Community and family perspectives on addressing overweight in urban, African-American youth

Obesity Prevention and Screening

Obesity is widespread, associated with several physical and psychosocial comorbidities, and is difficult to treat. Prevention of obesity across the lifespan is critical to improving the health of individuals and society. Screening and prevention efforts in primary care are an important step in addressing the obesity epidemic. Each period of human development is associated with unique risks, challenges, and opportunities for prevention and intervention. Screening tools for overweight/obesity, although imperfect, are quick and easy to administer. Screening should be conducted at every primary care visit and tracked longitudinally. Screening tools and cutoffs for overweight and obesity vary by age group.

The influence of parental participation on obesity interventions in african american adolescent females: an integrative review

African American adolescent females have the highest prevalence rates of obesity among those age 18 and under. The long-term health effects and associated comorbidities of obesity within this cohort threaten the health and well-being of a major section of the U.S. population. There is a need to understand the influence of parental support in reducing obesity related health disparities. Using a social ecological framework to explore parental influence on adolescent obesity interventions allows for greater insight into the complex and dynamic influences affecting the lives of African American adolescent females who are obese.

Reducing cardiovascular disease risk in mid-life and older African Americans: a church-based longitudinal intervention project at baseline

INTRODUCTION

African Americans (AAs) experience higher age-adjusted morbidity and mortality than Whites for cardiovascular disease (CVD). Church-based health programs can reduce risk factors for CVD, including elevated blood pressure [BP], excess body weight, sedentary lifestyle and diet. Yet few studies have incorporated older adults and longitudinal designs.

PURPOSES

The aims of this study are to: a) describe a theory-driven longitudinal intervention study to reduce CVD risk in mid-life and older AAs; b) compare selected dietary (fruit and vegetable servings/day, fat consumption), physical activity (PA) and clinical variables (BMI, girth circumferences, systolic and diastolic BP, LDL, HDL, total cholesterol [CHOL] and HDL/CHOL) between treatment and comparison churches at baseline; c) identify selected background characteristics (life satisfaction, social support, age, gender, educational level, marital status, living arrangement and medication use) at baseline that may confound results; and d) share the lessons learned.

METHODS

This study incorporated a longitudinal pre/post with comparison group quasi-experimental design. Community-based participatory research (CBPR) was used to discover ideas for the study, identify community advisors, recruit churches (three treatment, three comparison) in two-counties in North Florida, and randomly select 221 mid-life and older AAs (45+) (n=104 in clinical subsample), stratifying for age and gender. Data were collected through self-report questionnaires and clinical assessments.

RESULTS AND CONCLUSIONS

Dietary, PA and clinical results were similar to the literature. Treatment and comparison groups were similar in background characteristics and health behaviors but differed in selected clinical factors. For the total sample, relationships were noted for most of the background characteristics. Lessons learned focused on community relationships and participant recruitment.

Faithful five: exploring African American faith leaders' perspectives on factors affecting childhood obesity

This study used a community-based participatory research tool called photovoice to understand African American faith leaders' perspectives on the factors that influence childhood obesity in their communities. Five African American women, who self-identified as faith leaders, took photographs and discussed photographs and emergent themes in 5 meetings. Qualitative analysis involved identifying recurring themes from the transcriptions of the photograph discussions, as well as the photographs themselves. The results suggest that the cycle of stress related to family responsibilities influences childhood obesity in this community. The implications for further research and public health practice are discussed.

A systematic review of parent role modeling of healthy eating and physical activity for their young African American children

PURPOSE

We systematically reviewed current literature on parent role modeling of healthy eating and physical activity as a strategy to influence healthy weight of middle school-age African American children.

CONCLUSIONS

The evidence for parent role modeling is low to average. Most studies did not target African American participants or middle school-age children.

PRACTICE IMPLICATIONS

Nurses can begin to remedy deficient knowledge of parent role modeling by assessing parent attitudes, beliefs, and healthy behaviors, as well as the children's. Existing dietary and physical activity guidelines are not specific to African Americans but can be a starting point for educating parents.

Adapting interpersonal psychotherapy for the prevention of excessive weight gain in rural African American girls

OBJECTIVE

To obtain focus group data regarding the perspectives of rural African American (AA) girls, parents/guardians, and community leaders on obesity, loss of control (LOC) eating, relationships, and interpersonal psychotherapy for the prevention of excessive weight gain (IPT-WG).

METHODS

7 focus groups (N = 50 participants) were moderated and the transcripts analyzed by Westat researchers using widely accepted methods of qualitative and thematic analysis. A session was held with experts in health disparities to elucidate themes.

