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Gavryutina I, Bochner R, Chin V, Bargman R. A Cross-Sectional Pilot Study of Parental Outdoor Play Preferences and Association With Child Overweight and Obesity. Clin Pediatr (Phila) 2024; 63:466-473. [PMID: 37246752 DOI: 10.1177/00099228231176350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Childhood obesity is highly prevalent among certain populations of New York. This cross-sectional pilot study examined the associations between parental attitudes about outdoor activities and body mass index (BMI). A questionnaire was distributed among parents of 1 to 13 aged children at ambulatory pediatric clinics. Of 104 children included in the study 57 were of normal weight and 47 were overweight or obese. Most parents of children with BMI <85% reported frequent playground utilization, considered longer hours to spend outside on weekdays, reported a larger total temperature range for outdoor playground utilization and a lower tolerable minimum temperature compared to parents of children with BMI ≥85%, p < .05. Only having a parent born outside of the United States remained a significant predictor of overweight and obesity in the final model. Parents of children with BMI < 85% are more willing to spend time outdoors, regardless of weather. Immigrant parents are protective against overweight.
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Affiliation(s)
- Irina Gavryutina
- Department of Pediatrics, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Risa Bochner
- Department of Pediatrics, New York City Health and Hospitals Harlem Hospital, New York, NY, USA
| | - Vivian Chin
- Department of Pediatrics, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Renee Bargman
- Department of Pediatrics, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
- Department of Pediatrics, New York City Health and Hospitals Kings County Hospital, Brooklyn, NY, USA
- Department of Pediatrics, New York City Health and Hospital South Brooklyn Health, Brooklyn, NY, USA
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Teke J, Bolarinwa OA, Nnyanzi LA, Giles EL, Ells L, Elliott S, Okeke SR, Okeke-Obayemi DO. "For me, it is for longevity and making sure I am fit and around for my children": exploring motivations and barriers for weight management among minoritised communities in Medway, England. BMC Public Health 2024; 24:796. [PMID: 38481164 PMCID: PMC10938650 DOI: 10.1186/s12889-024-18281-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 03/05/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Migration-related changes in dietary patterns and other structural and individual factors affect weight-related health practices of individuals migrating from low-and-middle-income to high-income countries. Thus, individuals of ethnically diverse backgrounds may be disproportionately affected by poorer health outcomes, including weight-related health issues. Understanding how this community could be supported to adopt weight-related healthy practices such as optimum dietary and exercise behaviour is an important issue for public health research. Against this backdrop, we explored structural and individual factors that facilitate and constrain the uptake of weight management services among members of minority ethnic communities in Medway, England. METHODS Data were collected from audio-recorded interviews with 12 adult community members from minoritised ethnic communities using a semi-structured interview guide. Participants were recruited through a purposive and convenient sampling technique. Generated data were transcribed, coded into NVivo and analysed using the reflexive thematic analytical technique. RESULTS Results showed that social support and health benefits of weight management were the main motivating factors for weight management among the study participants. Conversely, systemic barriers, family commitment and caring responsibilities, changes in dietary patterns post-migration and cultural norms were major factors constraining participants from adopting weight management behaviours. CONCLUSION The results of this study indicate that structural and person-level factors serve as both facilitators and barriers to weight management among ethnically diverse communities in Medway, England. While our study is exploratory and opens doors for more studies among the population, we conclude that these minoritised communities could benefit from more equitable, tailored weight management programmes to support them in adopting weight-related practices.
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Affiliation(s)
- Jennifer Teke
- Department of Nursing and Midwifery, School of Health and Life Sciences, Teesside University, Teesside, UK
| | - Obasanjo A Bolarinwa
- Department of Public Health, York St John University, London, UK.
- Department of Demography and Population Studies, University of the Witwatersrand, Johannesburg, South Africa.
| | - Lawrence A Nnyanzi
- Department of Nursing and Midwifery, School of Health and Life Sciences, Teesside University, Teesside, UK
| | - Emma L Giles
- Department of Nursing and Midwifery, School of Health and Life Sciences, Teesside University, Teesside, UK
| | - Louisa Ells
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | | | - Sylvesters R Okeke
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
- ECA College of Health Science, Sydney, Australia
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Paudel S, Mishra GD, Veitch J, Mielke GI, Hesketh KD. Examination of Physical Activity, Organized Sport, and Sitting Time Among Women and Mothers From Culturally and Linguistically Diverse Backgrounds. J Phys Act Health 2024; 21:229-237. [PMID: 38086350 DOI: 10.1123/jpah.2023-0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 10/29/2023] [Accepted: 11/14/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND Little evidence is available from culturally and linguistically diverse (CALD) communities on the association between motherhood and physical activity (PA). This study aimed to examine independent and joint associations of cultural background and motherhood with meeting PA guidelines, participation in organized sports, and high sitting time (>8 h/d). METHODS We used self-reported cross-sectional data from survey 8 of the 1973-1978 cohort of the Australian Longitudinal Study on Women's Health. PA was measured using the Active Australia Survey while organized sport and sitting time were measured using single items. CALD was defined as being born in a non-English speaking country or primarily speaking a non-English language at home. Multivariable-adjusted logistic regression analyses were used to examine independent and joint associations. RESULTS Data from 5967 women (mean age 42.4 [SD 1.5] y, 6.9% CALD, 81.2% mothers) were analyzed. Women of CALD background had lower odds of meeting PA guidelines (odds ratio; 95% confidence interval: 0.80; 0.64-0.98) and participation in organized sports (0.68; 0.54-0.86), but no statistically significant association with sitting time (0.90; 0.72-1.14). Mothers had lower odds of meeting PA guidelines (0.75; 0.64-0.87) and high sitting time (0.42; 0.36-0.49). Compared with non-CALD women without children, mothers (irrespective of cultural background) were less likely to meet PA guidelines and have high sitting time. The association of "cultural background and motherhood" with organized sports participation was only significant for CALD mothers. CONCLUSIONS Increased efforts and investments are needed to ensure that sports and other PA promotion interventions are culturally sensitive and engaging for CALD women and those with children.
