Relationships between the home environment and physical activity and dietary patterns of preschool children: a cross-sectional study

Is family sense of coherence a protective factor against the obesogenic environment?

Despite greater risk for poor nutrition, inactivity, and overweight, some low-income children are able to maintain a healthy weight. We explore if a strong family sense of coherence (FSOC) acts as a protective factor against childhood obesity for low-income preschool children. Families with a strong FSOC view challenges as predictable, understandable, worthy of engaging, and surmountable. Data were collected from 321 low-income mothers and their preschool children in five states between March 2011 and May 2013. FSOC was assessed using the Family Sense of Coherence Scale. A 16-item checklist was used to assess practicing healthy child behaviors (fruit and vegetable consumption and availability, physical activity, and family meals) and limiting unhealthy child behaviors (sweetened beverage and fast food consumption, energy dense snack availability, and screen time). Child body mass index (BMI) z-scores were calculated from measured height and weight. FSOC was significantly associated with practicing healthy child behaviors (β = 0.32, p < .001). We did not find a statistically significant association between FSOC and limiting unhealthy child behaviors or child BMI z-scores in fully adjusted models. Our results suggest the importance of family functioning in predicting health behaviors around food consumption and availability, physical activity, and family meals.

Cross-sectional associations between high-deprivation home and neighbourhood environments, and health-related variables among Liverpool children

OBJECTIVES

(1) To investigate differences in health-related, home and neighbourhood environmental variables between Liverpool children living in areas of high deprivation (HD) and medium-to-high deprivation (MD) and (2) to assess associations between these perceived home and neighbourhood environments and health-related variables stratified by deprivation group.

DESIGN

Cross-sectional study.

SETTING

10 Liverpool primary schools in 2014.

PARTICIPANTS

194 children aged 9-10 years.

MAIN OUTCOME MEASURES

Health-related variables (self-reported physical activity (PA) (Physical Activity Questionnaire for Older Children, PAQ-C), cardiorespiratory fitness, body mass index (BMI) z-scores, waist circumference), home environment variables: (garden/backyard access, independent mobility, screen-based media restrictions, bedroom media) and neighbourhood walkability (Neighbourhood Environment Walkability Scale for Youth, NEWS-Y).

EXPLANATORY MEASURES

Area deprivation.

RESULTS

There were significant differences between HD and MD children's BMI z-scores (p<0.01), waist circumference (p<0.001) and cardiorespiratory fitness (p<0.01). HD children had significantly higher bedroom media availability (p<0.05) and independent mobility scores than MD children (p<0.05). MD children had significantly higher residential density and neighbourhood aesthetics scores, and lower crime safety, pedestrian and road traffic safety scores than HD children, all of which indicated higher walkability (p<0.01). HD children's BMI z-scores (β=-0.29, p<0.01) and waist circumferences (β=-0.27, p<0.01) were inversely associated with neighbourhood aesthetics. HD children's PA was negatively associated with bedroom media (β=-0.24, p<0.01), and MD children's PA was positively associated with independent mobility (β=0.25, p<0.01). MD children's independent mobility was inversely associated with crime safety (β=-0.28, p<0.01) and neighbourhood aesthetics (β=-0.24, p<0.05).

CONCLUSIONS

Children living in HD areas had the least favourable health-related variables and were exposed to home and neighbourhood environments that are unconducive to health-promoting behaviours. Less access to bedroom media equipment and greater independent mobility were strongly associated with higher PA in HD and MD children, respectively. Facilitating independent mobility and encouraging outdoor play may act as effective strategies to enhance PA levels and reduce sedentary time in primary school-aged children.

Minimal change in children's lifestyle behaviours and adiposity following a home-based obesity intervention: results from a pilot study

Background/Methods

Families of overweight and obese children require support to make sustainable lifestyle changes to improve their child’s diet and activity behaviours and in turn weight status. The aim of this pre-post intervention pilot study was to evaluate the feasibility of an individualised home-based intervention for treatment seeking overweight/obese 4–12 year olds and their caregivers. Baseline measures were used to develop a family-specific intervention to improve the quality of the home environment. The intervention was delivered as individualised written recommendations and resources plus phone call and home visit support. Baseline measures were repeated approximately 6 months later.

Results

Complete data for 24 children was available. Parents reported that 43 % of intervention recommendations were implemented ‘very much’. Some descriptive changes were observed in the home environment, most commonly including fruit and vegetables in their child’s lunchbox, not providing food treats, and restricting children’s access to chips/savoury snack biscuits. At the group level, minimal change was detected in children’s diet and activity behaviours or weight status (all p > 0.05).

Conclusion

The study findings did not support intervention feasibility in its current form. Future interventions should target the family food and activity environment, but also utilise an approach to address the complex social circumstances which limit parent’s ability to prioritise healthy family lifestyle behaviours.

Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR) 3/12/2014. http://www.ANZCTR.org.au. ACTRN12614001264673

Determinants of sugar-sweetened beverage consumption in young children: a systematic review

Sugar-sweetened beverage (SSB) consumption is associated with adverse health outcomes. Improved understanding of the determinants will inform effective interventions to reduce SSB consumption. A total of 46,876 papers were identified through searching eight electronic databases. Evidence from intervention (n = 13), prospective (n = 6) and cross-sectional (n = 25) studies on correlates/determinants of SSB consumption was quality assessed and synthesized. Twelve correlates/determinants were associated with higher SSB consumption (child's preference for SSBs, TV viewing/screen time and snack consumption; parents' lower socioeconomic status, lower age, SSB consumption, formula milk feeding, early introduction of solids, using food as rewards, parental-perceived barriers, attending out-of-home care and living near a fast food/convenience store). Five correlates/determinants were associated with lower SSB consumption (parental positive modelling, parents' married/co-habiting, school nutrition policy, staff skills and supermarket nearby). There was equivocal evidence for child's age and knowledge, parental knowledge, skills, rules/restrictions and home SSB availability. Eight intervention studies targeted multi-level (child, parents, childcare/preschool setting) determinants; four were effective. Four intervention studies targeted parental determinants; two were effective. One (effective) intervention targeted the preschool environment. There is consistent evidence to support potentially modifiable correlates/determinants of SSB consumption in young children acting at parental (modelling), child (TV viewing) and environmental (school policy) levels.

Reducing discretionary food and beverage intake in early childhood: a systematic review within an ecological framework

OBJECTIVE

To systematically review the literature and map published studies on 4-8-year-olds' intake of discretionary choices against an ecological framework (ANalysis Grid for Environments Linked to Obesity; ANGELO).

DESIGN

Articles were identified through database searches (PubMed, PyscINFO®, Web of Science) in February and March 2014 and hand-searching reference lists. Studies were assessed for methodological quality and mapped against the ANGELO framework by environment size (macro and micro setting) and type (physical, economic, policy and socio-cultural influences).

SETTING

Studies were conducted in the USA (n 18), Australia (n 6), the UK (n 3), the Netherlands (n 3), Belgium (n 1), Germany (n 1) and Turkey (n 1).

SUBJECTS

Children aged 4-8 years, or parents/other caregivers.

RESULTS

Thirty-three studies met the review criteria (observational n 23, interventions n 10). Home was the most frequently studied setting (67 % of exposures/strategies), with the majority of these studies targeting family policy-type influences (e.g. child feeding practices, television regulation). Few studies were undertaken in government (5·5 %) or community (11 %) settings, or examined economic-type influences (0 %). Of the intervention studies only four were categorised as effective.

CONCLUSIONS

The present review is novel in its focus on mapping observational and intervention studies across a range of settings. It highlights the urgent need for high-quality research to inform interventions that directly tackle the factors influencing children's excess intake of discretionary choices. Interventions that assist in optimising a range of environmental influences will enhance the impact of future public health interventions to improve child diet quality.

Household factors, family behavior patterns, and adherence to dietary and physical activity guidelines among children at risk for obesity

OBJECTIVE

To describe the proportion of children adhering to recommended physical activity and dietary guidelines, and examine demographic and household correlates of guideline adherence.

DESIGN

Cross-sectional (pre-randomization) data from a behavioral intervention trial designed to prevent unhealthy weight gain in children.

PARTICIPANTS

A total of 421 children (aged 5-10 years) at risk for obesity (body mass index percentile, 70-95).

