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RESEARCH

Qualitative Research

Traditional Foods and Practices ofSpanish-Speaking Latina Mothers Influencethe Home Food Environment: Implicationsfor Future InterventionsALEXANDRA EVANS, PhD, MPH; SHERMAN CHOW, MPH, MA; ROSE JENNINGS, MPH; JAYNA DAVE, PhD, MSPH; KATHRYN SCOBLICK;

KATHERINE REGAN STERBA, PhD, MPH; JENNIFER LOYO, PhD, RD

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ABSTRACTThis study aimed to obtain in-depth information from low-income, Spanish-speaking Latino families with young chil-dren to guide the development of culturally appropriatenutrition interventions. Focus groups were used to assessparent’s knowledge about healthful eating, the home foodenvironment, perceived influences on children’s eating hab-its, food purchasing practices, and commonly used strate-gies to promote healthful eating among their children. Thir-y-four Latino parents (33 women; 27 born in Mexico; 21ood-insecure) of preschool-aged children participated inour focus group discussions conducted in Spanish by arained moderator. The focus groups were audiotaped,ranscribed, translated, and coded by independent raters.esults suggest that in general, parents were very knowl-dgeable about healthful eating and cited both parentsnd school as significant factors influencing children’s

A. Evans is an associate professor, S. Chow is a seniorresearch assistant, and R. Jennings is a graduate re-search assistant, University of Texas School of PublicHealth-Austin Regional Campus, Michael and SusanDell Center for Healthy Living, Austin. J. Dave is aninstructor of nutrition, Department of Pediatrics, USDepartment of Agriculture/Agricultural Research Ser-vice Children’s Nutrition Research Center, Baylor Col-lege of Medicine, Houston, TX. K. Scoblick is director ofphysician relations, St David’s South Austin MedicalCenter, Austin, TX. K. R. Sterba is an assistant profes-sor, Department of Medicine, Division of Biostatisticsand Epidemiology, Hollings Cancer Center at the Medi-cal University of South Carolina, Charleston. J. Loyo isa research associate, Department of Kinesiology andHealth Education, College of Education, University ofTexas at Austin.

Address correspondence to: Alexandra Evans, PhD,MPH, University of Texas School of Public Health-Aus-tin Regional Campus, Michael & Susan Dell Center forHealthy Living, 1616 Guadalupe St, Ste 6.300 Austin,TX 78701. E-mail: Alexandra.e.evans@uth.tmc.edu

Manuscript accepted: January 12, 2011.Copyright © 2011 by the American Dietetic

Association.0002-8223/$36.00

sdoi: 10.1016/j.jada.2011.04.007

© 2011 by the American Dietetic Association

ating habits; at home, most families had more tradi-ional Mexican foods available than American foods; costnd familiarity with foods were the most influential fac-ors affecting food purchasing; many parents had rulesegarding sugar intake; and parents cited role modeling,einforcement, and creative food preparation as ways toncourage children’s healthful eating habits. Finally, par-nts generated ideas on how to best assist Latino familieshrough interventions. Parents indicated that future in-erventions should be community based and teach skillso purchase and prepare meals that include low-cost andraditional Mexican ingredients, using hands-on activi-ies. In addition, interventions could encourage and rein-orce healthy food-related practices that Latino familiesring from their native countries.Am Diet Assoc. 2011;111:1031-1038.

Latino children are disproportionately affected by thecurrent childhood obesity epidemic. In the UnitedStates, it is estimated that 38.2% of Latino children

ged 2 to 19 years are overweight or obese, compared toheir non-Latino black (35.9%) and non-Latino white29.3%) counterparts (1). Consequently, Latino childrenave a higher risk of acquiring obesity-related conditionsuch as type 2 diabetes compared to their non-Latinoounterparts (2,3). Because Latinos are currently theargest minority in the United States with a rapidly grow-ng population, fiscal demands on the health care systemue to obesity will continue to rise during the comingears.According to the Ecological Perspective, individuals’

ating behaviors are influenced by both proximal andistal environments (4). A young child is highly influ-nced by the home food environment (5-10). The homeood environment is created by parents or caregivers ofoung children who can make certain foods available ornavailable, encourage children to eat certain foods, cre-te rules about food, use positive reinforcement, andodel healthy dietary behaviors (11-15). These parent

