Purpose: The co-occurrence of energy balance-related behaviors (EBRBs) into the so-called lifestyle patterns could play a synergistic effect on the development of adiposity. However, few studies have considered sleep as part of these lifestyle patterns, nor have examined their contextual correlates. This study aimed to identify patterns of diet, screen viewing, outdoor play, walking, and sleep, in preschool girls and boys separately, and to explore their family socio-ecological correlates.

Methods: We used cross-sectional data collected by parental questionnaires of 978 5-year-old children participating in the EDEN cohort. We assessed contextual factors and organized them in three different socio-ecological levels: family (e.g socio-demographics), parents (e.g  health and EBRBs), parent-child interactions (e.g routines around EBRBs). We also assessed children’s dietary intake, screen, outdoor play, walking, and sleep times and applied a principal component analysis to identify sex-specific lifestyle patterns. In light of our three-block socio-ecological model, hierarchical linear regressions were undertaken to explore the cross-sectional relations between contextual factors and the patterns identified.

Results: Three types of lifestyle patterns were observed, with slight nuances between sexes: unhealthy, healthy and mixed. The unhealthy and mixed patterns were characterized, among other behaviours, by low or high sleep time. Focusing on the healthy pattern, labelled “High fish, dairy products, fruit and vegetables, low screen”, children whose mothers adhered to a healthy diet and whose parents scored higher on the home stimulation score had higher scores on this pattern. Among boys, higher scores were observed for those born to non-working mothers compared to full-time working mothers (β[95% CI]=0.30 [0.00;0.60]). Adherence to this pattern was also lower in boys with a later bedtime (-0.36 [-0.54;-0.17]). Among girls, adherence was lower when the mother presented more depression symptoms.

Conclusions: Our findings confirm that EBRBs, including sleep, combine in different lifestyle patterns in early childhood. They further suggest that time constraints experienced by working mothers; the provision of social support to mothers experiencing mental health issues; and the engagement with parents to promote healthy lifestyles for themselves and their children, are worth considering in the development of multi-behavioural obesity prevention interventions programs.

Purpose: Dietary habits are formed in early childhood and can persist into adulthood. The home environment plays an important role in shaping the diet of children. The aim of this study was to, by using the socioecological model modified for DAGIS-research project, explore associations between social and physical home environment factors and Finnish preschool children’s consumption of vegetables, fruits, berries (FV), and sugary foods and beverages (SFB).   

Methods: A cross-sectional study was conducted between 2015–2016. Guardians (N=819) of children aged 3–6 completed a food frequency questionnaire measuring the frequency of FV and SFB consumed by the child during the past week, and a questionnaire measuring the social and physical environment at home (N=809). Adjusted analyses were conducted using multiple (backward-method) linear regressions.

Results: In the final adjusted model for FV, predictors positively associated with child’s consumption of FV were: parents modelling of eating FV (standardized regression coefficient (β) being 0.286, p<0.001); satisfaction with the amount of FV in child’s diet (β=0.150, p<0.001); perceived norms of adequate amount of FV in child’s diet (β=0.098, p=0.005); parent´s opinion that serving children enough FV is important (0.094, p=0.010); offering FV as a snack (β=0.131, p=0.001) and number of different types of FV at home (β=0.142, p<0.001). In the final adjusted model for SFB, predictors positively associated with child’s SFB consumption were: giving the child some other food if he/she does not like what is offered (β=0.074, p=0.021); norms of acceptable amount of SFB in child’s diet (β=0.374, p<0.001) and the availability of SFB at home (β=0.144, p=0.001). Satisfaction with the amount of SFB in child’s diet was negatively associated with child’s consumption of SFB (β= -0.146, p<0.001). The models explained 40% and 29% of the total variance in children’s FV and SFB consumption respectively.

Conclusions: Parents’ norms and attitudes, and availability of foods at home are important in shaping the diet of preschool aged children. However, besides availability it is important that parents model FV eating for children and offer children FV to increase the frequency of FV consumption.

