Diet Modification
Conditions
Brief summary
U.S. children eat too little fruits and vegetables and whole grains, and too many energy dense foods, dietary behaviors associated with increased morbidity from cardiovascular diseases. Parents play a key role in shaping their child's diet and best practices suggest that parents should involve children in food preparation, offer, model and encourage a variety of healthy foods. In addition, while parents help to shape food preferences, not all children respond in the same way and certain appetitive traits, such as satiety responsiveness (sensitivity to internal satiety signals), food responsiveness (sensitivity to external food cues), and enjoyment of food may help explain some of these differences. Prior interventions among preschool aged children to improve their diet have not used a holistic approach that fully targets the home food environment, by focusing on food quality, food preparation, and positive feeding practices while acknowledging a child's appetitive traits. This proposal will build upon pre-pilot work to develop and pilot-test the feasibility, acceptability and preliminary efficacy of a novel home-based intervention. The proposed 6-month intervention, will include 3 monthly home visits by a community health worker (CHW) trained in motivational interviewing, that include in-home cooking demos. In between visits, parents will receive tailored text-messages 2x/wk. and monthly mailed tailored materials. During the last 3 months CHW phone calls will replace the home visits. The intervention will be tailored for individual families based on the child's appetitive traits. The proposed research will lay the groundwork for a larger trial to support, motivate, and empower low-income parents to prepare healthy meals and use healthy feeding practices, which will improve children's diets and ultimately their health.
Detailed description
There is a critical need for primary prevention interventions to help parents shape children's dietary behaviors early in life. These interventions need to be convenient for busy, working families and tailored to children's needs and the family environment. Although there have been several interventions among preschool aged children to improve dietary behaviors, none have used a holistic approach that fully targets the home food environment, by focusing on food quality, food preparation, and positive feeding practices while acknowledging a child's appetitive traits. The proposed research will develop and pilot-test the feasibility, acceptability and preliminary efficacy of a novel home-based intervention to improve the diet quality and family food environment of high-risk preschool age, low-income, ethnically diverse children. This research will build upon previous research including a pre-pilot intervention with 15 mother-child dyads which included two home visits: the first visit included a meal-recording and the second included a motivational interviewing (MI) session using coded video clips from the meal-recording as feedback on the parents' feeding practices. All families were retained and significant improvements in several parental feeding practices were found. Based on lessons learned in the pre-pilot, the proposed 6-month intervention will include home visits by a community health worker (CHW) trained in MI, enhanced by adding several innovative components. The home visits will include in-home cooking demonstrations; tailored text-messages, mailed materials and CHW phone calls. The intervention will be tailored for families based on the child's appetitive traits and eating behaviors. These strategies are expected to increase parental knowledge, self-efficacy, and motivation for serving easy, inexpensive healthy foods in the home, leading to increased child exposure to more healthy and varied foods, improvements in parental feeding practices, and ultimately, improvements in child diet quality. The specific aims are as follows: Aim 1: To conduct focus groups with 40 ethnically diverse low-income parents of preschoolers (2-5 years) to inform the adaptation and development of the enhanced intervention. Aim 2: To conduct a pilot randomized controlled trial with 60 parent-child pairs (30 intervention/30 control) from ethnically diverse, low-income families with preschoolers to: Aim 2.1 Determine the feasibility and acceptability of the enhanced intervention. Aim 2.2 Determine the preliminary efficacy of the enhanced intervention on changes in children's diet quality (primary outcome) and parental feeding practices and availability of healthy foods in the home (secondary outcomes) and calculate effect sizes for a future randomized controlled trial (RCT). The investigators hypothesize that the intervention will be feasible and acceptable to parents and that parent-child pairs randomized to the intervention condition will demonstrate greater improvements in the outcomes after six months compared to the comparison condition (attention control of a school readiness intervention). Exploratory aim: Explore how parents' skills, self-efficacy and intrinsic motivation are related to changes in children's diet quality and parental feeding practices.
