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