BackgroundOral health in early childhood is vital for long-term well-being, yet dental caries is highly prevalent among young children in the United States, especially in low-income and immigrant families. Brazilian immigrants, a rapidly growing Latin American population in the United States, face distinct barriers to oral health care, such as language differences, limited access to care, and a lack of culturally tailored resources. Despite this, Brazilian immigrants are understudied in public health research. Understanding Brazilian immigrant parents’ perspectives is essential to advancing oral health equity through culturally responsive strategies. ObjectiveThis study aims to understand (1) parents’ views on the best ways to support their children’s oral health, (2) perceived barriers to oral health care, and (3) preferred methods and strategies for addressing barriers and receiving oral health education and care. MethodsThis qualitative study usedin-depth, semistructured interviews with Brazilian immigrant parents. Guided by the social ecological model, the data were thematically analyzed to identify multilevel influences on oral health behaviors as well as intervention preferences. ResultsForty-eight Brazilian immigrant parents (29 mothers and 19 fathers) participated. Most had low acculturation levels and lived in primarily Portuguese-speaking households. Parents stressed the need for early, community-based oral health education in schools and daycares. They preferred visual and digital materials, such as videos, apps, and cartoons in Portuguese to overcome language barriers. Parents spoke of language and cultural challenges, limiting access and reducing confidence in navigating care. Access to affordable dental services was a major concern. Parents supported expanded school-based services and culturally welcoming care. Notably, mothers often focused on home routines and navigating systems, while fathers emphasized community outreach and structural barriers. ConclusionsBrazilian immigrant parents called for linguistically and culturally tailored oral health programs to be offered in trusted community settings, along with improved dental care access through policy changes and expanded insurance coverage. Multilevel strategies addressing both behavioral and systemic barriers show promise in reducing disparities. Future efforts should prioritize the development and evaluation of scalable, culturally responsive models that meet the needs of Brazilian immigrant families.

IntroductionLongitudinal anthropometric changes may provide prognostic information beyond single timepoint measurements in older adults. We tested whether the annual percentage change (APC) in five anthropometric metrics (body mass index [BMI], waist circumference [WC], weight-adjusted waist index [WWI], waist-to-height ratio [WHtR], and waist-to-height^0.5 [WHT.5R]) were associated with all-cause mortality in a 14-year U.S. cohort of older adults.MethodsUsing data from the National Health and Aging Trends Study (NHATS) 2011–2024 (N = 5,245 after excluding deaths < 2 years), we calculated APC in BMI, WC, WWI, WHtR, WHT.5R using participant specific log-linear models. Survey-weighted Cox proportional hazard models were used to examine APC categories (stable [≤ 2% change] vs. larger gain/loss [> 2% change]) in relation to all-cause mortality, adjusted for baseline age, sex, race, education, annual income, smoking status, homebound status, major chronic disease status, physical frailty, functional status, and cognitive impairment. To ensure the robustness of study findings across all five indices, supplementary restricted cubic spline analyses were performed to validate our primary categorization analysis. Sensitivity analyses included 3- and 5-year lags to minimize reverse causation, explore sex-specific differences, and a two-point APC to confirm findings were not a modeling artifact.ResultsCompared to stable (≤ 2% change) measures, fluctuations in all five anthropometric indices were associated with an elevated mortality risk (pooled HR range: 2.15–9.74; 95% CI boundaries ranged from 1.68 to 17.49; p < 0.001). Restricted cubic splines analyses supported a generally V-shaped association between anthropometric changes and mortality (all pnon-linearity < 0.05). Lagged sensitivity analyses produced findings generally consistent with the primary models (all p < 0.05). This elevated risk was observed for both gain and loss categories and were generally consistent across sex-stratified and two-point APC sensitivity analyses.ConclusionThese findings suggest that stability in anthropometric metrics may reflect a lower-risk physiological profile in older adults. Fluctuations (gain or loss) in the examined anthropometric metrics were associated with higher mortality risk, with generally consistent findings across sensitivity analyses. However, these associations should be interpreted cautiously as anthropometric changes may reflect underlying illness, frailty, or other unmeasured factors.

