Using Mobile Technology for Family-Based Prevention in Families with Low Incomes: Lessons from a Randomized Controlled Trial of a Childhood Obesity Prevention Program.

Researchers are increasingly using web-based technologies to deliver family-based, prevention programming. Few studies have examined the success of such approaches for families with low incomes. The purpose of this study was to describe the level of in-class and online engagement in a childhood obesity prevention program for parents with low incomes, to examine the demographic correlates of parent engagement, and to examine dosage effects on parental feeding outcomes as a function of online exposure. All participants attended in-class nutrition education classes (Eating Smart · Being Active) as part of the Expanded Food and Nutrition Education Program (EFNEP) in Colorado and Washington State (classes were offered in English and Spanish). Participants in this analysis were 168 parents from a larger cluster randomized controlled trial who had been randomly assigned to also receive a newly developed, mobile-based version of an efficacious, feeding-focused, childhood obesity prevention program. Results showed that despite high levels of in-person attendance (70%), participants only accessed 47% of the videos (online content). Older parents and parents of girls showed higher levels of in-person attendance; currently employed parents showed lower levels. Online engagement varied as a function of ethnicity and acculturation: non-Hispanic parents accessed the most videos, low-acculturated Hispanic parents accessed the second most, and highly acculturated Hispanic parents accessed the least. In contrast, low-acculturated Hispanic parents showed the highest in-person attendance. For all but one outcome, significant online program effects were found only for parents who accessed at least half of the videos. Implications for mobile-based, family-based prevention programs for parents with low incomes are considered.ClinicalTrials.gov Identifier: NCT03170700; Registration Date: March 08, 2017.

Parent and household influences on calcium intake among early adolescents.

BACKGROUND: Calcium intake during early adolescence falls short of requirements for maximum bone accretion. Parents and the home food environment potentially influence children's calcium intakes. This study aimed to quantify parental psychosocial factors (PSF) predicting calcium intakes of Asian, Hispanic, and non-Hispanic white (NHW) early adolescent children from a parental perspective. METHODS: This was a cross-sectional study involving the administration of a validated calcium-specific food frequency questionnaire to a convenience sample of children aged 10-13 years and the primary individual responsible for food acquisition in the child's household. Based on Social Cognitive Theory, parental factors potentially associated with children's calcium intake were also assessed via parent questionnaires. The total study sample consisted of 633 parent-child pairs (Asian = 110, Hispanic = 239, NHW = 284). Questionnaires were completed at community-based centers/sites. Outcome measures were the association between parent-child calcium (mg), milk (cups/day), and soda (cans/day) intakes and the predictive value of significant parental PSF towards calcium intakes of their children. Sex-adjusted linear regression and multivariate analyses were performed. RESULTS: Calcium intakes of parent-child pairs were positively associated among all ethnic groups (r = 0.296; P < 0.001). Soda intakes were positively associated among Hispanic parent-child pairs only (r = 0.343; P < 0.001). Home availability of calcium-rich foods (CRF), parental rules and expectations for their child's intake of beverages, and parents' calcium intake/role modeling were positively associated with children's calcium intake and overwhelmed all other PSF in multivariate analyses. Significant cultural differences were observed. Parental role modeling was a significant factor among Hispanic dyads only. Multivariate models explained 19-21% of the variance in children's calcium intakes. CONCLUSIONS: Nutrition interventions to improve children's calcium intakes should focus on parents and provide guidance on improving home availability of CRF and increasing rules and expectations for the consumption of CRF. Among Hispanic families, interventions promoting parental modeling of desired dietary behaviors may be most successful.

Field testing a questionnaire assessing parental psychosocial factors related to consumption of calcium-rich foods by Hispanic, Asian, and Non-Hispanic white young adolescent children.

Intervention strategies to increase calcium intake of parents and young adolescent children could be improved by identifying psychosocial factors influencing intake. The objective was to develop a tool to assess factors related to calcium intake among parents and Hispanic, Asian, and non-Hispanic white young adolescent children (10-13 years) meeting acceptable standards for psychometric properties. A parent questionnaire was constructed from interviews conducted to identify factors. Parents (n = 166) in the United States completed the questionnaire, with seventy-one completing it twice. Two constructs (Attitudes/Preferences and Social/Environmental) were identified and described by eighteen subscales with Cronbach's alpha levels from .50 to .79. Test-retest coefficients ranged from .68 to .85 (p < .001). Several subscales were statistically significantly associated with parent characteristics consistent with theory and published literature. This tool shows promise as a valid and reliable measure of factors associated with calcium-rich food intake among parents and young adolescent children.

