A qualitative study of the factors that influence mothers when choosing drinks for their young children

Parents' Perceptions of Claims on Packaged Commercial Toddler Foods: A Qualitative Study

Commercial toddler foods (CTFs) are widely used. Many are nutritionally poor despite displaying health, nutrition or marketing claims implying healthiness. This study aimed to: (i) explore how claims on CTFs influence parents' product perceptions and preferences, and gauge support for regulatory reform to ensure CTFs are marketed responsibly; (ii) identify other factors influencing parent's and toddlers' perceptions and preferences towards CTFs and toddler feeding in general. Six moderator-led online focus groups (N = 47) were conducted with parents of toddlers (aged 12 to < 36 months) in Victoria, Australia, using a discussion guide and mock CTFs to elicit discourse. Discussions were audio-recorded, transcribed, and analysed using exploratory content and thematic analysis. Parents found CTFs displaying claims more appealing, despite awareness and scepticism of claims. Parents expressed frustration over industry's use of claims and supported stronger regulation of claims. Some doubted the effectiveness of regulations, concerned that industry would find ways to circumvent rules. Parents perceive visual features (especially cartoon characters) on CTFs as highly influential for toddlers. Parents support honest labelling of CTFs, reflecting a product's actual ingredients and nutritional profile, especially signposting of sugar content. Parents evaluate CTFs based on perceived healthiness and convenience, often relying on social media and brand reputation for guidance on what to feed their toddlers. While parents are aware of, and sceptical about claims on CTFs, these claims still influence their perceptions. Findings highlight the need for stronger regulations to ensure that claims on CTFs do not create inaccurate perceptions of their healthiness.

"They start on the zero-alcohol and they wanna try the real thing": Parents' views on zero-alcohol beverages and their use by adolescents

OBJECTIVE

Zero-alcohol beverages containing 0.0-0.5% alcohol by volume may offer public health benefits if individuals use them to substitute for alcohol-containing products, thereby reducing alcohol use. There are, however, concerns that zero-alcohol beverages may encourage adolescents' earlier interest in alcohol and increase exposure to alcohol company branding. As this poses a challenge for parents, we studied parents' views on zero-alcohol beverages and their provision to adolescents.

METHODS

We interviewed n=38 parents of 12-17-year-olds and used reflexive thematic analysis to interpret interview data.

RESULTS

Parents considered zero-alcohol beverages to be 'adult beverages' that potentially supported reduced adult drinking but were unnecessary for adolescents. Parents were concerned that adolescent zero-alcohol beverage use could normalise alcohol consumption and be a precursor to alcohol initiation. There was a potential conflict between moderate provision in 'appropriate' contexts, and potential benefits, which were each supported by some parents. Uncertainty on health qualities was also reported.

CONCLUSIONS

Parents reported conflicting and cautious views on zero-alcohol beverage provision to adolescents.

IMPLICATIONS FOR PUBLIC HEALTH

As evidence on the impacts of zero-alcohol beverage availability develops, parent-targeted messages highlighting the potential risk of normalisation of alcohol use for young people could be developed, in conjunction with broader policy responses.

Which parents provide zero-alcohol beverages to adolescents? A survey of Australian parents' practices and intentions

OBJECTIVE

Zero-alcohol beverages (<0.5% alcohol by volume) appear and taste similar to alcoholic beverages but are regulated similarly to soft drinks in many countries, blurring the distinction between alcoholic and non-alcoholic beverages. How parents view provision of zero-alcohol beverages to adolescents is likely a key determinant of adolescent consumption. We investigated factors associated with parents' provision of zero-alcohol beverages to adolescents, including attitudes toward zero-alcohol beverages and demographic, knowledge, and behavioural factors known to be associated with provision of alcoholic beverages.

METHODS

We conducted an online cross-sectional survey of N = 1197 Australian parents of adolescents aged 12-17 years in April-May 2022. We examined associations with zero-alcohol beverage provision using binomial logistic regression, and with future provision intentions using multinomial logistic regression analyses.

RESULTS

Factors significantly associated (p < .001) with parents' provision and future intentions to provide zero-alcohol beverages to their adolescent included beliefs that zero-alcohol beverages had benefits for adolescents (Adjusted Odds Ratio [AOR] 2.69 (provision); 3.72 (intentions)), provision of alcoholic beverages (AOR 2.67 (provision); 3.72 (intentions)), and an incorrect understanding of alcohol guidelines for adolescents (AOR 2.38 (provision); 1.95 (intentions)).

