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Purpose: The purposes of the current study were to identify risk profiles for nonadherence among children and youth (5–17 y) at the 6-month mark of the COVID-19 pandemic and to discuss similarities and differences between risk profiles identified in the current study and those identified at the 1-month mark of the pandemic. Methods: Data were part of a nationally representative sample of 1143 parents (Mage = 43.07 y, SD = 8.16) of children and youth (5–17 y) living in Canada. Survey data were collected in October 2020. Results: Results showed that 3.8% met all movement behavior recommendations, 16.2% met the physical activity recommendation, 27% met the screen time recommendation, and 63.8% met the sleep recommendation. Characteristics associated with nonadherence to all movement behaviors included low parental perceived capability to restrict screen time and decreased overall time spent outdoors. Characteristics associated with nonadherence to the physical activity and screen time recommendations included youth (12–17 y), low parental perceived capability to restrict screen time, decreased time spent outdoors, and increased screen time. Conclusion: Results emphasized the importance of parental perceived capability to restrict screen time and children's and youth's outdoor time and showed that pandemic-related factors have impacted children and youth differently. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to examine whether an aggregate of health risk behaviours is associated with the number of untreated dental caries among 12‐ and 15‐year‐old children in England, Wales and Northern Ireland. Materials and Methods: Data were from the Children's Dental Health Survey (CDHS) 2013, a nationally representative sample of England, Wales and Northern Ireland. The survey included assessment of oral health and data on socioeconomic, demographic and behavioural factors pertaining to children aged 12–15 years. Tooth condition (decayed, missing and filled) was assessed by NHS dentists. The survey included questions on age, sex, country, index of multiple deprivation, smoking, alcohol consumption, frequent sugar consumption and sweetened sodas, infrequent dental visit, infrequent toothbrushing and infrequent consumption of fresh fruits. Health risk behaviours were summed up to create an aggregate variable of health risk behaviour. The association between number of untreated caries and the aggregate of health risk behaviours was assessed using negative binomial regression and adjusting for age, sex, country and deprivation. Results: The total number of children included in the analysis was 4414. The mean number of untreated caries was generally higher among children with health risk behaviours. The aggregate of risk behaviour was associated with greater prevalence of untreated dental caries with rate ratio (RR) 1.26 (95% confidence interval: 1.18, 1.36). Conclusion: This study demonstrated an association between an aggregate of health risk behaviours and untreated caries. The findings highlight the importance of addressing multiple risk factors not only those directly related to dental caries. [ABSTRACT FROM AUTHOR]

The primary objective of this study was to develop and validate a Social Cognitive Theory-based instrument to identify psychosocial factors that influence diet and physical activity among Chinese children aged 10–12 years. This is a cross-sectional study, with data collected from questionnaires. Two elementary schools in Beijing, China. Fourth to sixth-grade students (N = 1,486) aged 10–12 years were recruited. Gender, height, weight, nation, and grade were collected. Energy-balanced eating behaviors and their related sociopsychological factors were surveyed. Confirmatory factor analysis, Pearson correlations, Cronbach α index, and mediation analysis were used. (1) Confirmatory factor analysis revealed a 6-factor solution (51 items) and all factor loadings > 0.32, indicating that the model fitness was acceptable. (2) All correlation coefficients are statistically significant. All of the Cronbach α indexes were > 0.65, indicating acceptable reliability. (3) The mediating effect of goal intention and outcome expectations between self-efficacy and habit strength was statistically significant (P < 0.01), verifying the theory structure. This questionnaire exhibits good internal consistency, reliability, and structural validity. It can be effectively employed to investigate energy-balanced eating behaviors related to the Social Cognitive Theory in Chinese children. [ABSTRACT FROM AUTHOR]

Objective: To analyze the co‐existing patterns of health‐related behaviors among children and adolescents at different education stages and the association with obesity. Design: Cross‐sectional study. Sample: A total of 5651 primary and secondary school students were drawn from the National Student Physical Health Survey in 2014 with an average age of 13.53 ± 2.87 years. Measurements: Physical measurements and questionnaires were completed, which concluded height, weight, and health‐related behaviors (sleep, physical activity, dietary, and screen behavior et al.). Latent profile analysis (LPA) was conducted using Mplus 8.3 and SPSS 26.0 was used for other statistical analysis. Results: Three latent classes of health‐related behaviors were fitted for each of the education stages. After adjustment for age, gender, and region, the high‐screen behavior group were 2.217 (95%CI = 1.030–4.772, p =.042) times more likely to be obesity than the health‐behavior group in primary school, and the poor‐diet group and poor‐diet and high‐screen behavior group were 2.101 (95%CI = 1.396–3.396, p <.001) and 1.788 (95%CI = 1.003–3.190, p =.049) times more likely to be overweight than the health‐behavior group in junior middle school respectively. Conclusion: Obesity is mainly influenced by screen behavior and dietary patterns among children and adolescents. Health‐related behavior patterns should be accurately identified and comprehensive joint interventions should be carried out to prevent obesity. [ABSTRACT FROM AUTHOR]

This empirical research on children's poverty and the accompanying risk behavior was conducted in the Baktalórántháza micro-region, in one of the most disadvantaged micro-regions of Hungary. The study, completed in 2023, was conducted utilizing three methods, a questionnaire for families, interviews, and focus group interviews with social professionals working in the settlements. The region is one of the ten micro-regions with the highest poverty rate in the country. The majority of the population only has an elementary education, and the proportion of graduates is much lower than the national average. The proportion of households with three or more children is higher than the national average and the proportion of unemployed people in households with children is twice as high as the national average. Based on the experience of social workers working in the area, in addition to smoking and drinking alcohol, the consumption of psychoactive and psychotropic substances has increased among adolescents and young adults. Based on various indicators, children regularly consume illegal drugs. The origin and composition of these drugs are typically unknown. According to the reports by drug users, everyday life is easier, and they can escape from problems when under the influence of drugs. Based on the observations of experts, the consumption of various psychoactive substances has harmful effects on behavior, health, learning, and family life. School performance and the ability to think and learn decrease. Drug users are dissatisfied with their lives, have problems with social relationships, engage in partner violence, and may develop antisocial behavior in their lives. [ABSTRACT FROM AUTHOR]

Background: Cognitive development in pre-schoolers through healthy eating and socio-demographic support is crucial for their later lives. We investigated healthy eating encouragement, socio-demographic factors and their association with cognitive development in pre-schoolers. Methods: Quantitative data were collected using a multi-stage random sampling between February and April 2021. Pre-schoolers 36 and 71 months and their primary caregivers were recruited from three local government units of Rupandehi district. We compared healthy eating encouragement, socioeconomic and demographic factors with cognitive development using t-test, one-way analysis of variance and multiple linear regression analysis to identify the predictors of the cognitive development among pre-schoolers. Results: Cognitive development in pre-schoolers is significantly positively associated with age 36-48 months (β = 0.153; 95% CI: 0.12, 13.96), living in a nuclear family (β = 0.121; 95% CI: 0.59, 6.88) and following Buddhism (β = 0.148; 95% CI: 0.88, 14.32). Conversely, children from specific caste/ethnic backgrounds, such as Dalit (β = -0.126; 95% CI: -10.79, -0.68), Janajati (β = -0.237; 95% CI: -6.14, -2.09) and non-Dalit Tarai caste or ethnicity (β = -0.133; 95% CI: -3.46, -0.25) and mothers employed (β = -0.134; 95% CI: -10.62, -1.44) show significantly lower levels of cognitive development. Conclusions: The finding shows that socioeconomic factors have an influence on cognitive development and also stimulate the adoption of healthy eating encouragement practices. [ABSTRACT FROM AUTHOR]

Background: The first 2000 days of life are a crucial and opportunistic time to promote positive dietary and physical activity behaviours that can continue throughout life. The bulk of research on the impact of parents promoting positive dietary and physical activity behaviours has been on mothers, with the impact of fathers rarely investigated. The aim of this study is to investigate fathers' perceived role, self-efficacy and support needs in promoting positive dietary and physical activity behaviours in early childhood. Methods: A sequential explanatory mixed methods study design consisted of a cross sectional survey of Australian fathers (n = 200) from a convenience sample, followed by semi-structured qualitative interviews (n = 21) with a purposeful sample of Australian fathers. Results: Quantitative survey data revealed that more than 90.0% of fathers agreed that it is important to role model healthy eating and participating in physical activity with their babies, toddlers and children. A majority of fathers were confident in getting their child to eat fruit/ vegetables (90%) and playing with their child (80%). When searching for information about nutrition and physical activity, the highest proportion of fathers nominated online sources (52%) as their preferred source in survey data. Qualitative interview data revealed that while fathers exhibited high self-efficacy in their abilities, this was susceptible to deterioration due to feelings of isolation, pressures of fatherhood, a lack of information and resources that are father specific, and difficulties navigating the different types of information/resources to find what is right for them. Conclusions: Although possessing self-efficacy, being committed and seeking knowledge, many fathers found that useful information was hard to find and understand. Appropriate resources are therefore required to support the specific needs of fathers to promote positive dietary and physical activity behaviours in their infants and young children. [ABSTRACT FROM AUTHOR]

