1. Parent/Caregiver Knowledge, Behavior, and Beliefs Regarding Nutrition, Diet, and Exercise Serge K. Tankeu, M.S., MPH Kay Cherry, M.S., Assistant Professor Zhao Y, PhD, Assistant Professor The Graduate Program in Public Health Eastern Virginia Medical School and Old Dominion University 1

2. Presenter Disclosures (1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Serge K. Tankeu No relationships to disclose 2

3. Purpose and Objective To determine the knowledge, beliefs, and behaviors of parents and caregivers of children aged 18 and younger regarding nutrition, diet, and exercise; To provide new information regarding dynamics between parents/caregivers and children; To create effective health education programs within a community garden network in Suffolk, Virginia. 3

4. Suffolk by the Map 4

5. Introduction Suffolk, Virginia Population 83,659 Fastest growing city in population in Virginia Population density: 203/mi 2 Range: 48/mi 2 to 740/mi 2 Compared to: Philadelphia: 10,852/mi 2 Denver: 3,642/mi 2 Largest land area in Virginia 429 sq. miles Compared to: Philadelphia: 143. sq. miles Denver: 44.7 sq. miles 5

6. 6 White alone - 43,730 (53.1%) Black alone - 33,405 (40.6%) Hispanic - 2,185 (2.7%) Two or more races - 1,677 (2.0%) Asian alone - 1,228 (1.5%) American alone - 46 (0.06%) Other race alone - 30 (0.04%) http://www.city-data.com/city/Suffolk-Virginia.html Suffolk by the Numbers Median Income: $57,573 http://www.ers.usda.gov/data/unemployment/RDList2.asp?ST=VA Race and Ethnicity:

7. National and Local Challenges Dealing with weight gain of children and adolescents Understanding the dynamics between parents/caregivers and children in relation to nutrition, diet and exercise Creating effective programs to improve child and family health 7

8. Adult Weight Indicators Nationwide *Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of High Body Mass Index in US Children and Adolescents, 2007-2008.JAMA 2010;303:242-249. *Ogden CL, Carroll MD, Curtin LR, Flegal KM. High Body Mass Index in US Children and Adolescents, 2003-2006.JAMA 2008;299:2401-2405. Table 1: Prevalence Rate of Overweight Adults in the US: Age 20 years and older, 2005 – 2006 Overweight32.7% Obese34.3% Morbid obese5.9% 8

9. Child Weight Indicators Nationwide * **Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of High Body Mass Index in US Children and Adolescents, 2007-2008.JAMA 2010;303:242-249. * **Ogden CL, Carroll MD, Curtin LR, Flegal KM. High Body Mass Index in US Children and Adolescents, 2003-2006.JAMA 2008;299:2401-2405. Table 2: Prevalence Rates of Obesity in the U.S. 1976 -1980 and 2007 -2008 Age1976 – 19802007 – 2008 2 -55.0%10.4% 6 – 116.5%19.6% 12 – 195.0%18.1% 9

10. Weight Indicators in Study Population Reflect Nationwide Data 29.7% of adults age 20 and older are obese 15.7% of low-income preschool children are obese * http://www.city-data.com/city/Suffolk-Virginia.html 10

11. Meeting the Challenge To create effective programs to improve child and family health, NEW KNOWLEDGE is needed about the influence of parents and caregivers on children’s health. 11

12. Methods Study sample Parent/caregivers of children age 18 and younger Women, Infant, and Children (WIC) clinic Library branch of Suffolk Public Library System Study design Anonymous questionnaire Descriptive study Cross sectional study 12

13. Methods (Cont’d) Variables 1. Knowledge: 10 questions. Knowledgeable ≥ 70% correct responses Less knowledgeable < 70% correct responses 2. Belief This study examined: “A chubby child is healthier than a thinner child ” 13

14. Methods (Cont’d) 3. Behaviors A. Dietary intake for the DAY PRECEDING: 1) Fruit/vegetables Measure: ≥ 5 servings 2) Home-prepared meal: Measure: ≥ 1 time during the day B. Healthy Exercise (vigorous & moderate) Measure: Any combination that meets 90 minutes weekly C. Additional questions 14

15. Methods (Cont’d) KNOWLEDGE: Examples of Knowledge Questions: True or False Advertisers hope children will influence their parents to buy foods the children see on TV. Children see very few food ads on TV each day. Health risks for children who are over-weight include depression and low self-esteem. A child is still healthy is he or she has trouble breathing because of weight. 15

16. Results Table 1: Distribution of subjects characteristics CharacteristicsN = 211CharacteristicsN = 211 1.Subjects Mother Father Caregiver 196 (93.34) 03 (01.43) 11 (05.24) 5.Education Status Less Than High Graduate( < 12) High school graduate & attended college (12< E <14) Community, Four-Year & Graduate Degree ( E >= 14) 30 (14.35) 103 (49.28) 76 (36.36) 2. Age Group [18 -22] [23-29] [30-35] [36-39] >= 40 32 (15.17) 70 (33.18) 47 (22.23) 33 (15.64) 26 (13.74) 6. Annual Household Income (Approximates U.S. household income quintiles) Up to $ 19,999 $20,000 - $39,999 $40,000 - $61,999 $62,000 - $99,999 Over $99,999 79 (41.80) 29 (15.34) 31 (16.40) 25 (13.23) 3.Marital status Single Married Divorced Widowed 92 (42.81) 103 (49.05) 13 (06.19) 02 (00.95) 7.Child age range [0-1] [2-5] [6-12] [13-18] 46 (23.35) 64 (32.49) 62 (31.47) 25 (12.69) 4.Race Black/AA White/Caucasian Other 100 (47.39) 88 (41.71) 23 (10.90) 8.Number of children age 18 and younger in household 1 2 3 4 5 & 6 72 (34.45) 68 (32.54) 46 (22.01) 15 (07.18) 08 (03.82 16

