Purpose. Determine preliminary effectiveness of the Ecological Approach To Prevention (EAT for Prevention) intervention that includes two components: 1) Provider training on Responsive Feeding Evidence-Based Practices (RF-EBPs) through seven interactive online modules and 2) a continuous multilevel (Extension coach, childcare provider, and child) feedback engagement process. Despite global recommendations for RF-EBPs in childcare settings, no published studies have determined their effectiveness specifically in Family Child Care Homes (FCCHs).

Methods. Seventeen FCCH settings in Nebraska were randomly assigned to either a intervention (n=8) or the attention control condition (n=9). FCCH providers self-reported the primary implementation outcome of feeding practices, including responsive (e.g., modeling) and controlling (e.g., pressure) behaviors. Research assistants utilized the Dietary Observation in Child Care protocol to assess the primary effectiveness outcome of child dietary intake during lunch time. Average dietary intake for whole grains, proteins, vegetables, fruits, and dairy was calculated for 48 children (Control= 24; Intervention= 24). Preliminary analyses were conducted with paired and independent sample t-tests were conducted to identify mean differences.

Results/Findings. Post-intervention, intervention providers reported significantly reduced use of controlling feeding practices compared to control providers (Cohen’s d = -1.5, CI = [-2.58, -.39], p = .007). Intervention providers also demonstrated significantly higher levels of role modeling (d = 1.3, CI = [.22, 2.33], p = .026) and lower pressure (d = 1.3, CI = [-2.33, -.22], p = .018) in their feeding practices. Conversely, control providers exhibited significantly higher pressure (d = 7.7, SE = 1.6, p <.001) and more non-supportive verbal comments (d = 16.7, SE = 4.4, p = .002) post-intervention. Intervention children showed significantly increased vegetable (d = .9, CI = [.31, 1.5], p = .003) and dairy (d = .3, CI = [.15, 1.3], p = .014) intake compared to control children. Moreover, intervention children experienced a significant increase in vegetable consumption (d = .7, CI = [.27, 1.17], p = .002) post-intervention, while control children's vegetable consumption remained unchanged from pre to post.

Conclusions. This study paves the way for a properly powered clustered RCT by demonstrating the promise of RF-EBPs in improving children’s dietary outcomes in FCCHs.

Background: In 2017, the Government of British Columbia (BC) released the Appetite to Play (ATP) capacity building initiative which aimed, among others, to influence Healthy Eating (HE) in licensed childcare settings, amid limited mandatory HE regulations. Significant improvements in HE policies were noted in 2019 following the implementation of ATP.
Purpose: This study investigated whether the improvements observed in HE policies after the implementation of ATP were sustained post-pandemic.
Methods: Self-report healthy living policy and practice surveys were conducted among managers and staff of licensed childcare centers in BC caring for children aged 2-5 at three different time points: pre-ATP (2016-17, N=910), post-ATP (2018-19, N=549), and post-pandemic (2022-23, N=1048). Hierarchical mixed-effect models were used to assess post-pandemic changes in 11 HE policies.
Results: Post-pandemic, the most prevalent HE policies addressed managing fruit juice intake (88%), educating children about HE (78%) and type of milk served/type of foods and beverages brought from home (74%). Compared to baseline (pre-ATP), post-pandemic self-reported HE written policy implementation was higher for 10 of the 11 policies examined (i.e., educating children, staff training, encouragement of new foods, providing family-style meals, offering water/milk only, managing fruit juice intake, staff modeling eating behaviors, promoting fruit/vegetable inclusion, limiting foods brought for celebrations and regulating foods brought from home). Compared to post-ATP, post-pandemic HE written policies further improved for 4 of the 11 policies (i.e., staff training, providing family-style meals, managing fruit juice intake and limiting food brought for celebrations). Only the HE policy related to type of milk served did not change at all over time.
Conclusion: HE related policy implementation in BC childcare centers was improved after the release of ATP and sustained or further improved even in the face of the pandemic. These sustained policy enhancements are promising steps in creating healthier environments for children. Further examination of the influencing factors and comparison with other policy implementation will help to illuminate critical drivers of implementation and sustainability.

