Regular physical activity is important for child health and development. Recent reviews of literature and meta-analyses have found that physical activity is associated with improved child cardiometabolic (lower blood pressure, triglycerides, HDL cholesterol, and fasting insulin) and mental health (reduced depression and anxiety and increased self-esteem and cognitive functioning) outcomes (8). To achieve these health benefits, current physical activity guidelines suggest that children get 60–120 min or more of physical activity each day (22,34).
Parents and the home environment are thought to play a critical role in children’s socialization, including the attitudes, beliefs, and behaviors children adopt around physical activity (2,25). Current conceptual models suggest that parent behaviors, such as encouragement of child activity, personal activity patterns, preferences for activity, monitoring of child TV viewing, and family TV viewing, can influence children’s physical activity and inactivity behaviors (5,12). The term physical activity parenting practices is used to refer to this collection of techniques or behaviors parents may use to encourage or limit their children’s physical activity or inactivity. Several individual studies have seen associations between child physical activity or sedentary time with parenting practices like role modeling of physical activity or screen use, support/encouragement for activity, and screen time rules (10,13,17,20,24,30,31,36). However, a recent umbrella review found that there was no clear and consistent evidence linking specific physical activity parenting practices to children’s physical activity behaviors, particularly for those under 12 yr old (2). At the same time, this review found that parent involvement increased the effectiveness of interventions designed to promote child physical activity and prevent obesity (2). Together, this evidence suggests that parents play an important role in shaping children’s physical activity habits, but more work is needed to identify the specific practices through which they are exerting this influence.
One of the major challenges of interpreting existing literature is the discrepancies in how physical activity parenting practices are conceptualized and measured. Existing studies and measurement instruments generally take a very fragmented approach, measuring only a few select practices. A recent review of questionnaires assessing physical activity parenting identified 11 unique instruments (29), only five of which measured parenting practices around both physical activity and inactivity (7,10,11,17,32). Although a few additional instruments have come out in recent years (9,13,15,18,21,30), there is a clear preference for measuring practices that support physical activity (e.g., role modeling; coparticipation; and praise, negotiation, and rationalizing) or restrict inactivity (e.g., rules and limits, and monitoring). Even among these more comprehensive instruments, parent practices that may unintentionally support inactivity (e.g., modeling of screen time and enjoyment of sedentary activities) (10,13,17,32) and control/restrict physical activity (e.g., rules around outdoor play, pressure to be active, and bribes to be active) (11,19,21,27,32) are rarely measured. Rarely have studies included measures of both supportive and controlling practices around both physical activity and inactivity to see how these practices may interact to influence child activity and/or inactivity. More comprehensive instruments are needed to fully evaluate parents’ influence on child activity levels.
Much can be learned from the general parenting and food parenting literature to help inform the development of a more comprehensive measure of physical activity parenting practices. General child-rearing behaviors have been characterized using two major dimensions—demandingness and responsiveness (1). When trying to identify specific parenting practices to measure, it is important to recognize that there will be multiple specific parenting practices within each. Demanding or controlling practices would include constructs such as discipline, restriction, pressure, and bribes, whereas responsive or supportive practices would include constructs such as encouragement, negotiation, and positive reinforcement. Costanzo and Woody (4) applied these concepts to help understand domain-specific parenting, specifically around child obesity.
Food parenting measures have often used this general parenting literature to guide its identification of practices parents use to influence their child’s dietary intake and eating behaviors. Food parenting and physical activity parenting are similar in that they are trying to identify practices that both increase healthy behaviors (e.g., consumption of fruits and vegetables and participation in regular physical activity) and decrease unhealthy ones (consumption of sweets and snacks and watching excessive TV). The food parenting literature has identified a more balanced list of supportive and controlling parent practices thought to influence child intake of healthy and unhealthy foods and beverages. In comparison, most physical activity parenting measures have focused on measuring the supportive practices that parents use to encourage physical activity and the controlling practices parents use to restrict sedentary behaviors. More attention is needed to identify parents’ physical activity practices that may unintentionally support inactivity and discourage physical activity.
Another limitation of current literature is a lack of information about how the parent practices influence the physical activity levels of young children, particularly those under the age of 5 yr. These children have limited autonomy and are therefore even more dependent upon others for many of their behavioral choices (23). Yet, few studies to date have explored the relation between parent practices and child physical activity in families with young children (14).
