Influence of the Home Food Environment on Children's Fruit and Vegetable Consumption: A Study of Rural Low-Income Families

Longitudinal changes in home food availability across the first 3 years of life and associations with family context predictors

Background

There is limited research tracking changes in home food availability during the first 3 years of life and whether the family context influences these changes.

Objective

This study examined changes in and predictors of home food availability across the first 3 years of life.

Design

This study utilized longitudinal data from the STRONG Kids2 birth cohort from the target child at 6 weeks to 36 months postpartum.

Participants

Mothers of 468 children were surveyed at 6 weeks, 3, 12, 24, and 36 months postpartum.

Methods

Home observations were completed by trained research assistants to complete the presence of foods in the home. The primary outcomes were the availability of 10 food groups and scores from the Home Food Inventory (HFI), including dairy (regular fat), dairy (reduced fat), processed meats, other meats and non-dairy protein, savory snacks, vegetables, vegetables (no potatoes), and three obesogenic scores. Repeated measures ANOVA were used to examine changes in the HFI food groups and obesogenic scores over time. Multilevel regressions were conducted to examine whether the presence of an older sibling, entry into childcare, and mother's return to full-time work were associated with the HFI.

Results

Significant changes were detected for dairy (regular fat), other meats and non-dairy protein, savory snacks, vegetables, vegetables (no potatoes), and all obesogenic scores across time. A linear trend occurred for most HFI groups, however, the third obesogenic score (without milk and cheese) was highest at 3 months, declined at 12 months, and then slowly increased from 12 to 36 months years. The presence of an older sibling was a consistent predictor of the HFI groups over time. Entry into childcare was only associated with the availability of processed meats.

Conclusion

The availability of food types shift as children age and their dietary needs alter. It is important to consider the whole family context such as the presence of older siblings whose dietary needs may differ from younger children. Future efforts are warranted to consider changes in food availability among diverse samples and different family structures.

Intergenerational Determinants of Weight Status Concordance and Discordance in Parent/Adolescent Dyads from the Family Life, Activity, Sun, Health, and Eating Study

Background: Studies have shown that obesity (OB) has strong intergenerational linkages and tends to cluster in families, but there is a dearth of research examining the socioecological factors predictive of weight status concordance and discordance among parents and adolescents. Methods: We ran a stepwise multinomial logistic regression to assess for sociodemographic, individual-, and family-level predictors of four dyadic weight status groups using data from 1516 parent/adolescent dyads from the National Cancer Institute's Family Life, Activity, Sun, Health, and Eating Study. We categorized parent/adolescent dyads into one of four groups based on their BMI: (1) Healthy Weight Concordance (i.e., both parent and adolescent in the normal weight range); (2) overweight (OW)/OB Concordance (i.e., both parent and adolescent with OW or OB); (3) Discordance-Parent OW/OB (i.e., parent with OW/OB and adolescent in the normal weight range); or (4) Discordance-Adolescent OW/OB (i.e., adolescent with OW/OB and parent in the normal weight range). Results: There were 475 parent/adolescent dyads (31.3%) in the Healthy Weight Concordance group, 351 (23.2%) in the OW/OB Concordance group, 604 (39.8%) in the Discordance-Parent OW/OB group, and 86 (5.7%) in the Discordance-Adolescent OW/OB group. Being from a low socioeconomic family, identifying as a minority, and identifying as a male parent were associated with an OW/OB dyadic BMI. Higher levels of adolescent and parent emotional eating were significantly associated with parent/adolescent dyads being in the OW/OB Concordance group. Parent emotional eating was also associated with Discordance-Parent OW/OB. In contrast, parents' and adolescents' physical activity self-efficacy was associated with a Healthy Weight dyadic BMI vs. OW/OB Concordance or Discordance-Parent OW/OB. Conclusions: Our findings highlight the strength of OW/OB concordance in families, especially among lower socioeconomic and ethnic minority families and the significance of emotional eating and physical activity self-efficacy in contributing to BMI patterns among parents and adolescents.

