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. Author manuscript; available in PMC: 2013 Mar 5.
Published in final edited form as: West J Nurs Res. 2010 Oct 8;34(3):396–416. doi: 10.1177/0193945910381597

Patterns and Correlates of Nutrition Among Migrant Farm-Worker Children

Jill F Kilanowski 1
PMCID: PMC3587771  NIHMSID: NIHMS439351  PMID: 20935214

Abstract

Past research has demonstrated a higher incidence of overweight children in migrant farm-worker (MFW) families than in the general U.S. population. This study provided descriptive data on MFWs’ acculturation, household food security, and general self-efficacy, and children’s food patterns and body mass index. Convenience samples of 60 parent–child dyads were obtained from six MFW camps in two Midwest states. Acculturation and food security were low, higher general self-efficacy was associated with low acculturation, and the majority of children did not meet their U.S. Food Guide Pyramid recommendations. It was noteworthy that 48% of the sample, including siblings (excluded from data analysis), was overweight or obese. The knowledge learned concerning the food patterns and correlates of nutrition in this descriptive phase of the DINE study will direct counseling to MFW mothers on the purchase and preparation of affordable, nutritious, and culturally acceptable foods to achieve healthy weight in their children.

Keywords: migrant farm-worker, children, nutrition, obesity, food security, acculturation, self-efficacy

The epidemic of childhood overweight and obesity has created the need to design health care interventions to help prevent and treat this public health problem. National and foundation funding bodies have supported the design and testing of such interventions; however, these interventions are focused on the majority population, often excluding the distinctive needs of ethnic and minority groups. There is a paucity of research available on the unique characteristics of the itinerant children of migrant farm-workers (MFWs) and their families. This study, “Dietary Intake and Nutrition Education (DINE) in the Migrant Farmworker Child,” based on the framework of self-management, has three phases over 3 years: description of the MFWs’ unique characteristics, design of the nutritional intervention for MFW mothers, and finally testing of said intervention. The descriptive study is completed and data results on household food security, acculturation, self-efficacy, children’s food intake, and children’s growth parameters are reported here.

Current Knowledge About Latino Migrant Farm-Workers and Their Children

Migrant farm-worker families in the United States are primarily of Latino ethnicity. Past research has demonstrated a higher incidence of overweight children in this vulnerable population compared to the general U.S. population (Kilanowski, 2006; Kilanowski & Ryan-Wenger, 2007). Additional studies have shown that few children meet the U.S. Department of Agriculture (USDA) Food Guide Pyramid (MyPyramid) food group recommendations for age and gender, and food insecurity was common (Kilanowski, 2010). In the design of any ethnically tailored intervention, the unique characteristics of said group must be considered to optimize effectiveness and engage parental participation. Preventing and reducing childhood overweight and obesity necessitates a multifaceted program where parents play a critical role (Lindsay, Sussner, Kim, & Gortmaker, 2006). Effective programs in self-management of unhealthy weight may include techniques to improve dietary and physical activity habits. Self-management of children’s healthy weight involves a set or activities to promote active involvement in care, the acquisition of new skills and new knowledge, and may require an adaptation of what has previously been learned (Agency for Healthcare Research and Quality, 2008).

Food security refers to the availability of and access to food: a household is considered food secure when its members do not live in hunger or fear of starvation (Nord, Andrews, & Carlson, 2004). The association of low food security (food insecurity) and overweight status in children has been explored with inconclusive results. Research design has been limited by size of pediatric age, gender, race, and ethnicity data sets and using available data from past years that do not reflect the increasing rates of childhood overweight. The National Health and Nutrition Examination Survey (NHANES) 1999–2002 was used to evaluate the association of household food security and overweight status in children (n = 6,995; Casey et al., 2006). In the study, low levels of household food security were associated with overweight (body mass index [BMI] ≥ 85% for age and gender) status in (a) children ages 12 to 17 years, (b) girls, (c) household poverty 0%–100%, and (d) 400% to 500% times the federal poverty level. In addition, child food insecurity was associated with overweight status in (a) children 3 to 5 years, (b) boys, and (c) Mexican American children.

