Targeting the Home Food Environment for Obesity Prevention in Immigrant Ethnic Minorities

Immigrants from South Asian countries and Hispanic/Latino cultures represent the largest immigrant groups in the United Kingdom (UK) and United States (US), respectively, and are disproportionally affected by obesity. Parents influence their child’s risk for obesity in part by determining the home environment. However, examinations of the home food environment in parent-child dyads from ethnic minority, immigrant families are limited. We used data from a birth cohort in the UK (Born in Bradford 1000, BiB1000; n>1700; 47% Pakistani [predominately 1st and 2nd generation immigrant mothers], 38% White British, 14% Other), and a cross-sectional study of Hispanic/Latino 8- to 16-year-olds in the US (Study of Latino Youth, SOL Youth; n>1400). We examined: 1) ethnic/immigrant differences in home food availability (HFA) of snacks and sugar-sweetened beverages (SSBs; i.e., obesogenic items) and associations between obesogenic HFA and child’s obesogenic dietary intake and BMI in BiB1000, 2) longitudinal patterns of postpartum weight retention (PPWR) according to ethnic/immigrant group and associations of PPWR and obesogenic HFA in BiB1000, and 3) acculturation-related differences in food parenting practice use and associations between food parenting practices and obesogenic dietary intake in SOL Youth. Pakistani homes had greater obesogenic HFA, which was, irrespective of ethnic/immigrant group, associated with toddlers’ increased obesogenic dietary intake. Associations between obesogenic HFA and child’s BMI and mother’s PPWR were largely null. First generation Pakistani immigrants had a different longitudinal pattern of PPWR than White British mothers, and 2nd generation Pakistani immigrants retained more weight at each postpartum month than White British mothers. Hispanic/Latino parents who reported greater acculturative stress were more likely to use controlling food parenting practices. Parents who used controlling practices had increased odds of having children with high obesogenic dietary intake. Parents who pressured children to eat had increased odds of having 12- to 16-year-olds with high obesogenic dietary intake. Our findings provide novel insights into the importance of the physical and behavioral home food environment for obesity prevention in understudied ethnic minority groups. Future interventions may target the home food environment to prevent the intergenerational transmission of obesity in Pakistani and Hispanic/Latino parent-child dyads.Doctor of Philosoph

Barriers to and solutions for representative inclusion across the lifespan and in life course research: The need for structural competency highlighted by the COVID-19 pandemic

Exclusion of special populations (older adults; pregnant women, children, and adolescents; individuals of lower socioeconomic status and/or who live in rural communities; people from racial and ethnic minority groups; individuals from sexual or gender minority groups; and individuals with disabilities) in research is a pervasive problem, despite efforts and policy changes by the National Institutes of Health and other organizations. These populations are adversely impacted by social determinants of health (SDOH) that reduce access and ability to participate in biomedical research. In March 2020, the Northwestern University Clinical and Translational Sciences Institute hosted the Lifespan and Life Course Research: integrating strategies Un-Meeting to discuss barriers and solutions to underrepresentation of special populations in biomedical research. The COVID-19 pandemic highlighted how exclusion of representative populations in research can increase health inequities. We applied findings of this meeting to perform a literature review of barriers and solutions to recruitment and retention of representative populations in research and to discuss how findings are important to research conducted during the ongoing COVID-19 pandemic. We highlight the role of SDOH, review barriers and solutions to underrepresentation, and discuss the importance of a structural competency framework to improve research participation and retention among special populations

