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Militello L, Sobolev M, Okeke F, Adler DA, Nahum-Shani I. Digital Prompts to Increase Engagement With the Headspace App and for Stress Regulation Among Parents: Feasibility Study. JMIR Form Res 2022; 6:e30606. [PMID: 35311675 PMCID: PMC8981020 DOI: 10.2196/30606] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 11/07/2021] [Accepted: 12/13/2021] [Indexed: 01/20/2023] Open
Abstract
Background Given the interrelated health of children and parents, strategies to promote stress regulation are critically important in the family context. However, the uptake of preventive mental health is limited among parents owing to competing family demands. Objective In this study, we aim to determine whether it is feasible and acceptable to randomize digital prompts designed to engage parents in real-time brief mindfulness activities guided by a commercially available app. Methods We conducted a 30-day pilot microrandomized trial among a sample of parents who used Android smartphones. Each day during a parent-specified time frame, participants had a 50% probability of receiving a prompt with a message encouraging them to engage in a mindfulness activity using a commercial app, Headspace. In the 24 hours following randomization, ecological momentary assessments and passively collected smartphone data were used to assess proximal engagement (yes or no) with the app and any mindfulness activity (with or without the app). These data were combined with baseline and exit surveys to determine feasibility and acceptability. Results Over 4 months, 83 interested parents were screened, 48 were eligible, 16 were enrolled, and 10 were successfully onboarded. Reasons for nonparticipation included technology barriers, privacy concerns, time constraints, or change of mind. In total, 80% (8/10) of parents who onboarded successfully completed all aspects of the intervention. While it is feasible to randomize prompt delivery, only 60% (6/10) of parents reported that the timing of prompts was helpful despite having control over the delivery window. Across the study period, we observed higher self-reported engagement with Headspace on days with prompts (31/62, 50% of days), as opposed to days without prompts (33/103, 32% of days). This pattern was consistent for most participants in this study (7/8, 87%). The time spent using the app on days with prompts (mean 566, SD 378 seconds) was descriptively higher than on days without prompts (mean 225, SD 276 seconds). App usage was highest during the first week and declined over each of the remaining 3 weeks. However, self-reported engagement in mindfulness activities without the app increased over time. Self-reported engagement with any mindfulness activity was similar on days with (40/62, 65% of days) and without (65/103, 63% of days) prompts. Participants found the Headspace app helpful (10/10, 100%) and would recommend the program to others (9/10, 90%). Conclusions Preliminary findings suggest that parents are receptive to using mindfulness apps to support stress management, and prompts are likely to increase engagement with the app. However, we identified several implementation challenges in the current trial, specifically a need to optimize prompt timing and frequency as a strategy to engage users in preventive digital mental health.
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Affiliation(s)
- Lisa Militello
- College of Nursing, The Ohio State University, Columbus, OH, United States
| | - Michael Sobolev
- Cornell Tech, Cornell University, New York, NY, United States.,Feinstein Institute for Medical Research, Northwell Health, Great Neck, NY, United States
| | - Fabian Okeke
- Cornell Tech, Cornell University, New York, NY, United States
| | - Daniel A Adler
- Cornell Tech, Cornell University, New York, NY, United States
| | - Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
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Stotz S, Habibi M, Sanville L, Cotto-Rivera E, Soler A, Powell A, Giraudo S, Lee JS. Adapting a Nutrition Education Curriculum for Spanish-Speaking Adults Experiencing Low-Income: Recommendations from Key Stakeholders. Ecol Food Nutr 2021; 60:737-750. [PMID: 33781137 DOI: 10.1080/03670244.2021.1899917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The purpose of this study was to understand recommendations of key stakeholders regarding cultural adaptation of an evidence-based nutrition and physical activity education curriculum for Spanish-speaking adults. Findings from focus groups with Spanish-speaking adults (n=43) and telephone interviews with experts in Spanish nutrition and health education (n=9) revealed: 1) emphasis of the heterogeneity of Spanish-speaking communities; 2) importance of including family in nutrition education; 3) importance of addressing cultural differences between Spanish-speaking and general United States culture; and 4) tips for engaging Spanish-speaking adults in health education. These findings were used to inform cultural adaptation of a nutrition education curriculum.
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Affiliation(s)
- Sarah Stotz
- University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Department of Community and Behavioral Health, Center for American Indian and Alaska Native Health, Aurora, CO
| | - Mona Habibi
- University of Maryland Extension, University of Maryland, College Park, Derwood, MD
| | - Laurel Sanville
- , Department of Foods and Nutrition, The University of Georgia, Athens, GA, United States of America
| | - Edda Cotto-Rivera
- , Department of Foods and Nutrition, The University of Georgia, Athens, GA, United States of America
| | | | - Ariathni Powell
- , Department of Foods and Nutrition, The University of Georgia, Athens, GA, United States of America
| | - Silvia Giraudo
- , Department of Foods and Nutrition, The University of Georgia, Athens, GA, United States of America
| | - Jung Sun Lee
- , Department of Foods and Nutrition, The University of Georgia, Athens, GA, United States of America
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3
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Delaney CL, Spaccarotella K, Quick V, Byrd-Bredbenner C. A Comparison of Weight-Related Behaviors of Hispanic Mothers and Children by Acculturation Level. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E503. [PMID: 33435478 PMCID: PMC7827543 DOI: 10.3390/ijerph18020503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/04/2021] [Accepted: 01/08/2021] [Indexed: 12/13/2022]
Abstract
Hispanic mothers and children in the United States experience a high prevalence of obesity, which may be affected by maternal acculturation level. Little is known about the association of acculturation on weight-related behaviors. This study describes differences in weight-related behaviors by acculturation level of Hispanic mothers residing in the U.S. and compares them to behaviors of White mothers. Acculturation level was determined using personal acculturation and acculturation environment variables. Cluster analysis of acculturation variables identified three groups of Hispanic mothers: low personal and environmental acculturation (n = 46), high personal and low environmental acculturation (n = 65), and high personal and environmental acculturation (n = 38). Results indicate that, compared to White mothers (n = 340), the least acculturated cluster of Hispanic mothers tended to model physical activity less often and the most acculturated exerted more pressure on children to eat. Mothers in the least acculturated cluster tended to rate children's health status lower, indicate that children had greater fruit juice and less milk intakes, have more meals in locations associated with less healthy meals, and have the least space and supports for physical activity. Findings highlight relationships between maternal acculturation level and weight-related behaviors and suggest strategies for helping acculturating Hispanic mothers create healthier lifestyles and home environments.
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Affiliation(s)
- Colleen L. Delaney
- Department of Nutritional Science, Rutgers University, New Brunswick, NJ 08901-8554, USA; (V.Q.); (C.B.-B.)
| | - Kim Spaccarotella
- Department of Biological Sciences, Kean University, Union, NJ 07083-7131, USA;
| | - Virginia Quick
- Department of Nutritional Science, Rutgers University, New Brunswick, NJ 08901-8554, USA; (V.Q.); (C.B.-B.)
| | - Carol Byrd-Bredbenner
- Department of Nutritional Science, Rutgers University, New Brunswick, NJ 08901-8554, USA; (V.Q.); (C.B.-B.)
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4
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Branscum P, Lora K, Hernandez DC. Examining Determinants and Co-associations Between Fruit and Vegetable and Sugar-Sweetened Beverage Monitoring Practices Among a Sample of Low-Income Hispanic Mothers. J Racial Ethn Health Disparities 2020; 7:650-659. [PMID: 31916191 PMCID: PMC7338240 DOI: 10.1007/s40615-019-00695-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 12/19/2019] [Accepted: 12/30/2019] [Indexed: 01/04/2023]
Abstract
The etiology of obesity is complex, and a growing body of research suggests that changing two or more behaviors at the same time will likely have a stronger impact than changing one behavior in isolation. A lack of fruit and vegetable (FV) intake and high sugar-sweetened beverage (SSB) consumption are two behaviors related to childhood obesity in the Hispanic community. The purpose of this study was to evaluate theory-based determinants of monitoring practices of FV and SSB among Hispanic mothers with young children using the reasoned action approach. The study also examined the co-associations among the theoretical antecedents for both behaviors. Surveys were distributed in several community settings to urban Hispanic mothers (n = 238) of 2-5-year-old children. Surveys assessed FV and SSB monitoring practices, attitudes, perceived norms, perceived behavioral control (PBC), and intentions. Two models were evaluated using structural equation modeling: attitudes, perceived norms, and PBC of both behaviors were associated with intentions for both behaviors, and PBC and intentions were associated with monitoring practices of FV and SSB. Both models had adequate fit (FV (CFI = 0.973; GFI = 0.980; RMSEA = 0.121); SSB (CFI = 0.994; GFI = 0.993; RMSEA = 0.066)). PBC for both FV and SSB monitoring was significantly associated with SSB monitoring, whereas FV intentions was only significantly associated with FV monitoring. Results from this study gives evidence that among Hispanic mothers, FV and SSB monitoring behaviors are interrelated. To promote SSB monitoring, more implementation strategies (i.e., skills-based interventions) are warranted, whereas to promote FV monitoring, motivational strategies are warranted.
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Affiliation(s)
- Paul Branscum
- Department of Kinesiology and Health, Miami University, 420 S. Oak Street, Phillips Hall 202P, Oxford, OH, 45056, USA.
| | - Karina Lora
- Department of Exercise and Nutrition Sciences, The George Washington University, Washington, DC, USA
| | - Daphne C Hernandez
- Cizik School of Nursing, University of Texas Health Science Center, Houston, TX, USA
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Garcia ML, Crespo NC, Behar AI, Talavera GA, Campbell N, Shadron LM, Elder JP. Examining Mexican-Heritage Mothers' Perceptions of Their Children's Weight: Comparison of Silhouette and Categorical Survey Methods. Child Obes 2020; 16:44-52. [PMID: 31556701 PMCID: PMC6931916 DOI: 10.1089/chi.2019.0015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: Failure to recognize children's overweight status by parents may contribute to children's risk for obesity. We examined two methods of measuring mothers' perceptions of children's weight and factors associated with weight perception inaccuracy. Methods: Cross-sectional analyses of clinical and self-report data from 287 Mexican-heritage mother-child dyads. Mothers identified their child's weight category using a scale (e.g., "normal/overweight/obese") and a visual silhouette scale (11 child gender-specific weight-varying images). Children's height and weight were measured to calculate body mass index (BMI). Chi-square tests examined associations between categorical, silhouette, and BMI percentile categories of children's weight. Bivariate logistic regression analyses examined factors associated with mothers' inaccuracy of their children's weight. Results: Only 13% of mothers accurately classified their child as obese using the categorical scale, while 78% accurately classified their child as obese using the silhouette scale. Mothers were more likely to underestimate their child's weight using BMI categories (62%) compared to using the silhouette scale (23%). Predictors of mothers' underestimation using the categorical method were child sex [female] (adjusted odds ratio [AOR] = 1.99; 95% CI: 1.02-3.86), child age [younger age] (AOR = 10.39; 95% CI: 4.16-25.92 for ages 5-6 years), and mother's weight status (overweight AOR = 2.99; 95% CI: 1.05-8.51; obese AOR = 5.19; 95% CI: 1.89-14.18). Child BMI was the only predictor of mothers' overestimation (AOR = 0.89; 95% CI: 0.85-0.94) using the silhouette method. Conclusions: Using silhouette scales to identify children's body weight may be a more accurate tool for clinicians and interventionists to activate parents' awareness of unhealthy weight in children compared to using traditional categorical weight-labeling methods.
