A Community-Based Cultural Adaptation Process: Developing a Relevant Cooking Curriculum to Address Food Security for Burundian and Congolese Refugee Families.

Refugee-specific nutrition and cooking curricula addressing dietary acculturation barriers to food security are limited. A cooking curriculum was culturally adapted for Burundian and Congolese refugees to address their unique dietary acculturation experiences. A four-phase curriculum adaptation process (information gathering [literature review, researcher informed, and formative interviews; n = 18], preliminary adaptation design [data incorporation and steering committee; n = 5], pilot testing [n = 10 youth/adult dyads], and refinement) was applied to the existing evidence-based iCook 4-H curriculum using a five-strategy (peripheral, evidential, linguistic, constituent-involving, and sociocultural) cultural adaptation framework. A multiphase, two-cycle coding analytic process was completed within NVivo 12, followed by direct content analysis. Seventeen adaptations were made to the iCook curriculum, derived from varying combinations of four data sources (literature review, researcher informed, priority population, and steering committee), applying all five cultural adaptation strategies. A majority of the curriculum adaptations were derived from two or more data sources (71%) and were categorized within multiple adaptation strategies (88%). This study provided a community-based cultural adaptation process that could be used with various populations to address unique barriers and facilitators to food security. This innovative model addresses cultural needs while simultaneously aiming to improve health habits of refugee communities.

Feasibility and Acceptability of Implementing a Culturally Adapted Cooking Curriculum for Burundian and Congolese Refugee Families.

Pika Pamoja (Cook Together) is an eight-session cooking curriculum for Burundian and Congolese refugee families, culturally adapted from the evidence-based iCook 4-H curriculum to address dietary acculturation barriers to and facilitators of food security. The goal of this study was to determine the feasibility and acceptability of implementing Pika Pamoja. Researchers and a multilingual community aid implemented Pika Pamoja in a pre-post pilot intervention with randomized control (n = 5)/treatment (n = 5) dyads (youth/mother). Feasibility (recruitment/retention, implementation, fidelity testing, and assessment procedures) and acceptability (process and program evaluations) measures were collected. All 10 dyads (control and treatment) were retained throughout the study. All fidelity measures were 91% or above. The final youth assessment instrument included scales for cooking skills (α = 0.93), cooking self-efficacy (α = 0.90), openness to new foods (α = 0.81), and eating (α = 0.68), playing (α = 0.90), and setting healthful goals (α = 0.88) together as a family. The final adult instrument included scales for cooking, eating, and playing together (α = 0.68), kitchen proficiency (α = 0.89), and food security (α = 0.79). Participant feedback was uniformly positive. Based on these results, Pika Pamoja was feasible to implement and was accepted by the priority population. Larger scale studies to measure the effectiveness of Pika Pamoja to increase food security among refugee families are needed.

Barriers and Facilitators to Food Security among Adult Burundian and Congolese Refugee Females Resettled in the US.

Sub-Saharan African refugees in the US have reported food security rates seven times below the national average. Dietary acculturation issues may be a contributing factor. Criterion-specific sample (n = 18) was recruited using network then snowball sampling methods. Semi-structured interviews were facilitated with the aid of a culturally and linguistically appropriate interpreter. An iterative, two cycle coding analytic process was completed within NVivo 11 by two coders who sought inter-rater reliability. Codes were organized into hierarchical maps and coding matrices for direct content analysis, and pattern and theme detection. Saturation was achieved and validated with an additional two interviews. Participants were primarily Burundian (67% vs. 33% Congolese), married (72%), held no high school degree (72%), unemployed (56%) and reported limited English proficiency (72%). Barriers and facilitators to food security across all levels of the Socio-Ecological Model (SEM) were noted. Emerging themes included difficulty with language, cooking, and shopping; transportation; social network support; orientation services; reliance on nutrition assistance programs; limited culturally relevant food and land access; and program policy miscomprehension. The complex relationship between dietary acculturation barriers and facilitators at various SEM levels demonstrates the need for a multi-level intervention to improve food security among refugees.

