Obesity-related behaviors of US- and non-US-born parents and children in low-income households

Influence of parental nativity and perceived neighborhood environment on physical activity and screen time of United States youth

OBJECTIVE

This study assessed how parental nativity and perceived environment are associated with physical activity and screen time of U.S. children and adolescents.

METHODS

Data originated from the 2020-21 U.S. National Survey of Children's Health. We conducted multivariable Poisson regression to assess the cross-sectional association of parental nativity and perceived neighborhood environment variables on parental reports of youth meeting national physical activity and screen time guidelines. We tested interactions of parental nativity and neighborhood environment variables on both outcomes. Analyses were conducted using STATA v17 and p < 0.05 indicated statistical significance.

RESULTS

The sample of 24,928 children and 30,951 adolescents was 11.6 years of age, on average, with approximately 39% under 200% of the federal poverty level. About one-third of the sample (27.5%) had foreign-born parents. In adjusted models, we found that compared to youth with U.S.-born parents, those with foreign-born parents had a lower prevalence of meeting physical activity guidelines. Youth whose parents reported living in safe neighborhoods had a higher prevalence of meeting guidelines for physical activity (children: PR = 1.20, 95%CI 1.14, 1.27; adolescents: PR = 1.23, 95%CI 1.14, 1.32) and screen time (children: PR = 1.19, 95%CI 1.13, 1.26; adolescents: PR = 1.16, 95%CI 1.06, 1.28) than youth whose parents reported unsafe neighborhoods. We found similar associations between neighborhoods considered supportive or with many amenities and meeting physical activity and screen time guidelines.

CONCLUSIONS

Youth whose parents are foreign-born have a lower prevalence of sufficient activity, and perceived parental neighborhood safety and support may be significant influences on youth physical activity and screen time.

A Mixed-Methods Description of the Home Physical Activity Environments of Racially/Ethnically Diverse and Immigrant/Refugee Children

Disparities in childhood obesity prevalence by race/ethnicity remain high. Physical activity is an important factor to consider, however little is known about how physical activity resources in the home environment and neighborhood differ by race/ethnicity. This study examines the physical activity environments in the homes and neighborhoods of diverse households using both quantitative and qualitative data. Home visits were conducted with 150 families, and accelerometry data was collected for both parents and children (5-7 years old). Qualitative interviews were also conducted with parents, which provided context to quantitative data. Racial/ethnic differences were found for physical activity, sedentary behavior, and family-level resources for physical activity (P < .05). There were also differences by race/ethnicity in neighborhood physical activity promoters and perceived lack of neighborhood safety (P < .05). This study is important in informing providers and future interventions of the varying promoters and barriers to optimal physical activity that exist across race/ethnicity.

Measurement of screen time among young children aged 0-6 years: A systematic review

The impact of screen-based devices on children's health and development cannot be properly understood without valid and reliable tools that measure screen time within the evolving digital landscape. This review aimed to summarize characteristics of measurement tools used to assess screen time in young children; evaluate reporting of psychometric properties; and examine time trends related to measurement and reporting of screen time. A systematic review of articles published in English across three databases from January 2009 to April 2020 was undertaken using PROSPERO protocol (registration: CRD42019132599) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles measured screen time as outcome, exposure, or confounder in children 0-6 years. The search identified 35,868 records, 1035 full-text articles were screened for eligibility, and 622 met inclusion criteria. Most measures (60%) consisted of one to three items and assessed duration of screen time on a usual day. Few measures assessed content (11%) or coviewing (7%). Only 40% of articles provided a citation for the measure, and only 69 (11%) reported psychometric properties-reliability n = 58, validity n = 19, reliability and validity n = 8. Between 2009 and 2019, the number of published articles increased from 28 to 71. From 2015, there was a notable increase in the proportion of articles published each year that assessed exposure to mobile devices in addition to television. The increasing number of published articles reflects increasing interest in screen time exposure among young children. Measures of screen time have generally evolved to reflect children's contemporary digital landscape; however, the psychometric properties of measurement tools are rarely reported. There is a need for improved measures and reporting to capture the complexity of children's screen time exposures.

