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Showell NN, Perin J, Koebnick C, Jimenez J, Gonzalez I, DeCamp LR, Thornton RL. Racial/Ethnic Disparities in Parent Activation: Implications for Developing Interventions Addressing Early Childhood Obesity. Acad Pediatr 2022; 22:761-768. [PMID: 34798355 PMCID: PMC9108126 DOI: 10.1016/j.acap.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Examine racial/ethnic differences in parent activation and associations with child obesity risk behaviors in low-income families. METHODS Cross-sectional survey study of 300 low-income Black, Latinx, and White parents of patients aged 2 to 5 years receiving primary care within 2 health care systems (Systems 1 & 2). In-person and phone surveys were conducted. Parent activation, defined as parents' knowledge, confidence, and willingness to act concerning their child's health, was measured using the standardized 13-item Parent Patient Activation Measure (P-PAM). Differences in parent activation by race/ethnicity were assessed using analysis of variance. Multivariate regression analyses were used to test associations between parent activation and child obesity risk behaviors. RESULTS In pooled unadjusted analyses, Latinx parents had significantly lower activation compared to Black parents (P = .023), but these differences were no longer statistically significant after adjusting for other sociodemographic characteristics (P = .06). Higher activation was associated with slightly greater odds of consuming ≥ 5 daily servings of fruits and vegetables for System 2 only (odds ratio: 1.04, 95% confidence interval: 1.01, 1.07). Associations between parental activation and child screen time or physical activity were not significant. CONCLUSIONS Findings highlight potential measurement limitations of the P-PAM including the inability of the measure to capture barriers to health system navigation and cultural and linguistic considerations. Further attention to the nuanced interplay between parental activation and contextual and sociodemographic risk factors (eg, food availability, immigrant status, economic opportunity, language proficiency) should be considered in the development of early childhood obesity interventions in primary care settings.
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Affiliation(s)
- Nakiya N. Showell
- Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N. Wolfe Street, Room 2023, Baltimore, MD 21287, USA
| | - Jamie Perin
- Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N. Wolfe Street, Room 2023, Baltimore, MD 21287, USA
| | - Corinna Koebnick
- Kaiser Permanente Research, Department of Research & Evaluation, 100 S Los Robles, 6th Floor, Pasadena, CA 91101, USA
| | - Jennifer Jimenez
- Kaiser Permanente Research, Department of Research & Evaluation, 100 S Los Robles, 6th Floor, Pasadena, CA 91101, USA
| | - Ismael Gonzalez
- Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N. Wolfe Street, Room 2023, Baltimore, MD 21287, USA
| | - Lisa Ross DeCamp
- ACCORDS (Adult and Child Consortium for Health Outcomes Research and Delivery Science), Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Anschutz Medical Campus 13123 East 16th Avenue, Aurora, CO 80045, USA,Latino Research and Policy Center, Colorado School of Public Health, CU Denver Lawrence Street Center 1380 Lawrence St. Suite 1100, Denver, CO 80204, USA
| | - Rachel L.J. Thornton
- Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N. Wolfe Street, Room 2023, Baltimore, MD 21287, USA
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Abstract
Much has been written about the multifaceted significance of food and eating from an anthropological perspective; the same can be said about the role of food in collective identity construction and nation building. In contrast, the nexus of food, memory, psychological trauma, and disordered eating has been less explored. The aim of this interdisciplinary article is to synthesize available knowledge on this topic by engaging with research literature in fields such as food history, anthropology, sociology, and psychiatry as well as autobiographical works, cookbooks, etc. One main section of the article focuses on the role of food and cooking in exile and refuge. Another section deals with the role of food in the aftermath of historical trauma, whereas a final section discusses various works on disordered eating in the wake of traumatic experiences. In sum, the dual nature of food and cooking-at once concrete and abstract, material and symbolic-offers an arena in which ambivalent memories of trauma can take on tangible form. The concept of postmemory may be useful in understanding how food and cooking can function both as a vehicle and as a remedy for intergenerational trauma.
