Appendix M Research Questions, Key Measures, Analysis Methods, and Subgroups and Covariates by Objective

Appendix M: Research Questions, Key Measures, Analysis Methods, and Subgroups and Covariates by Objective

Research Questions, Key Measures, Analysis Methods, and Subgroups and Covariates by Objective

Research Questions and Key Measures	Analysis Methods	Subgroups/ Covariates in Regression Analyses
Objective 1: Nutrition and Wellness Includes: CACFP Child Care Providers (Head Start, Other Centers, FDCHs, Afterschool, At-Risk)
What is the distribution of the nutrient content of meals and snacks served in a typical week, overall, by age served, and by type of provider? Distribution and average nutrient content for each type of meal and snack served in a typical week Degree to which meals served meet the Dietary Guideline recommendations, the CACFP meal patterns, and Healthy Eating Index guidelines Distribution and variety of types of foods served by meal/snack occasion in a typical week Foods that are served most frequently Foods that are the main sources of calories, key nutrients, sodium, and solid fats and added sugars ( SoFAS) Frequency that fresh produce and whole grains are served	Descriptive statistics (mean, median) Subgroup tabulations with selected tests of differences or association Comparisons with, DGAs, CACFP meal patterns, DRIsi and HEIi	Age groups:a CACFP meal pattern (Ages 1-2 years, 3-5 years) DRI age groups (1-3 years, 4-8 years) Provider subgroups: Provider typeb Urban/rural Chain/other sponsor/ independentc Large/medium/small Race/ethnic compositiond
What are providers’ menu planning practices, overall, and by type of provider? Food preparation & storage equipment and capacity Provider policies and practices related to food allergies Entity that creates the menus (e.g., providers, sponsors, other) Percent of providers using cycled menus and nature of these cycles Percent of providers doing nutrient analysis of meals and tools used to do so Percent of providers participating in SBP, NLSP (CACFP sponsors only) Percent of providers with afterschool programs and percent participating in afterschool snack and/or at-risk supper program.	Descriptive statistics (mean, median) Subgroup tabulations with selected tests of differences or association	Provider subgroups: Provider typeb Urban/rural Chain/other sponsor/ independentc Large/medium/small Race/ethnic compositiond
What are providers’ meal purchasing practices, overall, and by type of provider? Sources of foods for meals and snacks (e.g., co-ops) Types of people responsible for food purchases and variation by provider type Frequency of use of sources by provider type If multiple sources, frequency of use of different types of sources by provider type If multiple sources, types of food (entrees, fruits and vegetables, etc.) typically obtained at each source by provider type Processes of documenting purchases and meal counts by provider type and types of people responsible for these activities	Descriptive statistics (mean, median) Subgroup tabulations with selected tests of differences or association	Provider subgroups: Provider typeb Urban/rural Chain/other sponsor/ independentc Large/medium/small Race/ethnic compositiond
What are providers’ food service practices, overall and by type of provider? Ways in which meals are served (e.g., family style, plated, etc.) Length of time participants have to eat by type of meal or snack Policies and practices on receiving seconds for meals & snacks, & for declining foods when served Policies about and frequency of children bringing meals/snacks from home Policies and practices related to serving water Policies and practices on food safety, frequency of use, & variation by provider characteristic Number of providers with systems in place to trace a product being recalled	Descriptive statistics (mean, median) Subgroup tabulations with selected tests of differences or association	Provider subgroups: Provider typeb Urban/rural Chain/other sponsor/ independentc Large/medium/small Race/ethnic compositiond
What are providers’ wellness policies and practices, overall and by type of provider? Policies and practices on frequency and amount of time participants are provided with opportunities for physical activities Policies and practices about types of physical activities offered? Amount of time spent on sedentary activities and, of this, amount that is “screen time” Comparison of physical activity levels with Institute of Medicine (IOM) and other recommendations (e.g., Let’s Move Child Care, Caring for our Children), as appropriate Barriers to physical activity (e.g. access to outdoor play space) and how they impact the quantity and type of physical activities by overall and by type of barrier (e.g., transient vs. more permanent barriers	Descriptive statistics (mean, median) Subgroup tabulations with selected tests of differences or association	Provider subgroups: Provider typeb Urban/rural Chain/other sponsor/ independentc Large/medium/small Race/ethnic compositiond