Individual-, family-, and contextual-level variables do not explain the protective effect of parental nativity status on changes in 3-15-year-old children's BMI

Individual-, family-, and contextual-level factors can simultaneously and interactively affect a child's body mass index (BMI). We examine parental nativity as a key determinant of changes in children's BMI over time. Prior research on this topic has been inconclusive. A longitudinal sample of households with children residing in four low-income, high minority New Jersey cities provided data on demographics, socioeconomic status, anthropometric measures, as well as dietary and physical activity behaviors for one randomly selected child. The baseline interview for two separate cohorts took place in 2009/10 and 2014-15, with a follow-up interview 2–5 years later. The outcome variable, change in BMI z-score was divided into three categories (decrease in BMI z-score; no meaningful change; increase in BMI z-score) and analyzed using ordinal logistic regressions. About 28% of the children in the sample had at least one foreign-born parent. For the two major racial/ethnic groups, i.e., Hispanics and non-Hispanic blacks, having a foreign-born parent was associated with a favorable change in BMI—children of foreign-born parents were more likely to experience a decrease BMI z-score between baseline and follow-up. Multivariate analyses reveal that the initial association between parental nativity and children's BMI change (OR = 0.20; p < 0.001) persists after controlling for an extensive set of covariates, such as child dietary and physical activity behaviors, family-level variables, census tract characteristics, and measures of food environment (OR = 0.17; p < 0.001). Through a series of sensitivity analyses, we verified that our results are consistent across different model specifications. In our sample, having a foreign-born parent was a protective factor for children's BMI change that operates through different pathways than might be anticipated.

Childhood Obesity Evidence Base Project: A Systematic Review and Meta-Analysis of a New Taxonomy of Intervention Components to Improve Weight Status in Children 2-5 Years of Age, 2005-2019

Objective: To evaluate the efficacy of childhood obesity interventions and conduct a taxonomy of intervention components that are most effective in changing obesity-related health outcomes in children 2-5 years of age. Methods: Comprehensive searches located 51 studies from 18,335 unique records. Eligible studies: (1) assessed children aged 2-5, living in the United States; (2) evaluated an intervention to improve weight status; (3) identified a same-aged comparison group; (4) measured BMI; and (5) were available between January 2005 and August 2019. Coders extracted study, sample, and intervention characteristics. Effect sizes [ESs; and 95% confidence intervals (CIs)] were calculated by using random-effects models. Meta-regression was used to determine which intervention components explain variability in ESs. Results: Included were 51 studies evaluating 58 interventions (N = 29,085; mean age = 4 years; 50% girls). Relative to controls, children receiving an intervention had a lower BMI at the end of the intervention (g = 0.10, 95% CI = 0.02-0.18; k = 55) and at the last follow-up (g = 0.17, 95% CI = 0.04-0.30; k = 14; range = 18-143 weeks). Three intervention components moderated efficacy: engage caregivers in praise/encouragement for positive health-related behavior; provide education about the importance of screen time reduction to caregivers; and engage pediatricians/health care providers. Conclusions: Early childhood obesity interventions are effective in reducing BMI in preschool children. Our findings suggest that facilitating caregiver education about the importance of screen time reduction may be an important strategy in reducing early childhood obesity.

Socio-ecological predictors of non-organized physical activity participation and decline between childhood and adolescence

Physical activity (PA) tends to decline during late childhood and adolescence. In Australia, this decline has been shown to particularly occur non-organized PA (e.g., active play, informal sport). This study aimed to explore predictors of non-organized PA at 13y; and decline between 11y and 13y. Data were sourced from the Longitudinal Study of Australian Children. Non-organized PA was measured using time-use diaries. Analyses included Cragg hurdle and binary logistic regressions. The likelihood of non-organized PA at 13y was predicted by PA enjoyment (OR = 1.36, p = 0.007), number of siblings (OR = 1.11, p < 0.001), sex (females) (OR = 0.66, p < 0.001) and home computer use at 11y (OR = 0.98, p = 0.002) (n = 3,193). Females also engaged in less non-organized PA at 13y (β = -77.77, p = 0.048) (n = 3,193). Significant predictors of decline in non-organized PA were socioeconomic position (OR = 0.92, p = 0.047) and sugary drink consumption at 11y (OR = 1.06, p = 0.033) (n = 3,222). Strategies to promote non-organized PA may include targeting females and those of lower socioeconomic position, and focusing on types of PA that may replace the perceived benefits of computer use.

