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The purpose of the study was to determine what nutritional, demographic, and behavioral differences existed between children one year of age from two similar WIC clinics with different prevalences of anemia. Children from the higher-prevalence site were found to consume significantly (p < .05) more B12, C, copper, fiber, folate, total kilocalories, and riboflavin than did children from the lower-prevalence site. Family income and maternal weight gain were significantly (p < .05) higher in the lower-prevalence group as compared to the higher-prevalence group. In addition, children from the higher-prevalence site were enrolled in the WIC program at a significantly (p < .05) younger age than were children from the lower-prevalence site.

<p>Inadequate nutrition in childhood can inhibit optimal growth and development, and is also associated with increased risk of chronic diseases later in life. Children living in households with limited financial resources may face a number of challenges to meet nutrient needs through unhealthy eating patterns, which may lead to health inequalities throughout the life-course. Therefore, improving low-income children’s diet would be an effective strategy for their health promotion and disease prevention, and potentially for narrowing health inequalities. The essential step for an efficient intervention would be to identify the unique nutrition risk that low-income children have. Therefore, the overarching aim of research in this dissertation was to identify nutrition risk of U.S. infants and children with low income or food insecurity, or participating in federal nutrition assistance programs using data from nationally representative surveys. An additional aim was to assess whether the inclusion of micronutrient intake from dietary supplements impacts micronutrient inadequacy in children. </p><p>For low-income infants and young children up to the age of 5 years, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides tailored food packages to improve dietary intake that may be inadequate due to economic constraints. Therefore, it is expected that nutrient intake of WIC participants would be more like those of higher-income nonparticipants and higher than those of lower-income nonparticipants who are likely to be eligible for WIC. The results from the Feeding Infants and Toddlers Study 2016 data analysis supported the hypothesis for several nutrients of concern, although WIC participants were more likely to exceed the recommended limits for sodium and added sugars compared to higher-income nonparticipants. However, higher-income nonparticipants were more likely to use dietary supplements than both WIC participants and lower-income nonparticipants, which can impact total nutrient intake (i.e., nutrient intake from all sources). </p><p>Systematic differences in dietary supplement use by income and WIC participation were also observed in a nationally representative sample of children aged 18 years and younger from the 2011-2014 National Health and Nutrition Examination Survey (NHANES). Dietary supplement use was lower among children in low-income families compared to those in higher-income families. Among children in low-income families, those participating in WIC were less likely to use dietary supplements compared to nonparticipants. In addition, food insecurity and the Supplemental Nutrition Assistance Program (SNAP) participation were associated with lower use of dietary supplements. Overall, one-third of children used any dietary supplements, mostly multivitamin-minerals, with primary motivations for use as “improve” or “maintain” health. </p><p>The following analysis of the 2011-2014 NHANES data showed that the inclusion of dietary supplements in nutrient intake assessments may lead to wider disparities in dietary intake by food security. This study also demonstrated the dose-response relationship between food security status and mean adequacy ratio, a summary measure of micronutrient adequacy. The mean adequacy ratio, inclusive of dietary supplements, was the highest in high food-security group (mean of 0.77), lower in marginal and low food security group (mean of 0.74), and the lowest in very low food security group (mean of 0.66), based on classification by food security among household children. However, the mean adequacy ratio does not reflect the usual intake (i.e., a long-term, habitual intake). </p><p>Therefore, another analysis of the 2011-2016 NHANES data estimated total usual nutrient intake of U.S. children 18 years and younger by food security status, using the National Cancer Institute method that adjusts for random error by statistical modeling. The results suggested that food insecurity was associated with higher risks of inadequate intakes for some nutrients, such as vitamins D and E and magnesium among boys and girls and vitamin A and calcium among girls only. Poor overall dietary quality and excessive sodium intake were of concern, regardless of food security status. </p><p>Collectively, the results from the studies in this dissertation add value to the evidence base about the adverse association of low income level and food insecurity status with dietary intake and extend the finding to include nutrient intakes from dietary supplements, which widens the disparity in nutrition risk. These findings highlight a need for interventions to reduce nutrient inadequacies and improve dietary quality among children across all socioeconomic levels, but especially among those with low income or food insecurity.</p><div><br></div>

