Psychometrics of the preschooler physical activity parenting practices instrument among a Latino sample

24-hour movement behaviours in the early years, potential behavioural determinants and prospective associations with growth, motor and social-emotional development: the My Little Moves study protocol

INTRODUCTION

The early years are a critical period for establishing healthy 24-hour movement behaviours (physical activity, sedentary behaviour and sleep), yet studies examining prospective associations between all 24-hour movement behaviours and young children's growth and development are lacking. The My Little Moves study aims to (1) examine the prospective association between 24-hour movement behaviours of young children (ie, 0-4 years) and their growth, motor and social-emotional development; and (2) explore potential determinants of young children's 24-hour movement behaviours from an ecological perspective, to inform public health strategies aimed at promoting healthy behaviours and development.

METHODS AND ANALYSIS

My Little Moves is a longitudinal observational cohort study, with data collection at baseline, and after 9 and 18 months follow-up. Data are collected in three subcohorts. In all subcohorts, 24-hour movement behaviours are assessed by parent-report. Additionally in subcohort 1, data on potential determinants are collected by parental questionnaires, including child, parental and environmental factors. In subcohort 2, social-emotional development is assessed using the Dutch version of the Bayley Scales of Infant and Toddler Development-third edition (Bayley-III-NL) Social Emotional Scale. In subcohort 3, data on height and weight, gross motor development, using the Bayley-III-NL Gross Motor Scale, and 7 consecutive days of 24-hour accelerometer data are collected. Hybrid model analyses are used to assess the prospective associations of 24-hour movement behaviours with young children's growth and development. Potential determinants of young children's 24-hour movement behaviours are explored using regression analysis.

ETHICS AND DISSEMINATION

The Medical Ethics Committee of the VU University Medical Center approved the protocol for the My Little Moves study (2022.0020). The results of this study will be disseminated through the network of all authors, to inform public health strategies for promoting healthy 24-hour movement behaviours and contribute to the evidence-base of recommendations for ideal 24-hour movement behaviours in young children.

Sex differences in physical activity of US children at age 13 months: child and Mother Physical Activity Study (CAMPAS)

BACKGROUND

Lower physical activity (PA) has been observed in females compared to males among preschool-aged and older children. However, the timing of when the sex gap emerges is unclear. The purpose of this study was to investigate whether females have lower PA levels than males in the early toddler age and to explore whether gross motor competency and PA parenting practices might explain a sex difference in PA.

METHODS

The study design was cross-sectional. Participants were a community-based sample of 137 children aged 10-16 months residing in US Midwest urban/suburban area. Participants' mothers completed a survey that contained a demographic questionnaire, the Ages and Stages Questionnaire gross motor competency subscale, and a PA parenting practices questionnaire. Participating children wore an ActiGraph accelerometer on their hip for 7 days. Accelerometer-measured time spent in moderate- and vigorous intensity PA (MVPA; minutes/day) and in total PA (minutes/day) were calculated. Multivariable linear regression analysis was conducted to predict MVPA and total PA by sex, gross motor competency, PA parenting practices, and socioeconomic status.

RESULTS

Among 137 participants (54.0% female), average age was 13.6 months (SD = 1.7). MVPA was 72 ± 25 and 79 ± 26 min/day for females and males, respectively (p = 0.14). Total PA was 221 ± 48 and 238 ± 47 min/day for females and males, respectively (p = 0.04). Both gross motor competency and PA-encouraging parenting practices were positively associated MVPA (p = 0.01 and p = 0.02, respectively) and total PA (p = 0.02 and p = 0.01, respectively); however, these relationships did not differ by sex (p = 0.11 and p = 0.89, respectively). After accounting for gross motor competency and PA parenting practices, total PA was 15 min/day lower among females than males (p = 0.04).

CONCLUSIONS

This cross-sectional study of US children observed a sex gap in total PA at 10-16 months of age. Gross motor development and PA parenting practices did not differ by child sex nor explain the sex difference in PA. A longitudinal investigation should follow to further narrow down when sex differences in PA emerge and to determine the factors that lead to this difference.

Sex Differences in Physical Activity of US children at age 13 months: Child and Mother Physical Activity Study (CAMPAS)

Background

Lower physical activity (PA) has been observed in females compared to males among preschool-aged and older children. However, the timing of when the sex gap emerges is unclear. The purpose of this study was to investigate whether females have lower PA levels than males in the early toddler age and to explore whether gross motor competency and PA parenting practices might explain a sex difference in PA.

Methods

The study design was cross-sectional. Participants were a community-based sample of 137 children aged 10-16 months residing in US Midwest urban/suburban area. Participants' mothers completed a survey that contained a demographic questionnaire, the Ages and Stages Questionnaire gross motor competency subscale, and a PA parenting practices questionnaire. Participating children wore an ActiGraph accelerometer on their hip for 7 days. Accelerometer-measured time spent in moderate- and vigorous intensity PA (MVPA; minutes/day) and in total PA (minutes/day) were calculated. Multivariable linear regression analysis was conducted to predict MVPA and total PA by sex, gross motor competency, PA parenting practices, and socioeconomic status.

Results

Among 137 participants (54.0% female), average age was 13.6 months (SD = 1.7). MVPA was 72 ± 25 and 79 ± 26 minutes/day for females and males, respectively (p = 0.14). Total PA was 221 ± 48 and 238 ± 47 minutes/day for females and males, respectively (p = 0.04). Both gross motor competency and PA-encouraging parenting practices were positively associated MVPA (p = 0.01 and p = 0.02, respectively) and total PA (p = 0.02 and p = 0.01, respectively); however, these relationships did not differ by sex (p = 0.11 and p = 0.89, respectively). After accounting for gross motor competency and PA parenting practices, total PA was 15 minutes/day lower among females than males (p = 0.04).

Conclusions

This cross-sectional study of US children observed a sex gap in total PA at 10-16 months of age. Gross motor development and PA parenting practices did not differ by child sex nor explain the sex difference in PA. A longitudinal investigation should follow to further narrow down when sex differences in PA emerge and to determine the factors that lead to this difference.

The Dimensionality, Consistency, and Structural Validity of an Instrument Used to Measure Obesogenic Attitudes in Parents from Southern Spain (The PRELSA Scale)

(1) Background: We aimed to analyze the dimensionality, internal consistency, and structural validity of the Preschool Eating, Lifestyle, and Sleeping Attitudes Scale (PRELSA Scale), which is an instrument that was designed to measure obesogenic behaviors. (2) Methods: We carried out an observational study by means of an online survey. The PRELSA Scale consists of 13 dimensions and 60 items relating to the most common obesogenic behaviors and attitudes. Additionally, we obtained sociodemographic characteristics and concrete habits from the sample. We obtained the responses of 791 parents and caregivers of preschool children between 2 and 6 years of age in Andalusia (southern Spain). We analyzed dimensionality through an Exploratory Factor Analysis (EFA), consistency through Cronbach's Alpha, structural validity through a Confirmatory Factor Analysis (CFA), and measurement invariance with multigroup CFA models. (3) Results: The EFA showed a 14-dimensional structure with 48 items. The internal consistency was acceptable in all dimensions (Cronbach's Alpha range of 0.72 to 0.97). The structure was confirmed in the CFA with good fit indices (CFI and TLI > 0.9 and RMSEA < 0.05). We ensured that the scale had measurement invariance regarding education, income, and marital status. (4) Conclusions: The PRELSA Scale shows promising properties that have the potential to measure obesogenic behaviors in Spain, which could be the basis for future interventions associated with the prevention of childhood obesity in healthcare and educational settings.

Psychometric properties of the Portuguese version of the physical activity parenting practices questionnaire

BACKGROUND

Adopting a healthy lifestyle, including regular physical activity, is often part of interventions targeting childhood overweight and obesity. However, to properly inform the objectives of the intervention, reliable psychometric measures are needed to better understand children's and their families necessities and characteristics.

OBJECTIVES

To evaluate the psychometric properties of the Physical Activity Parenting Practices questionnaire in a community sample of Portuguese parents of children aged 5-10, assess measurement invariance across children's weight status, and construct validity.

METHODS

Five hundred three parents completed the Portuguese version of the Physical Activity Parenting Practices (PAPP) questionnaire, a sociodemographic questionnaire, the Comprehensive Feeding Practices Questionnaire, and the Lifestyle Behavior Checklist. A subsample (n = 125) completed the PAPP questionnaire 1 month later. Data analyses were performed using R's lavaan (version 0.6-12) and psych (version 2.2.9) packages.

