Hispanic Caregiver Perceptions of Water Intake Recommendations for Young Children and Their Current Beverage Feeding Practices

Abstract

Hispanic children in the United States are at high risk of obesity. Sugar-sweetened beverage consumption (SSB) is a modifiable contributor to obesity. Hispanic children are more likely to drink SSB than non-Hispanic white children. The main goal of the study was to explore caregiver beverage feeding behaviors and evaluate reactions to water intake recommendations for children birth to five years old in a diverse U.S. Hispanic urban community. Findings will be used to develop community- and population-specific intervention messaging for obesity prevention for this population. The study used a qualitative focus group design using constant comparison coding methods. Participants included 35 Hispanic caregivers of children aged 0–5 years living in a low-income, predominantly Hispanic community in Chicago, Illinois. We found young children in this community drink a variety of SSBs and caregivers choose beverages based on cost, availability, health, and behavioral concerns. Participants report altering beverages for a variety of reasons, family member disagreement regarding beverage feeding practices, and older family members’ influence on children’s preferences. Puerto Rican and Mexican American participants differed in the range of beverages provided, concerns regarding water intake, and beverage alteration and feeding practices. Caregivers universally believe the recommended water intake amount of four six-ounce servings daily for children is too high. Findings will inform message development to reduce SSB intake and increase water consumption among young children in this community. Messaging should be ethnic group specific, target all family members, build on current beverage alteration practices, and include nutrition information specific to young children.

Keywords

children health promotion family sugar-sweetened beverages obesity prevention

Introduction

Childhood obesity is a serious public health problem in the United States. Low-income and racial/ethnic minority groups are disproportionately affected; 14.6 percent of low-income preschool-aged children (two to four years of age) are obese (Centers for Disease Control and Prevention [CDC] 2009), and 18.5 percent of low-income Hispanic preschoolers are obese. Obese preschool-aged children are at higher risk of becoming obese adults (Guo and Chumlea 1999).

Experts recommend obesity prevention among young children as the optimal approach to stem this trend (Berkowitz and Borchard 2009). Children learn health habits when they are young and are strongly influenced by family environments including availability of foods and rules for consumption (Westenhoefer 2002). Thus, many obesity prevention efforts have been directed toward young children and their families. The high rate of obesity among Hispanic children and the need for prevention among young children heighten the importance of understanding and effectively influencing the drivers of Hispanic family practices relative to healthy lifestyle behaviors.

Increasing evidence suggests a link between sugar-sweetened beverage (SSB; which includes some non-100 percent juice drinks, soda, energy drinks, and flavored drinks) consumption and obesity (Malik, Schulze, and Hu 2006). Young non-Hispanic black, Hispanic, and low-income children have higher rates of SSB consumption than non-Hispanic whites (Garnett, Rosenberg, and Morris 2012). Consumption of SSBs has also been linked to chronic diseases associated with obesity, including type 2 diabetes and cardiovascular disease among adults and children (Malik et al. 2010). In addition, consumption of SSBs is associated with dental caries in children. Among adults, reduction of SSBs has been associated with weight loss (Chen et al. 2009). A study examining the daily caloric contribution of SSBs among children and adolescents projected a reduction in SSB intake could result in an average reduction of 235 calories per day, enough to bring about weight loss (Wang et al. 2009).

For these reasons, SSB consumption represents a modifiable contributor to obesity. Many prevention efforts recommend the substitution of water for SSBs in adults and children. Evidence suggests that increased water consumption in lieu of SSBs may be a viable tool in the fight to reduce and control childhood obesity (Wang et al. 2009). However, there is little evidence in the literature to suggest what strategies may be successful in achieving the substitution of water for SSBs, particularly among those in urban, low-income, and/or racial/ethnic minority groups.