Risk Factors for Overweight and Obesity within the Home Environment of Preschool Children in Sub-Saharan Africa: A Systematic Review

Sub-Saharan Africa (SSA) is experiencing an increasing prevalence of young children being overweight and obese. Many feeding and physical activity-related behaviours are established at home during preschool years, yet the precise factors that contribute to preschool overweight and obesity have not been fully elucidated. This review aims to identify factors in the home environment associated with overweight and or obesity in preschool children in SSA. Ovid MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, Africa Journals Online (AJOL) and the African Index Medicus databases were systematically searched for qualitative and quantitative studies published between 2000 and 2021. Eleven studies (ten quantitative, one qualitative) met the inclusion criteria. Overall, the results highlight the paucity of studies exploring factors in the home environment associated with overweight and obesity in preschool children in Sub-Saharan Africa. The home food environment and maternal BMI appear to be important factors associated with overweight and obesity in preschool children; however, the information for all other factors explored remains unclear due to the lack of evidence. For successful obesity prevention and treatment interventions to be developed, more research in this area is required to understand how different aspects of the home environment contribute to overweight and obesity in preschool Sub-Saharan African children.

Implementation and outcome evaluation of a team nutrition intervention: increasing knowledge, attitudes, and preferences

Low-income, rural children are at a greater risk for poor dietary intake. Schools offer a venue to deliver appropriate interventions. Our aim was to evaluate the implementation and effectiveness of Healthy Schools, Healthy Students (HSHS). We conducted a mixed-methods evaluation using a cluster-randomized trial design with 20 schools in a rural, Midwestern state. HSHS included education sessions, cafeteria coaching and taste testing. We interviewed implementers (n = 13) and nutrition educators (n = 8), conducted six focus groups with cafeteria coaches, and surveyed fourth graders (n = 1057) about their nutrition knowledge, attitudes toward and preferences for fruits and vegetables (F&V), F&V consumption and MyPlate awareness. We used multi-level linear models to estimate the intervention effect and qualitative data were coded. There were very few challenges to implementation. HSHS participation was positively associated with knowledge, attitudes toward F&V, preferences for vegetables from the taste tests, MyPlate awareness and vegetable consumption. HSHS was viewed as beneficial and easy to deliver, suggesting this type of intervention could be widely implemented. Improving knowledge and attitudes through nutrition education and preferences through taste testing have the potential to improve dietary intake among rural students. Low-cost nutrition interventions can be successfully implemented in rural elementary schools with positive outcomes.

School-based gardening, cooking and nutrition intervention increased vegetable intake but did not reduce BMI: Texas sprouts - a cluster randomized controlled trial

BACKGROUND

Although school garden programs have been shown to improve dietary behaviors, there has not been a cluster-randomized controlled trial (RCT) conducted to examine the effects of school garden programs on obesity or other health outcomes. The goal of this study was to evaluate the effects of a one-year school-based gardening, nutrition, and cooking intervention (called Texas Sprouts) on dietary intake, obesity outcomes, and blood pressure in elementary school children.

METHODS

This study was a school-based cluster RCT with 16 elementary schools that were randomly assigned to either the Texas Sprouts intervention (n = 8 schools) or to control (delayed intervention, n = 8 schools). The intervention was one school year long (9 months) and consisted of: a) Garden Leadership Committee formation; b) a 0.25-acre outdoor teaching garden; c) 18 student gardening, nutrition, and cooking lessons taught by trained educators throughout the school-year; and d) nine monthly parent lessons. The delayed intervention was implemented the following academic year and received the same protocol as the intervention arm. Child outcomes measured were anthropometrics (i.e., BMI parameters, waist circumference, and body fat percentage via bioelectrical impedance), blood pressure, and dietary intake (i.e., vegetable, fruit, and sugar sweetened beverages) via survey. Data were analyzed with complete cases and with imputations at random. Generalized weighted linear mixed models were used to test the intervention effects and to account for clustering effect of sampling by school.

