Children's Health-related Behaviors Research Articles

The Health and Attainment of Pupils in Primary Education

ObjectivesHAPPEN (The Health and Attainment of Pupils in Primary EducatioN) aims to empower schools to make meaningful changes by gaining a better understanding of pupil’s physical, psychological, emotional and social health. HAPPEN has had 30,000+ children across Wales take part to develop an e-cohort that is supported by public engagement and involvement.
 MethodsPupils (aged 7-11 or years 4/5/6) complete a self-report survey within school about aspects of their health and wellbeing. HAPPEN is directly aligned to the new Curriculum for Wales and has a strong utilisation of consultation, engagement and collaboration with school staff and local authorities. Schools receive an individual report presenting group-level data on pupils’ health and wellbeing while creating a dataset of health and wellbeing across Wales. This data has been linked to routine data and has the potential to make signficant impact in Wales.
 ResultsHAPPEN data has most recently been used to explore children’s health and wellbeing during the Covid-19 pandemic. This included a retrospective cohort study using an online cohort survey (January 2018 to February 2020) linked to routine PCR SARS-CoV-2 test results to explore health-related behaviours in children (2018-2020) and association with being tested and testing positive (2020-2021). This found associations relating to parental health literacy and monitoring behaviours. As well as this, free school meal status was used as a proxy for deprivation in an exploratory study on the impact of school closures on the health and well-being. The physical health (eg, physical activity and diet) of children eligible for FSM may be affected by prolonged school closures. HAPPEN research is driven by the wants and needs of its user-group.
 ConclusionHAPPEN exists to empower schools and practitioners to improve the health and wellbeing of children across Wales by feeding into policy and practice. This infrastructure has facilitated the creation of a dataset that can be linked to answer past and future questions including an evaluation of current free school meal roll-out.

A systematic analysis and future projections of the nutritional status and interpretation of its drivers among school-aged children in South-East Asian countries.

Nutrition inadequacy during childhood and adolescence can cause suboptimal growth, intergenerational effects on offspring and an increased risk of chronic diseases in adulthood. There is little information on the prevalence and drivers of malnutrition in children aged 5-19 years, in the South-East Asian setting, since most existing interventions have to date targeted undernutrition. We assessed the national prevalence of nutritional indicators, their trends, and associated risk factors among children aged 5-19 years from 11 countries of WHO South-East Asia Region (SEA Region) in order to provide evidence to guide future policy direction. We included 5,210,646 children for analysis from 345 studies and 25 survey datasets. A Newcastle-Ottawa Scale was used to assess the quality of the study. Bayesian regression models were used to estimate the prevalence of malnutrition between 2000 and 2030, and a series of subgroup analyses were performed to assess variation in pooled estimates by different socio-demographic and lifestyle factors. The protocol was registered with PROSPERO database (CRD42023400104). Overall, pooled analysis demonstrated that indicators of undernutrition in SEA is predicted to decrease between 2000 and 2030 including stunting (36.6%-27.2%), thinness (29.5%-6.2%), and underweight (29.2%-15.9%). However, a substantial increase in prevalence of overweight (6.0% in 2000-16.9% in 2030), and obesity (2.6%-9.5%) are predicted. The prevalence of micronutrient deficiencies between 2000 and 2030 is predicted to decrease-vitamin A by 84% and vitamin D by 53%. Parents' education levels and household wealth were inversely associated with malnutrition. Children's health-related behaviours, such as unhealthy dietary habits and spending more time watching TV, playing games, or using the computer, were associated with increased chance of overweight and obesity. There were no clear signs of publication bias in our study. Our analysis highlights the pattern of a double burden of malnutrition, with clear differences between different socio-demographic groups. Despite a substantial reduction in the prevalence of stunting, underweight, and anaemia since 2000, an emerging increase in overweight/obesity and micronutrient deficiencies warrants urgent attention. World Health Organization Regional Office for South-East Asia New Delhi, India.

The Relationships between Parenting Practices and Child Health-Related Behaviors in Children with Intellectual Disability: The Moderating Role of Child Body Weight Status.

