Erica T. Sosa

Mexican American Mothers’ Perceptions of Childhood Obesity A Theory-Guided Systematic Literature Review

Childhood obesity continues to increase, disproportionately affecting Mexican American children. The aims of this review are to (a) assess the literature regarding Mexican American mothers’ knowledge and perceptions of childhood obesity, prevention, and their role in prevention; (b) critically evaluate the methodological quality of the research conducted on mothers’ perceptions of childhood obesity; and (c) make recommendations for future research on parental perceptions of childhood obesity. Four databases were searched for relevant articles and 22 studies met inclusion criteria and were included in the review. Social cognitive theory was used to sort findings across studies. Major findings included the following: (a) barriers to childhood obesity prevention included lack of education regarding prevention and role modeling, (b) only 23% of studies explicitly used a theoretical framework to guide their study, and (c) most studies used heterogeneous groups to examine perceptions. Implications for future research and practice are presented.

Treatment Interventions for Early Childhood Obesity: A Systematic Review

CONTEXT With 25% of preschool-age children in the United States being overweight or obese, effective interventions for these children would have significant public health implications. Randomized trials targeting this age group have been performed since the last systematic review. OBJECTIVE To systematically review the literature on treatment interventions for overweight or obesity in preschool-age children. DATA SOURCES Medline (1948-July 2014), the Cochrane Central Registry (1991-July 2014), CINAHL (1990-July2014), and PAS abstracts (2000-2014). STUDY SELECTION Inclusion criteria were children aged 0 to 6 in the study and adiposity as an outcome. Exclusions were having normal-weight children in the trial and not having a comparison group. DATA EXTRACTION Data were extracted independently by 2 authors using a template. RESULTS The initial search yielded 1981 results, narrowed to 289 abstracts after initial review. Further analysis and cross-referencing led to the selection of 6 randomized controlled trials representing 1222 children. Two studies used systems changes and motivational interviewing and showed no significant effect on adiposity. Two studies used an intensive, multidisciplinary approach over 6 months and demonstrated significant decreases in adiposity. One study tested parental coaching and showed a significant reduction in adiposity at 6 months. One study used education on a dairy-rich diet and showed a possible effect on adiposity. LIMITATIONS The study designs were too heterogeneous for meta-analysis; few ethnic minority subjects were included. CONCLUSIONS Multidisciplinary, intensive interventions have some evidence of efficacy in reducing adiposity in preschool children.

Perceived Risk of Developing Diabetes in Early Adulthood: Beliefs about Inherited and Behavioral Risk Factors across the Life Course:

This study aimed to determine how college students perceive their risk of developing diabetes over their life course, with specific emphasis on their beliefs about the influence of inherited versus behavioral risk factors. A bivariate ordered probit regression model was used to simultaneously predict perceived risk for 10-year absolute risk of diabetes and lifetime absolute risk of diabetes. Ten-year and lifetime absolute risk were both increased when the respondent self-identified with a race/ethnicity other than non-Hispanic white (β = 0.42, p < .001 and β = 0.33, p = .004, respectively), and when the respondent had an increasing number of family members with diabetes (β = 0.33, p < .001 and β = 0.45, p < .001, respectively). Beliefs linking behavioral risk factors to perceived risk of developing diabetes across the life course were not statistically significant. The absence of significant association between perceptions of behavioral risk as factors for developing diabetes and perceived risk for diabetes over the life course supports the need for educational interventions about behavioral and genetic causes of diabetes among the college-aged population.

Correlates of Family Health History Discussions Between College Students and Physicians: Does Family Cancer History Make a Difference?

Effective communication between young adults and their healthcare providers can contribute to early detection of risk for developing cancer and establishment of lifelong habits for engagement in healthcare and health promotion behaviors. Our objectives were to examine factors influencing family health history discussions between college students and physicians and factors associated with perceptions about who is responsible for initiating such discussions. Data from an internet-based study of 632 college students were analyzed. Approximately 60% of college student participants reported they had discussed their family health history with a physician. The perception that physicians are responsible for initiating family health history discussions was associated with being non-White and less than completely knowledgeable about cancer. Having a discussion with a physician was associated with being female, having a regular physician, perceiving genetics as a risk for developing cancer, and having a family member diagnosed with cancer. Understanding variation among college students’ perceptions about their role in initiating health-history-related discussions and characteristics of those who have or have not discussed family health issues with physicians can inform healthcare practice to foster optimal healthcare interactions in early adulthood.

Associations between a voluntary restaurant menu designation initiative and patron purchasing behavior.

Background. Restaurant initiatives provide an efficient opportunity to impact large numbers of patrons. The purpose of this study is to measure patron purchasing behaviors during the ¡Por Vida! menu designation initiative. Method. This study used a cross-sectional design and survey data to assess 23 restaurants throughout Bexar County and 152 restaurant patrons. The Patron Awareness Questionnaire assessed if patrons noticed the logo; believed nutrition, cost, and taste were important in making purchasing decisions; and purchased a ¡Por Vida! item. Descriptive statistics, Spearman correlations, and logistic regression were used to analyze the data. Results. Most (93.4%) patrons considered taste very important when deciding what to eat. Cost was very important to 63.8% and nutrition was very important to 55.9% of the sample. The strongest predictors of purchasing a ¡Por Vida! item were the patrons’ ages being between 18 and 35 years (odds ratio = 1.474; confidence interval = 0.017, 0.812; p < .05) and if patrons saw the logo (odds ratio = 4.327; confidence interval = 1.696-11.036; p < .01). Discussion/Conclusion. Menu logo designation initiatives can potentially influence patron purchasing behaviors among a segment of the population when the logo is visible.