Parents Report Positive Changes in Parental Feeding Practices 12 Months After Intervention.

OBJECTIVE: Determine self-reported parental feeding behavior changes and perspectives on parental feeding intervention at 12-month follow-up. METHODS: Telephone focus groups using a 2 × 2 design (English/Spanish × in-class or online) with Expanded Food and Nutrition Education Program participants (n = 37) with children 2-8 years and high exposure to the Food, Feeding, and Your Family intervention (7 lessons). Researchers (n = 3) independently identified themes. RESULTS: Parental behavior changes that (1) positively influenced children's diets, (2) involved children in food-related activities, (3) eased stressful situations around food, (4) led to healthier food choices, and (5) saved money when food shopping. Commonly implemented practices included establishing structured mealtime routines, introducing new foods multiple times, and encouraging children's eating competence. Online participants noted materials were easily accessible via text messages. CONCLUSIONS AND IMPLICATIONS: Incorporating parental feeding content (in-class or online) into nutrition education interventions, such as the Expanded Food and Nutrition Education Program, supports developing positive parental feeding behaviors in families with low income.

Short-Term Efficacy of a Childhood Obesity Prevention Program Designed to Pair Feeding Content With Nutrition Education.

Background: Family-based programs show considerable promise in preventing overweight and obesity in young children. However, dissemination is difficult because significant participant and staff involvement is required. This study examined the short-term efficacy of adding parental feeding content to a widely-used nutrition education curriculum for families in low-resourced communities comparing the influence of two delivery methods (in-class and online) on parents' feeding knowledge, practices, and styles. Methods: In this cluster randomized controlled trial, parents of 2- to 8-year-old children enrolled in the EFNEP (Expanded Food and Nutrition Education Program) in Colorado and Washington were randomly assigned to: in-class nutrition education only, in-class nutrition education with in-class feeding content, or in-class nutrition education with online feeding content. Data from the 382 participants who completed both pretest and posttest assessments are reported in this study. Results: Multilevel analyses showed empirical support for the influence of the program on parents' feeding knowledge, practices, and styles. Online and in-class methods were equally effective in delivering feeding content in low-resourced communities. Consistent effects were seen across the two delivery methods for encouraging children to try new foods (p < 0.05), use of child-centered feeding practices (i.e., greater responsiveness, p < 0.05), child involvement in food preparation (p < 0.05), and understanding the number of presentations often necessary for child acceptance of a new food (p < 0.001). Location and language differences were seen across some constructs. Conclusions: This study demonstrates the efficacy of in-class and online approaches to feeding highlighting the program's positive effects on promoting healthy feeding behaviors for parents of children in low-resourced families. ClinicalTrials.gov Identifier: NCT03170700.

Parent calcium-rich-food practices/perceptions are associated with calcium intake among parents and their early adolescent children.

OBJECTIVE: The study aimed to (i) segment parents of early adolescents into subgroups according to their Ca-rich-food (CRF) practices and perceptions regarding early adolescent CRF intake and (ii) determine whether Ca intake of parents and early adolescents differed by subgroup. DESIGN: A cross-sectional convenience sample of 509 parents and their early adolescent children completed a questionnaire in 2006-2007 to assess parent CRF practices and perceptions and to estimate parent and child Ca intakes. SETTING: Self-administered questionnaires were completed in community settings or homes across nine US states. SUBJECTS: Parents self-reporting as Asian, Hispanic or non-Hispanic White with a child aged 10-13 years were recruited through youth or parent events. RESULTS: Three parent CRF practice/perception segments were identified, including 'Dedicated-Milk Providers/Drinkers' (49 %), 'Water Regulars' (30 %) and 'Sweet-Drink-Permissive Parents' (23 %). Dedicated-Milk Providers/Drinkers were somewhat older and more likely to be non-Hispanic White than other groups. Ca intakes from all food sources, milk/dairy foods and milk only, and milk intakes, were higher among early adolescent children of Dedicated-Milk Providers/Drinkers compared with early adolescents of parents in other segments. Soda pop intakes were highest for early adolescents with parents in the Water Regulars group than other groups. Dedicated-Milk Providers/Drinkers scored higher on culture/tradition, health benefits and ease of use/convenience subscales and lower on a dairy/milk intolerance subscale and were more likely to report eating family dinners daily than parents in the other groups. CONCLUSIONS: Parent education programmes should address CRF practices/perceptions tailored to parent group to improve Ca intake of early adolescent children.

