Sleep Moderates and Mediates the Relationship Between Acculturation and Depressive Symptoms in Pregnant Mexican-American Women

Objective Greater acculturation is associated with adverse perinatal outcomes in Mexican-American women, but the mechanisms by which acculturation influences perinatal outcomes are unclear. Pregnant acculturated Mexican-American women are more likely to engage in unhealthy prenatal behaviors relative to those less acculturated, including poor sleep. As sleep disruptions are associated with acculturation and negative perinatal outcomes, particularly maternal depression, alterations in sleep may adversely affect pregnant Mexican-American women. Methods Sixty pregnant women of Mexican descent completed surveys about sleep, acculturation, depressive symptoms and potential protective factor of social support. Results Acculturation, but not social support, significantly predicted increased sleep disruptions as well as overall feeling less refreshed upon waking across pregnancy. Moderation analysis indicated that more acculturated women who took longer to fall asleep reported increased depressive symptoms. Feeling refreshed upon waking also mediated the relationship between increased acculturation and elevated maternal depressive symptoms. Conclusions Acculturation and altered sleep contribute to greater risk in Mexican-American women for maternal depressive symptoms in the perinatal period. These findings have implications for prevention and treatment of maternal mental health disorders, which may adversely affect perinatal outcomes in the vulnerable Mexican-American population.     

Mothers' acculturation and eating behaviors of Korean American families in California

OBJECTIVE: To compare eating behaviors of Korean American (KA) families with mothers of different acculturation stages with those of families in Korea. DESIGN: Survey research using a self-report questionnaire. Settings: Field survey on convenience sample in California and in Seoul, Korea. PARTICIPANTS: 225 KA and 216 Korean mothers. Main Outcome Measures: Frequency of eating at home, preparation of Korean foods, favorite dishes of families, and for special occasions. ANALYSIS: Chi-square, t test, and analysis of variance. RESULTS: Families of the more acculturated mothers dined out more frequently and had lower preferences for Korean foods than did the families with less acculturated mothers. The more acculturated mothers prepared Korean foods, including kimchi, less at home. Fewer Korean dishes were included among the 5 favored dishes, both for family and for special occasions, in KA families than in Korean families. The acculturation stage of the mothers affected preference for Korean dishes of the families but not for special occasions. CONCLUSIONS AND IMPLICATIONS: Mothers' acculturation stage influenced the family's eating habits. Changes of preference of typical Korean dishes varied by acculturation stage. Nutrition educators should be aware that dietary behaviors of KA families may differ by acculturation stage and tailor interventions appropriately.     

Attitudes, practices, and concerns about child feeding and child weight status among socioeconomically diverse white, Hispanic, and African-American mothers

Parents play an important role in the development of their children's eating behaviors. We conducted 12 focus groups (three white, three African-American, and three Hispanic-American low-income groups; three white middle-income groups) of mothers (N=101) of 2- to less than 5-year-old children to explore maternal attitudes, concerns, and practices related to child feeding and perceptions about child weight. We identified the following major themes from responses to our standardized focus group guide: 12 groups wanted to provide good nutrition, and most wanted children to avoid eating too many sweets and processed foods; 12 groups prepared foods their children liked, accommodated specific requests, and used bribes and rewards to accomplish their feeding goals (sweets were commonly used as bribes, rewards, or pacifiers); and 11 of 12 groups believed their children were prevaricating when they said they were full and mothers encouraged them to eat more. The common use of strategies that may not promote healthful weight suggests work is needed to develop culturally and socioeconomically effective overweight prevention programs. Further study is needed to verify racial/ethnic or income differences in attitudes, practices, and concerns about child feeding and perceptions of child weight.     

