Childhood obesity has increased significantly in the past decade. The same factors putting adults at risk for obesity apply to children as well. For children, the family environment may be one of the largest factors. Obesity affects both adults and children of low socioeconomic status. It also affects families living in the Appalachian region of the United States more frequently than other regions. The purpose of this study was to examine the relationships between obesity related behaviors and nutrition education among Appalachian participants in the Expanded Food and Nutrition Education Program (EFNEP). For this study eleven educators from the Appalachian region who work with the EFNEP/SNAP-Education program were interviewed by telephone. Their responses to questions were coded according to a pre-prepared answer guide. From answers provided by staff there are some areas that the EFNEP program could focus on more. Some of these areas include educating participants on budgeting and family finance, cooking skill, parenting skills and physical activity. Answers provided by participants in this study suggest that educators feel fairly successful with making changes related to healthy eating but less successful with making changes in participant’s physical activity.

Food insecure individuals do not always have access to adequate food for a healthy lifestyle and are at high risk of detrimental health outcomes. Researchers hypothesize that food insecurity leads to changes in dietary practices, including greater overall food purchase in times of adequate resources and purchase of low-cost, unhealthful foods when resources are constrained. Most measures of food insecurity do not measure changes in dietary practices and dietary quality. Research findings suggest education that provides alternative strategies to manage resources and improve dietary practices can improve food insecurity. We assessed the relationship between 1) food security and ability to afford foods and 2) the impact of Expanded Food and Nutrition Education Program (EFNEP) in a low-income, multi-cultural population in Massachusetts. We used a pre/post-education survey design, including the USDA six-item Food Security Module (FSM), food-affordability questions and EFNEP behavior checklist. EFNEP participants experienced high rates of food insecurity with over 40% of participants classified as food insecure (N=80). Pre-EFNEP, individuals in households with low food security were less likely to report being able to afford healthy foods (51.5%) and fruits and vegetables (57.6%) throughout the month compared to those in households with high (80.9%) and marginal (78.7%) food security (P=0.007, P=0.051). Individuals in households with marginal, low and very low food security were less likely to report being able to afford the same kinds of food throughout the month compared to individuals in high food secure households (56.4% vs. 84%) (P=0.022). Individuals in food insecure households reported running out of food before the end of the month more often than their food secure peers (P=0.013). Post-EFNEP, a greater proportion of participants fell into the high and marginal categories of food security (60.0% to 71.7%, P=0.065). Our results indicate that food insecure households have a harder time affording healthy foods throughout the month, leading to poor diet quality that possibly contributes to poor health outcomes. The food affordability questions may capture changes in dietary practices in food insecure populations throughout the month. EFNEP can provide skills and knowledge to at risk populations to improve abilities and combat food insecurity.

Master of Science / School of Family Studies and Human Services / Farrell J. Webb / The Food Sufficiency Status Model is a conceptual model that was devised to help explain why some individuals are at an increased risk of becoming food insufficient. This model proposes that there are four factors that can influence an individual’s food status they are—demographics, family status/household size, food risk factors, and depression. This study uses data from the National Health and Nutrition Examination Survey (NHANES, 2007-2008)—Flexible Consumer Behavior Survey Module (n = 3,413), collected by the Centers for Disease Control and Prevention (CDC). The overall results generally supported the Food Sufficiency model and explained 22% (R[superscript]2adj = 0.215) of the variance in food sufficiency in the study’s population.