Development of Reliable and Valid Questions to Assess Food Resource Management Behaviors in Adults With Limited Income.

OBJECTIVE: Develop reliable, valid questions to assess changes in food resource management (FRM) behaviors in adults with limited incomes. DESIGN: Questionnaire development using a mixed-methods approach: content validity (subject matter and curricula), face validity, temporal reliability (test-retest), sensitivity to change, and exploratory factor analysis (EFA). SETTING: Community settings in 12 states. PARTICIPANTS: Convenience samples of English-speaking Expanded Food and Nutrition Education Program (EFNEP) or EFNEP-eligible adults: 105 (cognitive interviews), 181 (test-retest), 185 (sensitivity), and 389 (EFA) adults. VARIABLES MEASURED: Behaviors related to FRM skills: planning, shopping, and budgeting. ANALYSIS: Consistency and agreement in cognitive interviews and temporal reliability; sensitivity at posttest (paired t tests, Wilcoxon signed-rank tests); internal consistency of scales identified in EFA (Cronbach α). P < 0.5. RESULTS: All questions had acceptable temporal reliability ranges for the intraclass correlation coefficient (0.48-0.74) and Spearman rank-order correlation (0.48-0.73). All questions were sensitive to change at posttest (P < 0.001). Planning and saving scales, revealed by EFA, demonstrated internal consistency (> 0.80 Cronbach α). CONCLUSIONS AND IMPLICATIONS: The 9 FRM behavior questions have acceptable temporal reliability and content and face validity and can be used nationally by EFNEP to assess participants' self-reported behavior changes. Other nutrition programs with similar audiences and content could use these questions to measure changes in FRM behaviors.

The Healthy Toddlers Trial Protocol: an intervention to reduce risk factors for childhood obesity in economically and educationally disadvantaged populations.

BACKGROUND: The number of overweight children in America has doubled to an estimated 10 million in the past 20 years. Establishing healthy dietary behaviors must begin early in childhood and include parents. The Healthy Toddlers intervention focuses on promoting healthy eating habits in 1- to 3-year-old children utilizing the Social Cognitive Theory and a learner-centered approach using Adult Learning principles. This Healthy Toddlers Trial aims to determine the efficacy of a community-based randomized controlled trial of an in-home intervention with economically and educationally disadvantaged mothers of toddlers. The intervention focuses on: (a) promoting healthy eating behaviors in toddlers while dietary habits are forming; and (b) providing initial evidence for the potential of Healthy Toddlers as a feasible intervention within existing community-based programs. METHODS/DESIGN: This describes the study protocol for a randomized control trial, a multi-state project in Colorado, Michigan, and Wisconsin with economically and educationally disadvantaged mother-toddler dyads; toddlers are between 12 and 36 months. The Healthy Toddlers intervention consists of eight in-home lessons and four reinforcement telephone contacts, focusing on fruit, vegetable, and sweetened beverage consumption and parental behaviors, taught by paraprofessional instructors. Healthy Toddlers uses a randomized, experimental, short-term longitudinal design with intervention and control groups. In-home data collection (anthropometric measurements, feeding observations, questionnaires, 3-day dietary records) occurs at baseline, immediately following the intervention, and 6 months after the intervention. Main toddler outcomes include: a) increased fruit and vegetable consumption and decreased sweetened beverage consumption; and b) improved toddler-eating skills (self-feeding and self-serving). Main parent outcomes include: a) improved psychosocial attributes (knowledge, attitudes, self-efficacy, feeding style) related to child feeding; b) provision of a more positive mealtime physical environment (turning off the TV); and c) creation of a more positive mealtime social environment (sitting down together for meals). DISCUSSION: If this project is successful, the expected outcomes are that the intervention will be effective in helping toddlers develop healthy eating skills that contribute to improve overall health and development and to the prevention of obesity. TRIAL REGISTRATION: Current Controlled Trials ACTRN12610000981022.

