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Purpose Parents play a critical decision-making role in vaccinating their children against human papillomavirus (HPV), and mothers, in particular, are key stakeholders as they are often the parent taking their children to healthcare visits. Given the importance of the HPV vaccination as a cancer prevention strategy, this study was designed to explore Latinx mothers’ suggested strategies to promote vaccine uptake among Latinx parents. Setting and Participants Community-based in Massachusetts, United States, and Latinx mothers. Design and Methods Descriptive qualitative research employing individual semi-structured interviews. Data were analyzed using a hybrid method of thematic analysis incorporating deductive and inductive approaches. Results Twenty-two, majority foreign-born (91%) Latinx mothers of adolescent girls (∼60%) and boys (∼40%) aged 11–19 years participated. Mothers suggested several strategies to promote uptake of the HPV vaccine among Latinx families including healthcare providers’ increased communication and anticipatory guidance addressing factors influencing parents’ HPV vaccination hesitancy, and improved community-wide dissemination of culturally and linguistically relevant information targeting not only parents of age-eligible participants but the broader community. Finally, mothers suggested the use of social media using personal narratives and an enhanced active role of schools in providing accurate information to raise awareness and educate adolescents and parents about the importance of HPV vaccination. Conclusion Findings are relevant to the development of tailored interventions to meet the needs of Latinx populations, and ultimately increase Latinx children’s HPV vaccination rates.

This descriptive qualitative study explored Latinx fathers' awareness, knowledge, and acceptability of the human papillomavirus (HPV) vaccine for their adolescent children. Data were collected through individual, semi-structured interviews and analysed using a hybrid method of thematic analysis that incorporated deductive and inductive approaches. Nineteen, majority foreign-born Latinx fathers participated. Four main themes and two subthemes emerged from the analyses. Results found fathers' low awareness and knowledge of HPV and the HPV vaccine. Results also identified fathers' positive attitudes toward vaccines in general. Moreover, results revealed fathers trust in healthcare providers and high willingness to vaccinate their children against HPV if recommended by their child's primary healthcare provider. Findings indicate the need for increased efforts to raise awareness and knowledge among Latinx fathers of HPV and the HPV vaccine. Given the limited research focused on Latinx fathers, the study's findings are valuable in building a knowledge foundation for developing future studies and interventions to promote the HPV vaccine targeting Latinx fathers living in the United States. Future research should quantify Latinx fathers' awareness, knowledge, and acceptability of the HPV vaccine for their sons and daughters and assess fathers' role in the decision-making process to vaccinate their children against HPV.

Objective:The objective of this study was to assess sources of information about gestational weight gain (GWG), diet and exercise among first-time pregnant Brazilian women in the USA.Design:Cross-sectional survey.Setting:Massachusetts, USA.Participants:First-time pregnant Brazilian women.Results:Eighty-six women, the majority of whom were immigrants (96·5 %) classified as having low acculturation levels (68 %), participated in the study. Approximately two-thirds of respondents had sought information about GWG (72·1 %), diet (79·1 %) and exercise (74·4 %) via the internet. Women classified as having low acculturation levels were more likely to seek information about GWG via the internet (OR = 7·55; 95 % CI 1·41, 40·26) than those with high acculturation levels after adjusting for age and receiving information about GWG from healthcare provider (doctor or midwife). Moreover, many respondents reported seeking information about GWG (67 %), diet (71 %) and exercise (52 %) from family and friends. Women who self-identified as being overweight pre-pregnancy were less likely to seek information about diet (OR = 0·32; 95 % CI 0·11, 0·93) and exercise (OR = 0·33; 95 % CI 0·11, 0·96) from family and friends than those who self-identified being normal-weight pre-pregnancy.Conclusions:This is the first study to assess sources of information about GWG, diet and exercise among pregnant Brazilian immigrants in the USA. Findings have implications for the design of interventions and suggest the potential of mHealth intervention as low-cost, easy access option for delivering culturally and linguistically tailored evidence-based information about GWG incorporating behavioural change practices to this growing immigrant group.

Latinos are the largest minority population group in the United States, and Latino children currently account for one fourth of U.S. children under age 18. Family is a core value in the Latino culture, and fathers play a central role within the family, including making decisions that influence their children’s health. Nonetheless, Latino fathers are often underrepresented in child health research. This study was designed to describe effective strategies to recruit Latino fathers into five child health research studies. Using a data recruitment log, we collected quantitative and qualitative data on recruitment strategies used to reach and enroll Latino fathers into five child health research studies from 2016 to 2020. Methods classified as direct recruitment strategies involved interaction between potential participants with research staff, whereas indirect methods involved no interaction with research staff and potential participants. In total 113 Latino fathers, majority low-income, immigrant, participated in the studies. Direct recruitment methods in combination with snowball sampling were the most successful strategies for recruiting Latino fathers, contributing to approximately 96% ( n = 107) of the total participants. Indirect methods were much less effective, with social media contributing to only 3.6% ( n = 4) of total participants. Not a single participant was recruited through printed materials (e.g., flyers posted or distributed). Furthermore, qualitative findings revealed the importance of culturally and linguistically relevant approaches in efforts to recruit and enroll Latino fathers. Future research should consider directly asking Latino fathers’ preferences for recruitment and participation in child health research.

Genital human papillomavirus (HPV) is the most common sexually transmitted virus in the United States and etiologically linked to several types of cancers including the cervix, vulva, vagina, penis, anus, and oropharynges. Evidence indicates certain types of HPV-associated cancers disproportionally affect Latinos in the United States. This qualitative study sought to explore Latina mothers' perceptions and understanding of HPV infection, HPV-associated cancers, and the HPV vaccination for their adolescent sons and daughters. Twenty-two individual, face-to-face interviews were conducted in 2018-2019 with mothers who had at least one child between the ages of 11 and 19 years. Data were analyzed using a hybrid method of thematic analysis that incorporated deductive and inductive approaches. Two major themes emerged from the analysis: (1) mothers' (mis) understanding about HPV infection transmission and HPV-associated cancer risk for girls and boys, and (2) mothers' (mis) understandings about the HPV vaccination for girls and boys. Results found that most mothers had inadequate understanding of HPV transmission, HPV-associated cancer risk for males, and need to vaccinate boys against the virus for their own personal health and prevention of HPV-associated cancers. Findings suggest that interventions should focus on improving Latina mothers' understanding of HPV transmission, addressing the lack or inadequate knowledge about HPV-associated cancer risk for males, as well as misconceptions about the importance of the HPV vaccination for males for their personal health and the prevention of HPV-associated cancers. Future research should quantify Latino parents' awareness, knowledge, and acceptability of the HPV vaccine for their sons and daughters.

This formative research used a cross-sectional survey to assess interest in informational content and intervention modalities for the design of an early childhood obesity prevention intervention for Central American families from the Northern Triangle countries (El Salvador, Guatemala, and Honduras) living in the United States. A total of 74 parents (36 mothers, 38 fathers) with a mean age of 31.6 years (SD = 5.6) completed the survey; 59.5% of whom were born outside of the United States. Although most parents reported being very interested in receiving information related to the seven assessed energy balance-related behaviors, there were significant differences by parents’ gender and nativity. Most parents endorsed remote modalities for content delivery via text/SMS, WhatsApp, and e-mail. However, respondents were also receptive to in-person delivery provided by community health workers. There were also significant differences in parents’ preferences for intervention modalities by parents’ gender and nativity. Future steps should include investigating different intervention modalities and their integration into a linguistic and culturally sensitive family-based intervention to promote healthful energy balance-related behaviors of preschool-age children in Central American families originating from the Northern Triangle countries.

Background Globally, children’s exposure to digital screens continues to increase and is associated with adverse effects on child health. We aimed to evaluate the association of screen exposure with child communication, gross-motor, fine-motor, problem-solving, and personal-social development scores. Methods We conducted a population-based, cross-sectional study with cluster sampling among children 0–60 months of age living in the state of Ceará, Brazil. Child screen time was assessed by maternal report and the World Health Organization (WHO) recommendations were used to define excessive screen time exposure. Child development was assessed with the Brazilian Ages and Stages Questionnaire. Generalized linear regression was used to determine the association of screen exposure with developmental outcomes. We also examined the potential non-linear relationship of screen time with development scores using spline analyses. Results A total of 3155 children 0–60 months of age had screen time exposure evaluated and 69% percent were identified as exposed to excessive screen time. This percentage of excess screen time increased with child age from 41.7% for children 0–12 months to 85.2% for children 49–60 months. Each additional hour of screen time was associated with lower child communication (standardized mean difference (SMD): -0.03; 95% CI: − 0.04, − 0.02), problem solving (SMD: -0.03; 95% CI: − 0.05, − 0.02) and personal-social (SMD: -0.04; 95% CI: − 0.06, − 0.03) domain scores. Conclusions Excess screen time exposure was highly prevalent and independently associated with poorer development outcomes among children under 5 years of age in Ceará, Brazil.

