Links between parents' and girls' television viewing behaviors: a longitudinal examination

Designing a childhood obesity preventive intervention using the multiphase optimization strategy: The Healthy Bodies Project

BACKGROUND/AIMS

Preventing the development of childhood obesity requires multilevel, multicomponent, comprehensive approaches. Study designs often do not allow for systematic evaluation of the efficacy of individual intervention components before the intervention is fully tested. As such, childhood obesity prevention programs may contain a mix of effective and ineffective components. This article describes the design and rationale of a childhood obesity preventive intervention developed using the multiphase optimization strategy, an engineering-inspired framework for optimizing behavioral interventions. Using a series of randomized experiments, the objective of the study was to systematically test, select, and refine candidate components to build an optimized childhood obesity preventive intervention to be evaluated in a subsequent randomized controlled trial.

METHODS

A 24 full factorial design was used to test the individual and combined effects of four candidate intervention components intended to reduce the risk for childhood obesity. These components were designed with a focus on (a) improving children's healthy eating behaviors and nutrition knowledge, (b) increasing physical activity and reducing sedentary activity in the childcare setting, (c) improving children's behavioral self-regulation, and (d) providing parental web-based education to address child target outcomes. The components were tested with approximately 1400 preschool children, ages 3-5 years in center-based childcare programs in Pennsylvania, the majority of which served predominantly Head-Start eligible households. Primary child outcomes included healthy eating knowledge, physical and sedentary activity, and behavioral self-regulation. Secondary outcomes included children's body mass index and appetitive traits related to appetite regulation.

RESULTS

Four intervention components were developed, including three classroom curricula designed to increase preschool children's nutrition knowledge, physical activity, and behavioral, emotional, and eating regulation. A web-based parent education component included 18 lessons designed to improve parenting practices and home environments that would bolster the effects of the classroom curricula. A plan for analyzing the specific contribution of each component to a larger intervention was developed and is described. The efficacy of the four components can be evaluated to determine the extent to which they, individually and in combination, produce detectable changes in childhood obesity risk factors. The resulting optimized intervention should later be evaluated in a randomized controlled trial, which may provide new information on promising targets for obesity prevention in young children.

CONCLUSION

This research project highlights the ways in which an innovative approach to the design and initial evaluation of preventive interventions may increase the likelihood of long-term success. The lessons from this research project have implications for childhood obesity research as well as other preventive interventions that include multiple components, each targeting unique contributors to a multifaceted problem.

A synthesis of early antecedents of eating behavior and weight status in girls: The legacy of girls' NEEDS project

Dr. Leann Birch, an innovator in the field of children's eating behavior, was the first scientist to synergize the fields of developmental psychology and nutrition science. One of Leann's groundbreaking projects was the Girls' NEEDS Project (GNP), an NIH-funded observational study of the longitudinal development of eating and weight-related behaviors of girls across middle childhood and adolescence. At the time of GNP, obesity prevalence during childhood had roughly doubled during the previous two decades, research interest in dieting had increased as societal expectations of the 'thin ideal' got even thinner, and little was known about how environmental factors such as parenting influenced the development of maladaptive eating and weight-related behaviors. GNP resulted in over 70 publications, covering a range of topics from girls' dietary intake and physical activity to parental influences on girls' eating behavior, thus laying the groundwork for many topics in the obesity, food parenting, and dieting literature today. Therefore, this narrative review aims to summarize and synthesize the literature that resulted from the GNP and provide implications for future work building from this foundation.

The associations of parental COVID-19 related worries, lifestyles, and insomnia with child insomnia during the COVID-19 outbreak

The impacts of the Coronavirus Disease 2019 (COVID‐19) pandemic on sleep health have been studied extensively. However, little is known about sleep problems within the family system during the pandemic. This study aimed to examine the influence of the COVID‐19 pandemic on insomnia in both adults and children, and to explore whether parental COVID‐19 related worries, lifestyles, and insomnia were associated with child insomnia. A total of 1355 parent–child dyads (39.2% fathers, mean age 38.37 years, SD = 5.34; 52.7% boys, mean age 12.47 years, SD = 1.67) were recruited from Jiangxi province in China from 4 to 18 February 2020. Data on insomnia, COVID‐19 related worries, physical activity, and screen time were collected using online questionnaires. Path analysis showed that COVID‐19 related worries and screen time were positively associated with insomnia in both parents and children; while children's physical activity was negatively related to children's insomnia. Parents' insomnia, COVID‐19 related worries, physical activity, and screen time were positively associated with children's insomnia, COVID‐19 related worries, physical activity, and screen time, respectively. Bootstrap tests showed that parents' worries were positively associated with children's insomnia via parents' insomnia and children's worries; parents' physical activity was negatively associated with children's insomnia via children's physical activity, parents' screen time was positively associated with children's insomnia via parents' insomnia and children's screen time. Both parental and child sleep are affected by the pandemic. Parental insomnia, stress reaction, and lifestyles contribute to child insomnia. Child sleep health may be maintained or improved by family bonds, home exercise, and sleep schedules.

Exploring a theory of change: Are increases in parental empowerment associated with healthier weight-related parenting practices?

INTRODUCTION

Parent health-related empowerment is defined as the process by which parents realize control over their life situation and take action to promote a healthier lifestyle. For decades, researchers have described the theoretical potential of empowerment in health promotion efforts, though few have empirically examined this hypothesized relationship. This study is one of the first to examine the relationship between parental empowerment and healthy weight parenting practices (i.e., food, physical activity, sleep, and media parenting), as a mechanism for early childhood health promotion in community settings.

METHODS

Low-income parents of preschool-aged children attending Head Start in Greater Boston between fall 2017 and spring 2019 were invited to complete a survey in the fall and spring of each academic school year (n = 578 with two surveys and n = 45 with four). Parental empowerment and healthy weight parenting practices were assessed using validated surveys. We used a multilevel difference-in-difference approach to estimate changes in healthy weight parenting practices score by changes in parental empowerment score.

RESULTS

Out of a possible score of four, the unadjusted mean (SD) score in fall was 3.20 (0.40) for empowerment and 3.01 (0.40) for parenting. An increase in parental empowerment was associated with an increase in healthier parenting practices (b = 0.14; 95% CI = 0.08, 0.20; p < 0.0001).

CONCLUSIONS

Parent empowerment may be an important target in interventions to prevent obesity in low-income children.

The Cultivation of Parent and Child Materialism: A Parent-Child Dyadic Study

Research has shown that television viewing cultivates a materialistic worldview in children. However, other socialization factors may also influence children's materialism. The current research tests two socialization pathways of parental influence: (a) an indirect path in which parents pass on their own materialism to their children, and the parent's materialism is at least partly the result of a parent cultivation effect (parent cultivation); (b) an indirect path in which parents pass on their television viewing behavior to their children, which in turn positively predicts the children's level of materialism (child cultivation). The results of two studies (initial study plus direct replication, N = 818) of U.S. parent-child dyads with 14- to 17-year-old children support the first path but not the second: The relation between parent TV viewing and child materialism is mediated through parent materialism. Child TV viewing is positively correlated with child materialism, but is nonsignificant when parent materialism is controlled.

