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

Prediction models for children/adolescents with obesity/overweight: A systematic review and meta-analysis

The incidence of obesity and overweight in children and adolescents is increasing worldwide and becomes a global health concern. This study aims to evaluate the accuracy of available prediction models in early identification of obesity and overweight in general children or adolescents and identify predictive factors for the models, thus provide a reference for subsequent development of risk prediction tools for obesity and overweight in children or adolescents. Related publications were obtained from several databases such as PubMed, Embase, Cochrane Library, and Web of Science from their inception to September 18th, 2022. The novel Prediction Model Risk of Bias Assessment Tool (PROBAST) was employed to assess the bias risk of the included studies. R4.2.0 and Stata15.1 softwares were used to conduct meta-analysis. This study involved 45 cross-sectional and/or prospective studies with 126 models. Meta-analyses showed that the overall pooled index of concordance (c-index) of prediction models for children/adolescents with obesity and overweight in the training set was 0.769 (95% CI 0.754-0.785) and 0.835(95% CI 0.792-0.879), respectively. Additionally, a large number of predictors were found to be related to children's lifestyles, such as sleep duration, sleep quality, and eating speed. In conclusions, prediction models can be employed to predict obesity/overweight in children and adolescents. Most predictors are controllable factors and are associated with lifestyle. Therefore, the prediction model serves as an excellent tool to formulate effective strategies for combating obesity/overweight in pediatric patients.

Aggressive parenting behavior among grandparents providing childcare for grandchildren: A case study of Shenzhen, China

BACKGROUND

Grandparents play an essential role in childrearing and fill the parenting gap for dual-earner Chinese families. Many Chinese grandparents engage heavily in childcare, which may increase the risk of child abuse.

OBJECTIVE

This study aimed to examine grandparental use of psychological and physical aggression toward children and explore its associated risk factors.

PARTICIPANTS AND SETTING

This was a cross-sectional study which involved purposive sampling of 278 grandparents (204 females and 74 males) taking care of at least one grandchild below 18 years old in Shenzhen, China.

METHODS

Information on childcare was collected, including grandparents' use of psychological and physical aggression and their involvement in childcare in terms of intensity and activity.

RESULTS

An alarming percentage (57.1 %) of grandparents had used psychological aggression, while 26.5 % had used corporal punishment, in the past year. The average use of psychological aggression and corporal punishment was 16.10 times and 10.08 times per year, respectively. Grandparents taking care of two or more grandchildren were more likely to use psychological aggression and corporal punishment compared to those taking care of only one grandchild. Higher mental and physical health summary scores were associated with lower likelihood of psychological and physical aggression of grandparents.

CONCLUSIONS

This study advances our understanding of negative grandparenting behavior in childcare. As grandparents play a significant role in childcare, we need to improve their grandparenting skills, provide more formal childcare services to ease their childcare burden, and support their physical and mental well-being to reduce the risk of child abuse.

Caregiver Concern About Child Overweight/Obesity in Grandparent Versus Parent-Headed Households in the United States

OBJECTIVE

To examine the association of caregivers' concern about children's overweight and obesity status with family structure (grandparent versus parent-headed households).

METHODS

Caregivers reported their relation to the child aged 10 to 17 years and the child's weight and height (National Survey of Children's Health 2016-20). Overweight/obesity was calculated using Centers for Disease Control and Prevention growth charts. We estimated associations (prevalence odds ratio) of residing in a grandparent-headed household with lack of weight concern (responding "Yes, it's too low" or "No, not concerned" to "Are you concerned about this child's weight?") among propensity score-matched children with overweight and obesity. Covariates included child's sex, race, ethnicity, age, family poverty ratio, primary household language, highest level of education among reported adults, caregiver mental and emotional health, usual source of care and survey year.

RESULTS

The prevalence of child overweight/obesity was higher in grandparent-headed households. Among children with overweight/obesity, 64.65 (SE = 3.27)% of grandparents and 66.55 (SE = 0.81)% of parents did not express concern about the child's weight status. Among children with obesity, it was 52.42 (SE = 4.63)% and 49.04 (SE = 1.28)%, respectively. Family structure was not associated with caregiver lack of weight concern in propensity score-matched samples.

