Culturally Appropriate Childhood Obesity Prevention Program for Hispanic Families

由于过去三十年来儿童肥胖症的患病率不断增加，儿童肥胖症已被列为美国的一个重要公共卫生威胁。在1976年至2002年之间，美国非老年人中肥胖症的患病率增加了一倍以上（Ogden等人，2006年）。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岁儿童的超重流行率增加了三倍以上（从约4%增加到约17%），并且自20世纪70年代以来，6岁以下儿童的超重流行率也增加了（Ogden et al.，2006年）。肥胖的增加与社区的物理设计的变化、美国饮食习惯的变化、身体活动的减少和久坐行为的增加相平行（Gortmaker等人，1990; Fitzgienic，2005）。 虽然这一流行病影响到所有社会经济阶层，但某些种族/族裔群体受到的影响尤其严重。与白色儿童相比，西班牙裔和非洲裔美国儿童的超重率增加更大（Strauss & Pollack，2001年）。与非西班牙裔白色儿童相比，西班牙裔儿童和非裔美国儿童中6岁及以上儿童的超重患病率要高得多（Ogden等人，2002年）。 儿童肥胖症造成中期和长期的健康风险，以及相当大的经济成本。近几十年来，儿童超重和肥胖率的增加已经导致对儿童现在和他们成年后的健康状况的严重公共卫生关注，因为肥胖是许多慢性健康状况（例如，糖尿病、心血管疾病、中风、癌症、关节炎），如Healthy People 2010（Newschaffer等人，1998年，Mokdad等人，2001年;美国卫生和公众健康部，2000年）。肥胖症和相关的慢性健康状况，如糖尿病和心血管疾病，总体上对美国社会造成了严重影响，并且不成比例地影响西班牙裔社区（Mokdad等人，2000年）。鉴于西班牙裔社区在肥胖和相关慢性病的日益流行中承担着相对沉重的负担，需要针对这一人群的文化适当和可持续的创新肥胖预防计划。 医学研究所（IOM）关于预防儿童肥胖的里程碑式报告将评估肥胖预防干预措施确定为研究重点，重点是改善饮食行为，增加身体活动水平和减少久坐行为（Koplan等人，2005年）的报告。国际移民组织的报告还建议父母“应该提倡健康饮食 行为和定期的体育活动，并作为积极的榜样，他们的孩子在饮食和体育活动的行为”（第15页）。国际移民组织的一份后续报告还建议，应制定高质量的干预措施，“考虑到不同的观点，使用与文化相关的方法，并满足不同人口和背景的需要”（Koplan等人，2007年：11）。《国家卫生研究院肥胖研究战略计划》（国家卫生研究院，2004：25）建议，作为解决肥胖症健康差距的战略，“基于社区参与的预期方法至关重要，可以通过应用传播理论和方法来发展。“因此，基于社区的参与性方法可以用于制定文化上适当的干预措施，针对父母解决儿童的营养，体育活动和久坐行为，以预防儿童肥胖。

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.