Increasing Consumption of Healthy Snacks at an Early Head Start Center

Childhood overweight and obesity are associated with preventable diseases later in life. Reducing overweight and obesity in children could significantly reduce costs to the U.S. health care system. In a review of data from the University of Maryland School of Nursing, body mass index screening indicated that 14.6% of children in a mid-Atlantic Early Head Start (EHS) program were overweight or obese. Head Start and EHS programs provide educational services to children from racial and ethnic minority groups and/or low-income families.

This quality improvement project aimed to improve caregivers' preparation and children's enjoyment of healthy snacks, as well as caregivers' nutrition literacy, through a nutrition education program at an inner-city EHS center.

The project was implemented over 14 weeks during the fall of 2023. All families of children enrolled in the EHS program were invited to participate. A nutrition literacy survey was administered at the beginning and end of the implementation period; scores ranged from 0 to 12, with higher scores indicating greater nutrition literacy. Ingredients and recipes for healthy snacks at each weekly visit and six on-site nutrition education workshops were offered. At each visit, caregivers were invited to complete a three-question survey asking whether they had prepared the week's healthy snack, whether the child tried it, and whether the child enjoyed it.

There were 21 families, with a total of 31 caregivers and 25 children, who participated in the program. The age range of caregivers was 22 to 49 years. The mean initial nutrition literacy score was 7.2 out of 12 (60%), and the mean postimplementation score was 4.9 (40.8%). Review of the weekly three-question surveys revealed that caregivers were more likely to prepare snacks with few ingredients and steps, and the weekly recipes and ingredients were adapted accordingly. Among the responding caregivers (135 total responses), 77.4% (n = 24; 96 responses) reported that they had given the weekly fruit or vegetable ingredient to their child at some point during the implementation period; 71% (n = 22; 95 responses) reported that they had made the weekly healthy snack recipe for their child; and 64.5% (n = 20; 85 responses) reported that their child had enjoyed the snack. Initially, completion of the weekly surveys was low but did increase in the fourth week, after the completion method was changed from a QR code to a paper survey. Attendance at the six workshops was also low, with approximately three caregivers at each.

Caregivers were more likely to prepare snacks with three or fewer ingredients and easy instructions. Given the low attendance at the nutrition education workshops and the lack of an improvement in nutrition literacy over the course of the project, further research should include finding other formats, such as brief nutrition videos, which may be more successful at reaching busy caregivers than traditional workshop formats.