Intergenerational and socioeconomic gradients of child obesity

The Accumulative Effect of Multiple Postnatal Risk Factors with the Risk of Being Overweight/Obese in Late Childhood

Most past studies focused on the associations of prenatal risk factors with the risks of childhood overweight/obesity. Instead, more postnatal risk factors are modifiable, with less knowledge of their cumulative effects on childhood obesity. We analyzed data of 1869 children in an Australian birth cohort. Key postnatal risk factors included: maternal and paternal overweight/obesity during the child's infancy, tobacco exposure, low family socioeconomic score, breastfeeding duration < 6 months, early introduction of solid foods, and rapid weight gain during infancy. The risk score was the sum of the number of risk factors. The primary outcome is overweight/obesity in late childhood (11-12 years); secondary outcomes are high-fat mass index (FMI), body fat percentage (BF%), and waist-to-height ratio (WHtR). Poisson regression models were used in the analyses. Children with higher risk scores had higher risks of overweight/obesity (p-for-trends < 0.001). After adjusting covariates, compared with those with 0-1 risk factors, children with 4-6 risk factors had 4.30 (95% confidence interval: 2.98, 6.21) times higher risk of being overweight/obesity; the relative risks for high FMI, BF%, and WHtR were 7.31 (3.97, 13.45), 4.41 (3.00, 6.50), and 6.52 (3.33, 12.74), respectively. Our findings highlighted that multiple postnatal risk factors were associated with increased risks of being overweight/obesity in late childhood.

Influence of Home Language Use on the Association Between Parent Education and Child Adiposity in Latino Families

BACKGROUND

Parent education and language use are associated with child obesity, but the impact of their interaction is less known. This study assessed whether parent education was associated with child adiposity and if this association was moderated by home language use in Latino families.

METHODS

Participants (n = 415) were Latino families from the Long Beach area. Demographic data were obtained by self-report parent surveys, and children's body size was objectively assessed via bioelectric impedance. Independent t-tests and hierarchical linear regressions were performed on baseline data from a larger intervention study.

RESULTS

In the overall sample, parent education and child body mass index (BMI) percentile were not related (p = .050). However, stratification by home language use revealed that parent education was inversely associated with child BMI percentile among those whose primary home language was Spanish (p = .049), but not English/bilingual homes (p = .296). There were no significant associations with child percent body fat.

CONCLUSION

Higher education was associated with a lower BMI percentile only in Spanish-speaking homes. Research to understand how home language influences this relationship is warranted, particularly as it relates to a subset of education and health literacy. Significant results with BMI percentile but not percent body fat highlight the fact that these distinct markers of obesity are not interchangeable.

The Contribution of the Underlying Factors to Socioeconomic Inequalities in Obesity: A Life Course Perspective

Objectives: Socioeconomic disparities in obesity have been observed in both childhood and adulthood. However, it remains unclear how the role of risk factors influencing these inequalities has evolved over time. Methods: Longitudinal data on 2,866 children and adolescents (6-17 years old) from the China Health and Nutrition Survey were used to track their BMI during childhood, adolescence, and adulthood. Concentration Index was utilized to measure socioeconomic inequalities in obesity, while Oaxaca decomposition was employed to determine the share of different determinants of inequality. Results: The concentration index for obesity during childhood and adulthood were 0.107 (95% CI: 0.023, 0.211) and 0.279 (95% CI: 0.203, 0.355), respectively. Changes in baseline BMI (24.6%), parental BMI (10.4%) and socioeconomic factors (6.7%) were found to be largely responsible for the increasing inequality in obesity between childhood and adulthood. Additionally, mother's education (-7.4%) was found to contribute the most to reducing these inequalities. Conclusion: Inequalities in obesity during childhood and adulthood are significant and growing. Interventions targeting individuals with higher BMI, especially those who are wealthy, can significantly reduce the gap.

Using electronic health record data to link families: an illustrative example using intergenerational patterns of obesity

OBJECTIVE

Electronic health record (EHR) data are a valuable resource for population health research but lack critical information such as relationships between individuals. Emergency contacts in EHRs can be used to link family members, creating a population that is more representative of a community than traditional family cohorts.

MATERIALS AND METHODS

We revised a published algorithm: relationship inference from the electronic health record (RIFTEHR). Our version, Pythonic RIFTEHR (P-RIFTEHR), identifies a patient's emergency contacts, matches them to existing patients (when available) using network graphs, checks for conflicts, and infers new relationships. P-RIFTEHR was run on December 15, 2021 in the Northwestern Medicine Electronic Data Warehouse (NMEDW) on approximately 2.95 million individuals and was validated using the existing link between children born at NM hospitals and their mothers. As proof-of-concept, we modeled the association between parent and child obesity using logistic regression.

RESULTS

The P-RIFTEHR algorithm matched 1 157 454 individuals in 448 278 families. The median family size was 2, the largest was 32 persons, and 247 families spanned 4 generations or more. Validation of the mother-child pairs resulted in 95.1% sensitivity. Children were 2 times more likely to be obese if a parent is obese (OR: 2.30; 95% CI, 2.23-2.37).

CONCLUSION

P-RIFTEHR can identify familiar relationships in a large, diverse population in an integrated health system. Estimates of parent-child inheritability of obesity using family structures identified by the algorithm were consistent with previously published estimates from traditional cohort studies.

Associations between socioeconomic status and risk of obesity and overweight among Chinese children and adolescents

BACKGROUND

In China, the threat of obesity and overweight in children and adolescents is developing quickly. It may be possible to lower the risk of obesity and overweight in children and adolescents by understanding the factors that drive these conditions. Therefore, this study aimed to investigate the association between SES and risk of obesity and overweight among children and adolesecnts in China's provinces of Jiangsu, Anhui, Zhejiang, and Shanghai.

METHODS

Chinese children and adolescents (n = 2,746; 46.3% boys) were recruited using multistage sampling. SES was measured using self-reported questionnaires, the specific indicators were parental education, perceived family wealth, and Family Affluence Scale II. Height and weight were measured and used to calculate body mass index (BMI, categorized into obesity or overweight). The definition of obesity or overweight was based on the Chinese standard "Screening for obesity and overweight among school-age children and adolescents". Descriptive statistics, independent sample t-tests, and a Chi-square test were used to report the sample characteristics and analyse BMI differences across different sociodemographic groups. A binary logistic regression was then applied to analyse the association of SES indicators with BMI in children and adolescents.

RESULTS

Overall, 22.5% of children and adolescents were obese or overweight. Participants with medium and high maternal education levels were 1.48 [95% CI 1.15-1.91] and 1.47 [95% CI 1.03-2.11] times more likely to be obese/overweight. Girls with medium maternal education levels were 1.70[95% CI 1.21-2.40] times more likely to be obese/overweight. For boys, no association was observed. Junior middle school students with medium maternal education levels were 1.51[95% CI 1.10-2.07] times more likely to be obese/overweight. Participants with medium or high FAS, perceived family wealth, or paternal education levels were not associated with obesity/overweight.

CONCLUSIONS

The findings of this study indicated a positive association between SES and risk of overweight/obesity in girls, suggesting that maternal education level may have a substantial impact on future prevention efforts for these conditions in girls. To increase the effectiveness of interventions, longitudinal studies are necessary to better understand the causal association between SES and obesity/overweight.

