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Objective: Brighter Bites is a school-based health promotion program that delivers fresh produce and nutrition education to low-income children and families. Due to COVID-19-related school closures, states were under "shelter in place" orders, and Brighter Bites administered a rapid assessment survey to identify social needs among their families. The purpose of this study is to demonstrate the methodology used to identify those with greatest social needs during this time ("high risk"), and to describe the response of Brighter Bites to these "high risk" families., Methods: The rapid assessment survey was collected in April 2020 across Houston, Dallas, Washington DC, and Southwest Florida. The survey consisted of items on disruption of employment status, financial hardship, food insecurity, perceived health status and sociodemographics. The open-ended question "Please share your greatest concern at this time, or any other thoughts you would like to share with us." was asked at the end of each survey to triage "high risk" families. Responses were then used to articulate a response to meet the needs of these high risk families., Results: A total of 1048 families completed the COVID-19 rapid response survey, of which 71 families were triaged and classified as "high risk" (6.8% of survey respondents). During this time, 100% of the "high risk" participants reported being food insecure, 85% were concerned about their financial stability, 82% concerned about the availability of food, and 65% concerned about the affordability of food. A qualitative analysis of the high-risk group revealed four major themes: fear of contracting COVID19, disruption of employment status, financial hardship, and exacerbated food insecurity. In response, Brighter Bites pivoted, created, and deployed a framework to immediately address a variety of social needs among those in the "high risk" category. Administering a rapid response survey to identify the immediate needs of their families can help social service providers tailor their services to meet the needs of the most vulnerable., Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: Dr. Sharma is on the Board of Directors of Brighter Bites nonprofit organization, the goal of which is to improve access to fresh fruits and vegetables and nutrition education among underserved communities. This is an unpaid, advisory board position. The other authors have no conflicts of interest relevant to this article to disclose. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Background: Through the Texas Childhood Obesity Research Demonstration study, we implemented and evaluated a system-oriented model of primary and secondary prevention approaches to mitigate obesity among low-income Texas children aged 2 to 12 years. Primary prevention included implementing the Coordinated Approach To Child Health Early Childhood (CATCH EC) program in Head Start preschools. In this paper, we describe the methods and results of CATCH EC program process evaluation over 2 years of implementation., Methods: We used a quasi-experimental design with serial cross-sectional data collected from Head Start centers across intervention and comparison catchment areas in Houston and Austin, Texas (intervention: N = 12 centers in 2012-2013 [Year 1], N = 12 in 2013-2014 [Year 2]; comparison: N = 13 centers in Year 1, N = 12 in Year 2). Process evaluation included center director and teacher surveys conducted in both years of implementation. We developed indices for implementation of CATCH EC and non-CATCH health events at the centers., Results: Implementation scores were higher among intervention centers as compared to comparison centers across both years of implementation, and these differences were statistically significant (p < .01). There was also high variability in program implementation in intervention centers across both years ranging from 55% to 95%., Conclusion: These implementation index strategies may inform future evaluation of preschool-based obesity prevention program implementation., (© 2019, American School Health Association.)

Background: This study presents the impact of a 2-year implementation of Coordinated Approach to Child Health Early Childhood (CATCH EC), a preschool-based healthy nutrition and physical activity program, on child BMI z-scores, BMI percentiles, diet, physical activity, and sedentary behaviors among 3- to 5-year old children across Head Start centers in Houston and Austin, Texas., Methods: We used a quasi-experimental study design with serial cross-sectional data collection (Intervention catchment area: n = 12 centers, 353 parent-child dyads in Year 1; n = 12 centers, 365 parent-child dyads; Comparison catchment area: n = 13 centers in year 1, 319 parent child dyads; and n = 12 centers, 483 parent-child dyads in year 2). Child height and weight were measured and parent self-report surveys were conducted at year 1 (fall 2012) and year 2 (spring 2014)., Results: In year 1, 34.8% of the children were overweight or obese, 74% were Hispanic, and >80% reported an annual household income of <$25,000. In year 2, 32.2% were overweight or obese, 72% were Hispanic, and 82.3% reported an annual income of <$25,000. Results demonstrated significantly lower child BMI z-scores [β = -0.26 (95% confidence interval, CI: -0.50 to -0.01), p = 0.041] and BMI percentiles [β = -6.5 (95% CI: -12.4 to -0.69), p = 0.028] from year 1 to 2 follow-up among those in intervention Head Start centers, compared to those in the comparison centers. There were no significant between-group changes in child dietary, physical activity, or screen time behaviors., Conclusion: Implementation of a preschool-based obesity prevention program can be modestly effective in lowering the prevalence of child overweight in low-income populations.

