The purpose of this study was to examine associations between screen time (ST) parenting practices and 2–5-year-old children’s TV viewing and weight status. Data were collected from 252 parent–child dyads enrolled in a randomized parent-focused childhood obesity prevention trial from 2009–2012. ST parenting practices were assessed at baseline using a validated parent-reported survey. Parent-reported child TV viewing and objectively measured anthropometrics were assessed at baseline, post-intervention (35 weeks), and follow-up (59 weeks). Marginal effect models were developed to test the association between baseline ST parenting practices and children’s TV viewing, BMI z-score, and waist circumference across all time points. Limiting/monitoring ST was associated with decreased weekly TV viewing (β = −1.79, 95% CI: −2.61; −0.95), while exposure to TV was associated with more weekly TV viewing over 59 weeks (β = 1.23, 95% CI: 0.71; 1.75). Greater parent use of ST as a reward was associated with increased child BMI z-score (β = 0.15, 95% CI: 0.03; 0.27), while limiting/monitoring ST was associated with decreased BMI z-score (β = −0.16, 95% CI: −0.30; −0.01) and smaller waist circumference (β = −0.55, 95% CI: −1.04; −0.06) over the study period. These findings suggest that modifying parent ST practices may be an important strategy to reduce ST and promote healthy weight in young children.

Child care-based interventions offer an opportunity to reach children at a young and impressionable age to support healthy eating and physical activity behaviors. Ideally, these interventions engage caregivers, including both childcare providers and parents, in united effort. This study evaluated the impact of the Healthy Me, Healthy We intervention on children’s diet quality and physical activity. A sample of 853 three- to four-year-old children from 92 childcare centers were enrolled in this cluster-randomized control trial. Healthy Me, Healthy We was an 8-month, social marketing intervention delivered through childcare that encouraged caregivers (childcare providers and parents) to use practices that supported children’s healthy eating and physical activity behaviors. Outcome measures, collected at baseline and post-intervention, assessed children’s diet quality, physical activity, and BMI as well as caregivers’ feeding and physical activity practices. Generalized Linear Mixed Models were used to assess change from baseline to post-intervention between intervention and control arms. No significant changes were noted in any of the outcome measures except for small improvements in children’s sodium intake and select parent practices. Despite the negative findings, this study offers many lessons about the importance and challenges of effective parent engagement which is critical for meaningful changes in children’s health behaviors.

Early care and education providers cite lack of parent engagement as a central barrier to promoting healthy behaviors among young children. However, little research exists about factors influencing parent engagement with promoting healthy eating and activity behaviors in the this setting. This study aimed to address this gap by examining low and high parent engagement with the Healthy Me, Healthy We campaign to identify barriers and facilitators of parent engagement with the intervention. This comparative case study used an explanatory sequential mixed-methods approach. We created center-level parent engagement scores using process evaluation data from the effectiveness trial of Healthy Me, Healthy We. Recruitment focused on centers with the five lowest and five highest scores. Twenty-eight adults (7 directors, 9 teachers, 12 parents) from seven centers (3 low engagement, 4 high engagement) completed semistructured interviews and the Family and Provider/Teacher Relationship Quality measure. Analytic approaches included descriptive statistical analyses for surveys and a framework-informed thematic analysis for interviews. Prominent contrasts between low- and high-engagement groups involved center culture for parent engagement and health promotion, practices for fostering networks and communication within centers, and communication between centers and parents. Personal attributes of providers (e.g., attitudes) also differentially influenced practices for engaging parents. Organizational characteristics and individual practices can facilitate or impede parent engagement with health promotion efforts. Assessing organizational context, gaining input from all stakeholders, and conducting capacity-building interventions may be critical for laying the foundation for positive relationships that support parent engagement in implementation of health promotion programs and beyond.

The COVID-19 pandemic has caused alterations to be made in the way many people access, prepare, and consume food. Rural communities are particularly impacted due to pre-existing structural vulnerabilities, i.e., poverty, lack of infrastructure, and limited fresh food options. This study aimed to characterize experiences of one rural Appalachian community’s changes to the food environment during the pandemic. In April 2021, six focus groups were conducted with residents of Laurel County, Kentucky. Using grounded theory, we identified losses, gains, and overall changes to the community food environment since the onset of COVID-19. Seventeen Laurel Countians (17 female; ages 30–74) participated in the six focus groups. Three main themes emerged regarding food environment changes—(1) modifications of community food and nutrition resources, (2) expansion and utilization of online food ordering, and (3) implications of the home food environment. Rural communities faced considerable challenges during the COVID-19 pandemic, in part, due to gaps in existing infrastructure and loss of pre-existing resources. This study illustrates the complexity of changes occurring during COVID-19. Using the preliminary data obtained, we can better understand pre-existing issues in Laurel County and suggestions for future programming to address the inequitable access and response during public health emergencies and beyond.

Summary: Community‐based policy, systems, and environmental interventions have the potential to reduce modifiable risk factors for obesity early in life. The purpose of this scoping review was to characterize the breadth, generalizability, and methodological quality of community‐based diet and obesity‐related policy, system, and environmental interventions during the first 1000 days of life, from pregnancy to 24 months of age. Eight databases were searched, and 83 studies (122 references) were included. Data were extracted for breadth (intervention characteristics), generalizability (reach, effectiveness, adoption, implementation, and maintenance), and study quality (Downs and Black Checklist). Systems and environmental approaches were common (> 80%), relative to policy approaches (39%). The majority (60–69%) occurred in the prenatal period and early infancy (0–3 months), assessed breastfeeding or child growth/obesity (53% for both), and included people with lower income (80%) or racial and/or ethnic minority groups (63%). Many interventions reported positive outcomes (i.e., in the expected direction) for child diet, breastfeeding, and feeding practices (> 62%). Few reported intervention maintenance or spanned the full 1000 days. Most studies were classified as good (32%) or fair (56%) methodological quality. The interventions mainly addressed pregnancy and early infancy. Rigorous and representative investigation is needed to improve intervention reach, sustainability, and application in toddlerhood.

The effectiveness of interventions targeting children's eating and physical activity behaviors through childcare settings is inconsistent. To enhance public health impact, it is imperative to evaluate fidelity of implementing complex interventions in real-world settings. This study evaluated fidelity and contextual factors influencing implementation of Healthy Me, Healthy We (HMHW). HMHW was an 8-month social marketing campaign delivered through childcare to support children's healthy eating and physical activity. HMHW required two levels of implementation support (research team and childcare providers) and two levels of campaign delivery (childcare providers and parents). Process evaluation was conducted among childcare centers in the intervention group (n=48) of the cluster-randomized control trial. Measures included attendance logs, self-report surveys, observation checklists, field notes, and semi-structured interviews. A 35-item fidelity index was created to assess fidelity of implementation support and campaign delivery. The fidelity with which HMHW was implemented by childcare providers and parents was low (mean 17.4 out of 35) and decreased between childcare providers and parents. Childcare providers had high acceptability of the program and individual components (80 – 93%). Only half of parents felt intervention components were acceptable. Frequently cited barriers to implementation by childcare providers included time constraints, parent engagement, staff turnover, and restrictive policies. The lack of observable effect of HMHW on children's dietary or physical activity behaviors may be due to inadequate implementation at multiple levels. Different or additional strategies are necessary to support implementation of multilevel interventions, particularly when individuals are expected to deliver intervention components and support others in doing so.