Diet quality during early childhood is a strong predictor of mental and physical outcomes, as well as future diet quality. Although many factors determine diet quality during childhood, food insecurity is a significant predictor of lower diet quality. On the other hand, participation in nutrition assistant programs, such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a significant predictor of higher diet quality. In addition, specific feeding practices, including timing of complementary food and beverage (CFB) introduction, types of CFB introduced early, and diversity of dietary exposures (DD), in the first year may predict future diet quality, and all of these feeding practices may be affected by both food insecurity and WIC participation. A limited number of studies have explored associations between food insecurity, WIC participation, and early-life feeding practices with a focus on initiation of the complementary feeding and diversity of dietary exposures in the first year of life. The present study is a secondary analysis of the WIC Infant and Toddler Feeding Practices Study 2 (WIC ITFPS 2) aimed at exploring associations between food insecurity, WIC participation, timing of CFB introduction, types of CFB introduced early, DD by 13 months, and diet quality at 2 years. The WIC ITFPS is a longitudinal, nationally representative study of mothers and children under 6 years old which examined feeding practices, associations between WIC services and feeding practices, and the health status of children participating in WIC. Data was collected via phone interviews and questionnaires. Logistic regression analysis was used to assess whether the presence of food insecurity predicted timing of CFB introduction and types of CFB introduced early. Multivariate linear regression analysis was used to assess whether the diversity of dietary exposures (DD) score at age 13 months and diet quality at 2 years was predicted by the combination of food insecurity, timing of CFB introduction, and WIC participation. The results showed that food insecurity was not significantly associated with timing of CFB introduction or types of CFB introduced before 4 months of age. Food insecurity was not a significant predictor of DD score at 13 months, but significant interactions between food insecurity and WIC participation were noted. Among families participating in WIC, infants in families with low or very low food security had significantly higher DD scores compared to families with high or marginal food security. Food insecurity was not associated with diet quality at 24 months, but higher diet quality scores were predicted by the combination of later introduction of CFB (after 4 months), higher DD scores at 13 months, and WIC participation at 24 months. The findings of this study point to the benefits of supporting parents in participating in WIC, introducing CFB on-time, and maximizing diversity of dietary exposures during infancy. Future research should aim to verify causality, include longitudinal studies, focus on exploring WIC recruitment and retention, and continue to add the limited research on the preceding relationships between the above mentioned factors, specifically during the first two years of life.

Oral caries is the most prevalent chronic disease among US children, and disproportionately impacts those of low socioeconomic status. Studies have shown that the Special Supplemental Nutrition Program for Women Infants and Children (WIC) improves access to dental care among Medicaid children. This study investigated the impact of WIC, Medicaid, and the State Children's Health Insurance Program (SCHIP) on the prevalence of dental caries among low-income children. The 1999-2000 and 2001-2002 NHANES data were utilized for this analysis. Children 2-4 years old who participated in WIC, Medicaid, or SCHIP, or who were uninsured, and for whom both interview and complete oral health exam data were available (n = 597) were included in the study. Multivariate logistic regression modeling was conducted to examine the effects of program participation on caries. There was no statistically significant association between dental caries and participation in public assistance programs. The risk of dental caries for children in MedicaidSCHIP only was comparable to the risk for children in WIC and MedicaidSCHIP (OR = 1.04; 95%CI = 0.622, 1.745) and also to uninsured children (OR = 0.96; 95%CI = 0.523, 1.773). Dental caries were not impacted if the child did not have a preventive dental visit in the past 6 months (OR = 0.68; 95% CI = 0.436, 1.063) or did not have a regular dental care provider (OR = 1.15; 95% CI = 0.646, 2.044). Participation in WIC and MedicaidSCHIP does not improve the oral health of low-income children. Because this population is a high-risk group requiring more specialized efforts, improving access to care is not sufficient to improve oral health. In addition to increased utilization of services, the program partnership between WIC and MedicaidSCHIP must provide targeted, educational interventions to prevent dental caries. It may also be necessary to increase the recommended number of preventive visits for low-income children.

