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Associations of Food Allergy-Related Dietary Knowledge, Attitudes, and Behaviors Among Caregivers of Black and White Children With Food Allergy

Published:December 02, 2021DOI:https://doi.org/10.1016/j.jand.2021.11.017

      Abstract

      Background

      The increasing prevalence of pediatric food allergy (FA) in the United States has disproportionately affected non-Hispanic Black youth. However, racial and other socioeconomic disparities in FA management among caregivers of children with FA remain unclear.

      Objective

      To determine associations between socioeconomic, clinical, and health care factors and FA-related knowledge, attitudes, and behaviors among caregivers of Black and White children with FA.

      Design

      Cross-sectional survey analysis from the Food Allergy Outcomes Related to White and African American Racial Differences Study.

      Participants/settings

      Longitudinal cohort of caregivers of 385 Black and White children with FA ages birth to 12 years residing in Chicago, Illinois, Cincinnati, Ohio, and Washington, DC from 2017 to March 2021.

      Main outcome measures

      There were 3 primary outcomes of interest: (1) FA knowledge assessed by scores from the Knowledge Survey, (2) FA-related attitudes assessed by newly developed survey, and (3) food-related behaviors assessed by the FORWARD Diet and Purchasing Habit Surveys completed 6 months postenrollment.

      Analyses

      Multivariable linear and logistic regression.

      Results

      The overall response rate to the 6-month postenrollment survey was 51.3% (385 of 751). White caregivers represented 69.4% of the participants. Black race was associated with a 1.5-point mean decrease in FA knowledge score (95% CI: −2.2 to −0.7) compared with White caregivers, and a graduate degree or bachelor’s degree was associated with associated with a 1.7-point mean increase (95% CI: 0.8-2.7) and 1.1-point mean increase (95% CI: 0.2-2.0) in FA knowledge score, respectively, compared with caregivers who had less than a bachelor’s degree. Multiple FAs and ever visited the emergency department for a food-related allergic reaction were also associated with higher levels of FA knowledge. Ever visited the emergency department for FA was also associated with higher odds of 2 measures of FA attitudes reflecting parental anxiety. Greater FA knowledge scores were consistently associated with lower odds of several FA-related food purchasing and eating behaviors assumed to have elevated risk of FA. Eating food prepared at school was the only FA behavior associated with race. Compared with White children, Black children were 2.5 times more likely to eat school-prepared foods (95% CI: 1.2-5.6).

      Conclusions

      Findings from this study identified socioeconomic, racial, and clinical factors associated with caregivers’ FA-related knowledge, attitudes, and behaviors, but further research is warranted to better understand these relationships.

      Keywords

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      Biography

      E. Vincent is an assistant director, clinical nutrition research, Northwestern University Feinberg School of Medicine, Center for Food Allergy and Asthma Research, Chicago, IL.

      Biography

      L. A. Bilaver is an associate professor, Northwestern University Feinberg School of Medicine, Center for Food Allergy and Asthma Research, Chicago, IL.

      Biography

      J. L. Fierstein is an epidemiologist, Johns Hopkins All Children’s Hospital, St. Peterburg, FL.

      Biography

      N. Thivalapill is a data analyst, Northwestern University Feinberg School of Medicine, Center for Food Allergy and Asthma Research, Chicago, IL.

      Biography

      A. A. Pappalardo is an assistant professor of medicine and pediatrics, University of Illinois at Chicago, Chicago, IL.

      Biography

      A. Coleman is an attending physician in the Division of Allergy and Immunology, Children’s National Health Systems and assistant professor of the Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington DC.

      Biography

      A. Robinson is a graduate student and former research coordinator, Children’s National Health Systems, Division of Allergy and Immunology, Washington DC.

      Biography

      H. Sharma is the chief of the Division of Allergy and Immunology, Children’s National Health Systems, and associate professor of pediatrics at George Washington University School of Medicine, and director of the Food Allergy Program at Children’s National Health Systems, Washington DC.

      Biography

      A. Brewer is an attending physician in advanced general pediatrics and primary care, Ann & Robert H. Lurie Children’s Hospital of Chicago, and is an instructor of pediatrics (advanced general pediatrics and primary care) at Northwestern University Feinberg School of Medicine, Chicago, IL.

      Biography

      A. Assa’ad is associate director of the Division of Allergy and Immunology, director of Clinical Services of the Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, and professor of pediatrics at the University of Cincinnati, Cincinnati, OH.

      Biography

      J. Jiang is a research project coordinator, Northwestern University Feinberg School of Medicine, Center for Food Allergy and Asthma Research, Chicago, IL.

      Biography

      J. Choi is a research assistant, Northwestern University Feinberg School of Medicine, Center for Food Allergy and Asthma Research, Chicago, IL.

      Biography

      H. W. Hultquist is a research assistant, Northwestern University Feinberg School of Medicine, Center for Food Allergy and Asthma Research, Chicago, IL.

      Biography

      A. J. Kulkarni is a research assistant, Northwestern University Feinberg School of Medicine, Center for Food Allergy and Asthma Research, Chicago, IL.

      Biography

      M. Mahdavinia is the chief of the Division of Allergy and Immunology and associate professor of medicine and graduate college, Department of Internal Medicine, Division of Allergy & Immunology, Rush University Medical Center, Chicago, IL.

      Biography

      J. Pongracic is chief of allergy and immunology, Ann & Robert H. Lurie Children’s Hospital of Chicago, and professor of pediatrics (allergy and immunology) at Northwestern University Feinberg School of Medicine, Chicago, IL.

      Biography

      M. C. Tobin is an associate professor of the Department of Internal Medicine, Division of Allergy and Immunology, Rush University Medical Center, Chicago, IL.

      Biography

      C. Warren is a post-doctoral research fellow, Northwestern University Feinberg School of Medicine, Center for Food Allergy and Asthma Research, Chicago, IL.

      Biography

      R. Gupta is a professor, Northwestern University Feinberg School of Medicine, and Director of the Center for Food Allergy and Asthma Research, Chicago, IL.