Zhou Peng
Patrick Wing-chung Lau
Li Ming Wen- 1Department of Sport Physical Education and Health, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
- 2School of Public Health, The University of Sydney, Sydney, NSW, Australia
Background: Early establishment of energy balance related behaviors (EBRBs) may be effective in combating unhealthy lifestyle in preschoolers. Parents are responsible for cultivating preschoolers’ EBRBs directly through parenting practices. Although investigating the impact of various parenting practices on preschoolers’ EBRBs is crucial to determine which practices should be recommended to parents to help reverse childhood unhealthy lifestyle, it is important to assess whether these effects of parenting practices on preschoolers’ EBRBs would be similar across different groups of preschoolers, necessitating research into the moderating effects of demographic characteristics.
Methods: Baseline dataset was utilized from an electronic health intervention study of Chinese 3-6-year-old preschoolers. Preschoolers’ PA and sleep duration and quality were objectively examined using wGT3X ActiGraph accelerometer. Data related to parents and preschoolers’ eating behaviors and sleep problems were subjectively assessed using parent-reported questionnaires. The PROCESS macro version 4.2 was used to perform moderation analysis. When the interaction revealed a p-value of less than 0.05 and the 95% confidence interval did not include 0, the conditional effects of the focal predictor at various levels of the moderator were further examined (p < 0.05) to investigate how the relationship between parenting practices and preschoolers’ EBRBs varied with different moderator levels.
Results: Married parents exhibited the desired outcomes in the relationship between parenting practices and their preschoolers’ EBRBs. In contrast, divorced/separated parents showed unfavorable results in this relationship. The association between the parents’ and preschoolers’ BMI varied depending on parents’ socioeconomic status, the preschoolers’ age, and the number of children in the household. The preschoolers’ age showed different moderating trend on the relationship between parents’ PA and preschoolers’ sedentary behaviors as well as the association of eating-related PSE with preschoolers’ eating behaviors. The mechanisms linking the parents’ PSE to the preschoolers’ PA, sedentary behaviors, and sleep duration were influenced by the preschoolers’ gender and the number of children in the household.
Conclusion: The potential parental influence warrants further investigation with the consideration that the relationship between parenting practices and preschoolers’ EBRBs varied across different group of children.
Clinical trial registration: NCT06025019.
Introduction
Preschoolers’ lifestyles have become increasingly characterized by physical inactivity, sedentary behaviors, unhealthy eating habits, disrupted sleep routines, and excessive screen time (1–5). Unhealthy lifestyle behaviors formed in the early childhood can track throughout the lifespan and may even contribute to the obesity and non-communicable diseases (e.g., cardiovascular diseases, diabetes, and chronic lung diseases) (6–8). Energy balance related behaviors (EBRBs) consist of physical activity (PA), dietary behaviors (DB), sleep and screen time (ST) (9). The early cultivation of health EBRBs, alongside with their synergistical effect, could be effective in reversing the unhealthy trend of lifestyle in the early childhood (e.g., adherence to recommended guidelines for PA, eating, sleep, and ST) (10). Parental involvement has played an important role in forming preschoolers’ EBRBs because parents may affect preschoolers’ EBRBs directly through parenting practices, which are identified as the practices parents use to effectively influence their children’s behaviors such as support and engagement in PA, role modeling in healthy eating, establishing the regulations of sleep and ST (11), while preschoolers are still developing their autonomy and rely on parental supervision (12).
Extensive studies have examined the relationship between parenting practices and preschoolers’ EBRBs. For example, previous study conducted in Canada found that parental support, encouragement to be physically active, and monitoring PA were associated with increased preschoolers’ PA (13). Restricting intake of unhealthy food was related to higher intake of those food and higher Body Mass Index (BMI) in the US and Sweden (14, 15). Philbrook (12) who explored a pathway linking the parental involvement at bedtime and preschoolers’ nighttime sleep duration and quality in the US found that longer parental presence and contact at bedtime were associated with better sleep (i.e., longer sleep time and greater sleep efficiency). Another study from the US indicated that restriction of child’s ST has found to be related to decrease weekly TV watching (16). Specific parenting behaviors arise from both cultural influences and the stimuli associated with the process of acculturation. Varying social values can lead to different socialization strategies aimed at helping children align with cultural norms. It can be inferred that parents with varying cultural values may adopt different parental values and practices (17). Consequently, the parental correlates of preschoolers’ PA, diet, sleep, and ST in western countries could not be generalized to other cultural contexts. Besides, given that EBRBs are not isolated but exhibit a tendency to co-occur in the early childhood (10), a clustered analysis of their parental influences is warranted, rather than examining them individually. In this perspective, comprehensive investigations on the relationship between parenting practices and preschoolers’ EBRBs within specific cultural context such as China are crucial to determine which practices should be recommended to parents to help combat unhealthy lifestyles of Chinese preschoolers.
The theoretical model proposed by Darling and Steinberg (18) argues that the influence of parenting practices on children’s development depends on children’s personality traits and parental factors. With regards to children’s traits, parents’ food restriction has been found to have undesirable impact on dietary intake of girls than of boys (14). Controlling diet-related parenting practices was positively related to favorable dietary consumption for normal weight children, but not for the overweight children (19). Also, the relationship between restrictive feeding practices and desirable dietary intake in preschoolers was found to be weaker or even non-existent among children with problematic eating styles, such as those who are picky eaters, reluctant to eat, or slow eaters (19). Regarding the parental factors, pressure to eat was found to be positively related to children’s dietary intake when parents were mother (20), had lower socioeconomic status (21), were older age (22), were higher BMI (23), and had higher educational level (24). Empirical evidence regarding the moderators of parenting practices on preschoolers’ EBRBs is generally lacking in Chinese cultural contexts, an examination of the interactions of parents and child characteristics with parenting practices may further help identify which parents use what practices can effectively improve preschoolers’ EBRBs, potentially informing the design of family-based programs and policies aimed at promoting healthy EBRBs in preschool-aged children.
The current study aims to explore whether the relationship between parenting practices and preschoolers’ EBRBs would be moderated by demographic characteristics, which in the present study refers to preschoolers’ age and gender as well as parents’ marital status, income, number of children in the household, and educational level. The hypothesis is that these children’s and parents’ demographic characteristics would moderate the association of corresponding parenting practices with preschoolers’ EBRBs.
