MSU RETURNING MATERIAL§z Place in book drop to remove this checkout from LIBRARIES . __ your record. FINES W1” be charged if book is returned after the date " ~a\\ stamped below. \F‘H-kVL ‘ i3? 833‘.» ‘ I "1' I 1‘ I? I 0' 5 re ”Q ‘- I'“ ABSTRACT NUTRITIONAL STATUS OF PRESCHOOL CHILDREN IN RELATION TO SELECTED FACTORS CHARACTERIZING THE FAMILY ENVIRONMENT- AN ECOLOGICAL APPROACH BY Laura Smail Sims Nutrient intake is recognized as but one of many environmental factors which act upon the genetic potential of the young child to influence his physical develogment. The syndrome of malnutrition occurs not in isolation, but within the context of an entire constellation of environ- mental factors which together contribute to the final manifestation of the problem. Often differences which may be observed in children's dietary intake may be traced to contributory factors in the home setting. Thus, because nutrient intake may be associated with various environmen- tal characteristics, the‘approach taken in the present study is ecological, i.e., the nutritional status of preschool children is examined in relation to factors which characterize his near environment, particularly his family. A total of 163 children served as the sample for the present study. These children were attending either a nursery school program or a public health clinic. Although Laura Smail Sims the sample was drawn from a relatively small_geographical area, the families of the children represented a variety of ethnic, socioeconomic, and resource characteristics. Data collected on the children which would serve to evaluate their nutritional status included: dietary records which were used for the calculation of nutrient intakes; blood tests analyzed for hemoglobin, hematocrit, serum albumin, and total serum proteins; urinalysis for the determination of urinary hydroxyproline and creatinine; and a series of anthrOpometric measurements. Because the objectives of the research entailed studying nutritional status in an environmental context, mothers of the children in the sample were asked to provide the researcher with data which would serve to characterize the family environment. Data collected included: a home interview to determine demographic characteristics and certain resource and management patterns, an evaluation of the home and immediate neighborhood, and a series of attitude-measuring instruments used to assess certain psychosocial attributes of the mothers. Analysis of the three-day food records indicated that children in the sample were, for the most part, well nourished. 0n the average, all nutrients, except iron, either met or exceeded the Recommended Dietary Allowances. For those few children who had nutrient intakes less than two-thirds of the RDA for any one nutrient, those nutrients which were most limiting were iron, ascorbic Laura Smail Sims acid, calcium, and Vitamin A. Evaluation of the blood components and anthropometric measurements failed to reveal evidences of gross malnutrition. Evaluation of weight and height measurements in reference to accepted standards revealed that more children were overweight for height than were underweight. .Using correlational and multiplefgroup cluster analysis procedures, a typology of family characteristics and maternal attributes was elucidated which, in turn, had a direct bearing on the dietary intake and resultant physical status of the children. The ”Type I" family had a higher socioeconomic status and this mother exhibited more equalitarian attitudes toward child-rearing. In contrast, the Type II family was from the lower socioeconomic groups, and the mother diSplayed more authoritarian attitudes and powerlessness. The typology of family environment characteristics was directly associated with certain patterns of nutrient intake. Children of the more affluent, non-authoritarian mothers tended to have higher intakes of calcium and ascorbic acid, while children of the Type II mothers ate more calories, carbohydrate, iron, and thiamin. Children of the latter type of mothers tended to have higher hemoglobin and hematocrit values and were somewhat more overweight for their height. The primary contribution of the present research is the demonstration that an ecological approach is a viable Laura Smail Sims means of studying the nutritional status of individuals in the context of their environmental setting. In addition, multivariate analysis procedures were effec— tively used to establish a typology of family environment characteristics which exerted a direct influence on the dietary intake and the consequent nutritional status of children within particular family environments. NUTRITIONAL STATUS OF PRESCHOOL CHILDREN IN RELATION TO SELECTED FACTORS CHARACTERIZING THE FAMILY ENVIRONMENT- AN ECOLOGICAL APPROACH BY Laura Smail Sims A THESIS Submitted to Michigan State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of Food Science and Human Nutrition 1971 62 Copyright by LAlHUA SMAJIJ.SIMS 1972 DEDICATION In honor of my mother, and in memory of my grandmother, whose inSpiration instilled a love for learning. ii n 4.! t r ACKNOWLE DGMEN TS Any successful research results not from the efforts of a single individual, but as a cooperative venture among many. It is virtually impossible to conduct a study of this nature without accumulating numerous debts to many pe0ple. Sincere appreciation is extended to members of my guidance committee: To Dr. Portia M. Morris, Department of Food Science and Human Nutrition, who served as my major professor, for her continuous support, encouragement, and guidance throughout this research. To Dr. Dena C. Cederquist, Department of Food Science and Human Nutrition, for her interest and support through— out my course of study. To Dr. Beatrice Paolucci, Department of Family Ecology, for her incisive direction and encouragement throughout the study. To Dr. Everett M. Rogers, Department of Communication, for his interest and advice, particularly in the area of multivariate analysis. .Dr. Dr. William B. Weil, Department of Human Develop- ment, for his support and advice regarding assessment of physical development and nutritional status. iii Thanks are extended to Dr. Robert P. Boger, the teachers and staff of the M. S. U. Laboratory Preschool Program, to Miss Mariella Aikman and the staff of the Spartan Nursery School, and to the staff of the Cristo Rey clinic for their invaluable assistance in helping me to obtain data from the children and their mothers. Sincere appreciation is expressed as well to others who helped me with various phases of the study. To Dr. Olaf Mickelsen and Dr. Modesto Yang, of the Department of Food Science and Human Nutrition, for technical guidance and advice regarding determination of nutritional status. To Mrs. Margaret Shick and Mrs. Nadine Fisher of the Olin Health Center who were reSponsible for the collection and analysis of blood samples. To TOm Nicol, Steve Huyser, and Dr. John Hunter of the Department of Psychology, who were extremely helpful in assisting me with the computer analyses and interpre- tation of data. I also wish to express my heartfelt appreciation to all the families who welcomed me and my interviewers into their homes. Without their c00peration and interest, this study could never have been conducted. Finally, a personal note of thanks is due to my husband, Henry P. Sims, jr., without whose understanding, encouragement, and insightful advice, this project would never have reached fruition. iv TABLE OF CONTENTS Chapter I INTRODUCTION Objectives Assumptions II DEVELOPMENT OF THE CONCEPTUAL FRAMEWORK An Ecological Systems Approach Characteristics of Ecosystems The Flow of Matter-Energy in the Ecosystem ' The Flow of Information in the Ecosystem The Ecosystem Approach to the Study of Nutritional Status Implications of the Model Description of the Model III SELECTION AND MEASUREMENT OF VARIABLES The Family as Environment Demographic Characteristics Family Resources Psychosocial Attributes of the Mother 1. Parent Attitude Research Instrument 2. Homemaker Values 3 . Anomie 4. Powerlessness 5. Semantic Differential Instrument Dietary Evaluation Assessment of Nutritional Status Clinical Methods: Nutritional Anthropometry Biochemical Parameters IV DATA COLLECTION AND ANALYSES Selection and Description of Sample Data Collection Data Analyses Factor Analysis Scale Develogment Moderator Effects Page Chapter Classification and Codification of Data for Analysis Dietary Data Biochemical Data V FINDINGS 'Characteristics of Families in the Sample Results from Home Interview Psychosocial Attributes of Mothers Interrelationships Among Family Characteristics ' Evaluation of Dietary Data Nutrient Intake of Children Relationship of Nutrient Intake to Other Variables Relationship of Biochemical Data to Other variables Results of AnthrOpometric Measurements . VI DISCUSSION, CONCLUSIONS, AND IMPLICATIONS Discussion of Results Limitations of the Present Research Summary and Conclusions Suggestions for Future Research Implications BIBLIOGRAPHY APPENDICES Vi Page 96 96 100 100 100 128 137 139 139 150 161 171 187 187 191 192 198 199 200 216 Table 3.1 4.1 5.8 5.9 LIST OF TABLES Items in PARI according to scale designation E.C.H.O. neighborhood profile, Lansing, Michigan Sex distribution Race distribution Age distribution Timing schedule for data collection Methods used in analysis of data Education of parents Employment status of parents . Hours per week child is cared for by someone other than parents Income distribution of families in sample Classification of families by source of family income Household size Characteristics of families in relation to number, age and spacing of children Description of families by stage in family life cycle ‘ Religion of children in sample £5.10 Number of years in present home vii Page 41 82 84 84 84 86 89 101 101 102 102 103 103 104 104 105 105 Table 5.11 5.12 5.13' 5.15 5.16 5.17 5.18 5.19 5.20 5.21 5.22 5.23 5.24, 5.25 5.26 5.29 5.30 Appliances present in the home Meals eaten together as a family Mothers' reSponses as to how important it is for child to finish everything on his plate Mothers' usual action when the child dawdles with food or refuses food served to him Frequency of snacking Food preferences of children Extent of feeding problems in the preschool period Reasons for shOpping in particular markets Weekly food expenditure Frequency of use of certain convenience food items Number of "Basic 4" named Scores on nutrition knowledge test Scales developed from items in interview schedule Intercorrelations among demographic- resource characteristics of families Deve10pment of new PARI scales Percentage of samples by value rating responses Intercorrelations among socipsychological attributes Correlations among soci0psychological attributes of mothers and selected demographic/resource characteristics of families Average nutrient intake for total sample Percentage of Recommended Dietary Allowances ‘ met by mean intake of nutrients from food viii Page 107 109 110 111 113 114 116 117 117 119 120 120 126 127 128 136 140 141 142 143 Table 5.31 5.34 5.35 5.36 5.37 5.38 5.39 5.40 5.41 5.42 5.43 5.44 5.45 5.46 Percentage of sample meeting Specified proportions of Recommended Dietary Allowances Percentage of calories supplies by carbohydrate, fat, and protein Pattern of consumption of calories and protein Consumption of calories and protein expressed by kilogram of body weight Food intakes of preschool children as exPressed by servings of food groups Nutrient intake data (by percentiles)in .comparison with Beal data Intercorrelations among nutrients Correlations among nutrient intake selected .demographic and resource characteristics Nutrient intake (as % RDA) in relation to family income Comparison between "low-income" children and "high-income" children in relation to nutrient intake Calories and protein/kg body weight basis in relation to family income Correlations among nutrient intake.and sociopsychological attributes of mothers Results of blood tests of preschool children expressed in relation to ICNND categories Correlation Matrix: Biochemical data vs nutrient intake Correlation matrix: Biochemical data vs anthrOpometric measurements Correlations among biochemical data and selected demographic characteristics of families Relationship of family income to blood data ix Page 144 144 146 147 148 149 151 152 143 154 157 158 160 162 164 166 167 Table 5.48 5.49 5.50. 5.54 5.55 5.56 5.57~ 5.58 Correlations among biochemical data vs sociOpsychological attributes of mothers Effects of selected moderator variables on the relationship between nutrients and blood components Distributions of heights and weights of preschool children compared with Stuart percentiles Distribution of heights and weights of preschool children compared with Fels percentiles Comparison of height and weight data in reference to Fels and Stuart standards Distribution of height and weight measurements by height-weight-age Intercorrelations among anthrOpometric measurements Correlations between anthr0pometric measure- ments and nutrient intake Correlations among anthropometric measure- ments and socipsychological attributes of mothers Correlations among anthrOpometric measure- ments and demographic characteristics of families Effects of selected moderator variables on the relationship between nutrient intake and anthropometric measurements Page 168 170 173 174 175 176 179 180 181 183 185 Figure 1 LIST OF FIGURES A conceptual model using an ecological approach for the study of nutritional status of children Description of variables in the study Techniques for evaluation of nutritional status Geographical distributions of children in the sample Nutrient intakes of children,expressed as percentage of the RDA, in relation to family income xi Page 23 26 60 83 156 LIST OF APPENDICES Appendix Page A Corre3pondence 1. Letter to mothers, December 1969 216 2. Letter to mothers, February 1970 217 3. Letter to mothers, May 1970 218 4. Permission request for blood tests 219 5. Letter to teachers scheduling measurements ' 220 6. Letter of thanks and appreciation 221 B Guidelines for Interviewers 222 C Instruments 1. Food record recording form 224 2. Home interview schedule 228 3. Attitudesmeasuring questionnaires a. Parent attitudes 247 b. Homemaker values 252 c. Parent Opinions scale (anomie) 254 d. Powerlessness 255 e. Nutrition knowledge and attitudes test ‘ 258 f. Semantic differential instrument 263 D Guidelines for data coding 1. Coding form for food records 266 2. Coding guide for all variables 267 3..Identification codes for derived scales 297 E Correlation matrices 1. Multiple group analysis for PARI scales 300 2. Final inter-scale matrix 305 xii CHAPTER I INTRODUCTION Nutrient intake is but one of a myriad of environ- mental factors that affects the growth and development of young children. Malnutrition does not occur in isolation; many of the non-nutritional factors which contribute to its occurrence may independently Operate to influence develOpment. Often differences in the level of dietary intake are associated with other profound differences in familial characteristics and environmental circumstances. Because preschool children are, by necessity, dependent on others (primarily other family members) for the provision of food as well as environmental Stimulation (both factors which operate to influence .9r0Wth and development), it is proposed that data on the PhYSical growth and nutritional status of the preschool Child is most meaningful when examined in the context of rfis home and family environment. It has been emphasized that, "...much more research is needed on the effect of interrelationships between socio-psychological and physical factors in the environment on the...physical status of the child (Wakefield and Merrow, 1967) ." The relationships which exist between malnutrition, certain disease states, and physical development have been well documented, although the underlying mechanisms are not yet well elucidated. It is commonly recognized that per capita income, infant mortality, sanitation, and malnutrition are interrelated. But, why then, are children from families of similarly low levels of income and deprived environmental circumstances not equally impaired in terms of nutritional status? Is it possible that the end result (in this case, malnutrition) may be a result of more than the linear sum of the individual contributing factors? It is not sufficient to identify only evidences of the clinical nutritional deficiency; the entire constellation of ecologic factors contributing to the problem must be examined (Read, 1970). Thus, there is a need for the development of a theoretical model for the study of the syndrome of malnutrition which identifies underlying causes as well as showing interre- lationships among contributory factors. The model presented by this research focuses on the nutritional status of the preschool-aged child. The Conference,("Malnutrition Is A Problem of Ecology", called attention to the fact that the preschool child was at the most vulnerable age class in human deve10pment “florgy and Kline, 1970). Bloom (1964:200) suggested that, "the environment will have its greatest effects in the period of most rapid development." This statement lends additional support to the contention that the young child is most vulnerable to changes in his environmental circumstances. It has been established from the results of animal experimentation that undernutrition at an early age may exert an adverse effect on subsequent physical development (McCance, 1962). There is considerable evidence both direct and indirect, that the increased growth rate seen in some children is attributable to improved nutrition (Greulich, 1958). Growth of underprivileged children, both in deve10ping countries and in the so-called developed countries, is accelerated when they receive improved environmental care (especially better food and more protection from infectious diseases), a factor which is eSpecially evident in the critical preschool age period (Jackson, 1966:18). In addition to the effect of nutri- tional intake on physical development of children, food Practices and attitudes developed during the formative Years of childhood tend to persist into adulthood. Eating Practices thus established during the early years are believed to affect food choices and consequently, nutritional status throughout life. Thus, because food intake varies with environmental cfircmmstances, the approach taken in the present study is ecological, i.e., a nutritional status of preschool children is examined in relation to factors which charac- terize the near environment of the child, particularly his family. Objectives The primary objective of the present research is to study the relationship between a child's physical growth and nutritional status with selected factors which may be used to characterize the family environment. A second objective is to determine which variables (of those selected as representative of the family environment) are the most predictive of the level of nutritional status of the preschool child. In addition, the study also seeks to obtain information on the physical growth and nutritional intake of children from several socioeconomic groups. A final objective entails the development of a conceptual framework appropriate to the study of nutritional status of children from an ecological perSpective. Assumptions l. Soci0psychological disturbances in the family enV'ironment exert an adverse effect on the physical growth and nutritional status of the growing child (Fried and Mayer, 1948). 2. Nutritional status and family environment cmaracteristics can be adequately appraised using the instruments selected for this study. 3. Mothers of preschool children are familiar with the family characteristics and eating practices of their children and can accurately report on such practices. CHAPTER II DEVELOPMENT OF THE CONCEPTUAL FRAMEWORK It is important in any research study to assimilate data from the literature in order to condense findings into a unified and valid theory. Conceptual frameworks have been used increasingly in recent years because Of their contribution to theory building, i.e., they intro- duce orderliness into the research process and provide Opportunities for replication and application of the findings. Hill and Hansen (1960) use the term conceptual framework to refer to "clusters of inter-related but not necessarily inter-defined concepts." Nye and Berardo (1966:5) have suggested that conceptualIframeworks have three functions: 1) identification of factors that enter into behavioral processes; 2) tracing the sequence of Various stages of behavioral processes; and 3) description 0f Structural relationships between and among factors susPected to, be associated with observed behaviors. The PIBSent study is primarily concerned with the latter f\lmztion, i.e., the development Of a framework by which the nutritional status of children may be studied. An Ecological Systems Approach In the development of a conceptual model for the study of the nutritional status of population groups, it is proposed that the most meaningful approach is one which deals with the subject pOpulation as an "ecosystem." An ecosystem framework is appropriate for the study of nutritional status because it integrates the science of ecology with the systems approach. A system may be conceptualized as "a set of components which act with and upon one another to bring about a state of balance, inter-dependence, or 'wholeness'" (Havelock, 1971). On the other hand, the enviromnent may be thought of as "all other factors [outside the system] which impinge upon that system“ (Chin, 1969). Systems may be characterized as either "Open" or "closed." Closed systems are isolated from their environ- ment in that there is no exchange Of information across System boundaries. In contrast, Open systems may exchange information, energy, and materials with their environments. Living entities most certainly demonstrate the complexity 0'15 Open systems, i.e., they have inputs and outputs. Systems may be further described as "static" or "dynamic." In static systems, components exist in a more or less fixed relationship with one another. In contrast, cOmponents of dynamic systems act upon one another; they force changes in a pattern of action and reaction that ‘Lmaintains a dynamic equilibrium or balance of forces. Most systems that can be identified and examined in the real world are likely to be open systems which contain both dynamic and static components (Havelock, 1971). In classical terms, ecology may be defined as the science of relationships between organisms and their environment. An ecological perspective in the study of living systems enables one to consider the "whole" being rather than isolated component parts in the analysis of any system. Jackson (1966) has stated, The study of nutrition is a study of ecology, and for a valid assessment the whole of the environment must be examined. The term "ecosystem" is used to describe the basic functional unit for the study of living entities (Evans, 1956) . This term, first proposed by Tansley in 1935, refers to the interaction system comprised both of lixrixlg things together with their non-living habitat, hTtiJnately linked by a variety of biological, chemical and physical processes. An ecosystem, can be visualized as a grouping of components linked by... flows of energy and connected to the surrounding biosphere by its system of inputs and outputs (Bormann and Likens, 1970). All ecosystems are Open systems in that matter-energy continually escape from them in the course of life pro- cesses and must be replaced if the system is to continue mafunction (Evans, 1956). The environment of the ecosystem is seen as providing resources potentially useful for the maintenance of life. Two types of environmental factors may be distinguished: 1) those independent of man, i.e., the physical and biological components; and 2) those related to the association of man with his fellow man, i.e., the social, cultural, and economic features of human existence (Rafalski and Mackiewicz, 1968). Within this total environment can be superimposed three human systems: 1) the biOphysical, or metabolic and physiological pro- cesses; 2) the psychosocial, or the interpersonal rtelationships expressed by individual and collective patterns of behavior; and 3) the technological, which includes materials, tools, and techniques (McHale, 1968). In order to utilize the systems approach effectively, it. is imperative that the environmental factors which .finpxinge upon the system be identified. Obviously, this task is far easier in describing physical systems than filr' systems in the life, behavioral, or social sciences. Many of the models which have addressed themselves to the multiple etiology of malnutrition focused upon a particular environment which exists in the develOping countries. The ecosystem approach allows one to develop a model which is appropriate for describing the environment for a complex, affluent society, as well as for more primitive societies. 10 According to Kartman (1967), the term, "human ecolOgy" implies, The broadest possible view of human beings, both as individuals and as populations, in terms of the ecosystem, that is, the biologic, socioeconomic, political, cul- tural, and emotional complexes in their dynamic action and reaction. Hanlon (1969) emphasized that the convergent complexity of the relationship of total man to his total environment must be recognized. He suggested that human ecology attempts to develop a conceptual framework whereby, ...needs of mankind--as individuals, in groups, and as communities--may be approached, not merely in a reductionist fashion...but rather in a holistic manner wherein the integrated reSponses of man to environmental forces find expression. The human ecologic approach must, by necessity, draw upon an interdisciplinary effort. Auerswald (1968) indLicated that an ecological systems approach focuses on the: interfaces between various disciplines and the processes taking place there, rather than on the concep- uRal. framework of each contributing discipline in the research. He suggested that this type of analysis coupled with the holistic nonexclusive nature of the ecol-<>gical approach, minimizes the dangers of excessive SElectivity in the collection of data and allows for much more clarity in the contextual contributions to the analysis of the problem. 11 Characteristics of Ecosystems Miller (1971) has stated that living systems are composed of matter and energy, organized by information. Thus, two cycles, or flows, may characterize an ecosystem: l) the matter—energy flow, and 2) the flow of information. The movement of matter-energy over space, action, is one form of process which describes the first type of flow. Another form of process is information processing or communication, which is the change of information from one state to another, or its movement from one point to another over Space (Miller, 1971a) . The exchange of unatter-energy contributes to the information a system processes, and communication of any type requires the input or out-take of matter-energy. Information signifies input of matter-energy or perceptual data from outside the system. Matter-energy and information always flow together (Miller, 1971a). Hanlon (1969) has applied the notion of the flows 0f matter-energy and information in the ecosystem to the stuuiyvof human ecology: ...We can think of the biosocial organism that we call man as an open-ended system through which the energy, resources, and influences of the environment are trans— formed for good or ill, and which transforms man in the process... From the sociocultural component comes the never-ending stream of informational stimuli which require correct decisions or adaptive strategies that too often pose a threat to psychological and social integrity, and trigger emotional and 12 behavioral patterns inimical to self and others. The Flow of Matter-Energy in the Ecosystem Katz and Kahn (1966:16—17) indicate that open systems are characterized by, ...input of energies and the conversion of output into further energic input [which] consist of transactions bet- ween the [system] and its environment. ...The stability or recurrence of activities, in the system can be examined in relation to the energic input into the system, the transforma- tion of energies within the system, and the resulting product or energic output. .Fom'all living things it is essential that a source of enaergy, in the form of calories, be provided from the errvironment in order to carry out growth and maintenance of life. The matter-energy flow through a system consists of three processes: 1) the input from the environment; 2) ‘the.transformation or utilization of energy by the Organism; and 3) the output of energy from the system, Which may or may not be recycled back into the system (Katz and Kahn, 1966) . The energy flow model may be applied to the study of nutJiitional status for energy which is essential for the maintenance of life and the promotion of growth is fur- nished from the larger environment. Although an individual functions as an ecosystem himself, he is also anmmber of a larger system--a family--which in turn exists 13 as but one subsystem in a much larger supersystem, or macrosystem. The input of energy (in the form of food) to the individual comes, usually, as a result of the transactional process between the family and the total environment . The Flow of Information in an Ecosystem Ecosystems, as any human organization, are informa- tional as well as energic systems in that both the exchange of matter-energy and information with the environment must be considered in order to understand the overall functioning of the system. Information exchange is itself energic, but its energic aSpects are negligible compared with its symbolic aspects, i.e., information flows are significant for what they imply, trigger, or control (Katz and Kahn, 1966:257) . Communication circuits, or information flows, within systems, may be characterized by the type of communication network which they represent. Several types of networks (named the “circle", "all-channel", and "wheel") have been Proposed (Katz and Kahn, 1966:237). The "wheel" network 13 most apprOpriate for consideration in the evaluation 0f nutritional status. This type of communication network may be represented by the following diagram: 0 I I 0 14 where each circle represents one individual in the system (such as the family). Using the "wheel“ network as a model for information flows, the mother in a nuclear family may be represented as the central figure. She acts as the major link between the outside environment and the other family members in that it is usually she who is responsible for the prepara- tion and distribution of energy, i.e., food, to the family members. Cultural patterns and folkways exert a powerful influence on the physical distribution of food to individual family members. In some African cultures, heads of house- holds receive food first and consume the larger portion of what is made available, Often thus depriving the small children of sufficient calories or protein to meet their nutritive requirements for growth. In the "typical" American family today, it seems (upon observation) that even when the amount of food available to the family is limited, small children are usually adequately fed, and their food likes and dislikes are a strong influence upon decisions regarding meal planning for the family.) The use of the "wheel" communications network to analyze the flow of energy and information within the family SYstem has relevance to Lewin's "channel theory" (1943) in ‘theh he described his theory why people eat what they Qatn Lewin (1943) suggests that food comes to the table 15 via channels that are controlled by a Fgatekeeper" figure, usually represented as the mother. The mother's psychology exerts an influence on food habits of the family. In turn, her choice of food may be influenced by: 1) her cognitive structure, i.e., what she considers "food for us” and what "fits into our idea of meals", and.2) the values behind her choice of foods, e.g., her motives and ideologies such as health, taste, status, cost. The Ecosystem Approach to the Study of Nutritional Status Two types of systems may be considered in the study of the nutritional status of preschool children, namely the family and the individual child. Hook and Paolucci (1970) suggest that the family may be viewed as an ecosystem on the basis that interdependent relations between man and his near environment basically focus on the family which acts as a life support system in providing both physical and social nurturance. The family as a life support system links both the natural environment with the social environ- ?ment because of its mutual dependency upon both the natural environment for physical sustenance and upon the social organizations which are related to man's humanness and .give quality and.meaning to life. Because the interactions of man as a total being and his near. environment may be Inanaged and controlled by the family, an ecological approach is implied. 16 Literature from the field of home management suggests that family resources, both tangible and intangible, may be managed in such a way as to direct family behaviors toward predetermined group goals, the major one being .growth and develOpment of individual family members. Home management helps the group create an environment in which members can perform, grow, and develOp as individuals and at the same time, cooperate in attaining group goals (Paolucci, 1966). The family may be seen as a system in that it acts as a processor or convertor Of input goods and services from the environment, by means of services (managed in such a way as to meet the needs of individual family members), and produce an output flow of converted products, waste, or surplus. Thus, when families manage resources appropriately and establish relevant goals, requirements of children will be met for a supply of required nutrients (as food) and for emotional support and stimulation, all required for Optimum growth and nutritional status. The individual family may be viewed as but one of a number of Subsystems (such as the political system, the educational System,_the religious system, etc.) within the total social Inacrosystem. . A second type of system which may be defined is that <3f the individual child as an ecosystemt The individual Inay be viewed as a type of open system in that he, too, (is a processor of information, materials, and energy from 17 his environment which he utilizes to provide sustenance to meet physical, mental, emotional, or social needs. Nutritional status.and physical development of the child are but facets of a larger, more complex, system which contributes to the total ecosystem concept of the child, thus: Mental Physical Psycho- SOClal emotional This approach views both the individual as a system and the family (as a unit of interacting personalities) (Hook and Paolucci, 1970) as a subsystem within the larger social macrosystem. The family is regarded as a system; however, in addition, this model also assumes that the family acts as environment for the develOping child. The family is seen as both an environ- ment for the individual and as existing in a larger physical and biological and social environment; the family exists within only part of the total environ- ment (Hook and Paolucci, 1970)._v \ In essence,_the family functions as an interface 'between the develOping child and his larger environment. (Am.interface is the boundary across which matter—energy oI'information is transmitted from the external systems ibnto the system at issue.) Breckenridge.and Murphy (1969) state, 18 ...how a child's needs will be met will depend upon the family and the circum- stances in which it lives. Certain fundamental needs, both physical and psychological, which are considered basic to a child's sense of well-being and optimum development include: 1) warmth, both physical and close personal warmth or love (Conceived of as an information flow component in the present model); 2) physical and psychologic security; 3) dependence and independence; 4) nutrition; 5) activity, which includes movement itself and as it provides a means for exploration of.the larger environment; 6) rest and sleep; 7) social contact. The child, although independent in being able to satisfy his tissue needs for nutrients and energy, to excrete waste products of metabolism, and to make involuntary movements, is dependent on others (primarily the family) to provide him with food, warmth, and security (Breckenridge.and Murphy, 1969). ImplicationS'of'the Model Nutrition is recognized as an important environmental factor affecting the growth and development of young Children. Moreover, the food practices and attitudes develOped during the early years are eStablished primarily :bY'the family in which the child is raised. Such food habitsare belieVed to affect food choices, and ‘Consequently, nutritional status throughout life. The development of food habits in children as a result of 19 family mealtime practices reflects an inter-meshing of the flows of energy and information. We may consider that food habits are a result of the transactional patterns between resources which may enter.the family from the environment, and the family's use of such resources which, in turn, may vary as a result of the decisionsmaking and valuing processes. Flows of matter-energy and of information in the ecosystem act together to influence the nutrient intake, and physical development of the child. .The matter-energy flow relates to the provision of food to the child to meet his physical, or survival, needs, while the informa- tion flow relates more Specifically to the affective or behavioral components of the system- Man directs his available resources to meet his needs, both for the survival and affective components of his environment. The energy flow concept may be related to Maslow's "Hierarchy of Needs" theory. In this concept, Maslow Classified all human needs into either physiological (survival) and social (e.g., the belongingness and love needs, the esteem needs, and the self-actualization needs). Hetmaintains that a minimum satisfaction of a need at one (level is essential before the person can move on to seek Satisfaction of the next need in the hierarchy. From 'Ehis theory, one can postulate that only when a person ihas.enough'food to satisfy hunger, i.e., to meet the 20 survival need, can he be interested in any other meaning for food (Lawenberg et al., 1968:105-106). . The flow of information in the system (the "communication circuit") reflects, to a largedegree, the affective or socio-emotional components of the child's environment. Many studies have been conducted to deter- mine the influence of the emotional climate on the child's physical growth and development. Widdowson (1951) suggests that an unfavorable psychological environment may Operate independently of caloric intake to retard linear growth. Fried and Mayer (1948) emphasize that emotional adjustment and physical growth of children are inseparably related. Patton and Gardner (1962) indicate that there are several means by which disturbances in the soci0psychological quality of the environment could interfere with growth, including: 1) inadequate intake of calories to meet physiological needs; 2) reduction in appetite resulting from the child's lethargy and depression; 3) altered intestinal motility and rates of absorption resulting from emotional disturbances; and 4) emotional effects on the endocrine system resulting in an interference with inter- lIlediary metabolic processes. A review of studies both on Children reared in an institutional setting and on those ‘flho.experienced maternal deprivation in their own homes, inevealed that neglected, or emotionally deprived, children maynotgrow as well as happy, emotionally secure youngsters. 