Children's physical activity and screen time: qualitative comparison of views of parents of infants and preschool children

Teachers' perception on physical activity promotion in kindergarten children in China: a qualitative study connecting social-ecological model

BACKGROUND

Globally, the majority of kindergarten-aged children face obesity issues and insufficient physical activity (PA) engagement. Regular PA participation can provide various health benefits, including obesity reduction, for kindergarten-aged children. However, limited studies have investigated the factors influencing kindergarten-aged children's PA engagement from the perspective of their teachers. This qualitative study aimed to identify factors that could help promote PA among kindergarten-aged children from teachers' perspectives, including facilitators, barriers, and teachers' recommendations.

METHODS

Fifteen kindergarten teachers (age range: 28-50 years; mean age: 38.53 years) with teaching experience ranging from 2 to 31 years (mean: 16.27 years) were recruited from Shanghai municipality, Henan, and Jiangsu provinces in China. One-on-one semi-structured interviews were conducted via face-to-face (n = 7) or telephone (n = 8) to gather insights into factors influencing PA promotion among kindergarten-aged children. The interviews were audio-recorded, transcribed, and analyzed using a constant comparison approach based on grounded theory, which involved open, axial, and selective coding processes.

RESULTS

The study revealed mutual theoretical support between themes and the social-ecological model (SEM), as factors identified in the study are distributed at various levels of the SEM. Twelve factors were identified at four levels of the SEM: (1) intrapersonal level (children's personality and skills), (2) interpersonal level (family, peers, and teachers influence), (3) organizational level (school environment and resources, opportunities for kindergarten teachers' training and children's PA, design and organization of PA, and PA that children need), (4) community level (family-school partnerships).

CONCLUSION

Various factors at different levels can influence kindergarten-aged children's PA. The study's findings revealed that these factors are distributed across the first four levels of SEM, with the majority being at the organizational level. These multilevel findings are expected to assist in developing and implementing more effective PA interventions for kindergarten-aged children. Future research is warranted to identify strategies for promoting PA among kindergarten-aged children at the policy level of the SEM.

Indian fathers' perceptions of young childcare and feeding - A qualitative study

The role of parents in fostering children's healthy habits is a robust area of research. However, most of the existing literature predominantly focuses on mothers' parenting practices. Given the emergence of nuclear, dual earning families and the recent surge in maternal employment in urban India, fathers' engagement in child rearing and feeding warrants attention. The purpose of this research was to document the views of Indian fathers about paternal parenting practices, with an emphasis on children's diet among other health behaviors. Thirty-three fathers of children aged 6-59 months from Kolkata, India took part in semi-structured interviews conducted either face-to-face or over Zoom/telephone in Hindi, Bengali, and English. The interviews were audio recorded, transcribed verbatim, and translated to English. The transcribed data were subjected to thematic analysis informed by the Template Analysis technique. Themes were detected using the NVivo software program. Overall, these Indian fathers played an important role in early childhood care and feeding as reflected in the following seven themes: (i) Involvement of fathers in various childcare activities; (ii) Implementation of responsive and non-responsive feeding practices; (iii) Concerns regarding fussy and slow eating; (iv) Concerns regarding excessive screen time; (v) Paternal vs maternal parenting; (vi) Barriers to routine engagement of fathers in childcare; (vii) Desire for more nutrition and health knowledge. This enhanced understanding of paternal parenting behavior supports the inclusion of fathers in future family-focused lifestyle interventions aimed at improving children's health outcomes, including their dietary habits.

Parental acceptance of brain health programs for preschool children: a mixed-methods study exploring barriers, facilitators and future approaches

Background

Recent research proposes that as much as 40% of dementia risk is amendable. Promoting healthy lifestyle behaviors in early life through educational methods can cultivate habits that may decrease dementia risk in later life. This study explores parental acceptance of brain health programs tailored for preschool children, aiming to identify barriers and facilitators affecting parental and child engagement.

Methods

Mixed-methods cross-sectional study. Urban and suburban parents (N = 187, M age = 37.3 SD = 5.53, range = 29) of children aged three to five years across Australia. Parents participated in an online survey containing both open and closed questions exploring their personal views and opinions on brain health programs for their preschool children. Descriptive statistics, multiple linear regression analyses, and thematic analysis were used to explore sociodemographic factors associated with parental program acceptance.

Results

Most participants accepted a brain health program with over 98% agreeing a program would be useful for their child(ren). Participants with younger aged children were more likely to exhibit acceptance of a program (β = -0.209, p = 0.007). Three main categories emerged: dual home and preschool environments, the need for engaging brain health programs that were hands-on and screen-free, and addressing key barriers such as time and financial constraints to support implementation.

Conclusion

Participants valued educating their children for a healthy life and viewed brain health programs favorably. This study contributes to early childhood education discussions, offering guidance for future generations' brain health and wellbeing.

Parent Support for Physical Activity and Motor Skills During Early Childhood: A Mixed-Methods Application of the Multi-process Action Control Framework

BACKGROUND

Promoting physical activity (PA) and fundamental movement skills (FMS) in early childhood is necessary to address the high rates of inactivity in children. Parent support is a determinant of PA in children, however, parental intentions to support are not always translated into behavior resulting in an intention-behavior gap.

PURPOSE

Positioned within the multi-process action control (M-PAC) framework, this study used an explanatory concurrent mixed-methods design to explore parents' intentions and support of PA and FMS during early childhood.

METHODS

Parents (N=124) of children aged 3-4 years completed an online survey consisting of items assessing reflective (e.g., attitudes), regulatory (e.g., planning), and reflexive (e.g., habit) processes of M-PAC and intentions and support for child PA and FMS. A subset of parents (n=20) completed a semi-structured online interview guided by the M-PAC framework.

RESULTS

Significantly more parents intended to support PA (71%) compared with FMS (44%; p<0.001) and successfully translated intentions into action for PA (57%) compared with FMS (27%; p<0.001). Discriminant function analysis showed parent behavior profiles for PA and FMS support were associated with a combination of reflective, regulatory, and reflexive processes, however, these differed based on support behavior. Qualitative findings highlighted parents' differential views on PA and FMS support and contextualized the psychological processes associated with each.

CONCLUSIONS

Parent PA support interventions during early childhood should include strategies for supporting FMS. Interventions should prioritize fostering a combination of reflective, regulatory, and reflexive behaviors to translate intentions to support PA and FMS into behavior among parents of young children.

Managing Screen Use in the Under-Fives: Recommendations for Parenting Intervention Development

The impact of excessive screen use on children's health and development is a public health concern and many countries have published recommendations to limit and guide the use of screen media in childhood. Despite this, international studies report that the majority of parents and children do not adhere to screen use recommendations. Existing research aiming to understand children' screen use has largely focused on older children, and on demographic and structural aspects of the child's environment. Parents play a central role in determining young children's screen use and identify numerous barriers to developing healthy screen use practices with their children. However, no clear models exist that incorporate key parenting factors in understanding children's screen use, which presents an impediment to intervention development. Likewise, while some evidence exists for interventions to improve children's screen use behaviours, most are focused on older children and parental involvement has generally been limited. In this paper, we overview key factors associated with screen use in young children (< 5 years) and summarise the existing evidence base for interventions designed to support healthy screen use. This paper proposes a conceptual model linking aspects of parenting and the socio-ecological environment to young children's screen use. Our proposed model could be used to design longitudinal studies of screen use predictors and outcomes, and inform intervention development. Finally, the paper provides key recommendations for future research, intervention development and testing.

Exploring the perception of parents on children's screentime: a systematic review and meta-synthesis of qualitative studies

BACKGROUND

Screentime (ST) has been increasingly pervasive in young children. Evidence suggests positive and negative effects of ST on children's development. Parents play a crucial role in influencing their children's ST. There is limited research consolidating the parental perceptions related to children's ST. This review consolidates the evidence on the perception of parents on their children's ST.

METHODS

Six electronic databases (PubMed, Embase, CINAHL, PsycINFO, Scopus, and ProQuest) were searched from their inception to September 2022. Critical appraisal was conducted using the Critical Appraisal Skills Program (CASP) checklist. Data synthesis was performed using Sandelowski and Barroso's approach.

RESULTS

Twenty studies were included in this review, encapsulating the experiences of 1,311 parents. Three main themes with corresponding subthemes were identified: (1) Varied reasons behind ST; (2) Attitudes toward ST; and (3) Strategies and approaches to managing ST.

CONCLUSION

The findings highlighted the varied reasons parents promote ST. Parents reported their concerns and confusion about ST and shared some strategies and approaches for better ST. Future research is needed to develop and evaluate educational programs to ensure that parents understand the risks and benefits of ST and in turn, ensure the appropriate adoption of ST for their children.

IMPACT

In the digital era, parents' attitudes towards screentime (ST) for their children are mixed. This review presents the dilemma parents face and their struggles with using optimal screen time for their children. This review provides up-to-date evidence on the parents' confusion and concerns about ST as well as strategies and approaches used by the parents for better ST. There is an urgent need for evidence-based educational programs to enhance parental knowledge about ST so that they can ensure appropriate ST among children.