Child-feeding strategies are associated with maternal concern about children becoming overweight, but not children's weight status

BACKGROUND: Research suggests that parents use specific child-feeding strategies to influence their child's weight based on perceptions and concerns about their child's overweight risk, but limited data are available on ethnically diverse low-income populations. OBJECTIVE: This cross-sectional study examined associations between mothers' perception and concern about children's weight, child-feeding strategies, and child overweight in an ethnically diverse population. SUBJECTS: Mothers of preschool children (n=967) who participated in a federally funded nutrition program were asked how they fed their child, how they perceived child's weight, and whether or not they were concerned about their child becoming overweight. STATISTICAL ANALYSES PERFORMED: Logistic regression to calculate odds of maternal perception/concern given child weight, feeding strategy given maternal perception/concern, and child overweight given feeding strategy. RESULTS: Only 21% (n=23/108) of overweight preschoolers were perceived as overweight. Maternal perception of overweight was not associated with feeding strategies. About 53% (n=76/144) of Hispanic, 42% (n=23/55) of African-American, and 29% (n=223/768) of white mothers reported concern about their child becoming overweight. Mothers reporting concern were more likely to restrict child's intake of select foods (odds ratio 5.94; 95% confidence interval 1.74 to 20.28) and less likely to pressure child to eat (odds ratio 0.39; 95% confidence interval 0.15 to 0.99); however, these strategies did not predict child overweight. CONCLUSIONS: Mothers concerned about their child becoming overweight were more likely to restrict children's intake of specific foods and less likely to pressure their child to eat; however, this study did not detect an association between feeding strategies and child overweight.     

Chinese and Korean immigrants' early life deprivation: an important factor for child feeding practices and children's body weight in the United States

This paper examines the associations between Chinese and Korean immigrant parents’ early life material and food deprivation and their concern about their child’s diet or weight, preferences for heavier children, and weight-promoting diet and child weight, alongside the moderating role of parents’ acculturation toward American culture. In 2010, Chinese and Korean immigrant parents of children ages 3–8 years in the United States (N = 130) completed interviews which asked about their perceived early life material deprivation and food insecurity, acculturation, child feeding practices, and evaluations of whether their child weighed more or less than the ideal, and child consumption of soda and candy. Independent measures of child and parent BMI were also obtained. Regression analyses revealed that parents’ early life food insecurity was associated with the evaluation that their child should weigh more than they do and greater consumption of soda and sweets by their child, among the least acculturated parents. Parental material deprivation was associated with more laissez-faire child feeding practices: less monitoring, less concern about the child’s weight or diet, and less perceived responsibility for the child’s diet, but only among less acculturated parents. Overall, the results suggest that immigrant parents’ child feeding practices and body size evaluations are shaped by material hardship in childhood, but these influences may fade as acculturation occurs.     

Food security and nutritional outcomes of preschool-age Mexican-American children

OBJECTIVE: To examine the relationship of food insecurity to nutrition of Mexican-American preschoolers. DESIGN: Cross-sectional survey of low-income Mexican-American families with children of preschool age (3 to 6 years). Data included food security using the Radimer/ Cornell scale; acculturation; parental education; monthly income; past experience of food insecurity; and child weight, height, and frequency of consuming 57 foods. Weight-for-height z scores (WHZ), height- for-age z (HAZ) scores, and the percentage of overweight (> or = 85th percentile WHZ) were calculated. SUBJECTS/SETTING: A convenience sample of Mexican-American families (n=211) was recruited through Head Start, Healthy Start, Migrant Education, and the Special Supplemental Nutrition Program for Women, Infants, and Children in Tulare, Fresno, Monterey, and Kern counties in California. Statistical analyses Analysis of variance, t tests, Spearman's correlations, and Mantel Haenszel chi2. RESULTS: Limited education, lack of English proficiency, and low income were negatively correlated with food security (r = -0.31 to -0.44, P<.0001). After controlling for acculturation, children in severely food-insecure households were less likely to meet Food Guide Pyramid guidelines than other children (median number of food groups > or = recommended levels [interquartile range]: 2.0 (2.0) vs 3.0 (2.0), P<.006). Although WHZ (mean +/- SD = 1.28 +/- 1.80) and percent overweight (48%, N=19) tended to peak among children from household level food insecure families, no significant differences were found in weight or height status of children by level of food insecurity. APPLICATIONS/CONCLUSIONS: Dietetics professionals working with low-income Hispanic-American families should screen for different levels of food insecurity to determine needs for nutrition education and other services.     

