Families in Context: Food Insecurity Among Hispanic Immigrant and Nonimmigrant Households With Children.

Using restricted, geo-coded Early Childhood Longitudinal Study, Kindergarten Class of 2010-2011 data (N = 2700) linked with 3 sources of contextual data, we examine whether a comprehensive set of individual, household, and county-level characteristics explains disparities in household food insecurity between Hispanic children of foreign- and US-born parents. Adjusting for individual, household, and county-level characteristics does not eliminate the higher odds of household food insecurity among Hispanic children in immigrant families, especially of Mexican origin. Moreover, growth in the noncitizen population at the county level is associated with food insecurity among Hispanic families, though the impact differs by parental nativity.

Social Cohesion and Food Insecurity: Insights from the Geographic Research on Wellbeing (GROW) Study.

Objectives Food insecurity in the United States is a stubborn public health issue, affecting more than one in five households with children and disproportionately impacting racial and ethnic minority women and their children. Past research and policy has focused on household predictors of food insecurity, but neglected broader factors, such as perceived neighborhood social cohesion, that might protect those most vulnerable to food insecurity. Methods We use a racially and ethnically diverse data set from the Geographic Research on Wellbeing study (N = 2847) of women and their young children in California to investigate whether social cohesion influences food insecurity and whether it moderates the relationship between race/ethnicity and food insecurity. Results We find that lower levels of perceived residential neighborhood social cohesion associate with higher odds of food insecurity even after considering important household socioeconomic factors. In addition, our results suggest that social cohesion is most relevant for reducing the risk of food insecurity among racial and ethnic minority mothers. For example, the probability of food insecurity for immigrant Latina mothers is nearly 0.40 in neighborhoods where mothers perceive little to no cohesion and less than 0.10 in neighborhoods where mothers perceive high cohesion. Conclusions for Practice Higher levels of neighborhood perceived social cohesion are protective against food insecurity in households with children and especially so for racial and ethnic minority households who are at a heightened risk of food insecurity. Supporting programs that focus on building closer knit communities may be a key to reducing food insecurity overall and for reducing disparities in food insecurity by race and ethnicity.

Sedentary behavior, body mass index, and weight loss maintenance among African American women.

OBJECTIVES: Relationships among sedentary behavior, weight gain, and weight loss and regain are understudied particularly for African Americans, a high risk group for obesity. The hypotheses were: sedentary behavior is positively associated with current body mass and % of weight loss maintained after initial weight loss; these associations differ by physical activity status. DESIGN: Cross-sectional. SETTING: National survey. PATIENTS OR PARTICIPANTS: 1,110 African American women. INTERVENTIONS: Observational study. MAIN OUTCOME MEASURES: A cross-sectional survey was administered to African Americans who had intentionally lost 10% of their body weight. Those who lost weight and maintained at least a 10% weight loss for a year were classified as weight loss maintainers; all others were classified as weight loss re-gainers. Participants were classified into one of four categories based on low and high levels of sedentary behavior and physical activity. The high physical activity, low sedentary behavior category was the reference group. Sociodemographic characteristics and health conditions were covariates. Data were collected in 2009 and analyzed in 2013. RESULTS: Each additional daily hour of sedentary time was associated with an increase in BMI (P<.001) and poorer weight loss maintenance (P<.01). Regardless of sedentary behavior, low physically active participants had BMIs that were greater (P<.001) compared to the reference group. Sedentary behavior had an independent effect on BMI and % of weight loss maintained for high but not low physically active participants. CONCLUSIONS: High levels of sedentary behavior were associated with poorer weight-loss maintenance among African American women even for those with high levels of physical activity. The implications of this study are that physical activity and sedentary behavior, independently and combined, are associated with BMI and weight-loss maintenance.

Community social environments and cigarette smoking.

