Dietary intakes of urban, high body mass index, African American children: family and child dietary attributes predict child intakes

ObjectiveTo identify family and child nutrition and dietary attributes related to children's dietary intakes.DesignAfrican American children (ages 8-11 years, n = 156), body mass index > 85th percentile, from urban, low-income neighborhoods. Baseline, cross-sectional data collected as part of an ongoing diabetes prevention intervention. Dietary intakes were collected by 3-day food diary to assess total energy, percent fat, discretionary fat, added sugar, whole grains, vegetables, fruit, meat, and dairy. Questionnaires on nutrition and dietary attributes administered to children and parents were used to develop 5 diet-related indices: child knowledge, child preferences, child snack habits, child beverage habits, and family food habits.ResultsA higher child nutrition knowledge score was significantly related to a lower starchy vegetable intake. Higher scores on the child snack habits index were significantly related to higher intakes of fruit, total fruits and vegetables, total fruits and nonstarchy vegetables, and to lower intakes of added sugars. A higher score on the family food habits index was significantly related to lower intakes of total energy and discretionary fat.Conclusions and ImplicationsTargeting both child and family food and nutrition attributes may be used to promote more healthful eating among urban, low-income, overweight African American children.     

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.     

Practice-Based Evidence of Effectiveness in an Integrated Nutrition and Parenting Education Intervention for Low-Income Parents

Research identifying associations between parental behaviors and children's food and activity choices and weight suggests that the integration of parenting and nutrition education holds promise for promoting healthful eating and activity in families. However, translational research leading to sustainable interventions lags behind. Development and testing of interventions within actual program contexts is needed to facilitate translation to full-scale implementation. Therefore, the goal of this pilot study was to develop and test an integrated nutrition and parenting education intervention for low-income families within the Expanded Food and Nutrition Education Program in New York State. During a 21-month period, low-income parents of 3- to 11-year-olds were recruited through usual programmatic channels by nutrition program staff to participate in a series of eight workshops delivered to small groups. A validated self-administered questionnaire was used to assess behavior change outcomes among 210 parents who completed the program. Mean scores improved significantly for most behaviors, including adult fruit and vegetable intake; adult and child low-fat dairy and soda intake; and child fast-food intake, activity, and screen time (P<0.001). Many parents reported eating together with children at program entry, leaving little room to improve, but about 20% reported at least a 1-point improvement (on a 5-point scale). The most frequent change was reducing how often children ate fast food and was reported by >50% of parents. Design and testing through practice-based research can facilitate development of interventions that are both feasible and likely to improve eating and activity behaviors among low-income families.     

Head Start teachers' perceptions of children's eating behavior and weight status in the context of food scarcity

ObjectiveTo describe Head Start teachers' perceptions of mealtime, feeding, and overweight risk in Head Start students.DesignQualitative focus group study.SettingFive Head Starts in a greater metropolitan area in the Northeast.ParticipantsThirty-five teachers in 5 focus groups.InterventionTwo experienced focus group facilitators elicited comments from each group.Main Outcome MeasureIdentification of themes for future nutrition education programming.AnalysisParticipant comments were transcribed and common themes identified by 7 readers.ResultsTeachers felt (1) empowered to shape the content of children's diets; (2) that meals served at Head Start were chaotic; (3) uncertain how to address children's voracious appetites, since children often were from homes with limited food resources; (4) skeptical about the definition of overweight; (5) that children's eating behaviors and their weight status were not connected; and (6) uncomfortable addressing overweight with students' families.Conclusions and ImplicationsTeachers' skepticism about overweight, uncertainty around managing the seemingly voracious eating behavior of children perceived as hungry as a result of inadequate food at home, and discomfort in addressing overweight with families may all represent nutrition education opportunities. Tailoring prevention programs such that they evoke support and agreement from these teachers as well as harnessing strengths, such as teachers' confidence in shaping children's eating behaviors, will be important.     

Trends in Korean parents' perceptions on food additives during the period 2014–2018

BACKGROUND/OBJECTIVESWhile the use of food additives in food processing has become a common practice worldwide, consumers'' worry about potential hazards has not diminished. The purpose of this study was to identify trends in South Korean parents'' perceptions about food additives by analyzing the results of surveys conducted from 2014 to 2018.SUBJECTS/METHODSWe conducted an off-line survey in Korea annually between 2014 and 2018 on perceptions about food additives. The numbers of survey respondents in each year from 2014 to 2018 were 381, 426, 301, 519, and 369, respectively. Our consumer respondents were parents of elementary-school-aged children.RESULTSThe ratios of respondents perceiving “food safety” as the most important factor in purchasing processed foods and “food additives” as the biggest threat to food safety have decreased over the years. However, most consumers still have negative perceptions of food additives. Additionally, among consumers lower confidence in or trust of the Korean government continued throughout the study period and appeared to be the main problem that needs to be overcome.CONCLUSIONSThis study found that Korean parents are still troubled by food additives. Consumers'' confidence in the government needs to be increased through public communications. More multifaceted educational programs communicating scientific knowledge of food additives are needed in order to correct consumers'' misperceptions.     

