Randomized control trial of a childhood obesity prevention family-based program: "Abriendo Caminos" and effects on BMI.

Background: Hispanic individuals are at increased risk for obesity and other chronic health conditions. This article evaluates the effect of a family-based, childhood obesity primary prevention intervention in a community setting. Methods: A multi-site, randomized controlled trial community program with assessments at pre (T0), post-program (T1), and 6-months post-program (T2). Participating families were recruited from five sites. Only families of Mexican or Puerto Rican heritage with a least one child between 6 and 18 years were included in the study, without weight restrictions. Families were randomized to the intervention and control arms. Intervention families received six-2 h weekly workshops. Control families received printed generic nutrition and wellness information. Heights and weights were measured at the 3-time points to calculate BMI z-scores, BMI-percentiles, and weight status using age- and sex-specific growth charts, according to the CDC guidelines. Results: There were no differences in BMI-z scores between children in the intervention (n = 239) and control groups (n = 187) at T0. BMI z-scores decreased in the intervention group (-0.03, 95% CI, -0.066, -0.003, p = 0.032) at T1, but not in the control group at T1. Changes in BMI z-scores were not statistically significant at T2. Conclusion: The Abriendo Caminos intervention effectively prevented unhealthy weight gain in Hispanic children in the short-term, but not at 6-months post-intervention. Younger children and girls benefited more from the program at 6-months post-intervention. Additional efforts are needed to sustain long-term changes. Culturally-tailored programs can provide families with the knowledge to produce short-term changes and a potential pathway for sustainable changes in implementing healthy behaviors.

Cultural Influences on Family Mealtime Routines in Mexico: Focus Group Study with Mexican Mothers.

Mexico's obesity rates are alarming, and experts project drastic increases in the next thirty years. There is growing interest in understanding how remote acculturation and globalization processes influence health behaviors. The present study used focus group data from a central state, San Luis Potosí, in Mexico to explore mothers' perspectives on factors that influence family mealtime routines. Thematic analysis was used to identify barriers and facilitators to healthy mealtime routines and diet within families. Twenty-one mothers participated in the focus groups; 76% were full-time stay at home mothers, the majority were low-income (65%), and fewer than half reached a high school education. Three major themes emerged: (1) mothers do most of the visible work involving mealtime routines; (2) family meals are different today, and globalization is a contributing factor; and (3) family mealtimes are shifting to weekend events. Empowering mothers to negotiate diet with family members to build healthy routines, navigate challenges due to changing environments, and set family boundaries around technology use during mealtimes should be taken into consideration when promoting healthy behaviors with Mexican families.

Time at Home during the COVID-19 Pandemic: Findings from Focus Groups with Hispanic Parents.

The COVID-19 pandemic upended family life, forcing many families to reorganize their daily routines. Hispanic families have been especially affected by the pandemic, experiencing cumulative stressors and increased risks of contracting the virus, hospitalization, and morbidity. To date, there is limited research examining home life within Hispanic families during the pandemic. Given the extended amount of time for which families have been isolated at home together, identifying factors that may enhance or detract from well-being within the home is important in advancing efforts to support at-risk families. In this qualitative study, 29 Hispanic parents (primarily mothers) living in California participated in one of eight focus groups conducted in Spanish. Parents described activities and behaviors during the first year of the COVID-19 pandemic. The following six themes were identified using reflexive thematic analysis: (1) parents focused on family time; (2) children adapted to the changes of the pandemic; (3) parents and children engaged in physical activity; (4) children mainly entertained themselves with screens; (5) COVID-19 media coverage was accessible in the home; and (6) parents worried about the virus, and its effects on the future. While findings include anxiety around the virus and its attendant effects, family strengths were also present throughout the discussions. Public policy should consider ways to leverage family strengths to preserve family relationships and routines during future public health crises.

Reducing Obesogenic Eating Behaviors in Hispanic Children through a Family-Based, Culturally-Tailored RCT: Abriendo Caminos.

