BRIDGING HOME AND PRESCHOOL ENVIRONMENTS TO PROMOTE HEALTHY EATING AND ACTIVITY BEHAVIORS AND PREVENT OBESITY IN EARLY CHILDHOOD

• Sponsoring Institution: National Institute of Food and Agriculture
• Project Status: COMPLETE
• Funding Source: AFRI COMPETITIVE GRANT
• Reporting Frequency: Annual
• Accession No.: 1005676
• Grant No.: 2015-68001-23240
• Cumulative Award Amt.: $4,989,552.00
• Proposal No.: 2014-08398
• Project Start Date: May 1, 2015
• Project End Date: Apr 30, 2022
• Grant Year: 2019
• Program Code: [A2101]- Childhood Obesity Prevention: Integrated Research, Education, and Extension to Prevent Childhood Obesity

Project Director
Cunningham-Sabo, L.

Recipient Organization
COLORADO STATE UNIVERSITY
(N/A)
FORT COLLINS,CO 80523

Performing Department
Food Science & Human Nutrition

Non Technical Summary
The HEROs Study (HEalthy EnviROnments Study) is an integrated Research, Extension, and Education project targeting preschoolers and their families with a long-term goal of reducing childhood obesity risk (Program Focus Area: Childhood Obesity). It addresses two central environments for young children, home and preschool, via developmentally appropriate, evidence-based, and innovative social marketing strategies. Building upon our current longitudinal study with preschoolers (the LEAP study), HEROs seeks to impact young children's healthy behaviors by incorporating our successes in improving willingness to try new foods and motor performance in preschool, and amplifying these effects by adding a powerful family component. We will target low income and Latino families living in rural Colorado, with the highest prevalence of obesity and health disparities. The project will develop technology-based mobile applications to improve parent-child interactions related to healthy eating and physical activity. In a quasi-experimental controlled design, the impact of the established Food Friends preschool programs (control) and the combined preschool and family-based programs (intervention) will be compared to determine effects on: 1) children's willingness to try new foods and dietary intake; 2) children's motor performance and physical activity; 3) quality of parent-child interactions related to eating and activity; and 4) the home environment. University students will gain valuable research experience and future educators, health care professionals and Extension agents, will receive childhood obesity prevention training. The project's long term goal is consistent with USDA's goal of improving the nation's nutrition and health by promoting the development of healthy eating and activity habits in children.

Animal Health Component

100%

Research Effort Categories

Basic

(N/A)

Applied

100%

Developmental

(N/A)

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
703	6010	1010	50%
724	6020	3030	50%

Knowledge Area
703 - Nutrition Education and Behavior; 724 - Healthy Lifestyle;

Subject Of Investigation
6010 - Individuals; 6020 - The family and its members;

Field Of Science
1010 - Nutrition and metabolism; 3030 - Information and communication;

Keywords

electronic media

health disparities

health literacy

home environment

obesity

preschool

Goals / Objectives
Overall Hypothesis/GoalThe overall objective of the HEROs Study (HEalthy EnviROnments Study) is to develop a companion, technology-based, interactive family intervention to assess the potential amplification of The Food Friends programs to promote healthy lifestyles and weight outcomes for young children in both Head Start and family settings.Specific ObjectivesThe project goal will be accomplished via the 3 functions of Agriculture Knowledge Systems (Research, Extension, and Education) and via the following objectives:Objective 1: To understand the target audience's behaviors, attitudes, motivations, facilitators, and barriers to improving the home environments we will conduct formative research including focus groups and interviews with parents, Head Start staff and community stakeholders. Function: ResearchObjective 2: To develop a family intervention that is tailored to our target audience, we will utilize the findings of our formative work to develop an instructional program, within the framework of electronic media, which will help children and parents to learn together and build skills related to healthy eating and activity. This interactive technology will increase parents' health literacy, facilitate improvements in the home food and activity environments, and support children's adoption of healthy eating and activity behaviors. Functions: Research & EducationObjective 3: To implement and evaluate the effectiveness of the family-based educational program, we will conduct an intervention in rural Colorado, delivered by Extension agents and Head Start teachers to families of limited resources who are at increased risk for childhood obesity. We will explore whether family functioning and organization impact the home food and activity environments and whether prior family functioning mediates the impact/adoption of the intervention. Functions: Research & ExtensionObjective 4: To advance knowledge related to childhood obesity prevention, we will train future educators, health professionals and Extension agents and increase knowledge exchange with current preschool educators, university faculty and parents. Functions: Research & Education

Project Methods
Efforts: Our goal for the HEROs Study is to use and build upon the strategies and messages utilized in The Food Friends programs to conduct a complementary family component for children and parents. The HEROs study will develop an innovative intervention for parents of preschoolers, in rural communities with high health disparities, utilizing interactive technology. The intervention will aim to enhance health literacy, skills, and behavioral capabilities of parents while improving dietary and activity outcomes in children. Children will be encouraged to try new foods and engage in physical activity at both school and home. We plan that the HERO's intervention will consist of both child-centered and parent components that facilitate parent-child interaction. The program will be delivered via a hybrid of face-to-face parent/family sessions (offered by Extension agents and Head Start parent/family coordinators) and mobile applications.Evaluation: This project aims to evaluate the extent to which a family-based intervention delivered via electronic media presented on an electronic tablet (or similar) platforms augments a successful theory-based nutrition and physical activity programming, specifically Food Friends and Mighty Moves delivered in preschool. We will evaluate the success of the project by comparing 2 groups in a quasi-experimental controlled study design: 1) the control group will receive the established, school-based Food Friends and Mighty Moves program; 2) the intervention group will receive the new family-based intervention program combined with the school-based programs. We will compare these 2 groups before and after the intervention programs, using a variety of outcome measures obtained from both children and parents. Research questions and their measures include:1. Do children participating in the family-based intervention demonstrate enhanced PA and eating behaviors?Hypothesis 1.1: Children receiving the family-based intervention will have higher PA levels and enhanced motor skills compared to children in the control group. (Dependent Measures: Physical Activity Survey, Accelerometers & PDMS-2 [gross motor skills])Hypothesis 1.2: Children receiving the family-based intervention will demonstrate enhanced eating behaviors compared to children in the control group. (Dependent Measures: Taste Panel [willingness to try new foods], consumption of novel foods, & Food Frequency)2. Can the home environment be improved by parents' self-monitoring of food availability and electronic devices in the child's bedroom?Hypothesis 2.1: Evaluation of food items in the home and electronic devices in the child's bedroom will demonstrate a more positive home environment of participants receiving the family-based HEROs intervention. (Dependent Measures: Home IDEA, Screentime estimate survey)3. Do parents and children participating in the family-based intervention demonstrate higher levels and increased quality of parent-child interaction during play? (Measures: Videotaped Parent-Child Interaction)

