Perspectives of Black and Hispanic Children Living in Under-Resourced Communities on Meal Preparation and Grocery Shopping Behaviors: Implications for Nutrition Education

Minority children living in under-resourced communities are at the greatest risk for obesity and poor diet quality. Child involvement in meal preparation may be a helpful strategy to improve diet quality. This paper explores minority children’s perspectives regarding this. Eighteen children participated in a mixed methods study (online surveys, telephone interviews). Descriptive statistics were calculated for child demographic and psychosocial factors. Thematic analysis was used to code and analyze the interviews. Most children reported having cooking experience (83%) and cooking with family (94%) and exhibited high cooking self-efficacy (21.8 ± 2.9) and positive cooking attitudes (25.7 ± 4.4). Children reported helping with meal preparation (50%) and grocery shopping (41%) sometimes. The qualitative data further supported the results obtained from the children’s psychosocial factors. Most children noted the importance of learning to cook with an emphasis on life skills. Children also shared their level of involvement in cooking and grocery shopping. Most children reported using technology when cooking to find demonstration videos and recipes. These findings highlight that minority children participate in meal preparation and grocery shopping. Their perspectives are important for the development of nutrition education programs to achieve equitable dietary outcomes in minority families living in under-resourced communities.

Associations Between Family Member Involvement and Outcomes of Patients Admitted to the Intensive Care Unit: Retrospective Cohort Study (Preprint)

BACKGROUND Little is known about family member involvement, by relationship status, for patients treated in the intensive care unit (ICU). OBJECTIVE Using documentation of family interactions in clinical notes, we examined associations between child and spousal involvement and ICU patient outcomes, including goals of care conversations (GOCC), limitations in life-sustaining therapy (LLST), and 3-month mortality. METHODS Using a retrospective cohort design, the study included a total of 858 adult patients treated between 2008-2012 in the medical intensive care unit at a tertiary care center in the northeastern United States. Clinical notes generated within the first 48 hours of admission to the ICU were used with standard machine learning methods to predict patient outcomes. We used natural language processing methods to identify family-related documentation and abstracted sociodemographic and clinical characteristics from the medical record. RESULTS Most patients were white (75.8%, n = 650/858), 50.9% (n = 437/858) were male, 55.8% (n = 479/858) were married, and the median age was 68.4 (IQR 56.5-79.4) years. Most patients had documented GOCC (75.9%, n=651/858). In adjusted regression analyses, child involvement (OR = 0.81, P = .41) and child plus spouse involvement (OR = 1.28, P = .30) were not associated with GOCC compared to spouse involvement. Child involvement was not associated with LLST compared to spouse involvement (OR = 1.49, P = .13). However, child plus spouse involvement was associated with LLST (OR = 1.60, P = .04). Compared to spouse involvement, there were no significant differences in 3-month mortality by family member type, including child plus spouse involvement (OR = 1.38, P = .13) and child involvement (OR = 1.47, P = .12). CONCLUSIONS Our findings demonstrate that statistical models derived from text analysis in the first 48 hours of ICU admission can predict patient outcomes. Early child plus spouse involvement in decision-making within the first 48 hours of ICU admission was associated with LLST, suggesting that families may prefer joint decision-making. Including all available family members early in ICU care may ease the limitations of life-sustaining treatments. CLINICALTRIAL Not applicable

Examining Empowerment Interventions With Families and Preschool Children: Systematic Review of Randomized Controlled Trials

Empowerment is a core construct in health behavior and an emerging trend in pediatrics. Although it has been suggested as an approach that may promote the person’s participation in health care decisions and positive outcomes, little is known about the nature and effectiveness of interventions to support empowerment in families and preschool-age children. The aim of this review is to identify, appraise, and synthesize the evidence on health interventions explicitly using empowerment as an orienting concept with families and their preschool-age children. We identified randomized controlled trials (RCTs) through systematic searches of eight databases for articles published between 1986 and January 2019 and included RCTs that addressed empowerment as a health intervention approach or outcome and that studied families with 3- to 5-year-old children. The application of empowerment theory, the family and child involvement, and the use of behavior change techniques (BCTs) were assessed through appropriate frameworks. Ten interventions were identified, and 50% of them showed positive outcomes. Most studies claimed a theoretical base. However, the studies provided limited details on theory application in intervention planning, implementation, and evaluation, and the children’s involvement in the interventions was generally scarce. The most commonly applied BCT was “instruction in how to perform the behavior.” We identified 16 potentially effective BCTs. The evidence was not sufficiently robust to determine the effectiveness of empowerment interventions with families and preschool-age children. Additional high-quality studies are needed to produce clearer conclusions. Our results are useful for the design and evaluation of future interventions.

Child Involvement in Meal Preparation and Grocery Shopping is Associated with Lower Levels of Food Fussiness Among Young Children

This study examined associations between child food involvement and food fussiness. Analyses used survey data from 62 children ages 1.5 to 5.9 years who participated in the Guelph Family Health Study Pilot. Overall involvement (β = -0.51, p = 0.02), involvement in meal preparation (β = -0.42, p = 0.009), and involvement in grocery shopping (β = -0.29, p = 0.04) were inversely associated with food fussiness. Experimental research including larger, more diverse samples is needed to test whether food involvement reduces food fussiness among young children. Novelty: • Our study identified significant, inverse associations between child food involvement and food fussiness

Children’s perceptions of a Centrally Procured School Food Program in southwestern Ontario, Canada

Introduction This qualitative study investigates children’s perceptions of the influences of a Centrally Procured School Food Program on their dietary behaviours and their recommendations on how to improve the program. Methods The observations of 208 students aged 9 to 14 years (Grades 5–8) at 21 elementary schools were collected through focus groups in 2017/18. The larger intervention consisted of a 10-week program offering daily snacks (i.e. fruit, vegetables, whole grains, dairy, meat alternatives) for elementary school children in southwestern Ontario, Canada. Results The participants’ overall impressions of the program were positive. They noted reduced hunger, increased energy and improved nutrition. Many children felt that the program changed their dietary patterns at home as well as at school, particularly in terms of eating more fruit and vegetables. The snack program also enabled children to try healthy foods. Conclusion Most participants considered the program to be beneficial in promoting healthy eating. Participants recommended adding educational activities, expanding the variety of foods and increasing child involvement in selecting and preparing foods.