The Autonomous Capacity of the Elderly Population in Spain for Shopping and Preparing Meals

A loss of the ability to buy and prepare meals, especially in people aged 65 and over, leads to a deterioration in their optimal level of nutrition. The Index of Autonomy in Food Acquisition (IAFA) was used to identify contributing factors. This is a composite indicator for shopping and meal preparation that can be used to assess the degree of autonomous capacity observed in a specific group. Data from the European Health Survey in Spain (7167 respondents aged 65 and over) show that capacity decreased with age and that women were less affected than men, with very little difference found in levels of autonomous capacity by territory. However, in relation to different income levels, after standardizing for age and sex, no evidence was found for differences in the ability to access and prepare meals in groups that were separated by income level. This result shows the importance of standardizing when analysing food acquisition autonomy in groups of people aged 65 years and over.

Grandchild care, inadequate medical insurance protection, and inequalities in socioeconomic factors exacerbate childhood obesity in China

This study examines the influences of grandchild care and medical insurance on childhood obesity. Nationally representative longitudinal data-from the China Family Panel Studies 2010-2020-of 26,902 school-age children and adolescents aged 6-16 years and China's new reference standard ("WS/T586-2018") are used to identify a child's obesity status. Using binary mixed-effects logistic regression models and the Blinder-Oaxaca decomposition method, this study explores the roots of obesity inequalities and finds that at least 15% of Chinese children aged 6-16 were obese in the 2010s. The logistic regression analysis results indicate that grandchild care, public medical insurance, and commercial medical insurance are key risk factors of child obesity. However, the influences are heterogeneous in different groups: Grandchild care and public medical insurance increase urban-rural obesity inequalities because of a distribution effect, and grandchild care may also exacerbate children obesity inequalities between left-behind and non-left-behind children owing to the event shock of parental absence. Inequalities in socioeconomic status (SES) factors such as income, education, and region also cause obesity inequalities. These results indicate that child obesity and its inequalities are rooted in multidimensional environmental inequalities, including medical protection policies and its benefit incidence; intergenerational behavior and family SES factors; and urban-rural and left-behind risk shocks. This study provides new evidence for the development of population-based interventions and equitable medical insurance policies to prevent the deterioration of child obesity among Chinese school-age children and adolescents.

Association between maternal and paternal employment and their children's weight status and unhealthy behaviours: does it matter who the working parent is?

Background

The growing number of employed women has been associated with an increase in the prevalence of overweight and obesity in children. We sought to determine whether childhood overweight/obesity in Spain is associated with labour participation of mothers and fathers, and whether the identity of the main caregiver has an influence on child’s weight and unhealthy behaviour.

Methods

We used microdata from the 2010 and 2014 Health Behaviour in School-Aged Children surveys performed in Spain (n = 32,694). Logistic and linear multi-level regression models were applied to assess the association between parental employment and children’s self-reported weight status, accounting for school effects and controlling for socioeconomic factors. Separated binary models were also fitted for consumption of fruit, sweets, screen viewing and sedentarism.

Results

In most cases, the significant associations between children’s weight and their parents’ work status disappeared once the models were adjusted for family wealth and education. However, we found persistent associations for some groups. Girls under 13 years-old living in households where the mother was the only employed parent were more likely to be affected by obesity and to report a higher body mass index value. Children in this type of household were more likely to show unhealthy lifestyles related to diet and leisure time activities.

Conclusions

Parents’ socioeconomic characteristics had a protective effect on their children’s risk of obesity. Unhealthy behaviours were observed in households with a non-working father and a working mother, although the link with obesity was limited to girls. Our results suggest the need for a more equally shared burden of caregiving.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13735-3.

Inequality in health opportunities in Indonesia: long-term influence of early-life circumstances on health

Background

This study explores inequality of opportunity in terms of the health of adult Indonesian people, associated with household and parental circumstances in childhood and adolescence.

Methods

Exploiting the longitudinal nature of the Indonesian Family Life Survey, this study measures inequalities relating to being underweight, overweight, hypertensive and diabetic across adult Indonesians aged between 20 and 35 through the dissimilarity index. This study explores their determinants by decomposing the observed inequality levels into contributing factors. Moreover, this study sheds light on the underlying mechanisms through which early-life circumstances influence the health of grown-up respondents, by estimating the intermediate effects of early-life circumstances on current lifestyles.

Results

For all health conditions, health risks are unequally distributed (all p<0.01). Demographic factors and parental health are major contributors to inequalities relating to being underweight, overweight and hypertensive. Family structure and parental occupation are major contributors to inequality in diabetes. The greater part of this inequality is explained by the indirect pathways through which early-life circumstances mediate current diet and exercise habits.

Conclusions

The results suggest that such interventions that compensate for disadvantaged early-life circumstances would be essential in reducing future health risks and mitigating health inequality.

Supplementary Information

The online version contains supplementary material available at (10.1186/s12889-022-13714-8).

Style of meal service and feeding practices among Mexican American fathers and mothers: An analysis of video-recorded children's evening mealtime at home

The aim of this study was to examine video-recorded observations of evening family mealtime at home among Mexican American children to help elucidate style of meal service, fathers' and mothers' feeding practices and child's eating behavior. Consistent with guidelines for coding behaviors, we analyzed observational data of evening mealtimes of 71 Mexican American children aged eight to 10 years. Regarding style of meal service, in almost all cases (96%), parents plated the child's food, with more available on the table or counter in 40% of the observations. Mothers almost always served the child (94%). Regarding parental feeding practices, parents used positive involvement in meals (80%), pressure to eat (42%) and restriction of food (9%). Using food as a reward to control behavior was never used by either parent. The majority (75%) of children requested or negotiated to eat less food, or only eat certain items. In Mexican American families, both mothers and fathers play a role in family mealtimes and both use positive involvement in child's meals, and to a lesser extent pressure to eat, with their children aged eight to 10 years. To help reduce the obesity epidemic, intervention strategies are needed, which integrate the family, a plating style of meal and parental feeding practices that promote healthy eating in the home. To reduce obesity among Mexican American children, interventions that focus on parental positive involvement in child's meal and maintenance of home cooked meals could have a positive impact on the entire family.

Developing an integrated microsimulation model for the impact of fiscal policies on child health in Europe: the example of childhood obesity in Italy

BACKGROUND

We developed an integrated model called Microsimulation for Income and Child Health (MICH) that provides a tool for analysing the prospective effects of fiscal policies on childhood health in European countries. The aim of this first MICH study is to evaluate the impact of alternative fiscal policies on childhood overweight and obesity in Italy.

METHODS

MICH model is composed of three integrated modules. Firstly, module 1 (M1) simulates the effects of fiscal policies on disposable household income using the tax-benefit microsimulation program EUROMOD fed with the Italian EU-SILC 2010 data. Secondly, module 2 (M2) exploits data provided by the Italian birth cohort called Nascita e Infanzia: gli Effetti dell'Ambiente (NINFEA), translated as Birth and Childhood: the Effects of the Environment study, and runs a series of concatenated regressions in order to estimate the prospective effects of income on child body mass index (BMI) at different ages. Finally, module 3 (M3) uses dynamic microsimulation techniques that combine the population structure and incomes obtained by M1, with regression model specifications and estimated effect sizes provided by M2, projecting BMI distributions according to the simulated policy scenarios.

