1
|
Gans KM, Chacón V, Warykas SW, Baird M, Esquivel V, Zhang S, Tovar A, Ray S, Inman N, McCauley P, Zambrano Rodriguez VC, Miller M, Stekler N, Markham Risica P. Exploring barriers and facilitators to water availability and accessibility, and potential strategies for improving water accessibility and children's intake in family childcare homes: a qualitative study. Front Nutr 2025; 12:1442070. [PMID: 40144563 PMCID: PMC11939014 DOI: 10.3389/fnut.2025.1442070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 01/23/2025] [Indexed: 03/28/2025] Open
Abstract
Background Children in the U.S. drink too little water and too much juice and sugar sweetened beverages. Inadequate access to drinking water in locations where children spend substantial time, like family childcare homes (FCCH) could play a role in low child water intake. The aim of this qualitative study was to explore barriers and facilitators to water availability and accessibility in FCCH, and determine potential strategies for facilitating water accessibility and children's intake in FCCH. Methods We conducted virtual interviews, in Spanish and/or English, with family child care providers (FCCP) from Rhode Island, Connecticut, and Massachusetts. Interviews were conducted by University of Connecticut graduate students, including two who were fluent in Spanish and English. These were audio-recorded, transcribed verbatim, and translated to English. We conducted a deductive analysis using a priori themes. Additional codes were developed and applied to capture emerging themes from the qualitative data. Results Twenty FCCP (100% identified as female; 50% as Latina) participated in the interviews. FCCP barriers to water availability at FCCH included focus on other beverages, e.g., milk; confusion with the Child and Adult Care Food Program (CACFP) guidelines regarding water, and concerns about: water quality, mess, children eating enough food/milk, bathroom accidents, and cost for filters/bottled water. Barriers to children drinking water included: children not liking or preferring water, parental preferences/role modeling, and parental concerns about water quality. Suggested potential strategies to facilitate water access and intake included water filters to ensure safe water access, self-serving stations and water bottles to encourage autonomy among children, and incorporating water into daily routines. Participants also favored materials and activities to educate and encourage children to drink water and to keep track of their intake. Conclusion These findings suggest that interventions to increase water consumption at FCCH should provide resources to guarantee safe water access to children, encourage children to drink water, and help clarify misperceptions and confusion around CACFP beverage guidelines. Future research should evaluate the effectiveness of interventions to provide education and water access resources to FCCP and families on improving child water access, availability and intake.
Collapse
Affiliation(s)
- Kim M. Gans
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, United States
| | - Violeta Chacón
- The UConn Rudd Center for Food Policy and Health, Hartford, CT, United States
| | - Sarah Wen Warykas
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, United States
| | - Madeline Baird
- Department of Anthropology, University of Connecticut, Storrs, CT, United States
| | - Vanessa Esquivel
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, United States
| | - Suge Zhang
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, United States
| | - Alison Tovar
- Department of Behavioral and Social Sciences, Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, RI, United States
| | - Snehaa Ray
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT, United States
| | - Naomi Inman
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, United States
| | - Peter McCauley
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, United States
| | - Viviana C. Zambrano Rodriguez
- School of Journalism and Mass Communications, College of Information and Communications, University of South Carolina, Columbia, SC, United States
| | - Michelle Miller
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, United States
| | - Nathaniel Stekler
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, United States
| | - Patricia Markham Risica
- Department of Behavioral and Social Sciences, Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, RI, United States
| |
Collapse
|
2
|
Bauer KW, Weeks HM, Clayson M, Needham B. Perceptions of tap water associated with low-income Michigan mothers' and young children's beverage intake. Public Health Nutr 2022; 25:1-10. [PMID: 35570674 PMCID: PMC9666652 DOI: 10.1017/s1368980022001136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/14/2022] [Accepted: 04/19/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To quantify perceptions of tap water among low-income mothers with young children residing in Michigan and examine associations between perceptions of tap water, mothers' and young children's beverage intake, and mothers' infant feeding practices. DESIGN Cross-sectional study. SETTING Online survey. PARTICIPANTS Medicaid-insured individuals who had given birth at a large Midwestern US hospital between fall 2016 and fall 2020 were invited by email to complete a survey in winter 2020 (N 3881); 15·6 % (N 606) completed eligibility screening, 550 (90·8 %) were eligible to participate, and 500 (90·9 %) provided valid survey data regarding perceptions of tap water, self and child beverage intake, and infant feeding practices. RESULTS Two-thirds (66·2 %) of mothers reported that their home tap water was safe to drink without a filter, while 21·6 % were unsure about the safety of their home tap water. Mothers' perceptions of their home tap water were associated with their own tap and bottled water intake and their young children's tap water and bottled water intake. Mothers with more negative perceptions of tap water in general, independent of their perceptions about their home tap water, consumed more bottled water and sugar-sweetened beverages, and their young children drank bottled water and fruit drinks more frequently. Few associations were observed between mothers' perceptions of tap water and infant feeding practices. CONCLUSIONS Uncertainty about tap water safety and negative perceptions of tap water are common among low-income Michigan mothers. These beliefs may contribute to less healthful and more costly beverage intake among mothers and their young children.
