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Assessing children’s skin carotenoid score (SCS) using reflection spectroscopy (RS) is a non-invasive, widely used method to approximate fruit and vegetable consumption (FVC). The aims for the current review were to (1) identify distributions of SCS across demographic groups, (2) identify potential non-dietary correlates for RS-based SCS, (3) summarize the validity and reliability of RS-based SCS assessment, and (4) conduct meta-analyses of studies examining the correlation between RS-based SCS with FVC. A literature search in eight databases in June 2021 resulted in 4880 citations and peer-reviewed publications written in English that investigated children’s (2–10 years old) SCS using RS. We included 11 studies (intervention = 3, observational = 8). Potential covariates included weight status, ethnicity, seasonal variation, age, sex, and income. Studies reported criterion validity with children’s FVC but not with plasma carotenoid. Additionally, no studies reported the reliability of RS-based SCS in children. Among the 726 children included in the meta-analysis, the correlation between RS-based SCS and FVC was r = 0.2 (p < 0.0001). RS-based SCS is a valid method to quantify skin carotenoids for children’s FVC estimation with the potential for evaluating nutrition policies and interventions. However, future research should use standardized protocol for using RS and establish how RS-based SCS can translate to the amount of daily FVC in children.

Objective:To compare the association of participation in Supplemental Nutrition Assistance Program (SNAP) alone v. in combination with Head Start (HS), Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) or both on household dietary environment (HDE) indicators: food security, nutrition security, healthfulness choice, dietary choice, perceived food store availability, utilisation barriers and healthy food access barriers in families with young children.Design:This study, part of SNAP-Ed Nebraska’s Needs and Assets Assessment ‘Healthy People, Healthy State’, utilised a cross-sectional design. HDE indicator means were compared across the federal assistance program (FAP) participation groups using multivariate ANCOVA, controlling for significant demographics, with Benjamini–Hochberg-adjusted P values compared with α = 0·05.Setting:Nebraska’s low-income households.Participants:Households (n 821) with at least one child aged 2–6 years participating in SNAP-only (n 257), SNAP + HS (n 349), SNAP + WIC (n 132) and SNAP + WIC + HS (n 83).Results:Compared with other groups, SNAP + HS reported comparatively higher levels of household food security, whereas SNAP + HS + WIC reported lower levels (P < 0·01). SNAP + HS also showed higher levels of nutrition security, dietary choices, perceived availability of healthy foods in stores, fewer healthy food access and utilisation barriers (P < 0·05).Conclusions:The findings support recent joint policy changes by Administration for Children and Families and Food and Nutrition Service, facilitating SNAP households’ access to HS. HS performance standards for nutrition and family engagement can serve as a model for creating healthy HDE. Future research should employ quasi-experimental or longitudinal designs to establish causal relationships between FAP participation and HDE outcomes.

To determine whether the 'Read for Nutrition' programme would increase liking and consumption of broccoli (a target vegetable) in preschool children and test acceptability and practicality of the programme. Pilot pre-post intervention study, where childcare teachers received training and coaching followed by reading the book 'Monsters Don't Eat Broccoli' multiple times with the children during a three-week intervention. Five classrooms of Educare, Lincoln, Nebraska in 2018. Sixty-nine (11 to 16 children per classroom) preschool-aged children and sixteen teachers (minimum, three per classroom). Average total consumption of broccoli increased 35 % (0·14 ounces or 0·05th cup) after the 'Read for Nutrition' programme ( = 2·66; = 0·01; 95 % CIs (0·035, 0·246)) for all children. Proportional consumption increased for children who received ≥ five exposures to the book ( = 2·77; = 0·008). Exposures to the book predicted proportional consumption ( = 0·365; = 0·002). Liking of broccoli increased ( = 2·2, = 0·03) as well. Teachers rated the programme as acceptable, practical and enjoyable to children and to themselves. Programmes such as 'Read for Nutrition' have the potential to improve children's vegetable liking and consumption in early care and education settings with only book readings and no exposure to a real vegetable.

