The Longitudinal Association Between Early Childhood Obesity and Fathers' Involvement in Caregiving and Decision-Making

Fathers Nutrition Knowledge and Child Feeding Practices Associated with Childhood Overweight and Obesity: A Scoping Review of Literature From 2000 to 2023

Objective. Childhood overweight/obesity is a serious global public health issue, demanding parental involvement to reverse trends. Despite fathers' crucial parenting roles, research on fathers and childhood overweight/obesity is limited. This scoping review examines the literature on fathers' nutrition knowledge and feeding practices with childhood overweight/obesity. Methods. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and Arksey and O'Malley (2005) framework, multiple databases were searched. Eligible father-child related studies focused on fathers' nutrition knowledge, feeding practices, and childhood overweight/obesity. Results. Of 26 eligible articles, 52% originated from the United States, and 44% focused on father-child dyads. Most studies were cross-sectional (64%) and survey-based (68%). Further, 11.5% assessed fathers' nutrition knowledge, and child feeding practices (53.4%). Conclusion. Literature on fathers' nutrition knowledge and feeding practices concerning childhood overweight/obesity is limited. Scaling-up fathers' inclusion in childhood nutrition research is encouraged for the design of holistic interventions.

Early childhood (1-5 years) obesity prevention: A systematic review of family-based multicomponent behavioral interventions

INTRODUCTION

Globally 38.9 million children under age 5 have overweight or obesity, leading to type 2 diabetes, cardiovascular complications, depression, and poor educational outcomes. Obesity is difficult to reverse and lifestyle behaviors (healthy or unhealthy) can persist from 1.5 years of age. Targeting caregivers to help address modifiable behaviors may offer a viable solution.

OBJECTIVE

Evaluate the impact of multicomponent family interventions on weight-based outcomes in early childhood and explore related secondary behavior outcomes.

METHODS

Four databases were searched (1/2017-6/2022) for randomized controlled trials (RCTs) of obesity-prevention interventions for children (1-5 years). Eligible studies included an objectively measured weight-based outcome, family interventions targeting the caregiver or family, and interventions including at least two behavioral components of nutrition, physical activity, or sleep.

RESULTS

Eleven interventions were identified consisting of four delivery modes: self-guided (n = 3), face-to-face group instruction (n = 3), face-to-face home visits (n = 2), and multiple levels of influence (n = 3). The reviewed studies reported almost no significant effects on child weight-based outcomes. Only two studies (one was an underpowered pilot study) resulted in significant positive child weight-management outcomes. Seven of the interventions significantly improved children's dietary intake.

CONCLUSION

Except for one, the reviewed studies reported that family based interventions had no significant effects on child weight-based outcomes. Future studies of this type should include measurements of age and sex-based body mass index (BMI) and trajectories, and also examine other important benefits to the children and families.

Caregiver Influences on Eating Behaviors in Children: An Opportunity for Preventing Obesity

PURPOSE OF REVIEW

This review seeks to define caregiver practices that impact childhood eating behaviors and identify ways to utilize these relationships to prevent childhood obesity.

RECENT FINDINGS

Childhood obesity, which correlates with adult obesity and increased cardiovascular risk, is increasing in prevalence and severity. Caregivers play a significant role in shaping a child's eating behaviors and their predisposition to obesity. Maternal influences during pregnancy and infancy impact a child's future food preferences. Caregiver feeding styles (authoritarian, authoritative, indulgent, and uninvolved) are associated with distinct effects on children's eating behaviors and self-regulation. Authoritative feeding styles promote child autonomy while setting boundaries in the feeding environment. Early caregiver education and coaching regarding nutrition and feeding practices is beneficial to establishing healthy eating behaviors for children. Various caregivers, including parents, grandparents, siblings, teachers, and others, influence a child's eating habits at different stages of development. These caregivers can both positively and negatively impact a child's diet. Comprehensive interventions involving these various caregivers to promote healthy eating practices in children is ideal. Such interventions should be sensitive to cultural and environmental factors. Childhood obesity is a complex issue with long-term health effects. Early intervention using comprehensive approaches including all caregivers, community support, and public policies to address the social determinants of health will be beneficial. Future research should focus on valid outcome measures and equitable interventions that encompass all aspects of a child's life.