Interventions
BEHAVIORALHealthy Feeding, Healthy Eating
Home Based Motivational Interviewing to Improve Diet Quality of Preschoolers
BEHAVIORALReading Readiness
Active Control that uses Motivational Interviewing to improve Reading Readiness of Preschool Children
Sponsors
Brown University
University of Connecticut
University of Rhode Island
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Investigator, Outcomes Assessor)
Intervention model description
Intervention vs. Attention Control
Eligibility
Sex/Gender
ALL
Age
18 Years to 95 Years
Healthy volunteers
Yes
Inclusion criteria
* Speak English or Spanish * Have a child between 2- 5 years of age * Live with their child most of the time * Have a phone that is able to video-record * Be willing to have evening meals video recorded in the home
Exclusion criteria
\*Has a diagnosed feeding disorder, dietary restrictions, or medical condition that impacts how they feed their child.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| HEI-2015 Total and Component Scores | Healthy Eating Index Scores at study completion (6 months) | HEI-2015 scores will be calculated from twenty four hour recall data (two of them which are combined and scored per 1000 kcal or as a % of intake per NCI scoring guidelines). HEI was designed to measure diet quality in terms of how well diets conform to the 2015 Dietary Guidelines for Americans. The total HEI score represents the sum of 12 components scores (minimum component can be 0 and maximum component score shown in parentheses for each), including total fruit (5), whole fruit (5), total vegetables (5), green and beans (includes dark green vegetables and cooked, dried beans and peas because intakes of these types of vegetables are furthest from the amounts recommended in the USDA Food Patterns) (5), whole grain (10), dairy (10), total protein food (5), seafood and plant proteins (5), fatty acids (10), refined grains (10), sodium (10) added sugar (10), saturated fat (10). Higher scores reflect better outcomes. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Food Parenting Practices | Food Parenting Practices at study completion (6 months) | The intervention effects on 14 subscales of the Food Parenting Inventory were used as secondary outcome measures: Encourage try new foods (P), Encourage exploration of new foods (P), Urge child to eat new foods (P), Repeated Presentation of New foods (P), Family meals (P), Regular timing of meals and snacks (P), Inconsistent mealtimes (N), Indifferent feeding (N), Child involvement in food preparation (P), Pressure to Eat (N), Restriction (N), Food as a reward (N), Responsiveness to child's fullness cues (P), Monitoring (P). We also use one subscale of the Comprehensive Feeding Practices Questionnaire: Healthy Eating Guidance (P). All scales are rated on a 5-point Likert scale ranging from 1 (min) to 5 (max). Higher subscale scores indicate greater use of that child feeding practice. We have noted which practice has more positive/desirable practices with a (P) and more negative/not desired sub-scales have an (N) with higher scores. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Home Food Availability Change | Changes in Home Food Inventory Scores between baseline and study completion at 6 months | Home Food Inventory Change Scores. Home food inventory (HFI) will be used to assess a wide range of commonly available foods in the home environment. A total healthy food availability score will be created from the following items (fruit- frozen, canned, fresh or dried, vegetables-frozen, fresh or canned, milk, water, whole grains, legumes) with a higher score representing more availability of healthy foods. Scores can range from 0-11. An unhealthy food score will also be created from the following items (Chips, Cakes/Cookies, Candy, Pastries, Juice, Soda, Sports drinks, Sweetened Beverages)- scores can range from 0-8 with higher scores representing availability of unhealthy foods. |
Countries
United States
Participant flow
Recruitment details
Participants were recruited through a variety of active and passive strategies. For active recruitment, Special Supplemental Nutrition Program for Women, Infants and Children (WIC) nutritionists collected contact information of interested participants, which was then passed to research staff for follow-up. Study staff members also recruited caregivers in WIC waiting rooms or child welfare organizations.
Participants by arm
| Arm | Count |
|---|---|
| Healthy Feeding, Healthy Eating The experimental arm will receive three home over the first three months of the intervention.Visits will be conducted by a community health worker (CHW) trained in Motivational Interviewing. The home visits will include video-feedback on a meal; in-home cooking demonstrations; tailored text-messages, and mailed materials. During the last three months of the intervention, CHW will conduct monthly phone calls, together with mailed materials and text messages. The intervention will be tailored for families based on the child's appetitive traits and eating behaviors.
