[Vegetables and fruits in early childhood: maternal nutritional practices]. / Vegetales y frutas en la primera infancia: prácticas alimentarias maternas.

INTRODUCTION: Global consumption of vegetables and fruits is currently below recommendations, impacting the prevalence of obesity and non-communicable diseases. In addition to environmental factors, mothers' feeding practices influence children's eating patterns. METHODS: Questionnaires were conducted with mothers of children 7 months to 7 years of age (n = 727), in 12 Primary Health Care Centers in the capital cities of three Argentine provinces. Fruit and vegetable consumption was evaluated with the Children's Dietary Questionnaire (CDQ). We tested the association with maternal feeding practices distributed across three domains: role modeling, accessibility, and socialization of the products in the home. We tested 11 practices separately and a variable summing the 11 practices. RESULTS: The majority of children (86%) had low fruit and vegetable intake. In regression models, each of the 11 practices showed a significant association with children's fruit and vegetable intake (beta 0,6-1,8). However, the variable testing the sum of the 11 practices showed a larger association parameter with intake, even in multiple regression (beta 3,9). Proximity of sale points and cost of products also showed a significant association with intake. CONCLUSION: Results provide information on home based strategies to promote children's fruit and vegetable intake that do not require complex resources and can be incorporated into community health education programs.

Introducción: El consumo de vegetales y frutas a nivel global está por debajo de lo recomendado, incidiendo sobre la prevalencia de obesidad y enfermedades crónicas no transmisibles a corto y largo plazo. Además de factores ambientales, las prácticas maternas influyen sobre los patrones alimentarios de hijos e hijas. Métodos: Se aplicaron cuestionarios a 727 madres con hijos/hijas de 7 meses a 7 años de edad, en 12 Centros de Atención Primaria de Salud en las ciudades capitales de Tucumán, Santiago del Estero y Jujuy, Argentina. La ingesta de vegetales y frutas se evaluó mediante el Cuestionario de Dieta para Niños (CDQ por sus siglas en inglés) y se evaluó su asociación con prácticas maternas en 3 dominios conceptuales, rol modélico, accesibilidad, y socialización de esos alimentos en el hogar. Con regresión simple se analizaron 11 prácticas en forma separada, y con regresión multivariada una variable compuesta por la sumatoria de las 11 prácticas. Resultados: El 86% de niños/niñas tenía un bajo consumo de vegetales y frutas. Cada una de las 11 prácticas alimentarias mostró una asociación significativa con el consumo (beta 0.6 a 1.8). Sin embargo, la sumatoria de las distintas prácticas, su utilización en forma combinada, mostró un mayor efecto (beta 3.9). Cercanía a locales de venta y costo también estaban asociados significativamente con el consumo. Conclusión: Los resultados informan sobre estrategias para promover el consumo de vegetales y frutas, que pueden aplicarse en el contexto del hogar no requieren de recursos complejos y pueden incorporarse a programas de educación para la salud a nivel comunitario.

Vegetales y frutas en la primera infancia: prácticas alimentarias maternas / Vegetables and fruits in early childhood: maternal nutritional practices

Resumen Introducción: El consumo de vegetales y frutas a nivel global está por debajo de lo recomendado, incidiendo sobre la prevalencia de obesidad y enfermedades crónicas no transmisibles a corto y largo plazo. Además de factores ambientales, las prácticas maternas influyen sobre los patrones alimentarios de hijos e hijas. Métodos: Se aplicaron cuestionarios a 727 madres con hijos/hijas de 7 meses a 7 años de edad, en 12 Centros de Atención Primaria de Salud en las ciudades capitales de Tucumán, Santiago del Estero y Jujuy, Argentina. La ingesta de vegetales y frutas se evaluó mediante el Cuestionario de Dieta para Niños (CDQ por sus siglas en inglés) y se evaluó su asociación con prácticas maternas en 3 dominios conceptuales, rol modélico, accesibilidad, y socialización de esos alimentos en el hogar. Con regresión simple se analizaron 11 prácticas en forma separada, y con regresión multivariada una variable compuesta por la sumatoria de las 11 prácticas. Resultados: El 86% de niños/niñas tenía un bajo consumo de vegetales y frutas. Cada una de las 11 prácticas alimentarias mostró una asociación significativa con el consumo (beta 0.6 a 1.8). Sin embargo, la sumatoria de las distintas prácticas, su utilización en forma combinada, mostró un mayor efecto (beta 3.9). Cercanía a locales de venta y costo también estaban asociados significativamente con el consumo. Conclusión: Los resultados informan sobre estrategias para promover el consumo de vegetales y frutas, que pueden aplicarse en el contexto del hogar no requieren de recursos complejos y pueden in corporarse a programas de educación para la salud a nivel comunitario.