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Affiliation(s)
- Melawhy L. Garcia
- Department of Health Science, Center for Latino Community Health, Evaluation, and Leadership Training, California State University Long Beach, Long Beach, CA.,Address correspondence to: Melawhy L. Garcia, MPH, PhD, Department of Health Science, California State University Long Beach, 1250 Bellflower Boulevard, HHS2-115, Long Beach, CA 90840
| | - Noe C. Crespo
- School of Public Health, Institute for Behavioral and Community Health, San Diego State University, San Diego, CA
| | - Alma I. Behar
- School of Public Health, Institute for Behavioral and Community Health, San Diego State University, San Diego, CA
| | - Gregory A. Talavera
- Department of Psychology, South Bay Latino Research Center, San Diego State University, Chula Vista, CA
| | - Nadia Campbell
- Sponsored Research Administration, San Diego State University Research Foundation, San Diego, CA
| | - Lisa M. Shadron
- Sponsored Research Administration, San Diego State University Research Foundation, San Diego, CA
| | - John P. Elder
- School of Public Health, Institute for Behavioral and Community Health, San Diego State University, San Diego, CA
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Hidalgo-Mendez J, Power TG, Fisher JO, O'Connor TM, Hughes SO. Child weight status and accuracy of perceived child weight status as predictors of Latina mothers' feeding practices and styles. Appetite 2019; 142:104387. [PMID: 31369764 PMCID: PMC6717553 DOI: 10.1016/j.appet.2019.104387] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/25/2019] [Accepted: 07/28/2019] [Indexed: 10/26/2022]
Abstract
This study focused on the relationship between low-income Latina mothers' perceptions of their preschool children's weight status and maternal feeding practices and styles, also considering the effects of actual child weight status and maternal concern about child weight. A total of 186 low-income Latina mother-child dyads participated. The vast majority of mothers underestimated the weight status of their child, but this varied by child weight status. Although only 30% of mothers of healthy weight children underestimated their child's weight status, 97% of mothers of overweight or obese children did so. No mother overestimated her child's weight status. Contrary to our hypotheses, in most cases, maternal perceptions of child's body weight were not related to maternal feeding styles, nor were many feeding practices predicted by concern about child weight. Instead, children's actual weight status was the strongest predictor of maternal feeding practices and feeding styles. Mothers of children with higher BMI z-scores reported higher levels of healthy eating guidance and responsiveness during feeding and lower levels of pressure to eat, food as reward, and using food to regulate the child's emotions. These mothers were more likely to show an indulgent and less likely to show an authoritarian feeding style. Concern about child weight did not account for any of these significant correlations. Maternal perceptions only mattered for restriction for weight purposes where there were independent effects of both perceived and actual weight status. Implications for understanding the development of child obesity in low-income, Latino populations are considered, along with recommendations for future research and for childhood obesity prevention programs.
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Affiliation(s)
- Jackelyn Hidalgo-Mendez
- Department of Human Development, Washington State University, PO Box 644852, Pullman, WA, 99164-4852, USA.
| | - Thomas G Power
- Department of Human Development, Washington State University, PO Box 644852, Pullman, WA, 99164-4852, USA.
| | - Jennifer Orlet Fisher
- Temple University, Center for Obesity Research and Education, 3223 N. Broad Street, Suite 175, Philadelphia, PA, 19140, USA.
| | - Teresia M O'Connor
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street, Houston, TX, 77030-2600, USA.
| | - Sheryl O Hughes
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street, Houston, TX, 77030-2600, USA.
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Luybli M, Schmillen H, Sotos-Prieto M. School-Based Interventions in Low Socioeconomic Settings to Reduce Obesity Outcomes among Preschoolers: A Scoping Review. Nutrients 2019; 11:E1518. [PMID: 31277426 PMCID: PMC6683276 DOI: 10.3390/nu11071518] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 12/21/2022] Open
Abstract
Pediatric obesity continues to grow globally, specifically in low-socioeconomic rural areas. Strategies that combat pediatric obesity have not yet been fully determined. While the implementation of some interventions in preschool (ages 2-5) populations have demonstrated successful results, others have proven to be inconclusive and less have focused specifically on low socioeconomic populations. This scoping review aims to examine the literature to study the effectiveness of the school-based interventions in low socioeconomic settings on adiposity-related outcomes among preschoolers. PubMed/MEDLINE and EBSCO (ERIC (Education Resource Information Center) and Food Science Source) were used to conduct the search strategy. A total of 15 studies were assessed that met the inclusion criteria: Studies that included school-based interventions; reported adiposity-related data; targeting preschoolers (2 to 5 years old) in rural/low socioeconomic/underserved/areas. Interventions were then described as successful or inconclusive based on the primary outcome. Nine out of the fifteen studies were labeled as successful, which had a reduction in adiposity-related outcomes (BMI (body mass index), BMI z-score, waist circumference, skinfold, percent body fat). Current evidence, although scarce, suggest that obesity outcomes can be targeted in low socioeconomic settings through school interventions with a multicomponent approach (nutrition and physical activity) and the inclusion of parents. Further research is needed to determine effective interventions, their efficacy, and their long-term outcomes.
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Affiliation(s)
- Megan Luybli
- Division of Food Sciences and Nutrition, School of Applied Health Sciences and Wellness, Ohio University, and Diabetes Institute, Athens, OH 45701, USA
| | - Hanna Schmillen
- Ohio University Libraries, Ohio University, Athens, OH 45701, USA
| | - Mercedes Sotos-Prieto
- Division of Food Sciences and Nutrition, School of Applied Health Sciences and Wellness, Ohio University, and Diabetes Institute, Athens, OH 45701, USA.
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, C/Arzobispo Morcillo, sn, 28029 Madrid, Spain.
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Arlinghaus KR, Hernandez DC, Eagleton SG, Chen TA, Power TG, Hughes SO. Exploratory factor analysis of The Comprehensive Feeding Practices Questionnaire (CFPQ) in a low-income hispanic sample of preschool aged children. Appetite 2019; 140:82-90. [PMID: 31054276 DOI: 10.1016/j.appet.2019.04.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 04/08/2019] [Accepted: 04/30/2019] [Indexed: 01/20/2023]
Abstract
The Comprehensive Feeding Practices Questionnaire (CFPQ) is an important measure to assess parent feeding practices as it encompasses a broad range of feeding behaviors, not just behaviors negatively associated with child weight outcomes. However, parent feeding practices have been shown to differ across ethnicities and the CFPQ has not been tested among low-income, Hispanic-American parents with preschool-aged children, a group at elevated risk for developing obesity. A confirmatory factor analysis was performed with the present Hispanic-American sample of Head Start mothers with preschoolers to confirm the original 12-factor, 49-item structure of the CFPQ. Because the original factor structure was not confirmed in the present Hispanic-American sample, an exploratory factor analysis was conducted to examine the psychometric properties of the CFPQ in this sample (n = 187). Among this sample, a five-factor model with 34 items was found to more appropriately assess parent feeding practices than the original 12-factor, 49-item CFPQ. This study provides preliminary validation of the CFPQ for use among low income, Hispanic-American families. Although future research is needed to replicate findings among a larger sample, this study takes an important first step toward more accurately assessing parent feeding practices among this high-risk population to inform tailored interventions that aim to reduce economic and ethnic disparities in child obesity.
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Affiliation(s)
- Katherine R Arlinghaus
- University of Houston, Department of Health & Human Performance, 3875 Holman Street, Garrison Gymnasium, Room 104, Houston, TX, 77240, USA.
| | - Daphne C Hernandez
- University of Houston, Department of Health & Human Performance, 3875 Holman Street, Garrison Gymnasium, Room 104, Houston, TX, 77240, USA; HEALTH Research Institute, University of Houston, Health 2, 3839 Calhoun Road, Houston, TX, 77204, USA.
| | - Sally G Eagleton
- Center for Childhood Obesity Research, Penn State College of Health and Human Development, University Park, PA, USA; Department of Nutritional Sciences, Penn State College of Health and Human Development, University Park, PA, USA.
| | - Tzu-An Chen
- HEALTH Research Institute, University of Houston, Health 2, 3839 Calhoun Road, Houston, TX, 77204, USA.
| | - Thomas G Power
- Department of Human Development, Washington State University, Pullman, WA, USA.
| | - Sheryl O Hughes
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Ave, Houston, TX, 77030, USA.
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Rodríguez-Pérez R, Correa-Matos N, Valdés-Valderrama A, Rodríguez-Cruz LA, Rodríguez MC. A Qualitative Study of Puerto Rican Parent and ChildPerceptions Regarding Eating Patterns. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:608-615. [PMID: 30509552 DOI: 10.1016/j.jneb.2018.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 09/13/2018] [Accepted: 10/08/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To identify barriers that prevent healthy eating practices in Puerto Rican early adolescents (EAs). DESIGN Qualitative data collected via focus groups. A total of 7 focus groups were conducted: 5 with EAs and 2 with parents and caregivers (PCs). SETTING Urban and rural Puerto Rico. PARTICIPANTS Early adolescents aged 12-14years (n = 52) and PCs (n = 17). PHENOMENON OF INTEREST Factors that prevent healthy eating behavior in EAs in Puerto Rico. ANALYSIS Verbatim transcripts from focus group interviews were coded for concept frequency, extension, and content analysis. RESULTS The 3 main factors that influenced participants' eating habits, according to EAs' and PCs' answers, were stores that sold less healthful foods on or near school and the community, parental influence in the development of unhealthy eating habits, and the low cost of unhealthy foods. CONCLUSIONS AND IMPLICATIONS When EAs chose what to eat, primary food choices were based on taste preferences, physical access, economic cost, and influence of PCs, whereas health effects had little consideration. Nutrition education programs have to meet taste preferences and provide eating options that are affordable, accessible, and easy to prepare to achieve healthy food practices among EAs.
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Affiliation(s)
- Robinson Rodríguez-Pérez
- Department of Agricultural Economics and Rural Sociology, College of Agricultural Sciences,University of Puerto Rico, Mayagüez Campus, Mayagüez, Puerto Rico.
| | - Nancy Correa-Matos
- Nutrition and Dietetics Program, College of Natural Sciences, University of Puerto Rico, Río Piedras Campus, Río Piedras, Puerto Rico
| | - Angélica Valdés-Valderrama
- Department of Agricultural Economics and Rural Sociology, College of Agricultural Sciences,University of Puerto Rico, Mayagüez Campus, Mayagüez, Puerto Rico
| | - Luis Alexis Rodríguez-Cruz
- Department of Food Science and Technology, College of Agricultural Sciences, University of Puerto Rico, Mayagüez Campus, Mayagüez, Puerto Rico
| | - María C Rodríguez
- Department of Agricultural Education, College of Agricultural Sciences, University of Puerto Rico, Mayagüez Campus, Mayagüez, Puerto Rico
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Howe TH, Hinojosa J, Sheu CF. Latino-American Mothers’ Perspectives on Feeding Their Young Children: A Qualitative Study. Am J Occup Ther 2019; 73:7303205110p1-7303205110p11. [DOI: 10.5014/ajot.2019.031336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. We explored the cultural beliefs that influence Latino-American mothers’ feeding practices with their young children and the sources they referenced in making food choices for their children.
METHOD. We conducted semistructured interviews with 12 Latino-American mothers focusing on their experiences of feeding their young children. Data analysis, based in grounded theory, consisted of interview transcription, content analysis, coding, and theme development.
RESULTS. We identified four themes summarizing the mothers’ feeding practices: (1) “Grandma knows best,” (2) “I want my child(ren) to be healthy,” (3) “always soup and always rice,” and (4) “mealtime is family time.”
CONCLUSION. Occupational therapy practitioners need to obtain accurate information from families about feeding practices and to understand and interpret those practices in broader cultural contexts to design and implement targeted feeding intervention strategies that avoid stereotyping or misinterpreted information. To promote family-centered, meaningful interventions, practitioners must understand the cultural influences on feeding practices and be sensitive to mothers’ needs.