Healthy Feeding, Healthy Eating: Home Based Motivational Interviewing to Improve Diet Quality of Preschoolers | 33 |
| Reading and Readiness The Reading and Readiness group will receive information on school readiness promotion. Materials will be adapted and delivered by the community health worker (CHW) with a similar dose and schedule as the intervention group (three home visits and three phone calls). During the home visits, the CHW will show a video that models early childhood caregiver-child activities and demonstrates simple methods to interact with their children. They will also send a video of themselves reading with a child, receive text-messages based on these materials as well as the print materials during the last three months of the intervention.
Reading Readiness: Active Control that uses Motivational Interviewing to improve Reading Readiness of Preschool Children | 30 |
| Total | 63 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Lost to Follow-up | 5 | 8 |
| Overall Study | Withdrawal by Subject | 4 | 6 |
Baseline characteristics
| Characteristic | Reading and Readiness | Healthy Feeding, Healthy Eating | Total |
|---|---|---|---|
| Age, Continuous | 34.27 years STANDARD_DEVIATION 8.36 | 34.67 years STANDARD_DEVIATION 6.94 | 34.48 years STANDARD_DEVIATION 7.59 |
| Annual Household Income < $25,000 | 20 Participants | 14 Participants | 34 Participants |
| Annual Household Income $25,000-74,999 | 6 Participants | 14 Participants | 20 Participants |
| Annual Household Income >75,000 | 1 Participants | 2 Participants | 3 Participants |
| Annual Household Income Unknown | 3 Participants | 3 Participants | 6 Participants |
| Caregiver's relationship to child Father or other | 3 Participants | 3 Participants | 6 Participants |
| Caregiver's relationship to child Mother | 27 Participants | 30 Participants | 57 Participants |
| Country of birth Other | 17 Participants | 22 Participants | 39 Participants |
| Country of birth United States | 13 Participants | 11 Participants | 24 Participants |
| Currently living with a spouse/partner Missing | 1 Participants | 2 Participants | 3 Participants |
| Currently living with a spouse/partner No | 9 Participants | 8 Participants | 17 Participants |
| Currently living with a spouse/partner Yes | 20 Participants | 23 Participants | 43 Participants |
| Currently pregnant Missing | 3 Participants | 4 Participants | 7 Participants |
| Currently pregnant No | 22 Participants | 27 Participants | 49 Participants |
| Currently pregnant Yes | 5 Participants | 2 Participants | 7 Participants |
| Employment status Employment full time | 5 Participants | 10 Participants | 15 Participants |
| Employment status Employment part time | 7 Participants | 6 Participants | 13 Participants |
| Employment status Other, includes employed seasonally, unemployed/looking for work, student, homemaker and disable. ) | 18 Participants | 17 Participants | 35 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 26 Participants | 29 Participants | 55 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 4 Participants | 4 Participants | 8 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Food Assistance Missing | 1 Participants | 0 Participants | 1 Participants |
| Food Assistance No | 5 Participants | 6 Participants | 11 Participants |
| Food Assistance Yes | 24 Participants | 27 Participants | 51 Participants |
| Food insecurity No | 13 Participants | 22 Participants | 35 Participants |
| Food insecurity Yes, Includes any level of food insecurity | 17 Participants | 11 Participants | 28 Participants |
| Gender of target child Female | 10 Participants | 18 Participants | 28 Participants |
| Gender of target child Male | 20 Participants | 15 Participants | 35 Participants |
| Highest level of education College | 13 Participants | 18 Participants | 31 Participants |
| Highest level of education High School | 12 Participants | 11 Participants | 23 Participants |
| Highest level of education Less than 8th grade | 5 Participants | 4 Participants | 9 Participants |