MAIN OUTCOMES MEASURED

Physical activity (accelerometry), screen time (parent survey), and fruit and vegetable and sugar-sweetened beverage intake (24-hour dietary recall).

ANALYSIS

Proportions meeting guidelines were calculated. Logistic regression examined associations between demographic and household factors and whether children met recommended guidelines for (1) physical activity (≥ 60 min/d), (2) screen time (≤ 2 h/d), (3) fruit and vegetable intake (≥ 5 servings/d), and (4) sugar-sweetened beverage avoidance.

RESULTS

Few children met more than 1 guideline. Only 2% met all 4 recommended guidelines and 19% met none. Each guideline had unique sociodemographic and domain-specific household predictors (ie, availability of certain foods and beverages, media, and active play and exercise equipment).

CONCLUSIONS AND IMPLICATIONS

Families equipped to promote healthy child behavior patterns in 1 activity or dietary domain may not be in others. Results have implications for the development of interventions to affect children's weight-related behaviors and growth trajectories.

Built environment and active play among Washington DC metropolitan children: A protocol for a cross-sectional study

Background

Research has demonstrated that children who participate in active play are more likely to be physically active, thereby improving long-term health outcomes. Many adult studies have also shown that neighborhood built environments can encourage or discourage routine physical activity. Limited evidence has demonstrated that children who reside in neighborhoods with a built environment that is more inviting to active play exhibit lower overweight and obesity rates as well as an overall better state of well-being. This Built Environment and Active Play (BEAP) Study aims to develop a neighborhood playability rating system in the Washington, DC (DMV) area. Similar to walkability scores, these playability scores will estimate how affable a neighborhood is to active play. The BEAP Study will attempt to provide a broad view of factors influencing the level and type of active play among children.

Methods/Design

Using a cross-sectional design, the BEAP Study will collect data using a mail questionnaire administered to the parents and/or guardians of 2000 children aged 7-12 years residing in select DMV areas in October of 2014. Questionnaire data, including information on active play, home and neighborhood characteristics, parental perceptions, and sociodemographic characteristics will be merged through a geographic information system (GIS) with objective built environment measures in the participants’ neighborhoods. An ordered logit model will be used to regress an ordinal active play outcome on built environment exposure variables while adjusting for potential confounders. Upon the construction of the final model, predictor coefficients will be used as parameters in the scoring system to develop neighborhood playability scores.

Discussion

The BEAP Study intends to generate a neighborhood playability index by characterizing and quantifying children’s active play using parent-reported physical activity data in children, GIS data and built environment measures in participant neighborhoods. The BEAP Study will improve our understanding of the built environment and childhood playability relationship while also contributing to the body of evidence-based built environment and physical activity research.

Electronic supplementary material

The online version of this article (doi:10.1186/s13690-015-0070-3) contains supplementary material, which is available to authorized users.

Dietary and Behavioral Factors Associated with Diet Quality among Low-income Overweight and Obese African American Women

OBJECTIVES

The goal of this research was to assess the roles of demographic and home food environment characteristics on diet quality measured with the U.S. Department of Agriculture's Healthy Eating Index (HEI) in a population of low-income overweight and obese African American women.

DESIGN

Cross-sectional analysis of baseline data.

SETTING

A community-based study of low-income overweight and obese African American women.

SUBJECTS

Participants enrolled in the Healthy Homes/Healthy Families study including a home environment survey (e.g., food availability, food practices and social support) and 24-hour recall dietary data collected on one weekday and one weekend day (n = 198).

RESULTS

In multivariate regression analyses, demographic characteristics were not significantly associated with diet quality; however, several home food environment characteristics were significantly associated with higher quality diets, including healthy shopping (e.g., regularly purchasing fresh fruits and vegetables), selecting healthy beverages (e.g., without added sugar), healthy food preparation, and serving behaviors. Eating while watching television was associated with lower quality diets. Nearly 33% (p < 0.001) of the variance in HEI total score was explained by the home food environment factors, far surpassing that explained by demographic characteristics (3.5%, p = 0.21).

CONCLUSIONS

Interventions targeting the home food environment may improve overall diet quality in low-income overweight African American populations.

The influence of the neighborhood physical environment on early child health and development: A review and call for research

This review examines evidence of the association between the neighborhood built environment, green spaces and outdoor home area, and early (0-7 years) child health and development. There was evidence that the presence of child relevant neighborhood destinations and services were positively associated with early child development domains of physical health and wellbeing and social competence. Parents׳ perceptions of neighborhood safety were positively associated with children׳s social-emotional development and general health. Population representative studies using objective measures of the built environment and valid measures of early child development are warranted to understand the impact of the built environment on early child health and development.

Australian children's consumption of caffeinated, formulated beverages: a cross-sectional analysis

BACKGROUND

Caffeine is a common additive in formulated beverages, including sugar-sweetened beverages. Currently there are no data on the consumption of caffeinated formulated beverages in Australian children and adolescents. This study aimed to determine total intake and consumption patterns of CFBs in a nationally representative sample of Australian children aged 2-16 years and to determine contribution of CFBs to total caffeine intake. Consumption by day type, mealtime and location was also examined.

METHODS

Dietary data from one 24-hour recall collected in the 2007 Australian National Children's Nutrition and Physical Activity Survey were analysed. CFBs were defined as beverages to which caffeine has been added as an additive, including cola-type beverages and energy drinks. Socioeconomic status was based on the highest level of education attained by the participant's primary caregiver. Time of day of consumption was classified based on traditional mealtimes and type of day of consumption as either a school or non-school day. Location of consumption was defined by the participant during the survey.

RESULTS

On the day of the survey 15% (n = 642) of participants consumed CFBs. Older children and those of low socioeconomic background were more likely to consume CFBs (both P < 0.001). Amongst the 642 consumers mean (95% CI) intakes were 151 (115-187)g/day, 287 (252-321)g/day, 442 (400-484)g/day, and 555 (507-602)g/day for 2-3, 4-8, 9-13 and 14-16 year olds respectively. Consumers of CFBs had higher intakes of caffeine (mean (95% CI) 61 (55-67)mg vs. 11 (10-12)mg) and energy (mean (95% CI) 9,612 (9,247-9978)kJ vs. 8,186 (8,040-8,335)kJ) than non-consumers (both P < 0.001). CFBs contributed 69% of total daily caffeine intake. CFB intake was higher on non-school days compared with school days (P < 0.005) and consumption occurred predominantly at the place of residence (56%), within the "dinner" time bracket (17:00-20:30, 44%).

CONCLUSIONS

The consumption of CFBs by all age groups within Australian children is of concern. Modifications to the permissibility of caffeine as a food additive may be an appropriate strategy to reduce the intake of caffeine in this age group. Additional areas for intervention include targeting parental influences over mealtime beverage choices.

Associations of parental influences with physical activity and screen time among young children: a systematic review

Parents play a critical role in developing and shaping their children's physical activity (PA) and sedentary behaviours, particularly in the early years of life. The aim of this systematic review is to identify current literature investigating associations of parental influences with both PA and screen time in young children. This systematic review was conducted in November 2013 using 6 electronic databases covering research literature from January 1998 to November 2013. Thirty articles that met inclusion criteria were identified. These studies covered five important aspects of parenting: (1) parenting practices; (2) parents' role modelling; (3) parental perceptions of children's PA and screen viewing behaviours; (4) parental self-efficacy; and (5) general parenting style. Findings suggest that parents' encouragement and support can increase children's PA, and reducing parents' own screen time can lead to decreased child screen time. Improving parenting practices, parental self-efficacy or changing parenting style may also be promising approaches to increasing PA time and decreasing screen time of young children.

Social Cognitive Maternal-Mediated Nutritional Correlates of Childhood Obesity

The purpose of this investigation was to examine the extent to which the maternal-facilitated, social cognitive theory constructs of environment, emotional coping, expectations, self-control, and self-efficacy predicted child fruit and vegetable consumption and sugar-free beverage intake. Instrumentation comprised three stages of data collection and analysis. Stage 1 included item generation, face and content validity by a panel of six experts, and readability by Flesch Reading Ease and Flesch–Kincaid Grade Level tests. Stage 2 assessed stability of the theoretical constructs using the test–retest procedure with 30 participants. Structural equation modeling was used during Stage 3 to conduct confirmatory factor analysis and to establish predictive validity of the models. A total of 224 respondents participated in this study. Maternal-facilitated home environment and self-efficacy were significant predictors of child fruit and vegetable consumption while maternal-mediated home environment and emotional coping were significant predictors of child sugar-free beverage intake.

