Reaching low-income families: Focus group results provide direction for a behavioral approach to WIC services

An Investigation of Social Ecological Barriers to and Facilitators of WIC Farmers Market Nutrition Program Voucher Redemption

In the United States, many communities lack sufficient access to fresh produce. To improve access to fresh fruits and vegetables, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides eligible participants vouchers through the Farmers Market Nutrition Program (FMNP) that can be redeemed directly from farmers at markets or farm stands. However, FMNP voucher redemption rates in New Jersey remain lower than those in neighboring states. This article used the social ecological model to examine differences between FMNP participants who redeem vouchers (Redeemers) and those who do not (non-Redeemers) in the areas of: produce procurement practices and consumption frequency, and barriers to and facilitators of FMNP voucher redemption. This cross-sectional study included WIC FMNP participants (N = 329) in northern New Jersey, USA. Analyses were conducted using descriptive statistics, independent sample t-tests, and one-way ANOVA. Compared to Redeemers, non-Redeemers consumed fewer average daily vegetable servings, were more likely to shop at small grocery/corner stores, and encountered significant barriers to FMNP redemption, e.g., difficulty finding time to redeem vouchers.

Lessons From the Feasibility Testing of a Parent-Focused, Life Skills-Based Intervention to Prevent Obesity in Preschoolers From Underserved Families

This article describes lessons from the feasibility testing of a parent-focused, life skills-based intervention to promote healthy weight in 58 low-income children aged 2 to 5 years. This intervention was feasible and acceptable, with a potential to impact child weight and diet (calories) and parental quality of life (QOL). The group delivery approach through a partnering organization (Head Start) was a more efficient way to reach/engage parents. Compared with one-on-one sessions, the group could provide an avenue to enhance parental psychosocial well-being, given QOL improvements among parents in group sessions. Lessons will inform future research to test the effectiveness of life skills interventions.

Facilitators and Barriers to Healthy Eating Among American Indian and Alaska Native Adults with Type 2 Diabetes: Stakeholder Perspectives

BACKGROUND

American Indian and Alaska Native (AI/AN) adults have a higher prevalence of type 2 diabetes (T2D) and related complications than non-AI/AN adults. As healthy eating is a cornerstone of diabetes self-management, nutrition education plays an important role in diabetes self-management education.

OBJECTIVE

To understand stakeholder perspectives on facilitators and barriers to healthy eating for AI/AN adults with T2D in order to inform the cultural adaptation of an existing diabetes nutrition education curriculum.

METHODS

Individual interviews were conducted with 9 national content experts in diabetes nutrition education (e.g. registered dietitians, diabetes educators, experts on AI/AN food insecurity) and 10 community-based key informants, including tribal health administrators, nutrition/diabetes educators, Native elders, and tribal leaders. Four focus groups were conducted with AI/AN adults with T2D (n = 29) and 4 focus groups were conducted with their family members (n = 22). Focus groups and community-based key informant interviews were conducted at 4 urban and reservation sites in the USA. Focus groups and interviews were recorded and transcribed verbatim. We employed the constant comparison method for data analysis and used Atlas.ti (Mac version 8.0) to digitalize the analytic process.

RESULTS

Three key themes emerged. First, a diabetes nutrition education program for AI/ANs should accommodate diversity across AI/AN communities. Second, it is important to build on AI/AN strengths and facilitators to healthy eating (e.g. strong community and family support systems, traditional foods, and food acquisition and preparation practices). Third, it is important to address barriers to healthy eating (e.g. food insecurity, challenges to preparation of home-cooked meals, excessive access to processed and fast food, competing priorities and stressors, loss of access to traditional foods, and traditional food-acquisition practices and preparation) and provide resources and strategies for mitigating these barriers.

CONCLUSIONS

Findings were used to inform the cultural adaptation of a nutrition education program for AI/AN adults with T2D.

Parents' Perceptions of 5210 Nutrition Messaging and Child Weight Status

OBJECTIVE

To explore parent perceptions of child weight status and 5210 nutrition messaging recommendations, including daily consumption of 5 fruits and vegetables, limiting child screen time to ≤2 hours, incorporating 1 hour of daily physical activity, and no consumption of sugary, sweetened beverages.

METHODS

Using the Convergence Model of Communication as a framework, qualitative focus groups (n = 5) were conducted at 4 Head Start sites across 1 Ohio County. Twenty-eight parents aged 20-60 years comprised the groups. A deductive analysis technique with respondent validation was used.

