Purpose: Report breastfeeding outcomes for the “Mothers & Others” study, a two-group randomized controlled trial conducted among 430 non-Hispanic Black women living in central North Carolina.

Methods: The two intervention arms were a multicomponent Obesity Prevention Group (OPG) (treatment) versus an attention-control, Injury Prevention Group (IPG). Baseline was at 28 weeks pregnancy, followed by 2 prenatal home visits and 4 postpartum visits/assessments at 3, 6, 9, and 12 months. Trained peer educators delivered an anticipatory guidance curriculum, adapted from the ‘Baby Behavior’ program, on infant behavioral cues, common reasons for crying, distinguishing hunger-related crying, and typical sleep patterns. The prenatal curriculum also focused on mobilizing social support for the birth transition and infant behavioral cues unique to the first 72 hours, e.g. cluster-feeding. Logistic and linear regression models were run to test between-group differences in breastfeeding initiation rates; any breastfeeding at 3, 6, and 12 months; exclusive breastfeeding at 3 and 6 months; breastfeeding duration; and whether women met their personal breastfeeding goal.

Results/findings: Participants were 25.7±5.2 years, 50.5% completed some college, 92.0% planned to return to work postpartum (82.6% before 12 weeks), and 22.7% delivered at a ‘Baby Friendly’ certified facility. There were no significant differences in breastfeeding outcomes, but the directionality of measures favored OPG. Nearly 90% of women in both groups initiated breastfeeding (OPG 88.1%, IPG 88.4%; OR=1.05, P=.91) with higher rates in OPG of any breastfeeding at 3- (OPG 45.2%, IPG 35.7%, P=.12), 6- (OPG 31.6%, IPG 31.0%, P=.59), and 12-months (OPG 17.0%, IPG 14.9%, P=.68). Overall duration was longer in OPG (3.6±4.2 months vs 2.9±4.0 months IPG, B=0.45, P=.22), with more women in OPG stopping breastfeeding at ‘3 through 5 months’ (17.4% vs 9.6% IPG) rather than ‘0 to 7 days’ (9.6% vs 16.5% IPG). More women in OPG reported meeting their personal breastfeeding goal (41.7% vs 35.9% IPG; OR=1.27, P=.41).

Conclusion: The adapted ‘Baby Behavior’ curriculum may decrease early breastfeeding cessation and warrants further research. In the United States, lower breastfeeding rates among Black women have been attributed to larger spheres of influence, including shorter maternity leave, which will require policy-level intervention.

Purpose: Families facing economic hardship find themselves in a cycle of food insecurity and face challenges with child feeding. The ‘Eat, Learn, Grow’ program was developed with families using a collaborative design thinking approach and delivers short, interactive, and engaging content about infant and young child feeding to Australian parents, using an educational strategy called digital microlearning. This abstract presents findings from a pilot randomised controlled trial that evaluated the impact of the program on the use of responsive feeding practices among families experiencing economic hardship.
Methods: Parents of children aged 6-24 months who self-identified as experiencing economic hardship participated in a 6-week pilot RCT (N=150) during May-October 2023 (ACTRN 12623000513617). Feeding practices and household food security were assessed using validated questionnaires, at baseline prior to randomisation, and again in both groups at the end of the 6-week period. During this time the intervention group (n=75) received 12 microlessons sent to their mobile phone via SMS which covered topics such as recognising hunger and fullness cues, role modelling and the ‘division of responsibility’ in feeding. Learning strategies included reflection, knowledge testing, shared learning and peer modelling. Mann Whitney U tests were used to compare difference in factor scores from baseline to 6-week follow-up across intervention and control groups, for five feeding practices, use of food to calm, persuasive feeding, parent led feeding, family meal environment and reward for eating.
Results: At baseline, parents were a mean age of 33.3 years (sd=.40, 98% mothers) and 54% reported low or very low household food security. One hundred and thirty-two parents completed the trial per protocol (n=65 intervention, n=67 control). Intention to treat analysis indicated that parents in the intervention group had significantly greater reduction in use of food to calm z = [-2.05], p = [.040] and persuasive feeding z = [-2.05], p = [.040] compared with parents in the control group.
Conclusions: Collaborative design thinking has produced a brief digital intervention that can reduce non-responsive feeding practices in families experiencing economic hardship. Measures are being repeated at 6 months post intervention commencement to assess longer term effectiveness.

