Thesis 11.15.11

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  • Chronic diseases can develop. Despite intervention efforts, the problem continues to grow.
  • Because childhood overweight and obesity are on the rise, researchers have been, for the past decades, creating models to explain all of the causes and affects that contribute to this problem. We wanted to touch on a few that we important in our road to developing our thesis. As RDs we are interested in research about childhood obesity. But really our primary focus is the HOW. How can we help change the situation. So we focused on models that supported more of a holistic approach to the contributors of childhood obesity.
  • This was the model that really got us thinking. The focus is on the affectors of childhood obesity but it is presented from a parental influence side of things. It was from here that we really began to delv into what the research was saying about each of these variables.
  • Obesity-promoting lifestyles includes sedentary/inactivity, poor dietary habits, increased fast food consumption, skipping breakfast.
  • There is lots of research on the effects of nutrition during pregnancy on the development of the child. In fact, Barker et al coined the term ‘Fetal Origins Theory’ to describe the idea that maternal dietary or placental insufficiency in utero can program an infant’s metabolism towards the development of chronic diseases such as HTN, DM and obesity. One study from Ravelli et al observed the effects of the Dutch famine in the mid 1900’s on women who were exposed to the famine and found that women who experienced the famine during their first two trimesters had significantly higher obesity rates and DM rates than control cohorts. Furthermore they termed this effect as the ‘Thrifty phenotype Hypothesis’ because the infants’ bodies were programmed to run on less energy due to their fetal environment. Other research has also be conducted on the diet macronutrients such as protein, fat content and calorie levels of mother during pregnancy. Results of malnutrition from such nutritional deficiencies often resulted low birth weight infants. Which leads us to another factor that contributes to childhood obesity: maternal/fetal growth rates. Macrosomia is the birth of big babies. Research shows that both excessively large and small babies are at risk for obesity. However, it is not only the size of the baby that puts them at risk; the mother’s pre-gravid weight and weight gain during pregnancy are also both factors associated with increased risk.
  • Similar to low birth weight, babies who experience rapid ‘catch-up growth’ in the first 6 months of life are also at risk of overweight and obesity. This idea can be directly related to the route of infant nutrition (ie breastfeeding or formula feeding). Mother’s who breastfed their children for >12 months had significantly lower rates of overweight and obesity than those that did not. Three hypotheses have been presented on the reasons for this association: varied insulin levels in bottle vs breast fed infants, protein content (lower protein in breast milk) and, most importantly, nipple vs bottle developmentment in hunger and satiety cues.
  • Both parents busy lifestyles = more outdoor meals, less control over children (whether they are sedentary or active, what they eat, etc), less time cooking.
  • Educated parents: Less fast food, more cooking, purchasing healthier foods, increasing physical activity.
  • (i.e., fruit and vegetable consumption in adolescents found lower SES consumed less from these groups)Unhealthy, processed foods often cheaper and more appealing to those on a budget.
  • The mental and emotional health of mothers is associated with risk of obesity. Mothers who are unstable are more likely to participate in obesogenic behaviors which can be passed onto children. Mothers who are concerned about their child’s weight status also put their children at risk by way of over or underfeeding. Increased pressure to eat AND the maternal restriction have both been shown to inhibit the child’s natural hunger signals which can lead them to a life of overeating as adults. Sometimes overweight mothers can also transfer their low self-esteem and fears of their child suffering from weight issues onto the child and practice restriction with good intentions. A research study examined this exact reaction in girls who experienced maternal food restriction. They found that girls aged 9 years had significantly higher scores of ‘eating without hunger’ when exposed to this variable. But then the question arises, how accurate are mothers at judging accurate weight status of their children? One study found that only 21% of mothers with children who were overweight correctly identified their children as overweight. Researchers also found that : maternal age, maternal weight status, cultural norms, and maternal education also played a role in their perception of their child’s weight status.
  • Social sciences research has found that families with less financial income have more children. While children are more mouths to feed, they are also more stability for the parents in old age. But research actually shows a bit of a controversy in the effect of the number of siblings on obesity. Silventoinen et al suggest that children of the same family all experience the same food culture and thus will exhibit the same health and weight results. But Keller et al argues that the family environment is experienced differently based on child weight status and maternal concern over child weight. For example a child who is smaller at birth may experience more pressure to eat and thus achieve a different weight status.
  • There was little research directly addressing the effect of religion on childhood obesity. But research on health behaviors and religion shows that there is an inverse relationship. Some potential reasons for this relationship are: stress coping mechanisms of prayer and positive reinforcement of reciting scripture, social support of a church community, and the theology itself that reaffirms that the ‘body is the temple of God’ which encourages healthy lifestyles. Additionally, some religions have dietary requirements built into their belief structures such as no meat on Fridays during lent for Catholics. However, one study broke the activities of religion down and showed a more negative association of religion to obesity related to the sedentary activities of prayer, reading bible, watching or listening to religious TV/radio etc.
