Influencing Parental Health Behavior: Implications of Community Assessments

A pragmatic evaluation of the primary school Be Active After-School Activity Programme (Be Active ASAP)

The period after school represents an opportunity to engage children in physical activity (PA) programmes in schools. The purpose of this study was to evaluate the effect of an afterschool programme, delivered in schools, on children's participation in and attitudes to PA. Ten schools took part in this non-randomized controlled trial (five experimental and five control schools). Experimental schools participated in an after-school programme delivered by teachers and parents for 50 min per week. Outcome measures included device-measured PA, self-report youth PA behaviour and parental perceptions of the school environment. Measurements took place at baseline, and mean follow-up was at 10 weeks. Data were collected from 196 participants, with a mean age of 8.1 ± 0.8 years. Mean daily minutes of moderate-to-vigorous physical activity (MVPA) for the entire sample at baseline was 69.9 ± 23.3. While both groups presented a decline in MVPA levels, there was a significant difference in the change from baseline to follow-up (P = 0.043) of min/day MVPA between the control group (-13.2 ± 23.9) and the experimental group (-0.9 ± 25.2). This programme may help maintain MVPA levels, with children exposed to the intervention experiencing a significantly lower decline in MVPA than their control counterparts.

Exploring parents' screen-viewing behaviours and sedentary time in association with their attitudes toward their young child's screen-viewing

Sedentary time and screen-viewing (SV) are associated with chronic disease risk in adults. Parent and child sedentary time and SV are associated. Parents influence children's SV through parenting styles and role modelling. Understanding whether parents' attitudes toward child SV are associated with their own SV and sedentary time will aid development of family interventions to reduce sedentary behaviours. Cross-sectional data with 809 parents from Bristol, UK were collected in 2012–2013 and analysed in 2016. Parental total sedentary time was derived from accelerometer data. Parents self-reported daily television viewing, use of computers, games consoles, and smartphone/tablets (none, 1–59 min, 1–2 h, > 2 h) and attitudes toward child SV. Adjusted linear and logistic regression models were used to examine associations, separately for weekdays and weekend days. Having negative attitudes toward child SV was associated with lower weekend sedentary time (Coeff: − 6.41 [95% CI: − 12.37 to − 0.45] min/day). Limiting behaviours and having negative attitudes toward child SV were associated with lower weekday television viewing (OR: 0.72 [0.57–0.90] and 0.57 [0.47–0.70] respectively), weekend television viewing (0.75 [0.59–0.95] and 0.61 [0.50–0.75]), and weekend computer use (0.73 [0.58–0.92] and 0.80 [0.66–0.97]). Negative attitudes were also associated with lower smartphone use on weekdays (0.70 [0.57–0.85]) and weekends (0.70 [0.58–0.86]). Parent self-efficacy for limiting child SV and setting SV rules were not associated with sedentary time or SV. Reporting negative attitudes toward child SV was associated with lower accelerometer-assessed weekend total sedentary time and self-reported SV behaviours, while limiting child SV was also associated with lower self-reported SV.

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Limiting child SV is associated with lower TV viewing and computer use in parents.

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Having negative attitudes toward child SV is associated with lower SV in parents.

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Negative attitudes toward child SV are associated with lower parent sedentary time.

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Self-efficacy for limiting SV is not associated with parents' SV & sedentary time.

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Setting SV rules for children is not associated with parents' SV & sedentary time.

Health promotion interventions to prevent early childhood human influenza at the household level: a realist review to identify implications for programmes in Hong Kong

AIMS AND OBJECTIVES

To identify factors affecting the delivery of health promotion interventions to prevent early childhood human influenza at the household level.

BACKGROUND

Yearly, influenza epidemics seriously affect all age groups, particularly those with weakened immune systems, including children. Influenza is transmitted easily from person to person through droplet and direct contact. Maintaining personal hygiene, avoiding close contact with the infected person and proper hand washing are recommended as the most effective means of preventing the transmission of influenza. However, it is not clear what programme-related mechanisms and contexts are crucial to the successful delivery of interventions in the home. This study systematically reviewed published research studies to identify factors influencing the effective delivery of health promotion programmes targeting influenza in a household.

DESIGN

Realist review.

METHODS

A realist review methodology was selected to examine what interventions are effective in preventing and managing influenza at the household level and in what circumstances. A structured search of the peer-reviewed primary research literature was undertaken using a defined search protocol.

