Validation of an instrument to assess toddler feeding practices of Latino mothers

This paper describes qualitative and quantitative aspects of testing a 34-item Toddler-Feeding Questionnaire (TFQ), designed for use in Latino families, and the associations between feeding practices and toddler dietary outcomes. Qualitative methods included review by an expert panel for content validity and cognitive testing of the tool to assess face validity. Quantitative analyses included use of exploratory factor analysis for construct validity; Pearson's correlations for test-retest reliability; Cronbach's alpha (α) for internal reliability; and multivariate regression for investigating relationships between feeding practices and toddler diet and anthropometry. Interviews were conducted using a convenience sample of 94 Latino mother and toddler dyads obtained largely through the Supplemental Nutrition Program for Women, Infants and Children (WIC). Data collection included household characteristics, self-reported early-infant feeding practices, the toddler's dietary intake, and anthropometric measurements. Factor analysis suggests the TFQ contains three subscales: indulgent; authoritative; and environmental influences. The TFQ demonstrated acceptable reliability for most measures. As hypothesized, indulgent practices in Latino toddlers were associated with increased energy consumption and higher intakes of total fat, saturated fat, and sweetened beverages. This tool may be useful in future research exploring the relationship of toddler feeding practices to nutritional outcomes in Latino families.     

The 7-day Beverage Intake Questionnaire for Latino Children: Validation of a Culturally Tailored Tool

ObjectiveTo validate a culturally tailored 7-day beverage intake questionnaire for Latino children (BIQ-L).DesignCross-sectional.SettingFederally qualified health center in San Francisco, CA.ParticipantsLatino parents and their children aged 1–5 years (n = 105).Variables MeasuredParents completed the BIQ-L for each child and three 24-hour dietary recalls. Participants’ height and weight were measured.AnalysisCorrelations between the mean intake of beverages in 4 categories as determined by the BIQ-L and three 24-hour dietary recalls were assessed. Multivariable linear regression examined the association between sugar-sweetened beverages (SSB) servings as determined by the BIQ-L and child body mass index z-score.ResultsMean daily intake of SSB (r = 0.52, P < 0.001), 100% fruit juice (r = 0.45, P < 0.001), flavored milk (r = 0.7, P < 0.001), and unflavored milk (r = 0.7, P < 0.001) from the BIQ-L were correlated with intake assessed via three 24-hour dietary recalls. In the multivariable model, weekly servings of SSBs were associated with child body mass index z-score (β = 0.15, P = 0.02). Culturally specific beverages comprised 38% of the SSB intake reported on the BIQ-L.Conclusions and ImplicationsThe BIQ-L is a valid tool for assessing beverage intake among Latino children aged 1–5 years. The inclusion of culturally specific beverages is critical for accurately assessing beverage intake among Latino children.     

Increased Sweetened Beverage Intake Is Associated with Reduced Milk and Calcium Intake in 3- to 7-Year-Old Children at Multi-Item Laboratory Lunches

Dietary survey data show that intake of sugar-sweetened beverages is negatively associated with intake of milk, but these findings have yet to be confirmed by laboratory feeding studies. The objectives of the present study were to analyze children's intake across two laboratory-based ad libitum lunches to (a) investigate the relationships between intake of sweetened beverages, milk, and calcium, and (b) explore relationships between beverage consumption and child age and weight status. Data were extracted from a cohort of 126 3- to 7-year-old twins from diverse ethnic backgrounds who participated in a cross-sectional study (conducted from November 1999 to September 2002) designed to determine the genetic and environmental contributions to eating and body weight. At two visits, children ate ad libitum from lunches that offered a variety of sugar-sweetened and calcium-rich beverages. Total beverage and nutrient intakes were computed from the test meals. Weight, height, and waist circumference were assessed on the final visit. Regression analyses tested the associations among intake of sweetened beverages, calcium, and milk (primary aim), and whether these variables were associated with child age and weight status (secondary aim). Sweetened beverage intake was negatively correlated with both milk (P<0.01) and calcium (P<0.01) intakes, and these relationships remained after controlling for age, sex, and ethnicity (P<0.01). Child age was negatively associated with milk intake (r=−0.22, P<0.01) but positively associated with intake of sweetened beverages (r=0.27, P<0.01). Results support the notion that sugar-sweetened beverages displace milk in a single meal, and this phenomenon may vary with child age. Due to the cross-sectional nature of this study, future investigations are needed to determine the long-term implications of this consumption pattern. The possibility that limiting sweetened beverages may help optimize dietary calcium during childhood is a topic that merits further research.     