21 Kallen (1971) has suggested that the slower mental develOpment Observed in some children from disadvantaged environment may Simply be a reflection that these children had insufficient energy to benefit from social stimulation provided by the environment. Likewise, Dubos (1968:86) Observed: ...a child may be listless, dull, and immobile because he hasn't enough energy to act otherwise. Such examples provide support for the contention that the flows of matter-energy and information within the eco- system are inseparably linked; both must be functioning well in order to meet the needs of the system. Whitten et a2. (1969) undertook a study to test.the validity of the assumption that the growth failure in the maternal deprivation syndrome is due solely to psycho- logical factors. Their data suggest that maternally deprived infants are underweight not because of some psychologically induced defect in absorption of metabolites, but.because of undereating, secondary to not being offered adequate food, or not accepting what is Offered. Studies such as this demonstrate.the interelatedness of the matter-energy flow with the information flow, i.e., the amount of matter—energy available to.the system influences communication patterns, and in turn, information flows influence the utilization of matter—energy components, Such as food. 22 'Description‘of " the "" Model The concept of the "child as ecosystem" implies a dynamic, changing system. Moreover, it is acknowledged that the present model is somewhat limited in its capacity to.deccribe.the ecosystem concept in its entirety because of its static nature, and because it views the subjects at one~point in time rather than over their entire life Span. .The overall conceptual model develOped to study nutritional status of preschool children is shown by Figure 1. In the context of this model, nutrient intake of the child is seen as the most significant linkage.between the systems of the family and the individual child. (Linkage is a term which may be used to indicate.that two systems are connected so as to.form a greater system; it Suggests a regularized pattern of interaction between the two systems which in~a sense forms a bond between them (Havelock, 1971:2-10).) Nutrient supply to the child is an output of the family system in that it is a result of theprocessing features or the interplay between the matter-energy and information flows within the family system. The child (functioning as an ecosystem), in turn, processes the nutrient supply in such a way as to produce (as outputs Of the system) his physical develOp- ment.and nutritional status. The model as develOped has been used to study physical develOpment of preschool 23 336 3:32.32 £395 .coEiU 5558“,. 2.6 a a a... O. >omwzm -mm._:_.454“— m1... 440.004 -02 tom... 4<¢Dh430 4405:; no.00m .v hzm220m=>zw NIL. 29104.10 “.0 94.53% 4095 MI». mo“. 4w002 4 including: nutrition knowledge, attitudes re feeding children, tood buying practices, use at __ space, housing conditions. 111. Social-psychological FA. Semantic differential: Attributes ol Mot'..er -p "How I See Mysell As Mother" instrument. Anomie . Powerlessness . Parental Attitudes on C..ild— rearing lPARI Instrument) E. Homemaker Values Scale capo . Nutrient Intake of Child Variables Measures Dietary __________ _. A. 3, Zd-hour Food Records Evaluation 8. Dietary History of child THE CHILD AS ECOSYSTEM - Physical DeveIOpment; Nutritional Status Variables Measures 1. Biochemical (A. Blood. Indices ————————— -p l. Hemoglobin 2. Hematocrit 3. lotal serum proteins 4. Serum albumin 8. Urine: hydroxyproline: _ creotlnine ratio. 11. Anthropo- EA. Height: shndlng, metrlc sitting. Measures --------- D Weight Sklnlold thickness: triceps, subsoapular D. Circumferences: head, upper arm, chest E. Diameters: biacromial, blcrishl. 5"?" 27 environment. A family may be viewed as, "a corporate unit of interacting and interdependent personalities who have a common theme and goals, have a commitment over time, and share resources and living space (Hook and Paolucci, 1970)." For the child, the family might be considered as an environment which represents a primary set of powerful pervading forces which affect human characteristics, such as physical develOpment and nutritional status. Within the home setting, as well as in the neighborhood and community, in which the young child is living and carrying out his daily activities, would be found those environ- mental resources or means for enabling him to meet his _growth potential. Operationally, the environment would be bounded by the child's direct and indirect involvement with these resources, whether they be persons, activities, or objects (Baker, 1970:50-51). Children are not isolated beings; they exist not only as individuals, but as members of families, as members of peer groups, and as members of general social systems. Any study of the nutritional status of children which fails to consider the impact of the family and other environmental influences can be expected to provide only limited insight regarding the nature of the situation. It is duly recognized that the influences upon a child's well—being act as a complex of interacting factors. 28 Identification and analysis of the interrelationships among such variables is essential for a complete under- standing of nutritional status of children. It is acknowledged that a wide range of environ- mental forces may act concurrently to influence human development. Burgess et al. (1942:29) suggest: ...any [factor]...may legitimately become the focus of interest: the biological influences,..., the highly specific features of the immediate environment, or, finally, those more general in- fluences which are characteristic of a particular culture... . A one-sided emphasis on any of these factors necessarily leads to false conclusions. Stott (1967:405-407) suggests that family environ- mental factors which act to influence the develOpment of children may be divided into two classes: 1) those that relate to family functions, such as providing the common essentials for health, growth, and personal develOpment; and 2) family structural differences, such as the composition, physical and social nature, as well as the cultural backgrounds of the family itself. It is apparent that families differ structurally, for instance in the number of family members, in the sex and age distributions of children in the home. In addition, differences are to be found in the physical facilities of the home, thegeneral educational level of family members, and the adequacy of intellectual and cultural stimulation within the home setting. 29 An outstanding example of the interchange between the developing child and his larger environment via his family is related to the food intake and dietary practices of the family. The adequacy or inadequacy of the food intake of the growing child depends directly, and in most cases completely, upon the family, most specifically the mother. The role of family members in influencing the develOpment of dietary practices of the young child may be viewed from two aspects: 1) the family directly influences dietary practices in terms of its obligation to provide the child with the necessary foods in sufficient quantities and in forms suitable to his needs and his ability to manage them, and 2) indirectly, dietary practices are influenced by the family's transmission of food attitudes, preferences, and other factors which affect lifetime eating patterns. In summary, two aSpects by which the family serves as an environment to influence the nutritional status and physical development of the young child are: 1. The family controls the food intake of the child, and in general, is reSponsible for directly providing the appropriate nutrients of sufficient quantity and quality which act to influence the child's develOpment. 2. The emotional climate of the home setting influences the child's physical growth. Studies, both on children in an institutional setting and on those in their 30 own homes who experienced "maternal deprivation", have shown that neglected, or emotionally deprived, children may not grow as well as happy, emotionally secure children (Widdowson, 1951; Fried and Mayer, 1948; Patton and Gardner, 1962). Demographic Characteristics Jessor and Richardson (1968) indicate that demo- ~graphic characteristics of the family (including race, amount and source of family income, occupation and education of parents, family composition [age and sex of family members] marital status of parents, mobility, and the like) may be considered components of the distal environment. They suggest that such distal environment characteristics can serve as indicators for the kinds of behaviors which can be expected of peOple located within a specified strata within the larger society. Comparable factors, such as family income, education and occupation of parents, family size and composition, employment status of the parents, and arrangements for child care when the mother is employed, have been included in other nutrition studies, such as the North Central Regional Study of Diets of Preschool Children (Fox et al., 1970) because it was felt that such variables influenced food habits and the nutri— tional well-being of the children. In the present research suCh.variables were included for study in order to more completely assess those environmental characteristics 31 which are most influential in affecting the nutritional quality of preschool children's diets. In addition, comparisons can thus be made with other studies which used the same variables. The concept of "socioeconomic status" has received considerable attention in recent literature. It is .generally accepted that socioeconomic status (SES) is not defined solely by the level of income, but is also related to education and occupation. One index of socioeconomic status used in the present study was that develOped for the Washington Heights Mental Health Survey and published in the Milbank Memorial Fund Quarterly (1969). This Index was formed as a summative score on the basis of the education and occupation of the head of household and the total family income. Students who were also heads of households were evaluated on the basis of potential occupations, i.e., they were rated in the "professional and managerial“ classification. There was a preponderance of scores in the nine to thirteen range in this sample of preschool children's families. Education of the parents was coded independently as the number of school years completed. Parental occupation was coded according to the system develOped by the Bureau of the Census as "scores for categories of occupation component" (Bureau of the Census, 1967). The family may be viewed as a developing entity in that as circumstances change, the family as a unit also 32 changes in order to c0pe with them. One approach used to study the family's sequence is in terms of its life cycle. Duvall (1967) has developed the concept of the "family life cycle" whose stages are determined according to the ages of the children and adults in the family, as follows: Stage I Beginning families (married couple without children) Stage II Childbearing families (oldest child, birth to 30 months) Stage III Families with preschool children (oldest child 2 1/2 to 6 years) Stage IV Families with school children (oldest child 6 to 13 years) Stage V Families with teenagers (oldest child 13 to 20 years) Stage VI Families as launching centers (first child gone to last child's leaving home) Stage VII Families in the middle years (empty nest to retirement) Stage VIII Aging families (retirement to death of both spouses) This scheme was used in the present study as one means of classifying individual families in the sample. Family Resources Literature in the field of home management emphasizes that through the use of resources families are able to achieve their goals. Thus, in order to achieve the goal of Optimum develOpment for its members, the family must have sufficient resources and be able to manage them well. Obviously, in terms of the study of nutritional status of children, the family must have resources so that sufficient nutrients may in turn be channeled to the child. Deacon and Maloch (1966) define family resources as, "...any- 33 thing-~knowledge, abilities, and skills, objects--which can be used or which has direct application in the meeting of demands." Gross and Crandall (1963:124) have suggested that family resources may be classified as hgman, which include thme,energY. Skills, knowledge, attitudes, and nonhuman which would apply to tangiblegoods and facilities. They stress that there may be potential human resources (such as increased capabilities in a particular skill) which may not presently be available for family use. In addition to studying tangible resources such as family income, the amount of money spent for food and other food buying practices, it is equally important to assess the human resources in the family which relate to the child's nutrient intake. For this reason, variables such.as the mother's knowledge of nutrition, her attitudes about feeding children, and factors which were influential in helping her choose what foods to feed her family are considered for study. Important among the human resources which may act to influence the child's nutrient intake and, consequently, his physical status are the mother's knowledge of nutrition and her attitudes about the.feeding of children. Mbrse et al. (1967) after assessing mothers' levels of nutrition knowledge using a standardized test,_determined that the higher the level of education, the better was the 34 Imother's knowledge of nutrition facts. In addition, a course in nutrition (irregardless of the level of higher education) was directly beneficial to the score attained. The investigators found positive linear correlations of mothers' scores of the nutrition knowledge test with the blood levels for plasma ascorbic acid, and, in male children, with plasma carotene and cholesterol levels. Eppright et a1. (1970) reported associations among the scores of mothers on nutrition knowledge and attitude tests, nutritional quality of the children's diets, and selected socioeconomic factors. They reported that the mothers of the children with the lowest and highest calorie intakes had the lowest nutrition knowledge test scores. Of the attitudes investigated, that of permis- siveness was negatively correlated with all nutrients, except fat. Favorable attitudes toward nutrition did not seem to influence.the nutritional quality of the children's diets. Of the socioeconomic variables studied, that of education of the mother was more highly related than was income to dietary components, but was less highly related than were money spent for food‘and the number of persons in the household. In the present study, several means were used to assess the amount of family resources and the manner in which they were used. The amount of family income was recorded independently as a variable. In addition, in 35 their study of the assessment of socioeconomic status, Warner et a1. (1949) concluded that source of family income was as significant a variable as was the absolute amount of income. Their classification scheme for deter- mining source of income was used in the present research. The.mother's level of nutrition knowledge and her attitudes about feeding children were measured using tests previously validated by empirical research1 (Appendix c-3e). The test designed to measure the knowledge of nutri- tion was composed of twenty-three true-false items dealing with factual information about nutrition. The total number of correct responses was used in subsequent statistical analyses. Attitude-measuring scales1 (Appendix C-3e) were employ- ed to measure the mother's attitudes regarding the importance of nutrition for the child and her feelings about permissive— ness in feeding children. Responses were scored on a Likert scale so that a "strongly agree" Opinion was assigned a score of one while responses of "strongly disagree" were given a value of four. Thus, a lower score on these instruments indicated that the mother felt that 1The tests were developed at Iowa State University, Ames, Iowa, under the direction of Dr. Ercel S. Eppright, Professor of Foods and Nutrition, and were used in the North.Central Regional Study on Diets of Preschool Children (Eppright et al., 1970). 36 jprOper nutrition was most important for her child or that she was highly permissive regarding the feeding of her children. Space, as evidenced by family housing conditions, is an important resource to be considered when defining environmental characteristics which influence a child's physical growth. Havighurst.and Neugarten (1942:206-207) indicate that the "life-space" in which a child lives and 'grows involves at least three different elements, including ”the physical Space, the objects contained within that space, and the peOple who inhabit that space.“ Crowded living conditions have been identified as characteristic of persons in the "lower" class (Bell, 1965). Rice (1969), in a study with preschool children to determine the effects of different housing environments and participation in a Head Start program on the achievement level of the child- ren, concluded that: ...rather than acting as a direct controlling influence in a child's _growth and develOpment, the housing environment may simply provide the setting or the conditioning variable which encourages or inhibits the influence of other variables within the total social environment. Housing and neighborhood quality were assessed by the interviewer according toguidelines developed by the U. 8. Bureau of the Census (1963). Each dwelling unit was Visually inepected immediately before or after the inter- view with the child's mother. The dwelling inspection 37 items were tallied to place the dwelling structure in one of four housing quality classifications: poor,fair, good or excellent (Rice, 1969). An attempt was made to obtain at least a cursory appraisal of a sample of the immediate neighborhood around each dwelling. Land use was noted and structural condition was recorded simply as dilapidated, deteriorating, or sound. Because literature has revealed that crowding may be appraised using the "one person per room” standard, this procedure was also included in the present study. Psychosocial Attributes of the Mother Bloom (1964:222) has indicated that a distinction should be made between: ...environmental measures which are based on relevant...features of the environment and a set of procedures which more searchingly summarize the interactional processes between the individual and various features of the environment... . The second approach should be especially useful for the further development of theories of human development and for attempts to alter environmental conditions. Thus, in addition to demographic characteristics of the family and a description of available family resources, it is important to assess some aspects of the qualitative facets of the family system as environment for the develOping child, i.e., characteristics which would be ‘indicative of the affective components, or communicative and symbolic aspects, within that family system. The 38 following sections describe variables which.were chosen for study because they characterize these psychosocial attributes of the child's mother, the key link between him and his near environment. Included also is a description of the manner in which these variables were measured in the present research. Parent Attitude Research Instrument Mothers' attitudes about childrearing have been assessed in the present study by use of the "Parent Attitude Research Instrument" (PARI) develOped by Schaefer and Bell (1958). The authors' aim was to develOp an instrument which would indicate how mothers felt about family life and their role as parents. Theoretically, such attitudes would extend to the mother's behavior toward the child and would, in turn, have a bearing on the child's physical development and nutritional status. The original instrument contained 115 items, desig- nated as beonging to thirty-two attitude scales (Schaefer and Bell, 1958). Cross and Kawash (1968) developed a shortened form of the PARI, which according to them, could be used to measure authoritarian attitudes about child- rearing. This revised instrument contained the following scales: Encouraging Verbalization, Equalitarianism, Deification, Excluding Outside Influences, Irritability, 'and Deception (used as a filler in this shortened 39 instrument because it was not associated with authoritarian attitudes.) Schaefer and Bell (1958) indicated that selection of concepts for measurement in the attitude instrument was based upon a literature search for areas which could pro- vide information relevant to parent-child relationships. Several of the "rapport" scales contained in the instrument included Equalitarianism and Encouraging Verbalization. The latter scale was written, according to the authors, to determine whether the parent would permit or encourage the child to talk about his anxieties, conflicts, hostilities, and disagreements with parental policies. Several of the scales were designed to measure concepts of marital adjustment and tensions in the home environment. Rejection of the Homemaking Role measured the mother's discontent over the confinement found in homemaking and dissatisfaction with the duties and responsibilities required of the homemaker and parent. Irritability scale was developed around items which indicate that children figet on a woman's nerves" and that any woman would "blow her t0p" frequently in the difficult job of managing a home. .The authors felt that this scale may be related to several sources of tension, including tensions in the marital relationship. Schaefer and Bell (1958) cite evidence of content validity for their instrument. Reliability was established 40 by the test-retest method. Pearson product-moment correlation coefficients reported for the scales used in the present study were: ’E. Equalitarianism --- Deification .79 Encouraging Verbalization .61 Irritability .73 Excluding Outside Influences .67 RejectiOn of the Homemaking Role .72 In the present research, the shortened form of the PARI develOped by Cross and Kawash (1968) was administered to mothers participating in the study. Originally, the scale, Rejection of the Homemaking Role, had been omitted from the short form in order to make the instrument suitable for use with fathers as well as mothers. For purposes of the present study, however, this scale was reinserted into the instrument because only mothers' responses were being evaluated. The final instrument used contained fifty-three items belonging to seven scales, according to the following distribution: (Copy of the instrument is in Appendix C-3a.) 41 Table 3.1. Items in PARI According to Scale Designation. Scale 'Number of Items Rejection of the homemaking role (8) Excluding outside influences (5) Irritability (5) Deification (5) Deception (5) Encouraging verbalization (5) Equalitarianism (5) Deification (reversed) (5) Excluding outside influences (reversed) (5) Irritability (reversed) (5) Mothers were asked to express their agreement with the statements on a four-point continuum. Statements were worded in such a manner that a lower score (after "reflec- tion" by the computer) represented less authoritarian attitudes about childrearing. Several studies using the techniques of factor analysis have been conducted using the PARI items. Schaefer and Bell (1958) suggest that the instrument is comprised of three factors: 1) democratic acceptance vs. rejection factor; composed of the "encouraging verbalization" and "equalitarianism" scales; 2) irritability vs. warmth factor, composed of the "irritability" and "rejection of the homemaking role" scales; and 3) parental authoritar- ianism vs. democratic acceptance factor, composed of the "excluding outside influences" and "deification" scales. Zuckerman et a1. (1958) also identified three main factors: 1) authoritarian--control factor; 2) hostility--rejection factor; and 3) democratic attitudes factor, all composed 42 of scales comparable to those previously indicated. A third study employing factor analysis was conducted by Yater et a2. (1968) to determine whether responses of mothers of Head Start children would be comparable to those of mothers from higher socioeconomic groups. They identified three factors, as well: 1) authoritarian-- control; 2) democratic attitudes; and 3) hostility-- rejection. These researchers concluded that since reSponses were so similar to those found in other studies, there was a commonality of childrearing attitudes across different socioeconomic and educational groups. According to the authors, such findings suggest that the PARI might be measuring cultural attitudes toward childrearing rather than attitudes endorsed by Specific groupings of mothers. Homemaker'Values Values represent those qualities or entities which are prized and for which one strives. They are derived from a number of factors, such as an individual's ideals, motives, attitudes, and tastes, which are in turn deter- mined by his cultural background, education, habits, and experiences. In their classic research, Vernon and Allport (1931) define values as, "...broad functions of personality common to all and universal enough for comparison of one person with another." .Values influence behavior in the sense that they provide a basis by which to make decisions, to choose 43 goals for which to work, and to make choices among alter- native paths to agoal. Kluckholn (1959) suggested that the concept of a value implies: ...a code or standard...which organizes a system of action...a conception, explicit or implicit, distinctive of an individual or characteristic of a group, of the desirable which influences the selection from available modes, means, and ends of action. To Operationalize values, Kluckholn (1959) suggested that "real" values can be discerned by careful analysis of selections made in situations demanding a choice of action, many of which occur in the usual run of living. Several studies have been done to identify those values related to home and family life. Dyer (1962) sought to determine homemakers' awareness of values as they were reflected in family activities. The values defined in that study were family centrism, health, aesthetics, friendship, freedom, education, economy, prestige, and religion. In Dyer's study, homemakers were asked to identify activities they performed for a given period of time and to state reasons for performing those activities. The reasons were sorted into value categories. Each homemaker then rank-ordered her activities and reasons. In addition, she also rank ordered the same values in a forced-choice test situation. Nearly all of the hOmemakers' activities and accompanying reasons for them were concerned with the values of health, aesthetics, and family centrism. The greatest number of activities 44 performed were those related to health. Many of these ‘health activities were those concerned with the daily care of family members. Religion and education were rated high on the rank order values test, but did not rate equally high when the homemakers assigned reasons for activities into.value categories. Data from this study seemed to indicate that activities centering around keeping the family healthy were more important to.homemakers than ,growth in interactional activities among family members. Kohlmann and Smith (1970) develOped two inventories of values (one for men, the other for women) which were designed to measure a functional aspect of personality in the areas of home and family life. Instead of the eight values originally included in the inventories, the researchers found that only two scales for women (Family Life and Status) and one for men (Family Life) could be well defined. Thus, because behavior may be influenced by values, it was felt that by assessing the mother's values, it would be possible to determine if such qualities as health and family well-being were significant in the sense that.they influenced the nutrient intake of the child. The forced choice values test, "Homemakers"Values" (included in Appendix C-3b) which was developed by Dyer (1962) was used in the present study. Mothers were asked to select the two value descriptions which 45 described them best (subsequently assigned a score of two),_and second best (assigned a value of one) and to choose the one value least likely to describe themselves; this choice was assigned a score of —2. Dyer indicated that Spearman rank order correlation coefficients between first choices on the rank order test and the categorized reasons for homemaker's activities were of the order 0.51. Anomie According to Seeman (1959), the concept of anomie is a facet of alienation, analogous to the condition of "normlessness." He indicated that,"in the traditional usage, anomie denotes a situation in which the social norms regulating individual conduct have broken down or are no longer effective as rules for behavior." Anomie has also been defined as "an anxious awareness that the prevailing values of society have little or no personal relevance to one's condition,“ (Funk and Wagnalls, 1968). A measure of anomie, or "interpersonal alienation" has been develOped by Srole (1956). In that study, certain "ideational states" or components were selected because they theoretically represented internalized counterparts or reactions in the individual's life situation to con- ditions of social dysfunction. Srole (1956) included five such components in his instrument. The first of these 'postulated components was the individual's sense that community leaders are detached from and are indifferent to 46 his needs, reflecting severance of the inter—dependent bond within the social system between leaders and those they represent. The second element of anomie was the individual's perception of the social order as essentially fickle and unpredictable, i.e., orderless, inducing the sense that under such conditions he could accomplish little toward realizing future life goals. Srole's third element of anomie related to the respondent's view that he, and pe0ple like him, were retrogressing from the goals they had already reached. The fourth component postulated that the deflation or loss of internalized social norms and values was reflected in extreme form in the individ- ual's sense of the meaninglessness of life itself. The fifth anomie component was conceptualized as the individual's perception that his framework of immediate personal relationships, i.e., the "very rock of his social existence," was no longer predictive or supportive (Srole, 1956). Using procedures of structural analysis, Srole determined that the five items in the instrument satisfied the criteria of unidimensionality, i.e., they comprised a single continuum. In a recent study, low income mothers participating in a summer camping experience through the Expanded Nutrition Program in Kent County, Michigan, were asked to .respond to the anomie instrument. Anomie scores did not differ significantly when compared with the number of 47 children in the home, the housekeeping "style", one-day dietary adequacy, or the education of the homemaker. Homemakers with.husbands present had higher anomie scores. The number of children at home made little difference in itself, but when the husband was present, anomie was higher when there was more children in the home. When the husband was absent, anomie was higher for mothers of fewer children (Evaluation, 1969). In the present research, Srole's (1956) five-item anomie instrument was administered to the mothers in the study (Appendix C-3e). Mothers were asked to express their agreement with the statements on a five-point Likert scale. Mothers with lower scores on the instrument would be considered less alienated and fatalistic than those with higher scores. It was hypothesized that if the mother reflected a high degree of anomie, she would feel as well that there was little she could do to aid in her child's develOpment and consequently, his dietary intake and physical status would be less than optimal. ‘Powerlessness Seeman (1959) identified the sense of powerlessness as one among five alternative meanings classically associated with the concept of alienation. He demonstrated by empirical research that persons with a strong sense of powerlessness are less likely to feel that they can control their environmental circumstances. 48 Polansky (1969) defines the concept of felt power- lessness as, "...the degree to which the individual believes that he has little control over his fate, but either is at the mercy of outside forces beyond his control, or his circumstances are due largely to chance, or both." Battle and Rotter (1963) suggested that this attitude relates to the individual's social circumstances, i.e.,_his class and ethnic group status. A "Powerlessness Scale", devised by Rotter and Seeman (1959), measures an individual's feelings that he is not in control of his own life, that he cannot see any real pattern or meaning to the things that happen to him or to peOple in general, and that his life is "other- administered" rather than "self-administered." Jaffee (1959:31) demonstrated adequate reliability for the instrument. In the study by Polansky (1969), a recheck of odd-even split—half reliability yielded an r of .72. Evidence of construct validity was cited in the study of delinquency—proneness by Jaffee and Polansky (1962). In the present study, it was felt that it would be productive to assess the level of felt powerlessness among mothers of preschool children. This attitude would, in turn, be reflected in the mother's behavior in which she would decline to take any responsibility for her child's .dietary intake because she believed that.there was little she could do to control her life situation and that her 49 efforts would not avail any lasting changes. Mothers were asked to indicate their agreement with twenty-five powerlessness items, using a Likert-type format (Appendix C-3d). After a reflection of scoring, a higher total score of this instrument indicated that the mother felt less in control of her own life or the greater were her feelings of powerlessness. ‘Semantic Differential Instrument The "semantic differential" is one method of observing and measuring the connotative meanings of various concepts as held by a number of individuals. The actual semantic differential instrument consists of a number of scales, each of which is a bipolar adjective pair (e.g., good-bad) together with the concepts to be rated using the various scales (Kerlinger, 1968:564-580). Osgood et a2. (1964: 37) have found that, when analyzed, adjective pairs fall into.clusters, which measure one or more of the basic dimensions or factors, such as evaluative (illustrated by the adjective paid, "large-—small"), potency (e.g., "strong- weak") and activity (illustrated by "fast-~slow"), adjectives which seem to express motion and action. The semantic differential can be applied to a variety of research problems. It has been shown to be sufficiently reliable and valid for many research purposes (Kerlinger, 1968:578). 50 In the present study, the concept, "Myself as Mother", was measured using a semantic differential instrument (Appendix C-3f). This instrument was adapted by Haiman (1970) from a similar semantic used to measure the “Myself as Teacher" concept (Wright and Tuska, 1966). This semantic differential instrument has been factored and the results may be found in Osgood et al. (1964). DietaryiEvaluation In the present study, the nutrient intake of the child is viewed as a key linking variable between the ecosystems of the family and the child. Assessment of dietary intake is therefore of prime importance in the reSearch. The evaluation of dietary, or nutrient intake, is integral to any study of nutritional status. The goal is to determine accurately what foods and how much of each food a person has eaten. Phases of the dietary intake survey include: collection of information about foods consumed and the quantity eaten, the determination of nutrients in the foods consumed, and an assessment of nutrient adequacy, using a comparison with a dietary standard, usually the Recommended Dietary Allowances (RDA) designed for use in this country. When dietary surveys form part of a clinica1--biochemical--dietary -triad, these data may serve as a check on the validity of the clinical and biochemical observations, and vice versa (Pearson, 1968:574). 51 In general, four methods may be used to determine individual food consumption: estimation by recall, dietary history, the weighed intake, and the food record (Pike and Brown, 1967:470). Becker et a2. (1960:4) have found it more useful to consider only two distinctly separate methods of collecting dietary information, rather than the above four. These are: 1) food records, where dietary intake is recorded in weighed, measured, or estimated amounts, and 2) the dietary history. ' The recall procedure is generally used for a twenty- four hour period only, where the subject is asked to recall all food consumed during the previous day and to esthmate quantities in ordinary household measures or servings. Information by this method obviously is not necessarily representative of the usual food intake of the individual. A very accurate record of food consumption may be obtained by having the subject weigh all food consumed during a specific period of time. This proce— dure for obtaining food intake data is expensive and time consuming, however’and consequently is rarely used in nutrition surveys (Pike and Brown, 1967:470). As an alternative method, the diet history is designed to discover usual food intake patterns over a relatively long period of time and is most often obtained by interview. This method measures frequency of intake of a large number of foods and thus smooths out seasonal variations in food intake. 