In another study, which examined data from the Early Childhood Longitudinal Study–Kindergarten Cohort 1998 (n = 21,000) of kindergarten children followed to the third grade, findings showed that at kindergarten, food insecurity predicted greater weight gain and BMI increases in girls, regardless of status of food insecurity reported at third grade (Jyoti, Frongillo, & Jones, 2005). Results also suggested an association between food insecurity and greater weight gain among boys. These results contradict the findings examining the 1999 study of the same sample set looking at the kindergarten cohort only (n = 16,889; Rose & Bodor, 2006). Here, results showed that children from households with food insecurity were 20% less likely to be overweight, but positive predictors of overweight were low physical activity levels, watching television for more than 2 hr per day, high birth weight, low family income, and black or Latino ethnicity. In addition, Latino boys demonstrated a greater prevalence towards being overweight compared to Latina girls, and lower maternal education was associated with higher rates of childhood overweight. This study did not examine dietary intake.

In an ecologic study of overweight children ages 12 to 24 months enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC; n = 374), it was found that overweight children had significant positive associations with maternal BMI and servings of dietary fat (Reifsnider, Keller, & Gallagher, 2006). In addition, overweight status was significant and negatively associated with servings of protein and child reporting hunger.

Typically, within a family unit, children are spared the effect of low food security until it becomes severe (Kaiser et al., 2002). When households are concerned about finances and adequate food supplies, lower-cost foods often replace more expensive, nutritionally balanced foods, reducing the quality and variety of the family diet. This is also seen at the end of the month when income from food assistance programs and paychecks is lowest. To stretch limited family funds, substitutions of low-cost energy-dense foods, changes in frequency of meals, and variations of portion sizes occur. Drewnowski and Specter (2004) summarized obesity and dietary intake research and found that the highest rates of obesity occurred among those with the highest poverty and lowest education levels. In addition, they found foods that are energydense (refined grains, added sugars, and fats) often represent to the consumer low-cost options, stretch the family food budget, and provide more sensory enjoyment than foods that are not energy-dense. Poverty and food insecurity were also associated with lower food expenditures, low vegetable and fruit consumption, and lower quality diets. Nutrition recommendations from this study included reducing energy-dense foods such as french fries, processed foods and meats, sugary snacks and drinks, and dairy fat products from the diet, while shifting dietary choices to increased fruits, vegetables, and whole grains. Despite common belief, improving diet quality is not necessarily associated with increased diet costs; however, low-cost, nutritionally adequate diets may not be palatable or socially acceptable (Maillot, Darmon, Darmon, Lafay, & Drewnowski, 2007).

Findings from studies examining obesity and acculturation have not been conclusive. For example, some studies show that individuals of Mexican heritage who are more acculturated to American society have a lower incidence of obesity (Hazuda, Haffner, Stern, & Eifler, 1988; Khan, Sobal, & Matorell, 1997). Contradictorily, another more recent study reported that individuals of Mexican descent who were less acculturated to American society had a smaller average waist circumference and a lower incidence of abdominal obesity (Sundquist & Winkleby, 2000). In regard to the present study’s variable of self-efficacy, one study looked at parental levels of self-efficacy and stages of change in increasing daily fruit and vegetable consumption of their preschool-aged children (Hildebrand & Betts, 2009). In the stages of change for altering behavior, time was identified as a limiting determinant of the number of fruit and vegetable servings offered to children. When money was limited, affecting parental capability to serve fruits and vegetables, the measure of self-efficacy was low in parents in two of three stages of change: precontemplation, contemplation, and preparation.

In summary, research on food security in low-income families and its relationship to children’s overweight status has shown positive correlations, but studies on MFWs are lacking. The role of acculturation to overweight in Mexican families has been inconclusive. Self-efficacy and nutrition (seen in offering daily servings of fruits and vegetables) were affected when time constraints and family finances were limited.

Purpose

The purpose of this study was to gather information on the characteristics of Midwest MFW families and children: including household food security, parent acculturation and general self-efficacy, and children’s anthropometric growth parameters to determine BMI for age and gender percentiles (BMI was the primary outcome). In addition, through assessment of food frequency and patterns, children’s diets were measured for adherence to the food group serving recommendations of the USDA Food Guide Pyramid. The research questions studied were as follows: (a) What are the measures of acculturation, food security, and self-efficacy in the MFW families? (b) What level of dietary intake is achieved by MFW children as per the recommended servings of the USDA Food Guide Pyramid for age and gender? and (c) Is there a difference in children’s BMI-for-age percentiles in MFW families that are categorized with different levels of acculturation, food security, self-efficacy, achievement of recommended Food Guide Pyramid servings? Knowledge learned from this study will influence the design of the health promotion materials on healthy eating and healthy weight.

