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Duh-Leong C, Au L, Chang LY, Feldman NM, Pierce KA, Mendelsohn AL, Perrin EM, Sanders LM, Velazquez JJ, Lei Y, Xing SX, Shonna Yin H. Infant Feeding Outcomes From a Culturally-Adapted Early Obesity Prevention Program for Immigrant Chinese American Parents. Acad Pediatr 2024:S1876-2859(24)00214-6. [PMID: 38880393 DOI: 10.1016/j.acap.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 06/01/2024] [Accepted: 06/06/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE To examine whether a cultural adaptation of an early childhood obesity prevention program promotes healthy infant feeding practices. METHODS Prospective quasi-experimental study of a community-engaged multiphasic cultural adaptation of an obesity prevention program set at a federally qualified health center serving immigrant Chinese American parent-child dyads (N = 298). In a group of historical controls, we assessed early infant feeding practices (breastfeeding, sugar-sweetened beverage intake) in 6-month-olds and then the same practices alongside early solid food feeding practices (bottle weaning, fruit, vegetable, sugary or salty snack consumption) in 12-month-olds. After implementation, we assessed these practices in an intervention cohort group at 6 and 12 months. We used cross-sectional groupwise comparisons and adjusted regression analyses to evaluate group differences. RESULTS At 6 months, the intervention group had increased odds of no sugar-sweetened beverage intake (aOR: 5.69 [95% confidence interval (CI): 1.65, 19.63], P = .006). At 12 months, the intervention group also had increased odds of no sugar-sweetened beverage intake (aOR: 15.22 [95% CI: 6.33, 36.62], P < .001), increased odds of bottle weaning (aOR: 2.34 [95% CI: 1.05, 5.23], P = .03), and decreased odds of sugary snack consumption (aOR: 0.36 [0.18, 0.70], P = .003). We did not detect improvements in breastfeeding, fruit, vegetable, or salty snack consumption. CONCLUSIONS A cultural adaptation of a primary care-based educational obesity prevention program for immigrant Chinese American families with low income is associated with certain healthy infant feeding practices. Future studies should evaluate cultural adaptations of more intensive interventions that better address complex feeding practices, such as breastfeeding, and evaluate long-term weight outcomes.
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Affiliation(s)
- Carol Duh-Leong
- Division of General Pediatrics (C Duh-Leong, LY Chang, KA Pierce, JJ Velazquez, and H Shonna Yin), Department of Pediatrics, NYU Grossman School of Medicine, New York, NY.
| | - Loretta Au
- Department of Pediatrics (L Au), Charles B. Wang Community Health Center, New York, NY
| | - Lucy Y Chang
- Division of General Pediatrics (C Duh-Leong, LY Chang, KA Pierce, JJ Velazquez, and H Shonna Yin), Department of Pediatrics, NYU Grossman School of Medicine, New York, NY
| | - Naumi M Feldman
- Department of Population Health (NM Feldman), Charles B. Wang Community Health Center, New York, NY
| | - Kristyn A Pierce
- Division of General Pediatrics (C Duh-Leong, LY Chang, KA Pierce, JJ Velazquez, and H Shonna Yin), Department of Pediatrics, NYU Grossman School of Medicine, New York, NY
| | - Alan L Mendelsohn
- Division of Developmental-Behavioral Pediatrics (AL Mendelsohn), Department of Pediatrics, NYU Grossman School of Medicine, New York, NY
| | - Eliana M Perrin
- Division of General Pediatrics, Department of Pediatrics (EM Perrin), Schools of Medicine and Nursing, Johns Hopkins University, Baltimore, MD
| | - Lee M Sanders
- Division of General Pediatrics, Department of Pediatrics (LM Sanders), Stanford University School of Medicine, Palo Alto, Calif
| | - Jessica J Velazquez
- Division of General Pediatrics (C Duh-Leong, LY Chang, KA Pierce, JJ Velazquez, and H Shonna Yin), Department of Pediatrics, NYU Grossman School of Medicine, New York, NY
| | - Yuxiao Lei
- Department of Health Policy (Y Lei), The London School of Economics and Political Science, London, United Kingdom
| | - Samantha X Xing
- Columbia Vagelos College of Physicians and Surgeons (SX Xing), New York, NY
| | - H Shonna Yin
- Division of General Pediatrics (C Duh-Leong, LY Chang, KA Pierce, JJ Velazquez, and H Shonna Yin), Department of Pediatrics, NYU Grossman School of Medicine, New York, NY