52 . The fourth method, the food record procedure, is used most often for nutritional status studies. In this method, the subject is asked to keep a record of the food he has eaten for a certain period of time, usually three to seven days. Quantities of food are estimated in common household measures. Obviously, usefulness of this method depends largely upon diligent reporting by the subject and upon his ability to estimate quantities of food accurately. The method appears to be a fairly accurate estimate of food intake over a specific period of time (Pike and Brown, 1967:470). In a comparison of the results of the various methodologies for obtaining dietary intake information, Huenemann and Turner (1942) recommend the use of the food record method when individ- uals or small groups are being studied or when reliable quantitative data are being sought. The literature has focused much attention on the length of time that a dietary survey should be conducted in order to furnish a true picture of the nutrient intake. Becker et al. (1960) indicated that when the mean intake of a group is desired, one-day records are sufficient, providing the sample is sufficiently large. But, when a comparison of intakes on an individual basis is desired, the suggested number of days was three to seven. Tinsley (1946) recommended that three days be accepted as the minimum length of time for a fairly satisfactory picture 53 of individual food intakes. For collecting dietary information about groups of children, Eppright et a1. (1952) suggest that data from dietary records should be interpreted in a variety of ways in order to get a true picture of the children's food habits. They recommended inclusion of week—end days and the use of seven-day food records for use with children. i: .As in all interview methods, the subject's ability to accurately recall or record what he has eaten is of utmost importance for the reliability of the results. Eppright et a1. (1952) indicated that when records are kept by.untrained peOple, the results obtained from recording food items by servings were likely to be some- what higher than those which were recorded by weighed amounts. Young et al. (1952) suggested that the errors in estimation of portion sizes were probably the largest single source of error in dietary record-keeping. Becker et a1. (1960) concluded that the recall technique tended to result in underestimations, while recording in household measures tended to lead to overestimations, on the basis of comparison with a weighed diet procedure. It is well accepted that the pattern of growth throughout childhood influences a corresponding changing food intake. -During infancy and adolescence, when physical growth is most rapid, nutritional requirements are high, and providing that the child has good physical S4 and emotional health, his appetite, and consequently, his food intake increases accordingly. The picture changes somewhat in regard to the preschool child. During this period, demands for physical growth are somewhat less, but at the same time, the child's development and maturation are rapidly progressing. There are intervals when appetite is decreased and the intake of some or all nutrients may be lowered. Other environmental or intrinsic factors may alter food intake or utilization. For example, appetite may be increased or decreased by the emotional changes within the child himself as he reacts to the progress of his own maturation and to the people and events in his surroundings. As a result, changes occur in the level of food intake as the individual progresses from birth.to maturity. Some of the classic work in exploring the nature of the changing food intake of the growing child has been done by Virginia Beal, working at the Child Research Council in Denver, Colorado. The objective of this comprehensive longitudinal study was to investigate the effects of differing levels of dietary intake on the physical and physiological findings of the children. Beal's studies lend much to understanding the nature of dietary intakes of preschool children; they suggested that the lowered nutrient intakes noted during the immediate post-weaning period were increased somewhat after the 55 third year (Beal, 1953, 1954, 1955, 1956). Beal (1961) also reported that healthy children growing at acceptable rates vary widely in the amount of food they consume. The tendency for very high intakes was observed to be Vgreater than the tendency toward very low intakes. An important environmental influence on dietary intake that has received considerable attention in the literature is that of family income. AS a result of the nationwide household food consumption survey in the mid- 1950's, it was suggested that the diets of families with low incomes were not as good as those of families with higher incomes. But, results of a comparable survey in 1965 revealed that a high family income alone does not necessarily insure good diets (Adelson, 1968). The more recent survey revealed that even at the highest income level, a sizable prOportion of families had poor diets. Food habits, not the inability to purchase adequate food, were the dominant causes behind poor diets for this group (Clark, 1969:270). Studies conducted with children have been inconclu- /¥’ sive in defining the association between low family income and inadequate dietary intake. Certain investigators (Hardy et aZ., 1943; Metheny et aZ., 1962a; Owen and Kram 1969) have reported an inverse correlation between the level of family income and dietary adequacy. Although they did not Specifically evaluate dietary 56 intakes of preschool children from "impoverished” families, Zee et al. (1970) attributed the growth retardation and anemia found in the children they studied to a lack of food; they suggested that this inadequate intake was primarily due to an inability of the family to obtain a sufficient quantity and quality of food. In contrast, other investigators have shown no association between dietary inadequacy and low family income. Hootman et a2. (1967) and Kerrey et al. (1968) indicated that poor diets may not be an inevitable accompaniment of low levels of family income. These studies reported that the calculated nutrient intakes of children from low-income families did not reveal the prevalence of gross inadequacies in the children's diets. Certain nutrients have been noted as the ones most often limiting in children's diets. Implicated in this regard have been iron, calcium, ascorbic acid, and to a somewhat lesser extent, Vitamin A, niacin, and calories (Metheny et al., 1962a; Skidmore, 1965; Cloud, 1967; Kerrey et aZ., 1968; Owen and Kram, 1969; Brown et aZ., 1970). Lund and Burk (1969) found a significant association between dietary intake of certain nutrients, particularly Vitamin A and ascorbic acid, with various socioeconomic parameters, most notably family income and educational level of the mother. Studies by Kerrey et al. (1968) and by Owen and Kram (1969) indicated that while children from high income 57 families had diets providing more ascorbic acid and Vitamin A, children from the low income groups received diets providing the same or additional amounts of iron and thiamin. Both studies indicated that higher income children received proportionately more calories from dairy products, while the greatest single source of calories for the lower income children was the bread and cereals.group. It has been suggested that the younger child may be more likely than an older, school-age child to consume a diet which meets the Recommended Dietary Allowances (Emerson, 1967). This observation may be related to the fact that the preschool-aged child is far less independent and is less likely to be eating meals away from home. In order to obtain information on children's nutrient intake, mothers participating in the present study were requested to keep a record of the child's food intake for a twenty-four hour period on three separate occasions. These food records were analyzed and the nutrient content of the diets was used for all subsequent data analyses. COpies of the.form used for the collection of dietary information are in Appendix C-l. Assessment of Nutritional Status Nutritional status may be defined as, "the state of health of an individual or group as conditioned by choice and amounts of foods, or more specifically, nutrients, 58 eaten (Morgan, 1959)." In assessing nutritional status, an attempt is made to obtain a composite picture of the many facets of the body's growth, function, and structure, as related to previous and present food intake; one aims to measure the extent of a cause-and-effect relationship between nutrient intake and the level of well-being of the individual (Leverton, 1960). Several reports have attempted to review the literature from the numerous studies conducted to learn the nutritional status of various population groups. The most comprehensive of these were probably by Morgan (1959) and by Kelsay (1969). Investigators have generally agreed that there is a serious lack of information on the nutritional status of young children in this country (Krehl and Hodges, 1965; Lowe, 1967; Select Comm., 1969:586). The first "comprehensive survey to assess the nutritional status of the pOpulation of the United States. of America" was the National Nutrition Survey, undertaken in 1967. This endeavor received much nationwide support and attention because the final results were intended to give a ”reliable picture of the nutritional health status of the pe0p1e living in the lower income areas of America" (Schaefer and Johnson, 1969). Only preliminary findings from the survey in several states have been published to date (McGanity, 1969; Unglaub, 1969). 59 Classic methods used for the evaluation of nutri- tional status include: 1) dietary evaluation; 2) biochemical tests; and 3) clinical examinations. In “general, dietary surveys evaluate current food intake; biochemical data reflect recent nutritional status, and clinical examinations evaluate long-term nutritional history (Pike and Brown, 1967:466). Figure 3 illustrates the relationships which exist between the three measures of nutritional status, their positions in the child's ecosystem framework as well as the sequence of events, which occur between nutrient inadequacy and the develOp- ment of a clinical lesion. It must be stressed that the appraisal of nutritional status involves more than merely an evaluation of dietary intake. In the present study, the other means of evaluating nutritional status, namely the biochemical and clinical measurements, are viewed as outputs of the child's ecosystem processes. Clinical Methods: Nutritional Anthropometry The clinical examination is an important practical method for assessing the nutritional status of a pOpulation .group. For the most part, the method is based on examination for bodily changes believed related to inadequate nutrition that can be seen or felt in super- ficial epithelial tissues (Jelliffe, 1966:10). The clinical assessment of nutritional status may include an appraisal of the following: 1) growth and develOpment; 60 .memumoma .uuoaoooo 6am ago: ca .c0muoom scum voodooa mouaa0bmume mo mao>oa ca momcmco g i IIY. _ onmmq .EoHsmmooHfl A 3332 mince s mucmfluusc IV mo mam>oa poon mcoHUHocou auouonfiuucoo maowmmom Gamma on i muoumwn wumumflo osoflcnoma ucoEmmommo msumum monoum wooowo cofluoammo ZOHBfiMDBm wmm How mmooflcnooe .m unseen 61 2) the degree of fatness or leanness; or 3) Specific physical signs thought to be associated with particular nutrient deficiencies (Pearson, 1968:565). The evaluation of growth and developmental status is important in the nutritional appraisal of infants and young children. Most commonly, anthropometric measurements, such as height, weight, or skinfold thicknesses, are employed for this purpose. Because growth performance is influenced by 'genetic factors, anthr0pometric measurements are more useful for describing certain population characteristics than for evaluating the growth of individuals. The assess- ment of fatness or leanness is most appropriate for pOpulation groups for whom height- and weight-for-age standards have been developed. Clinical signs of nutri- tional deficiency reflect the result of long-term nutritional impairment. The clinical evaluation is by far the most subjective area in the determination of nutritional status. Lesions observed are often non- specific, i.e., they may be due to trauma, exposure, or allergies rather than to some distinct nutritional deficiency. In addition, lesions may be attributable to some secondary conditioning factor, such as malabsorption or parasitism, and are rarely diagnostic by themselves. The Specific lesion noted should always be evaluated in Ilight of a continuum of severity; this procedure, as well, lends itself to subjective evaluation (Jelliffe, 1966:12). 62 A child's actual growth and develOpmental progress exists as an interrelated whole, involving concurrent progress in psychological and social development, as well as biological or physical growth- A comprehensive concept of development implies a growing body, a maturing ego, and the environment in which those processes are evolving. The physical development of children is directly influenced by environmental factors which act upon the 'genetic potential (Watson and Lowrey, 1967:51-52). Clinical observation substantiates the fact that genetic potentialities of the human organism may not become manifest unless a complex of stimuli act together in a favorable environment. Genetically determined factors thus remain used or unused to the extent that the environ- ment offers Opportunity for their realization. The final size a person attains is limited largely by heredity, but whether or not the individual realizes his full growth potential is determined largely by nutrition (Mitchell, 1962). It is well known that growth is stunted in young children receiving diets severely restricted in proteins and/or calories. The extent to which such undernutrition influences the size of an individual depends upon the age at which it occurs (the (greatest effect being at the period of maximum growth) and by its duration in relation to the total period of 'growth (Stoch and Smythe, 1963). 63 Jackson (1966:11) has stated, "growth rate of child- ren is one of the most Simple, inexpensive, reliable, and important tools available as an index of nutritional status." He.further suggested that nutritional surveys should always include observations on the height and weight of children. Hundley et a1. (1955) indicated that heighteweight measurements of young children could serve as a reliable index of nutritional status. Nutritional anthrOpometry is concerned with the measurement of the variations of the physical dimensions and the_gross composition of the human body at different degrees of nutrition (Jelliffe, 1966:50). Garn (1962) stated, "anthrOpometry provides the operational measure- ment of long-term nutritional status, given the assumption for growing children within a particular gene pool, that the larger ones have been better nourished." He further suggested that anthropometry can be a valuable adjunct to clinical appraisal providing a quantitative indication of the rapidity of size increase, the relative amount of different tissues present, and an indication of caloric excess. .The two most universally accepted measures of human physical growth are height (increase in linear size) and weight (increase in bulk). Weight seems to be the anthr0pometric measurement most in use. The prevalence of malnutrition, according to some investigators (Jelliffe, 64 1966), is best indicated by a weight deficiency as evidence by growth failure in children. On the other hand, height is considered by others to be a more accurate refleCtion of nutritional status in children because it is not influenced by such a variety of extraneous factors as is weight (Mickelsen et aZ., 1970). Bloom (1964:36) noted that height represents a highly stable characteristic and is not reversible in that growth once attained is not lost except as a result of senility, surgery, or disease. In contrast, weight may go up as well as down over a period of time and, to a limited extent, may be controlled by the individual. Jackson (1966:10) pointed out, ...although weight is used as a standard reference point, it is a poor index, whether used for maturity, growth, or body composition... . Rate of growth in length is a better criterion of adequacy of nutrition in infancy and childhood than are changes in body weight. A recent study suggested that the ratio, weight to the squared height, is a measure which can be used in field studies as a Simple and easy criterion of nutritional status (Rao and Singh, 1970). Height and weight measurements of children may be adversely affected by poor environmental conditions. Data from several studies supported the contention that height and weight.measurements tend to be greater for children from the higher socioeconomic groups (Hundley et al., 1955; Stine et al., 1967; Crispin et al., 1968). Comparing 65 heights and weights of Head Start children with measure- ments of children from suburgan areas in Cleveland, McClelland (1969) concluded that, "growth progress is related in a negative way with income level." Owen et a1. (1969) also indicated, "among factors serving to characterize low income children, undernutrition and underachievement in growth were evident and may well have been causally related." Sex differences in growth rates have been reported. Douglass (1962) stated that in the more prOSperous occupational groups in Britain, the girls gained more in height between two and four and one-half years than the boys did, whereas in the less prosperous groups they gained less, thus suggesting to the author that the growth of girls may be more affected by environmental factors than is the growth of boys. In contrast to this conclusion, Stine at al. (1967) indicated that in their sample of four-year-old children from impoverished families, they found that male children were significantly heavier than the females. Studies of racial differences in appearance and physiological attributes in which American Negro and whites have been compared commonly appear in medical literature. Malina (1969), in reviewing findings about the differences between American Negroes and whites on the basis of growth patterns, concluded that the major differences do not lie in over—all body Size as reflected 66 in stature and weight, but rather exist in the relative prOportions Of limbs and trunk. From physical measure- ments obtained from over 2000 healthy North.American Negro children from low-income families, verghese et a1. (1969) concluded.that, "height and weight of the Negro children [appeared] to be similar to those of North American Caucasian children." The Opposite vieWpoint was presented by Stine et a1. (1967) who concluded that Negro males and females were significantly taller than their white.counterparts. In the present study, certain physical measurements were selected for study on the basis that the literature revealed that differences in physical measurements would be observed in response to.various environmental circum- stances, sex, or race. The variables studied included standing height and weight. Weight was measured on a balance-beam scale to the nearest 0.25 pound. Standing height was measured according to the procedures outlined by Bayer and Bayley (l959:8) to the nearest 0.1 inch. Both.standing height and weight were measured on children who were wearing light indoor clothing, but no Shoes. 'Procedures used to classify children either by height or weight alone may be misleading because of the range in the heights and weights of children of any given age. In an attempt to rectify this situation in the present study, heights and weights Of the children were compared with several well accepted standards. One of 67 these was the height- and weight-for-age standards which had been developed at the Fels Research Institute by Garn and Rohmann; this standard was recommended for use in the evaluation of nutritional status of preschool children by.the U. S. Children's Bureau (1967). A second means used to assess physical measurements was the height- and weight-for-age.standards develOped by Stuart and his associates (Nelson, 1968:1007). From the various height or weight ratios used for defining body types, one weight-for-height classification system.used in the present study was that develOped by Sargent (1961). In this system, a linear regression line representative Of a normal weight is computed, and per- centile.deviations from this line are determined and identified by descriptive body type terms. Six weight- height classification codes were used. Children whose weight for height (regardless of age) fell within plus and minus ten percent of this average line were classified in the "normal" weight for height classifi- cation. Children weighing more in relation to their height were claSSified as "stocky" if their weight for height fell between ten and twenty percent above the average line; "overweight" for height if between twenty and forty percent above; or "obese" if forty percent or more above. Children weighing less in relation to their height were classified as "slender" if their weight for height fell between ten and twenty percent below the average line, or "underweight" for height if more than twenty percent below (Sargent, 1961:27). 68 Noting that no recommendations had been made by the Children's Bureau (1967) for the combining of weight-for- age and height-for-age classifications for estimating overweight or underweight, Smith and Brown (1970) developed five height-weight-age divisions based on the Fels Research Institute percentiles for height and weight. These divisions were also used for classification Of heights.and weights in the present study. Drash et a2. (1968:61) suggest that the assessment Of “developmental age" is a "useful means of comparing a _given individual to a standard population.“ This concept is valid for use for any anthropometric characteristic which varies predictably with chronologic age and for which there are acceptable standards for children at various ages. Assessments of "height age" and "weight age" were performed in the present study. The concept, ”height age”, expresses an individual's height as the age at which his height is equivalent to the median height of a standard, chronologically arranged population. "Weight age" is calculated in the same manner. The standard of reference for height and weight measurements used in the present study was the Boston Growth Chart, developed by Stuart and his associates (Nelson, 1968: 1007). The height and weight age for each of the subjects in the study was determined by finding the chronologic age (in monthS) at which the individual's measurement crossed 69 the fiftieth percentile line of the Stuart Percentile Grid (Nelson, 1968). . The "develOpmental index" concept, used by Drash et a2. (1968) expresses an individual's attainment of a particular height or weight numerically by eliminating chronologic age as a variable. Although this concept has been.more commonly used by psychologists in converting mental age to an intelligence quotient, it is equally applicable to variables of physical growth and develOpment. Its major drawback is the absence Of previous standardi- zation. As used in the present study, the develOpmental index was obtained by dividing develOpmental age for height and weight by chronologic age. In a normal population, the developmental index would equal 1.0. Advanced development would be represented by a value tgreater than 1.0 and retarded development by a value less than 1.0. According to Drash et al. (1968) a height index of 0.80 or less would indicate that the individual was below the third percentile for height, using the .Stuart standards (Nelson, 1968:1007). Weight index, which is a more variable factor, is 0.63 for the third percentile at theage of four years. ,The measurement of head circumference is a standard procedure widely used in pediatric practice. Head cir- cumference has been found to be smaller in malnourished children than in children who were well nourished (Stoch 70 and Smythe, 1963). Stine et a1. (1967) indicated that twenty-five percent of the children studied in their sample of preschool children from low-income families had smaller head circumferences than the lowest ten per- cent Of the standard pOpulation. These investigators found significant correlations between height and weight measurements and head circumferences. ‘Verghese et a1. (1969) found that the head circumference was consistently less for Negro children than for white children. In the present study, in addition to standing height and weight, other physical measurements.obtained included sitting height, circumferences Of head, upper arm and chest, bi-acromial (Shoulder) and bi-cristal (also called bi-iliac Or pelvic) diameters. Sitting height was measured according to the procedures specified by Bayer and Bayley (l959:9). Circumferences were measured to the nearest 0.25 centimeter using a flexible steel tape measure. Diameters were measured to the nearest millimeter using steel bow calipers (Bayer and Bayley, 1959:11). A comprehensive evaluation of the quality of growth requires not only measurements of overall body size, length and mass, but also of relative amounts Of muscula- ture and body fat. Since muscle and fat tissues are most influenced by the relative amounts of protein and calories, it is desirable to evaluate body composition in order to determine the amount and distribution of human subcutaneous 71 fat which represents caloric reserves. While several means of evaluating body composition are available, only the use Of skin-fold calipers has been shown to be practical for field studies (Jelliffe, 1966:72). Garn (1962) indicated that despite their simplicity (a fact which had led them to be scorned by some investigators), fat-fold calipers are of proved value. He concluded, "...fat-folds are useful measures of relative fatness." Differences in skinfold thicknesses according to race or socioeconomic status have been reported in the literature. Subcutaneous fat, as measured by skin-fold thickneSses has been reported to be less in Negro children than white children (Malina, 1971; Stine at al., 1967). Crispin et al. (1968) found that in contrast to all other measurements (such as height, weight, body circumferences, and muscularity measurements), skin—fold thicknesses were not greater for the higher than the lower socioeconomic _group. In the present study, skinfold measurements were taken at two sites on the body: at the triceps (at the back of the mid-arm over the triceps muscle), and the subscapular region (below the tip of the scapula on the back). All thicknesses were measured by the investigator using a Lange skinfold caliper and recorded to the nearest millimeter. 72 Biochemical Parameters Certain biochemical procedures may be employed tO test aspects Of nutrition, such as 1) the relative ade- quacy of dietary intake as reflected by levels in a particular tissue, e.g., blood; and 2) metabolic changes due.to tissue malnutrition; and 3) depletion of body stores of certain nutrients, e.g, protein (Jelliffe, 1966:78-85). Levels of nutrients in the body may be interpreted in relation to their biochemical Significance as well as compared with certain standards Of reference appropriate for the age and sex of the pOpulation under study. The Interdepartmental Committee for Nutrition for National Defense (ICNND) has established a set of standard values which carry descriptive labels, such as "deficient", "low", "acceptable", and "high" (ICNND, 1963). Certain biochemical measurements are important for study in preschool children because they either are associated with growth or reflect dietary intake Of certain nutrients noted as being particularly crucial for the Optimal develOpment of young children. The parameters of hemoglobin and hematocrit were apprOpriate for investiga- tion because low values are associated with the incidence of anemia. Filer (1969) has described iron deficiency anemia as a "significant public health problem among young children." In fact, some even regard this syndrome 73 as the most common deficiency disease occurring in infancy and childhood today (Jacobs, 1960). Certain investigators support the idea that anemia occurs more frequently among loweincome groups in the population (Klipstein, 1968; Hillman and Smith, 1968); this fact is commonly interpreted to mean that there is a significant association between low socioeconomic status and the prevalence Of anemia. Certain studies have focused on the prevalence of anemia among children from low-income families. A number Of surveys have shown that a rather large percentage of theSe children had hemoglobin or hematocrit values indi- cative of anemia. Studies which have supported this view would include Kravitz.(1966), Owen et a1. (1969), and Goldsmith and Unglaub (1968). In contrast, other studies, including Kerrey et al. (1968), Crumrine and Fryer (1970), Mickelsen at al. (1970) and Haughton (1963), have failed to document that anemia is widespread among preschool children from low-income families. Following the mass screening of 7000 preschool children enrolled in Head Start programs, Pearson et al. (1967) indicated that they had failed to reveal the ex- pected high incidence of anemia. Considering levels of hemoglobin below 11 gm/lOO ml as unacceptable for children between the ages Of twenty-four and seventy—one months, Owen et al. (1970) concluded that iron deficiency anemia was not 74 uncommon among preschool children, regardless of socio- economic.status...0ther researchers (Mickelsen et aZ., 1970) have suggested that other factors which.may account for the discrepancy in the prevalence figuresfrom the various.studies include the ages of the.children, race, and other regional differences. Measurement of total serum proteins and serum albumin levels reflects the protein status of the body. In addition to knowing the level of total proteins in the blood, it is also important to assess the albumin level because this component of the blood is noted to be reduced in cases of severe protein malnutrition (Jelliffe, 1966:87). Schendel et aZ.(l960) have stated that the albumin leVels of children can be used as an index of protein depletion. The recent study of Crumrine and Fryer (1970) indicated that only one child out of forty had a serum protein level below the acceptable level and that albumin levels for all the children studied were above the acceptable level. In the present study, blood tests were Obtained on each child to determine hemoglobin, hematocrit, total serum proteins, and serum.albumin levels. A finger prick blood sample was drawn by a registered medical technologist from the.Olin Health.Center on the Michigan State Univer- sity.campus where analyses for hemoglobin and hematocrit were performed. A portion of the whole.blood sample was 75 used for the hemoglobin determination, which was then analyzed by the cyanmethemoglobin method (ICNND, 1963: 115), as recommended by the Children's.Bureau for the determination of nutritional status of preschool children (1967).. This procedure has been widely adopted.because it is considered simple and accurate (O'Brien et al., 1968:167). Hematocrit was determined after collection Of an aliquot Of the whole blood sample in heparinized micro-capillary tubes by Spinning samples in a Micro Capillary centrifuge for five minutes.(O'Brien et al., 1968:187). Blood samples for the serum protein and serum albumin detenminations, which were subsequently analyzed by an independent commercial laboratory, were collected in unheparinized capillary tubes. The portion of serum used for the albumin determinations was analyzed colorimetri- cally using the dye, bromcresol green (BCG) (Rodkey, 1965; Hernadez et al., 1967; Dow and Pinto, 1969). At pH 4.0, albumin combines with the dye to yield a blue color, the intensity of which is prOportional to the albumin concen- tration in the serum; color intensity of the samples in the present study was measured on a Coleman Jr. Spectro- photometer at 600 mp. TOtal serum proteins were measured using a refractometer, a procedure which.measures only the dissolved proteins by means of light refraction. This 76 method is unaffected by the presence of chromogens in the.serum,(Bullen,,1970). A biochemical index of growth.that recently has been prOposed is the rate of urinary excretion of hydroxyproline. This amino acid is present in urine principally in the form of peptides derived from the metabolism of collagen. Processes such as growth which accelerate collagen formation are associated with an increase in hydroxyproline peptide excretion (Pearson, 1968:577). Whitehead (1965) indicated that hydroxyproline excretion might be used as "a Simple and practical test of assessing the rate of .growth, and consequently, the nutritional status Of children." In community studies, the collection Of twenty-four hour specimens of urine is not practical on a large.sca1e. For this reason, Whitehead (1965) has develOped a test called the "hydroxyproline index" which indicates the ratio between the amount of hydroxyproline and creatinine in random samples of urine, as corrected for body weight. The index is calculated as the following ratio: ”mmoles of hydroxyproline per liter of urine mmoles of creatinine per liter Of'urine per kg body weight Allison et a1. (1966) have shown that the simple ratio, hydroxyproline to.creatinine, falls progressively until the fifth year,_then levels off and is nearly constant ‘between the ages of five and twelve. Thus, the "hydroxy- proline index" may be used indepedently of age, but is 77 probably not valid for use after the age of five (Committee Report, 1970). Mohanram et a1. (1969) indicated that in the same child, there was considerable variation in the hydroxyproline index and that daily (fluctuations in the ratio of hydroxyproline to.creatinine could have been reSponsible for such variations. If used as one test Of nutritional status and_growth, Whitehead (1965) indicated that the hydroxyproline index may be used to pick up "marginal“ cases of malnutrition. Because a twenty-four hour urine sample can rarely be obtained in field studies, random.urine samples may be collected. Excretion data from such single samples are.then expressed in relation to creatinine content Of the sample on the assumption that creatinine excretion is relatively constant and thus can serve as a basis for equating excretion data from different individuals (Pike and Brown, 1967:474-475). In the present study, random urine samples were collected at the nursery school and clinic for approxi- mately one-third of the children in the total sample. Samples were stored in the refrigerator using toluene as a preservative. Analyses for urinary creatinine were performed by the investigator using the alkaline-sodium picrate method as modified by Bonsnes and Taussky (1945). _In this procedure, creatinine in solution with.picric acid and sodium hydroxide forms an intense yellow color 78 .measured on the Beckman DB spectrOphotometer at 525 mu. Analyses for urinary hydroxyproline.peptides were done using methods deVeloped by ProckOp and Udenfriend (1960). In this procedure, hydroxyproline is oxidized to pyrrole in the presence of alanine. Upon addition of p- dimethylaminobenzaldehyde (Ehrlich'sreagent), the pyrrole forms a chromophore. .The intensity Of the bright pink color thus formed was measured on the Beckman DB spectro- photometer at 560 mu. CHAPTER IV DATA COLLECTION AND ANALYSIS This chapter discusses the selection and description Of subjects in the sample; the methods used for data collection; classification and coding of data for analysis; and procedures used for data analysis. Selection and Description of Sample The particular sampling procedures employed in the present study may be described as "chunk" sampling (Kish, 1965:320) because typical or representative units Of preschool children were chosen on an a priori basis to be included in the final sample. In order that children in the study would come from a variety of family backgrounds (in terms Of ethnicity, family income, size and composi- tion, parental occupation and education), the only restrictions placed on the children included in the sample were: 1) That children should be between the ages of three and five years. 2) That mothers (or caretakers) of the children would agree to participate in the study by completing an linterview, questionnaires, and records of the child's food intake. 79 80 The final sample consisted of 163 children drawn from the following sources: 1. Michigan State.University Laboratory Preschool PrOgram. A total of sixty-four children who were enrolled in this program subsequently participated in the present study. Approximately one—fourth of these children had been previously designated as "disadvantaged" for purposes of inclusion in other concurrent research projects. The remainder Of children were from middle- and high-income families living in East Lansing and other surrounding communities. 2. Spartan'Nursery School. Ninety-one children were included in the sample from this program. Approximately 20% of these children were enrolled in a "Head Start" class and met the designated criteria for admission into that program. The majority Of the other children attending this nursery school lived in Michigan State University Married Student Housing; a large percentage of their parents were enrolled as full-time students at the University. 3. Public Health Clinic, Cristo Rey Area. Eight children attending the Clinic, which is staffed by personnel from the Ingham County Health Department and the Michigan State University College of Human Medicine, were included in the sample. All Of these children were from low-income families. 81 Certain previous studies conducted in the greater Lansing area documented the fact that the children included in the final sample had been drawn from a variety Of neighborhoods possessing different population character— istics. The Michigan Health Survey (known locally as "ECHO" for Evidence for Community Health Organization) was organized as a collaborative effort between the Ingham County Health Department and the Michigan Department of Public Health Center for Health Statistics to sample the Lansing area for the purpose of documenting the prevalence of health problems in certain areas of the city. Table 4.1 is a profile of the characteristics Of the neighbor- hood areas identified by ECHO sampling. (Comparable population characteristics were not available for the East Lansing and other outlying areas.) Figure 4 is a map Of the area indicating the number of children included in the sample from each ECHO neighborhood area. Low- income children enrolled in the Laboratory Preschool Program were drawn from ECHO Area NO. 5 and the Turner Street Housing Project in Area No. 3. Children in the Head Start class at Spartan Nursery School were drawn primarily from ECHO Area NO. 8. The Cristo Rey area in Lansing (included in ECHO Area No. 7) had been identified by previous public health studies as one in which certain .problems, including a high infant mortality rate, were particularly prevalent. £32 .ooonHOQnmfiu: poo mOAHHEMw mo wanes: mo mmumeHumm .o.m.u.m can Hume succumb can mead aumscmn «O mowed .u.o.< Eoum maaosnm wo mambo no omumasuamo mound .euaoom oeanso do .ude comfizoez can ..o.m.o.m uooflouo ..uooo nuamo: .00 Batman .o0a>uom Howoom no ucoEuumomo confine“: mo wumum can mucsoo EmnmcH "mousomm <2 m.~ m.m o.v h.~ H.m m.H m.m an. .cmn on me. .cmh mouuu acoamoomu .U.o.¢ aw omcmno ucoouomiOwumm H.mm m.mv ~.~wa H.om o.mma o.ow m.~h m.m~ anma xumscmn loonaaeoo coca poo condense ucoocoaoa op chad omoumu ucowomomu .U.Q.< ~.mm H.~ma H.vaa ~.mm m.av~ a.maa m.am a.mv Amnuuwn o>wa oooa Home mmoomm,o>wH oooEMonooaeH mcuuucoo Hmwoow omuuoHaw .o m.mm o.wm m.wm ~.mH ~.mo «.mv H.HH m.m mmcfiaau3o nausea o.HH o.ma m.Hm m.m h.- m.m ~.- o.o mcwuoquuouoo icofiuwocoo uOHuwucH v.ma o.~a m.nm n.h m.am m.~a ~.- 5.» mcaumuofluoumoicOwueocou uowuouxm num3 oomucouuom muwumauouowumso Hmucoecoue>cm .o v.wa o.~a m.ma s.h n.~m «.mm ~.HH o.h name a coca mmoa mocoofimmu sue: wwfiHwEmu uo omcucoouum h.mH m.ma o.o~ ~.aa o.mm n.ma h.@ 0.0 ummm\ooovm can» mmma mEoocfl the: mafiaweuw no ommucoouom m.mm m.am m.mm H.ov m.mm o.m~ m.vm m.om won mo muse» ma cmnu mmma aceumaoooo mo ommucouuom a.om w.om m.~m m.vm o.m~ H.mm m.~m m.om ouwnz couuoomu chmumo mo ommucoouoo muaumauouomucno :Oeumaomom .m no.0 No.0 mn.o mm.o om.o mm.o mw.o mm.o Econ woo mCOmuoo no Hones: oomuo>¢ v.m v.m m.m m.m m.m m.~ o.m o.m oaoeomsoo “we mcomumo mo Hones: mocuo>< was mm «m as an as as as oaoeoo ca mGOmuoo HO uanfisc Hmuoe «ma m~ we mm mm Hm ma w~ coaoamm mews: oHOcOmOO: Hmuoe mom.wm mmm.v mmv.m «mm.n Nnv.m NNm.m nm~.a mvm.m mafia: oceaao3o mo noncou mmo.maa cmm.nu emv.m som.H~ wav.oa m~m.ma ~Ho.v ooa.o~ ouoswumo acmuoeeooo muwumwuouomumcu Hmumcmu .< m h (m m o m m mend thoEdm Hmvmm, ummEdz MonmuommOwoz mEmuH looses ouooom ocaaooom gov .oooaeohz .mcnucoq .oanuouo oooauooemaoz .o.m.o.m .s.v oaoos 83 CLINTON CD. INGMAM CD. . 