Obstacles to Preventing Obesity in Children Aged 2 to 5 Years: Latino Mothers’ and Fathers’ Experiences and Perceptions of Their Urban Environments

Background The prevalence of obesity among Latino children is alarmingly high, when compared to non-Latino White children. Low-income Latino parents living in urban areas, even if they are well-educated, face obstacles that shape familial health behaviors. This study used qualitative methods to explore parents’ experiences in providing meals and opportunities to play to their children aged 2 to 5 years. In contrast to most prior studies, this study examined perceptions of familial behaviors among both mothers and fathers. Methods An ecological framework for exploring the associations of parental feeding behaviors and children’s weight informed this study. An interview guide was developed to explore parents’ experiences and perceptions about children’s eating and physical activity and administered to six focus groups in a community-based organization in the Mission District of San Francisco. Transcripts were coded and analyzed. Twenty seven mothers and 22 fathers of Latino children ages 2 to 5 participated. Results Mothers, fathers, and couples reported that employment, day care, neighborhood environments and community relationships were experienced, and perceived as obstacles to promoting health behavior among their children, including drinking water instead of soda and participating in organized playtime with other preschool-age children. Conclusions Results from this study suggest that the parents’ demographic, social and community characteristics influence what and how they feed their children, as well as how often and the types of opportunities they provide for physical activity, providing further evidence that an ecological framework is useful for guiding research with both mothers and fathers. Mothers and fathers identified numerous community and society-level constraints in their urban environments. The results point to the importance of standardized work hours, resources for day care providers, clean and safe streets and parks, strong community relationships, and reduced access to sugar-sweetened beverages in preventing the development of obesity in preschool-age Latino children

Parental Feeding Practices in Mexican American Families: Initial Test of an Expanded Measure

Background: Although obesity rates are high among Latino children, relatively few studies of parental feeding practices have examined Latino families as a separate group. Culturally-based approaches to measurement development can begin to identify parental feeding practices in specific cultural groups. This study used qualitative and quantitative methods to develop and test the Parental Feeding Practices (PFP) Questionnaire for use with Mexican American parents. Items reflected both parent’s use of control over child eating and child-centered feeding practices. Methods: In the qualitative phase of the research, 35 Latino parents participated in focus groups. Items for the PFP were developed from focus group discussions, as well as adapted from existing parent feeding practice measures. Cognitive interviews were conducted with 37 adults to evaluate items. In the quantitative phase, mothers and fathers of 174 Mexican American children ages 8–10 completed the PFP and provided demographic information. Anthropometric measures were obtained on family members. Results: Confirmatory factor analyses identified four parental feeding practice dimensions: positive involvement in child eating, pressure to eat, use of food to control behavior, and restriction of amount of food. Factorial invariance modeling suggested equivalent factor meaning and item response scaling across mothers and fathers. Mothers and fathers differed somewhat in their use of feeding practices. All four feeding practices were related to child body mass index (BMI) percentiles, for one or both parents. Mothers reporting more positive involvement had children with lower BMI percentiles. Parents using more pressure to eat had children with lower BMI percentiles, while parents using more restriction had children with higher BMI percentiles. Fathers using food to control behavior had children with lower BMI percentiles. Conclusions: Results indicate good initial validity and reliability for the PFP. It can be used to increase understanding of parental feeding practices, children’s eating, and obesity among Mexican Americans, a population at high risk of obesity

Parental feeding practices and child weight status in Mexican American families: a longitudinal analysis

Parental feeding practices are thought to influence children\u27s weight status, through children\u27s eating behavior and nutritional intake. However, because most studies have been cross-sectional, the direction of influence is unclear. Moreover, although obesity rates are high among Latino children, few studies of parental feeding practices have focused on this population. This 2-year longitudinal study examined mutual influences over time between parental feeding practices and children\u27s weight status, in Mexican American families with children 18 years old at baseline. Mothers (n = 322) and fathers (n = 182) reported on their feeding practices at baseline, 1-year follow-up, and 2-year follow-up. Weight status, defined by waist-height ratio (WHtR) and body mass index (BMI), was ascertained at all assessments. Cross-lagged panel models were used to examine the mutual influences of parental feeding practices and child weight status over time, controlling for covariates. Both mothers\u27 and fathers\u27 restriction of food predicted higher subsequent child weight status at Year 1, and for fathers this effect was also found at Year 2. Mothers\u27 and fathers\u27 pressure to eat predicted lower weight status among boys, but not girls, at Year 1. Child weight status also predicted some parental feeding practices: boys\u27 heavier weight predicted mothers\u27 less pressure to eat at Year 1, less use of food to control behavior at Year 2, and greater restriction at Year 2; and girls\u27 heavier weight at Year 1 predicted fathers\u27 less pressure to eat and less positive involvement in child eating at Year 2. This study provides longitudinal evidence that some parental feeding practices influence Mexican American children\u27s weight status, and that children\u27s weight status also influences some parental feeding practices. Feeding practices of both mothers and fathers were related to children\u27s weight status, underscoring the importance of including fathers in research on parental feeding practices and child obesity