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Affiliation(s)
- Susan Paudel
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Gita D Mishra
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Jenny Veitch
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Gregore I Mielke
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Kylie D Hesketh
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
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4
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Govindasamy S, Beek K, Yates K, Jayasuriya R, Reynolds R, de Wit JBF, Harris M. Experiences of overweight and obese patients with diabetes and practice nurses during implementation of a brief weight management intervention in general practice settings serving Culturally and Linguistically Diverse disadvantaged populations. Aust J Prim Health 2023; 29:358-364. [PMID: 36502858 DOI: 10.1071/py22013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 11/14/2022] [Indexed: 08/15/2023]
Abstract
BACKGROUND To explore the perspectives of overweight and obese patients with diabetes from culturally and linguistically diverse, and disadvantaged backgrounds, as well as practice nurses (PNs) during implementation of a brief PN-supported self-regulation nutrition strategy for weight management in general practice settings serving disadvantaged populations. METHODS During intervention implementation, semi-structured interviews were conducted with 12 patients and four nurses in two general practices located in metropolitan suburbs in Sydney, Australia. RESULTS Patients and PNs found challenges related to cultural expectations and the requirement of patients to set and adhere to dietary change goals and behaviours. Although patients expressed high levels of satisfaction with PNs, the suitability of the intervention to this group was questioned by PNs. Obstacles were also encountered in delivering the intervention in a busy general practice setting. CONCLUSIONS This pilot study provided initial evidence of the acceptability of a self-regulation nutrition intervention for weight management for overweight and obese patients with type 2 diabetes that was delivered by PNs. Cultural expectations of provider-patient roles, the type of intervention and flexibility in the workplace are important future considerations.
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Affiliation(s)
- Sumathi Govindasamy
- University of New South, School of Population Health, Samuels Building, F25, Samuel Terry Avenue, Kensington, NSW 2033, Australia
| | - Kristen Beek
- University of New South, School of Population Health, Samuels Building, F25, Samuel Terry Avenue, Kensington, NSW 2033, Australia
| | - Ken Yates
- Western Sydney University, School of Social Sciences, 100 Macquarie Street, Liverpool, NSW 2170, Australia
| | - Rohan Jayasuriya
- University of New South, School of Population Health, Samuels Building, F25, Samuel Terry Avenue, Kensington, NSW 2033, Australia
| | - Rebecca Reynolds
- University of New South, School of Population Health, Samuels Building, F25, Samuel Terry Avenue, Kensington, NSW 2033, Australia
| | - John B F de Wit
- UNSW Sydney, Centre for Social Research in Health, Level 2, Goodsell Building, Kensington, NSW 2052, Australia; and Utrecht University, Department of Interdisciplinary Social Science, PO Box 80140, 3508 TC Utrecht, the Netherlands
| | - Mark Harris
- University of New South, School of Population Health, Samuels Building, F25, Samuel Terry Avenue, Kensington, NSW 2033, Australia; and University of New South Wales, Centre for Primary Health Care and Equity, 3rd Floor AGSM Building, Sydney, NSW 2052, Australia
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Bally JMG, Spurr S, Mcharo K. "We Eat Without Thinking: We Just Eat, Eat, Eat" - A Thematic Exploration of Cultural Practices of Ethnically Diverse Youth and Their Parents Who Are at Risk for Prediabetes and Type 2 Diabetes. J Community Health Nurs 2023:1-15. [PMID: 37191357 DOI: 10.1080/07370016.2023.2211066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
PURPOSE Cultural beliefs and practices influence management of type 2 diabetes (T2D) in youth and their parents, and have been minimally explored, limiting our understanding and implementation of preventative healthcare. An enhanced evidence base may inform comprehensive, effective community health nursing (CHN). Thus, the purpose of this research was to explore the influence of youths' and their parents' understandings of cultural practices on risk for prediabetes and T2D. DESIGN A secondary thematic analysis was conducted. Qualitative data were obtained from semi-structured interviews with 24 participants who were purposefully recruited from two mid-western Canadian high schools. FINDINGS Three themes and one subtheme were developed including: 1) Food Culture and related subtheme, Acculturation to New Food Choices; 2) Exercise Culture: Adapting Physical Activity in a New Country; and, 3) Risk Perception of the Effects of T2D on Loved Ones: Behavior Modifications and Motivation. Cultural practices and acculturation to food such as dietary choices, preparation, large portions, different dietary staples, food availability, and food gathering patterns influenced health behaviors. Similarly, changes in exercise patterns including adapting to Western video game culture, weather in Canada, and the new way of life emerged as important factors that impacted health. Participants who perceived a familial risk of diabetes identified behavior modifications such as regular diabetes screening, nutrition counseling, healthier food choices, smaller food portions, and an increase in physical activity as strategies to reduce risk of prediabetes and diabetes. CONCLUSIONS There is a critical need for research aimed at prediabetes and T2D prevention, and intervention programs targeting ethnically diverse groups where prediabetes and T2D is most prevalent. CLINICAL EVIDENCE Community health nurses are at the core of implementing and supporting disease prevention and, therefore, may consider the findings from this research to develop family-focused, intergenerational, and culturally-based interventions.