Obesogenic home food availability, diet, and BMI in Pakistani and White toddlers

Individuals of South Asian ethnicity have an increased risk for obesity and related diseases. Foods available in the home during the first 1000 days (conception to 24 months old) are an important determinant of diet, yet no study has examined the association of early‐life home food availability (HFA) with later diet and obesity risk in South Asian households. We examined whether obesogenic HFA at 18 months of age is associated with dietary intake and body mass index (BMI) at 36 months of age in low‐income Pakistani and White households in the United Kingdom. In this prospective birth cohort study (Born in Bradford 1000), follow‐up assessments occurred at 18 (n = 1032) and 36 (n = 986) months of age. Variety and quantity of snack foods and sugar‐sweetened beverages (SSBs) in the home and consumed were measured using the HFA Inventory Checklist and food frequency questionnaires, respectively. BMI was calculated using measured length/height and weight. Multinomial logistic regression models examined associations between HFA and tertiles of dietary intake, and multivariable linear regression models assessed associations between HFA and BMI. Pakistani households had a greater variety and quantity of snack foods and SSBs available compared with White households. Variety and quantity of snack foods and SSBs in the home at 18 months were positively associated with children's intake of these items at 36 months, but associations between HFA and BMI were null. Reducing obesogenic HFA during the first 1000 days may promote the development of more healthful diets, though this may not be associated with lower obesity risk during toddlerhood

Dietary patterns and associations with body mass index in low-income, ethnic minority youth in the United States according to baseline data from four randomized controlled trials

Few studies have derived data-driven dietary patterns in youth in the United States (US). This study examined data-driven dietary patterns and their associations with BMI measures in predominantly low-income, racial/ethnic minority US youth. Data were from baseline assessments of the four Childhood Obesity Prevention and Treatment Research (COPTR) Consortium trials: NET-Works (N=534; 2–4-year-olds), GROW (N=610; 3–5-year-olds), GOALS (N=241; 7–11-year-olds), and IMPACT (N=360; 10–13-year-olds). Weight and height were measured. Children/adult proxies completed 3 24-hour dietary recalls. Dietary patterns were derived for each site from 24 food/beverage groups using k-means cluster analysis. Multivariable linear regression models examined associations of dietary patterns with BMI and percentage of the 95th BMI percentile. Healthy (produce and whole grains) and Unhealthy (fried food, savory snacks, and desserts) patterns were found in NET-Works and GROW. GROW additionally had a dairy and sugar-sweetened beverage based pattern. GOALS had a similar Healthy pattern and a pattern resembling a traditional Mexican diet. Associations between dietary patterns and BMI were only observed in IMPACT. In IMPACT, youth in the Sandwich (cold cuts, refined grains, cheese, and miscellaneous [e.g., condiments]) compared to Mixed (whole grains and desserts) cluster had significantly higher BMI [β=0.99 (95% CI: 0.01, 1.97)] and percentage of the 95th BMI percentile [β=4.17 (95% CI: 0.11, 8.24)]. Healthy and Unhealthy patterns were the most common dietary patterns in COPTR youth, but diets may differ according to age, race/ethnicity, or geographic location. Public health messages focused on healthy dietary substitutions may help youth mimic a dietary pattern associated with lower BMI

Validity and reliability of the semi-quantitative self-report Home Food Availability Inventory Checklist (HFAI-C) in White and South Asian populations.

Despite interest in the importance of the home food environment and its potential influence on children's diets and social norms, there remain few self-report checklist methods that have been validated against the gold standard of researcher-conducted inventories. This study aimed to assess the criterion validity and reliability of the 'Home Food Availability Inventory Checklist' (HFAI-C), a 39-item checklist including categories of fruit, vegetables, snacks and drinks.The HFAI-C was completed by 97 participants of White and Pakistani origin in the UK. Validity was determined by comparing participant-reported HFAI-C responses to data from researcher observations of home food availability using PABAK and weighted kappa statistics. The validity of measuring the amount of items (in addition to presence/absence) available was also determined. Test-retest reliability compared repeated administrations of the HFAI-C using intra-class correlation coefficients.Validity and reliability was fair to moderate overall. For validity, the average category-level PABAK ranged from 0.31 (95 % CI: 0.25, 0.37) for vegetables to 0.44 (95 % CI: 0.40, 0.49) for fruits. Assessment of the presence/absence of items demonstrated higher validity compared to quantity measurements. Reliability was increased when the HFAI-C was repeated close to the time of the first administration. For example, ICCs for reliability of the measurement of fruits were 0.52 (95 %CI: 0.47, 0.56) if re-administered within 5 months, 0.58 (95 % CI: 0.51, 0.64) within 30 days and 0.97 (95 %CI: 0.94, 1.00) if re-administered on the same day.Overall, the HFAI-C demonstrated fair to moderate validity and reliability in a population of White and South Asian participants. This evaluation is consistent with previous work on other checklists in less diverse, more affluent populations. Our research supports the use of the HFAI-C as a useful, albeit imperfect, representation of researcher-conducted inventories. The feasibility of collecting information using the HFAI-C in large, multi-ethnic samples can facilitate examination of home food availability in relation to exposures such as ethnicity and outcomes including behavioural, social and health outcomes. Future work using the HFAI-C could provide important insights into a modifiable influence with potential to impact health