Methods
Overview
The current study utilized baseline dataset (n = 206) from an electronic health intervention study of Chinese preschoolers aged from 3 to 6 years, which was designed as a two-arm single-blinded randomized controlled trial. A priori analysis was conducted using G*power 3.1.9.6 (25), a minimum sample size of 82 parent–child dyads in intervention and control group, respectively, is required to detect a small effect size d of 0.3 with a power of 0.80 under the condition of an alpha level of 0.05. Considering the 20% potential attrition rate, 206 parent–child dyads in total are needed (103 parent–child dyads in each group). The protocol for this parent-based eHealth intervention study has been published elsewhere (26). Data was collected from October 2023 to June 2024 and consisted of baseline, posttest, and follow-up, with a 12-week interval between each assessment. Parent–child dyads were recruited from four kindergartens in Guiyang, Guizhou province, China, with the assistance of Sun Yat-sen University and Guiyang Preschooler Education College. The inclusion criteria were [1] parents should be over 21 years old with children between the ages of 3 and 6; [2] parents and children should be in a healthy condition based on the health assessment conducted by kindergartens at the beginning of the new semester (referring to a state of physical, mental, social, intellectual, and emotional well-being and the absence of disease); [3] parents and children should reside together for at least 4 days per week. One face-to-face meeting was arranged in each of kindergartens to provide more details of this study. Parents/guardians were required to sign an informed consent form at the end of the parent meetings.
Measurements
Demographic information
Parents: socioeconomic status, age, gender, marital status, number of children in the household and Body Mass Index (BMI) were collected. Parent’s BMI was calculated based on the self-reported values of their weight and height (height/weight2), the results were then categorized using cutoff points for adults (i.e., 18.5 < BMI <23 indicating normal weight, BMI ≥ 23 indicating overweight or obesity) (27).
Preschoolers: child’s sex, age, weight, height, and BMI. Preschoolers’ weight was measured using standard practices to the nearest 0.1 kilograms using calibrated measurement scales (Salter) and height was measured using a stadiometer (SECA) to the nearest 0.1 cm. BMI was calculated with height and weight measurements (height/weight2). The BMI score was then categorized into overweight or obesity based on age and gender standard provided by the International Cutoff Points for Identification of Overweight and Obesity in Children (kg/m2) (28).
Preschoolers’ physical activity and sedentary behaviors
The PA level was objectively measured using a tri-axial accelerometer ActiGraph GT3X-BT, which has been validated and proven reliable for assessing PA levels in preschoolers (29). Both kindergarten teachers and parents received written and video instructions on how to use the accelerometer. Parents were also instructed to keep an activity diary to record both wear and non-wear time of the accelerometer. Teachers checked the accelerometer wear on each school day. The accelerometer was worn on the participant’s right wrist continuously for 7 days, except during water-related activities. Data was downloaded and processed using the ActiLife software (version 6.13) and analyzed in 1-s epochs. Valid wear time was defined as a minimum of 16 h of wear time over at least 3 days, including two weekdays and one weekend day (30). Non-wear time was determined as 60 consecutive minutes with zero counts per minute, following standard approaches in ActiLife. The accelerometer’s activity counts were categorized into different intensities by using the cut-off points: sedentary: <819 counts per minute (CPM); light: 820–3,907 CPM; moderate: 3908–6,111 CPM; and vigorous: ≥ 6,112 CPM.
Preschoolers’ dietary behavior
Children’s dietary behaviors was evaluated using the Children’s Eating Behavior Questionnaire, which has been validated in Chinese preschool-age children (31). Parents rated the frequency of their child’s eating behaviors on a 5-point scale (1 = never, 2 = rarely, 3 = sometimes, 4 = often, 5 = always) across eight domains comprising 35 items. These domains include satiety responsiveness (e.g., My child gets full before his/her meal is finished), slowness in eating (e.g., My child finishes meal quickly), food fussiness (e.g., My child enjoys tasting new foods), food responsiveness (e.g., if allowed to, my child would eat too much), enjoyment of food (e.g., My child enjoys eating), desire to drink (e.g., if given the change, my child would always be having a drink), emotional undereating (e.g., My child eats more when he/she is happy), and emotional overeating (e.g., My child eats more when she/he has nothing else to do). The scales demonstrate high internal consistency reliability, with an overall Cronbach’s alpha above 0.7.
Preschoolers’ sleep duration and quality
The ActiGraph was utilized to investigate the duration and quality of children’s sleep, in combination with a log sheet completed by parents and a nap schedule provided by kindergartens. Bedtime and wakeup time were determined using an algorithm developed by Sadeh et al. (32) and periods of sleep were estimated using algorithm developed by Tudor-Locke et al. (33). The ActiLife software (version 6.13) was employed to assess the duration of nighttime sleep, daytime naps, bedtime and wakeup time, sleep efficiency, and sleep latency using 60-s epochs. These data were then matched to the nap schedule recorded by kindergarten teachers and the log sheets completed by parents. The total daily sleep duration was calculated by summing up both nighttime and daytime sleep periods.
Preschoolers’ sleep problems
Chinese version of the Children’s Sleep Habits Questionnaire (34) was employed to evaluate sleep problems among preschoolers. It consists of 33 items that assess eight different domains related to sleep, including bedtime resistance, sleep onset delay, sleep duration, sleep anxiety, night waking, parasomnia, sleep-disordered breathing, and daytime sleepiness. Each item is scored on a 3-point scale: “usually,” “sometimes”and “rarely’. Scores higher than 41 indicate a sleep problems. The CSHQ has demonstrated good reliability (Cronbach’s Alpha is 0.73) and validity.
Preschoolers’ screen time
Parents were asked to estimate the usual amount of screen time for their children on a typical weekday and weekend to determine the average screen time per week. For example, during the usual week, how much time does your child spend watching TV at home on weekdays and weekends? Questions were also involved the availability of screens and rules about screen entertainment. This questionnaire was used in previous study (35).
Parent’s physical activity
The Chinese Version of the International Physical Activity-Short Form was utilized to assess the PA levels of parents. This questionnaire consisted of seven questions that inquired about the amount of time spent engaging in PA over the past 7 days. The responses were then converted into metabolic equivalent task (MET) scores for each dimension or intensity of PA. To calculate the weekly PA in MET-minutes/week, the total number of minutes spent in each activity category was multiplied by the specific MET score assigned to that activity. Walking was assigned a MET score of 3.3, moderate physical activity (MPA) was assigned a score of 4 METs, vigorous activity (VPA) was assigned 8 METs. The questionnaire has demonstrated good reliability and validity in China, with an overall Cronbach’s Alpha of 0.79 (36).
Parenting feeding style
The Chinese Version of the Parent Feeding Style Questionnaire was utilized to assess parenting feeding styles. The questionnaire consists of four parts: instrumental feeding (IF; 4 items), emotional feeding (EF; 5 items), prompting or encouragement to eat (EnF; 8 items), and control over eating (CE; 10 items). Respondents were asked to rate their agreement on a 5-point Likert scale, ranging from “never” to “always.” For instance, “I allow my child to choose which food to have for meals.” The average score for each scale was calculated, with higher scores indicating a greater inclination for parents to engage in a particular feeding style. The overall Cronbach’s Alpha reliability coefficient for the questionnaire is 0.75 (37).
