Effects of TV in the Bedroom on Young Hispanic Children

Home Environment Factors and Health Behaviors of Low-income, Overweight, and Obese Youth

Objectives: Home environment may influence children's health behaviors associated with obesity. In this study, we examined home environment factors associated with diet and physical activity behaviors of overweight or obese youth. Methods: We analyzed baseline data from child and parent/caregiver dyads enrolled in an urban family weight management program. Multivariable logistic regression examined how home environment (parenting practices, family meal habits, and home availability of fruits/vegetables, sugar-sweetened beverages (SSBs), screen media, and physical activity resources) are related to children's intake of fruit, vegetables, and SSBs, and moderate-vigorous physical activity and sedentary time (ST) after adjusting for potential confounders. Results: Children were more likely to consume fruit if their families frequently ate meals together and infrequently watched TV during meals, and more likely to consume vegetables with high fruit/vegetable availability and low SSB availability. Children were more likely to engage in ST if parents practiced monitoring and frequently watched TV during meals. Conclusions: Overweight or obese children appear to have healthier habits if their families eat meals together without watching TV and if healthy food choices are available in the home. Encouraging parents to focus these practices may promote healthier body weight in children.

Maternal Beliefs and Parenting Practices Regarding Their Preschool Child's Television Viewing: An Exploration in a Sample of Low-Income Mexican-Origin Mothers

OBJECTIVE

To explore maternal beliefs about television (TV) viewing and related parenting practices in low-income Mexican-origin mothers of preschoolers.

METHODS

Semistructured interviews were conducted with 21 low-income Mexican-origin mothers of preschoolers. Interviews were audio recorded and analyzed using a theoretically based thematic analytic approach.

RESULTS

Mothers described strong beliefs about the positive and negative impact of TV content. Mothers emphasized the educational value of specific programming. Content restrictions were common. Time restrictions were not clearly defined; however, many mothers preferred short versus long episodes of viewing. Mothers spoke positively about family viewing and the role of TV viewing in enabling mothers to accomplish household tasks.

DISCUSSION

These findings have implications for intervening in this population. Interventionists should consider the value mothers place on the educational role of TV viewing, the direct benefit to mothers of viewing time, the lack of clear time limits, and the common practice of family co-viewing.

Outcomes from a Pediatric Primary Care Weight Management Program: Steps to Growing Up Healthy

OBJECTIVE

To examine the efficacy of Steps to Growing Up Healthy, an obesity prevention intervention in preschool-age, urban-dwelling minority children.

STUDY DESIGN

Thirty-two pediatric primary care clinicians used a brief (3- to 5-minute) evidence-based behavior change intervention with low-income mothers of children aged 2-4 years during each regularly scheduled clinic visit over a 12-month period to target 4 specific obesogenic behaviors (milk consumption, juice and sugar-sweetened beverage consumption, television/screen time, and physical activity). A written contract, self-monitoring calendar, and telephone follow-up at 5-7 days after the clinic visit reinforced the intervention. Body mass index (BMI) percentile over 12 months and obesogenic behaviors were compared with those of a sex- and age-matched historical control group drawn from the same clinic.

RESULTS

Between January 2009 and November 2012, 418 mother-child dyads (82% Hispanic and 18% African American; mean child age, 35.8 ± 8.6 months; 21% overweight and 21% obese children) participated (218 in the control group and 200 in the intervention group). At 12 months, BMI percentile decreased by 0.33 percentile in the intervention group, compared with a mean increase of 8.75 percentile in the control group (P < .001). In participants with an initial BMI <85th percentile, BMI percentile did not change over time in the intervention group but increased in the control group (from the 48th ± 21 to 63th ± 29 percentile; P < .01). At 12 months, consumption of juice and milk were decreased in the intervention group (P < .001).

CONCLUSION

A brief, evidence-based intervention targeting 4 behaviors, coupled with a written contract and telephone follow-up, decreased the rate of increase in BMI percentile in young children, especially in normal weight children.

The physical activity levels and sedentary behaviors of Latino children in London (Ontario, Canada)

Objective: To assess the physical activity and sedentary behaviors of a sample of Latino children in London, Ontario, Canada. Methods: Seventy-four Latino children (54.1% male; mean age = 11.4) completed self-report questionnaires related to physical activity and sedentary behaviors. A subset of children (n = 64) wore Actical (Mini Mitter, Respironics) accelerometers for a maximum of four days. Results: Latino children self-reported moderate levels of physical activity (i.e., mean score of 2.8 on 5-point scale). Accelerometer data revealed that children spent an average of 50.0 min in moderate-to-vigorous physical activity (MVPA; 59.2 min on weekdays and 50.6 min on weekend days) and were sedentary for an average of 8.4 h (508.0 min) per day (533.5 min on weekdays and 497.7 min on weekend days). Children reported spending an average of 3.8 h (228 min) daily in front of screens—1.7 h (102 min) watching television, 1.2 h (72 min) on the computer, and 0.9 h (54 min) playing video games. Conclusions: This feasibility project provided a preliminary account of objectively measured daily physical activity and sedentary time among a sample of Latino children in Canada, as well as insight into the challenge of measuring these behaviors. Sedentary behavior reduction techniques should be explored and implemented in this young population, along with strategies to promote adherence to accelerometer protocols.

