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Suglia SF, Crookes DM, Belak L, Cammack AL, Clark TL, Daviglus M, Gallo LC, Perreira KM, Delamater AM, Isasi CR. Current Family Functioning and Youth Cardiometabolic Health in the SOL Youth Study. Int J Behav Med 2023; 30:914-923. [PMID: 36624323 PMCID: PMC10754224 DOI: 10.1007/s12529-022-10148-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Family functioning may impact children's cardiometabolic health; however, few studies have examined multiple cardiometabolic markers among a diverse racial/ethnic cohort. The relationship between child- and caregiver-reported family functioning and the cardiometabolic health of Hispanic/Latino youth was examined. METHOD Data were from the Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth) (2012-2014), a population-based cohort study of children and adolescents whose parents participated in the HCHS/SOL (2008-2011). The relationship between youth- and caregiver-rated family functioning, and concordance of ratings is modeled, utilizing the general functioning subscale of the McMaster Family Assessment Device with youth objective cardiometabolic health markers (obesity, central adiposity, prediabetes/diabetes, prehypertension/hypertension, triglycerides, HDL cholesterol) adjusting for sociodemographic factors. RESULTS Among boys, child/caregiver concordant ineffective family functioning rating was associated with higher cumulative cardiometabolic risk (adjusted B (95% CI): 0.30 (0.04, 0.56)), but no association was observed among girls (adjusted B (95% CI): 0.04 (-0.13, 0.21)). Among girls, ineffective child rating/effective caregiver rating was associated with higher cumulative cardiometabolic risk (adjusted B (95% CI): 0.27 (0.06, 0.48)), but no association was observed among boys (adjusted B (95% CI): 0.02 (-0.23, 0.27). CONCLUSION Findings suggest that family functioning among this Hispanic/Latino population may influence cardiometabolic risk among youth. Observed differences in the associations by youth sex and concordant/discordant reports of family functioning suggest interventions at the family level, targeting both caregivers and youth, that consider differential sex effects are warranted.
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Affiliation(s)
- Shakira F Suglia
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA.
| | - Danielle M Crookes
- Department of Health Sciences, Bouvé College of Health Sciences, Department of Sociology & Anthropology, College of Social Sciences & Humanities, Northeastern University, Boston, MA, USA
| | - Lauren Belak
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
| | - Alison L Cammack
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
| | - Taylor L Clark
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | | | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Krista M Perreira
- Department of Social Medicine, UNC School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Alan M Delamater
- Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Carmen R Isasi
- Department of Epidemiology & Population Health, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
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Jiang X, Zhao X, Zhou J, Zhang X, Song Y, Zhao L. The relationship between family function and the incidence of overweight/obesity in children and adolescents in Chengdu city, Sichuan province of China: based on latent profile analysis. BMC Public Health 2023; 23:2272. [PMID: 37978361 PMCID: PMC10656920 DOI: 10.1186/s12889-023-17143-z] [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: 07/22/2022] [Accepted: 11/02/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Overweight/obesity in children and adolescents has become a global health problem, and family function may be associated with its occurrence. Studies exploring the association between family function and overweight/obesity in children and adolescents were performed in Western and Taiwan, China. To date, related studies haven't been conducted in Mainland China. OBJECTIVES To investigate the current status of overweight, obesity, and family function among children and adolescents in Chengdu, China, and to explore their associations. METHODS Children and adolescents in five primary and middle schools were chosen by cluster sampling. Body Mass Index was used to measure the status of overweight and obesity, and the Chinese family assessment instrument was adopted to assess family function. Latent profile analysis and stepwise logistic regression were applied to identify family classification and explore the relationships between family function and overweight/obesity. RESULTS A total of 7616 (84.92%) children and adolescents out of 8968 completed the study with qualified-filled questionnaires. Nine hundred and sixty-six (12.68%)participants were overweight and 656 (8.61%) were obese. The family function was categorized into three profiles: mild (63.93%), moderate (12.32%), and severe (23.75%) dysfunction. The prevalence of overweight was 12.16%, 14.71%, and 13.05% for mild, moderate, and severe family dysfunction, respectively. And the prevalence of obesity was 8.19%, 10.77%, and 8.62% respectively. Participants in moderate and severe dysfunction families were more likely to be overweight (moderate: OR = 1.27, 95% CI:1.01 ~ 1.59, P = 0.04; severe: OR = 1.38, 95% CI:1.15 ~ 1.66, P = 0.001) and obese (moderate: OR = 1.35, 95% CI:1.02 ~ 1.79, P = 0.03; severe: OR = 1.55, 95% CI:1.23 ~ 1.96, P < 0.001). Sociodemographic data such as gender, residence, grade, pocket money per week, the number of siblings, and the education level of the mother were all associated with the risk of being overweight/obese in children and adolescents. CONCLUSIONS The problems of being overweight or obese exist among children and adolescents in Chengdu. And the risk of being overweight or obese increases along with the decrease in family function.
