Central American Parents' Preferences for Content and Modality for a Family-Centered Intervention to Promote Healthful Energy Balance-Related Behaviors of Their Preschool-Age Children

This formative research used a cross-sectional survey to assess interest in informational content and intervention modalities for the design of an early childhood obesity prevention intervention for Central American families from the Northern Triangle countries (El Salvador, Guatemala, and Honduras) living in the United States. A total of 74 parents (36 mothers, 38 fathers) with a mean age of 31.6 years (SD = 5.6) completed the survey; 59.5% of whom were born outside of the United States. Although most parents reported being very interested in receiving information related to the seven assessed energy balance-related behaviors, there were significant differences by parents’ gender and nativity. Most parents endorsed remote modalities for content delivery via text/SMS, WhatsApp, and e-mail. However, respondents were also receptive to in-person delivery provided by community health workers. There were also significant differences in parents’ preferences for intervention modalities by parents’ gender and nativity. Future steps should include investigating different intervention modalities and their integration into a linguistic and culturally sensitive family-based intervention to promote healthful energy balance-related behaviors of preschool-age children in Central American families originating from the Northern Triangle countries.

Exploration of Changes in Low-Income Latino Families’ Beliefs about Obesity, Nutrition, and Physical Activity: A Qualitative Post-Intervention Study

Objective: To investigate changes in beliefs around obesity, nutrition, and physical activity among low-income majority Latino families who participated in a community-based family-inclusive obesity intervention. Methods: Six focus groups were conducted with a predominately Latino low-income population, who completed the Healthy Living Program (HeLP). Two groups were conducted in English and four groups were conducted in Spanish, and were recorded, translated, transcribed, and analyzed for thematic content. Two coders independently coded transcripts then reflexive team analysis with three members was used to reach consensus. Results: Thirty-seven caregivers representing thirty-three families participated in focus groups. A number of themes emerged around changes in beliefs about obesity, nutrition, and physical activity (PA) as a result of the HeLP curriculum. Regarding obesity, the themes that emerged focused on the acceptability of children being overweight and the importance of addressing weight at an early age. Changes in beliefs regarding nutrition emerged, noting changes in the use of food as a reward, the multiple benefits of a healthy diet, and for some participants change in their beliefs around the adaptability of traditional foods and habits. Regarding physical activity, themes emerged around the difficulty of engaging in PA due to unsafe conditions and finding creative indoor and outdoor activities with whole family participation and becoming aware of the benefits of PA. Conclusions: Parental changes in beliefs about obesity, nutrition, and physical activity as a result of a family-inclusive weight management program in a population of low-income predominately Latino families can aid and inform the development of future weight management programs for this population.

Developing a Culturally Responsive Lifestyle Intervention for Overweight/Obese U.S. Mexicans

INTRODUCTION

Hispanics are the largest minority group in the United States, constituting 18 % of the population. Mexicans are the largest Hispanic subgroup and are at disproportionate risk for overweight/obesity. Lifestyle interventions targeting dietary change and physical activity have resulted in significant weight loss in several large randomized clinical trials in the general population, but few studies have tailored interventions to Mexican Americans. We conducted a community needs assessment from 2018 to 2020 in accordance with Domenech-Rodriguez and Wieling's Cultural Adaptation Process (CAP) model to inform the development of SANOS (SAlud y Nutrición para todOS) (Health and Nutrition for All), a culturally-tailored, community-based diet and lifestyle education and counseling program that addresses overweight/obesity among U.S. Mexicans.

METHODS

Five Spanish-language focus groups were conducted until thematic saturation with 31 overweight/obese Mexicans in New York City about their knowledge, priorities, and preferences regarding diet, exercise, and evidence-based strategies for behavioral change. A grounded theory approach was used to analyze the data.

RESULTS

Five themes were identified: (1) A strong desire for tangible information related to diet and health, (2) Family as a primary motivator for behavior change, (3) Desire for group-based motivation and accountability to sustain intervention participation, (4) Belief in short-term goal setting to prevent loss of motivation, and (5) Time and workplace-related barriers to intervention adoption.

CONCLUSIONS

Ecological factors such as the effect of acculturation on diet, family members' role in behavior change, and socioenvironmental barriers to healthy dietary practices and physical activity should be considered when adapting evidence-based treatments for Mexican Americans.