RESULTS

Parents have limited understanding of 5210 messages delivered by the program. Parent food preferences, family finances, and children's picky eating were identified as barriers to integrating healthy eating habits at home. Parents prefer practical strategies regarding how to integrate healthy eating habits into the home environment. Participants expressed concern about children's psychological health and happiness vs weight status.

CONCLUSIONS AND IMPLICATIONS

Understanding parental perceptions of 5210 messaging and program-reported weight status may assist Head Start programs in addressing childhood obesity through focused parent education and support.

Assessing Challenges in Low-Income Families to Inform a Life Skills-Based Obesity Intervention

BACKGROUND

This article describes the formative research undertaken to explore challenges of low-income parents of 3-to 5-year-olds to inform a parent-focused life skills-based intervention to prevent obesity in preschool-aged children.

METHOD

A total of 40 parents completed surveys, 30 parents participated in focus groups, and 5 community stakeholders participated in individual interviews. In each data mode, participants were asked to prioritize a list of challenges centered on parenting, family care, and self-care. Survey data were analyzed descriptively using SAS, while focus groups and interviews were analyzed for emerging themes using ATLAS.ti.

RESULTS

Parents reported needing strategies for managing children's behavior around picky eating, limits/boundaries, tantrums, and routines. Challenges with child behavior management were compounded by parents' inability to find affordable fun family activities outside the home and difficulties in communicating childrearing expectations to coparents/relatives who assisted with child care. Added to these were other competing priorities (e.g., financial) that led to the neglect of self, including the inability to find "me" time, build relationships, and care for one's health.

CONCLUSIONS

Interventions that address parenting, family care and self-care challenges of low-income parents may enhance resilience and support positive changes that can promote healthy development in children, including obesity prevention.

Strategies for public health initiatives targeting dairy consumption in young children: a qualitative formative investigation of parent perceptions

OBJECTIVE

Dairy products contain essential nutrients to ensure healthy growth and bone development in children. However, a significant proportion of children in developed countries fail to consume the daily recommended intake of dairy products. Parents are the gatekeepers of familial nutritional intake and represent a potential vehicle through which to increase dairy consumption in children. As such, formative research was conducted to gain insight into parents' perceived barriers to and benefits of purchasing and consuming dairy products and to develop innovative message content that could be utilized in future public health campaigns.

DESIGN

Seven in-depth group interviews were conducted in two phases between February and May 2015.

SETTING

Interviews were conducted in local recreational centres and libraries in British Columbia, Canada.

SUBJECTS

Mothers (n 21, mean age 38 (sd 5) years) and fathers (n 9, mean age 38 (sd 3) years) of children aged 4-10 years.

RESULTS

Parents perceived both positive and negative physical outcomes associated with consuming dairy. Lack of trustworthy information was a frequently discussed barrier theme to purchasing and consuming dairy products. Mothers were concerned about the cost of dairy products. Differences in purchasing and consumption strategies were reported between parents of children who consumed adequate dairy and those who did not. Parents believed the most appropriate communication channel was through print material.

CONCLUSIONS

Messages targeting parents, as a means of increasing dairy consumption in children, should address barriers identified by parents. In addition, practical tips should be provided to promote purchasing and consumption of dairy products.

Statewide Intervention to Reduce Television Viewing in WIC Clients and Staff

Purpose.

To evaluate a statewide campaign that was designed to reduce television viewing by clients and staff of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Television reduction is frequently recommended as a strategy for preventing pediatric overweight.

Methods.

Data were collected from a convenience sample of 10,445 clients and staff who attended clinics during a 3-week period before the intervention and 9188 clients and staff who attended clinics after the intervention. Chi-square tests were used to compare the proportion of WIC clients watching television 2 or 3 hours per day before and after the intervention. Within the context of WIC, which is a large and complex public health program, it was not possible to measure individual exposures or response rates.

Results.

At baseline, 64.2% of WIC clients reported watching 2 or less hours of television per day. After the intervention, 70.5% limited television viewing to this recommended level.

Conclusions.

It is feasible to deliver television-reduction messages in large public health programs.

