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Grafft N, Gago C, Garcia E, Aftosmes-Tobio A, Jurkowski JM, Blaine RE, Davison KK. Parent Experiences of Empowerment: Understanding the Role of Parent Empowerment in Child Health Promotion. FAMILY & COMMUNITY HEALTH 2024; 47:261-274. [PMID: 39158172 PMCID: PMC11335312 DOI: 10.1097/fch.0000000000000412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
BACKGROUND Establishing healthy behaviors during a child's first 5 years is essential for healthy growth. Parents are targeted as agents of change because they serve as primary models of behavior during this period. Although parent-focused interventions often target empowerment as a driver of change, our understanding of how parents experience the process of empowerment in the context of child health promotion remains limited. OBJECTIVE This qualitative study explored the process by which parents gain empowerment through participation in a health promotion intervention. METHODS Semi-structured interviews were conducted with 37 low-income parents who participated in Parents Connect for Healthy Living (PConnect), a 10-week empowerment-centered obesity prevention intervention. Data were analyzed using inductive-deductive thematic analysis and guided by empowerment theories. RESULTS Most parents were Hispanic/Latino (41%) and female (97%). Five themes emerged that correspond to the process by which parents gained empowerment: (1) friendships formed and relationships strengthened during PConnect, (2) parents strengthened relationships with their children and believed in their ability to parent successfully, (3) the experience of knowledge led to behavior change, (4) parents used new resources to improve family health, and (5) parents took action. CONCLUSION Empowerment theory should be a component of health promotion programs.
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Affiliation(s)
- Natalie Grafft
- Boston College School of Social Work, Chestnut Hill, Massachusetts (Mrs Grafft); Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts (Dr Gago); Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Ms Garcia); Boston College School of Social Work, Chestnut Hill, Massachusetts (Ms Aftosmes-Tobio); Health Policy, Management, & Behavior, University at Albany School of Public Health, Rensselaer, New York (Dr Jurkowski); Nutrition and Dietetics, Department of Family and Consumer Sciences, California State University Long Beach, Long Beach, California (Dr Blaine); and Boston College School of Social Work, Chestnut Hill, Massachusetts (Dr Davison)
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Gago CM, Jurkowski J, Beckerman-Hsu JP, Aftosmes-Tobio A, Figueroa R, Oddleifson C, Mattei J, Kenney EL, Haneuse S, Davison KK. Exploring a theory of change: Are increases in parental empowerment associated with healthier weight-related parenting practices? Soc Sci Med 2022; 296:114761. [PMID: 35123371 PMCID: PMC8894077 DOI: 10.1016/j.socscimed.2022.114761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Parent health-related empowerment is defined as the process by which parents realize control over their life situation and take action to promote a healthier lifestyle. For decades, researchers have described the theoretical potential of empowerment in health promotion efforts, though few have empirically examined this hypothesized relationship. This study is one of the first to examine the relationship between parental empowerment and healthy weight parenting practices (i.e., food, physical activity, sleep, and media parenting), as a mechanism for early childhood health promotion in community settings. METHODS Low-income parents of preschool-aged children attending Head Start in Greater Boston between fall 2017 and spring 2019 were invited to complete a survey in the fall and spring of each academic school year (n = 578 with two surveys and n = 45 with four). Parental empowerment and healthy weight parenting practices were assessed using validated surveys. We used a multilevel difference-in-difference approach to estimate changes in healthy weight parenting practices score by changes in parental empowerment score. RESULTS Out of a possible score of four, the unadjusted mean (SD) score in fall was 3.20 (0.40) for empowerment and 3.01 (0.40) for parenting. An increase in parental empowerment was associated with an increase in healthier parenting practices (b = 0.14; 95% CI = 0.08, 0.20; p < 0.0001). CONCLUSIONS Parent empowerment may be an important target in interventions to prevent obesity in low-income children.
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Affiliation(s)
- Cristina M Gago
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Janine Jurkowski
- Department of Health Policy, Management, and Behavior, State University of New York, Albany, NY, 12222, USA
| | | | | | - Roger Figueroa
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY, 14853, USA
| | - Carly Oddleifson
- School of Social Work, Boston College, Chestnut Hill, MA, 02467, USA
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Erica L Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Kirsten K Davison
- School of Social Work, Boston College, Chestnut Hill, MA, 02467, USA.
