M. Pia Chaparro

Immigrant enclaves and obesity in preschool-aged children in Los Angeles County.

While neighborhood environments are increasingly recognized as important contributors to obesity risk, less has been reported on the socio-cultural aspects of neighborhoods that influence obesity development. This is especially true among immigrants, who may lack the necessary language skills to navigate their new living environments. In this study, we tested the hypothesis that young children of immigrants would be at lower obesity risk if they lived in neighborhoods where neighbors share the same language and culture. Using 2000 Census data and 2003-2009 data from the Special Supplemental Nutrition Program for Women, Infants and Children in Los Angeles County, we examined the relation between BMI z-scores in low-income children aged 2-5 years (N = 250,029) and the concentration of neighborhood residents who spoke the same language as the childrens mothers. Using multi-level modeling and adjusting for childs gender and race/ethnicity, household education, neighborhood socioeconomic status, and year the child was examined, we found that percent of neighborhood residents who spoke the same language as the childs mother was negatively associated with BMI z-scores. This relation varied by childs race/ethnicity and mothers preferred language. The relation was linear and negative among children of English-speaking Hispanic mothers and Chinese-speaking mothers. However, for Hispanic children of Spanish-speaking mothers the relation was curvilinear, initially exhibiting a positive relation which reversed at higher neighborhood concentrations of Spanish-speaking residents. Our findings suggest that living in neighborhoods where residents share the same language may influence obesity-related behaviors (namely diet and physical activity) possibly through mechanisms involving social networks, support, and norms.

The New Food Package and Breastfeeding Outcomes Among Women, Infants, and Children Participants in Los Angeles County

OBJECTIVES We assessed the effect of the new Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package, implemented in October 2009, on breastfeeding outcomes among a predominately Latina sample of WIC participants in Los Angeles County, California. METHODS We used data from 5020 WIC participants who were interviewed in a series of repeated cross-sectional surveys conducted in 2005, 2008, and 2011. Participants were randomly selected from Los Angeles County residents who received WIC services during those years. RESULTS Consistent with the WIC population in Los Angeles, participants were mostly Latina and had low levels of income and education; more than half were foreign-born. We found small but significant increases from pre- to postimplementation of the new WIC food package in prevalence of prenatal intention to breastfeed and breastfeeding initiation, but no changes in any breastfeeding at 3 and 6 months. The prevalence of exclusive breastfeeding at 3 and 6 months roughly doubled, an increase that remained large and significant after adjustment for other factors. CONCLUSIONS The new food package can improve breastfeeding outcomes in a population at high risk for negative breastfeeding outcomes.

Mapping the nutrition transition in Peru: evidence for decentralized nutrition policies

The study objectives were to map the different stages of the nutrition transition for each department within Peru, and to determine the nutrition policy needs for each geographic area based on their current stage in the nutrition transition. Results show that most of the country is suffering from a double-burden of malnutrition, with high rates of stunting among children less than 5 years of age and high rates of overweight and obesity among women of reproductive age. Currently, Peru has only country-wide nutrition policies, administered by the Ministry of Health, that are primarily focused on stunting prevention. This study argues for the need to have decentralized nutrition policies that vary according to what type of malnutrition is being experienced in each geographic area.

Association between food assistance program participation and overweight

OBJECTIVE The objective of this study was to investigate the association between food assistance program participation and overweight/obesity according to poverty level. METHODS A cross-sectional analysis of data from 46,217 non-pregnant and non-lactating women in Lima, Peru was conducted; these data were obtained from nationally representative surveys from the years 2003, 2004, 2006, and 2008-2010. The dependent variable was overweight/obesity, and the independent variable was food assistance program participation. Poisson regression was used to stratify the data by family socioeconomic level, area of residence (Lima versus the rest of the country; urban versus rural), and survey year (2003-2006 versus 2008-2010). The models were adjusted for age, education level, urbanization, and survey year. RESULTS Food assistance program participation was associated with an increased risk of overweight/obesity in women living in homes without poverty indicators [prevalence ratio (PR) = 1.29; 95% confidence interval (CI) 1.06;1.57]. When stratified by area of residence, similar associations were observed for women living in Lima and urban areas; no associations were found between food assistance program participation and overweight/obesity among women living outside of Lima or in rural areas, regardless of the poverty status. CONCLUSIONS Food assistance program participation was associated with overweight/obesity in non-poor women. Additional studies are required in countries facing both aspects of malnutrition.

Influences of the neighbourhood food environment on adiposity of low-income preschool-aged children in Los Angeles County: a longitudinal study

Background Few studies have examined the association between the food environment and adiposity in early childhood, a critical time for obesity prevention. The objective of this study was to examine the longitudinal association between neighbourhood food environment and adiposity among low-income preschool-aged children in a major metropolitan region in the USA. Methods The study sample was 32 172 low-income preschool-aged children in Los Angeles County who had repeated weight and height measurements collected between ages 2 and 5 years through a federal nutrition assistance programme. We conducted multilevel longitudinal analyses to examine how spatial densities of healthy and unhealthy retail food outlets in the childrens neighbourhoods were related to adiposity, as measured by weight-for-height z-score (WHZ), while controlling for neighbourhood-level income and education, family income, maternal education, and childs gender and race/ethnicity. Results Density of healthy food outlets was associated with mean WHZ at age 3 in a non-linear fashion, with mean WHZ being lowest for those exposed to approximately 0.7 healthy food outlets per square mile and higher for lesser and greater densities. Density of unhealthy food outlets was not associated with child WHZ. Conclusions We found a non-linear relationship between WHZ and density of healthy food outlets. Research aiming to understand the sociobehavioural mechanisms by which the retail food environment influences early childhood obesity development is complex and must consider contextual settings.

