Ana Cristina Lindsay

Influence of Social Context on Eating, Physical Activity, and Sedentary Behaviors of Latina Mothers and Their Preschool-Age Children

As more U.S. children grow up in Latino families, understanding how social class, culture, and environment influence feeding practices is key to preventing obesity. The authors conducted six focus groups and 20 in-depth interviews among immigrant, low-income Latina mothers in the Northeast United States and classified 17 emergent themes from content analysis according to ecologic frameworks for behavior change. Respondents related environmental influences to child feeding, diet, and activity, namely, supermarket proximity, food cost, access to recreational facilities, neighborhood safety, and weather. Television watching was seen as integral to family life, including watching during meals and using TV as babysitter and tool to learn English. Participation in the WIC program helped families address food insecurity, and child care provided healthy eating and physical activity opportunities. Health promotion efforts addressing obesity trends in Latino children must account for organizational and environmental influences on the day-to-day social context of young immigrant families.

A Qualitative Study of Diverse Experts' Views about Barriers and Strategies to Improve the Diets and Health of Supplemental Nutrition Assistance Program (SNAP) Beneficiaries

The Supplemental Nutrition Assistance Program (SNAP), the largest federal food assistance program, currently serves 44.7 million Americans with a budget of

Prevalência e determinantes de obesidade e sobrepeso em mulheres em idade reprodutiva residentes na região semiárida do Brasil

75 billion in 2011. This study engaged leading experts for in-depth, semi-structured interviews to explore their opinions concerning the existing challenges and barriers to eating nutritiously in SNAP. Experts also proposed strategies for improving nutritional status among SNAP recipients. Twenty-seven individuals were interviewed from advocacy, government, industry, and research organizations. Interviews were recorded, transcribed, coded, and analyzed for thematic content. The high cost of nutrient-rich foods, inadequate SNAP benefits, limited access to purchasing healthy foods, and environmental factors associated with poverty were identified as barriers that influence nutrition among low-income households in the United States. Six themes emerged among respondents from diverse sectors about how to address these challenges, including providing SNAP participants with incentives to purchase nutrient-rich food consistent with the 2010 Dietary Guidelines for Americans, restricting the purchase of nutrient-poor foods and beverages with program benefits, modifying the frequency of SNAP benefit distribution, enhancing nutrition education, improving the SNAP retailer environment, and increasing state and federal level coordination and consistency of program implementation. Given the recent dramatic increase in SNAP enrollment, policymakers must address existing barriers as well as consider new strategies to improve nutrition policies in SNAP so that the program can continue to address food insecurity needs as well as provide a healthful diet for SNAP beneficiaries.

Latino family childcare providers' beliefs, attitudes, and practices related to promotion of healthy behaviors among preschool children: a qualitative study.

O estudo estimou a prevalencia e identificou fatores determinantes do sobrepeso e obesidade em mulheres em idade fertil na regiao semiarida do Brasil. Na amostra por conglomerados de oito mil domicilios do estado do Ceara, foram pesquisadas 6.845 mulheres. Sobrepeso e obesidade foram medidos pelo Indice de Massa Corporal, utilizando-se a analise multivariada para a identificacao dos fatores determinantes. As prevalencias de sobrepeso e obesidade foram de 32,6% e 16,1%, respectivamente. Na analise ajustada, a obesidade esteve positivamente associada a: idade >30 anos (RP=1,55), estado civil casada (RP=1,36), escolaridade fundamental (RP=1,40), idade na menarca 1 filho (RP=1,65), uso de contraceptivos (RP=1,31). Os fatores relacionados a saude e a nutricao, referentes a obesidade morbida, foram: hipertensao arterial (RP=3,11), diabetes (RP=2,08), insatisfacao com a imagem corporal (RP=4,26) e procedimentos para perder peso (RP=2,73). Sobrepeso e obesidade sao altamente prevalentes na regiao semiarida. A educacao foi o unico fator socioeconomico passivel de ser modificado. Os fatores reprodutivos identificados apontam para a necessidade de mobilizacao dos servicos de pre-natal, pos-parto e planejamento familiar na prevencao e no controle da obesidade.