| Language used at home English | 12 Participants | 9 Participants | 21 Participants |
| Language used at home Missing | 0 Participants | 1 Participants | 1 Participants |
| Language used at home Spanish | 18 Participants | 23 Participants | 41 Participants |
| Marital status Married | 13 Participants | 15 Participants | 28 Participants |
| Marital status Missing | 7 Participants | 3 Participants | 10 Participants |
| Marital status Not married includes never married, separated, divorced, widowed. | 10 Participants | 15 Participants | 25 Participants |
| Number of children (<18 y) living at home One | 11 Participants | 8 Participants | 19 Participants |
| Number of children (<18 y) living at home Two or more | 19 Participants | 25 Participants | 44 Participants |
| Number of other adults living in home Missing | 0 Participants | 1 Participants | 1 Participants |
| Number of other adults living in home None | 3 Participants | 2 Participants | 5 Participants |
| Number of other adults living in home One | 6 Participants | 9 Participants | 15 Participants |
| Number of other adults living in home Two or more | 21 Participants | 21 Participants | 42 Participants |
| Race/Ethnicity, Customized Multiracial | 5 Participants | 6 Participants | 11 Participants |
| Race/Ethnicity, Customized Other | 7 Participants | 6 Participants | 13 Participants |
| Race/Ethnicity, Customized Unknown | 6 Participants | 9 Participants | 15 Participants |
| Race/Ethnicity, Customized White | 12 Participants | 12 Participants | 24 Participants |
| Region of Enrollment United States | 30 participants | 33 participants | 63 participants |
| Sex: Female, Male Female | 28 Participants | 30 Participants | 58 Participants |
| Sex: Female, Male Male | 2 Participants | 3 Participants | 5 Participants |
| Target child attends childcare No | 21 Participants | 22 Participants | 43 Participants |
| Target child attends childcare Yes | 9 Participants | 11 Participants | 20 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 33 | 0 / 30 |
| other Total, other adverse events | 0 / 33 | 0 / 30 |
| serious Total, serious adverse events | 0 / 33 | 0 / 30 |
Outcome results
Primary
HEI-2015 Total and Component Scores
HEI-2015 scores will be calculated from twenty four hour recall data (two of them which are combined and scored per 1000 kcal or as a % of intake per NCI scoring guidelines). HEI was designed to measure diet quality in terms of how well diets conform to the 2015 Dietary Guidelines for Americans. The total HEI score represents the sum of 12 components scores (minimum component can be 0 and maximum component score shown in parentheses for each), including total fruit (5), whole fruit (5), total vegetables (5), green and beans (includes dark green vegetables and cooked, dried beans and peas because intakes of these types of vegetables are furthest from the amounts recommended in the USDA Food Patterns) (5), whole grain (10), dairy (10), total protein food (5), seafood and plant proteins (5), fatty acids (10), refined grains (10), sodium (10) added sugar (10), saturated fat (10). Higher scores reflect better outcomes.
Time frame: Healthy Eating Index Scores at study completion (6 months)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Healthy Feeding, Healthy Eating | HEI-2015 Total and Component Scores | HEI-2015 Added Sugar | 7.4 score on a scale | Standard Deviation 2.7 |
| Healthy Feeding, Healthy Eating | HEI-2015 Total and Component Scores | HEI-2015 Total Protein | 4.5 score on a scale | Standard Deviation 1.8 |
| Healthy Feeding, Healthy Eating | HEI-2015 Total and Component Scores | HEI-2015 Greens & Beans | 2.5 score on a scale | Standard Deviation 2.4 |
| Healthy Feeding, Healthy Eating | HEI-2015 Total and Component Scores | HEI-2015 Seafood Plant Protein | 2.3 score on a scale | Standard Deviation 2.4 |
| Healthy Feeding, Healthy Eating | HEI-2015 Total and Component Scores | HEI-2015 total | 61.6 score on a scale | Standard Deviation 10.8 |
