Are food and nutrition assistance programs fostering an equitable early care and education (ECE) food environment? A systematic review utilizing the RE-AIM framework

IF 3.2 1区教育学 Q1 EDUCATION & EDUCATIONAL RESEARCH Early Childhood Research Quarterly Pub Date : 2024-09-10 DOI:10.1016/j.ecresq.2024.08.010

Tirna Purkait , Dipti A. Dev , Deepa Srivastava , Lisa Franzen-Castle , Allison Magness Nitto , Erica L. Kenney

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Abstract

Background

Health inequities related to poor diet, food insecurity, and obesity negatively affect children from low-income minority families. The USDA administers Food and Nutrition Assistance Programs (FNAPs) in Early Care and Education settings (ECEs) to safeguard the health of vulnerable children. However, the extent to which FNAPs provide an equitable food environment in ECEs remains unclear.

Objective

Examine FNAPs’ association with young children's (2–6 years) food environment in ECE through a systematic review using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. The primary focus is to operationalize RE-AIM in ECE context and evaluate FNAPs' association with the ECE food environment using an equity lens.

Measurable outcomes

Food environment dimensions were assessed at three levels: ECE setting (availability, accessibility, affordability, acceptability, accommodation); ECE provider (feeding practices); and child (dietary intake, food insecurity, BMI percentile).

Results

The review included 38 articles (cross-sectional=30, mixed method=1, pre-post=5, longitudinal=2) with Child and Adult Care Food Program (CACFP; n = 35), Farm to ECE (n = 2), and Food Bank-ECE program partnership (n = 1). No study addressed all RE-AIM indicators. CACFP participation showed positive association with healthy food availability (n = 28), feeding practices (n = 12), child dietary intake (n = 6), and reduced risk of being overweight (n = 1). Farm to ECE interventions showed increased local food affordability (n = 1) and children's acceptance of healthy foods (n = 1). No study addressed foods served in ECEs to accommodate cultural diversity, special dietary needs, developmental disabilities, or reported child food insecurity.

Conclusion

CACFP emerges as the most prevalent FNAP nationally for having potential to improve ECE food availability and feeding practices, but further research is needed to address equity gaps by examining its impact on child outcomes (dietary intake, BMI percentile) across diverse geographic locations (urban vs. rural), ECE organizational structures (center-based vs. home-based), and demographic characteristics of ECE providers and children.

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食品和营养援助计划是否促进了公平的早期保育和教育（ECE）食品环境？利用 RE-AIM 框架进行系统审查

背景与不良饮食、食品不安全和肥胖有关的健康不公平现象对来自低收入少数民族家庭的儿童产生了负面影响。美国农业部在早期保育和教育机构（ECEs）中实施食品和营养援助计划（FNAPs），以保障弱势儿童的健康。目标通过使用 RE-AIM（覆盖、效果、采用、实施和维护）框架进行系统回顾，研究 FNAPs 与幼儿教育机构中幼儿（2-6 岁）饮食环境的关系。主要重点是在幼儿教育环境中实施 RE-AIM，并从公平的角度评估 FNAPs 与幼儿教育食品环境的关系：结果综述包括 38 篇文章（横断面=30，混合方法=1，事前-事后=5，纵向=2），涉及儿童和成人保育食品计划（CACFP；n = 35）、农场到幼儿教育（n = 2）和食品银行-幼儿教育计划合作（n = 1）。没有研究涉及所有 RE-AIM 指标。CACFP 的参与与健康食品的可获得性（n = 28）、喂养方式（n = 12）、儿童饮食摄入量（n = 6）和超重风险的降低（n = 1）呈正相关。农场对幼儿教育的干预表明，当地食品的可负担性提高了（n = 1），儿童对健康食品的接受程度提高了（n = 1）。没有研究涉及幼教机构为适应文化多样性、特殊饮食需求、发育障碍而提供的食物，或报告的儿童食物不安全问题。结论CACFP是全国最普遍的FNAP，具有改善幼教食物供应和喂养方式的潜力，但还需要进一步研究，通过考察其对不同地理位置（城市与农村）、幼教组织结构（中心与家庭）以及幼教提供者和儿童人口特征的儿童结果（饮食摄入量、BMI百分位数）的影响，解决公平差距问题。

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来源期刊

Early Childhood Research Quarterly Multiple-

CiteScore

7.00

自引率

8.10%

发文量

109

期刊介绍： For over twenty years, Early Childhood Research Quarterly (ECRQ) has influenced the field of early childhood education and development through the publication of empirical research that meets the highest standards of scholarly and practical significance. ECRQ publishes predominantly empirical research (quantitative or qualitative methods) on issues of interest to early childhood development, theory, and educational practice (Birth through 8 years of age). The journal also occasionally publishes practitioner and/or policy perspectives, book reviews, and significant reviews of research. As an applied journal, we are interested in work that has social, policy, and educational relevance and implications and work that strengthens links between research and practice.