This study took place in the Humboldt Park community of Chicago. Nearly half (48 percent) of Humboldt Park residents are Hispanic with 17.9 percent identifying as Puerto Rican and 24.7 percent identifying as Mexican American. Humboldt Park has a significant proportion of low-income households (U.S. Census Bureau 2000). A 2002 survey in Humboldt Park reported that nearly half (48 percent) of youth aged 2–18 years were obese and had high levels of juice and SSB consumption, 28 percent of children aged 2–5 years were consuming an average of one SSB per day, and 26 percent were consuming two or more SSBs per day (Sinai Urban Health Institute 2002).

Based on these findings, community leaders identified SSB intake among young children as a concern. As a first step, a partnership between the Consortium to Lower Obesity in Chicago Children (CLOCC) and the Puerto Rican Cultural Center (PRCC) was formed to conduct an exploratory study regarding caregiver perceptions and attitudes toward SSB and water consumption. Findings will inform local efforts to decrease SSB consumption and increase water intake among young children.

Method

Community Engagement

The study was a joint effort between an academic partner, an obesity prevention advocacy-focused organization, and a community-based institution to develop and implement the study. CLOCC is a nationally recognized partnership for strengthening community-based obesity prevention. The CLOCC team (Mason and Welch) has extensive research and program evaluation experience. Lead author (Mason) has expertise in qualitative methods. PRCC is a long-standing community organization working to promote the health and vitality of Humboldt Park. The PRCC team member (Morales) has extensive knowledge of the community and obesity-related health issues. PRCC also has many connections to families with young children through its preschool program and parental involvement efforts in local public schools. The study was approved by the Ann and Robert H. Lurie Children’s Hospital of Chicago (formerly Children’s Memorial Hospital) Institutional Review Board (IRB 2007-13178).

Design

Health promotion research has found cultural relevance is important for the success of programs reaching out to Hispanic populations, especially in settings in which a diversity of Hispanic groups are found (Castro et al. 1996). One key to the development of culturally relevant health promotion efforts is beginning with an understanding of current practices, motivations, and constraints (Garnett et al. 2012). This exploratory study follows this framework by focusing on uncovering perceptions, attitudes, and behaviors that can be used in subsequent efforts to develop tools for the promotion of decreased SSB consumption and increased water intake among Hispanic preschool-aged children in Humboldt Park. The project has a qualitative research design utilizing focus group methods with caregivers of young children in the community. Focus groups are a frequently used research method for generating an understanding of individual beliefs/attitudes and group norms toward a particular topic (Dye et al. 2000; Hewitt-Taylor 2001). The project is well-suited to focus group methods because of its focus on gaining a better understanding of community norms and caregiver perspectives on young children’s beverage exposure, choices, and consumption. Four focus groups (two in Spanish and two in English) with mixed Puerto Rican and Mexican American participants were conducted.

Protocol Development

The study used the 5-4-3-2-1 Go!® health promotion message that includes a recommendation for young children to drink four six-ounce servings of water per day (CLOCC 2012). The focus group domains included caregivers’ beverage feeding behaviors, beverage choice influences, perceptions of their child’s ability to reach the goal of four servings of water daily and attitudes toward the 5-4-3-2-1 Go!® water intake recommendation. The protocol was revised through consultation with PRCC staff and a key community informant regarding appropriate community context and comprehension level of community members. Because of the involvement of the community partner and key informant in reviewing the protocol, and resource restrictions limiting recruitment and participant incentives, the focus group protocol was not pilot tested in a focus group setting. Lead author (Mason), a trained and experienced facilitator, led the focus groups conducted in English and oversaw the analysis and interpretation of the results. A trained focus group facilitator from the community led the Spanish language focus groups. Training in focus group moderation and prompting techniques was provided by Mason.

Data Collection

In October and December of 2007 and 2008, the study team conducted four focus groups with parents and other caretakers of young children aged zero to five years residing in Humboldt Park. Focus groups were held in the parent room of a local elementary school. A PRCC staff member oversaw focus group recruitment by posting flyers in English and Spanish at local day care centers and elementary schools, and circulating announcements at parent attended meetings held at local elementary schools. Additional recruitment was done by a local elementary school’s parent-involvement coordinator. The research team had successfully used these same methods in this community to recruit caregivers of young children for a prior study.

