Promoting toddlers' self-regulation and healthy eating habits among families living in poverty: A randomized controlled trial of Recipe 4 Success.

The Recipe 4 Success preventive intervention targeted multiple factors critical to the health and well-being of toddlers living in poverty. This randomized controlled trial, which was embedded within Early Head Start home visits for 12 weeks, included 242 racially and ethnically diverse families (51% girls; toddler mean age = 2.58 years; data collected 2016-2019). Compared to parents in usual practice home visits, parents in Recipe 4 Success displayed greater sensitive scaffolding of toddlers' learning and more responsive food parenting practices (Cohen's d = .21-.30). Toddlers in Recipe 4 Success exhibited greater self-regulation and had healthier eating habits (Cohen's d = |.16-.35|). Results highlight the value of Recipe 4 Success in promoting parent and toddler behavior change that could have life-long benefits.

Designing a childhood obesity preventive intervention using the multiphase optimization strategy: The Healthy Bodies Project.

BACKGROUND/AIMS: Preventing the development of childhood obesity requires multilevel, multicomponent, comprehensive approaches. Study designs often do not allow for systematic evaluation of the efficacy of individual intervention components before the intervention is fully tested. As such, childhood obesity prevention programs may contain a mix of effective and ineffective components. This article describes the design and rationale of a childhood obesity preventive intervention developed using the multiphase optimization strategy, an engineering-inspired framework for optimizing behavioral interventions. Using a series of randomized experiments, the objective of the study was to systematically test, select, and refine candidate components to build an optimized childhood obesity preventive intervention to be evaluated in a subsequent randomized controlled trial. METHODS: A 24 full factorial design was used to test the individual and combined effects of four candidate intervention components intended to reduce the risk for childhood obesity. These components were designed with a focus on (a) improving children's healthy eating behaviors and nutrition knowledge, (b) increasing physical activity and reducing sedentary activity in the childcare setting, (c) improving children's behavioral self-regulation, and (d) providing parental web-based education to address child target outcomes. The components were tested with approximately 1400 preschool children, ages 3-5 years in center-based childcare programs in Pennsylvania, the majority of which served predominantly Head-Start eligible households. Primary child outcomes included healthy eating knowledge, physical and sedentary activity, and behavioral self-regulation. Secondary outcomes included children's body mass index and appetitive traits related to appetite regulation. RESULTS: Four intervention components were developed, including three classroom curricula designed to increase preschool children's nutrition knowledge, physical activity, and behavioral, emotional, and eating regulation. A web-based parent education component included 18 lessons designed to improve parenting practices and home environments that would bolster the effects of the classroom curricula. A plan for analyzing the specific contribution of each component to a larger intervention was developed and is described. The efficacy of the four components can be evaluated to determine the extent to which they, individually and in combination, produce detectable changes in childhood obesity risk factors. The resulting optimized intervention should later be evaluated in a randomized controlled trial, which may provide new information on promising targets for obesity prevention in young children. CONCLUSION: This research project highlights the ways in which an innovative approach to the design and initial evaluation of preventive interventions may increase the likelihood of long-term success. The lessons from this research project have implications for childhood obesity research as well as other preventive interventions that include multiple components, each targeting unique contributors to a multifaceted problem.

Heterogeneous Effects of Depression on Parenting Competence and Child Behavior Among Families Living in Poverty.

This study examined how depression and psychosocial protective factors, such as self-efficacy and conscientiousness, were related to parenting competence and child behavior among families living in poverty. The sample included 238 families (37% White, 25% Black, 19% Latinx, 17% Multiracial, and 2% Asian; 42% of parents reporting clinically significant symptoms of depression) with young children (mean age = 31 months, 51% female). Latent profile analysis identified five distinct subgroups of parents who differed on levels of depression and psychosocial protective factors. A small group of parents who had high levels of depression and low levels of protective factors displayed the least parenting competence and had children with lower levels of adjustment. At the same time, parents in two other profiles had high levels of depression, but moderate or high levels of protective factors, and displayed average parenting competence and had children who displayed average or above average levels of adjustment. In this study, depression appeared less predictive of parenting competence and child behavior than the psychosocial protective factors. This study suggests that many parents, despite having depression and living in poverty, exhibit psychosocial protective factors that are associated with high levels of parenting competence and rear children who are doing well.

