Advances in Nutrition 14 (2023) 914–945

journal homepage: https://advances.nutrition.org/

Review

A Scoping Review of Household Factors Contributing to Dietary

Quality and Food Security in Low-Income Households with School-Age
Children in the United States
Heather A. Eicher-Miller 1, *, Lisa Graves 1, Bethany McGowan 2, Barbara J. Mayfield 3,
Blake A. Connolly 4, Wanda Stevens 4, Angela Abbott 4
1
Department of Nutrition Science, Purdue University, West Lafayette, IN, USA; 2 Libraries and School of Information Studies, Purdue University,
West Lafayette, IN, USA; 3 Nutrition Communicator, LLC, Delphi, IN, USA; 4 College of Health and Human Sciences, Purdue Extension, Purdue
University, West Lafayette, IN, USA

A B S T R A C T

Low-income and food-insecure households are at risk of poor dietary quality and even more severe food insecurity. Especially in childhood,
consuming a nutritionally adequate diet is an essential driver of health, growth, and development. Household-level factors can present
challenges to support the nutritional needs of low-income and food-insecure household members. The aim of this scoping review is to
identify the contributing household factors to dietary quality and food security in US households of school-aged children 5 to 19 years and
synthesize the evidence around emergent themes for application to future interventions. The scoping review was conducted following the
Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols Extension for Scoping Reviews using search terms addressing
food insecurity, low income, and dietary behaviors in the database PubMed. Screening by 3 independent reviewers of the title, abstract, and
full study phases identified 44 studies. The 5 themes around which the studies grouped were: parental behaviors, child/adolescent be-
haviors, food procurement behaviors, food preparation behaviors, and household environment factors. Most studies were cross-sectional (n
¼ 41, 93%) and focused on parental behaviors (n ¼ 31, 70%), followed by food preparation and procurement behaviors. The themes
identified were interrelated and suggest that incorporating education on parent and child behaviors that influence food procurement and
preparation, along with strengthening organization and planning in the household environment, may hold promise to improve dietary
quality and food security among food-insecure and low-income households. The findings can be used to inform future nutrition education
interventions aimed at improving dietary quality and food security in households with school-aged children.

Keywords: food insecurity, food security, low-income, dietary quality, dietary selection, dietary behavior, family meal planning, food
purchasing, household, children

Statement of significance
Household factors of parental and child/adolescent behaviors, food procurement and preparation behaviors, and the household environment are
contributors to dietary quality and food security in low-income households for children in the United States. Addressing these factors holds
promise for interventions to improve dietary quality and food security.

Abbreviations used: DGA, Dietary Guidelines for Americans; SNAP, Supplemental Nutrition Assistance Program; SNAP-Ed, Supplemental Nutrition Assistance
Program-Education.
* Corresponding author. E-mail address: [email protected] (H.A. Eicher-Miller).

https://doi.org/10.1016/j.advnut.2023.05.006
Received 16 December 2022; Received in revised form 5 April 2023; Accepted 9 May 2023; Available online 13 May 2023
2161-8313/© 2023 The Author(s). Published by Elsevier Inc. on behalf of American Society for Nutrition. This is an open access article under the CC BY license
(http://creativecommons.org/licenses/by/4.0/).
H.A. Eicher-Miller et al. Advances in Nutrition 14 (2023) 914–945

Introduction influenced by interpersonal relationships and their household

settings, then the organizations they interact with, and the
About 10.2% of households, or 13.5 million households, communities they are situated in and further, the policy levels.
within the United States experienced food insecurity at some The model is also used as the framework for the DGA, showing
time throughout 2021 [1]. Food insecurity refers to a situation how these layers of influence can intersect to shape dietary
where households experience uncertainty regarding having suf- quality. Knowledge of the influence exerted by individuals,
ficient food or the inability to obtain enough food to meet the interpersonal relationships, and household settings in dietary
needs of all family members due to limited money or resources quality and food security is critical to inform successful in-
[1]. Food-insecure households are at risk of reduced dietary terventions directed through the outer levels of the social
quality when compared with households with food security [2, ecological model, ie, organizational, community, and policy
3]. Dietary quality as defined by the Dietary Guidelines for levels. These levels are where federal food assistance and nutri-
Americans (DGA) [4,5] may be lower in food-insecure compared tion education programming intervene. Therefore, the purpose
with food-secure households due to irregular dietary patterns, of this scoping review was to map current evidence of household
such as skipping meals and eating less or more of certain com- factors influencing dietary quality and food security within
ponents than are intended or required for health [6–8]. Low low-income US households with school-aged children around
dietary quality may be a contributor to the link of food insecurity major themes and to consider relationships of the themes and
with increased prevalence of chronic disease in adults [9–11]. their factors. The results can be applied to inform future nutrition
Specifically for children, consuming a nutritionally adequate education interventions and programming.
diet is an important driver in physical and mental health, growth,
development, and wellbeing [5]. Childhood is a life stage when Methods
specific amounts and types of nutrients are necessary at critical
times to achieve full genetic potential [5] and where decreased The Preferred Reporting Items for Systematic Reviews and
macronutrients important to emotional regulation and anxiety of Meta-Analysis Protocols Extension for Scoping Reviews was
food insecurity may link to mental health outcomes [12]. utilized to conduct this scoping review [29]. Search strategies
School-aged children 5 to 19 years interface with the National were developed collectively through discussion among the re-
School Lunch and School Breakfast Programs and begin to searchers involved in the project. The following search terms
practice autonomy in their dietary behaviors. Once established, were used: (food insecurity OR food security OR low-income OR
these behaviors may continue into adulthood [5,13,14]. Food poverty) AND United States AND (dietary quality OR dietary
insecurity during childhood may be associated with the con- behavior OR dietary selection OR dietary attitudes OR family
sumption of a nutritionally inadequate diet, low dietary quality, meal planning OR food purchasing). The online database,
and poor health outcomes compared with food security [3, PubMed, was identified to have a scope fitting of the aspects of
15–18]. For example, school-aged children who are food inse- focus in the study (food insecurity, dietary quality, household
cure are more likely to have asthma, poor health, and are nearly factors) and was used to search for studies written in English and
3 times more likely to have iron deficiency anemia than published within the last 10 years between 2012 and 2022, and
food-secure children [16,19,20]. the search was completed from February 2022 to March 2022
Insufficient money to purchase adequate food is a significant and updated in January 2023 to include all studies published in
risk factor for food insecurity [1,21] and poor dietary quality 2022.
[22,23]. Regardless of individuals having the necessary knowl- Studies were included in this review if they focused on food
edge and skills, a limited budget may result in opting for food of security and/or dietary quality of low-income households in the
more economical value instead of food with the most nutritional United States and identified factors/behaviors/attitudes/bar-
value. Households with lower incomes purchase foods of lower riers affecting food security and/or dietary quality in these
nutritional quality when compared to households with higher households. Dietary quality for the purposes of the review was
incomes [24,25]. Along with financial restraints, dietary choices inclusive of aspects of dietary behaviors, variety, food compo-
can be influenced by additional household factors, such as food nents, food group, or nutrient intakes. Studies were excluded if
accessibility and preferences, eating behaviors, parental and they focused on households that did not include children or did
child nutrition knowledge, parental modeling, and psychosocial not include school-aged children aged 5 to 19 years, low-income,
factors [26,27]. A comprehensive look at the body of evidence of or food-insecure households.
household factors contributing to food security and dietary The PubMed (NCBI) search identified 2324 studies. The
quality in low-income households with school-aged children 5 to search results were exported to EndNote and Rayyan software,
19 years in the United States and their synthesis or organization which was used to remove duplicates (n ¼ 3). Studies were
around themes has not been previously completed [28]. A reviewed at 3 stages: title, abstract, and full text. Each stage
scoping review integrating this research evidence may inform entailed evaluation by 2 independent reviewers, and a third in-
future nutrition education programming and interventions to dependent reviewer served as a tie-breaker when there was a
adults or households of school-aged children by identifying, discrepancy in the decisions. First, titles and abstracts were
organizing, and showing relationships among recognized family screened based on eligibility criteria. Studies were either marked
priorities and challenges in obtaining high dietary quality and as “included,” “excluded,” or “maybe” by the reviewers. Any
food security within the limited resource context, as well as studies that were marked as “maybe” were treated as “included.”
identifying any existing gaps in knowledge. The social ecological Next, the remaining chosen studies were screened by reading the
model serves as a framework for this study and an application for full text using the same process as the screening for previous
the results. Using the social ecological model, individuals are stages. One hundred and eight studies were selected for full-text

915
H.A. Eicher-Miller et al. Advances in Nutrition 14 (2023) 914–945

evaluation. Forty-four studies were included in the scoping re- household environment. After reading the studies and synthe-
view (Figure 1). sizing the evidence, the factors organized to themes were map-
The study year, title, author(s), aims, study design, studied ped to show relationships in Figure 2, which were
population, and main findings were extracted and presented in conceptualized within the framework of the social ecological
Table 1 and were used to identify household factors that each model, placing the individual and their dietary quality and food
study addressed and then to organize the studies to themes. security at the center, with interpersonal and household levels of
Contributing factors to dietary quality and food insecurity in influence shaping the behavior of individuals and encompassing
low-income households were organized into the following 5 the household factors addressed in this review. Beyond these
themes that emerged from the studies represented in Table 2: 1) levels, organizational, community, and policy levels extend with
parental behaviors, 2) adolescent/child behaviors, 3) food pro- further relevance on the individual, interpersonal, and house-
curement behaviors, 4) food preparation behaviors, and 5) hold levels. The organizational, community, and policy levels are

Identification of studies via databases and registers

Records identified from:

PubMed (n = 2,324) Duplicate records removed (n = 3)
Identification

References imported to Rayyan

for screening (n = 2,321)

Records excluded using exclusion

Studies screened against title criteria (n = 2,093)
(n = 2,321)
Screening

Studies screened against abstract Records excluded using exclusion

(n = 228) criteria (n = 120)

Full-text studies excluded (n = 64)

Studies assessed for full-text
eligibility Reasons for exclusion:
(n = 108) Not relevant to households with
school aged children (n = 37)
Only relevant to adults own eating
habits (n = 2)
Not within the U.S. (n = 1)
Not focused on low income
households (n = 2)
Not focused on the home
environment (n = 22)
Included

Studies included in review

(n = 44)

FIGURE 1. Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols flow diagram of 44 studies addressing household
factors of dietary quality and food security in US households of school-aged children from PubMed, years 2012 to December 2022.

