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The relationship between social vulnerabilities and the effectiveness of behavioral interventions to prevent obesity in children is poorly understood. Therefore, the objective of this study is to evaluate the association between parental employment and the effectiveness of IDEFICS, a multilevel behavioral intervention aiming to prevent obesity among children (2 to 9.9 years old) in eight European countries. Data from 9,901 children and their parents was included in the analysis. We determined the Body Mass Index (BMI) z-score mean difference as the measurement of the intervention effectiveness and we calculated it as the follow-up (T1) BMI z-score mean minus baseline (T0) BMI z-score mean. Parents self-reported their employment status at T0 and T1. Children were classified, at both study times (T0 and T1), as children with employed parents (both parents employed) or as children with unemployed parents (one or both parents unemployed or receiving social assistance). We calculated unadjusted and adjusted multilevel mixed model analyses to evaluate if the employment status at T0 and the evolution of the employment status within a two-year period (from T0 to T1) predicted the BMI z-score mean difference among boys and girls. In boys, parental unemployment at T0 and throughout a two-year period (T0 to T1) predicted an increase of BMI z-score mean difference when compared to boys with employed parents (unemployment at T0: adjusted β = 0.12; p = 0.028; and unemployment from T0 to T1: adjusted β = 0.20; p = 0.031). We found no difference in the effectiveness of the IDEFICS intervention among girls with unemployed parents at T0 and from T0 to T1 when compared to girls with employed parents (unemployment at T0: adjusted β = 0.04; p = 0.337; and unemployment from T0 to T1: adjusted β = 0.10; p = 0.216, respectively). Our results suggest that the influence of parental unemployment in the IDEFICS outcome is different for boys and girls. Employment of both parents, which is related to a higher income, could contribute the families to engage healthier eating and physical activity behaviors among boys. Future multilevel interventions should include a combination of community-based and school-based components, as well as family-centered components, specifically on those families with parents out of the labor force, to address specific barriers or vulnerabilities that prevent them from improving behavior and weight status.
Childhood obesity is one of the most serious global public health challenges of the 21stcentury. Health and scientific organizations demand early interventions, although their complexity generates difficulties in their implementation. In systematic reviews, quality assessments are intended to limit mislead reporting and it is important they are conducted in a manner that minimizes bias. Process evaluation (PE) is used to monitor and document program implementation and can aid in understanding the relationship between specific program elements and program outcomes. Failure to deliver an intervention as intended can lead to unclear conclusions about the effectiveness of the intervention. The aim of the present study is to evaluate the effectiveness of the studies based on the process evaluation and the quality on its interventions. We performed a systematic review of randomized control trials aiming to prevent childhood obesity. The Cochrane Handbook for Systematic Reviews of Interventions tool was used to assess and report methodological risk of bias. Each item was judged as being at high (HR), low (LR) or unclear (UN) risk of bias as per criteria. Key domains random sequence generation and allocation concealment were also assessed. Effectiveness was estimated when the study showed changes in body composition as the main outcome (BMI z-score or waist circumference). Process evaluation was evaluated if at least one process evaluation indicator was identified as being adequately implemented. From the 41 studies, 26 showed any degree of effectiveness and 15 were not effective. Almost half of studies scored high risk of bias: 20/41 (Effective 13/26; non effective 7/15). Moreover, 16/41 studies reported to have unclear risk of bias (effective 10/26; and non-effective 6/15). Only 5/41 articles reported to have low risk (effective 3/26; non effective 2/15). Regarding random sequence generation, there was no difference according to the quality of the studies (effective: LR 25/26, UN 1/26 AND HR 0/26; non effective: LR 15/15, UN 0/15 AND HR 0/15). Concerning the allocation concealment domain, there were no differences found either (effective: LR 11/26, UN 10/26 AND HR 5/26; non effective: LR 7/15, UN 5/15 AND HR 3/15). PE was used in 7 papers (effective 3/7 and non-effective 4/7). Quality seems to have slightly more influence in the non-effective studies (LR 13.3%) than in the effective studies (LR 11.5%). The non-effective studies showed the highest proportion of performing PE. There seems to be a relationship between the quality and PE performance.
