S. L. Johnson

• PhD Nutritional Sciences
• Managing Director at University of Colorado

Background: Exposure to vegetable flavors during infancy and toddlerhood is hypothesized to enhance vegetable acceptance when children transition to table foods. Objective: We sought to examine the vegetable types, ingredients, and nutrient contents of vegetable-containing infant and toddler foods (ITFs) manufactured and sold in the United State...

The 2020 Dietary Guidelines for Americans now include recommendations for infants and toddlers. Extension educators can use these expanded guidelines to provide feeding recommendations for caregivers of infants/toddlers. The purpose of this study was to explore 1) the infant and toddler feeding topics that Extension educators discuss with caregiver...

Iron and zinc are important nutrients during infancy, particularly for infants exclusively fed human milk at the beginning of complementary feeding (CF) from 6–12 months. The 1st Foods Study examined the ingredients and nutrient contents of commercially-available infant and toddler foods (ITFs) that were sold in the US and contained meat. Company w...

Introduction Language skills, such as the ability to understand words (receptive language), develop during infancy and are built through interactions with the environment, including eating. Exposure to complementary foods also begins in infancy and may play a significant role in language development, especially in understanding of food-related word...

Parent feeding styles, behaviors, beliefs, and practices are associated with developing children's eating behaviors. However, many children spend considerable time in childcare; thus, are exposed to child-feeding practices of other adults, e.g., early care and education (ECE) staff. Limited research exists on how and whether current classroom feedi...

Childhood appetitive traits are consistently associated with obesity risk, and yet their etiology is poorly understood. Appetitive traits are complex phenotypes which are hypothesized to be influenced by both genetic and environmental factors, as well as their interactions. Early-life epigenetic processes, such as DNA methylation (DNAm), may be inv...

Maternal self-care, including healthy eating, physical activity, and stress management behaviors, is influenced by environmental, social, and individual factors. Plan-Do-Study-Act (PDSA) Cycling is an effective quality improvement process using rapid cycling to refine interventions to fit audience-specific contexts and to address socioecological in...

Childhood obesity is an ongoing concern in the United States. Higher weight status in early childhood is associated with higher weight status at older ages. The Maternal Obesity Matters (MOMs) Study investigated associations between maternal risk of cardiovascular disease (CVD) and child BMI z-scores (BMIz) among preschool-aged children. This cross...

Background: Responsive feeding is important for helping children to develop healthy eating behaviors. Verbal feeding interactions between caregivers and children may reflect caregiver's responsiveness and contribute to children's developing lexical networks related to food and eating. Objectives: This project aimed to: 1) characterize what careg...

Introduction The goal of the present study was to investigate factors associated with sustainment of two evidence-based programs for nutrition promotion in early care and education (ECE) settings – Food Friends (FF) and Together, We Inspire Smart Eating (WISE). Materials and methods In a cross-sectional study design, ECE directors ( N = 55) from c...

This pilot evaluated strategies to decrease detrimental feeding practices in early care and education, which are hypothesized to compete with evidence-based feeding and obesity prevention practices. This study made two key comparisons: (1) a between-site comparison of sites receiving (a) no implementation or de-implementation strategies (i.e., Basi...

Objectives The introduction to a variety of foods during the first two years of life is recommended to ensure adequate intake of essential nutrients required for optimal growth and development. The purpose of this study was to assess dietary diversity among children 4–26 months and to identify associations between caregiver sociodemographic charact...

Objectives Infants and toddlers experience rapid growth and development, which necessitates changes in feeding practices throughout this period. We aimed to explore infant/toddler feeding topics that Extension and nutrition educators typically discuss with caregivers through formal curricula and informal conversations. Methods A mixed methods stud...

Objectives Children begin to learn words related to food during the complementary feeding period. Their food lexicons and schemas serve as a foundation for building food-related cognitions which, in turn, underpin the development of eating behaviors. We assessed caregiver perceptions regarding young children's food-related receptive and expressive...