CLINICAL TRIAL REGISTRATION

PROSPERO Registration No. CRD42022356083.

Primary Care Counseling of Parents Regarding Childhood Screen Media Use

Parental beliefs and motivation are instrumental in improving childhood digital media use (DMU). Parents (n = 611) completed questionnaires about childhood DMU assessing knowledge, interest in counseling, motivation to change, self-efficacy, and beliefs. Less than a third correctly recognized screen time limits. Twenty-seven percent received childhood DMU information from a doctor, while 46% stated they would like such information. Only 2% had a doctor-recommended DMU plan. Interest in DMU topics, motivation to improve, and management self-efficacy were moderate. Top negative beliefs were addiction to DMU (52%), sleep problems (39%), obesity (33%), social skills (33%), and inappropriate content (32%). Differences between age categories existed for social (48%, P = .01) and language (14%, P = .01) concerns (highest for toddlers), attention concerns (27%, P = .02; highest in preschoolers), and depression (13%, P < .001) and low self-esteem (8%, P = .04; highest in teens). Findings support further development of approaches to address DMU, tailored by age-specific common parental views.

Outdoor time, screen time and sleep reported across early childhood: concurrent trajectories and maternal predictors

BACKGROUND

Understanding the developmental trajectories of outdoor time, screen time and sleep is necessary to inform early interventions that promote healthy behaviours. This study aimed to describe concurrent trajectories of outdoor time, screen time and sleep across the early childhood period and their maternal predictors.

METHODS

Data across five time points at child age 4, 9, 19, 42 and 60 months from the INFANT intervention were analysed. Mothers reported their child's usual outdoor time, screen time and sleep duration, in addition to a range of maternal beliefs, attitudes, expectations and behaviours. Group-based multi-trajectory modelling was used to model concurrent trajectories of children's behaviours. Multinomial logistic regression models determined the associations of maternal predictors with trajectory groups, adjusting for child sex and baseline age, intervention allocation, and clustering by recruitment.

RESULTS

Of the 542 children recruited, 528 had data for outdoor time, screen time and sleep at one or more time points and were included in trajectory analyses Four trajectories were identified: 'unstable sleep, increasing outdoor time, low screen' (~ 22% of sample), 'high outdoor time, low screen, high sleep' (~ 24%), 'high sleep, increasing outdoor time, low screen' (~ 45%), 'high screen, increasing outdoor time, high sleep' (~ 10%). The 'high sleep, increasing outdoor time, low screen' group, comprising the largest percentage of the sample, demonstrated the healthiest behaviours. Predictors of group membership included: views of physically active children, screen time knowledge, screen time use, self-efficacy, physical activity optimism, future expectations for children's physical activity and screen time, perceptions of floor play safety, and maternal physical activity, screen time, and sleep quality.

CONCLUSIONS

Four distinct trajectories of outdoor time, screen time and sleep were identified, with the most common (and healthiest) characterized by high levels of sleep. Maternal beliefs, attitudes, expectations and behaviours are important in the development of movement behaviour trajectories across early childhood. Future interventions and public policy may benefit from targeting these factors to support healthy movement behaviours from a young age.

Screen media and non-screen media habits among preschool children in Singapore, South Korea, Japan, and Finland: Insights from an unsupervised clustering approach

The main purpose of the research was to describe the daily screen media habits and non-screen media habits like indoor and outdoor play, and sleep of preschool children aged 2 to 6 years from Singapore, South Korea, Japan, and Finland using a content-validated online questionnaire (SMALLQ®) and unsupervised cluster analysis. Unsupervised cluster analysis on 5809 parent-reported weekday and weekend screen and non-screen media habits of preschool children from the four countries resulted in seven emergent clusters. Cluster 2 (n = 1288) or the Early-screen media, screen media-lite and moderate-to-vigorous physical activity-lite family made up 22.2% and Cluster 1 (n = 261) or the High-all-round activity and screen media-late family made up 4.5%, respectively represented the largest and smallest clusters among the seven clusters that were emergent from the pooled dataset. Finland was best represented by Cluster 2 and Japan was best represented by Cluster 3 (High-screen media-for-entertainment and low-engagement family). Parents from Finland and Japan displayed greater homogeneity in terms of the screen media and non-screen media habits of preschool children than the parents from South Korea and Singapore. South Korea was best represented by Clusters 6 (Screen media-physical activity-engagement hands-off family) and 7 (Screen media-lite, screen media-late and high-physical activity family). Singapore was best represented by Clusters 4, 5, 6 and 7, and these clusters ranged from Low all-round activity-high nap time family to Screen media-lite, screen media-late and high-physical activity family. Future research should explore in-depth reasons for the across-country and within-country cluster characteristics of screen media and non-screen media habits among preschool children to allow for more targeted interventions.

Identification of positive parenting practices among parents of young children living in low-income and racially, ethnically, and culturally diverse households

Using the positive deviance approach, the purpose of this study was to identify parent feeding practices that might be protective against early childhood obesity among children with lower weight status (BMI percentile ≥5th-<85th) relative to higher weight status (BMI percentile ≥85th). Qualitative interviews were conducted with 71 parents of children aged 2-5 years old (48% girls) enrolled in the Minnesota Special Supplemental Nutrition Program for Women Infants and Children (WIC). Children were identified as having lower weight status (defined as 'positive deviants') (n = 36) or 'higher weight status' (n = 35), and were African American [n = 22], Hispanic [n = 23], or Hmong [n = 26]). Parents were asked about approaches to child feeding and health- and weight-related practices. Findings indicated that relative to caregivers of children with higher weight status, parents of children identified as positive deviant were more likely to report having a consistent routine for providing meals, using a guided choices approach, serving small portions of food during mealtimes, and trusting their child hunger and satiety cues. Moreover, parents of children identified as positive deviant were more likely to promote healthful eating and physical activity engagement and implement clear rules and limits for screen time than parents of children with higher weight status. Results suggest specific parent feeding behaviors and health-related practices that may influence child weight status among children living in low-income and racialized households. The findings of this study also provide research evidence and support the tenets of the Satter Division of Responsibility in Feeding framework. Parenting practices and strategies among parents of children identified as positive deviant are expected to be feasible and should be explored and communicated in future interventions to support age- and sex-recommended weight and health-related outcomes among young children to promote health equity.

Associations between Parents' Digital Media Habits, Engagement, Awareness, and Movement Guidelines among Preschool-Age Children: International Ipreschooler Surveillance Study

The 24-hour movement guidelines (24-h MG) recommend behaviors (physical activity, screen time, sleep) to aid appropriate physical and mental development in early childhood. This research examined parents' digital media habits (DMH), engagement (DME), and awareness (DMA) among parents in relation to their preschool-aged children's 24-h MG in Japan and identified and compared the modifiable determinants of adherence to 24-h MG in urban and rural regions. This cross-sectional study included 867 participants and data were obtained from the International Ipreschooler Surveillance Study Among Asians and OtheRs (IISSAAR). The results revealed that adherence to weekend screen time recommendations and weekday sleep duration were higher in the urban region. The parents' digital media variables that predicted moderate-intensity to vigorous-intensity physical activity among preschool-aged children were parents' DME and DMA in the urban regions and parents' DME in the rural regions. The children's screen time was significantly associated with parents' DMH, DME, and DMA in the urban regions and with parents' DMH and DMA in the rural regions (p < 0.005, p < 0.001, respectively). This study confirmed that parents' DMH, DME, and DMA are strong predictors of adherence to 24-h MG among preschool-aged children living in both rural and urban regions in Japan.

Electronic screen device usage and screen time among preschool-attending children in a suburban area of Sri Lanka

Background

Excessive use of screen devices and screen time are increasing health problems in children. We aim to describe the electronic screen device usage and determine the factors associated with their use among preschool-attending children in a suburban population in Sri Lanka.

Methods

A cross-sectional study was conducted in a suburban Medical Officer of Health area of Sri Lanka from January to March 2020. All children aged between 36–59 months attending ten randomly selected preschools were recruited. Data were collected using a parent-administered questionnaire and analysed using binary logistic regression in SPSS. The prevalence of electronic device usage, the average time spent on each device, and factors associated with individual device usage were analysed.

Results

A total of 340 children (Male-48%; mean age-50.1 ± 6.9 months) were recruited. Electronic devices were used by 96% of children. The most common devices were the television (87%) and the smartphone (63%). Of the children who used electronic devices, 60% exceeded the recommended screen time limit of one hour per day, 21% used devices for more than two hours per day, and 51% commenced using devices by two years of age. The higher education level of the father was independently associated with the use of smartphones and laptops and daily screen time of more than one hour (p < 0.05 for all). Male sex and being the only child were significantly associated with the use of smartphones, whereas maternal employment was associated with the use of laptops (p < 0.05 for all).

Conclusions

Electronic screen devices were used by 96% of preschool-attending children, and over 60% used them for more than the recommended daily upper limit of one hour. Higher paternal education, maternal employment and being the only child were significantly associated with electronic screen device use.

