Mothers play a vital role in providing healthy food choices for their preschool children. This role has become more complex in the present obesity-producing environment that has contributed to the increasing prevalence of childhood overweight and obesity in Canada. Childhood overweight and obesity is a significant public health issue in Nova Scotia where the percentage is higher than the national average. The purpose of this study was to generate a theoretical understanding of the process in which 18 mothers living within the Cape Breton Regional Municipality engaged while making food choices for their preschool children. Constructivist grounded theory methodology informed by sensitising constructs from symbolic interaction and the socio-environmental health promotion perspective facilitated a multilevel exploration of the factors that affect mothers’ food choice practices for their preschoolers. Data collection took place over 16 months. Thirty-five interviews were completed. Grounded theory methods were used to analyze the data and a substantive theory of how mothers made food choices for their preschool children was co-constructed with the participants. The substantive theory, Persistent Optimizing, consists of three main integrated conceptual categories. In the first conceptual category, Acknowledging Contextual Constraints, mothers acknowledged various individual, interpersonal, and socio-environmental contextual factors that hindered their ability to make intended, healthier food choices for their children. In the second conceptual category, Stretching Boundaries, mothers developed and enacted moderating strategies to lessen the impact of contextual constraints, thereby increasing the number of food choices available to them. In the third conceptual category, Strategic Positioning, mothers developed and enacted a variety of optimizing strategies to get them closer to making the optimal food choice for their children in a given situation. Mothers in this study struggled continuously with varying degrees of success to provide the foods they believed their children needed. The findings suggest that in practice, policy, research, and education, community health nurses must work independently and collaboratively at all levels of influence to facilitate, mediate, and advocate for social, economic, and physical environments that improve mothers’ ability to make food choices that promote their children’s health and reduce their risk of becoming overweight and obese.

Over the past 20 years there has been a clear shift in Peru’s mortality profile towards non-communicable diseases. As part of this transition, childhood overweight and obesity (O&O) has become a growing public health concern. In order to address this challenge, context-specific information is needed concerning prevalence, associated factors and culturally appropriate interventions. To this end, I conducted a mixed methods study using a socio-ecological framework to investigate childhood overweight and obesity in Peru. This study found a prevalence of 19.2% overweight and 8.6% obesity among children aged seven to eight in a pro-poor cohort in Peru. Factors associated with being overweight in this cohort included: a high socioeconomic status, living in metropolitan Lima, an O&O mother, being male and being an only child or having only one sibling. The quantitative analysis highlighted the prevalence in O&O in this population and revealed a number of relationships explored in more depth via interviews and focus group discussions. The qualitative component of this research explored these associations amongst a sub-sample of children, parents and teachers in three distinct geographical regions in Peru. My qualitative research showed that parents, teachers and children are aware of the health implications of childhood overweight and obesity and that they have a sophisticated understanding of the many factors that influence its aetiology. Participants also had many suggestions for ways to address this issue in their community. This information was complemented by a systematic review and meta-analysis of the evidence of childhood O&O interventions that took place in Latin America published between 1990 and 2011. A combination of diet, physical activity and pharmaceutical strategies have shown modest effect on BMI reduction in O&O children, but more evidence is needed for effective population-level prevention strategies. The findings highlight the need for comprehensive, multi-level interventions. Notable intervention components include: kiosco reform, junk food taxation, creation of recreational space and enhancement of school-based physical activity programmes. To accomplish this, communities need to be mobilised and work together with school administration, municipal and national government.

Children’s risk for overweight and obesity is particularly high in rural areas of the United States. Many health, psychosocial, and economic consequences are associated with childhood overweight and obesity, which concerns health researchers and professionals. But how and why might rural children be more at risk for being overweight and obese? This dissertation investigates childhood overweight and obesity in rural settings through three separate studies. First, a systematic literature review was conducted to identify determinants and mechanisms of childhood obesity-related behaviors that are specific to rural locations. The findings from the review show that lack of health resources and poverty within the rural environment may impact children’s social environment and individual factors. However, results are inconclusive and there continues to be a lack of studies focusing on linking environmental influence with individual factors. Second, a meta-analysis of current research evidence was conducted to assess the efficacy of rural interventions designed to reduce childhood overweight and obesity. Results showed that interventions have been efficacious yet modest, with a mean effect size of 0.18. Moderating variables were also examined. Mean intervention effect size was moderated by children’s age and intervention duration. Last, secondary data were used to examine the association between rural food stores and availability and affordability of fresh fruits and vegetables. A multilevel analytical approach was used to determine if rural location was associated with availability and affordability of fresh fruits and vegetables. After controlling for other variables, results showed that rural location was not associated with fruit and vegetable availability and affordability. The findings from this dissertation suggest that the area of rural childhood overweight and obesity remains understudied. More research is needed in order to understand the mechanisms of social ecological influences on diet, physical activity, and childhood overweight and obesity. This area of research, however, is rife with opportunities for public health education and promotion. Public health educators can help promote and advocate for environmental conditions that support healthy lifestyles.

