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1.  Physical Activity Parenting Measurement and Research: Challenges, Explanations, and Solutions 
Childhood Obesity  2013;9(Suppl 1):S-103-S-109.
Physical activity (PA) parenting research has proliferated over the past decade, with findings verifying the influential role that parents play in children's emerging PA behaviors. This knowledge, however, has not translated into effective family-based PA interventions. During a preconference workshop to the 2012 International Society for Behavioral Nutrition and Physical Activity annual meeting, a PA parenting workgroup met to: (1) Discuss challenges in PA parenting research that may limit its translation, (2) identify explanations or reasons for such challenges, and (3) recommend strategies for future research. Challenges discussed by the workgroup included a proliferation of disconnected and inconsistently measured constructs, a limited understanding of the dimensions of PA parenting, and a narrow conceptualization of hypothesized moderators of the relationship between PA parenting and child PA. Potential reasons for such challenges emphasized by the group included a disinclination to employ theory when developing measures and examining predictors and outcomes of PA parenting as well as a lack of agreed-upon measurement standards. Suggested solutions focused on the need to link PA parenting research with general parenting research, define and adopt rigorous standards of measurement, and identify new methods to assess PA parenting. As an initial step toward implementing these recommendations, the workgroup developed a conceptual model that: (1) Integrates parenting dimensions from the general parenting literature into the conceptualization of PA parenting, (2) draws on behavioral and developmental theory, and (3) emphasizes areas which have been neglected to date including precursors to PA parenting and effect modifiers.
PMCID: PMC3746238  PMID: 23944918
2.  Family ecological predictors of physical activity parenting in low income families 
Physical activity (PA) parenting, or strategies parents use to promote PA in children, has been associated with increased PA in children of all ages, including preschool-aged children. However, little is known about the circumstances under which parents adopt such behaviors. This study examined family ecological factors associated with PA parenting. Low-income parents (N = 145) of preschool-aged children (aged 2 to 5 years) were recruited from five Head Start centers in upstate New York. Guided by the Family Ecological Model (FEM), parents completed surveys assessing PA parenting and relevant family and community factors. Hierarchical regression analysis identified independent predictors of PA parenting. Parent depressive symptoms, life pressures that interfere with PA and perceived empowerment to access PA resources were associated with PA parenting. Community factors, including neighborhood play safety and social capital, were not independently associated with PA parenting in the multivariate model. Together, family ecological factors accounted for a large proportion of the variance in PA parenting (R2 = .37). Findings highlight the need to look beyond cognitive predictors of PA parenting in low-income families and to examine the impact of their broader life circumstances including indicators of stress.
PMCID: PMC4000568  PMID: 24236806
parenting; child; physical activity; family ecology
3.  Identifying Sources of Children’s Consumption of Junk Food in Boston After-School Programs, April–May 2011 
Little is known about how the nutrition environment in after-school settings may affect children’s dietary intake. We measured the nutritional quality of after-school snacks provided by programs participating in the National School Lunch Program or the Child and Adult Care Food Program and compared them with snacks brought from home or purchased elsewhere (nonprogram snacks). We quantified the effect of nonprogram snacks on the dietary intake of children who also received program-provided snacks during after-school time. Our study objective was to determine how different sources of snacks affect children’s snack consumption in after-school settings.
We recorded snacks served to and brought in by 298 children in 18 after-school programs in Boston, Massachusetts, on 5 program days in April and May 2011. We measured children’s snack consumption on 2 program days using a validated observation protocol. We then calculated within-child change-in-change models to estimate the effect of nonprogram snacks on children’s dietary intake after school.
Nonprogram snacks contained more sugary beverages and candy than program-provided snacks. Having a nonprogram snack was associated with significantly higher consumption of total calories (+114.7 kcal, P < .001), sugar-sweetened beverages (+0.5 oz, P = .01), desserts (+0.3 servings, P < .001), and foods with added sugars (+0.5 servings; P < .001) during the snack period.
On days when children brought their own after-school snack, they consumed more salty and sugary foods and nearly twice as many calories than on days when they consumed only program-provided snacks. Policy strategies limiting nonprogram snacks or setting nutritional standards for them in after-school settings should be explored further as a way to promote child health.
PMCID: PMC4241369  PMID: 25412028
4.  Social Support May Buffer the Effect of Intrafamilial Stressors on Preschool Children's Television Viewing Time in Low-Income Families 
Childhood Obesity  2013;9(6):484-491.
Background: Excessive television (TV) viewing in preschool children has been linked to negative outcomes during childhood, including childhood obesity. In a sample of low-income families, this study examined associations between intrafamilial factors and preschool children's TV-viewing time and the moderating effect of social support from nonfamily members on this association.
