Maternal Depressive Symptoms and Child Obesity in Low-Income Urban Families

ObjectiveTo characterize the relationship between maternal depressive symptoms and child weight status, obesity-promoting feeding practices, and activity-related behaviors in low-income urban families.MethodsWe conducted a cross-sectional survey of mothers with 5-year-old children receiving pediatric care at a federally qualified community health center. We used regression analyses to examine the relationship between maternal depressive symptoms (trichotomized: none, mild, moderate to severe) and 1) child weight status; 2) obesity-promoting feeding practices, including mealtime practices and feeding styles; and 3) activity-related behaviors, including sleep time, screen time, and outdoor playtime.ResultsThe sample included 401 mother–child pairs (78.3% response rate), with 23.4% of mothers reporting depressive symptoms (15.7% mild, 7.7% moderate to severe). Mothers with moderate to severe depressive symptoms were more likely to have overweight and obese children than mothers without depressive symptoms (adjusted odds ratio 2.62; 95% confidence interval 1.02–6.70). Children of mildly depressed mothers were more likely to consume sweetened drinks and to eat out at restaurants and were less likely to eat breakfast than children of nondepressed mothers. Mothers with depressive symptoms were less likely to set limits, to use food as a reward, to restrict their child’s intake, and to model healthy eating than nondepressed mothers. Children with depressed mothers had less sleep and outdoor playtime per day than children of nondepressed mothers.ConclusionsMaternal depressive symptoms are associated with child overweight and obese status and with several obesity-promoting practices. These results support the need for maternal depression screening in pediatric obesity prevention programs. Further research should explore how to incorporate needed mental health support.     

Sensitive Timing for Risk of Overweight Among Infants of Low-Income Hispanic Immigrants

Introduction

This study examined the association between early weight gain (0–6 months) and risk for overweight, as defined by the Institute of Medicine, at 1 year among infants of low-income Hispanic immigrant mothers.

Caregiver Concern About Child Overweight/Obesity in Grandparent Versus Parent-Headed Households in the United States

ObjectiveTo examine the association of caregivers’ concern about children's overweight and obesity status with family structure (grandparent versus parent-headed households).MethodsCaregivers reported their relation to the child aged 10 to 17 years and the child's weight and height (National Survey of Children's Health 2016–20). Overweight/obesity was calculated using Centers for Disease Control and Prevention growth charts. We estimated associations (prevalence odds ratio) of residing in a grandparent-headed household with lack of weight concern (responding “Yes, it's too low” or “No, not concerned” to “Are you concerned about this child's weight?”) among propensity score-matched children with overweight and obesity. Covariates included child's sex, race, ethnicity, age, family poverty ratio, primary household language, highest level of education among reported adults, caregiver mental and emotional health, usual source of care and survey year.ResultsThe prevalence of child overweight/obesity was higher in grandparent-headed households. Among children with overweight/obesity, 64.65 (SE = 3.27)% of grandparents and 66.55 (SE = 0.81)% of parents did not express concern about the child's weight status. Among children with obesity, it was 52.42 (SE = 4.63)% and 49.04 (SE = 1.28)%, respectively. Family structure was not associated with caregiver lack of weight concern in propensity score-matched samples.ConclusionsAppropriate caregiver concern about child's weight status was low in both grandparent and parent-headed households in the United States.     

Early Life Factors for Overweight Risk Among Infants of Hispanic Immigrant Mothers

Introduction

This study examined postpartum depression, food insecurity, and underestimation of infant size as potential early life factors for overweight risk at 12 months among infants of Hispanic immigrant mothers.

Material Hardships and Infant and Toddler Sleep Duration in Low-Income Hispanic Families