RESULTS

Both universal benefits, such as universal basic income (BI), and targeted interventions, such as child benefit (CB) for poorer households, have a significant effect on childhood overweight, with a prevalence ratio (PR) in 10-year-old children-in comparison with the baseline fiscal system-of 0.88 (95%CI 0.82-0.93) and 0.89 (95%CI 0.83-0.94), respectively. The impact of the fiscal reforms was even larger for child obesity, reaching a PR of 0.67 (95%CI 0·50-0.83) for the simulated BI and 0.64 (95%CI 0.44-0.84) for CB at the same age. While both types of policies show similar effects, the estimated costs for a 1% prevalence reduction in overweight and obesity with respect to the baseline scenario is much lower with a more focalised benefit policy than with universal ones.

CONCLUSIONS

Our results show that fiscal policies can have a strong impact on childhood health conditions. Focalised interventions that increase family income, especially in the most vulnerable populations, can help to prevent child overweight and obesity. Robust microsimulation models to forecast the effects of fiscal policies on health should be considered as one of the instruments to reach the Health in All Policies (HiAP) goals.

Influence of parental physical activity on offspring's nutritional status: an intergenerational study in the 1993 Pelotas birth cohort

OBJECTIVE

To investigate the influence of parental physical activity on offspring's nutritional status in the 1993 Pelotas (Brazil) birth cohort.

DESIGN

Birth cohort study.

SETTING

The main outcomes were overweight and obesity status of children. The main exposure was parental physical activity over time, measured during the 11, 15 and 18 years of age follow-ups. The exposure was operationalised as cumulative, and the most recent measure before the birth of child. We adjusted Poisson regression models with robust variance to evaluate crude and adjusted associations between parental physical activity and offspring's nutritional status. All analyses were stratified according to the sex of the parent.

PARTICIPANTS

A total of 874 members from the 1993 Pelotas (Brazil) birth cohort followed-up at 22 years of age with their first-born child were analysed.

RESULTS

Children were, on average, 3·1 years old. Crude analyses showed that the mother's cumulative physical activity measure had an indirect association with the prevalence of children's obesity. The most recent maternal physical activity measure before the birth of the child was associated with 41 % lower prevalence of obesity in children, even after adjustment for confounders.

CONCLUSIONS

The most recent maternal physical activity measure was indirectly associated with the prevalence of obesity in children. No associations were found for fathers, reinforcing the hypothesis of a biological effect of maternal physical activity on offspring's nutritional status.

Maternal stress during pregnancy and children's diet: Evidence from a population of low socioeconomic status

OBJECTIVES

This study examined the relationship between maternal exposure to stress during pregnancy and children's food preferences and diet in a population of low socioeconomic status.

METHODS

Indices of exposure to stress were constructed based on retrospective self-reported experience of stressful events during pregnancy (e.g., death of close family member, relationship difficulties, legal issues, health issues, financial issues, or other potentially stressful event[s]). Data were collected for >200 mothers of a low socioeconomic status with a child age 2 to 12 y. Data on mothers' body mass index, current exposure to stress, current diet, and diet during pregnancy were collected at the same time, as well as data on children's food preferences and current diet as reported by the mothers. Indices of the healthiness of food preferences and diet were constructed and used as outcome variables.

RESULTS

Maternal exposure to stress during pregnancy significantly predicts children's food and taste preferences, as well as their diet, in regression models controlling for maternal diet, current maternal stress, and demographic characteristics of both the child and mother. Higher average stress during pregnancy is linked with significantly less healthy food preferences and diet, as well as with weaker preferences for sour and bitter foods. This relationship is observed across different age groups.

CONCLUSIONS

Maternal exposure to stress during pregnancy could have long-term detrimental effects on dietary outcomes and thereby on health conditions related to diet. Prenatal care and preconception counseling could be critical to develop preventive strategies to improve public health.

Parent perspectives on preschoolers' movement and dietary behaviours: a qualitative study in Soweto, South Africa

OBJECTIVE

Childhood obesity is of increasing concern in South Africa, and interventions to promote healthy behaviours related to obesity in children are needed. Young children in urban low-income settings are particularly at risk of excess adiposity. The current study aimed to describe how parents of preschool children in an urban South African township view children's movement and dietary behaviours, and associated barriers and facilitators.

DESIGN

A contextualist qualitative design was utilised with in-depth interviews conducted in the home setting and analysed using reflexive thematic analysis. Field notes were used to contextualise findings.

SETTING

Four neighbourhoods in a predominantly low-income urban township.

PARTICIPANTS

Sixteen parents (fourteen mothers, two fathers) of preschool-age children were recruited via preschools.

RESULTS

Four themes were developed: children's autonomy and the limits of parental control; balancing trust and fears; the appeal of screens; and aspirations and pressures of parenthood. Barriers to healthy behaviours included children's food preferences, aspirations and pressures to consume unhealthy foods, other adults giving children snacks, lack of safe places to play, unhealthy food environments and underlying structural factors. Facilitators included set routines, the preschool environment, safe places to play and availability of healthy foods.

CONCLUSIONS

Low-income families in Soweto face many structural challenges that cannot easily be addressed through public health interventions, but there may be opportunities for behavioural interventions targeting interpersonal and organisational aspects, such as bedtime routines and preschool snacks, to achieve positive changes. More research on preschoolers' movement and dietary behaviours, and related interventions, is needed in South Africa.

Adolescent Obesity Modeling: A Framework of Socio-Economic Analysis on Public Health

Bayesian Structural Equation Modeling (SEM-Bayesian) was applied across different research areas to model the correlation between manifest and latent variables. The primary purpose of this study is to introduce a new framework of complexity to adolescent obesity modeling based on adolescent lifestyle through the application of SEM-Bayesian. The introduced model was designed based on the relationships among several factors: household socioeconomic status, healthy food intake, unhealthy food intake, lifestyle, body mass index (BMI) and body fat. One of the main contributions of this study is from considering both BMI and body fat as dependent variables. To demonstrate the reliability of the model, especially in terms of its fitting and accuracy, real-time data were extracted and analyzed across 881 adolescents from secondary schools in Tehran, Iran. The output of this study may be helpful for researchers who are interested in adolescent obesity modeling based on the lifestyle and household socioeconomic status of adolescents.

Parental unemployment during the Great Recession and childhood adiposity

The incidence of adiposity in the early years of life has outgrown the prevalence in older children and adolescents globally; however, the factors influencing weight gain are predominantly studied in adults. This study examines the relationship between changing economic conditions during the Irish recession and child weight in a nationally representative sample of 10,011 Irish children studied at 9 months, 3 years and 5 years old. This study is the first to use longitudinal anthropometric measurements to estimate the impact of direct parental unemployment on children's weight. Fixed effect logistic regression is used to examine the effects of parental unemployment on weight using the Growing up in Ireland infant cohort from 2008 to 2013. Weight and length/height measured by trained interviewers and child growth charts are used to quantify children's weight status according to BMI-for-age and weight-for-age measures. For BMI-for-age, the probability of a child being classified as overweight/obese is 8 percentage points higher if either parent experiences unemployment. A sensitivity analysis of weight-for-age indicates that the probability is of similar magnitude across several alternative growth charts and definitions of adiposity (the WHO standard, British Growth Reference, and Centers for Disease Control). The analysis is repeated, cross-sectionally, for physical activity and diet to clarify mechanisms of effect. The probability of a child consuming healthy food and physical activity with an implied cost is lower if either parent becomes unemployed. A focus on overweight/obesity in the early years is of crucial importance as if current trends are not addressed, a generation of children may grow up with a higher level of chronic disease.

