Carolina Arango Ca454@drexel.edu R03-11-328- Exploring Feeding Styles and Beliefs Across Hispanic and non-Hispanic White Mothers.

1 R03-11-328 Differing Feeding Styles Between Hispanic and Caucasian Mothers. Project Summary The purpose of this proposal is the exploration of infant feeding styles and beliefs among first time, first-generation Hispanic mothers and non-Hispanic White mothers living in Philadelphia, Pennsylvania. The proposal will evaluate the differences among the two groups through individual mother-child interviews using a phenomenological qualitative study approach. According to Briefel, Condon, Clusen, Harnack, Gemmill (2010), the first 2 years of life are critical to the development of children. Understanding the infant feeding practices during this time period is important in order to identify areas for improving the establishment of healthy habits and behaviors. Because mothers play a key role during this time period, it is essential to understand some of the factors that are influencing their infant feeding styles, including beliefs and practices due to their Ethnicity. Latinos are the largest minority in the United States and continue to have a growing population. They are also being excessively affected by the childhood obesity epidemic (Evans et al., 2011), making it imperative to study their eating habits. The two groups will be interviewed while being video recorded. Interviews will take place while the mother is feeding the infant in their own home, ensuring the observations and responses gathered are as natural as possible. The food will be spinach, and it will be kept constant across feedings in order to observe the mothers technique when introducing a novel solid food. Through the video, the mothers responses can then be compared to their actual actions. The hypothesis is that the group of first time, non-Hispanic White mothers will portray more feeding styles linked to the development of healthier eating habits, such as repeated exposures to novel foods, and an introduction of healthier solid foods such as fruits and vegetables. Project Narrative Relevance to Public Health: Data from this study should provide new insight into the infant feeding styles and beliefs of first time, first-generation Hispanic and second generation Non-Hispanic White mothers living in the United States. Identifying differing infant feeding styles and beliefs among the two groups will help develop appropriate intervention methods to aid parental influence in the development of healthy dietary habits in toddlers.

Specific Aims This proposal responds to PA-11-328, which accepts applications in the area of Studies to understand parental interventions based on cultural influences on the development of sustainable health behaviors. Using a phenomenological qualitative approach, interviews on feeding styles and beliefs will be conducted and videotaped on a sample size of 80 first time mothers (40 first-generation Hispanic mothers and 40 non-Hispanic White mothers) to assess their varying feeding approaches. The interviews will take place at the mothers own home while the mother feeds the baby a novel food: spinach. The mothers actual actions during feeding will be caught on camera and will be compared to the responses during the interview. The interview questions will explore how the introduction of solid foods and feeding styles varies among the two cultures. Among these, the areas regarding child-feeding practices, child-feeding perceptions and beliefs, child-feeding advice and beliefs on such advice, perceptions on the introduction of solid foods, and on their own households eating habits. These are important areas which can help develop a better understanding on the individual intervention methods that each group requires in order to help them develop healthier eating habits for their children. Interview responses will then be compared on content and recurring themes and subthemes will be identified across groups.

3 Research Strategy: Significance According to the Center for Disease Control and Prevention, from 2006 to 2008, about 28.7% of the Hispanic population in the United States was obese, compared to 23.7% of NonHispanic Whites. Then, in 2009, Hispanics were found to be 1.2 times as likely to be obese than Non-Hispanic Whites. Obesity is defined as having a Body Mass Index (BMI) above 30. Obesity has been linked to diseases such as cancer, diabetes, and heart disease, while an increased intake of fruits and vegetables has been linked to lower chances of obesity and illness. Because vegetable and fruit intake has been linked to lower obesity rates and a reduced risk for obesity related diseases, it is important to study the kinds of introduction methods that mothers are practicing with these foods since the first 2 years of life are critical to the development of childrens habits (Briefel et al, 2010). Our preferences for sweet tastes have been said to be innate, as are our tendencies to reject bitter tasting foods such as vegetables, says Forestell and Mennella (2007). Studies by Daniels et al. (2009) and Forestell et al. (2007) found that repeated exposure to a particular food resulted in its acceptance. Daniels et al. (2009) also states that 10 or more exposures to a food will enhance its acceptance is acquired after, yet many mothers dont reach these repetitions. In efforts to link infant feeding styles to Ethnic beliefs, various studies have explored differences in the practices of feeding styles across cultures. A study performed by Caton, Ahern, and Hetherignton (2011) explored infant feeding styles and mother perceptions in an UK sample of 75 mothers of infants aged six to eighteen months. This study found that UK mothers explored a variety of techniques to deal with their childs rejection to vegetable intake, including modeling, using dips and sauces, or modifying the texture of vegetables to enhance their acceptance. Several mothers in this study mentioned altering their own diet to include more vegetables as a means of acting as good role models for their children around meal times, a practice that opposed that of Hispanic parents interviewed by Sealy (2010). Parents here reported they would not cook a particular food at home if they didnt like it, for example vegetables, and would simply rely on school meals to provide the missing food in their childs diet. Research proposed in this application will expand on the results found in studies Lindsay, Sussner, Greaney, and Peterson (2010), Evans et al. (2011) and Chaidez, Townsend, and Kaiser (2011), and will help develop adequate intervention methods across groups to help them instill healthier eating habits in their children, thereby decreasing their chances of future obesity. This research will reveal and help define the varying infant feeding styles and beliefs across Hispanic and non-Hispanic White cultures. Increasing the understanding of individual feeding styles across cultures should 1) provide new and appropriate interventions to improve infant feeding styles in mothers of a particular culture in an effort to increase food and vegetable intake and prevent future obesity, and 2) may provide clinicians and nutrition educators with new methods for client-specific information to promote healthy eating. Innovation This research is innovative in that it is comparing two groups that have not been directly compared in previous studies, first generation Hispanic mothers with non-Hispanic White mothers. A previous study by Chaidez et al. (2011) have focused specifically on Mexican cultures, while studies by Lindsay et al. (2010) and Ventura, Gromis, and Lohse (2010) have included a variety of Hispanic backgrounds but all belonging to low income families. The proposed study will have a variety of Hispanic backgrounds and social statuses. According to Forestell et al. (2007) there are three different types of experiences an infant can have with food to acquire its taste. The first is while the mother is pregnant, the