'I Home” 3 ' - 1 ”Il‘vnn - 1 MAPOF LANSING MICH GAN 84 The sex and racial distribution of the children included in the sample are shown by Tables 4.2 and 4.3. Table 4.4 indicates the age distribution of the children studied. The mean age of the children in the sample at the beginning of the study in September, 1969 was approxi- mately four years. Table 4.2. Sex Distribution Number Percentage Male 81 49.7 Female 82 ‘ ' 50.3 Table 4.3. Race Distribution Number Percentage White 96 64.4 Negro 37 24.8 Mexican American 5 3.3 Other (including Oriental, 11 7.4 E. Indian, Mid-Eastern) Table 4.4. Age Distribution Age in Months, as of Sept. 1969 Number Percentage <36 12 7.4 36-42 40 24.5 43-48 43 26.4 49-54 46 28.2 55-60 19 12.9 '>60 1 .6 'Mean Age: 46.2 months 85 Data Collection Permission was granted by the directors, supervisors, and teachers of the two nursery school programs and by administrative personnel at the public health clinic for the researcher to study the children enrolled therein. A.multiple-phase program was initiated whereby serial measurements of anthrOpometric characteristics and food records for the children and interviews with the children's mothers could be obtained. Parental permission for inclusion of the child in the study had been obtained by the nursery school and clinic personnel prior to data collection. Refer to Table 4.5 for the scheduling of data collection. Measurements obtained on each child included: certain physical measurements, a blood test and urinalysis, and food records. Data for the anthrOpometric measure- ments were collected during the time that the child was attending the nursery SChOOl or clinic. Standing height and weight were measured three times throughout the school year, i.e., in November, February and May. In addition to these measurements, sitting height, triceps and subscapular skinfold thicknesses, biacromial and bicristal diameters, and head, chest and.upper arm cir- cumferences were collected in the Spring. A separate parental permission was requested prior to the blood tests. This letter is included in Appendix A-4. Blood samples for all participating children 86 Table 4.5. Timing Schedule for Data Collection Person From 'Data ‘Whom‘COllected ‘ Fall, 1969 Standing height and weight measurements ' Children One-day food record Mothers* Winter,'l970- Standing height and weight measurements Children Home interview ' Mothers* Attitude-measuring questionnaires Mothers* One-day food record Mothers* Spring,‘1970 All anthrOpometric measurements Children Blood test Children Urine collection Children One-day food record Mothers* .*COpies of instruments used may be found in Appendix C. 87 obtained by finger prick, was collected by a registered medical technologist from the Olin Health Center on the Michigan State.University campus. These tests were obtained in the Spring during the time that the children were attending the nursery school or clinic. Random urine Specimens, collected from approximately one-third Of the children, were collected by the investigator while the children were at the nursery school or clinic. Mothers of the children were requested to OOOperate in the study for purposes of gaining information about the child's family and his medical and dietary history. The mothers were first requested to complete a twenty-four hour food record (Appendix C-l) for each child. They were instructed to record all food in terms of household measures and to complete the record for a day when the child was not attending the nursery school in order that she might Observe first-hand her child's food intake. For the first record obtained in the fall, instructions for completing the food record forms were given by the researcher to a _group of approximately twenty mothers. For those not attending this meeting, the forms with accompanying instructions and a self-addressed stamped envelOpe were mailed. Completed food records were then returned by mail to.the researcher. The second food record form was “given to the mother at the time Of the home interview in the.winter; completed forms were again returned by mail. 88 In the spring, the food record forms were mailed to the mothers participating in the study; completed forms were returned by mail. An attempt was made to coordinate data collection so that measurements of height and weight on the children might be made at approximately the same time as records were being kept of their food intake. Interviews with the mothers were performed by persons Specifically selected and trained for the task by the investigator. Phone calls were made to arrange the most suitable time for the interview. At the time the appoint- ment for the interview was made, the attitude-measuring questionnaires were mailed to the mother so that she could independently re5pond to them and have the completed forms ready for the interviewer to collect at the time of the home interview. It required approximately one hour for completion of both the questionnaires and the interview. Data‘AnalyseS Data collected from measurements taken on the children and from the interview with the mother were scored and transferred to data processing cards. Analysis was primarily performed on the Control Data Corporation (CDC) 3600 model computer,supplemented by the CDC 6500 model computer. Table 4.6 summarizes the procedures used for the complete analysis Of the data including the statistical 'procedures used. The following sections present a more complete discussion of the classification and coding 89 Table 4.6. Methods Used in Analysis Of Data INTENT 0? ANALYSIS DATA EMPLOYED STATISTICS AND COMPUTER PROGRAMS 1. Determination of nutrient content of Three, one-day food Transformation program.2 children's food intake and number of records. Punch cards servings within specified food groups. with nutritive values per specified food unit. 2. Description Of nutrient intake infor- Data from food record Frequency distribution; mean range, nation, physical measurements, and transformation program. cell count, and percentages.3v . biochemical data for children in Results of analysis of sample. blood and urine. Physical measurements of children. 3. Description of family environmental Demographic data. Inter- Frequency distribution, including characteristics of subjects. view with mother. mean, range, cglg count, and ”ECHO” Project data. percentages.30 I 4. Determination of children's physical Serial measurements Of Conversion program.6 measurements according to weight- children's standing and height-for-ags standards. height and weight. 5. Graphical representation of Interview data; Histograms7 children's characteristics and DemOgraphic data. family environment characteristics. Results from food record transformation program. Analysis of blood and urine. Physical measurements of children. 6. Determination of degree of As above. Contingency tables.3"'8 association between characteristics Computation of Pearson product- 9 10 of the children with family moment correlation coefficients. ' environment variables. 7. Determination of clusters of As above. Oblique multiple-groups cluster variables which describe sample. analysis. 8. Determination Of effects of As above. Moderating effects-computer moderating variables. program.1 1Davenport, E. Calculating the Nutritive Value of Diets. A Manual Of Instructions for the Use of Punch Cards for Machine Tabulation. U. S. Department of Agriculture, ARS Publication No. 62-10-1, September 1964. 2Program written by Steven L. Huyser, Michigan State University, 1969. 3Price, L. A. and J. L. Peterson. Control Cards for PrOgrams on the New 6500 CISSR Library System. Computer Institute for Social Science Research Tech. Report No. 70-4. East Lansing: Michigan State University, 1970. ‘Price, L. A. and J. L. Peterson. Program DATA. Computer Institute for Social Science Research Tech. Report No. 70-3. East Lansing: Michigan State University, 1970. 5Thiel, L. and L. Patrick. PERCOUNT. Computer Institute for Social Science Research Tech. Report NO. 18. East Lansing: Michigan State University, 1968. 6Program written by Thomas Nicol, Michigan State University, 1971. 7Clark, J. and G. Gillmore. Data Plot and Statistics for Variables and Pairs of Variables-~DAPI. Computer Institute for Social Science Research Tech. Report NO. 15. East Lansing: Michigan State University, 1968. 8Holdridge, A. R. Four-dimensional contingency tables--NUCROS. Computer Institute for Social Science Research Tech. Report. No. 12, East Lansing: Michigan State University, 1968. 9Kline, D. IDCORR: Incomplete Data Correlation Program. Computer Institute for Social Science Research Tech. Report No. 4. East Lansing: Michigan State University, 1968. 10Hunter, J. E. and S. H. Cohen. PACKAGE, Version 1.0, CDC 3600 Extended FORTRAN. Computer Institute for Social Science Research. East Lansing: Michigan State University, 1969. 11Hunter, J. E. and R. J. Chesser. MODERATOR: A Family Of Computer Programs Designed to Show Simultaneously the Moderating Effects and Non-linear Relationships Among a Set of Variables. Unpublished paper written at Michigan State University, East Lansing, 1971. 9 0 " procedures used in preparing the data for analysis and the particular types of computer-assisted analyses which were performed on the data. Factor Analysis As a statistical technique for data analysis, factor analysis has been described as "a method for determining the number and nature of the underlying variables among large numbers of measures (Kerlinger, l967:650)." Its main contribution lies in helping the researcher to identify unities or fundamental properties underlying a large set of variables. As Harman (1967:4, 5) states, The principal concern of factor analysis is the resolution of a set of variables linearly in terms of (usually) a small number of categories or "factors". This resolutiOn can be accomplished by the analysis of the correlations among the variables. A satisfactory solution will yield factors which convey all the essential information of the original set of variables. Thus, the chief aim is to attain scientific parsimony or economy of description. ... This aim should not be construed to mean that factor analysis necessarily attempts to discover the 'fundamental' or 'basic' categories in a given field of investigation... Since measures for certain important .variables may not yet have been develOped, the factors identified from the available data cannot be considered completely fundamental...While the goal of complete description cannot be reached theoretically, it may be approached practically in a limited field of investigation where a relatively small number of variables is considered ex- haustive. In all cases, however, factor analysis does give a simple interpretation of a given body Of data and thus affords a fundamental description of the particular set of variables analyzed. 91 Factor analysis is an important technique in multi- variate research because it is a useful tool for the explication of constructs.1 Nunnally (1967:289) further explained: The first step...is to develOp measures of particular attributes which are thought to be related to the construct. The second step is to correlate scores on the different measures. The correlations are analyzed to determine whether 1) all measures are dominated by Specific factors, 2) all measures are dominated by one common factor, or 3) the measures tend to break up into a number of common factors. ... Factor analysis is a broad term referring to methods of analysis used in the second step above. Nunnally (1967:289) has also indicated that "factor analysis can be used either to test hypotheses about the existence of constructs, or if no credible hypotheses are at issue, to search for constructs in a group of interesting variables." In general, factor analysis consists of extracting common and unique factors that can be attributed to each variable from an intercorrelation matrix of a set of variables. Within the factor analysis system, a variable can be represented in terms of several underlying factors, i.e., 1A ”construct" may be thought of as an effort to measure relatively abstract variables, i.e., ones thought - to be evidenced in a variety of behaviors but which do not exist as an isolated, observable dimension of behavior. In essence, the construct represents a rather "half-formed" hypothesis that certain behaviors will correlate with one another in studies of individual differences (Nunnally, 1967:84-85). 92 A. Common Factors: those pertaining to more than one variable in the set. 1. General factor: present in all variables. 2. Group factor: present in more than one, but not all, variables. B. Unique Factors: those pertaining only to a single variable in the set. Common factors account for the observed intercorrelation among all variables. In contrast, each.unique factor accounts for that portion of the variance of a variable that is not associated with that of any other.variable in the set. The fundamental goal of factor analysis is to determine the amount of common variance which exists bet- ween sets of variables. One method available to the researcher for factor- analyzing a correlation matrix has been termed cluster analysis. Tryon and Bailey (1970:1) indicate that cluster analysis is a procedure by which entities are objectively ,grouped on the basis of their similarities and differ- ences. Such methods depend upon the identification of clusters and presumed factors by searching for interrelated ~groups of correlation coefficients or other measures of relation. This procedure is most apprOpriate when the inveStigator is able to designate a set of variables as . belonging to a particular cluster on an a priori basis. 93 In the present study, a system of correlational analysis programs (named "PACKAGE"), develOped by Hunter and Cohen (1969), was used. In addition to the computa- tion of means, standard deviations, and productrmoment correlation coefficients, these routines also perform an oblique multipleegroups analysis in which groups may be Specified by the investigator from those comprising the correlation matrix stored in core memory. It has been shown that factor analysis serves the cause of "scientific parsimony" (Harmon, 1967:4); thus, by using these programs in the present research, the initially large set of variables can be reduced to a more manage- able number. These procedures are useful in indicating which.measures can be added and studied together rather than separately. While a complete description of PACKAGE is beyond the sc0pe of this report, it must be pointed out that the analytical strategy used by PACKAGE is to de-emphasize blind rules for forming large clusters and to facilitate reordering and presenting correlational matrices for efficient visual inspection. A hierarchial approach to synthesis of data is employed in PACKAGE. The operational procedure entails first the inspection of an inter—item correlation matrix, followed by the formation of small . clusters of similar items, possibly two or three item groups. The procedure of combining items and groups into 94 larger groups is continued until it is felt that additional combinations would only blur important distinctions. ‘S‘c‘a‘l’e’ Development In practice, scale development is an iterative pro- cess of grouping items and evaluating the combinations. While PACKAGE was capable of generating and arranging the matrices, the final determination of the manner in which.items.were to be grouped was left to the discretion of the researcher. Three techniques were used, to evaluate item clusters, including internal analysis, external analysis, and content analysis. Internal analysis is concerned with internal con— sistency or how well the items in the scale are related to one another. If scales consist of parallel items, a high degree of internal consistency would be expected. A second means of evaluating the similarity of items in a group is to analyze the patterns of correlations with items outside the group; this is called external analysis. If items in the group "belong" together in the sense that they are parallel items, they should exhibit a similar pattern of correlations with other items. Unfortunately, no single quantitative measure exists to.facilitate an easy assessment of the external consistency. The researcher must visually inspect the correlation pattern ' of each item in the scale with other items, noting areas of inconsistency. A third means used to evaluate a 95 particular item combination was to examine the content of the items. If items were roughly parallel in their correlational patterns, one would expect that the content of the items would be similar. One must be cautious in interpreting the content of an item because an individual's perception of the content of that item may or may not be the same as the original writer's. Given this limitation, the researcher can subjectively judge the "reasonable" similarity of the content of the various items. 'Moderator»Effects To a limited extent, computer-assisted analysis was performed to determine the interaction (or "moderating") effects of a group of selected variables. Anastasi (1964: 2861 notes that it is not uncommon to find that a validity coefficient, whem computed for a total group, may be too low to be of much practical value; however, when recom- puted for subsets of individuals differing in some identi- fiable characteristic, validity may be high in one subset and negligible in anothers. One means of testing for this effect is to divide subjects into high and low groups on some.third variable (identified as the "moderator") and compute the correlations for both groups. The significance level of the difference between the correla— tions obtained for the high and low groups may then be ’teSted.. To test for such effects in the present research, a family of computer programs, called MODERATOR, was used; 96 this routine was designed to show simultaneously the moderating effects and the nonlinear relations among a set of variables. The mathematical derivation and description of the computer analysis may be found in Hunter and Chesser (1971). ‘Classification and deification'of Data-for'AnaLysis‘ ' Dietary Data Dietary data were obtained from three separate one- day food records kept by the children's mothers or persons responsible for the child's meals. Amounts of food con- sumed were recorded in terms of common household measures on forms provided by the researcher for that purpose (Appen— dix C-l). Transformations of the data from each of the three original food records were made for analytical pur- poses. The following is a brief discussion of each of the transformation procedures employed. 1. conversion of estimated quantities of food consumed to corresponding nutrient values. Transformation of the original food record data, reported in terms of estimated quantities of foods consumed, to nutrient values was made by using the coding system and conversion factors for computer usage developed by the Consumer and Food Economics Research Division, U. S. Department of Agriculture. Specifics of this method are presented in USDA—ARS ‘ Bulletin No. 62-10—1 (Davenport, 1964). 97 Briefly, this method involved calculation of the nutritive values of foods by means of: two sets of data-one with the quantities of food consumed, the other with nutri- tive values per Specified unit of food. The two sets are matched by identifying food codes. The products of quantity times nutritive value are derived and then summed to obtain the nutritive value of the diet. (Davenport,_l964:l) . The food composition values used in this method were those published in the U. S. Department of Agriculture Home and Garden Bulletin No. 72, 1964. Identification codes for 512 food items, along with a master set of punch cards carrying the nutritive values for each of the 512 items, were obtained from the U. S. Department of Agriculture, Agricultural Research Service. In the present study, approximately 300 additional identification codes and matching master cards were develOped for food items not included in the manual. Food composition data for these Dadditional items were obtained from food manufacturers, as well as from Agricultural Handbook No. 8 (Watt and Merrill, 1963! and from Bowes and Church (Church and Church,,l970). ......... 2. conversion of nutrient values to proportions of ‘Recommended'Dietary'AllowanceS'CRDA);w These computations involved comparisons of the individual nutrient intake values with the 1968 revision of the RDA for three- and four-year old children (Food and Nutrition Board, 1968). 98 Percentages of the Recommended Dietary Allowances provided by food intake were calculated for calories, protein, calcium, iron, vitamin A, thiamin, riboflavin, niacin, and ascorbic acid. 3.'Comparison'of'quantitieS‘of'calorieS'andgprotein consumed in relation to how each was eaten. The amount of food energy and protein ingested, as derived from the above computer transformations, were analyzed for the proportion of each eaten at meals or at snacks, with whom it was eaten (whether alone, with all of the family, with some of the family, or with others outside the family) and where.it was eaten (whether at home or elsewhere). 4.'Conversion'of‘estimatediquantitieS'of'foods‘con- 'sume ‘to‘number of servings eaten in certain food groupings. The manual (Davenport, 1964) used for the coding of food items for purposes of nutrient analysis provides a six- digit identification code per food item. The first three digits refer to the consecutive numbering process for this listed food items. The next three digits refer to a food_group code number, designed to group foods by major sources of nutrients for further study of the composition of the diets. This code number was used to analyze the food consumption data in terms of number of servings by specified food_groups. 99 5. Conversion of nutrient values of foods ingested according tOithe percentage'of‘calorieS'fUrnished by ‘carbohydrate,ffat, and protein. The number of calories consumed, as computed by the transformation procedures just described, were analyzed for the prOportions con- tributed by carbohydrate, fat, and protein. Each of the three food records for each child were analyzed separately. The results indicated no significant seasonal differences. Therefore, a computer program was written to average the figures obtained for the three separate food records and produce one set of data output for each child in the sample. This average value will be referred to as the nutritive values of the children's food intake records. Biochemical Data Data obtained from the blood tests for hemoglobin, hematocrit, total serum proteins, and serum albumin were transferred to computer cards. In addition, conversion of these values was made to a category designating the value as "deficient", "low", "acceptable", or "high", as Specified in the ICNND Manual for Nutrition Surveys (1963). Figures for urinary hydroxyproline and creatinine were transferred to computer cards as: l) the hydroxy- proline:creatinine ratio, and 2) the "hydroxyproline index" (Whitehead, 1965) which calculates urinary hydroxyproline:creatinine, as corrected for body weight. CHAPTER V FINDINGS The chapter presents a description of the findings for each category of variables studied and a discussion of the interrelationships between variables which was elucidated. Characteristics of Families in the Sample Results from Home Interview Demographic characteristics of families (analogous to the Jessor and Richardson concept of components of the "distal environment") were obtained by a home interview conducted with mothers of the children participating in the study. 11.4% of the children were from single—parent families in that their mothers were divorced, widowed, or had never married. The remaining 88.6% of the mothers were married and living with their husbands. Parents in the sample were rather highly educated in terms of the number of school years completed (Table 5.1). On the average, mothers had completed fourteen years (or two years past high school), while fathers had completed an average of seventeen years (or one year past undergraduate education). 100 101 Table 5.1. Education of Parents (as number school years completed) Mother Father <12 years 14.8% 12.1% 12-16 years 61.7% 25.0% >16 years 23.5% 62.9% MEAN YEARS 14 17 Over one-third of the mothers were employed either part-time or full-time (Table 5.2). Over half of the children were cared for by someone other than the parents ten hours or less per week. In contrast, 13.5% were cared for by others thirty-five hours or more per week (Table 5.3). Over half of the fathers were employed on a full- time basis. However, 13.8% of the fathers who were working indicated that they did not have "steady" work. Of the 38.5% of the fathers who were classified as "unemployed", many were full-time students at the university (Table 5.2). Table 5.2. Employment Status of Parents Mother ’Father unemployed 63.8% 38.5% Employed part-time 22.8% 9.6% Employed full-time 13.4% 51.9% 102 Table 5.3. Hours per Week Child is Cared for by Someone Other Than Parents Hours per week Number Percentage 0-6 34 23.0 7-10 46 31.1 11-15 28 18.9 16-34 20 13.5 35-60 20 13.5 Over 13% of the families in the sample were receiving less than $4000 annually, while nearly 5% had incomes of over $20,000. The mean annual family income was $9014, and the median family income was $7047 (Table 5.4). When classified according to the source of family income (Warner at al., 1949), the greatest percentage (69.1%) of families were receiving a salaried wage, while 10.7% were supported by public welfare (Table 5.5). Table 5.4. Income Distribution of Families in Sample Annual Family Income Number Percentage <$4000 19 13.3 $ 4000— 6999 46 32.2 7000- 9999 19 15.4 10000-14999 30 20.9 15000-19999 19 13.3 20,000+ 7 4.9 MEAN INCOME: $9014 MEDIAN INCOME: $7047 103 Table 5.5. Classification of Families By Source of Family Income (Warner et al., 1949) Source Number Percentage 1. Inherited wealth 0 0 2. Earned wealth 0 0 3. Fees, Services 1 0.7 4. Salary 103 69.1 5. Hourly wages 26 17.5 6. Private relief 3 2.0 7. Public welfare 16 10.7 For the most part, children came from two-parent, four member families (Table 5.6). Most families had two children, both of whom were preschool age; therefore nearly half of the sample children were first-born. On the average, over half of the families had two years between births of the children (Table 5.7). According to Duvall's (1967) stages in the "family life cycle", most of the families (59.1%) were in Stage III, i.e., their eldest child was from two and one-half to six years of age (Table 5.8). Table 5.6. Household Size Number of Persons Number Percentage in Home 2-3 19 12.8 4 61 40.9 5-7 55 36.9 8-11 14 9.4 104 Table 5.7. Characteristics of Families in Relation to Number, Age and Spacing of Children (Expressed as Percentage of Families in Each Category) ' One Two Three Four Five- Nine Total number of children in household Number of children 5 years & under 12.1 40.9 22.2 10.1 14.8 31.5 47.7 13.4 6.0 1.3 Average years between births in family Table 5.8. Description of Families by Stage in Family Life Cycle Stage Number Percentage III. Families with preschool children 88 59 l (oldest child 2 1/2 to 6 years) ° IV. Families with school children 43 28 9 (oldest child 6 to 13 years) ' V. Families with teenagers 17 11.4 (oldest child 13 to 20 years) VI. Families as launching centers (first child gone to last 1 0.7 child’s.1eaving home) It is thought that food habits are in part influenced by the family's religious practices. Most children in the present study were Protestant. Nationality ties did not exert a discernible influence on the types of foods con- sumed in the home (Table 5.9). 105 Table 5.9. Religion of Children in Sample Number Percentage No religion followed 15 10.7 Protestant 67 47.8 Roman Catholic 30 21.4 Jewish 6 4.3‘ Mixed (affiliated with 2 or more 4 2.8 religious_groups) .Other (inc. Buddism, Islam, etc.) 18 4 _ 12-9. In an attempt to ascertain the mobility of the families in the sample, mothers were asked how many years they had resided at their present address and how many times they had moved in the past three years. In general, families were rather mobile in that 39.9% had lived in their present home one year or less (Table 5.10). Approximately one-third of the families had moved two or more times in the previous three year period. Table 5.10. Number of Years in Present Home Years Number Percentage One or less 58 38.9 Two, three 57 38.3 Four to six 28 8.8 .Seven or more _ 6 I . . 3-4M 106 An index of crowding that has been extensively used is the ratio of the number of persons living in the home to the number of rooms in the house. A ratio of less than 1.0 is said to indicate a degree of crowding. In this sample,_the mean crowding index was 1.16:0.41, with a range of 0.4 to 2.8 rooms per person in the family. Using the guidelines set up by the U. S. Census Bureau (1963) to assess the quality of housing, it was determined that 85.2% of the homes were in "sound" condition, while 13.3% were "deteriorating" and 1.6% were "dilapidated." 66.2% of the homes were in residential areas. Observation of the exterior structure of the houses revealed that 42.1% were of excellent quality, 39.5% were good, 15.8% were fair and 2.6% were of poor quality. Analysis of the interviewers' evaluations of the general state of cleanli- ness and housekeeping conditions showed that nearly half (49.7%) were rated "very clean and orderly" while 10.5% were ”dirty and unkept." Certain appliances are important in the home in order to assess which items might contribute to the quality of the child's nutrient intake. Table 5.11 indicates that more families had a television than an automobile in working order and that more families had a telephone than had a properly functioning refrigerator. 107 m-m .me m.~m mma h.ma Hm m.mm and o.mm nma m.hm oma m.mm mma m.¢m flea mmmucmoumm measz mauumoum.mnflcoevpssw ecu .ucomwum ..hqwm. teed. m.n Ha m.om mad h.m 0H o.mH mm m.ma ma h.oa ma ¢.m m weapcoouom Hmnfioz Hono.mnflmmos.:H.uoz no anemone uoz mumam pom cm>o and: mmcmm peso Hmuomum mumummmm Houmuomflumom xosnu Ho Hmu soame>oaoe owomm mcoemoaoe ......................... maom one SH anemone houseflammd .HH.m OHQMB 108 The interview with the mother in regard to the child's medical and dietary history revealed that thirteen children (8.8% of the sample) had had a history of food allergy at some time in the past. However, only two children were on some type of Special diet at the time of the interview. Twenty-three children (15.5%) had been diagnosed as anemic in the past; of these, ten had been diagnosed recently, while the others had been diagnosed at an earlier age. Mothers reported that thirty-three children (nearly one-fourth of those inter- viewed) had had a history of feeding problems serious enough to warrant consultation with a physician. Of these seven had presented feeding problems recently. Nearly three-fourths of the mothers indicated that they gave their child some type of vitamin supplement. Of these, the most frequently named type was the multiple- vitamin capsule; 76.4% of the children received this type. (Mothers frequently reported during the course of the interview that they gave the child his "choice" of supplements; thus, the type of flavored, chewable supple- ment designed especially for consumption by children was the type most often named.) Thirteen mothers (8.7% of the sample) indicated that they also gave their child some other type of supplement or "health food." These were usually wheat germ and cod liver oil. Approximately half of the mothers indicated that the recommendation for 109 the child's taking vitamin supplements was of their own volition, while Slightly fewer indicated that the physician had recommended their use. . The vast majority of children had been seen by a physician within the past year for a routine physical examination and judged admissable to the nursery school programs. The other children were being seen by a physician at the public health clinic. At the time of the study, 45.8% of the children had been seen by a dentist within the past year, usually for the purpose of a routine dental examination. Nearly half (46.5%) had never been examined by a dentist. Twenty-five children (nearly 18%) had some filled teeth at the time of the interview. Questions were asked in order to gain information regarding the family's mealtime practices. In general, most families ate the evening meal together; lunch and snacks were consumed on an individual, rather than on a family, basis (Table 5.12). Table 5.12. Meals Eaten Together as a Family Less than Never 1/2 About 1/2 Almost the time the time always Breakfast 25.5% 26.9% 9.4% 38.2% Lunch 32.0% 32.7% 11.6% 23.8% Dinner 3.4% 3.4% 5.8% 87.9% Other, Inc. Snacks 50.8% 22.2% 3.9% 23.0% 110 Mothers were asked about their child's attitude about eating. Nearly half (45.6%) responded that her pre- schooler's attitude varied; however, almost as many mothers (39.6%) felt that their child truly enjoyed eating. Far fewer mothers felt that the child had to be coaxed to eat or that he presented an eating problem. In an attempt to gain information about how important it was, in the mother's Opinion,_for the child to finish everything on his plate, reSponses were fairly equally divided. The largest proportion of mothers (36.2%) thought.that this was fairly important (Table 5.13). Table 5.13. Mothers' ReSponses as to How Important It Is For a Child to Finish.Everything on His Plate Number Percentage Not important.at all 25 16.8 Slightly important 24 15,1 Moderately important 54 36.2 Considerably important 31 20.8 . Extremely important .. . , . 15 _ _., .710-l Table 5.14 presents the results of the mothers' usual actions when the child dawdles or plays with.his food. A nearly equal prOportion stated that they insist that the child eat a certain portion of each food (28.9%) as did those who threaten some type of punishment for not eating (26.7%). A somewhat fewer number tell the child 111 there will be nothing to eat until the next meal, then remove the food (11.1%), and 10.4% say nothing because they do not think this is important. Table 5.14. Mothers' Usual Action When the Child Dawdles With Food or Refuses Food Served to Him ....................... Number Percentage l. Insists that child finish meal . promptly 10 V 7.4 2. Insists that child complete a certain portion of each food 39 28.9 3. Promises reward e.g.,.dessert,. for completion of eating 9 6.7 4. Coaxes, but does not force eating 7 .5.2. 5. Tells child there will be nothing to eat until the next meal, then removes food 15 11.1 6. Threatens punishment, e‘.g., withholding of dessert, if food is not eaten 36 26.7 -7. Says nothing to child; talks to child later about it 0 0 8. Says nothing to child; does not like arguments at the table 5 3.7 9. Says nothing, does not think this is important . h 4,. t. _ l4 . ,_ 10.4 It was believed that preschool children consume a considerable proportion of their calorie intake as snacks. Mothers were thus asked to estimate the frequency of her child's snacking at particular times throughout the day. Table 5.15 indicates that few children snack before the 112 breakfast meal. (Some mothers indicated, however, that the child may have helped himself to food before She arose in the morning, and thus she had no way of knowing exactly if he.ate before breakfast.) Most children did snack during the day, and nearly two—thirds have something to eat between the noon and evening meals daily. Over 30% of the mothers indicated that the child may miss meals. Reasons cited for the.child's not eating included lack of time (19.5%), lack of appetite (43.9%), fatigue (22.0%), and illness (14.6%). ReSponses regarding the time of day when the child seemed to be the most hungry were fairly equally divided. 39.9% of the mothers felt her child was the most hungry in the morning, 27.8% stated that this occurred in the after- noon, while 33.3% indicated the evening. Over half (52.7%) of the mothers rated her child's appetite.in the previous three months as Fgood." 19.9% felt the appetite could be rated as "excellent", 22.6% rated it as “fair", and only 4.8% indicated that it had been "poor." Nearly all the children in the sample (97.1%) were able to feed themselves, using a Spoon and fork. Approxi- mately half of the children (49.0%) were able to use a knife. Most peOple have fairly definite ideas about the kinds of foods that children will or will not eat. Mothers 113 (waémm. wm.m wh.ma wm.mm Hm>oz w~.m , , wa.am_ e~.e w~.ma me.m ”5.4m wa.e $5.4 xmoz\ooco Moms you one» mmoq moEHu MIN wmwhe wm.mm wN.vv wh.N moo mHo>m meduomm a Hmcsfla.smmzuom Hoccwn a noose consumm noose w ummmxooum cmo3uom ummmxmoun mHomom mcaxomcm mo wooonomum .ma.m manna 114 were asked to name their child's "favorite" food and the food he disliked the most. Responses were categorized into food groups according to the distribution presented in Table 5.16. The most pOpular food group was meat (rated as a favorite by 32.8% of the mothers), followed by the bread and cereal group (24.4%). Nearly 18% indicated that sweets were the favorite. The overwhelming majority of the mothers indicated that vegetables were the most unpOpular food to the child. Table 5.16. Food Preferences of Children ............ Favorite Most Disliked Number Percentage Number Percentage 1. Meat 43 32.8 12. 10.3 2 " ”1:1; (132:? 11 8 . 4 o o 3. Fruits 5 3.8 3' 2.6 4. vegetables 13 9.9 94 81.0 5. Eggs 4 3.1 5 4.3 6. Bread, cereals 32 24.4 2 1.7 4 7. Sweets, . . . 23 ~17.6 _ . 0 _. .0. Mothers were asked to name the one factor which, she felt, exerted the most important influence on her meal planning. 40.4% of the mothers indicated that the nutri- tional quality of the food was the most important. Fewer mothers (31.2%) named family preferences. Other reSponses, in order of decreasing frequency, were: health needs of 115 the family (13.5%), cost of the food (7.8%), time required for preparation (3.6%), and the mother's own food pre- ferences (3.6%). A question was asked to determine how.the families accepted new foods or new methods of food preparation. Only 12.8% of the mothers answered that their families were “enthusiastic” about this, 43.3% said they were ”willing", 27.0% said they were "cautious", and 13.5% were "reluctant", but only 3.6% said their families refused to accept new foods at all. Only 19.4% of the mothers reported that the child regularly ate some meals away from home. Over one-fourth of these children usually ate at the home of a relative; a similar number ate at a restaurant. Approximately one— fifth of all children eating away from home ate at the home of the babysitter, and the rest ate in the homes of friends or neighbors. Because the preschool period is notorious for its reputed feeding problems, Table 5.17 presents the results of the mothers' reSponses to certain frequently encountered problems. In general, mothers did not feel that their children were eating inapprOpriate amounts of foods or were consuming the wrong types of foods. The exception to this was that more mothers (61.6% compared with 38.4%) felt that the child chose a limited variety of foods. 116 Table 5.17. Period Extent of Feeding Problems in the Preschool Do you think your child: Eats too little food? Eats too much food? Chooses a limited variety of foods? Eats too few fruitS.and vegetables? Plays or dawdles with his food? Eats too much meat? Eats too little meat? 'DrinkS too much milk? Drinks too little milk? .Eats too.many sweets? . No Yes 76.0% 24.0% ‘89.0% 11.0% 38.4% 61.6% '59.9% 40.1% 55.2% 44.8% 91.0% 9.0% 69.4% 30.6% 88.4% 11.6% 85.6% 14.4% ...;Q.63.8% ...... 36-2%, In order to gain a better understanding of families' food buying practices, a series of questions pertaining to this topic were included in the interview. In nearly threeefourths of the families (71.4%), the mother alone decides what foods should be purchased. others, the mother and father decide together, in 5.4% In 19.1% of the the entire family decides, and in 2% each, the father alone or the mother and children (without the father) have a voice in the decision-making. In nearly half (49.0%) of the families interviewed, the mother did the grocery shopping alone, while in 20.1% the grocery Shopping was done by the mother and the‘ children, in 12.8% by the entire family, in 10.7% by.the mother and father together without the children, in 6.7% 117 by the father alone, and in only one family (0.7% of the entire sample) by the father and children. Over half (53%) of the families did the grocery shopping once a week. Over 97% of the families shopped in supermarkets rather than in small,independent grocery stores. Table 5.18 shows the reasons the mothers gave for Shopping in the stores they preferred. Families Spent, on the average, $35.66 for food each week. Table 5.19 indicates the distribution of family food Spending. Table 5.18. Reasons for Shopping in Particular Markets ...................................... Number Percentage No reason given 1 0-7 Lower food prices 37~ 25.7 More convenient and/or personal 21 14-6 loyalty Store offers trading stamps, etc. 1 0.7 Combination of better quality and 58 40.3 lower food prices Better quality and/or variety and/ 26 18.1 .or ethnic foods, .. , _ . ,,, , Table 5.19. Weekly Food Expenditure NUmber Percentage .