Relationship of child-feeding practices to overweight in low-income Mexican-American preschool-aged children

OBJECTIVE: The purpose of this research was to examine the relationship of child-feeding practices and other factors to overweight in low-income Mexican-American preschool-aged children. DESIGN: Cross-sectional survey with anthropometric measurements of mothers and target children. Trained bilingual staff interviewed the parents to collect data on child-feeding strategies, food patterns, child's health history, parental acculturation level, food insecurity, and other household characteristics.Subjects and setting Complete data were available from 204 low-income Mexican-American parents residing in California with at least one child aged 3 to 5 years.Outcomes measured Risk of overweight was defined as body mass index (BMI) (measured as weight [in kilograms]/height [in meters](2)) >/=85th percentile and overweight was defined as BMI >/=95th percentile. The Student t test, chi(2) test, and logistic regression were used. RESULTS: Three variables were positively related to risk of overweight: birth weight (odds ratio [OR], 2.31; 95% confidence interval [CI], 1.11 to 4.82), mother's BMI >/=30 (OR, 2.05; 95% CI, 1.11 to 3.79), and juice intake (OR, 2.33; 95% CI, 1.09 to 4.98). Being enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children was negatively related to risk of overweight (OR, 0.40; 95% CI, 0.21 to 0.75). Additional variables related to overweight were monthly income >$1,500 (OR, 2.33; 95% CI, 1.00 to 5.42) and child takes food from the refrigerator between meals (OR, 0.32; 95% CI, 0.13 to 0.76). CONCLUSIONS: The results of this study suggest that biological and socioeconomic factors are more associated with overweight in Mexican-American preschool-aged children than most of the self-reported child-feeding strategies.     

Acculturation, socioeconomic status, obesity and lifestyle factors among low-income Puerto Rican women in Connecticut, U.S., 1998-1999.

OBJECTIVES: To examine the associations of socioeconomic status and acculturation with obesity and lifestyle characteristics that may be risk factors for diabetes and cardiovascular disease among low-income Puerto Rican women. METHODS: This cross-sectional study was conducted between 1998 and 1999 by interviewing a convenience sample of 200 low-income Puerto Rican female caretakers of young children in Hartford, Connecticut, United States of America. Various recruitment methods were used to ensure adequate representation of the target community. The associations of obesity (body mass index > or = 30.0) and lifestyle factors (physical activity, cigarette smoking, alcohol consumption, food intake) with socioeconomic status (education, employment, car ownership), acculturation, age, and marital status were examined with Spearman rho, chi-squared, and Mann-Whitney U tests and logistic regression analyses. RESULTS: Mean age was 29 years. Obesity (40%), physical inactivity (47%), and cigarette smoking (32%) were common. Less acculturated participants were 57% less likely to smoke and 54% less likely to be obese than their more acculturated counterparts. Lower socioeconomic status (not finishing high school or not owning a car) was associated with a higher likelihood of obesity, but unemployed (vs. employed) women were less likely to be obese (P < 0.05). Women who did not own a car consumed meat, eggs and fish less often than those who owned a car. Smokers were more likely to have an unhealthy food intake pattern than nonsmokers. CONCLUSIONS: The associations of acculturation and socioeconomic status with some lifestyle characteristics suggest the need for culturally appropriate programs to promote healthy lifestyle behaviors in this low-income community.     

Intergenerational perceptions of body image in hispanics: role of BMI, gender, and acculturation

OBJECTIVE: To assess role of BMI, gender, and acculturation on maternal and children's perception of body size, body ideal, and attractiveness. RESEARCH METHODS AND PROCEDURES: Eighty mothers and their 6- to- 12-year-old children (41 boys, 39 girls) participated. Maternal and children's perceptions of body size (actual and ideal) and attractiveness were assessed through a pictorial instrument. Mother and child height and weight, demographic, and acculturation characteristics were also assessed. RESULTS: Seventy-nine percent of the mothers were overweight, and 32% of the boys and 34% of the girls were overweight or at-risk for overweight. BMI influenced the children's selection of perceived ideal size. Overweight or at-risk for overweight children were more likely to select thinner figures as the ideal size than non-overweight children. Gender and acculturation differences concerning children's perceptions of body size and attractiveness were also found. Girls perceived the obese figure as being less attractive than did the boys. More acculturated children were likely to select thinner figures as more attractive than their less acculturated counterparts. Maternal acculturation was associated positively with the girls' choice of thinner figures as an ideal body size, but not with the boys. Mothers viewed their daughters' actual body size and BMI as ideal, although 34% of the girls were at-risk for overweight. Mothers perceived average body size figures as more attractive for their sons. DISCUSSION: Findings from this study provide empirical data about the role of BMI, gender, acculturation, and familial influences on children's perceptions of actual and ideal body sizes and attractiveness.     

