~nutrition knowledge and feeding practices
TRANSCRIPT
~NUTRITION KNOWLEDGE AND FEEDING PRACTICES ' OF THE PARENTS OF PRESCHOOL CHILDREty
IN TWO UPPER-MIDDLE INCOME COUNTIES IN VIRGINIA
by
Julia L. \\.Johansen,j'
Thesis submitted to the Graduate Faculty of the
Virginia Polytechnic Institute and State University
in partial fulfillment of the requirements for the degree of
MASTER OF SCIENCE
in
Human Nutrition and Foods
APPROVED:
n-;1/Jane Wentworth, Chairperson
--->t"'"' ,- - - ·- • Dr. Victoria R. Fu Dr. Forrest w. Thye
May, 1976
Blacksburg, Virginia
ACKNOWLEDGEMENTS
The writer wishes to express appreciation to Dr. Jane Wentworth
for her assistance in the preparation and writing of the thesis. She
wishes to acknowledge Dr. Forrest W. Thye and Dr. Victoria R. Fu for
serving as committee members. She wishes also to thank Dr. Robert
Frary for his assistance in the statistical analysis of the survey.
ii
TABLE OF CONTENTS
Page
Acknowledgements. ii
List of Tables . ..................................... C> • •.•••••••••• • iv
INTRODUCTION • •••••...••••••.•••.•..••.•.•••.. • •.•••••••.••.• e • • • • • 1
REVIEW OF LITERATURE • ••.••.•••.•.••.•.•...•..••..•••. 3
OBJECTIVE • -• • . . • . ·- . • • • • • . . • . • • . • • • • . . . . • • . . . • . 0 • 0 • • • • • • • • • • • • • • ID • • 8
EXPERIMENTAL PROCEDURE •.•••••••• 9
Sample Population ••••••.•.. 9
Description of the Questionnaire ..••.•• 9
Computer Tabulation and Scoring of the Nutrition Knowledge Test.................................... 9
RESULTS AND DISCUSSION.. • • • • • • • • • • • • • • • • • • • • • • • • • • . • • • • • . • . • • • • • . 11
Characteristics of the Children in the Survey ...•....••....• 11
Feeding Practices of the Sample Population. 17
Results of the Nutrition Knowledge Test. 28
Characteristics of the Parents Completing the Survey .•..•••• 33
S~Y AND CONCLUSION. . . • • . . . • . • • . • . . . . . . . . . • . . . . . . . . . . . . • . . . . . . 38
RECO~NDATIONS ...••••••...•.•.•.....••. ID •••• 0 • • • • • • • • • • • • • • • • • • • 40
LITERATURE CITED. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 42
Appendices. 45
Vi ta . ................................. e • o •••••• Cl •••••••••••• 49
iii
LIST OF TABLES A..~D FIGURES
Table Page
1 Percent of Children in the Survey For Age, Sex, and Position of Child in the Family ••••••••••••••••• 12
2 Correlation of Nutrition Knowledge with Total Score for Thirteen Selected Questions •••••••••••••• 13
3 Mean Birth Weight and Birth Length as Compared with the Falkner Scale •••••••••••••••••••••••••• 16
4 Percent of Responses for Nine Questions Concerning Feeding Practices ••••••••••••••••••••••••••••• 19-21
5 Percent of Responses for Two Questions Concerning Nutri:tion Information. and Meal Plailrl.ing ~ ........................ ·. . . . . . . . . . . . . . . . . . . 2 7
6 Percent of Responses for Ten Nutrition Kilowledge Questions . ................. ·· . . . . ... . . . . . . . . . . . . . 29-30
7 Correlation with Total Score for Ten Nutrition Knowledge Questions............................ 32
8 Percent of Responses of Parents Completing the Survey for Occupation, Education, Age, and Income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35-36
Figure
1 Birth Weight of Children ••••••••••••••••••••••••••••••••• 14
2 Birth Length of Children ............•.................... 15
3 Evaluation of Snack Food Responses When Rated as Good, Intermediate, or Poor ••••••••••••••••••••• 22
iv
INTRODUCTION
The nutrition of young children is a recognized environmental
factor affecting growth and development. Food practices and attitudes
established during the preschool years are believed to affect food
choice and consequently nutritional status throughout life (1). Hill
has stated that it is easier to develop good food habits in young
children than it is to correct poor habits as children grow older.
This requires that parents know and practice good food habits from the
time their children are born, if not before (2). A study by Beyer and
Morris of 44 preschool children in Michigan with a follow-up of the
same children during elementary school years emphasized the importance
of the early establishment of good food habits. Beyer and Morris
found that the food likes and dislikes and snacking patterns established
during the preschool years carried over to the elementary school years.
Their study points out the importance of teaching the principles of
good nutrition early in life with nutrition education aimed at the
whole family-(3). A young child imitates the family food habits,
therefore it is important that parents provide a good example right
from the start (4). Results of the 1965 United States Department of
Agriculture household food consumption survey indicated that 50 percent
of the families in the United States had diets supplying all the recom-
mended allowances of calories and seven nutrients, while 20 percent of
the families had diets which provided less than two-thirds of the
recommended dietary allowance for one or more nutrients (5). Hiemstra,
in an evaluation of United States Department of Agriculture food pro-
grams, stated that "although families tend to spend 4 to 6 percent
1
2
more money on food with every 10 percent increase in disposable income,
increased income does not insure an adequate diet, unless enough money
is spent on food and the foods selected make up a balanced diet" (6).
Nutrition knowledge and attitude toward meal planning, food pre-
paration, nutrition, and permissiveness in feeding children were inter-
related factors found to influence the quality of the diets of preschool
children in the North Central region of the United States. Eppright
et al. presented the results of a study covering a wide area of the
United States, with a sample of 3,444 preschool children from 1,664
households (7). In this study the education of the mother was a
prominent factor affecting the quality of the diet. However, of the
socioeconomic variables studied, amount of money spent for food was
the most influential in determining the quality of the diet of the
children. The typical family in the North Central region study was
urban with an annual income between $5,000 and $10,000 (7).
Sound nutrition knowledge is one of the most important factors
parents can develop to assure their children of a healthy future (2).
How much income and level of education affect nutrition knowledge is
important to understand as they are all related to how well our children
eat to obtain ade"quate nutrition. This study was therefore designed
to determine the relationship between nutrition knowledge and income
and level of education.
REVIEW OF LITERATURE
"Nutritional Status, USA" was published in 1959 and summarized
the results of regional nutritional studies done in the United States
between 1947 and 1958 and reported in 178 publications (8). Also
Kelsay listed 50 similar studies done between 1957 and 1967 (9). In
both of the compendiums a major observation was that the quality of
nutrition was generally related to economic status and level of educa-
tion (8, 9). Young et al. found in their studies of Virginia and New
York homemakers' knowledge of nutrition that the homemakers' perform-
ance in feeding their families was related to their knowledge of the
principles of good nutrition (10, 11). Morse et al. reported a study
which described the nutrition knowledge of 238 mothers of school children
in Vermont. Those with more.education scored the best on a nutrition
test (12). Ennnons and Hayes also studied mothers' knowledge of nutri-.
tion and compared it with their childrens' knowledge of nutrition.
Both the'mothers and their children had difficulty providing valid
nutritional reasons for the importance of inclusion of certain foods
in their diets. The mothers actually fed their children more adequate
diets than their nutrition knowledge indicated (13). Emmons and Hayes
felt it was disturbing to learn that their feeding practices were not
based on an understanding of what they were doing. These investigators
felt that the mothers could not provide basic nutrition knowledge to
their children, but were instead, instilling food habits based on habit
and custom.
