Health‐Related Parenting Among U.S. Families and Young Children's Physical Health
| Date | 01 June 2017 |
| DOI | http://doi.org/10.1111/jomf.12363 |
| Author | Jennifer March Augustine,Kate C. Prickett,Rachel Tolbert Kimbro |
| Published date | 01 June 2017 |
J M A University of South Carolina
K C. P University of Texas at Austin∗
R T K Rice University∗∗
Health-Related Parenting Among U.S. Families
and Young Children’s Physical Health
Parenting is a constellation of behaviors, yet
investigations of the link between parenting and
children’s health typically focus on singular
behaviors. Thus, patterns of health-related
parenting among U.S. families, associations
between patterns and children’sphysical health,
and the prevalence of such patterns among
different sociodemographic groups remain
unknown. Applying latent class analysis to
the Early Childhood Longitudinal Study–Birth
Cohort (2001; N=8,550) revealed 6 parenting
patterns. The pattern characterized by high lev-
els of television watching was associated with
the worst overall health; the pattern charac-
terized by the highest consumption of food and
amount of outdoor play was linked to the highest
odds of obesity. Children of less-educated moth-
ers and Black mothers were more likely to expe-
rience both of these patterns than the patterns
associated with the best child health, but these
patterns did not differ for Hispanics (vs. Whites).
Department of Sociology, Universityof South Carolina,
Columbia, SC 29208 (augustjm@mailbox.sc.edu).
∗Department of Sociology & Population Research Center,
University of Texasat Austin, Austin, TX 78712.
∗∗Department of Sociology, Rice University,Houston, TX
77005.
This article was edited by Linda Waite.
Key Words: early childhood, health, parenting, socioeco-
nomic status.
Income differences only appeared for patterns
associated with children’s general health.
Children’s physical health is determined by the
interplay among a number of factors, including
their social environment, physical environ-
ment, and genetics. Parents, however, have
been referred to as the primary gatekeepers of
children’s health, particularly when children
are young (Case & Paxson, 2002). This is
because parents, more than anyone else in a
child’s life, control the factors most proximate
to young children’s health. For example, parents
of infants— not medical providers—ultimately
decide to adopt health-related behaviors such
as breastfeeding and immunizing (Benin,
Wisler-Scher, Colson, Shapiro, & Holmboe,
2006; Giugliani, Caiaffa, Vogelhut, Witter, &
Perman, 1994). Among preschool-aged chil-
dren, parent behaviors such as boundary setting
or enrolling children in activities impact chil-
dren’s diets, routines, and levels of physical and
sedentary activity (Davison & Birch, 2001).
As such, parent–health related behaviors—or
broadly, parenting—is considered a proximate
determinant of children’s health that is just as
important as other determinants, such as insur-
ance coverage and access to quality health care
(Case & Paxson, 2002; Gable & Lutz, 2000;
Hoghughi, 1998).
At the same time, our understanding of
the role of parent behaviors in shaping
young children’s health remains limited by
816 Journal of Marriage and Family 79 (June 2017): 816–832
DOI:10.1111/jomf.12363
Health-Related Parenting and Children’s Health 817
investigations that typically conceptualize
parenting on the basis of singular behaviors
rather than as a constellation of behaviors.
Certainly, such an approach helps to clarify
the covariance between a behavior and health
outcome. Yet it does not reect the reality
of families’ lives in which parents perform
numerous health-related parent behaviors each
day (Hofferth & Sandberg, 2001). As such,
conventional approaches to studying the link
between parenting and child health overlook
how different health-related behaviors co-occur
in ways that may magnify or offset health risks
and advantages. They also can convey sim-
plistic assumptions about how behaviors vary
across different sociodemographic groups. For
example, the general nding that higher socioe-
conomic status (SES) families are better at
following through on individual healthy parent
behaviors than lower SES families (e.g., Prickett
& Augustine, 2016) suggests that higher SES
families are better at following through on all
healthy parent behaviors. Many higher SES fam-
ilies, however, likely engage in a combination
of adverse and advantageous behaviors.
Given these conceptual and methodolog-
ical limitations of prior research, our aim is
to generate new insights into how families
inuence young children’s health by studying
health-related parenting behavior as a holistic
concept. We do so by pursuing three aims.
The rst is to describe the typical patterns
of health-related parenting. Doing so will
provide new knowledge of how parent behav-
iors that promote children’s physical health
occur in tandem, how some risks co-occur,
and how advantageous and adverse behaviors
occur in some families simultaneously as well
as the prevalence of each distinct pattern of
health-related parenting among U.S. families.
Second, we describe how different patterns
in parenting correlate with young children’s
physical health, focusing on general health
and obesity—two key indicators of population
health disparities in children—and provide fresh
understanding in comparison to conventional
modeling approaches. Finally, we examine
how different patterns in health-related par-
enting vary across sociodemographic groups
(dened by family income, maternal education,
and race or ethnic background) and estimate
which groups of children are more likely to
experience the parenting patterns associated
with the greatest childhood health risks.
To pursue these aims, we use data from
the largest and most contemporary nationally
representative survey of U.S. families with
young children, the Early Childhood Longitu-
dinal Study–Birth Cohort, and an innovative
analysis strategy that pairs latent class analysis
(LCA) with regression techniques. We focus on
parenting behaviors during preschool, which
is a period when many behaviors linked to
children’s health take on greater salience when
compared with younger ages (e.g., household
routines have less relevance to infant children)
and long-term health trajectories are set in
motion (Williams & Goulding, 2009). Thus, it
is also a critical juncture for social policy and
research linking family life to child health.
H-R P C
H
Our rst aim, to describe the most common
patterns of health-related parenting among U.S.
families with preschool-aged children, draws
on multidisciplinary literature emphasizing the
importance of parenting for children’s phys-
ical health (Case & Paxson, 2002; Gable &
Lutz, 2000; Hoghughi, 1998; Philips, Sioen,
Michels, Sleddens, & De Henauw, 2014; Prick-
ett & Augustine, 2016). We consider parenting
to encompass activities, routines, or behaviors
that include some action on the part of the child,
but for which parents are the primary structur-
ing or controlling agents (Gable & Lutz, 2000).
We consider health-related parenting behaviors,
in particular, to be aspects of children’s lives
that parents structure or control to optimize chil-
dren’s healthy development or create bound-
aries that protect them against unhealthy phys-
ical development (Hoghughi, 1998).
Health-related parent behaviors that are pri-
marily intended to optimize children’s health
include on-time child well visits, which are
important for identifying health issues that
may become more problematic if left undiag-
nosed, administering vaccinations that prevent
many common child illnesses, and exchanging
information about children’s age-appropriate
health-related needs (Hagan, Shaw, & Duncan,
2008); promoting children’s physical activity
and healthy nutrition; and ensuring that children
have adequate sleep, which bolsters children’s
immunities and supports their growth (National
Institute of Health, 2012). Parent behaviors
that are primarily boundary-setting activities
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