Overweight and obesity among children and youth in the United States is a serious public health concern. The longitudinal relationships between maternal depression and childhood overweight and obesity were examined using data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (NICHD SECCYD). A national cohort of 1,384 children was followed from birth to adolescence and longitudinal data collected on multiple variables, including child weight and height, maternal depression, maternal influence, and family context. Maternal Depression was assessed by the Center of Epidemiological Studies Depression Scale (CES-D) and defined as a score of 16 or greater. Overweight and obesity were defined according to the recommended BMI age- and sex-specific percentiles. Maternal depression was assessed when the child was 1 month old, 36 months, and in grade 1. Overweight and obesity status was assessed at 36 months, grade 1, grade 3, and grade 6. The effect of changes or persistence in the pattern of maternal depression for different childhood age points on the development of childhood overweight and obesity was evaluated. A variety of statistical methods were used including t-test, ANOVA, multiple linear regression, multiple logistic regression, and generalized estimation equation (GEE). Results: After adjustment for confounding, compared with mothers with no depression at child's age of 1 month, 36 months, and in grade 1, mothers with depression at 1 or 2 of those time points had a 45% higher risk for childhood overweight and obesity at grade 3 (OR= 1.45, 95% CI= 1.01-2.07). For mothers with depression at all 3 time points, there was an even greater increase in risk at grade 3 (OR= 2.25, 95% CI= 1.05-4.84) and grade 6 (OR= 3.36, 95% CI= 1.46-7.77). Conclusion: Maternal depression is associated with childhood overweight and obesity. Child overweight and obesity intervention efforts may benefit from identifying strategies to improve maternal mental health status, including depression.

This study examined the longitudinal associations of family income level, maternal marital status, and maternal employment with body mass measurements and the development of overweight and obesity. Multiple linear and logistic regressions were used to assess the effects of the exposure variables on weight status with simultaneous adjustment for the exposure variables and the covariates. Key findings include: Children in families with incomes below the poverty line at child's 24 or 54 months of age were at a higher risk of becoming overweight and obese at child's third grade than children in families with incomes above the poverty line; longer maternal working hours at child's 54 months of age was associated with an increased risk of overweight and obesity at child's third grade. In conclusion, this study confirms that family poverty status and maternal working hours are associated with child's overweight and obesity risk.

The prevalence of childhood overweight and obesity is increasing at an alarming rate in the United States. Currently more than 1 in 3 children aged 2-19 are overweight or obese. This is of major concern because childhood overweight and obesity leads to chronic conditions such as type II diabetes and tracks into adulthood, where more severe adverse health outcomes arise. In this study I used the premise of the social ecological model (SEM) to analyze the common levels that a child is exposed to daily; the intrapersonal level, the interpersonal level, the school level, and the community level to better understand what risk factors are significantly associated with child weight status. Data came from the 2012 National Survey of Children's Health (NSCH) (n=41,361). Frequencies and confidence intervals were used to describe risk factors at each level. Bivariate analyses were conducted between each risk factor and the outcome variable. Using all risk factors that were significantly associated with overweight and obesity in the bivariate analyses, multinomial logistic regressions were performed for each SEM level. The 4 SEM levels were then analyzed together using stagewise multinomial logistic regression. A significance level cutoff of 0.05 was applied to all analyses. Thirty-three percent of participants were overweight or obese. Child sex, race, age, child physical activity participation, mother’s education and health, the child’s family structure, the child’s participation in extracurricular activities, frequency of family meals at home, safety and engagement in school, the number of amenities and the safety and support within their communities were found to be significantly associated with child weight status. The odds ratios of the covariates in the final stagewise model were similar to those in each individual model. Understanding both the risk factors associated with child overweight and obesity in each individual level and in the complete socio-ecological perspective is important when working toward more effective policy and program creation and the reduction of childhood obesity. Recognizing that all levels of a child's SEM influence his or her likelihood of being overweight or obese can lead to more effective strategies that tackle multiple SEM levels collectively instead of each level independently.