¡Miranos! (Look at Us! We Are Healthy!): Home-Based and Parent Peer–Led Childhood Obesity Prevention

Parent interventions for childhood obesity prevention have traditionally experienced low participation rates or used passive methods such as newsletters. In contrast, the ¡Miranos! intervention home-based activities included parent-led face-to-face meetings delivered after school, take-home bags with educational materials, and scavenger hunt games to deliver health information to Head Start families regarding nutrition, physical activity, and healthy growth promotion for their preschooler. This study employed a quasi-experimental design with three intervention centers (two that received only center-based activities and one that received center- and home-based activities) and one comparison center. Data were collected on participating Head Start children and their parents/guardians and included parent attendance, parent health message recall through intercept interviews, parent knowledge through pre- and posttests, and family supportive behaviors and child health behaviors through a parent questionnaire. Parents/guardians that received both center- and home-based activities significantly increased knowledge scores (t = 2.50, degrees of freedom = 123, p < .05) and family supportive behaviors from baseline to follow-up (t = 2.12, degrees of freedom = 122, p < .05). This study demonstrates the effects home-based interventions can have when coupled with center-based activities and implemented in the center at the end of the school day.

Health Communication and Obesity Prevention in Hispanic Communities: A Qualitative Exploration of Media's Roles

This study qualitatively explored Hispanics’ perceptions of obesity and media-related strategies to obesity prevention. Sixteen interviews were conducted with a purposeful sample of Hispanic adults (56% females; ~41 years old) in Texas. The interviews were audiotaped and transcribed verbatim and analysed using inductive content analysis approach. Results showed that participants were aware of the severity and consequences of obesity. Media, especially Spanish TV and Internet were the primary health communication channels. Participants wished for more frequent public health announcements of local government initiatives, programs and events; desired celebrity’s role modeling; and suggested media portray of fat body imagery to help the community recognize the seriousness of obesity, as well as demanded for regulations on junk food commercials. In conclusion, future obesity prevention communication should consider using Spanish TV and Internet as the primary channels, utilizing celebrities as message sources, focusing on public health announcements & messaging; as well as advocating junk food commercial regulation.

Mexican American Mothers' Perceptions of their Role in Childhood Obesity Prevention: A Qualitative Study

Despite myriad preventive efforts, childhood obesity rates continue to increase and disproportionately affect Mexican American children. Mothers can be very influential in preventing childhood obesity especially within the home. Home is where children first learn normative behaviors, including dietary and physical activities. Three focus groups with 23 Mexican American mothers were conducted in Bryan, TX to assess perceptions of childhood obesity prevention. Thematic analysis of interview transcripts was conducted. Mothers acknowledged they were primarily responsible for their children’s health and weight. However, they also identified barriers to obesity prevention and were unsure of which strategies were best for encouraging children to eat vegetables and be physically active. Mothers can be catalysts to obesity prevention, but programs need to provide the education, skill set, and opportunities to make these differences.

Perceived Responsibility to Initiate Family Health History Discussions among College Women Associated with Individuals Diagnosed with Heart Disease

Objectives: To examine young women’s perceived responsibility for initiating family health history discussion with their primary care providers when associated with individuals with heart disease. Methods:Data were obtained from an internet-based survey administered to 232 young women enrolled at a large university. Exploratory factor analysis and structural equation modeling were used to relate these women’s health beliefs to their perceived responsibility for initiating family health history discussion with their physicians. Results:Heart disease self-risk factors were positively related (β = 0.21, p = 0.005) to the physician being responsible for initiating family health history discussion. Motivation from friends and acquaintances to obtain family health history was positively related (β = -0.17, p = 0.022) to the woman being responsible for initiating family health history discussion. Conclusion: Friends and social networks play an important role in how young women perceive their responsibility for initiating family health history discussion with their primary care providers.

Study protocol: intervention in maternal perception of preschoolers’ weight among Mexican and Mexican-American mothers

BackgroundChildhood obesity is a public health issue negatively affecting children’s physical and psychosocial health. Mothers are children’s primary caregivers, thus key players in childhood obesity prevention. Studies have indicated that mothers underestimate their children’s weight. If mothers are unaware of their children’s weight problem, they are less likely to participate in activities preventing and treating excess weight. The “Healthy Change” intervention is designed to change maternal perception of child’s weight (MPCW) through peer-led group health education in childcare settings.Methods/DesignThe “Healthy Change” is a multicenter two-arm randomized trial in four centers. Three centers are in Mexican States (Nuevo Leon, Tamaulipas, and Zacatecas). The fourth center is in San Antonio, Texas, USA. A total of 360 mother-child pairs (90 pairs per center) are to be randomly and evenly allocated to either the intervention or the control group. Intervention group will receive four-session group obesity prevention education. Control group will receive a four-session personal and food hygiene education. The education is delivered by trained peer-mother promotoras. Data will be collected using questionnaires and focus groups. The primary outcome is a change in proportion of mothers with accurate MPCW. Secondary outcomes include change in maternal feeding styles and practices, maternal self-efficacy and actions for managing child excessive weight gain.McNemar’s Test will be used to test the primary outcome. The GLM Univariate procedure will be used to determine intervention effects on secondary outcomes. The models will include the secondary outcome measures as the dependent variables, treatment condition (intervention/control) as the fixed factor, and confounding factors (e.g., mother’s education, children’s gender and age) as covariates. Sub-analyses will be performed to compare intervention effects on primary and secondary outcomes between the samples from Mexico and Texas, USA. Qualitative data will be analyzed through analysis of inductive content. A combined coding model will be developed and used to code transcripts using the NVivo software.DiscussionHealthy Change intervention could help change MPCW, an initial step for obesity prevention among preschoolers. This study presents a first of its kind intervention available in Spanish and English targeting Mexican and Mexican-American mothers in Mexico and USA.Trial registrationISRCTN12281648