Neighborhood Walkability and Aerobic Physical Activity among Latinos.

Objective: In this study, we examined neighborhood social cohesion (NSC) as a moderator in the association between neighborhood walkability and meeting the aerobic physical activity guideline among US Latino adults. Methods: We used 2015 National Health Interview Survey cross-sectional data from 4525 adult US Latino participants ≥18 years of age. NSC and walkability measures were self-reported. Higher walkability scores indicating higher walkability. Aerobic activity was assessed based on self-reported frequency and duration of activity. Minutes per week of moderate and vigorous aerobic activity were then categorized based on the 2018 Physical Activity Guidelines for Americans. Survey logistic regression was used to compute odds ratios [OR] and 95% confidence intervals [CI]. Effect modification by neighborhood social cohesion was tested by inclusion of a walkability*NSC interaction term. Results: A one-unit higher walkability score was associated with higher odds of meeting the aerobic activity guideline (OR = 1.06; 95% CI: 1.02, 1.11). After adding NSC to the model, the association remained statistically significant (OR = 1.05; 95% CI: 1.01, 1.10). The walkability*NSC interaction term was not statistically significant. Conclusions: NSC did not moderate the association between neighborhood walkability and meeting the aerobic activity guideline among US Latino adults.

School-Based Weight Management Program Curbs Summer Weight Gain Among Low-Income Hispanic Middle School Students.

BACKGROUND: Research shows that elementary students gain weight over the summer. It is unknown if these findings apply to Hispanic adolescents. We evaluated school and summer standardized body mass index (zBMI) changes in Hispanic middle school students. METHODS: Hispanic middle school students were randomly assigned to a weight management program (N = 230) or control condition (N = 195). Paired sample t-tests compared zBMI change scores during the school year versus summer when not enrolled in a weight management program (eg, control group). We used 2 × 2 repeated measures analysis of variances to determine program group differences in zBMI scores across school versus summer periods separately for normal and overweight/obese students. RESULTS: In the control group, students' zBMI change scores decreased during the school year, but increased during summer for both normal weight and overweight/obese students. Program effects on zBMI indicated school year decreases and summer increases for both normal and overweight/obese students. However, zBMI scores did not differ by program status for normal weight students. Overweight/obese students in the program compared to the control group increased zBMI to a lesser extent over the summer. CONCLUSION: For all students, zBMI increased during the summer. A school-based weight management program protected overweight/obese students against potentially greater summer weight gain.

Self-reported Health Predicts Hispanic Women's Weight Perceptions and Concerns.

Objectives In this study, we examined how self-reported health is related to low-income, Hispanic women's underestimation and concerns of weight status. Methods Seventy Hispanic women from Houston-area community centers reported their perceptions and concerns about their weight and health. Height and weight were measured to calculate body mass index. Cross-tabulations and Cohen's kappa determined agreement between women's perception of their weight status and measured weight status. Covariate-adjusted OLS regression models analyzed the association between women's self-reported health as a predictor of weight underestimation and concerns about becoming overweight. Results Forty-three percent of women misperceived their weight status [37% (N = 26) underestimated; 6% (N = 4) overestimated]. Overweight and obese women who reported their health as poor had 84% lower odds of underestimating their weight. Women who reported their health as poor health had 52% lower odds of being concerned about becoming overweight. Conclusions Self-reported poor health predicts perceptions of weight and concerns about future weight gain among low-income Hispanic women. Assessing patients' self-reported health status will allow practitioners to identify who may be at risk for underestimating their weight and being unconcerned about becoming overweight. This knowledge may help practitioners identify patients who would benefit from health education.

Compañeros: High School Students Mentor Middle School Students to Address Obesity Among Hispanic Adolescents.

