Results from "Live Well", a randomized controlled community-based participatory intervention to prevent obesity in new immigrant mother-child dyads.

BACKGROUND: Upon arrival, the prevalence of overweight and obesity is lower in new immigrants than their native counterparts in the U.S. With longer residency in the U.S., these differences converge over time, followed by higher prevalence among immigrants than native U.S. residents. Results from the Live Well project in the Greater Boston area demonstrate the viability of utilizing a culturally adapted, community-based participatory research (CBPR) approach to reduce weight gain among newly immigrated mother-child dyads. METHODS: Haitian, Latina, and Brazilian mother-child dyads (n = 390), new to the U.S. (fewer than 10 years) were enrolled in a one- to two-year long CBPR lifestyle intervention that targeted dietary and physical activity behaviors. Attendance was recorded to establish dose. Demographics, anthropometrics, and relevant covariates were collected from participants at baseline, 6, 12, 18, and 24 months. Body Mass Index (BMI) was calculated using objectively measured height and weight. Linear mixed regression models were used to assess change in BMI and BMI z-score of mothers and children respectively. RESULTS: At baseline, nearly 75% of mothers and 50% of children were either overweight or obese (BMI ≥ 25.0 and BMI z-score ≥ 85th percentile, respectively). Only 20% of mothers attended all 12 intervention sessions in year 1. Using intent-to-treat analyses, no significant time, intervention, or time × intervention effects were observed for weight change of mothers or children at follow-up. Mothers in the highest quantile (those who attended all 12 intervention sessions) had significant reductions in BMI at 18 months (1.76 units lower, 95%CI: -3.14, -0.37) and 24 months (2.61 units, 95%CI -3.92, -1.29) compared to mothers in the lower quantiles, including those with no exposure. Such dose effects on BMI z-scores were not noted for children. CONCLUSIONS: Findings from Live Well demonstrate the viability of utilizing a CBPR approach to address overweight and obesity among immigrant mothers. Given the higher-than-expected prevalence of overweight and obesity among mother-child dyads by ~ 6 years of U.S. residency, and lower maternal participation rates in the intervention, additional research is necessary to identify the optimal intervention length, retention strategies, and approach to jointly support healthy maternal and child weight.

Depressive Symptoms and Weight Status Among Women Recently Immigrating to the US.

Objectives Depressive symptoms have been associated with obesity. Little is known about this relationship among immigrants. We examined relationships between depressive symptoms and weight status in immigrant women from three ethnic groups. Methods Participants were Brazilian, Haitian, and Latina women (n = 345) enrolled in Live Well, a community-based, randomized intervention designed to prevent weight gain in recent immigrants. Study data are from baseline when participants completed the Center for Epidemiological Studies Depression Scale (CES-D), Perceived Stress Scale, a physical activity questionnaire, and socio-demographic questions; BMI was calculated from measured height and weight. Results Forty-four percent of participants (36 % of Brazilians, 66 % of Haitians, 30 % of Latinas) had high depressive symptoms (CES-D ≥ 16), and 38 % (26 % of Brazilians, 49 % of Haitians, 42 % of Latinas) were obese (BMI ≥ 30.0). Those reporting more depressive symptoms were more likely to be obese (Wald Chi square = 4.82, p < .05). An interaction between depressive symptoms, ethnic group, and income was revealed (F(4,340) = 2.91, p < .05), such that higher depressive symptoms were associated with higher BMI among Brazilians earning ≥$30,000 per year and with lower BMI among Brazilians earning <$30,000. The relationship between depressive symptoms and obesity did not differ by income among Haitians or Latinas. Conclusions Depressive symptoms and obesity were highly prevalent among these recently-immigrated women. Positive relationships between these variables were consistent across ethnic and income groups, with the exception of lower-income Brazilians. While these findings suggest similar patterns and health needs across several groups of immigrants, cultural differences should be considered when addressing these health conditions.