<$20. 6 4.1 $20-30 45 30.6 30—40 51 34.7 40—50 18 12.2 .I_>$50,. .. .. ,7 _ . . 27_:_ , ... . f 18.4. 118 Because "convenience" foods are increasingly being used, mothers were asked how frequently they used certain food items. Table 5.20 presents the results of these data. The use of ready-to-eat cereal is so widespread that it can hardly be considered a "convenience" food item by most peOple. On the other hand,_the fact that approximately two-thirds of the families interviewed never used items such as frozen TV dinners, frozen dessert pies and pie crust mix, indicates that other items are not universally well accepted. 83.1% of the families in the sample were not using Food Stamps at the time of the interview., Eight families were using them.and eleven others said that although.they thought they were eligible.they were not using Food Stamps; the most frequently cited reasons for their not using them were that they did not know.enough,about them or that the inconvenience caused by a lack of transportation was a detriment. In an attempt to assess the mother's level of know- ledge of nutrition, two techniques were used. Mothers were asked to name.the foods thought to be necessary for her child every day; responses were evaluated in regard to the number of the "Basic Four" named (Table 5.21). Only one mother did not name any of these food_groups. Over half of the sample (54.7%) were able to name all four. A true‘false "Nutrition Knowledge Test" (Appendix C-Be) was administered and scored. Three-fourths of the mothers 119 m.oaA .onma. Hwae. m.~a m.m~ ads mqeeeem H.e e.m H.eH m.ea e.me xez umsuo wee m.He m.H~ m.m e.H e.m Hmmumo neon m.m~ o.HH e.m m.~H 5.5m mmmmoo penumeH m.e e.m~ H.mm h.mH N.OH mmxez memo h.o e.~ m.m e.e~ m.ae mmem cmuoum H.o~ m.m~ m.mm o.e o.e mamum .mnom vacuum 0 h.e e.ma m.o~ H.me mumeeeo >9 cmuoum h.o e.~ e.mH ~.em p.54 mmem new: emuoum men» we» . wees may Had Add waummz maamcowmmooo maoumm Ho>wz mfledefiflhfiwo,mwmucoonmm_ mamuH ooom mocmecmbcoo chuHmU mo mm: mo mucoswmum .o~.m manna 120 xvere able to answer fifteen of the twenty-three.items (a score of 65%) correctly (Table 5.22). Table 5.21. Number of "Basic 4" Named None 0.7% One 1.4% Two 14.2% Three 29.1% .Four... _ ..54.7%.. Table 5.22. Score on Nutrition Knowledge Test (23 total correct responses) 9 4.2% 9-14 20.8% 15-19 59.7% ,20923f 15-3%H Mothers were asked which classes, persons, or sources fiymmmz moon cmwmmosmo Am oHfleo one Scum Noam Hmeuoz AN mason msuuum mEoocH AH Ammonuoa oowunmzv maowo mead madame ca mmmum AN x603 Hoe coo“ How ucmmm mono: AH QCOZ cacao meea saeeam we» ea mmeum i. #663 mom coon How ucmmm mono: Am caeeo mo aoeuemom Hmaeeuo Am memo» m>Hm noon: cmuoafieo mo Honeoz AH omPMHmHHoU,Nwm>Hpflmom Hmeuofi we» no msumum Havana: cease mo eoeuemom queeuo mHomN deem Moons cmuoafleo mo Hmnasz 060: new SH mSOmumm mo Hones: amuOE «Homeum> 124 ummu wooed Isocx coauflwuoc co muoom omens sq venom: Hmaaoz mace mqflucom moon xooam oOOM How women choz mace one mqeucmm msumum oweosoomOHoom oaowo «med madame ea macaw ooom How unmmm mono: oomoamfiwco Hmeuomlmsumum meoocH Am AN AH AN AH AH AH Am AN AH wouMHmHHoO,NHo>Hummmz meowo owed NHAEMM cw oomum umou mmoma Isocx coauwuusc co ouoom omega av venom: Hmnfisz oooenonnmwmo Imaoe mo coauaocou oooeuonemem: lose: mo cowuwocoo xmocw mcaozono mononm anocoomoeoom QUMH GMHmmUQMU ammo mmoma Iaoox coeuanusc so whoom omega ea oamum: mo Honeoz wooenonemwmc one made no coauwoooo xmoow mcwozouu oafleo scum amen Hmeuoz mouuum oweoooooowoom $6005 mawfiom AH am am AH Am AN AH AH Ah Am Am Av Am AN AH ompmamunootmam>wuamom ooom How ucmmm mono: moumum oaeosoowowoom @8093 madame.“ cowoaeemca nonumwlmoumum msoqu demon cowumosom one cowummsooo Houcmuom manowhm>, 125 odomo emea madame ee mmeum 1H oaowo weed SHHSmm me mmmum 1H xooca mowosouu AH emanamHHoD,NHo>flummvz mGOZ ummu mmomaaocx coauwuua: co muoom AH ummu mmomaaocx soeufluuos co ouoom AH ooonnoaemwos loson mo coagflocoo AN S809." mounozouo 3 commamnnoo de>fluwmom. umou mmomazocx coeuauuoc so ouoom omega ea venom: mo Honfisz ooonuonememc can mean no coeuwosoo neon on» mqwnao oaweo scum Noam Hmnuoz manmflum>, 126 Table 5.23. Scales Developed From Items in Interview Schedule Scale Name Parents' occupation and education Income ItfltUB Mother away from child condition of home and neighborhood Infantile behavior Feeding problems Family eats together Frequency of snacking Use of convenience foods Items Fathers' schooling Mothers' schooling Fathers' occupation rating Mothers' occupation rating Fathers' employment status Father have steady work? Source of family income Mother's employment status Hours/week child is cared for by someone else Framed pictures Decorative accessories Green plants State of housekeeping condition Observation of home exterior condition Rating of neighborhood Use of car, truck? Telephone in home? Land use in neighborhood Drinks from bottle? Uses pacifier? History of food allergy? Special diet? History of feeding problems? Age of feeding problems? Child's attitude toward food, meals Meals ever missed? Child's appetite in past three months Child eats too little food? Child eats too much food? Child eats too few fruits and vegetables? Child dawdles with food? Child eats too little meat? Child drinks too little milk? Eats breakfast together? Eats lunch together? Eats dinner together? Snacks together? Snacking before breakfast? Snacking between breakfast and lunch? Snacking.between lunch and dinner? Snacking between dinner and bedtime? Use of cake and muffin mixes Use of ready-to-eat cereal Use of pie crust mix Use of pudding mix 127 :«f. :«.L 3...: N~.1 o~.I 90... na. no.1 3v. v AN... ma. «a. howfu mo. 3». . oof :5. v Gavan Quad .au 5 0 sum oo.H ..n. . ioN. . ma. ma. oo. m«.- so. .on... 15.. . vs. oo.- ism. . oo.- 1mm.-. io~.-. lav.-. ouooaaoex .uuoz .es oo.~ an. -. so. no.. ~o.- os. .o~.-. ado. . on. n~.- ion. 1 ~«.- .on... ~H.- 1."... .v canon. .02 .oH co.” o~. na.- no.- co. aka. . .«.- .~m. . ion. a co. in“. s oo. oo.. pa.- o~.- ooozowoeoaoe-osoa .ma oo.« .~..u. .o.- so. .en. a ma.- a~. aka. a no. .o~. . «a. ..~.-. .on... .m.... nouns oesoaouo ..a oo.a vo. o~.- -.- .o~.-. oo. inn.-. no.- as. .o.- inn.-. na.u .o..-. oeouxozo .na oo.~ oo.- .~.- oo. .H.. .a.- As. pa.n mo. ~o. on. so. eo>os ocean .- oo.~ n~.+ ~o.- .nu.-. so. am . a as.- ioN. . no. so. 1.4. a ixoaanxouas). «one .ss oo.~ 5a.- on. as. .o. .wm. . .o~. o -.- o~.- .oN.-. eaeeo noun eats ensue: .os oo.« .a~.n. on. me. ion.-. o ion. . o~. ion. . coco sou » .o oo.s ion. 1 ion.-. in.. . ....-. ion.-. .on... inn.-. nouns mum gonads: .. oo.~ ms.- ion. . ..~.-. no. ea.- oo. snooze xsslas .a oo.~ ion.-. lo”. a as. oo. so. «anon anon». queues .o oo.a ANn.-. inn.-. ice.-. .om.-. canon .0509 + .oouoo .n oo.a ea. .o. no.. noon». Susana: .o oo.~ mo.- .oa.+. oosusooo aaesouo .n oo.~ .mo.+. ...a» my eouosseo .N no.“ 069w cm ecoeuoa HsunIvr .H be we ,mH be me n» as o4 o \n b w m (h ,n in ,H eswzleh no suaueuuouosuefi 830-§\oafisu§ 0:084 econ-«enhances: .vn.n sans“. 128 Psychosocial Attributes of Mothers Items in the Parent Attitude Research Instrument were analyzed using the PACKAGE multipleégroups cluster analysis programs. Items were initially grouped on the basis of the original scales as elaborated by Cross and Kawash (1968). These initial procedures indicated that, for this sample, the original scales were not consistent with expectations. Thus, it was deemed necessary to develOp new scales from these data. The scales and the items of which they are composed are presented in Table 5.25. The matrix formed from the multiplegroups cluster analysis _ is in Appendix E-l. Following are brief descriptions of the eleven clusters of items which were formed from the original fifty-three items in the questionnaire. Table 5.25. Development of New PARI Scales 'Scales Used from Parent Attitude Research Instrument Questionnaire Items 1. Rejection of the Homemaking 5,10,15,20,25,30,35,40 Role 2- Irritability 6,17,28,39,49 3- Equalitarianism 2,13,24,36,46 4. Encouraging Verbalization 1,12,23,34,45 5. Excluding Outside 4,16,27,38,48 Influences 5- Parental Deification 9,21,32,43,52 7 ~ Deception 7,18,29,41,50 129 Table 5.25. (Cont'd) Questionnaire Items , f; I I 8. Deification (reflected)* 3,14,26,37,47 9. Excluding outisde : . ; 7 Influences (reflected) 8,19,31,42,51 10. Irritability (reflected) “11,22,23,44,53 As result of "multiple-groups cluster analysis": Items 1. Parents are "all-wise" 48,51,21,38,9 2. Children should be treated 45,1,23,12,13,34,19,8,42 as equals 3. Children should only 4,16,27 listen to and trust parents 4. Unquestioned loyalty 32,52,43,47,26 5. Deception 7,18,29,41 6. Homemaking is being 25,15,35,20,30 trapped in a dull job 7. Homemakers would like 5,10 to get out! 8. Raising children is 17,28,49 nerve—wracking 9. Occasional dissatis— 39,11,6 faction with being a homemaker ' 10. Frequent dissatisfaction 53,44,22 11- Residuals 2,3,14,24,31,33,36,37,40,46 Cluster No. 1: "Parents are all-wise." Those who agree with these items indicate a feeling thuat children should implicitly trust their parents because *Reflected means that the wording of the item as it aPpears in the questionnaire was reversed for scoring. £3 reversed score was used for all subsequent correlational analyses. 130 of the parents' superior knowledge and experience. The general content of items in thisgroup pre- sent a type of mother who feels that children have undevelOped judgment and therefore should always trust their parents without question. Cluster No. 2: "Children should be treated as equals." All of the items in this cluster deal with encour— agement of the child to verbalize disagreement with this parents' views. This cluster was inversely related to Cluster No. l. Cluster No. 3: “Children should listen to and trust only parents." This cluster was positively related to Cluster No. 1 and inversely correlated with Cluster No. 2. All items deal with external forces which potentially cause the parents to appear inferior in the child's eyes or to lose the confidence of their children. Although the relationship to Cluster No. l is positive, the discriminating aSpect of the relationship is the fact that here forces outside the parents' control cause a loss of confidence, while in the first cluster, children are not to express any lack of confidence in the parents. Cluster No. 4: "Unquestioned loyalty." This cluster consists of items which were all con- cerned indirectly with the unquestioning loyalty 131 of the child to his parents. It is positively correlated with the Clusters No. l, 3, yet is negatively correlated with the Cluster No. 2. Cluster No. 5: "Deception." This cluster contained all of the items from the original "deception" scale, with the exception of item 50. The content of the items implies a viewpoint that tricking children to get them to do what the parents want is a legitimate and common device of control. Item 50 does not use the concept of trickery in quite the same context, in that it implies a more subtle guiding rather than overt deception. An inter- esting point is the positive correlation of this cluster with item 40, "raising children is very much more difficult than most jobs men do." This finding implies the attitude on the part of the mother that raising children is difficult because the parent is forced to out-smart them by trickery. Cluster No. 6: "Homemaking is being trapped in a dull job." This cluster is composed of some items from the original "rejection of the homemaking role" scale. All items imply that the children are the ultimate cause of the mother's perceived loss of 132 freedom. Items 20 and 25 suggest that the mother is not free to do temporary activities, such as shOpping, while items 15 and 35 imply that the mother feels restrained from doing more time- demanding activities, such as taking a trip or taking a job. It is interesting to note that items 25, 15, and 35 correlate positively with the anomie scale, all implying a sense of helplessness on the part of the mothers. Cluster No.‘7: "Homemakers would like to get out!" Items in this cluster were strongly related to the previous cluster because they deal with the mother's feeling of being trapped by the demands of caring for a home and children. The differentiating aspect of the content between these items and Cluster No. 6 is the implication in Cluster No. 7 of the mother's feeling of being isolated from the happenings in the "outside world." This attitude is somewhat different from that expressed in the previous cluster because it reflects an inability on the part of the mother to experience a sense of accomplishment. This cluster correlates positively with Clusters 8, 9, and 10 which deal with the parents' irritability with children. Such relationships may be expected, since, if a mother feels trapped by the demands of 133 the children, she is more likely to feel resentful and irritable because of them. Cluster No. 8: "Raising children is a nerve- wracking job!" This cluster is composed of items which deal with the mother's feeling that she is justified in a sense of irritability with children because of her agreement that the job of raising children is certainly "nerve-wracking." 'Cluster No. 9: ”Occasional dissatisfaction." This cluster is composed of three items which imply that parents occasionally get upset with their children for no specific reason. The fact that no reasons were stated in the items of this cluster as they were in the previous scale (e.g., when children are demanding), seems to be the single difference with reSpect to content between this cluster and Cluster No. 8. Cluster No. 10: "Frequent dissatisfaction." This cluster is composed of items which deal with the mother's becoming frequently irritated with children.' While this scale was related to the Clusters 8 and 9, it is distinct because of the unique content of the items and lower inter-item correlations with other clusters. 134 Cluster No. 11: "Residuals" Ten items were placed in the "residuals" cluster because some contained independent information and others added nothing to the analysis. This cluster was not considered in subsequent analyses. Scales formed from items contained in the Parent .Attitude Research Instrument (PARI) were used in all sub- :sequent data analyses as representative of the psychosocial aattributes of the mothers in regard to authoritarian aattitudes about child-rearing. Anomie and Powerlessness Scales The five-item anomie test, developed by Srole, underwent item analysis and the scale was found to be unidimensional; consequently, further scale refinement was unnecessary. The final powerless- ness scale was develOped using only those items which were consistently strong in the inter-item correlation matrix. These items were 2, 3, 5 through 8, 10 through 16, and 18 through 24 (Appendix C-3d). Semantic Differential Scales The semantic differential instrument (Appendix C-3f) served as the basis for the development of two scales. The first, composed of items 1, 2, 4 through 15, 17 through 22, 24, 25, 28 and 30, 135 was felt to be measuring a general self concept or worthiness of the mother, while the second scale develOped from this instru- ment (composed of items 26, 29, 32, and 33) was felt to be related to a more general concept of feminity or "womanliness." Nutrition Attitudes Scales The permissiveness in feeding attitude from the Nutrition Attitudes Instrument (Appendix C-3e) was drawn from the following items 1, 4, 8, 9, 11, 16, and 18. Inter-item analysis revealed that all items appeared consistent throughout and therefore were retained for the final scale. The remainder of items in the instrument measured the "nutrition is important" attitude. Homemaker Values The mothers' ranking of values rated as "most important", "second most important", and "least important" were tabulated and the results appear in Table 5.26. The values of health, family centrism, and education received the largest number of "most important" ratings. Prestige and freedom values were rated as "least important" by the greatest number of mothers. Each value rating reSponse was considered as an independent measure in subsequent data analyses. 136 ,¢.m m.H m.Hm m.o m.h m.H o N.mv v.m pomuHomEH ummmq o.v m.mH h.~ m.HH m.ma m.ma m.va o.v m.ma usmuwomEH umoz ocoomm mcwpmm m.H o.hH 5.N h.N m.m m.¢m m.mm m.H m.h ucmuuomEH omoz moepmeumod coeumooom soommum deemccoeum coeoflom Emeuucmu wawemm oedema omeumonm meocoom mamz msam> noncommmm,msaumm mDHm>tmn. mHmEmm mo mmmucmonom .mm.m manna 137 Inte‘rr‘e’l‘a‘t‘ion‘ships Among Family Characteristics Selected demographic and resource characteristics of the families studied were analyzed to. determine the nature of the relationships with the psychosocial attributes of of the mothers (Table 5.27) . Again, a correlation co- efficient of 0.23 is considered to be significant at the 0.01 level (Dixon and Massey, 1969:569) . It is noted that although the correlations do vary considerably, these do not necessarily reflect differences in the degree of association between variables but rather show the variation in the reliability of the measurement. The following chart depicts the relationships revealed. , Variable Positively Correlated Inversel'y Related Total number of 1) Parents are all-wise 1) Nutrition is persons in the 2) Unquestioned loyalty important home. 3) Deception attitude 4) Trapped in a dull job 5) Powerlessness Number of child- 1) Parents are all- ren under five wise Years of age in 2) Unquestioned loyalty the home. 3) Trapped in a dull job ordinal position 1) Unquestioned loyalty 1) Nutrition is of child 2) Trapped in a dull important job attitude 3) Powerlessness Mother's marital 1) Parents are all- StatUS (high wise :901‘9 indicates 2) Trapped in a dull lng 1e parent job Statlas) 3) Anomie Variable Parental occu— pation and education scale Income status scale Family income biilbank socio- economic status scale ' M0 Flier away from child scale SFa-ge in family life cycle Race (white k¥1£a<2kg / 138 Positively Correlated Inversely Related 1) Treating child as 1) an equal 2) Nutrition is 2) important 3) Importance of edu- 3) cation--value rating 4) 5) 6) 7) 8) l) 2) l) 2) 3) 4) 1) Treating child 1) as an equal 2) Nutrition is 2) important 3) Family centrism 3) and education values 4) 5) 6) 7) 1) Friendship as a 1) value 1) Trapped in a dull 1) job 2) Powerlessness 3) Powerlessness Parents are all- wise Only listen to parent Unquestioned loyalty Deception Trapped in a dull job Powerlessness Prestige value Religion value Trapped in a dull job Anomie Parents are all- wise Unquestioned loyalty Trapped in a dull job Powerlessness Parents are all- wise Listen only to parent Unquestioned loyalty Deception Trapped in a dull job Powerlessness Prestige value Importance of religion value Nutrition is important attitude 'Black: White: I) Only listen to 1) Frequent parent dissatisfaction 2) Trapped in a dull job Variable Times moved in the past three years Crowding index (persons/rooms in house) Condition of .home—neighborhood scale Number of "Basic Four" named 139 Positively Correlated Inversely Related 1) Nutrition is important None 1) Nutrition is important Score on nutrition 1) Nutrition is Jenowledge test Amount of money Spent for food per week important 1) Deception 2) Powerlessness 1Ejraluation of Dietary Data Nutrient Intake of Children 1) l) 2) l) 2) 3) 1) 2) l) 2) 3) 4) 5) 6) Treating child as an equal Trapped in a dull job Powerlessness Deception Trapped in a dull job Powerlessness Parents are all- wise Trapped in a dull job Trapped in a dull job Parents are all— wise Listen only to parent Unquestioned loyalty Deception Powerlessness Food records completed for three days were analyzed to determine the nutrient content of preschool children's ‘11E31:sq the prOportion of the Recommended Dietary Allow- ances (RDA) provided by the diets, and the pattern of consmnption for calories and protein. 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Table 5 . 32 . ¥ Nutrient Percentage of Calories Supplied by Carbo- hydrate, Fat, and Protein Carbohydrate Fat 'IEES313ein. \ Percentiles Percentage Mean 25 50 75 Lowest Highest 49.3% 44.9 49.7 54.0 35.1 64.7 37.6% 34.4 37.4 41.3’ 23.9 50.1 15.0%. 13.4, 14-8),16.5. ..9.4 21.7 145 In order to determine the pattern of consumption for calories and protein, food items were originally coded according to where it was eaten (whether at home or elsewhere), with whom it was eaten, and if it was part of a meal or snack. Table 5.33 presents the results of this analysis. Table 5.34 indicates the consumption of calories and protein as expressed per kilogram of body weight. In general, consumption of both calories and protein was more than adequate. 146 H.m Hm.m MQm Hm.m mumnuo nuflz «.mmfim.om h.vmam.vv sHHEMM mo Ham nun: s.m~a~.oe H.mmfim.mv manage mo meow apes m.mHHo.h H.5HHh.m mcoafi “cmumm 50:3 nuflz N.HHHm.v h.HHHm.m mumnzmmam H.~HHH.mm m.aafio.qm meow um "cmumm muons m.num.m m.m Hm.ma mxomcm m4 e.num.om H.oaflm.am mammz me "sound 30m camuoum mo oomucmoumm moauoamu mo mmoucmoumm .coaumw>mfi oumocmum H com: um ommmmnmxmv cflmuoum can moHHonu How cowumssmcou mo cumuumm .mm.m magma 147 Table 5.34. Consumption of Calories and Protein Expressed by Kilogram of Body Weight Calories/kg Body Weight Percentage of Sample 50 0 50- 75 14.1 76—100 35.6 101-125 29.6 126-150 14.8 150 5.0. MEAN = 105 Cal/kg Gm Protein/kg Body Weight Percentage of Sample 1 8.9 2 37.8 3' 33.3 4 14.8 5 4.4 MEAN 2-66 gm/kg When assessing the dietary intake of preschool children by servings of certain food groups (Table 5.35), it is interesting to note that although the mean intake resembles that which would be expected, some children ate no fruits or vegetables while others ate voluminous quantities of certain foods, such as_grain products. 148 Table 5.35. Food Intakes of Preschool Children as Expressed by Servings of Food Groups Number of Servings Fbod Group ‘Mean 'Median 'Range Dairy products 2.9 _ 2.8 0.2— 7.1 Protein foods 2.3 2.0 0.3- 6.0 vegetables 1.4 1.3 0.0- 7.1 Fruits 1.5 1.4 0.0- 4.7 Grain products 5.7 5.5 1.0-13.0 Fats and oils 1.7 1.4 0.0- 7.8 Sugar products 1.6 . 1.4 t .0.0- 6.3 Beal found in analyzing the results of the dietary data from children that the skewness of the distribution prevented accurate description of the results merely in terms of the mean and standard deviation scores. In her papers (Beal, 1953, 1954, 1955, 1956), she presented results of the nutrient intake data in terms of the range of intake and corresponding percentile values. Table 5.36 presents a comparison between Beal's data (computed as the mean intake of children three to five years of age) and the nutrient intake data obtained in the present study. For the most part, the nutrient intakes of children in the present study exceeded those of children participating in the Denver project. 149 Table 5.36. Nutrient Intake Data (By Percentiles) in Comparison with Beal Data Percentile Lowest 25th 50th 75th Highest Calories 863' 1458 1801 2059 3569 Bea1* 984 1200 1384 1572 2063 Protein (gm) 26.2 54.5 66.2 76.6 140.3 25.1 40.6 47 54.9 87.6 Fat (gm) 30.2 57.9 . 175.6 91.7 170 38.5 51.4' “59.5 70.4 87.6 CHO (gm) 90 174 218 263 460 106 138 159 177 265 Calcium (mg) 297 707 889 1120 1785 438 716 891 1060 1490 Iron (mg) 3.92 7.6 9.2 11.4 37.7 3.46 5.1 6.1 7.1 10.76 Vitamin A (I.U.) 1260 2391 3644 5353 14000 1375 2806 3931 4900 7588 Thiamin (mg) .48 .85 1.06 1.34 2.88 .39 .64 .75 .85 1.15 Riboflavin (mg) .62 1.38 1.71 2.12 3.33 .753 1.28 1.52 1.78 2.39 Niacin (mg) 3.70 8.73 10.98 13.02 3.23 5.14 6.40 7.62 11.09 Ascorbic Acid (mg) 7 56 92 117 350 14 43 57 82 130 Cal/kg b.w. 54 84 102 117 192 61 74 87 106 126 Pro/kg b.w. (gm) 1.60 3.1 3.7 4.4 6.2 ... .... A .7 1.62 _ 2.5 2-9 . 3.5 .2 .4.6 *Computed as mean intake of children 3&5 years 150 Relationship'of‘Nutrient Intake to Other Variables Examination of the correlation coefficients among the various nutrients revealed that all were quite signi- ficantly inter-correlated (Table 5.37). The most notable eXception to this was ascorbic acid, which was not correlated with protein, fat, calcium, or riboflavin; this fact supports the contention that vitamin C was not supplied to any great extent by any of the foods high in those other nutrients. Correlations among nutrients and selected demo- (graphic and resource characteristics of families in the sample failed to reveal any significant patterns of association (Table 5.38). Ascorbic acid intake did correlate positively with the Milbank socioeconomic status index. Table 5.39 shows the nutrient intake (expressed as the percentage of RDA) in relation to categorized values for family income. In most cases, well over half of the children in the sample had nutrient intakes which met or exceeded the Recommended Dietary Allowance. Exceptions here were calcium (for children in the highest and lowest income categories) and iron intake. Protein and ribo- flavin were provided in the most liberal amounts for all children. The intake of ascorbic acid shows a definite trend with.increasing family income, thus confirming the conclusion reached from examining the correlation coefficients. 151 oo.H Hm._ ma. em.,, mm. mm. NH._ av]. ma. Hm. um. .cwofl OHnHoomm .HH oo.a mm. mm. mm. mm. ma. cm. .54. so. om. chomuz .oa oo.a mm. mm. 54. am. mm. as. mm. mm. cu>mauonem .m oo.a mm. No. we. mm. mm. mm. mm. shamans .m oo.a we. Hm. am. «m. cm. mm. 4 cuempu>..h oc.H mm. mm. mm. mm. mm. coHH .m oo.H mm. mm. «a. me. asuoamo .m oo.a mm. mm. Hm. mumuownonnmo .e oo.H ms. Hm. umm .m oo.H an. cumuoum .m oo.H mmuuoumo .H HH OH m m A m m a m N H mucmHHunz mGOE¢ mGOHumHmHHooumucH .hm.m manna .152 0H. H0. 0H. 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NH.- N0.- 00.- 00. 00. 00. 00. magnum HmuHume 0.000uoz HH.- 00. 00.- 00. NH. 0 00.- 00.- N0. 0 N0.- oHHno mo :oHuHmoa Hmchuo 00. 0H. 00. 00. N0.- 0H. 00. NH. 00. NH. NH. mumm» m “was: :chHHgo v0.1 mo. «0.1 mo. vH. mo. no.1 No.u mo. «0. Ho. 050: :0 chmuwm Haves o HH> «Hz ommm mHga < uH> couH ono omo umm-. cum Hmo mmHHHaum Ho moHumwumuomuan oOHDOmmm can owzmmumoemo pmuomaww can mxwucH ucmwuusz macE< mcowumamuuoo .mm.m manna 1.523 0.00 0.00 0.00H 0.00 0.00 H.00 0.N0 0.0H 0 0 0.0H 0.0H 0.0 0.HH 0 0.0N 0 0.0H 0.0H 0.HH 0.00 H.00 0.00 0.N0 0.00 0.00 0.00 0.00 0.0N 0.00 0.H0 0.00 0.0N 0.0H 0.0N 0.0H 0.0 0.0 0 0.0H 0 0.HH 0.00 0.00H 0.00H 0.00H 0.00H 0.00H 0.00H 0.0H 0 0 0 0 0 0 0 0 0 0 0 0 0 H.00 0.00 0.H0 0.H0 0.00 0.00 0.00 0.0H 0.00 0.0H 0.0N 0.0N 0.0H 0.H0 0.0N 0 0 0.0 0.0 0.HH 0.NH 0.0N 0.H0 0.00 0.N0 0.00 0.N0 0.0N 0.N0 0.0H 0.00 0.N0 0.00 0.00 N.H0 0.0N 0.H0 0.0 0.0 0.0H 0.HH 0.0N 0.N0 0.00 0.H0 0.H0 0.00 0.00 H.00 0.N0 0.H0 0.NH 0.0N 0.00 0.NN 0.0N 0.0H 0.0 0.0 0.0H 0.0 0.0 0.0N 0.00 0.00H 0.00H 0.00H 0.00H 0.00H 0.00H 0.0H 0 0 0 0 0 0 H0. HNHV Away Hume Home vav A00. 0.H0 0.00 0.00 0.00 0.00 0.00 0.00 0.0H 0.0N 0.NH 0.0 0.0N 0.HH 0.00 0.0H 0 0 0 0 0 0 +000.0N0 000.0H-000.0H 000.0H-000.0H 000.NH-000.0H 0000-0000 0000-0000 00000v «soocH 0HHaam on coHumHum :0 H0Huon00 «OOHA vocalhw «rev 4 cHa00H> aOOHA woodlho abwv GOH H oooaA weed-hm abov Eswoamo aooan vooauhw cwououm couoaflnu mo umnfisz vooHA coca-0o ohov mowuoHnU .mn.m manna 154 Table 5.40 is a comparison of children from families with ”high" incomes ($20,000 and above) with.chi1dren from "low-income" families ($4,000 and below). nutrients, except ascorbic acid, the percentages are remarkably similar. For most In a few instances, particularly for calories and vitamin A, the percentages of children from high—income families having less than two-thirds of the Recommended Dietary Allowances are greater than for low- income children . Table 5.40. Comparison Between "Low-income" Children and "High-income" Children in Relation to Nutrient Intake Nutrient Calories low Income : high Protein low high Calcium low high Iron low high Vitamin A low high Riboflavin low _ high Niacin low high % of Children ‘<2/3 RDA‘ '213-a11‘RDA ‘>RDA 0 35.3 64.7 14.3 14.3 71.4 0 0 100.0 0 14.3 85.7 23.5 29.4 47.1 14.3 42.9 42.9 29.4 41.2 29.4 28.6 42.9 28.6 12.5 31.3 56.3 28.6 14.3 57.1 0 0 100.0 0 14.3 85.7 11.8 29.4 58.8 14.3 28.6 57.1 155 Table 5.40 (Cont'd). Nutrient ‘ <2/3'RDA 2/3-a11 RDA“ “'>RDA 'Ascorbic Acid flow 35.3 11.8 52.9 high . 0 . 14.3 .. _ ..85.7 Figure 5 is a graph showing the relationship between dietary intake (expressed as a composite figure for all nutrients) and family income. A curvilinear relationship is evident, implying that the lowest nutrient intakes are consumed by children from the very lowest and the very highest income strata. The association between family income with protein and calorie intake (expressed on a per kilogram of body weight basis) (Table 5.41) indicates that the highest intakes per unit of weight are consumed by children in the two lowest income categories. The lower intakes observed in the higher income groups may reflect the mother's knowledge of and concern with the increasing prevalence of childhood obesity. Examination of the children's nutrient intake with the sociOpsychological attributes of the mothers indicated that two of the PARI scales were significantly correlated with nutrient intake (Table 5.42). These scales were Wtreating child as an equa1"(negatively correlated with intake of calories, carbohydrate, iron, and thiamin) and 156 H2007: >132m mimoafioo mm ooumHsono... .HEOU7: wduzxwh OH. ZOHBjmm ZH .Eocoom 0mm34¢> hH.+ 0 N0.! 0H.+ H0.! H0.! m0.! m0.! mo.+ H0. 0 ANV HmHucquMMHv OHucmEmm hH.+ H0.! 00.+ H0.+ 00.+ 00.+ NH.+ m0.! m0.+ HH.+ H0.+ AHV HwHucmummuHU oHucmEmm NN.! H0.! HH.! m0.+ 00.+ H0.! MH.! 00.! m0.+ 00.! m0.! OHMOm mmmcmmmHuw3om 00.! N0.! mH.! 0H.! ~0.! 0H.! mH.! mH.! 00.! 00.! MH.! wHMUm mHfioqd 0H.+ 00.+ Ahm.+v m0.+ m0.+ m0.+ Hom.+v mH.+ m0.+ mH.+ HH.+ HGMUHOQEH mH COHUHHUDZ H0.+ H0.! 0H.! v0.! Amm.!0 00.! HN.! m0.! 00.! 0N.! 00.! OCvamu CH mmmcm>HmmHEumm m0.+ N0.! 00.! vH.! m0.+ m0.+ 00.! m0.! NH.! 00.! 00.! coHuommeucmmHU unmswmum N0.! N0.! ~0.+ m0.! 00.! 00.! m0.+ mo.+ 00.+ 00.! ~0.+ coHuummeummmHv HmconmooO N0.+ 00.! #0.! 00.! m0.! 00.! H0.! 0 H0.! 00.! H0.! mchcmefl mum cmHCHHco mH.! 0H.! 0H.! H~.! 50.+ NH.! 00.! 0H.! 0N.! VH.! 0N.! uso uom Ou mxHH UHDO3 Ahm.!v m0.! NN.! m0.! 00.! 00.! Av~.!0 0H.! m0.! 00.! NH.! nofl HHSU m CH ommmmue 0 HH.! 0H.! m0.! mo.+ H0.+ 00.! H0.! m0.! 0H.! m0.! coHuamuwQ 00.! 0 HH.! m0.! H0.+ v0.+ NH.! m0.! H0.+ #0.! m0.! qum>OH UNCOHummDUCD 0H.! HH.+ h0.+ mH.+ H0.+ mH.+ v0.+ v0.+ mH.+ MH.+ 0H.+ ucmumm Cu cmumHH >Hco H0.+ HN.! 0H.! 00N.!v NH.! A0M.IV 00.! Am~.!0 mm.! 0H.! Amm.!v Hmsvw an no OHH£O mcHummua VH.! MH.+ 00.! 0H.+ ~0.+ HH.+ MH.! 50.+ mH.+ v0.+ HH.+ mHmom wmwleHm mun mucmumm umOHMUw Hmdm o uH> 0H2 onmm 00:0 0 uH> couH ono omo 000 000 Hmo muwnuoz no mmudnHuuud HMOHmoHoco>mQOHUOm can mxaucH ucmHuusz mcoea mcoHumHouuou .~¢.m oHnMB 159 "trapped in a dull job" (negatively related to calcium and ascorbic acid intakes). The group of nutrients to which the "treating child as an equal" scale is inversely related is provided by the bread and cereals food group. In contrast, the fact that the "trapped in a dull job" scale inversely relates to calcium and ascorbic acid may mean that these mothers who do not feel "trapped" are more apt to provide their children with more milk, fruits and vegetables. The only other scale which shows a relationship to nutrient intake is that of the "nutrition is important" attitude which is positively related to calcium and riboflavin. This may mean that mothers who feel that nutrition is of particular concern tend to provide their children with a greater amount of dairy products. Results of Blood Tests Finger prick blood samples were analyzed for hemoglobin, hematocrit, serum albumin and total serum proteins, using accepted procedures previously described. Results from these analyses are expressed in relation to the ICNND categories, designated as deficient, low, acceptable, or high values (Table 5.43). Less than 2% of the sample had hemoglobin and hematocrit values in the "low" category while none were “deficient." No children had serum protein levels in the "deficient" category, and less than 3% were classified as having "low" 160 values. None of the children for whom blood samples were obtained had values for serum albumin in either the deficient or low category. Table 5.43. .Results of Blood Tests of Preschool Children Expressed in Relation to ICNND Categories ICNND Categories Deficient Low Acceptable High <10 "' 10.0-10.9"'11;0—12.4‘ 312.5 Hemoglobin (2,) (60) (55) Mean = 12.38 <30 ' -'3o.o—33.9"-34.o—36.9* 237.0 Hematocrit (2). (5.7) (62) (PCV) 0 1.7% 47.1% 51.2% Mean = 36.69 ‘ <6‘ ‘ 6.00 6.4' ‘ 6.5- 6.9 *‘27.0 Total Serum (3) (19) (79) Proteins 0 2.9% 18.8% 78.2% (gm/100 m1) Mean = 7.23 <2.8 ‘ 2.8-3.51 '3.52—4.24‘ £4.25 Sermm Albumin (14) (97) (gm/100 m1) 0 0 12.6% 87.4% Mean :,4.551 Random urine samples, collected for approximately one— third of the children in the total sample, were analyzed for hydroxyproline and creatinine content. These values were then expressed as the hydroxyproline:creatinine ratio 161 and the "hydroxyproline index" (Whitehead, 1965). The mean values for these two entities were 0.251 t 0.090 and 3.577 t 1.374. These results are comparable to those listed by Whitehead (1965) for the more affluent children in his sample. Relationship of Biochemical Data to Other variables Data from the analyses of blood and urine were com- pared with the other variables selected for study by means of Pearson productdmoment correlation coefficients. Table 5.44 indicates how the blood and urine variables compare among themselves as well as with nutrient intake. Assuming that a correlation coefficient of 0.23 is significant at the .01 level (Dixon and Massey, 1969:569), it is seen that hemoglobin and hematocrit, total serum proteins and serum albumin, as well as the hydroxyproline: creatinine ratio and the hydroxyproline index are highly related, as would be expected. Hematocrit and serum albumin values are negatively related. None of the blood values are significantly related to protein or iron intake, although some of the B-complex vitamins, namely riboflavin and niacin are associated with the hydroxyproline variables. The relationships between the biochemical data and the anthrOpometric measurements are somewhat more definitive (Table 5.45). Hemoglobin is positively related 162 00. mo. 00. .0~.. ~00! mo. mm. 0H. Hm. mH. 00. 00. «m. 0H. mo. NH. 00.! 00. 0H. 00. 00.! H0. HH. mm. 0H. 00. mo. 0H. Hm.! 00.! 0 ! 00.! mH. 0H. mo. 00. mo. 00. 00.! 00. N0. m0. 0H. 00. 0 HH. 00.! NH. 0~.! ¢~.! H0.! 00. 00. 0H. HH. mo. 0H. 0H. 00. MH. 0 ! «0.! H0. 0H. 0.! 0H. 00.H «m. 00.H 00.H hm. 0H.! 00. 00.H m~.! 0H.! 00.H mq. .H 00.H xmocH .ummuu .oum ..bHa ... . oumlmo "OHQImo Ecumm Enumm and £00 pHo< OHAHoomd GHOMHZ GH>MHm0hHm GHEMHne d cHemuH> couH EDHOHMU mumuvmeonumu umm QHmuoum mmHuonu xmccH mcHHoummxoupmm mcHsHummHoumcHHoummxounmm mchuoum Esumm Hmuoa GHEchm Enumm uHHooumemm GHQOHmoEmm .hH .mH .mH .wH .MH .NH .HH .0H .m .0 .h .0 .m .0 .m .N .H mxmuqH ucmHHunz m> mumq HMOHsacOOHm uxHuumz GOHumHmHHoo .vv.m OHDMB 163 to most of the anthropometric values, particularly the scaled weight and height measurements. This tendency is not shown to any great extent by the hematocrit data, except for its significant association with the height-weight-age scale and upper arm circumference. Neither the serum albumin nor the total serum proteins show any signifccant association with any of the anthrOpometric measurements. The hydroxyproline:creatinine ratio is positively related to several of the scaled measurements, namely heightdweight- age and Sargent's weight-height scale; it is negatively related to the Fels' weight-age scale, the weightzheight ratio and chest circumference. Whitehead's (1965) hydroxyproline index is significantly related to the develogmental index for weight and shoulder diameter, while it shows a negative correlation with the gain in height and sitting height. Although the degree of correlation between the demographic characteristics of families and the biochemical data is inconclusive for the most part, the hydroxy- proline:creatinine ratio and hydroxyproline index are significantly associated with the number of children in the household under five years of age (Table 5.46). Table 5.47 indicates the relationship of family income to the blood data, classified according to the ICNND standards. This table reveals no significant association between low family income and an increased prevalence of 164 00.! mo. 00. 0 ! . 0H. 0H. 0H. 00. 0H. 0H.! 0H. HON.0 H0.! 0H. 0H.! 0H. ANN.V HNv.0 N0.I 0H. 00.! 00.! 0H. 00. 0H.! AmN.!0 00. 0 00. 0H. H0. 00.! 00.! 00.! 0H. 00. 00. 0N. 00.! H0.! 00.! AmN.V 00. HH. H0.! 00. 00.! AhN.0 H00.!0 00.! 00.! 0H. 00. HH. H0.! NN. 00. 0H. 00. NN. 00. H0. 0H.! 00.! 0H. AVN.0 H00. 0 00.! H0. 00. 0H. HmN.0 0H.! N0. 00.! 0H.! 00. HN. NH.! 00. H0.! 00.! 00. AmN.V 00. HmN.!V 00. NH. 0H. HON.0 N0. N0. mo. 00. NH. AhN.V NN.! 0N. 00.! H0.! AHN.0 AmN.0 00.! 0H. NH.! NH.! 0H. HmN.0 H0. 0H. 00.! N0. NH. ANO.V AON.!0 NH.! HH.! m0.! 0H. 0H. 0N.! H00.!0 0 N0. 0H. HmN.0 HvN.!V 0H.! 00. 00. H0. 00. 0H.! 00.! 00.! HH.! 00. 0H. xmvsH. ..ummuo .onm «3H0 ... . ... oumlmo “oumlmo Esumm ..Esumm and £00 HMHsmmombsmlmmmsMOHe# UHowstm mmonHu!mmmsonhu cHomcme mosmummsboHHo EH0 Amman nucmmuh xcduu mo meCH mosmummasouHo ummeo mosmummesouHo cums HmumEMHw OH>Hmm kumEMHo HmvHsonm pn0Hmn maHuuHm mmmluanwn\000!un0HmauxmocH uanmnlxmvsH Hmucmemon>mQ usmHmBIxmwcH HmucmEQOHm>mQ was s0 .mmMIHdemm was cH .mmmIHanmz OHumu uanmn\uanms Hucmmumm0 mHmom pfimHmeluanmz mmMIusmHmZIuanmm nuHcmumZqumsum .mmmluemHmm cpHcmHmzluHmsum .mmmtuanmz mHmm .GOMIHdemm mHmm .mmmludemz usmfimuocH.uemHmn Hmuoa chm udemS Hmpoe musmewusmmmz OHHumEomounus< m> mung HMOHemnOOHm uxHHumz COHuMHmHHOU .00.0 mHnme 165 low or unacceptable blood values. The proportion of children from families with an income of less than $4,000 who have high blood values is quite comparable to the proportion from families having annual incomes of $20,000 or more. For both hemoglobin and hematocrit values, children from families with an income of $10,000- 16,000 seem to have a greater share of children in the low and acceptable categories. The correlations between the biochemical data and the sociOpsychological attributes of the mothers (Table 5.48) revealed essentially no significant relation- ships. The semantic differential scales do show a positive association with hemoglobin, the hydroxyproline: creatinine ratio and the hydroxyproline index. The "frequent dissatisfaction" scale (from the PARI) was negatively correlated with the hydroxyproline index. The health value was also positively related to the hydroxyproline:creatinine ratio. Moderator Effects Table 5.49 indicates the effects of certain variables identified as "moderating" the effects of certain independent variables, i.e., the nutrients, on the dependent variables, in this case the blood components. The association between protein and hemoglobin was (positive for those children who mothers disagreed with the following PARI scales: only listen to parent, 166 NH-- 0H.- 00.- 0N., 0H.! 00.- 0000 0000Hzoqx .005: no muoom 00. H0.- 00. 0H. 00. 0H. 00500 .0 on0m. amnesz 00. 00. 00.- 00. HH.! H0.! mHmom 000£H0banmQImmson mo GOHuncou HH. 0H. 0H.- 0H.- 00. 00. 000:0 00chouo 0H.- 0H.- 00.! N0. 0H. 0H. Hcmu 00 ago 0H. 0H. 0H. 0H. 00.- 00.- 00000 0 0000 0H 00>os mmeHa 0H.- 0H.! HH. 0H.- N0. 0N.- on0Ha\000030 000m HH. N0. N0. 00.- H0N.-0 0H.- 0Homo mmHH mHHa0m 0H 00000 00. N0.! 00.! N0.! N0. 00.- 0HHeo 8600 0030 000002 NH. 00. 0 00. 0H. 0H.! 0003\00o0 How 00000 00:02 0H. 00. 00.! 0H.! 00.! 00. xmch 000 NH. 00. 00.- 00.! 00.- 00. meoqu 0HHE00 00.- 00. 0H. HH. 00. 00.- 0H0om 000000 meoqu 00. 00.- 00.- H0. H0.- 0H. 0H0om aoHu0oo00 can cOHummsooo .musmHmm 00.- 00. N0. 00. N0. 0N.- 000000 H0uHu0s 000000: HH.- 0H.! 00. H0. ANN.-0 0H.! 0HHno 0o coHuHmom H0aHouo H0N.0 10N.0 NH. H0.- 00. 0H.- 00000 0 000:: cmuuHHno .oz 00. N0. 0H. 00.- 0H.- 0H.! 0500 0H 0000000 H0uoa XmOGH . ummHU . .. OHnH . £2 OHQImO. noum!mo Edumm Esumm pom .mmm. moHHHEmm mo moHumHHmuomuan OHnmmumoemQ vmuomHmm 0cm mama HMUHEQSOOHm UGOEE mGOHMMHmHHOU .0v.m mHnma IL67 Amy Amy Amav “may .oav Ammv .mv o.oo o.oc any m.