Intrafamilial correlates of overweight and obesity in African-American and Native-American grandparents, parents, and children in rural Oklahoma

Understanding family dynamics of obesity: Do parents and children lose and gain weight together?

BACKGROUND

Obesity is prevalent among children and adults. Yet, understanding the relationship between parent and child weight trajectories is limited.

OBJECTIVE

(1) Examine the association between parent/child undesirable body mass index (BMI) category change. (2) Assess whether parental BMI category predicts child modified BMI z-score (mBMIz) annual change.

METHODS

We conducted a cross-sectional study of weight trajectories of 3821 parent-child dyads between March 2020 and December 2021 within the NYC Health + Hospitals system. Undesirability of child and parental BMI category change and the magnitude of mBMIz change by parental BMI are analysed.

RESULTS

Of 3821 children (mean [SD] baseline age, 9.84 [3.51]), 1889 were female. Of the 3220 parents (mean [SD] baseline age, 39.9 [8.51]), 2988 were female. Most children (53.52%) and parents (81.94%) presented with overweight and obesity. Undesirable BMI change in children was associated with concordant change in parents (adjusted OR: 1.7, 95% CI [1.45, 2.01], adjusted p < 0.001). Children of parents with obesity (adjusted coef: 0.076, 95% CI [0.004, 0.147], p < 0.038) and severe obesity (adjusted coef: 0.1317, 95% CI [0.024, 0.239], adjusted p < 0.016) demonstrated greater change in mBMIz than those of parents with normal weight or underweight.

CONCLUSION

Parents and children have concordant weight trajectories, and public health interventions targeting both populations are essential.

Empowered mothers and co-resident grandmothers: Two fundamental roles of women impacting child health outcomes in Punjab, Pakistan

We show that i) empowered mothers and ii) coresident grandmothers each benefit children's nutritional health measured by height-for-age z-scores (HAZ) and weight-for-age z-scores (WAZ) for age groups 5 years and less. First, using cross-sectional data from the Pakistan Demographic and Health Survey (PDHS) for the year 2017-18, we estimate the impact of empowered mothers on child health outcomes using an instrumental variable approach to correct for endogeneity. Empowerment is measured by two indices: as a sum of the questions that gauge both attitudinal and behavioral dimensions of female agency and also and using multiple correspondence analysis (MCA) for these same questions. Second, we use a fuzzy regression discontinuity design (FRDD) to measure the causal impact of coresident grandmothers on the health outcomes of the children using multiple rounds of the Multiple Indicator Cluster Survey (MICS) from the years 2008, 2011, 2014 and 2018. The difference between the actual ages of the grandmother from the Potential Retirement Eligibility Criteria (PREC) has been used to correct for potential endogeneity. The results show that on average, the weight for age z-scores (WFA) for children under five increases by 0.28 SD with a one-index point increase in mother's empowerment. Similarly, on average, WFA increases by 0.098 SD when grandmothers are present in a household. Finally, we explore heterogeneity in the average effects stated above based upon the gender of the child as well as the wealth and geographic location of the household. The benefits of mothers' empowerment are largely driven by improvements in girls' nutrition as well as children living in rural areas while the presence of grandmothers primarily improves the nutrition of boys, children in rural areas, and children belonging to poor families.

Relationship between Live-In Grandparents and Grandchild's Health and Well-Being in Palestinian Refugees in Lebanon

Grandparents (GP) play influential roles in grandchildren's health, behavior, and life. However, this relationship has not been examined in the Arab region. This study assesses whether the presence of GP in the household is associated with grandchildren's health and wellbeing. Health status was determined by a child experiencing chronic health conditions or an acute illness, and wellbeing was determined based on school attendance and child labor. Data were collected through surveys conducted in 2010 and 2015 of representative samples of Palestinian refugees living in Lebanon. Multivariate logistic regression showed that, even after controlling for potential confounders, including the presence of parents in the household and household food insecurity (FI), the presence of live-in GP was associated with lower odds of children experiencing acute illnesses (OR 0.74 95% CI 0.62-0.92) and higher odds of attending school (OR 2.22 95% CI 1.28-5.33), but not child labor. The presence of GP in the household may be protective to grandchildren's health status and school attendance in this population.