Contexte. Les attitudes et comportements alimentaires développés pendant la petite enfance influencent grandement la relation future du mangeur à l’égard des aliments. Le parent s’avère en ce sens des plus déterminants. Objectifs. Cette étude vise à connaître les pratiques et attitudes employées par les parents québécois d’enfants d’âge préscolaire pour favoriser le « bien manger » ainsi que le repas familial agréable. Méthodes. La collecte de données a été effectuée à l’aide de cartes postales qui étaient distribuées dans six cent cinquante Centres de la Petite Enfance parmi les mille retrouvés dans la province de Québec pour ensuite être remises aux parents. L’analyse des réponses aux deux questions ouvertes figurant sur la carte postale a été effectuée en se basant sur le modèle des prises alimentaires de Jean-Pierre Poulain. Résultats. Plus de mille (1257) cartes postales ont été retenues aux fins d’analyses. Les données recueillies permettent dans un premier temps de connaître la perception des parents quant à la notion de manger bien. Les notions de qualité et de quantité, diamétralement opposées se démarquent. Dans le cas du repas familial, la discussion, la présence de tous les membres à table ainsi que l’absence de télévision sont abondamment mentionnées. Conclusion. Cette étude permet de constater la variété des stratégies employées par les parents québécois au moment du repas. Ces données d’une grande pertinence pour la santé publique permettront de cibler les messages clés à promouvoir auprès de ces acteurs d’influence dans le développement des habitudes alimentaires des tout petits. / Context. Food attitudes and behaviors developed during early childhood greatly influence the future relationships that children will have with food. Parents play a major role in this part of their preschool child’s life. Objective The main goal of this study is to explore attitudes and behaviors that Quebec parents adopt at meal time with their preschooler in order to encourage healthy eating practices as well as enjoyable family meals. Methodology. To collect data, postcards, an innovative tool, were sent to six hundred fifty day-care centres, also known as Centres de la petite enfance (CPE), of which there are more than a thousand in Quebec. The postcards were then distributed to parents, who were asked to respond to two open-ended questions. Analysis of the qualitative data was based on Jean-Pierre Poulain’s food intake model. Results. More than a thousand (1,257) postcards were used in the analysis. Data collected illustrate first and foremost the vision that parents have of healthy eating and reveal two diametrically opposed perspectives: quality and quantity. With regard to family meals, respondents frequently mentioned conversation at the table, the presence of all family members and the absence of television while eating. Conclusion. Findings from this study show the diverse strategies used by Quebecers during mealtimes. The data are essential to defining key public health messages about eating habits for children that should be promoted among these influential actors.

Contexte. Les attitudes et comportements alimentaires développés pendant la petite enfance influencent grandement la relation future du mangeur à l’égard des aliments. Le parent s’avère en ce sens des plus déterminants. Objectifs. Cette étude vise à connaître les pratiques et attitudes employées par les parents québécois d’enfants d’âge préscolaire pour favoriser le « bien manger » ainsi que le repas familial agréable. Méthodes. La collecte de données a été effectuée à l’aide de cartes postales qui étaient distribuées dans six cent cinquante Centres de la Petite Enfance parmi les mille retrouvés dans la province de Québec pour ensuite être remises aux parents. L’analyse des réponses aux deux questions ouvertes figurant sur la carte postale a été effectuée en se basant sur le modèle des prises alimentaires de Jean-Pierre Poulain. Résultats. Plus de mille (1257) cartes postales ont été retenues aux fins d’analyses. Les données recueillies permettent dans un premier temps de connaître la perception des parents quant à la notion de manger bien. Les notions de qualité et de quantité, diamétralement opposées se démarquent. Dans le cas du repas familial, la discussion, la présence de tous les membres à table ainsi que l’absence de télévision sont abondamment mentionnées. Conclusion. Cette étude permet de constater la variété des stratégies employées par les parents québécois au moment du repas. Ces données d’une grande pertinence pour la santé publique permettront de cibler les messages clés à promouvoir auprès de ces acteurs d’influence dans le développement des habitudes alimentaires des tout petits. / Context. Food attitudes and behaviors developed during early childhood greatly influence the future relationships that children will have with food. Parents play a major role in this part of their preschool child’s life. Objective The main goal of this study is to explore attitudes and behaviors that Quebec parents adopt at meal time with their preschooler in order to encourage healthy eating practices as well as enjoyable family meals. Methodology. To collect data, postcards, an innovative tool, were sent to six hundred fifty day-care centres, also known as Centres de la petite enfance (CPE), of which there are more than a thousand in Quebec. The postcards were then distributed to parents, who were asked to respond to two open-ended questions. Analysis of the qualitative data was based on Jean-Pierre Poulain’s food intake model. Results. More than a thousand (1,257) postcards were used in the analysis. Data collected illustrate first and foremost the vision that parents have of healthy eating and reveal two diametrically opposed perspectives: quality and quantity. With regard to family meals, respondents frequently mentioned conversation at the table, the presence of all family members and the absence of television while eating. Conclusion. Findings from this study show the diverse strategies used by Quebecers during mealtimes. The data are essential to defining key public health messages about eating habits for children that should be promoted among these influential actors.