ractices are influenced by the broader environmentalilieu (16) as well as by sociocultural factors, such as

arents’ attitudes, preferences, and knowledge (17-19),nd demographic variables such as ethnicity (20,21), ac-ulturation (22,23), and family income (20,24,25).Among Latino families, acculturation is a particularly

ignificant factor. Acculturation is a process of cultural

Journal of the AMERICAN DIETETIC ASSOCIATION 1031

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transition and assimilation that is linked to the length oftime a family has lived in an immigrated country (22).Among Latinos, greater acculturation tends to be associ-ated with less healthy diets. For example, studies haveshown that more acculturated individuals consume moresugar, red meat, cheese, and added fat and less legumes,rice, vegetables, and fruits (22,23,26). On the other hand,eating less fried food and avoiding high-fat foods is alsoassociated with greater acculturation (22).

Previous qualitative research has explored the homefood environment within the Latino household (27-29),but very few studies have explicitly focused on low-in-come traditional Latinos. Two focus group studies con-ducted in Arizona and Boston with food-stamp eligibleLatina mothers and Special Supplemental Nutrition Pro-gram for Women, Infants, and Children participantsfound that unfamiliar produce, social networks, and costof healthy foods were among some of the barriers tohealthy feeding among these focus groups (28,29). An-other study found that cost, taste, time, family prefer-ence, convenience, body image, and weight loss were theprimary factors related to household nutrition decisionmaking among Latinos in San Diego County at variousacculturation levels (27).

Given the high prevalence of childhood obesity among

Figure 1. Structural model of health behavior factors and correspondexas.

Latinos, the negative consequences associated with child- s

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ood obesity, and the increasing number of Latino fami-ies who are immigrating to the United States, interven-ions to help families who are less acculturated to themerican culture prevent the development of overweightnd to decrease the prevalence of obesity among theirhildren are warranted. However, to ensure cultural ap-ropriateness of interventions, more qualitative researchxamining the risk factors for child overweight and obe-ity among these Latino families is needed. Thus, theverarching goal of this study was to obtain in-depthnformation from low-income, less-acculturated Latinoarents of preschool-aged children to guide the develop-ent of culturally specific nutrition interventions. The

pecific objectives were to assess the home food environ-ent (eg, availability of specific foods, physical charac-

eristics of the food, rules surrounding eating, and mediand cultural messages surrounding food, perceived influ-nces on children’s eating habits, common food purchas-ng practices, and commonly used strategies to promoteealthful eating among their children.

ETHODShis qualitative study collected data from 34 parents ofreschool-aged children through four focus group discus-

cus group questions administered to Latino families living in central

ing fo

ions. Institutional Review Board approvals from the

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University of Texas Health Science Center and from theAustin Independent School District were obtained. Par-ticipants received a $20 gift certificate to a local grocerystore.

ParticipantsLatino families were recruited through a public preschoolin an urban city in central Texas. In 2008, this school hada student body of approximately 550 students aged 4 to 5years, of which 95% were classified as economically dis-

Table. Characteristics of low-income Latina parents in focusgroups exploring the home food environment of preschool-agedchildren (n�34)

Demographicvariables Frequency %

Participantemployment

Full-time 8 23.5Part-time 8 23.5Unemployed 8 23.5Missing 10 30.5Household monthly

income ($)�1,000 6 17.61,000-1,999 20 58.82,000-2,999 3 8.83,000-3,999 2 5.9�4,000 0 0Missing 3 8.8Household languageEnglish 1 2.9Spanish 32 94.1Other 1 2.9BirthplaceMexico 27 79.4Central America 3 8.8United States 4 11.8Time in the United

States (y)�2 3 8.82-5 6 17.66-10 18 52.8�10 6 17.5Missing 1 2.9Do you ever run out of

food before end ofmonth?