Barriers and enablers to nutrition and physical activity in Lima, Peru: an application of the Pen-3 cultural model among families living in pueblos jóvenes

OBJECTIVES

Childhood obesity is increasing in Latin America as nutrition status and economies transition. Peru is one such country with an emerging childhood obesity epidemic. The Peruvian Ministry of Health established goals for achieving reductions in overweight and obesity prevalence among children 5 years and younger by 2021. However, specific intervention strategies for achieving these goals are lacking. Culturally appropriate interventions guided by evidence-based theories are needed to address the emerging problem of overweight and obesity among young children. This study utilized the Pen-3 model, a culture-based conceptual framework to explore barriers and facilitators to healthy diet and physical activity for parents of young children in pueblos jóvenes communities.

DESIGN

A qualitative investigation was conducted as part of a larger cross-sectional survey study of parents of three and four-year-old children at five school sites in the peri-urban slum neighborhoods of southern Lima. Parents were asked to describe barriers and facilitators of healthy diet and physical activity for their preschoolers and families. Thematic analysis guided by PEN-3 model constructs assisted in identifying emergent themes.

RESULTS

Two domains of the Pen-3 model guided the elucidation of barriers and facilitators of health behaviors deemed essential to healthy diet and physical activity. Parental perceptions about neighborhood safety, lack of community resources, such as parks and recreation spaces, and lack of information about appropriate serving sizes and healthy recipes were identified as barriers. Facilitators to healthy behaviors included mothers' views on their role as nurturers, and personal values for family-centered health behaviors.

CONCLUSIONS

Parents identified specific barriers and facilitators of eating healthy and physical activity for their preschoolers and families living in resource poor areas of Peru. Health promotion professionals can utilize findings to inform the design of culturally appropriate family-based interventions in Peru's pueblos jóvenes.

Association Between Breastfeeding and Child Overweight in Mexico

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.

Developing Adaptando Dieta Y Acción Para Todos (ADAPT): An Intervention to Improve Healthy Lifestyle Behaviors Among Latino Parents and Children Living in Rural Communities

Latino migrant farmworkers are at great risk of obesity and its concomitant negative health impacts. Obesity interventions for this underserved, minority population are limited. We expanded upon our prior intervention work in childhood obesity to develop a multi-family, behavioral intervention, ADAPT. We conducted three phases in the development of the ADAPT program: Phase 1, a needs assessment, Phase 2, in-depth focus groups with Latino parents, their children, and stakeholders, and Phase 3, a feasibility and acceptability trial to inform program optimization. Acceptability and feasibility of ADAPT promoting healthier eating and physical activity behaviors was found. Each phase of the project led to implementation changes to ADAPT, resulting in greater intervention optimization. Participants reported key facilitators and barriers to our intervention, expressing great interest in participation. They particularly liked our mindfulness session. We are currently examining the feasibility of integrating mindfulness to optimize ADAPT efficacy.

Mexican American Parental Knowledge and Perceptions of Childhood Obesity: An Integrative Review

INTRODUCTION

For the past two decades, childhood obesity has remained a national public health concern, particularly among Hispanic populations. Multiple cross-sectoral obesity prevention strategies have been implemented yet remain unsuccessful in generating sustainable lifestyle changes.

METHOD

The purpose of this integrative review, using the Whittemore and Knafl method, was to examine the literature from 2009 to 2018 regarding Mexican American parental knowledge and perceptions of childhood obesity. The CINAHL, PubMed, PsycINFO, and ERIC databases were used to search the literature, and 13 peer-reviewed articles met the inclusion criteria.

RESULTS

Three main themes emerged from the literature synthesis: (1) parental misperception of child body weight and size, (2) influence of cultural health and growth beliefs on parental perception of child weight, and (3) parental perspectives of causes and consequences of childhood obesity and how to address it. However, cultural variations in parental perceptions were found; therefore, attempts to generalize Mexican Americans' cultural practices should be avoided.

CONCLUSION

Studies using qualitative approaches are needed to gain deeper insights about Mexican American culture regarding children's health as it relates to body weight, the roles of different family members in the Mexican American childrearing tradition, and the impact of their associated health beliefs.

