Family Life and Child Obesity: Interactions that Matter

描述（由申请人提供）：美国儿童肥胖的患病率处于历史最高水平，6-11岁的儿童中有17%的人体重指数高于他们的年龄。儿童肥胖与较差的身心健康和社会福利有关。目的：家庭是对儿童中期健康影响最大的环境。这项拟议的研究将调查尚未得到充分研究的家庭结构、家庭活动与儿童营养和体重之间的关系。目的：本研究提出以下具体假设：家庭结构对儿童的营养环境和消费选择有影响；2. 家庭结构与儿童体重轨迹和肥胖风险相关；3. 家庭结构对儿童营养和体重轨迹的影响部分是通过家庭互动产生的；和4。家庭环境对儿童营养和体重的影响存在文化和种族差异。美国儿童经历了无数的家庭结构，包括父母共同居住（亲生的、继的、单亲的家庭），与其他非父母的成年人共同居住，以及与其他孩子共同居住，这些多样化和变化的环境可能会影响营养和肥胖风险。先前的研究表明，家庭环境的这些方面会影响儿童的几个方面，包括教育、健康行为、心理和身体健康。家庭结构也可能影响儿童的营养和肥胖风险。我们测试了预计会影响儿童体重的家庭互动，包括膳食、活动水平和规则，并考虑是否有些家庭互动更有可能提供促进健康的互动。此外，我们研究了不同出身儿童之间肥胖风险的差异，并探讨这些差异是否源于家庭环境的系统性差异。设计：这将是使用1998-99年幼儿纵向研究幼儿园班级（ECLSK）的二级数据分析，这是全国最大的测量儿童体重和身高的纵向研究。方法：我们使用了几种方法，在9年的7个时间点上获得了体重状况、家庭名单、家庭活动等协变量的时变信息：我们将使用一阶差分回归和层次线性模型来探索家庭结构变化与体重和营养变化之间的关系。两阶段模型和多层结构方程模型将被用来研究家庭结构如何通过家庭互动运作。意义：本研究将提供关于家庭环境对儿童肥胖风险影响的实证证据，哪些家庭活动对健康成长最有希望，以及将家庭纳入干预的策略。它将显示美国家庭的人口结构变化是否会影响儿童的肥胖风险，以及家庭活动的变化，如共同用餐，是否确实会影响儿童的体重，正如目前建议的预期那样。

DESCRIPTION (provided by applicant): The prevalence of obesity among American children is at an all-time high, with 17% of 6-11 year-olds having high body mass index for their age. Child obesity is associated with poorer physical and mental health and social wellbeing. OBJECTIVES: The home is the most influential environment for health in middle childhood. The proposed research will examine understudied relationships between family structure, family activities, and children's nutrition and weight. AIMS: The study addresses the following specific hypotheses: 1. Family structure is associated with children's nutrition environment and consumption choices in elementary and middle school; 2. Family structure is associated with children's weight trajectories and obesity risks; 3. The influence of family structure on children's nutrition and weight trajectories is partly through family interactions; and 4. There are cultural and racial differences in the implications of home environment for children's nutrition and weight. American children experience a myriad of family structures in terms of parental co-residence (biological, step, single-parent families), co-residence with other non-parental adults, and co-residence with other children, and these diverse and shifting circumstances may affect nutrition and obesity risks. Previous studies have shown that these aspects of the home environment affect several child outcomes, including education, health behaviors, and mental and physical health. Family structure may also influence children's nutrition and obesity risks. We test the family interactions that are expected to affect children's weight, including meals, activity levels and rules, and consider whether some are more likely to provide health promoting interactions. In addition, we examine disparities in obesity risks between diverse origin children and explore whether these arise from systematic differences in home environments. DESIGN: This will be a secondary data analysis using the Early Childhood Longitudinal Study Kindergarten Class of 1998-99 (ECLSK), the largest national longitudinal study measuring child weight and height. METHODS: We use several methods with time-varying information on weight status, family roster, family activities and other covariates at 7 points over 9 years: first-difference regressions and hierarchical linear models will be used to explore relationships between changes in family structure and changes in weight and nutrition. Two-stage models and multilevel structural equation models will be used to examine how family structure operates through family interactions. SIGNIFICANCE: This study will provide empirical evidence about the effects of the home environment on children's obesity risks, which family activities hold the greatest promise for healthy growth, and strategies for incorporating the family in interventions. It will show whether demographic changes in the American family are affecting children's obesity risks and whether changes in family activities, such as shared meals, can indeed affect children's weight, as is the expectation of current recommendations. PUBLIC HEALTH RELEVANCE: Childhood obesity is associated with poorer physical and mental health and social wellbeing. Previous studies and interventions have indicated that the family environment is important for healthy weight in children, but in order to reduce increases in child obesity, a better understanding is needed of specifically how the family environment affects children's weight trajectories, which individuals within the home are important, and what home-based activities really affect weight and bring about weight change in children. This study will inform research and policy about the extent to which children's health behavior and weight are shaped by the family and about the expected value of involving the family or promoting family activities as part of interventions to prevent and reverse obesity among children. Public