Expectant fathers' health behaviors, infant care intentions, and social-emotional wellbeing in the perinatal period: A latent class analysis and comparison to mothers

While parental behaviors during the 'first thousand days' are critical for child health, little is known about fathers during this time. We examined prenatal patterns of health behaviors, social-emotional wellbeing, and infant care intentions among expectant fathers, both overall and compared to expectant mothers. Among 227 mother-father dyads enrolling in a randomized controlled trial of a perinatal obesity prevention program in Boston, Massachusetts (July 2020-July 2022), participants independently completed baseline surveys addressing (1) health behaviors, (2) social emotional wellbeing, and (3) infant care intentions. We compared paternal and maternal responses to survey items within each of these domains. Further, we conducted a latent class analysis of paternal responses and examined their associations with sociodemographic characteristics. Compared to expectant mothers, fathers were more likely to report increased body mass index, less fruit intake, decreased sleep, increased physical activity, and no recent primary care visit. Latent class analysis revealed four distinct groups of paternal health behaviors and infant care intentions: (1) more health behaviors with less infant care; (2) less health behaviors with less infant care; (3) less health behaviors with more infant care; and (4) more health behaviors with more infant care. Fathers with increased health behaviors were more likely to have higher education and income. Fathers with decreased health behaviors were more likely to endorse food insecurity, housing insecurity, and social isolation. Our findings identify potential areas for targeting expectant fathers in health promotion initiatives and suggest that social needs may impact the capacity to adopt healthy lifestyle behaviors.

Associations between Paternal Co-residence and Child Health among African American Children

We investigated the associations between paternal co-residence and asthma, obesity, and blood pressure among children aged 3-5 years. Mother/child dyads (N = 250) self-identified as African American or Black. Mothers reported on father's co-residence and child's asthma diagnosis. Height, weight, and blood pressure were measured. Regression models were used to examine paternal co-residence with child health outcomes (i.e., asthma, obesity, and blood pressure). Confounders included maternal and child age, child sex, maternal smoking, and insurance status. Children who lived with their fathers were less likely to have asthma (OR = 0.39, 95% CI 0.18-0.79), though this association was not significant after adjustment for confounders (aOR = 0.47, 95% CI 0.22-1.01). Paternal co-residence was not significantly associated with child obesity (aOR = 0.78, 95% CI 0.35-1.73), systolic (β = 0.57, SE = 1.2, p = .64), or diastolic (β = 1.91, SE = 1.0, p = .07) blood pressure. More research is necessary to understand the diversity of family living situations and how they affect child health.

Association between maternal and paternal employment and their children's weight status and unhealthy behaviours: does it matter who the working parent is?

Background

The growing number of employed women has been associated with an increase in the prevalence of overweight and obesity in children. We sought to determine whether childhood overweight/obesity in Spain is associated with labour participation of mothers and fathers, and whether the identity of the main caregiver has an influence on child’s weight and unhealthy behaviour.

Methods

We used microdata from the 2010 and 2014 Health Behaviour in School-Aged Children surveys performed in Spain (n = 32,694). Logistic and linear multi-level regression models were applied to assess the association between parental employment and children’s self-reported weight status, accounting for school effects and controlling for socioeconomic factors. Separated binary models were also fitted for consumption of fruit, sweets, screen viewing and sedentarism.

Results

In most cases, the significant associations between children’s weight and their parents’ work status disappeared once the models were adjusted for family wealth and education. However, we found persistent associations for some groups. Girls under 13 years-old living in households where the mother was the only employed parent were more likely to be affected by obesity and to report a higher body mass index value. Children in this type of household were more likely to show unhealthy lifestyles related to diet and leisure time activities.

Conclusions

Parents’ socioeconomic characteristics had a protective effect on their children’s risk of obesity. Unhealthy behaviours were observed in households with a non-working father and a working mother, although the link with obesity was limited to girls. Our results suggest the need for a more equally shared burden of caregiving.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13735-3.

Stakeholder engagement in developing a father-inclusive early life obesity prevention intervention: First Heroes

Background

Although paternal involvement in the perinatal period is associated with benefits for maternal-child health and reduced obesity risk, fathers are seldom included in perinatal or obesity prevention efforts. Engaging community leaders and fathers as stakeholders in intervention development is a critical step in designing a father-inclusive intervention that is efficacious and responsive to their needs.