The Use of Infant Confinement Equipment in Community-Based Child Care Centers: An Analysis of Centers Participating in a Statewide Quality Rating and Improvement System.

Objectives Although infants increasingly spend time in community-based child care centers, little attention has been paid to their physical activity experiences while in group care. In particular, the use of devices to restrict infant mobility, such as bouncy seats, high chairs, cribs, and stationary activity centers, has received little attention in the physical activity literature. The current study examines the presence and use of these confinement devices in infant classrooms. Methods A secondary analysis of observational data in child care centers participating in Delaware's Quality Rating and Improvement System was conducted. Quality assessment observations were coded for the use of confinement devices and the actual amount of time the confinement device was employed per child. The sample consisted of 38 infant classrooms serving a total of 162 infants in the statewide system. Results Findings suggest a high level of utilization of confinement devices in infant child care classrooms with each classroom averaging three pieces of equipment used during the observations and 22% of observed children being confined 30 min or longer during the observation period. Conclusions for Practice The reliance on confinement devices in group child care is a potential concern in the quest to prevent childhood obesity by ensuring adequate physical activity and mobility for infants in group care settings. More research is needed to understand the implications of the use of confinement devices on physical activity in group care settings.

CULTURAL MODELS OF INFANT EMOTIONS AND NEEDS AMONG THE GAMO PEOPLE OF SOUTHERN ETHIOPIA.

How mothers perceive their infants' emotions and their subsequent responses are influenced by cultural values and beliefs. Mothers who live in particularly harsh environments may have perceptions about their infants' emotions that reflect not only cultural values but also constraints of the environment. In this qualitative study, 29 Gamo mothers living in rural Ethiopia were interviewed about perceptions of their infants' emotions, how they felt about these emotions, and what they believed their infants needed in response. Through constant comparative analysis and thematic coding, several patterns emerged in mothers' perceptions about their infants' emotions and what constituted appropriate responses. Mothers said that their infants' negative emotions were possibly related to illness and that appropriate responses were focused mostly on breastfeeding, complementary food, and needing to be held. Mothers also discussed their work demands and how they conflicted with their desire to respond to their infants; however, many mothers said that they relied on their older children to help. Mothers' responses were centered on a parenting strategy aimed at promoting infant health and survival, which is consistent with research on parents living in rural environments who subsist by farming and have relatively high risk for infant mortality.

Connections Between Prenatal Physical Activity and Breastfeeding Decisions.

Women who engage in prenatal physical activity give themselves, and their child, an advantage over women who did not engage in prenatal physical activity; not only are there significant health benefits for mothers, but there are also great benefits for the unborn child. Breastfeeding is another important decision parents make that can affect the mother and her child. There has been extensive research on the benefits of both prenatal physical activity and breastfeeding, but the connection between the two is unclear. The purpose of this grounded theory article was to identify potential connections between factors influencing women's decisions to engage in prenatal physical activity and breastfeeding among mothers in a medium-sized city in Tennessee. Responses from mothers revealed numerous themes related to both prenatal physical activity and breastfeeding. Connections between prenatal physical activity and breastfeeding, in addition to an overarching theme that captured the women's collective experience, were identified.

Multiple caregivers' touch interactions with young children among the Bofi foragers in Central Africa.

The current study examined the use of three types of touch (caregiving, active social-affectionate, and passive social-affectionate) by caregivers with young children among the Bofi foragers, a seminomadic group of hunter-gatherers in Central Africa. With the purpose of providing a more holistic view of touch interactions in early childhood, compared to extant Western mother-centric views, this study documents stylistic touch patterns used by multiple caregivers (mother, father, adult relatives, and juvenile relatives) with Bofi forager children. Thirty-five Bofi forager children, between 18 and 59 months of age, and their various caregivers were naturalistically observed over 12 daylight hours using a focal child observational technique. Frequencies of each type of touch and the rank order of types of touch that children received were compared between caregivers and examined by child age and gender. Even though nonmaternal caregivers showed high physical involvement with children, mothers exemplified the highest level of involvement. Overall, passive social-affectionate touch was utilized the most by all types of caregivers. Mothers used more caregiving touch, and fathers and adult relatives had similar frequencies of caregiving touch and active social-affectionate touch. In contrast, juvenile relatives showed more active social-affectionate touch with focal children. This study highlights the importance of examining multiple caregivers and physical interactions when studying early childhood experiences. Furthermore, by focusing on multiple caregivers and multiple types of touch, this study provides a more thorough characterization of the touch experiences of young children than previous studies of touch. Finally, the current study exemplifies the value of considering non-Western populations when investigating touch interactions.

