Food Photography as a Tool to Assess Type, Quantity, and Quality of Foods in Parent-Packed Lunches for Preschoolers.

OBJECTIVE: Explore using food photography to assess packed lunches in a university-based Early Childhood Center and contextualize these photographs through parent interviews. METHODS: An explanatory sequential design was used. Packed lunches were photographed to assess the type and quantity of foods offered and consumed by Child and Adult Food Care Program components (fruit, vegetable, grain, and protein) and quality of foods offered using the Healthy Meal Index. Parent interviews aimed to understand motivations and behaviors related to packing lunch. RESULTS: Data were collected on 401 lunches. Only 16.2% of lunches met all Child and Adult Food Care Program requirements. Most lunches included fruit (84%) and grains (82%), whereas fewer included vegetables (44%). Portion sizes were large, especially for grains (2.7 ± 1.5 servings). In interviews (n = 24), parents expressed tension between offering healthful items and foods they knew their child would eat, as well as concern about children going hungry. CONCLUSIONS AND IMPLICATIONS: Food photography is a feasible methodology to capture parent-packed lunches for preschoolers and may have utility in nutrition education, particularly related to age-appropriate portion sizes.

Food Insecurity in Primary Care: Patient Perception and Preferences.

BACKGROUND AND OBJECTIVES: Screening for and addressing food insecurity in primary care may improve associated comorbidities. The purpose of this study was to explore patient attitudes regarding screening for food insecurity and to elicit patient preferences for intervention in a primary care setting. METHODS: Patients (N=284) completed a brief, voluntary survey in a university-based clinic and two community-based clinics over a 5-month period. Respondents were classified as either food-secure or food-insecure based on their responses to a validated food insecurity screener. RESULTS: Participants stated that screening for food insecurity was valuable in the primary care setting (83.9%). Patients preferred having a nurse ask the screening questions (41.2%). The most popular intervention preference, regardless of food security status or clinic type, was to provide a list of food bank locations (76.4%) and local community organizations (71.6%) and to have referral to financial assistance programs (75.4%). There were no differences in preferences for screening or attitudes toward screening by food security status or clinic type (all P≥.05). CONCLUSIONS: Screening for food insecurity is not yet standard practice, partly due to concerns over potentially alienating patients with the screening questions. Based on our surveyed patient population and their indicated preferences, screening and providing resource referrals for food insecurity is not likely to damage the clinician-patient relationship.

Adverse Childhood Experiences in Infancy and Toddlerhood Predict Obesity and Health Outcomes in Middle Childhood.

BACKGROUND: The Adverse Childhood Experiences (ACEs) study articulated the negative effects of childhood trauma on adult weight and health. The purpose of the current study is to examine the associations between ACEs in infancy and toddlerhood and obesity and related health indicators in middle childhood. METHODS: We used data collected from a sample of low-income families enrolled in the national evaluation of Early Head Start (EHS). Data come from 1335 demographically diverse families collected at or near children's ages 1, 2, 3, and 11. An EHS-ACE index was created based on interview and observation items from data collected at ages 1, 2, and 3, which were averaged to represent exposure across infancy and toddlerhood. At age 11, children's height and weight were measured and parents were asked about their child's health. RESULTS: Children were exposed at rates of 30%, 28%, 15%, and 8% to one, two, three, and four or more EHS-ACEs, respectively. Logistic regressions revealed significant associations between EHS-ACEs in infancy/toddlerhood and obesity, respiratory problems, taking regular nonattention-related prescriptions, and the parent's global rating of children's health at age 11. Across all outcomes examined, children with four or more ACEs had the poorest health. Compared with children with no ACE exposure, the odds of each of the examined health outcomes were over twice as high for children who experienced four or more ACEs. CONCLUSIONS: Findings highlight that ACEs experienced very early in development are associated with children whose health is at risk later in childhood.

Facebook: The Use of Social Media to Engage Parents in a Preschool Obesity Prevention Curriculum.

OBJECTIVE: This study investigated the use of Facebook to deliver health-related education materials to augment a preschool classroom-based obesity prevention curriculum. DESIGN: Cross-sectional, mixed methods (descriptive and interviews). SETTING: Head Start classrooms administered by 2 large agencies (1 rural and 1 urban). PARTICIPANTS: Convenience sample of parents in 13 classrooms (cohort 1, 3 classrooms; cohort 2, 10 classrooms). INTERVENTION: Delivery of nutrition education curriculum content using social media (Facebook). VARIABLES MEASURED: Qualitative interviews assessed barriers and facilitators to Facebook use. Parent views, likes, and comments were measured to reflect parent engagement with Facebook. ANALYSIS: Content analyses (qualitative data) and descriptive statistics (quantitative data). RESULTS: Family access (views) and interaction (comments and likes) with the posts varied based on type and content of posts. Rural families were more active. Barriers to parental Facebook engagement included a desire to see more posts from classroom teachers, lack of time, and misunderstanding about privacy protections. Facilitators of parental Facebook engagement included perceived utility of the content and social support. CONCLUSIONS AND IMPLICATIONS: Facebook was found to be a feasible platform to provide nutrition education and facilitated varying levels of parental engagement. Lessons learned and implications for prevention and intervention programming are offered.