Sustained Benefits of a Preschool Home Visiting Program: Child Outcomes in Fifth Grade.

This study evaluated the sustained effects of the Research-based Developmentally Informed Parent program (REDI-P) at fifth grade, six years after intervention. Participants were 200 prekindergarten children attending Head Start (55% White, 26% Black, 19% Latinx, 56% male, mean age of 4.45 years at study initiation) and their primary caregivers, who were randomly assigned to a control group or a 16-session home-visiting intervention that bridged the preschool and kindergarten years. In addition, the study explored moderation of sustained effects by parenting risks (e.g., less than high-school education, single-parent status, parental depression, and low parent-child warmth). Growth curves over the course of the elementary years examined outcomes in three domains: child academic performance, social-emotional adjustment, and parent-child functioning. At fifth grade, significant main effects for intervention were sustained in the domains of academic performance (e.g., reading skills, academic motivation, and learning engagement) and parent-child functioning (e.g., academic expectations and parenting stress). Significant moderation by parenting risk emerged on measures of social-emotional adjustment (e.g., social competence and student-teacher relationships); parenting risk also amplified effects on some measures of academic performance and parent-child functioning, with larger effects for children from families experiencing fewer risks. Implications are discussed for the design of preschool home visiting programs seeking to enhance the school success and social-emotional well-being of children living in poverty.

Unfolding Relations among Mindful Parenting, Recurrent Conflict, and Adolescents' Externalizing and Internalizing Problems.

The current study examined unfolding relations among mothers' mindful parenting, parent-adolescent recurrent conflict, and adolescents' externalizing and internalizing problems. In a community sample of 117 families (31% black, Asian, American Indian, or Latino), parents and adolescents (52% female; average age = 12.13 years) were followed over 15 months. Parents answered questions about mindful parenting and recurrent conflict, and adolescents reported on their own externalizing and internalizing problems. Path analyses indicated that higher levels of mindful parenting were significantly related to lower levels of recurrent conflict 2-3 months later, controlling for previous levels of recurrent conflict. Moreover, lower levels of recurrent conflict were significantly related to lower levels of externalizing problems and internalizing problems 1 year later, controlling for previous levels of those problems. Subgroup analyses indicated that relations were comparable across subgroups defined by adolescent gender, race, parent marital status, and family financial strain. The effects of mindful parenting were robust even after accounting for other indicators of positive and supportive parenting, namely inductive reasoning and warmth in the parent-adolescent relationship. These findings highlight the potential of mindful parenting to improve family interactions and adolescent adjustment.

Sustained effects of a school readiness intervention: 5th grade outcomes of the Head Start REDI program.

This study examined the sustained effects of the Head Start Research-based Developmentally Informed (REDI) program, which enriched preschools with evidence-based programming targeting social-emotional and language/emergent literacy skills. 44 Head Start classrooms were randomly assigned to intervention or a usual practice control group, and 356 4-year-olds (25% African American, 17% Latino, 54% female) were followed through the end of 5th grade. Growth curve analyses revealed that significant intervention effects on teacher-rated social adjustment, academic engagement, and parent involvement identified at the end of the Head Start year were sustained throughout elementary school. These findings demonstrate that evidence-based curricula combined with professional development support can enhance preschool programming and promote the elementary school adjustment of children living in poverty.

Parent Engagement in a Head Start Home Visiting Program Predicts Sustained Growth in Children's School Readiness.

This study examined three components of parent engagement in an enriched Head Start home visiting program: intervention attendance, the working alliance between parents and home visitors, and parents' use of program materials between sessions. The study identified those family and child characteristics that predicted the different components of parent engagement, and the study tested whether those components predicted sustained growth in children's school readiness skills across four years, from preschool through second grade. Ninety-five low-income parents with four year-old children attending Head Start (56% white; 26% black; 20% Latino; 44% girls) were randomly assigned to receive the home visiting program. Assessments included home visitor, parent, and teacher ratings, as well as interviewer observations and direct testing of children; data analyses relied on correlations and hierarchical multiple regression equations. Results showed that baseline family characteristics, like warm parent-child interactions, and child functioning predicted both working alliance and use of program materials, but only race/ethnicity predicted intervention attendance. The use of program materials was the strongest predictor of growth in children's literacy skills and social adjustment at home during the intervention period itself. In contrast, working alliance emerged as the strongest predictor of growth in children's language arts skills, attention skills, and social adjustment at school through second grade, two years after the end of the home visiting intervention. To maximize intervention effectiveness across school readiness domains over time, home visiting programs need to support multiple components of parent engagement, particularly working alliance and the use of program materials between sessions.

