Elva M. Arredondo

Away-from-home food intake and risk for obesity: Examining the influence of context

Objective: This study examined sociodemographic and cultural determinants of away‐from‐home food consumption in two contexts and the influence of frequency of away‐from‐home food consumption on childrens dietary intake and parent and child weight status.

Development and validation of a scale to measure Latino parenting strategies related to children’s obesigenic behaviors: The Parenting strategies for Eating and Activity Scale (PEAS)

Research has shown that childrens dietary and activity-related behaviors are shaped by the family environment and parenting behaviors. The present study describes the development and validation of a bilingual (Spanish and English) scale assessing parenting strategies associated with childrens dietary and activity-related behaviors in the home. Items were generated from focus groups with Latina mothers and a review of the literature, and two different samples were used to assess the scales psychometric properties, including an examination of predictive validity using measured child body mass index. Factor analysis of the first sample (N=91) yielded a 5-factor solution (limit setting, monitoring, discipline, control and concern) and accounted for 65% of the variance. Confirmatory factor analyses on a second sample of Latina mothers recruited into a childhood obesity prevention study (N=714) showed that a 26-item 5-factor solution (limit setting, monitoring, discipline, control and reinforcement) provided the best fit for the data. Parenting strategies characterized as controlling were associated with a lower BMI among children. After using multiple samples and establishing its validity, the parenting strategies for eating and activity scale (PEAS) was found to be valid and reliable in measuring Latino parenting strategies related to childrens dietary and activity-related behaviors.

Results of a multi-level intervention to prevent and control childhood obesity among Latino children: The Aventuras para niños study

BackgroundCommunity-based interventions are needed to reduce the burden of childhood obesity.PurposeTo evaluate the impact of a multi-level promotora-based (Community Health Advisor) intervention to promote healthy eating and physical activity and prevent excess weight gain among Latino children.MethodsThirteen elementary schools were randomized to one of four intervention conditions: individual/family level (Family-only), school/community level (Community-only), combined (Family + Community), or a measurement-only condition. Participants were 808 Latino parents and their children enrolled in kindergarten through 2nd grade. Measures included parent and child body mass index (BMI) and a self-administered parent survey that assessed several parent and child behaviors.ResultsThere were no significant intervention effects on children’s BMI z-score. The family intervention changed several obesity-related child behaviors (e.g., fruit/vegetable consumption) and these were mediated by changes in parenting variables (e.g., parent monitoring).ConclusionA promotora-based behavioral intervention was efficacious at changing parental factors and child obesity-related health behaviors.

The association between family meals, TV viewing during meals, and fruit, vegetables, soda, and chips intake among Latino children.

OBJECTIVE Examine the relationship of family meals to childrens consumption of fruit and vegetables as well as soda and chips. Additionally, to assess the relationship between viewing TV during family meals and childrens diet. DESIGN Cross-sectional study that used a questionnaire completed by parents. SETTING Thirteen schools in San Diego, California. PARTICIPANTS Seven hundred ninety-four children and their parents. ANALYSIS Ordinal regression assessed associations between childrens intake of fruit, vegetables, soda, and chips with family meal frequency and TV viewing during family meals. RESULTS Children who consumed breakfast, lunch, or dinner with their family at least 4 days per week ate fruit and vegetables 5 or more times a week 84%, 85%, and 80%, respectively. Of those children who ate breakfast, lunch, or dinner with their family at least 4 days per week, 40%, 44%, and 43% consumed soda and chips 5 or more times a week, respectively. Children who ate breakfast with their families at least 4 times a week were more likely to consume fruit and vegetables, and children whose TV was never or rarely on during family meals were less likely to consume soda and chips (P = .04 and P < .001, respectively). CONCLUSIONS Interventions geared at increasing the frequency of eating breakfast as a family and decreasing the amount of TV watched during family meals are needed, especially among acculturating Latino families.

Longitudinal Intervention Effects on Parenting of the Aventuras para Niños Study

BACKGROUND Parenting interventions have achieved changes in factors associated with childhood obesity but few have tested the effects on multiple parental influences. PURPOSE This study examined the efficacy of an intervention aimed at improving several dimensions of parenting related to childhood obesity. DESIGN The study used a 2 x 2 factorial design. SETTING/PARTICIPANTS In 2003, a sample of 13 Southern California schools was randomized to one of four conditions: micro-environment only, macro-environment only, micro-plus-macro-environment, and no treatment control condition. Participants included 811 predominantly Mexican immigrant/Mexican-American mothers with children in kindergarten through second grade. INTERVENTION In both micro conditions, participants received monthly home visits by a promotora over a 7-month period plus monthly mailed newsletters. MAIN OUTCOME MEASURES In 2008, intervention effects were examined on (1) parenting strategies, including limit setting, monitoring, discipline, control, and reinforcement related to childrens diet and physical activity; (2) parental support for physical activity; (3) parent-mediated family behaviors such as family meals eaten together and TV watching during family dinners; and (4) perceived barriers and other parent cognitions related to childrens eating and activity. RESULTS At the 2-year follow-up, significant improvements were observed in three of five parenting strategies, parental support, and two of four parent-mediated family behaviors among parents receiving the micro intervention (i.e., those who received promotora visits and monthly newsletters), as compared with those in the macro-only and control conditions. CONCLUSIONS Aspects of parenting related to childrens risk for obesity and related health outcomes are modifiable with the support of a promotora and print media.