RESULTS

Participants understood LOC eating; however, they had culturally specific perceptions including usage of alternative terms. Relationships were highly valued, specifically those between mothers and daughters. IPT-WG program components generally resonated with participants, although modifications were recommended to respect parental roles. Experts interpreted focus group themes and discussed potential barriers and solutions to recruitment and participation.

CONCLUSION

Findings suggest that adapting IPT-WG may be acceptable to rural AA families. This research is the first step in developing a sustainable excessive weight gain and binge eating disorder prevention program for rural AA adolescents.

Childhood obesity prevention: fathers' reflections with healthcare providers

BACKGROUND

To prevent childhood obesity, parents and their children's healthcare providers need to engage in effective dialogue. We know much about mothers' experiences, but very little about fathers' experiences.

METHODS

We explored African-American, Caucasian, and Latino fathers' perceptions and experiences communicating with their children's provider during clinic visits regarding weight, diet, and physical activity. Focus groups (n=3), grouped by race/ethnicity, including a total of 24 fathers, were conducted. The men were asked open-ended questions; responses were recorded and transcribed, and analyzed using ATLAS.ti.

RESULTS

Findings revealed that these fathers were involved in their children's healthcare and found providers to be helpful partners in keeping their children healthy, yet they generally felt "left out" during clinic appointments. The quality of the relationship with their children's provider influenced how receptive fathers were to discussing their children's weight, diet, and physical activity behaviors. Fathers made suggestions to help improve communication between providers and fathers, such as personalizing the discussion.

CONCLUSIONS

These fathers expressed strong feelings about the provider-parent relationship when discussing weight, diet, and physical activity.

Perceptions of healthy eating and physical activity in an ethnically diverse sample of young children and their parents: the DEAL prevention of obesity study

BACKGROUND

Ethnicity is a consistent correlate of obesity; however, little is known about the perceptions and beliefs that may influence engagement with obesity prevention programmes among ethnic minority children. Barriers to (and facilitators of) healthy lifestyles were examined in the qualitative arm of the London (UK) DiEt and Active Living (DEAL) study.

METHODS

Children aged 8-13 years and their parents, from diverse ethnic groups, were recruited through schools and through places of worship. Thirteen focus group sessions were held with 70 children (n = 39 girls) and eight focus groups and five interviews with 43 parents (n = 34 mothers).

RESULTS

Across ethnic groups, dislike of school meals, lack of knowledge of physical activity guidelines for children and negativity towards physical education at school among girls, potentially hindered healthy living. Issues relating to families' wider neighbourhoods (e.g. fast food outlets; lack of safety) illustrated child and parental concerns that environments could thwart intentions for healthy eating and activity. By contrast, there was general awareness of key dietary messages and an emphasis on dietary variety and balance. For ethnic minorities, places of worship were key focal points for social support. Discourse around the retention of traditional practices, family roles and responsibilities, and religion highlighted both potential facilitators (e.g. the importance of family meals) and barriers (reliance on convenience stores for traditional foods). Socio-economic circumstances intersected with key themes, within and between ethnic groups.

CONCLUSIONS

Several barriers to (and facilitators of) healthy lifestyles were common across ethnic groups. Diversity of cultural frameworks not only were more nuanced, but also shaped lifestyles for minority children.

Linking Life Dissatisfaction to Health Behaviors of Older African Americans Through Psychological Competency and Vulnerability

The objective of this study was to examine the influence of life dissatisfaction on health behaviors of older African Americans and the linking role of psychological competency (e.g., control and agency) and psychological vulnerability (e.g., negative affect). A structural equation model using baseline data from a larger intervention study of older African Americans was examined. Respondents included 207 (153 females and 54 males with a median age of 60) older African Americans. Life dissatisfaction was directly associated with respondents’ daily fat consumption and sleep and indirectly associated with receiving regular physical exams, physical activity, and fruit and vegetable consumption through their psychological processes. The association between life dissatisfaction and respondents’ health behaviors varied depending on the behavior under consideration. Programs and services designed to improve older African Americans’ health behaviors should address their psychological processes, as this research suggests these psychological processes are associated with different health behaviors.

Weight perceptions of parents with children at risk for diabetes

Background

The growing epidemic of obesity and diabetes among African American, Latino American, and Native American children in the United States has led to increasing focus on strategies for prevention. However, little is known about the perceptions toward weight, nutrition, and physical activity among these youth. This pilot study explored the perceptions of body weight among overweight and obese children and their parents.