Preschool Intervention Can Promote Sustained Growth in the Executive-Function Skills of Children Exhibiting Early Deficits.

This study examined the effects of the Head Start Research-Based, Developmentally Informed (REDI) preschool intervention on growth in children's executive-function (EF) skills from preschool through third grade. Across 25 Head Start centers, each of 44 classrooms was randomly assigned either to an intervention group, which received enhanced social-emotional and language-literacy components, or to a "usual-practice" control group. Four-year-old children ( N = 356; 25% African American, 17% Latino, 58% European American; 54% girls) were followed for 5 years, and EF skills were assessed annually. Latent-class growth analysis identified high, moderate, and low developmental EF trajectories. For children with low EF trajectories, the intervention improved EF scores in third grade significantly more ( d = 0.58) than in the control group. Children who received the intervention also demonstrated better academic outcomes in third grade than children who did not. Poverty often delays EF development; enriching the Head Start program with an evidence-based curriculum and teaching strategies can reduce early deficits and thereby facilitate school success.

Enriching preschool classrooms and home visits with evidence-based programming: sustained benefits for low-income children.

BACKGROUND: Growing up in poverty undermines healthy development, producing disparities in the cognitive and social-emotional skills that support early learning and mental health. Preschool and home-visiting interventions for low-income children have the potential to build early cognitive and social-emotional skills, reducing the disparities in school readiness that perpetuate the cycle of poverty. However, longitudinal research suggests that the gains low-income children make during preschool interventions often fade at school entry and disappear by early elementary school. METHODS: In an effort to improve the benefits for low-income children, the REDI program enriched Head Start preschool classrooms (study one) and home visits (study two) with evidence-based programming, documenting positive intervention effects in two randomized trials. In this study, REDI participants were followed longitudinally, to evaluate the sustained impact of the classroom and home-visiting enrichments 3 years later, when children were in second grade. The combined sample included 556 children (55% European American, 25% African American, 19% Latino; 49% male): 288 children received the classroom intervention, 105 children received the classroom intervention plus the home-visiting intervention, and 173 children received usual practice Head Start. RESULTS: The classroom intervention led to sustained benefits in social-emotional skills, improving second grade classroom participation, student-teacher relationships, social competence, and peer relations. The coordinated home-visiting intervention produced additional benefits in child mental health (perceived social competence and peer relations) and cognitive skills (reading skills, academic performance). Significant effects ranged from 25% to 48% of a standard deviation, representing important effects of small to moderate magnitude relative to usual practice Head Start. CONCLUSIONS: Preschool classroom and home-visiting programs for low-income children can be improved with the use of evidence-based programming, reducing disparities and promoting complementary benefits that sustain in elementary school.

PATHS in Croatia: A school-based randomised-controlled trial of a social and emotional learning curriculum.

This study represents the first rigorous evaluation of a social-emotional learning curriculum, PATHS (Promoting Alternative Thinking Strategies; Kusché & Greenberg, 1994), in elementary schools in Croatia. This study randomly assigned 29 schools to receive the universal preventive intervention or continue with usual practices. Within those schools, this study included 57 classrooms and 568 children. Teachers rated nine child behaviours in the middle of first grade (pre-intervention) and near the end of second grade (post-intervention). Hierarchical linear models, nesting children within classrooms, revealed few changes in behaviour across the sample as a whole or among higher risk children. However, there were changes on eight of the nine behaviours for lower risk children. The findings are considered in the context of the classroom culture and teachers' preparation and readiness to implement a social-emotional learning curriculum in Croatia. This study highlights the need to supplement universal preventive interventions with selective preventive interventions that can provide more intensive and targeted skill practice for higher risk children. This study also highlights the nuanced effects of a universal preventive intervention in helping different children in different ways.

Helping Head Start Parents Promote Their Children's Kindergarten Adjustment: The Research-Based Developmentally Informed Parent Program.