Parents’ self-efficacy
Parents’ self-efficacy (PSE), identified as parent’s belief in their ability to successfully perform the parenting role in their child’s PA, DB, sleep, and ST (38), was evaluated using a questionnaire previously used by Hammersley et al. (39). The questionnaire was back-to-back translated into simplified Chinese. It consists of 13 questions, with 4 items related to PA, 6 items related to DB, 1 item related to sleep, and 2 items related to ST. For example, one question asks how confident parents are in promoting healthy eating habits for their child. Respondents were asked to rate their confidence level on a 10-point Likert scale, ranging from “not at all” to “to a very high degree.” The sum of the scores for the 13 questions reflects the overall self-efficacy of parents in managing their child’s PA, DB, sleep, and screen time. A higher total score indicates greater self-efficacy in these areas.
Statistical analysis
All analyses were conducted using IBM SPSS (version 29), p value <0.05 was considered statistically significant. Number and percentage were performed on all demographic variables. Mean, median, standard deviation, number and percentage were performed on all outcome variables. PROCESS Marco version 4.2 by Andrew F. Hayes was utilized to conduct moderation analysis. The parenting practices were employed as independent variables while preschoolers’ EBRBs were set as dependent variables, the demographic characteristics were potentially set as moderators, which include preschoolers’ age and gender as well as parents’ marital status, income, number of children in the household, and educational level in the current study. When the interaction indicated p value <0.05 and 95 confidence interval did not include 0, the conditional effects of the focal predictor at values of the moderator were further checked (p < 0.05) to explore the relationship between parenting practices and preschoolers’ EBRBs depending on the different level of moderators, which were visualized using Microsoft Excel version 16.
Results
A total of 327 parents attended the four face-to-face meetings. Of which, 237 parents signed the informed consent. All the participating parents completed questionnaires collection and 196 participating preschoolers provided valid ActiGraph data. An overview of demographic characteristics of preschoolers and their parents and outcome variables can be found in Table 1. Figure 1 shows how the significant relationship between parenting practices and preschoolers’ EBRBs varies across the different values of moderators.
Table 1. Demographic information and outcome variables of participating parent–child dyads.
Figure 1. Significant demographic characteristics moderating the association between parenting practices and preschoolers’ EBRBs (*p < 0.05; **p < 0.01; p < 0.001. n.s, not significant). *The green bars represent the positive associations between parenting practices and preschoolers’ EBRBs, while the red bars indicate the negative association between parenting practices and preschoolers’ EBRBs. Yellow bars represent the insignificant relationship under this condition. *TMVPA, total moderate to vigorous physical activity; LPA, light physical activity; ALSB, average length of sedentary behaviors. *Because none of preschoolers engaged in vigorous physical activity at baseline, thus resulting in the same values of MPA and TMVPA.
The moderating effects on the association of PA-related parenting practices with preschoolers’ PA and sedentary behaviors
The marital status of parents was found to moderate the association of parents’ PA with preschoolers’ TMVPA (B = 0.679, p = 0.004). Parents’ PA and preschoolers’ TMVPA was positively related when parents get married (effect = 0.828, p = 0.012, 95 CI: [0.184: 1.471]), whereas this relationship found negative in single-parent family (effect = −0.155, p = 0.033, 95 CI: [−0.297: −0.012]).
The association between PA-related PSE and preschoolers’ LPA was found to be moderated by preschoolers’ gender (B = 0.319, p = 0.031). The PA-related PSE was negatively related to LPA for the girls (effect = −0.352, p = 0.002, 95 CI: [−0.576: −0.129]), but no longer related for the boys (p = 0.723). The relationship between PA-related PSE and preschoolers’ ALSB was moderated by the number of children in the household. This relationship was only negatively significant for family with more than one kid (effect = −0.20, p = 0.021, 95 CI: [−0.368: −0.030]), but not for the single child family (p = 0.274).
Preschoolers’ age moderated the relationship between parent’s PA and preschoolers’ sedentary behaviors (B = 0.388, p = 0.0001). Parent’s PA demonstrated a negative association with preschoolers’ sedentary behaviors for children aged at three (effect = −0.573, p = 0.011, 95 CI: [−1.010: −0.135]) and 4 years (effect = −0.329, p = 0.010, 95 CI: [−0.580: −0.078]), but not for peers aged at 5 years (p = 0.098).
The moderating effects on the relationship between parents’ and preschoolers’ BMI
Parents’ educational level (B = −0.089, p = 0.008), household income (B = −0.114, p = 0.017), number of children in the household (B = 0.298, p = 0.018), and preschoolers’ age (B = −0.242, p = 0.014) moderated the relationship between parents’ BMI and preschoolers’ BMI. Specifically, parents’ BMI demonstrated a positive relationship with preschoolers’ BMI when parents were education level of college or lower (effect = 0.256, p = 0.000, 95 CI: [0.150: 0.362]). However, under the condition of parents with educational level beyond bachelor degree, this relationship was no longer significant (p = 0.079—0.524). When the household income ranged from 3,000 (effect = 0.341, p = 0.000, 95 CI: [206: 0.475]) to 20,000 RMB (effect = 0.170, p = 0.029, 95 CI: [0.017: 0.324]), there was a positive relationship between parents’ BMI and preschoolers’ BMI. However, this relationship was not observed when the income was below 3,000 or above 20,000 RMB (p = 0.090—0.226). There was a positive association between parents’ BMI and preschoolers’ BMI when there was more than one child in the household (effect = 0.237, p = 0.000, 95 CI: [0.145: 0.328]), but this association was not present in households with only one child (p = 0.592). A significantly positive relationship between parents’ BMI and preschoolers’ BMI was found when the children were 4 years old (effect = 0.495, p = 0.000, 95 CI: [354: 636]), but the relationship was absent when they were three and 5 years old (p = 0.266–925).
The moderating effects on the association between parenting feeding practices and preschoolers’ eating behaviors
Regarding parenting feeding practices, preschoolers’ age moderated the relationship between parenting feeding practices and emotional overeating (B = 0.187, p = 0.046, 95 CI: [0.003: 0.371]). However, when exploring the moderating effect of age on the relationship between each feeding behavior (i.e., instrumental feeding, emotional feeding, encouragement to eat, and control eating) and the child’s emotional overeating, preschoolers’ age did not have a moderating effect on any of the four feeding behaviors and the child’s emotional overeating (p = 0.084—0.265). Preschoolers’ gender moderated the relationship between parenting feeding practices and preschoolers’ desire to drink (B = −0.438, p = 0.022). But no moderating effects of gender in relation to the each feeding practices and desire to drink was observed (p = 0.274—0.495). The relationship between parenting feeding practices and preschoolers’ food fussiness was found to be moderated by household income (B = 0.183, p = 0.034) and parents’ marital status (B = 0.804, p = 0.04). Neither household income (p = 0.295—0.876) nor parents’ marital status (p = 0.269—0.851) moderated the relationship between each feeding practices and preschoolers’ food fussiness.