Collapse
Affiliation(s)
- Katherine W Bauer
- Department of Nutritional Sciences, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI48104, USA
| | - Heidi M Weeks
- Department of Nutritional Sciences, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI48104, USA
| | - Michelle Clayson
- Department of Nutritional Sciences, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI48104, USA
| | - Belinda Needham
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| |
Collapse
|
3
|
Grummon AH, Sokol RL, Goodman D, Hecht CA, Salvia M, Musicus AA, Patel AI. Storybooks About Healthy Beverage Consumption: Effects in an Online Randomized Experiment With Parents. Am J Prev Med 2022; 62:183-192. [PMID: 34688521 PMCID: PMC8748291 DOI: 10.1016/j.amepre.2021.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/29/2021] [Accepted: 07/28/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Parents spend substantial time reading to their children, making storybooks a promising but understudied avenue for motivating parents to serve their children healthier beverages. This study examines parents' reactions to messages promoting healthy beverage consumption embedded in a children's storybook. METHODS In 2020, a total of 2,164 demographically diverse parents of children aged 6 months to 5 years participated in an online survey. Participants were randomized to view control messages (school readiness) or 1 of 3 beverage message topics (sugary drink discouragement, water encouragement, or combined discouragement and encouragement) presented as pages from the storybook Potter the Otter. Survey items assessed parents' reactions to the messages and their perceptions, beliefs, and intentions regarding sugary drinks and water. Data were analyzed in 2021. RESULTS Compared with control messages, exposure to the beverage messages led to higher discouragement from serving children sugary drinks and higher encouragement to serve children more water (p<0.001). The beverage messages also elicited more thinking about beverages' health impacts and led to stronger perceptions that sugary drinks are unhealthy (p<0.001). Moreover, the beverage messages led to higher intentions to limit serving children sugary drinks and higher intentions to serve children more water (p≤0.02). Parents' reactions to the beverage messages did not differ by most demographic characteristics. Few differences in outcomes were observed among the 3 beverage message topics. CONCLUSIONS Embedding beverage messages in storybooks is a promising, scalable strategy for motivating parents from diverse backgrounds to serve children more water and fewer sugary drinks.
Collapse
Affiliation(s)
- Anna H Grummon
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
| | - Rebeccah L Sokol
- School of Social Work, Wayne State University, Detroit, Michigan
| | - Dina Goodman
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Christina A Hecht
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, California
| | - Meg Salvia
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Aviva A Musicus
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Anisha I Patel
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
| |
Collapse
|
4
|
Franse CB, Boelens M, Fries LR, Constant F, van Grieken A, Raat H. Interventions to increase the consumption of water among children: A systematic review and meta-analysis. Obes Rev 2020; 21:e13015. [PMID: 32167233 PMCID: PMC7317453 DOI: 10.1111/obr.13015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 02/21/2020] [Indexed: 12/17/2022]
Abstract
The aim of this study was to conduct a systematic review and meta-analysis on the effectiveness of interventions to increase children's water consumption. A systematic literature search was conducted in seven electronic databases. Studies published in English before 18 February 2019 that evaluated any type of intervention that measured change in water consumption among children aged 2 to 12 years by applying any type of design were included. Of the 47 interventions included in the systematic review, 24 reported a statistically significant increase in water consumption. Twenty-four interventions (17 randomized controlled trials and seven studies with other controlled designs) were included in the meta-analysis. On average, children in intervention groups consumed 29 mL/d (confidence interval [CI] = 13-46 mL/d) more water than did children in control groups. This effect was larger in eight interventions focused specifically on diet (MD = 73 mL/d, CI = 20-126 mL/d) than in 16 interventions focused also on other lifestyle factors (MD = 15 mL/d, CI = 1-29 mL/d). Significant subgroup differences were also found by study setting and socioecological level targeted but not by children's age group, intervention strategy, or study design. In conclusion, there is evidence that, on average, lifestyle interventions can lead to small increases in children's daily water consumption. More research is needed to further understand the specific intervention elements that have the greatest effect.
Collapse
Affiliation(s)
- Carmen B. Franse
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
| | - Mirte Boelens
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
| | | | | | - Amy van Grieken
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
| | - Hein Raat
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
| |
Collapse
|
5
|
Dibay Moghadam S, Krieger JW, Louden DKN. A systematic review of the effectiveness of promoting water intake to reduce sugar-sweetened beverage consumption. Obes Sci Pract 2020; 6:229-246. [PMID: 32523712 PMCID: PMC7278905 DOI: 10.1002/osp4.397] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/26/2019] [Accepted: 12/03/2019] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To examine whether the promotion of water intake could reduce sugar-sweetened beverage (SSB) consumption or purchases independent of interventions that target SSBs. METHODS Seven databases were systematically searched. Included studies used water promotion as the primary intervention; used a controlled trial, single group pre-post, or prospective cohort study design; included a measure of SSB consumption or purchase; enrolled human participants of any age who lived in high-income or middle-income countries; contained original data; and appeared in a peer-reviewed English-language article published from 1 January 2000 to January 4, 2019. The search yielded 7068 publications, from which 108 were chosen for full-text review. Seventeen were included in this review. RESULTS Nine of the 17 studies were randomized controlled trials, six were nonrandomized controlled trials, and 2 were single-group pre-post studies. Participants were primarily children and adolescents. Interventions included water provision, education or promotion activities. Ten of 17 studies were at low or some/moderate risk of bias. Seven studies showed a statistically significant decrease in SSB consumption of which only 2 were at low or some/moderate risk of bias. CONCLUSIONS This review found limited evidence that interventions aimed solely at increasing water consumption reduce SSB intake. Further research is needed to investigate whether interventions that combine water promotion and SSB reduction strategies could be synergistic for reducing SSB intake.