This exploratory community-based study assessed Brazilian immigrant parents' awareness of HPV and the HPV vaccine, HPV information sources, and their interest in participating in a future HPV-related cancer prevention study. This study is a cross-sectional analysis of data from a convenience sample of Brazilian immigrant parents living in selected cities in Massachusetts. Participants completed a brief survey in their language of preference (English or Portuguese) administered by bilingual interviewers. Forty-seven Brazilian immigrant parents, each representing a unique family, participated in the study. All participants completed the survey in Portuguese. Although the majority reported being aware of HPV (93.6%, n = 44), only 74.5% (n = 35) were aware of the HPV vaccine. Fewer fathers than mothers had heard of the HPV vaccine (61.9%; n = 13 vs. 84.6%, n = 22; p = 0.04). Of those who were aware of the HPV vaccine (n = 35), 82.6% (n = 29) reported hearing about the HPV vaccine from their child's physician. Additionally, nearly all participants (97.9%, n = 46) reported being interested in participating in future HPV-related cancer prevention study. Findings of this exploratory study indicate parents' low to moderate awareness of the HPV vaccine and high interest in participating in future HPV-related cancer prevention study. These findings are important and serve as a valuable first step toward building a knowledge foundation that is critically needed for developing future studies targeting Brazilians immigrant parents and adolescents living in the USA.

To conduct an integrative review to identify and synthesize studies exploring human papillomavirus (HPV) knowledge, awareness, beliefs, attitudes, and acceptability of the HPV vaccine among Latino fathers living in the United States. The review methodology was informed by those developed by Whittemore and Knafl, which allow for the inclusion of qualitative, quantitative, and mixed methods studies. Using the preferred reporting items for systematic reviews meta-analyses guidelines, five electronic databases (PubMed, Medline, PsycINFO, CINAHL, Science Direct) were searched for peer-reviewed, full-text studies published in English with samples that included Latino fathers and examined knowledge, awareness, beliefs, attitudes about the HPV and the HPV vaccines. Studies that did not provide information on the inclusion of fathers in the sample were excluded. Identified eligible studies were analyzed and synthesized using the matrix method. Eleven eligible studies were identified. Most (n = 10) included mothers and fathers. One study included only fathers, and this study determined that although fathers held positive attitudes toward the HPV vaccine, a notable number of participants were unsure of or had not formed an opinion about the HPV vaccine. Fathers felt that a recommendation from their child's physician would impact whether they vaccinated their child. Moreover, of the ten studies including both parents, only two specifically compared fathers' and mothers' knowledge and awareness about the HPV and vaccine acceptability. These two studies determined that fathers were less aware of the HPV and had lower HPV vaccine-related knowledge than mothers. Nevertheless, all of the 11 examined studies, found moderate to high acceptability of the HPV vaccine among Latino parents despite uncertainty about possible vaccine risks and costs. Only 11 studies were identified that included Latino fathers. Of these studies, only one was conducted exclusively with Latino fathers and two compared fathers and mothers. Additional research focusing on Latino fathers is needed given the central role of the family in the Latino culture and the shared role fathers and mothers have in decision-making related to their children's health.

One strategy to promote physical activity (PA) is for health care providers to give exercise prescriptions (ExRx) that refer to community-based facilities. However, facilitators and barriers specific to urban programs in the US for under-resourced women are unknown. Thus the purpose of this formative research was to explore ExRx barriers and facilitators specific to US under-resourced women to inform future intervention targets and strategies. This mixed-methods community-engaged research was conducted in partnership with an urban women’s only wellness center that exchanged ExRx for free access (1–3 months). Qualitative semi-structured interviews and validated quantitative questionnaires (SF-12, International Physical Activity Questionnaire, Physical Activity Self-Efficacy, Physical Activity Stage of Change, and Barriers to Physical Activity, Social Support for Exercise, and Confusion, Hubbub, and Order Scale) were administered by phone and guided by the socio-ecological model. ExRx utilization was defined as number visits/week divided by membership duration. Means and percentages were compared between ≥1 visit/week vs. &lt, 1 visit/week with t-tests and chi-square, respectively. Women (n = 30) were 74% Black, 21–78 years of age, 50% had ≤ high school diploma, and 69% had household incomes ≤45,000/year. Women with ≥1 visit/week (n = 10, 33%) reported more education and higher daily activity, motivation, number of family CVD risk factors and family history of dyslipidemia compared with &lt, 1 visit/week. Facilitators among women with ≥1 visit/week were “readiness” and “right timing” for ExRx utilization. Barriers among women with &lt, 1 visit/week (n = 20, 67%) were “mismatched expectations” and “competing priorities”. Common themes among all women were “sense of community” and “ease of location”. ExRx utilization at an US urban wellness center may be dependent on a combination of multi-level factors including motivation, confidence, peer support, location and ease of access in under-sourced women. Additional resources may be needed to address mental and/or physical health status in additional to physical activity specific programming.

This descriptive qualitative study explored Latinx mothers’ acceptance of the human papillomavirus (HPV) vaccine for their adolescent children. Data were collected through individual, semi-structured interviews and analyzed using a hybrid method of thematic analysis that incorporated deductive and inductive approaches. Twenty-two ( n = 22), mostly foreign-born, Latinx mothers of male and female adolescents participated in the study. Three main themes and nine subthemes emerged from the analyses. Findings identified the need for increased efforts to raise awareness and knowledge among Latinx mothers of the direct benefits of the HPV vaccine for sons, including stressing prevention of HPV-associated cancers in males. Findings also underscore the need for improved health care providers’ communication and recommendation of the HPV vaccine for Latinx adolescent males. Future research should intervene upon the study’s findings to address barriers that remain and affect Latinx mothers’ acceptance and uptake of the HPV vaccine for their children, in particular their sons.

The present study describes the cross-cultural adaptation of the Brazilian version (Rio de Janeiro) of the Caregiver&rsquo, s Feeding Styles Questionnaire (CFSQ) among caregivers of children aged 3 to 6 years enrolled in a family health service in Rio de Janeiro, Brazil. The cross-cultural adaptation process included the following phases: (1) literature review, (2) translation and back-translation of the instrument, (3) assessment of semantic equivalence through cognitive interviews with caregivers, (4) discussion with experts, (5) pretesting of the revised version, and (6) assessment of psychometric characteristics, including reliability and validity of the scale. Results showed the appropriateness of the caregiver&rsquo, s feeding styles concept within the Brazilian culture and that the instrument was understandable to caregivers enrolled in a family health service. The CFSQ measurements showed perfect intra-observer reliability for &ldquo, demandingness&rdquo, and almost perfect for &ldquo, responsiveness&rdquo, Inter-observer reliability was almost perfect for both dimensions, &ldquo, and &ldquo, Factor analysis of the Brazilian CFSQ version proposed an instrument with one dimension and 13 items. The satisfactory results of the cross-cultural adaptation of the CFSQ suggest its applicability in the population of interest with the possible reduction of some scale items.

Objectives:Brazilians comprise a rapidly growing immigrant Latino group in the USA, yet little research has focused on health issues affecting Brazilian children in immigrant families. As increasing evidence is documenting fathers’ influential role in their children’s eating behaviours and ultimately weight status, the current study sought to explore the Brazilian immigrant fathers’ perspectives and practices related to child’s feeding practices and their preschool-aged children’s eating.Design:Qualitative study using in-depth, semi-structured interviews. Interviews were conducted in Portuguese by native Brazilian research staff using a semi-structured interview guide. Interviews were audio-recorded and transcribed verbatim. Transcripts were analysed thematically using a hybrid approach that incorporated deductive and inductive analytical approaches.Setting:Massachusetts.Participants:Twenty-one Brazilian immigrant fathers who had at least one child aged 2–5 years.Results:Results revealed fathers’ awareness of the importance of healthy eating for their children, their influence as role models and their involvement in feeding routines of their preschool-aged children. Moreover, fathers were receptive to participating in family interventions to promote their children’s healthy eating. Nearly all fathers reported wanting to learn more and to do ‘what’s right’ for their children.Conclusions:The current study provides new information about Brazilian immigrant fathers’ views about factors influencing their children’s healthy eating behaviours and paternal feeding practices. Future research should quantify fathers’ feeding styles and practices and solicit fathers’ input in the design of culturally appropriate family interventions targeting the home environment of preschool-aged children of Brazilian immigrant families.