The concept of self-management from the PRECEDE–PROCEED Model of Health Program Planning and Evaluation (Green & Kreuter, 1999) contributes to this study by guiding choice of outcome variables and suggesting characteristics that can be identified as predisposing, enabling, and reinforcing factors. This study assumed that parents make day-to-day decisions for their children in food selection and meal preparation illustrated by food patterns. The outcome was BMI obtained from anthropometric measures. Predisposing factors for food patterns were operationally defined as acculturation and food security and an enabling factor was self-efficacy. Although the PRECEDE-PROCEED model doses not attempt to explain or predict relationship among variables and outcomes, it serves as a roadmap to develop health behavior change programs that are appropriate and culturally sensitive (Glanz, Rimer, & Lewis, 2002).

Method

Design

Approved in expedited review by the university’s institutional review board (IRB), this 4-month descriptive cross-sectional study involved the collection of qualitative and quantitative data. It also evaluated the feasibility of audio-enhanced personal digital assistants (APDAs) in the collection of survey data and included a qualitative study on the meaning of food to MFW mothers: both will be reported separately (Kilanowski, 2010; Kilanowski & Trapl, 2010).

Sample

Convenience samples of 60 parent–child dyads were obtained from six Midwest MFW camps in two states, Ohio 57% (34) and Michigan 43% (26). Inclusion criteria included adult parent residing in a migrant camp with a child aged 2 to 13 years. The age selection for children started at 2 years, as children are by then typically eating table foods, and the cutoff age of 13 years was chosen because children of that age are often permitted to work in the agricultural fields. Written consent was secured in the language of the participants’ choice and oral, and when appropriate written, assent were obtained from children. Audio-enhanced personal digital assistants were used to collect data and due to APDA errors or research team error and the sample size decreased to 58.

Instruments

All instruments used had a Flesch-Kincaid Grade Level of 2 to 4.2 and were available in English and Spanish (Kincaid, Fishburne, Rogers, & Chisson, 1975). Mode of survey data collection was paper-and-pencil or APDAs. All participants chose APDAs, which had the demographic questionnaire and acculturation, food security, and self-efficacy scales uploaded into the APDA using the administrative design module SEDCAadmin—an iteration of the Surveyor software package (Kilanowski & Trapl, 2010). The visual APDAs were enhanced with attached voice files that read the surveys to the participants heard via personal headphones. The dietary intake survey was only available in a paper-and-pencil format.

Demographic questionnaire

The demographic questionnaire adopted from a previous study (Kilanowski, 2006) was combined with questions on participants’ past usage of electronic equipment (i.e., APDAs) and commonly asked health promotion/anticipatory guidance questions such as play space safety and presence of a television in the sleeping area. It was translated and back-translated by native Spanish speakers and had undergone a cultural assessment by the IRB following university protocol with research studies involving non–English-speaking participants.

Acculturation

Acculturation is defined and measured as the psychological and social changes that occur when groups or individuals from different cultures come into continuous contact with each other (Cabassa, 2003). The Short Acculturation (12-item) Scale for Hispanics (SASH) is a reliable method to identify Hispanics who are low or high in acculturation and has been used in a variety of Hispanic subgroups, including Mexican Americans (Marin, Sabogal, Marvin, Otero-Sabogal, & Perez-Stable, 1987). The SASH item responses are averaged, and an average of 2.99 is used to differentiate the less acculturated (1 to 2.99) from the more acculturated (>2.99). The Cronbach’s alpha for the original 12 items of the SASH ranged from .78 to .92 and the testing of external validity measured by the examination of the relationship of the instrument to length of stay showed a significant correlation of .70, with correlations of the SASH to generational-level significant at .65 (Marin et al.). In the present study, Cronbach’s alpha was .891.

Food security

Food security is further defined as the ability of individuals to obtain sufficient food on a day-to-day basis for an active healthy life, in socially acceptable ways (Bickel & Nord, 2000; Keenan, Olson, Hersey, & Parmer, 2001). The U.S. Household Food Security Scale (HFSS), with its multiple indicator questions, captures and distinguishes the various levels and full range of severity of food insecurity. The HFSS is based on data collected annually by the U.S. Census Bureau as a supplement to the monthly Current Population Survey (CPS) of interviewed households (Nord et al., 2004). The five-question short form of the HFSS has been successfully used in noninterview data collections, with alternative language formats, and is available in Spanish (Blumberg, Bialostosky, Hamilton, & Briefel, 1999; Frongillo, 1999). It has classified 95.6% of U.S. households with children (n = 16,914) correctly (Harrison, Stormer, Herman, & Windham, 2003). Sensitivity and specificity of the short form for households with children to determine overall food security is 85.9% and 99.5%, respectively, and for the determination of very low security, 78.4 % and 99.2% (Economic Research Service, 2006). The HFSS has an internal consistency of Cronbach’s alpha ≥0.85, and accuracy for use in populations and in individuals was established in the comparison of three food security measures: the HFSS, the Radimer/Cornell, and the Community Childhood Hunger Identification Project (Chang, Brown, & Nitze, 2004). In the present study, Cronbach’s alpha was .781. Completed surveys are assigned scale scores and classified into food security levels based on standard values in total number of affirmatives: 0 to 1 = food secure, 2 = marginal food security, 3 to 4 = low food security, and 5 = very low food security.