| Healthy Feeding, Healthy Eating | HEI-2015 Total and Component Scores | HEI-2015 Fatty Acid | 3.5 score on a scale | Standard Deviation 3.1 |
| Healthy Feeding, Healthy Eating | HEI-2015 Total and Component Scores | HEI-2015 Whole Fruit | 4.1 score on a scale | Standard Deviation 1.7 |
| Healthy Feeding, Healthy Eating | HEI-2015 Total and Component Scores | HEI-2015 Sodium | 4.8 score on a scale | Standard Deviation 3.2 |
| Healthy Feeding, Healthy Eating | HEI-2015 Total and Component Scores | HEI-2015 Total Vegetable | 2.1 score on a scale | Standard Deviation 1.5 |
| Healthy Feeding, Healthy Eating | HEI-2015 Total and Component Scores | HEI-2015 Refined Grain | 6.6 score on a scale | Standard Deviation 2.9 |
| Healthy Feeding, Healthy Eating | HEI-2015 Total and Component Scores | HEI-2015 Whole Grain | 4.6 score on a scale | Standard Deviation 3.4 |
| Healthy Feeding, Healthy Eating | HEI-2015 Total and Component Scores | HEI-2015 Total Dairy | 8.3 score on a scale | Standard Deviation 2.7 |
| Healthy Feeding, Healthy Eating | HEI-2015 Total and Component Scores | HEI-2015 Saturated Fats | 7.0 score on a scale | Standard Deviation 3.1 |
| Healthy Feeding, Healthy Eating | HEI-2015 Total and Component Scores | HEI-2015 Total Fruit | 3.9 score on a scale | Standard Deviation 1.6 |
| Reading and Readiness | HEI-2015 Total and Component Scores | HEI-2015 Saturated Fats | 7.6 score on a scale | Standard Deviation 3 |
| Reading and Readiness | HEI-2015 Total and Component Scores | HEI-2015 Total Fruit | 3.8 score on a scale | Standard Deviation 1.8 |
| Reading and Readiness | HEI-2015 Total and Component Scores | HEI-2015 Whole Grain | 4.0 score on a scale | Standard Deviation 3.9 |
| Reading and Readiness | HEI-2015 Total and Component Scores | HEI-2015 total | 65.7 score on a scale | Standard Deviation 12.9 |
| Reading and Readiness | HEI-2015 Total and Component Scores | HEI-2015 Total Vegetable | 2.3 score on a scale | Standard Deviation 1.5 |
| Reading and Readiness | HEI-2015 Total and Component Scores | HEI-2015 Greens & Beans | 2.7 score on a scale | Standard Deviation 2.3 |
| Reading and Readiness | HEI-2015 Total and Component Scores | HEI-2015 Whole Fruit | 2.8 score on a scale | Standard Deviation 2.4 |
| Reading and Readiness | HEI-2015 Total and Component Scores | HEI-2015 Total Dairy | 8.7 score on a scale | Standard Deviation 2 |
| Reading and Readiness | HEI-2015 Total and Component Scores | HEI-2015 Total Protein | 4.0 score on a scale | Standard Deviation 1.6 |
| Reading and Readiness | HEI-2015 Total and Component Scores | HEI-2015 Seafood Plant Protein | 3.1 score on a scale | Standard Deviation 2.2 |
| Reading and Readiness | HEI-2015 Total and Component Scores | HEI-2015 Fatty Acid | 5.2 score on a scale | Standard Deviation 3.1 |
| Reading and Readiness | HEI-2015 Total and Component Scores | HEI-2015 Sodium | 7.0 score on a scale | Standard Deviation 2.7 |
| Reading and Readiness | HEI-2015 Total and Component Scores | HEI-2015 Refined Grain | 7.0 score on a scale | Standard Deviation 2.9 |
| Reading and Readiness | HEI-2015 Total and Component Scores | HEI-2015 Added Sugar | 7.5 score on a scale | Standard Deviation 3.2 |
Comparison: Inverse probability of retention weighted normal linear regression models for between-arm differences in HEI-2015 total score controlling for baseline HEI-2015 saturated fat, child involvement in food preparation, and receipt of any food assistance.p-value: 1Regression, Linear
Comparison: Inverse probability of retention weighted normal linear regression models for between-arm differences in HEI-2015 total vegetable component controlling for baseline HEI-2015 saturated fat, child involvement in food preparation, and receipt of any food assistance.p-value: 1Regression, Linear
Comparison: Inverse probability of retention weighted normal linear regression models for between-arm differences in HEI-2015 greens and beans component controlling for baseline HEI-2015 saturated fat, child involvement in food preparation, and receipt of any food assistance.p-value: 0.2Regression, Linear
