Rickelle Richards

Food store access and household fruit and vegetable use among participants in the US Food Stamp Program

OBJECTIVE Recent research on access to food among low-income populations in industrialised countries has begun to focus on neighbourhood food availability as a key determinant of dietary behaviour. This study examined the relationship between various measures of food store access and household fruit and vegetable use among participants in the Food Stamp Program, Americas largest domestic food assistance programme. DESIGN A secondary data analysis was conducted using the 1996-97 National Food Stamp Program Survey. The survey employed a 1-week food inventory method, including two at-home interviews, to determine household food use. Separate linear regression models were developed to analyse fruit and vegetable use. Independent variables included distance to store, travel time to store, ownership of a car and difficulty of supermarket access. All models controlled for a full set of socio-economic variables. SUBJECTS A nationally representative sample of participants (n=963) in the Food Stamp Program. RESULTS After controlling for confounding variables, easy access to supermarket shopping was associated with increased household use of fruits (84 grams per adult equivalent per day; 95% confidence interval 5, 162). Distance from home to food store was inversely associated with fruit use by households. Similar patterns were seen with vegetable use, though associations were not significant. CONCLUSIONS Environmental factors are importantly related to dietary choice in a nationally representative sample of low-income households, reinforcing the importance of including such factors in interventions that seek to effect dietary improvements.

Dietary intake, overweight status, and perceptions of food insecurity among homeless Minnesotan youth

Youth, 9–18 years (n = 202), living in homeless shelters in Minneapolis, Minnesota, were assessed for height, weight, dietary intake, and perceptions of food insecurity. Perceptions of food security were measured by asking youth to respond to the statements (1) “There are times when we do not have enough food in the house,” (2) “I go to bed hungry at night,” (3) “I do not get enough to eat at home,” and (4) “Have you ever had to miss a meal (or not been able to eat) because there was no food at home?” Additionally, questions evaluated coping mechanisms used by children to ward off hunger. Fifty‐five percent of the children reported not enough food in the house and 25% reported going to bed hungry. Youth had inadequate intakes of vitamin D, calcium, and potassium and the majority consumed less than the estimated average requirements (EAR) for vitamins A, C, and E, phosphorus, folate, and zinc. Fruits, vegetables, and dairy were also consumed below recommended levels. Forty‐five percent of boys and 50% of girls were at risk‐for‐overweight or were overweight. Overeating, eating anything, eating disliked foods, and eating at the homes of family and friends were identified as strategies to cope with food insecurity. Overeating when food is available may explain why we see a hunger‐obesity paradigm to the magnitude that we do among the poorest Americans. These strategies protect children from the immediate negative associations of poverty and hunger, but they may contribute to long‐term weight problems currently found in the US. Am. J. Hum. Biol., 2008.

Health Behaviors and Infant Health Outcomes in Homeless Pregnant Women in the United States

OBJECTIVE: To describe selected demographics; maternal health behaviors before, during, and after pregnancy; and infant health outcomes among homeless women in the United States. PATIENTS AND METHODS: Analyses are based on Pregnancy Risk Assessment Monitoring System data from 31 participating states from 2000 to 2007 that were linked to birth certificate data, which contain demographic and medical information collected through the states vital records system. Responses were then weighted to be representative of all women who gave birth in each state during that year. Assessment of these data takes into account the complex sampling designs employed by the states. RESULTS: Four percent of women reported homelessness within 12 months before pregnancy, with the highest percentage in Illinois, followed by Oregon and Washington. Homeless women were younger, unmarried, uninsured, less educated, less likely to initiate and sustain breastfeeding, and had less prenatal care and well-visits. They were also more likely to be black, Hispanic, smoke cigarettes, be underweight or have class III obesity, and not take preconception multivitamins. Infants had lower birth weights, a longer hospital stay, and were more likely to receive neonatal intensive care. CONCLUSIONS: In this study we provide additional insight into homelessness in the perinatal period and provide information on ways to direct interventions aimed at improving the health of homeless mothers and infants. Additional research is needed to determine factors that influence pregnancy weight gain and infant feeding practices among homeless women and how this affects infant health.

