Associations Between Parent Self-Reported and Accelerometer-Measured Physical Activity and Sedentary Time in Children: Ecological Momentary Assessment Study

Association between parental stress, coping, mood, and subsequent child physical activity and screen-time: an ecological momentary assessment study

BACKGROUND

Few children meet physical activity and screen-time guidelines. Parents play a key role in supporting children's physical activity and limiting child screen-time, but their own stress, management of stress (i.e., coping), and mood may impact their ability to do so. Ecological momentary assessment (EMA) is a methodology that can be used to assess the temporality of parental state (i.e., stress, mood) and subsequent child behavior. This study aimed to examine the relationship between parental stress, coping, and mood with child physical activity and screen-time, and whether there were differences by child sex.

METHODS

Parents and their children (n = 436, 5-9 y) participated in an EMA study that used signal-contingent and end-of-day surveys. Parents received three signal-contingent surveys during fixed 3-hour windows and one end-of-day survey over 7-days via smartphone notifications. Parents reported their current stress, ability to manage stress, and depressive mood at the first signal-contingent survey. Parents also reported the frequency of their child's physical activity and screen-time across the day during the end-of-day survey. Conditional fixed effects regression was fitted to examine current and lagged day stress, coping, and mood relationships on change in child physical activity and screen-time.

RESULTS

Children were girls (53.7%), mainly non-white (64.3%), and with a household income of less than $50,000 USD (54.1%). Overall, parent's current day stress was negatively related to the frequency of child physical activity (p = 0.001), but not screen-time. Among girls, higher parent current-day stress and lower coping were related to less frequent girl's physical activity (ps < 0.05). Parent's lagged day stress was then associated with more frequent girl physical activity the next day (p = 0.018). There were no associations among parent mood or in models with only boys.

CONCLUSIONS

This study found parent's stress may negatively impact child's physical activity that day, but may positively impact physical activity the next day, namely girls. Findings suggest that reducing parental stress and improving coping abilities may improve girl's physical activity, but other approaches are needed to reduce child screen-time at this age.

Parental education, Family Health Climate and accelerometer-based measured physical activity and sedentary behavior of primary school-aged children

Introduction

Sociodemographic factors such as parental education level (ED) influence the physical activity (PA) and sedentary behavior (SED) of primary school-aged children. In this context, family factors, such as the physical activity-related Family Health Climate (FHCPA), are relevant. However, the effect of FHCPA on the interaction between ED and children's activity behavior has not yet been investigated. Therefore, this study aimed to analyze the mediating effect of FHCPA on the relation between parental ED and children's device-based measured PA and SED.

Methods

A total of 94 children and their parents participated in the study. Questionnaires were used to assess parental ED and FHCPA. Children's moderate to vigorous physical activity (MVPA) and SED were measured using accelerometers. Bivariate correlations were conducted to investigate associations between parental ED and MVPA/SED/FHCPA. Mediation analyses were used to investigate the role of FHCPA in the association between maternal and paternal ED and children's MVPA/SED. Results indicate a small correlation between maternal ED and FHCPA for the total sample (ρ = 0.318, p < 0.001) and a medium correlation for girls only (ρ = 0.570, p < 0.001). Mediation analyses showed no significant mediation effect. However, there was a significant direct association when considering FHCPA in the relation between higher maternal ED and SED in girls compared to lower ED.

Discussion

Future research should examine more complex models to further develop and refine to facilitate the derivation of more effective recommendations for health prevention programs, particularly for mothers and girls.

Compliance with the 24-h Movement Guidelines for Portuguese children: differences between boys and girls

The 24-h Movement Guidelines for children recommend at least 60 min per day of moderate-to-vigorous intensity physical activity (PA), ≤ 2 h/day of screen time, and 9-11 h/day of sleep for children. Since little information is available on the 24-h Movement Guidelines in Portuguese children, this research attempts to know the proportion of Portuguese children meeting individual and combinations of these 24-h Movement Guidelines. Another aim of this study is to test sex differences in compliance with 24-h Movement Guidelines. A final sample of 1351 Portuguese children (51.4% girls, aged 7.65 ± 1.21) participated in this cross-sectional study. PA, screen time and sleep duration were parent-reported through a questionnaire. Only 3.7% of children met all three 24-h Movement Guidelines, whereas 11.9% met none. Although boys showed greater compliance with PA recommendations and girls with screen time recommendations, no significant sex differences were found in the compliance of all three 24-h Movement Guidelines. Given that 96.3% of Portuguese children did not meet 24-h Movement Guidelines, promoting these three movement behaviours in both boys and girls is crucial to encouraging positive consequences early.

