Andrea Dominica Smith

Background: Childhood obesity is a key policy challenge facing governments globally. Three decades of policy initiatives in England have been largely unsuccessful in reducing prevalence and inequalities in childhood obesity. Parents and families are often portrayed as responsible for children’s weight in the media. Less is known about their portrayal in policy documents. Understanding how parents and families are framed in policy documents can provide important insights into the factors shaping policy decisions and could thus support the development of more effective policies. This study extends prior work by shifting attention from media and intervention framing to the representation of parents and families within national policy texts. Methods: A qualitative framing analysis was conducted on how parents and families are framed in six seminal English childhood obesity policy documents published 2010–2020. Reflexive thematic analysis and framing theory were applied to identify themes. Results: Four themes were identified: (1) Parents and families are decision-makers; (2) Public services should empower parents and families; (3) Assumption of maternal responsibility for the family; and (4) Individual responsibility via the family. There were notable omissions in policies related to parents and childhood obesity, particularly broader societal factors such as financial constraints, contemporary family constellations and food insecurity. Conclusions: This research emphasizes the importance of both language and framing, and their potential biases in influencing policy approaches concerning parents’ role in childhood obesity. There is a need for re-evaluating commonly used frames that put excessive responsibility on parents to provide a healthy lifestyle for their children. Changes in framing in future policy are necessary to provide adequate support for parents and families for their effective involvement in addressing childhood obesity. Future policy should move beyond parent-blaming frames by combining recognition of family agency with practical, equitable support that addresses material, service and environmental constraints.

Background : Stress shapes parents’ decision making around risk-taking, yet little is understood about how this relates to the risks they allow their children to take. This study investigates the association between parental psychological distress and attitudes toward and tolerance of risky play in British parents of 2- to 11-year-olds. Methods : Data from 2 cross-sectional, nationally representative samples, the British Preschool Children’s Play Survey and the British Children’s Play Survey, were used. Survey respondents were parents and caregivers of preschoolers aged 2–4 years and school-aged children aged 5–11 years in Britain, respectively. Surveys used comparable methods and validated scales. Parental psychological distress was assessed using the Kessler Psychological Distress (K6) scale. Parental attitudes toward and tolerance of risky play were assessed by the Risk Engagement and Protection Survey (REPS) and the Tolerance of Risk in Play Scale (TRiPS). Linear regression investigated the association between K6 (exposure) and REPS and TRiPS (outcomes). Gender differences were tested with interactions and stratified analyses. Results : Among 1009 preschool parents, mothers experiencing greater distress were more protective ( B = 0.10, P = .038). Among 1272 parents of school-aged children, higher distress was associated with more protective attitudes ( B = 0.08, P = .006) and less supportive attitudes for risk engagement ( B = −0.07, P = .019). Conclusions : Parents who experience greater psychological distress have more risk-averse attitudes toward risky play in 2- to 11-year-olds than less distressed parents. Parental mental health is an important factor to consider when designing interventions to promote opportunities for child movement and risky play.

Background : Despite the benefits of physical activity (PA), evidence suggests around 25% of adults fail to meet PA guidelines, parents, and mothers in particular, and engage in less PA on average than their childless peers. This review sought to determine the correlates of parental PA, stratifying evidence by self-report and device-based measures. Methods : Quantitative studies (cross-sectional and longitudinal) investigating associations between correlates and parental PA (ie, parents with children aged 0–18 y) were identified across 4 databases (MEDLINE, EMBASE, PsycINFO and Scopus) up to October 2024. Correlates (assessed in 3 or more studies) and direction of associations were extracted, described, and synthesized narratively according to the socioecological model (individual, interpersonal, organizational, environmental, societal). Results : Of 4632 studies identified, 269 full texts were assessed and 105 studies included in the review. A total of 117 correlates were identified across all studies (103 for self-report measures, 55 for device-based). 53 correlates were assessed in 3/+ independent associations (n = 51 self-report, n = 14 device, n = 12 both). Consistently, partner PA was positively associated with parent PA regardless of measure used. Child PA, pet ownership, and environmental aesthetics were positively associated with (mothers’) PA, whereas car ownership was negatively associated with PA. Only one policy-level factor (COVID-19 restrictions) was assessed, being negatively associated with parental PA. Conclusions : Family-based correlates of PA were positively associated with parental PA, suggesting these may support wider family engagement in PA. Evidence from fathers and from low- and middle-income countries is needed to gain a better understanding of parental PA in these groups.