Influence of Parenting Practices on Eating Behaviors of Early Adolescents during Independent Eating Occasions: Implications for Obesity Prevention

Among early adolescents (10–14 years), poor diet quality along with physical inactivity can contribute to an increased risk of obesity and associated biomarkers for chronic disease. Approximately one-third of United States (USA) children in this age group are overweight or obese. Therefore, attention to factors affecting dietary intake as one of the primary contributors to obesity is important. Early adolescents consume foods and beverages during eating occasions that occur with and without parental supervision. Parents may influence eating behaviors of early adolescents during eating occasions when they are present or during independent eating occasions by engaging in practices that affect availability of foods and beverages, and through perceived normative beliefs and expectations for intake. Therefore, the purpose of this article was to describe the influence of parenting practices on eating behaviors in general and when specifically applied to independent eating occasions of early adolescents. This information may be helpful to inform parenting interventions targeting obesity prevention among early adolescents focusing on independent eating occasions.

Maternal health behaviors and infant health outcomes among homeless mothers: U.S. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) 2000-2007.

OBJECTIVE To determine whether participation in the Women, Infants, and Children Program is associated with improved maternal and infant health outcomes among homeless women in the Pregnancy Risk Assessment Monitoring System. METHOD Analyses were based on Pregnancy Risk Assessment Monitoring System participants from 31 states/cities in the United States, 2000-2007 (n=272,859). Overall, 4% of women completing the Pregnancy Risk Assessment Monitoring System survey were homeless, with 76% participating in the Women, Infants, and Children Program, a federally-funded supplemental nutrition program for low-income women and children less than 5 years old. RESULTS Among women in the Pregnancy Risk Assessment Monitoring System survey who reported using the Women, Infants, and Children Program, those experiencing homelessness were older, less educated, less likely to have private health insurance, and more likely to receive government assistance. Homeless women in the Women, Infants, and Children Program compared with those not in the program were significantly more likely to have a higher body mass index, to initiate breastfeeding after delivery, have prenatal care visits, have a longer gestational age, and have a greater infant birth weight. CONCLUSION Characteristics of homeless pregnant women choosing to participate in the Women, Infants, and Children Program are consistent with the requirements for program participation for women in general. Homeless women accessing the Women, Infants, and Children Program had better maternal and infant health outcomes.

Prenatal Maternal Stress and Physical Abuse among Homeless Women and Infant Health Outcomes in the United States

Background. This study examines whether the relationship between maternal stress or abuse situations and infant birth weight differs between homeless and non-homeless women. Methods. Analyses are based on data from the Pregnancy Risk Assessment Monitoring System (PRAMS), 2002–2007. Results. Homeless women were significantly more likely to experience stressful life events, abusive situations, and poor maternal health than non-homeless women during pregnancy. Birth weight among infants of homeless women was, on average, 17.4 grams lighter than for infants of non-homeless women, after adjusting for maternal age, race, ethnicity, region, education, and marital status. The impact of maternal health, stress, and abuse variables on pregnancy and infant birth weight significantly interacted with homeless status. For example, vaginal bleeding, nausea, kidney/bladder infection, and failure to receive early prenatal care had significantly larger negative impacts on birth weight among homeless women than non-homeless women. Infant birth weight was consistently lower among homeless women, more so when maternal stress and abuse were involved, across all classifications of their prepregnancy weight. Conclusion. Stress and abusive situations among pregnant women have a negative influence on pregnancy-related conditions and infant birth weight. However, this negative influence is even more pronounced among homeless women.

Correlates of energy intake and body mass index among homeless children in Minnesota.