The Association between Maternal Sugar-Sweetened Beverage Consumption and Infant/Toddler Added Sugar Intakes

Intake of added sugars during early life is associated with poor health outcomes. Maternal dietary intake influences the intake of their children, but little research investigates the relationship between maternal sugar sweetened beverage (SSB) and infant/toddler added sugar intakes. Our objective was to explore the relationship between maternal total sugars and SSB intakes and infant/toddler added sugar intakes. This cross-sectional study (n = 101) of mother-infant dyads measured maternal dietary intake by food frequency questionnaire and infant intake by three 24-h dietary recalls. Pearson’s correlations explored the relations between maternal total sugars and SSB intakes and infant added sugar intakes. Hierarchical stepwise regressions determined if maternal total sugars and SSB intakes explained the variation in infant added sugar intakes after accounting for known risk factors for early introduction of added sugars. Maternal total sugars (r = 0.202, p = 0.043) and SSB (r = 0.352, p < 0.001) intakes were positively correlated with infant/toddler added sugar intakes. In the hierarchical models, maternal total sugar intakes did not account for more variance in infant added sugar intakes (β = 0.046, p = 0.060), but maternal SSB intake was a significant contributor of infant added sugar intakes (β = 0.010, p = 0.006) after accounting for confounders. Interventions to reduced maternal SSB consumption may help reduce infant/toddler added sugar intakes.     

Moderating Effects of Parental Feeding Practices and Emotional Eating on Dietary Intake among Overweight African American Adolescents

This study examined the effects of parental feeding practices and adolescent emotional eating (EE) on dietary outcomes among overweight African American adolescents. Based on Family Systems Theory, it was hypothesized that parental feeding practices, such as parental monitoring and responsibility, would buffer the effects of EE on poor dietary quality, whereas practices such as concern about a child’s weight, restriction, and pressure-to-eat would exacerbate this relationship. Adolescents (N = 127; Mage = 12.83 ± 1.74; MBMI% = 96.61 ± 4.14) provided baseline data from the Families Improving Together (FIT) for Weight Loss trial and an ancillary study. Dietary outcomes (fruit and vegetables (F&Vs), energy intake, sweetened beverage, total fat, and saturated fat) were assessed using random 24-h dietary recalls. Validated surveys were used to assess adolescent-reported EE and parental feeding practices. Results demonstrated a significant interaction between EE and parental monitoring (adjusted analyses; B = 0.524, SE = 0.176, p = 0.004), restriction (B = −0.331, SE = 0.162, p = 0.043), and concern (B = −0.602, SE = 0.171, p = 0.001) on F&V intake; under high monitoring, low restriction, and low concern, EE was positively associated with F&V intake. There were no significant effects for the other dietary outcomes. These findings indicate that parental feeding practices and EE may be important factors to consider for dietary interventions, specifically for F&V intake, among overweight African American adolescents.     

