Screen-viewing behaviors among preschoolers parents' perceptions

Managing Screen Use in the Under-Fives: Recommendations for Parenting Intervention Development

The impact of excessive screen use on children's health and development is a public health concern and many countries have published recommendations to limit and guide the use of screen media in childhood. Despite this, international studies report that the majority of parents and children do not adhere to screen use recommendations. Existing research aiming to understand children' screen use has largely focused on older children, and on demographic and structural aspects of the child's environment. Parents play a central role in determining young children's screen use and identify numerous barriers to developing healthy screen use practices with their children. However, no clear models exist that incorporate key parenting factors in understanding children's screen use, which presents an impediment to intervention development. Likewise, while some evidence exists for interventions to improve children's screen use behaviours, most are focused on older children and parental involvement has generally been limited. In this paper, we overview key factors associated with screen use in young children (< 5 years) and summarise the existing evidence base for interventions designed to support healthy screen use. This paper proposes a conceptual model linking aspects of parenting and the socio-ecological environment to young children's screen use. Our proposed model could be used to design longitudinal studies of screen use predictors and outcomes, and inform intervention development. Finally, the paper provides key recommendations for future research, intervention development and testing.

Challenges encountered by parents from urban, lower social economic class in changing lifestyle behaviors of their children who are overweight or obese

BACKGROUND

Parents from urban, lower social economic classes often encounter unique challenges in their lives, which shape how they work with their children who are overweight or obese to change their exercise and eating behaviors at home. The present study took an initial step to address a gap in the literature by describing the challenges that parents from lower social economic classes in an urban city encountered in changing exercise and eating behaviors of their children who are overweight or obese.

METHODS

A conversational style semi-structured interview with prompts and probes was conducted to 44 parents whose child is overweight or obese. Inductive content analysis and constant comparison was used to analyze the data. Data trustworthiness was established by using a variety of strategies.

RESULTS

Two major themes with eight sub-themes emerged from the data: Challenges to promote a healthy active lifestyle, and challenges from their child's development and lifestyle behavior. Eight sub-themes were: (1) Need for effective strategies for a lifestyle behavior change, (2) monitor and promote healthy choices, (3) money, time, and dangerous neighborhood, (4) scientific knowledge to promote a healthy active lifestyle, (5) developmental changes of adolescence, (6) unmotivated and lack of persistence, (7) sneaking eating, and (8) peer pressure.

CONCLUSION

The challenges, from economic to parenting, are certainly of importance, and understanding these challenges will be crucial to help school-based professionals develop interventions. Those identified challenges should be clearly placed within family-school collaboration practices.

Parental Regulation of Parent and Child Screen-Based Device Use

Media use and screen time show both positive and negative effects on child development. Parents' behaviors, perceptions, and regulation of parent and child screen-based device (SBD) use may be critical understudied factors in explaining these mixed effects. We developed the Parent Screen-Based Device Use Survey (PSUS) to assess parental use of multiple SBDs (e.g., computers, phones, TVs) and tested its factor structure across two United States samples of mothers of children aged 2 to 6 years old (total N = 402). Subscales captured parental SBD use related to Discipline, Limit-Setting, Involvement, Child Care, Family Norms, Self-Regulation, Dysregulation, and Parenting Support, and showed good factor loadings and internal reliability. Validity was tested in relation to parent distress, parent executive function problems, and child behavior problems. Parental limit-setting and involvement were either unrelated to or related to fewer parent and child problems, whereas parental use of SBDs for self-regulation, child care, discipline, support, and family activities, as well as parents' more dysregulated use, were related to more parent and child problems. The PSUS holds promise in addressing the parental mechanisms that underlie media effects on child development.

Exploring the perception of parents on children's screentime: a systematic review and meta-synthesis of qualitative studies

BACKGROUND

Screentime (ST) has been increasingly pervasive in young children. Evidence suggests positive and negative effects of ST on children's development. Parents play a crucial role in influencing their children's ST. There is limited research consolidating the parental perceptions related to children's ST. This review consolidates the evidence on the perception of parents on their children's ST.

METHODS

Six electronic databases (PubMed, Embase, CINAHL, PsycINFO, Scopus, and ProQuest) were searched from their inception to September 2022. Critical appraisal was conducted using the Critical Appraisal Skills Program (CASP) checklist. Data synthesis was performed using Sandelowski and Barroso's approach.

RESULTS

Twenty studies were included in this review, encapsulating the experiences of 1,311 parents. Three main themes with corresponding subthemes were identified: (1) Varied reasons behind ST; (2) Attitudes toward ST; and (3) Strategies and approaches to managing ST.

CONCLUSION

The findings highlighted the varied reasons parents promote ST. Parents reported their concerns and confusion about ST and shared some strategies and approaches for better ST. Future research is needed to develop and evaluate educational programs to ensure that parents understand the risks and benefits of ST and in turn, ensure the appropriate adoption of ST for their children.

IMPACT

In the digital era, parents' attitudes towards screentime (ST) for their children are mixed. This review presents the dilemma parents face and their struggles with using optimal screen time for their children. This review provides up-to-date evidence on the parents' confusion and concerns about ST as well as strategies and approaches used by the parents for better ST. There is an urgent need for evidence-based educational programs to enhance parental knowledge about ST so that they can ensure appropriate ST among children.

CLINICAL TRIAL REGISTRATION

PROSPERO Registration No. CRD42022356083.

Primary Care Counseling of Parents Regarding Childhood Screen Media Use

Parental beliefs and motivation are instrumental in improving childhood digital media use (DMU). Parents (n = 611) completed questionnaires about childhood DMU assessing knowledge, interest in counseling, motivation to change, self-efficacy, and beliefs. Less than a third correctly recognized screen time limits. Twenty-seven percent received childhood DMU information from a doctor, while 46% stated they would like such information. Only 2% had a doctor-recommended DMU plan. Interest in DMU topics, motivation to improve, and management self-efficacy were moderate. Top negative beliefs were addiction to DMU (52%), sleep problems (39%), obesity (33%), social skills (33%), and inappropriate content (32%). Differences between age categories existed for social (48%, P = .01) and language (14%, P = .01) concerns (highest for toddlers), attention concerns (27%, P = .02; highest in preschoolers), and depression (13%, P < .001) and low self-esteem (8%, P = .04; highest in teens). Findings support further development of approaches to address DMU, tailored by age-specific common parental views.

Parental Perception of the Social and Physical Environment Contributes to Gender Inequalities in Children's Screen Time

BACKGROUND

This cross-sectional study aimed to explore how parental perceptions of the social and physical environment of the neighborhood was associated with 3- to 10-year-old children's use of traditional and modern screen devices.

METHODS

Participants were recruited under the scope of the project ObesInCrisis, conducted in 2016-2017 in the cities of Porto, Coimbra, and Lisbon (Portugal). Data from 6347 children aged 3-10 years were analyzed (3169 boys [49.9%]). A parental questionnaire was used to collect data on children's screen time (dependent variable) and parents' perceived social and physical environment (from the Environmental Module of the International Physical Activity Prevalence Study questionnaire; independent variable), parental education, and urbanization (used as covariates).

RESULTS

Neighborhood features were more correlated with girls' screen time, than with boys', particularly among younger children. Also, more social than physical characteristics of the neighborhood were positively associated with children's use of television and mobile devices (ie, tablet and smartphone).

CONCLUSIONS

Community-based approaches should improve the social environment and implement supervised after-school programs to encourage and support children to be outdoors and spend less time in sedentary pursuits.

