Adolescent participation in preventive health behaviors, physical activity, and nutrition: differences across immigrant generations for Asians and Latinos compared with Whites

Household Food Security and Consumption of Sugar-Sweetened Beverages among New York City (NYC) Children: A Cross-Sectional Analysis of 2017 NYC Kids' Data

Food insecurity is a stressor associated with adverse health outcomes, including the consumption of sugar-sweetened beverages (SSBs). Our study tests the hypothesis that other socioeconomic vulnerabilities may magnify this effect using cross-sectional data from the 2017 New York City (NYC) Kids Survey. Households providing an affirmative response to one or both food security screener questions developed by the US Department of Agriculture were coded as households with low food security. The number of sodas plus other SSBs consumed was standardized per day and categorized as 1 = none, 2 = less than one, and 3 = one or more. We tested the joint effect of low food security with chronic hardship, receipt of federal aid, and immigrant head of household on a sample of n = 2362 kids attending kindergarten and beyond using ordinal logistic regression and accounting for the complex survey design. Only having a US-born parent substantially magnified the effect of low household food security on SSB consumption (OR = 4.2, 95%CI: 2.9-6.3, p < 0.001) compared to the reference group of high household food security with an immigrant parent. The effect of low food security on SSB consumption among NYC children warrants intersectional approaches, especially to elucidate US-based SSB norms in low-food-security settings.

Association of nativity with survival among adults with hepatocellular carcinoma

INTRODUCTION

Immigrants comprise a considerable proportion of those diagnosed with hepatocellular carcinoma (HCC) in the United States. Nativity or birthplace affects incidence and risk factors for HCC, but little is known about its influence on survival after diagnosis.

METHODS

We identified 51 533 adults with HCC with available birthplace in the California Cancer Registry between 1988 and 2017. HCC cases were categorized as foreign born or US born and stratified by mutually exclusive race and ethnicity groups. Primary outcome was all-cause mortality. Race and ethnicity-specific Cox regression propensity score-weighted models evaluated the relationship between nativity and death as well as region of birth among foreign-born patients.

RESULTS

A total of 40% of all HCC cases were foreign born, and 92.2%, 45.2%, 9.1%, and 5.8% of Asian/Pacific Islander (API), Hispanic, White, and Black patients were foreign born, respectively. Five-year survival rates were higher in foreign-born patients compared with US-born patients: 12.9% vs 9.6% for White patients, 11.7% vs 9.8% for Hispanic patients, 12.8% vs 8.1% for Black patients, and 16.4% vs 12.4% for API patients. Nativity was associated with survival, with better survival in foreign-born patients: White patients: hazard ratio (HR) = 0.86 (95% confidence interval [CI] = 0.81 to 0.90), Hispanic patients: HR = 0.90 (95% CI = 0.86 to 0.93), Black patients: HR = 0.89 (95% CI = 0.76 to 1.05), and API patients: HR = 0.94 (95% CI = 0.88 to 1.00). Among foreign-born patients, lower mortality was observed in those from Central and South America compared with Mexico for Hispanic patients, East Asia compared with Southeast Asia for API patients, and East Europe and Greater Middle East compared with West/South/North Europe for White patients.

CONCLUSION

Foreign-born patients with HCC have better survival than US-born patients. Further investigation into the mechanisms of this survival disparity by nativity is needed.

Associations of peer generational status on adolescent weight across Hispanic immigrant generations: A social network analysis

BACKGROUND

Childhood obesity disproportionately impacts Hispanics in the United States (US), the nation's largest ethnic minority population. However, even among Hispanic children, those born in the US are at increased risk of developing obesity than those not born in the US (i.e. first-generation Hispanics). The objective of this study is to assess whether ethnic and generational differences in the friend networks of Hispanic adolescents moderate the association between immigrant generation and weight.

METHODS

We analyzed data from first-generation, second-generation, and third-generation Hispanic 12 to 19 year-old participants in Wave 1 of the Longitudinal Study of Adolescent to Adult Health (Add Health). Using multivariable linear regression, we examined the association between generational status and body mass index (BMI), and whether the ethnic and generational composition of friends moderated that association.

RESULTS

Higher generational status was associated with higher BMI. The ethnic and generational composition of friends was not independently associated with BMI among Hispanic adolescents. However, a social network with a greater proportion of second-generation Hispanics was positively associated with BMI among first-generation Hispanics, and negatively associated with BMI among second-generation Hispanics.

CONCLUSIONS

The generational status of peers in Hispanic adolescents' social networks, particularly the proportion that are second-generation Hispanic, moderates the positive association between immigrant generation and BMI. Moreover, this moderation effect is different across immigrant generations so that the proportion of second-generation adolescents within a social network is associated with higher BMI in first-generation Hispanic adolescents, but with lower BMI among those who are second-generation. These results were confirmed in sensitivity analyses. Our findings suggest that the generational composition of social networks alters the association between the generational status and weight of Hispanic adolescents, and thus that social factors within those networks may contribute to those associations.

Skin tone preferences and their influence on skin care behaviors

Knowledge regarding skin tone preferences and their influence on skincare behaviors among people of color is limited. The objective of this study was to determine whether there is a difference between ideal and actual skin tone among people of color and whether this difference is associated with tanning and sunscreen use. This was a one-time, voluntary, anonymous, electronic survey designed in REDCap and delivered through ResearchMatch, a national electronic, recruitment tool. Eligible participants were at least 18 years old and self-identified as Black, Asian, Latinx, American Indian/Alaskan Native or Mixed Race. In total, 548 completed survey results were analyzed using SAS. Only the Latinx population was found to have a significant preference for tanner skin (p < 0.05). The Latinx population had significantly more subjects that participated in outdoor tanning than both the Black (p < 0.0001) and Asian population (p < 0.05). Latinx participants who indicated a preference for tanner skin were 2.8 times more likely to never use sunscreen than those without this preference (OR = 2.821, CI = 1.029-7.732, p < 0.05). Our findings have implications for how dermatologists screen, treat, and educate Latinx and skin of color populations.

Association Between Birthplace and Time in the United States With Diet Quality in US Adolescents: Findings from the National Health and Nutrition Examination Survey, 2007 to 2018

BACKGROUND

During adolescence, diet quality reaches its lowest point compared to other childhood life stages. Acculturation is associated with decreased diet quality among many groups of US immigrant adults, but research is limited among adolescents.

OBJECTIVES

We investigated the associations between birthplace and length of time living in the United States, 2 proxy measures of acculturation, and diet quality among adolescents (12-19 years old).

METHODS

Data were from the NHANES (2007-2018), which included two 24-hour dietary recalls (n = 6113) to estimate Healthy Eating Index 2015 (HEI-2015) total scores and component scores. Multivariate linear regression and generalized linear models were performed to compare HEI-2015 total scores and component scores between US-born adolescents (n = 5342) and foreign-born adolescents with <5 years (n = 244), 5 to <10 years (n = 201), and ≥10 years (n = 290) of US residency.