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 H.A. Eicher-Miller et al.
TABLE 1
Dates of publication, titles, authors, aims, study design, population of focus and main findings for 44 studies addressing household factors of dietary quality and food security in US households of
school-aged children from PubMed, years 2012 to December 2022.
Year Title Authors Aim Study Design Population Outcomes/Findings
2020 Associations between Wirthlin R; Linde JA; Examine the association Observational, (n ¼ 150) Families w/ Parent modeling of
parent and child physical Trofholz A; Tate A; Loth between parent modeling quantitative, cross- children (5–7 y) dietary intake was
activity and eating K; Berge JM of physical activity and sectional significantly linked to
behaviors in a diverse dietary intake and child child dietary intake.
sample: an ecological dietary intake and Parent modeling of fruit
momentary assessment physical activity and vegetable intake was
study associated with increased
fruit and vegetable
intake in children.
Parent modeling of
energy-dense foods
(chips, fries, candy,
sugar-sweetened
beverages) was
associated with increased
intake of sugar-
sweetened beverages in
children.
No significant
association existed for
parent modeling of
dietary intake and child
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overall Healthy Eating

Index-2010 score.
2019 Barriers and facilitators to Beck AL; Iturralde EM; Explore barriers and Observational, (n ¼ 30) Low-income Adolescents portrayed
healthy eating among Haya-Fisher J; Kim S; facilitators to healthy qualitative, cross- adolescents (13–17 y) basic nutritional
low-income Latino Keeton V; Fernandez A eating among low-income sectional knowledge however had
adolescents Latino adolescents significant
misconceptions about
healthy eating.
Adolescents reported
parents showed support
with healthy eating
through purchasing
healthy foods, providing
home-cooked meals, and

Advances in Nutrition 14 (2023) 914–945

role modeling but also
that family meals were
calorie dense and had
low nutrient value.
Peers were mainly a
negative influence in
eating habits.
Half reported disliking
school lunch, and many
reported having easy
access to unhealthy food
near school.
(continued on next page)
 H.A. Eicher-Miller et al.
TABLE 1 (continued )
Year Title Authors Aim Study Design Population Outcomes/Findings
2020 Barriers to preparing and Landry MJ; Burgermaster Examine the association Observational, (n ¼ 1942) Parent-child Significant association
cooking vegetables are M; van den Berg AE; of barriers to buying and quantitative, cross- dyads (third–fifth grade) found between food-
associated with decreased Asigbee FM; Vandyousefi preparing/cooking sectional security status &
home availability of S; Ghaddar R; Jeans M R; vegetables and how this availability of vegetables
vegetables in low-income Yau A; Davis JN relationship differs in the home; food-
households according to food-security insecure households had
status a 15% lower availability
of vegetables in the home
than food-secure
households.
Food-insecure
households were
reported as more likely to
report barriers to
buying/cooking/
preparing vegetables.
Reported barriers
included cost, practical
food knowledge, and
skills.
2021 Caregiver feeding McIver MB; Colby S; Describe the use of Observational, (n ¼ 174) caregiver-child Greater use of caregiver
practices as predictors for Hansen-Petrik M; caregiver modeling, quantitative, cross- dyads (2–10 y) modeling positively
child dietary intake in Anderson Steeves ET dietary intake, and home sectional predicted child vegetable
low-income, Appalachian food availability, and intake and negatively
918

communities determine their predicted child intake of

association with fruit, high-sugar/high-fat
vegetable, and high- snacks.
sugar/high-fat snack food Higher caregiver dietary
intake in children intake of fruit and
vegetables was a
significant predictor of
child fruit and vegetable
intake.
Higher home availability
of healthier foods was
associated with child
fruit and vegetable
consumption and home

Advances in Nutrition 14 (2023) 914–945

availability of less health
foods predicted child’s
intake of high-sugar/
high-fat snacks.
2020 Describing independent Banna J; Richards R; Describe independent Observational, (n ¼ 46) adolescents About 58% of eating
eating occasions among Jones B; Anderson AK; eating occasions among qualitative, cross- (10–13 y) occasions were classified
low-income adolescents Reicks M; Cluskey M; low-income early sectional as independent eating
Gunther C; Hongu NK; adolescents including the occasions with about
Lora K; Misner S; Monroe- environmental context, 65% as snacks.
Lord L; Topham G; Wong foods selected, reasons for The top 4 most
SS; Lim E choosing foods, and frequently consumed
foods at independent
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 H.A. Eicher-Miller et al.
TABLE 1 (continued )
Year Title Authors Aim Study Design Population Outcomes/Findings
parental rules about foods eating occasions were
consumed sweets, total fruit, dairy,
and whole fruit. Reasons
for choosing foods
included preference, it
was the only option,
convenience,
availability, and food
was given by someone
else. Health was reported
as the least common
reason for choosing
foods.
Parental rules for
independent eating
occasions were focused
on avoiding certain foods
and not eating too much.
2014 Determinants of fruit and Di Noia, J; Byrd- Identify determinants of Systematic review Articles including low- Three determinants of
vegetable intake in low- Bredbenner C fruit and vegetable intake income children and fruit and vegetable were
income children and in low-income children adolescents (10–19 y) consistently related to
adolescents and adolescents and to intake were race/
identify which ethnicity, fruit and
determinants are vegetable preference,
919

associated with intake and maternal fruit and

vegetable intake.
2019 Diet and physical activity Zhen-Duan J; Engebretsen Explore how mothers and Observational, (n ¼ 18) low-income Two approaches to
changes among low- B; Laroche HH their children influence qualitative, cross- women with diabetes and behavior change were
income families: each other’s diet and sectional their children (10–17 y) identified from the study,
perspectives of mothers physical activity collaborative and
and their children noncollaborative
approaches.
A collaborative approach
involved accepting
change, encouraging
each other, abstaining
from buying and eating
certain foods, leading by

Advances in Nutrition 14 (2023) 914–945

example, mutual
expectations, and
compromise.
Noncollaborative
approaches were
individualistic with poor
communication.
Barriers identified
included resource
constraints and lack of
information regarding
healthy diets and recipes.
(continued on next page)
 H.A. Eicher-Miller et al.
TABLE 1 (continued )
Year Title Authors Aim Study Design Population Outcomes/Findings
2017 What's being served for Trofholz AC; Tate AD; Investigate the specific Observational, (n ¼ 120) Families with Foods from protein and
dinner? an exploratory Draxten ML; Rowley SS; foods available at family quantitative, cross- children (6–12 y) high sodium components
investigation of the Schulte AK; Neumark- meals, the overall sectional were included in most
associations between the Sztainer D; MacLehose healthfulness of the meals and over half had
healthfulness of family RF; Berge JM meals, and their foods from dairy and
meals and child dietary association with vegetable components,
intake children’s dietary intake whereas few had fruit,
juice or dark green
vegetable components,
and almost half had
added sugar components.
Significant association
existed between majority
of components served at
family dinner meals and
child overall dietary
intake.
2018 Understanding the Askelson NM; Meier C; Understand the strategies Observational, (n ¼ 127) Parents of Parents reported 3
process of prioritizing Baquero B; Friberg J; and priorities of families qualitative, cross- children in third grade common themes
fruit and vegetable Montgomery D; Hradek C with low-income related sectional considered when
purchases in families with to purchasing fruit and purchasing fruit and
low incomes: “A peach vegetables vegetables:
may not fill you up as Shopping strategies were
much as hamburger” a common and involved
920

making lists, basing

meals on sale items,
coupon use, limiting
shopping trips, buying
cheap and in season
foods and basing shops
around pay checks
Prioritizing food
purchases based on
budget involved sale
buying, foods to bulk out
meals, shelf-life, likely to
be eaten, lack of
preparation, cost, and

Advances in Nutrition 14 (2023) 914–945

health.
Paying for fruit and
vegetables a theme. High
cost was the most
commonly mentioned
barrier to fruit and
vegetable purchasing.
Participants indicated
that fruit and vegetable
are not a high priority
when food budgets are
tight as of perceived low
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 H.A. Eicher-Miller et al.
TABLE 1 (continued )
Year Title Authors Aim Study Design Population Outcomes/Findings
satiety level but “junk
foods” were perceived as
cheaper.
2017 “Stretching” food and Burke MP; Martini LH; Examine the strategies Observational, (n ¼ 746) Caregivers of Behaviors caregivers
being creative: caregiver Blake CE; Younginer NA; and behaviors caregivers qualitative, cross- children (<18 y) reported included
responses to child food Draper CL; Bell BA; Liese use to manage household sectional making changes in foods
insecurity AD; Jones SJ food supply when purchased or obtained
children experience food for household meals,
insecurity which involves
prioritizing some foods
(hot dogs, chicken, rice)
and using foods that can
be used to bulk out meals
(stew, pasta, soups).
Monetary and shopping
strategies were also used
and involved buying food
according to price and
shopping at budget
stores.
Other strategies used
were making changes in
household meal pattern
(eg, smaller portions, cut
921

adult portions or adult

not eating, and adapting
home preparations like
using leftovers and
freezing meals).
Behaviors to decrease/
increase specific foods in
children’s diet included
reducing protein foods
(meat, chicken, beef),
followed by reducing
veg, grains & starches
(bread and rice) and
increase grains &