Background/Objectives: Oral health (OH) in early childhood is a key determinant of long-term well-being, shaped by parenting-related dietary and hygiene habits. While these influences are well-documented, they remain underexplored among Brazilian immigrant families in the United States (U.S.). Therefore, this study was designed to examine how Brazilian immigrant parents’ perceptions and practices regarding diet and oral hygiene affect their preschool-aged children’s OH. Methods: This qualitative study consisted of in-depth interviews with Brazilian immigrant parents of preschool-aged children (ages 2–5) living in the U.S. Individual, in-depth interviews were conducted via Zoom, recorded, and transcribed in Brazilian Portuguese. Two native Brazilian researchers experienced in qualitative methods conducted a thematic analysis of the transcripts in Brazilian Portuguese using MAXQDA, a qualitative data analysis software. The analysis focused on identifying key perceptions, parenting practices, and barriers related to children’s diet and OH. Results: Parents strongly associated sugary foods with poor OH, identifying sugar as a major contributor to dental issues. Both mothers and fathers reported limiting sugar intake and encouraging good oral hygiene practices. While parents prioritized educating their children on healthy habits, barriers such as time constraints, reliance on external childcare, and economic limitations affected the consistent implementation of strategies. Conclusions: Brazilian immigrant parents understand the importance of diet and oral hygiene in in supporting their children’s early OH but face barriers in broader social contexts, such as daycare, preschools, and communities. Interventions should aim to support parents in their caregiving roles while simultaneously addressing systemic and environmental obstacles. Public health efforts should account for cultural, economic, and contextual factors to more effectively support Brazilian immigrant families in promoting their children’s OH.

Background: Maternal and child health (MCH) is a critical public health issue affecting individuals, families, and communities worldwide. Immigrant populations, including Brazilian mothers and children in the United States (U.S.), face unique challenges, such as language barriers, limited healthcare access, and socioeconomic disparities that exacerbate health risks. Despite their growing numbers, Brazilian immigrants in the U.S. are an understudied group in MCH research. Objective: This systematic review and qualitative meta-synthesis aims to identify, appraise, and synthesize qualitative and mixed-methods research focused on the MCH experiences of Brazilian immigrants in the U.S. Methods: This review will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines and is registered with PROSPERO, an international prospective registry of systematic reviews. Qualitative and mixed-methods research published between 2004 and 2024 that explicitly report qualitative methodology, analysis, and findings related to MCH experiences among Brazilians in the U.S. will be eligible to be included. Studies will be identified through a comprehensive search of seven databases (CINAHL, MEDLINE, PubMed, PsycINFO, Web of Science, Scopus, SocINDEX), and selected according to predefined inclusion/exclusion criteria. Only studies available in English, Portuguese, or Spanish and reporting original qualitative data will be included. Data extraction will be conducted using the Joanna Briggs Institute (JBI) Data Extraction Tool for Qualitative Research. Findings will be synthesized using the JBI meta-aggregation approach in MAXQDA software and evaluated for confidence using the JBI Confidence in Qualitative Research (ConQual) tool. Conclusions: By synthesizing qualitative findings, this review aims to inform the development of culturally responsive healthcare policies, community-based interventions, and future research tailored to the unique needs and experiences of Brazilian immigrant mothers and children in the U.S.

Objective: The COVID-19 vaccine is vital for protecting pregnant women and their babies, yet many foreign-born women face unique challenges in vaccine uptake. This study explores COVID-19-related fears and vaccine acceptance among from the Northern Triangle countries—El Salvador, Guatemala, and Honduras in the United States (U.S.). Methods: This cross-sectional study aimed to identify factors influencing COVID-19 vaccination among foreign-born pregnant women from Central America, specifically El Salvador, Guatemala, and Honduras, living in the U.S. Results: The study included 93 women (mean gestation: 23.3 weeks), most of whom had lived in the U.S. for at least 10 years and had low acculturation. Over two-thirds (66.7%) were fully vaccinated. Key factors driving vaccine acceptance included healthcare access, community health initiatives, and trusted provider recommendations. Cultural values emphasizing family protection and a heightened sense of vulnerability to COVID-19 also contributed to higher vaccination rates. However, 33.3% expressed hesitancy, particularly due to distrust in government, fear of needles, and concerns about the vaccine’s rapid development, with Guatemalan participants showing the highest hesitancy. Conclusions: Findings underscore the critical role of healthcare providers in vaccination decisions, and tailored communication strategies addressing cultural and emotional factors are essential to improving vaccine uptake, particularly in immigrant communities.

