PROJECT SUMMARY/ABSTRACT
Childhood obesity is a serious and costly health problem in the United States that disproportionately affects
economically disadvantaged children living in rural, low-income areas. Despite this, virtually no effective
preventive strategies target the childcare setting, where many children eat 75% of their meals. Responsive
feeding (RF) practices, which provide structure and limits while allowing the child to exercise some autonomy,
foster the development of self-regulation of food intake. RF has been shown to be a promising target of
interventions, but these trials have focused primarily on the home environment. Strategies to improve the food
environment and promote RF and child appetite regulation in multiple settings are needed.
The ONE PATH study will rigorously test the effect of adding RF and appetite regulation components to an
existing, evidence-based program that intervenes on the childcare setting environment. An innovative
methodological framework, Multiphase Optimization Strategy (MOST), will be used to identify which
intervention components improve RF and children’s appetite regulation among rural, low-income children
enrolled in Head Start. Using a factorial design, Head Start classrooms (n=48) will be randomized to receive or
not receive three components: a) RF training for early childhood education (ECE) providers, delivered via
online module; b) RF training for parents, delivered at home by Extension educators; and c) child self-
regulation curriculum, delivered in Head Start classrooms. The interventions will take place over the course of
one school year (~9 months), spanning three cohorts. Intervention component efficacy will be determined by
evaluating caregiver feeding practices and child appetite regulation (primary outcomes) and changes in
childcare and home environments, and child BMI z-score (secondary outcomes). This study will yield an
optimized intervention comprised of effective and efficient components that will be “packaged” and tested in a
future RCT. The proposed research will improve the evidence base needed to translate lessons learned in the
laboratory to community settings where children eat, optimizing the care of preschool-aged children.
To successfully complete this study, we have assembled a transdisciplinary team, including researchers,
educators, and Extension professionals. Advisory board members will represent the American Academy of
Pediatrics (AAP), Penn State Cooperative Extension - Better Kid Care, and Pennsylvania Head Start. Our
multi-disciplinary team has a history of working together and are well suited to design and test this multi-site,
multi-component intervention. We have experiences implementing interventions in the home and classroom
settings, with access to Head Start children in 7 rural counties in Pennsylvania. This application has several
unique features/strengths including: public health/clinical significance, targeting RF of ECE providers, engaging
parents in ECE care, and using innovative methods to optimize our intervention. This research compliments
the over-reaching goal of NIH to improve maternal/child health and it is consistent with the NIDDK mission.