The complementary feeding practices of low-income Black mothers with infants between 6 and 24 months of age: A qualitative study.

BACKGROUND: The period from 6 to 24 months in an infant's life presents a critical window for understanding feeding practices and for designing culturally appropriate interventions. However, little is known about the complementary feeding practices of Black mothers and how this period can be used to optimise the long-term health of their children. The present study aimed to identify factors that influence the complementary feeding practices of low-income Black mothers with children aged 6-24 months. METHODS: Participants were recruited through Research Match, Facebook advertising, flyers, and snowballing techniques. Low-income, Black mothers, with a 6-24-month-old infant, and who lived in Franklin County, Ohio, USA, were eligible for the study. A cross-sectional design using in-depth interviews was used. Reflexive thematic analysis was utilised to analyse and interpret the feeding practices of Black mothers. RESULTS: Mothers (n = 8) were aged between 18 and 30 years old and most completed college or had some college education (n = 6). Half (n = 4) were married, employed, and rated their diet quality and their children's as very good. Three themes emerged: (a) complementary feeding at ≥ 6 months of age; (b) involvement of health care providers and service organisations in feeding decisions; and (c) use of responsive feeding cues. CONCLUSIONS: All mothers breastfed exclusively and most (n = 6) initiated complementary feeding at 6 months. Paediatricians, other health providers and service organisations were instrumental in helping Black mothers adopt complementary feeding practices. Mothers also engaged in responsive feeding practices. These findings point to the critical nature of access and education in helping Black mothers in the study achieve feeding recommendations for their infants.

Measuring food insecurity: An introduction to tools for human biologists and ecologists.

OBJECTIVE: Food insecurity is a significant and growing concern undermining the wellbeing of 30% of the global population. Food in/security is a complex construct consisting of four dimensions: availability, access, utilization, and stability, making it challenging to measure. We provide a toolkit human biologists/ecologists can use to advance research on this topic. METHODS: We review the strengths and limitations of common tools used to measure food access and utilization, the two dimensions most proximate to people's lived experience, and emphasize tools that provide data needed to best link food security with human biological outcomes. We also discuss methods that provide contextual data human biologists/ecologists will find useful for study design, ensuring instrument validity, and improving data quality. RESULTS: Food access is principally measured using experience-based instruments that emphasize economic access. Social access, such as food sharing, is under-studied and we recommend using social network analysis to explore this dimension. In terms of utilization, emphasis has been on food choice measured as dietary diversity. Food preparation and intrahousehold distribution, also part of the utilization dimension, are less studied and standardized instruments for measuring both are lacking. The embodiment of food insecurity has focused on child growth, although a growing literature addresses adult mental wellbeing and chronic and infectious disease risk. CONCLUSIONS: We see the potential to expand outcomes to include reproductive and immune function, physical activity, and the gut microbiome. Human biologists/ecologists are well-positioned to advance understanding of the human health impacts of food insecurity and provide data to support intervention efforts.

Hair Cortisol Concentration, Perceived Stress, Mental Well-Being, and Cardiovascular Health in African American Older Adults: A Pilot Study.

(1) Background: African Americans experience high rates of psychological stress and hypertension, which increases their risk of cardiovascular disease with age. Easy-to-collect psychological and biological stress data are valuable to investigations of this association. Hair cortisol concentration (HCC), as a proxy biomarker of chronic stress exposure, provides such advantages in contrast to collection of multiple daily samples of saliva. Objective: To examine the relationships among HCC, perceived stress, mental well-being, and cardiovascular health (systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP)). (2) Methods: Cross-sectional secondary data (N = 25) were used from a mind-body intervention study in hypertensive African Americans ages 65 and older. Data included HCC, a four-item perceived stress scale, SF-36 mental components summary, and SBP/DBP. SBP + 2 (DBP)/3 was used to calculate MAP. (3) Results: The relationship between mental well-being and perceived stress (r = -0.497, p ≤ 0.01) and mental well-being and DBP (r = -0.458, p = 0.02) were significant. HCC change was not significant. In a regression model, every unit increase in well-being predicted a 0.42 decrease in DBP (ß = -0.42, 95% CI (-0.69-0.15)) and a 1.10 unit decrease in MAP (ß = -1.10, 95% CI (-1.99-0.20)). (4) Conclusions: This study contributes to the knowledge of physiologic data regarding the relationship between MAP and well-being. Findings from this study may aid in the development of interventions that address mental well-being and cardiovascular health in African American older adults with hypertension.

Ethnic disparities in cancer incidence and survival among the oldest old in the United States.

