Background: There is need to identify evidence-based early childhood obesity prevention programs that are feasible and demonstrate cost-effectiveness for a broader health impact. This scale-out study leveraged community-engaged principles to compare the feasibility and cost-effectiveness of three delivery modes of a childhood obesity prevention family meals program (Simple Suppers) that demonstrated positive impacts on child and caregiver diet/nutritional health-related outcomes in a previous experimental trial tested among elementary-aged children. Methods: This three-arm (in-person, online, hybrid) pre-(T0) and post-(T1)-test study included families recruited from Head Start. Forty-five families (45 caregivers; 55 children) completed the study. The program was adapted to families with younger children (3-5 years). During the 8-week program, participants received weekly group education and meals through in-person, online, or hybrid format. Feasibility outcomes were attendance, acceptability (post-test survey; focus groups), fidelity, and cost (food; staff). Participant outcomes were related to diet/nutritional health. Kruskal-Wallis test was used to compare T0 to T1 differences in participant outcomes across delivery modes. Qualitative data were analyzed using thematic analysis. Cost-effectiveness was calculated as the net-cost of the program by changes in outcomes. Results: Overall attendance was 51.2%, and higher for in-person (72.0%) and hybrid (59.7%). Program satisfaction rate was highest for hybrid (93.0%), as well as program fidelity (96.7%). Focus group results revealed areas of program improvement, behavior change, and program approval. Cost was lowest for hybrid ($17.09/family). Children in the hybrid group had a reduced waist circumference (p = 0.02) versus in-person and online groups. Conclusion: The hybrid mode of Simple Suppers demonstrated the greatest scaling potential for a broader public health impact.

Food insecurity increases among marginalized children during the summer when school is out of session. Summer programming that offers access to healthy meals and snacks may reduce the risk. There is a national call in the US for more research to assure equitable access to summer programming. The objective of this prospective observational study was to characterize patterns of participation in summer programming among elementary children from low-income urban neighborhoods of metropolitan[Blinded]. Summer programming was broadly defined (e.g., church, school, recreation center, community center). Caregivers(n = 100) received weekly text messages via TextIt during the summer (Jun-Aug 2017). They were asked: "How many days this week did [ChildName] attend a summer program? Please respond with a number from 0 to 5, where 0 - no days, 2 - 2 days, etc." Weekly counts were summed. Stepwise logistic and linear regression models were conducted to examine differences in patterns of attendance according to key sociodemographic characteristics. Mean age was 7.03 ± 0.23. 52 % identified as female, 70 % were low-income, and 80.0 % identified as Black. 51 % attended summer programming at least once; 49 % never attended. Those who attended at least once vs. not at all were more likely to be male(p < 0.01); 62.75 % males vs. 37.25 % females attended summer programming at least once, whereas 67.35 % females compared to 32.65 % males never attended. Overall mean attendance was 10.40 ± 1.43 days(out of 50). Mean + SE attendance was lower for females (7.52 + 1.76) vs. males (13.52 + 2.21)(p < 0.05), and non-Black (4.30 + 1.97) vs. Black (11.93 + 1.67)(p = 0.01) children. Future research is needed to understand barriers to participation in summer programming.

Individuals from racial minority backgrounds, especially those in low income situations, are at increased risk for obesity. Family meals positively impact child nutritional health; however, there is limited evidence examining the impact on caregivers, particularly racial minority and income-restricted individuals. The objective of this intervention study was to determine the effect of Simple Suppers, a 10 week family meals program, on caregiver diet and nutrition outcomes. Intervention versus waitlist control participants were compared from baseline (T0) to post-intervention (T1). In addition, intervention participants were assessed at a 10 week follow-up time point (T2). This study was a two-group quasi-experimental intervention trial. Lessons (10 total) were delivered on a weekly basis for 90 min. Data were collected from intervention and waitlist control participants at T0 and T1, and intervention participants at T2. After baseline (T0) data collection, families enrolled in the immediate upcoming session of Simple Suppers (intervention group) or waited for 10 weeks (waitlist control group) to begin the program. Participants were caregivers of children ages 4–10 years. This study was conducted in a faith-based community center for underserved families in Columbus, Ohio. Primary outcomes were: diet quality assessed by Healthy Eating Index (HEI) total and component scores, and total energy intake (kcal/day); body mass index (BMI) (kg/m2), waist circumference (cm), systolic and diastolic blood pressure (BP) (mmHG); and self-efficacy for having healthy meals and menu planning (both scalar). The impact of the intervention (T0:T1) was assessed using generalized mixed-effects linear regression models. Maintenance of change in study outcomes among intervention participants (T1:T2) was examined with paired t-tests. 109 caregivers enrolled in this study. The retention rate at T1 was 90% (i.e., 98 participants). 56 of 68 intervention participants completed T2, resulting in a retention rate of 82%. Almost all (99%) were female, 61% were Black, and 50% were between 31 and 40 years old. In total, 40% had low income and 37% had low or very low food security. At T1, intervention vs. waitlist controls had a lower daily energy intake (p = 0.04), but an HEI-2010 component score for fatty acids (adequacy) that was lower indicating a lower dietary intake of fatty acids (p = 0.02), and a component score for empty calories (moderation) that was significantly lower indicating a higher intake of empty calorie foods (p = 0.03). At T1, intervention vs. waitlist controls also had a lower BMI (p < 0.001) and systolic BP (p = 0.04), and higher self-efficacy (p = 0.03). There were no group differences in other outcomes. At T2, intervention participants maintained the changes in daily energy intake, BMI, systolic BP, and self-efficacy that improved during the intervention period. There was no change (improvement) in the component score for fatty acids; however, the component score for empty calories significantly improved (p = 0.02). Engagement in the Simple Suppers program led to improvements in caregivers’ daily caloric intake, weight status, systolic blood pressure, and self-efficacy for family meals. Future research should further explore the dietary and nutritional health benefits of family meals among caregivers at the highest risk for obesity.