ObjectiveTo assess relationships between material hardships, shortened sleep duration, and suboptimal sleep practices across infancy and toddlerhood in low-income Hispanic families.MethodsWe analyzed longitudinal data of 451 low-income Hispanic mother-child pairs from a child obesity prevention trial. During infancy and toddlerhood, we used adjusted linear regression to assess associations between material hardship (financial difficulty, food insecurity, housing disrepair, and multiple hardships), sleep duration (24-hour, night), and the number of suboptimal sleep practices (eg, later bedtime, co-sleeping). We used adjusted linear regression to assess the longitudinal association between the number of suboptimal sleep practices in infancy and toddlerhood, and tested whether specific or multiple hardships moderated this association.ResultsIn infants, financial difficulty and multiple hardships were associated with decreased night sleep (B = −0.59 hours, 95% confidence interval [CI]: −1.04, −0.14; and B = −0.54 hours, 95% CI: −1.00, −0.08). Housing disrepair was associated with decreased 24-hour sleep (B = −0.64 hours, 95% CI: −1.29, −0.01). In toddlers, each additional suboptimal sleep practice was associated with a decrease in night sleep (B = −0.19 hours, 95% CI: −0.29, −0.09). Each additional suboptimal sleep practice in infancy was associated with a 0.30 increase in the number of suboptimal sleep practices in toddlerhood (P < .001), with greater increases for those with food insecurity or multiple hardships.ConclusionSpecific and multiple hardships shortened sleep duration during infancy, and moderated the increase of suboptimal sleep behaviors between infancy and toddlerhood. Future studies should consider these early critically sensitive periods for interventions to mitigate material hardships and establish healthy sleep practices.     

Low-Income Black and Hispanic Children's Neighborhood Food Environments and Weight Trajectories in Early Childhood

BackgroundHigh obesity rates among young black and Hispanic children place them at a higher risk for adult obesity and its comorbidities. Neighborhoods with predominately racial and ethnic minority residents have fewer healthful food options, which may contribute to obesity disparities. Few studies have assessed the relationship between neighborhood food environments and obesity in this population.MethodsElectronic health records from 2 pediatric primary care clinics serving predominately low-income, black, and Hispanic children were used to create a cohort of 3724 2- to 5-year olds, encompassing 7256 visits from 2007 to 2012 (mean 1.9 visits per patient, range: 1–5 visits per child). Longitudinal regression was used to model the association of mean body mass index z-score (BMI-z) over time and 3 measures of the neighborhood food environment: healthful food availability, availability of stores accepting the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) benefits, and fast food availability.ResultsCompared to peers in neighborhoods with no or few stores accepting WIC, children in neighborhoods with many WIC stores had higher BMI-z at age 2 years (average difference of 0.272; 95% confidence interval: 0.041–0.503; P = .021). No relationship was found for healthful food or fast food availability. Although children in neighborhoods with low fast food availability did not have statistically significantly different BMI-z at age 2 as compared to children in areas with high fast food availability, they did have a statistically significantly higher change in average BMI-z over time (0.006 per month, 0.000–0.012, P = .024).ConclusionsAccess to WIC stores was associated with lower obesity rates and more healthful average BMI-z over time and represents a potentially important neighborhood food environment characteristic influencing racial/ethnic disparities in childhood obesity among young black and Hispanic children. More studies are needed to assess what aspects of WIC stores may underlie the observed association.     

Early Childhood Stress and Child Age Predict Longitudinal Increases in Obesogenic Eating Among Low-Income Children

Objective

To identify whether psychosocial stress exposure during early childhood predicts subsequent increased eating in the absence of hunger (EAH), emotional overeating, food responsiveness, and enjoyment of food.

Alcohol use among Dominican and Puerto Rican adolescents residing in New York City: role of Hispanic group and gender

Hispanic groups are often aggregated when examining adolescent drinking. The objective of this study was to determine the roles of Hispanic group (Puerto Rican versus Dominican) and gender in alcohol use among inner-city youth. Sixth and seventh graders in 22 New York City schools who identified themselves as Puerto Rican or Dominican completed self-report questionnaires at two assessments (N = 849 at baseline; N = 678 at 1-year follow-up). Dominican adolescents generally engaged in more alcohol use than Puerto Rican adolescents. In a number of cases, gender moderated the effect of Hispanic group on drinking. Specifically, Dominican boys reported greater use than Dominican girls, but use was similar across gender for Puerto Rican adolescents. These findings highlight the importance of considering Hispanic group and gender when examining adolescent drinking.     

Concordance and Discordance in the Geographic Distribution of Childhood Obesity and Pediatric Type 2 Diabetes in New York City