Adherence to 24-hour integrated activity guidelines among infants, toddlers and preschool children in Singapore

This study examined children's adherence to the Singapore Integrated 24-Hour Activity Guidelines for Early Childhood in infants, toddlers and preschoolers aged 0-6 years. A total of 901 caregivers, comprising 219 infants, 379 toddlers, and 303 preschoolers, provided information regarding their children's physical activity (PA), screen viewing time (SVT), and sleep durations on both weekdays and weekends. Meeting the 24-hour integrated activity guidelines was defined as follows: for infants ≥ 30 minutes per day of tummy time or floor-based play; zero SVT; total sleep of 14-17 hours per day for ages 0-3 months, 12-16 hours per day for ages 4-11 months; for toddlers ≥ 180 minutes of total PA per day; zero SVT under 2 years; <1 hour for ages 2 to less than 3 years; and a total sleep of 11-14 hours per day; for preschoolers ≥ 180 minutes of total PA per day; SVT <1 hour per day; total sleep of 10-13 hours per day for those aged 3-5 years, and 10-11 hours per day for 6-year-olds. Chi-squared tests were used to examine the differences in guideline adherence between weekdays and weekends. Compared to weekdays, during weekends there was a higher proportion of toddlers and preschoolers adhering to the PA guidelines (68.9% vs 50.1%; 78.9% vs 55.4%, respectively, p<0.05), and a lower proportion of toddlers adhering to SVT (38.8% vs 21.8%; p = 0.001). There was a declining adherence to all three activity guidelines as age groups progressed from infants (44.7%) to toddlers (15.8%) and then to preschoolers (9.4%). Concurrently, there was a decrease in adherence to SVT recommendations across the age groups, with adherence rates being highest among infants (83.1%), followed by toddlers (15.8%), and preschoolers (9.4%). Decreasing compliance with all three guidelines, coupled with a corresponding decline in adherence to SVT guidelines as children transition from toddlerhood to preschool age, is a cause for concern. This underscores the need for proactive efforts to educate caregivers about reducing or eliminating SVT among infants and young children.

Individual, family, and environmental correlates of fundamental motor skills among school-aged children: a cross-sectional study in China

OBJECTIVE

This cross-sectional study examined the socio-ecological factors influencing fundamental motor skills (FMS) in Chinese school-aged children.

METHODS

A total of 1012 parent-child pairs were randomly sampled between March-1st and April-15th, 2022. Based on the socio-ecological model of Children's FMS, three levels of factors: individual-level (e.g., demographic, physical, psychological, and behavioral characteristics of children), family-level (e.g., caregiver demographics, parental support, and socioeconomic status), and environmental factors (e.g., availability of physical activity equipment) were assessed using self-reported scales (e.g., the Self-perception Profile for Children, the Physical Activity Enjoyment Scale, and the 12-item Psychological Well-Being Scale for Children) and objective measures (e.g., ActiGraph GT3X, the Chinese National Student Physical Fitness Standard, and the Test of Gross Motor Development-Third Edition). Multi-level regression models were employed using SPSS.

RESULTS

The results demonstrated that children's age, sex, physical fitness, parental support, and the quality of home and community physical activity environments consistently influenced all three types of FMS, including locomotor, ball, and composite skills. Additionally, seven individual-level factors (children's age, sex, body mass index, light physical activity, sleep duration, perceived motor competence, and physical fitness) were associated with different types of FMS.

CONCLUSIONS

The findings underscore the multidimensional and complex nature of FMS development, with individual-level factors playing a particularly significant role. Future research should adopt rigorous longitudinal designs, comprehensive assessment tools covering various FMS skills, and objective measurement of parents' movement behaviors to better understand the strength and direction of the relationship between socio-ecological factors and children's FMS.

