The home environment and childhood obesity in low-income households: indirect effects via sleep duration and screen time

Household chaos and childhood obesity-related health outcomes

OBJECTIVE

Household chaos, defined as a lack of organization, structure, and predictability, has been linked to deleterious childhood health outcomes and may hinder attempts to initiate and maintain healthy lifestyle changes. This study examined the associations of household chaos and obesity-related health conditions in a sample of youth being treated for obesity.

METHODS

Participants were 715 patients (61.8% girls; Mage = 12.3 years; 68.7% non-Hispanic Black; M% of 95th BMI %-ile = 146.9%) enrolled in a pediatric weight management clinic. Caregiver report of household chaos was measured using the Confusion, Hubbub and Order Scale (CHAOS). Physiological obesity-related comorbidities (e.g., insulin resistance, hypertension, dyslipidemia) were assessed by a medical clinician and abstracted from electronic medical records; health conditions were dichotomized as present or not present. Psychological functioning was measured with the Pediatric Symptom Checklist, a caregiver-completed mental health screen that assesses internalizing, externalizing, and attention concerns.

RESULTS

The Wilcoxon rank-sum test was used to test differences in household chaos scores for each obesity-related health condition. Caregivers of youth diagnosed with hypertension and obstructive sleep apnea reported significantly lower levels of household chaos, while caregivers who reported clinical levels of psychological dysfunction reported higher levels of chaos.

CONCLUSIONS

Traditional management of childhood obesity requires changes across multiple health domains (e.g., dietary, exercise, sleep), and such change may be facilitated by structure and consistency. Present findings suggest that psychological resources within pediatric weight management settings should address individual patient-level factors associated with physiological and mental health as well as household functioning.

Testing a Biobehavioral Model of Chronic Stress and Weight Gain in Young Children (Family Stress Study): Protocol and Baseline Demographics for a Prospective Observational Study

BACKGROUND

Chronic stress is an important risk factor in the development of obesity. While research suggests chronic stress is linked to excess weight gain in children, the biological or behavioral mechanisms are poorly understood.

OBJECTIVE

The objectives of the Family Stress Study are to examine behavioral and biological pathways through which chronic stress exposure (including stress from COVID-19) may be associated with adiposity in young children, and to determine if factors such as child sex, caregiver-child relationship quality, caregiver education, and caregiver self-regulation moderate the association between chronic stress and child adiposity.

METHODS

The Family Stress Study is a prospective cohort study of families recruited from 2 Canadian sites: the University of Guelph in Guelph, Ontario, and McMaster University in Hamilton, Ontario. Participants will be observed for 2 years and were eligible to participate if they had at least one child (aged 2-6 years) and no plans to move from the area within the next 3 years. Study questionnaires and measures were completed remotely at baseline and will be assessed using the same methods at 1- and 2-year follow-ups. At each time point, caregivers measure and report their child's height, weight, and waist circumference, collect a hair sample for cortisol analysis, and fit their child with an activity monitor to assess the child's physical activity and sleep. Caregivers also complete a web-based health and behaviors survey with questions about family demographics, family stress, their own weight-related behaviors, and their child's mental health, as well as a 1-day dietary assessment for their child.

RESULTS

Enrollment for this study was completed in December 2021. The final second-year follow-up was completed in April 2024. This study's sample includes 359 families (359 children, 359 female caregivers, and 179 male caregivers). The children's mean (SD) age is 3.9 years (1.2 years) and 51% (n=182) are female. Approximately 74% (n=263) of children and 80% (n=431) of caregivers identify as White. Approximately 34% (n=184) of caregivers have a college diploma or less and nearly 93% (n=499) are married or cohabiting with a partner. Nearly half (n=172, 47%) of the families have an annual household income ≥CAD $100,000 (an average exchange rate of 1 CAD=0.737626 USD applies). Data cleaning and analysis are ongoing as of manuscript publication.

CONCLUSIONS

Despite public health restrictions from COVID-19, the Family Stress Study was successful in recruiting and using remote data collection to successfully engage families in this study. The results from this study will help identify the direction and relative contributions of the biological and behavioral pathways linking chronic stress and adiposity. These findings will aid in the development of effective interventions designed to modify these pathways and reduce obesity risk in children.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05534711; https://clinicaltrials.gov/study/NCT05534711.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/48549.

Impact of delaying high school start times on weight and related behaviors - the START study

In the US, few adolescents get adequate school night sleep, largely due to early school start times. In the START study we aimed to test the following hypothesis: That following the implementation of later high school start times students have lesser longitudinal increases in body mass index (BMI) and shift to more healthful weight-related behaviors relative to students attending schools that retain early start times. The study enrolled a cohort of students (n = 2426) in five high schools in the Twin Cities, MN metro. Heights and weights were measured objectively, and surveys were administered annually from 9th through 11th grades (2016-2018). All study schools started early (either 7:30 am or 7:45 am) at baseline (2016). At follow-up 1 (2017) and continuing through follow-up 2 (2018), two schools delayed their start times by 50-65 min, while three comparison schools started at 7:30 am throughout the observation period. Using a difference-in-differences natural experiment design, we estimated differences in changes in BMI and weight-related behaviors over time between policy change and comparison schools. Students' BMIs increased in parallel in both policy change and comparison schools over time. However relative to changes in comparison schools after the start time shift, students in policy change schools had a modestly more healthful profile of weight-related behaviors - for instance they had a relatively greater probability of eating breakfast, having supper with their family, getting more activity, eating fast food less frequently, and eating vegetables daily. Later start times could be a durable, population-wide strategy that promotes healthful weight behaviors.

Understanding the pathways between prenatal and postnatal factors and overweight outcomes in early childhood: a pooled analysis of seven cohorts

BACKGROUND/OBJECTIVES

Childhood overweight and obesity are influenced by a range of prenatal and postnatal factors. Few studies have explored the integrative pathways linking these factors and childhood overweight. This study aimed to elucidate the integrative pathways through which maternal pre-pregnancy body mass index (BMI), infant birth weight, breastfeeding duration, and rapid weight gain (RWG) during infancy are associated with overweight outcomes in early childhood from ages 3 to 5 years.

SUBJECTS/METHODS

Pooled data from seven Australian and New Zealand cohorts were used (n = 3572). Generalized structural equation modelling was used to examine direct and indirect associations of maternal pre-pregnancy BMI, infant birth weight, breastfeeding duration, and RWG during infancy with child overweight outcomes (BMI z-score and overweight status).

RESULTS

Maternal pre-pregnancy BMI was directly associated with infant birth weight (β 0.01, 95%CI 0.01, 0.02), breastfeeding duration ≥6 months (OR 0.92, 95%CI 0.90, 0.93), child BMI z-score (β 0.03, 95%CI 0.03, 0.04) and overweight status (OR 1.07, 95%CI 1.06, 1.09) at ages 3-5 years. The association between maternal pre-pregnancy BMI and child overweight outcomes was partially mediated by infant birth weight, but not RWG. RWG in infancy exhibited the strongest direct association with child overweight outcomes (BMI z-score: β 0.72, 95%CI 0.65, 0.79; overweight status: OR 4.49, 95%CI 3.61, 5.59). Infant birth weight was implicated in the indirect pathways of maternal pre-pregnancy BMI with RWG in infancy, breastfeeding duration, and child overweight outcomes. The associations between breastfeeding duration (≥6 months) and lower child overweight outcomes were fully mediated by RWG in infancy.

CONCLUSIONS

Maternal pre-pregnancy BMI, infant birth weight, breastfeeding duration and RWG in infancy act in concert to influence early childhood overweight. Future overweight prevention interventions should target RWG in infancy, which showed the strongest association with childhood overweight; and maternal pre-pregnancy BMI, which was implicated in several pathways leading to childhood overweight.

Youth-Onset Type 2 Diabetes: The Epidemiology of an Awakening Epidemic

In this narrative review, we describe the epidemiology (prevalence, incidence, temporal trends, and projections) of type 2 diabetes among children and adolescents (<20 years), focusing on data from the U.S. and reporting global estimates where available. Secondarily, we discuss the clinical course of youth-onset type 2 diabetes, from prediabetes to complications and comorbidities, drawing comparisons with youth type 1 diabetes to highlight the aggressive course of this condition, which, only recently, has become recognized as a pediatric disease by health care providers. Finally, we end with an overview of emerging topics in type 2 diabetes research that have potential to inform strategies for effective preventive action at the community and individual levels.