Cigarette smoking remains a primary contributor to health disparities in the United States, and significant evidence suggests that smoking behavior is socially influenced. Though residential neighborhoods are important for health disparities, recent evidence suggests that people spend the majority of their waking time away from the residential neighborhood. We advance research on neighborhoods and smoking by using individual, neighborhood, and activity space data for adults in the Los Angeles Family and Neighborhood Survey (L.A.FANS). Moving beyond socioeconomic indicators of neighborhoods, we investigate the ways in which residential neighborhood social cohesion, neighborly exchange, and perceived danger impact smoking behavior after accounting for confounding factors in both the residential neighborhood and other activity spaces in which adults spend their days. We find that perceptions of danger in the residential neighborhood is robustly associated with the likelihood of smoking cigarettes. Further, measures of community social organization interact with perceived danger to influence smoking behavior. Adults with high levels of perceived danger are twice as likely to smoke if residing in communities with lower levels of social organization in the form of helpful, trusting, and supportive relationships. Understanding how the social organization of communities contributes to smoking disparities is important for curbing smoking's impact on population health.

Neighborhood social environments, healthy resources, and adult diabetes: Accounting for activity space exposures.

This study broadens contextual environments to include adults' activity spaces-inside and outside the residential neighborhood-to examine how contextual exposures shape type 2 diabetes risk. We use novel longitudinal data from the Los Angeles Family and Neighborhood Survey, construct time-weighted exposure measures of adults' social-structural and healthy resource environments, and execute random effects logistic models predicting the probability of being diabetic. Results indicate that residential and activity space exposures are independently associated with adult diabetes, and that residential and activity space healthy resources combine to influence diabetes risk in synergistic ways. Living in more socioeconomically advantaged neighborhoods reduces diabetes risk, particularly when spending time in activity spaces with greater access to recreational facilities. Moreover, healthier activity space environments may compensate for living in neighborhoods devoid of healthy food options to lessen diabetes risk. Adopting an activity space framework can inform multilevel interventions aimed at alleviating type 2 diabetes and other chronic ailments.

Food insecurity in households with young children: A test of contextual congruence.

Household food insecurity, an inability to provide adequate nutrition for a healthy, active lifestyle, affects nearly 1 in 7 households with children in the United States. Though rates of food insecurity declined to pre-recession levels just prior to the COVID-19 pandemic, they are now once again increasing. As a result, in one of the wealthiest countries in the world, millions of young children continue to grow up in households that struggle daily with a problem that is often associated with the developing world. The result is both immediate and long-term health and development deficits for children. We propose that the degree of demographic and socioeconomic congruence between the households of young children and their neighborhood of residence lends unique insights to food insecurity. We examine this using the ECLS-K 2010-2011 for children in families with incomes below 400 percent of the federal poverty line (N = 8600). Results show that congruence between household and neighborhood education and race/ethnicity associates with the likelihood of experiencing food insecurity. For example, households with non-Hispanic black children living in neighborhoods with high proportions of non-Hispanic blacks have significantly lower probabilities of food insecurity than similar households living in neighborhoods with smaller black populations. Similarly, more highly educated families experience lower probability of food insecurity in high education neighborhoods than when they reside in low education neighborhoods. Focusing on neighborhood risk factors as absolute and independent contributors limits our understanding of how families experience food insecurity as well as any policy efforts to address it.

Racial and ethnic differentials in overweight and obesity among 3-year-old children.

OBJECTIVES: We estimated racial/ethnic differences in overweight and obesity in a national sample of 3-year-olds from urban, low-income families and assessed possible determinants of differences. METHODS: Survey, in-home observation, and interview data were collected at birth, 1 year, and 3 years. We used logistic regression analyses and adjusted for a range of covariates in examining overweight and obesity differentials according to race/ethnicity. RESULTS: Thirty-five percent of the study children were overweight or obese. Hispanic children were twice as likely as either Black or White children to be overweight or obese. Although we controlled for a wide variety of characteristics, we were unable to explain either White-Hispanic or Black-Hispanic differences in overweight and obesity. However, birthweight, taking a bottle to bed, and mother's weight status were important predictors of children's overweight or obesity at age 3 years. CONCLUSIONS: Children's problems with overweight and obesity begin as early as age 3, and Hispanic children and those with obese mothers are especially at risk.

Home and away: Area socioeconomic disadvantage and obesity risk.

