| Summary: | 博士 === 國立陽明大學 === 國際衛生碩士學位學程 === 104 === Background: Indonesia is facing a substantial increase in the numbers of overweight (including obese) children. Genetic, family influences (particularly parental influences), and environmental factors are the primary components which contribute to a child’s chances of being obese. Moreover, health disparities across the urban–rural gradient and economic groups exist. The dissertation aimed to assess the association of parental smoking during pregnancy with birth outcomes in urban and rural areas, to evaluate the influence of parents who have gained or lost weight on their children’s weights and to examine parental and child patterns of weight changes from a baseline over a 14-year duration, to assess the association of the availability of Posyandu with child weight status and what key factors might influence such associations at different household wealth, to assess the associations of parental smoking and amount of parental smoking with child overweight (including obesity) in urban and rural areas, to describe the relationship between birth weight and childhood obesity and investigate the influence that residence and household wealth has on this relationship.
Method: For the first and second topics, we performed a secondary analysis on the Indonesia Family Life Survey (IFLS), an ongoing national prospective longitudinal cohort study in Indonesia. Data were collected from children under five years old (n = 3,147) and their parents at different points in time, in 1993, 1997, 2000, and 2007. For the third, fourth, and fifth topics, we used a secondary analysis of data collected in the 2013 Riskesdas (or Basic Health Research) survey, a cross-sectional, nationally representative survey of the Indonesian population. Data were collected from parents with children aged 0 to 5 years (n = 63,237) in 2013.
Results: We found a significant reduction in birth weight to be associated with maternal smoking. Smoking (except for paternal smoking) was associated with a decrease in the gestational age and an increased risk of preterm birth. Different associations were found in urban area, infants born to smoking fathers and both smoking parents (>20 cigarettes/day for both cases) had a significant reduction in birth weight and gestational age as well as an increased risk of LBW and preterm birth. During each transition, the children of parents who gained weight had a significantly weights than did children of parents who lost weight. A mother’s positive weight change increased the chance of her pre-schooler’s or school-aged child’s positive weight change. However we found no such association between a father’s positive weight change and his child’s positive weight change. Non-availability of Posyandu significantly raised the odds of being obese (OR=1.13, p<0.01). However, non-availability of Posyandu did not seem to show a significant relationship in the odds for overweight. This relationship persisted after a full adjustment. There was effect modification by household wealth of the association between the availability of Posyandu and child weight status. Using logistic regression model adjusted for covariates, the odds ratios for smoking fathers, smoking mothers, and both parents smoking showed an association with a risk of overweight in their children. From the stratified analyses, children of smoking fathers, smoking mothers, and both parents smoking in urban area (odds ratio (OR) (95% confidence interval (CI): 1.28 (1.17 – 1.40), 20.30 (8.93 – 46.16), 2.40 (1.71 – 3.37), respectively) were associated with higher odds of overweight than those in rural area. We found a significant increase in the weight, BMI z-score, and risk of childhood obesity to be associated with LBW. LBW children in rural area and low class families were associated with higher BMI z-score (mean + Standard Error (SE): 1.39 + 0.03, 1.71 + 0.06, respectively) and higher odds (odds ratio (OR) (95% confidence interval (CI)): 7.45 (6.76 – 8.21), 14.87 (12.49 – 17.70), respectively) of obesity than those in urban area, middle class, and wealthy families.
Conclusions: Residence was found to be an effect modifier of the relation between parental smoking during pregnancy, amount of parental smoking, and birth outcomes on their children. Smoking cessation/reduction and smoking intervention program should be advised and prioritized to the area that is more prone to the adverse birth outcomes. Parental weight change is an independent predictor of child weight change. Positive weight change in the mother had a more dominant influence than did the father’s positive weight change. Future family-based obesity prevention and treatment programs should consider how best to include and engage mothers as a catalyst for the reduction of obesity-related risk factors in the long term. The availability of Posyandu has a protective association with child obesity in Indonesia. Household wealth modified this association. MCH services are well placed to play an important role in obesity prevention in early life. Residence was found to be an effect modifier of the relation between parental smoking and child overweight. Smoking cessation/intervention program should be aimed at adults and prioritized to the area that is more prone to the child overweight. Effective prevention and intervention to childhood obesity as early as possible were imperative. So far as our study was concerned, efforts, policies, and targets are required to reduce the prevalence of LBW. Children born of LBW, who live in a rural area and from low income families, should be emphatically intervened as early as possible.
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