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Mado FG, Sirajuddin S, Muis M, Maria IL, Darmawansyah D, Arifin MA. Intervention empowerment of families in preventing and controlling overweight and obesity in children: A systematic review. J Public Health Res 2021; 10. [PMID: 33855425 PMCID: PMC8129762 DOI: 10.4081/jphr.2021.2185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/17/2021] [Indexed: 12/18/2022] Open
Abstract
There have been an increasing overweight and obesity in very anxious children. Furthermore, obesity is a condition that occurs due to the accumulation of excess or abnormal fat. This disorder is believed to be the most significant public health problem that affects children in the 21st century. This study aimed to examine the literature review, articles and research results analyzing the effectiveness of family or parent empowerment interventions through health education. Many research articles were searched on several databases such as PubMed and PreQuest, using the following keywords which include “family empowerment”, “overweight”, “obesity”, “health lifestyle”, “BMI”, “children”, “RCT” starting from 2014 to 2019. The searched results obtained 162 articles on family empowerment, overweight and obesity. Out of the 162 articles, 20 were selected that discussed family empowerment interventions for overweight and obesity. Critical analysis of the 20 articles was carried out based on design, sample, treatment, parameters, findings and conclusions. The literature review analysis showed that family empowerment interventions in the form of health education or promotion activities vary widely in terms of methods, components, duration, individuals involved, specificity and effectiveness. Furthermore, this intervention consists of training activities, courses, and teaching practices. Statistical analysis showed that all these methods significantly increased the ability and independence of the family in controlling overweight and obesity. In conclusion, health education interventions that are packaged in various programs are proven to significantly improve the ability of families or parents in preventing and controlling overweight and obesity in children. Significance for public health Overweight and obesity are disorders that occur as a result of the accumulation of nutrients and fats which exceeds the normal body weight. The presence of this disorders in school children is a major problem because it continues into adulthood and act as risk factors for the incidence of metabolic and degenerative diseases. The Prevention and therapy of obesity in children is carried out by regulating their diet, increasing their physical activities and changing their pattern of behavior. One of the effective way of preventing overweight and obesity is through a family-based approach. Family empowerment interventions through Health Education and behavior change ultimately prevents and controls overweight and obesity. This study describes the strong relationship between family empowerment interventions and the efforts to prevent and control overweight and obesity.
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Affiliation(s)
- Fransiskus Geroda Mado
- Hasanuddin University, Makassar; Faculty of Public Health, Nusa Cendana University, Kupang.
| | | | - Masyta Muis
- Faculty of Health Public, Hasanuddin University, Makassar.
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Figueroa R, Gago CM, Beckerman-Hsu J, Aftosmes-Tobio A, Yu X, Davison KK, Jurkowski JJ. Development and Validation of a Parental Health-Related Empowerment Scale with Low Income Parents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228645. [PMID: 33233860 PMCID: PMC7699877 DOI: 10.3390/ijerph17228645] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/20/2020] [Accepted: 11/18/2020] [Indexed: 01/21/2023]
Abstract
Objectives: Consistent with empowerment theory, parental empowerment acts as a mechanism of change in family-based interventions to support child health. Yet, there are no comprehensive, validated measures of parental health-related empowerment to test this important perspective. Informed by empowerment theory and in the context of a community-based obesity intervention, we developed a self-report measure of parental health-related empowerment and tested its preliminary validity with low-income parents. Methods: The Parental Empowerment through Awareness, Relationships, and Resources (PEARR) is a 21-item scale designed to measure three subdimensions of empowerment including resource empowerment, critical awareness, and relational empowerment. In the fall of 2017 or the fall of 2018, low-income parents (n = 770, 88% mothers) from 16 Head Start programs in Greater Boston completed the PEARR. The resulting data were randomly split into two equal samples with complete data. The factorial structure of the PEARR was tested in the first half of the sample using principal component analysis (PCA) and exploratory factor analysis (EFA) and subsequently confirmed with the second half of the sample using confirmatory factor analysis (CFA). Internal consistency coefficients were calculated for the final subscales. Results: Results from the PCA and EFA analyses identified three component factors (eigenvalues = 8.25, 2.75, 2.12) with all items loading significantly onto the hypothesized subdimension (β > 0.59 and p < 0.01). The three-factor model was subsequently confirmed with the second half of the sample using CFA (β > 0.54 and p < 0.01). Fit indices met minimum criteria (Comparative Fit Index = 0.95, Root Mean Square Error of Approximation = 0.05 (0.05, 0.06), Standardized Root-Mean-Square Residual = 0.05). Subscales demonstrated strong internal consistency (α= 0.83–0.90). Conclusions: Results support initial validity of a brief survey measuring parental empowerment for child health among Head Start parents. The PEARR can be utilized to measure changes in parental empowerment through interventions targeting empowerment as a mechanism of change.