Abstract Introduction: Global consumption of vegetables and fruits is currently below recommendations, im pacting the prevalence of obesity and non-communicable diseases. In addition to environmental factors, mothers' feeding practices influence children's eating patterns. Methods: Questionnaires were conducted with mothers of children 7 months to 7 years of age (n = 727), in 12 Primary Health Care Centers in the capital cities of three Argentine provinces. Fruit and vegetable consumption was evaluated with the Children's Dietary Questionnaire (CDQ). We tested the association with maternal feeding practices distributed across three domains: role model ing, accessibility, and socialization of the products in the home. We tested 11 practices separately and a vari able summing the 11 practices. Results: The majority of children (86%) had low fruit and vegetable intake. In regression models, each of the 11 practices showed a significant association with children's fruit and vegetable intake (beta 0,6-1,8). However, the variable testing the sum of the 11 practices showed a larger association parameter with intake, even in multiple regression (beta 3,9). Proximity of sale points and cost of products also showed a significant association with intake. Conclusion: Results provide information on home based strategies to promote children's fruit and vegetable intake that do not require complex resources and can be incorporated into community health education programs.

Inseguridad alimentaria y obesidad en madres del Noroeste Argentino: estudio local en contexto global / Food insecurity and obesity among mothers in Northwest Argentina: local study in global context

RESUMEN INTRODUCCIÓN La inseguridad alimentaria (IA) es un fenómeno multidimensional, que obliga a las personas a reducir la cantidad o calidad de los productos que consumen y presenta un continuum de niveles de gravedad (de leve a severa). El objetivo fue analizar la relación entre IA y estado nutricional en madres de niños concurrentes a Centros de Atención Primaria de Salud de cuatro provincias del Noroeste de Argentina. MÉTODOS Se aplicó un cuestionario con el indicador de insuficiencia alimentaria de la USDA y NHANES III a 995 madres. El estado nutricional se evaluó mediante el indice de masa corporal (IMC) y la circunferencia de cintura. RESULTADOS La prevalencia de obesidad (IMC ≥30 kg/m2) fue mayor entre las participantes con IA severa (37,1%) y moderada (28,7%) que en aquellas con IA leve (20,3%) o con seguridad alimentaria (SA) (22,4%) (p 0,003). En modelos de regresión logística multivariada la IA severa incrementaba la probabilidad de IMC ≥30 kg/m2 (OR 1,8) y de circunferencia de cintura ≥80 cm (OR 1,8). Tener bajos niveles de ingresos y de educación, estar casada o en pareja y consumir asiduamente comidas fritas también constituían factores de riesgo significativos. DISCUSIÓN Las políticas alimentarias deben combinarse con politicas de empleo y de distribución de ingresos, de producción y acceso a alimentos saludables, junto a legislación sobre la composición y publicidad de alimentos y bebidas, y a la diseminación de información y de buenas prácticas alimentarias.