Purpose: With family style meal service (FSMS) providers allow and encourage children to serve themselves. Research indicates that FSMS significantly influences children’s eating behavior and is nationally endorsed to promote healthy eating habits among children aged 2-5 years. Given that eating behavior plays a crucial role in determining plate waste, this study aims to investigate the association between FSMS and plate waste in childcare homes in Nebraska.

Methods: In this cross-sectional study, the participants included 46 providers from family childcare homes (FCCH) enrolled in the Child and Adult Care Food Program in Nebraska, along with 146 3-5-year-old children who were attending these FCCH settings. One lunch meal was video-recorded and later coded using the Mealtime Observation in Child Care (MOCC) tool. FSMS is one of the MOCC constructs and consists of 18 items (of which 7 were excluded since recordings were used rather than live observations). Some examples of the items retained include whether the provider used developmentally appropriate food units and allowed children to serve themselves. Scores on the 11 items were averaged to obtain an FSMS score. Children’s plate waste data over the observed lunchtime were collected using the Dietary Observation in Child Care (DOCC) method. We conducted a multivariate, multilevel regression in SAS (version 9.4) to assess the relationship between FSMS score and children’s plate waste for whole grains, vegetables, fruits, dairy, and protein, while controlling for children’s age, gender, body mass index, and ethnicity and accounting for FCCH setting-level effects (ICCs 11.3-31.2%).

Results: Median waste for vegetables was the highest (28.2%, IQR: 0-70.9%), followed by dairy (4.9%, IQR: 0-39.3%). Increase in FSMS score was associated with a decrease in vegetable waste (B= -5.0, p= 0.02), fruit waste (B= -3.9, p= 0.007), dairy waste (B= -3.8, p= 0.04), and protein waste (B= -4.4, p=0.003). Grain waste was not associated with FSMS (p>0.05).

Conclusions: A higher FSMS score was associated with a 3 to 5% reduction in plate waste for four food groups. Results from this study warrant further research studying the effect of interventions promoting FSMS in childcare on improving children’s dietary intake and reducing plate waste.

Purpose: Racial and ethnic minorities face health disparities and need targeted programs to prevent diet-related chronic health conditions. Thus, the current study evaluates and compares 2–6-year-old children’s diet quality from following households- first-generation immigrants, Hispanics, non-Hispanic Whites, non-Hispanic Blacks and non-Hispanic American Indians and Native Hawaiians.
Methods: Self-reported survey data from Nebraska households with at least one 2-6-year-old child (n=1277) was collected using Qualtrics. Participants were categorized into five distinct groups: first-generation immigrants (n=61), non-immigrant Hispanics (n=538), non-immigrant non-Hispanic Whites (n=509), non-immigrant non-Hispanic African American (n=120) and non-Hispanic American Indians and Native Hawaiians (n=49). Children’s diet quality score was measured using the short Healthy Eating Index (sHEI). Assuming equal variances checked with Levene’s test (p =.1), ANCOVA was conducted to compare children’s total sHEI score and 13 sHEI sub-component scores among these four groups, while controlling for their household income, education, geographical location and federal program participation using IBM SPSS v.27.0. Benjamini-Hochberg correction was used for running multiple tests.
Results: Participating children’s diet quality was sub-optimal with an overall score of 47.7 out of 100 (range from 0-100). Children from the immigrant group (44.3, SE= ± 1.3) have significantly lower mean sHEI score as compared to non-Hispanic White (47.3, SE= ± .55), non-Hispanic African American (50.4, SE= ± .92) and non-Hispanic American Indian (49.2, SE= ± 1.35) but not from Hispanic group (46.8, SE= ± .6), F (4,973) = 5.21, p <.001. Children from the Immigrant group had higher added sugar consumption than non-Hispanic White (p=0.017) and non-Hispanic American Indian and Native Hawaiian (p=0.012) groups. Children from non-Immigrant Hispanic group had lower scores for total fruit compared to Immigrant (p=0.001), non-Hispanic African American (p<0.001), and non-Hispanic American Indian and Native Hawaiian (p=0.018) groups. They also had lower whole fruit and dairy scores than Immigrant (p<0.001 and p=0.015, respectively) and non-Hispanic African American (p<0.001) groups.
Conclusion: Immigrant and Hispanic children having the lower diet quality scores emphasize the need for culturally supportive multi-level nutrition interventions in households and educational settings. Future research is suggested to explore the association of child diet quality with culturally appropriate healthy food access in families with diverse backgrounds

