The prevalence of obese and overweight children has more than tripled since the early 1970s. This dramatic increase greatly impacts adult health as childhood obesity has been linked to markers for cardiovascular disease, such as high blood pressure, type-2 diabetes, elevated cholesterol and an early onset of obesity-related morbidity and mortality. This issue of childhood obesity is particularly problematic in the Latino community. Children have an elevated prevalence of obesity relative to other racial groups and Latinos are amongst the fastest growing ethnic groups in the country. Niños Sanos, Familia Sana (NSFS) is a completed five-year intervention study aimed at improving the health of Mexican-origin children in the rural agricultural communities of California’s Central Valley. This dissertation utilized data collected during the NSFS study to focus on various characteristics related to childhood obesity. The first study explored maternal perceptions of child weight and how they might be impacted by an intervention aimed at reducing BMI gains. Comparisons from baseline to follow-up showed dramatic improvement on the accuracy of maternal perception of their overweight and obese children. Further analysis, however, revealed no evidence of an association between the intervention and changing perception. The second study used mathematical models to estimate the timing of the adiposity rebound (AR) for children in the NSFS study and further examined associations between timing of the AR with exclusive breastfeeding practices. The AR was found to have occurred earliest in the heaviest children (mean age (standard deviation): normal weight: 5.58(0.55), overweight: 4.65(0.48), obese: 3.55(0.65)). No significant association was shown between exclusivity of breastfeeding and age at rebound. The third study aimed to determine the effect of an intervention targeting reduction in BMI gain on the growth of subcutaneous fat tissue in Mexican-origin preadolescent children. Outcomes of the models included a log-transformed sum of the raw measures and z-scores for triceps and subscapular skinfold thickness. For all measures and across age and gender, no significant reduction in skinfold thickness due to intervention was observed.

The prevalence of obesity in Mexican-American children is higher than in non-Hispanic white children. Binational studies conducted in US immigrant and Mexican communities can provide a unique perspective on factors that may be related to childhood obesity. This dissertation presents the findings from a cross-sectional, binational study, conducted from April to December 2006. The sample included families with children ages one to six years, living in immigrant households in Ventura County, California (US) with a similar cohort of children, living in the municipality of Cueramaro, Guanajuato (MX), where out-migration is common. The interview included items to collect data on demographic characteristics; household food security; infant and child feeding practices; maternal perception of the child's diet and weight; a 30-item food frequency questionnaire (FFQ); and a 24-hour dietary recall (DR). Also weight and height (or length for younger children) was measured on all children one to six years living in the household to calculate the body mass index-for-age z-scores (BMIZ) and the height-for-age z-scores (HAZ), indicators of body fatness and linear growth, respectively. The final sample includes 95 families in US and 200 families in MX. The present work includes four chapters. The first is a literature review that examines biological, family and community-level factors contributing to the development of childhood overweight and obesity among Mexican-American populations. The second chapter compares maternal perceptions and concerns; infant and child feeding practices; and growth status among US and MX populations. The third chapter identifies differences in child feeding strategies and dietary intakes across populations and also examines associations between feeding strategies and dietary intakes. The final chapter examines potential mechanisms through which country of residence is associated with childhood overweight among families in MX and US. Specifically, the study examines evidence for the hypothesis that food security mediates the relationship between country of residence and childhood obesity. Results of the analyses provide evidence that the prevalence of low and very low food security is significantly higher in the MX than in the US sample. Overweight and obesity is significantly higher among the US children compared to their counterparts in MX. There are also differences in child eating patterns and maternal concerns about their child's weight among countries. Based on the FFQ, children in the US, compared to children in MX, consume more pizza, hot dogs, hamburgers, instant noodles, ready-to-eat cereal, and American cheese and less fried beans, corn tortillas, and rice. However children in MX, compared with children in US, consume soda more often. Based on the 24-DR, there are few differences in most of the macro or micronutrient intakes. In examining the relationship between feeding strategies and nutrients intakes; children who ask for food/beverages or take food from the refrigerator or pantry between meals, have significantly higher intakes of total and animal protein. Children, whose mothers use food or beverages to calm his or her child, have significantly higher intakes of saturated fatty acids. Food security status is significantly related to BMIZ using different scales for food security. In the regression models to evaluate the mediation effect of food security on the country and BMIZ, food security does not remain significant in the models. However, after adjusting for household size and maternal education, about 15% of the relationship between country and BMIZ is explained by food insecurity, a Mexican dietary pattern, and maternal feeding strategies.

