Nutr Res Pract.  2023 Dec;17(6):1185-1200. 10.4162/nrp.2023.17.6.1185.

Nutrition and health challenges among low-income families of young children in the post COVID-19 era: a qualitative study

Affiliations
  • 1Department of Nutrition, Texas A&M University, College Station, TX 77843, USA
  • 2Department of Nutritional Sciences, Texas Tech University, Lubbock, TX 79409, USA
  • 3Department of Agriculture and Applied Economics, Texas Tech University, Lubbock, TX 79409, USA
  • 4Department of Human Development and Family Sciences, Texas Tech University, Lubbock, TX 79409, USA

Abstract

BACKGROUND/OBJECTIVES
In the United States, one in every 5 children is obese with greater likelihood in low-income households. The coronavirus disease 2019 (COVID-19) pandemic may have accelerated disparities in child obesity risk factors, such as poor dietary intake and increased sedentary behaviors, among low-income families because of financial difficulties, social isolation and other struggles. This study reveals insights into nutrition and health challenges among low-income families of young children in West Texas to better understand needs and develop interventions.
SUBJECTS/METHODS
In-depth individual interviews were performed via Zoom among 11 families of children under the age of 3. A semi-structured interview guide was developed to explore 3 areas: changes in (1) dietary intake and (2) sedentary behaviors and (3) families’ preferences regarding a parent nutrition education program. Each interview was audiorecorded, transcribed, and coded using MaxQDA software.
RESULTS
Eating together as a family become challenging because of irregular work schedules during the COVID-19 pandemic. Most parents stated that their children’s dietary habits shifted with an increased consumption of processed foods. Many parents are unable to afford healthful foods and have utilized food and nutrition assistance programs to help feed their families. All families reported that their children’s screen time substantially increased compared to the pre-pandemic times. Moreover, the majority of parents did not associate child screen time with an obesity risk, so this area could be of particular interest for future interventions. Meal preparation ideas, remote modality, and early timing were identified as key intervention strategies.
CONCLUSIONS
Online nutrition interventions that emphasize the guidelines for child screen time and regular meal routines will be effective and promising tools to reach low-income parents for early childhood health promotion and obesity prevention.