Preschoolers’ age moderated the association between eating-related PSE and preschoolers’ slow eating (B = −0.150, p = 0.024) and preschoolers’ food fussiness (B = −0.120, p = 0.020). Specifically, PSE in eating is only negatively related with the preschoolers’ slow eating (effect = −0.250, p = 0.0006, 95 CI: [−0.039: −0.011]) and food fussiness (effect = −0.170, p = 0.003, 95 CI: [−0.029: −0.006]) in children aged at 5, but not in 3-year-old (p = 0.354—0.472) and 4-year-old children (p = 0.053—0.082). The relationship between eating-related PSE and preschoolers’ food fussiness was also moderated by parents’ marital status (B = −0.072, p = 0.020). Compared to children raised in single parent family, married parents with eating-related PSE were more likely to decrease the food fussiness in preschoolers (−0.104 vs. −0.083, p = 0.007—0.014).
The moderating effects on the association of sleep-related PSE with preschoolers’ sleep duration
The relationship between sleep-related PSE and preschoolers’ sleep duration was moderated by the number of children in the household (B = −0.343, p = 0.034). Sleep-related PSE was positively related with preschoolers’ sleep duration in only child family (effect = 0.247, p = 0.046, 95 CI: [0.005: 498]), but not in family with more than one child (p = 0.262).
Discussion
This study aims to investigate the heterogeneity in the association between parenting practices and preschoolers’ EBRBs based on preschoolers’ age and gender as well as parents’ marital status, income, number of children in the household, and educational level. Understanding how these demographic characteristics affected the relationship between parenting practices and preschoolers’ EBRBs in China is important for developing tailored family-based programs for future studies. Collectively, age of preschooler moderated the several associations of parenting practices and EBRBs of preschoolers (i.e., parents’ and preschoolers’ BMI, parents’ PA and preschoolers’ sedentary behaviors, eating-related PSE correlates of preschoolers’ slow eating and food fussiness). Gender of preschooler moderated the relationship between PA-related PSE and preschoolers’ LPA. Additionally, marital status of parent influenced the association of parents’ PA with preschoolers’ MPA/MVPA and correlation of eating-related PSE with preschoolers’ food fussiness. Income moderated the relationship between parents’ and preschoolers’ BMI. Number of children in the household moderated the following relationships (parents’ and preschoolers’ BMI, PA-related PSE and preschoolers’ ALSB, and sleep-related PSE and preschoolers’ sleep duration). Educational level moderated the relationship between parents’ and preschoolers’ BMI.
Age of preschoolers showed different moderating trend on the relationship between parents’ PA and preschoolers’ sedentary behaviors as well as the association of eating-related PSE with preschoolers’ eating behaviors (i.e., slow eating and food fussiness). Specifically, the influence of parents’ PA on preschoolers’ decreased sedentary behaviors was more pronounced in 3-year-old children and in 4-year-old children, but was absent in 5-year-old children, whereas the associations of eating-related PSE with preschoolers’ slow eating and food fussiness were only significant in 5-year-old children but not in children aged at 3 and 4 years. The former moderation may reflect that younger preschoolers (3–4 years) may be more dependent on and responsive to their parents’ modeling and encouragement of PA, leading to reduced sedentary time (40). As preschoolers grow, they undergo significant physical, cognitive, and social–emotional development, older preschoolers (5 years) may become more independent and influenced by factors outside the immediate family, such as peer relationships and school environments, attenuating the direct impact of parents’ PA on their sedentary behaviors (41, 42). More importantly, Chinese parents have long placed great importance on education, believing that earlier and high academic achievements can lead to more successful career future and economic success (43–47). Chinese children are facing greater academic burden and higher expectations from their parents, which has led to the phenomenon of “educational involution” (neijuan in Chinese) (48–50). Parents were more likely to force their children as young as 5 years old (also known as transition stage from preschool to primary school in China) to participate in numerous self-care and academic-related activities to avoid falling behind (43). Another unique feature of China education system is that the enrollment rates vary significantly across provinces in China due to differences in socioeconomic status, the unequal geographic distribution of high-quality educational resources, and varying admission score requirements (51). Students from Guiyang (the undeveloped city in China where the data was collected) could be motivated to spend huge amounts of time and energy to pursue high scores in Zhongkao (High School Entrance Examination) and Gaokao (National College Entrance Examination) than their counterparts in advantaged regions, in hopes of gaining admission to top universities (52). This overemphasis on academic achievements potentially neglect the importance of less sedentary behaviors. In addition, any activities such as PA that may compromise examination results may be gradually eliminated from a very young age (53, 54). These potential explanations do not appear to be the case in the latter moderation. This may be due to food neophobia, a natural developmental stage characterized by the tendency of young children to reject or be reluctant to try new or unfamiliar foods (55). This picky eating behavior can be observed as early as the first year of life, but typically intensifies around 2 years old. This heightened aversion to novel foods is driven by innate factors during this early childhood. After reaching this peak, the level of nutritional neophobia gradually declines as children transition into adolescence and adulthood and shows a slight increase in old age (55). Although neophobia is genetically determined, it can be reversed by the environment in which the child is raised (e.g., family, peers, and parents) (56). The developmental progression shows a shift from innate and biologically driven food preferences in early childhood to a greater influence of learned and social factors on food choices as children mature (57–59). Therefore, 3- and 4-year-old children were more likely to be influenced by their innate food preferences and exhibit picky eating behaviors compared to 5-year-old children. As children grow older, their food preferences become increasingly shaped by environmental and social factors, such as parental modeling, exposure to new foods, and education about nutrition (60–62).
The relationship between PA-related PSE and preschoolers’ PA has been demonstrated in the previous studies (63, 64), but this relationship differed for the gender of preschoolers in the current study. PA-related PSE was negatively associated with girls’ PA but not related to boys’ PA. This may be because that females are viewed as inherently inferior and subordinate to males in the traditional Chinese Confucius ideology (65). From a young age, Chinese girls and boys are segregated and receive different treatment to prepare for their respective future roles (66). Girls may be more susceptible to significant societal and cultural pressure to conform to feminine norms (67). Girls are expected to be gentle, kind, and sensitive, PA are deemed inappropriate for them (17). Parents may hold passive attitudes and expectations when it comes to encouraging PA for their daughter, this concept could diminish the positive impact of PSE (17).