Comparison: Inverse probability of retention weighted normal linear regression models for between-arm differences in HEI-2015 total fruit component controlling for baseline HEI-2015 saturated fat, child involvement in food preparation, and receipt of any food assistance.p-value: 0.2Regression, Linear
Comparison: Inverse probability of retention weighted normal linear regression models for between-arm differences in HEI-2015 whole fruit component controlling for baseline HEI-2015 saturated fat, child involvement in food preparation, and receipt of any food assistance.p-value: 0.19Regression, Linear
Comparison: Inverse probability of retention weighted normal linear regression models for between-arm differences in HEI-2015 whole grain component controlling for baseline HEI-2015 saturated fat, child involvement in food preparation, and receipt of any food assistance.p-value: 1Regression, Linear
Comparison: Inverse probability of retention weighted normal linear regression models for between-arm differences in HEI-2015 total dairy component controlling for baseline HEI-2015 saturated fat, child involvement in food preparation, and receipt of any food assistance.p-value: 1Regression, Linear
Comparison: Inverse probability of retention weighted normal linear regression models for between-arm differences in HEI-2015 total protein foods component controlling for baseline HEI-2015 saturated fat, child involvement in food preparation, and receipt of any food assistance.p-value: 1Regression, Linear
Comparison: Inverse probability of retention weighted normal linear regression models for between-arm differences in HEI-2015 seafood and plant protein component controlling for baseline HEI-2015 saturated fat, child involvement in food preparation, and receipt of any food assistance.p-value: -0.12Regression, Linear
Comparison: Inverse probability of retention weighted normal linear regression models for between-arm differences in HEI-2015 fatty acid component controlling for baseline HEI-2015 saturated fat, child involvement in food preparation, and receipt of any food assistance.p-value: 1Regression, Linear
Comparison: Inverse probability of retention weighted normal linear regression models for between-arm differences in HEI-2015 sodium component controlling for baseline HEI-2015 saturated fat, child involvement in food preparation, and receipt of any food assistance.p-value: 1Regression, Linear
Comparison: Inverse probability of retention weighted normal linear regression models for between-arm differences in HEI-2015 refined grains component controlling for baseline HEI-2015 saturated fat, child involvement in food preparation, and receipt of any food assistance.p-value: 1Regression, Linear
Comparison: Inverse probability of retention weighted normal linear regression models for between-arm differences in HEI-2015 added sugar component controlling for baseline HEI-2015 saturated fat, child involvement in food preparation, and receipt of any food assistance.p-value: 1Regression, Linear
p-value: 1Regression, Linear
Secondary
Food Parenting Practices
The intervention effects on 14 subscales of the Food Parenting Inventory were used as secondary outcome measures: Encourage try new foods (P), Encourage exploration of new foods (P), Urge child to eat new foods (P), Repeated Presentation of New foods (P), Family meals (P), Regular timing of meals and snacks (P), Inconsistent mealtimes (N), Indifferent feeding (N), Child involvement in food preparation (P), Pressure to Eat (N), Restriction (N), Food as a reward (N), Responsiveness to child's fullness cues (P), Monitoring (P). We also use one subscale of the Comprehensive Feeding Practices Questionnaire: Healthy Eating Guidance (P). All scales are rated on a 5-point Likert scale ranging from 1 (min) to 5 (max). Higher subscale scores indicate greater use of that child feeding practice. We have noted which practice has more positive/desirable practices with a (P) and more negative/not desired sub-scales have an (N) with higher scores.
