"A lot of sacrifices:" work-family spillover and the food choice coping strategies of low-wage employed parents

Prevalence and patterns of cooking dinner at home in the USA: National Health and Nutrition Examination Survey (NHANES) 2007-2008

OBJECTIVE

To measure the prevalence of cooking dinner at home in the USA and test whether home dinner preparation habits are associated with socio-economic status, race/ethnicity, country of birth and family structure.

DESIGN

Cross-sectional analysis. The primary outcome, self-reported frequency of cooking dinner at home, was divided into three categories: 0-1 dinners cooked per week ('never'), 2-5 ('sometimes') and 6-7 ('always'). We used bivariable and multivariable regression analyses to test for associations between frequency of cooking dinner at home and factors of interest.

SETTING

The 2007-2008 National Health and Nutrition Examination Survey (NHANES).

SUBJECTS

The sample consisted of 10 149 participants.

RESULTS

Americans reported cooking an average of five dinners per week; 8 % never, 43 % sometimes and 49 % always cooked dinner at home. Lower household wealth and educational attainment were associated with a higher likelihood of either always or never cooking dinner at home, whereas wealthier, more educated households were more likely to sometimes cook dinner at home (P < 0·05). Black households cooked the fewest dinners at home (mean = 4·4, 95 % CI 4·2, 4·6). Households with foreign-born reference persons cooked more dinners at home (mean = 5·8, 95 % CI 5·7, 6·0) than households with US-born reference persons (mean = 4·9, 95 % CI 4·7, 5·1). Households with dependants cooked more dinners at home (mean = 5·2, 95 % CI 5·1, 5·4) than households without dependants (mean = 4·6, 95 % CI 4·3, 5·0).

CONCLUSIONS

Home dinner preparation habits varied substantially with socio-economic status and race/ethnicity, associations that likely will have implications for designing and appropriately tailoring interventions to improve home food preparation practices and promote healthy eating.

Resistant to the recession: low-income adults' maintenance of cooking and away-from-home eating behaviors during times of economic turbulence

OBJECTIVES

We examined the effects of state-level unemployment rates during the recession of 2008 on patterns of home food preparation and away-from-home (AFH) eating among low-income and minority populations.

METHODS

We analyzed pooled cross-sectional data on 118 635 adults aged 18 years or older who took part in the American Time Use Study. Multinomial logistic regression models stratified by gender were used to evaluate the associations between state-level unemployment, poverty, race/ethnicity, and time spent cooking, and log binomial regression was used to assess respondents' AFH consumption patterns.

RESULTS

High state-level unemployment was associated with only trivial increases in respondents' cooking patterns and virtually no change in their AFH eating patterns. Low-income and racial/ethnic minority groups were not disproportionately affected by the recession.

CONCLUSIONS

Even during a major economic downturn, US adults are resistant to food-related behavior change. More work is needed to understand whether this reluctance to change is attributable to time limits, lack of knowledge or skill related to food preparation, or lack of access to fresh produce and raw ingredients.

The hidden cost of moving up: type 2 diabetes and the escape from persistent poverty in the American South

OBJECTIVES

The paper tests the thrifty phenotype hypothesis, according to which nonharmonious growth trajectories are costly for adult health.

METHODS

The American surge in the prevalence of type 2 diabetes is concentrated in the South, a region characterized by a long history of poverty followed by rapid economic growth beginning in the 1960s. Civil rights legislation further accelerated income growth for African-Americans in the region. The paper investigates the hypothesis by using per capita income at the state level as a proxy for net nutritional conditions.

RESULTS

Regressions at the state level explain 56% of the variation in the prevalence rate of type 2 diabetes in 2009 using two explanatory variables: the ratio of per capita income in 1980 to that in 1950 and the share of the population that was African-American. The paper discusses ways that rapid economic growth may have translated into weight gain and type 2 diabetes.

CONCLUSIONS

If the thrifty phenotype hypothesis is correct, future rates in the prevalence of type 2 diabetes are predictable based on income history. The forecast for rapidly developing countries such as India and China are ominous.

Perceived benefits and challenges for low-income mothers of having family meals with preschool-aged children: childhood memories matter

Eating regular family meals is associated with a lower risk of obesity among preschool-aged children. Children in lower-income households are at higher risk for obesity, but there is little information about their mothers' perceptions of family meals, and such information could improve nutrition counseling. To identify the perceived benefits and challenges of having family meals, four focus groups were conducted with 20 mothers of preschool-aged children living in low-income households in Philadelphia, PA. Three authors independently analyzed verbatim transcripts using an inductive method of open coding, and themes were established by consensus among all authors. Of the 20 mothers, 18 were black, 11 had education beyond high school, and 12 were living with an adult partner or husband. Mothers' strong childhood memories of mealtimes, both negative and positive, motivated them to have family meals because of the opportunities afforded by mealtimes to build strong relationships with their children. However, mothers also described needing help, especially from other household adults, in preparing meals and establishing calm and order with their children during mealtimes. To identify what motivates the mothers of low-income, preschool-aged children to have family meals, registered dietitians can benefit from asking about the mothers' own childhood experiences of family meals. Studies are needed to examine whether such an approach to identifying maternal motivations, when combined with practical advice about overcoming challenges with meal preparation and managing children's mealtime behavior, could lead to more frequent and nutritious family meals in this population.

