Jeanne P. Goldberg

Why Americans Eat What They Do: Taste, Nutrition, Cost, Convenience, and Weight Control Concerns as Influences on Food Consumption

OBJECTIVE To examine the self-reported importance of taste, nutrition, cost, convenience, and weight control on personal dietary choices and whether these factors vary across demographic groups, are associated with lifestyle choices related to health (termed health lifestyle), and actually predict eating behavior. DESIGN Data are based on responses to 2 self-administered cross-sectional surveys. The main outcomes measured were consumption of fruits and vegetables, fast foods, cheese, and breakfast cereals, which were determined on the basis of responses to questions about usual and recent consumption and a food diary. SUBJECTS/SETTING Respondents were a national sample of 2,967 adults. Response rates were 71% to the first survey and 77% to the second survey (which was sent to people who completed the first survey). STATISTICAL ANALYSES Univariate analyses were used to describe importance ratings, bivariate analyses (correlations and t tests) were used to examine demographic and lifestyle differences on importance measures, and multivariate analyses (general linear models) were used to predict lifestyle cluster membership and food consumption. RESULTS Respondents reported that taste is the most important influence on their food choices, followed by cost. Demographic and health lifestyle differences were evident across all 5 importance measures. The importance of nutrition and the importance of weight control were predicted best by subjects membership in a particular health lifestyle cluster. When eating behaviors were examined, demographic measures and membership in a health lifestyle cluster predicted consumption of fruits and vegetables, fast foods, cheese, and breakfast cereal. The importance placed on taste, nutrition, cost, convenience, and weight control also predicted types of foods consumed. APPLICATIONS Our results suggest that nutritional concerns, per sc, are of less relevance to most people than taste and cost. One implication is that nutrition education programs should attempt to design and promote nutritious diets as being tasty and inexpensive.

A Community Intervention Reduces BMI z-score in Children: Shape Up Somerville First Year Results

Objective: The objective was to test the hypothesis that a community‐based environmental change intervention could prevent weight gain in young children (7.6 ± 1.0 years).

The Effects of School Garden Experiences on Middle School–Aged Students' Knowledge, Attitudes, and Behaviors Associated With Vegetable Consumption

This study describes the effects of garden-based education on children’s vegetable consumption. As part of a pre—post panel study, 236 students complete the Garden Vegetable Frequency Questionnaire and 161 complete a taste test. Results indicate that school gardening may affect children’s vegetable consumption, including improved recognition of, attitudes toward, preferences for, and willingness to taste vegetables. Gardening also increases the variety of vegetables eaten. Future research should explore whether effects persist over time and if and how changes in children’s behavior affect the behavior of their caregivers. Implications of study findings for policy and practice are discussed. Suggestions for applying results to future health promotions are provided.

Parent behavior and child weight status among a diverse group of underserved rural families.

The purpose of this study was threefold: to investigate the association between three parenting behaviors (parenting style, feeding style, and feeding practices), to evaluate whether these behaviors were associated with child weight, and to determine whether style (parenting and feeding) moderated the relationship between feeding practice and child weight. Ninety-nine parent-child dyads were recruited for a cross-sectional study where parents self-reported their parenting style, feeding style, and feeding practices along with demographic characteristics. Height and weight were measured for each dyad. The relationship between parenting style and feeding style showed modest agreement. Feeding style, but not parenting style, was associated with child BMI z-score while controlling for known covariates. An indulgent feeding style was associated with a higher child weight status. Multiple regression analysis demonstrated that feeding style moderated the association between restrictive feeding practices and child BMI z-score. No moderating relationship was found between feeding style and the practices of pressure to eat or monitoring and child weight. This research suggests that an indulgent feeding style may be predictive of higher child weight and that future studies should examine the possible moderating role of feeding style in the parent feeding practice-child weight relationship.

Parent-child interactions and objectively measured child physical activity: a cross-sectional study.