Associations among average parental educational attainment, maternal stress, and infant screen exposure at 6 months of age

Evidence suggests that increased use of screens early in life may have negative developmental consequences for children. However, little is known concerning parental factors that predict initial screen exposure in infancy. The primary goal of this study was to examine whether parental educational attainment and maternal stress were associated with infant screen exposure by 6 months of age. A diverse sample of mothers (N = 93) was recruited prenatally. In a follow-up visit when the infants were six months of age (N = 82), we examined factors that may be associated with initial infant exposure to screens. First, mothers reported whether they had already exposed their infants to screens. Thereafter, those mothers who reported already having exposed their infants to screens were further queried to determine the extent of infant screen use. Results demonstrated that among infants exposed to screens, mothers reported an average of nearly 3 h of daily screen use. Average parental educational attainment, but not maternal stress, was significantly associated with initial infant exposure. Of those families who endorsed screen exposure by 6 months, 70 % reported a screen in the room where the child sleeps, nearly half reported using screens to help calm the infant, and about a third reported using a screen at least sometimes during meals, when going to sleep, and while waiting. Parental education around infant screen use behaviors may be important to help promote child development and outcomes.

A Qualitative Study on Children's Digital Media Use and Parents' Self-interest

This qualitative study provides insight into the role of parents' self-interest in digital media use of children in different age groups. We conducted 31 semi-structured interviews with fathers/mothers of children aged 3-16 years who were recruited via targeted sampling. A deductive and inductive content analysis was applied. Results show that parents' self-interest in letting children use digital media includes being able to do other tasks without being bothered, having some me-time, managing children's behavior, avoiding discussions, having moments to use digital media themselves and spending quality-time together. In addition, we found that the manner in which parents let children use digital media out of self-interest seems to depend on age. With younger children, parents initiate digital media use or set times at which children are allowed to use digital media. With older children, parents use a passive manner by omitting restrictive responses to their children's media use. Current findings can be used to inform interventions aimed at reducing children's screen time.

Parents' Perceptions of Educational Apps Use for Kindergarten Children: Development and Validation of a New Instrument (PEAU-p) and Exploration of Parents' Profiles

Contemporary mobile technologies offer tablets and smartphones that elicit young children's active participation in various educational apps, dramatically transforming playing, learning, and communication. Even the most knowledgeable users face difficulties in deciding about the value and appropriateness of the so-called educational apps because of many factors that should be considered. Their importance for children's attitudes is affected by the perceived positive and negative aspects, which vary across a multiplicity of criteria. Filling the gap in the relevant literature, a new instrument, named PEAU-p (Perceptions about Educational Apps Use-parents), was developed and validated in the present study designed to measure parents' perception of educational apps for kindergarten pupils. Data (N = 435) were collected via online procedures, and the psychometric properties of PEAU-p were studied via exploratory and confirmatory methods. Principal Components Analysis extracted six factors, namely Usability, Enjoyment, Involvement, Learning, Worries, and Values, which explained 72.42% of the total variance. Subsequently, by implementing Latent Class Analysis based on the above factors, four Clusters (i.e., parents' Profiles) were extracted corresponding to their perceptions and attitudes towards the educational apps used for kindergarten pupils. Those were named as 'mild attitude', 'negative attitude', 'positive attitude', and 'indifferent attitude'. This categorization, besides the statistical support, is fully interpretable, and the profiles were associated with certain covariates, such as age, the number of children, knowledge on new technologies, or distal outcomes, e.g., the frequency of using apps, the general position towards apps or their intention to recommend apps use. The findings are discussed within the current research field, investigating the influential role parents play in young children's media selection and use.

Natural environment and childhood obesity: A systematic review

The associations between built and food environments and childhood obesity have been studied extensively. However, the association between the natural environment and childhood obesity has received too little scholarly attention. This study reviewed the literature published before 1 January 2019, which described associations between a full range of natural environmental factors (e.g., rainfall, temperature, sunlight, natural disasters, flood and drought) and weight-related behaviours and childhood obesity. Five cross-sectional studies and one longitudinal study were identified. Measures of natural environmental factors varied across six included studies, falling into five broad categories: weather conditions, altitude, natural disaster risk, air quality and day length. It was found that temperature was a significant weather indicator in most included studies and was associated with a reduction of daily physical activity. Children living in high-altitude areas were more likely to be shorter and heavier than their counterparts in low-altitude areas. Findings of this study will contribute to helping multiple stakeholders, including policy makers and urban planners, and formulate health policies and interventions to mitigate the detrimental impact of the natural environment on childhood obesity. More longitudinal studies should be designed to confirm these effects and explore the potential health effects of more natural environmental factors.

Food and cultural norms: rural mothers' selection of nutrition intake for their young children

Purpose

This study aimed at exploring food related cultural norms that influence rural mothers' food selection for their primary school aged children (aged 4–7 years).

Design/methodology/approach

This is a qualitative study conducted in northern parts of Balochistan province of Pakistan. The Theory of Planned Behaviour (TPB) was applied as the theoretical framework of the study. Within a qualitative research method four focused group interviews with 30 rural mothers were employed to generate data.

Findings

The study found that mothers’ food selection for their children was heavily influenced by certain cultural norms that have become taboos with the passage of time. It is evident through findings that subjective norms have a greater influence on mothers' behaviour than their attitude and perceived behavioural control (PBC).

Originality/value

We ensure originality of this research paper as fewer researches have been conducted to further elaborate the link between socio-cultural norms and food selection. In particular, the influence of this close relationship on child health has been of limited consideration in a developing context. This paper has neither been published elsewhere, nor it is currently under consideration for publication in any other journal.

Understanding physical activity and sedentary behaviour among preschool-aged children in Singapore: a mixed-methods approach

OBJECTIVES

This study investigated physical activity (PA) and sedentary behaviour (SB) among preschool-aged children in Singapore and potential correlates at multiple levels of the socioecological model from in-school and out-of-school settings.

DESIGN

A cross-sectional study using a mixed-methods approach.

PARTICIPANTS

Parent-child dyads from six preschools in Singapore.

METHODS

PA and SB of children (n=72) were quantified using wrist-worn accelerometers for seven consecutive days. Three focus group discussions (FGDs) among 12 teachers explored diverse influences on children's activities, and System for Observing Play and Leisure Activity in Youth (SOPLAY) assessed PA environment and children's activity levels at preschools. Seventy-three parents completed questionnaires on home and neighbourhood factors influencing children's PA and SB. Descriptive analyses of quantitative data and thematic analysis of FGDs were performed.

RESULTS

Based on accelerometry, children (4.4±1.1 years) spent a median of 7.8 (IQR 6.4-9.0) hours/day in SB, and 0.5 (0.3-0.8) hours/day in moderate-to-vigorous physical activity (MVPA). MVPA was similar throughout the week, and SB was slightly higher on non-school days. In preschools, SOPLAY showed more children engaging in MVPA outdoors (34.0%) than indoors (7.7%), and absence of portable active play equipment. FGDs revealed issues that could restrict active time at preschool, including academic requirements of the central curriculum and its local implementation. The teachers had varying knowledge about PA guidelines and perceived that the children were sufficiently active. In out-of-school settings, parents reported that their children rarely used outdoor facilities for active play and spent little time in active travel. Few children (23.5%) participated in extracurricular sports, but most (94.5%) reported watching screens for 1.5 (0.5-3.0) hours/day.

CONCLUSION

MVPA was low and SB was high in preschool-aged children in an urban Asian setting. We identified diverse in-school and out-of-school correlates of PA and SB that should be taken into account in health promotion strategies.

Unrestricted prevalence of sedentary behaviors from early childhood

Background

Light and sedentary behaviors impose heavy challenges on societies. The objectives of this study are to identify child sedentary behaviors, and to examine the relationship between parent knowledge and behavioral style on children’s sedentary time in Iran.

Methods

This cross-sectional study was done among children and their parents selected randomly using multi-stage method, from 12 urban districts in Tabriz, Iran;2017. Data were collected through designing a multi-sectional questionnaire adopted from the Bjelland and previous studies to assess the time spent on sedentary behaviors among children/adolescents along with parent knowledge and behavioral style.