Health Care Providers' Perspectives on Family Compliance and Behavior Change in a Childhood Obesity Program

Background. Evidence suggests that children and adolescents growing up in low-income families and those with underrepresented ethnocultural backgrounds tend to have high prevalence rates of obesity and more difficulty adhering to childhood obesity interventions. However, less is known about how intergenerational, family-based approaches to lifestyle interventions for childhood obesity support sustained behavior change. Aims. The aim of this study was to explore the perspectives of health care providers regarding family adherence and behavior change in a childhood obesity program that served ethnoculturally diverse and low-income families. Method. Semistructured in-person interviews were conducted with 18 providers at one of three hospitals participating in a Canadian family-based childhood obesity program. Data were thematically analyzed using a constant comparative approach. Results. The following key themes emerged as challenges from the provider's perspective for family adherence and behavior modification in the childhood obesity program: divergent views about obesity, complicated lives and logistical priorities, parental role modeling, and intergenerational tensions. Discussion and Conclusion. This examination of providers' perspectives on family adherence and behavior modification relevant to the management of childhood obesity highlight the importance of tailoring childhood obesity programs to the complex and diverse needs of families from diverse backgrounds. Recommendations include methods of service delivery that address logistical challenges and are better suited to extended families, particularly grandparents.

Is Childhood Overweight/Obesity Perceived as a Health Problem by Mothers of Preschool Aged Children in Bangladesh? A Community Level Cross-Sectional Study

Childhood obesity is rapidly rising in many developing countries such as Bangladesh; however, the factors responsible for this increase are not well understood. Being the primary caregivers of children, particularly in developing countries, maternal perceptions and knowledge could be important factors influencing the weight status of children. This study aimed to assess maternal perceptions of childhood obesity and associated socio-demographic factors in Bangladesh. A cross-sectional study using stratified random sampling was conducted among 585 mothers whose children aged 4 to 7 years attended preschools in a district town. Body Mass Index of the children was calculated and weight status categorized according to the Centers for Disease Control (CDC) criteria. Maternal perceptions were assessed using a self- or interviewer-administered questionnaire. Multinomial logistic regression was used to obtain crude and adjusted odds ratios. Fourteen percent of children were overweight or obese and approximately 30% were underweight. Only 3.1% of children were perceived as overweight/obese by their mothers. Over one-third (35%) of mothers perceived that childhood overweight/obesity could be a health problem and over two-thirds (68.6%) were not aware of any health consequences of childhood obesity. Maternal perceptions were significantly associated with maternal education, family income, and weight status of the child but were not associated with the sex of the child. We have identified knowledge gaps regarding maternal perception of childhood obesity and its contributing factors in a developing country. These findings can be used to develop and test parent-focused educational interventions for preventing childhood obesity in Bangladesh.

The Association Between Acculturation and Parental Feeding Practices in Families With Overweight and Obese Hispanic/Latino Children

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.

Latino Parents' Perceptions of Physical Activity and Healthy Eating: At the Intersection of Culture, Family, and Health

OBJECTIVE

To explore Latino parents' perspectives on healthy living and identify strategies to incorporate in a future child obesity intervention.

DESIGN

Descriptive, qualitative study.

SETTING

Participants were recruited from an emerging Latino community (area with low [ < 5%] yet growing concentrations of Latinos) in Allegheny County, PA.

PARTICIPANTS

Thirty-two parents of preschool children participated in 5 Spanish-language focus groups.

PHENOMENON OF INTEREST

Parents' perceptions of a healthy lifestyle (ie, physical activity and nutrition).

ANALYSIS

Data were analyzed using the constant comparison method to identify salient categories, themes, and patterns.

RESULTS

Three overarching themes were identified: (1) Healthy Living: Beyond One's Control; (2) Estamos Acostumbrados [We Are Used to a Certain Lifestyle]; and (3) Latin American and US Culture Conflict. In general, parents perceived maintaining a healthy lifestyle to require enormous effort and that change was difficult given a lack of knowledge and control.

CONCLUSIONS AND IMPLICATIONS

Key intervention approaches with this population may include a focus on the family environment. Increasing knowledge, building self-efficacy, and modeling behavior through family recipe preparation and physical activity breaks may be necessary, as well as an emphasis on and orientation to community resources to support behavior change and physical activity and healthy eating habits.

Race/Ethnicity, Obesity, and the Risk of Being Verbally Bullied: a National Multilevel Study

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.

Study protocol: intervention in maternal perception of preschoolers' weight among Mexican and Mexican-American mothers

Background

Childhood obesity is a public health issue negatively affecting children’s physical and psychosocial health. Mothers are children’s primary caregivers, thus key players in childhood obesity prevention. Studies have indicated that mothers underestimate their children’s weight. If mothers are unaware of their children’s weight problem, they are less likely to participate in activities preventing and treating excess weight. The “Healthy Change” intervention is designed to change maternal perception of child’s weight (MPCW) through peer-led group health education in childcare settings.