Using Qualitative Methods to Design a Culturally Appropriate Child Feeding Questionnaire for Low-Income,Latina Mothers

Obesity rates remain high among children in the United States (US), but children of low-income, minority families are at particularly high risk. Latinos are the largest and most rapidly growing US population group. Effective strategies will require attention to a wide array of culturally mediated variables that influence child feeding practices through the social contexts in which behaviors take place. This paper presents the design and implementation of a qualitative study examining low-income, Latina mothers’ perceptions of child weight status and feeding practices, and their associations with the development of overweight in children. Guided by the social ecologic model and social contextual model on the role of the family in mediating health behavior, the Latina Mother Child Feeding Practices (LMCFP) study provided a systematic exploration of the influence of social class, culture, and environmental factors associated with mothers’ perceptions of child overweight on feeding practices and behaviors. The design for this qualitative study consisted of three sequential phases: focus groups, in-depth interviews and cognitive interviews with Latina mothers conducted by Spanish-speaking researchers. Results showed the important role of socio-cultural factors in influencing Latina mothers’ child feeding practices. In the short-term, this research yielded information to develop a child-feeding questionnaire appropriate for low-income, Latina mothers. Findings have important implications in developing nutrition education strategies for child health promotion that account for the social and cultural context of minority, low-income caregivers.     

Family Mediators of the Relation Between Acculturation and Adolescent Mental Health*

Abstract: This study of 175 Mexican‐origin families examined a mediational model linking the linguistic acculturation of mothers and adolescents with a wide array of family mediators and adolescent mental health outcomes. Family linguistic acculturation, a latent construct based on maternal and adolescent acculturation, was positively related to increased family and interparental conflict but was not related to maternal parenting practices. Family conflict mediated the link between acculturation and two adolescent outcomes, conduct problems and depressive symptoms. Family acculturation showed a complex pattern of positive, indirect (mediated) and negative, direct effects on adolescent depressive symptoms. Findings are discussed in relation to traditional cultural values of Mexican heritage families and prevailing theories about why more acculturated Mexican‐origin youth are at increased risk for problem behaviors.     

Hmong food helps us remember who we are: perspectives of food culture and health among Hmong women with young children

ObjectiveTo examine perspectives on food habits, acculturation, and health among Hmong women with young children in northern California.MethodsQualitative interviews were conducted with 15 Hmong mothers with young children in a low-income community of northern California. The interviews were transcribed and coded based on the principles of grounded theory.ResultsThe main themes that emerged from the interviews included comparisons between American and Hmong food cultures, food culture preservation, obesity issues, diverse acculturation processes, and intergenerational food habits. Hmong food culture has been identified as the representation of their healthful lifestyle, self-identity, and social support. At the same time, mothers are facing enormous challenges in bridging 2 extreme generations; the less acculturated, immigrant adults and the highly acculturated, US-born children in their households.Conclusions and ImplicationsAddressing the healthful aspects of Hmong food culture and healthful options of American food should be a focus of nutrition-related programs.     

Toddler-feeding practices among Mexican American mothers. A qualitative study

Little is known about toddler feeding practices, particularly among Mexican American mothers. A convenience sample of 18 Mexican-American mothers with toddlers participated in individual in-depth interviews. In determining what to feed her child, mothers tended to cater to the child's preferences rather than exposing the child to different foods or repeating attempts to feed previously unaccepted foods. In deciding when to feed food or beverage, more than half said the child's cue was primary. Findings indicate that an indulgent feeding style may dominate compared to other styles in the toddler developmental stage in Mexican-American mothers.     