  • Built environmental factors are composed of several components such as grocery store access, presence of parks/playgrounds/walking paths and neighborhood safety. Children with reported easy access to grocery stores had increase fruit and vegetable intake. Neighborhoods with easy access to grocery stores was also associated with more open space and wider streets. As well, the physical activity variables can vary depending on several factors as well. SES is linked to income in that it affects things like housing and neighborhood characteristics such as presence of parks and walking paths. Additionally, research shows that the age and layout of the park also plays a factor. Older parks or parks without tracks/fields are less used than newer well formatted areas. But researchers have found that sex of the child is also a consideration; boys are more active than girls. However, recreational physical activity is only one aspect of a child’s activity. Another possible source of activity is the commute to and from school. This is where distance, the presence of friends in the area and the parents’ perception of safety are deciding factors in whether this is a source of activity for children.
  • Our new model!!!
  • Variables recoded for more simplified interpretation of results. “Don’t know” and “refused” responses were recategorized as missing data and removed from the data set.
  • Age and gender is evenly distributed.
  • 70.7% of the respondents were white!!Children’s BMI is distributed like the general population with 29% overweight or obese.
  • 80.8% are only children or only one sibling present. 77.2% were first or second born.
  • 72.8% of respondents were mothers.64.1% of family structure were two parent, biological/adopted families.
  • The results showed no significant association between child BMI and mother reported mental and emotional health status (X2 (2) = .148, p = 0.929). These results indicate that the null hypothesis, Ho3A: ‘There is no relationship between childhood obesity and maternal mental and emotional health status’, is accepted. Research shows that fair to poor mental and emotional health should be increased in overweight and obese populations.
  • (X2 (2) = .299, p = 0.861). These results indicate that the null hypothesis, Ho3B: ‘There is no relationship between childhood obesity and paternal mental and emotional health status’, is accepted.
  • The results showed a significant association between child BMI and parental reported perception of child health status (X2 (2) = 1224.201, p = 0.000). These results indicate that the null hypothesis, Ho3C: ‘There is a relationship between childhood obesity and parental perception of child health status’, is rejected. These results showed that most overweight and obese children had parents who perceived their child’s health as excellent, very good, or good. Very few (4.3%) rated their child’s health as fair or poor, despite their overweight or obese status. The parental perception of child’s health status was found to be significantly associated with childhood overweight and obesity indicating that parents are not accurate reporters of children’s weight status or may not place much importance on weight status as it relates to overall health status. This is consistent with previous research that shows that culture and body size norms affect parental perceptions of children’s body size and weight status. (62, 63)
  • The results showed no significant association between child BMI and the reported number of children under 18 years of age living in the household (X2 (3) = 4.970, p = 0.174). These results indicate that the null hypothesis, Ho8A: ‘There is no relationship between childhood obesity and number of siblings’, is accepted.Number of siblings has shown to be a controversial topic in the relationship to childhood obesity. Several studies suggest that environment plays a larger role in obesity than sibling interactions while other research finds that siblings in the same household are affected in similar ways to parental controls. (73)
  • (X2 (4) = 47.917, p = 0.000). These results indicate that the null hypothesis, Ho8B: ‘There is no relationship between childhood obesity and birth position of siblings’, is rejected. Birth position was found to be significantly associated to childhood obesity, however, number of people less than 18 years old living in the household was not found to be significantly associated. The results show that the majority of overweight and obese children came from families of only children or children with one other sibling, as well as, first born children.
  • (X2 (1) = .548, p = 0.459). These results indicate that the null hypothesis, Ho10A: ‘There is no relationship between childhood obesity and the presence of neighborhood parks and playgrounds’, is accepted.
  • (X2 (1) = .518, p = 0.472). These results indicate that the null hypothesis, Ho10B: ‘There is no relationship between childhood obesity and the presence of sidewalks and walking paths’, is accepted. . Despite these results, when looking at the breakdown of responses, the highest proportion of overweight and obese children were reported as having parks, playgrounds, sidewalks, and walking paths in their neighborhood, and as feeling safe usually or always. While this was not found to be significant, the results indicate another deviation from the research which indicates the presence of parks and playgrounds, sidewalks and walking parks and feelings of safety as protective factors against childhood obesity. (100)
  • (X2 (3) = 4.319, p = 0.229). These results indicate that the null hypothesis, Ho10B: ‘There is no relationship between childhood obesity and neighborhood safety’, is accepted.
  • (X2 (4) = 8.319, p = 0.081). These results indicate that the null hypothesis, Ho11A: ‘There is no relationship between childhood obesity and religious service attendance’, is accepted.The results were not found to have an association to childhood obesity. However, the highest percentage of children attended religious services weekly. In descending order, percentages were then monthly, yearly, and never. The lowest percentage attended services daily. However, this may be due to cultural norms as many religions commonly attend services once weekly.
  • (X2 (1) = 1.139, p = 0.286). These results indicate that the null hypothesis, Ho11B: ‘There is no relationship between childhood obesity and religious service attendance’, is accepted.
  • (X2 (1) = .107, p = 0.744). These results indicate that the null hypothesis, Ho11C: ‘There is no relationship between childhood obesity and parental social support’, is accepted.
  • (X2 (1) = 1.627, p = 0.202). These results indicate that the null hypothesis, Ho11D: ‘There is no relationship between childhood obesity and parent-child relationship status’, is accepted.
  • This table shows the conclusions that can be drawn about the variables being measured in the NSCH compared to the recommended variables to adequately measure childhood obesity.
