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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.

Buscando analisar as terminologias “Educação em Saúde” e “Educação na Saúde”, compreendendo o contexto histórico em que emergiram e seus fundamentos teórico-metodológicos, foi realizado um ensaio teórico a partir do movimento interativo da hermenêutica e dialética. Para tanto, utilizou-se de artigos científicos nacionais e internacionais, documentos legais e manuais do Ministério da Saúde do Brasil, assim como livros sobre a temática disponíveis nos últimos 20 anos. A análise favoreceu depreender que essas terminologias apresentam unidades de sentido próprias, com tessituras convergentes, agrupadas, neste ensaio, em duas categorias: Educação em Saúde e Educação em Saúde. Em seus aspectos, cada modalidade da Educação na Saúde apresenta contribuições aos sistemas de saúde. Todavia, levando em conta que a Educação Permanente tem a capacidade de transformar a realidade e o cotidiano do trabalho em saúde, ela emerge como prática pedagógica inovadora ao setor, estando em consonância com a abordagem educacional sociocultural de Paulo Freire.

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.

This study sought to explore Brazilian immigrant fathers’ perspectives on physical activity (PA) and screen time (ST) of their preschool-age children. Qualitative study consisted of in-depth, semi-structured interviews with a convenience sample of fathers. Interviews were conducted in Portuguese by native Brazilian research staff using a semi-structured interview guide, and were audio-recorded and transcribed verbatim in Portuguese. Transcripts were analyzed thematically using a hybrid method that incorporated deductive and inductive analytical approaches. Twenty-one fathers participated in the study. Analyses revealed that fathers in this study recognized the importance of PA and of limiting ST for their preschool-age for children’s overall health. Fathers also recognized their role in helping their children’s development and maintenance of healthy PA habits. Nonetheless, most fathers reported daily barriers faced in their day-to-day lives since immigrating to the United States that limit PA and promote ST in children. Fathers perceived several factors across levels of the socio-ecological model that influence their children’s PA and ST behaviors including low socioeconomic status, beliefs and practices related to PA and ST, housing, lack of access to safe spaces for PA, lack of affordable organized PA and sports programs for young children, lack of time, work demands, and cold weather. This is the first study conducted with Brazilian fathers living in the United States exploring fathers’ perspectives on PA and ST. Findings may assist in the of development of family-based interventions to promote healthy PA and ST behaviors among this ethnic minority population.

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.

Latinx is the largest minority population group in the United States and disproportionately affected by health disparities. Efforts to address such health disparities require a concerted, multipronged approach that should involve training the next generation of Latinx health professionals to become part of a culturally competent workforce. This article describes a formative assessment of a faculty mentored undergraduate research program at the University Massachusetts–Boston, called “ Avancemos!: Advancing Research Skills and Professional Career Opportunities in Health Sciences for Latinx Undergraduate Students” designed to provide mentorship, research training, and professional career development skills for undergraduate Latinx students. We employed a mixed-method approach in the formative assessment of the program. Our results showed that over the course of four academic semesters the program served a majority female, first-generation, immigrant low-income Latinx undergraduate students. Our qualitative assessment of students’ perceived benefits of participation in the program suggests positive effects on a number of areas including the acquisition of concrete and marketable research skills, enhanced understanding and application of knowledge gained in other courses, increased network, enhanced sense of belonging to the academic community, increased professional self-confidence, and enhanced preparedness and plans to pursue graduate studies. Furthermore, our findings suggest that participation in community-engaged research activities offered opportunities for students to realize the role research plays in reducing health disparities. Faculty-mentored undergraduate research programs such as the Avancemos! offer essential opportunities to build partnerships between academia and underserved Latinx communities to address health disparities, while contributing to the development of culturally competent health professions workforce.

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.

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.

Background: Data suggest that Latinx preschool-age children are at increased risk of obesity. The fastest-growing Latinx population in the United States originates from El Salvador, Guatemala, and Honduras, also known as the Northern Triangle countries. Purpose: To describe how Central American parents from the Northern Triangle countries perceive the importance of energy balance-related behaviors (EBRBs), their preferred sources to obtain information about EBRBs, and to assess whether these differ by parent's gender and country of the nativity. Methods: Cross-sectional survey. Results: Seventy-four parents with at least one child between 2 and 5 years of age participated in the study. More than half were immigrants from El Salvador, Guatemala, and Honduras and were classified as having low acculturation. Mothers perceived consuming >5 fruits and vegetables daily, limiting sugar-sweetened beverages consumption, and having

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.