Advances in Nutrition 14 (2023) 914–945

starches (bread, rice),
protein foods (hot dogs,
beans), mixed dishes.
2016 A qualitative Berge JM; Trofholz A; To describe parent Observational, (n ¼ 88) Parents with at Most parents reported
investigation of parents’ Schulte A; Conger K; feeding practices with qualitative, cross- least 2 children (6–12 y) that decisions on how to
perspectives about Neumark-Sztainer D siblings sectional feed siblings impacted
feeding practices with the foods prepared for
siblings among racially/ meals.
ethnically and Sibling food preferences,
socioeconomically planning meals, and in-
diverse households the-moment decisions
were the most common
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 H.A. Eicher-Miller et al.
TABLE 1 (continued )
Year Title Authors Aim Study Design Population Outcomes/Findings
influencers to food
choices.
Parents managed picky
eating by making one
meal or providing food
option flexibility.
Parents report engaging
in different feeding
practices based on child
weight status.
Food restriction was
reported to be used if the
child was overweight,
and pressure-to-eat
feeding practices were
used when one child was
a healthy weight.
2018 A qualitative Trofholz AC; Schulte AK; Investigate mother’s role Observational, (n ¼ 83) Mothers of Mothers described their
investigation of how Berge JM during family mealtimes qualitative, cross- children (6–12 y) roles in family meals as
mothers from low-income sectional helping children make
households perceive their healthy choices at family
role during family meals meals, making the meal
happen, monitoring
children’s food intake,
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managing behaviors at
the family meals, making
the family meal
atmosphere enjoyable,
and facilitating
conversation.
2020 Qualitative evaluation of Gray VB; Hardman AM; Explore food-related Observational, (n ¼ 126) Female Major drivers of food
drivers of eating decisions Byrd SH decision patterns among qualitative, cross- caregivers of children selection and preparation
among SNAP participants SNAP recipients with sectional (<13 y) were cost, convenience,
in Mississippi regard to barriers to eating habits, family food
healthy eating, preferences. Health was a
perceptions of healthy driver when disease was
eating, and healthy eating established.
strategies Strategies used by

Advances in Nutrition 14 (2023) 914–945

participants included
couponing, using sale
ads, buying in bulk,
freezing, shopping at
dollar stores, price
matching.
Participants reported
they used food parenting
practices in the home.
These practices included
encouraging healthy
eating and changing
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 H.A. Eicher-Miller et al.
TABLE 1 (continued )
Year Title Authors Aim Study Design Population Outcomes/Findings
habits in relation to
purchasing food.
2020 Putting knowledge into Palmer SM; Knoblauch Explore low-income Observational, (n ¼ 36) Low-income Main barriers to healthy
practice: low-income ST; Winham DM; Hiller women’s perceived quantitative and women (19–50 y) eating were
women talk about food MB; Shelley MC influences of their food qualitative, cross- convenience/
choice decisions choices sectional preparation time, cost,
family food preferences,
and limits to food
assistance programs.
Facilitators to healthy
eating included self-
efficacy for nutrition
change and nutritional
and health knowledge.
Sometimes, type of food
and amount were
modified because of not
having enough money
for food.
2021 Perceived produce Moffat LF; Ritchie LD; Determine the association Observational, (n ¼ 5138) Children and Parent perceptions of
availability and child fruit Gosliner W; Plank KR; Au of parent’s perception of quantitative, cross- their parents (4–15 y) produce access was
and vegetable intake: the LE the home food sectional linked to household fruit
Healthy Communities environment and child and vegetable
Study fruit and vegetable intake availability.
923

and BMI and differences Household fruit and

by food-security and vegetable availability
income status was also linked with
child fruit and vegetable
intake.
A higher fruit and
vegetable intake among
children was related to
lower BMI z-score.
Weaker relationships
were present among
children living in food-
insecure or low-income
households.

Advances in Nutrition 14 (2023) 914–945

2019 Parents as role models: Coto J; Pulgaron ER; Examine the relationship Observational, (n ¼ 86) Parent- children Most parents were not
associations between Graziano PA; Bagner DM; between child and parent quantitative, cross- dyad (5–7 y) healthy role models, and
parent and young Villa M; Malik JA; BMI, fruit and vegetable sectional most parents and
children’s weight, dietary Delamater AM consumption, and children did not meet
intake, and physical physical activity levels guidelines for healthy
activity in a minority weight, fruit and
sample vegetable intake, or
physical activity.
A significant association
was found between the
healthy parent role
model index score and
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 H.A. Eicher-Miller et al.
TABLE 1 (continued )
Year Title Authors Aim Study Design Population Outcomes/Findings
child-reported fruit and
vegetable intake,
indicating that parents
who were healthier role
models had children with
higher fruit and
vegetable intake.
2021 Family function and Col
on-Ramos U; Monge- Investigate family Observational, (n ¼ 1466) Children Family support was
eating behaviors among Rojas R; Smith-Castro V; function, home quantitative, cross- (8–16 y) associated with increased
Hispanic/Latino youth: Wang J; Cheng YI; environment, and eating sectional youth fruit and vegetable
results from the Hispanic Perreira KM; Van Horn L; behaviors among youth consumption.
Community Children's Sotres-Alvarez D; Isasi CR; Higher youth
Health Study/Study of Gallo LC acculturative stress and
Latino Youth (SOL Youth) increasing youth age was
associated with reduced
family function and
closeness.
Household food security
was indirectly linked
with higher fruit and
vegetable intake through
family closeness and
support.
Being older was linked to
924

higher intake of empty

calories through family
closeness.
Authoritarian parenting
style was associated with
reduced youth fruit and
vegetable consumption.
2019 Disrupted relationships, Rosemond TN; Blake CE; Investigate the Observational, (n ¼ 20) Caregiver-child In food-insecure
chaos, and altered family Shapiro CJ; Burke MP; relationships between qualitative, cross- dyads (9–15 y) households, meals varied
meals in food-insecure Bernal J; Adams EJ; food insecurity, sectional in frequency, location,
households: experiences Frongillo EA household chaos, and and quality, especially
of caregivers and children family meals in the when there was less food.
circumstances of food- Household chaos like
insecure household conflicts with work and

Advances in Nutrition 14 (2023) 914–945

afterschool schedules,
little food, child visits,
and coping with poverty
influenced the frequency
and location of meals and
strained family
interactions during
mealtimes. During food
shortages, parents
reported planning meals
to allocate scarce food
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 H.A. Eicher-Miller et al.
TABLE 1 (continued )
Year Title Authors Aim Study Design Population Outcomes/Findings
and using convenience
foods.
2016 Eating breakfast together Larson N; Wang Q; Berge Investigate the prevalence Observational, (n ¼ 827) Adolescents Family dinner frequency
as a family: mealtime JM; Shanafelt A; Nanney and experience of having quantitative, cross- (Ninth–Tenth grade) was directly associated
experiences and MS family meals at breakfast sectional with family breakfast
associations with dietary and to examine the frequency. Family
intake among adolescents association between meal breakfast frequency was
in rural Minnesota, USA frequency and adolescent associated with
diet quality adolescent involvement
in the preparation of
breakfast meals and with
positive attitudes about
mealtime.
No association found
between family breakfast
frequency and total diet
quality.
2015 Eating and weight-related Bauer KW; MacLehose R; Examine differences in Observational, (n ¼2,087) Mother- Mothers from households
parenting of adolescents Loth KA; Fisher JO; the eating and weight- quantitative, cross- adolescent dyads experiencing low or very
in the context of food Larson NI; Neumark- related parenting sectional (12–17 y) low food security were
insecurity Sztainer D practices that mothers use more likely to report that
with adolescent children they engage in parental
in both food-insecure and control of their child’s
food-secure households diet, including
925

encouraging children to
eat, frequently
commenting on child’s
weight, restricting
eating, and pressuring
children to eat compared
with mothers with food
security.
2019 Food parenting practices Sano Y; Routh B; Understand the influences Observational, qualitative (n ¼ 55) Women with a Results report the use of
in rural poverty context Lanigan J on food parenting and quantitative, cross- child (<13 y) coercive control
behaviors from a parent’s sectional strategies (high power),
perspective and balanced,
1) how do mothers bidirectional control
describe shaping their practices (low power).

