The aim of this research was to examine complex influences on immigrant Latina mothers’ feeding practices and their children’s eating and physical activity habits. Theory-driven qualitative approaches are essential to understanding and intervening on disparities in pediatric obesity (Lindsay et al., 2006a
). Our findings suggest that immigrant Latina mothers face numerous barriers to establishing and maintaining healthful eating and physical activity habits for their families. Emergent themes from focus groups and interviews reflected the applicability of a social contextual model (Sorensen et al., 2003
) that relates social class and culture to multiple levels of influence on families (Novilla, Barnes, de la Cruz, Williams & Rogers, 2006
) posited by ecologic approaches (Bronfenbrenner, 1986
; McLeroy, 1998
) including: individual (e.g., material circumstances and daily hassles), interpersonal (e.g., social support and networks), organizational (child care, federally-funded nutrition programs.) and environmental (e.g., access and proximity to grocery stores, neighborhood safety, access to parks and recreational facilities) factors.
Although we purposively invited mothers with children aged two to four to participate in the study and developed the discussion guides to focus on feeding practices and eating and physical activity habits of preschool children, most mothers discussed their caregiving practices and children’s behaviors within the context of the whole family, including older children and extended family members. This finding corresponds with other qualitative research emphasizing the central importance of family as the unit of change within Latino communities (Crawford et al., 2004
). This theme also suggests that prevention of child overweight and obesity will not be successful without considering parents and children as a complete unit (Novilla, et al., 2006
), rather than viewing the problems of an obese child in isolation. Considering the importance of parenting in obesity prevention, only a limited number of interventions report the direct involvement of parents in childhood prevention efforts (Lindsay, Kim, Mucha & Gortmaker, 2006b
Limited social support and social networks emerged as important influences in the lives of Latino, immigrant families, affecting children’s eating and physical activity habits and mothers’ feeding practices. Social support not only appears to enable individuals to become part of the social structure, but also affects health and health-related beliefs and behaviors (Thornton et al., 2006
). Social networks have been shown to effect how parenting behaviors, especially in relation to prescribing diets of their young children (Thomas & DeSantis, 1995). In our study, lack of tangible support seemed to affect children’s daily activities, such as, decreasing opportunities for physical activity due to unavailability of a caregiver while the mother was working.
For a few study participants, their financial situations were so limited that there were times when they could not afford to feed their families. These mothers discussed relying on WIC Program benefits in times of financial hardship. Previous studies (Melgar-Quinonez & Kaiser, 2004, Cook et al., 2006
) have shown that household food insecurity influences mothers’ child feeding practices, children’s eating habits and health. Food insecurity in low-income Latino households has been related to a decrease in household supplies of juice but not fruit-flavored punches and drinks; over-consumption of which could promote excessive weight gain (Kaiser et al., 2004
About half of the immigrant mothers participating in our study relied on childcare for their children and this setting emerged as an important social environment influence on children’s eating and physical activity. Previous research has shown that in addition to parents and family members, behaviors related to diet and physical activity are also modeled by other caregivers outside of the family unit and that childcare settings represent an important setting where children’s early eating and physical activity are developed (Williams et al., 2002
; Patrick & Nicklas, 2005
; McGarvey et al., 2006; Dunn et al., 2006; Dowda et al., 2004). With the growing trend of an increasing number of families relying on childcare this becomes an important point of intervention to prevent child overweight (Story, Kaphingst, & French, 2006
). Moreover, our findings revealed that mothers whose children attended daycare centers appeared to have a better understanding of their children’s eating and physical activity patterns than mothers whose children attended home childcare, suggesting closer regulation and technical assistance is needed to support feeding and physical activity interventions in home daycare.