Objective: To examine potential ethnic disparities in cancer incidence and survival rates among the oldest old using data from the SEER Program.Design: Cases diagnosed with one of the leading four cancer sites (lung and bronchus, colon and rectum, female breast, prostate) and four cancer sites (stomach, liver and intrahepatic bile duct, gallbladder, and cervical) that disproportionally affect Hispanics were reported to one of 18 SEER registries. Differences in cancer incidence were examined for cases aged ≥85 years diagnosed during the most recent 5-year time period (2009-2013) and, to examine changes over time, from 1992 to 2013. Five-year relative cancer survival probability was examined for Hispanics and non-Hispanics aged ≥85 years diagnosed 2006-2012.Results: From 2009 to 2013, non-Hispanics aged ≥85 years had higher incidence rates compared to Hispanics for colon and rectum, lung and bronchus, female breast, and prostate cancers. Five-year survival probability for cancers of all stages combined was higher for non-Hispanics than Hispanics in this age group. However, Hispanics had higher survival probability of colon and rectum and lung and bronchus cancers diagnosed at regional (colon and rectum: 67.2% vs. 60.5%; lung and bronchus: 15.9% vs. 12.7%) and distant (colon and rectum: 5.4% vs. 3.8%; lung and bronchus: 2.8% vs. 2.2%) stages than non-Hispanics, respectively.Conclusion: Ethnic differences in cancer incidence and survival probability exist for the ≥85 population. Continued efforts are needed to understand and reduce ethnic disparities in cancer prevention and treatment for this population.

An Examination of Demographic and Psychosocial Factors, Barriers to Healthy Eating, and Diet Quality Among African American Adults.

A healthy diet is associated with lower risk of chronic disease. African Americans generally have poor diet quality and experience a higher burden of many chronic diseases. We examined the associations of demographic and psychosocial factors and barriers to diet quality among African American adults. This cross-sectional study included 100 African American adults in a southeastern metropolitan area. Psychosocial factors (social support, self-efficacy), and barriers to healthy eating were assessed with validated measures. Diet quality was assessed using the Healthy Eating Index (HEI-2010). Nested linear regressions were used to examine the association between the variables of interest and HEI scores. Participants reported having social support (M (mean) = 2.0, SD (standard deviation) = 0.6, range 0⁻3), high levels of self-efficacy (M = 3.1, SD = 0.7, range 1⁻4), and low barriers (M = 1.4, SD = 0.6, range 0⁻4) to engage in healthy eating but total mean HEI scores needed improvement (M = 54.8, SD = 10.9, range 27.1⁻70.0). Participants consumed significantly higher empty calories and lower whole fruits, dairy, and total protein foods than the national average. Barriers to healthy eating (b = -12.13, p = 0.01) and the interaction between age and barriers (b = 0.25, p = 0.02) were most strongly associated with lower HEI scores. Younger African Americans with the highest barriers to healthy eating had the lowest HEI scores. Culturally appropriate interventions targeting empty calories, barriers to healthy eating, and knowledge of the Dietary Guidelines for Americans are needed for African Americans.

Physical Activity Among Native Hawaiians and Pacific Islanders: A Systematic Review and Meta-Analysis.

OBJECTIVE: To examine the proportion of Native Hawaiian and Pacific Islander (NHPI) meeting recommended physical activity guidelines for Americans (PAG) and determine differences in physical activity (PA) by sex and between NHPI and Asians when data are disaggregated. DESIGN: Systematic review and meta-analysis. SETTING: Articles identified in CINAHL, The Cochrane Library, Embase, PsychINFO, PubMed, Scopus, SocINDEX, SPORTDiscus, and Web of Science. PARTICIPANTS: NHPI children and adults, and Asian adults. INTERVENTIONS: Proportion of NHPI meeting PAG and differences in PA involvement by sex and by ethnicity. METHODS: Summary reporting for articles, and meta-analysis using random-effects and inverse-various weighted models. CONCLUSIONS AND IMPLICATIONS: Just over one-third of NHPI children met the PAG (mean = 38.6%, 95% CI [32.43-45.08]), with more males (42.8%) than females (34.7%) meeting the guidelines (t = 6.74, df = 1, P = .02). Less than half met the PAG for combination (mean = 48.7%, 95% CI [34.69-62.97]), moderate (mean = 47.1%, 95% CI [33.62-61.07]), and about one-third met the PAG for vigorous PA (mean = 33.4%, 95% CI [24.55-43.62]). There were no significant differences between Asians and NHPI in PA. Policy, systems, and environmental changes as well as culturally appropriate interventions are needed to increase physical activity among NHPI.