Patterns and trends of beverage consumption among children and adults in Great Britain, 1986-2009

Many dietary recommendations include reduction of excessive intake of sugar-sweetened beverages (SSB) and other energy-rich beverages such as juices and alcohol. The present study examines surveys of both individual dietary intake data and household food expenditure surveys to provide a picture of patterns and trends in beverage intake and purchases in Great Britain from 1986 to 2009, and estimates the potential for pricing policy to promote more healthful beverage purchase patterns. In 2008-9, beverages accounted for 21, 14 and 18?% of daily energy intake for children aged 1·5-18 and 4-18 years, and adults (19-64 years), respectively. Since the 1990s, the most important shifts have been a reduction in consumption of high-fat dairy products and an increased consumption of fruit juices and reduced-fat milk among preschoolers, children and adolescents. Among adults, consumption of high-fat milk beverages, sweetened tea and coffee and other energy-containing drinks fell, but reduced-fat milk, alcohol (particularly beer) and fruit juice rose. In testing taxation as an option for shifting beverage purchase patterns, we calculate that a 10?% increase in the price of SSB could potentially result in a decrease of 7·5?ml/capita per d. A similar 10?% tax on high-fat milk is associated with a reduction of high-fat milk purchases by 5?ml/capita per d and increased reduced-fat milk purchase by 7?ml/capita per d. This analysis implies that taxation or other methods of shifting relative costs of these beverages could be a way to improve beverage choices in Great Britain.     

Impact of Dairy and Sweetened Beverage Consumption on Diet and Weight of a Multiethnic Population of Head Start Mothers

Mothers with children in Head Start play a critical role in providing healthful diets and modeling good dietary behaviors to their children, but there is little information available on their diet, especially on beverage consumption. The objective of this study was to assess the association of milk and sweetened beverage consumption with nutrient intake, dietary adequacy, and weight of a multiethnic population of Head Start mothers. Using a cross-sectional, secondary analysis, African-American (43%), Hispanic (33%), and white (24%) women (n=609) were divided into four beverage consumption groups: high milk/low sweetened beverage, high milk/high sweetened beverage, low milk/low sweetened beverage, and low milk/high sweetened beverage. Nutrient intake was determined by averaging 24-hour dietary recalls from 3 nonconsecutive days. Dietary adequacy was determined with the Mean Adequacy Ratio. Mean body mass index for the four beverage consumption groups was compared; there were no differences among the groups (overall mean±standard error=30.8±0.3). Women in the high milk/low sweetened beverage group had higher mean intakes of vitamins A, D, and B-6; riboflavin; thiamin; folate; phosphorus; calcium; iron; magnesium; and potassium (P<0.0125 for all) when compared with the other beverage consumption groups. Mean Adequacy Ratio was highest in the high milk/low sweetened beverage (71.8±0.8) and lowest in the low milk/high sweetened beverage (58.4±0.8) consumption groups (P<0.0125). Women in the high milk/low sweetened beverage group consumed more nutrient-dense foods. Overall consumption of milk was low. Consumption of high milk/low sweetened beverage was associated with improved nutrient intake, including the shortfall nutrients, ie, calcium, potassium, magnesium, and vitamin A.     

Retailer Marketing Strategies and Customer Purchasing of Sweetened Beverages in Convenience Stores

BackgroundMarketing strategies for sweetened beverages (SBs) are pervasive across food retail. Yet few studies have examined how these strategies associate with planned and unplanned SB purchasing.ObjectiveThis study aimed to examine whether customers with greater exposure to SB retail marketing (eg, advertisements and product placement) were more likely to purchase an SB and whether this varied by customer characteristics.DesignThis was an observational, cross-sectional study using objective customer purchasing and store assessment data from convenience and other small food stores.Participants/settingParticipants were 1,604 food and beverage customers at 144 randomly sampled convenience and other small food stores in Minneapolis-St Paul, MN.ExposureMarketing strategies, including SB advertisements, placement, and shelf space were included.Main outcome measuresWe determined the probability of customers purchasing ≥4 fluid ounces of a ready-to-drink sugar and/or artificially sweetened beverage.Statistical analyses performedAssociations between marketing strategies and purchasing were estimated using mixed regression models, controlling for customer characteristics and accounting for customers nested within stores.ResultsFifty-six percent of customers purchased an SB; 14% also specified that it was an unplanned purchase. Customers were more likely to purchase an SB when exterior advertisements (P < .001) and advertisements hanging from the ceiling (P < .001) that promoted SBs were present. Customers with moderate and high cumulative exposure to SB marketing were significantly more likely to purchase SBs (51.2% and 54.9%, respectively) than those with lower exposure (34%); this effect was particularly salient for men. There were no significant associations between retail marketing strategies and unplanned purchases.ConclusionsFindings demonstrate that feasible and sustainable approaches are required from policy makers, retailers, and public health professionals to shift store environments away from cues that promote unhealthy beverage selections. Given that numerous retail actors are invested in the availability, promotion, and sales of SBs, changing the predominance of SB marketing in convenience stores will likely be challenging and require cross-sector collaboration.     

