A review of early influences on physical activity and sedentary behaviors of preschool-age children in high-income countries

Connections among family socioeconomic status, aerobic fitness, executive function, and the positive experiences of childhood physical activity

A family's socioeconomic status (SES) can be linked to a child's physical and cognitive health, with children from low-SES families often experiencing poor developmental outcomes. Early positive childhood experiences that include structured and unstructured physical activities (SUPAs) offer a potential avenue to promote positive health and cognitive development during early childhood. However, prior to school entry, it is not well-understood whether SES is related to participation in SUPAs or how SUPAs relate to early health and cognitive indicators such as aerobic fitnessand executive function (EF). Children (N = 99) aged 3 to 5 years were recruited from 17 classrooms in seven center-based pre-kindergartens. In fall and spring, children were assessed on EF using the Head-Toes-Knees-Shoulders task and aerobic fitness was assessed with the 20-m shuttle run test. Family SES significantly predicted SUPAs and fall and spring fitness, with SUPAs and spring fitness significantly predicting spring EF. Partial support for an indirect relationship between SES and EF through SUPAs was also found. Results suggest that family SES could play a role in predicting participation in SUPAs and aerobic fitness, with SUPAs and aerobic fitness linked to EF during pre-kindergarten.

Risk factors and discrimination model for screen exposure among children under 3 years: findings from Fujian province in China

BACKGROUND

Compliance with screen time guidelines among children worldwide remains low, and there is insufficient evidence on the current prevalence in China. This study aimed to investigate the prevalence of compliance with screen time guidelines among children under 3 years old in Fujian Province, East China, identify risk factors and their independent effects, and develop a risk discrimination model for targeted interventions.

METHODS

A cross-sectional survey was conducted among low-income families recruited from welfare programs at 96 sites in both urban and rural areas of Fujian Province, China. Face-to-face interviews gathered sociodemographic data, lifestyle information, attitudes towards screen exposure, and details on screen media device ownership. A multivariable logistic regression model was employed to identify independent risk factors for compliance with screen time guidelines, while the area under the receiver operating characteristic curve (AUC) was used to evaluate the model's discrimination ability.

RESULTS

A total of 4,707 children participated in the survey. The rates of compliance with screen time guidelines were 56.8% for children under 1 year old, 18.8% for those between 1 and 2 years old, and 81.9% for those between 2 and 3 years old. The multivariable regression analysis identified negative attitudes towards screen exposure, co-viewing and engagement, as well as single child, as significant positive independent factors for compliance with the guidelines. The risk discrimination model demonstrated good performance, with an AUC of 0.845 and 0.812 in the two younger age groups, but showed medium discrimination with an AUC of 0.691 for children between 2 and 3 years old.

CONCLUSIONS

Compliance with screen time guidelines among young children in Fujian Province, East China, is generally adequate, but notably low among children between 1 and 2 years old. Targeted interventions are needed to improve compliance, particularly for this age group.

An umbrella review of systematic reviews on interventions of physical activity before pregnancy, during pregnancy, and postpartum to control and/or reduce weight gain

BACKGROUND

The increasing prevalence of overweight and obesity worldwide represents a (chronic) complex public health problem. This is also seen among women of childbearing age despite increased efforts to promote physical activity (PA) interventions. Excessive gestational weight gain (GWG) is associated with negative health outcomes for both mothers and offspring.

OBJECTIVES

To summarize current systematic reviews (SRs) on PA interventions during pregnancy and postpartum to prevent excessive GWG and identify the most effective approaches.

SEARCH STRATEGY

A literature search was conducted on major electronic databases (MEDLINE/Pubmed, Cochrane, Web of Science, Epistemonikos) from inception to March 2023.

SELECTION CRITERIA

This study included SRs and meta-analyses of studies involving women aged 18 years or older from diverse ethnic backgrounds, who were either in the preconception period, pregnant, or within 1 year postpartum and who had no contraindications for exercise. Women with chronic diseases, such as pre-existing diabetes (type 1 or type 2) were excluded.

DATA COLLECTION AND ANALYSIS

Two reviewers extracted data from selected studies assessing the impact of PA in preconception, pregnancy, and postpartum. Methodologic quality was assessed with the AMSTAR-2 tool. A narrative summary of results addresses relationships between PA and weight before, during, and after pregnancy, informing future research priorities for preventing excessive weight gain. This study is registered on PROSPERO (CRD420233946666).

MAIN RESULTS

Out of 892 identified articles, 25 studies were included after removing duplicates, unrelated titles, and screening titles and abstracts for eligibility. The results demonstrate that PA can help prevent excessive GWG and postpartum weight retention. Structured and supervised moderate-intensity exercise, at least twice a week, and each session lasting a minimum of 35 min seems to provide the greatest benefits.

CONCLUSIONS

Women who comply with the PA program and recommendations are more likely to achieve adequate GWG and return to their pre-pregnancy body mass index after delivery. Further research is warranted to explore how preconception PA influences pregnancy and postpartum outcomes given the absence of identified preconception-focused interventions.

Pre-school-based behaviour change intervention to increase physical activity levels amongst young children: a feasibility cluster randomised controlled trial

Background

A significant rise in childhood obesity worldwide over the past three decades highlights the urgent need for early interventions, especially in preschools as key settings for child development. This study aimed to assess the feasibility and fidelity of a randomised controlled trial of "I'm an Active Hero" (IAAH), a theory- and evidence-based multi-component behaviour change intervention targeting physical activity and sedentary behaviour amongst preschool-aged children.

Methods

Two preschools in Taif city, Saudi Arabia were randomly assigned to either the intervention (n = 3 classrooms) or the usual curriculum control group (n = 3 classrooms). The intervention ran for 10 weeks from February to April 2023 and consisted of teacher-led physical activity and sedentary behaviour sessions in preschools, with an additional interactive home component. Primary outcome measures included intervention fidelity, recruitment rates, attrition rates, and compliance with trial procedures. Secondary outcomes included body mass index (BMI), objectively measured physical activity, and sedentary time via the ActiGraph GT3X accelerometer. Outcomes were measured at baseline and at 10 weeks in both study arms.

Results

The preschool intervention component had high fidelity (93.3%), but the home component fidelity was lower (74%). A cluster-level recruitment rate of 12% (13/112 centres) was attained, whilst the individual-level recruitment rate stood at 36% (52/143 children, mean age of 4.16 years; 23 girls). Attrition was 10%. Compliance varied with 90% for BMI, 71% for accelerometery, and 45% for questionnaires. The intervention group showed small decreases in BMI, slight increases in physical activity, and decreases in sedentary time at follow-up compared to the control group. Parents, facilitators, and assistant teachers considered the intervention to be feasible and beneficial.

Conclusion

The IAAH intervention was feasible to implement in Saudi Arabian preschools. Facilitators showed high fidelity in delivering it. However, preliminary data did not demonstrate effectiveness. A more comprehensive evaluation across a broader population is warranted. The intervention could be revised to optimise recruitment, compliance, and fidelity of the home-based component. Successful elements from this pilot should be retained whilst adaptations to implementation are made to strengthen key areas.Clinical trial registration: ClinicalTrials.gov, NCT05754359.

24-Hour movement behaviors and executive functions in preschoolers: A compositional and isotemporal reallocation analysis

This cross-sectional study explored the relationship between 24-hour movement behaviors and executive function (EF) in preschool children. A total of 426 Han Chinese preschoolers (231 males; 3.8 ± 0.6 years old) from Zhuhai, Guangdong Province, China were selected from October 2021 to December 2021. Accelerometers were used to measure physical activity (PA) and sedentary behavior (SB), while sleep duration was obtained via a parent-report questionnaire. Components of EF (cognitive flexibility, inhibitory control, and working memory) were assessed using computerized behavioral tasks. The daily composition was significantly associated with inhibitory control and working memory. Inhibitory control improvements were linked to the addition of moderate-to-vigorous physical activity (MVPA) at the expense of SB and sleep. The reallocation between MVPA, SB, sleep, and light physical activity yielded a significant association with working memory.

