Differences by race and ethnicity in the relationship between breastfeeding and obesity in preschool children.

OBJECTIVE: To test the hypothesis that the relationship between breastfeeding and later obesity would differ by race/ethnicity. DESIGN: Data were obtained from the Fragile Families and Child Wellbeing Study, a prospective birth cohort study. SETTING: Twenty large US cities in 15 states. PARTICIPANTS: The 2146 three-year-old children in the study were born between 1998 and 2000 and were either non-Hispanic White, non-Hispanic Black, or Hispanic (any MAIN OUTCOME MEASURES: Obesity was defined as having a BMI > or =95th percentile. RESULTS: Fifty-two percent of the children were ever breastfed and 18% were obese at 3 years of age. After adjustment for covariates (maternal BMI, smoking, age, relationship status, and education, plus the child's birth weight and the household income-to-poverty ratio), the relationship between breastfeeding and the prevalence of obesity was significantly different between White, Black, and Hispanic children (P = .02). The adjusted prevalence of obesity was lower in Hispanic children who were ever breastfed compared to those who were never breastfed (23.3% vs. 33.0%, P=.01), but there was no significant association between breastfeeding and obesity in either White or Black children (16.6% vs. 11.3%, P = .18 for Whites and 18.0% vs. 14.5%, P = .13 for Blacks). CONCLUSIONS: In this study we found that the relationship between breastfeeding and obesity differed by race/ethnicity. Future studies examining the relationship between breastfeeding and later adiposity should consider the possibility that this relationship may differ by race/ethnicity.

The association between maltreatment and obesity among preschool children.

OBJECTIVE: To determine whether child maltreatment is associated with obesity in preschool children. METHODS: Data were obtained from the Fragile Families and Child Wellbeing Study, a birth cohort study of 4898 children born between 1998 and 2000 in 20 large US cities. At 3 years of age, 2412 of these children had their height and weight measured, and mothers answered items on the Parent-Child Conflict Tactics Scales about three types of child maltreatment--neglect, corporal punishment, and psychological aggression. The frequency of each type of maltreatment behavior in the prior year was analyzed using categories--ever/never for neglect and quintiles for the other two types of maltreatment. Child obesity was defined as measured body mass index (kg/m(2)) > or =95th percentile. RESULTS: Eighteen percent of the children were obese, and the prevalence of any episode of neglect, corporal punishment, and psychological aggression was 11%, 84%, and 93%, respectively. The odds of obesity were increased in children who had experienced neglect (odds ratio 1.56, 95% confidence interval, 1.14-2.14), after controlling for the income and number of children in the household, the mothers' race/ethnicity, education, marital status, body mass index, prenatal smoking, and age, and the children's sex and birth weight. Neither the frequency of corporal punishment nor psychological aggression was associated with an increased risk of obesity. CONCLUSIONS: In a sample of preschool children from 20 large US cities, maternal self-report of neglectful behavior was associated with an increased risk of childhood obesity, after controlling for birth weight, maternal obesity, and multiple socioeconomic factors.

Breastfeeding, introduction of complementary foods, and adiposity at 5 y of age.

BACKGROUND: Although dual-energy X-ray absorptiometry (DXA) is considered the most accurate measure of adiposity in children, it has rarely been used to examine the relation between infant feeding and adiposity during childhood. OBJECTIVE: The objective was to ascertain whether adiposity at age 5 y was related to breastfeeding, to the timing of the introduction of complementary foods during infancy, or to both. DESIGN: Body composition was measured in 313 children at age 5 y by using DXA. Data on breastfeeding, formula feeding, and the timing of the introduction of complementary foods were obtained from the mothers when the children were 3 y old. Regression analysis was used to examine the relation between infant feeding and fat mass after adjustment for lean body mass, sex, birth weight, maternal obesity, race, and other sociodemographic variables. RESULTS: Fifty-three percent of the children were boys, 80% were white, and 20% were black. There was no significant difference in adjusted fat mass between those ever breastfed and those never breastfed (x +/- SE: 4.48 +/- 0.09 and 4.76 +/- 0.17 kg, respectively; P = 0.17). Children who were breastfed for a longer duration and those who were breastfed without concurrent formula feeding did not have significantly lower fat mass than did those children who were never breastfed. Children did not differ significantly in fat mass if they were introduced to complementary foods before or after 4 mo of age (4.49 +/- 0.12 and 4.63 +/- 0.12 kg, respectively; P = 0.42). CONCLUSION: Neither breastfeeding nor the timing of the introduction of complementary foods was associated with adiposity at age 5 y.

