Jayna M. Dave

Parental involvement in interventions to improve child dietary intake: A systematic review

OBJECTIVE Interventions that aim to improve child dietary quality and reduce disease risk often involve parents. The most effective methods to engage parents remain unclear. A systematic review of interventions designed to change child and adolescent dietary behavior was conducted to answer whether parent involvement enhanced intervention effectiveness, and what type of involvement was most effective in achieving desired outcomes. METHOD In 2008, Pub Med, Medline, Psych Info, and Cochrane Library databases were searched to identify programs designed to change child and adolescent dietary intake that also involved parents. Methods of parental involvement were categorized based on the type and intensity of parental involvement. These methods were compared against intervention design, dietary outcomes, and quality of reporting (evaluated using CONSORT checklist) for each study. RESULTS The literature search identified 1774 articles and 24 met review criteria. Four studies systematically evaluated parent involvement with inconsistent results. Indirect methods to engage parents were most commonly used, although direct approaches were more likely to result in positive outcomes. Four studies met >70% of CONSORT items. CONCLUSION Limited conclusions may be drawn regarding the best method to involve parents in changing child diet to promote health. However, direct methods show promise and warrant further research.

Neighborhood Disparities in Access to Healthy Foods and Their Effects on Environmental Justice

Environmental justice is concerned with an equitable distribution of environmental burdens. These burdens comprise immediate health hazards as well as subtle inequities, such as limited access to healthy foods. We reviewed the literature on neighborhood disparities in access to fast-food outlets and convenience stores. Low-income neighborhoods offered greater access to food sources that promote unhealthy eating. The distribution of fast-food outlets and convenience stores differed by the racial/ethnic characteristics of the neighborhood. Further research is needed to address the limitations of current studies, identify effective policy actions to achieve environmental justice, and evaluate intervention strategies to promote lifelong healthy eating habits, optimum health, and vibrant communities.

Associations among Food Insecurity, Acculturation, Demographic Factors, and Fruit and Vegetable Intake at Home in Hispanic Children

The purpose of this cross-sectional pilot study was to examine associations between food insecurity, acculturation, demographic factors, and childrens fruit and vegetable intake among a sample of Hispanic children ages 5 to 12 years. A convenience sample of 184 parents of low socioeconomic status completed one-time, self-administered questionnaires assessing demographic information, acculturation, and food insecurity in the spring of 2006. In addition, childrens fruit and vegetable intake at home was measured using a validated seven-item index. Parents were recruited through local elementary schools in San Antonio, TX. Pearson and Spearman correlations were used to examine the associations between the variables. t tests were used to explore the differences in means of childrens fruit and vegetable intake at home for acculturation and food insecurity levels. Statistical significance was set at P<0.05. Significant correlations were found between demographic variables, acculturation, food insecurity, and childrens fruit and vegetable intake at home. The overall mean fruit and vegetable intake at home was 1.04+/-0.63 (mean+/-standard deviation) servings per day. Higher rates of acculturation and higher rates of food insecurity were associated with lower fruit and vegetable intake at home. The findings reported in this study suggest a need for culturally tailored interventions targeting Hispanic children because fruit and vegetable intake at home among Hispanic children was low, regardless of the level of acculturation or food insecurity.

Relationship of Attitudes Toward Fast Food and Frequency of Fast-food Intake in Adults

The purpose of the study was to examine the association between attitudes toward fast food and the frequency of fast‐food intake in adults. This study is a cross‐sectional evaluation of random digit‐dial telephone surveys to identify patterns of eating away from home and attitudes toward it. Participants included 530 adults (94% white, 65% women, 70% married, 42% with college educated). Attitudes toward fast food was measured using an 11‐item, 4‐dimensional scale: perceived convenience of fast food (α = 0.56); fast food is fun and social (α = 0.55); fast food perceived as unhealthful (α = 0.45); and dislike toward cooking (α = 0.52). Frequency of fast‐food intake was found to be significantly associated with age (odds ratios (OR) = 0.981, P = 0.001), gender (men > women), and marital status of the participants (single > married/partnered and divorced/separated/widowed). Additionally, frequency of fast‐food intake was also found to be significantly associated with perceived convenience of fast food (OR = 1.162, P < 0.001) and dislike toward cooking (OR = 1.119, P < 0.001) but not with perceived unhealthfulness of fast food (OR = 0.692, P = 0.207). These findings suggest public education regarding the unhealthfulness of fast food may not influence fast food consumption. Interventions targeting the issue of convenience and quick or efficient preparation of nutritious alternatives to fast food could be more promising.