Sociodemographic factors, parental mental health and movement behaviours in the early years: the SUNRISE Finland study protocol

BACKGROUND

The World Health Organization (WHO) has identified the prevention of obesity in young children as one of its key priorities for the 21st century, and 24-hour movement behaviours (physical activity, sedentary behaviour and sleep) play a key role in this priority. The SUNRISE Finland Study is part of the international SUNRISE Study, which examines the movement behaviours of young children in 64 low-, middle- and high-income countries. The SUNRISE Finland Study will investigate what proportion of 3- to 4-year-old children living in Finland meet the WHO global guidelines on 24-hour movement behaviours, and how that proportion and children's motor and cognitive skills compare with children from other countries involved in the SUNRISE Study. We also aim to identify potential correlates of children's movement behaviours, focusing on socioeconomic factors, residential environmental features, and parents' mental health. In addition, this study will examine the associations between children's movement behaviours, motor and cognitive skills, adiposity, and psychosocial wellbeing. Finally, we aim to establish a cohort of families who participate in the study and conduct follow-ups in the future.

METHODS

We will recruit 1,000 children aged 3.0 to 4.9 years and their caregivers through early childhood education and care centres in Finland (50% in urban and 50% in rural areas). We will assess children's 24-h movement behaviours using two accelerometers and a parental report. Children will perform validated tests to measure gross and fine motor skills and executive functions, and their height, weight and waist circumference will be measured. Caregivers will complete questionnaires regarding sociodemographic factors, nature visits, their own movement behaviours, symptoms of depression, anxiety, stress, insomnia, nomophobia, social media self-control failure, and happiness, and child's psychosocial wellbeing. Geographic Information System (GIS) will be used to examine residential environmental features.

DISCUSSION

In addition to facilitating international comparisons on movement behaviours and motor and cognitive skills, the SUNRISE Finland Study will provide novel evidence on factors associated with movement behaviours in young children. The results of this study will help in planning actions to promote healthy levels of movement behaviours at an early age and equal opportunities for healthy development.

CLINICAL TRIAL NUMBER

This is not a trial study.

Which behaviour change techniques are associated with interventions that increase physical activity in pre-school children? A systematic review

BACKGROUND

Insufficient physical activity (PA) is a significant risk factor that contributes to several health problems and there is a need to improve our understanding of how to increase PA, particularly among young children. This review (PROSPERO registration: CRD42022328841) investigated the relationship between behaviour change techniques (BCTs) and interventions that increased PA among pre-school children aged < 6 years old.

METHODS

Systematic searches of six databases were undertaken from inception to July 2022, updated in December 2022, to locate studies that evaluated interventions and reported a positive change in PA levels in children aged < 6 years old.

RESULTS

A total of 5,304 studies were screened, and 28 studies involving 10,605 subjects aged 2.5 to 5.9 years met the eligibility criteria. Each eligible study (n = 28) was independently appraised by two researchers using the Cochrane risk of bias tool. The BCT Taxonomy v1 and the Template for Intervention Description and Replication (TIDieR) guided the extraction and analysis of data, and this process led to the identification of 27 BCTs.

CONCLUSIONS

Potentially promising BCTs for increasing PA among young children included 'shaping knowledge,' 'antecedents,' 'goals and planning,' and 'comparison of behaviour.' Future PA interventions that target young children should consider integrating these promising BCTs into their programmes. However, such consideration needs to be tempered by the fact that most of the reviewed studies were deemed to have a high or unclear risk of bias and/or were limited with respect to the populations that they targeted. Further research using rigorous methodologies is required to establish a higher standard that addresses the needs of young children who are expected to have insufficient levels of physical activity.

The impact of an e-newsletter or animated video to disseminate outdoor free-play information in relation to COVID-19 guidelines in New South Wales early childhood education and care services: a randomised controlled trial

BACKGROUND

State-based Guidelines were issued for Early Childhood Education and Care (ECEC) services (caring for children 0-6 years) recommending greater time outdoors and inclusion of indoor-outdoor programs to facilitate social distancing to reduce spread of COVID-19. The aim of this 3-arm randomised controlled trial (RCT) was to examine the impact of different dissemination strategies on increasing ECEC service intentions to adopt recommendations from the Guidelines.

METHODS

This was a post-intervention only RCT. A sample of eligible ECEC services in New South Wales (n = 1026) were randomly allocated to one of three groups; (i) e-newsletter resource; (ii) animated video resource; or (iii) control (standard email). The intervention was designed to address key determinants of guideline adoption including awareness and knowledge. Following delivery of the intervention in September 2021, services were invited to participate in an online or telephone survey from October-December 2021. The primary trial outcome was the proportion of services intending to adopt the Guidelines, defined as intention to; (i) offer an indoor-outdoor program for the full day; or (ii) offer more outdoor play time. Secondary outcomes included awareness, reach, knowledge and implementation of the Guidelines. Barriers to Guideline implementation, cost of the dissemination strategies and analytic data to measure fidelity of intervention delivery were also captured.

RESULTS

Of the 154 services that provided post-intervention data, 58 received the e-newsletter (37.7%), 50 received the animated video (32.5%), and 46 received the control (29.9%). Services who received the animated video had nearly five times the odds (OR: 4.91 [1.03, 23.34] p = 0.046) than those in the control group, to report having intentions to adopt the Guidelines. There were no statistically significant differences in awareness or knowledge of the Guidelines between either intervention or control services. Development costs were greatest for the animated video. The extent to which the dissemination strategy was viewed in full, were similar for both the e-newsletter and animated video.

CONCLUSION

This study found potential for the inclusion of interactive strategies to disseminate policy and guideline information within the ECEC setting, in the context of the need for rapid communication. Further research should explore the added benefits of embedding such strategies within a multi-strategy intervention.

TRIAL REGISTRATION

Retrospectively registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) on the 23/02/2023 (ACTRN 12,623,000,198,628).

Parental Influences on Physical Activity and Screen Time among Preschool Children from Low-Income Families in Brazil

Background: Children from low-middle income countries (LMIC) are disproportionately affected by obesity, and low physical activity (PA) and high screen time (ST) are major contributors. Parents are key influencers on children's PA and ST, yet, no study has investigated relationships between parenting practices and children's PA and ST in LMIC families. This study examined parental influences on PA and ST among preschool-aged children from low-income families in Brazil. Methods: Parents completed a validated, culturally adapted interviewer-administered survey assessing child ST and parenting practices. Child sedentary time, total movement, and energetic play were measured by accelerometery. Results: Data were available on 77 parent-child dyads [mean age 4.6 years (standard deviation = 0.8), 53% male, and 41% mixed-race]. Parenting practices associated with greater PA were use of PA to reward/control behavior (rho = 0.34-0.49), limiting or monitoring ST (rho = 0.30), explicit modeling/enjoyment of PA (rho = 0.24), verbal encouragement for PA (rho = 0.30), and importance and value of PA (rho = 0.24-0.38; p < 0.05). Parenting practices associated with higher ST were rules around active play indoor (rho = 0.23), use of ST to reward/control behavior (rho = 0.30), exposure to screens (rho = 0.40), and explicit modeling/enjoyment of ST (rho = 0.50; p < 0.05). Conclusion: Recognized parenting practices such as explicit modeling of PA and ST, monitoring and limiting ST, and rules and restrictions about PA and ST are associated with young children's PA and ST in low-income Brazilian families. The findings identify potential targets for family-based interventions to promote healthy lifestyle behaviors and prevent childhood obesity.

Relation between Demographics and Physical Activity among Preschoolers Attending Head Start

Limited empirical evidence is available about preschoolers' sedentary behavior (SB) and physical activity (PA) patterns in Head Start programs, we explored (a) preschoolers' SB and PA patterns (ranging from SB to light-moderate-vigorous physical activity [LMVPA]) and (b) their relationships with sociodemographic factors, weight status, and motor development. Participants included 216 preschoolers (M age = 4.32 ± 0.63; girls 56.5%) from six Head Start centers in an urban area in the southwestern region of the United States, assessing Actical® activity monitor-based PA, weight status, and motor development. The findings revealed preschoolers who were female, Hispanic/Latinx, with an at risk weight level, and/or in the below average motor development group tended to engage in less MVPA/LMVPA and also had higher SB patterns while participating in the Head Start program (p < 0.05-0.001, d ranged from 0.23 to 0.62). Head Start stakeholders (e.g., policymakers, leaders, curriculum coordinators, health professionals, and teachers) need to acknowledge the PA and health disparities, and intervene in underserved preschoolers' health-promoting behaviors.

