Associations Between Child Feeding Practices and Child Dietary Intake Among Families in Low-Income, Rural Communities in Appalachian East Tennessee

Objective: Low-income children and children living in rural areas in the United States have low adherence to federal dietary guidelines and have a higher risk of obesity than their higher income, non-rural counterparts. This study aimed to examine associations between child feeding practices (caregiver modeling, caregiver dietary intake, and home food availability) with child dietary intakes of fruit consumption, vegetable consumption, and high-sugar/high-fat snack food consumption (e.g. candy, doughnuts, cookies, and ice cream) among families with young children in low-income, rural areas in Appalachian East Tennessee.Design: Using cross-sectional data, descriptive statistics and multiple linear regression analyses were run using SPSS software version 25.Setting: Low-income, rural communities in Appalachian, East Tennessee. Subjects: Participants (n=178) were caregivers of children 2-10 years old who regularly shop at convenience stores. Caregiver participants identified as predominantly white (97%), non-Hispanic (99%) females (78%) with a mean age of 35 years (Standard Deviation (SD)=9.8). Results: After adjusting for potential confounders of child age, gender, and household income, results indicated that higher use of caregiver modeling positively predicted child vegetable consumption (Beta=1.1; SE=0.51; P\u3c0.05). Higher caregiver dietary intake of fruits and vegetables positively predicted child fruit consumption (Beta=0.29; SE=0.01; P\u3c0.05) and vegetable consumption (Beta=1.6; SE=0.28; P\u3c0.01), respectively. Higher home availability of healthier foods positively predicted child fruit consumption (Beta =0.06; SE=0.02; P\u3c0.01). Similarly, Higher home availability of less healthy foods positively predicted child consumption of high-sugar/high-fat snack foods (Beta=0.61; SE=0.20; P\u3c0.05). Conclusion: The use of health-promotive child feeding practices, such as caregiver modeling, healthy caregiver dietary intake, and maintaining healthful home food availability may promote healthier child dietary intake in families with young children in low-income, rural, Appalachian areas. Practitioners who work with low-income, rural, Appalachian families should consider working with caregivers to incorporate the use of these practices as an approach to potentially improve child diet quality, prevent obesity, and reduce nutrition-related chronic disease risk