Our data demonstrate that healthful snacks that meet the ESHE guidelines are on average more expensive than less healthful snacks. This difference was largely driven by fruits and canned or frozen vegetables, which are higher-priced foods consistent with ESHE standards. Our findings suggest useful strategies to increase the healthfulness of snacks without large price increases. These strategies include serving snacks with low-priced fresh vegetables, replacing refined grains with whole grains, and replacing 100% juice with tap water.
Our analysis identified repeatedly served snacks that met guidelines for healthful eating and CACFP nutrition guidelines and reimbursement rates. Many of these snacks contained lower-priced fruits and protein foods, indicating that programs could budget to occasionally include more expensive healthful foods rather than excluding them entirely. Although many potential snack combinations could be theoretically constructed on the basis of price and nutrition data alone, our analyses were based on snacks actually served, inherently incorporating issues of availability, feasibility, and acceptance in real-world situations.
To our knowledge, no prior investigation has prospectively evaluated the determinants of after-school snack prices. Tools for pricing and planning healthful snacks have been developed for after-school staff (19
), indicating interest in guidance on this area.
Evidence from economic analyses is consistent with our findings that less healthful foods are generally less expensive (21
). Our findings for fruits and canned or frozen vegetables are consistent with these analyses; however, they also indicate that the perception that more healthful foods are always more expensive is oversimplified. Studies often evaluate food prices per calorie rather than per serving, biasing results toward finding lower prices for high-calorie, energy-dense foods that would also generally be less healthy (21
). Such calorie-based metrics can create a circular argument, implicitly handicapping lower-calorie foods such as fruits and vegetables. Shifting from valuing foods strictly on a per-calorie basis toward foods that are satiating and nutritious would provide a more comprehensive view of the healthfulness of foods on which to evaluate price.
After-school programs would benefit from allocating money spent on less healthful beverages and foods toward more healthful options. Assuming tap water is safe to drink at after-school programs, serving water would save money that could be spent on even more healthful food options for snacks such as whole fruits, while still meeting price targets. Whole fruit is preferable to 100% juice because of its higher fiber content and effects on satiety and also because it requires a longer time to consume the same number of calories (24
). On the basis of our data, programs could add a banana and tap water to the snack for the same price as 100% apple juice ($0.24). Similarly, tap water and cheese slices instead of 1% chocolate milk would save $0.03 per serving and reduce sugar, while providing other nutrients. Within food categories, Cheerios and Triscuits were examples of whole grains that were less expensive than some refined grains with trans fat (eg, graham crackers). A recent study found that healthful foods that did not increase price were available within food categories (25
), further confirming the feasibility of this strategy. Moreover, similar to our definition of healthful foods, this study used metrics other than energy density alone to define healthful options (eg, no trans fat or white flour).
Little standardized guidance is offered for snacks in after-school programs, nor for upper or lower limits for total snack calories (26
). Programs generally must adhere to varying standards based on their specific local program, organization, or state agency. CACFP guidelines provide no direction beyond requirements to serve at least 2 of 4 components; by these standards, a reimbursable after-school snack could be Pop-Tarts (a grain) and milkshakes (a milk product). Development of standardized guidelines merits consideration. The National Afterschool Association adopted voluntary quality standards in 2011, a notable shift toward addressing this need (26
). Reimbursement guidelines can also complicate snack choices. For example, CACFP specifies that fruits and vegetables are reimbursable only in serving sizes of at least three-fourths of a cup (10
). Because some whole fruits count as less than a three-fourths cup serving (eg, a small apple or raisins), these reimbursement guidelines lead programs to also serve 100% juice to meet the guideline. After-school programs would have greater flexibility, nutritionally and financially, if they received reimbursement for standard age-appropriate serving sizes of fruits and vegetables.
This study has several limitations. Price analyses did not account for labor, preparation, or overhead costs (except price of water cups). We expect that such price differences would be small for the types of snacks served at these programs; for instance, repeatedly served snacks often included 1 food item requiring minimal or no preparation (eg applesauce, crackers, or banana). Food prices and availability vary by metropolitan area (27
), and some fruits and vegetables are less expensive in season than out-of-season. However, many frequently served fruits (eg, apples, bananas, applesauce) and vegetables (eg, carrots, celery) are available year-round with little seasonal price fluctuation (28
), making these good choices for after-school programs.
YMCAs in the Pacific Northwest metropolitan area served the widest variety of fresh fruits and vegetables; it is unclear if this was because of availability or because they served more expensive snacks. Additionally, some programs have vendor contracts, limiting control over foods served.
Menus were not independently validated. We collected data on beverages and foods served, not what was actually consumed; more research is needed to determine what kinds of healthful, inexpensive snack combinations children enjoy. Trans fat and nutrient information were obtained from 2006 to 2007; product formulations may have changed. These data do not represent snacks or prices of all after-school programs. Programs were located in areas with higher median income compared to the national median and lower percentages of racial/ethnic minority children than typical nationally, suggesting that this sample of YMCA after-school programs could have served more healthful and expensive snacks than programs in less affluent areas. Furthermore, these programs were situated within associations that had been part of a larger wellness initiative for several years. Nevertheless, our findings represent 32 sites in 4 US metropolitan areas in the largest private, nonprofit after-school provider nationwide and may be considered a reasonable estimate of average snack quality and prices in after-school programs.
Although healthful snacks are more expensive overall than less healthful snacks, our findings demonstrate that a range of healthful foods and snack combinations can be served at a similar or lower price than less healthful options. In light of the obesity epidemic and the increasing number of children attending after-school programs (1
), these findings may help programs to purchase and offer more healthful, affordable snacks.