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Giles ML, Ball GDC, Bonder R, Buchholz A, Gorter JW, Morrison KM, Perez A, Walker M, McPherson AC. Exploring the complexities of weight management care for children with spina bifida: a qualitative study with children and parents. Disabil Rehabil 2024; 46:3440-3448. [PMID: 37665663 DOI: 10.1080/09638288.2023.2251878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/11/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE 1) To explore how children with spina bifida (SB) and their parents understand bodyweight, health and weight management; and 2) To identify what services and supports children with SB and their families feel are most appropriate to help them manage their health and weight. METHODS The study used interpretive description within a qualitative design. Participants were children with SB (aged 10-18) attending two Canadian SB clinics and their parents. Data were collected through individual interviews and analyzed using inductive thematic analysis. RESULTS Five children and five parents participated in the study. Children and parents had a weight-centric approach to health, which was related to the child's mobility. Weight was considered to be under individual control and mostly through diet. Trusting relationships between healthcare providers, children and families were important to discuss weight in a non-judgemental manner. Children should be involved in setting meaningful and achievable weight management goals. CONCLUSION Greater knowledge of how children with SB and their families understand weight and health offers opportunities for non-judgemental discussions about their needs and wishes. Helping families to place more value on health over weight may reduce feelings of stigma, while allowing children to develop some autonomy over health-related decisions.
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Affiliation(s)
- Madison L Giles
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Revi Bonder
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Annick Buchholz
- Centre for Healthy Active Living, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Jan Willem Gorter
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands. Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- CanChild, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Katherine M Morrison
- Centre for Metabolism, Obesity and Diabetes Research, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Arnaldo Perez
- Educational Research & Scholarship Unit, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Meaghan Walker
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Amy C McPherson
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
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Lee NE, Parker MM, Concepcion JQ. An electronic medical record (EMR) prompt improves screening rates for metabolic conditions among children with obesity. Obesity (Silver Spring) 2023; 31:1376-1382. [PMID: 36988900 DOI: 10.1002/oby.23690] [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: 07/22/2022] [Revised: 11/19/2022] [Accepted: 12/10/2022] [Indexed: 03/30/2023]
Abstract
OBJECTIVE This study evaluated the effectiveness of an automated prompt in the electronic medical record (EMR) to increase screening rates for metabolic conditions and referrals to health education and to improve BMI percentile among children with obesity. METHODS The intervention used an EMR reminder that provided a panel of lab orders (hemoglobin A1c, lipid panel, and alanine aminotransferase) during clinical encounters among pediatric patients ages 10 to 18 with BMI ≥ 95th percentile. Data on demographics, comorbid conditions, BMI, lab results, and health education referrals were analyzed. Cohorts during the year before (n = 3479) and after (n = 3439) workflow implementation were compared. RESULTS The distribution of race/ethnicity among children with obesity was 56% Hispanic, 19% White, 11% Filipino, 4% Pacific Islander, 3% Black, and 1% East/South Asian. Orders for metabolic lab tests increased from 2% in the pre-workflow period to 52% in the post-workflow period (p < 0.0001). Completed screening rates improved from 1% to 27% (p < 0.0001). Health education referrals increased from 0.4% to 7% (p < 0.0001). We observed a mean change in BMI percentile of -0.13% (p = 0.06). CONCLUSIONS This study validates the use of an EMR-based prompt to improve metabolic lab screening and health education referrals among children with obesity. During the limited period of follow-up, we found no significant change in BMI percentile.