Our findings revealed that organizations such as the WIC program help address many of the barriers that mothers face in providing healthy foods to their children including food insecurity, nutrition education and cultural feeding practices. Others have emphasized the role that the WIC Program can play in addressing childhood overweight in low-income families, by building parenting capacity and skills to increase the effectiveness of nutritional education (Crawford et al. 2004
). Similar to previous research in this study population, (Dubowitz, Acevedo-Garcia, Salkeld, Lindsay, Subramanian & Peterson, 2007
), respondents reported that access and proximity to supermarkets influenced children’s eating habits and mothers’ feeding practices. Residents of lower socioeconomic, minority neighborhoods may be at a disadvantage regarding food choices, particularly if they perceive that alternative food options are not accessible or affordable (Popkin, Duffey & Gordon-Larsen, 2005
; Dibsdall, Lambert, Bobbin & Frewer, 2003
; Morland et al., 2002
; Laraia, Siega-Riz, Kaufman & Jones, 2004
). Mothers in our study also reported the cost of healthy foods as being an important factor influencing their daily food purchasing decisions and the variety of foods consumed by their children and families. A few studies suggest that expenditures for high priced foods typical of lower socioeconomic, minority neighborhoods, reduces servings of fruits, vegetables and dairy products consumed by lower income families (Chung & Myers, 1999
; MacDonald & Nelson, 1991).
Our findings revealed several environmental influences on children’s physical activity levels, including access to recreational facilities, neighborhood safety, weather and housing. A few studies of preschool children have found that the more time children spend outdoors, the higher their activity levels (Klesges et al., 1990; Baranowski et al., 1993
; Irwin et al., 2005
). Although eating and physical activity choices are ultimately made by individuals, environmental factors may pose barriers to individuals’ efforts to establish healthy lifestyles (Sallis & Glanz, 2006
). Substantial environmental changes in minority communities are needed to foster and maintain children’s healthful eating and physical activity habits (Sallis & Glanz, 2006
; Young & Nestle, 2002; Sherry et al., 2004
; Fitzgibbon & Stolley, 2004
Consistent with studies conducted in other populations, weather was one of the most important factors mentioned by Latino participants as a barrier for their children being physically active (Irwin, He, Bouck, Tucker & Pollett, 2005
; He, Irwin, Sangster Bouck, Tucker & Pollett, 2005
; Salmon, Owen, Crawford, Bauman & Sallis, 2003
). Among low socio-economic status population, lack of resources to obtain winter clothing could be yet another barrier to being active in cold weather. Interventions to promote physical activity among immigrant families from warm-weather countries could incorporate strategies to help families understand alternatives for being physically active during cool or rainy weather. For example, our findings suggest child care providers could educate Latino families about outdoor play suitable for young children, given mothers’ preference for “active play” as a leisure time physical activity.
Study participants reported that their children watched many hours of T.V. daily, influencing their physical activity levels. These findings are consistent with quantitative studies relating TV. viewing and children’s physical activity levels to risk of overweight (Ariza, Chen, Binns, & Christoffel, 2004
; Dennison, Erb, & Jenkins, 2002
). Several mothers also reported that having a TV in the bedroom increased the hours children watched TV during the day and at night. Consistent with research in older children (Wiecha, Sobol, Peterson & Gortmaker, 2001
), this theme suggests that parents should be educated about the importance of limiting preschoolers’ T.V. and video viewing time and access. Excessive TV viewing also may contribute to obesity by exposing children and families to advertising of unhealthy foods (Wiecha, Peterson, Ludwig, Kim, Sobol & Gortmaker, 2006
), a factor mentioned by some mothers participating in our study.
Results of this study should be considered in light of some limitations. Findings are based on a non-random, purposive sample of low-income, Latina mothers in the greater Boston metropolitan area initially recruited through the WIC Program to participate in a randomized health promotion trial (Peterson et al., 2002
). Purposive sampling can be considered a limitation on the generalizability of qualitative findings, but the multi-ethnic composition of participants in focus groups and interviews strengthens the potential applicability to several Latino population groups. The opinions and responses of mothers participating in the focus group discussions may have been influenced by some of the more vocal mothers at the discussion. Furthermore, mothers recruited to participate in this study could have been those who were more concerned in general about child feeding issues and healthy lifestyles. Future research can address these limitations by exploring social contextual influences on children’s eating and physical activity and sedentary behaviors in Latino immigrants from other countries and other immigrant groups. In addition, research is needed that builds upon the qualitative findings reported here, but quantifies the relationship of social context factors to early development of child overweight.