The moderating effects of parents’ marital status indicated that married status produced desired outcomes between parenting practices and preschoolers’ EBRBs while divorced status found unfavorable results. Specifically, the relationship between parents’ and preschoolers’ PA was positive when the parents were married but negative when they were divorced. Besides, married parents with PSE in eating were more likely to alleviate preschoolers’ food fussiness compared to divorced parents (−0.104 vs. − 0.083, p < 0.05). These findings accord with earlier observations. For instance, previous studies exploring the relationship between family circumstances and children’s PA demonstrated that children raised in dual-parent families were more likely to engage in PA while children with single-parent household were less physically active (68–70). A large-scale cross-sectional study of Piloquet et al. (71), who investigated the food fussiness correlates of family environmental factors, indicated that food fussiness measured by CEBQ (which is the same as the current study measurement used to assess eating behaviors) was higher in children who lived with only one of their parents. These findings could be attributed to crucial role family plays in preschoolers’ behavior development. Based on the Family Systems Theory proposed by Bowen (72), which is a framework for understanding human behavior that views the family as an emotional unit and employs systems thinking to describe the complex interactions within that unit. Family members are intensely connected emotionally, often seeking each other’s attention, approval, and support while responding to one another’s needs, expectations, and distress (72). This interconnectedness creates interdependence among family members, meaning that a change in one person’s behavior is likely to prompt reciprocal changes in others (72). Within this social system, families possess unique characteristics, rules, roles, communication patterns, and power structures that extend beyond individual members (73). Families also consist of various subsystems, such as parent–child, sibling, marital, and co-parenting subsystems. Each family member influences each other directly and indirectly, with one member potentially affecting the dynamics between others (73). Interactions within families are viewed as transactional, meaning that parent–child interactions are bidirectional rather than one-sided, and causality operates in a circular manner rather than a linear one (73). Importantly, research has shown that parents’ negative emotions stemming from marital issues can “spill over” into their relationships with their children, potentially leading to the child’s maladjustment (74). Zheng et al. (75) highlighted the positive association between intact family and children’s PA was based on the hypothesis that children living with dual-parent family have more access to the beneficial entities of parental influence (e.g., role modeling and support of PA) compared to children living with single parent. Moreover, in married families, parents typically have a more cohesive emotional bond, which can foster supportive environments for children. This emotional support may encourage both parents and preschoolers to engage in PA together, leading to a positive relationship between their levels of PA (68). In contrast, divorced parents might experience emotional distance and conflict, which can reduce the quality of parent–child interactions (68). This lack of emotional support can negatively affect the motivation and opportunities for PA, resulting in a weaker or negative relationship between parents’ and preschoolers’ PA. Hasenboehler et al. (76), who evaluated the association between family structure and children’s eating behaviors, indicated that family cohesion (i.e., emotional closeness with children) was related to decreased restrained eating of children (i.e., attempts to refrain from eating). This may be because in a married context, parents were likely to work together, reinforcing each other’s strategies and decisions regarding their child’s eating habits. This collaboration may lead to consistent approaches that effectively reduce food fussiness. On the other hand, divorced parents may have differing approaches or conflicting strategies due to their separate households, which can confuse the child and exacerbate food-related issues (73, 76).
The mechanism linking the sleep-related PSE and preschoolers’ sleep duration varied by the number of children in the household, sleep-related PSE demonstrated a positive relationship with preschoolers’ sleep duration in single-child family, but this relationship was not significant in family with more than one child. This phenomenon may be because in single-child families, parents can devote more attention and involvement in their child’s sleep routines and more easily implement sleep-related strategies such as establishing and maintaining more control over the child’s sleep environment (77). Whereas, with multiple children, coordinating sleep schedules and routines for multiple children can be more challenging because parents may need to divide their time and resources (78), potentially reducing the intensity of their involvement in each child’s sleep (79). This finding also accords with previous study, which indicated that the sleep patterns and routines of the parent or sibling that the child shares a room with can have a significant influence on the child’s own sleep duration and quality. The child may feel compelled to synchronize their sleep–wake cycles with those of the person they are sharing a room with, rather than being able to follow their own optimal sleep schedule. These sibling-related sleep disturbances may diminish the positive impact of sleep-related PSE (80).
By examining the moderating effects of demographic characteristics, the study sheds light on the importance of considering the broader social and family context when examining the parenting-EBRB relationship. However, this study also contains several limitations. Data related to parents, preschoolers’ eating behaviors and preschoolers’ sleep problems and quality were subjectively assessed using parent-reported questionnaires, which may have led to report bias and inaccuracy. In the current study, the unequal distribution of preschoolers’ age and gender as well as parents’ demographic characteristics may mask or exaggerate the moderating effects. Therefore, further research with a more balanced distribution is necessary. Questionnaire items assessing sleep-related PSE were limited, which may have compromised the sensitivity of the measures. The number of moderators tested were limited by the data that were collected in the baseline of main intervention study. Finally, caution is warranted when generalizing our results to the broader population of young children raised in developed regions in China.
Conclusion
The current study extends the existing literature by demonstrating the moderating effects of demographic background on the relationship between parenting practices and preschoolers’ EBRBs. Married parents exhibited the desired outcomes in the link between parenting practices and preschoolers’ EBRBs. Conversely, divorced or separated parents showed unfavorable results in this relationship. The relationship between parents’ and preschoolers’ BMI varied depending on parents’ educational level, household income, preschoolers’ age, and number of child in the household. The age of the preschoolers moderated the relationships between parents’ PA and preschoolers’ sedentary behaviors as well as the association of eating-related PSE with preschoolers’ slow eating and food fussiness. The mechanism linking PSE and preschoolers’ PA, sedentary behaviors and sleep duration were influenced by preschoolers’ gender and number of children in the household. These findings represent an important advancement in understanding the contextual influences on the parenting practices-children’s EBRBs relationship, which suggests that interventions should be multifaceted, considering factors such as age and gender sensitivity, family structure, economic factors, parental status, and educational attainment. By tailoring health promotion strategies to these moderating factors, practitioners and policymakers can better support families in fostering healthier behaviors in preschoolers.
Data availability statement
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
Ethics statement
The studies involving humans were approved by Hong Kong Baptist University Research Ethics Committee. The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation in this study was provided by the participants’ legal guardians/next of kin.
Author contributions
ZP: Conceptualization, Data curation, Formal analysis, Writing – original draft. PL: Conceptualization, Supervision, Validation, Writing – review & editing. LW: Conceptualization, Methodology, Validation, Visualization, Writing – review & editing.