Prevention of Sexual Violence in sport: A Socioecological Review

Sexual violence in sport is prevalent and represents a serious public health concern. The social-ecological model for health promotion has been used successfully as a framework to identify individual-to-policy level factors aimed at health promotion or disease prevention. The purpose of this review was to examine both published and non-published (publicly available) SVP efforts conducted within the context of sport and make recommendations for future practice. Grey literature search methods were utilized to conduct a review of publicly available documents. This included (a) a comprehensive Google search using unique search terms that would identify SVP efforts within sport settings and (b) a review of the publicly accessible websites identified in the previous step. Following the grey literature search, and using the SVP practices identified in step one, we conducted a supplementary literature search using scientific publication search engines to identify whether the SVP practices identified in step one had associated peer-reviewed publications. Finally, we assessed various characteristics of each SVP practice including the target population, age range of intended participants, and whether the SVP had associated peer review publications. This led to the identification of 35 unique SVP practices: 25 (71%) SVP practices were assigned to the Intrapersonal level, 6 (17%) were assigned to the Interpersonal level, 9 (26%) were assigned to the Organizational level, 3 (9%) were assigned to the Community, and 2 (6%) were assigned to the Policy level. This review uncovered several important findings including a lack of multi-level SVP practices within sport, a lack of SVP practices that target children, minimal programming aimed at specifically preventing perpetration, the need to elevate policy level action, and a lack of peer-reviewed literature. Ultimately findings suggest that sport organizations ought to prioritize sexual violence prevention using national organizations for guidance.

Effects of Group-Play Moderate to Vigorous Intensity Physical Activity Intervention on Executive Function and Motor Skills in 4- to 5-Year-Old Preschoolers: A Pilot Cluster Randomized Controlled Trial

The aim of the present study is to examine the effect of group-play intervention on executive function (EF) in preschoolers. This group-play intervention was integrated as moderate to vigorous physical activity and cognitively loaded exercise to promote EF in preschoolers. An 8-week group-play MVPA intervention program, consisting of a series of outdoor physical and cognitively loaded games, was designed to improve preschoolers' EF. This intervention program was implemented in group-play form, and conducted by teachers who received standardized training before the intervention. Two classes of second grade preschoolers (N = 62) were randomly allocated to experimental (n = 30, M age = 4.16, SD = 0.29) and control (n = 32, M age = 4.7, SD = 0.43) groups. The intervention group received the intervention three times a week, while the control group exercised as usual in preschool. Before, in the middle of, and after the intervention, 10-m running, standing broad jump, throwing, body flexion, balance beam, and skip jump were assessed as tests of motor skills. In addition, three components of EF were measured separately before, in the middle of, and after the intervention: inhibitory control was assessed by using the silly sound Stroop task, working memory was tested using the empty house task, and shifting was assessed using the dimensional change card sorting task. Although both groups showed an increasing trend in terms of motor skills and EF during the intervention, the increasing amounts of the intervention group were significantly higher than the control group. The findings of the present study suggested that group-play intervention has positive effects on aspects of EF in addition to motor skills in preschoolers.

Physical Activity Opportunities in US Early Child Care Programs

BACKGROUND AND OBJECTIVES

Physical activity provides health and developmental benefits to young children. The Study of Nutrition and Activity in Child Care Settings describes physical activity opportunities and sedentary occasions for children aged 1 to 5 years at programs participating in the US Department of Agriculture Child and Adult Care Food Program.

METHODS

The Study of Nutrition and Activity in Child Care Settings obtained a nationally representative sample of classrooms within Child and Adult Care Food Program-participating Head Start and child care centers via multistage cluster sampling. For 1 observation day, an observer in each classroom tallied designated outdoor and indoor playspaces; minutes children spent in playspaces; barriers and facilitators to physical activity; and classroom time when most children were physically active (eg, walking, dancing), sedentary (seated, lying down), or neither. Weighted descriptive tabulations by program type compared outdoor physical activity opportunity counts and total physical activity opportunity durations to national guidelines. Multivariate regression analysis investigated association of barriers with physical activity opportunity duration.

RESULTS

The sample included 227 classrooms, 96 in child care centers and 131 in Head Start programs. All had sedentary occasions outside meals, snacks, and naps; virtually all offered opportunities for physical activity. Seventy-four percent of programs met national guidance on sufficient number of outdoor opportunities, weather permitting. Just 50% met guidance of ≥60 to 90 minutes of physical activity, whereas only 43% met both sets of guidance. Weather and staff not joining in outdoor play were associated with 74 and 31 fewer minutes devoted to physical activity, respectively.

CONCLUSIONS

Findings suggest ample room for improvement in provision of physical activity opportunities during child care.

A randomised controlled trial of an implementation strategy delivered at scale to increase outdoor free play opportunities in early childhood education and care (ECEC) services: a study protocol for the get outside get active (GOGA) trial

BACKGROUND

Increased outdoor play time in young children is associated with many health and developmental benefits. This study aims to evaluate the impact of a multi-strategy implementation strategy delivered at scale, to increase opportunities for outdoor free play in Early Childhood Education and Care (ECEC) services.

METHODS

The study will employ a parallel-group randomised controlled trial design. One hundred ECEC services in the Hunter New England region of New South Wales, Australia, will be recruited and randomised to receive either a 6-month implementation strategy or usual care. The trial will seek to increase the implementation of an indoor-outdoor routine (whereby children are allowed to move freely between indoor and outdoor spaces during periods of free play), to increase their opportunity to engage in outdoor free play. Development of the strategy was informed by the Behaviour Change Wheel to address determinants identified in the Theoretical Domains Framework. ECEC services allocated to the control group will receive 'usual' implementation support delivered as part of state-wide obesity prevention programs. The primary trial outcome is the mean minutes/day (calculated across 5 consecutive days) of outdoor free play opportunities provided in ECEC services measured at baseline, 6-months (primary end point) and 18-months post baseline. Analyses will be performed using an intention-to-treat approach with ECEC services as the unit of analysis, using a linear mixed effects regression model to assess between-group differences. A sensitivity analysis will be undertaken, adjusting for service characteristics that appear imbalanced between groups at baseline, and a subgroup analysis examining potential intervention effect among services with the lowest baseline outdoor free play opportunities.

DISCUSSION

Identifying effective strategies to support the implementation of indoor-outdoor routines in the ECEC setting at scale is essential to improve child population health.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ( ACTRN12621000987864 ). Prospectively registered 27th July 2021, ANZCTR - Registration.

Interventions to Improve Child Physical Activity in the Early Childhood Education and Care Setting: An Umbrella Review

Early childhood education and care (ECEC) services are a key setting to support improvements in the physical activity of young children. This umbrella review gathered and synthesised systematic review evidence of the effectiveness of interventions in the ECEC setting on the physical activity levels of children aged 0-6. We also mapped the current evidence to the existing ECEC sector-specific physical activity practice recommendations. Five electronic databases were searched to identify systematic reviews that evaluated the impact of any ECEC-based interventions on the physical activity levels (e.g., moderate-to-vigorous physical activity, total physical activity) of children aged 0-6. One reviewer extracted data on intervention effectiveness and quality of the reviews, checked by a second reviewer. Ten reviews were included. Overall, the majority of the reviews found interventions delivered in ECEC improved child physical activity. Across reviews, the impact of six intervention strategies were identified, mapped to four (of eight) broad recommendations (i.e., providing opportunity, offering educator training, educators promoting the benefits of physical activity, creating a physical activity-promoting environment). The impact of the majority of recommendations, however, did not have systematic review evidence. Further investigation of the effectiveness of ECEC-based physical activity strategies is required to demonstrate support for the existing recommended practices.