Work is needed to develop a comprehensive conceptual model of physical activity parenting practices, to create a measure that assesses these practices, and to explore how these practices influence physical activity and inactivity, particularly for those under the age of 5 yr. This article is intended to help address these gaps in the literature, in that it will (a) describe the development of an instrument designed to assess physical activity parenting practices and the content map used to guide its development, (b) present the factor analysis and identification of constructs from the content map, and (c) explore the association between these practices and child physical activity in a sample of families with 2- to 5-yr-old children.
This new instrument was designed to assess parenting practices thought to influence children’s physical activity and inactivity (i.e., screen time behaviors). PubMed was used to identify articles describing development of instruments to assess parenting practices around child physical activity and screen time. Items and scales from these instruments were reviewed to identify common physical activity parenting practice constructs captured by existing instruments. The constructs identified provided the foundation for the content map (Fig. 1). Items and scales measuring similar constructs were compared to select the most appropriate items for inclusion and prevent redundancy. Also, experts on the project team reviewed the content map and identified additional constructs they felt were missing. For example, there were existing items to capture rules and limits around TV time, but there were insufficient existing items to assess the variety of rules and limits parents may impose around active play. For these constructs, new items were created. The final survey included 147 items that included 47 items about the home’s physical environment, including presence of TV, video games, and computers throughout the house, a variety of adult exercise equipment, and a variety and accessibility of child play equipment; 41 items about controlling practices, such as rules around indoor and outdoor active play, limits on and monitoring of screen time, parent control over child activity and screen time, rewarding and punishing with either physical activity or screen time, and using activity or screen time as a distraction for the child; and 45 items about supportive practices, such as support, encouragement, and praise of physical activity, explicit modeling of physical activity or sedentary behaviors, talking with children about activity/inactivity and health, parent attitudes around activity and sedentary behaviors, support from other adults in the household, and child preference for active versus sedentary activities. A few additional items were also included to capture parent report of child physical activity behaviors. (Instrument is available upon request.)
This new survey was administered as part of a larger intervention study involving families with preschool-age children (2–5 yr old). Protocols have been described in detail elsewhere (35) but are reviewed in brief here. A sample of 324 families with at least one child between the ages of 2 and 5 yr was recruited from central North Carolina. Recruitment strategies included interceptions at childcare centers, flyers sent home by childcare providers, advertisements and postings throughout the community, Listserv announcements, direct postal mailings, recruitment website, and informational tables at community fairs. Parents who indicated interest were screened by phone to confirm eligibility: having at least one child age 2–5 yr, having at least one overweight parent (body mass index ≥25 kg·m−2) in the household, and ability to read and comprehend English. All protocols were approved by the Institutional Review Board at the University of North Carolina at Chapel Hill.
Interested and eligible parents were scheduled for an in-person measurement event held in their local community. After signing consent, parents completed a variety of psychosocial surveys, including the newly developed physical activity parenting practices survey. In addition, parents were asked to have their child wear a belt with an ActiGraph GT3X accelerometer for 7 d (except when sleeping or participating in water activities). Monitors were programmed with a 15-s epoch, and belts were fit to the child’s waist so that the monitor was over their right hip. Parents were provided with a preaddressed, postage-paid envelop for monitor return.
The overarching themes of control and support were used to guide the exploratory factor analysis (EFA) of items from the physical activity and screen time parenting practices survey. Before beginning the EFA, item variability and correlations between items were examined. Any item where 85% or more of respondents selected one option (e.g., “strongly agree”) was considered for elimination because of low variation and limited ability to discriminate among participants. All items were found to have sufficient variability to be retained. Five pairs of items were found to be highly correlated (r > 0.80) and were therefore combined into a single item before beginning EFA. The EFA was performed with MPlus v6.1 (Muthen & Muthen, Los Angeles, CA) using a weighted least squares minimum variance estimator, oblique geomin rotation, and items as categorical where appropriate. Oblique rotation was used because we expect these social environment variables to be related to each other. Factors were developed and reduced using a stepwise process. At each step, eigenvalues, the scree plot, factors, and item loadings were reviewed; items that did not load on any factor (loading <0.20) were removed, then the EFA was repeated. The 0.20 criterion was set so that, if applicable, multiple items could be eliminated at one time, but that every item with low loadings (<0.40) was not eliminated during the first stages of the EFA. This approach gives items with loadings close to 0.40 “a chance” to be retained on a factor after the least significant items are removed. On this basis, no more than two items were removed during each reduction step. The process was repeated until all retained items had factor loadings of 0.40 or higher. For the few items that loaded higher than 0.40 on multiple factors (cross-loading), items were retained as part of the factor for which they had the highest factor loading. Once factors had been identified, alphas, means, SD, and correlations among the factor scores were examined.
