As researchers continue to analyze the role of parenting both in the development of childhood overweight and in obesity prevention, studies of child nutrition and growth are detailing the ways in which parents affect their children's development of food- and activity-related behaviors. Ana Lindsay, Katarina Sussner, Juhee Kim, and Steven Gortmaker argue that interventions aimed at preventing childhood overweight and obesity should involve parents as important forces for change in their children's behaviors. The authors begin by reviewing evidence on how parents can help their children develop and maintain healthful eating and physical activity habits, thereby ultimately helping prevent childhood overweight and obesity. They show how important it is for parents to understand how their roles in preventing obesity change as their children move through critical developmental periods, from before birth and through adolescence. They point out that researchers, policymakers, and practitioners should also make use of such information to develop more effective interventions and educational programs that address childhood obesity right where it starts—at home. The authors review research evaluating school-based obesity-prevention interventions that include components targeted at parents. Although much research has been done on how parents shape their children's eating and physical activity habits, surprisingly few high-quality data exist on the effectiveness of such programs. The authors call for more programs and cost-effectiveness studies aimed at improving parents' ability to shape healthful eating and physical activity behaviors in their children. The authors conclude that preventing and controlling childhood obesity will require multifaceted and community-wide programs and policies, with parents having a critical role to play. Successful intervention efforts, they argue, must involve and work directly with parents from the earliest stages of child development to support healthful practices both in and outside of the home.

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. We conducted six focus groups and 20 in-depth interviews among immigrant, low-income Latina mothers in the Northeast U.S. 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, i.e., supermarket proximity, food cost, access to recreational facilities, neighborhood safety and weather. Television watching was seen as integral to family life, including watching TV during meals and using TV as a 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.

Exposure to obesogenic environments in the U.S. may foster development of overweight in immigrants with greater acculturation. Few studies document mechanisms of the acculturation process from immigrants’ own perspectives or describe implications on the children of immigrants. Focus groups and in-depth interviews were conducted with immigrant Latina mothers (N=51) examining mothers’ beliefs, attitudes and practices related to early child feeding and weight. Focus group participants completing the Marin Acculturation Scale more closely identified with Latino culture, although the mean score (2.04, sd=0.59) was close to “bicultural”. Analysis revealed seven themes when mothers compared lifestyles between their native countries and the U.S., related to changes in 1) diet, perceived food quality and availability, 2) food and eating practices, 3) breastfeeding practices, 4) beliefs about food, child feeding and weight status, 5) weight status of mothers and children, 6) physical activity and sedentary lifestyles, and 7) social isolation and support.

Objective-To examine maternal beliefs and practices related to weight status, child feeding, and child overweight in the Latino culture that may contribute to the rising rates of overweight among preschool Latino children in the U.S.Design and sample-This two-phase qualitative study relies on data obtained in 6 focus groups with a total of 31 primarily Spanish-speaking, low income mothers, followed by 20 individual, indepth interviews with women participating in a health promotion educational program.Measures-Child-feeding beliefs, practices and weight status perceptions were elicited.Results-Findings indicated that most respondents reported personal struggles with weight gain, particularly during and after pregnancy, and were concerned that their children would become obese. Although subjects understood the health and social consequences related to overweight, many discussed the pressures of familial and cultural influences endorsing a "chubby child."Conclusions-Education and interventions that incorporate "culturally mediated" pathways to address mothers' feeding practices are essential for prevention and control of childhood overweight among low-income Latinos. Nurses should be aware of social and cultural influences on Latina mothers' beliefs and practices related to weight status and feeding practices and address these in their education approaches to prevent childhood overweight and obesity with this population group. Keywords childhood overweight; Latino; beliefs; feeding practices Overweight and obesity have become a serious public health problem in the United States (U.S.), affecting children of all ages (Ogden et al., 2002;Ogden et al., 2006). Overweight in children is defined as a body mass index (BMI) greater than the 85 th percentile and less than the 95 percentile and obesity as a BMI at or above the 95 th percentile of age and sex-specific 2000 CDC reference growth curves (Centers for Disease Control and Prevention, 2000). Among low (Mei et al., 1998) and middle-income ) preschool children, increases in overweight and obesity are highest among Latino children. In 2004, the Pediatric Nutrition Surveillance System classified 36% of Latino children aged 2 to 5 years as overweight or obese, compared with 27% of non-Latino children (Polhamus et al., 2003). Among middle-income preschool children, the greatest relative increase in obesity prevalence over a 22-year period was seen among Latinos; a 129% increase, from 7.2% to 16.5%, compared with relative increases of 32% in white and 36% in black children . These trends underscore the importance of research on factors driving early incidence of overweight and obesity in Latino children.Parents, especially mothers, are key players in preventing childhood obesity by developing a home environment that fosters healthful eating behaviors among children (Skinner et al., 2002;Birch, 1998;Birch, 1999;Birch & Fisher, 1995, 1998. Parents' knowledge of nutrition; their influence over food selection and meal structure; and their own modeling of eating, physic...

