Feeding decision-making among first generation Latinas living in non-metropolitan and small metro areas

The Role of Intervention Fidelity, Culture, and Individual-Level Factors on Health-Related Outcomes Among Hispanic Adolescents with Unhealthy Weight: Findings from a Longitudinal Intervention Trial

Previous studies have suggested the impact of intervention fidelity on the management and prevention of chronic diseases; however, little is known about the effect of the contributing determinants (at multiple levels of influence) that can impact health-related interventions intending to improve the health status of Hispanic adolescents with overweight or obesity. The current study aimed to assess whether fidelity (i.e., dosage and quality of the program delivery), acculturation (i.e., orientation to the American culture, retention of Hispanic cultural values), and individual-level socio-demographic characteristics (i.e., income, education) predict changes in family processes (e.g., parent control), which in turn may affect adolescent health-related outcomes including body mass index (BMI), physical activity, dietary intake, and adolescents' health-related quality of life. A pathway analysis model was utilized to explore the study variables among 140 Hispanic parent-adolescent dyads randomized to Familias Unidas Health and Wellness (FUHW) intervention. Results indicated that fidelity was significantly associated with changes in parent-adolescent communication, parent monitoring, limit-setting, and control. Parents' education was associated with changes in parent limit-setting, and parent Hispanicism was associated with changes in parent limit-setting and discipline. The examination between family processes and adolescent health outcomes revealed that parents' higher discipline and improved communication with their adolescents were significantly associated with improved adolescents' quality of life, and parent control was positively associated with physical activity and negatively associated with BMI in adolescents. Our findings demonstrated the significant contribution of intervention fidelity and participants' characteristics in parenting strategies leading to adolescents' health outcomes to prevent obesity-related chronic diseases. Future research is needed to investigate the effect of environmental and organizational factors on the delivery of the intervention materials.

Alaska Native Parents' Decision-Making About Food, Beverages, and Screen Time for Young Children: Formative Insights From the "Got Neqpiaq?" Project

With rising childhood obesity rates, ensuring children adopt healthy habits early is imperative. Given the unique context for Alaska Native families living in rural remote communities, who are concurrently experiencing changes in traditional practices, we investigated what impacts parents' decisions as they relate to daily living before revising a preschool curriculum focused on healthy habits. The objective of this study was to explore factors influencing parents' decisions about their children's foods, beverages, and activities. In focus group discussions with AN parents of young children across 12 communities, we asked about meals, traditional foods, beverages, physical activity, and screen time. All sessions were recorded, transcribed, and analyzed using open and selective coding to allow the most important themes to emerge. As parents discussed how they make decisions, several trends emerged related to adults' and children's food and beverage preferences; the impact of adult modeling on children; and how convenience, seasonality, access, and a reluctance to engage in conflict all impact decision-making. Parents and other community members shared important perspectives on exposing children to traditional subsistence foods and activities and passing important traditional knowledge to them at an early age. These perspectives will form the basis for preschool curricula in these communities.

The Determinants of Food Insecurity Among Hispanic/Latinx Households With Young Children: A Narrative Review