Refugees face multi-level barriers to seeking healthcare, making them vulnerable to poorer health outcomes. An estimated 100 to 345 refugees from 20 to 30 different countries settle in Rhode Island (RI) each year. In collaboration with refugee-serving organizations in Providence, RI, this qualitative study investigated refugees’ experiences of the COVID-19 pandemic and their beliefs about the COVID-19 vaccine. In 2023, we conducted eight focus group discussions (FGDs) in English, Spanish, Swahili, and Arabic with refugees from three world regions (Africa, Latin America, Middle East). Community advisory board input informed the FGD guide and recruitment efforts. Most participants had been in the United States (US) for less than one year. The sample (N = 60) consisted of 37 women and 23 men, with a mean age of 44.4. Data were analyzed using thematic analysis, and the National Institute of Minority Health Disparities (NIMHD) Framework was used as an organizing framework. Four themes with subthemes emerged: (1) The COVID-19 pandemic as a difficult, stressful, and fear-inducing experience; (2) Feelings of mistrust regarding the COVID-19 virus and vaccine; (3) Health concerns about the COVID-19 vaccine; and (4) The COVID-19 vaccine as protective and beneficial. These results suggest that feelings of mistrust surrounding the COVID-19 virus and its vaccine may have served as a crucial barrier to vaccine uptake. Study findings can inform culturally tailored interventions to promote better understanding of COVID-19 and other vaccines, and improve vaccine confidence and vaccine uptake among refugee communities.

Brazilians are a rapidly growing immigrant population in the United States (U.S.), yet little is known about their mental health and access to mental healthcare. Our goal was to access associations between the pursuit of– and access to—mental healthcare with mental health status and socio-demographic characteristics among Brazilian immigrant women. We conducted an online survey of Brazilian women aged 18 or older who reported being born in Brazil and currently residing in the U.S. We recruited respondents via Brazilian cultural media, community organizations serving Brazilian immigrants, and social media. We assessed respondents’ perceived access to mental healthcare, self-reported mental health (CES-D-10), and socio-demographic characteristics and conducted multivariable logistic regression. Our analysis included 351 participants. Half (52

IntroductionInformal caregiving is a critical component of the healthcare system despite numerous impacts on informal caregivers’ health and well-being. Racial and gender disparities in caregiving duties and health outcomes are well documented. Place-based factors, such as neighborhood conditions and rural–urban status, are increasingly being recognized as promoting and moderating health disparities. However, the potential for place-based factors to interact with racial and gender disparities as they relate to caregiving attributes jointly and differentially is not well established. Therefore, the primary objective of this study was to jointly assess the variability in caregiver health and aspects of the caregiving experience by race/ethnicity, sex, and rural–urban status.MethodsThe study is a secondary analysis of data from the 2021 and 2022 Behavioral Risk Factor Surveillance System (BRFSS) from the Centers for Disease Control and Prevention. Multivariable logistic regression or Poisson regression models assessed differences in caregiver attributes and health measures by demographic group categorized by race/ethnicity, sex, and rural–urban status.ResultsRespondents from rural counties were significantly more likely to report poor or fair health (23.2% vs. 18.5%), have obesity (41.5% vs. 37.1%), and have a higher average number of comorbidities than urban caregivers. Overall, rural Black male caregivers were 43% more likely to report poor or fair health than White male caregivers (OR 1.43, 95% CI 1.21, 1.69). Urban female caregivers across all racial groups had a significantly higher likelihood of providing care to someone with Alzheimer’s disease than rural White males (p < 0.001). Additionally, there were nuanced patterns of caregiving attributes across race/ethnicity*sex*rural–urban status subgroups, particularly concerning caregiving intensity and length of caregiving.DiscussionStudy findings emphasize the need to develop and implement tailored approaches to mitigate caregiver burden and address the nuanced needs of a diverse population of caregivers.