Progress 05/01/15 to 04/30/22

Outputs
Target Audience:Collectively, we reached 610 families at five Head Start/preschool centers across eastern Colorado. A majority of our participants were mothers. Participants had a range of education levels (~45% had a high school diploma or less) and approximately 40% identified as Hispanic/Latino, which is representative of demographics among Head Start families in Colorado. More than 2/3rds were considered low-income (<185% of poverty). Changes/Problems:Year 3: During Year 3 several changes in the landscape of preschool-based nutrition and activity programming in Colorado came to our attention necessitated modifications to our proposed intervention study and Objective 3. Specifically, due to changes in SNAP-Ed funding in Colorado, other preschool programs have elected to implement other nutrition and activity curricula. This change affected our ability to carry out our intervention study as proposed with an adequate sample size. We thus focused on testing implementation strategies and proof of concept. These changes were communicated to USDA and NIFA's National Program Leader and approved. Year 5-7: The COVID-19 pandemic began near the end of our intervention testing for the Family intervention. While we were able to complete the intervention delivery, we were unable to collect objective and observational measures. We were also unable to complete further recruitment of the Self-Care pilot or Parent-Child interaction studies. We were able to pivot and collect qualitative data virtually for both the family and self-care interventions and we had an adequate sample size in the parent-child interaction study to answer our primary research question. Manuscripts are being prepared on these components. Year 6-7: A change in PI occurred in 2021 as Dr. Laura Bellows changed institutions. Dr. Leslie Cunningham-Sabo is the PI of record, with Dr. Bellows leading all research, education, and extension aspects of the project through a subcontract in years 6-7. What opportunities for training and professional development has the project provided?Training was provided for 17 students (7 PhD, 5 Masters students, 3 undergraduates), 6 post-docs, and 4 research assistants. This consisted of Expert Workshops, IRB and Responsible Conduct of Research trainings. Expert workshops: 1) Mindful Parenting (D. Coatsworth), 2. Workshop Facilitation (D. Betts), 3. Quality Improvement (Plan-Do-Study-Act; SL Johnson), 4. Intervention Optimization (Multiple Optimization Strategy (MOST); K Guastaferro), 5. Intervention Development (D. Ward), 6. Intervention Design for Mealtimes (J. Fulkerson), 7. Qualitative Interview Techniques (L. Clark), 8. Dietary Intake Measures (C. Martin), 9. Childhood Feeding Practices, Strategies and Research (T.Kral), 10. Structural Equation Modeling (K. Grimm), 11. Qualitative Research Techniques (L. Clark), 12. Mobile Applications: Design Considerations (B. Chamberlin). Responsible Conduct of Research course (semester) and training modules IRB training Research Team Annual Retreats Professional Development was provided to research team members and students by attending a variety of professional conferences, university-sponsored programs/seminars, and short-courses. Society for Nutrition Education and Behavior (annually) American Society for Nutrition / Experimental Biology (annually) International Society for Behavioral Nutrition and Physical Activity (annually) Society for Behavioral Medicine (once) Society for Research and Child Development (once) American College of Sports Medicine (once) Digital Media in Learning (once) University programs/seminars Department seminars, Colorado State University, Cornell University and University of Colorado (weekly) Lillian Fountain Smith Conference, Colorado State University (bi-annually) Bronfenbrenner Center for Translational Research seminars, Cornell University (monthly) Center for Health Equity, Cornell University (quarterly) Short Courses Questionnaire Design for Social Surveys, Coursera Framework for Data Collection and Analysis, Coursera Data Collection: Online, Telephone and Face-to-face, Coursera Database Management, Colorado State University Atlas Qualitative Software workshops, University of Colorado NextGen Professors Program, Cornell University Postdoc Leadership Development Program, Cornell University How have the results been disseminated to communities of interest?Results from our study have been shared with participating Head Start and preschool centers. A final infographic for participants is under development. Research results have been primarily disseminated via journal articles (19 published, 10 in active preparation), conference presentations (31), dissertation/theses (5) as well as seminars and talks conducted by the research team. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? The overarching goal of this project was to provide parents of preschoolers with an intervention to improve children's diet and physical activity (PA) behaviors to promote healthy growth (and ultimately weight status). Beyond our priority populations (parents and preschoolers), this work provides evidence-based programming to Head Start and preschool centers and community stakeholders, such as Extension and Family Resource Centers. Educational workshops and field-based research opportunities have contributed to the development of the future workforce in nutrition and public health. Objective 1- Formative Research A mixed method iterative approach, using ecocultural theory, provided insights into 4 key topic areas: 1) food behaviors and environments, 2) PA behaviors and environments, 3) mobile device use, and 4) daily life. After analyses of these topics, a 5th topic area emerged, maternal self-care. Key finding served as the foundation of intervention design. Objective 2- Intervention Development HEROs Family Intervention. The intervention consisted of a 6-week family workshop series, including: parent workshop, child workshop and supporting materials (e.g., custom mobile apps). Parent workshops addressed mindful parenting, healthy eating and mealtimes, and PA and were designed to build parents' self-efficacy and behavioral capability, as well as provide strategies to promote healthy eating and activity behaviors with their preschoolers at home. Child workshops (SPORKshops) delivered tested activities aimed at improving willingness to try new foods and promoting PA and movement skills. Supporting materials focused on promoting parent-child interaction by providing additional at-home resources, including 4 mobile apps, educational enhancers, and other supports. Mobile Apps: Four custom, child-focused mobile apps - Jungle Gym 1, Jungle Gym 2, Spin-n-Go, and Tasting Party Express - were developed and provided on iPads to parents of preschoolers to build food and movement-based vocabulary, encourage trying new foods, and offer opportunities for PA. Jungle Gym 1 & 2 consisted of outdoor adventures that encouraged children to perform physical movements, Spin-n-Go asked children to perform a movement skill in which the spinner landed, and Tasting Party Express engaged children in feeding animated characters' new foods to virtually build familiarity with food textures and tastes. HEROs Self-Care Intervention. This component consists of 2 workshops and 4 individual health coaching sessions and supporting materials. This intervention focused on maternal health and addressed healthy eating, PA, stress and mindfulness. Objective 3- Intervention Testing HEROs Family Program. Thirty-three parent-child dyads from 2 preschool participated. Findings suggest that a mindful parenting approach to promote quality parent-child interactions during mealtimes and PA was feasible and well accepted. Parents reported developing a greater understanding of their preschooler and feeling less stressed about mealtime and PA interactions. Strategies related to mindful parenting were reported to positively influence how parents engaged with and communicated with their preschooler. Mobile Apps: Total downloads of the Apps were 43,359 (2019-2022). Our research indicates that children, on average, spend 80% of the app time (7 min) in moderate to vigorous PA. Parents reported high acceptability of the apps, perceived benefits towards target behavior, and likelihood for continued use. HEROs Self-Care Program. Participants (n=39) had high prevalence of cardiovascular risk factors with 70% of participants presenting with 3 or more risk factors with 60% were categorized as obese. Participants found the program to be feasible and acceptable. Recommendations for additional content and health coaching sessions are under consideration for future work. Parent-Child Interaction in PA. We examined parent-child interactions related to active play and electronic-facilitated PA (HEROs mobile apps and exergaming). Parent affection, responsiveness, encouragement, teaching and playfulness was examined in 20 families (16 mother-father-child triads, and 4 mother-child dyads, n=108 play sessions). Findings suggest that different types of parenting behaviors are elicited during parent-child interactions focused on PA, depending on the structure of the game. These differences (and in some instances, similarities) in parenting behaviors may foster multiple aspects of child development during PA. Objective 4 - Education We hosted 12 scholars (1.5 days) to present workshops, meet with students, and consult with PIs on a variety of topics relevant to the stage of the project. Project Impact The HEROs study was impactful in 3 areas. 1. An innovative approach to 'childhood obesity' interventions with parents Applying a mindful parenting approach, with an emphasis on child development, to healthy eating and PA, the HEROs study provided parents with knowledge and skills improved their own self-efficacy, behavioral capability, and parenting practices, aimed at ultimately impacting child target behaviors (willingness to try new foods and gross motor development). Post-intervention, participants articulated the importance of viewing their child as an individual and parenting to their temperament, personality, and other traits. Further, applying mindful parenting techniques reduced stress at mealtimes and was transferred as a parenting technique to other challenging parenting moments. Mindful parenting, in concert with an understanding of child development, resonated with study participants. During objective 1, it became clear that mothers were struggling with their own physical and psychological health, and thus there was a need to address mothers more holistically. Self-care, specifically mindful self-care, resonated with mothers as a feasible and acceptable strategy that deserves attention in future research as a mechanism to address childhood obesity. 2. Using digital strategies with low-income, rural populations As digital technology becomes more ubiquitous in daily life it is imperative to build digital tools to reach participants with behaviorally-focused information. Families in this study used study-issued iPads for data collection, program delivery, and communication with limited problems and need for tech support. Building on parent desires to provide age- and developmentally- appropriate educational apps to support engagement in our target behaviors, we developed 4 Apps. These have been freely available online since 2019 and were not promoted or heavily distributed prior to 2022. The impressive download numbers post-study (30,692 in 2021/22) indicate that these apps were found organically, through search, demonstrating a strong need for healthy, educational, free apps for this age group.Several large downloads from educational institutions indicate that the apps were also being used in a preschool setting.Noteworthy is the accolades for these apps with the 2022 award for the "Outstanding Professional Skill" award in the Informational Technology category (a "best in category" award), as well as a Gold award in Interactive Media Program from the Association for Communication Excellence. 3. Examining parent-child interactions during PA In the realm of eating and PA behavioral research, much work has been conducted to understand parent-child interactions at mealtimes, with little focused on how parents interact with their children during PA. Our study found differences in parenting styles between mothers and fathers as well as amongst intervention modalities (active play, HEROs mobile apps, and exergaming). Further analyses of our PA data will clarify the specific parenting behaviors that may be most responsible for differences across conditions (intervention modalities) and be used to further develop and test interventions designed to foster child development.

Publications

• Type: Journal Articles Status: Published Year Published: 2021 Citation: Barrett, K.J., Hibbs-Shipp, S.K.*, Hobbs, S., Boles, R.E., Johnson, S.L., Bellows, L.L. (2021). Validation of a Home Food Environment Instrument Assessing Household Food Patterning and Quality. Nutrients, 13, 3930. https://doi.org/10.3390/nu13113930
• Type: Journal Articles Status: Published Year Published: 2021 Citation: Mena, N.Z.*, Johnson, S.L., Ferrante, M.J.*, Hobbs, S.J.*, Zeng, N.*, Bellows, L.L. (2021). The SPORKS for Kids: Integrating Movement into Nutrition Education. Journal of Nutrition Education and Behavior, 53(10), 903-906. https://doi.org/10.1016/j.jneb.2021.07.002
• Type: Journal Articles Status: Published Year Published: 2021 Citation: Agard, R.*, Zeng, N.*, McCloskey, M., Johnson, S. L., & Bellows, L.L. (2021). Understanding Parent Perceptions related to Physical Activity and Motor Skill Development in Preschool Children. International Journal of Environmental Research and Public Health, 18(17), 9196. https://doi.org/10.3390/ijerph18179196
• Type: Conference Papers and Presentations Status: Published Year Published: 2022 Citation: Reyes, L.I.*, Johnson, S.L., Chamberlin, B., Mena, N.Z., Bellows, L.L. (2022). Acceptability of digital apps developed to engage preschoolers in food tasting and physical activity in the home environment. Ann Behav Med, 56 (Suppl 1):S103. Presented at the Society for Behavioral Medicine. Baltimore, MD.
• Type: Conference Papers and Presentations Status: Published Year Published: 2022 Citation: Mena, N.Z.*, Johnson, S.L., Barrett, K., Bellows L.L. (2022). The HEROs Study: Engaging mothers in the development of preschoolers physical literacy. Ann Behav Med, 56 (Suppl 1):S629. Presented at the Society for Behavioral Medicine. Baltimore, MD.
• Type: Theses/Dissertations Status: Published Year Published: 2021 Citation: Hobbs, S. (2021). Well Moms, Healthy Kids: Targeting Maternal Health to Improve Child Weight Status. Department of Food Science and Human Nutrition, Colorado State University.
• Type: Theses/Dissertations Status: Published Year Published: 2021 Citation: Leib, A. (2021). Sedentary and Screentime behaviors in Preschool-aged Children. Department of Food Science and Human Nutrition, Colorado State University.