Results

From 480 children/adolescents and their parents 54.6% came from middle class families, and 55.62% were boys aged 2 to18. The percentage of time spent more than 120 min per day (min/d) on weekdays was for watching television (TV): (girls 24.4%, boys 21.0%), for playing computer and video games: (girls 38.7%, boys 54.7%), for electronic media communication (EMC): (girls 52.8%, boys 60.2%). The associated factors for watching TV: child age [12 years and above OR = 1.37; 95% CI = 0.53–3.54], parent knowledge [OR = 0.59, 95% CI = 0.35–0.99], and communicative styles [OR = 1.43, 95%CI = 1.11–1.86], and for playing computer and EMC: child age [5 years old and above OR = 4.83,95% CI =1.52–15.38, 12 years old and above OR = 13.76, 95% CI= 4.22–24.91], family socio-economic status [middle class OR = 2.52, 95% CI = 1.54–4.11, high class OR = 5.53, 95%CI = 1.80–15.89].

Conclusion

There is an urgent need to combat the unrestricted prevalence of sedentary behaviors among Iranian children/ adolescents who use computers and other electronic devices more than the recommended time every day from early childhood.

Parents should be provided with appropriate information about adverse effects of using electronic devices longer than recommended time by children. It is also essential to teach them beneficial communicative styles to monitor their children’s sedentary behaviors.

Screen Media: A Powerful Reinforcement

The use of screen media has significantly increased and several lifestyle consequences have occurred following this change. Screen media exposure is more common among younger age children. Multiple factors may be the reason for this; however, their use is likely reinforced. Parents seek support from screen media devices, which can help calm and occupy their children in a matter of minutes. However, resorting to electronic devices for instant relief is likely to persist due to both negative and positive reinforcement. Reinforcing screen media in this way will make the use of screen devices inextricable for parents and their children. Explaining the issue clearly and coming up with feasible solutions will help minimize the negative health effects of prolonged screen use, the general desirability of screen media devices, and also improve (and increase) healthy screen time habits in children.

Young Children's Screen Time and Physical Activity: Perspectives of Parents and Early Care and Education Center Providers

Early care and education (ECE) providers and parents can facilitate physical activity (PA) and reduce screen time in preschoolers. Input from caregivers on barriers and facilitators of PA and screen time is needed to comprehensively address these behaviors and promote children’s health. Four focus groups (3 parent and 1 ECE provider) were conducted. Thematic analysis was performed to identify themes and subthemes. Twenty-eight caregivers (21 parents and 7 ECE providers) participated. Caregivers reported responsibility for modeling and shaping children’s PA and screen time. Parents felt that a busy lifestyle was a PA barrier and encouraged screen time. ECE providers were concerned about certain environmental influences on PA. The groups differed in their view of screen time as either entertainment (parents) or educational (providers). Both types of caregivers were unaware of PA or screen time guidelines. Investigation into opportunities to utilize screen time to serve priorities of both caregivers and promote child PA are needed.

Caregiver Reports of Screen Time Use of Children with Autism Spectrum Disorder: A Qualitative Study

Screen based media have progressively become an integral part in the daily lives of children and youths with and without autism spectrum disorder (ASD). However, research that exclusively pursues the functionality of screen media use of children with ASD is extremely rare. Through a triangulated approach, the present study aims to fill this gap. We conducted 13 interviews with parents of children with ASD and supplemented this interview-study with an online survey including parents of children with ASD (n = 327). Children with ASD mostly used screen media (especially television) for their wellbeing, which is associated with chances and risks. Based on the parental interviews it is suggested that the media usage of children with ASD should be supervised. The results are discussed in terms of their practical implementation.

Lower Body Mass Index Z-Score Trajectory During Early Childhood After the Birth of a Younger Sibling

OBJECTIVE

The objectives of this study were to examine differences in body mass index z-score (BMIZ) trajectory during early childhood among children with a younger sibling compared with those without and to test potential mediators.

METHODS

This longitudinal cohort study included 6050 participants of the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B). Focal children's weight, height, sibship status, screen time, active play time, family dinner frequency, and diet quality were assessed at 9 months, 24 months, preschool, and kindergarten when available. A piecewise linear regression model was used to examine the association between sibling birth and focal child's subsequent BMIZ trajectory to kindergarten. Mediation by screen time, active play time, family dinner frequency, and diet quality was tested.

RESULTS

BMIZ trajectory was lower among children who had a new sibling join the family before kindergarten compared to children who did not have a new sibling join the family by kindergarten. The association was strongest when new sibship occurred when the focal child was 48 to 66 months (b = -0.026, P = .044). The association was not mediated by screen time, active play time, family dinner frequency, or diet quality.

CONCLUSION

Among a nationally representative cohort of US children, new sibship before kindergarten was associated with a lower BMIZ trajectory. Several common obesogenic risk factors did not explain the association.

Physical activity and sedentary behavior legislation in Canadian childcare facilities: an update

Background

Within the childcare sector, physical activity and sedentary behaviors are not legislated at a national level in Canada. Efforts have been undertaken to identify factors within childcare facilities which support and deter physical activity and sedentary behaviors. The purpose of this paper was to provide an amended review of the legislative landscape, at the provincial and territorial level, regarding physical activity and sedentary behaviors (via screen-viewing) in Canadian childcare centers.

Methods

Individual childcare acts and regulations for each province and territory were collected; documents were reviewed with a focus on sections devoted to child health, physical activity, screen time, play, and outdoor time. An extraction table was used to facilitate systematic data retrieval and comparisons across provinces and territories.

Results

Of the 13 provinces and territories, 8 (62%) have updated their childcare regulations in the past 5 years. All provinces provide general recommendations to afford gross motor movement; but the majority give no specific requirements for how much or at what intensity. Only 3 provinces (Northwest Territories, Nunavut, and Nova Scotia) explicitly mentioned daily physical activity while all provinces’ and territories’ required daily outdoor play. Only 1 province (New Brunswick) made mention of screen-viewing.

Conclusions

The variability in childcare regulations results in different physical activity requirements across the country. By providing high-level targets for physical activity recommendations, by way of provincial/territorial legislation, staff would have a baseline from which to begin supporting more active behaviors among the children in their care. Future research is needed to support translating physical activity policies into improved activity levels among young children in childcare and the role of screen-viewing in these venues.

Canadian 24-hour movement guidelines for the early years (0-4 years): exploring the perceptions of stakeholders and end users regarding their acceptability, barriers to uptake, and dissemination

BACKGROUND

It is important to engage stakeholders and end users in the development of guidelines for knowledge translation purposes. The aim of this study was to examine stakeholders' (experts in pediatric and family medicine, physical activity knowledge translation, and research) and end users' (parents and early childhood educators) perceptions of the Canadian 24-Hour Movement Guidelines for the Early Years (0-4 years).

METHODS

Stakeholders (n = 10) engaged in telephone interviews and end users (n = 92) participated in focus groups (n = 14) to discuss perceived clarity and need for the guidelines, potential barriers to implementation, identification of credible messengers, and methods for dissemination of the guidelines. A thematic analysis was conducted.

RESULTS

The proposed guidelines were very well received by both stakeholders and end users. A clear need for such guidelines was identified, and most believed the guidelines were achievable. Stakeholders and end users identified several potential barriers to uptake, including low awareness of current guidelines; 'daily challenges' such as allure of screen time, lack of time, and competing priorities; and challenges in the context of shifting social norms. A range of methods and messengers of dissemination were identified. Medical and child care settings were the most frequently cited places for dissemination, and physicians and early childhood educators were the most common suggestions for messengers.

CONCLUSIONS

There was consistent support for the Canadian 24-Hour Movement Guidelines for the Early Years (0-4 years) from both stakeholders and end users. Moving forward, it is important to dedicate appropriate support and funding toward dissemination efforts in order to reach end users, particularly parents and early childhood educators.

Preschool children's context-specific sedentary behaviours and parental socioeconomic status in Finland: a cross-sectional study

OBJECTIVES

This study examined the associations of parental socioeconomic status (SES) with preschoolers' objectively measured sedentary time (SED) over the course of a week and with parent-reported children's screen and reading times at home as indicators of sedentary behaviours (SB).

