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Summer 2013
Thesis/ Purpose
Exploratory investigation of the status, perceptions and needs of food and nutrition education programs of early
childhood education centers from the District of Columbia.
Project Coordinators
Beatriz Zuluaga and Sofa Bustos, CentroNa Food & Nutrition Department
Authors
Camila Idrovo, Raquel Redmond, Christian Gonzalez
Editors
Beatriz Zuluaga, Renata Claros, Esteban Morales, Patrilie Hernandez, Julia Howell-Barros
This study was conducted under the auspices of the SECDCC (State Early Childhood Development Coordinating Council).
table of contents
background & significance...........................................................................................................................................2
Objective and Research Aims........................................................................................................................................5
Research Design & Methods...........................................................................................................................................6
Protection of Human Subjects & Ethical Considerations....................................................................................8
RESULTS................................................................................................................................................................................9
discussion........................................................................................................................................................................ 14
conclusion & recommendations .............................................................................................................................. 20
references...................................................................................................................................................................... 22
appendices....................................................................................................................................................................... 23
2 | Food and Nutrition Education in Early Childhood Centers | Status, Perceptions, and Needs in the District of Columbia
4 | Food and Nutrition Education in Early Childhood Centers | Status, Perceptions, and Needs in the District of Columbia
Measures
Through the use of three simple questionnaires we wanted
to gauge the food and nutrition education status of the
participating centers. Questionnaires were tailored for three
different stakeholders: directors, teachers, and parents.
The questionnaires used can be found in Appendix 2. Each
questionnaire, which had 14 questions in total, was divided
into three sections: Food, Nutrition Education, and Quality.
Questionnaires were made available in English and Spanish
to facilitate comprehension across different communities.
Food
Questions in the food section were directed to finding out
information about the menus, meal style, and overall opinions of food quality. Directors answered the questions in this
section to determine if centers prepared food in-house, got
their food catered, or if parents were responsible for bringing food for their children. In those cases where food was
prepared in-house or catered, the questionnaire also asked
who was in charge of creating and/or reviewing the menus.
We were also interested in knowing whether meals were
severed in family-style or as pre-plated meals. From teachers we wanted to get their opinion on the food served and
Nutrition Education
Questions in the nutrition education section were written
to assess curriculum needs as well as to gather information
about nutrition and wellness promotion activities at the centers. Directors were asked specifically about professional
development with regard to nutrition and wellness, nutrition
and wellness outreach to parents, and promotion within the
center. Teachers were also asked similar questions in an
attempt to determine if there were any disparities between
directors and teachers. From parents, questions centered
on their perception of nutrition education programs offered
to their children, whether they received any nutrition and
wellness information from their center, and if they had any
nutrition education activities at home.
Quality
This section was dedicated to finding out exactly what directors and teachers felt they need in order to make changes
at their center in terms of food and nutrition education. First
and foremost, we wanted to know if they were satisfied with
the current program and to assess the level of importance
the staff gives to this topic. Parents were also asked if they
were satisfied with the current food service and nutrition
initiatives at their center and if there are any changes they
would like to see implemented.
Procedures
Each center director was contacted directly through email
and by phone to arrange a meeting. At each meeting, directors were given a questionnaire to fill out on site and meetings with teachers and parents were scheduled. If meeting
times were not specified follow up emails and phone calls
6 | Food and Nutrition Education in Early Childhood Centers | Status, Perceptions, and Needs in the District of Columbia
Menu Analysis
One breakfast and one lunch menu from 12 of the centers
were analyzed for nutritional content. One center was no
able to provide a menu and the other two centers where not
included because parents brought their own food for their
children. A sample weekly menu can be found in Appendix
3. The first Wednesday from each menu sample was selected for nutritional analysis. The NutraCoster Professional Program (version 2.1 revision 130, 2009, SweetWARE, Oakland,
Calif) was chosen as the tool to do the menu analysis. Each
item on the date selected was entered into the program
as one single item. The same nutrition information was
used for items that appeared multiple times on menus from
different centers.
The menu items were analyzed using portion sizes listed on
the menus. In cases where the portion size was not listed
items were analyzed using standard portion sizes. The
minimum portion sizes were as follows: cup fluid milk, 1
oz meat or meat alternative or cup cooked dry beans or
peas, cup vegetables and fruit, slice of bread or bread
alternative. Once all menu items were analyzed we calculated total calories (kCal), fat (g), saturated fat (g), sugar (g),
and sodium (mg) for breakfast and lunch, including milk,
for each center. Breakfast and lunch values were added
and compared to two thirds of recommended intakes for
children ages one to three (1,000-1,400 calories/ day, 30-40
g total fat/ day, 2,300 mg sodium/ day, and 20 g sugar/ day).
There is no recommended intake for saturated fat.
Statistical Analysis
Pivot tables were the primary data analysis tools used to
evaluate questionnaire responses. As a data summarization
tool within Microsoft Excel, pivot tables allowed for the
cross-referencing of information across director, teacher,
and parent questionnaire responses. Results were based on
questionnaire results from 15 center directors, 153 teachers,
and 233 parents.