Although residential context is linked to obesity risk, less is known about how the additional places where we work, shop, play, and worship may influence that risk. We employ longitudinal data from the Los Angeles Family and Neighborhood Survey (LAFANS) to derive time-weighted measures of exposure to home and activity space contexts to ascertain the impacts of each on obesity risk for adults. Results show that increased exposure to socioeconomic disadvantage in the residential neighborhood significantly increases obesity risk, and although activity space disadvantage does not directly influence obesity, it reduces the association between residential disadvantage and obesity. We further explore the ways in which residential and activity space disadvantages may interact to influence obesity and discuss the value of integrating personal exposure and activity space contexts to better understand how places contribute to individual health risks.

Does neighborhood social and environmental context impact race/ethnic disparities in childhood asthma?

Utilizing over 140,000 geocoded medical records for a diverse sample of children ages 2-12 living in Houston, Texas, we examine whether a comprehensive set of neighborhood social and environmental characteristics explain racial and ethnic disparities in childhood asthma. Adjusting for all individual risk factors, as well as neighborhood concentrated disadvantage, particulate matter, ozone concentration, and race/ethnic composition, reduced but did not fully attenuate the higher odds of asthma diagnosis among black (OR=2.59, 95% CI=2.39, 2.80), Hispanic (OR=1.22, 95% CI=1.14, 1.32) and Asian (OR=1.18, 95% CI=1.04, 1.33) children relative to whites.

Physical Activity Disparities Between US-born and Immigrant Children by Maternal Region of Origin.

We examined and compared patterns in physical activity participation for children of US-born and immigrant mothers from seven world geographic regions, and tested whether the physical activity differences were attenuated by socioeconomic status or maternal language proficiency. Using the Early Childhood Longitudinal Study-Kindergarten data (N = 18,850) we utilized logistic regression to predict adequate vigorous physical activity and participation in group and individual sports for kindergarten children. US-born children of US-born parents have significantly higher rates of physical activity compared to immigrant children. Children of Mexican, Southeast Asian, and Caribbean immigrants were especially unlikely to participate in sports. These disparities were not significantly attenuated by socioeconomic status, but accounting for language proficiency reduced some differences between the US-born and immigrant children, particularly for group sports participation. Researchers interested in improving the physical activity patterns of second-generation children should consider the relevance of language barriers in promoting healthy living.

Transitions Into Food Insecurity Associated With Behavioral Problems And Worse Overall Health Among Children.

Children living in food-insecure households face myriad challenges to their well-being. The Great Recession of December 2007-June 2009 increased food insecurity to the highest levels ever measured in the United States. Using nationally representative data from the period 2010-12 for 6,300 children in the Early Childhood Longitudinal Study, Kindergarten Class of 2010-11, with household incomes below 300 percent of the federal poverty level and a dynamic measure of food insecurity transitions, we assessed the impact of transitions into and out of household food insecurity on the academic achievement, behavioral problems, and health status of young children. We found negligible impacts of food insecurity transitions on academic achievement in first grade. However, we found consistent negative impacts of the transitions on teachers' reports of children's externalizing behaviors, self-control, and interpersonal skills and on parents' reports of children's overall health status. Taken together, our findings underline the importance of food security for children's healthy development.

Neighborhood context and immigrant children's physical activity.

Physical activity is an important determinant of obesity and overall health for children, but significant race/ethnic and nativity disparities exist in the amount of physical activity that children receive, with immigrant children particularly at risk for low levels of physical activity. In this paper, we examine and compare patterns in physical activity levels for young children of U.S.-born and immigrant mothers from seven race/ethnic and nativity groups, and test whether physical activity is associated with subjective (parent-reported) and objective (U.S. Census) neighborhood measures. The neighborhood measures include parental-reported perceptions of safety and physical and social disorder and objectively defined neighborhood socioeconomic disadvantage and immigrant concentration. Using restricted, geo-coded Early Childhood Longitudinal Study-Kindergarten (ECLS-K) data (N = 17,510) from 1998 to 1999 linked with U.S. Census 2000 data for the children's neighborhoods, we utilize zero-inflated Poisson (ZIP) models to predict the odds of physical inactivity and expected days of physical activity for kindergarten-aged children. Across both outcomes, foreign-born children have lower levels of physical activity compared to U.S.-born white children. This disparity is not attenuated by a child's socioeconomic, family, or neighborhood characteristics. Physical and social disorder is associated with higher odds of physical inactivity, while perceptions of neighborhood safety are associated with increased expected days of physical activity, but not with inactivity. Immigrant concentration is negatively associated with both physical activity outcomes, but its impact on the probability of physical inactivity differs by the child's race/ethnic and nativity group, such that it is particularly detrimental for U.S.-born white children's physical activity. Research interested in improving the physical activity patterns of minority and second-generation immigrant children should consider how neighborhood context differentially impacts the health and physical activity of children from various racial, ethnic and nativity backgrounds.