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Affiliation(s)
- Xixi Jiang
- Department of Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiufang Zhao
- Department of Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Sichuan University, Chengdu, China
| | - Junxia Zhou
- Department of Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Sichuan University, Chengdu, China
| | - Xiujuan Zhang
- Department of Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Sichuan University, Chengdu, China
| | - Yan Song
- Department of Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Sichuan University, Chengdu, China
| | - Li Zhao
- Department of Health Policy and Management, West China Fourth Hospital, West China School of Public Health, Sichuan University, 610041, Chengdu, Sichuan, China.
- West China Research Centre for Rural Health Development, Sichuan University, Chengdu, China.
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3
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Kibibi NI, Dena I, Cummings PDW, Hicks CD, Bao W, Schweizer ML. Obesity in Refugees post-resettlement in a high-income country: a meta-analysis. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01688-1. [PMID: 37468741 DOI: 10.1007/s40615-023-01688-1] [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: 02/08/2023] [Revised: 06/10/2023] [Accepted: 06/18/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Refugees have a high prevalence of obesity post resettlement, but few studies have compared their risk of obesity to those of the host population. We systematically investigated the association between refugee status and obesity after resettlement in a high-income nation. METHODS We searched PubMed, Embase, OpenGrey and bibliographies of retrieved articles, with no date, location, and language restrictions, for observational studies assessing obesity rates in resettled refugees compared to the host population. RESULTS Nine studies were analyzed. We found no evidence of increased risk of obesity among refugees compared to the host population, with significant heterogeneity across studies. However, the risk of obesity among refugee men were significantly lower than the host population. DISCUSSION The heterogeneity between studies calls for more high-quality research to examine the risk of obesity among refugees compared to the host population in high-income countries. This will enable results to be pooled to provide more decisive evidence about obesity trends among refugees post migration in a high-income nation.
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Affiliation(s)
- Niclette I Kibibi
- Department of Epidemiology, University of Iowa College of Public Health, 145 N. Riverside Dr., S400 CPHB, Iowa City, IA, 52242, USA.
| | - Isabelle Dena
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Precious de-Winton Cummings
- Department of Epidemiology, University of Iowa College of Public Health, 145 N. Riverside Dr., S400 CPHB, Iowa City, IA, 52242, USA
| | - Chelsea D Hicks
- Harborview Injury Prevention and Research Center, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Wei Bao
- Institute of Public Health Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230026, Anhui, China
| | - Marin L Schweizer
- Division of Infectious Disease, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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4
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Paez J, Hurtado J, Reyes T, Abusleme R, Arroyo P, Oñate C. Relationship between Parents' Physical Activity Level and the Motor Development Level and BMI of Their Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159145. [PMID: 35897516 PMCID: PMC9332858 DOI: 10.3390/ijerph19159145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/13/2022] [Accepted: 07/21/2022] [Indexed: 01/27/2023]
Abstract
All the variables that arise in family dynamics can have significant effects on the lives of children concerning their nutritional status and motor development. The objective of this study was to relate the PAL of parents to the level of motor development and the BMI of their children. A total of 198 subjects participated, with the age of the students ranging between 8 and 10 years. To measure the BMI, the norms for the nutritional evaluation of children and teenagers from 5 to 19 years were used; to identify the motor behaviors, the TGMD-2 Test was used; and to identify the level of physical activity of parents, the International Physical Activity Questionnaire (IPAQ) was used. For the analysis, the independent samples t-test and the non-parametric Mann–Whitney U test (Wilcoxon) were used, and for the correlational analysis, Spearman’s rho test was applied. This study found no significant correlation between the activity level of parents and nutritional status variables (p = 0.162), or between the PAL variables of parents and the motor development of their children (p = 0.738). A parent’s level of physical activity does not have a direct relationship with the nutritional status or the motor development of their children.
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Affiliation(s)
- Jacqueline Paez
- Escuela Educación Física, Pontificia Universidad Católica de Valparaíso, Viña del Mar 252000, Chile; (J.H.); (R.A.)
- Correspondence:
| | - Juan Hurtado
- Escuela Educación Física, Pontificia Universidad Católica de Valparaíso, Viña del Mar 252000, Chile; (J.H.); (R.A.)
| | - Tomas Reyes
- Escuela Educación Física, Universidad Playa Ancha, Valparaíso 2340000, Chile;
| | - Rosita Abusleme
- Escuela Educación Física, Pontificia Universidad Católica de Valparaíso, Viña del Mar 252000, Chile; (J.H.); (R.A.)