Self-efficacy

Self-efficacy, the optimistic self-belief that one can perform a novel or difficult task (Mailbach & Murphy, 1995), was measured in this study to see if the design of the future health promotion intervention required its inclusion. There are many self-efficacy scales tailored specifically for domains of function and population, but none were identified for Latino MFWs and their children’s dietary intake. Self-efficacy was measured with the General Self-Efficacy Scale (GES), a self-administered test to assess individuals’ perceived self-efficacy, used to predict coping with daily challenges in health promotion behavior (Schwarzer, 2005). The 10-item survey available in English and Spanish is answered on a 4-point dimension: 1 = not at all, 2 = hardly true, 3 = moderately true, and 4 = exactly true. There is no cutoff score for self-efficacy; however, according to instrument directions, groups are established based on the empirical distribution of the population and the sample is dichotomized after a median split. Scores of MFWs were compared to an available international data set containing 18,000 respondents and Cronbach’s alphas range from .75 to .91 (Scholz, Dona, Sud, & Schwarzer, 2002). In the present study, Cronbach’s alpha was .919. The GES scale has been adapted to many languages and maintains the same structure across cultures, thus supporting its use in this study’s population. The construct of general selfefficacy has been studied and it was found to represent the universality of selfefficacy with unidimensionality (configural equivalence; Scholz et al., 2002; Luszczynska, Gutierrez-Dona, & Schwarzer, 2005).

Dietary intake

Dietary intake is defined as the cataloging of foods consumed on a daily basis (Cade, Thompson, Burley, & Warm, 2002). A 66-item dietary food frequency questionnaire (FFQ) was used to characterize food patterns based on foods discussed during focus groups with Mexican American parents in California (Kaiser et al., 2002). Parents were asked how often each food item typical to the Latino diet was consumed in the last month, and portion size was estimated by the use of visual props of household bowls, spoons, and glassware. Kitchen implements were provided to participants to assist in the completion of the survey—a lesson learned from pilot work from the previous summer (Kilanowski, 2010). The USDA Food Guide Pyramid for children was used to calculate number of servings per week from each food group and a minimum requirement for each group was determined. Scoring was assessed as 1 = a minimum requirement for a particular food group was achieved or 0 = minimum requirements were not achieved. A total Food Guide Pyramid score was obtained by summing across the five groups with a range of 0 to 5. The greater the score, the more of the minimum requirements suggested by the USDA were met. A similar food group scoring system used in toddlers was correlated to mean nutrient adequacy for 12 nutrients (Garcia, Kaiser & Dewey, 1990; Kaiser et al., 2002). The FFQ established validity through comparisons of direct observation that yielded similar estimates of food group servings and is available in Spanish and English.

BMI-for-age percentile

Children were weighed and measured in indoor clothing with their shoes removed behind a privacy screen. The weight of all children in this study was obtained on a Tanita 1582 Baby/Mommy Scale with a capacity for weighing children up to 250 lb to the nearest 0.2 lb (http://www.tanita.com/es/1582). The scale is standardized at the factory before shipment with a 150-lb weight and its accuracy is ± 0.25%. Standing height was assessed on the Seca 214 Portable Height Road Rod stadiometer with a measurement range of 10 in. to 6 ft 6 in. (http://www.seca-online.com/seca-214). Gradations of measurement are in 0.1 cm or ⅛ in. and the error measurement is ± one gradation or ⅛ in. All measurements were obtained twice. The percentiles for all growth parameters and body mass index (BMI) for age were determined from the Epi Info™ 3.3.2 program downloaded from the Centers for Disease Control and Prevention website; the program eliminates errors from paper-and-pencil markings on individual growth charts (U.S. Department of Health and Human Services, 2005). Siblings who asked to be measured (only 3% of the participants had a scale at home) joined those children of the parent–child dyads. No one was turned away and after consent and assent, the child sample measuring BMI increased to 82. These children were not included in the remainder of study analysis to avoid violation of the assumption of independence.