Food insecurity has disproportionately impacted Hispanic/Latinx households in the United States, specifically those with young children. Although the literature provides evidence of an association between food insecurity and adverse health outcomes in young children, minimal research has addressed the social determinants and related risk factors associated with food insecurity among Hispanic/Latinx households with children under three, a highly vulnerable population. Using the Socio-Ecological Model (SEM) as a framework, this narrative review identified factors associated with food insecurity among Hispanic/Latinx households with children under three. A literature search was conducted using PubMed and four additional search engines. Inclusion criteria consisted of articles published in English from November 1996 to May 2022 that examined food insecurity among Hispanic/Latinx households with children under three. Articles were excluded if conducted in settings other than the US and/or focused on refugees and temporary migrant workers. Data were extracted (i.e., objective, setting, population, study design, measures of food insecurity, results) from the final articles (n = 27). The strength of each article's evidence was also evaluated. Results identified individual factors (i.e., intergenerational poverty, education, acculturation, language, etc.), interpersonal factors (i.e., household composition, social support, cultural customs), organizational factors (i.e., interagency collaboration, organizational rules), community factors (i.e., food environment, stigma, etc.), and public policy/societal factors (i.e., nutrition assistance programs, benefit cliffs, etc.) associated with a food security status of this population. Overall, most articles were classified as "medium" or higher quality for the strength of evidence, and more frequently focused on individual or policy factors. Findings indicate the need for more research to include a focus on public policy/society factors, as well as on multiple levels of the SEM with considerations of how individual and policy levels intersect and to create or adapt nutrition-related and culturally appropriate interventions to improve food security of Hispanic/Latinx households with young children.

A Healthy Lifestyle Intervention for Hispanic Families: Moderating Effects of Education, Income, Nativity

OBJECTIVE

To explore the moderation effect of parental social determinant factors-educational attainment, income, and nativity-on intervention effects of a family-based lifestyle intervention, Familias Unidas for Health and Wellness (FUHW).

DESIGN

Longitudinal analysis across 6- and 24-months postbaseline of a randomized controlled trial.

PARTICIPANTS

Two-hundred and eighty primary caregivers.

ANALYSIS

Moderation analysis was used to examine the interactive effects between intervention effects and social determinant factors.

MAIN OUTCOME MEASURES

Parental body mass index, added sugar intake, sugar-sweetened beverage intake, and fruits and vegetable intake.

RESULTS

Findings indicated that FUHW effects on added sugar intake were moderated by educational attainment (P = 0.006), income (P = 0.023), and nativity (P = 0.024). In addition, FUHW effects on sugar-sweetened beverage intake were moderated by parent education (P = 0.042).

CONCLUSIONS AND IMPLICATIONS

This study suggests that FUHW may be helpful in reducing added sugar and sugar-sweetened beverage intake for Hispanic parents who face social determinant factors-educational attainment, income, and foreign-born status-that may influence their dietary behaviors. By including demographic information in intervention development, effects may be enhanced by ensuring that considerations related to participants' socioeconomic and cultural status are incorporated into intervention components and help reduce overweight and obesity.

Racial/ethnic differences in maternal feeding practices and beliefs at 6 months postpartum

OBJECTIVE

To examine racial/ethnic differences in maternal feeding practices and beliefs in a sample of low-income smoke-exposed women.

DESIGN

Cross-sectional analysis using data collected during a randomised control trial. Maternal feeding practices and beliefs were assessed using the Infant Feeding Questionnaire (IFQ), which was administered at 6 months postpartum. ANOVA was used to examine differences in IFQ items by race/ethnicity, while multivariable linear regression models were used to examine differences in IFQ factor scores by race/ethnicity adjusting for potential confounders.

SETTING

Participants were recruited from prenatal clinics.

PARTICIPANTS

343 women (39 % non-Hispanic White, 28 % Hispanic/Latina, 13 % Black, and 20 % other).

RESULTS

Racial/ethnic minority mothers were more likely than non-Hispanic White mothers to put cereal in their infant's bottle so that the infant would stay full longer (P = 0·032), state their infant wanted more than just formula or breast milk prior to 4 months (P = 0·019), allow their infant to eat whenever he/she wanted (P = 0·023) and only allow their infant to eat at set times (P < 0·001). Adjusting for potential confounders, racial/ethnic minority mothers had higher scores for factors 1 (concern about infant undereating or becoming underweight), 2 (concern about infant's hunger), 4 (concern about infant overeating or becoming overweight) and 5 (feeding infant on a schedule), and lower scores for factor 7 (social interaction with the infant during feeding) than White mothers. Racial/ethnic differences were not found for the other two factors.