Social-Emotional Problems Among 3-Year-Olds Are Associated With an Unhealthy Lifestyle: A Population-Based Study

Introduction: Little attention has been paid to the association between preschool children's social-emotional problems and lifestyle at the population level.

Objective: This study aimed to overcome this knowledge gap by investigating to what extent children's social-emotional problems are associated with their lifestyle and if there are any gender differences.

Methods: This cross-sectional, population-based study used data from the regional Salut Register in northern Sweden, including 7,179 3-year-olds during 2014–2017. Parents responded to a questionnaire including the 36-month interval of the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) and questions regarding family and lifestyle characteristics. Single and multiple logistic regression were used to assess the association between children's social-emotional problems and multiple family lifestyle characteristics.

Results: More reports of social-emotional problems were found among children who did not have parents living together or had markers of an unhealthy lifestyle. Children who ate vegetables less frequently, whose parent/-s brushed their teeth less often and did not read to them regularly were more likely to have social-emotional problems. Playing outdoors <3 h during weekdays and >1 h of sedentary screen time during weekends increased the risk of social-emotional problems among boys only, while >1 h of sedentary screen time during weekdays increased the risk among girls. When it comes to lifestyle and gender differences, a high proportion of the 3-year-olds had an unhealthy lifestyle, more so for boys than for girls. The dietary quality and tooth brushing were somewhat more adequate for the girls than for the boys, but boys spent more time playing outdoors compared to the girls.

Conclusions: This study provides us with an important overview picture of the family life situation of three-year-olds, including those with social-emotional problems. Such problems were significantly associated with markers of unhealthy lifestyle, with significant gender differences. Therefore, this study suggests that in order to maintain children's social-emotional ability and support children at risk of problems, public health intervention programs should have a broader perspective on improving children's lifestyle rather than merely focusing on their social and emotional problems, and the gender differences found may be taken in account.

How to Support Child Healthcare Nurses in Sweden to Promote Healthy Lifestyle Behaviors from the Start of Life

Child healthcare (CHC) nurses have a key role in promoting and supporting healthy lifestyle behaviors from a young age. Thus, this study aims to investigate the perspectives of CHC nurses regarding discussing food introduction, physical activity/active play, and screen time with parents; explore facilitators and barriers influencing the discussion of healthy lifestyle behaviors with parents; and explore the perspectives of CHC nurses regarding a complementary program to promote healthy lifestyle behaviors from the start of life. A total of fifteen nurses participated in semi-structured interviews, which were recorded, transcribed verbatim, and analyzed using thematic analysis. There were four themes that were generated: parental needs; facilitators and barriers; parental groups; and future working methods. This study found that CHC nurses have seen an increase in the need for support among today’s parents. Time, the need to tailor information, and confidence to address sensitive topics were perceived as the largest barriers during daily work for the nurses. Furthermore, large variations in parental groups were found. Finally, the CHC nurses displayed a willingness and openness to change and develop current working methods using digital solutions. These solutions could possibly ease the workload and at the same time, support parents to create healthy lifestyle behaviors from the start of their child’s life.

Exploring parents' provision of factors related to the establishment of physical activity between normal weight and overweight infants

PURPOSE

Infancy is a critical time for the prevention of obesity and establishment of healthy behaviors such as physical activity that help to control weight. A limited amount of research has examined if factors related to infant physical activity vary by infant weight status. Therefore, the purpose of this mixed methods triangulation study was to examine differences in motor development, the home environment, and infant-parent play behaviors as well as to explore how parents promote active play opportunities with normal weight infants (NWIs) and overweight infants (OWIs).

DESIGN AND METHODS

We used a mixed methods triangulated approach to combine quantitative and qualitative data strands to examine variables associated with active play in normal weight (n = 16) and overweight (n = 11) infants. Data were analyzed using a two-tailed Mann-Whitney U nonparametric test and a summative content analysis approach.

RESULTS

Although there were no differences in infants' motor development and parent play behaviors based on infant weight, several other differences were found. OWIs had less access to materials that stimulate locomotor movement. Further, parents of OWIs more often reported utilizing cognitive play strategies in comparison to parents of NWIs who more often reported using physical play strategies. Parents felt they were the greatest influence on their child's activity regardless of infant size. Importantly, all parents desired more specific guidelines on how to encourage active play and preferred this information was delivered by their healthcare provider.

PRACTICE IMPLICATIONS

To meet parents' desires and potentially improve infants' developmental outcomes through the establishment of healthy physical activity behaviors, pediatric nurses could provide more specific guidance on providing active opportunities for infants.

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.

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.

Family Social Capital: Links to Weight-Related and Parenting Behaviors of Mothers with Young Children

Family social capital includes the social relationships, values, and norms shared by a family and is positively linked with children’s mental and physical health status. This cross-sectional study addresses a gap in the literature related to family social capital vis-à-vis weight-related behaviors and home environments of 557 mothers and their young children (ages 2 to 9 years). Mothers completed an online survey comprised of valid, reliable questionnaires assessing family relationships and weight-related behavioral and home environment measures. The measures that determined family social capital (i.e., supportive, engaged parenting behaviors; family cohesion; family conflict; and family meal frequency) yielded distinct tertile groups that differed significantly (p < 0.001) on every family social capital measure with large effect sizes. Analysis of variance with Tukey post-hoc test revealed greater family social capital was linked to significantly better maternal health, dietary intake, physical activity, and sleep behavior. Additionally, maternal modeling of healthy eating and physical activity, child feeding practices, and home environments was higher in groups with greater family social capital. Child mental and physical health, physical activity, and sleep quality were better in families with greater family social capital. Findings suggest greater family social capital is linked to healthier weight-related behaviors and home environments. Future intervention studies should incorporate strategies to build family social capital and compare longitudinal outcomes to traditional interventions to determine the relative value of family social capital on health behaviors.

Family as a health promotion setting: A scoping review of conceptual models of the health-promoting family

BACKGROUND

The family is a key setting for health promotion. Contemporary health promoting family models can establish scaffolds for shaping health behaviors and can be useful tools for education and health promotion.

OBJECTIVES

The objective of this scoping review is to provide details as to how conceptual and theoretical models of the health promoting potential of the family are being used in health promotion contexts.

DESIGN

Guided by PRISMA ScR guidelines, we used a three-step search strategy to find relevant papers. This included key-word searching electronic databases (Medline, PSycINFO, Embase, and CINAHL), searching the reference lists of included studies, and intentionally searching for grey literature (in textbooks, dissertations, thesis manuscripts and reports.).

RESULTS

After applying inclusion and exclusion criteria, the overall search generated 113 included manuscripts/chapters with 118 unique models. Through our analysis of these models, three main themes were apparent: 1) ecological factors are central components to most models or conceptual frameworks; 2) models were attentive to cultural and other diversities, allowing room for a wide range of differences across family types, and for different and ever-expanding social norms and roles; and 3) the role of the child as a passive recipient of their health journey rather than as an active agent in promoting their own family health was highlighted as an important gap in many of the identified models.

CONCLUSIONS

This review contributes a synthesis of contemporary literature in this area and supports the priority of ecological frameworks and diversity of family contexts. It encourages researchers, practitioners and family stakeholders to recognize the value of the child as an active agent in shaping the health promoting potential of their family context.

Parents' Perceptions on Barriers and Facilitators of Physical Activity among Schoolchildren: A Qualitative Study

Given that physical activity (PA) plays an important role in early childhood, understanding the factors that affect the practice of PA at an early age could help develop effective strategies for overcoming barriers and increasing activity levels in this age group. A qualitative study was conducted based on grounded theory aimed at exploring the perceptions of mothers and fathers from Cuenca and Ciudad Real (Castilla La Mancha, Spain) regarding barriers and facilitators of physical activity of their children during the adiposity rebound period. Data were collected using focus groups involving 46 parents of children in the 3rd grade of pre-school and 1st grade of elementary school. During the analysis, the socio-ecological model and grounded theory were used. The barriers encountered were the preferences of children for sedentary activities (individual factors), academic tasks as a main priority of parents, the influence of older siblings and the unfavorable school environment (microsystem), the lack of family conciliation (mesosystem), and barriers related to the built environment or lack of facilities for physical activity (exosystem). Facilitators were the preferences for active games (individual factors), parental models including the co-participation of parents in activities, the influence of friends, living in large homes, the support provided by teachers and the school (microsystem), living in rural areas, having sufficient facilities, favorable weather conditions (exosystem), and the existence of free or subsidized activities (macro system). Programs aimed at promoting PA in early childhood should include strategies that address contextual factors and not only focus on individual factors related to the child.