Influences on the diet quality of pre-school children: importance of maternal psychological characteristics

OBJECTIVE

To test the hypothesis that maternal psychological profiles relate to children's quality of diet.

DESIGN

Cross-sectional study. Mothers provided information on their health-related psychological factors and aspects of their child's mealtime environment. Children's diet quality was assessed using an FFQ from which weekly intakes of foods and a diet Z-score were calculated. A high score described children with a better quality diet. Cluster analysis was performed to assess grouping of mothers based on psychological factors. Mealtime characteristics, describing how often children ate while sitting at a table or in front of the television, their frequency of takeaway food consumption, maternal covert control and food security, and children's quality of diet were examined, according to mothers' cluster membership.

SUBJECTS

Mother-child pairs (n 324) in the Southampton Initiative for Health. Children were aged 2-5 years.

SETTING

Hampshire, UK.

RESULTS

Two main clusters were identified. Mothers in cluster 1 had significantly higher scores for all psychological factors than mothers in cluster 2 (all P < 0.001). Clusters were termed 'more resilient' and 'less resilient', respectively. Children of mothers in the less resilient cluster ate meals sitting at a table less often (P = 0.03) and watched more television (P = 0.01). These children had significantly poorer-quality diets (β = -0.61, 95% CI -0.82, -0.40, P ≤ 0.001). This association was attenuated, but remained significant after controlling for confounding factors that included maternal education and home/mealtime characteristics (P = 0.006).

CONCLUSIONS

The study suggests that mothers should be offered psychological support as part of interventions to improve children's quality of diet.

Combating child obesity: impact of HENRY on parenting and family lifestyle

BACKGROUND

One-quarter of children in England are overweight/obese at school entry. We investigated the impact of a programme designed to provide parents of infants and preschool children with the skills required for a healthier family lifestyle.

METHOD

A cohort of families was followed across the 8-week HENRY (Health Exercise Nutrition for the Really Young) parent course at nine locations in England. Seventy-seven parents enrolled on the course, of which 71 agreed to complete questionnaires addressing eating behaviours, dietary intake and parental self-efficacy. Pre- and post-course data was available from 60 (84.5%) parents (8-week follow-up data from 58 parents) and was analysed using repeated measures analyses.

RESULTS

Significant changes were observed, with most sustained at follow-up. Parents reported increased self-efficacy and ability to encourage good behaviour (P < 0.001). Increased consumption of fruits and vegetables was reported in both children and adults, together with reduced consumption of sweets, cakes and fizzy drinks in adults (all P < 0.01). There were also positive changes in eating behaviours (e.g., frequency of family mealtimes and eating while watching television or in response to negative emotion [P < 0.01] ) and reduced screen time in adults (P < 0.001).

DISCUSSION

The results build upon earlier evaluation, indicating that the HENRY intervention has a beneficial impact upon the families of infants and preschool children. Furthermore, the findings suggest that positive changes inspired by the programme can be maintained beyond its completion. Such changes may serve to protect against later obesity.

Impact evaluation of Enabling Mothers to Prevent Pediatric Obesity through Web-Based Education and Reciprocal Determinism (EMPOWER) Randomized Control Trial

BACKGROUND

The family and home environment is an influential antecedent of childhood obesity. The purpose of this study was to pilot test The Enabling Mothers to Prevent Pediatric Obesity through Web-Based Education and Reciprocal Determinism (EMPOWER) intervention; a newly developed, theory-based, online program for prevention of childhood obesity.

METHOD

The two-arm, parallel group, randomized, participant-blinded trial targeted mothers with children between 4 and 6 years of age. Measures were collected at baseline, 4 weeks, and 8 weeks to evaluate programmatic effects on constructs of social cognitive theory (SCT) and obesity-related behaviors. Process evaluation transpired concurrently with each intervention session.

RESULTS

Fifty-seven participants were randomly assigned to receive either experimental EMPOWER (n = 29) or active control Healthy Lifestyles (n = 28) intervention. Significant main effects were identified for child physical activity, sugar-free beverage consumption, and screen time, indicating that both groups improved in these behaviors. A significant group-by-time interaction was detected for child fruit and vegetable (FV) consumption as well as the SCT construct of environment in the EMPOWER cohort. An increase of 1.613 cups of FVs (95% confidence interval = [0.698, 2.529]) was found in the experimental group, relative to the active control group. Change score analysis found changes in the home environment accounted for 31.4% of the change in child FV intake for the experimental group.

CONCLUSIONS

Child physical activity, sugar-free beverage consumption, and screen time improved in both groups over the course of the trial. Only the theory-based intervention was efficacious in increasing child FV consumption. The EMPOWER program was robust for inducing change in the home environment leading to an increase in child FV intake (Cohen's f = 0.160).

Home food and activity assessment. Development and validation of an instrument for diverse families of young children

The purpose of this study was to refine and psychometrically test an instrument measuring the home food and activity environment of geographically and economically diverse families of preschool aged children. Caregivers of preschool aged children (n = 83) completed a modified self-report questionnaire. Reliably trained researchers conducted independent observations on 25 randomly selected homes. Agreement statistics were conducted at the item level (154 total items) to determine reliability. Frequency counts were calculated to identify item availability. Results showed Kappa statistics were high (.67-1.00) between independent researchers but varied between researchers and parents resulting in 85 items achieving criterion validity (Kappa >.60). Analyses of reliable items revealed the presence in the home of a high frequency of unhealthy snack foods, high fat milk and low frequency of availability of fruits/vegetables and low fat milk. Fifty-two percent of the homes were arranged with a television in the preschool child's bedroom. Physical Activity devices also were found to have high frequency availability. Families reporting lower education reported higher levels of sugar sweetened beverages and less low-fat dairy (p < .05) compared with higher education families. Low-income families (<$27K per year) reported significantly fewer Physical Activity devices (p < .001) compared with higher income families. Hispanic families reported significantly higher numbers of Sedentary Devices (p < .05) compared with non-Hispanic families. There were no significant differences between demographic comparisons on available fruits/vegetables, meats, whole grains, and regular fat dairy. A modified home food and activity instrument was found to reliably identify foods and activity devices with geographically and economically diverse families.

The influence of home food environments on eating behaviors of overweight and obese women

OBJECTIVE

To describe home food environments and examine which aspects are associated with fruit and vegetable intake and percent calories from fat among overweight and obese women.

DESIGN

Baseline data from a weight gain prevention trial collected through telephone interviews.

SETTING

Participants were recruited from 3 federally qualified health centers in rural Georgia.

PARTICIPANTS

Overweight and obese patients (n = 319) were referred by their providers if they had a body mass index (BMI) > 25 and lived with at least 1 other person. Participants were primarily African American (83.7%), with a mean BMI of 38.4.

MAIN OUTCOME MEASURES

Fruit and vegetable intake and percent calories from fat.

ANALYSIS

Descriptive statistics and multiple regression.

RESULTS

Participants reported a large variety of both fruits and vegetables and unhealthy foods in their homes, and an average of 2.6 family meals from non-home sources per week. Eating family meals with the television on was common. Availability of fruits and vegetables in the home (P < .001) and frequency of fruit shopping (P = .01) were associated with fruit and vegetable intake. The number of unhealthy foods in the home (P = .01) and food preparation methods (P = .01) were associated with percent calories from fat.

CONCLUSIONS AND IMPLICATIONS

Home food environments may be effective intervention targets for nutrition programs designed for overweight and obese women.

Examining the role of parental self-regulation in family physical activity: a mixed-methods approach

Physical activity (PA) is essential for good health. However, parents risk becoming less active because of the demands of parenting. This has consequences for children as parents are role models. The present study used a mixed-methods approach to explore parental self-regulation associated with PA. Data were collected from 36 parents with preschool-aged children. They were interviewed about their PA and their family's PA. Parents also completed PA and self-regulation questionnaires and wore an accelerometer for five days. Qualitative data were examined using an inductive approach to thematic analysis. It showed that parents felt that they had limited time for personal PA. Mothers' self-regulation was driven by an ethic of care and subjective norms, whereas fathers' self-regulation was driven by beliefs about the importance of autonomy. Nevertheless, both parents saw caring for their children as the main priority. Quantitative data were examined using multiple regression analyses. Results showed that different self-regulatory behaviours predicted the PA of mothers and fathers. Which predictors were significant depended on the type of activity and how it was measured. The findings warrant longitudinal research that would enable the effect of family dynamics on self-regulation associated with PA to be assessed.