A comparison of self-reported exposure to fast food and sugary drinks marketing among parents of children across five countries

Exposure to unhealthy food and beverage marketing is an important environmental determinant of dietary intake. The current study examined self-reported exposure to marketing of unhealthy foods and beverages across various media channels and settings among parents of children younger than 18 years in five high and upper-middle income countries. Data from 4827 parents living with their children were analyzed from the International Food Policy Study (2017), a web-based survey of adults aged 18-64 years from Canada, the United States (US), the United Kingdom (UK), Australia, and Mexico. Respondents reported their exposure to marketing of fast food and of sugary drinks across media channels/settings overall and how often they see fast food and sugary drink marketing while viewing media with their children. Regression models examined differences across countries and correlates of marketing exposure. Parents in Mexico and the US reported greater exposure to marketing for fast food and sugary drinks compared to parents in Australia, Canada, and the UK. Patterns of exposure among parents were generally consistent across countries, with TV, digital media, and radio being the most commonly reported media channels for both fast food and sugary drinks. Exposure to marketing of fast food and sugary drinks was associated with a variety of sociodemographic factors, most strongly with ethnicity and education, and sociodemographic trends differed somewhat between countries. The findings demonstrate differences in self-reported parental exposure to marketing of fast food and sugary drinks between countries, and may help to evaluate the impact of marketing restrictions implemented over time.

Brief Report–Modeling Media Use: How Parents’ and Other Adults’ Posting Behaviors Relate to Young Adolescents’ Posting Behaviors

Middle school is a period when young adolescents become more engaged with social media and adults become increasingly concerned about such use. Although research finds that parents often post about their children on social media, little is known about how adults’ social media behaviors relate to youths’ online behaviors. We surveyed 466 middle-school students about their social media habits, privacy-respecting behaviors, and their parents’, other adults’, and their own posting behaviors on social media. While 68% used social media, only 41% posted pictures. Of those, 33.5% also had parents and/or adults that posted about them. Using this subset, we found that adults’ privacy-respecting behaviors (e.g., asking permission to post, showing post first) were significantly related to youth using these same privacy-respecting behaviors when posting on social media. Like many areas of development, young adolescents may learn about social media use by modeling their parents’ and other adults’ behaviors.

Development of a consensus statement on the role of the family in the physical activity, sedentary, and sleep behaviours of children and youth

BACKGROUND

Children and youth who meet the physical activity, sedentary, and sleep behaviour recommendations in the Canadian 24-Hour Movement Guidelines are more likely to have desirable physical and psychosocial health outcomes. Yet, few children and youth actually meet the recommendations. The family is a key source of influence that can affect lifestyle behaviours. The purpose of this paper is to describe the process used to develop the Consensus Statement on the Role of the Family in the Physical Activity, Sedentary, and Sleep Behaviours of Children and Youth (0-17 years) and present, explain, substantiate, and discuss the final Consensus Statement.

METHODS

The development of the Consensus Statement included the establishment of a multidisciplinary Expert Panel, completion of six reviews (three literature, two scoping, one systematic review of reviews), custom data analyses of Statistics Canada's Canadian Health Measures Survey, integration of related research identified by Expert Panel members, a stakeholder consultation, establishment of consensus, and the development of a media, public relations, communications and launch plan.

RESULTS

Evidence from the literature reviews provided substantial support for the importance of family on children's movement behaviours and highlighted the importance of inclusion of the entire family system as a source of influence and promotion of healthy child and youth movement behaviours. The Expert Panel incorporated the collective evidence from all reviews, the custom analyses, other related research identified, and stakeholder survey feedback, to develop a conceptual model and arrive at the Consensus Statement: Families can support children and youth in achieving healthy physical activity, sedentary and sleep behaviours by encouraging, facilitating, modelling, setting expectations and engaging in healthy movement behaviours with them. Other sources of influence are important (e.g., child care, school, health care, community, governments) and can support families in this pursuit.

CONCLUSION

Family is important for the support and promotion of healthy movement behaviours of children and youth. This Consensus Statement serves as a comprehensive, credible, and current synopsis of related evidence, recommendations, and resources for multiple stakeholders.

Development of a Survey to Assess Latino Fathers’ Parenting Practices Regarding Energy Balance–Related Behaviors of Early Adolescents

Latino adolescents face challenges to performing energy balance–related behaviors (EBRBs) to prevent childhood obesity, including healthy dietary intake, adequate physical activity, and limited screen time. Fathers are underrepresented in family-based obesity interventions but could be influential in shaping the EBRBs of Latino children. Three types of parenting practices (setting expectations/limits, role modeling, managing availability and accessibility) have shown relatively consistent positive relationships with children’s EBRBs in studies that have mostly involved mothers. The purpose of this study was to develop measures to assess Latino fathers’ parenting practices based on existing measurement instruments, focus groups and cognitive testing. Criterion validity of the measures (40 items) was examined with Latino fathers and their early adolescents (10-14 years old, n = 96 dyads) who were predominantly from low-income, two-parent households. Criterion validity was indicated by significantly higher intakes of fruit and vegetables; lower intakes of sugar-sweetened beverages, sweets/salty snacks and fast foods; more weekly physical activity hours; and fewer daily screen time hours among adolescents who reported high versus low levels/frequencies of supportive parenting practices. In addition, nearly all scales of adolescent-reported paternal behavioral modeling and availability/accessibility practices were significantly correlated with adolescents’ corresponding EBRBs (r = 0.22 to 0.54). However, poor validity and agreement with early adolescents’ reports were found for most father-reported parenting practices. Overall, this study indicated that the measures were acceptable for assessing adolescents’ report of Latino fathers’ parenting practices around EBRBs. The findings also indicate the importance of including early adolescents’ reports in measuring paternal parenting practices.

Socio-demographic and maternal predictors of adherence to 24-hour movement guidelines in Singaporean children

PURPOSE

Integrated 24-Hour Movement Guidelines provide specific recommendations on screen viewing (SV), moderate-to-vigorous physical activity (MVPA) and sleep to improve health of children and youth. However, few studies have examined whether these guidelines are met in young children, particularly in Asia. We evaluated adherence to integrated and individual guidelines and its predictors in 5.5-year-old Singaporean children.

METHODS

Growing Up in Singapore towards Healthy Outcomes (GUSTO) is a mother-offspring birth cohort study. At age 5.5 years, child SV was reported by parents. Movement behaviours (MBs) were measured continuously using wrist-worn accelerometers over 7 consecutive days and nights. For accelerometer data including ≥3 days with ≥16 h/day we estimated mean (±SD) daily MVPA, SV and nighttime sleep duration across the week. Adherence to integrated (Canadian/Australian) guidelines was defined as meeting all individual guidelines: ≥60 min of MVPA/day, ≤2 h of screen time/day, and 9-11 h of sleep/night. Socio-demographic and maternal predictors collected at pregnancy enrolment and at 26-28 weeks' gestation were examined by multivariable logistic regression.

RESULTS

Of 864 children followed up age 5.5 years, 547 (63.3%) had both valid ActiGraph and questionnaire data (51.7% boys and 58.3% Chinese ethnicity). Children averaged 101.9 (± 88.7) min/day SV, 67.3 (± 23.7) min/day MVPA and 480.6 (± 57.2) min/night sleep. Few children met integrated guidelines. Specifically, the proportions of children who met none, SV, MVPA, sleep and integrated guidelines were 11.2, 70.2, 59.6, 13.7 and 5.5%, respectively. Multivariable analysis showed that maternal activity and television (TV) viewing were associated with meeting integrated guidelines (insufficiently vs. highly active (OR [95% CI]): 0.11 [0.01, 0.95]; 2-3 vs. ≥ 3 h TV: 3.52 [1.02, 12.22]). Examining higher adherence to individual guidelines, Chinese ethnicity, younger maternal age and lower maternal TV and sleep time were associated with greater SV; male sex, Malay ethnicity, higher birth order and higher maternal activity level were associated with greater MVPA; and older maternal age was associated with adherence to sleep guideline.

CONCLUSIONS

Beyond individual behaviours, consideration of the full spectrum of MBs may be important to improve children's health. However, few Singaporean children adhere to integrated 24-h movement guidelines. Maternal behaviours as early as during pregnancy could be important targets for future interventions aiming to promote these MBs in children.

