Individual, family, and community environmental correlates of obesity in Latino elementary school children.

Trends in US children’s overweight and obesity have accelerated in recent years, including marked increases in racial and ethnic disparities.1 Over the past 3 decades, the childhood obesity rate has more than doubled for children aged 2–5 years and adolescents aged 12–19 years, and it has more than tripled for children aged 6–11 years. Recent national data indicate that an estimated 14.5% of low income preschool children are overweight.2 Latino adults and children have been particularly affected by overweight and obesity.3 In 2008, 18.5% of Latino children were overweight. According to the ecological systems theory (EST), childhood overweight is influenced by individual, family, and community factors.4,5 Children who are sedentary and consume high amounts of sugar-sweetened beverages have a higher prevalence of overweight and obesity.6–8 Studies also show that family characteristics and parenting styles shape children’s activity patterns, dietary intake, and obesity risk. Children of parents who use “controlling strategies” (eg, demanding, rigid) are less likely to eat healthy.9 In contrast, monitoring of children’s eating and reinforcing healthy eating encourage healthy eating.10,11 Although the relationship between parenting styles and children’s physical activity (PA) is not fully understood, research suggests that parents who encourage their children to engage in PA have more active children.12 Family characteristics such as parents’ income level are related to children’s weight status, healthy eating, and PA.13,14 Among Hispanics, studies have been inconsistent in showing an association between parental acculturation and children’s body mass index (BMI).15–17 Investigators finding such a relationship note that the process of parental acculturation likely influences the consumption of unhealthy foods, which places Hispanic families at risk for obesity.18 However, acculturation also has been associated with the adoption of PA which complicates the relation between acculturation and weight status.19 Among the strongest predictors of children’s BMI is parents’ BMI.20 School-related factors also impact children’s risk for obesity. Studies have shown that verbal encouragement by school cafeteria staff is positively related to children’s fruit and vegetable consumption.21 Students in schools that facilitate PA by maintaining their activity grounds and providing physical education classes are more active and less likely to be overweight. Veugelers and Fitzgerald22 found that schools offering at least 2 physical education classes per week had fewer overweight children than schools offering fewer classes. The neighborhood environment is also hypothesized to influence childhood obesity risk, but the evidence for this is mixed.23–25 When considering PA opportunities, Saelens and colleagues26 found that a walkable neighborhood environment (as assessed by residential density, mixed land use, street connectivity, aesthetics, and safety) was associated with higher PA and lower overweight among adults. Most studies examining correlates of children’s weight status have failed to simultaneously consider the relative impact of multiple levels of EST on Latino children’s weight status. As suggested by EST, the proposed study examines 4 levels of influence: child characteristics (eg, gender) and child risk factors (eg, dietary behavior); parenting and parents’ sociodemographic characteristics; school and community related characteristics; and parents’ BMI. Findings from this study can inform future interventions that target modifiable factors with the greatest promise to change the current upward trend in childhood obesity rates.