Prevalence, correlates, and trajectory of screen viewing among Chinese children in Changsha: a birth cohort study

BACKGROUND

High screen viewing time has detrimental effects on children's health, development, and behavior developing. Children are being exposed to more and more media devices at an earlier age. This study was aimed to determine the amount of daily screen time and its variation and to assess potential factors of screen time by identifying the trajectory of screen time among children aged 1 to 5 years.

METHOD

This study was based on a representative sample of Changsha young children from a cohort study during 2015-2020. The demographic information and children's screen viewing time were collected by parents or caregivers through face-to-face interviews. The Latent growth model was used to test the effects of outdoor play on screen viewing time at eight time points, meanwhile, unconditional and conditional models were examined sequentially.

RESULT

After excluding respondents with missing key variables, we included 953 children in the final analysis. Children's outdoor play was slightly increased at 18 months and subsequently declined at 24-60 months, with a maximum duration of 2.96 h per day. Children's average screen time was increased at 18-36 months, and decreased at 42-54 months, with a slight increase at 60 months. The duration of media exposure peaked at 1.4 h/d at age of 36 months and 60 months. Standardized coefficients of the outdoor play at age of 12 months showed negative effects on the screen time in children, but with positive influence at age of 24, 36, and 42 months (P <  0.01).

CONCLUSION

High proportions of young Chinese children in Changsha had more screen time than the AAP recommended according to our analysis. Significant predictors of screen time included pregnancy computer use, paternal educational level, and outdoor play in this study, however, further understanding of risk factors is needed to promote great public health efforts to reduce children's screen exposure.

Barriers and Facilitators to Toddlers’ Physical Activity during the COVID-19 Pandemic, as Perceived by Teachers, Principals and Parents: A Challenge for the Early Childhood Educational Environments

The aim of our study was to explore the barriers and facilitators that teachers, principals, and parents face when adapting to COVID-19 pandemic scenario in terms of promoting toddlers’ physical activity (PA). Thirty-four (20 teachers and principals, and 14 parents) semi-structured qualitative interviews were conducted from October 2020 to March 2021. The socioecological model has enabled the identification of barriers and facilitators, some of which are related to the pandemic and others which are not. The main results suggest that upon reopening the ECEC institutions, regarding environmental barriers, educators mentioned the impact on the use of space, and parents, the modification of daily activities generated by COVID-19. However, educators also considered that the presence of suitable spaces in the school for practicing PA was a facilitator. At the intra- and interpersonal level, facilitators of PA that were unrelated to the pandemic included, for parents, the predisposition of children to be physically active and their own function as role models, and for educators, the curricular practices themselves. At an environmental level, the risk of danger in the traditional classroom plus bad weather were considered barriers by educators, while parents mentioned difficulties accessing outdoor space and the poor suitability of indoor spaces. Our results suggest the simultaneous analysis of the perceptions of different actors in the educational environments offers a broad vision of the ecological alternatives for offering children opportunities for PA in these difficult times.

Determinants of Excessive Screen Time among Children under Five Years Old in Selangor, Malaysia: A Cross-Sectional Study

Excessive screen time interferes with the health and development of children. However, the screen time situation among Malaysian children remains poorly understood. This study aims to identify the prevalence and determinants of excessive screen time among children under five years in Selangor, Malaysia, using the latest World Health Organization guidelines. In this cross-sectional study, 489 parent−child dyads were randomly selected from nine government health clinics in Petaling district, Selangor. Total screen time and factors were assessed using validated self-administered questionnaires and analysed using multiple logistic regression. The overall prevalence of excessive screen time was 91.4% with a median of 3.00 h. The majority of children utilized television (66%), followed by handheld devices (30%) and computers (4%). Determinants of screen time identified were Malay ethnicity, (aOR 3.56, 95% CI 1.65−7.68), parental age of ≥30 years (aOR 3.12, 95% CI 1.58−6.16), parental screen time >2 h a day (aOR 2.42, 95% CI 1.24−4.73), moderate self-efficacy to influence a child’s physical activity (aOR 2.29, 95% CI 1.01−5.20) and the positive perception on the influence of screen time on a child’s cognitive wellbeing (aOR 1.15, 95% CI 1.01−1.32). Parents play an important role in determining their child’s screen time. Future interventions should focus on addressing parental determinants to ensure age-appropriate screen time.

Impact of cocreation training capsules for preschool teachers on children's healthy habits: a pilot study conducted in Barcelona, Spain

Background

Healthy habits are essential for preschoolers to have a healthy lifestyle. The promotion of these healthy habits from a holistic approach by preschool teachers guarantees a better quality of life and a healthier society. Using cocreation, we designed training for healthy habit promotion for preschool teachers (all@once). Then, we implemented the training and evaluated its impact on classroom teaching strategies.

Methods

This study presents the all@once training design and its implementation and evaluation during 2019. The cocreation process involved 8 parents, 9 preschool teachers and 9 health professionals (selected by a nonprobabilistic sampling system according to quotas) to design training from a holistic perspective. To evaluate the all@once impact in classroom practice, a pilot study was undertaken in four public schools in Barcelona (Spain). All@once was implemented with 16 volunteer teachers selected by convenience sampling and 328 children. A mixed methods approach was chosen to collect data based on direct nonparticipating naturalist systematic observations in June and October 2019. After qualitative data categorization, changes in health routines and actions at school were assessed by either contingency table analysis of frequency distributions or nonparametric comparisons of two related samples.

Results

The cocreation process provided training organized into online capsules with a holistic view of health in four main dimensions (nutrition, hygiene, physical activity and emotional health). Of these dimensions, the emotional health dimension comprised half of the training content. Pilot testing of the impact of all@once on classroom health-related activities evidenced an increase in the likelihood of observing fruit consumption by children, healthy habit promotion and hand washing. The most significant all@once-induced changes that we observed were related to teaching strategies concerning the emotional health dimension of the training.

Conclusions

This pilot study provides evidence of cocreation being a productive way to design training for preschool teachers regarding inclusive education in integral health. This approach collects the needs of the school community, provides training with a holistic concept of health and effectively impacts classroom routines and family health habits in the short term.

Associations among average parental educational attainment, maternal stress, and infant screen exposure at 6 months of age

Evidence suggests that increased use of screens early in life may have negative developmental consequences for children. However, little is known concerning parental factors that predict initial screen exposure in infancy. The primary goal of this study was to examine whether parental educational attainment and maternal stress were associated with infant screen exposure by 6 months of age. A diverse sample of mothers (N = 93) was recruited prenatally. In a follow-up visit when the infants were six months of age (N = 82), we examined factors that may be associated with initial infant exposure to screens. First, mothers reported whether they had already exposed their infants to screens. Thereafter, those mothers who reported already having exposed their infants to screens were further queried to determine the extent of infant screen use. Results demonstrated that among infants exposed to screens, mothers reported an average of nearly 3 h of daily screen use. Average parental educational attainment, but not maternal stress, was significantly associated with initial infant exposure. Of those families who endorsed screen exposure by 6 months, 70 % reported a screen in the room where the child sleeps, nearly half reported using screens to help calm the infant, and about a third reported using a screen at least sometimes during meals, when going to sleep, and while waiting. Parental education around infant screen use behaviors may be important to help promote child development and outcomes.

Winning Conditions for the Adoption and Maintenance of Long-Term Healthy Lifestyles According to Physical Activity Students

The literature has not yet well documented the relative elements of the adoption of healthy lifestyle habits (HLHs) over the long term. More especially, researchers are calling to complete the corpus with qualitative or mixed estimates that would allow them to better explain the conditions necessary for the adoption or maintenance of HLHs over the long term. The present study seeks to understand the winning conditions for the adoption and maintenance of HLHs. Semi-structured group interviews were conducted with three groups of university students (two in Bachelor’s degree in physical education (PE) and one in Master’s degree in physical activity science), all in favor with HLHs. The results identify some dominant winning conditions in the adoption and maintenance of HLHs, such as the role of the family environment, the role of diversity and choice in physical activities during youth, the physical and social environment, autonomy and also mental health, which is closely linked with physical health. Results were modelled in the form of an ideal pathway, which traces the impact of winning conditions from childhood to adulthood. The originality of this study stands out, among other things, because of its innovative methodology; therefore, this study opens the door to future qualitative research in the field. Investigating pathways, considering the different phases of development of children and adolescents to identify factors of change and maintenance of HLHs now seems to be an interesting and necessary avenue for research in the field.

A Qualitative Study on Children's Digital Media Use and Parents' Self-interest

This qualitative study provides insight into the role of parents' self-interest in digital media use of children in different age groups. We conducted 31 semi-structured interviews with fathers/mothers of children aged 3-16 years who were recruited via targeted sampling. A deductive and inductive content analysis was applied. Results show that parents' self-interest in letting children use digital media includes being able to do other tasks without being bothered, having some me-time, managing children's behavior, avoiding discussions, having moments to use digital media themselves and spending quality-time together. In addition, we found that the manner in which parents let children use digital media out of self-interest seems to depend on age. With younger children, parents initiate digital media use or set times at which children are allowed to use digital media. With older children, parents use a passive manner by omitting restrictive responses to their children's media use. Current findings can be used to inform interventions aimed at reducing children's screen time.