A comparison of the differences in the way parents and grandparents interact with children and their effects on children's creative performance

As grandparents' involvement in parenting becomes more common, it is valuable to understand the differences between grandparenting and parenting and how these differences affect children. To elucidate the differences between grandparenting and parenting and their effects on children's creativity performance, children's performance on creativity tasks after grandparent-child interactions and parent-child interactions were compared, and the behavioral differences between grandparents and parents when interacting with children were discussed. In this study, grandparents and parents were asked to interact with children separately, and creativity performance was measured before and after adult-child interactions. The results showed that children's creative performance improved significantly after parent-child interactions, while there was little change after grandparent-child interactions. In addition, according to parental investment theory, parents provided children with more cognitive and interpersonal resources during the interaction compared to grandparents.

Multigenerational transmission of obesity: A systematic review and meta-analysis

There is a strong link between parental and offspring obesity status. However, the state of epidemiological evidence on multigenerational transmission of overweight/obesity, such as from grandparents to grandchildren, is relatively unknown. This systematic review collates and appraises existing evidence on multigenerational transmission of overweight/obesity and uses meta-analytic estimates for quantitative synthesis. Six electronic databases were searched for publications reporting the relationship between grandparents and their grandchildren overweight/obesity status. A total of 25 studies from 17 countries with a combined population of 238,771 study participants met the inclusion criteria. About 60% (15) of the reviewed studies reported a positive association between grandparent-grandchild (GP-GC) overweight/obesity, out of which 11 were statistically significant. Seven studies reported odds ratios of GP-GC overweight/obesity associations and were included in the meta-analysis. The pooled estimates showed a significant GP-GC association in overweight/obesity status (odds ratio [OR]: 1.79, 95% confidence interval [CI]: 1.01-2.57). Thus, the current research evidence shows that grandchildren's overweight/obesity status is associated with their grandparents' overweight/obesity status, indicating a multigenerational transmission of obesity. However, more studies, especially from developing countries, are required to assess the robustness of these findings. Future studies should also focus on the mechanisms through which this transmission occurs.

Grandchildren's food workshop: Impact of an intergenerational cooking program on dietary habits, food courage, cooking skills and two-way interaction in Danish children and their grandparents

BACKGROUND

Good nutrition is a key aspect of health. Cooking activities can improve dietary habits, cooking skills and food courage in terms of courage to cook and taste new foods, in individuals of all ages. However, targeting both grandchildren and grandparents at the same time through intergenerational cooking activities, is new.

AIM

This paper aims to present the impact of intergenerational cooking activities on dietary habits, food courage, cooking skills and two-way interaction between young and old participants in The Grandchildren's Food Workshop.

METHODS

In this observational pilot study, the Danish Heart Foundation's experimental cooking program for grandchildren and grandparents was developed and tested. The influence of the food workshop on the participants' dietary habits, food courage, cooking skills and two-way interaction was assessed by a before and after questionnaire. McNemar's and chi-squared tests were used to evaluate the effects.

RESULTS

A total of 180 grandchildren (10 to 12 years) and 183 grandparents participated in The Grandchildren's Food Workshop. A total of 82 (46%) grandchildren (71% of which were girls) and 125 (68%) grandparents (83% of which were women) responded to the baseline and follow-up questionnaires. The impact on dietary habits and food courage was limited, while there was an impact on cooking skills in the grandchildren. The already good two-way interaction was unaltered.

CONCLUSIONS

The findings indicate an impact on cooking skills among grandchildren participating in The Grandchildren's Food Workshop, while the impact on dietary habits, food courage and two-way interaction between age groups was limited. Further research, including more detailed dietary data, should explore the significance of an intergenerational approach.

The Association of Grandparent Care with Childhood Overweight and Obesity in Chinese American Families

BACKGROUND

Grandparents are often the caretakers of children in Chinese American families. Studies have shown that Chinese grandparents underestimate the weight of their grandchildren and associate food with increased height and strength. This study examines the association of grandparental care with weight status in Chinese American children and adolescents.

METHODS

This is a cross-sectional study of 12,029 Chinese American pediatric patients ages 2-19 at a community health center in New York City in 2015. Grandparental care was defined as child care provided by at least one grandparent. Multivariable logistic regression was conducted to assess for association between having a grandparent caretaker and weight status in the age groups 2-5, 6-11, and 12-19 while adjusting for sex, place of birth, neighborhood poverty, and two-parent households.