Despite increasing interest in understanding the factors influencing awareness and acceptability of the human papillomavirus (HPV) vaccine among Latino parents, to date limited information is available specific to Central American parents living in the United States (US). Therefore, this pilot cross-sectional study was designed to explore and assess Central American immigrant parents&rsquo, awareness, acceptability, and willingness to vaccinate their children against HPV, and interest in participating in future HPV-associated cancer prevention study. Fifty-six Central American parents, majority immigrant (96.4%, n = 54) from four countries, El Salvador&mdash, 50% (n = 27), Guatemala&mdash, 25.9% (n = 14), Honduras&mdash, 22.2% (n = 12), and Panama&mdash, 1.9% (n = 1) participated in this study. Participants completed an interviewer-administered questionnaire survey in their preferred language (i.e., Spanish or English). A little over half of the participants were mothers (57.1%, n = 32) and parents&rsquo, mean age was 43.2 years (SD = 6.4). The majority was married or cohabitating (76.8%, n = 43), and 39.3% (n = 22) reported having two children. Seventy-five percent (n = 42) of parents reported they had heard of the HPV vaccine. Fewer fathers were aware of the HPV vaccine (58.3%, n = 14 vs.87.5%, n = 28, p = 0.01) than mothers. Among parents who had heard of the HPV vaccine (n = 42), 85.7% (n = 36) reported their children had received at least one dose of the HPV vaccine. Fewer fathers reported their child had been vaccinated against HPV (64.3%, n = 9 vs. 96.4%, n = 27, p = 0.06) than mothers. Moreover, 90% of parents (n = 18) whose children were unvaccinated reported willingness to vaccinate their adolescent children against HPV if recommended by their child&rsquo, s physician. Findings indicate parents&rsquo, low to moderate awareness of the HPV vaccine, and high willingness to vaccinate their adolescent children if recommended by their child&rsquo, s physician. Findings also demonstrate fathers&rsquo, lower awareness and acceptability of the HPV vaccine than mothers. Despite limitations and the need for more research, findings of this pilot study serve as a valuable first step toward building a knowledge foundation that is needed for developing future studies and interventions targeting Central American immigrant parents living in the US. Future studies can build on the findings of this exploratory study with other research designs and address its limitations by having a larger sample size and accounting for additional factors associated with Central American immigrant parents&rsquo, HPV awareness, knowledge, beliefs, attitudes, and vaccine acceptability from other communities across the US.

Childhood obesity is now an epidemic in many countries worldwide and is known to be a multifactorial condition. We aimed to examine the relationship of environmental, socioeconomic, and nutritional factors with childhood overweight and obesity. We conducted a population-based cross-sectional study of children from 2 to 6 years of age in Cear&aacute, Brazil. Children&rsquo, s nutritional status was assessed by body mass index (BMI) Z scores categorized as overweight and obesity. Ordinal logistic regression models were used to assess the relationship between the factors with overweight and obesity. A total of 2059 children participated, of which 50.4% were male. The mean age was 46 &plusmn, 17 months, with a prevalence of overweight and obesity of 12.0% (95% CI 10.7&ndash, 13.6) and 8.0% (6.7&ndash, 9.5), respectively. In multivariate analysis, the probability of childhood obesity increased as family income increased (adjusted hazard ratio (aHR) 0.6 (95% CI 0.37&ndash, 0.95), p-value = 0.03). Moreover, families with fewer children had more than 30% fewer overweight children (aHR 0.68, 95% CI 0.48&ndash, 0.96). Environmental, socioeconomic, and child nutritional factors were associated with overweight and obesity. The results provided could be used to design integrated interventions spanning from conception, or earlier, through the first years of life and may improve child nutritional outcomes.

Participation of racial/ethnic minority and immigrant populations in research studies is essential to understand and address health disparities. Nonetheless, these populations are often underrepresented in research because of limited participation that may be due to barriers to participation such as fear and mistrust of research, lack of or limited access to healthcare and social services, time and employment constraints, participation-associated costs (e.g., travel costs), language barriers, undocumented status, and cultural differences. Brazilians comprise a rapidly growing immigrant population group in the United States (US), and there is a need to identify and understand factors affecting the health status of Brazilian immigrants that are amenable to intervention. Therefore, this paper presents effective strategies and lessons learned from outreach and recruiting Brazilian immigrants living in the US to enroll in maternal and child health research studies. Using a data recruitment log, we collected quantitative and qualitative data on recruitment strategies that were employed to recruit pregnant women and parents into six health research studies. Direct recruitment strategies included personal contacts of research staff and recruiting partners, and on-site, in-person outreach and recruitment at faith- and community-based events (e.g., meeting participants after church services, at faith-based community events), and private and social events (e.g., household parties) conducted by bilingual, bicultural research assistants who were members of the priority population. We also used snowball sampling as a recruitment strategy by asking enrolled participants to share information about our studies and encourage their family and friends to participate. Indirect recruitment methods included posting flyers at local businesses, social service agencies, faith-based and healthcare organizations, and posting announcements on social media (Facebook). Direct recruitment methods in combination with snowball sampling were the most successful strategies for recruiting Brazilian immigrant parents, while social media was an effective indirect method for recruiting first-time pregnant women. In addition, analyses of qualitative data found that research staff's understanding of the sociocultural context of the target population combined with the use of linguistically and culturally sensitive recruitment strategies tailored to meet the needs of Brazilian immigrants was important for overcoming barriers to participation and facilitating successful recruitment and enrollment of participants. Study findings provide information on a suite of effective strategies and lessons learned for reaching, recruiting, and enrolling Brazilian immigrants in maternal and child health research. Future studies should continue to purposefully collect information on recruitment strategies and disseminate the findings, which will be instrumental in researchers' efforts to increase participation of ethnic minority and immigrant populations such as Brazilians in health research.

This article aims to investigate the relationship between intimate partner physical violence (IPPV) and breastfeeding (BF), use of breastmilk substitutes (BMS) and bottle-feeding among children aged 12 to 15 months. This is a cross-sectional study with mothers in primary care facilities of the city of Rio de Janeiro. IPPV was identified by the Brazilian version of the Conflict Tactics Scales 1-Form R and feeding practices were identified by a 24-hour Dietary Recall. Associations were verified by logistic regression with odds ratio (OR) estimates and 95% confidence intervals. BF was offered to 58.5% of the children and BMS to 88.5%. Also, 70.5% of the children used a baby bottle. Physical violence was observed in 26.7% of couples. Households where couples physically abuse each other are more likely to not breastfeed (OR=2.14, p-value=0.030), to use breastmilk substitutes (OR=5.15, p-value=0.03) and bottle-feed (OR=2.71; p-value=0.01), when compared to households without physical violence. The results highlight the need to investigate intrafamily relationships in cases where inadequate breastfeeding practices are identified, and to enable health professionals to support families in conflict situations.O objetivo deste artigo é investigar a relação da violência física entre parceiros íntimos (VFPI) e a oferta de leite materno (LM), os substitutos do leite materno (SLM) e o uso de mamadeiras entre crianças entre 12 e 15 meses. Estudo transversal com mães em unidades de saúde do município do Rio de Janeiro, realizado entre junho de 2005 e dezembro de 2009. A VFPI foi identificada pela versão brasileira da Conflict Tactics Scales 1- Form R e as práticas de alimentação foram identificadas por recordatório de 24 horas. As associações foram verificadas por regressão logística mediante estimativas de razão de chances (RC) e intervalos de confiança de 95%. O leite materno foi ofertado a 58,5% das crianças e os substitutos do leite materno a 88,5%, e 70,5% das crianças usavam mamadeira. A violência física foi observada em 26,7% dos casais. Em lares onde os casais se agridem fisicamente há uma maior chance de não ofertar leite materno, maior chance de ofertar substitutos do leite materno e de usar mamadeira comparado aos lares onde não existe violência física. Os resultados chamam atenção para a necessidade de se investigar as relações intrafamiliares em casos que são identificadas práticas inadequadas de aleitamento, e de capacitar os profissionais de saúde para apoiar as famílias em situações de conflito.

Background Length of residence in the United States (US), changes in dietary and physical activity behaviors, and economic and social barriers contribute to high childhood obesity rates among children from immigrant families in the US. Brazilians comprise a fast-growing immigrant population group in the US, yet little research has focused on health issues affecting Brazilian children in immigrant families. Understanding sociocultural and environmental influences on parents' beliefs and practices related to child feeding and weight status is essential to altering obesity trends in this group. Methods Qualitative study consisting of five focus groups with a convenience sample of 29 Brazilian immigrant mothers. Results Analyses revealed that the sociocultural and environment transitions faced by Brazilian immigrant mothers' influence their beliefs and practices related to child feeding and weight status. Additionally, acculturation emerged as a factor affecting mothers' feeding practices and their children's eating habits, with mothers preferring Brazilian food environments and that their children preferring American food environments. Mothers viewed themselves as being responsible for promoting and maintaining their children's healthy eating and feeding behaviors, but changes in their social and cultural environments due to immigration and the pressures and demands of raising a family in a new country make this difficult. Conclusions Health promotion interventions to improve healthful eating and feeding practices of Brazilian children in immigrant families must account for social and cultural changes and daily life demands due to immigration as well as potential variation in the levels of acculturation between mothers and their children.

Background: Exclusive breastfeeding for the first 6 months of life and timely introduction of appropriate solid foods are important determinants of weight status in infancy and later life stages. Disparities in obesity rates among young children suggest that maternal feeding practices during the first 2 years of life may contribute to these disparities. Brazilians are a growing immigrant group in the United States, yet little research has focused on parental beliefs and behaviors affecting the health of Brazilian immigrant children in the United States. Research aim: This study aimed to explore beliefs and infant-feeding practices of Brazilian immigrant mothers in the United States. Methods: Focus group discussions were conducted with Brazilian immigrant mothers. Transcripts were analyzed using thematic analysis and themes categorized using the socioecological model. Results: Twenty-nine immigrant Brazilian mothers participated in the study. Analyses revealed that all participants breastfed their infants. The majority initiated breastfeeding soon after childbirth. However, most mothers did not exclusively breastfeed. They used formula and human milk concomitantly. Family and culture influenced mothers’ infant-feeding beliefs and practices in early introduction of solid foods. Conclusion: As the number of children in the United States growing up in families of immigrant parents increases, understanding influences on Brazilian immigrant mothers’ infant-feeding practices will be important to the development of effective interventions to promote healthy infant feeding and weight status among Brazilian children. Interventions designed for Brazilian immigrant families should incorporate an understanding of social context, family, and cultural factors to develop health promotion messages tailored to the needs of this ethnic group.

