How a Racially/Ethnically Diverse and Immigrant Sample Qualitatively Describes the Role of Traditional and Non-Traditional Foods in Feeding Their Children

Abstract

Background:

Previous research suggests a deleterious impact on dietary quality when people immigrate to the United States and that children influence immigrant parent’s decisions to serve traditional and/or non-traditional foods.

Methods:

Interviews (n=75) were conducted with Hmong, Somali, and Latino parents of 5–7 year old children about the foods they serve to their children and how the child influences these food decisions. A racially/ethnically diverse team coded interviews using a mixed inductive/deductive approach.

Results:

Most Latino and Somali parents reported serving mostly traditional foods at home. Regarding feeding decisions, parents reported: 1) allowing children non-traditional foods when requested; 2) “Americanizing” traditional foods; and 3) that children prefer traditional foods. Some Hmong parents reported serving their children non-traditional foods at meals while parents ate traditional foods.

Discussion:

Results offer guidance to providers working with immigrant parents of young children regarding maintaining healthful diets when children request potentially unhealthy non-traditional foods.

Introduction

Previous research suggests there deleterious impact on dietary quality when people immigrate to the United States (US), including Hmong, Latino, and Somali families [1–5]. For example, prior focus group research found that Hmong immigrants reported a diet change upon immigrating to the US, which included eating excess food and foods with more fat and sugar [1]. Findings from a review article suggested a relationship between Latino adults’ higher acculturation and poorer diet quality [4].

Furthermore, there is evidence to suggest that children influence immigrant parents’ food choices, particularly around the decisions to serve traditional and/or non-traditional (“American”) foods. Focus group research with Latino and Hmong parents identified reasons parents struggled to feed their children traditional foods, including child preference and the ease of fast food [3,6]. A cross-sectional survey of Latina mothers found that immigrant mothers with assimilated (e.g., shedding traditional culture) children served more unhealthy foods (e.g., sugary beverages) than traditional mothers with bicultural children (children who maintain elements of traditional culture while also adopting elements of the dominant culture) [7]. Examining how parents make food choices for their children—particularly immigrant/refugee parents who may have children who prefer or have more contact with non-traditional foods—is important to explore as it provides possible outlets for improving dietary intake in diverse populations who are at highest risk for weight and weight-related disparities [8].

The current study was conducted in Minneapolis-St. Paul, MN. Minnesota, like the US, is becoming more racially/ethnically diverse. It is home to the largest Somali population and the second largest Hmong population in the country [9–12]. Using qualitative data and a racially/ethnically diverse and immigrant/refugee sample, this study explored whether parents consider the foods they serve to their family to be traditional or non-traditional foods and how parents make decisions about which food types to feed their children. Findings from this study may be useful for providers (e.g., dietitians) and interventionists working with diverse families with young children in targeting areas of food selection and parent feeding practices.

Methods

Data are from Family Matters, a two-phased, mixed-methods study examining familial risk and protective factors for childhood obesity [13]. Phase I was a cross-sectional study conducted between 2015 and 2016. Families with 5–7 year old children (study child) were recruited using data from primary care clinics. Families were eligible to participate if the study child had a sibling who lived in the same home, and if the parent shared at least one family meal with the study child per day. Additionally, parents needed to read and speak in English, Spanish, Somali, and/or Hmong. Data was collected at two home visits; this study focuses on completed qualitative interviews, which occurred during the second home visit. Parents consented to participate in the study; the University of Minnesota’s Institutional Review Board approved all study protocols.

Participants:

Participants (n=150) were purposely recruited and stratified so that there was equal representation of Latino, Somali, Hmong, White, African American, and Native American participants. Participants were further stratified so there was equal representation of nonoverweight and overweight children in each racial/ethnic group. As the main aim of the current study is exploring how immigrant/refugee parents feed their children, only interviews with Hmong, Latino, and Somali participants (n=75) are included. Most of the sample for this current study (60/75) were immigrants. This included over 60% of Hmong parents (16/25), over 75% of Latino parents (19/25), and 100% of Somali parents (25/25). Of the immigrants, the majority (77%) had lived in the United States for over 10 years. Nearly all participating parents were female (88%). Detailed study protocols have been published elsewhere [13]. See Table 1 for additional demographics.