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 children's 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.

While the 'immigrant health paradox' posits better health behaviours and outcomes for immigrants upon arrival to the US, research suggests that this advantage may deteriorate over time. This study analysed the relationship of acculturation and breast-feeding initiation and duration among a sample of predominantly Latina, low-income women in the US. The four measures of acculturation included: mother's nativity (foreign born vs US born), mother's parents' nativity (foreign born vs US born), years of US residence (<8 years vs > or =8 years) and a dichotomous measure of language acculturation adapted from three items on Marin's acculturation scale (preferred language spoken at home, reading language and writing language) as exclusive use of native language versus non-exclusive use (mixed or English only) (Marin et al., 1987; Marin & Gamba, 1996). Final multivariable models showed that mothers who exclusively used their native language were more likely to initiate breast-feeding as well as breast-feed for longer duration compared with mothers with non-exclusive use, whereas years of US residence and mother's nativity were not significantly associated with breast-feeding initiation or duration. Mother's parents' nativity also emerged as a significant predictor of breast-feeding duration, both within final models for immigrants and across study participants. Programmes providing nutrition education to low-income women may wish to consider the role of language as an important determinant of breast-feeding. The role of mother's parents' nativity on breast-feeding practices deserves exploration in future studies, as the cultural practices taught by family members born outside the US may exert strong pressure within immigrant families now living in the US.

Objectives: This study investigates how lifecourse, immigrant status and acculturation, and neighbourhood of residence influence food purchasing and preparation among low-income women with children, living in the USA. This research sought to understand physical and economic access to food, from both 'individual' and 'community' perspectives. Design: This study used qualitative methodology (focus groups) to examine the mechanisms and pathways of food preparation and purchasing within the context of daily life activity for US-and foreign-born women, living in the USA. The study methodology analysed notes and verbatim transcripts, summarised recurring responses and identified new themes in the discussions. Setting and subjects: A total of 44 women were purposively sampled from two metropolitan areas in Massachusetts, USA, based on (1) neighbourhood of residence and (2) primary language spoken. All focus groups were conducted in community health centres and community centres co-located with offices of the special supplemental nutritional programme for Women, Infants, and Children. Results: Analysis of key response themes suggested that scarcity of food and physical access to food purchasing points did not influence food purchasing and preparation as much as (1) limited time for food shopping, cooking and family activities; and (2) challenges in transportation to stores and childcare. The study results demonstrated differing attitudes toward food acquisition and preparation between immigrant and US-born women and between women who lived in two metropolitan areas in the western and eastern regions of the state of Massachusetts, USA. Conclusions: The findings illustrate 'hidden' constraints that need to be captured in measures of physical and economic access and availability of food. US policies and programmes that aim to improve access, availability and diet quality would benefit from considering the social context of food preparation and purchasing, and the residential environments of low-income women and families.

OBJECTIVETo analyze the evolution in the prevalence and determinants of malnutrition in children in the semiarid region of Brazil.METHODSData 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.RESULTSA 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.CONCLUSIONSSocioeconomic 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.