Collapse
Affiliation(s)
- Sepideh Dibay Moghadam
- Department of EpidemiologyUniversity of WashingtonWashingtonUnited States of America
- Fred Hutchinson Cancer Research CenterCancer Prevention ProgramWashingtonUnited States of America
| | - James W. Krieger
- Department of Health ServicesUniversity of WashingtonWashingtonUnited States of America
- Healthy Food AmericaWashingtonUnited States of America
| | - Diana K. N. Louden
- University LibrariesUniversity of WashingtonWashingtonUnited States of America
| |
Collapse
|
6
|
Developing a national research agenda to reduce consumption of sugar-sweetened beverages and increase safe water access and consumption among 0- to 5-year-olds: a mixed methods approach. Public Health Nutr 2019; 23:22-33. [PMID: 31486348 DOI: 10.1017/s1368980019002106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Sugar-sweetened beverage (SSB) consumption in early childhood is a public health concern. Adequate hydration in early childhood is also important. We developed a national research agenda to improve beverage consumption patterns among 0-5-year-olds. This article focuses on the process used to develop this research agenda. DESIGN A mixed methods, multi-step process was used to develop the research agenda, including: (i) a scientific advisory committee; (ii) systematic reviews on strategies to reduce SSB consumption and increase water access and consumption; (iii) two stakeholder surveys to first identify and then rank strategies to reduce SSB consumption and increase water access and consumption; (iv) key informant interviews to better understand determinants of beverage consumption and strategies to improve beverage consumption patterns among high-risk groups; (v) an in-person convening with experts; and (vi) developing the final research agenda. SETTING This process included research and stakeholders from across the United States. PARTICIPANTS A total of 276 participants completed survey 1 and 182 participants completed survey 2. Key informant interviews were conducted with 12 stakeholders. Thirty experts attended the convening, representing academia, government, and non-profit sectors. RESULTS Thirteen key issue areas and 59 research questions were developed. Priority topics were beverage consumption recommendations, fruit-flavoured drink consumption, interventions tailored to high-risk groups, and family engagement in childcare. CONCLUSIONS This research agenda lays the groundwork for research efforts to improve beverage patterns of young children. The methods used can be a template to develop research agendas for other public health issues.
Collapse
|
7
|
Effects of a multipronged beverage intervention on young children's beverage intake and weight: a cluster-randomized pilot study. Public Health Nutr 2019; 22:2856-2867. [PMID: 31303190 DOI: 10.1017/s1368980019001629] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate whether a multipronged pilot intervention promoting healthier beverage consumption improved at-home beverage consumption and weight status among young children. DESIGN In this exploratory pilot study, we randomly assigned four childcare centres to a control (delayed-intervention) condition or a 12-week intervention that promoted consumption of healthier beverages (water, unsweetened low- or non-fat milk) and discouraged consumption of less-healthy beverages (juice, sugar-sweetened beverages, high-fat or sweetened milk). The multipronged intervention was delivered via childcare centres; simultaneously targeted children, parents and childcare staff; and included environmental changes, policies and education. Outcomes were measured at baseline and immediately post-intervention and included children's (n 154) at-home beverage consumption (assessed via parental report) and overweight/obese status (assessed via objectively measured height and weight). We estimated intervention impact using difference-in-differences models controlling for children's demographics and classroom. SETTING Two northern California cities, USA, 2013-2014. PARTICIPANTS Children aged 2-5 years and their parents. RESULTS Relative to control group children, intervention group children reduced their consumption of less-healthy beverages from baseline to follow-up by 5·9 ounces/d (95 % CI -11·2, -0·6) (-174·5 ml/d; 95 % CI -331·2, -17·7) and increased their consumption of healthier beverages by 3·5 ounces/d (95 % CI -2·6, 9·5) (103·5 ml/d; 95 % CI -76·9, 280·9). Children's likelihood of being overweight decreased by 3 percentage points (pp) in the intervention group and increased by 3 pp in the control group (difference-in-differences: -6 pp; 95 % CI -15, 3). CONCLUSIONS Our exploratory pilot study suggests that interventions focused comprehensively on encouraging healthier beverage consumption could improve children's beverage intake and weight. Findings should be confirmed in longer, larger studies.
Collapse
|