Infant Care Practices among Resettled Refugee Mothers from East and Central Africa.

Refugees often parent under extreme circumstances. Parenting practices have implications for child outcomes, and parenting in the context of refugee resettlement is likely to be dynamic as parents negotiate a new culture. This study examined African origin mothers' infant care values and practices related to feeding, carrying, and daily activities following resettlement in the Southeastern region of the U.S. Ten African origin mothers were asked about their infant care practices through semi-structured interviews. Results indicated that mothers valued breastfeeding but often chose to use formula as a supplement or instead of breastfeeding. In addition, participants valued carrying their infants close to the body but used equipment such as strollers. Mothers expressed that perceptions of American culture and rules, social support, interactions with community agencies, and the need to engage in formal employment were factors that influenced their infant care practices.

U.S. obesity as delayed effect of excess sugar.

In the last century, U.S. diets were transformed, including the addition of sugars to industrially-processed foods. While excess sugar has often been implicated in the dramatic increase in U.S. adult obesity over the past 30 years, an unexplained question is why the increase in obesity took place many years after the increases in U.S. sugar consumption. To address this, here we explain adult obesity increase as the cumulative effect of increased sugar calories consumed over time. In our model, which uses annual data on U.S. sugar consumption as the input variable, each age cohort inherits the obesity rate in the previous year plus a simple function of the mean excess sugar consumed in the current year. This simple model replicates three aspects of the data: (a) the delayed timing and magnitude of the increase in average U.S. adult obesity (from about 15% in 1970 to almost 40% by 2015); (b) the increase of obesity rates by age group (reaching 47% obesity by age 50) for the year 2015 in a well-documented U.S. state; and (c) the pre-adult increase of obesity rates by several percent from 1988 to the mid-2000s, and subsequent modest decline in obesity rates among younger children since the mid-2000s. Under this model, the sharp rise in adult obesity after 1990 reflects the delayed effects of added sugar calories consumed among children of the 1970s and 1980s.

Mothers' feelings about infants' negative emotions and mother-infant interactions among the Gamo of Southern Ethiopia.

Parents' exposure to stressful ecosocial situations, like inadequate resources, is linked to parents' perceptions of infants' fussing and crying and less sensitive caregiving. However, studies supporting these findings predominantly come from Western contexts of parenting and infant care. Ecosocial situations may have different effects on parenting and infants in distinct cultural contexts. In this study, the link between Gamo mothers' expressions of stress about their infants' negative emotional displays (N = 29 mothers and infants) and mother-infant interactions was investigated. Mothers who expressed stress in response to their infants' negative emotions demonstrated fewer interactions overall with their infants compared to mothers who did not express stress. Regression analyses showed that mothers who did not express stress had infants that fussed and cried more in their presence than infants of mothers who did not express stress, albeit insignificant. These results are discussed in the context of Gamo infancy in Southern Ethiopia.

Social experiences and daily routines of African American infants in different socioeconomic contexts.