Table 1.

Demographics of Family Matters Somali, Hmong, and Latino Primary Caregivers (n=75)

Parent/Primary Guardian Characteristics	Primary Caregiver (n=75)
	N (%)
Female	66 (88%)
Age in years (sd)	34.2 (7.2)
Weight Status
Nonoverweight	20 (26.7%)
Non-overweight	22 (29.3%)
Overweight	33 (44.0%)
BMI (sd)	29.5 (6.2)
Race/ethnicity
Somali	25 (33.3%)
Hmong	25 (33.3%)
Latino	25 (33.3%)
Not born in the United States	60 (80%)
Immigrant Time in the United States1
<1 year	1 (2%)
1 year – <5 years	5 (8.3%)
5 years – <10 years	8 (13.3%)
10 years – <20 years	31 (51.7%)
20 years – <30 years	12 (20.0%)
30+ years	3 (5.0%)
Multi-generational family	2 (2.7%)
Household structure
One parent (no other adults)	13 (17.3%)
One parent (with other adults)	10 (13.3%)
Two parents (no other adults)	41 (54.7%)
Two parents (with other adults)	11 (14.7%)
Employment Status
Working full-time	33 (44%)
Working part-time	18 (24%)
Stay-at-home caregiver	12 (16%)
Currently unemployed/not working	12 (16%)

^1.The majority of Hmong immigrants (8/16) reported being in the US between 20-<30 years); the majority of Somali (15/25) and Latino (11/19) reported being in the US between 10-<20 years.

Data Collection:

Interview questions were designed after conducting a literature search identifying gaps in understanding the home food environment for racially/ethnically diverse households. The Family Matters team had bi-cultural and bi-lingual staff members who reviewed interview questions and pilot tested them to ensure cultural sensitivity. The research team was trained in qualitative interviewing best practices [14] and conducted semi-structured interviews with the primary guardians in their preferred language (i.e., English, Spanish, Hmong, or Somali). The interview had questions regarding the home food environment, including questions about the participant’s family meals growing up and how they feed their family now. See Table 2 for interview questions used in the current study. Interviewers were instructed to ask the main interview questions, and then use additional prompts for following-up with the participant if they did not fully respond to the main question. The interviews (n=75) were then translated (when necessary) and transcribed by a research staff member. The average interview was 34 minutes.

Table 2:

Family Matters Study Interview Questions Regarding How Parents Feed Their Children

Main Question

What foods do you eat that your family considers are “traditional foods”? By traditional foods I mean, foods or recipes that have been passed from generation to generation in your family or community. How often do you eat them?

Follow-up Questions

• Are there foods your family eats that you consider are “American Food”? What are these?

• How do you balance having traditional foods versus American/US foods?

• What do you do if your child really wants an American/U.S. food item and you don’t want them to have it? For example, do you give your children American/U.S. food to make them happy, or keep them quiet?

Analysis:

The racially/ethnically diverse study team coded the first twelve transcripts together to create an initial coding tree using a mixed inductive/deductive approach: the qualitative questions were used to guide the themes, and additional themes were allowed to emerge throughout the coding process [15]. This was particularly important as the initial coding team identified themes relevant to the specific race/ethnicities in the study. After the coding tree was developed, the two main coders coded the next twenty transcripts together line-by-line to achieve consensus, ensure the coding tree was effective at capturing themes and to identify broad themes. After reaching consensus, the two main coders continued individual line-by-line coding on the remaining transcripts. To ensure that qualitative themes were agreed upon by both coders throughout the coding process, each coder would code the same interview for every fifth interview. These interviews were discussed during in-person meetings, and any discrepancies in coding were discussed until 100% agreement was reached. After the line-by-line coding phase was complete, the coders organized the broad themes identified into more specific sub-themes. A racially/ethnically diverse team also met to discuss this manuscript and provide culturally appropriate interpretation of results and points for discussion. The kappa for all coded transcripts was 0.86. Qualitative coding was conducted using Nvivo 11 software.