Should child obesity be an issue for child protective services? A call for more research on this critical public health issue

Given the lasting effects on adolescent and adult health, childhood obesity is a major public health issue. The relatively slow progress toward the prevention and treatment of childhood obesity, however, has prompted leaders in both academic and practice sectors to advocate for what may be considered a radical intervention approach, to conceptualize extreme child obesity as an issue of child maltreatment. Advocates of this approach suggest that this conceptualization affords a new angle for intervention-the involvement of child protective services (CPS) in mandating family-focused lifestyle changes aimed at reducing child overweight and, in the most extreme cases, the removal of the obese child from the home. However, surprisingly little research has been conducted to inform policies or practices consistent with this recommendation, which is already being implemented in some states. This article aims to provide an overview of the challenges to the prevention and treatment of childhood obesity that have motivated the call for CPS involvement in extreme cases and to review the existing research related to this approach. Given that relatively little data are currently available to support or refute the merits of CPS involvement, recommendations for future research that would better inform public policy and decision making regarding this and other intervention strategies are also highlighted.

An exploration and comparison of food and drink availability in homes in a sample of families of White and Pakistani origin within the UK

OBJECTIVE

Knowledge of the types and quantities of foods and drinks available in family homes supports the development of targeted intervention programmes for obesity prevention or management, or for overall diet improvement. In the UK, contemporary data on foods that are available within family homes are lacking. The present study aimed to explore home food and drink availability in UK homes.

DESIGN

An exploratory study using researcher-conducted home food availability inventories, measuring all foods and drinks within the categories of fruits, vegetables, snack foods and beverages.

SETTING

Bradford, a town in the north of the UK.

SUBJECTS

Opportunistic sample of mixed ethnicity families with infants approximately 18 months old from the Born in Bradford birth cohort.

RESULTS

All homes had at least one type of fruit, vegetable and snack available. Fresh fruits commonly available were oranges, bananas, apples, satsumas and grapes. Commonly available fresh vegetables included potatoes, cucumber, tomatoes and carrots. The single greatest non-fresh fruit available in homes was raisins. Non-fresh vegetables contributing the most were frozen mixed vegetables, tinned tomatoes and tinned peas. Ethnic differences were found for the availability of fresh fruits and sugar-sweetened beverages, which were both found in higher amounts in Pakistani homes compared with White homes.

CONCLUSIONS

These data contribute to international data on availability and provide an insight into food availability within family homes in the UK. They have also supported a needs assessment of the development of a culturally specific obesity prevention intervention in which fruits and vegetables and sugar-sweetened beverages are targeted.

Parenting style, the home environment, and screen time of 5-year-old children; the 'be active, eat right' study

INTRODUCTION

The global increase in childhood overweight and obesity has been ascribed partly to increases in children's screen time. Parents have a large influence on their children's screen time. Studies investigating parenting and early childhood screen time are limited. In this study, we investigated associations of parenting style and the social and physical home environment on watching TV and using computers or game consoles among 5-year-old children.

METHODS

This study uses baseline data concerning 5-year-old children (n = 3067) collected for the 'Be active, eat right' study.

RESULTS

Children of parents with a higher score on the parenting style dimension involvement, were more likely to spend >30 min/day on computers or game consoles. Overall, families with an authoritative or authoritarian parenting style had lower percentages of children's screen time compared to families with an indulgent or neglectful style, but no significant difference in OR was found. In families with rules about screen time, children were less likely to watch TV>2 hrs/day and more likely to spend >30 min/day on computers or game consoles. The number of TVs and computers or game consoles in the household was positively associated with screen time, and children with a TV or computer or game console in their bedroom were more likely to watch TV>2 hrs/day or spend >30 min/day on computers or game consoles.

CONCLUSION

The magnitude of the association between parenting style and screen time of 5-year-olds was found to be relatively modest. The associations found between the social and physical environment and children's screen time are independent of parenting style. Interventions to reduce children's screen time might be most effective when they support parents specifically with introducing family rules related to screen time and prevent the presence of a TV or computer or game console in the child's room.

Steps to Growing Up Healthy: a pediatric primary care based obesity prevention program for young children

BACKGROUND

Leading medical organizations have called on primary care pediatricians to take a central role in the prevention of childhood obesity. Weight counseling typically has not been incorporated into routine pediatric practice due to time and training constraints. Brief interventions with simple behavior change messages are needed to reach high-risk children, particularly Latino and Black children who are disproportionately affected by obesity and related comorbidities. Steps to Growing Up Healthy (Added Value) is a randomized controlled trial testing the efficacy of brief motivational counseling (BMC) delivered by primary care clinicians and the added value of supplementing BMC with monthly contact by community health workers (CHW) in the prevention/reversal of obesity in Latino and Black children ages 2-4 years old.

METHODS/DESIGN

Mother-child dyads (targeted n = 150) are recruited for this 12-month randomized trial at an inner-city pediatric primary care clinic and randomized to: 1) BMC delivered by clinicians and nurses at well, sick, and WIC visits with the goal of reducing obesogenic behaviors (BMC); 2) BMC plus monthly phone calls by a CHW (BMC + Phone); or 3) BMC plus monthly home visits by a CHW (BMC + Home). During BMC, the medical team facilitates the selection of a specific goal (i.e., reduce sugar sweetened beverage consumption) that is meaningful to the mother and teaches the mother simple behavioral strategies. Monthly contacts with CHWs are designed to identify and overcome barriers to goal progress. Dyads are assessed at baseline and 12 months and the primary outcome is change in the child's BMI percentile. We hypothesize that BMC + Phone and BMC + Home will produce greater reductions in BMI percentiles than BMC alone and that BMC + Home will produce greater reductions in BMI percentiles than BMC + Phone.

DISCUSSION

Steps to Growing Up Healthy will provide important information about whether a brief primary care-based intervention that utilizes a motivational interviewing and goal setting approach can be incorporated into routine care and is sufficient to prevent/reverse obesity in young children. The study will also explore whether monthly contact with a community health worker bridges the gap between the clinic and the community and is an effective strategy for promoting obesity prevention in high-risk families.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01973153.

Ethnic differences in the home environment and physical activity behaviors among low-income, minority preschoolers in Texas

PURPOSE

To evaluate the ethnic differences in the home physical activity and screen time environment of preschoolers enrolled in Head Start.

DESIGN

Cross-sectional.

SETTING

Sixteen Harris County Department of Education (HCDE) Head Start centers, Texas.

SUBJECTS

Seven hundred and six preschoolers enrolled in HCDE Head Start centers and their parents. MEASURES. Items from the parent-reported Healthy Home Survey evaluating the home physical activity environment and the Nutrition Screening form evaluating screen time.

ANALYSIS

Mixed model linear and logistic regression analysis.

RESULTS

Of the parents, 75.06% were overweight or obese. Hispanic parents were more likely to have a yard or open space (p = .014) and usable play equipment in the yard (p = .019) for their children to play in compared to African-Americans. Conversely, more African-American parents reported having a television (TV) in their preschooler's bedroom (p = .032) and were less likely to cut down their child's TV viewing time (p = .036). African-American preschoolers were reportedly more likely to eat while watching TV (p = .009), play video games for ≥ 2 hours on weekdays (p = .018) and have computer time for ≥ 2 hours on weekends (p = .007), compared to Hispanics.

CONCLUSION

The Hispanic participants of this study had a healthier home environment for physical activity and screen time as compared with their African-American counterparts. Future interventions targeting lifestyle change need to address these factors in an ethnic-specific manner.

Evaluating a Fruit and Vegetable Program: In Eastern Ontario Schools

Purpose: Effectiveness was evaluated for a fruit and vegetable program developed to encourage Canadian elementary school children to eat the recommended number of daily servings. Also examined was whether the program modified children’s personal factors, perceived social environment, and perceived physical environment.