Co-occurrence and coaction of stress management with other health risk behaviors

This study provides a preliminary investigation of the role of stress management in multiple behavior change. Risk status on stress management and five health behaviors (healthy eating, exercise, alcohol, smoking, and depression management) was assessed before and after a multiple behavior change intervention. Findings suggested a link between stress management and a worse health risk behavior profile at baseline. Results also showed relationships between improved stress management over 6 months and heightened odds of improving on specific behaviors as well as improving one's overall behavioral risk profile. Particularly strong links between stress management and energy balance and other affective behaviors were observed.

Role of expendable income and price in food choice by low income families

The public health literature suggests that the cheapness of energy-dense foods is driving the obesity epidemic. We examined food purchases in low-income families and its relationship to the price of food and availability of funds. In-depth interviews were conducted with 22 parents with children less than 15 years of age whose major source of income was a government pension. A photo taxonomy, where participants sorted 50 photos of commonly purchased foods, was used to explore food choice. The most common food groupings used by the participants were: basic, emergency, treat and comfort. The process of food purchase was described by participants as weighing up the attributes of a food in relation to price and money available. Shoppers nominated the basic unit of measurement as quantity per unit price and the heuristic for food choice when shopping as determining "value for money" in a process of triage relating to food purchase decisions. Participants stated satiation of hunger to be the most common "value" relative to price. Given that the foods nominated as filling tended to be carbohydrate-rich staples, we suggest that public health initiatives need to acknowledge this triage process and shape interventions to promote nutrition over satiation.

Feasibility of using a community-supported agriculture program to improve fruit and vegetable inventories and consumption in an underresourced urban community

Introduction

Direct-to-consumer marketing efforts, such as community-supported agriculture (CSA), have been proposed as a solution for disparities in fruit and vegetable consumption. Evaluations of such efforts have been limited. The objective of this study was to test the feasibility of a CSA intervention to increase household inventory of fruits and vegetables and fruit and vegetable consumption of residents of an underresourced community.

Methods

For this randomized, controlled feasibility study, we recruited 50 low-income women with children. Intervention (n = 25) participants were offered 5 educational sessions and a box of fresh produce for 16 weeks; control participants were not offered the sessions nor were they included in the produce delivery. We collected data on participants’ home inventory of fruits and vegetables and on their consumption of fruits and vegetables at baseline (May 2012) and postintervention (August and September 2012).

Results

Of 55 potential participants, 50 were enrolled and 44 were reached for follow-up. We observed a significant increase in the number of foods in the household inventory of fruits and vegetables in the intervention group compared with the control group. The intervention group reported greater increases in fruit and vegetable consumption; however, these did not reach significance. Intervention participants picked up produce 9.2 (standard deviation = 4.58) of 16 weeks; challenges included transportation and work schedules. Most participants (20 of 21) expressed interest in continued participation; all stated a willingness to pay $10 per week, and some were willing to pay as much as $25 per week.

Conclusion

CSA is a feasible approach for providing fresh fruits and vegetables to an underresourced community. Future studies should evaluate the impact of such a program in a larger sample and should take additional steps to facilitate participation.

Family meal traditions. Comparing reported childhood food habits to current food habits among university students

The aim of this study is to investigate if reported childhood food habits predict the food habits of students at present. Questions addressed are: does the memory of childhood family meals promote commensality among students? Does the memory of (grand)parents' cooking influence students' cooking? And, is there still a gender difference in passing on everyday cooking skills? Using a cross-sectional survey, 104 students were asked about their current eating and cooking habits, and their eating habits and the cooking behavior of their (grand)parents during their childhood. Results show that frequencies in reported childhood family meals predict frequencies of students' commensality at present. The effects appear for breakfast and dinner, and stay within the same meal: recalled childhood family breakfasts predict current breakfast commensality, recalled childhood family dinners predict current dinner commensality. In terms of recalled cookery of (grand)parents and the use of family recipes a matrilineal dominance can be observed. Mothers are most influential, and maternal grandmothers outscore paternal grandmothers. Yet, fathers' childhood cooking did not pass unnoticed either. They seem to influence male students' cookery. Overall, in a life-stage of transgression students appear to maintain recalled childhood food rituals. Suggestions are discussed to further validate these results.

Trends in US home food preparation and consumption: analysis of national nutrition surveys and time use studies from 1965-1966 to 2007-2008

BACKGROUND

It has been well-documented that Americans have shifted towards eating out more and cooking at home less. However, little is known about whether these trends have continued into the 21st century, and whether these trends are consistent amongst low-income individuals, who are increasingly the target of public health programs that promote home cooking. The objective of this study is to examine how patterns of home cooking and home food consumption have changed from 1965 to 2008 by socio-demographic groups.

METHODS

This is a cross-sectional analysis of data from 6 nationally representative US dietary surveys and 6 US time-use studies conducted between 1965 and 2008. Subjects are adults aged 19 to 60 years (n= 38,565 for dietary surveys and n=55,424 for time-use surveys). Weighted means of daily energy intake by food source, proportion who cooked, and time spent cooking were analyzed for trends from 1965-1966 to 2007-2008 by gender and income. T-tests were conducted to determine statistical differences over time.

RESULTS

The percentage of daily energy consumed from home food sources and time spent in food preparation decreased significantly for all socioeconomic groups between 1965-1966 and 2007-2008 (p ≤ 0.001), with the largest declines occurring between 1965 and 1992. In 2007-2008, foods from the home supply accounted for 65 to 72% of total daily energy, with 54 to 57% reporting cooking activities. The low income group showed the greatest decline in the proportion cooking, but consumed more daily energy from home sources and spent more time cooking than high income individuals in 2007-2008 (p ≤ 0.001).