Childhood obesity risk increases with increased screen time: a systematic review and dose-response meta-analysis

BACKGROUND

The role of screen time in promoting obesity among children has been reported in previous studies. However, the effects of different screen types and the dose-response association between screen time and obesity among children is not summarized yet. In the current meta-analysis we systematically summarized the association between obesity and screen time of different screen types in a dose-response analysis.

METHODS

A systematic search from Scopus, PubMed and Embase electronic databases was performed. Studies that evaluated the association between screen time and obesity up to September 2021 were retrieved. We included 45 individual studies that were drawn from nine qualified studies into meta-analysis.

RESULTS

The results of the two-class meta-analysis showed that those at the highest category of screen time were 1.2 times more likely to develop obesity [odds ratio (OR) = 1.21; confidence interval (CI) = 1.113, 1.317; I2 = 60.4%; P < 0.001). The results of subgrouping identified that setting, obesity status and age group were possible heterogeneity sources. No evidence of non-linear association between increased screen time and obesity risk among children was observed (P-nonlinearity = 0.310).

CONCLUSION

In the current systematic review and meta-analysis we revealed a positive association between screen time and obesity among children without any evidence of non-linear association. Due to the cross-sectional design of included studies, we suggest further studies with longitudinal or interventional design to better elucidate the observed associations.

Promoting Sleep Duration in the Pediatric Setting Using a Mobile Health Platform: A Randomized Optimization Trial

Objective

Determine the optimal combination of digital health intervention component settings that increase average sleep duration by ≥30 minutes per weeknight.

Methods

Optimization trial using a 25 factorial design. The trial included 2 week run-in, 7 week intervention, and 2 week follow-up periods. Typically developing children aged 9-12y, with weeknight sleep duration <8.5 hours were enrolled (N=97). All received sleep monitoring and performance feedback. The five candidate intervention components (with their settings to which participants were randomized) were: 1) sleep goal (guideline-based or personalized); 2) screen time reduction messaging (inactive or active); 3) daily routine establishing messaging (inactive or active); 4) child-directed loss-framed financial incentive (inactive or active); and 5) caregiver-directed loss-framed financial incentive (inactive or active). The primary outcome was weeknight sleep duration (hours per night). The optimization criterion was: ≥30 minutes average increase in sleep duration on weeknights.

Results

Average baseline sleep duration was 7.7 hours per night. The highest ranked combination included the core intervention plus the following intervention components: sleep goal (either setting was effective), caregiver-directed loss-framed incentive, messaging to reduce screen time, and messaging to establish daily routines. This combination increased weeknight sleep duration by an average of 39.6 (95% CI: 36.0, 43.1) minutes during the intervention period and by 33.2 (95% CI: 28.9, 37.4) minutes during the follow-up period.

Conclusions

Optimal combinations of digital health intervention component settings were identified that effectively increased weeknight sleep duration. This could be a valuable remote patient monitoring approach to treat insufficient sleep in the pediatric setting.

Association of outdoor activity time and screen time with sleep for 36 to 54 months children in Kaifu District, Changsha: A birth cohort study

OBJECTIVES

The prevalence rate of sleep problems in children in China is increasing in recent years. There are inconsistencies in the relationship between physical activity and sleep, and the impact of screen time on young children seems more obvious.This study aims to understand the current situation of outdoor activity time, screen time and sleep (total sleep duration, bedtime, and wake-up time) and the associations between outdoor activity time and screen time with sleep for children aged 36-54 months in Kaifu District of Changsha.

METHODS

Using the cluster sampling method, 1 286 newborns delivered in 3 community health service centers in Kaifu District, Changsha from January to December 2015 were selected as the research subjects to establish a prospective birth cohort. According self-designed questionnaire and household follow-up to select 36, 42, 48, 54 months Children's data. The mixed linear model was used to explore the associations of outdoor activity time and screen time with sleep.

RESULTS

The 36-54 months children's total sleep duration was decreased from 11.60 h/d to 10.92 h/d (P<0.001); bedtime time delayed from 21:58 to 22:00 (P=0.124); wake-up time advanced from 7:52 to 7:37 (P<0.001); outdoor activity time was decreased from 2.58 h/d to 1.94 h/d (P<0.001), and screen time was decreased from 1.28 h/d to 1.09 h/d (P<0.001). With aging, the prevalence of sleep <10 h/d and outdoor activity time <2 h/d was increased significantly, and the prevalence of screen time ≥1 h/d was decreased (P<0.05). Mixed linear models showed that longer outdoor activity time was related to increased total sleep duration (β=0.22, 95% CI 0.00 to 0.44) and delayed wake-up time (β=0.16, 95% CI 0.00 to 0.32), and longer screen time was related to delayed bedtime (β=0.22, 95% CI 0.05 to 0.39) and wake-up time (β=0.24, 95% CI 0.08 to 0.41). These associations were different in gender. Longer outdoor activity time was related to delayed wake-up time (β=0.37, 95% CI 0.14 to 0.59) in boys, but not in girls (β=-0.16, 95% CI -0.33 to 0.01). Longer screen time was associated with delayed bedtime (β=0.40, 95% CI 0.09 to 0.63) and wake-up time (β=0.33, 95% CI 0.15 to 0.51) in girls, but only related to delayed wake-up time (β=0.29, 95% CI 0.06 to 0.52) in boys, and the degree of association was lower than that of girls.

CONCLUSIONS

Among children aged 36-54 months in Kaifu District, Changsha, there are problems including going to bed late and getting up late, insufficient physical activity, and long screen time. Outdoor activity time and screen time are related to sleep. Increasing outdoor activity time and reducing screen time can help to improve children's sleep.

Review and meta-analysis for the caregiver's feeding styles questionnaire administered to low-income families

The Caregiver's Feeding Styles Questionnaire (CFSQ) is a well-established measure which uses scores along two dimensions of demandingness and responsiveness to classify low-income parents into one of four feeding style typologies (authoritative, authoritarian, indulgent, and uninvolved; Hughes, et al., 2005). The measure is widely used by researchers to explore the relationship between feeding style and child weight status but has not been evaluated comprehensively in a review or meta-analysis. The aims of this study were to 1) compare established median cutoffs for responsiveness and demandingness in parent feeding (k = 5; see Hughes et al., 2012) to current median splits along these two dimensions for a larger sample of articles (k = 19) and 2) evaluate the relation between children's BMI, demandingness and responsiveness, and parent feeding style categories. Results indicated that the cutoffs for responsiveness and demandingness initially established based on five studies of low-income families did not differ significantly with the addition of 19 studies. Child BMI z-scores (k = 8) were above average for all four parent feeding style categories and highest for indulgent parents, which was consistent with the literature outlining low-income children at higher risk for obesity and children of indulgent parents being particularly at risk. While heterogeneity of samples should be considered, study results suggested that the CFSQ distribution for responsiveness and demandingness was relatively generalizable across low-income samples, though heterogeneity was higher among caregiver's feeding style categories. Furthermore, the study confirmed that parent feeding styles were related to child weight status in a meaningful way, but all children in these low-income samples, on average, were heavier than their same-aged peers across all parent feeding styles.

Screen Time and Body Mass Index Among Children and Adolescents: A Systematic Review and Meta-Analysis

Background

There is no summative quantitative study that report the difference in BMI in high screen user children and adolescents or give a difference in screen time in children and adolescents with obesity vs. children and adolescents without obesity. In the current meta-analysis we systematically summarized the association between obesity and screen time and meta-analyzed the results.

Methods

A systematic search from Scopus, PubMed and Embase electronic databases. Studies that evaluated the association between screen time and obesity up to June 2021.

Results

Results revealed that those at the highest screen time category had 0.7 kg/m2 higher BMI (WMD = 0.703; CI = 0.128, 1.278; P < 0.016; I 2 = 95.8%). Moreover, children and adolescents with obesity had a mean value of 0.313 h higher screen time compared with children and adolescents without obesity (WMD: 0.313; OR = 0.219, 0.407; P < 0.001; I 2 = 96%). The results of subgrouping showed that study quality, continent and sample size could reduce the heterogeneity values. No evidence of publication bias was reported according to visual asymmetry of funnel plots and the results of Begg's and Egger's tests.

Conclusion

For the first time, the current systematic review and meta-analysis revealed a positive association between screen time and obesity among children and adolescents. Due to the cross-sectional design of the included studies, causal inference is impossible, therefore, further studies in separate analysis of both genders are suggested to better elucidate gender-specific results.

Systematic Review Registration

[www.ClinicalTrials.gov], identifier [CRD4202123 3899].