Methods/Design

The “Healthy Change” is a multicenter two-arm randomized trial in four centers. Three centers are in Mexican States (Nuevo Leon, Tamaulipas, and Zacatecas). The fourth center is in San Antonio, Texas, USA. A total of 360 mother-child pairs (90 pairs per center) are to be randomly and evenly allocated to either the intervention or the control group. Intervention group will receive four-session group obesity prevention education. Control group will receive a four-session personal and food hygiene education. The education is delivered by trained peer-mother promotoras. Data will be collected using questionnaires and focus groups. The primary outcome is a change in proportion of mothers with accurate MPCW. Secondary outcomes include change in maternal feeding styles and practices, maternal self-efficacy and actions for managing child excessive weight gain.

McNemar’s Test will be used to test the primary outcome. The GLM Univariate procedure will be used to determine intervention effects on secondary outcomes. The models will include the secondary outcome measures as the dependent variables, treatment condition (intervention/control) as the fixed factor, and confounding factors (e.g., mother’s education, children’s gender and age) as covariates. Sub-analyses will be performed to compare intervention effects on primary and secondary outcomes between the samples from Mexico and Texas, USA. Qualitative data will be analyzed through analysis of inductive content. A combined coding model will be developed and used to code transcripts using the NVivo software.

Discussion

Healthy Change intervention could help change MPCW, an initial step for obesity prevention among preschoolers. This study presents a first of its kind intervention available in Spanish and English targeting Mexican and Mexican-American mothers in Mexico and USA.

Trial registration

ISRCTN12281648

Perceptions of Healthy Eating Among Hispanic Parent-Child Dyads

Limited research exists exploring the perceptions of healthy and unhealthy eating among Hispanic families, yet understanding their perceptions could inform public health practice with regard to nutrition and obesity prevention. This study conducted an exploratory analysis of interview data collected from 25 parent-child dyads as part of a program evaluation to learn more about both parent and child beliefs and practices regarding healthy eating, and in particular fruit and vegetable consumption. Families described an incomplete knowledge regarding healthy eating, specifically how to increase fruit and vegetable consumption, and the benefits of healthy eating as well as risks of unhealthy eating. Parents in particular seemed to identify many of the foods to avoid but were unclear about healthier alternatives. Children focused more on the benefits of healthy eating, while parents spoke more about the risks of unhealthy eating and the challenges of eating vegetables, particularly among families where child weight was also raised as a concern.

A qualitative study conducted in the USA exploring Latino fathers' beliefs, attitudes and practices related to their young children's eating, physical activity and sedentary behaviours

OBJECTIVE

Increasing evidence documents fathers' influential role in their children's eating, physical activity (PA) and sedentary behaviours (SB). We aimed to expand limited existing research examining fathers' influence in these areas by exploring Latino fathers' beliefs, attitudes and practices related to eating, PA and SB of their young children.

DESIGN

Seven focus group discussions were conducted in Spanish with Latino fathers (n 28) of children aged 2-8 years. Audio recordings were transcribed and translated verbatim without identifiers. Data were analysed using thematic analysis to identify key concepts and themes using NVivo 11 software.

RESULTS

Fathers expressed positive beliefs and attitudes about the importance of healthy eating for their young children, themselves and their families. Nevertheless, the majority reported familial practices including eating out, getting take-out, etc. that have been linked to increased obesity risk among Latino children. Fathers were more involved and engaged in children's PA than eating and feeding. However, several fathers reported engaging predominantly in sedentary activities with their children, appeared permissive of children's sedentary habits and struggled to set limits on children's screen-time.

CONCLUSIONS

We provide new information on Latino fathers' beliefs and child feeding and PA practices that may provide important targets for interventions aimed at promoting healthful eating and PA behaviours of Latino children. Future research should further quantify the influence of Latino fathers' parenting styles and practices on development of children's eating, PA and SB. This information is needed to identify risk factors amenable to interventions and to design culturally appropriate parenting and family-based interventions targeting Latino children's home environment and designed to meet this ethnic group's specific needs.

Parent Perceptions of Child Weight Status in Mexican-Origin Immigrant Families: An Investigation of Acculturation, Stress, and Coping Factors

Parents often underestimate their child's weight status, particularly when the child is overweight or obese. This study examined acculturation, stress, coping, and involuntary responses to stress and their relation to estimation of child's weight status among Mexican-origin immigrant families. Eighty-six families provided data on child's height and weight, caregiver's perception of their child's weight status, and caregiver's responses to acculturation, stress, and coping scales. Parents underestimated their child's weight status, particularly when the child was overweight or obese. Although acculturation and stress were not associated with accuracy, parents' responses to stress were linked to parent perceptions. Parents who reported more frequent use of involuntary engagement (e.g., rumination, physiological arousal) were more accurate. Future research, as well as healthcare providers, should consider how parents manage and respond to stress in order to fully understand the factors that explain weight perceptions among Mexican-origin immigrant parents.

