Parental influences on adolescent physical activity: a longitudinal study

BACKGROUND: Physical inactivity is increasing among adolescents in the U.S., especially among girls. Despite growing evidence that parents are an important influence on adolescent health, few longitudinal studies have explored the causal relationship between parental influence and physical activity. This study examines how the relationships between parental influences and adolescent physical activity differ by gender and tests whether these relationships are mediated by adolescents' self-esteem and depression. METHODS: Data are from the National Longitudinal Study of Adolescent Health. The sample includes 13,246 youth, grades 7 to 12, interviewed in 1995 and again 1 year later. Logit models were used to evaluate parental influences on achieving five or more bouts of moderate to vigorous physical activity per week [MVPA] and whether the relationship between parental influence and MVPA was mediated by adolescents' level of self-esteem and depression. RESULTS: Family cohesion, parent-child communication and parental engagement positively predicted MVPA for both genders one year later (odds ratios and 95% confidence intervals for females, 1.09 [1.05–1.12], 1.13 [1.07–1.19], 1.25 [1.17–1.33] and males, 1.08 [1.04–1.11], 1.14 [1.07–1.23], 1.23 [1.14–1.33], respectively); however, parental monitoring did not (odds ratio and confidence intervals for females and males, 1.02 [.97–1.07]). For both females and males, self-esteem mediated the relationship between parental influence and physical activity. Depressive symptoms were only a mediator among males. Females reported higher levels of parent-child communication and lower family cohesion compared with males. There were no gender differences in levels of parental monitoring and engagement. Females had significantly lower levels of self-esteem and higher levels of depressive symptoms than males. CONCLUSION: Strategies to promote physical activity among adolescents should focus on increasing levels of family cohesion, parental engagement, parent-child communication and adolescent self-esteem

A demonstration of modeling count data with an application to physical activity

Counting outcomes such as days of physical activity or servings of fruits and vegetables often have distributions that are highly skewed toward the right with a preponderance of zeros, posing analytical challenges. This paper demonstrates how such outcomes may be analyzed with several modifications to Poisson regression. Five regression models 1) Poisson, 2) overdispersed Poisson, 3) negative binomial, 4) zero-inflated Poisson (ZIP), and 5) zero-inflated negative binomial (ZINB) are fitted to data assessing predictors of vigorous physical activity (VPA) among Latina women. The models are described, and analytical and graphical approaches are discussed to aid in model selection. Poisson regression provided a poor fit where 82% of the subjects reported no days of VPA. The fit improved considerably with the negative binomial and ZIP models. There was little difference in fit between the ZIP and ZINB models. Overall, the ZIP model fit best. No days of VPA were associated with poorer self-reported health and less assimilation to Anglo culture, and marginally associated with increasing BMI. The intensity portion of the model suggested that increasing days of VPA were associated with more education, and marginally associated with increasing age. These underutilized models provide useful approaches for handling counting outcomes

Latino fathers’ feeding-related parenting strategies on children’s eating

This study examined father and child socio-demographic characteristics in relation to fathers’ feeding-related parenting strategies and whether his parenting strategies were associated with children’s-reported fruit and vegetable (FV), weekly fast food, and daily sugar-sweetened beverage intake among 81 Latino fathers-children pairs. Fathers’ employment status, acculturation, number of children in the home, and child’s age and weight status were associated with the use of different parenting strategies. Additionally, more control was associated with less FV intake, but more reinforcement was associated with more FV intake by children. Fathers play a role in their children’s diet and should be considered in future interventions

Correlates of measured prehypertension and hypertension in Latina women living along the US-Mexico border, 2007-2009.

