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Brief: Supporting Healthy Food and Beverage Choices in Afterschool Programs in Allegheny County, Pennsylvania

The information in this brief is intended only to provide educational information.

This brief summarizes a CHOICES Learning Collaborative Partnership model examining the potential impacts of a healthy snack policy in afterschool programs that already provide snacks through the National School Lunch Program or the Child and Adult Care Food Program.

The Issue

All children deserve the opportunity to grow up at a healthy weight. If current trends in childhood obesity continue, most of today’s children will have obesity at age 35.1 The health care costs of treating obesity-related conditions in adulthood were $147 billion in 2008.2 Snacks account for 25% of total calorie intake among most U.S. children and are frequently composed of sweet foods and sugar-sweetened drinks,3 beverages that increase the risk of excess weight gain.4 Promoting healthy food and beverage choices in afterschool programs is one opportunity to improve children’s diets and potentially reduce childhood obesity.5

In Allegheny County, nearly 10,000 children attend an afterschool program that typically allows participants to bring in snacks that they can consume during the program. When children bring in their own snacks to afterschool programs, those snacks are often less healthy than snacks served within federal reimbursable meal programs.6

About a Healthy Snack Policy

A policy that does not allow children to bring in their own snacks to afterschool programs and only offers healthy food and/or beverage choices that are part of federal reimbursable meal programs could support good nutrition. Snacks refer to both foods and beverages. In Allegheny County, UPMC Children’s Hospital of Pittsburgh, and Allegheny Partners for Out-of-School Time work with 120 sites across the county through Healthy Out-of-School Time and Quality Campaign. The majority of these sites (117) serve snacks though federal reimbursable meal programs, but allow children to bring in their own snacks. These sites could benefit from adopting a healthy snack policy. Activities to support adoption of this policy would include training site directors, who would in turn train program staff. During the academic year, Healthy Out-of-School Time and Quality Campaign site coordinators would provide technical assistance to support policy adoption.

Comparing Costs and Outcomes

CHOICES cost-effectiveness analysis compared the costs and outcomes of adopting a healthy snack policy in 117 Healthy Out-of-School Time and Quality Campaign afterschool programs over 10 years. Programs could adopt either a policy that does not allow children to bring in sugary drinks or a policy that does not allow children to bring in either sugary drinks or their own food to afterschool programs.

Implementing a healthy snack policy could support good nutrition and save families money. By the end of 2027:
An infographic about the healthy snack policy results. The bottom of the graphic shows increased numbers for a food and drink plan instead of only a drink plan. The food and drink results are: 4, 510 children would consume fewer unhealthy snacks; 50 cases of childhood obesity prevented; $1,690,000 saved by families.

Conclusions and Implications

Adopting a healthy snack policy could promote better health for children in afterschool programs and save families money. For some programs, it may be more feasible to adopt a policy addressing sugary drinks only. Clear evidence links sugary drink consumption to excess weight gain.4

We estimate that providing the training, technical assistance, communication, coordination, and monitoring in afterschool programs to support the adoption of a healthy snack policy that only addresses sugary drinks would cost $53,500 over 10 years. It could also result in $965,000 in savings for families ($243 per child) who are no longer purchasing beverages for their children to bring to afterschool. Those children who regularly bring sugary drinks to afterschool programs and attend Healthy Out-of-School Time and Quality Campaign afterschool programs that adopt a healthy snack policy could reduce sugary drink consumption by 10 ounces per day on those days they attend programming. In addition, 27 cases of childhood obesity could be prevented in 2027 and $53,900 in obesity-related health care costs could be saved. Afterschool programs adopting a healthy snack policy can support healthy nutrition habits for children and lay a foundation for better health.


  1. Ward Z, Long M, Resch S, Giles C, Cradock A, Gortmaker S. Simulation of Growth Trajectories of Childhood Obesity into Adulthood. New England Journal of Medicine. 2017 Nov 30;377(22):2145-2153.
  2. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual Medical Spending Attributable To Obesity: Payer-And Service-Specific Estimates. Health Affairs. 2009;28(5).
  3. Wang D, van der Horst K, Jacquier E & Eldridge AL. Snacking among US children: patterns differ by time of day. Journal of Nutrition Education and Behavior. 2016; 48(6), 369-375.
  4. Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: a systematic review. American Journal of Clinical Nutrition. 2006;84(2):274–88.
  5. Khan LK, Sobush K, Keener D, Goodman K, Lowry A, Kakietek J, et al. Recommended community strategies and measurements to prevent obesity in the United States. MMWR Recomm Rep 2009;58(RR-7):1–26.
  6. Kenney EL, Austin SB, Cradock AL, Giles CM, Lee RM, Davison KK, Gortmaker SL. Identifying sources of children’s consumption of junk food in Boston after-school programs, April-May 2011. Preventing Chronic Disease. 2014 Nov 20;11:E205
Suggested Citation:

Pagnotta M, Hardy H, Burry K, Flax C, Barrett J, Cradock A. Allegheny County: Supporting Healthy Food and Beverage Choices in Afterschool Programs [Issue Brief]. Allegheny County Health Department, Pittsburgh, PA, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; November 2019.

This issue brief was developed at the Harvard T.H. Chan School of Public Health in collaboration with the Allegheny County Health Department (ACHD) through participation in the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Learning Collaborative Partnership. This brief is intended for educational use only.