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Affiliation(s)
- Mattias Strand
- Transcultural Centre, Stockholm Health Care Services, Region Stockholm, Solnavägen 4, 113 65, Stockholm, Sweden.
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, 171 77, Stockholm, Sweden.
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Mayne SL, Hannan C, DiFiore G, Virudachalam S, Glanz K, Fiks AG. Associations of Neighborhood Safety and Collective Efficacy with Dietary Intake among Preschool-Aged Children and Mothers. Child Obes 2022; 18:120-131. [PMID: 34613834 DOI: 10.1089/chi.2021.0144] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Positive neighborhood environments may promote healthier behaviors, yet few studies have examined associations between neighborhood social environment and diet. We examined associations of neighborhood perceived safety, collective efficacy, and violent crime with dietary intake among preschool-aged children and their mothers. Methods: We administered a cross-sectional survey to 300 mothers/female caregivers of Medicaid-enrolled 2- to 4-year-old children in Philadelphia. Mothers reported their own and their child's dietary intake using the validated Dietary Screener Questionnaire. Mixed-effects linear regression models assessed associations of perceived neighborhood safety, collective efficacy, and census tract-level violent crime with parent and child dietary intake, adjusted for individual, family, and neighborhood covariates. Results: Among mothers, higher perceived neighborhood safety and collective efficacy were associated with higher daily intake of fruits/vegetables (β = 0.35 cups, 95% CI: 0.12-0.58 and β = 0.30 cups, 95% CI: 0.08-0.52, comparing the highest with lowest tertile). Higher neighborhood-perceived safety was also associated with higher whole-grain intake among mothers (β = 0.14 ounces, 95% CI: 0.02-0.27) and children (β = 0.07 ounces, 95% CI: 0.01-0.13, comparing the highest with lowest tertile). Neighborhood social exposures were not associated with intake of added sugars or sugar-sweetened beverages for mothers or children, nor were lower levels of violent crime associated with any outcome. Conclusions: More favorable perceptions of neighborhood safety and collective efficacy were associated with a slightly higher consumption of some healthy foods among mothers and their young children. Future prospective research is needed to confirm these findings, explore potential mechanisms, and determine whether intervening on the social environment improves diet.
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Affiliation(s)
- Stephanie L Mayne
- Center for Pediatric Clinical Effectiveness, Possibilities Project and PolicyLab, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute for Health Economics, University of Pennsylvania, Colonial Penn Center, Philadelphia, PA, USA
| | - Chloe Hannan
- Center for Pediatric Clinical Effectiveness, Possibilities Project and PolicyLab, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, PA, USA
| | - Gabrielle DiFiore
- Center for Pediatric Clinical Effectiveness, Possibilities Project and PolicyLab, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, PA, USA
| | - Senbagam Virudachalam
- Center for Pediatric Clinical Effectiveness, Possibilities Project and PolicyLab, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute for Health Economics, University of Pennsylvania, Colonial Penn Center, Philadelphia, PA, USA
| | - Karen Glanz
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Colonial Penn Center, Philadelphia, PA, USA.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Alexander G Fiks
- Center for Pediatric Clinical Effectiveness, Possibilities Project and PolicyLab, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute for Health Economics, University of Pennsylvania, Colonial Penn Center, Philadelphia, PA, USA
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Thorpe D, Klein DN. The Effect of Neighborhood-level Resources on Children's Physical Development: Trajectories of Body Mass Index and Pubertal Development and the Influence of Child Biological Sex. J Youth Adolesc 2022; 51:967-983. [PMID: 35028875 DOI: 10.1007/s10964-021-01547-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/19/2021] [Indexed: 10/19/2022]
Abstract