Analysis

Data were analyzed using SPSS, version 16.0, and sociodemographic variables of the sample were described. Analytic strategy included chi-square, independent t tests, and one-way ANOVA. In addition, Pearson’s r correlation assessed relationships between variables, and Cronbach’s alpha was assessed to measure internal consistency of the psychometric instruments.

Results

Demographic data on the characteristics of participants are seen in Table 1 and are complementary to findings in past studies (Kilanowski, 2006, 2010; Kilanowski & Ryan-Wenger, 2007).

Table 1.

Characteristics of Study Participants

Characteristics n (%) Characteristics n (%)
Gender–Parents Marital status
    Men   3 (5)     Married 35 (60)
    Women 55 (95)     Living with partner   2 (4)
Ethnicity     Widowed 12 (21)
    Hispanic 43 (74)     Divorced   3 (5)
    Non-Hispanica 12 (21)     Single parent   6 (10)
    Othera   3 (5) Gender of children
Adult self-selected raceb     Boys 43 (52)
    American Indian   6 (10)     Girls 39 (48)
    Asian   1 (2) Ages of study children (years)
    Black   1 (2)     2–5 46 (38)
    Native Hawaiian   2 (3)     6–11 49 (40)
    White   9 (16)     12–13   5 (4)
    Multigroup   7 (12) Monthly family income
    Other 32 (55)     <$500 50 (29)
Language at home     $500–$1,000 33 (19)
    English   3 (5)     $1,000–$2,000 10 (6)
    Spanish 44 (76)     >$2,000   5 (3)
    Both   8 (14)     Prefer not to answer   2 (1)
    Other (Mexican dialect)   1 (2) Highest parental education
    Missing   2 (3)     Less than 9th grade 69 (40)
Work status     9–11th grade 15 (9)
    Full-time 37 (64)     High school graduate   9 (5)
    Part-time 20 (34)     Some college   7 (4)
    Not employed   1 (2)
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a

Past research studies with migrant farm-worker (MFW) families that have used paper-and-pencil mode for the demographic survey have seen participants choosing other or non-Hispanic when asked about ethnicity and have then hand-written Mexicana or Hispana in the “other” box. Using audio-enhanced personal digital assistants did not permit the choice of other to have a hand-written answer.

b

Past research studies with MFW families have seen participants unsure as to what category of race they belong.

Levels of Acculturation, Food Security, Self-Efficacy

Frequency data from participants’ levels of acculturation, household food security, self-efficacy, children’s BMI, and their achievement of meeting recommendations for food group servings for Food Guide Pyramid are seen in Table 2. The acculturation means for those who completed survey questions in English was higher than those who completed the surveys in Spanish (M = 2.91, SD = 0.680, vs. M = 1.50, SD = 0.503). Those families reporting low acculturation were more likely to have their children meet Food Guide Pyramid dairy serving recommendations, χ2(4, N = 46) = 3.934, p = .047.

Table 2.

Participants Levels of Acculturation, Household Food Security, Generalized Self-Efficacy, and Children’s Achievement of the U.S. Food Guide Pyramid Food Group Serving Recommendations and Body Mass Index