THE ROLE OF THE OBESOGENIC ENVIRONMENT AND PARENTAL LIFESTYLES IN INFANT FEEDING BEHAVIOR

OBJECTIVE

To identify the role of the obesogenic environment and parental lifestyles in infant feeding behavior.

DATA SOURCES

The searches were performed in PubMed, Medline, Cochrane, Lilacs and Scielo databases, in Portuguese, English and Spanish. The descriptors used were found in the Medical Subject Headings and in the Descriptors in Health Sciences being these: Comportamento alimentar/Feeding Behavior/ Conducta Alimentaria; Crianças/Child/ Niño; Relações familiares/Family Relations/Relaciones Familiares; e Ecologia/ Ecology/ Ecología. These were combined by the Boolean operator AND.

DATA SYNTHESIS

Researchers consider that parents (orprimary caregivers) are responsible, in part, for the unhealthy eating behavior presented by children, and for them to change it is necessary to change the behavior of the family, ensuring the correct choice of food and the practice of physical activity. The family environment has a significant impact on the development of eating behavior, so adults should provide a good model of this behavior for children.

CONCLUSIONS

It was verified through this review that, in order to maintain and develop a healthy eating behavior, it is necessary to reach different spheres of life of the individual - physical, social, psychological, family, cultural and mediatic environment.

Conceptualizing Family Influences on Children's Energy Balance-Related Behaviors: Levels of Interacting Family Environmental Subsystems (The LIFES Framework)

Healthy or unhealthy behavioral patterns develop and are maintained in a family context. The importance of the family environment for children’s and adolescents’ energy balance-related behaviors (EBRBs) has been shown previously. However, the way different family environmental factors are interrelated and interact with personal factors (e.g., motivation) are not well understood. Furthermore, the majority of studies have focused on the parent-child subsystem. However, there are family-level socialization dynamics that affect the development of a healthy lifestyle beyond the impact of parenting behaviors. The current paper aims to synthesize theoretical and empirical literature on different types of family influences. The Levels of Interacting Family Environmental Subsystems (LIFES) framework incorporates family influences on three levels (immediate, proximal, distal) and of three subsystems (individual, parent-child, family), relates them to each other and postulates potential paths of influence on children’s EBRBs. Several studies examining specific sections of the framework provide empirical support for LIFES’ propositions. Future studies should place their research in the context of the interrelationship of different family environmental influences. A better understanding of the interrelated influences would enhance the understanding of the development and maintenance of overweight and obesity among children and is crucial for the development of effective interventions.

The amount of television that infants and their parents watched influenced children's viewing habits when they got older

AIM

Excessive television (TV) exposure has negative impacts on a child's development, health and behaviour. This study examined the under-researched area of what impact infant and parental TV viewing during a child's infancy had on the child's later viewing habits.

METHODS

Data on 18 577 babies born in 2005 were collected from the Taiwan Birth Cohort Study, a prospective longitudinal study of a nationally representative cohort. Group-based trajectory analysis was conducted to identify childhood TV viewing trajectories at 18, 36 and 66 months of age. Multinomial logistic regression was used to examine the influence of parents' TV behaviour on their children's TV viewing trajectories.

RESULTS

The percentage of children falling into the TV viewing trajectories that were identified were low (20%), increasing (46.5%) and high (33.5%). The child's TV viewing trajectory was significantly associated with the child's sex, parent's monthly household income, child's day care arrangements, maternal and paternal education, maternal and paternal TV viewing time and whether the child's TV viewing time was restricted.

CONCLUSION

The amount of TV that children watched when they were older was associated with a range of factors, and the results particularly highlight the need to restrict child and parental viewing time in infancy.

Knowledge, Attitudes, and Practices of Parents Facing Child and Adolescent Obesity in Brazzaville, Congo

The study aimed to assess obesity-related knowledge, attitudes, and practices of parents when facing child and adolescent obesity in order to improve the quality of care. A case-control study was conducted from February 1 to July 1, 2013. The study compared parents of obese school children (group 1 or cases; n = 254) and those school children without obesity (group 2 or controls; n = 254). These children were drawn from public and private primary schools of Brazzaville (Congo). Obesity-related knowledge was satisfactory in 83.5% of the cases, attitudes were correct in 29% of the cases, and the practices good in 25.6% of the cases. The parents' obesity-related knowledge was satisfactory when the socioeconomic level of the family was high (P < .02), the mothers' educational level greater than primary (P < .001), and the fathers' educational level was greater than primary (P < 10-4). The same observation was obtained with obesity-related attitudes and practices of the parents when correct. This influence remained after the adaptation of fathers' educational level. In conclusion, the disease-related knowledge of parents can be considered satisfactory in the majority of the cases; however, obesity-related attitudes and practices remain incorrect in most of the cases.

The impact of different types of parental support behaviours on child physical activity, healthy eating, and screen time: a cross-sectional study

BACKGROUND

In Canada, 31.5 % of children are overweight or obese, putting them at an increased risk of chronic co-morbidities and premature mortality. Physical activity, healthy eating, and screen time are important behavioural determinants of childhood overweight and obesity that are influenced by the family environment, and particularly parents' support behaviours. However, there is currently a limited understanding of which types of these support behaviours have the greatest positive impact on healthy child behaviours. This study aims to determine the relative contribution of different types of parental support behaviours for predicting the likelihood that children meet established guidelines for daily physical activity, daily fruit and vegetable consumption, and recreational screen time.

METHODS

A Computer Assisted Telephone Interview survey was used to collect data from a random sample of parents or guardians with at least one child under the age of 18 in Ontario (n = 3,206). Three multivariable logistic regression models were built to predict whether or not parents reported their child was meeting guidelines. Independent variables included parent and child age and gender, multiple indicators of parental support behaviours, and socio-demographic characteristics. Parental support behaviours were categorized post-hoc as motivational, instrumental, regulatory, and conditional based on an adapted framework.

RESULTS

Controlling for all other factors in the model, several parental support behaviours were found to be significant predictors of children meeting established health guidelines. For example, conditional support behaviours including taking the child to places where they can be active (OR: 2.06; 95 % CI: 1.32-3.21), and eating meals as a family away from the TV (95 % CI: 1.15-2.41) were significant positive predictors of children meeting physical activity and fruit and vegetable guidelines, respectively.

CONCLUSIONS

Health promotion efforts aimed at improving particular parent support behaviours could be effective levers for mitigating the burden of excess body weight in childhood. As such, the influence of support behaviours should be fully considered in any comprehensive approach to prevention and reduction of childhood overweight and obesity.

Parenting and childhood obesity research: a quantitative content analysis of published research 2009-2015

BACKGROUND

A quantitative content analysis of research on parenting and childhood obesity was conducted to describe the recent literature and to identify gaps to address in future research.

METHODS

Studies were identified from multiple databases and screened according to an a priori defined protocol. Eligible studies included non-intervention studies, published in English (January 2009-December 2015) that focused on parenting and childhood obesity and included parent participants.

RESULTS

Studies eligible for inclusion (N = 667) focused on diet (57%), physical activity (23%) and sedentary behaviours (12%). The vast majority of studies used quantitative methods (80%) and a cross-sectional design (86%). Few studies focused exclusively on fathers (1%) or included non-residential (1%), non-biological (4%), indigenous (1%), immigrant (7%), ethnic/racial minority (15%) or low-socioeconomic status (19%) parents.

DISCUSSION

While results illustrate that parenting in the context of childhood obesity is a robust, global and multidisciplinary area of inquiry, it is also evident that the vast majority of studies are conducted among Caucasian, female, biological caregivers living in westernized countries. Expansion of study foci and design is recommended to capture a wider range of caregiver types and obesity-related parenting constructs, improve the validity and generalizability of findings and inform the development of culture-specific childhood obesity prevention interventions and policies. © 2016 World Obesity.