Methods

We conducted a structured engagement study, including community stakeholder engagement and qualitative interviews with new fathers, to inform the development of a prospective randomized controlled trial that includes mothers and fathers as equal partners in infant obesity prevention. We interpreted stakeholder feedback through the Consolidated Framework for Implementation Research (CFIR) framework.

Results

Between September 2019 and April 2020, we held a Community Engagement meeting, formed a Community Advisory Board, and conducted 16 qualitative interviews with new fathers. Stakeholder engagement revealed insights across CFIR domains including intervention characteristics (relative advantage, complexity, design quality & packaging), outer setting factors (cosmopolitanism and culture), individual characteristics (including self-efficacy, state of change, identification with the organization) and process (engagement and adaptation). Stakeholders discussed the diverse challenges and rewards of fatherhood, as well as the intrinsic paternal motivation to be a loving, supportive father and partner. Both community leaders and fathers emphasized the importance of tailoring program delivery and content to meet specific parental needs, including a focus on the social-emotional needs of new parents.

Conclusions

A structured process of multidimensional stakeholder engagement was successful in improving the design of a father-inclusive perinatal obesity prevention interventions. Father engagement was instrumental in both reinforcing community ties and increasing our understanding of fathers’ needs, resulting in improvements to program values, delivery strategies, personnel, and content. This study provides a practical approach for investigators looking to involve key stakeholders in the pre-implementation phase of intervention development.

Trial registration

ClinicalTrials.gov, NCT04477577. Registered 20 July 2020.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04759-z.

Recruiting Fathers for Parenting Research: An Evaluation of Eight Recruitment Methods and an Exploration of Fathers' Motivations for Participation

Objective

We evaluated eight recruitment methods (Craigslist, Facebook ads, Google AdWords, in-person, newspaper, parenting magazines, ResearchMatch, and direct mailing) in terms of their ability to accrue fathers of 3- to 7-year-old children into a laboratory-based behavioral trial for parents. The trial was related to child obesity risk and parental health behaviors.

Design

Each recruitment method was implemented such that half its occurrences advertised for fathers only, and half advertised for mothers and fathers. Methods were evaluated in terms of number of fathers recruited, cost- and time-efficiency, response rates, and demographic characteristics of individuals recruited. We also assessed fathers' and mothers' motivations for participating in the study. 101 fathers and 260 mothers were recruited.

Results

Father-targeted ads were essential for father recruitment; 79% of accruals from father-targeted ads were male, whereas only 14% of accruals from parent-targeted ads were male. Craigslist, ResearchMatch, and Facebook ads were the most cost-efficient for accruing fathers. A greater proportion of fathers was motivated by increasing fathers' representation in research (16%) compared to mothers who wished to increase mothers' representation in research (5.4%). Similar proportions of fathers and mothers were motivated by improving their parenting knowledge and improving their child's health.

Conclusions

Future researchers should employ father-targeted recruitment materials (rather than parent-targeted) that capitalize on fathers' unique motivations for participating in research.

The enriched home environment and dietary intake are related to percent overBMI in children

Longitudinal research suggests that living in a cognitively enriched home environment, in which access to activities including hobbies and books are plentiful, can prevent excess weight gain and obesity in children. In order for the enriched home environment to influence weight it should influence energy and macronutrient intake and/or energy expenditure. To test this hypothesis, we used a cross sectional design to study aspects of the child's enriched home environment along with energy and macronutrient intake. A sample of 158 6-9-year-old children measured between February 2017 - April 2019 in Buffalo, NY were selected from a larger study based on criteria for accurate reporting of energy intake using the Block Kid's Food Frequency Questionnaire. Results showed that the Home Observation for Measurement of the Environment (HOME) subscales enriched environment, parental warmth and an integrated family structure were negatively related to child percent overBMI. Hierarchical regression showed that each of these factors improved variance in child percent overBMI accounted for beyond dietary intake or macronutrients, specifically accounting for a total of 18.2% variance in models controlling for total energy intake. These results provide the first demonstration that characteristics of a child's home environment are associated with lower energy intake and independently associated with percent overBMI beyond knowledge of diet. Enriching a child's home environment by providing alternative activities to eating, improving parental warmth and providing opportunities for parents to interact positively with their children may be novel ways to reduce childhood obesity that should be experimentally tested in future research.