Progress 05/01/20 to 04/30/21

Outputs
Target Audience:No new participants were enrolled in the study in Year 6 due to COVID. In Year 5, we collectively reached 83 mothers, 17 fathers, and 58 preschool-aged children in our studies. Two-thirds of our participants were considered low-income with 1/3 identifying as Hispanic. The majority of participants resided in rural communities. Changes/Problems:COVID. The COVID pandemic has had produced significant impacts on our study, including limited data collection at post-intervention and follow-up interventions. We also had to pivot our data collection and added qualitative focus groups and interviews for the HEROs family and self-care programs. We were unable to conduct more the HEROs self-care program with more cohorts, however, we were able to alter our approach and test digital components for feasibility and acceptability. Lastly, due to the limitations of on-campus, in-person research, we closed enrollment to our parent-child PA interaction study early. After reviewing the data that we do have, we believe we will be able to conduct exploratory analyses to provide insights into parenting behaviors in the PA domain. Change in Project Director. At the end of 2020, Dr. Laura Bellows, the original PD, changed institutions. Dr. Leslie Cunningham-Sabo was approved as the new PD at Colorado State University. Dr. Bellows remains very engaged in the project and has an approved subaward at her new institution. No Cost Extension. Due to COVID and the change in PD (resulting in transfer of research activities), we applied and were awarded for a second No Cost Extension. We will use this time to modify intervention materials, conduct data analyses and submit abstracts/manuscripts. Protocol Deviation. A protocol deviation occurred in the fall 2020 and was reported to CSU IRB in December 2020. This resulted in a non-compliance deviation and a reportable unanticipated problem. This deviation occurred in the parent-child PA interaction study. Some data files went missing that included consent forms, demographic information, and questionnaires. The survey data that was collected in paper format for early participants (before they were transferred to an electronic format). At this time, it is unclear how the data went missing. Several things occurred which may have contributed to the misplacement of these files, including offices being rearranged due to COVID spacing requirements as well as the study coordinator and PI leaving CSU during this same time. No personal information or sensitive information was lost. Dr. Bellows is working with CSU's IRB and Responsible Conduct of Research office for corrective actions. What opportunities for training and professional development has the project provided? Society for Nutrition Education and Behavior conference (n=4) American Society for Nutrition (n=5) International Society for Behavior in Nutrition and Physical Activity conference (n=1) Responsible Conduct of Research course (n=2) Responsible Conduct of Research modules (n=1) IRB training (n=1) Department seminars (weekly, n=12) How have the results been disseminated to communities of interest?Results from our study are pending and will be shared with participants and Head Start/preschool centers as they become available. What do you plan to do during the next reporting period to accomplish the goals?We plan to complete data coding and analyses on the data that has been collected to date and prepare abstracts, manuscripts and community-based materials for dissemination. We also plan to make modifications to materials. We plan to complete the transformation of study apps to Android platform via Google Play. Currently, they are only available on iOS platform for Apple products. We will then market the apps for dissemination. Anticipated Key Outputs Data will be analyzed and abstracts and manuscripts will be submitted on the development and testing of the HEROs Family and Self Care programs as well as the Parent-Child Interaction study. Modifications to program materials will continue to be made based on feedback from intervention testing. Program outcomes will be submitted to study participants.

Impacts
What was accomplished under these goals? Objective 1 - Formative Research This objective is complete and has resulted in 8 published manuscripts. Objective 2 - Intervention Development Three programs were developed as part of the HEROs intervention - HEROs Family program (target is caregivers), Sporks for Kids program (target is preschool children) and HEROs Self-Care program (target is caregivers). Workshop facilitators guides, activities, handouts and written materials, website, and mobile apps were developed. Manuscripts related to intervention development are in progress. Objective 3 - Intervention Testing HEROs Family Program. Our feasibility study consisted of 33 parent-child dyads from 2 preschool centers in eastern Colorado. Parent-child dyads were randomly assigned to participate in either Cohort 1 (fall 2019), or Cohort 2 (spring 2020). Due to COVID, post-intervention and follow-up data collection was limited to self-report caregiver surveys and no objective or observational data was collected. We are examining our quantitative data to determine post-hoc research questions and potential analyses. We were able to pivot and collect qualitative data via video conferencing in the spring of 2020. Thirty program participants were invited to post-intervention focus groups (n=4 groups; n=18 participants) and individual interviews (n=26) in the Spring of 2020 to collect information on intervention acceptability, behavioral capability, self-efficacy, and continued use of intervention materials. These findings suggest that a mindful parenting approach to promote quality parent-child interactions during mealtimes and PA was feasible and well accepted. Parents reported developing a greater understanding of their preschooler and feeling less stressed about mealtime and PA interactions, and strategies related to mindful parenting were reported to positively influence how parents engaged with and communicated with their preschooler. Related to the efficacy of our mobile apps, our research indicates that children, on average, spend 80% of the app time (7 minutes) in moderate to vigorous physical activity. Baseline data indicates that preschoolers are only participating in 13.3 (+7.6) minutes of MVPA per day, on average. This is far below the recommended 60 minutes of MVPA per day. Children being active with one of the HEROs apps would increase their daily MVPA by 5.5 minutes, resulting in an increase of ~41%. Playing the app twice would almost double their daily their MVPA. Thus, active screen time may play a role in promoting physical activity in young children. Dissemination of the mobile apps beyond the research study is occurring without marketing efforts at this time. App downloads by non-research participants in 2020 were 1,850 for Jungle Gym 1, 1,800 for Jungle Gym 2, 2,830 for Spin-n-Move, and 113 for Tasting Party. HEROs Self-Care Program. We completed one cohort of 6 participants for this program. Unfortunately, due to COVID we were not able to enroll additional cohorts. The program consists of 1 health fair, 2 workshops, and 4 individual health coaching and focused on healthy eating, physical activity and stress management through mindfulness. Supporting materials included an e-binder of handouts, Garmin PA tracker, and mobile apps. Baseline data for participants (n=6) indicate that several had health risk factors including an average BMI classification of overweight (=29.6 ± 6.1), borderline low high density lipoprotein (=45.7 ± 15.5), HbA1c on the upper range of normal (5.1%), and most mothers ranked their perceived stress as moderate or high (67%). Similar to the HEROs family program, post-intervention and follow-up data collection was limited to self-report surveys. Qualitative interviews were instead completed, and findings indicate high feasibility of intervention components (e.g., digital connectivity for health coaching sessions) and high acceptability of program content and delivery modalities. Parent-Child Interaction in Physical Activity. This study examines parent-child interactions related to active play and electronic-facilitated physical activity (mobile apps and exergaming). The study enrolled 20 families (16 mother-father-child triads, and 4 mother-child dyads) prior to concluding data collection due to COVID. Coding of videos (n=108 play sessions) for parent affection, responsiveness, encouragement, teaching and playfulness is complete. Data analyses is underway. Objective 4 - Education Education efforts consisted mainly of participation in department seminars and annual conferences. No new workshops were conducted this grant year.

Publications

• Type: Journal Articles Status: Published Year Published: 2021 Citation: Thompson, D.A., Bekelman, T.A., Ferrante, M.J.*, McCloskey, M.L., Johnson, S.L., Bellows, L.L. (2021). Picture perfect  how attaining the ideal meal isnt so easy for parents of young children. Journal of Nutrition Education and Behavior, 53(4), 290-298. https://doi.org/10.1016/j.jneb.2021.01.008
• Type: Journal Articles Status: Published Year Published: 2020 Citation: McCloskey, M.L., Kesterson, H.*, Mena, N.Z.*, Dellaport, J., Bellows, L.L. (2020). Farm to Early Care and Education Programming: A Descriptive Study of Challenges and Opportunities to Promote Healthful Foods to Young Children. International Journal of Environmental Research and Public Health, 17(18), 6857. https://doi.org/10.3390/ijerph17186857
• Type: Conference Papers and Presentations Status: Published Year Published: 2020 Citation: Leib A., Zeng, N., Johnson, S.L., Bellows, L.L. Screen time and physical activity patterns amongst preschoolers from rural, underserved communities. Society of Nutrition Education and Research Annual Meeting. Virtual.
• Type: Conference Papers and Presentations Status: Published Year Published: 2020 Citation: Hobbs, S., Johnson, S.L., Coatsworth, J.D., Bellows, L.L. Refining a Maternal Self-care Intervention to Promote Family Health Using the Plan, Do, Study, Act (PDSA) Model. Society of Nutrition Education and Research Annual Meeting. Virtual.

Progress 05/01/19 to 04/30/20

Outputs
Target Audience:In Year 5, we collectively reached 83 mothers, 17 fathers, and 58 preschool-aged children in our studies (19 mothers in our self-care interviews, 37 mother-child dyads in our Family Intervention, 6 mothers in our Self-Care Intervention, and 21 mothers, 17 fathers, and 21 children in our Parent-Child Interaction in Physical Activity study). Two-thirds of our participants were considered low-income with 1/3 identifying as Hispanic. The majority of participants resided in rural communities, with the expectation of our campus-based Parent-Child Interaction study. Changes/Problems:No-cost extension approved for Year 6. Covid-19 pandemic halted our study and we are unlikely to make up a portion of post-intervention data collection. The intervention was completed for Cohort 2 and survey data was collected but observed measures are not possible due to school closures. What opportunities for training and professional development has the project provided? Mindful Parenting. Dr. Doug Coatsworth presented on Mindful Parenting and application to our HEROs study. September 5, 2019 (2 post-docs, 8 students, 3 research staff) Parent Facilitation. Drew Betts, an Emeritus Extension faculty member at Washington State University and parenting expert, provided a presentation on facilitation skills for parent workshops. Parent Facilitation, October 2, 2019 (1 post-doc, 1 student, 4 research staff). American Society for Nutrition conference (n=4) Society for Nutrition Education and Behavior conference (n=2) International Society for Behavior in Nutrition and Physical Activity conference (n=2) Responsible Conduct of Research course (n=3) Responsible Conduct of Research modules (n=5) IRB training (n=5) Department seminars (weekly, n=16) How have the results been disseminated to communities of interest?Results from our feasibility study are pending and will be shared with participants and Head Start/preschool centers next academic year. What do you plan to do during the next reporting period to accomplish the goals?We plan to complete data coding and analyses on the data that has been collected to date and prepare abstracts, manuscripts and community-based materials for dissemination. Based on university guidance and timing on restarting research activities post-COVID-19, we will examine which of our studies warrant additional data collection.

