Individual and family correlates of calcium-rich food intake among parents of early adolescent children Marla Reicks, PhD, RD: University of Minnesota Miriam Edlefsen Ballejos, PhD, RD: Washington State University L. Suzanne Goodell, PhD, RD: North Carolina State University Carolyn Gunther, PhD: Ohio State University Rickelle Richards, PhD, MPH, RD: Brigham Young University Siew Sun Wong, PhD: Utah State University Garry Auld, PhD, RD: Colorado State University Carol J. Boushey, PhD, MPH, RD: Purdue University Christine Bruhn, PhD: University of California, Davis Mary Cluskey, PhD RD: Oregon State University Scottie Misner, PhD, RD: University of Arizona Beth Olson, Ph.D.: Michigan State University Sahar Zaghloul, MBBS, Ph.D.: Kuwait Institute for Scientific Research JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION Reicks M, et al, J Am Diet Assoc. 2011; 111 (March).

Background Adequate intake is important for overall health Individual and family correlates of calcium-rich food intake among parents of early adolescent children Background Adequate intake is important for overall health Calcium intakes fall short of recommended amounts among Asian, Hispanic, and non-Hispanic white (NHW) populations Dairy foods are important sources of calcium for many adults, but intake may be marginal for some race/ethnic groups JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION Reicks M, et al. J Am Diet Assoc. 2011; 111 (March).

Background (Continued) Individual and family correlates of calcium-rich food intake among parents of early adolescent children Background (Continued) Social Cognitive Theory can be applied to explore factors affecting calcium intake Individual factors Perceptions of health benefits or concern about the adequacy of calcium intake, knowledge of sources , concerns about weight gain or dairy or milk intolerance Behavioral factors Eating food away from home, lack of time and work stress Socio-environmental factors Parenting practices that enable intake of calcium-rich foods by children in the household Few studies available on how practices that enable improved intake by children may also affect intake among parents themselves. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION Reicks M, et al. J Am Diet Assoc. 2011; 111 (March).

Serum Vitamin C (mg/dl) by Salad Intake Individual and family correlates of calcium-rich food intake among parents of early adolescent children Serum Vitamin C (mg/dl) by Salad Intake Methods A cross sectional survey was used with 14 scales to assess attitudes/preferences and parenting practices regarding calcium-rich foods and a calcium-specific food frequency questionnaire (2006-2007). A convenience sample of self reporting non-Hispanic white, Hispanic, and Asian (n=661) parents in nine states completed self-administered questionnaires. Main outcome measures were predictors of calcium intake from three food groupings - all food sources, dairy foods, and milk. Multivariate regression analyses identified demographic, attitude/preference and behavioral factors associated with calcium intake. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION Reicks M, et al. J Am Diet Assoc. 2011; 111 (March).

Serum Vitamin C (mg/dl) by Salad Intake Individual and family correlates of calcium-rich food intake among parents of early adolescent children Serum Vitamin C (mg/dl) by Salad Intake Selected characteristics of Asian, Hispanic, and non-Hispanic white (NHW) parents of early adolescent children (10-13 years) (not adjusted) a Characteristics of children of parent respondents, all other characteristics are for parent respondents. b Values with different superscripts (x, y) indicate significantly different means between race/ethnic groups. c Numbers do not always add up to 100% due to rounding and missing data. d Federally funded programs included: Special Supplemental Nutrition Program for Women, Infants, and Children, Supplemental Nutrition Assistance Program, Supplemental Assistance Program, or free/reduced-price school meals. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION Reicks M, et al. J Am Diet Assoc. 2011; 111 (March).

Serum Vitamin C (mg/dl) by Salad Intake Individual and family correlates of calcium-rich food intake among parents of early adolescent children Serum Vitamin C (mg/dl) by Salad Intake Selected characteristics of Asian, Hispanic, and non-Hispanic white (NHW) parents of early adolescent children (10-13 years) (not adjusted) (cont’d) a Characteristics of children of parent respondents, all other characteristics are for parent respondents. b Values with different superscripts (x, y) indicate significantly different means between race/ethnic groups. c Numbers do not always add up to 100% due to rounding and missing data. d Federally funded programs included: Special Supplemental Nutrition Program for Women, Infants, and Children, Supplemental Nutrition Assistance Program, Supplemental Assistance Program, or free/reduced-price school meals. Reicks M, et al. J Am Diet Assoc. 2011; 111 (March). JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION

Individual and family correlates of calcium-rich food intake among parents of early adolescent children Selected characteristics of Asian, Hispanic, and non-Hispanic white (NHW) parents of early adolescent children (10-13 years) (not adjusted) (cont’d) a Characteristics of children of parent respondents, all other characteristics are for parent respondents. b Values with different superscripts (x, y) indicate significantly different means between race/ethnic groups. c Numbers do not always add up to 100% due to rounding and missing data. d Federally funded programs included: Special Supplemental Nutrition Program for Women, Infants, and Children, Supplemental Nutrition Assistance Program, Supplemental Assistance Program, or free/reduced-price school meals. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION Reicks M, et al. J Am Diet Assoc. 2011; 111 (March).

