Child Obesity And Parental Negligence Paper

Child Obesity And Parental Negligence Paper

  1. Introduction
    Explain the issue you are examining and why it is significant.
    2. Review of the Literature
    A description of what has already known about this area and short discussion of why the background studies are not sufficient.Child Obesity And Parental Negligence Paper

    3. Rationale
    A description of the questions you are examining and an exploration of the claims.
    4. Method and Design
    A description of how you would go about collecting data and test the questions your are examining. Method: How would you collect the data and why?
    • How will you analyze the results?
    • What kind of results would confirm your hypothesis?Child Obesity And Parental Negligence Paper
    • What kind of results would disconfirm your hypothesis

    5. Significance and Conclusion
    Discuss, in general, how your proposed research would lead to a significant improvement over the original studies, and how it would benefit the field. (In other words, why should someone care? If you were applying for money to do this, why would someone fund you? If you wanted to publish your results, why would they be interesting?)
    6. References
    Include all references in APA style.Child Obesity And Parental Negligence Paper


Analysis of Child Food Requests and Maternal
Compliance in Low-income Hispanic and Non-Hispanic
Amber Haroldson1, Zachary Cordell2 and Lauren Haldeman3
1Ball State University, 2University of Massachusetts Amherst, 3University of North
Carolina at Greensboro
This study examined child food requests, maternal compliance to those requests, and how these differed
between Hispanic and non-Hispanic participants. Low-income mother–child dyads (N = 149) completed an inhome
structured interview, and height and weight were measured. The average number of requests per child
by food group from most to least was as follows: grains, combination, sweets, dairy, fruits, fats, beverages,
meats, and vegetables. The average rate of maternal compliance by food group from highest to lowest was as
follows: vegetables, meat, fruits, combination, beverages, dairy, grains, fats, and sweets. Hispanic children
requested significantly more dairy (p < .001), beverages (p < .001), and combination foods (p = .045)
compared to non-Hispanic children, but maternal compliance rates were not significantly different between
groups. Utilizing child influence on dietary behaviors could be a strategy for future nutrition interventions in
this population.
Keywords: child obesity; compliance; food request; Hispanic; low-income families
Obese children have an increased risk of developing chronic conditions, such as
high blood pressure, high cholesterol, insulin resistance, musculoskeletal issues,
and breathing problems (Centers for Disease Control [CDC], 2013). Obesity
currently affects 17% of children in the United States, but prevalence rates have
great disparities between racial and income groups. Minority children and
immigrant children have higher obesity rates compared to nonminority
children and nonimmigrant children. Children in low-income families have
higher prevalence of obesity rates than children from middle- or high-income
families (CDC, 2013). Recognized determinants of obesity include high
consumption of fast food, refined grain products, added sugars, and high-fat
foods, along with low fruit and vegetable intake, and increased sedentary
behaviors (Hill & Trowbridge, 1998; Mandal & Powell, 2014). Nutrition
interventions focused on the determinants of obesity in low-income and
Authors’ Note: Amber Haroldson, PhD, RD, is an Assistant Professor in the Department of Family
and Consumer Sciences, Ball State University. Zachary Cordell, BS, is a Graduate Student at
Department of Nutrition, 213 Chenoweth Lab, School of Public Health and Health Sciences,
University of Massachusetts Amherst. Lauren Haldeman, PhD, is an Associate Professor and Director
of Undergraduate Studies of Department of Nutrition, University of North Carolina at Greensboro.
Please address correspondence to Amber Haroldson, Department of Family and Consumer Sciences,
206 Applied Technology Building, Ball State University, 2000 West University Ave, Muncie, IN
47306; Tel.: (336)740-2205; e-mail:
Family and Consumer Sciences Research Journal, Vol. 44, No. 1, September 2015 37–50
DOI: 10.1111/fcsr.12126
© 2015 American Association of Family and Consumer Sciences
minority families are needed to reduce the disparities in childhood obesity
The purpose of this exploratory study was to examine the food requests made
by school-aged children and maternal compliance to those requests in lowincome
families. Additionally, this study sought to compare child food requests
and rates of maternal compliance between Hispanic and non-Hispanic families.
