Browsing by Subject "childhood obesity"

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    Behavioral Economics Strategies and Vegetable Consumption Among Low-Income Children
    (2015-08) Leak, Tashara
    Children from a low socioeconomic background are at increased risk for becoming obese, which underscores the importance of encouraging healthful behaviors such as vegetable consumption. Several factors influence child vegetable intake, including whether children like vegetables and if vegetables are available for consumption. Researchers have attempted to improve child vegetable intake in the school setting through the use of behavioral economics-informed changes in the cafeteria, where the social and physical environment is manipulated in a way to "nudge" children to make healthier choices. Interventions grounded in behavioral economics have been shown to improve vegetable intake in the school setting but have not been thoroughly explored in the home food environment. The latter is an ideal setting in which to improve vegetable consumption because children consume the majority of their daily calories at home. This dissertation investigated the feasibility and effectiveness of behavioral economics strategies to improve vegetable intake at dinner meals among children aged 9-12 residing in households receiving food assistance. Included in this dissertation were three studies which determined the feasibility of implementing behavioral economics strategies (Phase 1), measured the effectiveness of behavioral economics strategies to increase child vegetable intake (Phase 2), and explored adolescent involvement in home food preparation. Exploring the Feasibility of Implementing Behavioral Economics Strategies to Increase Vegetable Intake, Liking, and Variety Among Children Aged 9 to 12 Residing in Food Assistance Households (Phase 1). Phase 1 was a formative study that aimed to identify facilitators and barriers caregivers may experience when implementing strategies during dinner preparation and mealtime. One-time, in-home observations of dinner preparation and mealtime were conducted with caregiver/child dyads (n = 20). Survey data to assess vegetable availability, parent and child vegetable liking, and household food security were collected. Facilitators included liking of most vegetables by caregivers and children, and home vegetable availability (most families had 7-21 different types of vegetables available in the home). Barriers included perceived time constraints, lack of appropriate vegetable types or utensils/dishware, and concerns about child involvement in food preparation. Based on Phase 1 data, nine behavioral economics strategies were selected for further evaluation in a randomized controlled trial (Phase 2). Testing the Effectiveness of In-Home Behavioral Economics Strategies to Increase Vegetable Intake and Liking Among Children Residing in Households that Receive Food Assistance (Phase 2). The objectives for Phase 2 were to 1) to determine the 6 of 9 most effective and feasible behavioral economics strategies, and 2) to evaluate if 9 behavioral economics strategies increase vegetable intake, liking, and availability during a randomized controlled trial. Over the course of six weeks, caregivers in the intervention group (n = 39) incorporated one new strategy/week. Caregivers in the control group (n = 10) were not assigned strategies. For Objective 1, parent-reported food records (3 days/week) were used to assess child vegetable consumption at dinner meals on the days that strategies were implemented. Caregivers in the intervention group rated the level of difficulty for assigned strategies (1 - not difficult to 10 - very difficult) during weekly phone calls. They also reported facilitators and barriers to implementing the strategies. No differences were observed between intervention and control group for mean child dinner meal vegetable intake for any of the nine strategies. However, pairwise comparisons for the intervention group showed that vegetable intake for the strategy of serving at least two vegetables for the dinner meal was greater than intake for two other strategies: 'Pair vegetables with other foods child likes" "Eat dinner together with an adult(s) modeling vegetable consumption". Caregivers indicated that the strategies were generally not difficult to implement. For Objective 2, three 24-hour dietary recalls were collected at baseline and study conclusion from children to assess changes in overall vegetable intake. Also, at baseline and study conclusion, children and caregivers provided liking scores for 36 different vegetable types on a10-point labeled hedonic scale (1-Hate it to 10-Like it a lot, or "Never tried"). For the same 36 different vegetable types, home vegetable availability data were collected at baseline and study conclusion. Change in total daily vegetable intake (baseline to study conclusion) was not different between intervention and control group. No differences were noted in changes (pre-post differences) in caregiver and child mean vegetable liking ratings when mean liking was assessed across all vegetables. There were also no changes in home vegetable availability from baseline to study conclusion between intervention and control group. Adolescent Involvement in Food Preparation. In the final study, the objective was to understand how low-income adolescents are involved in home food preparation. At the conclusion of Phase 2, if an adolescent (13-18 years) was present in the home, he or she was invited to participate in a semi-structured interview. Interview questions inquired about how adolescents were involved in food preparation. Interviews (n = 19) were analyzed using grounded theory methodology. Three levels of involvement in food preparation were described. Eight adolescents were highly involved with responsibility for cooking for others in the household. When deciding what to prepare at mealtimes, they considered preferences of others, variety, nutrition, and time. Some adolescents were highly involved in food preparation out of family obligation and cultural expectations. Those highly involved in food preparation indicated that the additional responsibilities produced stress. They also indicated that they were confident in their ability to cook without the assistance of an adult. Adolescents who were moderately involved in food preparation (n = 7) assisted with cooking. They reported that they enjoyed cooking. Four adolescents had low levels of involvement in food preparation and rarely, if ever, helped their caregiver with cooking. They were not expected or encouraged to be involved in food preparation by parents.