Serum Vitamin C (mg/dl) by Salad Intake Individual and family correlates of calcium-rich food intake among parents of early adolescent children Serum Vitamin C (mg/dl) by Salad Intake Description of measures to assess parental attitudes/preferences and practices/perceptions regarding parent and early adolescent intake of calcium-rich foods (CRF) a Responses for all variables were reported as1=strongly disagree, 5=strongly agree & Don’t know except for the following: Access to CRF based on location (1 = strongly disagree, 4 strongly agree & Don’t know), Making CRF available, Beverage expectations, and Family meal description (1 = Never, 5 = Always), Importance of calcium sources (1 =not at all important, 5 extremely important), Parent knowledge score (1 point if correct, 0 if incorrect – 7 total points), Eating food away from home/food prepared away from home (1 = once every 2-3 months, 5 = 5 or more times per week), and Family meals(1 = never, 5 = everyday). b Don’t know responses were considered missing data. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION Reicks M, et al. J Am Diet Assoc. 2011; 111 (March).

Individual and family correlates of calcium-rich food intake among parents of early adolescent children Description of measures to assess parental attitudes/preferences and practices/perceptions regarding parent and early adolescent intake of calcium-rich foods (CRF) (cont’d) a Responses for all variables were reported as1=strongly disagree, 5=strongly agree & Don’t know except for the following: Access to CRF based on location (1 = strongly disagree, 4 strongly agree & Don’t know), Making CRF available, Beverage expectations, and Family meal description (1 = Never, 5 = Always), Importance of calcium sources (1 =not at all important, 5 extremely important), Parent knowledge score (1 point if correct, 0 if incorrect – 7 total points), Eating food away from home/food prepared away from home (1 = once every 2-3 months, 5 = 5 or more times per week), and Family meals(1 = never, 5 = everyday). b Don’t know responses were considered missing data. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION Reicks M, et al. J Am Diet Assoc. 2011; 111 (March).

Individual and family correlates of calcium-rich food intake among parents of early adolescent children Description of measures to assess parental attitudes/preferences and practices/perceptions regarding parent and early adolescent intake of calcium-rich foods (cont’d) a Responses for all variables were reported as1=strongly disagree, 5=strongly agree & Don’t know except for the following: Access to CRF based on location (1 = strongly disagree, 4 strongly agree & Don’t know), Making CRF available, Beverage expectations, and Family meal description (1 = Never, 5 = Always), Importance of calcium sources (1 =not at all important, 5 extremely important), Parent knowledge score (1 point if correct, 0 if incorrect – 7 total points), Eating food away from home/food prepared away from home (1 = once every 2-3 months, 5 = 5 or more times per week), and Family meals(1 = never, 5 = everyday). b Don’t know responses were considered missing data. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION Reicks M, et al. J Am Diet Assoc. 2011; 111 (March).

Individual and family correlates of calcium-rich food intake among parents of early adolescent children Multivariate linear regression models for total calcium intake from food, dairy foods, and milk among parents of early adolescent children and parent/household characteristics, attitude/preferences, practices/perceptions, and behavioral factors SE = standard error. aβ represents differences in average calcium intakes (mg/day) among parents based on variables as labeled and adjusted for state of residence. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION Reicks M, et al. J Am Diet Assoc. 2011; 111 (March).

Individual and family correlates of calcium-rich food intake among parents of early adolescent children Multivariate linear regression models for total calcium intake from food, dairy foods, and milk among parents of early adolescent children and parent/household characteristics, attitude/preferences, practices/perceptions, and behavioral factors (cont’d) SE = standard error. aβ represents differences in average calcium intakes (mg/day) among parents based on variables as labeled and adjusted for state of residence. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION Reicks M, et al. J Am Diet Assoc. 2011; 111 (March).

Summary and Implications Individual and family correlates of calcium-rich food intake among parents of early adolescent children Summary and Implications Parent intake of calcium-rich foods was not strongly related to practices that would promote their children’s intake of calcium-rich foods Interventions to improve calcium intake for parents should: Focus on individual parental factors Concern about health Dietary adequacy Benefits from eating calcium rich foods Be tailored to tolerance of dairy products and typical intake Address economical food choices JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION Reicks M, et al. J Am Diet Assoc. 2011; 111 (March).

Summary and Implications (cont’d) Individual and family correlates of calcium-rich food intake among parents of early adolescent children Summary and Implications (cont’d) Additional research is needed to better understand unexpected findings Lack of a relationship between parental calcium intake and making calcium-rich foods available for children Positive relationship between parental calcium intake and frequency of meals eaten away from home. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION Reicks M, et al. J Am Diet Assoc. 2011; 111 (March).