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Title:Exploring Hispanic mothers’ perceptions of child weight in a family-based obesity prevention program
Author(s):Luna, Viridiana
Advisor(s):Teran-Garcia, Margarita
Contributor(s):Donovan, Sharon; Nickols-Richardson, Sharon; Hernandez, Rosalba
Department / Program:Nutritional Sciences
Discipline:Nutritional Sciences
Degree Granting Institution:University of Illinois at Urbana-Champaign
Subject(s):childhood obesity
weight perceptions
Hispanic health
health beliefs
nutrition education
Abstract:Hispanic children in the United States (US) have the highest prevalence of obesity compared to other groups. Childhood obesity prevention and treatment require the involvement of parents to promote healthy behaviors and help their child achieve a healthy weight. Particularly among Hispanic families, obesity interventions are successful when parents are integrated into intervention activities and lessons. However, there are certain barriers to engaging Hispanic parents in obesity treatment and prevention efforts including cultural beliefs and perceptions related to child weight. Parents often underestimate the weight of their child. Previous research demonstrates that parents who do not recognize that their child has obesity may be less likely to participate in obesity interventions. Parent perceptions of child weight have been associated with parent and child characteristics such as child age and parents’ weight status and acculturation level. However, these associations are not consistent among Hispanic populations. Additionally, there is limited knowledge about the impact of parent perceptions of child weight and health behaviors such as child diet. Therefore, the purpose of this thesis is to summarize recent findings about Hispanic parents’ beliefs and perceptions about child weight and health, analyze mother and child characteristics that may predict mother’s perception of child weight in a multi-state Hispanic sample, and to evaluate changes in child dietary behaviors following a nutrition education program for Hispanic families. Lastly, this thesis will explore the relationship between mother’s perception of child weight and child dietary behaviors. A narrative review was conducted to integrate the findings from qualitative and quantitative studies on the topics of Hispanic parents’ beliefs and perceptions of child weight. Three themes emerged from qualitative studies: 1) Hispanic parents often prefer a heavier child because heavier children are believed to have healthy appetites and are indicative of parents who can provide for their families, 2) Hispanic parents reported that obesity is an inherited disease and thus preventive behaviors may not be successful at achieving a healthy weight, and 3) Child health is not defined by weight but by a child’s physical and functional abilities. A total of 19 quantitative studies published from 2007 to 2017 were reviewed to identify common predictors of child weight perception. The majority of these studies included mothers and not fathers. Mother’s weight status was associated with weight perception in the majority of the studies reviewed. Findings on the impact of acculturation on weight perception were also inconsistent. The direction of this relationship is not clear because studies reported contradictory findings. Parents misperceived the weight of younger children and boys more often than older children and girls. Findings from the narrative literature review led to aim 1. This aim investigated predictors of Hispanic mothers’ perceptions of child weight. Hispanic mother-child dyads were recruited to participate in a multi-site obesity prevention program. Survey and anthropometric data were collected in Illinois, California, and Iowa at baseline. Mothers completed a questionnaire that contained items about their perception of their child’s weight, child physical activity level, and their level of concern about their child’s weight. Additionally, mothers provided demographic information and completed the Brief Acculturation Rating Scale for Mexican Americans-II (ARSMA-II) to assess acculturation level. A logistic regression analysis was conducted to determine which mother and child characteristics predicted which mothers accurately perceived their child’s weight status. Overall, 62.3% of mothers accurately perceived their child’s weight. Mothers were more likely to underestimate the weight of children with overweight and obesity compared to normal weight children. Mothers underestimated the weight of close to 80% of children with overweight and 41.4% of children with obesity. Child weight status and age, and mother’s concern for child weight predicted the accurate perception of child weight. Compared to older children, younger children were less likely to have their mothers accurately perceive their weight (OR 0.28, CI 0.08, 0.98, P=0.05). Mothers who reported concern for their child’s weight were more likely to accurately perceive the weight of their child compared to mothers who were not concerned (OR 5.79, CI 2.17, 15.43, P=0.0004). Child physical activity level and mother’s level of acculturation were not significantly associated with accurately perceiving child weight. Abriendo Caminos: Clearing the Path to Hispanic Health (AC2) is a randomized-controlled, family-based program that seeks to prevent childhood obesity through the promotion of healthy lifestyle changes. The AC2 intervention consists of a 6-week workshop that focuses on healthy eating, family wellness, and physical activity. Aim 2 focuses on evaluating the impact of the AC2 nutrition education curriculum of improving child dietary behaviors 6 weeks after the intervention. AC2 is being implemented at five sites, but aim 2 will include data from Illinois, and California only. The researchers were interested in understanding how the perception and concern for child weight moderate the effects of the intervention on child dietary behaviors. However, this analysis was not possible due to small sample size and limited predictive power. Therefore, an additional objective of aim 2 was to examine the relationship between child dietary behaviors and mother’s perception and concern for child weight. Mothers reported their child’s frequency of consumption of sugar-sweetened beverages (SSBs), 100% fruit juice, fruit, vegetables, French fries, sweets, and salty snacks. Mothers also completed questionnaires about the perception and concern for child weight. Overall, AC2 improved child dietary behaviors among children in the intervention group by decreasing the consumption of SSBs (P=0.01), 100% fruit juice (P=0.009), and sweets (P=0.02) after 6 weeks. Surprisingly, we found that significant changes in dietary behaviors were only observed among girls and not boys by conducting a stratified analysis. We found that one dietary behavior was associated with mother’s perception and concern for child weight. Children who were perceived as overweight by their mothers consumed vegetables less frequently compared to children who were perceived as normal weight (P=0.01). Mothers who were concerned about their child’s weight had children who consumed vegetables less frequently compared to children whose mothers were not concerned (P=0.006). Family-based interventions that aim to address childhood obesity among Hispanic families need to consider the parents’ perceptions and concerns about their children’s weights because misperception of child weight is prevalent. Culturally-tailored educational tools can help health professionals facilitate discussions about child weight with parents and educate parents on the importance of healthy child weight. AC2, a culturally-tailored intervention, was successful in improving child dietary behaviors after 6 weeks. However, improvements in dietary behaviors were not observed among boys in the intervention. Investigating moderators and mediators of intervention effects, such as parent’s perception and concern for child weight, can support program adaptations to improve its effectiveness.
Issue Date:2019-04-25
Rights Information:Copyright 2019 Viridiana Luna
Date Available in IDEALS:2019-08-23
Date Deposited:2019-05

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