AND EARLY CHILDHOOD OBESITY: A QUALITATIVE STUDY Cassie Alvarado - PowerPoint PPT Presentation

SINGLE PARENT FAMILIES, SOCIOECONOMIC STATUS, AND EARLY CHILDHOOD OBESITY: A QUALITATIVE STUDY Cassie Alvarado NS 5330 – Dr. Boylan November 9, 2009

Overview  Development of idea  Aims of the study  Hypotheses  Background research  Significance of contribution  Design  Methods  Implications/Conclusions  Why should this study be funded?

Background information  Childhood obesity epidemic  Rates have doubled in the past 25 years (Veldhuis, 2009)  Major health implications  Diabetes, early plaque formation, etc.  Development of diseases not usually prevalent at age  Growing concern for all families  Fear of fat in the USA  Teasing - Quality of Life  Media  Questions of how the epidemic came to be?  Epidemic growth

Development of idea  Reviewed multiple studies and found that many focused on the mothers of the children  What about the fathers?  Wanted to plan a study focusing on only fathers  Looked for studies focusing on fathers  One focusing on single sex (mother)  What about households with only one parent?  None separating families into single parent categories  Start to tackle issue by focusing on both mother and father

Aims of the study  To determine if childhood obesity is more prevalent in single-parent households  Time outdoors?  Child care?  To determine if socioeconomic status plays a role in food purchased for the households  High energy dense foods for low cost  Food shelf-life  Eating-out?

Aims of the study continued…  To determine if food insecurity is prevalent in either of the families  Access to food  Vehicle?  To determine if early childhood obesity is more prevalent when parents work longer hours  Longer time in child care?  After-school programs?  Outside play time?  To determine if stress levels differ in families  Any older children playing role of parent?-example  Perceptions of children

Hypotheses  Single parent families will have higher prevalence of childhood obesity  Less physical activity because less time in the home  Neighborhood?  Live in apartment with no backyard? Parking lot?  Safety of community

Hypotheses  Socioeconomic levels will be lower in single parent families compared to families with two or more parents/guardians.  Multiple incomes with two parents  Single salary?  Single parent households will have increased levels of stress.  Child taking place of parent in meal preparation  Lack of cooking skills or time to prepare meals  Long hours at work  Financial stressors  Worry/guilt

Hypotheses  Food insecurity will be more prevalent in single parent households.  Access to food (vehicle?)  Financial capability  Going to bed hungry  Children having snacks/ lunch at school

Maternal employment and early childhood overweight: findings from the UK Hawkins, Summer Sherburne, Cole, Tim J., Law, Catherine, et al. Millennium Cohort Study International Journal of Obesity . 2008. 32; 30-38

Hawkins – Maternal Employment  Objective: Study looked at the relationship to number of hours a mother worked to the overweight status of her children  Study Design: Cohort Study  Participants: 13,113 children at 3 years of age in 2000-2002  Data Collection  Parental interviews when child was age 9 months and 3 years  Child ’ s height and weight measured at 3 years  Statistical analysis  Analyses conducted using STATA software  Wald tests  Univariate logistic regression analyses

Hawkins - Maternal Employment  Confounding factors  Maternal ethnic group  Household income  Socioeconomic circumstances  # of children  Smoking during birth  Birth weight  Weaknesses  93% mothers were white -UK study  Only looked at mothers  No diet control  TV viewing  PA levels

Hawkins - Maternal Employment  Results: At 3 years:  Children were more likely to be overweight for every 10 hours a mother worked per week  23% children were overweight  Conclusion: Any maternal employment after child ’ s birth was associated with early childhood overweight  Why does it support need for my study?  If single parents are working, there may be an association with increased childhood overweight/obesity  This only looked at maternal employment  Potential effects for paternal employment?

