Daphne C. Hernandez

Accumulation of childhood poverty on young adult overweight or obese status: race/ethnicity and gender disparities

Background Childhood poverty is positively correlated with overweight status during childhood, adolescence and adulthood. Repeated exposure of childhood poverty could contribute to race/ethnicity and gender disparities in young adult overweight/obese (OV/OB) weight status. Methods Young adults born between 1980 and 1990 who participated in the Young Adult file of the 1979 National Longitudinal Study of Youth were examined (N=3901). The accumulation of childhood poverty is captured via poverty exposure from each survey year from the prenatal year through age 18 years. Body mass index was calculated and categorised into the reference criteria for adults outlined by the Center for Disease Control. Logistic regression models were stratified by race/ethnicity and included a term interacting poverty and gender, along with a number of covariates, including various longitudinal socioeconomic status measures and indicators for the intergenerational transmission of economic disadvantage and body weight. Results Reoccurring exposure to childhood poverty was positively related to OV/OB for white, black and Hispanic young adult women and inversely related for white young adult men. A direct relationship between the accumulation of childhood poverty and OV/OB was not found for black and Hispanic young adult men. Conclusions Helping families move out of poverty may improve the long-term health status of white, black and Hispanic female children as young adults. Community area interventions designed to change impoverished community environments and assist low-income families reduce family level correlates of poverty may help to reduce the weight disparities observed in young adulthood.

Reliability, Validity, and Diagnostic Value of a Pediatric Bioelectrical Impedance Analysis Scale

BACKGROUND Accurate body composition assessment is critical to identify children who are overfat or obese. Unlike BMI measures, bioelectrical impedance analysis (BIA) differentiates between lean and fat mass. However, bioelectrical impedance analysis has historically had questionable reliability and validity in children. The aim of this study was to determine the reliability, validity, and diagnostic value of a portable BIA scale (Tanita BF-689; Tanita Corporation, Tokyo, Japan) designed specifically for use within the pediatric population. METHODS Fifty-five children (males = 26; females = 29) had percent body fat (%BF) assessed twice using BIA and once using dual-energy X-ray absorptiometry (DEXA). Intraclass correlation coefficients (ICCs) were calculated for reliability. Mean difference and limits of agreement were calculated for convergent validity. Sensitivity/specificity for healthy, overfat, and obese classification were assessed. RESULTS Test-retest ICC was 0.999 (0.999, 0.999). The ICC comparing BIA and DEXA for %BF was 0.788 (-0.167, 0.942). Mean difference between BIA and DEXA was -6.75% (limits of agreement = -0.04%; -13.46%). No gender or proportional bias was observed. Sensitivity/specificity for healthy, overfat, and obese classification were 0.67/0.65, 0.22/0.78, and 0.43/1.0, respectively. CONCLUSIONS The Tanita BF-689 demonstrates excellent test-retest reliability, moderately strong absolute agreement with DEXA, and high specificity for overfat and obese classification. Compared to DEXA, the BF-689 is an accurate, portable, and efficient means of assessing %BF in elementary school children.

Gender disparities among the association between cumulative family-level stress & adolescent weight status.

OBJECTIVE To investigate precursors to gender-related obesity disparities by examining multiple family-level stress indices. METHODS Analyses was based on adolescents born between 1975 and 1991 to women from the 1979 National Longitudinal Study of Youth data set (N=4762). Three types of family-level stressors were captured from birth to age 15: family disruption and conflict, financial strain, and maternal risky health behaviors, along with a total cumulative risk index. Body mass index was constructed on reference criteria for children outlined by the Centers for Disease Control. Multivariate logistic regressions were conducted for the three types of family stressors and for the total cumulative index. RESULTS The accumulation of family disruption and conflict and financial stress was positively related to female adolescents being overweight/obese. Childhood exposure to maternal risky health behaviors was positively associated with higher weight status for male adolescents. Total cumulative stress was related to overweight/obesity for females, but not males. CONCLUSION Different family-level stress indices are associated with the weight status of female and male adolescents. Combining types of family-level stress into one cumulative index appears to mask these differences.

Does social support mediate the relationship among neighborhood disadvantage, incivilities, crime and physical activity?