Feasibility of Using Research Electronic Data Capture (REDCap) to Collect Daily Experiences of Parent-Child Dyads: Ecological Momentary Assessment Study

BACKGROUND

Intensive longitudinal data collection, including ecological momentary assessment (EMA), has the potential to reduce recall biases, collect more ecologically valid data, and increase our understanding of dynamic associations between variables. EMA is typically administered using an application that is downloaded on participants' devices, which presents cost and privacy concerns that may limit its use. Research Electronic Data Capture (REDCap), a web-based survey application freely available to nonprofit organizations, may allow researchers to overcome these barriers; however, at present, little guidance is available to researchers regarding the setup of EMA in REDCap, especially for those who are new to using REDCap or lack advanced programming expertise.

OBJECTIVE

We provide an example of a simplified EMA setup in REDCap. This study aims to demonstrate the feasibility of this approach. We provide information on survey completion and user behavior in a sample of parents and children recruited across Canada.

METHODS

We recruited 66 parents and their children (aged 9-13 years old) from an existing longitudinal cohort study to participate in a study on risk and protective factors for children's mental health. Parents received survey prompts (morning and evening) by email or SMS text message for 14 days, twice daily. Each survey prompt contained 2 sections, one for parents and one for children to complete.

RESULTS

The completion rates were good (mean 82%, SD 8%) and significantly higher on weekdays than weekends and in dyads with girls than dyads with boys. Children were available to respond to their own survey questions most of the time (in 1134/1498, 75.7% of surveys submitted). The number of assessments submitted was significantly higher, and response times were significantly faster among participants who selected SMS text message survey notifications compared to email survey notifications. The average response time was 47.0 minutes after the initial survey notification, and the use of reminder messages increased survey completion.

CONCLUSIONS

Our results support the feasibility of using REDCap for EMA studies with parents and children. REDCap also has features that can accommodate EMA studies by recruiting participants across multiple time zones and providing different survey delivery methods. Offering the option of SMS text message survey notifications and reminders may be an important way to increase completion rates and the timeliness of responses. REDCap is a potentially useful tool for researchers wishing to implement EMA in settings in which cost or privacy are current barriers. Researchers should weigh these benefits with the potential limitations of REDCap and this design, including staff time to set up, monitor, and clean the data outputs of the project.

Time to Play in Javanese Preschool Children-An Examination of Screen Time and Playtime before and during the COVID-19 Pandemic

This comparative-descriptive multi-national research examined the screen time and playtime of preschool children aged 1-6 years before and during the COVID-19 pandemic. Parents reported on the play and screen habits of preschool-aged children on the weekday and weekends using a questionnaire on the lifestyle habits of their children. Results indicated a significant difference in screen time and playtime on the weekday and weekend before the pandemic (screen time: 1.91 ± 2.40 vs. 2.16 ± 2.60 h; playtime: 3.55 ± 2.49 vs. 4.11 ± 2.58 h, both p < 0.05), but during the COVID-19 pandemic, only the weekday-weekend difference in screen time was significantly different (screen time: 2.87 ± 3.15 vs. 3.26 ± 3.18 h, p < 0.05; playtime: 3.25 ± 3.41 vs. 3.48 ± 2.41, p > 0.05). Before- and during-COVID-19 comparisons showed that the average daily screen time increased by 150% from 2.04 h to 3.06 h (p < 0.05), while the average play time decreased by 12.3% (3.83 to 3.36 h, p < 0.05). Based upon international guidelines for movement behaviours of young children, special attention and actions are needed to manage the excessive daily screen time and preserve the average daily playtime of Javanese preschool children. These results present useful benchmarking data for parents, teachers, and health authorities to initiate ameliorative interventions to better balance children's screen time and playtime as Indonesia emerges from the COVID-19 pandemic to a COVID-19 endemic.