Results

Quotes are labeled by parent sex, race/ethnicity, age and years in the United States: <1; 1–5: 5–10; 10–20; 20–30; 30+; NI (non-immigrant). Illustrative quotes are provided, and additional quotes can be found in Table 3. All names have been changed to protect participant confidentiality. Results will discuss “non-traditional” (versus American) foods unless the participant specifically describes a non-traditional food as being “American”.

Table 3:

Additional Quotes by Research Question Regarding Traditional and Non-Traditional Foods

Themes	Additional Quotes
Research Question 1: Do parents consider the foods they serve to their children to be traditional or non-traditional?
Theme 1: Parents serve mostly traditional foods	I’m very traditional. If I’m not making pasta or rice, then I’m making other traditional foods. All 7 days of the week. One day I might make pasta, the next day I might make Jabati, the next day I make sandwiches, another day it might be beans. I don’t make the same food, just different traditional foods (Female, Somali, 41 y.o., 10–20 years).
	It’s almost the same. I kind of make sure my kids eat Hmong, so we have to have everything like my parents have before. So basically rice, vegetable with pork, and pepper, that’s the main dish that we have. It has to be rice in the meals (Female, Hmong, 32 y.o., 20–30 years).
	Well, we just eat typical Hmong food. There is always going to be rice and different kinds of meat with vegetables. We try to mix like every different vegetables every night but then, you know, rice is the same thing every day (Male, Hmong, 49 y.o., 30+ years).
	I would say we eat [Mexican food] everyday, different types of meals. I do not eat American foods, I just eat Mexican foods (Female, Latino, 35 y.o., 1–5 years).
Theme 2: Parents serve a mixture of non-traditional and traditional foods	I tend to try to do the traditional food, but then my kids prefer American. It’s easy to make, and it best work for me, so I tend to do that more. (laughs) But then I still have them try out the traditional food to see if they like it (Female, Hmong, 24 y.o., NI).
	Well, we use whatever we feel like eating because if we feel we want some traditional food then we will cook traditional food. But if we feel like eating American foods, we just pick that” (Male, Hmong, 34 y.o., NI).
	Well, because I grew up eating more Hmong food, I still, you know, cook those, you know, here and there as well, so I think I have a good blend of both culture, where we would eat American food, but we also, you know, eat some of this traditional stuff that I grew up eating too....So I make a good mixture of both (Female, Hmong, 30 y.o., 20–30 years).
Research Question 2: How do racially/ethnically diverse and immigrant parents make decisions on how to feed their children?
Theme 1: Allow children non-traditional foods when requested	[For a family meal], for my kids, it would probably be boxed, pre meals, like macaroni and cheese. It comes in a box and then you cook it…If they want a specific food, they will tell me, and I’ll cook it. My kids eat the same. Me and my husband eat different, and my kids usually eat American food (Female, Hmong, 24 y.o., NI).
	[If my children request American foods], iťs not a problem. I look first what do I have. If I already have the food here at home, I’ll tell them, “Today we have this that we have to eat. Maybe tomorrow we'll go out we'll get that.” And they get it (Female, Somali, 27 y.o.. 10–20 years).
	[If my children request a food], I just go buy it, or if I do have it available then I’ll cook it for them. I just cook what I like to eat or my husband and then I’ll just cook what the kids eat (Female, Hmong, 26 y.o., 20–30 years).
	We also do a lot of American food because my kids suggest it sometime. So I let them have, like for one week, I let them have at least 2 or three of the American food too, because that’s what they like (Female, Hmong, 32 y.o., 20–30 years).
Theme 2: “Americanize” traditional foods	I think that it’s very important for my kids to know American food too. So like let’s say if I cook hamburgers, I will add a lot of vegetables, like mushrooms, onions. Instead of the mayo it’s going to be like guacamole the bread or salsa verde. Kind of mixed, you know (Female, Latino, 43 y.o., 10–20 years).
	I always try to put lots of vegetables in everything and my husband says “If you don’t know how, invent it!” Yes, for example, yesterday they have been wanting spaghetti for a while. I told them “tomorrow we can make it” and uh, with meat and I even minced cilantro to put into the spaghetti. And it was very tasty. I even shredded carrots even though it may not normally be included…(Female, Latino, 45 y.o., 20–30 years).
Theme 3: Children prefer traditional foods	Yeah, it rarely happens where they don’t like what I cook…they really like the Hmong food that I cook, too, like you know, boiled chicken with Hmong greens, or baby bok choy, whatever, stir-fried with pork. Yeah, so, they’re generally open to it, and we usually don’t complain over the food that mom makes (Female, Hmong, 30 y.o., 20–30 years).
	Hmong and Thai food [my children] eat. Because [Hmong and Thai food] is much tastier than American food. American food is basically bread, and my children donť really like to eat it (Female, Hmong, 31 y.o., 10–20 years).
Theme 4: Children are served non-traditional foods while parents eat traditional foods	My kids eat the same. Me and my husband eat different. He eats more fried food, and my kids usually eat American nice food (Female, Hmong, 24 y.o., NI).
	Yeah, I guess, for the kids, they’re more picky with their food. So, us adults, I guess we’re so used to our traditional food, how it tastes… kids, on the other hand, sometime when they’re eating or they’re hungry while we’re cooking, they probably think of something else, and you know, they’ll probably want pizza when we’re eating rice with meat (Female, Hmong, 23 y.o., NI).