Sixty-two 3- to 4-month-old African American infants from lower, middle, and upper socioeconomic status (SES) backgrounds were each observed in naturalistic contexts for 12 hr. The social experiences of infants in the 3 groups were similar in many ways: Infants from all backgrounds slept and were vocalized to for similar amounts of time. However, infants in the upper SES families engaged in more self-play, vocalized less, fussed less, had fewer but longer naps, and fewer but longer bouts of social interaction than did infants in the middle- and lower SES families. Infants in the upper SES families also received more verbal affection and soothing responses to their fussing and crying than did the other infants, whereas infants in the lower SES families interacted more with extended kin than did infants in the upper SES families. These results underscore the need to study African American families in a variety of socioeconomic contexts because families in more advantaged circumstances may greatly differ from those who are more disadvantaged, especially in terms of reliance on extended kin as caregivers.

Sociocultural factors influencing breastfeeding practices in two slums in Nairobi, Kenya.

BACKGROUND: Despite numerous interventions promoting optimal breastfeeding practices in Kenya, pockets of suboptimal breastfeeding practices are documented in Kenya's urban slums. This paper describes cultural and social beliefs and practices that influence breastfeeding in two urban slums in Nairobi, Kenya. METHODS: Qualitative data were collected in Korogocho and Viwandani slums through 10 focus group discussions and 19 in-depth interviews with pregnant, breastfeeding women and community health volunteers and 11 key-informant interviews with community leaders. Interviews were audiotaped, transcribed verbatim, coded in NVIVO and analyzed thematically. RESULTS: Social and cultural beliefs and practices that result to suboptimal breastfeeding practices were highlighted including; considering colostrum as 'dirty' or 'curdled milk', a curse 'bad omen' associated with breastfeeding while engaging in extra marital affairs, a fear of the 'evil eye' (malevolent glare which is believed to be a curse associated with witchcraft) when breastfeeding in public and breastfeeding being associated with sagging breasts. Positive social and cultural beliefs were also identified including the association of breast milk with intellectual development and good child health. The beliefs and practices were learnt mainly from spouses, close relatives and peers. CONCLUSION: Interventions promoting behavior change with regards to breastfeeding should focus on dispelling the beliefs and practices that result to suboptimal breastfeeding practices and to build on the positive ones, while involving spouses and other family members as they are important sources of information on breastfeeding. TRIAL REGISTRATION: ISRCTN83692672: December 2013 (retrospectively registered).

Rough-and-tumble play as a window on animal communication.

Rough-and-tumble play (RT) is a widespread phenomenon in mammals. Since it involves competition, whereby one animal attempts to gain advantage over another, RT runs the risk of escalation to serious fighting. Competition is typically curtailed by some degree of cooperation and different signals help negotiate potential mishaps during RT. This review provides a framework for such signals, showing that they range along two dimensions: one from signals borrowed from other functional contexts to those that are unique to play, and the other from purely emotional expressions to highly cognitive (intentional) constructions. Some animal taxa have exaggerated the emotional and cognitive interplay aspects of play signals, yielding admixtures of communication that have led to complex forms of RT. This complexity has been further exaggerated in some lineages by the development of specific novel gestures that can be used to negotiate playful mood and entice reluctant partners. Play-derived gestures may provide new mechanisms by which more sophisticated communication forms can evolve. Therefore, RT and playful communication provide a window into the study of social cognition, emotional regulation and the evolution of communication systems.

Mothers' and fathers' behaviors toward their 3- to 4-month-old infants in lower, middle, and upper socioeconomic African American families.

African American mothers' and fathers' availability, caregiving, and social behaviors toward their infants in and around their homes were examined. Twenty lower, 21 middle, and 21 upper socioeconomic families and their 3- to 4-month-old infants were observed for 4 3-hr blocks between 8:00 a.m. and 8:00 p.m. on 4 different weekdays. With increasing economic resources, children's exposure to multiple caregivers and nonresident fathers declined. Mothers were more available to infants than fathers were, regardless of socioeconomic status. Mothers fed infants more than fathers did, whereas fathers vocalized more and displayed more affection to infants than mothers did when they were examined in proportion to caregiver presence. Mothers and fathers interacted with male and female infants quite similarly, although, in the upper socioeconomic families, fathers of daughters were more available than fathers of sons. Fathers and mothers in the different socioeconomic groups held, displayed affection to, and soothed their infants differently.