Healthy babies through infant-centered feeding protocol: an intervention targeting early childhood obesity in vulnerable populations.

BACKGROUND: Poor feeding practices during infancy contribute to obesity risk. As infants transition from human milk and/or formula-based diets to solid foods, these practices interfere with infant feeding self-regulation and healthy growth patterns. Compared with other socioeconomic groups, lower-income mothers are more likely to experience difficulty feeding their infants. This may include misinterpreting feeding cues and using less-than-optimal feeding styles and practices, such as pressuring infants during mealtimes and prematurely introducing solid food and sweetened beverages. The Healthy Babies trial aims to determine the efficacy of a community-based randomized controlled trial of an in-home intervention with economically and educationally disadvantaged mother-infant dyads. The educational intervention is being conducted during the infant's first 6 months of life to promote healthy transition to solids during their first year and is based on the theory of planned behavior. METHODS/DESIGN: We will describe our study protocol for a multisite randomized control trial being conducted in Colorado and Michigan with an anticipated sample of 372 economically and educationally disadvantaged African American, Hispanic, and Caucasian mothers with infants. Participants are being recruited by county community agency staff. Participants are randomly assigned to the intervention or the control group. The intervention consists of six in-home visits by a trained paraprofessional instructor followed by three reinforcement telephone contacts when the baby is 6, 8, and 10 months old. Main maternal outcomes include a) maternal responsiveness, b) feeding style, and c) feeding practices. Main infant outcome is infant growth pattern. All measures occur at baseline and when the infant is 6 and 12 months old. DISCUSSION: If this project is successful, the expected outcomes will address whether the home-based early nutrition education intervention is effective in helping mothers develop healthy infant feeding practices that contribute to improving infant health and development and reducing the risk of early-onset childhood obesity. TRIAL REGISTRATION: Current Controlled Trials ACTRN126100000415000.

Positive Change in Healthy Eating Scores Among Adults With Low Income After Expanded Food and Nutrition Education Program Participation.

OBJECTIVE: Using 24-hour dietary recalls, compare Healthy Eating Index (HEI)-2005 scores of Expanded Food and Nutrition Education Program participants before and after 8-12 weekly lessons. DESIGN: Analysis of preexisting 24-hour dietary recalls information collected from October, 2012 through September, 2014. PARTICIPANTS: Participants with complete pre-post dietary data (n = 122,961); subset of those with complete demographic data (n = 97,522). MAIN OUTCOME MEASURES: Change in HEI-2005 scores (total and components). STATISTICAL ANALYSIS: Linear regression model fit separately for total HEI and 12 components. The response variable was changed in the HEI-2005 score; predictor variables included age, education, sex, and race/ethnicity. RESULTS: The mean total HEI scores were 51.1 (SD, 13.7) at entry and 56.5 (SD, 13.7) at exit, with a change of 5.4 (SD, 16.2). Nine of 12 component scores increased. Changes were greater as age increased, with increasing education, and in women. Hispanics had the greatest improvement (mean ± SE) in total HEI score (8.3 ± 0.1). CONCLUSIONS AND IMPLICATIONS: Although diet quality remained poor, participation in the Expanded Food and Nutrition Education Program resulted in improvement in dietary quality. The degree of improvements varied among demographic groups, but all groups improved.

Implementation Science Strategies Promote Fidelity in the Food, Feeding, and Your Family Study.