Research Question #1: Do parents consider the foods they serve to their children to be traditional or non-traditional?

Theme 1: Parents serve mostly traditional foods:

Traditional foods were described similarly by each racial/ethnic group. Latino parents commonly described traditional foods as tortillas, soups, rice and beans. Hmong parents overwhelmingly spoke of white rice, as well as vegetables, boiled meats, and soups. Somali parents described traditional foods as rice, pasta, anjero (a sourdough flatbread), meat, and beans.

The majority of Latino and Somali parents said they serve mostly traditional foods to their children; about one third of Hmong parents also endorsed this theme. One parent said, “Yes, we do eat American food, but rarely. Sometimes on Eid or my child’s birthday, I will get them American food. Majority of the time we only eat traditional food” (Female, Somali, 42 y.o., 5–10 years). A Latino parent said, “Mexican foods is what I would say we eat most. Definitely the majority, I would say always, every day…maybe once a week we will have American food. Or other foods like Chinese foods and hamburgers” (Female, Latino, 35 y.o., 10–20 years). Immigrant parents were much more likely to endorse this theme than non-immigrant parents; for example, nearly all (84%) immigrant Latino parents endorsed serving their children mostly traditional foods, while only one non-immigrant Latino participant endorsed this theme (17%).

Theme 2: Parents serve a mixture of non-traditional and traditional foods:

“American” foods (described in this manuscript as non-traditional) were overwhelmingly described by participants as quick-cook or pre-prepared foods (e.g., macaroni and cheese, cereal) and fast foods. The most commonly discussed “American” foods were pizza, hamburgers, and chicken. Nearly half of Hmong parents described serving a strong mixture of non-traditional and traditional Hmong foods; non-immigrant Hmong participants endorsed this theme more frequently than immigrant Hmong participants. Latino or Somali participants infrequently endorsed this theme. Hmong parents described wanting to expose their children to Hmong foods and the Hmong culture while also balancing the foods the children wanted to eat.