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Lin JLL, Zhong O, Tse R, Lau JD, Chao E, Au L. Weight Status Change in Chinese American Children over a Ten-Year Period: Retrospective Study of a Primary Care Pediatric Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105916. [PMID: 35627453 PMCID: PMC9142033 DOI: 10.3390/ijerph19105916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/28/2022] [Accepted: 05/11/2022] [Indexed: 12/10/2022]
Abstract
Weight change from childhood to adolescence has been understudied in Asian Americans. Known studies lack disaggregation by Asian subgroups. This retrospective study assessed the weight status change in 1500 Chinese American children aged 5−11 years from an urban primary care health center between 2007 and 2017. Weight status was categorized using the 2000 CDC growth charts into “underweight/normal weight” and “overweight/obese.” The overweight/obesity prevalence in 2007 and 2017 were determined. McNemar’s test and logistic regression were performed. The prevalence of overweight/obesity decreased from 29.9% in 2007 to 18.6% in 2017. Children who were overweight/obese at 5−11 years had 10.3 increased odds of staying overweight/obese over time (95% CI = 7.6−14.0, p < 0.001) compared to their underweight/normal weight counterparts. Of the children who were overweight/obese in 2007, 45.7% remained overweight/obese ten years later. Childhood overweight/obesity strongly predicts adult overweight/obesity in Chinese Americans. Targeted education and intervention are warranted to prevent adult obesity.
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Affiliation(s)
- Jia Lu Lilian Lin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada;
| | - Olivia Zhong
- CUNY School of Medicine, New York, NY 10031, USA;
| | - Raymond Tse
- Charles B. Wang Community Health Center, New York, NY 10013, USA; (R.T.); (J.D.L.); (E.C.)
| | - Jennifer D. Lau
- Charles B. Wang Community Health Center, New York, NY 10013, USA; (R.T.); (J.D.L.); (E.C.)
- Weill Cornell Medicine, New York, NY 10065, USA
| | - Eda Chao
- Charles B. Wang Community Health Center, New York, NY 10013, USA; (R.T.); (J.D.L.); (E.C.)
| | - Loretta Au
- Charles B. Wang Community Health Center, New York, NY 10013, USA; (R.T.); (J.D.L.); (E.C.)
- Correspondence: ; Tel.: +1-212-226-8866
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Ma Z, Wang J, Li J, Jia Y. The association between obesity and problematic smartphone use among school-age children and adolescents: a cross-sectional study in Shanghai. BMC Public Health 2021; 21:2067. [PMID: 34763684 PMCID: PMC8581960 DOI: 10.1186/s12889-021-12124-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 10/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study aimed to investigate the association between content-based problematic smartphone use and obesity in school-age children and adolescents, including variations in the association by educational stage and sex. METHODS Two-stage non-probability sampling was used to recruit 8419 participants from nineteen primary schools, five middle schools, and thirteen high schools in Shanghai in December 2017. Obesity was identified by body mass index (BMI), which was obtained from the school physical examination record, while problematic smartphone use was measured by the Revised Problematic Smartphone Use Classification Scale as the independent variable. RESULTS The rates of obesity varied with educational stages, while problematic smartphone use increased with educational stages. Male students reported higher obesity rates (37.1%vs19.4%, P < 0.001) and greater problematic smartphone use scores (25.65 ± 10.37 vs 22.88 ± 8.94, P < 0.001) than female students. Problematic smartphone use for entertainment (smartphone users addicted to entertainment games, music, videos, novels and other applications) was positively associated to obesity status for primary school [odds ratio (OR), 1.030; 95% confidence interval (95% CI), 1.005-1.057] and high school students (OR, 1.031; 95% CI, 1.004-1.059). For female students, problematic smartphone use for entertainment was positively associated with obesity status (OR, 1.046; 95% CI, 1.018-1.075). CONCLUSIONS Problematic smartphone use may be associated with obesity in children and adolescents. The association differed based on the educational stage and sex, and the difference possessed dimensional specificity.