Factors Associated with Successful Mentoring of Parents Addressing Childhood Obesity: A Mixed Methods Approach

Objective. Parents mentoring other parents as a behavioral intervention for child obesity is novel with limited data describing the experience and dynamics of this approach. This study aimed to describe the experiences of parent mentors and the self-efficacy and attitudes of their mentees in the context of a clinical trial for childhood obesity. Methods. The context for this study was a randomized clinical trial using either parent mentors or a community health worker engaging parents of obese children in behavioral change over six months. Parent mentors were interviewed at the mid-point of the intervention using a semistructured questionnaire to elicit their perceptions and experiences during the process of mentoring. Parent mentees completed a survey assessing their self-efficacy, perception of the parent mentor, and attitudes and beliefs related to their child's weight. Results. The qualitative analysis of parent mentor interviews indicated high commitment despite their nonprofessional status, facing challenges of engagement with fellow parents and attitudes of persistence and being nonjudgmental. The parent mentee ratings of parent mentors were overall very high and similar to the ratings of a community health worker (paraprofessional). Conclusion. The data suggest that a parent mentor model of intervention for child obesity is an acceptable mode of approaching behavior change in the Hispanic population around childhood obesity with potential for scalability if proven effective.

What are Asian-American youth consuming? A systematic literature review

Numerous studies have explored dietary practices among children, but there are limited studies on children of Asian background in the US. This review had three aims: (a) review literature regarding Asian-American youth's dietary behaviors, (b) critically evaluate the methodological quality of such research, and (c) provide recommendations for future nutrition-related research on Asian-American youth. The authors conducted a systematic literature review through MEDLINE (EBSCO), CINAHL Plus with Full Text (EBSCO), and Embase (Ovid); extracted descriptive data; and evaluated methodological quality. Thirteen articles were included. Major findings included: (a) frequent consumption of milk, fruit, meat, unenriched white rice, vegetables, and high-fat and high-sugar items among Asian-American children and (b) acculturation's influences on diet, resulting in Asian-American youth consuming diets characterized by both Asian and American foods. Findings from this review may inform education and promotion programs and services for Asian Americans in the US.

[Maternal perception of her child's weight and unrelated children less than 1 year old]

AIMS

To evaluate the maternal perception of their child's weight (MPCW) and perception of unrelated children's weight.

DESIGN

Cross-sectional.

LOCATION

Maternal and Child Nursing Health Department at 6 Units of Family Medicine.

PARTICIPANTS

486 dyads (mother and child under 1 year).

MAIN MEASUREMENTS

The following question was applied: "I think my child is", and images were provided according the child's gender. Children's weight and height were measured.

RESULTS

A total of 20.5% of the mothers of overweight (OW) children accurately perceived this situation, while none of the mothers of obese (OB) children did (κ=0.14±0.03, Z=5.36, p=.001). By images, 63.3% of mothers of OW children and 33.3% of mothers of OB children perceived this situation (κ=0.01±0.02, Z=0.73, p=.46). Most mothers selected the image of OW child as the image of a healthy child (κ=-0.04±0.01, Z=-2.65, p=.008), the image of a child under 1 year (κ=-0.01±0.02, Z=-0.86, p=.38) and the image that they would like their child to look like (κ=0.0004±0.01, Z=0.02, p=.98).

CONCLUSION

The mothers do not perceive the OW-OB of their children.

Barriers for Hispanic Caregivers With Obese Preschool Children

INTRODUCTION

Childhood obesity is a growing epidemic, and the rates are disproportionately higher in minorities. Clinical guidelines have contributed to decreased prevalence overall, but the rates in Hispanic preschoolers have increased.

METHOD

This review of the literature summarizes the perceptions and beliefs of caregivers of Hispanic preschool children regarding weight status and feeding behaviors, as well as the perceived cultural barriers to guideline adherence. A search of the CINAHL, PubMed, Joanna Briggs, and Global Health databases identified studies performed between January 1, 2008, and April 1, 2016. Search terms included Hispanics, guideline adherence, gap, barriers, obesity, overweight, and attitude to obesity.

