Racial/Ethnic Disparities in Parent Activation: Implications for Developing Interventions Addressing Early Childhood Obesity

Abstract Objective : Examine racial/ethnic differences in parent activation and associations with child obesity risk behaviors in low-income families. Methods : Cross-sectional survey study of 300 low-income Black, Latinx and white parents of patients aged 2-5 years receiving primary care within two healthcare systems (Systems 1& 2). In-person and phone surveys were conducted. Parent activation, defined as parents' knowledge, confidence, and willingness to act concerning their child's health, was measured using the standardized 13-item Parent Patient Activation Measure (P-PAM). Differences in parent activation by race/ethnicity were assessed using ANOVA. Multivariate regression analyses were used to test associations between parent activation and child obesity risk behaviors. Results : In pooled unadjusted analyses, Latinx parents had significantly lower activation compared to Black parents (p=0.023), but these differences were no longer statistically significant after adjusting for other sociodemographic characteristics (p=0.06). Higher activation was associated with slightly greater odds of consuming ≥ 5 daily servings of fruits and vegetables for System 2 only (OR: 1.04, 95% CI: 1.01. 1.07). Associations between parental activation and child screen time or physical activity were not significant. Conclusions : Findings highlight potential measurement limitations of the P-PAM including the inability of the measure to capture barriers to health system navigation and cultural and linguistic considerations. Further attention to the nuanced interplay between parental activation and contextual and sociodemographic risk factors (e.g., food availability, immigrant status, economic opportunity, language proficiency) should be considered in the development of early childhood obesity interventions in primary care settings. What's New : This is the first investigation of the role of parent activation on obesity risk behaviors among low-income racially/ethnically diverse families. Additional consideration of the intersection between parent activation and sociodemographic factors is needed to address obesity risk in early childhood.