Obesogenic Dietary Practices of Latino and Asian Subgroups of Children in California: An Analysis of the California Health Interview Survey, 2007–2012

Objectives. We examined obesogenic dietary practices among Latino and Asian subgroups of children living in California.Methods. We analyzed 2007, 2009, and 2011–2012 California Health Interview Survey data to examine the differences in dietary practices among Mexican and non-Mexican Latino children and 7 ethnic subgroups of Asian children. We used multivariable regression to examine the sociodemographic factors associated with specific dietary practices.Results. Latino subgroups of children had few differences in obesogenic dietary practices, whereas Asian subgroups of children exhibited significant differences in several obesogenic dietary practices. Korean and Filipino children were more likely than Chinese children to consume fast food and have low vegetable intake. Filipino children, followed by Japanese children, had the most obesogenic dietary practices compared with Chinese children, who along with South Asian children appeared to have the least obesogenic dietary practices. In general, income, education, and acculturation did not explain the dietary differences among Asian groups.Conclusions. Our findings suggest the need to disaggregate dietary profiles of Asian and Latino children and to consider nontraditional sociodemographic factors for messaging and counseling on healthy dietary practices among Asian populations.Dietary practices among pediatric racial and ethnic minority groups highlight possible contributions to the nation’s significant obesity disparities. High consumption of sugar- sweetened beverages (SSBs) and fast food and low consumption of fruits and vegetables have been found among Latino and African American children compared with White children.1–4 These dietary differences have been associated with environmental factors such as access to fresh foods and social factors such as family income, education level, and acculturation. Many of these factors have been understudied among Asian children. This gap in the literature is problematic given the emerging evidence that Asian children have notable differences in dietary practices compared with White children and that Asian Americans with the same body mass index (BMI; defined as weight in kilograms divided by the square of height in meters) are at a higher risk for cardiovascular diseases and type 2 diabetes than non-Hispanic Whites.5–8 Furthermore, children of various Asian and Latino ethnic groups with distinct historical, migration, and social contexts are generally grouped together in research analyses, making it difficult to understand the ethnicity-specific salient roles that education, income, and acculturation may play in specific dietary practices.9,10Acculturation has been described as both a protective factor and a risk factor for healthy dietary practices among immigrants. For example, acculturation among Latinos has been associated with higher consumption of fruits and vegetables but also with higher rates of fast food and sugary food consumption in both pediatric and adult Latino populations.11–13 Less is known about the role of acculturation in dietary practices among Asian and Latino ethnic subgroups.5,6,14,15 We examined dietary practices within ethnic subgroups of Latino and Asian children and the associated role of sociodemographic factors. On the basis of the thin literature that has examined dietary practices among Latino subgroups of children, we hypothesized that children of Mexican descent would have healthy dietary practices compared with other Latino groups and that Asian ethnic groups of children would show a wide variety of dietary practices. In addition, we hypothesized that acculturation, after controlling for education and income, would have an independent effect on dietary practices for all ethnic groups of children.     