This study aimed to examine the associations between parenting practices and child health-related behaviors, and the moderating role of child body weight status in children with intellectual disability (ID). A cross-sectional study was conducted among a sample of children with ID in Hong Kong; 440 participants were included in this study. All the variables investigated were collected from questionnaires, except body weight status, which was objectively measured. Logistic regression analysis was used to examine the associations between parenting practices and children's unhealthy behaviors. Interaction items were added to investigate the moderation effect of child body weight status, adjusting for significant background characteristics. Results showed that the parenting practices of "restricting access to unhealthy food and sedentary behaviors (RA)" (OR range: 0.63-0.64) and "using food or sedentary behaviors as rewards (UR)" (OR range: 1.28-1.60) were significantly associated with some eating behaviors, but not with sedentary behaviors. Body weight status significantly moderated these associations. Only RA showed favorable effects on some eating behaviors in children with overweight and obesity (OR range: 0.17-0.28), whereas the effects of UR differed by body weight status. Future research should focus on developing educational interventions which encourage parents to use practices that are tailored towards children's individual characteristics.

Effects of varying pandemic restrictions on the health-related behaviours of Australian children.

To explore the effects of COVID-19 pandemic restrictions varying in severity and duration on health-related behaviours in children aged 5-17 years. We used data from the Royal Children's Hospital National Child Health Poll, an online cross-sectional survey of Australian caregivers. The survey assessed 1222 caregivers' perceived changes in health-related behaviours (physical activity, sleep, screen-time, diet, outdoor activity, family and peer connectedness) of 2011 children aged 5-17 years in a typical week from June to September 2020 (when jurisdictions experienced varying restriction severity and duration) compared to retrospective reports of behaviour before March 2020 (pre-pandemic). To compare the effects of varying restriction severity in Victoria, New South Wales (NSW) and other states and territories on health-related behaviours binary logistic regression was used, adjusting for caregiver demographics and weighted to reflect Australia's parent population. Compared to pre-pandemic, Victoria's restrictions had a greater impact on child health-related behaviours compared to NSW restrictions and an even stronger impact compared to other states and territories which experienced few or no restrictions. A greater proportion of Victorian children reported more recreational screen time (71.3%) than NSW (53.9%) and other states and territories (34.5%) and less physical activity (57.2%) than NSW (30.3%) and other states and territories (26.5%). Victorian children reported less outdoor activity (62.6%) than NSW (32.0%) and other states and territories (25.2%), and less social connectedness (68.0%) than NSW (35.4%) and other states and territories (27.3%). More severe and longer COVID-19 pandemic restrictions are associated with greater impacts and predominantly more negative impacts to children's health-related behaviours. These should be mitigated through policies and programs to encourage healthier life-styles.

Pre-COVID-19 pandemic health-related behaviours in children (2018–2020) and association with being tested for SARS-CoV-2 and testing positive for SARS-CoV-2 (2020–2021): a retrospective cohort study using survey data linked with routine health data in Wales, UK

ObjectivesExamine if pre-COVID-19 pandemic (prior March 2020) health-related behaviours during primary school are associated with (1) being tested for SARS-CoV-2 and (2) testing positive between 1 March 2020 and 31...

Are social stories beneficial for oral health promotion in preschool children with special healthcare needs?