The specific aims were to (i) describe, by food group and setting, the types of
food requests made by low-income children; (ii) determine, by food group and
setting, the average rate of maternal compliance to those child food requests;
and (iii) examine how child food requests and maternal compliance differ
between Hispanic and non-Hispanic families.
An important factor related to the types of foods consumed by children and
their weight status is the household environment (Couch, Glanz, Zhou, Sallis, &
Saelens, 2014). This takes into account many aspects including, but not limited
to, the amount of television viewed, parenting styles, and food availability. The
average child in the United States spends approximately 6 hr a day using
media, including television, and watches about 40,000 television advertisements
per year (Kunkel, 2001; Roberts, Foehr, & Rideout, 2005). Children from lower
socioeconomic families tend to watch more television than children from higher
socioeconomic families (Story & French, 2004). The amount of television viewed
has been positively correlated with the number of food or beverage requests
made by school-aged children and negatively correlated with the healthy eating
profile of children (Chamberlain, Wang, & Robinson, 2006; Donkin, Neale, &
Tiltson, 1993).
Children of authoritarian parents, who use control strategies with food tend
to eat less healthy, whereas children with parents who monitor and reinforce
healthy eating behaviors, as found in authoritative parenting, tend to eat
healthier (Elder et al., 2010). Additionally, a household environment with little
parental restraint on food intake or permissive parenting practices in place may
be a contributing factor for increased obesity prevalence rates and consumption
of low-nutrient dense foods (Couch et al., 2014; Flegal, Ogden, & Carroll, 2004;
Hennessy, Hughes, Goldberg, & Hyatt, 2012). An earlier study conducted in the
United Kingdom examined children’s food purchase requests made to parents
and found that 7- to 11-year-old children tended to request easily consumable
foods such as breakfast cereals, snack foods (yogurt, sweets, and fruit), and
drinks (Donkin et al., 1993). This study did not assess parental compliance to
these requests, but it is plausible to assume that parents who are more
compliant with their child’s food requests could be contributing to their child’s
weight gain.
There are several hypotheses addressing the disparity of obesity prevalence
rates between ethnicities, including cultural beliefs regarding weight status,
access to resources, wages, and levels of acculturation (Centrella-Nigro, 2009;
Small, Melnyk, Anderson-Gifford, & Hampl, 2009). Acculturation has been
found to be a risk factor for obesity-related eating behaviors in adolescent
and adult immigrants (Barcenas et al., 2007; Gordon-Larsen, Harris, Ward, &
Popkin, 2003; Himmelgreen et al., 2004; Liu, Chu, Frongillo, & Probsts, 2012;
Unger et al., 2004). Less acculturated Hispanic immigrants have been found
to have higher fruit and vegetable availability, accessibility, and intakes
compared to more acculturated Hispanic immigrants (Dave, Evans, Pfeiffer,
Watkins, & Saunders, 2010; Ghaddar, Brown, Pagan, & Dıaz, 2010).
Availability refers to having those foods in the area, which is similar but not
identical to accessibility, which refers to being able to obtain and consume
available foods.
Some Hispanic families have identified television viewing as an important
source of nutrition information. Also, this has been associated with many
nutrition related behaviors, such as fast food consumption, lower fruit and
vegetable intake, and higher intake of high-fat, high-sodium snacks (Perez-
Escamilla et al., 2001). One study found that 55% of Latino preschool children
made requests for foods or beverages they had viewed on television in the
previous 2 weeks (Borzekowski & Poussaint, 1998). In a Mexican American
sample, parental fulfillment of child requests for foods advertised on television
has been associated with a higher number of snacks and overall fat intake
consumed per day by children (Ayala et al., 2007).