'Fit Moms/Mamás Activas' internet-based weight control program with group support to reduce postpartum weight retention in low-income women: study protocol for a randomized controlled trial

BACKGROUND

High postpartum weight retention is a strong independent risk factor for lifetime obesity, cardiovascular disease, and type 2 diabetes in women. Interventions to promote postpartum weight loss have met with some success but have been limited by high attrition. Internet-based treatment has the potential to overcome this barrier and reduce postpartum weight retention, but no study has evaluated the effects of an internet-based program to prevent high postpartum weight retention in women.

METHODS/DESIGN

Fit Moms/Mamás Activas targets recruitment of 12 Women, Infants and Children (WIC) Supplemental Nutrition Program clinics with a total of 408 adult (>18 years), postpartum (<1 year) women with 14.5 kg or more weight retention or a body mass index of 25.0 kg/m(2) or higher. Clinics are matched on size and randomly assigned within county to either a 12-month standard WIC intervention or to a 12-month WIC enhanced plus internet-based weight loss intervention. The intervention includes: monthly face-to-face group sessions; access to a website with weekly lessons, a web diary, instructional videos, and computer-tailored feedback; four weekly text messages; and brief reinforcement from WIC counselors. Participants are assessed at baseline, six months, and 12 months. The primary outcome is weight loss over six and 12 months; secondary outcomes include diet and physical activity behaviors, and psychosocial measures.

DISCUSSION

Fit Moms/Mamás Activas is the first study to empirically examine the effects of an internet-based treatment program, coupled with monthly group contact at the WIC program, designed to prevent sustained postpartum weight retention in low-income women at high risk for weight gain, obesity, and related comorbidities.

TRIAL REGISTRATION

This trial was registered with Clinicaltrials.gov (identifier: NCT01408147 ) on 29 July 2011.

Dash of faith: a faith-based participatory research pilot study

The Dash of Faith pilot used a community-based participatory research approach to design an experiential dietary intervention based on two African-American churches, one intervention and one comparison. Congregation members identified components that were incorporated into 12 weekly and 4 monthly sessions, with a goal of increasing fruit and vegetable and lowering fat intake. At 2 months, a marginally significant (p = 0.07) increase in fruit and vegetable consumption was observed in the intervention group but was not maintained at study conclusion. We propose that these mixed findings may be attributable, in part, to bias introduced by the participatory nature of the design.

Women, infants, and children cash value voucher (CVV) use in Arizona: a qualitative exploration of barriers and strategies related to fruit and vegetable purchases

OBJECTIVE

Women, Infants, and Children (WIC) cash value vouchers (CVV) have been inconsistently redeemed in Arizona. The objective of this study was to explore perceived barriers to use of CVV as well as strategies participants use to overcome them.

DESIGN

Eight focus groups were conducted to explore attitudes and behaviors related to CVV use.

SETTING

Focus groups were conducted at 2 WIC clinics in metro-Phoenix, AZ.

PARTICIPANTS

Participants in WIC who were at least 18 years of age and primarily responsible for buying and preparing food for their households.

PHENOMENON OF INTEREST

Perceived barriers to CVV use and strategies used to maximize their purchasing value.

ANALYSIS

Transcripts were analyzed using a general inductive approach to identify emergent themes.

RESULTS

Among 41 participants, multiple perceived barriers emerged, such as negative interactions in stores or confusion over WIC rules. Among experienced shoppers, WIC strategies also emerged to deal with barriers and maximize CVV value, including strategic choice of times and locations at which to shop and use of price-matching, rewards points, and other ways to increase purchasing power.

CONCLUSIONS AND IMPLICATIONS

Arizona WIC participants perceived barriers that limit easy redemption of CVV. Useful strategies were also identified that could be important to explore further to improve WIC CVV purchasing experiences.

Effect of a low-intensity parent-focused nutrition intervention on dietary intake of 2- to 5-year olds

OBJECTIVES

Community-based nutrition interventions aimed at influencing child dietary intake are rarely evaluated. We hypothesised that providing self-directed nutrition and parenting resources to parents living in rural northern New South Wales, Australia, would positively affect the dietary patterns of children ages 2 to 5 years.

METHODS

A total of 146 parent-child dyads (76 boys, ages 2.0-5.9 years) were randomly assigned to either a 12-month parent-centred intervention involving self-directed education provided in CD and DVD formats, or a participant-blinded control group who received generic nutrition and physical activity information. Data were collected at baseline, 3, and 12 months.