Individual and Environmental Factors Associated with Participation in Physical Activity as Adolescents Transition to Secondary School: A Qualitative Inquiry

The transition from elementary to secondary school is an emotionally and socially complex time when adverse behaviors appear, such as decreased levels of physical activity (PA). Behavioral and environmental factors that influence PA during this time are poorly understood. Therefore, we aimed to identify factors that influence PA as adolescents transition to secondary school. Qualitative interviews were conducted with a sample of 27 ethnically diverse child–parent dyads within the public-school system in British Columbia, Canada (50% boys, 68% mothers, 25% White). The interviews probed for environmental and behavioral factors in school, family, and social contexts that potentially initiated changes in PA, specifically related to the adolescents’ transitions. Interviews were recorded and transcribed verbatim. Thematic analyses identified factors at the individual, social, familial, and school levels that may trigger adolescents to change their participation in PA as they transition from elementary to secondary school. Twenty-two factors emerged from the qualitative analysis including school factors (8), household factors (3), social factors (4), and intrapersonal factors (7). These findings contribute to a better understanding of adolescents’ PA behaviors and highlight the influence of changing environments as they transition from elementary school to secondary school.

[Childcare Center Characteristics Associated with Children's MVPA: A Multilevel Analysis with Cross-Sectional Data from the QueB 2 Project]

OBJECTIVES

Characteristics of childcare centers influence the daily time spent on moderate-to-vigorous physical activity (MVPA) by children younger than 6 years. The study explores the characteristics of childcare centers and the behavior of staff that influence children's MVPA levels.

METHODS

We used cross-sectional data from 8 childcare centers in the research project QueB 2. MVPA per day was measured with ActiGraph GT3X+accelerometers. Independent variables included were age, sex, staff MVPA levels and 8 items from a self-assessment-checklist for childcare centers. Hierarchical linear regression models were run with SAS.

RESULTS

Valid accelerometer data on 126 children (51.59% girls) were available. Girls spent a mean of 33.01, boys of 49.11 min per day in MVPA. Childcare centers accounted for only 1.72% of variance. Indoor space, rules concerning physical activity and staff participating in activities were significantly associated with children's MVPA.

CONCLUSIONS

Individual variables (age, sex) seem to have a greater influence on children's daily time spent on MVPA than childcare center characteristics and should be taken into account when implementing interventions to promote physical activity.

Objectively Measured Physical Activity in South African Children Attending Preschool and Grade R: Volume, Patterns, and Meeting Guidelines

PURPOSE

To assess physical activity (PA) and determine the proportion of preschoolers meeting PA recommendations in different income settings in South Africa.

METHODS

Preschoolers from urban high-income (UH), urban low-income (UL), and rural low-income (RL) settings wore an ActiGraph GT3X+ accelerometer for 7 days. PA variables of interest included volume moderate- to vigorous-intensity PA (MVPA) and total PA (light- to vigorous-intensity PA), hourly PA patterns, and percentage of children meeting guidelines (180 min/d of total PA, inclusive of 60 min/d of MVPA). Between-sex differences were assessed using t tests and Mann-Whitney U tests; between-setting differences assessed using 1-way analyses of variance and Kruskal-Wallis tests.

RESULTS

For all children (n = 229, aged 5.17 [0.69] y), average MVPA was 124.4 (37.5) minutes per day and total PA was 457.0 (61.1) minutes per day; 96.9% of children met guidelines. Boys did significantly more MVPA than girls (136.7 [39.37] vs 111.5 [30.70] min/d, P < .001), and UH preschoolers were significantly less active than UL and RL preschoolers (UH 409.1 [48.4] vs UL 471.1 [55.6] and RL 461.6 [61.4], P < .001).

CONCLUSION

In both practice and research, it is necessary to explore ways to ensure that South African preschoolers from all income settings continue to engage in and benefit from healthy volumes of PA. This is especially important as preschoolers transition to a formal school environment.

Defining preconception: exploring the concept of a preconception population

Background

Health prior to conception can significantly impact offspring health, however, a clear definition of the attributes of the preconception population is currently lacking. We aimed to use existing literature to explore the concept and attributes of a preconception population by: [1] identifying characteristics and research recruitment methods; and [2] generating an attribute-based working definition of a preconception population.

Methods

A rapid review of current literature using CINAHL and the subject heading ‘pre-pregnancy care’ was conducted (Stage 1). Data extracted included definitions of preconception, participant inclusion/exclusion criteria, participant characteristics, and recruitment methods. Stage 2 involved a wider search of relevant publications beyond peer-reviewed literature followed by a concept analysis of the phrase “preconception population” applying Walker and Avant’s framework (Stage 2).

Results

Twenty-three papers (19 studies) were included in Stage 1. “Preconception” was explicitly defined in one study. Twelve studies specified participants must be planning a pregnancy. Stage 2 included 33 publications. Four key perspectives for the concept of the preconception population were derived: [1] intentional; [2] potential; [3] public health; and [4] life course.

Conclusions

Adopting these perspectives may allow researchers to accurately define, identify and recruit preconception populations and to develop interventions that are appropriately broad or tailored depending on population needs. We hope the definitions will facilitate research with this population and will subsequently improve the wellbeing of preconception men and women, which is essential to ensuring the health of future generations.

Health in Preconception, Pregnancy and Postpartum Global Alliance: International Network Pregnancy Priorities for the Prevention of Maternal Obesity and Related Pregnancy and Long-Term Complications

In this article, we describe the process of establishing agreed international pregnancy research priorities to address the global issues of unhealthy lifestyles and rising maternal obesity. We focus specifically on the prevention of maternal obesity to improve related clinical pregnancy and long-term complications. A team of multidisciplinary, international experts in preconception and pregnancy health, including consumers, were invited to form the Health in Preconception, Pregnancy and Postpartum (HiPPP) Global Alliance. As an initial activity, a priority setting process was completed to generate pregnancy research priorities in this field. Research, practice and policy gaps were identified and enhanced through expert and consumer consultation, followed by a modified Delphi process and Nominal Group Technique, including an international workshop. Research priorities identified included optimising: (1) healthy diet and nutrition; (2) gestational weight management; (3) screening for and managing pregnancy complications and pre-existing conditions; (4) physical activity; (5) mental health; and (6) postpartum (including intrapartum) care. Given extensive past research in many of these areas, research priorities here recognised the need to advance pregnancy research towards pragmatic implementation research. This work has set the agenda for large-scale, collaborative, multidisciplinary, implementation research to address the major public health and clinical issue of maternal obesity prevention.

Individual-, home- and preschool-level correlates of preschool children's sedentary time

BACKGROUND

Prechoolers' significant portions of sedentary time (ST) is a public-health concern due to its high prevalence and negative health consequences. However, few studies have explored correlates of preschoolers' ST covering individual-, home- and preschool- factors within one study. The aim of this study was to identify the associations between multiple individual-, home- and preschool-level factors and preschoolers' ST. In addition, it was studied how much individual-, home- and preschool-level factors explained the variance in children's ST.

METHODS

A total of 864 children aged three to six, their parents and 66 preschools participated in the cross-sectional DAGIS study, which occurred between 2015 and 2016. The children wore an accelerometer for 1 week. Guardians, principals and early educators completed questionnaires covering the potential correlates of children's ST, for example, temperament, practices, self-efficacy and regulations. Multilevel regression analyses were conducted in multiple steps; calculation of marginal and conditional R² values occurred in the final phase.

