Traditional foods and practices of Spanish-speaking Latina mothers influence the home food environment: implications for future interventions

This study aimed to obtain in-depth information from low-income, Spanish-speaking Latino families with young children to guide the development of culturally appropriate nutrition interventions. Focus groups were used to assess parent's knowledge about healthful eating, the home food environment, perceived influences on children's eating habits, food purchasing practices, and commonly used strategies to promote healthful eating among their children. Thirty-four Latino parents (33 women; 27 born in Mexico; 21 food-insecure) of preschool-aged children participated in four focus group discussions conducted in Spanish by a trained moderator. The focus groups were audiotaped, transcribed, translated, and coded by independent raters. Results suggest that in general, parents were very knowledgeable about healthful eating and cited both parents and school as significant factors influencing children's eating habits; at home, most families had more traditional Mexican foods available than American foods; cost and familiarity with foods were the most influential factors affecting food purchasing; many parents had rules regarding sugar intake; and parents cited role modeling, reinforcement, and creative food preparation as ways to encourage children's healthful eating habits. Finally, parents generated ideas on how to best assist Latino families through interventions. Parents indicated that future interventions should be community based and teach skills to purchase and prepare meals that include low-cost and traditional Mexican ingredients, using hands-on activities. In addition, interventions could encourage and reinforce healthy food-related practices that Latino families bring from their native countries.     

Weight loss attempts and attitudes toward body size, eating, and physical activity in American Indian children: relationship to weight status and gender

OBJECTIVE: This study examined dieting, weight perceptions, and self-efficacy to eat healthy foods and engage in physical activity and their relationships to weight status and gender among American Indian elementary schoolchildren. RESEARCH METHODS AND PROCEDURES: Data for this study were collected as part of the baseline examination for the Pathways study. Participants were 1441 second- through third-grade American Indian children in 41 schools representing seven tribes in Arizona, New Mexico, and South Dakota who filled out a questionnaire and had heights and weights taken. RESULTS: Forty-two percent of the children were overweight or obese. No differences were found between overweight/obese and normal weight children for healthy food intentions or self-efficacy. Heavier children (especially those with body mass index > 95th percentile) were more likely to have tried to lose weight or were currently trying to lose weight. No gender differences were found. Normal weight children chose a slightly heavier body size as most healthy compared with overweight/obese children. DISCUSSION: The results indicate that children are concerned about their weight and that weight modification efforts are common among overweight American Indian children. School, community, and family-based programs are needed to help young people adopt lifelong healthful eating and physical activity practices.     

Childhood obesity: do parents recognize this health risk?

OBJECTIVE: This study examined parents' understanding of excess weight as a health risk, knowledge of healthy eating habits, and recognition of obesity in their children. RESEARCH METHODS AND PROCEDURES: An anonymous questionnaire was distributed during well-care visits involving children 4 to 8 years of age at a pediatric faculty practice. Parents indicated their level of concern about excess weight and other familiar health risks using a four-point Likert scale, answered multiple-choice questions concerning healthy eating patterns, and communicated their perceptions about their child's weight using a visual analog scale. A parent's perception was considered "accurate" if it deviated from the child's growth chart percentile by <30 points. RESULTS: Of the 83 parents surveyed, 23% (19/83) had overweight children (> or = 95th percentile of age- and gender-specific BMI growth charts). These parents did not differ from other parents in their level of concern about excess weight as a health risk or in their knowledge of healthy eating patterns, but the two groups of parents did differ in the accuracy of their perceptions about their children's weight. Only 10.5% of parents of overweight children (2/19) perceived their child's weight accurately compared with 59.4% of other parents (38/64; p < 0.001). Parents of overweight children invariably underestimated their children's weight. The median difference between their perception and the growth chart percentile was -45 points. DISCUSSION: Given that most parents of overweight children fail to recognize that their child has a weight problem, pediatricians should develop strategies to help these parents correct their misperceptions.     