RESULTS

A total of 3135 children were enrolled in the study (intervention n = 1412, 45%). Average age was 9.2 years, 64% Hispanic, 47% male, and 69% eligible for free and reduced lunch. The intervention compared to control resulted in increased vegetable intake (+ 0.48 vs. + 0.04 frequency/day, p = 0.02). There were no effects of the intervention compared to control on fruit intake, sugar sweetened beverages, any of the obesity measures or blood pressure.

CONCLUSION

While this school-based gardening, nutrition, and cooking program did not reduce obesity markers or blood pressure, it did result in increased vegetable intake. It is possible that a longer and more sustained effect of increased vegetable intake is needed to lead to reductions in obesity markers and blood pressure.

CLINICAL TRIALS NUMBER

NCT02668744 .

Are Brazilian adolescents eating enough fruits and vegetables? An assessment using data from the Study of Cardiovascular Risk in Adolescents

ABSTRACT Objective To estimate the usual consumption of fruits and vegetables by Brazilian adolescents. Methods We used 24-hour dietary recall data from the Study of Cardiovascular Risk in Adolescents conducted in 2013-2014 with 71,740 adolescents between 12 and 17 years old. The usual consumption of fruits and vegetables was estimated in the Statistical Analysis Software using the model of the United States National Cancer Institute, and evaluated according to sex, age, place of residence, economic class, and nutritional status of the participants. Results The mean of usual fruit and vegetable consumption was estimated at 171g/day, mostly fruits (128g/day), mainly in the form of fruit juice (64.8%). The minimum fruit and vegetable consumption of 400g/day recommended by the World Health Organization was reached only by 2% of the adolescents. The adolescents’ socioeconomic class or nutritional status had no impact on the usual fruit and vegetable consumption, but adolescents from northern Brazil had a significantly lower consumption than those from the midwestern region. Orange was both the most consumed fruit on a daily basis (mean of 42.6g/day, 90% as juice) and the most reported fruit (by 12.7% of the adolescents), followed by apples (10g/day; 5.6%) and bananas (8.4g/day; 8.3%). Tomato was the most consumed vegetable (9.2g/day), reported by 11.5% of the adolescents. Conclusion Public health policies are necessary to encourage fruit and vegetable consumption among Brazilian adolescents, including of pure juice, essential foods to prevent chronic diseases in adulthood.

Relationships Among Parental Psychological Distress, Parental Feeding Practices, Child Diet, and Child Body Mass Index

BACKGROUND

Parents often play a main role in establishing the dietary patterns of preschool children, but there is no clear understanding about the relationship between parental psychological distress and child diet and body mass index (BMI).

OBJECTIVE

The aim of this study was to examine the relationships among parental psychological distress, parental feeding practices, child diet, and child BMI in families with young children.

METHODS

We conducted a mixed-methods study with families (parent-child dyad) of children aged 2-5 years. Measures included demographic data, parental general stress, parenting stress, parental sleep quality, parental depressive symptoms, social support for parents, mealtime environment, child feeding practice, child diet, and child BMI, with well-validated questionnaires completed by parents. Using structural equation models, we examined the path relationships of these factors. We also interviewed a subsample of 13 parents.

RESULTS

A total of 256 families participated. Higher parental psychological distress was associated with higher parental unhealthy feeding practices (B = 0.31, p < .01). However, a parental unhealthy practice in feeding was not associated with child's unhealthy diet or BMI. There was no direct relationship between parental psychological distress and child BMI. Social support for parents was significantly inversely related to parental psychological distress (B = -11.59, p < .01), and the relationship between social support for parents and parental unhealthy feeding practices approached significance (B = 6.11, p = .05). A main theme from analysis of parent interview was that parent stress and fatigue influenced their feeding and food preparation.