Twice daily parental supervised brushing (PSB) is recommended for the effective oral hygiene of children with toothpaste including fluoride. This cross-sectional study aimed to identify dentist mothers' attitudes, challenges, and facilitators in the oral health promotion of their young children. An online questionnaire was prepared and distributed to dentists via e-mail with a link to the form. Of all the mothers, 46.50% started brushing their children's teeth after the eruption of the first primary teeth. Nearly 50% of the mothers thought that they should brush their children's teeth until at least the age of 7–8 years old. In terms of the main barriers to toothbrushing, 52.9% said children could fall asleep at home or in the car, while 27.5% of all mothers reported being tired as the main barrier to toothbrushing. Although dentist mothers have sufficient knowledge to promote oral and dental health, they do not always have ideal attitudes and behaviors and they may encounter various barriers regarding themselves and their children in practical applications. Providing oral care for young children goes beyond 'knowledge' and is sometimes 'challenging'; however, it could be 'possible' by developing and implementing the most appropriate solution strategies suitable for each unique family and child. [ABSTRACT FROM AUTHOR]

Background: Understanding oral health behaviour s and their impact on Oral Health-Related Quality of Life (OHRQoL) may serve as an instrument to articulate the conventional oral health policy framework, thereby ameliorating the overall health of young individuals in the long term. Objective: The aim of this study was to investigate the relationship between children's oral health behaviour s and Oral Health-Related Quality of Life in the capital governorate, Kuwait. Methods: A cross-sectional study involving 607 children aged 12–14 years, randomly selected from schools in Kuwait Capital Region. A validated Oral Health Behaviour s and OHRQoL Child Perception Questionnaires (CPQ12-14) was used to collect the data. Chi-square, t-tests, and ANOVA were used to examine the association between oral behaviour s and children's OHRQoL. Results: About 52.2% of participants were males and the overall response rate was 93.8%. The mean ± SD for total OHRQoL impact was 3.1 ± 0.58, while the total mean for individual domains- for oral symptoms, functional limitations, emotional well-being and social well-being were 2.89 ± 0.63, 2.89 ± 0.72, 3.1 ± 0.91 and 3.4 ± 0.61, respectively. There was no significant difference in total OHRQoL impact score by frequency of last dental visit, flossing, use of mouth rinse or chewing gum (p > 0.05) but for the overall OHRQoL, frequency of soft drink intake was the only significant predictor associated with 0.2-unit decrease (B = -0.207, 95% CI, p = 0.002) in total OHRQoL scores. Conclusions: High frequency of soft drink consumption was related to poorer OHRQoL. Behaviour changing interventions based on OHRQoL inferences coupled with clinical intervention are needed. [ABSTRACT FROM AUTHOR]

Background: Children with visual impairment (VI) tend to maintain the insufficient physical activity (PA) engagement and excessive sedentary behavior (SB) that could elevate health risks of various domains. Anxiety have been shown to correlate with PA and SB in general population, whereas the longitudinal or temporal relationships between PA, SB, and anxiety have yet to be examined in children with VI. Therefore, the primary purpose of this study is to investigate the bidirectional relationships between these variables over time. Methods: 72 Chinese children with VI (mean age = 14.65 ± 3.34 years) recruited from a special school for individuals with VI participated in this study. Moderate-to-vigorous physical activity (MVPA) and SB were assessed using ActiGraph GT3x + accelerometers across seven consecutive days. Anxiety was assessed by a self-reported questionnaire. Cross-lagged panel models were employed to examine the potential bidirectional relationships between PA, SB, and anxiety at baseline (T1) and 12-week follow-up (T2). Results: T1 anxiety significantly predicted T2 MVPA only in children with low vision (β= -0.30, p = 0.01). In additional, children with blindness showed a cross-lagged effect of T1 MVPA on T2 anxiety (β=-0.29, p = 0.02). Lastly, anxiety significantly predicted T2 SB in the total sample (β = 0.21, p = 0.04) and children with low vision (β = 0.42, p < 0.01). Conclusion: The relationships between PA, SB and anxiety were not bidirectional in children with VI. It is suggested that higher anxiety predicted less PA and more SB in children with low vision. [ABSTRACT FROM AUTHOR]

Aim: The programme "Join the Healthy Boat" promotes amongst other things a healthy diet in primary school children. In order to evaluate the programme's effectiveness, this study longitudinally investigated children's nutrition behaviour. Subject and methods: A total of 1564 children (7.1 ± 0.6 years) participated in a cluster-randomised study. Teachers delivered lessons including behavioural contracting and budgeting. Nutritional behaviours of parents and child were assessed via parental report. Anthropometrics were measured on site. Results: After one year, children in the intervention group (IG) showed a significant reduction in the consumption of pure juices (p ≤ 0.001). Soft drink consumption reduced in both groups, although with a trend towards a slightly greater reduction in the IG. Children with fathers of normal weight as well as first graders showed a significant reduction of soft drink consumption in the IG (p = 0.025 and p = 0.022 respectively). Fruit and vegetable intake increased significantly for first graders (p = 0.050), children from families with a high parental education level (p = 0.023), and for children with an overweight father (p = 0.034). Significant group differences were found for fruit and vegetable intake of children with migration background (p = 0.01) and children of parents with a high school degree could be observed (p = 0.019). Conclusion: This shows that the programme appeals to a wider range of children, and is therefore more likely to compensate for differences due to origin or other social inequalities, which also shows that active parental involvement is vital for successful interventions. [ABSTRACT FROM AUTHOR]

Background: Physical inactivity, excessive sedentary time, and lack of sleep time have been independently associated with lower health‐related physical fitness. However, little is known about the combined association between 24‐h movement guidelines (i.e., physical activity, recreational screen time, and sleep duration) and components of physical fitness. Objective: The main aim was to examine the likelihood of having high/very high levels on different components of physical fitness based on meeting with 24‐h movement guidelines. Methods: In this cross‐sectional study, 1276 Spanish youths (13.07 ± 0.86; 55.88% boys), aged 11–16 years, completed self‐reported questionnaires on physical activity, recreational screen time, and sleep duration. Physical fitness components were assessed by 20‐m shuttle‐run test, standing long jump test, handgrip strength test, and 4 × 10‐m shuttle‐run test. Meeting 24‐h movement guidelines was defined as: 9–11 h/day (children aged 5–13) or 8–10 h/day (adolescents aged 14–17) of sleep, ≤2 h/day of recreational screen time and at least 60 min/day of moderate‐to‐vigorous physical activity. The probability of having a high/very high score for each physical fitness components (i.e., ≥60th centile according to the normative cut‐off points for European adolescents) in relation to adherence to 24‐h movement guidelines was analyzed using a series of binary logistic regressions. Results: Participants who met the three 24‐h movement guidelines were more likely to have high/very high for cardiorespiratory fitness (OR = 3.31; 95% CI: 1.79, 6.14; p < 0.001), standing long jump (OR = 1.91; 95% CI: 1.06, 3.45; p = 0.031), muscular fitness (OR = 2.05; 95% CI: 1.09, 3.86; p = 0.048) and physical fitness (OR = 1.99; 95% CI: 1.08, 3.66; p = 0.012), but not for handgrip strength (OR = 1.15; 95% CI: 0.64, 2.01; p = 0.636) and speed/agility (OR = 1.65; 95% CI: 0.92, 2.96; p = 0.093), compared to those who did not meet all three recommendations. Conclusion: Since meeting the three 24‐h movement guidelines increased the likelihood of having higher levels in most physical fitness components, it seems necessary to promote these movement behaviors early in life, as they could serve as a gateway for improving health‐related fitness in future generations. [ABSTRACT FROM AUTHOR]