Moving Together: Understanding Parent Perceptions Related to Physical Activity and Motor Skill Development in Preschool Children

Background: Establishing physical activity (PA) and motor behaviors in early childhood are important for developing healthy activity behaviors. Parents play a central role in shaping young children’s PA and fundamental motor skills (FMS). This qualitative study explored parents’ attributes, values, perceptions, and practices related to PA and FMS. Methods: Thirty-one parents (26 mothers) of preschool-aged children participated in semi-structured in-person interviews. Interviews were audio-recorded, transcribed verbatim, coded and analyzed using an iterative approach. Results: Four themes related to PA and FMS emerged: (1) parent attributes; (2) parent–child interactions; (3) parent perception of children’s attributes; and (4) parenting practices. Although most parents enjoyed playing with their child, some did not realize the importance of engaging in PA with their child and even believed that FMS are naturally developed. Parents indicated that children’s temperament may influence their preference for practicing motor skills. Conclusions: Social support and positive parenting practices, including encouragement, monitoring, logistical support, co-participation, and facilitation, are important for the development of PA and FMS. The findings add emphasis to the importance of parents’ role in the development of young children’s PA and FMS, and they inform future strategies aiming to promote young children’s activity behaviors.

How to Change Young Children's Physical Activity and Sedentary Behavior: Mechanisms of Behavior Change in the INFANT Cluster Randomized Controlled Trial

Background: Understanding the mechanisms (mediators) of behavior change is crucial to designing more effective interventions. However, this is rarely reported. This paper investigates the mechanisms that explain the lack of intervention effect on physical activity and the significant effect on television viewing time from an early childhood trial. Methods: Secondary analyses were undertaken of data from a cluster randomized controlled trial. The Melbourne Infant Feeding, Activity and Nutrition Trial (INFANT) was a 15-month group program promoting obesity-protective behaviors from the age of 4 months. Outcomes relevant to the current study were child physical activity (accelerometer), television viewing time (maternal report) and 12 potential mediator scales (maternal report). Linear regression models used the product of coefficients method with a joint significance test. Results: Complete data were from 398 mother-child dyads. Despite weak evidence of an intervention effect on the mother’s physical activity knowledge and optimism, there was no effect on children’s physical activity, and no clear mechanisms were identified. An intervention effect was observed for the mothers’ television knowledge (unstandardized regression coefficient for a path (a) = 0.34, 95% confidence interval (CI₉₅) = 0.22, 0.45), with weak evidence for maternal efficacy (a = 0.11, CI₉₅ = −0.02, 0.24) and the use of television (a = −0.10, CI₉₅ = −0.22, 0.01). The intervention impact on television knowledge explained 75% of the difference between the intervention and control groups in children’s television viewing. Conclusions: In the very early childhood period, as mothers are commencing their parenting journey, improving their behavioral knowledge appears to be the biggest contributor to reducing child television viewing, constituting a relatively simple strategy that could be implemented across clinical and public health settings. In contrast, it remains unclear what mechanisms may increase physical activity levels in this age group.

Sociodemographic Correlates of Parental Co-Participation in Digital Media Use and Physical Play of Preschool-Age Children

Young children’s digital media use and physical activity have gained attention in recent research. Parental co-participation has a major impact on children’s health consequences. This study addressed a gap in the research by investigating daily parental co-participation in children’s digital media use and physical play, using the family ecological model theoretical framework. The participants in this nationally representative cross-sectional study were 2512 Finnish parents with two- to six-year-old children. Parents completed a questionnaire. Sociodemographic correlates of co-participation and of the awareness of guidelines regarding co-participation and correlation between co-participation in digital media use and physical play were analysed. Parental co-participation in physical play and digital media use correlated positively. Lower parental age, male parental gender, Finnish and Swedish languages, a fewer number of children, and a male child gender were associated with more co-participation in one or both activities, and parental female gender and low family income were associated with more awareness. The awareness of guidelines was not associated with co-participation in digital media use. There were sociodemographic differences in parental co-participation. From a health counselling perspective, parents may benefit from national recommendations on digital media use and physical activity, but adherence to guidelines depends on the family context.

Barriers and motivators for preschoolers playing and walking with their dog: Results from qualitative research

ISSUES ADDRESSED

A large proportion of preschoolers do not meet the recommended three hours of daily physical activity. A potential source of daily physical activity could be that provided via the family dog. This qualitative study aimed to explore the barriers and motivators to preschoolers playing with their dog and participating in family dog walks.

METHODS

Twelve in-depth interviews were conducted with parents of preschoolers who owned a dog. A semistructured interview guide was used, and transcripts were analysed thematically.

RESULTS

Factors influencing preschoolers playing with their dog and participating in family dog walks included parents' level of attachment to their dog, parental history of dog ownership, parent modelling of safe dog play, type of play the family dog enjoys and proximity to dog- and child-friendly destinations. Other factors such as the size, level of socialisation and perceived exercise requirements of the dog, physical environment factors such as backyard size and individual factors such as time and existing commitments were also reported.

CONCLUSIONS

A number of dog, individual and physical environment specific factors should be considered when promoting preschooler physical activity through dog walking and play. SO WHAT?: A large proportion of preschoolers do not meet the recommended three hours of daily physical activity. In Australia, 43% of Australian households with children aged four to five own a dog. Dog-facilitated physical activity through family dog walks and active play could be an effective strategy for increasing preschooler physical activity.

Perspectives of infant active play: a qualitative comparison of working versus stay-at-home parents

BACKGROUND

Parents play a key role in infant's development through their interactions and the type of environment they provide to promote active play. The amount of time parents are able to spend with their infant is dependent on their working status, yet few studies have explored parent perception of their infant's active play by working status. The purpose of this study was to explore parent perception of active play and compare responses between working and stay-at-home parents.

METHODS

Twenty-nine parents participated in this qualitative study by completing a one-time, in-person semi-structured interview based on the Theory of Planned Behavior. Themes were developed and compared based on parental working status using a directed content analysis approach.

RESULTS

All parents believed active play could have a positive effect on their child's development through physical, social and emotional, cognitive, and/or language and communication development. However, stay-at-home parents reported a broader impact of active play across these domains; whereas working parents most often referenced active play as impacting infant's physical development. Social and emotional interactions were the highest reported form of active play among all parents. Additionally, all parents described similar barriers to increasing the time for active play. The most commonly reported barrier for all parents was time or schedule followed by care needs of the infant, environmental concerns, and need for restrictive devices (e.g., car seats). More stay-at-home parents than working parents reported the care needs of the infant as being a barrier. Recommendations for active play were not widely known amongst all parents, with a higher percentage of working parents reporting they would desire advice from a healthcare provider.

CONCLUSIONS

Working status of parents appears to have implications on perceptions of active play which in turn may influence infants' development. Future studies should objectively assess the impact of parents' working status on infant development and explore how gender of the parent may serve as a confounding variable.

The Need for an Evidence-Based Program in Sweden to Support Parents to Create Healthy Lifestyle Behaviors from the Start of Life-Parental Perceptions

In Sweden, there have been no interventions promoting the development of healthy lifestyle behaviors starting in infancy. Thus this paper aims to: (i) investigate Swedish parents’ experiences regarding feeding of solid foods, screen time, and physical activity in healthy infants; (ii) investigate parents’ needs and perceptions regarding information/support provided in primary child healthcare (CHC) and (iii) explore whether a parenting program focused on child diet and active play would be relevant and utilized. Semi-structured interviews were conducted with 20 parents. These were recorded, transcribed verbatim and analyzed using thematic analysis. Seven themes emerged: Feeling excited to enter a new phase; Parents’ responsibility of doing it “right” can be stressful; Motivated to learn during specific time windows; Information to trust; The importance of social support from peers; Experiences of support received from CHC; and the Infant, Feeding, Activity, and Nutrition Trial (INFANT) for a Swedish context. Parents were excited to enter new phases in their child’s development. However, this came with worry they were doing things “right”, leading parents to want more information/support. Overall, Swedish parents were very positive about the prospects of engaging in a primary CHC delivered program to support them to promote healthy lifestyle behaviors from birth and felt this could complement the care currently provided.