RESULTS

Approximately 12% of Chinese American children in this population had a grandparent caretaker. Children and adolescents with grandparent caretakers are more likely to be overweight than their counterparts with no grandparent caretakers at ages 6-11 (odds ratio [OR]: 1.48; 95% confidence interval [CI]: 1.23-1.79) and ages 12-19 (OR: 1.54; 95% CI: 1.18-2.02). No association was found between grandparental care and overweight in ages 2-5 nor with obesity in any age group.

CONCLUSIONS

Grandparental care is associated with the weight of school-age children and adolescents. Targeted education on appropriate nutrition for the child's age is needed for grandparents who take care of children.

Understanding Correlates of Physical Activity in American Indian Families: The Healthy Children Strong Families-2 Study

BACKGROUND

Little is known about factors contributing to physical activity (PA) in American Indian (AI) populations. Addressing this gap is paramount as sedentary activity and obesity continue to increase in this population. The purpose of this study was to determine factors associated with PA among AI families with young children.

METHODS

Height and weight of both adult (n = 423) and child (n = 390) were measured, and surveys assessed demographics, PA, stress (adult only), sleep, and screen time. Separate multivariate logistic regression models were constructed for adults and children (reported as adjusted odds ratios, aORs).

RESULTS

For adults, age (aOR = 0.952; P ≤ .001), television viewing (aOR = 0.997; P = .01), and computer use (aOR = 0.996; P = .003) decreased the odds of being active. For children, high adult activity (aOR = 1.795; P ≤ .01), longer weekday sleep (aOR = 1.004; P = .01), and family income >$35,000 (aOR = 2.772; P = .01) increased the odds of being active. We found no association between adult PA with stress or adult sleep or between child PA with body mass index and screen time.

CONCLUSIONS

Given the complexity of the factors contributing to obesity among AI families, multigenerational interventions focused on healthy lifestyle change such as decreasing adult screen time and increasing child sleep time may be needed to increase PA within AI families.

Engaging Native American Caregivers in Youth-Focused Diabetes Prevention and Management

Native American youth aged 10 to 19 years are disproportionately affected by type 2 diabetes. Intergenerational programs may improve health in tribal communities. We evaluated Together on Diabetes, a diabetes prevention and management program, among 257 participating Native American youths with or at risk for type 2 diabetes and their adult caregivers. Feasibility, acceptability, and demographic data were collected from 226 adult caregivers. Data on physical measurements (weight, height, waist circumference) were collected from 37 of the caregivers. Results indicated that engaging adult caregivers was feasible, acceptable, and effective. Furthermore, a subset of adult caregivers reduced their body mass index (weight in kilograms divided by height in m²) significantly from the start to the end of the program, a 12 month period (P = .02). Findings suggest the feasibility of engaging adult caregivers in youth diabetes prevention programs.

Cardiovascular Disease Risk Factors and Health Outcomes Among American Indians in Oklahoma: the THRIVE Study

INTRODUCTION

Limited available data document higher prevalences of cardiovascular disease (CVD) risk factors and health outcomes among American Indians (AIs) compared to other racial/ethnic groups.

METHODS

As part of a randomized control trial to improve tribal food and physical activity environments, our tribal-academic partnership surveyed a cross-sectional sample of American Indian adults (n = 513) to assess the prevalence of type 2 diabetes, obesity, hypertension, tobacco use, physical activity, and vegetable and fruit intake. Surveys were collected from April through May 2015. We used logistic regression to examine the association between CVD-related risk factors and health outcomes.

RESULTS

The prevalence of CVD-related outcomes was high, ranging from 25% for diabetes to 75% for low vegetable intake. The prevalence of diabetes, obesity, and hypertension tended to be higher among participants with any tobacco use compared to no tobacco use, but findings were not statistically significant. The prevalence of diabetes (prevalence ratio 2.1, 95% CI 1.4-3.2) and obesity (prevalence ratio 1.5, 95% CI 1.2-1.8) was higher among participants with low physical activity levels compared to recommended physical activity levels.

CONCLUSIONS

CVD risk factors and health outcomes persist among American Indians even as some risks (e.g., smoking) appear to be stabilizing or even declining in the general US population. Efforts to include American Indians in national health surveys, implement broad reaching environmental and policy interventions, and address the social determinants of health are critical to the elimination of these disparities.

The influence of familial predisposition to cardiovascular complications upon childhood obesity treatment

INTRODUCTION

The aim was to investigate whether a familial predisposition to obesity related cardiovascular complications was associated with the degree of obesity at baseline and/or changes in the degree of obesity during a multidisciplinary childhood obesity treatment program.

