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What do US and Canadian parents do to encourage or discourage physical activity among their 5-12 Year… Tu, Andrew W; O’Connor, Teresia M; Beauchamp, Mark R; Hughes, Sheryl O; Baranowski, Tom; Mâsse, Louise C Dec 1, 2017

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RESEARCH ARTICLE Open AccessWhat do US and Canadian parents do toencourage or discourage physical activityamong their 5-12 Year old children?Andrew W. Tu1, Teresia M. O’Connor2, Mark R. Beauchamp3, Sheryl O. Hughes2, Tom Baranowski2and Louise C. Mâsse1*AbstractBackground: Parents have the potential to substantively influence their child’s physical activity. This study identifiedthe parenting practices of US and Canadian parents to encourage or discourage their 5-12 year-old child’s physicalactivity and to examine differences in parenting practices by country, parental sex, age of child, and income.Methods: The sample consisted of 134 US and Canadian parents (54.5% US; 60.4% female) recruited from a web-basedpanel by a polling firm. The parents answered open-ended questions about what they and other parents do toencourage or discourage their child to be active. Responses were coded using a scheme previously developed to codeitems used in the published literature. Coded responses were summarized by domain and dimension with differencesin responses by country, parental sex, age of child, or household income assessed with a log-linear analysis.Results: The 134 parents provided 649 and 397 responses to ways that parents encourage or discourage their child’sphysical activity, respectively. Over 70% of responses for practices that encourage physical activity were related tostructure of the environment, parental encouragement, and co-participation. The most common response was co-participation in activity with the child. Of the practices that discourage physical activity, 67% were related to structureof the environment, lack of parental control, and modeling poor behaviors. The most common response was allowingscreen time. There were no differences in response by country, parental sex, child age, or household income.Conclusions: Parents most often encouraged physical activity through structure and emotional support anddiscouraged physical activity through lack of structure and control. Understanding how parents influence their child’sphysical activity may help improve intervention strategies. The current results will inform the development of a physicalactivity parenting practices instrument.Keywords: Parenting, Parenting practices, Physical activity, Child, QualitativeBackgroundHigh levels of physical activity during childhood havebeen linked to a number of health benefits including areduction in blood pressure, blood lipid levels, body fat,and depressive symptoms and an improvement in bonedensity [1]. Despite these benefits, national physical ac-tivity levels are low. Recent estimates have found thatless than 20% of Canadian and US children between theages of 6 and 19 accumulate at least 60 min of physicalactivity per day [2, 3].Parents have been identified as having the potential tosubstantively influence their child’s physical activity [4, 5].For example, parents can provide emotional (e.g., praise,encouragement) or tangible (e.g., financial, transportation)support for physical activity; directly model physical activ-ity; structure their child’s environment to promote phys-ical activity; promote autonomous decision makingregarding physical activity; or attempt to control theirchild’s behavior (e.g., through pressure or restriction) [6].These parenting behaviors or practices were related tochild physical activity levels, although the evidence was* Correspondence: Lmasse@bcchr.ubc.ca1Child & Family Research Institute, School of Population and Public Health,University of British Columbia, Vancouver, BC, CanadaFull list of author information is available at the end of the article© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Tu et al. BMC Public Health  (2017) 17:920 DOI 10.1186/s12889-017-4918-zweak and mixed [7–9]. A systematic review of physicalactivity parenting practice studies revealed that parentalsupport for physical activity was most consistently associ-ated with child physical activity; however, support typicallyencompassed multiple domains (e.g., encouragement,co-participation, tangible support) [9]. In a longitudinalstudy, parental encouragement to be physically active wasassociated with children’s levels of physical activity 5 yearslater [10].Few studies have qualitatively examined the parentingpractices that parents commonly use to encourage ordiscourage their child to be physically active. Existingqualitative studies focused on specific ethnic populations[11–13]. Nominal group technique sessions were con-ducted with Chinese [11] and Hispanic [12] parents ofpreschoolers and found that parents most often reportedparental engagement, logistic support, parental encour-agement, and promoting