Background: The prevalence of type 2 diabetes (T2D) in pediatric populations has increased in recent years, although the number of preventive health initiatives for children is substantial. Likewise, factors that contribute to the risk of developing T2D have increased. Studies have examined the effects of family-based interventions that promote health behaviors influence on T2D incidence and related risk factors, but only a few studies have examined the effect of such interventions in vulnerable families with a focus on the effects on children. Aim: To systematically describe and characterize the existing literature on family-based health promotion interventions and to assess their effects on children’s health behaviors and the quality of evidence. Methods: The PRISMA checklist for systematic reviews formed the methodological framework, inclusion criteria were defined based on PICO and the quality of evidence was assessed using the OHAT Risk of Bias Assessment Tool. Additional inclusion criteria were English peer-reviewed quantitative studies with a between-subjects design. The searches were completed in March 2021. Results: Across five databases, 3173 studies were identified; 43 studies met the inclusion criteria and 39 different interventions were identified. The findings showed that family-based interventions to promote healthy behavior and prevent T2D or related risk factors in vulnerable families are characterized by great diversity, with some consistent intervention components. Discussion: It was not possible to provide any rigorous recommendations for future designs of family-based interventions to promote healthy behavior in childhood. However, there were some intervention features that seem promising and beneficial for children, including empowering both child and parent, creating shared values by goal setting and social support, and promoting intrinsic motivation and self-efficacy on a social-cognitive theoretical basis. Conclusion: The ideal family-based intervention to promote health behavior is yet to be identified, but this review provides proposals for future research and indicates a need for streamlining intervention designs and not only raises the question does the intervention work but rather why does it work. Implications enhancing future policy and practice involve both children and parents to promote mutual empowerment, shared values, and whole-family ownership in which intrinsic motivation and self-efficacy for behavior change are implicit.

Purpose: More insight into the effects of school-based health-promoting interventions’ effects in the home environment is vital to optimise interventions’ potential, as information regarding this subject is scarce. The Healthy Primary School of the Future (HPSF) is a Dutch initiative aiming to improve children’s health and well-being by providing daily physical activity (PA) sessions and healthy school lunches. Earlier reports revealed favourable intervention effects on children’s anthropometrics and health behaviours. Nevertheless, additional quantitative analyses revealed that favourable changes in health behaviours were only seen in the school setting, and not in the home setting. The present study used qualitative methods to answer the research question: “Does HPSF lead to changes in health behaviours (especially PA and dietary behaviours) of children and parents in the home environment, and if so, what are the processes behind these changes?”

Methods: In 2018-2019, 27 semi-structured interviews were conducted with parents from two HPSFs. Interviews were recorded and transcribed, data was coded and interpreted through thematic analysis using NVivo software. As theory regarding behavioural changes in the home context resulting from school-based interventions is scarce, data analysis followed a deductive grounded theory approach.

Findings: HPSF resulted in various behavioural changes at home, initiated by both children and parents. Interviewees reported improvements in healthy behaviours, which were sometimes compensated by unhealthy behaviours. Reasons for behavioural change included increased awareness, perceived support to adopt healthy behaviours, and children asking for the same healthy products at home. Barriers to change included no perceived necessity for change, lack of HPSF-related information provision, and time and financial constraints.

Conclusions: The present study is one of the first to provide insight into the processes, facilitators, and barriers of the transfer of behavioural changes following a school-based health-promoting intervention from school to the home context. School-based lifestyle interventions can lead to both healthy and unhealthy behavioural changes at home, and both child-to-adult intergenerational learning and parent-initiated changes play an important role in the transfer of health behaviours from school to home. Further stimulating these mechanisms can therefore lead to an increased impact of school-based health-promoting interventions' impact in the home setting.

Purpose: Using screens during mealtimes, such as TV, handheld electronic devices or smartphones, can detrimentally influence diet and the development of healthy eating behaviours. However, around a third of young children engage in mealtime screen use every day. Given the complex nature of this behaviour in families with young children, the aim of this study was to explore the feasibility of reducing mealtime screen use using specific strategies co-designed with parents.

Method: Strategies aimed to reduce mealtime screen use were co-designed between the parent and researcher using individual motivational counselling sessions conducted via zoom, followed by a 3-4 week trial period and a follow up interview. Recruitment was conducted via social media. Interviews were recorded, transcribed and analysed thematically using a constructivist paradigm and the COM-B framework.  

Findings: Participants were 14 mothers with at least one child between six months and six years, from socioeconomically disadvantaged backgrounds. Strategies to reduce mealtime screen use such as goal setting, parental modelling, adjustments to meal location and reconsidering mealtime expectations were reported to be feasible. Mothers mostly described making changes less difficult than they had expected and some reported improvements in family mealtime atmosphere as a result of reducing their mealtime screen use. Feasibility was stronger when mothers felt confident, supported and prepared to make change. Reminders which were accessible and tailored to the commonly reported challenges of mealtimes were considered a useful strategy for prompting and supporting new behaviours. Mothers were open to receiving similar advice around limiting mealtime screen use from a reputable source and were motivated to continue new behaviours following the trial. 

Conclusions:  Strategies to reduce mealtime screen use in families with young children appear to be feasible if they focus on challenging motivations for mealtime screen use and increasing mothers’ parenting confidence. Utilising existing reputable health platforms to provide mothers with specific advice may be an opportunity to support parents in reducing existing mealtime screen use, and to promote limited mealtime screen use in families from the inception of feeding. 

Purpose: Physical activity (PA) has many health benefits. However, more than 75% of adolescents in the US, particularly Hispanics, did not meet current recommendations for daily moderate-vigorous PA (MVPA) compared to non-Hispanic Whites. It is likely that even fewer adolescents are meeting MVPA recommendations due to COVID-19 restrictions. Interventions are needed to increase MVPA in Hispanic adolescents. The purpose of this study is to identify barriers and facilitators to MVPA and sedentary time (ST) in this high-risk population to better inform future PA interventions. 