~w m.hm «.mw m.om Away o.vm «.ma Away o.cw 0.0N “Hay m.mh m.oa n.0H Ammv c.coa AHHV o.om 0.0N any mdm H.h Avav b.wm m.ma o.ooa Avav m.hm m.NH Anny m.Hm N.mH v.Hh o.m~ on Amy o.~¢ H.hm AmHv Aeav m.vm m.om m.vH Andy v.dm w.mv .omv AHHV c.om 0.0m o m.~m m.hm o N.wv m.mm o a.~v 0.0m H.h m.Hm m.mm o ~.hv m.~m m.mm m.h~ H.m :uucHHnU no umnabz .o.0Mv 000: Aa.wum.wv oHndumuoo¢ A¢.ouo.ov 30A mcwmuoum eauwm couvawnu no umnssz mHndumoood swabnaa asumm couuawnu mo gonadz Ho.hm.mv 0000 Aa.omno.¢mv mHnmummood Am.MMIc.omv 304 uwuooumEom 0000H000 mo umnabz 0H0 com \00 0.NH Av 00H: “0.NHuo.HH. magnummooc “Ha 00H \00 0.0H-o.oHv seq canonoewm .HHH .HH mmmfiwdloochH mmmmuocon mamolooov ooovmv 0000H000 00 0 +c°o.oN0 000.0H-ooo.0H 000.0Huoco.0H mama voon ou mEUOGH hHHEMm mo mwzchNumamm .hv.m manna 168 mowumnummc cowumoavm aooomum A020000000 newwfiamm Emfluucuo mafiamm avamum umwummum aaocoom mmDA<> “No H00000000000 00000000 AHV H00000000000 00000000 mHmom mmmcmmmaumsom mamom mflaoad no. wo.| o no. «0.: oo.| o~.| Hom.uv 0o. ma. No. Ho.l ha.| hH.| mo. mo. 5H. ho. mo.| oH.I oH.u H~.I HH. ma. so. ma. co. No. oo.u na.| mo. mo. MH.u oo.u mo. Ho.| ma. Aem.v oH. vo. HH.: o mo.u mo. vo. mo.| mo.| mo. wo. wo.: oo.| mo.n Ho.l no.1 Amv.|o Amm.|v No.1 >H.| oH.u Ao~.Io AHM.IV Am~.|v oH.+ ~o.+ HH.: AoN.Iv va.+ vH.+ Ho.+ mo.n No.| HH.: mH.I mH.| vo.+ oH.+ oo.+ ~o.+ «H.I ma.| o mo.+ mo.l ~o.+ mo.+ mo.+ mo.| oo.| ma.+ mo.+ .o~.+v ma.+ HH.+ ¢H.+ co.| oa.+ mo.l mo.| mo.| 0H.+ Ho.| mo.+ «H.I oH.| mo.| wo.+ oo.+ ho.+ vo.| no.1 mo.+ mH.+ Ho.u mo.+ A¢N.IV mH.n MH.+ vo.+ co.+ wa.t Ho.+ Ho.+ Ho.n 0H.: Ho.| ¢H.+ mo.n no.5 mo.+ N~.c oo.| wo.u mH.I oo.| Ho.+ HH.: mo.+ no.3 o~.l oH.I mo.+ mo.| NH.+ no.+ 0H.: wo.| No.3 no.| wo.l oo.u xoocu .umwuo oum Dad oumnmo ”oumumo Esumm 250mm 00: non acmuuomsfi auw> aw cofiuwuunz mcwvmwm 050nm mmocw>flmmfisumm mHmom cofluowumqummwc ucmsvmum mHmom cofiuomumHummmflv HMQOHmmooO mHmom mcfivcmewc mum cmuoafinu mamom 0:0 umm ou mxwa caaox mamom non Haze m :H ownmmua mamom newumwowa mamom wuammoH omcoflummavca mHMOm ucwumm ou :mumwa wane mamom Hmavm :0 mm vHfico mcwummus AHmdmo mHmom mmwzlaam mum mucmumm Hmdm mumnuoz mo mmuanwuuuc HMOHooHonoxmmoHoom .m> mama H0005m5000m wcoec chquHwHuou .m¢.m wHama 169 unquestioned loyalty, deception, trapped in a dull job, and with powerlessness. This same relationship was also noted in terms of those who were above the mean on the socioeconomic status scale, family income, parents' occupation and education scale, the family centrism value, and were of the Caucasian race. A significant positive correlation between iron intake and hemoglobin was observed among those who disagreed with the following PARI scales: only listen to parents, unquestioned loyalty, and trapped in a dull job, powerlessness, as well as the following variables-- socioeconomic status scale, parents' occupation and education scale. A negative correlation between iron and hemoglobin was indicated for the white children. The relationship between hemoglobin and calorie intake was positive for children whose mothers disagreed with the PARI "parents are all-wise" scale and the family centrism value and for those who agreed with the "would like to get out" scale. The relationship between serum albumin and dietary protein intake was positive for those children below the mean on the socioeconomic status scale, and whose mothers scored in the lower percentiles on the nutrition knowledge test. This correlation was negative for those mothers who rated less than the mean for the education value. The association between serum albumin and calorie intake was 1370 EN . b NH . I :8: 9m .w mo . I 03000.8 .0000on00000: 000m 00003 xo0Hm mo . I fin» 92393 0000093060: @509: >359.“ oH . I 3m» so“; 3000 HucoHuasooo no . I Am mu :Hmuoum cHnonosm: can coHuooHfim . unsound on . I .Nm .a sown m o . I awn 0 3800.3 EBOH 0050: mmmcmmoaumzom 0mw oN.I 0000o00 00000H0 0:000 0000 .0000H av. H~.I cfimuoum mcwmuoum Enumm I3ocx coHuwuuDCa co muoom a: . Iv mo .I c0050.; 0505030 5.00m 05.2; counumoapm 0H.I .va 0H00o00 oH.I fie» mmfiuono :NQOHoOEom £59, £00.00ch >HHE0u «on .v o awmuoum :Haanaa Enumw ma . I afim no.3” NH . I on 050093 cHnoHoOEmm 3000 mmm 300 000: adv; H~.I chuoud ammuwHo mchuoum 05.35 am v . Iv Hm . I moHuonu :HnonOEm: 302:: 01.6.0. mo . I fin» 03.00.20 5053.? 08.005 ..uao yum 0» .83..” 3:03.. oH . I m“ couH 3023 05000 9” . I v. :Hmuoum canoHOOEm: ..nofl HHHG m 5 0003008.. no . I fin % c.8098 cHnoHoOEm: :53. 0.2000 ..cofludwowo. MH .I arm.» 00.: 302.: 30.00 00 . I «mm .w c.3098 03000.30on shuHmon owcoMummsvcox N L .0 0 .u 09.: m N . I» «a v .9 9.300.; cHnoHOOEmm 35?: 05000 smucmumm ou :mumfla xacos 00 .I 3.0 .V 0000300 0330900: 32.: 0H000 sumHSIHHM mum mucmumm: ucmammumd acmemommmmwo muoum 000000602 cowunmuuou mHAmHIump ucmwcmqmpfi mfincwumxr ucmpcwdwol uowmummoz magmGOQEoo UOOHm fled MUCOflHUSZ C003UQQ QHEWGOHUGHQK USU CO mUHQMHHM> HOUflHQUOZ ”muomflwm MO muowwwnm omv.m OHQMB 171 positive for children whose mothers disagreed with the PARI "would like to get out" scale. The correlation between total serum proteins and dietary protein intake was positive for children whose mothers scored in the less than fiftieth percentile in the nutrition knowledge test and who agreed with the "would like to get out" scale. Results of Anthropometric Measurements Height and weight measurements for all children in the sample were taken at three intervals throughout the school year, while a complete set of anthrOpometric measurements (including certain diameters, circumferences, and skinfold thicknesses) were obtained towards the end of the school year. Results of the incrementalgains in height and weight throughout the school year revealed certain seasonal differences. The mean weight gain during the spring months (March to May) was nearly half of that which was gained throughout the winter months of November through March. Height gains did not indicate such seasonal differ- ences. In general, children gained nearly two and one-half pounds in weight and approximately one and one-quarter inches in height throughout the school year when measurements were made. Recognizing the influences of age, sex, and genetic differences on physical growth, any discussion of gross 172 height and weight measurements would be somewhat mis- leading. In an attempt to correct for such influences, height and weight data of children in the present study were compared with height-age and weight-age percentile values from two accepted growth standards, the Fels data (Children's Bureau, 1967) and the Boston standards (Nelson, 1968:1007). Tables 5.50 and 5.51 present the distribution of heights and weights of the children studied in relation to the percentiles of these two «growth.standards. On the average, over 15% of the sample was at the ninety-fifth percentile or above for weight on the Fels standard, while only 4.4% of the sample were below the fifth percentile for weight. In terms of height, 4.4% of the sample was at the ninety-fifth percentile or above on the Fels standard while over 11% were at the fifth percentile or below. In reference to the Boston percentiles for weight, over 7% of the sample was at the ninety—seventh percentile or above, while slightly more than 5% were at the third percentile or below. Approximately 3% of the sample was in the highest percentile for height while nearly 9% were at the third percentile for height. Table 5.52 presents a comparison of the height and weight measurements as expressed by the Fels and Boston standards. These data suggest that the children studied were somewhat stockier for their age than were children from the standard pOpulations. 0.0 N.HH 0.0N . 0.00 ,1 0.0H! 0.0 H.0 00: .000I000000 0.0 0.0 0.0H 0.00 0.0H 0.0 0.0H 0000s .000I000000 a. 0.N 0.0H 0.0N N.0m 0.NH 0.0 0.0 00000>oz .000I000000 7 IIIIIIIIIIII IIIIIII. lllllllllllllllllllzllnl ‘Ill‘l‘llllllallll‘ IIIIIIIIIII'IIIIIIII l 0.0 0.0H 0.0N 0.0N H.0H 0.HH N.0 00: .000I00000z 0.0 H.0H 0.0H H.0N H.0H 0.0 0.0 00002 .000I00000z 0.0 N.0H 0.0N N.0H N.0H 0.HH 0.0 00000>oz .000I00000z mamamm mo mmmusmoumm. 0000 0000 . 0000. 00omI- 000m- .000H . 000 w . 00H0000000m . mmaaucmoumm uumnum £003 omnmmfiov cmuoafino Hoonommum NO 0030003 can munmwmm mo coausnwnumao .om.m manna 174 H.N 0.H 0.0 ..m.0N H.00 0.0H 0.0 . 0.0 0.0 00: .000I000H00 0.0 0.H 0.0 0.0H H.0N 0.HN 0.0H H.0 0.0 00002 .000I000000 0.H H.0 0.0H 0.0H 0.0m 0.0H 0.0 0.0 0.0 00000>oz .000I000000 0.0 0.0 0.HH 0.HN 0.0N 0.0H 0.0 0.N H.N 00: .000I00000z 0.0 0.HH 0.HH 0.0H 0.0N 0.HN 0.0 o 0.0 00002 .000I00000z H.0 0.0 0.0H 0.0N 0.0H 0.0N 0.0 m.N m.N 000s0>oz .000I00000z wamemm mo mmmusmonmm. 0000. 0000 0000 0000 0000‘ 000N p000H 000 000 00H00000000 mmHHucmoumm mamm £003 omnmmfiou schHHnU Hoosommnm mo mpnmdma 6cm munmflmm mo coausnfluumwa .Hm.m manna 175 Table 5.52. Comparison of Height and Weight Data in Reference to Fels and Stuart Standards Lower 10th percentile Upper 10th (percentage of sample) Fels Boston Fels Boston Weight-age (mean) 9.9 16.2 28.8 22.4 Height-age (mean) 19.8 16.7 13-4 (14.8 Height and weight data for children in the study were also classified in relation to a certain height-weight- age classification devised by Smith and Brown (1970). This information is presented in Table 5.53. This classification also supports the contention that children in the sample were heavier and stockier than their counterparts in the Fels pOpulation. Over 31% of the sample were in the large and overweight categories com— pared to slightly more than 25% in the underweight and small categories. According to Sargent's (1961) weight-for-height classification, most children were classified in the "normal" category. A somewhat higher percentage of the sample were in the underweight-slender categories than were in the stocky-overweight—obese categories. The index, weight/height, has been proposed as a (useful means for evaluating physical measurements. In this sample of children, the mean ratio was 1.588 t 0.121,with the range from 1.21 to 1.94. 176 mm.oH . mo.HN _ mm.w¢V. ..vo.ma om.v . . cums 0H.HH 00.0N 0H.00 00.0H 00.0 .000 00: mv.HH H0.om mv.H¢ 0H.Nm 0~.¢ .uEE.£oumz o¢.o 0m.Hm mm.m¢ oo.o~ No.0 .085 Hmaem>oz Amdmamm mo manpcmoummo unoamsum>o mmHmn wmmum>¢, HHmEm _ unmflmznmopo _ ; .Nmmmmmmm. _ I I . 0mm Iunmamzlunmamm we mucmswusmmmz unmamz can uzmflmm mo coauanwuumaa .mm.m magma 177 The "develogmental age" concept was used to express the height—age or weight-age (calculated as the chronological age at which the child's height or weight crosses the fiftieth percentile of the Boston (Stuart) percentile in relation to the child's chronological age. Ideally, this term would approximate 1.0. For this ‘group of children the develOpmental index for weight averaged 0.978 i 0-196, while that for height averaged 0.949 t 0.126. The ratio develOpmental index for height/ developmental index for weight averaged 0.99 i 0.137. ”Relationships of Anthropometric Measurements to Other ‘Variables The intercorrelations among the various anthropometric measurements and scaled values for height and weight reveal some rather contrasting relationships (Table 5.54). For example, the total increments of height and weight are highly related to each other, but the change in weight is correlated only to weight-age in May, while the total height change is related only to the develOpmental index for height. The scaled weight-age and height-age values, as evaluated by the Fels and Stuart standards, are highly related (r = 0.96), so it seems that both scales are measuring the same dimension. Weight—age is significantly correlated with all other measurements, except head (circumference and index of trunk breadth. Scaled height- age is highly related to the other scaled weight and height values, but is not related to the other 178 anthrOpometric measurements, with the exception of pelvic diameter. The height- and weight-age indexes are inter- correlated, but are not related to head circumference. Skinfold thicknesses are not related to the height and weight increments or to the height indices. When the relationships between anthropometric measurements and nutrient intake are examined (Table 5.55), few significant correlations are evident. Protein intake is highly related to the scaled weight-age values and to the weight-age (in May) value. The weight—age/height-age index is correlated with both calcium and riboflavin. Riboflavin intake is also associated with the scaled weight-age values. Iron is related to the height increment, while Vitamin A intake is correlated with the scaled Stuart weight-age value. Although there are few significant correlation coefficients between the anthrOpometric measurements and the sociOpsychological attributes of the mothers, it is interesting to note that the PARI "trapped in a dull job" scale was inversely correlated with four scaled height- weight values and with sitting height and triceps skinfold thickness (Table 5.56). When anthropometric measurements were examined in relation to selected demographic and resource character- ‘istics of the families (Table 5.57), several showed significant relationships. The mother's marital status 179 00.H 00. 00. 0.. 0H. 0H. N0. N0. 00. 00. HH. 0o. 00. HH. 00. 0.. H0. HH. .0. 0H. 00. 0H.- 00. uaHsmuwunsn-0Houc0x0 .nN 00.H 0.. 0.. on. on. 00. 00. 00. H0. 0H. 0N. 0H. H0. 0.. 00. No. 00. 00. HH. .0. 00.- 00. 0000000I000000000 0H000000 .NN 00.H on. 00. 00. no. 00. 0.. 0H. 0H. HN. .N. 00. 00. H0. H0. 0H. 0.. 0H. Ho. 00. 0H. 0000000050000 :00 0000: .HN 00.H H0. 00. 00. .0. 00. «H. 00. NH. 00. NH. 0N. 0N. an. 00. 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Ho.I 0H. 0H000 000000-000H0: .0 00.H 0.. H0. 00. 00. HH. 0H. 000-00000>I000000 .0 00.H 00. 00. 00. 0H. 00. 0000000: 000000 .000.000000 .0 00.H 00. 00. 0o. 0H. 00H00002 000000 .000I000Hoz .0 00.H 00. 0H. 00. 0H00 .000.000000 .0 00.H no. 0H. 0H0. .ooaI000003 .0 00.H 30.. 0005005 0:30: 130... .n 00.H 0000 00000: H0000 .H 0N NN HN 0N 0H 0H 0H 0H 0H 0H 0H NH HH 0H 0 0 0 0 0 v n N H nucoluuduaut UHHuolomoh—nusd 0:3 accuucHounOououcn .vm.m 0.33. 180 00.- 00. 00. 0H. H0. 0H. 00. 00.- 00. 00. 0 00H00000000-000000000 0H000000 .00 00.- 00.- 00. H0.- 00. 00.- 00. 0H.- 00.- 0 00.- 0000000-000000000 0H0000xm .00 H0. NH. 00.- 00. mo.- 00. 00.- 00.- 0H.- 00. 00.- 0000000000000 000 00000 .H0 00.- 00.- 00.- 00.- 0H.- 00. 00.- 00.- 00.- 00.- 00.- 0000000 00000 00 x0000 .00 00. 00. 00.- 00.- 00. 00. 00.- 00.- 0H.- 00.- 00.- 0000000000000 00000 .0H 0 m0. 0H.- 00.- 00.- 00. 0H.- 00.- 00.- HH.- 0H.- 0000000000000 0000 .0H 00. 00. 00. 00. 0 HH. H0. 00. 00.- 00. H0. 00000000 00>H00 .0H H0. 00. 0 - 00.- 00.- 00. 00.- 00. 00.- 0 - H0.- 00000000 000H000m .0H H0.- H0. 00. 00.- H0. H0. 00. 00.- 0H.- H0.- 00.- 000000 0000000 .0H 00. 00. 000.0 00. 0H. 00.- 000.0 00. mo. 0H. 00. 000 .00\000 .03-00000 .0H 0H. 00. 0H. 0H. 0H. 0H. 00. 00. 00. 0H. 0H. .00-00000 H0000000H0>00 .0H 0H. HH. m0. 0H. 00. 00. 00. 00. 00. H0. 00. .03-x0000 H0000000H0>00 .0H 0H. 00. 0H. 0H. 0H. 00. 0H. 0H. mo. 0H. 0H. 002 00 .000-000000 .HH 0H. H0. 000.0 0H. 00. 0H. 00. HH. 00. 000.0 0H. 002 00 .000-000003 .0H 0 - 00. 00. 0H. 0H. 0H. 0H. H0.- HH. 00. 00. 00000 000000-000003 .0 00.- 00. 0H. 00. 00. 0H. 0H. 00. 00. 0H. 00. 0H000 000000-000003 .0 00. 00. 0H. 0H. 0H. 00. 0H. 00.- 00. 00. 00. 000-000003-000000 .0 0H. 00. 0H. 0H. 0H. 0H. 0H. 00. 00. 0H. 0H. .00: .000 .000-000000 .0 0H. 0H. 000.0 000.0 000.0 0H. 00. 00. 0H. “00.0 0H. .00: .000 .000-000003 .m 0H. 00. 00. 0H. 0H. 0H. 00. 00. 00. «H. 00. 0H00 .000-000000 .0 «0. 0H. 000.0 00. H0. 00. 0H. H0. 00. 000.0 00. 0000 .000-000003 .0 mo. ma. no. ma. mo. Ahm.v Ho.l mm. ma. 0H. om. unmewuocfl 0:000: H0009 .N mo. AH. «0. ma. HO. HA. vo.| ma. 0 mo. 0o. G000 unmfim3 H0009 .H o 00> 002 0000 000a 0 00> 0000 00 000 000 000 000 mxmucH 0:000052 can mucmsmusmmmz owuumaomounpcd cmm3umm mcofluMHmuuou .mm.m manna 181 A~o dowucououufiv cuunoaom * Au. adducoumuuwo vanadEUm mason ucduuoaau no acquwuusz : H ovauuuuo ocuuoOu usond unoco>unuoauom m A noon-noduwiom canon: 2 canon occuuucu-«uuuoav unoauuum. o A nuauonunuo~ ovcoaunusoc3- v sooner canon succuoa ou sound" >Aco- n oofiuuvum canon .Hnavo :1 no odwzo ocauQOua. N >a0coomh u cacao nouwiluao can nucouam- a "mubq¢> ".cnuum ~m~on oo. co. AH. no. o o~.0 no.0 ~A.0 no. o~.0 vo.0 no.0 mo.+ -.0 no.0 no.+ no.0 o -.¢ o~.0 no.0 no.0 oo.0 oo.+ m~.0 nouoalwv nooaaozw oo. mo. vo. ma. ao.0 o va.0 na.0 mo. na.0 no.0 v~.¢ ao.+ -.0 no.0 -.+ «o.+ no.0 mo.+ .o~.0. o~.0 va.0 o«.0 ~H.+ oa.0 unawuz ocwuuom we. no. go. no.0 no.- .o.- .o. .o.- .o. Ho.+ o~.+ no.0 oo.0 vo.0 no.0 0 no.+ "0.. ~o.- a~.- .o.- oo.+ v~.+ no.+ o~.- on. .unxoo. .9: uuuvcn ma. «H. oo.0 oo. «a.0 ma. ~H.0 v~.0 oa. o~.+ o~.+ -.o no.+ o~.0 n«.0 vo.+ no.0 -.0 no.0 H~.0 no.0 no.0 -.0 oa.+ n~.0 unoaonuxovca .>oo NA. oH. n~.0 no.0 HH.: mo. no. no.0 oo. no.0 o~.+ m~.+ vo.0 -.0 m~.0 no.0 no.0 no.0 Ho.0 .mn.0o a«.0 no.0 ~o.+ n~.+ ma.0 unouoa0noocd .>uo ~A. ca. -.0 o no.0 «a. do.0 no.0 .o. o~.+ ~H.+ oa.¢ no.0 «A.. «4.0 no.0 no.0 mo.0 Ho.+ .v~.0. 0H.- v0.0 o~.- HH.+ ~«.0 nu: a“ no~-u:oqou NH. no. no.0 no.0 m~.0 no. no. no.0 no. no.0 v~.+ n~.¢ no.0 -.0 o~.0 vo.+ no.0 no.0 ~o.0 .o~.0. -.0 o no.0 oo.+ .A.0 nut a“ ooa0ucouol oo. no.0 no. mo. we. oo.0 o oa.0 no.0 n~.0 o~.+ o«.0 no.0 no.0 -.0 ~o.+ o~.+ vo.0 n~.+ no.0 mo.+ no.+ o no.0 «o.0 ouuau unodonuucuauz o no.0 ma. mo. na. no.0 no.0 va.0 no. v~.0 do.0 no.0 no.0 no.0 no.0 ao.0 -.+ no.0 m~.+ «a.0 no.0 oo.0 vo.0 no.+ no.0 canon unouoc0u20wu3 ad. no. no. «a. no.0 «a.0 Hfl.- oo.0 no. no.- no.0 .o.0 vo.- -.0 «o.. oo.0 no.+ oo.- .~.+ .~.0 No.0 H0.+ .o.- no.0 nH.- oo--uzodo)-ucouom VA. on. no.0 AA. no.0 ea. n10 nu... no. no.+ na.+ Cu... 00.4 -.0 n~.0 no.0 v0.0 NN.! no.9 «.70 no.0 no.0 v~.l ON.+ ou.0 .Mot sum .ouulucowvm ma. no. ~o. no. no.0 no. oo.0 ~H.0 vo. no.0 va.+ no.+ no.0 o~.0 o~.0 no.0 oo.+ nu.0 o~.+ .m~.0o no.0 ~o.0 na.0 no.4 o«.0 .uox sum .oonuunofiol om. «A. no.0 ma. no.0 ~H. m~.0 v~.0 no. no.0 n~.+ na.+ vo.+ a~.0 m~.0 no.0 «o.0 o«.0 oo.+ on.0 no.0 vo.0 Av~.0o o~.+ n~.0 naom .oou0unowoz «a. co. no. AA. «o. «o. no.0 va.0 no. Ao.0 m~.+ no.+ no.0 o~.0 A~.0 ~o.+ oo.+ n~.0 o~.+ -.0 no.0 ~o.+ na.0 oa.+ v~.0 mach .oo-0ucoaos no. me. an.0 ao.0 AH. vo.0 no.0 no. no. mo.+ ~o.+ no.0 no.0 Ho.+ ao.0 no.+ vo.0 no.0 ao.+ ~a.+ o~.+ na.+ no.0 no.0 no.0 ucoiduuco ucmflom mo. m~.0 -.0 No. va. oo. «o. «o. no. ao.0 No.0 ~H.¢ no.0 no.0 o~.0 ~a.+ no.0 o o~.0 o «H.+ oo.+ o~.+ o~.0 va.+ :«cv usual) "duos mm on MN nu HH. on 9H. oH ha mH VHF le. hH\ no. HH ow .b 9 \IP w m .P\ n ~ H muozuot no unusnuuuu< Havaooaozonnmo«oom can nunDluusnaot vauu0I0n0u£un< 020.4 accuuuauuuou .om.m vanah 182 correlated negatively with six of the scaled height— weight values. The parents' occupation and education scale.showed a positive association with several anthrOpometric measurements, namely Fels' height—age, the deVeIOpmental index for height, sitting height, pelvic diameter, and triceps skinfold thickness. The socioeconomic status index (composed of parents' occupa- tion, education and famlly income) correlated significantly with weight-age, and height-age,.the develogmental index for weight, sitting height, pelvic diameter and triceps skinfold thickness. The mother's. ability to name the "Basic Four" food groups needed by the child daily showed a significant relationship to scaled height-age and weight-age values, and the develOpmental indices for height and weight. (Interest— ingly, the mother's performance on the nutrition knowledge test did not show similar significant correlations.) Moderator Effects In analyzing the correlations between the scaled height-weight values and nutrient intake, as moderated by selected family characteristics, the following relation- ships are indicated (Table 5.59). The weight-age value (according to both the Fels and Stuart standards) and ‘for other scaled height- and weight-age values were 183 umoo~30=x .Musz .oo .v Donna. .no oOOnuonnoooc-ousos .oo xooco ocootouu .mo ucoo\c)o .vo vo>oa manna .na oxuaonxuuooao «on: .no o~o>o Ouoo nonidm .AA noose econ nu). noose: .oo canuaosvo + canuuasooo 3003\000u Ham m . xenon mum QIOOCM nanadm nauaun oaoocH annoy» onuono: canunnoa unanouo undo» mv convancu 030: :« Icouuom I amnvmonaa no. no. oo. no. oo.- no.- oo.- oo. no.- oo. no. on. oo.- oo. oo.- no. on.- no. nooncoxn oaoammunnam nn. no. oo. no. no.- no.- oo.- oo.- oo.- oo. oon. . nn. oo.. onn. o on.+ oo.- on.- no.- nooncoxn noooooa no.- oo. oo.- no. no.. vo.- oo.- o no. oo.- no. no. oo.. oo. no.+ oo.- oo.- vo.- oocouooasooou sun noon: oo.- oo. no. no. no. oo.- on.- no.- oo. no.- no. no. oo.. oo. no.0 wn:- oo. oo.- savanna xcsuu no xooco oo.- no. no.- no. no.- oo.- .o.. no.- no. no.- no. no. no.+ no. oo.+ no.- no. oo.- «oomuouasouou guano no.- no.- o oo. no.- oo.- o.- oo.- oo. no.. no. oo. no.+ oo. no.+ no.- oo.- oo.- ouoouooasouou noon o no. oo. no. oo. no.0 no.- no.- oo. oo.- .nn. . no. oo.+ onn. o oo.+ oo.- oo.- oo.- owuoauou oonoon oo. oo. oo. no. no.- no.0 no.- no.- no.- no.0 no. no. oo.. no. oo.+ no.- no.- no.- nouoauoo uaooooom no. no. no. no. no. oo.- oon.-. nn.- no. no.- oon. o no. .o.+ onn. . no.+ Rn.- no.- non:& unmoao ncouuom oo. nn. no. no.- o - o no.0 o - o - oo. on. oo. no.+ no. no.+ oo.- oo. oo.- oo. .uoxooa .uy-xocco oo. oon. . no. no.- no. no.- no.- no.- no.- no.- on. no. nn.+ ovn. . onn.+o no.- oo.- no.- unnoon-xocco .>oo no. oon. o oo. no.- no. no.- no.- o oo.- no. own o oo. oo.+ oo. nn.+o no.- no.- no.- unnooa-xmoco .>wo no. no. o oo.- no. oo.- oo.- no. no.- no.- oon. o no. nn.+ ann.o no.+o no.- oo.- oo. nu: no .ooa-uooooz oo. onn. o oo. oo.- o no.- no.- oo. no.- no. oon. . oo. on.+ on. oon.+o no.0 no.- o - nu: no .ooa-unnooz oo.- oo. oo.- no.0 no.- no. no.0 no. oo.- oo. no.0 no. .o.+ oo.- oo.. ..n. o no.- on. oouuu unnooz-uonoos no.- no. no.. vo.- no.- oo. no.- no. no.- oo. oo.- no. .o.+ no.0 oo.+ on. oo.- oo. coco. unnooo-uznoo: oo. nn. o no. no.- no.0 no.- no. oo. oo. oo. oo. oo.+ oo. no.+ no. no.- no. cue-unnoua-unnooz no. oon. . vo. no. no.- no.- oo.- oo.- no. no.- on. oo. on.+ .nn.o own.+o o - no.- no.- .uo: .sum .uoo-uzooom no. inn. . no. no.- oo.- no.- no.0 oo. no. no. nn. oo. oon.+. no. onn.+ oo. oo.- .o. .no: .sum .ono-uznooz no. .nn. . no. no. oo.- no.- no.- o oo. 3.- nn. no. no.0 3n. . Rnfw no. no.0 no.- noon .ooo-unnoaa no. oon. o oo. oo.- no.- no.- no.- no. no. oo. on. no. on.+ no. onn.+. no. no.0 no. coon .ona-uomou: oo.- oo.- on.- no.- oo. oo.- oo.- no. oo.- no.0 nn.- nn.- no.+ on.- oo.. oo. no. vo. ucosouuco unnoo: no.- o no.- oo. no.- oo.- oo.- o - oo.- o oo.- oo. no.+ oo.- oo.+ oo.- nnn.u oo. noun anon.) oauoa no no oo no no no no oo oo n o n o n v n n o nooooaan uo abounnhououuddu DonaqquEDo and nucofiuusnouz Unuuuaom0u£uc< vocal accouaawouoo .nm.n canon 184 significantly associated with calorie intake and with fat, carbohydrate and protein in those children whose mothers indicated high agreement for the "nutrition is important" attitude. Similar trends were shown between fat intake and the develOpmental index for weight and the weight-age/height-age index. There was a significant positive correlation for "low" powerlessness mothers between the height-weight age scale, Sargent's height-weight scale and the weight: height ratio and calories (as well as the calorie- providing nutrients, fat, carbohydrate and protein). The Opposite trends in the relationships between these variables were evident for mothers who had agreed with items on the powerlessness scale. Positive relationships were shown between calories (also for fat, protein, and carbohydrate) and the various height-weight scales for children whose mothers disagreed the following PARI scales: trapped in a dull job, deceptioned, unquestioned loyalty, and would like to get out. An inverse correlation was shown between calories and the energy-yielding nutrients and the scaled values for children with mothers who did not agree with the "only listen to parent" scale. A high value on the Milbank socioeconomic status yindex moderated a positive correlation between calories and Sargent's height—weight scale, the weight:height Table 5.50. 185 Anthroposetric Heasurenents Effects of Selected Moderator Variables on the Relationship Between Nutrient Intake and :Eoderator Independent Variable Dependent Variable 'Nutrition is inportant' attitude Powerlessness 833 Index PARI Scales0 Trapped in a dull job Deception Unquestioned loyalty Only listen to parent Would like to get out! Occasional dissatisfaction Occasional dissatisfaction Frequent dissatisfaction Parents are all-wise Calories Protein Carbohydrate Calories Protein Carbohydrate Pat Calories Protein Carbohydrate Calories Protein Carbohydrate Calories Protein Pat Carbohydrate Calories Protein Carbohydrate Calories Carbohydrate Calories Carbohydrate Calories rat Carbohydrate Calories Calories Carbohydrate Iel's weight age Stuart weight age Ht-wt-ege Ht-wt-scale Weight-height ratio Ht-wt-sge Ht-wt-scale Height-height ratio Height-weight-age Dev. index-weight Ht-age/ht-age index Ht-wt-age Ht-wt scale weight-height ratio Ht-wt-age Ht-wt scale Height-height ratio Height-weight-age Ht-wt scale weight-height ratio Height-weight-sge Height-height ratio height-weight-age Height-weight scale Height-height ratio Dev. index for weight Isight-age/height-sge Height-weight scale Neight-age/height-sge Height-weight scale Height-height ratio Dev. index for weight Neight-age/height-sge Height-weight-sge Height-weigh: scale leight-height ratio Height-weight-age height-weight scale weight-height ratio Height-weight-age Height-weight scale Height-height ratio Height-weight-sge Height-weight scale Height-height ratio Height-weight-age Height-weight-age Height-weight-age Height-height ratio fleight-weight-sge weight-height ratio Height-weight-age Height-weight-age Height-weight scale Height-height ratio Height-age/height-age Height-weight scale Height-height ratio Height-weight scale Height-height ratio Dev. index for weigh: leight—age/height-age height-weight scale Weight-height ratio leight—age/height-age Height-weight scale Height-height ratio Dev. index for weight weight-age/height—age Height-weight scale Height-weight scale Weight-height ratio leight-sge/height-age Dev. index for weight Dev. index for weigit Correlation Hbderator Score Disagreement Agreeuent -.21 .25 -.13 .29 -.26 .34 -.58 .38 -.68 .48 -.07 .49 -.21 .45 .23 .53 -.21 .37 -so‘ .38 -.26 .36 -.31 .27 -.39 .27 ‘055 .33 .34 -.26 .10 -.30 .19 -.39 .51 -.09 .32 -.00 .39 -.09 02‘ -eJ° .12 -.34 .31 -.15 .25 405 -e13 s‘? -.10 .62 .37 -.13 .02 .50 .20 -.32 e1‘ -s37 -.14 .34 ’el‘ .00 .27 -.19 .16 -.36 .23 '0‘: .44 -.02 s30 ..06 03‘ -so‘ .22 -.26 .13 -.25 e13 -s35 .15 -.35 .11 -.31 015 -.35 .49 -.07 .20 -.12 e32 -e36 .10 -.32 .28 -021 .09 -.29 .42 0 .22 -.26 -.‘1 .21 -.39 .19 .46 -.02 -.34 .22 -.34 .12 .30 -.50 .31 -.51 -.02 .36 -.08 .52 .23 -.35 .20 -.42 -009 033 .14 -.34 .21 -.41 -.07 .41 -.14 .50 .13 -.29 .14 -.26 .13 -.35 .03 .41 -.07 .41 -.13 .33 186 ratio; an Opposite relationship was seen between mothers low on the SES index for the develOpmental index for weight and the weight-age/height-age index. CHAPTER‘VI DISCUSSION, CONCLUSIONS, AND IMPLICATIONS Discussion of Results The nature of the ecological approach forces the researcher to investigate the nature of relationships which might exist between (in this case) factors which characterize the family environment and the nutritional status of the preschool child who is living and_growing in that environmental setting. \This discussion will focus on those relationships elucidated by the present research. Computer-assisted data analysis revealed that certain variables did not provide any additional information. Therefore, the following discussion is based on only those data which were revealed by multi— variate analysis to be particularly pertinent to the problem as defined. The nutrients were highly inter-correlated among themselves, with the exception of ascorbic acid which acted independently of the rest. The nutrients exhibited no strong correlations with the blood components. It is acknowledged that since nutrient intakes for most . children either met or exceeded the RDA, such intakes could be considered limiting. Therefore, one cannot 187 188 expect to find significant correlations with the occurrence of clinical lesions. Only protein (for the energy-yielding nutrients) showed a positive correlation with several weight-for-age scales. The literature suggested that the degree of correlation which could be expected among dietary, biochemical, and clinical data is limited. In general,‘ dietary and biochemical data for most nutrients have been shown to be more closely related, than either of these criteria alone correlated with clinical findings (Pike and Brown, 1967:478). Such inter-relationships have been routinely sought in the nutrition surveys conducted by the Interdepartmental Committee on Nutrition for National Defense (ICNND), but these efforts have met with little success (Plough and Bridgforth, 1960). While realizing that the three approaches to the determination of nutritional status (clinical vs dietary vs biochemical) measure different chronologies of nutritional deficiency (Figure 3), Plough and Bridgforth (1960) undertook to determine the nature of the inter- relations between these three procedures, with.the expectation that each method would be comparable to the others. The following are but a few of their findings: no correlations were noted between caloric intake and pheight, weight, or skinfold thicknesses. Neither calories nor the parameters of body composition correlated with any of the clinical or biochemical 189 findings. The level of serum protein did not appear to be related to dietary protein intake. In that study, no relationships were found between dietary iron and hemoglobin or hematocrit levels. Pearson (1966) suggested the following reasons for the poor correlations found between biochemical and clinical findings: 1) the known non-Specificity of the clinical lesions; 2) the marked differences in the criteria and diagnostic expertise of different examiners; and 3) the different chronologies in the sequence of the development of nutritional deficiency signs associated with the clinical and biochemical lesions. Beal (1970) indicated that analysis of the longitudinal data of the subjects studied in the Child Research Council study has shown no clear relationship between dietary intake of iron or protein with levels of hemoglobin or hematocrit. Likewise, Davis et a1. (1967) concluded that a dietary survey of healthy subjects showed that no relation between iron intake and hematological status. They suggested that iron content of food is not a lbmiting factor in maintaining iron balance in normal individuals. Burroughs and Huenemann (1970) were unable to show consistent signifi- cant correlations between the nutrient levels and blood (variables; however, they did indicate that in general, children whose weights were in the lowest percentiles 190 received diets low in calories and other nutrients, and more of these children had less favorable blood values. Crumrine and Fryer (1970), studying blood components and dietary intake of preschool children, found that only protein was significantly correlated with hemo- Vglobin concentration; they attributed this finding to the fact that as an indicator of inadequate nutrition, hemoglobin is determined by many, rather than a single, nutrient. These investigators also found significant correlations between blood values and nutrient intakes for albumin and Vitamin A, between albumin and niacin, and between the albumin:globu1in ratio and fat. In the present study, examination of the correlation matrices supplemented by the findings of the moderator programs suggested a patterning of associations between family environment characteristics, nutrient intake and the physical status of the child. Thus, emerges a typology of maternal characteristics and family patterns which, in turn, act to influence the dietary intake and consequent nutritional status of the child. The Type I mother displayed many of the following characteristics: a. Non—authoritarian attitudes toward child rearing, indicating a basic disagreement with.the items in the following scales, Parents are all-wise Listen only to parents Unquestioned loyalty Trapped in a dull job Deception and showing agreement with the items in the "treating child as an equal“ scale. 191 Low feeling of powerlessness Values ranked of highest importance: family centrism, freedom, education. Values ranked of least importance: prestige and religion. High.agreement with the "nutrition is important" attitude. The Type I families were characterized by: Higher socioeconomic status higher family income higher parental education and occupations Higher score on nutrition knowledge test and number of "Basic Four" named. Fewer persons in the home and fewer children under five years of age in the family. Most mothers are married and living with their husbands. Families were at lower stages in the family life cycle. Less money is spent for food per week. In contrast, the Type II mother exhibited many of the following characteristics: a. Authoritarian attitudes toward child-rearing, evidenced by agreement with items on the "unques- tioned loyalty" scale, and by disagreement with the "treating child as an equal" items. Sense of powerlessness Lower-self-concept as mother (measured by semantic differential instrument) Lack of agreement with the "nutrition is important" attitude Value of greatest importance: prestige, religion Value of least importance: education Lower scores on nutrition knowledge test and number of "Basic Four" named. 192 The Type II family was characterized by: a. Lower socioeconomic status lower family income lower parental education and occupation rating b. Later stages in family life cycle c. More persons in the home and a greater number of children under five years of age in the family d. Mother is away from the child more time e. Greater amount of money spent for food per week f. Increased crowding in the home 9. Increased mobility patterns. The typology of family and maternal characteristics related, in turn, to certain patterns of nutrient intake. Children of the more affluent, non-authoritarian mothers tended to have higher intakes of calcium and ascorbic acid. On the other hand, children of mothers with more authoritarian attitudes toward child-rearing had higher intakes of calories, carbohydrate, iron and thiamin, all of which are typically provided by enriched bread and cereal products. The simple correlations between the biochemical measures and family characteristics were largely inconclusive. The MODERATOR programs indicated the correlation between blood components or anthropometric measurements, as they were moderated (or influenced) by the various family environment characteristics. Results of this .analysis revealed that for the Type I mothers (high socioeconomic status, non-authoritarian), there was a 193 positive correlation between calories and the energy— yielding nutrients and the various scaled height-weight for age values. In contrast, for the Type II mothers (low socioeconomic status, authoritarian) there was a positive relationship between calories and weight indices, namely the developmental index for weight and the weight-age/height-age index, but there were essentially no other significant correlations with the remaining scaled height-weight values. Such findings suggest that the children of Type II mothers may weigh more in relation to their height, while children of Type I mothers may have a more balanced physique, i.e., these children are more likely to be neither overweight or underweight. The tendency existed for children of mothers with a lower self-concept rating (characteristic of Type II) to have a higher hydroxyproline:creatinine ratio and hydroxyproline index. This finding suggests that children of Type II mothers may be growing at a more rapid rate. Whether these children weighed more for height because of a greater muscle mass or increased adipose tissue cannot be adequately determined from the data collected for this study. Correlational analysis revealed that children of mothers with a lower self-concept (characteristic of the Type II mothers) tended to have higher hemoglobin and hematocrit values. MODERATOR further indicated that there 194 was a positive association between both protein and iron with hemOglobin, when moderated by variables characteristic of the Type I mothers. Such relationships may suggest that in cases where hemOglobin is at acceptable or higher levels, such as was found of children of Type II mothers, that excess dietary iron remains unabsorbed and as a result, no correlations were made apparent. For children of the more authoritarian, lower income mothers (Type II), MODERATOR showed that positive correlations existed between dietary protein and serum albumin and total serum protein levels, even though dietary protein intake exceeded 100% of the RDA for these children. Limitations of the Present Research 1. Because of the nature of the sample selection, a bias was introduced. Information was obtained only for children whose mothers were c00perative in providing the information requested by the researcher. The "invisible poor" child, who is mistreated and possibly unwanted in the home is not likely to be attending a nursery school program or visiting a public health clinic. 2. Psychosocial data was obtained only for the mother. The focus of the present research was primarily on the dyadic relationship between the mother (as the supplier of nutrients) and the developing child rather on -the transactional patterns which may be evidenced by the entire group of family members. 195 3. Dietary intake information was obtained by food records completed by mothers of the children in the sample. The validity of this instrument as a data- collection device is controversial. Summary and Conclusions Analysis of the food records revealed that for the most part, children in the present study were quite amply nourished. On the average, all nutrients, except iron, met or exceeded the Recommended Dietary Allowances. However, in terms of the few children who had intakes less than two-thirds of the RDA for any one nutrient, the nutrients which were most limiting were iron, ascorbic acid, calcium, and vitamin A. These nutrient totals were calculated exclusive of the contribution of the vitamin supplement which many of the children were taking. Snacking was quite prevalent; approximately 10% of the total protein intake and 19% of the calories were contributed by snacks. Evaluation of blood components and various anthropo- metric measurements failed to reveal any evidences of gross malnutrition. In reference to the ICNND standards, all but two children had either "acceptable" or "high" values for hemoglobin and hematocrit. Total serum proteins were either acceptable or high for 97% of the Children, while all children had serum albumin levels which were either acceptable or high. 196 When height and weight measurements of the children were studied in reference to accepted standards, it was revealed that far more children were at the highest percentiles for weight than were at the lower ends of the scales. This inequitable distribution did not hold true, however, for the height values. Such findings lead to the conclusion that more children in the sample were overweight for their age than were underweight. An analysis of the demographic characteristics of the families in the sample indicated that a wide variation existed among the families sampled. Nearly two-thirds of the families were white, while approximately one-fourth were black; others in the sample were Mexican-American, Oriental or East Indian. The average annual family income was about $9,000, yet 13% of the families had an income of less than $4,000 per year. The parents in the sample were quite highly educated; mothers had completed an average of fourteen years of schooling while the fathers had completed approximately seventeen years. The "typical family" in the sample consisted of five persons-- two adults and three children, two of whom were less than five years of age. Using correlational and multiple-group cluster analysis procedures, a typology of family characteristics and maternal attributes was developed which bore a direct relationship to the dietary intake and resultant physical status of the children. The Type I mother 197 exhibited more equalitarian attitudes toward child- rearing and represented a higher socioeconomic strata. In contrast, the Type II mother was from the lower socioeconomic groups and displayed more authoritarian attitudes toward child-rearing. This typology of maternal characteristics related directly to certain patterns of nutrient intake. Children of the more affluent, non-authoritarian mothers tended to have higher intakes of calcium and ascorbic acid, while children of the Type II mothers ate more calories, carbohydrate, iron, and thiamin. The tendency existed for children of the more authoritarian, lower income mothers to have higher hemoglobin and hematocrit values. Yet, analysis of interactions among variables indicated that there was a positive association between both protein and iron with hemoglobin for children of the Type I mothers. Such associations suggest that in cases where hemoglobin levels are at higher levels, any dietary iron that is ingested which may not be needed remains unabsorbed, and as a result, does not contribute to any correlations with the blood value. The primary contribution of the present research is the demonstration that multivariate analysis procedures may be effectively utilized to establish a typology of family characteristics and maternal attributes which, in turn, exerts a direct influence on the dietary intake 198 and the consequent nutritional status of children within particular family environmental settings. Suggestions for Future Research .The suggestions for future research which emanate from the present study relate quite closely to the limitations previously cited. 