All ETDs from UAB

Advisory Committee Chair

Brenda Bertrand

Advisory Committee Members

Jose Fernandez

Retta Evans

Peter Jones

Greg Pavela

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Health Professions


Over 65% of children ages 2-5 years attend Early Care and Education (ECE) centers where they consume most of their daily caloric intake; however, children at these centers are not meeting the Dietary Guidelines for Americans (DGA). This could suggest poor diet quality, which is a risk factor for diet-related diseases. Currently, diet quality in ECE centers is measured through the assessment of either the food/beverages listed on the lunch menu (menu), served to the children during lunch (served), or consumed by the children during lunch (consumed). However, the lunch meal may be better viewed as a process, rather than a single measure. This study was the first to view the lunch meal as a process. Further, potential relationships that nutrition policies and center characteristics have with diet quality throughout the lunch process are currently unknown. Therefore, the purpose of this dissertation was to 1.) Understand if diet quality differs among the menu, served, and consumed lunch measures, 2.) Establish if diet quality differs by participation in state policies that have nutrition requirements, including Alabama licensure and the Child and Adult Care Food Program (CACFP), and 3.) Understand the potential relationships between center characteristics and diet quality. We observed a difference in diet quality from the lunch menu to what was served to the children. This gap in diet quality from the menu to what was served was not fully explained through policy participation as no differences were identified among centers participating in no policy, only CACFP, only Alabama licensure, or both policies. However, facility-type (i.e. center-based vs. faith-based) was identified as a predictor of menu diet quality, as center-based ECEs had higher diet quality than faith-based. In Alabama, center-based ECEs are required to be licensed and thus follow the accompanying nutrition requirements for foods listed on menu and served to the children. Faith-based ECEs are not required to hold licensure and therefore may not follow the accompanying nutrition requirements. Thus, Alabama licensure may be a mediator for the identified relationship between facility-type and diet quality. Future research should assess potential interactions between facility-type, Alabama licensure status, and diet quality.



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