Maternal Attitudes, Subjective Norms and Feeding Practices of Young Children Angela A. Northrup ...

186 Pages·2014·2.34 MB·English

by  Windows User

Maternal Attitudes, Subjective Norms and Feeding Practices of Young Children
Angela A. Northrup

Submitted in partial fulfillment of the
requirements for the degree of
Doctor of Philosophy
under the Executive Committee
of the Graduate School of Arts and Sciences

COLUMBIA UNIVERSITY

2014
© 2014
Angela A. Northrup
All rights reserved
ABSTRACT
Maternal Attitudes, Subjective Norms and Feeding Practices of Young Children
Angela A. Northrup

This exploratory study examined maternal attitudes, subjective norms and food selection
behaviors of 31 mothers (mean age 29.6 years, 50% Hispanic, 34% Black, 47% ≤ high school,
31% marginal health literacy, 71% Women, Infants and Children program participants) for their
2 and 3-year-old children (n=32, 50% female, 34.4% overweight/obese, 72% breastfed during
infancy) to identify factors associated with childhood overweight. The Theory of Reasoned
Action was used to examine relationships between variables of interest. Subjects were recruited
from two primary care sites. Measurements included 5 surveys, child anthropometric measures
and a simulation exercise to identify types and quantities of food mothers offered to their child.
Selected food items were weighed and organized bv food group and compared to USDA
recommendations by child’s age, gender and activity level. Data were analyzed using descriptive
statistics, Spearman’s rho correlation coefficients, and multivariate linear regression modeling.
On average, mothers offered their children more fruit (237%) and meat (153%) but less
vegetables (75%), dairy (79%) and grain (65%) than what is recommended. Mothers of 2 year
olds selected greater quantity of food compared to mothers of 3 year old children for all food
groups except dairy (p <0.05). Demographic, normative beliefs, maternal attitudes and health
literacy meeting criteria were entered into multivariate regression models to predict behavioral
intent. Final models explained 13% (dairy- restrictive attitude); 28% (grain- child’s age, maternal
BMI, physical activity); 40% (fruit-child’s age, maternal education, normative belief, and health
literacy); 44% (calories- child’s age, normative beliefs for all food groups, restrictive attitude);
38% (meat- child’s age, Hispanic ethnicity, normative belief) and 51% (vegetable- child’s age,
television viewing, normative belief and health literacy) of the variance of behavioral intent for
the respective food groups. Normative beliefs and health literacy are potentially modifiable.
Therefore, appraisal of maternal normative beliefs about dietary recommendations for children
and health literacy may identify children at risk for overweight and obesity.
Table of Contents
Page
List of Tables vi
List of Figures viii
Acknowledgements ix
Dedication xi
Chapters
I Introduction 1
Problem Statement and Purpose 1
Background and Significance 2
Definition of Terms 3
Causes of childhood overweight and obesity 4
Prevention and Treatment 5
The Effect of Portion Sizes 6
Conceptual Model 10
Purpose 12
Aims 12
II Literature Review 14
USDA guidelines 14
Women, Infants and Children (WIC) 16
Portion size estimation 17
Portion size research in adults 18
Portion size research in children 26
i
Table of Contents
Page
Feeding Toddlers and Infants studies (FITS) 28
2002 FITS sample 28
Studies using 2002 FITS data 29
Studies using 2008 FITS data 32
Studies using 2008 FITS data compared to 2002 FITS data 33
The theory of reasoned action 35
Attitudes and Behavioral Intent 41
Subjective Norm and Behavioral Intent 42
Rationale for study 44
III Methods 46
Study Design 46
Sample and Setting 48
Sample size estimation and power analysis 49
Subject Recruitment 49
Inclusion and Exclusion criteria 50
Study Procedures 50
Data Collection 51
Feeding simulation exercise 51
Survey Instruments 52
Interview Instrument 57
Pilot work 58
ii
Table of Contents
Page
Description of concepts and variables 59
Demographic Characteristics 59
Attitude toward child feeding 66
Normative Beliefs about food recommendations 68
Subjective Norm 68
Behavioral Intent 69
Data Management 71
Data Analysis Plan 71
Aim 1 72
Aim 2 73
Aim 3 75
Human Subject Protection 75
IV Results 76
Characteristics of the Sample 76
Maternal Attitudes 80
Normative Beliefs 80
Subjective Norm 83
Aim 1 Analysis 83
Behavioral Intent 87
Assessment for Confounding Variables 89
Aim 2 Analysis 91
iii
Table of Contents
Page
Normative Beliefs 91
Maternal Attitudes 91
Multivariate Regression Models 94
Aim 3 Analysis 112
V Discussion 114
Behavioral Intent 114
Normative beliefs 117
Subjective normative belief about child’s body size 118
Health literacy 120
Strengths and Limitations 121
Implications 124
Implications for Practice 124
Implications for Education 127
Implications for Policy 129
Areas for Future Research 131
References 134
Appendices
A. Parent Demographic Questionnaire 155
B. Comprehensive Feeding Practices Questionnaire 157
C. Body Outline Silhouette 163
D. Diet and Health Knowledge Survey- Short Form 164
iv
Table of Contents
Page
E. The Newest Vital Sign (Health literacy tool) 168
F. Oral Script for Consent 170
G. IRB Approval 171

v
List of Tables
Page
Table 1 Portion size research in adults 19
Table 2 Portion size research in children 23
Table 3 Studies examining healthy food choices using the Theory of Reasoned 37
Action
Table 4 Foods included in food simulation exercise and typical portions that 53
correlate with standard measurements
Table 5 Food Group Servings and Calorie Requirements for 2 and 3 year old 56
children by age, gender and activity level
Table 6 Theory of Reasoned Action Variables of Interest 60
Table 7 Characteristics of Sample 78
Table 8 Attitudes toward child feeding 81
Table 9 Normative beliefs of USDA recommended servings for child based on 82
age, gender and activity levels
Table 10 Maternal subjective norms 84
Table 11 Foods chosen by mothers during simulation exercise 85
Table 12 Behavioral intent by food group compared to USDA recommended 88
servings by age, gender and activity level
Table 13 Demographic variables as potential confounders for each behavioral 90
intent variable
Table 14 Correlations between normative beliefs and behavioral intent 92
Table 15 Correlations between attitudes and behavioral intent 93
vi