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Affiliation(s)
- Tsu-Hsin Howe
- Tsu-Hsin Howe, PhD, OTR, FAOTA, is Associate Professor, Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY;
| | - Jim Hinojosa
- Jim Hinojosa, PhD, OT, FAOTA, was Professor Emeritus, Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY
| | - Ching-Fan Sheu
- Ching-Fan Sheu, PhD, is Professor, Institute of Education, National Cheng Kung University, Tainan, Taiwan
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11
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Social and economic influences on infant and child feeding practices in a Marshallese community. Public Health Nutr 2019; 22:1461-1470. [PMID: 30793680 DOI: 10.1017/s1368980018004007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The present study aimed to examine the key influences on infant and child feeding practices among a Marshallese community at each social ecological level. It is the first study to examine the key influences on infant and child feeding practices with Marshallese immigrant women in the USA and helps fill a gap in the previous literature that has included other immigrant women. DESIGN Community-based participatory research design with twenty-seven participants taking part in four qualitative focus groups. SETTING The study took place within the Marshallese community in Arkansas, USA.ParticipantsParticipants included Marshallese women with children aged 1-3 years and/or caregivers. Caregivers were defined as someone other than the parent who cares for children. Caregivers were often older women in the Marshallese community. RESULTS There were five primary themes within multiple levels of the Social Ecological Model. At the intrapersonal level, mothers' and caregivers' autonomy emerged. At the interpersonal level, child-led and familial influences emerged. At the organizational level, health-care provider influences emerged; and at the policy level, the Special Supplemental Nutrition Program for Women, Infants, and Children emerged as the most salient influence. CONCLUSIONS Marshallese immigrant women's infant and child feeding practices are influenced at intrapersonal, interpersonal, organizational and policy levels. Understanding these multidimensional influences is necessary to inform the creation of culturally tailored interventions to reduce health disparities within the Marshallese community.
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Aguayo-Mazzucato C, Diaque P, Hernandez S, Rosas S, Kostic A, Caballero AE. Understanding the growing epidemic of type 2 diabetes in the Hispanic population living in the United States. Diabetes Metab Res Rev 2019; 35:e3097. [PMID: 30445663 PMCID: PMC6953173 DOI: 10.1002/dmrr.3097] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 12/15/2022]
Abstract
The prevalence and incidence of type 2 diabetes (T2D) among the Hispanic population in the United States are higher than the national average. This is partly due to sociocultural factors, such as lower income and decreased access to education and health care, as well as a genetic susceptibility to obesity and higher insulin resistance. This review focuses on understanding the Hispanic population living in the United States from a multidisciplinary approach and underlines the importance of cultural, social, and biological factors in determining the increased risk of T2D in this population. An overview of the acute and chronic complications of T2D upon this population is included, which is of paramount importance to understand the toll that diabetes has upon this population, the health system, and society as a whole. Specific interventions directed to the Hispanic populations are needed to prevent and alleviate some of the burdens of T2D. Different prevention strategies based on medications, lifestyle modifications, and educational programmes are discussed herein. Diabetes self-management education (DSME) is a critical element of care of all people with diabetes and is considered necessary to improve patient outcomes. To be more effective, programmes should take into consideration cultural factors that influence the development and progression of diabetes. These interventions aim to enhance long-term effects by reducing the incidence, morbidity, and mortality of T2D in the Hispanic population of the United States.
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Affiliation(s)
| | - Paula Diaque
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Sonia Hernandez
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
- Surgery Department, University of Chicago, Chicago, Illinois, USA
| | - Silvia Rosas
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Aleksandar Kostic
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
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Kim LP, Mallo N. Maternal Perceptions of Self-Weight and Child Weight May Influence Milk Choice of Participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). J Obes 2019; 2019:3654728. [PMID: 30719345 PMCID: PMC6335787 DOI: 10.1155/2019/3654728] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 12/11/2018] [Indexed: 11/17/2022] Open
Abstract
Objective To examine the association between maternal perceptions of self-weight and child weight status and milk consumption behavior of Hispanic WIC participants. Methods Mixed methods design with phone survey (n=529) and one-on-one interviews (n=35). Demographic characteristics, Chi-square, and thematic analyses were conducted. Results More than half of overweight mothers misperceived their own weight status as well as those of their children. Mothers who perceived their child to be overweight were more likely to make a healthier food choice for their family, namely, choosing reduced-fat milk instead of whole milk. Qualitative interviews revealed a cultural preference for larger size children, and mothers defined healthy weight for their child as a function of (1) the child's ability to be as active as other children their age, regardless of child's BMI, and (2) the pediatrician's opinion of the child's weight status. Conclusions Maternal perception of self-weight and child weight status seems to guide milk choices. Mothers may have some level of recognition of overweight in themselves and their child, thus adopting healthier milk choices. Culturally related perceptions should be considered when designing obesity prevention strategies, and the role of a pediatrician cannot be understated when developing obesity prevention programs for Hispanic families.
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Stang J, Bonilla Z. Factors Affecting Nutrition and Physical Activity Behaviors of Hispanic Families With Young Children: Implications for Obesity Policies and Programs. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2018; 50:959-967. [PMID: 28969899 DOI: 10.1016/j.jneb.2017.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/14/2017] [Accepted: 08/14/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To determine preferred policies and programs to prevent obesity and diabetes as identified by parents and caregivers of 3- to 5-year-old Latino children. DESIGN Constructs from the Social Ecological Model were used to develop 10 focus group and key informant interview questions. SETTING Community venues and schools in St Paul, MN. PARTICIPANTS A total of 64 parents and caregivers and 20 key informants provided comments. INTERVENTION(S) Community-based participatory research methods were used to gather opinions regarding appropriate and preferred methods to prevent obesity and diabetes among Latino youth. Native Spanish-speaking investigators who were members of the community conducted 7 focus groups (60-90 minutes each) and 20 key informant interviews. MAIN OUTCOME MEASURES Themes and subthemes of preferences based on participant comments. ANALYSIS Transcript-based, long-table qualitative analysis. RESULTS Five themes were identified: (1) cultural beliefs and practices are inconsistent with obesity prevention; (2) cost and convenience; (3) positive parenting practices; (4) we want to learn more about being healthy; and (5) gardens, parks, gyms, and school meals. At least 1 theme fell within each of the Social Ecological Model domains. CONCLUSIONS AND IMPLICATIONS Our results suggest that parents of young Hispanic children prefer that obesity and diabetes prevention programs address multiple levels of influence.
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Affiliation(s)
- Jamie Stang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN.
| | - Zobeida Bonilla
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
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Borner KB, Mitchell TB, Gray JS, Davis AM, Pont SJ, Sweeney BR, Hampl S, Dreyer Gillette ML. Factor Structure of a Spanish Translation of an Obesity-Specific Parent-Report Measure of Health-Related Quality of Life. J Pediatr Psychol 2018; 43:1028-1037. [PMID: 29771361 DOI: 10.1093/jpepsy/jsy030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 04/17/2018] [Indexed: 11/12/2022] Open
Abstract
Objective Latino youth are disproportionately affected by pediatric obesity and consequently experience impaired health-related quality of life (HRQOL). Although many caregivers of Latino youth do not speak English fluently, no validated Spanish translations of obesity-specific HRQOL measures exist for this population. Therefore, non-English-speaking Latino parents have typically been excluded from analyses related to HRQOL. This study assesses the factor structure of a Spanish translation of a parent-report measure of obesity-specific HRQOL, Sizing Them Up, in a treatment-seeking sample of children with obesity. Methods Structural equation modeling was used to assess the factor structure of the 6-subscale, 22-item Sizing Them Up measure in 154 parents of treatment-seeking Latino youth (5-18 years of age). Analyses exploring internal consistency and convergent validity were also conducted. Results Acceptable measurement fit was achieved for the six-factor solution. However, the higher-order model assessing Total HRQOL did not reach acceptable levels, as results found that the Positive Social Attributes (PSA) subscale was not representative of Total HRQOL; internal consistency and convergent validity results also supported this finding. Conclusions The current study provides support for the utility of a modified version of Sizing Them Up, excluding the PSA Scale, as a parent-report measure of obesity-specific HRQOL in treatment-seeking Latino youth with obesity.
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Affiliation(s)
- Kelsey B Borner
- Division of Pain Medicine, Children's National Medical Center
| | | | - Jane S Gray
- Texas Child Study Center, Dell Children's Medical Center, University of Texas at Austin
| | - Ann M Davis
- Center for Children's Healthy Lifestyles & Nutrition.,University of Kansas Medical Center
| | - Stephen J Pont
- Texas Department of State Health Services, Office of Science and Population Health.,University of Texas at Austin, Dell Medical School & College of Communications
| | - Brooke R Sweeney
- Center for Children's Healthy Lifestyles & Nutrition.,Department of Pediatrics, Division of General Academic Pediatrics, Children's Mercy Kansas City.,University of Missouri Kansas City School of Medicine
| | - Sarah Hampl
- Center for Children's Healthy Lifestyles & Nutrition.,Department of Pediatrics, Division of General Academic Pediatrics, Children's Mercy Kansas City
| | - Meredith L Dreyer Gillette
- Center for Children's Healthy Lifestyles & Nutrition.,Department of Pediatrics, Division of Developmental and Behavioral Sciences, Children's Mercy Kansas City
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Somali, Latino and Hmong parents' perceptions and approaches about raising healthy-weight children: a community-based participatory research study. Public Health Nutr 2018; 21:1079-1093. [PMID: 28803597 PMCID: PMC9931373 DOI: 10.1017/s1368980017001719] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Immigrants in the USA are confronted with health disparities, including childhood obesity and obesity-related chronic diseases. We aimed to identify perceptions of childhood body weight, approaches to raising healthy children and desires for supportive programmes of Somali, Latino and Hmong (SLM) parents in the Twin Cities, Minnesota, USA. DESIGN Using community-based participatory research, ten focus groups (FG) were conducted with sixty-seven parents (n 28 Somali, three FG; n 19 Latino, four FG; n 20 Hmong, three FG) of 3-12-year-old children in their native language. Demographic information was collected. RESULTS SLM parents perceived that health is not necessarily weight-based; childhood obesity is caused by overeating, eating unhealthy foods and sedentary activities; traditional foods are generally healthy while American foods are generally unhealthy; and healthy children are inherently physically active. Parents identified their goals as feeding children so they would be healthy and happy, helping them be active and safe, and teaching them to cook traditional foods to be self-sufficient and maintain their cultural identity. Parents were challenged by children's unhealthy food and sedentary preferences, their own uncertainties about healthy foods and behaviours, and structural factors. Parents thought interventions could help them with these challenges, including information about healthy foods, age-appropriate portion sizes, safe places to be active and strategies tailored to their cultural norms. CONCLUSIONS SLM parents are trying to raise healthy-weight children based on their understanding of children's health, weight, diet and physical activity, while dealing with social, economic and environmental challenges and trying to maintain cultural identity and traditions.
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Penilla C, Tschann JM, Sanchez-Vaznaugh EV, Flores E, Ozer EJ. Obstacles to preventing obesity in children aged 2 to 5 years: Latino mothers' and fathers' experiences and perceptions of their urban environments. Int J Behav Nutr Phys Act 2017; 14:148. [PMID: 29096651 PMCID: PMC5667480 DOI: 10.1186/s12966-017-0605-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 10/20/2017] [Indexed: 11/30/2022] Open
Abstract
Background The prevalence of obesity among Latino children is alarmingly high, when compared to non-Latino White children. Low-income Latino parents living in urban areas, even if they are well-educated, face obstacles that shape familial health behaviors. This study used qualitative methods to explore parents’ experiences in providing meals and opportunities to play to their children aged 2 to 5 years. In contrast to most prior studies, this study examined perceptions of familial behaviors among both mothers and fathers. Methods An ecological framework for exploring the associations of parental feeding behaviors and children’s weight informed this study. An interview guide was developed to explore parents’ experiences and perceptions about children’s eating and physical activity and administered to six focus groups in a community-based organization in the Mission District of San Francisco. Transcripts were coded and analyzed. Twenty seven mothers and 22 fathers of Latino children ages 2 to 5 participated. Results Mothers, fathers, and couples reported that employment, day care, neighborhood environments and community relationships were experienced, and perceived as obstacles to promoting health behavior among their children, including drinking water instead of soda and participating in organized playtime with other preschool-age children. Conclusions Results from this study suggest that the parents’ demographic, social and community characteristics influence what and how they feed their children, as well as how often and the types of opportunities they provide for physical activity, providing further evidence that an ecological framework is useful for guiding research with both mothers and fathers. Mothers and fathers identified numerous community and society-level constraints in their urban environments. The results point to the importance of standardized work hours, resources for day care providers, clean and safe streets and parks, strong community relationships, and reduced access to sugar-sweetened beverages in preventing the development of obesity in preschool-age Latino children.