other health behaviors as prac-tices used to encourage physical activity and safetyconcerns, permissiveness of sedentary behavior, lack oftime, psychological control, and emotional abuse aspractices used to discourage physical activity. AmongAustralian Middle Eastern parents of 5 to 12 year oldchildren, the majority of parents promoted physical ac-tivity through organized sports and encouraging outdoorplay while focus on academic achievement and lack oftime were reasons parents discouraged physical activity[13]. Therefore, there is need to gain a greater under-standing in more diverse samples. Assessing the physicalactivity parenting practices among samples representa-tive of the general US and Canadian populations caninform development of a parenting practice measure tofully understand how parenting affects health behaviors.Building from our previous study which found thatparents reported using physical activity parenting prac-tices that are not included in current measures [6], thisstudy qualitatively explored the parenting practices thatmay encourage or discourage physical activity in theirchildren. This disconnect between parent reported prac-tices and practices measured in the literature highlightsthe importance of collecting qualitative data to under-stand how parents influence their child’s behavior. Theobjective of this study was to identify the parentingpractices that are predominantly reported by US andCanadian parents to encourage or discourage theirchild’s physical activity. In addition, this paper exploredwhether the parenting practices differed by: 1) parentalsex and age of child as previous studies found differ-ences in physical activity parenting practices for both ofthese indicators [9]; 2) income as this variable is amarker of resources which can be devoted to physicalactivity; and 3) country as it was thought important toexamine the stability of the findings across the sample.This study opted to use income instead of educationalbackground since educational background of both par-ents was not collected.MethodsThis research protocol was approved by the ResearchEthics Board of the University of British Columbia andreceived Institutional Review Board approval from theBaylor College of Medicine.SampleThe sample consisted of parents of 5-12 year old chil-dren who were living in Canada or the USA. Parentswere recruited by an internet research polling firm (You-GovPolimetrix, US) from their web-based panel mem-bership. Recruitment from a polling firm represented acost-effective approach of obtaining a large representa-tive sample over other sampling approaches. Recruit-ment occurred between November 2013 and February2014. All panel members provided consent to be part ofthe panel and to participate in the survey. To be eligible,participants had to be the primary guardian of a 5 to12 year old child. Participants were excluded if the childhad a physical or learning disability that limited theirchild’s physically activity. Panel members were sampledto reflect the socio-economic and ethnic diversity of thetwo countries based on the 2012 US and 2011 Canadiancensus estimates. To reflect socio-economic diversity,country-specific household income cut-points (< 40thpercentile, ≥40th to ≤80th percentile, and >80th percent-ile) were created and a corresponding percentage of par-ticipants (40%; 40%; 20%) were recruited into each group.To reflect ethnic diversity, participants were recruitedbased on the percentages of the largest ethnic groups foreach country (White, Hispanic, Black, and other in the USand White, East/Southeast Asian, South/West Asian, andother in Canada). In addition, the sample was balancedbetween parents with younger (5-8 years of age) and older(9-12 years of age) children. In total, 134 parents (73 USand 61 Canadian) provided valid responses. Participantsreceived 2000 points for their participation in this surveywhich could be redeemed as cash or gift cards valued atabout $5 USD/Cdn.QuestionnaireParents were asked to respond to a series of screeningand socio-demographic questions to ensure eligibility.Those who met the eligibility criteria were asked torespond to the following four questions based on theiryoungest or oldest child within the age criteria (selectedby the data collection program): 1) What sorts of thingsdo you do to encourage your child to be physicallyactive?; 2) What rules or guidelines do you have thatmay encourage your child to be physically active?; 3) Whatsorts of things might you do that may unintentionallyTu et al. BMC Public Health  (2017) 17:920 Page 2 of 9affect your child from being physically active?; 4) Thinkingabout other parents with children of the same age, whatthings do they do that may discourage their children frombeing physically active? The fourth question asked parentsto respond generally about other parents to avoid sociallydesirable responses. Each of the four questions was open-ended and parents could provide up to ten 160 characterresponses per question. A character