Family vulnerability, disruption, and chaos predict parent and child COVID-19 health-protective behavior adherence

INTRODUCTION

This study examined the role of family functioning in predicting family adherence to health-protective behaviors (HPBs) aimed at reducing COVID-19 spread. Pre-COVID-19 family functioning, disruptions to family functioning (cohesion, conflict, routines), and family chaos during the COVID-19 pandemic were tested as pathways to HPB adherence.

METHOD

We utilized a sample of N = 204 families, comprising parents who had children (MAge = 4.17). Parents (MAge = 27.43) completed one survey prior to COVID-19 onset in the United States, and twice during COVID-19, at a 2-week interval. Structural equation modeling was used to test three potential pathways between prepandemic family-level functioning and HPB adherence during the COVID-19 pandemic.

RESULTS

Findings indicated that families with higher levels of chaos during COVID-19 demonstrated consistently lower HPB adherence across all three models. Additionally, disruptions in family cohesion from pre-COVID was associated with lower levels of parent and child HPB adherence. Family conflict was indirectly associated with HPB adherence via family chaos during COVID-19; whereas family routines were not associated with HPB adherence at all.

DISCUSSION

These findings suggest that family functioning is a meaningful predictor of HPB adherence. Family-based support may be effective in improving HPB adherence by focusing on promoting cohesion and reducing conflict and chaos for families coping with reduced community support and resources. Strategies for family-based supports are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Longitudinal associations between facets of sleep and adiposity in youth

OBJECTIVE

Beyond sleep duration, other facets of sleep such as variability and timing may be associated with obesity risk in youth. However, data are limited. Using a longitudinal design, this study tested whether multiple facets of sleep were associated with fat mass gain over 1 year.

METHODS

A convenience sample of non-treatment-seeking youth (age 8-17 years) wore actigraphy monitors for 14 days. Average weekly sleep duration, within-person sleep duration variability, weekend catch-up sleep, bedtime and wake time shift, social jet lag, bedtime, wake time, and sleep midpoint were calculated. The association of each facet of baseline sleep with 1-year fat mass, adjusting for baseline fat mass and height, was examined.

RESULTS

A total of 137 youths (54.0% female; mean [SD], age 12.5 [2.6] years; 28.4% non-Hispanic Black or African American; baseline fat mass = 15.3 [8.9] kg; 1-year fat mass = 17.0 [10.0] kg; 28.5% with baseline overweight or obesity) were studied. Wake time (p = 0.03) and sleep midpoint (p = 0.02) were inversely associated with 1-year fat mass, such that earlier wake time and midpoint were associated with higher 1-year fat mass. No other facet of sleep was significantly associated with 1-year fat mass (p > 0.09).

CONCLUSIONS

Using objective measures, youth with earlier wake times and sleep midpoints had greater gains in fat mass. Additional research is needed to determine whether sleep timing may be a modifiable target to prevent pediatric obesity.

A mixed methods analysis of environmental and household chaos: considerations for early-childhood obesity research

BACKGROUND

Chaos has implications for child health that may extend to childhood obesity. Yet, results from studies describing associations between chaos and childhood obesity are mixed. New approaches to studying the environments of young children may help to clarify chaos-obesity relationships.

METHODS

We conducted a concurrent mixed methods analysis of quantitative and qualitative data describing home and neighborhood chaos among a diverse cohort of 283 caregiver-toddlers dyads from Ohio. We examined the underlying structure of environmental and household chaos using exploratory factor analysis then sought to validate the structure using qualitative field notes. We generated total scores for factors of chaos and described their distributions overall and according to cohort characteristics. Additionally, we conducted a thematic content analysis of brief ethnographies to provide preliminary construct validity for our indicators of chaos.

RESULTS

Dyads varied according to household composition, income, education, and race/ethnicity. We found evidence for a multi-factor structure for chaos, which included disorganization and neighborhood noise. Household disorganization scores ranged from 0 to 7.3 and were on average 2.1 (SD = 1.8). Neighborhood noise scores ranged from 0 to 4 and were on average 1.1 (SD = 1.1). Both disorganization and neighborhood noise were associated with indicators of socioeconomic disadvantage, such as lower educational attainment and household income. Qualitative data from households with high and low scores on the two identified factors were aligned in ways that were supportive of construct validity and further contextualized the social and material environments in which chaos occurred.

CONCLUSIONS

Chaos represents a complex construct with implications spanning various disciplines, including childhood obesity research. Previous studies suggest challenges associated with measuring chaos may limit the conclusions that can be drawn about which aspect of chaos (if any) matter most of early childhood weight development. We advance the literature by demonstrating chaos may be comprised of conceptually distinct subdomains. Future childhood obesity prevention research may benefit from more contemporary measure of chaos, such as those relying on direct observations that account for a multifaceted underlying structure.

Life Interrupted: Family Routines Buffer Stress during the COVID-19 Pandemic

Adoption of certain behavioral and social routines that organize and structure the home environment may help families navigate the challenges presented by the COVID-19 pandemic. The current cross-sectional study aimed to assess family routines prior to and during the COVID-19 pandemic and examine associations with individual and family well-being. Using a national sample, 300 caregivers of children ages 6-18 were surveyed using Amazon Mechanical Turk platform during the first three months of COVID-19 pandemic in the United States. Caregivers reported on family demographics, COVID-19-related stress, engagement in family routines (prior to and during the COVID-19 pandemic), stress mindset, self-efficacy, and family resiliency. Overall, families reported engaging in fewer routines during the COVID-19 pandemic compared to prior to the pandemic. COVID-19-related stress was highest in low-income families, families of healthcare workers, and among caregivers who had experienced the COVID-19 virus. Moreover, COVID-19-related stress was negatively related to self-efficacy, positively related to an enhancing stress mindset, and negatively related to family resilience. Engagement in family routines buffered relations between COVID-19-related stress and family resilience, such that COVID-19-related stress was not associated with lower family resilience among families that engaged in high levels of family routines. Results suggest that family routines were challenging to maintain in the context of the COVID-19 pandemic, but were associated with better individual and family well-being during this period of acute health, economic, and social stress.

Exploring qualities of ethnically diverse parents related to the healthy home environment of toddlers

Parents serve as role models and household policy makers for their children's home social environment. Also, parents may influence the home physical environment through the provision of resources to support their children's dietary, activity, and sleep behaviors. Understanding the parental characteristics related to children's home environment may allow for tailoring obesity interventions to families' needs. This study aimed to explore parental qualities (general parenting styles, parent feeding practices, and parental BMI) related to healthy home food, physical activity, media and sleep environment of toddlers. A total of 50 multi-ethnic parents with toddler age children who were enrolled in a randomized pilot study of a wellness program completed the Structure and Control in Parent Feeding (SCPF) questionnaire and Comprehensive General Parenting Questionnaire (CGPQ). Parental BMI was calculated using self-reported weight and height data. The Healthy Home Survey, the Home Food Inventory, the Sleep Environment Questionnaire, and items developed for this study were standardized and summed to create home food, physical activity, screen media, and sleep environment scores; high scores reflected healthier environments. To examine the relationships between parental qualities and the home environment, Pearson's correlation test was performed. Parental BMI and overall healthy home environment were inversely associated (r = -0.306; p = 0.032). Structure in general parenting and parental feeding practice were positively correlated with the overall healthy home environment (r = 0.336; p = 0.026) and healthy home food environment (r = 0.415; p = 0.003), respectively. The coercive control general parenting was inversely related to overall healthy home environment score (r = -0.333; p = 0.022). Based on the findings from this study, parents who provide clear communication, set consistent rules, avoid pressure to control their child's behavior, and have lower BMI tend to live in a home environment that support children's health behaviors.

Electronic media use and symptoms of depression among adolescents in Norway

BACKGROUND

The purpose of this study was to examine the association between electronic media use, including use of social media and gaming, and symptoms of depression, and whether gender or having friends moderated these associations.

METHODS

This study was based on self-reported cross-sectional data from the Ungdata survey, conducted in 2018 by the Norwegian Social Research (NOVA) Institute in cooperation with seven regional drug and alcohol competence centres. The target group comprised 12,353 15-16 years old adolescents. Binominal logistic regression was used to analyse the association between electronic media use and symptoms of depression.

RESULTS

The odds of having symptoms of depression were higher for those who used social media more than 3 hours per day (OR: 1.60, 95% CI: 1.43-1.80), compared to those who used social media 3 hours or less per day. Additionally, the odds of having symptoms of depression was higher for those who used more than 3 hours on gaming per day (OR: 1.57, 95% CI: 1.36-1.80), compared to those who used 3 hours and less on gaming per day after adjustment for potential confounders. There were no interaction effects between social media and gaming use with symptoms of depression. Neither were the associations between social media use and gaming with symptoms of depression moderated by gender or having friends.