Advances in Nutrition 14 (2023) 914–945

children's food These coercive control
experiences? strategies included
2) how do mothers parents deciding what
negotiate food parenting and how much food and
practices in the context of using food rewards to
rural poverty? obtain control over their
food and behavior.
Structure strategies like
choosing available foods,
offering limited choice,
and modeling desired
behaviors were used.
(continued on next page)
 H.A. Eicher-Miller et al.
TABLE 1 (continued )
Year Title Authors Aim Study Design Population Outcomes/Findings
Bidirectional control
through autonomy
support was a method of
parenting that involved
children in food
decisions.
Food selection and food
parenting were informed
by their knowledge and
intention to promote
their child’s healthy
eating and their
assessment of the child’s
weight.
2019 Food parenting practices Gunther C; Reicks M; Investigate both parent Observational, (n ¼ 44) Parent-child Common ways to
that influence early Banna J; Suzuki A; and child perspectives on qualitative, cross- dyads (10–13 y) influence independent
adolescents’ food choices Topham G; Richards R; parenting practices that sectional eating occasions
during independent Jones B; Lora K; Anderson influence food choices included setting rules
eating occasions AK; da Silva V; Penicka C; during independent and expectations and
Hopkins LC; Cluskey M; eating practices managing food
Hongu N; Monroe-Lord L; availability and
Wong SS accessibility.
Other ways to influence
eating practices included
926

teaching, pressure to eat,

monitoring, and
modeling.
Children reported that
parents had rules about
what they could eat and
used certain strategies to
monitor eating.
2015 Characteristics of youth Sattler M; Hopkins L; Gain insight into food Observational, (n¼ 289) Child-adult Main food prepared in
food preparation in low- Anderson Steeves E; preparation among the quantitative, cross- dyads (9–14 y) the home required basic
income, African- Cristello A; McCloskey M; youth, including how sectional skill, few ingredients,
American Homes: Gittelsohn J; Hurley K often they are preparing little equipment, easily
associations with Healthy their own food, what found ingredients/foods
Eating Index Scores techniques are being in urban food

Advances in Nutrition 14 (2023) 914–945

used, what associations environment. The most
are there between age, common method of
gender, and food preparation was raw
preparation, and what is preparation,
the association between microwaving, and frying.
youth food prep and No association was found
dietary quality between frequency of
youth food preparation
and total HEI score, HEI
sodium, empty calories,
or dairy scores.
Older age and male sex
(continued on next page)
 H.A. Eicher-Miller et al.
TABLE 1 (continued )
Year Title Authors Aim Study Design Population Outcomes/Findings
were associated with
lower HEI score.
2017 Determinants of sugar- Tasevska N; DeLia D; Lorts Identify child and parent Observational, (n ¼ 1,403) Parents of Factors linked to lower
sweetened beverage C; Yedidia M; Ohri- lifestyle and household quantitative, cross- children (3–18 y) sugar-sweetened
consumption among low- Vachaspati P demographic factors that sectional beverage consumption
income children: are there predict high sugar- included living in a non-
differences by race/ sweetened beverage English speaking
ethnicity, age, and sex? intake frequency in household, low parental
children from low- consumption, having a
income, ethnically diverse parent with college
communities to inform education or higher, and
public health having moderate
interventions consumption of breakfast
of 6–7 d/wk compared
with 0–2 d/wk.
Older children compared
to younger had higher
intake as did non-
Hispanic black compared
with white. Six to 11 year
olds who were
moderate/high
consumers of breakfast
were 15%–20% points
927

less likely to be in the

highest sugar-sweetened
beverage category, and
3%–6% more likely to
never consume.
2021 Examining factors related Taylor EA; Foster JS; Examine the factors that Observational, qualitative (n ¼ 25) Mother and Results report that
to the food insecurity- Mobley AR may be related to the and quantitative, cross- father pairs with their parents sacrificing their
obesity paradox in low- gender disparity in the sectional child (2.5–10 y) own diet quality to feed
income mothers and food insecurity-obesity children was a common
fathers paradox strategy used in the
households.
Mothers were
significantly more likely
to restrict their own food

Advances in Nutrition 14 (2023) 914–945

to ensure their children
had enough to eat
compared to fathers.
Strategies parents used to
ensure children
obtaining enough food
included letting children
eat their meal first and
splitting the remainder,
prioritizing where money
is spent, or eating
(continued on next page)
 H.A. Eicher-Miller et al.
TABLE 1 (continued )
Year Title Authors Aim Study Design Population Outcomes/Findings
something else if there is
not enough of the meal.
2020 Factors related to poor Ranjit N; Macias S; To examine food Observational, (n ¼ 1171) Adults (18 y) The food-insecure
diet quality in food- Hoelscher D procurement related quantitative, cross- compared with food-
insecure populations behaviors and sectional secure group had less
psychosocial attitudes in healthful diets with less
food-insecure populations frequency and serving
size of fruits and
vegetables, were more
likely to use cost saving
practices, such as
comparing prices, and
less likely to cook/eat a
home-cooked meal or
read food labels
compared with food
secure.
There was little
difference in anticipatory
behaviors between
households such as meal
planning, making a list.
Self-efficacy for healthy
eating and planning
928

meals with vegetables

were lower among the
food-insecure vs food-
secure group.
2016 Family chaos and lack of Fiese BH; Gundersen C; Examine the role of family Observational, (n ¼ 221) Parents of Family chaos is
mealtime planning is Koester B; Jones B chaos and mealtime quantitative, cross- elementary school statistically significant
associated with food planning in food-insecure sectionally analyzed children and positively associated
insecurity in low-income and food-secure with food insecurity.
households households Food-insecure
households reported less
meal planning than food-
secure households.
2019 Food and financial coping Kinsey EW; Oberle M; Explore the nature and Observational, qualitative (n ¼ 12) Mothers Strategies reported to
strategies during the Dupuis R; Cannuscio CC; timing of coping and quantitative, receiving the SNAP manage the SNAP

Advances in Nutrition 14 (2023) 914–945

monthly Supplemental Hillier A strategies for managing prospective cohort benefits included:
Nutrition Assistance the SNAP cycle and  Adjustments to
Program cycle implications coping shopping and eating
mechanisms have for patterns like adjusting
health and financial purchasing at each
stability shopping trip, cooking
meals at home, menu
planning, making
shopping lists, buying
sale items, couponing,
using shopping outlets
(continued on next page)
 H.A. Eicher-Miller et al.
TABLE 1 (continued )
Year Title Authors Aim Study Design Population Outcomes/Findings
based on sales/
promotions.
 Eating less/skipping
meals when food is
running out to make
sure children have
enough.
 Price and quantity are
major determinants.
 Mental accounting,
constant vigilance, and
resilience for food
budgeting.
 Reliance on social
network for emotional
and informational
support or support
through resources.
2016 Food insecurity, Vedovato GM; Surkan PJ; Investigate links between Observational, (n ¼ 298) Caregiver-child Patterns of food sources
overweight and obesity Jones-Smith J; Anderson food insecurity, excess quantitative, cross- dyads (10–14 y) used, food acquisition,
among low-income Steeves E; Han E; Trude body weight, sectional preparation, knowledge,
African-American AC; Kharmats AY; psychosocial factors, and self-efficacy, and
families in Baltimore City: Gittelsohn J; food behaviors intentions were not
associations with food- different by food
929

related perceptions security.

Food-secure households
had higher level of
agreement with healthy
food as being affordable
when compared with
both food-insecure
groups and food-insecure
groups who experienced
hunger.
The food-insecure group
reported healthy food as
being less accessible and
less convenient to buy

Advances in Nutrition 14 (2023) 914–945

and prepare.
2014 Food preparation supplies Appelhans BM; Waring Investigate the Observational, (n ¼ 103) Caregivers of Higher food preparation
predict children’s family ME; Schneider KL; Pagoto association of food quantitative, cross- child (6–13 y) supplies associated with
meal and home-prepared SL preparation supplies sectional more frequent family
dinner consumption in availability in the home meals and child intake of
low-income households with family meal home-prepared meals.
frequency and child More frequent family
consumption of home- meals and intake of
prepared meals home-prepared meals
was linked to more
healthful dietary intake
such as higher intake of
(continued on next page)
 H.A. Eicher-Miller et al.
TABLE 1 (continued )
Year Title Authors Aim Study Design Population Outcomes/Findings
fruit and vegetables, and
reduced sugar-sweetened
beverage.
Financial strain was
associated with reduced
family meal frequency.
2018 Friends and family: how Wrobleski MM; Parker Determine if perceived Observational, (n ¼ 216) Caregiver- Dietary quality scores
African-American EA; Hager E; Hurley KM; parental dietary beliefs, quantitative, cross- adolescent dyads (11–16 among adolescents are
adolescents’ perceptions Oberlander S; Merry BC; caregiver-reported sectional y) positively associated
of dietary beliefs and Black MM parental monitoring of with adolescents’
behaviors of others relate the adolescent diet, and perceptions of parents’
to diet quality perceived peer eating beliefs regarding
behaviors are related to nutrition, healthy dietary
adolescent diet quality choices among peers, and
caregivers report of
parental monitoring of
adolescent dietary
behavior.
Adolescents’ dietary
behaviors reflect their
perceptions of the social
environment.
2020 What a city eats: Cummer E; Loyola Evaluate the dietary Observational, (n ¼ 63) Adults Sample population
examining the dietary Amador C; Montez K; patterns, food qualitative, cross- showed food preferences
930

preferences of families Skelton JA; Ramirez B; preferences, and meal sectional with a high intake of
living in communities at Best S; Zimmer R; preparation methods of calorie dense foods and
high risk for food Palakshappa D families at high risk of low consumption of
insecurity food insecurity vegetables.
Expressed little interest
in learning new recipes
or cooking methods to
assist with healthy
eating.
2015 Rural Latino caregivers’ Hoeft KS; Guerra C; Examine the knowledge, Observational, (n ¼ 61) Caregivers of Caregivers recognized
beliefs and behaviors Gonzalez-Vargas MJ; beliefs, and behaviors of qualitative, cross- children (elementary sources of sodium and
around their children’s Barker JC rural Latino caregivers sectional school age or less) reported they used
salt consumption regarding their children’s strategies to reduce their
salt consumption and child’s sodium intake; for