limit was set to limiteach response to one practice and to encourage parents toprovide multiple responses (i.e., identify several parentingpractices). Parents were prompted to expand on their re-sponses if they provided short answers (<50 characters).As the questions were open-ended, parents were blockedfrom completing the questionnaire on their mobile de-vices which may limit their ability to type more detailedresponses. The online survey was piloted among 25 Can-adian parents using cognitive interviewing techniques[14]. Responses from questions 1 and 2 were grouped andcategorized as encouraging parenting practices and re-sponses from questions 3 and 4 were grouped and catego-rized as discouraging parenting practices.Coding of responsesDetailed information about the development of the cod-ing scheme used in this study can be found elsewhere[6]. Briefly, the coding scheme was initially developed tocode 74 published questionnaires/instruments designedto assess physical activity parenting practices, whichincluded 608 items [6]. The coding scheme was devel-oped based on a review of these published constructs,associated items and was informed by conceptual frame-works of parenting practices for physical activity and nu-trition [15, 16]. The coding scheme consisted of 6 broaddomains, 14 dimensions, and 1 to 5 sub-dimensions [6].The domains (dimensions in parenthesis) were structur-ing of the activity environment (monitoring, structure ofthe environment); emotional support (expressing posi-tive emotions, parental encouragement); parental control(expressing negative emotions, lack of parental control,pressure to be active, restriction, rewards and discipline);informational support (modeling, teach/reason); auton-omy promotion (autonomy support, co-participation);and tangible support (logistic support/facilitation) (seeour previous study for the full coding scheme anddetailed definitions) [6]. Each item from the 74 instru-ments was assigned to a dimension and sub-dimensionin order to group similar items. The list of items wasfurther reduced using a winnowing process that groupedsimilar items into a statement that best captured theparenting practice (608 items winnowed to 100 parent-ing practice statements). For example, three publisheditems asking about parent co-participation in physicalactivity (“During a typical week, how often has a femaleadult done physical activity with you?”; “How often doyou exercise with one or both of your parents?”; and“How often do you do the following activities togetheras a family with at least one adult family member – Playsports?”) were reduced to the following generic state-ment “Participate in [physical activity, sports, exercise]or play active games with my child.”Each parent response to the four questions on the on-line questionnaire was coded to a parenting practicefrom the consolidated list of 100 parenting practicestatements. For example, when parents were asked whatthey did to encourage their child to be physically active,one parent responded “Ask if she wants to join sports atschool, usually she does not” which was coded to theitem “I allow my child to choose whether s/he partici-pates in sports or vigorous physical activity in his/herfree time.” As the item was meant to describe a concept,responses in a negative direction could have been codedto an item in the opposite direction, if that alreadyexisted in the coding scheme. For example, one parent’sresponse to a question asking what the other parents didto discourage their child from being physically activeresponded “Not participating with their kids at all”which was coded to the item “I participate in [activitytype] with my child.” If the parent response had ele-ments of two distinct items, then the response wascoded to both items. Coding was conducted independ-ently by two researchers, discrepancies were discussed,and a consensus was reached. A third researcherreviewed the coding and discussed discrepancies withthe other two researchers. A new code was created forany unique parenting item that did not appear in the lit-erature. If more than one response from the same parentwas coded to the same item, the additional responseswere removed to avoid repetition.AnalysisCoded responses to the encouraging and discouragingquestions were ranked by domain and dimension. Toassess whether there were differences in responses bycountry, parental sex, age of child, or household income,a log-linear analysis with iterative proportional fittingwas conducted. Log-linear analysis is an iterative processwhich can test for higher order (e.g., three-way) associa-tions among categorical variables. Analyses were con-ducted on the above four sets of variables with each setincluding the coded domain (6 categories), a dichotom-ous variable indicating whether the response was en-couraging or discouraging (2 categories), and one ofcountry (USA, Canada), parental sex (male, female), ageof child (5-8, 9-12), or household income (below median,above median). All two- and