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Affiliation(s)
- Roger Figueroa
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY 14853, USA
- Correspondence:
| | - Cristina M. Gago
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA; (C.M.G.); (X.Y.)
| | - Jacob Beckerman-Hsu
- School of Social Work, Boston College, Chestnut Hill, MA 02467, USA; (J.B.-H.); (A.A.-T.); (K.K.D.)
| | - Alyssa Aftosmes-Tobio
- School of Social Work, Boston College, Chestnut Hill, MA 02467, USA; (J.B.-H.); (A.A.-T.); (K.K.D.)
| | - Xinting Yu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA; (C.M.G.); (X.Y.)
| | - Kirsten K. Davison
- School of Social Work, Boston College, Chestnut Hill, MA 02467, USA; (J.B.-H.); (A.A.-T.); (K.K.D.)
| | - Janine J. Jurkowski
- Department of Health Policy, Management, and Behavior, University at Albany School of Public Health, State University of New York, Albany, NY 12144, USA;
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Interventions for obesity among schoolchildren: A systematic review and meta-analyses. PLoS One 2019; 14:e0209746. [PMID: 30625165 PMCID: PMC6326548 DOI: 10.1371/journal.pone.0209746] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 12/11/2018] [Indexed: 11/19/2022] Open
Abstract
Background Childhood overweight and obesity has emerged as a major public health threat worldwide with challenges in its management. This review assessed the effectiveness of interventions for childhood overweight and obesity. Methods A systematic literature search was conducted using CINAHL, EMBASE, Ovid MEDLINE, PsycINFO and SPORTDiscus databases to retrieve articles published from 1st January 2000 to 31st December 2017. Randomised controlled trials (RCTs) and quasi-experimental studies comparing different strategies in managing overweight and obesity among schoolchildren (6 to 12 years of age) were included. The main outcomes of interest were reductions in weight related variables included anthropometry and body composition measurements. All variables were analysed using random effects meta-analyses. Results Fourteen studies were reviewed, 13 were RCTs and one was a quasi-experimental study. The risk of bias for randomisation was low risk for all of RCTs except for one, which was unclear. The risk of bias for randomisation was high for the quasi-experimental study. Most interventions incorporated lifestyle changes and behavioural strategies such as coping and problem solving skills with family involvement. The meta-analyses did not show significant effects of the intervention in reducing weight related outcomes when compared with controls. Conclusion Meta-analyses of the selected studies did not show significant effects of the interventions on weight related outcomes among overweight and obese schoolchildren when compared with controls. The role of interdisciplinary team approaches with family involvement using behaviour and lifestyle strategies to curb obesity among schoolchildren is important.