Impacts
What was accomplished under these goals? Objective 1 - Formative Research Self Care Interviews. Interviews with 19 mothers were completed to ascertain current attitudes, values and behaviors related to self-care as well as potential intervention strategies. Findings were incorporated into our Intervention Map and drove development of intervention concepts and materials. Objective 2 - Intervention Development HEROs Family Intervention. The current intervention consists of a 6-week family workshop series, including 3 key components: parent workshop, child workshop and supporting materials, including our custom-built mobile apps for children. Intervention development combined results from our formative research phase, with the application of Intervention Mapping, Social Cognitive Theory and Adult Learning Theory. Parent workshops addressed mindful parenting, healthy eating and mealtimes, and physical activity. Workshops were designed to build parents' self-efficacy and behavioral capability, as well as provide strategies to promote healthy eating and activity behaviors with their preschoolers at home. Both parent and child workshops incorporated a new creative concept of the Sporks family who live in the town of Healthadelphia®. Child workshops delivered tested activities aimed at improving willingness to try new foods and promoting PA and FMS. Supporting materials focused on promoting parent-child interaction by providing additional at-home resources, including 4 child-focused mobile apps, musical journeys, recipe videos and family activity cards with fun activities to do at home. HEROs Self-Care Intervention. This component consists of 2 workshops and 4 individual health coaching sessions. This intervention focused on maternal health and addressed healthy eating, physical activity, stress and mindfulness. Supporting materials included an e-binder of handouts, Garmin PA tracker, and mobile apps. Objective 3 - Intervention Testing HEROs Family Intervention. Through a quasi-experimental staggered implementation design, our research team is currently assessing the feasibility of the HEROs intervention. Participants were recruited from 2 partner Head Start/preschool centers in northeastern Colorado (Iliff Head Start, ABC East Child Development Center; see letters of support). Parent-child dyads were randomly assigned to participate in either Cohort 1 (fall 2019), or Cohort 2 (spring 2020). Thirty-seven dyads completed all or partial baseline data (91% completed all measures) and 33 completed the intervention program (100% of participants who attended week 1 completed). Further demonstrating feasibility, 94% of participants at baseline were able to successfully take dinnertime photos for 6 days, submitting 78% quality photos (616 photos received out a possible 792 photos). Valid wear time (4+ days for 16 hours/day) for accelerometers was collected on 97% of mothers and 91% children. We were able to recruit our target population - mothers (=31.7y), Hispanic (36%), limited resources (67%) and range of education (36% high school or less, 24% technical school or some college). At baseline, moms had several health risk factors, including an average BMI classification of obese (=33.7 ± 7.3), borderline high triglyceride levels (=178 ± 113 mg/dl), and HbA1c on the upper range of normal (5.44%). Maternal diet was generally considered to be "poor," with an average HEI score of 50.4 (out of 100). Mothers' PA almost met the 30 minutes/day recommendation of MVPA (=29.1 ± 24.1 minutes), however sleep was low, averaging ~6.3 hours/night (=382.7 ± 62.2 minutes). Children were 55% male, mean age was 4.1 ± 1.2 years, and mean child BMI z-score was 0.33 ± 1.19 (range: -2.60 to 2.86). Children's diets were high in added sugar, they frequent fast food restaurants and have low vegetable availability. Children's PA was well below the recommendation of 60 minutes of MVPA/day (=16.1 ± 9.2) and sleep averaged only 7 hours/night (=430.1 ± 39.7 minutes). With the HEROs study ongoing, we are confident that we demonstrated the feasibility of our measures and program content. Further, these baseline characteristics indict a health disparate sample, meeting our recruitment goals. Preliminary outcomes related to child workshops include an increase in tasting of target foods as well as effectiveness of our PA apps. the Jungle Gym app, developed especially for the HEROS intervention, demonstrated high engagement and high levels of MVPA (81.04% ± 18.04%). In addition, during workshops children participated in nutrition activities, including the Tasting Party Express app, and were repeatedly offered cauliflower to taste. During week 1, 50% of children tried cauliflower and tries steadily increased reaching 100% by week 6. Once children tried cauliflower, they continued to try it across subsequent weeks (100%). HEROs Self-Care Intervention. This pilot study is ongoing. One cohort of 6 mothers was completed with the last workshop occurring by Zoom due to the pandemic. Parent-Child Interaction in Physical Activity. This cross-sectional study is underway to examine parent-child interactions related to active play and electronic-facilitated physical activity (mobile apps and exergaming). We will explore the quality of parent-child interactions and the relationship with PA and motor performance. Further, we will examine if there are differences between PA interactions amongst parent-child dyads (e.g., mothers and fathers). To date, 17 triads and 4 dyads have completed the study. This study is on hold due to the pandemic. Objective 4 - Education This objective focuses on education and training of research staff, students and key stakeholders. A multitude of workshops were conducted and professional development trainings opportunities were available to project staff and students. See next section for details.

Publications

• Type: Websites Status: Published Year Published: 2019 Citation: www.sporks.colostate.edu
• Type: Journal Articles Status: Published Year Published: 2019 Citation: Bekelman, T., Bellows, L.L., McCloskey, M.L., Martin, C.K., Johnson, S.L. (2019). Assessing Dinner Meals Offered at Home among Low-Income Preschoolers with Remote Food Photography Method. Pediatric Obesity, 14(11):e12558. https://doi.org/10.1111/ijpo.12558
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2020 Citation: Zeng, N., Johnson, S.L., McCloskey, M., Ferrante, M., Hobbs, S., Mena, N., Bellows, L.L. (2020). Increasing Preschoolers Physical Activity via a Mobile App Game. Society for Behavioral Medicine, San Francisco, CA.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2020 Citation: Zeng, N., Johnson, S.L., Bellows, L.L. (2020). An Ecological Framework and Intervention for Physical Literacy Parenting in Early Childhood. Society for Behavioral Medicine, San Francisco, CA.
• Type: Conference Papers and Presentations Status: Published Year Published: 2019 Citation: Zeng, N.*, Johnson, S.L., Boles, R.E., Bellows, L.L. (2019). Associations between Parents Physical Activity and Young Childrens Health Outcomes. Medicine & Science in Sports & Exercise, 51(S), Board #121. DOI: 10.1249/01.mss.0000562084.95047.e0. American College of Sports Medicine Annual Meeting, Orlando, FL.
• Type: Conference Papers and Presentations Status: Published Year Published: 2019 Citation: Bellows, L.L., Johnson, S.L., McCloskey, M., Chamberlin, B. (2019). The HEROs Study Year 4: Intervention Design to Promote Healthy Eating and Activity Behaviors in Early Childhood. Journal of Nutrition Education and Behavior, 51(7S), NP8. Presented at the Society for Nutrition Education and Behavior, Orlando, FL
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2020 Citation: Hobbs, S.*, McCloskey, M., Johnson, S.L., Bellows, L.L. (2019). Exploring Maternal Self-Care Practices to Facilitate Intervention Design. Presented at Colorado State University Graduate Showcase, Fort Collins, CO.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2020 Citation: Mena, NZ, Ferrante, MJ, Zeng, Nm Hobbs, S, McCloskey, M, Johnson, SL, Bellows, L. (2020). The SPORKS for Kids: A Preschool Nutrition Education Program to Increase Childrens Willingness to Try New Foods. Society for Nutrition Education and Behavior.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2020 Citation: Hobbs, S, McCloskey, ML, Johnson, SL, Coatsworth, JD, Bellows, LL. (2020). Intervention Mapping of Maternal Self-care Practices to Facilitate Intervention Design. Society for Nutrition Education and Behavior.
• Type: Conference Papers and Presentations Status: Published Year Published: 2019 Citation: Bellows, L.L., McCloskey, M. (2019). Beyond Nutrient Intake: Use of Food Photography Methodology to Examine Family Dinnertime. Society for Nutrition Education and Behavior. Webinar
• Type: Conference Papers and Presentations Status: Other Year Published: 2019 Citation: 2. Bellows, L. (2019). Optimizing Intervention Components in the HEROs Early Childhood Study. Presented as part of the USDA NIFA Childhood Obesity session at Society for Nutrition Education and Behavior Annual Conference, Orlando, FL.
• Type: Theses/Dissertations Status: Accepted Year Published: 2019 Citation: Agard, B. (2019). Moving Together: Understanding Parents Perceptions of Physical Activity and Movement Skills. Department of Food Science and Human Nutrition, Colorado State University.