Prevalence and determinants of child undernutrition and stunting in semiarid region of Brazil

Background. The continuing rise of obesity among Latinos is a public health concern with an immediate need for early prevention. Changes in family structures have increased demand and reliance for child care for young children. Latino children are the fastest-growing segment of the child population in the United States, and research shows that Latino families use preschools and day care centers much less than those of other ethnic groups, apparently because of cultural preferences for family-like care. Objectives. Given that many low income Latino children attend family child care homes (FCCHs), there is a need to explore the role that FCCH providers may play in establishing and reinforcing childrens early healthful eating and physical activity behaviors and consequently in the prevention of childhood obesity. Design. Using purposive sampling, six focus groups were conducted in Spanish with licensed Latino FCCH providers (n = 44). Data was analyzed to identify recurrent themes. Results. Latino FCCH providers described how they play an influential role in promoting healthful eating and physical activity behaviors of preschool children in their care. They also identified many barriers and challenges in establishing and maintaining healthful nutrition and physical activity behaviors, including high cost of healthy foods, cold weather, and physical environment of FCCH. Conclusions. Latino FCCH providers can have a strong impact in promoting healthful behaviors in low-income, Latino communities. They may be able to effectively deliver interventions targeting low-income, minority families to promote healthful eating and physical activity behaviors and prevent child obesity.

Condições sociodemográficas de crianças de zero a dois anos filhas de mães com HIV/Aids, Fortaleza, CE, Brasil

OBJETIVO : Analisar tendencias na prevalencia e determinantes da desnutricao em criancas na regiao semiarida do Brasil. METODOS : Foram analisados dados de duas pesquisas transversais domiciliares de base populacional que utilizaram a mesma metodologia. A amostragem por conglomerados foi utilizada para coletar os dados de 8.000 familias, do estado do Ceara, Nordeste do Brasil, para os anos de 1987 e 2007. A desnutricao aguda foi calculada como peso/idade < -2 desvios padrao; nanismo como altura/idade < -2 desvios padrao; e emaciacao como peso/altura < -2 desvios padrao. Os dados sobre os determinantes biologicos e sociodemograficos foram analisados por meio de analises multivariadas com base em um modelo teorico hierarquizado. RESULTADOS : Amostras de 4.513 e 1.533 criancas menores de tres anos de idade, em 1987 e 2007, respectivamente, foram incluidas nas analises. A prevalencia de desnutricao aguda foi reduzida em 60,0%, passando de 12,6% em 1987, para 4,7% em 2007, enquanto a prevalencia de nanismo foi reduzida em 50,0%, passando de 27,0% em 1987 para 13,0% em 2007. A prevalencia de emaciacao teve pouca alteracao no periodo. Em 1987, as caracteristicas socioeconomicas e biologicas (renda familiar, escolaridade da mae, disponibilidade de latrina e agua potavel, consulta medica e hospitalizacao da crianca, idade, sexo e peso ao nascer) foram fatores significativamente associados a desnutricao, ao nanismo e a emaciacao. Em 2007, os determinantes da desnutricao ficaram restritos as caracteristicas biologicas (idade, sexo e peso ao nascer). Apenas uma caracteristica socioeconomica, a disponibilidade de latrina, permaneceu significantemente associada ao nanismo. CONCLUSOES : O desenvolvimento socioeconomico, alem de intervencoes de saude, parecem ter efetivamente contribuido para a melhoria do estado nutricional das criancas. Peso ao nascer, especialmente o peso extremamente baixo (< 1.500 g), aparece como o fator de risco mais importante para a desnutricao na primeira infância.OBJECTIVE To analyze the evolution in the prevalence and determinants of malnutrition in children in the semiarid region of Brazil. METHODS Data were collected from two cross-sectional population-based household surveys that used the same methodology. Clustering sampling was used to collect data from 8,000 families in Ceará, Northeastern Brazil, for the years 1987 and 2007. Acute undernutrition was calculated as weight/age < -2 standard deviation (SD); stunting as height/age < -2 SD; wasting as weight/height < -2 SD. Data on biological and sociodemographic determinants were analyzed using hierarchical multivariate analyses based on a theoretical model. RESULTS A sample of 4,513 and 1,533 children under three years of age, in 1987 and 2007, respectively, were included in the analyses. The prevalence of acute malnutrition was reduced by 60.0%, from 12.6% in 1987 to 4.7% in 2007, while prevalence of stunting was reduced by 50.0%, from 27.0% in 1987 to 13.0% in 2007. Prevalence of wasting changed little in the period. In 1987, socioeconomic and biological characteristics (family income, mother’s education, toilet and tap water availability, children’s medical consultation and hospitalization, age, sex and birth weight) were significantly associated with undernutrition, stunting and wasting. In 2007, the determinants of malnutrition were restricted to biological characteristics (age, sex and birth weight). Only one socioeconomic characteristic, toilet availability, remained associated with stunting. CONCLUSIONS Socioeconomic development, along with health interventions, may have contributed to improvements in children’s nutritional status. Birth weight, especially extremely low weight (< 1,500 g), appears as the most important risk factor for early childhood malnutrition.