RESULTS

Confirmatory factor analyses revealed good psychometric properties for the PAPP's single-factor Encouragement scale and the three-factor Discouragement scale. Configural, metric, and scalar invariance were found across parents of children with different weight statuses for both scales' factor structures. Internal reliability ranged from α = .64 to α = .89, and test-retest reliability ranged from r = .57 to r = .74.

CONCLUSIONS

The constructs evaluated by PAPP questionnaire revealed adequate validity. The Portuguese version of the PAPP questionnaire is a reliable measure to assess relevant physical activity parenting practices, capable of differentiating the practices of parents with children of different weight statuses, and useful for both research and intervention purposes.

The Preschool Eating, Lifestyle, and Sleeping Attitudes Scale (PRELSA Scale): Construction and Pilot Testing of a Tool to Measure Factors Associated with Childhood Obesity

(1) Background: Childhood obesity poses a global health challenge. In the period from two to six years, the fundamental risk factors are associated with modifiable habits, related to parental attitudes. In this study, we will analyze the construction and pilot test of the PRELSA Scale, designed to be a comprehensive tool that covers the whole problem of childhood obesity, from which we can later develop a brief instrument. (2) Methods: First, we described the scale construction process. After that, we conducted a pilot test on parents to check the instrument's comprehensibility, acceptability, and feasibility. We detected items to be modified or eliminated through two criteria: the frequencies of the categories of each item and responses in the Not Understood/Confused category. Finally, we sought expert opinion through a questionnaire to ensure the content validity of the scale. (3) Results: The pilot test on parents detected 20 possible items for modification and other changes in the instrument. The experts' questionnaire showed good values on the scale's content, highlighting some feasibility problems. The final version of the scale went from 69 items to 60. (4) Conclusions: Developing scales that detect parental attitudes associated with the onset of childhood obesity may be the basis for future interventions to address this health challenge.

Parental Influences on Physical Activity and Screen Time among Preschool Children from Low-Income Families in Brazil

Background: Children from low-middle income countries (LMIC) are disproportionately affected by obesity, and low physical activity (PA) and high screen time (ST) are major contributors. Parents are key influencers on children's PA and ST, yet, no study has investigated relationships between parenting practices and children's PA and ST in LMIC families. This study examined parental influences on PA and ST among preschool-aged children from low-income families in Brazil. Methods: Parents completed a validated, culturally adapted interviewer-administered survey assessing child ST and parenting practices. Child sedentary time, total movement, and energetic play were measured by accelerometery. Results: Data were available on 77 parent-child dyads [mean age 4.6 years (standard deviation = 0.8), 53% male, and 41% mixed-race]. Parenting practices associated with greater PA were use of PA to reward/control behavior (rho = 0.34-0.49), limiting or monitoring ST (rho = 0.30), explicit modeling/enjoyment of PA (rho = 0.24), verbal encouragement for PA (rho = 0.30), and importance and value of PA (rho = 0.24-0.38; p < 0.05). Parenting practices associated with higher ST were rules around active play indoor (rho = 0.23), use of ST to reward/control behavior (rho = 0.30), exposure to screens (rho = 0.40), and explicit modeling/enjoyment of ST (rho = 0.50; p < 0.05). Conclusion: Recognized parenting practices such as explicit modeling of PA and ST, monitoring and limiting ST, and rules and restrictions about PA and ST are associated with young children's PA and ST in low-income Brazilian families. The findings identify potential targets for family-based interventions to promote healthy lifestyle behaviors and prevent childhood obesity.

Family‐based interventions for preventing overweight or obesity among preschoolers from racial/ethnic minority groups: A scoping review

Objective

This scoping review aimed to synthesize the published literature on family‐based childhood obesity prevention interventions from 2015 to 2021 that focused on children 2–5 years of age from racial and/or ethnic minority households.

Methods

A PICOS (population, intervention, comparison, outcome, and setting) framework was used to guide the development of the research question, search strategy, and inclusion/exclusion criteria. To be included, the study must have been a randomized controlled trial or quasi‐experimental trial that enrolled participants 2–5 years of age and their caregivers who identified as being from a racial and/or ethnic minority group in the United States. The study must have also examined a family‐based intervention that incorporated components to prevent childhood obesity (i.e., fruits and vegetable intake, parental responsive feeding, physical activity), be conducted in a remote (i.e., online, text, mail), home, community, primary care setting, or early childhood education institution setting, and report on body mass index (BMI, kg/m²), BMI z‐score, anthropometric measures (weight, waist circumference, fat mass, etc.), changes in health behaviors, or increase in nutritional knowledge.

Results

Fourteen individual studies were identified. Most interventions used multiple components for promoting nutritional knowledge and behavioral changes among families. Eight interventions included culturally tailored components targeting four aspects: (1) language barriers, (2) food choices, (3) relationships between family members, and (4) rapport building.

Conclusions

There is limited research in this field focusing on children from racial and/or ethnic minority groups. Future efforts should invest in developing culturally appropriate interventions for these groups.

Parent-perceived neighbourhood environment, parenting practices and preschool-aged children physical activity and screen time: a cross-sectional study of two culturally and geographically diverse cities

BACKGROUND

Preschool-aged children's physical activity (PA) and screen time (ST) are important health-related behaviours likely influenced by PA opportunities, parental perceptions of neighbourhood safety and parenting practices pertaining to PA and ST. How these factors interact to impact on young children's PA and ST, and whether their effects are generalisable across cultures and geographical location is not known. This study addressed these knowledge gaps by conducting pooled analyses of comparable data from two culturally and geographically diverse samples - Chinese parent-child dyads from an ultra-dense city (Hong Kong, China) and Latino parent-child dyads from a low-density city (Houston, USA).

METHODS

The analytical sample consisted of 164 Hong Kong Chinese and 84 US Latino parent-child dyads with data on socio-demographic characteristics, parent-perceived neighbourhood destinations and facilities for children's PA, physical and social safety-related neighbourhood attributes, PA-related parenting practices and child's ST and accelerometer-assessed PA. Generalised linear models with robust standard errors accounting for neighbourhood-level clustering were used to estimate associations and interaction effects.

RESULTS

Hong Kong Chinese children accumulated less PA than US Latino children, although the latter had more ST. Hong Kong Chinese parents reported more parenting practices promoting inactivity. Neighbourhood PA opportunities were positively related to children's PA only if parental perceptions of neighbourhood safety were favourable, and the associations of physical neighbourhood environment characteristics with children's PA and ST depended on PA-related parenting practices. Community cohesion was positively related to children's PA and negatively related to ST, while parental promotion of ST was positively associated with children's ST. Correlates of children's PA and ST did not differ by city.

CONCLUSIONS

The substantial differences in activity patterns between Hong Kong Chinese and US Latino preschool-aged children observed in this study are likely due to a combination of cultural and built environmental factors. However, the fact that no between-city differences in correlates of PA and ST were detected indicates that both populations of children are equally affected by parent-perceived neighbourhood environmental characteristics and parenting practices. Overall, this study highlights the importance of considering how various individual-, home- and neighbourhood physical and social factors interact to influence young children's health-promoting activity levels.

Psychometric properties of instruments to measure parenting practices and children's movement behaviors in low-income families from Brazil

Background

Childhood obesity has increased remarkably in low and middle-income (LMIC) countries. Movement behaviors (physical activity, screen time, and sleep) are crucial in the development of overweight and obesity in young children. Yet, few studies have investigated the relationship between children’s movement behaviors and parenting practices because validated measures for use among families from LMIC are lacking. This study evaluated the psychometric properties of previously validated measures of young children’s physical activity, screen time, and sleep and parenting practices, translated and culturally adapted to Brazilian families.

Methods

A total of 78 parent-child dyads completed an interviewer-administered survey twice within 7 days. Child physical activity, sedentary time and sleep were concurrently measured using a wrist-worn accelerometer. Internal consistency and test-retest reliability was assessed using McDonald’s Omega and Intraclass Correlation Coefficients (ICC’s). Concurrent validity was evaluated by calculating Spearman correlations between parent reported child behaviors and accelerometer measured behaviors.