Progress 05/01/18 to 04/30/19

Outputs
Target Audience:In Year 4 we completed pilot testing with 20 parents and 34 teachers (project total 527) at 3 Head Start/preschool across easten Colorado. The majority of our parent participants were mothers (2 fathers) and all teachers were female. Approximately 40% identified as Hispanic/Latino, which is representative of demographics among Head Start families in eastern Colorado. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?Workshops Plan-Do-Study-Act. Dr. Susan Johnson presented on the fundamentals of PDSAs, followed by an all-team planning workshop (2 faculty, 1 staff, 2 post-doc, 6 students) to develop research questions and strategies for our PDSA cycles. The presentation and workshop occured in November 2018 (7 students, 1 post doc, 3 research staff). MOST Design. Dr. Kate Guastaferro presented on the Multiphase Optimization Strategy (MOST), a framework for engineering efficacious and effective behavioral interventions. Dr. Guastaferro met with research staff for one day to consult on project activities and on the second day provided a research seminar and workshop for students, post-docs, and faculty to discuss the MOST design. The presentation, seminar and workshop occurred Feb 28th and March 1st, 2019 (8 students, 2 post doc, 3 research staff, 1 vistor). Professional Development and Training Opportunities: Note: n denotes number of participants for each training opportunity. Society for Nutrition Education and Behavior annual conference (n=7) monthly webinars (n=8) International Society for Behavioral Nutrition & Physical Activity annual conference (n=2) American Society for Nutrition Conference (n=2) LiveWell Colorado Healthy Eating Active Living Summit (n=1) Responsible Conduct of Research training modules (n=4) Responsible Conduct of Research semester course (n=1) IRB training (n=4) Department Seminars (weekly, n=14) How have the results been disseminated to communities of interest?Results from Formative Research (Objective 1) were compiled in a brief report and provided to participating Head Start/preschool staff. Further, a briefl summary of our findings were presented to teachers and staff at the pretesting focus group discussions. What do you plan to do during the next reporting period to accomplish the goals?Objective 1: Formative Research It is anticipated that all findings from the formative research will be disseminated (via abstracts, manuscripts and reports to participants, stakeholders, and community partners) prior to the start of Year 5. Objective 2 - Intervention Design Based on results from focus groups with key stakeholders and pilot testing, the structure and content of the intervention will be finalized at the beginning of Year 5. Objective 3 - Intervention Testing Several studies will be conducted to determine the efficacy of intervention components. A quasi experimental study (n=40) will be conducted from Fall 2019-Spring 2020 on the core HEROs intervention. Multiple waves will be conducted with families attending the 7-week series. Assessments will be collected at baseline, immediately following the intervention and at 4 month follow-up in order to assess any longer-term impacts of the intervention. A pilot study to assess a separate self-care component will be conducted with parents (n=30) to assess parental diet, activity and health outcomes. Last, a cross-sectional study will be conducted to examine parent-child interactions related to physical activity, active play, and mobile devises. Objective 4 - Education We will continue to bring nationally recognized experts in nutrition, physical activity, and intervention development to Colorado as invited visiting scholars to present a research seminar, offer workshops for skill development, and engage in dialogue with faculty, staff, students, and community stakeholders. Scholars with expertise in the areas of positive parenting practices, parent-child interactions, child development, or health literacy will be sought for our educational seminars and workshops. Anticipated Key Outputs All intervention modules will be finalized based on participant feedback completed at the end of Year 4 (Objective 2); 3 studies on intervention componets will be conducted (Objective 3); Educational seminars and workshops will be conducted by at least 1 visiting scholar each academic semester (Objective 4).

Impacts
What was accomplished under these goals? Objective 1: Formative Research Key activities have been completed for this objective. Two additional areas warranted futher exploration. Home Food Environment: An updated version of the Home-IDEA tool (Home-IDEA v3) was developed to ensure that it is an appropriate representation of the entire HFE, including both healthy and unhealthy food options. During Year 4, the psychometric properties of Home-IDA v3 were assessed with the target audience and final refinements are in progress. It is expected that the modified version of the Home-IDEA will be used to assess intervention outcomes in the HEROs study related to the home food environment. Self Care: One finding that emerged from our formative work is that parents would like an intervention that not only offers ways to help their child, but has something for them as well. Throughout our formative assessments, we heard that mothers in particular often feel guilty and overwhelmed. Therefore, we have decided to incorporate the concept of "self-care" and the importance of taking time for oneself in addition to taking care of family. Because this was not originally addressed, we have begun to conduct interviews with parents to understand current attitudes, values and behaviors related to self-care and how best this concept might be incorporated into the intervention. Objective 2 - Intervention Design This objective was the key focus in Year 4. Intervention Development Intervention mapping was employed to provide a framework to integrate theory, findings from the literature, previous research outcomes, and the information collected from all of the formative research assessments. We have developed an intervention map and overall structure of the intervention. The intervention will consist of an 8-week workshop series. As currently envisioned, the workshops will be held in the evenings to allow as many parents to participate as possible. Workshops will be held at either our partner Head Start/preschool sites or a convenient community location. Each parent workshop will address a topic area related to both physical activity and nutrition, with some weeks focusing the bulk of the time on nutrition rather than physical activity (and vice versa). In addition to key content areas, foundational parenting strategies, including fostering children's physical, social/emotional and cognitive development, knowledge of appropriate child development, and establishing positive parent-child relationships, will be woven throughout the curriculum. Workshops are being developed based on constructs of the Social Cognitive Theory and principles of adult learning theory. Currently, the overarching topic areas proposed for the intervention include Healthy Kids & Healthy Families, Meet Your Preschooler, Developmental Expectations, Parent-Child Interaction, Self-Care and the Home Environment. More specifically, we plan to address picky eating, portion size, mealtime conversations, fundamental movement skills, physical literacy, active play and setting up the home environment for success. These content areas will be further refined based on parent feedback. Child workshops will be complementary to the parent workshop and built off our successful, previous work on the Food Friends and Mighty Moves programs. Each child workshop module will have key learning objectives and will be centered on going on an imaginative adventure to a creative location related to food or activity, such as a picnic in the park, the farmer's market, a garden, playground, pizza restaurant, grocery store and county fair. Each week will include a taste test of a novel food, one eating lesson, one activity lesson and additional activities as time allows. The child workshop time will also be used to introduce children to the apps (described below). At the same time, we are working with a marketing company to develop a creative component to weave throughout the 8-week program and link the parent and child workshops. We have developed a "Spork Family" which will serve to inspire imagination in children and allow adults to speak about potentially difficult topics related to a hypothetical family rather than immediately sharing challenges they face in their own family. Development of Mobile Applications New Mexico State University has continued to develop and enhance two mobile apps, as well as work on two additional apps. "Tasting App" - is focused on encouraging children to try new foods, reducing fear of new foods, creating excitement in children for trying new foods, and helping children understand that reactions to foods are varied and can change over time. Children drag foods to "feed" different characters, who each have both a facial and verbal reaction, which serves to introduce children to a wide array of food vocabulary. In the last year, this app has been further refined based on audience and expert feedback. Jungle Gym - This app is focused on giving children new ways to move, and will create randomized activities through which kids can move through imaginative play in a physically active way. Specifically, the app features a character inviting the user to go on a jungle adventure. After this introduction, the app takes the user through a series of short adventures, each highlighting a specific movement skill: running, jumping, leaping, hopping, galloping or side-stepping. Additional improvements to this app have been made, such as script updates to increase clarity and encourage children to move more and the addition of a moving figure in the corner which demonstrates how to do each movement. Spinner App - Development began on a third app, which will serve to integrate multiple components of the intervention. This app will include multiple 'spinners' related to physical activity, nutrition and school readiness and will also tie into key places and themes for each week of the in-person child workshop. The spinner will randomly land on different spaces and ask children to act out creative movements such as moving like an animal, stretching long spaghetti or hopping a certain number of times. As soon as an initial prototype of the app is available, it will be tested with preschool children for further refinement. Jungle Gym 2 - Development also began on a fourth app, which will serve as a more advanced version of the Jungle Gym app. In Jungle Gym 2, older preschool children will have an opportunity to try more advanced skills, such as linking multiple movements together in a row. Prototype testing of this app with preschool children will also be conducted for further refinement. Initial Feedback on Proposed Intervention Focus groups were conducted to gain feedback on the proposed intervention with findings assisting in strategy refinement. In order to obtain both a breadth and depth of feedback from key stakeholders, three sets of focus groups were conducted with parents, teachers and administrative staff at partner Head Start/preschool sites. Parent focus groups aimed to understand which content areas are most desirable to parents, what would motivate them to come to an intervention session and who else in their family they would like to be there, who they would like to receive the information from as well as feedback on the technology component. Focus groups with teachers and staff aimed to understand their thoughts on the most important content areas for the families they work with, as well as their insight into ways to encourage and sustain parent engagement. Based on these conversations, proposed intervention components are being further further refined. Objective 4 - Education This objective focuses on education and training of research staff, students and key stakeholders. A multitude of workshops were conducted and professional development trainings opportunities were available to project staff and students. See next section for details.