Maternal employment: does it influence feeding practices during infancy?

Background: Although at least 30% of women with young children participate in the labour force, there has been very little research into the effect of maternal employment on the diets of young children. Increasingly it is being recognized that early feeding practices affect future health and may have a part to play in the development of eating disorders. Therefore it was decided to conduct a study in Sheffield to determine whether maternal employment influences infant feeding practices.
Methods: Mothers from social classes I and II (employed n =27; unemployed n =28) with infants aged 10–12 months were interviewed in their homes. Information was collected on past and present food and drink consumption, weaning practices, and progression to independent feeding.
Results: Employed mothers stopped breast-feeding earlier. This difference became evident after 2 months of age and reached significance at 4 months ( P < 0.05). Employed mothers introduced foods earlier and relied more on commercial baby foods, with significantly more spending over ú7–12 per week at the time of the survey ( P < 0.05).
Conclusions: Maternal employment does influence infant feeding practices and consequently may have repercussions on future health. Further studies are needed to investigate the long-term effects of maternal employment on infant feeding practices, particularly amongst lower socio-economic class families.     

Which adaptive maternal eating behaviors predict child feeding practices? An examination with mothers of 2- to 5-year-old children

Researchers have started to explore the detrimental impact of maladaptive maternal eating behaviors on child feeding practices. However, identifying which adaptive maternal eating behaviors contribute to lower use of negative and higher use of positive child feeding practices remains unexamined. The present study explored this link with 180 mothers of 2- to 5-year-old children. Hierarchical regression analyses (controlling for recruitment venue and maternal demographic characteristics, i.e., age, education, ethnicity, and body mass index) examined mothers' intuitive eating and eating competence as predictors of four feeding practices (restriction, monitoring, pressure to eat, and dividing feeding responsibilities with their child). Mothers who gave themselves unconditional permission to eat were less likely to restrict their child's food intake. Mothers who ate for physical (rather than emotional) reasons and had eating-related contextual skills (e.g., mindfulness when eating, planning regular and nutritious eating opportunities for themselves) were more likely to monitor their child's food intake. Mothers who had eating-related contextual skills were more likely to divide feeding responsibilities with their child. No maternal eating behavior predicted pressure to eat. Interventions to help mothers develop their eating-related contextual skills and eat intuitively, in particular, may translate into a more positive feeding environment for their young children.     

Effects of combining public assistance and employment on mothers and their young children

One goal of recent welfare reform legislation is to move welfare-dependent mothers with young children into the paid labor force. However, prior to the new legislation, many welfare-dependent women were already engaged in employment activities. In this paper we examine whether child or maternal well-being is influenced by a mother's strategy of combining work and public assistance receipt in the late 1980s. Measures of well-being include children's cognitive test scores and behavior problems, parenting behavior, and maternal mental health, social support, and coping strategies collected when children were 2 1/2 to 3 years of age. Data from the Infant Health and Development Program (a sample of low birthweight, premature infants born in 8 sites in 1985) were used to identify low-income families (incomes under 200% of the poverty threshold; N = 525). Comparisons were made among mothers in the following groups: (a) Work Only, (b) Some Work-Some Welfare, (c) Some Work-No Welfare, (d) No Work-No Welfare, and (e) Welfare Only. Mothers in the Some Work-Some Welfare group had children with cognitive and behavioral scores similar to children whose mothers were in the Work Only group; these two groups also had similar mental health, social support, and coping scores. However, not working and receiving welfare (Welfare Only) was associated with negative cognitive and behavioral outcomes for children, with less stimulating home learning environments, lower maternal mental health, less social support, and more avoidant coping strategies. We discuss the proposition that welfare and work may be complementary rather than opposing strategies, in terms of putting together a family income package.     

