Describing Independent Eating Occasions among Low-Income Adolescents.

The purpose of this formative, cross-sectional study was to describe independent eating occasions (iEOs) among a convenience sample of low-income early adolescents (10-13 years, n = 46) in 10 U.S. states, including environmental context, foods selected and reasons for selection, and parental rules about foods consumed. Participants took pictures of all foods consumed over 24 h and participated in semi-structured interviews to describe the context of each eating occasion using the pictures as a guide. Responses based on a total of 304 eating occasions were coded to classify foods based on United States Department of Agriculture (USDA) MyPlate food groups and to characterize parental rules and reasons for food selection. Average age was 10.9 ± 1.1 years and 60% were female. Approximately 58% of eating occasions were classified as iEOs with approximately 65% as snacks. Most iEOs took place at home. Foods frequently consumed during iEOs were from the sweets, total fruit, dairy, and whole fruit food categories. Primary parental rules for iEOs focused on avoiding certain foods and not eating too much. Early adolescents selected foods for convenience, taste preferences, and availability. Foods selected during iEOs were based on parent, household and early adolescent factors, which could be addressed to influence overall diet quality.

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.

Evaluation of emotion-based messages designed to motivate Hispanic and Asian parents of early adolescents to engage in calcium-rich food and beverage parenting practices.

BACKGROUND/OBJECTIVES: Setting healthful beverage expectations, making calcium-rich foods and beverages (CRF/B) available, and role modeling are parenting practices promoting calcium intake among early adolescents. This study aimed to evaluate emotion-based messages designed to motivate parents of early adolescents to perform these practices. SUBJECTS/METHODS: Emotion-based messages were developed for each parenting practice and tested in 35 parents from 5 states. Findings were used to modify messages and develop a survey administered via Amazon MechanicalTurk to a convenience sample of Asian (n = 166) and Hispanic (n = 184) parents of children 10-13 years. Main outcome measures were message comprehension, motivation, relevance, acceptability, and novelty. Engagement in the parenting practices was also assessed. RESULTS: Message comprehension was acceptable for the majority of parents. Most also agreed that messages were motivational (setting healthful beverage expectations (69.0%), making CRF/B available (67.4%), and role modeling (80.0%)), relevant and acceptable. About 30-50% indicated they had not seen the information before. Many parents indicated they were already engaging in the practices (> 70%). No racial/ethnic differences were observed for responses to messages or engaging in parenting practices. CONCLUSIONS: Results indicate that emotion-based messages designed to motivate parents to engage in parenting practices that promote calcium intake among early adolescents were motivating, relevant, and acceptable.

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.

Dietary sources of calcium among parents and their early adolescent children in the United States by parent race/ethnicity and place of birth.

Dietary calcium sources may differ by race/ethnicity and dietary acculturation. A cross-sectional, convenience sample including 587 United States (US) Asian, Hispanic and non-Hispanic White parent-child (10-13 years) pairs completed a calcium food frequency questionnaire. Calcium sources were ranked by mean percent contribution to total adjusted calcium intake, and compared by ethnic group and parents' location of birth. Five foods (fluid milk, cheese, milk on cereal, yogurt, and lattes) represented 49% of total calcium intake for parents. The same foods (except lattes) represented 55% of total calcium for early adolescent children. Fluid milk provided the largest mean percentage of intake for all race/ethnic groups among parents and children. Several food sources of calcium were greater for foreign-born versus US-born Asian or Hispanic parents and children. Understanding calcium food sources and changes in dietary patterns that affect calcium intake among parents and children is important to better promote adequate intake.

Need for specific sugar-sweetened beverage lessons for fourth- and fifth-graders.