Funding
The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher’s note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
1. Song, M, Dieckmann, NF, Stoyles, S, Kim, Y, and Lumeng, JC. Associations between mother's and children's moderate-to-vigorous physical activity and sedentary time in the family context. Prev Med Rep. (2017) 8:197–203. doi: 10.1016/j.pmedr.2017.10.012
2. Holmes, JF, and Spencer, R. Unhealthy diet is associated with poor sleep in preschool-aged children. J Genet Psychol. (2021) 182:289–303. doi: 10.1080/00221325.2021.1905598
3. Nathanson, AI, and Beyens, I. The relation between use of Mobile electronic devices and bedtime resistance, sleep duration, and daytime sleepiness among preschoolers. Behav Sleep Med. (2018) 16:202–19. doi: 10.1080/15402002.2016.1188389
4. Cerin, E, Barnett, A, Baranowski, T, Lee, RE, Mellecker, RR, Suen, YN, et al. Parent-perceived neighbourhood environment, parenting practices and preschool-aged children physical activity and screen time: a cross-sectional study of two culturally and geographically diverse cities. BMC Pediatr. (2022) 22:309. doi: 10.1186/s12887-022-03377-0
5. Detnakarintra, K, Trairatvorakul, P, Pruksananonda, C, and Chonchaiya, W. Positive mother-child interactions and parenting styles were associated with lower screen time in early childhood. Acta Paediatr. (2020) 109:817–26. doi: 10.1111/apa.15007
6. Abbott, S, Parretti, HM, and Greenfield, S. Experiences and perceptions of dietitians for obesity management: a general practice qualitative study. J Hum Nutr Diet. (2021) 34:494–503. doi: 10.1111/jhn.12855
7. Anderson, SE, and Keim, SA. Parent-child interaction, self-regulation, and obesity prevention in early childhood. Curr Obes Rep. (2016) 5:192–200. doi: 10.1007/s13679-016-0208-9
8. Avis, JL, Cave, AL, Donaldson, S, Ellendt, C, Holt, NL, Jelinski, S, et al. Working with parents to prevent childhood obesity: protocol for a primary care-based eHealth study. JMIR Res Protocols. (2015) 4:e35. doi: 10.2196/resprot.4147
9. van Stralen, MM, Yildirim, M, te Velde, SJ, Brug, J, van Mechelen, W, and Chinapaw, MJ. What works in school-based energy balance behaviour interventions and what does not? A systematic review of mediating mechanisms. Int J Obes. (2011) 35:1251–65. doi: 10.1038/ijo.2011.68
10. dos Santos, CS, Picoito, J, Loureiro, I, and Nunes, C. Clustering of health-related behaviours and its relationship with individual and contextual factors in Portuguese adolescents: results from a cross-sectional study. BMC Pediatr. (2020) 20:247. doi: 10.1186/s12887-020-02057-1
11. Vlasblom, E, van Grieken, A, Beltman, M, L'Hoir, MP, Raat, H, and Boere-Boonekamp, MM. Parenting support to prevent overweight during regular well-child visits in 0-3 year old children (BBOFT+ program), a cluster randomized trial on the effectiveness on child BMI and health behaviors and parenting. PLoS One. (2020) 15:e0237564. doi: 10.1371/journal.pone.0237564
12. Philbrook, LE. Associations between parental involvement at bedtime and young children's evening cortisol and nighttime sleep. Dev Psychobiol. (2022) 64:e22322. doi: 10.1002/dev.22322
13. Mâsse, LC, O’Connor, TM, Lin, Y, Carbert, NS, Hughes, SO, Baranowski, T, et al. The physical activity parenting practices (PAPP) item Bank: a psychometrically validated tool for improving the measurement of physical activity parenting practices of parents of 5–12-year-old children. Int J Behav Nutr Phys Act. (2020) 17:134. doi: 10.1186/s12966-020-01036-0
14. Chen, B, Kattelmann, K, Comstock, C, McCormack, L, Wey, H, and Meendering, J. Parenting styles, food parenting practices and dietary intakes of preschoolers. Nutrients. (2021) 13:3630. doi: 10.3390/nu13103630
15. Sandvik, P, Kuronen, S, Reijs Richards, H, Eli, K, Ek, A, Somaraki, M, et al. Associations of preschoolers’ dietary patterns with eating behaviors and parental feeding practices at a 12-month follow-up of obesity treatment. Appetite. (2022) 168:105724. doi: 10.1016/j.appet.2021.105724
16. Neshteruk, CD, Tripicchio, GL, Lobaugh, S, Vaughn, AE, Luecking, CT, Mazzucca, S, et al. Screen time parenting practices and associations with preschool Children’s TV viewing and weight-related outcomes. Int J Environ Res Public Health. (2021) 18:7359. doi: 10.3390/ijerph18147359
17. He, H, Usami, S, Rikimaru, Y, and Jiang, L. Cultural roots of parenting: mothers’ parental social cognitions and practices from Western US and Shanghai/China. Front Psychol. (2021) 12:12. doi: 10.3389/fpsyg.2021.565040
18. Darling, N, and Steinberg, L. Parenting style as context: an integrative model. Psychol Bull. (1993) 113:487–96. doi: 10.1037/0033-2909.113.3.487
19. Gubbels, JS, Kremers, SP, Stafleu, A, Dagnelie, PC, Goldbohm, RA, de, N, et al. Diet-related restrictive parenting practices. Impact on dietary intake of 2-year-old children and interactions with child characteristics. Appetite. (2009) 52:423–9. doi: 10.1016/j.appet.2008.12.002
20. Brown, KA, Ogden, J, Vögele, C, and Gibson, EL. The role of parental control practices in explaining children's diet and BMI. Appetite. (2008) 50:252–9. doi: 10.1016/j.appet.2007.07.010
21. Spurrier, NJ, Magarey, AA, Golley, R, Curnow, F, and Sawyer, MG. Relationships between the home environment and physical activity and dietary patterns of preschool children: a cross-sectional study. Int J Behav Nutr Phys Act. (2008) 5:31–12. doi: 10.1186/1479-5868-5-31
22. Liem, DG, Mars, M, and De Graaf, C. Sweet preferences and sugar consumption of 4-and 5-year-old children: role of parents. Appetite. (2004) 43:235–45. doi: 10.1016/j.appet.2004.05.005
23. Montgomery, C, Jackson, DM, Kelly, LA, and Reilly, JJ. Parental feeding style, energy intake and weight status in young Scottish children. Br J Nutr. (2006) 96:1149–53. doi: 10.1017/BJN20061968
24. Kröller, K, and Warschburger, P. Maternal feeding strategies and child's food intake: considering weight and demographic influences using structural equation modeling. Int J Behav Nutr Phys Act. (2009) 6:78–9. doi: 10.1186/1479-5868-6-78
25. Faul, F, Erdfelder, E, Lang, A-G, and Buchner, A. GPower 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. (2007) 39:175–91. doi: 10.3758/BF03193146
