Parent Health Literacy and “Obesogenic” Feeding and Physical Activity-Related Infant Care Behaviors

Abstract

Objective To examine the relationship between parent health literacy and “obesogenic” infant care behaviors. Study design Cross-sectional analysis of baseline data from a cluster randomized controlled trial of a primary care-based, early childhood obesity prevention program (Greenlight). English and Spanish-speaking parents of 2 month old children enrolled (n=844). The primary predictor variable was a parent health literacy (Short Test of Functional Health Literacy in Adults (STOFHLA); adequate>=23; low<23). Primary outcome variables involving self-reported obesogenic behaviors: (1) feeding content (more formula than breastmilk, sweet drinks, early solid food introduction) and feeding style-related behaviors (pressuring to finish, laissez-faire bottle propping/television [TV] watching while feeding, non-responsiveness in letting child decide amount to eat); and (2) physical activity (tummy time, TV). Multivariate logistic regression analyses (binary, proportional odds models) performed adjusting for child sex, out of home care, WIC status, parent age, race/ethnicity, language, number of adults/children in home, income, and site. Results 11.0% of parents were categorized as having low health literacy. Low health literacy significantly increased the odds of a parent reporting that they feed more formula than breast milk (AOR=2.0 [95%CI:1.2–3.5]), immediately feed when their child cries (AOR=1.8[1.1–2.8]), bottle prop (AOR=1.8 [1.002–3.1]), any infant TV watching (AOR=1.8 [1.1–3.0]), and inadequate tummy time (<30 minutes/day) (AOR=3.0[1.5–5.8]). Conclusions Low parent health literacy is associated with certain obesogenic infant care behaviors. These behaviors may be modifiable targets for low health literacy-focused interventions to help reduce childhood obesity.

Parent Health Literacy, Depression, and Risk for Pediatric Injury

“…Our findings are largely consistent with previous studies showing associations of low parent health literacy with pediatric 9,[11][12][13][14][15][16][17]32 and adult 3 health outcomes. Similar to a clinic-based study by Heerman et al, 12 parents with low health literacy in our sample were less likely than parents with adequate health literacy to adhere to certain injury prevention practices, such as having their hot water heaters set to <120°F or ensuring the home had a working smoke detector.…”

“…Similar to a clinic-based study by Heerman et al, 12 parents with low health literacy in our sample were less likely than parents with adequate health literacy to adhere to certain injury prevention practices, such as having their hot water heaters set to <120°F or ensuring the home had a working smoke detector. Consistent with Yin et al, 11 we also found that parents 5 by guest on May 9, 2018 http://pediatrics.aappublications.org/ Downloaded from with low health literacy were more likely to report television watching of >2 hours per day by their children, an obesogenic risk factor in preschool and young adult populations. 33 In contrast to other studies, however, parents with low health literacy were not more likely to report improper car seat placement, 12 and unexpectedly, they were also less likely to report having a television in the child's bedroom.…”

“…5,8 There is also some evidence that low maternal health literacy is independently associated with maternal depression, 9 a critical determinant of child health. 10 Recent investigations have identified several child health outcomes associated with low parent health literacy, including higher rates of obesogenic infant care practices (eg, formula feeding, television viewing), 11 nonadherence to injury prevention guidelines such as car seat position, 12 errors in dosing child medication, 13 children's poor oral health status, 14 and for children with asthma, increased emergency department visits, 15,16 hospitalizations, 16 and missed school days. 16 Still other studies report null findings.…”

Obesity Prevention in Children from Birth to Age 5

“…Obesity in infants is a controversial topic; however, research supports a link between rapid early infant growth and later obesity. [60][61][62][63] Feeding. There are concerns with diagnosing obesity in infancy because of the unintended consequence of a mother's restricting food intake during infancy; restriction of fat intake can adversely impact brain development.…”

“…85 Parental health literacy effects can create an obesogenic infant feeding environment; parents with low health literacy were significantly more likely to formula feed their children, feed as soon as the infant cried, and force the infant to consume all the bottle and early solid food supplement. 62 Since health literacy can be increased by education, a childhood obesity prevention strategy might be to increase parent's health literacy so that they do not create obesogenic conditions for their child. Higher caloric consumption (ie carbohydrate) during solid food supplementation is associated with higher BMI in childhood.…”