Home Visitation Program Staff Attitudes and Intentions Towards Using Digital Technology to Educate Families About Preventing Early Childhood Obesity: A Qualitative Study.

INTRODUCTION: Home visitation programs that reach families of young children offer a unique opportunity for large-scale early childhood obesity prevention efforts. The objective of this qualitative research was to determine stakeholder attitudes, subjective norms, perceived ease of use and usefulness, behavioral control, and behavioral intentions towards utilizing technology in a home visitation program targeting early childhood obesity prevention. METHODS: Staff from the Florida Maternal, Infant, and Early Childhood Home Visiting Program (n = 27) were interviewed individually by a trained research assistant using a semi-structured script based on constructs from the Technology Acceptance Model and Theory of Planned Behavior. Demographic and technology use information were collected. Interviews were recorded and transcribed verbatim, with data extracted and coded by two trained researchers using a theoretical thematic analysis approach. RESULTS: Most of the home visiting staff (78%) were white and non-Hispanic and employed for an average of 5 years with the program. Most staff (85%) indicated they were currently using videoconferencing for home visits. Themes and subthemes emerged, including positive attitudes towards technology as a flexible and time-efficient program alternative for childhood obesity prevention with recommendations to keep content short, at a low literacy level, and available in more than one language for ease of use. Participants recommended developing training tutorials to improve program implementation. Internet access and potential social disconnect were cited as concerns for using technology. DISCUSSION: Overall, home visitation staff had positive attitudes and intentions for using technology in home visiting programs with families for early childhood obesity prevention.

Parental Factors Associated With Intentions to Initiate a Family-Based Pediatric Weight Management Program.

Background: Childhood obesity can be addressed through family-based pediatric weight management; however, treatment enrollment in the United States is low. This study aimed to identify parental factors associated with intentions to initiate a family-based pediatric weight management program. Methods: Cross-sectional survey data were collected from an online panel of US parents with at least one 5- to 11-year-old child identified as likely to have overweight or obesity. Participants viewed a video about a hypothetical family-based pediatric weight management program, rated their 30-day initiation intentions for that program, and answered additional related questionnaires. Results: Participants (n = 158) identified as White/Caucasian (53%) or Black/African American (47%), were primarily female (61.4%) and married/cohabitating (81.6%) with children who were predominantly girls (53.2%) and, on average, 9-year-olds. Higher parents' perception of program effectiveness predicted initiation intentions (p < 0.001), while concern for their child's weight and parent depression and anxiety levels did not. Higher initiation intentions and perceived program effectiveness were reported by Black/African American participants (p < 0.01) and those with at least a bachelor's degree (p < 0.01) compared to White/Caucasian participants and those without a bachelor's degree, respectively. Initiation intentions were higher for those with greater financial security (p = 0.020) and fewer than three children in the home (p = 0.026). Participants endorsed initiation barriers of time constraints (25%), possible lack of enjoyment for the child (16.9%), and lack of family support (15%). Conclusions: Future program enrollment efforts may need to focus on strategies to increase perceived program effectiveness, although further research is needed that measures actual enrollment in real-world contexts.

A Qualitative Study to Compare Barriers to Improving Food Security among Households with Young Children in the U.S. as Perceived by Different Types of Stakeholders before and during COVID-19.

This qualitative study aimed to determine the perceived barriers of different community stakeholders' to providing resources for improving food security in households with young children in the U.S. Community stakeholders working with low-income families with children 0-3 years of age in Florida were recruited to represent healthcare (n = 7), community/policy development (n = 6), emergency food assistance (n = 6), early childhood education (n = 7), and nutrition education (n = 6) sectors. In 2020, one-on-one interviews were conducted with each stakeholder in via Zoom, using an interview script based on the PRECEDE-PROCEED model and questions to capture the impacts of COVID-19. The interviews were audio-recorded, transcribed verbatim, and analyzed using a deductive thematic approach. A cross-tab qualitative analysis was used to compare data across categories of stakeholders. Healthcare professionals and nutrition educators indicated stigma, community/policy development stakeholders indicated a lack of time, emergency food assistance personnel indicated a limited access to food, and early childhood professionals indicated a lack of transportation as the main barriers to food security prior to COVID-19. COVID-19 impacts included the fear of virus exposure, new restrictions, lack of volunteers, and a lack of interest in virtual programming as barriers to food security. As perceived barriers may vary with respect to providing resources to improve food security in families with young children and the COVID-19 impacts persist, coordinated policy, systems, and environmental changes are needed.