RESULTS

Total reported energy from nutrient-dense food groups and percentage energy from energy-dense, nutrient-poor foods were high at baseline relative to estimated total energy expenditure for child age. Using random effects modelling, there were significant group-by-time effects for a reduction in mean (standard deviation) total energy intake (EI) at 12 months (-461 kJ/day (196); P = 0.04). An intervention group-by-time effect on carbohydrate intake (-17.4 g/day (10.6); P < 0.05) was largely attributable to decreased consumption of breads and cereals (-180 g/day (80); P = 0.007). Decreases in energy-dense, nutrient-poor foods were not statistically significant.

CONCLUSIONS

The proportion of total EI from noncore foods in children in rural New South Wales is high and did not improve in response to a low-intensity nutrition intervention. Parents reported small changes in consumption frequency for core and noncore food intakes, leading to a reduction in total EI. Strategies to increase resource use such as prompting via e-mail are required to further explore the effectiveness of nutrition resource dissemination at a population level.

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.

A parent-focused pilot intervention to increase parent health literacy and healthy lifestyle choices for young children and families

Health literacy affects caregivers' ability to engage in preventive health care behaviors for themselves and their children. Studies suggest that health literacy among low-income families needs improvement, and this possibly contributes to disparities in preventive health care rates. Additionally, parents and caregivers may not be able to provide or seek preventive health care for their children because of lack of knowledge and skills to do so effectively. This study designed and piloted an intervention that delivered to parents of young children (1) health literacy information in an experiential manner and (2) practical skills to engage their families in healthy lifestyle choices. Specifically, the intervention focused on diet/nutrition, physical activity, sleep hygiene, parenting, and mental wellness. Postintervention improvements were noted for factual knowledge for diet/nutrition, physical activity, and sleep, beliefs about diet/nutrition, and the relationship between mental health and stress. Additionally, postintervention improvements were noted for general knowledge and beliefs about sleep, knowledge about the relationship between sleep and health, knowledge about common childhood sleep problems, and parents' bedtime interactions with children. The efficacy of the intervention should be evaluated on a larger, more diverse sample in the future with considerations for multiple health behavior change in the evaluation.

Parents' perceptions of child feeding: a qualitative study based on the theory of planned behavior

OBJECTIVE

The aim of this qualitative study was to investigate the child-feeding behaviors and attitudes of parents of children aged 2 to 5 years, within the theory of planned behavior (TPB) framework.

METHODS

Semistructured telephone interviews were conducted in October 2011. The interviewer conducted and recorded the interviews from a community health center, to interviewees who were in their own home environment. Verbatim transcription of interviews preceded manual coding of data. Emergent themes were mapped into a matrix against a priori-coded TPB constructs (attitudes, beliefs, subjective norms, perceived behavioral control, and behavioral intention).

RESULTS

Twenty-one consenting parents participated in interviews. Participants were predominantly tertiary-educated (65%) mothers (85%) who were older than 30 years (76%). Parents believed that optimal child nutrition is important but difficult to achieve. Behavioral intention to change feeding practices was limited by a belief that child's dietary intake is above average compared with their peer group. Perceived control over child dietary intake was influenced by food advertising, extended family, and peer influences. Parents supported targeting nutrition education directly at children and a policy approach to offset the costs of fresh foods by taxing "junk" foods.

CONCLUSIONS

The application of TPB to child feeding may explain the disparity between parents' child-feeding intentions and behaviors. Parents' feeding behaviors are more influenced by peers than by dietary guidelines. Future interventions need to target parents' perceived child-feeding responsibilities, influence subjective norms, and increase parents' perceived control over child feeding. Peer nutrition education is proposed as an intervention model.

Study protocol of a parent-focused child feeding and dietary intake intervention: the feeding healthy food to kids randomised controlled trial

BACKGROUND

Poor childhood nutrition is a more pervasive and insidious risk factor for lifestyle-related chronic disease than childhood obesity. Parents find it difficult to address the reported barriers to optimal child feeding, and to improve child dietary patterns. To impact at the population level, nutrition interventions need to be easy to disseminate, have a broad reach and appeal to parents while overcoming the barriers parents face when trying to improve child feeding behaviours. The Feeding Healthy Food to Kids (FHFK) Randomised Control Trial (RCT) examines the impact of providing low cost, self-directed nutrition and parenting resources to rural parents, on child dietary intake and parent-child feeding practices.