INTRODUCTION: Promotoras, Hispanic community health workers, are frequently employed to promote health behavioral change with culturally bound Hispanic lifestyle behaviors. Peer health mentors have been used in schools to promote healthy nutrition and physical activity behaviors among students. This study investigates the efficacy of combining these 2 approaches by training high school health mentors, called compañeros, to engage Hispanic middle school students in a school-based obesity intervention as a strategy to promote and sustain reductions in standardized body mass index (zBMI). METHODS: High school compañeros were trained to participate in a 6-month obesity program alongside middle school students in Houston, Texas. Middle school students were randomized to participate in the program either with compañeros (n = 94) or without compañeros (n = 95). The intervention was conducted from 2013 through 2016 in 3 cohorts of students, 1 each school year. Students were followed for 12 months. The primary outcome was zBMI, which was analyzed at baseline, 6 months, and 12 months. RESULTS: Significant differences were found between conditions across time (F = 4.58, P = .01). After the 6-month intervention, students in the condition with compañeros had a larger decrease in zBMI (F = 6.94, P = .01) than students in the condition without compañeros. Furthermore, students who received the intervention with compañeros showed greater sustained results at 12 months (F = 7.65, P = .01). CONCLUSION: Using high school compañeros in an obesity intervention for Hispanic middle school students could be effective in promoting and maintaining reductions in zBMI.

Maternal concerns and perceptions of elementary school-age children's weight status.

PURPOSE: The purpose of this study was to identify characteristics associated with maternal concerns for her child becoming overweight, and how these concerns are related to her perceptions of her child's weight. DESIGN: A school-based sample of 55 children and their mothers from Houston, Texas, participated in a cross-sectional survey. Mothers reported on their concerns and perceptions regarding their child's weight. Child and mother height and weight were directly assessed to calculate body mass index (BMI). Covariate-adjusted logistic regression models were conducted. RESULTS: Over one-third of mothers misperceived their child's weight status [9% (n = 5) overestimated; 27% (n = 15) underestimated]. Mothers of sons were less accurate compared with mothers of daughters. For every one unit increase in maternal BMI, mothers had 13% higher odds of being concerned of their child becoming overweight. Concerned mothers had 82% lower odds of underestimating their child's weight. PRACTICE IMPLICATIONS: In order for school-based childhood obesity prevention and intervention programs to be successful, parents must accurately perceive their elementary school-age child's weight status. School nurses can be vital to these efforts through proper training and resources. Nurses can use the "School Nurse Childhood Obesity Toolkit" and motivational interviewing techniques to address parental concerns and perceptions prior to teaching behavior modification strategies to children/families.

Food insecurity and adult overweight/obesity: Gender and race/ethnic disparities.

The majority of the food insecurity-obesity research has indicated a positive association among women, especially minority women. Less research has been conducted on men, and the findings are inconsistent. The aim was to assess whether gender and race/ethnic disparities exists between the food insecurity and overweight/obesity relationship among adults ages 18-59. We used the cross-sectional 2011 and 2012 National Health Interview Survey data (N = 19,990). Three or more affirmative responses on the 10-item USDA Food Security Scale indicated food insecure experiences. Self-reported height and weight were used to calculate body mass index according to the Centers for Disease Control and Prevention. Multivariate logistic regression models were stratified by gender and race/ethnicity to estimate the association between food insecurity and overweight/obesity controlling for several demographic characteristics. Adults on average were 36 years of age (51% female; 56% white, 27% Hispanic, and 17% black), 27% were food insecure, and 65% were overweight/obese. Food insecurity was most prevalent among blacks and Hispanics, regardless of gender. A greater percentage of food insecure women were overweight/obese compared to food secure women among all race/ethnicity groups; while similar proportions of white, black, and Hispanic men were overweight/obese irrespective of their food security status. In covariate-adjusted models, food insecurity was associated with a 41% and 29% higher odds of being overweight/obese among white and Hispanic women, respectively. Food insecurity was not related to overweight/obesity among black women nor among white, black, and Hispanic men. The complex relationship between food insecurity and obesity suggests a need to investigate potential behavioral and physiological mechanisms, and moderators of this relationship.

Food Insecurity and Pre-diabetes in Adults: Race/Ethnic and Sex Differences.

OBJECTIVE: We examined sex and race/ethnicity differences in the association between food insecurity status and prediabetes among adults. METHOD: We used cross-sectional 2011 and 2012 National Health Interview Survey data on non-Hispanic white, non-Hispanic black, and Hispanic adults aged 18-59 years whose household income was ≤ 299% Federal Poverty Line (N = 19,048). Food insecurity status was determined by 3 or more affirmative responses on the 10-item USDA Food Security Scale. Pre-diabetes was self-reported. Logistic regression analyses were used to estimate associations of food insecurity with pre-diabetes and adjusted for several demographic characteristics. All models were stratified by sex and race/ethnicity. RESULTS: In adjusted models, food insecure non-Hispanic white women and non-Hispanic black women had 53% and over 200% higher odds of being pre-diabetic, respectively. Food insecurity was not related to pre-diabetes for Hispanic women or men. CONCLUSION: Limited food resources appear to place non-Hispanic white and non-Hispanic black women at risk for pre-diabetes. Linking food assistance programs with community-based health education programs may be a comprehensive approach to support those who are food insecure with diabetes prevention.

