title: Cumulative Risk Exposure and Waist Circumference in Preschool-Aged Children: the Mediating Role of Television and Moderating Role of Sex.
abstract: BACKGROUND
  Children exposed to multiple stressors are more likely to be overweight, but little is known about the mechanisms explaining this association.
  
  
  OBJECTIVE
  This cross-sectional study examined whether children exposed to multiple stressors had higher waist circumference, and whether this association was mediated through children's television time.
  
  
  METHODS
  Participants were 319 parent-child dyads. Children were 2-5 years old and had at least one overweight parent (BMI ≥ 25 kg/m2). Data were collected at baseline of a larger childhood obesity prevention study and included information on psychosocial stressors (e.g., parenting stress), demographic stressors (e.g., low income), children's television time, and children's waist circumference. Two cumulative risk scores were created by summing stressors in each domain (demographic and psychosocial). Mediation and moderated mediation analyses were conducted.
  
  
  RESULTS
  Indirect effects of both cumulative risk scores on waist circumference through television time were not significant; however, moderated mediation analyses found significant moderation by gender. The indirect effects of both risk scores on waist circumference through television time were significant and positive for girls, but near-zero for boys.
  
  
  CONCLUSIONS
  Reducing television time should be explored as a strategy for buffering against the negative health effects of exposure to multiple stressors among girls. Longitudinal and intervention research is needed to confirm these results and to identify mediating factors between cumulative risk and body weight among boys.
authors.affiliation: Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Anna H
authors.initials: AH
authors.lastname: Grummon
authors.affiliation: Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Amber
authors.initials: A
authors.lastname: Vaughn
authors.affiliation: Department of Psychology, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Jones
authors.affiliation: Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA. dsward@email.unc.edu.|Department of Nutrition, Gillings School of Global Public Health, and Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, 135 Dauer Drive, 2200 McGavran-Greenberg Hall, CB no. 7461, Chapel Hill, NC, 27599-7461, USA. dsward@email.unc.edu.
authors.forename: Dianne S
authors.initials: DS
authors.lastname: Ward
mesh_terms: D000328:Adult; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D050177:Overweight; D010290:Parents; D012307:Risk Factors; D057185:Sedentary Behavior; D013315:Stress, Psychological; D013690:Television; D055105:Waist Circumference
keywords: Body weight; Childhood obesity; Childhood overweight; Cumulative risk; Environmental factors; Family stress; Mediation; Moderation; Sex differences; Stressors; Television viewing; Waist circumference