L. Suzanne Goodell

Parental Information, Motivation, and Behavioral Skills Correlate with Child Sweetened Beverage Consumption

OBJECTIVE To evaluate fit of the Information-Motivation-Behavioral Skills (IMB) model applied to sweetened beverage (SB) consumption in children. DESIGN Cross-sectional. Parents completed a home beverage inventory and IMB survey regarding SB consumption. SETTING Health fairs, Special Supplemental Nutrition Program for Women, Infants, and Children clinics. PARTICIPANTS Convenience sample of 198 parents of low socioeconomic status. MAIN OUTCOME MEASURES Independent variables included scores from 3 indices calculated from the IMB survey, information, motivation, and behavioral skills. The dependent variable was average child daily caloric consumption from SB consumption calculated from the home beverage inventory. ANALYSIS Structural equation modeling. RESULTS Parental information had direct and indirect negative relationships with SB consumption. Parental motivation was only indirectly associated with SB consumption mediated through behavioral skills. Parental behavioral skills had a negative correlation with SB consumption. CONCLUSIONS AND IMPLICATIONS In applying the IMB model to SB consumption, the authors found preliminary support for relationships between parental information, motivation, behavioral skills, and child SB consumption. Application of this model shows promise in identifying the complex interactions between factors influencing consumption behaviors. As nutrition educators frequently desire to alter behaviors, use of the IMB model may help with both targeting and assessment efforts.

Feeding practices of low-income mothers: how do they compare to current recommendations?

BackgroundDespite a growing consensus on the feeding practices associated with healthy eating patterns, few observational studies of maternal feeding practices with young children have been conducted, especially in low-income populations. The aim of this study was to provide such data on a low income sample to determine the degree to which observed maternal feeding practices compare with current recommendations.MethodsEighty low-income mothers and their preschool children were videotaped at dinner in their homes. Mothers were chosen from a larger study to create a 2 X 2 X 2 design: maternal ethnicity (African American vs. Latina) by child gender by child weight status (healthy weight vs. overweight/obese). Observers coded videotapes for a range of maternal feeding strategies and other behaviors.ResultsMany mothers spent considerable time encouraging eating—often in spite of the child’s insistence that he or she was finished. Mothers talked little about food characteristics, rarely referred to feelings of hunger and fullness, and made more attempts to enforce table manners than to teach eating skills. Latina mothers showed higher levels of teaching eating skills and encouraging their children to eat; African American mothers showed higher levels of enforcing table manners and getting children to clear their plates. Mothers of boys used more unelaborated commands and less questions/suggestions than mothers of girls. Finally, compared to mothers of overweight/obese children, mothers of healthy weight children showed higher levels of encouraging eating and lower levels of discouraging eating.ConclusionsMost of the mothers in this study did not engage in feeding practices that are consistent with current recommendations. They did this, despite the fact that they knew they were being observed. These results should be used to inform future research about the motivations behind mothers’ feeding practices and the development of interventions by helping identify areas in greatest need of change.

Understanding the State of Nutrition Education in the Head Start Classroom: A Qualitative Approach.

Background Early education is important for establishing healthy eating behaviors among young children; however, the literature describing nutrition education in the preschool environment is limited. Purpose The purpose of this study was to explore teacher experiences related to the incorporation of nutrition education in Head Start preschool classrooms. Methods Between September 2011 and May 2012, investigators conducted 74 in-depth, structured interviews (31 health/nutrition coordinators, 11 center directors, and 32 teachers). Participant interviews were recorded in digital audio format and transcribed verbatim. Results Researchers condensed identified interrelated themes into 4 categories within a substantive-level model. Outcomes revealed that teacher training/education, funding, and policies/regulations were the core factors influencing the quality and quantity of nutrition-related instruction. Discussion The proposed model establishes a framework for understanding the state of nutrition education in the preschool environment. Teachers need more opportunities for training/education in instructional methods and nutrition content; financial support for materials; and clear, supportive policies/regulations. Translation to Health Education Practice Teachers and administrators can use the proposed framework as an objective guide to identify the presence of these barriers in their organizations and to facilitate their ability to work together to improve the quality of nutrition education in the preschool environment.