Perception of sugar reduction,nutrition education,and frequency of snacking in children by the self-perceived sweet dietary habits of mothers in Busan

BACKGROUND/OBJECTIVESThe aim of this study was to investigate the perception of sugar reduction, nutrition education, and frequency of snacking in children according to the self-perceived dietary preferences for sweet taste by mothers in Busan.SUBJECTS/METHODSA total of 277 mothers were surveyed, and their perceptions of sugar reduction and the frequency of snacking in children were assessed using a questionnaire. The subjects were classified into either a sweet (n = 91) or an unsweet (n = 186) group according to their self-perceived preferences for a sweet taste.RESULTSIn the sweet group, the results for sweet products were sweetened ice (86.8%), confectionery (74.7%), processed milk (73.6%), carbonated beverages (71.4%), and fermented milk (53.9%). In the unsweet group, the results were sweetened ice (88.7%), carbonated beverages (78.5%), processed milk (75.8%), confectionery (69.4%), and fermented milk (50.5%). The necessity of sugar intake reduction was high in both groups (sweet = 89.0%, unsweet = 82.8%). Beverage purchases after identifying the nutrition labeling was significantly lower in the sweet group than in the unsweet group (P < 0.05). The reasons for the beverage purchases instead of water were "habitually" (50.5%) and "like sweet taste" (25.3%) in the sweet group (P < 0.01). Snacking in children was significantly higher in the sweet group based on the increased frequencies of carbonated drinks (P < 0.01), fast food (P < 0.001), candy and chocolate (P < 0.05), crackers (P < 0.01), ramen (P < 0.01), and fish paste/hotdogs (P < 0.01). The frequency of purchase education after identifying the nutrition labeling was significantly lower in the sweet group than in the unsweet group (P < 0.01).CONCLUSIONSThese findings suggest that a perception of sugar reduction and practical nutrition education aimed at reducing the sugar intake are necessary to improve dietary habits.     

Food Insecurity and Dietary Intake among College Students with Unlimited Meal Plans at a Large,Midwestern University

BackgroundFood insecurity, a state of not being able to consistently access nutritious food due to financial constraints, has been associated with poor dietary intake among college students. The extent to which campus food resources contribute to this association is unknown.ObjectivesThis study examined the association between food insecurity and dietary intake in a sample of undergraduate students with unlimited meal plans and dining hall access at a large, public Midwestern university.DesignThe study design is cross-sectional. The data used are baseline data from a broader sugar-sweetened beverage intervention study that were collected using a Qualtrics survey prior to the intervention.Participants/settingThe sample consisted of 1033 undergraduate students recruited from 3 dining halls. The data were collected in November 2018.Main outcome measuresFood security was assessed using the 6-item Short Form Food Security Survey Module. Dietary intake was assessed using the National Cancer Institute 26-item Dietary Screener Questionnaire and the Beverage Intake Questionnaire-15.Statistical analyses performedGeneralized linear regression models were used to examine differences in dietary intake by students’ food security status, adjusting for students’ sociodemographic characteristics.ResultsIn the sample, 14% of students were food-insecure. After adjusting for sociodemographic variables, food-insecure students reported 9% lower intake of fruits (P = 0.02), 9% lower intake of vegetables (P < 0.001), 10% higher intake of dairy (P = 0.002), 6% higher intake of total added sugars (P = 0.01), 10% higher intake of added sugars from sugar-sweetened beverages (P = 0.01), 4% higher intake of calcium (P = 0.01), and 4% lower intake of fiber (P = 0.01) compared with food-secure students. With respect to beverage intake, food-insecure students had 56% higher intake of total sugar-sweetened beverages (P = 0.002), which was driven by 185% higher intake of energy and sports drinks (P = 0.001), and 121% higher intake of sweetened teas (P = 0.001).ConclusionsDespite having identical food resources within campus dining halls, there were significant differences in the diets of college students by food security status.     