A Qualitative Study: Perceived Barriers and Facilitators to Nutrition Standard Adherence by In-home Childcare Providers

BackgroundThe Child and Adult Care Food Program (CACFP) nutrition standards may present food purchasing, preparation, and feeding challenges for caregivers of young children.ObjectiveTo elucidate perceived barriers and facilitators faced by in-home childcare providers to following the CACFP food and beverage nutrition standards.DesignVirtual, semistructured individual interviews elicited perceptions from a cross section of low-income, in-home childcare providers in Michigan.Participants/settingsTwenty childcare providers of various races, ethnicity, urban and rural residence, and licensure status.AnalysisThematic coding analysis with NVivo (ver12.0) to organize and interpret data.ResultsFour primary barriers to adhering to the CACFP nutrition standards emerged including (1) noncompliant food preferences of children and providers; (2) higher cost and lower availability of CACFP-approved items; (3) celebrations and food rewards; (4) excessive time and effort needed to prepare foods and beverages, especially with dietary restrictions for some children. Ten perceived facilitators included (1) using nutrition education available through community organizations; (2) finding convenient and easy ways to prepare foods and beverages; (3) using CACFP and Special Supplemental Nutrition Program for Women, Infants, and Children guidelines and funding; (4) increasing variety of foods and beverages by using a menu or recalling items recently served; (5) modeling eating healthful foods and encouraging sampling of new foods and beverages; (6) mixing preferred foods/beverages with less preferred; (7) using nutrition information available from social media and from peers; (8) allowing children to choose foods and beverages; (9) serving the same eligible food and beverages to all children; and (10) provider concern about impact of foods and beverages on children’s health and behavior.ConclusionsResults from this study can inform nutrition education from community organizations that occurs in tandem with CACFP sponsor organizations. In addition, they can be utilized to address state-level licensure regulations and quality improvement rating systems that include nutrition standards childcare providers are encouraged or required to follow.     

Parents’ Perceptions and Responses to the UK Soft Drinks Industry Levy

ObjectiveTo record parents’ awareness of the UK soft drinks industry levy (SDIL) and explore associations between negative psychological reactance to the levy and motivation and intentions to change consumption and purchasing.MethodsA cross-sectional online survey with UK-based parents of children aged 5–11 years (n = 237). Regression analyses were used to test associations between psychosocial responses to the levy and behavioral intentions to change family consumption and purchasing.ResultsA total of 92% of responding parents were aware of the SDIL. Of the responding parents, 57% supported its aims, but 29% felt it threatened their freedom of choice. A total of 41% expressed intention to change shopping habits or restrict their child's intake as a result. Reactance and motivation were poorer in low-income families, and intentions to change were positively predicted by motivation.Conclusions and ImplicationsThis snapshot suggests that the UK SDIL is largely supported by parents and associated with intentions to change their children's intake.     

Feeding Style Differences in Food Parenting Practices Associated With Fruit and Vegetable Intake in Children From Low-income Families

ObjectiveTo examine the moderating effects of feeding styles on the relationship between food parenting practices and fruit and vegetable (F & V) intake in low-income families with preschool-aged children.DesignFocus group meetings with Head Start parents were conducted by using the nominal group technique. Parents completed information on food parenting practices and feeding styles. Three dietary recalls were collected on each child.SettingParents completed measures in Head Start centers and/or over the telephone.Participants667 parents of preschool-aged children participated.OutcomesFood parenting practices and F & V intake.AnalysisMean differences in the food parenting practices across the 4 feeding styles were established through multivariate general linear modeling using MANOVA. Moderated multiple regression analysis was conducted to examine the moderating role of feeding style on food parenting practices and child F & V intake.ResultsThe indulgent feeding style moderated the relationship between food parenting practices and child F & V intake.Conclusions and ImplicationsThis study indicates that parents' feeding styles have a moderating effect on the relationship between the food parenting practices and children's F & V intake. This finding can facilitate the development of interventions aimed at reducing childhood overweight.     