Childhood Obesity Evidence Base Project: A Systematic Review and Meta-Analysis of a New Taxonomy of Intervention Components to Improve Weight Status in Children 2-5 Years of Age, 2005-2019

Objective: To evaluate the efficacy of childhood obesity interventions and conduct a taxonomy of intervention components that are most effective in changing obesity-related health outcomes in children 2-5 years of age. Methods: Comprehensive searches located 51 studies from 18,335 unique records. Eligible studies: (1) assessed children aged 2-5, living in the United States; (2) evaluated an intervention to improve weight status; (3) identified a same-aged comparison group; (4) measured BMI; and (5) were available between January 2005 and August 2019. Coders extracted study, sample, and intervention characteristics. Effect sizes [ESs; and 95% confidence intervals (CIs)] were calculated by using random-effects models. Meta-regression was used to determine which intervention components explain variability in ESs. Results: Included were 51 studies evaluating 58 interventions (N = 29,085; mean age = 4 years; 50% girls). Relative to controls, children receiving an intervention had a lower BMI at the end of the intervention (g = 0.10, 95% CI = 0.02-0.18; k = 55) and at the last follow-up (g = 0.17, 95% CI = 0.04-0.30; k = 14; range = 18-143 weeks). Three intervention components moderated efficacy: engage caregivers in praise/encouragement for positive health-related behavior; provide education about the importance of screen time reduction to caregivers; and engage pediatricians/health care providers. Conclusions: Early childhood obesity interventions are effective in reducing BMI in preschool children. Our findings suggest that facilitating caregiver education about the importance of screen time reduction may be an important strategy in reducing early childhood obesity.

Parental Perspectives and Experiences in Relation to Lifestyle-Related Practices in the First Two Years of a Child's Life: A Qualitative Study in a Disadvantaged Neighborhood in The Netherlands

The first two years of a child's life are a critical period in preventing several lifestyle-related health problems. A qualitative study was conducted to explore parental experiences and perspectives in relation to lifestyle-related child-rearing practices in order to minimize risk factors at an early stage. Data were collected through interviews (n = 25) and focus groups (n = 4) with parents of children aged 0-2 years, in a disadvantaged neighborhood in Amsterdam, the Netherlands. Results showed that parents were often uncertain about a number of lifestyle-related practices. Ambiguity also appeared regarding the parents' intentions to engage in certain practices and what they were able to achieve in everyday life. In addition, parents experienced strong sociocultural influences from their family, which interfered with their ability to make their own decisions on lifestyle-related practices. Parents also expressed a need for peer-support and confirmation of their practices. Future studies should focus on supporting parents in their parental practices during the first two years of their child's life. Any such study should take into account the specific sociocultural context accompanying lifestyle-related parental practices.

Influence of the Parental Educational Level on Physical Activity in Schoolchildren

The factors influencing physical activity participation in children are varied, although there is evidence that the educational level of parents may be one important factor. The aim of this study is to analyze the influence of parental education on the level of physical activity and the sedentary behavior of their children. The parents of 727 students, separated based on school group (preschool: n = 179; primary: n = 284; secondary: n = 230; high: n = 34), were invited to complete a series of questionnaires assessing their educational level (low, intermediate, and high) and their child’s level of physical activity and sedentary behavior. Primary school students with high- and intermediate-educated parents were found to engage in significantly more physical activity per week and spent more time engaged in homework than children with lower-educated parents. Secondary school students with higher-educated parents were found to spend significantly less time engaged in sedentary behavior than children with lower- or intermediate-educated parents, and high schoolers with higher-educated parents engaged in less tablet time than children with lower-educated parents. Multiple linear regression demonstrated that greater physical activity was precipitated by certain sedentary behaviors in children with more educated parents, such as total time watching TV (primary school), doing homework (secondary school), and total time using a tablet/similar (high school), which increased total time engaged in physical activity. These findings suggest that more educated parents may implement structured time for their children to engage in a balance of physical activity and sedentary behaviors.

Parent recommendations to support physical activity for families with young children: Results of interviews in deprived and affluent communities in South Wales (United Kingdom)

BACKGROUND

Physical inactivity is the fourth leading cause of mortality worldwide. Early childhood is a critical period when healthy behaviours can be instilled for a future active lifestyle. We explored community, societal and environmental factors affecting child and family physical activity and sought parent recommendations to support physical activity in families with young children.

METHODS

We interviewed 61 parents expecting a child or with a baby ≤12 months (35 mother and father paired interviews and 26 interviews with mothers only). We purposively sampled families for neighbourhood deprivation status (Townsend Index; 26 affluent; 35 deprived). We conducted thematic analysis of interview transcripts using Bronfenbrenner's socio-ecological framework to guide interpretation.

RESULTS

We identified four themes: work family-life balance; spaces for activity; beliefs and attitudes; and physical activity facilitators. We found that parents from deprived neighbourhoods were more likely to be underactive because of a complex web of community, social and personal factors which reduced motivation and hindered opportunity for physical activity. To increase knowledge and opportunity, respondents suggested 'help not tell' messages covering 'why', 'how' and 'where' information about physical activity, and using physical activity to support community engagement and social interaction.

CONCLUSIONS

Recommendations from parents highlight effective communication about the importance of early child and family physical activity and improved community access to safe facilities and opportunities. Both parents need to be engaged in designing interventions to support greater physical activity and healthy behaviours which are relevant and achievable in individuals' lives.

Co-participation in physical activity: perspectives from Australian parents of pre-schoolers

Co-participation in physical activity may be important for helping families with young children meet physical activity recommendations. Yet, little is known about what families perceive to be the benefits, barriers and facilitators of co-participation. This study explored (i) parents’ perceptions about physical activity and possible benefits of family-based co-participation in physical activity, (ii) their perceived facilitators and barriers to co-participation and (iii) their recommendations for improving co-participation within their community. Fifteen parents (14 mothers, 1 father) of 2- to 4-year-old children residing in Western Sydney, Australia, participated in one-on-one interviews between September 2016 and January 2017. Interviews were audio-recorded and transcribed verbatim. Four main themes and seven sub-themes emerged from the thematic analysis of the interview data. When parents were asked to reflect on their understanding of physical activity, they discussed a range of well-known activities (e.g. active play, active transport) and also reported ‘anything but screen time’. The major benefits parents reported about co-participation were spending quality time together, improving children’s general health and well-being and the development of physical skills. Social (e.g. social networks, negative stereotypes) and environmental (e.g. home space, neighbourhood design, shading) facilitators and barriers were identified, yet their impact on co-participation often varied depending on the presence (or lack thereof) of other factors in the physical or social environment. Key recommendations suggested by parents included improvements to home outdoor spaces, neighbourhood design and play spaces and community services.

Unrestricted prevalence of sedentary behaviors from early childhood

Background

Light and sedentary behaviors impose heavy challenges on societies. The objectives of this study are to identify child sedentary behaviors, and to examine the relationship between parent knowledge and behavioral style on children’s sedentary time in Iran.

Methods

This cross-sectional study was done among children and their parents selected randomly using multi-stage method, from 12 urban districts in Tabriz, Iran;2017. Data were collected through designing a multi-sectional questionnaire adopted from the Bjelland and previous studies to assess the time spent on sedentary behaviors among children/adolescents along with parent knowledge and behavioral style.

Results

From 480 children/adolescents and their parents 54.6% came from middle class families, and 55.62% were boys aged 2 to18. The percentage of time spent more than 120 min per day (min/d) on weekdays was for watching television (TV): (girls 24.4%, boys 21.0%), for playing computer and video games: (girls 38.7%, boys 54.7%), for electronic media communication (EMC): (girls 52.8%, boys 60.2%). The associated factors for watching TV: child age [12 years and above OR = 1.37; 95% CI = 0.53–3.54], parent knowledge [OR = 0.59, 95% CI = 0.35–0.99], and communicative styles [OR = 1.43, 95%CI = 1.11–1.86], and for playing computer and EMC: child age [5 years old and above OR = 4.83,95% CI =1.52–15.38, 12 years old and above OR = 13.76, 95% CI= 4.22–24.91], family socio-economic status [middle class OR = 2.52, 95% CI = 1.54–4.11, high class OR = 5.53, 95%CI = 1.80–15.89].

Conclusion

There is an urgent need to combat the unrestricted prevalence of sedentary behaviors among Iranian children/ adolescents who use computers and other electronic devices more than the recommended time every day from early childhood.

Parents should be provided with appropriate information about adverse effects of using electronic devices longer than recommended time by children. It is also essential to teach them beneficial communicative styles to monitor their children’s sedentary behaviors.

Supporting healthy lifestyle behaviours in families attending community playgroups: parents' perceptions of facilitators and barriers

BACKGROUND

Establishing healthy nutrition, activity, and sleep behaviours early in life is a key strategy in childhood obesity prevention. Parents are the primary influence on the development and establishment of obesity-related behaviours in young children. There is evidence that autonomy supporting parenting practices are crucial for the development of self-regulation and the internalisation of healthy behaviours in children. It is therefore imperative that parenting practices are targeted as part of an obesity prevention intervention. However, there is limited understanding of barriers and facilitators to parents using autonomy supporting parenting practices with their children aged 0-5 years. Therefore, the aim of the study was to identify barriers and facilitators to using autonomy supporting parenting practices. A secondary aim was to determine parent preferences in respect to an intervention program to be delivered in community playgroups.