There are no published data on which children are at risk for not engaging in programming during the summer window of risk. The objective of this study was to compare the demographic characteristics of children who do (“attenders”) and do not (“non-attenders”) participate in summer programming. Project SWEAT was a prospective observational study of pre-K through 5th grade children residing in low-income, urban neighborhoods. Caregivers were texted weekly during the summer (10 weeks) by the research team to gather information on their child's attendance in programming. Text messages stated, “Hello from Project SWEAT! How many days this week did [Child Name] attend a summer program? Please respond with a number from 0–5, where 0 – no days, 2 – 2 days, etc.” Attenders were defined as having attended ≥1 day of programming during the summer and non-attenders as 0 days. Chi-square was conducted to determine differences in demographic characteristics according to attender status. Attendance data were collected from 88.50% of the study sample (n = 100 out of 113). Mean age was 7.03 ± 0.23 years; 52.00% (n = 52), 70.10% (n = 68), and 80.00% (n = 80) were female, low-income, and Black, respectively. Almost one-third (32.99%, n = 32) were classified as overweight (19.59%, n = 19) or obese (13.40%, n = 13) at baseline. Fifty-one % (n = 51) of study participants were classified as attenders, and 49.00% (n = 49) were non-attenders. Mean attendance was 10.40 ± 1.43 days. Attenders were more likely to be male (62.75% [n = 32] vs. 37.25% [n = 19], P < 0.01). Children who are female are significantly less likely to attend summer programming than male participants. Given that summertime is a window of risk for child health (e.g., inappropriate weight gain) and food security, further research needs to be conducted to understand who and why certain children are attending summer programming. USDA North Central Nutrition Education Center for Excellence.

Assess the impact of an 8-week Head Start family meals intervention (Simple Suppers) on participating caregiver's weight status and health outcomes. This is a single arm pre- to post-test study. The intervention is occurring during the 2019–20 school year (fall, winter, and spring sessions) at 3 Head Start sites. Caregiver outcomes include: BMI (kg/m2), waist circumference (cm), blood pressure (mm Hg), and mental health measures (depression (Patient Health Questionnaire-9 (PHQ-9)), perceived stress (Perceived Stress Scale (PSS)), and anxiety (Generalized Anxiety Disorder-7 (GAD-7))). Regression models factoring in attendance will be used to examine pre- to post-test changes. Nineteen caregivers completed data collection for the fall session. 55.6% of families were low-income and 21.1% had low/very low food security. Mean (SD) caregiver age was 37.6 (12.1) yr, 94.7% were female, and 84.2% were non-Hispanic Black. There were no significant changes in BMI, blood pressure, waist circumference, depression, or perceived stress from pre- to post-test according to attendance level, however anxiety significantly decreased with increasing attendance (P < 0.05). Data collection for the remaining sessions will be completed in spring 2020. This study can be expected to have a positive impact by understanding the role of healthy family mealtime routines in caregiver's physical and mental health among racial minorities residing in low-income households. USDA NIFA.

