Assessing the Performance of a Nutrition Knowledge Questionnaire With a Low Socioeconomic Status Population Using Rasch Analysis.

Parents and preschool teachers play a key role in shaping children's dietary behaviors. Knowledge of nutrition and healthy dietary choices is a key component to improve dietary habits and reduce the prevalence of obesity and associated co-morbidities. Using valid and reliable instruments is necessary for accurate assessment of knowledge to tailor interventions and measure effectiveness specific to the population of interest. The objectives of this paper are to (1) identify potential gaps in the baseline nutrition knowledge among parents and teachers using a previously validated questionnaire prior to a preschool obesity prevention intervention; and (2) assess the instrument's reliability and construct validity for a low socioeconomic status population using a post hoc Rasch analysis. Participants included 177 parents and 75 teachers who participated in a Head Start intervention study. Knowledge scores, instrument reliability, and item fit and difficulty were assessed using a Rasch analysis; t-tests were used to determine differences in scores between parents and teachers. Parents answered 38% of questions correctly while teachers correctly answered 46% of the questions. Adequate item fit and reliability were indicated for Sections 1 and 2 of the Nutrition Knowledge Questionnaire (NKQ). Section 3 demonstrated less adequate reliability. The items were found to adequately and reliably define the unidimensional measures of the three components of knowledge represented in this instrument, providing evidence of construct validity. However, Rasch measures indicated the NKQ overall was difficult for participants. Recommendations for improving the instrument for nutrition education/intervention and research practice areas related to obesity and obesity-related conditions are addressed.

Engagement with reservation-based Head Start teachers to explore their stress and coping: A qualitative study.

BACKGROUND: Native Americans residing in remote reservation communities find strength in connection to place, culture, language, and sovereignty; they also face challenges as their communities struggle with historical and contemporary traumas that have resulted in poverty, high crime and suicide rates and drug misuse. The psychological well-being of Head Start teachers who teach and support the needs of Native American children, is overlooked. METHODS: Qualitative interviews (n = 18) and focus groups (n = 9) were conducted with Head Start teachers, supervisors, parents, and ancillary staff to identify risk and protective factors at each level of the socioecological model (individual, relationships, community, society). Using content analysis and F4 analyse software two coders identified recurring themes. RESULTS: Individually teachers are resilient, focused more on the children's well-being than their own. Family was both significant support and stressor. Community struggles with drug and alcohol misuse and homelessness were the most frequent stressors. Workplace support included their supervisors and the mentorship they provided each other. Spirituality in the form traditional cultural practices, prayer and Christen faith were important sources of support and well-being. CONCLUSIONS: This paper provides insight into the stress and coping mechanisms of reservation-based Head Start teachers, identifying ways to protect and promote their health and well-being. It is important to provide support at all levels of the socioecological model to enable these teachers to strengthen their physical and psychological health and wellbeing so that they may support the children and families of Head Start to help strengthen Native American health overall.

Possibilities and power during early Head Start Home visits: Comparing family- and home visitor-opened decision-making.

Decision-making by families and professionals about how to support children's development is an integral aspect of home visits. This study investigated home visit decision-making in a US program for families experiencing poverty, Early Head Start (EHS), through the following questions: What types of decisions do home visitors and families make about children's development during EHS home visits? How and to what extent do home visitors and families participate during these decisions? A convergent mixed methods research design was implemented to investigate participation through frequency counts and discourse analysis of home visit transcripts. Home visitor participants were four women, three white and one Black. Twelve families participated (12 mothers, 2 fathers). Parents identified as white (n = 8), Black (n = 3), and multiracial (n = 3; Black and white). One parent was a bilingual Arabic and English speaker. A total of 66 decisions about children's development were identified, with 49 decisions initiated by home visitors and 17 initiated by families. Although families talked more and took on active roles when they initiated (i.e., opened) decisions, home visitors predominantly controlled decision-making. Quantitative and qualitative participation differed only in the beginning of family-opened decisions, and home visitors gradually took more control.