A demonstration of modeling count data with an application to physical activity

Counting outcomes such as days of physical activity or servings of fruits and vegetables often have distributions that are highly skewed toward the right with a preponderance of zeros, posing analytical challenges. This paper demonstrates how such outcomes may be analyzed with several modifications to Poisson regression. Five regression models 1) Poisson, 2) overdispersed Poisson, 3) negative binomial, 4) zero-inflated Poisson (ZIP), and 5) zero-inflated negative binomial (ZINB) are fitted to data assessing predictors of vigorous physical activity (VPA) among Latina women. The models are described, and analytical and graphical approaches are discussed to aid in model selection. Poisson regression provided a poor fit where 82% of the subjects reported no days of VPA. The fit improved considerably with the negative binomial and ZIP models. There was little difference in fit between the ZIP and ZINB models. Overall, the ZIP model fit best. No days of VPA were associated with poorer self-reported health and less assimilation to Anglo culture, and marginally associated with increasing BMI. The intensity portion of the model suggested that increasing days of VPA were associated with more education, and marginally associated with increasing age. These underutilized models provide useful approaches for handling counting outcomes.

Depression, anxiety, antidepressant use, and cardiovascular disease among Hispanic men and women of different national backgrounds: results from the Hispanic Community Health Study/ Study of Latinos

PURPOSE To describe prevalence and relationships to cardiovascular morbidity of depression, anxiety, and medication use among Hispanic/Latinos of different ethnic backgrounds. METHODS Cross-sectional analysis of 15,864 men and women aged 18 to 74 years in the population-based Hispanic Community Health Study/Study of Latinos. Depressive and anxiety symptoms were assessed with shortened Center for Epidemiological Studies Depression Scale and Spielberger Trait Anxiety Scale. RESULTS Prevalence of high depressive symptoms ranged from low of 22.3% (95% confidence interval [CI], 20.4-24.3) to high of 38.0% (95% CI, 35.2-41.0) among those of Mexican or Puerto Rican background, respectively. Adjusted odds ratios for depression rose monotonically with number of cardiovascular disease (CVD) risk factor from 1.46 (95% CI, 1.18-1.75) for those with one risk factors to 4.36 (95% CI, 2.47-7.70) for those with five risk factors. Antidepressant medication was used by 5% with striking differences between those with and without history of CVD (15.4% and 4.6%, respectively) and between insured (8.2%) and uninsured (1.8%). CONCLUSIONS Among US Hispanics/Latinos, high depression and anxiety symptoms varied nearly twofold by Hispanic background and sex, history of CVD, and increasing number of CVD risk factors. Antidepressant medication use was lower than in the general population, suggesting under treatment especially among those who had no health insurance.

Individual, social, and environmental barriers to and facilitators of physical activity among Latinas living in San Diego County: focus group results.

The purpose of this study was to examine the barriers to and facilitators of physical activity (PA) relevant to a faith-based community living in a border region. Two focus groups were conducted with 25 Latina churchgoers. Latinas identified barriers to PA that included individual (eg, lack of motivation and time, language, economics, social support, family/household responsibilities), sociocultural (eg, fear of border patrol, machismo, and neighborhood safety), and environmental barriers (eg, traffic-related and dogs). Facilitators of PA were PA knowledge, child care, time management, and advocacy skills. The authors concluded that a church-based multilevel intervention targeting Latinas may be ideal for promoting PA and facilitating environmental changes.

Relationships among fitness, body composition, and physical activity.

PURPOSE This study was designed to examine the associations of physical activity and body composition with cardiorespiratory fitness in eighth grade girls. METHODS A random sample of 1440 eighth grade girls at 36 schools participated in this cross-sectional investigation, which represented an ethnically and geographically diverse group. Cardiorespiratory fitness was assessed using a modified physical work capacity test on a cycle ergometer that predicted workload at a heart rate of 170 beats.min. Physical activity was assessed over 6 d in each girl using an accelerometer and body composition was estimated from body mass index and triceps skinfolds using a previously validated equation. Pearson correlations and multiple regression analyses were used to determine the relationships among fitness, physical activity, and body composition. RESULTS Significant linear relationships among cardiorespiratory fitness, body composition, and physical activity were found. The combination of fat and fat-free mass along with racial group and a race by fat-free-mass interaction accounted for 18% (R) of the variation in physical fitness. Adding moderate-to-vigorous physical activity to the regression model increased the R to 22%. Black girls had somewhat lower fitness levels (P < 0.05) especially at higher levels of fat and fat-free mass than other racial/ethnic groups. CONCLUSIONS Physical activity, fat-free mass, and the interaction between fat-free mass and racial group are significantly associated with cardiorespiratory fitness in adolescent girls.

The relation of acculturation to Latinas' perceived neighborhood safety and physical activity: a structural equation analysis.

Background: Physical activity rates are low for adult Latinas. In the United States, only 7.8% of adult Latinas met Centers for Disease Control and Prevention recommendations for weekly vigorous leisure-time physical activity.Purpose: The purpose of this study is to test a theoretical model examining the direct and indirect influence of individual factors (demographic factors and acculturation) and the direct influence of built environmental variables (perceived neighborhood safety/aesthetics) on Latinas’ physical activity in a U.S. border region.Methods: Acculturation, perceived neighborhood safety/aesthetics, sociodemographic variables, and minutes of physical activity a week were collected from 526 Latinas using standardized survey measures.Results: Only 30% of the Latinas reported meeting International Physical Activity Questionnaire’s vigorous physical activity criteria, 8.6% met moderate, and 46.4% met walking. Findings from the structural equation modeling indicated that acculturation was positively associated with Latinas’ vigorous and moderate physical activity, with no significant relation to walking. There were no direct associations of perceived neighborhood safety/aesthetics on any of the three measures of physical activity.Conclusions: Data suggest that acculturating to the U.S. mainstream culture may have positive effects on Latinas’ reported physical activity. Contrary to studies of other populations, the perceived neighborhood environment was not related to Latinas’ physical activity. Culturally appropriate interventions are needed for Latinas who are less acculturated into the United States.