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    Keeping your child healthy: preventing childhood obesity
    (2008-10-16) Plog, Melissa
    As a parent, it is important to know that being overweight is a significant health risk for your child. In addition to increasing their risk for numerous diseases, being overweight may also affect how your child feels about himself or herself. In addition, overweight children often grow up to be overweight adults. Parents do have a significant impact on their children's eating and exercise habits, and establishing healthy habits is the key to maintaining a healthy weight.
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    Latino Father-Focused, Healthy Lifestyle Intervention to Improve Adolescent Energy Balance-Related Behaviors
    (2022-01) Baltaci, Aysegul
    Background: Poor dietary habits, lack of physical activity, and sedentary behaviors including frequent screen time have been identified as critical behavioral determinants of childhood obesity. Hispanic youth have disproportionately high rates of overweight and obesity in the U.S. The majority of Latino/Hispanic adolescents have lower healthy food and higher unhealthy food intakes and lower physical activity and higher screen time behaviors than recommended. Parenting practices were associated with child and adolescent food- and activity-related behaviors. Intervention studies focusing on positive parenting practices (setting expectations/limits, role modeling, home availability) to prevent overweight/obesity among Latino children and adolescents are limited with an underrepresentation by Latino fathers. Thus, the Padres Preparados, Jóvenes Saludables (Padres) program was developed based on principles of community-based participatory research and social cognitive theory to prevent overweight and obesity among Latino adolescents (10–14 years) by improving adolescents’ energy balance-related behaviors (EBRBs) and the frequency of positive paternal parenting practices. A two-arm (intervention versus delayed-treatment control group) randomized controlled trial was conducted to assess the effectiveness of 8 weekly 2.5-hour experiential learning sessions delivered to 103 fathers and 110 adolescents (mothers were encouraged to attend) in four trusted community locations in the Minneapolis/St. Paul urban area. Families completed surveys and anthropometric measurements for the assessment of changes in paternal parenting practices, and father and adolescent EBRBs and weight status at baseline and post-intervention. Adolescents also completed 24-hour dietary recall interviews at baseline and post-intervention. The intervention group participated in the learning sessions immediately after baseline data collection while the delayed-treatment control group participated in the learning sessions three months after the post data collection. Overall objective: The first objective was to assess associations between paternal food parenting practices and family meals and paternal food/meal involvement and adolescent dietary intake separately and in combination in a cross-sectional study design using Padres baseline data. The second objective was to evaluate the impact of the Padres program and intervention dose on father and adolescent EBRBs based on a randomized controlled trial. The third objective was to determine the Padres program impact and modifier effect on father- and adolescent-reported paternal food and activity parenting practices based on a randomized controlled trial. Methodology: The data analysis methods of the first study included multiple linear regression models to assess associations of paternal food parenting practices, family meals and paternal food/meal involvement with adolescent intake separately. In addition, adjusted GLM (generalized linear mixed model) procedures and slice statements and PLM (post GLM processing) procedures with Bonferroni corrections were used to evaluate the combination of paternal food parenting practices and family meals and paternal food/meal involvement on adolescent intake. The second study used baseline and post data to assess intervention impact (intervention vs. delayed-treatment control group) and dose effects on father and adolescent EBRBs. Analyses included paired and two sample t-tests and adjusted linear regression models (within groups), and mixed models (between groups) for continuous outcomes and McNemar’s tests (within groups) and Generalized Linear Mixed Models (GLMM) (between groups) for binary outcomes. The methods of the third study using baseline and post Padres data consisted of McNemar’s tests (within groups) and GLMM models (between groups) to assess intervention impact (intervention vs. delayed-treatment control group) and modifier effects on father- and adolescent-reported paternal food- and activity-related parenting practices. Results: The first study demonstrated that Latino adolescents consumed more healthy foods and less unhealthy foods when their fathers had more frequent positive food parenting practices. The first study also indicated significant combined associations of paternal food parenting practices and family meals on adolescent intakes of fruit, sweets/salty snacks, and sugar-sweetened beverages (SSBs). The second study showed lower intakes of SSBs, sweet/salty snacks, and fast food by intervention group fathers after attending the Padres program but did not show any intervention effect on adolescent EBRBs and father and adolescent weight status. In further analysis, the second study demonstrated that father SSB, sweet/salty snack, and fast food intakes and adolescent sweets/salty snack intake were lower after the Padres program for those who had a high intervention dose compared to low intervention dose. Also, a low adolescent BMI percentile was related to high intervention dose and mother attendance. In the third study, father-reported frequency of paternal fruit role modeling and fast food availability and adolescent-reported paternal allowance of adolescent screen time and frequency of fruit role modeling were improved after the intervention in the intervention compared to the delayed-treatment control group. Discrepancies in the frequencies of improved paternal parenting practices were shown except for the frequency of fruit role modeling. Paternal food responsibilities (father-reported) and family meals (adolescent-reported) were identified as modifiers of paternal food parenting practices. Conclusion: This dissertation research demonstrated improvements in only a small number of paternal parenting practices and father and adolescent EBRBs and weight status after the intervention. Possible explanations for the lack of significant findings include the small sample size, low family socioeconomic status and time constraints due to busy work schedules based on social determinants of health, and inadequate time for behavioral change to occur by measuring change immediately after the last learning session. Further family-focused intervention studies with a larger sample size are needed to further examine associations between parenting practices and Latino adolescent food and activity related behaviors to prevent childhood obesity. In family-focused interventions, increasing Latino fathers’ representation and recognizing the roles of social determinants of health and Latino family strengths are essential.