Participant characteristics and dietary correlates of SNAP and other assistance programs among families with children from racially and ethnically diverse households

The objective of this study was to describe food purchasing behaviors and the home food environment across families simultaneously receiving SNAP (Supplemental Nutrition Assistance Program) and other cash and food assistance benefits, and assess how child dietary intake varied across three distinct categories of assistance (i.e., SNAP and other assistance programs, assistance programs other than SNAP, and not enrolled in any assistance program). This cross-sectional study was conducted with parents of children aged 5-9 years (N = 1033) from low-income and racially and ethnically diverse households, living in Minneapolis and Saint Paul, Minnesota, metropolitan areas. In an online survey, parents reported enrollment in seven assistance programs (SNAP, WIC [Special Supplemental Nutrition Program for Women, Infants and Children Program], free or reduced-cost school breakfast, free or reduced-cost school lunch, SSI [Supplemental Security Income Program], MFIP [Minnesota Family Investment Program], daycare assistance), food purchasing behaviors, the home food environment, and child dietary and fast-food intake. Descriptive statistics were computed to describe food purchasing behaviors and the home food environment. Multivariable linear regressions were used to evaluate the association between assistance categories and child dietary intake factors. Models were adjusted for child age, parent and child sex, race and ethnicity, household income, primary caregiver's educational attainment, employment status, and place of birth. Relative to families participating in assistance programs other than SNAP and not enrolled in any assistance program, families participating in SNAP and other assistance programs had less reliable modes of transportation to go food shopping (use 'my own car or vehicle' 57% vs. 90% and 83%, respectively), shopped less frequently during the month ('1 big trip a month and small trips in between' 35% vs. 19% and 24%, respectively], had a somewhat higher presence of energy-dense (e.g., 'French fries' 60% vs. 35% and 25%, respectively) and high-sodium food items in the home (e.g., 'canned pasta' meals 48% vs. 35% and 20%, respectively), and some aspects of children's dietary intake that were not congruent with current dietary recommendations (e.g., consumption of 'fried vegetables' 3.9 times/week [95% CI 3.4, 4.4] vs. 2.9 [2.3, 3.5] and 2.8 [2.1, 3.6], respectively). Findings could inform targeted strategies to maximize the impact of simultaneous programs' benefits on improving child dietary intake and reaching eligible households not enrolled in assistance programs.

The effect of two COVID-19 lockdowns on physical activity of school-age children

The introduction of strict quarantine restrictions in many countries initiated a direction in science to study the behavioral characteristics of children and adolescents during the social isolation at the population level. We present our observations during the two lockdowns in Ukraine. The objective of this study was to determine: a) the level of light (LPA) and moderate-to-vigorous (MVPA) physical activity among school-age children, and b) the impact of the external and internal factors on their physical activity during the lockdown. Global Physical Activity Questionnaire (GPAQ) as part of our questionnaire Q-RAPH was used. Parents of 1091 children 6-18 years old (54% boys) filled Q-RAPH at two measurement points in 2020 and 2021. After performing ANCOVA and logistic regression, we found a significant decrease in MVPA by 12.7% in 2021 compared to 2020 (p ​< ​0.001) while LPA was about 1.5 ​h a day during both periods. The proportion of children who reach the recommended levels of MVPA also decreased by 13.7% in 2021 (p ​< ​0.001). Factors negatively affecting the achievement of 60 ​min a day of MVPA were female gender, chronic diseases, overweight/obesity, non-participation in organized sports, and a decrease in the average air temperature. This study evidences the insufficient level of preventive measures and requires an intensification of health education among the Ukrainian population. When developing preventive measures, special attention should be paid to groups vulnerable to MVPA reduction as children who have chronic diseases and/or overweight/obesity as well as non-participation in sports.

Ecological Momentary Assessment of Weight-Related Behaviors in the Home Environment of Children From Low-Income and Racially and Ethnically Diverse Households: Development and Usability Study

Background

Ecological momentary assessment (EMA) is an innovative tool for capturing in-the-moment health behaviors as people go about their daily lives. EMA is an ideal tool to measure weight-related behaviors, such as parental feeding practices, stress, and dietary intake, as these occur on a daily basis and vary across time and context. A recent systematic review recommended standardized reporting of EMA design for studies that address weight-related behaviors.

Objective

To answer the call for reporting study designs using EMA, this paper describes in detail the EMA design of the Family Matters study and how it was adapted over time to improve functionality and meet the needs of a racially, ethnically, and socioeconomically diverse sample.

Methods

Family Matters is an incremental, 2-phased, mixed methods study, conducted with a racially and ethnically diverse, immigrant and refugee sample from largely low-income households, designed to examine risk and protective factors for child weight and weight-related behaviors in the home environment. The Family Matters study intentionally recruited White, Black, Hmong, Latino, Native American, and Somali parents with young children. Parents in phase 1 of the study completed 8 days of EMA on their smartphones, which included signal-contingent surveys (eg, asking about the parent’s stress at the time of the survey), event-contingent surveys (eg, descriptions of the meal the child ate), and end-of-day surveys (eg, overall assessment of the child’s day).