Chinese immigrants are a fast-growing population group in many parts of the world. Childhood obesity is increasingly a public health problem among Chinese living outside mainland China. Evidence suggests that parenting feeding styles and practices critically influence children’s eating behaviors and risk of being overweight or obese. Therefore, the objectives of this review were to identify and synthesize the evidence from studies examining the associations between parenting feeding styles, feeding practices, and risk of overweight and obesity among children of Chinese parents outside mainland China. A systematic search of four electronic databases (CINAHL, Medline, PsycINFO, and PubMed) was conducted to identify peer-reviewed studies published in English between January 2000 and March 2022. Fifteen studies met the inclusion criteria and were included in the review. Findings of some of the reviewed studies showed that parenting feeding styles and practices varied according to children’s age, gender, weight, and parents’ acculturation levels. The two most identified parenting feeding styles were indulgent and authoritarian. Parents classified as having indulgent and/or authoritarian feeding styles reported using several feeding practices with unintended detrimental effects, such as pressuring children to eat and restricting or controlling child food intake (type and amount). Some of these feeding practices were associated with an increased risk of child overweight. The findings of this review provide important information that can inform the design interventions to address modifiable nonresponisve parental feeding practices such as pressuring, restricting, and controlling that meet the specific needs of Chinese parents and children outside mainland China.

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 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.

Resumo 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.

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.

Objective: Despite increasing interest in understanding factors influencing awareness, knowledge, and acceptability of the human papilloma virus (HPV) vaccine among Latino parents to date, limited information is available specific to Latino fathers living in the United States. Methods: This descriptive qualitative study explored Latino fathers’ awareness, knowledge, and acceptability of the 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. Results: Nineteen, majority foreign-born Latino fathers (63.2%; n = 12) fathers of male and female adolescents participated in the study. 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 attitude toward vaccines in general. Moreover, results revealed fathers’ trust in healthcare providers. This trust translated into an increased willingness to vaccinate their children against HPV if recommended by their child’s primary healthcare provider. Conclusion: Findings indicate the need for increased efforts to raise awareness and knowledge among Latino fathers of HPV and the HPV vaccine. In addition, findings underscore the critical role of healthcare providers’ recommendation of the HPV vaccine. Given the limited research focused on Latino fathers, this study’s findings are valuable in building a knowledge foundation needed for developing future studies and interventions to promote the HPV vaccine by targeting Latino fathers living in the United States. Future research should quantify Latino fathers' awareness, knowledge, and acceptability of the HPV vaccine for their children, and preferences for educational interventions to promote HPV vaccination.

Este estudo teve por objetivo identificar os fatores associados ao baixo peso ao nascer (BPN) em Sobral-CE. Trata-se de estudo transversal com investigação de 2.181 nascimentos ocorridos entre 2006 e 2017, nos quais o desfecho foi o BPN e as variáveis explicativas foram classificadas segundo modelo teórico hierarquizado. A análise recorreu a Regressão de Poisson com variância robusta. O BPN foi mais frequente entre mulheres: a) não brancas; b) que tiveram até 9 anos de estudo; c) que ganhavam até 1 salário mínimo; e d) que não residiam com o companheiro – valores do nível distal; e) menores de 19 anos; f) que realizaram menos de 6 consultas pré-natal; g) que fumaram; e h) que ingeriram álcool na gestação – valores do nível intermediário; bem como i) com intercorrências de hipertensão; j) com diabetes; e k) com sangramento transvaginal durante a gestação – valores do nível proximal. A análise multivariada demonstrou associação com o BPN entre mulheres: a) com hipertensão; b) com diabetes; c) com sangramento transvaginal; d) menores de 19 anos; e) que fumaram na gestação; f) não brancas; e g) que realizaram menos de 6 consultas pré-natal. Concluiu-se haver possibilidade de reduzir a prevalência de BPN com ações voltadas a: a) busca ativa precoce de gestantes para o pré-natal; b) combate ao fumo na gestação; e c) redução da gravidez na adolescência.