Abstract P128: Predicting BMI Percentile in Hispanic/Latino Youth Using a Machine Learning Approach: Findings From the Hispanic Community Children's Health Study/Study of Latino Youth

Byline: Madison N LeCroy, NYU Grossman Sch of Medicine, New York, NY; Ryung S Kim, Albert Einstein College of Medicine, Bronx, NY; David B Hanna, Albert Einstein College of Medicine, Bronx, NY; Krista M Perreira, Univ of North Carolina Sch of Medicine, Chapel Hill, NC; Linda C Gallo, San Diego State Univ, Chula Vista, CA; Maria M Llabre, Univ of Miami, Coral Gables, FL; Linda Van Horn, Northwestern Univ Feinberg Sch of Medicine, Chicago, IL; Martha L Daviglus, Univ of Illinois Chicago, Chicago, IL; Gregory A Talavera, San Diego State Univ, Chula Vista, CA; Daniela Sotres-Alvarez, Univ of North Carolina at Chapel Hill, Chapel Hill, NC; Carmen R Isasi, Albert Einstein College of Medicine, Bronx, NY Introduction: Among 2-19-year-olds in the United States (US), 26.2% of Hispanic/Latino youth vs. 16.6% of non-Hispanic White youth experience obesity (body mass index [BMI] percentile [greater than or equal] age- and sex-specific 95th BMI percentile). While health behaviors are important, psychological and sociocultural measures vary across racial/ethnic groups and may underpin obesity disparities. Machine learning is one statistical approach that can be used to identify determinants of obesity. However, few studies have applied these methods to childhood obesity research, with most studies only examining traditional risk factors and creating a single model across all racial/ethnic groups. Our objective was to identify key predictors of BMI percentile in Hispanic/Latino youth to help design childhood obesity interventions that reduce health disparities. Hypothesis: We hypothesized that a BMI percentile prediction model developed for Hispanic/Latino youth would identify both traditional and novel risk factors as important determinants. Methods: Hispanic/Latino 8-16-year-olds from the 4 US sites of the Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth) were examined (n=1,466). BMI percentiles were determined via measured height and weight and CDC growth charts. A supervised machine learning approach, Least Absolute Shrinkage and Selection Operator (LASSO) regression, was used with BMI percentile as the outcome. There were 98 predictor variables examined spanning demographics; health behaviors; and environmental, psychological, and sociocultural measures. LASSO-selected variables were entered into a multivariable linear regression model to obtain effect estimates. P-values were adjusted for both multiple testing and the variable selection process and assessed with ð$5 weekly on snacks/beverages/fast food (ð=-4.62 [95% CI: -19.18, -2.09]) was associated with a lower BMI percentile. Conclusions: Psychological and parental factors predicted higher BMI percentile and greater money spent on snacks/beverages/fast food predicted lower BMI percentile among Hispanic/Latino youth in the US. Addressing Hispanic/Latino youth's relationships with food, body weight, and parents may be important in obesity interventions. Longitudinal research is needed to clarify directionality and replicate novel findings.Professiona

Abstract P151: Acculturation Predicts Activity-specific Parenting Practices In Hispanic/Latino Youth