Background: Young adults increasingly rely on social media for nutrition information. However, little is known about (1) which types of eating-related content they actively engage with and why, and (2) how they interpret, evaluate, and incorporate this content into their everyday food choices and health behaviors. Objective: This qualitative study explored how UK young adults (aged 18-25 years) interact with food and nutrition content across social media platforms to inform the design of future social media interventions. Methods: Semistructured online interviews, guided by the Capability, Opportunity, Motivation–Behavior (COM-B) model, were conducted with 25 active social media users (18/25, 72% women, mean age 22.2, SD 1.9 years, ethnically diverse) in the United Kingdom between August and October 2024. The study design was informed by patient and public involvement to ensure relevance and acceptability. Data were analyzed using reflexive thematic analysis. To guide intervention development, key findings (coded as barriers and facilitators) were systematically mapped to the Theoretical Domains Framework, and the COM-B. Ethics approval was obtained from the University of Cambridge (24.368). Results: Five key themes were identified: (1) evolving engagement patterns (passive scrolling to active interaction and mixed feelings on algorithmic control), (2) conflicted information seeking (frustration with contradictory advice, varied strategies to assess credibility), (3) multifaceted behavioral impact (simultaneous positive impacts such as cooking inspiration and negative impacts such as restrictive eating triggers), (4) shifting goals (a movement from appearance-focused to health-centered goals; yet, vulnerability to body-image issues), and (5) intervention preferences (demand for credible professionals, customizable content, and privacy protection). Participants demonstrated a reactive learning process, developing “digital nutrition literacy” often after negative experiences. Social influences were identified as the most frequently cited domain (mapped to TDF [theoretical domains framework]/COM-B) shaping interactions with social media content. Conclusions: This study challenges assumptions of passive social media consumption, showing that young adults actively develop protective strategies yet remain vulnerable to misinformation. Digital interventions should leverage user agency and address diverse perceptions through customizable, credible content delivered with privacy and emotionally safe messaging. The COM-B and TDF mapping provide specific, evidence-based behavioral targets, particularly within the domain of Social Opportunity and Reflective Motivation, to guide the development of effective eHealth interventions. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2023-083465

Opportunities to engage in risky play and movement are critical for children’s development, physical and mental health. Parental attitudes, including fears and negative perceptions, are key modifiable barriers that directly impact these opportunities. The aim of this scoping review was to systematically identify and map the socioecological factors affecting UK parents that act as barriers or facilitators to children’s risky play to inform public health policy. Six electronic bibliographic databases (including MEDLINE, PsycINFO, ERIC, Child Development and Adolescent Studies, British Education Index, and Web of Science) were searched. Mixed Methods Appraisal Tool (MMAT) was used for quality appraisal, and stakeholders’ perspectives were incorporated through the UK Children’s Play Policy Forum. In total, 37 articles reporting 33 unique studies were included in the review. Parental barriers and facilitators were identified across all levels of the socioecological model (SEM). Most factors were at the individual and interpersonal levels, with relatively few at the policy level. Notably, the association with socioeconomic deprivation was mixed and inconsistent, suggesting complex social patterning of types of play and highlighting a critical research gap regarding play-related health inequalities in the UK. Stakeholders’ perspectives highlighted that individual behaviours are often tightly linked to structural determinants. Findings suggest that interventions focused solely on individual parental attitudes are likely to be insufficient, and both local and national policy must address parental fears around the social and built environment to meaningfully increase risky play opportunities for children.