ObjectiveResearch indicates that healthful eating and physical activity (PA) practices implemented in child-care settings can have a positive effect on children’s healthful behaviours in this setting, and this effect on healthful behaviours may possibly transfer to the home environment. While more research is needed to examine whether behaviours learned in family child-care homes (FCCH) transfer, the potential for transferability is especially important given that Latino children’s home environment has been characterized by obesogenic parenting practices. We aimed to examine Latino parents’ perceptions of their pre-school children’s eating and PA experiences at home and at FCCH.DesignQualitative study. Six focus groups were conducted in Spanish (n36). Transcripts were analysed using thematic analysis to identify key concepts and themes.ResultsAnalyses revealed that Latino parents perceive their children have healthier eating and PA experiences at FCCH than at home. Parents attributed this to FCCH providers providing an environment conducive to healthful eating and PA due to providers having more knowledge and skills, time and resources, and being required to follow rules and regulations set by the state that promote healthful eating and PA.ConclusionsUnderstanding parental perceptions, attitudes and practices related to establishing and maintaining an environment conducive to children’s healthful eating and PA at home and at the FCCH is essential for the design of successful interventions to promote children’s healthful behaviours in these two settings. Given that parents perceive their children as having more healthful behaviours while at FCCH, interventions that address both settings jointly may be most effective than those addressing only one environment by itself.

Latinos are the largest and fastest-growing minority group in the U.S., and Latina women represent the largest portion of minority births, having the highest birth rate in the U.S. for over 20 years. In addition, Latina women are at increased risk of entering pregnancy being overweight or having obesity and gaining excess gestational weight. Excess gestational weight gain (GWG) has short- and long-term adverse health outcomes for the woman and her child. Although culturally tailored interventions show promise toward promoting healthy GWG among Latina women, findings from current interventions have had mixed results, suggesting the need for further tailoring to meet the needs of this heterogeneous population group. This qualitative study was designed to explore first-time pregnant, low-income Latina women's beliefs, attitudes, and experiences with GWG. The study employed qualitative research using semi-structured interviews conducted with 23 first-time pregnant Latina women between 22 and 36 weeks of gestation. Interviews were conducted by trained bilingual staff, transcribed verbatim, and analyzed using thematic analysis. Results showed that participants were uncertain if their GWG was within a healthy range. Although the majority of participants knew that GWG should be limited, they were not sure what the amount should be. In addition, the majority of participants reported attitudes of acceptance of and resignation to excessive GWG as being part of pregnancy. Several women appeared to believe that they did not have control over their weight gain during pregnancy. Moreover, analysis identified that sociocultural and interpersonal factors such as social support influence the beliefs, attitudes, and experiences with GWG of the low-income, majority immigrant Latina women who participated in this study. Study findings can be used to further tailor prenatal care practices and interventions aimed at altering modifiable risk factors associated with excess GWG among Latinas. Future interventions designed for low-income, immigrant Latina women that consider sociocultural influences on women's beliefs and attitudes related to GWG, as well as the influence of social support networks on women's health behaviors during pregnancy, will likely be more effective in preventing excessive GWG.

OBJECTIVE To measure the prevalence of smoking cessation during pregnancy and to identify factors associated with its occurrence. METHODS The present survey included all puerperal women living in the municipality of Rio Grande, RS, whose birth occurred between January 1 and December 31, 2013. A single standardized questionnaire was applied, in the hospital, within 48 hours of delivery. Multivariate analysis was performed using Poisson regression with robust variance. RESULTS The prevalence of smoking cessation among the 598 parturients studied was 24.9% (95%CI 21.5-28.6). After adjusting for confounding factors, mothers aged 13 to 19 years (PR = 1.76; 95%CI 1.13-2.74), who had higher family income (PR = 1.83; 95%CI, 1.23-2.72), higher educational level (PR = 2.79; 95%CI 1.27-6.15), higher number of prenatal appointments (PR = 1.84; 95%CI 1.11-3.05), and who did not smoke in the previous pregnancy (PR = 2.93; 95% CI, 1.95-4.41) presented a higher prevalence ratio of smoking cessation. CONCLUSIONS Although pregnancy is a window of opportunity for smoking cessation, the rate of cessation was low. The prevalence of cessation was higher among mothers with lower risk of complications, suggesting the need for interventions prioritizing pregnant women of lower socioeconomic levels.

Brazilians are a rapidly increasing Latino immigrant group in the United States (US), yet little research has examined factors influencing physical activity (PA) levels and behaviors of children growing up in Brazilian immigrant families. This information is needed to develop culturally sensitive interventions tailored to this population. Therefore, this qualitative study explored PA parenting practices used by Brazilian immigrant mothers living in the US. Thirty-seven Brazilian immigrant mothers with at least one child between the ages of 2 and 5 years participated in 1of 7 focus group discussions. Thematic analysis identified seven parenting practices that mothers employ that may encourage or facilitate physical activity their preschool-aged children's PA including: 1) modeling PA; 2) engaging and being physically active with child; 3) providing logistic support; 4) encouraging, praising, and offering motivational support; 5) watching, supervising, and teaching children how to engage in PA; 6) monitoring and setting limits to child's screen time; and 7) prompting child to be physically active. In addition, analysis identified four parenting practices that may discourage or inhibit children's PA including: 1) modeling of sedentary behaviors; 2) having rules and restrictions due to safety- and weather-related concerns; 3) limiting child's outdoor time due to parental time constraints; and 4) restricting child's outdoor and play time as punishment. Furthermore, analyses demonstrated that social contextual factors (e.g., income, housing, neighborhood safety, etc.) influence mothers' PA parenting practices and consequently, their children's PA. This is the first qualitative study, to our knowledge, to explore PA parenting practices of Brazilian-born immigrant mothers living in the US. Future research should further explore PA parenting practices of Brazilian immigrant parents including quantifying PA parenting practices that encourage and discourage PA, as well as examining the influence of fathers' PA parenting practices on young children's PA.

In the United States (US), racial/ethnic minority children, low-income children, and children of immigrant families are at increased risk of childhood obesity. Mounting evidence documents that sleep duration and sleep quality are important modifiable factors associated with increased risk of obesity among preschool-aged children. The number of Brazilian immigrants in the US is increasing, yet no existing research, to our knowledge, has examined factors affecting sleep and bedtime routines of children of Brazilian immigrant families. Therefore, the purpose of this qualitative study was to explore Brazilian immigrant mothers&rsquo, beliefs, attitudes, and practices related to sleep and bedtime routines among preschool-aged children. Seven focus group discussions (FGDs) were conducted with 37 Brazilian immigrant mothers of preschool-age children living in the US. The audio-recordings of the FGDs were transcribed verbatim in Portuguese without identifiers and analyzed using thematic analyses. Mothers also completed a brief questionnaire assessing socio-demographic and acculturation. Analyses revealed that most mothers were aware of the importance of sleep and sleep duration for their children&rsquo, s healthy growth and development. Mothers also spoke of children needing consistent bedtime routines. Nevertheless, many mothers reported inconsistent and suboptimal bedtime routines (e.g., lack of predictable and orderly bedtime activities such as bath, reading, etc. and use of electronics in bed). These suboptimal routines appeared to be influenced by day-to-day social contextual and environmental factors that are part of Brazilian immigrant families&rsquo, lives such as parents&rsquo, work schedule, living with extended family, living in multi-family housing, neighborhood noise, etc. Analyses identified several modifiable parenting practices related to young children&rsquo, s sleep and bedtime routines (e.g., irregular bedtime, late bedtime, inconsistent bedtime routines, use of electronics in bed, etc.) that can be addressed in parenting- and family-based obesity prevention interventions. Interventions should consider the social context of the home/family (e.g., parents&rsquo, work schedules) and the environment (e.g., multi-family housing, neighborhood noise, etc.) faced by Brazilian immigrant families when developing health promotion messages and parenting interventions tailored to this ethnic group.