  • Thesis 11.15.11

    1. 1. The Efficacy of the National Survey ofChildren’s Health at assessing childhoodobesity risk in children ages 10-17 years. 1
    2. 2. INTRODUCTION 2  Childhood Obesity:  31.7% of 2-19 year old children in the U.S. are overweight/obese.  Overweight/obese children are more likely to be overweight/obese into adulthood.  Research indicates several parental factors may contribute to childhood obesity.Reference: 3, 17
    3. 3. Childhood Obesity Models 3 Several models used to depict variables involved in childhood obesity:  Socio-Economic Model  Ecological Systems Theory  Model of Societal/Environmental Factors Affecting Childhood Obesity
    4. 4. Parental Influence on Childhood Obesity 4Tabacchi G, Giammanco S, Guardia ML, Giammanco M. (2007) A review of the literature and a newclassification of the early determinants of childhood obesity: from pregnancy to the first years of life. NutritionResearch, 27, 587-604.
    5. 5. National Survey of Children’s Health (NSCH) 5 National Survey of Children’s Health  Sponsored by the Maternal and Child Health Bureau.  Assesses the physical and emotional health of children ages 0-17.  Age of children chosen for study (10-17 years)  State and Local Area Integrated Telephone Survey (SLAITS):  Used to determine the emotional and physical health status, as well as, children’ access to medical care and insurance in the U.S. NSCH overview (www.cdc.gov/SLAITS/NSCH)
    6. 6. Rationale 6 Childhood obesity is a growing problem.  Identification of contributing factors can lead to effective intervention efforts. NSCH is a fairly new surveillance system  Initiated in 2003  Potential to aid in future intervention efforts
    7. 7. Purpose 7  To investigate the extent of variables measured by NSCH that are predictive of childhood obesity risk in children ages 10-17 years.
    8. 8. What Research Says… 8
    9. 9. Parents’ Obesity 9 Genetic factors  Higher genetic predisposition when parents are obese.  Greater risk when both parents are overweight. Lifestyle factors  Parents with higher BMI scores may live obesity-promoting lifestyles  Parent physical activity: strong positive predictor of childhood inactivity. References: 26, 29
    10. 10. Maternal Pregnancy Nutrition 10  ‘Fetal Origins Theory’  The Dutch Famine: Early 1900’s  Higher rates of Obesity in women exposed to famine in 1st and 2nd trimesters: ‘Thrifty Phenotype Hypothesis’  Diet Composition  Low Protein  High fat/cholesterol  Low/High Calorie: Infant and mother weight gainReferences: 96, 98, 99, 10, 11, 12, 13
    11. 11. Maternal Practices of Breastfeeding and Weaning 11 Breastfeeding vs formula feeding  Rapid ‘catch-up growth’ Age of weaning  World Health Organization (WHO): > 6 mos  Department of Health (DOH): > 4 mos  Infant’s developmental progressReferences: 100, 84-86, 6, 10, 11, 8, 91, 90, 87, 88
    12. 12. Parental Employment Status 12 Shift away from traditional dynamic: Father = breadwinner and mother stays home.  Both parents lead busy lifestyles.  Research has shown mothers working more hours more likely to have overweight children. However, two incomes may result in access to healthier choices. References: 3, 17, 18
    13. 13. Parental Education 13 Higher parental education linked to higher physical activity in children. Research indicates inverse relationship between childhood obesity and education level of head of household. Parents who are educated on the importance of health may be more inclined to make healthier choices for their families. References: 15, 16, 26
    14. 14. Socioeconomic Status 14 Research is inconsistent.  Studies looking at nutrient level data found little association.  Studies looking at specific food groups found relationships.  One study found SES positively related to fruit/vegetable consumption and negatively related to fast food consumption.  Study by Ogden, et al found childhood obesity prevalence decreases as income increases, however, most obese children are not low income. References: 16, 18, 19
    15. 15. Single Mother or No-worker Father 15 Journal of Pediatrics: middle school children with unemployed father had increased risk compared to working fathers. Children of single mothers or unemployed parents more likely to develop obesity. References: 1, 2
    16. 16. Attitudes of Mother 16 Mother’s mental and emotional characteristics Mother’s perception of Child’s weight Mother’s concern for her child’s weight from personal experience Maternal restrictionReferences: 60-62, 68, 63, 64, 73, 82, 70, 72
    17. 17. Number of Siblings 17  Children of the same family will learn the same food culture  However, others argue that each child is different  Weight status of child  Concern of mother for child increases pressure to eat or restrict to change food culture  Genetic and environmental factors influence food culture and weightReferences: 50, 52, 57, 59
    18. 18. Religion and Beliefs 18 No direct research literature Participation in religion is inversely related to increased body weight Stress-coping mechanism, social support and doctrine itself Some religions promote dietary restriction  Catholicism, Judaism, Seventh Day Adventists What about prayer, reading your bible?References: 43, 46, 48, 41, 49
    19. 19. Built Environment 19  Grocery store access  Linked with open space and width of streets  Physical activity level varies based on:  SES  Housing and neighborhood characteristics  Presence of parks and walking/biking paths  Age of parks  Sex of child  Distance from school  Friends in the area  Parent’s perception of neighborhood safetyReferences: 120, 121, 125, 127, 129
    20. 20. OUR Model 20
    21. 21. Methodology 21 Study Design  Non-experimental  Analytical Key Variables:  Dependent: BMI  Independent: Childhood Obesity Factors IRB Approval Level - Exempt
    22. 22. Statistical Procedures 22 Data available for use through the NSCH. Analyzed using SPSS version 19. Computed Frequencies and Chi Square. Variables were recoded.