Using qualitative methods to design a culturally appropriate child feeding questionnaire for low-income, Latina mothers.

OBJECTIVES: to ascertain the socio-demographic conditions of children aged between 0 and 2 years born to mothers testing positive for HIV / AIDS in the city of Fortaleza, in the Northeastern Brazilian State of Ceara. METHODS: a cross-sectional study was conducted involving the application of a semi-structured questionnaire to women caring for children (63 mothers and 5 grandmothers) at a State hospital outpatient clinic, between December 2005 and April 2006. RESULTS: the mean age of the mothers was 26 years. Approximately 16% were illiterate; 57.3% were married and 5.9% widows. More than two thirds (79.4%) of the women taking part in the study first became aware of their HIV status during their last delivery. 51.5% reported not having received any kind of social assistance from the government. The mean age of children was 15.6 months and 13% had not been tested for HIV. Most women came from rural communities (60.3%), and had a mean household income of R

Integrating Quantitative and Qualitative Methods to Assess the Impact of Child Survival Programs in Developing Countries: The Case of a Program Evaluation in Ceara, Northeast Brazil

446.32. 57.9% of the children lived in a household of five individuals or more and 31% reported having four or more children living in the same residence. CONCLUSIONS: there is a need for health promotion and disease prevention strategies to be implemented that take into account the social context of families living with HIV/AIDS.

Assessing the Feasibility of a Multi-Program School-Based Intervention to Promote Physical Activity and Healthful Eating in Middle Schools prior to Wide-Scale Implementation

Obesity rates remain high among children in the United States (US), but children of low-income, minority families are at particularly high risk. Latinos are the largest and most rapidly growing US population group. Effective strategies will require attention to a wide array of culturally mediated variables that influence child feeding practices through the social contexts in which behaviors take place. This paper presents the design and implementation of a qualitative study examining low-income, Latina mothers’ perceptions of child weight status and feeding practices, and their associations with the development of overweight in children. Guided by the social ecologic model and social contextual model on the role of the family in mediating health behavior, the Latina Mother Child Feeding Practices (LMCFP) study provided a systematic exploration of the influence of social class, culture, and environmental factors associated with mothers’ perceptions of child overweight on feeding practices and behaviors. The design for this qualitative study consisted of three sequential phases: focus groups, in-depth interviews and cognitive interviews with Latina mothers conducted by Spanish-speaking researchers. Results showed the important role of socio-cultural factors in influencing Latina mothers’ child feeding practices. In the short-term, this research yielded information to develop a child-feeding questionnaire appropriate for low-income, Latina mothers. Findings have important implications in developing nutrition education strategies for child health promotion that account for the social and cultural context of minority, low-income caregivers.

Access and utilization of healthcare services in Massachusetts, United States: a qualitative study of the perspectives and experiences of Brazilian-born immigrant women

In evaluating public health programs, the tradition has been to design quantitative approaches, relying on epidemiological and statistical techniques to determine if and to what extent a program has an effect on a predetermined targeted population. More recently, however, qualitative methods such as rapid ethnographic assessments and focus groups have been implemented more frequently. This article describes an outcome evaluation of a community health workers program that integrated quantitative and qualitative methods to assess the impact of child survival interventions in reducing infant mortality and inadequate weight gain in children among municipalities in the state of Ceara, Northeast Brazil. By using multiple methods that combine quantitative and qualitative components, researchers can broaden their understanding of complex public health issues and direct use of data for decision making.