Father Involvement in Feeding Interactions with Their Young Children

OBJECTIVE

To examine the associations of father-child feeding and physical interactions with dietary practices and weight status in children.

METHODS

A nationally representative sample of children, mothers, and fathers who participated in the Early Childhood Longitudinal Study Birth cohort study (N = 2441) was used to explore the relationship of father-child feeding and physical activity interactions with child dietary practices and weight status. Logistic multivariable regression analyses were adjusted for child, father, mother, and socio-demographic characteristics.

RESULTS

Approximately 40% of fathers reported having a great deal of influence on their preschool child's nutrition and about 50% reported daily involvement in preparing food for their child and assisting their child with eating. Children had over 2 times the odds of consuming fast food at least once a week if fathers reported eating out with their child a few times a week compared to fathers who reported rarely or never eating out with their child (OR, 2.89; 95% CI, 1.94-4.29), adjusting for all covariates. Whether fathers reported eating out with their children was also significantly associated with children's sweetened beverage intake.

CONCLUSIONS

Potentially modifiable behaviors that support healthy dietary practices in children may be supported by targeting fathers.

A systematic review of determinants of sedentary behaviour in youth: a DEDIPAC-study

Sedentary behaviour (SB) has emerged as a potential risk factor for metabolic health in youth. Knowledge on the determinants of SB in youth is necessary to inform future intervention development to reduce SB. A systematic review was conducted to identify predictors and determinants of SB in youth. Pubmed, Embase, CINAHL, PsycINFO and Web of Science were searched, limiting to articles in English, published between January 2000 and May 2014. The search strategy was based on four key elements and their synonyms: (a) sedentary behaviour, (b) determinants, (c) types of sedentary behaviours, (d) types of determinants. The full protocol is available from PROSPERO (PROSPERO 2014:CRD42014009823). Cross-sectional studies were excluded. The analysis was guided by the socio-ecological model. 37 studies were selected out of 2654 identified papers from the systematic literature search. Most studies were conducted in Europe (n = 13), USA (n = 11), and Australia (n = 10). The study quality, using the Qualsyst tool, was high with a median of 82 % (IQR: 74–91 %). Multiple potential determinants were studied in only one or two studies. Determinants were found at the individual, interpersonal, environmental and policy level but few studies examined a comprehensive set of factors at different levels of influences. Evidence was found for age being positively associated with total SB, and weight status and baseline assessment of screen time being positively associated with screen time (at follow-up). A higher playground density and a higher availability of play and sports equipment at school were consistently related to an increased total SB, although these consistent findings come from single studies. Evidence was also reported for the presence of safe places to cross roads and lengthening morning and lunch breaks being associated with less total SB. Future interventions to decrease SB levels should especially target children with overweight or obesity and should start at a young age. However, since the relationship of many determinants with SB remains inconsistent, there is still a need for more longitudinal research on determinants of SB in youth.

Conceptual framework of a simplified multi-dimensional model presenting the environmental and personal determinants of cardiometabolic risk behaviors in childhood

Clinical manifestations of cardiometabolic risk (CMR) may be set early in childhood due to unfavorable behaviors or lifestyle patterns related to diet and physical activity. Several factors may determine the adoption of such lifestyle-related behaviors, which researchers have tried to cluster under certain frameworks or models. In this context, the framework developed and proposed by this review gathers all the present knowledge regarding these determining factors to date and groups them into three main categories related to personal characteristics and the social and physical environment. Based on the proposed framework, a large variety of personal, social and physical environmental factors can positively or negatively influence CMR-related behaviors (either directly or indirectly via their interrelations), thus leading to decreased or increased risk, respectively. This framework could be of great value to public health policy makers and legislators for designing and implementing interventional programs tailored to the needs of susceptible population groups who are most in need for such initiatives. Targeting the correlates as potential determinants of CMR-related behaviors, and not just on the behaviors themselves, has been shown previously to be the most effective approach for tackling health issues related to CMR starting from early life stages.

Mothers’ guilt responses to children’s obesity risk feedback

This study explored the influence of family health history-based obesity risk feedback for their child on 147 overweight mothers’ guilt related to children’s lifestyle behaviors and passing down a genetic propensity for overweight. Mothers were randomized to receive, or not, obesity risk feedback for their 4- to 5-year-old child and then made food choices for them using a virtual reality–based buffet. Receipt of risk information increased lifestyle- and genetics-related guilt. Choosing fewer unhealthful foods for the child attenuated both types of guilt. Work in this area may aid in development of obesity risk feedback strategies that enhance child feeding.

Associations between rule-based parenting practices and child screen viewing: A cross-sectional study

Background

Child screen viewing (SV) is positively associated with poor health indicators. Interventions addressing rule-based parenting practices may offer an effective means of limiting SV. This study examined associations between rule-based parenting practices (limit and collaborative rule setting) and SV in 6–8-year old children.

Methods

An online survey of 735 mothers in 2011 assessed: time that children spent engaged in SV activities; and the use of limit and collaborative rule setting. Logistic regression was used to examine the extent to which limit and collaborative rule setting were associated with SV behaviours.

Results

‘Always’ setting limits was associated with more TV viewing, computer, smartphone and game-console use and a positive association was found between ‘always’ setting limits for game-console use and multi-SV (in girls). Associations were stronger in mothers of girls compared to mothers of boys. ‘Sometimes’ setting limits was associated with more TV viewing. There was no association between ‘sometimes’ setting limits and computer, game-console or smartphone use. There was a negative association between collaborative rule setting and game-console use in boys.

Conclusions

Limit setting is associated with greater SV. Collaborative rule setting may be effective for managing boys' game-console use. More research is needed to understand rule-based parenting practices.

•

We examined parent limit and collaborative rule setting and child screen viewing.

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‘Always’ vs ‘never or rarely’ limit setting was associated with more screen viewing.

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Associations were stronger in mothers of girls compared to mothers of boys.

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Collaborative rule setting may be effective for managing boys' game-console use.

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More research is needed to understand the nature of rule-based parenting practices.

Psychosocial perspectives and the issue of prevention in childhood obesity

A dramatic increase in childhood overweight/obesity has been recognized globally over the past 50 years. This observed increase may reflect genetic, as well as psychological, environmental, and socio-cultural influences. In the first part of this review, we present an updated summary of the psychosocial factors associated with this change and discuss possible ways in which they operate. Among these factors, lower socio economic status (in both industrialized and non-industrialized countries), being female, belonging to a minority group, and being exposed to adverse life events may all be associated with a greater risk of childhood overweight/obesity. These influences may be mediated via a variety of mechanisms, in particular above-average food intake of low nutritional quality and reduction in physical activity. Other important psychosocial mediators include the influence of the family and peer environment, and exposure to the media. In the second part of the review, we discuss the potential of psychosocial prevention programs to intervene in the processes involved in the rise of childhood overweight/obesity. Two points are emphasized. First, prevention programs should be multidisciplinary, combining the knowledge of experts from different professions, and taking into consideration the important role of the family environment and relevant influential social organizations, particularly school. Second, effective change is unlikely to occur without large-scale programs carried out on a public policy level.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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

Factors influencing the television viewing practices of Indian children

OBJECTIVES

To study the effect of socio-demographic factors, parental regulations and maternal television usage on the television viewing practices of Indian schoolchildren.

METHODS

Mothers of 6-12 y old children were interviewed using a pre-tested questionnaire at the pediatric outpatient. The television viewing practices of 405 schoolchildren with maternal television viewing and parental television rules were analyzed. Specific television viewing practices considered harmful in the present study were- viewing television >2 h, viewing television just prior to sleep (at bedtime), predominantly viewing general adult channels and using television as an aid to sleep.