Parents' perceptions of curricular issues affecting children's weight in elementary schools

The purpose of this study was to examine Ohio parents' perceptions of the role of elementary schools in preventing childhood overweight. In the United States, overweight is the most widespread health threat facing children and adolescents. Schools may be a useful point of intervention in addressing the escalating prevalence of childhood overweight because children spend over half their day at school. A questionnaire was developed based primarily on the School Health Index, a tool developed by the Centers for Disease Control and Prevention to help schools assess and improve their physical activity, healthy eating, tobacco use prevention, and safety policies and programs. Seven hundred surveys were sent to a random sample of Ohio parents of elementary school-aged children. This study (53% response rate) found that the majority (51-73%) of parents identified 14 items as very important in preventing childhood overweight, which is indicative of their support for these curricular topics within the elementary school. All items from the physical education component had less than 50% of the parents identifying these items as very important. The item that was least supported (16%) by the parents was measuring a child's body mass index. The majority (51%) of parents indicated their preference for elementary students' access to vending machines only if they contained nutritious foods and beverages, while 42% of parents preferred that elementary students should not be allowed access to vending machines at all. The findings from this study suggest that Ohio parents would be supportive of school-based interventions focusing on healthy eating, physical activity, and the school environment to help reduce the prevalence of overweight in elementary children.     

Correlates of body mass index, weight goals, and weight-management practices among adolescents

The study examined associations among physical activity, cigarette smoking, body mass index, perceptions of body weight, weight-management goals, and weight-management behaviors of public high school adolescents. The CDC Youth Risk Behavior Survey provided a cross-sectional sample (n = 3,089) of public high school students in South Carolina. Logistic regression models were constructed separately for four race-gender groups. Adjusted odds ratios and 95% confidence intervals were calculated to determine the magnitude of associations. Based on self-reported height and weight, 13% of students were overweight, while 15% were at risk for becoming overweight. However, 42% of students were trying to lose weight, and 22% were trying to maintain current weight. Female students were less likely than male students to be overweight, but more likely to be attempting to lose weight. Extreme weight control practices were reported by 27% of the sample. Among Black females trying to lose weight, positive associations were observed for strengthening exercises (OR = 1.55), but that relationship was associated inversely in Black males (OR = .600). Among White females, attempted weight loss was associated with strengthening exercises (OR = 1.72) and cigarette smoking (OR = 1.54). For White males, attempted weight loss was associated positively with vigorous exercise (OR = 1.41) and inversely related to moderate exercise (OR = .617). Effective weight-management practices for adolescents should focus on appropriate eating behaviors, physical activity, and low-fat/calorie diets. Multicomponent weight management interventions should be conducted within a coordinated school health framework.     

Position of the American Dietetic Association: nutrition guidance for healthy children ages 2 to 11 years

It is the position of the American Dietetic Association that children ages 2 to 11 years should achieve optimal physical and cognitive development, attain a healthy weight, enjoy food, and reduce the risk of chronic disease through appropriate eating habits and participation in regular physical activity. The health status of American children has generally improved during the past 3 decades. However, the number of children who are overweight has more than doubled among 2- to 5-year-old children and more than tripled among 6- to 11-year-old children, which has major health consequences. This increase in childhood overweight has broadened the focus of dietary guidance to address children's overconsumption of energy-dense, nutrient-poor foods and beverages and physical activity patterns. Health promotion will help reduce diet-related risks of chronic degenerative diseases, such as cardiovascular disease, type 2 diabetes, cancer, obesity, and osteoporosis. This position reviews what US children are eating and explores trends in food and nutrient intakes as well as the impact of school meals on children's diets. Dietary recommendations and guidelines and the benefits of physical activity are also discussed. The roles of parents and caregivers in influencing the development of healthful eating behaviors are highlighted. Specific recommendations and sources of nutrition messages to improve the nutritional well-being of children are provided for food and nutrition professionals     

Position of the American Dietetic Association: Dietary guidance for healthy children ages 2 to 11 years

It is the position of the American Dietetic Association that children ages 2 to 11 years should achieve optimal physical and cognitive development, attain a healthy weight, enjoy food, and reduce the risk of chronic disease through appropriate eating habits and participation in regular physical activity. The health status of American children has generally improved over the past three decades. However, the number of children who are overweight has more than doubled among 2- to 5-year-old children and more than tripled among 6- to 11-year-old children, which has major health consequences. This increase in childhood overweight has broadened the focus of dietary guidance to address children's over consumption of energy-dense, nutrient-poor foods and beverages and physical activity patterns. Health promotion will help reduce diet-related risks of chronic degenerative diseases, such as cardiovascular disease, type 2 diabetes, cancer, obesity, and osteoporosis. This position paper reviews what US children are eating and explores trends in food and nutrient intakes as well as the impact of school meals on children's diets. Dietary recommendations and guidelines and the benefits of physical activity are also discussed. The roles of parents and caregivers in influencing the development of healthy eating behaviors are highlighted. The American Dietetic Association works with other allied health and food industry professionals to translate dietary recommendations and guidelines into achievable, healthful messages. Specific recommendations to improve the nutritional well-being of children are provided for dietetics professionals, parents, and caregivers.     