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Affiliation(s)
- Zhicong Ma
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, 200032, China
| | - Jiangqi Wang
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, 200032, China
| | - Jiang Li
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, 200032, China
- Health Communication Institute, Fudan University, Shanghai, 200032, China
| | - Yingnan Jia
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, 200032, China.
- Health Communication Institute, Fudan University, Shanghai, 200032, China.
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Cultural Influences on Complementary Feeding Beliefs amongst New Chinese Immigrant Mothers in England: A Mixed Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155468. [PMID: 32751218 PMCID: PMC7432469 DOI: 10.3390/ijerph17155468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/03/2020] [Accepted: 07/10/2020] [Indexed: 11/23/2022]
Abstract
Adequate nutrition during infancy and early childhood is essential for ensuring the growth, health, and development of children so that they can reach their full potential. There is a current void of data on infant and young child feeding practices (IYCF) in ethnic minority communities in the UK; specifically, it is difficult to find accurate Chinese IYCF data in the UK because survey data often includes Chinese in the category of ‘Chinese or other ethnic group’, further contributing to health inequalities. This mixed methods study aimed to explore the cultural influences on IYCF beliefs among new Chinese immigrant mothers. A total of 31 mothers of infants aged 6–23 months were recruited from informal community organizations. All 31 mothers were born in Mainland China, the mean length of their stay after immigrating to the UK was 10 years (range = 1–21 years), and their mean age was 29 ± 3.40 years. When using the Infant Feeding Style Questionnaire (IFSQ) to investigate IYCF beliefs, the highest score was obtained for responsive attention, with a value of 4.28 ± 0.92, indicating that parents were very attentive to child hunger and satiety cues; lower scores were obtained for indulgence soothing (1.82 ± 1.01), indulgence coaxing (2.11 ± 1.18), indulgence pampering (1.90 ± 0.95), and pressuring to soothe (1.92 ± 0.86), indicating lesser maternal indulgence and pressuring/controlling beliefs. A sub-sample (n = 14) participated in semi-structured interviews in order to understand the balancing sources of information and cultural preferences, the influence of traditional Chinese medicine, and language difficulties in accessing health services. The mothers reported barriers of IYCF beliefs and the introduction of solid foods earlier than the NHS guidelines. This study can promote optimal IYCF in Chinese immigrants and show health services the need to reconcile differences between the perceptions of British and Chinese health beliefs.
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Measuring overweight and obesity in Chinese American children using US, international and ethnic-specific growth charts. Public Health Nutr 2020; 23:2663-2670. [PMID: 32611456 DOI: 10.1017/s1368980020000919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim is to determine the disparity between the overweight and obesity prevalence of Chinese American school-aged children and adolescents as measured by the Centers for Disease Control and Prevention (CDC) growth reference and the prevalence as measured by international and ethnic-specific-growth references. DESIGN This retrospective, cross-sectional study measured overweight and obesity prevalence among a paediatric population using the CDC, International Obesity Task Force (IOTF), World Health Organization (WHO) and an ethnic Chinese growth curve. SETTING A community health centre in New York City, USA. PARTICIPANTS Chinese American children aged 6-17 years in 2017 (N 9160). RESULTS The overweight prevalence was 24 % (CDC), 23 % (IOTF), 30 % (WHO) and 31 % (China). The obesity prevalence was 10 % (CDC), 5 % (IOTF), 10 % (WHO) and 10 % (China). When disaggregated by age and sex, the difference was the most prominent in girls; using the China reference compared with using the CDC reference almost doubles the overweight prevalence (school-aged: 31 v. 17 %, P < 0·001, adolescent: 27 v. 14 %, P < 0·001) and the obesity prevalence (school-aged: 11 v. 5 %, P < 0·001, adolescent: 7 v. 4 %, P < 0·001). CONCLUSIONS Use of the CDC reference compared with the Chinese ethnic-specific reference results in lower overweight and obesity prevalence in Chinese American girls. Almost half of the girls who were overweight and half of the girls who were obese were not identified using the CDC reference. Using ethnic-specific references or ethnic-specific cut-points may help improve overweight identification for Chinese American children.
