Healthy eating behaviors and the cognitive environment are positively associated in low-income households with young children

Impacts of a School-Based Intervention That Incorporates Nutrition Education and a Supportive Healthy School Canteen Environment among Primary School Children in Malaysia

In this study, a school nutrition program (SNP) that incorporates nutrition education and a healthy school canteen environment was developed to improve nutrition knowledge among intervention respondents and provide a healthier environment for them to practice healthy eating. In the current study, we evaluated the impacts of the SNP on eating behaviors, physical activity, body mass index-for-age (BAZ), and cognitive performance at pre-intervention, post-intervention, and 3-month follow-up points between intervention and comparison groups. This intervention study involved 523 primary school children (7–11 years old) from six selected schools in Batu Pahat District, Malaysia. Each respondent completed anthropometric and cognitive performance assessments and a set of standardized questionnaire at pre-intervention, post-intervention, and 3-month follow-up points. Multiple linear mixed model analysis was performed to determine the impacts of that SNP after being adjusted for covariates. After the program, the intervention group increased their frequency of breakfast, lunch, and dinner consumption and morning tea snacking and showed more frequent physical activity and better cognitive performance as compared to the comparison group overtime (p < 0.05). At 3-month follow-up, the intervention group showed lower BAZ scores than their comparison counterparts (p < 0.05). The SNP showed positive effects on eating behaviors, physical activity, BAZ, and cognitive performance in school children. Hence, the SNP is highly recommended for all primary school children.

Relationships Between the Home Learning Environment, Weight Status, and Dietary Intake: Results From a Cross-Sectional Study of Preschool-Aged Children in New South Wales, Australia

The home learning environment is a potential correlate of childhood obesity and obesity-related factors. We examined relationships between the home learning environment and weight status and the home learning environment and dietary intake, in a sample of 303 preschool-aged children from Australia. We measured their height and weight, and their parents completed a questionnaire that included questions related to demographics, dietary intake, and the home learning environment. Parents reported their children’s usual consumption of foods from each food group, the frequency of their discretionary food intake, and the frequency of home activities that might support cognitive stimulation. We analysed relationships using regression, adjusting for parents’ education level, and household income. We found no significant associations between the home learning environment and BMI or weight category. We found a significant inverse relationship between the overall home learning environment and discretionary food intake scores, but when stratified by income, this result was significant for children from lower-income families only. Regarding specific elements of the home learning environment, we found significant inverse relationships between discretionary food intake and both reading to children, and teaching them the alphabet. While reading was significant across all income levels, teaching the alphabet was only significant in children from higher-income families. We also found significant inverse relationships between discretionary food intake and: visiting a library, teaching numbers or counting, and teaching songs, poems and nursery rhymes in lower-income families only. There was no association between the home learning environment and meeting individual dietary guidelines. This area requires further research to explore broader home environment factors that may influence these relationships. We also suggest that interventions explore the use of strategies to improve the home learning environment to determine its efficacy in improving healthy eating behaviors.

Who are the assistant cooks at the community child centers in South Korea? Focus group interviews with workfare program participants

Purpose

Community child centers (CCCs) were introduced to provide after-school activities and care, including meal services to children from low-income families. The assistant cooks, who have the main responsibility for making and serving food at CCCs, are a major factor influencing the eating habits of children using CCCs. In this study, we tried to identify and understand who the assistant cooks are, what their job responsibilities are, and what they need in order to be able to provide children with healthy meals.

Methods

Three focus group interviews were held with 17 workfare program participants who worked as assistant cooks at CCCs, and content analysis methods were applied using the NVivo 12 qualitative data analysis software.

Results

The assistant cooks reflected on their perceptions of the children’s health at the CCCs, their own cooking style, and their role at the CCCs. Additionally, barriers to the optimal provision of their services were pointed out, and improvements were suggested.

Conclusion

The results of this study can be used as a fundamental resource for the development of tailored interventions that consider a child’s unique environment to address health disparities, specifically with respect to childhood obesity.

Food and non-food reinforcement among pregnant women

Excessive gestational weight gain (GWG) in pregnancy may be driven in part by greater motivation to eat, and studying the relative reinforcing value of food versus non-food commodities may provide insight into factors important for excessive GWG. This study was a cross-sectional examination of the relationship between women meeting the Institute of Medicine (IOM) guidelines for GWG and the relative reinforcing value of food vs. non-food commodities during pregnancy. Two-hundred and thirty-three pregnant women (1st trimester, n = 44; 2nd trimester, n = 105; 3rd trimester, n = 84), aged 18-40, were recruited via a crowdsourcing platform and completed an online survey. Relative food reinforcement (RRV_food), relative non-food activity reinforcement (RRV_active) and relative non-food cognitively enriching activity reinforcement (RRV_cognitive) were measured by a questionnaire at the point of contact. Self-reports of gestational age and weight gain during pregnancy were collected. The relationship between food and non-food reinforcement was assessed based on IOM classifications for weight gain during pregnancy. After adjustment for women's education level and parity, higher RRV_food (p = 0.036) and lower RRV_cognitive (p = 0.040) responses were associated with greater GWG. Food reinforcing ratio (FRR) analysis was then conducted to systematically examine the effect of non-food behaviors on GWG when food reinforcement was accounted for. Women who gained below the IOM weight gain guidelines had significantly higher FRR_cognitive than those gaining above (p = 0.013), indicating cognitively enriching activities may better compete with food among pregnant women. Interventions that help to increase the reinforcing value of cognitively enriching activities may be a new avenue to regulate eating to minimize GWG.

