Exploring implementation of the 2010 Institute of Medicine’s Child and Adult Food Care Program recommendations for after-school snacks

The US school food programmes began extending into the after-school hours in 1998, when federal subsidies added reimbursements for snacks provided to students during after-school enrichment activities like homework assistance programmes(1,2). After-school snack programmes fall under federal purview of the US Department of Agriculture (USDA). Schools operating longer than the traditional school day may be eligible for after-school snack reimbursement through the Child and Adult Food Care Program (CAFCP) or the National School Lunch Program (NSLP). Nutrition standards for after-school snacks are the same for both CAFCP and NSLP, and have focused on food safety, minimum portion sizes and food groups(2,3). Although recommendations with a significant emphasis on obesity prevention have been established related to the food environment during the school day(4), guidance pertaining to snacks and meals served after school hours has only been recently released(5). The extent to which snacks that comply with the revised recommendations are available and affordable is unknown. Children at higher risk for obesity, including those in poverty or minority groups, constitute a significant proportion of participants in after-school programmes(6–8). For example, during the 2009 school year, NSLP-funded snack programmes served about 180 million snacks in US after-school settings representing an average daily distribution of over 1 million snacks(9). Ninety-one per cent of these snacks were served by programmes having at least 50% of students who qualify for free and reduced-price lunch benefits(9). CACFP also serves snacks to youth in other after-school settings like YMCA and other park and recreation centres. Both NSLP and CACFP serve high-needs programmes that are termed ‘area eligible’ and all snacks are reimbursed at the free rate, regardless of individual student eligibility for free or reduced price lunches(10). Area eligible designation is of particular benefit to programmes because it increases funding and simplifies programme administration for school food service. Conversely, snacks served in after-school care programmes that are not area eligible (<50% of students qualify for free and reduced-price lunch benefits) are reimbursed at the free, reduced price and paid rate depending on each individual’s eligibility for free or reduced-price meals. This means non-area eligible programmes must maintain a roster or sign-in sheet and process for reimbursement. The purpose of the present descriptive study was to explore the feasibility of developing an after-school snack menu that adheres to recommendations which reflect current nutritional science. Specifically, the aim of the present study was to identify foods and beverages that adhere to the 2010 Institute of Medicine (IOM) CACFP(5) recommendations for snacks served after school and local school district logistical and budgetary parameters for after-school homework programmes. This practical examination is important because schools are under pressure to improve the whole school food environment, including after school(11). This work is additionally important because after-school programmes are growing steadily in the USA and many are designed to reach underserved children where health disparities, including overweight and hunger, coexist(12,13).