CONCLUSIONS

Parents' provision and intentions to provide zero-alcohol beverages were associated with beliefs about zero-alcohol beverages as well as some factors associated with provision of alcoholic beverages. Precautionary advice to parents that the provision of zero-alcohol beverages may serve to normalise alcohol consumption may be warranted.

Seeking Sweetness: A Systematic Scoping Review of Factors Influencing Sugar-Sweetened Beverage Consumption in Remote Indigenous Communities Worldwide

It is well-established that remote Indigenous communities have higher rates of sugar-sweetened beverage (SSB) consumption than non-Indigenous counterparts, which results in higher rates of chronic diseases such as type 2 diabetes mellitus (T2DM), obesity, and kidney disease. The aetiology leading to this behaviour remains understudied and overlooked. Therefore, the aim of this literature review is to understand the underpinning factors that contribute to SSB consumption in remote Indigenous communities. Studies were identified through five databases (n = 2529) and grey literature searching (n = 54). Following the PRISMA guidelines, each paper was assessed for eligibility, which left 34 studies for inclusion in the review. Within these papers, 37 different factors were found to influence SSB consumption in remote Indigenous communities. These were organised according to the Determinants of Nutrition and Eating (DONE) framework. SSB consumption was found to influence intake through each main level of the framework; individual (n = 9), interpersonal (n = 18), environmental (n = 9), and policy (n = 3). Preference was identified to be the most common factor to influence intake (n = 19), followed by health literacy (n = 15) and community availability (n = 12). Despite this, interventions to reduce SSB intake have never targeted this factor. This paper highlights the importance of a multi-level whole-of-system approach and suggests that an individual’s taste/preference should shape the direction of future research and intervention in this area.

Social Representations of Drinking Water in Schoolchildren and Parents from Two Schools in Zapopan, Mexico

Childhood obesity and children being overweight has increased recently; although they are multi-causal problems, an unhealthy diet is a critical component. In Mexico, drinking water consumption in children from 9 to 18 years only reaches 30% of total fluid consumption. The aim of our study was to describe the social representations (SR) of drinking water in school-children and parents of two schools in Zapopan, Mexico. Associative free listing was used as an information gathering technique. Schoolchildren aged 8 to 12 years (n = 50) and parents (n = 23) from two elementary schools were selected by a convenience sampling from April to June 2015. A similarity analysis was performed using the co-occurrence index; with this, a similarity graph was obtained. Prototypical analysis was performed to explore the structure of the SR. Three dimensions were described in the children’s SR: a functional dimension related to health and nutrition, a practical dimension that describes the instruments used for its consumption, and a theoretical dimension that specifies the characteristics of water and its relationship with nature. In the parents’ SR, a functional dimension was also found; another dimension was described regarding the integral well-being that drinking water provides. A practical dimension describes the features related to its consumption. The investigation describes the structure of the water SR, which help to contextualize and explain the actions of schoolchildren and their parents regarding drinking water consumption.

Oral health status, behaviours, food and beverage consumption of aboriginal children in Australia

ISSUE ADDRESSED

Dental decay is prevalent among Australian Aboriginal children, yet little is known about their oral health-related behaviours. This study explored the oral health status, behaviours, food and beverage consumption of Aboriginal school children aged 7-9 years in Sydney, Australia.

METHODS

Parents who were part of an existing longitudinal birth cohort ("Gudaga") were surveyed when their child was between 7 and 9 years. Children (n = 110) also received oral health screening by a trained nurse.

RESULTS

A number of children (62%-91%) had at least one visible oral health problem across the 2 years. Around two thirds (62%-67%) of parents rated their child's oral health as excellent/very good and less than half the children (32%-45%) had received dental check-ups. Most children (79%-90%) brushed their teeth and drank water (97%) but more than half (57%-70%) also drank sugar sweetened beverages daily.

CONCLUSIONS

Parents are instilling good oral health behaviours, however, the oral health screening suggests children are experiencing oral health issues of which parents may be unaware. Parents also seem to be unaware of beverage consumption practices that can increase the risk of childhood decay. SO WHAT?: The findings highlight the need for greater oral health awareness among Aboriginal families on how to recognise early symptoms dental decay and risk factors like sugar sweetened beverages among school going children. This suggests that existing health promotion strategies may not be reaching many Aboriginal families in the urban areas and more culturally appropriate programs may be needed.