Parents and the home environment play a critical role in promoting movement behaviors (physical activity [PA], screen-time, and sleep) in preschoolers. However, parental stress and disruptions may negatively impact behaviors. Ecological momentary assessment (EMA) can help identify home-based contextual factors in real-time to inform promotion of appropriate amounts of behaviors.
Purpose: This study aimed to examine the relationship between home-based contextual factors on preschooler PA, screen-time, and sleep amongst those who met few 24-hour Movement Behavior Guidelines.
Methods: Parents (n=43) of preschoolers (ages 3-4 years, 51% female, 58% White) who met 0 or 1 of the 24-hour Movement Behavior Guidelines (PA: ≥180 minutes/day of Total PA, including ≥60 min/day of moderate-to-vigorous PA, sedentary screen-time: ≤1 hour/day, and sleep: 10-13 hours/day) participated in an EMA study. For at least 7-days, parents completed one morning survey, and four signal-contingent surveys during fixed 3-hour windows daily via a smartphone application. In the morning survey, parents reported screen-time 2-hours before bed, performed child bed-time ritual, overnight awakenings, and child sleep time from the previous night. During the signal-contingent surveys, parents reported their current stress, child alone status, child screen-time, and child PA intensity (sedentary, light, moderate, vigorous). Logit link and mixed effects models were used to examine the relationship between home-based contextual factors with child PA, screen-time, and overnight sleep. Models were adjusted for time of day and repeated subjects.
Results: Parents completed 1179 signal-contingent, and 613 morning surveys. Most preschoolers met one guideline (PA: 11%, screen-time: 9%, sleep: 48%), and some met 0 guidelines (30%). Bed-time rituals (78%) and screen-time before bed was common (65.7%), with some night awakenings reported (22%). Preschoolers were less likely to engage in sedentary behavior (-0.70±0.24, p<0.01) and screen-time (-0.80±0.19, p<0.01) when they were with others compared to being alone. Night awakenings were related to less sleep (-20.8±7.8 minutes, p<0.01), but not child bed-time rituals or screen-time before bed (p>0.05)
Conclusions: Alone status and overnight experiences were important for movement behaviors. Opportunities to promote PA while alone and prevent night awakenings may help support an adequate balance of movement behaviors in preschoolers who meet few guidelines.

Purpose: Climate-induced disasters have profound implications for public health, exacerbating existing diet-related inequities by disrupting supply chains and the means to access, prepare, and consume healthy foods. Preparedness and response plans are important to mitigate these consequences, yet research is sparse on the role of food in these plans. This study examined existing plans in five distinct US locations (states and territories) against the Disaster Food Security Framework (DFSF) to assess how existing policies address food-related issues, with a focus on hurricanes.
Methods: We employed purposeful sampling, selecting plans in locations that experienced the costliest hurricanes since 2017, namely: Texas, Florida, Puerto Rico, U.S. Virgin Islands, and Louisiana. We coded current preparedness plans utilizing a deductive, content analysis approach guided by the DFSF, structuring our examination around four domains: availability, accessibility, agency, and acceptability. Our analysis entailed a comparative assessment of the implementation of the US National Response Framework (NRF) and state/territory-mandated procedures, complemented by a document review encompassing gray literature and media sources to unravel insights into food security planning and post-hurricane aftermaths.
Results/findings: When compared against the DFSF, localities' disaster plans addressed availability and accessibility through safety net programs, complemented by localized NGO efforts facilitating donation assistance procedures in food availability. Other DFSF dimensions were less salient in plans, notably, considerations related to acceptability, encompassing nutritional aspects of emergency foods, and agency, involving infrastructure and self-efficacy. The analysis found noteworthy disparities between state and territory plans, where NGO roles, distribution challenges, and limited access to safety net programs are discernible and not well addressed across territories (Puerto Rico and US Virgin Islands).
Conclusions: Our analysis underscored the importance of structural elements within U.S. policy frameworks and the differences between state and territory plans as crucial factors influencing policy-level approaches to mitigate the effect of climate-induced disasters, with important repercussions to addressing transitory or episodic food security outcomes post-disaster.