Head Start enhances school readiness during preschool, but effects diminish after children transition into kindergarten. Designed to promote sustained gains, the Research-based Developmentally Informed (REDI) Parent program (REDI-P) provided home visits before and after the kindergarten transition, giving parents evidence-based learning games, interactive stories, and guided pretend play to use with their children. To evaluate impact, two hundred 4-year-old children in Head Start REDI classrooms were randomly assigned to REDI-P or a comparison condition (mail-home math games). Beyond the effects of the classroom program, REDI-P promoted significant improvements in child literacy skills, academic performance, self-directed learning, and social competence, demonstrating the utility of the approach in promoting gains in cognitive and social-emotional skills evident after the transition into kindergarten.

Understanding How Mindful Parenting May Be Linked to Mother-Adolescent Communication.

Researchers have sought to understand the processes that may promote effective parent-adolescent communication because of the strong links to adolescent adjustment. Mindfulness, a relatively new construct in Western psychology that derives from ancient Eastern traditions, has been shown to facilitate communication and to be beneficial when applied in the parenting context. In this article, we tested if and how mindful parenting was linked to routine adolescent disclosure and parental solicitation within a longitudinal sample of rural and suburban, early adolescents and their mothers (n = 432; mean adolescent age = 12.14, 46 % male, 72 % Caucasian). We found that three factors-negative parental reactions to disclosure, adolescent feelings of parental over-control, and the affective quality of the parent-adolescent relationship-mediated the association between mindful parenting and adolescent disclosure and parental solicitation. Results suggest that mindful parenting may improve mother-adolescent communication by reducing parental negative reactions to information, adolescent perceptions of over-control, and by improving the affective quality of the parent-adolescent relationship. The discussion highlights intervention implications and future directions for research.

Effects of Head Start REDI on children's outcomes 1 year later in different kindergarten contexts.

One year after participating in the Research-based, Developmentally Informed (REDI) intervention or "usual practice" Head Start, the learning and behavioral outcomes of 356 children (17% Hispanic, 25% African American; 54% girls; Mage  = 4.59 years at initial assessment) were assessed. In addition, their 202 kindergarten classrooms were evaluated on quality of teacher-student interactions, emphasis on reading instruction, and school-level student achievement. Hierarchical linear analyses revealed that the REDI intervention promoted kindergarten phonemic decoding skills, learning engagement, and competent social problem-solving skills, and reduced aggressive-disruptive behavior. Intervention effects on social competence and inattention were moderated by kindergarten context, with effects strongest when children entered schools with low student achievement. Implications are discussed for developmental models of school readiness and early educational programs.

The Mindfulness-enhanced Strengthening Families Program: integrating brief mindfulness activities and parent training within an evidence-based prevention program.

Teaching mindfulness to parents as well as adolescents through a family-centered intervention approach can have a positive impact on the parent-youth relationship. In mindful parenting, caretakers are aware of their own feelings and emotions, and interact with their adolescents in a mindful way by demonstrating emotional awareness, attentive listening, nonjudgment, self-regulation, and compassion. This chapter discusses the need for family-centered mindfulness approaches in adolescence. It introduces the Mindfulness-enhanced Strengthening Families Program, describes specific program activities and their theoretical rationale, and presents initial empirical evidence from pilot studies of the intervention.

Promoting Children's Social-Emotional Skills in Preschool Can Enhance Academic and Behavioral Functioning in Kindergarten: Findings from Head Start REDI.

