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Monge-Montero C, van der Merwe LF, Tagliamonte S, Agostoni C, Vitaglione P. Why do mothers mix milk feed their infants? Results from a systematic review. Nutr Rev 2024; 82:1355-1371. [PMID: 38041551 PMCID: PMC11384123 DOI: 10.1093/nutrit/nuad134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023] Open
Abstract
CONTEXT Combining or supplementing breastfeeding with formula feeding, also called mixed milk feeding (MMF), is a common infant feeding practice. However, there is no well-established MMF evidence-base for informing and guiding parents. A better understanding of the reasons why mothers practice MMF may facilitate identification of efficient strategies for supporting exclusive breastfeeding, and/or opportunities to prolong breastfeeding, at least partially. OBJECTIVE An updated systematic literature review was undertaken with the primary aim of gaining a deeper understanding of the reasons why mothers choose MMF. DATA SOURCES Six databases were searched for relevant articles published in English from January 2012 to January 2022. DATA EXTRACTION Two reviewers independently performed the screenings and data extraction, and any differences were resolved by a third reviewer. Data from 138 articles were included, 90 of which contained data on MMF reasons/drivers, and 60 contained data on infant age and/or maternal demographic factors associated with MMF. DATA ANALYSIS A total of 13 different unique MMF drivers/reasons were identified and categorized according to whether the drivers/reasons related to perceived choice, necessity, or pressure. Risk of bias was evaluated using the Quality Assessment Tool of Diverse Studies and the JBI Systematic Reviews tool. Several different terms were used to describe and classify MMF across the studies. The most commonly reported reasons for MMF were related to a perception of necessity (39% of drivers, eg, concerns about infant's hunger/perceived breast milk insufficiency or breastfeeding difficulties), followed by drivers associated with perceived choice (34%; eg, having more flexibility) and perceived pressure (25%; eg, returning to work or healthcare professionals' advice). This was particularly true for infants aged 3 months or younger. CONCLUSION The key global drivers for MMF and their distribution across infant age and regions were identified and described, providing opportunities for the provision of optimal breastfeeding support. A unified definition of MMF is needed in order to enable more comparable and standardized research. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42022304253.
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Affiliation(s)
- Carmen Monge-Montero
- Department of Research, Monge Consultancy Food and Nutrition Research, Leiden, The Netherlands
| | | | - Silvia Tagliamonte
- Department of Agricultural Sciences, University of Naples Federico II, Naples, Italy
| | - Carlo Agostoni
- Fondazione IRCCS Ospedale Maggiore Policlinico, Pediatric Clinic, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paola Vitaglione
- Department of Agricultural Sciences, University of Naples Federico II, Naples, Italy
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Fisher E, Patel P, Wouk KG, Neupane B, Alkhalifah F, Bartholmae MM, Tang C, Zhang Q. Breastfeeding Perceptions and Decisions among Hispanic Participants in the Special Supplemental Nutrition Program for Women, Infants, and Children: A Qualitative Study. Nutrients 2024; 16:1565. [PMID: 38892499 PMCID: PMC11173851 DOI: 10.3390/nu16111565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a nutrition assistance program in the U.S. WIC served 2.5 million eligible Hispanic women, infants, and children under the age of five in 2021, which is WIC's largest racial/ethnic group. However, limited research has been conducted to understand Hispanic WIC participants' perceptions of WIC breastfeeding recommendations and their breastfeeding decisions. For this qualitative study, we interviewed 18 of these pregnant and postpartum WIC participants on their experiences and decision-making processes related to breastfeeding. Hispanic cultures and home country norms were identified as prominent influences on breastfeeding decisions, along with perceptions of WIC's breastfeeding support. These results can help the WIC program to refine its breastfeeding education to better meet the needs of Hispanic participants.
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Affiliation(s)
- Emily Fisher
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA 23529, USA; (E.F.); (P.P.); (B.N.); (F.A.); (M.M.B.)
| | - Priyanka Patel
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA 23529, USA; (E.F.); (P.P.); (B.N.); (F.A.); (M.M.B.)
| | - Kathryn G. Wouk
- Pacific Institute for Research and Evaluation, Chapel Hill, NC 27514, USA;
| | - Bidusha Neupane
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA 23529, USA; (E.F.); (P.P.); (B.N.); (F.A.); (M.M.B.)
| | - Futun Alkhalifah
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA 23529, USA; (E.F.); (P.P.); (B.N.); (F.A.); (M.M.B.)
| | - Marilyn M. Bartholmae
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA 23529, USA; (E.F.); (P.P.); (B.N.); (F.A.); (M.M.B.)
- Department of Psychiatry and Behavioral Health, Eastern Virginia Medical School, Norfolk, VA 23510, USA
| | - Chuanyi Tang
- Department of Marketing, Old Dominion University, Norfolk, VA 23529, USA;
| | - Qi Zhang
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA 23529, USA; (E.F.); (P.P.); (B.N.); (F.A.); (M.M.B.)
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3
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Alvarado C, Nguyen-Rodriguez ST, Frank GC, Garcia M, Gatdula N. Influence of Home Language Use on the Association Between Parent Education and Child Adiposity in Latino Families. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01935-z. [PMID: 38381326 DOI: 10.1007/s40615-024-01935-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/25/2024] [Accepted: 01/31/2024] [Indexed: 02/22/2024]
Abstract
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.
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Affiliation(s)
- Carina Alvarado
- Department of Health Science, California State University, Long Beach, CA, USA
- School of Public Health, University of California, Berkeley, CA, USA
| | - Selena T Nguyen-Rodriguez
- Department of Health Science, California State University, Long Beach, CA, USA.
- Center forLatino Community Health, Evaluation, and Leadership Training, Long Beach, CA, USA.
| | - Gail C Frank
- Department of Health Science, California State University, Long Beach, CA, USA
- Center forLatino Community Health, Evaluation, and Leadership Training, Long Beach, CA, USA
- Department of Family & Consumer Sciences, California State University, Long Beach, CA, USA
| | - Melawhy Garcia
- Department of Health Science, California State University, Long Beach, CA, USA
- Center forLatino Community Health, Evaluation, and Leadership Training, Long Beach, CA, USA
| | - Natalia Gatdula
- Department of Health Science, California State University, Long Beach, CA, USA
- Center forLatino Community Health, Evaluation, and Leadership Training, Long Beach, CA, USA
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4
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Porter A, Langford R, Summerbell C, Tinner L, Kipping R. A qualitative exploration of food portion size practices and awareness of food portion size guidance in first-time parents of one- to two-year-olds living in the UK. BMC Public Health 2023; 23:1779. [PMID: 37704981 PMCID: PMC10500748 DOI: 10.1186/s12889-023-16647-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 08/29/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Food portion size guidance resources aimed at parents of young children in the UK are freely available from a number of credible sources. However, little is known about whether parents are aware of, and use, any of these resources to guide their food portioning practices. OBJECTIVES We aimed to explore the food portion size practices used by first-time parents living in the UK when feeding their one- to two-year-old child, and their awareness of and views on six food portion size guidance resources. METHODS Participants were recruited via parent Facebook groups and online parent forums. Online 1-1 semi-structured interviews were conducted, during which parents were shown images of six food portion size guidance resources to facilitate discussion. Data was analysed in NVivo 11 using a Reflexive Thematic Analysis approach. RESULTS Of the 27 participants, most were women (n = 25), white (n = 18), and educated to first degree level or higher (n = 24). First-time parents mostly relied on their own judgement and "instinct" to portion foods, based on their learned experience of how much their child ate on a day-to-day basis. This experience was used alongside physical indicators of food portion size, such as the size of children's dishware and food packaging. Most participants were unaware of any of the six food portion size guidance resources we showed them; only four had read any of the resources. Parents suggested they had previously sought advice about weaning from a range of sources (e.g. online, friends, community groups) but would be unlikely to seek out specific food portion size guidance. Parents suggested recommendations on food portion size should acknowledge and highlight parents' perception that "every child is different". CONCLUSIONS Existing food portion size guidance resources for parents of young children in the UK are ineffective as they have poor reach and impact. We suggest parents should be involved in developing novel strategies to promote age-appropriate consumption and healthy weight gain in young children.
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Affiliation(s)
- Alice Porter
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
- School for Public Health Research, NIHR, London, UK.
| | - Rebecca Langford
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Carolyn Summerbell
- School for Public Health Research, NIHR, London, UK
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
| | - Laura Tinner
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ruth Kipping
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- School for Public Health Research, NIHR, London, UK
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Schneider-Worthington CR, Lauzon M, Berger PK, Goran MI, Salvy SJ. Complementary Feeding and Child Appetitive Traits in a Sample of Hispanic Mother-Child Dyads. J Acad Nutr Diet 2023; 123:1340-1350. [PMID: 36375769 PMCID: PMC10175514 DOI: 10.1016/j.jand.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Complementary feeding practices may contribute to toddler eating practices that affect weight outcomes. Studies are needed to understand the relationship between complementary feeding practices and toddler dietary self-regulation. OBJECTIVE This study tests the hypothesis that earlier complementary food introduction predicts toddler food responsiveness and emotional overeating (ie, tendency to overeat in response to food cues and emotions, respectively), and considers whether introduction of certain foods better predict toddler dietary self-regulation. DESIGN This study is a secondary analysis of data from a parent longitudinal birth cohort study on early growth/development among Hispanic mother-infant dyads. PARTICIPANTS/SETTING The analytic sample included 174 mother-child dyads recruited from maternity clinics affiliated with the University of Southern California in Los Angeles County. Recruitment and data collection were ongoing from July 2016 to April 2020. At 1-, 6-, 12-, and 24-months postpartum, mothers reported exclusive breastfeeding duration and age of complementary food introduction via questionnaire. MAIN OUTCOME MEASURES Child food responsiveness and emotional overeating scores calculated from the Child Eating Behavior Questionnaire at 12 and 24 months of age. STATISTICAL ANALYSES PERFORMED Separate linear mixed models with repeated measures were used to examine associations between age of complementary food introduction as a predictor of child food responsiveness or emotional overeating, controlling for infant sex, birth body mass index z score, duration of exclusive breastfeeding, and mother's body mass index. RESULTS In separate models, delaying complementary food introduction by 1 month was associated with a 6% reduction in food responsiveness (P = 0.007) and a 5% reduction in emotional overeating scores (P = 0.013). Fifty-eight unique combinations of complementary foods introduced first were found, precluding analyses to examine whether specific combinations were related to eating behavior outcomes due to sample size limitations. CONCLUSIONS Earlier complementary feeding was associated with higher food responsiveness and emotional overeating scores among Hispanic children. Future studies in larger samples are needed to characterize patterns of complementary food introduction and their influence on child self-regulation.