Potential determinants of obesity among children and adolescents in Germany: results from the cross-sectional KiGGS study. Kleiser, Christina, Rosario, Angelika Schaffrath, Mensink, Gert BM, et al. BMC Public Health . 2009. 9:46

Kleiser - Determinants of Obesity  Objective: To find out potential determinants of obesity in children to provide basis for effective prevention strategies  Study Design: Cross-sectional  Participants: 17,641 children and adolescents (ages 1-17) and parents  Data Collection:  Children  Questionnaire with information on socio-demographic characteristics, living conditions, PA, and health.  Physical examination to calculate BMI.  Parents  Questionnaire with information on income, occupational status, and education.  Self-report of height and weight to calculate BMI

Kleiser - Determinants of Obesity  Statistical analysis: Binary logistic regression models  Strengths  Large sample size over large range of ages  Weaknesses  PA assessment, FFQ used, cross-sectional study  Results: Low SES associated with higher frequencies of overweight/obesity.  Children whose parents who are overweight, smoke, not predominantly breastfed, low PA status, symptoms of eating disorders, and consume mostly high energy providing foods/beverages are more often overweight or obese.

Kleiser - Determinants of Obesity

Kleiser - Determinants of Obesity  Conclusion: Low SES groups are important groups to focus prevention efforts towards.  Why does it support need for my study?  All SES groups are included in the study. Questionnaire will be passed out to assess SES status of participants in the study.

Early life risk factors for obesity in childhood: cohort study. Reilly, John J., Armstrong, Julie, Dorosty, Ahmad R. British Medical Journal. 330(7504):1357

Reilly - Early Life Risk Factors  Objective: This study aims to identify risk factors in early life for obesity.  Study Design: Prospective Longitudinal Cohort Study  Participants: 8234 children  Data Collection: Collection of anthropometric data over multiple years  Statistical analysis:  Multivariable analysis  Binary logistic regression models  Weaknesses:  Ethnic/minority groups underrepresented  Underestimate some risk factors

Reilly - Early Life Risk Factors

Reilly - Early Life Risk Factors  Results: 8 risk factors of potential 25 risk factors were significantly related to risk of obesity  Conclusion: Numerous risk factors exist for early childhood obesity. Not all of them have been found to be statistically different, but many have been loosely associated.  Why does it support need for my study?  We are still trying to find what are major risk factors.  More research is needed.

Early Intervention of multiple home visits to prevent childhood obesity in a disadvantaged population: a home-based randomized controlled trial (Healthy Beginnings Trial). Wen, Li Ming, Baur, Louise A., Rissel, Chris, Wardle, Karen, et al. BMC Public Health . 20087. 7:76

Wen - Home Visit Interventions  Objective: To compare the effect of an intensive, home-based early intervention for first-time mothers to usual care on child and family eating patterns, TV viewing, and PA.  Study Design: Randomized controlled trial  Two phases: Intervention phase for first 2 years, and follow-up for following 3 years  Intervention group: 8 one-hour home visits with trained community nurse, pro-active telephone support, age- appropriate feeding checklist, identify parental needs  Control group: Three home visits by trained community nurse, offer home safety promotion materials

Wen - Study Design

Wen - Home Visit Interventions  Participants: 782 first time mothers and their newborns (391 per group)  Data Collection:  Children: Anthropometric measures of height, weight, and waist size at birth, 12mo., and 24mo.  Parents: Demographic and socio-economic information collected using Child Health Survey

Wen - Home Visit Interventions  Statistical analysis:  Chi-square for categorical variables  t-tests or non-parametric equivalents for non-normally distributed variables  Weaknesses: No long-tem follow up, first two years of life may not be too significant

Wen - Home Visit Interventions  Results: Success can be seen with home-based interventions.  Conclusion: Epidemic is prevalent at two-years old. Efforts for prevention of childhood obesity must begin early in life.  Why does it support need for my study?  Interventions with young children have proven to be effective. This study stated that obese children have 25- 50% risk of progression to adulthood.  Need for more research on specific types of families to target.

Pediatric Obesity Attitudes, Services, and Information Among Rural Parents: A Qualitative Study. McGrath Davis, Ann, James, Rochelle L., Curtis, Melanie, et al. Obesity . 2008. 16(9): 2133-2140