AUXILIAR DE SECRETARIA

Introduction

Parents are gatekeepers of young children‟s eating, physical activity (PA), and screen time (ST) opportunities because they establish the home physical (availability and accessibility), and social environment (parenting practices). Parenting practices play a critical role in the development of young children‟s taste preferences, eating habits, PA and ST behaviors.6,8,10,12,23

Numerous parenting practices to influence children‟s eating and activity behaviors have been studied. While parental use of rewards to get children to eat certain foods or participate in an activity are effective at immediately increasing the targeted behaviors,26,44 evidence suggests that children‟s long term preferences for the targeted foods and activities decreases and preferences for the reward increases.9,13 Furthermore, excessive parent control such as pressure to eat or insisting their child participate in an activity may increase children‟s initial response for those behaviors, but may decrease preference later in life.15,21,41 Therefore, a need exists to identify the parenting practices that will lead to the development of children‟s capacity for lifelong healthful eating and PA.

Recent research suggests that developing self-regulation skills is a central mediator of health behavior change. For example, a review of the mediators of change in experimental designs showed that changes in self-regulation constructs had the most effect on changes in PA in adults compared to constructs such as self-efficacy and outcome expectations.45 Among children, self-regulation is positively associated with several outcomes, such as greater academic competence,39 university entrance exam scores,40 higher reasoning skills, and a greater ability to deal with stress more maturely.39 Evidence suggests that self-regulation is protective against overweight, as children with lower levels of self-regulation gain weight at a higher rate.20 Compared to normal weight children, overweight counterparts are less likely to delay

gratification, lack internal hunger cues, and respond more frequently to immediate rewards.48 Thus, a need exists to determine if parenting practices can contribute to the development of children‟s self-regulation skills to prevent obesity.

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Some research has examined the relationship between parenting practices and children‟s self-regulation skills, such as eating in absence of hunger, and ability to delay gratification. Children‟s ability to self-regulate their behavior increases in importance as children age, and are responsible for their own eating and activity decisions.33 Higher parent control through

monitoring, restriction, and pressure to eat may have negative consequences for children‟s health behaviors in the future, such as an inability self-regulate, eating in absence of hunger, and

increased dietary, sweet, and savory food intake.15,32,34,51 Similarly, restriction of certain foods and activities is associated with greater snack food intake, and decreased ability to self-regulate behavior.11,19 There is a gap in the literature such that, little evidence exists on the impact of parenting practices to develop self-regulation skills to prevent childhood obesity.

There is not a consensus on the theoretical underpinnings and theoretical and operational definitions of self-regulation.25,37,38,53 To examine self-regulation from a health behavior

perspective, we adopt a social cognitive definition that targets the development of personal agency.3 From this perspective, self-regulation is defined as dealing with a broad range of social and situational environmental challenges through the processes of goal setting and goal

striving.38 Simply, self-regulation is the ability to do a goal-directed behavior in the face of environmental challenges.2 Given that there are environmental pressures throughout life to choose unhealthy behaviors, this definition of self-regulation may identify a key skill necessary to develop in children and adults to perform sustained healthful eating, PA and decreased sedentary behavior.

Figure 1.1 illustrates our conceptual model for self-regulation based on a social cognitive health behavior approach3 that has been developed in the literature on self-regulation of learning in children.53 Our model suggests that parenting practices to foster self-regulation include three cyclical phases: forethought, performance, and self-reflection.53

The forethought phase precedes the behavior, and is where the processes of the behavior are learned. It is during this phase that an individual chooses health behavior goals, and develops plans to accomplish the goal. During the forethought phase, an individual‟s self-efficacy,

outcome expectations, task value and goal orientation fosters their health behavior choices. As such, individual‟s learn and choose health behavior goals, and develop plan to accomplish those goals.53 During forethought, an individual‟s beliefs guide actions that lead to health behaviors.1

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The performance phase occurs while participating in a behavior, and involves self- monitoring and self-control to make healthy eating and activity choices. Self-monitoring is defined as the tracking of one‟s behavior.53

Three processes comprise self-control: inhibition, emotion regulation, and compliance. First, inhibition is the ability to control impulses in reaction to unfamiliar objects and delay gratification.32 Second, there is a need to regulate emotions by recognizing, monitoring, and evaluating our reactions to accomplish one‟s goal.50 Third,

compliance is the ability for children to initiate, stop, or change their behavior to comply with the healthy goal.33

The last phase, self-reflection, occurs following a behavior and influences an individual‟s reaction to their experience, which in turn influences their forethought (and the cycle repeats itself). Self-satisfaction is included within self-reflection, such that positive self-reflection leads to increased self-satisfaction and continued health behaviors. However, negative self-reflection is more influential on behavior change, such that negative self-reflection will lead to self- dissatisfaction and higher motivation to change behavior.4 Zimmerman and Moylan (2009) define self-satisfaction as the “cognitive and affective reactions to one‟s self-judgments.”

Based on the literature that informed our conceptual model, parenting practices that foster children‟s self-regulation include “positive persuasion”,28

“active parenting encouragement,17 and “positive control”,32

where parents use “positive” control strategies about foods and activities (PA and ST). Positive control strategies are defined as deliberate comments and

judgments and are associated with increased ability for children to self-regulate.32 As such, these positive parenting practices include teaching, encouraging and guiding children‟s health

behavior32,36 to help foster children‟s acceptance of healthy eating and PA (forethought phase);

self-monitoring and self-control for those behaviors (performance phase); and reflection and self- satisfaction with their eating and activity behaviors (self-reflection phase).

Specific parenting practices may foster or discourage the development of self-regulation in children.15,17,28,32,34 However, few measures exist to examine parenting practices and the development of self-regulation in children. Thus, a need exists to develop a comprehensive measure of parenting practices to foster the development of child eating and activity self- regulation skills. Future interventions could target the identified parenting practices that foster self-regulation in children to prevent obesity.

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The purpose of this study is to develop a new measure of parenting practices to foster eating and activity self-regulation in young children. Through a review of the literature, we have developed a theory-based conceptual model (Figure 1.1) to operationalize parenting practices that foster self-regulation in young children. The model is an adaptation of Zimmerman and Moylan‟s (2009) social cognitive model of children‟s self-regulation for learning to children‟s self-regulation of eating, PA, and ST behaviors. We hypothesized that parenting practices to foster self-regulation of these health behaviors would be greater in normal weight compared to overweight children, and in higher socioeconomic status (SES) families compared to lower SES families. Also, it was hypothesized that children of parents who employ more practices to foster self-regulation compared to children of parents that employ lesser practices would perform greater healthful behaviors (FV consumption, PA) and less sedentary behavior.

Methods

Parents (n=258) were included in the study if they had a child aged 2.5 to 5.5 years, and completed a parent survey. Parents completed informed consents to have their child‟s height and weight measured, and nine parents did not consent to having their child measured and were excluded from the study. Parents were recruited through flyers sent home at child care programs, as well as research assistants asking parents directly at a local community center. Parents received a $10 gift card to a local department store as an incentive to complete the

survey. The Kansas State University Institutional Review Board approved the research protocol. Survey Development