Former Neonatal Intensive Care Unit Fathers' Involvement 4 Years Later: A Qualitative Study

PURPOSE

To explore the experience of fathering a previous Newborn Intensive Care Unit (NICU) infant four years after hospitalization.

DESIGN AND METHODS

Nineteen fathers of former NICU infants were interviewed using a semi-structured schedule.

RESULTS

Most of the fathers had children with ongoing health issues (84%). The median age of the fathers was 38 years old. Racial demographics included 12 white fathers (63%), 5 black fathers (26%), and 2 Hispanic fathers (11%). Themes that emerged included adjustments, prepared for anything, closeness, ambivalent normalcy, and vigilance. These fathers of former infants with health issues made 'adjustments' in their lives to be available and better fathers for their children. They familiarized themselves with their children's ongoing health issues so they could be better protectors and be 'prepared for anything', but considered their children 'normal kids' while still maintaining 'vigilance' for future health needs. Fathers described that the experience of having an infant with health issues helped them to develop 'closeness' with the child and boosted their confidence as fathers.

CONCLUSION

This involvement/confidence pattern is critically important to establishing and maintaining fathering, especially for fathers of children with disabilities.

PRACTICE IMPLICATIONS

Pediatric practitioners can continue to encourage this pattern after the initial hospital stay.

Measurement of screen time among young children aged 0-6 years: A systematic review

The impact of screen-based devices on children's health and development cannot be properly understood without valid and reliable tools that measure screen time within the evolving digital landscape. This review aimed to summarize characteristics of measurement tools used to assess screen time in young children; evaluate reporting of psychometric properties; and examine time trends related to measurement and reporting of screen time. A systematic review of articles published in English across three databases from January 2009 to April 2020 was undertaken using PROSPERO protocol (registration: CRD42019132599) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles measured screen time as outcome, exposure, or confounder in children 0-6 years. The search identified 35,868 records, 1035 full-text articles were screened for eligibility, and 622 met inclusion criteria. Most measures (60%) consisted of one to three items and assessed duration of screen time on a usual day. Few measures assessed content (11%) or coviewing (7%). Only 40% of articles provided a citation for the measure, and only 69 (11%) reported psychometric properties-reliability n = 58, validity n = 19, reliability and validity n = 8. Between 2009 and 2019, the number of published articles increased from 28 to 71. From 2015, there was a notable increase in the proportion of articles published each year that assessed exposure to mobile devices in addition to television. The increasing number of published articles reflects increasing interest in screen time exposure among young children. Measures of screen time have generally evolved to reflect children's contemporary digital landscape; however, the psychometric properties of measurement tools are rarely reported. There is a need for improved measures and reporting to capture the complexity of children's screen time exposures.

Inequalities in Exposure to Ambient Air Neurotoxicants and Disparities in Markers of Neurodevelopment in Children by Maternal Nativity Status

Exposure levels to environmental pollutants vary significantly among different populations. These inequities in exposure to hazardous air pollutants (HAP) among different populations can contribute to disparities in neurodevelopmental outcomes. The aim of this study was to determine if exposure to HAP varies by maternal nativity status, a demographic marker often overlooked in the study of health disparities. We also assessed if those inequalities in exposure levels are associated with neurodevelopmental measures in young children. To do this, we obtained data from the Early Childhood Longitudinal Study-Birth cohort (ECLS-B), a nationally representative sample of children born in the U.S. in the year 2001 (n = 4750). Bayley’s Short Form-Research Edition (BSF-R) was used to measure cognitive development at 2 years of age. Using residential location at nine months of age, participants were assigned exposures to ten HAPs identified as potentially neurotoxic. Linear regression models were used to assess the joint effect of maternal nativity status and HAP exposure on neurodevelopment. Results showed inequities in exposure levels to ten different HAPs among the populations, as approximately 32% of children of foreign-born mothers were exposed to high levels of HAPs, compared to 21% of children born to U.S.-born mothers. Adjusting for socioeconomic factors, both isophorone exposure (a marker of industrial pollution) (−0.04, 95% CI, −0.12, 0.04) and maternal nativity status (−0.17, 95% CI, −0.27, −0.06) were independently associated with lower standardized BSF-R mental scores in children. Interaction between nativity status and isophorone was not statistically significant, but the change in mental scores associated with isophorone exposure was greater in children of foreign-born mothers compared to children of U.S.-born mothers (−0.12, vs. −0.03, p = 0.2). In conclusion, exposure to HAPs within the highest quartile was more commonly found among children of foreign-born mothers as compared to children of US-born mothers, indicating inequities in pollutant exposure by nativity status within urban populations. Exposures associated with nativity status may negatively contribute to children’s neurodevelopment.