Advances in Nutrition 14 (2023) 914–945

related health example, limiting salt
implications used in food preparation,
limiting frequency of
salty food consumption.
However, caregivers
overlooked other
significant sources of salt
like bread, cheese, soup,
and sports drinks.
2018 Psychosocial Henry JL; Trude ACB; Identify psychosocial Observational, (n ¼ 465) Caregivers of Higher food-related
determinants of food Surkan PJ; Anderson factors influencing food quantitative, cross- children (10–14 y) behavioral intention
acquisition and purchasing and food sectional scores were marginally
(continued on next page)
 H.A. Eicher-Miller et al.
TABLE 1 (continued )
Year Title Authors Aim Study Design Population Outcomes/Findings
preparation in low- Steeves E; Hopkins LC; preparation behaviors of associated with healthier
income, urban African- Gittelsohn J adult caregivers in food acquisition,
American households African-American low- healthier food
income urban preparation methods,
communities and lower frequency of
purchasing at prepared
food sources.
Greater food-related self-
efficacy was associated
with healthy food
preparation methods and
negatively associated
with purchasing at
prepared food sources.
Higher nutrition
knowledge was only
associated with lower
frequency of purchasing
at prepared food sources.
2019 Parenting styles are Burke MP; Jones SJ; Examine the association Observational, (n ¼ 171) Parent-child Authoritative and
associated with overall Frongillo EA; Blake CE; between parenting styles quantitative, cross- dyads (9–15 y) authoritarian parenting
child dietary quality Fram MS and child dietary quality sectional styles had a significant
within low-income and in low-income and food- association such that as
food-insecure households insecure households parents reported more
931

authoritative parenting
attitudes and behaviors,
their children were
predicted to have higher
dietary quality if they
also reported average or
greater authoritarian
attitudes and behaviors.
Permissive parenting
attitudes and behaviors
were negatively
associated with child
dietary quality.
2016 Low-income mothers’ Pesch MH; Miller AL; Examine the association Observational, (n ¼ 265) Female Goal of restricting junk

Advances in Nutrition 14 (2023) 914–945

feeding goals predict Appugliese DP; Kaciroti of mothers feeding goals quantitative, longitudinal caregiver-child dyads food associated with
observed home mealtime N; Rosenblum KL; with observed home (mean age of child: 70.8 child always eating at the
and child feeding Lumeng JC mealtime and feeding mo) table, but not with
practices practices mother restricting junk
food.
Goal of promoting fruit
and vegetable associated
with mother promoting
vegetables.
Goals of promoting
autonomy and
preventing obesity not
(continued on next page)
 H.A. Eicher-Miller et al.
TABLE 1 (continued )
Year Title Authors Aim Study Design Population Outcomes/Findings
associated with home
mealtime or feeding
practices.
Parental feeding goals
may not turn into feeding
practices.
2022 Kitchen adequacy and Fertig AR; Trofholz AC; Investigate the kitchen Observational, (n ¼149) Families with The majority of families
child diet quality in a Loth K; Tate AD; Miner M; adequacy of households quantitative, cross- children (5–7 y) had adequate kitchen
racially/ethnically Neumark-Sztainer D; with young children from sectional facilities and supplies in
diverse sample Westfall EC; Westby A; low socioeconomic their homes.
Berge JM backgrounds with child A kitchen table was
dietary quality associated with higher
dietary quality among
children.
Can openers and
measuring spoons
present in the household
were linked to higher
sodium and added
sugars, respectively.
Results suggest that
kitchen adequacy is not a
major barrier to overall
healthy eating.
932

2020 Is healthy eating too Daniel C Investigate how low- Observational, (n ¼ 34) Caregivers of Findings report that
expensive? How low- income consumers qualitative, cross- children (primarily 4–8 y) participants judged the
income parents evaluate evaluate the cost of food sectional cost of food in 2 ways
the cost of food  Absolute judgment
regarding if food
would meet family
needs with few
resources
 Relative judgment or
evaluation of price in
comparison to other
foods that make an
item affordable or
expensive by contrast

Advances in Nutrition 14 (2023) 914–945

2019 “I try, I do:” Child feeding Schuster RC; Szpak M; Understand parents’ goals Observational, (n ¼ 21) Caregiver of Nutrition and health-
practices of motivated, Klein E; Sklar K; Dickin KL for feeding their children, qualitative, cross- child (3–11 y) oriented goals were
low-income parents underlying motivations sectional reported by parents,
reflect trade-offs between for these goals, the which included
psychosocial- and strategies they employed encouraging child to eat
nutrition-oriented goals to work toward them, and nutritious diet, fostering
the contextual healthful relationship
environment that with food, economizing
challenged or facilitated food costs, reducing
achievement of these parents’ own meal size/
goals frequency, and avoiding
inadequate nutrient
(continued on next page)
 H.A. Eicher-Miller et al.
TABLE 1 (continued )
Year Title Authors Aim Study Design Population Outcomes/Findings
intake.
Psychosocial-oriented
goals included having
family meals to enhance
family relationships and
helping child feel secure.
Sometimes psychosocial
goals were in conflict
with nutrition-oriented
goals, like giving into
child food preferences to
avoid conflict or preserve
self-esteem.
2017 How parents describe Trofholz AC; Schulte AK; Examine parents’ Observational, (n ¼ 88) Caregivers of Picky eating was
picky eating and its Berge JM experiences and qualitative, cross- children (2–18 y) reported to be disruptive
impact on family meals: a perspectives regarding sectional to family meals, creating
qualitative analysis picky eating in order to meal-related stress.
understand its impact on Picky eating can lead to
families, including during altering meal preparation
family meals or making separate
meals.
Strategies parents use in
response to picky eating
include making child try
933

the food, making

separate meal, using take
it or leave it approach, or
child makes separate
meal.
2016 Household, psychosocial, Trude ABC; Kharmats AY; Identify the Observational, (n ¼ 285) Caregiver- Fruit, vegetable, and
and individual-level Hurley KM; Anderson characteristic, quantitative, cross- youth dyads (10–14 y) fiber intake were
factors associated with Steeves E; Talegawkar SA; psychosocial, and sectional positively related to
fruit, vegetable, and fiber Gittelsohn J household factors youth intentions and self-
intake among low-income influencing fruit and efficacy for eating
urban African-American vegetable consumption in healthy.
youth low-income African- Youth who received free/
American youth low-cost breakfast were
more than 2 times as

Advances in Nutrition 14 (2023) 914–945

likely to have high fiber
intakes as those who did
not receive free
breakfast.
Youth purchasing food at
supermarkets was
associated with an
increase in vegetable
serving and fiber intakes.
Youth with parents who
purchase food at fast-
food restaurants showed
(continued on next page)
 H.A. Eicher-Miller et al.
TABLE 1 (continued )
Year Title Authors Aim Study Design Population Outcomes/Findings
a 7% decrease in odds for
vegetable intake.
Self-efficacy, health
outcome expectations,
intention, and
knowledge are important
psychosocial factors that
may influence eating
behavior.
2016 Home food environment Trofholz AC; Tate AD; Investigate what home Observational, (n ¼ 120) Families with Home availability and
factors associated with Draxten ML; Neumark- food environment quantitative, cross- children (6–12 y) accessibility of fruits and
the presence of fruit and Sztainer D; Berge JM characteristics are sectional vegetables were
vegetables at dinner: a associated with the predictive of fruit and
direct observational study presence of fruit and vegetable intake in
vegetables at family children and adolescents.
dinners Meal planning was linked
with the presence of fruit
at dinners.
Higher parent intake of
vegetables was
associated with
vegetables at dinner.
2013 Eat this, not that! Parental Loth KA; MacLehose RF; Investigate how food- Observational, (n ¼ 3709) Parents/ Parental control over
demographic correlates of Fulkerson JA; Crow S; related parenting quantitative, cross- guardians of adolescents their adolescent
934

food-related parenting Neumark-Sztainer D practices, specifically how sectional regarding how much
practices restriction and pressure to food to eat, as well as
eat among parents of what types of foods the
adolescents differ across adolescent should avoid
sociodemographic was common, especially
characteristics among parents of race/
ethnic minority
subgroups, those with
less than a high school
education, and those
with low household
income.
2022 Diet quality and Harper K; Caulfield LE; Lu Evaluate differences in Observational, (n ¼ 61) Adolescents No significant differences
contextual factors SV; Mmari K; Gross SM overall diet quality and quantitative and (14–19 y) in overall diet quality or

Advances in Nutrition 14 (2023) 914–945

influencing food choice food-related contextual qualitative, cross- components between
among adolescents with factors between sectional food-security groups
food security and food adolescents with food except for seafood and
insecurity in Baltimore security and insecurity plant proteins that was
City higher for food-insecure
adolescents, adolescents
were influenced by
having food available at
home and eating family
meals.