CONCLUSIONS

The odds of having symptoms of depression were significantly higher for adolescents with a more frequent use of electronic media.

Modifiable Early Childhood Risk Factors for Obesity at Age Four Years

Background: Childhood obesity is associated with an increased risk of adult obesity and related chronic disease. Our aim was to identify modifiable exposures that are independently associated with obesity in the preschool age group. Methods: A prospective cohort study of 5734 children in New Zealand with anthropometric measurements was completed at age 4.5 years. The modifiable exposures of interest, measured at age 9 months and 2 years, were: food security during infancy; and, at age 2 years, screen time; sleep duration; and takeaway food and soft drink intake. The risk of obesity independently associated with each exposure was determined using Binomial and Poisson regression and described using adjusted risk ratios (RRs) and 95% confidence intervals (CIs), after controlling for confounding variables including gender, ethnicity, birth weight, and mother's age. The probability of obesity given cumulative exposures to the four risk factors and the population attributable fraction (PAF) were estimated. Results: Lower food security during infancy (<mean study sample score; RR = 1.32; 95% CI : 1.06-1.64) and, at age 2 years, more screen time (>1 hour/day; RR = 1.22; 95% CI : 1.01-1.48), shorter sleep duration (≤11.5 hours/day; RR = 1.30; 95% CI : 1.05-1.61), and weekly to daily consumption of takeaway/soft drink (RR = 1.25, 95% CI : 1.00-1.57) were independently associated with an increased risk of obesity at age 4.5 years. The cumulative PAF for childhood obesity was 42.9%, under an ideal scenario where all risk factors were eliminated. Conclusion: Exposure to modifiable factors by age 2 years is associated with obesity at age 4.5 years. Interventions to prevent childhood obesity need to be effective during infancy.

Bidirectional associations between sleep quality or quantity, and dietary intakes or eating behaviors in children 6-12 years old: a systematic review with evidence mapping

CONTEXT

Although dietary advice has long been a cornerstone of a healthy lifestyle, how sleep quality and quantity may interact with dietary intake or eating behaviors remains unclear.

OBJECTIVE

To consider a bidirectional relationship between sleep and diet in children aged 6-12 years via a systematic review following PRISMA guidelines.

DATA SOURCES

Relevant trials and observational studies were identified by searching the PubMed, Medline, Embase, and CENTRAL databases up to June 1, 2019, without language or date restrictions and supplemented with hand searching. Recognized procedures and reporting standards were applied.

DATA EXTRACTION

Data on participant characteristics, study parameters, diet measures, sleep measures, and findings of study quality assessment criteria were collected.

DATA ANALYSIS

Forty-five articles involving 308 332 participants on a diverse range of topics were included. Meta-analyses were planned but were impossible to perform due to high study heterogeneity. Most studies (82%) were cross-sectional, which prevented examining directionality of the observed associations. Risk of bias was assessed for trial, cohort studies, and cross-sectional studies, using the Cochrane Risk of Bias Tool or Newcastle Ottawa Scale.

RESULTS

Of 16 studies in which the effect of sleep on dietary intake was investigated, 81% (n = 13) reported a significant association. All studies (n = 8) of sugar-sweetened or caffeinated beverages reported a negative association with sleep, and in 6 of 7 studies in which eating behaviors were investigated, associations with sleep were reported. The use of objective measures of sleep and diet were scarce, with most trials and studies relying on subjective measures of sleep (68%) or diet (93%).

CONCLUSION

Because most studies investigating the relationship between sleep and diet in this age group are cross-sectional, temporality could not be determined. Additional randomized controlled trials and long-term cohort studies in middle childhood, particularly those using objective rather than questionnaire measures of sleep, are required to better understand interactions between diet and sleep.

SYSTEMATIC REVIEW REGISTRATION

Prospectively registered with PROSPERO International Prospective Register of Systematic Reviews (CRD42018091647).

Family characteristics, perceived environment for physical activity, and childhood obesity: An approach with structural equation models

OBJECTIVES

To evaluate the direct and indirect effects of family characteristics and the perceived neighborhood environment on obesity risks among schoolchildren.

METHODS

Through phone contact with the child's mothers/guardians, the perceptions about the aspects of the neighborhood that could limit or promote health. Physical activity, socioeconomic data, self-reported weight and height, and ultra-processed consumption of the respondents were evaluated, in addition to the screen time of both mothers and children. A hybrid model of structural equations was used to test the direct and indirect effects of family and environmental variables on childhood obesity.

SETTING

Belo Horizonte, Minas Gerais, Brazil.

SUBJECTS

A total of 322 children from 9 to 10 years old from municipal schools and their respective mothers/guardians.

RESULTS

Childhood obesity was positively associated with obesity among mothers/guardians and with the latent variable "socioeconomic status (SES)." It was observed that the child's guardians positively influenced childhood obesity through their own habits, such as screen time and consumption of ultra-processed products, with obesity of mothers/guardians as mediators of both associations. There were no direct and indirect effects of the latent variables of the perceived environment in childhood obesity.

CONCLUSION

Family characteristics are important determinants of childhood obesity and should be considered when designing prevention strategies. Parental perceptions of neighborhood characteristics did not have an influence on childhood obesity.

The EnergyKids Pilot Study: Comparing Energy Balance of Primary School Children during School and Summer Camp

Children's energy requirements may vary during school and summer camp days. To evaluate energy balance during these two periods, seventy-eight children (45% females, 8-10 years) living in Parma, Italy, were enrolled in this observational study. Participants completed a 3-day food diary and wore an activity tracker for three consecutive days during a school- and a summer camp-week to estimate energy intake (EI) and energy expenditure (TEE). Height and body weight were measured at the beginning of each period to define children's weight status. BMI and EI (school: 1692 ± 265 kcal/day; summer camp: 1738 ± 262 kcal/day) were similar during both periods. Both physical activity and TEE (summer camp: 1948 ± 312; school: 1704 ± 263 kcal/day) were higher during summer camp compared to school time. Therefore, energy balance was more negative during summer camp (-209 ± 366 kcal/day) compared to school time (-12 ± 331 kcal/day). Similar results were observed when males and females were analyzed separately but, comparing the sexes, males had a higher TEE and a more negative energy balance than females, during both periods. The results strongly suggest that an accurate evaluation of children's energy balance, that considers both diet and physical activity, is needed when planning adequate diets for different situations.

Effects of Coparenting Quality, Stress, and Sleep Parenting on Sleep and Obesity Among Latinx Children: A Path Analysis

INTRODUCTION

We sought to examine the associations among parent-level constructs, sleep-related parenting practices, and child sleep in Latinx families.

METHOD

A quantitative study was conducted with 101 Latinx parents of children aged 2-5 years. Key variables that were examined included parental stress, coparenting quality, bedtime routine consistency, parent-child sleep interactions, and child's sleep duration.

RESULTS

Path analysis results indicated that (1) parent stress had a direct effect on child sleep duration (p =.005) and was mediated by parent-child sleep interactions (p =.021); (2) coparenting quality had a direct effect on child sleep duration (p =.001) and was mediated by bedtime routine consistency (p =.010); and (3) bedtime routine consistency had an indirect effect on child body mass index percentile and was mediated by sleep duration (p =.049).

DISCUSSION

Coparenting quality and parental stress may be important constructs to consider when designing interventions to improve Latinx child sleep duration.

Elements of Effective Population Surveillance Systems for Monitoring Obesity in School Aged Children

The continuing high prevalence of child overweight and obesity globally means that it remains the most common chronic health condition in children. Population-based child obesity surveillance systems are critical for monitoring trends in obesity and related behaviours, and determining the overall effect of child obesity prevention strategies. Effective surveillance systems may vary in methods, scope, purpose, objectives, and attributes, and our aim was to provide an overview of child obesity surveillance systems globally, and to highlight main components and other types of survey data that can enhance our understanding of child obesity. Measures of adiposity, including body mass index and waist circumference are essential, but effective surveillance must also include measures of weight-related behaviours, including diet, physical activity, sedentary time, and sleep. While objective measures are desirable, the variability in psychometrics and rapid evolution of wearable devices is potentially problematic for examining long-term trends over time and how behaviours may change. Questionnaires on self-reported behaviours are often used but also have limitations. Because the determinants of obesity are not only functioning at the individual level, some measures of the broader environmental and commercial determinants, including the built and food environments, are useful to guide upstream policy decisions.