Design A 24-month randomised, two-armed, double-blinded, parallel controlled trial.Methods Participants were recruited from educational centres for children with special healthcare needs (SHCN) aged 2-6 years. Out of the 37 special needs schools in Hong Kong, 19 were randomly selected, of which 16 met the inclusion criteria. Further exclusions occurred if the child was absent, no consent was signed or if they did not meet the inclusion criteria. All participants received standardised tooth brushing instructions. The test group were given validated social stories, while the control group utilised standard leaflets issued by the Department of Health. The resources were used both in education centre sessions in three phases and at home by parents. The oral health-related behaviours were assessed before and after interventions as well as dmft index. Caries was assessed via dmft at baseline and phase 3 (at 24 months). The severity of existing caries was assessed using the International Caries Detection and Assessment System. If existing carious lesions progressed from one stage to a more advanced stage, it was defined as progression. At baseline and each of the three follow-up visits, oral hygiene and gingival health were assessed using the modified gingival index and simplified debris index. Oral health behaviours assessed included tooth brushing performance (assessed by number of tooth brushing steps and duration/frequency), between-meal snacking (assessed by frequency) and dental visit experience (assessed as favourable if the child attended at least annual visits). It was then determined if these behaviours had improved. Data analysis utilised generalised estimating equations, negative binomial regression and binary logistic regression. Kappa statistics were used to test intra-examiner reliability on 10% of randomly selected participants.Results There was no significant difference in caries experience between the two groups after 24 months. The results suggest children in the test group displayed improved tooth brushing performance, better oral hygiene and more frequent dentist visits. Children from higher socioeconomic backgrounds also showed better oral hygiene compared to those from lower socioeconomic backgrounds.Conclusions Social stories may be useful resources to improve oral health-related behaviours in children with SHCN.

Stressed Out! Examining family meal decisions in response to daily stressors via ecological momentary assessment in a racially/ethnically diverse population.

The impact various sources of stress have on family meal decisions and child health-related behaviors is an understudied area. For this study, 128 racially/ethnically diverse parent/child dyads were recruited from primary care clinics in the Twin Cities, Minnesota between 2015 and 2016. Parent participants completed eight days of ecological momentary assessment, which included end-of-day surveys where the parent reported on (1) sources of daily stress (e.g., family demands, work/school demands) and related family meal choices (e.g., fixed quick meal, skipped meal), (2) meal planning, and (3) parent and child health-related behaviors (e.g., watched TV, ate unhealthy snack). Adjusted generalized estimating equations were used to estimate marginal probabilities and 95% confidence intervals of outcomes by race/ethnicity. Results indicated that common meal-related choices as a result of being stressed varied from fixing a quick/easy meal, buying fast food, everyone fixing their own meal or skipping a meal, or none of the above. When parents reported family demands as the source of stress, children were three times more likely to eat an unhealthy snack. Additionally, children were more likely to eat an unhealthy snack with higher levels of parental stress or if families have not planned the meal the night before. Interventions to lower parental stress and support family meal planning may increase the healthfulness of the home food environment during moments of elevated stress.

Managing Implementation of a Parental Support Programme for Obesity Prevention in the School Context: The Importance of Creating Commitment in an Overburdened Work Situation, a Qualitative Study

Health-related behaviours in children can be influenced by parental support programmes. The aim of this study was to explore barriers to and facilitators for the implementation of a parental support programme to promote physical activity and healthy dietary habits in a school context. We explored the views and experiences of 17 coordinating school nurses, non-coordinating school nurses, and school principals. We based the interview guide on the Consolidated Framework for Implementation Research. We held four focus group discussions with coordinating and non-coordinating school nurses, and conducted three individual interviews with school principals. We analysed data inductively using qualitative content analysis. We identified “Creating commitment in an overburdened work situation” as an overarching theme, emphasising the high workload in schools and the importance of creating commitment, by giving support to and including staff in the implementation process. We also identified barriers to and facilitators of implementation within four categories: (1) community and organisational factors, (2) a matter of priority, (3) implementation support, and (4) implementation process. When implementing a parental support programme to promote physical activity and healthy dietary habits for 5- to 7-year-old children in the school context, it is important to create commitment among school staff and school nurses. The implementation can be facilitated by political support and additional funding, external guidance, use of pre-existing resources, integration of the programme into school routines, a clearly structured manual, and appointment of a multidisciplinary team. The results of this study should provide useful guidance for the implementation of similar health promotion interventions in the school context.