What are infant feeding patterns and how do they align with the American Academy of Pediatrics (AAP) recommendations (only in CACFP child care environment)? Distribution and variety of types of foods served by meal/snack occasion in a typical week Foods that are served most frequently Percent of infants under 6 months and under 4 months of age served any solids. Percent of infants under 12 months old served juice Percent of infants consuming breastmilk, percent of infants consuming formula, and percent consuming a combination of formula and breastmilk Whether the center has necessary facilities to enable infants to consume breastmilk brought from home Whether breastmilk is being stored and prepared according to food safety guidelines	Descriptive statistics (mean, median) Subgroup tabulations with selected tests of differences or association	Provider type (center vs. FDCH) for survey data Infants will be a subgroup of children in CACFP centers
Objective 2: Dietary Intakes Includes: CACFP Child Care Providers (Head Start, Other Centers, FDCHs, Afterschool, At-Risk)
What is the food and nutrient intake of children in CACFP child care centers during child care days and non-child care days by provider type? Mean numbers of MyPlatee servings consumed from each food group within child care day and total for the day, overall by age of child and by type of provider Comparison of MyPlate servings consumed during child care day with CACFP standards; overall by age of child and by type of provider Comparison of intake levels to Dietary Reference Intakes (DRIs) overall by age of child and type of provider, and for those who bring food from home Proportion of daily mean nutritional intake from CACFP meals overall by age of child and type of provider Percent of children at risk of inadequate intakes for specific nutrients Mean scores on the Healthy Eating Index for meal participants Amount of water served during meals and whether water is available during non-meal times Frequency of participants bringing food from home, reasons for doing so	Descriptive statistics (mean, median) Tests of differences between means and medians for child care and non-child care days Regression-adjusted means for differences between subgroups Estimation of usual intakes (National Cancer Institute-NCI method)	Age groupsa CACFP meal pattern (Ages 1-2 years, 3-5 years) DRI age groups (1-3 years, 4-8 years) Provider subgroups:f Head Start vs. other CCC vs. at-risk vs. afterschool Large/small Child/family characteristics: Gender Race/ethnicity Poverty level/ FRP meals status Urban/rural location Full-time vs. part-time care
What is the weight status of CACFP participants and activity level and participation in assistance programs as reported by parents? BMI Percentage overweight Percentage underweight Activity level as reported by parents. Food assistance participation: Supplemental Nutrition Assistance Program (SNAP); Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); NSLP/SBP; emergency food Medicaid/Children’s Health Insurance Program (CHIP) participation Temporary Assistance for Needy Families (TANF) participation	Descriptive statistics (mean, median) Regression model including demographics and activity level or regression-adjusted means by age group	Child/family characteristics: Gender Race/ethnicity Poverty level/ FRP meals status Urban/rural location
What is the food intake of infants in CACFP child care centers during the child care day? Mean ounces of formula consumed per hour in child care Mean ounces of breastmilk consumed per hour in child care Mean ounces of juice consumed in child care Mean ounces of water consumed in child care Distribution and variety of types of foods consumed in child care centers Foods that are eaten most frequently Percent of infants under 6 months and under 4 months of age consuming any solids. Percent of infants consuming breastmilk, percent of infants consuming formula, and percent consuming a combination of formula and breastmilk Frequency of infants bringing food from home, reasons for doing so	Descriptive statistics (mean, median)	Infants will be a subgroup of children in other CACFP CCC (excludes Head Start centers)
What is the feasibility of measuring children‘s dietary intake during child care days and non-child care days and measuring children’s BMI in family day care homes (FDCH) receiving CACFP? Conducted in a small, purposive sample of FDCHs Discuss feasibility and issues involved in measuring dietary intake, including feasibility of recruiting parents Discuss feasibility and issues involved in measuring children’s BMI Discuss issues that arose in conducting menu survey and meal observations	Operational feasibility and data quality assessment	None