    23. 23. Sample Population Results 23 45,897 Children aged 10-17 made up the study  23,866 Males  21,985 Females Other Descriptive Statistics available:  Federal Poverty level based on SCHIP qualification  Family structure  Parental Marital/Cohabitation Status  Parent Social Support  Religious service attendance  Parental physical activity per week  Parental Mental and Emotional Health Status  Parental General Health  Parent Stress Coping Ability  Parent-Child Relationship Status
    24. 24. Child Statistics 24 Childs Age Sex of Child 6952 4940 10.8% 10 15.1% 4673 11 10.2% 13 23,855 6720 47.9% Male 1414.6% 5380 21,975 Female 15 52.1% 11.7% 16 6088 5861 17 13.3% 12.8%
    25. 25. Child Statistics 25 Ethnicity/Race Childs BMI 17761897 3.9% 4935 6040 21864.2% 10.9% Hispanic 5.0% 13.7% Underweight 4632 White10.3% Healthy 6754 Weight Black 15.3% 31,880 29,121 Overweight 70.7% Multi- 66% racial Obese Other
    26. 26. Siblings 26Number of Siblings Birth Position 2729 1315 214 5.9% 2.9% 0.5% 6043 8921 113.2% 20,672 1 19.4% 20,671 2 45.0% 2 45.0% 316,452 3 435.8% 4+ 14,774 32.2% 5
    27. 27. Family Members 27 Respondent Family StructureRelationship to Child Two 3446 Parent; 2806 7.6% Biological/ 6.1% Adopted Two Parent; 8027 Step Family 9656 Mother 17.6%21.0% Single Father 29,241 33,428 Mother; No All Other 64.1% 72.8% Father 4910 present Other 10.8% Family Type
    28. 28. Education 28 Mother Education Father Education Level Level 3261 2676 7.8% 7.6% Less than Less than High High School School 9209 High 8414 High 21.9% School 24,128 23.9% School29,499 Graduate 68.5% Graduate70.3% More than More than High High School School
    29. 29. Income 29Parent Empolyment Federal Poverty Levelstatus at least 50 out based on DHHS of past 52 weeks Guidelines41079.1% 4824 10.5% 0-99% FPL 18,119 7378 100-199% Yes 39.5% 16.1% FPL No 200-399% 15,576 41,256 FPL 33.9% 90.9% 400% FPL +
    30. 30. Results of Hypothesis Testing 30
    31. 31. Maternal General Health Status 31Hₒ1a: There is no association between childhood obesity and maternal general health status.  REJECTED(p value = .000) Maternal General Health Status Very Good and Health Status Excellent Fair and poor Total Good Underweight 8787 (30.2%) 17773 (61.2%) 2501 (8.6%) 29061 (100.0%) and Healthy Weight Overweight and 2458 (21.2%) 7437 (64.2%) 1686 (14.6%) 11581 (100.0%) Obese Total 11245 (27.7%) 25210 (62.0%) 4187 (10.3%) 40642 (100.0%)
    32. 32. Paternal General Health Status 32Hₒ1b: There is no association between childhood obesity and paternal general health status.  REJECTED (p value = .000) Paternal General Health Status Very good and Health Status Excellent Fair and poor Total good Underweight 7259 (28.9%) 16219 (64.6%) 1635 (6.5%) 25113 (100.0%) and Healthy Weight Overweight and 1946 (21.3%) 6195 (67.9%) 981 (10.8%) 9122 (100.0%) Obese Total 9205 (26.9%) 22414 (65.5%) 2616 (7.6%) 34235(100.0%)
    33. 33. Maternal Physical Activity Level 33Hₒ2a: There is no association between childhood obesity and maternal physical activity level.  REJECTED (p value = .000) Mother’s days of Physical Activity (PA) per week Underweight and Overweight and Obese Total Healthy Weight 0 days of PA 6253 (68.0%) 2948 (32.0%) 9201 (100.0%) 1 to 4 days of PA 15467 (72.7%) 5808 (27.3%) 21275 (100.0%) 5 to 7 days of PA 7217 (72.4%) 2749 (27.6%) 9966 (100.0%)
    34. 34. Paternal Physical Activity Level 34Hₒ2b: There is no association between childhood obesity and paternal physical activity level.  REJECTED (p value = .000) Father’s days of Physical Activity (PA) per week Underweight and Healthy Weight Overweight and Obese Total 0 days of PA 4425 (70.4%) 1859 (29.6%) 6284 (100.0%) 1 to 4 days of PA 11738 (75.4%) 3837 (24.6%) 15575 (100.0%) 5 to 7 days of PA 8733 (72.4%) 3321 (27.6%) 12054 (100.0%)
    35. 35. Maternal Mental and Emotional Health 35Hₒ3a: There is no association between childhood obesity and maternal mental and emotional health status.  ACCEPTED (p value = .929) Maternal Mental and Emotional Health Status Health Status Excellent Very Good and Fair and poor Total Good Underweight and 10324 (35.3%) 17252 (58.9%) 1691 (5.8%) 29267 (100.0%) Healthy Weight Overweight and 4192 (35.3%) 6993 (58.8%) 698 (5.9%) 11883 (100.0%) Obese Total 14516 24245 2389 41150
    36. 36. Paternal Mental and Emotional Health 36Hₒ3b: There is no association between childhood obesity and paternal mental and emotional health status.  ACCEPTED (p value = .861) Paternal Mental and Emotional Health Status Health Status Excellent Very Good and Fair and poor Total Good Underweight and 9773 (39.2%) 14136 (56.8%) 996 (4.0%) 24905 (100.0%) Healthy Weight Overweight and 3991 (39.5%) 5702 (56.4%) 409 (4.0%) 10102 (100.0%) Obese Total 13764 19838 1405 35007