BACKGROUND This study evaluated environmental, personal, and behavioral correlates of BMI-for-age percentiles, dietary intake (kilocalories, carbohydrates, protein, fat, and Food Guide Pyramid food groups), and physical activity variables among homeless children. METHODS A 74-item survey, using social cognitive theory as the theoretical framework, height, weight, and one 24-hour recall were collected from homeless children aged 9-13 (n=159) at two shelters in Minneapolis, MN. Principal component analysis was performed on the subsections of the survey. Independent t-tests, Fisher exact tests, and chi-squared statistics evaluated sociodemographic and BMI percentile variables. Nonparametric tests evaluated dietary data. Stepwise regression models evaluated correlates of BMI percentiles, physical activity, and dietary intake variables. RESULTS Approximately 45% were overweight or obese (≥85(th) percentile). Dietary data represented intake on a given day, with children consuming a median 1.2 servings from the fruits and vegetables food group, 17.3 servings from the fats and sweets food group (one serving=grams in 1 Tbsp. fat/1 tsp. sugar), and the percent of calories from fat varying significantly between shelter 1 (S1) versus shelter 2 (S2) boys (37.1% vs. 31.7%, p<0.001). Factors identified from survey items and sociodemographic variables accounted for between 6% and 14% of the variance in energy intake and other dietary and physical activity variables (p range, 0.008 to <0.001). CONCLUSIONS Parental role modeling of eating behaviors and getting enough food were associated with less favorable food choices among homeless children. Policy interventions and program initiatives in the homeless environment could promote healthier food choices among children.

Investigation of the Hunger–Obesity Paradigm Among Shelter-Based Homeless Women Living in Minnesota

A 264-item survey evaluated how two shelter environments influenced homeless womens health (n = 259). Measured heights and weights determined obesity prevalence. Nonparametric tests evaluated body mass index (BMI) and dietary intake data. Principle components analysis reduced the data and correlations were made to BMI and dietary intake. Almost 80% had a BMI ≥ 25 and 67% were food insecure. Median milk intake was significantly different between shelters (1.0 [S1] vs 0.5 [S2], P < 0.05). Most servings were from the fats/sugars group (median servings: 19.6 [S1]; 15.1 [S2], P = 0.73). Obesity is a public health problem among homeless women, with shelter environments limiting the modification of associated risk factors.

Identifying Barriers Preventing Latina Women from Accessing WIC Online Health Information

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a program for low-income women and children under age five. The purpose of this study was to identify barriers to accessing online WIC resources among Latina WIC clients. Five focus groups were conducted with Spanish-speaking participants recruited from a single WIC clinic. Two key themes emerged relating to barriers in accessing WIC’s online resources. The first theme, access issues, included three subthemes: lack of computer/Internet resources; family barriers to computer use; and computer literacy. The second theme, perceived value of the website, included three subthemes: limited time savings; preference for on-site education; and knowledge about the website. This is the first study to evaluate barriers to accessing online resources among Latina women in the WIC program. WIC sites attempting to increase utilization of online resources may be more successful if they serve clients with easy access to a computer with Internet access. They may also consider strategies to increase the value of the online resources, as compared to their current services offered to clients in a face-to-face setting.

Perceptions of Public Breastfeeding Images and Their Association With Breastfeeding Knowledge and Attitudes Among an Internet Panel of Men Ages 21–44 in the United States

Background: Men’s attitudes toward public breastfeeding may influence a woman’s decisions about breastfeeding and her perceived comfort with public breastfeeding. Research aim: This study aimed to evaluate factors associated with men’s visual perception of images of public breastfeeding. Methods: A 95-item online survey was administered to 502 U.S. men ages 21 to 44. Respondents were presented with four images of women breastfeeding and asked to evaluate agreement with 15 adjectives describing each image. Based on factor analysis, 13 of these adjectives were combined to create the Breastfeeding Images Scale for each image. An 8-item Situational Statements Scale and the 17-item Iowa Infant Feeding Attitude Scale (IIFAS) were used to assess breastfeeding knowledge and attitudes. Multiple regression was used to evaluate the association between breastfeeding attitudes and knowledge and the Breastfeeding Images Scale. Results: The image depicting a woman breastfeeding privately at home had the highest mean score of 71.95, 95% confidence interval (CI) [70.69, 73.22], on the Breastfeeding Images Scale, compared with 61.93, 95% CI [60.51, 63.36], for the image of a woman breastfeeding in a public setting. The overall mean scale score for the IIFAS was 56.99, 95% CI [56.27, 57.70], and for the Situational Statements Scale was 28.80, 95% CI [27.92, 29.69]. For all images, increasing breastfeeding knowledge and attitudes measured by the IIFAS and the Situational Statements Scale were associated with a more positive perception of the image. Conclusion: Images of public breastfeeding are viewed less favorably by men in the sample than are images of private breastfeeding. Knowledge and attitudes toward breastfeeding are positively associated with perception of breastfeeding images.