Is the intergenerational transmission of overweight 'gender assortative'?

Using almost two decades worth of data from the Health Survey for England, that contain representative records of clinically measured weight and height, this paper studies whether parents and children's overweight (including obesity) is 'gender assortative'. Our findings suggest that the intergenerational transmission of parent's overweight differs by children's sex and is statistically different for fathers and mothers. Gender assortative overweight is stronger among pre-school age and school-aged children. The parent-child associations are large and precisely estimated, heterogeneous by children's age and sex and stronger among white children and children of older parents. These results suggest there is a gender assortative intergenerational association of overweight.

Can shorter mothers have taller children? Nutritional mobility, health equity and the intergenerational transmission of relative height

This study develops the concept of nutritional mobility, defined here as the probability that a mother ranked low in her cohort's height distribution will have a child who attains a higher rank order. We demonstrate that rank-order regression provides a robust metric of health equity, revealing differences in opportunities for each child to reach their own growth potential. We estimate four indicators of nutritional mobility and test for associations between nutritional mobility and various local economic and environmental factors. Nutritional mobility has improved over time, and the nutrition environment contributes about 2.86 times as much as a mother's height to her child's expected rank in height-for-age. Populations with the least mobility are in Latin America, and the most mobility is in more urbanized areas of Africa and Asia. Rank-order mobility is an important aspect of health equity, offering valuable insight into the role of socioecological factors in nutrition improvement across generations.

A Bayesian spatio-temporal analysis of neighborhood pediatric asthma emergency department visit disparities

Asthma disparities have complex, neighborhood-level drivers that are not well understood. Consequently, identifying particular contextual factors that contribute to disparities is a public health goal. We study pediatric asthma emergency department (ED) visit disparities and neighborhood factors associated with them in South Carolina (SC) census tracts from 1999 to 2015. Leveraging a Bayesian framework, we identify risk clusters, spatially-varying relationships, and risk percentile-specific associations. Clusters of high risk occur in both rural and urban census tracts with high probability, with neighborhood-specific associations suggesting unique risk factors for each locale. Bayesian methods can help clarify the neighborhood drivers of health disparities.

Linking Mediterranean Diet and Lifestyle with Cardio Metabolic Disease and Depressive Symptoms: A Study on the Elderly in Europe

Against a backdrop of an aging population in Europe, promoting health in older adults becomes a pressing issue. This study aimed to explore if correlations exist between the adherence to the Mediterranean diet and specific health outcomes such as the incidence of chronic cardio metabolic illnesses and experiencing depressive symptoms for elderly individuals. We also looked into probable links between regularly engaging in vigorous physical activities and these health outcomes. Our goal was to clearly demonstrate these relationships while controlling for several individual characteristics and socio-demographic factors on a cross-national scale within Europe. Using the Survey of Health, Aging and Retirement in Europe (SHARE) data for adults aged 50 years and above, we found that following the Mediterranean diet was negatively correlated with the incidence of chronic illnesses, as well as with levels of depressive symptoms. These results were robust to the inclusion of a number of individual and socio-demographic controls. We also showed that regular participation in sports and other strenuous physical activities were associated with lesser chronic disorders and lower levels of depressive symptoms. These findings may have important implications in formulating preventive interventions on ensuring the quality of life of the older population.

Poverty and other correlates of obesity and underweight among 7-year-olds from Croatia and Montenegro

OBJECTIVES

This study aimed at investigating poverty and other correlates of childhood underweight and obesity in two urban regions with lower (Podgorica, Montenegro) and higher economic development (Osijek, Croatia).

STUDY DESIGN

Comparative study.

METHODS

A comparative study was conducted on 693 children (52% boys), aged 7 years old (224 from Podgorica and 469 from Osijek). Parents completed the study-specific questionnaire on relevant factors for children's nutritional status. We measured children's height and weight and calculated their body mass index (BMI). International Obesity Task Force cut-off values of BMI were used to assess children's nutritional status. Subjective social position was assessed by the Mac Arthur scale.

RESULTS

There were more underweight children in Osijek compared with Podgorica, both among boys (5.5% vs. 1.6%) and girls (6.9% vs. 1.0%). Obesity was more frequent in Podgorica than Osijek, both among boys (11.3% vs. 5.9%) and girls (10.0% vs. 4.3%). However, poverty in two cities diminished observed differences in children's nutritional status. The odds for child underweight decreased by 12.2%, while the odds for obesity increased by 3.6% per each paternal BMI unit. The frequency of child obesity was lowered per each step higher on the Mac Arthur scale and with breastfeeding by 23.2% and 68.0%, respectively.

CONCLUSIONS

We show that a higher economic development is related to less obese children but more underweight children. However, poverty seems to impact nutritionally all children equally, regardless of the regional economic development. Paternal and not maternal BMI is relevant for both extremes in children's nutritional status. Breastfeeding and higher social position independently protect from child obesity.

State-of-the-Science Review of Non-Chemical Stressors Found in a Child's Social Environment

Background: Children are exposed to chemical and non-chemical stressors from their built, natural, and social environments. Research is needed to advance our scientific understanding of non-chemical stressors, evaluate how they alter the biological response to a chemical stressor, and determine how they impact children’s health and well-being. To do this, we conducted a state-of-the-science review of non-chemical stressors found in a child’s social environment. Methods: Studies eligible for inclusion in this review were identified through a search of the peer-reviewed literature using PubMed and PsycINFO. Combinations of words associated with non-chemical stressors and children were used to form search strings. Filters were used to limit the search to studies published in peer-reviewed journals from 2000–2016 and written in English. Publications found using the search strings and filters went through two rounds of screening. Results: A total of 146 studies met the inclusion criteria. From these studies, 245 non-chemical stressors were evaluated. The non-chemical stressors were then organized into 13 general topic areas: acculturation, adverse childhood experiences, economic, education, family dynamics, food, greenspace, neighborhood, social, stress, urbanicity, violence, and other. Additional information on health outcomes, studies evaluating both chemical and non-chemical stressors, and animal studies are provided. This review provides evidence that non-chemical stressors found in a child’s social environment do influence their health and well-being in both beneficial (e.g., salutatory effects of greenspace and social support) and adverse (e.g., poor relationships between health and selected non-chemical stressors such as economics, educational attainment, exposure to violence, stress) ways. Conclusions: This literature review identified a paucity of studies addressing the combined effects of chemical and non-chemical stressors and children’s health and well-being. This literature review was further complicated by inconsistencies in terminology, methodologies, and the value of non-chemical stressor research in different scientific disciplines. Despite these limitations, this review showed the importance of considering non-chemical stressors from a child’s social environment when addressing children’s environmental health considerations.