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Affiliation(s)
- Jill M G Bally
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
| | - Shelley Spurr
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
| | - Kasha Mcharo
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
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Taghizadeh S, Alesaeidi S, Jafari-Koshki T, Valizadeh-Otaghsara SM, Poursheikhali A, Tousi AZ, Abbasalizad–Farhangi M. Trend Impact Analysis (TIA) of community-based futures study for pediatric obesity in Iran. BMC Pediatr 2023; 23:66. [PMID: 36750801 PMCID: PMC9905010 DOI: 10.1186/s12887-023-03880-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Childhood obesity has been regarded as one of the main healthcare challenges in the last century, leading to critical health problems and reduced life expectancy. Many factors can play a role in its development or prevention. Using the Trend Impact Analysis (TIA), this study aimed to conduct a community-based futures study for pediatric obesity in Iran. METHODS We obtained the prevalence of overweight and obesity from the database of the Ministry of Health and Medical Education. Moreover, we reviewed 21 documents, texts, and comments from three key stakeholders in Iran and prepared a list of key experts, who were stakeholders in the field of obesity prevention of childhood in different organizations. Then, we collected the expert opinions by Delphi method. Data analysis was performed using the Excel and R software. RESULTS Fourteen experts participated in the first stage and nine experts in the second stage. We identified two positive drivers, including the prevalence of coronavirus disease 2019 (COVID-19) and the widespread expansion of online educational programs. Meanwhile, we identified five negative drivers as follows: (1) controlling and limiting obesogenic environments in the community, school, and family; (2) running annual compulsory anthropometry programs for students of all educational levels in health centers; (3) integrating nutrition education interventions in the curricula of all educational levels; (4) taxation of unhealthy and fast foods; and (5) preparing safe and appropriate sports environments for children and adolescents (on the streets, schools, parks, and sports clubs). Without considering the drivers, the prevalence of overweight and obesity is predicted to reach 29.10% in 2031. However, it is expected that the negative drivers can increase the prevalence trend from 23.40% in 2018 to 19.57% in 2031, the positive drivers to 32.61%, and the combination of all drivers to 23.07%. CONCLUSION It seems that measures such as the effective communication of policy makers, basic evaluation of the programs and policies related to the prevention of childhood obesity, and localization of the programs of international organizations for the prevention of obesity can greatly control the prevalence of childhood obesity.
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Affiliation(s)
- Shahnaz Taghizadeh
- grid.412888.f0000 0001 2174 8913Department of Community Nutrition, Faculty of Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sogol Alesaeidi
- grid.411036.10000 0001 1498 685XDepartment of Pediatric Medicine, Imam Hossein Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Tohid Jafari-Koshki
- grid.412888.f0000 0001 2174 8913Department of Statistics and Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Atousa Poursheikhali
- grid.412105.30000 0001 2092 9755Health Foresight and Innovation Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ayda Zahiri Tousi
- grid.444802.e0000 0004 0547 7393Razavi Cancer Research Center, Razavi Hospital, Imam Reza International University, Mashhad, Iran
| | - Mahdieh Abbasalizad–Farhangi
- grid.412888.f0000 0001 2174 8913Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Taghizadeh S, Hashemi MG, Zarnag RK, Fayyazishishavan E, Gholami M, Farhangi MA, Gojani LJ. Barriers and facilitators of childhood obesity prevention policies: A systematic review and meta-synthesis. Front Pediatr 2023; 10:1054133. [PMID: 36714652 PMCID: PMC9874939 DOI: 10.3389/fped.2022.1054133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/08/2022] [Indexed: 01/13/2023] Open
Abstract
Objectives Childhood obesity is one of the worldwide considerable public health challenges and many factors can play a role in its management. Therefore, this article examined the facilitators and barriers of childhood obesity prevention (COP) policies. Methods This systematic review of qualitative studies was conducted via a search of the SCOPUS, PubMed, and Google Scholar databases between 1 January 2010 and 11 February 2022 and examined factors that influence the implementation of COP policies at a community approach. Results The parents' reluctance to engage in COP activities, lack of sufficient knowledge, and financial problems were the most reported barriers at the individual level. In addition, the beliefs about COP at the sociocultural level and limited funding and resources, time limitations in stakeholders at the implementation level, and lack of policy support at the structural level were the most frequently reported barriers. Further, effective communication between stakeholders and parents and school staff at the sociocultural level and flexibility of the intervention, delivery of healthy food programs in schools, low-cost and appropriate resources, and the availability of appropriate facilities are the most frequently reported facilitators in the structural level. Conclusion Individual, sociocultural, and structural level-related barriers and facilitators influence the implementation of COP policies. Most of the barriers and facilitators in this systematic review were related to the structural level.