Determinants of fruit and vegetable intake in low-income children and adolescents

Although low-income youth are likely to have low or less frequent fruit and vegetable intake, current understanding of the influences on intake in youth is limited. A systematic review of quantitative research on determinants of fruit and vegetable intake among low-income youth (i.e., persons aged <20 years) was conducted. The aims were to identify which determinants have been studied and which are consistently associated with intake. Fifty-eight papers published between 2003 and August 2013 were included. Across studies, 85 unique determinants were identified. Those best supported by evidence were race/ethnicity (with intake consistently higher among Hispanic as compared with African American and white youth), fruit and vegetable preferences, and maternal fruit and vegetable intake. For many potential determinants, the consistency of evidence could not be examined because of a lack of studies. Findings highlight racial/ethnic differences in fruit and vegetable intake and influences on intake that should be considered when designing dietary interventions for low-income youth. Further research on intake determinants in this at-risk population is needed to establish an evidence base to guide interventions.

Development of HomeSTEAD's physical activity and screen time physical environment inventory

BACKGROUND

The home environment has a significant influence on children's physical activity, sedentary behavior, dietary intake, and risk for obesity and chronic disease. Our understanding of the most influential factors and how they interact and impact child behavior is limited by current measurement tools, specifically the lack of a comprehensive instrument. HomeSTEAD (the Home Self-administered Tool for Environmental assessment of Activity and Diet) was designed to address this gap. This new tool contains four sections: home physical activity and media equipment inventory, family physical activity and screen time practices, home food inventory, and family food practices. This paper will describe HomeSTEAD's development and present reliability and validity evidence for the first section.

METHODS

The ANGELO framework guided instrument development, and systematic literature reviews helped identify existing items or scales for possible inclusion. Refinement of items was based on expert review and cognitive interviews. Parents of children ages 3-12 years (n = 125) completed the HomeSTEAD survey on three separate occasions over 12-18 days (Time 1, 2, and 3). The Time 1 survey also collected demographic information and parent report of child behaviors. Between Time 1 and 2, staff conducted an in-home observation and measured parent and child BMI. Kappa and intra-class correlations were used to examine reliability (test-retest) and validity (criterion and construct).

RESULTS

Reliability and validity was strong for most items (97% having ICC > 0.60 and 72% having r > 0.50, respectively). Items with lower reliability generally had low variation between people. Lower validity estimates (r < 0.30) were more common for items that assessed usability and accessibility, with observers generally rating usability and accessibility lower than parents. Small to moderate, but meaningful, correlations between physical environment factors and BMI, outside time, and screen time were observed (e.g., amount of child portable play equipment in good condition and easy to access was significantly associated with child BMI: r = -0.23), providing evidence of construct validity.

CONCLUSIONS

The HomeSTEAD instrument represents a clear advancement in the measurement of factors in the home environment related to child weight and weight-related behaviors. HomeSTEAD, in its entirety, represents a useful tool for researchers from which they can draw particular scales of greatest interest and highest relevance to their research questions.

Television viewing in low-income latino children: variation by ethnic subgroup and English proficiency

BACKGROUND

Television viewing is associated with an increased risk for obesity in children. Latino children are at high risk for obesity and yet little is known about differences in television viewing habits within this population. The purpose of this study is to determine if hours of television viewed by young children with low-income Latina mothers differs by maternal ethnic subgroup and English language proficiency.

METHODS

This was a cross-sectional analysis of data from the Welfare, Children, & Families: A Three City Study. Participants were 422 low-income Latina mothers of Mexican and Puerto Rican descent with children ages 0-4 years old. The dependent variable was hours of daily television viewed by the child. The independent variable was maternal ethnic subgroup and English language proficiency. Analyses involved the use of multiple negative binomial regression models, which were adjusted for demographic variables.

RESULTS

Multivariable regression analyses showed that compared to children with mothers of Mexican descent, children of mothers of Puerto Rican descent watch more daily television (<2 years old, incidence rate ratio (IRR)=4.18, 95% confidence interval (CI) 1.68, 10.42; 2-4 years, IRR=1.54, 95% CI 1.06, 2.26). For children with mothers of Mexican descent, higher maternal English language proficiency was associated with higher amounts of child television viewing (IRR=1.29, 95% CI 1.04, 1.61). No relationship was found for children of Puerto Rican descent.

CONCLUSIONS

Child television viewing varies in low-income Latino children by maternal ethnic subgroup and English language proficiency. Interventionists must consider the varying sociocultural contexts of Latino children and their influence on television viewing.

How did the television get in the child's bedroom? Analysis of family interviews

OBJECTIVE

Although recent research has shown associations between a television in the bedroom of children (BTV) and obesity, medical and negative societal consequences, the family decision making process supporting or opposing BTV is not yet understood. A qualitative research approach elicited rich, decision making experiences of families.

METHODS

Structured family interviews (n=21) in spring 2011 in Oklahoma City captured direct quotations about family beliefs and practices related to BTV. Systematic constant comparative methods of grounded theory guided identification of patterns and themes across families to develop a model of family decision making for BTV.

RESULTS

Nine themes represented family decision making processes for BTV. Supporting themes included "I didn't even think about it" and "benefit to me." Opposing themes included: "watch a lot more TV and get less sleep," "bedroom door would probably be closed a lot," "everyone knows it rots your brain," and "what the heck are they watching."

CONCLUSIONS

Development of a conceptual model represented the basis for decisions opposing BTV in child concerns for development and missed opportunities while decisions supporting BTV reflected its use as a parenting tool. The emerged model could be useful in guiding strategies to modify family routines and address active and passive parenting strategies that negatively affect child health.