Clustering of Obesity-Related Risk Behaviors Among Families With Preschool Children Using a Socioecological Approach: Cross-Sectional Study.

Virginia Quick

doi:10.2196/10320

Abstract

BackgroundLimited attention has been given to assessing home environments of parents with preschool-aged children using a socioecological approach to better understand potential influencers of obesity risk.ObjectiveThe purpose of this cross-sectional study was to examine the clustering of obesity-related risk behaviors among mothers with preschool children.MethodsMothers with preschool-aged children (ages 2 to 5 years) who participated in the online Home Obesogenic Measure of Environments (HOMES) survey were examined in clustering of four healthy recommended behaviors (ie, mother’s fruit and vegetable intake ≥5 per day, sedentary screen time <4 hours per day, sugar-sweetened beverage intake <1 time/day, and increased physical activity level). Frequencies and percents of the clustering variables were conducted along with Spearman rank order correlations to determine significant associations. Ward’s method with squared Euclidean distances were performed for the cluster analysis using the four standardized continuous variables. Identification of total cluster number was determined by visually inspecting the dendogram. Sociodemographic, intrapersonal, social environment, and home physical environment characteristic differences between cluster groups were further examined by independent t tests and chi-square analysis to validate findings.ResultsOf the 496 participants (72.6%, 360/496 white; age mean 32.36, SD 5.68 years), only a third (37.1%, 184/496) consumed five or more servings of fruits/vegetables daily, had low sedentary screen time of <4 hours/day, and reported moderate to high levels of physical activity (34.1%, 169/496). More than half (57.7%, 286/496) consumed <1 sugar-sweetened beverage serving daily. A positive correlation (r=.34, P<.001) between physical activity level and fruit/vegetable intake (≥5 servings/day), and a positive correlation (r=.15, P=.001) between low sedentary screen time (<4 hours/day) and low sugar-sweetened beverage intake (<1 serving/day) were found. Ward’s hierarchical analysis revealed a two-cluster solution: less healthy/inactive moms (n=280) and health conscious/active moms (n=216). Health conscious/active moms were significantly (P<.010) likely to be more physically active, have lower sedentary screen time, lower daily intake of sugar-sweetened beverages, and greater daily intake of fruits and vegetables compared to less healthy/inactive moms. Less healthy/inactive moms were significantly more likely to have a higher body mass index and waist circumference compared to the other cluster; however, there were no significant sociodemographic differences. There were many intrapersonal (eg, importance of physical activity for child and self) and home physical environment (eg, home availability of fruits/vegetables and salty/fatty snacks) characteristic differences between clusters, but few significant differences emerged for social environment characteristics (eg, family meals, family cohesion).ConclusionsFindings may have implications in tailoring future obesity prevention interventions among families with young children.

Highlights

In the United States, more than one-third of children are either overweight or obese [1]
Given the negative health outcomes associated with membership in the less healthy/inactive moms cluster and mothers’ influence on their children living in the same home environments [70], interventions that focus on improving obesity-related risk behaviors of mothers with young children are warranted
This study found cluster grouping associations at all levels; more significant associations were found at the intrapersonal and home physical environment levels suggesting parents might be strong influencers of their child’s behaviors

Summary

Introduction

In the United States, more than one-third of children are either overweight or obese [1]. The overall estimated annual medical costs and physical and mental health consequences of obesity are very high [3]. An energy imbalance in which too few calories are expended for the amount of calories consumed is often the primary focus of obesity research and interventions; the many intrapersonal and environmental (social and physical) factors facilitating this energy imbalance are critical to understand. The socioecological model posits that health and well-being of an individual is determined by multiple levels of influence [4]. Factors of the near physical environment (eg, home, neighborhood), family social environment, and intrapersonal characteristics more directly influence behaviors. Limited attention has been given to assessing home environments of parents with preschool-aged children using a socioecological approach to better understand potential influencers of obesity risk

Methods

Results

Discussion

Conclusion