| | - Patricio Arroyo
- Escuela Educación Física, Universidad San Sebastián, Santiago 8320000, Chile;
| | - Cristian Oñate
- Escuela de Kinesiologia, Universidad Católica de Temuco, Temuco 4780000, Chile;
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5
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Cong CW, Tan SA, Nainee S, Tan CS. Psychometric Qualities of the McMaster Family Assessment Device-General Functioning Subscale for Malaysian Samples. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042440. [PMID: 35206628 PMCID: PMC8875097 DOI: 10.3390/ijerph19042440] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 01/09/2023]
Abstract
Family functioning has been associated with psychological well-being and physical health. The 12-item McMaster Family Assessment Device–General Functioning Subscale (FAD-GF) has been widely used to assess individuals’ overall level of family functioning. However, it has shown an inconsistent factor structure across various studies. The present study investigated its psychometric qualities in two studies with two different adult samples in Malaysia. In Study 1 (N = 417, 55.3% females, 19 to 26 years old), exploratory factor analyses were conducted, and four models were found: a three-factor model with 11 items, a two-factor model with 12 items, and one-factor models with six negatively worded items and six positively worded items, respectively. Study 2 (N = 358, 65.1% females, 18 to 60 years old) compared models found in past studies and those found in Study 1 through confirmatory factor analyses on another sample of adults. Among the six competing models, the two-factor model with three positively worded and three negatively worded items (i.e., FAD-GF-SF) is preferable because it did not require modification and showed a clear-cut result of goodness of fit. The subscales demonstrated satisfactory internal consistency. In conclusion, the FAD-GF-SF is a useful instrument for measuring family functioning in the Malaysian context.
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Iwinski S, Donovan SM, Fiese B, Bost K. The Impact of Household Chaos and Dietary Intake on Executive Function in Young Children. Nutrients 2021; 13:nu13124442. [PMID: 34959994 PMCID: PMC8707498 DOI: 10.3390/nu13124442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 02/02/2023] Open
Abstract
Children's executive functions (EFs) emerge over time and can be shaped by household environments and dietary intake. However, there is a lack of knowledge about how these factors influence EFs in children aged 18-24 months. This study tested a model exploring the relations between parent-reported dietary intake, household chaos, and child EF. The sample consisted of 294 families participating in the STRONG Kids2 birth cohort study of nutrition and child health. Caregivers completed the Food Frequency Questionnaire (FFQ), the Confusion, Hubbub, and Order Scale (CHAOS), and the Behavior Rating Inventory of Executive Function®-Preschool Version (BRIEF-P) to assess model variables. Regression analyses revealed a significant and independent association between assorted snacks and processed foods and two EF subscales. There were also significant associations between household chaos and each EF subscale. There was no significant moderation effect. These findings suggest that family households characterized by dysregulation are associated with children's EF difficulties during early childhood and that the role of unhealthy dietary intake in child EF should be explored further. Future longitudinal studies that include multi-method approaches are needed to document the mechanisms through which household chaos impacts child EF over time.
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Affiliation(s)
- Samantha Iwinski
- Department of Human Development and Family Studies, University of Illinois, Urbana, IL 61801, USA; (B.F.); (K.B.)
- Correspondence: ; Tel.: +1-708-606-3235
| | - Sharon M. Donovan
- Division of Nutritional Sciences, University of Illinois, Urbana, IL 61801, USA;
- Department of Food Science and Human Nutrition, University of Illinois, Urbana, IL 61801, USA
| | - Barbara Fiese
- Department of Human Development and Family Studies, University of Illinois, Urbana, IL 61801, USA; (B.F.); (K.B.)
| | - Kelly Bost
- Department of Human Development and Family Studies, University of Illinois, Urbana, IL 61801, USA; (B.F.); (K.B.)
- Division of Nutritional Sciences, University of Illinois, Urbana, IL 61801, USA;
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7
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Parental Feeding Practices and Child-Related Factors are Associated with Overweight and Obesity in Children and Adolescents with Autism Spectrum Disorder. J Autism Dev Disord 2021; 52:3655-3667. [PMID: 34453670 DOI: 10.1007/s10803-021-05247-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
Atypical eating behaviors displayed by children with autism spectrum disorder (ASD) predispose them to unhealthy weight gain. We determined the factors associated with body weight status among 261 children with ASD (3-18 years) at nine autism intervention centers. Their mothers completed a self-administered questionnaire on sociodemographic background, parenting style, parental feeding practices, parenting stress, sleep habits, eating behaviors, and autism severity. Children with older age, non-full term gestational age, high maternal perceived weight, high maternal concern about child weight, and low pressure to eat were more likely to be overweight and obese. Obesity is a major concern among children with ASD. Healthy weight management programs for parents should incorporate appropriate feeding practices and a healthy perception of body weight.
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Fouche C, Richter S, Vallianatos H, Mason A, Fernández-Sánchez H, Mazzucato V, Kariwo M, Salami B. African immigrant child health: A scoping review. J Migr Health 2021; 4:100054. [PMID: 34405197 PMCID: PMC8352012 DOI: 10.1016/j.jmh.2021.100054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 06/08/2021] [Accepted: 06/13/2021] [Indexed: 11/17/2022] Open
Abstract
The health of migrant children is a pressing issue. While most African migration takes place within Africa, a significant number of African migrants travel to outside of the continent. This article reports findings from a scoping review on the health of African immigrant children from sub-Saharan Africa now living outside of Africa. A systematic search for studies published between 2000 and 2019 resulted in only 20 studies reporting on the health of children up to 18 years of age migrating from sub-Saharan Africa. Data from these articles were thematically analyzed, highlighting concerns related to the children's nutrition status (n = 8), mental health (n = 7), and physical health (n = 5). Study participants were primarily from Somali and Ethiopia, and most studies were conducted in Australia or Israel. The review highlights several gaps related to the scope, range, and nature of evidence on the health of African immigrant children living outside of Africa. In particular, most focus on children's nutritional and mental health, but pay little attention to other health concerns this specific population may encounter or to the benefits associated with effective responses.
