1. Intake of Calcium Rich Foods Among Early Adolescents Scottie Misner, PhD, RD April 2010 Scottie Misner, PhD, RD April 2010

2. Introduction Calcium and vitamin D intake in adolescents is important for bone health. important for bone health. Calcium intake in 9-13 yr olds is 67-88% of Ca req. Calcium and vitamin D intake in adolescents is important for bone health. important for bone health. Calcium intake in 9-13 yr olds is 67-88% of Ca req.

3. Skeletal Problems In 2005, and estimated $19 billion in medical costs resulted from osteoporosis and fractures. Fracture risk is greater in children with low bone mass. In 2005, and estimated $19 billion in medical costs resulted from osteoporosis and fractures. Fracture risk is greater in children with low bone mass. National Osteoporosis Foundation, (2008)

4. Adequate Nutrition for Prevention  The Adequate Intake for Calcium is 1300mg for adolescent boys and girls.  Sufficient consumption often is not met; interventions may be necessary.  http://www.health.gov/dietary guidelines/dga2005/report/HTML_Tables.htm http://www.health.gov/dietary  The Adequate Intake for Calcium is 1300mg for adolescent boys and girls.  Sufficient consumption often is not met; interventions may be necessary.  http://www.health.gov/dietary guidelines/dga2005/report/HTML_Tables.htm http://www.health.gov/dietary

5. Family Influence  Research suggests, “Multicomponent interventions with a focus on the family environment are likely to be most effective in increasing calcium intakes among adolescents.” Larson, et al, J Am Diet Assoc. (2006)

6. Family Influence of Calcium Intake  Studies have already found evidence suggesting parents influence children’s calcium intake beyond purchasing food.  Fi Fischer J, et al, Am J Clin Nutr. (2004)  Lee S. Reicks M. J Am Diet Assoc. (2003)  Studies have already found evidence suggesting parents influence children’s calcium intake beyond purchasing food.  Fi Fischer J, et al, Am J Clin Nutr. (2004)  Lee S. Reicks M. J Am Diet Assoc. (2003)

7. Parental Influence More on Parental Influence Parents and caregivers have dominant influence on eating and activity behaviors of early adolescents. Parents’ role is essential in osteoporosis prevention by promoting Calcium Rich Foods (CRF). Baranowski T, et al, Health Behavior and Health Education, 3 rd Ed. (2002). Parents and caregivers have dominant influence on eating and activity behaviors of early adolescents. Parents’ role is essential in osteoporosis prevention by promoting Calcium Rich Foods (CRF). Baranowski T, et al, Health Behavior and Health Education, 3 rd Ed. (2002).

8. Family Structure and Nutrient Intake  Studies have examined the effect of family composition on child behavioral and cognitive outcomes. Ex: Children coming from single-parent households exhibited lower cognitive test scores and more behavioral problems than two-parent households.  Could family structure affect nutrient intake? Carlson M. Corcoran M. J Mar & Family (2001)  Studies have examined the effect of family composition on child behavioral and cognitive outcomes. Ex: Children coming from single-parent households exhibited lower cognitive test scores and more behavioral problems than two-parent households.  Could family structure affect nutrient intake? Carlson M. Corcoran M. J Mar & Family (2001)

9. Family Structure and Nutrient Intake Family structure has been found to affect or relate to many aspects of nutritional intake from overall energy intake to mineral intake. Family structure has been found to affect or relate to many aspects of nutritional intake from overall energy intake to mineral intake.

10. Supported by research National statistics  found that children (ages 0- 17 years) with two-parents household show sig- nificantly lower rates of food insecurity when compared to children from single-parent households.  US Census Bureau (2002)  Hertzler A. Fam & Consumer Sci Rsch J (1976) Negative Correlation  Between hematocrit and dietary measures with girls receiving low family structure scores.

11. Multigenerational research  Both parent and grandparents would like to have a role in child nutrition.  “Healthy” and “unhealthy” eating could be a very emotional subject between family generations, especially if there were weight issues among the family. Kaplan, et al, J Nutr Educ Behav. (2006)  Both parent and grandparents would like to have a role in child nutrition.  “Healthy” and “unhealthy” eating could be a very emotional subject between family generations, especially if there were weight issues among the family. Kaplan, et al, J Nutr Educ Behav. (2006)

12. Study Populations  AZ,CA,CO,HI, KY, IN,MI,MN,OR,UT, WA  AZ,CA,CO,HI, KY, IN,MI,MN,OR,UT, WA  For this project data from the “You & Your Food” survey were used.  Parent/child dyads: combined FFQ and MBQ to measure calcium intake, behaviors and beliefs.  Data were collected by W-1003 researchers.