BabyByte: Qualitative Research to Inform the Development of an App to Improve Responsive Feeding Practices in Parents of Infants and Toddlers.

Responsive feeding is associated with a reduced risk of childhood obesity. The objective of this qualitative study was to determine parental preferences for mobile health (mHealth) app content and features designed to improve responsive feeding practices. Parents of 0-2-year-old children were interviewed individually. Interview questions were informed by the Technology Acceptance Model, and parents provided feedback on sample app content and features. Interviews were audio-recorded, transcribed verbatim, and coded by two researchers using thematic analysis; responses were compared by parent gender and income. Parents (n = 20 fathers, n = 20 mothers) were, on average, 33 years old, low-income (50%), identified as non-white (52.5%), and had a bachelor's degree or higher (62%). Overall, parents were most interested in feeding tips and recipe content, and app features that allowed tracking child growth and setting feeding goals. Fathers were most interested in content about first foods, choking hazards, and nutrition information, while mothers preferred content on breastfeeding, picky eating, and portion sizes. Parents with lower incomes were interested in nutrition guidelines, breastfeeding, and introducing solids. Non-low-income parents preferred information related to food allergies, portion sizes, and picky eating. The findings of this study provide considerations when developing mHealth apps to improve responsive feeding practices in parents.

The Determinants of Food Insecurity Among Hispanic/Latinx Households With Young Children: A Narrative Review.

Food insecurity has disproportionately impacted Hispanic/Latinx households in the United States, specifically those with young children. Although the literature provides evidence of an association between food insecurity and adverse health outcomes in young children, minimal research has addressed the social determinants and related risk factors associated with food insecurity among Hispanic/Latinx households with children under three, a highly vulnerable population. Using the Socio-Ecological Model (SEM) as a framework, this narrative review identified factors associated with food insecurity among Hispanic/Latinx households with children under three. A literature search was conducted using PubMed and four additional search engines. Inclusion criteria consisted of articles published in English from November 1996 to May 2022 that examined food insecurity among Hispanic/Latinx households with children under three. Articles were excluded if conducted in settings other than the US and/or focused on refugees and temporary migrant workers. Data were extracted (i.e., objective, setting, population, study design, measures of food insecurity, results) from the final articles (n = 27). The strength of each article's evidence was also evaluated. Results identified individual factors (i.e., intergenerational poverty, education, acculturation, language, etc.), interpersonal factors (i.e., household composition, social support, cultural customs), organizational factors (i.e., interagency collaboration, organizational rules), community factors (i.e., food environment, stigma, etc.), and public policy/societal factors (i.e., nutrition assistance programs, benefit cliffs, etc.) associated with a food security status of this population. Overall, most articles were classified as "medium" or higher quality for the strength of evidence, and more frequently focused on individual or policy factors. Findings indicate the need for more research to include a focus on public policy/society factors, as well as on multiple levels of the SEM with considerations of how individual and policy levels intersect and to create or adapt nutrition-related and culturally appropriate interventions to improve food security of Hispanic/Latinx households with young children.

Feasibility, Acceptability, and Preliminary Outcomes of a Father-Focused Childhood Obesity Prevention Program for Low-Income Families with Preschool-Age Children.

Background: Few childhood obesity prevention interventions have focused exclusively on fathers, particularly in low-income families. The objectives of this study were to determine feasibility, acceptability, and preliminary outcomes of a father-focused childhood obesity prevention program for low-income families with preschool children (ages 3-5 years old). Methods: Father-child pairs (n = 45) enrolled in a community-based intervention in a Northeastern US state and were assigned within groups to intervention (n = 31) or a delayed comparison group (n = 14). The 8-week (2 h/week) program included nutrition, cooking, and parent education. Feasibility (enrollment, retention, and attendance) and acceptability (quality and value of program) of the program were assessed. Pre/Post measures included the Meals in our Household, Comprehensive Feeding Practices, Healthy Kids, and the Cooking Matters questionnaires. T-tests were conducted and Hedge's g was calculated to estimate effect sizes. Significance was set at p ≤ 0.10. Results: Results indicated feasibility and acceptability of the program for intervention fathers, but recruitment and retention of comparison fathers proved challenging. Small to medium effect sizes were detected for improvements in fathers' feeding pressure (g = 0.48, p = 0.005), confidence in cooking skills (g = 0.25, p = 0.09), ability to cook healthy foods on a budget (g = 0.33, p = 0.10), and frequency that fathers cooked dinner (g = 0.15, p = 0.06). There was a large effect size detected in the increase of green salad consumption (g = 0.75, p = 0.01) by fathers and a small effect size for frequency of children eating vegetables (g = 0.13, p = 0.07). Conclusions: While results are promising, further research should evaluate impact of a larger scale father-focused intervention on diet and obesity risk. The project was registered on ClinicalTrials.gov as NCT03071419.

