Children In Low-income Households Research Articles

Evaluating the Association of the Increase in the WIC Cash Value Benefit on the Diversity of MyPlate Fruits and Vegetables Redeemed and Consumed By Children in Low-Income Households

BackgroundFruits and vegetables (FV) are a critical source of nutrients, yet children in the United States are not meeting the Dietary Guidelines for Americans (DGA). The monthly FV cash value benefit (CVB) included in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)’s food package to support child FV intake (FVI) received a substantial increase for economic relief during the COVID-19 pandemic. ObjectivesTo evaluate how an expansion of the monthly WIC CVB to purchase FV for WIC children ages 1–4 y is associated with diversity in FV redeemed, and how changes in redeemed FV are related to FVI. MethodsCaregivers representing 1463 WIC-participating children recruited from Los Angeles County, California, completed surveys during the CVB augmentation (T1: CVB = $9/mo; T2 = $35/mo; T3 = $24/mo). Redeemed price look-up codes (PLUs), corresponding to a food item, were assigned to its corresponding MyPlate FV group. Multivariable generalized estimating equation regression models assessed changes in amount and diversity of FV redemption across MyPlate groups and associations between changes in FV diversity and changes in FVI. ResultsSlightly over half of all households were food insecure (55%), half of the children were female (52%), and most were Hispanic (78%). Compared with T1, significant increases in the number of PLUs and dollars redeemed were observed in most MyPlate FV groups. From T1 to T2, significant increases in diversity scores were observed for total fruit (β: 1.6 pts; 95% confidence interval [CI]: 1.4, 1.7), total vegetable (β: 3.6 pts; 95%CI: 3.4, 3.9), and total FV (β:7.8 pts; 95%CI: 7.4, 8.2). Similarly, increases in diversity score were observed at T3 compared with T1. Changes in FV diversity redeemed were not associated with changes in FVI. ConclusionsDuring the CVB augmentation, WIC participants redeemed a greater amount and variety of FV according to DGA MyPlate recommendations, supporting its permanent increase.

Factors Associated With Caregiver Reporting of Developmental Concerns Among Children in Low-Income Communities

Early detection and access to interventions for developmental delays in young children have been shown to improve health, social, and academic outcomes later in life. The purpose of this study is to examine the factors associated with caregivers' perception of child developmental concerns in low-income communities. A countywide survey was conducted in Los Angeles County (LAC), California, among 4,863 participating Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) families with children ages 1–4 years. Proportional odds ordinal logistic regression was used to evaluate the association between the severity of reported developmental concerns and respondent characteristics. Results indicate that demographic characteristics, support systems, health care visits during COVID-19, and maternal symptoms of depression are associated with higher odds of reporting more severe developmental concerns among the WIC population. Advancing policies, programs, and research that aim to improve early detection and access to childhood professionals for all families will be essential to allow all children in low-income households to optimize their development.

Abstract P459: Socioeconomic Disadvantage and Adverse Childhood Events Associated With Risk of Obesity and Insufficient Sleep in Children

Introduction: Obesity and sleep problems are risk factors for various health problems. Children with both obesity and sleep problems are more likely than children with only one condition to develop cardiometabolic disorders later in life. This study estimates the prevalence of children with obesity and insufficient sleep duration and examines related demographic and social economic factors for their co-occurrence among children in the United States. Methods: Data were from the 2019 and 2020 National Survey of Children’s Health (NSCH). The NSCH provides national and state-level data on the physical and emotional health of non-institutionalized American children 0-17 y of age. For this study, children 10-17 y without missing data in the study variables (N=35678) were included. Age-adjusted, sex-specific body mass index was classified as underweight (<5th percentile); normal weight (5th to <85th percentile); overweight (85th to <95th percentile); or obese (≥95th percentile). Age-appropriate sleep duration was defined according to American Academy of Sleep Medicine guidelines (nighttime sleep for ages 10-12 y=9-12 h; 13-17 y=8-10 h). Children who slept below the minimum recommended duration on an average weeknight in the past week were classified as having insufficient sleep. The main outcome was co-occurrence of obesity and insufficient sleep. Descriptive statistics, chi-square tests and logistic regression were used applying sampling weights to account for non-response and sampling procedures. Results: In NSCH, 16.3% of children had obesity and 34.7 % reported insufficient sleep with 7.4% of children having both conditions. Younger children (age 10-12 y) had higher prevalence of obesity with insufficient sleep (11.3%) compared to older children (age 13-17 y; 5%). Non-Hispanic Black and Hispanic children had higher prevalence of co-occurring obesity and insufficient sleep compared to non-Hispanic white children (11.4% and 11% vs 4.7%, respectively). Children in low-income households had higher prevalence (12.4%) of both obesity and insufficient sleep than higher-income counterparts (2.9%) as did children with parents reporting less than high school education compared to those with more highly educated parents (13.8 vs 5.3%). Children exposed to ≥2 adverse childhood experiences had higher prevalence than those without (10.3 vs 5%). Logistic regression analyses show all these factors were significantly associated with co-occurring obesity and insufficient sleep (p-values <0.001). Conclusion: Combined prevalence of obesity and insufficient sleep duration among children varied by age, race, poverty, exposure to childhood adversity, and parental education. The study findings call attention from policy makers, pediatricians, and researchers to these co-existing health problems in children and develop effective strategies to combat obesity and improve sleep health.