Introduction: Children aged two to five years old are influenced by the behaviors of their guardians and Early Care Education (ECE) teachers. This study aims to determine the relationship between adults' and children's health behaviors in home and ECE settings. This study is novel in examining this correlation between multiple environments. Method: Surveys were conducted across 32 ECE centers. Guardians and teachers reported on their and their children's health behaviors within the home and ECE. Matched child-adult responses (n = 1,140) were analyzed from a representative sample of 32 ECE centers throughout Georgia. Frequency of consumption of fruits, vegetables, and water, as well as frequency of physical activity were measured. Spearman rho correlations were analyzed using SPSS software, with p < 0.05 indicating significance. Results: Spearman rho correlations indicated significant positive correlations between guardian and child behavior (rho = 0.49 to 0.70, p < 0.001) for all data. Teacher and child correlations were inconsistently significant across categories (rho = -0.11 to 0.17, p < 0.001). Discussion: The influence of guardian behavior modeling on child health outcomes is critical for improving ECE programming and child obesity outcomes. This research can be used to inform future health interventions for young children. Significance: Children's behaviors are influenced by the behaviors of guardians in their life. Childhood obesity rates are increasing in the United States, and increased physical activity and improved dietary practices are key methods to prevent obesity. This study assessed the degree to which children's health behaviors model those of their guardians and teachers. Children's health behavior practices were significantly correlated with the practices of their guardians but not with teachers, indicating home-based health promotions can have positive impacts on both adults and children. [ABSTRACT FROM AUTHOR]

This research assessed oral health behaviors changes in urban families with young children during the stay-at-home period of the COVID-19 pandemic (Nov 2020–August 2021). Survey data on oral health behaviors were collected in homes at three points before COVID-19, and via phone during COVID-19. A subset of parents and key informants from clinics and social service agencies completed in-depth interviews via video/phone. Of the 387 parents invited, 254 completed surveys in English or Spanish (65.6%) during COVID-19. Fifteen key informant interviews (25 participants) and 21 family interviews were conducted. The mean child age was 4.3 years. Children identified as mainly Hispanic (57%) and Black race (38%). Parents reported increased child tooth brushing frequency during the pandemic. Family interviews highlighted changes in family routines that impacted oral health behaviors and eating patterns, suggesting less optimal brushing and nutrition. This was linked to changed home routines and social presentability. Key informants described major disruptions in oral health services, family fear, and stress. In conclusion, the stay-at-home period of the COVID-19 pandemic was a time of extreme routine change and stress for families. Oral health interventions that target family routines and social presentability are important for families during times of extreme crisis. [ABSTRACT FROM AUTHOR]

Purpose:To examine (1) associations between body fat percent (BF) and lifestyle behaviors in children aged 9–11 years and (2) the consistency of these associations over a 10-year period. Methods: In this repeat, cross-sectional study, 15,977 children aged 9–11 years completed an anthropometric assessment and the SportsLinx Lifestyle survey between 2004 and 2013. Body fat was estimated according to the sum of the triceps and subscapular skinfold measurements. Multilevel models were utilized to examine associations between BF and responses to the lifestyle survey while controlling for known covariates. Results: Lifestyle behaviors explained 8.6% of the total variance in body fat. Specifically, negative associations were found between BF and active transport to school (β = −0.99 [0.19], P <.001), full-fat milk (−0.07 [0.15], P <.001), and sweetened beverage consumption (−0.40 [0.15], P =.007). Relative to the reference group of ≤8:00 PM, later bedtime was positively associated with BF: 8:00 to 8:59 PM (β = 1.60 [0.26], P <.001); 9:00 to 10:00 PM (β = 1.04 [0.24], P <.001); ≥10:00 PM (β = 1.18 [0.30], P <.001). Two-way interactions revealed opposing associations between BF and the consumption of low-calorie beverages for boys (β = 0.95 [0.25], P <.001) and girls (β = −0.85 [0.37], P =.021). There was no significant change in these associations over a 10-year period. Conclusions: In this population-level study covering a decade of data collection, lifestyle behaviors were associated with BF. Policies and interventions targeting population-level behavior change, such as active transport to school, sleep time, and consumption of full-fat milk, may offer an opportunity for improvements in BF. [ABSTRACT FROM AUTHOR]

One-third of American children are obese (13.7 million children). Although there are programs and strategies to address this issue, there is limited evidence regarding the role teachers and parents play as role models for healthy behaviors among preschool- aged children. This interventional study examined the impact educating parents and teachers as role models had on preschool-aged children's healthy behaviors (eating and physical activity). Parents and teachers in a public preschool in Newark, New Jersey, were invited to attend. Thirty-seven parents, teachers, and teacher aides representing 37 unduplicated children ages 3 to 5 years participated in the study. More than three-quarters of participants (83.8%, n = 31) were parents, and the remainder were teachers or teacher aides (16.2%, n = 6). The program was structured as a weekly 45-minute session over four weeks. Statistically significant results indicated that children's fruit and vegetable consumption increased by three servings from an average of one to five servings a day. Furthermore, the number of days children shared dinner and breakfast with the family increased from an average of two to five days a week, and children reduced eating takeout food by an average two days a week. There was also a 2-hour decline in the time children spent watching TV or playing video games, from slightly above 3.5 hours on average to 1.5 hours after the intervention. This family-centered/school-focused obesity intervention produced significant improvements in healthy behaviors for both adults and children. Educating parents and teachers to serve as role models for preschool children may contribute to decreasing the childhood obesity epidemic in the United States. [ABSTRACT FROM AUTHOR]

Background: Low back pain (LBP) is the leading cause of disability in the world that affects the population of all ages globally. The main aim of the present study was to analyze the cross-sectional association of postural education and postural hygiene habits with LBP, differentiating between frequency and intensity of pain. Methods: This cross-sectional study assessed 849 students aged 10-12 years from primary schools. The study was based on four different structured and self-administered questionnaires: back pain questionnaire, Back Pain and Body Posture Evaluation Instrument (BackPEI), Frequency of Commuting to and from School Questionnaire, and the Hebacaknow questionnaire. In addition, height and weight were included to determine the body mass index (BMI). Results: Participants with prevalence of LBP were significantly older (P =0.038), girls (P <0.001),>P=0.018), and practice active travelled back from school (P =0.016). Otherwise, participants with no prevalence of LBP sat correctly at the desk (P <0.001).> P =0.004). Conclusion: The knowledge related to postural education it is associated with less LBP. School interventions improving knowledge about postural education, ergonomics and postural hygiene are needed to address this important matter. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare the degree to which children and adolescents with and without visual impairments (VIs) met national physical activity, screen-time, and sleep guidelines. This observational, cross-sectional analysis of the 2016 National Survey of Children's Health focused on children (age 6–12 yr) and adolescents (age 13–17 yr) with and without VIs. The sample included 241 (weighted n = 472,127) and 17,610 (weighted n = 28,249,833) children, and 255 (weighted n = 505,401) and 17,417 (weighted n = 20,071,557) adolescents with and without VIs, respectively. Chi-square statistics were computed to examine the degree to which participants with and without VIs met health-behavior guidelines. Children (p =.02) with VIs were less likely to meet screen-time guidelines, but adolescents with VIs were not (p =.87). VI status was not associated with the likelihood of meeting physical activity or sleep guidelines (p <.05). Low numbers of children and adolescents with and without VIs meeting health-behavior guidelines warrant targeted interventions aimed at enhancing engagement. [ABSTRACT FROM AUTHOR]

The present study aimed to explore the association between healthy lifestyle pattern and childhood early onset of puberty. Based on a cohort study in Xiamen of China, a total of 1294 children was followed for three and a half years. Children's lifestyles, including dietary behaviour, physical activity, sleep duration, smoking and drinking behaviour and sedentary behaviour, were collected by questionnaires. Healthy lifestyle pattern was determined mainly according to the recommendations by the Dietary Guidelines for Chinese school-age children and Canadian Guidelines for children and youth. The pubertal development was assessed by clinical examination according to Tanner stages. The association between pre-pubertal lifestyle and early onset of puberty was estimated using linear regression and log-binomial regression. We found that children who adhered to a healthy lifestyle had a 0·36-year delay of the age of puberty onset (coef = 0·36, 95 % CI (0·08, 0·65)) and 53 % lower risk of early onset of puberty (risk ratio = 0·47, 95 % CI (0·27, 0·80)), compared with those who had a poor lifestyle. However, the beneficial effect of favourable lifestyles on the early onset of puberty was found only in boys with normal weight. Boys who adhered to active physical activity and low sedentary behaviour had a relatively delayed age of puberty onset (coef = 0·49, 95 % CI (0·26, 0·72)). This is the first time to find that healthy lifestyle pattern was associated with a substantially lower risk of early onset of puberty, especially in boys with normal weight. Advocating an integrated healthy lifestyle is essential for the development of children. [ABSTRACT FROM AUTHOR]