Maternal infant-feeding style and children's adiposity at 5 years of age.

OBJECTIVES: To examine the relationship between maternal infant-feeding style and adiposity in childhood and to determine whether feeding style explains any of the association between maternal obesity and childhood adiposity. DESIGN: Prospective cohort study. SETTING: Cincinnati metropolitan area. PARTICIPANTS: A total of 313 preschool children; 80% were white and 20% were black. MAIN OUTCOME MEASURES: Seven factors describing maternal infant-feeding style derived from the Infant Feeding Questionnaire administered at age 3 years; maternal obesity, defined as a body mass index of 30 or higher before pregnancy; and adiposity at 5 years of age as assessed by dual-energy x-ray absorptiometry. RESULTS: The mean +/- SD fat mass was 4.55 +/- 1.64 kg. Seventeen percent of the mothers were obese before pregnancy. Children whose mothers had high concern about the infant overeating or becoming overweight (the highest tertile of the "overeating" factor) had 0.67 kg (95% confidence interval, 0.31-1.03 kg) higher fat mass than children whose mothers did not have high concern (the other 2 tertiles). None of the other 6 feeding factors were related to childhood adiposity. Children of obese mothers had 0.54 kg (95% confidence interval, 0.10-0.98 kg) higher fat mass than children of nonobese mothers. High concern about the infant overeating, which was more common in obese mothers, accounted for 15% of this 0.54-kg difference. CONCLUSION: High maternal concern about an infant overeating or becoming overweight was associated with higher adiposity at 5 years of age and explained some of the association between maternal obesity and child adiposity.

Resurrecting free play in young children: looking beyond fitness and fatness to attention, affiliation, and affect.

We have observed that the nature and amount of free play in young children has changed. Our purpose in this article is to demonstrate why play, and particularly active, unstructured, outdoor play, needs to be restored in children's lives. We propose that efforts to increase physical activity in young children might be more successful if physical activity is promoted using different language-encouraging play-and if a different set of outcomes are emphasized-aspects of child well-being other than physical health. Because most physical activity in preschoolers is equivalent to gross motor play, we suggest that the term "play" be used to encourage movement in preschoolers. The benefits of play on children's social, emotional, and cognitive development are explored.

Parental report of outdoor playtime as a measure of physical activity in preschool-aged children.

BACKGROUND: Keeping young children physically active is an important strategy to promote their health and well-being. To our knowledge, survey measures of physical activity in preschool-aged children are unavailable. Time spent playing outdoors is a potential surrogate measure of physical activity in preschoolers, but parental-report measures of outdoor playtime have not been evaluated. OBJECTIVE: To compare a direct measure of physical activity in preschool-aged children with 2 parental-report measures of children's outdoor playtime. MAIN OUTCOME MEASURES: Three days of recording with a 3-dimensional accelerometer were used to directly measure physical activity in 250 preschool-aged children. We calculated each child's average vector magnitude per minute while awake. Parental report of outdoor playtime was measured in 2 ways: (1). the score from a checklist used to record outdoor playtime over 3 days and (2). a recall of the usual minutes of daily outdoor playtime during the prior month. We calculated Spearman rank correlation coefficients among these 3 measures. RESULTS: The mean age of the children was 44 months, 87.7% were white, and 12.3% were black. Parents reported that their children spent a mean (+/-SD) of 146 (+/-113) minutes playing outdoors each day. Physical activity as measured by the accelerometer was significantly correlated to the time spent playing outdoors, as measured by the checklist (r = 0.33, P <.001) and recall (r = 0.20, P =.003). CONCLUSION: Parental-report measures of outdoor playtime were significantly correlated to a direct measure of physical activity in preschool-aged children, and are worthy of future evaluation as a survey measure.

Association of maternal obesity and depressive symptoms with television-viewing time in low-income preschool children.