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Affiliation(s)
- Nolan E Lee
- Kaiser Permanente San Jose Medical Center, San Jose, California, USA
| | - Melissa M Parker
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
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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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Healthcare professionals' perceptions of childhood obesity in Iquitos, Peru: a qualitative study. BMC Health Serv Res 2022; 22:175. [PMID: 35144599 PMCID: PMC8832769 DOI: 10.1186/s12913-022-07519-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 12/08/2021] [Indexed: 01/18/2023] Open
Abstract
Background Childhood obesity is an urgent worldwide concern associated with increased morbidity in adulthood. Healthcare professionals (HCPs) are well placed to influence childhood obesity trends and implement interventions. English-language studies regarding HCPs’ perceptions of childhood obesity are limited to high-income countries. Peru is an upper-middle-income country with regional disparities in childhood obesity prevalence. This qualitative study aims to explore HCPs’ perceptions of childhood obesity in Iquitos, Peru, where prevalence is relatively low. Methods Twenty-one HCPs with child healthcare experience were purposively recruited from two primary healthcare centres. Semi-structured, individual interviews were conducted with a translator and audio recorded. Transcribed data were analysed using thematic analysis. Results Eight themes were identified and divided into four categories: (1) HCPs’ perceptions and attitudes towards childhood obesity (level of concern regarding childhood obesity, perceived consequences of childhood obesity); (2) Factors which HCPs perceive to be important in the development of childhood obesity (parental factors, contextual factors); (3) HCPs’ perceptions of their role in childhood obesity prevention and management (educating parents about childhood obesity, regular monitoring of child growth); and (4) Barriers and facilitators in childhood obesity prevention and management (in healthcare, in schools). Conclusions HCPs had a low level of concern regarding childhood obesity in Iquitos and prioritised undernutrition. Parental factors were perceived to be the most influential in the development of childhood obesity. HCPs perceived themselves to have minimal influence due to prevailing positive views of excess weight and difficulties engaging parents. Educating parents about childhood obesity was felt to be essential to prevention and management although regular monitoring of child growth and home healthcare visits were viewed as useful additional measures. This study can help to inform the development of targeted public health strategies which are sensitive to local contexts and could prevent the upward childhood obesity trends evident elsewhere in Peru. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07519-z.
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Concordance Between the Weight of Spanish Adolescent Soccer Players, Their Self-Perceived Weight, and Their Weight as Perceived by Their Parents. J Pediatr Nurs 2021; 60:e13-e18. [PMID: 33618980 DOI: 10.1016/j.pedn.2021.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE In the context of soccer clubs, to analyze the concordance between players' actual weight, their self-perceived weight, and their weight as perceived by their parents; to determine which variables might explain the presence of concordance between parents' perception of adolescents' weight and their actual weight. Design and study: A cross-sectional study involving 330 soccer players aged between 13 and 16. Data on personal characteristics of adolescents and parents were analyzed, as well as parents' perceptions of adolescents' weight status and their self-perception. A descriptive analysis of the personal characteristics of the sample (adolescents and parents) and an analysis of the variables explaining the presence of concordance between the parents' perception of adolescents' weight and their actual weight were performed. RESULTS 19% of the adolescents were overweight and 3.4% were obese. The concordance between parents' perceptions of players' weight and players' actual weight was weak. The concordance between adolescents' self-perceived weight and their actual weight was moderate. The difference in BMI scores according to presence or absence of concordance was statistically significant: these scores were higher in the absence of concordance. Discordance between adolescents' weight and their parents' perception of their weight was associated with parents having lower levels of education. CONCLUSION A high percentage of parents and players misperceived their actual weight. This discrepancy was associated with higher BMI scores for adolescents. PRACTICE IMPLICATIONS Nurses should include promotion of accurate weight perception in educational interventions on excess weight.
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Eanes LS, Huerta C, Fuentes LA, Bautista B. Nurse Practitioner Students' Perceptions on Delivering Culturally Congruent Care to Vulnerable Mexican Immigrants: A Qualitative Study. HISPANIC HEALTH CARE INTERNATIONAL 2021; 20:56-65. [PMID: 34132139 DOI: 10.1177/15404153211020417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Increasingly, nurse practitioners serve as vanguards in providing primary health care to vulnerable Mexican immigrants. The aims of this study were to explore the lived experiences of nurse practitioner students in caring for Mexican immigrant patients and to capture their meaning of cultural influences deemed essential to the delivery of culturally congruent care. An exploratory descriptive design was employed. Purposive sampling was used to select 17 nurse practitioner students who volunteered to complete a semistructured face-to-face audio-taped interview and follow-up focus group discussion. Constant comparison was utilized to analyze data. From this process, four distinct themes emerged: Culturally congruent care extends beyond race and ethnicity, understands the importance of therapeutic communication, accepts complementary and alternative medical modalities, and recognizes the importance of eating patterns, food choices, and perceptions of ideal weight and health. These findings build on our understanding of key evidence-based cultural beliefs and practices that are important in delivering culturally congruent care to this subgroup.