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Affiliation(s)
| | - Marie Lauzon
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Paige K Berger
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael I Goran
- Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California
| | - Sarah-Jeanne Salvy
- Research Center for Health Equity, Department of Medicine, Cedars-Sinai Medical Center, West Hollywood, California
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Palacios C, Bolton J, Wang W, Gatto A, Concepción L, Sadjadi M, Varella M, Hannan J. Development and pilot testing of the Baby-Feed web application for healthcare professionals and parents to improve infant diets. Int J Med Inform 2023; 174:105047. [PMID: 36948062 DOI: 10.1016/j.ijmedinf.2023.105047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/30/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Diet is key in preventing rapid infant weight gain but adherence to infant dietary recommendations is difficult to follow and low in adherence. OBJECTIVE Develop and pilot test the "Baby-Feed" web application for parents and healthcare professionals to easily evaluate infant diets and provide immediate feedback to promote adherence to current infant dietary recommendations. METHODS Baby-Feed was developed following the ADDIE (analysis, design, development, implementation, and evaluation) model. It was pilot tested among two clinicians and 25 parents of infants aged 4 to 12 months that had a scheduled well-child visit at a community health center in Miami. After 2 weeks of using Baby-Feed, parents completed a feasibility, acceptability, satisfaction, and usability questionnaire. Parents and clinicians were also asked to suggest improvements. Descriptive analysis included frequency and median (25th, 75th percentiles). One-sample binomial tests was used to evaluate if feasible, acceptable, satisfactory, and usable. RESULTS Twenty-three parents completed the evaluation (all were mothers), 31.0 (26.0, 33.0) years-old, 96% Hispanic, 83% had ≥ high school education, with 1.5 (1.0, 2.0) children. Infants' age was 6.1 (4.0, 9.0) months and 57% were boys. Binomial tests indicated that most parents (greater than87%) agreed that Baby-Feed was easy to use, learn, quick, would use it again, rated it as 4/5 stars. They used it greater than 1 times per week (p < 0.001). Parents suggested improving the visuals (more icons, colors, and pictures) and images of portion sizes, highlighting missing fields, being able to view/open it on their phones, and adding recipes and more information. The two clinicians (a pediatrician and a physician assistant) suggested to be open-access and to add more infant nutrition information. CONCLUSION Baby-Feed was feasible, usable, satisfactory, and acceptable. It could be used as a tool to easily evaluate infant diets in the healthcare setting to provide immediate feedback.
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Affiliation(s)
- Cristina Palacios
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA.
| | - Jennifer Bolton
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Wenjia Wang
- Vertically Integrated Projects, School of Computing and Information Sciences, Florida International University, Miami, FL, USA
| | - Alayne Gatto
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Lourdes Concepción
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Masoud Sadjadi
- Vertically Integrated Projects, School of Computing and Information Sciences, Florida International University, Miami, FL, USA
| | - Marcia Varella
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Jean Hannan
- Nicole Wertheim College of Nursing & Health Sciences, Florida International University, Miami, FL, USA
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Zhao F, Sun Y, Zhang Y, Xu T, Wang N, Yan S, Zeng T, Zhang F, Gao J, Yue Q, Rozelle S. Comparison of mothers' perceptions of hunger cues in 3-month-old infant under different feeding methods. BMC Public Health 2023; 23:444. [PMID: 36882770 PMCID: PMC9993530 DOI: 10.1186/s12889-023-15325-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/27/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Mothers' perception of infant hunger cues is a critical content of responsive feeding, which is central to the promotion of early childhood development. However, only a few studies have examined responsive feeding in China, especially lacking the studies on perceptions of infant hunger cues. Consider the cultural differences, the aim of this study was to describe the perceptions of infant hunger cues of Chinese mothers for infants aged 3 months, and explore the relationship between maternal perceptions of infant hunger cues and different feeding methods. METHODS A cross-sectional study was conducted with a sample of 326 mothers of healthy 3-month-old infants, including 188 exclusive breastfeeding (EBF) mothers and 138 formula feeding (FF) mothers. It was implemented in four provincial and municipal maternal and child health hospitals. The mothers' perceptions of infant hunger cues were surveyed by self-reporting questionnaires. Chi-square tests and logistic analysis were applied to analyze the differences in maternal perceptions of infant hunger cues, including the number of hunger cues and the specific cues, between EBF group and FF group by controlling sociodemographic variables and the daily nursing indicators. RESULTS We found that a higher proportion of EBF mothers could perceive multiple hunger cues (≥ 2) than FF mothers (66.5% vs.55.1%). For specific cues, the EBF mothers had higher perceptions of infant's "hand sucking" (67.6% vs. 53.6%) and "moving head frantically from side to side" (34.6% vs. 23.9%), all p < 0.05. Regression analysis revealed that EBF might support mothers to perceive infant hunger cues than FF mothers, with the number of infant hunger cues (OR = 1.70, 95% CI: 1.01-2.85), "hand sucking" (OR = 1.72, 95% CI: 1.04-2.87), "moving head frantically from side to side" (OR = 2.07, 95% CI: 1.19-3.62). The number of infant hunger cues perceived by mothers was also associated with their educational level and family structure. CONCLUSION EBF mothers of 3-month-old infants may be more likely to perceive infant hunger cues than FF mothers in China. It is necessary to increase the health education about infant hunger and satiety cues to caregivers in China, especially among mothers with lower education levels, mothers living in nuclear families, and FF mothers.
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Affiliation(s)
- Fenghua Zhao
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, 100081, China
| | - Yijie Sun
- Qingdao Maternal and Child Health and Family Planning Service Center, Shandong, 266072, China
| | - Yue Zhang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, 100081, China.
| | - Tao Xu
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, 100081, China
| | - Nianrong Wang
- Chongqing Health Center for Women and Children, Chongqing, 401147, China
| | - Shuangqin Yan
- Ma'anshan Maternal and Child Health Hospital, Anhui, 243011, China
| | - Ting Zeng
- Liuzhou Maternity and Child Healthcare Hospital, Guangxi, 545001, China
| | - Fenghua Zhang
- Qingdao Maternal and Child Health and Family Planning Service Center, Shandong, 266072, China
| | - Jie Gao
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, 100081, China
| | - Qing Yue
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, 100081, China
| | - Scott Rozelle
- Stanford University Freeman Spogli Institute for International Studies, Stanford, CA, 94305-6055, USA
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Macchi AK, Banna J, Moreira S, Campos M, Palacios C. Effect of a Short Messaging Service (SMS) intervention delivered to caregivers on energy, nutrients, and food groups intake in infant participants of the WIC program. Front Public Health 2022; 10:986330. [PMID: 36249246 PMCID: PMC9559930 DOI: 10.3389/fpubh.2022.986330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/12/2022] [Indexed: 01/26/2023] Open
Abstract
Objectives To test the effect of a weekly test message (SMS) intervention for improving feeding practices on infant intake of energy, nutrients, and specific food groups. Methods This study was a multi-site, randomized clinical trial, in 202 caregivers of healthy term infants participating in either the Puerto Rico or Hawaii WIC program. Participants were randomized to receive weekly SMS about either infant's general health issues (control) or SMS for improving feeding practices (intervention) to complement WIC messages for 4 months. Anthropometrics and demographics were assessed at baseline. A validated infant food frequency questionnaire was assessed at the four-month visit to assess intake of general food groups. Data was summarized as median (25th and 75th percentiles) or percentage and differences between study arms was compared using Mann Whitney or chi-square. Results A total of 163 participants completed the study (n = 84 control and n = 79 intervention). Baseline characteristics were similar between both groups. At 4-6 months of age, compared to the control group, the intervention group had a significantly higher intake of total grains (0.28 oz; 0.00, 0.60; P = 0.033), protein (13.5 g, 10.5, 18.3; P = 0.022), calcium (472 mg; 418, 667; P = 0.012), and zinc (4.39 mg; 2.61, 6.51; P = 0.028). No differences were seen in the other food groups, including breastmilk. Conclusions for practice Feeding SMS to complement WIC messages led to higher intakes of some key nutrients but did not have an overall improvement in the intake of food groups. Messaging also did not delay the introduction of complimentary foods or improve breastfeeding rates. Future studies should evaluate the use of more intensive SMS interventions for continued care between WIC visits.
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Affiliation(s)
- Alison K. Macchi
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States
| | - Jinan Banna
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu, HI, United States
| | - Stephanie Moreira
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu, HI, United States
| | - Maribel Campos
- Center for Community Outreach for Health Across the Lifespan (COHeAL), University of Puerto Rico, San Juan, PR, United States
| | - Cristina Palacios
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States,*Correspondence: Cristina Palacios
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Risica PM, Karpowicz JM, von Ash T, Gans KM, Stowers KC, Tovar A. Feeding and Activity Environments for Infants and Toddlers in Childcare Centers and Family Childcare Homes in Southeastern New England. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159702. [PMID: 35955058 PMCID: PMC9367851 DOI: 10.3390/ijerph19159702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/30/2022] [Accepted: 08/03/2022] [Indexed: 06/01/2023]
Abstract
Few studies have documented the food and physical activity (PA) environments of childcare settings caring for children <24 months of age, although they may be key contributors to developing child PA and diet patterns. We used an adapted Environment and Policy Assessment and Observation tool to assess the food and activity environments for infants and toddlers in childcare centers (n = 21) and family childcare homes (FCCH) (n = 20) and explored differences by childcare type. Many similarities were found between childcare site types; however, centers used more recommended feeding practices than FCCH (e.g., 100% of center providers talked with toddlers about feelings of hunger or fullness compared to 18% of family childcare providers (FCCP), p < 0.01). Differences in non-recommended feeding practices (e.g., spoon feeding, bottle propping and encouraging unhealthy foods) were mixed between childcare types. Toddlers in centers spent more time playing at higher PA levels than those in FCCH (61 vs. 13 min, p < 0.001). Screen time was observed in FCCH, but not in centers. Differences between childcare types may indicate differential influences on infant and toddler feeding and PA behaviors, which could predict disparate obesity risk. Future research should further observe these behaviors in a larger sample of centers and FCCH to inform childcare interventions and policies.