ObjectiveTo explore how Brazilian-born immigrant mothers living in the USA obtain information about physical activity (PA) and screen time (ST) behaviours for their preschool-aged children.Research designFocus group discussions (FGDs) were used to gain an in-depth understanding of research topics. All FGDs were audio-recorded and professionally transcribed verbatim. The Portuguese transcripts were analysed using thematic analysis, an iterative process of coding the data in phases to create meaningful patterns.ParticipantsThirty-seven Brazilian-born immigrant mothers of preschool-age children.SettingThis study was conducted in two cities in Massachusetts (MA). Participants were recruited from two predominantly Brazilian churches, local Brazilian businesses and community-based social and health services organisations in the Greater Boston area in MA.ResultsAnalyses revealed that the mothers participating in this study did not initially actively seek out information about PA and ST for their preschool-age children, but that they received unsolicited information about these behaviours from multiple sources including their child’s paediatrician, Women, Infant and Children (WIC) programme staff, members of their social network of Brazilian friends and the Brazilian media. Mothers reported that this unsolicited information increased their knowledge about the importance of making sure their children were physically active and not participating in excessive ST. This increased awareness led mothers to actively seek information about PA and ST behaviours via the internet and through interpersonal communication with fellow Brazilian friends and family.ConclusionsGiven the value Brazilian immigrant mothers placed on the advice of their paediatricians and WIC staff, interventions should consider involving these healthcare professionals, possibly through including endorsement (eg, prescription for PA and maximum ST). More research is needed to ensure Brazilian immigrant mothers’ health and media literacy including their ability to navigate the online environment and to discern the accuracy and quality of information from various web sites.

Objective: To review the association between intimate partner violence and breastfeeding practices in the literature. Data sources: The search was carried out in five databases, including MEDLINE, LILACS, SCOPUS, PsycoINFO, and Science Direct. The search strategy was carried out in February 2017. The authors included original studies with observational design, which investigated forms of intimate partner violence (including emotional, physical, and/or sexual) and breastfeeding practices. The quality of the studies was assessed based on the bias susceptibility through criteria specifically developed for this review. Summary of data: The study included 12 original articles (10 cross-sectional, one case-control, and one cohort study) carried out in different countries. The forms of intimate partner violence observed were emotional, physical, and/or sexual. Breastfeeding was investigated by different tools and only assessed children between 2 days and 6 months of life. Of the 12 studies included in this review, eight found a lower breastfeeding intention, breastfeeding initiation, and exclusive breastfeeding during the first six months of the child's life, and a higher likelihood of early termination of exclusive breastfeeding among women living at home where violence was present. The quality varied between the studies and six were classified as having low bias susceptibility based on the assessed items. Conclusions: Intimate partner violence is associated with inadequate breastfeeding practices of children aged 2 days to 6 months of life. Resumo: Objetivo: Revisar na literatura a associação da violência entre parceiros íntimos e as práticas de aleitamento materno. Fontes dos dados: Foram utilizadas para as buscas cinco bases de dados, incluindo o MEDLINE, LILACS, SCOPUS, PsycoINFO e Science Direct. A estratégia de busca foi realizada em fevereiro de 2017. Foram incluídos estudos originais com desenho observacional, os quais investigaram formas de violência entre parceiros íntimos: emocional, física e/ou sexual e as práticas de aleitamento materno. A qualidade dos estudos foi avaliada a partir da susceptibilidade a vieses por critérios especificamente desenvolvidos para esta revisão. Síntese dos dados: Foram incluídos 12 artigos originais (10 seccionais, 1 caso-controle e 1 coorte) realizados em diferentes países. As formas de violência entre parceiros íntimos observadas foram emocional, física e/ou sexual. O aleitamento materno investigado nos estudos se fez por diferentes instrumentos e avaliaram apenas crianças entre dois dias e seis meses de vida. Dos doze estudos incluídos nesta revisão, oito encontraram menor chance de intenção de amamentar, menor chance de iniciação ao aleitamento materno e de amamentação exclusiva durante os primeiros seis meses de vida da criança e maior probabilidade de interrupção precoce do aleitamento materno exclusivo entre as mulheres que viviam em domicílios onde a violência estava presente. A qualidade variou entre os estudos e seis foram classificados apresentando baixa suscetibilidade ao viés a partir dos itens julgados. Conclusões: A violência entre parceiros íntimos está relacionada às práticas inadequadas de aleitamento materno de crianças entre dois dias e seis meses de vida. Keywords: Breastfeeding, Human milk, Intimate partner violence, Domestic violence, Review, Palavras-chave: Amamentação, Leite humano, Violência entre parceiros íntimos, Violência doméstica, Revisão

Chinese are a fast-growing immigrant population group in several parts of the world (e.g., Australia, Canada, Europe, Southeast Asia, United States). Research evidence suggests that compared to non-Hispanic whites, individuals of Asian-origin including Chinese are at higher risk of developing cardiovascular disease and type 2 diabetes at a lower body mass index (BMI). These risks may be possibly due to genetic differences in body composition and metabolic responses. Despite the increasing numbers of Chinese children growing up in immigrant families and the increasing prevalence of obesity among Chinese, little research has been focused on children of Chinese immigrant families. This integrative review synthesizes the evidence on infant feeding beliefs, attitudes, knowledge and practices of Chinese immigrant mothers; highlights limitations of available research; and offers suggestions for future research. Using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, we searched four electronic academic/research databases (CINAHL, Medline, PsycINFO, and PubMed) to identify peer-reviewed, full-text papers published in English between January 2000 and September 2017. Only studies with mothers 18+ years old of normally developing infants were included. Of the 797 citations identified, 15 full-text papers were retrieved and 11 studies (8 cross-sectional studies, 3 qualitative studies) met the inclusion criteria and were included in this review. Reviewed studies revealed high initiation rates of breastfeeding, but sharp declines in breastfeeding rates by six months of age. In addition, reviewed studies revealed that the concomitantly use of breast milk and formula, and the early introduction of solid foods were common. Finally, reviewed studies identified several familial and socio-cultural influences on infant feeding beliefs and practices that may increase risk of overweight and obesity during infancy and early childhood among Chinese children of immigrant families. Nonetheless, as only 11 studies were identified and because the majority of studies (n = 8) were conducted in Australia, additional research including longitudinal studies, and studies conducted in countries with large Chinese immigrant population are needed to further identify and understand influences on Chinese immigrant mothers’ beliefs, attitudes, and practices related to infant feeding that may increase risk of child overweight and obesity. This information is needed to develop interventions tailored to the beliefs and needs of this fast-growing immigrant group and aimed at promoting healthy infant feeding practices to prevent childhood overweight and obesity.

ObjectiveLatinos are the largest and most rapidly growing minority population group in the USA and are disproportionally affected by obesity and related chronic diseases. Child care providers likely influence the eating and physical activity behaviours of children in their care, and therefore are important targets for interventions designed to prevent childhood obesity. Nonetheless, there is a paucity of research examining the behaviours of family child care home (FCCH) providers and whether they model healthy eating and physical activity behaviours. Therefore, this study explored Latino FCCH providers’ beliefs and practices related to healthy eating, physical activity and sedentary behaviours, and how they view their ability to serve as role models for these behaviours for young children in their care.MethodsThis is a qualitative study consisting of six focus groups conducted in Spanish with a sample of 44 state-licensed Latino FCCH providers in the state of Massachusetts. Translated transcripts were analysed using thematic analyses to identify meaningful patterns.ResultsAnalyses revealed that Latino FCCH providers have positive beliefs and attitudes about the importance of healthy eating and physical activity for children in their care, but personally struggle with these same behaviours and with maintaining a healthy weight status. The ability of Latino FCCH providers to model healthy eating and physical activity may be limited by their low self-efficacy in their ability to be physically active, eat a healthy diet and maintain a healthy weight.ConclusionsInterventions designed to improve healthy eating and physical activity behaviours of children enrolled in FCCHs should address providers’ own health behaviours as well as their modelling of these health behaviours. Future research can build on the findings of this qualitative study by quantifying Latino FCCH providers’ eating and physical activity behaviours, and determining how these behaviours influence behaviours and health outcomes of children in their care.

ObjectiveIncreasing evidence documents fathers’ influential role in their children’s eating, physical activity (PA) and sedentary behaviours (SB). We aimed to expand limited existing research examining fathers’ influence in these areas by exploring Latino fathers’ beliefs, attitudes and practices related to eating, PA and SB of their young children.DesignSeven focus group discussions were conducted in Spanish with Latino fathers (n 28) of children aged 2–8 years. Audio recordings were transcribed and translated verbatim without identifiers. Data were analysed using thematic analysis to identify key concepts and themes using NVivo 11 software.ResultsFathers expressed positive beliefs and attitudes about the importance of healthy eating for their young children, themselves and their families. Nevertheless, the majority reported familial practices including eating out, getting take-out, etc. that have been linked to increased obesity risk among Latino children. Fathers were more involved and engaged in children’s PA than eating and feeding. However, several fathers reported engaging predominantly in sedentary activities with their children, appeared permissive of children’s sedentary habits and struggled to set limits on children’s screen-time.ConclusionsWe provide new information on Latino fathers’ beliefs and child feeding and PA practices that may provide important targets for interventions aimed at promoting healthful eating and PA behaviours of Latino children. Future research should further quantify the influence of Latino fathers’ parenting styles and practices on development of children’s eating, PA and SB. This information is needed to identify risk factors amenable to interventions and to design culturally appropriate parenting and family-based interventions targeting Latino children’s home environment and designed to meet this ethnic group’s specific needs.