Protecting children's health in a calorie-surplus context: Household structure and child growth in the United States

Studies from the social and health sciences have tended to view the household as the locus of access to and distribution of care, resources, monitoring and modeling for children's wellbeing. Obesity may present a special case for the study of investments in children, being a component of health for which more of certain inputs may not lead to better outcomes. We expanded on common measures of household structure in the child health literature by considering co-residence and relatedness of parents, grandparents, other relatives, and other children. Data were from a longitudinal sample of 6,700 children participating in the Early Childhood Longitudinal Study Kindergarten Class of 1998-99 (ECLS-K), the largest U.S. national dataset with measures of child anthropometrics and household structure at seven time-points over nine years. We used lagged survey-adjusted regressions to estimate associations between household structure and subsequent changes in children's weight between ages 5 and 14 years in terms of BMI gain and incident obesity. Adjusting for household structure more thoroughly, children living in households with two parents rather than one parent did not experience advantages in terms of less excess weight gain or lower incidence of obesity during elementary and middle school. Children living with a grandmother gained more weight than children not living with a grandmother. Living with siblings and with non-related adults was associated with less weight gain. These findings corroborate a scenario in which, for health problems associated with caloric surplus, classic household factors have more complex associations with child wellbeing.

Income, Race and its Association with Obesogenic Behaviors of U.S. Children and Adolescents, NHANES 2003-2006

OBJECTIVES

To describe the associations of income and race with obesogenic behaviors and % body fat among a large sample of U.S. children and adolescents.

DESIGN

Data were obtained from the 2003-2004 and 2005-2006 National Health and Nutritional Examination Survey. Multiple linear regression models and interactions were used to examine the associations of moderate-to-vigorous physical activity (MVPA), sedentary time, diet quality, and screen-time with income-to-poverty ratio and race. Separate stratified analyses explored associations among individual obesogenic behaviors within race and income groups.

RESULTS

This study included children and adolescents (n = 3551, mean = 13.1 years, SD = 3.9 years) who were 37% Hispanic, 27% White, and 35% Black. Overall, Hispanic children/adolescents had significantly higher levels of adiposity (3.6, 95 CI = 0.9, 6.3) than white children and adolescents. Medium-income children and adolescents engaged in less MVPA (- 3.3 min, 95 CI = - 5.1, - 1.5), had poorer diet quality (- 1.1, 95 CI = - 1.9, - 0.2), and used screens less (- 33.9 min, 95 CI = - 45.4, - 22.4) than children and adolescents from low-income households. High-income children and adolescents also engaged in less MVPA (- 3.1 min, 95 CI = - 5.5, - 0.7) and used screens less (- 62.9 min, 95 CI = - 78.3, - 47.4) than children and adolescents from low-income households. However, there were significant race/ethnicity-by-income interactions for high-income Hispanic children and adolescents with diet quality (- 3.5 HEI-2010 score, 95 CI = - 6.6, - 0.4) and screen time (66.9 min, 95 CI = 24.7, 109.0). There was also a significant race/ethnicity-by-income interaction for the screen-time of Black children and adolescents from medium (33.8 min, 95% CI 0.2, 67.3) and high (75.8 min, 95% CI 34.7, 117.0) income households.

CONCLUSIONS

There appears to be a complex relationship that varies by race/ethnicity between income, obesogenic behaviors, and adiposity levels among children and adolescents. More work is needed to identify the behavioral mechanisms that are driving disparate rates of overweight and obesity among minority children and those from low-income households.

Spanish Version of the Family Health Behavior Scale: Adaptation and Validation

Different studies around the world indicate that the percentages of overweight and obesity in childhood and adolescence are high. In this context, it would be useful to have a common, valid, and reliable instrument to assess health behaviors of families that allows comparisons of data from different countries. The objective is the adaptation of a Spanish version of the Family Health Behavior Scale (FHBS). The questionnaire originally developed by Moreno group was translated and adapted following the International Test Commission protocol. Its psychometric properties were evaluated through analysis of internal consistency, factor analysis and other evidences of validity. The Spanish version of the FHBS demonstrated adequate reliability coefficients, and its factor structure sufficiently replicated that obtained by the original measurement. The results suggested that the adapted version of the questionnaire was an adequate and valid measure for the evaluation of family health behaviors related to the prevention of overweight and obesity.

Ego-centered relative neighborhood deprivation and reported dietary habits among youth

Dietary habits are important precursors of childhood obesity. Youths' dietary habits may be constrained by the experience of deprivation due to social (e.g., family purchasing power) and physical (e.g., availability of fast food outlets in low-income neighborhoods) factors limiting dietary choices. This study considers whether a Yitzhaki-based index of ego-centered relative neighborhood deprivation explains dietary outcomes (i.e., reported healthful and unhealthful food consumption), adjusting for absolute deprivation. The Yitzhaki index takes into account the total incomes to which a youth is deprived in relation to a meaningful reference group, and the youth's position in the cumulative income distribution of this meaningful reference group. The study also considers whether the impact of deprivation on dietary outcomes is moderated by the experience of symptoms of depression. There was some indication that reported healthful food consumption was highest for youth who experienced low absolute deprivation (p ≤ 0.01) and low symptoms of depression (p ≤ 0.01), but high relative deprivation (p ≤ 0.001). These youth therefore appear to benefit from being both "better-off", and living among "better-off" individuals. The results for reported unhealthful food consumption were less robust. The results may therefore suggest that youth who are not detrimentally impacted by their relative deprivation, and who have the financial means to access healthful foods, have improved dietary outcomes. The findings suggest that while absolute deprivation plays a key role in explaining healthful food consumption, additional insights can be gleaned from considering youths' relative deprivation and indicators of their well-being.

Can the sociology of social problems help us to understand and manage 'lifestyle drift'?

Lifestyle drift is increasingly seen as a barrier to broad action on the social determinants of health. The term is currently used in the population health literature to describe how broad policy initiatives for tackling inequalities in health that start off with social determinants (upstream) approach drift downstream to largely individual lifestyle factors, as well as the general trend of investing a the individual level. Lifestyle drift occurs despite the on-going efforts of public health advocates, such as anti-obesity campaigners, to draw attention to the social factors which shape health behavior and outcomes. In this article, we explore whether the sociology of social problems can help understand lifestyle drift in the context of obesity. Specifically, we apply Jamrozik and Nocella's residualist conversion model to the problem of obesity in order to explore whether such an approach can provide greater insight into the processes that underpin lifestyle drift and inform our attempts to mitigate it.

Child Nutritional Status in the Changing Socioeconomic Region of the Northern Amazon, Brazil

The living conditions (i.e., socioeconomic, healthcare-related, nutritional, and environmental) to which children are exposed may influence their ability to reach their optimal growth potential. This review focuses on the relationship between the nutritional status of children under five years of age and social and environmental factors in Northern Brazil. Children living in this region have limited access to healthcare and face precarious socioeconomic and environmental conditions. This analysis was based on data from national health surveys, the consolidated food, nutrition surveillance system (SISVAN), and indicators of the DPSEEA (driving force, pressure, state, exposures, health effects, and actions) framework. The northern region has the worst living conditions in the country, and children under five years of age have significant height-for-age, weight-for-age, and weight-for-height deficits. Concomitantly, the prevalence of children who are overweight has increased significantly, although it remains lower than that in more developed Brazilian regions. Insufficient and/or inadequate dietary practices and early exposure to unfavorable living conditions are risk factors for nutritional deviations. Further advances in public health policies that consider regional characteristics, particularly in the north, where progress has been slower, are needed.