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Affiliation(s)
- Patricia Markham Risica
- Brown University School of Public Health, Providence, RI 02912, USA
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI 02912, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
| | | | - Tayla von Ash
- Brown University School of Public Health, Providence, RI 02912, USA
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI 02912, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
| | - Kim M. Gans
- Brown University School of Public Health, Providence, RI 02912, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT 06269, USA
- Institute for Collaboration in Health, Interventions and Policy, University of Connecticut, Storrs, CT 06269, USA
| | - Kristen Cooksey Stowers
- Institute for Collaboration in Health, Interventions and Policy, University of Connecticut, Storrs, CT 06269, USA
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
- Rudd Center for Food Policy and Health, University of Connecticut, Hartford, CT 06103, USA
| | - Alison Tovar
- Brown University School of Public Health, Providence, RI 02912, USA
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI 02912, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
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10
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Gray MJ, Vazquez CE, Agnihotri O. "Struggle at night - He doesn't let me sleep sometimes": a qualitative analysis of sleeping habits and routines of Hispanic toddlers at risk for obesity. BMC Pediatr 2022; 22:413. [PMID: 35831852 PMCID: PMC9277846 DOI: 10.1186/s12887-022-03434-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/15/2022] [Indexed: 11/21/2022] Open
Abstract
Background Hispanic children face disproportionately higher risks for early life obesity and resultant comorbidities such as Type 2 diabetes and fatty liver disease. Sleep habits are modifiable behaviors that impact early childhood obesity; Hispanic infants have been shown to have less nighttime sleep compared to their white counterparts. Pediatricians often coach families on parents’ nighttime responsive feeding and longer child sleep duration as protective factors against early life obesity, but must understand the family context and potential barriers. This study aimed to discover the sleeping habits and routines of Hispanic toddlers at risk for obesity through the perspective of their mothers. Methods This qualitative study used a phenomenological approach. 14 Hispanic mothers were recruited from a Federally Qualified Health Center in Central Texas for qualitative interviews regarding their experience raising a small child. Children aged 6 to 18 months with child weight-for-length ratio ≥ 85% for age were approached for study involvement and consented during well child visits. Interviews occurred over several months during 2018–2019; NVivo software was used for analysis of qualitative themes. Two reviewers coded and used constant comparative methods to identify common themes. Results Mothers diverged from AAP recommended guidelines for infant and toddler feeding and sleep habits. Mothers shared their intentions and the real-life barriers to implementing recommended habits. Mothers discussed wanting to have their child sleep in a separate bed or room but not having the resources (i.e., financial, space) to do so. Additionally, mothers discussed knowing not to feed to soothe at night but couldn’t bring themselves to let their child cry if they knew feeding would soothe them. Co-sleeping, feeding to sleep, middle of the night feeding, and lack of structured sleep habits were common interview themes and potentially modifiable factors. Conclusions Pediatricians need to be sensitive to culture and the real-world needs of families to determine if best practices are “practical.” Themes from these parent interviews can inform tailored interventions for children at high risk of obesity. Interventions should promote responsive nighttime feeding and structured sleep, working with individual family logistics, to coach families towards optimal healthy environments and healthy child weight.
Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03434-8.
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Affiliation(s)
- Megan J Gray
- Departments of Pediatrics and Department of Population Health, Dell Medical School, The University of Texas at Austin, 1601 Trinity St., Bldg B, Austin, TX, 78712, USA.
| | - Christian E Vazquez
- School of Social Work, The University of Texas at Arlington, 211 South Cooper Street, Box 19129, Arlington, TX, 76019, USA
| | - Ojasvie Agnihotri
- UT Health San Antonio Joe R. & Teresa Lozano Long School of Medicine, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
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11
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Rodríguez-Arauz G, Ramírez-Esparza N. A naturalistic observational study on food interactions and indicators of healthy and unhealthy eating in White-European and Latinx families. Appetite 2022; 171:105905. [DOI: 10.1016/j.appet.2021.105905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 12/26/2021] [Accepted: 12/29/2021] [Indexed: 11/26/2022]
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12
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Bookhart LH, Anstey EH, Kramer MR, Perrine CG, Reis‐Reilly H, Ramakrishnan U, Young MF. A nation‐wide study on the common reasons for infant formula supplementation among healthy, term, breastfed infants in US hospitals. MATERNAL & CHILD NUTRITION 2022; 18:e13294. [PMID: 34905644 PMCID: PMC8932686 DOI: 10.1111/mcn.13294] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 11/29/2022]
Abstract
In‐hospital infant formula supplementation of breastfed infants reduces breastfeeding duration, yet little is known about common reasons for infant formula supplementation. We examined the three most common reasons for in‐hospital infant formula supplementation of healthy, term, breastfed infants in the US reported by hospital staff. Hospital data were obtained from the 2018 Maternity Practices in Infant Nutrition and Care survey (n = 2045), which is completed by hospital staff. An open‐ended question on the top three reasons for in‐hospital infant formula supplementation was analyzed using thematic qualitative analysis and the frequencies for each reason were reported. The top three most common reasons for in‐hospital infant formula supplementation reported by hospital staff included medical indications (70.0%); maternal request/preference/feelings (55.9%); lactation management‐related issues (51.3%); physical but non‐medically indicated reasons (36.1%); social influences (18.8%); perceived cultural/societal/demographic factors (8.2%) and medical staff/institutional practices (4.7%). These findings suggest that a variety of factors should be considered to address unnecessary infant formula supplementation. Lactation management support delivered in a timely and culturally sensitive manner and targeted to mother‐infant dyads with potential medical and physical indications may reduce unnecessary in‐hospital infant formula supplementation. The three most commonly reported reasons by hospital staff for infant formula supplementation were found to be related to medical indications (70.0%); maternal request/preference/feelings about breastfeeding such as frustration or lack of confidence (55.9%); lactation management‐related issues (51.3%); physical but non‐medically indicated reasons (36.1%); social influences (18.8%); perceived cultural/societal/demographic factors (8.2%); and medical staff/institutional practices (4.7%). Underlying many of the reported three most common reasons for infant formula supplementation is potentially lack of lactation management support that considers the social influences (e.g. from family and friends) and that is culturally relevant. These findings suggest that a variety of factors should be considered to address unnecessary infant formula supplementation.
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Affiliation(s)
- Larelle H. Bookhart
- Hubert Department of Global Health, Doctoral Program in Nutrition and Health Sciences, Laney Graduate School Emory University Atlanta Georgia USA
| | - Erica H. Anstey
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention Atlanta Georgia USA
| | - Michael R. Kramer
- Department of Epidemiology, Rollins School of Public Health Emory University Atlanta Georgia USA
| | - Cria G. Perrine
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention Atlanta Georgia USA
| | - Harumi Reis‐Reilly
- Maternal and Child Health National Association of County and City Health Officials Washington District of Columbia USA
| | - Usha Ramakrishnan
- Hubert Department of Global Health, Doctoral Program in Nutrition and Health Sciences, Laney Graduate School Emory University Atlanta Georgia USA
- Hubert Department of Global Health Emory University Atlanta Georgia USA
| | - Melissa F. Young
- Hubert Department of Global Health, Doctoral Program in Nutrition and Health Sciences, Laney Graduate School Emory University Atlanta Georgia USA
- Hubert Department of Global Health Emory University Atlanta Georgia USA
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13
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[Family influences on maternal feeding practices of preschool children from vulnerable families in the Metropolitan Region of Chile]. Aten Primaria 2021; 53:102122. [PMID: 34144427 PMCID: PMC8220171 DOI: 10.1016/j.aprim.2021.102122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 11/26/2022] Open
Abstract
Objetivo Explorar las influencias de integrantes del grupo familiar en las prácticas de alimentación de madres hacia preescolares, en familias de barrios vulnerables en la Región Metropolitana de Santiago, Chile. Diseño Estudio cualitativo. Lugar Nueve jardines infantiles de la Región Metropolitana, Santiago, Chile. Participantes Veinticuatro madres y un padre de hijos preescolares. Método Se realizaron 25 entrevistas semiestructuradas con técnica de foto-elicitación y su posterior análisis temático inductivo de las influencias familiares. Resultados Las participantes describieron que las influencias familiares sobre las prácticas de alimentación que aplicaban en sus hijos preescolares dependían de la estructura familiar y de la cercanía entre familiares. Algunas de estas influencias afectan directamente la conducta alimentaria del niño, especialmente en familiares que cohabitan juntos, mientras que otras estaban mediadas por las relaciones generadas entre padres y otros miembros de la familia. El padre, en familias biparentales, y abuelos del preescolar son los familiares más influyentes. Los padres participan en la alimentación del niño y generalmente se alinean a las prácticas de alimentación con la madre. Los abuelos enriquecen la experiencia alimentaria de preescolares ofreciendo preparaciones caseras, expresando afecto con los alimentos, incluso opciones poco saludables, y apoyando a padres a diversificar y estructurar la alimentación del niño. Conclusiones El impacto de familiares y sus dinámicas en las prácticas alimentarias parentales y la alimentación de preescolares varían según la cercanía o cohabitación entre familiares. El desarrollo de estrategias de prevención y tratamiento de obesidad infantil debería considerar un enfoque familiar en familias vulnerables.