Latinos are the largest minority population group in the United States (U.S.), and low-income Latina women are at elevated risk of depression and obesity. Thus, the prevention of these two problems is a pressing public health concern in this population. Both depressive symptoms and obesity are modifiable factors that can be addressed by culturally relevant interventions. However, the association between depressive symptoms and obesity in Latina immigrant women is not well understood. Therefore, this cross-sectional study examined the association between depressive symptoms and obesity among Latina women of childbearing age (15–44). Participants (n = 147) were low-income, predominantly immigrant Latina mothers enrolled in the Latina Mothers′ Child Feeding Practices and Style Study. Women were eligible to participate if they self-identified as Latina; were enrolled in or eligible for the Special Supplemental Nutrition Program for Women, Infants and Children program; had a child between ages two and five years; and were living in the U.S. for at least one year, and residing in Rhode Island. Enrolled participants completed a survey in their language of preference (English or Spanish) administered by bilingual interviewers. About one-third (34%) of participants were classified as having obesity (BMI ≥ 30 kg/m2), 28.3% had elevated depressive symptoms (CES-D ≥ 16), and 70.1% were immigrants. Women with elevated depressive symptoms had increased odds of having obesity (odds ratio (OR) = 2.80, 95% confidence interval (CI): 1.24–6.33). Additionally, among immigrants, length of U.S. residency was associated with increased odds of obesity (OR = 1.05, 95% CI: 1.02–1.09). Findings underscore the need for screening and culturally relevant interventions designed to address both depressive symptoms and obesity among low-income Latina women of childbearing age. Furthermore, findings highlight the importance of taking into account the length of residency in the U.S. when designing interventions targeting Latina immigrants.

The aim of this study was to investigate the role of intimate partner violence in the early interruption of exclusive breastfeeding in the first three months of life. We used data from a prospective cohort of 564 children attending four primary health clinics in Rio de Janeiro, Brazil. Interruption of exclusive breastfeeding was defined as a child receiving any kind of liquid or solid, regardless of breast milk intake, measured by a 24 hour recall. The Portuguese version of the Conflict Tactics Scales (CTS-1) was used to assess intimate partner violence. Associations were expressed as prevalence ratios and relative risks and their respective 95% confidence intervals. Children of mothers who experienced severe violence had 30% greater likelihood of early interruption of exclusive breastfeeding in the second month of life as compared to those who did not experience this type of violence. Strategies in health services for promoting exclusive breastfeeding should consider identifying and addressing family violence. Resumo: O objetivo do estudo foi de investigar o papel da violência entre parceiros íntimos na interrupção precoce do aleitamento materno exclusivo nos três primeiros meses de vida. Usamos dados de uma coorte prospectiva de 564 crianças atendidas em quatro unidades de atenção primária no Rio de Janeiro, Brasil. A interrupção do aleitamento exclusivo foi definida como a ingestão pela criança de qualquer forma de líquido ou sólido, independente da ingestão de leite materno, nas 24 horas anteriores. Violência entre parceiros íntimos foi avaliada com a versão em português das Conflict Tactics Scales (CTS-1). As associações foram expressas como razões de prevalência e riscos relativos e os respectivos intervalos de 95% de confiança. Os filhos de mulheres que haviam vivenciado violência grave apresentavam uma probabilidade 30% maior de interrupção precoce do aleitamento exclusivo no segundo mês de vida, comparados com aqueles cujas mães não haviam vivenciado esse tipo de violência. Estratégias dos serviços de saúde para promover o aleitamento materno exclusivo devem levar em conta a identificação e enfrentamento da violência familiar. Resumen: El objetivo del estudio era investigar el papel de la violencia en la pareja en la interrupción precoz de la lactancia materna exclusiva durante los tres primeros meses de vida. Usamos datos de una cohorte prospectiva de 564 niños, atendidos en cuatro unidades de atención primaria en Río de Janeiro, Brasil. La interrupción de la lactancia materna exclusiva fue definida como la ingestión por parte del bebé de cualquier forma de líquido o sólido, independientemente de la ingestión de leche materna, durante las 24 horas anteriores. La violencia en la pareja fue evaluada con la versión en portugués de las Conflict Tactics Scales (CTS-1). Las asociaciones fueron expresadas como razones de prevalencia y riesgos relativos con sus respectivos intervalos de confianza de un 95%. Los hijos de mujeres que habían experimentado violencia grave presentaban una probabilidad un 30% mayor de interrupción precoz de la lactancia materna exclusiva durante el segundo mes de vida, comparado con aquellos cuyas madres no habían experimentado ese tipo de violencia. Las estrategias de los servicios de salud para promover la lactancia materna exclusiva deben tener en cuenta la identificación y combate a la violencia familiar.

Background: Understanding immigrants ’ interactions with the United States (US) healthcare system will likely make it possible to meet their healthcare needs and improve their quality of life in the US. Although challenges to accessing and utilizing healthcare in the US have been identified, there is little information specific to Brazilian-born immigrants ’ experiences. Brazilians comprise a fast-growing immigrant population group in the US. The purpose of this study was to explore Brazilian immigrant women ’ s perspectives and experiences with healthcare services in the US to gain insights into factors amenable to interventio ns that may contribute to disparities in access to and utilization of services. Methods: Five focus groups were conducted from April to May in 2015 using a purposeful sampling of Brazilian-born immigrant women living in Massachusetts, US. Results: Thirty-five women participated in this study. Although participants expressed their overall satisfaction with the US healthcare system, they noted several barriers to care, including sociocultural differences in delivery of care and communication barriers, including inconsistent quality of interpreting services. Conclusions: This study provides new information on the experiences and challenges faced by Brazilian immigrant women in accessing and utilizing healthcare services in the US and points out opportunities for improving services and the overall health of this immigrant population. Addressing noted sociocultural differences and communication barriers including inconsistent quality of hospital ’ s interpreting services might enhance Brazilian-born immigrants ’ experiences with the healthcare system.

Purpose Promoting physical activity (PA) is a key component of preventing and controlling childhood obesity. Despite well-documented benefits of PA, globally, rates of PA among young children have declined over the past decades, and most children are not accruing sufficient PA daily. Helping children develop the foundation for PA habits early in life is critical for the promotion of health in childhood and prevention of chronic diseases later in life, and will ultimately promote longer and healthier lives for individuals and the general population. The purpose of this review is to provide a synthesis of current evidence on influences on PA and sedentary behaviors of preschool-age children in high-income countries. Design and Methods A systematic review of three databases was performed. Studies conducted in high-income countries and published from 2000 onward that addressed influences on PA and sedentary behaviors of preschool-age children were identified and reviewed. Additionally, reference lists of identified articles and relevant published reviews were reviewed. Studies that met the following inclusion criteria were considered: (a) sample included preschoolers (age ≤5 years); (b) PA and/or sedentary behaviors or factors associated with PA and/or sedentary behaviors was assessed; (c) published in English; (d) used either quantitative or qualitative methods; and (e) conducted in a high-income country. Data were extracted from selected studies to identify influences on PA and sedentary behaviors of preschool-age children and organized using the social–ecological model according to multiple levels of influence. Results Results from included studies identify multiple factors that influence PA and sedentary behaviors of young children in high-income countries at the various levels of the social–ecological model including intrapersonal, interpersonal, environmental, organizational, and policy. Practice Implications Given pediatric nurses’ role as primary care providers, and their frequent and continued contact with parents and their children throughout childhood through well-child visits, immunization, and minor acute illnesses, they are well positioned to promote and support the development of early healthful PA habits of children starting in early childhood.

Background Diarrhea is a major cause of death in children in developing countries. However, in Brazil, diarrhea-related morbidity and mortality have declined over the past decades. Objective To explore community perspectives in Brazil on changes in health related to diarrhea and factors that may have contributed to these changes. Methods This qualitative study included 12 focus group sessions held with 50 mothers and 42 grandmothers in the state of Ceará. Results Most grandmothers reported having lost at least one child to diarrhea, and all participants had witnessed children dying from diarrhea in the past. The participants saw a clear decline in diarrhea over the past 20 years. They felt that this was due to social, economic, and cultural progress. The participants also considered government-supported outreach programs very important for health improvement. Conclusions Knowledge of diarrhea and its causes in the community is broad, but many traditional beliefs about the illness still prevail. The Brazilian experience is an example of the critical effect that policies to promote income redistribution and universal access to education, health, water supply, and sanitation services may have on the reduction of undernutrition and diarrhea among children.

Latinos are the largest and fastest growing minority population group in the United States, and children in low-income Latino families are at elevated risk of becoming overweight or having obesity. A child’s home is an important social environment in which he/she develops and maintains dietary and physical activity (PA) habits that ultimately impact weight status. Previous research suggests the parents are central to creating a home environment that facilitates or hinders the development of children’s early healthy eating and PA habits. Therefore, the purpose of this study was to explore low-income Latino parents’ beliefs, parenting styles, and parenting practices related to their children’s eating and PA behaviors while at home. Methods: Qualitative study using focus group discussions (FGDs) with 33 low-income Latino parents of preschool children 2 to 5 years of age. FGDs were transcribed verbatim and analyzed using thematic analysis. Results: Data analyses revealed that most parents recognize the importance of healthy eating and PA for their children and themselves. However, daily life demands including conflicting schedules, long working hours, financial constraints, and neighborhood safety concerns, etc., impact parents’ ability to create a home environment supportive of these behaviors. Conclusions: This study provides information about how the home environment may influence low-income Latino preschool children’s eating and PA habits, which may be useful for health promotion and disease prevention efforts targeting low-income Latino families with young children, and for developing home-based and parenting interventions to prevent and control childhood obesity among this population group. Pediatric healthcare providers can play an important role in facilitating communication, providing education, and offering guidance to low-income Latino parents that support their children’s development of early healthy eating and PA habits, while taking into account daily life barriers faced by families. Moreover, pediatric healthcare providers also can play an important role in the integration and coordination of home-visitations to complement office-based visits and provide a continuum of care to low-income Latino families.

