African-American and Hispanic children's beverage intake: Differences in associations with desire to drink, fathers' feeding practices, and weight concerns.

Relationships of African-American and Hispanic fathers' feeding practices and weight concerns and preschoolers' desire to drink with children's beverage intake were examined, and associations between fathers' feeding practices and children's weight status were evaluated. Fathers' (Hispanic n = 61, African-American n = 49) difficulty in child feeding, use of food to calm, use of food as reward, and concern about the child being under and overweight as well as their child's desire to drink were assessed. Preschoolers' (ages 2 to 5) total sugar-sweetened beverage (SSB), fruit juice, and water intake were measured by a modified beverage intake questionnaire. Body Mass Index (BMI) and BMI percentile were calculated for fathers and children, respectively. Multiple regressions revealed that, in Hispanics, difficulty in feeding, concern about underweight, use of food to calm, and use of food as a reward were significantly associated with child intake of total SSB, whereas, in African-Americans, child desire to drink was associated with total SSB and fruit juice. Concern about the child being underweight was inversely associated with child BMI percentile in Hispanics. Significant differences in regression coefficients of child SSB intake to fathers' behaviors versus child desire to drink between the two racial-ethnic groups indicated that use of food to calm the child predicted increased intake of SSB by Hispanic but not by African-American children, while child desire to drink predicted increased intake of SSB by African-American but not by Hispanic children. Because of these significant differences, future research might profitably explore socio-cultural influences on associations of additional child feeding behaviors with fathers' attempts to control them. Furthermore, practitioners should consider developing and evaluating different child obesity interventions for these two racial-ethnic groups.

Assessing Initial Validity and Reliability of a Beverage Intake Questionnaire in Hispanic Preschool-Aged Children.

BACKGROUND: Understanding the relationship between high-calorie beverage consumption and weight gain requires an accurate report of dietary intake. A critical need exists to develop and test the psychometrics of brief quantitative tools for minority pediatric populations. OBJECTIVE: To modify the adult beverage intake questionnaire (BEVQ-15) for Hispanic preschool-aged children (BEVQ-PS) and test its validity and test-retest reliability in children aged 3 to 5 years. DESIGN: Cross-sectional. The modified quantitative 12-beverage category questionnaire assessed consumption of water, fruit juice, sweetened juice drinks, whole milk, reduced-fat milk, low-fat milk, flavored milk, carbonated sweetened drinks, diet carbonated drinks, sweet tea, tea with or without artificial sweetener, and sport drinks consumed during the past month. Hispanic mothers (n=109) recruited from day-care centers provided one 4-day food intake record (FIR) and completed two BEVQ-PS surveys during a 2-week period for their preschool-aged child. Data collection was conducted through one-on-one interviews in Spanish. Validity was assessed by comparing amounts (in grams) and energy intake (in kilocalories) for each beverage category between the first BEVQ-PS and the mean of the FIRs using paired t tests and Pearson's correlation coefficient. Criteria for validity were nonsignificant mean differences in grams and kilocalories from the first BEVQ-PS and mean of the FIRs beverage categories, and significant correlation coefficients between beverage categories. Test-retest reliability was assessed by comparing grams and kilocalories for each beverage category in the first BEVQ-PS with those from the second BEVQ-PS using Pearson's correlation coefficient. The criterion for reliability was a significant correlation coefficient between beverage categories. Significance was set at P<0.05. RESULTS: Mean differences between the first BEVQ-PS and FIR for water (42.4±23.1 g), sweetened juice drinks (-1.6±11.0 g), whole milk (18.3±9.91 g), sweetened carbonated drinks (-13.0±7.9 g), and total sugar-sweetened beverages (SSB) (1.4±8.9 g) were not significantly different, but were significantly correlated (r=0.20 to 0.37; P<0.05). Thus, validity criteria were met. With the exception of flavored milk and tea with or without artificial sweeteners, the remaining beverage categories-total beverages and SSB-in the first BEVQ-PS were correlated with those from the second BEVQ-PS (r=0.20 to 0.68; P<0.05), meeting reliability criteria. CONCLUSIONS: Researchers and clinicians may use the BEVQ-PS to assess SSB, water, and whole-milk intake in Hispanic children. Additional modifications should be evaluated to assess total beverage intake.