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Affiliation(s)
- Carlos Penilla
- School of Public Health, University of California, Berkeley, 50 University Hall, Berkeley, CA, 94720-7360, USA.
| | - Jeanne M Tschann
- Department of Psychiatry, University of California, San Francisco, Box 0848, San Francisco, CA, 94143-0848, USA
| | - Emma V Sanchez-Vaznaugh
- Health Education Department, San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Elena Flores
- Department of Counseling, University of San Francisco, 2130 Fulton St., San Francisco, CA, 94118, USA
| | - Emily J Ozer
- School of Public Health, University of California, Berkeley, 50 University Hall, Berkeley, CA, 94720-7360, USA
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Preferred Child Body Size and Parental Underestimation of Child Weight in Mexican-American Families. Matern Child Health J 2017; 20:1842-8. [PMID: 27016351 DOI: 10.1007/s10995-016-1987-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective To determine whether parents who prefer a heavier child would underestimate their child's weight more than those who prefer a leaner child. Methods Participants were Mexican-American families (312 mothers, 173 fathers, and 312 children ages 8-10) who were interviewed and had height and weight measurements. Parents reported their preferred child body size and their perceptions of their child's weight. Parents' underestimation of their child's weight was calculated as the standardized difference between parent's perception of their child's weight and the child's body mass index (BMI) z-score. Demographic factors and parental BMI were also assessed. Results Although 50 % of children were overweight or obese, only 11 % of mothers and 10 % of fathers perceived their children as being somewhat or very overweight. Multiple regressions controlling for covariates (parental BMI and child age) showed that parents who preferred a heavier child body size underestimated their children's weight more, compared to those who preferred a leaner child (β for mothers = .13, p < .03; β for fathers = .17, p < .03). Conclusions for Practice Parents who preferred a heavier child body size underestimated their child's weight to a greater degree than parents who preferred a leaner child. Attempts by pediatricians to correct parents' misperceptions about child weight may damage rapport and ultimately fail if the misperception is actually a reflection of parents' preferences, which may not be readily amenable to change. Future research should address optimal methods of communication about child overweight which take into account parent preferences.
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Lindsay AC, Wallington SF, Greaney ML, Hasselman MH, Machado MMT, Mezzavilla RS, Detro BM. Sociocultural and Environmental Influences on Brazilian Immigrant Mothers' Beliefs and Practices Related to Child Feeding and Weight Status. Matern Child Health J 2017; 21:1085-1094. [PMID: 28032238 DOI: 10.1007/s10995-016-2207-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Length of residence in the United States (US), changes in dietary and physical activity behaviors, and economic and social barriers contribute to high childhood obesity rates among children from immigrant families in the US. Brazilians comprise a fast-growing immigrant population group in the US, yet little research has focused on health issues affecting Brazilian children in immigrant families. Understanding sociocultural and environmental influences on parents' beliefs and practices related to child feeding and weight status is essential to altering obesity trends in this group. Methods Qualitative study consisting of five focus groups with a convenience sample of 29 Brazilian immigrant mothers. Results Analyses revealed that the sociocultural and environment transitions faced by Brazilian immigrant mothers' influence their beliefs and practices related to child feeding and weight status. Additionally, acculturation emerged as a factor affecting mothers' feeding practices and their children's eating habits, with mothers preferring Brazilian food environments and that their children preferring American food environments. Mothers viewed themselves as being responsible for promoting and maintaining their children's healthy eating and feeding behaviors, but changes in their social and cultural environments due to immigration and the pressures and demands of raising a family in a new country make this difficult. Conclusions Health promotion interventions to improve healthful eating and feeding practices of Brazilian children in immigrant families must account for social and cultural changes and daily life demands due to immigration as well as potential variation in the levels of acculturation between mothers and their children.
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Affiliation(s)
- Ana Cristina Lindsay
- Exercise and Health Sciences Department, Harvard School of Public Health, College of Nursing and Health Sciences, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, 02125, USA.
| | - Sherrie F Wallington
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Mary L Greaney
- Health Studies and Department of Kinesiology, University of Rhode Island, Kingston, RI, USA
| | - Maria H Hasselman
- Department of Social Nutrition, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Marcia M T Machado
- Department of Community Health, School of Medicine, Federal University of Ceara, Fortaleza, Brazil
| | - Raquel S Mezzavilla
- Department of Social Nutrition, Rio de Janeiro State University, Rio de Janeiro, Brazil
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Lora KR, Cheney M, Branscum P. Hispanic Mothers' Views of the Fathers' Role in Promoting Healthy Behaviors at Home: Focus Group Findings. J Acad Nutr Diet 2017; 117:914-922. [PMID: 28238895 DOI: 10.1016/j.jand.2017.01.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 01/04/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Overweight and obesity prevention interventions rarely take into account the unique role of fathers in promoting healthy home environments. OBJECTIVE To use qualitative methodology to examine the views of Hispanic mothers of children aged 2 to 5 years regarding fathers' roles in promoting healthy behaviors at home. DESIGN Nine focus groups were conducted in Spanish with Hispanic mothers of preschool-aged children (N=55) from October to December 2015. PARTICIPANTS/SETTINGS Hispanic mothers were recruited from churches, community agencies, and preschools located in five Zip codes in the southwest part of Oklahoma City, OK. ANALYSIS Questions examined the views of Hispanic mothers regarding fathers' roles in promoting healthy behaviors at home. Focus groups were audiorecorded, transcribed in Spanish, translated into English, and coded and analyzed for themes by two coders using NVivo version 10 software. RESULTS Four themes were identified: fathers' disagreement with mothers about food preferences and preparation, fathers' support for child's healthy eating, fathers' support for child's physical activity, and fathers' lack of support for a healthy home food environment. Fathers' traditional expectations about the type of foods and portion sizes adults should eat conflicted with mothers' meal preparations. Mothers reported that, although they favored eating low-calorie meals, the meals fathers preferred eating were high-calorie meals (eg, quesadillas). In general, fathers supported healthy eating and physical activity behaviors for their children. Supportive behaviors for children included preparing healthy meals, using healthier cooking methods, grocery shopping with their children for healthy foods, and asking the child to participate in household chores and/or play sports. Fathers' unsupportive behaviors included bringing high-calorie foods, such as pizza, and sugary drinks into the home, using sweets and savory foods for emotion regulation, and displaying an indulgent parental feeding style. CONCLUSIONS Mothers' views of fathers' perceived roles in child eating and physical activity, and maintaining a healthy eating environment, have important implications for the success of promoting healthy behaviors in the homes of Hispanic families.
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Hochdorn A, Faleiros VP, Camargo BV, Bousfield AB, Wachelke JF, Quintão IP, Azzolina D, Gregori D. Obese children are thin in parents' eyes: A psychologically, socially, or culturally driven bias? J Health Psychol 2016; 23:114-126. [PMID: 27821680 DOI: 10.1177/1359105316676328] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Although obesity presents a serious health problem in children, parents often underestimate their children's overweight and obesity status. Therefore, scientific literature was systematically screened through PubMed and PsycINFO to demonstrate the psychological, social, and cultural processes that underlie this evaluation bias. A total of 37 papers that focused on research conducted in different geopolitical contexts were taken into account. Furthermore, a lexicometric analysis of the papers' conclusions was performed. The findings showed that education plays a key role in promoting parents' awareness and their realistic recognition of their children's weight. Accordingly, adequate educational support for parents should be implemented in all healthcare policies addressing childhood obesity.
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Montoya C, Boursaw B, Tigges B, Lobo ML. Mirror, Mirror on the Wall: Children's Preferences and Self-Perceptions of Weight in a Rural Hispanic Community. J Pediatr Health Care 2016; 30:528-534. [PMID: 26810855 DOI: 10.1016/j.pedhc.2015.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 11/23/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Although studies have documented parents' misperceptions regarding their children's weight, studies examining preadolescent children's self-perceptions of weight-in particular, Hispanic children's self-perceptions of weight-are limited. METHOD A convenience sample of 424 children from a rural community, aged 8 to 11 years and in grades 3 through 5, participated in this cross-sectional, descriptive, nonexperimental study. Using the Children's Body Image Scale, the children were asked to select a figure representing their actual body perception and a figure representing their ideal body perception. The children were weighed and measured, body mass index (BMI) was calculated, and each child was assigned to one of the Centers for Disease Control and Prevention weight categories: underweight, normal or healthy weight, overweight, or obese. RESULTS Only BMI category was found to be significantly associated with accurate perception, χ2(3) = 201.4, p < .001, with only 9% of overweight or obese children selecting figures representing their actual BMI category. Actual BMI category, χ2(3) = 8.8, p = .032, and grade level, χ2(2) = 6.7, p = .036, had a significant association with selection of an underweight ideal. Overall, 32% of children selected an underweight figure as ideal. DISCUSSION Prepubertal children who are either overweight or obese do not accurately perceive their weight status. Rather than focusing solely on weight reduction programs, emphasis should be placed on promoting healthy lifestyles and choices.
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Gauthier KI, Gance-Cleveland B. Hispanic parents' perceptions of their preschool children's weight status. J SPEC PEDIATR NURS 2016; 21:84-93. [PMID: 27079822 DOI: 10.1111/jspn.12143] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 02/18/2016] [Accepted: 03/04/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to examine the accuracy of Hispanic parents' perceptions of their preschool children's weight status. DESIGN AND METHODS A cross-sectional descriptive design with Hispanic parent-child dyads (n = 83) from a Head Start setting was used to compare parents' perceptions of their children's weight status with their 2- to 5-year-old children's body mass index (BMI) and weight categories. Methods included a word choice from five response options, and varying body size silhouettes presented in a linear fashion and a random circular pattern. Parents' perceptions were compared with the children's BMI, and in relationship to parents' demographic characteristics and BMI. RESULTS Approximately half of parents underestimated their child's weight status, and overweight/obese parents tended to underestimate their overweight/obese children's weight status. PRACTICE IMPLICATIONS Eliciting parent perception of their child's weight is one way providers can engage in obesity prevention dialogue.
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Affiliation(s)
- Kristine I Gauthier
- Assistant Professor, University of Colorado, Anschutz Medical Campus, College of Nursing
| | - Bonnie Gance-Cleveland
- Professor, University of Colorado, Anschutz Medical Campus, College of Nursing, Aurora, Colorado, USA
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Baker EH, Altman CE. Maternal ratings of child health and child obesity, variations by mother's race/ethnicity and nativity. Matern Child Health J 2016; 19:1000-9. [PMID: 25108502 DOI: 10.1007/s10995-014-1597-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We examined whether indicators of child health, focusing on obesity, are associated with maternal ratings of child health (MRCH) and its variation by mother's ethnicity/nativity, focusing on Hispanics. The early childhood longitudinal study, kindergarten cohort kindergarten-eighth grade waves (n = 48,814) and nested general linear mixed modeling are used to examine excellent MRCH. The only indicator of child health that varies by mother's ethnicity/nativity for MRCH is child obesity. Child obesity did not influence MRCH for foreign-born Hispanic mothers, especially among less acculturated mothers, though significant differences among immigrants by acculturation were not found. However, among native-born white, black, and Hispanic mothers child obesity was associated with a lower likelihood of excellent MRCH even after controls for socioeconomic characteristics, family characteristics, and other indicators of child health are included. MRCH reflect not only child's actual health, but also the mother's perception of what contributes to poor child health. Our findings suggest that less acculturated foreign-born Hispanic mothers are less likely to associate child obesity with poor child health. Cultural orientations that prefer heavier children or are unlikely to associate child obesity with poor child health may contribute to the higher levels of obesity found among their children.