Changing the home nutrition environment: Effects of a nutrition and media literacy pilot intervention

The specific aim for this pilot study was to evaluate the effectiveness of a nutrition and media literacy intervention targeting elementary students and their parents. The purpose of the intervention was to increase child fruit and vegetables (FV) consumption and change the home nutrition environment (measured with FV availability and accessibility and parental social support). During the intervention, students learned about nutrition, the role media plays in shaping values concerning nutrition, and developed a media campaign for their parents. A quasi-experimental research design was used to evaluate the effectiveness of the intervention. The media intervention was effective in changing the home environment.

Traditional Foods and Practices of Spanish-Speaking Latina Mothers Influence the Home Food Environment: Implications for Future Interventions

This study aimed to obtain in-depth information from low-income, Spanish-speaking Latino families with young children to guide the development of culturally appropriate nutrition interventions. Focus groups were used to assess parents knowledge about healthful eating, the home food environment, perceived influences on childrens eating habits, food purchasing practices, and commonly used strategies to promote healthful eating among their children. Thirty-four Latino parents (33 women; 27 born in Mexico; 21 food-insecure) of preschool-aged children participated in four focus group discussions conducted in Spanish by a trained moderator. The focus groups were audiotaped, transcribed, translated, and coded by independent raters. Results suggest that in general, parents were very knowledgeable about healthful eating and cited both parents and school as significant factors influencing childrens eating habits; at home, most families had more traditional Mexican foods available than American foods; cost and familiarity with foods were the most influential factors affecting food purchasing; many parents had rules regarding sugar intake; and parents cited role modeling, reinforcement, and creative food preparation as ways to encourage childrens healthful eating habits. Finally, parents generated ideas on how to best assist Latino families through interventions. Parents indicated that future interventions should be community based and teach skills to purchase and prepare meals that include low-cost and traditional Mexican ingredients, using hands-on activities. In addition, interventions could encourage and reinforce healthy food-related practices that Latino families bring from their native countries.

Correlates of availability and accessibility of fruits and vegetables in homes of low-income Hispanic families

Availability and accessibility (AA) has been consistently shown across studies as the most important correlate of fruits and vegetables (FV) intake. However, there is little data on factors that influence AA of FV, especially in Hispanic families. The objective of this cross-sectional study was to examine the association between parental factors, childs preferences for FV and AA of FV in homes of low-income Hispanic families with children 5-12 years old. A convenience sample of 184 parents of low socioeconomic status recruited through public elementary schools completed a self-administered questionnaire about demographics, language spoken at home and food insecurity (FI). Parental factors and childs preferences were measured using a 16-item questionnaire, which was developed specifically for the study. AA of FV was measured using a validated nine-item index. Hierarchical multiple regression analysis indicated that language spoken at home, parental practices that promote consumption of FV, parental role modeling and perceived benefits of fast food had significant and independent associations with AA of FV at home. Intervention programs should take into consideration the language spoken at home and target at improving parental factors in order to improve AA of FV.

Differential Improvements in Student Fruit and Vegetable Selection and Consumption in Response to the New National School Lunch Program Regulations: A Pilot Study