BMI, body mass index; HEI, Healthy Eating Index; SNAP, Supplemental Nutrition Assistance Program
H.A. Eicher-Miller et al. Advances in Nutrition 14 (2023) 914–945

TABLE 2
Themes identified among 44 studies addressing household factors of dietary quality and food security in US households of school-aged children
from PubMed, years 2012 to December 2022.
Study Title Parental Adolescent /Child Food Procurement Food Preparation Household
Behaviors Behaviors Behaviors Behaviors Environment Factors
Associations between parent X
and child physical activity
and eating behaviors in a
diverse sample: an
ecological momentary
assessment study
Barriers and facilitators to X X
healthy eating among low-
income Latino adolescents
Barriers to preparing and X X
cooking vegetables are
associated with decreased
home availability of
vegetables in low-income
households
Caregiver feeding practices as X X
predictors for child dietary
intake in low-income,
Appalachian communities
Characteristics of youth food X
preparation in low-income,
African-American homes:
associations with healthy
eating index scores
Describing independent X X
eating occasions among
low-income adolescents
Determinants of fruit and X X
vegetable intake in low-
income children and
adolescents
Determinants of sugar- X X
sweetened beverage
consumption among low-
income children: arethere
differences by race/
ethnicity, age, and sex?
Diet and physical activity X
changes among low-income
families: perspectives of
mothers and their children
Disrupted relationships, X X
chaos, and altered family
meals in food-insecure
households: experiences of
caregivers and children
Eating breakfast together as a X X X X
family: mealtime
experiences and
associations with dietary
intake among adolescents
in rural Minnesota, USA
Eat this, not that! Parental X
demographic correlates of
food-related parenting
practices
Eating- and weight-related X
parenting of adolescents in
the context of food
insecurity
Examining factors related to X
the food insecurity-obesity
paradox in low-income
mothers and fathers
(continued on next page)

935
H.A. Eicher-Miller et al. Advances in Nutrition 14 (2023) 914–945

TABLE 2 (continued )
Study Title Parental Adolescent /Child Food Procurement Food Preparation Household
Behaviors Behaviors Behaviors Behaviors Environment Factors
Family chaos and lack of X X
mealtime planning is
associated with food
insecurity in low-income
households
Family function and eating X X
behaviors among Hispanic/
Latino youth: results from
the Hispanic Community
Children's Health Study/
Study of Latino Youth (SOL
Youth)
Food and financial coping X X
strategies during the
monthly Supplemental
Nutrition Assistance
Program cycle
Food insecurity, overweight X X
and obesity among low-
income African-American
families in Baltimore City:
associations with food-
related perceptions
Food parenting practices that X
influence early adolescents’
food choices during
independent eating
occasions
Food parenting practices in X
rural poverty context
Food preparation supplies X X
predict children's family
meal and home-prepared
dinner consumption in low-
income households
Friends and family: How X X
African-American
adolescents’ perceptions of
dietary beliefs and
behaviors of others relate to
diet quality
Home food environment X X
factors associated with the
presence of fruit and
vegetables at dinner: a
direct observational study
Household, psychosocial, and X
individual-level factors
associated with fruit,
vegetable, and fiber intake
among low-income urban
African-American youth
How parents describe picky X
eating and its impact on
family meals: a qualitative
analysis
“I try, I do”: Child feeding X X
practices of motivated, low-
income parents reflect
trade-offs between
psychosocial- and nutrition-
oriented goals
Factors related to poor diet X X X
quality in food-insecure
populations
X
(continued on next page)

936
H.A. Eicher-Miller et al. Advances in Nutrition 14 (2023) 914–945

TABLE 2 (continued )
Study Title Parental Adolescent /Child Food Procurement Food Preparation Household
Behaviors Behaviors Behaviors Behaviors Environment Factors
Is healthy eating too
expensive?: How low-
income parents evaluate the
cost of food
Kitchen adequacy and child X
diet quality in a racially/
ethnically diverse sample
Low-income mothers’ feeding X
goals predict observed
home mealtime and child
feeding practices
Parenting styles are X
associated with overall
child dietary quality within
low-income and food-
insecure households
Parents as role models: X
associations between parent
and young children's
weight, dietary intake, and
physical activity in a
minority sample
Perceived produce X
availability and child fruit
and vegetable intake: the
Healthy Communities Study
Psychosocial determinants of X X X
food acquisition and
preparation in low-income,
urban African-American
households
Putting knowledge into X X X
practice: low-income
women talk about food
choice decisions
Qualitative evaluation of X X
drivers of eating decisions
among SNAP participants in
Mississippi
A qualitative investigation of X
how mothers from low-
income households
perceive their role during
family meals
A qualitative investigation of X X
parents’ perspectives about
feeding practices with
siblings among racially/
ethnically and
socioeconomically diverse
households
Rural Latino caregivers’ X
beliefs and behaviors
around their children's salt
consumption
Stretching food and being X X X
creative: caregiver
responses to child food
insecurity
Understanding the process of X
prioritizing fruit and
vegetable purchases in
families with low incomes:
“A peach may not fill you
up as much as hamburger”
(continued on next page)

937
H.A. Eicher-Miller et al. Advances in Nutrition 14 (2023) 914–945

TABLE 2 (continued )
Study Title Parental Adolescent /Child Food Procurement Food Preparation Household
Behaviors Behaviors Behaviors Behaviors Environment Factors
What a city eats: examining X
the dietary preferences of
families living in
communities at high risk for
food insecurity
What’s being served for X
dinner? An exploratory
investigation of the
associations between the
healthfulness of family
meals and child dietary
intake
Diet quality and contextual X X X
factors influencing food
choice among adolescents
with food security and food
insecurity in Baltimore City

outside of the scope of this review as they provide levels where parental behaviors, 2) adolescent/child behaviors, 3) food pro-
the findings may be applied. curement behaviors, 4) food preparation behaviors, and 5)
household environment. For example, 31 studies (70%) included
Results parental behaviors, 10 studies (23%) included adolescent/child
behaviors, 10 studies (23%) included food procurement behav-
All of the 44 studies were observational, and the majority iors, 17 studies (39%) included food preparation behaviors, and
were published in the last 5 years (n ¼ 27, 61%); used a cross- 6 studies (14%) included household environment factors.
sectional (n ¼ 41, 93%) or prospective/longitudinal (n ¼ 2, Evidence of the theme, parental behaviors, related to dietary
5%) study design; and used quantitative (n ¼ 23, 52%), quali- quality and food insecurity in low-income US households with
tative (n ¼ 15, 35%), or a mixed methods (quantitative and children included behaviors of parental modeling, feeding
qualitative) approach (n ¼ 5, 11%). One of the studies was a practices, attitudes and support, parental self-efficacy, knowl-
systematic review (n ¼ 1, 2%). Data was collected from parents/ edge, and parenting styles. Each of these behaviors and the ev-
caregivers (n ¼ 19, 43%), parent/caregiver and child dyads (n ¼ idence of their relationship to dietary quality and food security
15, 34%), adolescents (n ¼ 6, 14%), and families (n ¼ 4, 9%). are described below. Parental modeling, or a parent’s effort to
Several studies addressed more than 1 of the 5 themes: 1) demonstrate healthy food choices and healthy eating behaviors

FIGURE 2. Conceptualized relationships of themes identified among 44 studies addressing household factors of dietary quality and food security
in US households of school-aged children from PubMed, years 2012 to December 2022.

938
H.A. Eicher-Miller et al. Advances in Nutrition 14 (2023) 914–945

with the objective that the child will exhibit similar behaviors, styles with few rules and freedom of child dietary choice were
was included in 11 of the studies [30–40]. Five studies showed negatively associated with child dietary quality [59]. However,
parental modeling was a support to encourage overall healthy the second study showed conflicting results with an association
eating behaviors among children [36–40], whereas 5 studies between authoritative parenting style and reduced fruit and
showed a more specific association to increased fruit and vege- vegetable consumption among adolescents [60]. Yet, both
table intake [30–34], and one showed healthy eating modeling studies showed parenting style as a potential determinant asso-
was associated with reduced child consumption of ciated with nutritional quality. Therefore, parenting style along
high-sugar/high-fat snacks [34]. Alternatively, modeling intake with all other parental behaviors reviewed have links to dietary
of energy-dense food was associated with increased quality and food security that also linked them to the other
sugar-sweetened beverage intake among children in 4 studies themes identified in the review and are likely influential in food
[31,33–35]. Parental feeding practices such as encouragement, procurement and preparation (Figure 2).
pressure to eat, food restriction, and controlling food intake, Adolescent/child behaviors in 10 studies [30,33,35,36,41,
based on child characteristics like weight, age, and develop- 46–48,61,62] included investigations of personal food prefer-
mental stage, were other parental behaviors contributing to di- ences; healthy eating knowledge, attitudes and self-efficacy;
etary quality and food security in the household [38–46]. Food picky eating behaviors; and involvement in food preparation.
restriction was a reported practice when the child was over- Adolescents reported choosing food based on preference, con-
weight, and pressure to eat was reported when the child was at a venience, and/or the foods available in the home or elsewhere
healthy weight [38,39,41]. Low-income households and those [30,46,48]. Health was considered the least common reason for
with low or very low food security were more likely to engage in food choice [46]. Adolescents were able to demonstrate basic
food restriction and pressure-to-eat practices compared with nutrition knowledge and recognized healthy and unhealthy
higher-income and food-secure households [42,43]. Parental foods but still held some misconceptions around healthy foods
eating attitudes, teaching, and support toward healthful diets [36]. Healthy eating intentions, self-efficacy, and purchasing
also played a role in eating habits among children [39,40,44,45]. food at supermarkets were linked to adolescent fruit, vegetable,
Practices related to attitudes, teaching, and support included and fiber intake [61] whereas poor eating behaviors like high
limiting the availability of sugar-sweetened foods in the home, intake of fast food and low breakfast intake were linked with
establishing healthy parental relationships with food, encour- other poor dietary practices like high sugar-sweetened beverage
aging children to make healthy choices, and family eating intake [35]. The dietary quality of adolescents was linked to
practices like eating meals together [39,40,44–48]. Parents from their perceptions of adult nutrition beliefs and peer dietary
low-income households expressed goals to restrict junk food and choices [33], which were a negative influence on eating habits
encourage a nutritious diet including fruit and vegetable intake [36]. Adolescents motivated to adopt healthy dietary practices
[45,49] but also reported that not all parental feeding goals reported that it was difficult to sustain healthy eating changes
turned into practices [49]. For example, parents reported buying [36]. Picky eating behaviors among children were also included
foods that they knew children would eat to avoid wasting food, in the studies and found to be disruptive on family mealtime and
which could contribute to purchasing foods with lower dietary the home environment, causing meal-related stress and
quality [44]. When food resources were low, parents sometimes increased time parents spend in meal preparation to adjust or
adapted the types of food served at meals and the amount [50, make additional meals [41,63]. However, adolescent involve-
51]. In food-insecure situations, parents reported reducing their ment in the preparation of breakfast and positive attitudes about
own portion sizes and skipping meals to ensure food was avail- mealtime were linked to family breakfast frequency [47]. Similar
able for children [45,50–53]. Several studies discussed the in- to the parent behaviors identified in the review, child behaviors
fluence of parent or caregiver self-efficacy for healthful diets and overall had relationships with the other themes and are likely
nutritional and health knowledge of dietary quality and/or food influential in food procurement and preparation.
security [51,54–57]. Self-efficacy, which refers to a person’s Food procurement behaviors in 10 studies [44,50–52,54,55,
belief in their ability to engage in healthy eating behaviors, was 63,64–66] comprised topics of purchasing behaviors and stra-
associated with increased dietary quality and healthy eating tegies and barriers to purchasing foods. Priorities that in-
behaviors in low-income families and adolescents [51,55). dividuals considered when purchasing foods included cost,
Nutritional knowledge [36,54,56] was also identified as a factor family preferences, food preparation time, family needs, and
in dietary quality. For example, caregivers had a basic under- shelf-life. Price was a major determinant in purchasing behaviors
standing of sodium sources but had difficulty identifying sodium [52] and more often reported in food-insecure compared with
in sources, such as cheese and prepared soups, and little food-secure households [65]. Strategies to help save money
knowledge of the effects of increased salt consumption on included making lists, buying sale items, buying in bulk,
childhood health [56]. The relationship of food insecurity to comparing prices, shopping in discount stores, limiting trips,
self-efficacy for healthy eating was less clear as 2 studies showed using certain foods to “bulk out” meals, and using coupons [44,
conflicting results [54,58], and food insecurity did not differ- 50–52,54,63,64]. Food-insecure compared with food-secure
entiate food knowledge or intentions [58]. Parenting style was households were significantly more likely to use cost saving
the last area of parental behavior showing links to dietary quality practices, such as price comparisons [54]. However, there was no
in children in 2 studies [59,60]. One showed that authoritarian difference between the groups in the use of anticipatory behav-
parenting attitudes and behaviors including high demands, low iors, including meal planning and making a shopping list [54].
responsiveness, low emotional warmth, and unwillingness to The high cost of fruit and vegetables was reported as a main
negotiate were positively associated with the dietary quality of barrier to their procurement [63,65], but another study found no
the child [59]. The same study also showed permissive parenting relationship between purchasing barriers and the presence of