Facebook Is an Effective Strategy to Recruit Low-income Women to Online Nutrition Education

ObjectiveNutrition education research recruitment expense and effort are substantial; sample selection is crucial for intervention assessment. Effectiveness and cost of Facebook to recruit low-income women to an online nutrition program were examined, including biopsychosocial characteristics of Facebook responders.MethodsAn ad appeared on the Facebook page of low-income women, 18-45 years old, living in Pennsylvania to invite access to an online nutrition program. Eligible persons completed surveys about food-related behaviors including eating competence, food security, and assistance program use.ResultsOf 465 people who clicked on the ad, 81 completed the eligibility survey, and 62 were eligible; 52 completed a preprogram survey. Completers were mostly white (79%), overweight/obese (mean body mass index 36.2 ± 12.9), and not eating competent (75%). Low-income status was identified for 75% (n = 39) of completers. Total recruitment cost over 19 days was $596.71.Conclusions and ImplicationsFacebook appears to be an effective tool to recruit low-income women to nutrition education projects.     

Food Insecurity Is Linked to a Food Environment Promoting Obesity in Households With Children

ObjectiveTo determine the extent to which the presence and accessibility of healthful and less healthful foods in children's homes vary with level of food security.MethodsA total of 41 parents or primary caregivers who had at least 1 child ages 2–13 and resided in a low-income area with limited food access completed a home food inventory and a validated measure assessing household food security.ResultsCompared with food-secure participants, marginal or low/very low food-secure caregivers reported significantly more obesity-promoting foods in the home, more microwavable or quick-cook frozen foods, and greater access to less healthful foods in the kitchen (all Ps < .05).Conclusions and ImplicationsGiven the greater presence and accessibility of less healthful foods, targeting home food environment may improve diet quality and health status in children of low-income, food insecure households.     

Community-Academic Partnerships to Promote Health Literacy and Address Social Needs Among Low-Income Families During COVID-19

Brighter Bites is a school-based health promotion program that delivers fresh produce and nutrition education to low-income children and their families across 6 locations in the US. This article provides a perspective on how, despite coronavirus disease 2019–related school closures, Brighter Bites pivoted rapidly to collaborate with medical and public health institutions to improve health and food literacy among their families. Through these partnerships, Brighter Bites was able to rapidly provide accurate, evidence-based information related to coronavirus disease 2019 and other social needs, including food, housing, transportation, and access to health care, to help fill a needed gap in vulnerable communities.     

Child-specific food insecurity and overweight are not associated in a sample of 10- to 15-year-old low-income youth

In the United States, 17% of children and adolescents are overweight and 20% live in a food insecure household. Previous studies examining the association between household food insecurity and overweight among children have been inconclusive but are limited insofar as they did not assess child-specific measures of food insecurity and overweight. In response, this study examined the association between food insecurity and child overweight status when these variables were measured for the same child using information on children (n = 1031) aged 10-15 y from the Three-City Study. Approximately 8% of the children were food insecure, whereas 50% were either at risk of overweight or overweight. Bivariate analyses indicated that there were no significant differences in the prevalence of at risk of overweight and overweight between food secure and food insecure children. Gender, race, and income showed similar patterns. Results from logistic regression analyses also indicated that the likelihood of being overweight or at risk of overweight was not significantly different for food secure and food insecure children. Although child-specific food insecurity was not associated with overweight in this sample of low-income children, food insecurity and overweight coexist among these low-income children, because approximately 25% of the food insecure children were overweight. Additional research is needed to explore the potential relationships between food insecurity and overweight and to better inform policy that attempts to address these issues among low-income households with children.     

What helps children eat well? A qualitative exploration of resilience among disadvantaged families

It is well known that persons of low socioeconomic position consume generally a less healthy diet. Key determinants of unhealthy eating among disadvantaged individuals include aspects of the family and external environment. Much less is known about family and environmental determinants of healthy eating among social disadvantaged children. The aim of this study was to gain insight into the family and environmental factors underlying resilience to poor nutrition among children and their mothers living in disadvantaged neighbourhoods. Semi-structured interviews were conducted with 38 mother-child pairs (N = 76) from disadvantaged neighbourhoods. Children were selected if they were a healthy weight, consumed adequate intakes of fruit and vegetables and were physically active. Two main themes emerged from the interviews: active strategies from parents to promote healthy eating and external barriers and supports to healthy eating. Mothers believed that exercising control over access to unhealthy food, providing education and encouragement for consumption of healthy food and enabling healthy food options aided their child to eat well. Children did not perceive food advertisements to be major influences on their eating preferences or behaviour. The results of the current study offer insight into potential avenues for nutrition promotion among disadvantaged children.     

