Healthy Living Behaviors Among Chinese-American Preschool-Aged Children: Results of a Parent Survey

Nonresponsive Parenting Feeding Styles and Practices and Risk of Overweight and Obesity among Chinese Children Living Outside Mainland China: An Integrative Review of the Literature

Chinese immigrants are a fast-growing population group in many parts of the world. Childhood obesity is increasingly a public health problem among Chinese living outside mainland China. Evidence suggests that parenting feeding styles and practices critically influence children's eating behaviors and risk of being overweight or obese. Therefore, the objectives of this review were to identify and synthesize the evidence from studies examining the associations between parenting feeding styles, feeding practices, and risk of overweight and obesity among children of Chinese parents outside mainland China. A systematic search of four electronic databases (CINAHL, Medline, PsycINFO, and PubMed) was conducted to identify peer-reviewed studies published in English between January 2000 and March 2022. Fifteen studies met the inclusion criteria and were included in the review. Findings of some of the reviewed studies showed that parenting feeding styles and practices varied according to children's age, gender, weight, and parents' acculturation levels. The two most identified parenting feeding styles were indulgent and authoritarian. Parents classified as having indulgent and/or authoritarian feeding styles reported using several feeding practices with unintended detrimental effects, such as pressuring children to eat and restricting or controlling child food intake (type and amount). Some of these feeding practices were associated with an increased risk of child overweight. The findings of this review provide important information that can inform the design interventions to address modifiable nonresponisve parental feeding practices such as pressuring, restricting, and controlling that meet the specific needs of Chinese parents and children outside mainland China.

Testing the Multiple Disadvantage Model of Health with Ethnic Asian Children: A Secondary Data Analysis

This study of ethnic Asian children in the United States asked whether their health exhibited relationship with any of six factors: social disorganization, social structural factors, social relationships, the health of their parents, their access to medical insurance, acculturation. The sample of 1350 ethnic Asian children was extracted from the 2018 National Survey of Children's Health. Logistic regression results showed that these children's excellent/very good/good health was associated positively with safe neighborhoods, family incomes, family cohesiveness, family support, and receipt of Temporary Assistance for Needy Families (TANF). In turn, health was associated negatively with single-mother households. Implications of the present results in terms of interventions promoting family support, TANF participation, safe neighborhoods, and professionals' cultural competency are discussed.

Communication Infrastructure in an Asian Immigrant Community

The health benefits of having a supportive community and access to community resources are well documented and for many immigrant communities, community-based organizations (CBOs) play an important role by providing culturally competent services. The current study uses communication infrastructure theory (CIT) to examine the associations between connections to CBOs, civic engagement, and protective health behaviors within the context of Boston Chinatown's Chinese immigrant community. According to CIT, neighborhood communication resources encourage residents to engage in civic activities and health-related problem-solving behaviors. To assess these associations, data from a needs assessment survey (N = 360) were analyzed. Results showed that connections to CBOs had a positive association with total number of protective health behaviors. Civic engagement was not found to be associated with health behaviors. We also found no indirect effect of connections to CBOs on the protective health behaviors via civic engagement. These results carry important theoretical and practical implications.

Measurement of screen time among young children aged 0-6 years: A systematic review

The impact of screen-based devices on children's health and development cannot be properly understood without valid and reliable tools that measure screen time within the evolving digital landscape. This review aimed to summarize characteristics of measurement tools used to assess screen time in young children; evaluate reporting of psychometric properties; and examine time trends related to measurement and reporting of screen time. A systematic review of articles published in English across three databases from January 2009 to April 2020 was undertaken using PROSPERO protocol (registration: CRD42019132599) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles measured screen time as outcome, exposure, or confounder in children 0-6 years. The search identified 35,868 records, 1035 full-text articles were screened for eligibility, and 622 met inclusion criteria. Most measures (60%) consisted of one to three items and assessed duration of screen time on a usual day. Few measures assessed content (11%) or coviewing (7%). Only 40% of articles provided a citation for the measure, and only 69 (11%) reported psychometric properties-reliability n = 58, validity n = 19, reliability and validity n = 8. Between 2009 and 2019, the number of published articles increased from 28 to 71. From 2015, there was a notable increase in the proportion of articles published each year that assessed exposure to mobile devices in addition to television. The increasing number of published articles reflects increasing interest in screen time exposure among young children. Measures of screen time have generally evolved to reflect children's contemporary digital landscape; however, the psychometric properties of measurement tools are rarely reported. There is a need for improved measures and reporting to capture the complexity of children's screen time exposures.