RESULTS

Fifteen studies met the inclusion criteria, including some about Hispanic caregivers of preschool-aged children. Several cultural perceptions and beliefs were identified.

CONCLUSION

Further study is needed to develop more culturally relevant and sensitive guidelines and to design specific and effective interventions for this population.

Korean Immigrant Motherhood: Child-Rearing and Child Weight

Health problems among immigrant children may persist not only throughout childhood but also into adulthood. The purpose of this study was to elicit information about Korean immigrant mothers' experiences with parenting, immigration, and raising their children in the United States. Four focus group interviews were conducted in the Chicago metropolitan area. Content analysis showed that Korean immigrant mothers practice intensive parenting and worry about it. They described the strategies they use to raise healthy children. Culturally appropriate intervention programs are needed to reduce stress, encourage a healthy lifestyle, and link this to the health of their children.

Family Factors and Body Mass Index Among Korean-American Preschoolers

PURPOSE

The purpose of this study was to examine family factors related to BMI z-scores and overweight/obesity among Korean-American (KA) preschoolers.

METHODS

A cross-sectional study was conducted with 104 KA preschoolers and their mothers in the Chicago metropolitan area. KA mothers completed questionnaires and their preschool-age children's weights and heights were measured. Hierarchical multiple linear regression and multiple logistic regression were performed.

RESULTS

Twenty-two percent of preschoolers were overweight or obese (BMI ≥85th percentile). Family factors explained 30% of the variance in the children's BMI z-scores, with parenting feeding style and family functioning contributing most. In logistic regression, children were more likely to be overweight/obese if: a family had more children, the mother perceived her child as overweight/obese, and the family had regular child routines.

CONCLUSION

Health care providers should consider the family as one unit of care and use that unit to implement culturally appropriate childhood overweight/obesity prevention for Korean-American preschool-aged children. Parental feeding style and parents' attitudes about child weight should be considered when advising Korean-Americans about reducing children's overweight/obesity.

Diet and physical activity for children's health: a qualitative study of Nepalese mothers' perceptions

OBJECTIVES

Non-communicable diseases account for 50% of all deaths in Nepal and 25% result from cardiovascular diseases. Previous studies in Nepal indicate a high burden of behavioural cardiovascular risk factors, suggesting a low level of knowledge, attitude and practice/behaviour regarding cardiovascular health. The behavioural foundation for a healthy lifestyle begins in early childhood, when mothers play a key role in their children's lives. This qualitative study, conducted in a Nepalese peri-urban community, aimed to explore mothers' perception of their children's diet and physical activity.

DESIGN

We notated, tape-recorded and transcribed all data collected from six focus group discussions, and used qualitative content analysis for evaluation and interpretation.

SETTING

The study was conducted in the Jhaukhel-Duwakot Health Demographic Surveillance Site in the Bhaktapur district of Nepal.

PARTICIPANTS

Local health workers helped recruit 61 women with children aged 5-10 years. We distributed participants among six different groups according to educational status.

RESULTS

Although participants understood the importance of healthy food, they misunderstood its composition, perceiving it as unappetising and appropriate only for sick people. Furthermore, participants did not prioritise their children's physical activities. Moreover, mothers believed they had limited control over their children's dietary habits and physical activity. Finally, they opined that health educational programmes would help mothers and recommended various intervention strategies to increase knowledge regarding a healthy lifestyle.

CONCLUSIONS

Our data reveal that mothers of young children in a peri-urban community of Nepal lack adequate and accurate understanding about the impact of a healthy diet and physical activity. Therefore, to prevent future cardiovascular disease and other non-communicable diseases among children, Nepal needs health education programmes to improve mothers' cardiovascular health knowledge, attitude and behaviour.

Perceptions of Weight and Health Practices in Hispanic Children: A Mixed-Methods Study

Background. Perception of weight by parents of obese children may be associated with willingness to engage in behavior change. The relationship between parents' perception of their child's weight and their health beliefs and practices is poorly understood, especially among the Hispanic population which experiences disparities in childhood obesity. This study sought to explore the relationship between perceptions of weight and health beliefs and practices in a Hispanic population. Methods. A cross-sectional, mixed-methods approach was used with semistructured interviews conducted with parent-child (2–5 years old) dyads in a primarily Hispanic, low-income population. Parents were queried on their perceptions of their child's health, health practices, activities, behaviors, and beliefs. A grounded theory approach was used to analyze participants' discussion of health practices and behaviors. Results. Forty parent-child dyads completed the interview. Most (58%) of the parents of overweight and obese children misclassified their child's weight status. The qualitative analysis showed that accurate perception of weight was associated with internal motivation and more concrete ideas of what healthy meant for their child. Conclusions. The qualitative data suggest there may be populations at different stages of readiness for change among parents of overweight and obese children, incorporating this understanding should be considered for interventions.

