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EARLY HEAD START – MICHIGAN STATE UNIVERSITY Final PARTNERSHIP MEETING Culturally Sensitive Measurement of Toddler – Parent Mealtime Behaviors. Funded By: The Office of Planning, Research and Evaluation of the Administration of Children and Families (OPRE/ACF), Grant Number: 90-YF0046.

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slide1

EARLY HEAD START – MICHIGAN STATE UNIVERSITY Final PARTNERSHIP MEETINGCulturally Sensitive Measurement of Toddler – Parent Mealtime Behaviors

Funded By: The Office of Planning, Research and Evaluation of the Administration of Children and Families (OPRE/ACF), Grant Number: 90-YF0046

slide2

Research Team

Principal Investigator

Mildred A. Horodynski, Ph.D., R.N.C.1

Co-Investigators

Manfred Strommel, Ph.D.1

Holly Brophy-Herb, Ph.D.2

Lorraine Weatherspoon, Ph.D., R.D. 3

1 College of Nursing

2 Department of Family and Child Ecology

3 Department of Food Science and Human Nutrition

Funded By: The Office of Planning, Research and Evaluation of the Administration of Children and Families (OPRE/ACF), Grant Number: 90-YF0046

acknowledgment to our early head start partners
Acknowledgment To Our Early Head Start Partners
  • Capital Area Community Services (CACS-Lansing) Early Head Start, Jump Start, Early Childhood Programs
  • Carman-Ainsworth (Flint) Early Head Start
  • City of Detroit Early Head Start
  • Eight CAP Early Head Start Site
  • Genesee County Community Action Resource Development (GCCARD) Early Head Start
  • Jackson County Community Action Agency Early Head Start
  • Mid-Michigan Community Action Agency (MMCAA) Early Head Start Sites
  • Northeast Michigan Community Service Agency (NEMCSA) Early Head Start Sites
special recognition of our participants
Special Recognition of our Participants

199 African American Mother-Toddler Dyads

&

200 Non-Hispanic White Mother-Toddler Dyads

Who Participated in this Research Study

outline of the presentation
Outline of the Presentation
  • Celebration of the Project
  • Summary of the Key Findings
  • Nutrition Assessment for Toddlers--- Assessment Tools
slide8

Purpose

  • Collaborative research study designed to develop culturally sensitive measures for assessing parent – toddler mealtime feeding behaviors.
specific aims
Specific Aims
  • Develop culturally appropriate measures (Phase I)
  • Test the psychometric properties of the tailored instruments (Phase II)
  • Provide evidence of validity of self-report mealtime behavior with direct mealtime observation (Phase II)
  • Develop a training manual and provide training and technical support to Early Head Start Programs (Phase III)
study design
Study Design
  • 3 Phases:
    • Phase I = Focus Groups
    • Phase II = Survey & Instrument Validation
    • Phase III = Nutrition Assessment
slide11

Phase I: Focus Groups

  • Two focus groups with 27 African American mothers with toddlers, 12 to 36 months of age.
  • Goal: Assess cultural appropriateness of the Toddler-Parent Mealtime Behavior Questionnaire.
slide12

Phase II: Survey

  • Instrument validation with 399 EHS mother-toddler dyads

-199 African American Mother-Toddler Dyads

-200 Non-Hispanic White Mother-Toddler Dyads

slide13

Phase III: Nutrition Assessment

  • Development of NEAT Toolkit (NEATT) for EHS staff to assess toddler:
        • Current dietary intake
        • Eating/feeding behaviors
        • Eating/feeding concerns/problems
        • Food safety
        • Physical activity level
slide15

Participant Characteristics

  • 399 mother-toddler dyads: 199 African American and 200 Non-Hispanic White
  • Mean Age: 27 years for mothers (15-66 years) and 25 months for toddlers (11-47 months).
  • 96% were mothers, 2% grandmothers, 2% other relatives
  • 71% were single
  • 58% had no education beyond high school
  • 46% did not work outside of the home, 20% worked full-time, 16% were employed part-time, and 18% were students
  • 66% of the families had annual income lower than $20,000.
slide17

Mothers’ Body Mass Index (BMI)

  • <18.5 = Underweight
  • 18.5 --- 24.9 = Average Weight
  • 25 --- 29.9 = Overweight
  • > 30 = Obese
slide18

Toddlers’ Body Mass Index (BMI)

  • < 5% = Underweight
  • 5th --- 84th % = Average Weight
  • 85th --- 94th % = At Risk of Overweight
  • > 95% = Overweight
slide23

Factors Predicting Quality of Toddlers’ Food Consumption

  • Mothers’ healthy food consumption predicted in toddlers’ healthy food consumption.

-When mothers consumed more healthy foods, toddlers consumed more healthy foods.

  • Healthy Foods include:
  • Vegetables
  • Fruits
  • Unsweetened cereal
  • Plain water
slide24

Factors Predicting Quality of Toddlers’ Food Consumption

  • Race, toddler’s age, whether more than one child was living in the family, and mother’s unhealthy food consumption predicted toddlers’ unhealthy food eating.

-African American families, older toddlers, and households with more than one child consumed unhealthy foods more frequently.

-Race predicted both mothers’ and toddlers’ unhealthy food consumption as well as TV watching during family mealtimes.

  • Unhealthy Foods include:
  • Canned, packaged or frozen dinners
  • Sweetened baked goods
  • Cookies, pastries
  • Snacks
  • Fried foods
  • Sweetened cereal
  • Sweetened drinks
slide26

Maternal factors (depression, lower education, and minority status) predict TV watching during mealtime.