La toma de decisiones por parte de familias y profesionales acerca de cómo apoyar el desarrollo de los niños es un aspecto integral de las visitas a casa. Este estudio investigó la decisión de hacer visitas a casa en el programa de Estados Unidos para familias que viven en pobreza, "De un comienzo temprano" (Early Head Start), a través de las siguientes preguntas: ¿Qué tipo de decisiones toman las visitadoras a casa y las familias acerca del desarrollo de los niños durante las visitas a casa del programa "De un comienzo temprano?" ¿Cómo y hasta qué punto las visitadoras a casa y las familias participan durante la toma de estas decisiones? Se implementó un diseño convergente mixto de métodos de investigación para investigar la participación por medio de conteos frecuentes y análisis de las transcritas conversaciones de la visita a casa. Las visitadoras a casa que participaron fueron cuatro mujeres, tres blancas y una de raza negra. Doce familias participaron (12 mamás, 2 papás). Los progenitores se identificaron como blancos (n = 8), negros (n = 3) y multirraciales (n = 3, negros y blancos). Uno de los progenitores era hablante bilingüe de árabe e inglés. Se identificó un total de 66 decisiones acerca del desarrollo de los niños, de las cuales 49 fueron iniciadas por las visitadoras a casa y 17 por las familias. Aunque las familias hablaron más y asumieron un papel activo cuando hablaban primero sobre las decisiones (v.g., cuando abrían la conversación), las visitadoras a casa predominantemente controlaron la toma de decisiones. La participación cuantitativa y cualitativa difirió sólo al principio de las decisiones iniciadas por las familias y las visitadoras a casa gradualmente asumieron mayor control.

A deeper dive, a wider pool: Preschool benefits sustain to first grade on a broader set of outcomes.

The current study provides new evidence on the sustained benefits of preschool attendance on a broader range of skills-both academic and executive functioning (EF)-than many prior studies have examined. Using propensity score methods, we predicted children's (N = 920, M age at 1st = 6.5 years) literacy, language, math, and EF skills in kindergarten and again at first-grade (2020-2021) based on whether they had attended public preschool (school-based pre-k; Head Start) versus no preschool. In our race-ethnically diverse sample of children (48% Hispanic/Latinx; 21% Black; 14% White; 9% Native American; 9% multiracial) from low-income families, preschool attenders showed advantages on English literacy, English language, and math in kindergarten, which mostly persisted into first-grade. Preschool did not boost EF in kindergarten or first-grade.

Feasibility, acceptability and effectiveness of a culturally informed intervention to decrease stress and promote well-being in reservation-based Native American Head Start teachers.

BACKGROUND: While benefiting from strong cultural ties to family, land and culture Native Americans residing on reservations experience psychological distress at rates 2.5 times that of the general population. Treatment utilization for psychological health in reservation-based communities is low with access to culturally appropriate care lacking. Evidence suggests that for mental health treatment, Native Americans prefer culturally informed care that respects Native perspectives on health and well-being. METHODS: To decrease stress and promote well-being in tribal Head Start teachers we adapted and implemented a culturally focused intervention within a community-based participatory research framework using mixed methods. Feasibility and acceptability of the adapted 5-session curriculum was tested in a single arm intervention study with a sample of 18 teachers on the Fort Peck Reservation. Participants completed surveys at baseline and upon completion of the intervention. Within session observations and two post-intervention focus groups (n = 8, n = 10) were conducted to elaborate and explain the quantitative results eliciting participant experience of intervention effectiveness and feasibility, acceptably and appropriateness. Implementation outcomes were assessed quantitatively using the Acceptability of Intervention, Intervention Appropriateness, and Feasibility of Intervention measures. RESULTS: Quantitively, attendance rate overall was 93% with no dropouts. Pretest/posttest surveys were analyzed using t-tests and Hedges g to measure effect size. Contrary to our hypothesis, self-perceived stress showed a small positive effect size, indicating that participants were more stressed post intervention. However, depression decreased, with tribal identity and resilience showing positive effect sizes. Content analysis for the qualitative data collected within session observations and post intervention focus groups revealed how lifetime traumas were affecting participants, providing some explanation for the increase in stress. Teachers reported that the sessions helped their psychological health and well-being, supporting feasibility of future interventions. Acceptability scored highest with a mean (SD) of 4.25 (.84) out of 5, appropriateness 4.18 (.86) and feasibility 4.06 (.96) supporting intervention to be acceptable, appropriate, and feasible. CONCLUSION: Utilizing a culturally based intervention to buffer stress and support the well-being of reservation-based teachers showed promise in helping them recognize their cultural strengths, stress, and need for ongoing support. Implementation outcomes show that intervention scale-out is feasible.

A Worksite Health Promoting Program for Early Head Start and Head Start Workforce.