Low-income,African American Adolescent Mothers and Their Toddlers Exhibit Similar Dietary Variety Patterns

ObjectiveTo examine the relationship between maternal and toddler dietary variety.DesignLongitudinal; maternal and toddler dietary data were collected at 13 months; anthropometry was collected at 13 and 24 months.SettingData were collected in homes.Participants109 primiparous, low-income, African American adolescent mothers and toddlers.Main Outcome MeasuresMaternal and toddler dietary variety and toddler obesity at 24 months.AnalysisCorrelations were computed to estimate associations between maternal and toddler dietary variety at 13 months; multiple logistic regression analyses were conducted to estimate associations between maternal and toddler diet and toddler growth.ResultsMaternal and toddler fruit, vegetable, snack, meat, dairy, and soda variety were significantly correlated. There was no association between maternal and toddler dietary variety and obesity at 24 months. Adolescent mothers who purchased groceries consumed more fruits and vegetables and provided more variety for their toddlers than those who relied on others to purchase groceries.Conclusions and ImplicationsAdolescent mothers and toddlers exhibited similar dietary patterns; consuming more sweets and less fruits and vegetables than recommended. Toddlerhood is an optimal time to address healthful dietary patterns and to help adolescent mothers influence grocery purchasing decisions. Goals are to establish healthful dietary patterns and reduce pediatric obesity.     

Associations Between Parental Concern for Adolescent Weight and the Home Food Environment and Dietary Intake

ObjectiveExamine associations between parental concern about adolescent weight and adolescent perceptions of their dietary intake, home food availability, family mealtime environment, and parents' feeding practices.DesignCross-sectional study.SettingAdolescents, aged 12-15 years from 37 secondary schools in Victoria, Australia, and their parents completed surveys in 2004-2005.Participants1,448 adolescent–parent pairs.Main Outcome MeasuresParental concern about adolescent weight; adolescent perceptions of their food intake and home food environment.AnalysisChi-square tests, exploratory factor analysis, independent t tests (P < .01).ResultsAlthough 12% of parents perceived their adolescent as overweight, 27% were concerned about their adolescent's weight (under- or overweight). Adolescents of concerned parents reported lower intakes of energy-dense snacks and less home availability of these food items, and they perceived that their parents less often listened to and considered their food preferences when shopping and cooking, than did adolescents of unconcerned parents. Concerned parents were no more likely to provide fruits and vegetables in the home or a positive family mealtime environment than unconcerned parents, at least as reported by their adolescents.Conclusions and ImplicationsParental concern about adolescent weight was associated with lower intakes of energy-dense snacks among adolescents, less home availability of these food items, and less supportive parental feeding practices. Parents should be encouraged to listen to and consider their adolescents' food preferences, and provide supportive family mealtime environments and healthful food in the home.     

The Contribution of Major Food Categories and Companies to Household Purchases of Added Sugar in Australia

BackgroundThe Australian Government will soon be releasing a series of sugar reformulation targets for packaged foods.ObjectiveTo estimate the amount of added sugar purchased from packaged food and beverages and the relative contribution that food categories and food companies made to these purchases in 2018. The secondary objective was to examine differences in purchases of added sugar across income levels.DesignCross-sectional study.Participants/settingWe used 1 year of grocery purchase data from a nationally representative panel of Australian households (the NielsenIQ Homescan panel), combined with a packaged food and beverage database (FoodSwitch).Main outcome measuresAdded sugar purchases (grams per day per capita), purchase-weighted added sugar content (grams per 100 g) and total weight of products (with added sugar) purchased (grams per day per capita).Statistical analyses performedFood categories and food companies were ranked according to their contribution to added sugar purchases. Differences in added sugar purchases by income levels were assessed by 1-factor analysis of variance.ResultsAdded sugar information was available from 7188 households and across 26,291 unique foods and beverages. On average, the amount of added sugar acquired from packaged foods and beverages was (mean ± SE) 35.9 ± 0.01 g/d per capita. Low-income households purchased 11.0 g/d (95% CI: 10.9-11.0 g/d, P < .001) more added sugar from packaged products than high-income households per capita. The top 10 food categories accounted for 82.2% of added sugar purchased, largely due to purchases of chocolate and sweets, soft drinks, and ice cream and edible ices. Out of 994 food companies, the top 10 companies contributed to 62.1% of added sugar purchases.ConclusionsThe Australian Government can strengthen their proposed sugar reduction program by adding further category-specific targets, prioritizing engagement with key food companies and considering a broader range of policies to reduce added sugar intakes across the Australian population.     