Methods: A prospective, quasi-experimental trial was conducted to compare the eight schools receiving the intervention curriculum (Freggie Friday schools [FFS]) with six control schools (CS). A food frequency questionnaire was used to measure differences in fruit and vegetable consumption. Personal factors, perceived social environment, and perceived physical environment supporting fruit and vegetable consumption were assessed with an adapted version of the validated Pro Children study questionnaire.

Results: Of the 942 children who completed the baseline assessment, 807 also completed the follow-up questionnaire (FFS, 450; CS, 357). A mixed-effects regression model indicated no significant intervention effects on fruit or vegetable consumption, snack food consumption, or knowledge or attitudes related to fruit and vegetable consumption.

Conclusions: The results suggest that an intervention based on a single visit from an external group, followed by teacher-led programming, may be an ineffective method of eliciting dietary behaviour change in this population. Future programs may need to implement multicomponent intervention designs.

Measuring the physical activity practices used by parents of preschool children

INTRODUCTION

Parents play a critical role in shaping children's attitudes, beliefs, and behaviors, including those around physical activity and inactivity. Our ability to identify which practices effectively promote children's physical activity and limit inactivity is limited by existing measurement instruments. This project will present a newly developed physical activity parenting practices survey, the psychometric properties of this survey's scales, and their association with child physical activity and screen time behaviors.

METHODS

A sample of 324 parents with 2- to 5-yr-old children from central North Carolina completed a series of questionnaires, including this newly developed survey of physical activity parenting practices. Child physical activity was assessed by ActiGraph GT3X accelerometers and parent report. Exploratory factor analysis was used to identify physical activity parenting practice constructs, and Pearson correlation was used to explore relations between constructs and child physical activity.

RESULTS

Fourteen parent practices used to either control or support children's physical activity or screen time were identified. Limits on screen time (r = -0.44), use of screen time to control behavior (r = 0.23), exposure to TV (r = 0.33), and parent modeling of physical activity (r = 0.37) were all significantly associated with children's TV viewing. Use of physical activity to control child behavior was significantly associated with time spent outside (r = 0.15) and minutes of moderate or vigorous physical activity (r = 0.16). Several supportive practices were associated with time outside (+) and TV time (-).

CONCLUSIONS

Results provide support for this new measure of physical activity parenting practices and identify several practices that are clearly associated with child physical activity.

Does parental warmth and responsiveness moderate the associations between parenting practices and children's health-related behaviors?

OBJECTIVE

To determine whether a higher number of parenting practices, such as those concerning meals, bedtime, and limited screen time, is associated with children's health behaviors. In addition, to determine whether perceived parental warmth and responsiveness toward the child strengthens (moderates) the associations between parenting practices and health behaviors.

DESIGN

Cross-sectional study.

SETTING

School-based survey in which children completed questionnaires at school, and parents at home.

PARTICIPANTS

A total of 805 child-parent dyads were used in analyses.

MAIN OUTCOME MEASURES

Intake of nutrient-dense and energy-rich foods, meal frequency per day, sleep duration, and screen time.

ANALYSIS

Linear and logistic regression analyses. Moderation was tested by adding the interaction term of parenting practices and parental warmth/responsiveness to the models. When moderation occurred, stratified analyses were conducted.

RESULTS

A higher number of parenting practices was associated with more favorable health behaviors. Stronger associations between parenting practices and nutrient-dense food intake and meal frequency were found when children perceived high parental warmth/responsiveness. Stronger associations between parenting practices and energy-rich food intake and screen time were found when children perceived low parental warmth/responsiveness.

CONCLUSIONS AND IMPLICATIONS

Parental warmth/responsiveness seems to strengthen the associations between parenting practices and favorable health behaviors. This knowledge could be used in family-focused obesity interventions.

Feeding style differences in food parenting practices associated with fruit and vegetable intake in children from low-income families

OBJECTIVE

To examine the moderating effects of feeding styles on the relationship between food parenting practices and fruit and vegetable (F & V) intake in low-income families with preschool-aged children.

DESIGN

Focus group meetings with Head Start parents were conducted by using the nominal group technique. Parents completed information on food parenting practices and feeding styles. Three dietary recalls were collected on each child.

SETTING

Parents completed measures in Head Start centers and/or over the telephone.

PARTICIPANTS

667 parents of preschool-aged children participated.

OUTCOMES

Food parenting practices and F & V intake.

ANALYSIS

Mean differences in the food parenting practices across the 4 feeding styles were established through multivariate general linear modeling using MANOVA. Moderated multiple regression analysis was conducted to examine the moderating role of feeding style on food parenting practices and child F & V intake.

RESULTS

The indulgent feeding style moderated the relationship between food parenting practices and child F & V intake.

CONCLUSIONS AND IMPLICATIONS

This study indicates that parents' feeding styles have a moderating effect on the relationship between the food parenting practices and children's F & V intake. This finding can facilitate the development of interventions aimed at reducing childhood overweight.

The family context of low-income parents who restrict child screen time

BACKGROUND

The American Academy of Pediatrics recommends that parents restrict child screen time to two hours per day, but many preschool-aged children exceed this viewing recommendation. Modifying children's viewing habits will require collaborating with parents, but little is known about the factors that influence parents' capacity for effective screen-related parenting. This study aimed to identify the demographic, family and community contextual factors associated with low-income parents' restriction of child screen time.

METHODS

Parents (N=146) of children (age 2-5 years) attending Head Start centers in the United States completed a self-report survey in 2010 assessing parent and child screen use (television, DVD, video, video games, and leisure-time computer use), parent restriction of child screen time, and family (parent stress, social support, and life pressures) and community (neighborhood safety and social capital) factors.

RESULTS

Children were more likely to meet the American Academy of Pediatrics screen time recommendation if their parent reported high restriction of child screen time. Parent and child demographic characteristics were not associated with parents' restriction of child screen time. In multivariate analysis, less parent screen time, fewer parent life pressures, and greater social support were associated with parents' high restriction of screen time.

CONCLUSION

Family contextual factors may play an important role in enabling low-income parents to restrict their children's screen time. When counseling low-income parents about the importance of restricting child screen time, practitioners should be sensitive to family contextual factors that may influence parents' capacity to implement this behavior change.

Weight changes in children in foster care for 1 year

OBJECTIVE

The aims of this study of predominately racial/ethnic minority children in foster care (N=360, birth to 19 years old) in Los Angeles, CA were to examine the (1) prevalence of obesity (≥ 95 percentile) and overweight/obese (≥ 85 percentile) upon entrance to foster care (T1) and after 1 year in foster care (T2); (2) comparison of high weight categories to national statistics; (3) relationship of changes in weight status to age, reason for entry into foster care, and placement.

METHODS

Chi-square test and McNemar test comparing paired proportions were used to determine whether there were significant changes in the proportion of high weight categories between T1 and T2. Chi-square test or Fisher's exact test were used to evaluate the association between age, placement, and reason for foster care with the change in weight category. Changes in weight were categorized as (1) decreased in weight, (2) remained at overweight or obese, (3) increased in weight, or (4) remained normal.

RESULTS

The proportion of obese and obese/overweight children between ages 2 and 5 were significantly lower at T2 than T1. There were no significant changes in the prevalence of obesity for the total population at T2. Children age 6 or older had a higher prevalence of obesity and overweight/obesity compared to national statistics. Of children at all ages, 64.7% of children of all ages entered foster care with a normal weight and stayed in the normal range during their first year in foster care, 12.2% decreased their weight, 15.4% remained overweight or obese, and 7.7% increased their weight. Age and parental substance use was related to change in weight category from T1 to T2.

CONCLUSION

Children did not become more overweight or obese in foster care; however 28% of the children were obese or overweight upon entry into foster care. Children who are 6 years or older and obese upon entering foster care should be targeted for weight reduction. The pediatric community and child welfare system need to work together by including weight percentiles in the foster care file and training/monitoring child welfare caregivers in weight reduction interventions.

The correlates of preschoolers' compliance with screen recommendations exist across multiple domains

OBJECTIVE

To investigate the individual, social and physical environment correlates of preschool children's compliance with Australian/Canadian and American Academy of Pediatrics (AAP) screen recommendations.