A positive deviance approach to early childhood obesity: cross-sectional characterization of positive outliers

OBJECTIVE

Positive deviance methodology has been applied in the developing world to address childhood malnutrition and has potential for application to childhood obesity in the United States. We hypothesized that among children at high-risk for obesity, evaluating normal weight children will enable identification of positive outlier behaviors and practices.

METHODS

In a community at high-risk for obesity, a cross-sectional mixed-methods analysis was done of normal weight, overweight, and obese children, classified by BMI percentile. Parents were interviewed using a semistructured format in regard to their children's general health, feeding and activity practices, and perceptions of weight.

RESULTS

Interviews were conducted in 40 homes in the lower Rio Grande Valley in Texas with a largely Hispanic (87.5%) population. Demographics, including income, education, and food assistance use, did not vary between groups. Nearly all (93.8%) parents of normal weight children perceived their child to be lower than the median weight. Group differences were observed for reported juice and yogurt consumption. Differences in both emotional feeding behaviors and parents' internalization of reasons for healthy habits were identified as different between groups.

CONCLUSIONS

We found subtle variations in reported feeding and activity practices by weight status among healthy children in a population at high risk for obesity. The behaviors and attitudes described were consistent with previous literature; however, the local strategies associated with a healthy weight are novel, potentially providing a basis for a specific intervention in this population.

Latino parents' perceptions of weight terminology used in pediatric weight counseling

OBJECTIVE

To identify which English and Spanish terms Latino parents consider motivating, as well as culturally and linguistically appropriate, for provider use during weight counseling of overweight and obese Latino youth.

METHODS

Latino parent perceptions of common Spanish and English terms for overweight were discussed with 54 parents in 6 focus groups (3 English, 3 Spanish). Atlas.ti software was used for qualitative analysis. An initial codebook was used to code passages for English and Spanish terminology separately. Subsequent changes to the coded passages and creation of new codes were made by team consensus.

RESULTS

"Demasiado peso para su salud" (too much weight for his/her health) was the only phrase for excess weight that was consistently identified as motivating and inoffensive by Spanish-speaking parents. "Sobrepeso" (overweight), a commonly used term among health care providers, was motivating to some parents but offensive to others. English-speaking parents had mixed reactions to "unhealthy weight," "weight problem," and "overweight," finding them motivating, confusing, or insulting. Parents found "fat" "gordo" and "obese" "obeso" consistently offensive. Most participants found growth charts and the term "BMI" confusing. Parents consistently reported that providers could enhance motivation and avoid offending families by linking a child's weight to health risks, particularly diabetes.

CONCLUSIONS

"Demasiado peso para su salud" (too much weight for his/her health) was motivating to many Spanish-speaking Latino parents. Among English-speaking Latino parents, no single English term emerged as motivating, well-understood, and inoffensive. Linking a child's excess weight with increased health risks was motivating and valuable to many parents regardless of language spoken.

Food and Beverage Marketing to Latinos

Obesity rates among U.S. adults and children have increased over the past two decades and, although signs of stabilization and decline among certain age groups and geographies are being reported, the prevalence of obesity among Latino adults and children remain high. The Latino population is growing in parallel to these obesity rates and marketers realize they cannot ignore this growing, high-spending, media-consuming segment. Studies examining food and beverage marketing strategies tend to discuss minority groups in general but do not account for racial and ethnic differences, reducing our ability to explain existing inequities. This article aimed to identify the food and beverage marketing strategies used to influence food environments for Latinos versus non-Latinos. A systematic literature review and analysis, guided by an established marketing conceptual framework, determined that the food and beverage marketing environment for Latinos is less likely to promote healthy eating and more likely to encourage consumption of low-nutrient, calorie-dense foods and beverages. This analysis also determined that Latinos’ food environment and the placement of food retail stores appears to influence their body mass index; however, placement of these stores cannot be generalized, as geographical differences exist. While food and beverage marketing is only one of many sources of influence on food and beverage consumption, these findings reinforce the notion that Latinos are at a disadvantage when it comes to exposure of healthy lifestyle messaging and health-promoting food environments.