Methods: In 2010, 129 mothers/female guardians of 2- to 5-year-old children enrolled at five Head Start centers in Rensselaer County, New York, completed a self-report survey. The survey assessed child TV-viewing time (including TV, DVDs, and videos) and intrafamilial risk factors, including maternal perceived stress, depressive symptoms, TV viewing, leisure-time physical activity (inactivity), and family functioning. Social support from nonfamily members (nonfamily social support) was also measured and examined as an effect modifier.
Results: Children watched TV an average of 160 minutes per day. Moderate depressive symptoms (Personal Health Questionnaire depression scale scores ≥10), higher perceived stress, poorer family functioning, and higher maternal TV-viewing were significantly and independently associated with greater minutes of child TV viewing, controlling for covariates. In all instances, nonfamily social support moderated these associations, such that negative experiences within the family environment were linked with higher child TV-viewing time under conditions of low nonfamily social support, but not high nonfamily support.
Conclusions: Social support from nonfamily members may buffer potentially negative effects of intrafamilial factors on preschool children's TV-viewing time.
PMCID: PMC3868299  PMID: 24168754
5.  The Family Context of Low-Income Parents Who Restrict Child Screen Time 
Childhood Obesity  2013;9(5):386-392.
The American Academy of Pediatrics recommends that parents restrict child screen time to two hours per day, but many preschool-aged children exceed this viewing recommendation. Modifying children's viewing habits will require collaborating with parents, but little is known about the factors that influence parents' capacity for effective screen-related parenting. This study aimed to identify the demographic, family and community contextual factors associated with low-income parents' restriction of child screen time.
Parents (N=146) of children (age 2–5 years) attending Head Start centers in the United States completed a self-report survey in 2010 assessing parent and child screen use (television, DVD, video, video games, and leisure-time computer use), parent restriction of child screen time, and family (parent stress, social support, and life pressures) and community (neighborhood safety and social capital) factors.
Children were more likely to meet the American Academy of Pediatrics screen time recommendation if their parent reported high restriction of child screen time. Parent and child demographic characteristics were not associated with parents' restriction of child screen time. In multivariate analysis, less parent screen time, fewer parent life pressures, and greater social support were associated with parents' high restriction of screen time.
Family contextual factors may play an important role in enabling low-income parents to restrict their children's screen time. When counseling low-income parents about the importance of restricting child screen time, practitioners should be sensitive to family contextual factors that may influence parents' capacity to implement this behavior change.
PMCID: PMC3791034  PMID: 24004326
6.  Maternal depression and childhood obesity: a systematic review 
Preventive medicine  2013;59:60-67.
Maternal depression is prevalent and has been associated with parenting practices that influence child weight. In this systematic review we aimed to examine the prospective association between maternal depression and child overweight.
We searched four databases (PsycINFO, PubMed, Embase, and Academic Search Premier) to identify studies for inclusion. We included studies with a prospective design with at least one year follow-up, measuring maternal depression at any stage after childbirth, and examining child overweight or obesity status, BMI z-score or percentile, or adiposity. Two authors extracted data independently and findings were qualitatively synthesized.
We identified nine prospective studies for inclusion. Results were examined separately for episodic depression (depression at a single measurement occasion) and chronic depression (depression on multiple measurement occasions). Mixed results were observed for the relationship between episodic depression and indicators of child adiposity. Chronic depression, but not episodic depression, was associated with greater risk for child overweight.
While chronic depression may be associated with child overweight, further research is needed. Research is also needed to determine whether maternal depression influences child weight outcomes in adolescence and to investigate elements of the family ecology that may moderate the effect of maternal depression on child overweight.
PMCID: PMC4172574  PMID: 24291685
maternal depression; childhood obesity; systematic review
7.  Mental Health and Family Functioning as Determinants of A Sedentary Lifestyle among Low-Income Women with Young Children 
Women & health  2012;52(6):606-619.
This cross-sectional study examined mental health and family environmental factors related to a sedentary lifestyle, including lack of leisure-time physical activity (LTPA) and high levels of television viewing, among low-income mothers/female guardians of preschool-aged children. A self-administered questionnaire was completed by 131 mothers in 2010. Primary outcome measures included television viewing time (minutes/day) and LTPA (< 150 versus ≥150 minutes per week). Independent variables included depressive symptoms, perceived stress and family functioning. Demographic factors (age, marriage, work status, education, number of children in the household and race/ethnicity) were examined as potential covariates. Participating women watched TV on average 186.1 minutes/day (i.e., >3 hours). Additionally, 36% of women engaged in less than the recommended 150-minute LTPA per week. Hierarchical multiple regression analyses indicated that greater depressive symptoms (B = 76.4, p<.01) and lower family functioning (B = 33.0, p < .05) were independently related to greater television viewing when controlling for other variables. No independent factors were identified for lack of LTPA when controlling for other covariates. Findings suggest that health promotion efforts to promote an active lifestyle among low-income women with young children should address mental health and family functioning factors, especially depressive symptoms.