Community Stakeholders' Perceptions on Barriers and Facilitators to Food Security of Families with Children under Three Years before and during COVID-19.

Children living in food-insecure households have poorer overall health than children in food-secure households. While U.S. nutrition assistance programs provide resources, these cannot consistently offer age-appropriate nutritional foods for young children. This study aimed to determine community stakeholders' perceptions of the barriers and facilitators to obtaining adequate, high-quality, and age-appropriate foods for children ages 0-3 in Florida before and during COVID-19. Community stakeholders (n = 32) participated in a 60 min interview via Zoom using a semi-structured script based on the PRECEDE component of the PRECEDE-PROCEED model. Interviews were transcribed verbatim and coded by two researchers using a thematic analysis approach. Stakeholders' perceptions revealed a lack of awareness surrounding eligibility for assistance programs, a lack of knowledge regarding how to obtain resources and services, and stigma associated with receiving benefits. These remained significant barriers to obtaining healthful foods for households with young children before and during COVID-19. Nonetheless, barriers were exacerbated during the pandemic. Unemployment rates rose, intensifying these households' financial hardships and food insecurity levels. Likewise, stakeholders suggested the need for families to become more aware of federal assistance eligibility requirements and available opportunities via social media and referrals. Identifying risk factors associated with food insecurity can inform future interventions to safeguard young children's health and well-being.

A qualitative study of providers' perceptions of parental feeding practices of infants and toddlers to prevent childhood obesity.

BACKGROUND: With a recent focus on establishing US Dietary Guidance for children ages 0 to 2 years old, the objective of this qualitative study was to determine misconceptions and barriers that prevent parents from implementing early childhood feeding and obesity prevention practices as reported by healthcare, community-based, and education providers. METHODS: Trained researchers conducted one-on-one qualitative phone interviews, using a semi-structured script, with early childhood health and education providers working with families of young children. Interviews were audiotaped, transcribed verbatim, and analyzed using the classic analysis approach. Transcripts were coded by researchers and analyzed for themes. RESULTS: Providers (n = 21) reported commonly observed obesogenic practices including overfeeding tendencies, early initiation of solids or less optimal feeding practices, lack of autonomy and self-regulation by child, and suboptimal dietary patterns. Sources of parental misconceptions about feeding were often related to cultural, familial, and media influences, or lack of knowledge about optimal feeding practices for infants or toddlers. CONCLUSIONS: Providers indicated a need for engaging and consistent child feeding and obesity prevention education materials appropriate for diverse cultural and literacy levels of parents, with detailed information on transitioning to solid foods. Early education and community-based providers reported limited access to evidence-based educational materials more so than healthcare providers. It is an opportune time to develop reputable and evidence-based child feeding guidance that is readily available and accessible for parents of infants and toddlers to prevent early childhood obesity.

Examining Factors Related to the Food Insecurity-Obesity Paradox in Low-Income Mothers and Fathers.

BACKGROUND: Prior research has indicated a varying relationship of food security and obesity risk between men and women yet factors affecting this relationship are unclear. OBJECTIVE: The objective of this study was to examine factors related to the gender disparity in the food insecurity-obesity paradox within a sample of low-income parents. METHODS: Low-income cohabiting mother and father pairs (n = 25) living with their child were interviewed individually using the United States Department of Agriculture Household Food Security Module, Center for Epidemiological Studies Depression Scale, and Coping Strategies Index to examine gendered factors related to the food insecurity-obesity paradox. RESULTS: There was a significant (P = .003) difference in report of adults in the household sacrificing consumption to feed young children between mothers (2.91 ± 0.92) and fathers (3.59 ± 0.73), with mothers reporting greater sacrifice and compromised diet quality to feed their children, but no significant correlation among body mass index, depression, and food insecurity was detected. CONCLUSIONS: Food insecure mothers may be more likely to compromise their diet quality to feed their children than fathers. This could help explain why the food insecurity-obesity paradox is significant only in women, and this work gives insights into gender-based differential consequences of food insecurity.