Understanding parental practices and attitudes regarding child sexual abuse (CSA) prevention could be used to improve CSA prevention, but little information is available. In this study, we summarise survey data collected from 248 Australian and UK parents (87% female) with at least one child aged 6-11 years (M = 8.6, SD = 1.8). This is the first study to quantify parental use of protective practices, other than prevention education, which may guard against CSA. Parental media mediation, which may safeguard against online dangers, was another unique focus of this study. Participants reported their discussion of sensitive topics with their children including CSA; behaviors that may reduce the incidence of CSA (e.g., monitoring, supervision, delegation of care and checking-in with the child); mediation of their child's media use; and attitudes towards CSA prevention education. Parents reported discussing sexual abuse less than other sensitive topics such as abduction dangers, drugs, and death but more than issues surrounding puberty, sex and pornography. Parents reported using high levels of protective behaviours, however some areas of concern were revealed. Of concern was the low-moderate level of parental media mediation, with substantial numbers of children potentially exposed to online risks such as using devices unsupervised in bedrooms or chatting to individuals unknown to their parents and not having their devices checked for concerning content. Almost all parents were supportive of CSA prevention education and felt they should provide this education. However, two-thirds of parents thought CSA education may be associated with harms for the child and two-thirds of parents believed children could prevent their own abuse. Reported results will aid in our understanding of which areas of parenting could be strengthened to create safer environments for children. This research has particularly highlighted the need for parents to be more protective around their children's access to online devices. [ABSTRACT FROM AUTHOR]

Summary: Background: The complex multifactorial nature of childhood obesity makes community interventions difficult to evaluate using traditional approaches; innovative methods are needed. Objective: To evaluate the impact of various interventions targeting childhood obesity‐related behaviours, and classified as using a micro‐level (e.g., home visitation programs) or macro‐level (e.g., business practices) strategy, on obesity among children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Methods: We simulated a population of 1500 children enrolled in WIC, with specific diet, physical activity, breastfeeding behaviours and body mass index z‐scores (BMIz), following them from age 2 to 5 years. Results: Combined interventions targeting breastfeeding appeared to be moderately effective, reducing BMIz by 0.03 (95% CI −005, −0.01). Two strategy‐specific interventions, home visitation programs and business practices targeting obesity‐related behaviours, appeared to be moderately effective at reducing BMIz by 0.04 (95% CI −0.06, −0.02) and 0.02 (95% CI −0.04, 0.00), respectively. Contrary to expectation, combining all micro and macro interventions appeared to have no impact or moderately increased the proportion of obesity/overweight among children. Conclusion: Interventions targeting breastfeeding behaviour were most effective when both micro and macro strategies were implemented. Interventions targeting obesity‐related behaviours in general were effective for two strategies, home visitation and business practices. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has resulted in substantial disruptions to daily functioning and lifestyle behaviours, with negative health consequences for youth. Parents play a large role in their children's health behaviour; yet changes to parenting behaviours during the pandemic related to food and physical activity remain relatively unexplored. The present study is the first to our knowledge to examine specific changes in American parents' parenting behaviours related to food and physical activity during COVID‐19, and potential correlates of such changes, including perceived stress and decision fatigue. Methods: A total of 140 parents (88.57% female; 88.41% White; 87.59% married; with one to five children) from middle to upper income households completed an online survey assessing demographics, perceived stress (Perceived Stress Scale), decision fatigue (Decision Fatigue Scale) and food and activity parenting behaviour changes during COVID‐19. Results: Overall, a greater proportion of parents engaged primarily in positive (57.14%) than negative (22.86%) parenting practices related to food and physical activity during the pandemic. Moderation analyses showed that the negative relation between perceived stress and positive parental behaviour changes was stronger at higher perceived increases in decision fatigue during the pandemic. Conclusions: In the face of a major public health crisis, adaptive parental responses may emerge, but perceived stress may inhibit such behaviour change. Perceived stress and decision fatigue may represent important explanatory factors in parental health promoting behaviours during times of uncertainty and change. [ABSTRACT FROM AUTHOR]

The Mediterranean diet (MD) is a model of a healthy diet and healthy lifestyle. Adherence to the MD has been correlated with a reduction in many metabolic disorders including cancers. The factors associated with adolescents' adherence to the MD in North Lebanon using the KIDMED index have never been explored. Therefore, we thought to examine these factors amongst a sample of them. A cross-sectional survey was conducted in the city of Tripoli, North Lebanon. A total of 798 adolescents aged 11–18 years were randomly selected to participate in this study. All participants completed a questionnaire assessing adherence to the MD (KIDMED index), physical activity (physical activity questionnaires for older children and adolescents), health-related quality of life (KIDSCREEN-27 index) and sociodemographic characteristics (age, sex, grade level and parents' educational status). Anthropometric measurements, including weight, height and waist circumference, were also collected. Adherence to the MD was good amongst only 13·3 % of the adolescents. The prevalence rate of overweight and obesity was elevated, affecting 36·9 % of the students. Lower adherence to the MD was significantly correlated with skipping meals (P = 0·001). Meanwhile, adolescents who were engaged in a high level of physical activity, those who consumed more meals with their families and those who benefited from better physical well-being had a better diet quality (P < 0·001). Nutrition intervention programmes, as well as public health policies, would be of interest in order to improve diet quality amongst Lebanese adolescents. [ABSTRACT FROM AUTHOR]

Children with autism spectrum disorder (ASD) engage in reduced levels of physical activity relative to neurotypical children. Researchers conducted 2 studies to 1) evaluate the influence of the number of physical activity options and effort on choice and 2) develop a token‐based intervention to increase physical activity engagement and evaluate whether the opportunity to access the intervention supported responding similar to physical or sedentary activity alone. Four children with ASD participated. Additional physical activity options alone did not increase physical activity selection, but increased effort reduced selection of sedentary activity. Tokens increased physical activity for 2 participants. A combination of physical and sedentary activities maintained as much as or more responding than either activity in isolation for all participants. Limitations and potential areas of future research on choice and physical activity are discussed. [ABSTRACT FROM AUTHOR]

Schools play an important role in promoting physical activity (PA) through school day schedules and policies. To investigate different intensities of children's movement behavior during instructional time, recess, and in relation to the Ontario Daily Physical Activity (DPA) policy. Movement behavior intensities were assessed using accelerometers during 5 school days. Behaviors were calculated for learning blocks, recesses, and physical education classes. Participants with ≥20 min of moderate-vigorous physical activity (MVPA)/day were considered compliant with the DPA policy. The sample included 159 children (52% female, 9.03 ± 1.66 years old). In all school day segments, sedentary behavior was higher than light PA and MVPA combined, and 21% met the DPA requirement. Females spent more time sedentary and less time in light PA and MVPA than males in all school day segments. Age was inversely associated with light PA and positively related to sedentary behavior. Participants who met the DPA requirement spent less time in sedentary behavior and more time in light PA and MVPA during school segments. Most of the time spent at school is sedentary behavior. There is room to potentialize the promotion of physical activity in physical and health education classes and enhance DPA. Our findings suggest that there is a need to strengthen DPA and improve the physical activity levels of children in school. [ABSTRACT FROM AUTHOR]