Total, n (%) Boys, n (%) Girls, n (%)
Acculturation      58
    <2.99 52 (90)
    >2.99 10 (10)
Household food security      58
    High 16 (28)
    Marginal 10 (17)
    Low 19 (33)
    Very low 13 (22)
General self-efficacy (dichotomized after median split)      58
    Low general self-efficacy 30 (52)
    High general self-efficacy 28 (48)
Meeting MyPyramid recommendations      47 29 (62) 18 (38)
     Grains 23 (49) 14 (48)   9 (50)
    Vegetables 18 (38) 11 (38)   7 (39)
    Fruit 36 (77) 22 (76) 14 (78)
    Dairy 28 (60) 16 (55) 12 (67)
    Meat/protein 41 (87) 25 (86) 16 (89)
    All groups 12 (25)   5 (17)   7 (39)
Body mass index
    Larger sibling sample      82 43 (52) 39 (48)
      Underweight (<5%)   1 (<1)   1 (2)   0 (0)
      Normal weight 42 (51) 19 (44) 23 (59)
      Overweight (≥85%) 18 (22)   9 (21)   9 (23)
      Obese (≥95%) 21 (26) 14 (33)   7 (18)
    Children 6–11 years 44 (54) 23 (52) 21 (48)
      Underweight (<5%)   0 (0)
      Normal weight 24 (55) 11 (48) 13 (62)
      Overweight (≥85%)   8 (18)   5 (22)   3 (14)
      Obese (≥95%) 12 (27)   7 (30)   5 (24)
    Children 2–5 years 38 (46) 20 (53) 18 (47)
      Underweight (<5%)   1 (3)   1 (5)   0 (0)
    Normal weight 18 (47)   8 (40) 10 (56)
      Overweight (≥85%) 10 (26)   4 (20)   6 (33)
      Obese (≥95%)   9 (24)   7 (35)   2 (11)
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The mean household food security scores were lower (meaning higher food security) for those who used the English version compared to those who used the Spanish version (M = 1.13, SD = 2.10, vs. M = 2.38, SD = 2.00). Table 3 reports the comparison of this study’s MFW sample’s levels of food security compared to the general U.S. population. The three large, most remotely located camps showed the highest food security scores (3.30, 3.38, 3.00), meaning lower levels of food security, compared to the smaller camps in closer proximity to towns or small cities (0.50, 0.75, 1.31). Fifty-five percent of the total MFW sample had low or very low levels of food security and in those families, children were more likely to meet their grain food serving recommendations, χ2(8, N = 46) = 7.977, p = .046, and dairy serving recommendations, χ2(8, N = 46) = 8.407, p = .038.

Table 3.

Comparison of Household Food Security of Migrant Farm-Worker Sample to National Values

Food Securea
(%)		 Low Food
Security (%)		 Very Low Food
Security (%)
National ratesb 82    7    4
    Hispanic 78  13    5
    Mexican 76 NA NA
    Below poverty linec 64  22  14
Sample migrant 2007 (n = 50) 48  44    8
Sample migrant 2008 (n = 58) 45  33  22
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a

Food secure category includes food secure and marginal food security.

c

Household income-to-poverty ratio <1.0.

The mean self-efficacy score for the total sample was (M = 31.14, SD = 8.3, median 34.00). Those using the English version has a lower self-efficacy score compared to those using the Spanish version (M = 27.00, SD = 7.60, vs. M = 31.80, SD = 8.29). Parents who showed higher levels of general self-efficacy were less likely to have their children achieve all the USDA Food Guide Pyramid/MyPyramid food group serving recommendations, χ2(4, N = 47) = 4.235, p = .040. Parents of male children had significantly higher self-efficacy scores compared to female children, M = 32.90, SD = 7.72, vs. M = 27.11, SD = 8.58; t = (1, 46) = 2.412, p = .020.

One-way ANOVA showed significant between-group (migrant camps) differences compared to within-group differences in household food security scores, F(5, 57) = 4.187, p = .003, and acculturation scores, F(5, 57) = 3.124, p = .015. Independent t test of parent general self-efficacy with male child gender was significant, t(1, 46) = 2.348, p = .020, with the mean scores greater for those with male children versus female children, M = 32.90, SD = 7.72, vs. M = 27.11, SD = 8.58. General self-efficacy was negatively correlated with acculturation (r = −.264, p = .045) and negatively associated with female child gender (r = −.335, p = .020).

In linear regression with the acculturation score as the dependent variable, the predictor, general self-efficacy, was significant (β = −.298, p = .027), household food security was nonsignificant, and the model approached significance, F(2, 57) = 2.918, r2 = .096, p = .062.

In linear regression with self-efficacy as the dependent variable, the predictor, acculturation score, was significant (β = −.289, p = .027), household food security approached significance (β = −.237, p = .067), and the model was significance, F(2, 57) = 3.938, r2 = .125, p = .025.

Dietary Intake of MFW Children

When assessing dietary intake in food patterns, it was found that of 59 (1 additional undamaged FFQ added to sample size) paper-and-pencil FFQ surveys completed, only 47 (80%) were able to be scored by a registered dietitian. Problems in completion were similar to those found in a pilot study the previous summer (Kilanowski, 2010). In this study, MWF girls were twice as likely to consume all recommended daily servings compared to MFW boys. Otherwise, gender differences were small when comparing achievement of each food group serving recommendations. U.S. national averages look at the age grouping of children 6 to 11 years, and comparing MFW children in this study to the U.S. national average (seen in Table 4), results showed that MFW children did better compared to their age-matched peers in the fruit and vegetable food groups, which was an unexpected finding.

Table 4.