Evaluation of a Farm-to-School Intervention to Improve Locally Grown Vegetable Choices of Low-Income, Primary School Students.

BACKGROUND: The study objective was to determine impact of a Farm-to-School intervention on low-income, diverse elementary school students' nutrition-related attitudes, self-efficacy, behaviors, and locally grown vegetable choices. METHODS: Six elementary schools within 1 US school district were equally assigned to 1 of 3 conditions: Local Message, Nutrition Message, or Control. Locally grown vegetables (kale, green beans, zucchini, butternut squash, and beets) were served twice during lunch over 16 weeks. "Local" and "Nutrition" groups also received biweekly nutrition education and a messaging campaign in the cafeteria. Knowledge, attitudes, self-efficacy, and related behaviors were assessed using a validated questionnaire. Vegetable selection was assessed using the food service daily production records. General linear model analysis, analysis of covariance, and t tests were performed. RESULTS: Students in the "Local" group (N = 81) had significantly improved nutrition-related attitudes (p = .0001), preferences (p = .001), and overall vegetable behavior score (p = .002), compared to control (N = 79). There was no difference in overall locally grown vegetable choices, but local beet choices were higher in the "Local" (p = .005) and "Nutrition" (p = .02) groups compared to control. CONCLUSIONS: Messages about local foods in school cafeterias may improve students' attitudes, preferences, and selection of certain locally grown vegetables.

Development and Qualitative Pretesting of Child Feeding and Obesity Prevention Messages for Parents of Infants and Toddlers.

BACKGROUND: Consistent, evidence-based child feeding guidance targeted to parents of children ages birth to 24 months (B-24) is needed for early childhood obesity prevention. OBJECTIVE: The aim was to develop and pretest a comprehensive set of child feeding and obesity prevention messages for parents of children ages B-24. DESIGN: A qualitative, 2-phase protocol, grounded in social and behavior change, was used as a conceptual interview framework to pilot test early childhood feeding messages with parents. PARTICIPANTS/SETTING: Participants were parents (n = 23) of children ages B-24. METHODS: A core set of 12 messages and supporting materials were developed for parents of children ages B-24 based on previous research findings, current research evidence, and feeding guidance. Parents were individually interviewed using a semistructured script along with additional questions to rank perceptions of message qualities. MAIN OUTCOME MEASURES: Overall comprehension, importance, believability, ease of implementation, and likelihood of use of messages were assessed. STATISTICAL ANALYSIS PERFORMED: Data analysis included qualitative thematic analysis and descriptive statistics for Likert-scaled responses. RESULTS: Participants were primarily female, non-Hispanic White, with a mean age of 33.3 ± 6.8 years and at least a bachelor's degree. Overall, most messages were understood, believable, perceived as important, and feasible by parents. Messages related to starting solid foods, encouraging child control of intake and self-feeding, and food allergen guidance were perceived as more difficult and less likely to be implemented by parents. CONCLUSIONS: Additional research is needed to evaluate actual implementation of messages by diverse parents and resulting outcomes including impact on child weight.

Revisiting nutrition backlash: Psychometric properties and discriminant validity of the nutrition backlash scale.

OBJECTIVES: Nutrition backlash is a disposition defined by negative feelings about dietary recommendations. Past research has measured nutrition backlash using the nutrition backlash scale (NBS) and found that it is negatively related to the consumption of fruits and vegetables. The aim of this study was to examine several aspects of the NBS, including factor structure, discriminant validity, and relationship to demographic characteristics and health behaviors. METHODS: Adults were recruited to participate in two studies. Study 1 (N = 480) included measures of nutritional backlash, information overload, worry, fatalism, and nutrition-related behaviors. Study 2 (N = 399) was a follow-up that examined the factor structure of the NBS in a separate sample. RESULTS: In study 1, a six-item version of the NBS was found to be a good fit for the data and discriminant from overload, worry, and fatalism. NBS was higher for those with less education, non-white participants, and men. Individuals with higher backlash were less likely to look at nutritional labels and to use sunscreen. Study 2 confirmed the factor structure from study 1. CONCLUSIONS: A six-item version of the NBS was found to be reliable, discriminant from related measures, higher in underserved groups (less-educated, non-white, and male participants), and related to nutrition label use.