BackgroundParents influence their childrens behaviors directly through specific parenting practices and indirectly through their parenting style. Some practices such as logistical and emotional support have been shown to be positively associated with child physical activity (PA) levels, while for others (e.g. monitoring) the relationship is not clear. The objectives of this study were to determine the relationship between parents PA-related practices, general parenting style, and childrens PA level.MethodsDuring the spring of 2007 a diverse group of 99 parent-child dyads (29% White, 49% Black, 22% Hispanic; 89% mothers) living in low-income rural areas of the US participated in a cross-sectional study. Using validated questionnaires, parents self-reported their parenting style (authoritative, authoritarian, permissive, and uninvolved) and activity-related parenting practices. Height and weight were measured for each dyad and parents reported demographic information. Child PA was measured objectively through accelerometers and expressed as absolute counts and minutes engaged in intensity-specific activity.ResultsSeventy-six children had valid accelerometer data. Children engaged in 113.4 ± 37.0 min. of moderate-vigorous physical activity (MVPA) per day. Children of permissive parents accumulated more minutes of MVPA than those of uninvolved parents (127.5 vs. 97.1, p < 0.05), while parents who provided above average levels of support had children who participated in more minutes of MVPA (114.2 vs. 98.3, p = 0.03). While controlling for known covariates, an uninvolved parenting style was the only parenting behavior associated with child physical activity. Parenting style moderated the association between two parenting practices - reinforcement and monitoring - and child physical activity. Specifically, post-hoc analyses revealed that for the permissive parenting style group, higher levels of parental reinforcement or monitoring were associated with higher levels of child physical activity.ConclusionsThis work extends the current literature by demonstrating the potential moderating role of parenting style on the relationship between activity-related parenting practices and childrens objectively measured physical activity, while controlling for known covariates. Future studies in this area are warranted and, if confirmed, may help to identify the mechanism by which parents influence their childs physical activity behavior.

Shape Up Somerville two-year results: a community-based environmental change intervention sustains weight reduction in children.

OBJECTIVE The objective of this study was to test the hypothesis that community-based environmental change intervention prevents undesirable weight gain in children. METHOD The method used in this study was a two-year, non-randomized, controlled trial (2003-2005) using community-based participatory methodology in three diverse cities in Massachusetts: one intervention and two socio-demographically-matched control communities (pooled for analysis). Children (n=1028), with a mean age=7.61+1.04years participated. Interventions were made to improve energy balance by increasing physical activity options and availability of healthful foods (Year 1). To firmly secure sustainability, the study team supported policies and shifted intervention work to community members (Year 2). RESULTS Change in body mass index z-score (BMIz) was assessed by multiple regression, accounting for clustering within communities and adjusting for baseline covariates. Sex-specific overweight/obesity prevalence, incidence and remission were assessed. Over the two-year period, BMIz of children in the intervention community decreased by -0.06 [p=0.005, 95% confidence interval: -0.08 to -0.04] compared to controls. Prevalence of overweight/obesity decreased in males (OR=0.61, p=0.01) and females (OR=0.78, p=0.01) and remission increased in males (OR 3.18, p=0.03) and females (OR 1.93, p=0.03) in intervention compared to controls. CONCLUSION Results demonstrate promise for preventing childhood obesity using a sustainable multi-level community-based model and reinforce the need for wide-reaching environmental and policy interventions.

Permissive Parental Feeding Behavior Is Associated with an Increase in Intake of Low-Nutrient-Dense Foods among American Children Living in Rural Communities

Parents play an important role in shaping childrens eating habits. Few studies have evaluated the influence of both parenting style and parenting practices on child outcomes such as dietary intake. During spring 2007, 99 parent-child dyads from four rural US areas participated in this cross-sectional study. Child food intake was reported during two interviewer-administered, parent-assisted 24-hour recalls. Diet quality was defined as the average number of low-nutrient-dense (LND) foods consumed. Validated questionnaires were used to assess parental feeding practices and feeding style. Pearson correlations identified relationships among child food intake, parental feeding style typologies, and covariates. Regression analyses were used to predict child diet quality. Sixty percent of children and 76% of parents were overweight or obese. A permissive feeding style, which is highly responsive to a childs requests and sets few demands on him or her, was the most common (n=37) parental feeding style. This feeding style was associated with child intake of LND foods (r=0.3; P<0.001) and moderated the relationship between parental feeding practices and child intake of LND foods. In the presence of a permissive feeding style, higher levels of monitoring were associated with child intake of LND foods (β=.69; P<0.05). Parental feeding style may alter the effectiveness of parental feeding practices on childrens food intake. More research is needed to understand the parent-child feeding relationship in the context of parental feeding styles and practices.