Comparison of National Surveys to Two Migrant Farm-Worker Samples of Boys and Girls 6 to 11 Years Meeting Dietary Recommendations of Fruits and Vegetables

1998
Continuing
Survey
of Food
Intakes By
Individualsa 		Healthy
People 2010
Databaseb 		Migrant Children
2007c (n = 18)		 Migrant Children
2008 (n = 23)
Boys
(n = 6)		 Girls
(n = 12)		 Boys
(n = 11)		 Girls
(n = 12)
Boys Girls Boys Girls
Fruit 23 24 37 66 50 42 92 73
Vegetable 18 19 NA NA   0 25 25 36
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Note: Values are percentages.

a

U.S. Department of Agriculture, Agricultural Research Service, retrieved from http://www.ars.usda.gov/Services/docs.html

b

U.S. Department of Health and Human Services (2002).

Relationship of Children’s BMI Percentiles and Study Variables

Families with low and high levels of acculturation had similar prevalence of children who were classified as overweight or obese (57% vs. 50%). Although not significant, children in this study with higher BMIs were more likely to meet all the food group recommendations: underweight or normal weight (13%, n = 16), overweight (34%, n = 11), or obese (33%, n = 12). Low or very low levels of food security were seen in 48% of children with under- or normal weight (n = 21), 75% in those classified as overweight (n = 12), and 53% in obese children (n = 15). In addition, integrating answers from the demographic questionnaire, BMI percentile was positively correlated with parent report of their child’s number of sleep hours (r = .345, p = .024).

Discussion

As expected, the mostly Latino MFW parents showed low levels of acculturation. The camps where they live are enclaves that enable families to continue ethnic customs and lifestyles and are often located off dirt roads in secluded areas often away from public view. One camp that was closest to a small city showed the largest mean acculturation score of 2.21: the next largest mean camp score of 1.92. In this study, lower than average acculturation levels were associated with higher levels of self-efficacy. General self-efficacy had a significant linear relationship with acculturation and household food security. It can be speculated that those families who chose to enter the migrant stream already have made decisions and have taken action to change an existing living environment. In the current study, no statistical significance was seen between acculturation and BMI. Higher levels of maternal acculturation have been associated with higher levels of children’s BMI (Fuentes-Afflick & Hessol, 2008). However, other studies contradict this finding and claim higher acculturation leads to decreased incidence of overweight (Nelson, Chiasson, & Ford, 2004). This relationship between acculturation and unhealthy weight in children needs further study. Those children in families with low acculturation were more likely to have met their dairy food serving recommendations. These families may decide the intake of milk and cheese a priority for their children.

Demographic data from this study showed that 83% of participants’ family incomes were less than $1,000 per month and most families had at least two children. With low family income, food choices are limited and cheaper, energy-dense foods are purchased to feed a hungry family. Research on socioeconomic status and obesity found there was a difference in obesity prevalence between developed and developing countries (Sobal & Stunkard, 1989). Being overweight in developing, limited-income society may be a sign of health and wealth. Thus, parental prosperity may be measured in the chubby child, especially in Latino culture (Brewis, 2003). The complex hunger–obesity paradox has also been explored in trying to understand the relationship of low food security and overweight (Scheier, 2005). Research has shown relationships do exist between low food security and the prevalence of overweight (Adams, Grummer-Strawn, & Chavez, 2003; Casey et al., 2006; Olson, 1999; Townsend, Peerson, Love, Achterberg, & Murphy, 2001); however, they were not seen statistically in this study. In contrast, other research with fifth-grade Californian Hispanic children (conducted in an urban setting) showed an inverse relationship of levels of low food security and BMI, and no association of food intake with food security, except for meat consumption (Matheson, Varady, & Killen, 2002). The influence of the Spanish language on low levels of food security seen in the 2000 Iowa WIC study (Iowa Department of Public Health, 2001) was not significantly confirmed in this study, although there was a higher frequency of low or very low levels of food security seen in those that chose Spanish versus English in consent and survey completion (60% vs. 25%).

Research on Mexican American families in the WIC program demonstrated that children in very low food secure households were less likely to meet the Food Guide Pyramid guidelines for diet (Kaiser et al., 2002). Results from the FFQ showed that most MFW children were not consuming the daily food group servings recommended in the Food Guide Pyramid. This agrees with data that previously identified Latino children as a high-risk group for inadequate consumption of vegetables and fruits (Hampl & Sass, 2001). However, researchers cannot fail to see the paradox that the parents of these children harvest fruits and vegetables, and yet their children still struggle to attain the recommended daily servings of these food groups. The meaning of the relationship of higher self-efficacy and low achievement of food group recommendations in children’s diets can only be speculated upon. It is unknown if this reflects the drive for those who are economically disadvantaged to take risks and join the migrant stream while still earning minimal salaries and having limited resources for family meals.