Background The Expanded Food and Nutrition Education Program (EFNEP) aims to improve the health-related behaviors of limited resource families. Increasing physical activity (PA) is an EFNEP core priority; however, anecdotal evidence suggests that EFNEP peer educators (PE) are challenged to incorporate PA into adult programming. Objective To assess the facilitators and barriers that EFNEP PE face when incorporating PA-related content in adult classes. This preliminary study, conducted in the Northeast region of the US, will inform expansion of this research nationally. Study Design, Settings, Participants This qualitative study consisted of virtual semi-structured interviews with EFNEP PE (n=15) in the Northeastern region of the United States. PEs recruited had ≥ 2 years as a PE, ≥ 1 year delivering adult programming, and ≥ 50% of workload targeting adults. Northeastern EFNEP Coordinators identified eligible PE who completed a screening survey on EFNEP experience, sociodemographics, and personal PA. PE interviews covered implementing PA, participant enjoyment, EFNEP PA environment, facilitators/barriers to delivering PA content, and future programmatic needs. Measurable Outcome/Analysis Descriptive statistics were used to analyze survey data. Interview transcripts were coded using Dedoose software. An inductive and deductive thematic analysis was used to identify preliminary themes. Results Interviewed PEs were primarily Hispanic (60%, n=9) and female (100%, n=15). Preliminary themes were categorized into barriers, facilitators, and programmatic needs. Barriers to PA delivery included: inadequate classroom size space, neighborhood safety concerns, environmental factors, and PE perception of participant barriers to PA. Facilitators included: motivational approaches such as participant encouragement, PA class discussions, PEs leading by example, and including participant PA interests. Programmatic needs included: PA training for PE, affordable recreational PA options, and PA-relevant educational extenders. Conclusions The results provided insight into potential barriers, facilitators, and programmatic needs for incorporating PA into adult EFNEP lessons. These findings set the groundwork for national research to address EFNEP training and curriculum needs for promoting PA. Funding None

Parents’ beliefs and practices significantly shape young children’s oral health (OH), particularly during preschool years when these habits are being established. Immigrant parents often face challenges in promoting OH due to cultural, financial, and logistical barriers. This qualitative study explored OH beliefs, practices, and barriers among Brazilian immigrant mothers in the United States (U.S.). Semi-structured interviews, guided by the Health Belief Model (HBM), were conducted with mothers of children aged 2–5 years. Thematic analysis, also guided by the HBM, revealed four key themes: (1) beliefs about children’s OH; (2) awareness of the parent’s role in fostering early OH behaviors; (3) identification of risk and protective factors affecting children’s OH; and (4) perceived barriers to maintaining children’s optimal OH. Mothers emphasized the importance of proper oral hygiene, regular dental check-ups, and balanced diets for promoting children’s OH. Despite recognizing their role in supporting oral hygiene routines and care, mothers noted barriers such as limited access to care, linguistic barriers, and difficulty adopting and maintaining healthy OH practices due to work and family demands. Notably, 96.6% (n = 28) of the mothers scored low on the SASH scale (SASH < 2.99), reflecting low acculturation levels, which may further contribute to these challenges. Study findings highlight the critical role of parental beliefs and practices in shaping early OH behaviors and the unique challenges faced by Brazilian immigrant mothers. Culturally relevant public health interventions, including tailored education and improved access to affordable dental care, are essential for enhancing OH outcomes in young children from these families.

