Obesity prevention should begin in early childhood, when children are learning nutrition and physical activity behaviors. Early childhood education (ECE) teachers’ ability to encourage children’s healthy eating and activity is related to their knowledge and self-efficacy. This study evaluated the effects of the Healthy Child Care Georgia intervention on teachers’ nutrition-related knowledge and self-efficacy. After in-depth training, teachers incorporated 30 hands-on activities into their curriculum and made improvements to classroom policies for six weeks. Teacher knowledge and self-efficacy were measured with the Confidence about Nutrition and Activity (CAN-Teach) survey before, immediately after, and 4 weeks after the intervention. Teachers in the immediate-intervention group implemented activities immediately after training. Teachers in the control/delayed-intervention group served as controls for the immediate-intervention group, and completed a second CAN-Teach assessment after the immediate intervention. Teacher knowledge and self-efficacy in the improved between baseline and the end of the intervention for both groups. These improvements persisted at the 4-week follow-up. Teachers in the control/delayed-intervention group did not show improvements in self-efficacy during the control period (between baseline and the end of the immediate intervention), but did show improvements between baseline and the end of implementing the delayed intervention. The HCCG intervention shows evidence of improving teachers’ knowledge and self-efficacy related to early obesity prevention. In-depth teacher training and one-on-one nutrition coaching are effective strategies to increase teacher knowledge and self-efficacy related to nutrition and physical activity.

Poor nutrition is the leading cause of chronic illness, which 6 of every 10 adults in the United States face. Caring for these conditions necessitates ongoing, expensive medical care, with 85% to 90% of healthcare costs attributable to chronic diseases. Recognizing this nutrition crisis, the Biden-Harris Administration hosted a historic White House Conference on Hunger, Nutrition, and Health that took place in September 2022. This conference was the first of its kind in more than 50 years and developed an agenda around a bold goal to end hunger and increase healthy eating and physical activity by 2030. The day before the 2022 conference, the Biden-Harris Administration released a National Strategy with actions the federal government would take across 5 pillars in addition to a fact sheet detailing more than $8 billion in new commitments from nongovernmental entities. Across the 5 pillars, this article summarizes the US Department of Agriculture accomplishments during the first 2 years of implementation and concludes with ways nutrition professionals can help accelerate progress.

Introduction: Sugar-sweetened beverages (SSBs) are a major contributor to obesity among young children 0 to 5 years of age. In addition, parental beverage intake influences children's beverage intake. Objective: This study explores Black parents' perceptions about and barriers to limiting SSBs among young children. Methods: Twenty-seven Black parents participated in six focus groups conducted across the state of Georgia. Questions grounded in Social Cognitive Theory (SCT) assessed perceived health impacts of SSBs and water consumption, influences of beverage choices, barriers to limiting SSB intake, and resources needed to overcome barriers. Before the focus group sessions, participants completed a demographic survey. Quantitative data were analyzed using R statistical software. Focus group sessions were analyzed using NVivo. Results: Family and cultural norms, price, taste, flavor, water safety, tantrums, and product placement at grocery stores primarily influenced beverage choice and consumption. Restaurant refills, price, lack of confidence, advertisements, cravings, tantrums, and budget were perceived barriers to drinking more water and fewer SSBs daily. Resources Black parents noted would help in promoting and serving healthy beverages to their young children included education on beverage recommendations, training on how to read nutrition labels, healthy alternatives, and the presence of support systems. Conclusion: Findings from this study will inform interventions to reduce SSB intake among Black families with young children.

Background Black children and families are the highest consumers of sweetened drinks and among the most impacted by their adverse health consequences. Instagram is becoming more popular for research, but strategies for using the platform and interpreting analytics data are limited. Objective To use Instagram analytics data to maximize the engagement of a pilot nutrition intervention for Black parents of young children on Instagram and to explore primary factors mediating engagement. Study Design, Settings, Participants Black Head Start parents (n=88) were recruited to participate in a 12-week pilot nutrition education campaign promoting health drinks on Instagram. The Theory of Planned Behavior and Uses and Gratifications Theory guided the delivery of content based on the beverage consensus statement by Healthy Eating Research of the Robert Wood Johnson Foundation. Parents were invited to follow the campaign Instagram page and metrics were tracked at 24 and 48 hours after posting. Measurable Outcome/Analysis Engagement is reported as totals (followers, likes, views), means (likes per week, views per week), and ratios (follower to view, and view to like). Wald Chi-Square tests were used to determine mediators of engagement (post topic, post type, presence of humor). Results The 12-week Instagram nutrition education campaign for Black parents included over 154 unique posts and garnered 88 followers, over 400 likes, and over 700 views on feed posts. The number of followers, likes, and views increased steadily during the campaign. Significant differences were found in the number of views received by post topic after 24 hours (p = .043), and number of likes received by post topic after 24 hours (p=.027), with posts about 100% juice garnering the most likes. Additionally, posts that contained a humorous element were more likely to receive a comment (p = .025). Conclusions Instagram analytics data represents an immediate and valuable feedback tool for message acceptability and engagement for research studies on social media. Strategies for developing a social media strategy for research are needed. Funding Robert Wood Johnson Foundation Healthy Eating Research