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Affiliation(s)
- C. Fouche
- Faculty of Education and Social Work, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - S. Richter
- Faculty of Nursing, University of Alberta, Canada
| | | | - A. Mason
- Faculty of Nursing, University of Alberta, Canada
| | | | - V. Mazzucato
- Faculty of Arts and Social Sciences, Maastricht University, Netherlands
| | - M. Kariwo
- Faculty of Nursing, University of Alberta, Canada
| | - B. Salami
- Faculty of Nursing, University of Alberta, Canada
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Tesfaw LM, Muluneh EK. Wealth index and other behavioral and sociodemographic characteristics associated with body mass index in Ethiopia. SAGE Open Med 2021; 9:20503121211016156. [PMID: 34094557 PMCID: PMC8142017 DOI: 10.1177/20503121211016156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 04/18/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Nowadays, the burden of non-communicable diseases including obesity has been an increasing public health concern. This menace can be monitored using indexing method like body mass index. Studies indicate that socioeconomic indicators such as income, biology, behavior, and demographic factors associated with body mass index. In Ethiopia, few studies associate wealth index with body mass index in people of ages between 15 and 49. This study was aimed to assess the association of body mass index with wealth index, and behavioral and sociodemographic population characteristics. Methods: A cross-sectional population-based study was conducted using the 2016 Ethiopian Demographic and Health Survey population of ages 15–49. A total of 10,245 individuals were considered to detect the effect of socioeconomic, biological, behavioral, and demographic factors on body mass index using logistic regression. Results: The prevalence of underweight, overweight, and obesity among men are 23.8%, 6.6%, and 2.0%, respectively, which is lower than that of women (underweight 25.3%, overweight 9.1%, and obesity 2.9%). The poorest men had higher odds of being underweight (adjusted odds ratio = 2.395%; 95% confidence interval = 2.020–3.544) as compared to the richest men. Merchants and government employees have lower odds (adjusted odds ratio = 0.744; 95% confidence interval = 0.588–0.899) compared to men whose occupation is farming and labor, indicating that merchants and government employees are more likely to become overweight and obese compared to men who are farmers and laborers. Conclusion: It is concluded that wealth index is an important socioeconomic determinant of body mass index among men and women of age 15–49 in Ethiopia. A high prevalence of underweight, and overweight, and obesity is observed, which increases instances of non-communicable diseases. Effects of socioeconomic, biological, behavioral, and demographic indicators on body mass index differed according to sex.
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Abstract
PURPOSE OF REVIEW The childhood obesity epidemic is widely considered to have reached pandemic proportions. Across the world, children with obesity are facing numerous psychological and physiological issues that follow them into adulthood, frequently leading to chronic illness and early death. In an effort to combat the compounding effects of childhood overweight, researchers are attempting to identify biological and environmental contributors to child weight. Parenting styles are one recognized influence on child diet and body mass index (BMI). This review is a comprehensive examination of the literature on the influence of parenting style on childhood diet and BMI over the past 5 years. RECENT FINDINGS Current research continues to support the use of traditional parenting style categories (i.e., authoritative, authoritarian, permissive, uninvolved/neglectful): however, newer subcategories of Baumrind's styles and the inclusion of previously underrepresented groups (e.g., fathers, cross cultural comparison studies) are shedding more light on the nuance of parenting's relationship with child weight. Parenting styles that focus on the balance of warmth and control (e.g., authoritative) in contrast to the styles dedicated to only one of these constructs (e.g., permissive, authoritarian) seem to promote the healthiest dietary habits and may be protective of child BMI.
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11
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Amiri S. Obesity and overweight prevalence in immigration: A meta-analysis. OBESITY MEDICINE 2021; 22:100321. [DOI: 10.1016/j.obmed.2021.100321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
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Skelton JA, Van Fossen C, Harry O, Pratt KJ. Family Dynamics and Pediatric Weight Management: Putting the Family into Family-Based Treatment. Curr Obes Rep 2020; 9:424-441. [PMID: 33108634 DOI: 10.1007/s13679-020-00407-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW The treatment of pediatric obesity entails working with entire families. However, aside from parenting and family health behaviors, family dynamics and relationships are not often incorporated in clinical treatment of obesity. RECENT FINDINGS Evidence across several studies suggest a relationship between family dynamics and child weight, with impaired family dynamics associated with higher weight status in children. Evidence is mixed if child age and family function are associated. Unfortunately, there is little evidence that addressing family dynamics (i.e., relationships and overall family system) will improve weight in children with obesity. Notably, few studies target family dynamics specifically. There are several validated measures of family dynamics available for researchers to explore the family system as it relates to child health and behaviors. A deeper understanding of family dynamics and relationships may provide new avenues to address issues of weight in children; accounting for the family, and their underlying functioning, may benefit the clinician and child engaged in weight management.