Always 4 11.8Sometimes 17 50.0Never 10 29.4Missing 3 8.8Worry about running

out of food?Always 12 35.3Sometimes 14 41.2Never 8 23.5

advantaged and 76.4% were considered to have limited 2

nglish proficiency. This specific school was selected ashe recruitment site because the student population re-ected the sample demographic characteristics necessaryo conduct this study. All parents who had a child en-olled at the school were eligible for participation in thistudy. The parent liaison at the school provided informa-ion about the study to parents during the Back-to-Schoolight. Interested parents signed up for a specific time slotnd, surprisingly, more parents attended the focusroups than originally signed up.Before starting each session, research staff obtained

nformed consent forms from all participants. Partici-ants were asked whether they preferred English orpanish forms. Individuals with limited literacy skillsere verbally provided with the informed consent infor-ation. Participants were told that all information would

e kept confidential, that participation was voluntary,nd that they could stop participation at any time with-ut any consequences.

ocus Group Questionsocus group questions, based on the Structural Model ofealth Behavior (30), were developed to specifically ex-mine four structural factors that have been hypothe-ized to characterize the home food environment: avail-bility of specific foods, physical characteristics of theood, social structures (rules surrounding eating), andedia and cultural messages surrounding food (Figure

). In addition, questions about perceived influences onhildren’s eating, food purchasing habits, and specificnfluences on which foods are available in the home wereeveloped. Additional questions were developed to exam-ne logistical issues of implementing community-basednterventions for this specific population group.

ata Collectionne trained Mexican moderator conducted all focus groupssing a standardized protocol of focus group questions androbes (31). Four focus groups were conducted at the pre-chool where participants were recruited. All focus groupsere conducted in the morning upon request of the partic-

pants. Before the start of the focus group, participants weresked to complete a short demographic questionnaire, in-luding participant employment, monthly household in-ome, language spoken at home, birth place, time lived inhe United States, and food insecurity status (32). Childare and refreshments were provided during each ses-ion. The sessions lasted on average 50 minutes and wereudiotaped. The audiotapes were transcribed in Spanish,hecked for accuracy against original recordings, andranslated into English by a native Spanish speaker, andhen back-translated to Spanish by another native Span-sh speaker.

ata Analysishe qualitative data analysis consisted of creating a cod-

ng scheme based on the focus group questions and re-ponses and a set of decision rules to standardize theoding procedure. Data analysis was conducted using theualitative software package QSR NVivo (version 8,

008, QSR International Pty Ltd, Cambridge, MA). Each

July 2011 ● Journal of the AMERICAN DIETETIC ASSOCIATION 1033

Figure 2. Themes and relevant quotes related to the home food environment of low-income Latina parents living in central Texas (n�34).

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translated transcript was uploaded into NVivo and tran-script passages were coded and further subcoded intoconceptual categories. Coding of transcript passages in-volved structured organizing of transcript passages intocategories to facilitate data analysis and interpretation.Organization of coded and subcoded passages of tran-scribed text was examined and differences in coding were

Figure 2. (Continued)

resolved by the two coders through consensus. Emergent g

hemes were identified through frequency of codingithin similar social contexts and across focus groups.

ESULTSarticipantshirty-four participants participated in the focus

roups (see the Table). Most of the participants were

July 2011 ● Journal of the AMERICAN DIETETIC ASSOCIATION 1035

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mothers (n�33), spoke Spanish at home (n�33), wereborn in Mexico (n�27), and had lived in the UnitedStates for 10 years or less (n�27). Using either theriteria of “language spoken at home”, “length in thenited States,” or “country of origin” as a proxy forcculturation level (22,33), all of the participants coulde considered less acculturated to the American culturer more traditional.

mergent Themesix salient themes emerged from the focus groups: knowl-dge about healthful eating, perceived influences on chil-ren’s eating habits, the home food environment, meal-ime rules, food shopping practices, and strategies toupport children to eat more healthfully. Quotes support-ng these themes are provided in Figure 2.

ealthful Eatingverall, the participants revealed shared beliefs regard-

ng healthful eating and a desire to improve healthyating in their families. Participants consistently identi-ed the following components of healthful eating: a dietith fruits, vegetables, and grains; balanced meals; and

ow sugar intake. Participants cited healthy fruits andegetables as lentils, cantaloupes, pineapples, watermel-ns, citrus fruits, guava, strawberries, broccoli, beans,nd squash. Grains, cereals, rice, and fish (due to its lowat content) were also cited as healthful foods. In additiono naming specific foods, participants stated that aealthy meal was one that was balanced, such as soups.inally, low sugar intake was seen as an importantealthy choice. Consistent with these findings are resultsrom other studies that have found that more traditionalatinos consume more fruit, rice, beans, and less sugarompared to Latinos more acculturated to the Americanulture (22,26,29) and have many of these types of foodsvailable in their homes (27). In addition, traditional

Latino women have been found to prepare soup-typedishes often (27,29).