Several studies reported by Owen and co-workers of preschool
children in the United States indicated, as did those of United States
3
4
Department of Agriculture researchers and of the Ten State Nutrition
survey, that with the possible exception of ascorbic acid and iron,
nutritional quality of the diet correlated poorly with socioeconomic
status. Among the socioeconomically depressed the problem was one of
lack of sufficient amounts of food rather than nutritional quality
(14, 15, 16, 17). Eppright et al. reported that income of the family·
affected the child's intake of ascorbic acid more than any other
nutrient. The diets of children in the highest income group exceeded
those of the lowest income group in iron, ascorbic acid, and thiamin,
but the children of the two income categories had about equal food
energy intakes (7). In a study of 558 preschool children in Mississippi,
Owen and Kram found that the lower income children consumed less calories
than the higher income children (15). Metheny et al. in a study of the
dietary patterns of 104 preschoolers found that the level of nutrients ~
in the diets varied with the family income. Generally, the higher the
income of the families surveyed the better the diet (18).
Kerrey et al. found that the more favorable nutritional status of
the higher income group in their study was attributed to their higher
nutrient intake over their entire lifetime, due in part to the use of
vitamin supplements (1). There was widespread use of vitamin supple-
ments by families in the middle income brackets and not such frequent
use in lower income families (1, 19, 20). Owen and co-workers found
that supplements contributed substantial amounts of vitamins to the
total intakes of preschool children with percentage increases greatest
for children of lower socioeconomic status (14). Eppright et al. in
their study of preschool children in the North Central region also
found widespread use of vitamin supplements. Without them many of
5
the children would have had diets below the allowances in ascorbic
acid, thiamin, and vitamin A, although these nutrients could easily
have been provided by available foods (7).
A recent study by Inano and Pringle of rural families in Iowa
and North Carolina indicated that some of the families in their study
obtained their entire vitamin A requirements from foods outside the
vitamin A rich fruit and vegetable group. Their findings indicated
that some families in their study obtained most or all of their
calcium, vitamin A, and ascorbic acid from food sources not usually
included in the Basic Four Food Groups (21). A similar finding was
reported by researchers at the United States Department of Agriculture
in the 1965 nationwide food intake study (22).
Kerrey et al. in their study of 40 preschool children from both -
low and high income groups found that children fr?m the low income
group received diets providing more iron and thiamin. Those of the
high income group had diets providing more vitamin A and ascorbic acid.
For both groups calcium, iron, calories, and ascorbic acid were among
the least well supplied nutrients (1). Iron deficienty is of particu-
lar concern to many nutritionists and nutrition educators. Morgan
listed iron deficiency as a number one problem (8). Emerson stated
that although overall nutrition in the United States was good in 1965,
iron deficiency in youths and pregnant women was still of concern (23).
Also in 1965, Goldsmith listed the most important nutritional problems
in the United States as obesity, iron deficiency anemia, and malnutrition
as secondary to disease states not primarily nutritional in origin (24).
Results of the Ten State Nutrition Survey indicated that consistently
6
high percentages of infants and adolescents fell below 70 percent of
the standard considered adequate in regard to iron intake (17).
Lamb and Ling's 1946 analysis of food preferences of nursery
school children found a drastic. deficiency in consumption of green
and yellow vegetables. The children in their study had a definite
preference for meat, chicken, eggs, and citrus fruits. They stated
that even in so-called normal and healthy children there was still
much that could be done by way of improving their dietary practices (25).
Almost 20 years later Dierks and Morse reported that vegetables in
general and certain specific vegetables were either disliked but eaten
or not eaten at all by the respondents in their survey. Meats were
liked the best by the preschool children followed by fruits, sweets,
cereal, and cereal products (26). Beyer and Morris in their study of
t:Y childrens' food attitudes in Michigan found that cooked vegetables
were the most disliked food. Raw vegetables were much preferred over
cooked vegetables (3). This preference for raw over cooked vegetables
has also been noted by other researchers (27, 28). Harrill et al.
found that green vegetables in particular were not liked by most of the
3 to 5 year olds in their study. Harrill et al. were able to increase
the consumption of vegetables by use of a food information program (29).
Sanjur and Scoma's study of low income children in Northern New York
found that milk, fruits, and vegetables had the lowest acceptance rates
with meat, bread, and cereal having the highest rates of acceptance (30).
Many of the households surveyed in the Ten State Nutrition survey
seldom used foods rich in vitamin A (17).
Snacks have become an important part of the average American diet
and can perhaps be indicative of general eating habits. The Dierks
7
and Morse study presented data on common snack foods and listed crackers,
milk, fruit, and fruit juices as being mentioned most often (26). Beyer
and Morris also listed those foods as the most common snack foods (3).
A study by Glazer indicated that raw vegetables and cheese in addition
to the above mentioned foods were widely used as snacks (31). Adelson's
comparison of the 1955 and 1965 nationwide surveys of household food
consumption indicated a downward trend over the ten year period in the
quality of the diets of the nations' families as a whole. More snack-
ing by youths and the population in general led to an increase in the
use of peanut butter, cheese, frozen milk desserts, fruit juice,
cookies, and crackers as snack foods. Adelson felt there needed to
be an emphasis on increased consumption of milk and milk products,
fruits, and vegetables (32). Kelsay stated the foods most needed to
improve the diets of the populations studied were milk, citrus fruits,
and green and yellow vegetables (9).
OBJECTIVE
In view of the significance of nutrition in the preschool age child,
it is important that food habit information be obtained about that
segment of our population in order to determine where to place the
emphasis in nutrition education programs. It is apparent from the
literature reviewed that low nutrient intakes do exist in the diets
of preschool children from families at all income levels. When suffi-
cient money is available to buy food it is vital that the nutrition
knowledge of the parents be good enough to provide adequate nutrition
for their children through good eating practices based on this know-
ledge rather than old habits or customs. The purpose of this study
was to evaluate the nutrition knowledge of parents of preschool
children in an upper-middle income area of Virginia. The survey used
was so designed to correlate nutrition knowledge with income, level
of education, and feeding practices.
8
EXPERIMENTAL PROCEDURE
Sample Population
Seven private preschools in Fairfax and Arlington counties,
Virginia were cont~cted and asked to provide names and addresses of
their enrollments. Those schools were randomly selected from the
yellow pages of the ~orthern Virginia telephone directory. The
survey was.then mailed to the parents of the children who were
enrolled in the private preschools. 530 surveys were mailed during
March of 1975. A cover letter and a stamped, self-addressed envelope
were enclosed with each survey form. 272 surveys were completed and
returned by the end of April, 1975.
Description of the Questionnaire
The survey was divided into four sections with a total of 34
questions. The questions were either in the form of fill in the blank,
true or false, or multiple choice. Section I was designed to provide
general information about the children; Section II was structured to
obtain data on feeding practices; Section III was the Nutrition Know-
led.$e Test; and Section IV was the optional section which was designed
to provide information about the parents completing the survey. (See
Appendix 2.)
·Computer Tabulation and Scoring of Nutrition Knowledge Test
All 34 questions were coded for computer tabulation to give fre-
quency and proportion for each choice. The 10 Nutrition Knowledge
Test questions (questions 17, 18, 20-27) were coded to give mean
response level of each question and correlated with mean total score.
9
10
The answers were tabulated to be right or wrong with only questions
17 and 26 tabulated for a variance of answers. Mean total score and
standard deviation values were also provided for the test questions.
Thirteen other questions concerning feeding practices were re-coded
to give mean response level and to correlate with the total nutrition
knowledge test score. Values of .3 or above were considered signifi-
cant correlations. Those 13 questions were: position of child in
the family (question 3); whether the child was breast fed or bottle
fed (question 7); use of vitamin supplements {questions 9 and 10);
snack foods eaten (question 11); kind of high protein foods served
{question 13); food acceptance (question 15); occupation of parents
(questions 28 and 29); level of education of parents (questions 30
and 31); and total family income for one year (question 34). The
program used was designed by Dr. Robert Frary of the Learning Resources
Center, Virginia Polytechnic Institute and State University, Blacksburg,
Virginia.