Time frame: Food Parenting Practices at study completion (6 months)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Healthy Feeding, Healthy Eating | Food Parenting Practices | Family meals (P) | 4.4 units on a scale | Standard Deviation 0.5 |
| Healthy Feeding, Healthy Eating | Food Parenting Practices | Child involvement in food preparation (P) | 3.0 units on a scale | Standard Deviation 0.8 |
| Healthy Feeding, Healthy Eating | Food Parenting Practices | Encourage exploration of new foods (P) | 3.9 units on a scale | Standard Deviation 0.9 |
| Healthy Feeding, Healthy Eating | Food Parenting Practices | Pressure to Eat (N) | 3.3 units on a scale | Standard Deviation 1.1 |
| Healthy Feeding, Healthy Eating | Food Parenting Practices | Regular timing of meals and snacks (P) | 4.3 units on a scale | Standard Deviation 0.6 |
| Healthy Feeding, Healthy Eating | Food Parenting Practices | Restriction (N) | 4.0 units on a scale | Standard Deviation 1.2 |
| Healthy Feeding, Healthy Eating | Food Parenting Practices | Repeated Presentation of New foods (P) | 4.0 units on a scale | Standard Deviation 0.9 |
| Healthy Feeding, Healthy Eating | Food Parenting Practices | Food as a reward (N) | 3.0 units on a scale | Standard Deviation 1 |
| Healthy Feeding, Healthy Eating | Food Parenting Practices | Inconsistent mealtimes (N) | 2.1 units on a scale | Standard Deviation 0.9 |
| Healthy Feeding, Healthy Eating | Food Parenting Practices | Responsiveness to child's fullness cues (P) | 4.2 units on a scale | Standard Deviation 0.8 |
| Healthy Feeding, Healthy Eating | Food Parenting Practices | Urge child to eat new foods (P) | 4.2 units on a scale | Standard Deviation 0.7 |
| Healthy Feeding, Healthy Eating | Food Parenting Practices | Monitoring (P) | 3.8 units on a scale | Standard Deviation 1 |
| Healthy Feeding, Healthy Eating | Food Parenting Practices | Indifferent feeding (N) | 2.5 units on a scale | Standard Deviation 1.2 |
| Healthy Feeding, Healthy Eating | Food Parenting Practices | Healthy Eating Guidance (P | 4.6 units on a scale | Standard Deviation 0.4 |
| Healthy Feeding, Healthy Eating | Food Parenting Practices | Encourage try new foods (P) | 4.1 units on a scale | Standard Deviation 0.5 |
| Reading and Readiness | Food Parenting Practices | Healthy Eating Guidance (P | 4.4 units on a scale | Standard Deviation 0.7 |
| Reading and Readiness | Food Parenting Practices | Encourage try new foods (P) | 4.1 units on a scale | Standard Deviation 0.6 |
| Reading and Readiness | Food Parenting Practices | Encourage exploration of new foods (P) | 3.9 units on a scale | Standard Deviation 1.2 |
| Reading and Readiness | Food Parenting Practices | Urge child to eat new foods (P) | 4.1 units on a scale | Standard Deviation 0.8 |
| Reading and Readiness | Food Parenting Practices | Repeated Presentation of New foods (P) | 4.0 units on a scale | Standard Deviation 0.9 |
| Reading and Readiness | Food Parenting Practices | Family meals (P) | 3.6 units on a scale | Standard Deviation 0.8 |
| Reading and Readiness | Food Parenting Practices | Regular timing of meals and snacks (P) | 2.2 units on a scale | Standard Deviation 1 |
| Reading and Readiness | Food Parenting Practices | Inconsistent mealtimes (N) | 2.2 units on a scale | Standard Deviation 1 |
| Reading and Readiness | Food Parenting Practices | Indifferent feeding (N) | 2.7 units on a scale | Standard Deviation 1.1 |
| Reading and Readiness | Food Parenting Practices | Child involvement in food preparation (P) | 2.8 units on a scale | Standard Deviation 1.2 |
| Reading and Readiness | Food Parenting Practices | Pressure to Eat (N) | 3.4 units on a scale | Standard Deviation 1.1 |
| Reading and Readiness | Food Parenting Practices | Restriction (N) | 4.1 units on a scale | Standard Deviation 1.1 |
| Reading and Readiness | Food Parenting Practices | Food as a reward (N) | 3.5 units on a scale | Standard Deviation 0.9 |
| Reading and Readiness | Food Parenting Practices | Responsiveness to child's fullness cues (P) | 3.6 units on a scale | Standard Deviation 1.2 |
| Reading and Readiness | Food Parenting Practices | Monitoring (P) | 3.8 units on a scale | Standard Deviation 1.2 |
Other Pre-specified
Home Food Availability Change
Home Food Inventory Change Scores. Home food inventory (HFI) will be used to assess a wide range of commonly available foods in the home environment. A total healthy food availability score will be created from the following items (fruit- frozen, canned, fresh or dried, vegetables-frozen, fresh or canned, milk, water, whole grains, legumes) with a higher score representing more availability of healthy foods. Scores can range from 0-11. An unhealthy food score will also be created from the following items (Chips, Cakes/Cookies, Candy, Pastries, Juice, Soda, Sports drinks, Sweetened Beverages)- scores can range from 0-8 with higher scores representing availability of unhealthy foods.
Time frame: Changes in Home Food Inventory Scores between baseline and study completion at 6 months