    37. 37. Paternal Perceptions of Child Health 37Hₒ3c: There is no association between childhood obesity and parental perceptions of child health status.  REJECTED (p value = .000) Parent’s Perception of Child health Status Parent reported Very Good and child health Excellent Fair and poor Total Good status Underweight and 21273 (68.0%) 9471 (30.3%) 557 (1.8%) 31301 (100.0%) Healthy Weight Overweight and 6493 (50.8%) 5743 (44.9%) 553 (4.3%) 12789 (100.0%) Obese Total 27766 15214 1110 44090
    38. 38. Maternal Education Level 38Hₒ4a: There is no association between childhood obesity and maternal education status.  REJECTED (p value = .000) Mother Highest Education Level Completed Education Level Less than high 12 years/high More than high Total Completed school school graduate school Underweight and 1639 (5.7%) 5846 (20.2%) 21411 (74.1%) 28896 (100.0%) Healthy Weight Overweight and 1217 (10.6%) 3018 (26.3%) 7262 (63.2%) 11497 (100.0%) Obese Total 2856 (7.1%) 8864 (21.9%) 28673 (71.0%) 40393 (100.0%)
    39. 39. Paternal Education Level 39Hₒ4b: There is no association between childhood obesity and paternal education status.  REJECTED (p value = .000) Father Highest Education Level Completed Education Level Less than high 12 years/high More than high Total Completed school school graduate school Underweight and 1405 (5.6%) 5433 (21.8%) 18095 (72.6%) 24933 (100.0%) Healthy Weight Overweight and 1002 (11.1%) 2678 (29.7%) 5348 (59.2%) 9037 (100.0%) Obese Total 2407 (7.1%) 8120 (23.9) 23443 (69.0%) 33970 (100.0%)
    40. 40. Parent Employment Status 40Hₒ5a: There is no association between childhood obesity and parent employment status.  REJECTED (p value = .000) Was anyone in the household employed at least 50 weeks out of the past 52 weeks? Employment Status No Yes Total Underweight and 2341 (7.6%) 28656 (92.4%) 30997 (100.0%) Healthy Weight Overweight and 1467 (11.6%) 11168 (88.4%) 12635 (100.0%) Obese Total 3808 (8.7%) 39824 (91.3%) 43632 (100.0%)
    41. 41. Parent Income 41Hₒ6a: There is no association between childhood obesity and household poverty level based on DHHS guidelines.  REJECTED (p value = .000) Poverty level of this household based on DHHS guidelines 100-199% 200-399% 400% Federal 0-99% Federal Federal Poverty Federal Poverty Poverty Level Total Poverty Level Level Level or greater Underweight 2436 (7.8%) 4453 (14.2%) 10673 (34.1%) 13745 (43.9%) 31307 and Healthy (100.0%) Weight Overweight 1891 (14.8%) 2539 (19.8%) 4459 (34.9%) 3905 (30.5%) 12794 and Obese (100.0%) Total 4327 (9.8%) 6992 (15.9%) 15132 (34.3%) 17650 (40.0%) 44101 (100.0%)
    42. 42. Parent Income 42Hₒ6b: There is no association between childhood obesity and household poverty level based on SCHIP qualifications.  REJECTED (p value = .000) Poverty level of this household based on DHHS guidelines based on SCHIP qualifications 100-199% 200-399% 400% Federal 0-99% Federal Federal Federal Poverty Level Total Poverty Level Poverty Level Poverty Level or greater Underweight 6889 (22.0%) 5551 (17.7%) 5122 (16.4%) 13745 (43.9%) 31307 and Healthy (100.0%) Weight Overweight 4430 (34.6%) 2513 (19.6%) 1946 (15.2%) 3905 (30.5%) 12794 and Obese (100.0%) Total 11319 8064 (18.3%) 7068 (16.0%) 17650 (40.0%) 44101 (25.7%) (100.0%)
    43. 43. Parental Marital Cohabitation Status 43Hₒ7a: There is no association between childhood obesity and parental marital cohabitation status.  REJECTED (p value = .000) Marital/Cohabitation Status of Childs Parent(s) in the Household No parents in Married Cohabitating Neither Total the household Underweight 23905 (76.8%) 1241 (4.0%) 5008 (16.1%) 954 (3.1%) 31108 and Healthy (100.0%) Weight Overweight and 8462 (66.7%) 757 (6.0%) 2848 (22.4%) 623 (4.9%) 12690 Obese (100.0%) Total 32367 (73.9%) 1998 (4.6%) 7856 (17.9%) 1577 (3.6%) 43798 (100.0%)
    44. 44. Parental Legal Status 44Hₒ7b: There is no association between childhood obesity and parental legal status.  REJECTED (p value = .000) Derived: Legal Marital Status of Childs Parent(s) in the Household No Parents Never Married Separated Divorced Widowed in Total Married Household Underweight 23905 708 3146 442 1961 954 31116 and Healthy (76.8%) (2.3%) (10.1%) (1.4%) (6.3%) (3.1%) (100.0%) Weight Overweight 8462 449 1514 255 1391 623 12694 and Obese (66.7%) (3.5%) (11.9%) (2.0%) (11.0%) (4.9%) (100.0%) Total 32367 1157 4660 697 3352 1577 43810 (73.9%) (2.6%) (10.6%) (1.6%) (7.7%) (3.6%) (100.0%)