CONCLUSIONS

US adults have decreased consumption of foods from the home supply and reduced time spent cooking since 1965, but this trend appears to have leveled off, with no substantial decrease occurring after the mid-1990's. Across socioeconomic groups, people consume the majority of daily energy from the home food supply, yet only slightly more than half spend any time cooking on a given day. Efforts to boost the healthfulness of the US diet should focus on promoting the preparation of healthy foods at home while incorporating limits on time available for cooking.

Measuring parent time scarcity and fatigue as barriers to meal planning and preparation: quantitative scale development

OBJECTIVE

To examine the psychometric properties of 9 quantitative items that assess time scarcity and fatigue as parent barriers to planning and preparing meals for their children.

METHODS

A convenience sample of 342 parents of children aged 2-6 years completed a 20-minute online survey. Exploratory factor analysis was used to examine the factor structure and create summary scales. Internal consistency reliability and measures of construct and concurrent validity were assessed.

RESULTS

Two scales were created based on the factor analysis: time and energy for meals and meal planning. Preliminary evidence suggests that both scales are reliable and valid.

CONCLUSIONS AND IMPLICATIONS

The time and energy for meals and meal planning scales can be completed quickly by busy and tired parents. As many children do not eat nutritious diets, a better understanding of the barriers that parents face is critical and may help inform interventions tailored to the needs of tired, busy parents.

Family meals among New Zealand young people: relationships with eating behaviors and body mass index

OBJECTIVE

To examine the relationship between family meals and nutrition behaviors of adolescents.

DESIGN

Secondary analysis of Youth'07, a nationally representative survey.

SETTING

Secondary schools in New Zealand.

PARTICIPANTS

Randomly selected adolescents (aged 13-17 years, n = 9,107) completed a multimedia and anonymous survey about their health.

VARIABLES MEASURED

Body mass index and eating behaviors.

ANALYSIS

Multiple logistic regression equations were used to determine the associations between family meals and body size and dietary behaviors, controlling for demographic variables.

RESULTS

Nearly 60% of young people shared a meal with their families 5 or more times in the previous week. Frequent family meals were associated with greater consumption of fruits and vegetables (P < .001), and breakfast (P < .001). Adolescents who frequently shared family meals were also more likely to report that what they ate in the past week was healthy than adolescents who did not (P < .001). There was no relationship between frequency of family meals and body mass index (P = .60).

CONCLUSIONS AND IMPLICATIONS

Data from the current study suggest that family meals cannot be used as a single strategy for obesity prevention, but they may provide an important opportunity for young people to consume healthy food.

What's for dinner? Types of food served at family dinner differ across parent and family characteristics

OBJECTIVE

To examine the types of food served at family dinner in the homes of adolescents and correlations with parent and family sociodemographic characteristics, psychosocial factors and meal-specific variables.

DESIGN

A cross-sectional population-based survey completed by mail or telephone by parents participating in Project F-EAT (Families and Eating and Activity in Teens) in 2009-2010.

SETTING

Homes of families with adolescents in Minneapolis/St. Paul urban area, MN, USA.

SUBJECTS

Participants included 1923 parents/guardians (90·8% female; 68·5% from ethnic/racial minorities) of adolescents who participated in EAT 2010.

RESULTS

Less than a third (28%) of parents reported serving a green salad at family dinner on a regular basis, but 70% reported regularly serving vegetables (other than potatoes). About one-fifth (21%) of families had fast food at family dinners two or more times per week. Variables from within the sociodemographic domain (low educational attainment) psychosocial domain (high work-life stress, depressive symptoms, low family functioning) and meal-specific domain (low value of family meals, low enjoyment of cooking, low meal planning, high food purchasing barriers and fewer hours in food preparation) were associated with lower healthfulness of foods served at family dinners, in analyses adjusted for sociodemographic characteristics.

CONCLUSIONS

There is a need for interventions to improve the healthfulness of food served at family meals. Interventions need to be suitable for parents with low levels of education; take parent and family psychosocial factors into account; promote more positive attitudes toward family meals; and provide skills to make it easier to plan and prepare healthful family meals.

Consumption of Fruits and Vegetables in Malaysia

This study examines the sociodemographic factors associated with daily fruit and vegetable (FV) consumption in Malaysia. Based on a cross-sectional sample of 2447 individuals from the Malaysia Non-Communicable Disease Surveillance-1, a multivariate sample selection system is developed and estimated, to accommodate high frequencies of daily FV consumption and the days of servings among nondaily consumers. Results indicate that the authors’ attempt to account for endogenous sample selectivity and cross-equation correlations is justified. There exist positive correlations between FV consumption likelihoods and longer work hours, higher levels of education, high income, female gender, nonsmoking status, and being from East Malaysia. Among nondaily consumers, those with longer work hours, singles, and people with diabetes are less inclined to eat fruits on more days. Overall, higher-educated, affluent people, nonsmokers, and East Malaysians display more days of FV consumption. Based on these outcomes, several policy implications are recommended vis-à-vis FV consumption patterns in Malaysia.