SNAP Participation and Emergency Department Use.

To examine whether Supplemental Nutrition Assistance Program (SNAP) participation is associated with emergency department use among low-income children and whether any such association is mediated by household food hardship and child health status and/or moderated by special health care needs (SHCN) status. We hypothesized SNAP to be associated with reduced likelihoods of emergency department use, with greater effect sizes for children with SHCN and mediation by food hardship and health status. In this secondary analysis, we estimated a bivariate probit model (with state-level SNAP administrative policies as instruments) within a structural equation modeling framework using pooled cross-sectional samples of children in low-income households from the 2016 to 2019 iterations of the National Survey of Children's Health (n = 24 990). Among children with and without SHCN, respectively, SNAP was associated with: 22.0 percentage points (pp) (95% confidence interval [CI] 12.2-31.8pp) and 17.1pp (95% CI 7.2-27.0pp) reductions in the likelihood of household food hardship exposure (4.8pp difference-in-differences, 95% CI 2.3-7.4pp), 9.7pp (95% CI 3.9-15.5pp) and 7.9pp (95% CI 2.2-13.6) increases in the likelihood of excellent health status (1.9pp difference-in-differences, 95% CI 0.7-3.0pp), and 7.7pp (95% CI 2.9-12.5pp) and 4.3pp (95% CI 1.0-7.6pp) reductions in the likelihood of emergency department use (3.4pp difference-in-differences, 95% CI 1.8-5.1pp). We found SNAP participation was associated with lower likelihoods of emergency department use, that better food hardship and health statuses mediated this association, and that effect sizes were larger among children with SHCN. Food hardship relief may improve outcomes for vulnerable children and the health systems serving them.

Barriers to Optimal Child Sleep among Families with Low Income: A Mixed-Methods Study to Inform Intervention Development

This study gathered formative data on barriers to optimal child sleep to inform the development of a sleep intervention for parents of preschool-aged children in low-income households. Parents (n = 15, age: 34 ± 8 years, household income: $30,000 ± 17,845/year) reporting difficulties with their child's sleep participated in this study. Mixed methods included an online survey and semi-structured phone interview. Items assessed barriers/facilitators to optimal child sleep and intervention preferences. Interview transcripts were coded using inductive analyses and constant-comparison methods to generate themes. Derived themes were then mapped onto the Theoretical Domains Framework to contextualize barriers and inform future intervention strategies. Themes that emerged included: stimulating bedtime activities, child behavior challenges, variability in children's structure, parent work responsibilities, sleep-hindering environment, and parent's emotional capacity. Parent's intervention preferences included virtual delivery (preferred by 60% of parents) to reduce barriers and provide flexibility. Mixed preferences were observed for the group (47%) vs. individual (53%) intervention sessions. Parents felt motivated to try new intervention strategies given current frustrations, the potential for tangible results, and knowing others were in a similar situation. Future work will map perceived barriers to behavior change strategies using the Behavior Change Wheel framework to develop a parenting sleep intervention.

Trends and associated factors of intergenerational obesity mother-child pairs in low-income households in Malaysia: Evidence from the National Health and Morbidity Survey.