Keyword

Food insecurity; screen time; COVID-19; qualitative research

Reference

1. World Health Organization. Obesity and overweight [Internet]. Geneva: World Health Organization;2021. cited 2023 January 3. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.
2. Centers for Disease Control and Prevention (US). Childhood obesity facts: prevalence of childhood obesity in the United States [Internet]. Atlanta (GA): Centers for Disease Control and Prevention;2021. cited 2023 January 3. Available from: https://www.cdc.gov/obesity/data/childhood.html#:~:text=For%20children%20and%20adolescents%20aged,to%2019%2Dyear%2Dolds.
3. Fryar CD, Carroll MD, Afful J. Prevalence of overweight, obesity, and severe obesity among adults aged 20 and over: United States, 1960–1962 through 2017–2018. NCHS Health E-Stats. Hyattsville (MD): National Center for Health Statistics;2021.
4. Weaver RG, Brazendale K, Hunt E, Sarzynski MA, Beets MW, White K. Disparities in childhood overweight and obesity by income in the United States: an epidemiological examination using three nationally representative datasets. Int J Obes. 2019; 43:1210–1222.
5. Isong IA, Rao SR, Bind MA, Avendaño M, Kawachi I, Richmond TK. Racial and ethnic disparities in early childhood obesity. Pediatrics. 2018; 141:e20170865. PMID: 29269386.
6. Hansen AR, Duncan DT, Tarasenko YN, Yan F, Zhang J. Generational shift in parental perceptions of overweight among school-aged children. Pediatrics. 2014; 134:481–488. PMID: 25157001.
7. Centers for Disease Control and Prevention (US). Overweight and obesity [Internet]. Atlanta (GA): Centers for Disease Control and Prevention;2012. cited 2023 January 3. Available from: https://www.cdc.gov/obesity/stateprograms/fundedstates/pdf/texas-state-profile.pdf.
8. United States Census Bureau. Quick facts: Texas [Internet]. Washington, D.C.: United States Census Bureau;2021. cited 2023 January 3. Available from: https://www.census.gov/quickfacts/TX.
9. Sahoo K, Sahoo B, Choudhury AK, Sofi NY, Kumar R, Bhadoria AS. Childhood obesity: causes and consequences. J Family Med Prim Care. 2015; 4:187–192. PMID: 25949965.
10. Hoffmans MD, Kromhout D, de Lezenne Coulander C. The impact of body mass index of 78,612 18-year old Dutch men on 32-year mortality from all causes. J Clin Epidemiol. 1988; 41:749–756. PMID: 3418364.
11. Rankin J, Matthews L, Cobley S, Han A, Sanders R, Wiltshire HD, Baker JS. Psychological consequences of childhood obesity: psychiatric comorbidity and prevention. Adolesc Health Med Ther. 2016; 7:125–146. PMID: 27881930.
12. Schwimmer JB, Burwinkle TM, Varni JW. Health-related quality of life of severely obese children and adolescents. JAMA. 2003; 289:1813–1819. PMID: 12684360.
13. Dehghan M, Akhtar-Danesh N, Merchant AT. Childhood obesity, prevalence and prevention. Nutr J. 2005; 4:24. PMID: 16138930.
14. Davison KK, Birch LL. Childhood overweight: a contextual model and recommendations for future research. Obes Rev. 2001; 2:159–171. PMID: 12120101.
15. Pietrobelli A, Pecoraro L, Ferruzzi A, Heo M, Faith M, Zoller T, Antoniazzi F, Piacentini G, Fearnbach SN, Heymsfield SB. Effects of COVID-19 Lockdown on lifestyle behaviors in children with obesity living in Verona, Italy: a longitudinal study. Obesity (Silver Spring). 2020; 28:1382–1385. PMID: 32352652.
16. Lee H, Oldewage-Theron W, Dawson JA. Effects of a theory-based, multicomponent eHealth intervention for obesity prevention in young children from low-income families: a pilot randomized controlled study. Nutrients. 2023; 15:2296. PMID: 37242179.
17. Bickel G, Nord M, Price C, Hamilton W, Cook J. Guide to measuring household food security (revised 2000) [Internet]. Washington, D.C.: United States Department of Agriculture;2000. cited 2023 January 3. Available from: https://nhis.ipums.org/nhis/resources/FSGuide.pdf.
18. DeJonckheere M, Vaughn LM. Semistructured interviewing in primary care research: a balance of relationship and rigour. Fam Med Community Health. 2019; 7:e000057. PMID: 32148704.
19. Torkan N, Kazemi A, Paknahad Z, Bahadoran P. Relationship of social cognitive theory concepts to dietary habits of pregnant women. Iran J Nurs Midwifery Res. 2018; 23:125–130. PMID: 29628960.
20. Young MD, Plotnikoff RC, Collins CE, Callister R, Morgan PJ. Social cognitive theory and physical activity: a systematic review and meta-analysis. Obes Rev. 2014; 15:983–995. PMID: 25428600.
21. Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, Eccles MP, Cane J, Wood CE. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013; 46:81–95. PMID: 23512568.
22. Creswell JW, Poth CN. Qualitative Inquiry & Research Design: Choosing Among Five Approaches. 3rd ed. Thousand Oaks (CA): SAGE Publications, Inc.;2008.
23. Hammons AJ, Fiese BH. Is frequency of shared family meals related to the nutritional health of children and adolescents? Pediatrics. 2011; 127:e1565–e1574. PMID: 21536618.
24. Fink SK, Racine EF, Mueffelmann RE, Dean MN, Herman-Smith R. Family meals and diet quality among children and adolescents in North Carolina. J Nutr Educ Behav. 2014; 46:418–422. PMID: 24974356.
25. Philippe K, Chabanet C, Issanchou S, Monnery-Patris S. Child eating behaviors, parental feeding practices and food shopping motivations during the COVID-19 lockdown in France: (How) did they change? Appetite. 2021; 161:105132. PMID: 33493611.
26. van der Horst K, Sleddens EF. Parenting styles, feeding styles and food-related parenting practices in relation to toddlers’ eating styles: a cluster-analytic approach. PLoS One. 2017; 12:e0178149. PMID: 28542555.
27. Sim AY, Lim EX, Forde CG, Cheon BK. Personal relative deprivation increases self-selected portion sizes and food intake. Appetite. 2018; 121:268–274. PMID: 29170121.
28. United States Department of Agriculture. Food security and nutrition assistance [Internet]. Washington, D.C.: United States Department of Agriculture;2022. cited 2023 June 11. Available from: https://www.ers.usda.gov/data-products/ag-and-food-statistics-charting-the-essentials/food-security-and-nutrition-assistance/.
29. United States Department of Agriculture, Economic Research Service. Household food security in the United States in 2018 [Internet]. Washington, D.C.: United States Department of Agriculture;2019. cited 2023 June 11. Available from: https://www.ers.usda.gov/webdocs/publications/94849/err-270.pdf.
30. Barroso A, Kochhar R. In the pandemic, the share of unpartnered moms at work fell more sharply than among other parents [Internet]. Washington, D.C.: Pew Research center;2020. cited 2023 June 11. Available from: https://www.pewresearch.org/short-reads/2020/11/24/in-the-pandemic-the-share-of-unpartnered-moms-at-work-fell-more-sharply-than-among-other-parents/.
31. United States Department of Agriculture, Economic Research Service. Access to affordable, nutritious food is limited in “food desserts” [Internet]. Washington, D.C.: United States Department of Agriculture;2010. cited 2023 January 3. Available from: https://www.ers.usda.gov/amber-waves/2010/march/access-to-affordable-nutritious-food-is-limited-in-food-deserts/.
32. Morales ME, Berkowitz SA. The Relationship between food insecurity, dietary patterns, and obesity. Curr Nutr Rep. 2016; 5:54–60. PMID: 29955440.
33. Sharma SV, Chuang RJ, Rushing M, Naylor B, Ranjit N, Pomeroy M, Markham C. Social determinants of health-related needs during COVID-19 among low-income households with children. Prev Chronic Dis. 2020; 17:E119. PMID: 33006541.
34. Chilton M, Rabinowich J, Council C, Breaux J. Witnesses to hunger: participation through photovoice to ensure the right to food. Health Hum Rights. 2009; 11:73–85. PMID: 20845852.
35. Fang D, Thomsen MR, Nayga RM Jr. The association between food insecurity and mental health during the COVID-19 pandemic. BMC Public Health. 2021; 21:607. PMID: 33781232.
36. Nagata JM, Cortez CA, Cattle CJ, Ganson KT, Iyer P, Bibbins-Domingo K, Baker FC. Screen time use among US adolescents during the COVID-19 pandemic: findings from the Adolescent Brain Cognitive Development (ABCD) study. JAMA Pediatr. 2022; 176:94–96. PMID: 34724543.
37. Lampard AM, Jurkowski JM, Davison KK. The family context of low-income parents who restrict child screen time. Child Obes. 2013; 9:386–392. PMID: 24004326.
38. American Academy of Pediatrics (AAP) Committee on Nutrition. Feeding the child and adolescent. Kleinman RR, Greer FR, editors. Pediatric Nutrition. 7th ed. Itasca (IL): AAP;2013. p. 143–162.
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