Parental employment and work-family stress: associations with family food environments

Parental employment provides many benefits to children's health. However, an increasing number of studies have observed associations between mothers' full-time employment and less healthful family food environments. Few studies have examined other ways in which parental employment may be associated with the family food environment, including the role of fathers' employment and parents' stress balancing work and home obligations. This study utilized data from Project F-EAT, a population-based study of a socio-demographically diverse sample of 3709 parents of adolescents living in a metropolitan area in the Midwestern United States, to examine cross-sectional associations between mothers' and fathers' employment status and parents' work-life stress with multiple aspects of the family food environment. Among parents participating in Project F-EAT, 64% of fathers and 46% of mothers were full-time employed, while 25% of fathers and 37% of mothers were not employed. Results showed that full-time employed mothers reported fewer family meals, less frequent encouragement of their adolescents' healthful eating, lower fruit and vegetable intake, and less time spent on food preparation, compared to part-time and not-employed mothers, after adjusting for socio-demographics. Full-time employed fathers reported significantly fewer hours of food preparation; no other associations were seen between fathers' employment status and characteristics of the family food environment. In contrast, higher work-life stress among both parents was associated with less healthful family food environment characteristics including less frequent family meals and more frequent sugar-sweetened beverage and fast food consumption by parents. Among dual-parent families, taking into account the employment characteristics of the other parent did not substantially alter the relationships between work-life stress and family food environment characteristics. While parental employment is beneficial for many families, identifying policy and programmatic strategies to reduce parents' work-life stress may have positive implications for the family food environment and for the eating patterns and related health outcomes of children and parents.

How people interpret healthy eating: contributions of qualitative research

OBJECTIVE

To identify how qualitative research has contributed to understanding the ways people in developed countries interpret healthy eating.

DESIGN

Bibliographic database searches identified reports of qualitative, empirical studies published in English, peer-reviewed journals since 1995.

DATA ANALYSIS

Authors coded, discussed, recoded, and analyzed papers reporting qualitative research studies related to participants' interpretations of healthy eating.

RESULTS

Studies emphasized a social constructionist approach, and most used focus groups and/or individual, in-depth interviews to collect data. Study participants explained healthy eating in terms of food, food components, food production methods, physical outcomes, psychosocial outcomes, standards, personal goals, and as requiring restriction. Researchers described meanings as specific to life stages and different life experiences, such as parenting and disease onset. Identity (self-concept), social settings, resources, food availability, and conflicting considerations were themes in participants' explanations for not eating according to their ideals for healthy eating.

IMPLICATIONS

People interpret healthy eating in complex and diverse ways that reflect their personal, social, and cultural experiences, as well as their environments. Their meanings include but are broader than the food composition and health outcomes considered by scientists. The rich descriptions and concepts generated by qualitative research can help practitioners and researchers think beyond their own experiences and be open to audience members' perspectives as they seek to promote healthy ways of eating.

Assessing the relationship between work-family conflict and smoking

OBJECTIVES

We examined the relationship between smoking and work-family conflict among a sample of New England long-term-care facility workers.

METHODS

To collect data, we conducted in-person, structured interviews with workers in 4 extended-care facilities.

RESULTS

There was a strong association between smoking likelihood and work-family conflict. Workers who experienced both stress at home from work issues (i.e., work-to-home conflict) and stress at work from personal issues (i.e., home-to-work conflict) had 3.1 times higher odds of smoking than those who did not experience these types of conflict. Workers who experienced home-to-work conflict had an odds of 2.3 compared with those who did not experience this type of conflict, and workers who experienced work-to-home conflict had an odds of 1.6 compared with workers who did not experience this type of conflict.

CONCLUSIONS

The results of this study indicate that there is a robust relationship between work-family conflict and smoking, but that this relationship is dependent upon the total amount of conflict experienced and the direction of the conflict.

Potential nutritional and economic effects of replacing juice with fruit in the diets of children in the United States

OBJECTIVE

To estimate the nutritional and economic effects of substituting whole fruit for juice in the diets of children in the United States.

DESIGN

Secondary analyses using the 2001-2004 National Health and Nutrition Examination Survey and a national food prices database. Energy intakes, nutrient intakes, and diet costs were estimated before and after fruit juices were completely replaced with fruit in 3 models that emphasized fruits that were fresh, inexpensive, and widely consumed and in a fourth model that partially replaced juice with fruit, capping juice at recommended levels.

SETTING

A nationwide, representative sample of children in the United States.

PARTICIPANTS

A total of 7023 children aged 3 to 18 years.

MAIN EXPOSURES

Systematic complete or partial replacement of juice with fruit.

MAIN OUTCOME MEASURES

Difference in energy intakes, nutrient intakes, and diet costs between observed and modeled diets.

RESULTS

For children who consumed juice, replacement of all juice servings with fresh, whole fruit led to a projected reduction in dietary energy of 233 kJ/d (-2.6% difference [95% CI, -5.1% to -0.1%]), an increase in fiber of 4.3 g/d (31.1% difference [95% CI, 26.4%-35.9%]), and an increase in diet cost of $0.54/d (13.3% difference [95% CI, 8.8%-17.8%]).

CONCLUSIONS

Substitution of juice with fresh fruit has the potential to reduce energy intake and improve the adequacy of fiber intake in children's diets. This would likely increase costs for schools, childcare providers, and families. These cost effects could be minimized by selecting processed fruits, but fewer nutritional gains would be achieved.