Does high optimism protect against the inter-generational transmission of high BMI? The Cardiovascular Risk in Young Finns Study

OBJECTIVE

The transmission of overweight from one generation to the next is well established, however little is known about what psychosocial factors may protect against this familial risk. The aim of this study was to examine whether optimism plays a role in the intergenerational transmission of obesity.

METHODS

Our sample included 1043 participants from the prospective Cardiovascular Risk in Young FINNS Study. Optimism was measured in early adulthood (2001) when the cohort was aged 24-39years. BMI was measured in 2001 (baseline) and 2012 when they were aged 35-50years. Parental BMI was measured in 1980. Hierarchical linear regression and logistic regression were used to examine the association between optimism and future BMI/obesity, and whether an interaction existed between optimism and parental BMI when predicting BMI/obesity 11years later.

RESULTS

High optimism in young adulthood demonstrated a negative relationship with high BMI in mid-adulthood, but only in women (β=-0.127, p=0.001). The optimism×maternal BMI interaction term was a significant predictor of future BMI in women (β=-0.588, p=0.036). The logistic regression results confirmed that high optimism predicted reduced obesity in women (OR=0.68, 95% CI, 0.55-0.86), however the optimism × maternal obesity interaction term was not a significant predictor (OR=0.50, 95% CI, 0.10-2.48).

CONCLUSIONS

Our findings supported our hypothesis that high optimism mitigated the intergenerational transmission of high BMI, but only in women. These findings also provided evidence that positive psychosocial factors such as optimism are associated with long-term protective effects on BMI in women.

Exploring the intergenerational persistence of health behaviour: an empirical study of smoking from China

Background

It is of significance to look into the intergenerational transmission of risk behaviour to explain the disparity of health. Our paper contributes to the literature by providing evidence in the context of China, focusing on smoking behaviour.

Methods

This paper studies the intergenerational transmission of smoking in the context of China using a nationally representative dataset – the China Health and Nutrition Survey (CHNS). The two-part model, the Tobit model, and the fixed effects model are utilized for the empirical analysis, respectively.

Results

We found a strong intergenerational persistence of health behaviour. That is, parents’ smoking behaviour is positively correlated with their children’s smoking initiation.

Conclusions

Our study provides evidence of the intergenerational persistence of health behaviour in the case of smoking, in the world’s most populous country. This has policy implications for the issue of intergenerational mobility and health education, as well as for tobacco control in China.

The Weight of Inequality: Socioeconomic Status and Adolescent Body Mass in Brazil

The high rate of obesity among adolescents is a global public health problem that has recently expanded to affect middle- and low-income countries. Brazil, which is undergoing a relatively rapid nutrition transition and has inadequate health systems, is currently experiencing the consequences of increasing rates of overweight and obesity concomitantly with the consequences of generations of malnourishment. Given this scenario, Brazil is an ideal context for examining the relationship between family socioeconomic status (SES) and adolescent body mass, as well as how this relationship varies across very different regions within the same country and across the body mass index (BMI) continuum. Guided by a framework that integrates nutrition transition and fundamental cause theories, we use unique nationally representative data with measured height and weight for all household members to conduct quantile regression models. The results suggest that family socioeconomic conditions are important theoretical factors associated with adolescent BMI, but that the way in which family SES impinges on adolescent BMI varies across regions characterized by different locations in the nutrition transition and varying levels of economic development. We also find that family socioeconomic disadvantages operate very differently according to BMI status. The results show that the socioeconomic gradient of adolescent BMI varies by stages of the nutrition transition and economic development and across BMI percentiles.

Influence maternal background has on children's mental health

BACKGROUND

In this paper, we aim to discern how a mother's health and her socioeconomic determinants may influence her children's mental health. In addition to this, we also evaluate the influence of other household characteristics and whether or not the economic downturn has heightened the effect a parent's social gradient has on their children's mental health.

METHODS

We use samples comprised of 4-14-year-old minors from the 2006 Spanish National Health Survey (SNHS), undertaken prior to the crisis, and the 2011 SNHS, carried out during the crisis. The participating children's mental health is assessed using the Strengths and Difficulties Questionnaire (SDQ). Mixed models are used to evaluate the influence a mother's health and her socioeconomic status may have on her children's mental health. We also add interactions to observe the effect specific socioeconomic determinants may have had during the economic downturn.

RESULTS

The risk of a child suffering from mental health disorders increases when their mother has mental health problems. Socioeconomic determinants also play a role, as a low socioeconomic status (SES) increases the risk of a child exhibiting behavioural problems, being hyperactive or antisocial, whereas when a mother has attained a high level of education, this significantly reduces the probability of a child having mental health problems. 'Homemaker' is the activity status most positively related to children's mental health. The findings show that the Spanish economic downturn has not significantly changed children's mental health problems and the negative effects of low maternal SES are no greater than they were before the crisis. The main difference in 2011, with respect to 2006, is that the risk of children suffering from mental health problems is higher when their parents are (long or short-term) unemployed.

CONCLUSIONS

In conclusion, both a mother's health and her socioeconomic status, as well as other household characteristics, are found to be related to her children's mental well-being. Although the crisis has not significantly changed mental health disorders in children or the social gradient of parents in general, at-risk children are the most negatively affected in the Spanish economic downturn.

Child physical development in the UK: the imprint of time and socioeconomic status

OBJECTIVES

Social health inequalities remain a key policy challenge. The existing literature has not presented a synthetic view on the evolution of inequalities in physical development across childhood. We examine social disparities as children grow older using a range of different outcomes.

STUDY DESIGN

Population-based secondary data analysis.

METHODS

We employ longitudinal data on British children aged 9 months to 12 years from the Millennium Cohort Study (n = 13,811-18,987) and focus on multiple child physical measures: weight, body mass index (BMI), overweight, fat mass and waist circumference.

RESULTS

Higher family income is associated with lower BMI (for females), less body fat and a smaller likelihood of overweight (for both genders) on average throughout childhood. When income is multiplied by 3, the probability of overweight decreases by 2.8 (95% CI -0.041 to -0.016) percentage points for females and by 2.7 (95% CI -0.038 to -0.016) percentage points for males. Social inequalities in weight, BMI, overweight and body fat significantly widen as children grow older, for both genders. For instance, for females, when income is multiplied by 3, the probability of overweight decreases by 1.6 (95% CI -0.032 to -0.000) percentage points at ages 2-3 years, but by 8.6 (95% CI -0.112 to -0.060) percentage points at ages 10-12 years.

CONCLUSIONS

The trajectory of social inequalities, which may reflect the cumulative effect of family socioeconomic status, is a precursor of inequalities in adulthood.

BAD TIMES, SLIMMER CHILDREN?