Perceived Influences on Children’s Eating HabitsParents saw themselves as an important influence ontheir children’s diets, either as role models or as teachers.However, most conversation was centered on schools andthe dual role that it plays in shaping the eating behaviorof their children. According to the participants, schoolsare not only an avenue where children can receive healtheducation, but they also prepare the meals which feedchildren. Most respondents expressed a positive opinionof schools as educators of health and nutrition. Motherscited that their children came home and reiterated thelessons they learned at school regarding health and nu-trition. However, the respondents also felt that the foodsprepared and served in school cafeterias were not cultur-ally appropriate for their children. As a result, many ofthe respondents felt that the children were not eatingenough at school and were coming home hungry.

Food Availability in the HomeFour main factors determined which types of foods are

available in the homes: preference for more traditional

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Mexican foods, child preferences, parents’ ability to cookwith the foods, and the price of foods. Similar to resultsfrom other studies (28), respondents overwhelminglystated that their homes contained more “Mexican” foodsas opposed to “American” foods. They explained that thiswas mostly because of familiarity with Mexican foods andof knowing how to prepare these types of foods. Parentsalso cited preparing and purchasing specific foods, suchas squash and vegetable soup, according to the prefer-ences of their children. In low-income Latino homes, thismay be in part due mothers’ desire not to waste money onfoods that children won’t eat or get full on, and also areported reluctance to deny children their preferred foods(28,29).

Participants expressed an interest in learning how toprepare American foods in a healthful way, but weresomewhat reluctant to prepare new meals or use newingredients because they may be wasted if other familymembers do not like them. This was similar to findings inother focus group studies with Latina women; that is, toknow more about nutrition and preparation of Americanfruits and vegetables (28).

What parents purchased and, thus, made available inthe home, appeared to be strongly influenced by theprices of foods. Parents talked about bringing home foodsthat were on sale or seasonal. There is substantial evi-dence that food purchases are influenced by food costs(34-36). Several studies, both qualitative and quantita-tive, have found diet costs as a barrier to dietary change,especially among low-income populations (29,36-39).Mealtime Rules. Although a few mothers brought up rulesin their households around television viewing and meal-times, most mothers were more concerned with the con-sumption of sugary foods. Rules surrounding sugarysnacks and drinks reflected the belief that sugary foodsshould be limited. For example, most parents agreed thatregular sodas were for special occasions only and re-stricted their consumption.Shopping for Food: Who’s in Charge, Influences, and Habits. Thepassages in this thematic category center on the topic offood purchasing. Respondents revealed three themes re-garding shopping, including the role of husbands or lackthereof, the influences of prices, and the reasons sur-rounding purchases of convenience foods.Responsibility for Food Purchasing. The focus group partici-pants established quite readily that they (mothers) werethe ones responsible for and in charge of planning, cook-ing, and serving meals. Similar to another study with asimilar population (27), respondents also stated that theywere also responsible for shopping duties and, more im-portantly, decisions on which foods were actually bought.In terms of shopping, there was almost unanimous agree-ment that husbands did not know how to shop economi-cally or choose nutritious foods.

Similar to other studies (27,29), respondents reportedthat the cost of food was the most significant influence onpurchasing behaviors. Supermarkets were cited by re-spondents as the primary locations where they shoppedfor groceries because of lower food costs. One respondentsuccinctly stated, “Prices above all!” as the sole reason forshopping at supermarkets as opposed to smaller stores,

such as convenience stores. Ayala (40) also found that

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traditional Latino women tend to shop at regular grocerystores more often than more acculturated Latino women,who tended to shop at larger stores such as Walmart(Bentonville, AR).