METHODS

Parents were recruited through Playgroup Queensland (PGQ), a not-for-profit organisation in Brisbane, Australia, to attend a focus group during their usual playgroup session. The focus group interview guide was designed to promote discussion among the participants in respect to their shared experiences as parents of young children. The focus group transcripts were coded and analysed using qualitative content analysis. Five focus groups with parents (n = 30) were conducted in May 2018. Most of the participants were mothers [1], and the majority (76%) had a child at playgroup aged between 2 and 4 years.

RESULTS

The support and guidance received from other parents at playgroup was a facilitator to autonomy supporting parenting practices. Barriers included beliefs around the need to use rewards to encourage child eating, beliefs around the need for screens as babysitters, and feeling disempowered to change sleep behaviours. Parents were enthusiastic about a potential program that would leverage off the existing playgroup support networks, but they did not want to be "educated", or to lose their "playgroup time" to an intervention. Rather they wanted strategies and support to deal with the frustrations of food, screen and sleep parenting.

CONCLUSION

These results will be used to inform the development of a childhood obesity prevention intervention to be delivered in a community playgroup setting.

Sitting and Screen Time Outside School Hours: Correlates in 6- to 8-Year-Old Children

BACKGROUND

Although there is increasing evidence regarding children's screen time, little is known about children's sitting. This study aimed to determine the correlates of screen time and sitting in 6- to 8-year-old children.

METHODS

In 2011-2012, parents in the Healthy Active Preschool and Primary Years (HAPPY) study (n = 498) reported their child's week/weekend day recreational screen time and potential correlates. ActivPALs™ measured children's nonschool sitting. In model 1, linear regression analyses were performed, stratified by sex and week/weekend day and controlling for age, clustered recruitment, and activPAL™ wear time (for sitting analyses). Correlates significantly associated with screen time or sitting (P < .05) were included in model 2.

RESULTS

Children (age 7.6 y) spent 99.6 and 119.3 minutes per day on week and weekend days engaging in screen time and sat for 119.3 and 374.6 minutes per day on week and weekend days, respectively. There were no common correlates for the 2 behaviors. Correlates largely differed by sex and week/weekend day. Modifiable correlates of screen time included television in the child's bedroom and parental logistic support for, encouragement of, and coparticipation in screen time. Modifiable correlates of sitting included encouragement of and coparticipation in physical activity and provision of toys/equipment for physical activity.

CONCLUSIONS

Interventions may benefit from including a range of strategies to ensure that all identified correlates are targeted.

Paternal self-efficacy for promoting children's obesity protective diets and associations with children's dietary intakes

Objective

Fathers’ parenting behaviours contribute to the development of children’s dietary behaviours and subsequent weight outcomes, yet the majority of research focusses on maternal influences. Understanding fathers’ perceptions of their effectiveness to influence children’s dietary behaviours will allow the development of whole-of-family interventions promoting obesity protective behaviours. This unique study is the first to investigate 1) tracking of paternal self-efficacy for promoting obesity protective dietary intakes in young children; 2) demographic characteristics of fathers and their self-efficacy category; and 3) associations between paternal self-efficacy and young children’s dietary intakes.

Methods

Paternal self-efficacy for promoting children’s obesity protective dietary intakes was assessed longitudinally from fathers (n = 195) in the Extended Infant Feeding Activity and Nutrition Trial Program at child age 4 and 36 months. Multinomial logistic regression examined self-efficacy tracking categories (persistently high; persistently low; increasing; decreasing) by paternal age, education and BMI. Linear regression examined associations between paternal self-efficacy tracking categories and child dietary intakes at 36 months.

Results

Paternal self-efficacy for promoting children’s obesity protective dietary intakes reduced over time. Fathers with trade/certificate or university qualifications had lower odds of having persistently low/decreasing self-efficacy (97 and 87% lower respectively) compared to high-school educated fathers. Positive associations (β (95% CI)) were observed between paternal self-efficacy category and children’s dietary intakes at 36 months: increasing self-efficacy and fruit (β89.8 (6.8; 172.7)), and vegetables (β39.2 (12.2; 66.2)); persistently high self-efficacy and water (β69.1 (2.9; 135.1)); decreasing self-efficacy and non-core drinks ((β30.1 (10.1; 50.1)). Persistently high self-efficacy was negatively associated with non-core drinks (β-20.2 (− 34.8; − 5.5)), with negative associations observed between decreasing self-efficacy and children’s intakes of fruit (β − 49.9 (− 87.5; − 12.3)), vegetables (β-19.9 (− 31.7; − 8.2)) and water (β-92.4 (− 172.6; − 12.3)).

Conclusions

Higher and/or sustained paternal self-efficacy is associated with fathers’ education and is important in promoting children’s obesity protective dietary intakes. Associations between paternal self-efficacy and children’s dietary intakes are present at a young age. This investigation was unique in its focus on paternal self-efficacy for promoting children’s obesity protective dietary intakes and associations with children’s dietary intakes. Future family interventions should consider how to maintain and/or improve paternal self-efficacy to promote obesity protective intakes from early childhood.

Key Messages in an Early Childhood Obesity Prevention Intervention: Are They Recalled and Do They Impact Children's Behaviour?

Knowledge of the impact of health messages as an intervention strategy is sparse. The aim of this study was to explore recall and use of health behaviour messages among mothers, and whether recall is associated with child health behaviours. Intervention group data from the 15 months Melbourne Infant Feeding, Activity and Nutrition Trial (InFANT) were used (n = 127, children 4 months at commencement). Mothers recalled (unprompted then prompted) at 2 and 3.5 years post-intervention six key messages used in the program, and reported whether they had used them. Children's food intake was measured by three days of 24-h recall; physical activity by accelerometers; and television viewing by parent report. Unprompted recall ranged between 1-56% across messages and follow-up points, and 37-90% for prompted recall. The most commonly recalled messages "tap into water", "parents provide, kids decide" and "color every meal with fruit and veg" were also most commonly used. There were few associations between recall and children's health behaviours. Given the association between recall and reported use, it is important to plan messages so they resonate well with the target group and its needs. Messages should be used as one of multiple strategies within health promotion programs.

Are preschool children active enough in Shanghai: an accelerometer-based cross-sectional study

OBJECTIVE

Engaging in physical activity (PA) plays an important role in promoting physical and mental health, but the PA data for Chinese preschool children are lacking. This study aims to objectively assess the PA levels of preschool children in Shanghai, China and to evaluate their PA levels relative to age-specific recommendations.

DESIGN, SETTING AND PARTICIPANTS

A cross-sectional study was conducted among preschool children in Shanghai, city of China. There were a total of 303 preschool children (boys, 174; girls, 129) recruited from eight kindergarten classes in the Yangpu and Baoshan Districts of Shanghai.

MAIN OUTCOME MEASURES

Daily PA was assessed using ActiGraph GT3X⁺ accelerometers for seven consecutive days. Children were required to have data from at least 2 weekdays and 1 weekend day, with a minimum daily wear time of 480 min to be included in the analysis.

RESULTS

Preschool children in Shanghai accumulated, on average, 70.9 min of moderate-to-vigorous PA (MVPA) and 168.0 min of total PA (TPA) per day (d). Boys engaged in more MVPA and TPA than girls (72.8 min/day vs 68.3 min/day and 171.9 min/day vs 162.9 min/day, respectively). Overall, 72.9% of the participants met the age-specific recommendations of MVPA, while 35.3% met TPA recommendations.

CONCLUSIONS

Findings of this study warn of the insufficiency of PA in Shanghai preschool children, suggesting there is substantial room to improve their PA.

TRIAL REGISTRATION NUMBER

ChiCTR-OOC-15007439; Results.

Five Approaches to Qualitative Comparison Groups in Health Research: A Scoping Review

Qualitative researchers have much to gain by using comparison groups. Although their use within qualitative health research is increasing, the guidelines surrounding them are lacking. The purpose of this article is to explore the extent to which qualitative comparison groups are being used within health research and to outline the lessons learned in using this type of methodology. Through conducting a scoping review, 31 articles were identified that demonstrated five different types of qualitative comparison groups. I highlight the key benefits and challenges in using this approach.

"If You Let Them, They Will Be on It 24 Hours a Day": Qualitative Study Conducted in the United States Exploring Brazilian Immigrant Mothers' Beliefs, Attitudes, and Practices Related to Screen Time Behaviors of Their Preschool-Age Children

BACKGROUND

The increasing prevalence of excessive screen time (ST) among children is a growing public health concern, with evidence linking it to an increased risk of overweight and obesity among children.

OBJECTIVE

This study aimed to explore the beliefs, attitudes, and practices of Brazilian immigrant mothers living in the United States related to their preschool-age children's ST behaviors.

METHODS

A qualitative study comprising 7 focus group discussions (FGDs) was conducted with Brazilian immigrant mothers living in the United States. All FGDs were audio-recorded and professionally transcribed verbatim. The Portuguese transcripts were analyzed using thematic analysis.