OBJECTIVE Neighborhood disadvantage (ND), incivilities, and crime disproportionately impact minority women, discouraging physical activity (PA). Social support (SS) is a cultural tool promoting PA in minority women. Socially supportive environments may promote PA in disadvantaged neighborhoods, yet few studies have investigated the mediating role of social support among minority women. This study examined SS as a mediator among ND, incivilities, crime, and PA. METHODS The Health Is Power study aimed to increase PA in African American and Hispanic Latina women (N=410) in Houston and Austin, TX. ND and crime data were taken from the National Neighborhood Crime Study. Incivilities were measured using the Pedestrian Environment Data Scan (PEDS). SS was measured using the Family and Friend Support for Exercise Habits scale and physical activity was measured using the International Physical Activity Questionnaire. Linear regression analysis was used to examine SS as a mediator following the Baron and Kenny method. RESULTS ND was negatively associated with PA and SS. SS was not a mediator as it was not significantly associated with ND, crime, and incivilities (F(3,264)=2.02, p>.05) or PA (F(1,266)=3.8 p=.052). CONCLUSION ND significantly discourages PA and limits SS. Future research should focus on developing strategies to overcoming these negative environmental factors.

Gender Disparities in the Food Insecurity–Overweight and Food Insecurity–Obesity Paradox among Low-Income Older Adults

BACKGROUND Obesity and obesity-related comorbidities are increasing among older adults. Food insecurity is a nutrition-related factor that coexists with obesity among low-income individuals. The majority of the research on the food insecurity-obesity paradox has been conducted on low-income mothers and children, with research lacking on large diverse samples of older adults. OBJECTIVE The purpose of this study was to assess gender disparities in the association between food insecurity and overweight and obesity among low-income older adults. STUDY DESIGN Cross-sectional 2011 and 2012 National Health Interview Survey data were used. Food insecurity status was determined by ≥3 affirmative responses on the 10-item US Department of Agriculture Food Security Scale (FSS). Body mass index (BMI) was calculated as outlined by the Centers for Disease Control and Prevention based on self-reported height and weight. PARTICIPANTS/SETTINGS Adults included were low-income (≤1.99 federal poverty level [FPL]), older (aged ≥60 years), with a normal BMI (18.5) or greater who had complete data on FSS, BMI, and the following covariates: age, race or ethnicity, marital status, income, nativity status, physical activity, poor health status, health insurance coverage, problems paying medical bills or for medicine, and region of residency (N=5,506). STATISTICAL ANALYSES PERFORMED Multivariate logistic regression models were stratified by gender to estimate the association between food insecurity and higher weight status. All models included covariates. RESULTS In covariate-adjusted models, compared with low-income, food secure men, low-income, food-insecure men had 42% and 41% lower odds of being overweight and overweight or obese, respectively. Despite the high prevalence rate of obesity among low-income, food-insecure women, food insecurity was not significantly related to overweight, obesity, or overweight or obesity for older adult women in adjusted models. CONCLUSIONS Food insecurity-overweight and -obesity paradox appears not to be present in older men. However, food insecurity and obesity coexist among low-income, older women.

Maternal Union Transitions and Household Food Insecurity Differences by Race and Ethnicity

The study investigates how transitions in maternal unions are related to household food insecurity among a low-income sample using pooled time series data from the Early Childhood Longitudinal Survey–Birth Cohort. Pooled time series fixed effects models indicate that transitioning into unions for White and Hispanic households is associated with reductions in household food insecurity compared with White and Hispanic households who experienced no transitions. Furthermore, transitioning into unions for Hispanic households is associated with reductions in household food insecurity status compared with Hispanic households that experienced dissolving unions. Last, results indicate that maternal union transitions are not related to household food insecurity status of Black and Other race and ethnic households. The authors discuss how the findings may be related to socioeconomic factors of race and ethnic households.

The built food environment and dietary intake among African-American adults

OBJECTIVES The built food environment surrounding peoples homes may influence their dietary intake. This exploratory study examined how the density of different sources of food in the residential environment was associated with dietary consumption among 77 African-American adults in Houston, Texas. METHODS The number of fast-food-type restaurants, large grocery stores, and convenience-type stores within 2- and 5-mile residential buffers were divided by the respective areas to obtain food environment density variables. Intake of fruit and vegetables [FV], fiber [FI], and percent energy from fat [PEF] was assessed using National Health Interview Survey items. Covariate-adjusted regressions were used to assess relations of interest. RESULTS Greater density of fast-food-type restaurants within 2 miles was associated with greater FV, FI, and PEF (ps ≤ .012); and for FV and FI within 5 miles (ps ≤ .004). Density of large grocery stores was unrelated to intake. Greater density of convenience-type stores within 2 miles was negatively associated with FV and FI (ps ≤ .03); results became marginal at 5 miles for FV (p = .10) but not FI (p = .03). CONCLUSION Maximizing healthy offerings in venue-rich metropolitan areas might provide direction for policies to reduce obesity.