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14
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Schneider-Worthington CR, Berger PK, Goran MI, Salvy SJ. Learning to overeat in infancy: Concurrent and prospective relationships between maternal BMI, feeding practices and child eating response among Hispanic mothers and children. Pediatr Obes 2021; 16:e12756. [PMID: 33225624 PMCID: PMC8105266 DOI: 10.1111/ijpo.12756] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/05/2020] [Accepted: 11/09/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Parents play a key role in shaping children's eating behaviours and self-regulation. There is limited data on how maternal weight influences feeding practices in the first year of life. OBJECTIVE To examine the relationships between maternal BMI, feeding practices and infant eating behaviours related to self-regulation. METHODS Participants were 160 mother-infant dyads. A longitudinal design was used to examine concurrent and prospective associations between maternal 6-month postpartum BMI, mothers' feeding practices at 6 months (Infant Feeding Practices Questionnaire) and children's eating behaviours at 6 months (Baby Eating Behaviour Questionnaire) and 12 months (Child Eating Behaviour Questionnaire). RESULTS Higher maternal BMI was associated positively with mothers' use of restrictive feeding practices (β = 0.036, p = 0.033), and inversely with responsivity to infant satiety cues (Spearman partial r = -0.249, p = 0.002) at 6 months. Mother's restrictive feeding practices were associated with infant food responsiveness (β = 0.157, p = 0.009) and emotional overeating (β = 0.118, p = 0.005) at 12 months. Maternal use of responsive feeding practices was associated with lower infant food responsiveness at 6 months (Spearman partial r = -0.173, p = 0.031) and lower emotional overeating at 12 months (Spearman partial r = -0.183, p = 0.022). CONCLUSIONS Our findings add to studies suggesting that feeding practices can provide mechanistic pathways in the intergenerational transmission of obesity. Postpartum family-system approaches focusing on maternal health while integrating infant feeding guidance may confer benefits in improving maternal-child health.
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Affiliation(s)
| | - Paige K. Berger
- Department of Pediatrics, Children’s Hospital Los Angeles, The University of Southern California, Los Angeles, California
| | - Michael I. Goran
- Department of Pediatrics, Children’s Hospital Los Angeles, The University of Southern California, Los Angeles, California
| | - Sarah-Jeanne Salvy
- Research Center for Health Equity, Cedars-Sinai Medical Center, West Hollywood, California
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15
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Cheney AM, Nieri T, Ramirez Zarate A, Garcia G, Vaca L, Valencia E, Versteeg C, Molina A, Castillo M, Tovar A. Grow well/Crecer bien: a protocol for research on infant feeding practices in low-income families. BMC Public Health 2020; 20:1431. [PMID: 32958017 PMCID: PMC7503435 DOI: 10.1186/s12889-020-09471-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of obesity among children remains high. Given obesity's significant lifelong consequences, there is great interest in preventing obesity early in life. There is a need to better understand the relation of common infant feeding styles and practices to obesity in infants using longitudinal study designs. There is also an urgent need to understand the role of caregivers other than mothers in feeding. A better understanding of variation in feeding styles and practices can inform the identification of risk groups and the tailoring of interventions to them. METHODS In partnership with Early Head Start programs across four counties in southern California, mothers and infants will be enrolled in a two-year longitudinal study collecting survey and anthropometric data. A subsample of mothers and their selected other caregivers will participate in qualitative research involving feeding diaries and dyadic interviews. The results will be used to develop and test an enhanced nutrition education program. DISCUSSION We outline a study methodology to examine feeding styles and practices and their association with early childhood obesity risk and enhance an existing intervention to promote healthy infant feeding and growth among children in low-income families.
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Affiliation(s)
- Ann M Cheney
- Department of Social Medicine Population and Public Health, 900 University Ave, Riverside, 92501, USA.
| | - Tanya Nieri
- Department of Sociology, University of California Riverside, Riverside, USA
| | - Ana Ramirez Zarate
- School of Public Policy, University of California Riverside, Riverside, USA
| | - Gretel Garcia
- Graduate School of Education, University of California Riverside, Riverside, USA
| | - Lucero Vaca
- Department of Social Medicine Population and Public Health, 900 University Ave, Riverside, 92501, USA
| | | | | | - Arlene Molina
- San Bernardino County Preschool Services Department, San Bernardino, USA
| | | | - Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, USA
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16
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Hepworth AD, Berlin LJ, Martoccio TL, Jones Harden B. Maternal attachment style, sensitivity, and infant obesity risk in low-income, Latino families. Attach Hum Dev 2020; 23:75-89. [PMID: 32126901 DOI: 10.1080/14616734.2020.1729214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Disparities in childhood obesity highlight the need for research to identify its early predictors in high-risk populations, such as low-income, Latino families. In the current study, the first of its kind in a low-income Latino sample (N = 55; M child age = 12.74 months, SD = 3.96), we investigated whether mothers' self-reported attachment style predicted their infants' weight-for-length (WFL; an early indicator of childhood obesity). We also explored whether observed maternal sensitivity, coded from a video-recorded semi-structured play assessment, mediated this association. We found a significant direct effect of maternal attachment style on infants' WFL z-scores (c' = -0.68, SE = 0.22, p = .004). Infants of mothers who classified themselves as secure had lower WFL z-scores than infants of insecure mothers (avoidant or anxious). Maternal sensitivity did not mediate this association, but was positively associated with infant WFL z-scores. We discuss implications of these findings for future research.
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Affiliation(s)
- Allison D Hepworth
- Department of Social Work, University of Maryland School of Social Work , Baltimore, MD, USA
| | - Lisa J Berlin
- Department of Social Work, University of Maryland School of Social Work , Baltimore, MD, USA
| | - Tiffany L Martoccio
- Department of Human Development and Quantitative Methodology, University of Maryland , College Park, MD, USA
| | - Brenda Jones Harden
- Department of Social Work, University of Maryland School of Social Work , Baltimore, MD, USA.,Department of Human Development and Quantitative Methodology, University of Maryland , College Park, MD, USA
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17
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Griauzde DH, Kieffer EC, Domoff SE, Hess K, Feinstein S, Frank A, Pike D, Pesch MH. The influence of social media on child feeding practices and beliefs among Hispanic mothers: A mixed methods study. Eat Behav 2020; 36:101361. [PMID: 31923649 PMCID: PMC8005295 DOI: 10.1016/j.eatbeh.2019.101361] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 11/22/2019] [Accepted: 12/23/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES (1) To identify factors that influence child feeding practices and beliefs among Hispanic mothers in a low-income community; (2) to describe the use of social media, other internet websites, and text messaging among Hispanic mothers; and (3) to explore mothers' perceptions of social media and/or text messaging interventions to prevent childhood obesity. METHODS Mixed methods descriptive study with a sequential explanatory design. Hispanic mothers (N = 66) from Detroit, Michigan with children between 6 and 36 months of age completed surveys regarding their child feeding practices, the source (s) influencing these practices, and their use of social media, internet, and text messaging. During qualitative interviews (N = 19), we explored mothers' use of social media and internet websites to find child health information as well as mothers' perspectives on social media/internet/text messaging interventions to promote child health. RESULTS Most survey respondents were between the ages of 20 and 39 years. One-third of mothers breastfed their child for >6 months; 68% did not introduce solids until their child was older than 6 months. The majority (96%) owned a cellphone; 75% used social media at least once daily. Few mothers indicated that social media and other internet websites influenced their child feeding decisions. During qualitative interviews (N = 19), almost all mothers expressed interest in social media and/or text messaging as a tool to communicate information regarding child health and feeding. CONCLUSIONS Hispanic mothers had high rates of social media use and most desired social media/internet/text messaging interventions to promote child health.
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Affiliation(s)
- Dina H Griauzde
- Ann Arbor VA Health System, Ann Arbor, MI, USA; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Edith C Kieffer
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Sarah E Domoff
- Department of Psychology, Central Michigan University, Mount Pleasant, MI, USA
| | - Kristen Hess
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | | | - Amy Frank
- Community Health and Social Services (CHASS) Center, Detroit, MI, USA
| | - Denise Pike
- Community Health and Social Services (CHASS) Center, Detroit, MI, USA
| | - Megan H Pesch
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
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18
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Maternal digital media use during infant feeding and the quality of feeding interactions. Appetite 2019; 143:104415. [DOI: 10.1016/j.appet.2019.104415] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 07/24/2019] [Accepted: 08/22/2019] [Indexed: 01/11/2023]
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19
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Linares AM, Cartagena D, Rayens MK. Las Dos Cosas Versus Exclusive Breastfeeding: A Culturally and Linguistically Exploratory Intervention Study in Hispanic Mothers Living in Kentucky. J Pediatr Health Care 2019; 33:e46-e56. [PMID: 31655788 PMCID: PMC6954491 DOI: 10.1016/j.pedhc.2019.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/21/2019] [Accepted: 07/22/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Formula supplementation among infants of breastfeeding Hispanic immigrants is common practice known as las dos cosas. The purpose of this study was to assess the feasibility, effectiveness, and acceptability of a culturally and linguistically diverse intervention to promote exclusive breastfeeding (EBF) for the first 6 months. METHODS A sample of 39 Hispanic pregnant women was recruited and randomly assigned to intervention (n = 20) and control groups (n = 19). The intervention included a peer counselor and professional support, and mothers were followed from pregnancy to 6 months after birth. RESULTS After the study, women assigned to the intervention group were over three times more likely to EBF their baby through all four postpartum assessed time points (odds ratio = 3.1, 95% confidence interval: 1.1-8.7). DISCUSSION This culturally and linguistically diverse intervention contributed to increased EBF duration and decreased formula supplementation in Hispanic mothers up to 6 months postpartum.