Publications

• Type: Journal Articles Status: Published Year Published: 2018 Citation: Bellows, L.L., McCloskey, M., Clark, L., Thompson, D.A., Bekelman, T.A., Chamberlin, B., Johnson, S.L. (2018). HEROs (HEalthy EnviROnments study): Design of a Mixed Methods Formative Research Phase for an Ecocultural Intervention to Promote Healthy Eating and Activity Behaviors in Rural Families with Preschoolers. J Nutr Educ Behav, 50(7),736-745. https://doi.org/10.1016/j.jneb.2018.02.012
• Type: Journal Articles Status: Published Year Published: 2018 Citation: Johnson, S.L., Moding, K.J., Maloney, K., Bellows, L.L. (2018). Development of the Trying New Foods Scale: a preschooler self-assessment of willingness to try new foods. Appetite, 128, 21-31. https://doi.org/10.1016/j.appet.2018.05.146
• Type: Journal Articles Status: Published Year Published: 2018 Citation: McCloskey M., Bekelman T.A., Thompson D.A., Chamberlin, B., Clark, L., Johnson S.L., Bellows L.L. (2018). Mobile Device Use among Rural, Low-Income Families and the Feasibility of an App to Encourage Preschoolers Physical Activity: A Qualitative Study. Journal of Medical Internet Research: Pediatrics and Parenting, 1(2):e10858. https://doi.org/10.2196/10858
• Type: Journal Articles Status: Published Year Published: 2018 Citation: Bekelman, T.A., Bellows, L.L., Clark, L., Thompson, D.A., Kemper, G., McCloskey, M., Johnson, S.L. (2018). An ecocultural perspective on eating-related routines among low-income families with preschool-aged children. Qualitative Health Research, Nov 30. doi: 10.1177/1049732318814540.
• Type: Journal Articles Status: Published Year Published: 2019 Citation: Bellows, L.L., Boles, R.E., Hibbs-Shipp, S.K., Burdell, A., Johnson, S.L. (2019). Checklist to Capture Food, Physical Activity and Sedentary Devices in the Home Environment: The Home Inventory Describing Eating and Activity (Home-IDEA2). Journal of Nutrition Education and Behavior https://doi.org/10.1016/j.jneb.2018.12.007 [Epub ahead of print]
• Type: Journal Articles Status: Published Year Published: 2019 Citation: McCloskey, M., Johnson, S.L., Bekelman, T.A., Martin, C.K., Bellows, L.L. (2019). Beyond Nutrient Intake: Use of Digital Food Photography Methodology to Examine Family Dinnertime. Journal of Nutrition Education and Behavior. https://doi.org/10.1016/j.jneb.2019.01.020 [Epub ahead of print]
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2018 Citation: Bellows, L.L., McCloskey, M., Bekelman, T.A., Martin, C.K., Johnson, S.L. Feasibility of Utilizing Food Photography to Capture Parent-Child Meal Intakes for Participants from Rural Areas of the United States. Presented as part of a symposium entitled Novel methods for dietary assessment with socially-disadvantaged populations at the International Society for Behavioral Nutrition and Physical Activity, Hong Kong, China.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2018 Citation: Bellows, L.L., Hibbs-Shipp, S.K., Boles, R.E., Johnson, S.L. Development of a Home Food Environment Quality Score using the Healthy Eating Index-2010. Presented at the International Society for Behavioral Nutrition and Physical Activity, Hong Kong, China.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2018 Citation: Bellows, L.L, Johnson, S.L., Bekelman T.A, Benz, C., Chamberlin, B., Clark, L., McCloskey, M., and Thompson, D. (2018). The HEROs Study Year 3: Engaging Families to Promote Healthy Eating and Activity Behaviors in Early Childhood. Journal of Nutrition Education and Behavior, 50(7), S122.
• Type: Journal Articles Status: Published Year Published: 2019 Citation: Boles, R.E., Burdell, A., Johnson, S.L., Davies, P.L., Gavin, W.J., Bellows, L.L. (2019). Home Food Availability Predicts Food Consumption in Young Children. Appetite, 134, 135-141. https://doi.org/10.1016/j.appet.2018.12.002
• Type: Journal Articles Status: Published Year Published: 2019 Citation: Hibbs-Shipp, S.K., Boles, R.E., Johnson, S.L., McCloskey, M., Hobbs, S.*, Bellows, L.L. (2019). Development of a Quality Score for the Home Food Environment using the Home-IDEA2 and the Healthy Eating Index-2010. Nutrients, 11, 372; doi:10.3390/nu11020372
• Type: Journal Articles Status: Published Year Published: 2019 Citation: Zeng, N., Johnson, S.L., Boles, R.E., Bellows, L.L. (2019). Social Ecological Correlates of Fundamental Movement Skills in Young Children. Journal of Sport and Health Science, 8(2), 122-129. https://doi.org/10.1016/j.jshs.2019.01.001
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2018 Citation: Lakin, C., McCloskey, M., Johnson SL., Bellows, L. Exploring Mealtime Behaviors and Attitudes of Families with Preschoolers. (2018). Journal of Nutrition Education and Behavior, 50(7), S27-28.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2018 Citation: Agard B., Courtney J.B., McCloskey, M., Johnson, S.L., Bellows, L. (2018). Understanding Parenting Practices and Values Related to Physical Activity with Preschoolers: A Qualitative Study to Inform Intervention Design. Journal of Nutrition Education and Behavior, 50(7), S200.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2018 Citation: McCloskey, M., Johnson, S.L., Bekelman T., Martin, C.K., Bellows, L. (2018). Whats for Dinner? Analyzing the Dinner Meal of Parent-Preschool Child Dyads Using Food Photography. Journal of Nutrition Education and Behavior, 50(7), S152.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2018 Citation: Hobbs, S., McCloskey, M., Johnson, S.L., Boles, R.E., Bellows, L. (2018). Examining Dinnertime Photos of Foods Served by Low-Income Families to Inform a Home Food Environment Checklist. Journal of Nutrition Education and Behavior, 50(7), S76-77.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2018 Citation: Bekelman TA, Bellows LL, McCloskey MM, Martin CK, Johnson SL. To eat or not to eat? A novel approach to understanding food offered and unconsumed among low-income families at dinnertime. Current Developments in Nutrition, July 4. ( 2nd place, Emerging Leaders in Nutrition Science Poster Competition)
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2018 Citation: Ferrante, M.J., Thompson, D.A., Bekelman, T.A., McCloskey, M., Johnson, S.L., Bellows, L.L. Family mealtime with preschoolers  differences in parent ideals and reality. Accepted for presentation at the Colorado State University Graduate Student Showcase, Fort Collins, CO, November 2018.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2018 Citation: Hobbs S, McCloskey M, Johnson SL, Boles RE, & Bellows LL. Whats in your pantry? Capturing the home food environment. Accepted for presentation at the Colorado State University Grad Student Showcase, Fort Collins, CO, November 2018.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2018 Citation: Agard, B., Zeng, N., McCloskey, M., Johnson, S.L., Bellows, L.L. Moving Together: Understanding Parents Perceptions of Physical Activity and Movement Skills. Accepted for presentation at the Colorado State University Graduate Student Showcase, Fort Collins, CO, November 2018.
• Type: Theses/Dissertations Status: Published Year Published: 2018 Citation: Lakin, C. (2018) Mealtime Environment Survey: Exploring Mealtime Behaviors and Attitudes of Families with Preschool-Aged Children. Colorado State University, Fort Collins, CO.
• Type: Theses/Dissertations Status: Published Year Published: 2018 Citation: Agard, R. (2018). Moving Together: Understanding Parents Perceptions of Physical Activity and Movement Skills. Colorado State University, Fort Collins, CO.

Progress 05/01/17 to 04/30/18

Outputs
Target Audience:We reached an additional241families in Year 3 (project total of 473) at five Head Start centers across eastern Colorado. A majority of our participants weremothers . Participants had a range of education levels and approximately40% identified as Hispanic/Latino, which is representative of demographics among Head Start families in Colorado. Changes/Problems:During Year 3 several changes in the landscape of preschool-based nutrition and activity programming in Colorado came to our attention which have necessitated modifications to our proposed intervention study and Objective 3. These changes have been communicated to USDA and NIFA's National Program Leader. Our original intent was to develop a family-based intervention and test whether it amplifies the behavior changes attained in the preschool classroom via the Food Friends and Mighty Moves programs. However, due to changes in SNAP-Ed funding in Colorado, other preschool programs have elected to implement other nutrition and activity curricula. This change has affected our ability to carry out our intervention study as proposed with an adequate sample size. These changes, in conjunction with findings from our formative research (Objective 1), have led us to propose a new approach to Objective 3 that, we believe, enhances our ability to be innovative, successful and contribute new knowledge to the field. Instead of conducting an efficacy trial with 244 families in Years 4 and 5, we propose conducting an Implementation study in Year 4 in which we will use the Plan-Do-Study-Act (PDSA) framework to test intervention components with a subset of families. Six intervention module cycles will be studied to ascertain which of the key components - parent workshop, child activities, or technology (mobile apps, website) - resonates with and drives participants towards behavior change. Once the modules are completed, we will conduct a pilot randomized controlled trial to test efficacy in Year 5. We believe that this approach is achievable given the changes in early childhood landscape in Colorado and will utilize a unique approach to understanding intervention components and strategies beyond just outcome measures. What opportunities for training and professional development has the project provided?Workshops Hosted: HEROs Team Retreat. The research team (4 faculty, 1 staff, 2 post-doc, 6 students) convened for a 3-day retreat from June 25th-28th, 2017. Each team member presented preliminary research findings, participated in discussions and were a critical part of group think to move forward toward intervention development. Intervention Development. Dr. Dianne Ward from the University of North Carolina Chapel Hill presented a department seminar for CSU's Dept of FSHN on the topic of early childhood obesity. Additionally, Dr. Ward provided a workshop for the research team on intervention development and design to assist us with enhancing our work on Objective 2. She visited CSU (2 faculty, 1 staff, 7 students) October 26-27, 2017. Interventions Related to Mealtime. Dr. Jane Fulkerson from University of Minnesota will present a department seminar for CSU's Dept of FSHN on the topic of family mealtime interventions. Dr. Fulkerson will also provide a workshop for the research team and will visit CSU (2 faculty, 1 staff, 6 students) on April 10-11th, 2018. Professional Development and Training Opportunities: Note: n denotes number of participants for each training opportunity. Society for Nutrition Education and Behavior annual conference (n=2) monthly webinars (n=6) International Society for Behavioral Nutrition & Physical Activity annual conference (n=2) American College of Sports Medicine Annual Conference (n=2) Food & Nutrition Conference & Expo (n=2) Experimental Biology conference (n=4) Society for Research and Child Development conference (n=1) Re-Imagining Education Conference (n=1) Digital Media in Learning Conference (n=1) Michigan Association for Computer Users in Learning conference (n=1) Colorado Public Health Association annual conference (n=1) CSU Ag Innovation Summit (n=3) LiveWell Colorado Healthy Eating Active Living Summit (n=1) Responsible Conduct of Research training modules (n=4) Responsible Conduct of Research semester course (n=1) IRB training (n=4) Department Seminars (weekly, n=14) How have the results been disseminated to communities of interest?Results from Objective 1 (formative research findings) are being compiled to disseminate to community stakeholders. What do you plan to do during the next reporting period to accomplish the goals?Objective 1: Formative Research-Findings from our formative research will continue to be analyzed and disseminated via abstracts, manuscripts and reports to participants, stakeholders, and community partners. Objective 2 - Intervention Design-Upon completion of the HEROs Intervention map, content and materials for the HEROs intervention will be developed. At this juncture, we are planning to develop 6 modules which will include 4 key components: parent workshops, child-centered activities, mobile applications, and a website. Modules will include topics such as developmental expectations, positive feeding experiences, physical literacy, social support, self-care and creating a healthy home environment. Modules will be theory-based and utilize the Know-See-Do-Improve framework. Preliminary content and prototypes of materials will be pretested with target audiences (parents, teachers, children, and Extension agents). Further, mobile app prototypes will be finalized for the two apps currently under development and we will explore an additional app for development based on our formative research report and intervention plan. It is anticipated that the majority of content and materials for the modules will be developed by September 2018. Additionally, measurement instruments and evaluation tools will be determined and pretested concurrently with intervention development. An emphasis will be placed on modifying and testing the Home-IDEA version 3, enabling us to assess changes in the quality of the home food environment during our intervention testing (Objective 3). Objective 3 - Intervention Testing-Intervention testing is planned for year 4. Each of the six modules will be assessed using the Plan-Do-Study-Act (PDSA) method. The PDSA method is a way to test a change that is implemented. The four steps will allow investigators to break down the steps (modules) of the intervention, evaluate the outcome, improve on it, and test again. Each step of the intervention, a module of the HEROs intervention, will go through an evaluation cycle. Each cycle will include a small sample size (8-10 participants) who will receive the module content in a staged, additive fashion. For example, in session 1 participants will receive the parent workshop only, session 2 will include the workshop plus child activities, session 3 will add the mobile apps to a parent workshops and child activities, and lastly, session 4 will include a parent workshop, child activities, mobile apps, and website content. This testing process allows investigators to assess participants' acceptance, behavioral intention, and observations related to each of the intervention components. Minor modifications will be made within the cycle testing with more comprehensive modifications being made after all PDSA cycles of the 6 modules have been completed. The addition of personnel to assist with this effort include Dr. Leslie Cunningham-Sabo (Co-I) and Dr. Taren Swindle (Consultant). Dr. Sabo will lead efforts focused on the process evaluation for the PDSA cycles. Dr. Swindle has expertise in Dissemination and Implementation Science and will guide our team on the development of our PDSA protocol and evaluations. Drs. Bellows (PD) and Johnson (Co-PD) will lead the development of the intervention modules and PDSA testing. We anticipate that all PDSA cycles will be completed in Year 4, allowing our team to conduct a pilot RCT in Year 5. In addition to the PDSA cycles, a protocol for coding parent-child interactions related to physical activity will be developed in Year 4 with a study being conducted in Year 5. Objective 4 - Education-We will continue to bring nationally recognized experts in nutrition, physical activity, and intervention development to Colorado as invited visiting scholars to present a research seminar, offer workshops for skill development, and engage in dialogue with faculty, staff, students, and community stakeholders. Scholars with expertise in the areas of mealtime environments, positive parenting practices, parent-child interactions, m-health interventions, or health literacy will be sought for our educational seminars and workshops.