Minutes of moderate or vigorous physical activity (MVPA) and sedentary time were estimated from accelerometer data, whereas TV time and outside time were estimated from parent report. Accelerometer data were considered valid if a child wore the monitor for 6 h or more for at least 4 d (33). Minutes of MVPA and sedentary time were quantified on the basis of calibration studies by Evenson et al. and Pate et al.; specifically, fewer than 25 counts per 15 s were considered sedentary, and more than 500 counts per 15 s were considered MVPA. Estimates of MVPA and sedentary times were standardized to a 10-h day by computing MVPA and sedentary minutes per hour (minutes of MVPA per wear hours) and multiplying by 10 h. This was done to account for the person-to-person variability in wear hours. Wear time should be accounted for in all analyses that use minutes of physical activity as an outcome. Parent-reported TV and outside times were summarized as hours of TV per day and hours outside play per day, respectively.
Simple correlations were calculated to explore the relations between individual factors of objectively measured and parent-reported physical activity parenting practices and child physical activity. Partial correlations were also calculated, controlling for parent race, family income, child sex, and child age.
A total of 324 parent–child dyads completed the baseline measures. The majority of parents were mothers (92.3%), either white (51.4%) or African American (39.8%), and well educated (75.3% having a 4-yr college degree or more). The majority of families (63.4%) had a household income ≥$50,000 (approximate median income for the area). The average age of the parent was 34.9 yr, and the average age of the child was 41.9 months.
Parent report of child outside and TV times were available for 303 children. On the basis of these data, children spend on average 1.87 ± 1.09 (mean ± SD) h·d−1 outside and 1.75 ± 1.28 h·d−1 watching TV. Two hundred eighty-one children had complete accelerometer data. On average, children spent 59.4 ± 19.7 min·d−1 in MVPA and 323.0 ± 33.3 min·d−1 in sedentary activity.
Of the original 147 items, 83 were retained to form the final 15 parent practices factors. Results from the EFA revealed six factors related to controlling parent practices and eight factors related to supportive parenting practices. There was one additional factor that captured parental perceptions of child preference for physical activity versus inactivity. Tables 1 and 2 provide descriptions for each factor along with their Cronbach alpha, range of factor loadings, and mean scores. More specifically, there were four factors related to parents’ controlling practices around children’s active play: rules around active play indoors, rules around active play outdoors, use of physical activity to reward/control behavior, and limiting outdoor play because of weather. There were two additional factors related to parents’ controlling practices around screen time: use of screen time to reward/control behavior and limiting or monitoring of screen time. With regard to supportive practices, there were six factors related to support for active play: explicit modeling and enjoyment of physical activity, verbal encouragement for physical activity, logistic support for sports, logistic support for active play, importance and value of physical activity, and support/reinforcement from other adults. In addition, there were two factors related to parental support for screen time: exposure to TV and explicit modeling and enjoyment of TV. Internal consistency for all factors was good, with Cronbach alphas ranging between 0.54 and 0.88.
The correlation matrix (Table 3) shows that many of these factors are significantly correlated with one another. Of the 105 total correlations among the factors, 65 were statistically significant (P < 0.05). Eleven were between 0.30 and 0.39 (absolute value), whereas six were greater than or equal to 0.40. Four of these correlations were between the screen-related factors (exposure, modeling, and limiting screen time). The other two “larger correlation” involved explicit modeling of physical activity, which correlated with verbal encouragement (r = 0.40) and logistic support for physical activity (r = 0.52). In addition, the four factors related to controlling practices around activity were often positively correlated with one another—parents who reported more rules, limits, or control tend to use more controlling practices in general. Importance and value for physical activity were significantly correlated with all six of the supportive practices around physical activity—those who reported greater importance and value of child physical activity tend to provide more supportive practices for physical activity. Child preference for physical activity was also significantly correlated with all but one of the supportive practices around physical activity—parents who reported higher child preference for physical activity tend to use more supportive practices. Although many correlations were statistically significant, the strength of these correlations was modest (with the majority being less than 0.4), which would suggest that factors are indeed measuring separate constructs.
The correlations between parent report of child outside time and TV time and the physical activity and screen time parenting practices revealed several significant associations (Table 4). With regard to controlling practices around physical activity, use of physical activity to reward/control behavior was positively associated with outside time (r = 0.15), whereas limiting outdoor play because of weather was negatively associated with outside time (r = −0.22). With regard to supportive practices around physical activity, five of the six practices (all but logistic support for sports) were positively associated with outside time (r = 0.15–0.28). With regard to screen time practices, use of screen time to reward/control child behavior, exposure to TV, and explicit modeling and enjoyment of screen time were all positively associated with TV time (r = 0.23–0.37). Limits on and monitoring of screen time were negatively associated with TV time (r = −0.44).