BACKGROUND:Little is known about the partnerships formed between early care and education (ECE) programs and the Child and Adult Care Food Program (CACFP) and other organizations to continue to feed young children during the COVID-19 pandemic. Such information can provide important lessons to build ECE capacity for feeding children during future emergencies and has the potential strengthen the ECE food systems. OBJECTIVE:This study aimed to identify the unique partnerships that CACFP state agencies established to provide nutrition to young children during the COVID-19 pandemic DESIGN: Qualitative semi-structured interviews with 24 participants representing 21 states across the United States. PARTICIPANTS/SETTING:Virtual interviews with CACFP directors from December 2020 through May 2021. ANALYSIS:Following the realist method, transcripts were analyzed using thematic analysis. Codes were developed inductively and grouped to identify themes and subthemes. RESULTS:Four themes were identified: (1) CACFP partnerships that supported children and families directly; (2) CACFP partnerships that built the capacity of ECE providers to provide food to children in their own settings; (3) CACFP systems-level partnerships that improved coordination of efforts to continue to feed children in ECE; and (4) CACFP directors encouraged other CACFP state agencies to build nontraditional, diverse partnerships that can be leveraged during pandemics and other natural disasters. Within these themes (subthemes), the purpose of the partnerships focused on improving waiver utilization (eg, Department of Transportation, state health departments), improving food access (eg, Summer Food Service Program [SFSP], food banks, grocery stores, dairy councils), supporting ECE programs to participate in food reimbursement programs (eg, SFSP, CACFP sponsors), and resource sharing (eg, coalitions, CACFP sponsors). CONCLUSIONS:The CACFP state directors reported that existing and new partnerships between CACFP state agencies and external entities successfully facilitated feeding young children in ECE during the COVID-19 pandemic. States may consider developing a road map to proactively explore potential partners in their state to meet specific needs such as accessibility, availability, and affordability for feeding young children in ECE.

OBJECTIVE:To assess plate waste of plant-based protein entrees compared with regularly served meat-based entrees in the National School Lunch Program (NSLP).DESIGN:Plate waste data were collected before and after introducing the plant-based entrees, using digital photography and the quarter-waste method.PARTICIPANTS:National School Lunch Program participants in grades 6-8.INTERVENTION:Two newly developed plant-based protein entrees were introduced into the menu cycle by replacing 2 regularly served meat-based entrees.MAIN OUTCOME MEASURE:Student plate waste of plant-based entrees compared with entrees regularly served in the NSLP meal pattern.ANALYSIS:A total of 4,138 meal observations were analyzed. Ordinary least-squares regressions and 2-sample unpaired t tests were used to determine significant differences in waste.RESULTS:National School Lunch Program participants wasted plant-based entrees more than all other entrees served during lunch. Students wasted all or none of the plant-based entrees more than partial servings. There were no significant differences in waste between demographic groups for the plant-based entrees.CONCLUSIONS AND IMPLICATIONS:Plant-based entrees served as a part of the NSLP may lead to increased plate waste than meat-based entrees. Novel food pairings and visibility of legumes may have led to increased plate waste.