Results

Seventeen of the 19 parenting practices scales exhibited acceptable internal consistency reliability (Ω ≥ 0.70). Test-retest reliability ICC’s were acceptable and ranged from 0.82 - 0.99. Parent reported child physical activity was positively correlated with objectively measured total movement (rho= 0.29 - 0.46, p < .05) and energetic play (rho= 0.29 – 0.40, p < .05). Parent reported child screen time was positively correlated with objectively measured sedentary time; (rho = 0.26, p < .05), and inversely correlated with total movement (rho = - 0.39 – - 0.41, p < .05) and energetic play (rho = - 0.37 – - 0.41, p < .05). Parent reported night-time sleep duration was significantly correlated with accelerometer measured sleep duration on weekdays (rho = 0.29, p < .05), but not weekends.

Conclusions

Measurement tools to assess children’s movement behaviors and parenting practices, translated and culturally adapted for use in Brazilian families, exhibited acceptable evidence of concurrent validity, internal consistency, and test-retest reliability.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12874-021-01320-y.

Involving Parents in Promoting Healthy Energy Balance-Related Behaviors in Preschoolers: A Mixed Methods Impact and Process Evaluation of SuperFIT

Parental involvement is an essential component of obesity prevention interventions for children. The present study provides a process and impact evaluation of the family component of SuperFIT. SuperFIT is a comprehensive, integrated intervention approach aiming to improve energy balance-related behaviors (EBRBs) of young children (2-4 years). A mixed methods design combined in-depth interviews with parents (n = 15) and implementers (n = 3) with questionnaire data on nutritional and physical activity-related parenting practices (CFPQ and PPAPP), the physical home environment (EPAO_SR) (n = 41), and intervention appreciation (n = 19). Results were structured using the concepts of reach, adoption, implementation, and perceived impact. Findings indicated that the families reached were mostly those that were already interested in the topic. Participants of the intervention appreciated the information received and the on-the-spot guidance on their child's behavior. Having fun was considered a success factor within the intervention. Parents expressed the additional need for peer-to-peer discussion. SuperFIT increased awareness and understanding of parents' own behavior. Parents made no changes in daily life routines or the physical home environment. Translating knowledge and learned strategies into behavior at home has yet to be achieved. To optimize impact, intervention developers should find the right balance between accessibility, content, and intensity of interventions for parents.

Exploring Correlates of Preschool-Aged Children's Locomotor Skills: Individual and Parent Demographics and Home Environment

We examined individual and parental demographics and home environment factors associated with locomotor skills in predominantly Hispanic preschool-aged children. We used questionnaires to survey parents, included inquiries regarding parenting practices, parents' physical activity levels, and home-based physical activity resources; and we administered the Progressive Aerobic Cardiovascular Endurance Run (PACER) and the CHAMPS Motor Skills Protocol (CMSP) to children to measure the quantity and quality of their locomotor skills. Participants were 144 parents and their children (78.9% Hispanic, 49.3% girls) recruited from urban, community-based childcare and education centers. We examined the relationship between survey measures and PACER and CMSP scores with forward-selection stepwise linear regression models. Overall, 142 children completed the PACER, and 91 completed the CMSP. At the individual level, a child's age was positively associated with both PACER and CMSP scores, and girls had lower PACER scores than boys. In the home environment, parental promotion of more screen time was associated with a higher children's PACER score. In addition, higher parent concern for children's safety was associated with a lower PACER score. We identified several physical activity promoting parent practices as new home environment factors related to the preschool-aged children's locomotor development. Additional studies are needed to test new hypotheses generated from these data. ClinicalTrials.gov Identifier: NCT03261492 (date of registration 8/25/17).

Are associations between home environment and preschool children's sedentary time influenced by parental educational level in a cross-sectional survey?

Background

Childhood obesity is a major public health concern, especially in low socioeconomic groups. Sedentary time (SED) is an important predictor of obesity. To be able to diminish SED it is important to find modifiable predictors of sedentary behavior. The home environment associated with children’s SED may vary by parental socioeconomic status. This study aims to clarify the association between parental educational level (PEL) and the home environment of 3–6-year-old children, and to examine how home environment associates with children’s SED, and whether PEL modifies these associations.

Methods

A cross-sectional Increased health and wellbeing in preschools (DAGIS) study was conducted in 2015–2016 in Finland. The parents (n = 809) filled in questionnaires assessing PEL, and the home physical and social environment related to children’s SED. Children’s SED was measured with accelerometers, which the children (n = 745) wore for 1 week.

Results

High PEL was associated with a home environment restraining sedentary behaviour compared with low PEL. Stricter descriptive norms about screen time, considering it important to limit the child’s screen time, and satisfaction about the child’s screen time associated with children’s lower SED. The association with parental psychological control and SED was influenced by PEL. In the PEL stratified analyses, however, the associations between psychological control and SED did not reach statistical significance.

Conclusions

Future interventions aiming to decrease SED should pay attention to relevant factors in children’s sedentary behaviour home environment. It is important to acknowledge the possible PEL differences in these factors.

Cross-Cultural Adaptation of Instruments Measuring Children's Movement Behaviors and Parenting Practices in Brazilian Families

Childhood obesity is a global problem, disproportionately affecting children in low-to-middle income countries (LMIC). Despite this evidence, no previous study has adapted instruments measuring children’s movement behaviors and associated parenting practices for use in LMIC families. This study reports the results of a cross-cultural adaptation of previously validated measures of children’s movement behaviors and parenting practices in economically disadvantaged Brazilian families. Study 1 involved translation of the instruments from English to Portuguese. A team of translators (fluent in both English and Portuguese) and researchers followed established procedures for translating measurement scales, identifying problematic items, and reaching consensus on discrepancies. Study 2 involved cognitive interviews with 24 parents from urban and rural North-eastern Brazil addressing the format, content, and clarity of the items. Half the parents provided feedback on the first 33 items of the questionnaire, with the remaining parents providing feedback on the final 29 items. Notes were recorded during the interview and parents’ feedback summarized in a report. In the translation and back-translation, 15 discrepancies were identified. These were mostly due to multiple Portuguese words having the same meaning in English. The research team discussed these discrepancies and consensus was reached to ensure that the concepts depicted in the Portuguese version were consistent with the English version. In the cognitive interviews, parents identified minor problems with item comprehension resulting in minor adaptations to response options, recall period, and format of the questionnaire. The process of translation and cognitive interviews conducted in Brazilian families resulted in an appropriate cultural adaptation of scales measuring children’s movement behaviors and parenting practices. Future studies should evaluate the validity and reliability of the measures in LMIC families.

Identification of Measurement Needs to Prevent Childhood Obesity in High-Risk Populations and Environments

INTRODUCTION

Children at highest obesity risk include those from certain racial/ethnic groups, from low-income families, with disabilities, or living in high-risk communities. However, a 2013 review of the National Collaborative for Childhood Obesity Research Measures Registry identified few measures focused on children at highest obesity risk. The objective is to (1) identify individual and environmental measures of diet and physical activity added to the Measures Registry since 2013 used among high-risk populations or settings and (2) describe methods for their development, adaptation, or validation.

METHODS

Investigators screened references in the Measures Registry from January 2013 to September 2017 (n=351) and abstracted information about individual and environmental measures developed for, adapted for, or applied to high-risk populations or settings, including measure type, study population, adaptation and validation methods, and psychometric properties.

RESULTS

A total of 38 measures met inclusion criteria. Of these, 30 assessed individual dietary (n=25) or physical activity (n=13) behaviors, and 11 assessed the food (n=8) or physical activity (n=7) environment. Of those, 17 measures were developed for, 9 were applied to (i.e., developed in a general population and used without modification), and 12 were adapted (i.e., modified) for high-risk populations. Few measures were used in certain racial/ethnic groups (i.e., American Indian/Alaska Native, Hawaiian/Pacific Islander, and Asian), children with disabilities, and rural (versus urban) communities.

CONCLUSIONS

Since 2013, a total of 38 measures were added to the Measures Registry that were used in high-risk populations. However, many of the previously identified gaps in population coverage remain. Rigorous, community-engaged methodologic research may help researchers better adapt and validate measures for high-risk populations.