Although the majority of the literature has confirmed that recessions are beneficial for adults' health and babies' outcomes at delivery, this effect should not necessarily be the same for children. In this paper, we study the effect of business cycle conditions on infant underweight, overweight, and obesity. We exploit eight waves of repeated cross-sectional data (1987-2012) of the Spanish National Health Survey for children aged 2-15 and use the regional unemployment rate of the trimester of the interview as a proxy for the business cycle phase at the local level. We find that an increase in the unemployment rate is associated with lower obesity incidence, especially for children under 6 years old and over 12 years old. However, economic shocks also proof to have potentially negative consequences as they increase the prevalence of infant underweight for the same age groups. Moreover, we show that the possible mechanisms through which the cycle is impacting infant obesity is the nutritional composition of the children's diet, as well as, increases in the frequency of exercise. We provide some evidence that suggests that the impact of business cycle conditions on infant weight disorders have little objective health consequences in the short run. However, the potential long-term effects may become important as underweight during childhood is associated with worse outcomes later in life. Copyright © 2016 John Wiley & Sons, Ltd.

High perceived social support protects against the intergenerational transmission of obesity: The Cardiovascular Risk in Young Finns Study

AIMS

Our aims were to assess whether offspring social support moderates the relationship between parental body mass index (BMI) and offspring BMI.

METHODS

A prospective design was used with an analytic sample of 1049 participants from Finland (the offspring) who were 35-50years old in 2012 when adulthood BMI was measured. Parental BMI was self-reported at baseline in 1980. Offspring social support was measured in 2007 when participants were 30-45years old. Linear and logistic regression was used to examine whether there was an interaction between parental BMI and offspring social support when predicting offspring BMI in adulthood. An analysis of simple slopes and multilevel growth curve modeling were used to further examine the interaction.

RESULTS

The interaction between maternal BMI and offspring social support was significantly and negatively related to offspring BMI in adulthood (β=-0.068, R(2) change=0.005, p=0.015) in the fully adjusted model which also adjusted for parental occupational status and offspring depressive symptoms. The logistic regression supported these results, with the interaction between maternal overweight (BMI≥25kg/m(2)) and offspring social support negatively associated with offspring overweight in adulthood (odds ratio=0.74, 95% confidence interval, 0.56 to 0.98). The growth curve analysis further demonstrated that high maternal BMI predicts more rapidly rising offspring BMI in those reporting low social support compared to high social support.

CONCLUSIONS

Our results suggest that social support protects against the intergenerational transmission of obesity and therefore presents an important opportunity for obesity prevention efforts.

Maternal correlates of body mass index in American Indian/Alaska Native and White adolescents: Differences between mother/son and mother/daughter pairs

INTRODUCTION

Obesity rates for American Indian and Alaska Native (AI/AN) adolescents are among the highest in the US. However, little is known about the influence of maternal correlates on adolescent body mass index (BMI), and the extent to which the size and significance of these correlates vary by adolescent sex and race.

METHODS

We conducted a cross-sectional analysis with a sample of 531 AI/AN and 8896 White mother/adolescent pairs from Wave 1 of the National Longitudinal Study of Adolescent to Adult Health. We used generalized estimating equations to measure the association of maternal educational attainment, marital status, employment status, obesity status, and adolescent BMI of AI/AN and White adolescents, while controlling for adolescents' demographic and behavioral covariates. We sought to determine whether the size and statistical significance of maternal correlates differed by race, and between mother/son and mother/daughter pairs.

RESULTS

The strength and statistical significance of maternal correlates varied between mother/son and mother/daughter pairs in both races. However, we did not find effect modification by race. Maternal obesity showed the strongest effect on adolescent BMI in all mother/adolescent pairs.

CONCLUSION

Our findings suggest that maternal factors are critical in the transmission of obesogenic behaviors from one generation to the next, and their effects vary between mother/son and mother/daughter pairs, and are similar for AI/ANs and Whites. We encourage future work aimed at preventing adolescent obesity to investigate causal pathways between maternal correlates and adolescent BMI.

Why are poorer children at higher risk of obesity and overweight? A UK cohort study

Background: There is limited evidence on which risk factors attenuate income inequalities in child overweight and obesity; whether and why these inequalities widen as children age. Method: Eleven thousand nine hundred and sixty five singletons had complete data at age 5 and 9384 at age 11 from the Millennium Cohort Study (UK). Overweight (age 5 : 15%; age 11 : 20%) and obesity (age 5 : 5%; age 11 : 6%) were defined using the International Obesity Taskforce body mass index cut-points. To measure socioeconomic inequalities, we used quintiles of family income and as risk factors, we considered markers of maternal health behaviours and of children’s physical activity, sedentary behaviours and diet. Binary and multinomial logistic regression models were used. Results: The unadjusted analyses revealed stark income inequalities in the risk of obesity at age 5 and 11. At age 5, children in the bottom income quintile had 2.0 (95% CI: 1.4–2.8) increased relative risk of being obese whilst at age 11 they had 3.0 (95% CI: 2.0–4.5) increased risk compared to children in the top income quintile. Similar income inequalities in the risk of overweight emerged by age 11. Physical activity and diet were particularly important in explaining inequalities. Income inequalities in obesity and overweight widened significantly between age 5 and 11 and a similar set of risk factors protected against upward and promoted downward movements across weight categories. Conclusions: To reduce income inequalities in overweight and obesity and their widening across childhood the results support the need of early interventions which take account of multiple risk factors.

Socioeconomic position and childhood-adolescent weight status in rich countries: a systematic review, 1990-2013

Background

Childhood obesity is a major problem in rich countries due to its high prevalence and its harmful health consequences. An exploratory analysis conducted in the PubMed database highlighted that the number of papers published on the relationship between socioeconomic position (SEP) and childhood-adolescent weight status had risen substantially with respect to an earlier review which had covered the period 1990–2005.

Methods

To describe the findings on the relationship between SEP and childhood-adolescent weight status in papers published in rich countries from 1990 through 2013, studies were identified in the following databases: PubMed; Web of Knowledge (WOK); PsycINFO; Global Health; and Embase. We included observational studies from the 27 richest OECD countries, which covered study populations aged 0 to 21 years, and used parental education, income and/or occupation as family SEP indicators. A total of 158 papers met the inclusion criteria and reported 134 bivariable and 90 multivariable analyses.

Results

Examination of the results yielded by the bivariable analyses showed that 60.4 % of studies found an inverse relationship, 18.7 % of studies did not found relationship, and 20.9 % of studies found a relationship that varied depending on another variable, such as age, sex or ethnic group; the corresponding percentages in the multivariable analyses were 51.1, 20.0 and 27.8 %, respectively. Furthermore, 1.1 % found a positive relationship.

Conclusion

The relationship between SEP and childhood-adolescent weight status in rich countries is predominantly inverse and the positive relationship almost has disappeared. The SEP indicator that yields the highest proportion of inverse relationships is parents’ education. The proportion of inverse relationships is higher when the weight status is reported by parents instead using objective measurements.

Electronic supplementary material

The online version of this article (doi:10.1186/s12887-015-0443-3) contains supplementary material, which is available to authorized users.

