title: Policy improves what beverages are served to young children in child care.
abstract: BACKGROUND
  During 2008, we conducted a statewide survey on beverages served to preschool-aged children in California child care that identified a need for beverage policy. During 2011, the US Department of Agriculture began requiring that sites participating in the Child and Adult Care Food Program (CACFP) make drinking water available throughout the day and serve only low-fat or nonfat milk to children aged 2 years and older. During 2012, the California Healthy Beverages in Childcare law additionally required that all child-care sites eliminate all beverages with added sweetener and limit 100% juice to once daily.
  
  
  METHODS
  To assess potential policy effects, we repeated the statewide survey in 2012. During 2008 and 2012, a cross-sectional sample of ∼1,400 licensed child-care sites was randomly selected after stratifying by category (ie, Head Start, state preschool, other CACFP center, non-CACFP center, CACFP home, and non-CACFP home).
  
  
  RESULTS
  Responses were obtained from 429 sites in 2008 and 435 in 2012. After adjustment for child-care category, significant improvements in 2012 compared with 2008 were found; more sites served water with meals/snacks (47% vs 28%; P=0.008) and made water available indoors for children to self-serve (77% vs 69%; P=0.001), and fewer sites served whole milk usually (9% vs 22%; P=0.006) and 100% juice more than once daily (20% vs 27%; P=0.038). During 2012, 60% of sites were aware of beverage policies and 23% were judged fully compliant with the California law.
  
  
  CONCLUSIONS
  A positive effect occurred on beverages served after enactment of state and federal policies. Efforts should continue to promote beverage policies and support their implementation.
authors.forename: Lorrene D
authors.initials: LD
authors.lastname: Ritchie
authors.forename: Sushma
authors.initials: S
authors.lastname: Sharma
authors.forename: Ginny
authors.initials: G
authors.lastname: Gildengorin
authors.forename: Sallie
authors.initials: S
authors.lastname: Yoshida
authors.forename: Ellen
authors.initials: E
authors.lastname: Braff-Guajardo
authors.forename: Patricia
authors.initials: P
authors.lastname: Crawford
mesh_terms: D000818:Animals; D001628:Beverages / Q000009:adverse effects / Q000592:standards; D002140:California; D002654:Child Care / Q000145:classification / Q000331:legislation & jurisprudence; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004034:Diet Surveys; D050528:Diet, Carbohydrate-Restricted; D018752:Diet, Fat-Restricted; D004326:Drinking; D005260:Female; D063105:Food Assistance / Q000331:legislation & jurisprudence; D005638:Fruit / Q000009:adverse effects; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008892:Milk / Q000009:adverse effects / Q000592:standards; D018673:Nutrition Policy; D064427:Nutritive Sweeteners / Q000009:adverse effects; D015397:Program Evaluation; D014481:United States; D016885:United States Department of Agriculture
chemical_list: D064427:Nutritive Sweeteners
keywords: Beverages; Child care; Food assistance; Nutrition policy; Policy compliance