Date of Award


Document Type

Open Access Dissertation


Exercise Science


The Norman J. Arnold School of Public Health

First Advisor

Michael W. Beets


The Child and Adult Care Food Program (CACFP) aims to increase children’s access to healthful foods in out-of-home care. Approximately half of the 10.2 million children enrolled in afterschool programs (ASPs) are eligible for nutrition assistance through programs like CACFP. Despite awareness of its potential impact on the nutritional status of millions of children, CACFP is underutilized among ASPs and notably understudied in comparison to other federal nutrition assistance programs.

This dissertation addresses key gaps in CACFP research and provides a deeper understanding of the nutrition assistance landscape in afterschool programs by (1) assessing the type of afterschool snacks served under CACFP guidance, (2) evaluating the nutrient content of snacks by ASPs’ CACFP participation, and (3) examining the challenges and benefits to CACFP enrollment as perceived by ASP administrators. A cross-sectional, mixed methods design with stratified, purposeful sampling of ASPs based on CACFP eligibility and enrollment was employed to examine the three study aims. Thirty-five administrators, representing 60 ASPs based in South Carolina participated in studies 1 and 2. Participants completed phone interviews; providing sample snack menus and nutrition policy information. Study 3, a qualitative investigation of CACFP enrollment barriers, was conducted with a subsample of 22 administrators from CACFP-enrolled ASPs and those eligible, but not enrolled.

Study 1 assessed the relationship between the average weekly servings of food/beverage categories and ASPs grouped by their (1) CACFP eligibility/enrollment status and (2) snack standards/guidelines utilized. ASPs enrolled in CACFP and adhering exclusively to their guidelines served significantly higher quantities of sugar-based snacks and fewer fresh fruits and vegetables than their peer ASPs.

For study 2, the energy and macro/micronutrient content of snacks, determined using the US Department of Agriculture’s (USDA) Nutrient Database, was compared: (1) across CACFP-eligibility/enrollment groups and (2) to existing USDA and Institute of Medicine nutrition standards. Snacks served in CACFP-enrolled ASPs were of lower nutritional quality than those served in CACFP-non-enrolled ASPs; containing significantly more energy, carbohydrates, total sugar, and added sugar. Across CACFP-eligibility/enrollment groups, snacks failed to meet many nutrient guidelines indicative of a healthy diet.

Study 3 aimed to identify plausible explanations behind CACFP’s underutilization among ASPs. Respondents participated in semi-structured qualitative interviews assessing their knowledge, experience, and perceptions surrounding nutrition assistance programs. CACFP-enrolled ASP administrators had a more favorable impression of nutrition assistance programs; however, both groups expressed similar CACFP-specific benefits and challenges. Both groups felt CACFP’s greatest strengths were the program’s monetary incentives and perceived impact on the nutritional quality of meals/snacks. Challenges include enrollment guidelines, paperwork demands, and lack of perceived administrator/sponsor support. Respondents provided suggestions for strengthening CACFP by addressing these key challenges.

This dissertation adds to the body of literature surrounding nutrition assistance programs and to our knowledge, is the first to provide empirical evidence regarding the type and nutritional content of snacks served in CACFP ASPs, as well as the first to capture the benefits and barriers to CACFP enrollment from the perspective of ASP administrators. In summary, this dissertation provides insight into the current state of CACFP in ASPs. Understanding the program’s strengths and weaknesses is crucial to developing effective strategies to increase participation within the afterschool setting and ensure that children are provided with nutritious snacks that support healthy growth and development.


© 2017, Falon Elizabet Tilley