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. Author manuscript; available in PMC: 2024 Nov 1.
Published in final edited form as: Appetite. 2023 Sep 6;190:107029. doi: 10.1016/j.appet.2023.107029

Parent Meal Self-Efficacy and Practices in Households with Healthy Home Food Environments in the Face of Economic Hardship

Aysegul Baltaci 1,*, Melissa N Laska 1, Melissa Horning 2, Mary Hearst 2, Jiwoo Lee 2, Jayne A Fulkerson 2
PMCID: PMC10543555  NIHMSID: NIHMS1930370  PMID: 37683896

Abstract

Some families who experience economic hardship demonstrate remarkable strength and resourcefulness to sustain a healthy home food environment. This ability to navigate economic barriers could be associated with parent meal practices that promote children’s healthful dietary intake. Therefore, this study aimed to examine 1) whether parent meal self-efficacy and practices were associated with economic assistance status and home fruit and vegetable (FV) availability and 2) how parent meal self-efficacy and practices differed by home FV availability and economic assistance status. Analyses utilized baseline data from 274 parent/child dyads from two childhood obesity prevention trials: HOME Plus (urban) and NU-HOME (rural). Parents in households with high FV availability (regardless of economic assistance) had significantly higher self-efficacy in preparing healthy foods, family dinner routines, frequency of child’s plate being half filled with FV, frequency of family dinner and breakfast, and lower frequency of purchasing dinner from fast food restaurants. Economic assistance was not associated with parent meal self-efficacy and practices. Four family groups were created and defined by economic assistance (yes/no) and home FV availability (high/low). About 31% of families that received economic assistance and had high home FV availability were food insecure. Families (n=39) receiving economic assistance and having high home FV availability had greater frequency of family dinners compared to those in households with economic assistance and low home FV availability (n=47) (p=0.001); no other parent meal self-efficacy or practices differed between groups. Our findings suggest some families can maintain healthy home food environments despite economic hardship and frequent family dinners may be an important strength for these families. More research is needed to investigate asset-based models to understand the family strengths that enable them to thrive during difficult times.

Keywords: Home fruit and vegetable availability, family strength, public assistance, parent meal self-efficacy and practices, family meals, low-income families

1. Introduction

The home food environment plays an essential role in eating behaviors and diet quality of children and adults (Kegler et al., 2021; Ong et al., 2016; Rasmussen et al., 2006; Trapp et al., 2015; Watts et al., 2017). For example, US adults’ fruits and vegetable intake has been found strongly associated with a greater variety of fruit and vegetable availability at home (Kegler et al., 2021). Similarly, Australian adults’ healthy eating habits are linked to more healthy and less unhealthy home food availability (Trapp et al., 2015). Additionally, children’s (ages 6–12 years) fruit and vegetable intake is positively associated with the availability and accessibility of healthy food (e.g., fruits and vegetables, and low-calorie nutrient-dense foods) at home (Ong et al., 2016). However, in the US, food insecurity is persistently high, impacting 10.5% of households (Coleman-Jensen et al., 2021). This lack of consistent access to sufficient food, largely due to limited resources, leads to lower home healthy food availability and poorer dietary intake (i.e., lower intakes of fruit, vegetables, and dairy product, higher intakes of sugar-sweetened beverages, more frequent eating fast food and skipping breakfast) compared to food-secure households (Hanson & Connor, 2014; Larson et al., 2020; Ranjit et al., 2020). These dietary habits contribute to a higher risk of health-related conditions and chronic diseases, including diabetes, obesity, cardiovascular disease, and mental health (Essien et al., 2016; Thomas et al., 2021). This connection between economic hardship, food insecurity, and diet highlights the importance of government assistance programs such as SNAP, WIC, TANF, and free/reduced school lunch programs (United States Census Bureau, 2021). These programs, aimed to support low-income families, have been shown to lower food insecurity (Irwin Oronce et al., 2021).

Families with low incomes face economic constraints that can make it difficult to afford healthy foods, such as fruits and vegetables (French et al., 2019). However, some families and communities faced with income constraints demonstrate an ability to sustain healthy food options possibly showing greater strength and resourcefulness to overcome economic barriers (F. Walsh, 2012). Low-income families, for example, those who qualify for government economic assistance, can maintain high availability of fruits, vegetables, and other healthy foods in their homes. It is important to better understand the practices, routines, and contexts of these families. Their experiences offer valuable insights into the role of family strengths within the healthy home food environment, ultimately contributing to positive parent meal self-efficacy and practices, such as parent self-efficacy and practices around dinner routines, family meals, food served in meals, and parent self-efficacy in preparing meals with healthy foods and portion sizes. This, in turn, can contribute to healthier dietary behaviors for families and children, ultimately resulting in a lower risk of chronic diseases such as obesity, diabetes, and heart disease.