The transmission in intergenerational overweight and obesity (OW/OB) from mothers to their offspring has been widely explored in numerous studies. This phenomenon of OW/OB is a greater concern globally in particular among low-income households. However, studies conducted to determine the factors associated with OW/OB among mother-child pairs in low-income families are very scarce especially in Malaysia. Therefore, this study aimed to determine the prevalence trend and associated factors of overweight mothers and children in low-income households using the National Health and Morbidity Survey data between the years 2006 to 2015. In each low-income household, mother and child were identified and grouped as mother-child pairs based on their body mass index categories. Multivariable logistic regression was conducted to determine the factors associated with overweight mother/overweight child pairs (OWM/OWC) in low-income households. The reference group determined in the analysis was normal weight mother/normal weight child pairs (NWM/NWC). Within a decade, the transmission of OWM/OWC mother-child pairs in the low-income households has increased by 9.0%, while the prevalence of NWM/NWC decreased by 6.9%. In low-income households, older mothers and children aged between 10 to 14 years were significantly associated with OWM/OWC, while a larger household size and being as Chinese were less likely to become OWM/OWC. In conclusion, intergenerational obesity in mother and their offspring is showing an alarming trend among the lowest socio-economic group in Malaysia.

A Case Study of Community-Academic Partnership in Improving the Quality of Life for Asthmatic Urban Minority Children in Low-Income Households.

Community–academic partnerships (CAPs) are being increasingly used to study and address health disparity issues. CAPs help to create new bodies of knowledge and innovative solutions to community problems, which benefits the community and academia. Supported by a grant, a partnership was formed between an academic research team and a community health organization to analyze and interpret data collected from the caregivers of asthmatic African American children living in urban low-income households. Using a case study approach, we discuss how we built a healthy CAP and the lessons learned from the process. Our analysis was guided by the six main factors that facilitate success in developing collaborative relationships, including (1) environment; (2) membership; (3) process and structure; (4) communication; (5) purpose; and (6) resources. Based on these six factors, we describe our collaboration process, challenges, and areas for improvement. We aimed to provide a “points-to-consider” roadmap for academic and community partners to establish and maintain a mutually beneficial and satisfactory relationship. Collaborating with community members and organizations provides unique opportunities for researchers and students to apply their skills and knowledge from textbooks and the classroom, engage with community members, and improve real-life community needs. Building a constructive CAP involves efforts, energy, and resources from both parties. The six major themes derived from our project offer suggestions for building a healthy, collaborative, and productive relationship that best serves communities in the future.

\u2018Hunger in early life\u2019: exploring the prevalence and correlates of child food insecurity in Canada

BackgroundAlthough food is a basic human right, food insecurity remains a major problem in the Global North including Canada. Children constitute a subgroup that is particularly vulnerable to food insecurity, with recent evidence showing that 1 in 6 Canadian children are food insecure. The rising rate of child food insecurity alongside its links with several adverse health outcomes reinforce the need to pay attention to its determinants. Although food insecurity is a multidimensional phenomenon shaped by diverse factors, in the Global North, including Canada, it is generally framed as a financial problem. Consequently, food policy has largely prioritized income support programs to the neglect of potentially important non-monetary factors. These non-monetary factors are also rarely explored in the literature despite their potentially relevant role in shaping policy responses to child food insecurity. Drawing data from the Canadian Community Health Survey (N = 21,455 households with children) and broadening the scope of potential predictors, this paper examined the correlates of child food insecurity in Canada.ResultsFindings show children in visible minority households (OR = 1.12, p < 0.01), single-parent households (OR = 1.55, p < 0.001), households with five or more members (OR = 1.35, p < 0.001), households with the highest level of education being secondary education or lower (OR = 1.14, p < 0.05), households where the adult respondent reported a very weak sense of community belonging (OR = 1.32, p < 0.001), poor physical health (OR = 1.61, p < 0.001) and poor mental health (OR = 1.61, p < 0.001) had higher odds of being food insecure. Children in lower income households were also more likely to be food insecure.ConclusionsThis study demonstrates the multidimensional nature of child food insecurity and highlights the need for food policy to pay attention to relevant social factors. Although commonly highlighted economic factors such as household income and employment status remain important correlates of child food insecurity in Canada, non-monetary factors such as visible minority status, sense of community belonging and living arrangement of parents/guardians are noteworthy predictors of child food insecurity that need equal policy attention.