The association between acculturation and health insurance coverage for immigrant children from socioeconomically disadvantaged regions of origin.

Among immigrant children whose parents have historically had lower education, the study explored which immigrant children were most likely to have coverage based on maternal region of origin. The direct and indirect relationship of acculturation on immigrant children's coverage was also assessed. A subsample of US-born children with foreign-born mothers from the Early Childhood Longitudinal Survey-Kindergarten Cohort was analyzed using multinomial logistic regressions (n = 1,686). Children whose mothers emigrated from the Caribbean or Indochina had greater odds of being insured compared to children whose mothers emigrated from Mexico. Moreover, Latin American children did not statistically differ from Mexican children in being uninsured. Maternal citizenship was positively associated with children's coverage; while living in a household with a mother who migrated as a child was negatively associated with private insurance. To increase immigrant children's coverage, Latin American and Mexican families may benefit from additional financial assistance, rather than cultural assistance.

Neighborhood context and racial/ethnic differences in young children's obesity: structural barriers to interventions.

Numerous studies in the last ten years have investigated racial/ethnic disparities in obesity for young children. Increasing attention is paid to the influence of neighborhood environments - social and physical-on a variety of young children's health outcomes. This work identifies resource-based and community-based mechanisms that impede on the maintenance of healthy weights for young children in socioeconomically depressed areas, and shows consistently higher rates of obesity in more deprived areas. None of this work, however, has explored whether area deprivation or the race/nativity composition of neighborhoods contributes to racial/ethnic disparities in young children's obesity. Utilizing restricted geo-coded data from the Early Childhood Longitudinal Study (Kindergarten) (N = 17,540), we utilize multilevel logistic regression models to show that neighborhood level measures do little to explain racial and ethnic differences in childhood obesity. However, living in neighborhoods with higher levels of poverty, lower levels of education, and a higher proportion of black residents is associated with increased child obesity risk after considering a host of relevant individual level factors. In addition, living in neighborhoods with a higher proportion of foreign-born residents is associated with reduced child obesity risk. Although well-intentioned childhood obesity intervention programs aimed at changing individual-level behaviors are important, our results highlight the importance of considering neighborhood structural factors for child obesity prevention.

Neighborhood Poverty and Maternal Fears of Children's Outdoor Play.

Investigating children's outdoor play unites scholarship on neighborhoods, parental perceptions of safety, and children's health. Utilizing the Fragile Families and Child Well-being Study (N=3,448), we examine mothers' fear of their five-year-old children playing outdoors, testing associations with neighborhood social characteristics, city-level crime rates, maternal mental health, and social support. Living in public housing, perceptions of low neighborhood collective efficacy, and living in a Census tract with a higher proportion of Blacks and households in poverty are associated with higher odds of maternal fear, but crime rates are not a significant predictor of fear. We also demonstrate that not being depressed - but not social support or collective efficacy - buffers the influence of neighborhood poverty on maternal fears of outdoor play.

Young children in urban areas: links among neighborhood characteristics, weight status, outdoor play, and television watching.

Although research consistently demonstrates a link between residential context and physical activity for adults and adolescents, less is known about young children's physical activity. Using data from the U.S. Fragile Families and Child Wellbeing Study (N=1822, 51% male), we explored whether outdoor play and television watching were associated with children's body mass indexes (BMIs) at age five using OLS regression models, controlling for a wide array of potential confounders, including maternal BMI. We also tested whether subjective and objective neighborhood measures - socioeconomic status (from U.S. Census tract data), type of dwelling, perceived collective efficacy, and interviewer-assessed physical disorder of the immediate environment outside the home - were associated with children's activities, using negative binomial regression models. Overall, 19% of the sample were overweight (between the 85th and 95th percentiles), and 16% were obese (≥ 95th percentile). Hours of outdoor play were negatively associated with BMI, and hours of television were positively associated with BMI. Moreover, a ratio of outdoor play to television time was a significant predictor of BMI. Higher maternal perceptions of neighborhood collective efficacy were associated with more hours of outdoor play, fewer hours of television viewing, and more trips to a park or playground. In addition, we found that neighborhood physical disorder was associated with both more outdoor play and more television watching. Finally, contrary to expectations, we found that children living in public housing had significantly more hours of outdoor play and watched more television, than other children. We hypothesize that poorer children may have more unstructured time, which they fill with television time but also with outdoor play time; and that children in public housing may be likely to have access to play areas on the grounds of their housing facilities.