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fruit and vegetables at dinner meals [66]. Acquisition of healthy assist in overcoming mealtime chaos [45]. However, sometimes
foods was linked to higher caregiver food-related behavioral prioritizing making children feel secure was in conflict with
intentions and self-efficacy and lower frequency of purchasing at nutrition-oriented goals like acquiescing to child food prefer-
prepared food sources, which was also linked with higher care- ences to maintain harmony or promote self-esteem [60]. Yet,
giver nutrition knowledge [55], exemplifying how paren- family support was associated with increased youth fruit and
tal/caregiver behaviors are related to food procurement. Food vegetable intake, and household food security had an indirect
procurement is also likely to influence food preparation as in- link to higher fruit and vegetable intake through family closeness
dividuals purchase foods that they plan to prepare, but food and support [60]. The household environment, then, and spe-
preparation factors may also change and influence food cifically the family chaos of coping with poverty, is likely to in-
procurement. fluence both parent and child behaviors along with the food
Food preparation factors and behaviors like meal planning, procurement and food preparation in the household.
having kitchen/cooking supplies and time to perform these be- None of the studies explored all 5 of the themes of household
haviors, cooking skills to carry out food preparation, and food factors linked to dietary quality and food security nor their
availability were addressed in 17 studies [34,47,48,50,51,54,55, various relationships, yet the connections between these 5
58,65–73]. Several studies investigated meal preparation and themes are conceptualized by the authors to be numerous and
planning behaviors [47,51,54,55,58,65,66,68,69,72,73]. complex. Figure 2 summarizes the potential relationships or
Adult/caregiver food-related self-efficacy was linked with directionality of influence of the themes based on the findings
healthy food preparation methods [55]. Food-insecure house- within the studies. In some cases, the relationships are likely
holds were more likely to report barriers to cooking and pre- bidirectional; for example, the household environment may be
paring vegetables or healthy food [58,65] and less likely to plan both influential on behaviors of household members and influ-
[73] and prepare a home-cooked meal compared to food-secure enced by those behaviors. In other cases, only one-directional
households [54]. Furthermore, low-income households, regard- relationships may be present, as in how parental behaviors
less of food-security status, had a low prevalence of planning likely drive food procurement with influence from children and
behaviors related to buying and preparing food [54]. Lack of how parental behaviors may drive food preparation similarly
sufficient time was identified as a barrier to making with influence from children.
home-cooked meals [51]. The accessibility of food preparation
supplies [67,70] was associated with the frequency of family Discussion
meals, and more frequent family meals were linked with more
healthful dietary intake, such as greater fruit and vegetable This scoping review identified 5 themes of household factors
intake and less sugar-sweetened beverage intake [48,67]. covered in the existing literature that are linked to dietary
Contradictorily, a longitudinal observational study’s results quality and food security among low-income households with
suggested that kitchen adequacy was not a barrier to healthy school-aged children and explored how various relationships
eating [70]. Youth also prepared food at home [48] using basic exist among these themes. Mapping the relationships of the
skills, a few pieces of cooking equipment, and easily accessible themes reveals new insights to apply to interventions and pro-
ingredients [68], and their involvement was linked to family grams aimed at improving food security and dietary quality
breakfast frequency [47].The availability of healthy foods was within the outer levels of the social ecological model. The themes
associated with dietary quality and food security in 6 studies [34, identified in this review may be conceptualized within the inner
48,65,66,70,71] and specifically increased fruit and vegetable levels of the social ecological model. For example, dietary quality
intake [34,48,66,71,72]. Food-security status had additional and food security are experienced by the individual. Next, the
links with the availability of vegetables in the home [65], bar- parent and child behaviors exert direct influence on individuals
riers of knowledge of how to prepare and cook vegetables [65], within the interpersonal relationships level, which includes the
and using strategies to manage the household food supply like family members in a person’s closest circle contributing to their
using leftovers and freezing meals [50] and planning meals to experiences. Food procurement and preparation are specific
allocate scarce food [69]. Such tactics suggest a bidirectional link food-related behaviors by household members that influence
from food preparation to food procurement and links to the those within the household, and the household environment
themes of adult/parent and child behaviors. encompasses the family dynamics, chaos or order, habits, and
Finally, the household environment and specifically family schedules that also exert influence on individual diet quality and
chaos was identified as an influencing factor on dietary quality food security. Evidence of themes in this review and their po-
and food security, owing to its negative impact on family re- tential application to improve diet quality and food security is
lationships and mealtime-related stress in 6 studies [45,47,60, discussed below.
67,69,73]. Household chaos included work and schedule con- Parental behaviors, included in the majority of studies, such
flicts, food shortages, coping with poverty, and children visiting as parental modeling, support and encouragement, feeding
multiple homes, which reportedly influenced the frequency and practices, and parenting styles, highlight the significant influ-
locations of meals [67,69]. Family dinner frequency was directly ence parents have on the food their child is consuming, including
linked with family breakfast frequency, which was linked with the amount and types of foods [30–60]. Parental modeling of
positive attitudes about mealtimes [47]. A qualitative study healthy eating appears an important contributor to dietary
found that aiming to have family meals to enhance family re- quality and food insecurity because of the consistency among
lationships and helping children feel secure in the home may studies showing a positive impact on their child’s eating