Previous research highlights the positive influence of family meals (Dallacker et al., 2018; Hammons & Fiese, 2011; Watts et al., 2017) and parent self-efficacy (Campbell et al., 2010; Möhler et al., 2020; Rohde et al., 2018; A. D. Walsh et al., 2019) on children’s dietary behaviors. These associations can be moderated by the home food environment and economic assistance status. Only a few studies have examined the relationship between the home food environment and parent meal self-efficacy and practices, and these studies have shown that high home fruit and vegetable availability is linked to frequent family meals (Newman et al., 2015; Utter et al., 2008) and that parents’ self-efficacy is inversely related to buying unhealthy meals for the family (Horning et al., 2017). However, to our knowledge, there is a lack of studies that explore the association between economic assistance status and parent meal self-efficacy and practices. Therefore, the first aim of this study was to examine the independent influence of economic assistance status and home fruit and vegetable (FV) availability on the parent meal self-efficacy and practices. The hypothesis was that the frequency of parent meal self-efficacy and practices will be higher in families with economic assistance than those without economic assistance as well as in families with high home FV availability than those with low home FV availability. The second aim of this study was to determine demographic characteristics and the parent meal self-efficacy and practices by home FV availability and economic assistance status. The first hypothesis was that families in households with economic assistance and high FV availability will have better meal self-efficacy and practices compared to families in households with low FV availability with and without economic assistance. The second hypothesis was that families in households with economic assistance and high FV availability will have similar meal self-efficacy and practices with families in households without economic assistance and high home fruit and vegetable availability. This knowledge can assist public health professionals and researchers in gaining a deeper understanding of how family strengths are associated with parent meal self-efficacy and practices, which can contribute to positive dietary behaviors among low-income families and children.

2. Methodology

2.1. Study Design and Sample

This cross-sectional study used baseline data from two family-focused, community-based, two-arm randomized control trials: 1) the New Ulm at HOME (NU-HOME) and 2) the Healthy Home Offerings via the Mealtime Environment (HOME) Plus. Both trials were designed to improve the frequency and healthfulness of family meals, home food environments, and activity behaviors to decrease excess weight gain in children. The HOME Plus study was conducted in Minneapolis/St. Paul metropolitan areas of Minnesota between 2010–2016 among English-speaking families with 8–12-year-old children (Fulkerson et al., 2014, 2015, 2018). The NU-HOME study was conducted in several rural communities in south central Minnesota between 2016–2022 among English and Spanish-speaking families and their 7–10-year-old children (Fulkerson et al., 2021, 2022). In this secondary analysis, a total of 274 parent/child dyads were included. Of those, 160 parent/child dyads were from the HOME Plus trial enrolled during the springs of 2011–2012 (Fulkerson et al., 2014), while 114 parent/child dyads were from the NU-HOME study enrolled during the summers of 2017–2018 (Fulkerson et al., 2021).

Flyers, email, and face-to-face interactions were used to recruit parent/child dyads through local schools, community organizations, and healthcare settings by research staff (for specifics by study see Fulkerson et al. (2014, 2015, 2018, 2021, 2022). In both studies, parents who were the primary meal preparers and children who lived with the primary meal preparer most of the time were eligible to participate. Families planning to move within six months or having a food allergy or medical conditions preventing participation in the studies were not eligible to participate. Parents provided written consent, and children provided assent to participate. Both study protocols and materials were approved by the University of Minnesota Institutional Review Board (IRB) (reference Numbers: 1003S78592 for HOME Plus and 1509S78583 for NU-HOME). NU-HOME study protocol and materials were also approved by Quorum (an external IRB for Allina Health) IRB (reference number: 806161) for all intervention-related activities. The HOME Plus study is registered at www.clinicaltrials.gov NCT01538615 (registered 01/17/2012) while the NU-HOME study is registered with NIH ClinicalTrials.gov: NCT02973815.

2.2. Measurements

In the HOME Plus study, paper copy surveys were completed by parents with assistance from trained study staff in the participants’ homes. Data were double-entered and verified by staff in secure RED-Cap software (https://www.project-redcap.org/). In the NU-HOME study, online surveys using secure RED-Cap software on iPad were completed by parents in a local school.