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Tabak RG, Dsouza N, Schwarz CD, Quinn K, Kristen P, Haire-Joshu D. A formative study to understand perspectives of families eligible for a pediatric obesity program: a qualitative study. BMC Public Health 2018; 18:586. [PMID: 29720138 PMCID: PMC5932800 DOI: 10.1186/s12889-018-5466-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 04/16/2018] [Indexed: 12/14/2022] Open
Abstract
Background Raising Well® (RW) was initiated in 2015 by Envolve PeopleCare™ at the request of health plans seeking a solution to work with families on Medicaid that have a child with overweight or obesity. RW uses expert clinical coaches via phone contact to deliver an educational intervention promoting lifestyle change to families with at least one overweight or obese child in an eligible Medicaid health plan. This gives RW significant potential for reach and population impact. This project aimed to understand how to maximize this impact by exploring perspectives of RW, using a conceptual framework informed by the Conceptual Model of Implementation Research, including assessment of the feasibility, acceptability, and appropriateness of RW; determining satisfaction among those experiencing coaching; identifying reasons individuals do not participate; and developing recommendations to enhance interest and participation. Methods Semi-structured interviews were conducted with 70 RW-eligible families across four states, who were described as: active participants, respondents who dropped or stopped RW, and RW non-participants. Following the interviews, the transcripts were coded inductively and deductively using a grounded theory approach, considering themes from the conceptual framework; themes also emerged from the data. Results From this sample, 19 families reported to be active coaching participants, 24 had dropped coaching, and 27 were RW non-participants. A number of themes were identified. Feasibility themes included coaches’ flexibility and willingness to work with the family’s schedule. Acceptability themes suggest providing actionable strategies tailored to the family’s context and needs, beyond just nutrition information and tips, early in the coaching relationship so the family perceives a benefit for continued participation. With regard to appropriateness, families were also interested in other methods of communication including email, texting, and in person visits. Access to resources for activity and healthy eating in their local community was also recommended. Conclusions RW has the potential to improve health and promote wellness. To enhance the impact of this program, RW could incorporate these findings to promote feasibility, acceptability, and appropriateness and improve program implementation. Strategies may include modifying the information provided or the mode of delivering the information.
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Affiliation(s)
- Rachel G Tabak
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA.
| | - Nishita Dsouza
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Cynthia D Schwarz
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Karyn Quinn
- Envolve PeopleCare, 20 Batterson Park Road, Farmington, CT, 06032, USA
| | - Patricia Kristen
- Envolve PeopleCare, 20 Batterson Park Road, Farmington, CT, 06032, USA
| | - Debra Haire-Joshu
- The Brown School and The School of Medicine, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
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Taveras EM, Marshall R, Sharifi M, Avalon E, Fiechtner L, Horan C, Gerber MW, Orav EJ, Price SN, Sequist T, Slater D. Comparative Effectiveness of Clinical-Community Childhood Obesity Interventions: A Randomized Clinical Trial. JAMA Pediatr 2017; 171:e171325. [PMID: 28586856 PMCID: PMC6075674 DOI: 10.1001/jamapediatrics.2017.1325] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Novel approaches to care delivery that leverage clinical and community resources could improve body mass index (BMI) and family-centered outcomes. OBJECTIVE To examine the extent to which 2 clinical-community interventions improved child BMI z score and health-related quality of life, as well as parental resource empowerment in the Connect for Health Trial. DESIGN, SETTING, AND PARTICIPANTS This 2-arm, blinded, randomized clinical trial was conducted from June 2014 through March 2016, with measures at baseline and 1 year after randomization. This intent-to-treat analysis included 721 children ages 2 to 12 years with BMI in the 85th or greater percentile from 6 primary care practices in Massachusetts. INTERVENTIONS Children were randomized to 1 of 2 arms: (1) enhanced primary care (eg, flagging of children with BMI ≥ 85th percentile, clinical decision support tools for pediatric weight management, parent educational materials, a Neighborhood Resource Guide, and monthly text messages) or (2) enhanced primary care plus contextually tailored, individual health coaching (twice-weekly text messages and telephone or video contacts every other month) to support behavior change and linkage of families to neighborhood resources. MAIN OUTCOMES AND MEASURES One-year changes in age- and sex-specific BMI z score, child health-related quality of life measured by the Pediatric Quality of Life 4.0, and parental resource empowerment. RESULTS At 1 year, we obtained BMI z scores from 664 children (92%) and family-centered outcomes from 657 parents (91%). The baseline mean (SD) age was 8.0 (3.0) years; 35% were white (n = 252), 33.3% were black (n = 240), 21.8% were Hispanic (n = 157), and 9.9% were of another race/ethnicity (n = 71). In the enhanced primary care group, adjusted mean (SD) BMI z score was 1.91 (0.56) at baseline and 1.85 (0.58) at 1 year, an improvement of -0.06 BMI z score units (95% CI, -0.10 to -0.02) from baseline to 1 year. In the enhanced primary care plus coaching group, the adjusted mean (SD) BMI z score was 1.87 (0.56) at baseline and 1.79 (0.58) at 1 year, an improvement of -0.09 BMI z score units (95% CI, -0.13 to -0.05). However, there was no significant difference between the 2 intervention arms (difference, -0.02; 95% CI, -0.08 to 0.03; P = .39). Both intervention arms led to improved parental resource empowerment: 0.29 units (95% CI, 0.22 to 0.35) higher in the enhanced primary care group and 0.22 units (95% CI, 0.15 to 0.28) higher in the enhanced primary care plus coaching group. Parents in the enhanced primary care plus coaching group, but not in the enhanced care alone group, reported improvements in their child's health-related quality of life (1.53 units; 95% CI, 0.51 to 2.56). However, there were no significant differences between the intervention arms in either parental resource empowerment (0.07 units; 95% CI, -0.02 to 0.16) or child health-related quality of life (0.89 units; 95% CI, -0.56 to 2.33). CONCLUSIONS AND RELEVANCE Two interventions that included a package of high-quality clinical care for obesity and linkages to community resources resulted in improved family-centered outcomes for childhood obesity and improvements in child BMI. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02124460.
