Background: Child overweight and obesity is a public health concern as it leads to health risks in childhood and later in life, such as increased risk factors for developing cardiovascular disease and Type 2 Diabetes. In the past several years, research has focused on child weight status in relation to the physical home environment and the social home environment. Parents substantially contribute to the physical and social aspects of the home that may impact both adult and child obesity. When considering the physical environment in terms of home food availability, several studies have found significant outcomes that relate home food availability to intake. This has been shown for individual foods, however, no tool currently exists that describes the overall quality of the home food environment. Relationships have also been reported for parent-child dietary intake, and select parent-child health factors, such as body mass index, blood pressure, and clustering of cardiovascular risk factors. What is currently unknown is how measures of overall quality for the home food environment, parental dietary quality, parent overall health associate with each other in the home environment, and how they associate with child weight status.

Purpose: The purpose of this research is two-fold, 1) to create a metric for describing the overall quality or patterning of the home food environment, the Home-IDEA Quality Score, and 2) to assess relationships among the quality of the home food environment, maternal dietary quality, maternal health indicators and child weight status in a multi-ethnic sample of mothers with young children.

Methods: The Home-IDEA Quality Score was developed using the Healthy Eating Index 2010 algorithms and evaluated against the National Food Acquisition and Purchase Survey food-at-home data set. Development and evaluation included assessments for content and criterion validity, and reliability. The Family Health Study included the following assessments for mothers: mailed surveys, in-person assessments of maternal cardiovascular risk factors and a facilitated 24-hr dietary recall using the National Cancer Institute's Automated Self-Administered 24-hr recall system. Child height and weight were measured in-person. Data were collapsed into quality variables. Differences by income for participant characteristics, the Home-IDEA Quality Score, Maternal Dietary Quality, Maternal cardiovascular risk and individual maternal cardiovascular risk factors were assessed with Kolmogorov-Smirnov Z and Chi-Square tests. Pearson and Spearman correlations were used to assess relationships among the home food environment with maternal dietary intake, and maternal health factors with child weight status. Linear regression models were constructed to further visualize relationships of the quality of the home food environment with maternal dietary quality, and for the prediction of child weight status based on maternal cardiovascular risk.

Results: A metric for describing the overall quality of the home food environment was successfully developed and evaluated. The exploratory Family Health Study demonstrated feasibility by collecting data that described the quality of the home food environment, maternal dietary quality, and overall maternal health with 85 mother-child dyads from 16 preschools in Colorado.

Discussion: The development and evaluation of the Home-IDEA Quality Score produced a novel tool for assessing the home food environment, which was successfully used in the analysis of the Family Health Study to characterize the overall quality of the home food environment. Future research on the Home-IDEA Quality Score should include refining the Home-IDEA Checklist to include items that are missing, but that regularly appear in homes, such as canned soup and ready-to-eat baked goods, and separating composite items, such as lettuce, into separate items that better profile the wide differences in nutrition across specific types of similar items. Additionally, it is recommended that the food amounts for shelf-stable foods be examined, such as for peanut butter, which could be contributing to ceiling effects for Seafood & Plant Proteins.

In terms of the findings from the Family Health Study, the linear regression model indicated that the Home-IDEA Quality Score was a significant contributor to the full model for predicting variance in Maternal Dietary Quality, a novel finding that adds to the literature. Additionally, Maternal CVD health was also a significant contributor to the linear regression model for examining predictors of variance in Child Weight Status. This extends the research literature in that few studies have examined multiple cardiovascular risk factors in mothers with young children for relationships with child weight status. From a public health perspective, it is troubling that the percentages of mothers with multiple cardiovascular risk factors was unexpectedly high. Colorado has long been considered a healthier state from an obesity perspective; however, the data from the Family Health Study indicate that this is simply not the case in this sample of rural, predominately low-income, multi-ethnic mothers of young children. (Abstract shortened by ProQuest.).