RESULTS AND DISCUSSION
Characteristics of the Children in the Survey
The mean age of the 272 children whose parents completed the
survey was 4.86 years. Ninety-three percent of the children were
born between 1969 and 1971. In the total sample 47 percent of the
children were girls and 53 percent were boys (Table_!). Forty-two
percent were the first child in the family, 33 percent second child
in the family, 15 percent third child in the family, 8 percent fourth
child in the family, 2 percent fifth child or other (Table]). There
was no significant correlation between the Nutrition Knowledge Test
and the position of the child in the family as shown in Table 2
(r = 0.03). The hypothesis was that parents would become more know-
ledgeable about nutrition as the size of the family increased. This
was not the case in the population surveyed perhaps because the
parents' knowledge of nutrition did not increase through actual experi-
ence in feeding their own children; and their knowledge was based on
what they had been taught and/or experienced in the past based both
on habit and on knowledge.
Ninety-three percent of the children were full term at birth
with 7 percent premature. Mean birth weight for all children was
7.24 pounds (Figure]). Mean birth length for all children was 20.32
inches (Figure 2). Using the Falkner scale for comparison of the
length at birth, the children in the survey were generally longer at
birth than those at the SOth percentile for length as computed by
Falkner. Birth weight for children in this survey was slightly lower
than the birth weight at the 50th percentile as computed by Falkner (34)
(Table]). 11
12
Table 1. Percent of Children in the Survey for Age, Sex, and Position of Child in the Family
Question
1. When was the child born?
1968 ............. 1969 ............. 1970 ............. 1971 ............... 1972 ...............
2. Sex of the Child?
Girl Boy
7 years .6 years 5 years 4 years 3 years
3. Position of child in the family
First child Second child Third child Fourth child Fifth child Other
old old old old old
Percentage of Respondents
• • • • • • • e • • "' • • • . ...... . ...... . ......... . .........
2% 14% 54% 25%
3%
47% 53%
42% 33% 15%
8% 1% 1%
13
Table 2. Correlation of Nutrition Knowledge with Total Score for Thirteen Selected Questions
Question
3. Position of child in the family
7. Breast fed or bottle fed
9. Do you currently give your child vitamins?
10. Did you give your child vitamins when he or she was a baby?
11. Snack foods
12. High protein foods
13. Servings of protein food
15. When served a food your child disliked will he or she taste it?·
28. Occupation of female head of household
29. Occupation of male head of household
30. School completed by female head of household
31. School completed by male head of household
34. Total family income
Correlation with Total Score
0.03
0.10
0.09
0.01
0.14
0.32
0.20
0.05
0.32
0.01
0.21
0.01
0.03
80%
60%
PERCENT 50%
OF CHILDREN 40%
30%
20%
10%
14
1%
UNDER 4' 4' TO 6' 6' l" TO 8'
WEIGHT IN POUNDS
FIGURE 1. BIRTH WEIGHT OF CHILDREN.
a• l" TO 10'
10' 1" TO 12'
PERCENT
OF CHILDREN
80%
70%
60%
50%
40%
30%
20%
10%
15
59%
1%
15.5" TO 17" 17 .5" TO 19" 19.5" TO 21" 21.5" TO 23"
LENGTH IN INCHES
FIGURE 2. BIRTH LENGTH OF CHILDREN.
16
Table 3. Mean Birth Weight and Birth Length as Compared with the Falkner Scalel
Falkner 50th percentile
Boys ••••.•••..•• 7.5 lbs.
Girls •••••••••.• 7.3 lbs.
Boys •.••..••.••• 19.8 in.
Girls ...•..•...• 19.5 in ..
1 Falkner, F. (34)
Birth Weight
Birth Length
This Survey Mean
Boys and Girls ... 7.24 lbs.
Boys and Girls .•• 20.32 in.
17
Feeding Practices of the Sample Population
Sixty-six percent of the children were primarily bottle fed as
infants and 34 percent were breast fed. There was no significant
correlation between method of feeding during infancy and total score
on the Nutrition Knowledge Test (r = 0.10) (Table 1)· Sanjur and
Scoma reported that among low income children in Northern New York
28 percent of the children were breast fed as infants (30). Wentworth
and Barton found in a survey carried out in Virginia in 1974 and 1975
primarily among low-income families that only 10 percent of the newborns
were breast fed (35). Fomon has indicated recently that the frequency
of breast feeding in the United States during the newborn period was
estimated to be 26 percent (36). Eppright et al. reported that of the
2,000 mothers in their study, 75 percent of them bottle fed their
children, 22 percent breas~fed, and 3 percent employed a combination
of breast and bottle feeding from birth. Of the mothers who breast
fed their infants a greater percentage came from the lowest and highest
income and education levels, rather than the middle levels (7).
Seventy-five percent of the parents responded that the first food
other than milk fed to the children in this study was cereal, followed
by 14 percent cereal and fruit, 6 percent fruit, and 3 percent fruit
juice. Eppright et al. found that cereals were accepted at an earlier
age than any other food (7). Sanjur and Scoma found that 55 percent
of the children had cereal as their first solid food, 11 percent fruit,
and 9 percent vegetables (30).
Vitamin supplements were given to 60 percent of the children
frequently or everyday at the time of the survey. Eighty-five percent
18
gave their children vitamin supplements frequently or everyday during
infancy (Table~). Questions 9 and 10 concerning the use of vitamin
supplements were correlated with Nutrition Knowledge Test scores but
there was no significant correlation (question 9, r = .09'; question 10,
r =· .01) (Table ~). These findings compare favorably with data from
other surveys pointing out the large scale use of vitamin supplements
in this country (1, 14, 19). Dierks and Morse found that 71 percent
of the preschool children in their study received supplements everyday
(26). A study by Lund and Burk of children in Minnesota reported that
· 44 percent of the children received nutrient supplements (20). Eppright
et al. found that 60 percent of the mothers in that study said they
gave supplements to their children regularly. As the level of education
of the mother increased the use of supplements increased (7).
Data on the type of snack foods consumed by the preschool children
in this survey are presented in Table 4. It was evident that a wide
variety was used with fruit, crackers, cookies, cheese, raw vegetables,
and juices being the most popular. These results are similar to those
presented in studies by Dierks and Morse (26), Beyer and Morris (3),
and Glazer (31). Snack foods were rated as either good, intermediate,
or poor and then correlated with scores on the Nutrition Knowledge Test.
Those who scored highest on the Nutrition Knowledge Test gave their
children the better snack foods (r = 0.14) (Table 1)· The rating scale
of good, intermediate, ~or used to rate snacks was based on the
potential nutritive value of"~he snacks listed by the parents completing ~
the survey. Listing one food of"·],ow nutritive value such as potato chips,
crackers, or ice cream dropped the rating from good to intermediate;
Table 4.