Longitudinal Effects of Parental, Child and Neighborhood Factors on Moderate-Vigorous Physical Activity and Sedentary Time in Latino Children

Background: Moderate-vigorous physical activity (%MVPA) confers beneficial effects on child musculoskeletal health, cardiovascular fitness, and psychosocial well-being; in contrast, sedentary time (%SED) is emerging as a risk factor for health. This study aimed to identify parental, child and neighborhood factors influencing longitudinal assessments of body mass index (BMI) and activity patterns among Latino children, and to estimate lagged and cross-lagged effects between child BMI, %MVPA and %SED. Methods: A longitudinal design with assessments at baseline, 1 and 2 years follow-up (FU) was used to evaluate the effects of maternal and paternal factors (BMI, age, education level, acculturation, household income and household size), child factors (gender, age, BMI, pubertal status) and neighborhood factors (disorder, victimization) on child BMI, %MVPA and %SED, expressed as a percent of awake time, in 282 Latino children ages 8–10 y and their parents. This study was restricted to families with a mother and biological father or father figure in the child’s life. Results: Across time, total daily accelerometer counts (p = 0.04) and steps decreased (p = 0.0001), %SED increased (p = 0.0001), and %MVPA decreased (p = 0.02). Moderate lagged effects or tracking was seen for %MVPA and %SED (p = 0.001). %MVPA varied by gender (5.5% higher in boys than girls, p = 0.0001); child age (−0.4% per year, p = 0.03), and child BMI in boys only (−0.22%, p = 0.0002). Negative effects of paternal age, maternal education and maternal changes in BMI on %MVPA also were seen. %SED increased with child age (2.5% higher per year, p = 0.0001). Positive effects of paternal acculturation, maternal change in BMI, paternal age, and negative effects of household size on %SED were observed. A cross-lagged positive effect of BMI at FU1 on %SED at FU2 was observed for boys and girls (p = 0.03). Neighborhood disorder and victimization were not significant predictors of child BMI, %MVPA or %SED. Conclusion: The major child determinants of physical activity (age, gender and BMI) and minor parental influences (maternal BMI and education, paternal age and acculturation) should be considered in designing interventions to promote %MVPA and reduce %SED among Latino children as they approach adolescence. Keywords: Physical activity patterns, Accelerometers, Childhood obesity, Maternal factors, Paternal factors, Education level, Acculturation, Household income, Household size, Environment, Disorder, Victimizatio

Parental Feeding Practices and Child Weight Status in Mexican American Families: A Longitudinal Analysis

Parental feeding practices are thought to influence children\u27s weight status, through children\u27s eating behavior and nutritional intake. However, because most studies have been cross-sectional, the direction of influence is unclear. Moreover, although obesity rates are high among Latino children, few studies of parental feeding practices have focused on this population. This 2-year longitudinal study examined mutual influences over time between parental feeding practices and children\u27s weight status, in Mexican American families with children 18 years old at baseline. Mothers (n = 322) and fathers (n = 182) reported on their feeding practices at baseline, 1-year follow-up, and 2-year follow-up. Weight status, defined by waist-height ratio (WHtR) and body mass index (BMI), was ascertained at all assessments. Cross-lagged panel models were used to examine the mutual influences of parental feeding practices and child weight status over time, controlling for covariates. Both mothers\u27 and fathers\u27 restriction of food predicted higher subsequent child weight status at Year 1, and for fathers this effect was also found at Year 2. Mothers\u27 and fathers\u27 pressure to eat predicted lower weight status among boys, but not girls, at Year 1. Child weight status also predicted some parental feeding practices: boys\u27 heavier weight predicted mothers\u27 less pressure to eat at Year 1, less use of food to control behavior at Year 2, and greater restriction at Year 2; and girls\u27 heavier weight at Year 1 predicted fathers\u27 less pressure to eat and less positive involvement in child eating at Year 2. This study provides longitudinal evidence that some parental feeding practices influence Mexican American children\u27s weight status, and that children\u27s weight status also influences some parental feeding practices. Feeding practices of both mothers and fathers were related to children\u27s weight status, underscoring the importance of including fathers in research on parental feeding practices and child obesity