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.

To: (i) understand the nutrition attitudes, self-efficacy, knowledge and practices of school food-service personnel (SFP) in Nebraska and (ii) identify potential barriers that schools face in offering healthy school meals that meet the US Department of Agriculture (USDA) nutrition standards. Convergent parallel mixed-methods study. Kindergarten-12th grade schools in Nebraska, USA.ParticipantsSFP (260 survey participants; fifteen focus group participants) working at schools that participate in the USDA National School Lunch Program. Mixed-methods themes identified include: (i) 'Mixed attitudes towards healthy meals', which captured a variety of conflicting positive and negative attitudes depending on the situation; (ii) 'Positive practices to promote healthy meals', which captured offering, serving and promotion practices; (iii) 'Mixed nutrition-related knowledge', which captured the variations in knowledge depending on the nutrition concept; and (iv) 'Complex barriers', which captured challenges with time, support and communication. The study produced relevant findings to address the barriers identified by SFP. Implementing multicomponent interventions and providing training to SFP may help reduce some of the identified barriers of SFP.

Explore the interrelationship between teachers' personal and professional socio-ecological structures while examining Head Start (HS) teachers' experiences with (1) trying to eat healthy and engage in physical activity (PA) and (2) promote healthy eating and PA in their classrooms. In-depth semi-structured interviews were collected from March through June 2017. Researchers designed the data collection and analysis methods using a phenomenological approach. All interviews were recorded using digital audio and transcribed verbatim. Seven HS centres in two rural eastern North Carolina counties. Teachers (n 15) who had recently participated in a healthy eating and physical activity intervention. Participants were 100 % female, an average age of 43 years (sd 9·6) and primarily Black/African American (93·3 %). Eighteen primary themes were identified providing unique insight into individual, social and environmental determinants that may influence teachers' personal health behaviours and professional health promotion practices. Findings indicated that teachers want to improve health behaviours personally (individual/family health) and professionally (children/families served); however, barriers exist at all levels impacting their ability to improve their own health and facilitate positive behaviours among the children/families they serve. Many teachers observed connections between their personal and professional experiences, but not beyond the individual level. Study findings highlight the importance of considering and emphasising the potential relationship between personal and professional determinants of health when working with early childhood teachers. Findings from this study may be useful for informing the development, implementation and evaluation of future health promotion interventions using teachers as implementers.

The study aims to identify family child care home (FCCH) setting- and environment-level predictors related to providers’ perceived difficulty in implementing the Child and Adult Care Food Program (CACFP) recommendations for serving vegetables to children. This was a cross-sectional study, which used a validated paper-based survey with a multi-method data analysis approach. Participants were licenced FCCH providers (N = 943) in Nebraska, who were predominantly White (94%), non-Hispanic (97%), CACFP-participants (89%), and in urban areas (64%). Reflective latent variable modelling was conducted in Mplus to explore associations between dependent variable and predictors. Dependent variable was providers’ perceived difficulty to implement CACFP recommendations for serving vegetables. Predictors were providers’ mealtime practices, perceived barriers to serve healthy foods, CACFP participation, geographic location, food access, food insecurity, and child poverty. Qualitative comments (n=122) from the survey were analysed using direct content analysis approach. Providers’ perceived lack of time to prepare foods and perceived children’s taste preferences increased their perceived difficulty; and CACFP-participation decreased their perceived difficulty to implement CACFP recommendations for serving vegetables. Qualitative comments highlighted that providers felt discouraged to serve vegetables knowing that vegetables would likely be wasted because of children’s preferences. More tailored professional development is required to address FCCH providers’ perceived difficulty and build providers’ skills on preparing time saving, CACFP-reimbursable and appealing vegetable recipes, and on strategies to promote vegetable consumption in children.