One mother said,

Because they go to school, eat American food, I try to cook [Hmong foods] at home for them, so I know that they will get at least one of each every day. So on the weekend I know that they don’t have American food, so I make sure they have a little bit of American food too. So I try to have both types of food all the time (Female, Hmong, 32 y.o., 20–30 years).

Research Question #2: How do racially/ethnically diverse and immigrant parents make decisions on how to feed their children?

Theme 1: Allow children non-traditional foods when requested:

This theme was endorsed by over half of the current study’s participants (n=39). The majority of Somali and Hmong parents and about a quarter of Latino parents endorsed this theme, and there was no difference by time in the US as an immigrant. Somali parents discussed wanting to give their children foods that make their children happy. For example, one mother said, “If they want American food, I give it to them. We eat traditional food mostly, but American food is part of our meals as well” (Female, Somali, 35 y.o., 10–20 years). Another said, “It’s important to give the food your child loves because they will eat it” (Female, Somali, 38 y.o., 10–20 years), and another mother said, “They love Somali food and also American food, so they tell me which they want that day” (Male, Somali, 38 y.o., 10–20 years).

Hmong parents discussed that American foods can be easier to provide. One mother said, For my kids, it would probably be boxed, pre meals, like macaroni and cheese…It comes in a box and then you cook it…I tend to try to do the traditional food, but then my kids prefer American. It’s easy to make, and it best works for me, so I tend to do that more. But then I still have them try out the traditional food to see if they like it (Female, Hmong, 24 y.o., NI).

Latino parents discussed occasionally providing American foods when requested, but limiting these foods because they are unhealthy. One father said,

I give them American food twice a week…but to eat American food every day is not good. [I give American food] to make them happy, like when I buy them a pizza….If I do not buy them pizza they get upset (Male, Latino, 39 y.o., 10–20 years).

Theme 2: “Americanize” traditional foods:

Some Latino families described cooking non-traditional foods, but altering them so they contain elements the participant feels are traditional. For example, one mother said, “We do our version of Mexican hotdogs. We kind of use both—Americanized and Hispanic cooking—we mix them. I think the Mexican version gets into the Americanized version depending on what foods need to be eaten first” (Female, Latino, 25 y.o., 20–30 years).

Theme 3: Children prefer traditional foods:

A few Hmong and Latino families said they did not have to balance serving their children traditional or non-traditional foods because their children preferred eating traditional foods. One parent said,

My kids are very open to food. If we go out, I either go, ‘Do you want McDonalds or do you want to go eat Pho’, they rather choose Asian food, and so I’m kind of glad my kids don’t choose fast food (Female, Hmong, 28 y.o., NI).

Another mother said,

I cook Brazilian and Hispanic…and the kids grew up on it, so they will ask me, and they would say like, ‘Oh, this is not food, you don’t give me food.’ So, that food for them means rice and beans and meat and vegetables. So, if I give it to them like spaghetti, like SpaghettiOs, or sloppy joes, then they say it’s not food (Female, Latino, 35 y.o., 10–20 years).

Theme 4: Children are served non-traditional foods while parents eat traditional foods:

A quarter of Hmong families endorsed this theme, and it was more frequently endorsed by Hmong non-immigrants than Hmong immigrants. One mother said, “My son doesn’t really like [traditional Hmong foods]. He finds them kind of bland and not up to his standards. So usually if I do cook Hmong foods, I have to do something on the side for him” (Female, Hmong, 28 y.o., NI). Another father said, “My sons are Americans. They eat McDonalds and pizza without rice, but I am tribal…eating American food does not satisfy me. I come home to make rice and vegetables and they eat more like Americans” (Male, Hmong, 49 y.o., 20–30 years).

Discussion

Using a diverse sample of participants, this study qualitatively explored parents’ relationship with traditional and non-traditional foods and how children impact the serving of these foods. The majority of parents reported serving traditional foods to their children; however, they also reported the children having a strong influence on their decision to serve traditional or non-traditional foods.