Results of the 3 Pillars Study (3PS), a relationship-based programme targeting parent-child interactions, healthy lifestyle behaviours, and the home environment in parents of preschool-aged children: A pilot randomised controlled trial

BACKGROUND

Early childhood is a critical period for the development of obesity, with new approaches to prevent obesity in this age group needed. We designed and piloted the 3 Pillars Study (3PS), a healthy lifestyle programme informed by attachment theory for parents of preschool-aged children.

METHODS

A 2-arm, randomised controlled pilot study was conducted to assess the effectiveness of 3PS, a 6-week programme involving a half-day workshop plus 6-week access to a study website. The programme was designed to promote routines around healthy lifestyle behaviours, including sleep, limited screen use, and family meals, within the context of positive, reciprocal parent-child interactions. Parents (n = 54) of children aged 2-4 years who regularly exceeded screen use recommendations (≥1 hour per day), were randomised to the 3PS programme (n = 27) or a wait-list control group (n = 27). Child screen time at 6 weeks was the primary endpoint. Frequency of family meals, parent feeding practices, diet quality, sleep, Child Routine Inventory (to assess predictability of commonly occurring routines), and household chaos were also assessed. Study data were collected online at baseline, 6 weeks, and 12 weeks via REDCap.

RESULTS

No group differences were observed for changes from baseline in screen time (primary endpoint), feeding behaviour scores, Child Routine Inventory scores, or total night time sleep duration at 6 and 12 weeks, although all measures improved in the hypothesised direction in the 3PS group. Compared with controls, the intervention group demonstrated significant improvements from baseline in household chaos scores (i.e. a reduction in chaos) and a number of measures of sleep outcomes, indicating improved sleep continuity. The programme was highly acceptable to parents.

CONCLUSIONS AND RECOMMENDATIONS

A relational approach appears promising as a novel way to promote healthy lifestyle behaviours associated with the prevention of childhood obesity in children aged 2-4 years. A larger study is warranted.

Growth patterns from birth to overweight at age 5-6 years of children with various backgrounds in socioeconomic status and country of origin: the ABCD study

INTRODUCTION

Children from minority groups are at increased risk of overweight. This study compared BMI growth patterns from birth onwards of boys and girls with overweight at 5-6 years, according to socioeconomic status (SES) and country of origin, in order to gain more insight into the critical periods of growth to overweight.

METHODS

A total of 3714 singletons of the multi-ethnic ABCD study were included. Within children with overweight at age 5-6 years (N = 487, prevalence boys: 11.6%, girls: 14.6%), BMI growth patterns from birth onwards (12.8 serial measurements; SD = 3.1) were compared between children from European (69.4%) and non-European mothers (30.6%), and between children from low (20.8%), mid (37.0%) or high SES (42.2%), based on maternal educational level.

RESULTS

BMI growth to overweight did not differ between children of European or non-European mothers, but it did differ according to maternal SES. Children with overweight in the low and mid SES group had a lower BMI in the first 2 years of life, an earlier adiposity rebound and increased in BMI more rapidly after age 2, resulting in a higher BMI at age 7 years compared to children with overweight in the high SES group [∆BMI (kg/m2 ) between high and low SES: boys 1.43(95%CI:0.16;3.01) and girls 1.91(0.55;3.27)].

CONCLUSION

Children with overweight from low SES have an early adiposity rebound and accelerated growth to a higher BMI at age 5-6 years compared to children with overweight from the high SES group. These results imply that timing of critical periods for overweight development is earlier in children with a low socioeconomic background as compared to other children.

Sex Differences in the Association between Household Chaos and Body Mass Index z-Score in Low-Income Toddlers

Background: Associations between household chaos and childhood overweight have been identified, but the mechanisms of association are not clearly established in young children, with some studies linking higher chaos to increased obesity risk, whereas other studies link higher chaos to lower obesity risk. Given the lack of consistent findings and early sex differences in vulnerability to chaos, we examined child sex as a moderator of the chaos-child overweight association. We also tested these associations with self-regulation, as self-regulation has been implicated in understanding the chaos-obesity risk association in low-income toddlers. Methods: Parent-reported household chaos and observed child self-regulation were collected at baseline [n = 132; M age 23.0 months (standard deviation 2.8)]. Children's body mass index z-score (BMIz) was measured at 33 months. Multivariate linear regression models were used to assess whether child sex moderated the chaos-BMIz association. A three-way interaction between chaos, child sex, and self-regulation was also tested. Results: Child sex moderated the chaos-BMIz association (b = -0.11, p = 0.04) such that chaos was positively associated with BMIz among boys (b = 0.12, p = 0.003), but unrelated in girls (b = 0.01, p = 0.78). A three-way interaction with self-regulation indicated that a positive chaos-BMIz association existed only for boys with average (b = 0.12, p = 0.004) and low (b = 0.22, p < 0.001) self-regulation. Conclusions: Boys with poor self-regulation may be particularly vulnerable to obesogenic effects of chaotic households.

Household chaos: a risk factor for adverse child outcomes gains attention in public health

Household chaos, characterized by high levels of confusion, disorganization and hurriedness in the home, is increasingly recognized as an important risk factor for adverse child outcomes. Early research on household chaos and child well-being was largely within the field of developmental psychology, where greater levels of household chaos has been associated with greater behavioral, attention and learning problems in young children. The potential influence of household chaos on child health behaviors is more recently gaining attention within public health. A recent study by Marsh et al., entitled, the Relationship between Household Chaos and Child, Parent, and Family Outcomes: A Systematic Scoping Review, presents the findings from 112 studies that assessed the influence of household chaos on a wide range of child outcomes. Findings highlight the various adverse child health outcomes across multiple domains that may be negatively affected by greater levels of household chaos including a few that reflect child health behaviors such as sleep, diet and weight gain. The review additionally presents findings from mediation and moderation analyses. This commentary highlights key aspects of the Marsh et al. review and outlines the implications of the work within health behavior research. This commentary further identifies child screen media use as a critically understudied area when considering the interplay between household chaos and child well-being.

The relationship between household chaos and child, parent, and family outcomes: a systematic scoping review

BACKGROUND

Household chaos, represented by the level of disorganisation or environmental confusion in the home, has been associated with a range of adverse child and family outcomes. This review aims to (1) identify how household chaos is measured, (2) chart study details of household chaos literature, and (3) map the existing literature with respect to the relationship between household chaos and child, parent, and family outcomes. We expect that this review will highlight the need to consider the importance of household chaos in child well-being research, particularly in those families where children may be more vulnerable to the adverse effects of household chaos.

METHODS

We searched five electronic databases (last updated September 1st 2018) in addition to Google Scholar, and identified publications via a 3-stage screening process, which was conducted by two researchers. Published studies were included if they investigated the association between household chaos and child, parent, or family outcomes. Research that investigated household chaos as a mediator or moderator, or that investigated how the relationship between household chaos and the outcome of interest was mediated or moderated, were also included.

RESULTS

One hundred twelve studies in 111 publications were included. The majority were conducted in the United States (n = 71), and used either cross-sectional (n = 60) or longitudinal (n = 49) study designs. Outcomes of interest were categorised into seven categories: (1) cognitive and academic (n = 16), (2) socio-emotional and behavioural (n = 60), (3) communication (n = 6), (4) parenting, family, and household functioning (n = 21), (5) parent outcomes (n = 6), (6) hormone (n = 8), and (7) physical health and health behaviours (n = 19). There was consistent evidence for significant correlations between household chaos and adverse outcomes across all seven categories in diverse populations with respect to age, disease status, and socio-economic status (SES).

CONCLUSION

There is consistent evidence for associations between household chaos and a number of adverse child, parent, and family-level outcomes. Household chaos may also help describe variations in outcomes between low SES and child development.

Depressive symptoms are associated with short and long sleep duration: A longitudinal study of Chinese adolescents

AIMS

Sleep loss and irregular sleep patterns in adolescents are major public health concerns in the modern society. This study aimed to explore the associations between short and long sleep duration and depressive symptoms among Chinese adolescents.

METHODS

A total of 7311 adolescents who participated in the baseline survey and were followed up 1 year or 2 years later were included in the analyses. Participants completed a self-administered questionnaire at baseline and follow-up surveys. The Center for Epidemiologic Studies Depression (CES-D) scale was used to assess depressive symptoms. Generalized estimating equation (GEE) and restrictive cubic spline models were used to estimate the association between sleep duration and depressive symptoms.

RESULTS

After adjusting for adolescent and family covariates, sleep duration <8 h and >=9 h on weekdays and sleep duration <8 h and >=12 h on weekends were significantly associated with depressive symptoms compared with sleep 8 h. Weekend-weekday sleep difference >=3 h or <-1 h (ie. sleeping >1 h on weekdays than weekends) was also associated with depressive symptoms. There were U-shaped relationships between sleep duration on weekdays, weekends, or weekday-weekend sleep difference and depressive symptoms.