Baseline Socio-demographic characteristics and self-reported diet and physical activity shifts among recent immigrants participating in the randomized controlled lifestyle intervention: "Live Well".

The goal of this paper is to describe the baseline characteristics of Live Well (intervention to prevent weight gain in recent immigrant mother-child dyads from Brazil, Haiti, and Latin America) participants, and to explore self-reported changes in diet and physical activity post-immigration. Baseline data from 383 mothers were used for this study. Dyads attended a measurement day where they completed self-administered surveys collecting information about socio-demographics, diet, physical activity, other psychosocial variables, and height and weight. Haitian mothers' socio-demographic profile differed significantly from that of Brazilians' and Latinas': they have been in the US for a shorter period of time, have higher rates of unemployment, are less likely to be married, more likely to have ≥3 children, more likely to be obese, and have immigrated for family or other reasons. In multivariate models, self-reported changes in diet and physical activity since migrating to the US were significantly associated with BMI with non-linear relationships identified. Future research is needed to understand how diet and physical activity change while acculturating to the US and explore the adoption of both healthy and unhealthy dietary changes.

Feeding styles and evening family meals among recent immigrants.

The protective effect of family meals on unhealthy weight gain and diet has been shown across multiple age groups; however, it is unknown whether a similar effect is present among diverse immigrant populations. In addition, little research has focused on factors associated with the frequency of evening family meals, such as feeding styles (how parents interact with their child around feeding). Therefore the goals of this paper are to explore the 1) association between the frequency of evening family meals and child weight status among new immigrant families, and 2) influence of immigrant mothers' feeding styles on the frequency of evening family meals. Baseline self-reported socio-demographic information and measured heights and weights were collected for both mother and child (age range: 3­12 years) among 387 mother-child dyads enrolled in Live Well, a community-based, participatory-research, randomized controlled lifestyle intervention to prevent excessive weight gain in recent (<10 years in the U.S.) immigrant mothers and children. For children, height and weight measurements were transformed into BMI z-scores using age-and sex-specific CDC standards and categorized as overweight (85th­94th percentile) and obese (≥95th percentile); mothers' BMI was calculated. Frequency of evening family meals, eating dinner in front of the TV, acculturation and responses to the Caregiver's Feeding Styles Questionnaire (CFSQ) were also obtained from the mother. Children were categorized as "eating evening family meals regularly" if they had an evening family meal ≥5 times per week. Overall, 20% of children were overweight and 25% were obese. Less than half (40.9%) of families had regular evening family meals. In multivariate analyses, adjusting for covariates, children who were overweight/obese were significantly less likely to have ≥5 evening family meals/week compared with normal weight children (OR = 0.51, 95% CI 0.32-0.82) . Mothers who had a low demanding/high responsive or a low demanding/low responsive feeding style, were less likely to have ≥5 evening family meals/week compared to mothers with a high demanding/high responsive feeding style (OR = 0.41, 95% CI 0.18-0.0.96, OR = 0.33, 95% CI 0.13-0.87, respectively). Future interventions and programs that seek to help parents establish healthy household routines, such as family meals, may consider tailoring to specific maternal feeding styles.

Immigrating to the US: what Brazilian, Latin American and Haitian women have to say about changes to their lifestyle that may be associated with obesity.

Our goal was to explore the perceived determinants of obesity in Brazilian, Latin American and Haitian women. This is part of an ongoing community-based participatory intervention. Focus groups by immigrant group were conducted and themes extracted. Women expressed differences in beliefs, attitudes, and barriers regarding diet and physical activity in the US versus their home country. Participants thought food in the US is "less natural," there is less time for preparation, and there is more variety. The weather is a barrier to physical activity in the US and work is more physically demanding. Job-related efforts were not considered physical activity. They reported higher levels of stress, less control of their time and less social support in the US. Providing immigrants with appropriate support and education early in the acculturation process has the potential to help prevent obesity.