BACKGROUND Background: Gestational weight gain (GWG) has been identified as one of the most important modifiable risk factors associated with short- and long-term health outcomes for both a woman and her newborn. Adoption of healthy lifestyles (e.g., diet, physical activity, etc.) during pregnancy has the potential to prevent excess GWG and reduce adverse health risks in pregnancy and beyond. Pregnant women’s access to accurate and evidence-based information about GWG, diet, and physical activity is key to promoting healthy GWG. Conclusions: To our knowledge currently no mHealth interventions are available in the United States for pregnant Brazilian immigrant women. The fact that women in our study were actively seeking information about GWG, diet, and exercise in the Internet suggests the potential for mHealth interventions to deliver linguistic and culturally tailored evidence-based information incorporating behavioral change practices through a low-cost, easy access method to this growing immigrant population in the United States. OBJECTIVE Objective: This study sought to assess sources used by first-time pregnant Brazilian women to seek information about GWG, diet, and exercise during pregnancy. METHODS Methods: Cross-sectional survey of first-time pregnant Brazilian women living in Massachusetts, United States. RESULTS Results: Eighty-six women participated in the study. The majority of the women were born in Brazil (96.5%; n = 83) and had lived in the United States for an average of 10.7 years (SD = 7.3). All women reported Portuguese as their primary language and 67.4% (n = 58) were classified as having low acculturation levels. The mean gestation was 27.5 weeks (SD = 5.6; range 14 – 38 weeks) and 25.6% (n = 22) self-reported being overweight pre-pregnancy. Overall, about two-thirds of the women had actively sought information about GWG (72.1%, n = 62), diet (79.1%, n = 68), and exercise (74.4%, n = 64) on the Internet during pregnancy. Adjusting for age, women who were classified as having low acculturation levels were more likely to seek information about GWG on the Internet (OR = 5.35 [CI: 1.08 – 26.50]; p = 0.04) compared to women who were classified as having high acculturation levels. Moreover, approximately 67% (n = 59), 71% (n = 61), and 52% (n = 45) of the women reported actively seeking information about GWG, diet, and exercise from family and friends, respectively. Women who self-reported being overweight pre-pregnancy were more likely to report seeking information about GWG (OR=2.94 [CI:1.07–8.06], p = 0.04) and less likely to report seeking information about diet (OR=0.27 [0.09–0.75], p = 0.01) and exercise (OR=0.30 [CI: 0.11–0.86], p = 0.02) from family and friends compared to women who self-reported normal weight pre-pregnancy. CONCLUSIONS Conclusions: To our knowledge currently no mHealth interventions are available in the United States for pregnant Brazilian immigrant women. The fact that women in our study were actively seeking information about GWG, diet, and exercise on the Internet suggests the potential for mHealth interventions to deliver linguistic and culturally tailored evidence-based information incorporating behavioral change practices through a low-cost, easy access method to this growing immigrant population in the United States.

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.

BACKGROUND Parents play a critical decision-making role in vaccinating their age-eligible adolescent children against HPV. Despite evidence indicating that Latino adolescents have higher HPV vaccination rates than non-Hispanic whites, uptake of the HPV vaccine remains lower than the 80% goal set by the Healthy People 2020. Moreover, studies suggest that Latino adolescent males have lower rates of HPV vaccination than Latina adolescent females. OBJECTIVE Given the importance of the HPV vaccination as a cancer prevention strategy and the unique decision-making role parents play in vaccinating their children, this study was designed to explore Latina mothers’: (1) acceptance of the HPV vaccine, and (2) suggested strategies to promote vaccine uptake among Latino parents and their adolescent children. METHODS A descriptive qualitative research employing individual semi-structured interviews. Data were analyzed using a hybrid method of thematic analysis that incorporated deductive and inductive approaches. RESULTS Twenty-two, majority foreign-born (91%; n = 20) Latina mothers of adolescent girls (~ 60%; n = 23) and boys (~ 40%; n = 15) aged between 11 and 19 years (mean age of adolescents: 15.3 years) participated in the study. Results revealed mothers’ high acceptance of the HPV vaccine for their daughters and their positive beliefs about the direct benefits of the vaccine to protect their daughters’ health by preventing STI and future cervical cancer risk. Such positive beliefs influenced mothers’ high uptake and initiation of the vaccine for their daughters. In contrast, study findings revealed mothers’ low acceptance and uptake of the vaccine for their sons. Our findings showed that the majority of mothers did not perceiving HPV infection as a major risk to their sons’ health, and therefore, did not perceive direct health benefits of the HPV vaccine for their sons as they did for their daughters (i.e., prevention of cervical cancer). CONCLUSIONS Findings identified the need for increased efforts to raise awareness and knowledge among Latino parents of the direct benefits of the vaccine for their sons and the cancer prevention benefits of the vaccine for HPV-associated cancers that affect not only females but also males. Finally, findings underscore the need for improved healthcare providers' communication and recommendation of the HPV vaccine for Latino adolescent males. Future research should intervene upon findings identified in this study in order to address barriers that remain and affect Latino parents’ acceptance and uptake of the HPV vaccine for their children, and in particular, for their sons. CLINICALTRIAL n/a

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.