RESULTS

35.8 % (n = 145) of the children viewed television for >2 h on schooldays. 20 % (n = 81) used television as sleep-aid. 28.1 % (n = 114) children had televisions in the room they slept. The frequency of parental television rules were with respect to: duration of viewing- 77.5 % (n = 314), timing of viewing- 63.7 % (n = 258), content- 35.6 % (n = 144). The children of families with the rule needing of parental permission to switch on the television [present in 34.8 % (n = 141) children] had lower harmful television viewing practices: duration of television viewing on schooldays >2 h (23.4 %, n = 33, P < 0.001); television viewed just before sleep (39 %, n = 55, P < 0.001); use of television as sleep-aid (12.1 %, n = 17, P = 0.003). 26.7 % (n = 108) of the mothers viewed television for >2 h. Linear regression analysis showed association between average television duration of children and average maternal television duration on schooldays (Beta = 0.246, t = 5.09, P < 0.001). Binary logistic regression analysis showed that harmful television viewing practices were significantly more in children with television in bedroom [OR = 7.49(4.19-13.38), P < 0.001]. It was reduced significantly by the parental rules on content viewed [OR = 0.41(0.23-0.72), P = 0.002]; need of permission to switch on television [OR = 0.31(0.18-0.53), P < 0.001] and a higher maternal education [OR = 0.29 (0.14-0.59), P = 0.001].

CONCLUSIONS

Lower maternal education, increased maternal television usage, presence of television in bedroom resulted in harmful television viewing practices among Indian children. The parental rules that were effective in countering these were the rule on content viewed and needing parental permission to switch on television.

Effects of providing personalized feedback of child's obesity risk on mothers' food choices using a virtual reality buffet

BACKGROUND

Providing personalized genetic-risk feedback of a child's susceptibility to adult-onset health conditions is a topic of considerable debate. Family health history (FHH), specifically parental overweight/obesity status, is a useful assessment for evaluating a child's genetic and environmental risk of becoming obese. It is unclear whether such risk information may influence parents' efforts to reduce their child's risk of obesity.

PURPOSE

To evaluate whether telling mothers the magnitude of their child's risk of becoming obese based on personal FHH influenced food choices for their young child from a virtual reality-based buffet restaurant.

METHODS

Overweight/obese mothers of a child aged 4-5 years who met eligibility criteria (N=221) were randomly assigned to one of three experimental arms, which emphasized different health information: arm 1, food safety control (Control); arm 2, behavioral-risk information (BRI) alone or arm 3, behavioral-risk information plus personal FHH-based risk assessment (BRI+FHH). Mothers donned a head-mounted display to be immersed in a virtual restaurant buffet, where they selected virtual food and beverages as a lunch for their child.

RESULTS

Mothers who were randomized to BRI+FHH filled the index child's plate with an average of 45 fewer calories than those in the Control arm (P<0.05); those in the BRI arm filled the plate with 35 fewer calories than the Control arm, a non-significant difference. Calorie restriction was greatest among mothers in the BRI+FHH arm who received the weaker-risk message (that is, only one overweight parent).

CONCLUSIONS

The influence of communicating a child's inherited risk of obesity on mothers' feeding practices may vary by the risk level conveyed. High-risk messages may best be coupled with strategies to increase mother's perceptions that efforts can be undertaken to reduce risk and build requisite behavioral skills to reduce risk.

General and specific approaches to media parenting: a systematic review of current measures, associations with screen-viewing, and measurement implications

BACKGROUND

Parent-focused interventions may help to reduce youth screen-viewing (SV). This review synthesized current information on the links between parenting styles, parenting practices, and youth SV with a focus on measurement.

METHODS

A systematic review of electronic databases was conducted.

RESULTS

In all, 29 of 1189 studies met the inclusion criteria. Parenting practices were divided into rule and nonrule-based practices. Seven rules: (1) Limits on total time (n studies=23); (2) limits on time of day (n=7); (3) content restriction (n=11); (4) mealtime rules (n=2); (5) parental supervision (n=3); (6) contingent screentime (n=3); and (7) no-TV policy (n=1) were reported. Two nonrule-based practices were reported: Co-viewing (n=6) and encouragement to view (n=2). Three studies (10.3%) provided information on parenting styles. Only 12 studies (41.4%) provided information on the reliability/validity of the outcome measure, 15 (51.7%) studies provided information on the reliability/validity of the parenting measure, and 6 (20.7%) provided information on the reliability/validity of both outcome and exposure measures.

CONCLUSIONS

There is mixed evidence that parenting styles and media-related parenting practices are associated with youth SV. The assessment of parental influence of youth media use is hampered by the diversity of measures that have been used. There is a need for new measures that assess a range of media parenting practices that are relevant to multiple forms of SV.

The relationship between parents' and children's television viewing

OBJECTIVE

To examine the effect of parental television viewing on children's television viewing compared with traditional predictors such as household television access, parental rules, and demographic characteristics of the child, parent, and household.

METHODS

An online survey using national samples of 1550 parents with children in 3 age groups (children ≤ 5 years, children aged 6-11 years, and adolescents aged 12-17 years), weighted to be representative of US parents with children in each age group. Adolescents (n = 629) of participating parents were also surveyed.

RESULTS

Parent television time is associated with child television time and had a stronger relationship to child time than access to television in the home or the child's bedroom, as well as parental rules about television viewing and coviewing. This pattern persisted across all age groups of children.

CONCLUSIONS

Educating parents about the relationship between their own and their child's viewing may be a useful strategy for interventions that aim to reduce children's excessive television viewing. Additionally, health professionals can engage parents in a discussion about how family television time is associated with increased television time for children.

Adolescents' prospective screen time by gender and parental education, the mediation of parental influences

Background

The present study investigated associations in gender dyads of parents’ and adolescents’ time spent on television and video viewing (TV/DVD), and computer and electronic game use (PC/games) at the ages of 11 and 13 years. Possible mediating effects of parental modelling and parental regulation in the relationship between parental education and adolescents’ prospective TV/DVD and PC/game time were further examined.

Methods

A total of 908 adolescents, participating at both ages 11 and 13 years in the Norwegian HEalth In Adolescents (HEIA) cohort study (2007–2009), were included in the analyses. Data on adolescents’, mothers’ and fathers’ self reported time spent on TV/DVD and PC/games were measured at both time points by questionnaires. Correlation coefficients were used to examine gender dyads of parents’ and adolescents’ reports. Mediation analyses using linear regression investigated possible mediation effects of parental modelling and parental regulation in the prospective relationship between parental education and adolescents’ time spent on TV/DVD and PC/games between the ages of 11 and 13 years.

Results

Correlations of screen time behaviours in gender dyads of parents and adolescents showed significant associations in time spent on TV/DVD at the age of 11 and 13 years. Associations between mothers and sons and between fathers and daughters were also observed in time spent on PC/games at the age of 11 years. Maternal and paternal modelling was further found to mediate the relationship between parental education and adolescents’ prospective TV/DVD time between the ages of 11 and 13 years. No mediation effect was observed for parental regulation, however a decrease in both maternal and paternal regulation at the age of 11 years significantly predicted more TV/DVD time among adolescents at the age of 13 years.

Conclusion

Cross-sectional and longitudinal relationships were observed in gender dyads of parents’ and adolescents’ screen time behaviours at the ages of 11 and 13 years, and further studies including both parents and their children should be emphasized. Moreover, maternal and paternal modelling were found to be important target variables in interventions aiming to reduce social differences by parental education in adolescents’ prospective time spent on TV/DVD.

Determinants of change in children's sedentary time

BACKGROUND

Understanding the determinants of sedentary time during childhood contributes to the development of effective intervention programmes.