To qualify, participants had to be 18 years of age or older, live in Humboldt Park, speak either English or Spanish, and serve as a primary caretaker for at least one child between zero and five years old. No demographic information other than age (≥18 years or <18 years), race/ethnicity, and relationship to the young child in their care was collected. Participants received a $15 stipend for their participation. Participants were assigned to the first available focus group in their preferred language; no attempt was made to segregate participants by ethnic origin, age, or any other status.

Focus group facilitators used the protocol to guide the group discussion. Table 1 maps the focus group topics to protocol questions. All focus group sessions were digitally recorded by the facilitator and transcribed into Microsoft Word by a transcription service. Spanish focus group transcripts were translated into English by the facilitator.

Table 1.

Focus Group Topics and Associated Questions.

Topic	Question(s)
Beverages consumed	Let us build a list of beverages your child drinks most . . . Are there other kinds of beverages we have not listed?
How child drinks beverages	How does your child drink these beverages? (probes: out of container, bottle, sippy cup, can, fountain, glass, straw)
Altering beverages	Do you sometimes change a beverage by adding something (probes: water, sugar, something else)
Where child drinks beverages	What are the places your child is likely to drink beverages? (probes: home, car, caregivers, out at events, relatives’ homes, other?)
	Are there some beverages your child is more likely to drink in some places than others? What are they?
How beverages are chosen	Think about how your child’s beverages are chosen. Who chooses what your child will drink?
Considerations for choosing beverage	What things do you consider when choosing a beverage for your child? Probes: cost, availability, nutrition, health content of drink, child’s preference, packaging, possibility of spills, cleanup, reward/punishment, other? Which of these is most important to you?
Reaction to water consumption recommendation	Health advocates recommend that children drink four cups of water a day. Does this sound right to you? Why?
Hard to follow recommendations	What are some reasons it might be difficult for you to follow the water recommendations for your child?
Suggestions for making it easier to follow recommendations	What could be done to make it easier for you to follow the four cups a day recommendation for your child?

Analysis

Word documents were coded by hand by the coding team using constant comparative methods (Hewitt-Taylor 2001). Initial codes were developed based on research questions and the protocol and informed by literature on SSB and water intake.

Initial coding was done by Mason (lead author) using descriptive coding categories and constant comparative analysis methods to develop and refine the initial coding scheme (Dye et al. 2000; Hewitt-Taylor 2001). Two additional coders ( interns from a local university’s Masters in Public Health program) assisted in coding the transcripts using the revised coding scheme. The coders each coded two of the same transcripts, and coding was compared for consistency. Further adjustments were made to the coding scheme to address coding disagreement and to clarify codes for which coders were unclear on rules for application. Coding disagreements were resolved through discussion among the team as a whole. These discussions were used to more clearly define codes and develop guidelines for the application of codes as well as to map the relationship of codes to one another to avoid duplication. Using the revised coding scheme, the coders completed coding of all transcripts.

Results were summarized into thematic statements and analysis expanded as the relationships between coded segments were examined and developed into themes.

Categorization by frequency of mention and status of contributor (ethnicity, caregiver-relationship) were completed after the final coding. Recommendations regarding factors to consider when developing and/or implementing water intake promotion campaigns were derived from findings.

Results

A total of 35 mothers, grandmothers, and other caretakers participated in four focus groups; none participated in more than one. Each focus group had between 6 and 11 participants. Two focus groups were held in Spanish with a total of 14 participants (n = 8 and n = 6), and two focus groups were held in English with a total of 21 participants (n = 10 and n = 11). Focus groups lasted one to two hours. All participants were women over 18 years of age. Most participants were Puerto Rican (75 percent). About 25 percent identified as Mexican American or both Puerto Rican and Mexican American. Mothers made up 57 percent (n = 20) of participants, grandmothers about 14 percent (n = 5), other caretakers (including several aunts and paid nonrelative caregivers) about 14 percent (n = 5), and women who were both grandmothers and parents of young children made up about 14 percent (n = 5) of participants. All participants who were both grandmothers and parents of young children were Puerto Rican.