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Affiliation(s)
- Linda S Eanes
- 12331The University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Carolina Huerta
- School of Nursing, 12331The University of Texas Rio Grande Valley, Edinburg, TX, USA
| | | | - Beatriz Bautista
- 12331The University of Texas Rio Grande Valley, Edinburg, TX, USA
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Campos AP, Vilar-Compte M, Hawkins SS. Association Between Breastfeeding and Child Overweight in Mexico. Food Nutr Bull 2021; 42:414-426. [PMID: 34044629 DOI: 10.1177/03795721211014778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Globally, the prevalence of child overweight has increased over the past few decades. The largest burden of child overweight is identified among upper-middle-income countries, such as Mexico. Breastfeeding has been identified as one of the key affordable and modifiable maternal health behaviors protecting against child overweight. OBJECTIVE To examine the association between breastfeeding and child overweight while sequentially controlling for individual, household, and area factors in Mexican children. METHODS Secondary data analysis using the 2012 Mexican National Health and Nutrition Survey which included risk factors for overweight on 2089 children aged 6 to 35 months and analyzed data to estimate fixed- and mixed-effects logistic regression models. RESULTS Overall, 9.0% of children were overweight and 71.1% of mothers reported any breastfeeding for ≥ 6 months. We found no evidence for a protective effect of any breastfeeding for ≥ 6 months on child overweight when compared to children who were never breastfed in the fully adjusted model and across all models (model 4, adjusted odds ratio [AOR] [95% CI] = 0.76 [0.31-1.86]). We identified risk factors for child overweight at the individual and area levels, with maternal obesity and offspring high birthweight being significant in the fully adjusted model and across all models (model 4, AOR [95% CI] = 2.26 [1.32-3.85] and 2.83 [1.44-5.56], correspondingly). CONCLUSIONS Our results suggest shared obesogenic environment influences from which the overweight-obese maternal-child dyads are emerging in Mexican households. More research is needed to better understand these obesogenic environments grounded on the particular contexts among upper-middle-income countries.
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Affiliation(s)
- Ana Paola Campos
- 205730Boston College School of Social Work, McGuinn Hall, Chestnut Hill, MA, USA
| | - Mireya Vilar-Compte
- EQUIDE Research Institute, 27829Iberoamericana University, Mexico City, Mexico
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Paduano S, Borsari L, Salvia C, Arletti S, Tripodi A, Pinca J, Borella P. Risk Factors for Overweight and Obesity in Children Attending the First Year of Primary Schools in Modena, Italy. J Community Health 2021; 45:301-309. [PMID: 31522302 DOI: 10.1007/s10900-019-00741-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Over the last four decades, childhood overweight/obesity has dramatically increased, becoming a significant public health concern. The main aims of this study were to investigate the prevalence of overweight/obesity among first-year primary schools children in Modena and to identify the associated risk factors. Data were collected on the socio-demographic characteristics of family and weight, height, dietary habits and sedentary behaviours of the children, and on the parents' perception of their child's weight status, through an anonymous questionnaire administered to parents. The questionnaires were delivered by 660 out of 890 (74.2%) families, and after excluding those without anthropometric data, 588 children were included in the study. The prevalence of overweight/obesity among the children was 25.2%, significantly lower in children born to parents with a high education, and higher among children born to foreign parents and overweight/obese mothers. The multivariable analysis showed that the children most likely to become overweight/obese were those who skipped breakfast (OR 2.3, 95%CI 1.3-4.2) and/or mid-morning snacks (OR 3.2, 95%CI 1.5-6.5). Breakfast consumption was positively associated with higher parental education levels, whereas skipping mid-morning snacks is more frequent among children born to foreign parents and overweight/obese mothers. Moreover, 84.7% of the parents of overweight/obese children underestimated their child's weight status. One in four 6-7 year-old children is already overweight or obese. Childhood overweight/obesity is significantly associated with unhealthy lifestyles and family lifestyle. It is therefore essential to implement public health intervention programs aimed at both parents and children, in order to promote healthy lifestyles in early childhood.