Understanding the influence of physical resources and social supports on primary food providers' snack food provision: a discrete choice experiment

BACKGROUND

Snack eating occasions contribute approximately a third of children's energy intake, with approximately half of all unhealthy foods consumed during snack times. Therefore, it is critical to understand the drivers of primary food providers' snack provision. The study aims were to determine the relative importance of physical resources and social supports when primary food providers are choosing snacks to provide to their child, and to investigate how these attributes differ in social versus non-social occasions, and between subgroups of primary food providers based on socio-economic position.

METHODS

Primary food providers of three to seven-year olds completed an online discrete choice experiment, by making trade-offs when completing repeated, hypothetical choice tasks on the choice of snacks to provide to their child in: 1) non-social and 2) social condition. Choice tasks included two alternatives consisting of varying attribute (i.e. factor) levels, and an opt-out option. The order of conditions shown were randomized across participants. Multinomial logit model analyses were used to determine utility weights for each attribute.

RESULTS

Two-hundred and twenty-five primary food providers completed the study, providing 1125 choice decisions per condition. In the non-social condition, the top three ranked attributes were type of food (utility weight 1.94, p < 0.001), child resistance (- 1.62, p < 0.001) and co-parent support (0.99, p < 0.001). In the social condition, top ranking attributes were child resistance (utility weight - 1.50, p < 0.001), type of food (1.38, p < 0.001) and co-parent support (1.07, p < 0.001). In both conditions, time was not a significant influence and cost was of lowest relative importance. Subgroup analyses revealed cost was not a significant influence for families from higher socio-economic backgrounds.

CONCLUSIONS

Type of food, child resistance and co-parent support were of greatest relative importance in primary food providers' snack provision decision-making, regardless of social condition or socio-economic position. In designing future interventions to reduce unhealthy snacks, researchers should prioritize these influences, to better support primary food providers in changing their physical and social opportunity.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry no. ACTR N12618001173280.

Are Australian parents following feeding guidelines that will reduce their child's risk of dental caries?

BACKGROUND

Early childhood is an important time to establish eating behaviours and taste preferences, and there is strong evidence of the association between the early introduction of sugar-sweetened beverages and obesity and dental caries (tooth decay). Dental caries early in life predicts lifetime caries experience, and worldwide expenditure for dental caries is high.

METHODS

Questionnaire data from the Splash! longitudinal birth cohort study of young children in Victoria, Australia was used to examine beverage consumption and parental feeding behaviours of young children, aiming to provide contemporary dietary data and assess consistency with the Australian dietary guidelines.

RESULTS

From 12 months of age, the proportion of children drinking sugar-sweetened beverages consistently increased with age (e.g. fruit juice consumed by 21.8% at 12 months and 76.7% at 4 years of age). However, the most common beverages for young children are milk and water, consistent with Australian dietary guidelines. In relation to other risk factors for dental caries, at 6 months of age children were sharing utensils, and at 12 months three quarters of carers tasted the child's food before feeding.

CONCLUSIONS

The increasing consumption of sugar-sweetened beverages and prevalence of other risk factors for dental caries and obesity through early childhood continues to be a problem despite efforts to raise awareness of these issues with parents.

Risk factors for oral health in young, urban, Aboriginal and Torres Strait Islander children

BACKGROUND

The caries process follows a strong social gradient which can commence in the first years of life. Yet data on young children remain limited. This study reports the potential risk factors and indicators in urban, Aboriginal and Torres Strait Islander children aged less than 5 and estimates the prevalence of caries.

METHODS

Demographic and risk factor and risk indicator data were collected at baseline in a cohort study of children attending a health clinic in north Brisbane. Dentulous children received a basic oral examination to explore the presence of decayed, missing and filled teeth (dmft). Descriptive analyses were performed. A backwards stepwise logistic regression model was performed to identify potential associations with dmft status.

RESULTS

In this study, 180 children enrolled: 111 children received the oral examination, of whom 14 (12.6%) (mean age 35 months) were estimated to have dmft >0. There was a high prevalence of socio-economic, dietary and behavioural risk factors/indicators present for children. Due to the small sample size, planned regression was not performed.