ObjectiveAs rates of childhood obesity and pediatric type 2 diabetes (T2D) increase, a better understanding is needed of how these 2 conditions relate and which subgroups of children are more likely to develop diabetes with and without obesity.MethodsTo compare hotspots of childhood obesity and pediatric T2D in New York City, we performed geospatial clustering analyses on obesity estimates obtained from surveys of school-aged children and diabetes estimates obtained from health care claims data, from 2009 to 2013. Analyses were performed at the Census tract level. We then used multivariable regression analysis to identify sociodemographic and environmental factors associated with these hotspots.ResultsWe identified obesity hotspots in Census tracts with a higher proportion of Black or Hispanic residents, with low median household income, or located in a food swamp. Total 51.1% of pediatric T2D hotspots overlapped with obesity hotspots. For pediatric T2D, hotspots were identified in Census tracts with a higher proportion of Black residents and a lower proportion of Hispanic residents.ConclusionsNon-Hispanic Black neighborhoods had a higher probability of being hotspots of both childhood obesity and pediatric T2D. However, we identified a discordance between hotspots of childhood obesity and pediatric diabetes in Hispanic neighborhoods, suggesting either under-detection or under-diagnosis of diabetes, or that obesity may influence diabetes risk differently in these 2 populations. These findings warrant further investigation of the relationship between childhood obesity and pediatric diabetes among different racial and ethnic groups, and may help guide pediatric public health interventions to specific neighborhoods.     

超重及肥胖儿童综合干预效果

目的 观察健康教育、行为矫正、膳食调整、运动处方等综合干预措施对控制超重及肥胖儿童形态指标、围度指标及血液指标的效果.方法 组织暑期夏令营,由具备研究能力的教练、医师、营养师及心理教师共10人,对23例北京市8～14岁超重及肥胖的中小学生进行为期21 d的封闭式综合干预,观察干预前后学生身体形态指标、围度指标及血液指标的变化.结果 23例超重及肥胖中小学生干预后体质量、体质量指数、体脂率等形态指标均优于干预前,且差异均有统计学意义(Pa<0.01);干预后相关围度指标,包括上臂皮脂厚度、肩胛下角皮脂厚度、腹部皮脂厚度及上臂围、胸围、腰围、臀围围度较干预前均降低,且差异均有统计学意义(Pa<0.05),大腿围亦有降低,但差异不显著(P>0.100);总胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白优于干预前,但差异均无统计学意义(Pa>0.100).结论 采取系统、有效、简便的综合干预措施可显著改善超重及肥胖儿童的形态指标和围度指标,短期综合干预对血液指标的改善效果不明显,提示要从根本上改善超重及肥胖儿童的体质健康需要持久的综合干预.     

Aging cohort of perinatally human immunodeficiency virus-infected children in New York City. New York City Pediatric Surveillance of Disease Consortium

BACKGROUND: New York City (NYC) pediatricians are now caring for fewer HIV-infected infants and more school age children and adolescents than earlier in the epidemic. METHODS: Clinical, laboratory and demographic data were abstracted from medical records at 10 NYC centers participating in the CDC Pediatric Spectrum of HIV Disease project. Pediatric AIDS cases and HIV-related deaths reported to the NYC Department of Health were examined. RESULTS: Median age of HIV-infected children in care increased from 3 years in 1989 to 1991 to 6 years in 1995 to 1998. The number of HIV-infected women giving birth in NYC declined 50% from 1990 to 1997 (1630 to 831); increasing numbers were identified prenatally (14% in 1989; 78% after 1995); and most received prenatal zidovudine prophylaxis (73% in 1997). Estimated perinatal transmission decreased to 10% by 1997. Improved identification of seropositive status in infants was associated with an increased proportion of infected infants receiving Pneumocystis carinii pneumonia (PCP) prophylaxis, 84% in 1997. AIDS free survival was longer for children born 1995 to 1998 than for those born before 1995, P = 0.004. In 1998 among children with advanced immunosuppression (CDC category 3), 66% were prescribed 3 or more antiretroviral medicines and 88% received PCP prophylaxis. Citywide AIDS cases and HIV-related deaths fell precipitously beginning in 1996. CONCLUSIONS: Based on the observations of this study, the cohort of NYC HIV-infected children in care is aging, associated with a decline in new HIV infections, high rates of PCP prophylaxis and increased time to AIDS. Falling HIV-related deaths citywide support these observations.     

Chronic Family Adversity and Early Child Behavior Problems: A Longitudinal Study of Low Income Families

Abstract— A beginning step in the prevention of child psychopathology is the identification of conditions associated with a disproportionately high incidence of behavior problems. Rutter and colleagues (British Journal of Psychiatry , 1975, 126, 493-509) have reported a dramatic increase in the probability of child adjustment difficulties as a function of multiple family stressors. However, few investigators have tested this association beginning in infancy. The present investigation examines this relationship at the ages of 1 and 2 with behavioral adjustment at age 3 among 100 low-income families. Broad support was found for the family adversity hypothesis, though sex differences were evident regarding individual correlates of problem behavior.