Background: Family style meal service is a nationally endorsed best practice. However, implementation in family child care homes (FCCHs) is low because child care providers are worried that it could increase plate waste. To examine this perceived barrier, the study aims to investigate the association between family style meal service and plate waste in FCCHs in Nebraska. Methods: In this cross-sectional study, the participants included FCCH providers ( n = 46) in Nebraska and 3–5-year-old children attending these FCCH settings ( n = 146). Providers were given a family style meal service score using 11 items from the Mealtime Observation in Child Care tool. Children’s plate waste data over the observed lunchtime were collected using the Dietary Observation in Child Care method. We conducted multivariate, multilevel regression analyses in SAS (v9.4) to assess the relationship between family style meal service score and children’s plate waste, while controlling for child-level characteristics and accounting for FCCH setting-level effects (ICCs 11.3%–31.2%). Results: Increase in family style meal service score was associated with a decrease in vegetable waste ( B = −4.7, p = 0.03), fruit waste ( B = −3.6, p = 0.03), and protein waste ( B = −4.2, p = 0.02). Dairy and grain waste were not associated with family style meal service score. Conclusions: A higher family style meal service score was associated with a 3%–5% reduction in plate waste for three food groups. These findings warrant further research examining the effect of interventions promoting family style meal service in child care on improving children’s dietary intake and reducing plate waste.

Background: Although racial, ethnic minorities, and immigrants are more likely to have poor diet-related health outcomes, few studies have compared children’s dietary quality across diverse households, which is the formative step to designing targeted interventions. The current study evaluates and compares the dietary quality of young children from diverse racial, ethnic, and immigrant households in Nebraska. Methods: Cross-sectional survey data were collected from adults living in Nebraska with at least one 2–6-year-old child residing in their household via an online survey regarding their federal assistance program participation and dietary quality of child(ren) residing in their household, measured using the short Healthy Eating Index (sHEI). Results: With nearly two-third participating in a federal assistance program, the sample includes respondents from diverse households ( n = 1,277) including first-generation immigrant ( n = 61), non-immigrant Hispanic ( n = 538), non-immigrant non-Hispanic White ( n = 509), non-immigrant non-Hispanic Black or African American ( n = 120), and non-Hispanic American Indian or Native Hawaiian ( n = 49). Based on analysis of covariance controlling for demographic variables, children from immigrant households had lower mean sHEI score 43.9 as compared to non-immigrant Hispanic 46.4, non-immigrant non-Hispanic White 47.1, non-immigrant non-Hispanic Black or African American 50.2, and non-Hispanic American Indian or Native Hawaiian 48.9. Racial/ethnic/immigrant household group differences were also observed for some sHEI component scores. Conclusions: Children from immigrant and non-immigrant Hispanic households had significantly lower sHEI scores on some subcomponents compared with other groups. Findings emphasize the need for additional research and culturally responsive multilevel nutrition interventions.

To determine if family childcare homes (FCCH) in Nebraska meet best practices for nutrition and screen time, and if focusing on nutrition and screen time policies and practices improves the FCCH environment. A pre-post evaluation was conducted using the Go Nutrition and Physical Activity Self-Assessment for Childcare (Go NAP SACC). FCCH in Nebraska, USA. FCCH enrolled in the Child and Adult Care Food Program (CACFP; n 208) participated in a pre-post evaluation using Go NAP SACC. At baseline, all FCCH met the minimum childcare standards for fifty-four of fifty-six practices in nutrition and screen time. After the intervention, FCCH demonstrated significant improvement in fourteen of the forty-four Child Nutrition items and eleven of the twelve Screen Time items. However, FCCH providers did not meet best practices at post-intervention. Lowest scores were found in serving meals family-style, promoting visible support for healthy eating, planned nutrition education and written policy on child nutrition. For screen time, lowest scores were reported on the availability of television, offering families education on screen time and having a written policy on screen time. FCCH in Nebraska were able to strengthen their policies and practices after utilizing Go NAP SACC. Continued professional development and participation in targeted interventions may assist programmes in sustaining improved practices and policies. Considering the varying standards and policies surrounding FCCH, future studies comparing the current findings with childcare centres and non-CACFP programmes are warranted.