Introduction: The incidence of type 2 diabetes (T2D) in youth is projected to increase through 2060, especially in minority youth. Every Little Step Counts (ELSC) has demonstrated efficacy in reducing T2D risk factors in Latino youth. Documenting the adaptation of ELSC to a family diabetes prevention program (FDPP) could support future adaptation and scaling of FDPPs.Purpose: To describe the process that guided the adaptation of a culturally grounded evidenced-based DPP tailored to Latino families, with the aim of using the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) to classify adaptations. Methods/Design: The approach that guided the adaptation involved community-based participatory research (CBPR) and phases commonly used to adapt health interventions. Inductive and deductive content analysis guided by the FRAME was conducted on data collected throughout the phases to identify and classify adaptations. Data was then triangulated with the entities involved in the adaptation, analyzed to determine the frequency and proportion of adaptations across the FRAME categories and levels, and cross tabulated. Results: A total of N=66 adaptations were identified. Adaptations occurred with the highest frequency during the grant preparation and after the pilot study. Most adaptations were led by both the academic institution and community partners. Content modifications were most common. Prominent reasons for adaptation included organization/setting time constraints and integrating community partners’ and interventionists’ feedback. Discussion: Study results align with the CBPR approach that guided the adaptation and the ELSC core tenet of integrating community partnerships throughout all aspects of the intervention. To efficiently track adaptations, consensus as to what constitutes varying levels of adaptation granularity (i.e., macro, meso, micro) is needed. While tracking adaptations can be time and resource intensive, tracking adaptations may support the development of strategies to tie adaptations to outcomes. Conclusion: It is critical to determine when adaptations are needed to avoid a “culture of adaptation hyperactivity”. There is an opportunity to analyze past and future ELSC adaptations to better understand the intervention’s core tenets and the relationship between adaptations and outcomes. Future ELSC adaptations would benefit from considering how to incorporate feedback from diverse stakeholders and populations in preparation for scaling.

Objectives. To determine the association between parental level of acculturation using the Anglo Orientation Subscale (AOS) and the Mexican Orientation Subscale (MOS) derived from the Acculturating Rating Scale for Mexican Americans-II (ARSMA II) and their likelihood of serving green salad, vegetables, fruit, 100% fruit juice, and sugar-sweetened beverages during family meals. Methods. A sample of Hispanic parents of 6th, 7th, or 8th-grade adolescents (n=447; 39.8±6.8 years; 89.7% female) enrolled in a parenting intervention promoting healthy nutrition and substance use prevention. Parents completed baseline surveys to self-report whether they had family meals or not, acculturation-related questions, and the frequency with which they serve green salad, vegetables, fruit, 100% fruit juice, and sugar-sweetened beverages (SSB) during family meals. Associations between parental acculturation level and their likelihood of serving green salad, vegetables, fruit, 100% fruit juice and sugar-sweetened beverages during meal times were assessed with Spearman’s rank correlations. Results. There was a positive correlation between a higher level of acculturation on the Mexican Orientation Subscale (MOS) scale and the frequency of serving SSB during family meals (p=.006). There was a positive correlation between a higher level of acculturation on the Anglo Orientation Subscale (AOS) with the frequency of parents serving green salad (p=<.001), vegetables (p=<.001), and 100% fruit juice (p=.025) during family meals. Conclusion. Findings suggest that a higher Mexican orientation is associated with serving more sugar-sweetened beverages, and a higher Anglo orientation is associated with serving more green salad, vegetables, and 100% fruit juice to adolescents during family meals. Further research is needed to understand how the association of parental acculturation, home food environment, family meals, and socioeconomic status impact what they serve during family meals to their adolescents. A better understanding of what is served would help develop more evidence-based interventions that could help improve adolescents’ diet, which could help curb down obesity prevalence.

