Date Published: March 18, 2019
Publisher: Public Library of Science
Author(s): Maria Pineros-Leano, Karen Tabb, Janet Liechty, Yvette Castañeda, Melissa Williams, Alessandra N. Bazzano.
Worldwide, overweight and obesity rates have more than tripled over the past three decades. Overweight and obesity rates are particularly high among Latinos. In order to determine some of the potential reasons, it is imperative to investigate how first-generation Latina mothers living in non-metropolitan and small metro areas decide how and what to feed their children. Using the Socio-Ecological Model, this study aimed to understand how Latina immigrant mothers make feeding decisions for their children.
A total of 29 semi-structured interviews were conducted with a purposive sample of immigrant mothers from Latin American countries whose preschoolers were enrolled in a Women, Infant, and Children supplemental nutrition program located in non-metropolitan and small metro areas. All interviews were recorded and transcribed verbatim in Spanish, and analyzed by a bilingual team.
Multi-stage qualitative analysis was employed to analyze the data. Nineteen participants originated from Mexico, four from Central America, and six from South America. Five themes emerged that helped illuminate mother’s decision-making around feeding choices: 1) culture as all-encompassing, 2) location and access to fresh and traditional foods, 3) disjunction between health provider advice and cultural knowledge 4) responsiveness to family needs and wants as determinants of food choices, 5) intrapersonal conflict stemming from childhood poverty and food insufficiency.
Findings suggest that Latina immigrant mothers engage in a difficult and even conflicting process when deciding how to feed their children. Future interventions should focus on implementing hands-on activities that can help consolidate, promote, and encourage healthy feeding choices.
The World Health Organization has declared the “global obesity epidemic” as one of the most pressing public health concerns . Globally, overweight and obesity have tripled in the last 30 years . In the United States (U.S.) the rates of obesity are higher among Latinos than any other racial/ethnic group . Seventy-seven percent of Latinos in the U.S. over the age of 20 years are overweight or obese, compared to 67% of their White counterparts. Among children, Latinos also have the highest prevalence rate (38.9%) of any other racial/ethnic group . For this reason, it is necessary to investigate the underlying factors for the high prevalence of obesity among Latinos.
The Socio-ecological Model [22, 23] served as a guide to understand the complex processes that take place when mothers decide how to feed their children. This model suggests that people’s health behaviors are influenced by multiple levels that include intra-personal and interpersonal factors, institutional factors, community factors and public policy factors [22, 23]. This model provides a lens to examine and better understand the layers of competing tensions that Latina immigrant mothers may experience at different levels of their social ecology when making feeding decisions.
This study explored how first-generation Latina mothers make feeding decisions when living in non-metropolitan and small metro areas. We found that mothers engage in a complex process when making feeding decisions for them and their children. The Socio-Ecological Model helped explain the different influences that participants had when making feeding decisions. These decisions ranged from the influence that culture has on feeding decisions, to the intrapersonal conflict that participants felt when having to decide what to feed their children. We discovered five themes related to determinants of mothers’ feeding choices for their children ranging from culture, the more macro-level of the socio-ecological model, to the individual, the most micro-level of the model: 1) culture as all-encompassing, 2) location and access to fresh and traditional foods, 3) disjunction between health provider advice and cultural knowledge 4) Responsiveness to family needs and wants as determinants of food choices, 5) intrapersonal conflict stemming from childhood poverty and food insufficiency. Connections to the literature and implications the themes are discussed below.
This study has multiple strengths including the use of the socio-ecological model to illustrate the tensions that Latina immigrant mother experience across and between levels of their social ecology when deciding what and how to feed their children. Also, this study highlights the experiences of women from different Latin American countries residing in non-metropolitan and small metro communities. Moreover, the data collection and analysis were conducted in Spanish by a bilingual and bicultural team, which enhanced the cultural sensitivity and interpretation of findings. Despite these strengths, this study is not without limitations. The participants interviewed in this study were all part of the WIC program and were under 185% of the Federal Poverty Level. Although participants from different nationalities were included in our study, our sample includes a particular set of Latinos. Most of our participants are low-income and grew up in extreme poverty. In fact, the majority mentioned that the reason they migrated to the U.S. was for economic reasons; in search of better economic opportunities. Because of these specific characteristics, the results of this study cannot be generalized to other Latino immigrant populations who grew up with more resources and income, or those residing in large metropolitan areas. Another limitation is that we did not collect information on mother or child health status. However, some participants volunteered some of this information as they were describing their feeding practices. A few participants mentioned that they changed their feeding practices when they found out they had certain chronic health condition such as diabetes. Future studies investigating eating practices should gather information on health status to try to determine the role that chronic health conditions play in relation to eating and feeding practices.
When deciding what to feed their children, Latina immigrant mothers engage in a complex and multilayered process. We used a socioecological model to explain the conflicts that mothers engage in at different levels when trying to decide what to feed their children. We found that although Latina immigrant mothers want to feed their children healthy and nutritious foods, there are certain tensions that make it difficult to do so. We recommend that when an obesity intervention is developed for Latino immigrants, their base knowledge be valued and promoted. Finally, healthy eating interventions should take into account the many ways in which Latina mothers’ care and concern for family drives decision-making and can motivate positive health behavior change.