The following thematic areas were identified.

Young Children in Humboldt Park Drink a Wide Array of Beverages, Including a Variety of SSBs

A total of 24 different types of beverages were identified as consumed by young children in the care of focus group participants. These beverages included unflavored and flavored milk of various fat content, fruit juice and fruit nectar, nondiet sodas, iced and hot tea, coffee, energy drinks, fruit-flavored sugary drinks, flavored water, bottled water, tap water, breast milk, nutritional supplement drinks, sports drinks, smoothies, milkshakes, yogurt drinks, and ethnic specialty drinks such as a Malta (nonalcoholic fermented malt drink popular in the Puerto Rican community). Juice was by far the most mentioned beverage consumed, with a total of 50 mentions. Other beverages frequently mentioned as consumed by young children of participants included: unflavored milk (26 mentions), sugar-sweetened juice-flavored drinks (26 mentions), unflavored water (24 mentions), and nondiet soda (21 mentions). Puerto Rican participants reported a wider range of beverages consumed than did Mexican American participants. Beverages reported uniquely by Puerto Rican participants included Malta, coffee, and energy drinks. Mexican American caregivers most often mentioned juice and juice-flavored beverages as beverages that were consumed by young children in their care.

Caregiver Beverage Choices for Young Children Are Based on Multiple Factors Oftentimes Operating in Combination

For example, concerns about cost may be accompanied by concerns about health effects. Factors considered, and their relative importance, depend on circumstances such as time of day, surroundings, availability, and child expectations. Factors included child’s likes and dislikes (mentioned 27 times), cost (mentioned 15 times), caregiver assessment of beverage nutritional qualities (mentioned 8 times), child’s nutritional needs and health conditions (mentioned 16 times), and perceived behavioral effects of beverages (mentioned 19 times). Puerto Rican participants more frequently mentioned cost as limiting the amount and kinds of beverages provided. In two of the focus groups, participants made decisions about beverages to serve their young children based on the joint considerations of cost, nutritional qualities, and health conditions. For example,

He thinks because he’s in Grandma’s house he’s going to drink a gallon of milk in a day. But at home mom doesn’t give him milk all the time either so I try to do the same. One, milk is expensive and two, it constipates.

Factors driving caregiver decisions varied by the context in which the beverage was to be consumed. For example, caregivers reported limiting drinks with high sugar content in the evenings because they believed sugar made children “hyper,” and they did not want to interfere with evening sleep. Concerns regarding hyperactivity were more often cited by Puerto Rican participants. Caregivers provided beverages with stimulants such as energy drinks and coffee earlier in the day.

Like the energy drinks they get early, it has to be early. Once the clock comes around, that’s it for the sugar.

Some Participants Chose Beverages Based Solely on Children’s Health Needs

After the cavity incidents I look at the sugar content on the back of the juices, so I try to buy the juices with the lowest sugar.

. . . she has to drink a lot of water because she has bowel movement issues.

Mothers were more likely to report giving children certain beverages (soda, juice) to avoid child temper tantrums than other caregivers.

I’ll be very honest. Sometimes I don’t want to deal with the tantrum. Sometimes he’s not in the mood for water and no matter how much I force it he won’t drink it. That’s when I break down and give him juice.

Caregivers Often Alter Children’s Beverages

Participants mentioned altering water 14 times including adding fruit, adding juice, boiling and flavoring with SSBs. Altering milk was mentioned 26 times. Alterations included adding flavoring, adding sugar or honey, adding peanut butter and chocolate, warming and adding herbs. Participants also mentioned adding water to juice (five times), adding sugar to juice (five times), and adding milk, sugar, and honey to coffee (four times). Adding raw egg to juice and Malta was mentioned five times.

Motivations for alterations included behavioral effects, health, taste, and cost. Participants report adding water to juice because juice was “too strong” or to cut costs. Altering milk (warming, adding sugar or honey or herbs) was done to enhance taste and as a sleep aid. Fruit or flavoring was added to water to improve its taste and appeal to children. Puerto Rican participants had distinct beverage alteration behaviors compared with Mexican American participants. For example, only Puerto Rican participants reported altering juices by adding raw eggs with the intention of increasing health benefits. Puerto Rican participants reported both mixing more additives into beverages and more mixing overall than Mexican American participants.