A pilot examination of the inter-rater reliability of the 18-item Household Food Security Module between cohabiting mothers and fathers.

Food insecurity, defined as the inability to access sufficient food for an active, healthy life, affects 11.1% of the US population and is primarily assessed using the United States Department of Agriculture's (USDA) 18-item Household Food Security Survey Module (HFSSM). The HFSSM is a self-report measure presumed to represent all household members, but it is unknown if cohabiting parents report food security differently. This pilot study aimed to determine (i) the inter-rater reliability of the HFSSM; (ii) the direction of any difference between responses to the HFSSM; and (iii) the item-level response similarities and differences among mothers and fathers of young children. Twenty-five pairs of low-income, food-insecure cohabiting parents of 2.5- to 10-year-old children participated in cognitive interviews assessing their level of food security using the USDA's HFSSM and completed related questionnaires. Intraclass correlations were computed to compare the responses of each dyad on the HFSSM overall and by item. Results revealed that overall report of food security was significantly but weakly correlated (r = .40, p = .02) within dyads. The majority of fathers (60%) reported higher food security scores on the HFSSM than their respective female partners. Furthermore, item-level intraclass correlations revealed that some HFSSM questions had poor reliability between cohabiting parents. This research identifies that a potential shortcoming of the HFSSM is the under-reporting of food insecurity by fathers compared with mothers within the household. These findings have implications for the utility of this measure used in national monitoring of the nation's food security.

Ripple Effects of the Communities Preventing Childhood Obesity Project.

This research examines the practice of community coaching within coalitions in the Communities Preventing Childhood Obesity project. A quasi-experimental design was used in seven Midwestern states. Each state selected two rural, low-income communities with functioning health coalitions. Coalitions were randomly assigned to be intervention or comparison communities. After 4 years of the coaching intervention, ripple effect mapping served as one method for examining the coalitions' work that may affect children's weight status. A research team from each state conducted ripple effect mapping with their two coalitions, resulting in 14 ripple maps. Community capitals framework and the social-ecological model were used for coding the items identified within the ripple maps. A quantitative scoring analysis determined if differences existed between the intervention and comparison coalitions in terms of the activities, programs, funding, and partnerships for social-ecological model score (e.g., individual, community, policy levels), community capitals score, and ripples score (e.g., number of branches formed within the maps). All scores were higher in intervention communities; however, the differences were not statistically significant (p > .05). Assessing community assets, such as availability of a community coach, is necessary in order to decide whether to deploy certain resources when designing health promotion strategies.

Interpretation and Understanding of the Dietary Guidelines for Americans Consumer Messages Among Low-Income Adults.

Objective: The objective of this study was to determine the interpretation, understanding, and implementation of the Dietary Guidelines for Americans (DGA) consumer messages among low-income adults and compare findings to perceptions of the messages for consumers by community nutrition educators.Methods: In this mixed methods, cross-sectional study, a convenience sample of low-income adults (n = 98) with a child between the ages of 3 and 10 years old and nutrition educators (n = 9) were interviewed individually about the DGA messages, food-related behaviors, and barriers related to consuming fruits, vegetables, and whole grains. Interviews were audio-taped, transcribed verbatim, and analyzed using the inductive approach. Interpretation and ranking of the clarity and ease of the DGA messages by low-income adults and nutrition educators and perceptions about the messages were assessed. Descriptive statistics were conducted for demographic data and Fisher's exact tests were used to examine differences regarding the clarity and ease of the messages among low-income adults and nutrition educators.Results: According to the interview results, messages that tended to be misinterpreted most frequently were on topics such as sodium, fruit and vegetables, portions, and whole grain intake. Low-income adults and nutrition educators also differed in perceptions for the message clarity addressing whole grain servings (p = .001), avoiding oversized portions (p = .002), and comparing sodium (p < .001).Conclusions: Improvements in the DGA consumer messages are warranted to improve clarity and feasibility for low-income adults through new communication tools or strategies that complement the DGA.

A qualitative investigation of body weight and weight loss-related attitudes of mothers and fathers in the context of food insecurity.