The childhood obesity epidemic continues to escalate, disproportionately impacting Mexican American children. It is unclear how Mexican American mothers, who are at high-risk of rearing obese children, perceive childhood obesity, prevention or their role in prevention. Three studies - a systematic literature review, a qualitative study focusing on Mexican American mothers' perceptions of childhood obesity, and a qualitative study examining Mexican American mothers' perceptions regarding childhood obesity prevention and their role in prevention - were used to address this research question. The first study is a systematic review of the literature regarding Mexican American mothers' perceptions of childhood obesity and their role in prevention. Four databases were searched for relevant articles and 22 studies met inclusion criteria and were included in the review. Social Cognitive Theory was used to sort similar findings across studies and identify scarce areas researched. Major findings included: (a) mothers felt inadequate to be role models for their children's healthy behaviors, (b) mothers did not identify short-term consequences of childhood obesity, (c) only 23% of studies explicitly used a theoretical framework to guide their study, and (d) most studies used heterogeneous groups (including all caretakers, including all Hispanics/Latinos) to discuss perceptions. The second study used naturalistic inquiry to examine mothers' perceptions regarding childhood obesity, its causes and its consequences. Using a Social Ecological Model adapted to childhood obesity, the study examined causes of childhood obesity at different levels of influence - intrapersonal, interpersonal, and community. Obesity was identified as an adult issue by the mothers. Mothers were more aware of the health risks associated with having underweight children rather than overweight children. Lastly, mothers identified overweight children as those who are suffering from consequences. The third study used a narrative inquiry approach to qualitatively investigate mothers' perceptions. Mothers suggested several ways parents could prevent childhood obesity and overweight among their children. However, fathers, grandparents and schools could unintentionally counter mothers' efforts to encourage healthful behaviors. Mothers identified a lack of ability to speak English, feelings of guilt associated with limiting food intake, and a lack of knowledge and skills as impediments in carrying out obesity preventive behaviors within the home.

The Joint U.S.-Mexico Workshop on Preventing Obesity in Children and Youth of Mexican Origin was initiated by a desire to share experiences regarding the problem of obesity in children and youth of Mexican origin on both sides of the border, with a particular focus on potential solutions. U.S and Mexican researchers, public health officials, industry leaders, and policy-makers engaged in valuable dialogue to share perspectives, challenges, and opportunities. Commonalities and differences in the United States and Mexico regarding risk factors, potential interventions and programs, and need for all sectors to collaborate and make progress toward solving this serious public health problem were also discussed. This dialogue served as a basis to explore a bi-national agenda for addressing this epidemic, which was the ultimate goal of the workshop.

Decades of research have demonstrated that the parent-child dyad and the environment of the familyâ€"which includes all primary caregiversâ€"are at the foundation of children's well- being and healthy development. From birth, children are learning and rely on parents and the other caregivers in their lives to protect and care for them. The impact of parents may never be greater than during the earliest years of life, when a child's brain is rapidly developing and when nearly all of her or his experiences are created and shaped by parents and the family environment. Parents help children build and refine their knowledge and skills, charting a trajectory for their health and well-being during childhood and beyond. The experience of parenting also impacts parents themselves. For instance, parenting can enrich and give focus to parents' lives; generate stress or calm; and create any number of emotions, including feelings of happiness, sadness, fulfillment, and anger. Parenting of young children today takes place in the context of significant ongoing developments. These include: a rapidly growing body of science on early childhood, increases in funding for programs and services for families, changing demographics of the U.S. population, and greater diversity of family structure. Additionally, parenting is increasingly being shaped by technology and increased access to information about parenting. Parenting Matters identifies parenting knowledge, attitudes, and practices associated with positive developmental outcomes in children ages 0-8; universal/preventive and targeted strategies used in a variety of settings that have been effective with parents of young children and that support the identified knowledge, attitudes, and practices; and barriers to and facilitators for parents' use of practices that lead to healthy child outcomes as well as their participation in effective programs and services. This report makes recommendations directed at an array of stakeholders, for promoting the wide-scale adoption of effective programs and services for parents and on areas that warrant further research to inform policy and practice. It is meant to serve as a roadmap for the future of parenting policy, research, and practice in the United States.