RESULTS

Foreign-born adolescents with <5 years (53.3 ± 1.2), 5 to <10 years (51.4 ± 1.5), and ≥10 years of US residency (49.9 ± 0.8) had higher HEI-2015 total scores than US-born adolescents (47.0 ± 0.3; P < 0.0001) and higher component scores for total vegetables, seafood and plant proteins, and added sugars (P values ≤ 0.0001). Foreign-born adolescents with more years of US residency had higher component scores for total fruits, whole fruits, and saturated fats than those with fewer years of US residency. A sensitivity analysis revealed this pattern held for Mexican-American and other Hispanic adolescents.

CONCLUSIONS

Being born outside the United States and living in the United States for less time (among foreign-born adolescents) are associated with higher diet quality. Culturally informed health promotion programs may help to reduce diet-related disparities related to acculturation among adolescents.

Impact of Acculturation on Cancer Prevention Dietary Patterns among Hispanic Families with a High Prevalence of Obesity

This study aimed to 1) examine the relationship between dietary intake and cancer prevention nutrition recommendations among Hispanic families, 2) differences in daily dietary intake by acculturation category and nativity (US born vs non-US born) status. Baseline data was used from a randomized clinical trial evaluating the efficacy of an obesity preventive intervention in Hispanic youth. Participants were 280 Hispanic parents (11.8% males, 88.2% females, Mage=41.87 ± 6.49; MBody Mass Index (BMI)=30.62 ± 5.68) and their adolescents (47.9% males, 52.1% females, Mage=13.01 ± 0.83; MBMI Percentile=94.55 ± 4.15). Intake of added sugar, dairy, whole grains, and fruits/vegetables were obtained. Participants were categorized into four acculturation categories based on Berry's acculturation model: Marginalization, Integration, Separation, and Assimilation. Results indicated that sugar intake was significantly higher than the recommendations among all adolescents' cultural categories but not in parents. Among adolescents the consumption of whole grains was lower in integration and assimilation, dairy was lower in integration, separation, and assimilation, and fruits/vegetables was lower among marginalization, integration, and assimilation categories than the recommendations. Parents' daily intake of whole grains, dairy, and fruits/vegetables were significantly lower than the recommendations across all the acculturation categories. Participants did not meet the healthy recommendations for cancer prevention regardless of their acculturation and nativity status.

Differences in physical activity between weekdays and weekend days among U.S. children and adults: Cross-sectional analysis of NHANES 2011–2014 data

This study investigates differences in physical activity between weekdays and weekend days, and its associations with sociodemographic and anthropometric characteristics in the U.S population using the NHANES 2011–2014 data. Physical activity was measured using ActiGraph GT3X+. Raw acceleration data were converted to Monitor-Independent Movement Summary units (MIMS-units) that account for inter-device variability and eliminates non-human movement. The daily MIMS-units were averaged for weekdays and weekend days. Demographic characteristics were self-reported. Height and weight were objectively measured. The sample included 6611 adults aged ≥ 20 years and 3520 children aged between 6 and 19 years. The results show that more MIMS-units were registered on weekdays compared to weekend days for adults (652, 95%CI = 533, 770) and children (889, 95%CI = 702, 1076). Factors associated with physical activity in adults (gender, age, marital status, ethnicity, education level, and weight status) were similar for weekdays and weekend days. In children, physical activity was associated with ethnicity, weight status, and age. The level of differences in physical activity between weekdays and weekend days among adults was larger for men, Hispanic Americans, and those with lower education levels. Differences among children were similar across subgroups, except for those aged 16–19 years who had smaller level of difference compared to those aged 12–15 years. In conclusion, adults and children were more active on weekdays than weekend days. The effects of structured days (i.e., weekdays) on physical activity appeared to be similar across most child subgroups but more heterogeneous for adult subgroups. Interventions increasing physical activity opportunities during weekend days are warranted.

Exploring Potential Mediation Pathways on the Relationship Between Acculturation and Body Mass Index (BMI) Among Latino Adolescents

BACKGROUND

Positive associations have been observed between acculturation and body mass index (BMI), but the mediators of this relationship are not well established. Acculturation researchers have called for investigating the influence of socio-contextual variables as mediators. The objective of this study was to test the mediating effects of salty snacks, sweet snacks, physical activity, and sedentary behavior on the relationship between acculturation and BMI among Latino adolescents.

METHODS

Adolescents who self-identified as Latino (n = 431) at public high schools in Southern California were recruited and completed a self-report survey. A bootstrapped multiple mediation model was used to test mediation pathways.

RESULTS

Acculturation was positively associated with physical activity (B = 0.09, p < .05). The indirect effects of salty snacks, sweet snacks, physical activity, and sedentary behavior were not associated with BMI, suggesting no mediation.

CONCLUSIONS

Future research should examine additional mediating variables on the relationship between acculturation and BMI.

Health Conditions and Dietary Intake Among Brazilian Immigrants in the United States of America

Immigration can improve economic status and access to education compared to the country of origin, but it challenges access to health and preventive care. Assess Brazilian immigrants' overall health conditions and dietary intake in New Jersey (US). This pilot study assessed health conditions and dietary intake. Brazilians immigrants were interviewed through their communities. Trained dietitians interviewed them using a questionnaire and three days of 24H recall. Dietary intake was analyzed using the Nutrition Data System for Research software. A sample of 118 individuals completed the protocol, majority female and overweight/obese, living in the US for 11.3 years with 21.1% declaring having Noncommunicable Diseases. The average number of daily meals was 2.20 ± 1.04. Energy intake does not correlate with time in the US. Obesity, dyslipidemia, and hypertension are the most prevalent Noncommunicable Diseases, demanding interventions that include managing saturated fat, cholesterol, and sodium intake.

Food Selection Factors and Perceived Influence on Household Foods Post-Arrival to the U.S. of Newcomer Immigrant and Refugee Adolescents

The objective of this study was to examine food selection factors and influence on household food selection by newcomer immigrant and refugee adolescents. Participants (n = 68) reported healthfulness (70.1%) and taste (44.2%) as their primary influencing factors. Adolescents' Refugee camp experience, BMI, sex, and ethnicity were associated with reported influences on food selection. Most (85.3%) had tried new foods, reported influence on household food selection (81%) and new food consumption was associated with adolescents' influence on the overall household's food selection. In summary, a variety of factors influence adolescent newcomer's food selection and influence on household food selection is high.