Parenting and environmental risk : an examination of child loss and maternal involvement among Bofi foragers in Central Africa.

The majority of adaptationist models and research related to parenting strategies have focused on extrinsic or population-level risk as predictors of parenting. However, some researchers have called for greater consideration of cultural factors as well as on intracultural variation in parenting. This study uses a biocultural approach to examine intracultural variation in environmental risk and parenting among the Bofi foragers in Central Africa. In particular, we examine 30 mothers' experiences of child loss as a predictor of variation in maternal involvement (proximity, holding, and affection) with their young children. Multivariate and univariate analyses indicate that child loss accounted for substantial variation in maternal behaviors and was predictive of maternal holding and the expression of physical affection. In sum, our findings indicate that intracultural variation in child loss is predictive of maternal involvement with young children and that a biocultural approach is useful in explaining this variation.

A biocultural approach to breastfeeding interactions in Central Africa.

Anthropologists have long recognized that breastfeeding involves much more than feeding; it entails intimate social interactions between infants or children and their mothers. However, breastfeeding has predominantly been studied with respect to structural features (frequency, timing) as well as nutritional and health aspects of infant feeding. Thus, in this study we complement previous anthropological studies by examining social interactions that occur during breastfeeding among the Aka and Bofi foragers and Ngandu and Bofi farmers at various ages (three to four months, nine to ten months, toddlers). Further, we use an integrated biocultural perspective to explore how patterns of breastfeeding and social interactions can be shaped by economic constraints, cultural values, and children's development. Overall, our findings illustrate how biological and cultural factors interact and provide useful explanations of variations in breastfeeding structure and social interactions more so than either perspective alone.

Social learning among Congo Basin hunter-gatherers.

This paper explores childhood social learning among Aka and Bofi hunter-gatherers in Central Africa. Existing literature suggests that hunter-gatherer social learning is primarily vertical (parent-to-child) and that teaching is rare. We use behavioural observations, open-ended and semi-structured interviews, and informal and anecdotal observations to examine the modes (e.g. vertical versus horizontal/oblique) and processes (e.g. teaching versus observation and imitation) of cultural transmission. Cultural and demographic contexts of social learning associated with the modes and processes of cultural transmission are described. Hunter-gatherer social learning occurred early, was relatively rapid, primarily vertical under age 5 and oblique and horizontal between the ages of 6 and 12. Pedagogy and other forms of teaching existed as early as 12 months of age, but were relatively infrequent by comparison to other processes of social learning such as observation and imitation.

Who feeds children? A child's-eye-view of caregiver feeding patterns among the Aka foragers in Congo.

This study describes the contributions of various types of caregivers to the direct provisioning and feeding of Aka children in households reliant on foraging in Congo. Ecological and family factors that predict allomaternal caregiving (i.e., caregiving by individuals other than mothers) are identified and discussed in light of current anthropological and public health perspectives on child feeding and cooperative caregiving. The study is based on 8 months of ethnographic fieldwork in the Republic of Congo in 2004 and 2005, and utilizes naturalistic observations of 22 focal children between two and four years of age. Observations spanned 12 daylight hours spread out over three different days. The results of this study demonstrate that even though mothers were the single highest contributor to child feeding, combined allomaternal contributions (i.e., contributions by fathers, grandmothers, aunts, siblings, and cousins) to child feeding was higher than that of mothers. Furthermore, birth order and the transition in families to having a new infant predicted allomaternal contributions. These results reinforce the need to extend public health and nutrition education programs to target more than just parents, as other individuals may have substantial influence over child feeding patterns. Furthermore, these results exemplify a cooperative child rearing pattern that is consistent with behavioral ecology perspectives that have suggested that humans evolved as cooperative childrearers rather than as maternal-centric or parent-only childrearers. Lastly, individual child and family characteristics predicted allomaternal contributions to child feeding and therefore research and public health initiatives need to consider variation in child and family characteristics in order to accurately describe and serve populations throughout the world.