Structural and Socio-cultural Barriers to Prenatal Care in a US Marshallese Community.

Objectives Pacific Islanders are disproportionately burdened by poorer perinatal health outcomes with higher rates of pre-term births, low birth weight babies, infant mortality, and inadequate or no prenatal care. The aim of this study is to examine Marshallese mothers' beliefs, perceptions, and experiences of prenatal care and to identify potential barriers. Methods Three focus groups were conducted with Marshallese mothers, who were 18 years or older, and living in Arkansas. Focus groups focused on mothers' beliefs, perceptions, and experiences of prenatal care. A thematic qualitative analysis was conducted to identify salient themes within the data. Results The results demonstrated that negotiating health insurance, transportation, and language barriers were all major structural barriers that constrain prenatal care. The social-cultural barriers that emerged included a lack of understanding of the importance of seeking early and consistent prenatal care, as well as how to navigate the healthcare process. The more complicated challenges that emerged were the feelings of shame and embarrassment due to the perception of their age or being unmarried during pregnancy not being acceptable in American culture. Furthermore, the participants described perceived discrimination from prenatal care providers. Lastly, the participants described fear as a barrier to seeking out prenatal care. Conclusions for Practice This study identified both structural and socio-cultural barriers that can be incorporated into suggestions for policy makers to aid in alleviating maternal health disparities among Pacific Islander women. Further research is needed to address the Marshallese mothers' perceived discrimination from maternal health care providers.

Breastfeeding Practices among Native Hawaiians and Pacific Islanders.

Background. Breastfeeding is associated with a decreased risk of obesity in the early and adult years. Native Hawaiians and Pacific Islanders (NHPI) experience high rates of obesity which is often obfuscated with aggregated data. Using disaggregated data, we examined breastfeeding practices among NHPI. Methods. Seven databases and reference lists were searched. Two independent researchers extracted relevant studies based on predetermined criteria. Nine studies met our inclusion criteria and a meta-analysis was conducted using random-effects, inverse-various weighted models. Results. Few studies disaggregated NHPI populations when examining breastfeeding practices. Most studies were cross-sectional and our search yielded no randomized or quasirandomized control trials. The results of the meta-analysis indicated that 46.5% NHPI women initiated breastfeeding with 40.8% breastfeeding exclusively. These pooled analyses show that NHPI breastfeeding practices are below the recommended national and international goals and guidelines. Conclusion. Breastfeeding practices among NHPI are heterogeneous and critical disparities exist among certain NHPI subgroups and additional research needs to be conducted to determine the reasons for the disparity. Future studies should work to disaggregate data for NHPI and the various subpopulations. Multicomponent, multilevel strategies are needed to support breastfeeding practices among NHPI.

The influence of HOPE VI neighborhood revitalization on neighborhood-based physical activity: A mixed-methods approach.

OBJECTIVES: This study uses a mixed methods approach to 1) identify surrounding residents' perceived expectations for Housing Opportunities for People Everywhere (HOPE VI) policy on physical activity outcomes and to 2) quantitatively examine the odds of neighborhood-based physical activity pre-/post-HOPE VI in a low socioeconomic status, predominantly African American community in Birmingham, Alabama. METHODS: To address aim one, we used group concept mapping which is a structured approach for data collection and analyses that produces pictures/maps of ideas. Fifty-eight residents developed statements about potential influences of HOPE VI on neighborhood-based physical activity. In the quantitative study, we examined whether these potential influences increased the odds of neighborhood walking/jogging. We computed block entry logistic regression models with a larger cohort of residents at baseline (n = 184) and six-months (n = 142, 77% retention; n = 120 for all informative variables). We examined perceived neighborhood disorder (perceived neighborhood disorder scale), walkability and aesthetics (Neighborhood Environment Walkability Scale) and HOPE VI-related community safety and safety for physical activity as predictors. RESULTS: During concept mapping, residents generated statements that clustered into three distinct concepts, "Increased Leisure Physical Activity," "Safe Play Areas," and "Generating Health Promoting Resources." The quantitative analyses indicated that changes in neighborhood walkability increased the odds of neighborhood-based physical activity (p = 0.04). When HOPE VI-related safety for physical activity was entered into the model, it was associated with increased odds of physical activity (p = 0.04). Walkability was no longer statistically significant. CONCLUSIONS: These results suggest that housing policies that create walkable neighborhoods and that improve perceptions of safety for physical activity may increase neighborhood-based physical activity. However, the longer term impacts of neighborhood-level policies on physical activity require more longitudinal evidence to determine whether increased participation in physical activity is sustained.