8 | Food and Nutrition Education in Early Childhood Centers | Status, Perceptions, and Needs in the District of Columbia
Results
Food Service
Thirteen of the centers reported participating in USDAs
Child and Adult Care Food Program (CACFP). Ninety-five
percent of parents surveyed reported that their children
eat at the center. Depicted in Figure 1 is the distribution
of different types of food service offered by the sample
centers. Sixty percent of centers (9) have their food catered
while 27% centers (4) prepare their food in-house. Thirteen
percent (2) of centers reported other, in which case they
required parents to bring food from home for their children.
Additionally, fifty-three percent of centers reported that the
director reviews the menus, 47% reported that the catering
company reviews the menus, and 40% reported that staff
also played a role in reviewing the menus, including school
cooks or other staff members.
Results | 9
Quality
Parents and teachers were asked whether
they thought the food served at the center
was healthy. Seventy-seven percent of
parents reported thinking the food was
healthy, compared to 75% of teachers.
Eighteen percent of teachers responded
that the food was sometimes healthy.
Less than 2% of teachers and parents
reported that the food was not healthy.
As seen in Figure 2, parents were the
most satisfied with the food served at
71%, compared to 63% of teachers and
53% directors. Thirty percent of teachers
were somewhat satisfied compared
to 27% of directors and 25% of parents.
Additionally, 20% of directors were not
satisfied, compared to 7% of teachers and
4% of parents.
10 | Food and Nutrition Education in Early Childhood Centers | Status, Perceptions, and Needs in the District of Columbia
within the recommended range and eight centers were below, shown
in Figure 6. Although there is no recommended intake of saturated
fat, the highest intake was 9.72 g and the lowest intake was 2.19 g, as
seen in Figure 7.
Results of analysis of menus in relation to I am Healthy, I am Happy
award levels can be found in Appendix 1. This standard was used
because the 13 centers that catered or prepared food on-site were
eligible to apply for awards through their involvement with CACFP.
I am Healthy, I am Happy is a program that provides incentives for
centers participating in CACFP to improve and maintain their wellness
environment. Menus were analyzed based on the established criteria
for the three award levels, which grade the quality and variety of the
food offered. We found that five centers out of 13 that serve breakfast
and lunch at their centers are eligible for the Red Apple award
level. Of these five centers, none were eligible for next award level,
which was the Green Apple award.
Eight centers were not eligible for any award levels, three of which
were only missing one criterion that prevented them from being
Results | 11
Nutrition Education
A holistic approach towards nutrition education is necessary
in order to engage key players influencing nutrition habits
in young children. This approach includes the use of
different tools such as a nutrition curriculum for children,
the establishment of a wellness policy for the centers, the
training of teachers and staff, as well as parental outreach
and involvement to promote healthy habits at home.
12 | Food and Nutrition Education in Early Childhood Centers | Status, Perceptions, and Needs in the District of Columbia
Quality
As seen in Figure 8, parents were the most satisfied with the nutrition
education at their center (73%), compared to 65% of teachers and
20% of directors. Forty-seven percent of directors were somewhat
satisfied compared to 25% of parents and 23% of teachers. Thirty-three
percent of directors were not satisfied, compared with 12% of teachers
and 5% of parents.
FIGure 11: p
arent perceptions on
wanting to see a change
in the food quality and
nutrition education
FIGure 9: w
illingness of directors
to change food quality
and nutrition education
services
Results | 13
Discussion
Food Preparation and Perceptions
A positive trend was observed between stakeholder
involvement as described by method of food preparation
(in-house, catered or brought by parents) and the
overall satisfaction of respondents with the food quality
offered at the centers. Additionally, there was a negative
trend between the method of food preparation and the
willingness of participants to change services offered at
the centers. As seen in Figure 12, 100% of directors with
in-house preparation were satisfied with the food offered
while 50% of directors from centers who used catering and
50% of directors from centers where parents brought their
own food were satisfied with the food quality. Similarly, 88%
of teachers with in-house preparation were satisfied with
the food at the center, compared to 67% of teachers from
centers where parents brought their own food and 48%
of teachers from centers that used catering. On the other
hand, parents were more satisfied with food prepared at
home showing a satisfaction level of 83%, compared to 73%
satisfaction from parents whose children went to centers
14 | Food and Nutrition Education in Early Childhood Centers | Status, Perceptions, and Needs in the District of Columbia
directly responsible for the quality of the food and may have
felt they needed to portray a positive image of their center.
Because of this, in future investigations it may be helpful
to use a rating scale method for satisfaction questions as it
allows respondents to provide more nuanced answers.
Comparing food preparation methods and satisfaction is
important because it provides the possibility of analyzing
peoples perception of quality of food services depending
on how involved they are in the food service process.