  • Race, education, and depression predicted TV watching during mealtime.
    • African American mothers watched TV more frequently during mealtime.
    • Mothers with less education watched TV more frequently during mealtime.
    • Depressed mothers watched TV more frequently during mealtime.
slide27

The more TV is watched during mealtime, the poorer the quality of maternal food intake

  • Maternal Quality of Food Intake
    • Maternal Healthy Food intake:
      • Mothers with higher education, less depression, and less TV watching during mealtime consumed healthy foods more frequently.
    • Maternal Unhealthy Food Intake:
      • African American mothers, younger mothers, and mothers who watched more TV during mealtime consumed unhealthy foods more frequently.
slide28

The quality of maternal food intake predicts the quality of toddlers’ food intake

  • Toddler Quality of Food Intake:
    • Toddler Healthy Food Intake:
      • Toddlers whose mothers consumed more healthy food consumed more healthy food.
    • Toddler Unhealthy Food Intake:
      • Older toddlers, and toddlers whose mothers consumed more unhealthy food consumed more unhealthy foods.
slide30

Toddlers’ Food Portion Sizes

  • The mothers were asked to provide their toddlers’ usual meal portion as follows:
toddlers food portions
Toddlers’ Food Portions
  • Food portion Sizes :

- (A) Appropriate Portion Size

- (B) Slightly Large Portion

- (C+D) Oversized Portion

  • Findings showed that toddlers’ food portion was influenced by two variables
    • Race
    • Gender
mothers perception of their toddlers weight compared to their real weight
Mothers’ Perception of their Toddlers’ Weight Compared to their Real Weight

Yellow: Mothers “overestimate” weight

Purple: Mothers “underestimates” weight

Lavender: Mothers “realistic” estimate weight

nutrition assessment for toddlers
Nutrition Assessment for Toddlers
  • Mealtime Behavior Assessment
    • Toddler Parent Mealtime Behavior Questionnaire (TPMBQ)
    • Mealtime Behavior Observation (MO)
  • Nutrition Education and Assessment for Toddlers Toolkit
mealtime behavior assessment
Mealtime Behavior Assessment
  • Toddler Parent Mealtime Behavior Questionnaire (TPMBQ)
  • Mealtime Behavior Observation (MO)
slide42

Mealtime Behavior Assessment--- TPMBQ

  • Toddler Parent Mealtime Behavior Questionnaire (TPMBQ)
    • 35 items
    • Measure of parents’ self-report of toddler eating and mealtime behaviors.
    • Approximately 15 minutes to complete.
    • 5-point Likert response scale how often the behavior occurs (i.e., never, rarely, sometimes, often, always).
slide43

Mealtime Behavior Assessment--- TPMBO

  • Parent-Toddler Mealtime Behavior Observation (TPMBO)
    • The Mealtime Observation (MO) was developed as a companion to the TPMBQ.
    • 29 items
    • Measure of the observed toddler eating and mealtime behaviors.
    • Approximately 20 minutes to observe and complete depending on the family mealtime duration.
    • A trained observer indicates on a 4-point Likert response scale how often the behavior occurs (i.e., “never/not at all”, “at times/occasionally”, “often”, and “throughout the entire meal”).
slide44

Instrument Validation

  • Test-Retest Reliability of TPMBQ & MO
    • Both self-report and observational measures contain three scales, the Mealtime Television Watching, the Mother Mealtime Socialization, and the Mother Mealtime distress.
    • These three scales were tested for its test-retest reliability.
  • Cross Validation of TPMBQ & MO
    • Mealtime Television watching had “high” consistency
    • Mother Socialization during mealtime had “moderate” consistency.
    • Mother Distress during mealtime had “low” consistency.
slide46

NEATT Toolkit

  • The NEATT includes three components:
    • a questionnaire with three different versions, a short version, a long version and a long version with action message;
    • 26 folders with 37 handouts; and
    • and a box (toolkit) with materials symbolizing a toddler’s stomach size and appropriate portion sizes for toddler’s food consumption.
slide47

NEATT Toolkit Update

  • CDI Question 1-Fruit and Vegetable Consumption
  • CDI Question 2 and 3-Tips for Lowering Dietary Sugar
  • CDI Question 2-Tips for Lowering Dietary Fat
  • CDI Question 3-Sugar in Beverages
  • CDI Question 4-Choking Hazards
  • CDI Question 6C-How To Cook
  • CDI Question 6C-Sample Menu recipes
  • CDI Question 6E - Food Labels
  • CDI Question 6E-Food Shopping
  • FS Extra Handout - Kitchen Safety
  • PF Question 1-Physical Fitness for all Seasons
  • PF Question 1 - Physical Activity for 2&3-year olds
slide48

Nutrition Assessment for Toddlers

  • Comparison of TPMBQ, MO and NEATT
    • Purposes
      • TPMBQ is a self-report measure completed by parents.
        • Participants might report what they “should have” done, not what they “have” done.
      • MO is an observationalmeasure completed by a trained observer, such as a home visitor/data collector.
        • Observers usually make references based on a one-time observation. It may not be the “usual” family behaviors.
      • The NEATT is designed for assessment and educational purposes.
        • Risk Score ( Appendix 8)> 10  a referral should be made to a nutritionist.
slide49

Reminder of Using Assessment Tools

  • It is important to remember that toddlers’ growth changes rapidly.
  • It is important to pay attention to the “pattern” of family mealtime, feeding, and/or eating behaviors.
  • Caution must be used to not make any conclusions based on a single observation or assessment.
  • Assessment provides educators the tools to educate the family about toddler feeding strategies and nutrition information.