three-way interactions wereassessed within each set. For each set, a saturated modelwas formed and each higher order term was sequen-tially removed to examine the goodness-of-fit. ModelTu et al. BMC Public Health  (2017) 17:920 Page 3 of 9fit was based on Pearson’s Chi-square statistic (χ2)and the deviance statistic (G2). Models with signifi-cant goodness-of-fit statistics suggest poor fit. Themost parsimonious model (model with least numberof interaction terms) was chosen as the best fittingmodel for each set. A p-value of <0.05 was consideredsignificant. Stata (version 13.1, College Station, Texas)was used for all analyses.ResultsParticipant characteristics can be found in Table 1. Ofthe 134 participants, 73 (54.5%) were from the US and81 (60.4%) were female. On average, each parent pro-vided 4.8 (SD 2.5; range 0-13) responses to practices thatencourage physical activity and 3.0 (SD 1.9; range 0-11)responses to practices that discourage physical activity.In total, from the 134 parents, 649 responses were prac-tices that parents said encouraged their child to engagein physical activity (coded to 78 unique parenting prac-tices) and 397 responses were practices that discouragedphysical activity (coded to 69 unique parenting prac-tices). In addition, 27 of the parenting practices (17encouraging and 10 discouraging practices) did not linkto any of the 100 parenting practices statements foundin the published measures of physical activity parenting(see Additional file 1: Appendices 1 and 2 for parentingpractices not included in the literature).Parenting practices that encourage physical activityAbout two-thirds of the responses to ways parentsencouraged physical activity were coded to structureof the activity environment and emotional support(see Table 2). The ten most coded responses are dis-played in Table 3 and represent 50% of all responsesrelated to encouraging physical activity. The full listof coded responses can be found in Additional file 1:Appendix 1. The percentage of participants that men-tioned each of the top 10 parenting practices rangedfrom 15.7% to 33.6%. The top 10 practices used toencourage physical activity included co-participation(participating in physical activity or walks with child),parental encouragement (encouraging outdoor play,physical activity, biking or walking in the neighborhood),structure of the environment (restricting sedentary behav-ior, ensuring active transport, taking child to park or playspaces), and tangible support (enrolling child in physicalactivity).Parenting practices that discourage physical activityAbout two-thirds of responses to ways parents discour-age physical activity were coded to the structure of theactivity environment and parental control domains withstructure, lack of parental control, and restriction beingthe dominant dimensions (Table 2). The top 10 mostcoded responses are displayed in Table 4 and make up60% of all responses to parenting practices that discourageTable 1 Participant characteristicsUSA (n = 73) Canada (n = 61)Parent Sex (female) 43 (58.9) 38 (62.3)Age of child5-8 33 (45.2) 32 (52.5)9-12 40 (54.8) 29 (47.5)Marital statusMarried or common-law 54 (74.0) 50 (82.0)Separated or divorced 11 (15.1) 8 (13.1)Never married 7 (9.6) 3 (4.9)Widowed 1 (1.4) 0EducationHigh school or less 22 (30.1) 5 (8.2)Certificate/diploma/or somecollege or university education13 (17.8) 16 (26.2)Bachelor’s degree 22 (30.1) 29 (47.5)Postgraduate degree 16 (21.9) 11 (18.0)IncomeBelow median 37 (50.7) 35 (57.4)Above median 32 (43.8) 26 (42.6)Missing 4 (5.5) 0Table 2 Responses by domain and dimensionEncourage(n = 649)Discourage(n = 397)Structure of the activity environment 236 (36.4) 154 (38.8)Monitoring 15 (2.3) 1 (0.3)Structure of the environment 221 (34.1) 153 (38.5)Emotional support 183 (28.2) 15 (3.8)Expressing positive emotions 8 (1.2) 5 (1.3)Parental Encouragement 175 (27.0) 10 (2.5)Parental control 32 (4.9) 113 (28.5)Lack of parental control 2 (0.3) 65 (16.4)Expressing negative emotions 6 (0.9) 8 (2.0)Pressure to be active 11 (1.7) 2 (0.5)Restriction 1 (0.2) 34 (8.6)Rewards and discipline 12 (1.9) 4 (1.0)Informational support 50 (7.7) 50 (12.6)Modeling 21 (3.2) 49 (12.3)Teach/reason 29 (4.5) 1 (0.3)Autonomy promotion 84 (12.9) 19 (4.8)Autonomy support 8 (1.2) 8 (2.0)Co-participation 76 (11.7) 11 (2.8)Tangible support 64 (9.9) 46 (11.6)Tu et al. BMC Public Health  (2017) 17:920 Page 4 of 9physical activity (see Additional file 1: Appendix 2 for en-tire list). The most common practice reported was lack ofparental control (allow child to watch TV or play video/computer games whenever s/he wants) which represented15.9% of all responses to ways parents discourage physicalactivity and was mentioned by 47% of participants. Theremaining parenting practices within the top 10 werementioned by 7.5% to 20.1% of the participants. Coded re-sponses in the top 10 included practices related to struc-ture of the environment (requiring supervision whenoutdoors, restricting outdoor play, restricting