title: Price and healthfulness of snacks in 32 YMCA after-school programs in 4 US metropolitan areas, 2006-2008.
abstract: BACKGROUND
  A common perception is that healthful foods are more expensive than less healthful foods. We assessed the cost of beverages and foods served at YMCA after-school programs, determined whether healthful snacks were more expensive, and identified inexpensive, healthful options.
  
  
  METHODS
  We collected daily snack menus from 32 YMCAs nationwide from 2006 to 2008 and derived prices of beverages and foods from the US Department of Agriculture price database. Multiple linear regression was used to assess associations of healthful snacks and of beverage and food groups with price (n = 1,294 snack-days). We identified repeatedly served healthful snacks consistent with Child and Adult Care Food Program guidelines and reimbursement rate ($0.74/snack).
  
  
  RESULTS
  On average, healthful snacks were approximately 50% more expensive than less healthful snacks ($0.26/snack; SE, 0.08; P = .003). Compared to water, 100% juice significantly increased average snack price, after controlling for other variables in the model. Similarly, compared to refined grains with trans fats, refined grains without trans fat significantly increased snack price, as did fruit and canned or frozen vegetables. Fresh vegetables (mostly carrots or celery) or whole grains did not alter price. Twenty-two repeatedly served snacks met nutrition guidelines and the reimbursement rate.
  
  
  CONCLUSIONS
  In this sample of after-school programs, healthful snacks were typically more expensive than less healthful options; however, we identified many healthful snacks served at or below the price of less healthful options. Substituting tap water for 100% juice yielded price savings that could be used toward purchasing more healthful foods (eg, an apple). Our findings have practical implications for selecting snacks that meet health and reimbursement guidelines.
authors.affiliation: Harvard Prevention Research Center, Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA. rmozaffa@hsph.harvard.edu
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Mozaffarian
authors.forename: Analisa
authors.initials: A
authors.lastname: Andry
authors.forename: Rebekka M
authors.initials: RM
authors.lastname: Lee
authors.forename: Jean L
authors.initials: JL
authors.lastname: Wiecha
authors.forename: Steven L
authors.initials: SL
authors.lastname: Gortmaker
mesh_terms: D002648:Child; D002675:Child, Preschool; D003132:Commerce / Q000191:economics*; D004034:Diet Surveys / Q000379:methods*; D002149:Energy Intake; D005518:Food Preferences; D005522:Food Services / Q000191:economics* / Q000592:standards; D006801:Humans; D018673:Nutrition Policy; D009753:Nutritive Value; D015397:Program Evaluation; D012189:Retrospective Studies; D012574:Schools / Q000458:organization & administration*; D014481:United States