Understanding How Latino Parents Choose Beverages to Serve to Infants and Toddlers

To determine Latino parents’ beliefs on the health effects of beverages on infants and toddlers, their sources of information on beverages and perceived barriers to following guidelines for healthy beverage consumption by children. We conducted 29 interviews with parents of Latino children ages 6–36 months. Parents were recruited in three community health centers in Northern California. The interviews were recorded, transcribed and analyzed using standard qualitative methods. The following dominant themes emerged. Parents believed that water and milk were healthy beverages for children and that sugar-sweetened beverages (SSBs) were unhealthy. Views on 100 % fruit juice were mixed. Parents distinguished between homemade beverages such as “agua fresca” which they considered healthy, despite containing added sugar, and beverages from stores which were viewed as unhealthy. Participants’ main source of information on beverages was the federal nutrition program for Women, Infants, and Children (WIC). Parents were confused, however, as to why WIC provides juice yet counseled parents to avoid giving their children juice. Parents preferred to receive information on beverages from experts. Differing practices among family members regarding which beverages they provide to children was the most important barrier to following beverage guidelines. Our study suggests that Latino parents are receptive to counseling on beverages from expert sources. Such counseling should address both store-bought and homemade beverages. The WIC program is a key source of information on beverages for Latino parents; thus counseling offered by WIC should be evidence-based and avoid mixed messages.     

Parent perceptions to promote a healthier lifestyle for their obese child

Parents of children referred to a pediatric multidisciplinary weight-management clinic were queried regarding the importance of and their readiness to promote healthy lifestyle behaviors with their children and also regarding their confidence in their ability to adopt those changes. Among the 193 children's parents who completed a questionnaire (93.7% response), greater than 75% of respondents recognized the importance of healthy eating and physical activity, and many indicated feeling both confident and ready to make changes. Surprisingly, even among those not confident, parents also indicated they were ready to change their child's eating (p < .001). This study explores the discrepancy between parents indicating a high level of importance and readiness to promote healthy lifestyle behaviors but having less confidence that they would actually be able to enact change.     

Latina Mothers’ Perceptions of Healthcare Professional Weight Assessments of Preschool-Aged Children

To understand Latina mothers’ definitions of health and obesity in their children and perceptions of physician weight assessments. 24 low-income Spanish speaking Mexican mothers of children ages 2–5 years were recruited to participate in 4 focus groups. Half of the mothers had overweight or obese children and half had healthy weight children. Focus group comments were transcribed and analyzed using grounded theory. Themes and supporting comments were identified independently by 3 reviewers for triangulation. A fourth reader independently confirmed common themes. Mothers define health as a function of their child’s ability to play and engage in all aspects of life. Obesity was defined with declining physical abilities. Mothers state health care provider assessments help determine a child’s overweight status. Causative factors of obesity included family role-modeling and psycho-social stress, physical inactivity, and high-fat foods consumed outside the home. Controlling food intake was the primary approach to preventing and managing obesity but mothers described family conflict related to children’s eating habits. These findings held constant with mothers regardless of whether their children were overweight, obese, or at a healthy weight. Mothers utilize physical limitations and health care professional’s assessment of their child’s weight as indicators of an overweight status. These results highlight the importance of calculating and communicating body mass indices (BMI) for Latino children. Eliminating non-nutritive foods from the home, increasing physical activity, and involving family members in the discussion of health and weight maintenance are important strategies for the prevention and management of childhood obesity.     

Parent Perceptions to Promote a Healthier Lifestyle for Their Obese Child

Parents of children referred to a pediatric multidisciplinary weight-management clinic were queried regarding the importance of and their readiness to promote healthy lifestyle behaviors with their children and also regarding their confidence in their ability to adopt those changes. Among the 193 children's parents who completed a questionnaire (93.7% response), greater than 75% of respondents recognized the importance of healthy eating and physical activity, and many indicated feeling both confident and ready to make changes. Surprisingly, even among those not confident, parents also indicated they were ready to change their child's eating (p < .001). This study explores the discrepancy between parents indicating a high level of importance and readiness to promote healthy lifestyle behaviors but having less confidence that they would actually be able to enact change.     