Family lives during the COVID-19 pandemic in European Societies: Introduction to the Special Issue

Objective: This chapter introduces the reader to the Special Issue "Family Lives during the COVID-19 Pandemic in European Societies".&#x0D; Background: This Special Issue analyses how families, parents, and children have been affected by the COVID-19 pandemic, and how they have been coping with its related challenges in different societal contexts.&#x0D; Method: The studies collected in this Special Issue are based on qualitative, quantitative, and mixed-methods approaches and data that have been gathered during 2020 in a range of European countries. It covers the first lockdown period, the reopening phases, and the months thereafter.&#x0D; Results: The 20 contributions of this Special Issue show that families shouldered large responsibilities during the pandemic. While the pandemic did not lead to radical shifts in gendered care patterns, mothers and fathers experienced the pandemic differently, with mothers reporting higher levels of stress. Moreover, there was great heterogeneity in how different types of families and children were affected by the pandemic. Single parents and parents and children in low-income households were most strongly affected in their social and economic wellbeing. Social and economic distress are strongly interwoven, and the developments during the pandemic aggravated existing social disparities. &#x0D; Conclusion: This Special Issue underlines the importance of the family for the functioning of societies during times of crisis. It also shows that policy makers often adopted a too narrow view of what constitutes a family and did not adequately address family diversity in their decision making. This Special Issue furthermore emphasized that there is a danger that the pandemic will increase disparities between families. Thus, parents and their children need adequate support measures that are tailored to their needs, and that are designed to alleviate these social, economic and educational disparities.

The Impact Of Household Health Insurance Coverage Gains On Children's Achievement In Iowa: Evidence From The ACA.

Low family income is associated with worse child academic achievement. Little is known about how health insurance expansions affect children's achievement in low-income households. This study examined the effects of the Affordable Care Act's coverage expansions primarily for Medicaid and Marketplace enrollment, beginning in 2014, on children's academic achievement in Iowa. The study employed a unique linkage of birth certificates and data on standardized school tests for children in Iowa and took advantage of differences in uninsurance rates across areas in the state before the ACA insurance expansions. There is evidence that the ACA expansions beginning in 2014 were associated with higher reading scores after three years for children born to mothers with a high school education or less. There is no consistent evidence of an effect on math scores. Overall, these findings suggest broad spillover benefits from health insurance expansions to the well-being and development of children in low-income households that should be part of the continuing policy debate surrounding state and national health insurance reforms.

A Systematic Review of Asthma Readmission Risk Factors

A Systematic Review of Asthma Readmission Risk Factors

Narrative Review of Primary Preventive Interventions against Water-Borne Diseases: Scientific Evidence of Health-EDRM in Contexts with Inadequate Safe Drinking Water.

Waterborne diseases account for 1.5 million deaths a year globally, particularly affecting children in low-income households in subtropical areas. It is one of the most enduring and economically devastating biological hazards in our society today. The World Health Organization Health Emergency and Disaster Risk Management (health-EDRM) Framework highlights the importance of primary prevention against biological hazards across all levels of society. The framework encourages multi-sectoral coordination and lessons sharing for community risk resilience. A narrative review, conducted in March 2021, identified 88 English-language articles published between January 2000 and March 2021 examining water, sanitation, and hygiene primary prevention interventions against waterborne diseases in resource-poor settings. The literature identified eight main interventions implemented at personal, household and community levels. The strength of evidence, the enabling factors, barriers, co-benefits, and alternative measures were reviewed for each intervention. There is an array of evidence available across each intervention, with strong evidence supporting the effectiveness of water treatment and safe household water storage. Studies show that at personal and household levels, interventions are effective when applied together. Furthermore, water and waste management will have a compounding impact on vector-borne diseases. Mitigation against waterborne diseases require coordinated, multi-sectoral governance, such as building sanitation infrastructure and streamlined waste management. The review showed research gaps relating to evidence-based alternative interventions for resource-poor settings and showed discrepancies in definitions of various interventions amongst research institutions, creating challenges in the direct comparison of results across studies.

Relationships Between Household Income and Functional Independent Behavior for Children With Autism.

