From childhood obesity risk to healthy growth in the U.S.: A 10-year social work research & policy update.

Childhood obesity is a major health issue and a prominent chronic health condition for children in the United States (U.S.), caused by a multitude of factors. Most existing models of childhood obesity prevention have not worked, yielding little to no effect on improving weight status or the proximal health behaviors most attributed to obesity risk: nutritional intake, physical activity, sedentary behaviors, and sleep. There is an urgent need for new approaches to prevent health disparities that are responsive to impacts of economic inequality on healthy child growth in marginalized populations. In this Short Commentary, a social justice update is provided to motivate a new generation of research that promotes equitable and healthy child growth under present-day social, economic, and political circumstances. Social work-specific research and policy recommendations are provided to guide future research that targets underlying social and economic determinants of weight-related health disparities in childhood. Recommendations include research on cross-disciplinary metrics to better capture reductions in health disparities and the development and testing of policy and system interventions that address structural issues and strengthen health resources in marginalized communities. Progress in reducing disparities in childhood obesity will likely remain inhibited until recommendations from social work research are incorporated to strengthen existing medical and public health models and redirect the childhood obesity epidemic toward equitable, healthy child growth.

Advancing shared accountability for meaningful community engagement with socially vulnerable communities: Lessons learned from COVID-19 health education and general outreach in an urban region.

As COVID-19 public health emergency measures come to an end, socially vulnerable communities have reduced access to resources that address social and health disparities created or exacerbated by the pandemic. Social workers must uphold access to healthcare as a human right in the post-pandemic era by reducing social vulnerability and strengthening community resilience to respond to future health emergencies and natural disasters. This paper draws on the experiences of a team of social work researchers, students, and practitioners engaged in efforts to disseminate information on COVID preventive measures and broker access to local health and social resources. This project, based in one of the fastest-growing metropolitan areas in the United States, formed part of the federal research response to promote community engagement in regions most disproportionately impacted by the COVID-19 pandemic. Through participation in health fairs and community events that targeted persons with limited access to healthcare resources, we gathered critical insights on how to build community capacity for meaningful community engagement. Drawing on a conceptual model for evaluating community engagement strategies, we describe three main barriers to collaborative community outreach: weak organizational communication and coordination, inconsistent strategies for requesting on-site health services, and low neighborhood awareness of outreach events. We advance strategies for improvement that engage community-based organizations, health systems, backbone organizations, and community members in targeted activities to build community resilience. This includes inter-organizational communication during outreach event planning, formal processes to promote greater use of mobile health services, centralized event communication, and grassroots outreach event promotion.

Alors que les mesures d'urgence de santé publique liées au COVID-19 prennent fin, les communautés socialement vulnérables ont un accès réduit aux ressources permettant de remédier aux disparités sociales et de la santé créées ou exacerbées par la pandémie. Les travailleurs sociaux doivent défendre l'accès aux soins de santé en tant que droit humain dans l'ère post-pandémique en réduisant la vulnérabilité sociale et en renforçant la résilience des communautés pour répondre aux futures urgences sanitaires et catastrophes naturelles. Cet article s'appuie sur les expériences d'une équipe de chercheurs, d'étudiants et de praticiens en travail social engagés dans des efforts visant à diffuser des informations sur les mesures préventives du COVID et à faciliter l'accès aux ressources santé et sociales locales. Ce projet, basé dans l'une des zones métropolitaines urbaines à la croissance la plus rapide des États-Unis, faisait partie de la réponse fédérale en matière de recherche visant à promouvoir l'engagement communautaire dans les régions les plus touchées de manière disproportionnée par la pandémie de COVID-19. Grâce à notre participation à des foires sur la santé et à des événements communautaires ciblant les personnes ayant un accès limité aux ressources de santé, nous avons recueilli des informations essentielles sur la manière de renforcer les capacités communautaires pour un engagement communautaire significatif. En nous appuyant sur un modèle conceptuel pour évaluer les stratégies d'engagement communautaire, nous décrivons trois principaux obstacles à la sensibilisation communautaire collaborative : une communication et une coordination organisationnelles faibles, des stratégies incohérentes pour demander des services de santé sur place et une faible sensibilisation du quartier aux événements de sensibilisation. Nous proposons des stratégies d'amélioration qui engagent les organisations communautaires, les systèmes de santé, les organisations de base et les membres de la communauté dans des activités ciblées visant à renforcer la résilience communautaire. Cela comprend la communication inter-organisationnelle lors de la planification des événements de sensibilisation, les processus formels visant à promouvoir une plus grande utilisation des services de santé mobiles, la communication centralisée des événements et la promotion des événements de sensibilisation au niveau local.

Impact of COVID social distancing measures on eating and exercise behaviors among a sample of Hispanic parents of young children in the United States.

Background: In the United States, healthy behaviors, such as eating fruits/vegetables and exercise, are well below recommended levels, particularly for Hispanics. The COVID pandemic may have exacerbated existing health behavior disparities. The current study examines the impact of COVID social distancing measures on Hispanic parents' eating and exercise behaviors, and how the impact may differ by socioeconomic status (SES) and distress levels. Design and methods: This cross-sectional logistic regression study utilized data from a sample of Hispanic parents in Texas (n = 237). COVID-related questions were collected in Summer 2020. Dependent variables included self-reported changes in exercise and eating behaviors due to the pandemic (i.e. got better or got worse). Primary independent variables included family-SES, neighborhood-SES, and distress due to COVID. Results: More than half (60%) of parents reported that their eating and exercise behaviors worsened. Results showed a significant relationship between distress due to COVID and both dependent variables; changes in eating (OR = 1.38, 95% CI [1.20, 1.58]) and changes in exercise (OR = 1.28, 95% CI [1.11, 1.48]). There were no observed differences by SES. Conclusions: Results suggest distress due to COVID was associated with worsening of eating and exercise behaviors, regardless of SES. The direction of the relationship between distress and healthy eating and exercise behaviors requires further attention.

