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Alternative caregivers (i.e., someone besides the primary caregiver who also takes care of children) make food choices for children. This study investigated what alternative caregivers consider when making food choices for children and their perspectives on their role in making food choices to feed children. In-depth interviews were conducted with 16 alternative caregivers of children aged 1-5 years old in semi-urban and urban areas of the State of Mexico in Mexico. Interviews were recorded, transcribed, coded, and analyzed using constant comparative method. Alternative caregivers described spaces and situations that exposed children to food while under their care. Alternative caregivers who spent longer periods of time with the child described more involvement in what the child ate. Healthy or nutritious food, cost of food and affection for children were important considerations for alternative caregivers when deciding what to feed the child. Alternative caregivers had a substantial role in child feeding, decisions about cooking, and advising mothers on how to feed their children. Efforts to promote healthy food choices for children should include targeting of alternative caregivers.

Food choice for children has important implications in establishing early‐life dietary habits and preferences. Food choice for children has been studied as parent–child dyad dynamics, but little is known about the extended system of relationships in maternal food choice for children. The objective of this study was to understand the functions of mothers' social networks in the food choices that mothers make for their children ages 1 to 5 years old in rural Mexico. In‐depth interviews were conducted with 46 participants in three rural communities. The interviews inquired about participants' child‐feeding practices, personal and local beliefs about child feeding and the individuals with whom they had conversations about food and child feeding. All interviews were conducted in Spanish, audio‐recorded, transcribed verbatim, verified for quality and analysed using the constant comparative method. Five interconnected networks emerged, consisting of household family, non‐household family, community, children's initial school and health and nutritional programme personnel. Each network had functions in food choice that ranged from shared food decision‐making in the household family network to imparting formal dietary guidance in the health and nutritional programme personnel network. Across the networks, professionals, participants' mothers and mothers‐in‐law, community senior women and other women with children emerged as prominent figures whom participants would turn to for child‐feeding advice. These findings provide empirical evidence that social networks, as an organized system of interconnected relationships, have vital functions in establishing social norms for food choices made for children that can be leveraged to promote healthy food choices.

This study aimed to determine if the Turner et al. (2018) framework allows researchers to identify and study relationships between food environments and individual food choice in diverse contexts and if updates to the framework are warranted. We mapped evidence from 15 drivers of food choice projects to the framework, using thematic analysis to identify common drivers within the food environment across countries and emergent characteristics not listed in the framework. The framework contained breadth and depth of content necessary to identify common drivers – prices and affordability, availability, and vendor and product properties. Insights regarding common drivers and emergent characteristics may inform iterative development of conceptual and empirical research and reinforce current strategies seeking to improve nutrition and health outcomes in LMICs through targeted policies and interventions.

OBJECTIVES: To understand the role of mothers’ social networks in the food choices that mothers make for their children ages 1 to 5 years old in rural Mexico. METHODS: In-depth interviews were conducted with 46 participants from 3 rural communities between November and December 2016. The interviews inquired about participants’ child-feeding practices, personal and local beliefs about child feeding, and individuals with whom participants discussed food. All interviews were in Spanish, audio-recorded, transcribed verbatim, verified for quality, and analyzed using the constant comparative method. RESULTS: The networks that participants described in relation to food choice were largely interconnected and embedded within the social space of their communities. These networks were household family, non-household family, community, children's initial school, and health and pantry personnel. Participants described the functions of each network for the feeding of their children. These functions ranged from directly intervening on feeding behavior in the most proximal network, i.e., household family, to providing formal feeding and nutritional guidance in the most peripheral network, i.e., health and pantry personnel. Some networks had unique functions that no other network had, while some functions were shared across networks. Across the networks, professionals, participants’ mothers and mothers-in-law, community senior women, and other women with children emerged as trusted figures whom mothers would turn to for child-feeding advice. Participants were in constant interaction with their social networks and rarely turned to only one advisor. Participants expressed striking a balance between the input received, what they make of it, and eventually weighing their children's responses, resources available, and situations in which interactions occur and food choice is made for children. CONCLUSIONS: Social networks have vital functions in establishing norms for food choices made for children. The multiplicity of child-feeding advisors may be especially important in strategies that seek to promote healthy food choices for children during developmental years to foster healthy eating patterns. FUNDING SOURCES: SPARC Graduate Research Grant from University of South Carolina.

International audience; Multiple recent global nutrition initiatives have recommended actions to transform food systems to improve food environments and food choice. This study aimed to identify actions recommended by these initiatives and understand their similarities and differences. Twelve global nutrition initiatives were reviewed, collectively spanning 13 action themes and accompanying strategies. Action themes were analyzed according to primary focus on either food environments and their food system drivers or food choice. Representation of the 13 actions varied across initiatives. Some actions overlapped; others were infrequently represented. Strategies targeting food environments and their food system drivers were more frequently recommended than strategies targeting food choice for 11 of the 13 action themes. Although these global initiatives share a mission to improve nutrition through food systems and food environments, less attention has been allocated to individual food choice and sustainability.