Federal nutrition program changes and healthy food availability.

BACKGROUND: Literature on food environments is expanding rapidly, yet a gap exists regarding the role of the U.S. Department of Agriculture's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on healthy food availability. In October 2009, the U.S. Department of Agriculture revised the WIC food package, requiring certified stores to stock fresh produce, whole grains, and lower-fat milk. PURPOSE: The goal of this study is to compare availability of foods in stores that are versus those that are not WIC-certified before and after the policy change. METHODS: Store inventories were collected in 45 corner stores in Hartford CT with four inventories each (180 total inventories) from January 2009 to January 2010. Data on availability and variety of fresh fruits, fresh vegetables, whole grains, and lower-fat milk were recorded. Analyses were completed in 2012 using Fisher's exact test, chi-square, and t-tests for descriptive analyses and multilevel models to measure food availability longitudinally (significance at p<0.05). RESULTS: Controlling for covariates, WIC-certified vendors carried more varieties of fresh fruit (p<0.01); a greater proportion of lower-fat milk (p<0.01); and had greater availability of whole grain bread (p<0.01) and brown rice (p<0.05) than vendors without WIC authorization after the policy change. Conversely, for all outcomes, stores without WIC authorization did not significantly increase healthy food availability. CONCLUSIONS: The 2009 WIC revisions increased availability of healthy foods among WIC-certified vendors compared to those without WIC authorization in Hartford CT. For many residents without a car, these changes can create a convenient shopping location for healthy foods when a larger supermarket is not nearby.

If you stock it, will they buy it? Healthy food availability and customer purchasing behaviour within corner stores in Hartford, CT, USA.

OBJECTIVE: Literature on food environments has expanded rapidly, yet most research focuses on stores and community characteristics without integrating customer-level data. The present study combines customer shopping behaviour with store food inventory data. DESIGN: Face-to-face interviews were conducted with customers shopping in corner stores to measure food shopping behaviour, household food security and demographics. Store inventories were conducted to measure availability of healthy food in corner stores. Multilevel logistic regression models estimated the probability of customers purchasing a food item given the availability of that item in the store. SETTING: Nineteen corner stores in Hartford, CT, USA, average size 669 ft(2) (62.15 m(2)). SUBJECTS: Sample of 372 customers. RESULTS: The majority of customers were Black or Hispanic (54 % and 40 %, respectively) and 61 % experienced food insecurity. For each additional type of fruits or vegetables available in the store, the estimated odds of a customer purchasing fruits increased by 12 % (P = 0.03) and the odds for purchasing vegetables increased by 15 % (P = 0.01). Customers receiving the Supplemental Nutrition Assistance Program (SNAP) were 1.7 times as likely to purchase fruit as those not receiving SNAP (P = 0.04). Greater availability of reduced-fat milk was not associated with increased likelihood of customers purchasing reduced-fat milk. CONCLUSIONS: There is a positive association between fruit and vegetable variety and the probability that a customer purchases fruits and vegetables. Increasing the selection of produce in corner stores may increase their consumption by food-insecure and low-income residents at risk for health disparities. These findings have implications for future store interventions and food policies.

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.

Rapid weight gain during the first year of life predicts obesity in 2-3 year olds from a low-income, minority population.