RESULTS

Eight studies were retrieved for the analysis. Mechanisms impacting on intervention delivery were identified, including timing of implementation, programme reach, organisational and healthcare worker involvement, mode and place of delivery, contact with infected person, health practice compliance and sustainability at home.

CONCLUSION

These findings suggest contextual factors that could be identified through ecological approaches to health promotion that are crucial for policymakers to consider when designing interventions.

RELEVANCE TO CLINICAL PRACTICE

The active involvement of community nurses through an integrated household visiting programme may help to better deliver family-based health promotion interventions to prevent illnesses such as influenza in children.

Mediating effects of home-related factors on fat intake from snacks in a school-based nutrition intervention among adolescents

The purpose of the present study was to investigate if the effects of the parental component of a school-based intervention on dietary fat intake from snacking were mediated by changes in home-related factors. A random sample of 10 schools with 2232 pupils aged 11-15 years was randomly assigned to one of two intervention groups [one with (n = 1226) and one without a parental component (n = 1006)]. Fat intake, home availability of low-fat foods and parental encouragement and support to eat a low-fat diet were assessed with validated self-administered questionnaires. Mediation was assessed with the product-of-coefficient test. Changes in home-related determinants were significantly related to changes in fat intake from snacks; therefore, school-based obesity programmes on adolescents should try to address these determinants. In the present study, one of the three investigated home-related factors, namely parental support, was affected by the parental component intervention. Decreases in parental support were prevented. These changes in parental support were found to mediate the parental intervention effects on changes in fat intake from snacks. Home-related factors appear to be related to changes in adolescents' snacking behaviours, therefore, school-based obesity programmes should target them. Nevertheless, more research is needed concerning effectively addressing the other determinants.

What do parents think about parental participation in school-based interventions on energy balance-related behaviours? a qualitative study in 4 countries

Background

Overweight and obesity in youth has increased dramatically. Therefore, overweight prevention initiatives should start early in life and target modifiable energy balance-related behaviours. Parental participation is often advocated as important for school-based interventions, however, getting parents involved in school-based interventions appears to be challenging based on earlier intervention experiences. The purpose of this study was to get insight into the determinants of and perspectives on parental participation in school-interventions on energy balance-related behaviours (physical activity, healthy eating, sedentary behaviours) in parents of ten- to twelve-year olds in order to develop an effective parental module for school-based interventions concerning energy balance-related behaviours.

Methods

Four countries (Belgium, Hungary, Norway and Spain) conducted the focus group research based on a standardised protocol and a semi-structured questioning route. A variation in parental socio-economic status (SES) and parental school involvement was taken into account when recruiting the parents. The audio taped interviews were transcribed, and a qualitative content analysis of the transcripts was conducted in each country.

Results

Seventeen focus group interviews were conducted with a total of 92 parents (12 men, 80 women). Physical activity was considered to be a joint responsibility of school and parents, nutrition as parent's responsibility but supported by the school, and prevention of sedentary behaviours as parent's sole responsibility. Parents proposed interactive and practical activities together with their child as the best way to involve them such as cooking, food tasting, nutrition workshops, walking or cycling tours, sport initiations together with their child. Activities should be cheap, on a convenient moment, focused on their children and not on themselves, not tutoring, not theoretical, and school-or home-based.

Conclusions

Parents want to be involved in activities related to energy balance-related behaviours if this implies 'doing things together' with their child at school or at home.

Parental social support and the physical activity-related behaviors of youth: a review

Social support from parents serves as one of the primary influences of youth physical activity-related behaviors. A systematic review was conducted on the relationship of parental social support to the physical activity-related behaviors of youth. Four categories of social support were identified, falling under two distinct mechanisms-tangible and intangible. Tangible social support is divided into two categories: instrumental-purchasing equipment/payment of fees and transportation-and conditional-doing activity with and watching/supervision. Intangible social support is divided into the two categories of motivational- encouragement and praise-and informational-discussing benefits of. The majority of studies demonstrated positive associations among selected measures of parental tangible and intangible social support and youth activity. Overall, parental social support demonstrated positive effects. Many studies, however, combine social support categories and/or respondents into composite measures, making it difficult to disentangle the specific effects of parents and the type of support provided.