METHOD

An Ecological Model (EM) was used to identify constructs potentially associated with children's screen time. In 2008-2009, parents in Melbourne, Australia, reported their child's screen time and on a range of potential correlates. Children (n = 935; 54% boys, mean age 4.54 ± 0.70 years) were assessed as meeting or not meeting each of the screen recommendations. Logistic regression assessed bivariable and multivariable associations.

RESULTS

In total, 15 explanatory variables, across the three domains of the EM were associated with boys' and/or girls' compliance with either Australian/Canadian or AAP recommendations. Correlates varied by sex and recommendation. Maternal television viewing time was the only consistent correlate for both boys' and girls' compliance with both recommendations. No demographic groups were identified as being less likely to comply with screen recommendations.

CONCLUSION

Public health programs should take account of the sex-specific nature of correlates of preschool children's screen time. Preschool children across all demographic groups need support to engage in less screen use. Parents may benefit from education and parenting skills to minimize potentially harmful effects of excessive screen time for their child.

Parenting efficacy related to childhood obesity: comparison of parent and child perceptions

The aim of this study was to explore child and parent perceptions of parenting efficacy related to child BMI. This descriptive, cross-sectional study recruited 27 parent-child dyads participating in a healthy eating/activity intervention. Parent and child perceptions of parenting efficacy were measured using a version of the Tool to Measure Parenting Self-Efficacy (TOPSE). Paired sample t test and correlational statistics were used. Parents and children had similar perception of parenting efficacy. Child report of parenting efficacy and child BMI was significant. Exploring perceptions of parenting efficacy will help individualize family-focused intervention programs to prevent obesity in children.

Measurement of general and specific approaches to physical activity parenting: a systematic review

BACKGROUND

Parents play a significant role in shaping youth physical activity (PA). However, interventions targeting PA parenting have been ineffective. Methodological inconsistencies related to the measurement of parental influences may be a contributing factor. The purpose of this article is to review the extant peer-reviewed literature related to the measurement of general and specific parental influences on youth PA.

METHODS

A systematic review of studies measuring constructs of PA parenting was conducted. Computerized searches were completed using PubMed, MEDLINE, Academic Search Premier, SPORTDiscus, and PsycINFO. Reference lists of the identified articles were manually reviewed as well as the authors' personal collections. Articles were selected on the basis of strict inclusion criteria and details regarding the measurement protocols were extracted. A total of 117 articles met the inclusionary criteria. Methodological articles that evaluated the validity and reliability of PA parenting measures (n=10) were reviewed separately from parental influence articles (n=107).

RESULTS

A significant percentage of studies used measures with indeterminate validity and reliability. A significant percentage of articles did not provide sample items, describe the response format, or report the possible range of scores. No studies were located that evaluated sensitivity to change.

CONCLUSION

The reporting of measurement properties and the use of valid and reliable measurement scales need to be improved considerably.

Exploring the use of storybooks to reach mothers of preschoolers with nutrition and physical activity messages

OBJECTIVE

To assess perceptions stay-at-home mothers have about their preschoolers' eating and physical activity behaviors and to explore the feasibility of using storybooks in home-based nutrition and activity programming.

METHODS

Focus groups were conducted with 24 mothers, intercept interviews were conducted with 30 parents, and a storybook prototype was developed and pretested in 8 preschool classrooms.

RESULTS

Mothers acknowledged picky eating as an issue and were less likely to identify issues with physical activity, but they were interested in information on gross motor development. Mothers strongly supported storybooks as a modality to convey and reinforce health messages at home. The storybook prototype was well liked by parents, teachers, and preschoolers.

CONCLUSIONS AND IMPLICATIONS

Storybooks are a practical method to reach mothers and preschoolers and have the potential to elicit changes in eating and activity behaviors. Understanding mothers' perceptions of healthy eating and physical activity is essential to ensure that storybook messages resonate with this audience.

Measuring parent food practices: a systematic review of existing measures and examination of instruments

During the last decade, there has been a rapid increase in development of instruments to measure parent food practices. Because these instruments often measure different constructs, or define common constructs differently, an evaluation of these instruments is needed. A systematic review of the literature was conducted to identify existing measures of parent food practices and to assess the quality of their development. The initial search used terms capturing home environment, parenting behaviors, feeding practices and eating behaviors, and was performed in October of 2009 using PubMed/Medline, PsychInfo, Web of knowledge (ISI), and ERIC, and updated in July of 2012. A review of titles and abstracts was used to narrow results, after which full articles were retrieved and reviewed. Only articles describing development of measures of parenting food practices designed for families with children 2-12 years old were retained for the current review. For each article, two reviewers extracted data and appraised the quality of processes used for instrument development and evaluation. The initial search yielded 28,378 unique titles; review of titles and abstracts narrowed the pool to 1,352 articles; from which 57 unique instruments were identified. The review update yielded 1,772 new titles from which14 additional instruments were identified. The extraction and appraisal process found that 49% of instruments clearly identified and defined concepts to be measured, and 46% used theory to guide instrument development. Most instruments (80%) had some reliability testing, with internal consistency being the most common (79%). Test-retest or inter-rater reliability was reported for less than half the instruments. Some form of validity evidence was reported for 84% of instruments. Construct validity was most commonly presented (86%), usually with analysis of associations with child diet or weight/BMI. While many measures of food parenting practices have emerged, particularly in recent years, few have demonstrated solid development methods. Substantial variation in items across different scales/constructs makes comparison between instruments extremely difficult. Future efforts should be directed toward consensus development of food parenting practices constructs and measures.

Double dose: the cumulative effect of TV viewing at home and in preschool on children's activity patterns and weight status

Little is known about how screen-based sedentary behavior at home and in preschool influences children's health and activity patterns. The current study examined the individual and cumulative influence of TV viewing at home and in preschool on children's physical activity (PA) and weight status. Children (n = 339) attending 16 preschools in South Carolina were grouped into high and low TV groups based on parent report of children's TV viewing at home and director report of TV use/rules in preschool. T-tests and mixed model ANOVAs examined differences in weight status and PA (min/hr) by high and low TV groups. Results revealed that children who were classified as High TV both at home and in pre- school had significantly lower levels of moderate-to-vigorous PA compared with their Low TV counterparts (8.3 (0.3) min/hr vs. 7.6 (0.2) min/hr, p < .05). However, there were no significant differences in weight status or physical activity between the high and low TV groups at home or in preschool when examined individually. These findings demonstrate the importance of total environmental TV exposure on preschooler's PA. Longitudinal and observational research to assess preschoolers' cumulative screen-based sedentary behavior and its relationship with PA and weight status is needed.

Differences in home food and activity environments between obese and healthy weight families of preschool children

OBJECTIVE

To develop and test a home food and activity instrument to discriminate between the home environments of obese and healthy weight preschool children.

DESIGN

A modified questionnaire about home environments was tested as an observation tool.

SETTING

Family homes.

PARTICIPANTS

A total of 35 obese children with at least 1 obese caregiver were compared with 47 healthy weight children with no obese caregivers.

MAIN OUTCOME MEASURES

Home observation assessments were conducted to evaluate the availability of devices supporting activity behaviors and foods based on availability, accessibility, and readiness to be eaten.

ANALYSIS

Agreement statistics were conducted to analyze psychometrics and MANOVAs were conducted to assess group differences, significance, P < .05.

RESULTS

Home observations showed acceptable agreement statistics between independent coders across food and activity items. Families of obese preschoolers were significantly less likely to have fresh vegetables available or accessible in the home, were more likely to have a television in the obese child's bedroom, and had fewer physical activity devices compared with healthy weight preschoolers.

CONCLUSIONS AND IMPLICATIONS

Families of young children live in home environments that were discriminatively characterized based on home observations. Future tool refinement will further clarify the impact of the home environment on early growth.

