1. Examination of Variables from the NHANES Consumer Behavior Follow-Up Module-Child
Erin Green, RD;  Alisha Gaines, PhD; Jamie S Dollahite, PhD
Division Of Nutritional Sciences, Cornell University
RESULTS
Sample Description
The total NHANES sample included observations when all data sets were merged, and 2450 individuals were eligible for the FCBS-Child Module.  Only participants who had completed a dietary interview in the mobile examination center were eligible for this follow up interview, and they had to be aged 1-15 years old at the time of the survey.  Additionally, a set of screening questions was asked to identify the family’s meal planner and/or food shopper and those individuals were the respondents for the FCBS-Child Module phone interview.  Of the 2450 eligible participants, 1803 individuals had complete survey and examination data for the variables on interest in this analysis.  Table 2 provides a description of the sample for all variables, and all information is presented using the appropriate sample weights, stratification, and cluster terms for the FCBS-Child Module.  
The average age of children in the sample was 8.5 years old, the average child weight was kg or approximately 81.9 pounds, and the average child BMI was for the sample.  The sample’s gender was evenly distributed based on the weighted percentages (male= 51.78%, female=48.22%).  For child race/ethnicity all five categories were represented, with the largest weighted percentage for non-Hispanic whites (63.82%), and followed by Mexican Americans (13.25%), Non-Hispanic Black (10.98%), Other Non-Hispanic (6.52%), and Other Hispanic (5.43%).  83.74% of the sample had an income greater than $20,000, and 66.52% of respondents had an education level of more than high school.
Figure 3 represents the proportions for this sample that responded to the four FCBS-Child Module questions of interest in this project (n=1803).  Weighted Samples and Percentages are also presented in Table 2.  While over half the sample has heard of MyPyramid (69%), only 19% of the sample then reports looking MyPyramid up, and only 38% of the sample report trying to use a MyPyramid/Food Pyramid plan.  For the variable of “Importance of Nutrition when Buying Food” 71% of the sample indicates this is very important while 29% do not considered it “very important” when making food purchasing decisions.  
Title: Examination Of Variables From The NHANES Consumer Behavior Phone Follow-Up Module-Child
(FCBS)
Authors: E Green, A Gaines, J Dollahite
Objective: Explore relationships among NHANES FCBS-Child Module variables related to
sociodemographic information and selected child outcomes. Despite the long history of USDA food
guidance programs in the United States, the awareness and use of these programs with parents of
children aged 1-15 years old has received little attention.
Design, Setting, Participants: Statistical analysis of NHANES FCBS-Child Module data.
Variables of interest included: 1.) Importance of Nutrition to the Respondent, 2.) Heard of MyPyramid,
3.) Looked up MyPyramid on the Internet, 4.) Tried MyPyramid, 5.) Child weight 6.) Child BMI 7.) Child
age, 8.) Child gender, 9.) Child ethnicity/race, 10.)Annual Family income, and 11.) Respondent’s
Education Level. Respondents were an adult in the family with a child aged 1-15 years.. Multiple logistic
regression explored potential associations between FCBS variables and relevant NHANES variables, and
multiple linear regressions were performed for the outcome variables of child weight and BMI (α=.05).
Results: Analyses included 1803 individuals (51.78% male, 48.22% female). Mean age was 8.5 years,
and mean BMI was Non-Hispanic white children (63.82%) composed the majority of the sample,
followed by Mexican Americans (13.25%), and non-Hispanic Black children (10.98%) % of the
sample had an income greater than the 2009 poverty level, and 66.52% of respondents had an
education level greater than high school. While 71% of participants reported nutrition was very
important when making food purchasing decisions and 69% was familiar with MyPyramid, only 19%
reported looking up MyPyramid, and only 38% of the sample reported trying to use MyPyramid.