Decision Making Regarding Beverage Choice Is Shared Among Adults in the Child’s Life

Participants universally said that parents decide what beverages children in their care are given, but that when children are not in their care, or are in social situations, parents have limited control over the beverages/amount of beverages their children are given.

Especially at a party, other people will be like, “just give it to them” and then you won’t notice until after they’re done drinking it or something.

This was particularly an issue among Puerto Rican participants who said that grandparents and fathers were more likely to give soda to children, although not all participants agreed with this.

Yea, my husband is more prone to give them soda when I’m not there. He only gets soda when my husband is taking care of him. He doesn’t get soda when I’m there.

I try to [tell grandparents not to give child certain things] but it’s hard when they say “I used to give you that and you’re fine.”

Young Children Want What Other Family Members Are Drinking

Participants mentioned the influence of older siblings, parents, and grandparents a total of 20 times. This is especially the case when caregivers are drinking coffee or soda. A minority of participants (n = 2) disagreed with this saying that their children understood that while they themselves as parents drank soda, soda was not for children and that the children understood this and did not drink or ask for soda.

In families with older siblings, older siblings’ beverage choices were seen as creating desire among younger children in the family. When younger children saw older siblings drinking a beverage, they wanted it as well. As a result, caregivers felt the pressure to be “fair” and give the same beverage to the younger child.

Rules for What, Where, and When Beverages Are Consumed Varies Widely

Most participants reported no limitations about where, when, or what children can drink at home (n = 24). A subgroup (n = 11) reported rules limiting beverage consumption. These rules included limited drinking of beverages to certain rooms (e.g., kitchen only), certain beverages to certain rooms (e.g., dark juices to the kitchen), certain beverages to mealtimes (e.g., soda only at meal times), certain beverages to a specific time of the day (e.g., no energy drinks later in the day), and beverages in general by time of the day (e.g., no of beverages after 7:30 in the evening). Only one of the rules (limiting soda to mealtimes) was set with the purpose of limiting the child’s intake of SSBs.

Barriers to Drinking Water Include Taste Preferences and Caregiver Safety Concerns

Participant reports about children’s like/dislike of water were mixed. A subset of participants reported that their children drink and enjoy water (n = 12), while others reported children’s desire for drinking flavored beverages over plain water (n = 20). Puerto Rican caregivers mainly voiced concerns about the taste of tap water. Several Mexican American caregivers were concerned about the safety of feeding water to young children, including fears about the health of tap water and water intake supplanting intake of beverages and foods with nutritional value.

I am scared to substitute water for milk because she is a good eater, but she goes through days when she doesn’t want to eat or only wants to eat one type of food. I mean she loves soup, I think I am giving her water through soup and that’s what she eats for lunch. Sometimes I think she is not getting all the nutrients she needs. So maybe through milk? I don’t know if she is going to get the calcium through another thing.

Caregivers Believe that the Recommended Four Six-Ounce Servings of Water Per Day Is Too Much, and Children in Their Care Are Not Drinking that Amount

Participants in all focus groups generally agreed that their children were likely not meeting this guideline and foresaw difficulty doing so.

I think that it is a little bit too much for me. Because one cup in the morning, then one cup at 3, then one cup at night. Then that’s a lot because it will cut into the milk she is drinking. If she drinks a cup of water she will not drink a cup of milk.

Discussion

This study explores caregiver behaviors, attitudes, and opinions regarding beverages served to young children (ages zero to five) in a low-income Hispanic community in Chicago. Our findings indicate that young children in Humboldt Park drink a wide array of beverages including SSBs.