CONCLUSIONS

Overall, the prevalence of risk factors and risk indicators for caries in the study population is high. More culturally appropriate resources that support preventive care need to be invested before children are school aged.

Psychosocial factors and oral health practices of preschool-aged children: a qualitative study with Hispanic mothers

OBJECTIVE

This qualitative study sought to gain an in-depth understanding of Hispanic mother's parenting experiences and perceptions about select psychosocial factors. How psychosocial factors influence mothers' engagement in recommended oral health-related behaviors for their preschool-aged children (3-5 years) was explored. Psychosocial resources and barriers explored included maternal knowledge about children's oral health, beliefs such as perceived self-efficacy and health locus of control, and parenting experience and stress.

DESIGN

Six focus groups and one individual interview with lower-income, Hispanic mothers of preschoolers (n = 36 total participants) were conducted in Spanish at a community health clinic on the California-Mexico border during summer 2010. A bilingual dentist led all sessions using a set of open-ended guiding questions. All sessions were audio-taped, translated and transcribed in English. Transcripts were coded and analyzed for common themes.

RESULT(S)

Six themes were identified around dental knowledge, the mothers' primary role in performing the child's oral hygiene among multiple caregiving priorities, parenting challenges, perceived self-efficacy, perceived future outlook for their child's oral health, and family influences. Mothers recognized the importance of caring for primary teeth. However, few were knowledgeable about preventive practices to promote young children's oral health, such as the recommended ages for brushing or first dental visit. Mothers that were more knowledgeable expressed feeling more efficacious about maintaining their child's oral hygiene. All mothers believed they were primarily responsible for their child's oral health, and most held positive future expectations for their child's oral health.

CONCLUSION

These findings provide insight into how Hispanic mothers of young children perceive their role as caregiver. Maternal knowledge and perceptions affect their ability to care for their child's oral health and should be accounted for in future interventions.

Assessing Preschoolers' Beverage Consumption Using the Theory of Planned Behavior

Childhood obesity and caries are linked to sugar-sweetened beverage (SSB) and excessive juice consumption. We assessed psychosocial factors influencing children's beverage consumption and strategies to promote healthier choices. Using a quantitative and qualitative approach guided by the theory of planned behavior, we surveyed and interviewed 37 parents of preschool-aged children on barriers and facilitators of children's beverage consumption. Most children (83.8%) consumed SSBs, 67.6% drank >4 to 6 oz of juice per day. Parent's self-efficacy was the strongest correlate of parent's behavioral intention to limit SSB (0.72, standard error 0.08, P = .03). Parents' motivations to limit their child's SSB intake extended beyond simply preventing caries and obesity; they also considered the implications of these conditions on children's self-image, future health, and quality of life. Yet, the influence of multidimensional barriers made it difficult to reduce children's SSB consumption. Interventions that address parental attitudes, values, and self-efficacy to address external factors could help reduce children's SSB consumption.

Sugar in Infants, Children and Adolescents: A Position Paper of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition

The consumption of sugars, particularly sugar-sweetened beverages (SSBs; beverages or drinks that contain added caloric sweeteners (ie, sucrose, high-fructose corn syrup, fruit juice concentrates), in European children and adolescents exceeds current recommendations. This is of concern because there is no nutritional requirement for free sugars, and infants have an innate preference for sweet taste, which may be modified and reinforced by pre- and postnatal exposures. Sugar-containing beverages/free sugars increase the risk for overweight/obesity and dental caries, can result in poor nutrient supply and reduced dietary diversity, and may be associated with increased risk of type 2 diabetes mellitus, cardiovascular risk, and other health effects. The term "free sugars," includes all monosaccharides/disaccharides added to foods/beverages by the manufacturer/cook/consumer, plus sugars naturally present in honey/syrups/unsweetened fruit juices and fruit juice concentrates. Sugar naturally present in intact fruits and lactose in amounts naturally present in human milk or infant formula, cow/goat milk, and unsweetened milk products is not free sugar. Intake of free sugars should be reduced and minimised with a desirable goal of <5% energy intake in children and adolescents aged ≥2 to 18 years. Intake should probably be even lower in infants and toddlers <2 years. Healthy approaches to beverage and dietary consumption should be established in infancy, with the aim of preventing negative health effects in later childhood and adulthood. Sugar should preferably be consumed as part of a main meal and in a natural form as human milk, milk, unsweetened dairy products, and fresh fruits, rather than as SSBs, fruit juices, smoothies, and/or sweetened milk products. Free sugars in liquid form should be replaced by water or unsweetened milk drinks. National Authorities should adopt policies aimed at reducing the intake of free sugars in infants, children and adolescents. This may include education, improved labelling, restriction of advertising, introducing standards for kindergarten and school meals, and fiscal measures, depending on local circumstances.