OBJECTIVE:To capture Child and Adult Care Food Program (CACFP) state directors' experiences implementing federal waivers for feeding children in early care and education (ECE) settings during coronavirus disease 2019.DESIGN:Qualitative semistructured interviews.SETTING:Virtual interviews with state CACFP directors.PARTICIPANTS:Child and Adult Care Food Program directors from 21 states from December 2020 to May 2021.PHENOMENON OF INTEREST:Implementation of state-level waivers.ANALYSIS:Qualitative thematic analysis.RESULTS:State directors reported that the coronavirus disease 2019 waivers allowed ECE programs to continue feeding children despite being closed or having limited enrollment. The meal pattern, noncongregate feeding, parent/guardian meal pick-up, and monitoring waivers were most frequently used by states. Challenges included maintaining integrity to CACFP meal pattern requirements, addressing the limited capacity of ECE to produce and distribute noncongregate meals, and adapting technology for virtual reviews. Suggested improvements included streamlined communication from the US Department of Agriculture, standing waivers for emergencies, ongoing flexibilities for feeding children, and strategies to increase CACFP enrollment and reduce financial viability requirements for ECE.CONCLUSIONS AND IMPLICATIONS:Results indicate the need for the US Department of Agriculture to consider issuing and extending waivers, increasing ECE participation in CACFP, and ensuring timely communication and guidance on waiver tracking.

Background Obesity disproportionately impacts children who are Black and Hispanic, those who live in rural communities and those who have low income. Predisposition to obesity early in life is profoundly impacted by feeding habits during the preschool years. The early care and education (ECE) setting impacts children's health by providing daily meals. Objective The goal of this study was to identify whether or not health disparities in foods and beverages served in ECE programs in Georgia exist based on socioeconomic, demographic and geographic variables. Methods A random sample was drawn from 3054 ECE programs across the state of Georgia. The likelihood of serving specific foods and beverages in ECE programs in the previous day was measured. Percentages and frequencies, logistic regressions, Spearman's rho and Odds ratio tests determined outcomes. Results A total of 974 surveys were returned. Data were stratified based on the income level of the participant families, race of enrolled children and geographic location of the ECE program. Disparities existed between programs based on race of enrolled children and geographic location. For example, although the odds of providing sweets increased by 0.6% as the percentage of Black children enrolled increased, the provision of healthier foods, such as the odds of providing fruits (P = .001), vegetables (P = .001) and protein (P = .001) also increased. However, after results were adjusted for covariates findings did not remain significant. Conclusions Future research focused on evaluating the foods and beverages provided in ECE programs and the relationship of how income, race and location are related may provide further understanding about the disproportionate childhood obesity rates in America.

To assess the acceptability of two newly developed plant-based protein entrees to be served in the National School Lunch Program (NSLP) among middle school students in the state of Georgia. Two newly developed plant-based entrees (sweet potato chili fries, lentil-based sloppy joes) were introduced at lunch and sensory evaluation was conducted using a nine-point hedonic scale were used to evaluate overall liking (OL) and specific sensory attributes (appearance, flavor, texture) of lunch entrees immediately following lunch. Recipe formulations were designed to meet NSLP standards, to address the recent popularity of plant-based meat alternatives, and to incorporate the flavor preferences of student populations. Sensory evaluation of both plant-based entrees and all other entrees sold at lunch or brought from home were assessed. A total of 964 sensory evaluations were collected from middle school students in grades 6–8 in the Jackson County School District in Jefferson, Georgia. The plant-based entrees had a mean OL = 2.43, appearance = 3.00, texture = 3.58, flavor = 2.63. The regular hotline entrees had a mean OL = 5.66, appearance = 5.21, texture = 5.16, flavor = 5.75. A la carte entrees had a mean OL = 6.07, appearance = 5.65, texture = 5.64, flavor = 5.95. Entrees brought from home had a mean OL = 8.14, appearance = 7.82, texture = 7.84, flavor = 8.19. Regressions and t-tests were used to determine significant differences in waste using the statistical software Stata. Little research has been conducted utilizing sensory evaluation to determine student liking of plant-based entrees. Plant-based entrees were liked least out of all entrees offered at school or brought from home. Sensory evaluation may be utilized to develop healthy school meals, ensure recipes are responsive to the taste preferences of children and profitable on the school lunch menu. Jackson County School District, Georgia Department of Education.