OBJECTIVES: To understand how mothers’ interpersonal relationships influence food choice decisions they make to feed children ages 1 to

OBJECTIVES: To understand how actions that link food environment and food choice, recommended by global nutrition initiatives, seek to promote sustainable healthy diets. METHODS: We reviewed recommended actions addressing food environments and food choice by global nutrition initiatives published between 2015 and 2020. Internal debriefing, expert solicitation, and targeted web searches were used to identify 20 documents, with 12 selected for review. Specific action descriptions were used to generate overarching actions present across the documents, were extracted into a matrix, and then were tabulated across overarching actions retaining document affiliation. The content assigned to each overarching action was disaggregated by environmental and individual focus guided by concepts from existing frameworks pertinent to food environments and food choice. RESULTS: We identified 13 overarching actions from the documents reviewed, ranging from reorienting agricultural priorities for improved nutrition to creating consumer demand for nutritious foods. The documents differed in the extent of detail describing specific actions. Between 3 and 11 documents were represented in each action. Environmental actions focused on building better bridges across the food value chain, regulation, and investment. Regulation ranged from municipal zoning restrictions of food outlets near schools to national and international strengthening of legally binding agreements for nutrient profiling, labeling, and marketing restrictions. Actions addressing individual behavior were fewer and focused on building capacity with special attention to smallholder farmers and women, recognizing their duality as suppliers and consumers, protecting traditional practices, and applied communication strategies to promote healthy diets. CONCLUSIONS: Actions portrayed prioritization of environmental change to achieve healthy diets with some attention to sustainability, but much less detail was presented about what, how, or why individuals may consider changes to their dietary choices. Better linking individuals’ perspective into environmental change may propel the success of active global efforts. FUNDING SOURCES: UK Government's Foreign, Commonwealth & Development Office and the Bill & Melinda Gates Foundation.

OBJECTIVES: This work aimed to understand what alternative caregivers value in making food choices for children and the perspectives of alternative caregivers on their role in making food choices to feed children. METHODS: This qualitative study was conducted in low-income semi-urban and urban communities of the State of Mexico, Mexico. Primary caregivers of children aged 12–59 months named people they considered alternative caregivers. A convenience sample was used for the selection of 16 alternative caregivers. Semi-structured interviews were conducted with alternative caregivers. On average interviews lasted 37.2 minutes; interviews were audio-recorded and transcribed verbatim. All Transcriptions were read, coded, and analyzed using a grounded theory approach. NVivo 10 was used for data management and analysis. RESULTS: Alternative caregivers were related to children as grandmothers (n = 10), fathers (2), aunts (2), uncle (1), and friend (1). Their average age was 52 years. The highest education was technical school and the lowest was no schooling. Most were homemakers. Almost all shared the same house or land with the children. Alternative caregivers chose the foods fed to children based on how nutritious and healthy food was, children, wanting or desiring certain food, their desire of the child to eat well, the affordability of the food, and how appropriate the food was for the age of children. Alternative caregivers described more influence on the process of decisions about food purchase, cooking, and feeding the child when they were closely related to the child and lived in the same household or land. Alternative caregivers who were not as active in all the process of decisions participated with advice to mothers on what to feed the child. When alternative caregivers expressed affection for children, they showed more interest in what children eat. CONCLUSIONS: Alternative caregivers had a substantial role in the process of making food choices for children. Considering how alternative caregivers participate and influence what children eat may be important in efforts to promote healthy food choices for children. FUNDING SOURCES: Office of the Vice President for Research, University of South Carolina

Additional research is needed to guide the design of narratives for use in practice-oriented, naturalistic settings to maximize health behavior change, particularly among populations affected by health disparities. This mixed methods study explored the influence of cultural tailoring and emotional arousal on identification and message recall in narratives promoting childhood obesity prevention among 40 Mexican American mothers. Participants were also asked about narrative exposure, narrative preferences, and beliefs about the purpose of a story. Participants were randomly assigned to listen to two stories: (1) a story tailored on non-cultural or cultural variables; and (2) a story designed to enhance or minimize emotional arousal. Participants reported high engagement and identification with all stories. Participants generally envisioned protagonists as Latina, despite limited cues, and identified with protagonists in four ways: sharing personal characteristics; having similar thoughts and feelings; engaging in similar actions; and experiencing similar situations. Mothers were most interested in narratives that helped them to improve their lives. Findings from this study yield several hypotheses for consideration in future study, including ways in which story setting and message enactment may moderate message recall.