DISCUSSION

Parental psychological distress is a critical influential factor in parental feeding practices. This finding highlights potential foci in intervention programs to address parental psychological distress.

Relationship between perception of emotional home atmosphere and fruit and vegetable consumption in European adolescents: results from the I.Family survey

OBJECTIVE

Consumption of fruits and vegetables (F&V) among adolescents falls below recommendations in many Western countries. The impact of social and emotional aspects of family life on adolescent dietary behaviour may contribute to this, yet remains under-investigated. The present study examines the association between adolescents' perceptions of emotional home atmosphere (EHA) and their F&V consumption frequency.

DESIGN

An FFQ was used to assess F&V consumption frequency. EHA was assessed by an eight-item measure with three subscales: perceived home warmth, strictness and relational tension. EHA subscales were used as binary variables: a score equal to or above the median value was considered as a higher perception, while a score below the median was considered as a lower perception of the EHA in question. Country differences in meeting the European 5-a-day recommendations were described. Further, the association between EHA and F&V consumption frequency was investigated using multiple linear regression.

SETTING

Regional examination centres in eight European countries.

PARTICIPANTS

Adolescents (n 3196) aged 12-18 years.

RESULTS

The mean F&V consumption frequency was 3·27 (sd 2·84) times/d. Only 16·1 % of boys and 18 % of girls in our study sample met the recommendation of five F&V daily. After controlling for age, sex, education level of the parents and country of origin, perceived home warmth was associated with a 16 (95 % CI 9, 22) % higher F&V consumption frequency (P < 0·001).

CONCLUSIONS

F&V consumption frequency was suboptimal in the survey areas. Interventions targeting perceived warmth as a component of EHA could potentially have a positive effect on adolescents' dietary behaviour.

Predictors of Dietary Energy Density among Preschool Aged Children

Childhood obesity is a global problem with many contributing factors including dietary energy density (DED). This paper aims to investigate potential predictors of DED among preschool aged children in Victoria, Australia. Secondary analysis of longitudinal data for 209 mother–child pairs from the Melbourne Infant Feeding, Activity and Nutrition Trial was conducted. Data for predictors (maternal child feeding and nutrition knowledge, maternal dietary intake, home food availability, socioeconomic status) were obtained through questionnaires completed by first-time mothers when children were aged 4 or 18 months. Three 24-h dietary recalls were completed when children were aged ~3.5 years. DED was calculated utilizing three methods: “food only”, “food and dairy beverages”, and “food and all beverages”. Linear regression analyses were conducted to identify associations between predictors and these three measures of children’s DED. Home availability of fruits (β: −0.82; 95% CI: −1.35, −0.29, p = 0.002 for DED_food; β: −0.42; 95% CI: −0.82, −0.02, p = 0.041 for DED_{food+dairy beverages}) and non-core snacks (β: 0.11; 95% CI: 0.02, 0.20, p = 0.016 for DED_food; β: 0.09; 95% CI: 0.02, 0.15, p = 0.010 for DED_{food+dairy beverages}) were significantly associated with two of the three DED measures. Providing fruit at home early in a child’s life may encourage the establishment of healthful eating behaviors that could promote a diet that is lower in energy density later in life. Home availability of non-core snacks is likely to increase the energy density of preschool children’s diets, supporting the proposition that non-core snack availability at home should be limited.

Direct Effects of the Home, School, and Consumer Food Environments on the Association between Food Purchasing Patterns and Dietary Intake among Rural Adolescents in Kentucky and North Carolina, 2017