Hmong, Somali, and some Latino parents reported letting their children have non-traditional foods when requested, usually to keep the children happy, which is consistent with previous focus group research with similar families [16]. Interestingly, most Somali families also report maintaining a traditional diet. This dichotomy may reflect parents’ strong desire to maintain a traditional diet; it may also show a difference in how parents view the foods they prepare for a meal (traditional foods), versus the foods that are added by request (non-traditional foods). If children are only requesting unhealthy foods, these parents may need child feeding practice strategies. For example, some parents may need assistance setting limits with their children or help strategizing methods of providing healthful meals without wasting food due to a child’s refusal to eat (as indicated by some quotes). In addition, it may be important for practitioners to be aware that some Hmong parents may be eating different meals than their children. These families may need assistance identifying healthy options for their children while also minimizing the time needed to prepare two meals.

One approach when working to improve child health may be to introduce parents to more healthy non-traditional options (e.g., soups, salads); however, research is needed to test these strategies. An article examining the healthfulness of foods served at family meals found that the healthiest meals (e.g., most fruits and vegetables served) were a mixture of homemade and pre-prepared foods [17], which is encouraging to families who may serve traditional foods alongside non-traditional foods but still desire to serve healthy foods to their children. Another approach is for places that provide food for children (e.g., schools, restaurants) to expand their offerings to regularly include healthy traditional options; if traditional foods are seen/available more frequently, they may be seen as more “mainstream” and become more accepted by children.

Future research should investigate how some families (e.g. Latino and Somali) successfully maintain a traditional diet at home despite having children who are exposed to non-traditional foods at school [18]. In the current sample, more Somali and Latino parents are immigrants with less time in the US than Hmong parents, thus they may have had less time to be exposed to non-traditional foods or requests for non-traditional foods. Some Hmong parents also indicated that their children preferred traditional foods to non-traditional foods; these families have much to teach regarding getting American-born children to accept traditional foods. Nearly half of Hmong families also said they provide a strong mixture of traditional and American foods. Understanding how they strike this balance may help other immigrant families navigate the complexities of serving traditional foods when children request non-traditional foods. For those who report a traditional diet, future research also needs to make a distinction between which traditional foods are served frequently, and which are served at special occasions.

Finally, while the definition of traditional foods may be amorphous, this does not necessarily mean the definition is unimportant. Hmong, Latino, and Somali families had strong connections to a traditional diet, which previous research has demonstrated to be important to maintaining a racial/ethnic group’s identity. It may be that an exact definition of traditional foods is less important than the strength of participant’s connection to these concepts. Future interventions may want to focus on families’ beliefs about traditional foods, goals for maintaining a traditional diet, and ways of approaching the challenges (e.g., child requests for non-traditional foods) related to meeting their goals. This fostering of a traditional diet and maintaining identity could be important to both immigrant and non-immigrants. Future research may also want to consider alternative words to “traditional” and “American” when inquiring about participant’s diets.

There were strengths and limitations to this study. A main strength is the racially/ethnically and immigrant/refugee sample. This study also benefitted from a large qualitative sample (n=75 interviews). The racially/ethnically diverse study team also helped ensure accurate representation of participant’s thoughts and beliefs. There were also limitations to be considered. First, we are unaware of how exposed children in this study are to non-traditional foods; this may help shed light on the finding related to some children’s dietary preferences (e.g., preferring traditional foods). All Somali participants were immigrants, making it difficult to translate these findings to non-immigrant Somali families. Finally, this study was conducted in a metropolitan area with many resources for obtaining culturally specific foods. Future research should investigate how racial/ethnic groups outside of an urban area incorporate traditional foods into their families’ diets.

Conclusion

This study provides a deeper understanding of how a diverse and immigrant sample make decisions around traditional foods when feeding their children. Future research should investigate families that maintain a traditional diet at home and have children who prefer traditional foods in order to identify lessons they can that other immigrant families can benefit from. Future research would also benefit from exploring traditional foods from children’s perspectives, particularly children of immigrant parents.