Anthropometric Evaluation and Assessment of Food Intake of Parents of Pediatric Patients with Chronic Rheumatic Diseases

INTRODUCTION

Parents' eating behavior, lifestyle, and food choices can interfere with their children's eating habits, bringing new perspectives for the development of beneficial interventions in the context of chronic rheumatic diseases.

OBJECTIVES

The objective is to evaluate BMI, dietary intake, physical activity, and biomarkers of lipid metabolism in parents of children and adolescents with chronic rheumatic diseases and to verify the association with those of their children.

METHODS

This is a cross-sectional study with 91 parents, and their respective children diagnosed with juvenile idiopathic arthritis (n = 30, 33.0%), juvenile systemic lupus erythematosus (n = 41, 45.0%), and juvenile dermatomyositis (n = 20, 22.0%). Anthropometric and dietary data, physical activity, lipid profile, and apolipoproteins A-I and B were evaluated.

RESULTS

In total, 67% of parents and 27.5% of children were overweight; 80% of overweight children/adolescents also had parents with the same nutritional diagnosis. We found a moderate association of total fat intake (Cramer's V test = 0.254; p = 0.037), and a weak association of saturated fat intake (Cramer's V test = 0.219; p = 0.050) and cholesterol intake (Cramer's V test = 0.234; p = 0.025) between parents and their children. A high prevalence of dyslipidemia was observed for parents (82.4%) and children (83.5%), however, with no association between both. A weak association was found between parents and children (Cramer's V test = 0.238; p = 0.024) for triglycerides, and no association was found between parents and children concerning physical activity.

CONCLUSION

The high frequency of overweight and dyslipidemia observed in parents, combined with the association between the fat intake by parents and their children with chronic rheumatic diseases, points to the importance of intervention strategies with the engagement and participation of families.

Engaging fathers in the first 1000 days to improve perinatal outcomes and prevent obesity: Rationale and design of the First Heroes randomized trial

BACKGROUND

Early pregnancy through the first year of life represents an important period for family health promotion and obesity prevention. Overall, preventive interventions in pregnancy and infancy have insufficiently engaged fathers. We describe the rationale and design of First Heroes, an intervention to improve perinatal and obesity-related outcomes among mother-father-infant triads beginning in pregnancy.

METHODS/DESIGN

First Heroes is a hybrid type 1 effectiveness-implementation randomized trial of mother-father-infant triads recruited in the second trimester of pregnancy from a large Obstetric practice in eastern Massachusetts and continuing through 12 months of infant age. Triads are randomized to the intervention arm or to an enhanced safety education control group. Triads randomized to the intervention arm receive three virtual visits with a health educator, in the 3rd trimester of pregnancy, at 3-4 weeks, and 3-4 months postpartum, and receive continuous multimedia education through text messaging, print material, and videos. The educational curriculum addresses parent health behaviors, family relationships, social determinants of health, and infant feeding, sleep, and development. The primary outcome is prevalence of rapid infant weight gain from birth to 6 months of age. Secondary outcomes include parent anthropometrics, parent obesogenic behaviors, family functioning, and infant behaviors.

DISCUSSION

First Heroes will evaluate the extent to which intentional mother-father dyad engagement, coaching on adoption of early life health behaviors, and addressing social determinants of health, influence obesogenic behaviors and outcomes in the first year of life. Findings from this work will inform future obesity prevention efforts, especially those focused on whole family inclusion.

