Where are family theories in family-based obesity treatment?: conceptualizing the study of families in pediatric weight management

Family-based approaches to pediatric obesity treatment are considered the 'gold-standard,' and are recommended for facilitating behavior change to improve child weight status and health. If family-based approaches are to be truly rooted in the family, clinicians and researchers must consider family process and function in designing effective interventions. To bring a better understanding of family complexities to family-based treatment, two relevant reviews were conducted and are presented: (1) a review of prominent and established theories of the family that may provide a more comprehensive and in-depth approach for addressing pediatric obesity; and (2) a systematic review of the literature to identify the use of prominent family theories in pediatric obesity research, which found little use of theories in intervention studies. Overlapping concepts across theories include: families are a system, with interdependence of units; the idea that families are goal-directed and seek balance; and the physical and social environment imposes demands on families. Family-focused theories provide valuable insight into the complexities of families. Increased use of these theories in both research and practice may identify key leverage points in family process and function to prevent the development of or more effectively treat obesity. The field of family studies provides an innovative approach to the difficult problem of pediatric obesity, building on the long-established approach of family-based treatment.

Mental health research with Latino farmworkers: a systematic evaluation of the short CES-D

Mental health research among Latino farmworkers is hampered by the absence of measurement evaluation that ensures farmworkers understand and can consistently and appropriately respond to questions about mental health. Cross-sectional data were obtained from 409 farmworkers via interviewer-administered survey questionnaires. Mental health was operationalized with the short-form Center for Epidemiologic Studies, Depression (CES-D) scale. The structured interviewer-administered survey questionnaires included measures to capture personal and work-related factors that could affect farmworkers' ability to understand and respond to mental health questions probed by the CES-D. Good variability in item response was observed across the 10 short-form CES-D items. There was no evidence of differential response across sub-groups of farmworkers for six of the 10 items. Responses to four of the 10 items differed by educational attainment, country of origin, and language preference. Overall, the internal consistency of the 10 items exceeded standard conventions, and observed differences in depressive symptoms were as expected. Researchers in farmworker mental health must remain attentive to the strength and validity of available measures for migrants, different ethnic groups and different socioeconomic backgrounds. Nevertheless, the overall pattern suggests that the CES-D is a viable tool for advancing farmworker mental health research.

Immigrant farmworkers' health-related quality of life: an application of the job demands-control model

This study tests basic predictions from the demands-control model of occupational stress in Latino immigrant farmworkers. Cross-sectional data were obtained from 151 farmworkers in eastern North Carolina via face-to-face interviews conducted in Spanish during the summer of 2005. Results suggest that farmwork is characterized by low psychological demand and low control, or that it is a "passive job." Multivariate analyses provided little support for predictions. Isometric load, an indicator of physical job demands reflecting how frequently workers maintain awkward postures for long periods, was associated with poorer physical health, and high worker control was associated with better mental health. However, pace of work, an indicator of psychological job demand, was unassociated with physical and mental health, and physical exertion, another indicator of physical job demand, was not robustly associated with health outcomes. The results suggest that core predictions from the demands-control model do not hold for immigrant farmworkers, and they foreshadow possible ways of refining the model.

Housing quality among North Carolina farmworker families

Substandard housing poses risks for health and safety. Few studies have documented the housing conditions experienced by Latino farmworker families in the U.S. The purpose of this analysis is to assess the quality of housing occupied by farmworker families in eastern North Carolina and determine how individual and family characteristics are associated with housing quality. Interviews were completed in six North Carolina counties with 186 Latino farmworker households that included a child under the age of 18 to document respondent, household, and dwelling characteristics. Most households were crowded, with 69.4% having more than one person per room (excluding bathrooms and kitchens). Dwellings were often located adjacent to fields (46.0%), suffered from structural problems (e.g., 18.3% had roof leaks), and lacked facilities and appliances (e.g., 26.9% did not have a working oven). Most farmworker family dwellings did not meet the U.S. Department of Housing and Urban Development's minimum criteria for health and safety. Respondents in their thirties, who lived in North Carolina for less than five years, moved two or more times in the past year to follow crops, and lived in grower-provided housing had the poorest housing quality. These results demonstrate that North Carolina Latino farmworker families lack adequate housing. Further research is needed to evaluate farmworker housing conditions in all areas of the U.S., and to document the relationship of these housing conditions to health outcomes. The collaboration of researchers, advocates, policy makers, housing developers, health care providers, and educators is needed to improve the housing conditions of farmworker families.

Oral Health and Quality of Life of Migrant and Seasonal Farmworkers in North Carolina

Oral health deficits can have a significant effect on workers' general health and their ability to carry out normal activities. Although farmworkers have been found to lack access to dental care, few studies have documented their oral health status or its impact on quality of life (QOL). This research (1) describes the oral health problems experienced and oral health care received by Latino farmworkers in North Carolina, and (2) explores the association between oral health and QOL. Data were collected using face-to-face interviews from a representative sample of 151 farmworkers; data included oral health-related QOL (OHIP-14) and general health-related QOL (SF-12 Health Survey). Workers reported a high number of unmet needs: 52% reported caries, and 33% reported missing teeth. Only 21% had received dental services in the past year, almost all in Mexico rather than the U.S. The dimensions of oral health-related QOL most impaired were psychological discomfort and physical pain caused by dental problems. Number of functional oral health problems was the strongest predictor of oral health-related QOL (p < 0.001) and physical health-related QOL (p < 0.05), but was unrelated to mental health-related QOL. These findings indicate that the high rate of unmet oral health needs is associated with poorer farmworker QOL. The consequences of suffering on-going dental pain for work performance, sleep, and nutritional status are unknown. Because national data indicate that fewer farmworkers are returning to their countries of origin, communities with large farmworker populations need to address their unmet needs for dental care.

