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School meals provide nourishment to a large portion of US schoolchildren. Research has examined the relationship between the consumption of school meals and the quality of schoolchildren's diets, with little emphasis on studying spillovers at the household level. Using National Food Acquisition and Purchase Survey data and unconditional quantile regression, we study the relationship between a household's quality of food‐at‐home acquisitions and the number of school meals acquired, subsampling households by their Supplemental Nutrition Assistance Program participation status. We do not find strong evidence supporting beneficial spillovers of school meals on a household's quality of food‐at‐home acquisitions. JEL CLASSIFICATION C31; D12; I14; Q18

Interest in farm to early care and education (ECE) programming, which consists of gardening, nutrition education, and local food procurement, has been growing in the United States, as it may be a promising technique for promoting healthful foods to young children. However, there is limited information about current farm to ECE efforts in specific states, including Colorado, to support funding and resource needs. An online survey was distributed to licensed Colorado ECE providers in two phases to understand current participation in the farm to ECE as well as provider perspectives on benefits and barriers to programming. A total of 250 surveys were completed. Approximately 60% of ECE facilities participated in gardening and nutrition education with providers almost unanimously agreeing on the child-centric benefits of programming. Fewer facilities (37%) participated in local food procurement likely due to significant time, cost, and knowledge barriers. To increase participation in farm to ECE as a technique for promoting healthful foods to young children, future efforts should focus on innovative solutions to reduce ECE-specific barriers.

Objective Explore using food photography to assess packed lunches in a university-based Early Childhood Center and contextualize these photographs through parent interviews. Methods An explanatory sequential design was used. Packed lunches were photographed to assess the type and quantity of foods offered and consumed by Child and Adult Food Care Program components (fruit, vegetable, grain, and protein) and quality of foods offered using the Healthy Meal Index. Parent interviews aimed to understand motivations and behaviors related to packing lunch. Results Data were collected on 401 lunches. Only 16.2% of lunches met all Child and Adult Food Care Program requirements. Most lunches included fruit (84%) and grains (82%), whereas fewer included vegetables (44%). Portion sizes were large, especially for grains (2.7 ± 1.5 servings). In interviews (n = 24), parents expressed tension between offering healthful items and foods they knew their child would eat, as well as concern about children going hungry. Conclusions and Implications Food photography is a feasible methodology to capture parent-packed lunches for preschoolers and may have utility in nutrition education, particularly related to age-appropriate portion sizes.

Eating-related routines, such as regular mealtimes, can protect against obesity. Little is known about eating-related routines among preschoolers or the factors that shape those routines. Ecocultural Theory and qualitative interviews with 30 caregivers of preschoolers in Colorado were used to describe eating-related routines at home and parents' perspectives on the factors that shape routines. Qualitative content analysis was used to analyze and interpret data. Consistent with clinical recommendations, parents' goals included dinner meals where adults and preschoolers eat the same food, in the same place, at the same time. However, parents' employment schedules and challenges in managing preschoolers' behavior prevented parents from consistently enacting recommended routines. Educating parents alone may not be sufficient to ensure optimal eating-related routines among preschoolers, and the household context needs to be considered. Families organized routines according to cultural values and available resources.

Objective To describe the mixed-methods formative research phase in the development of the Healthy Environments Study (HEROs), a technology-based, interactive family intervention to promote healthy eating and activity behaviors for young children in the home environment. Design A mixed-method iterative approach, using ecocultural theory as a framework, will guide the development of both quantitative and qualitative formative research assessments. Setting Rural eastern Colorado. Participants Low-income families (n = 200) with preschool-aged children enrolled at 6 Head Start/preschool centers. Main Outcome Measures Quantitative and qualitative methodologies will garner insights into 4 key topic areas: (1) food behaviors and environments (Remote Food Photography Method, parent focus group, and survey), (2) physical activity behaviors and environments (parent interview and survey), (3) mobile device use (parent survey and interview), and (4) daily life (ecocultural family interview and teacher/staff group discussions). Analysis Results will be interpreted in combination to allow for a holistic understanding of participant behaviors, beliefs, attitudes and values related to each of the 4 topic areas. Collectively, outcomes will provide a comprehensive picture of preschoolers' daily life and inform intervention design and strategies to enhance preschoolers' eating and activity behaviors in the home environment.