2.2.1. Sociodemographic Characteristics

Parents reported sociodemographic characteristics (their age, sex, race, ethnicity, education, marital status, their child’s age and sex) and household characteristics (economic assistance and food security) at baseline data collection via survey.

Parents’ race was dichotomized as black, Indigenous, and people of color (BIPOC) = 1 and white = 2. BIPOC included American Indian or Alaskan Native, Asian, Black or African American, Native Hawaiian or Pacific Islander, and other races/ethnicities. Parent’s education was categorized as less than or equal to high school = 1, some college = 2, associate degree = 3, and more than or equal to bachelor’s degree = 4. The parents’ marital status was categorized as married or not married and living with a partner = 1 and separated, divorced, widowed, never married = 2. Child age was calculated as the difference between birthdate and baseline data collection date divided by the number of days each year (365; 366 for leap years).

Food security was measured by asking parents the 6-item USDA Food Security Survey Module (Blumberg et al., 1999). Questions were about whether they worried about running out of food, having money to get more food, could afford balanced meals, cutting the size of meals, eating less, and skipping meals in the past 12 months. Food security status was categorized as food secure (high and marginal food security) = 1 and food insecure (low and very low food security) = 2.

2.2.2. Household Economic Assistance

Receipt of household economic assistance was measured by asking parents whether the household received economic assistance through free/reduced lunch at school for their children or other public assistance (like food support/stamps, EBT (electronic benefits transfer), WIC (Special Supplemental Nutrition Program for Women, Infants, and Children), TANF (Federal Temporary Assistance for Needy Families), SSI (Supplemental Security Income) or MFIP (Minnesota Family Investment Program)) with yes or no response options.

2.2.3. Home Food Inventory

The Home Food Inventory (HFI) was designed to evaluate the healthfulness of food availability and access in participants’ homes by asking parents to complete a food checklist with yes or no response options. The HFI checklist was created and validated by Fulkerson et al. (2008). The checklist categories were set up as refrigerated, frozen, and non-perishable items for easy completion. Parents were instructed to check all forms (fresh, frozen, dried, or canned) of the fruits and vegetables as relevant. Parents were asked to go through all areas of the home where food is stored, such as the refrigerator, freezer, pantry, cupboard, and other areas (e.g., basement), to look for food items in the checklist.

Home fruit and vegetable availability was assessed via the HFI checklist with 26 different fruits and 20 different vegetables (Fulkerson, Nelson, et al., 2008). The home fruit and vegetable availability summative score (home FV score) ranges between 0–46. A high FV availability score indicates healthier food availability at home. For the present study, the home FV availability score was dichotomized as a high home FV availability score (≥21) and a low home FV availability score (<21) based on median values of the study sample.

2.2.4. Parent Meal Self-Efficacy

Parents’ self-efficacy in preparing healthful meals scale was adapted from Beshara et al. (2010) and Nothwehr (2008). The frequency of parents’ self-efficacy in preparing healthful meals was assessed by asking parents four questions: “How are you likely to prepare a healthy meal… (1) after a tiring day, (2) when you haven’t been to the store recently, (3) when you feel stressed or tense, and (4) when you do not have access to a recipe?” with five response options ranging from not at all likely = 1 to very likely = 5. Responses to the four questions were summed to create a self-efficacy score in preparing healthful meals (Cronbach α coefficient = 0.83).

Frequency of parents’ self-efficacy in knowing portion size (Neumark-Sztainer et al., 2003) was examined by asking parents four questions: “I feel confident that… (1) I know appropriate portion sizes for my child’s meal, (2) I know appropriate portion sizes for my own meals, (3) I know what a serving size is compared to a portion size and (4) I can estimate recommended servings sizes for many foods” with four response options ranging from strongly agree = 4 to strongly disagree = 1. Responses to the four questions were summed to create a self-efficacy score in knowing portion size (Cronbach α coefficient = 0.84).

2.2.5. Parent Meal Practices

The family dinner routines scale was adapted from Fiese and Kline (1993) by eliminating two questions and changing from a two-statement format to a single question and modifying response options. Parents’ perceptions regarding family dinner routines was evaluated with a scale including six questions: “In my family… (1) everyone has a specific role and job to do at dinner time, (2) dinner time is flexible; people eat when they can, (3) everyone is expected to be home for dinner (4) people feel strongly about eating dinner together (5) dinner time is just for getting food, (6) there is little planning around dinner time” with three response options ranging from not true = 1 to true = 3. Response options for questions 2, 5, and 6 were reverse-coded. A single score for the family dinner routine was created by summing the responses to the six questions (Cronbach α coefficient = 0.71).