ABSTRACT INTRODUCTION Food insecurity (FI) is a multidimensional phenomenon which forces people to reduce the quantity or quality of consumed products and has a continuum of severity levels (from mild to severe). The objective of this study was to analyze the relationship between FI and nutritional status in mothers attending Primary Health Care Centers in four provinces of Argentine Northwest. METHODS A questionnaire with USDA and NHANES III FI indicator was applied to 995 mothers. Nutritional status was assessed using body mass index (BMI) and waist circumference. RESULTS The prevalence of obesity (BMI ≥30 kg/m2) was higher among women with severe (37.1%) and moderate (28.7%) FI than in women reporting low FI (20.3%) or food security (FS) (22.4%) (p 0.003). In multivariate logistic regression models, severe FI increased the likelihood of BMI ≥30 kg/m2 (OR 1.8) and of waist circumference ≥80 cm (OR 1.8). Low income and education level, being married/living with a partner, and fried food consumption also were significant risk factors for obesity. DISCUSSION Food policies should combine with employment and income distribution, production and access to healthy foods, food and beverage composition and advertising regulations, together with the dissemination of information and healthy nutrition practices.

Indicators of Readiness and Capacity for Implementation of Healthy Eating Strategies in Child Care Settings Serving Low-Income Children.

OBJECTIVE: Identify factors perceived to influence implementation of healthy eating policy, systems, and environmental strategies (PSEs) in child care settings serving low-income children. DESIGN: This mixed-methods study, conducted in 2015-2016, used semi-structured interviews (n = 18), focus groups (n = 23), and an expert panel. PARTICIPANTS: Public health (n = 11) and Supplemental Nutrition Assistance Program-Education practitioners (n = 9) and community residents (n = 174) from 9 counties in Ohio. Expert panelists (n = 10) had experience implementing PSEs in child care settings. PHENOMENON OF INTEREST: Implementation factors influencing healthy eating PSEs in child care settings. ANALYSIS: Qualitative thematic analysis of 41 transcripts using a grounded theory approach. Indicators for each theme were operationalized. Consensus feedback from an expert panel weighted themes and indicators based on perceived importance for implementation. RESULTS: Identified themes relevant to implementation of PSEs included (1) organizational and practitioner capacity, (2) child care capacity, (3) networks and relationships, and (4) community resources and motivations. Nineteen indicators related to the 4 themes were identified and weighted. CONCLUSIONS AND IMPLICATIONS: Findings highlighted key factors within domains of influence and informed the operationalization of the indicators and the development of an assessment tool. The assessment tool is designed to tailor PSE implementation to the realities of different child care settings.

Comparing Indigenous and public health infant feeding recommendations in Peru: opportunities for optimizing intercultural health policies.

BACKGROUND: The problem of childhood undernutrition in low-income countries persists despite long-standing efforts by local governmental and international development agencies. In order to address this problem, the Peruvian Ministry of Health has focused on improving access to primary healthcare and providing maternal and child health monitoring and education. Current maternal-child health policies in Peru introduce recommendations that are in some respect distinct from those of Indigenous highland communities. This paper analyses the similarities and differences between public health and mothers' infant feeding recommendations. Furthermore, it analyses persistence and change in those recommendations among women who were mothers before and after the introduction of current public health policies. METHODS: Semi-structured interviews were conducted with 18 older mothers, 15 currently breastfeeding mothers, and 15 public health staff in highland rural communities of Peru. During data analysis, thematic codes and text passages were used in an iterative analytic process to document emerging themes. RESULTS: The results highlight the existence of a traditional corpus of beliefs surrounding infant feeding and care that is consistent with Andean ethnomedical beliefs. This is illustrated by mother's accounts referring to the importance of maintaining a dietary balance of fluids and semi-fluids and of maintaining harmony with the elements in the natural environment. Mothers also incorporate aspects of public health recommendations that they find useful including initiating breastfeeding immediately after birth and exclusive breastfeeding up until 6 months. There are also tensions between the two systems including differences in the conceptualization of breastfeeding and infant food, the imposition of public health care services by coercive means, and negative stereotyping of rural Andean diets and mothers. CONCLUSIONS: Identifying similarities and differences between distinct systems may provide useful input for effective intercultural health policies. Sources of tension should be carefully assessed with the aim of improving public health policies. Such efforts should apply a process of cultural humility engaging health care professionals in exchange and conversations with patients and communities acknowledging the assumptions and beliefs that are embedded in their own understanding. This process should also recognize and value the knowledge and practices of Andean mothers and their role as primary caretakers.