OBJECTIVE To investigate changes in student food selection and consumption in response to the new National School Lunch Program meal patterns during fall 2011. DESIGN Eight elementary and four intermediate schools in one Houston area school district were matched on free/reduced-price meal eligibility and randomized into control or intervention conditions. INTERVENTION Both intervention and control school cafeterias served the same menu. The intervention school cafeterias posted the new meal pattern daily; students could select one fruit and two vegetable servings per reimbursable meal. Control school students could only select the previous meal pattern: a total of two fruit and vegetable servings per meal. MAIN OUTCOME MEASURES Students were observed during lunch: student sex and foods selected/consumed were recorded. Diet analysis software was used to calculate energy/food groups selected/consumed. STATISTICAL ANALYSES PERFORMED Cochran-Mantel-Haenszel χ² tests examined differences in the percent of students selecting each meal component by condition, controlling for sex, grade, and school free/reduced-price meal eligibility. Analysis of covariance assessed differences in amount of energy/food groups selected and consumed, and differences in percent of food groups consumed. RESULTS Observations were conducted for 1,149 elementary and 427 intermediate students. Compared with students in the control schools, significantly more intervention elementary and intermediate school students selected total (P<0.001, P<0.05) and starchy vegetables (P<0.001, P<0.01); more intervention intermediate school students selected fruit (P<0.001), legumes (P<0.05), and protein foods (P<0.01). There were significantly greater amounts of these foods selected and consumed, but no differences in the proportion of the foods consumed by condition. Fewer calories were consumed by elementary and intermediate school intervention students. CONCLUSIONS More intervention students selected fruit and vegetables at lunch and consumed them compared with control condition students. Future studies with larger and more diverse student populations are warranted.

Parent-reported Social Support for Child's Fruit and Vegetable Intake: Validity of Measures

OBJECTIVE To develop and validate measures of parental social support to increase their childs fruit and vegetable (FV) consumption. DESIGN Cross-sectional study design. SETTING School and home. PARTICIPANTS Two hundred three parents with at least 1 elementary school-aged child. MAIN OUTCOME MEASURE Parents completed a questionnaire that included instrumental social support scale (ISSPS), emotional social support scale (ESSPS), household FV availability and accessibility index, and demographics. ANALYSIS Exploratory factor analysis with promax rotation was conducted to obtain the psychometric properties of ISSPS and ESSPS. Internal consistency and test-retest reliabilities were also assessed. RESULTS Factor analysis indicated a 4-factor model for ESSPS: positive encouragement, negative role modeling, discouragement, and an item cluster called reinforcement. Psychometric properties indicated that ISSPS performed best as independent single scales with α = .87. Internal consistency reliabilities were acceptable, and test-retest reliabilities ranged from low to acceptable. Correlations between scales, subscales, and item clusters were significant (P < .05). In addition, ISSPS and the positive encouragement subscale were significantly correlated with household FV availability. CONCLUSIONS AND IMPLICATIONS The ISSPS and ESSPS subscales demonstrated good internal consistency reliability and are suitable for impact assessment of an intervention designed to target parents to help their children eat more fruit and vegetables.

Supplemental Nutrition Assistance Program participation did not help low income Hispanic women in Texas meet the dietary guidelines.

OBJECTIVE Low-income Hispanic women are at greater risk for dietary deficiencies and obesity. We assessed the association between Supplemental Nutrition Assistance Program participation and dietary intake among 661 Hispanic women aged 26-44 years living in Texas. METHODS Cross-sectional data was collected using standard methods. Analysis of variance and logistic regression examined the influence of Supplemental Nutrition Assistance Program on diet after adjusting for household characteristics, body mass index, and food security status. RESULTS Most women did not meet recommended dietary guidelines. Supplemental Nutrition Assistance Program participants consumed higher amounts of total sugars, sweets-desserts, and sugar-sweetened beverages than Supplemental Nutrition Assistance Program nonparticipants. High sodium intakes and low dairy consumption were observed in both groups. Only 27% of low-income eligible women received Supplemental Nutrition Assistance Program benefits. DISCUSSION Low-income Hispanic women participating in Supplemental Nutrition Assistance Program reported less healthful dietary patterns than nonparticipants. This may contribute to the increased obesity prevalence and related comorbidities observed in this population. CONCLUSION Supplemental Nutrition Assistance Program should play an important role in enhancing the overall dietary quality of low-income households. Policy initiatives such as limiting the purchase of sugar-sweetened beverages and education to enable women to reduce consumption of high sodium processed foods deserve consideration as means to improve the dietary quality of Supplemental Nutrition Assistance Program participants. Effective measures are needed to increase Supplemental Nutrition Assistance Program participation rates among Hispanics.