RESULTS

In total, 37 women participated in the FGDs. Analyses revealed that although most mothers expressed concerns for their preschool-age children's ST, nearly all viewed ST as an acceptable part of their children's daily lives. Furthermore, mothers perceived that ST has more benefits than disadvantages. The mothers' positive beliefs about (eg, educational purposes and entertainment) and perceived functional benefits of ST (eg, ability to keep children occupied so tasks can be completed and facilitation of communication with family outside the United States) contributed to their acceptance of ST for their preschool-age children. Nevertheless, most mothers spoke of needing to balance their preschool-age children's ST with other activities. Mothers reported using several parenting practices including monitoring time and content, setting limits and having rules, and prompting their children to participate in other activities to manage their preschool-age children's ST.

CONCLUSIONS

This study provides new information on the beliefs, attitudes, and practices of Brazilian immigrant mothers living in the United States related to their preschool-age children's ST. Study findings revealed several potentially modifiable maternal beliefs and parenting practices that may provide important targets for parenting- and family-based interventions aimed at limiting preschool-age children's ST.

Parent activation in the pediatric emergency department: Theory vs. reality

OBJECTIVE

To measure parent activation and test for its associations with sociodemographics, clinical factors, and short-term outcomes.

METHODS

By convenience sampling, 246 parents of children treated in an emergency department (ED) of a children's hospital completed the Parent-Patient Activation Measure (P-PAM) and answered sociodemographic questions. Clinical information was abstracted from medical records. Phone calls to parents and primary care physician offices were conducted within one-month post-ED visit for information about short-term outcomes.

RESULTS

We discovered higher than expected activation among our sample (mean = 73), higher activation scores by Spanish language and child chronic illness status, and associations between activation scores and ED visit and discharge instruction comprehension and filling prescriptions (short-term outcomes). However, the theory of parent activation did not adequately fit the data.

CONCLUSION

Before the P-PAM in pediatric clinical care becomes widespread, further research is necessary to better understand parent activation and its associations with pediatric outcomes.

PRACTICE IMPLICATIONS

Although the PAM has shown promise in accurately measuring patient activation across various populations and disease processes, the same is not yet true of the P-PAM. To date, pediatric studies using the P-PAM have called its psychometric properties into question. Further research is needed to understand and measure parent activation.

Impact of parents' physical activity on preschool children's physical activity: a cross-sectional study

Purpose

This study examined the associations of physical activity levels between parents and their pre-school children based on gender and weekday/weekend.

Method

A total of 247 parent-preschool child triads from Shanghai, China were analyzed. The children had a mean age of 57.5 ± 5.2 months. Both sedentary behavior and physical activity were measured in all participants using an ActiGraph GT3X⁺ accelerometer over seven consecutive days from Monday through the following Sunday. A multivariate regression model was derived to identify significant relationships between parental and child physical activity according to gender and weekday/weekend.

Results

There was a significant correlation between mothers’ and girls’ moderate-to-vigorous physical activity (MVPA) and total physical activity (TPA) on weekdays. Fathers’ MPVA levels correlated significantly with those of boys and girls, with paternal influence appearing to be stronger than maternal influence. However, there was not a significant correlation between fathers’ and children’s TPA. TPA levels of both mothers and fathers correlated with those of girls, but not with those of boys. Parental sedentary levels on the weekend correlated significantly with girls’ levels, but not with boys’ levels. Children’s physical activity levels on weekends were influenced more by fathers’ activity levels than by mothers’, while the opposite was observed on weekdays.

Conclusion

Sedentary behavior and physical activity levels of parents can strongly influence those of their preschool children, with maternal influence stronger during the weekdays and paternal influence stronger on the weekends. Parents’ activity levels influence girls’ levels more strongly than they influence boys’ levels.

Role of parental and environmental characteristics in toddlers' physical activity and screen time: Bayesian analysis of structural equation models

Background

Guided by the Socialization Model of Child Behavior (SMCB), this cross-sectional study examined direct and indirect associations of parental cognitions and behavior, the home and neighborhood environment, and toddlers’ personal attributes with toddlers’ physical activity and screen time.

Methods

Participants included 193 toddlers (1.6 ± 0.2 years) from the Parents’ Role in Establishing healthy Physical activity and Sedentary behavior habits (PREPS) project. Toddlers’ screen time and personal attributes, physical activity- or screen time-specific parental cognitions and behaviors, and the home and neighborhood environment were measured via parental-report using the PREPS questionnaire. Accelerometry-measured physical activity was available in 123 toddlers. Bayesian estimation in structural equation modeling (SEM) using the Markov Chain Monte Carlo algorithm was performed to test an SMCB hypothesized model. Covariates included toddlers’ age, sex, race/ethnicity, main type of childcare, and family household income.

Results

In the SMCB hypothesized screen time model, higher parental barrier self-efficacy for limiting toddlers’ screen time was associated with higher parental screen time limiting practices (β = 0.451), while higher parental negative outcome expectations for limiting toddlers’ screen time was associated with lower parental screen time limiting practices (β = − 0.147). In turn, higher parental screen time limiting practices was associated with lower screen time among toddlers (β = − 0.179). Parental modeling of higher screen time was associated with higher screen time among toddlers directly (β = 0.212) and indirectly through the home environment. Specifically, higher screen time among parents was associated with having at least one electronic device in toddlers’ bedrooms (β = 0.146) and, in turn, having electronics in the bedroom, compared to none, was associated with higher screen time among toddlers (β = 0.250). Neighborhood safety was not associated with toddlers’ screen time in the SEM analysis. No significant correlations were observed between the SMCB variables and toddlers’ physical activity; thus, no further analyses were performed for physical activity.

Conclusions

Parents and their interactions with the home environment may play an important role in shaping toddlers’ screen time. Findings can inform family-based interventions aiming to minimize toddlers’ screen time. Future research is needed to identify correlates of toddlers’ physical activity.

Chemical and non-chemical stressors affecting childhood obesity: a systematic scoping review

Childhood obesity in the United States has doubled over the last three decades and currently affects 17% of children and adolescents. While much research has focused on individual behaviors impacting obesity, little research has emphasized the complex interactions of numerous chemical and non-chemical stressors found in a child's environment and how these interactions affect a child's health and well-being. The objectives of this systematic scoping review were to (1) identify potential chemical stressors in the context of non-chemical stressors that impact childhood obesity; and, (2) summarize our observations for chemical and non-chemical stressors in regards to child-specific environments within a community setting. A review was conducted to identify chemical and non-chemical stressors related to childhood obesity for the childhood life stages ranging from prenatal to adolescence. Stressors were identified and grouped into domains: individual behaviors, family/household behaviors, community stressors, and chemical exposures. Stressors were related to the child and the child's everyday environments and used to characterize child health and well-being. This review suggests that the interactions of chemical and non-chemical stressors are important for understanding a child's overall health and well-being. By considering these relationships, the exposure science research community can better design and implement strategies to reduce childhood obesity.

Facilitator and Participant Use of Facebook in a Community-Based Intervention for Parents: The InFANT Extend Program

BACKGROUND

Social networking sites such as Facebook afford new opportunities for behavior-change interventions. Although often used as a recruitment tool, few studies have reported the use of Facebook as an intervention component to facilitate communication between researchers and participants. The aim of this study was to examine facilitator and participant use of a Facebook component of a community-based intervention for parents.

METHODS

First-time parent groups participating in the intervention arm of the extended Infant Feeding, Activity and Nutrition Trial (InFANT Extend) Program were invited to join their own private Facebook group. Facilitators mediated the Facebook groups, using them to share resources with parents, arrange group sessions, and respond to parent queries. Parents completed process evaluation questionnaires reporting on the usefulness of the Facebook groups.

RESULTS

A total of 150 parents (from 27 first-time parent groups) joined their private Facebook group. There were a mean of 36.9 (standard deviation 11.1) posts/group, with the majority being facilitator posts. Facilitator administration posts (e.g., arranging upcoming group sessions) had the highest average comments (4.0), followed by participant health/behavior questions (3.5). The majority of participants reported that they enjoyed being a part of their Facebook group; however, the frequency of logging on to their groups' page declined over the 36 months of the trial, as did their perceived usefulness of the group.

CONCLUSIONS

Facebook appears to be a useful administrative tool in this context. Parents enjoyed being part of their Facebook group, but their reported use of and engagement with Facebook declined over time.

Meeting new Canadian 24-Hour Movement Guidelines for the Early Years and associations with adiposity among toddlers living in Edmonton, Canada

BACKGROUND

Canada has recently released guidelines that include toddler-specific recommendations for physical activity, screen-based sedentary behaviour, and sleep. This study examined the proportions of toddlers meeting the new Canadian 24-Hour Movement Guidelines for the Early Years (0-4 years) and associations with body mass index (BMI) z-scores in a sample from Edmonton, Canada.

