Context matters! The relationship between mother-reported family nutrition climate, general parenting, food parenting practices and children's BMI

Improving family health climate, effect of role modeling and maternal support in female students

INTRODUCTION

Girls can use their mother's emotional, informational and behavioral support to perform healthy behaviors due to their constant access to their mothers. This study aimed to evaluate the effect of role modeling and maternal support in the family to improve healthy behaviors and perceived Family Health Climate (FHC) in female students.

METHODS

In this educational quasi-experimental study, 261 female students (133 in the intervention group and 128 in the control group) and 223 mothers (109 intervention and 114 control) were selected using the cluster multi-stages sampling method and entered the study. Participants (intervention and control groups) completed the FHC scale at three stages (before intervention, immediately after the intervention, and 2 months after intervention). A training program that comprised 12 sessions for students and six sessions for their mothers using collaborative learning techniques and printed materials was conducted with the experimental group. Also after completing the questionnaire in the follow-up phase, pamphlets and educational videos were given to the control group. Data were analyzed using SPSS20 via a chi-square test, independent t-test, and Repeated Measures ANOVA at a significance level of 0.05.

RESULTS

Before the intervention, there was no significant difference between demographic variables and the score of the FHC scale in both groups (p < 0.05). Immediately and 2 months after the intervention, the experimental group (female students and their mothers) showed a significant increase in dimensions of FHC, including FHC-NU (Family Health Climate-Nutrition) and FHC-PA (Family Health Climate-Physical Activity), compared to the control group (p < 0.05).

CONCLUSIONS

Educating and informing mothers about the impact of their role modeling on their children, especially girls, can make them more aware of health-oriented behaviors towards their children. Such findings reinforced the importance of focusing on actions to encourage a healthy lifestyle (healthy diet and physical activity) in students with a focus on role modeling and parental support, especially mothers.

The validation of culturally appropriate scales to assess the family health climate in a multi-ethnic Asian population

Background

The Family Health Climate (FHC) is a family environment attribute postulated to influence the health behaviors of family members. It can be measured by domain scales for physical activity (FHC-PA) and nutrition (FHC-NU), which have been validated and used to identify health climate patterns in families in Western populations. To extend the use of the scales to Asian settings, this study aimed to adapt and validate the instruments for use in the multi-ethnic population of Singapore, accounting for language and cultural differences.

Methods

In Part A (n = 40) to adapt the scales for the Singapore population, we performed cognitive interviews, face validity testing and pre-testing of the instruments (n = 40). Besides English, the scales were translated into Chinese and Malay. In Part B (n = 400), we performed exploratory and confirmatory factor analyses respectively on two random samples. We also tested for item discriminant validity, internal consistency reliability, construct validity, and measurement invariance.

Results

The findings from the cognitive interviews in Part A led to scale adaptations to accommodate cultural and linguistic factors. In Part B, EFA on Sample I resulted in a three-factor model for the PA scale (accounting for 71.2% variance) and a four-factor model for the NU scale (accounting for 72.8% variance). CFA on Sample II indicated acceptable model fits: FHC-PA: χ² = 192.29, df = 101, p < 0.001, χ²/df = 1.90; SRMR = 0.049; RMSEA = 0.067; CFI = 0.969; TLI = 0.963; FHC-NU: χ² = 170.46, df = 98, p < 0.001, χ²/df = 1.74; SRMR = 0.036; RMSEA = 0.061; CFI = 0.967; TLI = 0.960. The scores of family members demonstrated significant agreement on the FHC-PA (Sg) [ICC_{(2, 2)} = 0.77] and FHC-NU (Sg) [ICC_{(2, 2)} = 0.75] scales. Findings suggest good evidence for item discriminant validity, internal consistency reliability, construct validity, and measurement invariance. Short versions of the scales were also developed.

Conclusion

We adapted, translated and validated the scales for assessing the health climate of families in Singapore, including the development of short versions. The results showed good psychometric properties and the constructs had significant relationships with health behaviors and routines. Improving our understanding of family influences on individual health behavior will be important in developing multi-level strategies for health promotion and chronic disease prevention.