Question
19
Percent of Responses for Nine Questions Concerning Feeding Practices
Percentage of Respondents
7. Was your child primarily breast fed or bottle fed as a baby?
Breast fed Bottle fed
8. What was the first food other than milk that you fed your child?
34% 66%
Cereal • . • • • . . . • . • • . • . • • . . • • . . • • . • • • . • . • • . • • . • 75% Cereal and fruit • . . • • . • • . . . • . • . • • . . • • • . . . . . . . 14% Fruit • • • • • • • . • . . • • . • • • . . • • . . • • • . . • . • . • . . . • • • . 6% Fruit juice • . . . . . . . . • • . • . • . . . . . . . . • • . • • . . . . • . 3% Vegetable ..................... o • • • • • • • • • • • • • • 0. 5% Egg ••...••..••..•••••...•...••••.•.••••.••••• 0~5%
9. Do you currently give your child vitamins?
Everyday • . . . . • • • . . • . . . • • • . • • . • . . . • . . • . • • . . . . • 44% Frequently . . . • . • . • • . . • . • . • • . . . • • • • • . . • . • • • • . • 16% Sometimes • . • . • . • . . . . • • . • . . • • • . • . • • • . • • . • • . • • • 16% Never • . • . • • . • • • . • • • . • . • • • . . • • • • • • • • • • . • • • • . • • 24%
10. Did you give your child vitamins when he or she was a baby?
Everyday • . • . • . . • . . • • • . . . . • • • • . . . . • • . • • • • • • . . . 7 6% Frequently • . . . • • • . • • • • . • • • . • . . • • • . . . • . . . • • . . . 9% Sometimes . • • . • • . . • . . . . • • • . . . . • • . . . • . . . . . . . . . • 7 % Never
11. What foods does your child eat most often as a snack?*
Fruit . • . • • • • . . • • .. 67% Cookies . . . . • . • . . • • 45% Cheese •••...•..•.. 25% Crackers •••..••.•. 20% Raw Vegetables .... 12% Fruit Juice ..••••. 12% Milk . • . . . . • . . . . . • . 8% Ice cream •.•.•.•.. 8% Peanut butter ..... 6%
Potato .chips, pretzels, and popcorn •.••....
Cereal ••.•.•.••.• Sandwich .......•• Nuts, peanuts .... Candy .•.•.•••.... Bread .....•.•.... Pudding, Jello
*Percentages for this question are by frequency
6%
6% 5% 4% 4% 4% 4% 2%
20
Table 4. Continued. Percent of Responses for Nine Questions Concerning Feeding Practices
Question Percentage of Respondents
11. (Continued)
Yogurt, cottage cheese • • • • • . • • • • 2%
Lunch meat •.•••••• 1% Soft Drinks ••••••• 1% Cake • • • • • • • • • • • • . • 1%
12. What kind of high protein foods do you serve your child everyday?
*A good variety, Five varied responses ••.•••• 3% Four· good responses • • • • • • • • • • • • • • . • • • • • • • • • • • 11% Three good responses . • • • • . . . . . • . . . . . . . . • . • . . . 34% Two good responses • • • • • • • • • • . • • • • • • • • • • • • • • • • 31% One good response . . • • • • • • • • • • • • . • . • . • • . • . • . • • 18% No response or a poor response .•••.•••....•.• 2%
*A good variety such as meat, poultry, fish, eggs, other dairy products, peanut butter, dry bean~ and peas.
13. How many servings of foods high in protein does your child eat everyday?
One serving ••••••• : •••••••••••••••• ·. • • • • • • . • • 4% Two servings • • • • • • • • . . • • • • . • • . • • . • • • • . • • • • . . • 2 9% Three servings . . • • • . • • • • • . • • • . • . • • • • • . • • • • • • • 42% Four servings . • • • . • • • . . • • • • . • • • • . . • . . • • • • . . • . . 15% Five servings . • • • • • . . . • • • • • . . . . . • • • . • • • • • • . . • 8 %
14. What type of milk does your child drink most often?
Whole milk Lowf at or 2% milk ............................ . Skim milk ................................ ~ ... . Chocolate milk ............................... . Milkshake ................................... .
37% 42% 16%
3% 1%
None • • • • • . • • • • • • • • • . • • • • • • • • • . . • • • • • • • • • • • . • • 1% Special milk product for allergy problem •.••• 1 response
21
Table 4. Continued. Percent of Responses for Nine Questions Concerning Feeding Practices
Question Percentage of .Respondents
15. When served a food your child dislikes, will he or she taste it?
Everytime Frequently ............................ o •••••
Sometimes .................................. . Never •o••••••••••·························-··
21% 31% 41%
6%
PERCENT
OF SUBJECTS
78
38
2K
lK
22
39'1.
GOOD INTERMEDIATE
EVALUATION OF SNACK FOOD RESPONSES
FIGURE 3. EVALUATION OF SNACK FOOD RESPONSES WHEN RATED AS GOOD, INTERMEDIATE, OR POOR~
23
and if two foods of low nutritive value were listed the rating
dropped to poor. A food was considered to be of low nutritive value
if it was high in sugar and/or would not contribute to the recommended
dietary allowance for vitamins, minerals, or protein. Thirty-nine
percent were rated as good, 37 percent intermediate, and 24 percent
poor (Figure 1)· Those who did well on the Nutrition Knowledge Test provided the
best variety of foods high in protein for their child (r = 0.32)
(Table±)· It is interesting to note that only 14 percent of all
respondents to question 12 actually listed a good variety of high
protein foods; that is, at least four different types such as meat,
poultry, fish, eggs, dairy products other than milk, dry beans and
peas, and peanut butter. The purpose of this question was to deter-
mine the respondents' use of protein foods other than meat (primarily
beef) and milk. It may be that in answering this question some
respondents only listed those foods they were sure their child would
always eat. The data as presented in Table 4 does indicate a poor
variety in sources of protein served to this particular sample popula-
tion. The remainder of the responses to question 12 were : 31 percent
listed two good responses, 18 percent listed one good response, and 2
percent gave no response or a poor response. A poor response included
such answers as "vegetables, orange juice, bread, fruit, etc."
Forty-two percent of the respondents indicated that their children
daily ate three servings of high protein foods with 15 percent consuming
four servings, and 8 percent five servings. Thirty-three percent of
the respondents indicated that their children daily ate one or two
24
servings of foods high in protein, which would not be adequate for
growth unless the portion size were very large. Children in the
preschool years begin to display lack of enthusiasm for food at about
one year of age, and experience erratic eating habits and food jags
off and on for several years (37). Martin states that although
children may have favorable attitudes toward most foods, often the
intake of important foods is of too small a quantity. For :instance,
while most children drink milk and eat citrus fruits, some may not
consume the recommended amounts (38). Young children tend to eat
small servings of food and would need four or five small servings
(including milk) of high quality protein to provide for adequate
growth. The recommended dietary allowance for the 4 to 6 year old
child is 30 g. of protein (39). Lund and Burk reported that 96 percent
of the mothers in their study thought foods from the meat, fish or
poultry group should be served once a day. From the same study 98
percent thought foods from the milk group should be served at each
meal (20). Eppright et al. found that the mothers' idea of portion
size was very liberal (7). In view of that observation it may be
that the children in this survey who ate only orie or two servings of
foods high in protein each day actually received very liberal servings
of those foods. There was no significant correlation on number of
servings of high protein foods with the Nutrition Knowledge Test
(r = 0.20) (Table~).
Thirty-seven percent of the respondents listed whole milk as the
type of milk most often consumed with 42 percent using 2 percent or
lowfat milk, 16 percent skim milk, 3 percent chocolate milk, and one
percent a milkshake. This is in contrast to the families in the
25
North Central region studied in 1963 by Eppright et al. 92 percent
of whom used whole milk (7). The trend of using lowfat and skim milk
products rather than whole milk is apparently due to widespread and
constant information about saturated fats and cholesterol and their
link to heart diseases. Also, interest in obesity and its prevention
is no doubt a factor in the use of lower fat milk products.
Twenty-one percent of the children would taste a food he or she
disliked·· everytime·, 3T percent would frequently try it; 41 percent
sometimes; and 6 percent never (question 15). If children are to
develop the concept of eating a well balanced diet they should be
offered a wide variety of foods from the time solid food is introduced.
This survey indicated that the majority of the children will taste a
food that is disliked. For this question there was no significant
correlation with the Nutrition Knowledge Test (r = 0.05) (Table±_).