Population-Based Analysis of Differences in Gastric Cancer Incidence Among Races and Ethnicities in Individuals Age 50 Years and Older

BACKGROUND & AIMS

There are racial and ethnic differences in the incidence of gastric adenocarcinoma worldwide and in the US. Based on a decision analysis, screening for noncardia gastric adenocarcinoma might be cost-effective for non-White individuals 50 years or older. However, a lack of precise, contemporary information on gastric adenocarcinoma incidence in specific anatomic sites for this age group has impeded prevention and early detection programs in the US. We aimed to estimate the differences in gastric adenocarcinoma incidence in specific anatomic sites among races and ethnicities in individuals 50 years or older.

METHODS

We analyzed California Cancer Registry data from 2011 through 2015 to estimate incidences of gastric adenocarcinoma in specific anatomic sites for non-Hispanic White (NHW), non-Hispanic Black, Hispanic, and the 7 largest Asian American populations. We calculated the differential incidence between non-White groups and NHW using incidence rate ratios and 95% confidence intervals (CIs).

RESULTS

Compared with NHW subjects, all non-White groups had significantly higher incidences of noncardia gastric adenocarcinoma; the incidence was highest among Korean American men 50 years and older (70 cases per 100,000). Compared with NHW subjects 50 years and older, the risk of noncardia gastric adenocarcinoma was 1.8-fold (95% CI, 1.37-2.31) to 7.3-fold (95% CI, 5.73-9.19) higher in most non-White groups and 12.0-fold (95% CI, 9.96-14.6) to 14.5-fold (95% CI, 12.5-16.9) higher among Korean American men and women 50 years and older, respectively. Compared with NHW men 50 years and older, all non-White men, except Japanese and Korean American men, had a significantly lower risk of cardia gastric adenocarcinoma.

CONCLUSIONS

We identified several-fold differences in incidences of gastric adenocarcinoma in specific anatomic sites among racial and ethnic groups, with significant age and sex differences. These findings can be used to develop targeted risk reduction programs for gastric adenocarcinoma.

Global Prevalence of Physical Activity, Sedentary Behaviour, and Sleep of Immigrant Children: a Systematic Review

BACKGROUND

Although insufficient physical activity (PA), high sedentary behaviour (SB), and inadequate sleep are fairly common among children, little is known about these behaviours in immigrant children. This systematic review examined the prevalence of PA, SB, and sleep among immigrant children aged 5-17 years around the globe.

METHODS

Four electronic databases were searched to retrieve the English language peer-reviewed original articles published between 2000 and 2019. Cross-sectional, cohort, or longitudinal studies that reported on the prevalence of PA, SB, or sleep-related outcomes among immigrant children were included.

RESULTS

Of 2724 retrieved articles, 55 were selected for full-text screening and 12 met the eligibility criteria. Five studies were based on nationally representative samples. Over half (n = 7; 58%) of the studies assessed only PA, one reported only sleep, three reported both PA and SB, and one reported all three behaviours. Only one study used device-based measure. Assessment of PA and SB varied greatly across the studies with their differing definitions. The prevalence of doing PA ranged from 48 to 72%. Three studies reported an average sedentary time ranging from 1 to 3 h/day. One study reported that 10-13% of immigrant children in the USA had inadequate sleep. All of the studies reviewed were from Western countries with no study from non-Western countries.

CONCLUSIONS

Future studies should include all three movement behaviours and use standard assessment tools and definitions. Future research should extend beyond Western countries to non-Western countries with immigrant children.

Comparison of Cognitive Performance Between Two Generations of Immigrant School-Aged Children: Child Development Change Over Time

The objective of this research is to comparatively analyze the performance of two generations of children (as first generation of immigrants) attending primary and secondary education in different geographical areas, evaluated in different decades but with equivalent age brackets. Two samples of 169 immigrant school populations in Portugal, with fair immigration criteria, were evaluated for the same verbal reasoning and auditory discrimination tasks in different periods (cohort 1—2001–2009 and cohort 2—2013–2017). The aim is to verify if age remains a differentiating variable of the performance and acuity, as maintained by the critical period hypothesis. That performance referring to two samples evaluated in second language decoding tasks, in different periods. Additionally, to evaluate the emergence of other factors that explain proficiency, cognitive and linguistic discrimination behaviors of two generations of immigrant students in Portugal. The results contribute to a new direction in the analysis and intervention for school groups that are highly diverse in terms of mother tongue and nationalities. The data point to a greater divergence of performance and difficulties not according only to the disparity of ages, but considering the nationality (country of origin and respective educational system). It is also clear, despite just the difference of a decade, how subjects are changing their immigration routes and their cognitive and social development.

Body Composition, Physical Activity, and Convenience Food Consumption among Asian American Youth: 2011-2018 NHANES

The primary purpose of this study was to describe obesity, body composition, convenience food consumption, physical activity, and muscle strength among Asian American youth compared to other racial/ethnic groups. The secondary purpose was to examine whether obesity, body composition, convenience food consumption, physical activity, and muscle strength differed by acculturation levels among Asian American youth. A secondary analysis was conducted using data from 12,763 children aged 2 to 17 years that participated in the 2011-2018 US National Health and Nutrition Examination Survey (NHANES). In the NHANES interview, acculturation, dietary behavior, and physical activity questionnaires were administered. The acculturation level was indicated by the language spoken at home. In the NHANES examination, anthropometry, dual-energy X-ray absorptiometry (DXA), and muscle strength assessments were conducted. Compared to non-Hispanic White American boys, Asian American boys had similar levels of obesity, central obesity, and fat mass. Among the five racial/ethnic groups examined, lean body mass, muscle mass, convenience food consumption, and daily physical activity were the lowest in the Asian group. More acculturated Asian American boys, but not girls, were more likely to be obese (OR = 3.28 (1.63, 6.60)). More acculturated Asian American youth more frequently consumed convenience food (1.4 more meals/month (1.2, 1.6)). This study highlights the obesity problem among Asian American boys, which worsens with acculturation to America. The study results also suggest that although Asian American youth consume less convenience food overall than non-Hispanic White American youth, increasing acculturation may negatively influence food choices.

Adolescent Physical Activity Disparities by Parent Nativity Status: the Role of Social Support, Family Structure, and Economic Hardship

In this cross-sectional study, we examine disparities in physical activity (PA) rates, a determinant of obesity risk, by exploring the impact of household economic hardship, social support, and family structure on adolescent physical activity levels. We assess whether these factors have a different impact on PA stratified by parental nativity status (Hispanic adolescents of foreign- and native-born caregivers compared with whites). The sample included 1927 white and Hispanic 15-year-olds of foreign-born (outside of USA) and native US-born caregivers from the Fragile Families and Child Wellbeing Study. We assessed whether economic hardship, family/friend encouragement for PA, married/cohabiting caregivers, and having a resident grandparent was associated with frequency of PA in the past week, while controlling for age, education, and child's sex. We examined the interaction effects of parent nativity on economic hardship and family support. Results indicate disproportionately higher PA levels for white adolescents compared with Hispanic adolescents of foreign-born caregivers (B = -0.41, SE = 0.19, p = 0.03), for adolescents with more family/friend encouragement (B = 0.81, SE = 0.10, p < 0.001), and for adolescents in cohabiting households (B = 0.28, SE = 0.14, p = 0.04); support and hardship factors did not vary by nativity status. Researchers and practitioners should address differences among ethnic/generational subgroups and family/friend supports that may improve adolescent PA levels, particularly among Hispanic adolescent subgroups. Physical activity levels continue to be dismal especially for racial/ethnic minority groups, which puts them at further risk of consequences of physical inactivity, including life-long complications associated with being an obese adolescent.