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Affiliation(s)
- Joseph A Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27157, USA.
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Catherine Van Fossen
- Department of Human Sciences, Human Development and Family Science Program, College of Education and Human Ecology, The Ohio State University, Columbus, OH, USA
| | - Onengiya Harry
- Department of Pediatrics, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27157, USA
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Keeley J Pratt
- Department of Human Sciences, Human Development and Family Science Program, College of Education and Human Ecology, The Ohio State University, Columbus, OH, USA
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
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Alsubhi M, Goldthorpe J, Epton T, Khanom S, Peters S. What factors are associated with obesity-related health behaviours among child refugees following resettlement in developed countries? A systematic review and synthesis of qualitative and quantitative evidence. Obes Rev 2020; 21:e13058. [PMID: 32608177 DOI: 10.1111/obr.13058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 11/30/2022]
Abstract
Refugee children are likely to become less active and eat more unhealthily after their resettlement in developed countries. This review aims to identify and synthesize research about factors that influence unhealthy behaviours related to obesity in this population. Six electronic databases were searched systematically to identify studies that sampled refugee children or parents of refugee children aged 2 to 16 years who have resettled in a developed country. Methodological and cultural study quality was assessed and factors associated with obesity-related health behaviours investigated. Twenty studies fulfilled the inclusion criteria. Five major themes, representing factors influencing health behaviours, were identified from the data synthesis process: Acculturation, Environmental, Socioeconomic, Cognitive, and Family. The analysis revealed that refugee's health behaviours are influenced by several complex factors that are common to immigrant groups but have a greater influence among refugees. The review also revealed parental practices influence the health behaviours of children, especially those aged 2 to 10 years. Research is needed to understand further the role that parents have in influencing health behaviours and weight trajectories of children following resettlement.
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Affiliation(s)
- Maha Alsubhi
- Manchester Centre for Health Psychology, Division of psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester, UK
| | - Joanna Goldthorpe
- Manchester Centre for Health Psychology, Division of psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester, UK
| | - Tracy Epton
- Manchester Centre for Health Psychology, Division of psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester, UK
| | - Sonia Khanom
- Centre for Epidemiology Versus Arthritis, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Sarah Peters
- Manchester Centre for Health Psychology, Division of psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester, UK
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KavehFarsani Z, Kelishadi R, Beshlideh K. Study of the effect of family communication and function, and satisfaction with body image, on psychological well-being of obese girls: the mediating role of self-esteem and depression. Child Adolesc Psychiatry Ment Health 2020; 14:39. [PMID: 33062050 PMCID: PMC7552351 DOI: 10.1186/s13034-020-00345-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 10/05/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Obesity has become a global problem in childhood and adolescence. The objective of the present study was to investigate the impact of family communication and function, and body image satisfaction, on psychological well-being by considering: the mediating role of self-esteem and depression. METHODS In this cross sectional study, 173 obese and overweight female students were selected and evaluated based on body image satisfaction, self-esteem, depression, psychological well-being, functioning, and family Communication. The proposed model was evaluated through structural equation modeling, using AMOS and SPSS software. RESULTS Results showed that family communication and function directly affected adolescents' psychological well-being. In addition, family communication and function, as well body image satisfaction indirectly affected psychological well-being through self-esteem and depression. CONCLUSION The current finding suggests that the psychological well-being of obese adolescent girls is associated with many factors, including family functioning and communication, body image satisfaction, self-esteem, and depression. The factors identified in this study may be helpful for mental health policy-makers, in planning and implementing preventive and therapeutic intervention programs.
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Affiliation(s)
| | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Kioumars Beshlideh
- Department of Psychology, Shahid Chamran University of Ahvaz, Ahvaz, Iran
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Paz-Morales MDLÁ, Martínez-Martínez A, Guevara-Valtier MC, Ruiz-González KJ, Pacheco-Pérez LA, Ortiz-Félix RE. [Family functioning, parental rearing and its relationship to nutritional status in preschoolers]. Aten Primaria 2020; 52:548-554. [PMID: 32605723 PMCID: PMC7505860 DOI: 10.1016/j.aprim.2020.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/27/2020] [Accepted: 02/29/2020] [Indexed: 12/05/2022] Open
Abstract
Objetivo Analizar la asociación entre funcionalidad familiar, crianza parental y estado nutricional en preescolares. Diseño Estudio cuantitativo, descriptivo correlacional y transversal. Emplazamiento Instituciones públicas de educación preescolar en el estado de Nuevo León, México. Atención Primaria. Participantes Muestra compuesta por 228 diadas (madre o padre y preescolar); se tomó como único criterio de inclusión ser el responsable principal de la crianza del preescolar. Mediciones principales Se empleó un cuaderno de recogida datos sociodemográficos, el estado nutricional se determinó basándose en recomendaciones de la Organización Mundial de la Salud, se utilizaron la Escala de Evaluación de la Cohesión y la Adaptabilidad Familiar y el cuestionario de Estilos de Crianza Parental. Se obtuvo estadística descriptiva y el coeficiente de correlación de Spearman. Resultados El promedio de edad de los padres fue de 32,09 años, el 60,5% de las madres se dedican al hogar y el 100% de los padres trabaja; la media de escolaridad en años fue de 12,16; el 68,9% de los participantes son casados; referente a los preescolares, el 29,4% presentó sobrepeso u obesidad. En cuanto a la funcionalidad familiar, se identificó que en la dimensión de cohesión es semirrelacionada el 44,3%. El estilo de crianza parental que predominó en los padres fue el permisivo con el 62,3%. Conclusiones La mayoría de los padres de familia presentaron desequilibrio en la funcionalidad familiar. No se encontró significación estadística entre funcionalidad familiar y crianza parental con estado nutricional en preescolares (p < 0,05).