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20
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Hazrati S, Khan F, Huddleston K, De La Cruz F, Deeken JF, Fuller A, Wong WSW, Niederhuber JE, Hourigan SK. Clinical and social factors associated with excess weight in Hispanic and non-Hispanic White children. Pediatr Res 2019; 85:256-261. [PMID: 30643189 DOI: 10.1038/s41390-018-0264-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/01/2018] [Accepted: 11/05/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hispanic children are disproportionately affected by obesity, with this disparity starting at a young age, and there is a paucity of data comparing factors associated with excess weight in the first year of life in Hispanic vs. non-Hispanic populations. METHODS Excess weight was defined as weight-for-length ≥95th percentile. The associations of potential risk factors were compared by ethnicity stratification. RESULTS Of the 1009 children, 302 (30.0%) were Hispanic and 707 (70.0%) were non-Hispanic White. The rate of excess weight was 30.1% and 13.6% among Hispanic and non-Hispanic White children, respectively. Factors associated with excess weight for non-Hispanic White children were higher than recommended weight gain during pregnancy (odds ratio (OR) 1.8 (1.2-3.1)), higher paternal body mass index (BMI) (OR 1.1 (1.02-1.15)), higher birth weight (OR 1.001 (1.001-1.002)), and lower breast milk feedings at 6 months (OR 0.98 (0.96-0.98)). Factors associated with excess weight for Hispanic children were lower maternal education (OR 2.37 (1.1-4.5)) and lower breast milk feedings at 6 months (OR 0.98 (0.96-0.99)). CONCLUSION There are differential risk factors associated with excess weight at 12 months between Hispanic and non-Hispanic White children. Identification of differential factors in different ethnicities may allow for more targeted anticipatory guidance reduce obesity in at-risk populations.
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Affiliation(s)
- Sahel Hazrati
- Inova Translational Medicine Institute, Falls Church, VA, USA.
| | - Farah Khan
- Inova Children's Hospital, Falls Church, VA, USA
| | | | | | - John F Deeken
- Inova Translational Medicine Institute, Falls Church, VA, USA
| | - Alma Fuller
- Inova Translational Medicine Institute, Falls Church, VA, USA
| | - Wendy S W Wong
- Inova Translational Medicine Institute, Falls Church, VA, USA
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Garcia ML, Gatdula N, Bonilla E, Frank GC, Bird M, Rascón MS, Rios-Ellis B. Engaging Intergenerational Hispanics/Latinos to Examine Factors Influencing Childhood Obesity Using the PRECEDE–PROCEED Model. Matern Child Health J 2019; 23:802-810. [DOI: 10.1007/s10995-018-02696-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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22
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Gaffney KF, Kermer DA, Kitsantas P, Brito AV, Ramos KM, Pereddo G, Villatoro L. Early Life Factors for Overweight Risk Among Infants of Hispanic Immigrant Mothers. J Pediatr Health Care 2019; 33:35-41. [PMID: 30146364 DOI: 10.1016/j.pedhc.2018.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/10/2018] [Accepted: 05/28/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This study examined postpartum depression, food insecurity, and underestimation of infant size as potential early life factors for overweight risk at 12 months among infants of Hispanic immigrant mothers. METHOD Weight-for-length (WFL) measurements and face-to-face interviews were completed during well child visits. Regression models estimated the impact of early life factors (0-6 months) on overweight risk at 1 year. RESULTS WFL ≥ 85th percentile was found among 2.4% at birth and 42.7% at 1 year. Most mothers (78.6%) experienced food insecurity, a factor that increased the likelihood of infant overweight risk by 2.29 times (1.03-5.09). Maternal underestimation of infant size increased the likelihood of overweight risk 5.07 times (2.57-9.99). Postpartum depression risk did not contribute to infant weight status. DISCUSSION Assessment for maternal food insecurity and underestimation of infant weight status during early infancy may help reduce overweight risk and subsequent obesity for this vulnerable population.
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Affiliation(s)
- Kathleen F Gaffney
- Kathleen F. Gaffney, Professor, School of Nursing, George Mason University, Fairfax, VA.; Deborah A. Kermer, Data Services Research Consultant, University Libraries, Data Services, George Mason University, Fairfax, VA.; Panagiota Kitsantas, Professor, Health Administration and Policy Department, George Mason University, Fairfax, VA.; Albert V. Brito, Medical Director, Inova Cares Clinic for Children, Falls Church, VA.; Katya M. Ramos, Research Assistant, School of Nursing, George Mason University, Fairfax, VA.; Graciela Pereddo, Research Assistant, Global and Community Health Department, George Mason University, Fairfax, VA.; Luisa Villatoro, Research Assistant, School of Nursing, George Mason University, Fairfax, VA..
| | - Deborah A Kermer
- Kathleen F. Gaffney, Professor, School of Nursing, George Mason University, Fairfax, VA.; Deborah A. Kermer, Data Services Research Consultant, University Libraries, Data Services, George Mason University, Fairfax, VA.; Panagiota Kitsantas, Professor, Health Administration and Policy Department, George Mason University, Fairfax, VA.; Albert V. Brito, Medical Director, Inova Cares Clinic for Children, Falls Church, VA.; Katya M. Ramos, Research Assistant, School of Nursing, George Mason University, Fairfax, VA.; Graciela Pereddo, Research Assistant, Global and Community Health Department, George Mason University, Fairfax, VA.; Luisa Villatoro, Research Assistant, School of Nursing, George Mason University, Fairfax, VA
| | - Panagiota Kitsantas
- Kathleen F. Gaffney, Professor, School of Nursing, George Mason University, Fairfax, VA.; Deborah A. Kermer, Data Services Research Consultant, University Libraries, Data Services, George Mason University, Fairfax, VA.; Panagiota Kitsantas, Professor, Health Administration and Policy Department, George Mason University, Fairfax, VA.; Albert V. Brito, Medical Director, Inova Cares Clinic for Children, Falls Church, VA.; Katya M. Ramos, Research Assistant, School of Nursing, George Mason University, Fairfax, VA.; Graciela Pereddo, Research Assistant, Global and Community Health Department, George Mason University, Fairfax, VA.; Luisa Villatoro, Research Assistant, School of Nursing, George Mason University, Fairfax, VA
| | - Albert V Brito
- Kathleen F. Gaffney, Professor, School of Nursing, George Mason University, Fairfax, VA.; Deborah A. Kermer, Data Services Research Consultant, University Libraries, Data Services, George Mason University, Fairfax, VA.; Panagiota Kitsantas, Professor, Health Administration and Policy Department, George Mason University, Fairfax, VA.; Albert V. Brito, Medical Director, Inova Cares Clinic for Children, Falls Church, VA.; Katya M. Ramos, Research Assistant, School of Nursing, George Mason University, Fairfax, VA.; Graciela Pereddo, Research Assistant, Global and Community Health Department, George Mason University, Fairfax, VA.; Luisa Villatoro, Research Assistant, School of Nursing, George Mason University, Fairfax, VA
| | - Katya M Ramos
- Kathleen F. Gaffney, Professor, School of Nursing, George Mason University, Fairfax, VA.; Deborah A. Kermer, Data Services Research Consultant, University Libraries, Data Services, George Mason University, Fairfax, VA.; Panagiota Kitsantas, Professor, Health Administration and Policy Department, George Mason University, Fairfax, VA.; Albert V. Brito, Medical Director, Inova Cares Clinic for Children, Falls Church, VA.; Katya M. Ramos, Research Assistant, School of Nursing, George Mason University, Fairfax, VA.; Graciela Pereddo, Research Assistant, Global and Community Health Department, George Mason University, Fairfax, VA.; Luisa Villatoro, Research Assistant, School of Nursing, George Mason University, Fairfax, VA
| | - Graciela Pereddo
- Kathleen F. Gaffney, Professor, School of Nursing, George Mason University, Fairfax, VA.; Deborah A. Kermer, Data Services Research Consultant, University Libraries, Data Services, George Mason University, Fairfax, VA.; Panagiota Kitsantas, Professor, Health Administration and Policy Department, George Mason University, Fairfax, VA.; Albert V. Brito, Medical Director, Inova Cares Clinic for Children, Falls Church, VA.; Katya M. Ramos, Research Assistant, School of Nursing, George Mason University, Fairfax, VA.; Graciela Pereddo, Research Assistant, Global and Community Health Department, George Mason University, Fairfax, VA.; Luisa Villatoro, Research Assistant, School of Nursing, George Mason University, Fairfax, VA
| | - Luisa Villatoro
- Kathleen F. Gaffney, Professor, School of Nursing, George Mason University, Fairfax, VA.; Deborah A. Kermer, Data Services Research Consultant, University Libraries, Data Services, George Mason University, Fairfax, VA.; Panagiota Kitsantas, Professor, Health Administration and Policy Department, George Mason University, Fairfax, VA.; Albert V. Brito, Medical Director, Inova Cares Clinic for Children, Falls Church, VA.; Katya M. Ramos, Research Assistant, School of Nursing, George Mason University, Fairfax, VA.; Graciela Pereddo, Research Assistant, Global and Community Health Department, George Mason University, Fairfax, VA.; Luisa Villatoro, Research Assistant, School of Nursing, George Mason University, Fairfax, VA
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Towards appropriate feeding to prevent malnutrition in infants and toddlers. Eur J Clin Nutr 2018; 72:1274-1281. [PMID: 30185846 DOI: 10.1038/s41430-018-0266-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 06/13/2018] [Indexed: 11/09/2022]
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Garrett CC, Azimov M, Campwala K, Sarmiento M, Linton KF. Breastfeeding Practices Among Hispanic and Non-Hispanic Women at the Postpartum Visit. J Hum Lact 2018; 34:485-493. [PMID: 29787690 DOI: 10.1177/0890334418774765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Breastfeeding is an active area in public health advocacy. Despite documented benefits for infants and mothers, exclusive breastfeeding is not universal. Ethnicity, among other variables, has been shown to influence breastfeeding practice. Research aim: Our study aimed to determine which variables are associated with infant feeding patterns at the postpartum visit; compare the sociodemographic variables associated with infant feeding patterns between Hispanic and non-Hispanic mothers; and determine the odds of exclusive breastfeeding, mixed feeding, and exclusive formula feeding associated with sociodemographic characteristics. METHODS A retrospective, cross-sectional two-group comparison design was used. Hispanic and non-Hispanic women's ( N = 666) infant feeding patterns at 6-week postpartum were analyzed. Group comparisons were made of the demographic characteristics and infant feeding practice. RESULTS Thirty-four percent of Hispanic participants reported exclusive breastfeeding compared with 59% of non-Hispanic White participants. Language and body mass index were significantly associated with infant feeding patterns among Hispanic participants. Compared with non-Hispanic White participants, Hispanic participants had increased odds of reporting mixed feeding and exclusive formula feeding. CONCLUSION Breastfeeding initiatives should target English-speaking Hispanic mothers and obese Hispanic mothers to align breastfeeding rates with medical recommendations. Healthcare providers may benefit from additional training to address barriers to breastfeeding among obese women and to provide culturally sensitive support that encourages continued breastfeeding in this population.
