Shirlene Wang PM 500 Exam 2A: Literature Review
Review of the Influence of Parent’s Physical Activity on Child’s Physical Activity
The family is the child’s most proximal environment and is expected to have the greatest influence on behavior in early life. There are many forms of support that can be provided by parents to their children in the context of physical activity (PA). The two main forms previously studied are instrumental support (providing opportunities for physical activity, for example, taking the child to a playground or buying activity-promoting equipment) and emotional support (parent is responsive to the child’s needs). However, in this literature review, I wanted to explore a less researched and potentially more direct form of influence- parents modeling physical activity behaviors.
Zecevic CA, Tremblay L, Lovsin T, Michel L: Parental influence on young children’s physical activity. Int J Pediatr 2010:1-9.
In this paper, the researchers examined the variables that best predict the PA behaviors of their children. The authors rely on social learning theory which explains that individuals learn their habits and attitudes toward PA very early in development by observing and imitating their parents and receiving parental influence that increases the level of physical activity through role modeling. The article aimed to combine parental influence factors including a previously neglected factor, parent’s perceptions of their child’s PA, and characteristics of the child’s family.
The study was part of a larger project that examined the factors linked to preschool children’s overweight and obesity levels. The one-time questionnaire was administered to the parents which sought characteristics of the child (age and gender), characteristics of the parent (gender, marital status, household income, level of education), average amount their child watches TV or videos each day and average amount of daily physical activity, perception of the intensity of the child’s PA at different times throughout the day, parental PA behavior and attitudes items drawn from previous scales, parental support for PA, and frequency of the parents’ physical activity habits, and importance of child’s PA ability. The questionnaire was designed specifically for the study with some material being adapted or taken from previous research.
The centers from which the families were sampled were selected to represent a diverse range of socioeconomic, ethnic, linguistic (French and English) backgrounds found in the Ontario region. One hundred and two parents-child dyads were enrolled which included 54 boys and 48 girls between 3-5 years of age and their parents. Almost all of the parents (98) responding to the questions were women. A majority (72.5%) of the parents were married. Logistic and multiple regression analyses were performed using child characteristics, parent characteristics and parents’ physical activity to predict reported child daily activity and the parents’ perceived intensity of the child’s PA.
The results showed that 75% of the children were reported to participate in 1-2 hours of PA per day. The authors suggest this is due to existing Canadian child care center policies that require at least two hours each day of outdoor play to children. Unfortunately, due to this policy, parents may assume that their preschoolers engage in sufficient activity. Among the four parental PA variables, only parental enjoyment of PA significantly predicted child daily PA while parent’s support and parents PA habits approached statistical significance. Children who had parents who rated PA as highly enjoyable (B=.69, p<.05) were significantly more likely to engage in one hour or more of daily activity. The importance parents place on child’s PA abilities did not predict the outcome variable of child daily PA.
A limitation of the study is that the cross-sectional design does not allow causal inferences between the PA outcome and predictor variables. Additionally, all child PA reports were from self-report rather than an objective measure such as from an accelerometer potentially due to device cost. Since researchers collected data about watching an hour of TV/videos per day, it would have been interesting to see how the different parental factors influenced sedentary behavior as a contrast. Additionally, it is unclear if the study was as adequately powered with 102 dyads completing a one-time survey compared to the other studies in this review. It is also unclear the sources of the questionnaire items and if they have acceptable reliability within both the parent and child age groups.
Madsen KA, McCulloch CE, Crawford P. Parent modeling: perceptions of parents’ physical activity predict girls' activity throughout adolescence. J Pediatr. 2009;154:278–83.
African-American girls have lower levels of activity and steeper rates of decline in physical activity compared to Caucasian girls. Additionally, while other studies have indicated that parent physical activity behaviors positively influence the child’s PA, no association has been found in studies with African-American girls. The researchers aimed in this study to determine the impact of modeling physical activity, if it differs by race, and if this association declines over time.
The study involved a multi-center prospective study with a longitudinal study design of 1213 African American girls and 1166 Caucasian girls from age 9-10 to 18-19. Girl’s physical activity outside of school was assessed using the Habitual Activity Questionnaire (HAQ) which provides metabolic equivalents for all leisure-time physical activity. The HAQ was administered as a structured interview during year 1, 3, 5 and then self-administered years 7-10. Along with parental modeling, other predictors from previous research were selected and organized using the ecological approach suggested by Social Cognitive Theory and asked in questionnaires. Using univariate linear regression, parent’s modeling was found to predict future leisure-time PA with a two-year time lag. Additionally, to determine if associations changed over time, a linear trend statistic was calculated across time for the standard beta coefficients of each time-lagged predictor. The researchers found that perception of parent modeling significantly predicted future log transformed metabolic equivalents of leisure-time PA in each study year and this association remained stable over time and did not differ by race (s .27-.64, p< 0.001). Interestingly, researchers used girls’ perception of parental activity rather than parent’s self-report of activity since it better predicted the outcome variable. This may be because it eliminates parents’ workday physical activity which is less likely to influence the child’s activity level and less likely to represent parental values for physical activity.