Social inequalities and exercise during adulthood: toward an ecological perspective

Grounded in ecological theory, this study examines the association among participation in regular vigorous exercise and social status, aspects of prominent life settings, interactions between life settings, and more proximal individual resources and processes using data from the National Survey of Midlife Development in the United States (N = 3,032). Among women, a higher level of earnings was associated with more vigorous exercise, yet those women with more education had a steeper decline in exercise across adulthood. Among men, those with the lowest level of education had the steepest decline in physical activity across adulthood, and earnings did not affect exercise patterns. Less participation in vigorous exercise among blacks, in contrast to nonblacks, was explained by their tendency to live in less safe neighborhoods and having more functional health problems. Finally, contextual factors from multiple domains were independently associated with participation in regular exercise. Consistent with ecological theory, these results suggest that interventions to promote exercise habits among adults need to consider the independent and interactive effects of multiple contextual factors.

The social ecology of health: leverage points and linkages

The authors demonstrate the usefulness of social ecology theory for improving the treatment and prevention of poor health. The social ecology of health, unlike the topics of previous triptychs in Behavioral Medicine, is a field without a clearly defined body of literature. We begin with an overview of the ecological perspective and ecological theory as outlined by Bronfenbrenner and colleagues, provide examples of how ecological concepts have been demonstrated to influence health, and discuss how these concepts can be used by health professionals. We present a heuristic model illustrating leverage points and linkages (i.e., socioeconomic status, family, work, and school), for health, and we conclude with a consideration of the benefits of social ecology to health professionals and a summary of the limitations of the ecological model.

Workers' perceptions of how jobs affect health: a social ecological perspective

A national sample of 2,048 workers was asked to rate the impact of their job on their physical and mental health. Ordered logistic regression analyses based on social ecology theory showed that the workers' responses were significantly correlated with objective and subjective features of their jobs, in addition to personality characteristics. Workers who had higher levels of perceived constraints and neuroticism, worked nights or overtime, or reported serious ongoing stress at work or higher job pressure reported more negative effects. Respondents who had a higher level of extraversion, were self-employed, or worked part time or reported greater decision latitude or use of skills on the job reported more positive effects. These findings suggest that malleable features of the work environment are associated with perceived effects of work on health, even after controlling for personality traits and other sources of reporting bias.

Work-family spillover and health during midlife: is managing conflict everything?

PURPOSE

To examine the association between multiple dimensions of work-family spillover, and physical and mental health among working midlife adults.

DESIGN

Cross-sectional analyses of self-reported data.

SETTING

The National Survey of Midlife Development in the United States (MIDUS), 1995.

SUBJECTS

Employed adults aged 35-65 years (n = 1547) who participated in the telephone interview and returned the mail-back questionnaires of the MIDUS (overall response rate of 60.8%).

MEASURES

Independent variables included negative spillover from work to family, positive spillover from work to family, negative spillover from family to work, positive spillover from family to work. Self-rated physical health, chronic conditions, obesity, self-rated mental health, negative psychological well-being, and positive psychological well-being were outcomes.

RESULTS

Independent of negative spillover between work and family, more positive spillover from work to family was associated with better physical health (odds ratio [OR] = 1.17, p < or = .05) and mental health (OR = 1.28, p < or = .01). More positive spillover from family to work was associated with less chronic conditions (OR = .85, p < or = .05), less negative well-being (OR = .67, p < or = .001), as well as better mental health (OR = 1.45, p < or = .01) and more positive well-being (OR 1.76, p < or = 001).

CONCLUSIONS

Health promotion or employment programs and policies may need to focus on minimizing negative spillover between work and family and promoting positive spillover between work and family.

Reconceptualizing the work-family interface: an ecological perspective on the correlates of positive and negative spillover between work and family

Ecological theory was used to develop a more expanded conceptualization of the work-family interface and to identify significant correlates of multiple dimensions of work-family spillover. Using data from employed adults participating in the National Survey of Midlife Development in the United States (N = 1,986), negative spillover from work to family, positive spillover from work to family, negative spillover from family to work, and positive spillover from family to work were found to be distinct work-family experiences. Analyses indicated that work and family factors that facilitated development (e.g., decision latitude, family support) were associated with less negative and more positive spillover between work and family. By contrast, work and family barriers (e.g., job pressure, family disagreements) were associated with more negative spillover and less positive spillover between work and family. In some cases, results differ significantly by gender.

Reconceptualizing the work-family interface: an ecological perspective on the correlates of positive and negative spillover between work and family

Ecological theory was used to develop a more expanded conceptualization of the work-family interface and to identify significant correlates of multiple dimensions of work-family spillover. Using data from employed adults participating in the National Survey of Midlife Development in the United States (N = 1,986), negative spillover from work to family, positive spillover from work to family, negative spillover from family to work, and positive spillover from family to work were found to be distinct work-family experiences. Analyses indicated that work and family factors that facilitated development (e.g., decision latitude, family support) were associated with less negative and more positive spillover between work and family. By contrast, work and family barriers (e.g., job pressure, family disagreements) were associated with more negative spillover and less positive spillover between work and family. In some cases, results differ significantly by gender.