"If You Let Them, They Will Be on It 24 Hours a Day": Qualitative Study Conducted in the United States Exploring Brazilian Immigrant Mothers' Beliefs, Attitudes, and Practices Related to Screen Time Behaviors of Their Preschool-Age Children

BACKGROUND

The increasing prevalence of excessive screen time (ST) among children is a growing public health concern, with evidence linking it to an increased risk of overweight and obesity among children.

OBJECTIVE

This study aimed to explore the beliefs, attitudes, and practices of Brazilian immigrant mothers living in the United States related to their preschool-age children's ST behaviors.

METHODS

A qualitative study comprising 7 focus group discussions (FGDs) was conducted with Brazilian immigrant mothers living in the United States. All FGDs were audio-recorded and professionally transcribed verbatim. The Portuguese transcripts were analyzed using thematic analysis.

RESULTS

In total, 37 women participated in the FGDs. Analyses revealed that although most mothers expressed concerns for their preschool-age children's ST, nearly all viewed ST as an acceptable part of their children's daily lives. Furthermore, mothers perceived that ST has more benefits than disadvantages. The mothers' positive beliefs about (eg, educational purposes and entertainment) and perceived functional benefits of ST (eg, ability to keep children occupied so tasks can be completed and facilitation of communication with family outside the United States) contributed to their acceptance of ST for their preschool-age children. Nevertheless, most mothers spoke of needing to balance their preschool-age children's ST with other activities. Mothers reported using several parenting practices including monitoring time and content, setting limits and having rules, and prompting their children to participate in other activities to manage their preschool-age children's ST.

CONCLUSIONS

This study provides new information on the beliefs, attitudes, and practices of Brazilian immigrant mothers living in the United States related to their preschool-age children's ST. Study findings revealed several potentially modifiable maternal beliefs and parenting practices that may provide important targets for parenting- and family-based interventions aimed at limiting preschool-age children's ST.

Exploring Brazilian Immigrant Mothers' Beliefs, Attitudes, and Practices Related to Their Preschool-Age Children's Sleep and Bedtime Routines: A Qualitative Study Conducted in the United States

In the United States (US), racial/ethnic minority children, low-income children, and children of immigrant families are at increased risk of childhood obesity. Mounting evidence documents that sleep duration and sleep quality are important modifiable factors associated with increased risk of obesity among preschool-aged children. The number of Brazilian immigrants in the US is increasing, yet no existing research, to our knowledge, has examined factors affecting sleep and bedtime routines of children of Brazilian immigrant families. Therefore, the purpose of this qualitative study was to explore Brazilian immigrant mothers' beliefs, attitudes, and practices related to sleep and bedtime routines among preschool-aged children. Seven focus group discussions (FGDs) were conducted with 37 Brazilian immigrant mothers of preschool-age children living in the US. The audio-recordings of the FGDs were transcribed verbatim in Portuguese without identifiers and analyzed using thematic analyses. Mothers also completed a brief questionnaire assessing socio-demographic and acculturation. Analyses revealed that most mothers were aware of the importance of sleep and sleep duration for their children's healthy growth and development. Mothers also spoke of children needing consistent bedtime routines. Nevertheless, many mothers reported inconsistent and suboptimal bedtime routines (e.g., lack of predictable and orderly bedtime activities such as bath, reading, etc. and use of electronics in bed). These suboptimal routines appeared to be influenced by day-to-day social contextual and environmental factors that are part of Brazilian immigrant families' lives such as parents' work schedule, living with extended family, living in multi-family housing, neighborhood noise, etc. Analyses identified several modifiable parenting practices related to young children's sleep and bedtime routines (e.g., irregular bedtime, late bedtime, inconsistent bedtime routines, use of electronics in bed, etc.) that can be addressed in parenting- and family-based obesity prevention interventions. Interventions should consider the social context of the home/family (e.g., parents' work schedules) and the environment (e.g., multi-family housing; neighborhood noise, etc.) faced by Brazilian immigrant families when developing health promotion messages and parenting interventions tailored to this ethnic group.

Exploring how Brazilian immigrant mothers living in the USA obtain information about physical activity and screen time for their preschool-aged children: a qualitative study

OBJECTIVE

To explore how Brazilian-born immigrant mothers living in the USA obtain information about physical activity (PA) and screen time (ST) behaviours for their preschool-aged children.

RESEARCH DESIGN

Focus group discussions (FGDs) were used to gain an in-depth understanding of research topics. All FGDs were audio-recorded and professionally transcribed verbatim. The Portuguese transcripts were analysed using thematic analysis, an iterative process of coding the data in phases to create meaningful patterns.