LIMITATIONS

Sleep duration and depression were measured by self-report.

CONCLUSIONS

Our findings highlight the risk of short and long sleep duration, and weekday-weekend sleep imbalance for depression in adolescents.

Family entropy: understanding the organization of the family home environment and impact on child health behaviors and weight

Child obesity is a major public health issue with a high disease burden. Although numerous contributing factors have been identified, the family home environment is a central context of influence that requires deeper understanding. The level of organization in the family home environment may influence obesity and obesogenic behaviors, but the literature has suffered from the lack of a strong overarching construct and model to guide this area of research. Family entropy is a conceptual framework that fills this gap by representing the level of organization across the home environment. The current study empirically assesses family entropy using factor analysis in a longitudinal sample of 968 children measured yearly from Grades 3 to 6 as part of the NICHD Study of Early Child Care and Youth Development. Mixed modeling using MPLUS examined the influence of family entropy on child weight both directly and indirectly through weight-related health behaviors (i.e., sleep and physical activity), and considered the moderating role of socioeconomic status (SES). Results suggest that family entropy is comprised of distinct elements of household organization and disorganization, which are moderately related. Household disorganization may be particularly detrimental to child sleeping behavior both concurrently and over time in families of both high and low SES. The study concludes with recommendations for advancing understanding of the home environment by using nuanced measurement strategies, and incorporating support for household organization within child obesity prevention and intervention efforts.

Food insecurity is associated with suboptimal sleep quality, but not sleep duration, among low-income Head Start children of pre-school age

OBJECTIVE

To examine the association between food insecurity and child sleep outcomes and to investigate whether parent psychosocial factors mediate such associations.

DESIGN

Cross-sectional study. Usual wake time and bedtime, bedtime routine and sleep quality were reported by parents using the adapted Brief Infant Sleep Questionnaire. Food insecurity was assessed using the eighteen-item US Department of Agriculture Household Food Security Module. Parent psychosocial factors, including perceived stress, parenting self-efficacy and depressive symptomology, were assessed using validated scales. Multivariable logistic regression models were performed to determine the association between food insecurity and sleep outcomes controlling for potential confounders. Mediation analyses and Sobel tests were applied to test the mediating effect of psychosocial factors.

SETTING

Head Start pre-school classrooms in four regions across central Pennsylvania, USA.

PARTICIPANTS

Low-income children of pre-school age (n 362) and their caregivers.

RESULTS

Prevalence of household, adult and child food insecurity was 37·3, 31·8 and 17·7 %, respectively. Food security status at any level was not associated with child sleep duration or bedtime routine. Child food insecurity, but not household or adult food insecurity, was associated with 2·25 times increased odds (95 % CI 1·11, 4·55) of poor child sleep quality in the adjusted model. Perceived stress, self-efficacy and depressive symptomology mediated less than 2 % of the observed effect (all Sobel test P > 0·6).

CONCLUSION

Food insecurity, particularly at the child level, is a potential modifiable risk factor for reducing sleep-related health disparities in early childhood. Future studies are needed to explore the plausible mechanisms underlying the associations between food insecurity and adverse child sleep outcomes.

Sleep Duration and Weight-Related Behaviors among Adolescents

Background: Insufficient sleep is widespread among adolescents and has consequences that extend far beyond hampering day-to-day functioning. It may influence eating and physical activity patterns and be an important determinant of adolescent overweight/obesity status. Methods: We assessed how self-reported sleep duration on school nights was associated with weight-related behaviors (eating, diet, and physical activity) and overweight/obesity at the baseline wave (ninth grade year) of the START study (n = 2134). Results: Fifteen percent of our sample reported optimal sleep duration (8.5-10.0 hours); nonwhites, participants of lower socioeconomic status, and girls were at greater risk for insufficient sleep. Suboptimal sleep was associated with various poor weight-related behaviors such as increased sugar-sweetened beverage consumption, decreased vegetable consumption, and decreased breakfast eating (p < 0.001). Fewer hours of sleep were also associated with less physical activity and an increased likelihood of obesity (p = 0.02 for both associations). Conclusions: The influence of adolescent sleep insufficiency on diet and activity could impact childhood obesity and following chronic disease risk especially if lack of sleep sets the stage for enduring, lifelong, poor, weight-related behavior patterns.

Participant experiences in a paraprofessional-led weight management program for children and families

Background:

Pediatric obesity is a serious and widespread medical condition that is increasing in the United States. Unfortunately, family-based programming to address the disorder fails to successfully reach and engage many children, particularly in low-income communities. To provide more affordable, accessible, and scalable programming options, researchers partnered with pediatricians and the Cooperative Extension Service (Extension) in a Midwestern state to develop a collaborative intervention. Partnering pediatricians referred children and families to a weight management program delivered by a trained Extension paraprofessional. The current study describes family experiences with the program.

Methods:

Researchers conducted a focus group or family interview with 13 program completers to elicit program perceptions, experiences with paraprofessionals, and motivators to continue. The focus group and family interviews were audio recorded and transcribed verbatim for textual analysis. Using thematic analysis, researchers examined patterns across transcripts and formulated emerging themes.

Results:

Key themes that emerged included (1) nutrition guidance, (2) interaction, (3) child influence, and (4) family engagement. Families viewed paraprofessionals as compassionate and competent educators who were instrumental in helping families modify health-related behaviors.

Conclusions:

Results of the current study are important to efforts focused on addressing childhood obesity, particularly in underserved communities where access to healthcare services is limited.

Generational Differences: A Comparison of Weight-Related Cognitions and Behaviors of Generation X and Millennial Mothers of Preschool Children

A ‘generation’ is an identifiable group sharing birth years and significant life events at critical developmental ages. There is a paucity of literature examining how parental cognitions and lifestyle behaviors differ by generation and whether generational differences are substantial enough to warrant consideration during the development of health interventions. This study compared generational differences in weight-related cognitions and lifestyle behaviors of mothers of young children who were categorized as Generation X (born 1965–1981, n = 158) and Generation Y (aka Millennials; born 1982–1999, n = 162). Survey results indicated that Generation X had significantly higher family affluence; thus, this was controlled in subsequent analyses. Analysis of covariance indicated that Millennials had more positive expectations about the benefits of engaging in healthy eating and physical activity than comparators, but not significantly so. Millennial mothers placed significantly higher value on physical activity for themselves than Generation X mothers, but both generations were neutral on the value of personal physical activity. No generational differences were noted in self-efficacy of mothers for promoting childhood obesity-prevention practices to children and self-efficacy for personally engaging in weight-protective behaviors. Millennial mothers had significantly more family meals/week, however generations did not differ on the value placed on family meals, where family meals were eaten, or whether media devices were used at mealtime. Few differences were noted between the generations for most child feeding behaviors, except that Millennials reported placing significantly less pressure on children to eat. Mothers’ modeling of weight-related behaviors as a means for children’s observational learning about healthy eating, physical activity, and sedentary behaviors did not differ by generational group. The eating behaviors of mothers differed little between generations. Millennial mothers allowed significantly more media devices in children’s bedrooms and personally engaged in more screen time daily than comparators. Overall, the two generational groups were more similar than different in weight-related cognitions as well as for personal and parenting lifestyle behaviors. The results suggest that tailoring interventions for individuals at a similar life-stage (e.g., mothers of young children) by generation may not be warranted.

Association between television viewing and early childhood overweight and obesity: a pair-matched case-control study in China

BACKGROUND

Television (TV) viewing may affect children's obesity status. In the present study the association between TV viewing and early childhood overweight/obese status was investigated as well as the association based on age difference.

METHODS

The present study included 933 children 1-5 years of age that were individually matched on a 1:2 (cases: controls) ratio based on age and community. Cochran-Mantel-Haenszel test was used to evaluate the association between TV viewing time and the related unhealthy behaviors. Conditional logistic regression models were used to quantify the association between TV viewing and children overweight/obese status in two age groups. The effects of TV viewing-related behaviors on the associations were further investigated.

RESULTS

TV viewing time > 1 h was positively associated with the prevalence of TV viewing-related unhealthy behaviors (P < 0.05). After controlling for these behaviors, the association between TV viewing and childhood overweight/obese status was significant among 4- to 5-year-old children (odds ratio, OR = 1.72, 95% confidence interval, CI: 1.16--2.54), but not significant among 1- to 3-year-old children.

CONCLUSIONS

Childhood overweight/obese status was positively associated with longer TV viewing time only among 4- to 5-year-old children. The results from the present study may help in identifying the population susceptible for overweight and obesity caused by TV viewing.