Results

Thirty eight children, ages 8-16 years who were enrolled in a diabetes prevention study were surveyed to assess their perception of their weight. Nearly all (84%) of the children were obese. When asked whether they considered themselves to be overweight, African-American children were less likely to report that they were overweight than other children (33% vs. 80% of other children, p = 0.01). The parents of these children (n = 29) were also surveyed to assess their perception of their child's weight. The parents of two-thirds (65%) of the children reported that the child was overweight, while the rest reported their child was underweight or the right weight. African-American parents were less likely to report that their child's weight was unhealthy compared to other parents (46% vs. 77%, p = 0.069).

Conclusions

This study's findings indicate that future intervention efforts should assess children's and parents' awareness of obesity and diabetes risk and these factors should be considered when developing prevention interventions for families with youth at risk for diabetes in underserved communities.

Life dissatisfaction and eating behaviors among older African Americans: the protective role of social support

OBJECTIVES

To examine (a) the influences of life dissatisfaction and dietary social support on eating behaviors (a high-fat diet and fruit/vegetable consumption) of older African Americans and (b) the moderating role of perceived dietary social support on the association between their life dissatisfaction and unhealthy eating behaviors.

DESIGN

Baseline data from a larger intervention study of mid-life and older African Americans. The study incorporated a quasi-experimental design with random selection of participants, stratifying for age and gender.

SETTING

Six churches in North Florida.

PARTICIPANTS

One hundred and seventy-eight (132 females and 46 males with a median age of 60) older African Americans.

MEASUREMENTS

A structured questionnaire elicited personal data as well as information on eating behaviors, life dissatisfaction, and perceived dietary social support.

RESULTS

Older African Americans with more cumulative life adversity, as reflected by high life dissatisfaction, had significantly poorer eating behaviors including the consumption of a high-fat diet and low intake of fruits and vegetables. Older African Americans' dietary choices were also associated with their perceived social support. More importantly, perceived social support acted as a buffer to mitigate the influence of life dissatisfaction on older African Americans' eating behaviors.

CONCLUSION

Life dissatisfaction places older African Americans at risk for unhealthy eating behaviors. However, high levels of dietary social support can protect older African Americans from the influence of life dissatisfaction on unhealthy eating behaviors. There are practical implications of this research for health interventions and programming.

Reach-out: a family-based diabetes prevention program for African American youth

OBJECTIVE

To pilot test and assess the feasibility of a culturally grounded approach to adolescent overweight and diabetes prevention.

STUDY DESIGN

Reach-Out, a family-based nutrition and exercise program for overweight African American youth aged 9 to 12 years and their families, is led by lay health leaders and conducted in a community setting on Chicago's south side (Illinois). Age-appropriate interactive sessions focus on skills building, problem solving, and setting goals during 14 weekly sessions, with monthly meetings thereafter. Pre-post comparisons were made for 29 families (62 subjects) using physical (body mass index [BMI], blood pressure, waist circumference), biochemical (glucose, insulin, lipid levels) and behavioral data. Statistical analyses included mixed-effects linear models and logistic regression.

RESULTS

Children's mean BMI z score fell from 2.46 at baseline to 2.38 at 14 weeks and 2.39 at 1 year (p=.02), while parents' BMI remained stable. Children reported increased walking (p=0.07) and exhibited a corresponding rise in mean serum high-density lipoprotein cholesterol from 49.4 to 54.2 (p<.001). Qualitative assessment showed that participants enjoyed the program but felt the program could be improved by making the sessions even more interactive.

CONCLUSION

A community-based program for overweight minority youth and families can successfully address overweight, with the potential to decrease diabetes risk in youth.

What about N? A methodological study of sample-size reporting in focus group studies

BACKGROUND

Focus group studies are increasingly published in health related journals, but we know little about how researchers use this method, particularly how they determine the number of focus groups to conduct. The methodological literature commonly advises researchers to follow principles of data saturation, although practical advise on how to do this is lacking. Our objectives were firstly, to describe the current status of sample size in focus group studies reported in health journals. Secondly, to assess whether and how researchers explain the number of focus groups they carry out.

METHODS

We searched PubMed for studies that had used focus groups and that had been published in open access journals during 2008, and extracted data on the number of focus groups and on any explanation authors gave for this number. We also did a qualitative assessment of the papers with regard to how number of groups was explained and discussed.