Even though data were self-report, the use of time-lagged predictor variables minimized bias from girls’ current activity, potential confounding, and the effects of temporal trends.
It is unclear why the study did not begin to measure the influence of friends until year 7 of the study. Even though the data was collected, the authors did not report any results related to this potentially important contributor to the girls’ activity. Additionally, their model did not include logistic support, parental encouragement, or self-efficacy which have been shown to be related to activity in other studies and mediate the impact of parents’ activity on child physical activity. It is surprising that the researchers used a two-year time lag and the prompting schedule wasn’t explained. For example, girls’ perception of parent activities was only assessed years 1,3,5,7,8 instead of every year. Because of the longitudinal design, it is surprising the researchers did not provide information about compliance or missing data in the paper. Additionally, the study relies on self-report data but did not discount the possibility of social desirability, reactivity, or recall bias.
Barkin SL, Lamichhane AP, Banda JA, JaKa MM, Buchowski MS, Evenson KR, Bangdiwala SI, Pratt C, French SA, Stevens J. Parent’s physical activity associated with preschooler activity in underserved populations. Am J Prev Med. 2017;52(4):424–432.
In the U.S., children from low-income families are more likely to be obese and Latino and African American youth are at lower odds of meeting daily PA recommendations. The impact of parent modeling of physical activity (PA) and sedentary behaviors in low-income American ethnic minorities is unclear, and previous studies examining objective measures of preschooler and parent PA are sparse. Thus this study aimed to expand past studies that had small sizes and did not represent underserved populations. The purpose of the research was to examine the associations between accelerometer-measured parental and preschool child PA, among low-income black, white, and Latino families in the U.S. The authors hypothesized that amount of parental time in PA of varying intensities and sedentary behavior would be associated with their preschooler's PA and sedentary behavior.
This cross-sectional study examined data from 1,003 parent-child pairs in ongoing pediatric obesity prevention RCTs in which the child was preschool aged (2-5) and who were of low income. Parents and children wore GT3X/GT3X+ accelerometers for an average of >12 hours/day (7:00am-9:00pm) for 1 week. To explore total volume of PA, average counts per minutes were assessed. Multiple linear regression analyses were conducted using parents' PA (minutes/day) spent in sedentary behavior, light, or MVPA as the main predictor variable and child's PA (minutes/day) spent at that same PA intensity level as the outcome variable, with parent and child accelerometer wear time as covariates.
About 75% of children were Latino and >10% were African American. Mean child age was 3.9 years and more than a third were overweight/obese. Children's total PA was 6.03 hours/day, with 1.5 hours spent in moderate to vigorous PA (MVPA). Covariate-adjusted models showed a monotonic, positive association between parent and child minutes of sedentary behavior (β=0.10, 95% CI=0.06, 0.15) and light PA (β=0.06; 95% CI=0.03, 0.09). Child and parent MVPA were positively associated up to 40 minutes/day of parent MVPA, but an inverse association was observed when parental MVPA was beyond 40 minutes/day (p=0.002).
The study reported higher average minutes of MVPA/day likely due to the long accelerometer wear times. Surprisingly, on average, the children in the study achieved the recommended levels of MVPA despite their parents’ low mean levels of MVPA. The authors explain the curvilinear relationship as parents spending more than 40 minutes/day in MVPA are likely engaging in activities that couldn’t be sustained by young children or are exercising without their young children.
One major limitation of the study is that the researchers only examined objective accelerometer data and did not collect additional information about what type of activity was done or where the activity occurred. Especially since these children are younger, it is possible the window of wake time the researchers defined included naptime which would overestimate the child’s sedentary time. Due to the focused population of the study, the study’s results cannot be generalized to US preschool children and adults. It is unfortunate that although parents’ role modelling could be influenced by social and cultural domain features, these factors were not explicitly discussed in this article studying mostly Latino families.
Moore LL, Lombardi DA, White MJ, Campbell JL, Oliveria SA, Ellison RC. Influence of parents’ physical activity levels on activity levels of young children. J Pediatr. 1991;118:215–9.
All studies to date of the publication of this article had been based on self-reporting or parental reports of PA. This article argues that PA questionnaires typically administered focus on structured physical activity like sports and do not reflect the level of activity of young children. Additionally, these previous studies tend to display similar reporting tendencies within families.
The study aimed to assess the influence of parent’s levels of physical activity on their 4-7-year-old children using the Caltrac accelerometer in 100 children and their parents. The dyads were instructed to wear the monitor over the right hip for two periods of 5 consecutive days six months apart. Wear time was reported as at least 10 hours per day for 8.6 +/- 1.8 days for the children, 8.3 +/- 2.1 days for mothers, and for 7.7 +/- 2.3 days for fathers.
The research question was analyzed using contingency table analysis. The children and their parents were categorized as active or inactive based on if their counts per hour were above or below the median for their generation and sex-specific distribution. The sample size did not allow for a stable estimate of effect using quartiles so outcomes were presented in a dichotomous fashion. A standard odds ratio was calculated to estimate the likelihood that children of active parents would be active themselves and stratification assessed any confounding by child’s gender, child’s relative weight, or the parent’s age. The results support the hypothesis that parents who are more physically active are more likely to have children who are physically active. Children of active mothers were two times as likely to be active as inactive mothers and 3.5 for active fathers. When both parents were active the children were 5.8 times as likely to be active compared to children of two inactive parents.
