Culturally Appropriate Childhood Obesity Prevention Program for Hispanic Families

在过去的三十年里，由于儿童肥胖的日益普遍，儿童肥胖已被列为美国严重的公共健康威胁。1976年至2002年间，美国非老年人的肥胖患病率增加了一倍多（Ogden, et al., 2006）。根据国家疾病控制中心（CDC）的估计，自20世纪60年代以来，6-19岁儿童的超重患病率增加了三倍多（从约4%增加到约17%），自20世纪70年代以来，6岁以下儿童的超重患病率也有所增加（Ogden et al., 2006）。肥胖的增加与社区物理设计的变化、美国饮食习惯的变化、体育活动的减少和久坐行为的增加是同步的（Gortmaker等人，1990;Fitzgibbon, 2005）。

Childhood obesity has been ranked as a critical public health threat in the U.S. due to the increasing prevalence of obesity among children over the past three decades. Prevalence of obesity in the U.S. more than doubled among non-elderly adults between 1976 and 2002 (Ogden, et al., 2006). According to national Centers for Disease Control (CDC) estimates, the prevalence of overweight among children ages 6-19 has increased more than three-fold since the 1960's (from around 4% to around 17%), and prevalence of overweight in children under age 6 has also increased since the 1970's (Ogden et al., 2006). The rise in obesity parallels changes in the physical design of communities, changes in American dietary practices, decreases in physical activity, and increases in sedentary behavior (Gortmaker et al., 1990; Fitzgibbon, 2005). While this epidemic affects all socioeconomic levels, certain racial/ethnic groups are disproportionately affected. Rates of increase in overweight among children have been greater among Hispanic and African American children compared to White children (Strauss & Pollack, 2001). Prevalence of overweight among children age 6 and over is substantially higher among Hispanic children and African American children, compared to non-Hispanic White children (Ogden et al., 2002). Childhood obesity poses both intermediate and long-term health risks, as well as considerable economic costs. Increases in rates of overweight and obesity among children over recent decades have led to a serious public health concern over the health status of children now and when they become adults, given that obesity is a risk factor for numerous chronic health conditions (e.g., diabetes, cardiovascular disease, stroke, cancer, arthritis), as highlighted in Healthy People 2010 (Newschaffer et al., 1998, Mokdad et al., 2001; US DHHS, 2000). Obesity and related chronic health conditions such as diabetes and cardiovascular disease are taking a heavy toll on the U.S. society in general and disproportionately affect Hispanic communities (Mokdad et al., 2000). Given that Hispanic communities carry a relatively heavy burden in the growing epidemic of obesity and related chronic conditions, innovative obesity prevention programs that are culturally-appropriate and sustainable are needed to target this population. A landmark Institute of Medicine (IOM) report on preventing childhood obesity identified as a research priority the evaluation of obesity prevention interventions that focus on improving dietary behaviors, increasing physical activity levels, and reducing sedentary behaviors (Koplan et al., 2005). The IOM report also recommends that parents "should promote healthful eating behaviors and regular physical activity for their children and serve as positive role models for their children regarding eating and physical-activity behaviors" (p. 15). A follow-up IOM report also recommends that quality interventions should be developed "that take into account diverse perspectives, that use culturally relevant approaches, and that meet the needs of diverse populations and contexts" (Koplan et al., 2007:11). The Strategic Plan for NIH Obesity Research (NIH, 2004:25) recommends as a strategy for addressing health disparities in obesity that "[p]articipatory approaches based on community engagement are essential and could be developed through the application of communication theories and methods." Thus, community-based participatory approaches can be used to develop culturally-appropriate interventions that target parents to address nutrition, physical activity, and sedentary behaviors in their children to prevent childhood obesity.