DESIGN

Cross-sectional.

SETTING

In years 2015 and 2016 in Finland.

PARTICIPANTS

864 children, aged 3-6 years, with their parents.

OUTCOME MEASURES

Children's accelerometer data were transformed into average SED minutes per hour in different contexts (preschool, home during preschool days, weekend and total). Parent-reported children's screen and reading times were expressed as average daily minutes. The SES indicators (maternal and paternal education and relative household income) were grouped into three categories. Linear or logistic regression analyses were used, with municipality, season, and children's gender and age as covariates. CIs were adjusted for clustering at the preschool group level.

RESULTS

Children with low maternal (β=17.21, 95% CI: 8.71 to 25.71) and paternal (β=10.54, 95% CI: 0.77 to 20.30) education had more overall screen time at home than their more advantaged counterparts. SES differences in overall screen time were mostly explained by TV viewing. Children with low as opposed to high maternal education (β=-2.66, 95% CI: -4.95 to -0.38) had less reading time at home. Children whose fathers were on the middle (β=-1.15, 95% CI: -2.01 to -0.29) educational level had less weekend SED than those with high paternal education. Otherwise, parental SES was not related to objectively measured SED.

CONCLUSIONS

The results of this study highlight the fact that the associations between parental SES and preschoolers' SB are dependent on the indicators of SES and SBs, and vary between different contexts. Generally, parental SES was not associated with SED, whereas some SES differences existed in screen time and reading time at home. Interventions aiming to diminish SES differences in children's SB should focus on home hours.

TRIAL REGISTRATION NUMBER

ISRCTN57165350.

Family-Based Obesity Prevention: Perceptions of Canadian Parents of Preschool-Age Children

Our objectives were to explore the perspectives of a community-based sample of Canadian parents with 2-5-year-old children on: (i) strategies to support the development of healthful weight-related behaviours and (ii) assessment approaches to measure weight-related behaviours and outcomes among children and families. We conducted 4 focus groups with 28 parents (89% mothers and 68% identified as White). Transcripts were analyzed using conventional content analysis. Regarding parent's perceptions of strategies to support healthful behaviours, we found that parents largely valued: home-based interventions, expert opinion, practical health behaviour strategies delivered in a nonjudgmental manner, and opportunities for social support. Regarding perceptions of assessment procedures, parents had mixed views on children providing blood samples, but looked upon it more favourably if it would contribute to research on child health. Our results suggest that to increase parental engagement interventions focused on improving weight-related behaviours among families with young children should be delivered within the home and include easy-to-implement behaviour change strategies communicated by experts, such as dietitians working in the clinical or public health setting. Using social media to share information and provide a platform for social support may also be an effective way to engage parents of young children.

Physical Activity and Physical Fitness in Pediatric Obesity: What are the First Steps for Clinicians? Expert Conclusion from the 2016 ECOG Workshop

One of the main aims of the European Childhood Obesity Group (ECOG) is to assist healthcare workers in delivering evidence-based assessment and treatment of childhood obesity. Every year the ECOG Congress includes working groups whose objective is to highlight concerns faced by clinicians and practitioners who work in the field of pediatric obesity. This year, a working group was devoted to the assessment of physical activity and physical fitness in this population. The present commentary attempts to summarize the main themes identified by practitioners during these workshops in order to provide the basic and essential first steps required to address physical activity and fitness in children with obesity.

A review of early influences on physical activity and sedentary behaviors of preschool-age children in high-income countries

PURPOSE

Promoting physical activity (PA) is a key component of preventing and controlling childhood obesity. Despite well-documented benefits of PA, globally, rates of PA among young children have declined over the past decades, and most children are not accruing sufficient PA daily. Helping children develop the foundation for PA habits early in life is critical for the promotion of health in childhood and prevention of chronic diseases later in life, and will ultimately promote longer and healthier lives for individuals and the general population. The purpose of this review is to provide a synthesis of current evidence on influences on PA and sedentary behaviors of preschool-age children in high-income countries.

DESIGN AND METHODS

A systematic review of three databases was performed. Studies conducted in high-income countries and published from 2000 onward that addressed influences on PA and sedentary behaviors of preschool-age children were identified and reviewed. Additionally, reference lists of identified articles and relevant published reviews were reviewed. Studies that met the following inclusion criteria were considered: (a) sample included preschoolers (age ≤5 years); (b) PA and/or sedentary behaviors or factors associated with PA and/or sedentary behaviors was assessed; (c) published in English; (d) used either quantitative or qualitative methods; and (e) conducted in a high-income country. Data were extracted from selected studies to identify influences on PA and sedentary behaviors of preschool-age children and organized using the social-ecological model according to multiple levels of influence.

RESULTS

Results from included studies identify multiple factors that influence PA and sedentary behaviors of young children in high-income countries at the various levels of the social-ecological model including intrapersonal, interpersonal, environmental, organizational, and policy.

PRACTICE IMPLICATIONS

Given pediatric nurses' role as primary care providers, and their frequent and continued contact with parents and their children throughout childhood through well-child visits, immunization, and minor acute illnesses, they are well positioned to promote and support the development of early healthful PA habits of children starting in early childhood.

How parents perceive screen viewing in their 5-6 year old child within the context of their own screen viewing time: a mixed-methods study

BACKGROUND

Few studies have examined parental perceptions of their child's screen-viewing (SV) within the context of parental SV time. This study qualitatively examined parents' perceptions of their 5-6-year-old child's SV within the context of their own quantitatively measured SV.

METHODS

A mixed-methods design employed semi-structured telephone interviews, demographic and SV questionnaires, objectively-measured physical activity and sedentary time. Deductive content analysis was used to explore parents' perceptions of, and concerns about, their child's SV, and management of their child's SV. Comparisons were made between parent-child dyads reporting low (<2-h per day) versus high SV time.

RESULTS

Fifty-three parents were interviewed (94.3% mothers), with 52 interviews analysed. Fifteen parent-child dyads (28.8%) exceeded the 2-h SV threshold on both weekdays and weekend days; 5 parent-child dyads (9.6%) did not exceed this threshold. The remaining 32 dyads reported a combination of parent or child exceeding/not exceeding the SV threshold on either weekdays or weekend days. Three main themes distinguished the 15 parent-child dyads exceeding the SV threshold from the 5 dyads that did not: 1) parents' personal SV-related views and behaviours; 2) the family SV environment; and 3) setting SV rules and limits. Parents in the dyads not exceeding the SV threshold prioritized and engaged with their children in non-SV behaviours for relaxation, set limits around their own and their child's SV-related behaviours, and described an environment supportive of physical activity. Parents in the dyads exceeding the SV threshold were more likely to prioritise SV as a shared family activity, and described a less structured SV environment with minimal rule setting, influenced their child's need for relaxation time.

CONCLUSIONS

The majority of parents in this study who exceeded the SV threshold expressed minimal concern and a relaxed approach to managing SV for themselves and their child(ren), suggesting a need to raise awareness amongst these parents about the time they spend engaging in SV. Parents may understand their SV-related parenting practices more clearly if they are encouraged to examine their own SV behaviours. Designing interventions aimed to create environments that are less supportive of SV, with more structured approaches to SV parenting strategies are warranted.

Relationship between leisure time screen activity and aggressive and violent behaviour in Iranian children and adolescents: the CASPIAN-IV Study

BACKGROUND

This study aimed to assess the relationship between leisure time spent watching television (TV) and at a computer and aggressive and violent behaviour in children and adolescents.

METHODS

In this nationwide study, 14,880 school students, aged 6-18 years, were selected by cluster and stratified multi-stage sampling method from 30 provinces in Iran. The World Health Organization Global School-based Health Survey questionnaire (WHO-GSHS) was used.