Perspectives and Impact of a Parent-Child Intervention on Dietary Intake and Physical Activity Behaviours, Parental Motivation, and Parental Body Composition: A Randomized Controlled Trial

Adults and children in Canada are not meeting physical activity guidelines nor consuming sufficient nutrient-rich foods. High engagement in these unhealthy behaviours can lead to obesity and its associated diseases. Parent-child interventions aimed at obesity prevention/treatment have assisted families with making positive changes to their nutrition and physical activity behaviours. Given that the home environment shapes early health behaviours, it is important to target both parents and children when addressing diet and physical activity. One method that has been shown to improve health outcomes is co-active coaching. The current study explored the impact of a three-month co-active coaching and/or health education intervention on the dietary intake and physical activity behaviours of parents with overweight/obesity and their children (ages 2.5-10; of any weight). Body composition (i.e., body mass index [BMI] and waist circumference), changes in parental motivation with respect to physical activity and dietary behaviours, and parental perceptions of program improvements were collected. A concurrent mixed methods study comprised of a randomized controlled trial and a descriptive qualitative design was utilized. Fifty parent-child dyads were recruited and randomly assigned to the control (n = 25) or intervention (n = 25) group. Assessments were completed at baseline, mid-intervention (six weeks), post-intervention (three months), and six-month follow-up. A linear mixed effects model was utilized for quantitative analysis. Inductive content analysis was used to extract themes from parent interviews. No significant results were observed over time for the dependent measures. Parents in both control and intervention groups reported varied program experiences, including developing changes in perspective, increased awareness of habits, and heightened accountability for making positive changes in themselves, and consequently, their families. Parents also shared barriers they faced when implementing changes (e.g., time, weather, stress). Qualitatively, both groups reported benefitting from this program, with the intervention group describing salient benefits from engaging in coaching. This research expands on the utility of coaching as a method for behaviour change, when compared to education only, in parents with overweight/obesity and their children.

The association between father involvement in caregiving and early childhood overweight or obesity

BACKGROUND

Despite the increasing trend of paternal engagement in caregiving, fathers remain underrepresented in studies on parenting and childhood obesity.

OBJECTIVES

This study examined the association between father involvement in caregiving and child's weight status within a longitudinal dataset from Japan.

METHODS

The data were obtained from a population-based cohort study in Japan (N = 29 584). The association between father's involvement in child caregiving (age 18 months) on the weight status of the same children at age 3.5 years was examined by logistic regression and linear regression analysis. Furthermore, we checked the interaction between maternal employment & father involvement by creating four mutually exclusive groups of families.

RESULTS

Children whose fathers were highly involved in caregiving were less likely to be overweight (OR = 0.90, 95% CI, 0.85-0.96). Employed mothers with high paternal involvement in caregiving were 30% less likely to have children with overweight or obesity compared to those with low paternal involvement (95% CI, 0.55-0.90).

CONCLUSIONS

Father involvement in caregiving is associated with the development of overweight or obesity in early childhood, and may also modify the association between maternal employment and child's weight status. Social policies to support shared child-rearing such as expanding paid parental leave could help families to raise children with healthy weight.

Landscape analysis for a community-designed intervention to enhance early childhood development in San Francisco

To determine the appropriate components for a community-based intervention for early childhood development, a broad series of stakeholder interviews was completed in a three-month period (January-March 2019) and a systematic review of their responses was performed. Additionally, 11 citywide assessment reports for child equity were reviewed and added to the information matrix. We performed this population-based assessment in San Francisco, a dense urban environment with roughly 43,000 children under the age of 5. The city has high rates of income inequity, with roughly half of the children considered to be living in low-income or poverty conditions. Interviews were conducted with 34 stakeholders representing various sectors, including community organizations, government, healthcare, and academia. Nine main concerns surrounding low-income families and children (LIFC) living in San Francisco were extracted from stakeholder interviews. The concerns were divided into subcategories based on a socioecological health model. City-funded, community-based, family resource centers were an identified space for performing an early childhood health intervention supporting LIFC. Furthermore, any proposed intervention to support LIFC must be implemented with a culturally tailored focus, as a one-size-fits-all, clinic-based model is not desired. Community-engaged and culturally specific activities are requested and required for effectively promoting early childhood development in an urban environment. In this article we propose that additional work towards implementing community-based interventions with support from the clinic are needed.

The Role of the NICU in Father Involvement, Beliefs, and Confidence: A Follow-up Qualitative Study

BACKGROUND

Fathers are important to infant outcomes. Infants of involved fathers have improved weight gain, sleep, and psychosocial behaviors. Father involvement with neonatal intensive care unit (NICU) infants reduces the length of stay.