SummarySummary. With the rapid pace of the nutrition transition worldwide, understanding influences of child feeding practices within a context characterized by the co-existence of overweight and undernutrition in the same population has increasing importance. This qualitative study describes Brazilian mothers’ child feeding practices and their perceptions of their association with child weight status and explores the role of socioeconomic, cultural and organizational factors on these relationships. Forty-one women enrolled in the Family Health/Community Health Workers Programme were selected from rural, urban, coastal and indigenous areas in Ceara State, north-east Brazil, to participate in four focus group discussions. Content analysis identified fourteen emergent themes showing mothers’ child feeding practices in this setting were influenced by economic resources, mothers’ immediate social support networks (e.g. neighbours and family members) and participation in nutrition assistance programmes. Child malnutrition was the most common nutritional concern; nevertheless, mothers were aware of the negative health consequences of obesity but misunderstood its causes (e.g. foods filled with fat would make a person fat; others thought that birth control pills and stimulants given to children were causes of obesity); several reported their own struggles with overweight. Food assistance programmes emerged as an important influence on children’s dietary adequacy, especially among mothers describing dire economic situations. The findings have implications for targeting food assistance as well as health and nutrition education strategies in low-income families undergoing the nutrition transition in north-east Brazil.

This qualitative study aims to understand how personnel in state and federal agencies view surveillance systems and the extent to which systematically collected data inform nutrition and physical activity policies and interventions addressing obesity. In-depth interviews were conducted with 17 respondents purposively sampled from state health departments, federal public health agencies, and prevention research centers. All informants acknowledged the importance of surveillance systems and influence of the data-action cycle for monitoring trends and increasing obesity awareness. However, state-level respondents believed surveillance systems should be designed for programmatic purposes, whereas federal participants thought they should be designed for monitoring. Respondents held differing opinions about the flexibility, timeliness, accessibility, and usefulness of existing national surveillance systems, highlighting significant differences in state and federal agencies’ perceptions and utilization of surveillance systems. Such discrepancies call for increased communication surrounding purposes and uses of surveillance data, enabling stronger partnerships between state and federal agencies.

The Behavioral Change Consortium (BCC) Nutrition Workgroup (NWG) is a multidisciplinary collaboration of representatives from BCC sites and federal agencies. Its mission is to improve measurement of dietary variables. This article presents findings from a qualitative study of perceived effectiveness of the workgroup collaboration. Twelve in-depth interviews were conducted and examined for common themes using the constant comparison method. Themes contributing to perceived effectiveness included: funding and additional resources; invested, committed, and collegial members; strong leadership, clearly articulated goals, and regular communication. Influences seen as reducing effectiveness were: distance, disparate nature of the studies, limited time, and problems associated with starting collaboration after the primary studies had begun data collection. NWG members felt that the workgroup would continue to be successful; however, there were concerns about responsibility for writing and authorship of manuscripts and the need for continued funding to ensure full participation and productivity.

Background. The continuing rise of obesity among Latinos is a public health concern with an immediate need for early prevention. Changes in family structures have increased demand and reliance for child care for young children. Latino children are the fastest-growing segment of the child population in the United States, and research shows that Latino families use preschools and day care centers much less than those of other ethnic groups, apparently because of cultural preferences for family-like care.Objectives. Given that many low income Latino children attend family child care homes (FCCHs), there is a need to explore the role that FCCH providers may play in establishing and reinforcing children’s early healthful eating and physical activity behaviors and consequently in the prevention of childhood obesity.Design. Using purposive sampling, six focus groups were conducted in Spanish with licensed Latino FCCH providersn=44. Data was analyzed to identify recurrent themes.Results. Latino FCCH providers described how they play an influential role in promoting healthful eating and physical activity behaviors of preschool children in their care. They also identified many barriers and challenges in establishing and maintaining healthful nutrition and physical activity behaviors, including high cost of healthy foods, cold weather, and physical environment of FCCH.Conclusions. Latino FCCH providers can have a strong impact in promoting healthful behaviors in low-income, Latino communities. They may be able to effectively deliver interventions targeting low-income, minority families to promote healthful eating and physical activity behaviors and prevent child obesity.

In evaluating public health programs, the tradition has been to design quantitative approaches, relying on epidemiological and statistical techniques to determine if and to what extent a program has an effect on a predetermined targeted population. More recently, however, qualitative methods such as rapid ethnographic assessments and focus groups have been implemented more frequently. This article describes an outcome evaluation of a community health workers program that integrated quantitative and qualitative methods to assess the impact of child survival interventions in reducing infant mortality and inadequate weight gain in children among municipalities in the state of Ceara, Northeast Brazil. By using multiple methods that combine quantitative and qualitative components, researchers can broaden their understanding of complex public health issues and direct use of data for decision making.

Childhood obesity is increasing dramatically in many Southeast Asian countries, and becoming a significant public health concern. This review summarizes the evidence on associations between parental feeding practices, child eating behaviors, and the risk of overweight and obesity in Southeast Asian children 2–12 years old. We systematically searched five electronic academic/research (PubMed, PsycINFO, ProQuest Nursing, Medline, and CINAHL) databases using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for peer-reviewed studies published in English between January 2000 and December 2016. Fourteen observational studies met the inclusion criteria and were reviewed. Reviewed studies were examined separately for preschool- and school-aged children and revealed that non-responsive parental feeding practices and unhealthy child eating behaviors were associated with a risk of child overweight and obesity in several Southeast Asian countries. Nonetheless, due to the small number of identified studies (n = 14) and because only about half of the Southeast Asian countries (Thailand, Vietnam, Singapore, the Philippines, and Malaysia) were represented (5/11) in the examined studies, additional research is needed to further understand the factors associated with childhood obesity among children in Southeast Asia to develop interventions that are tailored to the specific needs of Southeast Asian countries and designed to address practices and behaviors that may promote childhood obesity.

OBJECTIVE: To analyze the evolution in the prevalence and determinants of malnutrition in children in the semiarid region of Brazil. METHODS: Data were collected from two cross-sectional population-based household surveys that used the same methodology. Clustering sampling was used to collect data from 8,000 families in Ceará, Northeastern Brazil, for the years 1987 and 2007. Acute undernutrition was calculated as weight/ age < -2 standard deviation (SD); stunting as height/age < -2 SD; wasting as weight/height < -2 SD. Data on biological and sociodemographic determinants were analyzed using hierarchical multivariate analyses based on a theoretical model. RESULTS: A sample of 4,513 and 1,533 children under three years of age, in 1987 and 2007, respectively, were included in the analyses. The prevalence of acute malnutrition was reduced by 60.0%, from 12.6% in 1987 to 4.7% in 2007, while prevalence of stunting was reduced by 50.0%, from 27.0% in 1987 to 13.0% in 2007. Prevalence of wasting changed little in the period. In 1987, socioeconomic and biological characteristics (family income, mother’s education, toilet and tap water availability, children’s medical consultation and hospitalization, age, sex and birth weight) were significantly associated with undernutrition, stunting and wasting. In 2007, the determinants of malnutrition were restricted to biological characteristics (age, sex and birth weight). Only one socioeconomic characteristic, toilet availability, remained associated with stunting. CONCLUSIONS: Socioeconomic development, along with health interventions, may have contributed to improvements in children’s nutritional status. Birth weight, especially extremely low weight (< 1,500 g), appears as the most important risk factor for early childhood malnutrition. RESUMO OBJETIVO: Analisar tendências na prevalência e determinantes da desnutrição em crianças na região semiárida do Brasil. MÉTODOS: Foram analisados dados de duas pesquisas transversais domiciliares de base populacional que utilizaram a mesma metodologia. A amostragem por conglomerados foi utilizada para coletar os dados de 8.000 famílias, do estado do Ceará, Nordeste do Brasil, para os anos de 1987 e 2007. A desnutrição aguda foi calculada como peso/idade < -2 desvios padrão; nanismo como altura/idade < -2 desvios padrão; e emaciação como peso/altura < -2 desvios padrão. Os dados sobre os determinantes biológicos e sociodemográficos foram analisados por meio de análises multivariadas com base em um modelo teórico hierarquizado. RESULTADOS: Amostras de 4.513 e 1.533 crianças menores de três anos de idade, em 1987 e 2007, respectivamente, foram incluídas nas análises. A prevalência de desnutrição aguda foi reduzida em 60,0%, passando de 12,6% em 1987, para 4,7% em 2007, enquanto a prevalência de nanismo foi reduzida em 50,0%, passando de 27,0% em 1987 para 13,0% em 2007. A prevalência de emaciação teve pouca alteração no período. Em 1987, as características socioeconômicas e biológicas (renda familiar, escolaridade da mãe, disponibilidade de latrina e água potável, consulta médica e hospitalização da criança, idade, sexo e peso ao nascer) foram fatores significativamente associados à desnutrição, ao nanismo e à emaciação. Em 2007, os determinantes da desnutrição ficaram restritos às características biológicas (idade, sexo e peso ao nascer). Apenas uma característica socioeconômica, a disponibilidade de latrina, permaneceu significantemente associada ao nanismo. CONCLUSÕES: O desenvolvimento socioeconômico, além de intervenções de saúde, parecem ter efetivamente contribuído para a melhoria do estado nutricional das crianças. Peso ao nascer, especialmente o peso extremamente baixo (< 1.500 g), aparece como o fator de risco mais importante para a desnutrição na primeira infância.