Most participants reported that young children in their care were drinking SSBs. This is not uncommon. Hispanic, non-Hispanic black, and low-income children are more likely to drink such beverages (Garnett et al. 2012; Malik et al. 2006). In addition, Garnett et al. (2012) found that about 25 percent of children as young as two years old were drinking SSBs. This is a concern since SSB consumption has been linked to excess weight gain and because young Hispanic children are at increased risk for obesity. These facts suggest that health promotion messaging around SSB reduction could have an important impact on a contributor to the health inequality we see in obesity burden in these racial and ethnic groups (Kreuter and McClure 2004).

Consistent with other literature, within our sample of Hispanic caregivers, we found cultural differences in motivation, practices, and attitudes regarding beverage selection for children in Humboldt Park (Elder et al. 2009; Malik et al. 2006). Specific differences between Mexican American and Puerto Rican caregivers that can inform culturally specific communication areas were found in beverages provided, beverage alteration practices, and concerns regarding increased water intake. These findings support the need to create health promotion messaging that goes beyond addressing Hispanic communities as a homogeneous unit and acknowledges the different cultures within that group (Huerta and Macario 1999). Focusing health promotion messaging on cultural practices that may impact health is a practical strategy that may increase message acceptance (Castro et al. 1996; Institute of Medicine [IOM] 2002; Kreuter et al. 2003). The information gathered in this study can inform various strategies for enhancing the cultural appropriateness of health promotion messaging around beverage choices and consumption (Kreuter et al. 2003).

Ethnically targeted messaging on the topic of young children’s SSB consumption may be a promising strategy to decrease SSB intake among young children in this community as this strategy has been found effective in numerous studies of public health message framing (American Psychological Association 2004; Schneider et al. 2001). In this instance, messaging geared toward Puerto Rican community members might emphasize the range of beverage choices appropriate for young children; while messages geared toward Mexican American caretakers might emphasize education about tap water safety and the sugar content in juice and juice-flavored drinks.

Participants reported disagreement among family members regarding beverages served to young children in their care. In particular, grandparents and fathers were identified as providing young children with soda over the objections of mothers. These findings suggest that beyond ethnic group targeting, the targeting of messages to different adults and caregivers in the child’s life may be important for developing effective messages for the reduction of SSB consumption among young children in this community. There is a need for messaging that reaches fathers, grandparents, aunts, and uncles. Messaging at worksites where fathers are employed and at senior centers where grandparents visit may be beneficial.

Further, participants noted that young children’s family members routinely drink SSBs, influencing young children’s beverage desires. It is well established in the literature that children’s food choices are significantly affected by the home food environment and the behaviors of family members (Brown and Ogden 2004; Campbell et al. 2007; Contento et al. 1993; Tzou and Chu 2012; Wardle 1995). This suggests that to be successful in limiting young children’s SSB consumption and increasing water intake, family members will have to change current habits. Messaging should address the connection between older family members’ habits and young children’s behaviors.

This study identified participants’ motivations for beverage choices including cost, health and behavioral effects, child preferences and availability. Motivations sometimes worked in combination. For example, a primary motivation may have been the cost but health concerns helped reinforce the beverage decision. This study also found that participants were already using several strategies for improving the health content of beverages consumed by young children including diluting sugary drinks and juices with water, flavoring water and milk with nonsugar flavorings, and blending fruit with water. Building on current practices and motivations is a recommended practice in public health and messaging developed from these findings should incorporate both motivations and current practices for reducing SSB intake (American Psychological Association 2004; Dorfman, Wallack, and Woodruff 2005). Beverage choice motivations to build messaging upon could include the oral health benefits of limiting SSBs, the cost of different beverage choices, beliefs about behavioral connections between SSB consumption and “hyper” behavior, and the effect of beverage choice on conditions such as constipation. Some strategies for improving the health of beverages could include diluting juice with water, adding small amounts of fruit to water, and substituting high-sugar drinks for lower-sugar alternatives (e.g., flavored water for regular soda, mixing a small amount of 100 percent fruit juice with seltzer water, or using no- or low-sugar milk flavoring as alternatives to highly sugared drinks).