Two noteworthy findings emerged from data analysis. First, gender of children showed significant relationships to parent general self-efficacy: parents of male children had higher levels of measured self-efficacy. The cause for this relationship is unknown but can be speculated that those parents who feel empowered to make change and enter the migrant stream may seek a better life for their male children who accompany them. Future research needs to investigate this relationship. Second, the demographic questionnaire also contained some questions typically seen in well-child examinations of standard of care. Children’s BMI was correlated to parent-report children’s hours of sleep: the greater hours a child slept was significantly associated with larger BMI percentile. This finding contrasts work done on the effects of sleep on childhood obesity. Research has emerged that short sleep duration was associated with weight gain, and higher present and future BMI prevalence (Patel & Hu, 2008; Van Cauter & Knutson, 2008; Wing, Li, Li, Zhang, & Kong, 2009).

The convenience sample of those MFW parents and children recruited from this study’s preselected MFW camps should not be generalized to all Latino MFW families. The survey results of this study may not be representative of the larger MFW sample population. In addition, this study was limited to MFW camps located in the Midwest, and other areas of the country may have different values of the measured constructs in MFW children. Low health literacy levels in Spanish or English may have presented problems in the completion of survey questionnaires, but was hopefully compensated by the availability of a bilingual research team of Latina ethnicity. The use of audio-enhanced personal digital assistants supported fidelity in survey completion, as all participants chose to use the APDAs. Despite careful recruitment strategies, discovery of children being away from the migrant camp was often learned after the parent completed the surveys, thus decreasing sample size of the actual parent–child dyads. Finally, with only 80% of the FFQs sufficiently being complete enough to be scored, and the absence of some children to be measured in the parent–child dyads, limitations were placed on data analysis.

The results of this study and previous studies show that MFW children continue to demonstrate high rates of overweight and obesity when compared to their peers (Kilanowski, 2006; Kilanowski & Ryan-Wenger, 2007). The study’s purpose was to obtain descriptive knowledge on the MFW families to facilitate curriculum, style, and content of the DINE intervention. Statistical analysis of the variables and their relationship on children’s BMI-for-age percentiles showed no significant results; however, the knowledge learned from these study instruments will direct the design and components of the DINE intervention, stressing the importance of honoring ethnic traditions, consideration of limited finances, and the incorporation of greater variety in mealtime food groups. Information about these characteristics of the MFW families and observing the living conditions of their camps will affect the manner and direction of the teaching unit. For example, in one camp there was a communal kitchen with three shared stoves, and each of the many refrigerators in the kitchen were shared by at least two families. In other camps, ovens were reported to be malfunctioning (19%) and this will affect DINE’s selection of recipes and meal preparation techniques. Respect for culture, seen in educational and nutritional guidelines, will be incorporated into the DINE intervention (Miller, 2009; Racher & Annis, 2007). Although limited significant trends emerged from the study’s statistical analysis, possibly because of the small size of the sample, the conduct of this descriptive study nonetheless added to the current data on the health and nutritional needs of this itinerant and vulnerable population. Using this knowledge, the study’s second phase will provide counseling to MFW mothers on the purchase and preparation of affordable, nutritious, and culturally acceptable foods to achieve healthy weight in their children.

Acknowledgment

The author would like to thank the research team of Kimberly Garcia, RN, and Emily Horacek, BSN, both students of the Frances Payne Bolton School of Nursing at Case Western Reserve University, and Nathan Gardner and Sarah Boyle from the Center for Health Promotion Research at Case Western Reserve University.

Funding

The author disclosed receipt of the following financial support for the research and/or authorship of this article: This work was supported by the National Institutes of Health (NIH), National Institute for Nursing Research grant P30NRO10676 Self-management (SMART) Center; and Grant 1KL2RR024990 from the National Center for Research Resources, a component of the NIH, and NIH Roadmap for Medical Research.

Footnotes

Information on Reengineering the Clinical Research Enterprise can be obtained from http://nihroadmap.nih.gov/clinicalresearch.overview-translational.asp. The content of this research study is solely the responsibility of the author and does not necessarily represent the official view of the National Center for Research Resources or the National Institutes of Health.

Declaration of Conflicting Interests

The author declared no conflicts of interests with respect to the authorship and/or publication of this article.

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