Barriers and facilitators to physical activity among ethnic Chinese children: a qualitative systematic review

OBJECTIVE

The review aimed to synthesize the barriers and facilitators from the available studies that explored physical activity among ethnic Chinese children and uncover any differences or similarities in these barriers and facilitators.

INTRODUCTION

Physical activity promotes overall health, fitness, and well-being in children, yet prevalence of this has been low among ethnic Chinese children who reside in either Chinese and non-Chinese territories. Research has been conducted to explore the barriers and facilitators to physical activity among ethnic Chinese children. However, no qualitative systematic review has been conducted to synthesize these barriers and facilitators.

INCLUSION CRITERIA

Studies were considered for inclusion if they explored the barriers and facilitators to physical activity among ethnic Chinese children aged six to 17 years in either Chinese or non-Chinese territories, or among people who had responsibility for them in school, home, and community settings. The review included studies that focused on their views, experiences, attitudes, understandings, perceptions, and perspectives. Studies were included if they focused on qualitative data including, but not limited to, designs such as phenomenology, ethnography, grounded theory and action research. In addition, the authors considered cross-sectional surveys to find any free text relating to the review question.

METHODS

MEDLINE, Embase, CINAHL, PsycINFO, BNI, AMED, Web of Science, Scopus, CNKI, Wanfang and VIP databases were searched to identify published studies. The search for unpublished studies included EThOS, OpenGrey, ProQuest Dissertations and Theses, CNKI and Wanfang. Databases were searched from their inception dates to 10 December 2018 and no language restrictions were applied. The JBI guidelines for qualitative systematic reviews were followed in conducting the review. The JBI process of meta-aggregation was used to identify categories and synthesize findings.

RESULTS

Out of 9460 records identified, 11 qualitative studies met the eligibility criteria and were included in the review. Using the JBI checklist for qualitative research (10 criteria), the critical appraisal scores of the majority of studies ranged from a moderate score of 6 (n = 1) to a high score of 7 and above (n = 9). Seven studies were from China, two from Australia, one each from the United Kingdom and the United States. The sample size ranged from 12 to 115 participants. A total of 56 findings were extracted and aggregated into 21 categories, based on the similarity of meaning. From studies conducted in the Chinese territories, four synthesized findings (personal, socio-cultural, environmental, and policy- and program-related barriers and facilitators) were aggregated from 37 extracted findings and 14 aggregated categories. From studies conducted in the non-Chinese territories, only two synthesized findings (personal and socio-cultural barriers and facilitators) were derived from 19 extracted findings and seven aggregated categories. Based on the ConQual scores, confidence in the synthesized findings was moderate.

CONCLUSIONS

Four broad themes emerged from the participants' accounts, namely personal, socio-cultural, environmental, and policy- and program-related factors. Barriers and facilitators at the personal and socio-cultural level (e.g., parents and teachers) were most frequently cited, reflecting the importance of children's self-influence and the role of adults. Future interventions are needed to address the identified barriers and enhance the facilitators.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42018097124.

Food Insecurity and Major Diet-Related Morbidities in Migrating Children: A Systematic Review

Children of migrant families are known to be at a higher risk of diet-related morbidities due to complex variables including food insecurity, cultural and religious beliefs, and sociodemographic factors like ethnicity, socioeconomic status, and education. Several studies have assessed the presence of specific diseases related to dietary issues in migrant children. This systematic review aims to highlight the existing body of work on nutritional deficiencies in the specific vulnerable pediatric population of immigrants. Refugees were intentionally excluded because of fundamental differences between the two groups including the reasons for migration and health status at the time of arrival. A total of 29 papers were included and assessed for quality. Most of them described a strong correlation between obesity and migration. A high prevalence of stunting, early childhood caries, iron and vitamin D deficiency was also reported, but the studies were few and heterogeneous. Food insecurity and acculturation were found important social factors (nevertheless with inconclusive results) influencing dietary habits and contributing to the development of morbidities such as obesity and other metabolic disorders, which can cause progressive unsustainability of health systems. Public health screening for diet-related diseases in migrant children may be implemented. Educational programs to improve children’s diet and promote healthy-living behaviors as a form of socioeconomic investment for the health of the new generations may also be considered.