Observing higher satisfaction of more involved participants,
such as seen in Figure 12 where parents who bring their
own food were the most satisfied with the food quality
offered to their children, highlights the importance of
creating and supporting programs that enable centers to
take charge of food preparation and overall nutrition in the
center. However, because the level of personal satisfaction
and healthiness of the food prepared may not be congruent,
it is important to properly educate all parties involved in
nutrition before they make decisions as to what should
be served. This is especially important in the long term
because, as seen in Figure 13, there was a negative trend
between involvement in food preparation and willingness
FIGure 14: Food quality satisfaction rates among stakeholders depending on implementation of a nutrition curriculum
16 | Food and Nutrition Education in Early Childhood Centers | Status, Perceptions, and Needs in the District of Columbia
FIGure 15: n
utrition education satisfaction rates among stakeholders
depending on implementation of a nutrition curriculum
discussion | 17
Limitations
Throughout the study various limitations were revealed.
To begin, there were two centers that did not serve food
because parents were responsible for providing the meals.
This created some problems with the results, particularly
in the food and quality sections of the questionnaire. The
answers received from these two centers may have skewed
the results slightly because some parents were filling out
this section even if their children did not eat at the center.
It is important to note that even if parents are responsible
for bringing food, the DC Child Care Licensing Regulations
require all licensed centers to provide parents with a set of
guidelines so that they meet the CACFP food requirements.
Another possible reason for skewed results, which was
mentioned earlier, is that some centers may have answered
the questionnaires wanting to depict a more positive image
of the food and nutrition services they offer. Similarly,
parents responses may have been influenced by what they
perceive their children should be eating at home rather than
what they actually eat. Some parents also had a difficult
time with the questionnaires. Many were rushed and did
not read each question in its entirety before answering.
Others had limited knowledge regarding the food and
nutrition education practices at their childs day care center.
Additionally, questions should not only be directed towards
determining the levels of satisfaction of participants but
should also incorporate statements that allow participants
to explain what factors played a role in determining their
satisfaction.
Another limitation was that there were some
misunderstandings among respondents regarding
basic concepts such as wellness policy and nutrition
curriculum. The question concerning a wellness policy
seemed to cause some confusion particularly among
18 | Food and Nutrition Education in Early Childhood Centers | Status, Perceptions, and Needs in the District of Columbia
discussion | 19
20 | Food and Nutrition Education in Early Childhood Centers | Status, Perceptions, and Needs in the District of Columbia
References
1.
13. 2012 Child Care in the State of: District of Columbia Child
Care Aware of America. March 2012. Web. September 16,
2013. PDF file.
6. Scott KM, McGee MA, Wells JE, Oakley Browne MA. Obesity
and mental disorders in the adult general population.
Journal of Psychosomatic Research 65.1 (2008): 99. Web.
August 29, 2013.
20. About The Child Development Associate (CDA) Credential Council for Professional Recognition. Council for Professional
Recognition. N.p., n.d. Web. September 16, 2013.
21. Milner, John A., and Richard G. Allison. The Role of Dietary
Fat in Child Nutrition and Development: Summary of an ASNS
Workshop. Journal of Nutrition 129.11 (1999): 2094-105. Web.
22 | Food and Nutrition Education in Early Childhood Centers | Status, Perceptions, and Needs in the District of Columbia
Appendices
1. Tables: Red Apple and Green Apple Criteria
appendices | 23
2. Sample Questionnaires
director
Food
1. Where is the food prepared for your center?
a. Catering
b. In house
c. Other: _____________
2. Who creates or reviews the menus?
a. Director
b. Staff (Title:_________________________________)
c. Catering company
3. How many fresh fruits and vegetables are served per
day (not including juice)?
a. 0
b. 1-2
c. 3-5
4. How do you serve meals?
a. Family style
b. Pre-plated
c. Other: ____________
5. Which meals are offered every day? (Circle all that
apply.)
a. Breakfast
b. Lunch
c. Snack
Nutrition Education
1. Do you have a nutrition education curriculum and if so,
what do you use?
a. No
b. Our own
c. Other: __________________________________
2. How many hours of professional development are
dedicated to nutrition education each year?
a. 0 hours
b. 1-2 hours
c. 3-5 hours
d. 6 or more hours
Additional Comments:
Teachers
Food
1. How do you interact with children during lunchtime?
a. I serve lunch
b. I eat with them
c. We talk about various topics
d. N/A
2.
Additional Comments:
Appendices | 25
parents
Food
1. Does your child eat the food that is provided at the
center?
a. Yes
b. No
c. Sometimes
2. What do you think of the food served to your child at the
center?
a. It is healthy
b. It is not healthy
c. Can be improved
Quality
1. Are you satisfied with the food served at your center?
a. Yes
b. No
c. Somewhat
26 | Food and Nutrition Education in Early Childhood Centers | Status, Perceptions, and Needs in the District of Columbia
3. Sample Menu
sample menu of surveyed center
Monday
Tuesday
Wednesday
Thursday
Friday
Breakfast
Whole Grain Honey &
Oats Granola Bar (2 oz)
100% Grape
Juice (3/4 cup)
Mixed Fruit Jelly (.12 g)
Lunch
Whole Grain Chicken
Fried Steak (3 oz)
Appendices | 27