Impacts
What was accomplished under these goals? Objective 1: Formative Research -A mixed method iterative approach, using ecocultural theory as a framework, guided the development of formative research assessments. Quantitative and qualitative methodologies provided insights into four key topic areas: 1) food behaviors and environments (Remote Food Photography Method, parent focus group and survey), 2) physical activity behaviors and environments (parent interview and survey), 3) mobile device use (parent survey and interview) and 4) daily life (ecocultural family interview and teacher/staff group discussions). Data collection has been completed for this objective. Analysis, synthesis of data, and dissemination of findings is ongoing. 1. Food Behaviors and Environment Parents value the evening meal, particularly as a time to be together as a family and learn about everyone's day From the perspective of mothers, key contributors to the success of a dinner meal are if the family is interacting, if the child eats everything on their plate or if they receive compliments on the food offered Parents and children snack frequently, often before dinnertime, and parents are aware of the impact of both positive and negatively role modeling related to food Mothers and preschoolers frequently eat dinner together (both the same food and at the same time) Food served at dinner frequently meets recommendations for protein and dairy (cheese), but there is a lack of variety in the vegetables served and few families serve fruit, whole grains or milk with dinner 2. Physical Activity Behaviors and Environment Parents view physical activity as a way to spend time with family and model an active lifestyle Parents promote physical activity for the child (physical health, development) as well as the parent (behavior management) Parents value activity and motor skills as a way to build confidence, enhance coordination, and enable social interactions A majority of parents believe that gross motor skills are "naturally learned" and were relatively ambivalent about the need to deliberately teach preschoolers these skills 3. Mobile Device Use Mobile devices are a part of families' daily routines and a majority of children use tablets and/or smartphones on a daily basis Parents view preschoolers' mobile device use differently based on the content; parents are much more positive about preschoolers using devices for learning vs entertainment However, a majority of parents recognize mobile devices are useful for behavior management, especially keeping children calm, quiet and occupied in certain situations Balance is the most important part of mobile device use in families; parents want their children to be comfortable using devices in a technology-driven world, but also want them to do traditional "kid" activities such as creative play or being active outdoors 4. Daily Life Children's eating and activity routines are shaped by a complex interaction between social and economic conditions, the physical environment, neighborhood resources, cultural values related to eating and activity, and the strategies parents use to get through the day. Interventions to support healthy eating and activity in this population will have the best chance of success if they alleviate some of the daily stresses associated with being a low-income parent of a preschoolers. Objective 2: Intervention Design - 1. Mobile App development and prototype testing:New Mexico State University has continued to develop and enhance two mobile apps. One app is focused on encouraging children to try new foods, reducing fear of new foods, creating excitement in children for trying new foods, and helping children understand that reactions to foods are varied and can change over time. The second app is focused on giving children new ways to move, and will create randomized activities through which kids can move through imaginative play in a physically active way.The PAapp was shown to parents during the Parent Interviews about Physical Activity, who primarily reacted positively and felt that it was a helpful way to combine mobile device use and activity. Further, the prototype was tested with preschoolers who were highly engaged with the app and all children completed some physical activity as instructed by the app.

Publications

• Type: Journal Articles Status: Published Year Published: 2017 Citation: 1. Bekelman, T.A., Bellows, L.L., Johnson, S.L. (2017). Are Family Routines Modifiable Determinants of Preschool Childrens Eating, Dietary Intake, and Growth? A Review of Intervention Studies. Topical Collection on Food Acceptance and Nutrition in Infants and Young Children in Current Nutrition Reports, 6(2), 171-189. http://dx.doi.org/10.1007/s13668-017-0207-9
• Type: Journal Articles Status: Published Year Published: 2017 Citation: 2. Bellows, L.L., Davies, P.L., Courtney, J.B.*, Gavin, W.J., Johnson, S.L., Boles, R.E. (2017). Motor Skill Development in At-risk Preschoolers: A Community-Based Longitudinal Intervention Study. Journal of Science and Medicine in Sport, 20(11), 997-1002. http://doi.org/10.1016/j.jsams.2017.04.003
• Type: Journal Articles Status: Published Year Published: 2018 Citation: 3. McCloskey, M., Johnson, S.L., Benz, C., Thompson, D.A., Chamberlin, B., Clark, L., Bellows, L.L. (2018). Parent Perceptions of Mobile Device Use among Preschool-Aged Children in Rural Head Start Centers. Journal of Nutrition Education and Behavior, 50(1), 83-89. doi: 10.1016/j.jneb.2017.03.006
• Type: Conference Papers and Presentations Status: Published Year Published: 2017 Citation: 1. Bellows, L., Johnson, S.L., Bekelman T., Benz, C., Chamberlin, B., Clark, L., McCloskey, M., and Thompson, D. The HEROs Study Year 2: Engaging Families to Promote Healthy Eating and Activity Behaviors in Early Childhood. Journal of Nutrition Education and Behavior, 49(7), S110-111.
• Type: Conference Papers and Presentations Status: Published Year Published: 2017 Citation: 2. Benz, C., McCloskey, M., Johnson, S.L., Clark, L., Thompson, D.A., Chamberlin, B., Bellows, L. Exploring Mobile Device Use among Preschoolers: A Feasible Intervention Strategy for Rural Families? Journal of Nutrition Education and Behavior, 49(7), S91.
• Type: Conference Papers and Presentations Status: Published Year Published: 2017 Citation: 3. McCloskey, M., Johnson, S.L., Benz, C., Thompson, D.A., Chamberlin, B., Clark, L., Bellows, L.L. (2017). Parent Perceptions of Mobile Device Use Among Young Children in Rural Preschool Centers. Presented at International Society for Behavioral Nutrition and Physical Activity, Victoria, British Columbia, Canada; June 2017.
• Type: Conference Papers and Presentations Status: Published Year Published: 2017 Citation: 4. Courtney, J. B.*, Johnson, S. L., Li, K., & Bellows, L. L. (2017). At-risk Preschoolers Perceived Physical Competence and Observed Fundamental Movement Skills: 2029 Board# 42 June 1 2. Medicine & Science in Sports & Exercise, 49(5S), 555.
• Type: Conference Papers and Presentations Status: Published Year Published: 2017 Citation: Moding, K.J., Bellows, L.L., Palmer, C., Johnson, S.L. Sustained Effects of an Intervention to Improve Willingness to Try New Foods on Preschoolers Liking Ratings of a Target Vegetable. FASEB Journal, April 2017, 31:432.2
• Type: Theses/Dissertations Status: Awaiting Publication Year Published: 2018 Citation: Hibbs-Shipp, S. (2018). Maternal Health Matters  The Home Food Environment and Cardiometabolic Risk Factors. Doctoral Dissertation. Colorado State University, Fort Collins, Colorado.

