The role of family variables in fruit and vegetable consumption in preschool children

<p>Most Americans, including children, continue to eat fewer fruits and vegetables than is recommended, putting themselves at increased risk of various health conditions. The aim of this study was to evaluate the relative importance of several family environment variables (food availability and accessibility, modeling of food consumption, parenting style, and family mealtime environment) for predicting children’s consumption of fruits and vegetables in a sample of low income minority preschool children. Two hundred and twenty nine primary caregivers and their preschool children were recruited from Head Start programs in New York and New Jersey. Caregivers consented, completed a battery of paper and pencil questionnaires, and had both their height and weight and their children’s height and weight measured. Higher availability, accessibility, and parental modeling were associated with higher consumptions of fruits and vegetables in children. Availability and accessibility were the best predictors, but parental modeling significantly enhanced prediction over the other variables. Public health interventions should be geared toward helping poorer families increase the availability of fruits and vegetables in their homes, advising parents on how to make them accessible, and encouraging parents to model their consumption.</p>

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Wellness in the Schools: A Lunch Intervention Increases Fruit and Vegetable Consumption

Nutrients ◽

10.3390/nu13093085 ◽

2021 ◽

Vol 13 (9) ◽

pp. 3085

Author(s):

Pamela A. Koch ◽

Randi L. Wolf ◽

Raynika J. Trent ◽

Ian Yi Han Ang ◽

Matthew Dallefeld ◽

...

Keyword(s):

New York ◽

Public Schools ◽

Low Income ◽

Fruits And Vegetables ◽

Vegetable Intake ◽

Vegetable Consumption ◽

School Lunch ◽

Baseline Data ◽

Fruit And Vegetable ◽

Time Points

Wellness in the Schools (WITS) is a national non-profit organization partnering with public schools to provide healthy, scratch cooked, less processed meals (called an Alternative Menu), and active recess. This study examined the effects of WITS programming on school lunch consumption, including fruit and vegetable intake, in second and third grade students in New York City public schools serving a high proportion of students from low-income households. The intervention was evaluated with a quasi-experimental, controlled design with 14 elementary schools (7 that had initiated WITS programming in fall 2015 and were designated as intervention schools, and 7 matched Control schools). School lunch consumption was assessed by anonymous observation using the System of Observational Cafeteria Assessment of Foods Eaten (SOCAFE) tool in the fall of 2015 (Time 0, early intervention) and the spring of 2016 (Time 1) and 2017 (Time 2). There were no baseline data. Data were also collected on the types of entrées served in the months of October, January, and April during the two school years of the study. Across time points, and relative to students in the Control schools, students in WITS schools ate more fruits and vegetables (units = cups): Time 0: Control 0.18 vs. WITS 0.28; Time 1: Control 0.25 vs. WITS 0.31; and Time 2: Control 0.19 vs. WITS 0.27; p < 0.001. They also had more fruits and vegetables (cups) on their trays, which included more vegetables from the salad bar. However, students in the WITS schools ate fewer entrées (grain and protein) and drank less milk than students in the Control schools. Compared to the Control schools, WITS schools offered more homestyle entrées and fewer finger foods and sandwich entrees, i.e., less processed food. Students in WITS schools who received the Alternative menu and all of the WITS programming at all data collection time points selected and consumed more fruits and vegetables. Replication studies with randomized designs and true baseline data are needed to confirm these findings and to identify avenues for strengthening the effects of the program on other school lunch components.

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Healthy eating: a matter of prioritisation by households or policymakers?

Public Health Nutrition ◽

10.1017/s1368980021000677 ◽

2021 ◽

pp. 1-3

Author(s):

Joreintje Dingena Mackenbach

Keyword(s):

Decision Making ◽

Healthy Eating ◽

Low Income ◽

Fruits And Vegetables ◽

Food System ◽

Vegetable Consumption ◽

Fruit And Vegetable Consumption ◽

Healthy Foods ◽

Fruit And Vegetable ◽

Decision Making Processes

Abstract I reflect upon the potential reasons why American low-income households do not spend an optimal proportion of their food budgets on fruits and vegetables, even though this would allow them to meet the recommended levels of fruit and vegetable consumption. Other priorities than health, automatic decision-making processes and access to healthy foods play a role, but solutions for the persistent socio-economic inequalities in diet should be sought in the wider food system which promotes cheap, mass-produced foods. I argue that, ultimately, healthy eating is not a matter of prioritisation by individual households but by policymakers.

