Table 1.

Literature Regarding Factors in the Home Food Environment that Influence Childhood Obesity in the Latino Population.

PARENTAL INFLUENCE
Reference	Sample Characteristics	Design/Measures	Findings
Evans et al, 200910	Parents of children ages 1–5 years. 659 parents, 55% of whom were Hispanic.	Cross-sectional questionnaire in which parent answered questions about: child overeating concerns, child underweight concerns, difficulty with picky eating, using food to calm, and pushing child to eat.	Three significant findings: 1) Most common feeding practices were pressuring children to eat more and dealing with picky eating. Parents were less likely to restrict their children from eating; 2) There are differences between less acculturated and more acculturated Latino parents; 3) There were significant differences in parent feeding practices and concerns according to demographics, suggesting that parental feeding practices may not be the cause of the disparities but instead they may be rooted in the environment in which these children and their families live.
Larios et al, 200912	30 mothers for phase 1 and 91 mothers for phase 2. 100% of the mothers were Hispanic. Mothers had average of 3 children under age 18 (mean=7 years) but when answering surveys they imagined a 5-8 year old.	For phase 1, mothers participated in focus groups. For phase 2, mothers completed a one-time survey- the child- feeding questionnaire (CFQ). The intent of phase 1 was to identify types of parenting strategies used in participant homes that may be related to child feeding activity. In phase 2, the CFQ measured limit setting, monitoring, discipline, control and concern.	Results from the focus groups suggested three primary themes: 1) Latina mothers restrict snacks and other foods; 2) The day of the week (week day vs. weekend) affected the rules for sedentary behaviors; 3) Discipline strategies used in home are generally communicated verbally to children. From the CFQ in phase 2, it was concluded that parenting strategies characterized as controlling were associated with a lower BMI among children.
Olvera et al, 200940	Sixty-nine low-income Mexican American mothers and their 4- to 8- year-old children	4-year longitudinal study. Mothers completed demographic and parenting measures. Children's body weight and height were assessed annually. Body mass index was calculated to determine weight status.	Analyses examined how parenting styles at baseline predicted child's weight status 3 years later, controlling for initial weight status. Children of indulgent mothers were more likely to become overweight 3 years later than children of authoritative or authoritarian mothers. This study provides longitudinal evidence for the role of indulgent parenting in predicting overweight in Mexican American children. Possible mediating factors that may account for this relationship (e.g., dietary patterns, physical activity patterns, and children's self- regulation) were identified.
Kersey et al, 201011	Parents of children ages 2-5. 369 parents, 100% of whom were Mexican immigrants.	Examine the knowledge, attitudes and health beliefs regarding childhood obesity among parents of Latino preschoolers. Determine whether the knowledge, attitudes and beliefs of parents with overweight children differ from those of parents with non- overweight children.	Parents underestimated their own child’s weight status and had high levels of perceived control over their children’s eating and activity behaviors. Parents of overweight (≥95%ile- for-age-and-sex BMI) versus non-overweight (<95%ile BMI) children did not differ in their beliefs about ideal child body size. Latino parents of overweight children did not differ from parents of non-overweight children with respect to their knowledge, attitudes and health beliefs about childhood obesity.
Gallagher, Martina. 201016	Mothers of at least two children, one of them between the ages of 2-5. 100% of the mothers were of Mexican descendent.	A qualitative, naturalistic design using ethnographic interviews was selected for this study. Study measures views that mothers of Mexican descent have related to lifestyle habits (such as nutrition, physical activity, and television viewing) that put children at risk for obesity.	Participants held views that were congruent with the American Academy of Pediatrics’ recommendations. Participants understood the role that healthy habits play in their children’s lives. A unique finding was the perspective of discipline in eating- the behaviors and beliefs mothers expressed are congruent with an authoritative feeding style, which provides a supportive environment for healthy eating. An unexpected finding was the mothers’ view of the benefits of viewing television. Parents encouraged their children to watch English television shows to learn words and pronunciation.
Guerrero et al, 201115	Mothers of children ages 2-5 years. 24 mothers, 100% of whom were Mexican.	Mothers participated in focus groups led by the authors and were asked open- ended questions and elaboration was sought as topics arose. Focus groups were designed to measure Latina's mother’s perception of child's weight status and definition of health and obesity in their children and perceptions of physician weight assessments.	Mothers define health as a function of their children’s ability to play and engage in all aspects of life. Causative factors of obesity included family role-modeling and psycho-social stress, physical inactivity, and high fat foods consumed outside the home.