Owen, et al. found that childrens' reactions to new foods were related
to the child's age. Seventy-seven percent of children 12 to 23 months
would try a new food; 68 percent of children 24-27 months would do so;
and 60 percent of children over four would readily try a new food (14).
In comparison, 52 percent of the 4 year olds in this survey would
frequently try a new food. Lund and Burk reported that 56 percent of
the mothers in their survey would insist that their child taste a new
food (20).
When asked how information was obtained about how to feed their
child, 29 percent relied on printed information, 18 percent received
help from the child's physician, 10 percent had received formal train-
ing, 3 percent had help from relatives, 2 percent had help from friends,
26
and 27 percent gave.combination answers from the above choices.
Eleven percent chose other as the means of obtaining information and
then indicated "self or common sense" as the response.(Table _2).
Owen et al. found that few mothers in the lower socioeconomic groups
obtained information about food from professional or public service
channels. Instead they tended to obtain information from neighbors
or relatives. Sixty-one percent of those in upper socioeconomic
groups obtained information about food from a cookbook while 41 per-
cent of those in the lower socioeconomic groups did (14). Metheny
et al. found that mothers from all economic levels rank their past
experience and education as the most influential source of nutrition
information. Printed materials were second in importance with the
pediatrician listed as third in importance (18). Lund and Burk,
however, reporte~ that printed information was the most important
source of nutrition information among respondents in their survey
with friends and relatives also given as important sources of inf orma-
tion (20). Sanj.ur and Scoma found that among the low income when
sources of nutrition information were studied 69 percent ranked mother
or relative first; 59 percent ranked past experience second; 58 percent
ranked own children's food preference third; 40 percent ranked self-
education as fourth; 35 percent ranked advertisement fifth; 18 percent
ranked friends sixth; and 17 percent ranked printed information seventh
(30).
In responding to question 19, 56 percent stated they used the
Basic Four Food Groups in planning their child's diet. Twenty-nine
percent stated they frequently used the Basic Four, with 11 percent
Table 5.
Question
27
Percent of Responses for Two Questions Concerning Nutrition Information and Meal Planning
Percentage of Respondents
16. Where do you get information about how to feed your child?
Printed information Child's Doc tor ...••••...•••.•.•....•.•.•• Formal class ............................ . Other ................................... . Relatives ............................... . Friends ................................. . Combination answer of the above ...•••.•••
19. Do you use the Basic Four Food Groups in planning your child's diet?
29% 18% 10% 11%
3% 2%
27%
Everyday . . . • • • • • • • . • . . . • • • . • • • • • . . . . . • . • • 56% Frequently . • • . • . . • • . . • . . . • . • . . • . . . . . . . . • . 29% Sometimes • . . . . . . . • • . . • . . • . . . . . . . . • . • . . . . . 11% Never . . • . • • • . • . • • . • • • . • . • . • • . . • • . • . • . • . . . 1% Never heard of it ............•..•.......• 3%
28
responding sometimes, 1 percent responding never, and 3 percent stated
they never heard of it (Table -2.).
Results of the Nutrition Knowledge Test
Responses to the 10 Nutrition Knowledge Test questions are given
in Table 6. Questions 17, 18, and 20-27 were specifically written to
provide data on nutrition knowledge. In question 17 respondents were
asked to list the kind of foods their child needed to eat everyday.
Seventy-six percent were able to list correctly three or four of the
Basic Four Food Groups, 10 percent were able to correctly give two
groups, 1 percent were·able_to correctly give one group, and 13 percent
gave a wrong answer. A wrong answer to this question included responses
such as: "protein, fat, carbohydrate," "foods with vitamins and
minerals," "nothing special required," and "foods rich in vitamins A ~
and Band C." The question specifically asked for kinds of food rather
than specific nutrients. Seventy-four percent of the respondents gave
a correct answer and 26 percent gave a wrong answer to question 18 con-
cerning what beverages children needed to consume everyday. A correct
answer was: water, milk, and fruit juices; all other answers were
considered wrong. Sixty-five percent gave a correct answer with 35
percent wrong when asked in question 20 whether gelatin or "Jello"
desserts were a good source of protein. In question 21, 66 percent
gave a correct answer when asked to pick the better source of calcium
from the three choices of orange juice, turnip greens, or apple. The
correct response to this question·was turnip greens.
Question 22 was concerned with diets being nutritionally adequate
when children have enough food to satisfy their appetites. Ninety-seven
29
Table 6. Percent of Responses for Ten Nutrition Knowledge Questions
Question
17. What kind-of foods does your child need to eat everyday?
Percentage of Respondents
Wrong • • • • • . • • • • • • • • . • • • • • . • • • • • • • • • • • • • • • • • . 13% One food group . • • • • . • • . . • • • • • • • • • . • • • • • • • • • . 1% Two food groups • • . • • . . • • . • • • • • • • • • • • • • . • • • • • 10% Three food groups • • • . . • • . . • • • • . • • • . . • • • • • . • • 26% Right answer, four food groups .••••••.•••.•. 50%
18. What beverages does your child need to eat everyday?
Wrong Right
20. Gelatin or "Jello" desserts are a good source of protein.
Wrong Right
21. What is a better source of calcium?
Wrong Right
22. When children have enough food to satisfy their appetite's, their diets are certain to be nutritionally adequate.
Wrong Right
23. It is better not to include orange juice and milk in the same meal.
Wrong Right
24~ A good source of protein for a meal is?
Wrong Right
26% 74%
35% 65%
34% 66%
3% 97%
9% 91%
7% 93%
30
Table 6. Continued. Percent of Responses for Ten Nutrition Knowledge Questions
Question Percentage of Respondents
25. Three foods that are good sources of Vitamin C are?
Wrong Right
26. What are some sources of Vitamin A?
14% 86%
Wrong answer • . • . . • . • • • . • . • . • • . • • • • • . • • • • . • • • 20% One good answer • . . • . • • . • • • • . • • . • • • • • • • . . • • • • 23% Two good answers • . • • • • . . • • • . • • • • • • . • • • • • • • • . 25% Three good answers • • • . • • . • • . • . • • • • • . . . . • • • • . 19% Right answer, four good answers •••••••.••••. 13%
27. Three foods that are good sources of iron are?
Wrong Right
36% 64%
31
percent of the respondents got this question right. For question 23,
the old belief that orange juice and milk could not be included in the
same meal was no longer considered valid by this population. In
question 24 when asked which source of protein was good, 93 percent
picked cheese, the one correct answer, and the remainder chose bacon,
cornbread, or carrots. Eighty-six percent picked the correct response
in question 25 concerning sources of ascorbic acid. The best answer
from the multiple choice question was tomatoes, oranges, and straw-
berries. In question 26 respondents were asked to list good sources
of foods high in vitamin A. Four good answers included such sources
as: deep green and deep yellow vegetables, liver, eggs, milk and
dairy products, and butter or fortified margarine. Thirteen percent
gave four or more good sources of vitamin A; 19 percent provided three
good sources; 25 percent gave two good sources; 23 percent· provided one
good source; and 20 percent gave a wrong answer. A wrong answer to this
question was most often no answer at all. Sixty- fo.ur percent of the
respondents picked the best sources of iron in a multiple choice question
listing foods both high and low in iron. Thirty-six percent selected
the wrong answer to question 27 concerning iron sources.
There were 10 Nutrition Knowledge questions (questions 17, 18, and
20-27) with a mean correct response of 30.26 out of a possible 40 points.
Question 26 concerning food sources of vitamin A had the lowest mean
response level with 1.83 points. Those who did the best on total score
also did the best on question 26 (Table]_).
The wrong answer on food sources of iron and calcium was given by
36 and 34 percent, respectively, of the respondents. Forty-three percent
32
Table 7. Correlation with Total Score for Ten Nutrition Knowledge Questions
MEAN
Question
17.
18.
20.
21.
22.
23.
