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S90 Poster Abstracts / 56 (2015) S85eS129

further exploration of why Hispanic adolescents with eating dis- RESEARCH POSTER SESSION II: HEALTH
orders are presenting earlier (higher BMI) than non-Hispanics.
DISPARITIES
Sources of Support: none.
176.
175.
ADVERSE CHILDHOOD EVENTS AMONG YOUTHS IN CUSTODIAL
EATING BEHAVIORS AND BODY IMAGE PERCEPTIONS IN A
FACILITIES: THEIR IMPACT AND THE ADDITIONAL IMPACT OF
LATINO COMMUNITY CLINIC ADOLESCENT POPULATION
MONOPARENTAL FAMILIES
Cynthia Su, MD, Karen Soren, MD, FSAHM.
Yasmine Ratnani, MD 1, Rosanne V. Krajden 1,
NYP-Morgan Stanley Childrens Hospital/Columbia University Sebastien Bergeron, MD 1, Manon Duchesne, MD 2,
Medical Center. Yves Lambert, MD 3, Ronald Chartrand, BA 4, Pierre McDuff, MSc 5,
Jean-Yves Frappier, MD 1.
1
CHU Ste-Justine; 2Centre Jeunesse de Montral; 3Centre Jeunesse
Purpose: Recent research has focused on the increasing recogni- de la Montrgie; 4Association des Centres Jeunesse du Qubec;
5
tion of disordered eating behaviors and discordant body image Universit de Montral.
perceptions in ethnic groups; community-based studies indicate
that Hispanics/Latinos may be at signicant risk. Several mediating
factors have been implicated, including environmental factors, Purpose: Over the last two decades, studies in adults have
socioeconomic status, and degree of integration with American shown a correlation between adverse childhood experiences
culture. The objective of this study was to characterize the eating (ACE) and unfavorable health outcomes (mental health, sub-
behaviors and body image perceptions of a sample of primarily stance abuse, suicide attempts, high-risk sexual behaviour,
Latino adolescents and young adults in New York City. chronic diseases, etc.). However, there are few data on the
Methods: An adapted version of the Project EAT questionnaire was impact of ACEs on the health status of teenagers, especially
used to survey a convenience sample of adolescents presenting to a youths living in custodial facilities who represent an at-risk
community health clinic during the 2013-2014 academic year. group. We undertook this analysis with the objective of evalu-
Patients who were 13-21 years old were asked to report specic ating if there is an association between the number of adverse
eating behaviors and body image perceptions, which were studied childhood experiences and the health status of teenagers in
in the context of various demographic variables. Reported heights custodial facilities.
and weights were used to compute body mass indices (BMI), which Methods: This is a secondary analysis from a cross sectional
were categorized by CDC BMI-for-age guidelines. health evaluation study of youth in custodial facilities that took
Results: Out of 229 distributed surveys, 201 were returned for place in 2011-2013. A total of 315 teenagers 14-17 y.o. (134 girls
analysis. The study population was 65% female: 75% self-identied and 181 boys) were asked to complete a self-reported question-
as Hispanic/Latino with a mean age of 16.5 years. Of the 176 re- naire about their health status/problems/needs and were then
spondents with calculated BMIs, 74% were of normal weight, 10.2% evaluated by a nurse/doctor using a comprehensive standardized
overweight, 14.2% obese, and 1.7% underweight. Most (80%) of those data collection form/check list. We identied 8 ACEs: (1)