physical ac-tivity indoors), restriction (due to potential injury), model-ing (child sees me being sedentary), and tangible support(lack of time).Table 3 Top 10 coded responses to parenting practices that encourage physical activity (n = 649)Coded Response Domain Dimension Number ofresponsesPercent ofresponsesPercent ofparticipantsSample parent responsesI participate in [activity type] or playactive games with my child.AutonomyPromotionCo-participation 45 6.9 33.6 “We ride bike every afternoon”“When it is warm, we play tagoutside”“We will wrestle around the house”When the weather is nice, I encouragemy child to play outside.EmotionalSupportParentalEncouragement40 6.2 29.9 “Weather permitting, put themoutside in the yard for set periodsof time”“We encourage her to go outside”“I encourage her to invite her friendsover to play outside or go to the park”I limit the amount of time my childspends [sedentary activity type] onweekend/weekday.Structure ofthe ActivityEnvironmentStructure of theEnvironment39 6.0 29.1 “We limit her computer and TV time”“Cut back video games to onlyweekends”“They only have 2 h a day of videogames, the rest either outside orreading”I enroll my child in [activity type]. TangibleSupportLogisticSupport/Facilitation37 5.7 27.6 “She is signed up in swimming andtennis classes”“Sign him up to soccer, hockey, andbasketball clubs to ensure that theyget enough activity”“Enroll him in a fitness program”I encourage my child to participatein physical activity, or play sports(/in his/her free time).EmotionalSupportParentalEncouragement34 5.2 25.4 “Encourage him to participate inschool sports”“Play games with other siblings”“Encourage him to play at schoolplaygrounds instead of staying insidethe classes after lunch”I encourage my child to ride a bikeand walk in our neighborhood tobe active.EmotionalSupportParentalEncouragement33 5.1 24.6 “They love riding bikes so I encouragethat”“Go for walks, walk the dog”“Allow her to go outside to ride herbike and scooter”I make sure my child uses activetransportation to go to school(e.g., walk, bicycle, use publictransportation).Structure ofthe ActivityEnvironmentStructure of theEnvironment27 4.2 20.1 “She walks to and from school withher brother”“My kids walk to and from the busstop every school day”“Walk to school when we can”I take my child to the park,playground, or places thats/he can be physically active.Structure ofthe ActivityEnvironmentStructure of theEnvironment26 4.0 19.4 “I take her to the park to play”“I take him to the skating rink”“Go to the pool 3-4 times a week”I make sure my child uses activetransportation to do errands close tohome or to go places close to homesuch as by walking or bicycling.Structure ofthe ActivityEnvironmentStructure of theEnvironment24 3.7 17.9 “We do light shopping on foot andheavy shopping by car”“I encourage him to use a bicycleto go to close places”“We walk to the library when theweather allows”I go for walks with my child. AutonomyPromotionCo-participation 21 3.2 15.7 “She goes for walks with me”“Usually, we love to walk after meals”“Take them for walks with me everyevening”Tu et al. BMC Public Health  (2017) 17:920 Page 5 of 9Log linear analyses were conducted to examinewhether the responses differed by country, parental sex,age of child, and household income. Results of the log-linear analyses found that the best fitting model in allfour cases was one that only included an interactionbetween dimension and encouraging/discouraging par-enting practices (Table 5). Specifically, the interactionfound that parents emphasized different dimensions de-pending on whether they wanted to encourage or dis-courage their child to be physically active. The lack of anTable 4 Top 10 coded responses to parenting practices that discourage physical activity (n = 397)Coded Response Domain Dimension Number ofresponsesPercent ofresponsesPercent ofparticipantsSample parent responsesI allow my child to watch TVor play video/computer gameswhenever s/he wants to.ParentalControlLack of parentalcontrol63 15.9 47.0 “I let her watch more TV or use thecomputer more than she should dueto other demands around the house”“Letting their children rely on too manyelectronic devices”“Allow too much time on the computer/TV”My child must be supervisedwhen s/he is active outside.Structure ofthe ActivityEnvironmentStructure of theEnvironment27 6.8 20.1 “I don’t let her go outside alone”“If I can’t monitor you, you can’tparticipate in that”“She does not ride her bike outsidealone except when an adult is with her”I don’t allow my child to playoutside in the street after darkor after a certain time.Structure ofthe ActivityEnvironmentStructure of theEnvironment26 6.5 19.4 “He is to come inside before it gets toodark outside”“Not allowing children out after dark”“She can only play inside after dark”My child sees me beingsedentary (e.g. watchingTV, on the computer,sleeping a lot).InformationalSupportModeling 26 6.5 19.4 “We’re both out of shape and watcha lot of TV at night laying on