It is important to incorporate nutrition-related information for young children into health promotion messaging around water intake. It has been shown that maternal decision-making criteria for food served to their families has a strong influence on the diet of their children; and one important component of these criteria is knowledge of the healthfulness of foods (Contento et al. 1993). Helpful information might include the American Academy of Pediatrics (2001) guidelines regarding limits on juice consumption based on age and clear information about which types of beverages are not meant for consumption by young children (e.g., energy drinks). Consistent with our findings, others have noted concerns in urban communities around tap water safety for children (Huerta-Saenz et al. 2012). Information about the safety and benefits of fluoride found in tap water could be helpful for increasing water consumption over SSBs.

Participants universally agreed that the recommended amount of water servings was too much for young children, and their children were not drinking that amount of water. Adapting the 5-4-3-2-1-Go!® guidelines to include age-specific recommendations and recommendations specific to different liquid sources (e.g., water, milk, juice) might help to address these concerns. Another strategy may be to provide information on dietary sources of water intake (e.g., soups) that could be combined with water intake in beverage form to achieve recommended water intake goals.

Given the study’s findings, we recommend that messaging to promote water intake and decrease SSB intake for young children in the Humboldt Park community should be targeted both ethnically and to all family members including fathers and grandparents, and that it acknowledge current beverage feeding practices and motivations, and promote transitioning from SSBs to water gradually using existing SSB modification strategies. Further, such messaging may benefit from educational content including pediatrician-recommended beverages for young children and the safety of tap water. Finally, we recommend providing additional information for the 5-4-3-2-Go!® water intake guidelines. This could include provision of specific water intake recommendations based on children’s ages and the balance between water intake and other nutritional needs.

Limitations

Focus groups are inherently limited in their generalizability due to their structure. Focus groups are small, facilitated discussions of short duration andmay not cover all topics relevant to participants’ experiences and opinions. In this way, the information may not be as complete as other time-intensive methods of inquiry such as interviews. In addition, the information presented here represents the opinions of the small number of women with whom we spoke. Their experiences may not be representative of all women in their community or similar communities. So while some findings may be transferable to other communities/populations, the findings as a whole may not be generalizable to other places/populations. It is up to communities to evaluate these findings to determine what applies to their setting. The focus group discussions centered on beverage choices and consumption practices to identify potential topics or messaging strategies for health promotion communications. We cannot speak to the modes of communication that might be effective for Hispanic caregivers in Humboldt Park as this was beyond the scope of this project. Finally, the findings from this study are limited by the fact that food intake data were not collected, and therefore beverage consumption cannot be understood in context of children’s overall diets.

Conclusion

The findings reported here help us understand the current practices, motivations, and influencing factors of caregiver beverage choices in Humboldt Park and can help in the development of culturally relevant health promotion programs for this population. Study findings will inform health promotion efforts aimed at influencing caregivers to increase water intake and decrease SSB consumption among young children in Humboldt Park. Other communities with similar populations may find the implications drawn from these findings applicable to their situations.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author Biographies

Maryann Mason is an Assistant Research Professor in the Department of Pediatrics at Northwestern University’s Feinberg School of Medicine. She is also the Community and Evaluation Research Director for the Consortium to Lower Obesity in Chicago Children (CLOCC) where she conducts community-based research projects and program evaluations on the topic of childhood obesity prevention. Dr. Mason also serves as Community-Faculty Liaison for Research with Northwestern University’s Alliance for Research in Chicago Communities (ARCC), a program of Northwestern University’s Clinical and Translational Science Institute. She received her PhD in Sociology from Loyola University of Chicago.

Sarah B. Welch is a graduate of Tufts University in Medford, MA. Sarah received her Master of Public Health in 2009 in Health Behavior and Health Education from the University of Illinois at Chicago School of Public Health. Sarah’s research interests include obesity prevention and reduction, specifically through policy and environmental changes in community, workplace, clinical and school settings.

Miguel Morales has worked in the Humboldt Park neighborhood of Chicago for many years as a community organizer and high school teacher. He is currently enrolled in the Master’s in Public Health program at the University of Illinois at Chicago, focusing on epidemiology

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