Growing research substantiates the role of neighborhood disadvantage in contributing to early pubertal maturation and higher body mass index; however, previous studies in this area have design limitations. Specifically, many studies have been cross-sectional, have used singular indicators of neighborhood disadvantage (e.g., poverty), and have provided mixed findings about the role of biological sex. The present study addresses these gaps by examining how neighborhood resources (spanning educational, health/environmental, and social/economic domains) predict trajectories of pubertal maturation and body mass index using longitudinal multi-wave data. Furthermore, multigroup analyses assessed how these associations may differ by child biological sex. Participants in this study (n = 505; 54% male) were assessed every 3 years at age 9 (M = 9.17, SD = 0.39), age 12 (M = 12.63, SD = 0.43), and age 15 (M = 15.23, SD = 0.37). Approximately 12% of the sample identified as Hispanic, and 11% as non-White. Using multigroup latent growth analyses, the study examined how neighborhood resources predicted trajectories of pubertal maturation and body mass index using multi-wave data across middle childhood through mid-adolescence. The findings suggested that greater neighborhood resources were cross-sectionally associated with lower pubertal development and predicted slower trajectories across time. Although all girls in the study eventually progressed through pubertal development, girls in lower resourced neighborhoods experienced a much earlier onset of puberty. Additionally, greater neighborhood resources predicted lower BMI both cross sectionally and longitudinally. Specifically, higher resourced neighborhoods were protective against obesity risk for both boys and girls across mid-childhood through mid-adolescence. In sum, the study highlights the role of broader neighborhood factors on early maturity risk for female children, and obesity risk for children regardless of biological sex.
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Affiliation(s)
- Daneele Thorpe
- Stony Brook University, Department of Psychology, 100 Nicolls Rd, Stony Brook, New York, NY, 11794-2500, USA.
| | - Daniel N Klein
- Stony Brook University, Department of Psychology, 100 Nicolls Rd, Stony Brook, New York, NY, 11794-2500, USA
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Nguyen TH, Götz S, Kreffter K, Lisak-Wahl S, Dragano N, Weyers S. Neighbourhood deprivation and obesity among 5656 pre-school children-findings from mandatory school enrollment examinations. Eur J Pediatr 2021; 180:1947-1954. [PMID: 33576893 PMCID: PMC8105223 DOI: 10.1007/s00431-021-03988-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/29/2021] [Accepted: 02/05/2021] [Indexed: 11/20/2022]
Abstract
The risk of child obesity is strongly related to socioeconomic factors such as individual socioeconomic position (SEP) and neighbourhood deprivation. The present study analyses whether the relationship between neighbourhood deprivation and child obesity differs by child's individual SEP. Data from 5656 children (5-7 years) from the mandatory school enrollment examinations of the pre-school cohorts 2017/2018 in Düsseldorf were analysed. Obesity was determined by the age- and gender-specific body mass index (BMI); neighbourhood deprivation by using the socio-spatial degree of deprivation of the children's residential addresses; and individual SEP by the level of parental education. Using Poisson regression, we estimated prevalence ratios (PR with 95% confidence interval (CI)) of child obesity by neighbourhood deprivation and parental education. Interactions between neighbourhood deprivation and parental education were tested. The prevalence of child obesity increases with the degree of neighbourhood deprivation. Compared to children living in low deprivation neighbourhoods, the proportion of obese children was twice as high in high deprivation neighbourhoods (PR=2.02; CI=1.46-2.78). Likewise, children from families with medium and low education have twice the risk for obesity compared to children with high parental education (PR=2.05; CI=1.46-2.78). The relationship between neighbourhood deprivation and child obesity was significantly moderated by parental education; it was stronger for higher parental education than for medium and low parental education (p<.001).Conclusion: Our findings suggest that children from deprived neighbourhoods and families with lower education have a higher risk for child obesity. The identification of particularly deprived neighbourhoods with structural interventions in combination with the strengthening of parental health literacy seems reasonable. What is Known: • Studies show that children from disadvantaged neighbourhoods are more frequently obese. What is New: • The relationship between neighbourhood deprivation and child obesity is significantly moderated by parental education. It is stronger for children with higher parental education than for children with medium and low parental education.