Six-Week Latino Family Prevention Pilot Program Effectively Promotes Healthy Behaviors and Reduces Obesogenic Behaviors

ObjectiveTo test the effectiveness of a 6-week family-based healthy eating pilot program aimed to reduce obesogenic behaviors among Latino parents and children.MethodsA 6-week healthy eating pilot program focused on dietary changes within Latino families with a 6- to 13-year-old child. A 1-group, pre-posttest design with 2-month follow-up examining fruit, vegetable, and sugar-sweetened beverage consumption.ResultsThe program was effective at increasing parent-report of child fruit consumption, (P < .001, effect size = .26), vegetable consumption, (P = .001, effect size = .20), and decreasing sugar-sweetened beverage consumption, (P = .002, effect size = .16).Conclusions and ImplicationsThis family-based prevention program was effective at improving healthy eating in Latino families, especially for children. The curriculum can be used in future prevention programs for Latino families with a 6- to 13-year-old child.     

Postpartum Symptoms of Depression are Related to Infant Feeding Practices in a National WIC Sample

ObjectiveTo examine the association between elevated maternal postpartum depression symptoms and select targets of nutrition education within the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), including infant feeding beliefs, feeding practices, and dietary intake choices.DesignLongitudinal analysis of secondary data from the WIC Infant and Toddler Feeding Practices Study-2.SettingEighty WIC sites.ParticipantsThe WIC Infant and Toddler Feeding Practices Study-2 participants interviewed through 13 months postpartum (n = 1,851).Main Outcome MeasuresLatent factor variables for infant feeding beliefs, feeding practices, and dietary intake choices.AnalysisConfirmatory factor analysis using structural equation modeling; multivariable linear regression models.ResultsBiological mothers with elevated postpartum depression symptoms engaged in significantly less optimal feeding practices than biological mothers with fewer symptoms of depression, in multivariable analyses controlling for sociodemographic variables (β = ?0.26; P = 0.02). Maternal depression symptoms were not significantly associated with infant feeding beliefs or dietary intake choices.Conclusions and ImplicationsMaternal depression symptoms are specifically associated with infant feeding practices. The Special Supplemental Nutrition Program for Women, Infants, and Children could consider screening for depressive symptoms and referring mothers for treatment. For mothers with elevated depression symptoms, nutrition education may need greater emphasis on healthy and safe feeding practices.     

Association Between Educational Attainment and EFNEP Participants’ Food Practice Outcomes

ObjectiveExamine the association between educational attainment and improvement in food practice outcomes of the California Expanded Food and Nutrition Education Program (EFNEP) participants.DesignSecondary data analysis.ParticipantsA total of 19,089 participants, 92.3% female, 77.2% Hispanic, 19.7% with ≤ sixth-grade education, and 68.9% with incomes ≤ 100% of the federal poverty level.Main Outcome MeasuresImprovement in food resource management practices (FRMP), nutrition practices, and food safety practices (FSP).AnalysisWilcoxon signed rank tests examined pre-post outcomes. Mann-Whitney U tests compared whether participants in the lowest and highest educational attainment quartiles had similar levels of improvement.ResultsCalifornia EFNEP is associated with improved FRMP (z = ?95.33), nutrition practices (z = ?94.91), and FSP (z = ?92.37); (P < 0.001). Lowest educational quartile was associated with more improvement in FRMP and FSP (P < 0.001).Conclusions and ImplicationsCalifornia EFNEP contributed to improved food practice outcomes for low and high educational attainment participants. Program content and instruction are effective across the education continuum.     