CONCLUSIONS

Appropriate caregiver concern about child's weight status was low in both grandparent and parent-headed households in the United States.

The association of grandparental co-residence and dietary knowledge with excess body weight among children aged 7-15 years in China

OBJECTIVES

To investigate the impact of grandparent's co-residence and dietary knowledge on the overweight and obesity risk among school-age children in China.

METHODS

Data of 790 children aged 7-15 years were retrieved from the China Health and Nutrition Survey (CHNS). Co-residential status was evaluated using household and individual ID. Dietary knowledge was assessed using 17 dietary statements, which was scored by participants. Three principal factors were extracted by factor analysis. Logistic regression analysis was applied to examine the influence of grandparent's co-residence and dietary knowledge on the weight status of the child.

RESULTS

The overweight and obesity incidence of the children increased significantly when they co-reside with two grandparents (OR=1.447, 95CI: 1.001-2.090, p=0.049). Mother's dietary knowledge regarding to protein-related food choices (PT) scored higher was associated with the increased risk (OR=1.270, 95CI: 1.059-1.523, p=0.010). For grandmother's dietary knowledge, the higher score in balanced food consumption (BF) was associated with the decreased overweight and obesity risk (OR=0.456, 95CI: 0.294-0.706, p<0.001). Grandfather's dietary knowledge in BF showed the similar result (OR=0.454, 95CI: 0.271-0.759, p=0.003).

CONCLUSIONS

Living with two grandparents is associated with higher overweight and obesity risk, but grandparents with an adequate knowledge in the balanced food consumption may decrease the risk.

Low-income mothers' perspectives on the involvement of family members in child feeding

Nearly all research on child feeding has focused on mothers. Very little is known about other family members' roles in feeding children nor how mothers engage with these family members regarding child feeding. The objective of this study was to examine mothers' perceptions of other family members' child feeding roles and practices within low-income families, including the challenges experienced and strategies employed by mothers when sharing responsibility for child feeding. Low-income mothers (n = 100) of pre-adolescent children participated in semi-structured interviews regarding child feeding including shared responsibility for child feeding. A content analysis was then conducted to identify main themes in mothers' responses, with three main themes arising from the interviews. First, many family members were actively involved in child feeding and food-related decision-making. The majority of mothers (85%) reported that another family member was involved in feeding their child including fathers and father figures, who were involved in feeding in 63% of families. Other family members, mainly grandparents, were involved in feeding in 35% of families. Mothers identified several concerns regarding their child's eating when with other family members, particularly when grandparents fed children. Finally, mothers employed several strategies to control their children's eating when children were cared for by other family members. Future interventions to promote healthy child feeding among low-income families may benefit from helping mothers negotiate child feeding with other family members, particularly grandparents, and supporting family members' engagement in child feeding.

Influence of Grandparental Child Care on Childhood Obesity: A Systematic Review and Meta-Analysis

Objective: This study systematically reviewed the scientific literature on the relationship between grandparental child care and childhood obesity. Methods: Keyword/reference search was performed in CINAHL, PsycINFO, PubMed, and Web of Science. Meta-analysis was conducted to estimate the pooled effect of grandparental child care on children's weight outcomes. Results: A total of 23 studies were identified, including 9 longitudinal, 9 cross-sectional, 2 case-control, and 3 qualitative studies. Eight studies were conducted in China, five in Japan, three in the United Kingdom, two in the United States, and one in five other countries each. Twelve studies focused on grandparents' roles as a main caregiver in the family, and seven on grandparents' co-residence. Data from 14 studies were used in meta-analysis, 10 focusing on childhood overweight/obesity and the other 4 on children's BMI z-scores. Meta-analysis found that grandparental child care was associated with a 30% (95% confidence interval = 21-40) increase in childhood overweight/obesity risk. Grandparental child care was not associated with children's BMI z-scores after correcting for publication bias. Meta-regressions revealed no difference in the estimated effect of grandparental child care on children's weight outcomes by country or grandparents' specific roles (main caregiver in the family vs. co-residence). Conclusions: Preliminary evidence links grandparental child care to elevated risk of childhood overweight/obesity, but not BMI z-scores. Future research should focus on a specific child age group within a country, adopt systematic and field-validated measures on grandparental child care, and elucidate the pathways linking grandparental child care to children's weight outcomes.