METHODS

Participants included 151 toddlers (aged 19.0 ± 1.9 months) for whom there was complete objectively measured physical activity data from the Parents' Role in Establishing healthy Physical activity and Sedentary behaviour habits (PREPS) project. Toddlers' physical activity was measured using ActiGraph wGT3X-BT monitors. Toddlers' screen time and sleep were measured using the PREPS questionnaire. Toddlers' height and weight were objectively measured by public health nurses and BMI z-scores were calculated using World Health Organization growth standards. Meeting the overall 24-Hour Movement Guidelines was defined as: ≥180 min/day of total physical activity, including ≥1 min/day of moderate- to vigorous-intensity physical activity; no screen time per day (for those aged 12-23 months) or ≤1 h/day of screen time per day (ages 24-35 months); and 11-14 h of sleep per 24-h period. Frequency analyses and linear regression models were conducted.

RESULTS

Only 11.9% of toddlers met the overall 24-Hour Movement Guidelines, but this finding was largely driven by screen time. The majority of toddlers met the individual physical activity (99.3%) and sleep (82.1%) recommendations, while only 15.2% of toddlers met the screen time recommendation. No associations were observed between meeting specific and general combinations of recommendations within the guidelines and BMI z-scores.

CONCLUSIONS

Most toddlers in this sample were meeting physical activity and sleep recommendations but were engaging in more screen time than recommended. Consequently, only a small proportion of toddlers met the overall guidelines. Based on the findings of this study, identifying modifiable correlates of screen time to inform appropriate strategies to reduce screen time appears key for increasing the proportion of toddlers meeting the 24-Hour Movement Guidelines for the Early Years. Future research should examine the associations between meeting the new guidelines and other health indicators. Furthermore, future high-quality studies examining dose-response relationships between movement behaviours and health indicators are needed to inform guideline updates.

Barriers and facilitators to young children's physical activity and sedentary behaviour: a systematic review and synthesis of qualitative literature

Positive activity behaviours (i.e. higher physical activity [PA]/lower sedentary behaviour [SB]) are beneficial from infancy, yet evidence suggests that young children (0- to 6-year-olds) are relatively inactive. To better understand the perceived influences on these behaviours and to aid intervention development, this paper systematically synthesizes the extensive qualitative literature regarding perceived barriers and facilitators to PA and SB in young children (0-6 years old). A search of eight electronic databases (July 2016) identified 43 papers for inclusion. Data extraction and evidence synthesis were conducted using thematic content analysis, underpinned by the socio-ecological model (i.e. individual, interpersonal, community, organizational and policy levels). Parents, childcare providers and children perceived seven broad themes to be important for PA and SB, including the child; the home; out-of-home childcare; parent-childcare provider interactions; environmental factors; safety; and weather. Each theme mapped onto between one and five levels of the socio-ecological model; barriers and facilitators at the interpersonal level (e.g. parents, care providers and family) were most frequently cited, reflecting the important (perceived) role adults/peers play in shaping young children's behaviours. We provide an overarching framework to explain PA and SB in early childhood. We also highlight where gaps in the current literature exist (e.g. from male carers; in developing countries; and barriers and facilitators in the environmental and policy domains) and where future quantitative work may focus to provide novel insights about children's activity behaviours (e.g. safety and weather).

Associations between the physical activity levels of fathers and their children at 20 months, 3.5 and five years of age

Background

Early childhood (under five years of age) is a critical developmental period when children’s physical activity behaviours are shaped and when physical activity patterns begin to emerge. Physical activity levels track from early childhood through to adolescence with low levels of physical activity associated with poorer health. The aims of this study were to examine cross-sectional and longitudinal associations between the physical activity levels of fathers and their children at the ages of 20 months, 3.5 and 5 years, and to investigate whether these associations differed based on paternal body mass index (BMI) and education.

Methods

The Melbourne Infant Feeding Activity and Nutrition Trial (InFANT) Program was a cluster randomized-controlled trial delivered to pre-existing first-time parent groups. Physical activity levels of fathers and their first-born children were assessed using the Active Australia Survey and ActiGraph accelerometers respectively. Cross-sectional associations between father and child physical activity behaviours were assessed at each time point. Longitudinal associations between father and child physical activity were also investigated from child age 20 months to both 3.5 and 5 years. Additional stratified analyses were conducted based on paternal BMI and paternal education as a proxy for socioeconomic position (SEP). Data from the control and interventions groups were pooled and all analyses adjusted for intervention status, clustering by first-time parent group and accelerometer wear time.

Results

Physical activity levels of fathers and their children at child age 20 months were not associated cross-sectionally or longitudinally at child age 3.5 and 5 years. Positive associations were observed between light physical activity of healthy weight fathers and children at age 3.5 years. Inverse associations were observed for moderate/vigorous physical activity between fathers and children at age 5 years, including between overweight/obese fathers and their children at this age in stratified analyses.

Conclusions

There were no clear associations between the physical activity of fathers and children. Future research should include the use of more robust measures of physical activity among fathers to allow in-depth assessment of their physical activity behaviours. Investigation of well-defined correlates of physical activity in young children is warranted to confirm these findings and further progress research in this field.

Parenting Practices and Children's Physical Activity: An Integrative Review

The purpose of this integrative review was to analyze the state of science concerning the influence of parenting practices on children's physical activity (PA) levels. A total of 38 studies met the inclusion criteria after full-text review. The body of research is limited in experimental designs with only three studies measuring the influence of the intervention on parenting practices. Seven of the 30 quantitative studies (23.3%) found significant associations between parental role modeling of PA and children's PA levels. Seven of the eight (87.5%) qualitative studies identified parental role modeling of PA as important in promoting children's PA. Sixteen of the 30 (53.3%) quantitative studies found that parental support of PA was significantly associated with children's PA. Five of the eight (62.5%) qualitative studies identified logistic support as supporting PA in children. The science could be expanded by the development of randomized controlled trials aimed at this area.

Exploring parent-reported barriers to supporting their child's health behaviors: a cross-sectional study

Background

Parents can influence the health behaviors of their children by engaging in supportive behaviors (e.g., playing outside with their child, limiting recreational screen time). How, and the extent to which parents engage in supportive behaviors may be influenced by perceived barriers. The purpose of this study is to explore whether the frequency, and types, of barriers to providing parental support are dependent on the type of child health behavior being supported (i.e., physical activity, recreational screen time reduction, healthy eating, and sleep).

Methods

Study participants were 1140 Ontario parents with at least one child under the age of 18 who completed a Computer Assisted Telephone Interview (CATI) survey about parental support behaviors. Open-ended responses about perceived barriers to parental support were coded, and aggregated to meta-categories adopted from the social-ecological model (i.e., individual child, individual parent, interpersonal, environmental). Freidman rank sum tests were used to assess differences across child behaviors. Wilcoxon rank sum tests with Bonferroni adjustments were used as a post hoc test for significant Freidman results.

Results

There were more barriers reported for supporting physical activity than for any other child behavior (ps < .01, As ≥ .53). Parents reported more parent level and environmental level barriers to supporting child physical activity versus other behaviors (ps < .001, As ≥ .55), child level barriers were more frequently reported for supporting healthy eating and sleep (ps < .001, As ≥ .57), and interpersonal barriers were more frequently reported for supporting recreational screen time reduction (ps < .001, As ≥ .52). Overall, parents reported more child and parent level barriers versus interpersonal and environmental barriers to supporting child health.

Conclusions

Parents experience a variety of barriers to supporting their children’s health behaviors. Differences in types of barriers across child health behaviors emerged; however, some frequently reported barriers (e.g., child preferences) were common across behaviors. Interventions promoting parental support should consider strategies that can accommodate parents’ busy schedules, and relate to activities that children find enjoyable. Creating supportive environments that help facilitate support behaviors, while minimizing parent level barriers, may be of particular benefit. Future research should explore the impact of barriers on parental support behaviors, and effective strategies for overcoming common barriers.

What mums think matters: A mediating model of maternal perceptions of the impact of screen time on preschoolers' actual screen time

Screen time during the preschool years is detrimental to wellbeing. The impact of parental perceptions on preschoolers' screen time is unknown. This paper explores the association between maternal perceptions of the impact of screen time on their preschoolers' wellbeing with their child's screen time and the potential mediating role of their perception of the appropriate amount of screen time. In 2013–2014, mothers of 575 preschoolers (2–5 years; metropolitan Melbourne and online sources) reported: their perceptions of the impact of screen time on 11 aspects of wellbeing, conceptually grouped to physical, social and cognitive well-being; their perceptions of the appropriate amount of screen time for preschoolers; and their child's actual screen time. Regression analyses investigated associations between perceptions and children's screen time. Mediation by perception of the appropriate amount of screen time was examined using indirect effects. Mothers' perceptions of the impact of screen time on social and cognitive wellbeing had a significant indirect effect on children's actual screen time through mothers' perception of the appropriate amount of screen time for their child. Findings illustrate the potential impact of parents' perceptions on their children's behaviors. Although a significant indirect effect was identified, direction of causality cannot be implied. Further exploration of the direction of association to determine causality, and interventions targeting parental perceptions, are warranted.

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Majority of mothers believe screen time is harmful to children's physical wellbeing.

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Perception of screen time volume associated with preschoolers' screen time

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Concern of poor cognitive, social wellbeing associated with screen time

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Interventions should target perceptions of impact of screen time.