Prostate cancer is the most commonly diagnosed non-skin cancer among all men and the second most common cause of death. To ameliorate the burden of prostate cancer, there is a critical need to identify strategies for providing men with information about prostate cancer screening and the importance of informed decision making. With mobile phones becoming more ubiquitous, many individuals are adopting their phones as sources for health information. The objective of this systematic review is to identify and evaluate commercially available apps for promoting informed prostate cancer screening decisions. Two keywords “prostate cancer screening” and “prostate cancer” were entered into the search engines of Google and iOS app stores in May 2017. Evaluations were conducted on apps’ (a) quality, (b) grade-level readability, (c) cultural sensitivity, and (d) usability heuristics. None of the 14 apps meeting the inclusion criteria contained the full breadth of information covered in the 2016 American Cancer Society’s Prostate Cancer Prevention and Early Detection Guidelines, but over half were inclusive of topics consistent with these guidelines. Most apps’ readability was higher than an eighth-grade reading level. Most apps were also not framed and had a neutral tone. Only four apps met most criteria for being culturally sensitive to African Americans. Usability among apps was variable, but some contained major usability concerns. Recommendations for improving educational apps for prostate cancer screening include: disseminating evidence-based information; using culturally sensitive language; knowing the implications of the one and framing of content; making apps interactive; and following common usability principles.

BackgroundUp to 70% of lung cancer survivors are affected by chronic obstructive pulmonary disease (COPD), a common, debilitating, comorbid disease. Lung cancer and COPD are both characterized by symptoms such as breathlessness, fatigue, and psychological distress. These distressing chronic symptoms are exacerbated by stress and detract from an individual’s quality of life. ObjectiveThe aim of this study was to identify and evaluate evidence-based, commercially available apps for promoting mindfulness-based strategies among adults with a COPD or lung cancer history (ie, chronic lung disease). MethodsFor this review, an interdisciplinary research team used 19 keyword combinations in the search engines of Google and iOS app stores in May 2017. Evaluations were conducted on the apps’ (1) content, (2) usability heuristics, (3) grade-level readability, and (4) cultural sensitivity. ResultsThe search resulted in 768 apps (508 in iOS and 260 in Google stores). A total of 9 apps met the inclusion criteria and received further evaluation. Only 1 app had below an eighth-grade reading level; the ninth one did not have enough text to calculate a readability score. None of the 9 apps met the cultural sensitivity evaluation criteria. ConclusionsThis systematic review identified critical design flaws that may affect the ease of using the apps in this study. Few mobile apps promote mindfulness-based strategies among adults with chronic lung disease (ie, COPD or lung cancer or both), but those that exist, overall, do not meet the latest scientific evidence. Recommendations include more stringent regulation of health-related apps, use of evidence-based frameworks and participatory design processes, following evidence-based usability practices, use of culturally sensitive language and images, and ensuring that content is written in plain language.

This qualitative study explored values, attitudes, and beliefs held by Mexican-origin mothers of preschool-aged children to enhance understanding of cultural influences on behaviors associated with childhood obesity risk.During face-to-face interviews, 39 Mexican-origin mothers of preschool-aged children discussed their hopes for their children, their image of the perfect mother, Mexican and American foods, why they taught their children about these foods, and their opinions about television (TV) viewing language.Participants wanted their children to become successful, "good" people, which necessitated doing well in school. Mothers also wanted their children to know them, which required understanding the mothers' Mexican backgrounds. Mothers wanted their children to maintain Mexican values and identities. Some mothers viewed American culture as harmful. Many participants prepared their child for going to Mexico by exposing them to Mexican culture and foods. Some mothers fed their children American foods to prepare them for school. Perceptions of American foods generally reflected stereotypical unhealthy foods. TV helped teach children Spanish and English. Being a good mother was core to participants' identities; thus, hearing about child overweight made some mothers feel like failures.Health promotion programs may be more salient to mothers if they: underscore how a healthy weight can help children in school; teach mothers to prepare healthy American foods that their children will encounter in kindergarten; assist mothers in teaching their children about Mexico; and present information about childhood obesity in ways that reinforce what mothers are doing well, enhance mothers' self-efficacy, and allay feelings of failure.

BACKGROUND Up to 70% of lung cancer survivors are affected by chronic obstructive pulmonary disease (COPD), a common, debilitating, comorbid disease. Lung cancer and COPD are both characterized by symptoms such as breathlessness, fatigue, and psychological distress. These distressing chronic symptoms are exacerbated by stress and detract from an individual’s quality of life. OBJECTIVE The aim of this study was to identify and evaluate evidence-based, commercially available apps for promoting mindfulness-based strategies among adults with a COPD or lung cancer history (ie, chronic lung disease). METHODS For this review, an interdisciplinary research team used 19 keyword combinations in the search engines of Google and iOS app stores in May 2017. Evaluations were conducted on the apps’ (1) content, (2) usability heuristics, (3) grade-level readability, and (4) cultural sensitivity. RESULTS The search resulted in 768 apps (508 in iOS and 260 in Google stores). A total of 9 apps met the inclusion criteria and received further evaluation. Only 1 app had below an eighth-grade reading level; the ninth one did not have enough text to calculate a readability score. None of the 9 apps met the cultural sensitivity evaluation criteria. CONCLUSIONS This systematic review identified critical design flaws that may affect the ease of using the apps in this study. Few mobile apps promote mindfulness-based strategies among adults with chronic lung disease (ie, COPD or lung cancer or both), but those that exist, overall, do not meet the latest scientific evidence. Recommendations include more stringent regulation of health-related apps, use of evidence-based frameworks and participatory design processes, following evidence-based usability practices, use of culturally sensitive language and images, and ensuring that content is written in plain language.