Parental optimism about childhood obesity-related disease risks

Addressing childhood obesity through policy: A cross-sectional study in Malta

Introduction

Childhood overweight and obesity are major public health challenges, with Malta having one of the highest prevalences among European countries. The COVID-19 pandemic may further worsen this epidemic. The food and physical activity environments impact children's behaviours. This study looks at barriers to maintain a healthy weight, responsibility to address obesity, and assesses parental support for 22 policies aimed at addressing childhood obesity. Public support for policy is key because it influences which policies are adopted and their success.

Methods

A cross-sectional, paper-based, quantitative survey was conducted amongst parents of primary school-aged children in Malta in 2018-2019. Ethical approval was obtained. Statistical analysis was performed using SPSS.

Results

1,169 parents participated. The food environment was more commonly identified as a barrier to maintain a healthy weight than the physical activity environment. Parents were least supportive of taxation policies, and most in favour of increasing spaces available for safe physical activity (94.0%), followed by providing free weight management services for children (90.8%). The level of support varied significantly by various socio-demographic/economic characteristics; parents with a higher educational level were significantly more supportive of most policies. Most findings were consistent with the international literature.

Conclusions

Most policies supported are trans-sectoral; a health-in-all policies approach is needed to address the obesogenic environment. The strong public support identified for several policies should embolden policymakers to consider policy options that were not previously considered.

How beliefs about weight malleability and risk perceptions for obesity influence parents' information seeking and feeding

This study surveyed 185 parents to determine whether their perceived risk of their child developing obesity and their implicit theories about the malleability of weight independently and/or interactively predict their child-feeding and pursuit of child-related obesity risk information. Higher risk perceptions were associated with healthier feeding intentions and more information seeking. More incremental (malleable) beliefs predicted healthier feeding intentions and greater pursuit of environmental, but not genetic, information. Contrary to hypotheses, the influence of implicit theories and risk perceptions were primarily independent; however, more incremental beliefs predicted less "junk food" feeding among only parents with lower perceived risk.

On a Different Page! Perceptions on the Onset, Diagnosis, and Management of Type 2 Diabetes Among Adolescent Patients, Parents, and Physicians

To examine perceptions about the diagnostic process and post-diagnosis care of type 2 diabetes (T2D) from adolescent patients, parents, and diabetes care physicians, semi-structured interviews were conducted with 8 individuals from each group. Interview transcripts were coded using content analysis. Emerged categories were compared among 3 groups. Half of adolescent patients and parents were surprised by the T2D diagnosis, despite most reporting that patients experienced common symptoms of T2D prior to diagnosis. Adolescents and parents recognized diet, exercise, and weight gain as risk factors after diagnosis, whereas physicians noted weight gain as a common risk factor pre-diagnosis. All 3 groups noted the importance of maintaining a healthy lifestyle and adherence to T2D management, though physicians noted the challenges from socioeconomic structural inequalities. Adolescent and parents were surprised by the T2D diagnosis, suggesting the need for increasing awareness of risk factors and symptomatology of T2D among at-risk adolescents and parents.

Using behavioural insights to reduce sugar in primary school children's packed lunches in derby; A cluster randomised controlled trial

Children's packed lunches contain more sugar than school-provided meals. Interventions to improve the provision of healthier packed lunches have modest effects on lunch contents. This cluster randomised controlled trial tested an intervention to encourage healthier provision of packed lunches by parents of primary school children in Derby. Schools were randomised to intervention (n = 8) or control (n = 9) using blocked random allocation. In the intervention group, parents of children who brought packed lunches to school in years 3-6 (age 7-11 years) received three bundles of materials (including packed lunch planner, shopping list, information on sugar content of popular lunchbox items and suggestions for healthier swap alternatives) in bookbags/lunchboxes over a 4-week period. Control parents received no materials. Photos of lunchbox contents were taken at baseline, immediately post-intervention and at three-month follow-up. A parental survey aimed to assess capability, opportunity and motivation for packing a healthier lunchbox. No intervention effects were observed for primary outcomes (presence and number of sugary snacks or chilled sugary desserts). The intervention had a significant impact on one secondary outcome (increased number of healthier "swap" items suggested in intervention materials) immediately post-intervention, but this effect had disappeared at three-month follow-up. No intervention effects were found on survey variables. Parent comments revealed that materials were either received positively (as they reinforced existing behaviours) or negatively (as they were not perceived to be helpful or appropriate). The results of this study suggest that providing educational materials and resources to parents of primary school children in Derby was not sufficient to increase provision of healthier packed lunches. Future research should investigate how behavioural science can support families to improve the nutritional content of primary school children's lunchboxes.