    45. 45. Family Structure 45Hₒ7c: There is no association between childhood obesity and family structure.  REJECTED (p value = .000) Type of family structure in household Two parent, Single mother, Two parent, Other family biological or no father Total step family type adopted present Underweight 20872 (67.0%) 3299 (10.6%) 4829 (15.5%) 2148 (6.9%) 31148 and Healthy (100.0%) Weight Overweight and 7234 (56.9%) 1473 (11.6%) 2851 (22.4%) 1156 (9.1%) 12714 Obese (100.0%) Total 28106 (64.1%) 4772 (10.9%) 7680 (17.5%) 3304 (7.5%) 43862 (100.0%)
    46. 46. Number of Siblings 46Hₒ8a: There is no association between childhood obesity and number of siblings.  ACCEPTED (p value = .174) How many people less than 18 years old live in this household Children in 1 2 3 4 Total Household Underweight 14095 11305 4106 (13.1%) 1800 (5.7%) 31306 and Healthy (45.0%) (36.1%) (100.0%) Weight Overweight 5900 (46.1%) 4505 (35.2%) 1645 (12.9%) 744 (5.8%) 12794 and Obese (100.0%) Total 19995 15810 5751 2544 44100
    47. 47. Birth position of Siblings 47Hₒ8b: There is no association between childhood obesity and birth position of siblings.  REJECTED (p value = .000) Birth position of the child relative to other children in the household Birth 1 2 3 4 5 Total Position Underweigh 14095 10314 5916 865 (2.8%) 116 (.4%) 31306 t and (45.0%) (32.9%) (18.9%) (100.0%) Healthy Weight Overweight 5900 3842 2612 364 (2.8%) 76 (.6%) 12794 and Obese (46.1%) (30.0%) (20.4%) (100.0%) Total 19995 14156 8528 1229 192 44100
    48. 48. Family Meals 48Hₒ9a: There is no association between childhood obesity and number of family meals.  REJECTED (p value = .000) In the past week, on how many days did all family members living in the household eat a meal together? Days per week 0 1 to 4 5 to 7 Total Underweight and 1483 (4.8%) 12181 (39.0%) 17551 (56.2%) 31215 (100.0%) Healthy Weight Overweight and 616 (4.8%) 4656 (36.5%) 7490 (58.7%) 12762 (100.0%) Obese Total 2099 (4.8%) 16837 (38.3%) 25041 (56.9%) 43977 (100.0%)
    49. 49. Neighborhood Parks and Walking Paths 49Hₒ10a: There is no association between childhood obesity and the presence of neighborhood parks and walking paths.  ACCEPTED (p value = .459) Does a park or playground area exist in your neighborhood? No Yes Total Underweight and 6388 (20.6%) 24652 (79.4%) 31040 (100.0%) Healthy Weight Overweight and Obese 2569 (20.3%) 10108 (79.7%) 12677 (100.0%) Total 8957 34760 43717
    50. 50. Presence of Sidewalks and Walking Paths 50Hₒ10b: There is no association between childhood obesity and the presence of walking paths.  ACCEPTED (p value = .472) Do sidewalks or walking paths exist in your neighborhood? No Yes Total Underweight and 8876 (28.6%) 22172 (71.4%) 31048 (100.0%) Healthy Weight Overweight and Obese 3579 (28.2%) 9092 (71.8%) 12671 (100.0%) Total 12455 31264 43719
    51. 51. Neighborhood Safety 51Hₒ10c: There is no association between childhood obesity and neighborhood safety.  ACCEPTED (p value = .229) How often does your child feel safe in your community or neighborhood? Never Sometimes Usually Always Total Underweight 569 (1.8%) 2734 (8.8%) 10587 (34.2%) 17098 (55.2%) 30988 and Healthy (100.0%) Weight Overweight 229 (1.8%) 1188 (9.4%) 4242 (33.5%) 6985 (55.2%) 12644 and Obese (100.0%) Total 798 3922 14829 24083 43632
    52. 52. Religious Service Attendance 52Hₒ11a: There is no association between childhood obesity and religious service attendance.  ACCEPTED (p value = .081) About how often does the child attend a religious service? At least At least once At least once per per year but once per month but None less than week but Daily Total less than once per less than once per month daily week Underweight 4850 4094 5886 15947 312 (1.0%) 31089 and Healthy (15.6%) (13.2%) (18.9%) (51.3%) (100.0%) Weight Overweight 1974 1549 2430 6631 125 (1.0%) 12709 and Obese (15.5%) (12.2%) (19.1%) (52.2%) (100.0%) Total 6824 5643 8316 22578 437 43798
    53. 53. Parental Social Support 53Hₒ11b: There is no association between childhood obesity and parental social support.  ACCEPTED (p value = .286) Is there someone that you can turn to for day-to-day emotional help with parenthood/raising children? Definitely and Somewhat and Total somewhat agree definitely disagree Underweight and 28313 (92.1%) 2444 (7.9%) 30757 (100.0%) Healthy Weight Overweight and Obese 11505 (91.7%) 1035 (8.3%) 12540 (100.0%) Total 39818 3479 43297
    54. 54. Parental Stress Coping Skills 54Hₒ11c: There is no association between childhood obesity and parental stress coping skills.  ACCEPTED (p value = .744) In general, how well do you feel you are coping with the day to day demands of parenthood/raising children? Very well and Not very well and not Total somewhat well very well at all Underweight and 30739 (98.5%) 479 (1.5%) 31218 (100.0%) Healthy Weight Overweight and Obese 12547 (98.4%) 201 (1.6%) 12748 (100.0%) Total 43286 680 43966