Frequency of eating dinner together as a family was measured using adapted questions from existing instruments (Fulkerson, Story, et al., 2008; Larson et al., 2013; Powers, 2005). Family dinner frequency was evaluated by asking parents four questions: “During the past 7 days, how many times… (1) did all or most of your family living in your home eat dinner together, (2) was at least one parent sitting with your child when your child at his/her dinner, (3) were you sitting and eating with your child when he/she ate his/her dinner, (4) were most members of your family sitting and eating dinner together” with a response ranging from 0 (never) to 7 times. A summative family meal frequency score was created by summing up responses of the four questions (Cronbach α coefficients = 0.92).

The frequency of purchasing dinner from fast food restaurants was assessed by one question using an adapted question from existing instruments (Fulkerson et al., 2011; Fulkerson, Story, et al., 2008). Specifically, “During the past 7 days, how many times was a family dinner purchased from a fast food restaurant and eaten either at the restaurant or at home?” with a response range from 0 (never) to 7 times.

Family breakfast frequency (Fulkerson, Story, et al., 2008; Larson et al., 2013; Powers, 2005) was assessed by asking parents a single question: “During the past 7 days, how many times did all of most of your family living in your home eat breakfast together?” with response options ranging from 0 (never) to 7 times.

The frequency of the child’s plate being half filled with FV was measured by asking parents one question “During the past seven days, how many times was ½ of your child’s plate filled with fruits and vegetables at dinner?” with eight response options ranging from 0 (never) to 7 times. The study team created this question to incorporate the MyPlate message regarding fruits and vegetables by the Dietary Guidelines for Americans into the HOME Plus study.

2.3. Statistical Analysis

Data analyses were conducted using SAS software version 9.4 (Cary, NC, USA, 2002–2012) with statistical significance defined as P < 0.05. Shapiro-Wilk test and histogram were used to examine whether the variables were normally distributed in the study sample.

Creation of Four Family Groups: Four family groups were created by combining the household economic assistance status (yes vs no) and home FV availability score (high vs low), resulting in the following groups: family group-1 = high home FV availability with economic assistance, family group-2 = low home FV availability with economic assistance, family group-3 = high home FV availability without economic assistance, and family group-4 = low home FV availability without economic assistance.

2.3.1. Analysis of Comparisons between Parent Meal Self-Efficacy and Practices and Home FV Score and Household Economic Assistance

Multiple linear regression models were performed to examine the independent associations between parent meal self-efficacy and practices (dependent variables) and family group variables (separate models): (a) home FV score and (b) household economic assistance status (independent variables). All models were adjusted for study (NU-HOME or Home Plus), parent’s education and marital status based on preliminary family group comparisons of demographic characteristics and Spearman correlation analysis. Other variables such as parent age, race, child age, and household food security were considered but included not in the models due to collinearity.

2.3.2. Comparisons of Demographic Characteristics of Participants, Parent Meal Self Efficacy and Practices among Four Group

First, sociodemographic characteristics, household characteristics, parent meal self-efficacy, and practices were compared using chi-square (for categorical variables) and t-tests (for continuous variables) by the four family groups. Second, unadjusted associations between parent meal self-efficacy and practices and four family groups were examined using one-way ANOVA tests to explore initial associations. Third, another set of multiple linear regression models was performed to examine the association between the interactions of family group variables (home FV score * household economic assistance status) and parent meal self-efficacy and practices using GLM (generalized linear mixed model) procedure adjusted for parent education and marital status. For the models with significant interactions (defined with a p-value < 0.10), PLM (post GLM processing) procedures with slice statements and Bonferroni corrections for multiple comparisons were used to calculate the simple effects of each parent’s meal self-efficacy and practices within each family group. The results of the models were presented as adjusted means and standard errors for each level of independent variables.

3. Results

3.1. Sample Demographic Characteristics

The demographic characteristics of participants are shown in Table 1. Most parents self-identified as white (85%) and as women (96%) with a mean age of 39.4 (SD = 7.0) years. Most were food secure (82%), married or living with a partner (74%), and without economic assistance (65.7%). More than half of parents had at least a bachelor’s degree (56%). The mean age for children was 9.7 (SD = 1.4) years, and about half were girls (51.8%). The mean and standard deviation (SD) for the frequency of parent meal self-efficacy and practices were described in Table 1.

Table 1.

Demographic characteristics of the participants (N=274).