Factors Affecting Health-Related Behaviors in Younger School-Age Korean Children

PurposeAlthough many studies have reported factors influencing school-age children's health behaviors, most focus on later childhood and early adolescence. It is important to understand children's own perspectives on their health-related behaviors to promote child health. This study identified factors affecting health-related behaviors among younger school-age children via self-report assessments. Design and methodsParticipants (N = 636) were children aged 8 to 9 years (second and third grade) at six elementary schools in South Korea. The variables examined were child characteristics, health locus of control, perceived parental attention, peer support, school environment, and health-related behaviors. A hierarchical linear regression analysis was performed to identify factors predicting younger school-age children's health-related behaviors. ResultsSocioeconomic status (family affluence score) had the strongest impact on health-related behaviors, followed by health locus of control, parental attention, and peer support. Living with both parents also had a positive effect. The present results suggest that children within aged 8 to 9 years have the ability to consciously choose and implement health-related behaviors. ConclusionsBased on these findings, recommendations are as follows: 1) collaboration between parents and health professionals, which, given the importance of parental attention, represents the best approach for guiding children's health-related behaviors; and 2) attention paid to children from low-income backgrounds (at both the school and community levels) can help prevent health inequalities arising from socioeconomic status.

Oral health related habits, knowledge and attittude in children with asthma

Summary Introduction The aim of this research was to determine oral hygiene related habits, knowledge and behavior in children with asthma compared to healthy children. Methodology This study included 136 children, between 6 to 16 years of age, divided into the two groups. The first group included children with asthma (study group - SG), while the second included healthy children (control group - CG). A questionnaire containing three groups of questions related to oral-hygiene and dietery habits as well as oral health related behaviour in children was prepared. Results The percentage of children from SG that brush teeth several times a day was 60.2% compared to 77.2% of CG children (p<0.05). 19.1% of SG group children versus 38.2% of CG children brush their teeth longer than 2 minutes (p<0.05). There was no significant difference in the level of knowledge about plaque impact on oral health between the two groups (p>0.05). More than half (52.9%) of CG respondents regularly visit dentist, while 50.0% of SG goes regularly (p<0.01). 51.5% of CG children visit the pediatric dentist due to preventive reasons, while SG children goes mainly due to rehabilitation of teeth (42.6%). The fear of dental procedures is more pronounced in SG compared to CG children (p<0.001). Conclusion Oral hygiene related habits and oral health behavior were worse in children with asthma, while no difference was found in relation to the knowledge among the observed groups.

Risky behaviour in adolescents in the East Bohemian region

The aim of the study was to examine selected factors of health-related behaviour in children and youth in the Pardubice and Hradec Králové regions (which constitute East Bohemia). The participants were 664 pupils and were students of selected elementary and secondary schools.The research was carried out by means of quantitative data collection, using a questionnaire of our own design which included scale questions. The questionnaire of risk behaviour in adolescence investigates the risk factors of lifestyle in children and youth, i.e. specifically the category of truancy, neglecting school duties, addictive behaviour, aggressive behaviour including self-harm, reproductive health-related risk behaviour, and computer and internet use-related risk behaviour. The contribution presents results concerning the selected categories of risk behaviour, including their interrelations. The results demonstrate the significant relations among the individual examined phenomena in the research group. Low gender differences are also interesting. In terms of gender, there were differences only in aggressive behaviour and the time spent using a computer or the internet. Male pupils scored higher in both the mentioned variables. Respondents’ age was only related to truancy, which decreased as their age increased.

Development of dental anxiety in schoolchildren: A 2-year prospective study.

To assess the development of high dental anxiety and the factors that are associated with it over a 2-year period. This longitudinal study focused on 416 Brazilian children aged 5-7 years over 2 years. Interviews were conducted with the children's parents to investigate the children's health-related behaviours. Additionally, the children's dental caries experience was clinically evaluated to obtain information about DMFT/dmft (decayed, filled and missing teeth) indices. Using the Dental Anxiety Question, children whose parents responded "yes" to the prompt "Is he/she very afraid of going to the dentist?" were classified as having high dental anxiety. Multilevel mixed-effects logistic regression was used to analyse factors to determine the extent to which they were associated with high dental anxiety longitudinally. The prevalence of high dental anxiety in children at baseline was 16.2%, whereas it was 19.8% at follow-up. Additionally, 38% of the children with high dental anxiety at baseline still had the condition after two years, although 62% of them no longer had high dental anxiety. The incidence of high dental anxiety at 2-year follow-up was 15.0%. Children who used medication chronically had a 2.1 times greater likelihood of having high dental anxiety. Furthermore, children whose parents reported high dental anxiety had a 2.6 times greater likelihood of having high dental anxiety themselves. A one-unit increase in a child's dmft score increased the risk of high dental anxiety by 1.1 times at follow-up. After two years, the incidence of high dental anxiety was 15.0%. Poor oral health, unstable general health and parents with high dental anxiety were factors that were associated with this type of anxiety in schoolchildren. It is important that dentists are aware of children's high dental anxiety and the associated factors so that they can appropriately intervene. Dentists fulfil an important role and should stimulate and promote good general hygiene habits that may prevent future problems.