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Affiliation(s)
- Thuy Ha Nguyen
- grid.14778.3d0000 0000 8922 7789Faculty of Medicine, University Hospital Duesseldorf, Centre for Health and Society, Institute of Medical Sociology, Moorenstrasse 5, 40225 Duesseldorf, Germany
| | - Simon Götz
- grid.14778.3d0000 0000 8922 7789Faculty of Medicine, University Hospital Duesseldorf, Centre for Health and Society, Institute of Medical Sociology, Moorenstrasse 5, 40225 Duesseldorf, Germany
| | - Katharina Kreffter
- grid.14778.3d0000 0000 8922 7789Faculty of Medicine, University Hospital Duesseldorf, Centre for Health and Society, Institute of Medical Sociology, Moorenstrasse 5, 40225 Duesseldorf, Germany
| | | | - Nico Dragano
- grid.14778.3d0000 0000 8922 7789Faculty of Medicine, University Hospital Duesseldorf, Centre for Health and Society, Institute of Medical Sociology, Moorenstrasse 5, 40225 Duesseldorf, Germany
| | - Simone Weyers
- Faculty of Medicine, University Hospital Duesseldorf, Centre for Health and Society, Institute of Medical Sociology, Moorenstrasse 5, 40225, Duesseldorf, Germany.
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Gutiérrez-Camacho C, Méndez-Sánchez L, Klünder-Klünder M, Clark P, Denova-Gutiérrez E. Association between Sociodemographic Factors and Dietary Patterns in Children Under 24 Months of Age: A Systematic Review. Nutrients 2019; 11:E2006. [PMID: 31454895 PMCID: PMC6770717 DOI: 10.3390/nu11092006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/21/2019] [Accepted: 08/23/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Understanding early-life complementary feeding dietary patterns and their determining factors could lead to better ways of improving nutrition in early childhood. The purpose of this review was to evaluate evidence of the association between sociodemographic factors and dietary patterns (DPs) in children under 24 months. METHODS Medline (PubMed), Cochrane Central, NICE guidelines, and Trip database were searched for observational studies that evaluated sociodemographic factors and their associations with DP. RESULTS Seven studies were selected for the present review. High education level among mothers was inversely associated with unhealthy DPs and positively associated with healthy DPs. Higher household income was negatively associated with unhealthy DPs. Four studies showed a positive association between low household income and unhealthy DPs and three studies showed a positive association between higher household income and healthy DPs. Additionally, in younger mothers, body mass index (BMI ≥ 30.0 kg/m2) and number of children were positively associated with unhealthy DPs. CONCLUSIONS This review provides evidence of a positive association between mothers' higher education level, higher household income, higher maternal age, and healthy dietary patterns as well as a negative association between these factors and unhealthy dietary patterns. Further studies from low- and middle-income countries are needed for comparison with associations showed in this review.
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Affiliation(s)
- Claudia Gutiérrez-Camacho
- Physical Therapy Research Unit, Hospital Infantil de México Federico Gómez, and Medicine Faculty of Autonomous National University, Mexico City 06720, Mexico
| | - Lucia Méndez-Sánchez
- Clinical Epidemiology Research Unit, Hospital Infantil de México Federico Gómez, and Medicine Faculty of Autonomous National University, Mexico City 06720, Mexico.
| | - Miguel Klünder-Klünder
- Research Headmaster's Office, Hospital Infantil de México Federico Gómez, Ciudad de México 06720, Mexico
| | - Patricia Clark
- Clinical Epidemiology Research Unit, Hospital Infantil de México Federico Gómez, and Medicine Faculty of Autonomous National University, Mexico City 06720, Mexico
| | - Edgar Denova-Gutiérrez
- Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca 62100, Morelos.
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