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Affiliation(s)
- Elsie M. Taveras
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
- Department of Nutrition, Harvard School of Public Health; Boston, MA
| | - Richard Marshall
- Department of Pediatrics, Harvard Vanguard Medical Associates, Boston, MA
| | - Mona Sharifi
- Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | | | - Lauren Fiechtner
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
- Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA
| | - Christine Horan
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Monica W. Gerber
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - E. John Orav
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Sarah N. Price
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | | | - Daniel Slater
- Department of Pediatrics, Harvard Vanguard Medical Associates, Boston, MA
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Fiechtner L, Puente GC, Sharifi M, Block JP, Price S, Marshall R, Blossom J, Gerber MW, Taveras EM. A Community Resource Map to Support Clinical-Community Linkages in a Randomized Controlled Trial of Childhood Obesity, Eastern Massachusetts, 2014-2016. Prev Chronic Dis 2017; 14:E53. [PMID: 28682745 PMCID: PMC5510302 DOI: 10.5888/pcd14.160577] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Novel approaches to health care delivery that leverage community resources could improve outcomes for children at high risk for obesity. Community Context We describe the process by which we created an online interactive community resources map for use in the Connect for Health randomized controlled trial. The trial was conducted in the 6 pediatric practices that cared for the highest percentage of children with overweight or obesity within a large multi-specialty group practice in eastern Massachusetts. Methods By using semistructured interviews with parents and community partners and geographic information systems (GIS), we created and validated a community resource map for use in a randomized controlled trial for childhood obesity. We conducted semistructured interviews with 11 parents and received stakeholder feedback from 5 community partners, 2 pediatricians, and 3 obesity–built environment experts to identify community resources that could support behavior change. We used GIS databases to identify the location of resources. After the resources were validated, we created an online, interactive searchable map. We evaluated parent resource empowerment at baseline and follow-up, examined if the participant families went to new locations for physical activity and food shopping, and evaluated how satisfied the families were with the information they received. Outcome Parents, community partners, and experts identified several resources to be included in the map, including farmers markets, supermarkets, parks, and fitness centers. Parents expressed the need for affordable activities. Parent resource empowerment increased by 0.25 units (95% confidence interval, 0.21–0.30) over the 1-year intervention period; 76.2% of participants were physically active at new places, 57.1% of participant families shopped at new locations; and 71.8% reported they were very satisfied with the information they received. Interpretation Parents and community partners identified several community resources that could help support behavior change. Parent resource empowerment and use of community resources increased over the intervention period, suggesting that community resource mapping should inform future interventions.
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Affiliation(s)
- Lauren Fiechtner
- Division of Gastroenterology and Nutrition, Massachusetts General Hospital for Children, 175 Cambridge St, 5th FL, Boston, MA 02114. .,Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Gabriella C Puente
- Columbia University, the College of Physicians and Surgeons, New York, New York
| | - Mona Sharifi
- Section of General Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Jason P Block
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Sarah Price
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | | | - Jeff Blossom
- Center for Geographic Analysis, Harvard University, Cambridge, Massachusetts
| | - Monica W Gerber
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts.,Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
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