P2B304: Eatable Alphabet Curriculum at Head Start Schools

Background: Food literacy in early childhood has potential for promoting healthy growth and mitigating future cardio-metabolic risks. The Eatable Alphabet are activity cards for preschool age children and caregivers that promote experiences with food tastes and preparation and pre-reading skills. An experiential curriculum designed for use in Head Start classes with children and caregivers may improve knowledge and familiarity of fruits and vegetables. We report the interim primary study objective results that measure changes among preschool age participants in new food exposure and knowledge of fruits/vegetables. Secondary objectives include interim acceptability of the curriculum among participating children, caregivers, and teachers.

Methods: The study is a prospective clustered randomized step-wedge study design of child and caregiver participants. Six Head Start sites in Peoria, IL elected to participate in a 4-session Eatable Alphabet curriculum (3 sites in fall 2022 and 3 sites in spring 2023). Health professional learners delivered each session featuring 2 letters and a 3rd letter assigned for homework. Caregivers were invited to participate when possible. Nutrition literacy among children was measured using an adapted assessment based on a validated fruit and vegetable tool. Caregiver food literacy was assessed using a Maryland Extension tool previously used in this population. The GEE model was used to analyze the primary outcome.

Results: 219 preschool age children from 6 Head Start sites participated. 56/121 children had available data to measure nutrition literacy changes and 22 caregivers participated from 3 fall sites. Children increased food and letter identification (aOR of 2.15 and 1.78 respectively, p< .0001). There was no difference in foods tried and liked. (Table 1) Of the 8 foods prepared and tasted, students liked spinach the least (56%) and watermelon (100%) the most. (Figure1) Teachers who observed or participated highly rated (mean range 4.32 to 4.74 on a 5-point Likert scale) the curricular delivery, enjoyment, and content. All participating caregivers reported the session was fun and had high satisfaction (mean range 2.79 to 3 on a 3-point Likert scale) with the experience of food preparation, tastes, and learning letters.

Conclusion: This interim report on Eatable Alphabet as Head Start curriculum with caregivers and children reveals high acceptability and shows promise in increasing knowledge and exposure to foods at an age when selective eating patterns can be prominent. Limitations to this report include missing data and variable dose exposure due to fluctuating student enrollment, attendance, and pick-up times. Additionally, an observational study design is subject to bias. During the second half of this study, Efforts to increase uniform dose exposure and promote more caregiver participation and survey completion regarding home food behaviors were employed during Spring 2023.