Influence of sedentary, social, and physical alternatives on food reinforcement

OBJECTIVE

This study examined the potential for nonfood alternative activities to compete with the reinforcing value of food. Participants rated the frequency and pleasantness of engaging in a variety of activities and made hypothetical choices between food and 4 types of alternatives; cognitive-enriching (reading, listening to music), social (attending a party or event), sedentary (watching TV), and physically active (running, biking).

METHOD

Two-hundred seventy-six adults completed an online survey using a crowdsourcing platform.

RESULTS

Adults with higher BMI reported engaging in fewer activities within the cognitive-enriching, social, and physically active categories. When examining how well each alternative activity type was able to compete with food, sedentary alternatives were associated with the highest food reinforcement, or were least able to compete with food reinforcers, as compared with cognitive-enriching, social, and physical. Social activities were associated with the lowest food reinforcement, or the best able to compete with food reinforcers.

CONCLUSION

These results suggest that increasing the frequency and range of nonfood alternative activities may be important to obesity. This study also suggests that the class of social activities may have the biggest impact on reducing food reinforcement, and the class of sedentary may have the smallest effect on food reinforcement. These tools have relevance to clinical interventions that capitalize on increasing access to behaviors that can reduce the motivation to eat in clinical interventions for obesity. (PsycINFO Database Record

Determinants of fruit and vegetable intake in low-income children and adolescents

Although low-income youth are likely to have low or less frequent fruit and vegetable intake, current understanding of the influences on intake in youth is limited. A systematic review of quantitative research on determinants of fruit and vegetable intake among low-income youth (i.e., persons aged <20 years) was conducted. The aims were to identify which determinants have been studied and which are consistently associated with intake. Fifty-eight papers published between 2003 and August 2013 were included. Across studies, 85 unique determinants were identified. Those best supported by evidence were race/ethnicity (with intake consistently higher among Hispanic as compared with African American and white youth), fruit and vegetable preferences, and maternal fruit and vegetable intake. For many potential determinants, the consistency of evidence could not be examined because of a lack of studies. Findings highlight racial/ethnic differences in fruit and vegetable intake and influences on intake that should be considered when designing dietary interventions for low-income youth. Further research on intake determinants in this at-risk population is needed to establish an evidence base to guide interventions.

Caregivers' psychosocial factors underlying sugar-sweetened beverage intake among non-Hispanic black preschoolers: an elicitation study

The purpose of this study was to explore caregivers' beliefs and perceptions regarding serving sugar-sweetened beverages (SSBs) to non-Hispanic black preschoolers. The Theory of Planned Behavior (TpB) was used as the framework for conducting elicitation interviews among a sample of (n = 19) caregivers. Thematic coding of interview transcripts revealed that the decision to serve SSBs to preschoolers is driven by numerous individual, familial, cultural, and environmental factors. Salient factors associated with serving SSBs included convenience, cost, taste, potential health consequences, availability, and pressure from other parents. Population-specific interventions aimed at reducing SSB intake among non-Hispanic preschoolers are discussed.

A health literate approach to the prevention of childhood overweight and obesity

OBJECTIVE

To describe a systematic assessment of patient educational materials for the Growing Right Onto Wellness (GROW) trial, a childhood obesity prevention study targeting a low health literate population.

METHODS

Process included: (1) expert review of educational content, (2) assessment of the quality of materials including use of the Suitability Assessment of Materials (SAM) tool, and (3) material review and revision with target population.

RESULTS

12 core modules were developed and assessed in an iterative process. Average readability was at the 6th grade reading level (SMOG Index 5.63 ± 0.76, and Fry graph 6.0 ± 0.85). SAM evaluation resulted in adjustments to literacy demand, layout & typography, and learning stimulation & motivation. Cognitive interviews with target population revealed additional changes incorporated to enhance participant's perception of acceptability and feasibility for behavior change.

CONCLUSION

The GROW modules are a collection of evidence-based materials appropriate for parents with low health literacy and their preschool aged children, that target the prevention of childhood overweight/obesity.

PRACTICE IMPLICATIONS

Most trials addressing the treatment or prevention of childhood obesity use written materials. Due to the ubiquitous prevalence of limited health literacy, our described methods may assist researchers in ensuring their content is both understood and actionable.

Culturally competent interventions to address obesity among African American and Latino children and youth

While obesity impacts all ethnic groups in the United States, African Americans and Latinos are particularly at high risk for obesity. The purpose of this paper is to provide an analysis of the literature on evidence-based culturally competent strategies for addressing and preventing obesity and discuss roles for occupational therapists working with populations at risk for obesity in the school or therapeutic clinical environment. A review was conducted of over 80 research articles describing successful interventions conducted in schools and communities targeting African Americans and Latino children. Although unique single strategies are highlighted in this paper, obesity interventions are complex and involved a number of multilevel strategies. The results of the analysis of the literature are presented according to strategies that promote healthy eating, physical activity, and overall healthy lifestyles. Along with the cultural competent strategies, we recommend specific roles for occupational therapists in order to promote the implementation of each particular strategy. Lastly, implications for occupational therapy are discussed.