OBJECTIVE: Consumption of sugar-sweetened beverages (SSB) is linked to obesity. The authors hypothesized that school-based nutrition education would decrease SSB consumption. DESIGN: Self-selected interventional cohort with random selection for pre and post measurements. SETTING: Arizona Supplemental Nutrition Assistance Program-Education Program-eligible schools. PARTICIPANTS: Randomly selected (9%) fourth- and fifth-grade classroom students. INTERVENTION: The University of Arizona Nutrition Network provided general nutrition education training and materials to teachers, to be delivered to their students. The University of Arizona Nutrition Network administered behavioral questionnaires to students in both fall and spring. MAIN OUTCOME MEASURE(S): Change in SSB consumption. ANALYSES: Descriptive statistics were computed for student demographics and beverage consumption on the day before testing. Paired t tests evaluated change in classroom averages. Linear regression assessed potential correlates of SSB consumption. RESULTS: Fall mean SSB consumption was 1.1 (± 0.2) times; mean milk and water intake were 1.6 (± 0.2) and 5.2 (± 0.7) times, respectively. Beverage consumption increased (3.2%) in springtime, with increased SSBs (14.4%) accounting for the majority (P = .006). Change in SSB consumption was negatively associated with baseline SSB and water consumption but positively associated with baseline milk fat (P ≤ .05). CONCLUSIONS AND IMPLICATIONS: The results suggest the need for beverage-specific education to encourage children to consume more healthful beverages in warmer weather.

Perceptions of how parents of early adolescents will personally benefit from calcium-rich food and beverage parenting practices.

OBJECTIVE: To identify and rank perceived personal benefits from parenting practices that promote intake of calcium-rich foods and beverages (CRF/B) by early adolescents. METHODS: A convenience sample of parents/caregivers (n = 133) of early adolescents (10-13 years) from 6 states (CA, HI, MN, OH, OR, UT) participated in a qualitative study using a Nominal Group Technique process. Benefits identified by parents/caregivers were ranked by importance, given a score weight, and summed to create a total weighted score across states. RESULTS: The top benefit from making CRF/B available was parent emotional rewards. The top benefit perceived by parents from role modeling intake of CRF/B and setting expectations for intake of CRB was child health promotion. CONCLUSIONS AND IMPLICATIONS: Child health promotion and parent emotional rewards were important perceived benefits derived from CRF/B parenting practices, and thus, should be included as the focus of education to increase the frequency of these practices.

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.

Individual and family correlates of calcium-rich food intake among parents of early adolescent children.

BACKGROUND: Most adults do not meet calcium intake recommendations. Little is known about how individual and family factors, including parenting practices that influence early adolescents' intake of calcium-rich foods, affect calcium intake of parents. This information could inform the development of effective nutrition education programs. OBJECTIVE: To identify individual and family factors associated with intake of calcium-rich foods among parents of early adolescents (aged 10 to 13 years). DESIGN: A cross-sectional survey was used with 14 scales to assess attitudes/preferences and parenting practices regarding calcium-rich foods and a calcium-specific food frequency questionnaire (2006-2007). PARTICIPANTS/SETTING: A convenience sample of self-reporting non-Hispanic white, Hispanic, and Asian (n=661) parents was recruited in nine states. Parents were the primary meal planner/preparer and completed questionnaires in homes or community settings. MAIN OUTCOME MEASURES: Predictors of calcium intake from three food groupings-all food sources, dairy foods, and milk. STATISTICAL ANALYSES PERFORMED: Multivariate regression analyses identified demographic, attitude/preference, and behavioral factors associated with calcium intake. RESULTS: Most respondents were women (∼90%) and 38% had a college degree. Education was positively associated with calcium intake from all three food groupings, whereas having an Asian spouse compared to a non-Hispanic white spouse was negatively associated with calcium intake only from all food sources and from dairy foods. Expectations for and encouragement of healthy beverage intake for early adolescents were positively associated with calcium intake from dairy foods and milk, respectively. Parental concern regarding adequacy of intake was negatively associated, whereas perception of health benefits from calcium-rich foods was positively associated with calcium intake from all food sources and from dairy foods. Between 20% and 32% of the variance in calcium intake from all food groupings was explained in these models. CONCLUSIONS: Individual factors and positive parenting practices may be important considerations for nutrition education programs targeted to parents.

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.

Development of a decision tree to determine appropriateness of NVivo in analyzing qualitative data sets.

A decision tree was developed to determine when NVivo is an appropriate tool for qualitative analysis. NVivo, a qualitative analysis software package, was used to analyze interviews of 204 Asian, Hispanic, and white parents in 12 states. The experience provided insight into issues that should be considered when deciding to use the software. NVivo can enhance the qualitative research process, quickly process queries, and expand analytical avenues. Before using, however, the following must be considered: training time, establishing inter-coder reliability, number and length of documents, coding time, coding structure, use of automated coding, and possible need for separate databases or additional supporting software.

Development of a food frequency questionnaire to estimate calcium intake of Asian, Hispanic, and white youth.