The Supplemental Nutrition Assistance Program (SNAP), the largest federal food assistance program, currently serves 44.7 million Americans with a budget of $75 billion in 2011. This study engaged leading experts for in-depth, semi-structured interviews to explore their opinions concerning the existing challenges and barriers to eating nutritiously in SNAP. Experts also proposed strategies for improving nutritional status among SNAP recipients. Twenty-seven individuals were interviewed from advocacy, government, industry, and research organizations. Interviews were recorded, transcribed, coded and analyzed for thematic content. The high cost of nutrient-rich foods, inadequate SNAP benefits, limited access to purchasing healthy foods, and environmental factors associated with poverty were identified as barriers that influence nutrition among low-income households in the United States. Six themes emerged among respondents from diverse sectors about how to address these challenges including: 1) providing SNAP participants with incentives to purchase nutrient-rich food consistent with the 2010 Dietary Guidelines for Americans; 2) restricting the purchase of nutrient-poor foods and beverages with program benefits; 3) modifying the frequency of SNAP benefit distribution; 4) enhancing nutrition education; 5) improving the SNAP retailer environment and 6) increasing state and federal level coordination and consistency of program implementation. Given the recent dramatic increase in SNAP enrollment, policymakers must address existing barriers as well as consider new strategies to improve nutrition policies in SNAP so that the program can continue to address food insecurity needs as well as provide a healthful diet for SNAP beneficiaries.

The scope of this study is to describe aspects related to the dimensions of access, the service characteristics and factors associated with satisfaction of mothers in the city of Fortaleza, Ceará. It is an observational, cross-sectional population-based study conducted in 2008 in Fortaleza, Ceará. Families with at least one child under 5 years of age living at home and who were users of the Unified Health System (SUS) were included, The Pearson chi-square test, and when appropriate the Fisher exact test, were used for the statistical associations. The study included 350 families. Most reasons given for the consultation was sickness and on a larger scale, performed by physicians; 2/3 of mothers reported having been satisfied with the last service received by the child. The main factors associated with satisfaction were: the doctors who treated the mother/child called them by name, the service was given on the day that the mother needed and the waiting room of the unit had entertainment. Access to primary care was well evaluated. The satisfaction of users is related to the relationship established with health professionals, however the organization of the service and infrastructure of the units are still considered weak points.

This qualitative study of low-income mothers in Buenos Aires, Argentina, examines the influence of socio-economic conditions, organizational structures, family relationships, and food insecurity on child feeding practices and weight status. Thirty-eight mothers of preschool children living in urban Buenos Aires participated in four focus group discussions. The results indicated that many mothers were aware that obesity may be detrimental to the child's health, but most of them are unclear about the specific consequences. Maternal employment, family pressures, food insecurity and financial worries seem to influence child feeding practices. These findings have important implications for developing strategies for nutritional assistance that could benefit the health of children and provide opportunities for educational programs that are directed to nutritional awareness in Buenos Aires, Argentina. The right to eat regularly and properly is an obligation of the State and must be implemented taking into account the notion of food sovereignty and respecting the importance of preserving the culture and eating habits of a country and its diverse population groups

The study estimated the prevalence and determinants of overweight and obesity in women of reproductive age in the Semi-Arid Region of Brazil. In the cluster sampling of 8,000 households of the state of Ceará, 6,845 women were surveyed. Overweight and obesity were measured by the body mass index and risk factors identified by multivariate analysis. The prevalences of overweight and obesity were 32.6% and 16.1%, respectively. After adjusted analysis, obesity was positively associated with age30 years (PR=1.55), marital status, married (PR=1.36), elementary education (PR=1.40), age at menarche12 years (OR=1.59), having1 child (PR=1.65) and contraceptive use (PR=1.31). Specific health and nutritional conditions were identified as highly associated to morbid obesity: hypertension (PR=3.11), diabetes (PR=2.08), dissatisfaction with body image (PR=4.26) and procedures for weight loss (PR=2.73). The study concluded that overweight and obesity are highly prevalent in the Semi-Arid Region of Brazil. Education was the only socioeconomic determinant considered as amenable to change. The reproductive risk factors identified enforce the need to mobilize the services of prenatal and postpartum care and family planning to prevent and control obesity.

As more U.S. children grow up in Latino families, understanding how social class, culture, and environment influence feeding practices is key to preventing obesity. The authors conducted six focus groups and 20 in-depth interviews among immigrant, low-income Latina mothers in the Northeast United States and classified 17 emergent themes from content analysis according to ecologic frameworks for behavior change. Respondents related environmental influences to child feeding, diet, and activity, namely, supermarket proximity, food cost, access to recreational facilities, neighborhood safety, and weather. Television watching was seen as integral to family life, including watching during meals and using TV as babysitter and tool to learn English. Participation in the WIC program helped families address food insecurity, and child care provided healthy eating and physical activity opportunities. Health promotion efforts addressing obesity trends in Latino children must account for organizational and environmental influences on the day-to-day social context of young immigrant families.

BackgroundBreastfeeding and weaning practices are important determinants of growth and development not only in infancy but also later in life.ObjectiveTo describe infant-feeding practices and beliefs about complementary feeding among low-income Brazilian mothers.MethodsQualitative methods included focus group discussions with low-income mothers enrolled in a Family Health/Community Health Workers program in Ceará, Northeast Brazil.ResultsBreastfeeding is widely practiced in this area, and overall, mothers are knowledgeable about the benefits of breastfeeding for their infants and themselves. Practices of prolonged breastfeeding and delayed supplementation of infants with semisolid foods emerged as a problem among very poor women. In addition, the results showed common problems related to complementary feeding practices, such as the early introduction of solid foods and the use of expensive commercial cereals and formula for weaning. Cultural factors and taboos appeared to have an important influence on mothers' infant-feeding practices and eating patterns of their children.ConclusionsThe results have implications for the design of breastfeeding promotion and interventions to improve complementary feeding. Improvements of the national Food Grant Program are also suggested, which are needed by low-income mothers to improve their infant-feeding practices.

Exposure to obesogenic environments in the U.S. may foster development of overweight in immigrants with greater acculturation. Few studies document mechanisms of the acculturation process from immigrants’ own perspectives or describe implications on the children of immigrants. Focus groups and in-depth interviews were conducted with immigrant Latina mothers (N = 51) examining mothers’ beliefs, attitudes and practices related to early child feeding and weight. Focus group participants completing the Marin Acculturation Scale more closely identified with Latino culture, although the mean score (2.04, SD = 0.59) was close to “bicultural”. Analysis revealed seven themes when mothers compared lifestyles between their native countries and the U.S., related to changes in (1) diet, perceived food quality and availability, (2) food and eating practices, (3) breastfeeding practices, (4) beliefs about food, child feeding and weight status, (5) weight status of mothers and children, (6) physical activity and sedentary lifestyles, and (7) social isolation and support.

While the 'immigrant health paradox' posits better health behaviours and outcomes for immigrants upon arrival to the US, research suggests that this advantage may deteriorate over time. This study analysed the relationship of acculturation and breast-feeding initiation and duration among a sample of predominantly Latina, low-income women in the US. The four measures of acculturation included: mother's nativity (foreign born vs US born), mother's parents' nativity (foreign born vs US born), years of US residence (8 years vsor =8 years) and a dichotomous measure of language acculturation adapted from three items on Marin's acculturation scale (preferred language spoken at home, reading language and writing language) as exclusive use of native language versus non-exclusive use (mixed or English only) (Marin et al., 1987; MarinGamba, 1996). Final multivariable models showed that mothers who exclusively used their native language were more likely to initiate breast-feeding as well as breast-feed for longer duration compared with mothers with non-exclusive use, whereas years of US residence and mother's nativity were not significantly associated with breast-feeding initiation or duration. Mother's parents' nativity also emerged as a significant predictor of breast-feeding duration, both within final models for immigrants and across study participants. Programmes providing nutrition education to low-income women may wish to consider the role of language as an important determinant of breast-feeding. The role of mother's parents' nativity on breast-feeding practices deserves exploration in future studies, as the cultural practices taught by family members born outside the US may exert strong pressure within immigrant families now living in the US.