4 second is through breastfeeding, and the third is through repeated exposure. In this qualitative study, we will further explore the third experience by including related questions in the interview and then comparing the answers with their actions during feeding. Approach: Hypotheses I hypothesize: 1a. that first generation Hispanic mothers feeding styles will vary from those of non-Hispanic White mothers in respects to the amount of times they repeat exposure to a novel food, this will be evaluated according to the interview and the video recording and 1b. they will differ in the kinds of solid foods they introduce to their infants, including more fruits and vegetables. Rationale Previous studies have addressed parent feeding styles based on their Ethnic background and whether or not their approach helps infants acquire taste for unfamiliar foods. Studies by Daniels et al. (2009) and Sussner, Kindsay, Greaney, Peterson (2008) found through focus groups of Hispanic mothers, that the biggest factors affecting their food choices at home was their ethnicity or culture and time constraints. A study by Evans et al. (2011) showed that Spanish-speaking Hispanics were more concerned with their children being underweight and they used foods to calm their children down more often when compared to English-speaking Hispanics, showing that beliefs can change through acculturation. These findings were consistent with those from a study by Lindsay et al. (2010), where Latina mothers living in the United States for an average of 9 years reported giving importance to their children eating a hearty amount of food in order for them to grow up strong and healthy. They also expressed their beliefs that having a skinny child is a sign of bad parenting and poor health. A study conducted by Soussignan, Schaal, Boulanger, Gaillet, and Jiang (2012), found that Hispanics were three times more likely to cook only foods they already knew their children liked instead of introducing them to new foods. These studies could be showing some of the beliefs and practices that can be causing Latinos to experience higher rates of obesity and obesity-related conditions such as type 2 diabetes when compared to non-Latinos (Evans et al. 2011). Other studies have focused their research on infant acceptance of foods, especially fruits and vegetables, since the consumption of these has been found to have a positive effect on weight control and disease prevention. Studies by Daniels et al. (2009), Forestell et al. (2007) and Ventura and Mennella (2011) have shown that repeated exposures to a particular food will increase childrens acceptance of it. This can be observed with bitter tasting foods such as vegetables. The proposed study will explore the varying feeding styles between first time, first generation Hispanic mothers and first time, non-Hispanic White mothers in order to establish appropriate intervention methods for each group. . The experiment will use 80 first time mothers between the ages of 25-35 with infants between the ages of 6 to 12 months. Forty first-generation Hispanic mothers and 40 second-generation Non-Hispanic White mothers will be interviewed on their child feeding practices, child feeding perceptions and beliefs, obtained child feeding advice and beliefs, beliefs and practices on the introduction of solid foods, and the families own personal eating habits. The interviews will take place in the mothers own homes and will be videotaped. Interviews will then be examined for their content in similarities and differences across the two groups, and themes and subthemes will be extracted.

5 Outcome Measure Recurring themes and subthemes will be determined. Co-variates: Hispanic Mothers family background, mothers BMI, financial income, previous education, feeding history of breast versus formula or a combination of both, and baby feeding times. Timeline Year 1 The first 2 months of year 1 will involve the recruiting of the participants. Experiment 1 should begin in month 3. We anticipate running 5 days of interview sessions a week, with 2 sessions a day (10 interviews a week). There will be a total of 80 individual mother-child interview sessions which should take approximately no more than 3 months to complete. The remaining 7 months will be used to analyze the data from the interviews, anticipating the Study will be completed in one year. Participants and Recruitment For the experiment described, the participants will be 25 to 35 year old first-time mothers of healthy 6 to 12 month old babies. Since we are assessing the general first-generation Hispanic population in the United States, having mothers coming from various Latin countries will generalize the findings to the overall Hispanic population in the Philadelphia area, as opposed to just Hispanics from a specific country. Earnings across the groups will also differ in order to address the general population instead of a specific sample according to income. A demographic questionnaire will be filled out by each mother before the interview to properly account for the diversity in participants. Limiting our participants to first-time mothers of ages 25-35 will help avoid confounding by experience. Infants age will vary from 6 to 12 months, and as part of the recruitment criteria they will be required to have previous experience with cereal, yet close to none experience with vegetables. Exclusion Criteria Potential participants must be either first-generation Hispanics or non-Hispanic White mothers of a healthy child and being that their first birth. Income, education, and familys place of birth will vary across the two individual groups. Age of the mothers will be between 25 to 35 years old. Only healthy infants who have been weaned to cereal but have very little experience with fruits and vegetables and are between 6 to 12 months will qualify for the study. Participant Recruitment Subjects will be recruited through flyers and newspaper ads, from Philadelphia mother support groups and breastfeeding support groups, word-of-mouth, and the Supplemental Nutrition Program for Women, Infants and Children in Philadelphia, Pennsylvania. Data Management Participant retention and data quality will be monitored throughout the data collection period. There will be no control group. Prior to performing all interviews all of the Demographic questionnaires will be completed. Participants age will be verified. The video recordings will be essential to analyze the interview responses. Data Analysis Data will be analyzed as that of a phenomenological qualitative study. Recurring themes and subthemes found in the participants responses will be determined in both groups, then compared across groups. The mothers responses will also be compared to their actual actions while feeding the baby.

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