PURPOSE

To examine family and home-environmental determinants of 1-year change in objectively measured sedentary time after-school and at the weekend.

METHODS

Participants wore accelerometers at baseline and 1 year later. Longitudinal data for after-school and weekend analyses were available for 854 (41.5%male, mean ± SD age 10.2 ± 0.3 years) and 718 (41.8%male, age 10.2 ± 0.3 years) participants. Information on 26 candidate determinants, including socioeconomic status (SES), availability of electronic media and parental rules for sedentary behaviours was self-reported by children or their parents at baseline. Change in the proportion of registered time spent sedentary was used as the outcome variable in multi-level linear regression models, adjusted for age, sex, body mass index and baseline sedentary time. Simple and multiple models were run and interactions with sex explored.

RESULTS

Children from higher socioeconomic status families exhibited greater increases in after-school (beta; 95% CI for change in % time spent sedentary 1.02; 0.37, 1.66) and weekend (1.42; 0.65, 2.18) sedentary time. Smaller increases in after-school sedentary time were observed in children with more siblings (-1.00; -1.69, -0.30), greater availability of electronic media (-0.81; -1.29, -0.33) and, for boys, more frequent family visits to the park (-1.89; -3.28, -0.51) and family participation in sport (-1.28; -2.54, -0.02). Greater maternal weekend screen-time (0.45; 0.08, 0.83) and, in girls, greater parental restriction on playing outside (0.91; 0.08, 1.74) were associated with larger increases in weekend sedentary time. The analytical sample was younger, more likely to be female, had lower BMI and was of higher SES than the original baseline sample.

CONCLUSIONS

Intervention strategies aimed at reducing parents' weekend screen-time, increasing family participation in sports or recreation (boys) and promoting freedom to play outside (girls) may contribute towards preventing the age-related increase in sedentary time.

Correlates of physical activity in adolescence: a study from a developing country

BACKGROUND

Physical activity is important for adolescent health. The current study aimed to explore factors that predict physical activity among adolescents.

METHODS

This was a cross-sectional study of physical activity among a sample of adolescents in Tabriz, Iran. Information on physical activity was collected using a modified version of the Adolescent Physical Activity and Recall Questionnaire (APARQ). In addition, a self-administrated questionnaire was used to collect data on demographic characteristics, perceived family support, and self-efficacy. Both univariate and multivariate logistic regression analyses were performed to examine the association between physical activity and independent variables including gender and psychosocial predictors.

RESULTS

In all, 402 students were studied. The mean age of adolescents was 12.93 (SD=0.49) years; 51.5% were female. The mean time of moderate and vigorous physical activity for all adolescents was 44.64 (SD=23.24) Metabolic Equivalent (MET) min per day. This figure for female adolescents was 38.77 (SD=19.94) MET min per day and for males it was 50.87 (SD=24.88) (P<0.001). The results obtained from multiple logistic regression analysis indicated that female gender (OR=2.59, 95% CI=1.46-4.57, P=0.001) and poor family support (OR=1.10, 95% CI=1.03-1.20, P=0.038) were the most significant contributing factors to low level physical activity in adolescents. Other variables studied did not show any significant results.

CONCLUSION

The findings from the current study indicated that female adolescents were at risk of lower level of physical activity. In addition, it was found that the lack of family support represented an increased risk for low-level physical activity. It seems that family support should be an integrated part of any health education/promotion programs for improving physical activity among young adolescents in general and for female adolescents in particular.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Integrating risks for type 2 diabetes across childhood: a life course perspective

Type 2 diabetes (T2DM) emerged among children, due in large measure to a strong physiological link between increased weight states and T2DM. In this article, cumulative risk factors for T2DM across childhood and its underlying mechanisms are reviewed. The points of intervention for T2DM should occur throughout childhood. The use of Halfon and Hochstein's framework enables practitioners and researchers in the nursing field to better understand a child's individual risk for T2DM. Only with this long view will prevention and interventions be successful in stemming the tide of the "twin epidemic" threatening children worldwide.

Examining the Interpersonal Reactivity Index (IRI) among early and late adolescents and their mothers

We examined whether the Interpersonal Reactivity Index (IRI; Davis, 1980 ), consisting of Perspective Taking (PT), Empathic Concern (EC), Personal Distress (PD), and Fantasy (FN), is a psychometrically invariant empathy measure for early and late adolescents and their mothers. Confirmatory factor analyses demonstrated adequate properties and psychometric invariance across 2 Dutch samples (269 early adolescents, 232 late adolescents). Females scored higher than males on each subscale. Early adolescents scored lower than late adolescents on PT and FN, and higher on PD. The different groups showed similar subscale associations with psychosocial health indexes, and similar subscale contributions to a higher order empathy dimension. Most dimensions showed positive correlations between adolescents and mothers. The IRI appears adequate for examining empathy across the span of adolescence, as well as patterns between youths and mothers.

Parental sedentary restriction, maternal parenting style, and television viewing among 10- to 11-year-olds

OBJECTIVE

To examine whether parenting styles or practices were associated with children's television (TV) viewing.

METHODS

A total of 431 parent-child dyads (10- to 11-year-old children) from Bristol, United Kingdom, were included. Child and parent TV viewing were self-reported and categorized as <2, 2 to 4, or >4 hours/day. Children reported maternal parenting style (authoritarian, authoritative, or permissive). Child-reported maternal and paternal sedentary restriction scores were combined to create a family-level restriction score. Multinomial logistic regression was used to examine whether child TV viewing was predicted by parenting style or family restriction.

RESULTS

A greater proportion of children with permissive mothers watched >4 hours of TV per day, compared with children with authoritarian or authoritative mothers (P = .033). A greater proportion of children for whom both parents demonstrated high restriction watched <2 hours of TV per day (P < .001). The risk of watching 2 to 4 hours (vs <2 hours) of TV per day was 2.2 times higher for children from low-restriction families (P = .010). The risk of watching >4 hours (vs <2 hours) of TV per day was 3.3 times higher for children from low-restriction families (P = .013). The risk of watching >4 hours of TV per day was 5.2 times higher for children with permissive (versus authoritative) mothers (P = .010).

CONCLUSIONS

Clinicians need to talk directly with parents about the need to place limitations on children's screen time and to encourage both parents to reinforce restriction messages.

Sociodemographic and home environment predictors of screen viewing among Spanish school children

BACKGROUND

Higher screen-viewing levels increase the risk of obesity. Understanding the correlates of screen viewing is an important first step in designing interventions but there is lack of information on the correlates among Spanish children. This study examined associations among environmental, sociocultural, age variables and screen viewing among Spanish children.

METHODS

Children completed a questionnaire about time spent in screen viewing. BMI was assessed and children were classified into obesity groups using International Obesity Task Force cut-off points. Parents completed a questionnaire about sociodemographic, environmental and sociocultural variables.

RESULTS

Participants were 247 primary and 256 secondary school-aged children and their parents. Time spent in screen viewing increased with age. Males spent more time than females in screen viewing. Greater access to bedroom media sources was associated with higher screen viewing. Younger children from single-parent households and older children having a younger parent, siblings and a father who was not working were higher screen-viewers on weekends and weekdays, respectively. For older children parental TV viewing time appeared to be a significant correlate, while parental rules was a determinant predictor for younger children on weekdays.

CONCLUSIONS

Environmental and sociocultural factors influence the time children spend in screen viewing. Parents play a central role in child's screen viewing; therefore, interventions that target environmental and family TV viewing practices are likely to be effective.