    55. 55. Parent-Child Relationship Status 55Hₒ11d: There is no association between childhood obesity and parent-child relationship status.  ACCEPTED (p value = .202) How well can you and your child share ideas or talk about things that really matter? Very well and Not very well and not Total somewhat well very well at all Underweight and 21289 (97.5%) 550 (2.5%) 21839 (100.0%) Healthy Weight Overweight and Obese 8732 (97.2%) 249 (2.8%) 8981 (100.0%) Total 30021 799 30820
    56. 56. Conclusions of NSCH Variables 56 Not Addressed Needs Improvements Addressed
    57. 57. Conclusions 57  NSCH has room for growth  NSCH has a narrow scope of variables measured that are predictive childhood obesity risk.  10 out of 25 variables measured adequately  10 out of 25 variables not measured adequately  5 out of 25 variables need revisions
    58. 58. DISCUSSION 58 Strengths  Large sample size  Randomized sample size  Large variety of topics Limitations  Random digit dialing  Self reported data  Bias?  Potential for non-response bias exists: the sample interviewed differed from the targeted child population in a systematic fashion  Lack of continuous data for all age groups
    59. 59. RECOMMENDATIONS for Changes to NSCH 59 Alternate selection method  Eliminate SLAITS as selection method  Adding cell phones Increase variability of sample by over-sampling minorities  Hispanic/African American populations  Low income  Housing type  Education Level All data for all ages  Breastfeeding/Age of Weaning
    60. 60. QUESTIONS? 60
    61. 61. References 616. Position of the American Dietetic Association: Promoting and Supporting breastfeeding. (2009) JADA, 1926- 42.84. Stettler N, Zemel BS, Kumanyika S and Stallings VA. (2002) Infant weight gain and childhood overweight status in a multicenter cohort study. Pediatrics, 109: 194-9.85. Sloan S, Gildea A, Stewart M Sneddon H and Iwaniec D. (2007) Early weaning is related to weight and rate of weight gain in infancy. Child: Care, Health and Development, 34(1): 59-64.86. Dennison BA, Edmunds LS, Stratton HH, and Pruzek RM. (2006) Rapid weight gain predicts childhood obesity. Obesity, 14(3): 491-99.87. Ong KK, Ahmed ML, Emmet PM, Dunger DB and ALSPAC study team. (2000) Association between postnatal catch-up growth and obesity in childhood: a prospective cohort study. British Medical Journal, 320: 967-71.88. Mehta KC, Specker BL, Batholmey S, Giddens J and Ho M. (1998) Trial on timing of introduction to solids and food type on infant growth. Pediatrics, 102: 569-73.90. Manios Y, Moschonis G, Grammatikaki E, Anastasiadou A and Liarigkovinos T. (2010) Determinants of childhood obesity and association with maternal perceptions of their children’s weight status: the GENESIS study. J Am Diet Assoc, 110: 1527-31.91. Ounsted M and Sleigh G. (1975) The infant’s self-regulation of food intake and weight gain. Difference in metabolic balance after growth constraint or acceleration in utero. Lancet, 7922: 1393-97.100. Dewey KG. (2001) Nutrition, growth and complementary feeding of breastfed infant. Pediatr Clin North Am, 48: 87-104.
    62. 62. References 6210. Von Kries R, Koletzko B, Sauerwald T, Von Mutius E, Barnert D. (2003) Breastfeeding and obesity: cross sectional study. BMJ, 319, 147-50.11. Hedinger ML, Overpeck MD, Kuczmarski RJ, Ruan WJ. (2001) Association between infant breastfeeding and overweight in young children. JAMA, 285, 2461-506.12. Moreira P, Padez C, Mourao-Carvalhal R, Rosado V. (2007) Maternal weight gain during pregnancy and overweight in Portuguese children. International Journal of Obesity, 31, 608-14.13. Fawzi WW, Forman MR, Levy A, Graubard BI, Naggan L, Berendes HW. (1997) Maternal anthropometry and infant feeding practices in Israel in relation to growth in infancy: North African Infant Feeding study. Am J Clin Nutr, 65, 1731-37.96. Barker DJ. (2007) The origins of the developmental origins theory. J Intern Med, 261: 412-17.98. Ravelli GP, Stein ZA, and Susser MW. (1976) Obesity in young men after famine exposure in utero and early infancy. New England J of Med, 295: 349-53.99. Hales CN and Barker DJ. (2001) The Thrifty Phenotype hypothesis. Br Med Bull, 60: 5-20.49. Shatenstein B and Ghadirian P. (1997) Influences on diet, health behaviours and their outcomes in select ethnoclutural and religious groups. Nutrition, 14: 223-30.48. Hummer RA, Rogers RG, Nam CB, and Elison CG. (1999) Religious involvement and U.S adult mortality. Demography, 36: 273-85.46. Kim KH, Sobal J and Wethington E. (2003) Religion and Body weight. International Journal of Obesity, 27: 469-77.