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Affiliation(s)
- Shahnaz Taghizadeh
- Department of Community Nutrition, Faculty of Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Rahim Khodayari Zarnag
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ehsan Fayyazishishavan
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States
| | - Marjan Gholami
- Department of Pharmacy, Faculty of Pharmacy, Islamic Azad University Pharmaceutical Sciences Branch, Tehran, Iran
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Khatri RB, Assefa Y. Access to health services among culturally and linguistically diverse populations in the Australian universal health care system: issues and challenges. BMC Public Health 2022; 22:880. [PMID: 35505307 PMCID: PMC9063872 DOI: 10.1186/s12889-022-13256-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/19/2022] [Indexed: 12/14/2022] Open
Abstract
Background About half of first- or second-generation Australians are born overseas, and one-in-five speak English as their second language at home which often are referred to as Culturally and Linguistically Diverse (CALD) populations. These people have varied health needs and face several barriers in accessing health services. Nevertheless, there are limited studies that synthesised these challenges. This study aimed to explore issues and challenges in accessing health services among CALD populations in Australia. Methods We conducted a scoping review of the literature published from 1st January 1970 to 30th October 2021 in four databases: PubMed, Scopus, Embase, and the Web of Science. The search strategy was developed around CALD populations and the health services within the Australian context. We used Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for selection and Arksey and O’Malley framework for analysis of relevant articles. A narrative synthesis of data was conducted using inductive thematic analysis approach. Identified issues and challenges were described using an adapted socioecological model. Results A total of 64 studies were included in the final review. Several challenges at various levels were identified to influence access to health services utilisation. Individual and family level challenges were related to interacting social and health conditions, poor health literacy, multimorbidity, diminishing healthy migrants’ effect. Community and organisational level challenges were acculturation leading to unhealthy food behaviours and lifestyles, language and communication problems, inadequate interpretation services, and poor cultural competency of providers. Finally, challenges at systems and policy levels included multiple structural disadvantages and vulnerabilities, inadequate health systems and services to address the needs of CALD populations. Conclusions People from CALD backgrounds have multiple interacting social factors and diseases, low access to health services, and face challenges in the multilevel health and social systems. Health systems and services need to focus on treating multimorbidity through culturally appropriate health interventions that can effectively prevent and control diseases. Existing health services can be strengthened by ensuring multilingual health resources and onsite interpreters. Addressing structural challenges needs a holistic policy intervention such as improving social determinants of health (e.g., improving living and working conditions and reducing socioeconomic disparities) of CALD populations, which requires a high level political commitment. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13256-z.
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Affiliation(s)
- Resham B Khatri
- School of Public Health, the University of Queensland, Brisbane, Australia.
| | - Yibeltal Assefa
- School of Public Health, the University of Queensland, Brisbane, Australia
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Taghizadeh S, Farhangi MA, Khodayari-Zarnaq R. Stakeholders perspectives of barriers and facilitators of childhood obesity prevention policies in Iran: A Delphi method study. BMC Public Health 2021; 21:2260. [PMID: 34895191 PMCID: PMC8665716 DOI: 10.1186/s12889-021-12282-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 11/22/2021] [Indexed: 12/03/2022] Open
Abstract
Background The prevalence of obesity among children and adolescents is one of the most important health challenges of the present century. Many factors affect the prevention policies related to this health problem and make their implementation difficult. This study examined perceived barriers and facilitators of childhood obesity prevention policies by stakeholders. Methods A qualitative descriptive research design based on Delphi method was conducted. In addition, semi-structured one-to-one interviews were conducted with childhood obesity prevention policy stakeholders (n=39) and initial identification of barriers and facilitators in this area. Interviews were digitally recorded, transcribed verbatim, and finally analyzed, followed by using thematic analysis. Subsequently, two-round Delphi panel was done by sending e-mails to stakeholders (21 stakeholders participated in the first round and 15 stakeholders in the second round) for the final selection of barriers and facilitators of obesity prevention policies among children and adolescents in Iran. Results The identified barriers and facilitators were divided into three levels: individual, executive, and structural. Barriers and facilitators of the structural level showed a high score and priority regarding obesity prevention policies among children and adolescents. Conclusion The existence of significant barriers at all three levels and especially at the structural level were among the concerns of stakeholders. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12282-7.