Effectiveness of interventions to promote physical activity among socioeconomically disadvantaged women: a systematic review and meta-analysis

Physical activity is important for preventing weight gain and obesity, but women experiencing socioeconomic disadvantage are at high risk of inactivity. This study aimed to determine the effectiveness of interventions to increase physical activity among women experiencing disadvantage, and the intervention factors (i.e. physical activity measure, delivery mode, delivery channel, setting, duration, use of theory, behavioural techniques, participant age, risk of bias) associated with effectiveness. We conducted a meta-analysis of controlled trials using random-effects models and meta-regression. Seven databases were searched for trials among healthy women (18-64 years), which included a physical activity intervention, any control group, and statistical analyses of a physical activity outcome at baseline and post-intervention. Nineteen studies were included (n = 6,339). Because of substantial statistical heterogeneity (χ(2) = 53.61, df = 18, P < 0.0001, I(2) = 66%), an overall pooled effect is not reported. In subgroup analyses, between-group differences were evident for delivery mode, which modestly reduced heterogeneity (to 54%). Studies with a group delivery component had a standardized mean difference of 0.38 greater than either individual or community-based delivery. Programs with a group delivery mode significantly increase physical activity among women experiencing disadvantage, and group delivery should be considered an essential element of physical activity promotion programs targeting this population group.

Promoting physical activity in preschoolers to prevent obesity: a review of the literature

This literature review summarizes clinical recommendations for adequate physical activity and reviews recently published studies that focus on identifying common factors associated with physical activity levels among preschoolers in the United States and Canada. Currently, there is inconsistency in both the definition of and recommendations for physical activity. In addition, there is relatively little research in this area. Common factors and contexts associated with physical activity levels in preschoolers in this review included (a) child characteristics; (b) interpersonal dynamics between preschoolers and their families, childcare providers, and health care providers; (c) childcare setting; and (d) neighborhood environment.

Effects of parenting style and parent-related weight and diet on adolescent weight status

OBJECTIVE

This study examined the interaction between parental limit setting of sedentary behaviors and health factors (weight status, physical activity [PA], fruit and vegetable [FV] intake) on standardized body mass index (zBMI) in African American adolescents.

METHODS

Data were from 67 parent-adolescent dyads. Parental limit setting, PA and FV intake were assessed via self-report, and objective height and weight measurements were collected.

RESULTS

Regressions examined the interaction between parental limit setting and BMI, PA, FV intake on adolescent zBMI. The model for parent BMI and FV intake accounted for 31% of the variance in adolescent zBMI. A significant interaction for parent BMI by limit setting showed that as parental BMI increased, higher (vs. lower) limit setting was associated with lower adolescent zBMI. Higher parent FV consumption was associated with lower adolescent zBMI.

CONCLUSION

Future interventions should integrate parent limit setting and target parent fruit and vegetable intake for obesity prevention in underserved adolescents.

Community food environment, home food environment, and fruit and vegetable intake of children and adolescents

OBJECTIVES

To determine (1) reliability of new food environment measures; (2) association between home food environment and fruit and vegetable (FV) intake; and (3) association between community and home food environment.

METHODS

In 2005, a cross-sectional survey was conducted with readministration to assess test-retest reliability. Adolescents, parents of adolescents, and parents of children (n = 458) were surveyed in San Diego, Boston, and Cincinnati.

RESULTS

Most subscales had acceptable reliability. Fruit and vegetable intake was positively associated with availability of healthful food (r = 0.15-0.27), FV (r = 0.22-0.34), and ratio of more-healthful/less-healthful food in the home (r = 0.23-0.31) and was negatively associated with less-healthful food in the home (r = -0.17 to -0.18). Home food environment was associated with household income but not with community food environment.

CONCLUSIONS AND IMPLICATIONS

A more healthful home food environment was related to youth FV intake. Higher income households had more healthful food in the home. The potential influence of neighborhood food outlets warrants further study.

Weight status and weight-related behaviors of children commencing school

OBJECTIVE

To describe the weight status and weight-related behaviors of children commencing school.

METHODS

This study is a representative cross-sectional survey of Australian children in their first year of schooling (n=1141) in 2010. Height and weight were measured, and parents reported their child's diet, physical activity and screen-time.

RESULTS

18.7% of children were overweight/obese. Compared with non-overweight/obese peers, overweight/obese boys were 1.73 times (95% CI 1.08, 2.79) as likely to exceed recommended screen time and 2.07 times (95% CI 1.11, 3.87) as likely to eat dinner three or more times/week in front of the TV. Overweight/obese girls were twice as likely to have a TV in their bedroom (OR 2.00, 95% CI 1.12, 3.59) and usually be rewarded with sweets for good behavior (OR 1.96, 95% CI 1.09, 3.51) and were 1.65 times as likely to be inactive (95% CI 1.08, 2.55).

CONCLUSION

We showed that many children begin school with established weight-related behaviors that occur in the home environment. The inclusion of parents and the home environment in intervention strategies will be important to support changes to reduce childhood obesity. The weight status and weight-related behaviors of children entering school may potentially be a general indicator of the overall effectiveness of obesity prevention interventions among preschool-aged children.

Results from an intervention to improve rural home food and physical activity environments

BACKGROUND

Ecological models of healthy eating and physical activity emphasize the influence of behavioral settings such as homes and worksites in shaping behavior. Research on home environments suggests that both social and physical aspects of the home may impact physical activity and healthy eating.

OBJECTIVE

Using a community-based participatory research (CBPR) approach, the Emory Prevention Research Center (EPRC), Cancer Coalition of South Georgia, and the EPRC's Community Advisory Board (CAB) designed and tested a coach-based intervention to make the home environment more supportive of healthy eating and physical activity for rural adults.

METHODS

The 6-week intervention consisted of a tailored home environment profile, goal-setting, and behavioral contracting delivered through two home visits and two telephone calls. The study used a quasi-experimental design with data collected via telephone interviews at baseline, 2 and 4 months post-baseline. Ninety households (n = 90) completed all three telephone interviews.

RESULTS

Multilevel models indicated that intervention households reported significant improvements in household food inventories, purchasing of fruit and vegetables, healthier meal preparation, meals with the TV off, and family support for healthy eating, relative to comparison households. Intervention households also reported increased exercise equipment and family support for physical activity relative to comparison households. Percent of fat intake decreased significantly, but no changes were observed for fruit and vegetable intake, physical activity, or weight among intervention relative to comparison households, although trends were generally in a positive direction.

CONCLUSION

Coaching combined with a focus on the home environment may be a promising strategy for weight gain prevention in adults.

Associations between parenting styles and nutrition knowledge and 2-5-year-old children's fruit, vegetable and non-core food consumption

OBJECTIVE

During the early years, parents have a major influence on children’s diets and developing food choices. We investigated parenting styles as predictors of 2–5-year-old children’s diets and whether general nutrition knowledge (GNK) mediated these influences.

DESIGN

Cross-sectional research. Questionnaires measured demographic and lifestyle variables, family environment, parenting styles and feeding practices, child diet and GNK. Regression models tested GNK as a mediator of relationships between parenting variables and child diet (fruit/vegetable and non-core food consumption), controlling for confounders and family environment.

SETTING

Questionnaires were completed by main caregivers at home.

SUBJECTS

Parents of children aged 2–5 years (n 269).

RESULTS

Higher child fruit/vegetable consumption was associated with lower overreactive parenting and restriction, higher authoritative parenting and dining together as a family; with lax parenting approaching statistical significance (P50?083) and 19% of variance explained by the model. GNK was not a significant predictor. Conversely, non-core food consumption was associated with higher over-reactive and lax parenting as well as child age, increased takeaway food consumption and higher television viewing; GNK had a small effect (P = 0.043) and 28% of variance was explained by the model. GNK was a significant mediator only for authoritative parenting on non-core food (effect = -0.005).

CONCLUSIONS

These findings highlight that young children’s diets may be improved by interventions targeting a range of positive and supportive parenting practices in conjunction with nutrition knowledge education for parents of young children. Further insights will come from closer attention to the nature and role of restrictive feeding practices v. laxness and longitudinal research.

Validation of a home food inventory among low-income Spanish- and Somali-speaking families

OBJECTIVE

To refine and validate an existing home food inventory (HFI) for low-income Somali- and Spanish-speaking families.

DESIGN

Formative assessment was conducted using two focus groups, followed by revisions of the HFI, translation of written materials and instrument validation in participants’ homes.

SETTING

Twin Cities Metropolitan Area, Minnesota, USA.

SUBJECTS

Thirty low-income families with children of pre-school age (fifteen Spanish-speaking; fifteen Somali-speaking) completed the HFI simultaneously with, but independently of, a trained staff member. Analysis consisted of calculation of both item-specific and average food group kappa coefficients, specificity, sensitivity and Spearman’s correlation between participants’ and staff scores as a means of assessing criterion validity of individual items, food categories and the obesogenic score.