Flores et al , 201225	19 parents, 100 % of whom were Hispanic. School- aged Latino children (6-18 years), all of whom were overweight.	Parents were asked 33 questions in focus groups and sampled 4 healthy substituted for Latino foods. The study aim was to identify parents’ perspective on healthy eating, physical activity, and weight management strategies for overweight Latino children.	Parents identified 22 themes regarding the most important things parents can do to help overweight children lose weight, including encouragement, not making the child feel left out, the whole family eating healthy, and the parent setting a good example for example. Parents identifies 17 themes regarding the most important things overweight children can do to help themselves lose weight, including eating healthier, limiting portion size and second helpings, drinking more water, increased physical activity, decreased screen time, asking parents for help and participating in interventions that include the whole family. Challenges to getting kids to exercise include expense, time constraints, and neighborhood safety. Parents were open to integrating healthy substitutes into traditional Latino meal/snacks, and found them palatable.
Martinez et al, 201413	41 mothers, 100% were Hispanic. Elementary school-aged children.	Using qualitative methods through focus groups, this study explored the attitudes and behaviors of Latino mothers around feeding their children. The focus groups were in Spanish.	The following themes around feeding emerged: feeding attitudes central to the maternal responsibility of having well- fed children and feeding behaviors that centered on cooking methods, supportive behaviors, and reinforcement strategies for “eating well”. These findings increase our understanding of the Latino maternal role to feed children and can help to inform more culturally appropriate research to effectively address nutritional issues and obesity prevention in Latino children.
SCREEN TIME
Del Rio Rodríguez et al, 201319	20 parents, 100% were Hispanic. 5-8 year old overweight or obese children.	This qualitative study used semi- structured interviews to explore parental outcome expectation regarding children’s television viewing among parents of overweight or obese children.	Parent’s positive OE for allowing TV viewing were the convenience of using TV for entertainment or as a babysitter. Hispanic parents would limit children’s TV viewing to improve their children’s health, restrict content, and promote other activities. Negative OE such as children misbehavior and the loss of positive OE for allowing TV emerged as reasons parents may not limit TV.
PHYSICAL ACTIVITY/SEDENTARY BEHAVIORS
Ruiz et al, 201123	Children ages 3-5.	Measures activity pattern associations between Latino parents and their preschool-aged children.	Results suggest that parental activity levels are a powerful explanation of preschool-aged child activity levels, except for vigorous activity, which children do on their own without parental participation. Latino parents play a critical role in setting physical activity patterns in their children.
SOCIOECONOMIC STATUS
Cortés et al. 201330	20 Spanish-speaking, low-income Latino families.	Analyze food selection practices in shopping practices. Participants received nutrition education during home visits and a supermarket tour. Grocery receipts for grocery purchases were collected at baseline and at the end, to analyze exact nutritional content of purchased foods.	After receiving nutrition education sessions over a 6-month period, many families adopted instructions on buying budget- friendly, healthier alternative foods. This study demonstrated that grocery-shopping practices are important factors to address in childhood obesity.
Kaufman et al., 200727	12 Latin American families with children between the ages of 2 months and 21.	Ethnographic study that uses participant observation, interviews, and life histories to understand the sociocultural roots of childhood obesity by exploring the food practices and everyday lives of Latino families.	Many low-income Latino families provide/care for their children using strategies such as, everyday food practices (e.g., nurturing=feeding). Many parents associate these food practices with good parenting and well-being. These practices drive food choices and related activities of families, often leading to overweight and obesity in their children.
SLEEP DURATION
Wong et al, 201322	333 Latino children ages 9-12.	Sleep duration and hours spent in physical activity were measured objectively with accelerometers over 5-7 consecutive days.	Children slept ~8.8 h/d and spent ~45 min/d on moderate- vigorous physical activity. Obese children slept 0.2 h/d less than normal-weight children. SES had no effect on amount of sleep. There was a significant interaction between gender and age; girls aged 11-12 y slept 0.3 h/d less than boys and the younger girls. Children slept 0.6 h/d longer during the weekend than weekdays. Overall, minority children were not meeting the National Sleep Foundation recommendation for sleep duration which is 10-11 h/d.