Gender Disparities in the Food Insecurity-Overweight and Food Insecurity-Obesity Paradox among Low-Income Older Adults.

BACKGROUND: Obesity and obesity-related comorbidities are increasing among older adults. Food insecurity is a nutrition-related factor that coexists with obesity among low-income individuals. The majority of the research on the food insecurity-obesity paradox has been conducted on low-income mothers and children, with research lacking on large diverse samples of older adults. OBJECTIVE: The purpose of this study was to assess gender disparities in the association between food insecurity and overweight and obesity among low-income older adults. STUDY DESIGN: Cross-sectional 2011 and 2012 National Health Interview Survey data were used. Food insecurity status was determined by ≥3 affirmative responses on the 10-item US Department of Agriculture Food Security Scale (FSS). Body mass index (BMI) was calculated as outlined by the Centers for Disease Control and Prevention based on self-reported height and weight. PARTICIPANTS/SETTINGS: Adults included were low-income (≤1.99 federal poverty level [FPL]), older (aged ≥60 years), with a normal BMI (18.5) or greater who had complete data on FSS, BMI, and the following covariates: age, race or ethnicity, marital status, income, nativity status, physical activity, poor health status, health insurance coverage, problems paying medical bills or for medicine, and region of residency (N=5,506). STATISTICAL ANALYSES PERFORMED: Multivariate logistic regression models were stratified by gender to estimate the association between food insecurity and higher weight status. All models included covariates. RESULTS: In covariate-adjusted models, compared with low-income, food secure men, low-income, food-insecure men had 42% and 41% lower odds of being overweight and overweight or obese, respectively. Despite the high prevalence rate of obesity among low-income, food-insecure women, food insecurity was not significantly related to overweight, obesity, or overweight or obesity for older adult women in adjusted models. CONCLUSIONS: Food insecurity-overweight and -obesity paradox appears not to be present in older men. However, food insecurity and obesity coexist among low-income, older women.

Addressing Outcomes Expectancies in Behavior Change.

Individuals commonly seek help for problem health behaviors, such as excessive drinking, smoking, and weight gain. Yet, there is a high rate of recidivism in these behaviors because outcome expectancies are either too high, negative outcome expectancies are not considered, or outcome expectancies are not properly addressed. Healthcare providers are recommended to list the outcome expectancy for the problem behavior and corresponding treatment for their patient. Through the process it is important to acknowledge both the positive and negative outcomes of engaging in the problem behavior. Healthcare providers are then encouraged to have their patient identify the goals and objectives that will assist in achieving the desired outcome. By recognizing and addressing outcome expectancies, it is more likely that the patient will be less resistant to the healthcare provider's recommendations to change problematic behavior.

Low-Income Immigrant Hispanic Mothers' Concerns and Perceptions of Their Young Child's Weight.

OBJECTIVES: To describe how low-income Hispanic immigrant mothers' concerns and perceptions of her child's health, along with her concerns for herself becoming overweight, relate to her (a) concerns that her child will become overweight and (b) underestimation of her child's weight status. DESIGN AND SAMPLE: Cross-sectional survey and direct body composition assessments were collected among 96 low-income Hispanic mothers and their young children from Houston-area community centers. MEASURES: Data were collected on maternal concerns and perceptions of child's weight and health, concerns about her own weight, demographic characteristics, and measured child's height and weight. RESULTS: Fifty-four percent of mothers with an overweight/obese child perceived their child was "about the right weight." Mothers concerned with becoming overweight themselves had 3 times higher odds of being concerned that her child would become overweight (OR = 3.01, p < .01). Mothers who perceived their child as less healthy had approximately 2 times higher odds of underestimating their child's weight (OR = 1.86, p < .01). CONCLUSIONS: Short screeners that focus on maternal concerns about herself and her child becoming overweight, along with perceptions of her child's health and weight status, may assist nurses in effectively tailoring their health message at point of care.