A systematic review of grandparents' influence on grandchildren's cancer risk factors

Many lifestyle patterns are established when children are young. Research has focused on the potential role of parents as a risk factor for non communicable disease in children, but there is limited investigation of the role of other caregivers, such as grandparents. The aim of this review was to identify and synthesise evidence for any influence grandparents' care practices may have on their grandchildren's long term cancer risk factors. A systematic review was carried out with searches across four databases (MEDLINE, Embase, Web of Science, PsycINFO) as well as searches of reference lists and citing articles, and Google Scholar. Search terms were based on six areas of risk that family care could potentially influence-weight, diet, physical activity, tobacco, alcohol and sun exposure. All study designs were included, as were studies that provided an indication of the interaction of grandparents with their grandchildren. Studies were excluded if grandparents were primary caregivers and if children had serious health conditions. Study quality was assessed using National Institute for Health and Care Excellence checklists. Grandparent impact was categorised as beneficial, adverse, mixed or as having no impact. Due to study heterogeneity a meta-analysis was not possible. Qualitative studies underwent a thematic synthesis of their results. Results from all included studies indicated that there was a sufficient evidence base for weight, diet, physical activity and tobacco studies to draw conclusions about grandparents' influence. One study examined alcohol and no studies examined sun exposure. Evidence indicated that, overall, grandparents had an adverse impact on their grandchildren's cancer risk factors. The theoretical work in the included studies was limited. Theoretically underpinned interventions designed to reduce these risk factors must consider grandparents' role, as well as parents', and be evaluated robustly to inform the evidence base further.

Preschoolers' influence on and help with beverage selection at the grocery store is linked to maternal responsiveness and child beverage intake: An exploratory study

Children's involvement in beverage selection or purchase has seldom been investigated. The responsiveness dimension of parental feeding styles has been related to healthy maternal feeding practices. Assessing mothers' reports of responsiveness and demandingness in grocery stores may shed light on influences on purchases of sugar-sweetened beverages (SSB) and fruit juice (FJ). Study objectives were to explore whether (1) maternal responsiveness and demandingness were associated with preschoolers' a) help with selection of and b) influence on SSB and FJ purchases during grocery shopping and whether (2) preschoolers' a) help with selection of and b) influence on SSB and FJ purchases were associated with child intake of these beverages. Mothers of 3-to-5-year-old children (n=185) who co-shopped with the child completed the Caregiver Feeding Style Questionnaire, reported frequency of child help with selection and influence on beverage purchase via questionnaire, and provided a one-day weekend food recall for the child. In adjusted logistic regressions, responsiveness was associated with child help selecting FJ (OR=6.50, 95% CI[1.04, 40.75], p<0.05), but not SSB. In multiple regressions, children who frequently helped select or influenced SSB purchases had higher SSB intake, b(SE)=3.63(1.40), t(176)=2.59, and b(SE)=3.18(1.25), t(176)=2.53, p<0.05. Mothers with higher responsiveness were more likely to let their preschoolers select FJ but not SSB during shopping. Children who frequently helped select or influenced SSB purchases had higher SSB intake than children who did so infrequently. Additional parenting behaviors associated with grocery shopping should be explored.

African-American and Hispanic children's beverage intake: Differences in associations with desire to drink, fathers' feeding practices, and weight concerns