OBJECTIVE: To develop a food frequency questionnaire (FFQ) that estimates calcium intake of Asian, Hispanic, and white youth living in the western United States. DESIGN: A list of 80 foods was assembled to create an FFQ to measure calcium intake. Evaluation of the FFQ spanned four consecutive weeks. An FFQ was completed during Week 1 and Week 4, and a 24-hour dietary recall was completed during Week 2 and Week 3.Subjects/setting A convenience sample of 162 Asian, Hispanic, and white youth ages 10 to 18 years was selected. Statistical analyses performed Percent agreement, paired t tests, Pearson correlation coefficients of cube-root transformed values, and deattenuated Pearson correlation coefficients of cube-root transformed values were used to evaluate the FFQ. RESULTS: The correlation between calcium intake estimates, when measured by first and second administrations of the FFQ, was 0.68 (Pearson's r) for the total sample. Correlations differed by age, sex, and ethnic subgroups as follows: 10 to 13 years (r=0.62), 14 to 18 years (r=0.73), male (r=0.73), female (r=0.64), Asian (r=0.77), Hispanic (r=0.72), and white (r=0.48). The correlation between calcium intakes as estimated by the second FFQ vs the average of the two 24-hour dietary recalls was 0.54 (deattenuated Pearson's r) for the total sample. This correlation differed by age, sex, and ethnic subgroups as follows: 10 to 13 years (r=0.46), 14 to 18 years (r=0.59), male (r=0.65), female (r=0.45), Asian (r=0.64), Hispanic (r=0.18), and white (r=0.57). CONCLUSIONS: A unique dietary survey has been developed to estimate calcium intake among Asian, Hispanic, and white youth in the United States.

Calcium intake of Asian, Hispanic and white youth.

OBJECTIVE: To examine calcium intake and food sources among Asian, white and Hispanic youth, in order to develop and target interventions to improve calcium intake. METHODS: Cross-sectional survey with two 24-hour dietary recalls one week apart. Calcium intake was evaluated in 167 male and female adolescents of Asian, Hispanic and white ethnicity, ages 10-18 years, from six states. Main outcome measures were mean daily calcium intake (mg/day). STATISTICAL ANALYSES PERFORMED: t tests, Chi-square and analysis of variance for differences by age, ethnicity and gender, multiple regression of factors influencing calcium intake. RESULTS: Overall median calcium intake was 938 mg/day with 868 mg/day for Asians, 1180 mg/day for whites and 896 mg/day for Hispanics. Daily milk intake was the primary predictor of calcium intake with Asian ethnicity and female gender each showing a negative association to calcium intake in multiple regression models. CONCLUSIONS: Milk intake was the primary factor positively influencing calcium intake, while Asian ethnicity and female gender negatively influenced calcium intake. Thus, interventions to improve calcium intake should focus on improving milk intake of Asians and females.

Perspectives on intake of calcium-rich foods among Asian, Hispanic, and white preadolescent and adolescent females.

OBJECTIVE: Declining calcium intake among adolescents warrants attention. Our objective was to identify influences on adolescents' consumption of calcium-rich foods. DESIGN: Focus groups were conducted with girls representing 2 age groups (11 to 12 or 16 to 17 years) and 3 macroethnic groups (Asian, Hispanic, or white). SETTING: Public schools in 10 states. PARTICIPANTS: A convenience sample (n = 200) was recruited through schools. VARIABLES MEASURED: Focus groups (n = 35) were audiotaped and transcribed. Influences relative to consumption of milk or other calcium-rich foods were identified. ANALYSIS: Comments were coded as motivators or barriers within each focus group. Content analysis procedures were used to compare ethnic and age groups. RESULTS: A barrier to milk consumption that was more common among older girls and Asian groups was the limited expectation within families for drinking milk. Many controlled their own beverage choices, and milk, even if liked, was only one option. Milk was positively associated with strength and bone health, but these attributes were viewed as being more important for boys than girls. Milk was associated with breakfast, school lunches, cereal, and desserts. White girls had the most positive reactions to milk and Hispanic girls the most negative. All groups were positive toward pizza, ice cream, and cheese. CONCLUSIONS AND IMPLICATIONS: To improve calcium intake among teens, interventions should include a family component, stress the benefits of milk for girls, and focus on breakfast.