Family-based interventions that incorporate culturally-tailored multi-component curricula and are grounded on evidence-based information and theoretical frameworks can help reduce the prevalence of obesity among Hispanic children. Abriendo Caminos: Clearing the Path to Hispanic Health is a multi-site culturally-tailored randomized control trial that aims to reduce obesity rates in Hispanic families by delivering education on nutrition, family wellness, and physical activity. This study evaluated the effect of the Abriendo Caminos six-week intervention on dietary behaviors of Hispanic children (6-18 years). Mothers (n = 365) reported their child's eating behavior intake using the U.S. Department of Education's Early Childhood Longitudinal Study protocol (ECLS). Pre/post dietary changes were evaluated using separate generalized estimating equation models adjusted for site, child sex, and child age group. Findings indicate a reduction in the frequency of sugar-sweetened beverages (OR 0.55, 95% CI 0.35, 0.87, p = 0.01), French fries (OR 0.56, 95% CI 0.36, 0.86, p = 0.009), and fast food (OR 0.55, 95% CI 0.36, 0.84, p = 0.006) consumption among children in the intervention arm. Additionally, children in the intervention arm increased their frequency of vegetable consumption (OR 1.84, 95% CI 1.08, 3.12, p = 0.03). The Abriendo Caminos intervention effectively improved four of eight eating behaviors in a short-term intervention.

Hispanic Parents' Views of Family Physical Activity: Results from a Multisite Focus Group Investigation.

Understanding parental views regarding family physical activity is essential to the development of family-focused physical activity interventions. Using a qualitative methodology with thematic analysis and a socio-demographic questionnaire, this study aimed to examine Mexican American and Puerto Rican parental views on child and family physical activity. Sixty-one parents (56 mothers, five fathers) from four sites (California, Illinois, Texas, and Puerto Rico) each participated in a single one-hour focus group session, which included an average of five parents. The findings of this study indicated that parents perceived themselves and their families to be physically active, while some parents believed their children were getting enough physical activity at school and afterschool programs. Walking, bicycling, and playing soccer were the most common physical activities that parents reported engaging in as a family. In addition, some parents shared their preference for exercising without their children. Time constraints along with unsafe neighborhood streets and parks were identified as the major barriers to being physically active as a family. Mothers reported that fathers' involvement in physical activity and combining a healthy diet with exercise were useful strategies for physical activity promotion. This study provides valuable information regarding Hispanic parental views concerning family physical activity relevant to the design of culturally family-based physical activity interventions for this population.

"It's Been Negative for Us Just All the Way Across the Board": Focus Group Study Exploring Parent Perceptions of Child Screen Time During the COVID-19 Pandemic.

BACKGROUND: Child screen time (ST) has soared during the COVID-19 pandemic as lockdowns and restrictions have forced changes to regular family routines. It is important to investigate how families are navigating ST. OBJECTIVE: This study aimed to explore families' experiences of ST during the COVID-19 pandemic. METHODS: Virtual focus group sessions were conducted between December 2020 and February 2021 in English and Spanish. Transcripts were analyzed using reflexive thematic analysis. RESULTS: In total, 48 parents (predominantly Hispanic) residing in California participated in 1 of 14 focus group sessions. Children were attending school remotely at the time of the study. A total of 6 themes and 1 subtheme were identified: (1) total ST has increased; (2) children are too attached to screens; (3) ST has advantages and disadvantages but parents perceive ST as mostly negative; (4) parents and children have limited options; (5) ST restrictions (subtheme: children react negatively when ST is restricted); and (6) parents are concerned that children are not getting enough exercise. CONCLUSIONS: This study provides a cross-sectional insight into how family life has changed with regard to ST during the COVID-19 pandemic. Parents expressed concerns about total ST, the addictive nature of it, and lack of physical activity. It is important that future studies examine the long-term effects of heavy ST and preemptively introduce ways to redirect children's ST habits as the country attempts to establish a new normal.