RESULTS

Overall, 13,486 children and adolescents (50·8% boys, 75·6% urban residents) completed the study (participation rate 90·6%). The risk of physical fighting and quarrels increased by 29% (OR 1·29, 95% CI 1·19-1·40) with watching TV for >2 hr/day, by 38% (OR 1·38, 95% CI 1·21-1·57) with leisure time computer work of >2 hr/day, and by 42% (OR 1·42, 95% CI 1·28-1·58) with the total screen time of >2 hr/day. Watching TV or leisure time spent on a computer or total screen time of >2 hr/day increased the risk of bullying by 30% (OR 1·30, 95% CI 1·18-1·43), 57% (1·57, 95% CI 1·34-1·85) and 62% (OR 1·62, 95% CI 1·43-1·83). Spending >2 hr/day watching TV and total screen time increased the risk of being bullied by 12% (OR 1·12, 95% CI 1·02-1·22) and 15% (OR 1·15, 95% CI 1·02-1·28), respectively. This relationship was not statistically significant for leisure time spent on a computer (OR 1·10, 95% CI 0·9-1·27).

CONCLUSIONS

Prolonged leisure time spent on screen activities is associated with violent and aggressive behaviour in children and adolescents. In addition to the duration of screen time, the association is likely to be explained also by the media content.

Bedtime Electronic Media Use and Sleep in Children with Autism Spectrum Disorder

OBJECTIVES

The purpose of this study was to better understand the use of screen-based media at bedtime among children with autism spectrum disorder (ASD). The study specifically examined whether the presence of media devices in the child's bedroom, the use of media as part of the bedtime routine, and exposure to media with violent content just before bedtime were associated with sleep difficulties.

METHODS

Parents of 101 children with ASD completed questionnaires assessing their children's sleep habits, bedroom media access (including television, video game devices, and computers), and patterns of nighttime media use (including timing of media exposure and violent media content).

RESULTS

Children with ASD who used media as part of the bedtime routine showed significantly greater sleep onset latency than those who did not (39.8 vs 16.0 minutes). Similarly, children who were exposed to media with violent content within the 30-minute period before bedtime experienced significantly greater sleep onset delays and shorter overall sleep duration. In contrast, the mere presence of bedroom media was not associated with either sleep onset latency or sleep duration.

CONCLUSION

Overall, these findings indicate that incorporating television and video games into the bedtime routine is associated with sleep onset difficulties among children with ASD. Exposure to violent media before bed is also associated with poor sleep. Families of children with ASD should be encouraged to regulate and monitor the timing and content of television and video game use, whether or not such devices are physically present in the child's bedroom.

The effect of educational programs based on the theory of planned behavior on parental supervision in students' television watching

BACKGROUND

Excessive and uncontrolled television watching by children predisposes them to some risks such as developmental, social and psychological disorders. Parents play an important role in nurturing their children and controlling the factors affecting their health. The aim of this study was to determine the impact of health education programs on parents' supervision skills to control their children's television watching habits based on the theory of planned behavior.

METHODS

One hundred twenty parents of the students at the first and fifth grades of primary school were randomly divided into an intervention and a control group. Data were collected by a self-report questionnaire at the beginning of and one month after intervention. An educational intervention was implemented for the case group parents, who were divided into four 15-member groups, in the form of three 45-60 minute sessions with focus group discussions. Moreover, the parents were provided with children and television booklet. Data were entered into SPSS-16 and were analyzed using Chi-square, paired t test, Mann-Whitney and Wilcoxon tests.

RESULTS

After the intervention, significant changes were detected in the intervention group with respect to the mean hours of watching television (from 6.74±2.02 to 4.28±2.40; p= 0.039), knowledge scores (from 5.8±2.1 to 7.7±1.9; p= 0.001), attitude towards less television watching (from 35.5±11.5 to 48.4±8.9; p=0.003), subjective norms (from 11.8±8.1 to 24.5±8.6; p>0.001) and behavioral intention (from 18.6±7.4 to 31.8±5.1; p=0.001).

CONCLUSION

The results revealed that educational interventions based on the theory of planned behavior are capable of changing knowledge, attitude, subjective norm and intention of parents towards controlling and monitoring their children's television watching and can improve the performance of parental control and reduce the hours of TV watching by children. Therefore, this pattern is suggested for reforming the nurturing skills of parents about other behavioral problems of their children.

Mothers' views of their preschool child's screen-viewing behaviour: a qualitative study

Background

Research on screen-viewing in preschool children has predominantly focused on television viewing. The rapid development of mobile devices (e.g. tablets, smart phones and e-readers) and the increase in their use by preschool children means there is a need to understand how and why these devices are used by this age group. The aim of this study was to explore mothers’ views of their preschool children’s screen viewing behaviour (including mobile devices) and investigate how preschool children use different screen-viewing devices.

Methods

One-to-one, semi-structured interviews with mothers of preschool children (aged between 2 and 4 years old). Mothers were recruited through preschools, nurseries, and mother and toddler groups located within four areas of varying socio-economic status within Bristol, UK. Data were analysed thematically using a framework approach.

Results

Twenty-six mothers were interviewed. Mobile devices were regularly used as a form of screen-viewing for most children but were used on an ad hoc basis rather than being a habitual activity. The reasons and influences of mobile device use described by mothers were similar to that of television viewing. However, the portability of mobile devices meant that they were often used outside of the home as a distraction tool. Their multi-functionality meant that they could be used as a portable television, or for purposeful learning through educational games and applications. Some mothers showed concerns over mobile device use by their child, whilst others felt it was an important and useful educational tool. Although the majority of mothers felt they needed to set rules and restrictions for mobile device use, many mothers felt that they are also a necessary and unavoidable part of life.

Conclusions

Mothers in this study suggested that mobile device use by preschool children is common. More research is needed to determine the impact of mobile device use in preschool children, how much time preschool children spend using mobile devices and which activities their use may be replacing.

Adherence to Canadian physical activity and sedentary behaviour guidelines among children 2 to 13 years of age

Active living is relevant for healthy child development and disease prevention. In 2011-2012 new Canadian Physical Activity and Sedentary Behaviour Guidelines were developed for children under four and 5-17 years of age. This cross-sectional study assessed children's adherence to the national guidelines, using a large sample of Alberta children ages 2-4 and 5-13 years in 2013. The proportions of children achieving the average daily duration of physical activity and screen time recommended were determined, and child and parental predictors of non-achievement were identified. Participants were 631 parent and child dyads. Data were collected by parental reports of physical activity and screen time during weekdays, and analysed using univariate and multivariate techniques (p < 0.05). Logistic regression models were used to examine factors associated with children's non-achievement of physical activity and screen time recommendations while adjusting for covariates. Sixty-two percent of children aged 2-4 and 26% of children aged 5-13 did not meet physical activity time recommendations, and 64% of children aged 2-4 and 23% of children aged 5-13 exceeded the maximum screen time recommendation. Several associations between parental age and education with non-achievement were observed but associations were not consistent across age groups or behaviours. Among preschoolers, those with middle-age parents were more likely to not achieve physical activity recommendations. Evidence of high non-achievement of the recommendations among children 2-4 years highlights the need for increased programming targeting preschool children. Further research is required to identify modifiable risk factors that may inform future health promotion efforts.

Treating Obesity in Preschoolers: A Review and Recommendations for Addressing Critical Gaps

Developing interventions targeting obesity reduction in preschoolers is an emergent area. Although intensive, multicomponent interventions seem a promising approach to preschool obesity reduction, this review identifies and discusses approaches to 3 critical gaps (poor reach to families from low-income and minority backgrounds, lack of sufficient evidence to determine the most effective and efficient treatment components and approaches to treating obesity in early childhood, and lack of consensus on how best to discern intervention effectiveness) that need to be addressed to advance the preschool obesity literature.

Managing the screen-viewing behaviours of children aged 5-6 years: a qualitative analysis of parental strategies

OBJECTIVES

The present study used qualitative methods to: (1) examine the strategies that were used by parents of children aged 5-6 years to manage screen viewing; (2) identify key factors that affect the implementation of the strategies and (3) develop suggestions for future intervention content.