IntroductionAlthough Latinos have lower hypertension rates than non-Latino whites and African Americans, they have a higher prevalence of undiagnosed and uncontrolled hypertension. Research on predictors of hypertension has mostly focused on intrapersonal factors with no studies assessing the combined influence of intrapersonal, interpersonal, and environmental factors. The purpose of this study was to assess a broad range of correlates including intrapersonal, interpersonal, and environmental factors on measured blood pressure category (nonhypertensive, prehypertensive, and hypertensive) in a sample of Latina women residing in San Diego, California.MethodsThis cross-sectional study used baseline data from the San Diego Prevention Research Center's Familias Sanas y Activas program, a promotora-led physical activity intervention. The sample was 331 Latinas who self-selected into this program. Backward conditional logistic regression analysis was conducted to determine the strongest correlates of measured blood pressure category.ResultsLogistic regression analysis suggested that the strongest correlates of prehypertension were soda consumption (odds ratio [OR] = 1.34, [1.00-1.80], P ≤ .05) and age (OR = 1.03, [1.00-1.05], P ≤ .05). The strongest correlates of hypertension were soda consumption (OR = 1.92, [1.20-3.07], P ≤ .01), age (OR = 1.09, [1.05-1.13], P ≤ .001), and measured body mass index (OR = 1.13, [1.05-1.22], P ≤ .001). All analyses controlled for age and education. No interpersonal or environmental correlates were significantly associated with blood pressure category.ConclusionFuture research should aim to further understand the role of soda consumption on risk for hypertension in this population. Furthermore, interventions aimed at preventing hypertension may want to focus on intrapersonal level factors

Examination of the Relationship between In-Store Environmental Factors and Fruit and Vegetable Purchasing among Hispanics.

Retail food environments have received attention for their influence on dietary behaviors and for their nutrition intervention potential. To improve diet-related behaviors, such as fruit and vegetable (FV) purchasing, it is important to examine its relationship with in-store environmental characteristics. This study used baseline data from the "El Valor de Nuestra Salud" study to examine how in-store environmental characteristics, such as product availability, placement and promotion, were associated with FV purchasing among Hispanic customers in San Diego County. Mixed linear regression models indicated that greater availability of fresh FVs was associated with a $0.36 increase in FV purchasing (p = 0.01). Placement variables, specifically each additional square foot of display space dedicated to FVs (p = 0.01) and each additional fresh FV display (p = 0.01), were associated with a$0.02 increase and $0.29 decrease, respectively, in FV purchasing. Introducing FV promotions in the final model was not related to FV purchasing. Exploratory analyses indicated that men reported spending$3.69 fewer dollars on FVs compared to women, controlling for covariates (p = 0.02). These results can help inform interventions targeting in-store environmental characteristics to encourage FV purchasing among Hispanics

Predictors of Routine Medical Care Use among Mexican Immigrants/Mexican-Americans Varying in Legal Status