The influence of social support on cardiovascular health in families

The purpose of this qualitative study was to identify how social support in families can influence the health behaviors of multigenerational families already at risk for cardiovascular disease (CVD). Using a case study method, semistructured individual and family group interviews were conducted of 3 members of 10 families (N = 30) with known cardiovascular risk. Each family member represented a different generation. The index member was a senior or middle family member who had undergone coronary bypass surgery. A convenience sample was recruited from individuals having had coronary bypass surgery at a regional hospital in a rural area. Prior to group family interviews, each participant completed a behavior risk questionnaire to determine high or low risk of CVD. A subsample of 6 participants received individual interviews. A participant with high CVD risk and one with low CVD risk represented each generation. Themes generated from the family interviews formed the basis for the individual interview questions. All interviews were audiotaped and transcribed, and interviewer reflections were documented. Analysis consisted of coding, naming, and categorizing data according to conceptual patterns. The findings revealed examples of family social support that influenced cardiovascular health behaviors. Opportunities are identified as to when healthcare professionals can encourage positive social support and sustained changes in health behaviors in families already at risk for CVD.

Changing the tide: an Internet/video exercise and low-fat diet intervention with middle-school students

The rising tide of obesity erodes the health of youths and many times results in adult obesity. The purpose of this investigation was to examine the effectiveness of an eight-session health promotion/transtheoretical model Internet/video-delivered intervention to increase physical activity and reduce dietary fat among low-income, culturally diverse, seventh-grade students. Those who completed more than half the sessions increased exercise, t (103) = -1.99, p = .05, and decreased the percentage of dietary fat, t (87) = 2.73, p = .008. Responses to the intervention by stage of change, race, and income are examined.

An assessment of outcomes following parents' participation in a child abuse prevention program

The purpose of this study was to evaluate the outcomes following participation in the ESPACE parents' workshop. A group of 55 parents who participated in the program, implemented in elementary schools in the Quebec city region, was compared to a group of 217 parents who did not attend the prevention workshop. The results revealed that attending parents suggested more adequate interventions to the vignette depicting a hypothetical situation of sexual abuse compared to nonattending parents. Attending parents are found to be more likely to suggest interventions sustaining the child in her own problem-solving process, seek help from specialized agencies, and attempt to offer emotional support to the victim. Data also reveal that the parents workshop has a positive outcome on knowledge. While the workshop is associated with beneficial outcomes, attendance rates are low. The findings are discussed in the context of identifying means to foster parent involvement in the prevention of child abuse.

Parents' perceptions of a school-based prevention education program

There are few studies of parents' views about prevention education in general, or about specific prevention education activities. Yet, their perceptions are important because families are a primary socialization source, and because parents' opinions can either reinforce or countermand the message of prevention education programs. This article is an analysis of parents' views of the Drug Abuse Resistance Education (D.A.R.E.) program based on a statewide survey of adults from rural, suburban, and urban communities who had a child participate in the program within the past year. Parent involvement and knowledge of D.A.R.E. was high. Generally, parents were very positive about D.A.R.E., especially when they viewed the D.A.R.E. officer as an effective educator. This article suggests that much more research on parents' views and support of prevention education program needs to be conducted, especially within the context of how their perceptions may mediate the influence of the prevention effort on young people's attitudes and behaviors about substance use.

Family members' influence on decision making about food: differences in perception and relationship with healthy eating

PURPOSE

This study provides insight into decision making about food choices in the family and its relationship with (un)healthy eating, by including the responses of four members of the family as a sampling unit.

SETTING

The study was conducted through four medical centers, visited by 69 classes from 19 different schools in Belgium.

SUBJECTS

Ninety-two family quartets, including both parents and two adolescents between 12 and 18 years old, completed questionnaires independently.

MEASURES

Four previously investigated measures of decision-making power (30 items on a seven-point scale) were administered, along with a short food choice questionnaire and demographic variables.

RESULTS

Results indicate that the influence of fathers but more especially that of children is important in food decisions. Moreover, the relative influence of each family member is dependent on the kind of product or product group considered. Differences in perceptions between the four family members show the importance of considering the responses of all the people involved in family decision making. Finally, it is clear that in families where adolescents have more power, food choices are less healthy.

CONCLUSIONS

Our main conclusion is the rejection of the "gatekeeper hypothesis" as an artifact of biased measurement. A multidimensional approach to the issue of influence in food decision making in the family is potentially richer and leads to different conclusions. The necessity of the involvement of the entire family for the introduction and adoption of healthy eating is emphasized.

Development of an intervention map for a parent education intervention to prevent violence among Hispanic middle school students

This paper describes development of Padres Trabajando por la Paz, a violence prevention intervention for Hispanic parents to increase parental monitoring. The intervention was developed using an innovative new program planning process: intervention mapping. Theory and empirical evidence broadly defined performance objectives and determinants of parental monitoring. These objectives were further refined through group and individual interviews with the target parent group. Learning objectives for the intervention guided the content of the intervention that used modeling as the primary method and role model stories as a strategy delivered through newsletters. Stage-matching members of the target population for their readiness to implement the parental monitoring behaviors further refined the social cognitive message design strategies. Intervention mapping provides an explicit theory- and data-driven guide for intervention development that maximizes intervention impact for a specific target population.