Background: Establishing physical activity (PA) and motor behaviors in early childhood are important for developing healthy activity behaviors. Parents play a central role in shaping young children’s PA and fundamental motor skills (FMS). This qualitative study explored parents’ attributes, values, perceptions, and practices related to PA and FMS. Methods: Thirty-one parents (26 mothers) of preschool-aged children participated in semi-structured in-person interviews. Interviews were audio-recorded, transcribed verbatim, coded and analyzed using an iterative approach. Results: Four themes related to PA and FMS emerged: (1) parent attributes, (2) parent–child interactions, (3) parent perception of children’s attributes, and (4) parenting practices. Although most parents enjoyed playing with their child, some did not realize the importance of engaging in PA with their child and even believed that FMS are naturally developed. Parents indicated that children’s temperament may influence their preference for practicing motor skills. Conclusions: Social support and positive parenting practices, including encouragement, monitoring, logistical support, co-participation, and facilitation, are important for the development of PA and FMS. The findings add emphasis to the importance of parents’ role in the development of young children’s PA and FMS, and they inform future strategies aiming to promote young children’s activity behaviors.

Background Farm to school programs have been shown to have positive impacts on child outcomes. As such, interest and initiatives in farm to ECE programs have become common. Information on ECE providers’ perceptions on farm to ECE programming and current farm to ECE activities is limited. Objectives To describe perceived benefits, barriers, and participation of farm to ECE programming (gardening, nutrition education, and local food procurement) by ECE providers in Colorado. Study Design, Setting, Participants A descriptive cross-sectional design targeting ECE providers statewide was employed in 2 phases using an electronic survey that was distributed through snowball sampling: Phase 1 (46 questions) and Phase 2 (48 questions). Questions were adapted from the National Farm to School Network 2018 Farm to ECE Survey, or developed to capture specific Colorado initiatives. Measurable Outcome/Analysis Descriptive statistics were performed using IBM SPSS Statistics (version 25). Results A total of 250 complete surveys were used for analysis. Child-centered benefits were most important to respondents, and included helping children develop healthy eating habits (99%), children connecting with nature via gardening (98%), and opportunities for children to try more fruits/vegetables (98%). The greatest challenges of farm to ECE programming were limited resources, including the cost of procuring local foods (80%), and expenses and staff time associated with gardening (68%). More than half of respondents reported that the ECE facility had a garden (59%) and provided some form of nutrition education (57%). Only one-third of respondents (37%) indicated that their program procured food from local sources. Conclusions Findings highlight that a majority of farm to ECE activities revolve around gardening and nutrition education, with less participation in local food procurement. Future efforts to understand successes and address barriers associated with local food procurement efforts is warranted to enhance participation in all farm to ECE programming components.

OBJECTIVES: To examine the quality of meals offered to children ages 3–5 years in parent packed lunches at a university-based early childhood center. METHODS: Using a protocol based on the Remote Food Photography Method, trained research staff used iPads to take before and after photos of preschoolers’ packed lunches over 1 week. Meal quality was assessed using the Healthy Meal Index (HMI) and Child and Adult Food Care Program (CACFP) standards. Photos were independently coded by 2 researchers for key meal details, including availability and type of fruits, vegetables, grains, proteins and dairy, which fed into established scoring criteria to generate a HMI adequacy score. The mean HMI adequacy score for all lunches and percentages of lunches containing each adequacy food group were calculated to assess total meal quality. Photos were also reviewed using CACFP standards for availability, type, and amount of foods offered. Researchers coded photos (k = .86) for the inclusion of 4 food groups (fruits, vegetables, grains, and protein; milk was not served), and serving sizes were visually estimated and compared with recommended CACFP serving sizes: 1.5 oz of protein and 0.25 c each of fruits, vegetables, and grains. Mean standardized servings offered to children were calculated from these standards. RESULTS: Lunches (n = 301) from 79 children were photographed (2-5 days/child). The mean HMI adequacy score was [Formula: see text] = 37.7 11.0 (out of 65), with a range of 15.0 to 65.0. For all meals, 89% contained a grain, 86% contained fruit, 75% contained dairy (non-milk), 60% contained protein, and 48% contained a vegetable. Compared to CACFP standards, lunches had an average of 2.77 0.78 food groups present out of 4. Standardized servings offered for grains ([Formula: see text] = 2.60 ± 1.49), fruits ([Formula: see text] = 1.89 ± 1.09), protein ([Formula: see text] = 1.42 ± .68), and vegetables ([Formula: see text] = 1.35 ± .74) were high when calculated based on recommended CACFP serving sizes. CONCLUSIONS: In this study, parent packed lunches fell short of meeting CACFP guidelines by offering less than 3 of the recommended 4 food groups, with a large percentage of lunches containing grains, fruits, and dairy. Children were provided with larger amounts than recommended for all food groups, particularly for grains. FUNDING SOURCES: Colorado State University Health Behaviors Lab.

