Intake of Calcium Rich Intake of Calcium Rich Foods Among Early Foods Among Early AdolescentsAdolescents

Intake of Calcium Rich Intake of Calcium Rich Foods Among Early Foods Among Early AdolescentsAdolescents

Scottie Misner, PhD, RD Scottie Misner, PhD, RD

April 2010April 2010

Scottie Misner, PhD, RD Scottie Misner, PhD, RD

April 2010April 2010

IntroductionIntroductionCalcium and vitamin DCalcium and vitamin D

intake in adolescents isintake in adolescents is

important for bone health.important for bone health.

Calcium intake in 9-13 yr Calcium intake in 9-13 yr

olds is 67-88% of Ca req.olds is 67-88% of Ca req.

Calcium and vitamin DCalcium and vitamin D

intake in adolescents isintake in adolescents is

important for bone health.important for bone health.

Calcium intake in 9-13 yr Calcium intake in 9-13 yr

olds is 67-88% of Ca req.olds is 67-88% of Ca req.

Skeletal ProblemsSkeletal 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) <http://www.nof.org/>

Adequate Nutrition for PreventionAdequate 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

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

Family InfluenceFamily Influence

Research suggests, “Multicomponent interventions with a focus on the family environment are likely to be most effective in increasing calcium intakes among adolescents.”

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)

Family Influence of Calcium Intake

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)

More on Parental InfluenceParental InfluenceMore on Parental InfluenceParental InfluenceParents 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, 3rd 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, 3rd Ed. (2002).

Family Structure and Nutrient IntakeFamily 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)

Family Structure and Nutrient Intake

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.

Supported by researchSupported by research

National statisticsNational 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)

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 CorrelationNegative Correlation Between hematocrit and

dietary measures with girls receiving low family structure scores.

Between hematocrit and dietary measures with girls receiving low family structure scores.

Multigenerational researchMultigenerational 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)

Study PopulationsStudy 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.

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.

Research Proposals Research ProposalsW-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.

W-2003 How to motivate

parent(s) to promote intake of calcium rich foods among early adolescents.

W-1003W-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.

Family EnvironmentFamily 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

Methods: 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:

Using data collected from the questionnaires of White, Hispanic & Asian households:

Psychosocial constructs and Scales

Social and Environmental Factors

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

Meal eating occasion Family environment

Family drinks milk Family expectations Family influence

Encouragement and ExpectationsEncouragement 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

W-1003 found: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

Nutrition Education MessagesNutrition Education MessagesNutrition Education MessagesNutrition 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.

Food Related FactorsFood Related FactorsFood Related FactorsFood Related Factors Taste Preferences Familiarity Positive social context Models and rewards

Taste Preferences Familiarity Positive social context Models and rewards

Environmental FactorsEnvironmental Factors

Availability Social structure Cultural practices Price Time

Availability Social structure Cultural practices Price Time

Availability and ModelingAvailability 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.

Prevalent Parental FactorsPrevalent 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)

Negative Parental Influences Lack of Parents Modeling Lack of Parental

Expectation Child Preference (Dislike)

W-1003 ResearchersW-1003 ResearchersW-1003 ResearchersW-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

SourcesSources

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.

Cont.Cont.

Baranowski, T, et al, Health Behavior and Health Education, 3rd 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, 3rd 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.

Thanks!

Comments, questions,

other?

Thanks!

Comments, questions,

other?

Scottie Misner, PhD, RDScottie Misner, PhD, RD

University of Arizona Cooperative ExtensionUniversity of Arizona Cooperative Extension1177 E 41177 E 4thth , NSC, 309 Shantz , NSC, 309 Shantz

Tucson, AZ 85721-0038Tucson, AZ 85721-0038

Scottie Misner, PhD, RDScottie Misner, PhD, RD

University of Arizona Cooperative ExtensionUniversity of Arizona Cooperative Extension1177 E 41177 E 4thth , NSC, 309 Shantz , NSC, 309 Shantz

Tucson, AZ 85721-0038Tucson, 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/

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