Diet, Physical Activity and Weight-Related Behaviors, Changes and Risks with Newly-Arrived (< 1 Year) Immigrant and Refugee Adolescents (Ages 12-17)

Adolescent immigrants and refugees are at elevated risk for obesity, however, gaps remain regarding specific diet and lifestyle changes. This study examined: (1) weight status, behaviors and perceptions, (2) diet patterns and changes, (3) sociodemographic and dietary factors associated with BMI. Cross sectional survey, anthropometric measures were conducted at a school for newcomer youth in North Carolina. Data analysis included descriptive, frequency, bivariate and linear regression. Participants (n = 68, 55% female, < 1 year US) included immigrants and refugees ages 12-17. Thirty-one percent were overweight or obese. Forty-seven percent had attempted to lose weight. Positive weight perceptions were associated with normal BMI (p = 0.010). Fruit, milk, fruit juice, soda, and meat consumption increased post-arrival (p = 0.037, p = 0.010, p = 0.003, p = 0.044, p = 0.014, respectively). Dietary change was positively associated with BMI (p = 0.002). Adverse diet and lifestyle changes occur rapidly, are associated with obesity, and weight control behaviors and concerns warrant early intervention.

Language Use and Children’s BMI Growth among Second-Generation Immigrants in the United Kingdom

This research note analyzes the relationship between language use and children’s Body Mass Index (BMI) growth in the United Kingdom. Making use of the Millennium Cohort Study (MCS), we assess whether the main language spoken in the household explains BMI divergences between immigrants’ and natives’ children. We provide evidence that the integration process hampers BMI growth and therefore exerts a small protective effect: male children living in English-speaking households gain weight slower than those with less integrated parents. However, the protective effect applies only to sons from higher social origins.

The double burden of food insecurity and obesity among Latino youth: Understanding the role of generational status

BACKGROUND

Obesity is linked to food insecurity and generational status; however, little is known about how both impact obesity risk among Latino youth.

OBJECTIVE

To investigate the joint effect of generational status and food insecurity on obesity prevalence among Latino youth.

METHODS

We pooled data from the 2011 to 2017 waves of the National Health Interview Survey to derive a sample Latino youth aged 12 to 17 (N = 7532). Four generational categories were constructed: first generation (foreign-born children); second generation (US-born child; foreign-born parent[s]); 2.5 generation (US-born child; one foreign-born parent and one US-born parent); third generation (US-born child; U.S.-born parent[s]). Food insecurity was defined by monthly instances of food scarcity over the past year. Obesity was measured using age- and sex-specific body mass index percentile cut-offs. Log-binomial multivariable regression models estimated the association between generational status and food insecurity categories on obesity.

RESULTS

Obesity percentages among food-insecure households ranged from 12.8% in the first generation, 15.8% in the second, 24.3% in the 2.5, and 19.2% in the third. In fully adjusted models, 2.5 generation food secure youth had the highest prevalence of obesity (aPR: 1.53; 95% CI, 1.09-2.16) when compared with first generation food secure youth, followed by third generation food insecure youth (aPR: 1.49; 95% CI, 1.01-2.20).

CONCLUSIONS

Food security status is associated with increased obesity prevalence among Latino youth across the generations. Given that obesity is a risk factor for top causes of mortality and morbidity, growing rates among this population is of public health and clinical importance.

The use of cultural identity in predicting health lifestyle behaviors in Latinx immigrant adolescents

OBJECTIVES

This study explored whether cultural identity predicts health lifestyle behaviors.

METHOD

Participants included 302 recently immigrated (<5 years in the U.S.) Latinx adolescents (53% boys; mean age 14.51 years at baseline) from Miami and Los Angeles. Participants completed cultural identity measures at baseline and 1-year post baseline. A path analysis was used to estimate associations between cultural identities (ethnic, national, and bicultural) and health lifestyle behaviors (physical activity, diet, and sleep hygiene).

RESULTS

Ethnic identity positively predicted diet. Results also indicated a significant interaction between ethnic and national identity on sleep hygiene. Specifically, when national identity was high (+1 SD), ethnic identity positively predicted sleep hygiene.

CONCLUSION

This study focuses on health lifestyle behaviors such as physical activity, diet, and sleep hygiene in this population. Results highlight the need to explore the protective nature of cultural identity retention in relation to health lifestyle behaviors in Latinx adolescents. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Socioeconomic Disparities in Diet Vary According to Migration Status among Adolescents in Belgium

Little information concerning social disparities in adolescent dietary habits is currently available, especially regarding migration status. The aim of the present study was to estimate socioeconomic disparities in dietary habits of school adolescents from different migration backgrounds. In the 2014 cross-sectional “Health Behavior in School-Aged Children” survey in Belgium, food consumption was estimated using a self-administrated short food frequency questionnaire. In total, 19,172 school adolescents aged 10–19 years were included in analyses. Multilevel multiple binary and multinomial logistic regressions were performed, stratified by migration status (natives, 2nd- and 1st-generation immigrants). Overall, immigrants more frequently consumed both healthy and unhealthy foods. Indeed, 32.4% of 1st-generation immigrants, 26.5% of 2nd-generation immigrants, and 16.7% of natives consumed fish ≥two days a week. Compared to those having a high family affluence scale (FAS), adolescents with a low FAS were more likely to consume chips and fries ≥once a day (vs. <once a day: Natives aRRR = 1.39 (95%CI: 1.12–1.73); NS in immigrants). Immigrants at schools in Flanders were less likely than those in Brussels to consume sugar-sweetened beverages 2–6 days a week (vs. ≤once a week: Natives aRRR = 1.86 (95%CI: 1.32–2.62); 2nd-generation immigrants aRRR = 1.52 (1.11–2.09); NS in 1st-generation immigrants). The migration gradient observed here underlines a process of acculturation. Narrower socioeconomic disparities in immigrant dietary habits compared with natives suggest that such habits are primarily defined by culture of origin. Nutrition interventions should thus include cultural components of dietary habits.