CONCLUSIONS

Differences in maternal feeding practices and beliefs across race/ethnicity are present at 6 months postpartum.

Cultural Health Beliefs and Practices Among Hispanic Parents

Parents' beliefs about and approaches to their child's health vary with culture and change within cultures over time. To provide an updated understanding of folk and traditional medicine (FTM) among Hispanic parents in the United States, we surveyed 200 caregivers identifying their child as Hispanic in a pediatric primary care clinic about their cultural health beliefs and practices. Overall, 84% of participants believed in ≥1 folk illness, with foreign-born participants more likely than US-born to endorse folk illness beliefs. Eighty-three percent had used cultural remedies for their children. Of those, although just 15% had discussed such practices with their child's provider, 86% would feel comfortable doing so. No demographic factors predicted use of cultural remedies/healers or comfort talking to providers. Beliefs and practices related to FTM are prevalent among Hispanic parents and cannot be predicted using demographics; providers should routinely ask all families about FTM.

'They Are Kids, Let Them Eat': A Qualitative Investigation into the Parental Beliefs and Practices of Providing a Healthy Diet for Young Children among a Culturally Diverse and Deprived Population in the UK

In the UK, ethnic minority children are at greater risk of obesity and weight-related ill health compared to the wider national population. The factors that influence the provision of a healthy diet among these populations remain less understood. An interpretive qualitative study with a phenomenological perspective comprised of 24 single sex semi-structured focus groups was conducted with 110 parents (63 mothers and 47 fathers) of young children (aged 0-5 years). The participants were recruited from deprived and ethnically diverse wards in Luton, UK and self-identified as being white British, Pakistani, Bangladeshi, black African-Caribbean or Polish. The findings highlighted a wide range of inter-relating psychological and sociocultural factors that underpin parental beliefs and practices in providing children with a healthy diet. Parents, whilst aware of the importance of providing children with a healthy diet, faced challenges such as lack of time and balancing competing responsibilities, which were clear barriers to providing children with a healthy diet. Access to and affordability of healthy food and the overexposure of cheap, convenient, and unhealthy processed foods made it increasingly difficult for parents to provide a healthy diet for their growing families. Household food practices were also found to be situated within the wider context of sociocultural and religious norms around cooking and eating, along with cultural identity and upbringing.

Food environment interactions after migration: a scoping review on low- and middle-income country immigrants in high-income countries

Objective:

To map and characterise the interactions between the food environment and immigrant populations from low- and middle-income countries living in high-income countries.

Design:

A scoping review was carried out following the framework outlined by Arksey and O’Malley, as well as Levac et al. Peer-reviewed studies in English published between 2007 and 2021 were included. Two reviewers screened and selected the papers according to predefined inclusion criteria and reporting of results follows the PRISMA-ScR guidelines. A ‘Best fit’ framework synthesis was carried out using the Analysis Grid for Environments Linked to Obesity (ANGELO) framework.

Setting:

High-income countries.

Participants:

Immigrants from low- and middle-income countries.

Results:

A total of sixty-eight articles were included, primarily based in the USA, as well as Canada, Australia and Europe, with immigrants originating from five regions of the globe. The analysis identified three overarching themes that interconnected different aspects of the food environment in addition to the four themes of the ANGELO framework. They demonstrate that in valuing fresh, healthy and traditional foods, immigrants were compelled to surpass barriers in order to acquire these, though children’s demands, low incomes, time scarcity and mobility influenced the healthiness of the foods acquired.

Conclusion:

This study brought together evidence on interactions between immigrant populations and the food environment. Immigrants attempted to access fresh, traditional, healthier food, though they faced structural and family-level barriers that impacted the healthiness of the food they acquired. Understanding the food environment and interactions therein is key to proposing interventions and policies that can potentially impact the most vulnerable.