See corresponding article on page 111. The complementary feeding (CF) period, from ∼6 through 24 mo, is a developmental interval during which young children learn about flavors, food, and eating. Lifetime habits begin to form during this period. Early experiences with foods and eating, including social aspects learned via caregiver eating and feedi...

Validated measures predicting infant consumption of nutrient supplements or fortified foods are essential for the success of nutritional interventions to improve undernutrition. Behavioural coding of food acceptance is one promising approach, though the required time and resources are limiting. The overarching goal of the present study was to adapt...

Objective Language development, both what is understood (receptive language) and spoken (expressive language), is considered critical to a child's ability to understand and interact with their environment. However, little research has investigated the role children's early language skills might play in their food acceptance. The objective of this s...

Prior work has examined associations between cardiometabolic pregnancy complications and autism spectrum disorder (ASD), but not how these complications may relate to social communication traits more broadly. We addressed this question within the Environmental influences on Child Health Outcomes (ECHO) program, with 6,778 participants from 40 cohor...

Background: Despite the potential for Early Care and Education (ECE) settings to promote healthy habits, a gap exists between current practices and evidence-based practices (EBPs) for obesity prevention in childhood. Methods: We will use an enhanced non-responder trial design to determine the effectiveness and incremental cost-effectiveness of a...

The early care and education (ECE) environment has the potential to affect both children and their families. Food insecurity in ECE and its management may be an important influence. Objectives of this mixed methods study were to (1) elicit prominent themes relating to teacher experiences with food insecurity (in the classroom) through qualitative i...

The home food environment (HFE) is associated with dietary intake; yet measuring HFE quality often requires burdensome collection of detailed inventories. This project evaluated the capacity of the Home Inventory to Describe Eating and Activity, version 2 (Home-IDEA2) to capture HFE quality by measuring the presence or absence of household foods. V...

In the United States, one in five adolescents are obese. Index-based dietary patterns are measures of the overall diet that have the potential to serve as valuable obesity risk stratification tools. However, little is known about the association between adherence to index-based dietary patterns in childhood and BMI during the transition from childh...

Background Accuracy and participant burden are two key considerations in the selection of a dietary assessment tool for assessing children’s full-day dietary intake. Objective The aim of this study was to identify barriers experienced by parents and burden when using two technology-based measures of dietary intake to report their child’s intake: t...

U.S. children's frequent consumption of restaurant foods has been associated with low vegetable consumption. Use of choice architecture in restaurants has been shown to increase children's orders of healthy sides, but what children consume when healthy sides are included is unknown. The purpose of the present study was to investigate whether alteri...

Background: Establishing physical activity (PA) and motor behaviors in early childhood are important for developing healthy activity behaviors. Parents play a central role in shaping young children’s PA and fundamental motor skills (FMS). This qualitative study explored parents’ attributes, values, perceptions, and practices related to PA and FMS....

Background High levels of screen time and low levels of physical activity (PA) are associated with childhood obesity. Sixty minutes or less for daily screen time and at least 180 minutes of PA, including 60 minutes of moderate-to-vigorous PA (MVPA), are current recommendations for preschoolers. The home environment, including the physical environme...

Background Maternal self-care, behaviors facilitating healthy eating, physical activity (PA), and stress management, are targets for child obesity prevention efforts and there is a need for optimized interventions to enhance these efforts. Plan, Do, Study, Act (PDSA) Cycling, a quality improvement process using rapid cycle testing to develop and re...

Background Limited evidence exists on how the quality of maternal-child interactions influences preschoolers’ eating and physical activity (PA) behaviors and environments and, ultimately, growth. A 6-week, mindful parenting intervention was developed to facilitate positive parent-child interactions during mealtimes and PA. The intervention targeted...

Background Infants are born with the biological predisposition to reject bitterness. Dark green vegetables contain essential nutrients but also bitter compounds, making them more difficult to like. Objective The Good Tastes Study was designed to determine whether reducing bitterness by adding small amounts of sugar or salt would alter infant accep...