Background: Childhood obesity is a growing problem in the United States and results in increased risk for chronic diseases such as diabetes, heart disease, and hypertension. Thirteen percent of youth in Georgia are obese. Identifying strategies to assist children in establishing healthy habits is essential to reduce the risk of childhood obesity. The Early Care and Education (ECE) setting is ideal for the implementation of obesity prevention practices. However, there are barriers present for implementing nutrition policies in this setting. This report explores the implementation of food and beverage best practices in the ECE setting and highlights barriers to and facilitators for adopting these policies. Methods: We conducted 24 interviews and 6 focus groups with ECE program directors and teachers in 6 regions in Georgia. The statewide sample included directors from child care learning centers, family child care homes, and license-exempt programs. A trained qualitative researcher facilitated focus groups and interviews. Data were audio recorded and transcribed verbatim. Qualitative data analysis software, NVivo 10, was used to code data and identify emergent themes. Results: Several key themes related to barriers to food and beverage policy implementation emerged including the need for: 1) enhanced parent communication, 2) resources to limit juice consumption, and 3) financial support to decrease food costs. Facilitators of nutrition policy implementation included: 1) ease of access to water, 2) children’s preferences for fruits and vegetables, and 3) availability of existing nutrition resources. Findings will inform the development of resources to support nutrition policy implementation as well as policy training for ECE teachers in Georgia. Conclusions: Study themes may provide insight about how to improve current resources and develop new solutions to improve adoption and implementation of nutrition policies in the ECE setting in the future.

Objective: To determine the eLearning preferences of early care and education (ECE) teachers for an effective beverage policy training. Methods: Mixed methods study conducted with ECE directors and teachers in 6 regions throughout Georgia. Researchers used an eLearning survey (n = 646) along with focus groups (n = 6) and interviews (n = 24) to determine eLearning preferences and preferred eLearning format. Descriptive statistics and qualitative content analysis were used for data analysis. Results: Most ECE teachers in Georgia (85%) have never had a beverage policy training. Participants (48%) reported they would definitely use the Internet for training. Qualitative analysis revealed key themes; training should be engaging, concise, hold the trainees accountable, and be interactive. Interactive video is the preferred eLearning format . Conclusions and Implications: Interventions that promote national beverage recommended in the ECE setting are critically needed. Study findings may inform other states about the feasibility of using eLearning to for ECE in other states.

2019.Of the 103 mothers enrolled in the program, 98% initiated breastfeeding and 76% were still breastfeeding at 6 months.Conclusions: Home visiting peer counselors were effective in promoting breastfeeding success in mothers in Flint.Many participants mentioned the importance of the peer counselor being a trusted mother representative of their community.This strategy should continue to be utilized and expanded to improve breastfeeding rates.

The emergence of COVID-19 in the United States led most states to close or severely limit the capacity of their early child-care and education (ECE) programs. This loss affected millions of young children, including many of the 4.6 million low-income children who are provided free meals and snacks by their ECE programs through support from the federal Child and Adult Care Food Program (CACFP). Although Congress swiftly authorized waivers that would allow CACFP-participating ECE programs to continue distributing food to children, early evidence suggests that most ECE programs did not have the capacity to do so, leaving a fragmented system of federal, state, and local food programs to fill the gaps created by this loss. Critical steps are needed to repair our nation's fragile ECE system, including greater investment in CACFP, to ensure the nutrition, health, and development of young children during the COVID-19 pandemic and beyond.

Purpose: Low-income children are disproportionately affected by high rates of food insecurity and obesity, placing them at risk for poor health outcomes. Diets that are rich in fruits and vegetables (FV) are associated with health benefits such as reducing the risk of obesity. Despite these benefits, American children do not consume nationally recommended amounts of fruits (63%) and vegetables (90%) per day. Data reveal that young children exhibit increased food neophobia toward vegetables. One way to decrease food neophobia is to introduce FV to young children via recipe tasting. The purpose of the study was to increase willingness to try FV among low-income children using live characters at Summer Food Service Program Sites. Methods: The study design was a small-scale pilot study to conduct taste tests of recipes with 125 low-income children. Researchers created recipe-tasting stations at two different sites. At Site 1, characters promoting FV characters were present at the recipe-tasting station. At Site 2, researchers presented recipes without characters being present. Taste tests were conducted once per week for a period of 4 weeks using two previously validated instruments, Taste Test Tool and the Taste and Rate Questionnaire. Results: Results demonstrated that introducing FV recipes with characters showed a trend toward increasing willingness to try FV among low-income children. Data also suggested that low-income children had limited exposure to specific FV before recipe tastings. Conclusion: The use of characters is a promising approach to increase willingness to try FV among low-income children.