This study examined processes of change associated with the positive preschool and kindergarten outcomes of children who received the Head Start REDI intervention, compared to "usual practice" Head Start. In a large-scale randomized-controlled trial (N = 356 children, 42% African American or Latino, all from low-income families), this study tests the logic model that improving preschool social-emotional skills (e.g., emotion understanding, social problem solving, and positive social behavior) as well as language/emergent literacy skills will promote cross-domain academic and behavioral adjustment after children transition into kindergarten. Validating this logic model, the present study finds that intervention effects on three important kindergarten outcomes (e.g., reading achievement, learning engagement, and positive social behavior) were mediated by preschool gains in the proximal social-emotional and language/emergent literacy skills targeted by the REDI intervention. Importantly, preschool gains in social-emotional skills made unique contributions to kindergarten outcomes in reading achievement and learning engagement, even after accounting for the concurrent preschool gains in vocabulary and emergent literacy skills. These findings highlight the importance of fostering at-risk children's social-emotional skills during preschool as a means of promoting school readiness. The REDI (Research-Based, Developmentally-Informed) enrichment intervention was designed to complement and strengthen the impact of existing Head Start programs in the dual domains of language/emergent literacy skills and social-emotional competencies. REDI was one of several projects funded by the Interagency School Readiness Consortium, a partnership of four federal agencies (the National Institute of Child Health and Human Development, the Administration for Children and Families, the Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services, and the Office of Special Education and Rehabilitation Services in the Department of Education). The projects funded through this partnership were designed to assess how integrative early interventions for at-risk children could promote learning and development across multiple domains of functioning. In addition, the projects were charged with examining processes of change and identifying mechanisms of action by which the early childhood interventions fostered later school adjustment and academic achievement. This study examined such processes of change, with the goal of documenting hypothesized cross-domain influences on kindergarten outcomes. In particular, this study tested whether gains in the proximal language/emergent literacy and social-emotional competencies targeted during Head Start would mediate the REDI intervention effects on kindergarten academic and behavioral outcomes. In addition, it tested the hypothesis that gains in social-emotional competencies during preschool would make unique contributions to intervention effects on both academic and behavioral outcomes, even after accounting for the effects of preschool gains in language and emergent literacy skills.

Elaboration of parents' schemas of their children: Unique relations to sensitivity and learning support among families living in poverty.

This study examined how distinct aspects of parents' schemas of their children are related to caregiving behaviors. It included 242 families with toddlers and young children, most of whom were living in poverty (37% White, 25% Black, 19% Latine, 17% Multiracial, and 2% Asian; child age = 21-39 months; median family income = $1,555 per month). The elaboration and emotional valence of parents' schemas were coded from brief responses to open-ended questions about children's personality; observations of parents' sensitivity and learning support were assessed in structured and unstructured settings. Results of regression equations controlling for multiple family, parent, and child characteristics revealed that both greater elaboration and positive emotional valence were uniquely related to parents' sensitivity (standardized ß = .15, p = .05, and ß = .13, p = .04, respectively), but only elaboration was uniquely related to learning support (ß = .35, p < .001). This study highlights the special importance of the elaboration of parents' schemas in understanding caregiving behaviors among families living in poverty and the potential value of enhancing elaboration in family-focused preventive interventions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

What kind of parenting is associated with early self-control among toddlers living in poverty? The importance of learning support.

The present study examined what kind of parenting best supports toddlers' self-control in the context of poverty. Parents and toddlers (52% female; Mage = 2.60 years) in 117 families (35% White, 25% Black, 22% Latinx, 15% Multiracial, and 3% Asian; M family income = $1,845/month) engaged in structured interaction tasks, and toddlers completed a snack delay task concurrently and after 6 months. Latent profile analysis based on eight observed parenting behaviors representing learning support and responsiveness/sensitivity (e.g., teaching, technical scaffolding, teamwork, instructions, choices, language use, specific praise, and warmth) identified four parenting profiles: Lower Learning Support/Lower Responsiveness, Moderate Learning Support/Moderate Responsiveness, High Responsiveness, and High Learning Support. Toddlers with parents in the High Learning Support profile demonstrated the greatest self-control 6 months later, compared with toddlers of parents in the other three profiles, and there were no statistically significant differences in self-control among toddlers of parents in those other three profiles. Results were robust even after controlling for initial levels of self-control, as well as multiple other child, parent, and family characteristics. These study findings highlight the importance of parents' learning support in understanding the early development of toddlers' self-control in the context of poverty and reinforce the need to create and refine preventive interventions in this area. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Profiles of Behavioral Self-Regulation and Appetitive Traits in Preschool Children: Associations With BMI and Food Parenting Practices.

