Elsevier

Annals of Epidemiology

Volume 24, Issue 1, January 2014, Pages 36-43
Annals of Epidemiology

Original article
Theoretical foundations of the Study of Latino (SOL) Youth: implications for obesity and cardiometabolic risk

https://doi.org/10.1016/j.annepidem.2013.10.011Get rights and content

Abstract

Purpose

This article describes the conceptual model developed for the Hispanic Community Health Study/Study of Latino Youth, a multisite epidemiologic study of obesity and cardiometabolic risk among U.S. Hispanic/Latino children.

Methods

Public health, psychology, and sociology research were examined for relevant theories and paradigms. This research, in turn, led us to consider several study design features to best represent both risk and protective factors from multiple levels of influence, as well as the identification of culturally relevant scales to capture identified constructs.

Results

The Socio-Ecological Framework, Social Cognitive Theory, family systems theory, and acculturation research informed the specification of our conceptual model. Data are being collected from both children and parents in the household to examine the bidirectional influence of children and their parents, including the potential contribution of intergenerational differences in acculturation as a risk factor. Children and parents are reporting on individual, interpersonal, and perceived organizational and community influences on children's risk for obesity consistent with Socio-Ecological Framework.

Conclusions

Much research has been conducted on obesity, yet conceptual models examining risk and protective factors lack specificity in several areas. Study of Latino Youth is designed to fill a gap in this research and inform future efforts.

Introduction

The problem of childhood obesity continues in the United States, with a prevalence of 31% among the general population of children aged 6–19 years [1]. Mexican-American boys aged 12–19 years are among the highest at risk for being obese (49%), followed closely by other Hispanic/Latino boys aged 12–19 years (46%). Studies examining differences by specific Hispanic/Latino background in the United States are lacking, although evidence from Latin America suggests that among adults, Mexicans have the highest prevalence rates followed by residents of Central America [2]. Research to better understand sources of influence are sorely needed, given the numerous negative implications of childhood obesity, including adult obesity [3], associated comorbidities [4], compromises in quality of life [5], and early mortality [6]. The Study of Latino (SOL) Youth study is designed to fill this gap.

SOL Youth is a multisite observational study funded by the National Heart, Lung, and Blood Institute to examine factors associated with childhood obesity and cardiometabolic risk among a diverse sample of Hispanic/Latino children (aged 8–16 years; N = 1600) living in one of four U.S. cities (Bronx, Chicago, Miami, and San Diego; see Isasi et al., in press). The specific aims of SOL Youth are to (1) evaluate the influence of child acculturation and intergenerational differences in acculturation between children and parents on children's obesity-related behaviors and their cardiometabolic risk profiles; (2) test the association of parenting strategies and practices with children's obesity-related behaviors and cardiometabolic risk profiles; and (3) assess the influence of child psychosocial functioning on obesity-related behaviors and cardiometabolic risk profiles. Aims were informed by several theoretical frameworks relevant to childhood obesity and based on a conceptual model representing sources of influence specific to U.S. Hispanic/Latino children.

The SOL Youth study is informed predominantly by the Socio-Ecological Framework (SEF) [7], [8] and Social Cognitive Theory (SCT) [9]. SEF differentiates influences as occurring at multiple levels [7], including at the individual, interpersonal, organizational, and community levels. These levels exert both direct and indirect influences on behaviors and interact with each other to influence behaviors and health outcomes. Research demonstrates associations between multiple levels of SEF and childhood obesity [10], [11]. Similarly, SCT supports the concept of interactions between influences in its concept of reciprocal determinism, the dynamic interplay between a person, his/her behaviors, and the environment in which these behaviors take place [9]. Elements of the person include his/her cognitions, norms, and factors that may influence these (e.g., demographic variables). The environment includes both social and physical influences, the former best represented by personal relationships and the latter represented by the availability of healthy options in a grocery store, for example. There is substantial evidence supporting the association between concepts in SCT and childhood obesity [12].