Gestational weight gain (GWG) is critical for maternal and neonatal health, but excessive GWG can lead to complications such as gestational diabetes, hypertension, and increased obesity risk later in life. Minoritized and immigrant women often face higher risks of excessive GWG. This cross-sectional study assessed Central American women’s beliefs and concerns about GWG, the receipt of advice from healthcare providers, and sources of information for healthy weight management during pregnancy. A cross-sectional survey was conducted with 93 pregnant women from El Salvador (31.2%), Guatemala (46.2%), and Honduras (22.6%). Most participants were married (91.4%), and 91.2% had household incomes below $40,000. Self-reported pre-pregnancy weight status varied significantly (p = 0.03), with more Guatemalans self-reporting as overweight (34.9%) compared to Salvadorans (10.3%) and Hondurans (19.1%). Beliefs about GWG varied significantly; 72.1% of Guatemalan women accepted “eating for two”, while only 31.0% of Salvadorans did (p = 0.002). More Honduran women (90.5%) received weight gain recommendations from healthcare providers than Salvadorans (62.1%) and Guatemalans (60.5%) (p = 0.04). The Internet and family were common information sources on weight management, highlighting the need for culturally tailored health education. This study underscores critical differences in beliefs and access to prenatal care among pregnant Central American immigrant women, emphasizing the importance of culturally competent health education to support healthy pregnancy outcomes.

BACKGROUND:Racial health disparities are well documented and pervasive across the United States. Evidence suggests there is a "rural mortality penalty" whereby rural residents experience poorer health outcomes than their urban counterparts. However, whether this penalty is uniform across demographic groups and U.S. regions is unknown. OBJECTIVE:To assess how rural-urban differences in mortality differ by race (Black vs. White), U.S. region, poverty status, and how rural-urban status is measured. METHODS:Age-standardized mortality rates (ASMRs)/100,000 by U.S. county (2015-2019) were obtained by race (Black/White) from the CDC Wonder National Vital Statistics System (2015-2019) and were merged with county-level social determinants from the US Census Bureau and County Health Rankings. Multivariable generalized linear models assessed the associations between rurality (index of relative rurality [IRR] decile, rural-urban continuum codes, and population density) and race-specific ASMR, overall, and by Census region and poverty level. RESULTS:Overall, average ASMR was significantly higher in rural areas than urban areas for both Black (rural ASMR = 949.1 per 100,000 vs. urban ASMR = 857.7 per 100,000) and White (rural ASMR = 903.0 per 100,000 vs. urban ASMR = 791.6 per 100,000) populations. The Black-White difference was substantially higher (p < 0.001) in urban than in rural counties (65.1 per 100,000 vs. 46.1 per 100,000). Black-White differences and patterns in ASMR varied notably by poverty status and U.S. region. CONCLUSION:Policies and interventions designed to reduce racial health disparities should consider and address key contextual factors associated with geographic location, including rural-urban status and socioeconomic status.

Objectives Due to substantial regional variability in available caregiving services and supports, culture and health status among informal caregivers in the USA, the study objective was to explore how rural-urban differences in aspects of caregiving—caregiving intensity, distance to care recipient, caregiver burden, caregiver health and caregiving support—vary by US Census region (Northeast, South, Midwest and West) after accounting for other social determinants of health.Design This study was a secondary analysis of multiwave, cross-sectional study data.Setting The data were collected on a representative sample of informal, unpaid caregivers to older adults.Participants A sample of n=3551 informal caregivers from the National Study of Caregiving identified by older adult care recipients from waves 1 (2011) and 5 (2015) of the National Health and Aging Trends Study.Primary and secondary outcome measures Primary outcome measures were caregiving intensity (provided support for/with the number of activities of daily living (ADLs) and instrumental ADL (IADLs)) caregiver assisted with, hours of caregiving per month), caregiver burden (physical, emotional and financial), support services sought (types and total number), caregivers’ self-reported health and health status (individual comorbidities and a total number of comorbidities). Analyses were stratified by US Census region and rural-urban status, as defined by the US Census Bureau, of census tract of caregiver residence.Results Urban caregivers provided higher levels of ADL support in the Northeast (beta=0.19, 95% CI 0.03, 0.35) and West (beta=0.15, 95% CI 0.05,0.26) regions. Urban caregivers provided significantly higher levels of ADL support (p=0.020), IADL support (p=0.033) and total ADLs plus IADLs (p=0.013) than rural caregivers. Caregivers living in the South had higher amounts of monthly hours spent caregiving, ADL support, IADL support and combined ADLs plus IADLs and were more likely to have obesity, report poor or fair health, have heart conditions and experience emotional difficulty from caregiving (all p<0.001).Conclusions Study findings underscore caregiving’s multifaceted and complex nature and identify important urban-rural and regional differences in caregiving in the USA. Healthcare providers and healthcare organisations can have an important role in identifying and mitigating the negative impacts of caregiving on caregivers’ overall health. Interventions and support should be tailored to caregivers’ demographic backgrounds, addressing regional differences.