Relationships of African-American and Hispanic fathers' feeding practices and weight concerns and preschoolers' desire to drink with children's beverage intake were examined, and associations between fathers' feeding practices and children's weight status were evaluated. Fathers' (Hispanic n = 61, African-American n = 49) difficulty in child feeding, use of food to calm, use of food as reward, and concern about the child being under and overweight as well as their child's desire to drink were assessed. Preschoolers' (ages 2 to 5) total sugar-sweetened beverage (SSB), fruit juice, and water intake were measured by a modified beverage intake questionnaire. Body Mass Index (BMI) and BMI percentile were calculated for fathers and children, respectively. Multiple regressions revealed that, in Hispanics, difficulty in feeding, concern about underweight, use of food to calm, and use of food as a reward were significantly associated with child intake of total SSB, whereas, in African-Americans, child desire to drink was associated with total SSB and fruit juice. Concern about the child being underweight was inversely associated with child BMI percentile in Hispanics. Significant differences in regression coefficients of child SSB intake to fathers' behaviors versus child desire to drink between the two racial-ethnic groups indicated that use of food to calm the child predicted increased intake of SSB by Hispanic but not by African-American children, while child desire to drink predicted increased intake of SSB by African-American but not by Hispanic children. Because of these significant differences, future research might profitably explore socio-cultural influences on associations of additional child feeding behaviors with fathers' attempts to control them. Furthermore, practitioners should consider developing and evaluating different child obesity interventions for these two racial-ethnic groups.

Choosing foods for infants: a qualitative study of the factors that influence mothers

BACKGROUND

Examining the experiences of parents making food choices for infants is important because ultimately this influences what infants eat. Infancy is a critical period when food preferences and eating behaviour begin to develop, shaping dietary patterns, growth and health outcomes. There is limited evidence regarding what or why foods are chosen for infants.

OBJECTIVE

To describe the experiences of mothers making food choices for their infant children.

METHODS

Semi-structured interviews with 32 Australian mothers of infants aged four to 15 months from a range of socioeconomic backgrounds. An inductive thematic analysis through a process of constant comparison was conducted on transcribed interviews.

RESULTS

Mothers described many ideas and circumstances which influenced food choices they made for infants. Themes were developed which encapsulate how the wider environment and individual circumstances combine to result in the food choices made for infants. Beliefs, values, norms and knowledge were a central influence on choices. Cost, quality and availabilities of various foods were also key factors. Related to this, and combined with inherent factors such as perishability and infant acceptability, fresh fruits and vegetables were often singled out as an easy or difficult choice. Influences of time, parents' capacities, social connections and different information sources were clearly apparent. Finally infants' own preferences and how parents helped infants with learning to eat were also key influences on food choices.

CONCLUSIONS

Choosing foods for infants is a complex social practice. An ecological framework depicting the multiple influences on what people eat and sociological theory on food choice regarding the role of 'social structure' and 'human agency' are both applicable to the process of choosing foods for infants. Equity issues may be key regarding the degree to which mothers can choose particular foods for infants (e.g. choosing foods which promote health).

Factors influencing obesogenic dietary intake in young children (0-6 years): systematic review of qualitative evidence

BACKGROUND

Obesogenic dietary intake is prevalent in young children and is associated with obesity and other adverse health outcomes in childhood and later in life.

OBJECTIVE

To describe the barriers to and facilitators of obesogenic dietary intake in early childhood, in order to inform interventions and public health policies to prevent obesity.

DESIGN

Systematic review of qualitative literature on factors influencing obesogenic diets in children aged 0-6 years.

DATA SOURCES

MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Knowledge, British Nursing Index, ASSIA and Sociological Abstracts.

REVIEW METHODS

Qualitative studies meeting the inclusion criteria were synthesised. Data were analysed by creating a thematic framework, underpinned by the socioecological model, which included familiarisation of data across the studies, indexing, charting, mapping and interpretation.

RESULTS

20 studies from the USA (10), Europe (6) and Australia (4) included the views of 1067 participants (901 parents/caregivers, 37 children, 87 teachers, 15 dieticians and 27 nursery staff). Study designs included focus groups (n=16), individual interviews (n=6) and ethnography (n=1) with some studies using more than one design. Despite wide differences in the study context and focus, several consistent themes emerged. Parental factors increasing young children's obesogenic diets were: negative parent/family/peer modelling, lack of knowledge, time constraints, using food as reward, affordability and concerns about child's health. Child preferences also increased intake. Environmental factors increasing intake include: availability, advertising, societal, cultural and preschool/childcare influences.

CONCLUSIONS

Future intervention strategies should aim to promote modelling of positive behaviours, create home and preschool environments that promote healthy diets, and simultaneously target factors at the family and preschool/childcare levels.

TRIAL REGISTRATION NUMBER

This review is one of a series of systematic reviews on the determinants of obesogenic behaviours in young children, registered with the International Prospective Register for Systematic Reviews (PROSPERO), CRD42012002881.