Guidelines for school health programs to promote lifelong healthy eating

Healthy eating patterns in childhood and adolescence promote optimal childhood health, growth, and intellectual development; prevent immediate health problems, such as iron deficiency anemia, obesity, eating disorders, and dental caries; and may prevent long-term health problems, such as coronary heart disease, cancer, and stroke. School health programs can help children and adolescents attain full educational potential and good health by providing them with the skills, social support, and environmental reinforcement they need to adopt long-term, healthy eating behaviors. This report summarizes strategies most likely to be effective in promoting healthy eating among school-age youths and provides nutrition education guidelines for a comprehensive school health program. These guidelines are based on a review of research, theory, and current practice, and they were developed by CDC in collaboration with experts from universities and from national, federal, and voluntary agencies. The guidelines include recommendations on seven aspects of a school-based program to promote healthy eating: school policy on nutrition, a sequential, coordinated curriculum, appropriate instruction for students, integration of school food service and nutrition education, staff training, family and community involvement, and program evaluation.

Evaluation of a parent child drug education program

The purpose of the study was to evaluate the effectiveness of a parent-child drug education program. One thousand four hundred and forty-seven fourth, fifth, and sixth grade students and 2,036 of their parents participated in the study. Results indicated that the program produced changes in the responses of children and their parents to questions concerning attitudes, use, perceptions of use, and intended use of drugs.

Using the health belief model to explain parents' participation in adolescents' at-home sexuality education activities

The Health Belief Model (HBM) was used to study parents' involvement in six at-home sexuality education activities for nine grade students. These activities are part of Skills for Healthy Relationships: A Program About Sexuality, AIDS, and Other STD (SHR). Some 216 parents, 62% of the population, completed and returned a self-administered questionnaire. Perceived barriers correlated most strongly with lack of parents' involvement in SHR. Additionally, perceived barriers and perceived self-efficacy were the most significant factors differentiating parents involved in SHR at-home activities from those who were uninvolved. Compared with highly involved parents, noninvolved parents were: 1) less confident their children wanted to do the activities with them (F[4,204] = 19.58, p < .0005), 2) less sure of their children's desire to talk with them about sex-related issues (F[4,213] = 7.03, p < .0005), and 3) less certain their AIDS-related facts were current (F[4,213] = 2.39, p = .05). Parents highly involved in SHR reported becoming more comfortable talking with their adolescents about STDs (F[4,205] = 4.04, p = .004) and felt their children talked a little more openly with them about AIDS and STDs (F[4,205] = 2.54, p = .04). In contrast, uninvolved parents reported no changes relative to communicating with their children about sexuality. For these reasons, SHR's inclusion of at-home activities shows promise for increasing parent-adolescent communication about sexuality.

CATCH: family process evaluation in a multicenter trial

The Child and Adolescent Trial for Cardiovascular Health (CATCH) is an elementary school cardiovascular health education field trial in progress in San Diego, California, New Orleans, Louisiana, Minneapolis, Minnesota, and Austin, Texas. Because a significant part of a child's health behaviors are shaped within the home, CATCH is evaluating whether the effects of the school-based program are enhanced by the inclusion of a home-based program. A 7 x 7 x 10 randomized design with 7 school-only and 7 school-plus-family intervention schools, along with 10 control schools is implemented at each site. The CATCH family intervention is implemented during Grades 3 through 5 and consists of home-based curricula and Family Fun Nights focusing on healthier eating and increased physical activity during Grades 3 and 4, along with a smoking prevention curriculum in Grade 5. CATCH is examining the effectiveness of family (household) involvement through changes in students' dietary intake of fat and sodium. This paper describes the process evaluation methods used to document the extent of participation in the family program. Data reported for the third-grade Family Fun Nights held in the 28 family schools across all sites reflected an average student participation rate of 67%. The average family member to student ratio was approximately 2:1. Participation by all third-grade teachers and the majority of physical education specialists was observed.