Perceived barriers to children's active commuting to school: a systematic review of empirical, methodological and theoretical evidence

Active commuting to school (ACS) may increase children's daily physical activity and help them maintain a healthy weight. Previous studies have identified various perceived barriers related to children's ACS. However, it is not clear whether and how these studies were methodologically sound and theoretically grounded. The purpose of this review was to critically assess the current literature on perceived barriers to children's ACS and provide recommendations for future studies. Empirically based literature on perceived barriers to ACS was systematically searched from six databases. A methodological quality scale (MQS) and a theory utilization quality scale (TQS) were created based on previously established instruments and tailored for the current review. Among the 39 studies that met the inclusion criteria, 19 (48.7%) reported statistically significant perceived barriers to child's ACS. The methodological and theory utilization qualities of reviewed studies varied, with MQS scores ranging between 7 and 20 (Mean =12.95, SD =2.95) and TQS scores from 1 to 7 (Mean =3.62, SD =1.74). A detailed appraisal of the literature suggests several empirical, methodological, and theoretical recommendations for future studies on perceived barriers to ACS. Empirically, increasing the diversity of study regions and samples should be a high priority, particularly in Asian and European countries, and among rural residents; more prospective and interventions studies are needed to determine the causal mechanism liking the perceived factors and ACS; future researchers should include policy-related barriers into their inquiries. Methodologically, the conceptualization of ACS should be standardized or at least well rationalized in future studies to ensure the comparability of results; researchers' awareness need to be increased for improving the methodological rigor of studies, especially in regard to appropriate statistical analysis techniques, control variable estimation, multicollinearity testing, and reliability and validity reporting. Theoretically, future researchers need to first ground their investigations in theoretical foundations; efforts should be devoted to make sure theories are used thoroughly and correctly; important theoretical constructs, in particular, need to be conceptualized and operationalized appropriately to ensure accurate measurement. By reviewing what has been achieved, this review offered insights for more sophisticated ACS studies in the future.

Theoretical foundations of the Study of Latino (SOL) Youth: implications for obesity and cardiometabolic risk

PURPOSE

This article describes the conceptual model developed for the Hispanic Community Health Study/Study of Latino Youth, a multisite epidemiologic study of obesity and cardiometabolic risk among U.S. Hispanic/Latino children.

METHODS

Public health, psychology, and sociology research were examined for relevant theories and paradigms. This research, in turn, led us to consider several study design features to best represent both risk and protective factors from multiple levels of influence, as well as the identification of culturally relevant scales to capture identified constructs.

RESULTS

The Socio-Ecological Framework, Social Cognitive Theory, family systems theory, and acculturation research informed the specification of our conceptual model. Data are being collected from both children and parents in the household to examine the bidirectional influence of children and their parents, including the potential contribution of intergenerational differences in acculturation as a risk factor. Children and parents are reporting on individual, interpersonal, and perceived organizational and community influences on children's risk for obesity consistent with Socio-Ecological Framework.

CONCLUSIONS

Much research has been conducted on obesity, yet conceptual models examining risk and protective factors lack specificity in several areas. Study of Latino Youth is designed to fill a gap in this research and inform future efforts.

Canaries in a coalmine: Immigration and overweight among Mexican-origin children in the US and Mexico

The prevalence of overweight is higher for Hispanic children of immigrants than children of natives. This does not fit the pattern of the epidemiological paradox, the widely supported finding that immigrants tend to be healthier than their U.S.-born peers, and it suggests that exposure to the U.S. increases immigrant children's risk of overweight. This study's primary contribution is to better assess how exposure to the U.S. environment affects childhood overweight among a homogamous ethnic group, Mexican-Americans. We do so by using an innovative binational study design to compare the weight of Mexican-American children of immigrants, Mexican-American children of natives, and Mexican children in Mexico with different propensities of having immigrant parents. Cross-sectional data are derived from a pooled sample of 9982 6-19 year old children living in either Mexico or the United States in the early 2000s. Mexican-resident children with a very high propensity to have immigrant parents have significantly lower percentile BMIs and lower odds of overweight than Mexican children with lower propensities of emigration and U.S.-resident Mexican-American children. This suggests that selection into immigration streams does not account for the high prevalence of overweight among children of Mexican immigrants. Rather, U.S. exposure significantly raises children of Mexican immigrants' risk of being overweight. Moreover, second generation children have the highest percentile BMIs and greatest odds of overweight of all comparison groups, including children of natives. This suggests that they experience risks above and beyond the effects of exposure to American society.