The Effectiveness of the ‘Child-Friendly’ Approach in Educating Health-Related Behaviour in Children

The Effectiveness of the ‘Child-Friendly’ Approach in Educating Health-Related Behaviour in Children

Health-Related Behaviour Among Children of Childhood Cancer Survivors in Germany.

Purpose: Childhood cancer survivors fear that previous therapy could not only impair their own but also their children's health. We examined whether health-related behaviour in children of childhood cancer survivors differs from the general population. Methods: Our first nationwide survey wave (2013-2014) surveyed offspring health in 396 German childhood cancer survivors known to have a child of their own. Answers about health behaviour were analysed using descriptive statistics. Data were collected for 418 offspring and 394 could be integrated for matched-pair analyses with data from the German general population (KIGGS, n=17 641). Results: Teeth-cleaning routine, body-mass-index or subjective body image evaluation by parents were no different from children in the general population. Parents who included a cancer survivor smoked less in the presence of their children (p=0.01). During pregnancy, mothers in cancer survivor parent pairs abstained from drinking alcohol more often (p=0.01) and smoked less (p=0.05). While the calculated effect sizes (Phi) were generally low (0.135-0.247), children from cancer survivors played less outdoors than peers did (p=0.01). Boys participated in sports outside a club more often (p=0.05) and watched less TV on weekdays (p=0.01) and girls spent more time on the computer during weekdays than peers did (p=0.01). Conclusions: This study provides the first data for health-related behaviour in cancer survivors' offspring and sheds light on differences to parenting in the general population. Multivariate analyses in a larger study population are needed to relate these differences to fear issues in cancer survivors.

Identifying developmental trajectories of body mass index in childhood using latent class growth (mixture) modelling: associations with dietary, sedentary and physical activity behaviors: a longitudinal study

BackgroundTo date, many epidemiologic studies examining associations between obesity and dietary and sedentary/physical activity behaviors have focused on assessing Body Mass Index (BMI) at one point in time. Recent developments in statistical techniques make it possible to study the potential heterogeneity in the development of BMI during childhood by identifying distinct subpopulations characterized by distinct developmental trajectories. Using Latent Class Growth (Mixture) Modelling (LCGMM) techniques we aimed to identify BMI trajectories in childhood and to examine associations between these distinct trajectories and dietary, sedentary and physical activity behaviors.MethodsThis longitudinal study explored BMI standard deviation score (SDS) trajectories in a sample of 613 children from 4 to 12 years of age. In 2006, 2009 and 2012 information on children’s health related behaviors was obtained by parental questionnaires, and children’s height and weight were measured. Associations with behaviors were investigated with logistic regression models.ResultsWe identified two BMI SDS trajectories; a decreasing BMI SDS trajectory (n = 416; 68 %) and an increasing BMI SDS trajectory (n = 197; 32 %). The increasing BMI SDS trajectory consisted of more participants of lower socio-economic status (SES) and of non-western ethnicity. Maternal overweight status was associated with being in the increasing BMI SDS trajectory at both baseline and follow-up six years later (2006: Odds Ratio (OR), 2.9; 95 % confidence interval (CI) 1.9 to 4.3; 2012 OR, 1.8; 95 % CI 1.2 to 2.6). The increasing BMI SDS trajectory was associated with the following behaviors; drinking sugared drinks > 3 glasses per day, participation in organized sports < 1 h per week, and TV viewing > 2 h per day, though participation in organized sports at follow-up was the only significant result.ConclusionsOur results indicate the importance of healthy lifestyle behaviors at a young age, and indicate that maternal BMI is a very important risk factor for the development of childhood overweight. Comprehension of heterogeneity in the development of BMI and associations with modifiable health related behaviors is interesting for prevention by targeting high risk behaviors in early childhood, especially in low SES children, children of non-western ethnicity and children whose mother is overweight.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3757-7) contains supplementary material, which is available to authorized users.