Federal food policy and childhood obesity: a solution or part of the problem?

Amid growing concern about childhood obesity, the United States spends billions of dollars on food assistance: providing meals and subsidizing food purchases. We examine the relationship between food assistance and body mass index (BMI) for young, low-income children, who are a primary target population for federal food programs and for efforts to prevent childhood obesity. Our findings indicate that food assistance may unintentionally contribute to the childhood obesity problem in cities with high food prices. We also find that subsidized meals at school or day care are beneficial for children's weight status, and we argue that expanding access to subsidized meals may be the most effective tool to use in combating obesity in poor children.

The Influence of Acculturation on Breastfeeding Initiation and Duration for Mexican-Americans.

This paper uses data from the Fragile Families and Child Wellbeing Study to test the hypotheses that (1) Similar to other positive pre- and post-natal outcomes, Mexican immigrant mothers are more likely to breastfeed, and to breastfeed longer, than white or Mexican-American mothers; and (2) Acculturation accounts for the ethnic/nativity differential in breastfeeding initiation and duration. The results support both hypotheses. Mexican immigrants to the U.S. are much more likely than whites to breastfeed, and to breastfeed longer. Mexican-American mothers, after controlling for background characteristics, have similar initiation and duration to whites. Using expanded acculturation measures developed for this paper, acculturation accounts for some of the difference between whites and Mexican immigrants in breastfeeding initiation, and much of the difference for breastfeeding duration. The results suggest that low levels of acculturation operate to protect Mexican immigrants from choosing to formula-feed, which gives their babies many health advantages, and may be associated with better health outcomes across the life course. The results also suggest that successive generations of Mexican immigrants may abandon breastfeeding, which is deleterious for their infants.

Race, ethnicity, and the education gradient in health.

Using pooled data from the 2000-2006 National Health Interview Survey, we document how the relationship between education and a broad range of health measures varies by race/ethnicity and nativity. We found that education is a more powerful determinant of health behaviors and outcomes for some groups than it is for others. In addition, the education differentials for foreign-born groups are typically more modest than those for corresponding native-born populations. We also show how the education-health relationship varies across Hispanic and Asian subgroups. We argue that any intervention for eliminating health disparities must take these patterns into account.

On-the-job moms: work and breastfeeding initiation and duration for a sample of low-income women.

OBJECTIVES: As both employed and breastfeeding mothers increase, more women are facing the decision of whether and how to combine the behaviors. This paper examines three hypotheses for a sample of low-income women: 1) Mothers who expect to return to work after the birth of their baby will be less likely to initiate breastfeeding; 2) The timing of the return to work and quitting breastfeeding will coincide; 3) Mothers in professional jobs and Stay-at-Home (SAH) Moms will breastfeed for longer durations than mothers with other types of jobs. METHODS: The Fragile Families and Child Wellbeing Study, a sample of mostly low-income, unmarried U.S. mothers, offers a unique opportunity to study this issue, as there is reason to believe that employment may impact breastfeeding differently for low-income women. Logistic regression determines the relationship between the expectation of work and breastfeeding initiation, and discrete-time logit models examine breastfeeding duration, the timing of the return to work, and occupation type. RESULTS: Expecting to work in the year after the baby's birth does not impact breastfeeding initiation. The timing of quitting breastfeeding and the return to work are closely and powerfully linked, and mothers in administrative and manual positions quit earlier than other women. Interestingly, women in service occupations do not differ in breastfeeding duration from SAH mothers or professionals. CONCLUSIONS: This research demonstrates that low-income women are having difficulty combining work and breastfeeding, which has important health implications for their infants, and that women working in administrative and manual occupations may face special constraints.