RESULTS

We identified 220 papers published in 117 journals. In these papers insufficient reporting of sample sizes was common. The number of focus groups conducted varied greatly (mean 8.4, median 5, range 1 to 96). Thirty seven (17%) studies attempted to explain the number of groups. Six studies referred to rules of thumb in the literature, three stated that they were unable to organize more groups for practical reasons, while 28 studies stated that they had reached a point of saturation. Among those stating that they had reached a point of saturation, several appeared not to have followed principles from grounded theory where data collection and analysis is an iterative process until saturation is reached. Studies with high numbers of focus groups did not offer explanations for number of groups. Too much data as a study weakness was not an issue discussed in any of the reviewed papers.

CONCLUSIONS

Based on these findings we suggest that journals adopt more stringent requirements for focus group method reporting. The often poor and inconsistent reporting seen in these studies may also reflect the lack of clear, evidence-based guidance about deciding on sample size. More empirical research is needed to develop focus group methodology.

Qualitative study to explore Prospect Theory and message framing and diet and cancer prevention-related issues among African American adolescents

BACKGROUND

There is a dearth of knowledge regarding factors that may motivate African American adolescents to consume healthier diets.

OBJECTIVE

To develop and test cancer prevention messages based on Prospect Theory on motivation to improve dietary intake in African American adolescents and to explore other salient factors that may inform dietary intervention design and implementation in this population.

METHODS

Semistructured in-person qualitative interviews were conducted with 13 African American male and female adolescents, aged 12 to 16 years, in North Carolina. Prospect Theory and message framing were used to guide the design of the 4 sets of diet-related messages related to cancer prevention: short-term, gain-framed; long-term, gain-framed; short-term, loss-framed; and long-term, loss-framed messages. Data were also collected on demographic, behavioral, and psychological factors; usual health behaviors; and preferences for intervention delivery.

RESULTS

Most respondents found the gain-framed, short-term messages most salient for both fruits/vegetables (8 [61.5%]) and fat consumption (7 [53.8%]). For fat consumption only, 2 (15.4%) found the loss-framed, short-term messages pertinent; none found the loss-framed, long-term messages relevant for either dietary variable. All indicated interest in participating in a dietary intervention/education program; most preferred the Internet as a channel for intervention delivery. Participants expressed diverse views regarding knowledge, attitudes, and beliefs regarding healthy eating.

CONCLUSION

The gain-framed, short-term messages were most salient for motivating the majority of respondents to consume a healthy diet and most expressed a strong interest in participating in programs about diet and nutrition, with the Internet as the preferred communication channel.

IMPLICATIONS FOR PRACTICE

Researchers conducting dietary interventions and education initiatives and medical professionals who counsel African American adolescents should consider using Prospect Theory as a theoretical framework, should focus on gain-framed, short-term messages regarding cancer prevention, and should use the Internet for data collection and intervention and information delivery.

Overweight in Latino preschoolers: do parental health beliefs matter?

OBJECTIVE

To characterize the knowledge, attitudes, and beliefs (KAB) regarding childhood obesity among parents of Latino preschoolers.

METHODS

Three hundred sixty-nine Mexican immigrant parents of children ages 2-5 were interviewed. Children were weighed and measured.

RESULTS

Parents underestimated their own child's weight status and had high levels of perceived control over their children's eating and activity behaviors. Parents of overweight (>95%ile-for-age-and-sex BMI) versus nonoverweight (<95%ile BMI) children did not differ in their beliefs about ideal child body size.

CONCLUSION

Latino parents of overweight children did not differ from parents of nonoverweight children with respect to their KAB about childhood obesity.

One size does not fit all: identifying risk profiles for overweight in adolescent population subsets

PURPOSE

The purpose of this study is to identify population subgroups of adolescents who are homogenous with respect to sociodemographic factors and potentially modifiable risk and protective factors related to overweight status in a nationally representative sample of adolescents ages 12-17.

METHODS

The data used for this study are from the Centers for Disease Control and National Center for Health Statistics' National Survey of Children's Health, 2003 (NSCH). Classification and Regression Trees (CART) were used to identify population segments of adolescents based on risk and protective factors for obesity.

RESULTS

In the final CART model, 12 variables remained, including: poverty level, race, gender, participation in sports, number of family meals, family educational attainment, child physical activity, participation in free lunch programs, neighborhood safety and connectedness, TV viewing time, and child age in years. Poverty level was determined to be the most variable related to weight status in this sample of adolescents. Adolescents living in households below approximately the 300% poverty level were subject to a different constellation of predictors than adolescents living in homes above the 300% poverty level.

CONCLUSIONS

Our results demonstrate how risk and protective factors related to obesity emerge differently among sociodemographic subgroups and the relative importance of these risk and protective factors in relation to adolescent overweight status. Interventions that work for one population subgroup may not work for another.