Alma D. Guerrero

Racial and Ethnic Disparities in Pediatric Experiences of Family-Centered Care

Background:Previous studies have examined racial and ethnic disparities in the receipt of family-centered care among children with special health care needs and health plan enrollees, but the extent of disparities in the general pediatric population remains unclear. Objective:To examine racial and ethnic disparities in the receipt of family-centered care among a general population of US children. Methods:Linked data from the Medical Expenditure Panel Survey and the National Health Interview Survey (2003–2006) were used to study 4 family-centered care items and an overall composite measure of family-centered care. Adjusted models examined the extent to which child characteristics, socioeconomic, and access to care factors explained racial and ethnic disparities in the provision of family-centered care. Results:Black children have similar experiences as white children on overall family-centered care and on each of the 4 components of family-centered care in models that adjust for child characteristics and socioeconomic factors. In contrast, differences in dimensions of and overall family-centered care between white children and Latino children, irrespective of interview language, persist after multivariate adjustment. Conclusions:Future research should examine the extent to which Latino-white differences in the receipt of family-centered care can be narrowed with programs and policies geared at improving parental education, health literacy, the quality of provider communication, and quality improvement strategies for health care systems.

A Systematic Review of Obesity Prevention Intervention Studies among Immigrant Populations in the US

The aim of this review was to systematically assess the effectiveness of obesity prevention and control interventions in US immigrant populations across the life course, from preschool-age to adults. A systematic review of relevant studies was undertaken and eligible articles included. The initial search identified 684 potentially relevant articles, of which only 20 articles met the selection criteria, representing 20 unique studies. They were divided into interventions that targeted adults (n=7), interventions that targeted children (n=5) and pilot studies (n=8). The majority of interventions targeted Latinos, predominately Mexican-origin populations. Among the interventions targeting adults, five had an effect on obesity related outcomes. However, they tended to use less rigorous study designs. Among the interventions that targeted children, three had a positive effect on obesity-related outcomes. Three of the eight pilot studies had an effect on obesity-related outcomes. There is a paucity of data on effective interventions but a great need to address obesity prevention to help inform health policies and programs to reduce migration-related obesity inequalities.

A public health approach to pediatric residency education: responding to social determinants of health.

OBJECTIVE To evaluate the impact of a public health approach to pediatric residency education on learner knowledge, skills, attitudes, beliefs, and career choice. BACKGROUND Incorporating public health principles into traditional residency education can give pediatricians the population-oriented perspective to address social determinants of health. METHODS The Community Health and Advocacy Training (CHAT) program is an educational intervention with a public health framework. From 2001-2007, 215 categorical pediatric residents and 37 residents in the CHAT program were evaluated by using an annual survey of community pediatrics exposure, knowledge, attitudes, and beliefs. American Board of Pediatrics (ABP) examination passage rates for both groups were also examined, as was career choice after graduation. RESULTS While interns in both the categorical and CHAT programs scored similarly on attitudes, beliefs, skills, and knowledge of community pediatrics, the postgraduate level-3 (PL-3) year CHAT residents scored higher in attitudes (P < .001) and skills (P < .05). Exposure to both didactic (P < .05) and practical (P < .001) community pediatrics curricular experiences were higher for CHAT residents than for categorical residents. No significant differences between ABP examination scores were found for the 2 groups, although 100% of CHAT graduates passed on the first try compared to 91% of categorical graduates during this time period. A greater percentage of CHAT graduates (82%) than categorical graduates (53%) reported pursuing careers in primary care. CONCLUSION With a public health approach to residency education, residents gain the knowledge, attitudes, and skills to address child health problems from a population perspective. Participation in such a curriculum still resulted in high passage rates on the ABP examination.