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Caregiver Feeding Practices as Predictors for Child Dietary Intake in Low-Income, Appalachian Communities

Nutrients ◽

10.3390/nu13082773 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2773

Author(s):

Mikaela B. McIver ◽

Sarah Colby ◽

Melissa Hansen-Petrik ◽

Elizabeth T. Anderson Steeves

Keyword(s):

Rural Communities ◽

Young Children ◽

Dietary Intake ◽

Low Income ◽

Fruits And Vegetables ◽

Vegetable Consumption ◽

Feeding Practices ◽

Fruit Consumption ◽

Cross Sectional ◽

Home Availability

The Appalachian region of the U.S. is disproportionately impacted by poverty, obesity, and nutrition-related chronic diseases. Evidence suggests that caregiver feeding practices may promote healthful eating behaviors among children; however, this has not been examined in low-income, rural, Appalachian populations. This study examines caregiver feeding practices as predictors for child diet in low-income Appalachian families, using a cross-sectional analysis of 178 caregivers of young children (ages 2–10 years old), that were recruited from low-income, rural communities in East Tennessee, from November 2017 to June 2018. Caregivers self-reported measures of demographics, feeding practices, and child dietary intake. Multiple linear regression analyses were run, and found that higher use of caregiver modeling positively predicted child vegetable consumption (Beta = 1.02; p = 0.04). Higher caregiver intake of fruits and vegetables positively predicted child fruit consumption (Beta = 0.29; p = 0.02) and vegetable consumption (Beta = 1.56; p < 0.001), respectively. Higher home availability of healthier foods positively predicted child fruit consumption (Beta = 0.06; p = 0.002) and vegetable consumption (Beta = 0.09; p = 0.05). Higher home availability of less healthy foods positively predicted child consumption of high-sugar/high-fat snack foods (Beta = 0.59; p = 0.003). The findings of this study indicate that caregiver modeling, healthy caregiver dietary intake, and healthful home food availability are associated with healthier child dietary intake among young children in low-income, rural, Appalachian areas. Promoting these practices among caregivers may be an important strategy to enhancing dietary intake of children in this hard-to-reach, underserved population.

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Fruit and Vegetable Prescriptions for Pediatric Patients Living in Flint, Michigan: A Cross-Sectional Study of Food Security and Dietary Patterns at Baseline

Nutrients ◽

10.3390/nu11061423 ◽

2019 ◽

Vol 11 (6) ◽

pp. 1423 ◽

Cited By ~ 7

Author(s):

Amy Saxe-Custack ◽

Jenny LaChance ◽

Mona Hanna-Attisha ◽

Tiffany Ceja

Keyword(s):

