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Fathers' Impact on the Dietary and Physical Activity Behaviours of Children Aged 0‐5 Years

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Fathers' Impact on the Dietary and Physical Activity Behaviours of Children Aged 0‐5 Years Fathers’ impact on the dietary and physical activity behaviours of children aged 0‐5 years Adam Walsh BAppSc (Human Movement) MNutr & Diet Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy Deakin University December, 2017 Acknowledgements There are many people who have been with me, in one way or another, throughout my PhD journey. Firstly, I must thank my supervisors without whom I couldn’t have taken the road less travelled. Karen Campbell, who would have thought a shared flight home from DAA in Darwin would end like this? Thank you for giving me the opportunity to better myself. I truly value the support you have provided throughout my journey. Your constant looking out for me has not gone unnoticed and has been greatly appreciated. Kylie Hesketh, thank you for your constant support and guidance throughout my PhD. Your insights into the nuances of research and ability to guide me with them has helped me gain the confidence I needed to believe I could actually do this. Thank you for your promotion of my work – I know this has opened doors that perhaps would have otherwise remained closed. David Crawford, I’m not sure my academic journey would be as it is without your endless support. You’ve provided guidance, advice and ceaseless encouragement in my academic life, none more so than during my PhD. The opportunities that have been afforded me are, in large part, because of you. For that I am truly obliged. Adrian Cameron, in many ways you were the sounding board of my PhD. Always ready with some advice as well as endless patience for my seemingly never ending stats questions! Your pointed feedback always made me think about, and justify, what I was doing, which, in the end, probably made my PhD experience a (mostly) pleasurable one. There were many others who played their part ‐ it is truly a situation where the whole is greater than the sum of the parts. Sandrine Lioret, for working closely with me on my first paper; Sarah McNaughton, for encouraging me to believe in the same; Paige van der Pligt, for joining me on my qualitative journey; Claire Margerison, for holding the fort when my thesis called; and to my colleagues at IPAN, who were always willing to offer advice or guidance and ask me how things were going ‐ to you all I am indebted for your support. i To my family and friends…what can you say when you’ve received nothing but unconditional support for longer than you can remember? In your own way you have shaped me and I wouldn’t be who I am today without you. Finally, to my beautiful wife, Kim, and wonderful boys, Jack and Sam. Thank you for sharing this part of our amazing voyage and supporting me in whatever way you could. Mostly though, thank you for the pride you’ve shown in my work – to me that has been the greatest reward. My love and gratitude always. ii List of publications Published 1. Walsh AD, Cameron AJ, Hesketh KD et al. (2015) Associations between dietary intakes of first‐time fathers and their 20‐month‐old children are moderated by fathers' BMI, education and age. The British Journal Of Nutrition 114, 988‐994. 2. Walsh AD, Cameron AJ, Crawford D et al. (2016) Dietary associations of fathers and their children between the ages of 20 months and 5 years. Public Health Nutrition 19, 2033‐2039. 3. Walsh AD, Crawford D, Cameron AJ et al. (2017) Associations between the physical activity levels of fathers and their children at 20 months, 3.5 and five years of age. BMC Public Health 17, 628. 4. Walsh AD, Lioret S, Cameron AJ et al. (2014) The effect of an early childhood obesity intervention on father’s obesity risk behaviors: The Melbourne InFANT Program. The International Journal of Behavioral Nutrition and Physical Activity 11. 5. Walsh AD, Hesketh KD, van der Pligt P et al. (2017) Fathers' perspectives on the diets and physical activity behaviours of their young children. PLoS One 12, e0179210. iii Table of Contents List of Abbreviations………………………………………..…………………………………………… 4 List of Tables……………………………….…………….….……………………………………………… 5 List of Figures…………………………….……….…………...………………………………………….. 7 List of Appendices……………………………..……………….………………………………………… 8 Abstract………………………………………………..……………………………………………………… 9 Chapter One Introduction……………………………….……………………………………………………… 15 Chapter Two Literature review….……………………………………………………………………..……. 18 2.1 Introduction……………………….……………………………………………..……… 18 2.2 Children’s Health...……………………………………………………………………. 18 2.3 Children’s Dietary Intakes and Physical Activity Levels….…..…….. 20 2.3.1 Children’s Dietary Intakes…………………………………………………………. 20 2.3.2 Children’s Physical Activity Levels...…………………..……………………… 22 2.4 The Family Ecological Model..