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Affiliation(s)
| | | | | | | | - Kristen Faye Linton
- 2 Health Science Program, California State University, Channel Islands, Camarillo, CA, USA
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25
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Shin CN, Reifsnider E, McClain D, Jeong M, McCormick DP, Moramarco M. Acculturation, Cultural Values, and Breastfeeding in Overweight or Obese, Low-Income, Hispanic Women at 1 Month Postpartum. J Hum Lact 2018. [PMID: 29543552 DOI: 10.1177/0890334417753942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Most Hispanic infants are fed formula during the first 6 weeks, and although 80% of Hispanic women initiate breastfeeding, rates of exclusive breastfeeding are much lower. Research aim: The purpose was to examine the influence of acculturation and cultural values on the breastfeeding practices of pregnant women of Mexican descent participating in the Special Supplemental Nutrition Program for Women, Infants, and Children who were enrolled in a prospective randomized clinical trial that aimed to reduce child obesity. The data were abstracted from a larger randomized clinical trial focused on prevention of child obesity. METHODS The sample consisted of 150 women of Mexican origin who were enrolled at the time of these analyses from the randomized clinical trial and had a prepregnancy body mass index of ≥ 25 and spoke English and/or Spanish. All breastfeeding data for this report came from data collection at 1 month postpartum. RESULTS A higher score on the Anglo orientation scale of the Acculturation Rating Scale for Mexican Americans was associated with less breastfeeding at 1 month postpartum and less exclusive breastfeeding. CONCLUSION Acculturation plays a role in breastfeeding practice. Exploring acculturation associated with breastfeeding can guide us to design culturally relevant interventions to promote breastfeeding exclusivity among immigrant mothers.
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Affiliation(s)
- Cha-Nam Shin
- 1 College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Elizabeth Reifsnider
- 1 College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Darya McClain
- 1 College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Mihyun Jeong
- 1 College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - David P McCormick
- 2 School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Michael Moramarco
- 1 College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
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Gaffney KF, Brito AV, Kitsantas P, Kermer DA, Pereddo G, Ramos KM. Institute of Medicine Early Infant Feeding Recommendations for Childhood Obesity Prevention: Implementation by Immigrant Mothers From Central America. J Pediatr Nurs 2018; 40:27-33. [PMID: 29776476 PMCID: PMC5962027 DOI: 10.1016/j.pedn.2018.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/26/2018] [Accepted: 02/26/2018] [Indexed: 11/18/2022]
Abstract
PURPOSES Describe implementation of Institute of Medicine (IOM) early infant feeding recommendations for child obesity prevention by immigrant mothers from Central America; examine potential relationships with food insecurity and postpartum depressive symptoms. DESIGN AND METHODS Using a cross-sectional, descriptive design, face-to-face interviews were conducted with 318 mothers of 2month old infants at a large pediatric setting for low income families. Logistic regression models assessed feeding practices, food insecurity and postpartum depressive symptoms. RESULTS Exclusive breastfeeding rates were low (9.4%); most mothers (62.7%) both breastfed and bottle fed their infants. Mothers who bottle fed at moderate and high intensity were twice as likely to affirm that if you give a baby a bottle, you should always make sure s/he finishes it (OR=2.30, 95% CI=1.13, 4.69; OR=2.29, 95% CI=1.26, 4.14). Food insecurity was experienced by 57% of mothers but postpartum depressive symptoms were low (Possible range=0-30; M=2.96, SD =3.6). However, for each increase in the postpartum depressive symptoms score, the likelihood of affirming a controlling feeding style increased by 11-13%. CONCLUSIONS Immigrant mothers from Central America were more likely to both breastfeed and bottle feed (las dos cosas) than implement exclusive breastfeeding. Bottle feeding intensity was associated with a controlling feeding style. PRACTICE IMPLICATIONS Infant well visits provide the ideal context for promoting IOM recommendations for the prevention of obesity among children of immigrant mothers from Central America.
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Affiliation(s)
| | - Albert V Brito
- Inova Cares Clinic for Children, Falls Church, VA, United States.
| | - Panagiota Kitsantas
- Health Administration and Policy Department, George Mason University, Fairfax, VA, United States.
| | - Deborah A Kermer
- University Libraries, Data Services, George Mason University, Fairfax, VA, United States.
| | - Graciela Pereddo
- Global and Community Health Department, George Mason University, Fairfax, VA, United States.
| | - Katya M Ramos
- School of Nursing, George Mason University, Fairfax, VA, United States.
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Hassan NE, El-Masry SA, El Batrawy SR, Khalil A, Ali MM, Al Tohamy M, Abo Hashish M. Relationship between breast feeding duration and risk of overweight/obesity among Egyptian children. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2018. [DOI: 10.1016/j.epag.2018.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Cartagena D, McGrath JM, Linares AM. Associations between Introduction of Age-Inappropriate Foods and Early Eating Environments in Low-Socioeconomic Hispanic Infants. J Pediatr Health Care 2018; 32:e27-e36. [PMID: 29249647 DOI: 10.1016/j.pedhc.2017.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 09/04/2017] [Accepted: 09/09/2017] [Indexed: 01/28/2023]
Abstract
PURPOSE To examine the associations between feeding practices and eating environments of low-socioeconomic Hispanic infants. METHODS Secondary analysis of cross-sectional data from a sample of 62 low-income immigrant Hispanic mothers and their infants (age range = 4-12 months). Measures of infant feeding practices (food groups and beverages consumption) and eating environment domains were included using the Infant Feeding Scale. RESULTS TV exposure and allowing the infant to play with toys during meals significantly correlated with intake of energy-dense foods in 4- to 6-month-olds (p = .05). Among 7- to 9-month-olds, mealtime TV watching correlated with consumption of snacks (p = .05) and sweetened beverages (p = .01). Consumption of energy-dense foods was significantly different among groups with higher mean intake in older infants (p = < .01). CONCLUSION Findings highlight the need for culturally and socioeconomically sensitive approaches to improve infant feeding practices and support low-income Hispanic families in providing healthy and nurturing eating environments required to prevent later obesity risk.
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Differences in the Protective Effect of Exclusive Breastfeeding on Child Overweight and Obesity by Mother's Race. Matern Child Health J 2017; 20:1971-9. [PMID: 27178429 DOI: 10.1007/s10995-016-2015-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives To examine the relationship between infant feeding and risk of child overweight and obesity across race and ethnicity in a diverse community-based cohort. Methods 2172 mother baby dyads were drawn from a prospective cohort constructed using data from electronic medical records linked to birth records. The primary exposure was exclusive breastfeeding at 2 months of age; outcome was BMI Z-score and BMI ≥ 85th percentile (overweight and obese) at 4 years of age. Regression models were adjusted for confounding using covariance balanced propensity score and inverse probability weighting. Results At age 4, exclusively breast fed children had lower BMI Z-score (-0.109, SE = 0.048) and a decreased odds of a BMI ≥ 85th percentile (0.832; 95 % CI 0.792, 0.994), when compared to those exclusively formula-fed or had mixed feeding. Race and ethnicity significantly moderated these associations. Sub-population analysis showed the effect was significant for BMI Z-score (p = 0.0002) and BMI ≥ 85th percentile (p < 0.0001) only for children of NH white mothers. For children of NH black mothers exclusive breastfeeding was not associated with a significant difference in BMI Z-score, however there was an increased odds of overweight or obesity (p = 0.0145). Conclusions The protective effect of breastfeeding against early childhood overweight and obesity may differ by race and ethnicity. This suggests that programs aiming to reduce obesity by increasing rates of breastfeeding may have limited impact for some groups and should be coupled with other racially and ethnically focused efforts to encourage healthy feeding practices in infancy and early childhood.
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Linares AM, Wambach K, Rayens MK, Wiggins A, Coleman E, Dignan MB. Modeling the Influence of Early Skin-to-Skin Contact on Exclusive Breastfeeding in a Sample of Hispanic Immigrant Women. J Immigr Minor Health 2017; 19:1027-1034. [PMID: 26969615 PMCID: PMC5018413 DOI: 10.1007/s10903-016-0380-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Using data from a longitudinal study of breastfeeding in Hispanics, this study evaluated the influence of early skin-to-skin contact (SSC) on initiation and sustained exclusive breastfeeding (EBF) at 1 month postpartum. Two-thirds of the women in the sample participated in early SSC. At discharge, over half of the women were EBF; this proportion decreased to one-third at 1 month postpartum. Controlling for demographic and clinical variables in the model, participation in early SSC was associated with a greater than sevenfold increase in the odds of EBF at discharge (p = .005) but was not predictive of EBF at 1 month post-discharge (p = .7). Younger maternal age and increased prenatal infant feeding intention were associated with an increased likelihood of EBF across both timepoints. Promoting early SSC may help with initiation of EBF, while further breastfeeding support may be needed to maintain EBF following discharge for this vulnerable population.
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Affiliation(s)
- Ana M. Linares
- College of Nursing, University of Kentucky, Faculty of Health Science, Universidad de Tarapaca, Arica, Chile. 315 College of Nursing Building, University of Kentucky, Lexington, KY, 40536-0230, USA
| | - Karen Wambach
- School of Nursing, University of Kansas, Kansas City, KUMC,
| | - Mary K. Rayens
- College of Nursing and College of Public Health, University of Kentucky,
| | | | | | - Mark B. Dignan
- Department of Internal Medicine and Director of the University of Kentucky, Prevention Research Center,
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31
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Kiraly C, Turk MT, Kalarchian MA, Shaffer C. Applying Ecological Frameworks in Obesity Intervention Studies in Hispanic/Latino Youth:. HISPANIC HEALTH CARE INTERNATIONAL 2017; 15:130-142. [DOI: 10.1177/1540415317731069] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: In the United States, Hispanic children have higher rates of obesity compared with non-Hispanic White children. An ecological framework provides a holistic view of the environment to which Hispanic/Latino children are exposed that can potentially inform prevention and treatment initiatives for this vulnerable population. Method: This systematic review examines the existing evidence on the use of an ecological framework in intervention studies targeting overweight and obesity in Hispanic youth from birth to 8 years. Key terms guided the search of PubMed, Google Scholar, CINAHL, and EBSCOhost databases from 1997 to 2016. Results were organized using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) method. Results: Seven studies met the inclusion and exclusion criteria. Significant improvements in body mass index z scores in treatment children were evident in five of the seven studies. Increases in fruit, water, and vegetable consumption and physical activity levels were reported in four of the seven studies. Conclusion: Multilevel interventions targeting a child’s home and community suggest efficacy in reducing or preventing obesity; increasing fruit, water, and vegetable consumption; and increasing physical activity in overweight/obese young Hispanic children. Future research is needed to explore the sustainability of multilevel obesity prevention interventions in this vulnerable population.