METHODS/DESIGN

Up to 150 parents of two-to-five year old children will be recruited in five rural Australian towns. Eligible, consenting parents will be randomly allocated to intervention or 12-month wait-list control groups. Intervention group parents will receive an interactive nutrition CD and parenting DVD, and be provided with instructions for optimal resource utilisation. Intervention and control group participants will also receive a generic nutrition and physical activity brochure and a physical activity resource to blind participants to group allocation. Primary outcome measures are dietary intake of vegetables (serves/day), fruit and energy dense nutrient poor foods (serves/day and %Energy). Secondary outcome measures are total energy (kCal), other food groups (serves/day and %Energy), key nutrients (mg/day), child feeding domains and parenting style domains.Analysis of dietary outcome measures, child feeding and parenting domains will be conducted on an intention-to-treat basis and compared at baseline, three and 12 months using the random effects model, using STATA software. Details of the methodological aspects of recruitment, inclusion criteria, randomisation and statistical analysis are described.

DISCUSSION

This paper will add to existing research examining child feeding practices and dietary intake of young children, by specifically focusing on the efficacy of an RCT that has the potential to be implemented at a population level. The correlation of the RCT outcomes with parents' perceptions about child feeding practices and children's dietary intake of their children in a subsequent qualitative study will further contribute to this emerging area of research.

TRIAL REGISTRATION

Australian Clinical Trials Registration Number: ACTRN12609000356268.

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.

Padrão de refeições realizadas por adolescentes que frequentam escolas técnicas de São Paulo

OBJETIVO: Avaliar e caracterizar o consumo de refeições realizadas por adolescentes. MÉTODOS: Estudo transversal com 71 adolescentes do ensino médio de escolas técnicas de São Paulo. Foi utilizado um questionário que avalia atitudes alimentares de ado-lescentes. As variáveis estudadas foram: frequência, local, com quem realiza as refeições e substituição de refeições por lanches. Os dados foram analisados descritivamente e o teste do qui-quadrado comparou as variáveis segundo gênero, considerando nível de significância de 5%. RESULTADOS: Do total, 58% eram do gênero feminino. A maioria relatou realizar as principais refeições em casa (88% café da manhã, 91% almoço e 96% jantar). Quanto à frequência do consumo, 49% realizavam todos os dias o café da manhã, 65% o almoço e 51% o jantar. Os adolescentes consumiam tanto o café da manhã (48%) quanto o almoço (39%) sozinhos, enquanto o jantar (77%) era realizado com os pais, havendo, para o jantar, diferença entre gêneros (p=0,022). Observou-se que 29% substituíam o almoço por lanches e, destes, 17% o faziam uma a duas vezes por semana. No jantar, uma porcentagem maior de adolescentes o subs-tituía por lanche (62%), sendo a frequência de substituição de uma a duas vezes por semana para 42% deles. CONCLUSÕES: Apesar de os adolescentes realizarem as re-feições em casa, as mesmas não são feitas diariamente nem acompanhadas pelos pais.

Use of qualitative research to inform development of nutrition messages for low-income mothers of preschool children

OBJECTIVE

To develop and test nutrition messages and supporting content with low-income mothers for use with theory-based interventions addressing fruit and vegetable consumption and child-feeding practices.

DESIGN

Six formative and 6 evaluative focus groups explored message concepts and tested messages, respectively.

SETTING

Research facilities in Maryland, Texas, California, Florida, North Carolina, New York, Alabama, and Illinois.

PARTICIPANTS

Ninety-five low-income mothers of 2- to 5-year-old children; over half from households participating in a federal nutrition assistance program.

PHENOMENON OF INTEREST

Preference for and comprehension of nutrition messages.

ANALYSIS

Qualitative data analysis procedures to generate common themes from transcripts and observers' notes.

RESULTS

Messages on role modeling, cooking and eating together, having patience when introducing new food items, and allowing children to serve themselves were well received. Mothers preferred messages that emphasized their role as a teacher and noted benefits such as their children becoming more independent and learning new skills. Mothers commonly doubted children's ability to accurately report when they are "full" and disliked messages encouraging mothers to allow children to "decide" whether and how much to eat.

CONCLUSIONS AND IMPLICATIONS

This study generated 7 audience-tested messages for incorporation into nutrition education interventions targeting low-income mothers of preschool-age children.

Perceptions of factors influencing healthful food consumption behavior in the Lower Mississippi Delta: focus group findings

OBJECTIVE

To identify perceptions of Lower Mississippi Delta (LMD) residents regarding factors that influence a change in healthful food consumption behavior to assist in planning sustainable nutrition interventions in the LMD.