Psychometric Properties of the Persian Version of Parenting Style and Dimensions Questionnaire: Application for Children`s Health-related Behaviors

Background: Parenting style is associated with children's health-related behaviors. One of the popularity and applicability assessment tools is Parenting Style and Dimensions Questionnaire (PSDQ) that the lack of Iranian version can be seen.This study was conducted to determine the validity and reliability of Iranian version of PSDQ.Materials and Methods: This study was done with randomized cluster sampling on 588 parents. Cronbach's α coefficient was used to determine the internal consistency and Pearson`s correlation coefficients was used for test-retest reliability and the construct validity. Conformity factor analysis was also applied to determine the construct validity. Results: Cronbach's α coefficient for two authoritative and authoritarian styles with the highest estimated value were 0.86 and it was 0.41 for permissive style. The results of the correlation test in all three afore mentioned styles were significant. Correlation coefficients between authoritative style and its subscales were about 0.86 to 0.89 and between authoritarian style and its subscales were about 0.81 to 0.87. Confirmatory factor analysis showed that goodness-of-fit indices, including CMIN/DF,GFI, CFI, IFI and RMSEA, were 2.1, 0.91, 0.90, 0.90, and 0.04, respectively, which indicated a good the construct validity of instrument.Conclusion: The PSDQ that has been translated into Persian obtained good reliability and validity. PSDQ questionnaire can be considered a useful tool in the assessments and interventions concerning parenting styles used in Iran.

Effectiveness of a behavioral incentive scheme linked to goal achievement: study protocol for a randomized controlled trial.

BackgroundChildhood obesity is a concern in Australia and across the world. Community-based weight management programs are an important response to address childhood obesity. However, the scientific literature suggests that their effectiveness could potentially be enhanced by providing a structured incentive scheme. This proposal aims to determine the effectiveness of enhanced goal setting linked to a structured incentive scheme designed to improve the sustained health and wellbeing of overweight/obese children within the context of an existing community-based program.Methods/DesignThis study is a cluster randomized controlled trial delivered within the context of the existing NSW “Go4Fun” program with a 10-week and 6- and 12-month follow-up (n = 40 sites, 570 participants) that compares the effectiveness of small changes to the program in which children were asked to set goals (supported by text messages) and were given rewards for achieving them (intervention). This will be compared to the standard/existing program (control), which did not have the same structured incentive program. Data will be collected for all participants at baseline, end of program, and at 6 and 12 months. The primary outcome is a mean change in body mass index (BMI) z score at the 12-month follow-up. Secondary outcomes include anthropometric measures (body weight, height, and waist circumference) and behavioral measures collected via validated questionnaires. A process evaluation (comprising surveys and focus groups) to determine acceptability and sustainability and to inform downstream translation will also be conducted.DiscussionThis study will inform policy and program delivery as well as the broader evidence base regarding goal achievement and incentive schemes directed at children’s health-related behaviors and will provide evidence that is likely to be transferrable across a range of health conditions.Trial RegistrationACTRN12615000558527 registered on 29 May 2015.

The keys to healthy family child care homes intervention: Study design and rationale

BackgroundObesity is a major public health problem for which early preventive interventions are needed. Large numbers of young children are enrolled in some form of child care program, making these facilities influential environments in children's development. Family child care homes (FCCH) are a specific type of child care in which children are cared for within the provider's own residence. FCCHs serve approximately 1.5 million children in the U.S.; however, research to date has overlooked FCCH providers and their potential to positively influence children's health-related behaviors. MethodsKeys to Healthy Family Child Care Homes (Keys) is a cluster-randomized controlled trial testing the efficacy of an intervention designed to help providers become healthy role models, provide quality food- and physical activity-supportive FCCH environments, and implement effective business practices. The intervention is delivered through workshops, home visits, tailored coaching calls, and educational toolkits. Primary outcomes are child physical activity measured via accelerometry data and dietary intake data collected using direct observation at the FCCH. Secondary outcomes include child body mass index, provider weight-related behaviors, and observed obesogenic environmental characteristics. ConclusionKeys is an innovative approach to promoting healthy eating and physical activity in young children. The intervention operates in a novel setting, targets children during a key developmental period, and addresses both provider and child behaviors to synergistically promote health.

