PROJECT SUMMARY/ABSTRACT Early childhood is a formative period for establishing healthy dietary habits and weight trajectories, as such habits and weight predict later health outcomes, and rural children from socio-economically disadvantaged families are 26% more likely to be obese than their urban counterparts, underscoring the need to promote foundational healthy eating habits in rural children to prevent obesity and chronic disease. Given the majority of rural children are enrolled in family childcare homes (FCCHs), these childcare settings are ideal for reaching rural, low-income children and fostering healthy eating habits. FCCH providers can serve as role models, provide repeated exposure and positive reinforcement to choose healthy foods, teach children the knowledge and skills to pay attention to their hunger and fullness signals, and foster healthy food acceptance. National efforts to address childhood obesity call upon childcare programs to implement these responsive feeding evidence-based practices (RF-EBPs); however, their effectiveness is not known, especially in rural FCCHs. The team's EAT for Prevention multilevel feedback engagement model builds rural FCCH capacity to use RF- EBPs and improve rural children's dietary intake. Preliminary studies have shown the feasibility and acceptability of this model, paving the way for the proposed study objective to test EAT for Prevention's effectiveness by conducting a properly powered cluster-randomized trial with 3-5-year-old children (n=200) attending rural FCCHs (n=100). The central hypothesis is that EAT for Prevention will improve dietary and health outcomes among children and improve feeding practices among FCCH providers. The specific aims are to determine the impact of EAT for Prevention on 3-5-year-old children's dietary intake and health outcomes (Aim 1) and on FCCH providers' feeding practices and mealtime emotional climate (Aim 2) and to determine mediators of EAT for Prevention effectiveness (Aim 3). Nebraska rural FCCHs participating in federal food assistance programs will be recruited to reach rural children from low-income families. EAT for Prevention is delivered through Cooperative Extension, and Nebraska's FCCH and Extension systems have characteristics consistent with other rural states, improving the likelihood of rapid and effective dissemination. Extension agents will serve as coaches to provide personalized and targeted feedback to FCCH providers based on their mealtime video observations while addressing FCCH provider challenges and children's eating behaviors. For evaluating the effectiveness of EAT for Prevention with its dissemination in mind, outcomes will be aligned with the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to assess rural FCCH's implementation of RF-EBPs, changes in children's dietary intake, skin carotenoid and BMI z-scores, and drivers influencing effectiveness. The long-term objective is to improve public health by building rural childcare capacity for addressing the growing problem of childhood obesity in rural America.

PROJECT NARRATIVE This project aims to combat childhood obesity, a pressing public health concern, by focusing on early childhood nutrition habits in rural areas. Rural children are more likely to become obese, making it crucial to promote healthy eating habits in rural family childcare homes (FCCHs). This project will evaluate the “EAT for Prevention” program's ability to empower FCCH providers in rural communities to implement evidence-based practices that improve children's diets and overall health, ultimately contributing to better public health outcomes.