Postpartum Teens' Perception of the Food Environments at Home and School

BACKGROUND

An environment that supports healthy eating is one factor to prevent obesity. However, little is known about postpartum teen's perceptions of their home and school environments and how this relates to dietary behaviors.

PURPOSE

This study explores the relationship between home and school environments and dietary behaviors for postpartum teens.

DESIGN

Conducted cross-sectionally during 2007-2009 across 27 states and included 889 postpartum teens enrolled in Parents as Teachers Teen Program. Data included measures of sociodemographics and perceptions of school and home food environments. A 7-day recall of snack and beverage frequency assessed dietary behaviors. Logistic regression explored associations between baseline environment measures and dietary behaviors at baseline and postintervention (approximately 5 months after baseline) for the control group.

RESULTS

Respondents reported greater access and selection (i.e., variety of choices) of healthy foods and beverages at home than school. At baseline, fruit and vegetable intake was associated with home selection (1.9, 95% confidence interval [CI: 1.3, 2.9]) and availability (1.8, 95% CI [1.3, 2.6]), sweet snack consumption was associated with selection (1.5, 95% CI [1.0, 2.1]), and total snack consumption and sugar-sweetened beverage intake were associated with selection (snack: 2.1, 95% CI [1.5, 3.0]; beverage: 1.7, 95% CI [1.2, 2.4]) and availability (snack: 2.1, 95% CI [1.4, 3.1]; beverage: 1.5, 95% CI [1.0, 2.3]). Water intake at baseline and at the postintervention for control group teens was associated with selection (1.6, 95% CI [1.1, 2.2]). No significant associations were identified between the school environment and dietary behaviors.

CONCLUSIONS

Interventions should target improvements in the home environment for high-risk, postpartum teens.

Poor, Unsafe, and Overweight: The Role of Feeling Unsafe at School in Mediating the Association Among Poverty Exposure, Youth Screen Time, Physical Activity, and Weight Status

This study applied socioecological and cumulative risk exposure frameworks to test the hypotheses that 1) the experience of poverty is associated with feeling less safe at school, and 2) feeling less safe is associated with engaging in poorer weight-related behaviors, as well as an increased probability of being overweight or obese. Data were from the ongoing Québec Longitudinal Study of Child Development, initiated in 1998 with a population-based cohort of 2,120 Québec (Canada) infants 5 months of age and their parent or primary caregiver. Measures of youths' (age, 13 years) self-reported feelings of safety, screen time, physical activity, and objectively assessed not overweight/obese (70%), overweight (22%), and obese (8%) weight status were collected in 2011. Family poverty trajectory from birth was assessed by using latent growth modeling. As hypothesized, exposure to poverty was associated with feeling less safe at school and, in turn, with an increased probability of being overweight or obese. The association was most pronounced for youths who experienced chronic poverty. Compared with youths who experienced no poverty and felt unsafe, those who experienced chronic poverty and felt unsafe were nearly 18% more likely to be obese (9.2% vs. 11.2%). Although feeling unsafe was associated with screen time, screen time did not predict weight status.

Association between childhood obesity and use of regular medications in the UK: longitudinal cohort study of children aged 5-11 years

OBJECTIVES

Increasing rates of childhood obesity have been suggested as a possible cause for the increasing prevalence of chronic conditions among adults and children. Few studies have examined whether obese children are more likely to use medications than normal weight children. We investigate this association in the UK.

DESIGN

A panel study with repeated observations at ages 5, 7 and 11.

SETTING

A general population sample drawn from the Millennium Cohort Study, a UK-based birth cohort.

PARTICIPANTS

A sample of 9667 children.

PRIMARY AND SECONDARY OUTCOME MEASURES

Our primary outcomes were crude and adjusted probabilities of taking any regular medications and the number of medications among overweight and obese children compared with normal weight children. Our secondary outcome was the distribution of medication use by therapeutic classification across body mass index (BMI) groups.

RESULTS

Obese children were more likely to use any medication (marginal effect (ME)=0.02, 95% CI 0.01 to 0.03) and to use more medications (ME=0.08, 95% CI 0.04 to 0.12) than normal weight children. Obese children used more medications for respiratory conditions than those of other BMI groups.

CONCLUSIONS

Obese children are more likely to use regular medications and have comorbid conditions, even at young ages. This suggests that the cost of prescriptions should be considered when evaluating the economic burden of childhood obesity and that preventative strategies to reduce childhood obesity could be cost-effective in the short as well as in the long term. While more research is needed, both clinicians and policymakers should be aware of these findings when planning prevention and treatment strategies.

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

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

Race/ethnic disparities in early childhood BMI, obesity and overweight in the United Kingdom and United States

OBJECTIVE

Racial/ethnic patterning in the risk of obesity and overweight has been observed in early childhood; however, little research has compared these disparities between the United Kingdom (UK) and United States (US) using detailed ethnic classifications. We use comparable nationally representative cohort studies to examine racial/ethnic disparities in mean body mass index (BMI) and in the odds of obesity/overweight in the UK and US. The contribution of sociodemographic, cultural and family routine factors are assessed.

METHODS

Data on BMI, obesity and overweight in 5-year-old children from the MCS (Millennium Cohort Study) and ECLS-B (Early Childhood Longitudinal Study, Birth Cohort) were examined. We investigated race/ethnic disparities in mean BMI and in the odds of obesity and overweight, as compared to normal weight. We assessed the independent contribution of sociodemographic, cultural and family routine factors to observed disparities.

RESULTS

In the UK, after adjustment for sociodemographic, cultural and family routine factors and maternal BMI, we found Black Caribbean children to have higher odds ratio (OR=1.7, confidence interval (CI)=1.1-2.6), Pakistani children to have lower odds of obesity (OR=0.60, CI=0.37-0.96) and Black African children were more likely to be overweight (OR=1.40, CI=1.04-1.88). In the US, in fully adjusted models, there were no race/ethnic disparities in children's odds of obesity and overweight.

CONCLUSION

Disparities for Bangladeshi children in the UK and Mexican, other Hispanic and American Indian children in the US can be explained by socioeconomic disadvantage, whereas a range of cultural and family characteristics partially explain disparities for other groups in the UK. Future public health initiatives focused on reducing risk of overweight and obesity should consider the diverse socioeconomic and cultural profiles of all race/ethnic groups.

The evaluation of the impact of a stand-biased desk on energy expenditure and physical activity for elementary school students

Due to the increasing prevalence of childhood obesity, the association between classroom furniture and energy expenditure as well as physical activity was examined using a standing-desk intervention in three central-Texas elementary schools. Of the 480 students in the 24 classrooms randomly assigned to either a seated or stand-biased desk equipped classroom, 374 agreed to participate in a week-long data collection during the fall and spring semesters. Each participant’s data was collected using Sensewear^® armbands and was comprised of measures of energy expenditure (EE) and step count. A hierarchical linear mixed effects model showed that children in seated desk classrooms had significantly lower (EE) and fewer steps during the standardized lecture time than children in stand-biased classrooms after adjusting for grade, race, and gender. The use of a standing desk showed a significant higher mean energy expenditure by 0.16 kcal/min (p < 0.0001) in the fall semester, and a higher EE by 0.08 kcal/min (p = 0.0092) in the spring semester.