13. Research Proposals W-1003  Data were collected by the various states  FFQ and MBQ  Completed by parents and adolescents age 10-13 years W-1003  Data were collected by the various states  FFQ and MBQ  Completed by parents and adolescents age 10-13 years W-2003  How to motivate parent(s) to promote intake of calcium rich foods among early adolescents.

14. W-1003 W-1003 Research Objectives Identify factors (knowledge, attitudes, behavior and environment) associated with total calcium intake among the parents of early adolescent children using qualitative methods. Identify parental factors (knowledge, attitudes, behavior and environment) related to total calcium intake of their early adolescent children using qualitative methods. Quantify the salient parental and early adolescent factors (attitudes, knowledge, behaviors, and environment) that predict total calcium intake of the early adolescent using quantitative methods. Develop and test potential messages and dietary strategies among parents and preadolescents based on the salient factors related to early adolescent calcium intake.

15. Family Environment Physical Environment availability & accessibility dependent upon parental preferences, beliefs and attitudes & income, education & time Social Environment socioeconomic and socio-cultural factors, mealtime structure and parental modeling Physical Environment availability & accessibility dependent upon parental preferences, beliefs and attitudes & income, education & time Social Environment socioeconomic and socio-cultural factors, mealtime structure and parental modeling

16. Methods: The primary exposure (parent(s) in the household) can be separately related to  Attitudes and preferences,  the influence family environment has on early adolescent calcium consumption. These factors can then be separately related to total calcium intake. The primary exposure (parent(s) in the household) can be separately related to  Attitudes and preferences,  the influence family environment has on early adolescent calcium consumption. These factors can then be separately related to total calcium intake. Using data collected from the questionnaires of White, Hispanic & Asian households:

17. Psychosocial constructs and Scales Social and Environmental Factors  Availability of calcium foods  Eating location  School  Restaurant  Availability of calcium foods  Eating location  School  Restaurant  Meal eating occasion  Family environment  Family drinks milk  Family expectations  Family influence

18. Encouragement and Expectations  Parents shape food-beliefs, attitudes, knowledge and preferences through food and socialization practices  Messages can be verbal and non-verbal  Parents establish rules and frequency of when foods should be offered and consumed  41% of 10 year olds said they were expected to drink milk-when they were older, their milk intake decreased  Parents shape food-beliefs, attitudes, knowledge and preferences through food and socialization practices  Messages can be verbal and non-verbal  Parents establish rules and frequency of when foods should be offered and consumed  41% of 10 year olds said they were expected to drink milk-when they were older, their milk intake decreased

19. W-1003 found:  More CRF foods are consumed when breakfast is eaten and when meals are eaten with family  Parents serve as gate keeper for CRF  Parents serve as role models-mothers who drank more milk influence daughter’s intake of milk  More CRF foods are consumed when breakfast is eaten and when meals are eaten with family  Parents serve as gate keeper for CRF  Parents serve as role models-mothers who drank more milk influence daughter’s intake of milk

20. Nutrition Education Messages  3-A-Day Campaign  Dietary Guidelines  MyPyramid  Parents and caregivers have dominant influence on eating and activity behaviors of early adolescents.  Parents’ role is essential in osteoporosis prevention by promoting CRF.  3-A-Day Campaign  Dietary Guidelines  MyPyramid  Parents and caregivers have dominant influence on eating and activity behaviors of early adolescents.  Parents’ role is essential in osteoporosis prevention by promoting CRF.

21. Food Related Factors  Taste Preferences  Familiarity  Positive social context  Models and rewards  Taste Preferences  Familiarity  Positive social context  Models and rewards

22. Environmental Factors  Availability  Social structure  Cultural practices  Price  Time  Availability  Social structure  Cultural practices  Price  Time

23. Availability and Modeling  Family structure has been found to affect or relate to many aspects of nutritional intake from overall energy intake to mineral intake.  Meal patterns and where foods are consumed are important in parental modeling.  Family structure has been found to affect or relate to many aspects of nutritional intake from overall energy intake to mineral intake.  Meal patterns and where foods are consumed are important in parental modeling.