Demographic variables Overall
Child demographics
Age, years, mean (SD) 9.7 (1.4)
Gender, n (%)
 Boys 132 (48.2)
 Girls 142 (51.8)
Parent demographics
Age, years, mean (SD) 39.4 (7.0)
Race, n (%)
 BIPOC1 41 (15.0)
 White only 233 (85.0)
Education, n (%)
 Less than or equal to high school 24 (9.3)
 Some college or associate degree 85 (33.1)
 More than or equal to bachelor’s degree 148 (57.6)
Marital status, n (%)
 Married or not married, living with a partner 204 (74.4)
 Separated, divorced, widowed, never married 70 (25.6)
Household Economic Assistance, n (%)
 Yes 94 (34.3)
 No 180 (65.7)
Food security status, n (%)
 Food secure 222 (81.6)
 Food insecure 50 (18.4)
Parent meal self-efficacy and practices
Parent meal self-efficacy, mean (SD)
 Preparing healthful meals 11.8 (3.9)
 Knowing portion sizes 10.8 (2.4)
Parent meal practices, mean (SD)
 Family dinner routines 13.9 (2.7)
 Frequency of purchasing dinner from fast food restaurants 1.1 (1.2)
 Family dinner frequency 20.2 (7.1)
 Family breakfast frequency 2.6 (2.3)
 Frequency of child’s plate being half filled with FV 2.8 (2.1)
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1

BIPOC = Black, Indigenous, and people of color.

3.2. Associations among Parent Meal Self-Efficacy and Practices, Home FV Availability, and Economic Assistance Status

Based on the adjusted multiple linear regression models (Table 2), statistically significant associations were observed between the home FV availability score and all parent meal self-efficacy and practices, except for self-efficacy in knowing portion sizes. Families with high FV availability scores had better self-efficacy in preparing healthful meals (p < 0.0001) compared to those with lower FV availability scores. Families with high FV scores had better family dinner routines (p = 0.002), lower frequency of purchasing dinner from fast food restaurants (p = 0.014), higher frequency of family dinner (p = 0.003) and breakfast (p = 0.013), and higher frequency of child’s plate being half filled with FV (p = 0.0004) compared to the families with lower FV availability scores. No significant differences were observed in parents’ meal self-efficacy and practices by household economic assistance status (Table 3).

Table 2.

Adjusted associations of parent meal self-efficacy and practices by home FV availability (N=261)1.

Home FV availability2
High home FV availability score (n=133) Low home FV availability score (n=128) High vs. low FV availability score3
Outcomes LSMeans LSMeans Mean Differences (SE) P-value3
Parent meal self-efficacy
 Preparing healthful meals 12.6 10.6 2.0 (0.5) <0.0001
 Knowing portion sizes 11.1 10.7 0.4 (0.3) 0.148
Parent meal practices
 Family dinner routines 14.0 13.0 1.0 (0.3) 0.002
 Frequency of purchasing dinner from fast food restaurants 1.1 1.5 −0.4 (0.2) 0.014
 Family dinner frequency 20.6 18.1 2.5 (0.8) 0.003
 Family breakfast frequency 2.6 1.9 0.7 (0.3) 0.013
 Frequency of child’s plate being half filled with FV 3.2 2.3 0.9 (0.2) 0.0004
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1

There were 13 missing observations in home FV availability data which reduces N to 261 from 274;

2

Home FV availability score ranges between 0–46. Home FV availability score was dichotomized as a high home FV availability score (≥21) and a low home FV availability score (<21) based on median values;

3

Multiple linear regressions adjusted by study (NU-HOME and Home Plus), parent education and marital status were used for comparisons; P < 0.05.

Table 3.

Adjusted associations of parent meal self-efficacy and practices by economic assistance status (N=274).

Household economic assistance status
Yes (n=94) No (n=180) Yes vs. no1
Outcomes LSMeans LSMeans Mean Differences (SE) P-value
Parent meal self-efficacy
 Preparing healthful meals 11.5 11.5 0.0 (0.6) 0.955
 Knowing portion sizes 10.7 11.1 −0.4 (0.4) 0.292
Parent meal practices
 Family dinner routines 13.5 13.5 −0.0 (0.4) 0.962
 Frequency of purchasing dinner from fast food restaurants 1.3 1.3 −0.0 (0.2) 0.996
 Family dinner frequency 18.8 20.1 −1.3 (1.1) 0.236
 Family breakfast frequency 2.5 2.2 0.3 (0.4) 0.394
 Frequency of child’s plate being half filled with FV 3.0 2.5 0.5 (0.3) 0.208
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1

Multiple linear regressions adjusted by study (NU-HOME and Home Plus), parent education and marital status were used for comparisons; P < 0.05.