Trends and Determinants of Food Insecurity Among Adults in Low-Income Households in California

Data from 66 446 low-income adults who participated in the California Health Interview Survey are used to describe trends in food insecurity between 2001 and 2009. Food security was assessed using the short form of the Household Food Security Survey Module. There was a statistically significant increase in food insecurity between 2001 and 2009, from 28.6% to 40.5%. During the same time period, the prevalence of very low food security nearly doubled, from 8.3% to 15%. The increase in food insecurity remained significant even after controlling for differences in income, employment status, participation in food assistance programs, and other sociodemographic factors.

Social inequality in pre-pregnancy BMI and gestational weight gain in the first and second pregnancy among women in Sweden

Background High pre-pregnancy body mass index (BMI) and inappropriate gestational weight gain (GWG) are associated with adverse short and long-term maternal and neonatal outcomes and may act as modifiable risk factors on the path to overweight/obesity, but their social patterning is not well established. This study investigates the association of education with BMI and GWG across two consecutive pregnancies. Methods The study includes 163 352 Swedish women, having their first and second singleton birth in 1982–2010. In both pregnancies, we investigated the association of womens education with (1) pre-pregnancy weight status and (2) adequacy of GWG. We used multinomial logistic regression, adjusting for childs birth year, mothers age and smoking status. Results Overall, the odds of starting either pregnancy at an unhealthy BMI were higher among women with a low education compared to more highly-educated women. Lower education also predicted a greater increase in BMI between pregnancies, with this effect greatest among women with excessive GWG in the first pregnancy (p<0.0001 for interaction). Education was also inversely associated with odds of excessive GWG in both pregnancies among healthy weight status women, but this association was absent or even weakly reversed among overweight and obese women. Conclusions Lower educated women had the largest BMI increase between pregnancies, and these inequalities were greatest among women with excessive GWG in the first pregnancy. The importance of a healthy pre-pregnancy BMI, appropriate GWG and a healthy postpartum weight should be communicated to all women, which may assist in reducing existing social inequalities in body weight.

Regional inequalities in pre-pregnancy overweight and obesity in Sweden, 1992, 2000, and 2010

Aims: To investigate regional differences and time trends in women’s overweight and obesity in Sweden. Methods: Using data from the Swedish Medical Birth Register (women aged ⩾18 years, first pregnancy only) and the Total Population Register accessed through the Umeå SIMSAM Lab, age-standardized prevalence of pre-pregnancy overweight/obesity (BMI ⩾ 25 kg/m2) and obesity (BMI ⩾ 30 kg/m2) were estimated by county for the years 1992, 2000, and 2010. Maps were created using ArcMap v10.2.2 to display regional variations over time and logistic regression analyses were used to assess if the observed trends were significant. Results: The prevalence of pre-pregnancy overweight/obesity and obesity increased significantly in all Swedish counties between 1992, and 2010. In 2010, Södermanland and Gotland exhibited the highest age-standardized overweight/obesity (39.7%) and obesity (15.1%) prevalence, respectively. The sharpest increases between 1992 and 2010 were observed in Västerbotten for overweight/obesity (75% increase) and in Gotland for obesity (233% increase). Across the years, Stockholm had the lowest prevalence of overweight/obesity (26.3% in 2010) and obesity (7.3% in 2010) and one of the least steep increases in prevalence of both between 1992 and 2010. Conclusions: Substantial regional differences in pre-pregnancy overweight and obesity prevalence are apparent in Sweden. Further research should elucidate the mechanisms causing these differences.

Individual and Neighborhood Predictors of Participation in the Supplemental Nutrition Assistance Program (SNAP) in Los Angeles County

Using data from the Los Angeles Family and Neighborhood Survey, we investigated individual and neighborhood-level predictors of participation in the Supplemental Nutrition Assistance Program (SNAP) among eligible households in Los Angeles County. Among eligible groups, those with lower participation rates included older people, married couples, Hispanics, and those living in higher income neighborhoods. Reporting poor physical and/or mental health was associated with higher odds of SNAP participation. Future studies should focus on disentangling the relationship between poor health and SNAP participation, as well as on studying the pathway by which neighborhood resources may impact SNAP participation.

The Relationship Between Obesity and Participation in the Supplemental Nutrition Assistance Program (SNAP): Is Mental Health a Mediator?

Focusing on adults from the Los Angeles Family and Neighborhood Survey, we investigated whether mental health was a mediator in the association between obesity (body mass index ≥ 30 kg/m2) and participation in the Supplemental Nutrition Assistance Program (SNAP). The analyses included 1776 SNAP participants and eligible nonparticipants. SNAP participants had higher odds of obesity (odds ratio [OR] =2.6; 95% confidence interval [CI], 1.52–4.36) and of reporting a mental health problem (OR = 3.8; 95% CI, 1.68–8.44) than eligible nonparticipants; however, mental health was not a mediator in the association between SNAP participation and obesity. We recommend changes in SNAP to promote healthier food habits among participants and reduce the stress associated with participation.