INTRODUCTION: Early Head Start (EHS) and Head Start (HS) staff comprise a large segment of the public sector workforce and experience numerous risk and chronic factors for medical conditions or symptoms. Few health and wellness workplace interventions, however, specifically focus on EHS/HS staff. METHODS: A train-the-trainer (TTT) approach was used to build capacity among directors and staff from 57 EHS/HS programs on how to strategically plan and implement a health promoting worksite program focusing on improving nutrition and physical activity practices among EHS/HS staff. Baseline and 3-month post-training questionnaires assessed EHS/HS staff changes on knowledge and practices related to nutrition and physical activity. Paired t-tests or chi2 statistics assessed changes in questionnaire responses over time. RESULTS: 1,363 staff from 57 programs completed baseline and follow-up surveys. Staff had high knowledge regarding healthful dietary patterns at baseline. Over one-third of staff reported drinking soda with meals and almost 50% identified soda as their most common drink. Roughly one-third of staff also reported no physical activity in the prior week at baseline. Staff demonstrated significant improvements in dietary, nutrition, and physical activity practices. Staff also improved grocery shopping behaviors. IMPLICATIONS FOR PRACTICE: The TTT approach to disseminate an EHS/HS staff-focused health promotion program, "Eat Healthy, Stay Active!' provides a potentially promising strategy to build upon and disseminate more broadly to reach the over >300,000 EHS/HS staff workforce.

An investigation of Head Start preschool children's executive function, early literacy, and numeracy learning in the midst of the COVID-19 pandemic.

The COVID-19 pandemic's impact on preschool children's school readiness skills remains understudied. This research investigates Head Start preschool children's early numeracy, literacy, and executive function outcomes during a pandemic-affected school year. Study children (N = 336 assessed at fall baseline; N = 237-250 assessed in spring depending on outcome; fall baseline sample: mean age = 51 months; 46% Hispanic; 36% Black Non-Hispanic; 52% female) in a network of Head Start centers in four states (Nevada, New Jersey, Pennsylvania, and Wisconsin) experienced low in-person preschool exposure compared to national pre-pandemic norms. Children experienced fall to spring score gains during the pandemic-affected year of 0.05 SD in executive function, 0.27 SD in print knowledge, and 0.45-0.71 SD in early numeracy skills. Descriptively, for two of the three early numeracy domains measured, spring test score outcomes were stronger among children who attended more in-person preschool. We discuss implications for future research and policy.

Online Grocery Shopping and the Supplemental Nutrition Assistance Program (SNAP) Electronic Benefit Transfer Card (EBT): Perceptions of Head Start Caregivers.

The objective of this study was to explore perceptions of online grocery shopping and the online United States Department of Agriculture's (USDA) Supplemental Nutrition Assistance Program (SNAP) Electronic Benefit Transfer card (EBT) program among Head Start caregivers. Three focus groups were conducted between December 2019 and January 2020. Most participants hadn't tried online grocery shopping. Concerns included others choosing perishables, receiving wrong items, and inappropriate substitutes. Perceived benefits included saving time, preventing impulse buys, and eating healthier. Results have broad applicability in the current COVID-19 pandemic where online grocery shopping and the online SNAP EBT program have rapidly expanded across the United States.

University-Community Partnerships to Support Responsive Caregiving: The Hearts and Minds on Babies Implementation Story.

Consistent, sensitive caregiving across home and childcare contexts supports optimal development. In this paper, we share the story of the development of Hearts and Minds on Babies (HMB) for Early Head Start (EHS) administrators, teachers, and parents. HMB was designed to support caregiver reflective functioning and sensitivity and reduce caregiver stress. This paper describes a series of Plan-Do-Study-Act cycles used to adapt an existing parenting intervention into the HMB programming for EHS. Throughout the paper, we present HMB concepts and learning objectives and share teachers' and parents' feedback and adaptations to content and delivery options that support implementation by EHS programs. Feedback from the final cycle suggests that HMB supports EHS administrators, teachers, and parents in their roles and improves relationships. The paper highlights the importance of research-practice partnerships in developing programming that meets the needs of EHS.

Increasing Teacher Opportunities to Respond in a Head Start Program Using a Bug-In-Ear Coaching Model.