RESULTS

Of the 29 studied correlates, the following factors remained significant in the final models. Being a boy (p < 0.001) and having high levels of surgency temperament (p < 0.001) were associated with lower ST. Regarding the home setting, frequent co-visits in physical activity (PA) places (p = 0.014) were associated with lower ST. Higher parental perceived barriers related to children's outside PA (p = 0.032) was associated with higher ST. None of the preschool setting factors remained significant in the final model. Approximately 11% of the variance in children's ST was attributed to factors related to the individual level whereas 5% was attributed to home-level factors; and 2% to preschool-level factors.

CONCLUSIONS

This study identified a set of correlates of preschool children's ST. Interventions aimed at reducing children's ST should develop strategies targeting established correlates of preschoolers' ST covering individual-, home- and preschool-level factors. The preschool-level factors included in this study explained little the variance in children's ST. However, the included measures may not have captured the essential preschool-level factors that specifically influence children's ST. Therefore, more studies are needed regarding potential preschool-level factors.

Health in Preconception, Pregnancy and Postpartum Global Alliance: International Network Preconception Research Priorities for the Prevention of Maternal Obesity and Related Pregnancy and Long-Term Complications

The preconception period is a key public health and clinical opportunity for obesity prevention. This paper describes the development of international preconception priorities to guide research and translation activities for maternal obesity prevention and improve clinical pregnancy outcomes. Stakeholders of international standing in preconception and pregnancy health formed the multidisciplinary Health in Preconception, Pregnancy, and Postpartum (HiPPP) Global Alliance. The Alliance undertook a priority setting process including three rounds of priority ranking and facilitated group discussion using Modified Delphi and Nominal Group Techniques to determine key research areas. Initial priority areas were based on a systematic review of international and national clinical practice guidelines, World Health Organization recommendations on preconception and pregnancy care, and consumer and expert input from HiPPP members. Five preconception research priorities and four overarching principles were identified. The priorities were: healthy diet and nutrition; weight management; physical activity; planned pregnancy; and physical, mental and psychosocial health. The principles were: operating in the context of broader preconception/antenatal priorities; social determinants; family health; and cultural considerations. These priorities provide a road map to progress research and translation activities in preconception health with future efforts required to advance evidence-translation and implementation to impact clinical outcomes.

Physical Activity and Fundamental Movement Skills of 3- to 5-Year-Old Children in Irish Preschool Services

The aim of this study was to quantify levels of physical activity (PA) and fundamental movement skills (FMS) of children aged 3 to 5 years in Irish preschool services during care hours, and investigate the relationship between these two variables. Data were collected from 141 children (50.3% boys, ageM = 3.9 ± 0.5 years) across 9 preschool services. Measurements included PA via accelerometry, and proficiency in four FMS (run, vertical jump, throw and catch). The recommended guideline of 15 minutes of PA per hour (min PA/hour) was met by 35% of children (M = 13.6 min PA/hour). Significant differences in mean PA per hour were found by gender, with boys (14.2 min PA/hour) more active than girls (13.0 min PA/ hour), and age, with younger children (14.2 min PA/hour) more active than older (12.6 minutes PA/hour). Percentage of children proficient in the run was high (88.4%), but low across the other skills (4.9%–18.5%). Significant differences were identified by gender for vertical jump with girls scoring higher than boys. No significant relationship was found between FMS and total PA. Low levels of PA and FMS proficiency highlight need for intervention in early years settings to ensure children develop skills to participate in PA.

Maternal body dissatisfaction in pregnancy, postpartum and early parenting: An overlooked factor implicated in maternal and childhood obesity risk

BACKGROUND

Current evidence indicates that to prevent the intergenerational transfer of overweight and obesity from parent to child, interventions are needed across the early life stages, from preconception to early childhood. Maternal body image is an important but often overlooked factor that is potentially implicated in both short- and long-term maternal and child health outcomes, including maternal gestational weight gain, postpartum weight retention, obesity, child feeding practices and early parenting.

AIM

The aim of this paper is to propose a conceptual model of the relationship between maternal body image (with a specific focus on body dissatisfaction) and maternal and child excess body weight risk across the pregnancy, postpartum and early childhood periods, as well as to highlight opportunities for intervention.

CONCLUSION

Our conceptual model proposes factors that mediate the associations between antenatal and postpartum maternal body dissatisfaction and maternal and childhood obesity risk. Pregnancy and postpartum present key risk periods for excess weight gain/retention and body dissatisfaction. Psychosocial factors associated with maternal body dissatisfaction, including psychopathology and disordered eating behaviours, may increase maternal and child obesity risk as well as compromise the quality of mother-child interactions underpinning child development outcomes, including physical weight gain. Our conceptual model may be useful for understanding modifiable psychosocial factors for preventing the intergenerational transfer of obesity risk from mothers to their children, from as early as pregnancy, and highlights next steps for multidisciplinary research focused on combatting maternal and child obesity during critical risk periods.

Educator perceptions on the benefits and challenges of loose parts play in the outdoor environments of childcare centres

It is important to consider physical activity and movement in early life to ensure children establish and maintain healthy physical activity patterns. Recent evidence has highlighted the importance of outdoor play and the childcare environment. Active outdoor play, especially free play, supports independence, self-regulation and allows children to explore their world and make decisions. Loose parts or open-ended materials are natural or synthetic resources that can be used in more than one way, allowing children to experiment through play. Incorporating loose parts into play environments creates opportunity for new play experiences. Despite growing evidence supporting loose parts play, the perspectives of childcare providers on the benefits and challenges of this type of play have been overlooked. The purpose of this study was to identify the benefits and challenges of incorporating loose parts play into the outdoor environments of childcare centres, from the perspectives of educators who took part in the Physical Literacy in the Early Years (PLEY) project. PLEY is a larger, mixed methods intervention study with the goal of evaluating a loose parts intervention in early childcare settings. This portion of the project used qualitative description to explore educators' perspectives. Data were collected using focus groups (n = 15) with early childhood educators (n = 3–5 in each group). Thematic analysis was used to identify five themes relating to benefits, and four themes relating to challenges. Benefit themes included: loose parts enable children to take risks; loose parts spark creativity and imagination; loose parts contribute to problem-solving abilities; loose parts cultivate independence and confidence; and loose parts build relationships and leadership. Challenges included: apprehension of loose parts; loose parts as a novelty; sustainability of loose parts; and loose parts present challenges with storage. Overall, we found educators perceived outdoor loose parts play to have multiple social and cognitive benefits for preschool-aged children that are critical for optimal growth and development, and overall health and wellness.

Implementation of continuous free play schedules in Australian childcare services: A cross-sectional study

ISSUE ADDRESSED

Modifying the scheduling of physical activity opportunities to provide children with more frequent opportunities for outdoor free play has been demonstrated to increase child physical activity while in care. The primary aim of this study was to describe the implementation of continuous free play schedules to allow children to access outdoor play areas, consistent with sector guidelines in a national sample of Australian childcare services. Secondary aims were to investigate the associations between the implementation of such schedules and service characteristics, and assess the perceived barriers and enablers to implementation.

METHODS

A cross-sectional study was undertaken with a random sample of 326 centre-based childcare services located across Australia. Childcare service characteristics, continuous free play scheduling and perceived barriers and enablers to implementation were assessed via a survey administered to service managers online or via telephone.

RESULTS

A total of 203 service managers (62%) reported implementing a continuous free play schedule, for three periods of 126 minutes per period, each day on average. Service type (long day care services), size (services with higher numbers of child enrolments [≥80 children]) and socio-economic area (services located in lower socio-economic areas) were associated with the implementation of a continuous free play schedule. The most prevalent barriers to implementation included insufficient staff to ensure adequate supervision of children (69%) and service layout being unsuitable (65%), while the most prevalent enablers included advice on how to overcome staffing or supervision issues (89%) and to re-orientate the service layout (54%).

CONCLUSIONS

There is scope to support the implementation of continuous free play schedules consistent with childcare sector guidelines. SO WHAT?: Future intervention research that targets the reported barriers and enablers to implementation is needed.