Abstract Background The United States (U.S.) has a growing population of Brazilian immigrant women. However, limited research has explored Pap tests and human papillomavirus (HPV) vaccination among this population. Methods Participants completed an online survey between July—August 2020. Bivariate analyses examined associations between healthcare-related variables (e.g., insurance, having a primary care provider) and demographics (e.g., age, education, income, marital status, years living in the U.S., primary language spoken at home) with 1) Pap test recency (within the past 3 years) and 2) HPV vaccination (0 doses vs. 1 + doses). Variables significant at p < 0.10 in bivariate analyses were included in multivariable logistic regression models examining Pap test recency and HPV vaccination. Results The study found that 83.7% of the sample had a Pap test in the past three years. Women who did not know their household income were less likely to be than women who reported a household income of < $25,000 (adjusted OR [aOR] = 0.34, 95% CI: 0.12, 0.95). Women who had seen a healthcare provider in the past year were more likely to have had a Pap test within the last three years than those who had not seen a provider in the past year ([aOR] = 2.43, 95% CI: 1.32, 4.47). Regarding HPV vaccination, 30.3% of respondents reported receiving one or more doses of the HPV vaccine. The multivariable logic regression models determined that women aged 27 -45 (aOR = 0.35, 95% CI: 0.18, 0.67) were less likely than women aged 18–26 to have been vaccinated against HPV). and that women with a PCP were more likely to be vaccinated than those without a PCP (aOR = 2.47. 95% CI:1.30, 4.59). Conclusion This study found that Brazilian immigrant women in the youngest age groups (21 – 29) for Pap test, 18- 26 for HPV vaccination) had somewhat better rates of Pap screening and HPV vaccination than the general U.S. population. This study adds new information about cervical cancer prevention and control behaviors among Brazilian immigrant women.

Objective: To assess prescribing of tramadol among patients with contraindications and higher risks of adverse events in a large population of commercially insured and Medicare Advantage members. Design: We performed a cross-sectional analysis evaluating tramadol utilization in patients with higher risk of adverse outcomes. Setting: This study utilized 2016-2017 data from the Optum Clinformatics Data Mart. Patients and participants: Patients with at least one tramadol prescription without a cancer or sickle cell diagnosis during the study period. Main outcome measures: We first determined if tramadol was prescribed among patients with contraindications or risk factors for adverse outcomes. We then determined if patient demographic or clinical factors were associated with the use of tramadol in these higher-risk scenarios using multivariable logistic regression models. Results: Among patients with at least one prescription for tramadol, 19.66 percent (99 percent CI: 19.57-19.75) concurrently received an interacting cytochrome P450 isoenzyme medication, 19.24 percent (99 percent CI: 19.15-19.33) concurrently received a serotonergic medication, and 7.93 percent (99 percent CI: 7.88-8.00) concurrently received a benzodiazepine. Additionally, 1.59 percent (99 percent CI: 1.56-1.61) of patients who received tramadol also had a seizure disorder, while 0.55 percent (99 percent CI: 0.53-0.56) of patients were under the age of 18. Overall, nearly one in three patients (31.17 percent) received tramadol in the presence of at least one of these risks (99 percent CI: 31.06-31.27). Conclusion: Almost one in three patients prescribed tramadol had a clinically significant drug interaction or contraindication for use, suggesting that prescribers often disregard these concerns. Real-world studies are needed to better understand the likelihood of harms associated with the use of tramadol in these contexts.