Objectives: Sleep is important for healthy child development; however, sleep disturbances are common across childhood. This study aims to identify the parental, child and environmental correlates of sleep disturbances in early childhood; and examine the moderating effects of sociodemographic factors.

Methods: Longitudinal data of 700 children aged 0-8 years, gathered in the CIKEO cohort-study in the Netherlands were analyzed. Sleep disturbances were defined as the presence of night awakenings≥3 times per night or sleep‐onset latency of > 30 minutes. Multivariable logistic regression was used to identify correlates of sleep disturbances in children.

Results: The mean age of the children was 3.2± 1.9 years at baseline and 4.4 ± 1.8 years at follow-up; 47.3% were girls. The presence of sleep disturbances was 13.3% and 15.4% at the baseline and follow-up, respectively. The incidence and persistence rates of sleep disturbances at follow up were 12.0 % and 37.6 %, respectively. Being a girl (OR [95%CI] = 1.77[1.06,2.97]), being the first parity (OR [95%CI] =1.84 [1.05,3.23]), having a younger age (OR [95%CI] = 0.85[0.72,1.00]), and previously being diagnosed with any diseases (OR [95%CI] =3.18 [1.18,8.55]) was associated with the incidence of sleep disturbances in children. Higher parenting self-efficacy was a protective factor for sleep disturbances in children (OR [95%CI] =0.94 [0.88,1.00]). Children that experienced one (OR [95%CI] =2.66[1.26, 5.65]) or more (OR [95%CI] =2.50[1.10,5.68]) stressful life events had a higher risk of sleep disturbances at follow up.

Conclusions: In this sample, several parental (i.e., parity, parenting self-efficacy), child (i.e., age, gender, previous diagnosis of any diseases) and environmental (i.e., stressful life events) correlates of sleep disturbances in children were identified. Further research is warranted to verify our findings and to unravel possible pathways and interactions underlying these associations. Parents, preventive interventions and policies should adequately address the specific and ongoing needs of these particular subgroups of children and realize sufficient reach among these children using insights on prevention of sleep disturbances.

Keywords: Child, Sleep disturbances, Night awakenings, Sleep latency, Correlates

Purpose: Regular visits and interacting with nature have been shown to provide numerous health benefits for adults and children. Children’s possibility to engage with and being physically active in nature depends to some degree on whether parents spend time with them out in nature. Parental mental health has been linked with children’s physical activity levels. No prior studies have examined whether parental mental well-being is related to children’s nature visit frequency. Nature visits have also been associated with the degree of barriers that parents perceive. The aim was to examine the association between parental mental well-being and adult-child nature visit frequency, and whether this association is mediated by parental perceived barriers.

Methods: An online cross-sectional survey was conducted in Finland in spring 2019. Parents (N = 1463) of children aged 2-7 answered the questionnaire. Parental mental well-being was measured by the Short Warwick Edinburgh Mental Well-Being Scale (SWEMWBS), and 12 perceived barriers for visiting nature with their child were explored. Adult-child nature visit frequency during the previous month was asked on a scale from not once to 5 times/week or more. Process Macro version 3.5 for SPSS was used to test the hypothetical mediation model with bias-corrected bootstrapped 95% CI.

Results: In the multiple mediation model, a direct positive association was found between parental mental well-being and adult-child nature visit frequency, unstandardized regression coefficient (B) being 0.02 (95% CI: 0.00, 0.04), N=1377. There was also an indirect effect of parental mental well-being on nature visit frequency through "Lack of competence and logistics" (B=0.02, 95% CI: 0.01, 0.02) and "Lack of time and interest" (B=0.02, 95% CI: 0.02, 0.03), but not through “Insecurity and fear” (B=-0.00, 95% CI: -0,00, 0,00). The model explained 19% of the variance in adult-child nature visit frequency (total effect B=0.06, 95% CI: 0.04, 0.08).

Conclusions: This study was the first to study whether parental mental well-being is related to adult-child nature visit frequency. Better parental mental well-being was associated with more frequent adult-child nature visits, and this relationship was partially mediated by perceived barriers. Further studies are needed to confirm the explored findings.