"I Don't Have Time to Be Sad": Experiences and Perceptions of Sadness among Latina Mothers

Maternal depression affects 10 percent to 17 percent of mothers in the United States. Women of color, particularly Latina women, may be at an elevated risk for adverse consequences of maternal depression. However, scant research addresses cultural experiences and perceptions of maternal depressive feelings. This study included interviews with 30 Latina immigrant mothers who were living in rural or small towns in the Midwest. Data were analyzed in Spanish using a thematic network approach. Authors identified three themes in relation to the experiences that Latina immigrant mothers described around sadness and depressive feelings: (1) normalization of feelings of sadness, (2) lack of social support that exacerbates feelings of isolation and sadness, and (3) traditional gender roles that compromise disclosure of feelings. The results from this study indicate that it is critical to increase support, provide culturally grounded discussions around mental health among Latina immigrant women, and continue these conversations beyond the perinatal period.

Brazilian immigrant fathers' perspectives on child's eating and feeding practices: a qualitative study conducted in the United States

OBJECTIVES

Brazilians comprise a rapidly growing immigrant Latino group in the USA, yet little research has focused on health issues affecting Brazilian children in immigrant families. As increasing evidence is documenting fathers' influential role in their children's eating behaviours and ultimately weight status, the current study sought to explore the Brazilian immigrant fathers' perspectives and practices related to child's feeding practices and their preschool-aged children's eating.

DESIGN

Qualitative study using in-depth, semi-structured interviews. Interviews were conducted in Portuguese by native Brazilian research staff using a semi-structured interview guide. Interviews were audio-recorded and transcribed verbatim. Transcripts were analysed thematically using a hybrid approach that incorporated deductive and inductive analytical approaches.

SETTING

Massachusetts.

PARTICIPANTS

Twenty-one Brazilian immigrant fathers who had at least one child aged 2-5 years.

RESULTS

Results revealed fathers' awareness of the importance of healthy eating for their children, their influence as role models and their involvement in feeding routines of their preschool-aged children. Moreover, fathers were receptive to participating in family interventions to promote their children's healthy eating. Nearly all fathers reported wanting to learn more and to do 'what's right' for their children.

CONCLUSIONS

The current study provides new information about Brazilian immigrant fathers' views about factors influencing their children's healthy eating behaviours and paternal feeding practices. Future research should quantify fathers' feeding styles and practices and solicit fathers' input in the design of culturally appropriate family interventions targeting the home environment of preschool-aged children of Brazilian immigrant families.

“Diberi air gula… awalnya nangis menjadi diam, karena kenyang, gak lemas, daya tahan tubuhnya meningkat”; Studi Pola Asupan pada Bayi