Overall, the associations between parenting practices and accelerometer-measured physical activity were less consistent than that of parent-reported outside and TV times. Specifically, MVPA was significantly associated with three controlling practices: rules around active play indoors (r = 0.20), use of physical activity to reward/control behavior (r = 0.16), and limiting outdoor play because of weather (r = 0.12). However, use of physical activity to reward/control behavior was the only controlling factor to remain significant in partial correlations that controlled for demographic factors. Verbal encouragement for physical activity (r = 0.15) and logistic support for active play (r = 0.15) were the only two supportive practices significantly associated with child MVPA, but significance was only observed in the partial correlations controlling for demographic factors.
It is important to establish healthy lifestyle behaviors, such as regular physical activity, early in life before unhealthy habits take root. During childhood, parents play a critical role in the socialization of their child and hence the behaviors they adopt, including physical activity and sedentary behaviors. Our results provide important construct validity and internal consistency evidence for a newly developed instrument that can be used to assess a wide range of parent practices to control and support their child’s active play and screen time behaviors. EFA and correlational findings support the construct validity of the new instrument and show strong internal consistency reliability for the individual scales.
The comprehensiveness of this new instrument is a positive extension of existing measures of physical activity parenting practices. Interest in how parental practices influence child physical activity and inactivity has intensified in recent years. However, there are very few well-developed measures of physical activity parenting practices, and those that do exist are often limited in scope. A recent review of existing measures called for the development of theory-based, multidimensional measures of physical activity parenting (29). Most instruments to date assess only a few select factors, primarily focusing on parental practices thought to support child activity, such as encouragement, logistic support, explicit modeling, and family activity (6,10,16,26,32). However, parent practices can also impede child activity. Instruments like the Parenting Strategies for Eating and Activity Scale survey (18) capture the opposite end of the spectrum, with items that assess limiting, monitoring, or controlling practices. This new instrument was developed using the existing literature and a clear conceptual model to provide an assessment of both controlling and supportive parenting practices around physical activity and screen time. It includes 15 factors—10 specific to practices around active play, 4 to screen time, and 1 around child preference.
The content map (Fig. 1) helps illustrate our attempts to create an instrument with comprehensive coverage of potential parental behaviors. It also shows how the original constructs were combined or separated during the EFA process. Some of the constructs emerged as unique factors, whereas others grouped together to form overarching factors. For example, parental value for physical activity was envisioned as one component of implicit modeling, and the factor analysis pulled three relevant items together to form one factor. In comparison, the factor that emerged for parental modeling of physical activity includes items related to multiple constructs in the original content map—parents’ use of their own behavior to be a model of activity, as well as doing activities together with their child, and parental enjoyment of activity. Although EFA is a useful strategy for scale development, it is also important to understand and describe the original constructs used to guide the initial selection of items. We can then better compare similarities across scales and possibly understand why results vary across studies.
One major theme that emerged from these data is a clear association between supportive practices around physical activity and child’s outside time and TV time. Similar studies with families of preschool-age children have also demonstrated an association between child physical activity and similar scales of “parental support” and “parental modeling” (20,30,36). In these other studies, parental support was measured using a single scale formed from five items about encouragement, coactivity, transportation, watching child do activities, and talking with child about the health benefits of physical activity. In comparison, our instrument expands many of these items into separate scales. This could be explained by differences in how parental modeling was conceptualized or defined. It is common to use parent report of their own physical activity as a measure of parent modeling (3,6,28,32), but in our content map, parental modeling was conceptualized as purposeful behavior on the part of the parent to use his/her own behavior to encourage the child to be more active by letting the child see him/her being active, hearing him/her talk about activity, being active together, and enjoyment of activity. Despite these differences, results from these different studies suggest that supportive practices may help promote children’s physical activity. Using this new instrument may allow researchers to highlight specific areas of support that offer the greatest effect on physical activity.
These findings are also consistent with the broader literature involving children and adolescents. The umbrella review of Cislak et al. (2) of interventional and correlational studies looking at relations of parent practices and child physical activity found strong evidence for the importance of instrumental support and preliminary support for the importance of parental physical activity and modeling, and encouragement, at least for adolescents. In addition, Pugliese and Tinsley’s (25) meta-analysis found that parental modeling, encouragement, and instrumental support were all significantly associated with child activity.