BACKGROUND Young adults increasingly rely on social media for nutrition information. However, little is known about (1) which types of eating-related content they actively engage with and why, and (2) how they interpret, evaluate, and incorporate this content into their everyday food choices and health behaviors. OBJECTIVE This qualitative study explored how UK young adults (aged 18-25 years) interact with food and nutrition content across social media platforms to inform the design of future social media interventions. METHODS Semistructured online interviews, guided by the Capability, Opportunity, Motivation–Behavior (COM-B) model, were conducted with 25 active social media users (18/25, 72% women, mean age 22.2, SD 1.9 years, ethnically diverse) in the United Kingdom between August and October 2024. The study design was informed by patient and public involvement to ensure relevance and acceptability. Data were analyzed using reflexive thematic analysis. To guide intervention development, key findings (coded as barriers and facilitators) were systematically mapped to the Theoretical Domains Framework, and the COM-B. Ethics approval was obtained from the University of Cambridge (24.368). RESULTS Five key themes were identified: (1) evolving engagement patterns (passive scrolling to active interaction and mixed feelings on algorithmic control), (2) conflicted information seeking (frustration with contradictory advice, varied strategies to assess credibility), (3) multifaceted behavioral impact (simultaneous positive impacts such as cooking inspiration and negative impacts such as restrictive eating triggers), (4) shifting goals (a movement from appearance-focused to health-centered goals; yet, vulnerability to body-image issues), and (5) intervention preferences (demand for credible professionals, customizable content, and privacy protection). Participants demonstrated a reactive learning process, developing “digital nutrition literacy” often after negative experiences. Social influences were identified as the most frequently cited domain (mapped to TDF [theoretical domains framework]/COM-B) shaping interactions with social media content. CONCLUSIONS This study challenges assumptions of passive social media consumption, showing that young adults actively develop protective strategies yet remain vulnerable to misinformation. Digital interventions should leverage user agency and address diverse perceptions through customizable, credible content delivered with privacy and emotionally safe messaging. The COM-B and TDF mapping provide specific, evidence-based behavioral targets, particularly within the domain of Social Opportunity and Reflective Motivation, to guide the development of effective eHealth interventions. CLINICALTRIAL INTERNATIONAL REGISTERED REPORT RR2-10.1136/bmjopen-2023-083465

Background: Childhood obesity inequalities in England persist despite targeted interventions focused on promoting healthy diets and food environments. This study, part of the Family Food Experience Study-London, aimed to investigate the impact of deprivation and neighbourhood food environments on home food environments, parental feeding practices, child eating behaviours, food preferences, and child BMI. Methods: Families (n = 728) with primary school-aged children were recruited from four socioeconomically diverse London boroughs in 2022. Data were collected through computer-assisted interviews (30.8% in-person, 69.2% telephone) on home food environment, parental feeding practices, and children’s eating behaviours and food preferences. Deprivation was characterised using a composite measure of family and neighbourhood indicators of socioeconomic position. Neighbourhood food environment exposures were estimated from individualised activity spaces derived from home postcodes and reported commuting patterns. Child BMI was measured objectively. Generalised linear models examined cross-sectional associations between deprivation and neighbourhood food environment with family food-related outcomes, adjusting for school-level clustering, child sex, age and ethnicity. Results: Greater family deprivation was significantly associated with more ‘obesogenic’ family food practices, child eating behaviours and child BMI. Deprivation was linked to higher food responsiveness (β = -0.12, p = 0.002), emotional overeating (β = -0.11, p < 0.001), and increased desire to drink (β = -0.26, p < 0.001). Parents in more deprived households used more emotional (β = -0.10, p < 0.05), instrumental (β = -0.11, p = 0.003) and pressuring feeding practices (β = -0.14, p < 0.001). Greater deprivation was also associated with a more obesogenic home food environment (β = -0.19, p < 0.001) and lower meal structure (β = 0.17, p < 0.001). Exposure to less healthy neighbourhood food environments around and between home and school were associated with a more obesogenic home food environment (β = -0.07, p < 0.01), but no significant associations were found with feeding practices, child eating behaviours or child BMI. Conclusions: In this study, family deprivation, rather than neighbourhood food environments, was more strongly linked to obesogenic feeding practices, child eating behaviours and child BMI. Policies focusing on improving neighbourhood food environments will likely be most effective if combined with those addressing systemic issues related to deprivation such as welfare policies (e.g. reforms to benefit caps) or targeted subsidies for healthy food. Future research should examine the independent and accumulative impact that environment and household interventions have on childhood obesity inequalities.