Complementing both SEF and SCT are additional theoretical frameworks including Family Systems Theory (FST) [13], [14] and theories of acculturation [15], [16], [17]. FST posits that individuals within the family exert an influence over others, while simultaneously being influenced by the environment that is created by these interactions [18]. As such, intervention researchers have successfully targeted the family to prevent and control childhood obesity [19]. Central to the present study are the FST concepts of subsystems and levels within the family system. Among the most widely studied subsystems in childhood obesity research is the parent-children relationship [18]. A wealth of research supports the importance of parenting on childhood obesity [20]. Second, within families, there are both first- and second-order system levels. From the perspective of childhood obesity, Skelton et al. [18] argues that first-order system levels are considered primary; for example, whether families eat meals together. However, first-order system levels may not occur without the presence of second-order system levels; for example, families having the necessary time management and communication skills to facilitate family meals. This evidence dictates the need to consider both direct and indirect influences on obesity.

Finally, as defined by Berry [15] and others [17], [21], acculturation refers to the process of change that occurs in language use, behaviors, social norms, and other aspects of human life with continuous, first-hand contact with a dominant ethnic group that is different from one's own. This process is considered both multidimensional (occurring on more than one cultural dimension, e.g., language and norms), as well as bidirectional. Regarding the latter and in part depending on the characteristics of the receiving community (e.g., individuals living on the U.S.-Mexico border can function without learning English), individuals may retain aspects of their original culture and thus remain traditional in their cultural orientation, they may become assimilated and lose all or most of their original culture, or they may become bicultural, retaining some aspects of their original culture and adopting new ones from their new culture. Research in acculturation provides some evidence supporting the associations between several dimensions of acculturation and Hispanic/Latino childhood obesity.

SOL Youth researchers brought these complementary lines of research to create a conceptual model (see Fig. 1) that was then used to guide selection of measures (Table 1).

Section snippets

Individual

At the individual level, genetic factors can influence the development of obesity and often work in concert with behavioral and environmental influences [22], [23]. Behaviors such as diet [24], [25], [26], [27], physical activity (PA) [25], [28], [29], and inactivity (most notably screen time) [26], [30], [31] and short sleep duration [32] are associated with childhood obesity among U.S. Hispanic/Latino children. Nevertheless, results are not always consistent. For example, Field et al.

Application to SOL Youth

The conceptual model described above was used to inform the selection of study measures (see Table 1; additional details on study measures can be found in Isasi et al, in press). Highlighted next are three innovative features of the SOL Youth study and their implications for Latino family health research: collection of data from children and parents, multiple operationalizations of acculturation, and multiple operationalizations of familial/parental influences.

Conclusions

SOL Youth is an innovative study examining factors associated with childhood obesity and cardiometabolic risk. Using several well-established theoretical frameworks, SOL Youth investigators created a conceptual model to inform several study design features, as well as contextually and culturally relevant measurement approaches to the collection of measured and self-reported data.

Acknowledgments

The SOL Youth study was supported by grant number R01HL102130 from the National Heart, Lung, And Blood Institute (NHLBI). The children in SOL Youth are drawn from the study of adults: The Hispanic Community Health Study/Study of Latinos, which was supported by contracts from NHLBI to the University of North Carolina (N01-HC65233), University of Miami (N01-HC65234), Albert Einstein College of Medicine (N01-HC65235), Northwestern University (N01-HC65236), and San Diego State University (

References (92)

  • E. Fuentes-Afflick et al.

    Overweight in young Latino children

    Arch Med Res

    (2008)
  • K.M. Sussner et al.

    The influence of maternal acculturation on child body mass index at age 24 months

    J Am Diet Assoc

    (2009)
  • M.K. Fox et al.

    Association between school food environment and practices and body mass index of US public school children

    J Am Diet Assoc

    (2009)
  • F. Harrison et al.

    A framework for understanding school based physical environmental influences on childhood obesity

    Health Place

    (2012)
  • L.M. Powell et al.

    Associations between access to food stores and adolescent body mass index

    Am J Prev Med

    (2007)
  • M.P. Galvez et al.

    Childhood obesity and neighborhood food-store availability in an inner-city community

    Acad Pediatr

    (2009)
  • M.A. Lewis et al.

    Understanding health behavior change among couples: an interdependence and communal coping approach

    Soc Sci Med

    (2006)
  • L.M. Hunt et al.