Individual and social predictors of screen-viewing among Spanish school children

Many children exceed suggested screen-viewing guidelines and this is likely to be a risk factor for obesity. Understanding the predictors of screen-viewing may be the first step in designing interventions that target these behaviours, but there is lack of information on predictors among Spanish children. This study examined associations between individual, friend and family based social variables and screen-viewing behaviours, and how these associations differ by age and gender in a sample of Spanish children. Participants were 247 primary school-aged and 256 secondary school-aged children and their parents. Children reported time spent in screen-viewing and information about individual and friend and family based social variables. Body mass index was assessed and children were classified using International Obesity Task Force cut-off points. Parents reported sociodemographic characteristics and family co-viewing practices. Lower self-efficacy for reducing screen-viewing (console playing p < 0.05; overall p < 0.01), stronger sedentary group-norms (TV p < 0.001; console playing p < 0.05; overall p < 0.05) and stronger social reasons (console playing p < 0.05) were associated with higher screen-viewing. For younger children, parental screen-viewing rules appeared to be significant predictors while family co-viewing practices were significant predictors for older children. Older children (TV p < 0.001; console playing p < 0.01; overall p < 0.001) and males (TV p < 0.01; console playing p < 0.001; overall p < 0.01) were likely to spend more time screen-viewing. Individual and social factors influence children's screen-viewing and operate differently during childhood. Increasing self-efficacy may be important for screen-viewing based behaviour changes. Friends and parents play a central role, therefore understanding the dynamics of friends and targeting family influences may be critical to the success of interventions to reduce screen-viewing.

Tracking of sedentary behaviours of young people: a systematic review

OBJECTIVE

To review the empirical evidence concerning the strength of tracking of sedentary behaviours from childhood and adolescence.

METHODS

Published English language studies were located from computerised and manual searches in 2009. Included studies were prospective, longitudinal studies with at least one sedentary behaviour for at least two time-points, with tracking coefficients reported, and included children (aged 3-11 years) and adolescents (12-18 years) at baseline.

RESULTS

Based on data from 21 independent samples, tracking coefficients (r) ranged from 0.08 (over 16 years) to 0.73 (over 2 years) for TV viewing, from 0.18 (boys over 3 years) to 0.52 (over 2 years) for electronic game/computer use, from 0.16 (girls over 4 years) to 0.65 (boys over 2 years) for total screen time, and from -0.15 (boys over 2 years) to 0.48 (over 1 year) for total sedentary time. Study follow-up periods ranged from 1 to up to 27 years, and tracking coefficients tended to be higher with shorter follow-ups.

CONCLUSIONS

Sedentary behaviours track at moderate levels from childhood or adolescence. Data suggest that sedentary behaviours may form the foundation for such behaviours in the future and some may track slightly better than physical activity.

Parental and home influences on adolescents' TV viewing: a mediation analysis

OBJECTIVE

To explore the association between home environmental variables and television (TV) time, and the mediating pathways underlying this association.

METHODS

The current study used data from the longitudinal ENDORSE study. Self-reported data was available for 1 265 adolescents (mean age of 12-15 years at baseline) on home environment (availability of a TV in the bedroom, perceived parental modelling, family rules), potential mediators (intention, attitude, perceived behavioural control, subjective norm towards TV viewing) and TV viewing time. Mediation analyses were conducted using General Estimating Equations and mediation effects were calculated as the product-of-coefficients.

RESULTS

Significant overall positive associations were found for the presence of a TV in the bedroom and parental modelling with self-reported TV viewing. Controlling family rules showed an inverse association with reported TV time. Similarly, parental modelling and a TV in the bedroom were significantly positively associated with the Theory of Planned Behaviour variables and habit strength, while family rules showed an inverse association with these potential mediators. In turn, most potential mediators were positively associated with TV viewing. Intention, attitude and habit strength were the strongest mediators in all three associations explaining more than 55% of the overall association. Habit strength alone explained 38.2%-58.0% of the overall associations.

CONCLUSIONS

Home and family environmental predictors of TV time among adolescents may be strongly mediated by habit strength and other personal factors. Future intervention studies should explore if changes in home and family environments indeed lead to reductions in TV time through these mediators.

Parental influences on television watching among children living on the Texas-Mexico border

PURPOSE

We examined the association of parental television (TV) rules and compliance with the American Academy of Pediatrics' (AAP) recommendations of <or=2 h of television per day in a primarily Hispanic sample of elementary school children (n=734) living on the U.S. side of the Texas-Mexico border. The potential modifying effects of children's home environment (parental TV watching, parent at home after school, and TV in bedroom) were also examined.

METHODS

A cross-sectional analysis was performed on baseline survey data merged from two waves (2006 and 2007) of a CDC-funded TV reduction intervention with 4th grade children (mean age: 9.5 years). Logistic regression analyses were conducted to examine associations.

RESULTS

Children who had TV rules were 1.4 (95% CI: 1.04, 1.94) and 1.7 (95% CI: 1.22, 2.32) times more likely to meet the AAP recommendation for weekend and weekday TV watching, respectively. Parental TV watching and TV in bedroom modified the effect of TV rules on children's TV watching, with null associations found for children whose parents watch TV frequently and for children with no TV in bedroom. No interaction effect was found for children's afterschool context.

CONCLUSIONS

Parental TV limits is one strategy for reducing children's television watching that merits further investigation.

The Model of Children's Active Travel (M-CAT): a conceptual framework for examining factors influencing children's active travel

BACKGROUND

The current decline in children's participation in physical activity has attracted the attention of those concerned with children's health and wellbeing. A sustainable approach to ensuring children engage in adequate amounts of physical activity is to support their involvement in incidental activity such as active travel (AT), which includes walking or riding a bicycle to or from local destinations, such as school or a park. Understanding how we can embed physical activity into children's everyday occupational roles is a way in which occupational therapists can contribute to this important health promotion agenda.

AIMS

To present a simple, coherent and comprehensive framework as a means of examining factors influencing children's AT.

METHODS

Based on current literature, this conceptual framework incorporates the observable environment, parents' perceptions and decisions regarding their children's AT, as well as children's own perceptions and decisions regarding AT within their family contexts across time.

CONCLUSION

The Model of Children's Active Travel (M-CAT) highlights the complex and dynamic nature of factors impacting the decision-making process of parents and children in relation to children's AT. The M-CAT offers a way forward for researchers to examine variables influencing active travel in a systematic manner. Future testing of the M-CAT will consolidate understanding of the factors underlying the decision-making process which occurs within families in the context of their communities.

Developmental trajectories of girls' BMI across childhood and adolescence

This study describes qualitatively distinct trajectories of BMI change among girls participating in a longitudinal study of non-Hispanic, white girls (n = 182) and their parents, assessed at daughters' ages 5, 7, 9, 11, 13, and 15 years. Height, weight, body fat, fasting blood glucose and lipids, blood pressure, waist circumference, and pubertal status were measured, and participants self-reported dietary, physical activity, and television (TV) viewing patterns. Growth mixture models were used to model heterogeneity in girls' BMI trajectories over 10 years. Statistical support was strongest for four distinct BMI trajectories: (i) upward percentile crossing (UPC; n = 25, 14%); (ii) delayed downward percentile crossing (DDPC; n = 37, 20%); (iii) 60th percentile tracking (60PT; n = 52, 29%); and (iv) 50th percentile tracking (50PT; n = 68, 37%). Girls in the UPC group had more metabolic risk factors at age 15 years, even after adjusting for concurrent weight status. Girls in the UPC group had mothers with the highest BMIs at study entry and were breast-fed for a shorter duration. This novel approach for examining differences in growth trajectories revealed four distinct BMI trajectories that predicted adolescent metabolic health outcomes in girls. The present study provides support for BMI monitoring in girls and for the potential utility of combining data on BMI tracking with data on familial characteristics for the early identification of girls at elevated risk for obesity and metabolic syndrome.