Background: Studies have examined student fruit/vegetable (FV) consumption, selection, and waste related to lunch duration and found that longer duration at lunch was associated with greater consumption, selection, and reduced waste. However, few studies have investigated the relationship between time to eat and FVs. The aim of this research is to analyze the relationship between objective time to students took to eat (“time to eat”) as it relates to their fruit and vegetable consumption, selection, and plate waste.in elementary, middle, and high schools. Methods: A secondary analysis of cross-sectional study of 37 Arizona schools to discover the differences in the selection, consumption, and waste of FVs from students (Full N = 2226, Elementary N = 630, Middle School N = 699, High School N = 897) using objective time to eat measures. Zero-inflated negative binomial regressions examined differences in FV grams selected, consumed, and wasted adjusted for sociodemographics including race, ethnicity, eligibility for free or reduced lunch, academic year, and sex and clustering for students within schools. Results are presented across school level (elementary, middle, and high school). Results: The average time taken to eat ranged from 10-12 minutes for all students. The association of time to eat and lunch duration were not closely related (r=0.03, p = 0.172). In the count model for every additional minute spent, there was a 0.5% greater likelihood of selecting FVs for elementary kids among those who took any FVs. In the zero-inflated model, it was found that there was a statistically significant relationship between time spent eating and the selection of fruits and vegetables. For the total sample and high schoolers, a minute more of eating time was associated with a 4.3% and 8.8% greater odds of selecting FV. This means that longer eating time increased the likelihood of choosing fruits and vegetables. The results indicated that the longer students took to eat, the higher the likelihood of consuming more of FVs. Each 10 more minutes spent eating (i.e., time to eat) is associated with a 5% increase in grams of FV selected relative to mean (for those that chose FV) over 1 week this equates to 32 g increase of FV selected. However, for middle schoolers, the time to eat was not found to be significant in relation to the grams of fruits and vegetables consumed. There was some significance in the sociodemographic factors such as gender (all) and other (middle school). There was a relationship between time taken to eat and waste as a proportion for fruits and vegetables. For example, among those among the students who wasted something (as a proportion of selection), each additional 10 minutes of eating time was associated with a .6% decrease in waste relative to the mean (for those who chose fruits and vegetables) over a week, resulting in a decrease in waste percentage of 16.5%. Among high schoolers, males had a slightly higher odds of wasting a proportion of fruits and vegetables. Conclusions: This study aimed to examine the association between the time students take to eat during lunch and their fruit and vegetable (FV) consumption, selection, and plate waste. The findings revealed that the time to eat was related to FV consumption, depending on the school level. However, it was not significantly associated with FV selection or waste. The study emphasized the need for further research on time to eat, distinguishing it from the duration of lunch. Longer lunch periods and adequate time could influence better food choices, increased FV consumption, and reduced waste. The study highlighted the importance of interventions and school policies promoting healthier food choices and providing sufficient time for students to eat. Future research should validate these findings and explore the impact of socialization opportunities on promoting healthier eating habits. Understanding the relationship between lunch duration, time to eat, and students' dietary behaviors can contribute to improved health outcomes and inform effective strategies in school settings.

Food insecurity affects more than 10 million households in the United States and has been shown to impact what and how a child is fed. Additionally, there is some evidence to suggest that food insecurity may affect how an infant is soothed (either with food or another mechanism), but no study has examined the possible relationship between soothing techniques and the incidence of food insecurity. To evaluate whether food security status and nighttime soothing techniques have a relationship, surveys were administered to a sample of mothers from various racial and socioeconomic backgrounds at 3-weeks, 8-weeks, and 3-months postpartum. Of the 69 participants sampled, 61 had data that could contribute to evaluations of food security status and soothing techniques used at night. A chi-square model was utilized to determine what, if any, relationship existed between the two variables. The chi-square model did not yield statistically significant results (Pearson Chi-Square= .506, p=.477) and descriptive statistics showed that just six of the 61 participants sampled did not use food to soothe at the time their baby was 3-weeks-old. Further examination of descriptive statistics revealed that, between breastfeeding and bottle-feeding as a means to soothe an infant, breastfeeding was used twice as much as bottle-feeding. For participants enrolled in the Special Supplemental Nutrition Program for Women, Infants, Children (WIC), the use of food to soothe increased at each of the three time points. Among participants found to be food-insecure, the use of breastfeeding and bottle-feeding as means to soothe varied from time point to time point. The physical and mental toll of the postpartum period may contribute to the high use of food-to-soothe among mothers seen in this study. Future research efforts in this area should examine whether the observations reported in this study are similar among larger samples, and if more mental health support for mothers has any effect on whether food is used to soothe.