Does acculturation affect the dietary intakes and body weight status of children of immigrants in the U.S. and other developed countries? A systematic review

OBJECTIVE

This paper reviews available studies on the relationship between acculturation and obesity among children of immigrants who have at least one foreign-born parent.

METHODS

A systematic review of relevant studies was undertaken using PubMed, Web of Science, and PsychInfo.

RESULTS

The initial search identified 1317 potentially relevant publications, of which 21 were retained after three rounds of screening. Most studies were conducted in the U.S. The majority of studies used BMI or overweight/obesity prevalence as the outcome variable, while two studies used dietary intake. Three studies used standardized acculturation scales, while most of the studies used generation, duration of residency in host country, and language as proxy measures of acculturation. The relationship between acculturation and outcomes varied between the host countries and origin countries for children of immigrants.

CONCLUSION

This study suggests children of immigrants with different cultural backgrounds may interact with host countries to varying degrees, ultimately influencing their diet behaviours and body weight status. Researchers are encouraged to adopt standardized acculturation scales to compare the results across countries and populations.

Description of the home food environment in Black, White, Hmong, Latino, Native American and Somali homes with 5-7-year-old children

OBJECTIVE

To categorize the home food environment and dietary intake of young children (5-7 years old) from racially/ethnically diverse households using objectively collected data.

DESIGN

Cross-sectional study.

SETTING

In-home observations in Minneapolis/Saint Paul, Minnesota, USA.

SUBJECTS

Families with 5-7-year-old children who identified as Black, White, Hmong, Latino, Native American or Somali.

RESULTS

There were many significant differences by race/ethnicity for child dietary intake and for the home food environment, with specific patterns emerging by race/ethnicity. For example, Somali children had high Healthy Eating Index-2010 (HEI-2010) scores, but low daily intakes of fruits and vegetables. Black children had low HEI-2010 scores and a pattern of low intake of healthful foods and high intake of unhealthful foods. White and Latino families had high levels of both healthful and unhealthful home food availability and children with high HEI-2010 scores.

CONCLUSIONS

Results indicate that the home food environment of young children varies across racial/ethnic group. Study findings also provide new information regarding the home food environment of young children in previously understudied racial/ethnic groups and indicate that interventions working to improve the home food environment and dietary intake of children may want to consider race/ethnicity.

Racial Differences in Mechanisms Linking Childhood Socioeconomic Status With Growth in Adult Body Mass Index: The Role of Adolescent Risk and Educational Attainment

PURPOSE

The present study examined whether risk factors during adolescence, including substance use, depression, overweight status, and young adult educational attainment, mediated the association between low childhood socioeconomic status (SES) and higher body mass index (BMI) in adulthood. We also evaluated whether the hypothesized pathways differed based on racial group status.

METHODS

Participants from the Seattle Social Development Project were followed from ages 10 to 39years. Thepresent study included white (n = 381), African American (n = 207), and Asian American (n = 171) participants. Structural equation models tested pathways linking low childhood SES to BMI from ages 24 to 39 years. Multiple-group modeling was used to test potential racial differences.

RESULTS

Analyses indicated racial differences in the pathways linking low childhood SES with adult BMI. For whites, overweight status and educational attainment were significant mediators. For Asian Americans, there was an unmediated and significant pathway between low childhood SES and low adult BMI. For African Americans, there were no significant mediated or unmediated pathways.

CONCLUSIONS

Results stress that the pathways that link childhood SES with adult BMI may operate differently based on race. Research is particularly needed to identify mechanisms for African Americans in order to better inform obesity prevention efforts.

Associations between acculturation, ethnic identity, and diet quality among U.S. Hispanic/Latino Youth: Findings from the HCHS/SOL Youth Study

BACKGROUND

Acculturation among Hispanic/Latinos has been linked to deteriorating dietary quality that may contribute to obesity risks. This study examined the relationship between acculturation, ethnic identity, and dietary quality in U.S. Hispanic/Latino youth.

METHODS

This cross-sectional study included 1298 Hispanic/Latino youth ages 8-16 from the Hispanic Community Health Study/Study of Latino Youth (HCHS/SOL Youth), an ancillary study of offspring of participants in the adult HCHS/SOL cohort. Multivariable regression analyses assessed relationships between acculturation and ethnic identity with dietary quality as measured by Healthy Eating Index (HEI) scores, accounting for covariates, design effects, and sample weights. We also compared HEI scores by immigrant generation and language of interview.

RESULTS

Youth were 12 ± 2.5 -years and 49.3% female. They were placed into five acculturation categories-including 48% integrated (bicultural orientation), 32.7% assimilated (high U.S. and low Latino orientation), 5.9% separated (high Latino and low U.S. orientation) or marginalized (neither U.S. nor Latino orientation), and 13.3% unclassified. Mean HEI was 53.8; there were no differences in HEI scores by acculturation category, but integrated youth had higher whole grains scores, lower sodium scores, and lower empty calories scores compared to assimilated youth. There were no differences in HEI scores by ethnic identity scores, and no consistent trend between dietary quality and ethnic identity. First- and second-generation youth had higher HEI scores, compared to third-generation youth, and, Spanish-speaking youth had higher HEI scores compared to English-speaking youth.

CONCLUSION

Results suggest that integrated youth in the U.S. may engage in healthier eating behaviors than those who are assimilated. Additional research on Hispanic/Latino youths' acculturation and diet can inform health promotion efforts to improve eating habits and health outcomes among this population.

Ethnic density and cancer: A review of the evidence

Accumulating data suggest that factors in the social environment may be associated with cancer-related outcomes. Ethnic density, defined as the proportion of racial/ethnic minority individuals residing in a given geographic area, is 1 of the most frequently studied social environment factors, but studies on ethnic density and cancer have yielded inconsistent findings. Thus, the objective of the current review was to summarize the extant data on ethnic density and cancer-related outcomes (cancer risk, stage at diagnosis, and mortality) with the aim of identifying pathways by which ethnic density may contribute to outcomes across populations. In general, the findings indicated an association between ethnic density and increased risk for cancers of infectious origin (eg, liver, cervical) but lower risk for breast and colorectal cancers, particularly among Hispanic and Asian Americans. Hispanic ethnic density was associated with greater odds of late-stage cancer diagnosis, whereas black ethnic density was associated with greater mortality. In addition, this review highlights several methodological and conceptual issues surrounding the measurement of ethnic neighborhoods and their available resources. Clarifying the role of neighborhood ethnic density is critical to developing a greater understanding of the health risks and benefits accompanying these environments and how they may affect racial and ethnic disparities in cancer-related outcomes. Cancer 2018;124:1877-903. © 2018 American Cancer Society.

Physical activity and sedentary behavior of US immigrant versus non-immigrant adolescents: findings from the NEXT Generation Health Study data

OBJECTIVE

This study examined associations of physical activity (PA) and sedentary behavior (SB) with adolescents' immigration status and language spoken at home and with friends.