Family Food Environment during the COVID-19 Pandemic: A Qualitative Study.

BACKGROUND: The COVID-19 pandemic, with its cyclical lockdown restrictions and school closures, has influenced family life. The home, work, and school environments have collided and merged to form a new normal for many families. This merging extends into the family food environment, and little is known about how families are currently navigating this landscape. The objective of the present study was to describe families' adaptations in the family food environment during the COVID-19 pandemic. METHODS: Parents participated in one of 14 virtual focus groups (conducted in English and Spanish between December 2020 and February 2021). Reflexive thematic analysis was used to analyze the transcripts. RESULTS: Forty-eight parents (81% Hispanic and SES diverse) participated. Five themes and one subtheme were identified around changes in eating habits and mealtime frequency, increases in snacking, family connectedness at mealtimes, and use of screens at meals. CONCLUSIONS: The COVID-19 pandemic has influenced the family food environment. Families shared how their eating habits have changed and that device usage increased at mealtimes. Some changes (e.g., weight gain) may have lasting health implications for both children and parents. Public health officials, pediatricians, and schools should work with families to resume healthy habits post pandemic.

The effects of adiposity, muscular strength, cardiorespiratory fitness, and fatigue on gait biomechanics in overweight and obese children.

BACKGROUND: Obesity rates continue to increase in the child population. Muscular strength, cardiorespiratory fitness, and fatigue can potentially affect joint stresses in obese children. The purposes are to examine: (1) the relationship between cardiorespiratory fitness and the change in joint stress pre- to post-fatigue; (2) the predictive value of fitness, adiposity, and muscular strength on joint stresses in fatigued and non-fatigued states; and, (3) the relationships between % body fat from skinfold and air displacement plethysmography. METHODS: Twenty-seven children, with body mass index above the 85th percentile for their age participated in this study. Lower limb joint moments were recorded before and after a fatiguing Progressive Aerobic Cardiovascular Endurance Run protocol. Linear regression was used to assess the relationship between (1) fitness and change in joint stress pre- to post-fatigue, and (2) measures of %body fat using skinfold and plethysmography. Furthermore, Bland-Altman analysis quantified the agreement between measured adiposity using the two methods. FINDINGS: The strongest relationship was observed between fitness and the change in the knee extensor moment pre- to post-fatigue (R2 = 0.24). Regardless of fatigue state, adiposity and strength were identified as the strongest predictors of joint moments. Skinfold estimates were moderately predictive (R2 = 0.56) of %body fat from air displacement plethysmography, and these two measures demonstrated instrument agreement with no proportional bias. INTERPRETATION: Fitness level is not related to changes in biomechanics pre- to post-fatigue in overweight and obese children. Adiposity and lower extremity strength most strongly influenced joint moments in the frontal and sagittal planes.

Rural Midwestern Mexican Fathers' Perspectives on Family Food, Mealtimes, and Physical Activity.

Two focus group interviews with eight low-income Mexican fathers in two communities in a rural Midwestern state explored fathers' perceptions, behaviors, and roles related to child and family food consumption, mealtimes, and physical activity. On average, fathers were 34 years of age, had 10 years of formal education, and annual household incomes ranged from $36,250 to $46,249. Findings include the identification of fifteen themes through the process of thematic analysis that are organized by five thematic areas of interest (family food patterns, strategies for healthy eating, family roles in food shopping and preparation, family mealtimes, physical activity among families). Findings revealed ways fathers contributed to their children's and families' health and well-being, and challenges they faced. Health promotion efforts aimed at rural, low-income Mexican immigrant families can benefit from embracing fathers' perspectives and how they influence the health and well-being of their children and families.

Mealtime resistance: Hispanic mothers' perspectives on making healthy eating changes within the family.