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Affiliation(s)
- Stefania Paduano
- Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, Modena, Italy.
| | - Lucia Borsari
- Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Salvia
- Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Alberto Tripodi
- Department of Public Health, Food Hygiene and Nutrition Service, AUSL Modena, Modena, Italy
| | - Jenny Pinca
- Department of Public Health, Food Hygiene and Nutrition Service, AUSL Modena, Modena, Italy
| | - Paola Borella
- Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, Modena, Italy
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Messiah SE, Weerakoon S, Atem F, Schulte M, Lebron C, Kambali S, Mathew MS, Chang C, Natale RA. Determinants of accurate visual perception of child anthropometric phenotype among ethnically diverse preschool parents in the United States. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:2095-2104. [PMID: 32510693 DOI: 10.1111/hsc.13020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 02/25/2020] [Accepted: 04/15/2020] [Indexed: 06/11/2023]
Abstract
The literature reports that regardless of the high obesity prevalence estimates in young children, parents often do not accurately perceive their child's weight status. The purpose of this analysis was to examine the association between parent/child demographic characteristics including ethnicity, country of birth and years living in the United States and the perception of child's anthropometric phenotype status based on a visual silhouette instrument. Caregiver (n = 456) and child sociodemographic, perception of child anthropometric phenotype status and height/weight measurements were collected in 2015, from 24 childcare centres in Miami, Florida, among children ages 2-to-5 years old. Chi-square analysis determined parent perception accuracy by actual child healthy (<body mass index [BMI] 85th percentile) or unhealthy (≥ BMI 85th percentile) status. Multivariable linear regression modelled phenotype trends by caregiver perception. Twenty-eight per cent of the sample was of unhealthy weight. Overall, 74.6% of caregivers did not accurately identify their child's BMI phenotype category versus 25% who did (p < .001); 8% of Hispanic and 13% of non-Hispanic parents of a child with an unhealthy BMI correctly identified their child's anthropometric phenotype. A higher proportion of Cuban (22%) caregivers of a child with an unhealthy BMI percentile versus Mexican caregivers (13.9%) visually identified their child as healthy weight. Child BMI percentile was significantly associated with parent perception of child healthy phenotype (OR: 1.05, 95% CI 1.04, 1.06). Findings here add evidence to the existing body of literature that emphasise parent perception of child weight status as a critical lynchpin in the childhood obesity epidemic. Intervention efforts must continue to educate parents on healthy weight development strategies.