PMCID: PMC3459328  PMID: 22860706
8.  A childhood obesity intervention developed by families for families: results from a pilot study 
Ineffective family interventions for the prevention of childhood obesity have, in part, been attributed to the challenges of reaching and engaging parents. With a particular focus on parent engagement, this study utilized community-based participatory research to develop and pilot test a family-centered intervention for low-income families with preschool-aged children enrolled in Head Start.
During year 1 (2009–2010), parents played an active and equal role with the research team in planning and conducting a community assessment and using the results to design a family-centered childhood obesity intervention. During year 2 (2010–2011), parents played a leading role in implementing the intervention and worked with the research team to evaluate its results using a pre-post cohort design. Intervention components included: (1) revisions to letters sent home to families reporting child body mass index (BMI); (2) a communication campaign to raise parents’ awareness of their child’s weight status; (3) the integration of nutrition counseling into Head Start family engagement activities; and (4) a 6-week parent-led program to strengthen parents’ communication skills, conflict resolution, resource-related empowerment for healthy lifestyles, social networks, and media literacy. A total of 423 children ages 2–5 years, from five Head Start centers in upstate New York, and their families were exposed to the intervention and 154 families participated in its evaluation. Child outcome measures included BMI z-score, accelerometer-assessed physical activity, and dietary intake assessed using 24-hour recall. Parent outcomes included food-, physical activity- and media-related parenting practices and attitudes.
Compared with pre intervention, children at post intervention exhibited significant improvements in their rate of obesity, light physical activity, daily TV viewing, and dietary intake (energy and macronutrient intake). Trends were observed for BMI z-score, sedentary activity and moderate activity. Parents at post intervention reported significantly greater self-efficacy to promote healthy eating in children and increased support for children’s physical activity. Dose effects were observed for most outcomes.
Empowering parents to play an equal role in intervention design and implementation is a promising approach to family-centered obesity prevention and merits further testing in a larger trial with a rigorous research design.
PMCID: PMC3547740  PMID: 23289970
Community-based participatory research; CBPR; Action research; Head Start; Diet; Physical activity; Family intervention
9.  Engaging Low-Income Parents in Childhood Obesity Prevention from Start to Finish: A Case Study 
Journal of Community Health  2012;38(1):1-11.
Prevention of childhood obesity is a national priority. Parents influence young children’s healthy lifestyles, so it is paradoxical that obesity interventions focus primarily on children. Evidence and theory suggest that including parents in interventions offers promise for effective childhood obesity prevention. This case study engaged parents’ as co-researchers in the design, implementation and evaluation of an intervention for low-income families with a child enrolled in Head Start. Parent engagement mechanisms include: (1) targeted partnership development (2) operationalizing a Community Advisory Board (CAB) that was the key decision making body; (3) a majority of CAB members were parents who were positioned as experts, and (4) addressing structural barriers to parent participation. Lessons learned are provided for future research, and practice.
PMCID: PMC3547242  PMID: 22714670
Community based participatory research; Childhood obesity; Parent engagement; Health promotion
10.  Measuring Parental Support for Children’s Physical Activity in White and African American Parents: The Activity Support Scale for Multiple Groups (ACTS-MG) 
Preventive medicine  2010;52(1):39-43.
The Activity Support Scale (ACTS) was expanded for use with African American families. Its factorial invariance and internal reliability were examined for non-Hispanic white and African American parents.
The ACTS was modified to improve its applicability to African American families based on information from five focus groups with 27 African American parents of elementary school-aged children. Between 2006 and 2008, the revised scale was administered to 119 African American and 117 non-Hispanic white parents in northeastern NY and Alabama. Its factorial invariance across race/ethnicity and internal consistency were examined.
Factor analysis of the revised scale, the Activity Support Scale for Multiple Groups (ACTS-MG), identified four parenting factors in white and African American parents including logistic support, modeling, use of community resources to promote physical activity (PA), and restriction of sedentary behaviors. Results supported the scale’s internal reliability and factorial invariance across race/ethnicity.