METHODS

Participants (N = 2475) were included from Wave 1 of the NEXT Generation Health Study, a nationally representative 10th-grade cohort study starting in 2009. PA included recommended moderate-to-vigorous PA (MVPA) and vigorous PA (VPA); SB included screen viewing and social-media use. Linear and logistic regressions were conducted controlling for complex survey variables.

RESULTS

Adolescents with non US-born compared with US-born parents were less likely to engage in VPA (odds ratio = 0.60, p ≤ .05, 95% CI = 0.38-0.96). Parent country of origin and language spoken were not significantly associated with recommended MVPA engagement. None of screen viewing and social-media use was significantly associated with immigration status.

CONCLUSIONS

Recent immigration status was negatively associated with adolescents' PA documenting an important health disparity.

Comparing health promotion behaviors of male and female high school students in Southeast of Iran

Background Adolescence is one of the most challenging periods of human life. Many healthy or risky behaviors may be formed during this period and continue to the end of life. The aim of this study was to examine and compare the health promotion behaviors of male and female students in high schools. Methods In this descriptive-comparative study, 609 high school students were selected using multi-stage random sampling method. Data were collected using demographic and health-promoting lifestyle profile (HPLPII) questionnaires. Results The mean of health promotion behaviors was moderate in female (2.43 ± 0.46) and male (2.61 ± 0.45) students. The highest and lowest means in the male students were respectively the dimensions of spiritual growth and health responsibility. Also, the highest and lowest means in the female students were dimensions of interpersonal relationships as well as physical activity and exercise. The status of male health promotion behaviors was significantly more favorable than that of the female (p = 0.001, t = -4.71). The male students had a better situation than female in terms of all the six dimensions of HPLPII, so there was a significant difference between them in the four dimensions of spiritual growth, stress management, physical activity and health responsibility. There was also a significant relationship between the history of physical and mental illness in the past year and the students' health promotion behaviors (p < 0.05). Conclusion The results indicated the importance of promoting self-care and educational interventions in the aspects such as physical activity and health responsibility of young people in order to improve the health of the community.

Social and Environmental Determinants of Child Physical Activity in a Rural Mexican-Origin Community

California's rural agricultural communities face an increased burden of obesity and metabolic disease. The present objective is to define the social and environmental influences to child obesity and physical activity within Mexican-origin communities in California's Central Valley. A range of data (anthropometric, socioeconomic, demographic, cultural and environmental) were collected on more than 650 children enrolled in Niños Sanos, Familia Sana. Physical activity data were gathered from a subsample of children 4-7 years of age (n = 148) via accelerometer. Cross sectional analyses explored the relationship between BMI and physical activity and the influence of numerous social and environmental variables. In this sample 45 % of children were determined to be overweight or obese. Boys had a higher daily average moderate-to-vigorous physical activity than girls (p = 0.008). Chi square analyses showed weight status was associated with activity level in girls (p = 0.03) but not boys. Multivariate regression revealed several social and environmental indicators influenced BMI and physical activity (p = 0.004). In this population of school-age children of Mexican-origin, girls may benefit more from targeted efforts to increase MVPA. Family and community support systems may also boost child participation in physical activities.

Dietary sources of calcium among parents and their early adolescent children in the United States by parent race/ethnicity and place of birth

Dietary calcium sources may differ by race/ethnicity and dietary acculturation. A cross-sectional, convenience sample including 587 United States (US) Asian, Hispanic and non-Hispanic White parent-child (10-13 years) pairs completed a calcium food frequency questionnaire. Calcium sources were ranked by mean percent contribution to total adjusted calcium intake, and compared by ethnic group and parents' location of birth. Five foods (fluid milk, cheese, milk on cereal, yogurt, and lattes) represented 49% of total calcium intake for parents. The same foods (except lattes) represented 55% of total calcium for early adolescent children. Fluid milk provided the largest mean percentage of intake for all race/ethnic groups among parents and children. Several food sources of calcium were greater for foreign-born versus US-born Asian or Hispanic parents and children. Understanding calcium food sources and changes in dietary patterns that affect calcium intake among parents and children is important to better promote adequate intake.

Buckling up in Singapore: residency and other risk factors for seatbelt non-compliance - a cross-sectional study based on trauma registry data

BACKGROUND

Seatbelt non-compliance is a problem in middle income countries, and little is known about seatbelt compliance in populations with a high proportion of non-residents. This study analyses the profile of seatbelt non-compliance in Singapore based on trauma registry data from five of the six public hospitals.

METHODS

This is a cross-sectional study of seatbelt compliance of patients aged over 18 years, attending the emergency departments of five public hospitals in Singapore after road collisions from 2011-2014. Seatbelt data was obtained from paramedic and patient history.

RESULTS

There were 4,576 patients studied. Most were Singapore citizens (83.4 %) or permanent residents (2.4 %), with the largest non-resident groups from Malaysia, India, and China. Overall seatbelt compliance was 82.1 %. On univariate analysis, seatbelt compliance was higher in older patients (OR 1.02, 95 % CI 1.001-1.021, p < 0.0001); drivers, followed by front passengers (OR 0.65, 95 % CI 0.51-0.83, p < 0.0001), were more compliant than rear passengers (OR 0.08, 0.06-0.09, p < 0.0001); occupants of larger vehicle types (buses, heavy transport vehicles, minibuses and vans) were more non-compliant compared to occupants of private cars and taxis. Morning peak travel (0700 h-0900 h) and being a non-resident were other risk factors for non-compliance. On multivariable analysis, older age (OR 1.01, 95 % CI 1.001-1.014, p = 0.03) was associated with compliance, while non-residents from China (OR 0.43, 95 % CI 0.18-0.99, p = 0.05), seat position (front passenger compared to driver, OR 0.64, 95 % CI 0.48-0.85, p = 0.002; rear passenger compared to driver, OR 0.067, 95 % CI 0.05-0.09, p < 0.0001), vehicle type (bus compared to car, OR 0.04, 95 % CI 0.017-0.11, p < 0.0001, van compared to car, OR 0.55, 95 % CI 0.36-0.83, p = 0.004), and travel at morning peak periods were independent predictors of seatbelt non-compliance. When the sub-group of drivers was analysed, only vehicle type was a significant predictor of seatbelt compliance, with bus drivers least likely to be compliant to seatbelts (multivariable analysis, OR 0.057 compared to cars, 95 % CI 0.019-0.18, p < 0.0001).

CONCLUSIONS

While overall seatbelt compliance in our study is high, efforts can be made to increase compliance for morning rush hour passengers, rear seat passengers, and occupants of buses, heavy transport vehicles, and vans or pickups.