Racial and Ethnic Disparities in Dietary Intake among California Children

BACKGROUND The prevalence of childhood obesity among racial and ethnic minority groups is high. Multiple factors affect the development of childhood obesity, including dietary practices. OBJECTIVE To examine the racial and ethnic differences in reported dietary practices among the largest minority groups of California children. METHODS Data from the 2007 and 2009 California Health Interview Survey were analyzed using multivariate regression with survey weights to examine how race, ethnicity, sociodemographic characteristics, and child factors were associated with specific dietary practices. RESULTS The sample included 15,902 children aged 2 to 11 years. In multivariate regressions, substantial differences in fruit juice, fruit, vegetable, sugar-sweetened beverages, sweets, and fast-food consumption were found among the major racial and ethnic groups of children. Asians regardless of interview language were more likely than whites to have low vegetable intake consumption (Asians English interview odds ratio [OR] 1.20, 95% CI 1.01 to 1.43; Asians non-English-interview OR 2.09, 95% CI 1.23 to 3.57) and low fruit consumption (Asians English interview OR 1.69, 95% CI 1.41 to 2.03; Asians non-English interview OR 3.04, 95% CI 2.00 to 4.6). Latinos regardless of interview language were also more likely than whites to have high fruit juice (Latinos English interview OR 1.54, 95% CI 1.28 to 1.84 and Latinos non-English interview OR 1.29, 95% CI 1.02 to 1.62) and fast-food consumption (Latinos English interview OR 1.74, 95% CI 1.46 to 2.08 and Latinos non-English interview OR 1.48, 95% CI 1.16 to 1.91); but Latinos were less likely than whites to consume sweets (Latinos English interview OR 0.81, 95% CI 0.66 to 0.99 and Latinos non-English interview OR 0.56, 95% CI 1.16 to 1.91). CONCLUSIONS Significant racial and ethnic differences exist in the dietary practices of California children. Increased fruit and vegetable consumption appears to be associated with parent education but not income. Our findings suggest that anticipatory guidance and dietary counseling might benefit from tailoring to specific ethnic groups to potentially address disparities in overweight and obesity.

Obesogenic Dietary Practices of Latino and Asian Subgroups of Children in California: An Analysis of the California Health Interview Survey, 2007–2012

OBJECTIVES We examined obesogenic dietary practices among Latino and Asian subgroups of children living in California. METHODS We analyzed 2007, 2009, and 2011-2012 California Health Interview Survey data to examine the differences in dietary practices among Mexican and non-Mexican Latino children and 7 ethnic subgroups of Asian children. We used multivariable regression to examine the sociodemographic factors associated with specific dietary practices. RESULTS Latino subgroups of children had few differences in obesogenic dietary practices, whereas Asian subgroups of children exhibited significant differences in several obesogenic dietary practices. Korean and Filipino children were more likely than Chinese children to consume fast food and have low vegetable intake. Filipino children, followed by Japanese children, had the most obesogenic dietary practices compared with Chinese children, who along with South Asian children appeared to have the least obesogenic dietary practices. In general, income, education, and acculturation did not explain the dietary differences among Asian groups. CONCLUSIONS Our findings suggest the need to disaggregate dietary profiles of Asian and Latino children and to consider nontraditional sociodemographic factors for messaging and counseling on healthy dietary practices among Asian populations.

Father Involvement in Feeding Interactions with Their Young Children.

OBJECTIVE To examine the associations of father-child feeding and physical interactions with dietary practices and weight status in children. METHODS A nationally representative sample of children, mothers, and fathers who participated in the Early Childhood Longitudinal Study Birth cohort study (N = 2441) was used to explore the relationship of father-child feeding and physical activity interactions with child dietary practices and weight status. Logistic multivariable regression analyses were adjusted for child, father, mother, and socio-demographic characteristics. RESULTS Approximately 40% of fathers reported having a great deal of influence on their preschool childs nutrition and about 50% reported daily involvement in preparing food for their child and assisting their child with eating. Children had over 2 times the odds of consuming fast food at least once a week if fathers reported eating out with their child a few times a week compared to fathers who reported rarely or never eating out with their child (OR, 2.89; 95% CI, 1.94-4.29), adjusting for all covariates. Whether fathers reported eating out with their children was also significantly associated with childrens sweetened beverage intake. CONCLUSIONS Potentially modifiable behaviors that support healthy dietary practices in children may be supported by targeting fathers.

Differences in the Association of Physical Activity and Children's Overweight and Obesity Status Among the Major Racial and Ethnic Groups of U.S. Children.

Objective. To examine the relationship of exercise with overweight and obesity among an ethnically diverse sample of U.S. children. Method. Data from the 2011-2012 National Survey of Children’s Health were analyzed to examine the relationship of daily exercise with children’s weight status. Propensity score covariate adjustment and multivariate logistic regression with survey weights were used to control for child, home, and community characteristics. Results. Approximately 22% of all children ages 10 to 17 years engaged in daily exercise for at least 20 minutes. In the adjusted model for the entire sample, daily exercise was associated with children having a lower likelihood of being overweight or obese (odds ratio = 0.79; 95% confidence interval = 0.68-0.91). In a stratified analysis of the major racial and ethnic groups, however, while White children who exercised daily were found to have a lower odds of being overweight or obese (odds ratio = 0.70; 95% confidence interval = 0.60-0.82), this relationship was not found for most minority children. Conclusions. Racial and ethnic minority children were not found to have the same weight status relationship with exercising daily. These findings suggest that some population-average exercise recommendations may not be as applicable to minority children.