Examining Relationships between Food Procurement Characteristics and Nutritional Quality in Washington State Child Care Settings.

BACKGROUND: Sixty percent of US children 5 years old and under receive up to two-thirds of their daily nutrition in early care and education (ECE) settings. Although participation in the federal Child and Adult Care Food Program (CACFP) is shown to improve nutrition, little is known about the relationship between procurement practices (where and how child care programs purchase food) and nutrition in ECE settings or whether these practices differ depending on participation in CACFP. METHODS: We assessed self-reported nutrition practices and procurement practices by CACFP participation using a 2013 cross-sectional survey of 690 Washington ECE centers ("Centers") and 1260 family homes (family home child care [FHCCs]) serving children aged 2-5 years old using validated survey tools. We examined the relationship between procurement variables (i.e., main store and main mode) and nutrition scores using multinomial logistic regression models that adjusted for sociodemographic and program characteristics. RESULTS: In-person shopping was the primary mode of shopping for all programs, regardless of CACFP participation. Some Centers but very few FHCCs reported online shopping as their primary mode. Centers and non-CACFP FHCCs shopped primarily at megastores (Costco, Target, etc.). CACFP FHCCs used both megastores and grocery stores (Albertsons, QFC, etc.) at similar rates. Adjusted multinomial models found that shopping online or at two or more stores was associated with higher nutritional quality of foods served by programs. CONCLUSIONS: Understanding the procurement behaviors of ECE programs helps to illuminate and prioritize potential interventions that would support healthy food purchases.