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Affiliation(s)
- Carmen Kiraly
- Suffolk County Community College, Brentwood, NY, USA
| | | | | | - Cheryl Shaffer
- Suffolk County Community College, Brentwood, NY, USA
- Suffolk County Community College, Sayville, NY, USA
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Banna J, Campos M, Gibby C, Graulau RE, Meléndez M, Reyes A, Lee JE, Palacios C. Multi-site trial using short mobile messages (SMS) to improve infant weight in low-income minorities: Development, implementation, lessons learned and future applications. Contemp Clin Trials 2017; 62:56-60. [PMID: 28827160 DOI: 10.1016/j.cct.2017.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/08/2017] [Accepted: 08/15/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Jinan Banna
- University of Hawaii at Manoa, Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, Agricultural Sciences 216, 1955 East-West Rd, Honolulu, HI 96822, United States.
| | - Maribel Campos
- University of Puerto Rico, Medical Sciences Campus, Endowed Health Services Research Center, Dental and Craniofacial Genomics Center, United States.
| | - Cheryl Gibby
- University of Hawaii at Manoa, Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, Agricultural Sciences 216, 1955 East-West Rd, Honolulu, HI 96822, United States.
| | - Rafael Enrique Graulau
- University of Puerto Rico, Graduate School of Public Health, Medical Sciences Campus, PO Box 365067, San Juan, PR 00936-5067, United States.
| | - Marytere Meléndez
- University of Puerto Rico, Center for Clinical Research and Health Promotion, Medical Sciences Campus, PO Box 365067, San Juan, PR 00936-5067, United States.
| | - Alexandra Reyes
- Nutrition Division, Puerto Rico WIC Program, Department of Health, San Juan, PR 00928-5220, United States.
| | - Jae Eun Lee
- Jackson State University, College of Science, Engineering and Technology, 1230 Raymond Rd, Jackson, MS 39204, United States.
| | - Cristina Palacios
- University of Puerto Rico, Graduate School of Public Health, Medical Sciences Campus, PO Box 365067, San Juan, PR 00936-5067, United States.
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Musaad SMA, Speirs KE, Hayes JT, Mobley AR, Fitzgerald N, Jones BL, VanBrackle A, Sigman-Grant M. The impact of environmental, parental and child factors on health-related behaviors among low-income children. Appetite 2017; 112:260-271. [PMID: 28159663 DOI: 10.1016/j.appet.2017.01.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 01/26/2017] [Accepted: 01/27/2017] [Indexed: 12/19/2022]
Abstract
Multi-level factors act in concert to influence child weight-related behaviors. This study examined the simultaneous impact of variables obtained at the level of the home environment (e.g., mealtime ritualization), parent (e.g., modeling) and child (e.g., satiety responsiveness) with the outcomes of practicing healthy and limiting unhealthy child behaviors (PHCB and LUCB, respectively) in a low-income U.S. SAMPLE This was a cross sectional study of caregivers of preschool children (n = 432). Caregivers were interviewed using validated scales. Structural equation modeling was used to examine associations with the outcomes. Adjusting for study region, demographics and caregiver's body mass index, we found significant associations between PHCB and higher mealtime ritualizations (β: 0.21, 95% confidence interval [CI]: 0.11; 0.32, more parental modeling (β: 0.39, 95% CI: 0.27; 0.49) and less parental restrictive behavior (β: -0.19, 95% CI: -0.29; -0.10). More parental covert control (β: 0.44, 95% CI: 0.35; 0.54), more parental overt control (β: 0.14, 95% CI: 0.03; 0.25) and less parental permissive behavior (β: -0.25, 95% CI: -0.34; -0.09) were significantly associated with LUCB. Findings suggest the synergistic effects of mealtime ritualizations and covert control at the environmental-level and parental modeling, overt control, restrictive and permissive behavior at the parent-level on the outcomes. Most factors are modifiable and support multidisciplinary interventions that promote healthy child weight-related behaviors.
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Affiliation(s)
- Salma M A Musaad
- Family Resiliency Center, Department of Human Development and Family Studies, University of Illinois at Urbana-Champaign, 2031 Doris Kelley Christopher Hall, 904 W. Nevada, Urbana, IL 61801, USA.
| | - Katherine E Speirs
- Department of Family Studies and Human Development, Norton School of Family and Consumer Sciences, University of Arizona, 650 N Park Ave, 315-L McClelland Park, Tucson, AZ, 85721-0078, USA.
| | - Jenna T Hayes
- University of Nevada, Reno, Human Development and Family Studies, 1664 N. Virginia St./Mail Stop 0140, Reno, NV 89557, USA.
| | - Amy R Mobley
- Department of Nutritional Sciences, University of Connecticut, 3624 Horsebarn Road Extension Unit 4017, Storrs, CT 06269-4017, USA.
| | - Nurgul Fitzgerald
- Department of Nutritional Sciences, Rutgers, The State University of New Jersey, 26 Nichol Avenue, Room 229A, New Brunswick, NJ 08901, USA.
| | - Blake L Jones
- Department of Human Development and Family Studies, Purdue University, 1202 W. State St., West Lafayette, IN 47907-2055, USA.
| | - Angela VanBrackle
- University of Nevada, Reno Cooperative Extension, 8050 Paradise Rd., Suite 100, Las Vegas, NV 89123, USA.
| | - Madeleine Sigman-Grant
- University of Nevada, Reno Cooperative Extension, 8050 Paradise Rd., Suite 100, Las Vegas, NV 89123, USA.
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Gaffney KF, Brito AV, Kitsantas P, Kermer DA. Early Feeding Practices and Weight Status at One Year of Age: A Comparison of Hispanic Immigrant Mother-Infant Dyads with Participants of the Infant Feeding Practices Study II. Child Obes 2016; 12:384-91. [PMID: 27385467 DOI: 10.1089/chi.2016.0037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Hispanic preschoolers have higher rates of BMI ≥85th percentile than any other racial/ethnic group. To identify underpinnings of this disparity, we compared early feeding practices and subsequent weight status for a sample of infants of low-income, Hispanic immigrant mothers with participants from the Infant Feeding Practices Study II (IFPS II). METHODS Proyecto de Bebés Hispanos Saludables (PBHS) collected medical record data for mother-infant dyads (n = 550) from a large pediatric clinic for low-income families and merged it with IFPS II data (n = 1502) to compare early feeding practices and late infancy weight status. RESULTS Mode of milk delivery for PBHS mothers was less likely to be exclusive breastfeeding at 6 months (9.0% vs. 27.5%), but more likely to be both breast and bottle feeding (43.5% vs. 26.3%) compared to IFPS II mothers. No difference was found in age for solid food introduction. Weight for age of PBHS infants was more likely to be ≥85th percentile at 12 months than IFPS II infants (39.1% vs. 25.4%). Both PBHS and IFPS II infants were more likely to be ≥85th percentile at 1 year if mode of milk delivery was bottle only at 6 months compared to those who were breastfed only, even after adjusting for potential confounders. CONCLUSION Differences in PBHS and IFPS II feeding practices and weight status suggest additional studies of modifiable, early life risk factors are needed to inform clinical and public health interventions that reduce childhood obesity for this growing sector of the US population.
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Affiliation(s)
| | | | - Panagiota Kitsantas
- 3 Department of Health Administration and Policy, George Mason University , Fairfax, VA
| | - Deborah Ann Kermer
- 4 University Libraries Data Services, George Mason University , Fairfax, VA
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Tomori C, Palmquist AEL, Dowling S. Contested moral landscapes: Negotiating breastfeeding stigma in breastmilk sharing, nighttime breastfeeding, and long-term breastfeeding in the U.S. and the U.K. Soc Sci Med 2016; 168:178-185. [PMID: 27664771 DOI: 10.1016/j.socscimed.2016.09.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/08/2016] [Accepted: 09/09/2016] [Indexed: 12/20/2022]
Abstract
Recent public health breastfeeding promotion efforts have galvanized media debates about breastfeeding in wealthy, Euro-American settings. A growing body of research demonstrates that while breastfeeding is increasingly viewed as important for health, mothers continue to face significant structural and cultural barriers. Concerns have been raised about the moralizing aspects of breastfeeding promotion and its detrimental effects on those who do not breastfeed. Far less, however, is known about the moral experiences of those who pursue breastfeeding. This study draws together research on breastmilk sharing (2012-2016) and nighttime breastfeeding from the U.S. (2006-2009), and long-term breastfeeding from the U.K. (2008-2009) from three ethnographic projects to address this gap. Comparative analysis of these cases reveals that while breastfeeding is considered ideal infant nutrition, aspects of its practice continue to evoke physical and moral danger, even when these practices are implemented to facilitate breastfeeding. Breastmilk sharing to maintain exclusive breastmilk feeding, nighttime breastfeeding and bedsharing to facilitate breastfeeding, and breastfeeding beyond the accepted duration are considered unnecessary, unhealthy, harmful or even deadly. The sexual connotations of breastfeeding enhance the morally threatening qualities of these practices. The cessation of these "problematic" breastfeeding practices and their replacement with formula-feeding or other foods is viewed as a way to restore the normative social and moral order. Mothers manage the stigmatization of these breastfeeding practices through secrecy and avoidance of health professionals and others who might judge them, often leading to social isolation. Our findings highlight the divide between perceptions of the ideal of breastfeeding and its actual practice and point to the contested moral status of breastfeeding in the U.S. and the U.K. Further comparative ethnographic research is needed to illuminate the lived social and moral experiences of breastfeeding, and inform initiatives to normalize and support its practice without stigmatizing parents who do not breastfeed.