Background: Hispanic youth are less physically active and more sedentary than non-Hispanic youth, contributing to relatively high rates of obesity among the nation’s largest ethnic minority group. Though parents can influence children’s behavior, it is unclear whether parenting practices related to the child’s physical activity are associated with activity in Hispanic/Latino youth, and whether cultural and environmental contexts predict the use of these parenting practices. Objective: We assessed 1) whether activity-specific parenting practices (ASPPs) are associated with moderate-to-vigorous physical activity (MVPA) and sedentary activity among Hispanic/Latino youth, and 2) if higher parental acculturation and greater perceived neighborhood-level socioeconomic challenges are associated with the use of less effective ASPP patterns. Methods: Youth from the Hispanic Community Children’s Health Study/Study of Latino Youth (SOL Youth; n=976) were examined. Activity was assessed using 7-day accelerometer data. ASPPs were identified from the Parenting strategies for Eating and Activity Scale (PEAS) using exploratory and confirmatory factor analysis of the ten items on activity. We used survey-weighted linear regression models to assess whether derived ASPPs predicted mean daily MVPA and sedentary time. K-means cluster analysis was used to group individuals based on ASPP use. Finally, we used survey-weighted multinomial logistic regression models to examine the association of parent acculturation-related measures and perceived neighborhood socioeconomic status and barriers to activity with ASPP cluster membership. Results: Factor analysis of the activity-specific PEAS items identified three ASPPs: Limit Setting, Discipline, and Monitoring/Reinforcement. Discipline predicted higher MVPA in females only (β 1.89 [95% CI 0.11-3.67]), and Monitoring/Reinforcement predicted higher MVPA in males only (β 4.71 [95% CI 0.68-8.74]). There was no association between Limit Setting and MVPA or any ASPPs and sedentary activity. K-cluster analysis revealed three ASPP patterns: Restrictive (high scores for Limit Setting and Discipline), Supportive (high scores for Limit Setting and Monitoring/Reinforcement) and Permissive (low score across ASPPs). Higher Anglo-orientation on the Brief ARSMA-II acculturation measure predicted membership in the Supportive compared to Permissive cluster (p= 0.03), while perceived neighborhood characteristics did not predict ASPP cluster membership. Conclusions: ASPPs are associated with MVPA in sex-specific ways but have no association with sedentary activity in Hispanic/Latino youth. Among acculturation and neighborhood characteristics, only Anglo-orientation predicted ASPPs patterns. More research is needed to understand how acculturation is influencing ASPPs and if ASPPs can be leveraged to change children’s activity

Cultural and neighborhood characteristics associated with activity-specific parenting practices in Hispanic/Latino youth: a secondary analysis of the Hispanic Community Children's health study/study of Latino youth

Hispanic/Latino youth are less physically active than non-Hispanic/Latino youth. We assessed whether activity-specific parenting practices relate to moderate-to-vigorous physical activity (MVPA) and sedentary behavior among Hispanic/Latino youth, and whether cultural (acculturation) and neighborhood characteristics (perceived barriers to activity) relate to the use of parenting practice patterns. Using the Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth, n=976 8-16-year-olds), we modeled linear regression associations between parenting practices and mean daily MVPA and sedentary behavior. Parenting practice patterns were then developed using k-means cluster analysis, and regressed on parental acculturation and neighborhood characteristics. Discipline predicted higher MVPA in females (beta 1.89 [95% CI 0.11-3.67]), while Monitoring/Reinforcement predicted higher MVPA in males (beta 4.71 [95% CI 0.68-8.74]). Three patterns were then identified: Negative Reinforcement (high Limit Setting and Discipline use), Positive Reinforcement (high Limit Setting and Monitoring/Reinforcement use), and Permissive Parenting (low parenting practice use). Higher acculturation predicted use of Positive Reinforcement. Activity-specific parenting practices are associated with activity in sex-specific ways among Hispanic/Latino youth, and cultural factors predict the use of parenting practices

Abstract MP03: The Association of the Parent-Child Acculturation Gap With Obesity and Cardiometabolic Risk in Hispanic/Latino Youth: Results From the Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth)