Familial and individual predictors of obesity and insulin resistance in urban Hispanic children

BACKGROUND

High intake of sugar-sweetened beverages (SSB) has been suggested to contribute to the pediatric obesity epidemic, however, how the home food environment influence children's intake of SSB among Hispanic families is still poorly understood.

OBJECTIVES

To evaluate the relationships between the home food environment and Hispanic children's diet in relation to weight status and insulin resistance (IR).

METHODS

A food frequency questionnaire was administered to 187 Hispanic children (ages 10 to 14 years) and anthropometrics were measured. IR was estimated from fasting insulin and glucose levels using the homeostasis model assessment of insulin resistance (HOMAIR ). Parents reported on family demographics and the home food environment. A structural equation modelling approach was applied to examine the hypothesized relationships among variables.

RESULTS

The prevalence of childhood overweight and obesity was 52.8% and it was positively associated with HOMAIR (β = 0.687, P < .0001). Children's SSB consumption was positively associated with children's body mass index z-score (β = 0.151, P < 0.05) and subsequently to HOMAIR . Children's SSB consumption was predicted by home availability (β = 0.191) and parental intake of SSB (β = 0.419) (P < 0.05). The model fit indices [χ(2)  = 45.821 (d.f. = 30, P > 0.01 and < 0.05), χ(2) /d.f. = 1.53, root mean square error of approximation = 0.053 (90% confidence interval = 0.016, 0.082), comparative fit index = 0.904] suggested a satisfactory goodness-of-fit.

CONCLUSIONS

The home food environment and parental diet seem to play an important role in the children's access to and intake of SSB, which in turn predicted children's weight status.

Caring for Children in Immigrant Families: Vulnerabilities, Resilience, and Opportunities

Demographics indicate that pediatricians increasingly care for children in immigrant families in routine practice. Although these children may be at risk for health disparities relating to socioeconomic disadvantage and cultural or linguistic challenges, immigrant families have unique strengths and potential for resilience. Adaptive and acculturation processes concerning health and well-being can be mediated by cultural media. Pediatricians have a professional responsibility to address the medical, mental health, and social needs of immigrant families. Advocacy and research at the practice level and beyond can further explore the unique needs of this population and evidence-based strategies for health promotion.

Nonalcoholic Fatty Liver Disease in Latinos

Nonalcoholic fatty liver disease (NAFLD) is a serious public health concern that affects almost one third of the US population. The prevalence of NAFLD varies among ethnic/racial groups, with the Latin American population being affected disproportionately. The severity of NAFLD also may be greater in the Latino population. The increased prevalence and severity of NAFLD in Latino Americans likely is related to the interplay between issues such as genetic factors, access to health care, or the prevalence of chronic diseases such as metabolic syndrome or diabetes. In this review, we summarize the current literature on the prevalence and risk factors of NAFLD that are seen to be more common in the Latino population in the United States. Finally, we discuss available treatment options, medical and surgical, that are available for NAFLD and how they affect the Latino population. Health care providers need to address modifiable risk factors that impact the natural history as well as treatment outcomes for NAFLD among Latinos. Additional efforts are needed to improve awareness and health care utilization for Latinos.

Obesity Risk in Children: The Role of Acculturation in the Feeding Practices and Styles of Low-Income Hispanic Families

BACKGROUND

Parent feeding has been associated with child overweight/obesity in low-income families. Because acculturation to the United States has been associated with increased adult obesity, our study aim was to determine whether acculturation was associated with feeding in these populations.

METHODS

Low-income Hispanic mothers of preschoolers were recruited to participate in a longitudinal study examining child eating behaviors. At baseline, mothers completed questionnaires on feeding styles, feeding practices, and acculturation. Regression analyses compared feeding styles and food parenting practices of first-generation, immigrant mothers born outside the United States (n = 138) and mothers born in the United States (n = 31). The correlates of acculturation with these same constructs were also examined.

RESULTS

Immigrant mothers reported using highly directive food parenting practices more often than mothers born in the United States, including pressuring their child to consume more food, using food as a reward, and controlling child food intake by limiting less-healthy foods. First-generation mothers were more likely to show authoritarian, and less likely to show indulgent, feeding styles. Greater maternal acculturation was associated with less restriction of food for weight reasons.

CONCLUSIONS

Although first-generation, immigrant mothers reported using highly controlling food parenting practices with their children, those born in the United States were more indulgent with their children in the feeding context. Mechanisms that promote greater indulgence in more-acculturated mothers need to be identified.

Prevalence and predictors of bicycle helmet use in a southeastern, US city

Fatalities and head injuries from bicycle-related crashes remain a concern in the United States. Despite legislation in many states, helmet use remains low. This observational study examined the helmet use and related factors in a North Carolina city. The sample consisted of 2088 observations of bicyclists. The objectives were to (1) determine helmet use; (2) describe other safe bicycling practices; and (3) examine the relationship of demographic variables and safe riding practices with helmet use. Helmet use was observed for 25% of the sample. Demographic factors related to helmet use were being female (OR = 1.32), 26 years old or older (OR = 4.94), and White (OR = 2.17). Bicyclists riding on the road with traffic were more likely to wear a helmet than bicyclists riding on the sidewalk (OR = 2.04). Findings indicate that helmet use remains low in the city. Research to monitor, better understand, and promote helmet use is needed.

Obesogenic Dietary Practices of Latino and Asian Subgroups of Children in California: An Analysis of the California Health Interview Survey, 2007-2012

OBJECTIVES

We examined obesogenic dietary practices among Latino and Asian subgroups of children living in California.

METHODS

We analyzed 2007, 2009, and 2011-2012 California Health Interview Survey data to examine the differences in dietary practices among Mexican and non-Mexican Latino children and 7 ethnic subgroups of Asian children. We used multivariable regression to examine the sociodemographic factors associated with specific dietary practices.

RESULTS

Latino subgroups of children had few differences in obesogenic dietary practices, whereas Asian subgroups of children exhibited significant differences in several obesogenic dietary practices. Korean and Filipino children were more likely than Chinese children to consume fast food and have low vegetable intake. Filipino children, followed by Japanese children, had the most obesogenic dietary practices compared with Chinese children, who along with South Asian children appeared to have the least obesogenic dietary practices. In general, income, education, and acculturation did not explain the dietary differences among Asian groups.

CONCLUSIONS

Our findings suggest the need to disaggregate dietary profiles of Asian and Latino children and to consider nontraditional sociodemographic factors for messaging and counseling on healthy dietary practices among Asian populations.