Does Parental Warmth and Responsiveness Moderate the Associations Between Parenting Practices and Children's Health-related Behaviors?

To determine whether a higher number of parenting practices, such as those concerning meals, bedtime, and limited screen time, is associated with children's health behaviors. In addition, to determine whether perceived parental warmth and responsiveness toward the child strengthens (moderates) the associations between parenting practices and health behaviors. Cross-sectional study. School-based survey in which children completed questionnaires at school, and parents at home. A total of 805 child-parent dyads were used in analyses. Intake of nutrient-dense and energy-rich foods, meal frequency per day, sleep duration, and screen time. Linear and logistic regression analyses. Moderation was tested by adding the interaction term ofparenting practices and parental warmth/responsiveness to the models. When moderation occurred, stratified analyses were conducted. A higher number of parenting practices was associated with more favorable health behaviors. Stronger associations between parenting practices and nutrient-dense food intake and meal frequency were found when children perceived high parental warmth/responsiveness. Stronger associations between parenting practices and energy-rich food intake and screen time were found when children perceived low parental warmth/responsiveness. Parental warmth/responsiveness seems to strengthen the associations between parenting practices and favorable health behaviors. This knowledge could be used in family-focused obesity interventions.

Limited evidence available for the impact of school-based behavioural interventions on oral health

The Cochrane Oral Health Group's Trials Register, and Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CINAHL, PsycINFO, Current Controlled Trials, ClinicalTrials.gov, Web of Science and Dissertations and Theses via Proquest databases were searched. A number of relevant journals, (Acta Odontologica Scandinavica, ASDC Journal of Dentistry for Children, British Dental Journal, Caries Research, Community Dental Health, Community Dentistry and Oral Epidemiology, Journal of the American Dental Association, Journal of Dental Research, Journal of Public Health Dentistry, Swedish Dental Journal, International Journal of Paediatric Dentistry) not already searched as part of the Cochrane Journal Handsearching Programme were handsearched. There were no restrictions regarding language or date of publication. Randomised controlled trials (RCTs) where randomisation occured at the level of the group (cluster by school and/or class) or individual children were included. Included studies had to include behavioural interventions addressing both toothbrushing and consumption of cariogenic foods or drinks and have a primary school as a focus for delivery of the intervention. Two pairs of review authors independently extracted data related to methods, participants, intervention design including behaviour change techniques (BCTs) utilised, outcome measures and risk of bias. A qualitative synthesis was conducted. Four studies involving a total of 2302 children were included. One study was at unclear risk of bias and three were at high risk of bias. The studies were heterogeneous in both intervention and outcome measures and also suffered from poor reporting. Only one included study reported caries development as an outcome. This small study at unclear risk of bias showed a prevented fraction of 0.65 (95% confidence interval (CI) 0.12 to 1.18) in the intervention group. However, as this is based on a single study, this finding should be interpreted with caution. All three studies that reported plaque outcomes found statistically significant reduction in plaque in the intervention groups, but due to differences in plaque reporting between studies these could not be combined. Two of these studies included an active home component where parents were given tasks relating to the school oral health programme (games and homework), to complete with their children. Secondary outcome measures from one study reported that the intervention had a positive impact upon children's oral health knowledge. Currently, there is insufficient evidence for the efficacy of primary school-based behavioural interventions for reducing caries. There is limited evidence for the effectiveness of these interventions on plaque outcomes and on children's oral health knowledge acquisition. None of the included interventions were reported as being based on or derived from behavioural theory. There is a need for further high quality research to utilise theory in the design and evaluation of interventions for changing oral health related behaviours in children and their parents.