): Agreement 1 (strongly disagree) / 4 (strongly agree)
Training Needs to Create and Maintain a Wellness Environment in Child Care Centers
In this section of the survey, participants responded to 20 statements regarding their specific training issues/needs as CCC directors and the training issues/needs of CCC staff. Two 4-point Likert scales ranging from 4 (strongly agree) to 1 (strongly disagree) were associated with each training issues/needs statement to rate respondents’ level of agreement to training issues/needs of CCC directors, and then complete the second scale related to training issues/needs of CCC staff. High level of agreement was indicated by mean values of 3.0 and above for training issues/needs statements for CCC directors and CCC staff.
Table 3 presents the means and standard deviations for each of the 20 training statements relating to CCC directors, listed in descending order. “Acquiring additional funding sources (grants, community organizations) to support a healthy environment” was the only training statement with a mean rating greater than three. Mean ratings for the remaining 19 statements ranged from 2.93 to 2.40.
Table 3. Mean Agreement Ratings and Standard Deviations for Training Issues/Needs of Child Care Center Directors to Create a Wellness Environment in Child Care Centers
|Addressing the needs of children with disabilities.||338||2.88||0.81|
|Communicating nutrition education information to parents.||342||2.87||0.82|
|Assessing the wellness needs of child care centers.||342||2.79||0.85|
|Handling illnesses in child care centers.||342||2.76||0.94|
|Providing nutrition education to staff.||334||2.72||0.84|
|Providing nutrition education to children.||338||2.70||0.80|
|Teaching safety and sanitation to children.||337||2.58||0.90|
|Communicating effectively with children.||334||2.51||0.93|
|Implementing safe food handling practices.||332||2.42||0.90|
|Planning and engaging in direct active play with children.||331||2.40||0.89|
aScale = 4 (strongly agree) to 1 (strongly disagree)
Table 4 presents the means and standard deviations for each of the 20 training statements relating to CCC staff, listed in descending order. Four of the five statements generated mean ratings greater than 3.0. The statement with the highest mean rating for training child care staff was, “acquiring additional funding sources (grants, community organizations) to support a healthy environment” (3.15 + .94). Respondents also agreed that child care staff needed training “addressing the needs of children with special food and nutrition needs” (3.04 + .79); “communicating nutrition education information to parents” (3.01 + .78); and “addressing the needs of children with disabilities” (3.01 + .79). The remaining 16 training statements for CCC staff received ratings below mean value of 3.0 and ranged from 2.99 to 2.69.
Exploratory factor analysis was performed on the statements in the training section of the survey to identify meaningful dimensions or factors. Principal component factor analysis was used as the extraction method and varimax rotation with Kaiser Normalization. Factor analysis of the training statements did not yield factors that would explain any plausible relations or factors between the training statements.
Table 4. Mean Agreement Ratings and Standard Deviations for the Training Issues/Needs of Child Care Center Staff to Create a Wellness Environment in Child Care Centers
|Communicating nutrition education information to parents.||344||3.01||0.78|
|Addressing the needs of children with disabilities.||342||3.01||0.79|
|Communicating effectively with parents about health- related issues.||336||2.97||0.78|
|Handling illnesses in child care centers.||348||2.97||0.92|
|Assessing information and resources to perform health-related activities.||341||2.96||0.74|
|Providing nutrition education to children.||345||2.92||0.77|
|Preparing food for children with special food and nutrition needs.||340||2.89||0.85|
|Implementing strategies to effectively conduct active play activities.||345||2.88||0.89|
|Assessing the wellness needs of child care centers.||339||2.86||0.86|
|Communicating effectively with children.||342||2.85||0.92|
|Planning and engaging in direct active play with children.||342||2.82||0.95|
|Teaching safety and sanitation to children.||343||2.80||0.87|
|Providing nutrition education to staff.||338||2.80||0.84|
|Implementing safety and sanitation practices in child care centers.||339||2.77||0.89|
|Implementing safe food handling practices.||341||2.69||0.90|
aScale = 4 (strongly agree) to 1 (strongly disagree)
Conclusions And Application
The CCC environment provides a unique atmosphere to promote healthy eating, physical activity, and other health promotion practices; thus providing an avenue for combating childhood obesity and other preventable diseases and disorders. However, few studies exist exploring the impact and influence of the CCC setting on children’s health and well being. The aim of the current study was to identify the perceptions, practices, and training issues/needs of CCC directors to create or maintain a wellness environment in CCCs. Focus group and survey responses from this research study indicate that CCC professionals believe that a child care wellness environment is supported by a comprehensive approach that includes healthy foods and nutrition education, safety, and physical activity for children. This approach is well documented in the child care literature as necessary for children’s optimal growth and development and for establishing quality standards. In addition to this approach, CCC directors identified several components for creating and maintaining a healthy wellness environment. They believed that active play opportunities, providing healthy meals and snacks that meet the CACFP requirements, and providing safety provisions that make children feel secure are essential components for a wellness environment. The child care wellness approach and components identified in this research study could be used to establish and sustain current wellness and health practices that meet CACFP, state, and local health and safety requirements.