Introduction: Hispanic/Latino youth are disproportionately burdened by obesity and have a high prevalence of pre-diabetes and dyslipidemia. Acculturation may help explain this elevated cardiometabolic risk. Within immigrant families, parents and children acculturate at different rates. A difference in the degree of acculturation, known as the “acculturation gap”, between parents and their children has been associated with behaviors that may increase cardiometabolic risk in youth. However, no previous studies have investigated the association between the parent-child acculturation gap and cardiometabolic health. Hypothesis: We tested whether greater gaps in parent-child acculturation were associated with worse cardiometabolic health in Hispanic/Latino youth. Methods: Hispanic/Latino youth ( n =1466, 8-16-year-olds) and parents from the Hispanic Community Children’s Health Study/Study of Latino Youth (SOL Youth) were examined. Mean scores on the Brief Acculturation Rating Scale for Mexican Americans-II (ARSMA-II) Anglo and Latino Orientation Scales (AOS and LOS, respectively) were used to represent parent and youth acculturation. The Brief ARSMA-II primarily assesses language use patterns on a 5-point Likert-type scale, with higher scores on the AOS indicating a preference for English and higher scores on the LOS indicating a preference for Spanish. Cardiometabolic markers included youth body mass index (BMI) percentile, blood pressure percentiles, fasting glucose, HOMA-IR, HbA1c, cholesterol, triglycerides, and hsCRP. Missing data were addressed using multiple imputation. Survey-weighted multivariable linear regression examined associations of youth, parent, and youth x parent (the acculturation gap) scores for the AOS and LOS scales separately with each cardiometabolic marker. Results: On average, compared to their parents, youth reported a greater preference for English and a lower preference for Spanish (AOS=4.2 vs. 2.7; LOS=3.1 vs. 4.2, respectively). Greater discordance (i.e., an acculturation gap) in parent and youth AOS scores was associated with elevated BMI percentile only (p-for-interaction≤0.001). The LOS acculturation gap was not associated with any cardiometabolic measures. Adjustment for acculturative stress, family functioning and closeness, parenting style, and youth’s diet and physical activity did not alter the findings. Removal of non-significant acculturation gaps indicated an inverse association between parent AOS score and youth SBP percentile (β=-2.47, 95% CI: -4.73, -0.21) and between parent LOS score and youth total cholesterol (β=-2.87, 95% CI: -5.52, -0.21). Conclusions: Discrepancies in English language use in parent-child dyads may relate to increased obesity risk in Hispanic/Latino youth. Future studies are needed to identify mediators of this association, such as general stress and English language fluency

The Association of the Parent-Child Language Acculturation Gap with Obesity and Cardiometabolic Risk in Hispanic/Latino Youth: Results from the Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth)

Hispanic/Latino youth are disproportionately burdened by obesity and have a high prevalence of prediabetes and dyslipidemia. Differences in parent and child acculturation related to language use and preference (i.e., language acculturation) are associated with adverse cardiometabolic health behaviors, but no study has examined associations with cardiometabolic markers. To determine whether discordance in parent-child language acculturation (parent-child acculturation gap) was associated with poor youth cardiometabolic health. Hispanic/Latino 8-16-year-olds (n = 1,466) and parents from the Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth) were examined. Mean scores for the Brief ARSMA-II's Anglo (AOS) and Latino (LOS) Orientation Scales represented language acculturation. Cardiometabolic markers included youth body mass index (BMI) percentile, blood pressure percentiles, and dysglycemia and hyperlipidemia measures. Missing data were imputed. Survey-weighted multivariable linear regression examined the association of youth, parent, and youth × parent (the acculturation gap) AOS and LOS scores separately with each cardiometabolic marker. Youth reported greater English and lower Spanish use than parents. Greater discordance in AOS scores was associated with elevated BMI percentile only (p-for-interaction < .01). The LOS acculturation gap was not associated with any outcome. Adjustment for acculturative stress, family functioning and closeness, parenting style, and youth's diet and physical activity did not alter findings. Removal of nonsignificant acculturation gaps did not indicate an association between individual youth or parent AOS or LOS scores and any cardiometabolic marker. Discordance in Hispanic/Latino parent-child dyads' English use may relate to increased risk for childhood obesity. Future studies should identify mediators of this association