Objectives To characterize parental verbal prompts to infants during feeding and the relation of parent verbalizations to infant acceptance of a novel food. Methods Feeding interactions of parent-child dyads (n = 106; 54% boys; mean age 13.3 ± 4.9 mo) were video-recorded and all parental verbal communications to infants and infant acceptance/rejec...

Objectives Little inquiry has been undertaken regarding the interface of children's development of eating behaviors and their understanding of food-related (FR) words. Thus, we explored the relationship between young children's understanding of FR vocabulary (FR receptive language) and their acceptance of a novel food. Methods Caregivers (n = 35)...

The limitations of self-report measures of dietary intake are well known. Novel, technology-based measures of dietary intake may provide a more accurate, less burdensome alternative to existing tools. The first objective of this study was to compare participant burden for two technology-based measures of dietary intake among school-age children: th...

Objective Assess effects of an obesity prevention program promoting eating self-regulation and healthy preferences in Hispanic preschool children. Design Randomized controlled trial with pretest, posttest, 6- and 12-month assessments. Fourteen waves, each lasting 7 weeks. Setting Families recruited from Head Start across 2 sites. Participants Tw...

Background Small-quantity lipid-based nutrient supplements (SQ-LNS) are designed to address undernutrition during the complementary feeding period. SQ-LNS contains added sugars, but limited research has assessed whether infants’ acceptance varies between versions with and without sugars. Objectives Our objective was to examine the effects of repea...

Background Together, We Inspire Smart Eating (WISE) is an intervention for the early care and education setting to support children’s exposure to and intake of fruits and vegetables. WISE emphasizes 4 evidence-based practices (EBPs): (1) use of a mascot; (2) educators’ role modeling; (3) positive feeding practices; and (4) hands-on exposures. The c...

BACKGROUND Improving children's fruit and vegetable (FV) preferences may be important as preferences can predict FV consumption. The purpose of this study was to evaluate FV preferences over time, with repeated experience, as part of the Fresh Fruit and Vegetable Program (FFVP). METHODS Fruits (F; N = 28) and vegetables (V; N = 29) were distribute...

Background A majority of children’s restaurant meals are nutritionally deficient; use of behavioral economics may improve healthful menu selections. Parents play a role in children’s restaurant meal selection, thus understanding parent preferences for potential behavioral economic strategies is warranted. Objective To examine parent-derived and -s...

Food neophobia, defined as an unwillingness to consume novel and unfamiliar foods is common in young children. Assessment of neophobia or willingness to try new foods can be a challenge with this audience. With the increase in nutrition interventions focused on the young child, valid and reliable measures to assess willingness to try new foods that...

Objective To explore parental perspectives on the ideals and realities of family mealtimes. Design Mini-focus groups (n = 7). Setting Rural Colorado, US. Participants Parents (n = 30) were recruited at Head Start/preschool centers. Phenomenon of Interest Parent perspectives on mealtimes with preschool-aged children. Analysis Transcripts were a...

Objective To investigate the alignment between vegetables and fruits listed in the ingredients of commercially produced infant and toddler food (ITF) and inclusion in front-of-package product names. Design A database of commercial ITF containing vegetables (n = 548) was created. Inclusion of each vegetable or fruit in the product name (yes/no), fo...

Background Despite the importance of sustainability for nutrition and physical activity in public health interventions, limited studies have explored the factors that promote and inhibit evidence-based program sustainment in the childcare setting. This study protocol describes a mixed-methods approach to develop novel sustainability strategies base...

A cluster randomized trial design was used to test the efficacy of a behaviour change communication intervention on the quality of the home environment and infant development at 15 months of age. Children (n = 600) in rural South India were followed from 3 through 15 months of age. The control group (C group) received the standard of care, the comp...

Background Early childhood educators (ECEs) often use detrimental feeding practices and are slow to implement positive feeding practices. Nevertheless, few studies have aimed to understand and change ECEs’ feeding practices. This gap needs to be addressed because implementation (i.e., adding new, evidence-based practices) and de-implementation (i.e...

Children reportedly consume a variety of adequate vegetables during the introduction of complementary foods, and breastfeeding helps to facilitate child food acceptance. However, dietary intake of vegetables is reported to fall when children begin to eat foods of the family table. In laboratory settings, repeated exposure is effective in promoting...