24.
25.
26.
27.
STD. DEV.
MEAN NO. OF OMITS
RELIABILITY (KR20)
STD. ERROR OF MEAS.
Correlation with Total Score
0.35
0.33
0.48
0.60
0.18
0.24
0.35
0.46
0.54
0.61
30.26 (out of 40 possible)
6.357
1. 95
0.502
4.48
33
either could not list a good source of vitamin A or listed only one.
Studies·with infants and preschool children have indicated the low
nutrient intakes are most likely to be of vitamin A, ascorbic acid,
iron, and calcium (1, 5, 8, 9, 16, 17, 18, 26, 40, 41). In the
report of the Ten State Nutrition Survey hemoglobin levels were found
to be sufficiently low to be diagnosed as anemia for orte-third of the
children under six years of age (42, 43). In addition, low serum
concentrations of vitamin A were observed for one-third and low ascorbic
acid levels for 15 percent of the children under six years old (42, 43).
The results of this survey reflect the lack of knowledge of good food
sources of vitamin A, iron, and calcium. In a-nutrition knowledge
evaluation of urban homemakers in New York state, Young et al. found
that only one-fourth could provide a definition of a "balanced diet",
and one-third lacked any evidence of any nutrition knowl~dge (10).
Morse et al. studied the nutrition knowledge of 238 mothers in Vermont.
On a 33 question test the largest number of respondents, 102, were in
the 20-26 correct question range. Not one mother got all 33 questions
correct (12).
Characteristics of the Parents Completing the Survey
Occupation
Data collected about the parents completing the survey are
presented in Table 8. This included occupation, education, age, and
income. Sixty-two percent of the females listed housewife as their
occupation. Of those who responded with a job title other than house-
wife, 27 percent were professionals and 11 percent were non-professionals.
34
The correlation for this question was significant (r = 0.32) (Table 2) ~~ -
in that the professional female heads of household scored higher on
the Nutrition Knowledge Test than did the non-professionals. There was
no significant correlation for male heads of household, 77 percent of whom
were professionals and 17 percent non-professionals (r = 0.01) (Table l)· Metheny et al. found that although three-fourths of the mothers in their
study were employed outside the home, a few more of their children had
better diets than did the children of mothers not employed (18). Morse
et al. reported that of the mothers employed full or part-time the
professionals scored better on a nutrition knowledge test than the non-
professionals (12).
Education
Forty-eight percent of the female heads of household and 76 percent
of the male heads of household were college graduates. Eight percent
of the females and 44 percent of the males had graduate degrees. Eighty
percent of the females and 88 percent of the males had completed high
school. There was no significant correlation for questions 30 and 31
concerning level of education with the Nutrition Knowledge Test
(question 30, r = 0.21; question 31, r = 0.01) (Table l). Emmons and
Hayes reported that of the females in their study of low and middle
income mothers and children, 50 percent had completed high school,
14 percent had some college or other form of training beyond high
school, and 36 percent had not finished high school. The mothers in
that study had difficulty in providing valid nutritional reasons for
the inclusion of specific foods high in nutrients in the diets of their
children (13). Eppright et al. reported that three-fourths of the
Table 8.
Question
35
Percent of Responses of Parents Completing the Survey for Occupation, Education, Age, and Income
Percentage of Respondents
28. Occupation of female head of household:
Housewife . ·• • • • • • •. • • • • • • • • • • • • • • • • • . • • • • • • • . 62% Professional . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27% Non-professional • • • . • • . • • • • • • • • • . • • • • • • • . • • 11%
29. Occupation of male head of household:
Professional •...•••.••.••••••.•...••••••.•. 77% Non-professional • • • . • . • • . . . • . • • . . • • • • • • . • • • 17%
30. Number of years of school completed by female head of household:
First -College
twelfth grade ..................... .
College graduate .....•..................... Graduate study ............................ .
15% 32% 33%
7% Graduate degree • . • • • . • . • . . . • • • • . • . . • • . • • • • • 8%
31. Number of years of school completed by'male head of household:
First -College
twelfth grade ................. -.... .
College graduate ..••••••..•••••.•••..•••••• Graduate study ............................ . Graduate degree ........................... .
32. Age of female head of household:
7% 12% 22% 10% 44%
'5% 44% 40%
4% 0
18-25 years 26-32 years 33-39 years 40-47 years 48-54 years 55 and over •••••••••••.••••••..•.•••• 1 response
36
Table 8. Continued. Percent of Responses of Parents Completing the Survey for Occupation, Education, Age, and Income
Question Percentage of Respondents
33. Age of male head of household:
18-25 years 26-32 years 33-39 years 40-47 years 48-54 years 55 and over
• e • e •••••• e • e e II II e II e II II II II II e e II II II II II II
34. Total family income for one year:
3% 30% 40% 18%
1% 0.5%
Under $5, 000 . • . • • • • . . • . . • . • • • • . • . . . • • 1 response $5 '000-9' 999 . . • . . • . . . • . • . . • • . . . . • . . . . . . • . . • 3% $10' 000-14' 999 • . • . . . • • • . • • • . . • • . • • • • . . • • • . • 6% $15,000-19,999 •..•......•.....••..••..•.... 24% $20,000 and over •..••.........•.•...•..•... 56%
37
parents of preschool children in the North Central region of the United
Stated had completed high school or more. Three-fourths of the mothers
in the survey had at some time attended organized classes in nutrition.
Levels of educational attainment of the mothers were related positively
and significantly to the calcium, iron, thiamin, riboflavin, and ascorbic
acid content of their children's diets. The better educated mothers
scored higher on a test designed to ascertain nutrition knowledge (7).
Age
Eighty-~four percent of the females and 70 percent of the males
were between 26 and 39 years of age.
Income
Eighty percent of those responding to the question on total family
income for one year earned over $15,000. There was no significant
correlation between total family ·income and total score on the Nutrition
Knowledge Test (r = 0.03, Table~). Lund and Burk reported that level
of education went up as income went up in their survey of Minnesota
children (20). Owen et al. reported that three-fourths of the family
incomes in their study were below $5,500 per year. They found that as
income decreased and proportion of income spent on food increased,
nutritional quality increased although total food intake was less.
Calories appeared to be the limiting factor in this study. These
investigators also reported that as the educational level of the mothers
increased, the family income also increased (14). Young et al. found
that among the urban homemakers studied in New York there was no con-
sistent pattern in the relationship between family income and nutrition
knowledge (10).
SUMMARY AND CONCLUSION
Thirty-four percent of the children were primarily breast fed as
infants which is a higher percentage than that reported earlier by
several other researchers (7, 30, 35). There was widespread use of
vitamin supplements which corresponded with an apparent nationwide
trend toward use of vitamin and nutrient supplements (1, 7, 14, 19, 20).
Those who scored the best on the Nutrition Knowledge Test gave their
children the more nutritious snack foods, and also provided the best
variety of foods high in protein. Variety in type of protein food was
very limited. There was in the population surveyed a general trend
toward consumption of lowfat and skim milk products. More parents
relied on printed information than any other source of information
in obtaining knowledge to feed their children.
Very few respondents had knowledge of food sources of vitamin A.
Knowledge of food sources of iron and calcium was limited although not
to the same degree as was evident for sources of vitamin A. A majority
of the respondents stated they used the Basic Four Food Groups in meal
planning, however their knowledge of food sources of vitamin A, iron
and calcium was quite limited. Scores on the Nutrition Knowledge Test
were considered fair with a mean of 30.26 out of 40 possible points
since at least 48 percent of the females and 76 percent of the males
participating in the survey were college graduates. In comparison, the
degree of difficulty on the Nutrition Knowledge Test was considered to
be first year high school level. Professional women in this survey
scored higher on the Nutrition Knowledge Test than did the non-
professional women. Eighty percent of the parents reported annual
38
39
incomes of $15,000 and over. There was no correlation between nutri-
tion knowledge and level of education or income. However, it should
be noted that the level of education and income of this particular
population far exceeds the national average and that the lower levels
of income and education were not represented in this study.
