Celiac disease is an autoimmune disorder triggered by the ingestion of gluten, which is found in wheat, barley, and rye. The only treatment for celiac disease is a strict gluten-free diet (GFD), which eliminates common gluten-containing foods found in many cultures and cuisines. This research examined how families experienced celiac disease and the GFD in their households, focusing on the ripple effect of celiac disease for all members of the family and how families promoted adherence and quality of life (QOL). A mixed-methods approach used questionnaires, photographs, and semi-structured interviews with families recruited from the Celiac Disease Center at Columbia University Medical Center. Participants were 16 families with children ages 8-18 living at home who had physician-confirmed diagnoses of celiac disease. A total of 71 in-depth semi-structured interviews were conducted (n =16 reference children with celiac disease, 16 mothers, 15 fathers, 24 siblings). Results showed that the reference children with celiac disease had high GFD adherence (mean CDAT = 9) and QOL (mean CDPQOL 81 of 100). Mothers’ and fathers’ ratings of how their child’s celiac disease diagnosis affected their lifestyle, social life, and level of burden in caring for child’s dietary needs differed significantly (all p-values < 0.05), with mothers reporting more change and burden. Emerging themes related to a negative ripple effect included the burden of assuming the majority of food tasks related to GFD (mothers), the limited restaurant choices for the family (fathers), and feeling annoyed by having to limit certain foods at home (siblings). Emerging themes related to a positive ripple effect, included becoming more creative cooks (mothers), incorporating new family traditions (fathers), and developing empathy for others (siblings). Overall, there was substantial evidence of a ripple-effect of a child’s celiac disease diagnosis on other family members, including how mothers and fathers may experience the change in lifestyle and added responsibilities of maintaining the GFD differently. Including parents and siblings in research provides insight into the entire family experience and can help inform family-centered interventions on how to maximize QOL for everyone impacted by a child’s celiac disease diagnosis.

Thesis (M.Sc.Agric.) - University of KwaZulu-Natal, Pietermaritzburg, 2008. / Full text also available online. Scroll down for electronic link.

published_or_final_version / Sociology / Master / Master of Philosophy

Acculturation, defined as the process of adopting the behaviors and beliefs of the dominant host culture, is often associated with dietary change and negative health outcomes, such as increased risk for obesity and diet-related diseases. The large and rising immigrant population in the U.S. necessitates a better understanding of the acculturation process in order to design appropriate health and nutrition interventions. It is well established that parents play a key role in child and preadolescent nutrition through parenting style and control of the home food environment. However, little is known about the potential influence of parental acculturation on preadolescent children's dietary patterns and habits, frequency and characteristics of family meals, and parent child-feeding behaviors, particularly among families who have lived in the U.S. for a considerable time and whose children have grown up in the U.S. The objective of this study was to quantitatively examine the association between parental acculturation and parent child-feeding behaviors, family meals, and child dietary patterns and habits in families where the primary food-providing parent self-identified as Asian/Asian American ("Asian") or Hispanic/Latino ("Hispanic"). Nativity was used as a proxy measure of acculturation, with foreign-born (FB) parents assumed to be less acculturated than native-born (NB). Sampled participants from nine states consisted of 74 Asian and 134 Hispanic parents or caretakers and their preadolescent children. Survey questions addressed children's intake of foods considered typical of the American diet to determine associations between frequency of consumption and parental nativity. Parent child-feeding behaviors examined were parental encouragement of milk-drinking and breakfast consumption, and discouragement of soda-drinking. Lastly, associations between frequent family meals and meals away from home and parental nativity were examined. Among Asian participants, no statistically significant associations were found between child intakes, family meals, or parenting behaviors among NB versus FB parents. However, among the Hispanic group, parental nativity was significantly associated with several variables. Children of NB parents were more likely to frequently consume hamburgers or hot dogs with cheese, chocolate bars, cupcakes or cake, and soda. By contrast, children of FB parents were more likely to consume raw broccoli and pancakes, waffles, or French toast frequently. NB parents had greater odds of encouraging children’s milk intake at lunch. Families with NB parents also had significantly greater odds of consuming dinner together five or more days per week. The findings of this study suggest that parental nativity may have some influence on children's dietary patterns and habits, parent child-feeding behaviors, and family meals among Hispanics. More research is needed in larger, more representative, and culturally specific samples. The results of this study suggest that nutrition interventions targeting Asian and Hispanic families with preadolescent children may benefit families with a wide range of parental acculturation, although some interventions may be slightly more applicable to the more or less acculturated. Potential areas for intervention include coaching parents on effective child-feeding behaviors and strategies for fostering healthy eating practices, promoting quality family meals, and educating parents on the health risks and sources of excess sugar. / Graduation date: 2012

The purposes of this study were: (1) to present a picture of the home-management aspect of a selected group of Farm Security families, {2) to picture in more detail the clothing and dietary problems of these families, (3) to determine whether family life is satisfying to this selected group of Farm Security women, (4) to ascertain the stability of the family members, and (5) on the basis of these findings, to make suggestions for helping Farm Security families to more satisfactory living. / Master of Science