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Hruska V, Ambrose T, Darlington G, Ma DWL, Haines J, Buchholz AC. Stress is Associated with Adiposity in Parents of Young Children. Obesity (Silver Spring) 2020; 28:655-659. [PMID: 32030916 DOI: 10.1002/oby.22710] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 10/15/2019] [Indexed: 01/24/2023]
Abstract
OBJECTIVE This study investigated associations between stress (general stress, parenting distress, and household chaos) and adiposity among parents of young children. METHODS The sample consisted of 49 mothers and 61 fathers from 70 families with young children living in Ontario, Canada. Linear regression using generalized estimating equations was used to investigate associations between stress measures and BMI, waist circumference (WC), waist to height ratio (WHtR), and percent fat mass. RESULTS General stress was significantly associated with BMI ( β ^ = 0.54; 95% CI: 0.04-1.03) and WC ( β ^ = 1.44; 95% CI: 0.10-2.77). Parenting distress was significantly associated with BMI ( β ^ = 0.16; 95% CI: 0.02-0.31), WC ( β ^ = 0.39; 95% CI: 0.04-0.75), and WHtR ( β ^ = 0.003; 95% CI: 0.001-0.005). Household chaos was significantly associated with all adiposity measures (BMI: β ^ = 0.20 [95% CI: 0.08-0.33]; WC: β ^ = 0.48 [95% CI: 0.21-0.75]; WHtR: β ^ = 0.003 [95% CI: 0.001-0.005]; percent fat mass: β ^ = 0.29 [95% CI: 0.08-0.49]). CONCLUSIONS General stress, parenting distress, and household chaos are associated with adiposity among parents of young children. Future research should elucidate mechanisms by which this occurs and elucidate how this risk may be mitigated.
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Affiliation(s)
- Valerie Hruska
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Tory Ambrose
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Gerarda Darlington
- Department of Mathematics and Statistics, University of Guelph, Guelph, Ontario, Canada
| | - David W L Ma
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Jess Haines
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Andrea C Buchholz
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
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Prasetyo YB, Kurnia AD, Masruroh NL, Nursalam N, Hargono R, Ahsan A, Kumboyono K. Factors influencing promotive behaviours in mothers of Indonesian children with avoidant restrictive food intake disorder. J Taibah Univ Med Sci 2019; 14:454-459. [PMID: 31728144 PMCID: PMC6838962 DOI: 10.1016/j.jtumed.2019.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/24/2019] [Accepted: 07/26/2019] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES This study aimed to identify predictors of promotive behaviours in mothers of Indonesian children with avoidant restrictive food intake disorder (ARFID). METHODS A cross-sectional descriptive survey was administered to 245 mothers who were caring for children with ARFID. Data were collected with a self-administered questionnaire. For descriptive data analysis, independent t-test, Mann-Whitney U test, one-way analysis of variance, Kruskal-Wallis, and multiple linear regression were employed. RESULTS The factors related to promotive behaviours in these mothers were embodied in mutual parenting, especially in terms of childcare (p = 0.001 < 0.05) and interaction with children (p = 0.001 < 0.05. Additionally, multiple linear regression showed that mutual parenting remained at the communication domain, with children as the primary predictor (β 0.401, p 0.001), where the number of children (β -0.201, p = 0.008) influenced the promotive behaviours. CONCLUSIONS This study found that the number of children and mutual parenting in interacting with children were key factors that influenced promotive behaviours in mothers of children with ARFID. We suggest that nursing interventions can potentially improve promotive behaviours in this population.