A comparison of rural-urban differences in out-of-pocket expenses among older Mexicans with diabetes.

Objective: To compare total out-of-pocket expenses for physician visits and medications among older adults living with diabetes in Mexico from urban, semi-urban, and rural areas. Methods: The sample included 2,398 Mexicans aged 65 years and older with self-reported diabetes from the 2018 Mexican Health and Aging Study. Out-of-pocket expenses for physician visits and medications were regressed on locality, controlling for several factors. Results: The profile of those with higher out-of-pocket medication expenditures included rural localities, higher education, unmarried, depressive symptoms, participation in Seguro Popular, and lacking insurance. In the multivariate analysis, rural older adults with diabetes paid a higher amount in medication expenditures compared with other localities. Conclusion: Differences in locality are closely tied to the effective implementation of Seguro Popular. Although this program has improved access to care, participants have higher out-of-pocket expenditures for medications than those on employer-based plans across all localities. Among all groups, the uninsured bare the highest burden of expenditures, highlighting a continued need to address health inequities for the most underserved populations.

How Does Consistency of Food and Nutrition Support Effect Daily Food Consumption among Children Living in Poverty? Recession-Era Implications.

Underutilization of the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and the Supplemental Nutrition Assistance (SNAP) food safety net programs may compromise child nutritional benefits for families with limited incomes. Using a sample of children surveyed before (2003−2006) and after the Great Recession (2007−2009), we examine whether consistent access to WIC and SNAP during times of increased economic stress moderated the association between poverty level (i.e., income-needs ratio [INR]) and fruits and vegetables (FV) or foods high in saturated fats and added sugars (SFAS). Fragile Families and Child Wellbeing Study income-eligible mothers/children (≤185% of poverty) with available FV and SFAS data at the 5- (2003−2006) and 9-year (2007−2010) waves (n = 733) were included. Main effects of INR and interaction effects of consistency of WIC, SNAP, and dual WIC and SNAP support from birth through age 5 were examined. INR was associated with decreased FV consumption frequency from age 5 to 9, conditional upon consistency of dual WIC/SNAP enrollment. FV declined when there was low consistency (<1 year) of dual support. FV consumption was stable across INR when combined WIC/SNAP support lasted at least 2 years. Results can inform strategies for optimizing the nutritional impact of WIC and SNAP by focusing on those most at risk for underutilization of multiple benefits.

Socioeconomic Status and Childhood Obesity: a Review of Literature from the Past Decade to Inform Intervention Research.

PURPOSE OF REVIEW: This is a review of the patterns, conceptualization, and suggested mechanisms underlying the relationship of socioeconomic status (SES) to obesity in childhood and the implications of these data for interventions going forward. RECENT FINDINGS: Adiposity and SES are negatively associated in high-income countries and positively associated in medium to low-income countries. Several mechanisms, such as early introduction of solid food and parental behaviors, which may explain the association of SES and adiposity, have been identified. Parental education and adiposity and early pediatric nutrition appear to be particularly salient SES-related effectors on adiposity. There is a clear association of SES and adiposity which is affected by population affluence. Evaluation of the relationship of SES and obesity in children are complicated by the complexity of SES and lack of common definition. A number of SES-related interventional targets have been identified. Intervention research should ensure they are addressing SES-associated issues in the study population.

Associations between breastfeeding duration and overweight/obese among children aged 5-10: a focus on racial/ethnic disparities in California.

Research on the association between breastfeeding and childhood obesity and research on racial/ethnic differences in breastfeeding both show inconsistencies. The current study examines: 1) whether immigrant Hispanic women have higher rates of breastfeeding compared to non-Hispanic (three separate groups: African-American, Asian/Pacific Islander, and White) and U.S.-born Hispanic women; 2) whether children who were breastfed are less likely to be overweight/obese compared to children who were not breastfed; and 3) whether associations between breastfeeding and weight status vary by race/ethnicity/nativity. The study builds on prior literature using representative data from the Geographic Research On Wellbeing study (GROW, 2012-2013) and focusing on ages 5-10 years, an age group that has not been well studied (N = 2675 mother/child dyads). Logistic regression was used to investigate the odds of child obesity (≥95th%) and child overweight (≥85th%) in a series of models: unadjusted (each variable individually), demographic (child's sex, child's age, mother's age, mother's race/ethnicity, and mother's marital status), socioeconomic status (mother's education and family income), and full model (mother's BMI); with breastfeeding included in all models. Interactions between race/ethnicity and breastfeeding duration were also examined. African-American (9.54%) and white (32.8%) women had the lowest and highest rates of ever breastfeeding, respectively. White women breastfed the longest (M = 10.52 months, SE = 0.028) and U.S.-born Hispanic women breastfed the shortest (M = 7.05 months, SE = 0.41), on average. Children of African-American and U.S.-born Hispanic mothers had higher odds of being overweight/obese (74-75%) compared with children of white mothers. No associations were found between breastfeeding duration and child's weight status in adjusted models, nor was there a significant interaction between mother's race/ethnicity and breastfeeding duration on child's weight status; however, mother's own weight status was a significant driver of child's weight status and explained the racial/ethnic disparities. These results provide evidence in favor of there being no association between breastfeeding and childhood obesity.