PURPOSE: To examine attitudes about body weight and weight loss among low-income parents of young children experiencing household food insecurity. METHODS: One-on-one interviews were conducted with 25 dyads of cohabitating low-income mothers and fathers who lived with their child aged 2.5-10 years old. Basic inductive analysis was conducted using NVivo to identify emerging themes related to body weight. RESULTS: Three main themes emerged including (1) weight loss as a "Blessing in Disguise," (2) trouble with losing weight, and (3) the impact of compromised diet quality. Some differences existed in themes between mothers and fathers, but both placed value on weight loss resulting from food insecurity. CONCLUSION: This research underscores the importance of sufficient nutrition assistance for limited resource families. A lack of money for food was a barrier towards maintaining a healthy weight but the value our culture places on weight loss even in times of despair was undeniably present. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

A randomized controlled trial of a theory-based weight-loss program for couples.

OBJECTIVE: Weight gain occurs during marriage, yet obesity treatment is focused on individuals. Outcomes may be improved by targeting joint weight loss and the interpersonal milieu that fosters spousal interdependence. Self-determination theory (SDT) posits that autonomy-supportive environments (e.g., promote meaningful choice, minimize control) produce better health outcomes. This trial tested an SDT-informed weight-loss intervention intended to facilitate autonomy support in couples. METHOD: Sixty-four couples were randomized to standard behavioral weight loss (BWL) that couples attended together or to a SDT-informed weight-loss intervention (SDT-WL) that aimed to bolster autonomy support (AS). Groups met weekly for 6 months with assessments at 0, 3, 6, and 12 months. RESULTS: Percent weight loss at 6 and 12 months was 10.4% ± 6.5% and 9.2% ± 8.2%. No differences were observed between the BWL and SDT-WL conditions in percent weight loss or changes in AS. Across conditions, higher baseline AS predicted greater weight loss at 6 and 12 months (ps <.001). Increases in AS over time predicted greater weight loss at 6 and 12 months (ps ≤ .02). Post hoc moderation analysis indicated that only participants with low (but not high) baseline AS achieved greater gains in AS at 12 months in SDT-WL than in the BWL conditions (p < .02). CONCLUSIONS: Although no differences were found between conditions on weight loss or changes in autonomy support behavior, autonomy support from one's spouse predicted weight loss in both couples-based weight-loss approaches. For couples with low levels of AS, an SDT-informed approach was effective at increasing this desirable interpersonal behavior. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Recruitment, Engagement, and Retention of Fathers in Nutrition Education and Obesity Research.

This article provides a perspective about recruiting, engaging, and retaining fathers in research and programming related to nutrition education and childhood obesity prevention. Recent research emphasizes the importance of fathers in childhood obesity prevention, and although father-friendly approaches can emulate other underserved populations, some researchers have acknowledged that differences may exist. Family sciences- related and nutritional sciences-related literature is summarized to provide guidance for nutrition and obesity scholars. Best practices may vary by the type of study and father characteristics; and the venues, content, structure, timing, and approach of research and interventions may need to be tailored for fathers.

Feeding Infants and Toddlers: A Qualitative Study to Determine Parental Education Needs.

Background: Limited evidence-based guidance is available to parents regarding optimal child feeding practices to prevent early childhood obesity from birth to 24 months of age (B-24). The objective of this qualitative study was to determine current child feeding practices, barriers to implementation, and educational needs of parents of varying socioeconomic backgrounds as it relates to responsive feeding to prevent early obesity in children of ages B-24. Methods: One-on-one interviews were conducted with parents (n = 66) of children ages B-24 from both low-and non-low-income households. Interviews were audiorecorded, transcribed verbatim, and analyzed with NVivo using classical qualitative analysis. Results: Participants were primarily female (91%), married (53%), low-income (59%), and were not first-time parents (72%). The results revealed overarching themes, including parents' reported need for information on preparing child meals, optimal dietary intake, affordable healthy foods, promoting child self-feeding, and food and nutrition knowledge. Low-income parents more frequently requested guidance about identifying affordable healthy options and overfeeding while non-low-income parents requested information about food allergens, transitioning to solids, and creating structured mealtimes. Conclusions: Additional and focused outreach to parents of children ages B-24 regarding optimal feeding practices is needed especially on topics related to complementary feeding during the transition to solid food.