Development of a measure of the relative reinforcing value of food versus parent-child interaction for young children

The relative reinforcing value (RRV) of food captures individual differences in the motivation to eat and is associated with weight status among infants, children, and adults. Currently, there is no concurrent measure of the RRV of food versus a non-food alternative for 4-to-5-year-old children. The present study aimed to develop and validate a measure of the RRV of food versus time spent interacting with a parent in the context of reading among 4-to-5-year-old children. The first phase of the study involved an online survey. Parents of 4-to-5 year olds (n = 102) reported their children's consumption frequency and liking for thirty-six snack foods. A priori criteria were used to identify snacks that were well-liked and served at least sometimes for use in the subsequent laboratory study. Then, a validation study was conducted in the laboratory to examine the construct validity of the finalized RRV task. Thirty-one parent-child dyads completed a laboratory visit, in which children's RRV of food versus time spent reading with a parent was measured concurrently on a progressive ratio reward schedule. Linear regression was used to assess validity of the task. Children's RRV of food positively and significantly predicted BMI z-scores among children with complete data (B = 0.41, p < 0.05, n = 28). Maximum schedules reached for food also positively and significantly predicted BMI z-scores (B = 0.30, p < 0.05). The relationship between maximum schedules reached for parent-child reading and BMI z-scores was in the expected direction, but this relationship was non-significant. Results support the validity and feasibility of the RRV paradigm used in the present study. Future research could continue to examine the measurement properties of this paradigm, as well as the potential for positive parent-child interactions to serve as a novel alternative to food.

Study Protocol for the Evaluation of "SuperFIT", a Multicomponent Nutrition and Physical Activity Intervention Approach for Preschools and Families

The promotion of healthy energy balance-related behaviours (EBRB) is already important for children at a young age. Different settings, for example childcare and home, play an important role in the EBRB of young children. Further, factors in different types of environment (e.g., physical, sociocultural and political) influence their behaviours. SuperFIT (Systems of Underprivileged Preschoolers in their home and preschool EnviRonment: Family Intervention Trial) is a comprehensive, integrated intervention approach for 2-4 year old children. This paper describes the development and design of the evaluation of SuperFIT. The SuperFIT intervention approach consists of preschool-based, family-based, and community-based components. Intervention activities aimed at changing the physical, sociocultural and political environments in each setting and establishing an increased alignment between the settings. A quasi-experimental design was adopted with twelve intervention and nine control preschools to evaluate effectiveness. The primary outcomes were Body Mass Index (BMI) z-scores (objectively assessed height and weight), dietary intake (24 h recall), and physical activity (accelerometer) of the children. Further, the effects on the nutrition- and physical activity-related practices of preschool teachers and parents were evaluated (questionnaires). Intervention effectiveness was evaluated using linear mixed models. Process evaluation was performed using mixed methods; both quantitative (questionnaires) and qualitative (observations and in-depth interviews) measures were used. The comprehensive, integrated approach of SuperFIT is expected to support healthy EBRB in young children.

Competency-Based Approaches to Community Health: A Randomized Controlled Trial to Reduce Childhood Obesity among Latino Preschool-Aged Children

Background: Health behavior change interventions that target childhood obesity in minority populations have led to inconsistent and short-lived results. The purpose of this study was to test a novel intervention that was personalized and family-based in a Latino population to reduce childhood obesity. Methods: Competency-Based Approaches to Community Health (COACH) was a randomized controlled trial. Latino parent-child pairs were recruited from community settings in Nashville, TN. Child eligibility criteria included age 3-5 years and a BMI ≥50th percentile. The intervention included 15 weekly, 90-minute sessions followed by 3 months of twice-monthly health coaching calls. The control group was a twice-monthly school readiness curriculum for 3 months. Sessions were conducted by a health coach in local community centers, with groups of 8-11 parent-child pairs. The primary outcome was child BMI trajectory across 12 months, measured at four times. The intervention's effect was assessed by using a longitudinal, linear mixed-effects growth model, adjusting for child gender, baseline child and parent age, and baseline parent BMI and education. Results: Of the 305 parent-child pairs assessed for eligibility, 117 were randomized (59 intervention, 58 control). Child BMI was available for 91.5% at 1-year follow-up. Mean baseline child age was 4.2 [standard deviation (SD) = 0.8] years, and 53.8% of children were female. Mean baseline child BMI was 18.1 (SD = 2.6) kg/m². After adjusting for covariates, the intervention's effect on linear child BMI growth was -0.41 kg/m² per year (95% confidence interval -0.82 to 0.01; p = 0.05). Conclusions: Over 1-year follow-up, the intervention resulted in slower linear BMI growth for Latino preschool-aged children from poverty.

The Obesity Parenting Intervention Scale: Factorial Validity and Invariance Among Head Start Parents

INTRODUCTION

Obesity affects 15.7% of U.S. preschoolers, with higher rates among low-income and Spanish-speaking populations. Food, physical activity, and sleep parenting practices, referred to collectively as obesity-related parenting practices, are linked with children's risk of obesity and are a common target in family-based obesity interventions. Yet, there is no brief, validated measure of obesity-related parenting practices that is appropriate for use in intervention studies and for diverse audiences. This study tests the factorial validity of a brief measure of obesity-related parenting and measurement invariance of the English and Spanish versions of the scale, as well as among mothers and fathers.

METHODS

Parents of children enrolled in Head Start (n=578; 500 mothers and 78 fathers) completed a brief survey of food (7 items), physical activity (5 items), and sleep parenting (3 items) in fall of 2017 and 2018. Scale items were drawn from existing measures and the evidence base, initially drafted in English, and then translated to Spanish. One parent per family completed the scale independently in English (n=448) or Spanish (n=130). A confirmatory factor analysis framework was adopted to test a 3-factor model for the total sample. Multi-group structural equation modeling was used to assess measurement invariance of the scale by the language of administration (English or Spanish) and among mothers and fathers separately.

RESULTS

Results supported a 3-factor model of obesity parenting with a single factor each for food, physical activity, and sleep parenting. There was statistically significant measurement invariance across all groups (p<0.05). Internal consistency was adequate across factors (α=0.65-0.80).

CONCLUSIONS

This brief obesity-parenting scale demonstrates adequate factorial validity in English and Spanish and among mothers and fathers. This measure has been integrated into an intervention, and future work will test sensitivity to change.

Unravelling the Effects of the Healthy Primary School of the Future: For Whom and Where Is It Effective?

The 'Healthy Primary School of the Future' (HPSF) aims to integrate health and well-being within the whole school system. This study examined the two-year effects of HPSF on children's dietary and physical activity (PA) behaviours at school and at home and investigated whether child characteristics or the home context moderated these effects. This study (n = 1676 children) has a quasi-experimental design with four intervention schools, i.e., two full HPSF (focus: nutrition and PA), two partial HPSF (focus: PA), and four control schools. Measurements consisted of accelerometry (Actigraph GT3X+) and questionnaires. Favourable effects on children's dietary and PA behaviours at school were found in the full HPSF; in the partial HPSF, only on PA behaviours. Children in the full HPSF did not compensate at home for the improved health behaviours at school, while in the partial HPSF, the children became less active at home. In both the full and partial HPSF, less favourable effects at school were found for younger children. At home, less favourable effects were found for children with a lower socioeconomic status. Overall, the effect of the full HPSF on children's dietary and PA behaviours was larger and more equally beneficial for all children than that of the partial HPSF.

Association Between Moderate and Vigorous Physical Activity and Gross Motor Coordination in Preschool Children

Introduction: Adequate gross motor coordination is essential for children participating in age-related physical activities and has an important role in maintaining sufficient physical activity levels during the life course. Aim: To examine the association between moderate-to-vigorous physical activity (MVPA) and gross motor coordination during sedentary behavior in early childhood (ages 3–6 y). Methods: The sample comprised 209 children aged 3–6 y. Gross motor coordination was assessed according to the Movement Assessment Battery for Children (MABC-2). The battery to assess gross motor coordination comprised the aiming and catching, and balance components. MVPA was measured by accelerometry worn for 7 consecutive days (Monday to Sunday). Results: Our data indicated that 31.5% of the sample had low, 32.5% medium, and 36.0% high gross motor coordination. Multiple linear regression analysis showed that MVPA was positively associated with gross motor coordination, adjusted for gender and sedentary behavior. Conclusions: Preschoolers with high gross motor coordination spend more time in MVPA. Gross motor coordination development should therefore be a key strategy in childhood interventions aiming to promote physical activity.