3.3. Comparisons of Demographic Characteristics among Four Family Groups

Analyses comparing the demographic characteristics of the four family groups are shown in Table 4. Children’s age and gender were similar across the four family groups. Parents’ age, race, education and marital status, and household food security status significantly differed across family groups (Table 4). The mean age of family group-1 was 38.7 (SD = 9.4) and 38.5% of those were BIPOC. Most family group-1 had received less than or equal to an associate degree education (66.7%) while about half were married or not married living with a partner (46%) and approximately 31% were food insecure.

Table 4.

Demographic characteristics by family groups (N=261)1.

Demographic variables Family group-1
Households with economic assistance & high home FV availability (n=39)		 Family group-2
Households with economic assistance & low home FV availability (n=47)		 Family group-3
Households without economic assistance & high home FV availability (n=94)		 Family group-4
Households without economic assistance & low home FV availability (n=81)		 p-value2
Parent demographics
Age, years, mean (SD) 38.7 (9.4) 35.2 (7.3) 40.5 (5.6) 40.7 (6.2) <0.00011
Race, n (%)
 BIPOC4 15 (38.5) 18 (38.3) 0 (0.0) 3 (3.7) <0.00013
 White only 24 (61.5) 29 (61.7) 94 (100.0) 78 (96.3)
Education, n (%) <0.00013
 Less than or equal to high school 9 (23.1) 7 (15.6) 3 (3.2) 5 (6.2)
 Some college or associate degree 17 (43.6) 21 (46.7) 27 (29.0) 20 (25.0)
 More than or equal to bachelor’s degree 13 (33.3) 17 (37.8) 63 (67.8) 55 (68.8)
Marital status, n (%) <0.00013
 Married or not married living with a partner 18 (46.1) 20 (42.6) 85 (90.4) 73 (90.1)
 Separated, divorced, widowed, never married 21 (53.9) 27 (57.4) 9 (9.6) 8 (9.9)
Food security status, n (%) <0.00013
 Food secure 27 (69.2) 25 (53.2) 90 (95.7) 73 (92.4)
 Food insecure 12 (30.8) 22 (46.8) 4 (4.3) 6 (7.6)
Child demographics
Age, years, mean (SD) 9.9 (1.5) 9.9 (1.6) 9.6 (1.4) 9.8 (1.4) 0.5222
Gender, n (%) 0.6903
 Boys 16 (41.0) 22 (46.8) 49 (52.1) 38 (46.9)
 Girls 23 (59.0) 25 (53.2) 45 (47.9) 43 (53.1)
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1

There were 13 missing observations in home FV availability data which reduces N to 261 from 274;

2

One way ANOVA tests were used for comparisons and

3

Chisquare tests were used for comparisons, P < 0.05;

4

BIPOC = Black, Indigenous, and people of color.

3.4. Unadjusted Comparisons of Parent Meal Self-Efficacy and Practices among Four Family Groups

Table 5 shows unadjusted comparisons between parent meal self-efficacy and practices and family groups. Statistically significant differences were observed across four family groups in parent self-efficacy in preparing healthful meals (p = 0.0002), family dinner routines (p = 0.003), frequency of purchasing dinner from fast food restaurants (p = 0.049), family dinner frequency (p = 0.0001), and frequency of child’s plate being half filled with FV (p = 0.002). Families in households with economic assistance and high FV availability (family group-1) had significantly higher family dinner frequency [mean (SD) = 20.9 (6.7)] than families in households with economic assistance and low home FV availability (family group-2) [mean (SD) = 16.3 (8.2)] as well as greater frequency of child’s plate being half filled with FV [mean (SD) = 3.3 (2.3)] compared to those in households without economic assistance and low home FV availability (family group-4) [mean (SD) = 2.2 (2.0)]. However, no significant differences were observed in the rest of the meal self-efficacy and practices for parents in families in households with economic assistance and high FV availability compared to those in the other family groups.

Table 5.

Unadjusted parent meal self-efficacy and practice outcomes by family groups (N=261).