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Affiliation(s)
- Cecilia Tomori
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | - Sally Dowling
- University of the West of England, Bristol, United Kingdom
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36
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Gonzalez G. Primary Care Interventions to Reduce Childhood Obesity in Latino Families. J Pediatr Health Care 2016; 30:471-9. [PMID: 26677979 DOI: 10.1016/j.pedhc.2015.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/30/2015] [Accepted: 11/06/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Increasing rates of obesity in Latino children call for culturally sensitive primary care interventions. Despite recent efforts to address this growing disparity, little is known about cultural variables that influence obesity management programs in Latino children. METHODS A literature search was conducted using CINHAL, Scopus, PubMed, and PsycINFO to review the state of the science regarding primary care interventions to decrease obesity in Latino children. The author analyzed the effects of several cultural practices on obesity and made recommendations based on their clinical implications for weight reduction management programs. RESULTS Obesity in Latino children is a multifactorial problem influenced by family behaviors, cultural perceptions of weight and health, traditional dietary norms, and socioeconomic status. Current practice lags behind national obesity management recommendations and is further hindered by a lack of consideration of the roles of key cultural differences in Latino families. DISCUSSION It is imperative to recognize the importance of family preferences and culture when developing weight reduction programs so as to foster long-term behavior changes. More research assessing the efficacy of culturally competent interventions is necessary to guide national efforts to address this increasing disparity.
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Russell CG, Taki S, Azadi L, Campbell KJ, Laws R, Elliott R, Denney-Wilson E. A qualitative study of the infant feeding beliefs and behaviours of mothers with low educational attainment. BMC Pediatr 2016; 16:69. [PMID: 27209010 PMCID: PMC4875628 DOI: 10.1186/s12887-016-0601-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 05/10/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Infancy is an important period for the promotion of healthy eating, diet and weight. However little is known about how best to engage caregivers of infants in healthy eating programs. This is particularly true for caregivers, infants and children from socioeconomically disadvantaged backgrounds who experience greater rates of overweight and obesity yet are more challenging to reach in health programs. Behaviour change interventions targeting parent-infant feeding interactions are more likely to be effective if assumptions about what needs to change for the target behaviours to occur are identified. As such we explored the precursors of key obesity promoting infant feeding practices in mothers with low educational attainment. METHODS One-on-one semi-structured telephone interviews were developed around the Capability Opportunity Motivation Behaviour (COM-B) framework and applied to parental feeding practices associated with infant excess or healthy weight gain. The target behaviours and their competing alternatives were (a) initiating breastfeeding/formula feeding, (b) prolonging breastfeeding/replacing breast milk with formula, (c) best practice formula preparation/sub-optimal formula preparation, (d) delaying the introduction of solid foods until around six months of age/introducing solids earlier than four months of age, and (e) introducing healthy first foods/introducing unhealthy first foods, and (f) feeding to appetite/use of non-nutritive (i.e., feeding for reasons other than hunger) feeding. The participants' education level was used as the indicator of socioeconomic disadvantage. Two researchers independently undertook thematic analysis. RESULTS Participants were 29 mothers of infants aged 2-11 months. The COM-B elements of Social and Environmental Opportunity, Psychological Capability, and Reflective Motivation were the key elements identified as determinants of a mother's likelihood to adopt the healthy target behaviours although the relative importance of each of the COM-B factors varied with each of the target feeding behaviours. CONCLUSIONS Interventions targeting healthy infant feeding practices should be tailored to the unique factors that may influence mothers' various feeding practices, taking into account motivational and social influences.
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Affiliation(s)
| | - Sarah Taki
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Leva Azadi
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
| | - Rachel Laws
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
| | - Rosalind Elliott
- Faculty of Health, University of Technology Sydney, Sydney, Australia
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Bertmann FMW, Yaroch AL. Role of Breast Milk and Breastfeeding within the Context of a Sustainable, Resilient Food System. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2016. [DOI: 10.1080/19320248.2015.1066732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Salarkia N, Omidvar N, Zaeri F, Zeinab HE, Neyestani TR. Mother’s Self-Efficacy Mediates the Relationship Between Household Food Insecurity and Maternal Infant Feeding Styles. Matern Child Health J 2015; 20:602-12. [DOI: 10.1007/s10995-015-1859-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Papachrisanthou MM, Davis RL. Clinical Practice Guidelines for the Management of Gastroesophageal Reflux and Gastroesophageal Reflux Disease: Birth to 1 Year of Age. J Pediatr Health Care 2015; 29:558-64. [PMID: 26318381 DOI: 10.1016/j.pedhc.2015.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 07/27/2015] [Accepted: 07/28/2015] [Indexed: 11/17/2022]
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Piovanetti Y. The Puerto Rican Experience: Overcoming Institutional and Cultural Barriers to Improve Breastfeeding Equity in the Hospital, Workplace, and the Community. Breastfeed Med 2015; 10:391-4. [PMID: 26348931 DOI: 10.1089/bfm.2015.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Yvette Piovanetti
- Medical Director, Centro Pediátrico de Lactancia y Crianza , Inc. (Proyecto Lacta), San Juan, Puerto Rico .,Department of Pediatrics, University of Puerto Rico School of Medicine , San Juan, Puerto Rico
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Differences in modifiable feeding factors by overweight status in Latino infants. Appl Nurs Res 2015; 30:210-5. [PMID: 27091280 DOI: 10.1016/j.apnr.2015.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 09/08/2015] [Accepted: 09/08/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Obesity prevalence remains disproportionally high for young American children from low-socioeconomic and ethnic minorities. Modifiable feeding factors may lead to infant overfeeding and an increased risk for obesity. This study explored differences in modifiable feeding factors by overweight status (>85% weight-for-length) in the first year of life of Latino infants. METHODS Data were obtained from a cross-sectional pilot study of 62 low-income immigrant Latina mothers and their infants (ages 4-12 months). Measures included maternal feeding practices, feeding pattern, infant's 24-hour dietary recall, and maternal perception of infant weight. Chi-square and t-tests were used for comparisons between healthy weight and overweight infants. RESULTS Birth weight z-scores did not significantly differ by weight status. Overweight status was not associated with maternal feeding practices, feeding pattern or infant dietary intake. A trend toward significance was seen in the maternal perception of infant weight. CONCLUSION Overweight infants were similar to healthy weight infants in their birth weight z-scores and supports the premise that modifiable feeding factors are in play and thus targeted early feeding interventions may prove effective in decreasing obesity risk in Latinos.
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Factors contributing to infant overfeeding in low-income immigrant Latina mothers. Appl Nurs Res 2015; 28:316-21. [PMID: 26608432 DOI: 10.1016/j.apnr.2015.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/21/2015] [Accepted: 03/05/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Approximately 10% of U.S. infants and toddlers are considered overweight. Hispanic infants persistently show higher prevalence rates for being overweight compared to other infants. Little is known about factors promoting excessive infant weight gain in Latinos. PURPOSE The aim of this study was to describe multidimensional factors and maternal feeding practices that may correlate with infant overfeeding in Latina mothers. METHODS Participants were 62 low-income immigrant Latina mothers and their infants. Study measures were: acculturation; maternal feeding beliefs and practices; food availability; temperament; 24-hour dietary recall; and infant's weight-for-height z score. RESULTS In regression models adjusted for infant's age, healthier feeding practices were significantly predicted by maternal education and infant's age. Most mothers preferred feeding their infants either formula or a combination of breast milk and formula. A significant proportion of the infants were overweight or obese and yet some mothers displayed difficulty recognizing this problem. CONCLUSION Future intervention efforts should focus primarily on the promotion of healthy feeding practices that discourage overfeeding and support exclusive breastfeeding among this ethnic group.
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Wilhelm SL, Aguirre TM, Koehler AE, Rodehorst TK. Evaluating motivational interviewing to promote breastfeeding by rural Mexican-American mothers: the challenge of attrition. ACTA ACUST UNITED AC 2014; 38:7-21. [PMID: 25373565 DOI: 10.3109/01460862.2014.971977] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Although most Hispanic/Latino-American mothers initiate breastfeeding, duration and exclusivity of breastfeeding remain low. We explored whether a motivational interviewing (MI) intervention could help rural Mexican-American mothers continue breastfeeding. We used a two-group (MI intervention n = 26, attention control [AC] n = 27) repeated measures experimental design. Assessments and interventions occurred at 3 days, 2 weeks, and 6 weeks postpartum (time points when mothers are particularly vulnerable to discontinuing breastfeeding), with a final phone assessment at 6 months postpartum. We collected demographic data and measured intent to breastfeed for 6 months (intent question), self-efficacy (Breastfeeding Self-Efficacy Scale-Short Form), and collected breastfeeding information (breastfeeding assessment questionnaire). Independent t-tests and Mann Whitney U non-parametric tests were used to evaluate group differences (α = 0.05). High levels of attrition by week 6 impaired our ability to evaluate the potential of our MI intervention. No significant differences were found between groups for any of the outcome variables (intent to breastfeed for 6 months, breastfeeding self-efficacy, and duration of breastfeeding). Though the mothers intended to breastfeed for 6 months and were confident in their ability to do so, most did not breastfeed for 6 months. At 6 months, mothers receiving the MI intervention had breastfed an average of 90 days compared to 82 days for those receiving the AC sessions and 22% of the mothers in each group were still breastfeeding at some level. Because of the impact of attrition during this study, we discuss factors that contributed to attrition and approaches to lessen this problem in future studies. Such efforts may require a greater investment of time and resources and should be budgeted accordingly. Culturally appropriate interventions are needed to help rural Mexican-American mothers meet their breastfeeding goals, thus providing an opportunity to reduce their children's risk of multiple diseases and obesity. Only when we address these considerations will we have an opportunity to decrease health disparities, promote healthy behaviors, and be trusted health care partners.
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Affiliation(s)
- Susan L Wilhelm
- University of Nebraska Medical Center, College of Nursing-West Nebraska Division , Scottsbluff, Nebraska , USA
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