Findings from this study also suggest that controlling physical activity practices may influence children’s physical activity and inactivity. Use of physical activity to reward/control child behavior was positively associated with both parent report of child’s outside time as well as accelerometer-measured MVPA. This association may indicate that this strategy to manage child behavior encourages participation in physical activity. There were, however, some unexpected associations between child MVPA and rules around active play indoors and limiting outdoor play because of weather. One might hypothesize that rules and limits would decrease children’s physical activity, but these results show a positive association—more rules associated with more activity. Similar results have been observed in the food parenting practices literature around restrictive practices—with greater restriction being associated with higher intakes of junk foods (2). As in the food practices, this relation may reflect parents’ reaction to their child’s behavior, with parents of very active children finding that they need to impose more rules and limits as a strategy for managing their child’s behavior.
A third theme that emerged from the results is the association between screen time practices and child TV time. Supportive practices, including exposure to TV and explicit modeling and enjoyment of screen time, were positively associated with the time children spent watching TV. These constructs appear to operate similarly around screen time as they do in physical activity, with greater presence of TV and modeling of screen time behaviors by parents being associated with greater screen time behaviors in children. Controlling practices seemed to operate differently. Limits on and monitoring of screen time were inversely associated with TV time and thus may be an effective strategy for discouraging screen time. This is consistent with at least one other study in preschool-age children (30). However, use of screen time to reward/control behavior was associated with greater TV time. These findings may suggest that this strategy to manage child behavior leads to an increase in children’s screen time.
The associations observed between parenting practices and child physical activity often varied depending on the method used to assess child activity. Parent report of children’s time spent outside and watching TV was more strongly related to parenting practice factors than the accelerometer-based estimates of MVPA and sedentary times. This may be, in part, because of some sort of self-reporting bias. Although some reporting bias may be present, not all practices showed significant associations with child outside time and TV time, and the strength of these associations also varied considerably, suggesting that the type of data collection (self-report) does not account for all of this discrepancy. Another reason for these differences in findings is that different behaviors are being measured. Accelerometers are used to calculate minutes of MVPA and sedentary time. Although children tend to be more active when outdoors, outside time and MVPA are very different concepts. Children may be outside and be engaged in sedentary activities, or they may be inside and engaged in active play. Similarly, sedentary and TV times are not equivalent measures of child activity. Not all sedentary time is spent watching TV, and not all TV time is sedentary. In these data, neither TV and sedentary times (r = 0.12, P = 0.06) nor MVPA and outside times (r = −0.02, P = 0.76) were significantly related.
Additional research is needed to further explore how physical activity and screen time parenting practices influence children’s physical activity and screen time habits. Similar to food parenting practices, associations may differ depending on the sample’s demographic characteristics. More work is needed to examine differences between boys and girls, between low-income and high-income families, across different races/ethnicities, and for different age groups. Controlling for parental race, family income, child sex, and child age leads some insignificant associations to become statistically significant and vice versa. Preliminary analyses looking at different subgroups would suggest that this is a rich area for future research.
As with any study of this nature, we must acknowledge that the cross-sectional nature of the data does not allow for determination of causation, only association. In addition, the sample was recruited for a larger intervention trial, which may limit generalizability. The sample does, however, include a larger number of African American mothers and overweight or obese parents compared with other measures development articles. In addition, because of the nature of this project and of data collection, we were unable to have participants complete the items a second time; thus, we cannot provide test–retest reliability evidence for the scales. Finally, most participants were women. The literature has shown some differential effects of parent modeling of physical activity on child behavior between mothers and fathers. Unfortunately, at this point, we cannot evaluate this effect.
The results provide strong validity evidence for the 15 parental support and control for physical activity factors identified using EFA. These findings endorse the use and further development of these factors, which build on previous research, refining our understanding of the factors that influence physical activity behavior. Many of these factors show promise as modifiable intervention and public health targets.
The current research was funded by the National Heart, Lung, and Blood Institute at the National Institutes of Health (1R01HL091093). Support was also received from the National Institutes of Health through their grant to the University of North Carolina at Chapel Hill Nutrition Obesity Research Center (DK056350).
The project was conducted out of the University of North Carolina at Chapel Hill’s Center for Health Promotion and Disease Prevention, a prevention research center funded through a cooperative agreement with the Centers for Disease Control and Prevention (U48-DP001944).
The authors have no conflicts of interest to declare.
The findings and conclusions in this journal article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
The results of the present study do not constitute endorsement by the American College of Sports Medicine.
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Keywords:© 2013 American College of Sports Medicine
HOME ENVIRONMENT; PHYSICAL ACTIVITY; SEDENTARY TIME; SCREEN TIME; SCALE DEVELOPMENT; PSYCHOMETRIC PROPERTIES