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Affiliation(s)
- Shahnaz Taghizadeh
- Department of Community Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Rahim Khodayari-Zarnaq
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, 14711, Tabriz, 5166614711, Iran.
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Hayba N, Shi Y, Allman-Farinelli M. Enabling Better Nutrition for Adolescents from Middle Eastern Backgrounds: Semi-Structured Interviews with Parents. Nutrients 2021; 13:3918. [PMID: 34836174 PMCID: PMC8624745 DOI: 10.3390/nu13113918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 11/17/2022] Open
Abstract
The unyielding obesity epidemic in adolescents from Middle Eastern (ME) backgrounds warrants culturally-responsive and co-designed prevention measures. This study aimed to capture the opinions of ME parents residing in Australia on the crisis and their enablers and barriers to healthy eating interventions given their influence on adolescent eating behaviors. Twenty-six semi-structured interviews were conducted with ME mothers, aged 35-59 years, and most residing in low socioeconomic areas (n = 19). A reflexive thematic analysis using the Capability, Opportunity, Motivation-Behaviour model and Theoretical Domain Framework was conducted. Parents expressed confidence in knowledge of importance of healthy eating, but were reluctant to believe behaviours were engaged in outside of parental influence. Time management skills are needed to support working mothers and to minimize reliance on nearby fast-food outlets, which was heightened during COVID-19 with home-delivery. Time constraints also meant breakfast skipping was common. A culture of feeding in light of diet acculturation and intergenerational trauma in this diaspora was also acknowledged. Parents pleaded for upstream policy changes across government and school bodies to support parental efforts in the form of increased regulation of fast-food and subsidization of healthy products. Opportunities for weight-inclusive programs including parenting workshops underpinned by culturally-responsive pedagogy were recommended.
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Affiliation(s)
- Nematullah Hayba
- Discipline of Nutrition and Dietetics, Charles Perkins Centre, University of Sydney, Sydney 2006, Australia; (Y.S.); (M.A.-F.)
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11
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Goedhart NS, Pittens CACM, Tončinić S, Zuiderent-Jerak T, Dedding C, Broerse JEW. Engaging citizens living in vulnerable circumstances in research: a narrative review using a systematic search. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:59. [PMID: 34479622 PMCID: PMC8414765 DOI: 10.1186/s40900-021-00306-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/23/2021] [Indexed: 06/13/2023]
Abstract
Although public engagement in research is increasingly popular, the involvement of citizens living in vulnerable circumstances is rarely realized. This narrative review aims to describe and critically analyse concerns and corresponding strategies, tools, and methods that could support the inclusion of these citizens in health research. The 40 studies that are included were thematically analysed using the socioecological model. Concerns originate most often on the intrapersonal level of the socioecological model, but concerns were also identified at institutional, community, and policy levels. It is thought-provoking that there is a lack of attention for the research and policy structure in which engagement practices are designed, implemented and evaluated. More research is needed to explore how these cultures could be changed in a way that promotes rather than restrains the engagement of citizens living in vulnerable circumstances in research and policymaking.
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Affiliation(s)
- N S Goedhart
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Department of Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, The Netherlands.
| | - C A C M Pittens
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - S Tončinić
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - T Zuiderent-Jerak
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - C Dedding
- Department of Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, The Netherlands
| | - J E W Broerse
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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12
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Niknam M, Omidvar N, Amiri P, Eini-Zinab H, Kalantari N. Community readiness for childhood obesity prevention programs: findings from an urban population in Iran. Health Promot Int 2021; 36:824-835. [PMID: 33111938 DOI: 10.1093/heapro/daaa101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study aimed to examine the Iranian local communities' readiness stage to engage with childhood obesity prevention programs for late primary school children in districts 2 and 16 of Tehran as the representatives of high and low socio-economic districts, respectively. First, a Delphi approach was conducted to assess the socio-cultural necessity/appropriateness and adequacy of the community readiness model and its dimensions as a planning basis for childhood obesity prevention program(s) in Iran. Then, the community readiness interview guide's translation, modification, content and face validity were performed. Finally, 66 interviews with key informants were conducted and scored to assess community readiness. The socio-cultural necessity/appropriateness and adequacy of community readiness model and its dimensions were confirmed by Delphi participants and two questions were added to the interview guide. Content and face validity of the interview guide were at acceptable levels. Assessment of the community readiness based on the key informants' perspective showed that the overall mean readiness score of targeted local communities was 4.61 ± 0.54 and 4.22 ± 0.26 in high and low socio-economic districts, respectively, corresponded to 'preplanning stage'. The highest score was 5.00 ± 0.48 correspond to the 'preparation stage', which belonged to girls' schools in district 2. Small differences were found in the readiness stage of local communities by sex and socio-economic status of schools. The results highlight the need to increase community awareness, gain their support to recognize childhood obesity as a priority, address cultural misconceptions and improve the obesity prevention programs to achieve a higher level of readiness.