Early childhood teachers play a critical role in the kindergarten readiness of preschool age children. Yet, they often receive little and insufficient training in the use of evidence-based practices that can increase academic success and prevent undesired behaviors. As a result, preschool teachers tend to use more exclusionary practices when disciplining students. A promising strategy for developing the skills of preschool teachers is the use of bug-in-ear coaching, a coaching strategy where a trained individual provides in-the-moment support to a teacher from a location outside of the classroom. This study examined bug-in-ear coaching to support preschool teachers in using opportunities to respond during explicit math instruction. A multiple baseline design across teachers was used to assess the impact of the intervention on the teachers' rates of implementation of opportunities to respond. Bug-in-ear coaching was associated with an increased rate of opportunities to respond for all teachers during the intervention with a functional relation for two out of four teachers. All teachers' rates of opportunities to respond were below their intervention rates during maintenance. Further, teachers reported enjoying the intervention and the opportunity given to improve their practices. Teachers also expressed their desire to have this level of coaching in their centers.

Caring for Whole Families: Relationships Between Providers and Families During Infancy and Toddlerhood.

Caring relationships among families and providers are at the heart of high-quality early care and education (ECE). This study examines relationships between parents and providers in a nationally representative sample of infants and toddlers and their families (N = 527) enrolled in the two-generation Early Head Start (EHS) program in the U.S. EHS' primary services include home visiting and center-based early education, taking a whole family approach to provide comprehensive services within caring and trusting relationships. Using weighted lagged regression models, we found that parent and provider reports of their positive relationships with one another at age 2 years were related to some child and family outcomes at the end of their EHS experience at age 3 years. Providers who reported better relationships with parents rated children as having lower behavior problems and enhanced social competence, language comprehension, language production, and home environments. Parents who reported better relationships with providers also reported lower parenting stress and family conflict. Findings suggest that caring relationships between providers and parents are a key part of high-quality ECE within an environment dedicated to an ethic of care not just for children, but for the whole family.

Supporting family meal frequency: Screening Phase results from the Simply Dinner Study.

We aimed to test main, additive, interactive effects, and feasibility of all possible combinations of six intervention components implemented for 8 weeks (Cooking/Serving Resources; Meal Delivery; Ingredient Delivery; Community Kitchen; Nutrition Education; Cooking Demonstrations). Primary outcomes were family meal frequency and preschoolers' dietary quality; secondary outcomes included family meal preparation type, meal preparation barriers, family functioning, and kitchen inventory adequacy. All possible intervention combinations were tested using a randomized factorial trial design in the first phase of a Multiphase Optimization Strategy (MOST). Feasibility was assessed via attendance, delivery logs, and satisfaction. Parent-reported data collection included: socio-demographics, frequency and type of family meals; preschooler dietary intake; perceived barriers to meal planning and preparation; assessment of family functioning; and a kitchen inventory of materials generally needed for meal preparation. Participants (n = 499) were recruited at two Head Start agencies in mid-Michigan with data collection and delivery of some intervention components in participants' homes. Promising intervention bundles were identified by evaluating pre-to post-intervention effect sizes. The combination of Cooking/Serving Resources and Meal Delivery increased family meal frequency (Cohen's d = 0.17), cooking dinner from scratch (d = 0.21), prioritization of family meals (d = 0.23), and kitchen inventory (d = 0.46) and decreased use/consumption of ready-made (d = -0.18) and fast foods (d = -0.23). Effects on diet quality were in the expected direction but effect sizes were negligible. Community Kitchen, Nutrition Education, and Cooking Demonstration showed poor feasibility due to low attendance while Ingredient Delivery was infeasible due to staffing challenges related to its labor intensity. Additionally, although not one of our pre-specified outcomes, Cooking/Serving Resources (RR = 0.74) and Meal Delivery (RR = 0.73) each decreased food insecurity. Cooking/Serving Resources combined with Meal Delivery showed promise as a strategy for increasing family meal frequency.

Promoting Child Development During the COVID-19 Pandemic: Parental Perceptions of Tele-Home Visits in Early Head Start Programs.

OBJECTIVE: The COVID-19 pandemic prompted families to receive Early Head Start (EHS) home-based services virtually. This qualitative study evaluated parental perceptions of EHS tele-home visits. METHODS: EHS parents who had transitioned to tele-home visits using any video-chat platform were recruited to participate in a Spanish or English virtual focus group that assessed their perceptions of tele-home visits. Using an iterative, consensus-seeking inductive content analysis approach, themes and subthemes were identified. RESULTS: Thirty-five mothers of children newborn to 3-years-old, where the majority were Latino and Spanish-speaking, participated in four focus groups. Several patterns pertaining to technology, child engagement, child learning and development, and parent-home visitor relationship emerged in the qualitative analysis. Mothers revealed varying degrees of digital proficiency, device preference, and technology challenges. Mothers reported variability in child engagement and concerns with missed socialization opportunities for children as a results of tele-home visits, but also reported increased self-efficacy in supporting child development, positive relationships with their home visitor, and overall satisfaction with services. CONCLUSION: Parents revealed tele-home visits have the potential to be a viable service delivery method for EHS home-based programs. While parents perceived increased engagement and an uncompromised parent-home visitor relationship, they revealed areas of needed support that would optimize the use of tele-home visits.

