Background

The increasing prevalence of obesity and diabetes in children and adolescents is a major public health problem. Current dietary problems include the regular consumption of snacks, sweets, soft drinks, and fatty foods while consumption of fruit and vegetables (F&V) is lower than recommended. As socially disadvantaged groups are at particular risk of having poor diet, we investigated the factors that influence the food choices made by mothers of young children who live in areas of high deprivation.

Interviewing mothers

The study was conducted with mothers of two year old children living in areas of high deprivation in Dundee city and Fife, Scotland. The mothers were interviewed in their own homes. The study investigated the role of family characteristics; health knowledge and beliefs, and patterns of food purchasing, cooking and serving, in determining diet among disadvantaged children. The study also investigated what predicted mothers’ intentions and behaviour in providing breakfast, cooking with raw ingredients, and eating a meal together as a family.

Family characteristics

A very high response rate (81%) was achieved. Most families lived in council housing (81%), 43% of mothers reported that no other adult lived in the home and 91% were not employed. Only 22% of children had ever been breastfed and 60% of mothers were current smokers.

Children’s diet

The quality of the children’s diet was mixed. All children had dairy products daily and nearly all had a portion of a protein-rich food every day. However, most (91%) ate processed meat two or more times a week. Only 12% of children met the recommended five portions of (F&V) daily, with 47% eating one or more portions of vegetables per day. Only two children ate fish every week.

Children were allocated a composite dietary score based on whether or not their diet was balanced on the four main food groups (bread, other cereals and potatoes; (F&V); meat, fish and alternatives; milk and dairy foods) and limited high sugar and/or high fatty foods. Based on current guidelines, most (85%) of the children were classified as having a poor quality diet.

Factors associated with a poor diet

Univariate analysis showed that many types of factors were significantly associated with poor diet. These included:

• low levels of knowledge of specific dietary recommendations,
• seldom cooking with raw ingredients,
• a busy lifestyle,
• reluctance to change current diet,
• concern that the child did not eat enough,
• belief that it was difficult to provide 2-3 portions of fruit,
• mothers reporting that they were unlikely to restrict sweets.

Factors which decreased the risk of a poor diet included:

• providing breakfast every day,
• eating together regularly as a family,
• believing that a healthy diet would help the child to eat more.

Several factors were not associated with the children’s diet. Mothers’ general knowledge about healthy eating was high, and did not predict the quality of the children’s diet. Measures of food availability, cooking skills, knowledge of a healthy diet, and beliefs about the health benefits of a healthy diet were also unrelated to the children’s diet.

Predicting diet quality

Regression modelling identified five factors which exerted independent, statistically significant effects. An increased risk of a poor diet was associated with mothers reporting that they were unlikely to restrict sweets (OR=21.6, p<0.0001), or that they found it difficult to provide 2-3 portions of fruit (OR=2.9, p=0.005). Concern that the child who did not eat enough had a higher risk of a poor diet (OR=2.4, p=0.03). Believing that a healthy diet would help the child to eat more reduced the risk of having a poor diet (OR=0.3, p=0.04), as did providing breakfast every day (OR=0.2, p=0.02).

Implications for pratice and Policy

The study has important implications for practice and policy for children living in disadvantaged areas. Mothers’ intentions about preparing and serving meals and perceived control over the child’s diet are the most powerful predictors of diet quality. To improve children’s diet, efforts should be made to promote more positive intentions to the preparation and serving of food (breakfast every day, cooking from raw ingredients, eating together). The benefits of these behaviours to the mother (enjoyment) and the child (improved diet, weight control) should be emphasised. Mothers could be encouraged to plan specific meals at which the family eats together. The impact on a child’s weight from the regular consumption of high fat/ high sugar snacks and take-away meals could also be stressed. General education about foodstuffs and the health benefits of a good diet are unlikely to improve children’s diet.