The influence of parental nativity, neighborhood disadvantage and the built environment on physical activity behaviors in Latino youth

Little evidence exists examining if parental nativity, neighborhood disadvantage and built environment features are associated with physical activity behaviors in Latino youth. We used a representative sample of Latino youth (n = 616) living in New Jersey to examine parental nativity associations with active transport to school, active use of sidewalks, use of local neighborhood parks, and use of neighborhood physical activity facilities. We estimated prevalence ratios (PR) that accounted for the complex survey design. Latino youth with foreign-born parents were generally more active than their US-born peers, and those with parents in the US 10 years or less were more likely to engage in active transport to school (PR = 1.51, 95% CI 1.04-2.21), after adjusting for census-based neighborhood disadvantage, self-reported neighborhood measures, and geocoded distance to school. Parental nativity status should be considered in policies or interventions designed to increase physical activity among Latino youth.

Longitudinal study of acculturation and BMI change among Asian American men

BACKGROUND

Cross-sectional studies examining the association between Western acculturation and BMI in Asians have been inconsistent, and studies on BMI change are lacking.

OBJECTIVE

This study examined the associations between indicators of acculturation (generational status, length of US residence, and age at immigration) and overweight (BMI ≥25kg/m(2)) as well as 5-year BMI changes in 7,073 Chinese, Japanese, Korean, Filipino, and Vietnamese men who lived in the US and were 44-71years old at baseline of the California Men's Health Study (2002-2003).

METHODS

Indicators of acculturation were reported at baseline. Repeated clinical measures of BMI were extracted from electronic health records (2005-2012).

RESULTS

Using generalized estimating equations we found that lower generational status, shorter duration of US residence and older age at immigration were inversely associated with being overweight. However, analysis of BMI curves using linear mixed models showed that shorter length of US residence and older age at immigration were associated with larger 5-year increases in BMI.

CONCLUSIONS

Asian immigrants who were less acculturated had larger BMI increases as they became more acculturated but had not achieved overweight status. Healthy weight interventions among Asians immigrants may be most effective when targeting weight maintenance early in the process of acculturation.

Nutritional strategies of Latino farmworker families with preschool children: identifying leverage points for obesity prevention

Obesity and overweight are significant problems for children in the US, particularly for Hispanic children. This paper focuses on the children in families of immigrant Hispanic farmworkers, as farm work is the portal though which many immigrants come to the US. This paper (1) describes a model of the nutritional strategies of child feeding in farmworker families; and (2) uses this model to identify leverage points for efforts to improve the nutritional status of these children. In-depth interviews were conducted in Spanish with 33 mothers of 2-5 year old children in farmworker families recruited in North Carolina in 2010-2011. The purposive sample was balanced by farmworker status (migrant or seasonal), child age, and child gender. Interviews were transcribed and translated. Multiple coders and a team approach to analysis were used. Nutritional strategies centered on domains of procuring food, using food, and maintaining food security. The content of these domains reflected environmental factors (e.g., rural isolation, shared housing), contextual factors (e.g., beliefs about appropriate food, parenting style), and available resources (e.g., income, government programs). Environmental isolation and limited access to resources decrease the amount and diversity of household food supplies. Parental actions (parental sacrifices, reduced dietary variety) attempt to buffer children. Use of government food sources is valuable for eligible families. Leverage points are suggested that would change nutritional strategy components and lower the risk of overweight and obesity. Further prospective research is needed to verify the nutritional strategy identified and to test the ability of leverage points to prevent childhood obesity in this vulnerable population.

Life transitions and relevance of healthy living in late adolescence

Using a cross-sectional qualitative design involving focus groups and interviews, we sought to gain a more detailed understanding of adolescents’ physical activity, eating habits and health perceptions during the transition from secondary school (or high school) to work. Based on thematic analyses, three themes were extracted: (1) perceptions of lifestyle and health, (2) changes in priorities and (3) passive acceptance of internal and external influences on physical activity and diet. Poor diet and physical inactivity appeared to reflect participants’ amotivation towards health behaviours, reluctance to divert from perceived peer norms and efforts to assert independence from parents.

Neighborhood context and immigrant children's physical activity

Physical activity is an important determinant of obesity and overall health for children, but significant race/ethnic and nativity disparities exist in the amount of physical activity that children receive, with immigrant children particularly at risk for low levels of physical activity. In this paper, we examine and compare patterns in physical activity levels for young children of U.S.-born and immigrant mothers from seven race/ethnic and nativity groups, and test whether physical activity is associated with subjective (parent-reported) and objective (U.S. Census) neighborhood measures. The neighborhood measures include parental-reported perceptions of safety and physical and social disorder and objectively defined neighborhood socioeconomic disadvantage and immigrant concentration. Using restricted, geo-coded Early Childhood Longitudinal Study-Kindergarten (ECLS-K) data (N = 17,510) from 1998 to 1999 linked with U.S. Census 2000 data for the children's neighborhoods, we utilize zero-inflated Poisson (ZIP) models to predict the odds of physical inactivity and expected days of physical activity for kindergarten-aged children. Across both outcomes, foreign-born children have lower levels of physical activity compared to U.S.-born white children. This disparity is not attenuated by a child's socioeconomic, family, or neighborhood characteristics. Physical and social disorder is associated with higher odds of physical inactivity, while perceptions of neighborhood safety are associated with increased expected days of physical activity, but not with inactivity. Immigrant concentration is negatively associated with both physical activity outcomes, but its impact on the probability of physical inactivity differs by the child's race/ethnic and nativity group, such that it is particularly detrimental for U.S.-born white children's physical activity. Research interested in improving the physical activity patterns of minority and second-generation immigrant children should consider how neighborhood context differentially impacts the health and physical activity of children from various racial, ethnic and nativity backgrounds.

Racial/ethnic and socioeconomic disparities in the use of helmets in children involved in bicycle accidents

PURPOSE

While bicycle helmet use reduces bicycle-related head injury, few children wear them regularly. We aimed to describe racial/ethnic and socioeconomic differences in pediatric helmet use in Los Angeles County (LAC) to help target groups for injury prevention programs.

METHODS

A retrospective review of all pediatric patients involved in bicycle-related accidents in LAC between 2006 and 2011 was performed. Our primary analysis examined the association between helmet use and age, gender, insurance status, and race/ethnicity. We also evaluated the association between helmet use and the need for emergency surgery, mortality, and length of hospital stay (LOH), after adjusting for injury severity score (ISS), age, insurance status, and race/ethnicity.

RESULTS

Of 1248 patients, 11.3% wore helmets, with decreased use among children 12years and older, minorities, and those without private insurance. Overall, 5.9% required an emergency operation, 34.1% returned to their pre-injury capacity, and mortality was 0.7%. On multivariable analysis, higher ISS increased LOH, the risk for emergency surgery, and mortality.

CONCLUSION

Nearly 90% of children involved in bicycle-related accidents were not wearing helmets. Helmet use was lower among older children, minorities, and those from a low socioeconomic status. Injury prevention programs targeting low-income middle and high schools and minority communities may help increase helmet use in children in LAC.