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The Association of Acculturation and Complementary Infant and Young Child Feeding Practices Among New Chinese Immigrant Mothers in England: A Mixed Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183282. [PMID: 31500137 PMCID: PMC6765794 DOI: 10.3390/ijerph16183282] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 12/13/2022]
Abstract
Acculturation has an influence on mothers' beliefs and the perceived behaviours of different ethnicities. Few studies have been conducted on complementary infant and young child feeding practices (CIYCFP) in minorities in England, particularly in Chinese immigrants. This mixed study aims to explore the association of acculturation and IYCF among new Chinese immigrant mothers using purposive snowball sampling from an informal Chinese community. The participants' responses to the Infant Feeding Style Questionnaire (IFSQ) and Mutual Intercultural Relations in Plural Societies (MIRIPS), questionnaire (n = 32) were collected. A sub-set of 15 also participated in semi-structured interviews. Pearson's correlation coefficient analysis and thematic analysis were performed to analyse the survey and semi-structured interview data, and triangulation was employed to integrate quantitative and qualitative findings. This study indicated that Chinese mothers who scored high in integration were more likely to respond to satiety and attention; those inclined to be marginalised were more likely to indulge their children. Those who were more culturally separated were more likely to restrict the food quality offered to their children. This study also indicated that Chinese immigrants balanced western and Chinese feeding practices to combat feeding and culture conflict. This study presents preliminary findings of the association between acculturation and CIYCFP, which can improve culturally appropriate CIYCFP in minorities. Further studies are needed to explore intervention programs to tailor CIYCFP with consideration for acculturation in the minority.
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Lau JD, Au LY, Chao E, Elbaar L, Tse R. The Association of Grandparent Care with Childhood Overweight and Obesity in Chinese American Families. Child Obes 2019; 15:14-20. [PMID: 30256661 DOI: 10.1089/chi.2018.0113] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Grandparents are often the caretakers of children in Chinese American families. Studies have shown that Chinese grandparents underestimate the weight of their grandchildren and associate food with increased height and strength. This study examines the association of grandparental care with weight status in Chinese American children and adolescents. METHODS This is a cross-sectional study of 12,029 Chinese American pediatric patients ages 2-19 at a community health center in New York City in 2015. Grandparental care was defined as child care provided by at least one grandparent. Multivariable logistic regression was conducted to assess for association between having a grandparent caretaker and weight status in the age groups 2-5, 6-11, and 12-19 while adjusting for sex, place of birth, neighborhood poverty, and two-parent households. RESULTS Approximately 12% of Chinese American children in this population had a grandparent caretaker. Children and adolescents with grandparent caretakers are more likely to be overweight than their counterparts with no grandparent caretakers at ages 6-11 (odds ratio [OR]: 1.48; 95% confidence interval [CI]: 1.23-1.79) and ages 12-19 (OR: 1.54; 95% CI: 1.18-2.02). No association was found between grandparental care and overweight in ages 2-5 nor with obesity in any age group. CONCLUSIONS Grandparental care is associated with the weight of school-age children and adolescents. Targeted education on appropriate nutrition for the child's age is needed for grandparents who take care of children.
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Affiliation(s)
- Jennifer D Lau
- 1 Research and Evaluation Department, Charles B. Wang Community Health Center, New York, NY
| | - Loretta Y Au
- 2 Pediatrics Department, and Charles B. Wang Community Health Center, New York, NY
| | - Eda Chao
- 2 Pediatrics Department, and Charles B. Wang Community Health Center, New York, NY
| | - Laminasti Elbaar
- 3 Clinical Informatics Department, Charles B. Wang Community Health Center, New York, NY
| | - Raymond Tse
- 2 Pediatrics Department, and Charles B. Wang Community Health Center, New York, NY
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