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behaviors [30–34,36–40]. Additionally, parental support and dietary quality of foods/meals consumed in the home and
encouragement for healthy eating can improve children’s atti- contribute to feelings of stress with regard to obtaining enough
tudes toward healthy eating whereas food restriction and pres- food in the household when resources are also low. Challenges
sure to eat can result in a child’s negative attitude toward food with these skills may contribute to the higher prevalence of
and meals [38–46]. Children’s behaviors had less coverage in food-insecure groups eating away from home and reduced
studies compared with parental behaviors, and therefore there prevalence of food-insecure groups eating home-cooked meals
less evidence; however, children were shown as having an [54]. However, the potentially complex nature of how the
influential role in their dietary quality and household food se- various factors influence food insecurity and dietary quality
curity [30,33,35,36,41,46–48,61,62]. Their behaviors, prefer- synergistically should be addressed in future studies.
ences, self-efficacy, and nutrition knowledge were linked to
parental behaviors, food purchasing, and preparation in the Implications
household. Self-efficacy for healthy eating behaviors among both
parents [51,55] and children [61] was linked with healthful di- The evidence summarized has implications to the organiza-
etary intake. Considering the role parents play in managing food tional, community, and policy levels of the social ecological
resources, influencing children, and the household environment, model. Individuals from low-income households participate in
and the role that children also play in parental behaviors and federal US nutrition assistance programs, such as the Supple-
decisions on food purchasing and preparation, future in- mental Nutrition Assistance Program (SNAP) [77], which pro-
terventions to food insecurity and dietary quality of household vide participants with financial benefits to assist with food
members should address parent and child behaviors, attitudes, purchasing and operate through organizations, communities,
and preferences. and policy. SNAP resources are external to the household and
Food procurement [44,50–52,54,55,63,64–66] and prepara- can play an important role in supporting households to improve
tion factors [34,47,48,50,51,54,55,58,65–73] were also themes food security [21]. SNAP eligibility also allows individuals to
linked to dietary quality and food security in this review. Findings participate in nutrition education programs such as
suggest that low-income and food-insecure households experi- SNAP-Education (SNAP-Ed), evidence-based nutrition education
ence more barriers to purchasing and preparing foods, including program focusing on nutrition, budgeting, and a healthy lifestyle
lack of access to foods and challenges with the price of food, when [78–84]. Nutrition education programs target household factors,
compared with households of higher-income and food-secure such as nutrition behaviors, attitudes, and knowledge, and can
households [52,54,58,65,73]. Overcoming barriers to purchas- play a significant role in improving food security [79–82,84]
ing and preparing foods may assist in improving the availability with limited evidence regarding dietary quality [81,83]. In other
of food within the household. Several studies documented the use studies, nutrition education has been shown to improve partici-
of strategies in purchasing foods, for example comparing prices, pants’ food security over 1 year after receiving the program [79,
buying sale items, and shopping in budget stores, to assist parents 81,84]. However, less evidence has shown nutrition education
in managing their budgets [44,50-52,54,63,64]. Similarly, many improvement on dietary quality despite aims to help align
studies [34,48,65,66,71,72] also associated availability of household dietary choices with the recommendations in the DGA
healthy foods in the home with increased dietary quality and [80,82]. The results of this scoping review can be applied to
increased consumption of fruit and vegetables, which is consis- future nutrition education efforts to improve healthful dietary
tent with previous studies and reviews [74,75], whereas the habits and behaviors by informing educational content.
availability of less healthy foods in the home was linked with Nutrition education may include behaviorally focused pro-
increased child intake of high-sugar/high-fat snacks [76]. gramming through direct nutrition education that promotes di-
Therefore, applications to improve the availability of healthful etary strategies to maximize the intake of nutrient-dense foods and
foods and decrease access to less healthful foods in the household beverages while stretching food dollars [78]. This review identi-
may enhance the dietary quality of children and food security. fied additional topics to be considered for inclusion in future
The household environment may also play a role in food se- nutrition education programming for households with
curity and dietary quality of household members as the chaos or school-aged children such as addressing parent and child behav-
order in the home can impact plans for food purchasing and iors and attitudes. Involvement of children in adult lessons and
preparation [45,47,60,67,69,73]. Furthermore, the household recognition of their influence on household food procurement,
environment may impact how much control, self-efficacy, and purchasing, and parent behaviors may promote parents and chil-
other behaviors parents and children have toward dietary intake dren to jointly learn about nutrition, improve attitudes toward
and ensuring access to food. However, fewer studies contributed healthful foods, and promote self-efficacy to support dietary
to the evidence of the relationships of various themes with the quality. Similarly, educating parents on the importance of
household environment despite these expected relationships, modeling healthy eating behaviors in the home and providing
representing a gap in the literature and a contribution of this their children with encouragement and support may also build
scoping review. The interactions between the household-level healthful habits. Promoting early exposure to a range of
factors of household environment, parent and child behaviors, nutrient-dense foods, including fruits and vegetables, and having
and food procurement and preparation may ultimately work these foods available in the home should be encouraged as it may
together to impact dietary quality and food security for all within improve diet quality in future life stages and promote positive
a household. For example, lack of nutritional knowledge, food attitudes toward eating throughout childhood and adolescence. In
preparation, and cooking skills with a low self-efficacy for addition, future nutrition education lessons should consider
healthy eating among parents and children and a chaotic educating parents on the implications of feeding practices, such as
household can act as barriers to healthy eating and reduce the pressure to eat and food restriction, on their child’s dietary quality.

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The food procurement and preparation themes identified in studies in other databases may not have been included. Addi-
this review are addressed in current nutrition education pro- tionally, studies that explored exclusively preschool-aged chil-
grams such as by teaching practical strategies to improve cook- dren or younger were not included. These studies may have
ing skills, meal selection, and planning, and improve attitudes offered additional relevant findings as some households with
toward healthy eating. However, the household environment young children also include older children and may impact the
and factors contributing to family chaos may be less recognized overall dietary quality and food security in the household. In
within current lessons. Focusing on strengthening order and contrast, this study included all school-aged children, which
planning in the food environment of the household could pro- could range from ages 5 to 19 years, encompassing childhood
mote a strength-based approach to behavior change within les- and adolescent life stages. The household factors identified may
sons to improve family chaos. The application specifically for vary by the ages within this range and should be considered in
households with school-aged children in this review is important application of the findings to particular interventions. This re-
because the prevalence of food insecurity is disproportionally view was limited to household factors contributing to dietary
high among households with children compared with all US quality and food security in low-income households with school-
households [1]. The situation of food insecurity within house- aged children in the United States and did not explore environ-
holds with children may also introduce varying levels of access mental, community, and social factors that may have an influ-
or restriction of foods within the household that may be applied ence on dietary quality and food security in this population. For
to developing educational content. For example, in 7.8% of example, social factors, such as discrimination in policies and
households with children, only the adults were affected by food practices, could have a myriad of links to the relationships
insecurity [1]. Parents often protect their child against food se- explored in this review and the characteristics of the groups
curity by decreasing their own intake or by saving certain foods represented. The studies included were observational and most
for children, yet each household may have varying relationships were cross-sectional. This study design is not able to provide
between members and access to food [1]. Future nutrition edu- support for causal relationships. Several studies included in the
cation could recognize these complex household dynamics. review were qualitative, meaning that the findings may have
SNAP-Ed is designed to allow curriculum in each state to tailor been gleaned from focus groups or interviews and did not
educational lessons to the targeted population [78]. Therefore, necessarily indicate a statistical association with food security or
sensitivity to these issues among target groups of very low food dietary quality. Knowledge of this type should be further eval-
security in the development of educational content may promote uated for prevalence in groups and relationships with food se-
a tailored and effective approach to delivery. curity and dietary quality. In addition, the relative importance of
The household factors related to dietary quality and food the factors summarized is not known. The inclusion of stronger
security identified in this review are further applicable to the study designs to provide scientific evidence over the long term
emerging area of nutrition security [85], the consistent access, and randomized experimental evidence would strengthen the
availability, and affordability of a diet that promotes health and links between various themes identified in this review and their
prevents disease. Nutrition security is equity focused, aligning potentially causal relationships.
with an emphasis on tailoring interventions to meet the needs of
underserved groups and those with a greater disease burden Conclusion
compared with the general US population. The US Department of
Agriculture has defined and set goals to address nutrition secu- Parent and child behaviors, food procurement and prepara-
rity, but a national measure to quantify nutrition security has not tion, and the household environment are household factors that
yet been developed. Since this review identified factors related may impact dietary quality and food security in low-income and
to both dietary quality and food security, key aspects of nutrition food-insecure households with school-aged children. These fac-
security, the findings may inform creation of measures and in- tors are interrelated, and their synergy holds promise for future
terventions to address nutrition security in households with interventions to improve food security and dietary quality. The
children. Specifically, components of a measure to assess nutri- findings of this review are especially relevant to inform the
tion security may include queries to some of the household fac- design and implementation of nutrition education programming
tors identified here that impact dietary quality and food security, aimed at improving dietary quality and food security in low-
such as nutrition knowledge, self-efficacy, attitudes and prefer- income and food-insecure households with children.
ences regarding a healthful diet, barriers to purchasing and
preparing healthful foods, and household chaos impacting diet Acknowledgments
or family meals.
The authors acknowledge the contributions of Denise
Limitations McKeown who helped design the study, completed the search for
articles, screened studies for inclusion, integrated the results,
Although the goal of a scoping review is to be broad, exclu- and created a discussion that became her thesis, on which this
sion criteria help to narrow the resulting map of the relevant manuscript is based.
literature for a concise topic with definable boundaries. Limiting
the search strategy to only include studies from the past 10 years Author contributions
may have excluded older relevant studies, yet most studies The authors’ responsibilities were as follows – HEM:
included in the review were published within the past 5 years. conceived the study and designed the research plan; BM, HEM:
The search only included the PubMed database so relevant designed the search strategy; HEM, LG: screened the studies for

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inclusion; HEM: wrote the paper with contributions from LG; [11] C.W. Leung, J.T. Kullgren, P.N. Malani, D.C. Singer, M. Kirch,
HEM: had primary responsibility for final content; and all au- E. Solway, et al., Food insecurity is associated with multiple chronic
conditions and physical health status among older US adults, Prev.
thors: read and approved the final version of the paper. Med. Rep. 20 (2020), 101211, https://doi.org/10.1016/
j.pmedr.2020.101211.
[12] K.S. Cain, S.C. Meyer, E. Cummer, K.K. Patel, N.J. Casacchia, K. Montez,
Funding et al., Association of food insecurity with mental health outcomes in
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doi.org/10.1016/j.acap.2022.04.010.
Institute of Food and Agriculture, Agriculture and Food Research [13] L. Birch, J.S. Savage, A. Ventura, Influences on the development of
Initiative Competitive Grants Program, Foundational and children’s eating behaviours: from infancy to adolescence, Can. J. Diet.
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conclusions, or recommendations expressed in this publication [15] S. Jun, A.E. Cowan, K.W. Dodd, J.A. Tooze, J.J. Gahche, H.A. Eicher-
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HAEM is a member of the Advances in Nutrition editorial board C.J. Boushey, Food insecurity is associated with iron deficiency anemia
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LG, BM, BJM, BAC, WS, and AA report no conflicts of interest. [17] H.A. Eicher-Miller, A.C. Mason, C.M. Weaver, G.P. McCabe,
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