Changes in diet behavior when adults become parents

BACKGROUND

Cross-sectional studies suggest that parents eat more saturated fat than nonparents. Few studies exist on other dietary factors or using longitudinal data.

OBJECTIVE

To compare change in daily dietary intake of selected foods and nutrients across 7 years between adults who have children enter the home and those who do not.

DESIGN

Analysis of data from the Coronary Artery Risk Development in Young Adults cohort study. Dietary intake was assessed by the diet history questionnaire used in that study. The main dependent variables were change from baseline (1985-1986) to Year 7 (1992-1993) for intake of percent saturated fat, energy, daily servings of fruits and vegetables and sugar-sweetened beverages, and frequency of fast-food intake. The primary independent variable was whether or not participants had children in their home by Year 7.

PARTICIPANTS

Two thousand five hundred sixty-three black and white adults who did not have children at baseline from four urban centers.

STATISTICAL ANALYSES PERFORMED

Linear regression adjusting for baseline demographics, energy intake, physical activity, and smoking status.

RESULTS

Parents were more likely to be women, full-time workers, married, and older. Diet did not differ at baseline. Seven-year change in diet for parents and nonparents did not differ for fruit and vegetable, sugar-sweetened beverages, or fast food. Percent saturated fat decreased among both groups but parents showed a smaller decrease in percent saturated fat (1.59 vs 2.10; P<0.001). Compared with nonparents, parents increased energy intake by 79 kcal/day (P=0.058), but this difference did not reach statistical significance.

CONCLUSIONS

Parenthood does not have unfavorable effects on parents' diets, but neither does it lead to significant improvements. In fact, parents lag behind their childless counterparts in decreasing intake of saturated fat and overall diets remain poor. Nutrition education programs and food and nutrition practitioners should develop strategies to support and motivate healthy eating habits in parents.

Stressed out and overcommitted! The relationships between time demands and family rules and parents' and their child's weight status

OBJECTIVE

This study aimed to determine the relationship between parent time demands and presence and enforcement of family rules and parent/child dyad weight status.

METHOD

In dyads of one child/parent per family (N = 681 dyads) in Twin Cities, Minnesota, 2007-2008, height and weight were measured, and a survey of demographics, time demands, and family rules-related questions was taken. Parent/child dyads were classified into four healthy weight/overweight categories. Multivariate linear associations were analyzed with SAS, testing for interaction by work status and family composition (p < .10).

RESULTS

In adjusted models, lack of family rules and difficulty with rule enforcement were statistically lower in dyads in which the parent or child was healthy weight compared with dyads in which the parent and child were both overweight (difference in family rules scores = 0.49, p = .03; difference in rule enforcement scores = 1.09, p ≤ .01). Of parents who worked full-time, healthy weight dyads reported lower time demands than other dyads (difference in time demands scores = 1.44, p = .01).

CONCLUSIONS

Family experiences of time demands and use of family rules are related to the weight status of parents and children within families.

Perceptions of Employed Parents About Early Childhood Obesity and the Need for Prevention Strategies

Responses to the increased prevalence of childhood obesity are merging, and employed parents will become targets for strategies designed to prevent childhood obesity. This study aimed at describing their perceptions of employed parents about childhood obesity and determining which prevention strategies they would need the most. In this cross-sectional study, 504 employed parents were recruited from 33 child care centers in Sherbrooke (Quebec, Canada) who completed a self-administered questionnaire on their perceptions about childhood obesity and the need for prevention strategies. Logistic regression was used to explore differences in needs for prevention strategies according to participant characteristics. Most participants were female, aged 32.9 ± 4.9 years, and perceived childhood obesity was an important problem. The prevention strategies that seemed most needed were the implementation of (a) physical and nutrition education programs in child care settings and (b) measures that give employed parents more time to cook for and be physically active with their children. Support for specific strategies differed across genders and education levels. Moreover, they depended on the perceived relationship between work and meal preparation. Policy makers should be aware of the needs of employed parents to develop policies that would have the greatest likelihood of success in this population.

Allocation of household responsibilities influences change in dietary behavior

This study was undertaken to understand dietary behavior as situated within the household, an important social context that serves to either inhibit or promote a healthy diet. Data were collected as part of a worksite-based health behavior intervention trial that took place between 1999 and 2003 in small manufacturing businesses in New England, U.S.A. The subjects were a cohort of 790 male and female workers who participated in the intervention trial and responded to both the baseline and the 18-month follow-up surveys. Regression models were built to determine whether proportion of household responsibility predicted daily fruit and vegetable consumption and weekly red meat consumption at 18-months. The results indicate that participants who were responsible for earning most or all of the money to support the household ate more servings of fruits and vegetables per day at 18-month follow-up than those without this responsibility. Further, those responsible for earning about half ate fewer servings of red meat than those responsible for earning most or all of the money to support the household. The results for red meat consumption differed by sex, such that responsibility for more than half or less than half of the money to support the household had different effects for men and women. The results of this study demonstrate that the distribution of household responsibilities can be an important factor in determining the effectiveness of a worksite-based health behavior intervention and that these effects can be different for women versus men.

Knowledge of food production methods informs attitudes toward food but not food choice in adults residing in socioeconomically deprived rural areas within the United Kingdom

OBJECTIVE

Understand food choice, from the perspective of people residing in socioeconomically deprived rural neighborhoods.