Outcome Family group-1
Households with economic assistance & high home FV availability (n=39)		 Family group-2
Households with economic assistance & low home FV availability (n=47)		 Family group-3
Households without economic assistance & high home FV availability (n=94)		 Family group-4
Households without economic assistance & low home FV availability (n=81)		 P-value
Parent meal self-efficacy
 Preparing healthful meals 12.7 (4.4) 10.7 (3.9) 13.0 (3.6) 10.9 (3.6) 0.0002
 Knowing portion sizes 10.9 (2.6) 10.6 (2.7) 11.0 (2.2) 10.5 (2.5) 0.581
Parent meal practices
 Family dinner routines 13.8 (2.8) 13.3 (2.6) 14.7 (2.5) 13.5 (2.7) 0.003
 Frequency of purchasing dinner from fast food restaurants 1.1 (1.4) 1.4 (1.5) 0.8 (1.0) 1.2 (1.2) 0.049
 Family dinner frequency 20.9 (6.7) 16.3 (8.2) 21.9 (5.9) 20.5 (7.0) 0.0001
 Family breakfast frequency 2.7 (2.3) 2.3 (2.3) 3.0 (2.4) 2.1 (2.2) 0.070
 Frequency of child’s plate being half filled with FV 3.3 (2.3) 2.5 (1.9) 3.2 (2.0) 2.2 (2.0) 0.002
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1

Home FV availability score ranges between 0–46. Home FV availability score was dichotomized as a high home FV score (≥21) and a low home FV score (<21) based on median values;

2

One-way ANOVA tests were used for comparisons, P < 0.05;

3.5. Adjusted Comparisons of Parent Meal Self-Efficacy and Practices among Four Family Groups

No notable interactions (p-value < 0.10) were observed between home FV availability and economic assistance status in most adjusted regression models examining parent meal self-efficacy and practices and family groups, except for the models with family dinner frequency (data not shown). A significant interaction was observed between home FV availability and economic assistance status (p-value = 0.056 for interaction) in the model with family dinner frequency. Family group-1 had more frequent family dinners [mean (SD) = 21.9 (1.2), p = 0.001] than those in households with economic assistance and low home FV availability (family group-2) [mean (SD) = 17.1 (1.1)]. Also, families without economic assistance and low home FV availability (family group 4) had more frequent family dinners [mean (SD) = 20.2 (0.8), p = 0.025] compared to those with economic assistance and low home FV availability (family group 2) [mean (SD) = 17.1 (1.1)]. No significant differences were observed in family meal frequency among the rest of the family group comparisons.

4. Discussion

The purpose of this cross-sectional study was twofold: 1) to investigate the association between parent meal self-efficacy and practices, economic assistance status, and the availability of home FV, and 2) to compare the parent meal self-efficacy and practices among four family groups. Parents with high home FV availability had better meal self-efficacy and practices, except for self-efficacy in knowing portion sizes, compared to parents with low home FV availability. However, there were no significant associations between parent meal self-efficacy and meal practices and economic assistance status. Only the frequency of family meals was associated with an interaction between home FV availability and economic assistance status when we compared the four family groups. Moreover, among families receiving financial assistance, families in households with high FV availability were less likely to experience food insecurity. In conclusion, our study highlights the positive association between the home food environment and parent meal self-efficacy and practices among parents. Also, family dinner frequency was found as an important strength for families in households with economic assistance and high FV availability.

Our study found that families receiving economic assistance that also had high home FV availability, were more likely to have frequent family dinners in both the unadjusted models and the adjusted interaction models. This finding suggests that family dinners may be an important family strength in families facing economic challenges as well as could be associated with proactive food preparation and the presence of more fruits and vegetables. Family meals provide a context for social support, communication, and shared experiences among family members (Berge et al., 2013; Utter et al., 2018). Thus, family meals may help low-income families to cope better with economic stressors and challenges by developing strong bonds with family members during meals. Recognizing these connections could inform interventions aimed at promoting healthy eating practices and family strength in low-income households, by emphasizing the value of family dinners.

Despite finding a significant independent relationship between home FV availability and parent meal self-efficacy and practices, we did not observe a significant difference in the majority of parent meal self-efficacy and practices between families that received economic assistance and had high home FV availability compared to the other three family groups in the adjusted interaction models. This finding suggests the availability of FV in the home is an important factor for all families, regardless of economic assistance status and that increasing access to FV in the home could be an effective strategy for improving parent meal self-efficacy and practices generally. Overall, future studies are needed to explore the complex relationships between economic status, access to healthy foods, and parent meal self-efficacy and practices in order to better understand how to support healthy eating habits in all families.

Our study also examined the relationship between parent meal self-efficacy and practices and economic assistance status; surprisingly, we did not observe any significant associations. Further research is needed to examine the underlying factors that contribute to this relationship and to develop effective strategies for promoting healthy eating behaviors among low-income families.