Feeding coparenting: Associations with coercive control, structure-based, and autonomy-promoting food parenting

Feeding coparenting refers to how two parents work together in the child feeding domain. However, little is known about feeding coparenting in relation to food parenting. The current study seeks to examine 1) whether parent demographics (i.e., sex, age, BMI, and employment status) and parent concern about child weight are related to feeding coparenting (i.e., Shared Views, Active Engagement, Solo Parenting) and 2) whether feeding coparenting is related to food parenting (i.e., coercive control feeding, structure-based feeding, autonomy-promoting feeding). Parents (n = 160) of 3- to 5-year old children completed an online survey. Parents' sex, employment status, and concern about child weight were related to feeding coparenting (Shared Views, Active Engagement, Solo Parenting). After controlling for those variables, feeding coparenting was related to structure-based (Shared Views and Active Engagement) and autonomy-promoting feeding (Active Engagement). However, none of the feeding coparenting variables were associated with coercive control feeding. These findings illuminate the importance of understanding how parents' feeding coparenting relationship plays a part in food parenting.

Acculturation, food-related and general parenting, and body weight in Chinese-American children

Parents' food-related and general parenting behaviors may vary according to cultural background, with consequences for child eating behavior and weight. A better understanding of food-related and general parenting behaviors adopted by Chinese-American parents, and the relationships of all of these behaviors with child weight, is essential to aid the development of culturally appropriate interventions to prevent obesity in Chinese-American children. We investigated cross-sectional relationships of acculturation with parental feeding behaviors assessed with the Child Feeding Questionnaire, Parent Feeding Styles Questionnaire and Caregiver's Feeding Styles Questionnaire, and general parenting behaviors assessed with the Parenting Styles and Dimensions Questionnaire, in a sample of Chinese-American parents of 5-12 year-old children (n = 233). Parental level of acculturation was assessed using the Suinn-Lew Asian Self-Identity Acculturation scale. We performed generalized linear regressions to explore associations of acculturation levels with parental feeding and general parenting subscales and also associations of these factors with child body mass index (BMI) z-score. Acculturation was associated with higher scores on Responsiveness in feeding, lower scores on subscales assessing controlling feeding behaviors (Restriction, Pressure to eat, Demandingness in feeding), lower scores on non-nutritive feeding behaviors (Emotional feeding, Instrumental feeding), and greater likelihood of an indulgent feeding style. With regard to general parenting, acculturation was associated with lower scores on subscales assessing authoritarian parenting. Parental Prompting/Encouragement to eat was associated with lower child BMI z-score, while authoritarian parenting subscales were associated with higher BMI z-score. An appreciation of the impact of cultural variation on food-related and general parenting may help to inform the development of culturally-sensitive obesity prevention interventions.

Families' Health Behavior: Validity and Reliability of the Turkish Version of the Family Health Climate Scale

This study aims to adapting the Family Health Climate Scale (FHC Scale) into Turkish and to conduct its validity and reliability analyses. The FHC Scale consists of two subscales, the Physical Activity Scale (FHC-PA) and the Nutrition Scale (FHC-NU). The validity and reliability analyzes of the scales were done separately. The sample included 789 participants (263 students, 263 mothers, 263 fathers). The sample was randomly allocated to two groups. Explanatory Factor Analysis (EFA) was performed on Sample I (132 students, 132 mothers, 132 fathers); and Confirmatory Factor Analysis (CFA) on sample II (131 students, 131 mothers, 131 fathers). As a result of the EFA it was determined that three factors FHC-PA Scale; and four factors FHC-NU Scale were included. The CFA result it was determined that scale models had good fit values. The FHC-Scale could be used as a reliable and valid measurement tool in Turkey.

An App-Based Parenting Program to Promote Healthy Energy Balance-Related Parenting Practices to Prevent Childhood Obesity: Protocol Using the Intervention Mapping Framework

BACKGROUND

The family environment plays an important role in the development of children's energy balance-related behaviors. As a result, parents' energy balance-related parenting practices are important targets of preventive childhood obesity programs. Families with a lower socioeconomic position (SEP) may benefit from participating in such programs but are generally less well reached than families with a higher SEP.

OBJECTIVE

This paper describes the application of the Intervention Mapping Protocol (IMP) for the development of an app-based preventive intervention program to promote healthy energy balance-related parenting practices among parents of children (aged 0-4 years) with a lower SEP.

METHODS

The 6 steps of the IMP were used as a theory- and evidence-based framework to guide the development of an app-based preventive intervention program.

