Research ArticleA Qualitative Study of Puerto Rican Parent and ChildPerceptions Regarding Eating Patterns
Introduction
According to the US National Center for Health Statistics,1 obesity rates doubled among children and quadrupled in adolescents over the past 30years. The prevalence of childhood obesity in the US from 2015 to 2016 was 18.5% among children and adolescents aged 2–19years. The Centers for Disease Control and Prevention2 reported significant racial and age disparitiesamong these groups, finding a higher incidence of childhood obesity in Hispanics (25.8%) compared with other racial groups. Data reported in the Youth Risk Behavior Surveillance System3 showed that 24.2% of Puerto Rican adolescents (grades 9–12) were overweight or obese, 14.3% did not eat fruit, and 16.4% did not eat vegetables during the 7days before the survey. Moreover, 30% did not participate in ≥60 minutes physical activity on at ≥1day of the week. Studies showed that being overweight or obese between ages 14 and 19 is associated with increased adult mortality from a wide variety of systemic diseases.4, 5
Cultural differences among Hispanics suggest that to develop a successful program, it is important to address regional food preferences, attitudes, and beliefs regarding healthy eating as well as barriers to achieving good nutrition and health.6, 7, 8, 9, 10 There are not enough data on the dietary and physical activity behaviors of Puerto Rican children in the ages before adolescence.Such information is necessary to make the reduction of childhood obesity possible, which is why it is imperative to reduce the research gap.
One important way to prevent childhood obesity is to integrate parents and caregivers (PCs) into strategies for change by helping them understand their role in providing nutritious meals and physical activity coordination.11 A first step to promoting healthy food changes is to know the barriers that PCs believe can prevent them from feeding their children healthy foods. Among the barriers identified were difficulty low-income mothers had in understanding nutritional information on food labels, the lack of healthy choices while away from home, and time constraints resulting from everyday chores;12, 13 the time and effort PCs needed to prepare healthy meals;11, 14,15 preferences some children had for unhealthy foods, which may be influenced by peers; and the fact that unhealthy foods were more accessible compared with healthier alternatives, which were also more expensive.11, 15 In some areas, the low availability of healthy foods was also reported as a barrier owing to the social and physical environments.13, 16
The objective of the current study was to identify and discuss barriers to healthy eating among Puerto Rican early adolescents (EAs) and their PCs using focus groups. This methodology allowed for an in-depth exploration of the attitudes, opinions, and perceptions in underserved populations.17, 18, 19, 20 Furthermore, use of focus groups proved suitable in the development of educational or health-oriented interventions.21, 22, 23
Section snippets
Methods
A total of 7 focus groups were conducted: 5 with EAs and 2 with their PCs. Because the researchers were interested in focusing on the ages of EAs when children had not yet acquired habits that might lead to a higher incidence of obesity, the children selected for the study were all aged 12–14years. Studies showed that individual food choices of EAs are still influenced by parents even when they were in school.24 This influence was based mainly on parental role modeling rather than peers.25
Results
Five focus groups were conducted with EAs aged 12–14years (n = 52; 35 females and 17 males) and 2 were conducted with PCs (n = 17; 13 females and 4 males).
Discussion
The findings of this study provide insights into the factors that make healthy eating difficult among Puerto Rican EAs from the perspective of EAs and their PCs. Lack of accessibility to healthy food and its economic cost were the most frequently mentioned barriers by both EAs and PCs. This is in agreement with what was found inother studies with Latinos.42, 43, 44 Nevertheless, in those studies, participants focused on the cost and availability of fresh fruits and vegetables at the grocery
Implications for Research and Practice
A healthy eating program adequate for 12- to 14-year-old Puerto Rican children should be affordable and easy to prepare, and should respond to individual and regional preferences as well as food availability. It should consider the creation of healthy and tasty culturally sensitive recipes, encourage the enforcement of local and federal laws for food management at school, and offer recommendations for making healthy choices when eating away from home. Because most Puerto Ricans living in the US
Acknowledgments
This study was funded by Agriculture and Food Research Initiative of theUS Department of Agriculture, National Institute of Food and Agriculture Grant No. 2016-69001-24960. The authors would like to thank the Puerto Rico Agricultural Extension Service Consumer and Family Science educators who helped with their insights and the logistics of the focus group interviews in 4-H clubs, and the dietetic interns from the Nutrition and Dietetics Internship Program of the University of Puerto Rico,
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Conflict of Interest Disclosure: The authors have not stated any conflicts of interest.