Tovar et al. (2012) argued that immigrant mothers may be more compliant to
their child’s food requests due to their transitional circumstance. They may have
had to refuse their child’s requests while living in an underserved country, but
in the United States, where inexpensive food is more abundant, mothers may
have the ability to be more compliant to food requests. There is also evidence
that past food deprivation prior to immigrating is associated with a preference
for calorie dense food when available (Olson, Bove, & Miller, 2007). Also, with
the stress and difficulties faced during the acculturation process, it may be easier
for immigrant mothers to be compliant with food requests than to argue about
why the child cannot have those foods (Tovar et al., 2012).
It is important to note that often immigrant children acculturate more quickly
than their parents. This puts immigrant parents in a role where they depend on
their children to navigate American language and culture, and this role might
require the children to be involved in many types of family decisions (Dale,
Andreatta, & Freeman, 2001). Children in this position who interpret, translate,
and mediate information for their parents are referred to as language brokers
(Love & Buriel, 2007). It is plausible that the experience of acculturation and
language brokering may cause immigrant mothers to be more compliant with
their child’s food requests.
Sampling Procedures and Characteristics
This study took place in a southeastern metropolitan area consisting of
approximately 50% Caucasian, 40% African American/Black, and 8% Hispanic
residents (U.S. Census Bureau, 2010). The majority of Hispanic immigrants in
this area are originally from Mexico, and they have arrived in the United
States since 1990 (Center for New North Carolinians, 2010). A communitybased
cross-sectional design with quota and snowball sampling techniques
was utilized to achieve a sample that was approximately 50% Hispanic and
50% non-Hispanic.
All study protocols were approved by the Institutional Review Board and
all participants provided informed consent and child assent. Participants were
recruited through clinics and agencies serving primarily low-income and
immigrant and minority families. Various recruitment techniques were utilized
based on the agency’s preference, such as talking to patients in the waiting
rooms of clinics, speaking to potential participants at classes offered by the
agency, posting and handing out recruitment fliers (made available in both
English and Spanish), and contacting potential participants over the
Screening of potential participants was performed during recruitment.
Participants consisted of a mother, or other primary female caregiver of at least
one 7- to 12-year-old child, and said child. This particular age group was
chosen because they may exhibit more influence on family behaviors than
younger children. It has been estimated that children aged 8–14 years old
annually spend and influence the spending of approximately $1.2 trillion dollars
(Lindstrom, 2004). Families with more than one child in the 7- to 12-year-old
age range were included in the data collection, but only one child per family
was allowed to participate. The child who participated was chosen by the
parent based on convenience (i.e., which child was home at the time, which one
wanted to participate, etc.). There was no record in the data collection of
whether or not there were additional children in that age range also in the
home, except that the language brokering questionnaire included questions
regarding number and ages of siblings. Participants also had to be fluent in
either English or Spanish. Eligible and willing participants made an
appointment to complete an interview.
Data Collection
Structured interviews took place at the participant’s home. Interviews were
conducted by trained research assistants or community interpreters. Two
researchers/interpreters went on each interview. The interview questions and
procedures were content validated by three individuals with expertise in
nutrition and/or working with the Hispanic population, and pilot tested with
three members of the target population.
Interviews lasted between 30–90 min, were audio recorded, and conducted in
English or Spanish depending on the participant’s preference. The interview
questions focused on family dietary behaviors on the most recent weekday,
weekend day, and grocery store visit. This also included dietary behaviors
outside the home (e.g., restaurant or convenience store), inside the home, and at
the grocery store. Participants were asked how typical the days in question were
with regard to meals and snacks so that only days that were at least somewhat
typical were used. Demographic and socioeconomic information was collected,
along with questions to assess household food security, parenting style,
acculturation level (only for mothers and children who identified as Hispanic),
and language brokering (only for children who were identified as Hispanic).
While at the participant’s home, the researchers measured heights and
weights for the mother and child. Research assistants and community
interpreters were trained on how to conduct the interview and measure height
and weight according to approved protocol. Participants received a $10 gift card
to Wal-mart and a child activity booklet upon completion of the interview.