PURPOSE

The purpose of this study was to explore and describe involvement, confidence, and beliefs of fathers of infants who were hospitalized in the NICU and discharged home in order to begin to investigate NICU father involvement from a longitudinal perspective.

METHODS

This exploratory qualitative study was conducted 4 to 5 years after the initial NICU stay using telephone interviews. Fathers who participated in this study were selected from participants of a previous NICU study. Qualitative analysis was conducted using standard procedures for grounded theory.

RESULTS

Nineteen fathers participated in the study. The major themes were "It was scary," "Just be there," "It was rough," "It's not about yourself," "A special bond," and "Almost a treat." The fathers reported that the NICU providers, nurses, and staff helped them to overcome uncertainty and lack of knowledge, which helped them improve their confidence and involvement during the NICU stay.

IMPLICATIONS FOR PRACTICE

Fathers see nurses as a source of support. Nurses can encourage fathers to visit regularly and participate in infant care activities. NICU presence aids fathers in developing confidence and knowledge in parenting during their child's infancy, which can set the stage for ongoing involvement.

IMPLICATIONS FOR RESEARCH

Future work should continue to focus on longitudinal studies of fathering and the role of the NICU in encouraging involvement and parenting readiness.

Validation of the Infant Feeding Beliefs Questionnaire (IFBQ) among pregnant African- American women and their study partners

Maternal feeding beliefs and practices have been associated with weight gain in infants and young children. Less work examines feeding beliefs prenatally or the feeding beliefs of other non-maternal caregivers (NMCs) who play important roles in infant feeding. This study validates a scale, the Infant Feeding Beliefs Questionnaire (IFBQ), to assess feeding beliefs during pregnancy among African-American women and other caregivers and tests whether the resulting belief constructs (laissez-faire, restrictive, responsive, pressuring and indulgent) are associated with maternal and NMC characteristics. Data come from 429 pregnant women and 374 NMCs including fathers, grandmothers and other family and friends enrolled in the baseline 28-week gestation visit of the Mothers and Others Study, a family-based, randomized control trial to support healthy infant feeding and prevent obesity. Confirmatory factor analysis (CFA) was used to test the fit of four a priori feeding constructs. Models were modified iteratively in mothers and then separately tested in the NMCs sample. Construct scores were created by averaging the remaining items and scale reliability was assessed. External validity was tested using bivariate and multivariable regression models. We validated five feeding belief constructs, measured through 8 sub-constructs. Reliability coefficients ranged from 0.58 for laissez faire to 0.76 for pressuring. Goodness of fit indices for CFA models indicated good fit with CFIs from 0.97 to 0.99 and RMSEA from 0.00 to 0.06. Construct scores differed significantly by depressive symptoms, obesity, education, income, and previous children in mothers and NMCs. The IFBQ may be used among mothers and NMCs to assess feeding beliefs beginning in the prenatal period, providing a tool to assess the longitudinal development of feeding beliefs and to highlight avenues for intervention on feeding practices during a critical period for behavior change.

Development and preliminary validation of a feeding coparenting scale (FCS)

Evidence is growing that fathers, along with mothers, play an important role in children's eating and obesity risk. Qualitative work with a small sample found that the roles of fathers and mothers are not mutually exclusive in shaping their child's eating behaviors, rather fathers and mothers may relate to one another in their roles as parents in food parenting (i.e., feeding coparenting). There is currently no self-reported measure of how fathers and mothers coparent around child feeding. However, it would be useful in order to be able to assess this construct more broadly. Hence, based on prior qualitative work and findings related to the roles of fathers and mothers in food parenting, we developed a feeding coparenting scale (FCS). Parent responses on the FCS and measures of related constructs (i.e., relationship satisfaction, traditional gender-role attitudes, general coparenting, and perceived involvement in child feeding tasks) that were hypothesized to relate to feeding coparenting were assessed among 307 parents (n = 178 females) of preschool-aged children through Amazon Mechanical Turk (MTurk) in order to examine the validity and reliability of the FCS. An exploratory factor analysis was conducted to examine the psychometric properties of the FCS. Three factors emerged: 1) shared positive views and values in child feeding, 2) active engagement in child feeding, and 3) solo parenting in child feeding. A total feeding coparenting score was also calculated. Support for construct validity of the measure with constructs hypothesized to be associated with FCS (e.g., relationship satisfaction) was observed. The internal consistency of the FCS total and subscales was adequate for whole sample, fathers, and mothers. Results suggest that the FCS may be a useful tool for assessing how mothers and fathers work together with each other in the child feeding domain.