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Affiliation(s)
- Elizabeth H Baker
- Department of Sociology, University of Alabama at Birmingham, 460F Heritage Hall, 1401 University Blvd, Birmingham, AL, 35294-1152, USA,
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Hernandez DC, Reesor L, Machuca I, Chishty M, Alonso Y. Low-Income Immigrant Hispanic Mothers' Concerns and Perceptions of Their Young Child's Weight. Public Health Nurs 2016; 33:412-20. [PMID: 26854020 DOI: 10.1111/phn.12252] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To describe how low-income Hispanic immigrant mothers' concerns and perceptions of her child's health, along with her concerns for herself becoming overweight, relate to her (a) concerns that her child will become overweight and (b) underestimation of her child's weight status. DESIGN AND SAMPLE Cross-sectional survey and direct body composition assessments were collected among 96 low-income Hispanic mothers and their young children from Houston-area community centers. MEASURES Data were collected on maternal concerns and perceptions of child's weight and health, concerns about her own weight, demographic characteristics, and measured child's height and weight. RESULTS Fifty-four percent of mothers with an overweight/obese child perceived their child was "about the right weight." Mothers concerned with becoming overweight themselves had 3 times higher odds of being concerned that her child would become overweight (OR = 3.01, p < .01). Mothers who perceived their child as less healthy had approximately 2 times higher odds of underestimating their child's weight (OR = 1.86, p < .01). CONCLUSIONS Short screeners that focus on maternal concerns about herself and her child becoming overweight, along with perceptions of her child's health and weight status, may assist nurses in effectively tailoring their health message at point of care.
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Affiliation(s)
- Daphne C Hernandez
- Department of Health and Human Performance, University of Houston, Houston, Texas.
| | - Layton Reesor
- Department of Health and Human Performance, University of Houston, Houston, Texas
| | - Iris Machuca
- Department of Health and Human Performance, University of Houston, Houston, Texas
| | - Misha Chishty
- Department of Health and Human Performance, University of Houston, Houston, Texas
| | - Yanely Alonso
- Department of Health and Human Performance, University of Houston, Houston, Texas
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How parents process child health and nutrition information: A grounded theory model. Appetite 2015; 97:138-45. [PMID: 26626822 DOI: 10.1016/j.appet.2015.11.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 10/23/2015] [Accepted: 11/21/2015] [Indexed: 01/21/2023]
Abstract
The aim of the present study was to investigate low-income parents' experiences receiving, making meaning of, and applying sociocultural messages about childhood health and nutrition. Semi-structured interviews were conducted with parents from 16 low-income Early Head Start families. Verbatim interview transcripts, observations, field notes, documentary evidence, and follow-up participant checks were used during grounded theory analysis of the data. Data yielded a potential theoretical model of parental movement toward action involving (a) the culture and context influencing parents, (b) parents' sources of social and cultural messages, (c) parental values and engagement, (d) parental motivation for action, (e) intervening conditions impacting motivation and application, and (f) parent action taken on the individual and social levels. Parent characteristics greatly impacted the ways in which parents understood and applied health and nutrition information. Among other implications, it is recommended that educators and providers focus on a parent's beliefs, values, and cultural preferences regarding food and health behaviors as well as his/her personal/family definition of "health" when framing recommendations and developing interventions.
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Rapid infant weight gain and early childhood obesity in low-income Latinos and non-Latinos. Public Health Nutr 2015; 19:1777-84. [DOI: 10.1017/s1368980015003201] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AbstractObjectiveTo examine the growth of infants and toddlers in a population that is both under-represented in the literature and at high risk for childhood obesity.DesignWeight and height measurements were extracted from all visits for a sample of 0–4-year-old, low-income, Latino and non-Latino patients of an urban, academic general paediatric practice. Early growth was characterized as change in weight-for-length Z-score (WLZ) from birth to 3 years. The outcome of interest was BMI Z-score (BMIZ) at age 3 years. Mixed-effects models and multivariate linear regression were used to analyse the association between infant growth and early childhood obesity.SettingBaltimore, MD, USA.SubjectsLatino (n 210) and non-Latino (n 253) children, born in 2003–2004.ResultsAn increase in WLZ from birth to 2 years was observed for this cohort as well as a high incidence of overweight and obesity. WLZ at birth and change in WLZ from birth to 2 years were both significantly and positively associated with increases in BMIZ at 3 years of age. The effect of the change in WLZ was twofold higher than the effect of WLZ at birth.ConclusionsAn increase in WLZ during the first 2 years of life increased the risk of early childhood obesity. Latino children had a higher incidence of early childhood obesity than non-Latino children in this low-income sample.
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Gauthier KI, Gance-Cleveland B. Hispanic Parental Perceptions of Child Weight in Preschool-Aged Children: An Integrated Review. Child Obes 2015. [PMID: 26218438 DOI: 10.1089/chi.2014.0152] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Obesity continues to disproportionately affect ethnic minorities. Parents play an integral role in early childhood, and parental perceptions regarding their child's weight are key to obesity prevention. Cultural differences contribute to parental perceptions, and increased understandings of these characteristics provide a basis to address obesity in high-risk populations at an earlier age. The aim of this integrative review was to analyze extant literature to identify Hispanic parental perceptions of their preschool-aged child's weight status. METHODS An integrative review of studies measuring Hispanic parental perception was conducted. Computerized searches were completed using MEDLINE, PubMed, CINHAL, Eric, and PsychINFO. Articles were included if they were English, included children 2-5 years of age, included a Hispanic population, and evaluated parental perception of their child's weight status. A total of 14 articles (n=8 qualitative; n=6 quantitative) met criteria and were included in the review. Cooper's integrative review methodology was used, and articles were evaluated for quality using Polit and Beck's evidence hierarchy leveling system. RESULTS The results revealed six themes of Hispanic parental perceptions relative to their preschool-aged child's weight: parental perception of body weight; relationship between child weight and health; causes and consequences of overweight; familial roles and influences on child weight; prevention of overweight; and cultural influences within the United States. CONCLUSIONS This review highlights the importance of developing sociocultural approaches to addressing childhood obesity within the Hispanic population. Additional research is needed to incorporate what is known about Hispanic parental perceptions to positively influence behavior change during early childhood.
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Affiliation(s)
- Kristine I Gauthier
- College of Nursing, University of Colorado Anschutz Medical Campus , Aurora, CO
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Davis RE, Cole SM, Reyes LI, McKenney-Shubert SJ, Peterson KE. "It Hurts a Latina When They Tell Us Anything About Our Children": Implications of Mexican-Origin Mothers' Maternal Identities, Aspirations, and Attitudes About Cultural Transmission for Childhood Obesity Prevention. Child Obes 2015; 11:608-15. [PMID: 26186285 PMCID: PMC4808285 DOI: 10.1089/chi.2015.0011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND This qualitative study explored values, attitudes, and beliefs held by Mexican-origin mothers of preschool-aged children to enhance understanding of cultural influences on behaviors associated with childhood obesity risk. METHODS During face-to-face interviews, 39 Mexican-origin mothers of preschool-aged children discussed their hopes for their children, their image of the perfect mother, Mexican and American foods, why they taught their children about these foods, and their opinions about television (TV) viewing language. RESULTS Participants wanted their children to become successful, "good" people, which necessitated doing well in school. Mothers also wanted their children to know them, which required understanding the mothers' Mexican backgrounds. Mothers wanted their children to maintain Mexican values and identities. Some mothers viewed American culture as harmful. Many participants prepared their child for going to Mexico by exposing them to Mexican culture and foods. Some mothers fed their children American foods to prepare them for school. Perceptions of American foods generally reflected stereotypical unhealthy foods. TV helped teach children Spanish and English. Being a good mother was core to participants' identities; thus, hearing about child overweight made some mothers feel like failures. CONCLUSIONS Health promotion programs may be more salient to mothers if they: underscore how a healthy weight can help children in school; teach mothers to prepare healthy American foods that their children will encounter in kindergarten; assist mothers in teaching their children about Mexico; and present information about childhood obesity in ways that reinforce what mothers are doing well, enhance mothers' self-efficacy, and allay feelings of failure.
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Affiliation(s)
- Rachel E. Davis
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Suzanne M. Cole
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Ligia I. Reyes
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | | | - Karen E. Peterson
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI
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Natale R, Uhlhorn SB, Lopez-Mitnik G, Camejo S, Englebert N, Delamater AM, Messiah SE. Caregiver’s Country of Birth Is a Significant Determinant of Accurate Perception of Preschool-Age Children’s Weight. HEALTH EDUCATION & BEHAVIOR 2015; 43:191-200. [DOI: 10.1177/1090198115599395] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. One in four preschool-age children in the United States are currently overweight or obese. Previous studies have shown that caregivers of this age group often have difficulty accurately recognizing their child’s weight status. The purpose of this study was to examine factors associated with accurate/inaccurate perception of child body mass index (BMI) among a multicultural sample of caregivers who were predominantly low-income and foreign-born. Methods. A total of 980 caregivers (72% Hispanic, 71% born outside of the United States) of preschool-age children ( N = 1,105) were asked if their child was normal weight, overweight, or obese. Answers were compared to actual child BMI percentile category via chi-square analysis. Logistic regression analysis was performed to assess predictors of accurate perception of child BMI percentile category. Results. More than one third of preschoolers were either overweight (18.4%) or obese (16.5%). The majority (92%) of caregivers of an overweight/obese child inaccurately perceived that their child was in a normal BMI category. Overall, foreign-born caregivers were significantly less likely to accurately perceive their child’s BMI percentile category versus U.S.-born caregivers (odds ratio [OR] = 0.65, 95% confidence interval [CI] = 0.48-0.88). Specifically, those born in South America (OR = 0.59, 95% CI = 0.36-0.98), Central America/Mexico (OR = 0.59, 95% CI = 0.41-0.85), and Caribbean Hispanic nations (OR = 0.54, 95% CI = 0.35-0.83) were significantly less likely to accurately perceive their child’s BMI category versus U.S.-born caregivers. Conclusions. The results of this study suggest that foreign-born caregivers of U.S. preschool-age overweight/obese children in particular do not accurately perceive their child’s BMI status. Health care professionals serving foreign-born caregivers may consider additional culturally appropriate healthy weight counseling for these families.
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Affiliation(s)
- Ruby Natale
- University of Miami Miller School of Medicine, Miami, FL, USA
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Wijtzes AI, Jansen W, Jaddoe VWV, Franco OH, Hofman A, van Lenthe FJ, Raat H. Social Inequalities in Young Children's Meal Skipping Behaviors: The Generation R Study. PLoS One 2015. [PMID: 26225757 PMCID: PMC4520523 DOI: 10.1371/journal.pone.0134487] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Regular meal consumption is considered an important aspect of a healthy diet. While ample evidence shows social inequalities in breakfast skipping among adolescents, little is known about social inequalities in breakfast skipping and skipping of other meals among young school-aged children. Such information is crucial in targeting interventions aimed to promote a healthy diet in children. Methods We examined data from 4704 ethnically diverse children participating in the Generation R Study, a population-based prospective cohort study in Rotterdam, the Netherlands. Information on family socioeconomic position (SEP), ethnic background, and meal skipping behaviors was assessed by parent-reported questionnaire when the child was 6 years old. Multiple logistic regression analyses were performed to assess the associations of family SEP (educational level, household income, employment status, family composition) and ethnic background with meal skipping behaviors, using high SEP children and native Dutch children as reference groups. Results Meal skipping prevalence ranged from 3% (dinner) to 11% (lunch). The prevalence of meal skipping was higher among low SEP children and ethnic minority children. Maternal educational level was independently associated with breakfast skipping ([low maternal educational level] OR: 2.21; 95% CI: 1.24,3.94). Paternal educational level was independently associated with lunch skipping ([low paternal educational level] OR: 1.53; 95% CI: 1.06,2.20) and dinner skipping ([mid-high paternal educational level] OR: 0.39; 95% CI: 0.20,0.76). Household income was independently associated with breakfast skipping ([low income] OR: 2.43, 95% CI: 1.40,4.22) and dinner skipping ([low income] OR: 2.44; 95% CI: 1.22,4.91). In general, ethnic minority children were more likely to skip breakfast, lunch, and dinner compared with native Dutch children. Adjustment for family SEP attenuated the associations of ethnic minority background with meal skipping behaviors considerably. Conclusion Low SEP children and ethnic minority children are at an increased risk of breakfast, lunch, and dinner skipping compared with high SEP children and native Dutch children, respectively. Given these inequalities, interventions aimed to promote regular meal consumption, breakfast consumption in particular, should target children from low socioeconomic groups and ethnic minority children. More qualitative research to investigate the pathways underlying social inequalities in children’s meal skipping behaviors is warranted.