Several perceived barriers to healthy eating within the family (e.g., cost, lack of time, energy, accessibility) are documented. However, few studies have assessed Hispanic mothers' perceived barriers and strategies in implementing healthy eating changes in the family's meals. The primary goal of this qualitative study was to investigate Mexican and Puerto Rican mothers' barriers and strategies to creating healthy eating changes within the family at home. A sample of 46 Mexican-American and Puerto Rican mothers in California, Illinois, and Texas participated in this study. An average of 5 mothers participated in a focus group session in Spanish and completed a demographic survey. Focus group thematic analysis revealed that major barriers to implementing healthy eating changes within the family include child and spouse resistance as well as meal preparation time. The resistance mothers reported encountering magnify their meal preparation workload. Mothers shared that they sometimes prepared multiple meals in a single mealtime to please family members. Several strategies to promote healthy eating at home, including serving as role models, providing easy access to healthy food items at home, and not purchasing, or hiding, unhealthy food at home, were also discussed. The current study expands the existing literature by emphasizing the need to empower parents to make healthy changes within their family and the importance of taking fathers and children into account in programming so that the whole family is involved in making healthy changes.

The Evolving Family Mealtime: Findings From Focus Group Interviews With Hispanic Mothers.

BACKGROUND: Given the protective effects of shared family mealtimes and the importance of family in the Hispanic culture, this context should be explored further to determine how it can be leveraged and optimized for interventions. OBJECTIVE: This study aimed to explore contextual factors associated with family mealtimes in Mexican and Puerto Rican families. METHODS: A total of 63 mothers participated in 13 focus group interviews across 4 states. Thematic analysis was used to analyze transcripts. RESULTS: Seven overarching themes were identified through the thematic analysis. Themes reflected who was present at the mealtime, what occurs during mealtime, the presence of television, the influence of technology during mealtime, and how mealtimes have changed since the mothers were children. CONCLUSIONS: Hispanic mothers may be adapting family mealtimes to fit their current situations and needs, keeping the television and other devices on during mealtimes, and making additional meals for multiple family members to appease everyone's tastes. All of these are areas that can be incorporated into existing culturally tailored obesity prevention programs to help families lead healthier lives.

Implementation and Evaluation of the Abriendo Caminos Program: A Randomized Control Trial Intervention for Hispanic Children and Families.

OBJECTIVE: To describe the methodology of a family-focused, culturally tailored program, Abriendo Caminos, for the prevention of excess weight gain in children. DESIGN: Randomized control trial with outcome assessment at pretest, posttest, and 6 months after intervention or abbreviated-attention control group. SETTING: Community setting across 5 sites (Illinois, California, Iowa, Texas, and Puerto Rico). PARTICIPANTS: Mexican American and Puerto Rican families (parent and 1 child aged 6-18 years). A sample size of 100 families (50 intervention and 50 control) per site (n = 500) will provide adequate power to detect intervention effects. INTERVENTION: Families will participate in 6 weekly, 2-hour group workshops on nutrition education through combined presentations and activities, family wellness, and physical activity. MAIN OUTCOME MEASURES: The primary outcome is prevention of excess weight gain in children; secondary outcomes include changes in child diet, specifically fruit, vegetable, and sugar-sweetened beverage consumption, and changes in parents' diets and improvement of family routines. Measures will be collected at baseline, postintervention, and 6 months after. ANALYSIS: Modeling to assess changes within and between experimental groups will be checked using standard methods including assessment of model fit, influence diagnostics, adjusted R2, and multicollinearity. Significance of effects will be examined using Type III tests.

Transdisciplinary Obesity Prevention Research Sciences (TOPRS) Curriculum Increases Knowledge About Complex Causes and Consequences of Obesity for Undergraduate Students.