with BMI >85th%ile considered themselves somewhat or very monoparental family; (2) violent death of a family member;
overweight, but only 3/4 were actively trying to lose weight. family history of (3) incarceration, (4) mental health issues, (5)
Conversely, more respondents rated themselves as overweight or substance abuse; personal history of (6) intrafamilial or (7)
obese than actually were, as calculated by BMI. Over half of the total extrafamilial physical abuse before 13 years old; personal history
sample cared very much about how they looked and over 1/4 re- of (8) sexual abuse. CHI square analyses were performed between
ported that they had fasted, eaten very little food, or skipped meals the number of ACEs and some relevant variables. Since 66% of
to lose or keep from gaining weight in the past year. 20 respondents youths came from a monoparental family, we thought that this
(10%) endorsed binge-eating behavior. Older respondents, aged 18- ACE might be a confounding variable. Thus, we performed two
21 years, were more likely to be very dissatised with their weight analysis, one including and one excluding monoparental family
compared to those 13-17 years old (28% vs. 11%, p0.01). Re- from the ACE denition.
spondents with immigrant versus US-born mothers were signi- Results: 91% of the youths reported at least one ACE (girls,
cantly more likely to be very dissatised with their bodies; 95%;boys, 89%) while 48% of them had  3 ACEs (girls, 58%; boys,
however, respondents own country of birth, paternal immigration 40%). There was a statistically signicant difference (p < 0.05)
status, and language spoken at home had little or no effect. Those between youths presenting no ACE versus those presenting one or
with immigrant mothers were more likely to endorse that their more ACEs: more of the latter perceived their health status as being
mothers had very much or somewhat encouraged them to diet, worse, presented with chronic conditions and more health prob-
compared to those with US-born mothers (54% vs. 31%, p0.01). lems, had functional complaints, were currently taking medication,
Conclusions: Immigration and acculturation issues may have an had mental health disorders, ADHD, were asking for an appoint-
effect on adolescent body and weight perception. In our commu- ment with a mental health specialist, had attempted suicide, pre-
nity clinics primary Latino adolescent population, a substantial sented sleep disorders, were feeling more aggressive, although we
number of adolescents reported dissatisfaction with their found very little difference for drug abuse and at-risk sexuality.
appearance and endorsed unhealthy eating behaviors, including Withdrawing monoparental family from the ACE denition did not
dieting, fasting and binge eating. In this sample, maternal country changed much of the associated conditions except for more
of birth appeared to have the most signicant inuence on body teenagers with a higher number of ACEs having a history of self-
image. Further analysis is needed to interpret these results in the mutilation (p 0.017).
context of social and demographic parameters. Conclusions: The results of the study conrm that a higher
Sources of Support: None. number of ACEs is associated with increased mental and physical
Poster Abstracts / 56 (2015) S85eS129 S91