The health benefits of breastfeeding exceed well beyond the first few years of an infant's life. Breast milk is often referred to as liquid gold because of its extensive protective properties that promote child growth and development. Unfortunately, African American women have the lowest breastfeeding rates compared to any other racial group. Given that African American children are disproportionately affected by the current obesity epidemic in the United States, there may be a link between a mother's preference to breastfeed her infant and her influence over her child's eating behaviors and physical activity levels. Guided by social cognitive theory, the purpose of this quantitative longitudinal study was to explore the association between exclusive breastfeeding and maternal control over childhood nutrition and physical activity among African American women and children enrolled in the Women Infants and Children Nutritional Supplementation Program (WIC). Secondary data were used from the Infant Feeding Practices II Survey and its Year 6 Follow Up. Crosstabulations were performed to assess the relationship between exclusive breastfeeding and maternal control over child health behaviors after 6 years. The null hypotheses were not rejected, as there was no relationship between exclusive breastfeeding and maternal control over physical activity or child eating behaviors. Findings revealed moderate to high levels of maternal control among WIC participants who breastfed for 3 months. This study may lead to positive social change by increasing the number of children who benefit from breast milk and improving childhood nutrition and physical activity, which will ultimately reduce child obesity disparities and promote maternal and child health altogether.

Introduction: ReadNPlay for a Bright Future is an initiative developed by the East Tennessee State University (ETSU) pediatricians and partners, to promote healthy active living among families with young children. The project includes giving families a packet with a baby book and a tips booklet when they bring their young children to the pediatrician's office for the newborn visit. My Baby Book is based on Bright Futures guidelines and contains age-appropriate advice on keeping babies healthy, sharing books, eating healthy, preventing injury, and being active as a family, as well as space to record special memories and milestones. The vision of this project is to encourage families in the region to Play More, Play Together, Play Safely, and have Fuel to Play. Methodology: In January 2013, anonymous surveys in English or Spanish were administered to a sample of 80 mothers of infants under 24 months of age during well child visits at the ETSU Pediatric Clinic. This served as the pre-intervention survey to assess baseline self-reported behaviors of mothers and infants before the intervention (My Baby Book) was implemented. 3 follow up surveys were carried out in July 2013, April 2014 and July 2015 respectively to collect post-intervention data. Questions centered around screen time, physical activity, injury prevention, and healthy eating. Pre-intervention data was compared to post-intervention data consisting of the 3 follow up surveys combined together to determine the effectiveness of the ReadNPlay project. Data was collected using Epi Info and Excel and analyzed with SPSS. Results: The total sample size was 80 at each time point. Majority of the mothers are beneficiaries of the Women, Infants and Children (WIC) program. Preliminary results include that there was a 5.28% decrease in the number of mothers who reported spending more than 20 hours/week watching TV or videos; 4.22% increase in the number of mothers who spent at least 3 hours/week being engaged in light/moderate recreational activities; 14.35% increase in the number of mothers who spent at least 2 hours engaged in vigorous recreational activities or sports; 3% increase in the number of mothers who spent at least 3 hours/week walking for fun/exercise, and a 3.3% increase in the number of mothers who breastfed their children for at least 6 months. Among infants, a 6.39% decrease in hospital visits for injuries was reported as well as 8.23% increase in the number of infants who had no screen time. Conclusion: Limitations of this study include lack of a control group, potential for cohort effect, and the self-reported nature of the data collection. ReadNPlay for a Bright has subsequently been expanded to include distribution of a ReadNPlay children’s book series, development of a mobile application based on My Baby Book, and development of regular healthy active living community events and support groups to link families to in the region. A longitudinal evaluation of the program including several different clinics in the region is underway.