People and places shaping food procurement among recipients of Supplemental Nutrition Assistance Program (SNAP).

A key gap in existing food environment research is a more complex understanding of the interplay between physical and social contexts, including the influence of social networks on food habits. This mixed methods research examined the nature of social connections at food procurement places among a sample of 30 people receiving Supplemental Nutrition Assistance Program (SNAP) benefits in an urban setting. Results highlight the significance of social connections as motivators to use food places, the value of access to information and other resources at food places, and the role of weak ties with actors within food places to facilitate utilization and interaction. Social connections at the varied places individuals procure food may be leveraged to disseminate information and resources to further healthy food access.

Effect of appreciation for Indigenous cultures and exposure to racial insults on alcohol and drug use initiation among multiethnic Argentinean youth.

OBJECTIVES: This study evaluated the effect of factors reflecting appreciation of Indigenous culture and racial insults on alcohol and drug use initiation among multi-ethnic youth in Jujuy, Argentina. METHODS: Students were surveyed from 27 secondary schools that were randomly selected to represent the province. A total of 3040 eligible students in 10th grade, age 14 to 18years were surveyed in 2006 and 2660 of these same students completed surveys in 11th grade in 2007. Multivariate logistic regression models assessed the effect of appreciation for Indigenous cultures and reported exposure to racial insults in 10th grade on incident current alcohol drinking in previous 30days, binge drinking (≥5 drinks at one sitting), and lifetime drug use (marijuana, inhalants or cocaine) in 11th grade among students not reporting these behaviors in 2006. RESULTS: In 2006, 63% of respondents reported high appreciation for Indigenous cultures and 39% had ever experienced racial insults. In 2007, incident current drinking was 24.4%, binge drinking 14.8%, and any drug use initiation was 4.1%. Exposure to racial insults increased the likelihood of binge drinking (OR=1.6; 95% CI 1.2-2.1) but was not significant for any drug use. Appreciation for Indigenous cultures reduced the risk of any drug use initiation (OR=0.5, 95% CI 0.3-0.7) but had no effect for alcohol drinking outcomes. These effects were independent of Indigenous ethnicity. CONCLUSIONS: Enhancing appreciation for Indigenous cultures and decreasing racial insults are achievable goals that can be incorporated into programs to prevent youth substance use.

Smoking and exposure to racial insults among multiethnic youth in Jujuy, Argentina.

PURPOSE: Exposure to racial insults among youth in Jujuy, Argentina, was examined as a factor associated with smoking behavior. METHODS: Youth sampled from eighth-grade classes in 27 randomly selected middle schools completed annual surveys in the ninth and tenth grades. Demographics, race/ethnicity (Indigenous/Amazonian, Indigenous/Andean, Indigenous unspecified group, Mixed European-Indigenous, European), cigarette smoking, and other attitudinal and behavioral factors were measured. Exposure to racial insults, measured in the ninth grade, was modeled to predict cigarette smoking in the previous 30 days (defined as current) in the tenth grade conditional on ninth grade smoking. RESULTS: Of the 3,122 respondents, 35.5% reported exposure to racial insults and 33.8% were current smokers. Factors associated with racial insults were being male, indigenous language spoken at home, ever and current smoking, smoking in a ceremonial context, exposure to second-hand smoke at home, number of friends who smoke, having low expectations for the future, low identification with conforming role models, high identification with defiant role models, and depressive symptoms. Reported exposure to racial insults increased the risk of current smoking in the 10th grade among Indigenous Amazonian respondents (OR = 3.8; 95% CI 1.4-10.4) and among the Indigenous-unspecified group (OR = 1.8; 95% CI 1.1-2.8), but not among European or Indigenous Andean youth. CONCLUSIONS: Exposure to racial insults is commonplace among youth in Jujuy. Evidence of a longitudinal effect of ninth-grade racial insults on tenth-grade smoking rates provides support for an association of racial insults with smoking behavior.