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Affiliation(s)
- Sarah E Messiah
- University of Texas Health Science Center at Houston, School of Public Health, Dallas Regional Campus, Dallas, TX, USA
- Center for Pediatric Population Health, UTHealth School of Public Health and Children's Health System of Texas, Dallas, TX, USA
| | - Sitara Weerakoon
- University of Texas Health Science Center at Houston, School of Public Health, Dallas Regional Campus, Dallas, TX, USA
- Center for Pediatric Population Health, UTHealth School of Public Health and Children's Health System of Texas, Dallas, TX, USA
| | - Folefac Atem
- University of Texas Health Science Center at Houston, School of Public Health, Dallas Regional Campus, Dallas, TX, USA
- Center for Pediatric Population Health, UTHealth School of Public Health and Children's Health System of Texas, Dallas, TX, USA
| | - Mikayla Schulte
- University of Texas Health Science Center at Houston, School of Public Health, Dallas Regional Campus, Dallas, TX, USA
- Center for Pediatric Population Health, UTHealth School of Public Health and Children's Health System of Texas, Dallas, TX, USA
| | - Cynthia Lebron
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Shweta Kambali
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Matthew Sunil Mathew
- University of Texas Health Science Center at Houston, School of Public Health, Dallas Regional Campus, Dallas, TX, USA
- Center for Pediatric Population Health, UTHealth School of Public Health and Children's Health System of Texas, Dallas, TX, USA
| | | | - Ruby A Natale
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA
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Garcia ML, Crespo NC, Behar AI, Talavera GA, Campbell N, Shadron LM, Elder JP. Examining Mexican-Heritage Mothers' Perceptions of Their Children's Weight: Comparison of Silhouette and Categorical Survey Methods. Child Obes 2020; 16:44-52. [PMID: 31556701 PMCID: PMC6931916 DOI: 10.1089/chi.2019.0015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: Failure to recognize children's overweight status by parents may contribute to children's risk for obesity. We examined two methods of measuring mothers' perceptions of children's weight and factors associated with weight perception inaccuracy. Methods: Cross-sectional analyses of clinical and self-report data from 287 Mexican-heritage mother-child dyads. Mothers identified their child's weight category using a scale (e.g., "normal/overweight/obese") and a visual silhouette scale (11 child gender-specific weight-varying images). Children's height and weight were measured to calculate body mass index (BMI). Chi-square tests examined associations between categorical, silhouette, and BMI percentile categories of children's weight. Bivariate logistic regression analyses examined factors associated with mothers' inaccuracy of their children's weight. Results: Only 13% of mothers accurately classified their child as obese using the categorical scale, while 78% accurately classified their child as obese using the silhouette scale. Mothers were more likely to underestimate their child's weight using BMI categories (62%) compared to using the silhouette scale (23%). Predictors of mothers' underestimation using the categorical method were child sex [female] (adjusted odds ratio [AOR] = 1.99; 95% CI: 1.02-3.86), child age [younger age] (AOR = 10.39; 95% CI: 4.16-25.92 for ages 5-6 years), and mother's weight status (overweight AOR = 2.99; 95% CI: 1.05-8.51; obese AOR = 5.19; 95% CI: 1.89-14.18). Child BMI was the only predictor of mothers' overestimation (AOR = 0.89; 95% CI: 0.85-0.94) using the silhouette method. Conclusions: Using silhouette scales to identify children's body weight may be a more accurate tool for clinicians and interventionists to activate parents' awareness of unhealthy weight in children compared to using traditional categorical weight-labeling methods.
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Affiliation(s)
- Melawhy L. Garcia
- Department of Health Science, Center for Latino Community Health, Evaluation, and Leadership Training, California State University Long Beach, Long Beach, CA.,Address correspondence to: Melawhy L. Garcia, MPH, PhD, Department of Health Science, California State University Long Beach, 1250 Bellflower Boulevard, HHS2-115, Long Beach, CA 90840
| | - Noe C. Crespo
- School of Public Health, Institute for Behavioral and Community Health, San Diego State University, San Diego, CA
| | - Alma I. Behar
- School of Public Health, Institute for Behavioral and Community Health, San Diego State University, San Diego, CA
| | - Gregory A. Talavera
- Department of Psychology, South Bay Latino Research Center, San Diego State University, Chula Vista, CA
| | - Nadia Campbell
- Sponsored Research Administration, San Diego State University Research Foundation, San Diego, CA
| | - Lisa M. Shadron
- Sponsored Research Administration, San Diego State University Research Foundation, San Diego, CA
| | - John P. Elder
- School of Public Health, Institute for Behavioral and Community Health, San Diego State University, San Diego, CA
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Mojica CM, Liang Y, Foster BA, Parra-Medina D. The Association Between Acculturation and Parental Feeding Practices in Families With Overweight and Obese Hispanic/Latino Children. FAMILY & COMMUNITY HEALTH 2019; 42:180-188. [PMID: 31107728 PMCID: PMC6581037 DOI: 10.1097/fch.0000000000000226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study examines the association between acculturation and parental feeding practices in low-income Latinos. Overweight/obese children (N = 117), aged 5 to 14 years, and their parents were recruited from a rural health clinic. Findings show that more acculturated parents have greater control over their child's eating behavior (P = .04). Parents who perceive their child as having a weight problem also have more control over their child's eating behavior (P = .02). Control measured from regulation of how much and when the child should eat to offering sweets and screen time for good behavior. Results underscore the need for interventions to consider parental acculturation and perceptions of child weight.