Daughter-initiated health advice to mothers: perceptions of African-American and Latina daughters

The prevailing paradigm of health exchange within the family is for health advice to flow from parent to child. Consistent with this pattern of exchange, most research has focused on the one-directional influence of the parent on the child and there is thus an absence of literature that explores the ability of adolescents to influence their parents' health behaviors. This qualitative study addressed this gap by exploring the feasibility of daughters providing health advice to their mothers. Twelve focus groups were conducted with 78 African-American and Latina daughters between the ages of 12 and 17 from low-income neighborhoods in a Mid-Western city in the United States. This study utilized a grounded theory approach to examine the focus group data. The findings indicate that many daughters report that they are already giving their mothers a wide spectrum of advice, including health advice. Differences were found in the reported willingness of African-American daughters when compared to Latina daughters to provide their mothers with specific cancer advice. These data suggest that some of these daughters have the potential to be valuable health education conveyers in the family.

Overweight in children and adolescents associated with TV viewing and parental weight: Project HeartBeat!

BACKGROUND

Parental obesity and TV viewing are risk factors for childhood obesity. This study assessed the association of children's TV viewing and computer use with body mass and examined whether parental weight status modified the association.

METHODS

Cross-sectional associations of parental weight status, hours of TV viewing and computer use, and children's body composition were studied in a subsample of 526 black and nonblack children, aged 8, 11, and 14 years at baseline, enrolled in Project HeartBeat!, a longitudinal study of cardiovascular disease risk factors, 1991-1995. BMI, fat-free mass (FFM), and percent body fat (PBF) were calculated from children's body composition measured at baseline. Children's TV viewing and computer use habits and parental height and weight were self-reported. Multivariate regression analysis was used in assessing inter-relations of parental weight status and child's TV viewing and computer use habits with BMI, FFM, PBF, and risk for overweight status (BMI > or =85th percentile), adjusting for age, gender, race, and Tanner stage.

RESULTS

Children of one or two overweight/obese parents watched an average of 22+/-6 minutes or 30+/-11 minutes more TV per day than children of normal-weight parents, respectively (both p<0.01). In multivariate regression analyses, BMI and PBF increased significantly by 0.42 kg/m(2) and 1.14% (both p<0.001), respectively, for each hour of TV watched among children with overweight parents, but not for those with normal-weight parents (p(interaction)<0.05). Similar results were observed for total screen time.

CONCLUSIONS

These study findings are consistent with a genetic contribution of parental weight; however, overweight/obese parents may also exhibit behavior patterns that negatively influence children's TV viewing and have an impact on child overweight status. The effect of parental BMI on children's BMI may have both a genetic and an environmental linkage.

Understanding Screen-Related Sedentary Behavior and its Contributing Factors among School-Aged Children: A Social-Ecologic Exploration

Purpose.

To explore the factors that contribute to children's screen-related sedentary (S-RS) behaviors.

Settings.

Elementary schools.

Subjects.

A random sample of children in grades five and six and their parents.

Measures.

The outcome measure was children's S-RS activity level measured by a self-administered questionnaire. A full spectrum of potential contributing factors for children's S-RS behaviors was obtained through surveys. Multilevel linear regression methods were used to determine the associations between these factors and children's screen time (hours per day) and results were expressed as regression coefficients (g).

Results.

Of 955 child-parent pairs in 14 participating schools, 508 pairs (53%) completed the surveys. At an intrapersonal level, protective factors included being a girl (g = − .71); belonging to a sports team inside (g = −.56) or outside (g = −.49) of school; having a negative attitude toward S-RS activities (g = −.13); and having a positive attitude toward physical activity (g = −.48). At the interpersonal and social levels, parental leisure S-RS behaviors (g = .32) were positively associated, whereas strict parental rules on computer use (g = −.27) and family income (g = −.32) were inversely correlated with S-RS behavior. At the environmental level, the presence of TVs in children's bedrooms (g = .44) and owning videogame devices (g = .58) increased the risk of S-RS behaviors, whereas after school programs (g = −.86) and schools' participation in the Turn Off the Screen Week campaign (g = −.91) decreased the risk.

Conclusions.

Public health interventions should target multilevel factors, including increasing children's awareness, promoting parental involvement in healthy lifestyle pursuits, and creating less screenogenic environments.

Factors associated with television viewing time in toddlers and preschoolers in Greece: the GENESIS study

BACKGROUND

The aim of this work was to describe the television (TV) viewing time of preschoolers and to examine factors that may be associated with it.

METHODS

A representative sample of 2374 Greek children aged 1-5 years was examined (GENESIS study). Several anthropometric, socio-demographic and lifestyle characteristics were recorded.

RESULTS

The mean value of children's TV viewing time was 1.32 h/day. Twenty six percent of participants spent > or =2 h/day in TV viewing. The percentage of children whose TV viewing time was longer than 2 h/day was higher in children aged 3-5 years (32.2%) than in those aged 1-2 years (11.1%). Multiple logistic regression revealed that the time parents spent viewing TV and the region of residence were significantly associated with child's TV viewing time among children aged 3-5 years. Among children aged 1-2 years, the maternal educational status, the region of residence and the maternal TV viewing time were found to be related to child's TV viewing time.

CONCLUSIONS

The current findings suggest that almost one third of Greek preschoolers exceed the limit of 2 h/day TV viewing and that parental TV viewing time may be the most important determinant of children's TV viewing time.

Social factors and television use during meals and snacks is associated with higher BMI among pre-school children

Aim

The present paper examines the relationship between social factors, food consumption during television viewing, and overall television viewing and how these are associated with BMI when the role of familial and social factors are considered in a population-based birth cohort of pre-school children from Québec (Canada).

Methods

The analyses were performed using data from the Longitudinal Study of Child Development in Québec (1998–2002) (LSCDQ). The study follows a representative sample (n 2103) of children born in 1998 in the Canadian province of Québec. A nutrition assessment was conducted on 1549 children aged 4·5 years and included a 24 h dietary recall, an eating behaviour and television viewing questionnaire, and a measurement of children’s heights and weights. Statistical analyses were performed.

Results

Nearly one-quarter of children ate at least twice daily in front of the television. Children who consumed snacks while watching television on a daily basis had higher BMI than children who did so less frequently. Children who ate snacks in front of the television every day, or some times during the week, ate more carbohydrates (total), more fat and less protein, fewer fruits and vegetables, and drank soft drinks more often than children who never ate snacks in front of the television.

Conclusions

Health professionals should target parents of children at risk of overweight/obesity with focused strategies to help children change the types of foods consumed during television viewing and to reduce the time spent watching television, particularly during meal times, which may change children’s dietary intake and eating patterns.

Screen-viewing and the home TV environment: the European Youth Heart Study

OBJECTIVE

Examine if home environmental factors are associated with screen-viewing.

METHODS

Data are for 2670, 3rd and 9th grade participants in Denmark, Portugal, Estonia and Norway collected between 1997 and 2000. Outcomes were spending >2 h after-school watching television (TV) and >1 h per day playing computer games. Child Autonomy and the home TV Environment were exposures.

RESULTS

Each unit increase in Child Autonomy was associated with 9% increase in risk of watching more than 2 h of TV per day after school and a 19% increase in risk of spending more than an hour per day playing computer games. TV Environment was associated with a 31% per unit increase in risk of watching >2 h of TV after school and 11% increase in risk of spending >1 h playing computer games.

CONCLUSIONS

A family environment in which after-school TV viewing is part of the home culture and homes where children have more autonomy over their own behavior are associated with an increased risk of watching >2 h of TV per day after school and spending more >1 h per day playing computer games. The home screen-viewing environment and Child Autonomy may be malleable targets for changing screen-viewing.