“It’s Sort Of,Like, in My Family’s Blood”: Exploring Latino Pre-adolescent Children and Their Parents’ Perceived Cultural Influences on Food Practices

ABSTRACT

This study examined the perceived connections between culture and food practices among Latino pre-adolescents (n = 17) and their parents (n = 15) through semi-structured interviews. Results show that pre-adolescents have formed perceptions concerning the association between their eating behaviors and cultural background that coincide with their parent’s notions. Participants associated culture to both healthy and unhealthy food practices. Latin American food environments were described as healthier than in the US. The interviews revealed conflict between traditional foods preferences and perceptions of health, underscoring the need for better approaches to help Latino families navigate US food environments, while also preserving healthful traditional food practices.     

Is parenting style related to children's healthy eating and physical activity in Latino families?

Parenting styles influence a child's risk for obesity. The goals of this study are to evaluate the influence of (i) parenting style on children's health behaviors (physical activity and dietary intake), (ii) children's sociodemographic characteristics on parenting style and on children's health behaviors and (iii) parents' sociodemographic characteristics on their use of controlling styles to promote a healthy home environment. Survey and anthropometric data were collected from a community sample of Latino parents (n = 812) and their children in kindergarten through second grade. Parental use of positive reinforcement and monitoring was associated with children's healthy eating and exercise. Also, parents' use of appropriate disciplining styles was associated with healthier eating, while parental use of control styles was associated with unhealthy eating. The daughters of parents who used controlling styles ate more unhealthy foods than did the sons. Older, employed and more acculturated parents used less controlling styles than their counterparts. Parenting interventions targeting children's dietary intake and physical activity should encourage parents to use more positive reinforcement and monitor their children's health behaviors as these parenting styles are associated with healthier behaviors. Moreover, intervention researchers may want to encourage Latino parents to use less controlling styles with girls as this parenting style increased girls' risk for unhealthy eating.     

A Review of Family and Social Determinants of Children’s Eating Patterns and Diet Quality

With the growing problem of childhood obesity, recent research has begun to focus on family and social influences on children’s eating patterns. Research has demonstrated that children’s eating patterns are strongly influenced by characteristics of both the physical and social environment. With regard to the physical environment, children are more likely to eat foods that are available and easily accessible, and they tend to eat greater quantities when larger portions are provided. Additionally, characteristics of the social environment, including various socioeconomic and sociocultural factors such as parents’ education, time constraints, and ethnicity influence the types of foods children eat. Mealtime structure is also an important factor related to children’s eating patterns. Mealtime structure includes social and physical characteristics of mealtimes including whether families eat together, TV-viewing during meals, and the source of foods (e.g., restaurants, schools). Parents also play a direct role in children’s eating patterns through their behaviors, attitudes, and feeding styles. Interventions aimed at improving children’s nutrition need to address the variety of social and physical factors that influence children’s eating patterns.     

Developing health messages: qualitative studies with children,parents, and teachers help identify communications opportunities for healthful lifestyles and the prevention of obesity

Childhood overweight is at an all-time high in the United States. In an effort to better understand children's, parents', and teachers' attitudes, perceptions, and behaviors about preventing overweight in childhood and to explore potential avenues for communicating overweight prevention messages, we conducted qualitative research with these three groups in 2000. Our research consisted of three progressive phases, each building on information obtained from the previous phase: Phase 1, 16 focus groups (N = 112); Phase 2, in-home observations, in-depth interviews, and diaries (N = 6 families); Phase 3, 10 qualitative interview sessions (N = 46). Both parents and children indicated that encouragement and "small victories" to sustain involvement in getting more fit were critical to success. The findings also suggest that children need direct messages to motivate them to change their exercise and eating habits, as well as tips on cooperating with their parents to achieve fitness goals. Parents need to learn how to talk about eating and exercise habits with their children in positive and encouraging ways and to learn how to help their children maintain efforts to get fit. Teachers consider it essential that parents support healthful lifestyles at home. Parents and children need positive, realistic approaches to getting fit, such as answers to questions about healthful lifestyles; ideas for physical games and activities the family can enjoy together; attainable goals and small steps to healthful eating; healthful meal, snack, and recipe suggestions; incentive ideas for getting kids active; and referral services for local support groups. Parents and children need to work together in addressing the overweight prevention issue and need effective tools to facilitate this cooperative effort.     