Problématique et objectifs : Quels sont les comportements et les choix alimentaires d’un travailleur du secteur de la restauration rapide, continuellement exposé à des aliments majoritairement frits ou ultra-transformés? Peu de données sont disponibles pour répondre à cette question. L’étude de cas de la rôtisserie participante permettra de générer des données exploratoires afin de décrire les comportements alimentaires des employés et d’identifier les déterminants individuels, sociaux et contextuels susceptibles de les influencer. Méthodologie : Des entrevues individuelles intégrant des photographies d’aliments consommés au travail, prises par les participants, ont été menées dans une rôtisserie de type restaurant-minute. La grille d’entretien est inspirée du modèle socio-écologique de Zorbas et al. (2018). L’analyse des verbatims faite avec le logiciel NVivo combine une approche inductive et déductive. Des histoires de cas ont été produites pour chacun des participants afin de synthétiser les données. Une approbation éthique fut obtenue. Résultats : Un total de 17 participants, répartis en termes de genre, âgés de 18 à 53 ans, ayant de 6 mois à plus de 20 ans d’expérience à différents postes ont participé à l’étude. Tous les participants consomment de façon épisodique ou régulière des aliments ou des boissons en provenance des lieux du travail. La solution pour pallier leurs ressources limitées en temps, argent, compétences culinaires et au peu de motivation reliée à l’acte culinaire est de s’alimenter à partir de l’offre alimentaire en milieu de travail. Celle-ci s’avère être très accessible et peu coûteuse. La praticité, le goût, l’accessibilité et le prix des aliments sont prioritaires à la santé dans le processus de choix alimentaires de ces travailleurs. Les conditions de travail et les normes sociales contextuelles à l’emploi imposent aux travailleurs une pression supplémentaire à la consommation d’aliments au travail. Des attitudes ambivalentes y sont reliées. Conclusion : Un emploi en restauration rapide est susceptible d’exercer une influence défavorable sur l’alimentation des travailleurs. Ces derniers ne sont pas supportés dans l’adoption d’habitudes plus saines. Au fil du temps, le tout peut mener à des patrons alimentaires délétères pour la santé. Ces connaissances mettent en évidence le défi de développer des interventions pour les protéger d’un environnement alimentaire difficilement modifiable. Ces actions devraient agir sur l’ensemble des déterminants tant individuels que contextuels. / Context and objectives : What are the behaviors and choices of fast-food workers, those who are continuously exposed to fried and ultra-processed food? Few data are currently available. This case study of a chicken fast food restaurant aimed to describe workers’ food behaviors at work and to identity individual, social, and contextual determinants of influence. Method : Individual interviews using pictures of food and beverages eaten at work and taken by fast food workers of a chicken fast food restaurant was used. The interview guide was based on a socio-ecological model adapted by Zorbas et al. (2018). Analysis of verbatims was made with NVivo with an inductive and deductive approach. Case stories were written for data synthesis purpose. Ethics approvals were obtained. Results : Seventeen male and female fast-food workers from 18 to 53 years and working from 6 months to over 20 years at different positions participated in this study. All participants ate food or drank beverages from work on an occasional or regular basis. They generally are time and money constrained with few culinary skills and motivations. This leads them to eat food that is of easy access and cheap at work. Commodity, taste, accessibility, and price are more important than health in the decision-making process. Labor conditions and contextual social norms at work impose additional pressure on workers to consume food at work, despite ambivalent attitudes. Conclusion : Working in a fast-food restaurant is likely to exert an unfavorable influence on the diet of workers. They are not supported in adopting healthier habits. This can lead to unhealthy eating patterns over time. Those evidence highlight the challenges of developing interventions to protect people working in a food environment that is difficult to modify. These actions should act on all determinants, both individual and contextual.

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