DESIGN

Telephone interviews were conducted with parents of children aged 5-6 years participating in a larger study. Interviews were transcribed verbatim and analysed using an inductive and deductive content analysis. Coding and theme generation was iterative and refined throughout.

SETTING

Parents were recruited through 57 primary schools located in the greater Bristol area (UK).

PARTICIPANTS

53 parents of children aged 5-6 years.

RESULTS

Parents reported that for many children, screen viewing was a highly desirable behaviour that was difficult to manage, and that parents used the provision of screen viewing as a tool for reward and/or punishment. Parents managed screen viewing by setting limits in relation to daily events such as meals, before and after school, and bedtime. Screen-viewing rules were often altered depending on parental preferences and tasks. Inconsistent messaging within and between parents represented a source of conflict at times. Potential strategies to facilitate reducing screen viewing were identified, including setting screen-viewing limits in relation to specific events, collaborative rule setting, monitoring that involves mothers, fathers and the child, developing a family-specific set of alternative activities to screen viewing and developing a child's ability to self-monitor their own screen viewing.

CONCLUSIONS

Managing screen viewing is a challenge for many parents and can often cause tension in the home. The data presented in this paper provide key suggestions of new approaches that could be incorporated into behaviour change programmes to reduce child screen viewing.

A question of balance: Explaining differences between parental and grandparental perspectives on preschoolers' feeding and physical activity

RATIONALE

Although one quarter of US and UK families rely on grandparents as the main providers of informal childcare, grandparental perspectives on the feeding and physical activity of young children remain understudied.

OBJECTIVE

The study's aim was to elucidate parents' and grandparents' perspectives on young children's feeding and physical activity, and identify how they negotiate potential differences between these perspectives.

METHODS

We interviewed 22 parents and 27 grandparents from 16 families of children aged 3-5 years in the Pacific Northwest, US. Using familial homeostasis as a novel theoretical framework, the interviews were analyzed to assess differences between parental and grandparental perspectives on feeding and physical activity.

RESULTS

The analysis yielded six thematic categories: (1) disagreements about feeding stem from parents' and grandparents' differing definitions of healthy feeding; (2) differences between parents' and grandparents' feeding practices reflect differences in perceived caretaking roles; (3) parents and grandparents negotiate differences in feeding practices through grandparental compliance and parental compromise; (4) differences in preschoolers' physical activity are influenced by parents' and grandparents' own access to and engagement in physical activity; (5) parents and grandparents express few disagreements about preschoolers' screen-time; (6) parents and grandparents rarely discuss preschoolers' physical activity. The findings suggest that parental and grandparental decision-making about feeding and exercise is informed by ideas of what constitutes familial balance and a balanced lifestyle for a preschool aged child, rather than by the child's weight status.

CONCLUSIONS

Parents and grandparents appear to engage in practices designed to preserve familial homeostasis, which may provide a compelling explanation for the persistent difficulties in implementing family-based childhood obesity interventions.

Mothers' perceptions of the UK physical activity and sedentary behaviour guidelines for the early years (Start Active, Stay Active): a qualitative study

OBJECTIVES

Higher levels of physical activity (PA) during early childhood have been associated with improved health outcomes, whereas sedentary behaviour (SB) has been associated with poorer health outcomes in children. In 2011, the UK produced guidelines for PA and SB in children under 5 years. Mothers have been identified as key influences in young children's PA and SB. The aim of this study was to use in-depth interviews with mothers of preschool children to examine attitudes to the guidance.

DESIGN

Qualitative study using one-to-one, semistructured interviews; Data were analysed thematically using a framework approach.

SETTING

Mothers were recruited from preschools, nurseries, and mother and toddler groups located in four areas of varying socioeconomic status within Bristol, UK.

PARTICIPANTS

24 mothers who were considered the main or joint carer for a preschool child who was at least 2 years of age but had not yet started formal schooling.

RESULTS

Mothers are not aware of the UK PA and SB guidelines for the early years. They believe that their child achieves the guideline targets for PA and SB and therefore, they do not believe these quidelines are relevant to them. Mothers feel that an increase in PA and reduction in SB (especially screen-viewing) would cause stress for mothers. Mothers found defining and quantifying PA and SB in their preschool child problematic.

CONCLUSIONS

As mothers do not identify with the need to increase PA or reduce SB in their child, awareness of the guidelines alone is unlikely to initiate behaviour change. Information on how mothers can make a more accurate assessment of their preschool child's PA and SB levels, and information about the benefits of increased PA and reduced SB should be provided alongside the guideline targets. Clear messages need to be developed that reframe the guidelines into pragmatic and usable targets.

Sex differences in prevalence of overweight and obesity, and in extent of overweight index, in children and adolescents (3–18 years) from Kraków, Poland in 1983, 2000 and 2010

Objective

The increasing prevalence of overweight and obesity among children is now an important health problem. This fact, however, does not reflect the scale of the problem. The aim of the present study was to find how much the BMI threshold was exceeded in a population from Kraków.

Design

The study was based on three cross-sectional surveys conducted in 1983, 2000 and 2010. The prevalence of overweight and obesity was estimated based on the International Obesity Task Force cut-off points. In addition to these, an extent of overweight (EOW) index was calculated.

Setting

Poland.

Subjects

Children aged 3–18 years (n14 534) from Kraków.

Results

Between the populations examined in 1983 and 2010, the EOW index in boys rose by almost 10 %, and the prevalence of overweight and obesity by 39 %. In girls, however, the EOW index decreased by 45 %, while the prevalence of overweight and obesity remained at similar levels. Analyses in separate age groups showed that the EOW index increased only among early adolescents (150 % for boys, 94 % for girls) and late adolescents (390 % and 64 %, respectively).

Conclusions

The observed increased prevalence of overweight and obesity mainly concerned boys and was accompanied by an increase in the amount by which the BMI threshold values were exceeded.

The influence of friends and siblings on the physical activity and screen viewing behaviours of children aged 5-6 years: a qualitative analysis of parent interviews

OBJECTIVES

The present study uses qualitative data to explore parental perceptions of how their young child's screen viewing and physical activity behaviours are influenced by their child's friends and siblings.

DESIGN

Telephone interviews were conducted with parents of year 1 children (age 5-6 years). Interviews considered parental views on a variety of issues related to their child's screen viewing and physical activity behaviours, including the influence that their child's friends and siblings have over such behaviours. Interviews were transcribed verbatim and analysed using deductive content analysis. Data were organised using a categorisation matrix developed by the research team. Coding and theme generation was iterative and refined throughout. Data were entered into and coded within N-Vivo.

SETTING

Parents were recruited through 57 primary schools located in Bristol and the surrounding area that took part in the B-ProAct1v study.

PARTICIPANTS

Fifty-three parents of children aged 5-6 years.

RESULTS

Parents believe that their child's screen viewing and physical activity behaviours are influenced by their child's siblings and friends. Friends are considered to have a greater influence over the structured physical activities a child asks to participate in, whereas the influence of siblings is more strongly perceived over informal and spontaneous physical activities. In terms of screen viewing, parents suggest that their child's friends can heavily influence the content their child wishes to consume, however, siblings have a more direct and tangible influence over what a child watches.

CONCLUSIONS

Friends and siblings influence young children's physical activity and screen viewing behaviours. Child-focused physical activity and screen viewing interventions should consider the important influence that siblings and friends have over these behaviours.

Latino family childcare providers' beliefs, attitudes, and practices related to promotion of healthy behaviors among preschool children: a qualitative study

BACKGROUND

The continuing rise of obesity among Latinos is a public health concern with an immediate need for early prevention. Changes in family structures have increased demand and reliance for child care for young children. Latino children are the fastest-growing segment of the child population in the United States, and research shows that Latino families use preschools and day care centers much less than those of other ethnic groups, apparently because of cultural preferences for family-like care.