Parental Optimism and Perceived Control over Children's Initiation of Tobacco, Cannabis, and Opioid Use

Families play an important role in helping teenagers avoid using tobacco, cannabis, and opioids, but some parents may underestimate the risk of their children using those substances. This study aimed to determine parents' perceived likelihood of their child initiating tobacco, cannabis, and opioid use, as well as the control they have in preventing their child from using those substances. We surveyed 427 parents of children aged 0-18 years old using the online Amazon Mechanical Turk platform in the spring of 2019. We measured participants' perceived likelihood of their child initiating tobacco, cannabis, or opioid use before the age of 18 compared to other children, using a five-point Likert scale. This perceived likelihood was dichotomized between optimistic (less likely than average) and non-optimistic (average or more likely than average). Independent variables included parental tobacco use, perceived parental control, and perceived severity of the behavior. Participants with missing data and participants with children who had already initiated substance use were excluded from statistical analyses. Mean age of participants was 38.1 years (Standard Deviation 8.4); 67% were female. Level of parental optimism was 59% for cannabis, 77% for tobacco, and 82% for opioids. Perceived severity was significantly lower for cannabis use (71/100) than tobacco (90/100) and opioid use (92/100) (p < 0.001). Current smokers were less likely than never smokers to be optimistic about their child's risk of initiating using tobacco (Adjusted Odds Ratio (AOR): 0.18 [95% Confidence Interval (CI) 0.10-0.34]) or cannabis (AOR: 0.21 [95% CI 0.12-0.38]). Parental perceived likelihood of a child initiating substance use represents an understudied and potential target for substance use prevention.

Intra-familial health polarisation: how diverse health concerns become barriers to health behaviour change in families with preschool children and emerging obesity

In a disadvantaged rural area in Denmark, severe challenges have been identified concerning overweight and obesity in families with preschool-age children. The present paper examines how families with young children and emerging obesity issues perceive 'healthy living' and barriers to practising it. Using data from qualitative workshops with families and professionals working with them, we reveal health perceptions and related family dynamics. Drawing on P. Bourdieu's theory of habitus and 'tastes of necessity', K.L. Frohlich et al.'s notion of 'collective lifestyles' and E. Lindbladh and C. H. Lyttken's theory of preconditions for health behaviour change and reactions to risk-related information, we analyse how risk perceptions and related health practices within the families are influenced by the local contexts in the disadvantaged area under study. Despite shared perceptions of 'healthy living', we found that diverse health-risk perceptions created family dynamics in which parents performed opposed health behaviours, which became a huge barrier to becoming a healthier family. Based on our theoretical approach, we propose that risk perceptions and reactions are highly context dependent, as illustrated in both micro-contexts (family dynamics) and the macro-context (the disadvantaged area).

Longitudinal changes and determinants of parental willingness to pay for the prevention of childhood overweight and obesity

BACKGROUND

Willingness to Pay (WTP) is an alternative to measure quality-adjusted life years for cost-effectiveness analyses. The aim was to evaluate longitudinal changes and determinants of parental WTP for the prevention of childhood overweight and obesity.

METHODS

Longitudinal data from post- (T2) and follow-up (T3) measurements of a school-based health promotion program in Germany. Parental questionnaires included general WTP and the corresponding amount to reduce incidental childhood overweight and obesity by half. Longitudinal differences were examined with the McNemar test for general WTP and the Wilcoxon signed-rank test for the amount of WTP. Regression analyses were conducted to detect determinants.