RESULTS

In step 1, behavioral outcomes for the app-based program (ie, children have a healthy dietary intake, sufficient sleep, and restricted screen time and sufficient physical activity) and sociocognitive (ie, knowledge, attitudes, and self-efficacy) and automatic (ie, habitual behaviors) determinants of energy balance-related parenting were identified through a needs assessment. In step 2, the behavioral outcomes were translated into performance objectives. To influence these objectives, in step 3, theory-based intervention methods were selected for each of the determinants. In step 4, the knowledge derived from the previous steps allowed for the development of the app-based program Samen Happie! through a process of continuous cocreation with parents and health professionals. In step 5, community health services were identified as potential adopters for the app. Finally, in step 6, 2 randomized controlled trials were designed to evaluate the process and effects of the app among Dutch parents of infants (trial 1) and preschoolers (trial 2). These trials were completed in November 2019 (trial 1) and February 2020 (trial 2).

CONCLUSIONS

The IMP allowed for the effective development of the app-based parenting program Samen Happie! to promote healthy energy balance-related parenting practices among parents of infants and preschoolers. Through the integration of theory, empirical evidence, and data from the target population, as well as the process of continued cocreation, the program specifically addresses parents with a lower SEP. This increases the potential of the program to prevent the development of obesity in early childhood among families with a lower SEP.

TRIAL REGISTRATION

Netherlands Trial Register NL6727, https://www.trialregister.nl/trial/6727; Netherlands Trial Register NL7371, https://www.trialregister.nl/trial/7371.

The Role of General Parenting Style in Child Diet and Obesity Risk

PURPOSE OF REVIEW

The childhood obesity epidemic is widely considered to have reached pandemic proportions. Across the world, children with obesity are facing numerous psychological and physiological issues that follow them into adulthood, frequently leading to chronic illness and early death. In an effort to combat the compounding effects of childhood overweight, researchers are attempting to identify biological and environmental contributors to child weight. Parenting styles are one recognized influence on child diet and body mass index (BMI). This review is a comprehensive examination of the literature on the influence of parenting style on childhood diet and BMI over the past 5 years.

RECENT FINDINGS

Current research continues to support the use of traditional parenting style categories (i.e., authoritative, authoritarian, permissive, uninvolved/neglectful): however, newer subcategories of Baumrind's styles and the inclusion of previously underrepresented groups (e.g., fathers, cross cultural comparison studies) are shedding more light on the nuance of parenting's relationship with child weight. Parenting styles that focus on the balance of warmth and control (e.g., authoritative) in contrast to the styles dedicated to only one of these constructs (e.g., permissive, authoritarian) seem to promote the healthiest dietary habits and may be protective of child BMI.

Involving Parents to Help Improve Children's Energy Balance-Related Behaviours Through a School-Based Intervention

The Challenge Me intervention aimed to indirectly involve parents in a school-based intervention, by challenging primary school children to perform physical activity (PA) and nutrition-related activities with their parents. The aim of this study is to gain insight in whether this was a feasible strategy to engage children and parents, especially those of vulnerable populations. An exploratory cross-sectional study design was applied. Four primary schools implemented the intervention. Data consisted of challenges completed (intervention posters) and child and family characteristics (questionnaires and anthropometric measurements). Associations between challenges performed and child and family characteristics were assessed using linear regression analysis. Of the 226 study participants, 100% performed at least one challenge, and 93% performed at least one challenge involving parents. Children who performed more PA challenges were often younger, a sports club member, lived in higher socioeconomic status neighbourhoods, of Western ethnicity and from larger families. Regarding nutrition challenges involving parents, younger children performed more challenges. There was no difference in intervention engagement regarding gender, weight status, PA preference, healthy nutrition preference, or the Family PA and Family Nutrition Climate. Challenge Me has potential in involving parents in a school-based intervention. However, certain characteristics were associated with higher involvement.

The association of parenting practices with toddlers' dietary intake and BMI, and the moderating role of general parenting and child temperament

Objective:

The objective was to examine the association between parenting practices, toddler’s dietary intake and BMI. In addition, potential moderation of these associations by general parenting and child temperament was examined.

Design:

The current cross-sectional study assessed parenting practices using the Comprehensive Feeding Practices Questionnaire, general parenting using the Comprehensive General Parenting Questionnaire, child temperament using the Child Behavior Check List, and children’s dietary intake through parental questionnaires. Children’s weight and length were objectively measured to determine BMI z-scores. Associations were examined using multiple linear regression analyses. Moderation was examined using interaction terms.

Setting:

Home setting.

Participants:

393 Dutch toddlers (age 1–3 years) and their parents recruited through fifty childcare centres and preschools in the Netherlands.