Abstract Background A preponderance of evidence suggests that higher income inequality is associated with poorer population health, yet recent research suggests that this association may vary based on other social determinants, such as socioeconomic status (SES) and other geographic factors, such as rural–urban status. The objective of this empirical study was to assess the potential for SES and rural–urban status to moderate the association between income inequality and life expectancy (LE) at the census-tract level. Methods Census-tract LE values for 2010–2015 were abstracted from the US Small-area Life Expectancy Estimates Project and linked by census tract to Gini index, a summary measure of income inequality, median household income, and population density for all US census tracts with non-zero populations (n = 66,857). Partial correlation and multivariable linear regression modeling was used to examine the association between Gini index and LE using stratification by median household income and interaction terms to assess statistical significance. Results In the four lowest quintiles of income in the four most rural quintiles of census tracts, the associations between LE and Gini index were significant and negative (p between < 0.001 and 0.021). In contrast, the associations between LE and Gini index were significant and positive for the census tracts in the highest income quintiles, regardless of rural–urban status. Conclusion The magnitude and direction of the association between income inequality and population health depend upon area-level income and, to a lesser extent, on rural–urban status. The rationale behind these unexpected findings remains unclear. Further research is needed to understand the mechanisms driving these patterns.

Brazilians are a rapidly growing ethnic immigrant population in the United States (U.S.), and there is a lack of childhood obesity prevention interventions addressing the needs of Brazilian preschool-age children. Using the family ecological model (FEM) as a guide, this developmental cross-sectional study assessed the preferences (content, intervention modality, and language) of 52 individual Brazilian immigrant parents (27 mothers, 25 fathers) for a family-based intervention to promote healthful energy balance-related behaviors (EBRB). Overall, 85% or more of parents reported being interested or very interested in content related to five of the seven assessed EBRBs (increasing fruits and vegetables, reducing unhealthy foods and sugar-sweetened beverages, increasing physical activity, and reducing screen time). Parent-preferred intervention modalities were group sessions delivered by community health workers (CHWs, 86.5%), email (84.6%), and messaging (78.8%), with most parents (71.2%) indicating a preference for content in Portuguese. Interventions integrating multiple components, such as group sessions offered by CHWs and text messaging using SMS and WhatsApp, should be considered. Future steps for intervention development should include investigating different communication channels and their integration into a culturally and linguistically tailored family-based intervention designed to promote healthful EBRBs of preschool-age children in Brazilian families living in the U.S.

This cross-sectional study explored differences in the receipt of health care provider (HCP) counseling to control/lose weight and adopt weight-related lifestyle behavior changes among Hispanic respondents according to acculturation level. Differences in reported action regarding HCP counseling were also examined. Data from four National Health and Nutrition Examination Survey (NHANES) cycles (2011–2018) were analyzed, with the analytic sample limited to Hispanic respondents who were overweight/obese. Respondents’ acculturation levels were derived from their reported country of origin and the primary language spoken at home. Respondents who reported speaking only Spanish or more Spanish than English at home were classified as primarily speaking Spanish at home. In contrast, those who reported speaking Spanish and English equally, more English than Spanish, or only English were categorized as primarily speaking English at home. Weighted multivariate logistic regression models were utilized to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to determine if differences in acculturation levels existed regarding the likelihood of receiving HCP counseling to (1) control/lose weight, (2) increase exercise/PA, and (3) reduce fat/calorie intake. Similar analyses examined differences in reported action regarding HCP counseling according to acculturation level. The analysis found no significant differences in receiving HCP counseling according to acculturation level. However, non-US-born respondents who primarily spoke Spanish at home were less likely than US-born respondents to report acting to control/lose weight (p = 0.009) or increase exercise/PA (p = 0.048), but were more likely to report having taken action to reduce fat/calorie intake (p = 0.016). This study revealed differences between acting on recommendations of health care professionals according to acculturation level, indicating a need for interventions tailored to acculturation levels.