METHODS

The study included 1421 obese children (634 boys) with a median age of 11.5 years (range 3.1-17.9 years), enrolled in treatment for 0.04 to 5.90 years (median 1.3 years) at the Children's Obesity Clinic, Denmark. At baseline, weight and height were measured, body mass index (BMI) standard deviation score (SDS) calculated, and self-reported information on familial predisposition to obesity, hypertension, type 2 diabetes mellitus (T2DM), thromboembolic events, and dyslipidaemia were obtained. A familial predisposition included events in biological parents, siblings, grandparents, uncles, and aunts. The treatment outcomes were categorically analysed according to the prevalence of familial predispositions.

RESULTS

The median BMI SDS at enrollment was 3.2 in boys and 2.8 in girls. One-thousand-and-forty-one children had obesity in their family, 773 had hypertension, 551 had T2DM, 568 had thromboembolic events, and 583 had dyslipidaemia. Altogether, 733 had three or more predispositions. At baseline, familial T2DM was associated with a higher mean BMI SDS (p = 0.03), but no associations were found between the other predispositions and the children's degree of obesity. During treatment, girls with familial obesity lost more weight, compared to girls without familial obesity (p = 0.04). No other familial predispositions were associated with changes in BMI SDS during treatment.

CONCLUSION

Obese children with a familial predisposition to T2DM showed a significantly higher degree of obesity at baseline and girls with familial obesity responded better to treatment. Besides these findings, no other associations were found between the occurrence of familial predispositions and the degree of obesity or changes herein during multidisciplinary childhood obesity treatment.

Parental correlates in child and adolescent physical activity: a meta-analysis

OBJECTIVE

Physical activity (PA) has a profound impact on health and development in children. Parental behaviors (i.e., modeling and support) represent an obvious important factor in child PA. The purpose of this paper was to provide a comprehensive meta-analysis that overcomes the limitations of prior narrative reviews and quantitative reviews with small samples.

METHODS

Ten major databases were used in the literature search. One-hundred and fifteen studies passed the eligibility criteria. Both fixed and random effects models with correction for sampling and measurement error were examined in the analysis. Moderator analyses investigating the effects of child's developmental age, study design, parental gender, measurement of child PA, and quality rating were performed.

RESULTS

Based on the random effects model, the results showed that parental modeling was weakly associated with child PA (summary r = .16, 95% CI .09-.24) and none of the proposed moderators were significant. Separate analyses examining the moderating effects of parental gender and boys' PA found that that father-son PA modeling (r = .29, 95% CI .21-.36) was significantly higher compared to mother-son PA (r = .19, 95% CI .14-.23; p < .05). However, parental gender did not moderate the relationship between parental modeling and girls' PA (p > .05). The random effects model indicated an overall moderate effect size for the parental support and child PA relationship (summary r = .38, 95% CI .30-.46). Here, the only significant moderating variable was the measurement of child PA (objective: r = .20, 95% CI .13-.26; reported: r = .46, 95% CI .37-.55; p < .01).

CONCLUSIONS

Parental support and modeling relate to child PA, yet our results revealed a significant degree of heterogeneity among the studies that could not be explained well by our proposed moderators.

The Impact of Familial Predisposition to Obesity and Cardiovascular Disease on Childhood Obesity

The prevalence of childhood obesity has reached alarming rates world-wide. The aetiology seems to be an interplay between genetic and environmental factors, and a surrogate measure of this complex interaction is suggested as familial predisposition. Familial predisposition to obesity and related cardiovascular disease (CVD) complications constitute the presence of obesity and/or obesity-related complications in primarily blood-related family members. The approaches of its measurement and applicability vary, and the evidence especially of its influence on obesity and obesity treatment in childhood is limited. Studies have linked a familial predisposition of obesity, CVD (hypertension, dyslipidaemia and thromboembolic events), and type 2 diabetes mellitus to BMI as well as other adiposity measures in children, suggesting degrees of familial aggregation of metabolic derangements. A pattern of predispositions arising from mothers, parents or grandparents as being most influential have been found, but further comprehensive studies are needed in order to specify the exact implications of familial predisposition. In the scope of childhood obesity this article reviews the current literature regarding familial predisposition to obesity and obesity-related complications, and how these familial predispositions may impact obesity in the offspring.