Associations of Socio-demographic, Family, and Neighborhood Factors with Physical Activity-Related Parenting Practices Among Hong Kong Preschoolers' Parents

Objectives Regular engagement in physical activity (PA) has numerous health benefits in young children. Young children's parents can influence their children's PA behavior through different PA-related parenting practices. This cross-sectional study examined the independent contributions of socio-demographic, family/home and parent-perceived neighborhood environmental characteristics explaining PA-related parenting practices encouraging or discouraging PA among Hong Kong preschool-aged children (3-5 years-old). Methods Hong Kong Chinese preschoolers' parents were recruited from pre-selected kindergartens and Maternal and Child Health Centers located in areas stratified by residential density and socio-economic status. They self-completed socio-demographic, family/home and perceived neighborhood characteristics and PA-related parenting practices questionnaires. Generalized linear models were used to examine associations of socio-demographic, family/home and neighborhood variables with PA-related parenting practices. Results Socio-demographic and family/home characteristics were significantly correlated with parenting practices encouraging and discouraging PA. Parent-perceived neighborhood characteristics were significantly correlated with parenting practices discouraging PA only. Conclusions for Practice This study identified correlates of PA-related parenting practices among parents of Hong Kong Chinese preschoolers. The findings suggest future PA-promoting interventions among Chinese preschoolers via the promotion of parenting practices encouraging children's PA should consider multiple factors, including family relationships and childcare sharing, promotion of PA and its benefits among parents, and neighborhood social cohesion, traffic safety and safety from crime.

The Moderating Role of the School Context on the Effects of the Healthy Primary School of the Future

Background: The current study investigated the moderating role of the school context on the effects of a Dutch health promoting school initiative on children's health and health behaviors. Methods: The study used a mixed-methods design. The school context (n = 4) was assessed by the characteristics of the school population, teacher's health-promoting (HP) practices, implementers' perceived barriers, school's HP elements, and dominating organizational issues. Outcomes included objectively assessed BMI z-scores and physical activity (PA), and parent and child-reported dietary intake. Analyses included linear mixed models (four intervention schools versus four control schools), and qualitative comparisons between intervention schools with similar HP changes. Results: Effects on outcomes varied considerably across schools (e.g., range in effect size on light PA of 0.01-0.26). Potentially moderating contextual aspects were the child's socioeconomic background and baseline health behaviors; practices and perceived barriers of employees; and organizational issues at a school level. Conclusions: Similar HP changes lead to different outcomes across schools due to differences in the school context. The adoption of a complex adaptive systems perspective contributes to a better understanding of the variation in effects and it can provide insight on which contextual aspects to focus on or intervene in to optimize the effects of HP initiatives.

Process evaluation of the healthy primary School of the Future: the key learning points

Background

While schools have potential to contribute to children’s health and healthy behaviour, embedding health promotion within complex school systems is challenging. The ‘Healthy Primary School of the Future’ (HPSF) is an initiative that aims to integrate health and well-being into school systems. Central to HPSF are two top-down changes that are hypothesized as being positively disruptive to the Dutch school system: daily free healthy lunches and structured physical activity sessions. These changes are expected to create momentum for bottom-up processes leading to additional health-promoting changes. Using a programme theory, this paper explores the processes through which HPSF and the school context adapt to one another. The aim is to generate and share knowledge and experiences on how to implement changes in the complex school system to integrate school health promotion.

Methods

The current study involved a mixed methods process evaluation with a contextual action-oriented research approach. The processes of change were investigated in four Dutch primary schools during the development year (2014–2015) and the first two years of implementation (2015–2017) of HPSF. The schools (each with 15–26 teachers and 233–389 children) were in low socio-economic status areas. Measurements included interviews, questionnaires, observations, and analysis of minutes of meetings.

Results

Top-down advice, combined with bottom-up involvement and external practical support were key facilitators in embedding HPSF within the schools’ contexts. Sufficient coordination and communication at the school level, team cohesion, and feedback loops enhanced implementation of the changes. Implementation of the healthy lunch appeared to be disruptive and create momentum for additional health-promoting changes.

Conclusions

Initiating highly visible positive disruptions to improve school health can act as a catalyst for wider school health promotion efforts. Conditions to create a positive disruption are enough time, and sufficient bottom-up involvement, external support, team cohesion and coordination. The focus should be on each specific school, as each school has their own starting point and process of change.

Trial registration

The study was retrospectively registered in the ClinicalTrials.gov database on 14 June 2016 (NCT02800616).

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6947-2) contains supplementary material, which is available to authorized users.

Parenting practices that may encourage and discourage physical activity in preschool-age children of Brazilian immigrant families: A qualitative study

Brazilians are a rapidly increasing Latino immigrant group in the United States (US), yet little research has examined factors influencing physical activity (PA) levels and behaviors of children growing up in Brazilian immigrant families. This information is needed to develop culturally sensitive interventions tailored to this population. Therefore, this qualitative study explored PA parenting practices used by Brazilian immigrant mothers living in the US. Thirty-seven Brazilian immigrant mothers with at least one child between the ages of 2 and 5 years participated in 1of 7 focus group discussions. Thematic analysis identified seven parenting practices that mothers employ that may encourage or facilitate physical activity their preschool-aged children's PA including: 1) modeling PA; 2) engaging and being physically active with child; 3) providing logistic support; 4) encouraging, praising, and offering motivational support; 5) watching, supervising, and teaching children how to engage in PA; 6) monitoring and setting limits to child's screen time; and 7) prompting child to be physically active. In addition, analysis identified four parenting practices that may discourage or inhibit children's PA including: 1) modeling of sedentary behaviors; 2) having rules and restrictions due to safety- and weather-related concerns; 3) limiting child's outdoor time due to parental time constraints; and 4) restricting child's outdoor and play time as punishment. Furthermore, analyses demonstrated that social contextual factors (e.g., income, housing, neighborhood safety, etc.) influence mothers' PA parenting practices and consequently, their children's PA. This is the first qualitative study, to our knowledge, to explore PA parenting practices of Brazilian-born immigrant mothers living in the US. Future research should further explore PA parenting practices of Brazilian immigrant parents including quantifying PA parenting practices that encourage and discourage PA, as well as examining the influence of fathers' PA parenting practices on young children's PA.

A preschool-based intervention for Early Childhood Education and Care (ECEC) teachers in promoting healthy eating and physical activity in toddlers: study protocol of the cluster randomized controlled trial PreSchool@HealthyWeight

BACKGROUND

Interventions to prevent overweight and obesity in toddlers are needed to minimize health inequalities, especially in migration and lower socio-economic groups. Preschools are identified as important environments for interventions to prevent overweight and obesity. Early Childhood Education and Care (ECEC) teachers in preschools are potential key actors in promoting healthy eating and physical activity. This paper describes the research design of a Dutch preschool-based intervention for ECEC teachers in promoting healthy eating and physical activity in toddlers.

METHODS

PreSchool@HealthyWeight concerns a cluster randomized controlled trial on preschools in Amsterdam Nieuw-West, Netherlands. This city district is characterised by inhabitants with a migration background and low socio-economic status. Forty-one preschools, with 115 ECEC teachers and 249 toddlers/parents, were randomly allocated to an intervention or control group. An intervention for teachers will be carried out on intervention locations and consists of modified versions of 2 existing programs: 'A Healthy Start' and 'PLAYgrounds'. In 'A Healthy Start', ECEC teachers learn to provide a healthy and active environment for toddlers. The 'PLAYgrounds for Toddlers' program, coaches ECEC teachers to stimulate physical activity in the playgrounds of preschools. PreSchool@HealthyWeight aims to evaluate the effectiveness of the intervention after 9 months. Primary outcomes are the teachers' knowledge, attitude and practices concerning healthy eating and physical activity, and consequently the level of confidence of ECEC teachers in promoting healthy eating and physical activity in toddlers. Secondary outcomes include the Body Mass Index, body composition, dietary intake and physical activity level of teachers and toddlers. In addition, the activating role of ECEC teachers and the physical activity of toddlers on the playgrounds will be evaluated. Lastly, the knowledge, attitude and practices of parents concerning healthy eating and physical activity will be assessed.

DISCUSSION

It is hypothesized that this preschool-based intervention for ECEC teachers improves the knowledge, attitude and practices regarding healthy eating and physical activity, and consequently the level of confidence of ECEC teachers in promoting healthy eating and physical activity of toddlers. The intervention addresses the call for early intervention to prevent overweight and obesity and to minimize health inequalities.