Effects of Covid-19 lockdown on parental functioning in vulnerable families

The Covid-19 pandemic has caused major changes to family life followed by a call for knowledge about how these changes have affected parental functioning, particularly in vulnerable families (Prime, Wade & Brooks, 2020). This study uses a natural experiment design to investigate the effect of the Covid-19 lockdown on parental mental health, parenting stress and three dimensions of destructive interparental conflict in a heterogeneous sample characterized by pre-existing relationship problems. Results from mixed model regression analyses showed that despite significantly higher levels of parenting stress in the lockdown group (n = 744 families) compared with the control group (n = 427 families), lockdown did not adversely affect parental mental health or levels of destructive conflicts behaviors. In fact, levels of verbal aggression and child involvement in conflict decreased during lockdown among parents living apart. Pre-existing destructive conflict levels, financial problems and age of youngest child did not moderate any of the associations. Thus, findings indicated that pre-existing family vulnerability did not predispose for reduced parental functioning during lockdown, beyond increased parenting stress. Resilient processes and an increased sense of purpose may be potential mechanisms. Caution should be taken when generalizing the findings due to the welfare context of the sample and as long-term lockdown effects were not investigated. Importantly, children in vulnerable families may have been negatively impacted by increased family time, despite relatively stable parental functioning during lockdown.

Child health behaviour and parent priorities for a school-based healthy lifestyle programme

Objective: The purpose of this study was to characterise parents’ concerns for their children’s health behaviour and perceptions of motivators and barriers to positive child health behaviour change, and to determine associations between motivators and barriers and parents’ priorities for a school-based healthy lifestyle programme. Design: Cross-sectional study of 46 parents who had completed an un-validated survey distributed during school-wide events. Setting: School for children aged 5–14 years in The Bronx, New York City, USA. Methods: Wilcoxon Rank Sum tests compared motivators and barriers to positive child health behaviour change by heath behaviour concern; Spearman’s correlation assessed associations between motivators and barriers and programme priorities. Results: Parents concerned about child weight significantly ranked keeping up with others and decreasing clothing size as motivators, while parents concerned about child food choices significantly ranked improving food choices and decreasing body mass index (BMI) and clothing size as motivators. Food-, play-, and self-esteem-related motivators were associated with nutrition education ( rs ⩾ .41, p ⩽ .01), physical activity classes ( rs ⩾ .29, p ⩽ .04) and child involvement in programme decision-making ( rs ⩾ .43, p ⩽ .01) priorities. Consistency-, child resistance- and home rules-related barriers were associated with nutrition education ( rs ⩾ .37, p = .02), physical activity classes ( rs ⩾ .32, p = .02) and child involvement ( rs ⩾ .40, p ⩽ .02) priorities. Conclusions: Despite the study sample size, selection bias, and generalisability limitations, prioritising nutrition, physical activity and child involvement in programme decision-making may enhance parent support for school-based healthy lifestyle programmes.

The Effect of Simple Suppers, A Family Meal Program, on The Relationship between Children's Food Preparation Skills and Their Involvement in Meal Preparation

Objectives Examine the relationship between children's food preparation skills and their involvement in meal preparation with their caregiver among families participating in a Head Start family meals program (Simple Suppers). Methods Simple Suppers is an 8-week family meals program tailored to low-income caregivers and their preschool age child(ren). The study design is a single arm pre- to post-test, and the intervention is occurring during the 2019–2020 school year (fall, winter, and spring sessions) at 3 Head Start sites. Caregiver lessons focus on overcoming family meal barriers (i.e., meals on a budget, time saving strategies) through interactive group discussions and goal setting. Child lessons focus on age-appropriate food preparation skills through experiential learning. Children's food preparation skills are assessed via a 9-item questionnaire. Questions are situated on a 4-pt Likert scale (1 = strongly disagree (1pt); 4 = strongly agree (4pt)). Child involvement in meal preparation is assessed with a single item scalar question (0–7 times per week). Pearson correlation was used to examine the relationship between child food preparation skills and involvement in meal preparation. Significance was set at P < 0.05. Results 19 families completed data collection for the fall session. 55.6% were low-income according to federal poverty guidelines, mean (SD) caregiver age was 37.6 (12.1), 94.7% were female, and 84.2% were non-Hispanic Black. Mean (SD) child age was 3.4 (0.5) and 47.6% were female. There was a significant association between the change in child food preparation skills and the level of child involvement in meal preparation with their caregiver (r = 0.62, P < 0.01). Conclusions Preliminary data from this study demonstrate that children's food preparation skills influence the extent to which they are involved in preparing family meals with their caregivers. Funding Sources USDA NIFA CYFAR.

Smart, vulnerable, playful or just disturbing? A discourse analysis of child involvement in palliative care

In Scandinavian countries, health professionals are legally obliged to involve patients’ minor children. A growing field of research focuses on the support to, and needs and experiences of, these children. We add to previous research by analysing discourse in qualitative interviews with nurses and doctors in Norwegian public palliative health care. The analysis identifies four interpretative repertoires picturing the child in different ways and defining possibilities for what health professionals can say and do regarding child involvement.