Compared with family incomes >$20,000, respondents from lower income households were significantly
less likely to report having heard of MyPyramid (OR: 0.448; 95%CI 0.310, 0.648) and to have looked up
MyPyramid (OR: 0.332; 95%CI 0.133, 0.828). Similarly, children with parents with <HS education were
less likely to have heard of (CI: 0.475; 95%CI 0.264, 0.853) or looked up MyPyramid (OR: 0.397; 95%CI
0.24, 0.652) compared with >HS educational achievement. Participants that believed nutrition was very
important when making food purchases were more likely to have looked up (OR: 1.819; 95%CI 1.213,
2.729) and used MyPyramid (OR: 3.551; 95% CI 1.624,7.766) compared with children reporting other
levels of nutritional importance. Lastly, no significant relationships were found among awareness of
MyPyramid or having tried MyPyramid. However, having looked up MyPyramid was associated with
slightly decreased child BMI (insert OR, CI)..213, 2.729).
Conclusions and Implications:
Age, gender, race-ethnicity were not significantly associated with MyPyramid use, though
socioeconomic status and educational attainment were… putting more emphasis on parents?
MyPyramid awareness and use were not associated with decreased BMI, and the association between
looking up MyPyramid and BMI may reflect nutrition seeking behaviors that expand beyond MyPyramid
to influence weight. Results may inform future design and marketing of national nutrition guidance
systems to bridge gaps in awareness and use based on sociodemographic differences…thinking
particularly about use of these systems in school curricula and programming that reaches low-income
audiences.
Background
Sample Description
Multivariate Results
HEART Clubs were implemented by Cooperative Extension educators in three rural Northeastern towns. At each site, educators recruited 7-12 community members (n=26)  to collectively address an issue related to their local food or physical activity environment and establish benchmarks for self-monitoring of progress.  This is the number of members recruited across all three sites. Total N (including educators) is 29
Data from 1871 adult respondents were included in analyses
Adult respondents:
Mean age 38.2 years
86.7% female
90.3% the main food shopper, 91.3% main meal planner
66.4% had more than a high school education
15.8% annual family income <$20,000, 42.6% $20,000-$75,000, and 36.2% ≥$75,000
Children in adult respondents’ HH:
1-15 years (Mean age 8.5 years), 51.4% males and 48.6% females
63.2% non-Hispanic White, 13.2 % Mexican American, 11.0% non-Hispanic Black
FCBS-Child variables of interest:
it was eye-opening to- I think had we not done that, we might have gotten together and skipped things.
Research consistently emphasizes the important role of parents as prominent gate-keepers, role models, & sources of nutrition information.
Many parents may lack information to encourage development of a healthy & balanced child diet.
National food guidance resources like MyPyramid provide a range of nutrition information, which can help parents improve household (HH) food environments & children’s diets.
However, awareness and use of MyPyramid among parents of children aged 1-15 & the association of MyPyramid use on child health outcomes has received little attention.
Association of characteristics with MyPyramid awareness & use
Respondents with lower income & less educational attainment were less likely to have heard of or looked up MyPyramid.
Respondents with <HS education were less likely to indicate nutrition was important when buying food.
Hispanic & Mexican Americans were more likely to believe nutrition was important when buying food compared to non- Hispanic Whites.
Respondents who rated nutrition as important when buying food were significantly more likely to have tried MyPyramid.
Association of MyPyramid awareness & use with child outcomes
No FCBS variables in these analyses were significantly associated with child BMI and weight (data not shown)
Association of Participant Characteristics with FCBS Variables
Category
OR (CI)
p value
Heard of MyPyramid
Income- under $20k (vs $20-75k)
0.44 ( )
0.0015
Respondent Education-less than HS (vs >HS)
0.41 ( )
0.0035
Looked Up MyPyramid
0.29 ( )
0.0132
Income-other (vs $20-75k)
0.29 ( )
0.027
0.39 ( )
0.0005
Tried MyPyramid/Food Pyramid Plan
Importance of Nutrition when buying food
3.6 ( )
0.0031
Mexican American (vs Non-Hispanic White)
3.71 ( )
0.0001
Other Hispanic (vs Non-Hispanic White)
2.75 ( )
0.0079
Other Non-Hispanic (vs Non-Hispanic White)
3.095 ( )
0.0037
0.66 ( )
0.0405
Bivariate Results
Objective
Significant differences by FCBS variable
Heard of MyPyramid: Income & respondent education level
Looking up MyPyramid: Ethnicity, income, respondent education level, & child age
Tried MyPyramid: Respondent gender & reported meal responsibilities
Importance of Nutrition: Respondent gender, reported meal responsibilities, & ethnicity
Identify characteristics associated with awareness & use of MyPyramid.