Authoritative parent feeding style is associated with better child dietary quality at dinner among low-income minority families

Abstract Background Parent feeding styles have been linked to child weight status across multiple studies. However, to our knowledge, the link between feeding styles and childrens dietary quality, a more proximal outcome, has not been investigated. Objective The purpose of this study was to examine the relation between parent feeding styles and dietary quality of Head Start preschoolers’ dinner meals. Design The amount of food served and consumed by children was measured by using a standardized digital photography method during 3 in-home dinner observations of low-income minority families in Houston, Texas. Trained dietitians entered food served and consumed into the Nutrient Data System for Research 2009 for nutrient analysis. Overall dietary quality of the food served and consumed at dinner was evaluated by using the Healthy Eating Index 2010 (HEI-2010). Parent feeding style was assessed with the use of the Caregivers Feeding Style Questionnaire (CFSQ). On the basis of a parents level of demandingness and responsiveness to his or her child during feeding, the CFSQ categorizes parent feeding into 4 styles: authoritative (high demandingness and high responsiveness), authoritarian (high demandingness and low responsiveness), indulgent (low demandingness and high responsiveness), or uninvolved (low demandingness and low responsiveness). Results For the overall sample, the mean ± SD HEI score for dinner served was 44.2 ± 8.4, and the mean ± SD HEI score for dinner consumed was 43.4 ± 7.0. In the fully adjusted model, ANCOVA indicated that the authoritative parent feeding style was associated with significantly higher child dietary quality compared with the authoritarian feeding style (mean ± SEE HEI consumed—authoritative 45.5 ± 0.9; authoritarian: 41.9 ± 0.7; P = 0.001). Conclusions Parent feeding style contributes to the overall dietary quality of children, and among low-income minority preschoolers an authoritative feeding style was associated with the highest dietary quality of the 4 feeding styles. Interventions to promote feeding practices that contribute to authoritative feeding are needed to improve the dietary quality of preschool children at dinner. This trial was registered at https://clinicaltrials.gov as NCT02696278.

Use of a Unique Farmers’ Market Program Targeting Lower-Income Community Members

We examined use of a farmers’ market that leverages community partnerships to provide free produce to lower-income persons. Participants (n = 422) were asked to complete a questionnaire and given an ID number, which was used to track market use from 2014 to 2015. Chi square tests were used to examine associations between 2014/2015 market use and reasons for market use, financial support received, and how attendees had learned about the market. Ordinal regression was used to identify household characteristics associated with increased market attendance. Although the proportion of lower-income attendees declined over the study period, a substantial proportion of households in 2014 (69.1%) and 2015 (54.6%) were below the poverty threshold. We identified significant differences in attendees’ reasons for market use and ways attendees heard about the market from 2014 to 2015. The most frequently reported reason for 2014 market use was retirement/fixed income (P < 0.001) and in 2015 was low-income (P < 0.001). Most attendees heard about the market through flyers (P < 0.001) and word of mouth (P ≤ 0.001) in 2014 and through local, non-profit services (P < 0.001) in 2015. In the ordinal regression, households with an older person registering the household for the market used the market more times per year (P < 0.001). Impoverished households (P = 0.020) and households receiving more financial support services (P < 0.001) used the market fewer times per year. While a substantial proportion of lower-income persons used the free-produce market, frequency of use was still lowest among this group indicating a need to address barriers beyond produce cost.

Levels of adherence needed to achieve significant weight loss

Background/ObjectivesPositive associations have been found between adherence and weight loss in behavioral weight-management interventions. However, less attention has been given to the level of adherence needed to reach clinically significant weight loss. This study examined the levels of adherence associated with a ≥ 5% – < 10% or ≥ 10% weight loss in a community-based, intensive behavioral weight management program, Weight Watchers® (WW), which included three modes of access: (1) 24-weekly WW meetings over 6 months, (2) the WW member website, and (3) the WW mobile application.MethodsA total of 292 participants were randomized to a WW (n = 147) or a self-help (SH) (n = 145) condition. To assess the impact of adherence, only participants in the WW condition were included in analyses (n = 147). Adherence was defined as use of the three modes of access. Measured heights and weights were obtained at baseline and 6 months. Receiver-operating characteristic curve analyses were conducted to determine the minimal level of adherence associated with clinically significant weight loss.ResultsIn a 6-month period, increased likelihood of achieving a weight loss ≥ 5% – < 10% was associated with attending approximately one-third (35.4%) of weekly meetings, use of the member website about 25% of days, and use of the mobile application 16.1% of days. Attendance at approximately two-thirds (64.5%) of meetings, use of the member website 41.6% of days, and use of the mobile application 14.7% of days were associated with a clinically significant weight loss of ≥ 10%. Meeting attendance was the strongest predictor of weight loss at 6 months.ConclusionsAlthough adherence to a behavioral weight management program was an important predictor of weight loss, extremely high levels were not needed to achieve clinically significant weight loss. These results are important to help patients and treatment providers understand realistic goals for weight management.