Simple Suppers is a 10-week evidence-based intervention (EBI) designed to improve family mealtime routines and child weight status among racially diverse elementary-age children from low-income households. Results from a previous trial demonstrated effectiveness, thereby warranting a scale-out study to reach other child populations (i.e., preschool-age children). In the current study, Southside Simple Suppers Scale-Up (S4), we propose a hybrid type 2 effectiveness-implementation trial, which has a dual focus on effectiveness and implementation outcomes. This type of trial will allow facilitation of the research translation process to develop effective solutions to promote the health of preschool-age children. S4 is occurring during the 2019–20 school year (fall, winter, spring) at 3 Head Start sites (school readiness program for low-income children). Effectiveness outcomes (child food preparation skills, family meal routines) are collected at pre- and post-programming via direct measure and survey. Child food preparation skills are rated on 4-point Likert scale (strongly disagree to strongly agree). Family mealtime routines (i.e., eating meals together, TV on while eating) are reported by number of days per week. Implementation outcomes (adoption, fidelity, fiscal efficiency) are collected throughout programming. Adoption is assessed by weekly attendance. Fidelity is assessed with a program-specific checklist and videotaping. Fiscal efficiency is evaluated by assessing cost of programming per family. Nineteen caregivers completed data collection for the fall session. 55.6% families were low-income. Mean(SD) caregiver age was 37.6(12.1) yr, 94.7% were female, 84.2% were Black, and mean(SD) BMI was 35.3(11.2) kg/m2. Mean(SD) child age was 3.4(0.5) yr, 47.6% were female, and mean (SD) BMI z-score was 1.16(1.38). Child food preparation skills significantly increased from pre- to post-test (P < 0.05); there were no significant changes in family mealtime routines. Programming was delivered as intended 78% of the time and mean cost of weekly programming was $8.63 per family. Programming and data collection will be complete in spring 2020. Results from this novel hybrid effectiveness-implementation trial will inform the future scale-up of the EBI Simple Suppers program in Head Start. USDA NIFA.

Examine the relationship between children's food preparation skills and their involvement in meal preparation with their caregiver among families participating in a Head Start family meals program (Simple Suppers). Simple Suppers is an 8-week family meals program tailored to low-income caregivers and their preschool age child(ren). The study design is a single arm pre- to post-test, and the intervention is occurring during the 2019–2020 school year (fall, winter, and spring sessions) at 3 Head Start sites. Caregiver lessons focus on overcoming family meal barriers (i.e., meals on a budget, time saving strategies) through interactive group discussions and goal setting. Child lessons focus on age-appropriate food preparation skills through experiential learning. Children's food preparation skills are assessed via a 9-item questionnaire. Questions are situated on a 4-pt Likert scale (1 = strongly disagree (1pt); 4 = strongly agree (4pt)). Child involvement in meal preparation is assessed with a single item scalar question (0–7 times per week). Pearson correlation was used to examine the relationship between child food preparation skills and involvement in meal preparation. Significance was set at P < 0.05. 19 families completed data collection for the fall session. 55.6% were low-income according to federal poverty guidelines, mean (SD) caregiver age was 37.6 (12.1), 94.7% were female, and 84.2% were non-Hispanic Black. Mean (SD) child age was 3.4 (0.5) and 47.6% were female. There was a significant association between the change in child food preparation skills and the level of child involvement in meal preparation with their caregiver (r = 0.62, P < 0.01). Preliminary data from this study demonstrate that children's food preparation skills influence the extent to which they are involved in preparing family meals with their caregivers. USDA NIFA CYFAR.

USDA North Central Nutrition Education Center for Excellence.

The objective of this study was to assess the reliability and construct validity of the SNAP-Ed Youth Behavior Survey (YBS). SNAP-Ed is a USDA program responsible for administering nutrition and physical activity education to SNAP-eligible children. The SNAP-Ed YBS is a 12-item program evaluation questionnaire pertaining to child food and physical activity behaviors and knowledge. There are 7 behavior questions (2 relate specifically to fruit and vegetable intake; scalar) and 5 knowledge questions (binomial). A demographic survey and the YBS was administered to 58 children attending a USDA Summer Food Service Program (SFSP) site where SNAP-Ed programming was occurring. Reliability was assessed using Cronbach’s Alpha test for internal consistency. Skin carotenoid level was selected as the gold standard for assessing construct validity. Resonance Raman Spectroscopy (RRS) intensity was used to determine skin carotenoid levels. Construct validity was determined by comparing YBS fruit and vegetable behavior scores with skin carotenoid levels via Pearson Correlation coefficients. Mean age of participants was 8.43 ± 0.25 years, 92.86% were white, and mean RRS intensity was 26,717 counts. Alpha coefficients for internal consistency for behavior and knowledge questions were 0.66 and 0.20, respectively. There was an inverse relationship between fruit and vegetable responses and RRS intensity counts. Results from this pilot demonstrate that the YBS is a reliable tool for assessing child behaviors, but not knowledge; validity of the fruit and vegetable intake questions was not observed. Future research should be conducted to confirm findings from this study to assure use of reliable and valid assessment tools in SNAP-Ed. USDA SNAP-Ed.