Child Food Requests
A child food request was defined as any food verbally requested to their mother
or other primary female caregiver to prepare, provide, or purchase. To assess
child food requests, mothers were asked about the foods their child requested
on the most recent weekday, weekend day, and grocery store trip. This included
foods requested from outside the home (e.g. restaurant or convenience store),
inside the home, and at the grocery store. The number of foods requested for
each time period and setting was recorded.
Food requests were categorized into food groups based on the Nutrient Data
System for Research (NDSR) software (Version 2011; Nutrition Coordinating
Center, 2011), with the addition of a combination food group. Because the
NDSR software ultimately measures food group servings and not food requests,
a food request made up of multiple food groups counted as one food request
rather than multiple food requests. For example, the NDSR software categorizes
a turkey sandwich as one meat serving and two grain servings, but for the
purposes of this study, it was categorized as one combination food request. The
average number of food requests per child was calculated by the number of
food requests (total or per food group) divided by the number of children per
group (total or ethnicity group). This was done as a total of all three settings
and by each of the three settings separately.
Maternal Compliance
Maternal compliance was defined as a mother or other primary female caregiver
fulfilling a food request made by their child by purchasing, providing, or
preparing the requested food item. To assess maternal compliance to their
child’s food requests, mothers were asked whether they prepared, provided, or
purchased each food requested by their child throughout the various time
periods (weekday and weekends) and settings (outside the home, inside the
home, or at the grocery store). The number of food requests with which mothers
complied was recorded, and a percentage of complied food requests was
Child Body Mass Index (BMI) Percentile
Height was recorded to the nearest tenth of a centimeter using a portable
stadiometer (Charder HM200P Portstad Portable Stadiometer. Charder Medical,
Taiwan ROC). Weight was recorded to the nearest tenth of a kilogram using a
calibrated scale (Tanita BWB800. Tanita Corporation of America, Inc., Arlington
Heights, IL). Shoes and heavy clothing were removed prior to height and weight
measurements. BMI was calculated for mothers and children (BMI = kg/m2)
using the average of two height and two weight measurements. The CDC’s
BMI-for-age growth charts for 2- to 20-year olds were utilized to plot children’s
BMI status (CDC, 2009).
Descriptive Variables
Data about monthly household income, parenting style, household food security
status, acculturation level (of Hispanic mothers and children), and language
brokering experience (of Hispanic children) were also collected. Parenting style
was determined utilizing the Primary Caregivers Practices Report (PCPR), which
categorizes authoritative, authoritarian, and permissive parenting styles
(Robinson, Mandleco, Olsen, & Hart, 1995).
To assess household food security status the Six-Item Household Food
Security Scale (SIFSS) was included during the interview (U.S. Department of
Agriculture, 2010). The SIFSS has been found to be effective in identifying food
insecurity at the household level experienced within the previous 12 months
(Blumberg, Bialostosky, Hamilton, & Briefel, 1999).
Level of acculturation of the mother was assessed using the Short
Acculturation Scale for Hispanics. This scale has been shown to be reliable
and valid in a Hispanic population (Marın, Sabogal, VanOss Marın, Otero-
Sabogal, & Perez-Stable, 1987). The child’s level of acculturation was assessed
using the Short Acculturation Scale for Hispanics–Youth Version. This scale
has been shown to be reliable in school-aged Hispanic children (Barona &
Miller, 1994). Language brokering was assessed using a modified version of
the Language Brokering Scale. The scale was answered by the child (Love &
Buriel, 2007).
Statistical Methods
Frequencies and percentages were utilized to describe the types of food requests
made by children and maternal compliance to those food requests, by food
group, setting, and ethnicity grouping. Pearson’s chi-squared analysis and
independent and paired sample t-tests were conducted to examine the
differences between ethnicity groups. Alpha level of .05 was used to identify
statistical significance. SPSS (version 21. IBM Corp., Armonk, NY) and Microsoft
Excel were used for statistical analysis.