School heart health promotion: the National Heart Foundation (Western Australian) approach

The National Heart Foundation of Australia's commitment to school health promotion expanded progressively since 1983. Following establishment of health education curriculum documents by the state Ministries of Education, the Foundation targeted schoolchildren with primary prevention programs and resources. The Foundation looked beyond instructional settings to examine the influence of the school environment on the health of students and school personnel. This paper describes a school heart health promotion model implemented by the Western Australian Division of the National Heart Foundation, serving one of Australia's eight states and territories. The model incorporates elements of policy, curriculum, environment, health services, and community interaction. Though similar to comprehensive models of school health education, this model limits its application to heart health. The program operates in a nongovernment agency with unmatched potential for national reach.

Parent education in youth-directed nutrition interventions

Since parents play a pivotal role in helping their children to implement eating pattern changes, interest in parent education in youth-directed nutrition interventions is likely to increase along with heightened interest in primary prevention. Previous experience indicates, however, that it may be difficult to recruit and sustain parent involvement. This article describes an evaluation of the effect on parents of two youth-directed interventions with a parent component, a classroom curriculum called Hearty Heart and Friends and a mailed-home, parent-taught approach called Hearty Heart Home Team. Using incentives, a participation rate of 85.6% was achieved in Hearty Heart Home Team. This parent-taught intervention had significantly greater impact on parent than did the school-only curriculum in the following areas: knowledge about diet and heart disease; attitudes of efficacy, intention, outcome expectation and modeling; and parent-child communication and child involvement in food or nutrition-related issues in the home. In addition, the parent-taught approach influenced foods present in the home as evidenced by Home Team groups having significantly more encouraged foods and more positive choices in six scores on a shelf inventory measure conducted by in-home interviewers.

Parent involvement with children's health promotion: a one-year follow-up of the Minnesota home team

This study compares the long-term outcomes of a school-based program to an equivalent home-based program with 2250 third-grade students in 31 urban schools in Minnesota and North Dakota in order to detect changes in dietary fat and sodium consumption. The school-based program, The Adventures of Hearty Heart and Friends, involved 15 sessions over five weeks in the third-grade classrooms. The home-based program, the Hearty Heart Home Team, involved a five-week correspondence course with the third graders, where parental involvement was necessary in order to complete the activities. Outcome measures included anthropometric, psychosocial, and behavioral assessments at school, and dietary recall, food shelf inventories, and urinary sodium data collected in the students' homes. Participation rates for all aspects of the study were notably high. Eighty-six percent of the parents participated in the Home Team and 71% (almost 1000 families) completed the five-week course. Students in the home-based program reported more behavior change at posttest, had reduced the total fat, saturated fat, and monounsaturated fat in their diets and increased their complex carbohydrate consumption. The changes derived from the dietary recall data did not maintain after one year. The data converge to suggest the feasibility and importance of parental involvement for initiating health behavior changes with children of this age.

School-based blood cholesterol screening

Coronary artery disease, the major cause of death in developed countries, begins early in childhood. Elevated blood cholesterol, a major risk for coronary artery disease in adults, has been associated at autopsy with atherosclerotic disease in children. To explore the feasibility of mass screening of blood cholesterol levels in children, a school-based screening and education program for fourth-graders was carried out in a Southern California school district. Approximately 10% of the children had blood cholesterol levels of 200 mg/dl or more, the upper limit of desirable levels for adults. These children and their parents returned for repeat cholesterol testing and nutrition counseling. A family history of early coronary artery disease was present in only one third of the children with high cholesterol levels; this fact, coupled with consumable costs less than $2 per child, suggests that cholesterol screening is a practical, cost-effective addition to school health programs.

Parent involvement with children's health promotion: the Minnesota Home Team

This study compares the efficacy of a school-based program to an equivalent home-based program with 2,250 third grade students in 31 urban schools in Minnesota in order to detect changes in dietary fat and sodium consumption. The school-based program, Hearty Heart and Friends, involved 15 sessions over five weeks in the third grade classrooms. The home-based program, the Home Team, involved a five-week correspondence course with the third graders, where parental involvement was necessary in order to complete the activities. Outcome measures included anthropometric, psychosocial and behavioral assessments at school, and dietary recall, food shelf inventories, and urinary sodium data collected in the students' homes. Participation rates for all aspects of the study were notably high. Eighty-six per cent of the parents participated in the Home Team and 71 per cent (nearly 1,000 families) completed the five-week course. Students in the school-based program had gained more knowledge at posttest than students in the home-based program or controls. Students in the home-based program, however, reported more behavior change, had reduced the total fat, saturated fat, and monounsaturated fat in their diets, and had more of the encouraged foods on their food shelves. The data converge to suggest the feasibility and importance of parental involvement for health behavior changes with children of this age.