The home food environment (HFE) is an important factor in the development of food preferences and habits in young children, and the availability of foods within the home reflects dietary intake in both adults and children. Therefore, it is important to consider the holistic quality of the HFE. The purpose of this study was to apply the Healthy Eating Index (HEI, a measure of diet quality in conformance to the Dietary Guidelines for Americans) algorithm to the Home-IDEA2, a valid and reliable food inventory checklist, to develop a Home-IDEA2 HEI Score. After an initial score was developed, it was psychometrically tested for content, criterion, and construct validity. Content validity testing resulted in 104 foods being retained. Internal criterion testing demonstrated that 42 foods (40%) changed component scores by &gt, 5%, however, no single food changed a total Home-IDEA2 HEI score by &gt, 5%. Testing of hypothetical HFEs resulted in a range of scores in the expected directions, establishing sensitivity to varied HFEs. This study resulted in a validated methodology to assess the overall quality of the HFE, thus contributing a novel approach for examining home food environments. Future research can test interventions modifying the HFE quality to improve individual dietary intake.

Objective To assess the impact of an experiential nutrition education program, The SPORKS for Kids program, on preschoolers’ willingness to try a novel vegetable. Use of Theory or Research Intervention approaches which integrate repeated taste exposure, sensory learning, and nutrition education to provide repeated exposures to novel foods in fun, positive environments (positive valence) have been successful at increasing willingness to try new foods. These approaches were coupled with Social Cognitive Theory constructs to develop The SPORKS activities. Target Audience Preschool-aged children from 2 rural Colorado communities. Program Description The 6-week program was conducted in evenings as a complementary component to parent workshops. Children attended weekly 90-minute sessions focused on taste exposure and sensory learning via nutrition-related activities and imaginary trips/musical journeys. The SPORKS family consists of Sally Spoon (mom), Frankie Fork (dad); Buddy and Bubbles (preschoolers) and Junior and Freckles (older siblings). The SPORKS characters were embedded into activities and materials to facilitate experiential learning and build children's familiarity with the target vegetable (cauliflower). At tasting activities, 3 pieces of cauliflower were provided to each child and children were encouraged to try the food in a group setting. Evaluation Methods Observers recorded whether each child tried the cauliflower provided during the sessions. Results Sixteen children participated in the program across 2 sites. During week 1, 50% of children tried cauliflower and tries steadily increased (58%, 80%, 73%, 85%, weeks 2-5, respectively), and by week 6 this number rose to 100%. Once children tried cauliflower, they continued to try it across subsequent weeks (100%). Half of the children requested ‘seconds’ beginning in week 3. Conclusions While half of the children tried the food at the start of The SPORKS program, repeated exposure with positive valence resulted in the remaining children's willingness to try a target vegetable.