On the other hand, our findings indicate that parents with high FV availability at home have a higher frequency of family breakfast and dinner, lower reliance on fast food restaurants, and higher frequency of child’s plate being half filled with FV during dinner. These results are consistent with previous research that found a significant relationship between home FV availability and frequent family meals (Newman et al., 2015; Utter et al., 2008) and overall healthy dietary behaviors in both parents and children (Arcan et al., 2019; Larson et al., 2012; Ong et al., 2016; Rex et al., 2021). Our study also highlights the importance of examining the impact of fruit and vegetable availability on other meal practices, such as reliance on fast food restaurants. Our findings suggest that high FV availability at home is associated with lower reliance on fast food restaurants for dinner. These results are particularly relevant given the high prevalence of fast food consumption among children (Fryar et al., 2020) and families (Dunn et al., 2021; Fryar et al., 2018) in the US and the potential health consequences associated with a diet high in fast food. By assessing the influence of FV availability on these important meal practices, our study provides further evidence for the importance of promoting healthy food environments within the home.

Previous studies have found a positive association among household healthy food availability (Pearson et al., 2017) and parent self-efficacy (Arcan et al., 2019; Campbell et al., 2010; Cullen et al., 2000; Möhler et al., 2020; Pearson et al., 2017; Rohde et al., 2018; A. D. Walsh et al., 2019; Young et al., 2004) and the dietary behaviors of children. Our study builds on this by examining the association between home FV availability and parental self-efficacy to prepare healthful meals. Our findings suggest that increasing FV availability in households may support parents’ ability to prepare healthful meals, which has important implications for promoting healthy eating behaviors among children and families, although we did not assess that in this study. Our study highlights the importance of addressing food availability and meal practices together as an important component of efforts to promote children’s healthy eating behaviors.

Strengths of this study include its large population-based sample who were from both urban and rural areas of the MN. Another strength of this study is that data were collected by validated survey questions and came from two rigorous randomized controlled trials. Also, this study examined associations between home FV availability in conjunction with economic assistance status and parent meal self-efficacy and practices. This study had several limitations. It was not possible to derive a causal relationship from this study due to the nature of the cross-sectional design. Participants had certain demographic characteristics (the majority were white, food secure, and had a high education) and were from the same geographical region, which could limit the generalizability of the study to the general population. Monetary incentives and/or interest in health and nutrition may have influenced some of the parents’ decisions to participate in the study.

To conclude, this cross-sectional study highlights the critical role of home FV availability on parent meal self-efficacy and practices which can potentially impact healthy eating behaviors among children and families. The study findings indicate that increasing FV availability in households may support parents’ ability to prepare healthful meals, promote frequent family meals, and lower reliance on fast food restaurants. The study also showed that parent meal self-efficacy and practices did not significantly differ by economic assistance status (yes/no), suggesting that receiving economic assistance may help some low-income parents to have better meal self-efficacy and practices. Moreover, our study indicated family dinners as an important strength for families who are capable of maintaining a healthy home food environment despite facing economic hardship. Moving forward, this study underscores the need for promoting healthy home food environments and suggests the use of asset-based models to explore the complex relationships between economic status, access to healthy foods, and parent meal self-efficacy and practices to better support healthy eating habits in all families.

Acknowledgment

The authors want to thank to the families who participated in the studies and the community support that made these trials possible as well as the research team members, and students who contributed to both studies.

Funding

This study was supported by Grant R01 HL123699 (NU-HOME) from the National Heart Lung and Blood Institute (NHLBI) and Grant R01 DK08400 (HOME Plus) from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at the National Institutes of Health (NIH). Both trials are registered with ClinicalTrials.gov (NU-HOME trial is NCT02973815 and the HOME Plus trial NCT01538615). This study used REDCap for data collection, which was supported by the Clinical and Translations Science Institute grant (UL1TR002494) from the National Institutes of Health’s National Center for Advancing Translational Science. AB’s time was supported by Award Number T32DK083250 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The study content is solely the responsibility of the authors and does not necessarily represent the official views of the NHLBI, NIDDK, or NIH.

Footnotes

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Ethics Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board (IRB) of the University of Minnesota Institutional Review Board (reference number: 1003S78592 for HOME Plus and 1509S78583 for NU HOME) for studies involving humans. NU-HOME study protocol and materials were also approved by Quorum (for Allina Health) IRB (reference number: 806161).

Data Sharing

The deidentified datasets used in the current study are available to other scientists upon reasonable request from Dr. Fulkerson.

Conflicts of Interest

All the authors declare no conflict of interest.

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