The authors propose four possible mechanisms to explain the association. First, parents (and siblings) serve as role roles. If parents value physical activity and are more active themselves, it is likely the child will value activity as well. Second, there may be a tendency toward sharing activities. As the children were young, much of their activity may have been carried out with the family. However, as the parents probably worked and the children went to school, the shared environment would be limited. Third, parents can support the participation of their child in PA by buying equipment or providing transportation to facilities or events. Finally, there could be genetically transmitted factors that predispose the child to increased levels of PA.
The participants were not randomly selected but instead were sampled from an existing cohort representing typically middle-class American families. While it is clear that the research is based on a social-ecologic framework and the authors propose different mechanisms, the researchers did not include any explicit discussion of existing theory. Additionally, no measures or instruments of parental influence were measured so the statistical analysis cannot take into account any confounding. It would have been interesting to analyze the influence of mothers’ activity and fathers’ activity on child’s activity individually.
Trost SG, Sallis JF, Pate RR, Freedson PS, Taylor WC, Dowda M. Evaluating a model of parental influence on youth physical activity. Am J Prev Med. 2003;25:277–82.
Although there is a large amount of literature on the correlates of youth physical activity, most of the variance is unexplained. The authors state that while previous studies have focused on the direct modeling hypothesis and show a positive correlation between the physical activity of parents and children, when considering other forms of influence, the importance of role modeling is diminished and other constructs like parental beliefs or encouragement emerge as better predictors. The objective of the study was to test a conceptual model to link parental physical activity orientations (amount of PA, enjoyment of PA, perceived importance of PA), parental instrumental support, children’s self-efficacy perceptions with physical activity participation. Researchers hypothesized that the relationship between parental physical activity orientation and child’s PA behaviors would be mediated by level of parental support and the child’s resultant self-efficacy perceptions.
The researchers collected data from 380 students in 7th-12th grade and their parents as part of the Amherst Health and Activity study, a cross-sectional observational study examining age and gender difference in PA and the correlated of PA. Parents completed a questionnaire assessing physical activity habits, enjoyment of physical activity, beliefs regarding the importance of the child participating in physical activity, and supportive behaviors for their child's physical activity. Students completed a 46-item inventory assessing physical activity during the previous 7 days and a 5-item physical activity self-efficacy scale. The model was tested via observed variable path analysis using structural equation modeling techniques. Overall, the level of parent support was low.
Standardized path coefficients for the model ranged from 0.17 to 0.24, and all were significant at the p<0.0001 level. Age, gender, parental physical activity, parental enjoyment of physical activity, and importance of physical activity accounted for 22% of the variance in parental support, with parental support in turn accounting for 4% of the variance in children's physical activity self-efficacy. Collectively, age, gender, parental support, and child self-efficacy accounted for 17% of the variance in child physical activity. Interestingly compared to other studies, parental physical activity did not directly influence child physical activity. The authors explain this is due to the fact that parental PA itself does not remove barriers for child’s PA. Perceived importance of physical activity had the strongest association with parental support for physical activity. This is consistent with the major attitude-behavior theories such as thr theory of planned behavior or social cognitive theory. Parents are more likely to provide the support necessary for participation in physical activity if they valued the outcomes associated with regular physical activity.
The study design is cross-sectional which prevents the ability to infer causal relationships between the hypothesized parent and child level determinants and physical activity behaviors. The direct of the regression paths are all theoretical and not temporal. As these children were older, the influence of their parents on their behaviors is probably diminished compared to younger children. The researchers missed an opportunity to ask and analyze the levels of support the children actually received or felt they received from their parents in terms of social support or the influence of peers and siblings. Even though the study models the importance of the influence of the social environment in PA and focuses on the influence of parents, researchers should recognize that the role of peers and peer support could confound and could contribute stronger and significantly to the prediction of a child’s PA behavior.
Integration
These articles all used some form of social-ecological framework to try to summarize the correlates of parental and child PA. While most of the articles focused on the domains of behavioral attributes, demographic, or biological factors, other interesting domains of the framework such as social and cultural factors, psychological factors (parenting style or modern learning theory) or the impact of the physical environment (i.e. spatial factors such as location of parks) were not explicitly discussed in any of the articles. Only one study considered the implications of policy (required PA in school) on the child’s activity level. Physical activity research would benefit from the development of clear PA guidelines for different age ranges/developmental stages. Most of these articles showed that boys report significantly more PA than girls but these studies did not examine if parents reported different levels of support and the perceived importance of PA for boys compared to girls. Physical activity is important to the health and development of children and parental behaviors are an obvious factor that influences engagement in behaviors. These findings demonstrate that parental modeling is just as important as parental support in influencing child PA. As with all types of learning, parental role modeling cannot entirely explain the physical activity habits that children develop. The impact of personal, familial, and environmental factors compounds to influence physical activity and sedentary behaviors but in the development of future interventions, it is critical to try to integrate parents’ behavior as a source of behavior change for their children.