A total of 149 interviews (45% Hispanic, 55% non-Hispanic) were conducted
between May 2012 and November 2013. All participants were low-income which
was defined as an annual household income </= 200% of the federal poverty
level. Because all participants had an annual income of </= 200% of the federal
poverty level, a monthly income of <$1000 was used in Table 1 to provide
further detail regarding the income level of participants. For a family of 4, this is
roughly 50% of the federal poverty level.
Self-reported prepregnancy weight was used for pregnant mothers (n = 3;
Hispanic = 1, non-Hispanic = 2). p-values in Table 1 correspond to Pearson’s chisquared
analysis comparing Hispanic and non-Hispanic participants. Hispanic
mothers had significantly less education (p < .001), reported a higher monthly
income (p = .006), had a lower rate of participation in the Supplemental
Nutrition Assistance Program (SNAP) (p < .001), and had a lower prevalence
rate of obesity (p = .006). Demographic and socioeconomic characteristics of the
total sample and by ethnicity grouping are shown in Table 1.
Data on acculturation and language brokering among the Hispanic
participants are shown in Table 2. The p-value in Table 2 corresponds to a
paired sample t-test comparing acculturation levels between mothers and
children. Children were significantly more acculturated than their mothers. Two
children chose not to participate in the interview.
In all settings combined, children made an average of 5.16 food requests on
the most recent weekday, most recent weekend day, and grocery store trip, and
mothers complied with approximately 80.8% of those requests. To compare the
number of food requests between ethnicity categories with different sample
sizes, the average number of food requests per child is shown in Table 3 and the
average maternal compliance rates by food group and ethnicity are shown in
Table 4. The tables contain decimals when, in actuality, only whole number
requests were possible. p-values correspond to independent t-tests comparing
Hispanic and non-Hispanic samples in both tables. The miscellaneous food
group was not included in Table 4 because there was only one request made in
the non-Hispanic sample.
The total number of child food requests on the most recent weekday,
weekend day, and grocery store trip by food group are depicted in Figure 1.
TABLE 1: Characteristics of the Total Sample and by Ethnicity
(n = 67)
(n = 82)
Total Sample
(N = 149) p-Value
Hispanic/Latino 100% (67) — 45.0% (67)
African American/Black — 75.6% (62) 41.6% (62)
Caucasian/White — 18.3% (15) 10.1% (15)
Other — 6.1% (5) 3.4% (5)
Mother’s Education Level:
High School Diploma or
95.5% (64) 43.9% (36) 67.1% (100) <.001***
Monthly Household Income:
≤$1000 22.4% (15) 43.9% (36) 34.2% (51) .006**
Participation in SNAP 47.8% (32) 75.6% (62) 63.1% (94) <.001***
Food Insecure 35.8% (24) 47.6% (39) 42.3% (63) .149
Mothers 43.3% (29) 20.7% (17) 30.9% (46) .006**
Children 23.9% (16) 19.5% (16) 21.5% (32) .669
Mothers 40.3% (27) 64.6% (53) 53.7% (80) .006**
Children 22.4% (15) 28.0% (23) 25.5% (38) .669
Sex of Child: Female 58.2% (39) 53.7% (44) 55.7% (83) .578
Parenting Style:
100% (67) 98.5% (81) 99.3% (148) .364
NOTE: ** p < 0.05; *** p < 0.001.
TABLE 2: Level of Acculturation and Language Brokering Status Among Hispanic
Child (n = 65) Mother (n = 67) p-Value
First Generation Immigrant (%) N/A 95.5%
Acculturation Level [Mean (SD)] 33.5 (5.4) 17.7 (4.4) <.001***
Language Brokering Experience: Yes [Number (%)] 61 (93.8%) N/A
NOTE: *** p < 0.001.