BACKGROUND: Decreasing television (TV)-viewing time may improve child health and well-being. These viewing patterns are shaped during the preschool years. Because mothers play an important role in determining how much TV their preschool children watch, a better understanding is needed of the maternal factors that influence children's TV viewing. OBJECTIVE: To examine the relationship of depressive symptoms and obesity in low-income mothers with TV-viewing time in their preschool children. METHODS: Cross-sectional, self-administered survey of 295 low-income mothers of 3- and 4-year-old children (92% white) enrolled in the Vermont Special Supplemental Nutrition Program for Women, Infants, and Children. Mothers reported children's usual weekday and weekend-day TV-viewing time. Maternal depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D). Maternal body mass index was calculated from self-reported height and weight measurements (weight in kilograms divided by height in meters squared). RESULTS: Children watched a mean of 2.2 +/-1.2 hours of TV per day. Those in the upper quartile of TV-viewing time (high TV viewers) watched 3 or more hours of TV per day. Of the mothers, 12% had both obesity (BMI > or =30) and depressive symptoms (CES-D score > or =16), 19% were obese only, and 18% had depressive symptoms only. Children were more likely to be high TV viewers if their mothers had clinically significant depressive symptoms (35% vs 23%; P =.03) or if their mothers were obese (35% vs 22%; P =.03). Forty-two percent of children were high TV viewers if the mother had both depressive symptoms and obesity, 30% if the mother had only depressive symptoms, 29% if the mother had only obesity, and 20% if the mother had neither depressive symptoms nor obesity (P =.06 overall; P for trend =.009 using the chi2 test). CONCLUSIONS: Among low-income preschool children, those whose mothers had either depressive symptoms or obesity were more likely to watch 3 or more hours of TV a day. Strategies to reduce TV viewing in young children should consider the role that maternal obesity and depressive symptoms may play in how preschool children spend their time.

Depressive symptoms in low-income mothers and emotional and social functioning in their preschool children.

OBJECTIVE: To determine which factors modify the relationship between maternal depressive symptoms and emotional and social functioning in low-income preschool children. METHODS: A cross-sectional, self-administered survey of 295 low-income (< or =185% poverty level) mothers of 3- and 4-year-old children. Both child emotional functioning and social functioning were measured with the Pediatric Quality of Life Inventory. Low emotional functioning and social functioning were defined as scores in the lowest tertile for each measure. Maternal depressive symptoms were measured by the Center for Epidemiologic Studies Depression Scale (CES-D). RESULTS: Of the children, 92% were white and 55% were boys. Of the mothers, 31% had clinically significant depressive symptoms (CES-D scores > or =16) and 30% were smokers. Among girls, the percentage with low emotional functioning was significantly higher in those whose mothers had clinically significant depressive symptoms than in those whose mothers did not (62% vs 27%, P <.001), but the same was not true among boys (36% vs 30%, P = NS). When mothers were smokers, the percentage of children with low social functioning was higher if mothers had clinically significant depressive symptoms (54% vs 29%, P =.02); however, this was not the case when mothers were nonsmokers (25% vs 28%, P =.69). Maternal education, marital status, and age did not modify the relationship between maternal depressive symptoms and child emotional or social functioning. CONCLUSIONS: Among low-income preschool children, both the sex of the child and the smoking status of the mother appear to influence the relationship between maternal depressive symptoms and children's emotional and social functioning.

Neighborhood safety, collective efficacy, and obesity in women with young children.

OBJECTIVE: To test the hypothesis that mothers of young children would have a higher prevalence of obesity if they lived in neighborhoods that they perceived as unsafe or as having a low level of collective efficacy. RESEARCH METHODS AND PROCEDURES: Using data from the Fragile Families and Child Wellbeing Study, a cross-sectional analysis was conducted of 2445 women living in 20 large (population > or = 200,000) U.S. cities. BMI was measured on 72% and self-reported on 28%. Perception of neighborhood safety was assessed with the Neighborhood Environment for Children Rating Scales. The collective efficacy measure was adapted from the Project on Human Development in Chicago Neighborhoods. RESULTS: Thirty percent of the women were married, 38% lived below the U.S. poverty threshold, and 66% reported no education beyond high school. Approximately one-half of the women were non-Hispanic black, and one-fourth were Hispanic (any race). After adjustment for sociodemographic factors (household income, education, race/ethnicity, age, and marital status), smoking, depression, and television time, the prevalence of obesity (BMI > or = 30 kg/m2) increased across tertiles of neighborhood safety from safest to least safe (37% vs. 41% vs. 46%, p = 0.004) but did not differ across tertiles of collective efficacy from highest to lowest (41% vs. 40% vs. 42%, p = 0.67). DISCUSSION: In a national sample of women with young children, obesity was more prevalent among those who perceived their neighborhoods to be unsafe.