1. The ecological approach should be applied in analyzing the nature of the relationships between nutritional status and family environment characteristics in populations of children different from the one studied. These might include.the "invisible poor", the."battered" child, or the mentally retarded. Cross cultural approaches as well may be useful. 2. Children from a younger age group (e.g., one.to three years of age) should be studied to.determine if they are more sensitive to alterations and/or extreme conditions which may occur in the family environment. 3. Studies should be performed utilizing research techniques designed to assess transactional patterns of exchange amongfamily members, rather than the dyadic relationship between mother and child. In any event,_ attempts should be made to include more members of the family in the research design than just the mother. 4. A study is recommended to determine the most accurate yet practical method (i-e., comparing the food 199 record vs recall vs observational teChniques) for.use in field studies particularly with.low—inCome mothers. Implications Theory The present research demonstrates the viability of the ecological approach in studies designed to assess the nutritional status of individuals. Action'Programs The value of the present study to.potential application in programs carried out by change agents lies both in the conceptual orientation, i.e., the edological approach, and the typology of family characteristics which was revealed. If more authoritarian, low-income mothers have children who consume.fewer fresh fruits andvegetables, as evidenced by lower ascorbic acid intakes, techniques which would encouroge an increased consumption of these foods should be emphasized in nutrition education pro- .grams. 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Assoc. 28:124-128, Feb. 1952. Zee, P., T. Walters and C. Mitchell. Nutrition and poverty in preschool children. J.A.M.A. 213(5): 739-742, Aug. 3, 1970. 215 Zuckerman, M., B. B. Ribback, I. Monashkin and J. A. Norton. Normative data and factor analysis on the Parental Attitude Research Instrument. J. Consult. Psychol. 22:165—172, 1958. APPENDICES O‘U‘iubWNl" APPENDIX A Correspondence Letter to mothers, December 1969. Letter to mothers, February 1970. Letter to mothers, May 1970. Permission request for blood tests. Letter to teachers scheduling measurements. Letter of thanks and appreciation. 216 APPENDIX A-l Letter to mothers, December 1969 Michigan State University Department of Foods and Nutrition December, 1969 Dear As part of an ongoing project to study the growth and eating habits of preschool children, we request your help in completing the attached form. We would like you to record everything that your child eats from the time he gets up in the morning until he goes to bed at night--for a day when he is not attending Nursery School. Since accuracy of information—is important to the success of the project, please be as descriptive and as accurate about the quantities and types of food eaten as possible. Your cooperation is most appreciated. Thank you! Very truly yours, Mrs. Laurie Sims Graduate Assistant Portia Morris Associate Professor Foods and Nutrition LS:PM/gjn Enclosure 217 APPENDIX A-Z Letter to mothers, February 1970 MICHIGAN STATE UNIVERSITY Department of Foods and Nutrition February, 1970 Dear As you recall, last term you cooperated on a study of the growth and eating habits of preschool children by completing a one-day's food intake record for your child. This information has been most helpful. We are now requesting your further c00peration to complete our study. In order to learn not only what children eat, but why they eat it, we feel it is important to also learn about the children's families. This study should answer several fundamentally important questions, & you alone, as a parent of a preschool child can supply the information we need. Enclosed are a set of questionnaires designed to let us know about how you feel about certain important tOpics. There are no right or wrong answers. All participants will be assigned a code number and responses will be analyzed by a computer, so you may be sure that all answers will be kept strictly confidential. These forms will be collected at the time you have agreed upon for the interview on at . Your cooperation is most appreciated. Thank you! Sincerely, Student Interviewer Mrs. Laurie Sims Graduate Assistant Mrs. Portia M. Morris Associate Professor Foods & Nutrition Enclosures 218 APPENDIX A-3 Letter to mothers, May 1970 MICHIGAN STATE UNIVERSITY Department of Foods and Nutrition May, 1970 Dear As you recall, you have cooperated with us this year on a study of the physical growth and eating habits of young children by completing a one day's food intake record for your child. This information has been most helpful, and we are again requesting your help one more time. Please complete the attached food record form again. (Only by averaging several day's meals can we determine a representative intake for your child.) We would like you to record everything that your child eats from the time he gets up in the morning until he goes to bed at night--for a day when he is not attending Nursery School. Since accuracy of information—is important to the success of the project, please be descriptive and accurate about the quantities and types of food eaten (e.g., whether fresh, frozen or canned) and how the food was cooked (fried, boiled, broiled). Brand names are always helpful! Please return the completed forms in the attached envelope by June 1, 1970. Your continuing c00peration is most appreciated. Thank you! very truly yours, Mrs. Laurie Sims Graduate Assistant Portia Morris Associate Professor Foods and Nutrition LS:PM/gjn Enclosure 219 APPENDIX A-4 Permission Request for Blood Tests MICHIGAN STATE UNIVERSITY East Lansing! Michigan 48823 Family and Child Study Unit College of Home Economics April 16, 1970 Dear In conjunction with the ongoing study of the physical growth and eating habits of preschool children, it is important for us to assess your child's growth by several methods. These include food intake records, height and weight measure- ments, and a simple blood test. We are asking that you complete and return the enclosed permission form allowing us to obtain one drop of blood by pricking the finger of your child. This procedure is painless and will be carried out by a registered medical technologist from the 01in Health Center on campus. This work will be done the latter part of May, and you are invited to be present if you so desire. You will later be informed of the exact date and time. If any medical problems are detected, you will be informed and referral will be then made to your family physician. Please return the signed form to us by May 1, 1970. Your cooPeration is greatly appreciated. Thank you. Sincerely, Robert P. Boqer, Chairman Preschool Research Committee 220 APPENDIX A-5 Letter to Teachers Scheduling Measurements MICHIGAN STATE UNIVERSITY East Lansing, Michigan 48823 CoIlege of Home Economics Department of Foods and Nutrition Home Economics Building April 27, 1970 To: From: Laurie Sims During the weeks of May 4-8 and May 11-15, I plan to take the third, and final, set of physical measures on the nursery school children. In addition to the usual height and weight measure- ments, this set will also include skinfold thickness measures as well as several diameters and circumferences of the body. The finger prick blood sample will (hOpefully!) be taken the last two weeks of May (May 18-22, and May 25-29). I shall inform you later of the specific time. I shall contact you later this week to arrange a time for these measurements when it will be most convenient for your class. Thank you for your cooperation. 221 APPENDIX A-6 Letter of Thanks and Appreciation June 9, 1970 Dear Now that the data for your study are nearly complete, the time has come to thank each of you for your help and c00peration this past year. As you may know, there are many misconceptions about the eating habits of preschool children and the factors , influencing food intake. We hope that by this compre- hensive study we will be able to make a meaningful contribution to knowledge in this area. This study was possible only with the cooperation of‘a great many people--parents, teachers, children and others. We extend to each of you our heartfelt thanks. We will be happy to share with you our findings following com- pletion of the data analysis next year. Sincerely, (Mrs.) Laurie Sims Dr. Portia M. Morris Graduate Student Associate Professor APPENDIX B Guidelines for Interviewers 222 APPENDIX B Guidelines for Interviewers 1. Set up appointment with mother of child. Explain that you are an MSU student who is involved with the study dealing with the physical growth and eating habits of preschool children. Suggest that in order to learn not only what children eat, but why they eat it, it's important to learn something about their families. Since she is a parent, only she can supply the infor- mation and insights about children which we need to know. Set up an appropriate time when you can talk with her. Explain that you will be sending ahead a few short forms which you would like her to complete before you get there. 2. Conduct the interview. Record the information concisely and'accurately. Try to make the respondent feel as much at ease as possible. Pick up the completed questionnaire forms which you had previously mailed. Check to see that all items have been correctly filled out. There should be six separate forms: 1) Parent Attitudes 2) "Now, we would like you..." 3) "Some statements concerning nutrition..." 4) Homemaker Values 5) Parent Opinions Scale 6) "Read each of the statements..." Leave the "Food Record" form to be filled out. Remind the mother that she is to record a one-day's food intake for a day when her child is n22 attending nursery school, and that she should return the form within one week. (A stamped self-addressed envelope is attached to the form for her convenience in returning it.) Emphasize that accuracy is extremely important and that she should record only what the child actually eats and not what she thinks he should be eating. Thank her for her time and generosity in supplying the information we need. 3. Return all completed forms to me. 223 Appendix B (cont'd) 4. You may call me anytime if questions or problems arise: Home: 351-3895 Nutrition "Grad Room" (108 Home Ec.):353-2937 5. Your rate of pay is $1.90 per hour (maximum allowed for student employment) plus mileage. Record all mileage accrued. Thanks--and good luck! Laurie Sims APPENDIX C Instruments 1. Food Record Recording Form 2. Home Interview Schedule 3. Attitude-Measuring Questionnaires a. b. c. d. e. f. Parent Attitudes Homemaker Values Parent Opinions Scale Powerlessness Nutrition Knowledge and Attitudes Test Semantic Differential Instrument 224 APPENDIX C-l Food Record Recording Form RECORD OF FOOD EATEN IN ONE DAY Name N.S. Code Date Recorded: Code No. SUGGESTIONS FOR RECORDING INFORMATION: Milk, fruit juice and other liquids: Record in terms of measuring cup or ounces. (1 measuring cup equals 8 ounces.) Butter: Record as level teaSpoons. (1 average pat equals I level teaspoon.) Sugar: Record as level teaSpons. Egg: Note whether egg, or yolk or white only. Cereals and vegetables: Record in terms of measuring cup or tablespoons. (1/2 measuring cup equals 4 heaping tablespoons equals 8 level tablespoons.) Fruit or vegetable: If whole, give sizeITas small, medium, or large.) If sliced or canned, express in terms of measuring cup or tablespoons, as above. Note whether fresh, frozen, or canned. Meat: Record as ounces or level tableSpoons, if possible. (1 ounce equals 2 level tableSpoons.) Note how cooked, e.g., fried, boiled, broiled. Other foods: Record as accurately as possible in terms of ordinary household measures. Note flavor of a baked product and whether it was iced. Brand names are always helpful. 225 Appendix C-l (cont'd.) COMPLETE RECORD OF THE DAY'S FOOD BREAKFAST: Time a.m. Did child eat alone? If not, with whom? Fruit or juice, (circle one): Kind Amt. Cereal: Kind Amt. Milk on cereal: Amt. oz. Sugar tsp. Bread: Kind No. slices Butter or Margarine, (circle one used): ' tSp. Other Spread: Kind Amt. Egg: How cooked? Amt. Bacon or other meat: Kind Amt. Milk: Kind Amt. oz. Other beverage: Kind Amt. oz. Other foods: (Specify) Kind: Amt. BETWEEN BREAKFAST AND NOON MEAL: Food (Kind) Amount Time Where With whom? 226 Appendix C-l (cont'd.) NOON MEAL: Time Did child eat alone? If not, with whom? Soup: Kind Amt. Meat or Main Dish: Kind ' Amt. Potato: How cooked? No. and size Vegetables: Kind Amt. Sandwich: Filling: Kind Amt. Bread: Kind Amt. Butter/Margarine, (circle) on bread, etc. tSp. Salad dressing: Kind Amt. Milk: Kind Amt. oz. Other beverage: Kind Amt. ' oz. Dessert: Kind Amt. Other Foods: (Specify) Kind: Amt. BETWEEN NOON AND EVENING MEALS: Food (Kind) Amount Time Where With whom? 227 Appendix C-l (cont'd.) EVENING MEAL Did child eat alone? If not, with whom? Time Meat or Main Dish: Kind Amt. Potato: How cooked? No. and size Vegetables: Kind Amt. Kind Amt. Kind Amt. Bread: Kind No. slices Butter or Margarine (circle one) on bread, etc. tsp. Gravy: Amt. Salad dressing: Kind Amt. oz. Milk or Other beverage: Kind Amt. oz. Dessert: Kind Amt. Other Foods: Kind: Amt. Amt. BETWEEN EVENING MEAL AND BEDTIME: Food (kind) Amount Time Where With whom? Is this day's intake usual? Less than usual? Vitamin supplements: Kind More than usual? Amt. If any of the above meals were not eaten at home, indicate which: where? 228 APPENDIX C-2 Home Interview Schedule NUTRITION INTERVIEW Child's name Parent's name Address: Preschool: LPS = 1 SNS = 2 Oflwr=u3 Identification number Sex 1 Male Phones: Home 2 Female Office Birthdate Interviewer: (Month, day, year) - - INTRODUCTION: We are conducting a study to learn more about the growth and eating habits of preschool children. In order to learn not only what children eat, but why they eat it, we need to know certain things about the children's families. This study should answer several important questions, and you glgng, as a parent of a young child, can supply the information we need! There are no "right" or "wrong" answers to the ques- tions you will be asked. All participants will be assigned a code number and reSponses will be analyzed by a computer, so you may be sure that your answers will be kept confidential. Please answer the questions as frankly and accurately as possible. 229 .HH .0H .m .m .h .m .m .v .m .N .H upmmm xwm3 Hum prumamfioo Amadoeuufln pHHeU pmxuos Hoonom mummm shadow m>Hm How» A meflummflowuumm Amoamcv mason .oc ummemflmv mo Hopes oafleo on numbed: Hwnadz coflumosooo coflumosom oumum xmm MHV mom mflnmcoflumHmm waflEMh mUHBmHmMBufimfimU qummmbom mSuMbm anaconda maaamm msumum HMDHMME ucmnmm paflso mcflummfloauumo mo coHuHmom Hmcflpuo man ca Hoodoo» Ho mummw m coupaaeo Hmnfidz Dads maflamm ca dmnoafiso Hones: Hmuoa mammmmson cm unsound amen Hmsuo measpm mo Hmbfisz paoemmooe ca muaspm mo Hogan: Hobos umns SHHEMm GA mGOmHmm Hones: Hobos mHOQWMDOA GM maomumo Hmnadc Hobos "mQOU mofimm MHmB ZH mBHMS 802 OD mmqum mpaoemmsoe Moo» ea o>fla mGOmumm wane 30m Qmoomm wdHde A.p.u:oov NIU xflpcmmod 230 :26: 9:8 mm sanguine .% NH .....nofl 33 m 9:2 38.. Dim... ..olz 3 gasoc Hoonom Ga mHg .xmm .m>0bm no G mom paonmmson mo Hmnfima 20mm Homv .vH .MH .ma gmmfion H50» CH maH>HH mm>fiumamuudoc how macaw mud: uxmfi .Uaoemmsoe CH mcfl>fla mGOmHmm umsuo A.p.ucoov «no xfipcmmdd 231 Appendix C-2 (cont'd.) 10. "Are you now married? If 11. No, ask, "Have you ever been married? 12. 1. 2. O‘U’lbw (If applicable only, Married and living with husband Married, but hus- band temporarily absent (e.g., in Army, jail, etc.) Separated Widowed Divorced Single, never married "Do you now have a paid job?“ No, not working and not looking for work (housewife) No, not working but looking for work No, retired or disabled No, full-time student Yes, employed part- time (less than 35 hours per week) Yes, employed full time (35 hours per week or more) If response to question is ask) "What about your Yes, ask, "What is your job?" husband? Is he now or, "What kind of work do employed?" you do?" Specify: 1. No, not working and not looking for work " . , 2. No, not working but 13' (£22? izbgeur husband 3 looking for work S ecifj- 3. No, retired or p Y' 4 gdsangI—time 14. How far did you go in ‘———— ‘ student school? (Record as number 5. Yes, employed part- school years completed.) time (less than 35 hours per week) . _ 6. Yes, employed full 15. (If applicable ask.) How time (35 hours per week or more) Does your husband have steady work? far did your husband go in school?" 16. How many hours each week is X cared for by someone else? No. hrs/week Where Within own home Home of relatives Home of someone else Nursery school Other, specify: 232 Appendix C-2 (cont'd.) 17. 18. 19. 20. 21. 22. 23. 24. About how much money in all does your family make (or get)? (Record verbatim answer, including whether amount given is per week, month, or year. "Would you tell me where most of your money comes from?" (DO NOT PROBE). Specify: "Some peOple believe that food habits are related to religious affiliation: what is yours?" 0. None 1. Protestant 2. Catholic 3. Jewish 4. Mixed 5. Other, specify: ”How long has your family lived at this address?" (Record answer verbatim) "How many times have you moved within the last three years?” (Actual number of moves) "Do you own or rent your house?" 1. Own the house 2. Rent from private agency or person 3. Rent from public housing 4. MSU-student married housing "How many rooms are there in this house?" (Exclude bathroom, utility rooms, halls and other areas unsuitable for sleeping or general living purposes. Include porch if used for living at least 9 months of the year.) Number of rooms. "Do other persons regularly sleep in the same room as X ?" 0. No 1. Yes How many? 233 Appendix C—2 (cont'd.) 26. 27. 28. 29. 30. 31. 32. 33. 34. 36. 37. 38. 39. 40. 41. "I would like to find out about the following items you have in your home and their condition." (If more than one of a particular appliance is present, place an apprOpriate check for the one in the best condition.) Do you have a " Not Yes, but Yes, work- Yes present not in 0p. ing, but works (1) condition not satis. well (2) (3) (4) Telephone, Number in home Radio, Numberdin home Television, Number in home Automobile or trudk, Number in home Refrigerator Freezer (as separate unit, not part of refrigerator Range (with oven) Hotplate (or range with no oven) HEATH RECORD. "We would like some information about your child's health record and medical history." Birth Weight 35. Was X l. Premature? 2. Full term? Did you receive prenatal care during your pregnancy with X ? Ask: "How old were you when you were first pregnant? "How old were you when you were pregnant with X ? Present height Mother Father Present weight Which method was used in feeding X as an infant? Breast-fed Bottle-fed Both breast and bottle Did not receive any milk #WNH Approximately how long was X fed by the above method(s)? 42. Bottle months 43. Breast months 234 Appendix C-2 (cont'd.) 44. 45. 46. 47. 48. 49. 50. Does X ever drink from a bottle now? 1. No 2. Yes Does X use a pacifier now? 1. No 2. Yes Is X allergic to any foods? I. No 2. Yes If so, which foods is X allergic to now? 1. Milk 4. Fruit, Specify which: 2. Eggs 5. Combination of foods: 3. Meat 6. Other, Specify: Is X on a Special diet now? I. No 2. Yes Why is he on this diet? 1. Weight reduction (own prescription) 2. Weight reduction (physician's prescription) 3. For gaining weight 4. Other Specify: Has X eVer been anemic? -_I} No 2. Yes At what age was anemia present? 1. Before 6 months 2. 6 months to 1 year 3. l to 2 years 4. 3 to 4 years (recently) Was medication prescribed for the anemia? 0. Not applicable ("No" above) 1. No 2. Yes 3. Don't remember Have you ever consulted a physician about feeding problems with X ? 1. No __—' 2. Yes what age? 1-6 months old 6 months to 1 year old 1 to 2 years old 3 to 4 years old (recently) Combination of above UIhwdhOF‘W t 235 Appendix C-2 (cont'd.) 51. 52. 53. 54. 55. 56. 57. Do you give _X_ a vitamin/mineral supplement? 1. No 2. Yes Name: 1. Multivitamin . Vitamin-mineral . Multivitamin plus iron . Single vitamin (e.g. Vitamin C) . Group of vitamins (e.g. B complex, ADEC, etc.) Iron Other, Specify: \lmUluwa How often is this given: 0. Not applicable ("No" above) 1. Daily 3-6 times a week 3. Once a week 4. Only occasionally Do you give X any other kind of supplement or health food (e.g. wheat germ, cod liver oil, etc.)? 1. No 2. Yes Kind: Reason: If you do give any supplements, on whose recommendation? 0. Not applicable (none given) 1. Physician 2. Friend or relative 3. On your own Do any members of your immediate family have any disease or condition (e.g. diabetes, kidney disease) which requires a Special diet? 1. No 2. Yes Who? Condition How much sleep (including naps) does _X_ get (on the average) each day? 1. Less than 8 hours 4. 13-15 hours 2. 8-9 hours 5. More than 15 hours 3. 10-12 hours When was the last time that X was examined by a physician? 1. Less than 1 mo. age 4. More than 1 year ago 2. 1-6 months ago 5. Never 3. 7-12 months ago 236 Appendix C-2 (cont'd.) 58. What was the reason for _X_ last seeing a physician? 1. Don't know 4. Illness 2. Routine checkup 5. Injury 3. Immunizations 59. Has _X_ ever been examined by a dentist? 1. No 2. Yes When was the last time? 1. Less than 1 month ago 2. 1-6 months ago 3. 7-12 months ago 4. More than 12 months ago 5. Never 60. What was the reason for his seeing the dentist? 1. Don't know 4. Tooth extraction 2. Routine checkup 5. Injury 3. Tooth filled 61. Does X have any filled teeth? 1. No 2. Yes HOUSEHOLD MEAL PROACTICES "Some people believe that food habits are related to mealtime practices. The following questions have to do with the mealtime practices of your family." How often does your total family eat meals together during the major part of the week? Meal Never Less than 11? the time Almost (I) 1/2 the time or more alwa s (2) (35' _TYL( 62. Breakfast 63. Noon meal 64. Evening meal 65. Other, (in- cluding snacks) 66. Do children eat at the same time as the adults in your family? 1. Yes, almost always 2. Usually 3. Only occasionally (4-6 times a week) 4. Rarely 5. Never 237 Appendix C-2 (cont'd.) 67. Which of the following describes _X_'S attitude toward food or meals? 1. Enjoys eating 4. Has to be urged to eat 2. Attitude varies 5. Presents an eating problem 3. Indifferent to food 68. How important do you think it is that a child eats everything he has been served on his plate? 1. Not at all 4. Considerably 2. Slightly 5. Extremely 3. Moderately 69. What is your usual action when X dawdles at his food or refuses food served to him? 1. Insist that he finish his meal promptly. 2. Insist that he complete a certain portion of each food. . Threaten punishment, e.g. withholding of dessert, if food is not eaten. Promise reward, e.g. dessert for completion of food. Tell child there will be nothing to eat until the next meal, then remove food. Coax, but do not force eating. Say nothing at the time; talk to child later about it. Say nothing to child; do not like arguments at the table. mum U‘lnhh U C O 9. Say nothing; do not think this is important. SNACKS 70. Does X eat in the morning before breakfast? 71. 72. 73. How ofiEn? 1. Every day 2. 2 to 3 times/week 3. Less than once a week 4. Never Does X eat between breakfast and lunch? How offEn? 1. Everyday 2. 2 to 3 times/week 3. Less than once a week 4. Never Does _X_ eat between lunch and dinner? How often? 1. Everyday 2. 2 to 3 times a week 3. Less than once a week 4. Never Does _X_ eat between dinner and bedtime? How often? 1. Everyday 2. 2 to 3 times/week 3. Less than once a week 4. Never 238 Appendix C-2 (cont'd.) 74. 75. 76. 77. 78. 83. 84. 85. 86. 87. 88. 89. 90. 91. 92. Does X ever miss any meals? iT_YeS 2. No Which does he miss most often? 1. Breakfast 2. Lunch 3. Dinner If so, why does X miss meals? 0. Does not apply—T"No" above) 1. Lack of time 2. Lack of appetite 3. Too tired to eat 4. Illness At what time of day does _X_ seem to be the most hungry? 1. Morning 2. Afternoon 3. Evening Would you describe X 'S appetite in the past 3 months as: 1. Excellent 2. Good 3. Fair 4. Poor Does _X__feed himself? 0. No 1. Yes 79. Does he use a Spoon? 1. No 2. Yes 80. Drink from a cup or glass? 1. No 2. Yes 81. Use a fork? 1. No 2. Yes 82. Use a knife? 1. No 2. Yes What foods does X like particularly well? Itemize Specific foods: What is X '5 favorite food? Specify: What foods does X dislike? Itemize: Does _X_ refuse to eat any foods? 0. No Yes What are they? Specify: When planning meals for your family, are you influenced by the following? No (1) Yes (2) Cost of the food Time required for preparation Likes of the family Your own likes Health needs of family Nutritive value of food 93. Which do you believe is the most important influence? (Circle number above) 239 Appendix C-2 (cont'd.) 94. 95. 99. 100. 101. 102. 103. 104. 105. 106. 107. 108. 109. 110. FOOD 113. How does your family generally accept new foods or new methods of preparation? 1. Enthusiastically 4. Reluctantly 2. Willingly 5. Not at all 3. Cautiously Would you consider your child's mealtime pattern to be: (Or Does your child eat at the same time every day?) 1. Regular 0. No 2. Irregular 1. Yes (usually) What time does X usually eat? 96. Breakfast_ :i— _ 97. Lunch _ _:_ _p 98. Dinner Are all meals usually eaten at home? 0. Yes No. Which meals are eaten elsewhere? 1. One meal such as 2. Two meals such as Breakfast, Breakfast and lunch, or Lunch, or Lunch and dinner, or Dinner Breakfast and dinner 3. All meals Where are these meals usually eaten? 1. Relative's home 3. Restaurant 2. Babysitter's home 4. Home of friends, neighbors Do you think X : No (1) Yes (2) Eats too little food Eats too much food Chooses a limited variety of foods Eats too few fruits and vegetables Dawdles with his food Eats too much meat Eats too little meat Drinks too much milk Drinks too little milk Eats too many sweets PURCHASING Who in the family usually decides what foods to buy? 1. Mother only 4. Mother & children 2. Father only 5. Entire family 3. Mother and father together 240 .Appendix C-2 (cont'd.) 114. 115. 116. 117. 118. 119. 120. 121. 122. 123. 124. 125. 126. 127. 128.' Who usually does the grocery ShOpping? 1. Mother alone 5. Father and children 2. Father alone 6. Entire family 3. Mother & father together 7. Non-family member (no children) 4. Mother and children How often does your family buy groceries? 1. Daily 5. Once erery 2-3 weeks 2. 2-3 times a week 6. Once a month 3. Major ShOpping weekly, 7. Varies, no pattern other foods as needed 4. Once a week In what kind of store do you do most of your Shopping? 1. Neighborhood store; small independent market 2. Supermarket or discount store Other Why do you shop there? (order by no.) 1. Can buy on credit . Don't know Lower food prices More convenient and/or personal loyalty Offer trading stamps or other sales promotions Cbmbination of better quality and lower prices Better quality and/or variety and/or sells ethnic foods gaunt-awn About how much money did you spend for food last week? 8 How often do you generally use the following foods? Never Rarely Occasion- Nearly All 1 2 ally all the the 3 time time 4 5 Frozen meat pies Frozen "TV" dinners Canned soups, stews Frozen dessert pies Cake, muffin mixes, inc. prepared mixes such as Bisquick Instant coffee Ready-to-eat cereal Pie crust mix Pudding mix Other, Specify: 241 Appendix C-2 (cont'd.) 129. 130. 131. 132. 133. Do you receive Federal Food Stamps at the present time? 1. No; not eligible 2. No; eligible but do not participate (to next item) 3. Yes If eligible & answered N9 (#2), why do you not use stamps? 1. Family applied, but told "not eligible" . Family applied; eligibility not yet determined . Family chose not to participate temporarily, plans to reapply Cannot afford them Do not know enough about them Inconvenient, tranSportation problems Family says, "do not need them" \lO‘U‘IIb um If Yes (#3), do you buy any foods now that you did not buy‘EEfore you got food stamps? Or do you buy more of any foods now than you did before? 1. No 2. Yes Which ones? Specify: NUTRITION EDUCATION What foods do you think you should serve your child every day? (Record answer verbatim; probe for specific foods) "Have you ever had any classes or attended any group activities concerned with food and nutrition?" 0. No Yes. Which? Junior high school Senior high school Professional training (e.g. nurse's) Adult education classes Public health classes, clinics Prenatal classes Youth group: eg. 4-H, Girl Scouts Course in cooking mummwat-I o o o o o o o o 134. "Which do you believe has been the most helpful to you in preparing your family's meals?" (Circle number above) 242 Appendix C-2 (cont'd.) 135. 136. "There are many pe0p1e from whom homemakers can get information concerning needs of families. Which of the following persons has influenced you the most?” (Circle number.) 0. \lO‘U‘lukwNH No one Mother or other relative Friends or neighbors Physician Dentist Nurse Home economist, dietitian, or nutritionist Combination of above "If you wanted to know more above the nutritive value of various fruits or vegetables, what sources of infor- mation do you think you would find most helpful?" (Circle number of the most helpful.) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. ll. Cookbooks Books (other than cookbooks), extension bulletins Food articles in magazines or newspapers Food advertisements in magazines or newspapers Radio TV Neighbors and friends Mother or other relatives Members of immediate family (husband, children) County extension agent or home economist Teacher 243 Appendix C-2 (cont'd.) COMPLETE THIS PAGE AFTER YOU LEAVE THE HOME INTERVIEWER'S OBSERVATIONS To Interviewer: Code one as appropriate: The dwelling is a: 1. Single house, one family 2. Duplex or row house, one unit for each family 3. Converted Single house, converted rowhouse, multi- family 4. Apartment (privately owned; garden-type) 5. Trailer 6. Apartment (public housing; garden-type - housing project) 7. Apartment (privately owned; multi-story) 8. Apartment (public housing; multi-story - housing project) When interviewing, did you observe: Yes No Not Applicable Bed‘in'livingrroom? Rug on living room floor? Cléan7neat home? Bed made? Temperature adequate/comfortable? Bad smell in housleoom? ********** ********** Did children appear sick? (runny eyes, sores, etc.) Did children appear clean? Did you see mother (or caretaker) hit a child? Did’mother yell at a child? Did mother offer you anything to eat or drink? Did mother ask you for any help or information? Were accessories visible in the home? framed pictures 1. No 2. Yes green plants 1. No 2. Yes decorative accessories 1. No 2. Yes 244 Appendix C-2 (cont'd.) Evaluate the general state of cleanliness and housekeeping condition of the home, the furnishings, and appliances: . very dirty and unkept . dirty and unkept . fairly clean and orderly . very clean and orderly uwaH 245 Appendix C-2 (cont'd.) APPRAISAL OF A "SAMPLE OF THE IMMEDIATE NEIGHBORHOOD" OF THE DWELLING [d] X = dwelling in which interview was conducted [a] [X] [c] a,b,c,d = dwelling, structures or lots adjacent to or facing X [b] Comments: Evaluation of the structure or lot: Land Use Condition Vacant Residential Non- Description Sound Dilap- Deteri- residential of non- idated orating residential use a b c d Structural observation of exterior: 1. Poor quality 2. Fair quality 3. Good quality 4 . Excellent quality Rate the person interviewed as to cooperativeness: 1. Very cooperative. Appeared friendly and relaxed with interviewer. No defensiveness. VOlunteered informa- tion readily. Showed interest in the study and became involved in the interview. 2. COOperative. Appeared friendly and relaxed with the interviewer. Answered questions readily, but did not volunteer information beyond that requested. May or may not have shown interest in the study. 3. Slightly unc00perative. Generally answered questions readily, but mayihave Shown some defensiveness; maintained distance from interviewer. 246 Appendix C-2 (cont'd.) Uncooperative. Tenseness and defensiveness in answering questions. Expressed reservations about amount of time Spent. An undercurrent of resistance to the interview. Little interest in the study. very uncooperative. Explicit resistance to the interviewer or the interview. No interest in the study. Much of the information obtained may be unreliable because person interviewed seemed so concerned with making a "good impression" that questions may not have been answered validly. ANY OTHER COMMENTS: 247 APPENDIX C-3a Parent Attitudes Read each of the statements below and then rate them as follows: A a d D Strongly mildly mildly strongly agree agree disagree disagree Indicate your opinion by drawing a circle around the "A" if you strongly agree, around the "a“ if you mildly agree, around the ”d" if you milding disagree, and around the "D" if you strongly disagree. There are no right or wrong answers, so answer according to your own Opinion. It is very important to the study that all questidns be answered. Many of the statements will seem alike, but all are necessary to Show slight differences of opinion. Agree Disagree 1. Children Should be allowed to disagree A a d D with their parents if they feel their own ideas are better. 2. When a parent asks a child to do some- A a d D thing the child should always be told why. 3. A child Should be taught that there are A a d D many other peOple he will love and respect as much or more than his own parents. 4. Children Should never learn things A a d D outside the home which make them doubt their parents' ideas. 5. Having to be with the children all the A a d D time gives a woman the feeling her wings have been clipped. 6. Parents very often feel that they can't A a d D stand their children a moment longer. 7. There's no excuse wasting a lot of time A a d D explaining when you can get kids doing What you want by being a little clever. 248 Appendix C-3a (cont'd.) 10. 11. 12. 13. 14. 15. l6. 17. 18. 19. 20. Children have every right to question their parents' views. A child should grow up convinced his parents always know what is the right thing to do. One of the worst things about taking care of a home is that a woman feels that she can't get out. Most parents can spend all day with the children and remail calm and even tempered. Children should be encouraged to tell parents about it whenever they feel family rules are unreasonable. Parents Should adjust to the children sometimes rather than always expecting the children to adjust to the parents. Most children soon learn that their parents were mistaken in many of their ideas. A young mother feels "held down" because there are lots of things she wants to do while She is young. There is no excusing someone who up- sets the confidence a child has in his parents' ways of doing things. The things children ask of a parent after a hard day's work are enough to make anyone lose his temper at times. Often you have to fool children to get them to do what they Should without a big fuss. If a parent is wrong he should admit it to his child. Most young mothers are bothered more by the feeling of being shut up in the home than by anything else. Agree A a A a A a Disagree d D 249 Appendix C-3a (cont'd.) 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. A child soon learns that there is no wisdom than that of his parents. A parent should keep control of his temper even when children are demanding. A child's ideas should be seriously considered in making family decisions. In a well-run home, children should have things their own way as often as the parents do. One of the bad things about raising children is that you aren't free enough of the time to do just as you like. Loyalty on the part of children to their parents is something that the parents Should earn. A parent should never be made to look wrong in a child's eyes. It's natural for a parent to "blow his top" when children are selfish and demanding. It's best to trick a child into doing something he doesn't want to do instead of having to argue with him. Husbands Should know how "hemmed in" a woman feels staying in the home a great deal. A good parent can tolerate criticism of himself even when the children are around. Loyalty to parents comes before anything else. Raising children is an easy job. When a child is in trouble he ought to .know he won't be punished for talking about it with is parents. Agree A a A a Disagree d D 250 Appendix C-3a (cont'd.) 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. It isn't fair that men have a chance for interesting work and women mostly have to do the hard job of keeping the home. AS much as it is reasonable, a parent Should try to treat a child as an equal. A parent Should not expect to be more highly esteemed than other worthy adults in their children's eyes. It's best for the child if he never gets started wondering whether his parents' view are right. It's a rare parent who can be even tempered with his children all day. Raising children is very much harder than most jobs men do. You have to fool children into doing many things because they wouldn't understand anyway. When a child thinks his parent is wrong he should say so. More parents should teach their children to have unquestioning loyalty to them. Most parents never get to the point where they can't stand their children. A child has a right to his own point of view and ought to be allowed to express it. Children are too often asked to do all the compromising and adjustment and that is not fair. Loyalty to parents is an overemphasized virtue. The child Should not question the thinking of his parents. Raising children is a nerve-racking job. Agree A a Disagree d D 251 Appendix C-3a (cont'd.) 50. 51. 52. 