Authors: Emilie Holloway, MS, RDN; Kristoffer Berlin, PhD; Scott Crouter, FACSM, PhD; Leonard H. Epstein, PhD; J. Graham Thomas, PhD; Hollie Raynor, PhD, RDN

Corresponding author(s): Emilie Holloway, MS, RDN; Hollie Raynor, PhD, RDN

Presenting author: Emilie Holloway, MS, RDN

Purpose: Home food availability (HFA) and variety of foods consumed influences dietary intake. Few studies have assessed how variety of fruits and vegetables (FV) and high-energy-dense (HED) foods available in the home and variety of these foods consumed are related to FV and HED food intake in children.

Methods: This is a secondary data analysis on baseline data from the Families Becoming Healthy Together study, which implemented a childhood obesity intervention. Children (n=92) aged 8-12 years with overweight/obesity were included. Participants self-identified as 50.5% female, 74.2% White, with a mean body-mass-index percentile of 97.6+2.7. Number of different FV and HED foods available in the home was assessed using the Home Food Inventory (HFI). Variety of FV and HED foods consumed and intake of these foods was assessed using 3, 24-hour dietary recalls (24HR). Hierarchical multiple regression, controlling for demographic variables, examined if the total number of different FV or HED foods from the HFI or 24HR were related to daily servings and energy of FV or HED foods consumed.

Results: Home food availability was 20.9+6.8 different FV and 62.0+9.2 different HED foods. Over three days, children consumed 4.7+3.0 different FV and 15.0+4.3 different HED foods. Children consumed 2.5+1.5 servings/d and 148+120 kcal/d from FV, and 8.4+2.6 servings/d and 1,416+509 kcal/d from HED foods. Variety, or number of different FV consumed, was positively associated with servings (R2=0.49, R2 change=0.43, p<0.001) and energy (R2=0.12, R2 change=0.09, p=0.005) from FV. Similarly, the number of different HED consumed was positively associated with servings (R2=0.45, R2 change=0.43, p<0.001) and energy (R =0.46, R2 change=0.43, p<0.001) of HED foods. No significant associations between HFA of different FV or HED foods and servings or energy consumed were found (all p values >0.05).

Conclusions: Results, similar to research conducted with adults, suggest that variety of FV and HED foods consumed influences dietary intake in children. Future research should explore interventions that address increasing variety of FV and reducing variety of HED to influence dietary intake among children.

Purpose: Eating in the absence of hunger (EAH) is a behavior that has been observed in children as young as 3 years old and has been associated with higher obesity risk in prospective studies. Parental feeding practices during infancy and early childhood may influence children’s eating behaviors later in life; yet associations of early life feeding factors with EAH remain unclear.

Methods: We studied 1004 mother-child pairs from the US pre-birth cohort Project Viva to determine the extent to which parental feeding practices in early life were associated with EAH in early adolescence (mean age (SD): 13.2 (1.0) years old). The exposures were: 1) timing of complementary food introduction (dichotomized as <4 months vs. ≥4 months); 2) maternal use of pressure to eat and restrictive feeding practices at 3 years old (each dichotomized as yes vs. no); and 3) breastfeeding practices at 6 months, in 4 categories (Formula only (never breastfed); Weaned (from breastmilk to formula before 6 months); Mixed feeding (breastmilk + formula); and Breastmilk only (never introduced formula)). We used 2 questions from the Eating in the Absence of Hunger questionnaire for Children and Adolescents to derive the outcome EAH (range 2-10 points, a higher score indicates more EAH). We used multivariable linear regression models adjusted for child’s age at outcome, child’s sex, child’s race/ethnicity, maternal age, maternal education, marital status, maternal parity, median household income, pre-pregnancy body mass index and infant birthweight for gestational age z-score.

Results: Mean (SD) EAH score was 4.4 (1.4) points and 50% were girls. Compared to those who received breastmilk only at 6 months, adolescents who received formula only or mixed feeding at 6 months had higher EAH scores (0.34 points; 95%CI [0.01–0.67] and 0.26 points; 95%CI [0.02–0.50], respectively). No associations were found for timing of complementary feeding, maternal use of pressure to eat and restrictive feeding practices.

Conclusions: These results suggest that breastfeeding practices may have a modest association with EAH in early adolescence.

