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Influences on Parents' Food Shopping for Children's Consumption in South Carolina

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Influences on Parents' Food Shopping for Children's Consumption in South Carolina University of South Carolina Scholar Commons Theses and Dissertations Spring 2020 Influences on arP ents’ Food Shopping for Children’s Consumption in South Carolina Nazratun Nayeem Monalisa Follow this and additional works at: https://scholarcommons.sc.edu/etd Part of the Public Health Education and Promotion Commons Recommended Citation Monalisa, N. N.(2020). Influences on Parents’ Food Shopping for Children’s Consumption in South Carolina. (Doctoral dissertation). Retrieved from https://scholarcommons.sc.edu/etd/5779 This Open Access Dissertation is brought to you by Scholar Commons. It has been accepted for inclusion in Theses and Dissertations by an authorized administrator of Scholar Commons. For more information, please contact [email protected]. INFLUENCES ON PARENTS’ FOOD SHOPPING FOR CHILDREN’S CONSUMPTION IN SOUTH CAROLINA by Nazratun Nayeem Monalisa Bachelor of Social Sciences University of Dhaka, 1998 Master of Social Sciences University of Dhaka, 2000 Master of Public Health North South University, 2010 Submitted in Partial Fulfillment of the Requirements For the Degree of Doctor of Philosophy in Health Promotion, Education, and Behavior Arnold School of Public Health University of South Carolina 2020 Accepted by: Edward A. Frongillo, Major Professor Christine E. Blake, Committee Member Susan E. Steck, Committee Member Robin B. DiPietro, Committee Member Cheryl L. Addy, Vice Provost and Dean of the Graduate School © Copyright by Nazratun Nayeem Monalisa, 2020 All Rights Reserved. ii DEDICATION For my parents -- Dr. M. Mustafa Kamal and Mrs. Ayesha Akter & For my children -- Samin Ishraq and Faiza Anjum iii ACKNOWLEDGEMENT I would like to thank my advisor and committee chair, Dr. Edward Frongillo for his mentorship and guidance. Without his advice, guidance, patience, and constant support, this work would not be done. I am grateful to my committee members Drs. Christine Blake, Susan Steck, and Robin DiPietro for their support, valuable feedback, words of encouragement. Their questions prompted me towards critical thinking. I also want to thank all professors and staff members of the Department of Health Promotion, Education, and Behavior for their heartiest support during my PhD program. Thank you to Dr. Mark Macauda for his flexibility and support. My gratitude to my parents Dr. M Mustafa Kamal and Mrs. Ayesha Akter for the support, sacrifices, and encouragement. My thanks to my two brothers Shahryar Tashreef and Anwar Sadat, and my husband, A K M Syful Alam for staying by me whenever I needed them. The two young people who gave me the inspiration to work for children’s health are my son Samin Ishraq and daughter Faiza Anjum. My heartfelt thanks to them for their patience, cooperation, and relentless support throughout this process. I also want to thank my entire HPEB cohort, and my friends, Tatiana Martinez Jaikel, Nguyen Thi Mai Hoa, Sulochana Basnet, and Yoojin Cho for walking this path with me as colleagues and friends. I would also like to thank Dr. Tiara Rosemond, Dr. Andrea Warren as well as Dominique Barbee and Annie for their help and suggestions. Finally, I would like to thank the mothers and children in Columbia and its surrounding areas who gave their time and shared their experiences for this research. iv ABSTRACT Background: The diets of children in the United States typically do not meet dietary guidelines. Energy-dense nutrient-poor (EDNP) foods dominate children’s diets, contributing excessive energy, sugar, sodium, and fat intake. Home is the major source of children’s energy intake. Parents oversee household food purchases including foods for children. Objectives: This research aimed to 1) identify parents’ food and beverage purchases for their household and for 6-11-year old children; 2) understand how parents made food purchase decisions by adjudicating among different values; 3) understand children’s food choice construction, strategies to influence parents for desired items, and extent of children’s influence. Methods: Semi-structured qualitative interviews were conducted with 40 parents and their 6-11 years old children from South Carolina. Food shopping receipts for one week were collected. The interviews were audio-recorded, transcribed verbatim, and open- coded. Coding matrices compared decision-making processes by race/ethnicity, household food security, and child age; and parent-child perspectives on children’s strategies to influence parents’ food purchases. Results: Satisfying children's desire was the driving value in parents’ food purchasing decisions. Parents purchased desired breakfast items, snacks, fruits, fast food, and drinks specifically for children. Parents experienced conflicts among children’s desire, v food acceptance, emotions, health needs, food’s healthfulness, convenience, and cost. Value conflicts were exacerbated by stress. Parents wanted to purchase healthy foods if children desired. Children weighed three values, on average, to make food choices. Children in our sample reported 157 strategies that they used to influence parents’ food purchases including repeated polite requests, reasoned requests, and referencing friends. Parents had concordance with 83 of those strategies; more concordance was observed between parents and sons than daughters. Eighty percent of the parents perceived children had more than 50% influence on food purchases. One-third of the children perceived that their parents bought their desired items a lot or often. Conclusions: Children’s desire for, acceptance of, and emotions toward foods and drinks were important in parents’ decision making. Foods that parents purchased as per children’s requests were mostly EDNP except fruits. Interventions may help parents develop alternative strategies to make healthy items appealing to children instead of yielding to unhealthy food requests, and bridge the gap between their knowledge and purchases. Parents’ acknowledgement of children’s substantial influence on them suggests that children can serve as change agents for improving parents’ food purchases if children request healthy options. vi TABLE OF CONTENTS Dedication .......................................................................................................................... iii Acknowledgements ............................................................................................................ iv Abstract ................................................................................................................................v List of Tables ..................................................................................................................... ix List of Figures ......................................................................................................................x List of Abbreviations ......................................................................................................... xi Chapter 1: Introduction ........................................................................................................1 Chapter 2: Background and significance ...........................................................................14 Chapter 3: Research design and methods ..........................................................................59 Chapter 4: Results ..............................................................................................................79 4.1 Manuscript 1: Satisfying children’s desire: a primary value driving parents’ food purchasing decisions for elementary- school- aged children in South Carolina ..........................................................................80 4.2 Manuscript 2: Food-choice values of elementary school children and strategies used to influence mothers’ food purchasing decisions ............................................................................................................128 Chapter 5: Conclusions and implications ........................................................................174 References ........................................................................................................................188 Appendix A: Drinks and foods purchased for everyone in households ...........................205 Appendix B: Drinks and foods purchased for the elementary- school-aged children participating in the study ......................................................217 Appendix C: Drinks and foods elementary-school-aged children participating in the study liked..................................................................223 vii Appendix D: Drinks and foods elementary-school-aged children participating in the study requested ..........................................................230 Appendix E: Interview guide for parents .........................................................................235 Appendix F: Interview guide for children .......................................................................239 Appendix G: Socio-demographic and household food security questionnaire ................243 Appendix H: Informed consent form for parents: University of South Carolina: Consent to be a research subject ...................................................247 Appendix I: Assent form for children: University of South Carolina: Assent to be a research subject ...............................................................250 viii LIST OF TABLES Table 3.1 Total population, race/ethnicity, median household income, and poverty rate in Richland and Lexington counties in 2018 ....................60
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