Family Life and Child Obesity: Interactions that Matter

描述(申请人提供)：美国儿童肥胖率创历史新高，在6-11岁的儿童中，有17%的儿童与其年龄相称的身体质量指数偏高。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。这项拟议的研究将考察家庭结构、家庭活动以及儿童营养和体重之间的关系。研究目的：本研究提出以下具体假设：1.家庭结构与儿童在中小学的营养环境和消费选择有关；2.家庭结构与儿童的体重轨迹和肥胖风险有关；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实现的；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。美国儿童在父母共同居住(亲生、继子女、单亲家庭)、与其他非父母成年人共同居住以及与其他儿童共同居住方面经历了无数的家庭结构，这些多样化和不断变化的情况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几个孩子的结果，包括教育、健康行为以及心理和身体健康。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，并考虑其中一些是否更有可能提供促进健康的互动。此外，我们还检查了不同来源儿童之间肥胖风险的差异，并探索这些差异是否源于家庭环境的系统性差异。设计：这将是一个二次数据分析使用幼儿纵向研究幼儿园班级1998-99(ECLSK)，最大的国家纵向研究测量儿童的体重和身高。方法：我们使用了几种方法，在9年中的7个点上使用了关于体重状况、家庭花名册、家庭活动和其他协变量的时变信息：将使用第一差分回归和分层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。两阶段模型和多层次结构方程模型将用于研究家庭结构是如何通过家庭互动来运作的。意义：这项研究将提供关于家庭环境对儿童肥胖风险的影响的经验证据，哪些家庭活动最有希望健康成长，以及将家庭纳入干预措施的策略。它将显示美国家庭的人口结构变化是否正在影响儿童的肥胖风险，以及家庭活动的变化，如合餐，是否真的会影响儿童的体重，正如目前建议的预期一样。 公共卫生相关性：儿童肥胖与较差的身心健康和社会福利有关。以前的研究和干预措施表明，家庭环境对儿童健康体重很重要，但为了减少儿童肥胖的增加，需要更好地了解家庭环境具体如何影响儿童的体重轨迹，家庭中哪些人是重要的，以及哪些家庭活动真正影响儿童体重并导致儿童体重变化。这项研究将为研究和政策提供信息，说明家庭在多大程度上影响儿童的健康行为和体重，以及作为预防和扭转儿童肥胖的干预措施的一部分，让家庭参与或促进家庭活动的预期价值。公众

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