As the prevalence of childhood obesity increases, researchers continue to attempt to identify factors contributing to obesity. The purpose of this study was to define the relationship between birth weight, rapid weight gain (RWG), and early childhood obesity in a low-income, inner-city minority population. In this retrospective chart review, researchers documented every medical encounter recorded in the chart from birth to 3 years for 203 3 year old minority children from low-income families living in an urban area. Based on Center for Disease Control and Prevention's growth charts and tables, z-scores at birth, 4 months, and 1 year were calculated and RWG determined. Researchers determined Body Mass Index percentiles at 3 years of age using the last available weight and height between 24 and 38 months of age. Eight percent of children were underweight, 62% were normal weight, 12% were at overweight and 18% were obese. Children who experienced RWG during the first year of life were 9.24 (CI: 3.73-22.91) as likely to become obese as those who did not experience RWG. Neither low birth weight nor being male increased the odds of becoming obese. Low birth weight predicted underweight at 24-38 months. In this high-risk population, children experiencing RWG during the first year of life have a significantly increased risk of being obese during the preschool years. Future research should identify factors leading to RWG, including specific infant feeding practices.

Parental perceptions of overweight during early childhood.

Prior to developing an overweight prevention program, researchers examined perceptions of overweight during early childhood among minority, low-socioeconomic status (SES) parents of preschoolers living in Hartford, Connecticut (USA). Content analysis of 10 focus groups (average size = 7) and 18 follow-up interviews revealed parents have a distorted, detached view of clinically defined overweight preschoolers, and they do not include weight in their definition of health. The result is a disconnect in communicating with health care providers regarding overweight during early childhood. Findings suggest that overweight intervention programs will be more effective by focusing on the main concern of parents, which is good health rather than weight. By developing new approaches to communicating the diagnosis and implications of overweight during early childhood, health providers are more likely to be able to work collaboratively with parents to prevent and treat overweight during early childhood.

Food insecurity and gender are risk factors for obesity.

OBJECTIVE: Examine relationships between adult obesity, childhood overweight, and food insecurity. DESIGN: Cross-sectional retrospective study. SETTING: Community settings in Hartford, Connecticut. PARTICIPANTS: Convenience sample of 200 parents and their 212 children, aged 2-12. MAIN OUTCOME MEASURES: Adult obesity (Body Mass Index [BMI] > 30), childhood overweight (BMI-for-age > 95(th) percentile), and household food security (U.S. Department of Agriculture module). ANALYSIS: Chi-square tests between weight status and socioeconomic characteristics. Multinomial regression analyses to determine risk factors for adult obesity and childhood overweight. RESULTS: Over half of parents (51%) were obese, and almost one-third of children (31.6%) were overweight. Over half of households were food insecure. Food insecure adults were significantly more likely to be obese as those who were food secure (Odds Ratio [OR]=2.45, p = .02). Being a girl and having an obese parent doubled the likelihood of children being overweight (OR=2.56, P = .01; OR=2.32, P = .03). Children with family incomes below 100% of poverty were half as likely to be overweight as those with higher incomes (OR=.47, P = .05). Food insecurity did not increase odds of childhood overweight. CONCLUSIONS AND IMPLICATIONS: Obesity prevention programs and policies need to address food insecurity and gender as key risk factors.

Comparative effectiveness of zinc protoporphyrin and hemoglobin concentrations in identifying iron deficiency in a group of low-income, preschool-aged children: practical implications of recent illness.

OBJECTIVE: The goal was to assess the influence of recent infection on screening tests for iron depletion (zinc protoporphyrin and hemoglobin) among low-income, preschool-aged children. METHODS: This cross-sectional study was conducted at community sites and ambulatory care clinics in Hartford, Connecticut, and included 180 preschool-aged children. Iron depletion was defined as serum ferritin levels of < or = 15 microg/L. Recent illness was defined by parent or guardian (caretaker) report or evidence of elevated C-reactive protein concentrations. History of anemia was determined through medical records review. Sensitivity, specificity and positive predictive values of hemoglobin and zinc protoporphyrin were calculated overall and for children with and without recent illness. RESULTS: At enrollment, more than one half of the children had a recent illness, and 57.5% had a history of anemia. More than one third had iron depletion. Serum ferritin levels were significantly higher among recently ill children. Secondary to recent illness, the positive predictive value of elevated zinc protoporphyrin, but not low hemoglobin, was reduced significantly. Zinc protoporphyrin levels of >69 micromol/mol heme identified significantly more iron-deficient children. CONCLUSIONS: Compared with anemia, elevated zinc protoporphyrin levels identified significantly more iron-deficient children. Recently ill children were one half as likely to have low serum ferritin levels, compared with children without recent illness. The negative effect of recent illness on the positive predictive value of zinc protoporphyrin when ferritin is used to determine iron status has many practical implications.