DESIGN

Nine focus groups were conducted with LMD residents in 9 counties in Arkansas, Louisiana, and Mississippi. One focus group was held in each county on the topical area of behavioral change.

SETTING

Nine counties in Arkansas, Louisiana, and Mississippi.

PARTICIPANTS

The study population included 91 persons, 85 females and 6 males (18-60+ years of age), of whom 71 were African Americans, 17 were Caucasians, and 3 were Hispanics, who participated in the focus group discussions.

ANALYSIS

Data analyses were completed by general and specific content coding. Data were reviewed for emerging themes for each topic. The Social Cognitive Theory served as the framework for understanding the determinants of a change in healthful food consumption behavior.

RESULTS

The study showed considerable variability in perceptions that are influenced by both personal and external factors. These factors include health concerns, family influence, and need for and availability of nutrition information. Participants were interested in learning about healthful eating, food preparation skills, and portion control.

CONCLUSIONS

Focus groups in the LMD identified many important themes relevant to the development of nutrition interventions in these communities. These data will be used to guide the community-based participatory interventions that will be developed and implemented in the LMD. The findings could be applicable to other researchers designing interventions for similar populations.

Addressing barriers to health promotion in underserved women

Underserved women face numerous barriers to adopting healthy eating behaviors. To develop effective health-promotion interventions for underserved women, barriers specific to the individual need should be addressed. Influenced by individual characteristics, experiences, and culture, different types of barriers (internal, interpersonal, and environmental) can overlap to impede healthy eating in underserved women. On the basis of literature review and qualitative research experiences with underserved women, 4 potential approaches for addressing barriers to health promotion were identified: (1) individualizing interventions; (2) developing collaborative partnerships within the community; (3) using positive deviance inquiry to build on community assets; and (4) changing public policy.

Community empowerment: a partnership approach to public health program implementation

Public policy implementation models reflect who makes decisions, how success is defined, and whether learning is built into decision making. The extant implementation models capture many important features of public policy implementation, including the desire of large public bureaucracies to impose order and rationality on implementation structures that include many public and private organizations. Analysis of the three-decades-long process of implementation of the Special Supplemental Nutrition Program for Women, Infants, and Children suggests that a new public policy implementation model is needed. The new model builds on the iterative learning cycles and shared decision making of community participatory research and better addresses the transactional relationship between program targets and providers than do current implementation models.

Intergenerational family conversations and decision making about eating healthfully

OBJECTIVE

To explore how youth, parents, and grandparents discuss issues related to eating healthfully and unhealthfully and to identify intergenerational strategies for educators to improve this communication.

DESIGN

In three intergenerational focus groups, each with 4-8 families, a trained moderator asked questions about family practices and conversations for eating healthfully and unhealthfully.

SETTING

Three focus group sites, each with Pennsylvania Nutrition Education Program sites (PANEP) programs serving low-income populations and multigenerational clientele, based in geographically and culturally diverse communities in Pennsylvania.

PARTICIPANTS

Forty-four individuals (21 pre-teens, 16 parents, and 7 grandparents) from 17 families.

PHENOMENON OF INTEREST

How youth, parents, and grandparents discuss and influence each other's healthful and unhealthful eating practices.

ANALYSIS

"Strength" of evidence determined by repetition of ideas across focus groups and from the respondents' quotes providing in-depth information.

RESULTS

Families demonstrated a wide range of ways that family communication is associated with the adoption of healthful and unhealthful patterns of eating. Parents and grandparents expressed anguish over their struggle and inability to help their children eat more healthfully. All three generations enumerated strategies for dealing with disagreement.

CONCLUSIONS AND IMPLICATIONS

Grandparents, parents and children indicate that they need opportunities to learn together and communicate about ways to improve nutrition behaviors.

Using focus group results to inform preschool childhood obesity prevention programming

OBJECTIVE

This study about maternal feeding practices and beliefs was conducted as background for the development of a childhood obesity prevention program for multi-ethnic parents in the USA receiving services from a federal government supplemental nutrition program for low-income mothers.

DESIGN

Using a grounded theory approach, focus groups were conducted with low-income African American, white non-Hispanic (i.e. the majority Caucasian American population), Hispanic and Vietnamese parents to collect cross-cultural perspectives on: (a) infant and child feeding practices, (b) childhood overweight, (c) healthy dietary intake, (d) physical activity and inactivity, and (e) infant feeding information sources.