METHODS

Focus groups (n = 7) were undertaken within a community setting involving 42 adults (2 males and 40 females) recruited through voluntary action groups. Data were recorded, transcribed verbatim, and content analyzed.

RESULTS

Attitudes to food and health were influenced by knowledge of food production and processing. Healthful foods were considered those which were fresh and unprocessed, and taste was taken as an indicator of how the food had been produced. Despite negative views of food production, processed foods were consumed. Explanations for this tension between what people wanted to eat (unprocessed food) and what they actually chose to eat (processed food) were attributed to lifestyle compression.

CONCLUSIONS AND IMPLICATIONS

Dietary health promotion initiatives targeted at deprived rural dwellers should consider perceived issues regarding food production and processing that may influence views on food.

Parent calcium-rich-food practices/perceptions are associated with calcium intake among parents and their early adolescent children

Objective

The study aimed to (i) segment parents of early adolescents into subgroups according to their Ca-rich-food (CRF) practices and perceptions regarding early adolescent CRF intake and (ii) determine whether Ca intake of parents and early adolescents differed by subgroup.

Design

A cross-sectional convenience sample of 509 parents and their early adolescent children completed a questionnaire in 2006–2007 to assess parent CRF practices and perceptions and to estimate parent and child Ca intakes.

Setting

Self-administered questionnaires were completed in community settings or homes across nine US states.

Subjects

Parents self-reporting as Asian, Hispanic or non-Hispanic White with a child aged 10–13 years were recruited through youth or parent events.

Results

Three parent CRF practice/perception segments were identified, including ‘Dedicated-Milk Providers/Drinkers’ (49 %), ‘Water Regulars’ (30 %) and ‘Sweet-Drink-Permissive Parents’ (23 %). Dedicated-Milk Providers/Drinkers were somewhat older and more likely to be non-Hispanic White than other groups. Ca intakes from all food sources, milk/dairy foods and milk only, and milk intakes, were higher among early adolescent children of Dedicated-Milk Providers/Drinkers compared with early adolescents of parents in other segments. Soda pop intakes were highest for early adolescents with parents in the Water Regulars group than other groups. Dedicated-Milk Providers/Drinkers scored higher on culture/tradition, health benefits and ease of use/convenience subscales and lower on a dairy/milk intolerance subscale and were more likely to report eating family dinners daily than parents in the other groups.

Conclusions

Parent education programmes should address CRF practices/perceptions tailored to parent group to improve Ca intake of early adolescent children.

Validation of a measure of the Satter eating competence model with low-income females

Background

The purpose of this study was to evaluate the construct validity of a version of the ecSatter Inventory (ecSI), a measure of eating competence (EC), as adapted for use in a low-income (LI) population.

Methods

Females (n = 507), aged 18 to 45 years, living in households with a history of participating in the Supplemental Nutrition Assistance Program completed a web-based survey that included the ecSI for LI (ecSI/LI) and valid measures of cognitive and affective eating behavior, food preference and practice, and food preparation.

Results

Most correlations and differences between eating competent and non-eating competent categories and among EC tertiles were compatible with hypothesized relationships. ecSI/LI scores were positively related with self-reported physical activity, food acceptance, fruit and vegetable intake, and food planning/resource management. ecSI/LI scores were negatively associated with body mass index, dissatisfaction with body weight, tendency to overeat in response to external or emotional stimuli, and indices of psychosocial attributes related to disordered eating.

Conclusions

The ecSI/LI is a valid measure of EC for low-income females and provides a tool for researchers and educators to assess intervention outcomes and further explore the EC construct.

Behavioral contexts, food-choice coping strategies, and dietary quality of a multiethnic sample of employed parents

Employed parents' work and family conditions provide behavioral contexts for their food choices. Relationships between employed parents' food-choice coping strategies, behavioral contexts, and dietary quality were evaluated. Data on work and family conditions, sociodemographic characteristics, eating behavior, and dietary intake from two 24-hour dietary recalls were collected in a random sample cross-sectional pilot telephone survey in the fall of 2006. Black, white, and Latino employed mothers (n=25) and fathers (n=25) were recruited from a low/moderate income urban area in upstate New York. Hierarchical cluster analysis (Ward's method) identified three clusters of parents differing in use of food-choice coping strategies (ie, Individualized Eating, Missing Meals, and Home Cooking). Cluster sociodemographic, work, and family characteristics were compared using χ(2) and Fisher's exact tests. Cluster differences in dietary quality (Healthy Eating Index 2005) were analyzed using analysis of variance. Clusters differed significantly (P≤0.05) on food-choice coping strategies, dietary quality, and behavioral contexts (ie, work schedule, marital status, partner's employment, and number of children). Individualized Eating and Missing Meals clusters were characterized by nonstandard work hours, having a working partner, single parenthood and with family meals away from home, grabbing quick food instead of a meal, using convenience entrées at home, and missing meals or individualized eating. The Home Cooking cluster included considerably more married fathers with nonemployed spouses and more home-cooked family meals. Food-choice coping strategies affecting dietary quality reflect parents' work and family conditions. Nutritional guidance and family policy needs to consider these important behavioral contexts for family nutrition and health.

Dose Adjustment for Normal Eating: a qualitative longitudinal exploration of the food and eating practices of type 1 diabetes patients converted to flexible intensive insulin therapy in the UK

AIM

To explore whether, and why, patients change their food and eating practices following conversion to flexible intensive insulin therapy (FIIT), a regimen which requires quick acting insulin doses to be matched to the carbohydrate content of meals/snacks consumed.