OBJECTIVE: Use of implementation science strategies to promote fidelity in the Food, Feeding, and Your Family study. DESIGN: Cluster randomized controlled trial with 3 conditions: control, in-class, or online, delivered in English or Spanish. Observations of 20% of classes. SETTING: Expanded Food and Nutrition Education Program (EFNEP) in 2 states. PARTICIPANTS: EFNEP peer educators (n = 11). INTERVENTION: Parental feeding content incorporated into EFNEP lessons (in-class) or through text with links to videos/activities (online). Extensive educator training, scripted curriculum, frequent feedback. ANALYSIS: Assessment of fidelity compliance. Qualitative analysis of verbatim educator interviews and classroom observer comments. RESULTS: During 128 class observations (40-45 per condition), peer educators followed scripted lesson plan 78% to 89% of the time. There was no evidence of cross-contamination of parental feeding content in control and only minor sharing in online conditions. Variations with fidelity were primarily tied to the EFNEP curriculum, not the parent feeding content. Educators (n = 7) expressed favorable opinions about the Food, Feeding, and Your Family study, thought it provided valuable information, and appreciated support from EFNEP leadership. CONCLUSIONS AND IMPLICATIONS: Incorporating implementation science strategies can help ensure successful adherence to research protocols. With proper training and support, EFNEP peer educators can deliver an evidence-based curriculum as part of a complex research study.

Best Practices in Curricula Revisions: Using the Evidence-Based Eating Smart • Being Active as an Exemplar.

This article describes the processes employed to revise the widely used curriculum, Eating Smart • Being Active. Because of its popularity among nutrition education programs serving the low-income population, the curriculum developers felt it was important to share the revision process after the release of the 2015-2020 Dietary Guidelines for Americans. Extensive feedback during formative evaluation, updated content from the Dietary Guidelines for Americans, and a modern look resulted in a fully revised curriculum released in 2017. Program leaders should have confidence that their educators will be able to implement this evidence-based curriculum with fidelity. An outcome evaluation of the revised Eating Smart • Being Active curriculum is recommended.

Development of a National Dietary Behaviors Questionnaire for EFNEP Adult Participants.

OBJECTIVE: Develop and establish the reliability and validity of dietary behavior evaluation questions for the Expanded Food and Nutrition Education Program (EFNEP). DESIGN: A mixed-methods study using cognitive interviews, expert panels, test/retest reliability, and pretests/posttests. SETTING: 14 states across the US. PARTICIPANTS: A convenience sample of low-income EFNEP or EFNEP-eligible participants for cognitive interviews (n = 111), reliability testing (n = 181), and sensitivity to change testing (n = 382). MAIN OUTCOMES MEASURES: Indicators of face and content validity, temporal reliability, and sensitivity to change. ANALYSIS: Questions interpreted as intended in cognitive interviews, intraclass correlation coefficient and Spearman rank-order correlation for reliability testing; paired t tests or Wilcoxon signed-rank tests for sensitivity to change; and exploratory factor analyses to identify possible scales. RESULTS: Cognitive interviews resulted in 3 rounds of question revisions; reliability value ranges were 0.48-0.77 for intraclass correlation coefficient and 0.43-0.77 for Spearman rank-order correlation. For sensitivity to change, 9 items had evidence of change (P < 0.05) between pretests and posttests, whereas 5 items had evidence for change after removing those with little room to change. Two scales were identified: diet quality and non-cheese dairy. CONCLUSIONS AND IMPLICATIONS: The EFNEP's new dietary behavior evaluation questions demonstrated face and content validity, moderate to strong reliability, and sensitivity to detect self-reported behavior changes among low-income, diverse populations (culturally, racially/ethnically, and level of education) across 14 states. Nutrition education programs targeting similar behaviors with English speaking clients could consider this dietary behavior questionnaire.

Identification of a Framework for Best Practices in Nutrition Education for Low-Income Audiences.

To promote effective low-income nutrition education programs, an expert panel of nutrition education and public health researchers built consensus around 28 best practices grouped into 5 domains (Program Design, Program Delivery, Educator Characteristics, Educator Training, and Evaluation) targeting direct delivery of nutrition education. These best practices can be used to assess program strengths, promote fidelity in delivery and evaluation, and design research to strengthen programs' evidence base. A survey of Supplemental Nutrition Assistance Program-Education nutrition education leaders helped identify staff development needs and interest relative to specific best practices. Best practices can be used to identify staff development needs among frontline educators, supervisors, and program leaders in Supplemental Nutrition Assistance Program-Education, Expanded Food and Nutrition Education Program, and other programs targeting low-income audiences.

Evaluation and Lessons Learned From the Development and Implementation of an Online Prenatal Nutrition Training for EFNEP Paraprofessionals.