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Affiliation(s)
- Mahdieh Niknam
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, West Arghavan, St. Farahzadi Blvd., Shahrak Qods, Tehran, Iran 1981629573
| | - Nasrin Omidvar
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, West Arghavan, St. Farahzadi Blvd., Shahrak Qods, Tehran, Iran 1981629573
| | - Parisa Amiri
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Velenjak St., Shahid Chamran Highway, Tehran, Iran 1985717413
| | - Hassan Eini-Zinab
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, West Arghavan, St. Farahzadi Blvd., Shahrak Qods, Tehran, Iran 1981629573
| | - Naser Kalantari
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, West Arghavan, St. Farahzadi Blvd., Shahrak Qods, Tehran, Iran 1981629573
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Marshall S, Xu H, Taki S, Laird Y, Love P, Wen LM, Rissel C. Engagement, satisfaction, retention and behavioural outcomes of linguistically diverse mothers and infants participating in an Australian early obesity prevention trial. Health Promot J Austr 2021; 33:350-360. [PMID: 34245623 DOI: 10.1002/hpja.521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 07/06/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Early obesity prevention research interventions in Australia generally expect participants to be able to communicate in English, but do not account for other languages. This study aimed to investigate engagement, satisfaction, retention and behavioural outcomes of linguistically diverse participants from a mainstream early childhood obesity prevention trial. METHODS Healthy Beginnings is a nurse-led intervention based in Sydney, supporting families with optimal infant feeding and active play via telephone. This secondary analysis assessed participant engagement in the nurse telephone calls (call completions), satisfaction and behavioural outcomes (6- and 12-month survey data) and retention (survey completions), in the first year of life according to participants' language spoken at home (English or other language). RESULTS Of 1155 mothers, 533 (46%) spoke a language other than English at home. Significantly fewer mothers speaking a language other than English completed the 6-month survey (79%) compared to those speaking English (84%), yet mothers speaking a language other than English who completed the program were more satisfied with the program overall. Significantly fewer mothers speaking a language other than English completed the final four nurse calls (of six) (56%-65%) compared to those speaking English (70%-80%). Adjusted odds ratios showed selected behavioural outcomes were significantly more positive for participants speaking English at home. CONCLUSIONS Healthy Beginnings trial participants who spoke a language other than English at home had less favourable engagement, retention and behavioural outcomes compared to those who spoke English. So what? Early obesity prevention interventions should consider cultural adaptations to improve engagement and effectiveness among culturally and linguistically diverse families.
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Affiliation(s)
- Sarah Marshall
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,The National Health and Medical Research Council Centre for Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia
| | - Huilan Xu
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia
| | - Sarah Taki
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,The National Health and Medical Research Council Centre for Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia.,Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia
| | - Yvonne Laird
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Penelope Love
- The National Health and Medical Research Council Centre for Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia.,Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Li Ming Wen
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,The National Health and Medical Research Council Centre for Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia.,Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia
| | - Chris Rissel
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,The National Health and Medical Research Council Centre for Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia
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14
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Hayes AJ, Carrello JP, Kelly PJ, Killedar A, Baur LA. Looking backwards and forwards: tracking and persistence of weight status between early childhood and adolescence. Int J Obes (Lond) 2021; 45:870-878. [PMID: 33558641 DOI: 10.1038/s41366-021-00751-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 11/19/2020] [Accepted: 01/12/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/OBJECTIVE Many studies have shown that child BMI or weight status tracks over time, but the demographic predictors of high tracking have not been investigated. Our objective was to identify demographic predictors of persistence (duration) of healthy weight and overweight/obesity throughout childhood, and to examine whether tracking was age dependent. METHODS We conducted secondary data analysis of 4606 children from the Birth cohort and 4983 children from the Kindergarten cohort of the Longitudinal Study of Australian Children with follow-up to age 12/13 and 16/17 years, respectively. Retrospective and prospective tracking were examined descriptively. Time-to-event analysis determined demographic predictors of persistence of healthy weight and overweight/obesity beyond age 4-5 years, after controlling for child BMI z-score. Weight status was determined using WHO methods. RESULTS Tracking of healthy weight was consistently higher than that of overweight/obesity, and incident overweight was equally likely throughout childhood and adolescence. Tracking of overweight was lower for children under 7 years than in middle childhood and adolescence (2-year probability 65%, compared with 80%; 2-year resolution of overweight 35 and 20%). Children of lower socioeconomic position, those from culturally and linguistically diverse backgrounds, and girls were more likely to move into overweight (hazard ratios [95%CI] for incident overweight: 1.39 [1.26-1.52], 1.16 [1.02-1.31] and 1.12 [1.02-1.23], respectively) and less likely to resolve their overweight (hazard ratios for resolution of overweight/obesity: 0.77 [0.69-0.85], 0.8 [0.69-0.92] and 0.79 [0.71-0.81], respectively) during childhood. However, persistence of weight status was not significantly affected by rurality or Indigenous status (P > 0.05). CONCLUSIONS Lowest tracking and highest natural resolution of overweight in children under 7 years suggests this may be an opportune time for interventions to reduce overweight. Primary and secondary prevention programmes during the school years should be designed with special consideration for lower socioeconomic communities, for culturally and linguistically diverse populations and for girls.