METHODS

repeat, in-depth interviews with 30 type 1 diabetes patients converted to FIIT recruited from Dose Adjustment for Normal Eating (DAFNE) courses in the UK. Data were analysed using an inductive, thematic approach.

RESULTS

despite the potential of FIIT to enable greater dietary flexibility and freedom, most patients reported food and eating practices which were remarkably resistant to change. In some cases, FIIT adoption resulted in greater dietary rigidity over time. The opportunities FIIT presented for greater dietary freedom were counterbalanced by new challenges and burdens (e.g. having to simplify food choices to make carbohydrate estimation easier). Due to the emphasis FIIT places on carbohydrate counting, and patients' fears of hypos, low/no carbohydrate foodstuffs sometimes came to be seen as the healthiest or safest options.

CONCLUSION

concerns that FIIT may result in more excessive or unhealthy eating appear largely unfounded; however, consideration needs to be paid to the ways in which patients' conceptualisations of, and relationship with, food may change following FIIT conversion.

Maternal employment, work schedules, and children's body mass index

Previous work has shown that mothers' employment is associated with increases in children's body mass index (BMI), a measure of weight for height. Nonstandard work (working evenings or nights, weekends, or an irregular shift) may also be associated with children's BMI. This article examines the association between maternal work and children's BMI and considers the influence of mothers' nonstandard work schedules. Using data from school-age children (approximately 8 to 12 years) in the NICHD's Study of Early Child Care and Youth Development (N = 990), this study found that an increase in the total time a mother is employed is associated with an increase in her child's BMI; additionally, the association between maternal employment and children's weight is much stronger at 6th grade relative to younger ages. There was no evidence that maternal or home characteristics or children's time use mediated these associations, nor was there any evidence that nonstandard work was associated with children's BMI. Implications for policy and future research are discussed.

Incentives, health promotion and equality

The use of incentives to encourage individuals to adopt ‘healthier’ behaviours is an increasingly popular instrument in health policy. Much of the literature has been critical of ‘negative’ incentives, often due to concerns about equality; ‘positive’ incentives, however, have largely been welcomed as an instrument for the improvement of population health and possibly the reduction of health inequalities. The aim of this paper is to provide a more systematic assessment of the use of incentives from the perspective of equality. The paper begins with an overview of existing and proposed incentive schemes. I then suggest that the distinction between ‘positive’ and ‘negative’ incentives – or ‘carrots’ and ‘sticks’ – is of limited use in distinguishing those incentive schemes that raise concerns of equality from those that do not. The paper assesses incentive schemes with respect to two important considerations of equality: equality of access and equality of outcomes. While our assessment of incentive schemes will, ultimately, depend on various empirical facts, the paper aims to advance the debate by identifying some of the empirical questions we need to ask. The paper concludes by considering a number of trade-offs and caveats relevant to the assessment of incentive schemes.

The beneficial effect of family meals on obesity differs by race, sex, and household education: the national survey of children's health, 2003-2004

Studies have indicated that family meals may be a protective factor for childhood obesity; however, limited evidence is available in children with different racial, socioeconomic, and individual characteristics. The purpose of this study was to examine family meal frequency as a protective factor for obesity in a US-based sample of non-Hispanic white, non-Hispanic black, and Hispanic children age 6 to 11 years, and to identify individual, familial, and socioeconomic factors that moderate this association. Data were from the 2003 National Survey of Children's Health (n=16,770). Multinomial logistic regression analyses were used to test the association between family meal frequency and weight status, and the moderating effects of household structure, education, poverty level, and sex, by racial group. Non-Hispanic white children who consumed family meals every day were less likely to be obese than those eating family meals zero or a few days per week. A moderating effect for sex was observed in non-Hispanic black children such that family meal frequency was marginally protective in boys but not in girls. Higher family meal frequency was a marginal risk factor for obesity in Hispanic boys from low-education households, but not in girls from similar households. In conclusion, family meals seem to be protective of obesity in non-Hispanic white children and non-Hispanic black boys, whereas they may put Hispanic boys living in low-education households at risk. Greater emphasis is needed in future research on assessing why this association differs among different race/ethnic groups, and evaluating the influence of the quality and quantity of family meals on child obesity.

Dietary intake patterns of low-income urban african-american adolescents

Unhealthy eating increases risks for chronic disease. Few studies have examined the multifaceted aspects of dietary intake of low-income, urban African-American adolescents. This study aimed to describe dietary patterns including energy, nutrients, food groups, and diet quality and to identify areas to guide future interventions. Baseline data for a school-based obesity prevention study were collected from 382 African-American adolescents (10- to 14-year-olds) from four Chicago, IL, public schools in 2003. Diet was assessed using a 152-item food frequency questionnaire. Diet quality was measured using a modified version of the US Department of Agriculture Healthy Eating Index (HEI) and compared to published estimates for a nationwide sample. Participants reported high energy intakes and several unhealthy eating patterns: 58.6% consumed one or more servings of sweetened beverages per day and 15.7% consumed three or more servings per day; average fried food consumption was high (1.4 servings/day), 58.4% consumed one or more serving per day; and 75% consumed three or more three snacks per day. Only 49% of participants met the recommended three servings of dairy foods per day. Compared to a national, mostly white sample, participants had lower HEI scores (P<0.05); mean score was 66.0+/-12.8 (100=maximum HEI score) vs 70.3+/-13.0 in boys vs girls, one third had scores <60 ("needs improvement") and only 15% scored >80 ("good"). This study reveals key areas of problematic dietary patterns for future interventions targeting low-income African-American adolescents, including frequent intakes of calorie-dense, low nutrient-rich foods, such as fried foods, snacks, and sweetened beverages.