Most researchers and public health officials would agree that the causes and consequences of obesity are complex and multi-faceted. However, curricula designed to address these complexities are limited and often guided by a single discipline. The purpose of the Transdisciplinary Obesity Prevention Research Sciences (TOPRS) program was to develop a "flip-the-classroom" curriculum on obesity prevention across multiple disciplines such that students would gain an appreciation of the complex origins of obesity. The curriculum is based on the 6 C's model (cell, child, clan, community, country, culture) that proposes a cell-to-society approach to obesity. Twenty video micro-lectures were developed and students were tested on content knowledge pre- and post-viewing. The curriculum was administered at three university sites to 74 undergraduate students across 23 declared majors from 2014-2016. There were significant gains in knowledge about the causes and consequences of obesity. Recommendations are offered to adopt this curriculum in undergraduate and other educational settings.

Effects of Culturally Tailored Nutrition Education on Dietary Quality of Hispanic Mothers: A Randomized Control Trial.

OBJECTIVE: To assess whether participation in a culturally tailored nutrition education program increases diet quality of Hispanic mothers. DESIGN: A randomized controlled trial. SETTING: Community centers and universities. PARTICIPANTS: Sixty-five mothers (35 in experimental group, 30 in control group) completed pre- and postworkshop surveys. Eligibility criteria included being of Mexican or Puerto Rican descent and having a child between the ages of 6 and 18 years who could participate in the workshops with the parent. INTERVENTION: Families in the experimental group participated in a 6-week workshop series that included weekly nutrition education classes. MAIN OUTCOME MEASURE: Diet quality was assessed by the Rate Your Plate questionnaire. ANALYSIS: Repeated measures ANOVA was used to compare differences between the experimental and control groups. A Wilcoxon signed rank test was conducted to test for significant shifts in categorization pre- and postprogram. RESULTS: There was a significant change in diet quality categorization after participating in the workshops (P < .001, effect size 0.39). No changes were found in the control group. CONCLUSIONS AND IMPLICATIONS: Abriendo Caminos was effective at increasing the diet quality of Hispanic mothers who participated the most in the program. More research is needed in this at-risk population to determine the relationships among nutrition knowledge, diet quality, and achievement of healthy weight.

The Effects of Hispanic Immigrant Mother's Resiliency on Children's Dietary Adjustment.

This study explored the adjustment phase of the resiliency model of family adjustment and adaptation, particularly how stress and food insecurity interact with protective mechanisms to influence children's dietary adjustment. With increasing rates of Hispanic childhood obesity and disproportionate health disparities, this is an issue that must be better understood. Altogether, 137 Mexican immigrant mothers from Illinois and California completed questionnaires reporting their stressors, protective mechanisms, and family health behaviors. Multiple regression analyses revealed that higher perceived stress levels for mothers predicted non-nutritive snacking reasons. Furthermore, mother's dietary patterns predicted child's poor dietary quality. Taken together, maternal stressors play a role in family health behaviors, and future studies should consider household food environment factors when trying to understand protective mechanisms for families.

Correction to: The Effects of Hispanic Immigrant Mother's Resiliency on Children's Dietary Adjustment.

The original version of this article unfortunately contained errors in Affiliation 3, Acknowledgement, Table 1 and in the text under Methods section. Also, a Co-corresponding author has to be included in the article.

Associations between adult attachment style, emotion regulation, and preschool children's food consumption.

OBJECTIVE: The goal of this study was to test 3 serial mediation models of how caregiver adult attachment style influences children's food consumption through its influence on emotion regulation. Three mediators that have been shown to increase the risk for pediatric obesity and that are likely to be influenced by negative emotion regulation strategies in everyday family interactions were chosen: (1) caregiver feeding practices (2) family mealtime routines, and (3) child television (TV) viewing. METHOD: A total of 497 primary caregivers of 2.5- to 3.5-year-old children reported on their own attachment style, typical responses to their children's negative affect, feeding styles, mealtime and TV viewing routines, and their children's consumption of healthful and unhealthful foods. RESULTS: Insecure mothers were more likely to use punishing or dismissing responses to their children's negative affect, and negative emotion regulation predicted the increased use of emotion-related feeding styles and fewer mealtime routines. These variables, in turn, were found to predict children's unhealthful food consumption, documenting serial mediational influences. With respect to TV viewing, caregiver insecurity influenced child food consumption indirectly through its direct effect on child TV viewing. CONCLUSION: Taken together, these data suggest that insecure attachment may put parents at a risk for using negative emotion regulation strategies in response to their children's distress, which may also have important implications for the interpersonal environment surrounding food and the development of children's early eating behaviors.