The ACTS-MG is appropriate for use with non-Hispanic white and African American families and will enable the extension of current research with white families to the examination of strategies supporting PA in African American families. Additional psychometric work with the ACTS-MG is encouraged.
PMCID: PMC3022380  PMID: 21111755
Children; Youth; Parenting; Social Support; Scale Development
11.  Feasibility of Increasing Childhood Outdoor Play and Decreasing Television Viewing Through a Family-Based Intervention in WIC, New York State, 2007-2008 
Preventing Chronic Disease  2011;8(3):A54.
Active Families is a program developed to increase outdoor play and decrease television viewing among preschool-aged children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Our objective was to assess its feasibility and efficacy.
We implemented Active Families in a large WIC clinic in New York State for 1 year. To this end, we incorporated into WIC nutrition counseling sessions a community resource guide with maps showing recreational venues. Outcome measures were children's television viewing and time playing outdoors and parents' behaviors (television viewing, physical activity), self-efficacy to influence children's behaviors, and parenting practices specific to television viewing. We used a nonpaired pretest and posttest design to evaluate the intervention, drawing on comparison data from 3 matched WIC agencies.
Compared with the children at baseline, the children at follow-up were more likely to watch television less than 2 hours per day and play outdoors for at least 60 minutes per day. Additionally, parents reported higher self-efficacy to limit children's television viewing and were more likely to meet physical activity recommendations and watch television less than 2 hours per day.
Results suggest that it is feasible to foster increased outdoor play and reduced television viewing among WIC-enrolled children by incorporating a community resource guide into WIC nutrition counseling sessions. Future research should test the intervention with a stronger evaluation design in multiple settings, with more diverse WIC populations, and by using more objective outcome measures of child behaviors.
PMCID: PMC3103559  PMID: 21477494
12.  Parenting styles, parenting practices, and physical activity in 10- to 11-year olds 
Preventive Medicine  2011;52(1-3):44-47.
The objective of this study was to determine whether parenting styles and practices are associated with children's physical activity.
Cross-sectional survey of seven hundred ninety-two 10- to 11-year-old UK children in Bristol (UK) in 2008–2009 was conducted. Accelerometer-assessed physical activity and mean minutes of moderate-to-vigorous physical activity (mean MVPA) and mean counts per minute (mean CPM) were obtained. Maternal parenting style and physical activity parenting practices were self-reported.
In regression analyses, permissive parenting was associated with higher mean MVPA among girls (+ 6.0 min/day, p < 0.001) and greater mean CPM (+ 98.9 accelerometer counts/min, p = 0.014) among boys when compared to children with authoritative parents. Maternal logistic support was associated with mean CPM for girls (+ 36.2 counts/min, p = 0.001), while paternal logistic support was associated with boys' mean MVPA (+ 4.0 min/day, p = 0.049) and mean CPM (+ 55.7 counts/min, p = 0.014).
Maternal permissive parenting was associated with higher levels of physical activity than authoritative parenting, but associations differed by child gender and type of physical activity. Maternal logistic support was associated with girls' physical activity, while paternal logistic support was associated with boys' physical activity. Health professionals could encourage parents to increase logistic support for their children's physical activity.
PMCID: PMC3025352  PMID: 21070805
Parenting; Physical activity; Children; Adolescents; Parenting style; Public health; Prevention
13.  Children’s Active Commuting to School: Current Knowledge and Future Directions 
Preventing Chronic Disease  2008;5(3):A100.
Driven largely by international declines in rates of walking and bicycling to school and the noted health benefits of physical activity for children, research on children's active commuting to school has expanded rapidly during the past 5 years. We summarize research on predictors and health consequences of active commuting to school and outline and evaluate programs specific to children's walking and bicycling to school.
Literature on children's active commuting to school published before June 2007 was compiled by searching PubMed, PsycINFO, and the National Transportation Library databases; conducting Internet searches on program-based activities; and reviewing relevant transportation journals published during the last 4 years.
Children who walk or bicycle to school have higher daily levels of physical activity and better cardiovascular fitness than do children who do not actively commute to school. A wide range of predictors of children's active commuting behaviors was identified, including demographic factors, individual and family factors, school factors (including the immediate area surrounding schools), and social and physical environmental factors. Safe Routes to School and the Walking School Bus are 2 public health efforts that promote walking and bicycling to school. Although evaluations of these programs are limited, evidence exists that these activities are viewed positively by key stakeholders and have positive effects on children's active commuting to school.
Future efforts to promote walking and bicycling to school will be facilitated by building on current research, combining the strengths of scientific rigor with the predesign and postdesign provided by intervention activities, and disseminating results broadly and rapidly.
PMCID: PMC2483568  PMID: 18558018

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