Purpose: Young children’s engagement in outdoor play is an important contributor to their physical activity (PA) levels. However, parent’s perceptions of risk in outdoor play may limit children’s opportunities to engage in this health enhancing type of PA. We know little of the importance of parental perceptions of risk from a Scottish context, yet a greater understanding may offer insight for targeted intervention to ensure young children are exposed to developmentally beneficial play opportunities. This paper explores this relationship in a sample of Scottish parents of children aged 2-5 years old.

Methods: Parents (n=205, 87% female) of children aged 2-5 years old (mean=3.7 ±1.03) were recruited through social media and national parent and early years networks to complete an online survey exploring perceptions of risk in 10 different outdoor play situations (including height, water, speed, and sharp objects). Each pictorial scenario had parents responding with their level of agreement of the risk associated with the activity. Aggregated scores across scenarios represented parent’s overall perception of risk (0 = least risky – 10 = most risky). Outcome variable was a four-level ordered response (‘Once a week or less’ ‘2-3 times a week’, ‘Once a day’ and ‘more than once a day’) representing the frequency parents took their children outdoors to play. Analysis was ordered logistic regression, adjusting for child age, parent education, scenario benefits, child’s physical ability, and parent’s childhood risk experience.     

Results: Mean number of risky scenarios was 3.3 (±2.16, range 0-10). Overall benefits (r=-0.45), child’s physical ability (r=-0.39), and parent’s childhood risk experience (r=-0.17) were all negatively associated (p<0.01) with perception of risk. All parents would permit their child to engage in each scenario, the majority conditional (e.g., 82% of scenarios stipulated adult supervision). No significant relationship was found between risk and the frequency of outdoor play (proportional OR=1.00; 95%CI=0.88,1.15).

Conclusions: Parental perceptions of risk may not influence the likelihood of young children engaging in outdoor play; potentially reflecting the adult supervision over these activities. It remains important to educate parents about the benefits of outdoor play to reduce the perceived risk associated with these activities. 

Purpose: Systematic reviews have demonstrated that physical activity interventions in childcare settings are effective. However, as many studies do not collect follow-up information, the sustainability of physical activity changes remains unclear. This study aims to explore changes in children’s and staff’s moderate-to-vigorous physical activity (MVPA) after a 12-month quality development process and at one-year follow-up.

Methods: Eight childcare centers in a rural region in Bavaria, Germany, enrolled in the study. Staff from all childcare centers took part in five workshops (kickoff, goal setting, participation of children and parents, reflection and exchange, presentation of results) that were accompanied by tasks for the team of each childcare center (use a self-evaluation-app to assess PA environments and practices, set three center-specific goals targeting PA based on the results of the app, implement center-specific actions, use Goal Attainment Scaling to track the success at implementation).

Changes in PA environments, policies and practices were documented by the childcare staff. Changes in children’s and staff’s MVPA were evaluated in a quasi-experimental study with a one group pretest-post-test design. MVPA (minutes per day) was measured at baseline, post-intervention and one-year follow-up using ActiGraph GT3x+ accelerometers.

Results: The implemented and documented actions mainly targeted activities offered, e.g., daily structured staff-led activities (n = 9), and parental work, e.g., workshops with parents (n = 8). 55 children (41.8 % male) and 22 childcare workers completed the one-year follow-up. Children’s mean MVPA increased from 34.55 min/day (SD = 22.30) at baseline to 41.12 min/day (SD = 25.57) post-intervention and 54,94 min/day (SD = 31.85) at one-year follow-up. A repeated-measures analysis of variance showed statistically significant effects of time on children’s MVPA (F [2, 108] = 26.550; p < 0.001; η² = 0.330). Staff’s MVPA levels showed a small but not significant increase over time (baseline: 51.35 min/day, post-intervention: 57.62 min/day, one-year follow-up: 64.08 min/day).

Conclusions: These findings suggest that the quality development process may be a sustainable way to promote children’s and childcare staff’s physical activity.