TRIAL REGISTRATION

Netherlands Trial Register (NTR): NL5850 . Date registered: August 26, 2016.

Design and methodology of a cluster-randomized trial in early care and education centers to meet physical activity guidelines: Sustainability via Active Garden Education (SAGE)

Strategies are needed to help early care and education centers (ECEC) comply with policies to meet daily physical activity and fruit and vegetable guidelines for young children. This manuscript describes the design and methodology of Sustainability via Active Garden Education (SAGE), a 12-session cluster-randomized controlled crossover design trial using community-based participatory research (CBPR) to test a garden-based ECEC physical activity and fruit and vegetables promotion intervention for young children aged 3-5 years in 20 sites. The SAGE curriculum uses the plant lifecycle as a metaphor for human development. Children learn how to plant, water, weed, harvest, and do simple food preparation involving washing, cleaning, and sampling fruit and vegetables along with active learning songs, games, science experiments, mindful eating exercises, and interactive discussions to reinforce various healthy lifestyle topics. Parents will receive newsletters and text messages linked to the curriculum, describing local resources and events, and to remind them about activities and assessments. Children will be measured on physical activity, height, and weight and observed during meal and snack times to document dietary habits. Parents will complete measures about dietary habits outside of the ECEC, parenting practices, home physical activity resources, and home fruit and vegetable availability. SAGE fills an important void in the policy literature by employing a participatory strategy to produce a carefully crafted and engaging curriculum with the goal of meeting health policy guidelines and educational accreditation standards. If successful, SAGE may inform and inspire widespread dissemination and implementation to reduce health disparities and improve health equity.

The Healthy Primary School of the Future: A Contextual Action-Oriented Research Approach

Background: Schools can play an important role in promoting children’s health behaviours. A Dutch initiative, ‘The Healthy Primary School of the Future’, aims to integrate health and well-being into the school system. We use a contextual action-oriented research approach (CARA) to study the implementation process. Properties of CARA are its focus on contextual differences and the use of monitoring and feedback to support and evaluate the process of change. The aim of this article is to describe the use of the approach. Methods: Four schools (each with 200–300 children, aged 4–12 years) were included; all located in low socio-economic status areas in the south of the Netherlands. Data collection methods include interviews, observations, questionnaires, and health and behavioural measurements. Research contributions include giving feedback and providing schools with a range of possibilities for additional changes. The contextual data we examine include schools’ health promoting elements, practices of teachers and parents, dominating organisational issues, and characteristics of the student population; process data include the presence of potential barriers to changes. Discussion: CARA is an adaptive research approach that generates knowledge and experiences on how to deal with health promotion in complex systems. We think this approach can set an example for research efforts in comparable initiatives.

Competency Based Approach to Community Health (COACH): The methods of a family-centered, community-based, individually adaptive obesity randomized trial for pre-school child-parent pairs

Competency-Based Approaches to Community Health (COACH) is a randomized controlled trial of a family-centered, community-based, and individually-tailored behavioral intervention for childhood obesity among Latino pre-school children. COACH focuses on improving personal agency for health behavior change by tailoring content to overcome contextual barriers. The intervention focuses on diet, physical activity, sleep, media use, and engaged parenting. The content is individually adapted based on routine assessments of competency in specific health behaviors using a mobile health platform and novel measurement tools developed by our team. In response to these regular assessments, health coaches provide tailored health behavior change strategies to help families focus on the areas where they decide to improve the most. The intervention consists of a 15-week group-based intensive phase, with weekly sessions delivered by health coaches in community centers. Following weekly sessions, a 3-month maintenance phase of the intervention consists of twice monthly coaching calls for participants to focus on individual health goals for their families. The primary outcome of the trial is child body mass index trajectory over 1 year. Secondary outcomes include parent body mass index change, child waist circumference, child diet, child physical activity, and other psychosocial mediators of child health behavior change. The control arm consists of a school readiness intervention, delivered by the Nashville Public Library. By applying a personalized approach to child behavior change, in the setting of both family and community, COACH aims to develop sustainable solutions for childhood obesity by supporting healthy childhood growth in low-income, minority preschool children.

Energy balance-related parenting and child-care practices: The importance of meso-system consistency

Background

Our knowledge of the role of parental and child-care staff behavior in the development and prevention of obesity is rapidly increasing. Potential interaction between both settings in so-called meso-systems, as hypothesized by the ecological systems perspective, is however often ignored. Specifically, inconsistency between home and child-care is hypothesized to have negative effects on child outcomes.

Methods

Participants were recruited through 23 child-care centers in the Netherlands. Data regarding 161 child-parent-child-care staff triads were available. Parenting and child care practices were assessed using validated questionnaires for parents (Child Feeding Practices Questionnaire, Preschooler Physical Activity Parenting Practices instrument) and child-care staff (Child-care Food and Activity Practices Questionnaire), using similar items in both settings. Absolute difference scores between parents and child-care staff were calculated for each triad as a measure of meso-system consistency. Child outcomes were physical activity (as assessed by accelerometry), dietary intake (from the parental questionnaire), and measured BMI z-scores. Paired t-tests were used to examine consistency between practices in both settings. Linear regression analyses were used to explore the association of parenting practices, child-care practices and difference scores on the one hand, and child outcomes on the other.

Results

Significant differences between settings were found for almost all practices, and in most cases child-care staff scores more favorable on the practices than parents. Inconsistencies were mostly associated with unhealthy dietary intake and lower physical activity levels, but not with BMI.

Conclusion

The current study showed that inconsistencies in parenting and child-care practices exist, and that these inconsistencies seem to be associated with unhealthy behavior in children. The results underline the importance of studying meso-system influences on behavior in general, and children’s energy balance-related behavior specifically.

Study protocol of the quasi-experimental evaluation of "KEIGAAF": a context-based physical activity and nutrition intervention for primary school children

Background

The environment affects children’s energy balance-related behaviors to a considerable extent. A context-based physical activity and nutrition school- and family-based intervention, named KEIGAAF, is being implemented in low socio-economic neighborhoods in Eindhoven, The Netherlands. The aim of this study was to investigate: 1) the effectiveness of the KEIGAAF intervention on BMI z-score, waist circumference, physical activity, sedentary behavior, nutrition behavior, and physical fitness of primary school children, and 2) the process related to the implementation of the intervention.

Methods

A quasi-experimental, controlled study with eight intervention schools and three control schools was conducted. The KEIGAAF intervention consists of a combined top-down and bottom-up school intervention: a steering committee developed the general KEIGAAF principles (top-down), and in accordance with these principles, KEIGAAF working groups subsequently develop and implement the intervention in their local context (bottom-up). Parents are also invited to participate in a family-based parenting program, i.e., Triple P Lifestyle. Children aged 7 to 10 years old (grades 4 to 6 in the Netherlands) are included in the study. Effect evaluation data is collected at baseline, after one year, and after two years by using a child questionnaire, accelerometers, anthropometry, a physical fitness test, and a parent questionnaire. A mixed methods approach is applied for the process evaluation: quantitative (checklists, questionnaires) and qualitative methods (observations, interviews) are used. To analyze intervention effectiveness, multilevel regression analyses will be conducted. Content analyses will be conducted on the qualitative process data.

Discussion

Two important environmental settings, the school environment and the family environment, are simultaneously targeted in the KEIGAAF intervention. The combined top-down and bottom-up approach is expected to make the intervention an effective and sustainable version of the Health Promoting Schools framework. An elaborate process evaluation will be conducted alongside an effect evaluation in which multiple data collection sources (both qualitative and quantitative) are used.

Trial registration

Dutch Trial Register NTR6716 (registration date 27/06/2017, retrospectively registered), METC163027, NL58554.068.16, Fonds NutsOhra project number 101.253.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5764-3) contains supplementary material, which is available to authorized users.

Examining Influences of Parenting Styles and Practices on Physical Activity and Sedentary Behaviors in Latino Children in the United States: Integrative Review

BACKGROUND

Research indicates that parents influence their children's physical activity (PA) and sedentary behaviors (SB) through their parenting styles and practices.

OBJECTIVE

The objectives of this paper were to evaluate existing research examining the associations between parenting styles, parenting practices, and PA and SB among Latino children aged between 2 and 12 years, highlight limitations of the existing research, and generate suggestions for future research.