Background: One of the highest risk groups for childhood obesity and associated co-morbidities in the United States are low-income Hispanic preschool children. To reduce obesity, effective interventions are being sought to improve health behaviors among high risks groups. Objectives: To evaluate a subset of data from a larger 9-month promotora facilitated obesity intervention study. The aims were to determine: 1) pre- to post-program differences in health behaviors including: (a) children's consumption of high carbohydrate beverages (HCB); and (b) maternal walking, beliefs, knowledge, self-efficacy, and relationship building regarding nutrition and physical activity; and 2) which covariates were significant for change in outcome variables. Methods: A retrospective data analysis, pre post single group design was used to analyze a subset of data from the larger study consisting of a case sample of 33 low-income, Hispanic mothers (18- to 35-year-olds) with pre-school children (3- to 5-year-olds). Differences in outcome variables for related samples between baseline and 9 months were examined using: descriptive statistics, a matched-pairs t-test, the Wilcoxon signed-ranks test, and the chi-square test. Pearson and Spearman correlations were performed to assess relationships between covariates and outcome variables, and if regression analysis assumptions were met. A backward step-wise linear regression was run to determine covariates significant for change in health behaviors. Results: From baseline to 9 months, there was a 56% decrease in children's overall HCB consumption (soda, 100% juice, and sugary drinks); a 47% increase in water consumption; and a 58% increase in total maternal steps (Tuesday and Saturday). By 9 months, maternal beliefs were more positive about walking, knowledge increased about healthy drinks, and maternal self-efficacy improved regarding role modeling healthy behaviors. Gravida was correlated with increased Saturday steps and increased water consumption; and promotora visits were correlated with increased consumption of soda. Implications: Findings suggest a 9-month childhood obesity intervention program was effective in improving the target health behaviors for a low-income Mexican American community and identifying effective means for reducing the incidence of obesity in high risks groups. A larger randomized control trial is needed to further test the feasibility of this intervention program.

Background: The prevalence of overweight/obesity in Hispanic preschoolers has increased significantly over recent decades. Weight related health problems and risks often present during early childhood making early identification and intervention essential to prevent future health problems. Parental perceptions regarding their child's weight status are key in obesity prevention. Research examining Hispanic parental perceptions in preschoolers finds parents frequently underestimate excess weight in their children. The research is limited and has not examined whether it is possible to influence parental perceptions. Health Information Technology (HIT) is an innovative approach to providing parents with personalized education about their preschooler's weight status. This pilot study was undertaken to examine the impact of a HIT tool on Hispanic parental perception of their preschooler's weight status. Methods: A quasi-experimental one-group pre-test, post-test design examined the impact of a bilingual HIT tool, HeartSmartKidsTM, on Hispanic parental perception of preschooler weight status. HSKTM was adapted to ascertain parental perception of preschooler's weight status and was used to implement the tailored educational intervention in the study. The intervention included discussing the child's actual weight status with the parent's perceived weight status of their child based on parental response to the three perception (word, linear and circular silhouette) presentations. Results: Pre-intervention, about half of parents underestimated their child's weight status. Parents of overweight/obese children were more likely to have inaccurate perceptions of their child's actual weight, regardless of assessment presentation (word (p = .0001), linear silhouette (p = .0001), circular (p = .0001)). Accuracy of parental perception did not differ between circular and linear silhouette presentation. Modest improvements in accuracy were seen post intervention on all three measures, with statistically significant findings on word perception presentation (p = 0.039). Parental BMI was associated with perception accuracy (word, p = .009; linear silhouette, p = .022), suggesting parents with normal BMIs are less able to perceive excess weight in their preschoolers. Conclusions: Findings from this study suggest individualized educational interventions using HIT may be a viable means by which to improve parental perceptions. This research highlights HIT as a promising strategy for influencing parental perceptions through tailored educational interventions.