The grains group was the most requested group; it consisted of requests for
flour-based food items. Overall, half of the food requests in the grains group
consisted of cookies, pastries, or sugar-sweetened cereals. Other requests in the
grains group were for pancakes, Goldfish crackers, pasta/noodles, and rice.
The second most requested food group was the combination food group,
representing food requests such as Lunchables, pizza, macaroni and cheese, and
Hot Pockets. The third most requested food group was sweets, consisting
mostly of candy and gummy fruit snacks. The next most requested food group
was dairy, and the items most requested in this group were yogurt, ice cream,
and drinkable yogurts/smoothies containing added sugars.
TABLE 3: Average Number of Food Requests per Child During the Most Recent Weekday,
Weekend Day, and Grocery Shopping Trip by Food Group and Ethnicity
By Ethnicity:
Hispanic (n = 67) Non-Hispanic (n = 82) p-Value Total Sample (N = 149)
By Food Group:
Fruits 0.43 0.50 .634 0.47
Vegetables 0.31 0.26 .564 0.28
Grains 1.46 1.08 .247 1.32
Dairy 0.73 0.30 .001*** 0.50
Meats 0.43 0.35 .459 0.39
Fats 0.52 0.38 .183 0.44
Sweets 0.61 0.49 .410 0.54
Beverages 0.64 0.28 .001*** 0.44
Miscellaneous 0 0.01 .367 0.01
Combination 0.88 0.59 .045** 0.72
All Food Requests 6.04 4.37 .001*** 5.16
NOTE: ** p < 0.05; *** p < 0.001.
TABLE 4: Average Rate of Maternal Compliance During the Most Recent Weekday, Weekend
Day, and Grocery Shopping Trip by Food Group and Ethnicity Grouping
By Ethnicity:
Total Sample
(N = 149)
(n = 67)
(n = 82)
% n % n p-Value % n
By Food Group:
Fruits 90.0 26 92.3 38 .735 91.4 64
Vegetables 93.8 20 94.7 20 .904 94.3 40
Grains 83.9 82 73.3 73 .105 78.6 155
Dairy 78.8 40 82.6 21 .670 80.2 61
Meats 96.0 28 88.9 26 .311 92.3 54
Fats 68.2 24 69.0 21 .948 68.5 45
Sweets 53.2 22 54.4 22 .922 53.9 44
Beverages 85.0 37 81.0 19 .691 83.6 56
Combination 86.3 51 82.1 39 .574 84.1 90
All Food Requests 81.7 330 79.8 279 .762 80.8 609
NOTE: n is the number of complied requests.
Fruits were requested next most often, with apples, oranges, bananas, and
grapes being the most popular in that group. Beverages and fats were the next
most requested food groups. Items in the beverages group consisted of only
non-100% fruit or vegetable juice and nondairy beverages. Children requested
juice drinks, sodas, lemonades, and Kool-Aid drinks. The fats group consisted
almost exclusively of requests for potato chips and Takis (mini rolled corn
tortilla chips), which was also the most requested single food item overall.
The meat, fish, and protein alternative group was requested next most often,
and the usual requests within this food group consisted of chicken nuggets,
bacon, and hot dogs. The least requested food group besides the miscellaneous
group was the vegetable group. The most common foods requested within the
vegetable group were French fries and mashed potatoes. Almost half of the food
requests in the vegetable group consisted of French fries.
The miscellaneous food group contained a very limited number of foods, and
only one request for gravy was categorized into that food group. Reported
maternal compliance from the most recent weekday, weekend day, and grocery
store visits ranged from 53.9% to 94.3% by food group, excluding the
miscellaneous group (Figure 1). The order of highest compliance rate to lowest
compliance rate by food group was as follows: (i) vegetables; (ii) meat, fish, and
alternative protein; (iii) fruits; (iv) combination; (v) beverages; (vi) dairy; (vii)
grains; (viii) fats; and (ix) sweets.