Practices to support and maintain wellness in CCCs were also assessed in this research study. Two practice factors were identified as “Resources and Partnerships” and “Healthy Environment.” The “Resources and Partnerships” factor relates to creating a wellness environment and includes practices that support the acquisition of resources and networking with community organizations to sustain wellness practices in child care. The “Healthy Environment” factor relates to child care practices that create active play and socialization opportunities for children and staff and healthy food and nutrition practices.
Finally, the acquisition of funds and resources to support a health and wellness environment was identified as a major training issue/need of CCC directors and staff. Child care directors’ level of agreement to this statement confirms focus group participants’ statements related to their need to secure and maintain funding and other resources to support wellness initiatives in CCCs. Sixty-eight percent of those responding to the survey reported participating in training related to CCC operations three to four times per year. Their level of agreement to this training issue/need in relation to other training issues may imply that directors receive adequate training to address child care wellness needs, but believe additional training is necessary for securing funding to establish and maintain wellness activities.
Similar training needs were identified for CCC staff. Study respondents indicated that staff needed training to address communicating the special food and nutrition needs of children, communicating nutrition education information to parents, and addressing the needs of children with disabilities. These training issues are essential to the child care wellness environment and address CCC staff’s role in providing direct care for children and communication with parents about the children’s needs. The lower mean ratings for training CCC directors and staff may be attributed to several factors. Child care literature indicates that child care providers are interested and perceive health and safety workshops and training as important. However, lack of resources, lack of time, and transportation restraints are often the primary barriers for CCC directors and staff to attend training (Cody, O’Leary, & Martin, 2005; Enke, Briley, Curtis, Greninger, & Staskel, 2007).
To better understand the training needs of CCC directors and staff, directors indicated their preferences for training time and method of training delivery. The majority of respondents reported that training should take place when the CCC was closed and chose satellite seminars or offsite group training sessions as the preferred methods of training delivery. These suggestions for future training opportunities may provide more avenues for training and avoid disruption of daily child care activities.
Research findings from this study also suggest that training and education sessions and materials for CCC professionals addressing child care wellness initiatives should be developed with consideration for the preferred methods of delivery and time parameters reported in this research study. Best practices or quality indicators for creating and maintaining a wellness environment in CCC should include the two practice factors (Resources and Partnerships and Healthy Environment) and the comprehensive wellness approach to develop a best practice resource. This best practice resource could be used as a self-assessment resource for CCC professionals to implement or assess wellness practices in CCC.
Limitation to the Research Study
The limitation to this research was the contact lists and CCC database used for this study did not include representation from all 50 states. This was due in part from the lack of response from state agencies to provide the requested information. However, state agency directors provided complete contact information for CCC directors in thirty states as requested. Therefore, a stratified, systematic sampling technique was used to achieve a representative sample from all seven USDA regions.
This manuscript has been produced by the National Food Service Management Institute – Applied Research Division, located at The University of Southern Mississippi with headquarters at The University of Mississippi. Funding for the Institute has been provided with federal funds from the U.S. Department of Agriculture, Food and Nutrition Service to The University of Mississippi. The contents of this publication do not necessarily reflect the views or policies of The University of Mississippi or the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.
The information provided in this manuscript is the result of independent research produced by NFSMI and is not necessarily in accordance with U.S. Department of Agriculture Food and Nutrition Service (FNS) policy. FNS is the federal agency responsible for all federal domestic child nutrition programs including the National School Lunch Program, the Child and Adult Care Food Program, and the Summer Food Service Program. Individuals are encouraged to contact their local child nutrition program sponsor and/or their Child Nutrition State Agency should there appear to be a conflict with the information contained herein, and any state or federal policy that governs the associated Child Nutrition Program. For more information on the federal Child Nutrition Programs please visit www.fns.usda.gov/cnd
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Lofton is a Research Scientist at the Applied Research Division of the National Food Service Management Institute located at the University of Southern Mississippi, Hattiesburg, MS. At the time of the study, Carr was Director of the Applied Research Division of the National Food Service Management Institute located at The University of Southern Mississippi. She presently has retired from that position.