the couch”“I am on the computer often”“Stay inside and do nothing ourselves”I [am/have enough timeto be] involved in my child’sactivities (e.g. coaching activities,watching child play).TangibleSupportLogistic Support/Facilitation22 5.5 16.4 “Too tired/busy to play with themoutside”“Not taking enough time or effort tocare for their children”“Our lifestyle for now prevent him to bemore active”I restrict some physical activitiesbecause I am afraid my child willbe hurt.ParentalControlRestriction 20 5.0 14.9 “I don’t let my child ride her scooter asmuch as she would like because I amscared she will get hurt”“Bubble-wrapping them by not lettingthem explore their environments”“Discouraging him to run outside duringwinter for fear of slipping and falling”I don’t allow my child to playoutside in bad weather. (*)Structure ofthe ActivityEnvironmentStructure of theEnvironment13 3.3 9.7 “If it is too cold, he is not allowedoutside”“We don’t allow our children to play inthe rain”“I do not allow my child to play outsidewhen it is too cold/hot”I restrict the amount of time mychild spends playing outside.Structure ofthe ActivityEnvironmentStructure of theEnvironment12 3.0 9.0 “Not allow them to play outside withother kids”“He’s always sick and I don’t let himoutside”“Keep them indoors versus taking themoutdoors”I have rules that my child is notallowed to walk [e.g., to theneighborhood park] alone.Structure ofthe ActivityEnvironmentStructure of theEnvironment10 2.5 7.5 “I won’t let her walk alone”“Do not allow him to go to the park onhis own”“Don’t let their kids walk anywhere ontheir own”I restrict [activity type] insidethe house.Structure ofthe ActivityEnvironmentStructure of theEnvironment10 2.5 7.5 “I won’t allow them to run in the house”“Don’t let them install chin-up bars inthe doorway”“Stop them from playing when I am tired”Tu et al. BMC Public Health  (2017) 17:920 Page 6 of 9interaction with any of the socio-demographic variablesindicates no differences were found in the responses bycountry, parental sex, age of child, or income.DiscussionThis study examined the parenting practices US andCanadian parents used to encourage and discourage phys-ical activity. While the majority of the practices reported bythe parents were captured in published research instru-ments, this study uncovered 27 unique parenting practicesthat were not captured (see Additional file 1: Appendix).This highlights the importance of conducting qualitative re-search in gaining a better understanding of parent’s beliefsand health behaviors.The most emphasized parenting practices used toencourage physical activity among children include co-participation in physical activity, encouraging physicalactivity or outdoor play, limiting sedentary behavior,enrolling children in physical activity classes or lessons,ensuring children use active transportation to go places,and taking children to the park or play spaces. Similar toother studies, co-participation in physical activity wasthe most endorsed parenting practice used to encouragephysical activity [11, 12]. Previous studies have foundinconsistent associations between parent-child co-participation in physical activity and child physical activ-ity [17–19]; however, co-participation has also been in-cluded in a higher domain of parental support orencouragement which has been frequently associatedwith child physical activity [9]. The remaining parentingpractices used to encourage physical activity were domi-nated by two domains: structure of the environment andparental encouragement. Structure refers to ways par-ents set up the environment in the home to influencetheir child’s physical activity whereas parental encour-agement refers to the various ways parents encouragechildren to participate in physical activity [6]. The fre-quency of reporting of these parenting practices suggeststhat parents may be more accepting to use these prac-tices to encourage physical activity. Future interventionsshould explore whether promoting these practices willinfluence child physical activity behavior.The most common parenting practices used by Canadianand US parents to discourage physical activity includedallowing sedentary behavior, limiting outdoor time due tolack of supervision, darkness, or poor weather, modelingpoor behaviors, lack of time, restricting physical activitydue to injury, restricting the time spent outdoors, andrestricting indoor physical activity. Similar to past studies,allowing sedentary behavior was the most endorsed practiceto discourage physical activity [11, 12].. This practice wasreported by almost half of the participants which was morethan double the number of participants who reported thesecond-most endorsed practice used to discourage physicalTable 5 Results of the log linear analysis to test for differencesin responses by parental sex, country, age of child, andhousehold incomeG2 X2 df p-valueModel 1: Parental sex(D, P, S) 235.9 213.1 16 <0.001(D, PS) 235.7 212.8 15 <0.001(P, DS) 226.4 205.4 11 <0.001(S, DP) 