Background:The second an individual is born, the gut microbiome starts acquiring unique characteristics, including microbial richness and evenness. In addition, it has been found that during infancy, the mode of delivery, antibiotic exposure, feeding patterns, and environment play a role in such development. However, infancy is still an understudied population related to the gut microbiota, specifically its’ connection to two modifiable factors-sleep-wake patterns and its’ interconnection with feeding practices in the first year of life. Methods: This secondary data analysis from a randomized longitudinal intervention study assessed the efficacy of a home-based education program in preventing the onset of childhood obesity. A convenience sample of 40 Hispanic mother and infant dyads were recruited to participate in an additional collection of fecal samples to evaluate associations between lifestyle/behavioral factors in infancy and gut microbiome composition in toddlerhood. Total sleep duration and feeding practices (breastmilk and formula) were assessed at one, six, and twelve months. In addition, alpha and beta diversity metrics were assessed from infant stool samples collected at 36 months. Results: This study found some significant and trending values for pairwise comparisons of alpha (Shannon Diversity Index) and beta (Bray Curtis and Jaccard Distance). Sleep-wake adequacy consisted of 14-17 total hours of sleep in 24 hours at one month and 12-16 hours for six and twelve months of age. No significant values were identified at one month of age. However, six and twelve months demonstrated significant observations for gut microbial richness and evenness. Trending differences (p=.06, Shannon Diversity Index) persisted in infants receiving adequate sleep at six months but for different feeding modalities. Faith’s PD, Pielou’s measure, and observed OTUs were three additional alpha-diversity metrics performed in all groups. Observed OTUs (p=.03) and Faith’s PD (p=.03) were significant at twelve months, demonstrating an increased microbial feature in infants receiving adequate sleep. Conclusion: The findings from this study may show how different timestamps in the first year of life may create gut microbial milestones. However, the interrelation between sleep-wake patterns, feeding modalities, and gut microbiome development is limited; further investigation is needed to monitor close changes and potentially create a criterion

OBJECTIVE: In 2020, the COVID-19 pandemic disrupted the health and wellbeing offamilies and communities alike. The purpose of this qualitative research study was to better understand the perspectives and experiences of Arizona mothers who gave birth and transitioned to parenthood during the COVID-19 pandemic. METHODS: This research study was a qualitative thematic analysis. Arizona residents aged 18 and older who gave birth after March 2020 and spoke English proficiently were eligible to participate in this research study. Participants completed a 90-minute virtual interview, answering questions about their overall perinatal experiences during the pandemic. Interviews were recorded, transcribed and reviewed for accuracy. A codebook of themes was created. The transcriptions were analyzed and coded using Delve software. RESULTS: In total, 18 interviews were coded for this study when saturation was reached. The average participant age was 31.78 ± 5.52 years and was predominantly White (89%). In total, 61% reported experiencing birth-related trauma and approximately 60% of participants were able to take parental leave, while 40% did not. Four principal themes emerged from data describing the transition to parenthood during the COVID-19 pandemic: 1) Maternal Experiences During COVID, 2) Navigating the Support System, 3) Perinatal Healthcare Insufficiencies, and 4) Retrospective Insights. Of these four primary themes, fourteen associated subthemes were also identified. CONCLUSION: The transition to parenthood is a multidimensional ecosystem centered around maternal and infant wellbeing with family, friends, community, and healthcare providers serving as primary influences. Inadequate healthcare, broken social networks, and diminished health promotion skills that bridge families to the care and support to thrive in parenthood have been reduced during the pandemic as women in this study exhibited poor mental health, faded self-efficacy, and reduced access to care.