Background: Babies were vulnerable to health and nutrition problems. WHO states that 60% of deaths of children under five were caused by malnutrition. Of these, two-thirds of them were caused by improper feeding of babies. Objective: to describe patterns of food intake in infants in Kepung Village, Kediri District.Methods: The study was designed qualitatively with an ethnographic approach. Data collection was performed using in-depth interviews and participatory observation. The study was conducted in Kepung Village, Kediri, East Java. The process of collecting data was done by researchers by staying with the target for 6 months. Results: The pattern of intake in infants aged 0-6 months in Kepung Village was not only given breast milk but was given food in the form of formula milk, sugar water and ‘kepok’ banana. When the mother or caregiver feels that the baby was still hungry, it will be given food intake other than the milk. The practice of feeding was inseparable from the influence of hereditary belief, where sugar water was believed to make the baby not fussy because the baby becomes full and healthy. Conclusion: The pattern of intake in infants in Kepung Village was very varied. Not only breast milk, babies have also been given mashed up adult food. People in Kepung Village also have a habit of giving their babies sugar water. ABSTRAKLatar Belakang: Bayi adalah masa yang rentan terhadap masalah kesehatan dan gizi. WHO menyatakan bahwa 60% kematian anak balita disebabkan oleh keadaan kurang gizi. Dari jumlah tersebut, dua per tiga diantaranya disebabkan oleh pemberian makan yang kurang tepat.Tujuan: Penelitian ditujukan untuk menggambarkan pola asupan pada bayi di Desa Kepung, Kabupaten Kediri.Metode: Studi didesain secara kualitatif dengan pendekatan etnografi. Pengumpulan data dilakukan dengan menggunakan metode wawancara mendalam dan observasi partisipatif. Studi dilakukan di Desa Kepung, Kecamatan Kepung, Kabupaten Kediri, Jawa Timur. Proses pengumpulan data dilakukan oleh peneliti dengan tinggal bersama target. Peneliti lived in di lokasi penelitian selama 6 bulan.Hasil: Pola asupan pada bayi usia 0-6 bulan di Desa Kepung tidak hanya diberikan ASI saja, tapi diberikan makanan berupa susu formula, air gula dan pisang kepok. Praktik pemberian makanan tersebut tidak terlepas dari pengaruh kepercayaan yang turun-temurun, yang mana air gula diyakini dapat membuat bayi tidak rewel karena bayi menjadi kenyang dan menyehatkan.Kesimpulan: Pola asupan pada bayi di Desa Kepung sangat bervariasi. Tidak hanya ASI, bayi juga sudah diberi makanan orang dewasa yang dilembutkan. Masyarakat di Desa Kepung juga memiliki kebiasaan memberikan bayinya air gula.

Hidden Realities of Infant Feeding: Systematic Review of Qualitative Findings from Parents

A growing, global conversation, regarding realities and challenges that parents experience today is ever-present. To understand recent parent's attitudes, beliefs, and perceptions regarding infant feeding, we sought to systematically identify and synthesize original qualitative research findings. Following the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) framework, electronic databases were searched with a priori terms applied to title/abstract fields and limited to studies published in English from 2015 to 2019, inclusive. Study quality assessment was conducted using the Critical Appraisal Skills Programme (CASP) checklist, and thematic analyses performed. Of 73 studies meeting inclusion criteria, four major themes emerged. (1) Breastfeeding is best for an infant; (2) Distinct attitudes, beliefs, and perceptions of mothers that breastfeed, and those that could not or chose not to breastfeed, are evident; (3) Infant feeding behaviors are influenced by the socio-cultural environment of the family, and (4) Parent's expectations of education and support addressing personal infant feeding choices from health care providers are not always met. This systematic review, guided by constructs within behavioral models and theories, provides updated findings to help inform the development of nutrition education curricula and public policy programs. Results can be applied within scale-up nutrition and behavioral education interventions that support parents during infant feeding.

Youngest versus oldest child: why does mothers' snack choice differ?

Young children frequently consume energy dense snacks, which is one of the factors contributing to childhood overweight. The consumption of more healthy snacks could help in meeting the dietary intake requirements of children. Previous research suggested that mothers of first children showed more health-conscious food behavior compared to mothers of not-first children. However, what is missing from earlier research is an in-depth exploration of differences in considerations to choose a snack and the reasons connected. Therefore, this study aims to characterize differences in mothers' snack choice for their youngest child at 2-3 years and their oldest child when he/she was of the same age. Moreover, this study aims to identify reasons for these differences. A grounded theory approach was used for data collection and analysis. Semi-structured interviews were carried out with 17 Dutch mothers with two or three children. All mothers indicated differences between snacks provided to their youngest child (2-3 years) and their oldest child when it was of the same age. Most frequently mentioned differences were youngest children receive unhealthy snacks at a younger age, the structure regarding snack providing is more fixed, and that youngest children receive less age-specific snacks. Most frequently mentioned reasons for these differences were role-modelling, novelty of the first-born, availability of other types of snacks at home, and school hours of the oldest child. The study provided insights into the possible role of siblings in shaping snack consumption. Results might be relevant for the development of intervention strategies to increase mothers' awareness and to help to meet children's dietary requirements.