Building Blocks for Healthy Children: Evaluation of a Child Care Center–Based Obesity Prevention Pilot Among Low-Income Children

ObjectiveTo assess the impact of a multilevel nutrition intervention for low-income child care environments, staff, and center-enrolled children.DesignA cluster-randomized, controlled trial conducted among eligible centers. Staff and parent self-report surveys and objective field observations at baseline and follow-up were conducted.SettingA total of 22 low-income child care centers (enrolling ≥ 25 2- to 5-year-old children).ParticipantsChildren aged 18–71 months; 408 children and 97 staff were randomized into intervention (208 children and 50 staff) and waitlist-control groups (200 children and 45 staff). Retention rates were high (87% for children and 93% for staff).Intervention(s)A 6-session, 6-month director's child nutrition course with on-site technical support for center teachers.Main Outcome Measure(s)Center nutrition/physical activity environment; staff feeding styles, dietary patterns, and attitudes about food; child food preferences and dietary patterns.AnalysisCovariance regression analyses to assess the intervention effect, adjusting for clustering within centers.ResultsSignificant intervention effects were found for the center nutrition training/education environment (b = 3.01; P = .03), nutrition total scores (b = 1.29; P = .04), and staff-level prompting/encouraging feeding styles (b = 0.38; P = .04). No significant intervention effects were found for child-level measures.Conclusions and ImplicationsCurriculum-driven training and implementation support improved nutritional policies and practices and staff–child interactions during meals. Future research could extend the intervention to families and the evaluation to children's dietary behaviors and weight changes.     

Nudging Our Way to a Healthier Population: The Effect of Calorie Labeling and Self-Control on Menu Choices of Emerging Adults

Emerging adults are among those in the United States with concerning rates of overweight and obesity, putting them at risk for chronic diseases. One proposed intervention to address these issues across populations is to require that chain restaurants and similar establishments provide nutrition information, such as calorie labels, on menu items. This study therefore aims to examine the effect of menu calorie labeling and self-control on food and beverage choices of emerging adults. Results of a between-subjects experiment (n = 179) revealed that calorie labeling increased the likelihood of choosing lower calorie food and beverage options. Moreover, calorie labeling only led to selecting a lower calorie food option among those with high self-control, but not among those with low self-control. This moderating effect was not revealed for beverage choice. Public health practitioners and policymakers should consider intervention approaches that address other drivers of choice, such as self-control, in addition to nutrition information.     

Children of working low-income families in California: does parental work benefit children's insurance status,access, and utilization of primary health care?

OBJECTIVE: To examine financial and nonfinancial access to care and utilization of primary health care services among children of working low-income families earning below 200 percent of the federal poverty level in California, and to compare them to children in nonworking low-income families and in families earning over 200 percent of poverty. DATA SOURCES/STUDY SETTING: The 1994 National Health Interview survey weighted to reflect population estimates for California. STUDY DESIGN: This cross-sectional study of 3,831 children under age 19 focuses on financial access, that is, the prevalence and continuity of health insurance coverage; structural access, including the presence of a usual source of care, the predominant care source, its responsiveness to patient's needs, and any indications of delayed or missed care; and utilization of health care measured by the presence of an outpatient doctor's visit and the mean number of visits relative to child health status. DATA COLLECTION: The study uses secondary analysis. FINDINGS: Compared to children of nonworking low-income parents and to nonpoor children, children of working low-income parents were more likely to be uninsured (32.1 percent versus 15.6 percent and 10.3 percent, p = .0001) and to experience disruptions in insurance coverage (p = .0009). These differences persisted after controlling for other covariates in multivariate analyses. Children of working low-income parents did not differ significantly from children of nonworking low-income parents on measures of structural access or utilization, after adjusting for other covariates. However, they differed significantly from nonpoor children on structural access and utilization, and these differences mostly persisted after adjusting for other covariates (odds ratios from 1.5 to 2.9). Similar patterns were observed when children of full-time, year-round working parents with low earnings were compared with the two reference populations. CONCLUSION: Children in working low-income families in California have some of the worst access problems. Even full attachment to the workforce does not guarantee health insurance benefits, access to care, or improved health care use for children of low-income parents. These children are not better off than other low-income children of nonworking parents and are much worse off than nonpoor children. Expansion of health insurance coverage through Healthy Families and Medi-Cal, and attention to nonfinancial barriers to care for working low-income families may help to reduce these disparities.