Purpose: Although numerous studies exist regarding the health impact of the Special, Supplemental Program for Women, Infants and Children (WIC) and the Supplemental Nutrition Assistance Program (SNAP) on their participants’, limited studies have examined how participation in one federal nutrition assistance program, may impact participation or perceived benefit of the other. This study aimed to examine how SNAP participation may impact weight-related pregnancy outcomes and participation of pregnant WIC participants. Methods: The present study is a cross-sectional, secondary data analysis of data available from the Arizona Department of Health Services. A total of 35,659 pregnant woman participated in the Arizona WIC program during 2018 and were included in the study. Pregnant participants were assigned to Group WIC or Group WIC+SNAP respectively. Data was aggregated to the clinic level and clinics with less than 10 pregnant participants were combined for a total of 101 clinics included in the analysis. Weight-related pregnancy outcomes measures included average pre-pregnancy weight, average gestational weight gain, BMI class, and delivery weight. Participation indicator outcomes included average number of visits during pregnancy, timing of first prenatal and postnatal WIC appointment, and entry into WIC within the first trimester. Race, ethnicity, language, and education were also analyzed. Results: This study found average pre-pregnancy weight was statistically significant for women in group SNAP+WIC weighing 2.8 kg more than women in group WIC(p<0.001). Group WIC had a lower delivery weight average (p<0.001) and a higher amount of women beginning pregnancy with a normal BMI (p=0.004). Group WIC participants were statistically more likely to not enroll in WIC during the first trimester compared with Group WIC+SNAP (p=0.049). Group WIC was more likely to enroll in the 8th (p=0.045) and 9th month (p=0.009) of pregnancy and attend their first postpartum visit 6 months after delivery (p=0.007) as compared to Group WIC+SNAP. Conclusions: This study found that pregnant WIC participants, not enrolled in SNAP have a lower pre-pregnancy weight and are more likely not to enroll within the first trimester. Future research should focus on individualized characteristics of WIC participants to further improve prenatal and postnatal support.

Background: Adequate consumption of fruit and vegetables has been shown to prevent chronic diseases, such as cardiovascular disease, high blood pressure, and type two diabetes. The majority of Americans still consume inadequate daily servings of fruit and vegetables, which include women. Inadequate consumption of fruit and vegetables can be contributed to multiple barriers that hinder consumption in both urban and non-urban areas. The Special Supplemental Nutrition Program for Women, Infant, and Children (WIC) has been shown to positively influence fruit and vegetable consumption by providing healthy foods, such as fruit and vegetables. This study aims to compare the fruit and vegetable consumption of WIC and non-WIC participants between urban and non-urban Rural-Urban Commuting Area (RUCA) codes. Methods: This study was a cross-sectional, secondary analysis of a single time point from the Snuggle Bug/Acurrucadito Study, which had a sample size of (n=53) participants. The participants were separated into two groups, WIC participants, and non-WIC participants, and then further divided based on their respected RUCA code for comparison purposes. The assessment of fruit and vegetable consumption assessment derived from the participant’s 3-day food record. Results: The average consumption of fruit and vegetable consumption among participants was 3.8±2.5 servings There was an inverse relationship between WIC participation and fruit and vegetable consumption among all categories (fruit no juice -0.79, vegetables -0.32, vegetables no potato -0.32, fruit no juice and vegetables -1.1, and fruit no juice and vegetables no potato -1.1). However, none of the results were considered statistically significant. In addition, our study was unable to identify an association between fruit and vegetable consumption and locale due to the small sample size. Conclusions: There was no link observed between fruit and vegetable consumption and WIC participation. Further research of high quality is needed to confirm the relationship between fruit and vegetable consumption of WIC and non-WIC participants in urban and non-urban populations.