RECOMMENDATIONS
Respondents of the survey had above average levels of formal
education and annual incomes, yet their knowledge of nutrition was
fair at best as determined from results on a basic Nutrition Knowledge
Test and responses to feeding practice questions. In this survey
only 14 percent of the respondents could list a variety of foods high
in protein. Variety in eating patterns is the key to obtaining the
essential nutrients. This is particularly true for preschool children
who eat very small servings of food. Emphasis should be placed on
increasing the variety of foods rich in vitamin A, calcium, and iron.
In this day of inflated food prices a way to teach consumer's
better eating habits would be to provide information which shows that
a good knowledge of nutrition and the sources of the essential nutrients
applied to food selection could lower their food bill. How to obtain
vitamins, minerals, and proteins from foods and not from vitamin
supplements or higher priced sources of protein would be a good example.
Also emphasis should be placed on those foods that are good sources of
several nutrients.
The majority of the children in this survey would taste a food
that was disliked. Children need to develop good eating habits early
and a good way to do this is to encourage them to try a wide variety
of foods, even those which may be disliked.
An intensive campaign using all forms of mass media is needed to
teach food sources of the essential nutrients. A good example of how
this type of campaign has been effective is the current trend of using
lowfat and skim milk products as indicated by the results of this survey.
40
41
Reliance on the Basic Four Food Groups to reach the public is not
enough. Teaching basic nutrition, chemistry, and food sources of
nutrients should be started in early elementary school and then con-
tinued throughout high school, and taught to men as well as women.
It is strongly recommended that the ability to display a good knowledge
of nutrition and application of that knowledge should be as much a
prerequisite of graduation from high school as the ability to read
or write.
Encouraging parents to make wiser food choices will help them
to pass the information along to their children. Only 10 percent of
the parents in this survey stated that they had taken formal classes
in nutrition, when asked how information was obtained about how to
feed their child. Our goal in nutrition education should be to
increase that figur~ppreciably. In this study, level of education
did not correlate with nutrition knowledge because the lower levels
of education were not represented. Other authors have shown that
educational level influences the nutritive quality of the diet (7, 10).
Section 4, panel 1 of the White House Conference on Food, Nutrition
and Health suggested many ideas to improve the health of the children
of the United States. The following is part of recommendation six:
"Throughout his life every person should be able to make decisions on his choices of food based on an understanding of his needs as determined by: 1) his physiological state and physical activities; 2) his knowledge of the nutrient composition of plant, animal, and formulated foods in his environment; 3) his ability to distinguish between truth and distortion in relation to foods, nutrition, and health; 4) his personal likes and cultural background; and 5) his ability to use his available resources whatever they may be. As future citizens in a democracy, children must acquire knowledge and social consciousness which will enable them to participate intelligently in the adoption of public policy affecting the nutrition of the people." (44)
r
LITERATURE CITED
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2. Hill, M. M~- _ 1969_ Creating good food habits--start young, never quit, in Food For Us All, The Yearbook of Agriculture, United States Department of Agriculture, Washington, D. C.
3. Beyer, N. R. and P. M. Morris 1974. Food attitudes and snacking patterns of young children, J. of Nutr. Ed., ~:131.
4. Burkhart, A. C., 1969 Smarten up and snack right! here's how to do it, in Food For Us All, The Yearbook of Agriculture, United States Department of Agriculture, Washington, D. C.
5. United States Department of Agriculture 1968 Dietary Levels of Households in the United States, ARS 62-17, Washington, D. c.
6. Hiemstra, S. J. _· 1972 Evaluation of USDA food programs, J. of the Am. Diet. Assoc., 60:193.
7. Eppright, E. S., H. M. Fox, B. A. Fryer, G. H. Lamkin, V. M. Vivian, and E. S. Fuller 1972 Nutrition of infants and preschool children in the North Central region of the United States of America, in World Review of Nutrition and Dietetics, 14:269.
8. Morgan, A. F. 1959 Nutritional Status USA, California Agricultural Experimental Station Bulletin 769.
9. Kelsay, J. L. 1969 A compendium of nutritional status studies and dietary evaluation studies conducted in the United States, 1957-1967, J. of Nutr., .22_:119.
10. Young, C. M., B. G. Waldner, and K. Berresford 1956 What the homemaker knows about nutrition, II, Level of nutrition knowledge, J. of Am. Diet. Assoc., ~:218.
11. Young, C. M., B. G. Waldner, and K. Berresford 1956, What the homemaker knows about nutrition, III. Relation of knowledge to practice, J. of the ~.lll. Diet. Assoc., ~:321.
12. Morse, E. H., M. M. Clayton, L. deG. Cosgrove 1967 Mothers nutrition knowledge, J. of Ho. Ee., 2.2_:667.
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14. Owen, F. M., K. M. Kram, P. J. Garry, J.E. Lowe, and A.H. Lubin 1974 A study of nutritional status of preschool children in the United States, Ped., 53:597.
42
43
15. Owen, G. M. and K. M. Kram 1969- Nutritional st~tus of preschool children in Mississippi, J. of the Am. Diet. Assoc., 54:490.
16. United States Department of Agriculture 1969 Food intake and nutritive value of diets of men, women, and children in the United States, Spring, 1965, ARS 62-18, Washington, D. C.
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18. Metheny, N. Y., F. E. Hunt, M. B. Patton, and H. Heye 1962 The diets of preschool children, I. Nutritional sufficiency findings and family marketing practices, II. Factors in food acceptance, J. of Ho. Ee., 54:297.
19. Brown, M. L., D. S. Smith, J. L. Mertz, H. M. Hill, and S. F. Adelson, 1970_ Diet and nutriture of preschool children in Honolulu, J. of the Am. Diet. Assoc., 22_:22.
20. Lund, L. A. and M. C. Burk_ 1969 A Multidisciplinary Analysis of Children's Food Consumption Behavior, Agricultural Experiment Station Technical Bulletin 265, University of Minnesota, Minneapolis.
21. Inano, M. and D. J. Pringle 1975 Dietary survey of low income, rural families in Iowa and North Carolina, III. Contribution of food groups to nutrients, J. of the Am. Diet. Assoc., ~:366.
22. United States Department of Agriculture 1968 Nutritive quality of diets, USA, Report to the Committee on Agriculture of th~ United States House of Representatives, Washington, D. C.
23. Emerson, G. A. 1967 Nutritional Status, USA, J. of Nutr., 91:51.
24. Goldsmith, G. A. 1965 Clinical nutrition problems in the United States today, Nutr. Rev., ±.1:1.
25. Lamb, M. W. and B. C. Ling 1946 An analysis of food consumption and preferences of nursery school children, Child Dev., 11.:187.
26. Dierks, E. C. and L. M. Morse 1965 Food habits and nutrient intakes of preschool children, J. of the Am. Diet. Assoc., ~:292.
27. Vance, T. F. 1932 Food selections of nursery school children, Child Dev., 2_:169.
28. Breckenridge, M. E. 1959 Food attitudes of five to twelve year old children, J. of the Am. Diet. Assoc., 35:704.
44
29. Harrill, I., D. Smith and J. J. Gangever 1972 Food acceptance and nutrient intake of preschool children, J. of Nutr. Ed., !:103.
30. Sanjur, D. and A. c .. Scoma. 1971, Food habits of low income children in Northern New York, J. of Nutr. Ed., 1_:85.
31. Glazer, A. 1964 Nursery school can influence foods acceptance, J. of Ho. Ee., 56:680.
32. Adelson, s. F. 1968. Changes in diets of households, 1955 to 1965, J. of Ho. Ee., 60:449.
33. Frary, R. B. 1974- Comprehensive questionnaire analysis program, Virginia Polytechnic Institute and State University, Blacksburg, Virginia.