Methods: A total of 409 Hispanic middle schoolers (55% female, Mage = 11.9 years) were recruited from a public charter school in Houston, Texas. Participants completed a validated Barriers to Youth Physical Activity Scale (3 subscales: Competing interests, Environmental, Social) and Facilitators to Youth Physical Activity Scale (3 subscales: Enjoyment, Family support, Socialization) for low-income, Hispanic youth (Arlinghaus et al. 2019). Average daily MVPA was assessed by 7-day actigraph wGT3x (Pensacola, Florida). ST was estimated via the self-reported Modifiable Activity Questionnaire item, “During a normal week, how many hours a day do you watch television and videos or play computer or video games before or after school?” Participants’ height and weight were measured by trained researcher. Body Mass Index (BMI) was calculated using Quetelet’s index. BMI percentile was derived from CDC growth curves. Hierarchical linear regression analyses were conducted to evaluate the influence of PA barriers and facilitators on MVPA and ST in Hispanic adolescents, controlling for gender, age, and BMI percentile.

Results: Overall, 10.1% of the variance in MVPA was explained by the model (p = .001), family support was the only unique significant predictor of MVPA in Hispanic adolescents (β=.183; p=.027). The model explained 19.9% of the variance in ST (p<.001), but competing interests to PA, such as rather watch television or play computer games, was the only unique predictor of ST in Hispanic adolescents (β=.424; p<.001). 

Conclusions: These findings suggest that increasing family support may improve MVPA in Hispanic adolescents. Conversely, focusing on removing barriers to PA, like screen media devices, might be a more salient strategy for decreasing ST in this population.

Purpose: Fathers’ role in child appetite and weight development is not well understood and this omission from research is particularly apparent in the context of the COVID-19 pandemic, during which families spent more time at home and thus more time together for meals. Here we examined fathers’ engagement in child feeding during the pandemic.

Methods: We surveyed a large number of fathers of 2-12-year-old children in May 2020 (N=112) and a sub-sample also completed a follow-up survey investigating reported changes in food parenting practices, mealtime interactions and share of feeding responsibilities in August 2021 (n=56). Paired t-test were calculated to examine differences in food parenting practices between 2020 and 2021. 

Results/findings: In May 2020, around 25% of fathers reported utilizing obesity-promoting feeding practices (e.g., using food to manage emotions or behavior) ‘sometimes or more’ while ≥80% reported implementing structure-related practices in terms of monitoring, timing, and setting. Fifteen months later, fathers used obesity-promoting practices less frequently than early in the pandemic while the frequency of using structure-related practices went up to ≥85%. However, these differences were not statistically significant. More than a year into the pandemic, 26% of fathers indicated that their share of feeding responsibilities had increased due to the pandemic (for 68% it stayed the same). Interactions with the child (e.g., serving, socializing, feeding, or eating with child), cooking/food preparation, cleaning up, and eating together as a family occurred more frequently now in 1/3 of the sample compared to before the pandemic while shopping, food budgeting, meal planning, and eating meals in front of the TV or using other devices remained the same for the majority of fathers. Fathers in a relationship expressed high levels of agreement (>81%) with their partner around child feeding.

Conclusion: The share of feeding responsibilities during the pandemic has slightly shifted, with increased engagement of fathers. Investigating paternal influences on child eating and weight is therefore warranted more than ever. While we did not see a significant change in paternal feeding practices during the ongoing pandemic, longitudinal relationships with child outcomes need to be examined next to determine lasting impacts of paternal engagement.  

Background: Elementary-age children increase obesogenic behaviors and experience accelerated weight gain during summer vacation (i.e., shifted/disrupted sleep, increased screen time, poor diet intake). It is hypothesized parents relax health-promoting rules/routines around obesogenic behaviors during the summer. Attending summer day camp (SDC) may prevent decreased rules/routines in the home by providing external structure. In a secondary analysis of a randomized controlled trial, we evaluated 1) whether health-promoting rules/routines changed from the school year to summer and 2) the impact of access to free SDC on changes in these rules/routines.

Methods: Elementary-age children (n=309; 5-12 years, 51% female, 50% Black) from low-income households were randomly assigned to receive free access to a community-based SDC for eight weeks or a control condition. Parents (n=237) reported on household rules/routines during the school year (April/May) and summer (July/August) 2021. We focused on rules/routines about sleep (e.g., bed/wake times, 10-items), screen time (e.g., set limits on access to devices, 6-items), and meals (e.g., eats with family, 3-items). We utilized linear mixed effects models with measurements nested within children and children nested within families to evaluate differential changes between groups (time-x-treatment interaction) in rules/routines from the school year to summer (time). Statistically significant standardized effects (β) were evaluated as P<.001 to account for multiple comparisons.

Results: Compared to the school year, rules/routines decreased during the summer for sleep (βrange = -0.47 to -0.16, 7/10-items), screen time (βrange = -0.21 to -0.19, 2/6-items), and meals (β= -0.19, 1/3-items). Those who received access to free SDC maintained rules/routines during the summer for sleep (βrange =0.15 to 0.23, 4/10-items) and meals (β= 0.17, 1/3-items), but not screen time, compared to those in the control condition.

Conclusions: Parents relaxed health-promoting rules/routines during the summer compared to the school year; however, SDC protected against changes in rules/routines for sleep and meals. This study is among the first to show SDC facilitates a healthier home environment as demonstrated by maintenance of parent rules/routines, suggesting the benefits of SDC extend beyond what children experience at SDC into the home.