Divisions of General Pediatrics and
Developmental and Behavioral Pediatrics, Department of Pediatrics, School of Medicine, New York University, New York, New York.
Pediatrics. 2019 Jun;143(6). doi: 10.1542/peds.2018-4113. Epub 2019 May 14.
Pregnancy, infancy, and toddlerhood are sensitive times in which families are particularly vulnerable to household food insecurity and when disparities in child obesity emerge. Understanding obesity-promoting infant-feeding beliefs, styles, and practices in the context of food insecurity could better inform both food insecurity and child obesity prevention interventions and policy guidelines.
We performed purposive sampling of low-income Hispanic mothers ( = 100) with infants in the first 2 years of life, all of whom were participants in a randomized controlled trial of an early child obesity prevention intervention called the Starting Early Program. Bilingual English-Spanish interviewers conducted semistructured qualitative interviews, which were audio recorded, transcribed, and translated. By using the constant comparative method, transcripts were coded through an iterative process of textual analysis until thematic saturation was reached.
Three key themes emerged: (1) contributors to financial strain included difficulty meeting basic needs, job instability, and high vulnerability specific to pregnancy, infancy, and immigration status; (2) effects on infant feeding included decreased breastfeeding due to perceived poor maternal diet, high stress, and limiting of healthy foods; and (3) coping strategies included both home- and community-level strategies.
Stakeholders in programs and policies to prevent poverty-related disparities in child obesity should consider and address the broader context by which food insecurity is associated with contributing beliefs, styles, and practices. Potential strategies include addressing misconceptions about maternal diet and breast milk adequacy, stress management, building social support networks, and connecting to supplemental nutrition assistance programs.
妊娠、婴儿期和幼儿期是家庭特别容易受到家庭食物不安全影响的敏感时期，也是儿童肥胖出现差异的时期。了解在食物不安全的情况下促进肥胖的婴儿喂养信念、风格和实践，可以更好地为食物不安全和儿童肥胖预防干预措施和政策指南提供信息。
我们对生活在婴儿期的低收入西班牙裔母亲（n=100）进行了有目的的抽样，所有这些母亲都是早期儿童肥胖预防干预措施“开始早期计划”的随机对照试验的参与者。双语英语-西班牙语访谈员进行了半结构化的定性访谈，这些访谈进行了录音、转录和翻译。通过使用恒定性比较方法，通过文本分析的迭代过程对抄本进行编码，直到达到主题饱和。
出现了三个关键主题：（1）经济压力的促成因素包括难以满足基本需求、工作不稳定以及与怀孕、婴儿期和移民身份相关的高度脆弱性；（2）对婴儿喂养的影响包括由于认为母亲饮食不良、压力大以及限制健康食品而减少母乳喂养；（3）应对策略包括家庭和社区层面的策略。
预防与贫困相关的儿童肥胖差异的计划和政策的利益相关者应该考虑并解决与食物不安全相关的促成信念、风格和实践的更广泛背景。潜在的策略包括解决关于母亲饮食和母乳充足性的误解、管理压力、建立社会支持网络以及与补充营养援助计划联系。