34. Falkner, F. 1962 Some physical growth standards for white North American children, Ped., l2_:467.
35. Wentworth, J. and J. Barton. 1975 Personal Communication, Unpublished data, Virginia Polytechnic Institute and State University, Blacks-burg, Virginia.
36. Fomon, S. J. 1974 Infant Nutrition, 2nd Edition, Saunders, Philadelphia, Pennsylvania.
37. Llg, F 1948 The· child's idea of what and how to eat, J. of the Am. Diet. Assoc., ~:658.
38. Martin, E. A. 1965. Nutrition in Action, 2nd Edition, Holt, Rinehart, and Winston, New York.
39. National Academy of Sciences, Washington, D. C. 1974 Recommended Dietary Allowances, 8th Edition, Food and Nutrition Board, Washington, D. c.
40. Filer, L. J. and G. A. Martinez 1963. Caloric and iron intake by infants in the United States, an evaluation of 4000 representative six-month olds, Clin. Ped., 1_:470.
41. Guthrie, H. A. 1963 Nutritional intake of infants, J. of the Am. Diet. Assoc., 43:120.
42. Schaefer, A. E. 1969 The national nutrition survey, J. of the Am. Diet. Assoc., 54:371.
43. Schaefer, A. E. 1969 Are we well fed? the search for the answer, Nutr. Tod., !:2.
44. The White House Conference on Food, Nutrition, and Health; Section Four, Panel One, Nutrition Teaching in Elementary and High Schools 1970 J. of Nutr. Ed., 1:24.
APPENDIX 1 Cover Letter for Questionnaire
Dear Parents:
This is a nutrition knowledge and feeding questionnaire about what your child eats. If you would take just 5 minutes to complete the survey and return it to me I would appreciate it very much. I need your help in supplying data for this survey. The information you provide will give nutritionists and physicians a better under-standing of the various factors which contribute to the development of food habits of young children. If you have more than one child, pick the youngest one who is currently in a preschool program, to use as a reference for this survey. All the information you give will be kept strictly confidential. Neither your name nor address will be used in any published data.
This questionnaire forms a basis for my thesis which is part of the requirements for the degree of Master of Science in Human Nutrition and Foods, Virginia Polytechnic Institute and State University, Blacksburg, Virginia. If you have any question, call 591-3675 (home phone) or 591-3900, ext. 221 (work phone).
Thank you, •
Julia L. Johansen, R.D. (Mrs.)
JLJ/mew
45
APPENDIX 2 Nutrition Knowledge and Feeding Questionnaire
Directions: 1.) Fill in your name and the date. 2.) Fill in the blank or check the best answer for each question. 3.) Seal the survey in the envelope provided and mail.
1.
2. 3.
4. 5. 6. 7.
8.
9.
10.
11.
When was the child born? a.) ----------~-----~ month day year
Sex of the child? a.) girl __ , b.) boy . • Is this your a.) first child , b.) second child c.) third child __ , d.) fourth child __ , e.) fifth child __ , f.) other __ ? Was your child a.) full term __ or b.) premature __ ? How much did the child weigh at birth? a.) __ lbs., __ ozs. What was the length of the child at birth? a.) inches. Was your child primarily a a.) breast fed baby __ , or b.) bottle fed baby __ ? What.was the first food other than milk that you fed your child? a.) ------------------------------Do you currently give a.) everyday b.) frequently~
your child vitamins? c.) sometimes d.) never
Did you give your child vitamins when he or she was a baby? c.) sometimes a.) everyday .
b.) frequently~ What foods does your
d.) never child eat most often as a snack? -----
12. What kind of high protein foods do you serve your child everyday? (other than milk)
--~-~~~-~~-~~-~-~~-----13. How many servings of foods high in protein does your child eat everyday? a.) one d.) four b.) two e.) five--c. ) three £. ) none
14. What type of milk does your child drink most often? a.) whole d.) chocolate milk b.) 2% or lowfat milk e.) milkshake c.) skim milk f.) none
15. When served a food which your child dislikes, will (he,she) taste it?
16.
a.) everytime__ c.) sometimes b.) frequently__ d.) never Where do you get information about how to feed your child? Pick one: a.) Relative o.; Child's doctor c.) Formal classes (such as Home Economics, nutrition, etc.) __ d.) Printed information e.) Friends f.) Other
46
I.
II.
IIL
47
Appendix 2, Continued. Nutrition Knowledge and Feeding Questionnaire
17. What kind of foods does your child need to eat everyday? ----18. What beverages (or liquids) does your child need to eat everyday?
19. Do you use the "Basic Four Food Groups" in planning your child's diet? a.) everyday__ d.) never b.) frequently__ e.) never heard of it c.) sometimes
20. Gelatin or "Jello" desserts are a good source of protein. a.) True b.) False
21. What is a better source of calcium: a.) orange juice__ c.) apple __ b.) turnip greens __
22. When children have enough food to satisfy their appetites, their diets are certain to be nutritionally adequate. a.) True b.) False
23. It is better not to include orange juice and milk in the same meal because the orange juice causes the milk to curdle in the stomach. a.) True b.) False
24. A good source of protein for a meal is: a.) bacon c.) cheese b.) cornbread d.) carrots
25. Three foods that are good sources of vitamin C are: a.) Apples, grapes, and cooked carrots b.) Tomatoes, oranges, and strawberries __ c.) Green beans, wal~uts, and grapefruits __ d.) Oranges, meat, and milk
26. What are some sources of vitamin A? --------------~·
27. Three foods that are good sources of iron are: a.) Liver, milk, prunes b.) Dry beans and peas, egg yolks, liver c.) Spinach, apples, enriched bread __ --
OPTIONAL SECTION: It would be helpful to have the following information. But you are not required to answer the questions if you feel they are too personal. 28. Occupation of female head of household a.)
----------~ 29. Occupation of male head of household a.) ------------30. Number of years of school completed by female head of household: a.) First grade through 12th grade years b.) College years c.) College graduate· d.) Years graduate study __ e.) Graduate degree __
31. Number of years of school completed by male head of household: a.) First grade through 12th grade_____years b.) College_____years c.) College graduate __ d.) Years graduate study __ · e.) Graduate degree __
IV.
48
Appendix 2, Continued. Nutrition Knowledge and Feeding Questionnaire
32. Age of female head of household years. 33. Age of male head of household years. 34. Total family income for one year:
a.) Under $5,000 ~~-
b.) $5,100-$9,999 c.) $10,000-$14,999 d.) $15,000-$19,999 e.) $20,000 and ove-r~-
The vita has been removed from the scanned document
ABSTRACT
A survey of the parents of preschool children in an upper-middle
income area of Northern Virginia. The 34 question survey, which was
answered by 272 families, was designed to correlate nutrition knowledge
with income, level of education, and feeding practices. Over half the
parents reported annual incomes of $20,000 and over. At least 48
percent of the females and 76 percent of the males were college gradu-
ates. Thirty-four percent of the children were primarily breast fed
as infants. There was widespread use of vitamin supplements. There
was a trend toward the use of lowfat and skim milk products. More
parents relied on printed information as the primary source in obtaining
nutrition information. Nutrition knowledge was rated as fair by
analysis of the results of a 10 question test which was part of the
survey. Those who scored the best on the Nutrition Knowledge Test
gave their children the better snack foods, and also provided the best
variety of foods high in protein. Knowledge of food sources of vitamin
A, iron, and calcium was limited. Professional women scored higher
on the Nutrition Knowledge Test than did the non-professional women.
There was no correlation between nutrition knowledge and level of
education or income.
50