Purpose: Cross-age mentoring (i.e., mentoring from an older peer) is gaining popularity as a strategy to promote youth health. While outcomes typically focus on youth mentee health, cross-age mentoring programs may also benefit older peer mentors. We developed an adolescent afterschool program, “DiscoverU,” that uses cross-age mentoring to promote social-emotional learning, nutrition, and physical activity. This study aims to 1.) evaluate the feasibility of the DiscoverU mentoring component and 2.) explore initial quantitative and qualitative outcomes for mentors.

Methods: In the Fall of 2022, we recruited and trained mentors (N=14, primarily college students, 21.7±2.43 years, 57% female, 43% White). DiscoverU was implemented twice: September-December 2022 and January-March 2023. We recorded mentor attendance and measured self-reported quantitative outcomes in September, December, and March, which we analyzed using Friedman’s ANOVA. Outcomes included youth and mentoring skills, civic attitudes and actions, mindful eating, and days with an hour of moderate-vigorous physical activity. Following each program implementation, we conducted focus groups with mentors, mentees, and afterschool staff. We analyzed qualitative data using thematic analysis. Consistent with convergent parallel mixed methods study design, we analyzed qualitative and quantitative data separately and integrated findings through discussion.

Results: Mentoring was acceptable (e.g., 73-100% of mentors were satisfied/very satisfied). Mentors reported enjoying activities, developing relationships, and viewed mentoring as beneficial for professional development. A supportive supervisor, extensive training, and mentor enjoyment were factors related to the high retention across the two program implementations (79% retention; 93% average attendance). Mentors improved skills working with youth (p<.001) and mentoring (p=.001). We observed increases in awareness-based metrics over time, but no changes in behavioral measures (e.g., increase in civic attitudes (p=.02), but no change in civic actions (p=.92); increase in Awareness of Eating Triggers and Motives (p=.03), but no change Eating in Response to Awareness of Fullness (p=.85); and qualitative reports of increased motivation to be active, but no change in the number of days reported being physically active (p=.13).

Conclusions: DiscoverU’s mentoring component was feasible, highly acceptable, and raised mentor self-awareness of health behaviors. However, additional research is needed on program augmentations to incite health behavior change among mentors themselves.

Purpose: Little is known about the prevalence of the metabolic syndrome (MetS) during emerging adulthood (18-23y). This is important because health status at this stage affects later life outcomes. Diet quality is a key contributor to metabolic risk factors, and the diet quality of emerging adults is less optimal when compared to other adults. The objective of this study is to explore the prevalence of metabolic risk factors and examine the association between diet quality and risk factors among emerging adults.

Methods: We use NHANES 2015-2018 data (N=502) to explore the prevalence of MetS in emerging adults aged 18-23y. We estimate the prevalence of five risk factors that comprise MetS: abdominal obesity, high blood pressure, elevated plasma glucose, high triglycerides, and low levels of HDL cholesterol. We operationalize MetS according to the National Cholesterol Education Program-Adult Treatment Panel III criteria. We use the Healthy Eating Index (HEI) 2020 to measure diet quality (range: 0-100, with higher numbers indicating better diet quality). We use unadjusted logistic regression to estimate the association between the HEI 2020 and metabolic risk factors.

Results: The mean age of our sample was 20.7y (standard error [SE]: 0.1). The majority were non-Hispanic White (55.1% [SE: 4.7]) and had a high school degree (37.8% [SE:3.8]) or some college (37.8% [SE: 3.5]). Among emerging adults, 33.8% (SE: 2.1) had abdominal obesity, 29.4% (SE: 2.7) had elevated fasting plasma glucose, and 26.9% (SE: 2.6) had low HDL cholesterol. Even in this young sample, 10.3% (SE: 2.2) met criteria for MetS. The mean HEI 2020 was 46.9 (SE: 0.9). A higher HEI 2020 was significantly associated with reduced odds of having elevated fasting plasma glucose (p<0.05) and marginally lower odds of having abdominal obesity (p=0.052).

Conclusions: Emerging adulthood is characterized by the formation of enduring health behavior patterns and presents heightened risks for excessive weight gain, diminished physical activity, and a decline in diet quality – all of which can contribute to increased risk for cardiometabolic disease. Our study findings indicate that MetS risk factors occur even at young ages, warranting increased public health attention in the emerging adult age group.