Early Life Factors And Health Outcomes In Children And Mothers

This dissertation focused on early life exposures and their impact on children and mothers’ health. It consists of three distinct studies with an overarching goal of understanding how early life factors influence health outcomes among children and mothers. The broad aims are: 1) to examine the association between maternal gestational weight gain and offspring weight at 1 year, while assessing the mediating role of birth weight; 2) to determine the association between breastfeeding practices and development of allergic conditions (eczema/skin allergy, hay fever/respiratory allergy, and asthma); and 3) to examine the association between breastfeeding and postpartum weight retention at 12 months. The first study used recent data collected from a prospective cohort of Chinese pregnant women living in Daxin County, in southern China. Using multivariable linear regression models, we found that maternal gestational weight gain is positively related to offspring weight-for-age Z scores in early infancy and this relationship was significantly mediated by birth weight. The last two studies utilized data from the Infant Feeding Practice Survey (IFPS) II, a longitudinal prospective cohort study of mothers and their newborn infants conducted by the CDC in 2005–2007. The second study combined data from IFPS II and its Year 6 Follow Up (Y6FU) collected in 2012. Using multivariable logistic regression models, we found that the odd of eczema/ skin allergy was higher among non-exclusively breastfed infants when compared with exclusively breastfed infants. However, no association was found between breastfeeding practices and hay fever/ respiratory allergy and asthma. The last study, which used multivariable linear regression models and generalized estimating equations found a significant association between breastfeeding (intensity and duration) and postpartum weight retention over time and at 12 months among a cohort of US mothers. When stratified by prepregnancy body mass index (BMI), this association remained significant only among normal weight women (BMI \u3c25 kg/m2). In conclusion, early life exposures such as maternal gestational weight gain and breastfeeding practices were significantly related to health outcomes in children and mothers both in China and in the US. Targeted efforts should be made to encourage mothers to gain healthy weight in pregnancy and to adhere to the American Academy of Pediatrics recommendations for breastfeeding. Such efforts may be an effective strategy to improve health outcomes in the maternal and child health (MCH) population

Socio-Cultural and Environmental Factors that Influence Weight-Related Behaviors: Focus Group Results from African-American Girls and Their Mothers

African-American girls experience higher rates of obesity than other youth and are more likely to live in environments that may inhibit healthy lifestyles. Focus groups with African-American girls (14.2 ± 2.36 years) and their mothers were conducted to explore socio-cultural and physical factors within the home, neighborhood, and school environments that influence physical activity (PA) and food choices (i.e., availability and accessibility). Being active at home was dependent on availability of unstructured PA, possibility of activity with family/friends/pet, structured sports in the community, and perceived safety of neighborhood. Girls reported unhealthy foods and excessive snacking as issues at home while citing choice of school meals vs. vending machine items and easy accessibility to fast food restaurants as concerns at school. Learning more about the PA and food environments is a fundamental step to develop effective and innovative, environmental strategies to address unhealthy weight-related behaviors in this population

Consideration of Factors Influencing Weight Outcomes among U.S. Racial-Ethnic Minority Populations in the Social Work Literature

Objective: This study explores the social work profession’s empirical contribution to addressing factors influencing overweight and obesity outcomes among racial-ethnic minority populations in the United States. The high prevalence of obesity in U.S. adults and children, particularly in racial/ethnic minority populations, continues to be an important public health issue. The African American Collaborative Obesity Research Network (AACORN) Expanded Obesity Research Paradigm was used to assess the studies. Constructs in this paradigm identify conceptual and multilevel influences on obesity offering social work practitioners a comprehensive understanding of obesity-related factors in populations of color: cultural and psychosocial processes, historical and social contexts, and physical and economic environments. Methods: A systematic search of obesity-related, social work studies providing data for U.S. racial/ethnic minority populations was conducted in March through July 2013 with updated searches in February 2016 and July 2017. Findings: Identified studies were mostly cross-sectional, offering only a snapshot of factors associated with obesity among racial-ethnic minority populations. Articles addressing factors contributing to overweight/obesity were more likely to discuss cultural and psychosocial features and provided limited information about health behaviors embedded in the daily lives of racial-ethnic groups affecting obesity. Future Directions: Given that social workers’ interactions with clients occur in a variety of social services settings, they are in a unique position to assist with developing strategies for facilitating obesity prevention integrating conceptual features outlined by the AACORN paradigm. Practice and policy implications are discussed for social work professionals employed in community settings