Obesity and type 2 diabetes in children: epidemiology and treatment

The incidence of overweight and obesity among children has increased dramatically in recent decades, with about one-third of children in the U.S. currently being either overweight or obese. Being overweight in early childhood increases risk for later obesity. There is evidence for the efficacy of family-based behavioral treatment to control weight and improve health outcomes. Obesity-related health risks have been documented, including metabolic syndrome. There is also increasing incidence of type 2 diabetes (T2D) among youth in recent years, with obesity and family history of T2D generally present. Lower income and ethnic minority status are associated with both obesity and T2D in youth. Most youth with T2D do not achieve optimal glycemic control, and are at high risk for later health complications. Obesity and T2D represent significant public health issues with potentially great personal and societal cost. Research addressing the prevention of obesity and T2D among youth is urgently needed.

Sociodemographic and anthropometric factors associated with screen-based sedentary behavior among Japanese adults: a population-based cross-sectional study

BACKGROUND

Concern over the health risks of sedentary behavior has highlighted the need to examine factors associated with screen-based (television/computer) sedentary behavior. The present study examined the association of screen-based sedentary behavior with body weight and sociodemographic attributes among Japanese adults.

METHODS

A population-based cross-sectional study enrolled 1034 Japanese adults aged 40 to 69 years who lived in 2 Japanese cities. Sociodemographic variables, height, weight, and time spent on screen-based sedentary behavior were collected by self-administered questionnaire. Differences in screen time in relation to body mass index and weight gain since age 20 years were assessed by the Mann-Whitney U test. Independent associations of each variable with screen time were examined by forced-entry logistic regression analyses.

RESULTS

Mean (SD) age and median (interquartile range) duration of screen time per week were 55.6 (8.4) years and 832.0 (368.8-1263.1) minutes, respectively, for men, and 55.3 (8.4) years and 852.6 (426.0-1307.5) minutes, respectively, for women. Screen time among participants with weight gain was longer than among those with a weight gain of less than 10 kg (P = 0.08). Unmarried and unemployed participants had longer screen times. Participants aged 40 to 49 years were less likely than older age groups to spend time on screen-based sedentary behavior during leisure hours.

CONCLUSIONS

The present findings imply that strategies are necessary to discourage screen-based sedentary behavior among all demographic groups, especially among adults who are elderly, unmarried, or unemployed.

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

PURPOSE

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

CONCLUSIONS

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

PRACTICE IMPLICATIONS

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

Correlation of intestinal microbiota with overweight and obesity in Kazakh school children

BACKGROUND

This study sought to investigate a possible correlation between the intestinal microbiota, Bacteroidetes and Firmicutes, and obesity in Kazakh school children, aged 7-13 (n = 175).

RESULTS

Obese subjects had significantly greater systolic blood pressure, waist and hip circumference, as well as HOMA-IR as compared to normal and overweight participants. In addition, Bacteroides copy number and Bact/Firm ratios were significantly lower in the obese group as compared to the normal and overweight groups (P < 0.0167). This difference is only significant in girls, but not in boys when stratified by gender. Furthermore, a negative correlation between BMI and Bacteroidetes copy number (r = -0.18, P = 0.017) as well as Bact/Firm (r = -0.22, P = 0.003) was observed.

CONCLUSION

An association between reduced gut Bacteroidetes and Bact/Firm ratio with obesity in female Kazakh children was identified. Further studies are necessary to elucidate the mechanism behind these changes as well as the value of determining their presence for predicting obesity.

The Weighty Matter intervention: a family-centered way to tackle an overweight childhood

The complexity of childhood overweight and obesity requires that researchers continue to investigate potential solutions. We developed "The Weighty Matter" intervention to prevent obesity in mildly overweight 4- and 6-year-old children. This article describes the intervention protocol, the health habits of families (n=86), and the effect of the intervention on children's weight for height, parents' body mass indices, and family health habits after a 12-month follow-up. Positive changes were seen in families' health habits, although the results did not reach statistical significance. As a result of this study, a new and practical method was developed to focus on the issue of family health habits.