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Affiliation(s)
- Cynthia M Mojica
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis (Dr Mojica); Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore (Dr Liang); Division of Hospital Medicine, School of Medicine, Oregon Health & Science University, Portland (Dr Foster); and Director, Latino Research Institute, Mexican American and Latina/o Studies, University of Texas at Austin (Dr Parra-Medina)
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Parsons K, Rutkowski EM, Turel O. Health behavior knowledge among Hispanic California islanders: Evaluation of a parental educational intervention. J SPEC PEDIATR NURS 2019; 24:e12235. [PMID: 30779417 DOI: 10.1111/jspn.12235] [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: 08/13/2018] [Revised: 12/21/2018] [Accepted: 01/30/2019] [Indexed: 01/23/2023]
Abstract
PURPOSE To evaluate the impact of a school nurse-led pilot parent-focused education program for healthy eating and physical activity to reduce childhood obesity. DESIGN AND METHODS A quasi-experimental intervention design was used to assess the knowledge of 11 Hispanic mothers regarding healthy food choices and physical activity over a period of 1 year. RESULTS There was an improvement in parental knowledge domains. Children's body mass index (BMI) stabilized at the 1-year follow-up in the intervention group, while the BMI increased in the nonintervention group. Outcomes included improvement in parental health knowledge and children's BMI. PRACTICE IMPLICATIONS Pediatric and school nurses have a powerful role in preventive education. Knowledge gained by identifying the benefits of healthy food choices and physical activity for Hispanic mothers of obese children can be transformed into lifestyle changes for their children's weight control that begins in the home.
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Affiliation(s)
- Karla Parsons
- School of Nursing, California State University, Fullerton, California
| | | | - Ofir Turel
- Department of Information Systems and Decision Sciences, California State University, Fullerton, California
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Race/Ethnicity, Obesity, and the Risk of Being Verbally Bullied: a National Multilevel Study. J Racial Ethn Health Disparities 2018; 6:245-253. [PMID: 30062676 DOI: 10.1007/s40615-018-0519-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 07/18/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To examine the effects of obese/overweight status and race/ethnicity on the risk for being verbally bullied among second grade children, and to investigate if the relationship between weight status and verbal bullying varies based on race/ethnicity. DESIGN Data on second graders from the Early Childhood Longitudinal Study, Kindergarten Class of 2010-11 (Children = 18,130; Schools = 2419) were analyzed. Hierarchical generalized logistic modeling was used to address the objectives. RESULTS Independent of the child's sex, age, academic performance, family socioeconomic status, and school characteristics, obese/overweight children (relative to non-obese/overweight children) and Black children (relative to White children) were more likely to be verbally bullied. Hispanic and Asian children were less likely to be verbally bullied relative to White children. Hispanic obese/overweight children experienced less verbal bullying than White obese/overweight children. CONCLUSIONS This study documented disproportionate risks of being verbally bullied for obese/overweight US second graders. The risk of being verbally bullied was significantly greater for obese/overweight White children vs. obese/overweight Hispanic children. IMPLICATIONS Findings can inform the development of strategies to reduce verbal bullying of obese/overweight children in US elementary schools.