Of the total sample, 61 (40.9%) mothers reported their child requesting at
least one food item to be purchased or provided from outside of the home
(when the mother and child were already at the food establishment) on the most
recent weekday or weekend day. Seventy-four (49.7%) mothers reported at least
one child food request for an item to be prepared in the home on the most
recent weekday or weekend day, and 131 (87.9%) mothers reported their child
requesting at least one food item to be purchased during their most recent
grocery shopping trip. Mothers’ average reported compliance rates were 91.7%
for child food requests from outside the home, 79.8% for child food requests
from inside the home, and 72.4% for child food requests made while grocery
58 66
81.3% 92.3% 68.5% 53.9% 83.6%
250 Number of Child Food Requests
Rate of Maternal Compliance
Figure 1: Total (includes most recent weekday, weekend day, and grocery store trip) number
of child food requests and rates of maternal compliance according to food group.
Tables 3 and 4 also include a comparison of child food requests and rates of
maternal compliance by ethnicity grouping, respectively. There was a
statistically significant difference between the overall number of food requests
made by Hispanic and non-Hispanic children with an average of 6.04 requests
per Hispanic child compared to 4.37 requests per non-Hispanic child (p < .001).
Hispanic children requested more dairy products (p < .001), more beverages
(p < .001), and more combination foods (p = .045) compared to non-Hispanic
children. However, there were no statistically significant differences in the
maternal compliance rates between Hispanic and non-Hispanic mothers.
The purpose of this study was to examine the food requests made by schoolaged
children in low-income families, maternal compliance to those requests,
and how this might differ between Hispanic and non-Hispanic families. The
most requested food groups were the grains, combination, and the sweets
groups. Although it is possible for the grains and combination food groups to
contain highly nutritious foods, the requested foods within those groups
consisted mostly of highly processed, high-sugar, high-fat, convenience, and/or
low-nutrient density food items. These results are consistent with Donkin et al.
(1993) who found that children often requested foods they could consume on
their own.
The food groups with the highest maternal compliance rates were the meat,
fish, and protein alternatives, fruit, and vegetable groups. This seems positive
given that most of the foods requested in these groups provide important
nutrients, although some may be of higher fat content and/or processing.
However, even though these food requests were complied with most often,
these groups were some of the least requested food groups by children.
In examining requests and compliance rates for all the food groups, there are
several areas of importance. The beverages group had an average compliance
rate of 83.6%, which is high considering these are mostly sugar-sweetened
beverages. There were also relatively high levels of compliance for the fats and
sweets groups, which contain little nutrient value compared to energy density.
There is evidence that frequent consumption of these types of foods and
beverages can lead to weight gain (Ludwig, Peterson, & Gortmaker, 2001;
Shang, O’ Loughlin, Tremblay, & Gray-Donald, 2014). This is likely a
contributing factor to the high prevalence of combined overweight and obesity
in mothers and children demonstrated in this sample (84.6% in mothers and
46.0% in children), in addition to ethnicity and socioeconomic status (Wang &
Beydoun, 2007).
It was surprising to find the high rate of authoritative parenting style given
that authoritative parenting has generally been associated with positive health
behavior and indicators in children such as BMI (Patrick, Hennessy, McSpadden,
& Oh, 2013). It could be that mothers use different parenting styles in different
situations (e.g., food vs nonfood related issues) and so what was measured did
not correspond to how they parent in food situations (Patrick et al., 2013).
Variation in maternal compliance rates based on setting was also identified.
The highest compliance rate by setting was for foods from outside the home.
These requests were made when the family was already at the food
establishment. This may be explained by a mother’s desire to not purchase foods
that their children would not consume. Another explanation for this high
compliance rate could be that the food requests were usually for that individual
child’s consumption, reinforcing the work of Atkin (1978) who also found that
children tended to have more influence on family purchases when they were the
primary consumer of that product. Food requests made for foods inside the
home tended to be items that would become part of the entire family’s or
numerous family members’ meal or snack.