The Process of Integrating an Evidence-Based Intervention into a Public Health Department to Improve Nutrition and Physical Activity Behaviors in Parents and Children

The purpose of this manuscript is to describe a mutually beneficial collaboration with a Public Health Department and a University to implement an evidence-based program to teach nutrition and physical activity to improve adult and child outcomes. We first assessed the needs of the Public Health Department to build sustainable capacity. Next, all collaborators were invited to work together to focus on success. We invested in the leadership structure and strategically planned together. Finally, all of the collaborators worked together to practice cultural awareness. The process of implementing evidence-based programs allows all collaborators to emerge from the interaction stronger as a result of respectful dialogue and team building.

Parenting practices that may encourage and discourage physical activity in preschool-age children of Brazilian immigrant families: A qualitative study

Brazilians are a rapidly increasing Latino immigrant group in the United States (US), yet little research has examined factors influencing physical activity (PA) levels and behaviors of children growing up in Brazilian immigrant families. This information is needed to develop culturally sensitive interventions tailored to this population. Therefore, this qualitative study explored PA parenting practices used by Brazilian immigrant mothers living in the US. Thirty-seven Brazilian immigrant mothers with at least one child between the ages of 2 and 5 years participated in 1of 7 focus group discussions. Thematic analysis identified seven parenting practices that mothers employ that may encourage or facilitate physical activity their preschool-aged children's PA including: 1) modeling PA; 2) engaging and being physically active with child; 3) providing logistic support; 4) encouraging, praising, and offering motivational support; 5) watching, supervising, and teaching children how to engage in PA; 6) monitoring and setting limits to child's screen time; and 7) prompting child to be physically active. In addition, analysis identified four parenting practices that may discourage or inhibit children's PA including: 1) modeling of sedentary behaviors; 2) having rules and restrictions due to safety- and weather-related concerns; 3) limiting child's outdoor time due to parental time constraints; and 4) restricting child's outdoor and play time as punishment. Furthermore, analyses demonstrated that social contextual factors (e.g., income, housing, neighborhood safety, etc.) influence mothers' PA parenting practices and consequently, their children's PA. This is the first qualitative study, to our knowledge, to explore PA parenting practices of Brazilian-born immigrant mothers living in the US. Future research should further explore PA parenting practices of Brazilian immigrant parents including quantifying PA parenting practices that encourage and discourage PA, as well as examining the influence of fathers' PA parenting practices on young children's PA.

'Treat them into the grave': cancer physicians' attitudes towards the use of high-cost cancer medicines at the end of life

The prescribing of high-cost cancer medicines at the end of life has become a focus of criticism, due primarily to concerns about the safety, efficacy and cost-effectiveness of these medicines in this clinical context. In response to these concerns, a number of interventions have been proposed - frequently focused on improving physician-patient communication at the end of life. Underpinning these strategies is the assumption that the prescribing of high-cost cancer medicines at the end of life is primarily the result of poor communication on the part of cancer physicians. In this paper, we explore the factors perceived by cancer physicians to be driving the use of high-cost cancer medicines at the end of life. Drawing on semi-structured interviews with 16 Australian oncologists and haematologists, we demonstrate that these physicians believe that the use of high-cost medicines at the end of life is driven by multiple factors - including individual, interpersonal, socio-cultural and public policy influences. We conclude that these factors, and their interactions, need to be taken into account in the development of public policy and clinical interventions to address the use of high-cost medicines at the end of life.

Excessive Screen Time and Psychosocial Well-Being: The Mediating Role of Body Mass Index, Sleep Duration, and Parent-Child Interaction

OBJECTIVES

To examine the relationship between excessive screen time and psychosocial well-being in preschool children, and the potential mediating role of body mass index, sleep duration, and parent-child interaction.

STUDY DESIGN

A cross-sectional survey was conducted in Shanghai, China using stratified random sampling design. A representative sample of 20 324 children aged 3-4 years old from 191 kindergartens participated in this study. Parents completed the Strengths and Difficulties Questionnaire and reported the child's time spent on screen exposure, sleep duration, height, weight, and parent-child interactive activities.

RESULTS

Preschool children in Shanghai were exposed to 2.8 (95% CI 2.7, 2.9) hours/day of screen time, with 78.6% (95% CI 77.8,79.3) exceeding 1 hour/day and 53% (95% CI 52.0,53.9) exceeding 2 hours/day. Every additional hour of screen time was associated with increased risk for poor psychosocial well-being. Body mass index, sleep duration, and parent-child interaction mediated the effect of excessive screen time on children's psychosocial well-being, among which parent-child interaction contributed most. Parent-child interaction could explain 28.1% of the effect on total difficulties and 58.6% on prosocial behavior.

CONCLUSIONS

Excessive screen time during early childhood exists in Shanghai preschool children. Excessive screen exposure was associated with poor psychosocial well-being in preschool children via a number of mediators, mostly by reducing parent-child interaction.

Objectively measured physical activity in population-representative parent-child pairs: parental modelling matters and is context-specific

Background

Evidence for the context-specific influence of parental modelling on physical activity (PA) in childhood remains inconclusive. This nationwide Swiss study assessed the cross-sectional association between objectively measured PA of parents and their children and whether it varied across different levels of sociodemographic and environmental factors. In a second step a structural equation-model (SEM) was used to assess, whether associations between children’s PA and sociodemographic and environmental factors are mediated by the parental PA behaviour.

Methods

The population-based sample of the SOPHYA-study consisted of 889 children aged 6 to 16 years living in Switzerland and 1059 parents. PA was measured using accelerometers. Information on sociodemographics, sports behaviour, family characteristics, and perceived environment was obtained by telephone interview and parental questionnaire. Objective environmental data was allocated to each family’s residential address using GIS (geographic information system). A structural equation model tested these factors for both independent associations with children’s PA and associations mediated through the parental PA behaviour.

Results

Parental moderate to vigorous physical activity (MVPA) was associated with MVPA of their children in general (p < 0.001). Correlations between parents’ and children’s MVPA were stronger for children aged 10–12 years and for those living in the Italian speaking part of Switzerland. An increase of 1 min of mother’s and of father’s MVPA was associated with 0.24 and 0.21 min more MVPA in children, respectively. Father’s PA was associated with that of their sons, but not with that of their daughters, whereas the association of mothers’ and children’s PA did not depend on the parent-offspring sex-match. The pathway analysis in our structural equation model showed direct effects on children’s MVPA as well as indirect effects mediated by the parental PA behaviour.

Conclusions

Parental modelling seems relevant for children’s PA, but not to the same degree in all children. Interventions focusing on strengthening parental PA behaviour for the promotion of PA in the young must consider additional contextual factors related to the socio-cultural and structural environment.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5949-9) contains supplementary material, which is available to authorized users.

Exploring how Brazilian immigrant mothers living in the USA obtain information about physical activity and screen time for their preschool-aged children: a qualitative study

OBJECTIVE

To explore how Brazilian-born immigrant mothers living in the USA obtain information about physical activity (PA) and screen time (ST) behaviours for their preschool-aged children.

RESEARCH DESIGN

Focus group discussions (FGDs) were used to gain an in-depth understanding of research topics. All FGDs were audio-recorded and professionally transcribed verbatim. The Portuguese transcripts were analysed using thematic analysis, an iterative process of coding the data in phases to create meaningful patterns.

PARTICIPANTS

Thirty-seven Brazilian-born immigrant mothers of preschool-age children.

SETTING

This study was conducted in two cities in Massachusetts (MA). Participants were recruited from two predominantly Brazilian churches, local Brazilian businesses and community-based social and health services organisations in the Greater Boston area in MA.

RESULTS

Analyses revealed that the mothers participating in this study did not initially actively seek out information about PA and ST for their preschool-age children, but that they received unsolicited information about these behaviours from multiple sources including their child's paediatrician, Women, Infant and Children (WIC) programme staff, members of their social network of Brazilian friends and the Brazilian media. Mothers reported that this unsolicited information increased their knowledge about the importance of making sure their children were physically active and not participating in excessive ST. This increased awareness led mothers to actively seek information about PA and ST behaviours via the internet and through interpersonal communication with fellow Brazilian friends and family.