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Affiliation(s)
- Alison J Hayes
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, NSW, Australia.
| | - Joseph P Carrello
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Patrick J Kelly
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Anagha Killedar
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Louise A Baur
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, NSW, Australia.,Speciality of Child and Adolescent Health, Clinical School, University of Sydney, Sydney, NSW, Australia.,The Children's Hospital at Westmead, Sydney, NSW, Australia
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15
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Definitions of Culturally and Linguistically Diverse (CALD): A Literature Review of Epidemiological Research in Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020737. [PMID: 33467144 PMCID: PMC7830035 DOI: 10.3390/ijerph18020737] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 01/04/2023]
Abstract
Objective: To identify how Culturally and Linguistically Diverse (CALD) communities are defined in epidemiological research in Australia and provide a definition of CALD status that aids the consistency and interpretability of epidemiological studies. Methods: Peer-reviewed literature from January 2015 to May 2020 was searched via four databases (Ovid Medline combined with PubMed, Embase, Emcare, and CINAHL) to identify quantitative studies of CALD people in Australia. Results: A total of 108 studies met the criteria for inclusion in the review. Country of birth was the most commonly used CALD definition (n = 33, 30.6%), with combinations of two or more components also frequently used (n = 31, 28.7%). No studies used all the components suggested as core to defining CALD status. including country of birth, languages other than English spoken at home, English proficiency, and indigenous status. Conclusions: There was considerable inconsistency in how CALD status was defined. The review suggests that CALD status would best be defined as people born in non-English speaking countries, and/or who do not speak English at home. Additionally, indigenous peoples should be considered separately. This recommended definition will support the better identification of potential health disparity and needs in CALD and indigenous communities.
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Wijayaratne S, Westberg K, Reid M, Worsley A. A qualitative study exploring the dietary gatekeeper's food literacy and barriers to healthy eating in the home environment. Health Promot J Austr 2020; 32 Suppl 2:292-300. [PMID: 32761932 DOI: 10.1002/hpja.398] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 06/09/2020] [Accepted: 07/31/2020] [Indexed: 11/09/2022] Open
Abstract
ISSUE ADDRESSED Food literacy has been recognised as a collection of interrelated food skills and knowledge to support healthy dietary outcomes. In the home environment, the dietary gatekeeper is the individual most responsible for food preparation, and therefore, has a significant influence on the family diet. This study explored how the dietary gatekeeper's food literacy skills are used to manage dietary barriers to facilitate healthy eating in the home environment. METHODS Qualitative data were collected from a sample of household dietary gatekeepers with children (n = 17). Participants were also instructed to take photographs of family meals prior to the interview and these were used as interview prompts to gain deeper insights into gatekeeper behaviour. RESULTS Participants reported the two most significant barriers to healthy eating in households were time pressure and fussy eating. Four strategies were identified that used gatekeepers' food literacy to manage these barriers: breaking up meal tasks; customising meals for family tastes; camouflaging healthy ingredients; and facilitating food choice autonomy. These strategies incorporated interrelated food literacy skills related to the planning, preparation, selection and eating domains. CONCLUSION The current findings highlight the dietary gatekeeper's food literacy as an interrelated concept and show how it is operationalised to successfully manage barriers to healthy eating experienced in the home environment. SO WHAT?: Future health promotion campaigns must offer tailored communications and interventions that provide resources and support to dietary gatekeepers to foster food literacy and counteract the influence of barriers to healthy eating.
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Affiliation(s)
| | - Kate Westberg
- School of Economics, Finance & Marketing, RMIT University, Melbourne, Australia
| | - Mike Reid
- School of Economics, Finance & Marketing, RMIT University, Melbourne, Australia
| | - Anthony Worsley
- School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
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17
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Factors influencing the food choices of urban Sri Lankan preschool children: Focus groups with parents and caregivers. Appetite 2020; 150:104649. [DOI: 10.1016/j.appet.2020.104649] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 12/21/2022]
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18
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Chatham RE, Mixer SJ. Cultural Influences on Childhood Obesity in Ethnic Minorities: A Qualitative Systematic Review. J Transcult Nurs 2019; 31:87-99. [PMID: 31423926 DOI: 10.1177/1043659619869428] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Introduction: Childhood obesity remains an unrelenting public health problem disproportionately affecting ethnic minorities. Although research has examined ethnicity as a factor of childhood obesity, few studies have examined cultural influences. The purpose of this systematic review was to examine the qualitative evidence of cultural influences on childhood obesity in ethnic minority groups. Methodology: Selective sampling of studies since 2008 yielded 251 articles. Twelve articles that addressed cultural influences on childhood obesity were identified for review. The Culture Care Theory Sunrise Enabler factors were used as an a priori framework for theme coding. Results: Nine themes emerged: child feeding, family, gender roles, food, healthy child appearance, physical activity, sedentary activity, food cost, and obesogenic environment. Discussion: Cultural care practices such as traditional foods and family meals are protective factors in childhood obesity and should be encouraged by nurses caring for and working with ethnic minority populations.