Although the highest maternal compliance rate was for foods outside the
home, far more child food requests were made at the grocery store with a
relatively high rate of maternal compliance. Due to the high number of food
requests made in this setting and the corresponding rate of maternal compliance
to these requests, this would seem like a suitable setting to have an impact on
family food decisions.
Research has shown that as Hispanic adults and children become more
acculturated, they tend to increase their consumption of processed, high-fat, and
fast foods; this appeared to be the case in this study (Unger et al., 2004).
Significant differences were identified between Hispanic and non-Hispanic child
food requests. Hispanic children requested more dairy, beverages, and
combination foods. These results seem to support a recent finding of a higher
proportion of low-nutrient and high-calorie foods advertised to children on
Spanish-language television compared to English-language television. Many of
the foods that are advertised on Spanish-language television would fit into the
aforementioned food groups (Kunkel, Mastro, Ortiz, & McKinley, 2013).
The increased exposure to these types of foods coupled with the Hispanic
child’s role as a language broker may contribute to the higher number of food
requests for these types of foods compared to non-Hispanic children, as they
may feel they have more influence in family decisions. Our results support
previous findings of yogurt being popular among Hispanic American
consumers, with drinkable yogurt particularly being more common for
Hispanics compared to non-Hispanics (Innovation Center for US Dairy, 2010).
Many of the dairy foods requested within this population were for drinkable
yogurts/smoothies that contained added sugar and less nutrients than
traditional yogurt. Although the maternal compliance rates were similar
between these food groups, Hispanic children would likely have greater access
to foods from these groups compared to non-Hispanic children due to the
higher number of requests, which could be a contributing factor in the obesity
prevalence rates in the Hispanic immigrant population.
The results of this study suggest potential targets for nutrition interventions
in this population. The high proportion of child requests made for foods high in
sugar, fat, and/or sodium are reflective of the types of foods typically marketed
to children (Powell, Szczypka, Chaloupka, & Braunschweig, 2006). There has
been a great deal of effort to decrease this type of marketing, but it still seems to
have a substantial impact on child food requests (Cairns, Angus, Hastings, &
Caraher, 2013). Maternal education regarding the foods typically marketed to
children could be helpful given the relatively high rate of compliance for food
groups that offer little nutritional value. For example, many mothers were quick
to point out that they did not give soda to their children, but they provided
non-100% juice drinks or lemonade, possibly not realizing that these are not
nutritious choices.
This point was also illustrated with the drinkable yogurts/smoothies. Mothers
generally perceived these as healthy, when in reality, they sometimes have a
higher sugar content and lower protein, calcium, and vitamin D content than
traditional yogurt, depending on the particular brand. It may be beneficial to
focus on how mothers can modify their parenting practices in order to
discourage frequent consumption of high-sugar, high-fat, and/or high-sodium
foods, such as those typically marketed to children.
The study has some limitations. First, a convenience sample was utilized,
which could yield selection bias. Second, data were dependent on mothers’ recall
and report, sometimes from as many as 4 days, and this could be inaccurate.
Third, the majority of the Hispanic participants were first generation (95.5%).
These results may differ from Hispanic participants who were born in the United
States. Finally, interviews with mothers were not always conducted separately
from the children, which could have caused some bias, particularly for questions
about parenting style. Interviewers tried to remedy this by having mothers
answer with numerical responses instead of actual responses on the PCPR.
In conclusion, this study suggests that children in a low-income population
probably have a substantial impact on the foods consumed by requesting certain
food items to be purchased, provided, or prepared by their mothers. However,
children are most often requesting highly processed, high-fat, and/or high-sugar
foods that may have little nutritional value, and mothers, on average, are
complying with these food requests at least half the time. Differences in the
number of food requests made within certain food groups were identified
between Hispanic and non-Hispanic participants. The results could be used to
develop an intervention focused on promoting healthy dietary behaviors in lowincome
families by further examining and utilizing the influence both Hispanic
and non-Hispanic children have on family food decisions.
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