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Estradé M, Burgos-Gil R, Witting L, Rivera I, Gittelsohn J, Colón-Ramos U. Shared Perceptions on Upstream Factors that Influence Water and Sugar-Sweetened Beverage Consumption Among Hispanic Families in the Greater Washington, DC, Metro Area: Qualitative Results From Focus Group Discussions. J Acad Nutr Diet 2024; 124:833-840. [PMID: 38224835 DOI: 10.1016/j.jand.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND Hispanics in the United States are among those with highest consumption of sugar-sweetened beverages (SSBs) and lowest consumption of water. These dietary disparities are rooted in systemic influences that must be identified and addressed. OBJECTIVE The study aimed to describe how Hispanic parents currently living in the greater Washington, DC, metro area and born outside of the United States, perceived upstream factors that influenced their current beverage choice. DESIGN Six qualitative focus groups were conducted in Spanish in 2021. PARTICIPANTS/SETTING Hispanic parents (n = 31) of children enrolled in Early Head Start in the greater Washington, DC, metro area were recruited (all women, born outside the United States, and spoke Spanish as a first language). STATISTICAL ANALYSIS Verbatim transcripts were analyzed deductively using the Community Energy Balance Framework. RESULTS The five key findings were: Growing up (in their countries of origin in Central America and Mexico) participants were used to drinking water, often gathered it from the source, and liked its flavor. Relatives passed down their knowledge about potabilization of water, the health benefits of drinking water, and health consequences of drinking SSBs. Growing up, prepackaged SSBs were not as accessible compared with where they now live in the United States. Participants perceived that sociocultural hospitality norms dictated that guests should be served SSBs and not water. Participants noted that messages regarding juice and water across US public health programs and policies were not aligned. CONCLUSIONS These findings suggest there are opportunities for public health messaging and procurement of safe, palatable drinking water in lieu of SSBs and juice.
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Affiliation(s)
- Michelle Estradé
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Lillian Witting
- Milken Institute, School of Public Health, George Washington University, Washington, District of Columbia
| | | | - Joel Gittelsohn
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Uriyoán Colón-Ramos
- Milken Institute, School of Public Health, George Washington University, Washington, District of Columbia.
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Okoli CB, Arrington N, Hall J, Paulus T, Miles I, Shieh J, Sharpe K, Cotwright CJ. Black Parents' Perceptions and Barriers to Limiting Sugar-Sweetened Beverages Among Young Children: A Social Cognitive Theory Application. Child Obes 2024; 20:23-34. [PMID: 36576994 DOI: 10.1089/chi.2022.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction: Sugar-sweetened beverages (SSBs) are a major contributor to obesity among young children 0 to 5 years of age. In addition, parental beverage intake influences children's beverage intake. Objective: This study explores Black parents' perceptions about and barriers to limiting SSBs among young children. Methods: Twenty-seven Black parents participated in six focus groups conducted across the state of Georgia. Questions grounded in Social Cognitive Theory (SCT) assessed perceived health impacts of SSBs and water consumption, influences of beverage choices, barriers to limiting SSB intake, and resources needed to overcome barriers. Before the focus group sessions, participants completed a demographic survey. Quantitative data were analyzed using R statistical software. Focus group sessions were analyzed using NVivo. Results: Family and cultural norms, price, taste, flavor, water safety, tantrums, and product placement at grocery stores primarily influenced beverage choice and consumption. Restaurant refills, price, lack of confidence, advertisements, cravings, tantrums, and budget were perceived barriers to drinking more water and fewer SSBs daily. Resources Black parents noted would help in promoting and serving healthy beverages to their young children included education on beverage recommendations, training on how to read nutrition labels, healthy alternatives, and the presence of support systems. Conclusion: Findings from this study will inform interventions to reduce SSB intake among Black families with young children.
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Affiliation(s)
- Chisom B Okoli
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia, Athens, GA, USA
| | | | - Jori Hall
- College of Education, University of Georgia, Athens, GA, USA
| | - Trena Paulus
- Division of Family Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Isa Miles
- Isa Miles Consulting, Atlanta, GA, USA
| | - Josephine Shieh
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia, Athens, GA, USA
| | - Kassidy Sharpe
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia, Athens, GA, USA
| | - Caree J Cotwright
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia, Athens, GA, USA
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Reese AC, Burgos-Gil R, Cleary SD, Lora K, Rivera I, Gittelsohn J, Seper S, Monge-Rojas R, Colón-Ramos U. Use of a Water Filter at Home Reduces Sugary Drink Consumption among Parents and Infants/Toddlers in a Predominantly Hispanic Community: Results from the Water Up!@ Home Intervention Trial. J Acad Nutr Diet 2023; 123:41-51. [PMID: 35714910 PMCID: PMC9751227 DOI: 10.1016/j.jand.2022.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/10/2022] [Accepted: 06/09/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Water is recommended as an alternative for sugar-sweetened beverages (SSBs). Low-income, minority groups in the United States continue to exhibit high SSB and low water consumption, and are more likely to exceed 100% fruit juice recommendations. OBJECTIVE To test the effects of a home-based intervention designed to replace SSBs with tap water and reduce excess juice consumption among parents and their infants/toddlers. DESIGN Randomized controlled trial. PARTICIPANTS Parents (n = 92) of infants/toddlers who participated in three Early Head Start home-visiting programs that serve predominantly Hispanic, low-income communities during 2019-2021. INTERVENTION The 12-week intervention (Water Up!@Home) simultaneously addressed physical barriers to tap water consumption (via a water filter) and sociocultural barriers to replacing SSBs and juice with water (via a curriculum). Comparison group received a water filter only. We hypothesized that the intervention would lead to a reduction of 6 fl oz/d in SSB and juice consumption. MAIN OUTCOMES Parent-reported self and infant/toddler SSBs, water (filtered, tap, or bottled), and 100% fruit juice consumption. STATISTICAL ANALYSES Analysis of covariance to compare changes in consumption between experimental groups was performed. We also conducted t tests to assess changes within groups. RESULTS Participants in both groups reported significant reductions in SSBs from baseline (parents: intervention [-11.2 fl oz/d; P < 0.01]; comparison [-8.0 fl oz/d; P < 0.01]; children: intervention [-1.50 fl oz/d; P = 0.03]; comparison [-1.56 fl oz/d; P = 0.02]), increased water consumption (parents in both groups [+5.6 fl oz/d]; children: intervention [+3.61 fl oz/d; P = 0.01], comparison [+2.24 fl oz/d; P = 0.05]), mostly from filtered tap water. Differences between groups were not statistically significant. Intervention participants reported significant reductions in 100% fruit juice vs comparison (parents: -3.6 fl oz/d vs -1.0 fl oz/d; P < 0.01; children: -0.73 fl oz/d vs +0.48 fl oz/d; P = .03). CONCLUSIONS The intervention effectively reduced 100% fruit juice consumption. Water security should be examined as a contributor to SSB consumption in this population.