Differing perspectives of inner-city parents and pediatric clinicians impact management of iron-deficiency anemia.

OBJECTIVE: To ascertain the beliefs and experiences of inner-city pediatric clinicians and parents regarding anemia in young children. DESIGN: Focus groups and in-depth interviews. SETTING: Pediatric clinics and community agencies in Hartford, Connecticut. PARTICIPANTS: Convenience sample of 41 pediatric clinicians (93% white, 73% female) and 85 parents (100% minority, 88% female, 47% < 12 years education). PHENOMENON OF INTEREST: Identification, understanding, and management of anemia. ANALYSIS: Researcher pairs coded complete transcriptions. Recurrent themes were identified, which were then contrasted and compared between clinicians and parents. RESULTS: Both clinicians and parents were familiar with, but frustrated by the persistence of anemia. They noted time constraints and poor communication during office visits as contributing to the problem. Parents felt alarmed upon initial diagnosis; linked anemia with heredity, food patterns, and activity; reported culturally linked management strategies; but were uncertain of the seriousness. Health clinicians saw physiological processes as outside the parents' understanding and emphasized prevention through feeding recommendations. CONCLUSIONS AND IMPLICATIONS: In order to address childhood anemia effectively, differing socio-cultural perspectives of clinicians and parents need to be incorporated into a unified health care plan. Nutritionists are well suited to collaborate on the health care team to effectively address this issue.

A universal product code scanner is a feasible method of measuring household food inventory and food use patterns in low-income families.

This study assesses the feasibility of using a Universal Product Code (UPC) scanner to record the home food inventory of limited-resource families. Feasibility was based on UPC scanner accuracy, time involved, and researcher/study participant feedback. Program staff members completed a traditional line-item inventory and UPC scan of 5,920 food items during 51 separate visits to the homes of 32 families. Foods reported from the UPC scanner were compared with the manual line-item food inventory. The UPC scanner report had an accuracy of 95.6% (5,661/5,920). Further, the UPC scanning technique offered a 31.8% time savings over the traditional line-item inventory approach. The UPC scanner was easy to use and participants reported that scanning food items was non-intrusive. A UPC scanner is a feasible method of recording the home food inventory, and the accuracy and simplicity of this approach can provide useful information on foods available for consumption within a home.

Managing anemia in low-income toddlers: barriers, challenges and context in primary care.

Iron-deficiency remains a concern among low-income toddlers in the U.S. This formative study describes how primary care providers serving high-risk 1- to 3-year-old children in an urban ambulatory care setting approach anemia. Data collection included a retrospective review of randomly selected medical records (n=264) and semi-structured interviews with clinicians (n=41). Thirty-eight percent of the children presented with anemia (Hgb < 11.0 g/dl) at least once between 12 and 36 months of age. Just under half of these children were treated for anemia. Follow-up laboratories for iron-treated children were completed within 35 days in 16% of cases (median: 3 months). Interviews identified four key themes (iron-deficiency, communication, poverty, system) running through the two major categories of prevention and treatment. Treatment cut-points were variable. While providers felt clinically comfortable with anemia, they felt burdened and challenged by follow-up. Communication and system barriers weighed most heavily on perceived treatment outcomes.