Summary: Background: Few randomized controlled trial (RCT) interventions targeted children's early risk behaviours using telephone or short message service (SMS) support. Objective: To evaluate the effectiveness of telephone or SMS early intervention focusing on mothers' behaviours starting from late pregnancy to improve BMI, and eating and screen time behaviours of children aged 2 years in comparison with the control group. Methods: A 3‐arm RCT was conducted in Australia, 2017–2019. Two arms involved the interventions using nurse‐led telephone or SMS support, delivered in nine stages from late pregnancy to age 2 years. The third arm was control. The primary outcome was children's objectively measured BMI and BMI z‐score at 2 years. Secondary outcomes included child eating and screen time behaviours as reported by parents at 2 years. Results: At 2 years, 797 mother–child dyads (69%) completed the telephone survey with 666 (58%) completing weight and height measurements. The study found no statistically significant difference in BMI between the groups. The mean BMI for telephone support was 16.93 (95% CI: 16.73 to 17.13), for SMS 16.92 (95% CI: 16.73 to 17.11) or for control 16.95 (95% CI: 16.73 to 17.16) with a difference of −0.02 (95% CI: −0.31 to 0.27, p = 0.907) in telephone versus control, and a difference of −0.03 (95% CI: −0.30 to 0.24, p = 0.816) in SMS versus control. Telephone support was associated with higher odds of no bottle at bedtime (adjusted odds ratio [AOR]: 2.99; 95% CI: 2.01 to 4.47), family meals (AOR: 2.05; 95% CI: 1.26 to 3.33), drinking from a cup (AOR: 1.89; 95% CI: 1.24 to 2.88), less screen time (<1 h/day) (AOR: 1.56; 95% CI: 1.10 to 2.23) and not eating dinner in front of the TV (AOR: 1.50; 95% CI: 1.09 to 2.06). SMS support was also associated with higher odds of no bottle at bedtime (AOR 2.30, 95% CI: 1.58 to 3.33) than the control. Conclusion: The telephone or SMS support intervention had no significant effects on BMI, but was effective in increasing no bottle use at bedtime. Telephone support showed more effects than SMS on reducing screen time and eating behaviours. [ABSTRACT FROM AUTHOR]

To evaluate the association between individual and environmental determinants of diet quality with diet quality of children exposed to gestational diabetes mellitus (GDM+) and unexposed (GDM−); to study the association between mother and child vegetables and fruit (VF) intakes. Cross-sectional study. One hundred forty-two children (104 GDM+; 38 GDM−) aged 6.2 ± 2.5 years. Canadian Healthy Eating Index 2007 (HEI-C) and VF were obtained with 2 24-hour dietary recall questionnaires in children. Maternal VF was obtained by a validated food frequency questionnaire, and weight and height were measured. Sociodemographic determinants were obtained by questionnaires. Linear regression models were used to evaluate the association between individual and environmental determinants and the HEI-C score with interaction for GDM status. Family meals were associated with HEI-C among GDM− but not GDM+ children (β = 9.97, P = 0.01 and β = −0.41, P = 0.84, respectively; P for interaction = 0.02). Children's age (β = −1.45; 95% confidence interval, −2.19 to −0.72; P < 0.001) was a determinant of HEI-C among all children. Maternal VF intakes were positively associated with children's VF intake (r = 0.30, P < 0.001, r 2 = 0.09), with association of larger variance among GDM− children (r = 0.38, r 2 = 0.14, P = 0.02) than GDM+ children (r = 0.23, r 2 = 0.05, P = 0.02). The food environment at home was associated differently with the diet quality of GDM+ and GDM− children. Whether targeting family meals and maternal diet quality is a good strategy to improve children's diet quality among GDM+ children needs to be further investigated. [ABSTRACT FROM AUTHOR]

The study aimed to investigate the individual and combined association of health-risk behaviors with mental health among Chinese children. A cross-sectional study was conducted in Wuhan, China, from May to June 2018. Participants self-reported the information on physical activity (PA), screen time (ST), fruit and vegetable (FV) intake, and sleep duration. Mental health, including depression, social anxiety and self-esteem, was assessed using standard questionnaires. A total of 1296 children (704 males and 592 females) aged 9.2 ± 0.4 years were included in the present study. The prevalence of low PA, high ST, low FV intake, and inadequate sleep duration was 45.6%, 18.0%, 69.7%, and 64.7%, respectively. Overall, significant associations were found between individual health-risk behavior and increased risks of mental health. Furthermore, children with three or four health-risk behaviors showed significantly increased risks of anxiety (OR: 3.18, 95%CI: 1.63–6.21), depression (OR: 4.55, 95%CI: 2.28–9.09) and low self-esteem (OR: 3.59, 95%CI: 2.20–5.88) compared with those without health-risk behavior. Results of this study revealed a high prevalence of health-risk behaviors among Chinese children. Furthermore, the clustering of health-risk behavior was associated with significantly increased risks of mental health in this population. Considering these findings, it is important to perform early interventions to reduce children's health-risk behavior and prevent mental health problems. [ABSTRACT FROM AUTHOR]

Background: Parenting practices influence children's health and development. The current study aimed at assessing gender differences in children's perception of the parenting practices of both parents, and in the association between children's oral health behaviors and parenting practices. Methods: A cross-sectional household survey of 6–12 year old children was conducted in a rural area in Northwestern Egypt in 2019. Clinical examination assessed caries and gingivitis. The Alabama Parenting Questionnaire assessed parenting practices in five domains (positive parenting, involvement, inconsistent disciplining, poor monitoring and corporal punishment) and the World Health Organization questionnaire assessed oral health behaviors including sugar consumption and daily toothbrushing. Sugar consumption was the dependent variable in linear regression and daily toothbrushing was the dependent variable in logistic regression. Parenting practices were the explanatory variables adjusting for confounders. Effect modification by child gender was assessed. Results: The response rate was 94.1% (n = 433), mean age = 9.9 years, 44.1% boys, 17.8% with daily toothbrushing and mean sugar consumption score = 3.4/8. Girls perceived more mothers' positive parenting than boys (mean = 14.15 and 13.46) and boys perceived more poor monitoring and corporal punishment. Boys and girls differed in the association between sugar consumption and fathers' inconsistent disciplining, poor monitoring (P = 0.004 and 0.02) and mothers' corporal punishment (P = 0.02), and also daily toothbrushing and mothers' involvement, positive parenting (P = 0.05 and 0.02), fathers' positive parenting (P = 0.02), mothers' inconsistent discipling and poor monitoring (P = 0.01 and 0.04). Conclusions: There were differences between boys and girls in perceiving mothers' and fathers' parenting practices and in the association between these parenting practices and toothbrushing and sugar consumption. [ABSTRACT FROM AUTHOR]

Introduction. The success of family-based community programs for childhood obesity may be increased by promoting social-cognitive factors that influence motivation and participant engagement. Incentivizing behavior can potentially enhance engagement and encourage behavior change. This research investigated motivators to engagement with a multicomponent incentive-based strategy to improve attendance and health-related behavior change in a family community-based weight management program for overweight and obese children. Method. Qualitative analysis combining; demographic data (n = 512), survey of parents (n = 273), and stakeholder (n = 10) and family interviews (n = 24). Participants were selected from program providers and families participating in an Australian community weight management program during a randomized controlled trial (n = 512 children). Maximum variation sampling (demographics and group characteristics) and inductive thematic analysis were used. Results/Conclusion. Four factors influencing engagement were (1) personal value, (2) achievement, (3) support, and (4) overwhelm. These themes corroborated with social-cognitive factors, fostered by a combination of behavior change components in the program that increased participant accountability and intrinsic motivation. Focusing on autonomous goal planning with parental involvement, tracking of goals, and reviewing of goals may complement existing strategies in child-focused treatment programs. Low-value noncash incentives linked to goal setting for encouraging healthy eating and physical activity were well accepted and may enhance family engagement and attendance. [ABSTRACT FROM AUTHOR]

Brazilians are a growing immigrant population in the United States and there is a lack of interventions to promote healthful energy balance-related behaviors (EBRBs) and prevent obesity among Brazilian preschool-age children. To develop needed interventions, information is required about parents' perceptions of the importance of EBRBs and where they obtain information about these behaviors. To assess Brazilian immigrant parents' perception of the importance of EBRBs and information sources they use to support their preschool-age children's healthful EBRBs. Cross-sectional survey. Fifty-two immigrant parents, most classified as having low acculturation, participated. In total, about 20–50% of parents perceived the six examined EBRBs as being extremely important. Parents reported that pediatricians, nurses, and WIC professionals were their primary sources for information about EBRBs. Increased health education on the importance of EBRBs is needed. Health educators can facilitate linguistic and culturally sensitive communication, education, and provide guidance to parents on how to foster the development and maintenance of their preschool-age children's healthful EBRBs. Bicultural, bilingual health educators can help raise awareness, facilitate communication, provide education and guidance to Brazilian immigrant parents about the importance of children's healthful EBRBs in the prevention of obesity. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) [ABSTRACT FROM AUTHOR]