Appetitive traits that contribute to appetite self-regulation have been shown to relate to non-food-related regulation in general domains of child development. Latent profile analysis (LPA) was used to identify typologies of preschool children's behavioral self-regulation (BSR) and appetitive traits related to appetite self-regulation (ASR), and we examined their relation with children's BMIz and food parenting practices. Participants included 720 children and their parents (90% mothers), drawn from the baseline assessment of a childhood obesity preventive intervention. BSR measures included teacher reports of children's inhibitory control, impulsivity and attentional focusing, as well as an observed measure of inhibitory control. ASR was assessed using parents' reports of children's appetitive traits related to food avoidance (e.g., satiety responsiveness, slowness in eating) and food approach (e.g., enjoyment of food, food responsiveness). Children's body mass index z-score (BMIz) was calculated from measured height and weight. Parents' BMI and food parenting practices were also measured. Four profiles were identified that characterized children with dysregulated behavior, higher food approach and lower food avoidance (16%), dysregulated behavior but lower food approach and higher food avoidance (33%), regulated behavior but highest food approach and lowest food avoidance (16%), and highly-regulated behavior, lowest food approach and highest food avoidance (35%). Children's BMIz was highest in the profile consisting of children with dysregulated behavior, higher food approach and lower food avoidance. BMI was similar in the profile with children with regulated behavior but highest food approach and lowest food avoidance; children in this profile also had parents who reported the highest levels of controlling food parenting practices, and the lowest levels of parental modeling of healthy eating. Compared to all other profiles, children in the profile characterized by highly-regulated behavior, lowest food approach and highest food avoidance had the lowest BMIz and had parents who reported food parenting practices characterized by the highest levels of child control in feeding and the lowest levels of pressure to eat. These findings provide evidence of differing patterns of relations between self-regulation across behavioral and eating domains, and children's obesity risk may vary based on these different patterns.

Reducing Adolescent Psychopathology in Socioeconomically Disadvantaged Children With a Preschool Intervention: A Randomized Controlled Trial.

OBJECTIVE: Living in poverty increases exposure to adversities that undermine healthy development, impeding growth in the social-emotional and language skills that support adaptive coping and promote mental health. Evidence-based programs have the potential to improve current preschool practice and strengthen these early skills, potentially reducing risk for later psychopathology. The authors tested the hypothesis that an enrichment program in preschool would be associated with reduced levels of psychopathology symptoms at the transition from middle to secondary school. METHODS: The Head Start REDI (Research-Based, Developmentally Informed) intervention was used to enrich preschool classrooms serving children from low-income families with an evidence-based social-emotional learning (SEL) program and a coordinated interactive reading program. Centers were randomly assigned to the intervention or usual practice, and 356 4-year-olds (58% White, 25% Black, 17% Latino; 54% female) were followed into early adolescence. Hierarchical linear models were used to evaluate intervention effects on teacher-rated psychopathology symptoms using the Strengths and Difficulties Questionnaire in grade 7 (ages 12-13) and grade 9 (ages 14-15), 8-10 years after the end of the intervention. RESULTS: Statistically significant intervention-related reductions were observed in conduct problems and emotional symptoms in the intervention group. In addition, the proportion of youths with clinically significant levels of conduct problems, emotional symptoms, and peer problems was reduced in the intervention group, with rates one-third of those in the control group. CONCLUSIONS: The study findings indicate that enriching preschool programs serving at-risk children with a relatively inexpensive evidence-based SEL program with interactive reading substantially improved the later benefits for adolescent emotional and behavioral health. This kind of SEL enrichment represents an approach that can leverage public investments in preschool programs to enhance public health.

Improving Toddlers' Healthy Eating Habits and Self-regulation: A Randomized Controlled Trial.

OBJECTIVES: In this study, we tested whether Recipe 4 Success, a preventive intervention featuring structured food preparation lessons, was successful in improving the following 4 protective factors related to overweight and obesity among families living in poverty: toddlers' healthy eating habits, toddlers' self-regulation, parents' responsive feeding practices, and parents' sensitive scaffolding. METHODS: This randomized controlled trial was open to families enrolled in Early Head Start home visits and included 73 parents and their toddlers aged 18 to 36 months. Multimethod assessments were conducted at baseline and posttreatment. RESULTS: Compared with toddlers in usual practice Early Head Start, toddlers in Recipe 4 Success consumed healthier meals and snacks (d = 0.57; P < .03; 95% confidence interval [CI]: 0.08-1.06) and displayed better self-regulation (d = 0.95; P < .001; 95% CI: 0.43-1.45). Compared with parents in usual practice Early Head Start, parents in Recipe 4 Success engaged in more responsive feeding practices (d = 0.87; P < .002; 95% CI: 0.34-1.40) and were better able to sensitively scaffold their toddlers' learning and development (d = 0.58; P < .04; 95% CI: 0.07-1.09). CONCLUSIONS: This randomized controlled trial revealed medium to large intervention effects on 4 important protective factors that are related to overweight and obesity but are often compromised by living in poverty.