METHODS

The method of this integrative review was informed by methods developed by Whittemore and Knafl, which allow for the inclusion of qualitative, quantitative, and mixed-methods studies. Using the Preferred Reporting Items for Systematic Reviews Meta-Analyses guidelines, five electronic academic databases (PubMed, SPORTDiscus, PsycINFO, PsycARTICLES, and CINAHL) were searched for peer-reviewed, full-text papers published in English. Of the 641 unique citations identified, 67 full-text papers were retrieved, and 16 were selected for review.

RESULTS

The majority of the 16 reviewed studies were conducted with predominantly Mexican American or Mexican immigrant samples, and only 1 study examined the association between parenting styles and Latino children's PA and SB. Most (n=15) reviewed studies assessed the influence of parenting practices on children's PA and SB, and they provide good evidence that parenting practices such as offering verbal encouragement, prompting the child to be physically active, providing logistic support, engaging and being involved in PA, monitoring, and offering reinforcement and rewards encourage, facilitate, or increase children's PA. The examined studies also provide evidence that parenting practices, such as setting rules and implementing PA restrictions due to safety concerns, weather, and using psychological control discourage, hinder, or decrease children's PA.

CONCLUSIONS

Because this review found a very small number of studies examining the relationship between parenting styles and Latino children's PA and SB, additional research is needed. Given that the majority of reviewed studies were conducted with predominantly Mexican American or Mexican immigrant samples, additional research examining parenting styles, parenting practices, and PA and SB among multiethnic Latino groups is needed to design interventions tailored to the needs of this ethnically diverse population group.

Validity of a scale of neighbourhood informal social control relevant to pre-schoolers' physical activity: A cross-sectional study

Childhood physical activity (PA) is important for health across the lifespan. Time pre-schoolers spend outdoors, which has been associated with more PA, is likely influenced by parents' perception of neighbourhood informal social control relevant to pre-schoolers' PA, defined as the willingness of neighbours to intervene to ensure social order and a safe community environment for young children's active play. To advance measurement of this construct, we assessed factorial and construct validities of the PA-related neighbourhood informal social control scale for parents of pre-schoolers (PANISC-PP). In 2013-2014, Hong Kong primary caregivers (n=394) of 3-5 year-old children completed a socio-demographic questionnaire, the preliminary version of the PANISC-PP, and self-report measures of theoretical neighbourhood correlates of PA-related neighbourhood informal social control (perceived signs of physical and social disorder, community cohesion, perceived stranger danger, risk of unintentional injury and traffic safety). The fit of the data to an a priori measurement model of the PANISC-PP was examined using confirmatory factor analyses. As the a priori model showed inadequate fit to the data, the factor structure was re-specified based on theoretical considerations. The final measurement models of the PANISC-PP showed acceptable fit to the data and consisted of three correlated latent factors: "General informal supervision", "Civic engagement for the creation of a better neighbourhood environment" and "Educating and assisting neighbourhood children". The internal reliability of the subscales was good (Cronbach's α values 0.82-0.89). Generalised additive mixed models indicated that all subscales were positively associated with community cohesion and scores on the subscale "Educating and assisting neighbourhood children" were related in the expected direction to all indicators of traffic and personal safety, supporting construct validity of the PANISC-PP. This study suggests that the PANISC-PP is a reliable and valid instrument for assessing parents' perceived neighbourhood informal social control related to pre-schoolers' PA.

A systematic review of methods to measure family co-participation in physical activity

The family environment is key in influencing children's health behaviours. Encouraging family co-participation in physical activity may therefore be an effective approach to increasing children's physical activity levels. Yet, little is known about how to best assess family co-participation in physical activity. This review summarizes methods to measure family co-participation in physical activity, which was defined as joint physical activities including at least one healthy child (0-18 years) and one other family member. Methods were identified through a systematic literature search, cross-referencing pre-selected reviews and contacting research groups. Thirty-seven measurement methods were included. Questionnaires were the most common method used, with the majority assessing frequency of co-participation and few also assessing duration and type. Reliability and internal consistency of scales were often reported, but rarely specified for the item(s) relevant to co-participation. Other methods of measuring co-participation included diaries, event history calendars, direct observations and accelerometry combined with diary, ecological momentary assessment or global positioning systems (GPS). Whilst a large number of measurement methods of family co-participation in physical activity exist, few are comprehensive and/or report acceptable psychometric properties. Future work should focus on reaching consensus in defining family co-participation in physical activity, and subsequently developing reliable and valid measures.

Physical inactivity and associated factors in Iranian children and adolescents: the Weight Disorders Survey of the CASPIAN-IV study

Introduction: This study aims to assess the associated factors of physical inactivity among Iranian children and adolescents at national level. The second objective is to assess the relationship of physical inactivity with anthropometric measures. Methods: Along with a national surveillance program, this survey on weight disorders was conducted among a nationally-representative sample of Iranian children and adolescents, aged 6-18 years. Students were selected by multi-stage cluster sampling from rural and urban areas of 30 provinces of Iran. The Physical Activity Questionnaire for Adolescents (PAQ-A) was used to assess physical activity (PA). Using PAQ-A instrument, PA of past week categorized as; low PA level, that included those who scored between 1 to 1.9 on the PAQ-A instrument and high PA level that included participants with estimated scores between 2-5 PAQ-A. Results: Participants were 23183 school students (50.8% boys) with a mean age of 12.55 ± 3.3 years, without significant difference in terms of gender. Totally, 23.48% of participants (13.84% of boys and 33.42% of girls) were physically inactive. In multivariate logistic regression model, with increased age in children and adolescence, the odds of a physically inactivity increased (OR: 1.08; 95% CI: 1.07-1.10). The odds of prevalence of both obesity and underweight were high in children and adolescents with low PA. There was a decreasing trend in PA in higher school grades. Conclusion: We found a considerably high prevalence of physical inactivity in Iranian children and adolescents, with higher rates among girls and older ages. However, we did not find correlation between PA and socioeconomic status (SES). Because of the positive relationship between PA and ST, future studies should consider the complex interaction of these two items. Multidisciplinary policies should be considered in increasing PA programs among children and adolescents.

Sustainability via Active Garden Education (SAGE): results from two feasibility pilot studies

Background

Low physical activity (PA) and fruit and vegetable (F&V) consumption in early childhood are continued public health challenges. This manuscript describes outcomes from two pilot studies for Sustainability via Active Garden Education (SAGE), a program designed to increase PA and F&V consumption among 3 to 5 year old children.

Methods

SAGE was developed using community-based participatory research (CBPR) and delivered to children (N = 89) in early care and education centers (ECEC, N = 6) in two US cities. Children participated in 12 one-hour sessions that included songs, games, and interactive learning activities involving garden maintenance and taste tests. We evaluated reach, efficacy, adoption, implementation, and potential for maintenance of SAGE following the RE-AIM framework. Reach was evaluated by comparing demographic characteristics among SAGE participants and residents of target geographic areas. Efficacy was evaluated with accelerometer-measured PA, F&V consumption, and eating in the absence of hunger among children, parenting practices regarding PA, and home availability of F&V. Adoption was evaluated by the number of ECEC that participated relative to the number of ECEC that were recruited. Implementation was evaluated by completion rates of planned SAGE lessons and activities, and potential for maintenance was evaluated with a parent satisfaction survey.

Results

SAGE reached ECEC in neighborhoods representing a wide range of socioeconomic status, with participants’ sociodemographic characteristics representing those of the intervention areas. Children significantly increased PA during SAGE lessons compared to usual lessons, but they also consumed more calories in the absence of hunger in post- vs. pre-intervention tests (both p < .05). Parent reports did not suggest changes in F&V consumption, parenting PA practices, or home F&V availability, possibly due to low parent engagement. ECEC had moderate-to-high implementation of SAGE lessons and curriculum. Potential for maintenance was strong, with parents rating SAGE favorably and reporting increases in knowledge about PA and nutrition guidelines for young children.

Conclusions

SAGE successfully translated national PA guidelines to practice for young children but was less successful with nutrition guidelines. High adoption and implementation and favorable parent reports suggest high potential for program sustainability. Further work to engage parents and families of young children in ECEC-based PA and nutrition programming is needed.