FV, putting them at risk for obesity later in life.Repeated exposures and opportunities to taste in a positive environment are needed to encourage acceptance and consumption of FV by children.Target Audience: The program targeted low income children of all ages at SNAP-Ed and EFNEP nutrition education sites and their parents.Program Description: Each child received $4 vouchers to shop at a farmers market set up at their school, child care center or other youth-based program site.Children received nutrition education and were offered taste tests in conjunction with markets.Evaluation Methods: A 12-question, parent survey was sent home with all children participating in the market.Paper surveys were entered in SurveyMonkey for analysis.A total of 724 were returned (32% response rate).Results: Of those parents returning surveys, 91% said their child ate all the produce they purchased, 77% said their child was more excited about FV, 71% said their child talks about FV more and 78% said their child could identify more FV.Conclusions: Parents reported changes in their child's knowledge, attitude and consumption of FV because of the program which are important factors in development of food preferences.This program offers a replicable model for nutrition education programs focused on increasing FV consumption and access in low income audiences.

Food Talk: Better U (FTBU) is a healthful weight management curriculum developed by the University of Georgia's Supplemental Nutrition Assistance Program Education (SNAP-Ed) team. FTBU addresses the high burden of obesity among low-income Georgians by focusing on healthful weight management practices. Topics include practicing portion control, tracking dietary intake, setting goals, limiting added sugar, making small healthful behavior shifts, and implementing problem-solving strategies. Lesson structure includes sharing sessions, didactic lessons, cooking demonstrations, and physical activity. FTBU is based on needs assessment results and rigorous evaluation and thereby aligns with requirements outlined in current SNAP-Ed guidance materials. Other Extension SNAP-Ed providers may benefit from understanding the FTBU development and evaluation processes.

Background Limiting sugar-sweetened beverages served to children can help decrease childhood obesity risk. Early Care and Education (ECE) providers are key to promoting these beverage policies because they play a role in establishing healthy habits among young children. As a majority of Americans have Internet access, eLearning would be an appropriate format for a beverage policy training platform for ECE providers. Objective The specific aim of this study was to determine the preferred eLearning format of ECE providers in Georgia to inform the development of an eLearning beverage policy training. Study Design, Settings, Participants The target population for study included licensed and license exempt ECE providers in GA serving children ages 0-5. A randomized, stratified sample of facilities was selected. ECE providers completed an electronic or paper survey evaluating the degree in which their program implemented beverage policy recommendations and their eLearning preferences. Mock prototypes for preferred eLearning formats were developed. A convenience sample participated in semi-structured interviews to yield preferences for the development of the eLearning training. Measurable Outcome/Analysis Descriptive statistics were calculated to determine eLearning preferences. Qualitative data analysis was conducted to reveal themes from interviews. Results A total of 646 respondents completed the eLearning survey. Sixty eight percent of ECE providers reported participation in the Child and Adult Food Care Program. Participants had access to the internet (98.5%) and 44% would use the internet for a 15-minute educational session. Eighty five percent of participants reported having no beverage policy training. The preferred eLearning formats identified online were interactive video (46.8%), podcast (37.5%) and video-based learning (31.7%). A subset of ECE providers participated (N = 20) participated in interviews. Most participants chose interactive videos as the most effective training format. Findings showed that effective trainings should be engaging, concise, and hold trainees accountable. Conclusion Study results revealed that most participants have not received a beverage policy training. eLearning trainings is a promising method to educate ECE providers and improve the quality of beverages served to young children. Funding None.

BACKGROUND The child care setting is a promising venue to establish healthy habits and promote obesity prevention. One major contributor to weight gain among young children is high intake of sugar-sweetened beverages (SSBs). Increasing access to water and other healthy beverages is a viable strategy to reduce childhood obesity. The goal of our study was to investigate implementation of the beverage policies in child care programs in Georgia (GA) by Child and Adult Care Food Program (CACFP) participation and program type. METHODS The study employed a cross-sectional design. A statewide survey was conducted using the GA Child Care Wellness Survey. A random sample of 3054 child care programs was obtained. Programs were stratified by six state regions to acquire a representative sample. RESULTS A total of 974 surveys were returned. Sixty-seven percent of the respondents were enrolled in CACFP. Programs participating in CACFP (96%) were less likely to serve SSBs (x2(2) = 15.309, p < 0.001), than non-CACFP programs (90%). CACFP programs were more likely to serve low-fat or fat-free milk to 2-5-year olds than non-CACFP programs (87% vs. 35%, p < 0.001). Family child care homes were significantly more likely to comply with serving only whole milk to 1 year olds (66%; p < 0.001) than other program types. All program types had low compliance with implementing water policies. CONCLUSIONS Study outcomes provide vital information on the implementation of beverage policies that can inform beverage policy training, with the ultimate goal of reducing obesity risk and promoting healthier diets among preschool children in GA.