Occupational health and safety experiences among self-identified immigrant workers living or working in Somerville, MA by ethnicity, years in the US, and English proficiency.

In this community based research initiative, we employed a survey instrument predominately developed and administered by Teen Educators to assess occupational health risks for Haitian, Salvadoran, and Brazilian immigrants (n = 405) in Somerville, MA, USA. We demonstrate that a combined analysis of ethnicity, years in the US, and English proficiency better characterized the occupational experience of immigrant workers than considering these variables individually. While years in the US (negatively) and English proficiency (positively) explained the occurrence of health risks, the country of origin identified the most vulnerable populations in the community. Brazilians, Salvadorans, and other Hispanic, all of whom who have been in the US varying length of time, with varying proficiency in English language had twice the odds of reporting injuries due to work compared to other immigrants. Although this observation was not significant it indicates that years in the US and English proficiency alone do not predict health risks among this population. We recommend the initiation of larger studies employing c community based participatory research methods to confirm these differences and to further explore work and health issues of immigrant populations. This study is one of the small number of research efforts to utilize a contemporaneous assessment of occupational health problems in three distinct immigrant populations at the community level within a specific Environmental Justice context and social milieu.

Feeding styles and child weight status among recent immigrant mother-child dyads.

BACKGROUND: Research has shown that parental feeding styles may influence children's food consumption, energy intake, and ultimately, weight status. We examine this relationship, among recent immigrants to the US. Given that immigrant parents and children are at greater risk for becoming overweight/obese with increased time in the US, identification of risk factors for weight gain is critical. METHODS: Baseline data was collected on 383 mother-child dyads enrolled in Live Well, a community-based, participatory, randomized controlled lifestyle intervention to prevent weight gain in recent immigrant mothers. Socio-demographic information together with heights and weights were collected for both mother and child. Acculturation, behavioral data, and responses to the Caregiver's Feeding Styles Questionnaire (CFSQ) were also obtained from the mother. RESULTS: The children's average age was 6.2 ± 2.7 years, 58% male. Mothers had been in the country for an average of 6.0 ± 3.3 years, and are Brazilian (36%), Haitian (34%) and Latino (30%). Seventy-two percent of the mothers were overweight/obese, while 43% of the children were overweight/obese. Fifteen percent of mothers reported their feeding style as being high demanding/high responsive; 32% as being high demanding/low responsive; 34% as being low demanding/high responsive and 18% as being low demanding/low responsive. In bivariate analyses, feeding styles significantly differed by child BMIz-score, ethnic group, and mother's perceived stress. In multiple linear regression, a low demanding/high responsive feeding style was found to be positively associated (ß = 0.56) with a higher child weight as compared to high demanding/high responsive, controlling for known covariates (p = 0.01). CONCLUSIONS: Most mothers report having a low demanding/high responsive feeding style, which is associated with higher child weight status in this diverse immigrant population. This finding adds to the growing literature that suggests this type of feeding style may be a risk factor for childhood obesity. Further research is needed to help understand the larger socio-cultural context and its influence on feeding dynamics among immigrant families and families of lower incomes. How parents establish a certain feeding style in their home country compared to when they move to the US "obesogenic" environment, should also be explored.

The Vida Verde Women's Co-Op: Brazilian immigrants organizing to promote environmental and social justice.

We reviewed the key steps in the launch of the Vida Verde Women's Co-Op among Brazilian immigrant housecleaners in Somerville, MA. The co-op provides green housecleaning products, encourages healthy work practices, and promotes a sense of community among its members. We conducted in-depth interviews with 8 of the first co-op members, who reported a reduction in symptoms associated with the use of traditional cleaning agents and a new sense of mutual support. Critical to the co-op's success have been the supportive roles of its academic partners (Tufts University and the University of Massachusetts, Lowell), effective media outreach, and a focus on advancing social justice. Next steps include implementing a formal business plan and assessing the appropriateness of cooperatives in other industries.