Table 3.

HABITS target behaviors, scientific premises and intervention description

Scientific premise	Intervention
Behavior #1: Limit fried foods
Fried foods are energy-dense and contain a large amount of saturated fat. Higher consumption of high-saturated fat is associated with greater weight gain and poorer health [65–71].	Habit formation: Mothers (with children involved) will learn to change habits around intake of fried foods: (1) identify cues/situations/triggers associated with fried food intake (e.g., certain foods such as fish, okra or chicken; fast food restaurant), (2) select alternative cooking methods or food selection (e.g., grilled or baked), (3) consistently repeat the new behavior in response to the cues until mastery and automaticity are reached. Didactic recommendations (e.g., modifying families’ deep fried chicken recipe for oven-baked “fried chicken”) will be supported by hands-on practice activities involving both mothers and children. Similar habits will be shaped and practiced to address food selection outside the home. Home environment: Mothers will be taught to change their home food environment by avoiding bringing fried foods into the home, limiting access to ingredients necessary for frying foods, and promoting access to recipes and ingredients for alternative cooking methods.
Behavior #2: Limit sugar-sweetened beverages (SSB)
Higher SSB consumption, which may lead to excess energy intake, is associated with greater weight gain and poorer health [72–75]. Current guidelines recommend that adults limit their SSB consumption and that fruit juice be limited to <4 ounces/day for children under the age of 3.	Habit formation: Mothers (with children involved) will learn to change habits around consumption of SSB: (1) identify cues/situations/triggers associated with SSB intake (e.g., meals, soothing children), (2) select an alternative beverage (e.g., water or lower-fat milk), and (3) consistently repeat the new behavior in response to the cues until mastery and automaticity are reached. Home environment: Mothers learn to change their beverage choice architecture by avoiding bringing SSB in the home and by storing SSB in inconvenient/inaccessible/hidden locations.
Behavior #3: Increase intake of non-starchy vegetables and fruits
The USDA guidelines recommend that preschoolers consume 1–11/2 cups of raw or cooked vegetables, or 2 cups of raw leafy greens (raw or cooked; fresh, frozen, canned) and 1–11/2 cup of fruits (fresh, canned, frozen, or dried) [86–88].	Habit formation: Mothers (with children involved) will learn to form habits around consumption of fruits and vegetables instead of energy-dense alternatives (i.e., switch message): (1) identify meals and snacks as cues/situations/triggers associated with fruits and vegetables intake, (2) learn to prepare/cook/store non-starchy fruits and vegetables, and (3) consistently provide fruits and non-starchy vegetables for every snack and meal instead of energy-dense foods. Hands-on activities (e.g., taste tests, cooking and storing demonstrations) will promote multi-sensory exposure and increase children’s acceptance of novel fruits and vegetables. Home environment: Mothers learn to increase the accessibility and visibility of fruits and vegetables in their home. Proper food preparation and storage (e.g., freezing) can reduce food waste of perishable items and ensure availability of fruits and vegetables throughout the month (i.e., not limited by monthly financial fluctuations)
Behavior #4: Increase daily steps
Preschoolers (3 to 5 years of age) should be physically active every day for at least 60 minutes (up to several hours), and avoid being sedentary for more than 60 minutes at a time, except when sleeping [89, 90].	Habit formation: Mothers (with children involved) will learn to form habits around physical activity and active play: (1) identify child and mother specific cues/situations/triggers that will become associated with physical activity (e.g., stairs; time of day), and (2) identify specific activities that will be consistently repeated in response to daily cues (e.g., 10-min walk after breakfast; acting out movements in response to storytelling). Home environment: Mothers are key contributors of children’s activities in providing access and opportunities. Mothers will learn to increase the availability/accessibility/visibility of physical activity cues (e.g., walking shoes, jump rope) and reminders in the home, and to optimize their use of safe spaces around the house. They will receive information on free group activities and classes they can share with their children and other families.
Behavior #5: Self-monitoring of weight and targeted behaviors (mothers only)
Grounded in self-regulation theory, self-monitoring of weight and related behaviors (e.g., food intake) provides immediate feedback, allows for corrective actions, and are foundational components of evidence-based weight management programs. Regular self-weighing and completion of food/activity records are associated with program adherence and successful weight management [79–85].	Habit-formation: Mothers will receive simplified self-monitoring forms with instruction to record weight and HABITS behaviors daily: number of fried foods, SSB, steps, and F/V servings. They will practice monitoring with their home visitors who will provide corrective feedback. Mothers will be instructed to weigh themselves at the same time each day in the same context (e.g., in the bathroom after brushing teeth). Similarly, they will be instructed to pair dietary self-monitoring with meals/snacks and to write down their step counts before bed (cue/context). Home environment: Mothers will be encouraged to place scales in highly visible and accessible locations, in close proximity to cues eliciting other well-established behaviors (e.g., beside the toilet). Mothers will be instructed to keep their self-monitoring checklist with them to ensure tracking occurs in close temporal proximity with the target behavior. Additional tips will be discussed, such as taking a picture of one’s meal for later recording when necessary. With support and guidance from home visitors, posting of weight and target behavior graphs in visible locations (e.g., bathroom mirror, refrigerator door) to monitor progress will also be encouraged.