Food Security ◽

Low Income ◽

Dietary Patterns ◽

Fruits And Vegetables ◽

Vegetable Consumption ◽

Daily Intake ◽

Fruit And Vegetable ◽

Dietary Recommendations ◽

Cross Sectional ◽

Health Maintenance

Though fruit and vegetable consumption is essential for disease prevention and health maintenance, intake among children fails to meet dietary recommendations. Limited access to and the affordability of fresh produce, particularly among low-income youth, are barriers to adequate intake. To address these challenges, researchers and pediatricians in Flint, Michigan, expanded a successful fruit and vegetable prescription program that provides one $15 prescription for fresh fruits and vegetables to every child at every office visit. Vendors include the downtown farmers’ market and a local mobile market. This study describes baseline characteristics, dietary patterns, food access, and food security among 261 caregiver–child dyads enrolled August 2018–March 2019. The child-reported mean daily intake of vegetables (0.72 cups ± 0.77), dairy products (1.33 cups ± 1.22), and whole grains (0.51 ounces ± 0.49) were well below recommendations. Furthermore, 53% of children and 49% of caregivers who completed the food security module indicated low or very low food security. However, there were no statistically significant differences in the child consumption of fruits and vegetables between households that reported high versus low food security (p > 0.05). Results validate and raise deep concerns about poor dietary patterns and food insecurity issues facing Flint children, many of whom continue to battle with an ongoing drinking water crisis. Additional poverty-mitigating efforts, such as fruit and vegetable prescription programs, are necessary to address these gaps.

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The effect of a fresh produce incentive paired with cooking and nutrition education on healthy eating in low-income households: a pilot study

Public Health Nutrition ◽

10.1017/s1368980021000094 ◽

2021 ◽

pp. 1-11

Author(s):

Angela R Fertig ◽

Xuyang Tang ◽

Heather M Dahlen

Keyword(s):

Pilot Study ◽

Nutrition Education ◽

Healthy Eating ◽

Low Income ◽

Financial Incentives ◽

Fruits And Vegetables ◽

Vegetable Consumption ◽

Financial Incentive ◽

Future Research ◽

Control Group

Abstract Objective: This study pilot-tested combining financial incentives to purchase fruits and vegetables with nutrition education focused on cooking to increase the consumption of fruits and vegetables and improve attitudes around healthy eating on a budget among low-income adults. The goal of the pilot study was to examine implementation feasibility and fidelity, acceptability of the intervention components by participants and effectiveness. Design: The study design was a pre-post individual-level comparison without a control group. The pilot intervention included two components, a scan card providing free produce up to a weekly maximum dollar amount for use over a 2-month period, and two sessions of tailored nutrition and cooking education. Outcomes included self-reported attitudes about healthy eating and daily fruit and vegetable consumption from one 24-h dietary recall collected before and after the intervention. Setting: Greater Minneapolis/St. Paul area in Minnesota. Participants: Adults (n 120) were recruited from five community food pantries. Results: Findings indicated that the financial incentive component of the intervention was highly feasible and acceptable to participants, but attendance at the nutrition education sessions was moderate. Participants had a statistically significant increase in the consumption of fruit, from an average of 1·00 cup/d to 1·78 cups/d (P < 0·001), but no significant change in vegetable consumption or attitudes with respect to their ability to put together a healthy meal. Conclusions: While combining financial incentives with nutrition education appears to be acceptable to low-income adult participants, barriers to attend nutrition education sessions need to be addressed in future research.

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The Translation of School Based Nutrition into Home Eating Behaviors (OR13-05-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz050.or13-05-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Pamela Weisberg-Shapiro ◽

Victoria Biancavilla ◽

Camille Chan ◽

Tiffany Yeh

Keyword(s):

New York ◽

Elementary School ◽

Nutrition Education ◽

Healthy Eating ◽

Low Income ◽

Eating Behaviors ◽

Fruits And Vegetables ◽

Theory Approach ◽

Upstate New York ◽

School Based

Abstract Objectives The purpose of this study was to assess how a school based nutrition education program in a low-income rural elementary school in upstate New York influenced families’ eating behaviors. Methods Students attending an elementary school in a low-income, rural community in upstate New York attended monthly nutrition education sessions and cooking demonstrations that included child-friendly recipes for fruits and vegetables. Recipes from the cooking demonstration were sent home with the children. In year two and three of the program, twenty caregivers participated in 45–75 qualitative interviews assessing how the program influenced the families’ eating behaviors. Interviews were transcribed verbatim and coded in Atlas TI using a grounded theory approach. In addition, the community's food availability was assessed using google maps and ground truthing. Results Preliminary findings indicate that families did not change their eating behaviors in response to the school based nutrition program. Most parents reported that they received the recipes from school and some reported trying recipes. However, with the exception of one family, overall eating patterns and food routines did not change. Parents who described a low consumption of fruits and vegetables indicated that barriers to incorporating the recipes, and healthy foods in general, into their food routines included perception of children's food preferences, time constraints and financial constraints. Parents who described a high consumption of fruits and vegetables indicated that they did not incorporate recipes into their routines because they already had healthy eating routines. Conclusions School based programs should engage families in community events and family cooking classes. These events should aim to assist parents in navigating barriers to healthy eating. Funding Sources Engaged Cornell.