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19
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Yoshida Y, Simoes EJ. Sugar-Sweetened Beverage, Obesity, and Type 2 Diabetes in Children and Adolescents: Policies, Taxation, and Programs. Curr Diab Rep 2018; 18:31. [PMID: 29671076 PMCID: PMC6025796 DOI: 10.1007/s11892-018-1004-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE OF REVIEW Obesity has grown at an alarming rate in children and adolescents. Concurrently, consumption on sugar-sweetened beverages (SSBs) also rose significantly. This review provides an overview of obesity and type 2 diabetes mellitus (T2DM) related to SSBs and current policies restricting SSBs in schools, school-based interventions, and taxation on reducing SSB intake and obesity. We also discuss challenges of and future steps for these initiatives. RECENT FINDINGS Clinical and epidemiological studies suggest a strong association between SSB intake and obesity and T2DM. School food policies have been initiated at federal, state, and local levels. School-based interventions have shown positive effects on SSB intake and obesity reduction. Taxation on SSBs is promising in combating obesity and in generating revenue. Challenges towards compliance and implementation of the policies and programs exist. The relationship between SSB and obesity and T2DM is a complex problem which requires comprehensive solutions. Continued efforts in restricting SSBs in schools are needed. Intervention programs should be tailored to age, gender, language, and culture and involve participation from families and local communities. Taxation can reduce SSB consumption by direct economic incentive, earmarking revenues to support healthy foods, and sending negative message. However, a higher tax rate may be necessary to have a measurable effect on weight.
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Affiliation(s)
- Yilin Yoshida
- Department of Health Management and Informatics, School of Medicine, University of Missouri-Columbia, CE707 CS&E Bldg., One Hospital Drive, Columbia, MO 65212, USA
- Missouri Cancer Registry and Research Center, University of Missouri-Columbia, Columbia, MO, USA
| | - Eduardo J. Simoes
- Department of Health Management and Informatics, School of Medicine, University of Missouri-Columbia, CE707 CS&E Bldg., One Hospital Drive, Columbia, MO 65212, USA
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20
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Renzaho AMN. Dissecting and customising the Childhood Obesity Prevention Advisory Council (COPAC): the development and application of a community engagement framework to improve childhood obesity prevention among migrant populations. Glob Health Action 2017; 10:1321822. [PMID: 28573912 PMCID: PMC5496055 DOI: 10.1080/16549716.2017.1321822] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Migrant communities in Australia bear a disproportionate childhood obesity burden. They also show poor engagement in obesity prevention initiatives which may contribute to widening obesity disparities. Community engagement has been shown to be effective in reducing health disparities by improving migrant communities’ participation in prevention programmes. Objective: This study aimed to develop a community engagement framework to improve childhood obesity prevention among migrants. Design: Based on the African Review Panel model and the Community-Based Participatory Research conceptual logic model, the Childhood Obesity Prevention Advisory Council (COPAC) framework was developed and established in four disadvantaged areas in Victoria, Australia. The COPAC included service providers and migrant community members from the same project’s site. Results: COPAC demonstrated several benefits including cross-organisational and multidisciplinary collaborations; understanding of the cultural barriers in childhood obesity prevention; enthusiasm from the COPAC members in addressing childhood obesity in their multicultural communities; equitable involvement, motivation, and empowerment of COPAC members in research development; and establishing organisational affiliations to foster long-term community involvement. This study also documented several challenges in community engagement including lack of prioritisation of migration-related childhood obesity disparities by the policymakers; staffing constraints among service providers leading to frequent disruptions in COPAC members’ contributions; and lack of adequate training and skill-building of bicultural workers. Conclusions: The COPAC model adopted a flexible and dynamic community engagement process to suit the ongoing needs of the migrant community which incorporated the existing talents and resources within the community. For effective community engagement of migrant communities, it is important for policymakers to develop the knowledge, capacity and skills of the bicultural migrant workforce. Integrating both service providers and migrant community members in the COPAC has demonstrated that a multifaceted community-led approach has the potential to reduce childhood obesity-related disparities in Australia.
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Affiliation(s)
- A M N Renzaho
- a Humanitarian and Development Studies, School of Social Sciences and Psychology , Western Sydney University , Penrith , NSW , Australia
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