Objectives Obesity is the most prevalent risk factor for cardiovascular disease (CVD) in children. We developed a 2-year lifestyle intervention for youth at risk of CVD. We assessed changes in body mass index z-scores (zBMI) and key cardiometabolic risk factors, physical fitness, and capacity among those who completed the program. Methods The CIRCUIT program is a multidisciplinary lifestyle intervention for children aged 4 to 18 years at risk of CVD, based on a personalized plan to improve cardiometabolic outcomes by increasing physical activity and reducing sedentary behaviours. Both at baseline and 2-year follow-up, we measured zBMI, blood pressure z-scores (zBP), adiposity (%body and %trunk fat), fasting blood glucose and lipid profile, aerobic (VO2max) and anaerobic (5×5 m shuttle run test) fitness, and physical capacity indicators. Differences between baseline and follow-up were examined using paired t-tests (for age-sex standardized outcomes) and multivariable mixed effect models, adjusted for age and sex (for other outcomes). Results Among the 106 participants (53 males) who completed the 2-year program, mean age at baseline was 10.9 years (SD=3.2). After 2 years, zBMI and diastolic zBP decreased by 0.30SD (95% CI: −0.44; −0.16) and 0.43SD (95% CI: −0.65; −0.23), respectively. Participants improved %body and %trunk fat, lipid profile, aerobic and anaerobic fitness levels, and physical capacity (p<0.02). No changes in systolic zBP nor in fasting plasma glucose were observed. Conclusion Our findings showed improved zBMI, cardiometabolic outcomes, physical fitness, and capacity among children at risk of CVD, suggesting that CIRCUIT is a promising intervention. [ABSTRACT FROM AUTHOR]

The development of healthy eating habits in childhood is essential to reducing later risk of obesity. However, many parents manage fussy eating in toddlerhood with ineffective feeding practices that limit children's dietary variety and reinforce obesogenic eating behaviours. Understanding parents' feeding concerns and support needs may assist in the development of feeding interventions designed to support parents' uptake of responsive feeding practices. A total of 130 original posts by parents of toddlers (12–36 months) were extracted from the online website Reddit's 'r/Toddlers' community discussion forum over a 12‐month period. Qualitative content analysis was used to categorise the fussy eating topics that parents were most concerned about and the types of support they were seeking from online peers. The most frequently raised fussy eating concerns were refusal to eat foods offered, inadequate intake (quantity and quality), problematic mealtime behaviours and changes in eating patterns. Parents were primarily seeking practical support (69.2%) to manage emergent fussy eating behaviours. This consisted of requests for practical feeding advice and strategies or meal ideas. Nearly half of parents sought emotional support (47.7%) to normalise their child's eating behaviour and seek reassurance from people with lived experience. Informational support about feeding was sought to a lesser extent (16.2%). Fussy eating poses a barrier to children's dietary variety and establishing healthy eating habits. These results suggest parents require greater knowledge and skills on 'how to feed' children and support to manage feeding expectations. Health professionals and child feeding interventions should focus on providing parents with practical feeding strategies to manage fussy eating. Supporting parents to adopt and maintain responsive feeding practices is vital to developing healthy eating habits during toddlerhood that will continue throughout adulthood. [ABSTRACT FROM AUTHOR]

Few studies have examined variations in obesity by geographic location in youth and its relation with fitness levels. The present study investigated the association between geographic status (islands versus mainland), excess of body weight and fitness levels among 335.810 schoolchildren (male: 51.3%, 6–18 y, during the school year 2014–2015). Students' anthropometric parameters and fitness levels - accessed via the Euro-fit test - were measured by trained physical education teachers and evaluated according to published norms. Prevalence of overweight (23.0 Vs 21.8%) and obese (10.1 Vs 8.0%) was significantly higher for students living in the islands contrary to their mainland counterparts. A significant difference was also observed for centrally obese children (33.5 Vs 28.2%). Except for speed test.408), in all other four fitness tests, the students from the islands presented significantly lower performance (≤25th percentile of published age- and sex-specific normative values) versus their mainland counterparts. Boys and girls living in the islands had 48% and 37% increased odds of low physical fitness (as a total), respectively, compared to their mainland counterparts. Likewise, children living in islands presented increased odds of being overweight or obese by 19% and 15% in boys and girls, respectively, as compared to those living in the mainland. Increased general and abdominal adiposity have a direct negative impact on students' performance in Physical Fitness tests. Our data highlight the problem of excessive body weight that children living in rural areas, face. [ABSTRACT FROM AUTHOR]

Objectives Age stereotypes and expectations about one's own aging commence in childhood but most research focuses on predictive associations with midlife health behaviors, later-life chronic conditions, biomarkers, and longevity. Surprisingly little is known about the role of poor childhood health in these associations. This study aims to fill this gap. Methods Using data from the Health and Retirement Study (HRS: N = 5,773, aged 50–98), we investigated whether diagnosed chronic illness before age 16 and self-rated childhood health predict late-life self-perceptions of aging (SPA) and proportional subjective age discrepancy (PSAD). We conducted multivariate multiple regression analysis (MMRA) to determine the joint and partial effects of the two indicators of childhood health. Models included controls for childhood family financial status as well as late-life self-rated health, chronic illnesses, memory status, and demographic covariates (age, gender, race/ethnicity, marital status, socioeconomic status) in 2016. Results Over and above all covariates and the covariation of the two views of one's own aging, the MMRA models revealed that the number of childhood chronic illnesses predicted SPA but not for PSAD. Self-rated childhood health predicted both SPA and PSAD in the unadjusted models, but not in the adjusted models. Discussion This study provides new insight into potential early-life precursors of self-evaluations of aging. In particular, childhood diagnoses of chronic illness enhance negative SPA up to 50 years later. Non-normative experiences related to poor health in childhood are lifelong foundations for socioeconomic status, health, and for self-related beliefs about age and aging. [ABSTRACT FROM AUTHOR]

To measure pediatric preventive counseling at patient-centered medical homes (PCMHs) compared with practices that reported undertaking some or no quality-related activities. We analyzed 4814 children and adolescents ages 0 to 17 who visited their usual sources of care in the nationally representative Medical Expenditure Panel Survey Medical Organizations Survey (MEPS-MOS), a household survey combined with a survey of household members' usual sources of care. We identified PCMHs using lists from certifying or accrediting organizations. For other practices in the MEPS-MOS, 2 quality-related activities were 1) reports to physicians about their clinical quality of care, and 2) electronic health record system reminders to physicians. Regressions controlled for practice, child, and family characteristics. Compared with other practices, PCMHs were generally associated with greater likelihood of receiving preventive counseling. Estimates varied with the quality-related activities of the comparison practices. Counseling against smoking in the home was 10.4 to 18.7 percentage points (both P <.01) more likely for PCMHs. More associations were statistically significant for PCMHs compared with practices that undertook 1 of 2 quality-related activities examined. Among children ages 2 to 5, compared with practices undertaking both quality-related activities, those with PCMHs were more likely to receive counseling on 3 of 5 topics. Among adolescents, compared with practices undertaking both quality-related activities, those with PCMHs were more likely to receive counseling on smoking, exercise, and eating healthy. PCMHs were associated with substantially greater receipt of pediatric preventive counseling. Evaluations of PCMHs need to account for the quality-related activities of comparison practices. [ABSTRACT FROM AUTHOR]

Objectives: The association between poor parenting and dental caries in children remains unclear. We investigated the association of poor parenting with dental caries and oral health behaviour among children aged 6‐7 years in Japan. Methods: Two waves of repeated cross‐sectional surveys on children and their caregivers in Adachi City, Tokyo, were analysed. Questionnaires on parenting behaviour and the child's oral health behaviour were distributed through schools and completed by 8499 caregivers (response rate = 80.8%). The number of decayed or filled primary teeth (dft) at school dental health check‐ups was linked to the survey data (N for complete case analysis = 6309). Factor analysis was performed to identify types of poor parenting: poor involvement, child abuse and lack of supervision of a child's health behaviours. The association between factor scores (z‐score), the number of dft and oral health behaviour (not brushing teeth twice a day, not controlling snack eating habits and drinking juice every day) was evaluated by Poisson's regressions adjusted for covariates, including caregiver's socioeconomic status. Results: Poor involvement and lack of supervision of a child's health behaviours were positively associated with dft (mean ratio, MR [95% confidence interval, CI] =1.05 [1.03, 1.07] and 1.18 [1.16, 1.21], respectively) and unhealthy oral health behaviours. Child abuse was not associated with dft (MR = 0.99 [0.96, 1.01]) but was associated with all three unhealthy oral health behaviours (prevalence ratio, PR [95% CI] were 1.11 [1.06, 1.16], 1.11 [1.06, 1.16] and 1.06 [1.00, 1.11] for not brushing teeth, not controlling snack eating and drinking juice, respectively). Conclusions: Poor involvement and lack of supervision of a child's health behaviours were associated with dental caries, and any type of poor parenting was associated with poor oral health behaviour among children. [ABSTRACT FROM AUTHOR]