Engaging Fathers in Early Obesity Prevention During the First 1,000 Days: Policy, Systems, and Environmental Change Strategies

OBJECTIVE

Fathers are critical stakeholders in childhood obesity prevention but are difficult to engage. This review presents a new approach to engaging fathers in obesity prevention during the first 1,000 days.

METHODS

The review focuses on five existing health and social service programs, including prenatal care, pediatric care, the Special Supplemental Nutrition Program for Women, Infants, and Children, home visiting, and Early Head Start. For each program, the obesity prevention services provided, evidence of father engagement, and barriers thereto are outlined. Subsequently, policy, systems, and environmental strategies are outlined to address the noted barriers and promote father engagement.

RESULTS

Although the programs hold great promise in bringing obesity prevention services to fathers, barriers to their engagement are present in the inner (e.g., limited hours of operation, lack of father-specific materials and programming) and outer (e.g., lack of model programs, best practice models, and consistent funding) settings of programs. Policy, systems, and environmental strategies to increase father engagement focus on earmarked funding, changes to national practice guidelines and practitioner training requirements, and the establishment of father-engagement performance metrics.

CONCLUSIONS

Increasing father involvement in the specified programs will likely increase their engagement in early obesity prevention in an efficient and sustainable manner.

Home and Family Environment Related to Development of Obesity: A 21-Year Longitudinal Study

BACKGROUND

Early-life conditions are important for the development of obesity. We hypothesized that home and family characteristics reflective of less supportive environments during childhood will be associated with higher adult BMI and faster BMI growth between ages 5 and 21 years. We also examined the timing and acceleration of BMI increase by adult weight status (normal weight, overweight, obese, and extremely obese) to discern how BMI increase differs across group and across time.

METHODS

BMI was assessed in 1000 Chilean youth (52% female) at ages 5, 10, 15, and 21 years. Latent growth curve analysis modeled BMI trajectories from 5 to 21 years. Observer and maternal ratings assessed children's home and family environments and parenting at 1 and 10 years.

RESULTS

The four weight groups differed in acceleration of BMI increase starting at age 5, with bigger children getting bigger faster. Higher 21-year BMI related to family stress, father absence, maternal depression, frequent child confinement (in playpen), an unclean home environment at 1 year, and low provision for active stimulation and few stimulating experiences at 10 years. Accelerated BMI increase related to lower learning stimulation in the home at 1 year and less parental warmth and acceptance at child age 10.

CONCLUSIONS

Home and family characteristics that reflect an absence of support for children's development were associated with overweight/obesity in young adulthood and accelerated BMI growth. Findings identify several home and family characteristics that can serve as preventive or intervention targets.

The forgotten parent: Fathers' representation in family interventions to prevent childhood obesity

Despite recognition that parents are critical stakeholders in childhood obesity prevention, obesity research has overwhelmingly focused on mothers. In a recent review, fathers represented only 17% of parent participants in >600 observational studies on parenting and childhood obesity. The current study examined the representation of fathers in family interventions to prevent childhood obesity and characteristics of interventions that include fathers compared with those that only include mothers. Eligible studies included family-based interventions for childhood obesity prevention published between 2008 and 2015 identified in a recent systematic review. Data on intervention characteristics were extracted from the original review. Using a standardized coding scheme, these data were augmented with new data on the number of participating fathers/male caregivers and mothers/female caregivers. Out of 85 eligible interventions, 31 (37%) included mothers and fathers, 29 (34%) included only mothers, 1 (1%) included only fathers, and 24 (28%) did not provide information on parent gender. Of the interventions that included fathers, half included 10 or fewer fathers. Across all interventions, fathers represented a mere 6% of parent participants. Father inclusion was more common in interventions targeting families with elementary school-aged children (6-10 years) and those grounded in Ecological Systems Theory, and was less common in interventions focused on very young children (0-1 years) or the prenatal period and those targeting the sleep environment. This study emphasizes the lack of fathers in childhood obesity interventions and highlights a particular need to recruit and engage fathers of young children in prevention efforts.