Associations between food patterns, socioeconomic position and working situation among adult, working women and men in Oslo

BACKGROUND/OBJECTIVES

Socioeconomic disparities in diet are well documented, but the relative importance of different indicators of socioeconomic position (SEP) is not well known. The aim of this study was to explore relationships between food patterns, SEP (occupation, education and income) and degree of work control.

SUBJECTS/METHODS

A cross-sectional population-based study 2000-2001, using three self-administered questionnaires including food frequency questions (FFQs). Factor analysis was used to explore food patterns. Participants include 9762 working Oslo citizens, 30-60 years of age, having answered the questionnaires with <20% of the FFQ missing.

RESULTS

Four food patterns were found: Western, prudent, traditional and sweet. In multivariate analyses, the likelihood of having a high intake of the Western pattern was lowest in the two highest educational groups (women: odds ratio (OR)=0.54/OR=0.75; men: OR=0.51/OR=0.76), and in the two highest occupational groups for men (OR=0.73/OR=0.78). The odds of having a high intake of the prudent pattern was highest in the two highest educational groups (women: OR=2.50/OR=1.84; men: OR=2.23/OR=1.37), and among the self-employed (women OR=1.61, men OR=1.68), as well as in the highest occupational group for men (OR=1.33). Women always having work control were least likely to have high intake of the Western pattern (OR=0.78) and most likely to have high intake of the prudent pattern (OR=1.39).

CONCLUSIONS

The SEP indicators were in different ways related to the food patterns, but the effect of occupation and income was partly explained by education, especially among women. Women's work control and men's occupation were important for their eating habits.

Contributions of the life course perspective to research on food decision making

BACKGROUND

The life course perspective (LCP) has emerged as a powerful organizing framework for the study of health, illness, and mortality. LCP represents a "whole life" analysis perspective which originated in the field of sociology.

METHODS

Its concepts are increasingly applied to understanding the development of chronic disease over long periods of time in the human life span. A missing link, however, in the adaptation of the LCP to health research, is the insight the LCP may offer into understanding the societal, social network, and family contexts that frame stability and change in dietary behavior.

RESULTS

This paper reviews key concepts that comprise the LCP but primarily focuses on applications that have relevance to food decision making in social context. A case study of chronic work-family stress and perceived time scarcity as barriers to dietary improvement is included.

CONCLUSION

Illustrative findings are presented on dietary behavior in a diverse sample of lower-income working parents. This paper also offers ideas on increasing the contributions of the LCP to nutritional research.

Work conditions and the food choice coping strategies of employed parents

OBJECTIVE

How work conditions relate to parents' food choice coping strategies.

DESIGN

Pilot telephone survey.

SETTING

City in the northeastern United States (US).

PARTICIPANTS

Black, white, and Hispanic employed mothers (25) and fathers (25) randomly recruited from low-/moderate-income zip codes; 78% of those reached and eligible participated.

MAIN OUTCOME MEASURES

Sociodemographic characteristics; work conditions (hours, shift, job schedule, security, satisfaction, food access); food choice coping strategies (22 behavioral items for managing food in response to work and family demands (ie, food prepared at/away from home, missing meals, individualizing meals, speeding up, planning).

ANALYSIS

Two-tailed chi-square and Fisher exact tests (P < or = .05, unless noted).

RESULTS

Half or more of respondents often/sometimes used 12 of 22 food choice coping strategies. Long hours and nonstandard hours and schedules were positively associated among fathers with take-out meals, missed family meals, prepared entrees, and eating while working; and among mothers with restaurant meals, missed breakfast, and prepared entrees. Job security, satisfaction, and food access were also associated with gender-specific strategies.

CONCLUSIONS AND IMPLICATIONS

Structural work conditions among parents such as job hours, schedule, satisfaction, and food access are associated with food choice coping strategies with importance for dietary quality. Findings have implications for worksite interventions but need examination in a larger sample.

Employed parents' satisfaction with food-choice coping strategies. Influence of gender and structure

This study aimed to understand parents' evaluations of the way they integrated work-family demands to manage food and eating. Employed, low/moderate-income, urban, U.S., Black, White, and Latino mothers (35) and fathers (34) participated in qualitative interviews exploring work and family conditions and spillover, food roles, and food-choice coping and family-adaptive strategies. Parents expressed a range of evaluations from overall satisfaction to overall dissatisfaction as well as dissatisfaction limited to work, family life, or daily schedule. Evaluation criteria differed by gender. Mothers evaluated satisfaction on their ability to balance work and family demands through flexible home and work conditions, while striving to provide healthy meals for their families. Fathers evaluated satisfaction on their ability to achieve schedule stability and participate in family meals, while meeting expectations to contribute to food preparation. Household, and especially work structural conditions, often served as sizeable barriers to parents fulfilling valued family food roles. These relationships highlight the critical need to consider the intersecting influences of gender and social structure as influences on adults' food choices and dietary intake and to address the challenges of work and family integration among low income employed parents as a way to promote family nutrition in a vulnerable population.