Purpose: Cycling for transport promotes health and sustainable lifestyles. Conducting studies assessing the impact of top-down regulatory policy decisions (e.g., eliminating gasoline subsidies and creating low-emission zones) on active travel is challenging. System disruptions can provide a “glimpse” of the possible effects of regulatory policies and large-scale built environment changes on active travel. This study examined the immediate and sustained effects of two system disruptions on public bicycle-share program (EcoBici) in Mexico City.

Methods: This study used a natural experiment design to assess if the acute gasoline shortage in 2019 and the stay-at-home recommendations due to the COVID-19 pandemic affected the Ecobici ridership patterns between 2018 and 2021. An interrupted time series analysis was used to estimate the impact of these system shocks on the number of daily Ecobici trips and their mean duration.

Results: Daily ridership increased by 3,322 trips during the acute gasoline shortage, with a decreasing trend of 206 daily rides during this disruption period. Daily ridership increased by 51% on average after the gasoline crisis, with a post-system disruption slope suggesting a comparable decline in daily ridership as what was occurring prior to the start of the gasoline crisis. The COVID-19 stay-at-home recommendations initially reduced daily trips by 13,145. None of the system disruptions had significant effects over time. Changes in mean trip duration were also observed during the two system disruptions. The gasoline shortage period had an immediate effect, causing a drop in mean trip duration by 3.22 minutes, while during COVID-19, the mean trip duration decreased by 1.04 minutes after adopting stay-at-home recommendations; both system disruptions had marginal effects over time. Finally, differences were found across gender and type of day in both daily ridership and mean trip duration.

Conclusion: These two natural experiments provided important insights that can help inform regulatory policies and built environment modifications to promote active travel and disincentivize car dependency. The temporary increase in bicycle-share program utilization following the gasoline shortage supports the notion that policies to increase the cost of driving in cities may lead to reductions in driving and increases in active travel.

Purpose: Adolescents consume fewer fruits and vegetables (FVs) as they age. However, most school nutrition interventions target elementary-age students. Though school salad bars may be effective at improving adolescents’ FV consumption during lunch, few studies have examined this among middle schools and none in high schools. This cluster randomized controlled trial evaluated how implementing school salad bars impacts low-income adolescents’ FV consumption.

Methods: Middle and high schools (n=24) without existing salad bars were block-randomized to receive a salad bar (6 middle and 6 high schools, respectively) or wait-list control. Using photographic plate waste methods, aggregate grams of FV consumption from observations (n=3504, 76% from students receiving free/reduced-price lunch; 60% from Hispanic/Latino students), measured to the nearest 2 grams, were collected from students randomly selected to participate. Schools provided students’ grade, sex, race/ethnicity, and free/reduced priced lunch status. Zero-inflated negative binomial models examined salad bar effects on any vs. no intake and grams of aggregate FV intake, controlling for sociodemographics (grade, sex, race/ethnicity, free/reduced-priced lunch status) and school-level clustering.

Results/findings: Adjusted mean FV intake for the control condition at baseline was 75.9g and 61.1g at follow-up. In the Salad Bar condition, adjusted mean FV intake was 80.7g at baseline and 89.4g at follow-up. Among adolescents who consumed any FV, the control condition showed a significant decrease in FV consumption (IRR=0.81; 95% CI: 0.66, 0.99), and despite a non-significant increase (IRR=1.11; 95% CI: 0.91, 1.36) in the Salad Bar condition, change in FV consumption did differ significantly between conditions (IRR = 1.38; 95% CI: 1.03, 1.83). The predicted probability of any FV consumption showed almost no change in either condition (in the control condition, baseline and follow-up probabilities were 0.87 and 0.86, respectively; and 0.90 and 0.89, respectively in the Salad Bar condition).

Conclusions: Adolescents in schools with salad bars had a higher FV consumption relative to control schools. School salad bars may be an effective strategy in attenuating the decrease of FV consumption across the school year for middle and high school students in the US. More work is needed to promote greater FV consumption once FVs are on the tray.