Progress 05/01/16 to 04/30/17

Outputs
Target Audience:Collectively, we reached 232 families at five Head Start centers across eastern Colorado. A majority of our participants were mothers (88%). Participants had a range of education levels (44% had a high school diploma or less) and approximately 43% identified as Hispanic/Latino, which is representative of demographics among Head Start families in Colorado. In the coming months, we will continue recruiting from Head Start centers in eastern Colorado for future stages of formative research. Changes/Problems: A change for Year2 is the inclusion of a subaward to LSU's Pennington Biomedical Center and Dr. Corby Martin.As part of Objective 1, we will be using Remote Food Photograph Method (RFPM) to assess parent-child mealtime dietary intake.This change was approved by NIFA. What opportunities for training and professional development has the project provided?Workshops Hosted: Qualitative Interview Techniques, Dr. Lauren Clark from the University of Utah led our CSU and CU interdisciplinary research team through best practices in qualitative research and interviewing techniques (3 faculty, 3 staff and 4 students). Denver, CO, October 7th, 2016. Dietary Intake Measures, Dr. Corby Martin from Louisiana State University's Pennington Biomedical Center was an invited speaker at Colorado State University's annual Lillian Fountain Smith conference.His talk outlined various methodologies for capturing dietary intake, including his novel remote food photography method. Dr. Martin also met with the research team to provide input and guidance on capturing dietary intake and quality for this grant (3 faculty and 2 students). Fort Collins, CO, May 19th - 20th, 2016. Childhood Feeding Practices, Strategies and Research, Dr. Tanja Kral from the University of Pennsylvania met with the research team to provide guidance and delivered a department-wide seminar at CSU (2 faculty, 4 staff, 6 students) and the University of Colorado, October 13th - 14th, 2016. Faculty, Staff, Post-Doc, and Graduate Studentsparticipated in various training opportunities, including: Society for Nutrition Education and Behavior annual conference (n=4) monthly webinars (n=6) Experimental Biology (n=2) International Society for Behavioral Nutrition & Physical Activity annual conference (n=1) American Public Health Association (n=1) Lillian Fountain Smith Conference (hosted by CSU Dept Food Sci & Human Nutrition; n=8) Coursera: Questionnaire Design for Social Surveys (n=3) Framework for Data Collection and Analysis (n=2) Data Collection: Online, Telephone and Face-to-face (n=2) Database Management (n=1) Responsible Conduct of Research course (n=6) Atlas Qualitative Software workshops (n=2) Department Seminars (weekly, n=14) How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals?Objective 1: Year 3 activities will include finishing data collection for our formative research and analyzing findings. Findings from each component will be summarized and included in an overall formative research report for the HEROs study, which will guide strategy development (summer/fall 2017). The proposed intervention strategies will be summarized and presented to target audiences via informal conversations (market research) with Head Start staff and teachers, and focus groups with parents (fall 2017). Input from these interactions will lead to strategy refinement and a final intervention plan (fall 2017). Objective 2: Based on the strategy development and refinement, content for the HEROs intervention will be developed and pretested with target audiences (parents, teachers, children, and Extension agents). Preliminary content and prototypes of materials will be developed as strategy development and refinement (Objective 1) are taking place (summer/fall 2017). Further, mobile app prototypes will be finalized for the two apps currently under development and we will explore an additional set of apps (one nutrition and one physical activity) for development based on our formative research report and intervention plan. Objective 3: Pilot testing of the intervention is anticipated to occur at the end of Year 3. A protocol for coding parent-child interactions related to physical activity will be developed. Additionally, measurement instruments and evaluation tools will be determined concurrently with intervention development (Objective 2). Lastly, we will continue to support Head Start centers programming efforts related to the Food Friends programs. Objective 4: In Year 3, we are proposing to bring two experts to Colorado, as well as having our research team members, present on topics such as gross motor development in preschoolers, intervention strategies in early care environments, and cultural competence/working with at-risk populations. Anticipated Key Outputs Abstracts and manuscripts will be submitted on formative research components; HEROs Formative Research report finalized and disseminated to advisory committee; Preliminary intervention content and prototypes of educational materials developed; Mobile applications - 2 final apps and 2 prototypes - developed; Protocol for coding parent-child interaction related to physical activity developed. Workshops (3-4) for students, staff and faculty will be delivered.

Impacts
What was accomplished under these goals? Objective 1: Formative research was a major focus of Year 2. To understand child use and parents' beliefs about young children's use of mobile devices/technology in this audience a survey was developed and disseminated to families at five Head Start centers in northeastern Colorado (192 surveys were returned). Findings indicate relatively high mobile device use among families and their preschool children, confirming that it is feasible to utilize technology as an intervention component. Differences in parental technology beliefs by education and ethnicity were found as well as a relationship between parent comfort with technology and preschool child use, which will help to inform development and packaging of the intervention (Objective 2). As part of our mixed-methods, nested formative research design more detailed information on preschool children's use of mobile devices was obtained via telephone interviews with primary caregivers. To date, 29 interviews (30-40 minutes) have been conducted. A qualitative coding plan is being implemented with expected completion of coding by the end of Year 2. A third arm of our formative research includes conducting ecocultural family interviews (12 interviews to date) to understand family routines, particularly related to mealtime and physical activity. Formative research will extend continue through Year 2 and extend into the early portion of Year 3. Lastly, we have identified key stakeholders for our advisory committee and have continued working closely with Head Start personnel to enhance relationships and be prepared for Objective 3 in future years. Objective 2: Progress was made toward development of the technology component of the family based educational program. First, the design team conducted a review of the literature regarding app design for this content and audience, reviewed existing products and conducted design research with target audience members to inform gameplay, characters and storylines. Next, the team established a basic design for two applications (apps) and developed prototypes for each app, which will be ready for testing by the end of Year 2. One app is focused on changing behaviors regarding trying new foods, and includes encourages children to try new foods, reducing fear of new foods, creating excitement in children for trying new foods, and helping children understand that reactions to foods are varied and can change over time. The second app is focused on giving children new ways to move, and will create randomized activities through which kids can move through imaginative play in a physically active way. Objective 3: Nothing to report at this time. Objective 4: Trainings at 3 Head Start centers were conducted on the implementation of the Food Friends and Mighty Moves programs, designed to encourage preschool children to try new foods and develop gross motor skills. These programs will be the base of the school-based intervention conducted in Years 4 and 5 (Objective 3). Collectively, the trainings reached 57 Head Start teachers and staff. The trainings were interactive and provided opportunities for discussion and knowledge exchange between current preschool educators and university faculty, staff and students. Educational seminars were conducted for faculty, staff and students and are outlined below.

Publications

• Type: Conference Papers and Presentations Status: Published Year Published: 2016 Citation: Bellows, L., Johnson, S.L., Davies, P., Gavin, W., Chamberlin, B., Boles, R., Thompson, D., Gleason, J. (2016) The HEROs Study: Bridging Home and Preschool Environments to promote Healthy Eating and Activity Behaviors to Prevent Obesity in Early Childhood. Journal of Nutrition Education and Behavior, 48(7), S112-113.
• Type: Conference Papers and Presentations Status: Submitted Year Published: 2016 Citation: McCloskey, M., Johnson, S.L., Benz, C., Chamberlin, B., Clark, L., Thompson, D.A., Bellows, L.L. Parent Perceptions of Mobile Device Use among Preschool-Aged Children in Rural Head Start Centers. Submitted to International Society for Behavioral Nutrition and Physical Activity.
• Type: Journal Articles Status: Accepted Year Published: 2016 Citation: McCloskey, M., Johnson, S.L., Benz, C., Thompson, D.A., Chamberlin, B., Clark, L., Bellows, L.L. Parent Perceptions of Mobile Device Use among Preschool-Aged Children in Rural Head Start Centers. Submitted to Journal of Nutrition Education and Behavior.

Progress 05/01/15 to 04/30/16

Outputs
Target Audience:We have reached to Head Start and preschool personnel in the planning phase of these of this project. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?Workshops Hosted Structural Equation Modelling, Dr. Kevin Grimm from Arizona State University conducted 3 day workshop for our CSU and CU interdisciplinary research team (6 faculty and 3 students). Fort Collins, CO, July 21-23, 2015. Qualitative Research Techniques, Dr. Lauren Clark from the University of Utah lead our team through various methodologies to be considered for our projects (5 faculty, 2 students). Aurora, CO, June 29-30, 2015. Mobile Applications: Design Considerations, Dr. Barbara Chamberlin from New Mexico State University led an interactive workshop for 5 faculty, 1 staff, 5 students. Fort Collins, CO, September 2, 2015. How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals?We plan to complete our formative research in Year 2 and answer Objective 1. The completion of Objective 1 will drive the development of the family-based intervention and begin to address Objective 2. To address Objective 4, we will continue to offer seminars and workshops for our research team (faculty, staff, and students) to enhance the interdisplinary knowledge and appreciation for fields related to childhood obesity prevention.

Impacts
What was accomplished under these goals? Progress towards Objective 1 has been the focus for Year 1. Our team has developed a Formative Research plan and is in the midst of finalizing instruments to garner input from the target audience (families) on technology usage and usual family routines (ecocultural family interviews). Upon completion of technology survey and family interviews, we will conduct focus groups to build on these findings to ascertain what motivators and barriers exist related to family mealtimes and physical activity. Further, we have begun discussions with Head Start staff and teachers to obtain their views on technology and family needs related to our projects. These discussions will also assist in identifying key stakeholders for our advisory committee.

Publications