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Affiliation(s)
- Yoyok B. Prasetyo
- Department of Health Sciences, Faculty of Public Health, Airlangga University, Indonesia
| | - Anggraini D. Kurnia
- Community Department, Department of Nursing, Faculty of Health Sciences, University of Muhammadiyah Malang, Indonesia
| | - Nur L. Masruroh
- Community Department, Department of Nursing, Faculty of Health Sciences, University of Muhammadiyah Malang, Indonesia
| | | | - Rahmat Hargono
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Airlangga University, Indonesia
| | - Ahsan Ahsan
- Department of Nursing, Faculty of Medicine, Brawijaya University, Indonesia
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Armoon B, Karimy M. Epidemiology of childhood overweight, obesity and their related factors in a sample of preschool children from Central Iran. BMC Pediatr 2019; 19:159. [PMID: 31109318 PMCID: PMC6526611 DOI: 10.1186/s12887-019-1540-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 05/14/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Childhood overweight and obesity are strongly associated with the psychological and physical health of those for the duration of the lifetime. The purpose of this study was to assess the epidemiology of childhood overweight and obesity and their related factors in Zarandieh city, of Iran, in 2017. METHODS In a cross-sectional study, 572 preschool-mother dyads from primary care Clinics were selected by multi-stage sampling method. BMI of the children and mothers were calculated using standard method and the demographic, children nutrition and physical activity habits; the mothers perceived threat toward obesity, and their life style data were collected by self-report questionnaires for the literate mothers and interviewing for illiterate mothers. RESULT The prevalence of overweight and obesity in mothers was 30.8 and 20.3% respectively. This rate in children was 15.5 and 9.9% respectively. The multiple logistic regression analysis showed that variables of mother's BMI, Birth weight, Mother's employment, watching TV > 2 h/day, Computer games> 2 h/day and daily breakfast eating (≥4/week), perceived threat, health responsibility, stress management, physical activity, and healthy eating were the significant predictors of the child's BMI respectively. CONCLUSIONS Our results indicated that the prevalence of overweight and obesity are high in preschool children and their mothers. It seems that necessary to have suitable intervention programs to help mothers understand the serious risk of childhood obesity and the importance of creating a healthy lifestyle by them in childhood.
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Affiliation(s)
- Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Tehran-Saveh freeway, Keveh Industrial Estate Company, Saveh, Postcode: 3914334911, Iran
| | - Mahmood Karimy
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Tehran-Saveh freeway, Keveh Industrial Estate Company, Saveh, Postcode: 3914334911, Iran.
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Martin-Biggers J, Quick V, Spaccarotella K, Byrd-Bredbenner C. An Exploratory Study Examining Obesity Risk in Non-Obese Mothers of Young Children Using a Socioecological Approach. Nutrients 2018; 10:E781. [PMID: 29914210 PMCID: PMC6024647 DOI: 10.3390/nu10060781] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/11/2018] [Accepted: 06/15/2018] [Indexed: 11/23/2022] Open
Abstract
This cross-sectional, exploratory study aimed to (1) develop an obesity risk score using a comprehensive set of variables assessing mothers’ intrapersonal weight-related characteristics and those of their homes’ interpersonal and physical environments, and (2) determine how weight-related characteristics differ by obesity risk level. U.S. mothers (N = 550) of preschool-aged children completed an online survey that assessed maternal self-report weight status, sociodemographics, health-related characteristics, and maternal intrapersonal and their homes’ interpersonal and physical environment weight-related characteristics. Binomial logistic regression analysis identified variables significantly associated with obesity. Scores for all obesity risk variables were summed to create a weighted obesity risk score for non-obese participants (n = 386). Analysis of variance and Tukey post-hoc tests determined how non-obese mothers’ sociodemographic, health-related, and intrapersonal and their homes’ interpersonal and physical environment characteristics differed among obesity risk score tertiles. Results revealed that eight variables explained 53 percent of maternal obesity risk, including African American race, lower education level, more children in household, poorer maternal health, higher weight teasing history, higher body dissatisfaction, primary relative with obesity, and greater concern about children’s overweight risk. Non-obese mothers in the highest obesity risk tertile had greater food insecurity risk, lower family affluence, worse sleep quality, less fruit/vegetable availability, and reported less frequent modeling of healthy behaviors and more family conflict. In conclusion, eight characteristics that explained more than half of the risk for obesity in non-obese mothers of young children, may help healthcare professionals identify mothers at increased risk of obesity and offer preventive care early.
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Affiliation(s)
- Jennifer Martin-Biggers
- Department of Nutritional Sciences, Rutgers University, 26 Nichol Avenue, New Brunswick, NJ 08901, USA.
| | - Virginia Quick
- Department of Nutritional Sciences, Rutgers University, 26 Nichol Avenue, New Brunswick, NJ 08901, USA.
| | - Kim Spaccarotella
- Department of Biological Sciences, Kean University, 1000 Morris Avenue, Union, NJ 07082, USA.
| | - Carol Byrd-Bredbenner
- Department of Nutritional Sciences, Rutgers University, 26 Nichol Avenue, New Brunswick, NJ 08901, USA.