Background: The Special Supplemental Nutrition Program for Women, Infant andChildren (WIC) provides participants with a supplemental food package that follows the Dietary Guidelines for Americans (DGA’s). The WIC food package has been shown to improve the diet quality and overall health status of WIC participants. Since the 2009 WIC food package revision, standard issuance of 1% or fat-free milk has been practiced for participants 24 months or older. Improving the value that participants have on the WIC foods can be an effective method to improve redemption of WIC foods and improve overall participation. The aim of this study was to examine if allowing issuance of 2% milk when clients refuse issuance of 1% or skim milk would affect benefit redemption of milk and other WIC foods. The study also examined how providing clarification through training on policy change for issuance of 2% milk would improve staff and director knowledge of this change in policy. Methods: This study was an observational, longitudinal study that used linear regression analysis of aggregated data at the local agency-level from the Arizona WIC program. Redemption data were analyzed using the Arizona WIC Health and Nutrition Delivery System (HANDS) at three different intervals throughout the study. The three months prior to the policy introduction (March-May 2020), redemption after policy introduction (July-September 2020), and redemption after policy clarification with 2% milk policy trainings (December 2020-February 2021). Redemption was measured as benefits issued versus benefits redeemed. Two separate surveys were delivered (via Qualtrics) to the 18 local agency directors (n=18) and their staff members (n=287). These surveys were used for descriptive purposes. Results: The results of this study found that there was a decrease in redemption of 2% milk and all foods at the post intervention stage of the study. WIC staff were found to have a better understanding of policy to issue 2% milk. Conclusion: Although these findings are consistent with other current research, further research is needed to examine how changing policy on current food restrictions placed on WIC foods affects redemption and how this may improve overall participation.

Background: Studies have addressed food insecurity (FI) and fruit and vegetable (FV) consumption; however, not many have looked at the relationship between FI and FV consumption of caregivers with children. Researchers have not extensively evaluated if locale (urban and rural) plays a role in FV consumption. This cross-sectional study investigates the relationship between FI and consumption of FVs in caregivers and whether this relationship varies by locale. Methods: Caregivers with children completed baseline surveys as part of the Nutrition Incentive programs from the Gus Schumacher Nutrition Incentive Program (GusNIP) were included in analyses (n=3455; mean age= 33 ±0.12 years, 53.8% female). Caregivers reported their intake using the Dietary Screener Questionnaire (DSQ). The USDA 6-item food security screening module was used to assess food insecurity. Zip codes and Rural-Urban Continuum Codes (RUCC) were used to identify locale. Mixed linear models adjusted for sociodemographics (age, sex, race, and ethnicity), and clustered at the site level were used to assess the relationship between FV consumption and FI. Locale was examined as an interaction and was found to be not statistically significant, was included as a confounder in the models. Sensitivity analyses were conducted examining all FVs, FVs without potatoes included, FVs without juice included, and FVs without potatoes or juice. Results did not vary greatly, the aggregate FV variable is reported on below. Results: The mean FV consumption was 4.83 +/- 0.060 servings. The prevalence of FI was 78.7%. FI was reported at 92.9% of urban households and 7.1% of rural households. The mixed linear model indicated that there was a significant relationship between FI and participant’s FV consumption (β=-0.51., 95% CI: -0.81, -0.22). This study found a relationship between FV consumption and locale only. Conclusion: Caregivers’ FV consumption was significantly related to FI status; however, locale was not associated with their FV consumption. Research should further investigate the relationship between locale and FV consumption with consideration in the adolescent aged population, as these findings may be limited given the relatively small proportion of families living in rural settings.