Objective Explore using food photography to assess packed lunches in a university-based Early Childhood Center and contextualize these photographs through parent interviews. Methods An explanatory sequential design was used. Packed lunches were photographed to assess the type and quantity of foods offered and consumed by Child and Adult Food Care...

Small-quantity lipid-based nutrient supplements (SQ-LNS) could help prevent malnutrition. Our primary objective was to examine the acceptability and consumption of sweetened and unsweetened versions of SQ-LNS before and after 14-days of repeated exposure. A total of 78 mother-infant dyads recruited from health centers in Morelos, Mexico, were rando...

Parents play a critical role in the development of children's eating behaviours and weight status, serving as providers, models and regulators of the food environment. Many research reviews have focused on the robust body of evidence on coercive control in feeding: how parenting practices such as restriction and pressure to eat increase children's...

Interventions designed to improve children's self-regulation of energy intake have yielded mixed results. We tested the efficacy of a technology-enhanced intervention designed to teach children to eat in response to internal hunger and fullness cues. Thirty-two children (mean age 4.9 ± 0.8 y) completed this within-subjects, pre-post design study th...

Background Children in the US are eating frequently in restaurants, which is associated with poor dietary quality, including decreased vegetable intake. Behavioral economic strategies, such as optimal defaults, have increased children's orders of healthful sides, but it is unknown what children consume when healthful sides are presented. Objective...

Background Children's restaurant meals are nutritionally deficient; use of behavioral economic strategies may improve healthfulness. Parents play a role in children's restaurant meal selection, thus understanding parent preferences and potential behavioral economic strategies for healthful children menu options is warranted. Objective To examine p...

Objective To assess the impact of an experiential nutrition education program, The SPORKS for Kids program, on preschoolers’ willingness to try a novel vegetable. Use of Theory or Research Intervention approaches which integrate repeated taste exposure, sensory learning, and nutrition education to provide repeated exposures to novel foods in fun,...

Background Maternal self-care, or behaviors facilitating healthy eating, physical activity (PA), and stress management practices, may play an important role in child weight status. Few childhood obesity interventions, however, consider maternal self-care and health practices. Objective To understand existing beliefs, practices, and supports or bar...

Objectives Child feeding can be challenging during the infant and toddler period when children are learning to eat complementary foods. We examined associations among children's eating behaviors, whether children were caregiver fed or self-fed, and children's intake of a novel food during two eating occasions in a laboratory setting. Methods Careg...

Objectives Limited evidence suggests that the timing of introduction to food texture may be important for early food acceptance patterns, but little is known about developmental shifts in children's acceptance of varying textures. Methods This research evaluated acceptance of varying textures of a single vegetable among children (n = 57, 46% femal...

Objectives The ability to self-feed using utensils develops steadily from late infancy through toddlerhood. Here, we examine differences in food acceptance when infants and toddlers are self-fed versus caregiver-fed. Methods Caregivers (89% mothers) and their infants/toddlers (n = 57, 46% female, 86% black) aged 6–11 months (n = 13), 12–23 months...

Objectives Small-quantity lipid-based nutrient supplements (SQ-LNS) are designed to address malnutrition among infants and toddlers during complementary feeding. There is currently limited research assessing children's acceptability (i.e., behavioral response to the taste) of these supplements, and acceptability may predict long term consumption of...

Objectives Early life flavor exposure is important in shaping lifelong eating habits. We examined relationships among maternal current breastfeeding status, infant vegetable experience and acceptance of a novel vegetable. Methods Caregivers (n = 106, 82% White) and children (n = 106, 54% male) aged 6–12 months (n = 46; infants), 12–18 months (n =...

Objectives Repeated exposure (RE) paradigms produce improvements in food acceptance during infancy, however, less is known about RE effectiveness in toddlers. Here we examine the effects of RE on acceptance of sweetened and unsweetened versions of a lipid nutrient supplement (LNS). Methods Mothers and children (n = 56, 86% NonHispanic White), aged...

