Faculty Bibliography

PurposeTo estimate the effect of the culturally-adapted Greenlight intervention on parent activation and locus of control (LOC) among Chinese-American immigrant parents.DesignProspective, quasi-experimental study.SettingA New York City-based federally-qualified health center with a large patient population of low-income, ethnically Chinese immigrant individuals and families.Sample444 Immigrant Chinese-American parents of infants (267 cross-sectionally enrolled historical controls and 177 Greenlight recipients followed prospectively).InterventionA culturally-adapted version of Greenlight, a health literacy- and communication-informed early childhood obesity prevention intervention in primary care which promotes certain healthy infant feeding practices at 12 months in the present sample.MeasuresParent activation and LOC were measured at 6, 12, 24, and 36 month well child visits.AnalysisGeneralized estimating equations were used to examine the effects of the Greenlight intervention on the outcome measures.ResultsCompared to historical controls, parents receiving Greenlight were more likely to strongly agree with the activation statements: "I know how to prevent my child from becoming overweight" (adjusted odds ratio (aOR): 9.62 [4.70, 19.73]); "I have been able to help my child maintain recommended changes like eating right or exercising" (aOR: 6.42 [4.14, 9.97]); and "I am confident I can keep my child eating and exercising right, even when I am busy or stressed" (aOR: 8.44 [5.35, 13.31]). Greenlight recipients also demonstrated increased internal LOC (aOR: 2.02 [1.35, 3.03]) and decreased powerful others external LOC (aOR: 1.76 [1.23, 2.51]).ConclusionTo reduce disparities in child obesity, especially among immigrant families, interventions must also prioritize parent factors like parent activation and LOC to build upon their inherent assets and promote long-term change.

OBJECTIVE:To examine whether a cultural adaptation of an early childhood obesity prevention program promotes healthy infant feeding practices. STUDY DESIGN/METHODS:Prospective quasi-experimental study of a community-engaged multiphasic cultural adaptation of an obesity prevention program set at a federally qualified health center serving immigrant Chinese American parent-child dyads (N=298). In a group of historical controls, we assessed early infant feeding practices (breastfeeding, sugar-sweetened beverage intake) in 6-month-olds and then the same practices alongside early solid food feeding practices (bottle weaning, fruit, vegetable, sugary or salty snack consumption) in 12-month-olds. After implementation, we assessed these practices in an intervention cohort group at 6 and 12 months. We used cross-sectional groupwise comparisons and adjusted regression analyses to evaluate group differences. RESULTS:At 6 months, the intervention group had increased odds of no sugar-sweetened beverage intake (aOR: 5.69 [95% CI: 1.65, 19.63], p=0.006). At 12 months, the intervention group also had increased odds of no sugar-sweetened beverage intake (aOR: 15.22 [95% CI: 6.33, 36.62], p<0.001), increased odds of bottle weaning (aOR: 2.34 [95% CI: 1.05, 5.23], p=0.03), and decreased odds of sugary snack consumption (aOR: 0.36 [0.18, 0.70], p= 0.003). We did not detect improvements in breastfeeding, fruit, vegetable, or salty snack consumption. CONCLUSION/CONCLUSIONS:A cultural adaptation of a primary care-based educational obesity prevention program for immigrant Chinese American families with low-income is associated with certain healthy infant feeding practices. Future studies should evaluate cultural adaptations of more intensive interventions that better address complex feeding practices like breastfeeding and evaluate long-term weight outcomes.

Parent perception of weight and feeding styles are associated with obesity in other racial groups but have not been explored in-depth in Chinese-American preschoolers. Cross-sectional survey of 253 Chinese-American parents with preschoolers was performed in a community clinic. Regression analysis was used to assess relationships between parental perception of weight and feeding styles. Parent under-perception of weight was common but more likely in boys than girls (chi2 = 4.91, p = 0.03). Pressuring was also greater in boys [adjusted mean difference (95% CI) 0.24 (0.004, 0.49)]. In girls, pressuring was lower for children perceived as overweight [adjusted mean difference in CFQ scores -0.75 (-1.27, -0.23)]; in boys, pressuring was high regardless of perceived child weight. Weight perceptions and feeding styles related to childhood obesity in other groups were identified in Chinese-American families. Parent under-perception of child weight and pressure to eat were more common in boys. These factors should be addressed in Chinese-American preschooler obesity prevention programs.

The authors studied toddlers with low-level lead exposure to determine whether adverse developmental effects were evident. The study sample consisted of a cohort of 68 children aged 12 to 36 months who had blood lead levels lower than 25 microg/dL on a routine screening in a large urban public hospital clinic. Children with blood lead levels between 10 and 24.9 microg/dL had a mean Mental Developmental Index (Bayley Scales of Infant Development, Second Edition) score that was 6.3 points lower than that of children with blood lead levels between 0 and 9.9 microg/dL (95% confidence interval: 0.6, 11.9). After adjusting for confounders, the difference was 6.2 points (95% confidence interval: 1.7, 10.8). Pediatricians and public health entities should continue in their efforts to reduce the lead burden through environmental control and ongoing surveillance