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Martin-Biggers J, Quick V, Zhang M, Jin Y, Byrd-Bredbenner C. Relationships of family conflict, cohesion, and chaos in the home environment on maternal and child food-related behaviours. MATERNAL AND CHILD NUTRITION 2017; 14:e12540. [PMID: 28994511 DOI: 10.1111/mcn.12540] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/25/2017] [Accepted: 09/11/2017] [Indexed: 11/29/2022]
Abstract
This study examined how food-related behaviours differed in mothers and their preschool children by levels of family functioning (cohesion and conflict) and household disorganization (chaos). A nationally representative sample of mothers of preschoolers completed an online survey assessing food-related behaviours of themselves and their children. Maternal and child diet, eating behaviours, and health status; household availability of fruits/vegetables, salty/fatty snacks, and sugar-sweetened beverages; family mealtime atmosphere; and family conflict, cohesion, and household chaos were assessed with valid, reliable scales. Cluster analyses assigned families into low, middle, and high conflict, cohesion, and chaos groups. Participants (n = 550) were 72% White, and 82% had some post-secondary education. Regression analysis examining the association of cluster grouping levels on diet-related behaviour measures revealed that positive home environments (i.e., low family conflict, high family cohesion, and low household chaos) were associated with healthier food-related behaviours (e.g., increased fruits/vegetables intake), whereas negative home environments (i.e., high family conflict, low family cohesion, and high household chaos) were associated with unhealthy food-related behaviours (e.g., greater % total calories from fat) even after controlling for sociodemographic and related behavioural factors. Findings suggest family functioning and household chaos are associated with food-related behaviours. This frequently overlooked component of family interaction may affect intervention outcomes and objectives of educational and interventional initiatives.
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Affiliation(s)
- Jennifer Martin-Biggers
- Department of Nutritional Sciences, Rutgers University, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Virginia Quick
- Department of Nutritional Sciences, Rutgers University, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Man Zhang
- Department of Food Science, Rutgers University, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Yanhong Jin
- Department of Agricultural, Food and Resource Economics, Rutgers University, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Carol Byrd-Bredbenner
- Department of Nutritional Sciences, Rutgers University, The State University of New Jersey, New Brunswick, New Jersey, USA
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Espinoza J, Chen A, Orozco J, Deavenport-Saman A, Yin L. Effect of personal activity trackers on weight loss in families enrolled in a comprehensive behavioral family-lifestyle intervention program in the Federally Qualified Health Center setting: a randomized controlled trial. Contemp Clin Trials Commun 2017; 7:86-94. [PMID: 29308436 PMCID: PMC5753795 DOI: 10.1016/j.conctc.2017.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 06/02/2017] [Accepted: 06/10/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Childhood obesity continues to be a substantial problem despite major public health efforts, and disproportionately impacts children from low-income families. Digital health tools and consumer technology offer promising opportunities for interventions, but few studies have evaluated how they might be incorporated into existing interventions or used to create new types of interventions. It remains unclear which approaches would be most beneficial for underserved pediatric populations. PURPOSE To describe the design and rationale of a single-center randomized, controlled trial evaluating the effects of personal activity tracker (PAT) use by parents on weight-status improvement in both parents and overweight children enrolled in BodyWorks (BW), a comprehensive behavioral family-lifestyle intervention program (CBFLI), in a primary-care clinic serving a predominantly low-income Latino population. METHODS This study is being conducted in the AltaMed general pediatrics clinic at Children's Hospital Los Angeles. Eligible participants are families (child and adult caregiver) in which the child is between 7-18 years of age, has a BMI ≥85th percentile for age and sex, and has been referred to BW by their AltaMed pediatrician. BW consists of one weekly, two-hour session for 7 weeks. In a given cycle, the program is offered on two separate nights: Monday (Spanish) and Wednesday (English). Families self sort into one of two groups based on language preference. To ensure balanced allocation of language preference groups and prevent in-group cross contamination, block randomization is used to assign whole groups to either the intervention or control arms of the study. The control arm consists of usual care, while the intervention arm adds assigning a Fitbit PAT to the parents and training them in its proper use. Study personnel are blinded to group assignment during the analysis phase. Study outcomes include attendance rate, program completion rate, and changes in weight-status improvement, defined as change in weight and BMI for adults and change in BMI z-score for children. We hypothesize that the intervention arm will have better weight-related outcomes than the control arm. Study completion is anticipated in 2017, after the enrollment of approximately 150 families. CONCLUSIONS The study aim is to evaluate the effects of PATs on weight-related outcomes in overweight children and parents participating in a CBFLI. The results will be important for determining whether wearable devices are an effective addition to weight loss interventions for overweight and obese children.
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Affiliation(s)
- Juan Espinoza
- Division of General Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA
| | - Alexander Chen
- Keck School of Medicine of Keck School of the University of Southern California, 1975 Zonal Avenue, Los Angeles, CA 90033, USA
| | - Jazminne Orozco
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, 1540 Alcazar Street, CHP 133, Los Angeles, CA 90089, USA
| | - Alexis Deavenport-Saman
- Keck School of Medicine of Keck School of the University of Southern California, 1975 Zonal Avenue, Los Angeles, CA 90033, USA
| | - Larry Yin
- Division of General Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA
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