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Agriculture Supported Communities: Connecting Low-income Communities with Small-scale Vegetable and Fruit Producing Farms (P04-128-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz051.p04-128-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Renate Winkels ◽

Susan Veldheer ◽

Andrew Smith

Keyword(s):

Low Income ◽

Environmental Sustainability ◽

Fruits And Vegetables ◽

Direct Marketing ◽

Health Indicators ◽

Farmers Markets ◽

Community Supported Agriculture ◽

Small Scale ◽

Increased Risk ◽

Fresh Vegetables

Abstract Objectives Barriers regarding affordability of and access to fresh vegetables and fruit pose low-income families at increased risk of diet-related diseases. Small farms can play a key role in providing local communities with fresh produce, through farmers’ markets, Community Supported Agriculture (CSA), and other direct marketing strategies. Nevertheless, these farms face specific challenges related to payment terms and conditions and delivery when aiming to connect with low-income communities. Rodale Institute's Agriculture Supported Communities (ASC) program aims to connect small-scale fruit and vegetable farms with low-income communities. This farm-share program sells weekly food boxes with organic fruits and vegetables in cities with major food insecurity problems in Pennsylvania (Allentown and Reading). ASC allows members to pay week-to-week, rather than upfront as in a traditional CSA. ASC shareholders can use federal SNAP dollars to pay for discounted shares or apply for subsidized shares. ASC pick-up sites are located in the targeted communities. Our objective is to evaluate the ASC program and its ability to reach the intended low-income communities. Methods In 2016 and 2017, surveys were distributed among ASC shareholders to collect socio-economic data and program satisfaction. In addition, we evaluated how many participants used SNAP to pay for the shares. Results ASC had 150 shareholders in 2016 and 151 in 2017. In 2016, 89 shareholders (59%) were living in low-income areas in Allentown or Reading, in 2017 this was 76 (50%). In 2016, 43% of the shareholders reported an income < 50k$, in 2017 this was 25%. In 2016, 11 members (7%) paid with SNAP, in 2017 15 members (10%). Conclusions ASC reached low-income community members; however, the program also reached a population at the other end of the economic spectrum. This poses challenges for the farmer regarding production and distribution. The farmers within ASC are using these data to optimize production and methods of delivery to meet the needs of low-income communities. In a future project, we hope to evaluate the effect of ASC membership on dietary intake and other health indicators, and measure the social, economic and environmental sustainability of the model. Funding Sources For a list of funders see rodaleinstitute.org/asc.

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Youth Willingness to Purchase Whole Grain Snack Packs from New York City Corner Stores Participating in a Healthy Retail Program

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16183233 ◽

2019 ◽

Vol 16 (18) ◽

pp. 3233

Author(s):

Tashara M. Leak ◽

Felicia Setiono ◽

Navika Gangrade ◽

Erika Mudrak

Keyword(s):

New York ◽

New York City ◽

Low Income ◽

York City ◽

Fruits And Vegetables ◽

Whole Grain ◽

Corner Stores ◽

Willingness To Purchase ◽

The City ◽

Healthy Retail

Corners stores in low-income communities are a promising setting to intervene in youth whole grain intake. One strategy that may encourage whole grain intake is if corner stores were to pair and sell whole grain snacks in combination with either a liked fruit or vegetable and an optional condiment (i.e., a whole grain snack pack). This study examined youth in terms of their (1) liking of fruits, vegetables, and whole grain snacks; (2) perceptions about which fruits and vegetables pair best with whole grain snacks; and (3) willingness to pay for a whole grain snack pack. One-time intercept surveys were conducted with 10–18-year-olds (n = 402) who visited a New York City (NYC) corner store (n = 34) participating in the City Harvest Healthy Retail Program. On average, youth were willing to spend $2.38 (SD $4.32) on a whole grain snack pack. Higher overall liking scores for vegetables and whole grain snacks were associated with willingness to spend 24.4% (95% confidence interval (CI): 11.5–38.7%) and 21.6% (95%CI: 5.2–40.6%) more on whole grain snack packs, respectively. In conclusion, youth are receptive to purchasing whole grain snack packs from NYC corner stores participating in a healthy retail program.