Places where preschoolers are (in)active: an observational study on Latino preschoolers and their parents using objective measures

BACKGROUND

To combat the disproportionately higher risk of childhood obesity in Latino preschool-aged children, multilevel interventions targeting physical (in) activity are needed. These require the identification of environmental and psychosocial determinants of physical (in) activity for this ethnic group. The objectives were to examine differences in objectively-measured physical activity and sedentary behavior across objectively-determined types of locations in Latino preschool-aged children; and determine whether the differences in physical activity by location were greater in children of parents with higher neighborhood-safety perceptions and physical activity-supportive parenting practices.

METHODS

An observational field study was conducted in Houston (Texas, USA) from August 2011 to April 2012. A purposive sample of Latino children aged 3-5 years and one of their parents (n = 84) were recruited from Census block groups in Houston (Texas) stratified by objectively-assessed high vs. low traffic and crime safety. Seventy-three children provided valid data. Time spent outdoors/indoors tagged with geographic locations was coded into location types based on objective data collected using Global Positioning Systems units that children wore >8 hr/day for a week. Physical activity parenting practices, perceived neighborhood-safety, and demographics were reported by parents. Time spent in sedentary behavior and moderate-to-vigorous physical activity was measured based on objective data collected using accelerometers (motion sensors) that children wore >8 hr/day for a week.

RESULTS

The odds of children engaging in moderate-to-vigorous physical activity were 43% higher when outdoors than indoors (95% confidence interval: 1.30, 1.58), and the odds of being sedentary were 14% lower when outdoors compared to indoors (95% confidence intervals: 0.81, 0.91). This difference depended on parental neighborhood-safety perceptions and parenting practices. Children were most active in parks/playgrounds (30% of the time spent in moderate-to-vigorous physical activity) and least active in childcare/school settings (8% of the time spent in moderate-to-vigorous physical activity).

CONCLUSIONS

Objectively-assessed time spent in specific locations is correlated with physical activity and sedentary behavior in Latino preschoolers. Interventions and policies should identify ways to engage Latino preschool-aged children in more physical activity and less sedentary behavior while in childcare, and encourage parents to spend more time with their young children in parks/playgrounds and other safe outdoor places.

Barriers and facilitators to the nationwide dissemination of the Dutch school-based obesity prevention programme DOiT

BACKGROUND

This article describes the barriers and facilitating factors to the adoption, implementation and continuation of the Dutch Obesity Intervention in Teenagers (DOiT) programme in the Netherlands.

METHODS

We evaluated the adoption, implementation and continuation of the programme at 20 voluntary prevocational schools, which adopted the programme. Interviews were conducted with DOiT coordinators and/or teachers (n = 44) at the end of the first and second school year of the 2-year implementation period. Interviews were recorded and transcribed verbatim. Data were coded by two researchers independently. Identified barriers and facilitating factors were categorized into four groups: (i) organizational factors, (ii) individual factors, (iii) characteristics of the programme and (iv) characteristics of the implementation strategy.

RESULTS

Teachers and DOiT coordinators identified various implementation barriers (e.g. lack of planning, other urgent unforeseen priorities, no plan to cope with teacher turnover and high teacher workload) as well as facilitating factors (e.g. involvement of DOiT coordinator and support from the DOiT office, sufficient communication and collaboration between teachers, strong teacher motivation and flexibility of the programme).

CONCLUSION

Overall, DOiT implementers were satisfied with the compatibility, layout, content and potential for tailoring the programme. Barriers for successful implementation were mainly at the school and teacher level. Findings of this study can be used for further improvement of the DOiT programme and for the development and improvement of other health promotion programmes in the school setting.

The Child-care Food and Activity Practices Questionnaire (CFAPQ): development and first validation steps

OBJECTIVE

To develop and validate a questionnaire to measure food-related and activity-related practices of child-care staff, based on existing, validated parenting practices questionnaires.

DESIGN

A selection of items from the Comprehensive Feeding Practices Questionnaire (CFPQ) and the Preschooler Physical Activity Parenting Practices (PPAPP) questionnaire was made to include items most suitable for the child-care setting. The converted questionnaire was pre-tested among child-care staff during cognitive interviews and pilot-tested among a larger sample of child-care staff. Factor analyses with Varimax rotation and internal consistencies were used to examine the scales. Spearman correlations, t tests and ANOVA were used to examine associations between the scales and staff's background characteristics (e.g. years of experience, gender).

SETTING

Child-care centres in the Netherlands.

SUBJECTS

The qualitative pre-test included ten child-care staff members. The quantitative pilot test included 178 child-care staff members.

RESULTS

The new questionnaire, the Child-care Food and Activity Practices Questionnaire (CFAPQ), consists of sixty-three items (forty food-related and twenty-three activity-related items), divided over twelve scales (seven food-related and five activity-related scales). The CFAPQ scales are to a large extent similar to the original CFPQ and PPAPP scales. The CFAPQ scales show sufficient internal consistency with Cronbach's α ranging between 0·53 and 0·96, and average corrected item-total correlations within acceptable ranges (0·30-0·89). Several of the scales were significantly associated with child-care staff's background characteristics.

CONCLUSIONS

Scale psychometrics of the CFAPQ indicate it is a valid questionnaire that assesses child-care staff's practices related to both food and activities.

Development and reliability of a scale of physical-activity related informal social control for parents of Chinese pre-schoolers

Background

Parents’ perceived informal social control, defined as the informal ways residents intervene to create a safe and orderly neighbourhood environment, may influence young children’s physical activity (PA) in the neighbourhood. This study aimed to develop and test the reliability of a scale of PA-related informal social control relevant to Chinese parents/caregivers of pre-schoolers (children aged 3 to 5 years) living in Hong Kong.

Methods

Nominal Group Technique (NGT), a structured, multi-step brainstorming technique, was conducted with two groups of caregivers (mainly parents; n = 11) of Hong Kong pre-schoolers in June 2011. Items collected in the NGT sessions and those generated by a panel of experts were used to compile a list of items (n = 22) for a preliminary version of a questionnaire of informal social control. The newly-developed scale was tested with 20 Chinese-speaking parents/caregivers using cognitive interviews (August 2011). The modified scale, including all 22 original items of which a few were slightly reworded, was subsequently administered on two occasions, a week apart, to 61 Chinese parents/caregivers of Hong Kong pre-schoolers in early 2012. The test-retest reliability and internal consistency of the items and scale were examined using intraclass correlation coefficients (ICC), paired t-tests, relative percentages of shifts in responses to items, and Cronbach’s α coefficient.

Results

Thirteen items generated by parents/caregivers and nine items generated by the panel of experts (total 22 items) were included in a first working version of the scale and classified into three subscales: “Personal involvement and general informal supervision”, “Civic engagement for the creation of a better neighbourhood environment” and “Educating and assisting neighbourhood children”. Twenty out of 22 items showed moderate to excellent test-test reliability (ICC range: 0.40-0.81). All three subscales of informal social control showed acceptable levels of internal consistency (Cronbach's α >0.70).

Conclusions

A reliable scale examining PA-related informal social control relevant to Chinese parents/caregivers of pre-schoolers living in Hong Kong was developed. Further studies should examine the factorial validity of the scale, its associations with Chinese children’s PA and its appropriateness for other populations of parents of young children.

Environmental and cultural correlates of physical activity parenting practices among Latino parents with preschool-aged children: Niños Activos

Background

Latino children are at high risk of becoming obese. Physical activity (PA) can help prevent obesity. Parents can influence children’s PA through parenting practices. This study aimed to examine the independent contributions of (1) sociodemographic, (2) cultural, (3) parent perceived environmental, and (4) objectively measured environmental factors, to PA parenting practices.

Methods

A cross-sectional sample of Latino parents (n = 240) from Harris County, TX in 2011–2012 completed validated questionnaires to assess PA parenting practices, acculturation, familism, perception of their neighborhood environment, and demographics. Home addresses were mapped and linked to Census block-level crime and traffic data. Distance to the closest park was mapped by GIS. Regression models were built in a hierarchical step-wise fashion.

Results

Combined models showed R² of 6.8% to 38.9% for different parenting practices. Significant correlations included sociodemographic variables with having outdoor toys available, psychological control, and promotion of inactivity. Cultural factors correlated with PA safety concern practices. Perceived environmental attributes correlated with five of seven parenting practices, while objectively-measured environmental attributes did not significantly correlate with PA parenting practices.

Conclusion

Interventions promoting PA among Latino preschoolers may need to address the social-ecological context in which families live to effectively promote PA parenting, especially parents’ perceptions of neighborhoods.