RESULTS

A content analysis of the data yielded three main themes common to all four groups: (a) lack of awareness of the relationship between increased physical activity and health, (b) the use of food to influence behavior, and (c) the loss of parental control over feeding when a child starts child care or school, and revealed perspectives on age-appropriate food, infant satiety, overweight and information sources that were specific to each group.

CONCLUSION

Interventions that enhance parent self-efficacy that build on themes that are specific to ethnic groups toward preventing childhood obesity are needed. There is also a need for culturally appropriate information for governmental nutrition programs that is in the client's own language and takes into account ethnic differences in beliefs and traditions.

wichealth.org: impact of a stages of change-based Internet nutrition education program

OBJECTIVE

To determine the usefulness and impact of on stage of change associated with 8 WIC client nutrition issues.

DESIGN

Cross-sectional design. Data were collected through an online survey and via Web pages visited by clients for each module.

SETTING

intervention and data collection are Internet-based.

PARTICIPANTS

39,541 WIC participants from 7 states completed a module and online survey. Subjects were likely between the ages of 18 and 34, residing in Michigan, Illinois, or Indiana, and accessing the Internet from home.

INTERVENTIONS

Intervention included 5 online modules focusing on parent-child feeding behaviors.

VARIABLES MEASURED

Impact variables included stage of change movement, user belief in ability to engage in behavior, and perception of site usefulness.

ANALYSIS

Data were reported using frequency, ANOVA (analysis of variance) (P < . 01), and chi-square (P < .01) analyses.

RESULTS

Movement in stage was greatest for the "picky eater" (PE) module. Contemplation as the beginning stage had the greatest stage movement. Participants responded well to all measures of site usefulness. User belief in ability to engage in behavior was associated with 7 of the 8 modules.

IMPLICATIONS FOR RESEARCH AND PRACTICE

is a highly popular and viable method for impacting movement in stage of change with a number of parent-child feeding issues.

Promoting family meals in WIC: lessons learned from a statewide initiative

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program in Washington State developed a module to be used at local WIC agencies to promote family meals. Needs assessment and formative evaluation ensured that the module met the needs of WIC staff and clients. The Promoting Family Meals module includes background information on family meals, tools for training WIC staff, outlines for group sessions, handouts tailored to each client's stage of change, children's coloring sheets, bookmarks, banners, and posters. After the first 6 months of use, there was a statistically significant (F = 26.17, df = 3, P < .001) increase in family meal participation in intervention agencies as compared to controls.

Compliance with dietary guidelines and relationship to psychosocial factors in low-income women in late postpartum

OBJECTIVES

The goals were to evaluate compliance with the Dietary Guidelines among low-income women during late postpartum and to examine the relationship between psychosocial variables and dietary compliance.

SUBJECTS/SETTING

Participants were 146 triethnic, low-income women who were recruited 0 to 1 days after childbirth and who visited a clinic site at 1 year postpartum.

DESIGN

At 1 year postpartum, multiple psychosocial characteristics were measured, and food choices and nutrient intakes were assessed via a validated food frequency questionnaire. Dietary guidelines index scores and measures of adherence to dietary recommendations were computed.

STATISTICAL ANALYSES PERFORMED

Descriptive statistics, analysis of variance with post-hoc Scheffe tests, chi 2 with follow-up tests of independent proportions, and Pearson correlation coefficients were utilized.

RESULTS

For dietary compliance, 60% had adequate intakes of meat, but less than 30% met recommendations for grains, vegetables, fruits, dairy foods, total fat, and added sugar. Healthful weights (body mass index <25) were observed in 37% of women. Those in the highest tertile of dietary compliance had a more positive body image than those in the lowest tertile, and less neglect of self-care, weight-related distress, stress, depressive symptoms, and perceived barriers to weight loss ( P <.05). Dietary compliance and psychosocial scale scores did not vary by ethnicity.

CONCLUSIONS

Adherence to dietary guidelines was limited in the low-income, postpartum women. Psychosocial variables, such as neglect of self-care, weight-related distress, negative body image, stress, and depressive symptoms were associated with less healthful diets and lifestyle in late postpartum. Programs that target diet-related behavior change in low-income women might be improved by inclusion of psychosocial assessment and counseling components.