16.4 17.0 11 0.126(DP, DS) 6.86 6.92 6 0.334(DP, PS) 16.2 16.7 10 0.093(DS, PS) 226.2 205.0 10 <0.001(DP, DS, PS) 6.59 6.70 5 0.253(DPS) 0 0 0Model 2: Country(D, P, C) 228.7 209.4 16 <0.001(D, PC) 228.7 209.4 15 <0.001(P, DC) 225.3 205.2 11 <0.001(C, DP) 9.22 9.22 11 0.601(DP, DC) 5.80 5.82 6 0.446(DP, PC) 9.17 9.17 10 0.516(DC, PC) 225.3 205.2 10 <0.001(DP, DC, PC) 5.79 5.81 5 0.327(DPC) 0 0 0Model 3: Age of child(D, P, A) 228.7 208.3 16 <0.001(D, PA) 228.7 208.3 15 <0.001(P, DA) 222.5 201.5 11 <0.001(A, DP) 9.20 9.12 11 0.604(DP, DA) 2.95 2.93 6 0.815(DP, PA) 9.19 9.12 10 0.514(DA, PA) 222.5 201.5 10 <0.001(DP, DA, PA) 2.81 2.78 5 0.729(DPA) 0 0 0Model 4: Household income(D, P, I) 233.7 209.7 16 <0.001(D, PI) 233.6 209.4 15 <0.001(P, DI) 224.9 203.3 11 <0.001(I, DP) 17.5 17.5 11 0.093(DP, DI) 8.75 8.70 6 0.188(DP, PI) 17.5 17.5 10 0.065(DI, PI) 224.8 203.2 10 <0.001(DP, DI, PI) 8.74 8.69 5 0.120(DPI) 0 0 0D Dimension (6 categories), P Parenting behavior (Encourage/Discourage), SParental sex (M/F), C Country (USA/Canada), A Age of child (5-8/9-12), IHousehold income (below median/above median). XY represents two-wayinteractions; XYZ represents three-way interactionsTu et al. BMC Public Health  (2017) 17:920 Page 7 of 9activity. Parental permissiveness of sedentary behaviors hasbeen linked to increase screen time [20] but its associationwith physical activity is unclear. Permissive parenting ingeneral has been associated with higher amounts of phys-ical activity among children [21, 22]. Practices related tostructure of the environment were also heavily emphasizedby parents as practices used to discourage physical activity.The most common practices related to structure involvedrestriction or rules surrounding outdoor time. There isevidence that outdoor play is declining in North America[23, 24]. Active outdoor play is important for healthy devel-opment of children and parents should encourage theirchildren to explore their environment [25].There were no significant differences in the reportingof parenting practices used to encourage or discouragephysical activity by domain and each of the four socio-demographic variables tested (country, parental sex, ageof child, and income).The results are in contrast withstudies that have found differences in parenting practicesby parental sex [26] and income [11]; however, thesestudies were conducted in countries other than Canadaand the US. Lack of differences in our results amongthese four socio-demographic variables suggests that thefindings of this study may be generalizable to the largerCanada and US population.This study is not without limitations. The web-basedplatform used to collect parent responses only allowedfor structured questions. Therefore, there was no oppor-tunity to ask parents to elaborate on specific responsesor to probe further the meaning of their responses. Fur-ther discussions with parents may have uncovered moreparenting practices used to encourage or discouragephysical activity. In addition, the participants for thisstudy were sampled from a web-based panel and maynot be representative of US and Canadian parents. How-ever, a quota sampling approach was used to ensure anincome and ethnic distribution that matched the incomeand ethnic distribution of the US and Canadian popula-tion. Furthermore, information about the child’s sex wasnot collected; therefore, we could not examine differ-ences in parenting practices by child sex. Finally, childphysical activity behavior was not measured; therefore,the extent to which specific parenting practices influencechild behavior cannot be ascertained from this study.ConclusionsThis study explored common parenting practices usedby US and Canadian parents to encourage or discouragephysical activity among their children. Parents mostoften encouraged physical activity through structure andemotional support and discouraged physical activitythrough lack of structure and control. The findings pro-vide a unique understanding of the approaches used byparents to influence their child’s physical activity andhighlight the importance of using qualitative methods touncover parental beliefs and behaviors. Understandingthe different behaviors used by parents to influencephysical activity will help in the development of an in-strument to measure parenting practices related to phys-ical activity. Future studies are needed to ascertainwhether these practices used by parents affect childphysical activity behavior.Additional fileAdditional file 1: Appendix 1. Coded responses to parenting practicesthat encourage physical activity. Appendix 2. Coded responses toparenting practices that discourage physical activity. (DOCX 26 kb)AcknowledgementsNot applicable.FundingThe project described was supported by the Canadian Institute of HealthResearch Institute of Nutrition, Metabolism and Diabetes (CIHR-INMD;MOP-119359); AT received post-doctoral support from the Child & Family ResearchInstitute (CFRI) and the Michael Smith Foundation for Health Research; LCMreceived