Child Temperament as a Moderator of Promoting First Relationships Intervention Effects Among Families in Early Head Start.

As availability of parent-child interaction curricula increases, Early Head Start (EHS) provides a relevant context to test research-based parenting models as part of everyday practice. We trained EHS staff to incorporate the Promoting First Relationships (PFR) intervention into ongoing weekly home visits with mothers and their young children (n = 102) enrolled in EHS. Children had a mean age of 19.75 months and were 56% Hispanic, 23% Black, and 14% White. Families were randomly assigned to an intervention group where they participated in PFR as an EHS enhancement, or to a waitlist-control group where they received only typical EHS services. To explore the possibility that effectiveness of parent-child curricula may differ based on child characteristics, we used linear regression to examine children's temperament as a potential moderator of PFR efficacy on outcomes related to parenting stress, family functioning, and parent-child interaction. While we did not find a significant main effect of PFR for the full sample, there were several significant moderated effects. For families where children showed higher levels of surgency, mothers' parenting stress was significantly reduced after PFR participation. Also, when children showed higher levels of negative affect, mothers demonstrated higher sensitivity in parent-child interactions after participating in PFR. Given findings from our exploratory study, agencies should consider the characteristics of families served and the match with intervention priorities, when selecting intervention programs. When delivered as a home visitation enhancement, PFR may be a valuable support for certain enrolled families, based on child characteristics including high levels of surgency or negative affect.

Perspectives of Region XI Head Start Federal, Research, and Program Partners in Carrying out a National Study of American Indian and Alaska Native Head Start Children, Families, and Programs.

The American Indian and Alaska Native Head Start Family and Child Experiences Survey (AIAN FACES) 2015 was the first national study of children served by Region XI Head Start programs, which are those operated by federally recognized AIAN tribes. Until 2015, Region XI programs had not been included in national studies of Head Start children's experiences and development, leaving them without this critical source of data to inform policy and practice as is available to other Head Start regions. To address this gap, four groups of stakeholders gathered to plan for a study that put the needs of Region XI Head Start at the forefront, was informed by the historical context of research with AIAN communities, and was guided by community psychology and community-based and tribal participatory approaches. Engaged partnership is a common practice in research with AIAN communities, but rarely on a national scale across diverse communities. The study's success speaks to the success of the unique national partnership between the Region XI Head Start, research, and federal stakeholders who formed the AIAN FACES Workgroup. This first-person account documents the perspective of each group as they undertook this seminal effort and reviews connections with, and lessons learned for, the broader field of community psychology.

The Associations between Adverse Childhood Experiences and Social Services Use among Head Start-Eligible Low-Income Families.

This study examined the effects of adverse childhood experiences (ACEs) on parental social services use among Head Start-eligible low-income families. Based on the Head Start Impact Study data (N = 3,562), three questions were addressed: (1) Does the number of ACEs impact parental social services use? (2) Do family characteristics have any association with parental social services use? and (3) Does parental social services use differ between Head Start and non-Head Start parents? Regression indicated that parents with more ACEs tended to use more social services. Compared with parents with one ACE, parents with two ACEs and parents with three or more ACEs used more social services with income assistance, food and nutrition assistance, and housing and utility assistance programs. Parents with three or more ACEs tended to use more social services related to alcohol and drug use, mental health, and foster care payments than parents with one ACE. Barriers to social services use were identified and include racial disparities, native language, immigration status, and geographical location. Head Start was not found to have a significant impact on whether parents used more social services. Recommendations include increasing effective collaboration between social workers and services, assessing barriers to receiving services, and implementing ACE screenings.

Do high childcare costs and low access to Head Start and childcare subsidies limit mothers' employment? A state-level analysis.