Six-week Latino family prevention pilot program effectively promotes healthy behaviors and reduces obesogenic behaviors.

OBJECTIVE: To test the effectiveness of a 6-week family-based healthy eating pilot program aimed to reduce obesogenic behaviors among Latino parents and children. METHODS: A 6-week healthy eating pilot program focused on dietary changes within Latino families with a 6- to 13-year-old child. A 1-group, pre-posttest design with 2-month follow-up examining fruit, vegetable, and sugar-sweetened beverage consumption. RESULTS: The program was effective at increasing parent-report of child fruit consumption, (P < .001, effect size = .26), vegetable consumption, (P = .001, effect size = .20), and decreasing sugar-sweetened beverage consumption, (P = .002, effect size = .16). CONCLUSIONS AND IMPLICATIONS: This family-based prevention program was effective at improving healthy eating in Latino families, especially for children. The curriculum can be used in future prevention programs for Latino families with a 6- to 13-year-old child.

Family mealtimes: a contextual approach to understanding childhood obesity.

There has been a growing interest in the role that shared family mealtimes may play in promoting the health and well-being of children. Families that regularly eat their main meal together four or more times a week are more likely to have children who do better in school, are of average weight, less likely to use drugs and alcohol at an early age, and consume more fruits and vegetables. The mere fact that families eat together does not address the process by which shared family mealtimes may protect children from unhealthy weight gain. Just as there is no simple explanation for the rising rates of obesity, the link between shared family mealtimes and childhood obesity is a complex one including socioeconomic and cultural context. In this paper, we provide an overview of how shared family mealtimes are embedded in a socio-cultural context that may either support or derail healthy eating patterns for children and youth. Evidence from an observational study of 200 family mealtimes demonstrates the complex interplay between socio-economic factors, family mealtime behaviors, and child obesity status. Families who had a child of healthy weight spent more time engaged with each other during the meal, expressed more positive communication, and considered mealtimes more important and meaningful than families who had a child who was overweight or obese. Using a cumulative risk model, it was found that the combination of family level and neighborhood risk factors predicted child overweight status. Recommendations are made for future research directions and policies directed toward families living in diverse economic circumstances.

Is frequency of shared family meals related to the nutritional health of children and adolescents?

OBJECTIVE: We used meta-analytic methods to examine the frequency of shared family mealtimes in relation to nutritional health in children and adolescents. The primary objective was to determine consistency and strength of effects across 17 studies that examined overweight and obese, food consumption and eating patterns, and disordered eating. METHODS: The total sample size for all studies was 182 836 children and adolescents (mean sample age: 2.8-17.3 years). Pooled odds ratios were calculated. A random-effects model was used to estimate all outcomes. RESULTS: The frequency of shared family meals is significantly related to nutritional health in children and adolescents. Children and adolescents who share family meals 3 or more times per week are more likely to be in a normal weight range and have healthier dietary and eating patterns than those who share fewer than 3 family meals together. In addition, they are less likely to engage in disordered eating. CONCLUSIONS: Educational and public health initiatives aimed at promoting shared family mealtimes may improve nutritional health of children and adolescents. Clinicians may advise their patients about the benefits of sharing 3 or more family mealtimes per week; benefits include a reduction in the odds for overweight (12%), eating unhealthy foods (20%), and disordered eating (35%) and an increase in the odds for eating healthy foods (24%).