Latino parents' perceptions of their ability to prevent obesity in their children

The obesity epidemic in Latino children has reached staggering proportions. This study explored Latino parents' perceptions of their ability to prevent obesity in children. Three focus groups were conducted with 26 Latino parents of preschoolers at a New York City Head Start program. Parents perceived high levels of ability to prevent obesity primarily via dietary influence. Four factors negatively impacted parents' ability: family history, intergenerational and interparental issues, adolescence, and societal pressures. Culturally effective, family-based obesity interventions among Latinos should build upon parental perceptions of ability to prevent obesity, while simultaneously helping parents address the factors they perceive challenge this ability.     

How do parents' child-feeding behaviours influence child weight? Implications for childhood obesity policy

BACKGROUND: Parents have some responsibility for children's dietary habits and they are often the focus of public health interventions designed to improve children's diets and thereby reduce the prevalence of childhood obesity. The current UK interventions promote awareness of healthy food choices, but offer little guidance for parents on child-feeding behaviours. METHODS: A review of recent literature regarding child-feeding behaviours and child weight. RESULTS: Parents report using a wide range of child-feeding behaviours, including monitoring, pressure to eat and restriction. Restriction of children's eating has most frequently and consistently been associated with child weight gain. Furthermore, there is substantial evidence for a causal relationship between parental restriction and childhood overweight. CONCLUSIONS: Parents may inadvertently promote excess weight gain in childhood by using inappropriate child-feeding behaviours. We recommend the development of interventions to increase awareness of the possible consequences of inappropriate child-feeding behaviours. Parents who are concerned about their child's weight will also require guidance and support in order to adopt more appropriate child-feeding behaviours.     

Improving nutrition and physical activity in child care: what parents recommend

A large percentage of children in the United States spend part of their day in out-of-home child care. As rates of obesity continue to rise, especially among young children, child care has become a focus for nutrition and physical activity intervention. Parental involvement is an important component of these efforts. During summer 2006, parents of children in child care were surveyed to better understand their perceived quality of meals, snacks, and physical activity at the child-care center, and their recommendations for improvement. Parents of children who attended 94 licensed child-care centers in North Carolina were invited to complete a brief survey of perceived quality of meals, snacks, and physical activity at their centers using close-ended questions. Open-ended questions were used to identify suggestions for improvement. Five hundred eight parents from 91 child-care centers completed the questionnaire. The majority of parents reported quality of meals and snacks at the center as either excellent (30% meals, 27% snacks) or good (42% meals, 46% snacks). The main recommendations for improving meals and snacks were to increase fruits and vegetables and provide a variety of healthful foods. The majority of parents categorized the quality of physical activity at the center as excellent (36%) or good (46%), and suggested more structured, outdoor activities for children. Findings from this study provide insight into key areas of concern for parents regarding the nutrition and activity environment of child-care centers. This information may be used to create or modify interventions or policies and to help motivate parents to become advocates for change in child care.     

Parent Readiness to Change Differs for Overweight Child Dietary and Physical Activity Behaviors

Parent involvement is important to help overweight children lose weight. However, parent readiness to make changes around child eating and physical activity (PA) behaviors can differ across domains. Using a cross-sectional design, our aim was to examine which factors were associated with parents being in the Action/Maintenance stage of change in each domain. From November 2008 to August 2009, parents of overweight/obese children (n=202) attending a tertiary care obesity clinic in Providence, RI, answered questions assessing their stage of change, beliefs about child health and weight, and provider behaviors. Separate multivariate logistic regression models were created to determine which factors were associated with parent readiness to make changes for child dietary and PA behaviors. Almost 62% of parents were in the Action stage of change for child dietary behaviors, but only 41% were in the Action stage of change for PA behaviors. Parents who believed their own weight was a health problem were less likely to be ready to make changes to their child's dietary behaviors. Physician discussion of strategies was related to readiness to make changes for child dietary behaviors, but not PA behaviors. In the PA domain, parents of younger children were more likely to be ready to make changes. Training health care providers to address PA readiness and be aware of factors influencing dietary and PA readiness may result in more effective conversations with parents and improve behavior change efforts for pediatric weight loss.