Evaluating Parents and Adult Caregivers as “Agents of Change” for Treating Obese Children: Evidence for Parent Behavior Change Strategies and Research Gaps

This scientific statement addresses parents and adult caregivers (PACs) as “agents of change” for obese children, evaluating the strength of evidence that particular parenting strategies can leverage behavior change and reduce positive energy balance in obese youth. The statement has 3 specific aims. The first is to review core behavior change strategies for PACs as used in family-based treatment programs and to provide a resource list. The second is to evaluate the strength of evidence that greater parental “involvement” in treatment is associated with better reductions in child overweight. The third is to identify research gaps and new opportunities for the field. This review yielded limited and inconsistent evidence from randomized controlled clinical trials that greater PAC involvement necessarily is associated with better child outcomes. For example, only 17% of the intervention studies reported differential improvements in child overweight as a function of parental involvement in treatment. On the other hand, greater parental adherence with core behavior change strategies predicted better child weight outcomes after 2 and 5 years in some studies. Thus, the literature lacks conclusive evidence that one particular parenting strategy or approach causally is superior to others in which children have a greater focus in treatment. A number of research gaps were identified, including the assessment of refined parenting phenotypes, cultural tailoring of interventions, examination of family relationships, and incorporation of new technologies. A conceptual model is proposed to stimulate research identifying the determinants of PAC feeding and physical activity parenting practices, the results of which may inform new treatments. The statement addresses the need for innovative research to advance the scope and potency of PAC treatments for childhood obesity.

Adult sedentary behavior: a systematic review

CONTEXT

While the health benefits of meeting moderate/vigorous-intensity physical activity (MVPA) guidelines have been well established, the health risks of sedentary behavior, independent of meeting MVPA guidelines, are becoming evident. Sedentary behavior may require different interventions, based on correlates that differ from MVPA. The current review aimed to collect and appraise the current literature on correlates of sedentary behaviors among adults.

EVIDENCE ACQUISITION

Papers were considered eligible if they were published in English-language peer-reviewed journals and examined correlates of sedentary behaviors. Literature searches were conducted in August 2011 among ten search engines yielding 3691 potentially relevant records; of these, 109 papers (82 independent samples) passed eligibility criteria.

EVIDENCE SYNTHESIS

Articles included were published between 1982 and 2011, with sample sizes ranging from 39 to 123,216. Eighty-three were cross-sectional, 24 followed a prospective design, one was experimental baseline data, and one was cohort design. Sedentary behavior was primarily measured as TV viewing or computer use, followed by analysis of a more omnibus assessment of time spent sitting. Evidence was present for sedentary behavior and correlates of education, age, employment status, gender, BMI, income, smoking status, MVPA, attitudes, and depressive symptoms/quality of life. Notable differences by specific sedentary behaviors were present that aided in the explanation of findings.

CONCLUSIONS

Results point to the high specificity of various sedentary behaviors (e.g., TV viewing vs sitting and socializing), suggesting that the research domain is complex and cannot be considered the simple absence of MVPA. Several sociodemographic and health factors appear reliably linked to sedentary behavior, yet there is an obvious absence of research focused on cognitive, social, and environmental factors that could be of use in anti-sedentary behavior interventions.

Formative assessment using social marketing principles to identify health and nutrition perspectives of Native American women living within the Chickasaw Nation boundaries in Oklahoma

OBJECTIVE

To identify health product and promotion channels for development of a Chickasaw Nation Supplemental Nutrition Assistance Education Program (SNAP-Ed) social marketing program.

METHODS

The study was qualitative and used social marketing principles to assess Native American women's views of health and nutrition. Focus groups (n = 8) and interviews (n = 4) were conducted to identify indigenous views of product, promotion, price, and place related to SNAP-Ed behavioral objectives.

RESULTS

The major theme identified for product was diabetes prevention. Participants (n = 42) indicated a preference for family-based education with promotion by elders, tribal leaders, and "everyday people." Participants identified tribe-specific community sites for program implementation at times conducive to work schedules.

CONCLUSIONS AND IMPLICATIONS

Culturally appropriate social marketing programs are necessary to address diabetes prevention with a focus on family, heritage, and tribal community. Additional research is necessary to explore the role of elders and tribal leaders in diabetes prevention efforts.

Toward an integrative framework of grandparental investment

This response outlines more reasons why we need the integrative framework of grandparental investments and intergenerational transfers that we advocated in the target article. We discusses obstacles – from misconceptions to poor measures – that stand in the way of such a framework and of a better understanding of the effects of grandparenting in the developed world. We highlight new research directions that have emerged from the commentaries, and we end by discussing some of the things in our target article about which we may have been wrong.