Purpose: To explore whether the physical activity (PA) component of the Coordinated Approach to Child Health Early Childhood (CATCH EC) program helps increasing preschoolers' PA during active times at preschool., Design: Nonrandomized controlled experimental study., Setting: Head Start centers in Houston, Texas, 2009 to 2010 school year., Participants: A total of 439 preschoolers aged 3 to 5 years (3 intervention centers, n = 220; 3 comparison centers, n = 219)., Intervention: The CATCH EC preschool-based teacher-led nutrition and PA program., Measures: Preschoolers' PA was measured at baseline and postintervention using the System for Observing Fitness Instruction Time-Preschool version, a direct observation method measuring PA at the classroom level. Parent surveys provided demographic data., Analysis: Pre-to-post changes in preschoolers' PA were examined using the Mann-Whitney U test., Results: Results show a significant decrease in the percentage time preschoolers spent in level 2 PA (low activity) at intervention ( P = .005) and comparison ( P = .041) centers. Indoor vigorous activity increased significantly on an average by +6.04% pre-to-post intervention among preschoolers in the intervention group ( P = .049); no significant change was found in the comparison group., Conclusion: The CATCH EC favorably increased indoor vigorous PA level among low-income children attending Head Start.

Intake of fruits and vegetables (F&V) continues to be low in children in the United States. The purpose of this study was to conduct a pilot feasibility evaluation of Brighter Bites, a school-based food co-op to provide access to fresh F&V and nutrition education to low-income children and their families. Brighter Bites is a 16-week school-based food co-op consisting of: (1) Weekly distribution of 50-60 servings of fresh F&V; (2) Weekly bilingual parent handouts and recipe demonstrations; and (3) implementing CATCH, a coordinated school health program in schools. Brighter Bites was pilot tested using a pre-post evaluation design in one charter school in Houston, TX, USA (n = 57 3rd grade parent-child dyads; 94.1 % Hispanic, 91 % low-income). Evaluation, at baseline, midpoint, and post-intervention, included self-reported child and parent surveys on psychosocial factors, dietary habits and mealtime practices. Pearson's Chi square test, Fisher's exact-test or paired t test were used to determine changes pre- to post-intervention (at p < 0.05). Process data using parent surveys, teacher surveys, attendance logs, and produce cost data were used to determine feasibility and acceptability of program. Participants received on average 61 servings of F&V weekly for 16 weeks at the cost of $4.31/family/week. Results showed significant increases in child reported self-efficacy, outcome expectations and attitudes towards consuming F&V (p < 0.05). We found significant increases in child exposure to F&V and child preference of various F&V from baseline to post-intervention (p < 0.05). Parent surveys showed significant improvements in mealtime practices at home: decrease in children eating while watching TV, increase in eating dinner with the family, less fast food, less sugary drinks with meals, more children asking for F&V as snacks. Process data showed 98 % retention rate and high parent acceptability of program components. Brighter Bites is a promising strategy to increase F&V access and education in low-income populations using existing infrastructure of schools and food banks.

Purpose: To evaluate the ethnic differences in the home physical activity and screen time environment of preschoolers enrolled in Head Start., Design: Cross-sectional., Setting: Sixteen Harris County Department of Education (HCDE) Head Start centers, Texas., Subjects: Seven hundred and six preschoolers enrolled in HCDE Head Start centers and their parents. MEASURES. Items from the parent-reported Healthy Home Survey evaluating the home physical activity environment and the Nutrition Screening form evaluating screen time., Analysis: Mixed model linear and logistic regression analysis., Results: Of the parents, 75.06% were overweight or obese. Hispanic parents were more likely to have a yard or open space (p = .014) and usable play equipment in the yard (p = .019) for their children to play in compared to African-Americans. Conversely, more African-American parents reported having a television (TV) in their preschooler's bedroom (p = .032) and were less likely to cut down their child's TV viewing time (p = .036). African-American preschoolers were reportedly more likely to eat while watching TV (p = .009), play video games for ≥ 2 hours on weekdays (p = .018) and have computer time for ≥ 2 hours on weekends (p = .007), compared to Hispanics., Conclusion: The Hispanic participants of this study had a healthier home environment for physical activity and screen time as compared with their African-American counterparts. Future interventions targeting lifestyle change need to address these factors in an ethnic-specific manner.

The family and home environment are important in shaping the dietary patterns of children, yet research among low-income, minority groups is limited. We examined ethnic differences in the home food environment and parental practices among 706 low-income, African-American and Hispanic families of preschoolers. Questionnaires measured the access and availability of various foods in the home, parental practices, and meal consumption behaviors. Mixed model logistic regression and ANCOVA were used to assess ethnic differences. Unhealthy foods were available for both groups. Hispanic families were more likely to have fresh vegetables (AOR = 2.9, P ≤ 0.001), fruit (AOR = 2.0, P = 0.004), and soda available (AOR = 1.40, P = 0.001) compared to African-Americans. African-Americans families were more likely to restrict (AOR = 0.63, P ≤ 0.001) and reward with dessert (AOR = 0.69, P ≤ 0.001). Hispanic families consumed more family meals together (P = 0.003) and less meals in front of the television (P ≤ 0.006). Health promotion interventions should consider the behavioral differences between ethnicities.