Feeding practices of mothers from varied income and racial/ethnic groups

Objective: Relatively few investigators have explored the role of maternal control in describing the feeding behaviour of nonwhite parents of preschool-age children. The present study was conducted to examine if controlling feeding behaviours (i.e. restriction and pressuring) varied by income (middle vs. low) and race/ethnicity (white vs. Hispanic), and if they were associated with the body mass index (BMI) of their four-year-old offspring. Methods: Responses to the ‘restriction’ and ‘pressure to eat’ variables of the Child Feeding Questionnaire were compared between 51 white middle-income mothers and 49 Hispanic low-income mothers. Results: Mothers from both groups gave predominantly ‘neutral’ ratings in their self-reports of feeding practices. However, relative to the Hispanic mothers, white mothers indicated significantly less restriction and pressure to eat. Higher child BMI was predicted by male gender and being Hispanic. Conclusions: The utility of maternal feeding practices in predicting child overweight is discussed, and the significant association between the conceptually different constructs of restriction and pressure to eat is examined.     

Acculturation and health risk behaviors among Californians of Korean descent

BACKGROUND: This study examined the effects of acculturation on health behaviors among Korean-Americans in California compared to Koreans in Seoul. METHODS: Telephone interviews were conducted with 2,830 Korean-American adults in California (completion rate exceeding 86%) and 500 Korean adults in Seoul (completion of about 50%). RESULTS: Among Korean-Americans, acculturated women were more likely to smoke and drink while acculturated men were more likely to become obese. All Korean-American men reported significantly decreased rates of smoking and drinking compared to Koreans in Seoul. Among both men and women in California, acculturation was associated with high consumption of American foods, and low consumption of traditional Korean foods. CONCLUSIONS: These results indicate that more acculturated Korean-Americans were exposed to greater health risk than those who were less acculturated.     

The Effect of Time in the U.S. on the Duration of Breastfeeding in Women of Mexican Descent

Objectives: Although women of Mexican decent have high rates of breastfeeding, these rates may vary considerably by acculturation level. This study investigated whether increased years of residence in the U.S. is associated with poorer breastfeeding practices, including shorter duration of any and exclusive breastfeeding, in a population of low-income mothers of Mexican descent. Methods: Pregnant women (n = 490) were recruited from prenatal clinics serving a predominantly Mexican-origin population in an agricultural region of California. Women were interviewed during pregnancy, shortly postpartum, and when their child was 6 months, 1 year, 2 years, and 3.5 years of age. Results: Increased years of residence in the U.S. was associated with decreased likelihood of initiating breastfeeding and shorter duration of exclusive and any breastfeeding. Median duration of exclusive breastfeeding was 2 months for women living in the U.S. for 5 years or less, 1 month for women living in the U.S. for 6 to 10 years, and less than one week for women living in the U.S. for 11 years or more, or for their entire lives (lifetime residents). After controlling for maternal age, education, marital status and work status, lifetime residents of the U.S. were 2.4 times more likely to stop breastfeeding, and 1.5 times more likely to stop exclusive breastfeeding, than immigrants who had lived in the U.S. for 5 years or less. Conclusions: Efforts are needed to encourage and support Mexican-origin women to maintain their cultural tradition of breastfeeding as they become more acculturated in the U.S.     

Food avoidance in children. The influence of maternal feeding practices and behaviours

The aim of this study was to examine the contribution of a broad range of maternal feeding practices in predicting parental reports of food avoidance eating behaviours in young children, after controlling for child temperament, and maternal dietary restraint which have previously been associated with feeding problems. One hundred and four mothers of children aged between 3 and 6 years completed self report measures of their child's eating behaviour and temperament, maternal dietary restraint and child feeding practices. Maternal reports of food avoidance eating behaviours were associated with an emotional child temperament, high levels of maternal feeding control, using food for behaviour regulation and low encouragement of a balanced and varied food intake. Maternal feeding practices, predominantly pressure to eat, significantly predicted food avoidance eating behaviours after controlling for child emotionality and maternal dietary restraint. The significant contribution of maternal feeding practices, which are potentially modifiable behaviours, suggests that the feeding interactions of parents and their children should be targeted for intervention and the prevention of feeding difficulties during early childhood. Future research should continue to explore how a broader range of feeding practices, particular those that may be more adaptive, might influence child eating behaviour.