Purpose Childhood obesity inequalities in England persist despite targeted interventions focused on promoting healthy diets and food environments. This study, part of the Family Food Experience Study-London, aimed to investigate the impact of deprivation and neighbourhood food environments on home food environments, parental feeding practices, child eating behaviours, food preferences, and child BMI. Methods Families (n=728) with primary school-aged children were recruited from four socioeconomically diverse London boroughs in 2022. Data were collected through computer-assisted interviews (30.8% in-person, 69.2% telephone) on home food environment, parental feeding practices, and children’s eating behaviours and food preferences. Deprivation was characterised using a composite measure of family and neighbourhood indicators of socioeconomic position. Neighbourhood food environment exposures were derived from individualised activity spaces. Child BMI was measured objectively. Generalised linear models examined associations between deprivation and neighbourhood food environment with family food-related outcomes, adjusting for school-level clustering, child sex, age and ethnicity. Results Greater neighbourhood deprivation was significantly associated with more ‘obesogenic’ family food practices, child eating behaviours and child BMI. Deprivation was linked to higher food responsiveness (β=-0.12, p=0.002), emotional overeating (β=-0.11, p Conclusions Family deprivation, rather than neighbourhood food environments, is more strongly linked to obesogenic feeding practices, child eating behaviours and child BMI. Policies focusing on improving neighbourhood food environments will likely be most effective if combined with those addressing systemic issues related to deprivation such as welfare policies (e.g. reforms to benefit caps) or targeted subsidies for healthy food. Future research should examine the independent and accumulative impact that environment and household interventions have on childhood obesity inequalities.

Objectives: To understand (1) healthcare professionals’ (HCPs) perceptions and experiences of commercial milk formula (CMF) marketing to consumers and HCPs and (2) HCPs’ perspectives on regulation of CMF marketing.Setting: UK.Design: In-person and online interviews with 41 HCPs with regular contact with pregnant women and mothers. Individual semistructured interviews were conducted from October 2019 to March 2021, focusing on experiences of CMF marketing and perceptions of legislation. Data were analysed using reflexive thematic analysis.Results: Three themes were developed: (1) ‘Industry relationships have changed and not disappeared’—some HCPs reported contact with industry ceasing due to the Baby Friendly Initiative (BFI) but contact with HCPs in other roles was believed to have increased; (2) ‘Direct-to-consumer marketing presents challenges for HCPs’—to support women to make informed choices about infant feeding, HCPs felt they had to challenge misinformation families receive from the CMF industry; (3) ‘System changes are needed to support informed infant feeding decisions’—HCPs wanted policy changes, including effective legislation to restrict CMF marketing to both HCPs and families. They also felt initiatives to normalise breastfeeding were important.Conclusions: Reduced contact with CMF representatives was reported by HCPs covered by the BFI but continued or increased contact was seen with other HCPs. HCPs believed CMF marketing impacted women’s beliefs about infant feeding and they had to work hard to provide a balanced perspective. HCPs wanted stricter regulation of CMF marketing.