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Affiliation(s)
- Anne I. Wijtzes
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
- * E-mail:
| | - Wilma Jansen
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Social Development, City of Rotterdam, Rotterdam, The Netherlands
| | - Vincent W. V. Jaddoe
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Oscar H. Franco
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Albert Hofman
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Frank J. van Lenthe
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
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Gray VB, Byrd SH, Fountain BJ, Rader NE, Frugé AD. Childhood nutrition in the Mississippi Delta: challenges and opportunities. Health Promot Int 2015; 31:857-868. [PMID: 26188336 DOI: 10.1093/heapro/dav072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Childhood obesity in the USA has more than tripled in the last three decades, and the prevalence is higher in the Mississippi Delta. Insight into the social, cultural and environmental factors that influence inequity can inform efforts to mediate health disparities. Focus groups (n = 12) among parents/guardians of elementary school children (n = 44) and teachers (n = 59) in the Mississippi Delta were used to investigate barriers and facilitators of healthy eating. Transcriptions were analyzed for themes. A strong preference for junk food among children and the pervasiveness of junk foods in schools and communities were cited as barriers to healthy eating. Potential facilitators of healthy eating included desire to avoid chronic disease, effort to limit junk food consumption and school support. Despite support for efforts to improve nutrition in the Delta, participants voiced a sense of inevitability related to children's consumption of unhealthy foods. This study suggests that parents and teachers express concern related to eating habits of children, yet they experience barriers to healthy eating which contribute to a sense of disempowerment. Improving health in the Mississippi Delta requires comprehensive strategies that offer its citizens a sense of agency.
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Affiliation(s)
- Virginia B Gray
- Department of Family and Consumer Sciences, California State University Long Beach, Long Beach, CA, USA
| | - Sylvia H Byrd
- Department of Food Science, Nutrition, and Health Promotion, Mississippi State University, Mississippi State, MS, USA
| | - Brent J Fountain
- Department of Food Science, Nutrition, and Health Promotion, Mississippi State University, Mississippi State, MS, USA
| | - Nicole E Rader
- Department of Sociology, Mississippi State University, Mississippi State, MS, USA
| | - Andrew D Frugé
- Department of Food Science, Nutrition, and Health Promotion, Mississippi State University, Mississippi State, MS, USA
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Falbe J, Cadiz AA, Tantoco NK, Thompson HR, Madsen KA. Active and Healthy Families: A Randomized Controlled Trial of a Culturally Tailored Obesity Intervention for Latino Children. Acad Pediatr 2015; 15:386-95. [PMID: 25937516 DOI: 10.1016/j.acap.2015.02.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 02/01/2015] [Accepted: 02/09/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE There is a critical need for culturally relevant interventions to address obesity among Latino children, who have a greater risk of obesity and diabetes than non-Hispanic white children. To test the impact of a family-centered, culturally tailored obesity intervention delivered through group medical appointments on body mass index (BMI) and other measures of cardiovascular risk among Latino children. METHODS In a randomized controlled trial, 55 parent-child dyads were assigned to Active and Healthy Families (AHF) or a usual care wait-list control condition. Dyads were eligible if they spoke Spanish and if the child received care in a federally qualified health center, was aged 5 to 12 years, had a BMI in the 85th percentile or higher, and had not participated in AHF. The 10-week AHF intervention included biweekly group sessions delivered by a registered dietitian, physician, and promotora triad. Sessions covered topics such as parenting, screen time, healthy beverages, physical activity, and stress due to immigration. RESULTS Child BMI (kg/m(2)) decreased (-0.50) in the AHF group and increased (+0.32) in the control group, yielding an adjusted difference in change of -0.78 (95% confidence interval [CI] -1.28, -0.27). Children assigned to AHF also exhibited relative improvements over controls in BMI z score (-0.10; 95% CI -0.19, -0.02) and triglycerides (-26.8 mg/dL; 95% CI -50.1, -3.6), but no significant between-group differences were observed for blood pressure or other fasting blood measures. CONCLUSIONS AHF resulted in reductions in child BMI, BMI z score, and triglycerides. AHF, which was designed for low-income Latino families, has potential to reduce health disparities, but future studies are needed to determine long-term impact.
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Affiliation(s)
- Jennifer Falbe
- Division of Community Health and Human Development, School of Public Health, University of California, Berkeley, Calif.
| | - Annabelle A Cadiz
- Contra Costa Public Health, Contra Costa Health Services, Martinez, Calif
| | - Nicole K Tantoco
- Division of Community Health and Human Development, School of Public Health, University of California, Berkeley, Calif
| | - Hannah R Thompson
- Division of Community Health and Human Development, School of Public Health, University of California, Berkeley, Calif
| | - Kristine A Madsen
- Division of Community Health and Human Development, School of Public Health, University of California, Berkeley, Calif
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Tovar A, Risica P, Mena N, Lawson E, Ankoma A, Gans KM. An assessment of nutrition practices and attitudes in family child-care homes: implications for policy implementation. Prev Chronic Dis 2015; 12:E88. [PMID: 26043303 PMCID: PMC4456854 DOI: 10.5888/pcd12.140587] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction Family child-care homes (FCCHs) provide care and nutrition for millions of US children, including 28% in Rhode Island. New proposed regulations for FCCHs in Rhode Island require competencies and knowledge in nutrition. We explored nutrition-related practices and attitudes of FCCH providers in Rhode Island and assessed whether these differed by provider ethnicity or socioeconomic status of the enrolled children. Methods Of 536 licensed FCCHs in Rhode Island, 105 randomly selected FCCH providers completed a survey about provider nutrition attitudes and practices, demographics of providers, and characteristics of the FCCH, including participation in the federal Child and Adult Care Food Program (CACFP). No differences between CACFP and non-CACFP participants were found; responses were compared by provider ethnicity using χ2 tests and multivariate models. Results Nearly 70% of FCCHs reported receiving nutrition training only 0 to 3 times during the past 3 years; however, more than 60% found these trainings to be very helpful. More Hispanic than non-Hispanic providers strongly agreed to sitting with children during meals, encouraging children to finish their plate, and being involved with parents on the topics of healthy eating and weight. These differences persisted in multivariate models. Discussion Although some positive practices are in place in Rhode Island FCCHs, there is room for improvement. State licensing requirements provide a foundation for achieving better nutrition environments in FCCHs, but successful implementation is key to translating policies into real changes. FCCH providers need culturally and linguistically appropriate nutrition-related training.
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Affiliation(s)
- Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, Rhode Island 02881.
| | - Patricia Risica
- Institute for Community Health Promotion, Brown University School of Public Health, Providence, Rhode Island, and Human Development and Family Studies Department and Center for Health, Intervention, and Prevention, University of Connecticut, Storrs, Connecticut
| | - Noereem Mena
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, Rhode Island
| | - Eliza Lawson
- Chronic Disease Prevention and Control Initiative, Rhode Island Department of Health, Providence, Rhode Island
| | - Angela Ankoma
- Office of Minority Health, Rhode Island Department of Health, Providence, Rhode Island
| | - Kim M Gans
- Institute for Community Health Promotion, Brown University School of Public Health, Providence, Rhode Island, and Human Development and Family Studies Department and Center for Health, Intervention, and Prevention, University of Connecticut, Storrs, Connecticut
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Foster BA, Farragher J, Parker P, Hale DE. A positive deviance approach to early childhood obesity: cross-sectional characterization of positive outliers. Child Obes 2015; 11:281-8. [PMID: 25885174 PMCID: PMC4484711 DOI: 10.1089/chi.2014.0098] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Positive deviance methodology has been applied in the developing world to address childhood malnutrition and has potential for application to childhood obesity in the United States. We hypothesized that among children at high-risk for obesity, evaluating normal weight children will enable identification of positive outlier behaviors and practices. METHODS In a community at high-risk for obesity, a cross-sectional mixed-methods analysis was done of normal weight, overweight, and obese children, classified by BMI percentile. Parents were interviewed using a semistructured format in regard to their children's general health, feeding and activity practices, and perceptions of weight. RESULTS Interviews were conducted in 40 homes in the lower Rio Grande Valley in Texas with a largely Hispanic (87.5%) population. Demographics, including income, education, and food assistance use, did not vary between groups. Nearly all (93.8%) parents of normal weight children perceived their child to be lower than the median weight. Group differences were observed for reported juice and yogurt consumption. Differences in both emotional feeding behaviors and parents' internalization of reasons for healthy habits were identified as different between groups. CONCLUSIONS We found subtle variations in reported feeding and activity practices by weight status among healthy children in a population at high risk for obesity. The behaviors and attitudes described were consistent with previous literature; however, the local strategies associated with a healthy weight are novel, potentially providing a basis for a specific intervention in this population.
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Affiliation(s)
- Byron Alexander Foster
- Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Jill Farragher
- Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Paige Parker
- Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Daniel E. Hale
- Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, TX
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Tschann JM, Martinez SM, Penilla C, Gregorich SE, Pasch LA, de Groat CL, Flores E, Deardorff J, Greenspan LC, Butte NF. Parental feeding practices and child weight status in Mexican American families: a longitudinal analysis. Int J Behav Nutr Phys Act 2015; 12:66. [PMID: 25986057 PMCID: PMC4453102 DOI: 10.1186/s12966-015-0224-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 05/06/2015] [Indexed: 11/22/2022] Open
Abstract
Background Parental feeding practices are thought to influence children’s weight status, through children’s eating behavior and nutritional intake. However, because most studies have been cross-sectional, the direction of influence is unclear. Moreover, although obesity rates are high among Latino children, few studies of parental feeding practices have focused on this population. Methods This 2-year longitudinal study examined mutual influences over time between parental feeding practices and children’s weight status, in Mexican American families with children 18 years old at baseline. Mothers (n = 322) and fathers (n = 182) reported on their feeding practices at baseline, 1-year follow-up, and 2-year follow-up. Weight status, defined by waist-height ratio (WHtR) and body mass index (BMI), was ascertained at all assessments. Cross-lagged panel models were used to examine the mutual influences of parental feeding practices and child weight status over time, controlling for covariates. Results Both mothers’ and fathers’ restriction of food predicted higher subsequent child weight status at Year 1, and for fathers this effect was also found at Year 2. Mothers’ and fathers’ pressure to eat predicted lower weight status among boys, but not girls, at Year 1. Child weight status also predicted some parental feeding practices: boys’ heavier weight predicted mothers’ less pressure to eat at Year 1, less use of food to control behavior at Year 2, and greater restriction at Year 2; and girls’ heavier weight at Year 1 predicted fathers’ less pressure to eat and less positive involvement in child eating at Year 2. Conclusions This study provides longitudinal evidence that some parental feeding practices influence Mexican American children’s weight status, and that children’s weight status also influences some parental feeding practices. Feeding practices of both mothers and fathers were related to children’s weight status, underscoring the importance of including fathers in research on parental feeding practices and child obesity. Electronic supplementary material The online version of this article (doi:10.1186/s12966-015-0224-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jeanne M Tschann
- Department of Psychiatry, University of California at San Francisco, 94143-0848, San Francisco, CA, USA.
| | - Suzanna M Martinez
- Department of Pediatrics, University of California at San Francisco, 94143-0503, San Francisco, CA, USA.
| | - Carlos Penilla
- School of Public Health, University of California at Berkeley, 50 University Hall, 94720-7360, Berkeley, CA, USA.
| | - Steven E Gregorich
- Department of Medicine, University of California at San Francisco, 94143-0856, San Francisco, CA, USA.
| | - Lauri A Pasch
- Department of Psychiatry, University of California at San Francisco, 94143-0848, San Francisco, CA, USA.
| | - Cynthia L de Groat
- Department of Psychiatry, University of California at San Francisco, 94143-0848, San Francisco, CA, USA.
| | - Elena Flores
- Counseling Psychology Department, School of Education, University of San Francisco, 2130 Fulton Street, 94118, San Francisco, CA, USA.
| | - Julianna Deardorff
- Division of Community Health and Human Development, School of Public Health, University of California at Berkeley, 50 University Hall, 94720-7360, Berkeley, CA, USA.
| | - Louise C Greenspan
- Kaiser Permanente, 2200 O'Farrell Street, 94115, San Francisco, CA, USA.
| | - Nancy F Butte
- Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, 1100 Bates Street, 77030-2600, Houston, TX, USA.