Watching Television while Eating: Associations with Dietary Intake and Weight Status among a Diverse Sample of Young Children

BackgroundTelevision (TV) watching at family meals has been associated with poorer dietary quality and weight outcomes in children. Most research has been limited to family meals, overlooking the influence of TV at any meal.ObjectiveThis study assesses how often children are eating meals at home while watching TV, the association between child dietary intake while watching TV during meals eaten at home and whether the association depends on meal type (eg, breakfast) or child race/ethnicity, and whether the number of meals consumed while watching TV at home is associated with overall child dietary quality or weight status.DesignThe Family Matters study utilized a cross-sectional design and was conducted between 2015 and 2016.Participants/settingThree 24-hour dietary recalls were conducted on children aged 5 to 7 years (n=150; 25 each from non-Hispanic white, African American, Latino, Native American, Somali, and Hmong households).Main outcome measuresMain outcomes of this study were dietary intake at meals, overall dietary quality, and child weight status.Statistical analysis performedConditional fixed effects estimators were used to address correlated error terms to model within-person variation between TV and dietary intake and race/ethnicity differences in child dietary outcomes.ResultsTV was watched during 30% of meals eaten at home, which differed significantly by race/ethnicity (P<0.001). Although effect sizes were small, TV watching at meals was associated with unhealthier intake of some foods groups (eg, increased sugar-sweetened beverages and chips/crackers and decreased fruits), dependent on the meal occasion (eg, snacks). However, TV watching during meals at home was not significantly associated with dietary intake for other food groups. These associations did not depend on race/ethnicity. An association between number of meals consumed while watching TV with overall dietary quality or weight status was not found.ConclusionsAlthough more research is needed, results suggest TV watching while eating meals at home is relatively common, depends on race/ethnicity, and that TV watching at some meal occasions is associated with child intake of certain food groups, with a majority being unhealthy.     

Beverage displacement between elementary and middle school, 2004-2007

BackgroundSweetened beverages of low nutritional quality might be displacing more nutritious beverages, such as 100% fruit juice and milk, from children's diets. However, previous research has not examined changes in beverage intake over time using nationally representative longitudinal data.ObjectiveOur objective was to examine changes in sweetened beverage, milk, and juice consumption between 5th and 8th grade.DesignWe used a longitudinal analysis of self-reported beverage consumption.Participants/settingData were from the Early Childhood Longitudinal Survey–Kindergarten Cohort 1998-1999 (ECLS-K), a nationally representative study of children followed from kindergarten through 8th grade. This analysis used data from Spring 2004 and 2007, when most children were in 5th and 8th grade, respectively (n=7,445).Main outcome measuresMain outcome measures were changes in consumption of sweetened beverages, milk, and 100% fruit juice last week.Statistical analyses performedSurvey-adjusted linear regression was used to estimate longitudinal relationships between servings of milk, sweetened beverages, and 100% fruit juice, controlling for child and family characteristics and food consumption.ResultsChildren's milk consumption decreased between 5th and 8th grade, and these decreases were larger among children who drank sweetened beverages daily. However, after controlling for demographic characteristics, changes in children's milk consumption were not significantly related to changes in their consumption of sweetened beverages over time (β=.005; P=0.81), while changes in milk consumption were positively related to changes in juice consumption (β=.087; P<0.01).ConclusionsObserved decreases in average milk consumption from 5th to 8th grade were not related to changes in sweetened-beverage consumption. They were positively related to changes in fruit juice consumption, so not indicating displacement. Caloric beverages generally tended to increase or decrease in tandem, so focus must be placed on their role in children's entire diet and on balancing them with food and total beverage intake.