Role of fathers in overweight prevention: an analysis of a Caribbean cohort

OBJECTIVE: To investigate the role of parental characteristics and maternal perceptions of ways fathers might influence risk of overweight in Caribbean infants. DESIGN AND METHODS: Data from participants in a three island parenting intervention study were analyzed. Maternal and paternal characteristics were obtained by questionnaire at enrolment (infant age 6-10 weeks). At 18 months, 501 infants (82.9% of cohort) had weight and length measured using standardized methods and body mass index (BMI-Z scores) calculated. Participants with Z scores ≥1 were classified as at risk of overweight. Multi-level logistic regression analyses were utilized to assess the effect of parents’ characteristics on the risk of infant overweight. Additionally data from 4 focus group discussions among mothers with infants (6 - 24 months) in Jamaica were used to explore how any effects might be mediated. RESULTS: Overall 20.6% of the children were classified as at risk of overweight. The father was present in 52% of households. Fathers’ presence and higher paternal occupation level were associated with reduced risk of overweight after controlling for maternal age, education, occupation, receptive vocabulary and SES score. The presence of the father in the home (OR[95% CI] =0.78 (0.62 - 0.99)) decreased the odds of overweight in these infants. From focus group discussions mothers reported that the majority of fathers encouraged breastfeeding, healthier meal choices and discouraged use of unhealthy snacks. CONCLUSION: More information on paternal characteristics should be collected in future studies of childhood obesity. Interventions to address childhood overweight should include fathers as part of the strategy.

Turn off the TV?: attitudes towards TV-viewing and childhood obesity in Jamaican mothers

OBJECTIVE: TV-viewing has been associated with childhood obesity and reducing screen time might help address this epidemic in Caribbean children. We explored the attitudes and beliefs of Jamaican mothers on the impact of television viewing on childhood obesity. DESIGN AND METHODS: Community health aides recruited mothers, 18 years and older with children aged 6-24 months, from four primary care clinics in Jamaica. Four focus group discussions (2 rural and 2 urban) were conducted using a semi-structured interview guide. Audio recordings and field notes from discussions were collected by field investigators. Transcripts were reviewed by study investigators and immersion/crystallization techniques were used to identify emerging themes. RESULTS: the mothers had a mean age of 28.26 ñ 6.25 years and 63% were unemployed. Parenting decisions were made based on instinct developed through experience, example and external input (friends, family, community and media) and information not consistent with this instinct was not readily accepted. Among the risk factors for obesity identified by mothers, TV-viewing was not perceived as important. The causal link between TV-viewing and obesity in young children was unclear to mothers. The perceived benefits from TV-viewing on their child’s development outweighed any potential harm and strong evidence would be required to convince them otherwise. CONCLUSION: Jamaican mothers may not easily accept obesity interventions that discourage TV-viewing. Incorporating evidence from credible sources, and interventions focused on healthy growth and development using examples of children developing optimally without the aid of TV, may overcome this perception.

Mamas voices, mamas choices: understanding maternal beliefs that drive decision making around feeding practices which influence childhood obesity

OBJECTIVE: To explore the beliefs shaping maternal decision-making around feeding practices in early childhood in a subset of Jamaican mothers from rural and urban communities. DESIGN AND METHODS: Focus group discussions guided by semi-qualitative questionnaires were conducted with thirty mothers of infants 6-24 months recruited from health clinics in 2 urban and 2 rural Jamaican communities. Data from discussions transcribed from audio recordings and field notes were categorized and interpreted using pre-set themes through an iterative process to identify emergent themes. Analysis was guided by the Theory of Reasoned Action embedded in the Socio-Ecological Perspective. RESULTS: Rural and urban mothers’ beliefs, and by extension their actions, were influenced by (a) their instincts, (b) their accepted knowledge (from personal and observed experience, credible professional input, and personal experimentation), (c) cultural norms (i.e. views of body weight/health relationship and visual perceptions of ‘healthy’); (d) input of experienced family members; and (e) their accepted concept of infants’ innate ability to express needs. Additionally, rural mothers’ beliefs were influenced by non-family social networks. For all mothers, the use of growth charts in portable health records and reliance on specific local television programs with health segments for health information was salient. The latter presents a unique tool for potentially building maternal confidence for healthy feeding practices. CONCLUSION: Early childhood food choices are predominantly dictated by parental belief-driven actions. Effective interventions targeting the impact of maternal feeding practices on childhood obesity should incorporate supportive, credible professional input, address how and what knowledge influences individual beliefs, increase community-wide knowledge, and target cultural norms.