53. When a child is doing something he shouldn't do, one of the best ways of handling it is to just get him interested in something else. A child Should be encouraged to look for answers to his questions from other people even if the answers con- tradict his parents'. A child should always love his parents above everything else. There is no reason why a day with the children Should be upsetting. Agree A a Disagree d D 252 APPENDIX C-3b Homemaker Values Below is a list of value descriptions. Most peOple hold several or all of these values in varying degrees. Please read all nine value descriptions. Now select the value that describes you BEST; put a "l" in the blank pre- ceding this description. Put a "2" in front of the one that describes you NEXT BEST. From the remaining seven descriptions, select the one that is LEAST LIKELY to des- cribe you. Put a (/) in the blank preceding it. 1. I WANT TO GET THE MOST FOR MY MONEY. I shop around for bargains. I try not to waste things, money, or time. I consider myself economical. 2. I WANT THE THINGS MY FAMILY DOES TO BE SOCIALLY ACCEPTABLE AND INFLUENTIAL. I would always want my family to do things that other people like and would want to copy. I want other people to reSpect my house and family. I want to be admired by other peOple. 3. I LIKE TO DO THINGS THAT KEEP MY FAMILY HEALTHY AND GOOD-NATURED. I want to prevent illness in my family and avoid accidents. I see that the family gets nutritious meals and arrange the house and activities so they get enough rest. 4. I LIKE TO DO THINGS WITH MY FAMILY BECAUSE I THINK IT'S IMPORTANT FOR FAMILY MEMBERS TO BE TOGETHER BOTH IN WORK AND PLAY. I want to help my family be con- tent. I arrange the home atmOSphere so that family members can be with each other in work and play. 5. I LIKE THE THINGS THAT I DO TO AGREE WITH THE TEACHINGS AND BELIEFS OF MY RELIGION. I arrange it so that my family can practice our religion-- attend religious services, hear prayers, and the like. I teach my family to be honest and kind to other people. 6. I ENJOY MY FRIENDS AND LIKE TO DO THINGS FOR THEM. I like to be around people. I like to get together with my friend. I think it is important to have close friends. 7. I WANT LOTS OF FREEDOM TO DO THE THINGS I WANT TO DO. I would prefer to come and go as I please. I would like to do things as I want, without restric- tions of daily duties. I take the time to do things that interest me. 253 Appendix C-3b (cont'd.) 8. I LIKE TO DO THINGS THAT INCREASE MY EDUCATION AND FITNESS FOR PRESENT AND FUTURE TIMES. I want to know what is going on around me. I want my family to be interested in learning. I arrange house and activities for new experiences for my family. Reading material is available for all the family. I WANT TO HAVE THINGS ATTRACTIVE AND ORDERLY. I would like my surroundings to be harmonious. I enjoy working with pretty things. I arrange it so that my family can express themselves artistically. 254 APPENDIX C-3C Parent Opinions Scale We'd like your Opinion on a few different things. Tell me if you strongly agree, agree, disagree, or strongly disagree with each statement by circling the number. Strongly Unde- Dis- Strongly Agree Agree cided Agree Disagree 1. In spite of what some pe0ple say, the lot of the average man is getting worse. 1 2 3 4 5 2. It's hardly fair to bring children into the world with the way things look for the future. 1 2 3 4 5 3. Nowadays a person has to live pretty much for today and let tommorow take care of itself. 1 2 3 4 5 4. These days a person doesn't really know who he can count on. 1 2 3 4 5 5. There's little use writing to public officials because often they aren't really interested in the problems of the average man. 1 2 3 4 5 255 APPENDIX C-3d Powerlessness Read each of the statements below and then rate them as follows: A a d D strongly mildly mildly strongly agree agree disagree disagree Indicate your opinion by drawing a circle around the "A" if you strongly agree, around the "a" if you mildly agree, around the "d" if you mildly disagree, and around the "D" if you strongly disagree. Below are a number of statements about various t0pics. They have been collected from many groups of peOple and state some of their opinions. There are no right or wrong answers; for every statement there are large numbers of people who agree and disagree. Please Show whether you agree or disagree as follows: Agree Disagree 1. I think we will always have wars between A a d D countries no matter what we do to try to stop it. 2. If you are a success you will usually have more good breaks than bad breaks. A a d D 3. Many times I feel that it does not do any real good to think about what to A a d D do. You might just as well flip a coin. 4. A man who gets a good job is just lucky A a d D to be at the right place at the right time. 5. I don't understand why other people act A a d D the way toward me that they do. 6. Much of what happens to me is probably A a d D a matter of chance and luck. 7. I feel I have little influence over A a d D the way other people act. 8. It is very hard to figure out what the A a d D future will be. 256 Appendix C-3d (cont'd.) 10. ll. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. The ordinary person has very little control over what the politician does in office. The things that happen to most peOple are outside their own control. It isn't wise to plan too far ahead because most things turn out to be a matter of good or bad fortune anyhow. I don't see how you can really tell how other people are going to act. When things are going well for me I usually think of it as a run of good luck. Most people don't realize how much their lives are influenced by things that happen just accidently. I have usually found that what is going to happen will happen no matter what I do or think about it. Most of the things that have dis- appointed me in my life have come because my luck ran out. I don't really believe the saying that a person can be "The master of his fate." Success is mostly a matter of getting good breaks. What happens in the world seems to be beyond the control of most peOple. I feel that most peOple can't really be held reSponsible for themselves since no one has much choice about where he was born or raised. Many times the way people act has absolutely no reason behind it. 'Success in working with people de- pends much more on the way they feel than on what I do. ree A a Disagree d D 257 Appendix C-3d (cont'd.) 23. Many times I feel that I have little influence over the things that happen to me. 24. Sometimes I feel that I don't have enough control over the way my life is going. 25. To get ahead you have to gamble on things that you are not sure of. PLEASE SEE THAT YOU HAVE GIVEN YOUR OPINION Agree Disagree A a d D A a d D A a d D FOR EACH QUESTION 258 APPENDIX C-3e Nutrition Knowledge and Attitudes Test Some statements concerning nutrition are given below. Please indicate whether or not you think a statement is true or false. Circle "T" for true and "F" for false. After you have reached this decision indicate how certain you are about the answer. If you are very confident of your decision, circle "1"; if you are very doubtful, circle "5". Circle other numbers to indicate degrees of certainty between these extremes. Please be sure to respond twice True How sure are you? to every statement: or Very Pretty Very False Confi- Sure Doubt- dent ful l. Protein-rich foods, such as T 1 2 3 4 5 meat, milk and eggs, provide F liberal amounts of several nutrients needed for the growth of small children. 2. It is better not to include T l 2 3 4 5 orange juice and milk in the F same meal because the orange juice causes the milk to curdle in the stomach. 3. By the end of the first year T l 2 3 4 5 babies Should have learned F to use a variety of foods besides milk because a one- Sided milk diet may be inadequate for total growth and development. 4. School age children need T l 2 3 4 5 multiple vitamin pills every F day to ensure good health. 5. Chemicals now used to bleach T l 2 3 4 5 flour are harmful to human F beings. 6. When children have enough food T l 2 3 4 5 to satisfy their appetites F their diets are certain to be nutritionally adequate. 7. A good nutritional practice is T l 2 3 4 5 to eat a wide variety of types F of foods from day to day. 259 Appendix C-3e (cont'd.) 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. Citrus fruits include straw- berries, raspberries, and blueberries. Skim milk contains about the same amounts of the body- building minerals and protein as whole milk. No reducing diet Should con- tain bread or potatoes. Most fat children and adults have a glandular disturbance. Milk is a food needed mainly for infants and growing children. Apples are an excellent source of Vitamin C. Foods enriched with Vitamin D help to ensure the normal develOpment of bones and the prevention of rickets. Gelatin, or "Jello" desserts are a good source of protein. All people should use a low- fat, low-cholesterol diet to prevent heart disease and strokes. Cheese is constipating. A glass of lemonade can be substituted for a glass of orange juice so far as the Vitamin C in the two products is concerned. Grape juice is an important source of nutrients which guard against anemia. True How sure are you? or Very Pretty Very False Confi- Sure Doubt- dent ful T l 3 4 5 F T l 3 4 5 F T l 3 4 5 F T l 3 4 5 F T 1 3 4 5 F T l 3 4 5 F T l 3 4 5 F T l 3 4 5 F T l 3 4 5 F T 1 3 4 5 F T 1 3 4 5 F T l 3 4 S F 260 Appendix C-3e (cont'd.) 20. 21. 22. 23. The green leafy and yellow vegetables are stressed in daily food plans because they help to ensure meeting the Vitamin A needs of the individual. Healthy, active, young child- ren require some concentrated sweets each day for energy needs. Pasteurization destroys much of the food value of milk. The "Basic Four" includes (1) Dairy Foods (2) Meat & Eggs (3) Breads & Cereals (4) Fruits & vegetables. True or False “18 '11P] ”16 How sure are you? Very Pretty Very Confi- Sure Doubt- dent ful l 2 3 4 5 l 2 3 4 5 1 2 3 4 5 l 2 3 4 5 ATTITUDE TOWARD NUTRITION AND EATING HABITS OF CHILDREN 1. If the statement describes how you feel about your child's nutrition or eating habits, circle the "A" if you strongly agree, the "a" if you mildly agree, the "d" if you mildly disagree and the "D" if you strongly disagree. I let the child choose whatever he wants for breakfast. Children's foods have so many vitamins added that I don't have to bother about nutrition. I feel the foods my child eats now will affect his future health. AS long as the child doesn't pick the same thing constantly, I feel it is all right to let him select his own food. As long as my child is not sick, I guess I must be feeding him right. Agree Disagree A a A a A a d D 261 Appendix C-3e (cont'd.) 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. Nutrition is important, and one should not be careless about it. Even if I give vitamins, I feel that I should be concerned about my child's diet. Children are more likely to eat well if they select the meat for the meal. If my child says, "Let's have for lunch," I feel that I should do so. I feel that if the child drinks milk, I don't have to worry about nutrition. Because the children are fussy about what they eat, I feel it is necessary to let them pick what they want for meals. AS long as the doctor doesn't say any- thing to me about nutrition, I don't think I need to worry about it. I feel that as long as my child is gaining weight, I don't have to worry about his nutrition. I just don't have time to think much about nutrition. Nutrition is not so important as long as my child eats a lot. I believe a child should be allowed to choose what he wants for breakfast and lunch, even if it means a little more preparation for me. I am concerned about getting my child to eat nutritious foods throughout the day. Children should be allowed to eat what- ever they want. Nutrition is not so important if my ‘child has plenty of liquids. Agree A a A a d Disagree D 262 .Appendix C-3e (cont'd.) Agree Disagree 20. Young children don't grow correctly A a d D when they have improper diets. 21. I believe that a child should not be A a d D permitted to have a diet which is deficient in protein, minerals and vitamins. 263 APPENDIX C-3f Semantic Differential Instrument Now, we would like you to think about yourself and how you might describe yourself as a mother. On the next page are some pairs of words used by many people in describing themselves. Each pair of words is separated by a broken line. Somewhere on the broken line please place an "X". Put the "X" where you now feel or see yourself to be. If you feel that one or the other end of the line is extremely like what you are like as a mother, place your X as follows: warm X : : : : : : cold or warm : : : : : X cold If one end is quite closel like what you are like as a mother, place your X as follows: warm : X : : : : : cold or warm : : : : : X : cold If one end is only sli htl like what you are like as a mother, place your X as follows: warm : : X : : : : cold or warm : : : : X : : cold If you do not feel either one way or the other, place your X as follows: warm : : : X : : : cold Remember, you are describing yourself 32 yourself. Do as well as you can in describing yourself. Please be sure to mark each line with an X. 264 Appendix C-3f (cont'd.) MYSELF AS MOTHER happy : : : : : sad strange : : : : : : familiar unusual : : : : : usual cruel : : : : : kind sharp : : : : : dull high : . . : : low comfortable : : : : : . uncomfortable good : : . : : : bad enjoyable : : : : : : distasteful negative : : : : positive valuable : : : : - worthless worst : : : : : best dislike : : . . . like relaxed : : : : tense hesitant : : . : . eager easy : . : : : : hard unfair : : : : : fair active : : : : : . passive fast : : : : : : slow insecure : : - : : : secure weak : : . : : strong interesting : : : : : boring heavy : : : . : : light warm : : . : : : cool mean : : : : : nice neat : : : : : : sloppy Appendix C-3f (cont'd.) soft impulsive clean plain loud woman-like 265 hard stable dirty fancy quiet man-like APPENDIX D Guidelines for Data Coding l. Coding Form for Food Records 2. Coding Guide for All Variables 3. Identification Codes for Derived Scales 266 APPENDIX D-l Coding Form for Food Records INPUT: Card 1 COLUMN 1 Card number 2 Preschool identification code 3-5 Child identification number 6 Sex of child 1 = male, 2 = female 7 Vitamin supplement 1 = no, 2 = yes 8 Mother's assessment of child's intake for the day l = less than usual, 2 = usual; 3 = more than usual 9-10 Total number of food items consumed ll-l6 Food Identification Number 17-19 Units food consumed (e.g. 100= l serv; 050 = 1/2 serv.) 20-21 Time consumed - (code) 22 Meal (1) or snack (2) 23 With whom eaten: l = alone 2 = all of family 3 = some of family 4 = friends, other 24 Where eaten l = home; 2 = elsewhere 25-38 39-52 53-66 67-80 Repeat columns 11-24 for each food item consumed 267 mmHanHm> HHH Hoe moHso mcHuoo NIQ XHszmm< oo.omm-oo.om Ham H mm .esHono SHum N mH oo.om~-oo.om «am H mm .aHmuoum anus» H SH oo.om~-oo.om «mm H mm .mmHuono mkumo H mH oo.omH-oo.o~ lose 0 cHemuH> smumo H NH oo.mH-oo.m lose aHomHz Hmukm H HH 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I umnuo n muoo oz Haccoom < vamm ucmuuomEH ummmH n NI mmsHm> ummemEom OOIMO vH HmHmm HmNHmmHHNHONHHHHmHHMHHNH .HH.HHH.HH mamufl uomawmuv ucmEduum OIH IGH HMHucmHQMMHQ UHuCMEmm NOIHm vH AmmHOMmHC mecouum ou mmumm mHmcouumv ¢IH mHmom mmmCmmmHumzom omIO wH mmDA¢> mo mwz .oz omdu .oz .qou .m«> Ho.ucoov HIO xflccmmma 295 m>onm mm OIH mvou m>onm mm mIH mvoo czoum a nuflam uanm3um>o .O mmumq .w mommm>¢ .m HHmEm .N uanmzumocD .H OHHH Hc3onm a :uHEm umm m>onm mm HIH wnoo m>onm mm hIH mUOU m>onm mm HIH mooo m>onm mm hIH 0000 m>onm mm HIH mooo "mmHHucmoumm vacuum nuom .v nunm .n :uON .m :uOH .O nuOH .N zumh .m can .H "mmHHucmoumm uumsum m>onm mm OIH mvoo m>onm mm mIH mvoo m>onm mm mIH mcoo OHIO «0 mm mmMIuanm3Iganmm OHIm mo mm HmOMIuanm3Iuanmm OOIHH mo mm Hmmquzme3Iuanmm HHIH mo mm .mHquOHHmm OHIO mo mm HmOMIuanwm mOIHH MO mm HmmMIuanmm OHIH mo mm .mHqunHHmz OHIm mo mm HmOMIusmHmz OOIHH mo mm HmOMImeHmB AmHmmO OHIO mo mm HmOMIuanmm AmHmmv OHIO mo mm HmmMIuanmm AmHmmO HOIHH mo mm HmOMIuanmm ON OH OH OH OH OH OH OH OH OH OH OH vH OH MH OH NH OH HH OH OH OH O OH m MDH¢> .mO MUS midz mqmfiHm¢> .02 deu .oz .400 .m<> AO.ucouv «In xHOammm¢ 296 OO.HIOH.O Om\mo OOIOO OH HOOHIOOO OHIO Oo mm .usHHmn OOH x <0\oo OOIHO OH HOOHIOOO OHIO H0 mm .OOHHmz OOH x OU\<3 you .meOH Hmucmeaon>ma HOIOO OH H.on OHIOO OHIO no mo .mHquOHHmm HOIHH OH Avumvcmum uumsum mo GHHHcmoumm nuom mmmmouo .uEE SUHns um mom .connuv H.on OHIOH OHIO H0 mm OHOIOOHHmz HHIOO OH OHIO OO.~IOO.O O0 HO meOH HOHHHOIHOHHHS OHIHH OH OHIO OO.~IOO.O O0 HO meOH HOHHOOIOOHHmz HOIHH OH OO.~IOO.O HOIHH O0 OH OHHH .OHOHO O 0mm oHuOu HOHHOOIOOHng ”mecH HHIHH OH OHIO m>onm mm OIH mnou mo mm HmHmom uanmnluanmz MN OH m>onm mm OIH mcoo OHIm ucmmumm mo mm HmHmom uanwnIuanmz NN OH mmmno .O uanm3Hm>o .m onoum .v Hmauoz .H umocmHO .H HOIHH HOHHmsumOcO .H O0 OH .mHmom OOHHmnIunHHmz HO OH HOHH .ucmmumm OmOH¢> Oo moz .oz ammo .oz .Hoo .m«> HO.ucoov NIQ chcmmm< 297 APPENDIX D-3 Identification Codes for Derived Scales CARD VAR. NO. NO. VARIABLE NAME 1 l Calories 2 Protein 3 Fat 4 Carbohydrate 5 Calcium 6 Iron 7 Vitamin A 8 Thiamin 9 Riboflavin lO Niacin ll Ascorbic acid 2 21 Parents are all-wise male (PARI) 22 Treating child as an equal scale (PARI) 23 Only listen to parent scale (PARI) 24 Unquestioned loyalty scale (PARI) 25 Deception scale (PARI) 26 Trapped in a dull job scale (PARI) 27 Anomie scale 28 Would like to get out! scale (PARI) 29 Children are very demanding scale (PARI) 30 Occasional dissatisfaction scale (PARI) 31 Frequent dissatisfaction scale (PARI) 32 Socio-economic status index 3 41 Sex of child 42 Age of child (in months) 43 Hemoglobin 44 Hematocrit 45 Serum albumin 46 Serum proteins 47 Change in weight of child 48 Change in height of child 4 51 Weight-age, Fels 52 Height-age, Fels 53 Weight-age, Stuart-Meredith 54 Height-age, Stuart-Meredith 55 Height-weight-age 56 Weight-height scale (Sargent) 57 Weight-height2 ratio 58 Weight-age, in May 59 Height-age, in May 60 Developmental index for weight 61 Developmental index for height 62 Weight-age/height-age, developmental index 298 Appendix D-3 (cont'd.) CARD VAR. NO. NO. VARIABLE NAME 5 71 Sitting height 72 Shoulder width 73 Pelvic width 74 Head circumference 75 Chest circumference 76 Index of trunk breadth 77 Upper arm circumference 78 Skinfold thickness for triceps 79 Sucscapular skinfold thickness 80 Hydroxyproline: creatinine ratio 81 Hydroxyproline index 6 91 Permissiveness attitude about child's eating habits scale 92 Nutrition is very important for the child scale 93 powerlessness scale 94 Semantic differential (l) 95 Semantic differential (2) 96 Values: Economy 97 Prestige 98 Health 99 Family centrism 100 Religion 101 Friendship 102 Freedom 103 Education 7 104 Aesthetics 8 111 Child premature or full term? 112 Mother received prenatal care? 113 Mother's age when pregnant with child 114 Mother's present height 115 Mother's present weight 116 Father‘s present height 117 Father's present weight 118 Child bottle or breast fed? 119 Age at weaning 120 Infantile behavior scale 121 Child has ever been anemic? 122 Feeding problems scale 123 Child receives vitamin supplement? 124 Child received other supplement or health food? 125 Amount sleep per day 126 Last medical exam 127 Reason for last seeing physician 128 Dental record 129 Amount of time that family eats together 130 Children eat at the same time as parents? 131 Mother's Opinion about eating everything on child's plate 299 Appendix D-3 (cont'd.) CARD VAR. NO. NO. 10 12 13 132 133 134 135 136 137 138 139 140 141 142 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 VARIABLE NAME Mother's action when child dawdles or plays with food Frequency of snacking scale Time of day when child seems most hungry Child uses spoon? Child uses fork? Child uses knife? Child's favorite food Food child refuses to eat Most important influence on the mother's meal planning Family acceptance of new foods Meal pattern of child--regular or irregular? Total number of persons in home Number of children five years or younger in home Ordinal position of child Mother's marital status Parents' occupation and education scale Income status scale Family income Mother away from child scale Stage in family life cycle Race: white vs. black Number of times moved in last three years Own or rent dwelling? Crowding index: rooms in house/persons in family Condition of house and neighborhood scale Child's birth weight Mother's Opinion that child eats too many sweets Person who decides foods to buy Frequency of grocery sh0pping Amount of money spent for food per week Frequency of use: convenience foods scale Family receives food stamps? Number of Basic Four named Score on Nutrition Knowledge test Calories/kg body weight Gm protein/kg body weight APPENDIX E Correlation Matrices 1. Multiple Group Analysis for Develogment of New PARI Scales 2. Final Inter-Scale Matrix 'ACYOI INYERCO'IFL|YIOIS AND LOADI“G ”47.1! Is 09 32 no a: 100 . ‘I 100 30 35 100 i: 33 4: :oo 37 27 ,1 29 3 2 o o o 1 o o 0“ .2, 0‘, 0‘, 0‘, ~20 -s o '70 -22 .24 .26 .1. .41 -10 -?O -15 -10 -80 -20 -12 -11 .9 0’4 '13 13 01 32 1. 22 30 39 11 I2 12 2 a 91 J «a 47 so 90 29 ‘3 ‘1 41 II 15 29 2: ’0 :7 12 17 32 ‘6 1111 O I. 01 0 1. I 4 '6 11 5 :5 71 AA 11 4:9 41 14 31 :oo 3 .27 oz: -13 o: -17 -I -:o -:I -II 9 s a: 3: so 30 5' OJ 37 10 27 7 39 72 39 12 13 25 95 91 98 92 62 94 300 '70 05 13 100 ‘4 3. 37 32 10 11 12' 83 '39 34 79 100 4 87 50 I in 13 O 7 23 12 1 ?O lo 24 10 19 ‘9 I. 7 1 LA -I In 9 ’1 31 32 44 30 3. 12 14 2O 22 77 I: 0: ~17 ~11 013 13 '7 C 3 -1 -o -5 -1 l 3 ‘15 0‘ 0. oil .1 03 - 41 11 ’1 20 11 20 11 19 2 '1 -29 535 -?1 - :11 -21 -15 -19 '1 ‘1' 1'017 9 “Q -IC -3 ~13 o7: ’3’ 9 '3 2 0. 1. 0" o 2 o. .1. 3 'l 3 11 O A-14 -13 ~19 o1 - 1 I3 3 .24 ~10 ~10 {If 1 19 -7 0 co 1. '22 '21 012 '1 .2 o . o I .‘43117 C; 1 0. 131:1. 3 17 6 2 11 4 -g 3 2 7 10 10 04 '1 9 a 16 5 2 18 l 9 4 .2 O, o‘ ‘. ’ 20 2O 13 9 19 7 7 7 '6 l 3 .7 6 ‘3 75 9 41 2 73 7| 6! -27 .23 -41 1. 14 _3 36 1’ 1. 012 0‘ .13 03! -22 -37 O. 07 CI. . 0‘. O. 0’ A, '13 '3’ 017 '21 I! 10 I 18 ’1‘ 5" 7 '6 .12 21 4 '1 '6 O '17 .7 1O 0' '15 1. '0 '5 I:, ’17 I'11 r10 11 ’1 b4. 70 ’21 P11 r17 0. O 17 C 0" ,9 .3. .4 ’1 '3. 01. C 0" I U '1! 0‘. O7 .13 C. .. 2 .0 O o o '1' '3. 5. ‘0 '1. '11 '1. '14 "1 1 ‘3 4 1’ IO '11 . .1. .12 73 .7 '10 '10 0‘. 6‘ 0‘2 43 .41 109 104 1.8 21 30 6 10 9 1’ 0‘. a a 06-» u a 301 111 102 5 J 7 4 0 1 2 22 23 29 24 91 21 95 94 02 72 101 100 9 12 9 10» 3 I9 ’3 04 100 7 21 I3 37 40 100 4 7 2 45 42 79 10. _A_ 15 29 A 32 23 1 ~19 ~Io 74 79 I0 73 1 0 2 4 .2 11 2A, In 39 10 31 100 22 12 I2 73 11 J 12 23 20 9 100 23 1 -7 4 4 a 22 26 23 13 79 100 _21 12 72 21 14 4 22_ 21 11 21 41, 2:119! 24 ~17 o o .1 .5 10 22 79 74 32 70 ’30 zoo 91 ~5 ~10 ~1 .9 5 t 12 I2 15 16 15 23 36 109 21, 1 I 1 .2 1 1 -0 70 71 21 1n 2 27 23 100 1 95 ~10 ~1 ~1 ~0 ~12 '2 4 72 11 11 14 35 19 23 14 100 '0 0 11 ~I ~1 ~1 ~4 I7 15 13 11 0 17 4 19 25 40 100 . 12 ~23 os, ~1, 1g 3 ~11 ~I 19 ~1 JO ~1 ~19 .2, .9 :1 11 11 72 ~18 ~10 ~15 ~30 ~10 ~24 ~4 ~19 ~22 ~19 ~7 ~12 ~14 5 ~22 ~0 ~0 14 100 a: ~10 ~13 n ~s ~9 3 7 4 ~2 7 11 14 14 7 1 21 I4 13 0 93 9 I5 I 10 7 11 a 6 ~l 12 ~7 23 13 23 16 17 24 ~9 ~2 I :7 72 23 92 17 7 11 4 25 9 13 ‘3 7 ~J 15 2 O 2 ~6 61 5 ~15 4 5 2 9 17 4 5 6 32 2 I 11 2 ~6 ~15 ~9 ~J 65 ~9 ~5 7 ~12 ~21 ~12 H ~12 ~10 5 ~0 ~14 ~16 ~0 ~15 5 1 79 29 44 -5 ~7 -4 -4 4 ~3 ~4 ~3 12 ~23 10 ~3 ~0 1 3 0 ~0 ~3 1o 03 ‘1 ~1 L3! 1 ~5 1 12 ~23 ~2 ~4 20 ~1 ~19 ~12 2 ~1 ~9 ~0 ~3 74 9 ~I3 1 ~12 ~o ~13 ~9 ~19 2 ~23 a 7 ~10 ~13 ~7 ~10 ~2 ~13 2o 71 J ~11 7 ~s ~o ~11 v ~4 1 ~4 11 ~0 ~2 ~4 ~9 -3 4 5 14 41 ~10 ~o 11 ~15 4 ~4 I1 11 3 ~4 7 1 I ~3 5 ~3 3 ~14 ~1 501 40 32 4 77 71 0 4 ~11 13 0 o 10 ~10 .5 ~1 ~11 ~2 ~17 ~27 502 I: 14 ~1 14 o 3 ~0 ~30 ~17 ~7 4 ~2 ~19 ~J ~2 ~27 ~10 ~22 ~4 503 ~~ ~10 II .2 -3 21 u 25 0 7 ~2 ~4 15 0 9 ~2 .4 .0 ~13 504 31 6 17 29 11 11 4 ~14 ~O I 21 19 ~15 ~19 ~0 ~10 ~9 ~10 ~12 505 35 4 ~s 7 1 ~5 2 ~19 ~l ~4 10 10 ~19 ~13 ~3 ~10 1 ~10 ~0 304 19 13 n 13 ~1 ~3 I ~4 12 12 17 20 4 14 4 9 10 ~| ~17 907 *0 96 23 ‘9 25 11 7 ~12 14 19 ~3 10 ~15 ~15 ~4 ~16 3 ~10 ~21 500 22 10 75 so 70 71 90 31 44 21 21 24 13 4 8 ~5 8 ~2 ~27 509 ~10 ~s In 32 20 30 21 P1 I1 1| 2! 22 32 17 29 20 10 0 ~23 510 11 12 27 13 7 2s 31 20 19 7O 71 74 ‘0 72 23 27 14 4 ~17 511 ~I ~o s ~2 1 1! 10 2| 22 32 21 SI 75 73 A, 2‘ 22 ~12 ~15 512 ’19 3 ~2 3 c4 ~9 0 2! I 12 11 21 1 29 13 01 79 67 9 513 6 ~9 0 ~12 ~a ~9 14 ~11 3 ~11 22 14 ~9 3 ~2 7 I 2 39 '3 100 73 100 O 61 69 64 68 70 71 29 521 15 85 32 84 81 14 31 55 51 53 52 62 54 82 13 11 12 33 35 34 75 73 42 44 43 41 105 104 103 101 102 302 APPENDIX E-l Item Names: PARI Scales The child should not question the thinking of his parents Child should look for answers from other peOple even if controdict parents Child soon learns that there is no greater wisdom than parents When a child thinks his parent is wrong he should say so Children have every right to question their parents views Its best for the child if he never gets started wondering whether his parents views are okay Child should grow up convinced parents know what is right thing to do Child has right to own point of view and ought to be allowed to express it Children should be allowed to disagree with parents if own ideas are better A childs ideas should be seriously considered in making family decisions Children should be encouraged to tell parents if family rules are unreasonable Parents should adjust to children sometimes When child is in trouble, should know he wo't be punished for talking with parents If a parent is wrong he should admit it to his child Parent should never be made to look wrong in childs eyes Children should never learn things outside home which make them doubt parents ideas There is no excusing someone who upsets the confidence a child has in his parents Loyalty to parents comes before anything else Child should always love his parents above everything sele More parents should teach childrentto have unquestioning loyalty to them Loyalty to parents is an overemphasized virtue Parents should earn loyalty from children Often you have to fool children to get them to do what they should You have to fool children into doing many things because they wouldn't understand 18% best to trick a child into doing something he doesn't want to do There's no excuse wasting time explaining when you can be a little clever Little use in writing public officials because don't care about average man' These days a person doesn't really know who he can count on Today peOple has to live pretty much for today and let tomorrow take care of itself The lot of the average man is getting worse Because of the future it us hazardly fair to bring children into it One of bad things about raising children is that you aren't free enough to do as like 303 Appendix E-l (Cont'd) 3 7 25 22 23 95 94 92 24 91 21 72 83 61 65 64 63 74 71 45 Young mother feels held down because there are lots of things she wants to do while young It isn't fair that men have a chance for interesting work and most women to do jobs of home Most young mothers are bothered more by feeing of being shut up in home Husbands should know how hemmed in a woman feels staying at home a lot One of worst things about care of a home is women feels can't get out Having to be with child all the time gives women feeling wings are clipped Raising children is a nerve racking job The things children ask a parent after a hard days work are enough to make any lose temper Its natural for parent to blow his 0p when children are selfish and demanding There is no reason why a day with the children should be upsetting Most parents never get to the point where they can't stand their children A parent should keep control of his temper even when child is demanding Its a rare parent who can be even tempered with his children all day Most parents can spend all day with their children and remain calm and even tempered Parents very often feels that they can't stand their children a moment longer Children soon learn that parents were wrong about many of their ideas A good parent can tolerate criticism even when children are around Raising children is an easy job Raising children is very much harder than most jobs men do When parent asks child to do something, child should always be told why Children are too often asked to do all the compromising and adjustment As much as reasonable, parent should try to treat child as an equal In well-run homes children should have things their own way as often are parents ' Parents should not expect to be more esteemed than oother worth adults by child Child should be taught that will love and respect many other people besides parents When child does something he shouldn't, bet him inter- ested in something else 304 Appendix E-l (Cont'd) Multiple Groups Program Becomes GRPC (111) 501 GRPC (15,85,32,84,81,l4,31) 502 GRPC (55,51,53,52,62,54,82) 503 GRPC (13,11,12) 504 GRPC (ll,35,34,75,73) 505 GRPC (42,44,43,4l) 506 GRPC (105,104,103,101,102) 507 GRPC (5,3,7,4,6 508 GRPC(1,2) ' 509 GRPC (22,23,25) 5l0 GRPC (24,91,21) 511 GRPC (95,94,92) 512 GRPC (72,83,83,8,6l,65,64,63,74,7l, 45) 513 Standard Score Coefficient Alphas 100 79 71 69 74 69 74 71 47 59 55 59 41 305 own .31 ma YT am can can .31 mm1 00H mm 00.H vm mH+ NH... 5H1 hH+ «HI vml oml mel OOH mm mm mN+ HH+ w + 5N... hmu. mml moi mml mv+ ooa Hm ...; l N N Nmmmommonmmm + vamxooncunm :—1 H N 1"! 1+1 11111-1- OCH 3.. 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Hml hH+ Nm+ NNI ma... men mm... 3+ \OI-Ir-INONNr-IMMMG hoomm u-Iv—Io-Iv-I u-I I‘mHOmMI‘MNMI‘FMHfl'r-IHOO‘Q'NLO I-I r-IM O \D I I‘OQ‘NVLDMIDG) I «N mm «0.... mm ma ha ma «H mm ma I-II-I 1++++ l \Ofl‘fi'mmmmNflfl'Oafi‘mMu-IOHV‘V‘H I-I Nm Hl-‘I «a ma ha om ma ma mm NH v-I +++1 u-IN H I I \DMI‘QHVOOSMOMNHI‘OMLDSDQHHI‘FLD t-INv-Iv-I ' oovm t-IN IDQ‘OM r-INv-Ir-I [x ....q H mmmNOMVOQI‘NHVHMQNI‘VOO‘OI‘MHOHNOOO r-Ir-Iu—IFIt-‘Ir-II-IN H H \D co m H I I‘NHNWOKDLDLDQMFI ' N I OV‘MU‘MNOOQ‘ r-It-Ir-Ir-INv-INr-IN CNN N Ln 0 r-I I '1-11-1 mmmHMHv—INVQVI‘NNQMWI‘ Q‘ mmmmmmr-{oom O H I mmboobaoommmm r-I HONHNO‘MOQLO I ann r-Io-l Nlnmr-I NNI-IN VI‘ONQ r-INv-INr-I N ...1 H H H .-1.-1 H + + I I + mm mm hm mm mm vm mm mm am am om mm. as on mm. «l. mu NN. an me am ow mm pm mm mm vm mm mm Ao.ucoov mum xflncmdmm 307 «CI CCI m I CH+ CCI v v C v NHI C I N NH C v I h CCH h + C I CHI HH+ mNI CH CHI C CH1 CH C I HH C I CH1 C I C I CCH m I C + C I N I CH+ C I C C CH HHI h C vH CH C CH vCH H I CH1 C I HHI CHI CNI m I C I C I C C C I CNI HHI C CH1 CCH NHI CHI H + mH+ vHI N NH1 5 C C CH1 C C I H C I N I NCH CN+ vv+ CN+ CCI Cv+ CH1 C C I w I H vH C I H I N v H HCH NH+ v + HH+ CHI mH+ CH1 m 0H1 H I N I h NHI v C I C I H I CCH C I H I C + HH+ m I «H C C C C I b C I C C CH C CNH VH+ CH+ CH+ C I mH+ vNI C I h H I C N C C I C C N I CNH C + m I N I m + m I H H I C I H «H1 CH1 HHI C H C I H I CNH NH+ m + CHI C I N 1 CH C N v C v I H I C m N w CNH CHI mH+ h I v I C + N N I C H H 1 N C I C H I H I C I CNH H I C + C + v I C + H CH C HHI C I H I C C C I C H CNH C + h + HH+ NH+ CH+ HH v I C C H N C C m C C CNH CH+ C + m + N + C + CHI «HI CHI CH1 CN1 «N1 CH1 CH1 CN1 le CHI NNH mN+ vN+ mH+ C + NH+ «H1 C I CH1 CH1 C C I CH1 CH1 CHI HHI hHI HNH CH1 CH1 CHI oH+ CH1 CN C HHI NHI H m I HHI C I C I C I w I CNH C + CH+ CC+ C + CH+ CH CH C I v C I H I HHI N m I H I H I CHH HH+ CH+ NH+ CNI CN+ N NC H I CN C I vN C I CH CN CH HN CHH HNI m I C I h + HNI N I N 1 NH w HH C NH N C C C hHH CCI C I CHI CH+ «N1 N C C C b I C C C C C C CHH mH+ CN+ ¢H+ CNI hN+ C CH C NH NN CH C N NH CH C mHH vNI h I CHI C + C I CH CH CH NH CN CH CH NH NH CH CH vHH C + CH+ v + C + v I C m I h I C I H I HNI CHI HHI HHI VH1 CHI CHH NNI HCI N I m I CHI C CH v C C m C CH C m CH NHH C I N + H I CH+ C I N C I v C C C I C CH1 C I H C I HHH C I H + C I mH+ HHI NH m CH N H NH 5 CH CH CH CH vCH CHI CNI CNI NC+ CCI CH H I h N m C m H I C I H N I CCH CNI HCI CH1 C + vNI C I CH1 C I C C C I N I C I b I HHI C I NCH CH+ m + C I HHI C + CH1 CN1 HHI H m C I NHI «H1 C I CHI CHI HCH CH+ CN+ CH+ C I eN+ H H C v N N I C N I C I C v I CCH \MN INN mN INN Hm \HH CH C C h C m w 1% N H Ac.ucooc mum xaocmmm< 308 C CC NN CH+ 5+ CN+ CH+ N NC NN HN+ m... 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HI I MNOr-ImOanI‘NI—IO‘NV'WGNQWQ' H H v-I m NH N CC CC mNr-‘IOKDmkowml‘mm "*7 H N 1n CC CC NC Ch Ch Cm N HH NH CH CH C 1 CH CH CH C C C I NHI CNI CH1 C C H I m H I h I C I m I H C I CHI 5 N CN NH C I N I C I CHI C CH1 HHI m I HHI C I m C h I CHI CHI C C C C I N C I NH C NH N I C C m N I C I H I C I CHI C C CH H h b C I HNI CH1 C I H C C C N H H H I I ....q OSLOO‘OHHNMLOOHomwNCDONN I H CCH CCH CCH NCH HCH CCH CCH CCH CCH CCH CCH CCH CCH NCH HCH CCH CCH CCH CCH CCH CCH CCH CCH NCH HCH NCH HCH CCH CCH CCH CCH A©.ucouv Nnm chchQC 309 CH N I C C I C 1 CH C CH N C I C I H I N I CHI N HH CC NC H 1 CH C I H I C CN HN C CN C I C I HH C I CH NN CC NC C CH H I C C I CN NC NH CH C I C I C NHI C CN NC NC C I C C I CH C HH CH C CN NHI H I CH C I C CN HC CC NNI CH C CH C NN CH N CN C I C I C I N C CH NC NC CN HH CH1 C 1 CH CN C I C HN C N HN C I CH HN HC CC N CH H C CH CN H C CN C C C H CH CN CC CC CH CH C I CHI C HN CC NH CN C I C C H I CH CN CC HC H CN H I C I C CN CC CH HC C I C C N CN CN CC NC C CH C NH CN C I H N I N I N I CHI C CH1 NH C CC NC H I CH C C NH CN C C I H I H NHI C CH1 C NH CC CC HH CH C I H I CN CN C C 1 HH C I C I C CH1 N CH CC CC CH C NHI NHI CH CN C I H I HN C C NN C I CH CH CC CC C CH C I N NH NC C C I NN C I C I CH CHI CN CN CC CC CH C HHI C I CH CH C I CH NN C H CH C 1 CH CN NC CCH C CH1 C N CH CN C HH CN N I C I CH CHI HN NN HC CCH CC C C H C CHI CHI NNI C I C C H I H NHI CC CCH C I HHI C CH HH N I H I NHI C C I CH IN C I CC CCH CC CHI C C 1 CH C I HHI C C C I C I CHI CC CCH CNI CHI CH1 C I C CH1 CH1 C I CHI CHI C I CC CCH CC C I NHI C I C H C I H I C I C I CC CCH C CH1 CH CH1 C I C I C I N I CH CC CCH C CN CHI C C I N I C CH NC CCH C I H CH H C N C I HC CCH CH1 C I CH H CH CC NC CCH CHI NNI CNI N + HH+ HC CCH CC1 CC1 C I CH+ CC CCH CNI CNI C I CN CCH CC1 C I CN CCH CNI CN CCH CN HC CC CC CC CC CC CC NC HC NC HC CC CN CN CN CN AU.UGOUC NIm wacmmmd 310 CH+ CHI C + CC CH CC CC HC CH NC HC N I +++ I-Ir-I IIII ml‘mwoommmI-INIDMI‘LOQ‘ I (D V MQ'mv-IOV‘O‘LOVNCD NV) NH II Q'N H r... .1. 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Inmfl'MI-INNLOI‘I-INQNLHDV' H H H ++++I I ++ I I‘lnI-I o-Ir-I +1 CH+ NN+ NNI CH+ CHI CHI NH+ HHI HHI m + CHI C + N + CH+ CH+ CH+ C + N + HNI CH CN+ CH+ CH+ CHI Hmmfi‘l‘fl' I CHI LnN I-II-I +II +++I+I mommmmmkomCh 00 141-1 ++ M + NH+ NI‘IDOIOMO LnI-Iln H I‘ N CHI CH+ CH+ HN+ CC+ CC+ CNH CHH CHH CHH CHH CHH CHH CHH NHH HHH CCH CCH NCH HCH CCH CC CC CC CC CC CC NC HC HC CC CC CC CC CC CC Ac.ucoov mum xflncmmm< 311 m OFMO N NI—I I I I I ...1 1-1 I mmfl'OI‘I‘mNNmOQ‘mva‘I-II-IVI‘I-IV ...1 I \OQI-IO I-I ' v-Ir-I m <1' I-I O'IKONI‘V'LOMI‘I-Iml‘r-IMI‘I‘NNOHON I‘ V H CHHCHHCNC CHI H N N I I I I I H H I H H I I (\MCDHUII‘FOOMr-II‘MNQ'QOmNHQMI‘IfiNNI—IQI‘NLO r-II-I I V V V'mmmmfi' Q'Or-ICDOV‘f‘r-IKDMVMNO‘ I 1* HI fl' CH+ CN+ + CDLOMLDKDNFMIDO‘ H + +-+-+ O m + CH+ Q'Q' Nrfi I+-+ r~C PI II I H + NH+ +-++-+ m I CH+ CHI CH+ l m I N0 r-Ir-I +I mmONOmmNOI‘r-II-I r-I +~+ I 01") HH I + I +-++-I N +-+I + + I IDMNKOLOQQQM 7 007-1me I 0" N (D N I++I I-I I MI‘NmmmMQ‘O‘OI‘V‘LflLfil-OV'O‘CDNQQQI‘Q' +-++-+ I+-+-++-+-+I +-+I I‘ N CN+ m 1.. 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I‘ ‘1' CN CH CN H I mmlnlnmm CHI H I CHI H CH CH1 NCCCHCCCCCHHCCCH I-I CC v V' HH II N I H MCCHCCCCCCHCCCC H I O N I m V OIHNO‘IDQI‘Q‘Q‘O‘GDVGJI‘WUI H V“ H I H ,_.| NH+ +++ H NH CH HH+ CH+ CH+ NH+ CHI C + C + CH+ CHI CN HN+ HN+ CN CH+ NC+ CN CCH CCH CCH NCH HCH CCH CCH CCH CCH CCH CCH CCH CCH NCH HCH CCH A©.ucoov NIm xHUcmmm< III III is I] i III-III I]: III. 313 CH+ CCH CC CCH CC CNI HNI CHI C+ C + CC CH NC CC CC CC CC CC CCH CC HHI CHI NHI CH+ C + CN NC CC CC CC CC CC CC CCH NC CHI CHI CHI NHI CH+ H + CC CC CC om CC CC CC mC CC CC CCH HC r-I +-+ \Dmfl'OI-IV'Q'CD .1. \OhHOMQ—IQNC I—Ir-Ir-INI-II—Im NM CH CCH NC NHI CHI CH OH+ CH+ omI NH+ m + CH HH CH CH CH CN CH HN CCH HC CC CCH CC HH+ NHI CH+ m + mm CH CN NN CH CC NC CN HH CC CC CCH CC CC CCH CC CN CCH CC CC CCH CC HHI CHI C I CHI m C m I C + C + CH+ NHI NNI C I CH+ C I C + Cm OH H CHI Hm HH NC C HC CH om C mm CH CH C CC CC CC CH mm mm CC C CC CC CC Hm CC CC Hm NC CC Hm Cm CH 00H CC OOH CC CC CH+ CHI C + CN CC CC CC HN CC CH CC NC CC CC HC CC CC CC HC HC HC CC CCH CC CH1 CH1 C + CH+ HNI CH+ C+ NH CH HH CH CH CN CH CN CC CC CC CC CN HN CC CC CC CCH NC NC Aw.ucouv NIm xHucmmm< I-I I-Ir-I IIII ,_I I 314 H I H H MNNI-INmmNOO‘fl‘fi'QVMMVOmmmI‘OCDNQ‘O‘O‘ONCD HHMQO‘NQ‘Q‘NQ‘MOI‘Q‘HNNNNNW OHkDV‘LDKOr-IQ'mF-ImMOkOWN Ln [x v [\ I-I [\ CH mmko H H I I I LDNO‘kDOv-IMI‘Q' er T'.‘ r-INU'INF ”MT . HH CH I‘MO‘ "'7. mvhmmMVom I mr-IO‘MONFMO‘Q'I-IQ'OI-IOMV'O O \O CH CC CN \Dv—Imm T” I H NN II mmwovmr-ILOBMNMN I m N CH CN CH CN HH CH CH CCH CCH CCH NCH HCH CCH CNH CNH CNH CNH CNH CNH CNH NNH HNH CNH CHH CHH CHH CHH CHH CHH CHH NHH HHH CCH CCH NCH HCH CCH CC A©.ucoov NIm xHocmmmm 306 CNI CCI HNI CH+ HCI N C I C H I C C I C C I C I C C I CC H + C + HH+ CNI CH+ CHI NH C I C C I C C I C C N C CC CN+ CC+ CC+ C I NC+ C I C CH1 C I C I C I CHI N I H I C I N I CC CH1 CH1 C CH NNI C C C I HH HH NH C I CH C C NH CC C I CNI C I CHI CHI CH+ C N I CH+ H I H I C I C I C + H I C + CC C + NHI N + CNI C I CH+ H I C + H + C + C + NH+ C I N + HH+ H + CC CC1 CCI CCI CN+ NCI NNI H I HHI C + C + H I CH1 C I C + C I C I CC HC+ HC+ CH+ CNI CC+ CH+ C + CN+ C + C + C + CC+ CH+ C + CH+ HH+ NC C I CH+ NH+ CHI CH+ H + H I CHI C I CNI C I HNI C I C I CNI C I HC H I C CH CN CH C CC CN CH CH C I C CH CNI HH C I HC H I C C CH C C CH CH C C C I C C CNI C C I CC C NH HH C I NH C I C C CH H CH C C I C C C CC CH HN CH N I CH C I C I C H I N C I C CH1 C I C I C I CC CH C H I C C H NH C I N C I C C I C I CHI C C I CC NH C C C C N I C I C I C I CHI N C I C I C I C I C I CC HH C H I CH1 C N C C I C I C C C I C I CHI N I C I CC C C H I C I C C C NHI C I C I C NHI C I CNI HHI CHI CC CH CH CH C 1 CH N C C C C HH H N H I N H CC C C C C I CH H C C I C I C I C N I N C I C I H I NC CH CH CH NHI CH H I H C C I H H C C I CHI H I C I HC C C I CH1 C I CH C C CN C CH N I CN C C CH C NC C C NN CHI CH CH C CH CH CH CH CH C C CH CH HC HH C I N I CHI CH CH HH CN NH CN C CN C C HN C CC CH C CH HHI NH CH NN CH CH CH CN NH NH C CH NH CC NH C I C C I CH CH HN CN CH CN CH CN HH C CN CH CC N I C I C N H C I C CH CH CH CH CH H I HH NN C CC C C C C I C N I C CH CN C CH CH C C CH C CC N I H I C C I CH C C CH CH CH NH CH H I C NN C CC C C CN CNI CN CH C CH CH CH CH CH C C CH CH CC C N CH CHI CH CH NH CN CN CN CH NN C NH CN CH CC C C CN CNI CH CH C CH NH CH CH C C C CH C NC CN CN CN NN HN HH CH C C C C C C C N H AC.ucooC NIm xflocommC 307 CCI CCI C I CH+ CCI C C C C NHI C I N NH C C 1 C CCH C + C I CHI HH+ CNI CH CH1 C CHI CH C I HH C I CH1 C I C I CCH C I C + C I N I CH+ C I C C CH HHI C C CH CH C CH CCH H I CH1 C I HHI CH1 CN1 C I C I C I C I C C I CNI HHI C CH1 CCH NHI CHI H + CH+ CHI N NHI C C C CH1 C C I H C I N I NCH CN+ CC+ CN+ CCI CC+ CHI C C I C I H CH C I H I N C H HCH CH+ C + HH+ CHI CH+ CH1 C CH1 H I N I C NHI C C I C I H I CCH C I H I C + HH+ C I CH C C C C I C C I C C CH C CNH CH+ CH+ CH+ C I CH+ CNI C I C H I C I N C C I C C N I CNH C + C I N I C + C I H H I C I H CHI CHI HHI C H C I H I CNH NH+ C + CH1 C I N 1 CH C N C C I C I H I C C N C CNH CHI CH+ C I C I C + N N I C H H I N C I C H I H I C I CNH H I C + C + C I C + H CH C HHI C I H I C C C I C H CNH C + C + HH+ NH+ CH+ HH C I C C H N C C C C C CNH CH+ C + C + N + C + CH1 CH1 CH1 CH1 CNI CNI CHI CHI CNI CNI CHI NNH CN+ CN+ CH+ C + CH+ CH1 C I CHI CHI C I C I CHI CHI CHI HHI CHI HNH CH1 CH1 CHI oH+ CHI CN C HHI NHI H C I HHI C I C I C I C I CNH C + CH+ CC+ C + CH+ CH CH C I C C I H I HHI N C I H I H I CHH HH+ CH+ CH+ CNI CN+ N NC H 1 CN C I CN C 1 CH CN CH HN CHH HNI C I C I C + HNI N I N I NH C HH C NH N C C C CHH CCI C I CHI CH+ CNI N C C C C I C C C C C C CHH CH+ CN+ CH+ CNI CN+ C CH C NH NN CH C N NH CH C CHH CNI C I CH1 C + C I CH CH CH NH CN CH CH NH NH CH CH CHH C + oH+ C + C + C I C C I C I C I H I HNI CHI HHI HHI CH1 CH1 CHH NNI HCI N I C I CHI C CH C C C I C C CH C C CH NHH C I N + H I CH+ C I N C I C C C C I C CH1 C I H C I HHH C I H + C I CH+ HHI NH C CH N H NH C CH CH CH CH CCH CHI CNI CNI NC+ CCI CH H I C N C C C H I C I H N I CCH CNI HCI CHI C + CNI C I CHI C I C C I C I N I C I C I HHI C I NCH CH+ C + C I HHI C + CH1 CNI HHI H C I C I NHI CH1 C I CH1 CH1 HCH CH+ CN+ CH+ C I CN+ H H C C N I N I C N I C I C C I CCH Cm INN mN INN HN IHH CH C C IF. 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