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Ganter C, Chuang E, Aftosmes-Tobio A, Blaine RE, Giannetti M, Land T, Davison KK. Community stakeholders' perceptions of barriers to childhood obesity prevention in low-income families, Massachusetts 2012-2013. Prev Chronic Dis 2015; 12:E42. [PMID: 25811497 PMCID: PMC4375987 DOI: 10.5888/pcd12.140371] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION The etiology of childhood obesity is multidimensional and includes individual, familial, organizational, and societal factors. Policymakers and researchers are promoting social-ecological approaches to obesity prevention that encompass multiple community sectors. Programs that successfully engage low-income families in making healthy choices are greatly needed, yet little is known about the extent to which stakeholders understand the complexity of barriers encountered by families. The objective of this study was to contextually frame barriers faced by low-income families reported by community stakeholders by using the Family Ecological Model (FEM). METHODS From 2012 through 2013, we conducted semistructured interviews with 39 stakeholders from 2 communities in Massachusetts that were participating in a multisector intervention for childhood obesity prevention. Stakeholders represented schools; afterschool programs; health care; the Special Supplemental Nutrition Program for Women, Infants, and Children; and early care and education. Interviews were audio-recorded, transcribed, coded, and summarized. RESULTS Stakeholder reports of the barriers experienced by low-income families had a strong degree of overlap with FEM and reflected awareness of the broader contextual factors (eg, availability of community resources, family culture, education) and social and emotional dynamics within families (eg, parent knowledge, social norms, distrust of health care providers, chronic life stressors) that could affect family adoption of healthy lifestyle behaviors. Furthermore, results illustrated a level of consistency in stakeholder awareness across multiple community sectors. CONCLUSION The congruity of stakeholder perspectives with those of low-income parents as summarized in FEM and across community sectors illustrates potential for synergizing the efforts necessary for multisector, multilevel community interventions for the prevention of childhood obesity.
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Affiliation(s)
- Claudia Ganter
- Department of Nutrition, Harvard School of Public Health, Landmark Center, 401 Park Drive, 3rd floor East, Boston, MA 01225. . Ms. Ganter is also affiliated with the Technical University of Berlin, Department of Health Care Management, Berlin, Germany
| | - Emmeline Chuang
- University of California, Los Angeles, Los Angeles, California (Dr. Chuang was at University of California, San Diego, at the time this article was written)
| | | | | | - Mary Giannetti
- Montachusett Opportunity Council, Fitchburg, Massachusetts
| | - Thomas Land
- Massachusetts Department of Public Health, Boston, Massachusetts
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Franzen-Castle L, Aguirre T. Perceptions of Body Habitus and Cultural Health Among Hispanic Adults. J Immigr Minor Health 2014; 17:1206-13. [PMID: 25331685 DOI: 10.1007/s10903-014-0064-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
To investigate whether perceptions of health and health outcomes are impacted by acculturation level, nativity, and years in the United States (US) for Hispanic adults in the Nebraska Panhandle. Focus groups (n = 10), surveys (demographics, body image silhouettes, and acculturation), and anthropometric measurements were conducted. US-born (n = 36) had higher household incomes, education level, and acculturation scores compared to foreign-born (n = 23). Years in the US was positively correlated with acculturation and anthropometrics. No significant differences were detected between groups for rating infant and adolescent health, indicating mid-sized infants were considered healthy and heavier adolescents had increased health risks. However, qualitative data revealed misconceptions regarding obesity and chronic disease and a cultural preference for heavier infants. Despite differences between groups, qualitative data indicated cultural perceptions of health still persist. Data indicates a need for behavioral modification using culturally appropriate methods and for collecting quantitative and qualitative data.
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Affiliation(s)
- Lisa Franzen-Castle
- Nutrition and Health Sciences Department, University of Nebraska-Lincoln, 110 Ruth Leverton Hall, Lincoln, NE, 68583-0806, USA,
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Are the children and adolescents with congenital heart disease living in Southwestern Ontario really overweight and obese? Cardiol Young 2014; 24:848-53. [PMID: 24067132 DOI: 10.1017/s1047951113001157] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the prevalence of overweight and obesity in children with congenital heart disease and compare them with age-matched healthy children in Southwestern Ontario, Canada. METHODS We compared the Center of Disease Control weight and body mass index z-scores of 1080 children, aged 2 to 18 years, who presented to our paediatric cardiology outpatient clinic from 2008 to 2010 for congenital heart disease with 1083 healthy controls. RESULTS In all, 18.2% of the children with congenital heart disease and 20.8% of healthy children were identified to be either overweight or obese. Overall, the weight category distribution had been similar between the congenital heart disease and healthy control groups, as well as between the congenital heart disease subgroups. There was no difference in normal weight and overweight/obese categories between children with congenital heart disease and healthy children. The underweight category, however, showed a significantly higher prevalence in congenital heart disease compared with healthy children (6.8 and 4.5%, respectively, p = 0.03). CONCLUSION The prevalence of overweight/obesity did not differ in children with congenital heart disease compared with age-matched healthy children; however, it is still high (18.2%). Obesity may represent an additional risk factor for the long-term cardiovascular health of congenital heart disease patients aside from the underlying heart defect.
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Berger-Jenkins E, Rausch J, Okah E, Tsao D, Nieto A, Lyda E, Meyer D, McCord M. Evaluation of a Coordinated School-Based Obesity Prevention Program in a Hispanic Community: Choosing Healthy and Active Lifestyles for Kids/Healthy Schools Healthy Families. AMERICAN JOURNAL OF HEALTH EDUCATION 2014. [DOI: 10.1080/19325037.2014.932724] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
| | - John Rausch
- Columbia University Medical Center, Children's Hospital of New York
| | | | | | - Andres Nieto
- Ambulatory Care Network, New York-Presbyterian Hospital
| | | | - Dodi Meyer
- Columbia University Medical Center, Children's Hospital of New York
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Gorin AA, Wiley J, Ohannessian CM, Hernandez D, Grant A, Cloutier MM. Steps to Growing Up Healthy: a pediatric primary care based obesity prevention program for young children. BMC Public Health 2014; 14:72. [PMID: 24456698 PMCID: PMC3933325 DOI: 10.1186/1471-2458-14-72] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 12/05/2013] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Leading medical organizations have called on primary care pediatricians to take a central role in the prevention of childhood obesity. Weight counseling typically has not been incorporated into routine pediatric practice due to time and training constraints. Brief interventions with simple behavior change messages are needed to reach high-risk children, particularly Latino and Black children who are disproportionately affected by obesity and related comorbidities. Steps to Growing Up Healthy (Added Value) is a randomized controlled trial testing the efficacy of brief motivational counseling (BMC) delivered by primary care clinicians and the added value of supplementing BMC with monthly contact by community health workers (CHW) in the prevention/reversal of obesity in Latino and Black children ages 2-4 years old. METHODS/DESIGN Mother-child dyads (targeted n = 150) are recruited for this 12-month randomized trial at an inner-city pediatric primary care clinic and randomized to: 1) BMC delivered by clinicians and nurses at well, sick, and WIC visits with the goal of reducing obesogenic behaviors (BMC); 2) BMC plus monthly phone calls by a CHW (BMC + Phone); or 3) BMC plus monthly home visits by a CHW (BMC + Home). During BMC, the medical team facilitates the selection of a specific goal (i.e., reduce sugar sweetened beverage consumption) that is meaningful to the mother and teaches the mother simple behavioral strategies. Monthly contacts with CHWs are designed to identify and overcome barriers to goal progress. Dyads are assessed at baseline and 12 months and the primary outcome is change in the child's BMI percentile. We hypothesize that BMC + Phone and BMC + Home will produce greater reductions in BMI percentiles than BMC alone and that BMC + Home will produce greater reductions in BMI percentiles than BMC + Phone. DISCUSSION Steps to Growing Up Healthy will provide important information about whether a brief primary care-based intervention that utilizes a motivational interviewing and goal setting approach can be incorporated into routine care and is sufficient to prevent/reverse obesity in young children. The study will also explore whether monthly contact with a community health worker bridges the gap between the clinic and the community and is an effective strategy for promoting obesity prevention in high-risk families. TRIAL REGISTRATION ClinicalTrials.gov NCT01973153.
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Affiliation(s)
- Amy A Gorin
- Department of Psychology, Center for Health, Intervention and Prevention, University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT 06269-1248, USA
| | - James Wiley
- Children’s Center for Community Research, Connecticut Children’s Medical Center, 282 Washington Street, Hartford, CT 06106, USA
| | - Christine McCauley Ohannessian
- Children’s Center for Community Research, Connecticut Children’s Medical Center, University of Connecticut Health Center, 282 Washington Street, Hartford, CT 06106, USA
| | - Dominica Hernandez
- Department of Psychology, Center for Health, Intervention and Prevention, University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT 06269-1248, USA
| | - Autherene Grant
- Children’s Center for Community Research, Connecticut Children’s Medical Center, 282 Washington Street, Hartford, CT 06106, USA
| | - Michelle M Cloutier
- Children’s Center for Community Research, Connecticut Children’s Medical Center, University of Connecticut Health Center, 282 Washington Street, Hartford, CT 06106, USA
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Camargo APPDMD, Barros Filho ADA, Antonio MÂRDGM, Giglio JS. [The non perception of obesity can be an obstacle to the role of mothers in taking care of their children]. CIENCIA & SAUDE COLETIVA 2014; 18:323-33. [PMID: 23358758 DOI: 10.1590/s1413-81232013000200004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 07/10/2011] [Indexed: 11/21/2022] Open
Abstract
The goal of this study is to review articles in the scientific literature investigating the role of mothers, fathers and relatives in the treatment of obesity of their children. A search for original articles was conducted in the BIREME (BVS), PUBMED (MEDLINE) and Scielo platforms from 2004 to 2010, using the key words "the role of parents" and "childhood obesity," "the role of parents" and "child obesity treatment," "the mother's role" and "childhood obesity," "the mothers role" and "child obesity treatment." Twenty papers were selected and divided into two thematic categories. It was revealed that there are implications of the role of family, namely the father or mother, on the obesity of children, and more specifically related to the role of mothers. The conclusion drawn is that the role of parents and relatives is fundamental in promoting healthy behavior and lifestyles. Distorted maternal perception leads to excess weight being perceived as normal and this may prejudice treatment of child obesity. Acknowledging that the children are overweight most probably promotes greater acceptance of the need for treatment, in addition to being the necessary impetus for seeking professional assistance.
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Ogu LC, Janakiram J, Hoffman HJ, McDonough L, Valencia AP, Mackey ER, Klein CJ. Hispanic Overweight and Obese Children. ACTA ACUST UNITED AC 2013. [DOI: 10.1177/1941406413510175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Through Value Enhanced Nutrition Assessment and other techniques, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) engages clients to set their own nutrition goals. A case series of 30 Hispanic children (2-4.5 years) at ≥85th body mass index (BMI) percentile and their caregivers were followed through an urban WIC clinic. The dyads received either standard counseling ( n = 15) or motivational interviewing (MI; n = 15) by one bilingual WIC nutritionist during 4 regularly scheduled visits over 6 months. Repeated measurements of anthropometric data, dietary patterns, and physical activity were obtained at each visit. Longitudinal bivariate analyses of caregiver concerns and goal selection were conducted along with mean comparisons of anthropometric and food frequency measures. Participation in counseling sessions as rated by the nutritionist was assessed by comparing Wilcoxon rank-sum scores. After counseling, children lost an adjusted mean weight of 0.878 kg (95% confidence interval = 0.280-1.717). A decline in median BMI of more than 3 percentiles ( P = .042) was observed with both counseling approaches. Caregiver-reported vegetable intake of children increased an average of one additional serving in the MI-counseled group by visit 3 ( P = .013) despite MI recipient caregivers being scored as significantly more distracted than standard WIC participants in the first visit ( P = .036). MI is a viable option for WIC counseling to improve diet and health outcomes in participants, particularly in addressing child BMI status and vegetable intake. Public health professionals should examine scalability of the MI approach among larger samples of WIC participants and other innovative techniques to improve client focus during counseling.