PARTICIPANTS

Thirty-seven Brazilian-born immigrant mothers of preschool-age children.

SETTING

This study was conducted in two cities in Massachusetts (MA). Participants were recruited from two predominantly Brazilian churches, local Brazilian businesses and community-based social and health services organisations in the Greater Boston area in MA.

RESULTS

Analyses revealed that the mothers participating in this study did not initially actively seek out information about PA and ST for their preschool-age children, but that they received unsolicited information about these behaviours from multiple sources including their child's paediatrician, Women, Infant and Children (WIC) programme staff, members of their social network of Brazilian friends and the Brazilian media. Mothers reported that this unsolicited information increased their knowledge about the importance of making sure their children were physically active and not participating in excessive ST. This increased awareness led mothers to actively seek information about PA and ST behaviours via the internet and through interpersonal communication with fellow Brazilian friends and family.

CONCLUSIONS

Given the value Brazilian immigrant mothers placed on the advice of their paediatricians and WIC staff, interventions should consider involving these healthcare professionals, possibly through including endorsement (eg, prescription for PA and maximum ST). More research is needed to ensure Brazilian immigrant mothers' health and media literacy including their ability to navigate the online environment and to discern the accuracy and quality of information from various web sites.

Exploring How the Home Environment Influences Eating and Physical Activity Habits of Low-Income, Latino Children of Predominantly Immigrant Families: A Qualitative Study

Latinos are the largest and fastest growing minority population group in the United States, and children in low-income Latino families are at elevated risk of becoming overweight or having obesity. A child’s home is an important social environment in which he/she develops and maintains dietary and physical activity (PA) habits that ultimately impact weight status. Previous research suggests the parents are central to creating a home environment that facilitates or hinders the development of children’s early healthy eating and PA habits. Therefore, the purpose of this study was to explore low-income Latino parents’ beliefs, parenting styles, and parenting practices related to their children’s eating and PA behaviors while at home. Methods: Qualitative study using focus group discussions (FGDs) with 33 low-income Latino parents of preschool children 2 to 5 years of age. FGDs were transcribed verbatim and analyzed using thematic analysis. Results: Data analyses revealed that most parents recognize the importance of healthy eating and PA for their children and themselves. However, daily life demands including conflicting schedules, long working hours, financial constraints, and neighborhood safety concerns, etc., impact parents’ ability to create a home environment supportive of these behaviors. Conclusions: This study provides information about how the home environment may influence low-income Latino preschool children’s eating and PA habits, which may be useful for health promotion and disease prevention efforts targeting low-income Latino families with young children, and for developing home-based and parenting interventions to prevent and control childhood obesity among this population group. Pediatric healthcare providers can play an important role in facilitating communication, providing education, and offering guidance to low-income Latino parents that support their children’s development of early healthy eating and PA habits, while taking into account daily life barriers faced by families. Moreover, pediatric healthcare providers also can play an important role in the integration and coordination of home-visitations to complement office-based visits and provide a continuum of care to low-income Latino families.

A review of early influences on physical activity and sedentary behaviors of preschool-age children in high-income countries

PURPOSE

Promoting physical activity (PA) is a key component of preventing and controlling childhood obesity. Despite well-documented benefits of PA, globally, rates of PA among young children have declined over the past decades, and most children are not accruing sufficient PA daily. Helping children develop the foundation for PA habits early in life is critical for the promotion of health in childhood and prevention of chronic diseases later in life, and will ultimately promote longer and healthier lives for individuals and the general population. The purpose of this review is to provide a synthesis of current evidence on influences on PA and sedentary behaviors of preschool-age children in high-income countries.

DESIGN AND METHODS

A systematic review of three databases was performed. Studies conducted in high-income countries and published from 2000 onward that addressed influences on PA and sedentary behaviors of preschool-age children were identified and reviewed. Additionally, reference lists of identified articles and relevant published reviews were reviewed. Studies that met the following inclusion criteria were considered: (a) sample included preschoolers (age ≤5 years); (b) PA and/or sedentary behaviors or factors associated with PA and/or sedentary behaviors was assessed; (c) published in English; (d) used either quantitative or qualitative methods; and (e) conducted in a high-income country. Data were extracted from selected studies to identify influences on PA and sedentary behaviors of preschool-age children and organized using the social-ecological model according to multiple levels of influence.