Background: Research is lacking regarding the eating habits of cartoon characters in relation to their body weight. The present study explored the context of food consumption and the cartoon characters' traits, according to body weight. Studies show that slim cartoon characters are usually considered as attractive; however, little is known regarding the type of messages projected about their physical appearance. Method: One hundred episodes of ten series with high TV audience rates were reviewed. Characters' body weight status was classified into underweight, normal weight, and overweight, and food consumed as processed and less processed. Characters' traits such as physical activity and attractiveness were classified as positive, negative, or neutral. Comments made by the characters themselves regarding their proper physical appearance or the appearance of partner characters were recorded and classified as positive or negative. Results: Results show that characters' body weight was related to both type and quantity of foods consumed, as 58% of the non-core and 48% of all foods were actually eaten by oversized characters. Positive characters' traits, as defined by attractiveness and physical activity engagement, referred consistently to slim characters, with nine out of ten shown as good-looking and physically active. In addition, the majority (51 out of 58) of the positive comments on physical appearance were recorded for slim and attractive characters, either expressed by fellow actors or the characters themselves. Conclusion: Body weight of cartoon characters seems to follow stereotypic perceptions which value slimness and relate unhealthy food consumption with overweight. [ABSTRACT FROM AUTHOR]

OBJECTIVES: In this study, we present an epidemiological profile of middle childhood (children aged 6-11 years) using the 2016-2017 National Survey of Children's Health. METHODS:We used data from the 2016 and 2017 National Survey of Children's Health, a national cross-sectional, address-based survey administered annually. The study sample included 21 539 children aged 6 to 11 years. Survey items chosen to create this profile of middle childhood described sociodemographic and family characteristics, health status, and behaviors. Weighted descriptive and bivariate analyses were applied to examine the population and differences by subgroups. RESULTS: Most children aged 6 to 11 years were in excellent or very good physical health (89%) and oral health (73%). More than 20% were considered to have special health care needs, and 20% had at least 2 health conditions. Allergies and asthma were the most prevalent physical conditions, whereas attention-deficit/hyperactivity disorder and behavioral or conduct problems were the most prevalent of emotional, behavioral, and/or developmental disorders. More than half of children participated in sports or other activities for at least 60 minutes per day, whereas more than one-third of children had $4 hours of parent-reported screen time per day, and nearly two-thirds received $9 hours of sleep per night. We found several significant differences in screen time and activity behaviors as children aged and by sex. CONCLUSIONS: The middle-childhood population is generally healthy, yet several patterns observed with respect to age and sex indicate a need to examine the emergence and progression of select health-risk behaviors. In this study, we highlight opportunities to implement targeted interventions at earlier ages and different points along the life course. [ABSTRACT FROM AUTHOR]

This study examined the relationships among family socioeconomic status, parental attention, and health behaviors in children during middle childhood. For this descriptive cross‐sectional study, six elementary schools in a metropolitan city in South Korea were selected for recruitment. We surveyed 857 elementary school students aged 8 to 10 years by using self‐report questionnaires. A hierarchical multilinear regression analysis found that family socioeconomic status positively related to children's health behaviors and that parental attention had a moderating effect on this relationship. These results suggest that family socioeconomic status influences health behaviors from the child's perspective. The influence of family socioeconomic status on children's health behaviors might be weakened by parental attention. Healthcare providers should be aware of children's health behaviors and focus interventions on families with low socioeconomic status. Nurses should emphasize to parents that parental supervision and monitoring might benefit their children and improve their health behaviors. [ABSTRACT FROM AUTHOR]

Background: Overweight/obesity is a substantial global public health concern, which can be caused by genetic factors and energy balance-related behaviors (EBRBs). If it occurs in children with congenital heart disease (CCHD), it can yield an extra burden on their health.Most studies on CCHD have taken place inWestern societies, leaving Asian populations understudied, especially children. Objective: We sought (1) to determine body mass index distribution among school-aged CCHD in Taiwan, (2) to ascertain whether the body mass index of CCHD differs from that of the general population, (3) to describe EBRBs in CCHD, and (4) to identify factors associated with underweight and overweight/obesity among CCHD. Methods: In this cross-sectional study, 97 child-parent dyads (53.6% boys; mean age, 9.73 years; 25.8%moderate-to-severe heart conditions) were enrolled. Self-administered questionnaires were used to collect demographics, medical factors, food frequency, physical activity, and sedentary behaviors. Anthropometric measurementswere taken in the hospital. Independent predictors of EBRBs and health conditionswere calculated through logistic regression analysis. Results: Among Taiwanese CCHD, 19.6% were underweight and 14.4% were overweight/obese. Children with moderate-to-severe heart defects were more often underweight. Body mass index did not differ between CCHD and children in the general population. More complex heart defects and asthma were associated with being underweight, whereas sedentary behaviors, cardiomegaly, and the NewYork Heart Association classification II to IV were associated with being overweight/obese. Conclusions: Sedentary lifestyle is seemingly the only EBRB correlatedwith being overweight. Physical activity programs for childrenmay help prevent and treat overweight or obesity in Asian CCHD, similar to Western countries. [ABSTRACT FROM AUTHOR]

Objective: This research was performed to identify the effect of education, which is offered in accordance with Bandura's social learning theory, on children's health locus of control, perceptions and behaviors. Material & Method: The research was performed as pre-test & post-test and in quasi-experimental design. Research sample was comprised of a total of 269 students who were enrolled at schools selected by lot when the research was performed and who agreed to participate in the study. Children who agreed to take part in the research were randomly selected and categorized as one experimental group and one control group. The research was completed with the participation of 158 students in experimental group and 111 students in control group. Introductory survey form, Children's Health Locus of Control Scale and Children's Health Perceptions & Healthy Lifestyle Behaviors Scale were utilized in the research. The delivery of education which was prepared on the basis of social learning theory took six weeks and it was offered in eight sessions. Each session lasted approximately 40 minutes. Findings: In the wake of this educational endeavor, it was found that the health locus of control and health perceptions & behaviors of children who were in experimental group were enhanced. It was discerned that there was no statistically significant difference in the mean of pre-test scores obtained by participants of experimental group and control group from Children's Health Locus of Control Scale and Children's Health Perceptions & Healthy Lifestyle Behaviors Scale. Result: It was ascertained that the education delivered on the basis of Bandura's social learning theory was effective in enhancing children's health locus of control and health perceptions & behaviors. [ABSTRACT FROM AUTHOR]

Purpose: To describe toothbrushing frequency/duration and toothpaste use among young children in an urban, vulnerable population in Chicago, Ill., USA. Methods: Caregivers of children younger than three years old were recruited from university and community pediatric dental clinics. Caregivers completed a 37-item questionnaire in English or Spanish about predictors/covariates (demographics, child/ caregiver oral health, access to dental care) and primary outcomes (child toothbrush-ing behaviors, toothpaste use). Models employed generalized logit and ordinal logistic regression. Results: A total of 148 caregivers completed the survey. The average child age was 18.8 months (±7.4 SD). Approximately 41 percent of children brushed once a day or less, and 19 percent of caregivers did not regularly assist. Almost all children used toothpaste (96 percent), but 36 percent of caregivers did not know if it contained fluoride. Increased child brushing frequency was associated with older child age, higher caregiver brushing frequency, history of a child dental visit, and caregiver assistance (P<0.05). Children with a history of dental visits were seven times more likely to brush for 30 seconds or more, and receiving caregiver assistance was associated with brushing longer than two minutes (P<0.05). Conclusion: Most children brushed at least once daily and nearly all of them used toothpaste. Access to dental care, parental involvement, and parental oral health were associated with favorable child toothbrushing behaviors. Toothbrushing duration, frequency, and encouraging family assistance are modifiable protective factors and opportunities for intervention. [ABSTRACT FROM AUTHOR]