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Preschool Children with Behavioral Problems: Observation in Instructional and Free Play Contexts

Behavioral Disorders ◽

10.1177/019874299401900301 ◽

1994 ◽

Vol 19 (3) ◽

pp. 221-232 ◽

Cited By ~ 19

Author(s):

Melissa Ann Del'homme ◽

Esther Sinclair ◽

Connie Kasari

Keyword(s):

At Risk ◽

Preschool Children ◽

Problem Behavior ◽

Low Income ◽

Behavioral Problems ◽

Free Play ◽

Children At Risk ◽

Instructional Context ◽

Head Start Programs ◽

Play Context

Task-related and social behaviors of teacher-identified preschool children at risk for behavior problems were examined in two school settings, a structured instructional context and an unstructured free play context. Participating as study subjects were 42 preschoolers from low-income, minority families attending local Head Start programs, 21 from a teacher-identified problem behavior group and 21 from a nonidentified comparison group. The problem behavior group was composed of approximately equal numbers of children at risk for externalizing and internalizing behavioral problems. Results demonstrated that on-task behavior was significantly higher in the instructional context in the free play context, and group differences in on-task, aggressive, and prosocial behavior depended on context.

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A Pilot Fruit and Vegetable Prescription (FVRx) Program Improves Local Fruit and Vegetable Consumption, Nutrition Knowledge, and Food Purchasing Practices

Health Promotion Practice ◽

10.1177/15248399211018169 ◽

2021 ◽

pp. 152483992110181

Author(s):

Nicholas Slagel ◽

Taylor Newman ◽

Laurel Sanville ◽

Jennifer Jo Thompson ◽

Jackie Dallas ◽

...

Keyword(s):

Nutrition Education ◽

Low Income ◽

Fruits And Vegetables ◽

Vegetable Consumption ◽

Safety Net ◽

Nutrition Knowledge ◽

Fruit And Vegetable Consumption ◽

Fruit And Vegetable ◽

Farmers Market ◽

Food Purchasing

Fruit and Vegetable Prescription (FVRx) programs rely on diverse community and clinic partnerships to improve food security and fruit and vegetable consumption among medically underserved patient populations. Despite the growth in these programs, little is known about the feasibility or effectiveness of the unique partnerships developed to implement FVRx programs conducted in both community and free safety-net clinic settings. A 6-month nonrandomized controlled trial of an FVRx program was pilot tested with 54 Supplemental Nutrition Assistance Program (SNAP)–eligible adults with diet-related chronic conditions. The intervention combined monthly produce prescriptions for local produce at a farmers market, SNAP-Ed direct nutrition education, and health screenings for low-income adults. Process and outcome evaluations were conducted with respective samples using administrative program data (recruitment, retention, and prescription redemption) and self-administered pre- and postintervention surveys with validated measures on dietary intake, nutrition knowledge and behavior, and food purchasing practices. Descriptive statistical analyses were conducted. The FVRx program retained 77.3% of participants who spent nearly 90% of their prescription dollars. After the intervention, the FVRx group reported significantly increased total intake of fruits and vegetables, knowledge of fresh fruit and vegetable preparation, purchase of fresh fruits and vegetables from a farmers market, and significantly altered food purchasing practices compared with the control group. Community-based nutrition education organizations enhance the feasibility and effectiveness of community and clinic-based FVRx programs for improving low-income adults’ ability to enhance food and nutrition-related behaviors.

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