Children in lower income households are less likely to be diagnosed with autism spectrum disorder (ASD) and diagnosis is often delayed. Lack of or delayed identification of ASD minimizes a child's ability to receive effective early intervention services that support development of functional independence skills. Research has yet to identify relationships between functional independence and household income for children with ASD. A cross-sectional national survey with 231 caregivers of children with autism aged 2-12 years was conducted. Caregivers completed a 90-min survey examining family demographics, intervention services, autism symptom severity, and children's functional behavioral outcomes. Significant differences in functional independence behavior scores were identified for children from the highest and lowest income categories when controlling for autism symptom severity, age of diagnosis, and receipt of intervention services. This study provides preliminary evidence to support the association between income and functional independent behavior for children with ASD.

Home ownership, income and oral health of children in Australia-A population-based study.

Income inequalities in children's oral health have been well described. It is plausible that the security of tenure reflected by the ownership status of children's housing dynamically interacts with household income to shape these inequalities. We examined whether housing tenure modifies the known association between household income and oral health. Data were analysed on 3344 10- to 11-year-old children from the Longitudinal Study of Australian Children. Multivariable regression models tested associations between household income and dental caries and tooth loss due to caries. Effect modification by home ownership (yes/no) was tested on the additive and multiplicative scales. Models were adjusted for sex, Indigenous status, main language spoken at home, area of residence, main carer education and family arrangement. Children in households in the low income group had worse oral health than children in the high group for caries and tooth loss. Models only weakly supported an additive interaction for tooth loss; that is, the relative excess risk due to interaction (RERI) for low household income was -0.903 (-2.38; 0.571) for tooth loss and -0.076 (-0.42; 0.271) for dental decay, although we note that the low proportion of children from low-income homeowning households (6%) reduces the power to detect interactions. Notably, our models suggest renters in both high- and low-income categories had the highest risk of tooth loss compared to owners (PR for high-income renters: 2.19 (95% CI: 1.25, 3.85); PR for low-income renters: 2.11 (95% CI: 1.42, 3.16)). Our study confirms that children in low-income households have poorer oral health outcomes than their high-income counterparts. Our findings additionally suggest that children in rental households may fare the worst of all housing and income combinations considered. Improving the security of housing for families privately renting may have wider health benefits that currently acknowledged.

An Integrated Data System Lens Into Evictions and Their Effects

ABSTRACT This study uses linked administrative records to examine the disruptive effects of eviction on adults and children in low-income households. By linking eviction filings for the City of Cleveland, Ohio, with administrative records, we depict residential mobility, homeless shelter use, and children’s school attendance for households, spanning a period of 2 years before and after the filings. Using difference-in-differences models, we find that eviction orders further erode housing stability, with differential impacts for tenants of private and public housing. Children of evicted households have lower rates of lead testing relative to children of nonevicted households, despite the extremely high levels of poisoning both groups exhibit. These findings point to the need to focus on eviction prevention, in conjunction with an overall strategy to address the weaknesses in our social safety net and housing programs. Throughout the analyses we discuss the potential and challenges of using linked administrative data to understand the consequences of evictions with the goal of informing social and housing policy.

Weight Change for Pediatric Completers in a National Weight Loss Program.

Overweight and obese children in low-income households have limited access to weight loss programs. Low-cost programs should be evaluated in this population. The objective of the current study is to determine weight change among 7 to 17-year-old participants in Take Off Pounds Sensibly (TOPS), a national, low-cost weight loss program. This nonconcurrent prospective study analyzes the cumulative change in weight z-score for overweight and obese children and adolescents who joined TOPS from 2008 to 2011 and consecutively renewed their annual membership. The study includes 586 individuals. At 1-year, cumulative mean (SD) weight z-score change was −0.13 (31). In general, mean change in weight z-scores was no different in subsequent years. Mean weight z-score of children and adolescent TOPS participants who renew their program membership decreased significantly in the first year. Randomized controlled trials should prospectively evaluate this program in children and adolescents.

Increases in Income-Related Disparities in Early Elementary School Obesity, 1998-2014.