salary support from BC Children’s Hospital Research Institute. Thework is also a publication of the US Department of Agriculture (USDA/ARS)Children’s Nutrition Research Center, Department of Pediatrics, BCM fundedin part by the USDA/ARS (Cooperative Agreement 6250-51,000).Availability of data and materialsPlease contact corresponding author for data requests.Authors’ contributionsLCM, TMO, SOH, MRB and TB designed the study. LCM oversaw the datacollection. TMO, LCM, AWT were involved in the coding of responses. AWTperformed the statistical analyses and drafted the manuscript. All authorsprovided input to the manuscript and approved the final draft.Ethics approval and consent to participateThe protocol was approved by the Institutional Review Boards at theUniversity of British Columbia and Baylor College of Medicine.Consent for publicationNot applicable.Competing interestsThe authors declare that they have no competing interests.Publisher’s NoteSpringer Nature remains neutral with regard to jurisdictional claims inpublished maps and institutional affiliations.Author details1Child & Family Research Institute, School of Population and Public Health,University of British Columbia, Vancouver, BC, Canada. 2USDA/ARS Children’sNutrition Research Center, Baylor College of Medicine, Houston, TX, USA.3School of Kinesiology, University of British Columbia, Vancouver, BC, Canada.Received: 2 August 2017 Accepted: 15 November 2017References1. Janssen I, Leblanc AG. Systematic review of the health benefits of physicalactivity and fitness in school-aged children and youth. 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Parental influences on physical activity behavior inchildren and adolescents: a brief review. Am J Lifestyle Med. 2011;5:171–81.8. Beets MW, Cardinal BJ, Alderman BL. Parental social support and thephysical activity-related behaviors of youth: a review. Health Educ Behav.2010;37:621–44.9. Sleddens EFC, Kremers SPJ, Hughes SO, et al. Physical activity parenting: asystematic review of questionnaires and their associations with child activitylevels. Obes Rev. 2012;13:1015–33.10. Bauer KW, Nelson MC, Boutelle KN, et al. Parental influences on adolescents’physical activity and sedentary behavior: longitudinal findings from projectEAT-II. Int J Behav Nutr Phys Act. 2008;5:12.11. Suen Y, Cerin E, Wu S. Parental practices encouraging and discouragingphysical activity in Hong Kong Chinese preschoolers. J Phys Act Health.2015;12:361–9.12. O’Connor TM, Cerin E, Hughes SO, et al. What Hispanic parents do toencourage and discourage 3-5 year old children to be active: a qualitativestudy using nominal group technique. Int J Behav Nutr Phys Act. 2013;10:93.13. Hardy LL, Hector D, Saleh S, et al. Australian middle eastern parents’perceptions and practices of children's weight-related behaviours: talkingwith parents’ study. Health Soc Care Community. 2016;24:e63–71.14. Willis GB. Gordon B. Cognitive interviewing : a tool for improvingquestionnaire design. Thousand Oaks: Sage Publications; 2005.15. Davison KK, Mâsse LC, Timperio A, et al. Physical activity parentingmeasurement and research: challenges, explanations, and solutions. ChildObes. 2013;9:S103–9.16. Vaughn AE, Ward DS, Fisher JO, et al. Fundamental constructs in foodparenting practices: a content map to guide future research. Nutr Rev. 2016;74:98–117.17. Cleland V, Timperio A, Salmon J, et al. A longitudinal study of the familyphysical activity environment and physical activity among youth. Am JHealth Promot. 2011;25:159–67.18. Jago R, Fox KR, Page AS, et al. Parent and child physical activity andsedentary time: do active parents foster active children? BMC Public Health.2010;10:194.19. Verloigne M, Van Lippevelde W, Maes L, et al. Family- and school-basedcorrelates of energy balance-related behaviours in 10–12-year-old children:a systematic review within the ENERGY (EuropeaN Energy balance researchto prevent excessive weight gain among youth) project. Public Health Nutr.2012;15:1380–95.20. Jago R, Davison KK, Thompson JL, et al. Parental sedentary restriction,maternal parenting style, and television viewing among 10- to 11-year-olds.Pediatrics. 2011;128:e572–8.21. Jago R, Davison KK, Brockman R, et al. Parenting styles, parenting practices,and physical activity in 10- to 11-year olds. Prev Med (Baltim). 2011;52:44–7.22. Salmon J, Timperio A, Telford A, et al. 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Appetite. 2014;79:149–57.•  We accept pre-submission inquiries •  Our selector tool helps you to find the most relevant journal•  We provide round the clock customer support •  Convenient online submission•  Thorough peer review•  Inclusion in PubMed and all major indexing services •  Maximum visibility for your researchSubmit your manuscript atwww.biomedcentral.com/submitSubmit your next manuscript to BioMed Central and we will help you at every step:Tu et al. BMC Public Health  (2017) 17:920 Page 9 of 9


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