Examining the impact of a summer learning program on children's weight status and cardiorespiratory fitness: A natural experiment

This study examined the impact of an existing 7-week summer learning program on children's weight status and cardiorespiratory fitness (CRF).

METHODS

Using an observational repeated measures within-subjects design, children's (N = 20 mean age = 6.35; 45% female; 80% African American) height, weight, and CRF (i.e., Fitnessgram PACER), were measured during the first and final week of the seven week program. Descriptive statistics were calculated for all variables. Median regression analysis examined estimated the differences in BMI zscore, overweight and obesity prevalence, and CRF during the first week (baseline) compared to the final week (outcome).

RESULTS

Of those enrolled initially in the program, 77% attended for more than 4 weeks. When controlling for attendance and sex, no statistically significant changes were observed for, median zBMI (pre: 0.12, post: 0.11) or CRF (pre: 10, post: 13.5 PACER laps). All children except for one maintained the same weight status (e.g. normal weight, overweight) from baseline to outcome. A total of 12 participants increased or maintained the number of PACER laps completed, while 8 participants' PACER laps decreased.

CONCLUSION

The results of this natural experiment provides preliminary evidence that participation in a structured summer program can potentially mitigate unhealthy weight gains and fitness loss over the summer for some children. Future studies with larger more representative samples are needed to establish the impact of structured summer programming on children's CRF and weight status.

Association between Access to Electronic Devices in the Home Environment and Cardiorespiratory Fitness in Children

This study examined the association between access to electronic devices in the home and cardiorespiratory fitness in children. Participants were children aged 8⁻12 years from a local elementary school (n = 106, mean age = 9.7 + 1.1 years, male = 50). Child access to electronic devices was measured with a 37-item parent-reported questionnaire. Estimated maximal aerobic capacity (VO2 Peak) was calculated from The Progressive Aerobic Cardiovascular Endurance Run (PACER) using a validated algorithm. The association between access to electronic devices in the home and cardiorespiratory fitness was explored by employing hierarchical ridge regression, using the Ordinary Least Squares (OLS) model, controlling for the covariates of sex, age, and Body Mass Index (BMI). Controlling for sex, age, and BMI, the number of electronic items in a child's bedroom was significantly inversely related to the estimated VO2 Peak (b = -1.30 mL/kg/min, 95% C.I.: -2.46 mL/kg/min, -0.15 mL/kg/min, p = 0.028) and PACER laps (b = -3.70 laps, 95% C.I.: -6.97 laps, -0.41 laps, p = 0.028) However, the total number of electronic items in the home and total number of electronic items owned did not significantly relate to the estimated VO2 Peak (p = 0.847, 0.964) or the number of PACER laps (p = 0.847, 0.964). Child health behavior interventions focused on the home environment should devote specific attention to the bedroom as a primary locus of easily modifiable intervention.

Advertising Susceptibility and Youth Preference for and Consumption of Sugar-Sweetened Beverages: Findings from a National Survey

OBJECTIVE

This study investigated variables that may mediate the relationship between advertising susceptibility and adolescent preference for and consumption of sugar-sweetened beverages (SSBs), with the goal of informing inoculation-based mitigation approaches grounded in media literacy and messaging resistance.

DESIGN

The study utilized data from a nationally representative sample of US adolescents (ages 12-17 years, n = 1,657) from the National Cancer Institute's Family Life, Activity, Sun, Health, and Eating survey.

MAIN OUTCOME MEASURE

Variables of interest were SSB preference and consumption, advertising susceptibility, perceived self-efficacy to make good nutritional choices, perceived SSB consumption by peers, and attitude toward SSBs. Exposure to obesogenic environments was examined as a moderator.

ANALYSIS

Direct and mediated associations between advertising susceptibility and SSB preference were estimated through a series of regression and mediation analyses.

RESULTS

Advertising susceptibility was a strong predictor of SSB preference (unstandardized B = .29, SE = .026, P < .001), which, in turn, was a strong predictor of consumption (unstandardized B = .10, SE = .01, P < .001), controlling for potential mediators. The only statistically significant mediator of this association was perceived peer consumption (unstandardized B = .38, SE = .08, P < .001), which was stronger for adolescents with higher exposure to obesogenic environments.

CONCLUSIONS AND IMPLICATIONS

This study offers developers of inoculation-based strategies additional insight into levers that could be targeted for building adolescent resistance to advertising effects.

Combined interventions for physical activity, sleep, and diet using smartphone apps: A scoping literature review

BACKGROUND

The use of smartphone apps to track and manage physical activity (PA), diet, and sleep is growing rapidly. Many apps aim to change individual behavior on these three key health dimensions (PA, sleep, diet) by using various interventions. Earlier reviews have examined interventions using smartphone apps for one or two of these dimensions. However, there is lack of reviews focusing on interventions for all three of these dimensions in combination with each other. This is important since the dimensions are often inter-related, and all are required for a healthy lifestyle.

OBJECTIVE

The objective of this study is to conduct a review to: (1) map out the research done using smartphone app interventions targeting all three or any two of the three dimensions (PA, sleep, and diet), (2) examine if the studies consider the inter-relationships among the dimensions, and (3) identify the personalization methods implemented by the studies.

METHODS

A literature search was conducted in electronic databases and libraries related to medical and informatics literature - PubMed, ScienceDirect, PsycINFO (ProQuest, Ovid) - using relevant selected keywords. Article selection and inclusion were done by removing duplicates, analyzing titles and abstracts, and then reviewing the full text of the articles.

RESULTS

In the final analysis, 14 articles were selected - 2 articles focusing on PA and sleep, 8 on PA and diet, and 4 that examine or (at least) collect data of all three dimensions (PA, sleep, and diet). No research was found that focused on sleep and diet together. Of the 14 articles, only 4 build user profiles. Further, 3 of these 4 studies deliver personalized feedback based on the user's profile, with only 1 study providing automated, personalized recommendations for behavior change. Additionally, 6 of the included studies report all positive outcomes, while for 3 studies the primary outcomes are awaited. The remaining 5 studies do not report significant changes in all outcomes. In all, only 1 study examines the relationship between two (PA and diet) dimensions. No study was found to assess the relationships among the 3 dimensions.

"Let's talk about sleep": a qualitative examination of levers for promoting healthy sleep among sleep-deprived vulnerable adolescents

OBJECTIVE

Deficient sleep is highly prevalent in disadvantaged adolescents and contributes to a range of adverse health and behavioral outcomes. We examined mediating mechanisms and strategies that adolescents adopt to improve sleep, and possible levers for promoting sleep in this population.

METHODS

We conducted three focus groups (N = 27 total, age 14-18 years) in adolescents living in low- and middle-income racially/ethnically diverse neighborhoods of Boston, Massachusetts. Participants completed a survey on their sleep and health habits prior to the moderator-led discussions. Discussions were audio-recorded, transcribed, and thematically analyzed.

RESULTS

The study population did not meet the minimum sleep recommendations, and we found a high prevalence of "social jet-lag." We also identified a disconnect between the acknowledgment of the importance of sleep and actual behavior, especially for electronic use. Phone use and screen time were the most commonly cited barriers to a good night's sleep, along with caffeine consumption, which was also high in this sample. There was also a general lack of awareness of sleep hygiene practices and recommendations. Participants reported regulating food intake and physical activity, using allopathic sleep aids, creating a comfortable sleeping environment, and a routine as some strategies to improve sleep.

CONCLUSION

Results from this study suggest facilitating the linkage between participant-generated mediating factors and strategies for better-designed interventions. These include making the negative impact of sleep on health more explicit, improving youth awareness about sleep hygiene, targeting caffeine consumption and electronic use, and introducing sleep recommendations through appropriate and effective channels.

Household chaos and screen media use among preschool-aged children: a cross-sectional study

Background

Excess screen media use is a robust predictor of childhood obesity. Understanding how household factors may affect children’s screen use is needed to tailor effective intervention efforts. The preschool years are a critical time for obesity prevention, and while it is likely that greater household disorder influences preschool-aged children’s screen use, data on that relationship are absent. In this study, our goal was to quantify the relationships between household chaos and screen use in preschool-aged children.

Methods

A cross-sectional, online survey was administered to 385 parents of 2–5 year-olds recruited in 2017. Household chaos was measured with the Confusion, Hubbub and Order Scale (i.e., the chaos scale), a validated, parent-reported scale. The scale consists of 15 items, each scored on a 4-point Likert scale. Final scores were the sum across the 15 items and modeled as quartiles for analyses. Parents reported their children’s screen use for nine electronic media activities. Adjusted linear and Poisson regression were used to model associations between household chaos and children’s total weekly screen use, screen use within one hour of bedtime and screen use in the bedroom.