OBJECTIVE: Design, implement, and evaluate the effectiveness of a video-based online training addressing prenatal nutrition for paraprofessional peer educators. METHODS: Quasi-experimental pre-posttest study with 2 groups of paraprofessionals working for the Expanded Food and Nutrition Education Program in 17 states and US territories: intervention (n = 67) and delayed intervention comparison group (n = 64). An online training was systematically developed using Smith and Ragan's instructional design model, the Cognitive Theory of Multimedia Learning, principles of adult learning, and selected constructs of the Social Cognitive Theory. Changes in knowledge, identification of inappropriate teaching practices, and self-efficacy, were assessed. Within- and between-group comparisons were done using ANCOVA. RESULTS: The intervention group scored significantly higher (P < .05) in all evaluations compared with preassessments and the comparison group. After delayed intervention, the comparison group scored significantly higher (P < .05) than in preassessments. Paraprofessionals reacted positively to future online trainings and were interested in them. CONCLUSIONS AND IMPLICATIONS: A video-based online training is an effective method to complement in-person trainings to prepare paraprofessionals to teach nutrition lessons.

Similar 24-Hour Dietary Recall Results from Low-Income Women When Collected by a Paraprofessional Nutrition Educator or Registered Dietitian Nutritionist.

BACKGROUND: The Expanded Food and Nutrition Education Program (EFNEP) is a federally funded, community nutrition education program that assists the low-income population in acquiring knowledge and skills related to nutrition, food safety, food resource management, food security, and physical activity. Evaluation of EFNEP includes a 24-hour dietary recall (24HDR) administered by paraprofessional educators, yet protocols for most large-scale nutrition research studies employ registered dietitian nutritionists (RDNs) or individuals with educational backgrounds in nutrition or related fields to collect dietary recalls. OBJECTIVE: To compare 24HDRs collected by trained paraprofessional educators with recalls collected by an RDN. DESIGN: Exploratory cross-over study comparing same-day 24HDR in a one-on-one setting collected by paraprofessional educators and an RDN. Paired recalls were separated by at least 1 hour. PARTICIPANTS AND SETTING: The participants (n=41) were volunteer women who were eligible for participation in EFNEP in two states. MAIN OUTCOME MEASURES: The 24HDRs were compared for energy, macronutrients, micronutrients, and food groups. STATISTICAL ANALYSIS PERFORMED: Mixed-model analysis to account for repeated measures. Intraclass correlation and Spearman correlation coefficients to determine interrater agreement. RESULTS: No difference in 24HDR was seen when compared by interviewer (paraprofessional vs RDN) or by site (Colorado vs North Carolina). There were significant differences in four components (energy, total fat, saturated fat, and solid fats-added sugar) based on recall order, with a higher intake in the second recall compared with the first. CONCLUSION: The results of this preliminary study suggest that a well-trained paraprofessional educator using a valid methodology can collect a 24HDR that is similar to a recall collected by an RDN. The paraprofessional educator can be employed for dietary data collection, allowing the RDN to focus on more advanced aspects of scope of practice, such as data evaluation and program development.

The Expanded Food and Nutrition Education Program's Impact on Graduates' Quality of Life.

OBJECTIVE: To determine how the Expanded Food and Nutrition Education Program (EFNEP) affects the quality of life (QoL) of its low-income adult participants. METHODS: A cross-sectional exploratory study using focus groups (n = 15) in 8 states with EFNEP participants (n = 111) 2-4 months after graduation. Focus groups were conducted with non-Hispanic white (4 groups), black (4), English-speaking Hispanic (4), and Spanish-speaking Hispanic (3) respondents. A priori template analysis based on constructs from the University of Toronto's Quality of Life Profile for Adults and constant comparative procedures were used to generate results. RESULTS: Participants reported following healthier dietary and physical activity behaviors and having increased motivation to improve themselves and greater satisfaction with life. All groups noted being a more positive influence on their families and a having willingness to learn and try new things. CONCLUSIONS AND IMPLICATIONS: The EFNEP enhances the QoL of its participants, which suggests that the program's benefits go beyond participants' documented nutrition and health-related behavior changes. In the future, EFNEP might examine whether improved QoL is also a predictor of sustained behavior change and a means for differentiating program impacts owing to variations in dose (number of contacts) or delivery methods (face-to-face vs online).