Results

A detailed description of EMA strategies, protocols, and methods used in phase 1 of the Family Matters study is provided. Compliance with EMA surveys and participants’ time spent completing EMA surveys are presented and stratified by race and ethnicity. In addition, lessons learned while conducting phase 1 EMA are shared to document how EMA methods were improved and expanded upon for phase 2 of the Family Matters study.

Conclusions

The results from this study provided an important next step in identifying best practices for EMA use in assessing weight-related behaviors in the home environment.

International Registered Report Identifier (IRRID)

DERR1-10.2196/30525

Momentary associations between stress and physical activity among children using ecological momentary assessment

Chronic and acute stress may have a detrimental effect on children's physical activity. Research on stress as a predictor of children's physical activity has mostly focused on stress between children, rather than how children's within-day variation in stress may predict physical activity. The current study assessed the within- and between-effects of stress on subsequent physical activity in three different time windows using ecological momentary assessment (EMA) and accelerometry. Children (N = 190; M_{Baseline Age} =10.1±0.9, 53% female, 56% self-identified Hispanic/Latino) completed six semi-annual assessment bursts across three years. During each burst, participants responded to up to seven (weekend) or three (weekday) randomly prompted EMA surveys on smartphones for seven days and wore a waist-worn accelerometer. Multi-level structural equation modeling examined within- and between-subjects effects of stress as a predictor of children's subsequent moderate-to-vigorous physical activity (MVPA) in the 15, 30, and 60 minutes following the EMA prompt. Latent variables were created for within- and between-subjects stress were comprised of three EMA stress items. Higher than average levels of stress (within-subjects) significantly predicted lower MVPA in the subsequent 15, 30 and 60 minutes (ps < .05). Between-subjects stress was not significantly associated with subsequent MVPA (ps > .05). Results indicate that elevated momentary stress predicts less subsequent MVPA. These findings suggest that within-day fluctuations in stress may be a barrier for children engaging in physical activity. Childhood physical activity promotion and interventions should consider the role of children's stress, aim to reduce the stress children experience throughout the day, and incorporate stress coping strategies.

Health-Related Behaviors Among School-Aged Children and Adolescents During the Spanish Covid-19 Confinement

In response to the coronavirus disease 2019 (Covid-19) world pandemic, affected countries such as Spain enacted measures comprising compulsory confinement as well as restrictions regarding free movement. Such measures likely influence children's and adolescents' lifestyles. Our study aimed to investigate the impact that the Covid-19 confinement has on health-related behaviors (HRBs) among Spanish children and adolescents. An online survey was administered to 516 parents to collect data about 860 children and adolescents (49.2% girls) aged between 3 and 16 years in relation to physical activity, screen exposure, sleep time, and fruit and vegetable consumption during the Covid-19 confinement. Respectively, t-paired test and t-test between groups served to check differences between HRBs levels before and during the confinement as well as between strict and relaxed confinement. Significant differences were found for a reduction of weekly minutes of physical activity during the confinement (-102.5, SD 159.6) (p < 0.001), an increase of daily hours of screen exposure (2.9, SD 2.1) (p < 0.001), and a reduction of daily fruit and vegetable consumption (-0.2, SD 1.6) (p < 0.001). Sleep time showed a significant difference between strict and relaxed confinement (-0.3, SD 0.1) (p < 0.05), whereas binomial logistic regression adjusted for covariates (age, sex, education of the parents, siblings, current condition, exposure to Covid-19, and previous health risk behavior) showed significantly lower odds for screen exposure risk behavior with relaxed confinement (OR 0.60, 95%CI 0.40-0.91). The present study suggests that Covid-19 confinement reduced physical activity levels, increased both screen exposure and sleep time, and reduced fruit and vegetable consumption. Therefore, most HRBs worsened among this sample of Spanish children and adolescents. Closure of schools, online education, and the lack of policies addressing the conciliation between labor and family life could have played an important role in HRBs worsening among pupils, which might be mitigated with adequate conciliation policies, parental guidance, and community support.