24. Prevalent Parental Factors  Positive Parental Influences  Availability  Child Preference (Like)  Health Benefit Beliefs  Convenience  Positive Parental Influences  Availability  Child Preference (Like)  Health Benefit Beliefs  Convenience  Negative Parental Influences  Lack of Parents  Modeling  Lack of Parental Expectation  Child Preference  (Dislike)

25. W-1003 Researchers  Garry Auld-Colorado State University  Christine Bruhn-UC-Davis  Beth Olson-Michigan State University  Marla Reicks-University of Minnesota  Mary Cluskey-Oregon State University  Carol Boushey-Purdue  Siew Sun Wong-Utah State University  Mariam Ballejos-WSU  April Mason-advisor-KSU  Susan Welsh-Advisor-USDA  Garry Auld-Colorado State University  Christine Bruhn-UC-Davis  Beth Olson-Michigan State University  Marla Reicks-University of Minnesota  Mary Cluskey-Oregon State University  Carol Boushey-Purdue  Siew Sun Wong-Utah State University  Mariam Ballejos-WSU  April Mason-advisor-KSU  Susan Welsh-Advisor-USDA

26. Sources Carlson, M. Corcoran, M. (2001) “Family Structure and Children's Behavioral and Cognitive Outcomes.” Journal of Marriage and Family 63 (3), 779–792 doi:10.1111/j.1741- 3737.2001.00779.x Fisher, J. Mitchell, D. Smiciklas-Wrick, H. Mannino, M. Birch, L. “Meeting calcium recommendations during middle childhood reflects mother-daughter beverage choices and predicts bone mineral status.” American Journal of Clinical Nutrition, Vol. 79, No. 4, 698-706, April 2004 Hertzler, A. Iron Status and Family Structure of Teenage Girls in a Low-Income Area. Family and Consumer Sciences Research Journal, Vol. 5, No. 2, 92-99 (1976) Kaplan M, et Al. “Intergenerational family conversations and decision making about eating healthfully.” J Nutr Educ Behav. 2006: 38 (5): 298-306 Larsen, et al. “Calcium and dairy intakes of adolescents are associated with their home environment, taste preferences, personal health beliefs, and meal patterns.” J Am Diet Assoc. 2006 Nov;106(11):1816-24. Carlson, M. Corcoran, M. (2001) “Family Structure and Children's Behavioral and Cognitive Outcomes.” Journal of Marriage and Family 63 (3), 779–792 doi:10.1111/j.1741- 3737.2001.00779.x Fisher, J. Mitchell, D. Smiciklas-Wrick, H. Mannino, M. Birch, L. “Meeting calcium recommendations during middle childhood reflects mother-daughter beverage choices and predicts bone mineral status.” American Journal of Clinical Nutrition, Vol. 79, No. 4, 698-706, April 2004 Hertzler, A. Iron Status and Family Structure of Teenage Girls in a Low-Income Area. Family and Consumer Sciences Research Journal, Vol. 5, No. 2, 92-99 (1976) Kaplan M, et Al. “Intergenerational family conversations and decision making about eating healthfully.” J Nutr Educ Behav. 2006: 38 (5): 298-306 Larsen, et al. “Calcium and dairy intakes of adolescents are associated with their home environment, taste preferences, personal health beliefs, and meal patterns.” J Am Diet Assoc. 2006 Nov;106(11):1816-24.

27. Cont. Baranowski, T, et al, Health Behavior and Health Education, 3 rd ED. (2002). Lee, S. Reicks, M. Environmental and behavioral factors are associated with the calcium intake of low-income adolescent girls, JADA 103(11): pp 1526-1529 (November 2003) Mayo Clin Proc. 1997;72:943-949 © 1997 Mayo Foundation for Medical Education and Research U.S. Census Bureau, Current Population Survey Food Security Supplement; tabulated by U.S. Department of Agriculture, Economic Research Service and Food and Nutrition Service. Baranowski, T, et al, Health Behavior and Health Education, 3 rd ED. (2002). Lee, S. Reicks, M. Environmental and behavioral factors are associated with the calcium intake of low-income adolescent girls, JADA 103(11): pp 1526-1529 (November 2003) Mayo Clin Proc. 1997;72:943-949 © 1997 Mayo Foundation for Medical Education and Research U.S. Census Bureau, Current Population Survey Food Security Supplement; tabulated by U.S. Department of Agriculture, Economic Research Service and Food and Nutrition Service.

28. Thanks! Comments, questions, other?

29. Scottie Misner, PhD, RD University of Arizona Cooperative Extension 1177 E 4 th, NSC, 309 Shantz Tucson, AZ 85721-0038  520-621-7123  misner@ag.arizona.edu  Cals.arizona.edu/extension/ /  520-621-7123  misner@ag.arizona.edu  Cals.arizona.edu/extension/ /