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Affiliation(s)
- Amanda C. Reese
- Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205
| | - Rosalina Burgos-Gil
- Early Childhood Programs, CentroNia, 1420 Columbia Rd., Washington, DC, 20009
| | - Sean D. Cleary
- Milken Institute School of Public Health, George Washington University,, 950 New Hampshire Avenue, #511, Washington DC 20052
| | - Karina Lora
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, #214, Washington DC 20052
| | - Ivonne Rivera
- Rivera Group, 8206 17th Avenue, Hyattsville, MD 20783
| | - Joel Gittelsohn
- Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Room W2041, Baltimore Maryland 21205
| | - Sara Seper
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington DC 20052
| | - Rafael Monge-Rojas
- Costa Rican Institute for Research and Education on Nutrition and Health (INCIENSA), San Jose, Costa Rica. 506-22799911
| | - Uriyoán Colón-Ramos
- Milken Institute, School of Public Health, George Washington University, Washington, DC.
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How providing a low-cost water filter pitcher led Latino parents to reduce sugar-sweetened beverages and increase their water intake: explanatory qualitative results from the Water Up!@Home intervention trial. Public Health Nutr 2022; 25:3195-3203. [PMID: 35983682 DOI: 10.1017/s1368980022001744] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study sought to explain results of the Water Up!@Home randomized controlled trial where low-income parents were randomized to receive an educational intervention +a low-cost water filter pitcher or only the filter. Parents in both groups had reported statistically significant reductions in SSB and increases in water intake post-intervention. DESIGN Qualitative explanatory in-depth interviews analyzed thematically and deductively. SETTING Washington DC metropolitan area, US. PARTICIPANTS Low-income Latino parents of infants/toddlers who had participated in the Water UP! @Home randomized controlled trial. RESULTS The filter stimulated water consumption in both groups by: 1) increasing parents' perception of water safety, 2) acting as a cue to action to drink water, 3) improving the flavor of water (which was linked to perceptions of safety), and 4) increasing the perception that this option was more economical than purchasing bottled water. Safe and palatable drinking water was more accessible and freely available in their homes; participants felt they did not need to ration their water consumption as before. Only intervention participants were able to describe a reduction in SSB intake and described strategies, skills, and knowledge gained to reduce SSB intake. Among the comparison group, there was no thematic consensus about changes in SSB or any strategies or skills to reduce SSB intake. CONCLUSIONS A low-cost water filter facilitated water consumption, which actively (or passively for comparison group) displaced SSB consumption. The findings have implications for understanding and addressing the role of water security on SSB consumption.
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Poirier L, Flores L, Rivera I, St Pierre C, Wolfson J, Fuster M, Gittelsohn J, Colón-Ramos U. Feasibility of collaborating with independent Latino-owned restaurants to increase sales of a healthy combo meal. J Public Health Res 2021; 11. [PMID: 34850621 PMCID: PMC8958448 DOI: 10.4081/jphr.2021.2659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/14/2021] [Indexed: 11/23/2022] Open
Abstract
Americans spend the majority of their food dollars at restaurants and other prepared food sources, including quick-service and fast-food restaurants (PFS); independent small restaurants make up 66% of all PFS in the US. In this feasibility study, 5 independent and Latino-owned PFS in the Washington DC metro area worked with academic partners to start offering healthy combo meals with bottled water and promote these using on-site, community, and social media advertising. The number of healthy combos sold was collected weekly, showing that the new combos sold, and customers in all 5 sites were surveyed as they exited the PFS (n=50): >85% had noticed the combo meals; 100% thought it was a good idea to offer it, 68% had ordered the combo (of these, >94% of customers responded that they liked it). Results suggest that it is feasible to work with independent Latino-owned restaurants to promote healthy combos and collect data. Significance for public health Consuming foods away from home once a week or more has been associated with risk for obesity, and targeting independent, ethnic restaurants (full service and fast casual) with health interventions can attract segments of populations that are more vulnerable to health disparities and are typically hard to reach. There is need to determine potential dietary health impacts on consumers, the potential for profitability at the restaurant level, and if these types of restaurant interventions can be a sustainable, all of which would likely improve community health. This report adds that it is feasible, based on operability, acceptability, and perceived sustainability, to work with independent-owned restaurants to promote healthier food and beverage alternatives.
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Affiliation(s)
- Lisa Poirier
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
| | | | | | - Christine St Pierre
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC.
| | - Julia Wolfson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
| | - Melissa Fuster
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA.
| | - Joel Gittelsohn
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
| | - Uriyoán Colón-Ramos
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC.
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