…………………………………………………… 24 2.5 The Family Ecological Model and children’s dietary intakes and behaviours……………………………………………………………….………… 26 2.5.1 Parental nutrition knowledge and attitudes………..…………………….27 2.5.2 Child food accessibility……………………...……………….…………………….. 31 2.5.3 Dietary modelling………..……………………………………………………………. 34 2.5.4 Shaping……………………………………………………………………………………… 36 2.5.5 Diet and socioeconomic position………………………………………………. 38 2.6 Family Ecological Model and children’s physical activity Behaviours…………………………….………………………………………….………. 39 2.6.1 Physical activity and parental modelling……………………………………. 41 2.6.2 Physical activity and accessibility………………..….…………………………. 42 2.6.3 Physical activity and socioeconomic position..........…………………… 44 2.7 Fathers’ and Children’s Dietary and Physical Activity Behaviours……………………………………………...................................... 47 2.7.1 Associations between Fathers’ and Children’s Dietary and Physical Activity Behaviours…………….……………………………………..… 49 2.7.2 Involvement of Fathers in Interventions to Change Young Children’s Health Behaviours……………………………………………………. 53 2.8 Summary and Thesis Aims…..……………………………………………………. 55 2.9 References…..……………………………………………………………………………. 59 Chapter Three Methods…………………………………….……………………………………………………… 67 3.1 Introduction………………….............………….…………………………………… 67 3.2 The InFANT Program...………………………………………….…………..……… 67 3.2.1 Sample size...……………………………………………………………………..…….. 68 3.2.2 Recruitment…..……..………………………………………………………………….. 69 3.2.3 InFANT Program Intervention……..……………………………………………. 73 3.2.4 Data collection...………………………………………………………………..…….. 73 3.2.5 Study measures………………………………………………………………………... 74 3.3 Qualitative Study.…..…………………………………………………………………. 77 3.3.1 Participant recruitment…………………………………………………………….. 77 3.3.2 Data collection...............................….………………………………………… 79 3.3.3 Data analysis………………..……………….………………………………………….. 79 3.4 References…..………………………………………………………………..…………. 81 Chapter Four Associations between dietary intakes of first‐time fathers and their 20‐month‐old children are moderated by fathers’ BMI, education and age ………………………………………………………………..…..…..… 82 4.1 Introduction.…………………………………………………………………………….. 82 Chapter Five Dietary associations of fathers and their children between the ages of 20 months and five years…………………………………………………….… 95 5.1 Introduction.……………………………………………………………..……………… 95 Chapter Six Associations between the physical activity levels of fathers and their children at age 20 months, 3.5 and five years of age............. 106 6.1 Introduction.………………………………………………………………………..…… 106 Chapter Seven The effect of an early childhood obesity intervention on father’s obesity risk behaviors: the Melbourne InFANT Program……………………. 118 7.1 Introduction….……………………………………………………………..………..…. 118 Chapter Eight Fathers’ perspectives on the diets and physical activity behaviours of their young children……………………………………………………. 131 8.1 Introduction….…………………………………………………………..…..…………. 131 Chapter Nine Thesis discussion...…………………………………………………………………….……… 158 9.1 Thesis summary………………………………………………………………..………. 158 9.2 Overview of findings….…………………...………….…………………….……… 159 9.3 Strength and limitations……...…………...……………………………..………. 164 9.4 Implications and future directions…….....…………………………….…… 168 9.5 Conclusion.………….……………...…………………………………………….…….. 172 9.6 References………………………………………………………………………….……. 174 Appendices…………………………………...………………………………………………………..…… A1 Appendix 1 InFANT Partner Survey at Child Age 20 Months………………………… A1 Appendix 2 InFANT Partner Survey at Child Age 3.5 Years………………….………. A14 Appendix 3 InFANT Partner Survey at Child Age Five Years……………….………… A25 Appendix 4 Cancer Council of Victoria’s Dietary Questionnaire for Epidemiological Studies (version 3.1) Food Frequency Questionnaire……………………………………………………………………..…… A36 Appendix 5 Response Categories for The Cancer Council of Victoria’s Dietary Questionnaire for Epidemiological Studies Food Frequency Questionnaire………………………………………………………… A41 Appendix 6 Australian Institute of Health and Welfare Active Australia Survey ……………………………………………………………………………………………………………. A42 Appendix 7 Flyer for Father Recruitment for Qualitative Study……..……………. A46 Appendix 8 Intervention Focus and Time Frame……………………………….………… A48 List of Abbreviations Abbreviation Meaning 95% CI 95% Confidence interval ANCOVA Analysis of covariance ANNPAS Australian National Nutrition and Physical Activity Survey BMI Body mass index CPM Counts per minute d Day DVD Digital video disk FFQ Food Frequency Questionnaire g Grams h Hour HEI Healthy eating index InFANT Infant Feeding, Activity and Nutrition Trial kg Kilogram LPA Light physical activity LSAC Longitudinal Study of Australian Children m2 Metres squared MCH Maternal and Child Health min Minutes MVPA Moderate‐vigorous physical activity NDNS National Diet and Nutrition Survey NHANES National Health and Nutrition Examination Survey
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