Practical Qualitative Research Strategies: Training Interviewers and Coders

The increased emphasis on incorporating qualitative methodologies into nutrition education development and evaluation underscores the importance of using rigorous protocols to enhance the trustworthiness of the findings. A 5-phase protocol for training qualitative research assistants (data collectors and coders) was developed as an approach to increase the consistency of the data produced. This training provides exposure to the core principles of qualitative research and then asks the research assistant to apply those principles through practice in a setting structured on critical reflection.

EFNEP Graduates' Perspectives on Social Media to Supplement Nutrition Education: Focus Group Findings From Active Users

OBJECTIVE To identify ways to effectively use social media to communicate nutrition-related information to low-income populations. METHODS The authors conducted 4 focus groups with female Expanded Food and Nutrition Education Program graduates who used social media at least twice a week (n = 26 total). Transcripts were analyzed using the constant comparative method to identify key themes. RESULTS For participants, page content, page maintenance, and networking opportunities with others were important aspects of a nutrition education social media page. Trust emerged as a central theme, because participants expressed a need for reliable information from known, credible sources and safe places to share ideas. CONCLUSIONS AND IMPLICATIONS Using social media to provide nutrition-related messages may be an effective way to encourage sustained positive behavior changes resulting from educational programming and to engage participants beyond class time. Establishing the trustworthiness of the social media site is essential to its use among low-income participants.

Evaluation of a pictorial method to assess liking of familiar fruits and vegetables among preschool children

Research suggests fruit and vegetable (FV) preferences greatly influence on FV intake. Methods for assessing childrens FV preference in a reliable and valid manner are needed. The purpose of this study was to develop a practical, reliable, and valid method for evaluating FV liking among preschool-aged children using photographs. Authors formatively assessed a series of digital FV photographs and hedonic scales to develop content for the liking measure. The measure for assessment included 20 high-quality, digital photographs presenting 13 FVs. A non-gendered 5-point face scale (super yummy to super yucky) was chosen to determine level of liking. We used this measure to establish reliability (i.e., test re-test) and concurrent validity (i.e., photograph versus tasting experience) of the pictorial method. Data were analyzed using Spearmans Rho Correlation Coefficients and Wilcoxon signed-rank tests. The measure demonstrated varying levels of reliability/validity for individual FV items and the fruit scale; however, the vegetable scale and collapsed FV scale were determined to be valid measures. Authors recommended the removal of one weak pictorial fruit item (halved peach) from the fruit and FV scales to improve validity. The final recommended measure included 19 high-quality, digital photographs presenting 12 FVs. The pictorial FV measure and subscales may be useful for assessing FV liking among groups of preschool-aged children within the studied population. Additional research is needed to further validate the use of the pictorial FV measures in a larger, more generalizable sample.

Expanding the Supply of Pasteurized Donor Milk: Understanding Why Peer-to-Peer Milk Sharers in the United States Do Not Donate to Milk Banks.

Background: Lactating women in the United States have several options for what they do with excess breast milk, including donating to milk banks that serve medically fragile infants, sharing directly with families seeking milk, and selling to individuals or for-profit entities. The World Health Organization and the US Surgeon General have issued calls to increase access to pasteurized donor milk for medically fragile infants. Objective: To explore how lactating women with a surplus of breast milk come to the decision to share their milk with a peer rather than donate to a milk bank. Methods: A qualitative design using a grounded theory approach was employed. Semistructured telephone interviews were conducted with 27 women who had shared milk with a peer but not with a milk bank. Results: Five dominant themes were identified: a strong belief in the value of breast milk, unexpected versus planned donation, sources of information regarding milk exchange, concerns and knowledge gaps about milk banks, and helping and connecting. Conclusions: This research offers insights into potential strategies for promoting milk bank donation among peer-to-peer milk sharers, including developing donor education campaigns focused on knowledge gaps regarding milk banks and developing health care professional referral programs that can reduce barriers associated with the convenience of milk bank donation.

Head Start Administrator and Teacher Perceptions of Parental Influence on Preschool Children's Nutrition Education.