RESULTS

General parental WTP significantly decreased from 48.9% to 35.8% (p < 0.001, n = 760). Logistic regression analysis (n = 561) showed that parents with a tertiary education level and a positive general WTP at T2, families with a higher monthly household income, and those with abdominally obese children were significant predictors of general WTP at T3. Median amount of WTP at T3 was €20.00 (mean = €27.96 ± 26.90, n = 274). Assuming a WTP of €0 for those who were generally not willing to pay or did not answer, resulted in a median amount of WTP at T3 of €0 (m = €8.45, sd = €19.58, n = 906). According to linear regression analysis WTP at T2 was the only significant predictor for the amount of WTP at T3 (p = 0.000, n = 181).

CONCLUSIONS

Despite the decline of general WTP, these results are a reflection of the public awareness of the problem and the need for action. Policy makers should recognize this and initiate sustainable public preventive strategies.

TRIAL REGISTRATION

DRKS, DRKS00000494. Registered 25 August 2010, https://www.drks.de/drks_web/.

Parental Optimism About Children's Risk of Future Tobacco Use and Excessive Weight Gain

BACKGROUND

Adults tend to underestimate their personal risk of disease, but little is known about parents' perceptions of children's risk.

METHODS

In total, 648 parents of children 0 to 18 years old attending 2 pediatric practices were surveyed about their children's exposure to smoking; 344 parents with children ≥2 years old also were asked about their children's sugar-sweetened beverage (SSB) consumption and physical activity. Children were categorized as "at risk" or "not at risk" for each factor. Parents estimated the risk of their child becoming a smoker or gaining excessive weight and were categorized as "optimistic" if they believed their children were less likely than others to use tobacco or gain weight.

RESULTS

Overall, 92% of parents thought their children were at lower risk than average for tobacco use, and 86% believed their children were at lower risk for excessive weight gain. A high frequency of optimistic bias occurred even among parents with "at-risk" children, including parents with children exposed to tobacco use (70.4%), SSB consumption (77.6%), >2 hours of screen time (82.1%), and low physical activity (84.1%). In multivariable analyses, parents with children exposed to tobacco smoke (odds ratio = 0.21, 95% confidence interval, 0.09-0.51); or who consumed SSBs daily (odds ratio = 0.44, 95% confidence interval 0.20-0.97) were less likely to be optimistic about their child's future tobacco use and excessive weight gain, respectively.

CONCLUSIONS

Most parents believed their children were at lower risk than average for tobacco use or excessive weight gain. Eliciting parents' optimistic biases might facilitate behavior change counseling in pediatric settings.

Healthy, Wealthy, and Wise? Exploring Parent Comparative Optimism About Future Child Outcomes

Objectives. Comparative optimism is present in parental predictions of their child’s long-term, obesity-related health outcomes and some of this optimism is unrealistic. An understanding of how comparative optimism relates to parents’ predictions of health versus other child outcomes could contribute to the development of interventions and strategies pediatricians can use to improve risk assessment. Methods. In a nationally representative survey, we asked American parents of 6- to 17-year-old children (n = 410) to estimate the chances that their child and “a typical child in their community” would be affected by overweight, get married, and complete a 4-year college degree by age 30, and the child’s future salary at age 30. We collected data on family demographic and health characteristics. We modeled the difference in parent predictions for their child versus the typical child using multivariate linear regressions. Results. Compared to the typical child, parents were less likely to predict that their child would be affected by overweight (−26.6 percentage points, 95% confidence interval [CI]: −35.6, −17.7) and more likely to predict that their child would complete a 4-year degree (16.7 percentage points, 95% CI: 2.5, 31.0). Parents predicted their child would have a higher income than the typical child at age 30 ($15,266, 95% CI: $7,487, $23,046). Parents did not predict that their child would be more likely than the typical child to be married by age 30 (−2.2 percentage points, 95% CI: −8.1, 3.7). Conclusions. Some parents appear to exhibit comparative optimism around their child’s future weight status, education, and economic outcomes, but not marriage. Future experimental work should assess whether risk communication approaches that consider optimism bias influence parent risk perception and parenting behaviors.