Mother-Reported Sleep, Accelerometer-Estimated Sleep, and Weight Status in Mexican American Children: Sleep Duration Is Associated with Increased Adiposity and Risk for Overweight/Obese Status

We know of no studies comparing parent-reported sleep with accelerometer-estimated sleep in their relation to pediatric adiposity. We examined: 1) the reliability of mother-reported sleep compared with accelerometer-estimated sleep, and 2) the relationship between both sleep measures and child adiposity. The current cross-sectional study included 304 Mexican American mother-child pairs recruited from Kaiser Permanente Northern California. We measured sleep duration, using maternal report and accelerometry, and child anthropometrics. Concordance between sleep measures was evaluated using the Bland-Altman method. We conducted zero-ordered correlations between mother-reported sleep, accelerometer-estimated sleep and child BMI z-scores (BMIz). Using linear regression, we examined three models to assess child BMIz with mother-reported sleep (model 1), accelerometer-estimated sleep (model 2), and both sleep measures (model 3). Children had an average age of 8.86 years (SD= .82). Mothers reported that their child slept 9.81 ± 0.74 (95% CI: 9.72, 9.89) hours, compared to 9.58 ± 0.71 (95% CI: 9.50, 9.66) hours based on accelerometry. Mother-reported sleep and accelerometer-estimated sleep were correlated (r = 0.33, p \u3c 0.001). BMIz outcomes were negatively associated with mother-reported sleep duration (model 1: β = −0.13; P = .02) and accelerometer-estimated sleep duration (model 2: β = −0.17; P \u3c .01). Accounting for both sleep measures, only accelerometer-measured sleep was related to BMIz (model 3: β = −0.14, P = .02). Each sleep measure was significantly related to adiposity, independent of covariates. Accelerometry appeared to be a more reliable measure of children’s sleep than maternal report, yet maternal report may be sufficient to examine the sleep-adiposity relationship when resources are limited

Parental Feeding Practices and Children’s Weight Status in Mexican American Families

It is known that mothers’ child-feeding behaviors are associated with their children’s weight status, but this is only one familial factor. There is a dearth of research on the associations of both mothers’ and fathers’ child-feeding behaviors and their children’s weight status in Mexican American families. In 2009-2010, 22% of Mexican American children aged 6 to 11 years had a body mass index (BMI) greater than or equal to the 95th percentile and were considered obese compared to 14% of non-Latino White children of similar ages. This disparity was also seen among children under age 6. In the same period, 16% of Mexican American children aged 2 to 5 years were considered obese compared to 9% of non-Latino White children. Obesity during these early years is associated with increased risk of obesity later in life. In Mexican families, where fathers often influence family decisions, it is important to understand how they may also influence decisions around child feeding. Parental child-feeding behaviors are a major focus of my research because they are modifiable risk factors in children’s weight status, particularly when compared to other predictors, such as parental weight status, parental education level and ethnicity. Using the conceptual framework from Davison and Birch’s (2001) ecological model, which identifies individual, family and sociocultural influences on children’s weight status, this dissertation applies quantitative and qualitative methods to examine parental and sociocultural associations with child-feeding behaviors in Mexican American families.This dissertation research examines the associations of parental feeding behaviors and child weight status in Mexican American families, with a special focus on the role of fathers. I apply a three-pronged approach to the study of childhood obesity that includes a family, environmental, and nutrition policy component. At the family level, I demonstrate in my quantitative study (paper 1) that fathers’ child-feeding practices, such as pressure to eat and use of food to control behavior are equally as significant as mothers’ child-feeding practices in their associations with child weight status. For example, findings indicate that fathers’ higher use of pressure to eat and use of food to control behavior were significantly related to children’s lower weight status, after accounting for mothers’ feeding practices and other covariates. At the environmental level, I demonstrate in my qualitative study (paper 2) that both mothers and fathers experience structural and environmental obstacles, such as a lack of social support among neighbors and dirty, under-policed streets in urban neighborhoods, which negatively influences their ability to leave the house and makes it difficult to feed their children healthful foods. Specifically, I examine how these obstacles in turn influence the development of overweight and obesity in children aged 2 to 5 years. I have integrated the results of my first two studies with the existing literature on obesity in Latino children to inform the third component of my dissertation, a health policy brief. In this brief, I ask the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) to take steps and develop procedures to encourage full access to their services by Latino fathers and encourage their participation and, by so doing, support WIC goals for the nutrition of low-income children and their families. Overall, my findings suggest that in order to effectively intervene in the development of childhood obesity, community stakeholders, scholars and policymakers need a better understanding of how structural and environmental obstacles, and parents’ resources, culture, gender and ethnicity intersect and impact child weight