RESULTS

Results from included studies identify multiple factors that influence PA and sedentary behaviors of young children in high-income countries at the various levels of the social-ecological model including intrapersonal, interpersonal, environmental, organizational, and policy.

PRACTICE IMPLICATIONS

Given pediatric nurses' role as primary care providers, and their frequent and continued contact with parents and their children throughout childhood through well-child visits, immunization, and minor acute illnesses, they are well positioned to promote and support the development of early healthful PA habits of children starting in early childhood.

Latino parents' perceptions of the eating and physical activity experiences of their pre-school children at home and at family child-care homes: a qualitative study

OBJECTIVE

Research indicates that healthful eating and physical activity (PA) practices implemented in child-care settings can have a positive effect on children's healthful behaviours in this setting, and this effect on healthful behaviours may possibly transfer to the home environment. While more research is needed to examine whether behaviours learned in family child-care homes (FCCH) transfer, the potential for transferability is especially important given that Latino children's home environment has been characterized by obesogenic parenting practices. We aimed to examine Latino parents' perceptions of their pre-school children's eating and PA experiences at home and at FCCH.

DESIGN

Qualitative study. Six focus groups were conducted in Spanish (n 36). Transcripts were analysed using thematic analysis to identify key concepts and themes.

RESULTS

Analyses revealed that Latino parents perceive their children have healthier eating and PA experiences at FCCH than at home. Parents attributed this to FCCH providers providing an environment conducive to healthful eating and PA due to providers having more knowledge and skills, time and resources, and being required to follow rules and regulations set by the state that promote healthful eating and PA.

CONCLUSIONS

Understanding parental perceptions, attitudes and practices related to establishing and maintaining an environment conducive to children's healthful eating and PA at home and at the FCCH is essential for the design of successful interventions to promote children's healthful behaviours in these two settings. Given that parents perceive their children as having more healthful behaviours while at FCCH, interventions that address both settings jointly may be most effective than those addressing only one environment by itself.

Health Issues in Hispanic/Latino Youth

This review focuses on obesity, asthma and mental health functioning as salient health issues affecting Hispanic youth. Burden of these conditions and consequences for adult health are also discussed. Hispanic youth are affected by obesity at an early age; the prevalence of obesity among Hispanic children 6-11 years old is twice as high as the prevalence for non-Hispanic White children of the same age, but among 2-5 years old is 4 times higher. Asthma disproportionally affects certain Hispanic groups, notably children of Puerto Rican ancestry, and the comorbidity of asthma and obesity is an emerging health issue. Another area of concern is the scant data on mental health functioning among Hispanic youth. Research on Hispanic youth mental health have reported high rates of depressive symptomatology and high rates of alcohol use among Hispanic adolescents but despite these findings, they have inadequate access to mental health services. This review highlights the need for better data to gain a better understanding of the health status of Hispanic youth and help develop preventive programs that addresses the need of this population. Improving access to health services, in particular mental health services, is also a crucial aspect.

Low demanding parental feeding style is associated with low consumption of whole grains among children of recent immigrants

We explored the influence of immigrant mothers feeding style on their children's fruit, vegetable and whole grain intake and how this relationship differed by mother's time in the U.S. Baseline data were collected on mother-child (3-12 yrs) dyads enrolled in Live Well (n = 313), a community-based, participatory, randomized controlled lifestyle intervention (2008-2013). Socio-demographics, years of residence in the U.S., behavioral data, and responses to the Caregiver's Feeding Styles Questionnaire (CFSQ) were obtained from the mother. Measured heights and weights were obtained for both mother and child. Child dietary intake was assessed using the Block Food Screener. Separate multiple linear regression models were run, adjusting for child and mother covariates. Interactions between feeding styles and years in the U.S. (<5 and ≥ 5 years), ethnicity, and child age were tested. Sixty-nine percent of mothers were overweight or obese, 46% of the children were overweight or obese. For mothers in the U.S. for<5 years, having a low demanding/high responsive style was associated with lower child intake of whole grains in adjusted models vs. a high demanding/high responsive style (p < 0.05). This was not seen for mothers in the U.S. for≥5 years. Thus, the influence of feeding style on dietary intake may change with length of time in the U.S. These hypotheses-generating findings call for future research to understand how broader socio-cultural factors influence the feeding dynamic among immigrants.