Background: Immigration has been the focus of intense political debate, with a recurrent theme being the use of public services, including healthcare. Although Latinos are the largest and fastest growing ethnic group in the United States (U.S.), evidence suggests they underutilize healthcare, with Mexican Immigrants and Mexican Americans (MI-MA) living on the U.S.-Mexico border exhibiting the greatest disparities. Objective: This study explored the association of predisposing, enabling and need characteristics, including legal status, with the use of routine medical care (RMC) among 387 MI-MA living on the California-Mexico border. Methods: This cross-sectional study used data collected in 2009 for the San Diego Prevention Research Center (SDPRC) community survey; data analyses were completed in Summer 2012. This study involved multistage sampling and recruitment of Latino adults in 200 census blocks near the California-Mexico border to complete an interview and height and weight measurements. Sequential logistic regressions assessed the relative contribution of predisposing, enabling and need factors to the use of RMC. Results: Predisposing and enabling factors (gender, undocumented status, cost) distinguished between respondents with recent (<1 year) versus limited (≥ 5 years including never) use of RMC, whereas enabling and need factors (insurance, dispositional trust, presence of a chronic illness) adequately differentiated between those with recent versus delayed (≥1 year, but <5 years) use. Undocumented status distinguished between those with delayed versus limited use of RMC. Conclusions: Consideration of different factors, including financial difficulties and legal status, is necessary for promoting use of RMC among MI-MA living in this border region.Contexte : L'immigration est au cœur de débats politiques intenses, dont l'un des thèmes récurrents est l'utilisation des services publics, et notamment des soins de santé. Bien que les Latinos constituent le groupe ethnique le plus important et connaissant la croissance la plus rapide des Etats-Unis, les données semblent indiquer qu'ils sous-utilisent les services de santé, les immigrés mexicains et les Américano-Mexicains (IM-AM) vivant à la frontière américano-mexicaine affichant les plus fortes disparités. Objectif : Cette étude a exploré les liens entre les facteurs prédisposants, favorables et de nécessité, dont le statut juridique, et l'utilisation des soins médicaux courants (SMC) chez 387 IM-AM vivant à la frontière entre la Californie et le Mexique. Méthodes : Cette étude transversale s'est fondée sur les données recueillies en 2009 dans le cadre de l'enquête communautaire du San Diego Prevention Research Center (SDPRC), dont l'analyse s'est achevée à l'été 2012. Cette étude prévoyait un échantillonnage à plusieurs degrés et le recrutement d'adultes latinos dans 200 îlots de recensement situés à proximité de la frontière entre la Californie et le Mexique, afin de les interroger et de relever des mesures de taille et de poids. Des modèles de régression logistique séquentielle ont permis d’évaluer la contribution relative des facteurs prédisposants, favorables et de nécessité à l'utilisation des SMC.  Résultats : Les facteurs prédisposants et favorables (sexe, statut non documenté, coût) faisaient la différence entre les répondants ayant récemment (<1 an) ou peu (≥ 5 ans ou jamais) eu recours aux SMC, tandis que les facteurs favorables et de nécessité (assurance, prédisposition à faire confiance, présence de maladie chronique) distinguaient convenablement ceux qui avaient récemment eu recours aux SMC de ceux qui y avaient eu recours tardivement (≥1 an, mais <5 ans). Le statut non documenté faisait la différence entre ceux qui avaient tardivement ou peu eu recours aux SMC. Conclusions : La prise en compte des différents facteurs, y compris des difficultés financières et du statut légal, est nécessaire pour encourager l'utilisation des SMC chez les IM-AM vivant dans cette région frontalière.Antecedentes: La inmigración es objeto de un intenso debate político en el que uno de los temas recurrentes es el uso de los servicios públicos, entre ellos la atención sanitaria. Aunque los latinos constituyen el grupo étnico más numeroso y de más rápido crecimiento en Estados Unidos, las pruebas indican que no utilizan lo suficiente las instituciones de asistencia sanitaria. Son los inmigrantes mexicanos y los estadounidenses de origen mexicano que viven en la frontera entre Estados Unidos y México los que mayores disparidades muestran al respecto.  Objetivo: Este estudio analizó la asociación existente entre las características de los predisponentes, facilitadores y factores de necesidad, como el estado legal, y el uso de la asistencia médica rutinaria entre 387 estadounidenses de origen mexicano residentes en la frontera de California con México. Métodos: Este estudio transversal utilizó los datos recopilados en 2009 para un estudio comunitario del Centro de Investigación para la Prevención en San Diego (SDPRC), y el análisis de los datos se llevó a cabo en verano de 2012. Se realizaron muestreos en diferentes fases y se reclutaron adultos latinos en bloques censales de 200 cerca de la frontera mexicana con California para completar una entrevista y realizar mediciones de peso y altura. Las regresiones logísticas secuenciales evaluaron la contribución relativa de los predisponentes, facilitadotes y factores de necesidad al uso de la atención médica rutinaria.  Resultados: Los predisponentes y facilitadores (género, situación ilegal o “sin papeles”, coste) variaron entre los participantes entre un uso reciente (<1 año) o limitado (≥ 5 años, o nunca) de la atención médica rutinaria, mientras que los facilitadotes y factores de necesidad (seguro, confianza, presencia de enfermedad crónica) se diferenciaron de forma adecuada entre un uso reciente o retardado (≥1 año, pero <5 años). El estado de indocumentado se diferenció igualmente entre un uso retardado o limitado de la asistencia médica rutinaria. Conclusiones: Es necesario tener en cuenta factores diversos, como las dificultades económicas y la situación jurídica, para promover el uso de la asistencia médica rutinaria entre los estadounidenses de origen mexicano que residen en esta región fronteriza