Objectives To assess the feasibility of using a live coding method developed in a laboratory to a naturalistic field setting in Mexico and report lessons learned and recommendations for future use. Methods Two coders previously trained to reliability for video-coding of child food acceptance were trained on video live coding (coding video recordin...

Objectives Caregiver feeding styles differ in their responsivity and thereby shape children's early feeding experiences. Laissez-faire feeding beliefs and practices are less engaged than the responsive feeding style. This study aimed to examine how the mothers’ infant feeding beliefs and behaviors are associated with infant/toddler consumption of a...

On 26 May, 2019, the nutrition community lost a visionary ambassador, trusted advisor, and cherished mentor. Leann Birch was a pioneer in bringing a developmental psychology perspective to the study of children's nutrition as a means to respond to real-world questions raised by parents. Leann Elsie Traub was born in Owosso, Michigan 25 June, 1946....

Biography of Leann L. Birch, PhD

Mexican American adolescents have an increased risk for obesity compared to non-Hispanic whites (NHWs), especially as their degree of acculturation increases. Snack intakes can impact diet quality and may affect obesity risk, yet little is known about differences in snack intakes among NHW and Mexican American adolescents from different acculturati...

Vegetables are an important but under consumed part of a healthy diet. There is growing interest in promoting vegetable acceptance and consumption among infants to help establish life-long healthy eating patterns. A recent survey of commercial baby food products in the United States (U.S.) by Moding and colleagues revealed a lack of variety in the...

Objective: Prompted engagement with a new food's sensory properties (smell, texture) has been associated with young children's acceptance of new foods. However, little is known about the prevalence and stability of children's sensory exploratory behaviors exhibited spontaneously when trying new foods. The aim of this analysis was to examine develo...

Objective: To assess the short-term effects of an obesity prevention program promoting eating self-regulation and healthy food preferences in low-income Hispanic children. Design: Randomized controlled trial with pretest, posttest, and 6- and 12-month assessments. Setting and participants: Head Start and similar early learning institutions in...

This study introduces the concept of Food Acquisition Stress (FAS), the stress associated with food acquisition among those who do not necessarily screen positive for food insecurity. This study used an exploratory sequential mixed methods approach among a sample of predominantly early childhood educators to develop a 7-item tool for measuring curr...

The ingredients and nutrients of infant and toddler foods (ITFs) sold in pouches were compared with products available in other packages, such as jars/packs and other containers. Company websites (n = 21) and in-store shelf inventory (n = 3) were used to create a database of commercial ITFs containing vegetables (n = 548) sold in the United States....

Objective: To assess whether feeding questionnaire responses reflect observed mealtime behavior. Design: Cross-sectional associations between self-reported and observed behaviors. Setting: Participants' homes. Participants: Parents (n = 75) of toddlers (mean age = 24.7 months) in the US. Main outcome measures: Feeding behavior questionnair...

Background The high prevalence of obesity among preschoolers may be partially explained by the type and quantity of foods offered by parents and left unconsumed by preschoolers. Objectives (a) To compare foods offered and consumed at dinner to the Dietary Guidelines for Americans (DGAs) and the Child and Adult Care Food Program (CACFP) standards a...

Eating-related routines, such as regular mealtimes, can protect against obesity. Little is known about eating-related routines among preschoolers or the factors that shape those routines. Ecocultural Theory and qualitative interviews with 30 caregivers of preschoolers in Colorado were used to describe eating-related routines at home and parents’ pe...

Objective The objective of the HEROs Study (HEalthy EnviROnments Study) is to develop a technology-based, interactive family intervention to promote healthy lifestyles and weight outcomes for young children in the family setting. Description The project aims to improve family routines and parent-child eating and physical activity (PA) interactions...

Objective: To identify positive and negative deviant cases using quantitative fidelity data from a previous implementation of a nutrition intervention, Together, We Inspire Smart Eating (WISE), and to determine barriers and facilitators to fidelity by conducting qualitative interviews with deviant cases. Design: Explanatory sequential mixed meth...