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Abel JW, Allen O, Bullock D, Finley E, Walter EA, Schnarrs PW, Taylor BS. "I don't want to look sick skinny": Perceptions of Body Image and Weight Loss in Hispanics Living with HIV in South Texas. JOURNAL OF HEALTH DISPARITIES RESEARCH AND PRACTICE 2018; 12:9. [PMID: 38828271 PMCID: PMC11141404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Objective Obesity is rising in people with HIV (PLWH) and Hispanics. Both HIV and obesity are associated with cardiovascular disease morbidity and mortality. Our goal is to understand perceptions of body image and lifestyle in Hispanics with HIV to adapt interventions appropriately. Methods We conducted semi-structured interviews with 22 Hispanic PLWH and 6 providers. Purposive sampling selected patient participants across weights and genders. Interviews were coded and analyzed using grounded theory, comparing perspectives between patients with and without obesity, and patients and providers. Results Participants felt obesity and diabetes were "normal" in the community. Patients exhibited understanding of healthy diet and lifestyle but felt incapable of maintaining either. Traditionally Hispanic foods were blamed for local obesity prevalence. Five patients equated weight with health and weight loss with illness, and four expressed concerns that weight loss could lead to unintentional disclosure of HIV status. Participants with overweight or obesity expressed awareness of their weight and felt shamed by providers. Providers found weight loss interventions to be ineffective. Conclusion Interventions in this population must address identified barriers: overweight/obesity as a normative value, lack of self-efficacy, cultural beliefs surrounding food, fear of HIV-associated weight loss and stigma, and provider perspectives on intervention futility.
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Affiliation(s)
- Jordan W Abel
- Department of Medicine, Division of Hospital and General Medicine, University of Texas Health Science Center
| | - Omar Allen
- Department of Medicine, Division of Infectious Diseases, University of Texas Health Science Center
| | - Delia Bullock
- Department of Medicine, Division of Infectious Diseases, University of Texas Health Science Center
| | - Erin Finley
- Departments of Medicine and Psychiatry, University of Texas Health Science Center San Antonio and Veterans Evidence-Based Research Dissemination and Implementation Center (VERDICT), South Texas Veterans Health Care System
| | - Elizabeth A Walter
- Department of Medicine, Division of Infectious Diseases, University of Texas Health Science Center San Antonio and South Texas Veterans Health Care System
| | - Phillip W Schnarrs
- Department of Population Health, Dell Medical School, University of Texas
| | - Barbara S Taylor
- Department of Medicine, Division of Infectious Diseases, University of Texas Health Science Center San Antonio
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Abstract
PURPOSE Obesity prevention efforts may be ineffective if parents lack awareness of their children's overweight status. This study examined the factors that predicted parents' underestimation of child weight status. DESIGN AND METHODS Using a cross sectional design, researchers recruited children and parents in a local children's museum. Parents completed a demographic questionnaire, the Newest Vital Sign, and the Child Body Image Scale. Children's height and weight were measured to calculate child BMI. Random effects modeling examined the association between predictor variables (parent race/ethnicity, income, education, and health literacy, and child BMI percentile, gender, and age) and the dependent variable, parent underestimation of child weight status. RESULTS Participants included 160 parents (213 children aged 7-12years) representing a racially and ethnically diverse sample who were affluent, educated, and with 36.6% of parents assessed with limited health literacy. Although 45.1% of children were overweight/obese, only 7.5% of parents chose this weight status; 80% of parents underestimated the weight of their normal weight children, 96% underestimated their overweight children, and 72% underestimated their obese children. Parents were more likely to underestimate weight of older children and those under 81st percentile of BMI. No other predictors were significant. CONCLUSIONS Parent underestimation of child weight status appears to be a widespread phenomenon in this sample, regardless of race, ethnicity, income, education, and health literacy. PRACTICE IMPLICATIONS The consistent underestimation of child weight suggests that parents' misperception of weight status represents a critical pathway for intervention. Methods to improve parents' perception of child weight need be developed and tested.
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Affiliation(s)
- Carol J Howe
- Harris College of Nursing and Health Sciences, Texas Christian University, Fort Worth, TX, United States.
| | - Gina Alexander
- Harris College of Nursing and Health Sciences, Texas Christian University, Fort Worth, TX, United States.
| | - Jada Stevenson
- Department of Nutritional Sciences, College of Science and Engineering, Texas Christian University, Fort Worth, TX, United States.