Research shows that population-level rates of obesity, which rose dramatically from the 1970s through the mid-2000s, have since plateaued or even started to decline. However, overall improvements may mask differences in trends for different subgroups. For instance, obesity rates have continued to climb among low-income adolescents, leading to growing income-related gaps in obesity. By comparison, we know little about whether income-related disparities have also changed among elementary school children. To address this gap, we examined two cohorts of the Early Childhood Longitudinal Study - Kindergarten cohort, which followed children entering school in 1998 and 2010. We hypothesized that income-related disparities in obesity have also grown larger over time among young children. We used data from nationally representative samples of children who entered kindergarten in 1998 and 2010. We documented rates of overweight and obesity from kindergarten through third grade, examined how rates differed for children from high- and low-income families, and tested whether income-related disparities changed over time. Rates of overweight and obesity were 2 to 5 percentage points higher in the later cohort, and overall increases masked substantial variation by income. Specifically, these increases were driven by children in lower-income households, resulting in substantially larger income-related disparities in overweight and obesity in the later cohort. As we hypothesized, income-related disparities in young children's obesity grew between 1998 and 2014. This suggests that efforts to curb increasing rates of obesity may have been more successful for higher-income families. We discuss potential mechanisms that may account for increasing disparities.

Does Household Income Affect children\u2019s Outcomes? A Systematic Review of the Evidence

There is abundant evidence that children in low income households do less well than their peers on a range of developmental outcomes. However, there is continuing uncertainty about how far money itself matters, and how far associations simply reflect other, unobserved, differences between richer and poorer families. The authors conducted a systematic review of studies using methods that lend themselves to causal interpretation. To be included, studies had to use Randomised Controlled Trials, quasi-experiments or fixed effect-style techniques on longitudinal data. The results lend strong support to the hypothesis that household income has a positive causal effect on children’s outcomes, including their cognitive and social-behavioural development and their health, particularly in households with low income to begin with. There is also clear evidence of a positive causal effect of income on ‘intermediate outcomes’ that are important for children’s development, including maternal mental health, parenting and the home environment. The review also makes a methodological contribution, identifying that effects tend to be larger in experimental and quasi-experimental studies than in fixed effect approaches. This finding has implications for our ability to generalise from observational studies.

A systematic review examining the relationship between food insecurity and early childhood physiological health outcomes.

Food insecurity, or limited access to nutritious foods, is a significant public health concern especially among vulnerable populations including infants and young children in low-income households. While literature to date has thoroughly examined the psychological and behavioral impacts of food insecurity on children, no known study to date has specifically synthesized the literature exploring the relationship between food insecurity and physiological health outcomes during early childhood. The purpose of this study was to review the literature on physiological health outcomes associated with food insecurity during early childhood among children aged 0-5 years in developed countries. Our literature search sources included PubMed, PsycInfo, CINAHL, and Embase databases. A total of 657 articles published up to September 2019 were reviewed for eligibility by two coders, with a third reviewer in cases of disagreement. Eighty-three articles remained after screening by abstract, with a final 27 studies ultimately included in the final synthesis. This review is registered with PROSPERO and adhered to PRISMA guidelines. In total, 20 articles (74%) noted significant relationships between food insecurity and physiological health outcomes in young children. Findings included an association with overweight or obesity (n = 9), anemia (n = 3), poor child health (n = 3), low birth weight (n = 3), chronic illness (n = 1), special health care needs (n = 1), and increased cortisol (n = 1), in young children who experience food insecurity. Identifying relationships between food insecurity and health outcomes during early childhood has the potential to inform future prevention interventions to reduce health disparities in these vulnerable populations.

Culinary Education Programs for Children in Low-Income Households: A Scoping Review.

Child obesity in the United States is at an all-time high, particularly among underserved populations. Home-cooked meals are associated with lower rates of obesity. Helping children develop culinary skills has been associated with improved nutrition. The purpose of this study is to report results from a scoping review of culinary education interventions with children from low-income families. Three databases and hand searches of relevant articles were examined. Retained articles met inclusionary criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, as appropriate. A data extraction template was developed. Data were independently extracted and verified. Only nine out of 370 articles met the inclusionary criteria and were included in the review. Most interventions were school-based, used a quasi-experimental design, and recruited minority children. Children-only was the primary intervention focus. Primary outcomes were mostly psychosocial from child self-report. Most interventions focused on children only and were guided by Social Cognitive Theory. Most reported stakeholder involvement; however, type and degree varied. All had an in-person component; only one used technology. Few reported training program leaders. Culinary education programs for children from low-income families could benefit from a broader theoretical grounding, program leader training, and greater parental involvement.