health problems during adolescence for youths in custodial facil- being bicultural. These ndings engaged physicians and Latino
ities. This shows the importance of not only asking about ACEs, but adolescents in direct dialogue on how equity in quality of care is
to consider their cumulative impact. Especially for teenagers with compromised by race-specic societal forces of migration and
3 or more ACEs, services should be intensied in order to alleviate discrimination.
their negative consequences. Even if monoparental families Conclusions: Promoting authentic dialogue between Latino ado-
are highly prevalent in this group, including this event in the lescents and physicians is an essential rst step toward designing
ACE denition seems appropriate, as in the original ACE study system change interventions to enhance equity in healthcare
(Filetti & al). quality and outcomes.
Sources of Support: None. Sources of Support: NIH 1-R24-EB018620-01.

177. 178.

ENVISIONING HEALTH: A TRANS-DISCIPLINARY, COMMUNITY- FAMILY AND HOME FOOD ENVIRONMENTS OF ETHNICALLY/
ENGAGED VISUAL INTERVENTION FOR HEALTHCARE RACIALLY DIVERSE ADOLESCENTS IN MINNESOTA: DISPARITIES
PROVIDERS ON IMPLICIT BIAS TOWARD LATINO/A IMMIGRANT AND LINKAGES TO DIETARY INTAKE AND WEIGHT STATUS
YOUTH Nicole Larson, PhD 1, Marla E. Eisenberg, ScD 2, Jerica M. Berge, PhD 3,
Alexandra Lightfoot, EdD 1, Mimi Chapman, MSW, PhD 1, Chrisa Arcan, PhD 3, Dianne Neumark-Sztainer, PhD 1.
Robert Colby, PhD 2, Eugenia Eng, DrPH 3, Florence Siman, MPH 4, 1
School of Public Health, University of Minnesota; 2University of
Kari Thatcher 1, Tamera Coyne-Beasley, MD, MPH, FSAHM 1. Minnesota; 3University of Minnesota Medical School.
1
University of North Carolina; 2Ohio Humanities Council; 3UNC
Gillings School of Global Public Health; 4El Pueblo, Inc.
Purpose: Multi-contextual studies examining the inuence of
environmental factors on dietary intake and risk for obesity have
Purpose: North Carolina (NC) has experienced 943% growth in the emphasized the inuence of family and home environments, but
Hispanic/Latino population over the last 20 years. Compared to additional research is needed to conrm that public health rec-
whites in NC, Latinos face signicant health care barriers, such as ommendations for family/home food environments are equally
lack of insurance, access to care, and difculty communicating with relevant for ethnically/racially diverse adolescent populations. This
medical providers. Such barriers have potential lifelong implica- study examined differences in the family/home food environments
tions for the health and well-being of Latino adolescents. of adolescents and associations with measures of their dietary
Addressing implicit bias within patient-provider relationships may intake and weight status.
be one intervention point for reducing Latino health disparities. Methods: The sample included 2,374 ethnically/racially diverse
Our trans-disciplinary community-academic team developed and adolescents and their parents enrolled in two coordinated studies,
piloted an intervention, Envisioning Health, which used visual EAT 2010 (Eating and Activity in Teens) and Project F-EAT (Families
images (a photojournalism series documenting the migration and Eating and Activity in Teens). Participants were recruited
journey of Latinos and adolescent-generated images through through 20 public secondary schools in the Minneapolis/St. Paul
Photovoice) to engage pediatric residents in an exploration of metropolitan area in 2009-2010. Adolescents completed anthro-
Latino ethnicity and the experience of migration on health. Our pometric measurements and surveys at school, including a food
objective was to make transparent to medical providers, the frequency questionnaire. Parents completed surveys by mail or
invisible impact of implicit bias on Latino adolescents health. phone. Analysis of variance was used to examine differences in
Methods: We used the community-based participatory research family/home environment variables (i.e., healthy food availability,
(CBPR) method of Photovoice with groups of Latino adolescents unhealthy food availability, meal planning and preparation, family
from different communities. The adolescents took photos and meal frequency, priority for family meals, healthy foods served at
engaged in the facilitated SHOWED/VENCER dialogue process (in meals, parental modeling of healthy food consumption, and
English and Spanish) focusing on What I wish my doctor knew parental healthy eating encouragement) across seven ethnic/racial
about my life. They organized a forum with pediatric residents to groups. Multiple linear regression analysis modeled each adoles-
discuss their Photovoice ndings and prioritize next steps for cent outcome variable (i.e., intake of fruit and vegetables and
enhancing equity in health care interactions and to improve the sugar-sweetened beverages, BMI z-scores) based on each family/
system of care. home environment variable, separately, adjusted for ethnicity/
Results: Four themes emerged: 1) Its hard to develop a good race, gender, age, and parental education. In order to determine if
relationship with doctors because teens can tell when doctors the observed associations between family/home environment
dont really care about our feelings, life, economic situation and variables and each adolescent outcome variable were consistent
besides that, the clinic switches our doctor each time we go; 2) across the ethnic/racial groups, interaction terms were added to
Teens are very aware everyday of being judged, suspected, moni- each regression model (ethnicity/race by environment variable).
tored, up to no good, and expected to fail by people in authority Results: Nearly all family/home environment variables, with the
(teachers, MDs, police) - causing teens to avoid interacting with exception of family meal frequency, were found to vary signi-
them as normal persons; 3) Because our parents are excluded from cantly across the ethnic/racial groups; however, no consistent
many systems, Latino teens are stressed by their conicting re- patterns emerged among the ethnic/racial groups in terms of their
alities of having to play the adult role and advocate for themselves family/home being more or less supportive of healthy eating.
in every arena, but adults dont listen to teens or accord the same Several of the family/home food environment variables were
respect or benets as they would to other adults; 4) Having signicantly associated with one or more adolescent outcome in
bilingual interpreters, or even native speakers serve as in- expected directions. For example, parental modeling of healthy
terpreters, doesnt necessarily make the communication problem food choices was inversely associated with BMI z-score (p0.03)
go away because there is a difference between being bilingual and and positively associated with fruit/vegetable consumption

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