Access to affordable childcare is crucial to mothers' employment. Yet, childcare costs and access to Head Start, childcare subsidies, and state-funded preschool vary dramatically across U.S. states. Using data from the 2016 American Community Survey five-year estimates, we apply hierarchical logistic regression models to show mothers are more likely to work in states with inexpensive childcare, higher Head Start enrollment and childcare subsidy participation, and increased availability of state-funded preschool. Childcare subsidy access is associated with higher maternal employment amongst those with lower levels of educational attainment, whereas state-funded preschool is associated with higher employment primarily among the college educated. Additionally, our analysis revealed that Head Start has a stronger association with maternal employment in states where childcare costs are high, reducing the negative relationship of employment with expensive childcare. As national discussions continue to center on the importance of childcare, our research adds evidence that public programs support maternal employment through reducing out-of-pocket childcare costs.

"There's no off-switch for us:" Head start family engagement amidst COVID-19.

Head Start center closures as a result of the COVID-19 pandemic required providers to innovate to continue engaging families and building relationships. Family Engagement has long been a pillar of Head Start's holistic approach to working with children and families in poverty. The present study provides a unique qualitative, longitudinal perspective of 20 Illinois-based Head Start/Early Head Start center directors regarding their engagement and communication strategies with families prior to, during, and after state-mandated center closures. Findings indicate that staff developed novel approaches to working with families within the context of COVID-19, some of which may have an important place in a post-pandemic world.

Job Demands and Resources Experienced by the Early Childhood Education Workforce Serving High-Need Populations.

The early childhood education (ECE) workforce plays a key role in promoting early childhood development by their interactions with young children during formative years. However, the inherent demands of the profession and the work conditions within ECE settings affect job satisfaction and overall health and well-being. This study applied the Job Demands-Resources Model (JD-R) and administered a cross-sectional survey (n = 137) to examine disparities in personal and external demands and resources that may impact job satisfaction and turnover rates among ECE staff who provide care for preschool children (3-5 years of age). ECE staff reported higher levels of personal demands, including depression and perceived stress, and external demands, including workload and staffing concerns, compared to the national workforce (all p < .01). The data also illustrated disparities related to resource access; ECE staff reported lower levels of personal resources, including mindfulness, and less access to external resources including safety climate, resource adequacy, role clarity, respect, and management relationships (all p < .01). Only 34% of ECE staff reported being very satisfied with their work compared to 49% of the national workforce (p < .01). External resources were significantly and positively associated with job satisfaction (B = .09, p < .01). These findings suggest that ECE staff experience significantly higher demands and have access to significantly fewer resources in the workplace, and that bolstering job-related resources may translate to increased job satisfaction.

Head Start Parents With or Without Food Insecurity and With Lower Food Resource Management Skills Use Less Positive Feeding Practices in Preschool-Age Children.

BACKGROUND: Food resource management (FRM), strategies to stretch limited food resource dollars, may mitigate the impact of household food insecurity (HFI) on family members, including young children. However, little is known about how FRM and HFI are associated with child feeding practices. OBJECTIVES: The study aimed to explore relationships between HFI, FRM, and child feeding practices of low-income parents. METHODS: In a cross-sectional sample of 304 Head Start households, caregivers completed the USDA HFI module [classifying them as either food secure (FS) or food insecure (FI)], FRM behavior subscale (classifying them as being high or low in management skills based on a median score split), Comprehensive Feeding Practices Questionnaire, and Perceived Stress Scale. Households were categorized into 4 HFI-FRM subgroups: FS/high FRM (30.6%), FS/low FRM (31.3%), FI/high FRM (18.8%), and FI/low FRM (19.4%). Multivariable linear regression was used to examine whether feeding practices differed across HFI-FRM categories and whether the addition of parental perceived stress contributed to differences in feeding practices by HFI-FRM group. RESULTS: In our study, 38% of households were FI. Compared to the FS/high FRM group in the adjusted models, the FS/low FRM group used less monitoring (-0.53; 95% CI: -0.78 to -0.28), modeling (-0.38; 95% CI: -0.64 to -0.13), and involvement (-0.57; 95% CI: -0.82 to -0.32) in feeding. A similar pattern emerged for the FI/low FRM group. The use of food as a reward was higher in the FI/high FRM (0.35; 95% CI: 0.02-0.67) and FI/low FRM groups (0.33; 95% CI: 0.01-0.66) compared to the FS/high FRM group. Perceived stress was positively associated with the use of negative, controlling feeding practices, and contributed to differences in using food as a reward within the HFI-FRM group. CONCLUSIONS: Suboptimal child feeding is evident in low-income caregivers with low FRM skills, with or without food insecurity. Promoting high FRM skills, in addition to addressing food insecurity, could potentially synergistically improve child feeding practices in low-income households.