The Association of Acculturation and Complementary Infant and Young Child Feeding Practices Among New Chinese Immigrant Mothers in England: A Mixed Methods Study

Acculturation has an influence on mothers' beliefs and the perceived behaviours of different ethnicities. Few studies have been conducted on complementary infant and young child feeding practices (CIYCFP) in minorities in England, particularly in Chinese immigrants. This mixed study aims to explore the association of acculturation and IYCF among new Chinese immigrant mothers using purposive snowball sampling from an informal Chinese community. The participants' responses to the Infant Feeding Style Questionnaire (IFSQ) and Mutual Intercultural Relations in Plural Societies (MIRIPS), questionnaire (n = 32) were collected. A sub-set of 15 also participated in semi-structured interviews. Pearson's correlation coefficient analysis and thematic analysis were performed to analyse the survey and semi-structured interview data, and triangulation was employed to integrate quantitative and qualitative findings. This study indicated that Chinese mothers who scored high in integration were more likely to respond to satiety and attention; those inclined to be marginalised were more likely to indulge their children. Those who were more culturally separated were more likely to restrict the food quality offered to their children. This study also indicated that Chinese immigrants balanced western and Chinese feeding practices to combat feeding and culture conflict. This study presents preliminary findings of the association between acculturation and CIYCFP, which can improve culturally appropriate CIYCFP in minorities. Further studies are needed to explore intervention programs to tailor CIYCFP with consideration for acculturation in the minority.

Barriers and facilitators to physical activity among ethnic Chinese children: a systematic review protocol

OBJECTIVE

The purpose of this systematic review is to summarize the barriers and facilitators to physical activity among ethnic Chinese children.

INTRODUCTION

Several studies have been conducted to determine the barriers and facilitators to physical activity among ethnic Chinese children. However, no qualitative systematic review on this topic has been published in English.

INCLUSION CRITERIA

This review will consider studies conducted among ethnic Chinese children (between six and 17 years of age) residing in either Chinese or non-Chinese territories or among people who have responsibility for the children (such as their ethnic Chinese/non-Chinese parents, guardians or teachers). Any study setting will be included, such as home, community and school. Studies that present qualitative data on the views and experiences of the barriers and facilitators to physical activity will be considered.

METHODS

MEDLINE, Embase, CINAHL, PsycINFO, British Nursing Index, Allied and Complementary Medicine Database, Web of Science, Scopus, CNKI, Wanfang and VIP will be searched to identify published studies. EThOS, OpenGrey, ProQuest Dissertations and Theses, CNKI and Wanfang will be searched to identify unpublished studies. Databases will be searched from their inception dates, and no language restrictions will be applied. The Joanna Briggs Institute (JBI) systematic review guidelines will be followed to conduct the review. The JBI process of meta-aggregation will be used to identify categories and synthesize findings. The ConQual approach will be used to assess confidence in the findings.

Infant Feeding Beliefs, Attitudes, Knowledge and Practices of Chinese Immigrant Mothers: An Integrative Review of the Literature

Chinese are a fast-growing immigrant population group in several parts of the world (e.g., Australia, Canada, Europe, Southeast Asia, United States). Research evidence suggests that compared to non-Hispanic whites, individuals of Asian-origin including Chinese are at higher risk of developing cardiovascular disease and type 2 diabetes at a lower body mass index (BMI). These risks may be possibly due to genetic differences in body composition and metabolic responses. Despite the increasing numbers of Chinese children growing up in immigrant families and the increasing prevalence of obesity among Chinese, little research has been focused on children of Chinese immigrant families. This integrative review synthesizes the evidence on infant feeding beliefs, attitudes, knowledge and practices of Chinese immigrant mothers; highlights limitations of available research; and offers suggestions for future research. Using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, we searched four electronic academic/research databases (CINAHL, Medline, PsycINFO, and PubMed) to identify peer-reviewed, full-text papers published in English between January 2000 and September 2017. Only studies with mothers 18+ years old of normally developing infants were included. Of the 797 citations identified, 15 full-text papers were retrieved and 11 studies (8 cross-sectional studies, 3 qualitative studies) met the inclusion criteria and were included in this review. Reviewed studies revealed high initiation rates of breastfeeding, but sharp declines in breastfeeding rates by six months of age. In addition, reviewed studies revealed that the concomitantly use of breast milk and formula, and the early introduction of solid foods were common. Finally, reviewed studies identified several familial and socio-cultural influences on infant feeding beliefs and practices that may increase risk of overweight and obesity during infancy and early childhood among Chinese children of immigrant families. Nonetheless, as only 11 studies were identified and because the majority of studies (n = 8) were conducted in Australia, additional research including longitudinal studies, and studies conducted in countries with large Chinese immigrant population are needed to further identify and understand influences on Chinese immigrant mothers' beliefs, attitudes, and practices related to infant feeding that may increase risk of child overweight and obesity. This information is needed to develop interventions tailored to the beliefs and needs of this fast-growing immigrant group and aimed at promoting healthy infant feeding practices to prevent childhood overweight and obesity.