Factors Affecting Implementation of the California Childhood Obesity Research Demonstration (CA-CORD) Project, 2013.

IntroductionEcological approaches to health behavior change require effective engagement from and coordination of activities among diverse community stakeholders. We identified facilitators of and barriers to implementation experienced by project leaders and key stakeholders involved in the Imperial County, California, Childhood Obesity Research Demonstration project, a multilevel, multisector intervention to prevent and control childhood obesity.MethodsA total of 74 semistructured interviews were conducted with project leaders (n = 6) and key stakeholders (n = 68) representing multiple levels of influence in the health care, early care and education, and school sectors. Interviews, informed by the Multilevel Implementation Framework, were conducted in 2013, approximately 12 months after year-one project implementation, and were transcribed, coded, and summarized.ResultsRespondents emphasized the importance of engaging parents and of ensuring support from senior leaders of participating organizations. In schools, obtaining teacher buy-in was described as particularly important, given lower perceived compatibility of the intervention with organizational priorities. From a program planning perspective, key facilitators of implementation in all 3 sectors included taking a participatory approach to the development of program materials, gradually introducing intervention activities, and minimizing staff burden. Barriers to implementation were staff turnover, limited local control over food provided by external vendors or school district policies, and limited availability of supportive resources within the broader community.ConclusionProject leaders and stakeholders in all sectors reported similar facilitators of and barriers to implementation, suggesting the possibility for synergy in intervention planning efforts

What influences Latino grocery shopping behavior? Perspectives on the small food store environment from managers and employees in San Diego, California

To inform the design of a multilevel in-store intervention, this qualitative study utilized in-depth semistructured interviews with 28 managers and 10 employees of small-to-medium-sized Latino food stores (tiendas) in San Diego, California, to identify factors within the tienda that may influence Latino customers’ grocery-shopping experiences and behaviors. Qualitative data analysis, guided by grounded theory, was performed using open coding. Results suggest that future interventions should focus on the physical (i.e., built structures) and social (i.e., economic and socio-cultural) dimensions of store environments, including areas where the two dimensions interact, to promote the purchase of healthy food among customers

Provider Discussion, Education, and Question-Asking about Control Medications during Pediatric Asthma Visits

Background. Few studies have explored how providers communicate about control medications during pediatric asthma visits. Objectives. The purpose of this study was to: (a) describe the extent to which providers discuss, educate, and ask children and their caregivers questions about control medications and (b) examine how child, caregiver, and provider characteristics are associated with provider communication about control medications during pediatric asthma visits. Methods. Children ages 8 through 16 with mild, moderate, or severe persistent asthma and their caregivers were recruited at five pediatric practices in nonurban areas of North Carolina. After audio-tape recording medical visits, caregivers completed questionnaires and children were interviewed. Generalized estimating equations were used to analyze the data. Results. Providers educated families about control medications during 61% of the visits, and they asked questions about control medications during 67% of visits. Providers were significantly more likely to discuss control medications if a child was taking a control medication, if the child had moderate to severe persistent asthma, and if the child was present for an asthma-related visit. Conclusion. Providers need to educate and ask more questions of families about side effects and how well control medications are working

Efficacy of a store-based environmental change intervention compared with a delayed treatment control condition on store customers’ intake of fruits and vegetables

The present store-based intervention was designed to promote sales of fruits and vegetables (F&V) to increase intake among store customers – specifically customers of tiendas, small-to-medium-sized Latino food stores