17. Results (Cont’d) Table 2: Distribution of Subjects Knowledge on Nutrition, Diet, Exercise Questions on Knowledge [n=211 ] Knowledgeable Less Knowledgeable 1.Advertisers hope children will influence their parents to buy foods the children see on TV 196 (92.89) 15 (07.11) 2. Advertising has very little influence on what Americans buy and serve their children to eat. 183 (86.73) 28 (13.27) 3. Most ads during children’s TV shows promote candy, fast foods, sodas and sugary cereals. 161 (76.67) 49 (23.33) 4. Children see very few food ads on television each day 178 (84.36) 33 (15.64) 5. Health risks for children who are overweight would not include diabetes, heart disease or high blood pressure because children are too young to worry 187 (88.63) 24 (11.37) 6. Health risks for children who are overweight include depression, and low self-esteem 195 (92.42) 16 (07.58) 7. Health risks for children who are overweight include some forms of cancer. 102 (48.80) 107 (51.20) 8. A child is still healthy if he or she has trouble breathing because of weight. 201 (95.26) 10 (04.74) 9. A child weighs too much to be healthy if he or she refuses to play because of weight. 54 (25.99) 157 (74.41) 10. A child weighs too much to be healthy if he or she measures above a certain percentile (85%) on the growth chart. 96 (45.93) 113 (54.07) 17

18. Results (Cont’d) Table 3: Knowledge Questions/Responses Knowledge Questions (Number/Percentage) N = 211 Correct Responses Incorrect Responses Advertising: Influence of advertising (4) questions) 127 (60.48%)83 (39.52%) Health risks of overweight/obesity in children (3 questions) 91 (43.54%)118 (56.46%) Health risks and benefits of exercise for children/adults (3 questions) 193 (91.90%)17 (8.10%) 18

19. Results (Cont’d) 19 Histogram A

20. Results (Cont’d) Table 4: Belief Question (Number/Percentage) N = 211 NoYes A chubby child is healthier than a thinner child148 (70.48%)62 (29.52%) 20

21. Results (Cont…) Table 5: Behaviors / Questions/Responses 21 Behaviors Questions (Number/Percentage) N = 211 Healthy BLess Healthy B Reads nutrition labels170 (80.57%)41 (19.43%) Use food as reward184 (87.20%)27 (12.80%) Offer food when crying, to feel better191 (90.95%)19 (9.05%)

22. Results (Cont…) 22 Behaviors Questions (Number/Percentage) N = 211 ≥ 5 fruits and vegetables129 (61.14%) ≤ 4 fruits and vegetables82 (38.86%) Histogram C

23. Results (Cont’d) 23 Behavior Questions (Number/Percentage) N = 211 Exercise for one week (vigorous and moderate) ≥ 90 minutes35 (83.41%) < 90 minutes176 (16.59%) Histogram D

24. Results (Cont’d) Number of home prepared meal ate. N = 211 0 - 19 (9) 1 - 57 (27.01) 2 - 61 (28.91) 3 - 74 (35.07) 24 Histogram E

25. Results (Cont’d) Table 6:Economic Influence on Purchasing fresh fruits & vegetables YesNo Cost of food has an influence on my ability to buy fresh fruits and vegetables. 117 (55.45%)94 (44.55%) 25

26. Discussion The majority of participants were mothers who graduated from high school and attended college. The major age range was between 23-29 years-old (33.18). The racial distribution of participants were Black/African American (47.39), White/Caucasian ( 41.71), and other (10.90). The greater number of participants was from the first income quintile. Results showed the majority of participants was knowledgeable. (75.83 Vs 24.17). However, higher Income levels subjects seemed more knowledgeable about nutrition, diet, and exercise. Higher income levels seem to be a factor in eating at least 1 home prepared meal a day. However, this was not true for eating 5 or more fruits and vegetables a day. 26

27. Discussion (Cont’d) Participants were likely to acknowledge the benefits of physical activity on their health and well being (>94 positive response). Participants reported healthy behaviors on reading nutrition labels on food container (80.57 Vs 19.43). Most participants reported not using food as a reward for children (87.20 Vs 12.80) and not offering food when children cry to make them feel better (90.95 Vs 9.05). Participants reported healthy behaviors on eating at least one home prepared meal a day, respectively 91.00 & 93.75. The cost of fruits and vegetables was reported as a factor in purchasing them for the majority of participants (55.45 Vs 44.55). 27

28. Conclusion Income level emerges as a major influencing factor in the adoption of healthy beliefs, behaviors, and being knowledgeable on nutrition, diet, and exercise. These findings should be regarded as a welcomed development since actions aim at improving parent/caregiver healthy behaviors also focus on affordability of healthy food and mainly on education/information. 28

29. Acknowledgements The Office of the City Manager of the City of Suffolk The Chief of Staff to the City Manager Members of the Suffolk Partnership for a Healthy Community Western Tidewater Department of Public Health Department of Social Services The Suffolk Public Library System 29

30. Questions? 30