Federal Nutrition Assistance for Young Children: Underutilized and Unequally Accessed.

Introduction: The federal Child and Adult Care Food Program (CACFP) improves nutrition and reduces food insecurity among young children by helping cover the food costs for child care pro-viders and families. This nationwide study evaluated the extent and predictors of the CACFP's utili-zation among licensed child care centers to identify opportunities for expanding CACFP nutrition support. Methods: Administrative data from the CACFP and child care licensing agencies in 47 states and District of Columbia were compiled and geocoded for 93,227 licensed child care centers. CACFP participation was predicted using a multivariable Bayesian spatial logistic regression model in the sample of low-income areas to target CACFP eligible child care centers. Data were collected in 2020 - 2021 and analyzed in 2022. Results: Of all licensed child care centers, 36.5% participated in the CACFP, ranging from 15.2% to 65.3% across states; when restricted to low-income areas, 57.5% participated (range, 15.7% - 85.7%). Income differences did not explain the large variation in CACFP participation rates across states. Having at least three CACFP sponsoring agencies per state predicted a 38% higher probabil-ity of CACFP participation (OR=1.38; 95% Credible Interval=1.08-1.78). Conclusions: Currently CACFP participation rates among licensed child care centers point to pro-gram underutilization and unequal access, particularly in some states and regions. Work at the fed-eral and state levels is warranted to expand participation in the program, above all in low-income areas, so that more young children could eat healthfully with the CACFP. Am J Prev Med 2024;66(1):18-26. (c) 2023 American Journal of Preventive Medicine. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).