Introduction: Childhood obesity is rising in all countries. Dietary habits are modifiable factors which develop early in life. During growth, several factors, such as peer- influence and food availability, determine the development of food preferences and eating behaviour. Parents play also a key role model by influencing their own food intake.
Objetives: The purpose of this study was to assess the influence of parental role modelling, as predictor of fruits and vegetables intake in European pre-schoolers.
Methods: The present study included a sample of 6633 preschool children (51.9% boys) from six European centres (Belgium, Bulgaria, Germany, Greece, Poland and Spain), 3.5 to 5.5 years of age, participating in the ToyBox-study. Data on parental role modelling related with their own fruits and vegetables intake (portions/day) and children's fruits and vegetables intake (portions/day) were collected via standardized proxy-administered questionnaires. Linear regression model was used to assess this association. The adjusted model included socioeconomic status and weight status.
Results: In the unadjusted model, boys whose parents consumed fruits, showed a mean intake of 0.09 (95% CI: 0.08–0.11; p ≤ 0.001) portions of fruits more than the boys whose parents did not consume fruits. Also, girls whose parents consumed fruits, had intake of 0.10 (95% CI: 0.08–0.12; p ≤ 0.001) portions of fruits more than the girls whose parents did not consume fruits.
Moreover, boys whose parents consumed vegetables, showed a mean intake of 0.09 (95% CI: 0.07–0.11; p ≤ 0.001) portions of vegetables more than the boys whose parents did not consume vegetables. Also, girls whose parents consumed fruits, had intake of 0.11 (95% CI: 0.09–0.13; p ≤ 0.001) portions of vegetables more than the girls whose parents did not consume vegetables.
Finally, parental role related with fruits consumption explained 19.3% of fruits intake in European pre-schoolers and the 17.8% of vegetables intake in boys and 21.9% of vegetable intake in girls taking into consideration the potential effect of socioeconomic status of the family and the weight status of the children.
Conclusions: Parental role model of fruit intake has moderate effect on the pre-schooler's dietary intake. However, home environment characteristics such as family rules or availability and accessibility of foods should be considered as potential factors related to food intake in pre-schoolers.
Introduction: Dietary habits are established from a very young age. Parental role modeling is an important factor influencing the eating behavior of their children. Drinking behavior may have an impact in the development of childhood obesity. This study aimed to explore the correlations of core drinking beverages between parents and their children.
Materials and Methods: The present study included children of 3.5–5.5 years and their parents from the (Multifactorial evidence-based approach using behavioral models in understanding and promoting fun, healthy food, play and policy for the prevention of obesity in early childhood) ToyBox study. The study was a kindergarten-based family-involved intervention, in preschool children from six European countries: Belgium, Bulgaria, Germany, Greece, Poland, and Spain. For this study, we analyzed data from the baseline cross-sectional survey.
Data on consumption frequency of water, homemade or fresh fruit juice, prepacked fruit juice, light beverages and sugared sweetened beverages consumption from parents and their children was obtained via a validated food frequency questionnaire. Parents were given examples of serving sizes and asked about how to self-report their usual consumption per day or week. Beverage consumption of children was reported by their parents and information about frequency and portion sizes was collected. Body weight and height of children was measured and classified according to the International Obesity Task Force (IOTF). Bivariate correlations were performed to analyze beverage consumption (servings per day) in children and their parents.
Results: The studied sample included 5266 pairs of children (49.2% girls) and parents (91.7% women) that were included in the analysis.
Girls presented higher correlations in water (r2 = 0,317) and sugar sweetened beverages (r2 = 0,302), whereas boys, presented slightly higher correlations of light soft drinks (r2 = 0,273), pure fruit juices (r2 = 0,308) and prepacked fruit juices (r2 = 0,324), all of them at < 0.01 level of significance. Considering boys and girls together, a slightly higher significant correlation coefficients were found between children-parents’ dyads with overweight/obesity compared to normal weight children-parentś for sugar sweetened beverages (r2 = 0,303) and light soft drinks (r2 = 0,396).
Discussion: Beverage consumption of children and their parents were found to be moderately correlated. Overweight children seem to have better correlations with their parents in relation of sugar sweetened beverages and light soft drinks. Parents should encourage a healthy beverage consumption for their own health and most important, because there are key role models to their children.
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