Objective 3: Costs & Revenues Includes: CACFP Child Care Center Providers (Head Start, Other Centers, Afterschool, At-Risk)
What are the costs of producing an average CACFP meal or snack by type of meal/snack? Average reported and full cost of each type of meal and snack, overall and by provider type Composition of the average reported costs and full costs including administrative costs Relationship between costs and provider characteristics (e.g., meals served, size, enrollment growth, revenue, participant income and other demographics) Relationship between meal/snack cost and use of fresh produce Relationship between costs of production and the types of foods served by CACFP providers to meet CACFP Meal patterns	Descriptive statistics (mean, median) Exploratory correlation analysis of relationship of costs to provider characteristics and meal characteristics	Provider subgroupsg Head Start vs. other CCC vs. at-risk vs. afterschool Large/ small Financial status Covariates: Revenue/cost for CACFP Meals served Enrollment trend Race/ethnic compositiond Free/reduced price meal percentage Meal characteristics to be determinedh
What is the relationship of costs to CACFP reimbursements and other revenues? Percent that receive additional resources for meals/snacks (e.g., donations, state augmentation of rates) Relationship between meal/snack production costs and CACFP reimbursements	Descriptive statistics (mean, median)	Provider subgroupsg Head Start vs. other CCC vs. at-risk vs. afterschool Large/ small Financial status
Objective 4: Plate Waste Includes: CACFP Child Care Center Providers (Head Start, Other Centers, Afterschool, At-Risk)
At the individual level, how much and what types of food are wasted? Amount of food left over from individual meals by type of food, food group and type of meal/snack Amount of food left over from individual meals by participant characteristic (e.g., age, gender) Nutritional value of food served but not eaten Relationship between characteristics of the food environment (e.g. time of meal) and the degree to which fruits and vegetables are not consumed Relationship between plate waste, the timing and length of the meal, and the timing of physical activities	Descriptive statistics (mean, median) Tests of differences between means and medians for child care and non-child care days Regression-adjusted means for differences between subgroups	Age groupsa CACFP meal pattern (Ages 1-2 years, 3-5 years) DRI age groups (1-3 years, 4-8 years) Provider subgroups:f Head Start vs. other CCC vs. at-risk vs. afterschool Large/small Child/family characteristics: Gender Race/ethnicity Poverty level/ FRP meals status Urban/rural location
At the center level, what happens to food that is not eaten during meals and snacks by CACFP participants Amount of food left over after meals are served Uses of food left over from meals (served again, taken home by staff, etc.) Amount of food left over from meals that is discarded	Descriptive statistics (mean, median)	Provider subgroups: Head Start vs. other CCC vs. at-risk vs. afterschool Large/ small

^aMenu survey results will be reported for CACFP age groups with data representing 20% or more of the provider sample. See discussion in sampling section.

^bProvider type categories for Objective 1 are: Head Start center, other CACFP child care center, at-risk programs, afterschool programs, CACFP family child care home (FDCH, Objective 1, 5, and 6 only),.

^cChain centers are those with a sponsor that operates numerous centers under a corporate identity. Sponsored centers include affiliated centers (those that are part of the sponsor organization) and unaffiliated centers (those that have a sponsor but are not part of the sponsor organization). Independent centers are those that have their own agreement with the State.

^dRace/ethnic composition categories for providers will be defined based on the race/ethnicity composition of the local area.

^eThe USDA Food Pattern food groups, or MyPlate groups, are defined in accordance with the 2010 Dietary Guidelines for Americans (USDA and USDHHS, 2010).

^fSubgroups for analysis of food and nutrient intakes will be limited to subgroups of at least 20% of the sample in order to assure adequate samples for analysis of usual intakes.

^gSee discussion on selection of provider characteristics for exploratory analysis of costs in Section 5.4

^hMeal characteristics for exploratory analysis of meal costs will be determined based on those that are substantively important.

ⁱComparisons will be made to DRIs and HEI if feasible and appropriate measures can be constructed

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