OBJECTIVES

Given that many low income Latino children attend family child care homes (FCCHs), there is a need to explore the role that FCCH providers may play in establishing and reinforcing children's early healthful eating and physical activity behaviors and consequently in the prevention of childhood obesity.

DESIGN

Using purposive sampling, six focus groups were conducted in Spanish with licensed Latino FCCH providers (n = 44). Data was analyzed to identify recurrent themes.

RESULTS

Latino FCCH providers described how they play an influential role in promoting healthful eating and physical activity behaviors of preschool children in their care. They also identified many barriers and challenges in establishing and maintaining healthful nutrition and physical activity behaviors, including high cost of healthy foods, cold weather, and physical environment of FCCH.

CONCLUSIONS

Latino FCCH providers can have a strong impact in promoting healthful behaviors in low-income, Latino communities. They may be able to effectively deliver interventions targeting low-income, minority families to promote healthful eating and physical activity behaviors and prevent child obesity.

Screen-Time Weight-loss Intervention Targeting Children at Home (SWITCH): a randomized controlled trial

BACKGROUND

Screen-based activities, such as watching television (TV), playing video games, and using computers, are common sedentary behaviors among young people and have been linked with increased energy intake and overweight. Previous home-based sedentary behaviour interventions have been limited by focusing primarily on the child, small sample sizes, and short follow-up periods. The SWITCH (Screen-Time Weight-loss Intervention Targeting Children at Home) study aimed to determine the effect of a home-based, family-delivered intervention to reduce screen-based sedentary behaviour on body composition, sedentary behaviour, physical activity, and diet over 24 weeks in overweight and obese children.

METHODS

A two-arm, parallel, randomized controlled trial was conducted. Children and their primary caregiver living in Auckland, New Zealand were recruited via schools, community centres, and word of mouth. The intervention, delivered over 20 weeks, consisted of a face-to-face meeting with the parent/caregiver and the child to deliver intervention content, which focused on training and educating them to use a wide range of strategies designed to reduce their child's screen time. Families were given Time Machine TV monitoring devices to assist with allocating screen time, activity packages to promote alternative activities, online support via a website, and monthly newsletters. Control participants were given the intervention material on completion of follow-up. The primary outcome was change in children's BMI z-score from baseline to 24 weeks.

RESULTS

Children (n = 251) aged 9-12 years and their primary caregiver were randomized to receive the SWITCH intervention (n = 127) or no intervention (controls; n = 124). There was no significant difference in change of zBMI between the intervention and control groups, although a favorable trend was observed (-0.016; 95% CI: -0.084, 0.051; p = 0.64). There were also no significant differences on secondary outcomes, except for a trend towards increased children's moderate intensity physical activity in the intervention group (24.3 min/d; 95% CI: -0.94, 49.51; p = 0.06).

CONCLUSIONS

A home-based, family-delivered intervention to reduce all leisure-time screen use had no significant effect on screen-time or on BMI at 24 weeks in overweight and obese children aged 9-12 years.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials RegistryWebsite: http://www.anzctr.org.au

TRIAL REGISTRATION NUMBER

ACTRN12611000164998.

A qualitative examination of the perceptions of parents on the Canadian Sedentary Behaviour Guidelines for the early years

BACKGROUND

Minimizing sedentary behavior, in particular screen-based sedentary behavior, during the early years is important for healthy growth and development. Consequently, new Canadian Sedentary Behaviour Guidelines for the Early Years (aged 0-4 years) were recently released. Researchers are unclear what messages should supplement the guidelines when disseminating them to parents and when using the guidelines in behaviour-change interventions to increase adoption. The objective of this study was to qualitatively examine parents' perceptions of the new Canadian Sedentary Behaviour Guidelines for the Early Years.

METHODS

Parents with a child ≤4 years who attended a child care centre were purposefully recruited from child care centres. A total of 7 semi-structured focus groups with 2 to 5 parents were conducted from August to November, 2013 by a trained and experienced moderator. Participants were asked a series of open-ended questions pertaining to the Sedentary Behaviour Guidelines information sheet. Initial themes were identified followed by further review and analysis.

RESULTS

For the most part parents thought the guidelines were clear and did not disagree with the recommendations per se. However, some confusion arose around the value of some sedentary activities, such as reading and coloring, for social and cognitive development. Many parents described feeling guilty after reading the guidelines and perceived several barriers in meeting the daily recommendations. Common barriers included the need to balance multiple demands of family life, the prevalence and accessibility of screen technology, and the weather and built environment where families live. Parents expressed the importance of communicating the guidelines early enough for good habits to be established and the need for realistic strategies and ideas to help them meet the recommendations.

CONCLUSIONS

Overall the findings indicate that gain-framed messages around the role of screen-based and non-screen-based sedentary behavior for children's cognitive and social development might be most effective for adoption of the guidelines. Furthermore, providing parents the guidelines early with resources for minimizing sedentary behavior should also be considered. Future research is needed in other demographic groups of parents to confirm these findings.

The Canadian Sedentary Behaviour Guidelines for the Early Years (zero to four years of age) and screen time among children from Kingston, Ontario

OBJECTIVES

To assess the proportion of children meeting the new Canadian Sedentary Behaviour Guidelines for the Early Years (zero to four years of age) and to describe parental attitudes toward and barriers to reducing screen time.

METHODS

Participants included 657 children zero to four years of age from the Kingston, Ontario, area. From May to September 2011, parents completed a questionnaire regarding their child's screen time and their attitudes toward and barriers to reducing their child's screen time.

RESULTS AND CONCLUSIONS

Approximately 32% of children younger than two years of age engaged in no screen time and approximately 46% of children two to four years of age engaged in <1 h per day; thereby, meeting the recommendations of the new guidelines. Most parents believed that their child did not engage in excessive screen time. Physicians and other health professionals should inform parents of these new guidelines and provide strategies to help their children meet targets.

Hispanic parents of overweight and obese children and their outcome expectations for children's television viewing: a qualitative study

OBJECTIVE

Explore parental outcome expectations (OE) regarding children's television (TV) viewing among parents of overweight or obese children.

METHODS

Qualitative study using semi-structured interviews with 20 parents of 5- to 8-year-old overweight or obese children.

RESULTS

Parent's positive OE for allowing TV viewing were the convenience of using TV for entertainment or as a babysitter. Hispanic parents would limit children's TV viewing to improve their children's health, restrict content, and promote other activities. Negative OE such as children misbehavior and the loss of positive OE for allowing TV emerged as reasons parents may not limit TV.

CONCLUSIONS AND IMPLICATIONS

Although Hispanic parents expected to improve their child's health by limiting TV, the negative OE may prevent them from doing so. Interventions targeting children's TV viewing, as a strategy to fight childhood obesity, may be more effective if they promote parent's positive OE and address parent's negative OE for children's TV viewing.

Influencing factors of sedentary behavior in European preschool settings: an exploration through focus groups with teachers

BACKGROUND

Sedentary behavior refers to activities involving sitting down and reclining (eg, watching TV, using the computer) and has been associated with different health outcomes. In preschool, children are sedentary for 50% to 80% of the time, in the classroom as well as during recess. Because of the absence of qualitative studies examining influencing factors of preschoolers' sedentary behavior in preschool settings, this study explored teachers' opinions on potentially influencing factors of this behavior.

METHODS

Eighty-seven teachers of 4- to 6-year-old preschoolers from 6 European countries participated in a total of 18 focus groups between October 2010 and January 2011. Key findings were reported separately by country, and were independently analyzed by 2 researchers using qualitative content analysis.

RESULTS

Teachers perceive the lack of play space and small classroom size as being influential factors on preschoolers' sedentary behavior; increasing play equipment and using teachers' prompts are mentioned as ways to stimulate children to be less sedentary on the playground. Computer use is reported to be more common in preschool than watching TV.