CONCLUSIONS

Given the value Brazilian immigrant mothers placed on the advice of their paediatricians and WIC staff, interventions should consider involving these healthcare professionals, possibly through including endorsement (eg, prescription for PA and maximum ST). More research is needed to ensure Brazilian immigrant mothers' health and media literacy including their ability to navigate the online environment and to discern the accuracy and quality of information from various web sites.

Activating Childcare Environments for All Children: the Importance of Children's Individual Needs

Characteristics of the physical childcare environment are associated with children’s sedentary behavior (SB) and physical activity (PA) levels. This study examines whether these associations are moderated by child characteristics. A total of 152 1- to 3-year-old children from 22 Dutch childcare centers participated in the study. Trained research assistants observed the physical childcare environment, using the Environment and Policy Assessment Observation (EPAO) protocol. Child characteristics (age, gender, temperament and weight status) were assessed using parental questionnaires. Child SB and PA was assessed using Actigraph GT3X+ accelerometers. Linear regression analyses including interaction terms were used to examine moderation of associations between the childcare environment and child SB and PA. Natural elements and portable outdoor equipment were associated with less SB and more PA. In addition, older children, boys and heavier children were less sedentary and more active, while more use of childcare and an anxious temperament were associated with more SB. There were various interactions between environmental factors and child characteristics. Specific physical elements (e.g., natural elements) were especially beneficial for vulnerable children (i.e., anxious, overactive, depressive/withdrawn, overweight). The current study shows the importance of the physical childcare environment in lowering SB and promoting PA in very young children in general, and vulnerable children specifically. Moderation by child characteristics shows the urgency of shaping childcare centers that promote PA in all children, increasing equity in PA promotion in childcare.

The effects of mothers' musical background on sedentary behavior, physical activity, and exercise adherence in their 5-6-years-old children using movement-to-music video program

Objectives

The purpose of this study was to examine whether mothers’ musical background has an effect on their own and their children’s sedentary behavior (SB) and physical activity (PA). The aim was also to assess children’s and their mothers’ exercise adherence when using movement-to-music video program.

Design

Sub-group analysis of an intervention group in a randomized controlled trial (ISRCTN33885819).

Method

Seventy-one mother-child-pairs were divided into two categories based on mothers’ musical background. Each pair performed 8 weeks exercise intervention using movement-to-music video program. SB and PA were assessed objectively by accelerometer, and exercise activity, fidelity, and enjoyment were assessed via exercise diaries and questionnaires. Logistic regression model was used to analyze associations in the main outcomes between the groups.

Results

Those children whose mothers had musical background (MB) had greater probability to increase their light PA during the intervention, but not moderate-to-vigorous PA compared to those children whose mothers did not have musical background (NMB). SB increased in both groups. Mothers in the NMB group had greater probability to increase their light and moderate-to-vigorous PA and decrease their SB than mothers in the MB group. However, exercise adherence decreased considerably in all groups. Completeness, fidelity, and enjoyment were higher among the NMB group compared to the MB group.

Conclusions

The present results showed that mothers without musical background were more interested in movement-to-music exercises, as well as their children. For further studies it would be important to evaluate an effect of children’s own music-based activities on their SB and PA.

Parental Education and Pre-School Children's Objectively Measured Sedentary Time: The Role of Co-Participation in Physical Activity

Parental co-participation in physical activity (PA) may be a beneficial parenting practice for diminishing children's sedentary time (ST). Less information is available, however, on the explanatory role of co-participation in PA regarding parental educational differences in children's ST. Preschool-aged children (N = 864, mean age 4.8, 52% boys) with their parents participated in a cross-sectional DAGIS (Increased Health and Wellbeing in Pre-schools) study between years 2015 and 2016. Children (N = 821) wore an accelerometer for one week. Parents were informed of their educational background, and the frequency of visits with their child in nature, to parks or playgrounds, their own yard, and indoor sport facilities (N = 808). Testing the associations required multiple regression analyses. Parents with a low educational background reported more frequent visits with their child to their own yard, and these visits were associated with children's lower ST. More highly educated parents co-visited indoor sport facilities more frequently, although this did not have a significant association with children's ST. More frequent visits in nature were associated with a lower ST at weekends, regardless of educational background. Future health promotion strategies should inform parents that frequent co-participation in PA, for example, in one's own yard, is beneficial for lowering children's ST.

Nutrition in the First 1000 Days: Ten Practices to Minimize Obesity Emerging from Published Science

The prevalence of childhood overweight and obesity has increased in most countries the last decades. Considering this in a simplistic way, we can say that obesity is the result of an imbalance between energy intake and energy expenditure. Moreover, the environment from conception to childhood could influence the child's future health. The first 1000 days of life start with woman's pregnancy, and offer a unique window of opportunity to contribute to obesity prevention. In light of the actual literature, the aim of our article is to discuss a proposal of 10 good practices to minimize obesity in the first 1000 days emerging from published science. (1) Both the mother's and the father's behaviors are important. A balanced diet with appropriate fat and protein intake, and favoring fruits and vegetables, is recommended for both parents during the conception period and pregnancy. Furthermore, overweight/obese women who are planning to become pregnant should reduce their weight before conception. (2) During pregnancy, at birth, and during early life, body composition measurements are crucial to monitor the baby's growth. (3) Exclusive breastfeeding is recommended at the beginning of life until six months of age. (4) Four to six months of age is the optimal window to introduce complementary feeding. Until one year of age, breast milk or follow-on/commercial formula is the main recommended feeding source, and cow's milk should be avoided until one year of age. (5) Fruit and vegetable introduction should begin early. Daily variety, diversity in a meal, and repeated exposure to the food, up to eight times, are efficient strategies to increase acceptance of food not well accepted at first. There is no need to add sugar, salt, or sugary fluids to the diet. (6) Respect the child's appetite and avoid coercive "clean your plate" feeding practices. Adapt the portion of food and don't use food as reward for good behavior. (7) Limit animal protein intake in early life to reduce the risk of an early adiposity rebound. Growing-up milk for children between one and three years of age should be preferred to cow's milk, in order to limit intake and meet essential fatty acid and iron needs. (8) The intake of adequate fat containing essential fatty acids should be promoted. (9) Parents should be role models when feeding, with TV and other screens turned-off during meals. (10) Preventive interventions consisting of promoting physical activity and sufficient time dedicated to sleep should be employed. In fact, short sleep duration may be associated with increased risk of developing obesity. Based on literature reviews, and given the suggestions described in this manuscript, concerted public health efforts are needed to achieve the healthy objectives for obesity and nutrition, and to fight the childhood obesity epidemic.

A qualitative study conducted in the USA exploring Latino fathers' beliefs, attitudes and practices related to their young children's eating, physical activity and sedentary behaviours

OBJECTIVE

Increasing evidence documents fathers' influential role in their children's eating, physical activity (PA) and sedentary behaviours (SB). We aimed to expand limited existing research examining fathers' influence in these areas by exploring Latino fathers' beliefs, attitudes and practices related to eating, PA and SB of their young children.

DESIGN

Seven focus group discussions were conducted in Spanish with Latino fathers (n 28) of children aged 2-8 years. Audio recordings were transcribed and translated verbatim without identifiers. Data were analysed using thematic analysis to identify key concepts and themes using NVivo 11 software.

RESULTS

Fathers expressed positive beliefs and attitudes about the importance of healthy eating for their young children, themselves and their families. Nevertheless, the majority reported familial practices including eating out, getting take-out, etc. that have been linked to increased obesity risk among Latino children. Fathers were more involved and engaged in children's PA than eating and feeding. However, several fathers reported engaging predominantly in sedentary activities with their children, appeared permissive of children's sedentary habits and struggled to set limits on children's screen-time.

CONCLUSIONS

We provide new information on Latino fathers' beliefs and child feeding and PA practices that may provide important targets for interventions aimed at promoting healthful eating and PA behaviours of Latino children. Future research should further quantify the influence of Latino fathers' parenting styles and practices on development of children's eating, PA and SB. This information is needed to identify risk factors amenable to interventions and to design culturally appropriate parenting and family-based interventions targeting Latino children's home environment and designed to meet this ethnic group's specific needs.