Obesity and Stunting in Childhood. Do Grandparents Play A Role? A Systematic Review

Introduction: Obesity and stunting in childhood has become one of the greatest global health challenges. The impact of this issue is serious and lasting for individuals, their families, communities and countries. Most of the studies on child weight status have only focused on the mother as the primary caregiver, whereas the role and influence of the grandparents has received less attention. Grandparent-provided child care has become a trend in many countries, with reported rates of approximately 40% to 58%. The objective of this systematic review was to analyze whether children become stunted or obese when they are cared for by their grandparents.Methods: The methodological search of the literature was conducted using Scopus, Science Direct, PubMed, Pro Quest and ResearchGate, and it was undertaken using PRISMA guidelines. The search identified 1803 papers and 135 full-text articles were screened for eligibility. Finally, 15 met the inclusion criteria. The keyword chain was as follows: ("obesity" OR "stunting") AND (“children”) AND (“grandparents”).Results: As grandparents take on increasingly responsible roles in the lives of their grandchildren, there is an influence on the higher risk of child obesity rather than stunting.Conclusion: In future, nurses should target not only the mother but also the grandparents to control their child’s health, especially when related to their weight status.

The relationship between body shape perception and health behaviors among Korean normal-weight adolescents using Korea Youth Risk Behavior Web-Based Survey

Inappropriate adolescent health behavior can be influenced by the negative impact of physical and mental health promotion. Obesity influences subjective improper weight perception. This study aimed to verify Korean normal-weight adolescents' subjective experience of weight control, mental health, physical activity, and subjective status based on their body mass index (BMI). As a result, efforts to control weight appeared less in normal-weight boys. Thin girls were less likely to carry out 60 min of physical activity 7 or 5 days per a week. Obese boys were less likely to carry out vigorous physical activity 3 days per a week. Normal-weight girls were less likely to practice muscular strength training 3 days per a week. Thin boys and thing girls were less likely to practice regular physical activity, and less likely to practice at the rate stipulated in the sedentary behavior guideline. In conclusion, boys and girls with inappropriate weight perception reported feeling stressed and depressed, and reported subjective sleep fulfillment, perceived subjective happiness, and perceived subjective health.

How do grandparents influence child health and development? A systematic review

Grandparents are often a key source of care provision for their grandchildren, yet they are sidelined in caregiving research and policy decisions. We conducted a global, systematic review of the literature to examine the scope and quality of studies to date (PROSPERO database CRD42019133894). We screened 12,699 abstracts across 7 databases, and identified 206 studies that examined how grandparents influence child health and development. Indicators of grandparent involvement were contact, caregiving behaviors, and financial support. Our review focused on two research questions: how do grandparents influence child health and development outcomes, and what range of child outcomes is reported globally? We examined study design, sample characteristics, key findings, and outcomes pertaining to grandchildren's physical health, socio-emotional and behavioral health, and cognitive and educational development.  Our search captured studies featuring grandparent custodial care (n = 35), multigenerational care (n = 154), and both types of care (n = 17). We found substantial heterogeneity in the data provided on co-residence, caregiving roles, resources invested, outcomes, and mechanisms through which "grandparent effects" are manifested. We identified two important issues, related to operationalizing indicators of grandparent involvement and conceptualizing potential mechanisms, leading to gaps in the evidence base. Currently, our understanding of the pathways through which grandparents exert their influence is constrained by limited data on what grandparents actually do and insufficient attention given to interpersonal and structural contexts. We present a conceptual framework to explicitly measure and theorize pathways of care, with a view to inform research design and policy implementation. We underscore the need for more robust data on three indicators of caregiver involvement-contact, behavior, and support-and for careful description of structural and interpersonal contexts in caregiving research.