Results:

Various practices were related to children’s diet and BMI. For instance, the availability of healthy foods is the most important predictor of healthy dietary intake (e.g. β = –0·35 for sweets; β = 0·18 for fruit). The association of availability with a healthier diet was strongest when parents scored low on the positive parenting style dimensions, including nurturance, structure and/or behavioural control. In addition, it seemed that a high availability of healthy foods and low availability of unhealthy foods is especially beneficial for children showing withdrawal/depressive, anxious or overactive behaviour, while encouraging balance and variety is not beneficial for these children. All other practices were related to children’s diet and/or BMI as well.

Conclusions:

The findings underline the importance of viewing the impact of parenting practices in the context of general parenting and child temperament.

A Cross-Sectional Study on the Relationship between the Family Nutrition Climate and Children's Nutrition Behavior

Background: Parents influence their children’s nutrition behavior. The relationship between parental influences and children’s nutrition behavior is often studied with a focus on the dyadic interaction between the parent and the child. However, parents and children are part of a broader system: the family. We investigated the relationship between the family nutrition climate (FNC), a family-level concept, and children’s nutrition behavior. Methods: Parents of primary school-aged children (N = 229) filled in the validated family nutrition climate (FNC) scale. This scale measures the families’ view on the consumption of healthy nutrition, consisting of four different concepts: value, communication, cohesion, and consensus. Parents also reported their children’s nutrition behavior (i.e., fruit, vegetable, water, candy, savory snack, and soda consumption). Multivariate linear regression analyses, correcting for potential confounders, were used to assess the relationship between the FNC scale (FNC-Total; model 1) and the different FNC subscales (model 2) and the child’s nutrition behavior. Results: FNC-Total was positively related to fruit and vegetable intake and negatively related to soda consumption. FNC-value was a significant predictor of vegetable (positive) and candy intake (negative), and FNC-communication was a significant predictor of soda consumption (negative). FNC-communication, FNC-cohesion, and FNC-consensus were significant predictors (positive, positive, and negative, respectively) of water consumption. Conclusions: The FNC is related to children’s nutrition behavior and especially to the consumption of healthy nutrition. These results imply the importance of taking the family-level influence into account when studying the influence of parents on children’s nutrition behavior. Trial registration: Dutch Trial Register NTR6716 (registration date 27 June 2017, retrospectively registered), METC163027, NL58554.068.16, Fonds NutsOhra project number 101.253.

Conceptualizing Family Influences on Children's Energy Balance-Related Behaviors: Levels of Interacting Family Environmental Subsystems (The LIFES Framework)

Healthy or unhealthy behavioral patterns develop and are maintained in a family context. The importance of the family environment for children’s and adolescents’ energy balance-related behaviors (EBRBs) has been shown previously. However, the way different family environmental factors are interrelated and interact with personal factors (e.g., motivation) are not well understood. Furthermore, the majority of studies have focused on the parent-child subsystem. However, there are family-level socialization dynamics that affect the development of a healthy lifestyle beyond the impact of parenting behaviors. The current paper aims to synthesize theoretical and empirical literature on different types of family influences. The Levels of Interacting Family Environmental Subsystems (LIFES) framework incorporates family influences on three levels (immediate, proximal, distal) and of three subsystems (individual, parent-child, family), relates them to each other and postulates potential paths of influence on children’s EBRBs. Several studies examining specific sections of the framework provide empirical support for LIFES’ propositions. Future studies should place their research in the context of the interrelationship of different family environmental influences. A better understanding of the interrelated influences would enhance the understanding of the development and maintenance of overweight and obesity among children and is crucial for the development of effective interventions.

The Comprehensive Snack Parenting Questionnaire (CSPQ): Development and Test-Retest Reliability

The narrow focus of existing food parenting instruments led us to develop a food parenting practices instrument measuring the full range of food practices constructs with a focus on snacking behavior. We present the development of the questionnaire and our research on the test-retest reliability. The developed Comprehensive Snack Parenting Questionnaire (CSPQ) covers 21 constructs. Test-retest reliability was assessed by calculating intra class correlation coefficients and percentage agreement after two administrations of the CSPQ among a sample of 66 Dutch parents. Test-retest reliability analysis revealed acceptable intra class correlation coefficients (≥0.41) or agreement scores (≥0.60) for all items. These results, together with earlier work, suggest sufficient psychometric characteristics. The comprehensive, but brief CSPQ opens up chances for highly essential but unstudied research questions to understand and predict children’s snack intake. Example applications include studying the interactional nature of food parenting practices or interactions of food parenting with general parenting or child characteristics.