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Two Studies Examine Obesity Among Agricultural Worker Children

study examines obesity in children of ag workers

[photo by Earl Dotter]

Why do children in agricultural worker families have high rates of obesity? Two new research papers seek to examine how mothers’ experiences and interactions with their children may impact child obesity. The analyses are the result of the Niños Sanos study, a multi-year longitudinal study of diet and physical activity among Latino children in agricultural worker families in North Carolina, which collected data between 2011 and 2014.

In the first study, published in Maternal and Child Nutrition, Marshall, et. al. followed 248 agricultural worker families over two years. The Niños Sanos research team enrolled families with two-year-old children through Head Start and Migrant Head Start programs, migrant education programs, community health centers, a Special Supplemental Nutrition Program for Women, Infants and Children site, and various community partner sites, churches, and stores. Mothers were asked to complete the Center for Epidemiologic Studies Depression Scale nine times over the study period; the team found that two-thirds of mothers experienced at least moderate symptoms of depression at some point during the two years. At the end of the study period, the researchers compared the patterns of maternal depression over the two years with the differences in obesity among their children, and compared feeding styles, physical activity, and other risk factors for obesity.

After controlling for other covariates, the researchers found that children of mothers with severe episodic depressive symptoms and chronic symptoms were significantly more likely to be overweight or obese than children of mothers with few symptoms. The researchers found less responsive feeding styles – in which parents are attending less to a child’s hunger cues, where feeding “may be overly indulgent, allowing the child to control selection and intake of food, or overly demanding, in which case the child’s own sense of fullness may be disregarded” — among children whose mothers recorded moderate episodic or chronic symptoms, and lower diet quality among children whose mothers reported chronic symptoms.

Feeding styles were further evaluated among the same agricultural worker families in a second research paper, “Child Feeding Style and Dietary Outcomes in a Cohort of Latino Farmworker Families,” published in the Journal of the Academy of Nutrition and Dietetics, wherein Ip, et. al. categorized and examined feeding styles among the same children to determine their relation to childhood obesity. The authors note that feeding style is just one of many factors that may contribute to obesity among children in agricultural worker families, who encounter numerous barriers to healthy food as low income rural residents, and may be further influenced by cultural cues and beliefs, as well as migration disruptions in food access, such as through local safety net programs.

Participants completed a Caregiver’s Feeding Style Questionnaire at baseline, and 12 and 24 months later. The researchers categorized the mothers’ feeding styles into four types, separating out the demandingness or authoritativeness of the parent (how “parent-centered” the feeding style is) and the responsiveness to the child (how “child centered” the feeding style is). Among participants, 28 percent were categorized as low parent-centered/moderate child centered feeding style; 24 percent as high parent-centered/high child-centered, without physical control; 26 percent as high parent-centered/high child-centered; and 22 percent as moderate parent-centered/moderate child-centered. They then compared the diet quality (using the Revised Children’s Diet Quality Index) and body mass index of children in each group.

The results were consistent with other recent research: children whose parents used low parent-centered feeding, indicating less attention from the parent on the child’s feeding pattern, ate a diet of lower quality and had higher mean body mass index percentiles compared to children with high parent-centered feeding. The authors concluded that future research “should account for the unique circumstances of Latino [agricultural worker] families, many of which contend with poverty, lack of education, discrimination, limited access to nutritious food, deficiency of safe play spaces, frequent relocation, and acculturative stress.”

Several of the previously published research papers resulting from the Niños Sanos longitudinal study are provided as open access on PubMed. Previous papers from this study cover food security, physical activity of preschool-aged children, and economic hardship and depression among women. Visit and search Ninos Sanos. Copies of all papers can be obtained from the Principal Investigator, Sara A. Quandt, PhD (

Health Network, MCN’s mobile bridge case management system, helps mobile patients with any ongoing condition to access health services, transfer medical records, and more – and it is available for mobile pediatric patients as well. Learn more about Health Network at: .

This publication is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $1,094,709.00 with 25 percentage financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit


Health Network and PRAPARE
In 2016, just as PRAPARE was set to launch, Migrant Clinicians Network was beginning to develop its new database to better serve patients enrolled in Health Network, MCN’s bridge case management program. Over the course of the following year, MCN configured the new database to allow for the integration of PRAPARE data, in which one health center’s PRAPARE data can be transferred to the next health center, as a mobile patient moves.
“When we started thinking about that data and [Health Network] case management work, so much of case management isn’t just ‘are you taking your medication every day?’ It’s more about, ‘How can I help you access care and manage your health in general?’” explained Anna Gard, RN, who assisted MCN in the development of the new database. “One piece of this is: ‘Let me help you find a health center.’ But the larger pieces around effective case management are, ‘How are you going to get there? Is there public transportation? How are you going to pick up your medications if you live in a hostile community and you’re afraid of leaving the house?’ PRAPARE gives a structured format to capture [these] data, in a form that’s been tested and validated.”
As more health centers provide case management and chronic care management to address the social determinants of health, Gard noted, integration of the PRAPARE data with Health Network, a virtual case management, seemed to make sense. Now, the Health Network team is working to fit PRAPARE into their own workflow.
Saul Delgado, Health Network Data Specialist, who has been integral in building and launching Health Network’s new case management system, notes that asking such personal questions over the phone, when a patient doesn’t have transferrable PRAPARE data from a previous health center, can be challenging. “When we call, the patient doesn’t know you. They’re very scared to answer these kinds of personal questions, whereas when you go the clinic, you at least see the nurse or case worker face-to-face,” he explained. But he recognizes the utility of the data, and has developed the PRAPARE data screens within the database to be easily accessed from the main patient information screen. With drop-down menus, Health Network Associates can populate the information they hear from patients, like how many people live with them in their household, or if they’re worried about losing their home. The information, either attained from a previous health center or inputted by a Health Network Associate, will be transferred when the mobile patient gets to his or her next destination, just as the basic medical records do.
“Health centers are doing more to integrate social and behavioral determinants of health, and we’re recognizing that all of those things have to be integrated with care management. So we’re on the forefront,” Gard concluded.

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