Mississippi has the highest obesity rate in the Nation, with adults averaging a body mass index (BMI) of 32 (30 or greater indicates obesity). In the Mississippi Delta, even higher rates of obesity exist. Residents of this region, with its high poverty level and limited access to grocery stores, are especially vulnerable to improper nutrition, which can lead to obesity. The high poverty rate is especially evident among children under age 18. In 2005, 12 of the 13 Mississippi counties with poverty rates of 45 percent or more were located in the Delta. One way to make an impact on these health and poverty issues is to ensure that children in this region have access to nutritious foods. The primary purpose of this study was to examine the role of the Child and Adult Care Food Program (CACFP) in the food environments of licensed child care centers in the Mississippi Delta.
This study began by first engaging in a deeper understanding of how the CACFP program operates in Mississippi. An initial assessment of program administration included examining web-based data, interviewing the Mississippi CACFP State director, and reviewing the procedures of administration and operations of the Mississippi CACFP program as they pertain to licensed child care centers. Interviews with 21 child care center directors in one Delta county allowed for indepth analysis about their experiences with CACFP, as well as the food environments of their child care centers. Surveys with the parents of children enrolled in these centers generated data on their perceptions of the food environments in the child care centers and at home. Finally, height and weight measurements were collected for a subsample of 4-year-old children in order to calculate body mass indices.
The interviews conducted with the Mississippi CACFP director revealed important details about program administration in Mississippi. The only data collected by the State program are the administrative data required by USDA. Further, no actual database exists. Although forms are completed online, the forms and records are kept as hard copies for just 3 years as required by USDA. Without a database and additional information beyond the aggregation of administration data, the impact and effectiveness of the CACFP in providing nutritious meals for children in child care centers cannot be determined, but can only be surmised.
Child care center directors stated that CACFP assists them in serving nutritious meals. Center directors reported that participation in CACFP influences the food choices at their child care centers. The majority of directors reported that 75 percent or more of their food budget comes from CACFP. Without CACFP resources, they believe their centers would no longer be able to operate, let alone be able to offer nutritious meals and snacks. However, while most menus submitted to the Mississippi State Department of Health met State guidelines, opportunities exist to improve the nutritional quality of the food that is served. Detailed data on how foods are prepared would reveal the true nutritional content of the meals as well.
Among the subsample of children whose BMIs were calculated, 3.1 percent were underweight, 58.5 percent were of average weight, 21.5 percent were at risk of being overweight, and 16.9 percent were overweight. Of particular concern, 4.4 percent of parents surveyed about their child’s weight felt that their child was overweight and 3.8 percent reported that a doctor told them that their child was at risk for being overweight or was currently overweight. The outcomes for parents were similar. Among 429 respondents who self-reported their height and weight, 38.3 percent had BMIs in the obese range, which is higher than the average rate in Mississippi. Once again, 3.8 percent reported that they are obese and 20.9 percent reported that a doctor talked to them about being overweight.
Effective policies targeting nutrition and healthy food access are required in order to substantially reduce the obesity rate in the Mississippi Delta and the Nation as a whole. Evaluating the CACFP in terms of its ability to provide nutritious food to children from low-income households could help in targeting effective policies. The Mississippi CACFP does not currently collect sufficient data to allow for appropriate evaluation of the program; the only data collected are administrative data that are required by USDA. Information on whether the CACFP influences food choices in child care centers in the Mississippi Delta cannot be answered based on the structure of this administrative data. For instance, the Mississippi CACFP requires no information on menu choices from participating centers. Furthermore, State-level differences in administrative data make it difficult to evaluate the program performance in Mississippi relative to that in other States. Development of a nationwide standardized database would facilitate analysis and allow for accurate evaluation of the CACFP.
Direct inquiries about this study to the Project Contact listed above.