Explore associations among awareness & use of MyPyramid and child weight outcomes.
Selected Cross Tabulation Results for FCBS variables (N=1871)
Characteristic:
Freq
Heard of MyPyramid (%)
Looked up MyPyramid (%)
Tried MyPyramid/
Food Pyramid Plan (%)
Importance of Nutrition
(%)
Yes No
Not Asked
Child Race/Ethnicity * **
Mexican American
508
69.7
30.3
10.5
59.2
37.9
62.1
83.5
16.5
Other Hispanic
191
79.7
20.3
8.5
71.2
40.3
59.7
81.0
19.0
Non-Hispanic White
708
71.3
28.7
15.8
55.4
34.6
65.4
58.2
41.8
Non-Hispanic Black
333
64.0 36
12.5
51.4
36.1
44.5
55.5
72.0
28.0
Other Non-Hispanic
131
65.6
34.4
24.0
41.6
43.4
56.6
Annual Family Income
Under $20k
417
52.3
47.7
5.3
47.0
37.0
63.0
77.0
23.0
$20-75k
890
73.5
26.5
17.5
56.1
34.9
65.1
36.0
$75k and over
450
72.5
27.5
17.1
39.6
60.4
61.1
38.9
Other
114
83.8
16.2
7.3
76.4
37.3
62.7
81.5
18.52
Respondent Education Level
Less than HS
815
59.3
40.7
7.2
52.1
32.7
67.3
65.8
34.2
More than HS
1056
76.0
18.8
57.2
39.3
60.7
66.0
34.0
Respondent Gender
Male
70.4
29.6
11.5
58.9
14.8
85.2
28.4
71.6
Female
1680
15.4
55.0
40.5
59.5
71.7
28.3
Respondent is Main Meal Planner
1689
71.0
29.0
15.1
55.9 29
38.1
61.9
68.3
31.7
182
63.6
36.4
12.6
51.0
25.7
74.3
41.4
58.6
Respondent is Main Food Shopper
1662
71.4
28.6
15.0
56.4
38.6
61.4
68.6
31.4
209
60.8
39.2
13.6
47.2
22.7
77.3
40.9
59.1
Importance of Nutrition when Buying Food
Very Important
1330
69.85
30.2
52.7
46.5
53.5
Somewhat-Not at all Important
541
71.5
28.5
61.0
18.9
81.1
(*) p = / (**) p= <.0001
Methods
Secondary cross-sectional analyses of NHANES Consumer Behavior Follow-Up Module-Child (FCBS-Child)
Telephone interview with a trained NHANES interviewer & review of the data by field staff for accuracy
Eligible respondents
Adult in the HH with a child aged 1-15 years
Respondents answered questions based on their own behaviors, & information linked to sequence # for eligible children in the HH
FCBS-Child variables of interest
Heard of MyPyramid
Looked up MyPyramid on the Internet
Tried MyPyramid Plan/Pyramid Plan
Importance of nutrition when buying food
Analyses performed in SAS, accounted for complex sampling design, & included(α=0.05)  
Descriptive statistics
Bivariate analyses (Student’s t-tests & Rao-Scott Modified Chi-Square Test)
Multiple logistic & linear regressions to examine associations between FCBS variables of interest & relevant respondent and child variables
Conclusions & Implications
These findings suggest that resident-driven initiatives that build upon local resources and establish feasible goals can successfully foster environmental change in rural communities.
SES & educational attainment were frequently associated with MyPyramid awareness & usage variables.
Other variables such as child gender & age were not significantly associated with MyPyramid variables.
Based on these analyses, there is room to improve awareness & use of national food guidance resources such as MyPyramid with parents.
Future research should investigate how to better reach populations with lower awareness & usage of healthy eating guidelines.
Acknowledgements
This material is based upon work supported by U.S. Department of Agriculture. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the view of the USDA