CONCLUSION

Interventions should focus on increasing teachers' awareness of how sedentary preschoolers are during the preschool day. Teachers also should be informed about strategies to decrease sedentariness in the classroom and on the playground.

Parental self-efficacy in childhood overweight: validation of the Lifestyle Behavior Checklist in the Netherlands

Background

Evaluating whether parental challenges and self-efficacy toward managing children’s lifestyle behaviors are successfully addressed by interventions requires valid instruments. The Lifestyle Behavior Checklist (LBC) has recently been developed in the Australian context. It consists of two subscales: the Problem scale, which measures parental perceptions of children’s behavioral problems related to overweight and obesity, and the Confidence scale, measuring parental self-efficacy in dealing with these problems. The aim of the current study was to systematically translate the questionnaire into Dutch and to evaluate its internal consistency, construct validity and test-retest reliability.

Methods

The LBC was systematically translated by four experts at Maastricht University. In total, 392 parents of 3-to13-year-old children were invited to fill out two successive online questionnaires with a two-week interval. Of these, 273 parents responded to the first questionnaire (test, response rate = 69.6%), and of the 202 who could be invited for the second questionnaire (retest), 100 responded (response rate = 49.5%). We assessed the questionnaire’s internal consistency (Cronbach’s α), construct validity (Spearman’s Rho correlation tests, using the criterion measures: restrictiveness, nurturance, and psychological control), and test-retest reliability (Spearman’s Rho correlation tests).

Results

Both scales had high internal consistency (Cronbach’s α ≥ 0.90). Spearman correlation coefficients indicated acceptable test-retest reliability for both the Problem scale (r_s = 0.74) and the Confidence scale (r_s = 0.70). The LBC Problem scale was significantly correlated to all criterion scales (nurturance, restrictiveness, psychological control) in the hypothesized direction, and the LBC Confidence scale was significantly correlated with nurturance and psychological control in the hypothesized direction, but not with restrictiveness.

Conclusions

The Dutch translation of the LBC was found to be a reliable and reasonably valid questionnaire to measure parental perceptions of children’s weight-related problem behavior and the extent to which parents feel confident to manage these problems.

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.

SECULAR TRENDS IN BODY COMPOSITION AND FREQUENCY OF OVERWEIGHT AND OBESITY IN BOYS AGED 3–18 FROM KRAKOW, POLAND, WITHIN THE LAST 30 YEARS (FROM 1983 TO 2010)

The aim of this study was to examine the changes in body composition (fatness and muscle and bone mass) and BMI in three cohorts of boys living in Krakow, Poland, over the last 30 years, and to assess how overweight and obesity frequencies have developed over the period. The anthropological survey was conducted in 2010, and comprised 1863 boys from Krakow aged 3–18 years. The analysis compared the latest measurements of selected skinfold thicknesses, BMI, total body muscle mass and bone mass with the results of surveys from 1983 (N=1934) and 2000 (N=2323). The frequency of overweight and obesity was assessed for the last survey series, and their trends determined for the years 1983–2000 and 2000–2010. The analysis of fat tissue distribution showed that the boys from the 2010 cohort, as compared with those examined in 2000, had a higher trunk adiposity, as manifested by greater thickness of subscapular and suprailiac skinfold thicknesses, and boasted a larger muscle mass and lower bone mass. The survey results also showed that, from 1983 to 2000, the percentage of overweight boys increased slightly (from 11.69% to 12.48%), whereas the frequency of obesity did not change. Over the last decade, the percentage of overweight people has increased to 15.94%, and the frequency of obesity has doubled, equalling 4.94% in 2010. The last decade has seen a minor trend in boys towards increased trunk adiposity, muscle mass, BMI and prevalence of overweight and obesity, and a slight decrease in bone mass.

Neighborhood disorder and screen time among 10-16 year old Canadian youth: a cross-sectional study

Background

Screen time activities (e.g., television, computers, video games) have been linked to several negative health outcomes among young people. In order to develop evidence-based interventions to reduce screen time, the factors that influence the behavior need to be better understood. High neighborhood disorder, which may encourage young people to stay indoors where screen time activities are readily available, is one potential factor to consider.

Methods

Results are based on 15,917 youth in grades 6-10 (aged 10-16 years old) who participated in the Canadian 2009/10 Health Behaviour in School-aged Children Survey (HBSC). Total hours per week of television, video games, and computer use were reported by the participating students in the HBSC student questionnaire. Ten items of neighborhood disorder including safety, neighbors taking advantage, drugs/drinking in public, ethnic tensions, gangs, crime, conditions of buildings/grounds, abandoned buildings, litter, and graffiti were measured using the HBSC student questionnaire, the HBSC administrator questionnaire, and Geographic Information Systems. Based upon these 10 items, social and physical neighborhood disorder variables were derived using principal component analysis. Multivariate multilevel logistic regression analyses were used to examine the relationship between social and physical neighborhood disorder and individual screen time variables.

Results

High (top quartile) social neighborhood disorder was associated with approximately 35-45% increased risk of high (top quartile) television, computer, and video game use. Physical neighborhood disorder was not associated with screen time activities after adjusting for social neighborhood disorder. However, high social and physical neighborhood disorder combined was associated with approximately 40-60% increased likelihood of high television, computer, and video game use.

Conclusion

High neighborhood disorder is one environmental factor that may be important to consider for future public health interventions and strategies aiming to reduce screen time among youth.

Influencing factors of screen time in preschool children: an exploration of parents' perceptions through focus groups in six European countries

Preschoolers already spend significant proportions of their waking hours being sedentary. Screen time (i.e. television/DVD viewing and computer use) has been negatively associated with several health outcomes but interventions aiming to reduce preschoolers' sedentary behaviour are scarce. This study aimed to explore parents' perceptions of their preschool children's screen time. One hundred twenty-two parents of low and medium-high socioeconomic status from six European countries with children between 4 and 6 years old were involved in 24 focus groups. Following a qualitative content analysis, the available information and key findings were centrally analysed. Results showed that children tend to like watching television (TV) and most parents do not express worries about their children's TV viewing time. Education is considered to be the main benefit of watching TV and in general, parents only have informal rules about TV viewing. Computer and active games use are less frequent compared with TV viewing. No univocal results are found about the influence of siblings or friends on children's screen time. Weather conditions and parental habits at home are the most important factors influencing children's screen time. Alternatives for screen activities and information on how to set rules for screen time should be provided to parents to assist them in decreasing their preschool children's screen time.

Obesity in preschoolers: behavioral correlates and directions for treatment

Nearly 14% of American preschoolers (ages 2-5) are obese (BMI ≥ 95th percentile for age and gender), yet this group has received little attention in the obesity intervention literature. This review examines what is known about behavioral correlates of obesity in preschoolers and the developmental context for lifestyle modification in this age group. Information was used to critically evaluate existing weight management prevention and intervention programs for preschoolers and formulate suggestions for future intervention research development. A systematic search of the medical and psychological/behavioral literatures was conducted with no date restrictions, using PubMed, PsycInfo, and MEDLINE electronic databases and bibliographies of relevant manuscripts. Evidence suggests several modifiable behaviors, such as sugar sweetened beverage intake, television use, and inadequate sleep, may differentiate obese and healthy weight preschoolers. Developmental barriers, such as food neophobia, food preferences, and tantrums challenge caregiver efforts to modify preschoolers' diet and activity and parental feeding approaches, and family routines appear related to the negative eating and activity patterns observed in obese preschoolers. Prevention programs yield modest success in slowing weight gain, but their effect on already obese preschoolers is unclear. Multi-component, family-based, behavioral interventions show initial promise in positive weight management for already obese preschoolers. Given that obesity intervention research for preschoolers is in its infancy, and the multitude of modifiable behavioral correlates for obesity in this age group, we discuss the use of an innovative and efficient research paradigm (Multiphase Optimization Strategy; MOST) to develop an optimized intervention that includes only treatment components that are found to empirically reduce obesity in preschoolers.