26. Zhou, P, Song, H, Lau, PWC, Shi, L, and Wang, J. Effectiveness of a parent-based eHealth intervention for physical activity, dietary behavior, and sleep among preschoolers: protocol for a randomized controlled trial. JMIR Res Protoc. (2024) 13:e58344. doi: 10.2196/58344
27. Masih, D, Rakhra, G, Vats, A, Verma, SK, Singh, VK, Kirar, V, et al. Optimal cut-off values for body mass index and fat mass index based on age in physically active males using receiver operating characteristic curve. Diseases. (2023) 11:137. doi: 10.3390/diseases11040137
28. Cole, TJ, Bellizzi, MC, Flegal, KM, and Dietz, WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ. (2000) 320:1240–3. doi: 10.1136/bmj.320.7244.1240
29. Leeger-Aschmann, CS, Schmutz, EA, Zysset, AE, Kakebeeke, TH, Messerli-Bürgy, N, Stülb, K, et al. Accelerometer-derived physical activity estimation in preschoolers – comparison of cut-point sets incorporating the vector magnitude vs the vertical axis. BMC Public Health. (2019) 19:513. doi: 10.1186/s12889-019-6837-7
30. Lau, PWC, Song, H, Song, D, Wang, JJ, Zhen, S, Shi, L, et al. 24-hour movement behaviors and executive functions in preschoolers: a compositional and isotemporal reallocation analysis. Child Dev. (2023) 95:e110–e121. doi: 10.1111/cdev.14013
31. Zhou, N, and Sun, L. Confirmatory factor analysis of the Children's eating behaviour questionnaire in a Chinese urban preschooler sample. Int. J. Behav. Nutr. Phys. Act. (2021) 18:113. doi: 10.1186/s12966-021-01175-y
32. Sadeh, A, Sharkey, KM, and Carskadon, MA. Activity-based sleep-wake identification: an empirical test of methodological issues. Sleep. (1994) 17:201–7. doi: 10.1093/sleep/17.3.201
33. Tudor-Locke, C, Barreira, TV, Schuna, JM Jr, Mire, EF, and Katzmarzyk, PT. Fully automated waist-worn accelerometer algorithm for detecting children's sleep-period time separate from 24-h physical activity or sedentary behaviors. Appl Physiol Nutr Metab. (2014) 39:53–7. doi: 10.1139/apnm-2013-0173
34. Tan, TX, Wang, Y, Cheah, CSL, and Wang, G-H. Reliability and construct validity of the Children's sleep habits questionnaire in Chinese kindergartners. Sleep Health. (2018) 4:104–9. doi: 10.1016/j.sleh.2017.10.008
35. Hammersley, ML, Jones, RA, and Okely, AD. Time2bHealthy – an online childhood obesity prevention program for preschool-aged children: a randomised controlled trial protocol. Contemp Clin Trials. (2017) 61:73–80. doi: 10.1016/j.cct.2017.07.022
36. Ren, YJ, Su, M, Liu, QM, Tan, YY, Du, YK, Li, LM, et al. Validation of the simplified Chinese-character version of the international physical activity questionnaire-long form in Urban Community-dwelling adults: a cross-sectional study in Hangzhou. China Biomed Environ Sci. (2017) 30:255–63. doi: 10.3967/bes2017.035
37. Tam, W, Keung, V, Lee, A, Lo, K, and Cheung, C. Chinese translation and validation of a parental feeding style questionnaire for parents of Hong Kong preschoolers. BMC Public Health. (2014) 14:1194. doi: 10.1186/1471-2458-14-1194
38. Kieslinger, K, Wartha, O, Pollatos, O, Steinacker, JM, and Kobel, S. Parental self-efficacy-a predictor of Children's health behaviors? Its impact on Children's physical activity and screen media use and potential interaction effect within a health promotion program. Front Psychol. (2021) 12:712796. doi: 10.3389/fpsyg.2021.712796
39. Hammersley, ML, Okely, AD, Batterham, MJ, and Jones, RA. An internet-based childhood obesity prevention program (Time2bHealthy) for parents of preschool-aged children: randomized controlled trial. J Med Internet Res. (2019) 21:e11964. doi: 10.2196/11964
40. Goncalves, WSF, Byrne, R, de Lira, PIC, Viana, MT, and Trost, SG. Psychometric properties of instruments to measure parenting practices and children’s movement behaviors in low-income families from Brazil. BMC Med Res Methodol. (2021) 21:1–129. doi: 10.1186/s12874-021-01320-y
41. Carson, V, Langlois, K, and Colley, R. Associations between parent and child sedentary behaviour and physical activity in early childhood. Health Rep. (2020) 31:3–10. doi: 10.25318/82-003-x202000200001-eng
42. Keyes, BL, and Wilson, KS. Influence of parental physical activity and sedentary behavior on young children: considering time together. Res Q Exerc Sport. (2021) 92:311–20. doi: 10.1080/02701367.2020.1727405
43. Liu, Q, Hong, X, and Wang, M. Parental educational anxiety during Children's transition to primary School in China. Int J Environ Res Public Health. (2022) 19:15479. doi: 10.3390/ijerph192315479
44. Zhong, JD, He, Y, Gao, JJ, Wang, TY, and Luo, RF. Parenting knowledge, parental investments, and early childhood development in rural households in Western China. Int J Environ Res Public Health. (2020) 17:2792. doi: 10.3390/ijerph17082792
45. Zhu, J, Liu, M, Shu, X, Xiang, S, Jiang, Y, and Li, Y. The moderating effect of marital conflict on the relationship between social avoidance and socio-emotional functioning among young children in suburban China. Front Psychol. (2022) 13:1009528. doi: 10.3389/fpsyg.2022.1009528
46. Bai, Y, Liu, BY, Wang, L, Li, MJ, Zhang, SQ, Dang, RR, et al. Parenting practices and cognitive development of preschool-aged children: evidence from rural China. J Child Fam Stud. (2021) 30:2980–91. doi: 10.1007/s10826-021-02134-8
47. Chen, JJ, Sun, PZ, and Yu, ZW. A comparative study on parenting of preschool children between the Chinese in China and Chinese immigrants in the United States. J Fam Issues. (2017) 38:1262–87. doi: 10.1177/0192513X15619460
48. Chen, G, Oubibi, M, Liang, A, and Zhou, Y. Parents' educational anxiety under the "double reduction" policy based on the family and Students' personal factors. Psychol Res Behav Manag. (2022) 15:2067–82. doi: 10.2147/PRBM.S370339
49. Wu, P, Robinson, CC, Yang, C, Hart, CH, Olsen, SF, Porter, CL, et al. Similarities and differences in mothers’ parenting of preschoolers in China and the United States. Int J Behav Dev. (2002) 26:481–91. doi: 10.1080/01650250143000436
50. Wang, X, Yang, J, Zhou, J, and Zhang, S. Links between parent–grandparent coparenting, maternal parenting and young children’s executive function in urban China. Early Child Dev Care. (2022) 192:2383–400. doi: 10.1080/03004430.2021.2014827
51. Li, R, editor. “Analysis on the Chinese anxiety of involution from Jiwa with the background of globalization.” 2021 4th international conference on humanities education and social sciences (ICHESS 2021); (2021). Atlantis Press.