    63. 63. References 6359. Lajunen HR, Kaprio J, Keski-Rahkonen A, Rose RJ, Kulkkinen L, Rissanen A, et al. (2009) Genetic and environmental effects on body mass index during adolescence: a prospective study among Finnish twins. Int J Obes, 33: 559-67.57. Keskitalo K, Silventoinen K, Tuorila H, Perola M, Pietilainen KH, Rissanene A, et al. (2008) Genetic and environmental contribution to food use patterns of young adult twins. Physiol Behav, 93: 235-42.52. Silventoinen K, Rokholm B, Kaprio J and Sorensen TIA. (2010) The genetic and environmental influences on childhood obesity: a systematic review of twin and adoption studies. International Journal of Obesity, 34: 29-40.50. Keller KL, Pietrobelli A, Johnson SL and Faith MS. (2006) Maternal restriction of children’s eating and encouragements to eat as the ‘non-shared environment’: a pilot study using the child feeding questionnaire. International Journal of Obesity, 30: 1670-75.60. Magnus O, Irgens LM, Haug K Mystad W, Skjaerven R and Stoltenberg C. (2006) Cohort Profile: the Norwegian Mother and child cohort study. Int J Epidemiol, 35: 1146-1150.61. Ystrom E, Nielgel S, Knut-Inge K and Vollrath ME. (2008) The impact of maternal negative affectivity and general self-efficacy on breastfeeding: the Norwegian Mother and child cohort study. J Pediatr, 152: 68-78.62. Ystrom E, Nielgel S, Knut-Inge K and Vollrath ME. (2005) The impact of maternal negative affectivity on dietary patterns of 18-month-ol children in the Norwegian mother and child cohort study. Matern Child Nutr, 5: 234-42.63. Kroke A, Strathmann S and Gunther ALB. (2006) Maternal perceptions of her child’s body weight in infancy and early childhood and their relation to body weight status at age 7. Eur J Pediatr, 165: 875- 83.
    64. 64. References 6464. Francis LA, Hofer SM and Birch LL (2001) Predictors of maternal child-feeding style: maternal and child characteristics. Appetite, 37: 231-43.68. Birch LL, Fisher JO, and Davison KK. (2003) Learning to overeat: maternal use of restrictive feeding practices promotes girls’ eating in the absence of hunger. Am J Clin Nutr, 78: 215-20.70. Lindsay AC, Sussner KM, Greaney ML, and Peterson KE. (2011) Latina mothers’ beliefs and practices related to weight status, feeding and the development of child overweight. Public Health Nursing, 28(2): 107-18.72. Boyington JA, and Johnson AA. (2004) Maternal perception of body size as a determinant of infant adiposity in an African-American community. J Natl Med Assoc, 96: 351-62.73. Kuang JS, Becerra K, Oda T, Walker E, Xu R, Donohue M, et al. (2007) Parental ability to discriminate the weight status of children: results of a survey. Pediatrics, 120: 112-19.82. Baughcum AE, Chamberlin LA, Deeks CM, Powers SW and Whitaker RC. (2000) Maternal perceptions of overweight preschool children. Pediatrics, 106: 1380-86.120. Galvez MP, Pearl M, and Yen IH. Childhood obesity and the Built Environment: A Review of the Literature from 2008-2009. Curr Opin Pediatr, April 2010; 22(2) 202-07.121. Veugelers P, Sithole F, Zhang S, et al. Neighborhood characteristics in relation to diet, physical activity and overweight of Canadian children. Int J Pediatr Obes, 2008(3); 152-159.125. Santos MP, Page AS, Cooper AR, et al. Perceptions of the built environment in relation to physical activity in Protuguese adolescents. Health Place, 2009 (15); 548-52.127. Babey SH, Hastert TA, Yu H, et al. Physcial activity among adolescents. When do parks matter? Am J Prev Med, 2008(34); 345-48.129. Tester J, Baker R. Making the playfields even: Evaluating the impact of an environmental intervention on park use and physical activity. Prev Med, 2009 (48); 316-20.
    65. 65. References 6543. Williams DR and Sternthal MJ. (2007) Spirituality, religion and health; evidence and research directions. MJA, 186(10): S47-50.41. Koenig HG, Jays JC, George LK, Blazer DG, Larson DB, and Lanerman LF. (1997) Modeling the cross-sectional relationships between religious, physical health, social support and depressive symptoms. Am J Geriatr Psychiatry, 5: 131-44.17. Anderson PM, Butcher KF, Levine PB (2003). Economic Perspectives on Childhood Obesity. Federal Reserve Bank of Chicago.3. Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. (2010) Prevalence of High body mass index in US children and adolescents, 2007-2008. JAMA, 303, 235-275.

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