Adaptations to achieve physical activity in rural communities

This multiple, descriptive, explanatory case study design described and explained the perceptions of rural women regarding rural built environments conducive to physical activity. Sources of data included women's focus groups, city council focus groups, city administrator and clerk interviews, women's verification individual interviews, individuals referred to the researcher as individuals with perceived power, and analysis of documents. The study involved two rural communities with populations of 1,000 or less, and data were collected between March 2006 and April 2007. Content analysis of each data source and a combined data source analysis for each community was completed using NVivo7. Rural women adapted to conditions of built environments, seasonal concerns, wild animals, traffic control issues, other people, and personal needs. Adaptation emerged as a central theme in the women's focus groups as a way rural women engaged in physical activity.

Factors affecting low-income women's food choices and the perceived impact of dietary intake and socioeconomic status on their health and weight

OBJECTIVE

To investigate factors affecting food choice and health beliefs among low-income women in the context of their weight and socioeconomic status.

DESIGN

Two researchers conducted 14 90-minute focus groups, which were audiotaped.

SETTING

Libraries, homeless shelters, and a community center.

PARTICIPANTS

Ninety-two low-income women (18-65 years) with at least 1 child aged 9-13 years in the household.

MAIN OUTCOME MEASURES

Food choice and health beliefs of low-income women.

ANALYSIS

Transcripts were coded and reconciled; common themes and subthemes were identified.

RESULTS

Over 75% of participants were overweight/obese (body mass index [BMI] > or = 25), and most were in charge of purchasing and preparing food for their families. Health concerns included diabetes, hypertension, and overweight/obesity, and most felt their health status had genetic or metabolic origins. Although many would like to regularly consume healthful food (eg, fresh fruits and vegetables), such food was perceived as unaffordable.

CONCLUSIONS AND IMPLICATIONS

A disconnect between diet and health among low-income women calls for nutrition interventions that educate low-income families on inexpensive, healthful eating in a structured environment, and diet-disease relationships. Changes at a policy level should be considered to increase affordability and accessibility of healthful food in low-income neighborhoods and through federal food assistance programs.

A home-based nutrition and physical activity intervention for grandparents raising grandchildren: a pilot study

Five African American grandparents raising their grandchildren participated in a home-based nutrition and physical activity intervention. The primary goals were to increase grandparents' knowledge and skills in selecting and preparing healthy foods and to increase the grandparents' and grandchildren's physical activity levels. Results revealed that grandparents' concerns regarding their chronic diseases and desire to prevent health problems in their grandchildren served as motivators. Following the intervention, grandparents scored higher on nutrition and physical activity knowledge and their self-efficacy improved, although most health status indicators remained unchanged. Self-reported changes included walking more, reading food labels, and switching to a healthier type of fat.

Parent modeling: perceptions of parents' physical activity predict girls' activity throughout adolescence

OBJECTIVES

To determine whether parent modeling of physical activity (PA) has a differential impact on girls' PA by race, whether the association declines with time, and to assess the contribution of parent modeling to girls' activity relative to other potential predictors.

STUDY DESIGN

Longitudinal examination of parent modeling's impact on future log transformed metabolic equivalents (log METs) of leisure-time PA in 1213 African-American and 1166 Caucasian girls in the National Heart, Lung, and Blood Institute Growth and Health Study, from age 9 to 10 years through 18 to 19 years, using linear regression. Race interaction terms and time trends were examined.

RESULTS

Girls' perceptions of parent modeling significantly predicted future log METs in each study year; associations remained stable with time and were similar by race. Girls' perception of parent PA better predicted girl log METs than did parent self-report. On average, girls reporting that their parents exercised > or =3x/week were about 50% more active than girls with sedentary parents.

CONCLUSIONS

Girls' perception of parent activity predicts PA for girls throughout adolescence, despite age-associated decreases in PA. We did not find differences in this association by race. Interventions designed to increase parental activity may improve parent health, positively influence daughters' activity, and begin to address disparities in cardiovascular health.

Ecological differences in weight, length, and weight for length of Mexican American children in the WIC program

PURPOSE

Examine factors common in the environments of children who obtain services from a WIC program to determine if differences in ecological/environmental factors can be found in the children who differ in weight, length, and weight for length.