    Should “acculturation” be a variable in health research? A critical review of research on US Hispanics

    Soc Sci Med

    (2004)
  • S. Larios et al.

    Development and validation of a scale to measure Latino parenting strategies related to children's obesigenic behaviors. The Parenting Strategies for Eating and Activity Scale (PEAS)

    Appetite

    (2009)
  • C.L. Ogden et al.

    Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010

    JAMA

    (2012)
  • C. Filozof et al.

    Obesity prevalence and trends in Latin-American countries

    Obes Rev

    (2001)
  • D.S. Freedman et al.

    Racial differences in the tracking of childhood BMI to adulthood

    Obes Res

    (2005)
  • A.D. Liese et al.

    The burden of diabetes mellitus among US youth: prevalence estimates from the SEARCH for Diabetes in Youth Study

    Pediatrics

    (2006)
  • J.B. Schwimmer et al.

    Health-related quality of life of severely obese children and adolescents

    JAMA

    (2003)
  • M.H. Park et al.

    The impact of childhood obesity on morbidity and mortality in adulthood: a systematic review

    Obes Rev

    (2012)
  • D. Stokols

    Translating social ecological theory into guidelines for community health promotion

    Am J Health Promot

    (1996)
  • U. Bronfenbrenner

    The ecology of human development: experiments by nature and design

    (1979)
  • A. Bandura

    Social foundations of thought and action: a Social Cognitive Theory

    (1986)
  • W. Maziak et al.

    Childhood obesity: are we missing the big picture?

    Obes Rev

    (2008)
  • E.T. Sosa

    Mexican American mothers' perceptions of childhood obesity: a theory-guided systematic literature review

    Health Educ Behav

    (2012)
  • C. Broderick

    Understanding family process: basics of Family Systems Theory

    (1993)
  • J.M. White et al.

    The systems framework. Family theories

    (2007)
  • J.W. Berry

    Conceptual approaches to acculturation

  • A.F. Abraído-Lanza et al.

    Toward a theory-driven model of acculturation in public health research

    Am J Public Health

    (2006)
  • I.A. Cuéllar et al.

    Acculturation Rating Scale for Mexican Americans-II: a revision of the original ARSMA scale

    Hispanic J Behav Sci

    (1995)
  • J.A. Skelton et al.

    Where are family theories in family-based obesity treatment?: conceptualizing the study of families in pediatric weight management

    Int J Obes (Lond)

    (2012)
  • J.M. Berge et al.

    Family-based interventions targeting childhood obesity: a meta-analysis

    Child Obes

    (2011)
  • A. Ventura et al.

    Does parenting affect children's eating and weight status?

    Int J Behav Nutr Phys Act

    (2008)
  • G. Marín et al.

    A new measurement of acculturation for Hispanics: the Bidimensional Acculturation Scale for Hispanics (BAS)

    Hispanic J Behav Sci

    (1996)
  • J.R. Fernandez et al.

    Genetic influences in childhood obesity: recent progress and recommendations for experimental designs

    Int J Obes (Lond)

    (2012)
  • J. Carlson et al.

    Dietary-related and physical activity-related predictors of obesity in children: a 2-yr prospective study

    Child Obes

    (2012)
  • A.J. Ariza et al.

    Risk factors for overweight in five- to six-year-old Hispanic-American children: a pilot study

    J Urban Health

    (2004)
  • R. Andersen et al.

    Relationship of physical activity and television watching with body weight and level of fatness among children: results from the Third National Health and Nutrition Examination Survey

    JAMA

    (1998)
  • J. Giammattei et al.

    Television watching and soft drink consumption: associations with obesity in 11- to 13-year-old schoolchildren

    Arch Pediatr Adolesc Med

    (2003)
  • J. Liu et al.

    Sleep duration and overweight/obesity in children: review and implications for pediatric nursing

    J Spec Pediatr Nurs

    (2012)
  • A.E. Field et al.

    Association between fruit and vegetable intake and change in body mass index among a large sample of children and adolescents in the United States

    Int J Obes Relat Metab Disord

    (2003)
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