Strategies of Asian, Hispanic, and non-Hispanic white parents to influence young adolescents' intake of calcium-rich foods, 2004 and 2005.

INTRODUCTION: Optimal intake of dietary calcium is critical to prevent osteoporosis later in life, yet most young adolescents do not consume the recommended amount. We describe parental strategies that can influence young adolescents' calcium intake in Asian, Hispanic, and non-Hispanic white households METHODS: A qualitative research design employed semistructured individual interviews with a convenience sample of mostly female parents self-reported as Asian (n = 48), Hispanic (n = 44), or non-Hispanic white (n = 76) having a child aged 10 to 13 years at home. Interviews were conducted in homes or community centers in 12 states. Interview data were analyzed by using qualitative data analysis software and thematic content analysis procedures. RESULTS: Parents monitored calcium intake by making calcium-rich foods available, preparing calcium-rich foods, and setting expectations that children would consume calcium-rich foods. As mentors, parents encouraged intake of calcium-rich foods and advised children to moderate or increase intake of specific foods. Although parents perceived modeling of calcium intake as important, some were ambivalent about its effects. We noted minimal differences by racial/ethnic groups and sex of children in reported availability of selected calcium-rich foods at home, parental modeling of intake, and mentoring behaviors. CONCLUSION: Our findings suggest that interventions to help parents increase children's intake of calcium should focus on types of foods made available, giving age-appropriate encouragement and advice, and modeling proper intake.

At-home and away-from-home eating patterns influencing preadolescents' intake of calcium-rich food as perceived by Asian, Hispanic and Non-Hispanic white parents.

OBJECTIVE: To explore at-home and away-from-home eating patterns influencing Asian, Hispanic, and non-Hispanic white preadolescents' intake of calcium-rich food from a parental perspective. DESIGN: Individual semistructured interviews. SETTING: Home or community site. PARTICIPANTS: Convenience sample (n = 201) of self-reported Asian (n = 54), Hispanic (n=57), and non-Hispanic white (n = 90) parents of 10- to 13-year-old children recruited from community youth programs. PHENOMENON OF INTEREST: Description of at-home and away-from-home family eating patterns. ANALYSIS: NVivo software to code and sort transcript segments, qualitative data analysis procedures. RESULTS: Participants from all groups shared common at-home and away-from-home meal patterns. A lack of time often resulted in negative factors that impacted intake of calcium-rich food and beverages including breakfast on the run, fewer home-prepared or shared family meals, and more frequent meals eaten away from home. Asian and Hispanic parents indicated eating out less frequently than non-Hispanic white parents. Parents from all groups lacked expectations for their child to drink calcium-rich beverages with meals. CONCLUSIONS AND IMPLICATIONS: Practical strategies are needed to facilitate intake of calcium-rich food and beverages through more frequent family meals at home and parental expectations for children's intake of calcium-rich beverages with meals.

Communicating and Assessing Physical Activity: Outcomes From Cognitive Interviews With Low-Income Adults.

OBJECTIVE: This investigation sought to identify the physical activity (PA) terms and concepts that are best understood by low-income adults. DESIGN: This was a cross-sectional study using semistructured cognitive interviews that employed retrospective verbal probing techniques. SETTING: Interviews were conducted in Expanded Food and Nutrition Education Program (EFNEP) sites in New Jersey, Tennessee, and Washington. PARTICIPANTS: A convenience sample of 57 adults participating in or eligible for participation in EFNEP. PHENOMENON OF INTEREST: Participants' interpretations and conceptualizations of PA concepts and terms. ANALYSIS: Template and constant comparative analysis. RESULTS: Participants interpreted many PA terms and concepts in unintended ways. Exercise was the term that came closest to conveying moderate to vigorous PA. Terms used to describe muscle-strengthening activities were mostly understood. Intentional engagement in extra activities was difficult for participants to conceptualize despite multiple tested wordings; making small changes to be active came closest to conveying this concept. Participants' comprehension of the PA terms differed by their PA and literacy levels. CONCLUSIONS AND IMPLICATIONS: Nutrition educators should be mindful of the terminologies they used in communicating messages and assessing PA behaviors to EFNEP participants or similar populations.