With increasing childhood obesity rates and type 2 diabetes developing in younger age groups, many schools have initiated policies to support healthy eating and active living. Policy interventions can influence not only health behaviours in students but can also impact these behaviours beyond the school walls into the community. We articulate a policy story that emerged during the data collection phase of a study focused on building knowledge and capacity to support healthy eating and active living policy options in a small hamlet located in the Canadian Arctic. The policy processes of a local school food policy to address unhealthy eating are discussed. Through 14 interviews, decision makers, policy influencers and health practitioners described a policy process, retrospectively, including facilitators and barriers to adopting and implementing policy. A number of key activities facilitated the successful policy implementation process and the building of a critical mass to support healthy eating and active living in the community. A key contextual factor in school food policies in the Arctic is the influence of traditional (country) foods. This study is the first to provide an in-depth examination of the implementation of a food policy in a Canadian Arctic school. Recommendations are offered to inform intervention research and guide a food policy implementation process in a school environment facing similar issues. [ABSTRACT FROM AUTHOR]

The purpose of this pilot quasi-experimental study was to examine the feasibility and preliminary efficacy of using Facebook in a 10-week lifestyle intervention with Head Start caregiver–preschooler dyads to improve healthy behaviors and reduce body mass index. Sixty-nine dyads participated with 39 in the intervention group. Average preschooler attendance rate for the Head Start center-based program was 77%, and caregiver participation rate was 87%. About 94% of the caregivers were satisfied with the program, and 97% would recommend the program to others and/or participate again. The intervention decreased preschoolers’ body mass index z score (Cohen’s d = –.30) and screen time (d = –.21), and increased their fruit and vegetable intake (d = .40) and moderate-to-vigorous physical activity (d = .42). The intervention increased caregivers’ fruit and vegetable intake (d = .40). The intervention is feasible, and preliminary efficacy is encouraging, but further investigation using a rigorous study design is warranted. [ABSTRACT FROM AUTHOR]

Background: Childhood obesity has become a global health issue, yet little is known about the influence of maternal factors on children’s weight-related health behaviors (dietary habits and physical activity), especially in China. The purpose of this study was to examine the influence of maternal factors on children’s eating behaviors and physical activity in Chinese preschool-age children. Method: A cross-sectional study was utilized to describe weight-related health behaviors among preschool-aged children and identify maternal factors that are associated with children’s weight-related health behaviors in China. Mothers completed questionnaires regarding family eating and activity habits, child feeding practices, and maternal self-efficacy regarding their child’s health-related health behaviors. Results: A total of 222 mother–child dyads participated in this study. Maternal health-related behavior and attitudes regarding feeding practices and self-efficacy were associated with children’s health-related behaviors, including eating behaviors and physical and sedentary activities. The influence of maternal behaviors and attitudes were domain specific. Discussion: Improvement of children’s health behaviors, promoting a healthy lifestyle of the mother and self-efficacy, and providing health home environment for the child are critical in obesity prevention. Implications for Practice: Because children’s health is critical to the health of the nation and to global development, understanding the factors related to children’s health-related behaviors is an important first step toward development of tailored, culturally sensitive interventions for promoting a healthy lifestyle and preventing obesity. [ABSTRACT FROM AUTHOR]

Abstract: Background: Childhood nutrition is important in optimising growth, development and future health. The present study compared dietary intakes of Australian children aged 4–8 years with (i) Australian Guide to Healthy Eating (AGHE) food group recommendations and (ii) age‐specific Nutrient Reference Values (NRVs), in addition to (iii) describing food group intakes of children meeting key NRVs. Methods: Data were obtained from a representative sample of children (n = 789) from the National Nutrition and Physical Activity Survey between May 2011 and June 2012. Parent‐reported 24‐h recall dietary data were disaggregated into five core food groups, along with energy‐dense, nutrient‐poor (EDNP) foods, with intakes being compared with AGHE recommendations. Food group intakes were compared for children meeting the NRVs for 10 nutrients used for the development of AGHE food groups. Chi‐squared and t‐tests were performed to determine differences in food group intakes with P < 0.05 considered statistically significant. Results: Only one child met the recommended daily servings for all AGHE core food groups and none met both core and energy‐dense, nutrient‐poor (EDNP) food group recommendations. The lowest level of alignment (percentage meeting recommendations) was for vegetables (4.6%) and the highest was for fruit (47.7%). Mean (SD) daily intake of EDNP foods [4.7 (3.2) serves day−1] accounted for 38.4% of total energy intakes. Children meeting key NRVs (n = 395) consumed greater daily servings of fruit [2.2 (1.7)], dairy [2.2 (1.2)] and EDNP foods [5.0 (3.4)] compared to the total sample (n = 789). Conclusions: Significant discrepancies exist between contemporary dietary patterns of Australian children and national recommendations. Future AGHE revisions should incorporate greater diversity of consumption patterns, including sub‐categories of EDNP foods. [ABSTRACT FROM AUTHOR]

In the United States 80% of obese adolescents, 50% of obese preschool-aged children, and 50% of school-aged children are prone to develop adult obesity. Health education and physical activity for children at risk for obesity are key to mitigating the risk of developing obesity as an adult. Health education and physical activity complement each other, improving children's behaviors and attitudes towards health. This study builds upon an existing body of knowledge about the prevention of obesity and long-term morbidity among rural youth from disadvantage backgrounds. The purpose of this study was to improve the attitudes and behaviors towards healthy eating through combining health education and physical activity among children of Macon County, Alabama. We conducted a mixed method design with a cluster sample of 11 participants. We used a pre/posttest lifestyle student created questionnaire guided by the Institut de Recherches Cliniques de Montréal (IRCM) lifestyle questionnaire and the Simple Lifestyle Indicator Questionnaire to characterize health behaviors (i.e., consumed vegetables, fruits, sweet drinks and water) and attitudes (i.e., enjoyment of exercise, emotional eating, ways of staying active when the weather is bad). Our study concluded that an interactive health education and physical activity interventions positively influenced healthy eating behaviors and attitudes in nine out of eleven participants for attitudes and six out of eleven participants for behaviors on healthy eating. [ABSTRACT FROM AUTHOR]

Statement of the Problem: Oral and general health status depends on several factors such as the individual's personal attributes, behaviors, and perceptions. Purpose: This study aimed to evaluate the factors affecting the oral health-related behaviors in 12-year-old children. Materials and Method: This cross-sectional study was based on the data obtained from 1554 students being 12 years old and from five provinces in Iran. The data were collected with a culturally adapted questionnaire about the students' demographic characteristics, knowledge, attitudes, and practice (KAP). Path analysis was conducted to evaluate the effect of these factors on oral health-related behaviors in urban and rural areas. Results: Based on the findings, 61.1% of the samples resided in urban and 38.9% in rural areas. The mean scores were relatively good for knowledge (74.1±21.1%) and attitudes (72.6±21.1%), but unsatisfactory for oral health practice (51.8±12%). Having measured the correlation between the independent variables and oral health-related behaviors, the province of residence and the parents' education and job had the most significant correlations. Behavioral biases were seen in all dimensions of practice such as brushing habits, dental visits, and diet. In urban areas, 30% and in rural areas 49% of oral health behaviors were directly related to knowledge and attitudes. All of the calculated effects exhibited significant differences from zero (p< 0.0001). Conclusion: Path analysis identified some direct and indirect factors influencing the children's oral health-related behaviors. Factors included in this model could only justify a part of oral health behaviors. Thus, other educational models should be considered based on the psychology or social learning theories. [ABSTRACT FROM AUTHOR]

Background: Children's overweight and obesity have increased in Western societies, including Israel. Childhood is an important time for shaping healthy habits. Purpose: The purpose of this study was to evaluate the effectiveness of a healthy lifestyle intervention on health knowledge, behavior, and anthropometric measurements. Methods: A total of 396 fifth- and sixth-grade children, from 2 religious and 2 secular schools, participated in a nonrandomized controlled trial during the 2011-2012 school year. Intervention group were given an extensive educational program focusing on eating habits and physical activity. Results: Overweight and obesity decreased significantly within the intervention group (from 25% to 17.9%, P = .04), without a significant change in the control group (from 20.5% to 17.6%, P = .12). Religious children had double the risk of being overweight or obese (odds ratio [OR] = 2.10; 95% confidence interval [CI], 1.15-3.73; P = .02). Knowledge was improved in both study groups (P < .01), with no difference in health behavior scores at the beginning (P = .59) or end (P = .36) of the year. Discussion: Health Education during fifth and sixth grades improved children's weight and health knowledge but not healthy behavior. Translation to Health Education Practice: School-based healthy lifestyle educational programs are important for primary prevention and weight management. [ABSTRACT FROM AUTHOR]