Background: Obesity rates are higher among rural versus urban adolescents. To examine possible mechanisms for the rural-urban adolescent obesity disparity, we examined the direct and indirect effects of food purchasing patterns, and the home, school, and consumer food environments on dietary intake among rural adolescents. Methods: A baseline survey was conducted among adolescents in eight rural high schools (four in Eastern Kentucky, and four in Eastern North Carolina). Participants answered questions about food purchasing patterns, dietary intake, home food availability, and demographics. The school and consumer food environments were assessed using validated measures from the School Meals Cost Study (United States Department of Agriculture-Mathematica) and the Nutrition Environment Measurement Survey for Stores, Restaurants, and Corner Stores. Results: Of 432 adolescents, 55% were normal weight, 24% were overweight, and 21% were obese. There was a direct association between unhealthy food purchasing patterns (shopping frequently at gas stations, fast food, and dollar stores) and consuming more added sugars, when compared to those with a healthy shopping pattern (shopping less frequently at gas stations, fast food, and dollar stores) [Odds Ratio = 2.41 (95% CI (confidence interval) 0.99, 3.82)]. Those who reported always having fruits and vegetables in the home consumed more servings of fruits and vegetables [OR = 0.31 cups (95% CI 0.22, 0.44)] compared to those who reported never having fruits and vegetables in the home. Adolescents attending a school with a low healthy food availability score consumed fewer servings of fruits and vegetables [−0.001 (95% CI −0.001, 0.0001)] compared to those attending a school with a high healthy food availability score. Conclusions: There are direct associations between food purchasing patterns, the home and school food environments, and dietary intake among rural adolescents. These cross-sectional results informed the development of the “Go Big and Bring it Home” program, a text messaging intervention to improve adolescents’ fruit, vegetable, and healthy beverage intake.

Multilevel Correlates of Healthy BMI Maintenance and Return to a Healthy BMI among Children in Massachusetts

OBJECTIVES

To examine predictors of healthy BMI maintenance (HBM) or return to a healthy BMI (RHB) among children.

METHODS

We studied 33,272 children in Massachusetts between 2008 and 2012. We used multinomial logistic regression to examine associations of individual- and neighborhood-level factors with the odds of: (1) HBM: maintenance of a healthy BMI ≥5th to <85th percentile and (2) RHB: transition to a healthy BMI range from an initial BMI ≥85th percentile between two clinic visits spanning an average of 3.5 years.

RESULTS

Racial/ethnic minorities had lower odds of HBM and RHB than non-Hispanic white children. Higher neighborhood educational attainment was associated with an increased odds of HBM and RHB. Higher neighborhood median household income, proximity to a supermarket, and access to more open recreational space were associated with a higher odds of HBM. Children of ages 2-5 years at baseline had higher odds of RHB and HBM than children 13 years and older.

CONCLUSIONS

Early childhood interventions and efforts to create health-promoting neighborhoods including improving access to supermarkets and open recreational space could have important effects on obesity prevention and management.

Relationship between the home environment and fruit and vegetable consumption in children aged 6-12 years: a systematic review

OBJECTIVE

As numerous factors in the home environment have been related to children's fruit and vegetable (F&V) consumption as a component of a healthy diet, the purpose of the present systematic review was to examine these factors specifically for children aged 6-12 years.

DESIGN

Relevant observational studies published in English between January 2007 and December 2015 were obtained through electronic database searches. Studies were included if the researchers reported on a potentially modifiable measure of the home physical, political and sociocultural environment related to child F&V consumption.

RESULTS

Of the thirty-three articles reviewed, overall methodological quality was poor with twenty studies rated as weak, mainly due to cross-sectional design (majority of studies), selection bias, convenience sampling and voluntary participation. Half of the studies had strong-moderate ratings for using valid and/or reliable tools while for the other half, psychometric properties were either not reported or weak. The most consistent evidence for children's combined F&V consumption was found for availability and accessibility of F&V, parental role modelling of F&V and maternal intake of F&V.

CONCLUSIONS

A vast array of home environment components and their influence on children's consumption of fruits and/or vegetables have been studied in recent years. Specific components of the home environment may have more influence than others, but more compelling evidence is needed to draw strong conclusions. Recommendations are made for future studies to be based upon conceptual/theoretical models to provide consistency in defining the home environment and investigation of potential moderators, such as personal or contextual factors.