DESIGN AND METHODS

Cross-sectional study of 300 children, 100 each who were stunted, normal weight for length, or overweight. Instruments used were NCATS, ARSMA II, 24-hr diet recall, and Baecke Activity Questionnaire.

RESULTS

Significant differences were present in children's diet, parents' BMI, parents' generation in United States, parents' activity levels, and maternal-child relationship.

PRACTICE IMPLICATIONS

Encourage parents to adopt family approaches to encourage normal body size in children.

Factors associated with overweight in preschool-age children in southwestern France

BACKGROUND

Pediatric overweight and obesity are becoming an epidemic worldwide, which indicates the need for formulating preventive programs and policies during a child's early years.

OBJECTIVE

We identified factors associated with overweight in young children in southwestern France.

DESIGN

Children [n = 1780; x (+/-SD) age: 3.9 +/- 0.4 y] were recruited in kindergarten. Medical information on the parents, grandparents, and child as well as the child's 3-d dietary intake, participation in organized sports, and television-viewing habits were ascertained, and anthropometric measurements of the child were taken.

RESULTS

The prevalence of overweight was 9.1% when using body mass index >or= 90th percentile of French reference curves as a cutoff. In a multivariate logistic regression, overweight at 4 y was associated with female sex, having an overweight mother, and having >or=1 diabetic grandparent; odds ratios (ORs; 95% CIs) for these variables were 1.9 (1.2, 3.0), 2.2 (1.0, 4.7), and 2.6 (1.6, 4.1), respectively. Being small or large for gestational age was not associated with the risk of overweight at 4 y, whereas this risk was increased for children who were overweight at 9 or 24 mo: ORs (95% CIs) were 4.0 (2.4, 6.9) and 11.7 (6.1, 22.2), respectively. Nutrient intakes did not differ significantly with weight status in girls; however, overweight boys had significantly greater energy and lipid intakes than did their nonoverweight counterparts. Overweight was positively associated with television viewing (>1 h/d) in both sexes and with participation in organized sports in girls only.

CONCLUSIONS

A family history of overweight or diabetes, overweight in the first 2 y of life, and television viewing are associated with overweight at 4 y. These factors should be considered in developing programs for the prevention of overweight in early childhood.

Children's health in the rural environment

The rural environment is not as wholesome as some might think. In fact, smoking, drinking, illicit drug use, and obesity are more prevalent in rural than in urban youngsters. Childhood mortality is higher in rural areas, with drowning, motor vehicle accidents, firearm injuries, and farm machinery accidents as the leading causes. Air and water quality are monitored less and actually may be worse in the country than in urban areas. This article describes children's health problems associated with the rural environment and provides a list of resources for addressing these problems.

The nutrition transition in American Indians

The purpose of this article was to examine whether a nutritional transition has occurred among American Indians (AI) by evaluating related articles and government health statistics. Findings indicate that although the primary health risk for the AI population around 1970 was undernutrition, now there is an obesity epidemic among all age groups that is associated with a loss of traditional food practices and reduced physical activity. Deaths caused by cardiovascular disease, diabetes mellitus, and cancer have outpaced death from infectious disease. With abundant high-energy foods and limited physical activity, the acculturated environment has resulted in obesity and increased mortality from chronic diseases. To improve AI health and survival, the obesity epidemic must be approached in a concerted, culturally appropriate manner with encouragement of traditional foods and safe opportunities for physical activity.

Definitions of childhood obesity: current practice

OBJECTIVE

To review current practice in the definition of childhood obesity based on body mass index (BMI), in order to understand why the recommendations of the International Task Force on Obesity (IOTF) have not been fully adopted.

DESIGN

Literature search using MEDLINE to identify papers on childhood obesity published in the first 4 months of 2005, and a cited reference search on the recommendations of the IOTF.

RESULTS

Citations of the IOTF definition have increased since publication, but less than half of papers on childhood obesity published in the period used the definition. Most used the 95th centile of a national distribution to define obesity.

CONCLUSIONS

Reasons for using centiles of a national distribution included the need for z-scores or centiles to define underweight or extreme obesity, not available in conjunction with the IOTF definition, inclusion of children under 2 years, and concerns about over- or underestimation of the prevalence of obesity. None of these preclude use of the principle underlying the IOTF definition, that of continuity with the adult definition of BMI of 30 kg/m2 or more. Adoption of either the IOTF definition or corresponding centiles of a national distribution would enable comparisons of prevalence between countries and over time.