Communicating Cardiovascular Disease Risk Due to Elevated Homocysteine Levels: Using the EPPM to Develop Print Materials:

Improving the effectiveness of written information to promote compliance with therapeutic regimens is essential, particularly among older adults. Guiding their development and evaluating their effectiveness with an accepted communication theory or model may help. A preliminary test of written materials developed within the context of the Extended Parallel Process Model (EPPM) to motivate compliant behaviors among older adults at risk for cardiovascular disease is described. Participants who were not previously following the recommendations felt more confident in their ability to do so after reading a high-threat/high-efficacy message. Advanced age, lower education level, an existing chronic illness, and a higher initial homocysteine level were factors associated with lower levels of perceived threat and/or fear and may have attenuated the effectiveness of the message. This study’s results contribute to our understanding of the usefulness of theory-guided written materials in motivating compliant health behaviors. Recommendations for using this model are provided.

School's out: what are urban children doing? The Summer Activity Study of Somerville Youth (SASSY)

BackgroundResearch indicates that in the United States, children experience healthier BMI and fitness levels during school vs. summer, but research is limited. The primary goal of this pilot study was to assess where children spend their time during the months that school is not in session and to learn about the different types of activities they engage in within different care settings. A secondary goal of this pilot study was to learn what children eat during the summer months.MethodsA nine-week summer study of 57 parents of second and third grade students was conducted in an economically, racial/ethnically and linguistically diverse US urban city. Weekly telephone interviews queried time and activities spent on/in 1) the main caregivers care 2) someone elses care 3) vacation 4) and camp. Activities were categorised as sedentary, light, moderate, or vigorous (0-3 scale). For each child, a mean activity level was calculated and weighted for proportion of time spent in each care situation, yielding a weighted activity index. On the last phone call, parents answered questions about their childs diet over the summer. Two post-study focus groups were conducted to help interpret findings from the weekly activity interviews.ResultsThe mean activity index was 1.05 ± 0.32 and differed between gender (p = 0.07), education (p = 0.08) and primary language spoken in the household (p = 0.01). Children who spent a greater percentage of time in parent care had on average a lower activity index (β = -0.004, p = 0.01) while children who spent a greater percentage of time in camp had a higher activity index (β = 0.004, p = 0.03). When stratified into type of camp, percentage of time spent in active camp was also positively associated with mean activity index (β = 0.005, p =< 0.001). With regards to diet, after adjusting for maternal education, children who attended less than five weeks of camp were four times more likely to eat their meals in front of the TV often/almost all of the time (OR = 4.0, 95%CI 1.0-16.2, p < 0.06).ConclusionsSummer activities and some dietary behaviours are influenced by situation of care and socio-demographic characteristics. In particular, children who spend a greater proportion of time in structured environments appear to be more active. We believe that this pilot study is an important first step in our understanding of what children do during the summer months.

Communicating actionable nutrition messages: challenges and opportunities

As long as health communications have existed in the USA, Americans have faced the task of sorting the agenda of the source from the advice it provides. That task has become more complicated as advances in the science of nutrition and the technology used to present it have heightened the complexity of nutrition communications. Getting consumers to adopt a healthier diet has been a protracted undertaking with limited successes along the way. The obesity epidemic has added urgency to this discourse: not only do we need to eat better, but most of us also need to eat less. This paper reviews the dynamics that have made the communication of accurate and actionable health behaviour information an ongoing challenge, and outlines strategies for moving ahead. It considers the interplay of four sets of factors: the evolutionary nature of the science on which recommendations are based; the many sources of communication about that science; the agendas or motivations of each source; and finally the multifaceted nature of consumers, the recipients of these communications. Communication alone has not been, and will not be, sufficient for consumers to adopt the behavioural changes endorsed by experts. Broad environmental interventions coupled with individual skills development will need to be part of the process. Ultimately, it is the consumer who decides what is for dinner. Media literacy will play a critical role in building consumer efficacy in sorting fact from fiction in order to select food for a healthful diet.