Background Maternal self-care, or behaviors facilitating healthy eating, physical activity (PA), and stress management practices, may play an important role in child weight status. Few childhood obesity interventions, however, consider maternal self-care and health practices. Objective To understand existing beliefs, practices, and supports or barriers related to self-care in mothers of preschoolers in rural communities via in-depth interviews, and develop and refine a theory-based self-care intervention using Intervention Mapping (IM). Study Design, Setting, Participants A semi-structured interview guide was developed using Social Cognitive Theory constructs and pilot tested to establish content and face validity. Telephone interviews with mothers (n = 19) recruited from preschool centers in rural Colorado were conducted by a trained researcher. Measurable Outcome/Analysis Interviews were recorded, transcribed verbatim, coded, and analyzed using an iterative approach. IM steps were then followed: formulation of change objectives, material creation, and implementation/evaluation plan development. Results Three interview themes emerged: self-care practices; facilitators and barriers; and resources. Mothers had varying definitions of self-care and contexts in which self-care strategies were used. The majority of participants described self-care practices as important for helping them be a better mom, but reported infrequent practices of self-care. Barriers such as time, access to healthy food options or facilities for PA, and exhaustion made incorporation difficult in daily life. This input guided IM for the development of a self-care program which includes 2 workshops, 4 remote health coaching sessions, and a companion website. Topics addressed include what defines self-care, how to incorporate self-care behaviors into a busy life, and how self-care can benefit families. Conclusions Understanding mothers’ existing self-care practices and beliefs provided insights to inform and guide the development and refinement of a self-care intervention using IM. A maternal self-care intervention offers a unique approach to childhood obesity prevention efforts.

Objective To explore the feasibility of using an image-based food photography methodology (Remote Food Photography Method) in a rural, low-resource audience and use the photos to examine the context of family dinner. Design Parents used the SmartIntake app on study-issued tablets to take before and after photos of their and their child's dinner for about 7 nights and participated in a mini-focus group to discuss their experience with the Remote Food Photography Method. Setting Six Head Start/preschool centers in rural Colorado. Participants Mother–child dyads (n = 31). Variables Measured Number and quality of photos received, participant feedback, meal timing, concordance, location, preparation, and quality. Analysis The researchers assessed feasibility via practicality (percent photos received) and acceptability (general inductive approach used to analyze mini-focus group transcripts for participant feedback); time stamps, meal quality, and food preparation scales were used to analyze dinner photos. Results The majority of photographs (738 of 864) were received. Participants reacted favorably to the methodology; for some, it led to greater self-reflection about mealtime. Mother–child dyads usually ate dinner at the same time and often ate the same food. Children were frequently served protein and refined grains and were rarely served whole grains or fruit. Many families relied on convenience foods. Conclusions and Implications Digital food photography was feasible in this audience. Photos yielded a holistic picture of family dinnertime: meal timing, location, concordance in parent–child meals, level of preparation, and meal quality.

Objective The objective of the HEROs Study (HEalthy EnviROnments Study) is to develop a technology-based, interactive family intervention to promote healthy lifestyles and weight outcomes for young children in the family setting. Description The project aims to improve family routines and parent-child eating and physical activity (PA) interactions. Research activities will be conducted through four key objectives: Formative Research; Intervention Design; Intervention Testing; and Education. Evaluation Year 4 focused on intervention development. Focus groups were conducted with parents (n = 3) and Head Start/preschool teachers and staff (n = 3) to assist in strategy refinement. Core content was developed for parent workshops, child lessons, and web content using Social Cognitive Theory constructs. Prototypes of nutrition and physical activity mobile applications continued to be developed and tested. Creative concepts were developed and pretested with children, parents, and teachers/staff. Testing will occur to determine outcomes for intervention components, including the core set of parent workshops (behavioral mediators), mobile apps (parent child interaction), self-care module (parent behaviors), and home food environment assessment tool (availability and quality). Conclusion and Implications The HEROs intervention will be studied to understand which of the key intervention components resonates with and drives participants towards behavior change. It is anticipated that this intervention will lead to improved parent-child interactions specific to engaging children to try new foods and enhancing fundamental movement skills, foundational behaviors to developing a quality diet and positive physical activity behaviors in early childhood. Funding 2015-68001-23240.

Objective To describe child use and parents' beliefs and comfort with young children's use of mobile devices in low-income, rural communities. Methods This was a descriptive, cross-sectional study. The survey, which consisted of 18 multiple-part questions, was distributed to families at 5 Head Start/preschool centers in Colorado. Results In total, 192 surveys were returned (28.5% response rate). Most children (92%) used a smartphone or tablet at some frequency and most parents (90%) had downloaded apps specifically for their child. Education and ethnicity were related to parents' technology beliefs. Parent comfort with technology was positively associated with greater child use of technology (P Conclusions and Implications Mobile device use was relatively high in this sample. Mobile devices appear to be a feasible platform to offer nutrition and physical activity education for this audience. Ensuring parent comfort with technology and apps will be important.