52. Luo, Y, Guo, F, and Shi, J. Expansion and inequality of higher education in China: how likely would Chinese poor students get to success? High Educ Res Dev. (2018) 37:1015–34. doi: 10.1080/07294360.2018.1474856
53. Li, XW, Zhou, SY, and Guo, YF. Bidirectional longitudinal relations between parent-grandparent co-parenting relationships and Chinese Children's effortful control during early childhood. Front Psychol. (2020) 11:11. doi: 10.3389/fpsyg.2020.00152
54. Zhang, X, Hu, BY, Ren, L, Huo, S, and Wang, M. Young Chinese Children's academic skill development: identifying child-, family-, and school-level factors. New Dir Child Adolesc Dev. (2019) 2019:9–37. doi: 10.1002/cad.20271
55. Białek-Dratwa, A, Szczepańska, E, Szymańska, D, Grajek, M, Krupa-Kotara, K, and Kowalski, O. Neophobia-a natural developmental stage or feeding difficulties for children? Nutrients. (2022) 14:1521. doi: 10.3390/nu14071521
56. Scaglioni, S, De Cosmi, V, Ciappolino, V, Parazzini, F, Brambilla, P, and Agostoni, C. Factors influencing children’s eating behaviours. Nutrients. (2018) 10:706. doi: 10.3390/nu10060706
57. Ventura, AK, and Worobey, J. Early influences on the development of food preferences. Curr Biol. (2013) 23:R401–8. doi: 10.1016/j.cub.2013.02.037
58. Russell, CG, and Worsley, A. Why don’t they like that? And can I do anything about it? The nature and correlates of parents’ attributions and self-efficacy beliefs about preschool children’s food preferences. Appetite. (2013) 66:34–43. doi: 10.1016/j.appet.2013.02.020
59. Montaño, Z, Smith, JD, Dishion, TJ, Shaw, DS, and Wilson, MN. Longitudinal relations between observed parenting behaviors and dietary quality of meals from ages 2 to 5. Appetite. (2015) 87:324–9. doi: 10.1016/j.appet.2014.12.219
60. Dovey, T, Staples, P, Gibson, E, and Halford, J. Food neophobia and 'picky/fussy' eating in children: a review. Appetite. (2008) 50:181–93. doi: 10.1016/j.appet.2007.09.009
61. Xi, Y, Liu, Y, Yang, Q, Liu, H, Luo, J, Ouyang, Y, et al. Food neophobia and its association with vegetable, fruit and snack intake among 12- to 36-month toddlers in China: a cross-sectional study. Food Qual Prefer. (2022) 98:104513. doi: 10.1016/j.foodqual.2021.104513
62. Finnane, JM, Jansen, E, Mallan, KM, and Daniels, LA. Mealtime structure and responsive feeding practices are associated with less food fussiness and more food enjoyment in children. J Nutr Educ Behav. (2017) 49:11–18.e1. doi: 10.1016/j.jneb.2016.08.007
63. Xu, H, Wen, LM, and Rissel, C. Associations of parental influences with physical activity and screen time among young children: a systematic review. J Obes. (2015) 2015:1–23. doi: 10.1155/2015/546925
64. Ward, DS, Mazzucca, S, Hales, D, and Vaughn, AE. Parenting self-efficacy for Children's healthy weight behaviors: relationship to body weight status in preschool-aged children. Obesity. (2011) 19:S122.
65. Luo, R, Tamis-LeMonda, CS, and Song, L. Chinese parents’ goals and practices in early childhood. Early Child Res Q. (2013) 28:843–57. doi: 10.1016/j.ecresq.2013.08.001
66. Lau, PWC, Lee, A, and Ransdell, L. Parenting style and cultural influences on overweight Children's attraction to physical activity. Obesity (Silver Spring). (2007) 15:2293–302. doi: 10.1038/oby.2007.272
67. Agbaria, Q, Mahamid, F, and Veronese, G. The association between attachment patterns and parenting styles with emotion regulation among Palestinian preschoolers. SAGE Open. (2021) 11:2158244021989624. doi: 10.1177/2158244021989624
68. Singhammer, J, Ried-Larsen, M, Møller, NC, Lund-Kristensen, P, Froberg, K, and Andersen, LB. Single parent status and children’s objectively measured level of physical activity. Sports Medicine - Open. (2015) 1:10. doi: 10.1186/s40798-015-0020-1
69. Hesketh, K, Crawford, D, and Salmon, J. Children's television viewing and objectively measured physical activity: associations with family circumstance. Int J Behav Nutr Phys Act. (2006) 3:36–10. doi: 10.1186/1479-5868-3-36
70. Gorely, T, Atkin, AJ, Biddle, SJ, and Marshall, SJ. Family circumstance, sedentary behaviour and physical activity in adolescents living in England: project STIL. Int J Behav Nutr Phys Act. (2009) 6:33–8. doi: 10.1186/1479-5868-6-33
71. Piloquet, H, Berge, B, Maigret, P, and Hospital, V. Food fussiness is associated with family environmental factors in 1-3-year-old children: a large-scale cross-sectional study. Appetite. (2024) 192:107043. doi: 10.1016/j.appet.2023.107043
72. Bowen, M. The use of family theory in clinical practice. Compr Psychiatry. (1966) 7:345–74. doi: 10.1016/S0010-440X(66)80065-2
73. Zhu, H, Zhao, K, Huang, L, Shi, W, Tang, C, Xu, T, et al. Individual, family and social-related factors of eating behavior among Chinese children with overweight or obesity from the perspective of family system. Front Pediatr. (2024) 12:12. doi: 10.3389/fped.2024.1305770
74. Kouros, CD, Papp, LM, Goeke-Morey, MC, and Cummings, EM. Spillover between marital quality and parent-child relationship quality: parental depressive symptoms as moderators. J Fam Psychol. (2014) 28:315–25. doi: 10.1037/a0036804
75. Zheng, X, Chen, J, Guo, Y, Xiong, Q, Hu, Y, Shi, S, et al. The buffer effect of physical activity: why does parental marital satisfaction affect adolescents’ problematic internet use. Addict Behav Rep. (2020) 11:100271. doi: 10.1016/j.abrep.2020.100271
76. Hasenboehler, K, Munsch, S, Meyer, AH, Kappler, C, and Vögele, C. Family structure, body mass index, and eating behavior. Int J Eat Disord. (2009) 42:332–8. doi: 10.1002/eat.20612
77. Tyler, D, Donovan, CL, Scupham, S, Shiels, AL, and Weaver, SA. Young Children’s sleep problems: the impact of parental distress and parenting style. J Child Fam Stud. (2019) 28:2098–106. doi: 10.1007/s10826-019-01429-1
78. Akacem, LD, Simpkin, CT, Carskadon, MA, Wright, JKP, Jenni, OG, Achermann, P, et al. The timing of the circadian clock and sleep differ between napping and non-napping toddlers. PLoS One. (2015) 10:e0125181. doi: 10.1371/journal.pone.0125181
79. Schlieber, M, and Han, J. The sleeping patterns of head start children and the influence on developmental outcomes. Child Care Health Dev. (2018) 44:462–9. doi: 10.1111/cch.12522
Keywords: physical activity, diet, sleep, screen time, child-rearing behaviors, preschool-age children
Citation: Peng Z, Lau PW-c and Wen LM (2024) Moderating effects of demographic characteristics on the relationship between parenting practices and energy balance related behaviors of Chinese preschoolers. Front. Public Health. 12:1476733. doi: 10.3389/fpubh.2024.1476733
Edited by:
Graça S. Carvalho, University of Minho, PortugalReviewed by:
Jiawen Wu, University of Illinois at Urbana-Champaign, United StatesWidjane Sheila Ferreira Goncalves, UNINASSAU, Brazil
Copyright © 2024 Peng, Lau and Wen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Patrick Wing-chung Lau, d2NsYXVAaGtidS5lZHUuaGs=