Results

Children averaged 31.0 (SD = 23.8) hours per week with screens, 49.6% used screens within one hour of bedtime and 41.0% used screens in their bedrooms. In adjusted regression models, greater household chaos was positively associated with weekly screen use (P = 0.03) and use of screens within one hour of bedtime (P < 0.01) in a dose-dependent manner. Children in the fourth versus the first quartile of household chaos were more likely to use screens in their bedroom (P = 0.03).

Conclusions

Greater household chaos was associated with increased total screen use as well as screen use behaviors that are related to disrupted nighttime sleep. Findings suggest that household chaos may be an obesity risk factor during the preschool years because of such effects on screen use, and highlight the need to consider household chaos when implementing home-based obesity prevention programs for young children.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6113-2) contains supplementary material, which is available to authorized users.

Association between household poverty dynamics and childhood overweight risk and health behaviours in the United States: a 8-year nationally representative longitudinal study of 16 800 children

BACKGROUND

No study has examined how the pattern of income dynamics influences both of children's body mass index (BMI) trajectory and health behaviours.

OBJECTIVES

To examine the association between household poverty dynamics and childhood overweight risk in the USA.

METHODS

Using the longitudinal data of 16 800 children (from kindergarten to the 8th grade) in the nationally representative US cohort-Early Childhood Longitudinal Study, Kindergarten Class 1998-1999, we examined the differences in BMI trajectory, weight-related health behaviours and risk of overweight in association with household poverty dynamics during follow-up (never [no experience of poverty], transient [once], recurrent [≥2 times] and persistent poor [remained]) using mixed models with fractional polynomial functions and estimating equation models.

RESULTS

Overall, children experiencing poverty were more likely to have adverse BMI growth trajectory and eating and sedentary behaviours compared with the never poor. The recurrently poor children (12.8%) had the fastest BMI trajectory, highest overweight/obesity prevalence from 5 to 16 years old and highest proportion of excessive soda/fast food consumption and irregular exercise at 8th grade than did others (p < 0.05). The persistently poor (8.4%) were the lowest in BMI growth trajectory but became the second highest in childhood obesity through a steady increase in BMI over time. Children in the recurrently poor group had a 1.5 times (95% CI = 1.0-2.2) higher risk of overweight than those having never experienced poverty during follow-up.

CONCLUSIONS

The experience of recurrent household poverty had a significant association with children's adverse eating behaviours and increased obesity risk subsequently.

Household chaos during infancy and infant weight status at 12 months

BACKGROUND

Infancy is a critical period for obesity prevention. Emerging evidence links household chaos to poor health outcomes, yet its impact on obesity in infancy is unknown.

OBJECTIVES

We examined associations between household chaos when infants were 6 and 12 months and weight-for-length (WFL) z-score at 12 months, exploring potential mediation by infant sleep and screen time.

METHODS

We examined 401 predominately Black women and infants in the southeastern United States. We conducted multivariable linear regressions examining household chaos and infant WFL z-score, assessing breastfeeding, sleep, screen time as potential mediators.

RESULTS

Among infants, 69.7% were Black and 49.0% were female. Mean breasting duration was 3.7 months. Over half (50.4%) of families had annual household incomes <$20 000. After adjustment for potential confounders, household chaos was associated with infant WFL z-score (0.02; 95% CI 0.001, 0.04; p = 0.04) at 12 months. We did not observe associations between chaos and infant breastfeeding, sleep or screen time.

CONCLUSIONS

Higher household chaos was associated with greater infant weight at 12 months, but there was no evidence of mediation by breastfeeding, sleep or screen time.

Dietary diversity determinants and contribution of fish to maternal and under-five nutritional status in Zambia

Background

This study examines socio-economic determinants of food consumption patterns amongst women of reproductive age and children aged 6–59 months from urban poor settlements of Lusaka and their implications for nutritional status. Particular emphasis was placed on the role of fish in their diets and nutritional status.

Methods

A cross-sectional survey design was applied, in which 714 mother-child dyads, with children aged 6–59 months were enrolled. A three-stage randomized cluster sampling approach was applied.

Results

The mean dietary diversity score among children aged 6–23 and 24–59 months was 2.98 (±1.27) and 3.478 (±1.07), respectively. In children aged 6–23 months, there was a significant difference in their nutritional status, based on fish consumption (χ² = 10.979, df = 2, p = 0.004). Children from poorer households consumed mostly small fish (Kapenta). The quantity of fish consumed by children was significantly associated with stunting in both age groups, odds ratio = 0.947 (95% CI: 0.896, 1.000) for children aged 6–23 months and odds ratio = 1.038 (95% CI: 1.006, 1.072) for children aged 24–59 months old. Other significant risk factors for stunting in children aged 6–23 months were the child’s age, mother’s body mass index, access to treated water and child morbidity. Child’s age, mother’s educational level and wealth status were determinants of dietary diversity in children aged 6–59 months as shown by the Poisson regression.

Conclusion

Nutritional status of children aged 6–23 months is associated with fish consumption, with children consuming fish less likely to be stunted. Small fish (Kapenta) is an animal-source food that is particularly important in the diet of children in urban poor households in Zambia and contributes to better nutritional outcomes. As all small fish stem from capture fisheries, sustainable one health environmental integration, monitoring and management strategies are desirable.

Relationship of body mass index to sleep duration, and current smoking among medical students in Tabuk City, Saudi Arabia

Background

Being overweight is associated with cardiometabolic risk, and lifestyles including smoking and good sleep hygiene are also implicated. We aimed to assess the dietary habit, time spent on social media, and sleep duration relationship to body mass index (BMI) among medical students in Tabuk, Saudi Arabia.

Methods

A cross-sectional study was conducted among 147 clinical phase medical students in the Medical College, University of Tabuk (Saudi Arabia) from January 2018 to May 2018. A checklist questionnaire was used to measure variables such as age, sex, smoking, level of exercise, whether taking meals and snacks regularly, eating fast food, fruit and vegetable consumption, sleep duration, time spent on social media, and breakfast skipping. Data were analyzed by IBM-SPSS version 20, using one-way ANOVA and Pearson's production-moment correlation (r). A p-value of less than 0.05 was considered statistically significant.

Results

Participants consisted of 51% males, mean age (Mean ± SD) was 22.90±1.27 years, sleep duration was 7.50±2.17 hours, time spent on social media was 5.54±3.49 hours, body mass index was 24.8±5.19, and breakfast skipping, fast food consumption, smoking, and regular exercise were reported in 52.4%, 87.7%, 12.9%, and 36.1% respectively. A significant negative correlation was evident between BMI and sleep duration (r= -0.185, p=0.025), cigarette smokers were more likely to be obese compared to their counterparts (27.28±6.85 vs. 24.10±4.98, p=0.018). No significant statistical relationship was evident between BMI, breakfast skipping, fast food, fruit and vegetable intake, and time spent on social media.

Conclusion

BMI was higher among smokers and those with shorter sleep duration, there was no association between BMI and other students' characteristics. Measures to smoking quitting and good sleep hygiene are recommended.

Household chaos and family sleep during infants' first year

Household chaos has been linked with dysregulated family and individual processes. The present study investigated linkages between household chaos and infant and parent sleep, a self-regulated process impacted by individual, social, and environmental factors. Studies of relations between household chaos and child sleep have focused on older children and teenagers, with little attention given to infants or parent sleep. This study examines these relationships using objective measures of household chaos and sleep while controlling for, respectively, maternal emotional availability at bedtime and martial adjustment, in infant and parent sleep. Multilevel modeling examined mean and variability of sleep duration and fragmentation for infants, mothers, and fathers when infants were 1, 3, 6, 9, and 12 months (N = 167). Results indicated infants in higher chaos homes experienced delays in sleep consolidation patterns, with longer and more variable sleep duration, and greater fragmentation. Parent sleep was also associated with household chaos such that in higher chaos homes, mothers and fathers experienced greater variability in sleep duration, which paralleled infant findings. In lower chaos homes, parents' sleep fragmentation mirrored infants' decreasingly fragmented sleep across the first year and remained lower at all timepoints compared to parents and infants in high chaos homes. Collectively, these findings indicate that after controlling for maternal emotional availability and marital adjustment (respectively) household chaos has a dysregulatory impact on infant and parent sleep. Results are discussed in terms of the potential for chaos-induced poor sleep to dysregulate daytime functioning and, in turn, place parent-infant relationships at risk. (PsycINFO Database Record