Parent-child associations for changes in diet, screen time, and physical activity across two decades in modernizing China: China Health and Nutrition Survey 1991-2009.
While the household context is important for lifestyle behavior interventions, few studies have examined parent-child associations for diet and physical activity (PA) changes over time in a rapidly urbanizing country. We aimed to investigate changes in diet, screen time, and PA behaviors over time in children and their parents living in the same household, and examine the parent-child association for these behaviors.



We studied dietary, screen time, and PA behaviors in 5,201 parent-child pairs (children aged 7-17y) using longitudinal data from the China Health and Nutrition Survey (1991, 1993, 1997, 2000, 2004, 2006, and 2009). We collected three-day 24-h recall diet data to generate percentages of energy from animal-source foods, away-from-home eating, and snacking from 1991-2009, which are known urbanization-related behaviors. We used a seven-day PA recall to collect screen time (hours/week) and leisure-time sports participation (yes/no) since 2004. We examined the changes in children's and parents' behaviors over time using random-effects negative binomial regression for diet and screen time, and random-effects logistic regression for leisure-time sports. We then regressed each of the behaviors of offspring on each of their parents' same behaviors to examine the parent-child association, using the same set of models.



We observed increases in energy from animal-source foods, eating away-from-home, and snacking, as well as screen time and leisure-time sports in parents and children over time, with different rates of change between children and their parents for some behaviors. We found positive parent-child associations for diet, screen time, and PA. When parental intakes increased by 10 % energy from each dietary behavior, children's increase in intakes ranged from 0.44 to 1.59 % total energy for animal-source foods, 0.17 % to 0.45 % for away-from-home eating, and 2.13 % to 7.21 % for snacking. Children were also more likely to participate in leisure-time sports if their parents participated in leisure-time sports.



Our findings support household-based health behavior interventions targeting both children and their parents. However, generation-specific intervention strategies may be needed for children and adults, especially for dietary behaviors, which changed differentially in children versus parents in this rapidly modernizing population.
Department of Nutrition, Gillings School of Global Public Health & School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.|Carolina Population Center, University of North Carolina at Chapel Hill, 137 East Franklin Street, Room 6124, Campus Box #8120, Chapel Hill, NC, 27514, USA.
Fei
F
Dong
Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA.|Carolina Population Center, University of North Carolina at Chapel Hill, 137 East Franklin Street, Room 6124, Campus Box #8120, Chapel Hill, NC, 27514, USA.
Annie Green
AG
Howard
Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA.|Carolina Population Center, University of North Carolina at Chapel Hill, 137 East Franklin Street, Room 6124, Campus Box #8120, Chapel Hill, NC, 27514, USA.
Amy H
AH
Herring
Carolina Population Center, University of North Carolina at Chapel Hill, 137 East Franklin Street, Room 6124, Campus Box #8120, Chapel Hill, NC, 27514, USA.|Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, USA.
Amanda L
AL
Thompson
Department of Nutrition, Gillings School of Global Public Health & School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.|Carolina Population Center, University of North Carolina at Chapel Hill, 137 East Franklin Street, Room 6124, Campus Box #8120, Chapel Hill, NC, 27514, USA.
Linda S
LS
Adair
Department of Nutrition, Gillings School of Global Public Health & School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.|Carolina Population Center, University of North Carolina at Chapel Hill, 137 East Franklin Street, Room 6124, Campus Box #8120, Chapel Hill, NC, 27514, USA.
Barry M
BM
Popkin
Carolina Population Center, University of North Carolina at Chapel Hill, 137 East Franklin Street, Room 6124, Campus Box #8120, Chapel Hill, NC, 27514, USA.|Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA.
Allison E
AE
Aiello
National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China.
Bing
B
Zhang
Department of Nutrition, Gillings School of Global Public Health & School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. pglarsen@unc.edu.|Carolina Population Center, University of North Carolina at Chapel Hill, 137 East Franklin Street, Room 6124, Campus Box #8120, Chapel Hill, NC, 27514, USA. pglarsen@unc.edu.
Penny
0000-0001-5322-4188
P
Gordon-Larsen
D000293:Adolescent; D000328:Adult; D002648:Child; D002652:Child Behavior; D002681:China; D004032:Diet; D015444:Exercise; D005191:Family Characteristics; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D007899:Leisure Activities; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D010287:Parent-Child Relations; D010290:Parents; D057185:Sedentary Behavior; D062410:Snacks; D012922:Social Change; D013177:Sports
Animal-source food; Away-from-home eating; China; Household structure; Leisure-time sports; Screen time; Snacking; Urbanization