Measuring Physical Environments of Parks and Playgrounds: EAPRS Instrument Development and Inter-Rater Reliability.

BACKGROUND: Reliable and comprehensive measurement of physical activity settings is needed to examine environment-behavior relations. METHODS: Surveyed park professionals (n = 34) and users (n = 29) identified park and playground elements (e.g., trail) and qualities (e.g., condition). Responses guided observational instrument development for environmental assessment of public recreation spaces (EAPRS). Item inter-rater reliability was evaluated following observations in 92 parks and playgrounds. Instrument revision and further reliability testing were conducted with observations in 21 parks and 20 playgrounds. RESULTS: EAPRS evaluates trail/path, specific use (e.g., picnic), water-related, amenity (e.g., benches), and play elements, and their qualities. Most EAPRS items had good-excellent reliability, particularly presence/number items. Reliability improved from the original (n = 1088 items) to revised (n = 646 items) instrument for condition, coverage/shade, and openness/visibility items. Reliability was especially good for play features, but cleanliness items were generally unreliable. CONCLUSIONS: The EAPRS instrument provides comprehensive assessment of parks' and playgrounds' physical environment, with generally high reliability.

A national study of neighborhood safety, outdoor play, television viewing, and obesity in preschool children.

OBJECTIVE: To test the hypothesis that preschool children have a higher prevalence of obesity, spend less time playing outdoors, and spend more time watching television (TV) when they live in neighborhoods that their mothers perceive as unsafe. METHODS: In a cross-sectional survey in 20 large US cities, mothers reported the average daily time of outdoor play and TV viewing for their 3-year-old children, and the children's BMI was measured. Maternal perception of neighborhood safety was assessed with the Neighborhood Environment for Children Rating Scales; the scale score was used to divide children into tertiles of neighborhood safety. RESULTS: Of the 3141 children studied, 35% lived in households with incomes below the US poverty threshold. After adjustment for sociodemographic factors (household income and mothers' education, race/ethnicity, age, and marital status), obesity prevalence (BMI > or =95th percentile) did not differ in children from the least safe to the safest neighborhood safety tertile (18% vs 17% vs 20%) or in weekday (160 vs 151 vs 156 minutes/day) or weekend (233 vs 222 vs 222 minutes/day) outdoor play time. Children who lived in neighborhoods that were perceived by their mothers as the least safe watched more TV (201 vs 182 vs 185 minutes/day) and were more likely to watch >2 hours/day (66% vs 60% vs 62%). TV viewing and outdoor play minutes were not significantly correlated to each other or to BMI. CONCLUSIONS: In a national sample of preschool children, mothers' perception of neighborhood safety was related to their children's TV viewing time but not to their outdoor play time or risk for obesity.

Neighborhood playgrounds, fast food restaurants, and crime: relationships to overweight in low-income preschool children.

BACKGROUND: We examined the relationship between overweight in preschool children and three environmental factors--the proximity of the children's residences to playgrounds and to fast food restaurants and the safety of the children's neighborhoods. We hypothesized that children who lived farther from playgrounds, closer to fast food restaurants, and in unsafe neighborhoods were more likely to be overweight. METHODS: This was a cross-sectional study of 7,020 low-income children, 36 through 59 months of age living in Cincinnati, OH. Overweight was defined as a measured body mass index > or =95th percentile. The distance between each child's residence and the nearest public playground and fast food restaurant was determined with geographic information systems. Neighborhood safety was defined by the number of police-reported crimes per 1,000 residents per year in each of 46 city neighborhoods. RESULTS: Overall, 9.2% of the children were overweight, 76% black, and 23% white. The mean (+/- SD) distances from a child's home to the nearest playground and fast food restaurant were 0.31 (+/- 0.22) and 0.70 (+/- 0.38) miles, respectively. There was no association between child overweight and proximity to playgrounds, proximity to fast food restaurants, or level of neighborhood crime. The association between child overweight and playground proximity did not differ by neighborhood crime level. CONCLUSIONS: Within a population of urban low-income preschoolers, overweight was not associated with proximity to playgrounds and fast food restaurants or with the level of neighborhood crime.