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Affiliation(s)
- Linda C. Ogu
- Department of Epidemiology and Biostatistics, School of Public Health and Health Services, The George Washington University, Washington, DC (LCO, HJH)
- Children’s National Medical Center, Washington, DC (JJ, LM, ERM)
- University of Maryland, College Park, Maryland (APV)
- LSRO Solutions, Bethesda, Maryland (CJK)
| | - Jayasri Janakiram
- Department of Epidemiology and Biostatistics, School of Public Health and Health Services, The George Washington University, Washington, DC (LCO, HJH)
- Children’s National Medical Center, Washington, DC (JJ, LM, ERM)
- University of Maryland, College Park, Maryland (APV)
- LSRO Solutions, Bethesda, Maryland (CJK)
| | - Heather J. Hoffman
- Department of Epidemiology and Biostatistics, School of Public Health and Health Services, The George Washington University, Washington, DC (LCO, HJH)
- Children’s National Medical Center, Washington, DC (JJ, LM, ERM)
- University of Maryland, College Park, Maryland (APV)
- LSRO Solutions, Bethesda, Maryland (CJK)
| | - Libia McDonough
- Department of Epidemiology and Biostatistics, School of Public Health and Health Services, The George Washington University, Washington, DC (LCO, HJH)
- Children’s National Medical Center, Washington, DC (JJ, LM, ERM)
- University of Maryland, College Park, Maryland (APV)
- LSRO Solutions, Bethesda, Maryland (CJK)
| | - Ana P. Valencia
- Department of Epidemiology and Biostatistics, School of Public Health and Health Services, The George Washington University, Washington, DC (LCO, HJH)
- Children’s National Medical Center, Washington, DC (JJ, LM, ERM)
- University of Maryland, College Park, Maryland (APV)
- LSRO Solutions, Bethesda, Maryland (CJK)
| | - Eleanor R. Mackey
- Department of Epidemiology and Biostatistics, School of Public Health and Health Services, The George Washington University, Washington, DC (LCO, HJH)
- Children’s National Medical Center, Washington, DC (JJ, LM, ERM)
- University of Maryland, College Park, Maryland (APV)
- LSRO Solutions, Bethesda, Maryland (CJK)
| | - Catherine J. Klein
- Department of Epidemiology and Biostatistics, School of Public Health and Health Services, The George Washington University, Washington, DC (LCO, HJH)
- Children’s National Medical Center, Washington, DC (JJ, LM, ERM)
- University of Maryland, College Park, Maryland (APV)
- LSRO Solutions, Bethesda, Maryland (CJK)
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Zhao Y, Goto K, Wolff C, Bianco-Simeral S, Song C. Relationships Between Children's Food Consumption and Social and Cultural Capital Levels Among Latino, Hmong, and Non-Hispanic White Parents of K–2 Children. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2013. [DOI: 10.1080/19320248.2013.816996] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Su D, Huang TTK, Anthony R, Ramos A, Toure D, Wang H. Parental perception of child bodyweight and health among Mexican-American children with acanthosis nigricans. J Immigr Minor Health 2013; 16:874-81. [PMID: 23843016 DOI: 10.1007/s10903-013-9869-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Acanthosis nigricans (AN) is a cutaneous marker associated with elevated risk of type 2 diabetes. This study assesses mother-father differences in perception of child's bodyweight and health by Mexican-American parents with AN-positive children. The study used medical records in conjunction with survey data collected between 2011 and 2012 for 309 Mexican-American children with AN in South Texas. Multivariate logit models were estimated to assess mother-father differences in perception of child bodyweight and health controlling for selected child- and parent-level covariates. About 91 % of the children in the sample were obese and 6.5 % were overweight. One fifth of mothers and 38.5 % of fathers in the sample expressed no concern of their children's bodyweight. After adjusting for selected explanatory variables at both the child and parent level, the odds for fathers, relative to mothers, to be concerned about child's bodyweight were 82 % lower (OR = 0.18, p < 0.05). Similar findings also hold for parental awareness of child's AN (OR = 0.19, p < 0.05). Among Mexican-American families with AN-positive children, the lack of concern over child's bodyweight, unawareness of AN, and misconception of child's health on the part of many parents, especially of fathers, constitutes a challenge to diabetes prevention. Health education programs targeting Mexican-American families with AN-positive children might be more cost effective to consider mother-father differences in perception of child health and bodyweight.
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Affiliation(s)
- Dejun Su
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, 984340 Nebraska Medical Center, Omaha, NE, 68198-4340, USA,
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Lowenstein LM, Perrin EM, Berry D, Vu MB, Pullen Davis L, Cai J, Tzeng JP, Ammerman AS. Childhood obesity prevention: fathers' reflections with healthcare providers. Child Obes 2013; 9:137-43. [PMID: 23472966 PMCID: PMC3621357 DOI: 10.1089/chi.2012.0111] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
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.
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Affiliation(s)
- Lisa M. Lowenstein
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC.,Present address: Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Eliana M. Perrin
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, NC.,Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC
| | - Diane Berry
- School of Nursing, University of North Carolina, Chapel Hill, NC
| | - Maihan B. Vu
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC
| | - Lisa Pullen Davis
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC.,Present address: Duke Translational Medicine Institute, Duke University, Durham, NC
| | - Jianwen Cai
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Janice P. Tzeng
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC.,Present address: RTI International, Raleigh, NC
| | - Alice S. Ammerman
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC.,Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC
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Barrera M, Castro FG, Strycker LA, Toobert DJ. Cultural adaptations of behavioral health interventions: a progress report. J Consult Clin Psychol 2013; 81:196-205. [PMID: 22289132 PMCID: PMC3965302 DOI: 10.1037/a0027085] [Citation(s) in RCA: 385] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To reduce health disparities, behavioral health interventions must reach subcultural groups and demonstrate effectiveness in improving their health behaviors and outcomes. One approach to developing such health interventions is to culturally adapt original evidence-based interventions. The goals of the article are to (a) describe consensus on the stages involved in developing cultural adaptations, (b) identify common elements in cultural adaptations, (c) examine evidence on the effectiveness of culturally enhanced interventions for various health conditions, and (d) pose questions for future research. METHOD Influential literature from the past decade was examined to identify points of consensus. RESULTS There is agreement that cultural adaptation can be organized into 5 stages: information gathering, preliminary design, preliminary testing, refinement, and final trial. With few exceptions, reviews of several health conditions (e.g., AIDS, asthma, diabetes) concluded that culturally enhanced interventions are more effective in improving health outcomes than usual care or other control conditions. CONCLUSIONS Progress has been made in establishing methods for conducting cultural adaptations and providing evidence of their effectiveness. Future research should include evaluations of cultural adaptations developed in stages, tests to determine the effectiveness of cultural adaptations relative to the original versions, and studies that advance our understanding of cultural constructs' contributions to intervention engagement and efficacy.
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Affiliation(s)
- Manuel Barrera
- Department of Psychology, Arizona State University (Tempe, Arizona) and Oregon Research Institute (Eugene, Oregon)
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Rosado JI, Johnson SB, McGinnity KA, Cuevas JP. Obesity among Latino children within a migrant farmworker community. Am J Prev Med 2013; 44:S274-81. [PMID: 23415193 DOI: 10.1016/j.amepre.2012.11.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 11/15/2012] [Accepted: 11/21/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Childhood obesity has increased substantially among Latino children, placing them at risk for its related health consequences. Limited attention has been given to childhood obesity among Latino migrant farm-working communities. PURPOSE To examine, within a migrant farm-working community, (1) the prevalence of obesity among Latino children and parents and (2) parent perceptions of children's weight status and intentions to take corrective action. METHODS Structured interviews were completed with the parents of 495 children seen for well-child office visits in the pediatric department of a community health center during a 15-month period between 2010 and 2011. Medical chart reviews were completed for each child participant. RESULTS Forty-seven percent of the children were overweight (20%) or obese (27%). In comparison to preschool-aged children, those in elementary and middle school were more likely to be obese. In elementary school, girls were more likely than boys to be overweight or obese. Child obesity was associated with parent obesity. Parental concern about their child's weight was associated with child obesity but not with child overweight. Parental concern was associated with parent intention to address the child's weight, particularly in older children. Analysis was completed in 2012. CONCLUSIONS Interventions are needed that address both childhood obesity and parent weight status among Latino migrant farmworkers. Prevention programs that address the weight status of Latino children who are overweight, but not necessarily obese, are also needed, as their parents tend to be no more concerned about a child who is overweight than one who is normal weight.
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Affiliation(s)
- Javier I Rosado
- College of Medicine, Florida State University, Immokalee, Florida, USA.
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Lindberg NM, Stevens VJ, Halperin RO. Weight-loss interventions for Hispanic populations: the role of culture. J Obes 2013; 2013:542736. [PMID: 23533725 PMCID: PMC3600335 DOI: 10.1155/2013/542736] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 01/28/2013] [Indexed: 11/17/2022] Open
Abstract
In the United States, ethnic minorities are overrepresented among the overweight and obese population, with Hispanic individuals being among the groups most at risk for obesity and obesity-related disease and disability. Most weight-loss interventions designed for the general population have been less successful with individuals from ethnic minorities and there is a pressing need to develop more effective interventions for these groups. This paper examines the importance of culture in the development of "culturally competent" weight-loss interventions for ethnic minority populations, and discusses specific culturally mediated factors that should be considered in the design and implementation of treatment interventions. While specifically focusing on Hispanic populations, we also address issues of relevance to other multiethnic societies.
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Affiliation(s)
- Nangel M Lindberg
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Avenue Portland, OR 97227-1110, USA.
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Kalin SR, Fung TT. Comparison of child obesity prevention and control content in mainstream and Spanish-language US parenting magazines. J Acad Nutr Diet 2013; 113:133-40. [PMID: 23260730 DOI: 10.1016/j.jand.2012.09.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 09/21/2012] [Indexed: 11/18/2022]
Abstract
Mass media coverage of child obesity is rising, paralleling the child obesity epidemic's growth, and there is evidence that parents seek parenting advice from media sources. Yet little to no research has examined the coverage of child obesity in parenting magazines or Spanish-language media. The purpose of this study was to use qualitative and quantitative content analysis methods to identify, quantify, and compare strategies for child obesity prevention and control presented in mainstream and Spanish-language US parenting magazines. Child obesity-related editorial content in 68 mainstream and 20 Spanish-language magazine issues published over 32 months was gathered. Magazine content was coded with a manual developed by refining themes from the sample and from an evidence-based child obesity prevention action plan. Seventy-three articles related to child obesity prevention and control were identified. Most focused on parental behavior change rather than environmental change, and only 3 in 10 articles referred to the social context in which parental behavior change takes place. Child obesity-focused articles were not given high prominence; only one in four articles in the entire sample referred to child obesity as a growing problem or epidemic. Key differences between genres reflect culturally important Latino themes, including family focus and changing health beliefs around child weight status. Given mass media's potential influence on parenting practices and public perceptions, nutrition communication professionals and registered dietitians need to work to reframe media coverage of childhood obesity as an environmental problem that requires broad-based policy solutions. Spanish-speaking media can be an ally in helping Latina women change cultural health beliefs around child weight status.
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Affiliation(s)
- Sari R Kalin
- Nutrition and Health Promotion, Department of Nutrition, Simmons College, Boston, MA, USA.
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