The objective of this study was to understand the influence of eating episodes and snack quality on body weight of children ages 3-4.9 years participating in the Broward County Special Supplementation Nutrition Program for Women, Infants, and Children (WIC).Additional objectives were to evaluate obesity risk factors and to examine the effect of childcare arrangements on body weight. Data was collected from 7 Broward County Health Department WIC clinics over 4 months via a researcher-administered questionnaire. Additional data was extracted from the WIC data system. BMI-for-age percentiles were used to categorize children by weight according to Centers for Disease Control (CDC) guidelines, which were further categorized into under/normal weight and overweight/obese. There were 197 participants included (45.7% boys), 3.6% of the children were underweight, 64.4% normal weight, 16.8% overweight, and 15.2% were obese. Most children consumed 3 meals (97.5%) and 2 to 3 snacks per day (33.0% and 37.1% respectively), with a significantly higher intake of snacks on the weekends when compared to weekdays (p=0.001). Children consumed more nutritious snacks more often (66%) than the nutrient-poor snacks (33.5%). We observed a marginally significant trend in which the WIC preschool children that more frequently consumed nutrient-poor snacks had a higher prevalence of overweight/obesity (p=0.090). In multivariate analyses, the children who consumed more than 4-oz of sugar sweetened beverages (SSB) per day, exercised for less than 1 hour per day, and had a higher birth weight had increased odds of being overweight/obese. Race and ethnicity were not predictive of body weight status, but Blacks or African Americans were at a higher risk for many of the risk factors. Children spent on average 20 hours per week under some type of nonparental care arrangement. There was no significant relationship between childcare and weight status. Our findings indicate that WIC children are at a greater risk for overweight and obesity, however there is potential for successful prevention interventions addressing prevalent risk factors. Longitudinal studies including a large sample of racial and ethnic diverse preschool children from low socioeconomic families could help elucidate the results from our study. This study was approved by FIU IRB (Protocol Approval #15-0369) the State of Florida Department of Health IRB (Protocol Title: Meal Frequency and the Role of Snacking on Weight of Minority Preschool Children).

Spanish-Dutch Relations in the New World during the Existence of the West Indische Compagnie Eva Kubátová Abstract This dissertation is dedicated to the Spanish-Dutch relations in the New World during the existence of the first Dutch West India Company (1621-1674). On base of an imagological analysis, this thesis presents elements of mutual relations, reflected in hetero-images, together with self-representation of both analyzed parties (thus self-image) within the ongoing conflict of the Eighty Years' War. The imagological analysis is applied on archival material, chiefly the Dutch pamphlets and Spanish Relaciones de sucesos (which can be translated as "Treatises of Successes"). The result of this thesis is then an analysis of development and changes of mutual images, upon the historical events of the Spanish-Dutch war conflict: thus since the beginnings of the Dutch Revolt, passing through the Twelve Years' Truce, until the signature of the Peace of Westphalia in 1648. A special emphasis is put to the final phase of the Eighty Years' War, in this thesis delimited by the years 1621-1648, which was marked by the official entrance of the West India Company into the Spanish waters of Greater Caribbean. An important watershed in mutual relations is afterwards represented by the Peace of Westphalia, which...

An international maritime labour market study, the thesis focuses on the Dutch naval labour market, analysing wartime Zeeland admiralty crews. The research is based primarily on unique naval pay sources. Analysis of crew compositions has not been made on this scale in the period before. The 1667 Dutch Medway Raid is the starting point, where a few British played a leading role – amongst many others reported on the Dutch side. Pepys and Marvell primarily blamed their joining the enemy on the lure of superior Dutch payment. The thesis asks how many British there were really, how they came to be in Dutch service, and whether this involvement occurred, as indicated, at other times too. Part One is thematic and explores the background mechanisms of the maritime environment in detail, determining causation. First, the two naval recruitment systems are compared and completely reassessed in the light of state intervention in the trade sphere. Two new sets of ‘control’ data – naval wages and foreign shipping – are amongst the incentives and routes determined. British expatriate communities are examined as conduits for the supply of naval labour and civilian support. British personnel are compared and contrasted with other foreigners, against the background of Anglo-Dutch interlinkage and political transition from neutrality through conflict to alliance. Part Two is chronological, covering four major wars in three chapters. Micro-case studies assembled from the scattered record streams enable analysis of the crews of particular officers and ships. Seamen were an occupation that made them a very little known group: the thesis examines the different career types of British personnel of many different ranks, shedding light on their everyday lives. The thesis shows that British personnel were an integral part of Dutch crews throughout the period, even when the two nations were fighting each other. The basic need of subsistence labour for employment took precedence over allegiance to nation/ideology, demonstrating limitations in state power and the continual interdependence forced on the maritime powers through the realities of the labour market.