Although most participants stated that economical rea-sons guided their food purchases, they also revealed thatthey bought foods that were (at times) more expensive,yet more convenient. These foods included chicken nug-gets, frozen pizza, Maruchan/ramen noodles, frozen veg-etables, and other “kids’ meals.” However, mothers whopurchased these food items also stated that these foodsare served to their children in moderation due to theirlack of nutrition. Latina mothers from another study alsoadmitted to relying more on convenience food because oftheir fast-paced lifestyles even though these foods wereless healthy (29).

Strategies to Increase Healthy EatingAlthough parents clearly described their beliefs regard-ing healthy eating, they also admitted that it was difficultat times to have their children eat well. When presentedwith challenges from their children, most participantsstated that they employed a number of strategies to in-crease healthy eating habits. Mothers support healthyeating among their children by referencing positive rolemodels; reinforcing children’s healthy behaviors throughmotivation; getting children to taste new foods; andthrough creative food preparation, such as yogurt withfruit, apples with peanut butter, and orange juice mixedwith beet juice. Because these types of parenting strate-gies have been found to encourage healthful eatingamong Latino children (11), parents need to be encour-aged to continue practicing these strategies.

Nutrition Education PreferencesTo ascertain the utility of parent nutrition classes andexamine how to best offer classes to Latino mothers,participants were asked to report intervention prefer-ences. Participants resoundingly expressed interest inattending community-based nutrition classes. Regard-ing the actual individual who would lead these classes,participants did not express a preference but only“someone that would be capable.” In terms of locationand time of day, schools were deemed “ideal” locationsand participants preferred classes to be held “duringschool hours so we don’t have to bring the children.”Again, regarding children, respondents stated that itwould be more beneficial without children present so“we’d not be distracted.” Regarding the audience forcommunity-based nutrition classes, respondents sug-gested that husbands and fathers should also be in-vited and included. However, many respondents didnot express much faith that husbands and fatherswould actually attend even if invited.

Regarding topics that should be covered in commu-nity-based nutrition classes, participants expressedtheir desire to improve healthy eating in their house-holds and believed that classes should take a familyapproach. Interaction between mothers and other nu-trition class attendants was seen as an important way

to exchange ideas. One person wanted to share her

experience as a mother” and that “other moms’ recipeselp also, to share recipes, cook them, taste them.”egarding children, participants wanted to learn moretrategies to increase children’s healthy eating. Lastly,ne topic that was echoed among participants was un-erstanding portion control and reading nutrition la-els.

IMITATIONSs with any study, this study had some limitations.irst, the sample was a convenience sample and con-isted only of low-income Spanish-speaking Latinaothers, thus limiting generalizability of the findings.owever, because the purpose of this study was to

pecifically obtain more in-depth information from thispecific population group, the results are very usefulor those researchers interested in this population. Sec-nd, we used the school’s parent liaison as our recruiteror this study and this could have affected the compo-ition of the sample. However, the liaison recruitedarents through the Back-to-School night in an at-empt to provide the same information to all parentsho attend the Back-to-School night to reduce sam-ling bias.

CONCLUSIONSAddressing cultural context and preferences is critical toinform the development of interventions and resourcestargeting traditional Latino families. Latina mothers inthis study revealed a clear motivation to improve healthyeating in their children but also identified barriers toadopting healthier practices. Therefore, future obesityprevention interventions should reinforce and encouragegood practices parents bring from their native countrieswhile also introducing new strategies to navigate a less-familiar food culture and promote healthy eating amongchildren. In addition to understanding cultural prefer-ences, it is important to tailor interventions with an un-derstanding of environmental factors such as family dy-namics and the availability, access, and cost of food. Itwas clear that family approaches should be consideredand information should be delivered from trusted sourcessuch as other mothers or other female community mem-bers. Schools provide an ideal location for community-based classes, and developing partnerships with schoolsto develop community-based interventions needs to befurther explored. Future studies should further explorethe differences in beliefs and practices of more vs lessacculturated Latina women and should focus on interven-tion development and testing.

STATEMENT OF POTENTIAL CONFLICT OF INTEREST:No potential conflict of interest was reported by the au-thors.

FUNDING/SUPPORT: The Michael & Susan DellFoundation provided funding for this study.

ACKNOWLEDGEMENTS: The authors thank LindaPerez, the parent liaison at Lucy Reed Preschool, for herenthusiastic support and her help with recruiting parentsfor this study. The authors also thank all parents who

participated in the focus groups.

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