Parents play a significant role in molding their children’s nutrition knowledge and behavior. The purpose of the present study was to explore parental influence on preschooler’s nutrition education from the perspectives of North Carolina–based Head Start coordinators and teachers. Investigators conducted 63 in-depth, structured interviews with Head Start Health/Nutrition Coordinators (n = 31) and teachers (n = 32). Interviews were recorded in digital audio format and transcribed verbatim. Following a grounded theory approach, researchers identified primary, emergent themes related to parental influence and a substantive-level model was developed. Head Start staff described parental background (i.e. nutrition knowledge, culture), socioeconomic status, food preferences and parental engagement/support of teacher provided nutrition education as the primary factors that affect preschooler’s nutrition education. The proposed theoretical model provides an initial understanding of the influence Head Start parents may have on their children’s nutrition education. The findings suggest more training and education opportunities for parents and teachers may be needed. Despite barriers, teachers and local community partners should continue to support parents in their efforts to reinforce positive nutrition messages among preschool children.

Stakeholder views of breastfeeding education in schools: a systematic mixed studies review of the literature

BackgroundBreastfeeding provides numerous health benefits for mothers and infants, but worldwide breastfeeding rates fall below recommendations. As part of efforts to increase breastfeeding initiation and duration, the World Health Organization and UNICEF UK recommend educational interventions to increase awareness and positive attitudes towards breastfeeding beginning during the school years. Breastfeeding education in the school setting offers the opportunity to improve the knowledge base, address misconceptions, and positively influence beliefs and attitudes for students from a wide range of socioeconomic and cultural backgrounds. The purpose of this paper is to present a comprehensive narrative review of the literature regarding student and teacher (stakeholder) views of breastfeeding and breastfeeding education programs in schools to inform future research in the area.MethodsArticles were located through a systematic search of online databases and journals using the following keywords in various combinations: (1) breastfeeding, lactation, breast-feeding, “bottle feeding”, “infant feeding” (2) student, educator, teacher, “school administrator” and (3) schools, “secondary education”, “primary education”, “K-12”, “high school”, “middle school”, “elementary school”, education, adolescents, curriculum, and a manual search of article references. Studies were screened for inclusion against specific criteria and included papers were assessed using the Mixed Methods Appraisal Tool (MMAT).ResultsThis review suggests that adolescents have a deficit in breastfeeding knowledge and express negative conceptions about breastfeeding. Breastfeeding is being discussed in some school environments, but the extent of lessons and the specific messages that teachers communicate have not been explored. Students appear to be interested in receiving more information about breastfeeding, especially if delivered by health professionals or breastfeeding mothers. The majority of teachers are supportive of incorporating breastfeeding education in family and consumer sciences, sexual education, and health classes; however, time constraints and limited knowledge of infant feeding recommendations may be barriers to implementation of appropriate lesson plans.ConclusionsStudents generally support and are receptive to breastfeeding education; however, research on educator attitudes, knowledge, and experiences are necessary for appropriate implementation of breastfeeding education in varying school settings around the world.

Observed and self-reported assessments of caregivers' feeding styles: Variable- and person-centered approaches for examining relationships with children's eating behaviors

BACKGROUND Demandingness and responsiveness are dimensions used in general parenting as well as the feeding literature to measure parent attitudes and behaviors. These dimensions can be treated as continuous variables (variable-centered) or used to form groups of parents based on scores on each dimension (person-centered). Research focusing on these dimensions in the feeding domain has relied exclusively on maternal self-reports; observational studies of feeding styles have yet to be conducted. OBJECTIVES The purpose of this study was to investigate the effectiveness of variable-centered versus person-centered analyses in examining relationships between maternal feeding styles, child eating behaviors, and child weight status using both self-reported and observational methods for assessing parental feeding style. METHODS Participants included 137 low-income Head Start mothers and their preschoolers. Mothers completed the Caregivers Feeding Styles Questionnaire and the Childrens Eating Behavior Questionnaire. Parent/child interactions were observed during dinner meals at home and were coded using a previously developed coding system. RESULTS Maternal demandingness during feeding was negatively associated with child BMI z-scores and positively associated with slowness in eating and satiety responsiveness. Maternal responsiveness was associated positively with enjoyment of food and associated negatively with food fussiness. Significant demandingness by responsiveness interactions showed that children of authoritarian mothers showed the highest levels of food fussiness and the lowest enjoyment of food. Overall, the findings were stronger for the self-report than for the observational measures and the variable-centered approach was clearly superior to the person-centered approach. CONCLUSIONS The current results indicate that for research purposes the variable-centered approach may be the most powerful for examining relationships between maternal feeding and child eating. However, for clinical purposes, the person-centered approach might be most informative.