RESULTS

The formative assessment revealed the need for few changes/additions for food items typically found in Spanish-speaking households. Somali-speaking participants requested few additions, but many deletions, including frozen processed food items, non-perishable produce and many sweets as they were not typical food items kept in the home. Generally, all validity indices were within an acceptable range, with the exception of values associated with items such as ‘whole wheat bread’ (k = 0.16). The obesogenic score (presence of high-fat, high-energy foods) had high criterion validity with k = 0.57, sensitivity = 91.8%, specificity = 70.6% and Spearman correlation = 0.78.

CONCLUSIONS

The revised HFI is a valid assessment tool for use among Spanish and Somali households. This instrument refinement and validation process can be replicated with other population groups.

Effect of a family focused active play intervention on sedentary time and physical activity in preschool children

Background

Early childhood provides a window of opportunity for the promotion of physical activity. Given the limited effectiveness of interventions to date, new approaches are needed. Socio-ecological models suggest that involving parents as intervention targets may be effective in fostering healthier lifestyles in children. This study describes the effectiveness of a family-focused ‘Active Play’ intervention in decreasing sedentary time and increasing total physical activity in preschool children.

Method

Seventy-seven families were recruited from 8 randomly selected SureStart children’s centres in the North West of England. Centres were randomly assigned to either an intervention (n = 4) or a comparison group (n = 4). Parents and children in the intervention group received a 10-week active play programme delivered by trained active play professionals; this included an activity and educational component. Families in the comparison group were asked to maintain their usual routine. Each participating parent and child wore a uni-axial accelerometer for 7 days at baseline and post-test. Week and weekend day sedentary time and total physical activity adjusted for child- and home- level covariates were analysed using multilevel analyses.

Results

Significant intervention effects were observed for sedentary time and physical activity for both week and weekend days. Children in the intervention group engaged in 1.5% and 4.3% less sedentary time during week and weekend days, respectively and 4.5% and 13.1% more physical activity during week and weekend days, respectively than children in the comparison group. Parent’s participation in sport and their physical activity levels, child’s sex, availability of media in the home and attendance at organised activities were significant predictors of sedentary time and physical activity in this age group.

Conclusion

A 10-week family focused active play intervention produced positive changes in sedentary time and total physical activity levels in preschool children. Specific covariates were identified as having a significant effect on the outcome measures. Moreover, children whose parents were active engaged in less sedentary time and more physical activity suggesting that parent’s activity habits are mediators of physical activity engagement in this age group.

Caregiver food behaviours are associated with dietary intakes of children outside the child-care setting

Objective

To evaluate whether food behaviours of parents are associated with children's dietary intakes outside the child-care setting, and to compare children's dietary intakes at home with foods and beverages consumed when they are at child-care centres.

Design

In 2005–2006, a survey was completed by parents of at least one child between 3 and 5 years old who attended group child-care centres. Surveys about nutrition practices were completed by centre directors. Research assistants observed foods and beverages consumed by children at lunchtime at the centres.

Setting

Sixteen licensed group child-care centres in three underserved New York City communities (South Bronx, East/Central Harlem, Central Brooklyn) and the Lower East Side of Manhattan.

Subjects

Two hundred parents.

Results

Children were more likely to consume healthful foods including fruits or vegetables if parents reported purchasing food from produce stands/farmers’ markets, shopped for frozen or canned fruits frequently and ate family meals or meals prepared at home daily. Children were more likely to consume less healthful foods such as French fries, or fruit drinks, more frequently if parents reported eating meals from fast-food or other restaurants at least once weekly, or if children ate while watching television. Types of foods and beverages offered to children at home (e.g. higher-fat milk, soft drinks and desserts) were less healthful than those offered at child-care centres.

Conclusions

Children's dietary intakes at home need to be improved. Parents need to understand the importance of providing home environments that support healthful food behaviours in children.

Is there an association between the home food environment, the local food shopping environment and children's fruit and vegetable intake? Results from the Dutch INPACT study

Objective

To examine: (i) the association between home availability of fruit and vegetables and children's fruit and vegetable intake; (ii) the association between parental perception of the local food shopping environment and the home availability of fruit and vegetables; and (iii) whether the home availability of fruit and vegetables mediates the association between parental perception of the local food environment and children's fruit and vegetable consumption.

Design

Cross-sectional study.

Setting

A total of ninety-one primary schools in the Netherlands.

Subjects

In total 1501 primary caregivers completed a questionnaire to measure children's fruit and vegetable consumption, home availability of fruit and vegetables, parental perceptions of the local food shopping environment (price, quality and availability), the child's socio-economic status, the child's ethnicity and maternal height and weight.

Results

The home availability of fruit and vegetables was positively associated with children's fruit and vegetable intake (P < 0·01 and P < 0·001, respectively). Negative parental perceptions of the local food shopping environment were associated with less fruit available at home (P < 0·05, P < 0·01 and P < 0·05 for price, quality and availability of fruit, respectively). No significant associations were found between parental perception of the local food shopping environment and children's fruit and vegetable consumption. We found no evidence that home availability of fruit and vegetables mediates the association between parental perception of the local food environment and children's fruit and vegetable intake.

Conclusions

Interventions focusing on improving the home availability of fruit and vegetables may help to increase children's fruit and vegetable consumption. However, more data are required on factors influencing the home availability of fruit and vegetables.

A qualitative study of staff's perspectives on implementing an after school program promoting youth physical activity

Minimal effects found across youth physical activity (PA) interventions, and increased attention to circumstances that impede adequate delivery of program components, has highlighted the importance of learning from staff what is needed to foster staff comprehension and engagement for developing, adopting, and successfully implementing PA-based youth interventions. The purpose of this study is to address this knowledge gap by conducting a qualitative assessment of school staff perspectives on the positive aspects and challenges of implementing the 17-week ACT program, an after-school intervention that integrated motivational and behavioral components to promote PA in underserved adolescents. Interviews were conducted with one school staff member from each participating school for all four trial cohorts (N=12). Transcripts were coded by independent coders (r=.84) and content analyses of themes was performed using QSR NVivo. Themes were organized into five meta-themes: (1) Logistics; (2) Essential Elements; (3) Staff and Child Challenges; (4) Staff Comprehension, Value, and Enjoyment; (5) Spill-Over Effects. Findings indicate that staff can be successful at understanding, valuing, and reaching fidelity in implementing climate-based mediation components. The insight gained from this study lays the foundation for understanding the components needed for establishing well-implemented, effective, and generalizable interventions for increasing youth PA.

Associations between factors within the home setting and screen time among children aged 0-5 years: a cross-sectional study

BACKGROUND

Excessive engagement in screen time has several immediate and long-term health implications among pre-school children. However, little is known about the factors that influence screen time in this age group. Therefore, the purpose of this study was to use the Ecologic Model of Sedentary Behavior as a guide to examine associations between intrapersonal, interpersonal, and physical environment factors within the home setting and screen time among pre-school children.

METHODS

Participants were 746 pre-school children (≤ 5 years old) from the Kingston, Ontario, Canada area. From May to September, 2011, parents completed a questionnaire regarding several intrapersonal (child demographics), interpersonal (family demographics, parental cognitions, parental behavior), and physical environment (television, computer, or video games in the bedroom) factors within the home setting. Parents also reported the average amount of time per day their child spent watching television and playing video/computer games. Associations were examined using linear and logistic regression models.

RESULTS

Most participants (93.7%) watched television and 37.9% played video/computer games. Several intrapersonal, interpersonal, and physical environment factors within the home setting were associated with screen time. More specifically, age, parental attitudes, parental barriers, parental descriptive norms, parental screen time, and having a television in the bedroom were positive predictors of screen time; whereas, parental education, parental income, and parental self-efficacy were negative predictors of screen time in the linear regression analysis. Collectively these variables explained 64.2% of the variance in screen time. Parental cognitive factors (self-efficacy, attitudes, barriers, descriptive norms) at the interpersonal level explained a large portion (37.9%) of this variance.

CONCLUSIONS

A large proportion of screen time in pre-school children was explained by factors within the home setting. Parental cognitive factors at the interpersonal level were of particular relevance. These findings suggest that interventions aiming to foster appropriate screen time habits in pre-school children may be most effective if they target parents for behavioral change.