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Vangeepuram N, Ramos MA, Fei K, Fox AM, Horowitz CR, Kleinman LC, Galvez MP. Are Parental Perceptions of Child Activity Levels and Overall Health More Important than Perceptions of Weight? Matern Child Health J 2017; 20:1456-63. [PMID: 27010551 DOI: 10.1007/s10995-016-1944-x] [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: 12/12/2022]
Abstract
Objectives To examine relationships between parental perceptions of child weight and overall health, reported lifestyle behaviors and measured body mass index (BMI). Methods Using community-partnered methods, we surveyed families residing in a two census tract area identified for targeted interventions to decrease diabetes related disparities. The survey included demographics, child dietary and physical activity behaviors, and parental perception of child's health and weight. We measured child BMI using a standardized protocol. Results We surveyed parents of 116 children with a mean age of 7 years (range 3-15) with 51 % boys, 74 % Hispanic, and 26 % Black. Over half of the children (55 %) were overweight or obese. Half (50 %) of the parents underestimated their children's weight. Reported daily hours of walking and/or running trended higher (3.6 vs. 2.6 h, p = 0.08) for children perceived to be of normal weight. Parents who correctly estimated their child's weight status reported more hours of daily walking/running than parents who underestimated child weight status, 4.5 versus 2.4 h, p = 0.0002. Parents of healthy weight children were more likely to report that children were in excellent or very good health compared to parents of overweight/obese children, 75 versus 56 % respectively (p = 0.04). We found significant racial/ethnic differences in reported diet and physical activity behaviors and perception of overall health. Conclusions for Practice Parental perceptions of child health and physical activity level may be related to perceptions of their child's weight status. Study findings informed community-based initiatives for reducing diabetes risk among children.
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Affiliation(s)
- Nita Vangeepuram
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1077, New York, NY, 10029, USA.
| | - Michelle A Ramos
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1077, New York, NY, 10029, USA
| | - Kezhen Fei
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1077, New York, NY, 10029, USA
| | - Ashley M Fox
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1077, New York, NY, 10029, USA
| | - Carol R Horowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1077, New York, NY, 10029, USA
| | - Lawrence C Kleinman
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1077, New York, NY, 10029, USA
| | - Maida P Galvez
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1077, New York, NY, 10029, USA
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Hernandez DC, Reesor L, Machuca I, Chishty M, Alonso Y. Low-Income Immigrant Hispanic Mothers' Concerns and Perceptions of Their Young Child's Weight. Public Health Nurs 2016; 33:412-20. [PMID: 26854020 DOI: 10.1111/phn.12252] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To describe how low-income Hispanic immigrant mothers' concerns and perceptions of her child's health, along with her concerns for herself becoming overweight, relate to her (a) concerns that her child will become overweight and (b) underestimation of her child's weight status. DESIGN AND SAMPLE Cross-sectional survey and direct body composition assessments were collected among 96 low-income Hispanic mothers and their young children from Houston-area community centers. MEASURES Data were collected on maternal concerns and perceptions of child's weight and health, concerns about her own weight, demographic characteristics, and measured child's height and weight. RESULTS Fifty-four percent of mothers with an overweight/obese child perceived their child was "about the right weight." Mothers concerned with becoming overweight themselves had 3 times higher odds of being concerned that her child would become overweight (OR = 3.01, p < .01). Mothers who perceived their child as less healthy had approximately 2 times higher odds of underestimating their child's weight (OR = 1.86, p < .01). CONCLUSIONS Short screeners that focus on maternal concerns about herself and her child becoming overweight, along with perceptions of her child's health and weight status, may assist nurses in effectively tailoring their health message at point of care.
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Affiliation(s)
- Daphne C Hernandez
- Department of Health and Human Performance, University of Houston, Houston, Texas.
| | - Layton Reesor
- Department of Health and Human Performance, University of Houston, Houston, Texas
| | - Iris Machuca
- Department of Health and Human Performance, University of Houston, Houston, Texas
| | - Misha Chishty
- Department of Health and Human Performance, University of Houston, Houston, Texas
| | - Yanely Alonso
- Department of Health and Human Performance, University of Houston, Houston, Texas
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