Kathryn R. Hesketh

Introduction: Adventurous play (AP), defined as play involving thrill, fear and uncertainty, has health and developmental benefits but can be challenging for parents to support. This study aimed to explore parent-reported facilitators and barriers to AP in preschool-aged children and whether these differ by sociodemographic characteristics. Methods: Cross-sectional data were from the British Preschool Children’s Play Survey, a nationally representative survey investigating play in British 2–4-year-olds. Parent-reported facilitators and barriers were analysed using a coding framework, with χ ² tests used to determine whether facilitators and barriers differed by sociodemographic characteristics (parent gender; child gender; ethnicity (white vs non-white); urbanicity (urban/suburban/rural); social grade (higher/lower); child age (2, 3 or 4 years); and child’s perceived motor skills). Results: Parents of 1166 children provided valid data. Safety (15.0%) and supervision (10.4%) were the most commonly reported facilitators, with child preferences (χ²=10.74, p=0.0008) and parental attitudes (χ²=5.60, p=0.006) more likely to be reported by white (vs minority ethnic) parents. Barriers were dominated by concerns about physical injury (18.8%) and safety (11.7%), with risk of injury reported by mothers more frequently than fathers (χ²=21.5, p<0.001) and parental attributes reported more frequently than fathers (χ²=17.2, p<0.001). Conclusions: Ensuring safety and supervision are important facilitators for children’s AP. Similar concerns about injury are perceived barriers. Given the benefits of AP for preschool-aged children, efforts to support AP opportunities should be prioritised. As the largest identified factor (both positive and negative) is children’s safety, future research efforts should acknowledge this.

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.

Objectives: To investigate associations between adventurous play, outdoor play and screen time and mental health (MH) in British preschool-aged children. Design: Cross-sectional. Setting: A nationally representative sample of caregivers of 2–4 years old (n=1066) in England, Scotland and Wales (Britain), recruited through an online research data and analytics group (YouGov UK). Participants: Caregivers of 1018 children provided valid complete-case data (age 2: n=298 (29%), age 3: n=365 (36%), age 4: n=355 (35%); female n=481 (47%); white: n=878 (81%)). Outcome measures: Four outcomes, derived from parent-report questionnaires: internalising and externalising scores (using the Strengths and Difficulties Questionnaire) and positive and negative affect scores (using the Positive and Negative Affect Schedule for Children-P). Linear regression was used to explore associations between the three exposures (time (in hours per week) a child spent: (1) playing adventurously; and engaging in (2) educational screen time and (3) recreational screen time) and the four outcomes; interactions between play and screen time variables were also tested. Models were adjusted for child and parental demographic variables. Results: For each additional hour per week a child engaged in adventurous play, they had lower internalising scores (−0.02 (−0.03 to –0.01)) and higher positive affect scores (0.04 (0.02 to 0.05)). More hours per day (vs <1 hour/day) of educational screen time and recreational screen time were associated with higher internalising and negative affect scores. Greater educational screen time was associated with lower positive affect and higher externalising scores, with adventurous play moderating the association between higher educational screen time, internalising and negative affect. Conclusion: In British preschoolers, adventurous play is associated with better MH outcomes, whereas higher educational screen time was associated with poorer MH, indicating that adventurous play may benefit preschoolers’ MH or that preschoolers with better mental health are more likely to engage in adventurous play. Adventurous play may also offset possible negative associations with screen time.

Background: Limited evidence exists for the role of parent–child coparticipation in physical activity (joint light, moderate, or vigorous physical activities involving at least 1 child and a parent) in parents’ and children’s overall physical activity. This study examined the association of parent–child coparticipation in physical activity with parental and children’s daily physical activity and explored correlates of coparticipation. Methods: Data were from 149 participants (41 families: 67 parents [30–55 y, 57% female] and 82 children [4–16 y, 40% girls]) in the Families Reporting Every Step to Health pilot study. Families Reporting Every Step to Health was a 3-armed, parallel-group, randomized controlled pilot trial. Participants’ physical activity and location were measured simultaneously with accelerometers and Global Positioning System monitors. Data from 3 data collection points (baseline and 2 follow-ups) were analyzed cross-sectionally using multivariable linear mixed models with random intercepts at the family and participant levels. Results: At baseline, children and parents accumulated an average of 70 and 36 minutes per day, respectively, of parent–child coparticipation in physical activity, which contributed 33% and 17% of their daily total physical activity, respectively. For both parents and children, coparticipation was positively associated with daily total physical activity ( β = 0.37; 95% CI, 0.19–0.55 min/d) and daily moderate- to vigorous-intensity physical activity ( β = 0.10; 95% CI, 0.03–0.16 min/d). Coparticipation in physical activity was on average 28.80 (11.23–46.37) minutes per day lower among parents than among children. Conclusion: Parent–child coparticipation in physical activity might be a promising component of family-based interventions to promote physical activity among children and parents.

Background: Outdoor, adventurous play supports physical activity and might help to prevent mental health problems, yet data on preschool-aged children’s outdoor play are scarce. Method: Data were collected from a nationally representative sample of 1166 parents/caregivers of children aged 2–4 years (52% male; 88% white) living in Britain. Caregivers reported time children spent playing in 7 locations and corresponding adventure level. Responses were used to derive: total play time, outdoor play time, and adventurous play time (in hours per year). Associations between sociodemographic characteristics and play outcomes were examined, controlling for relevant confounding variables. Results: Outside of childcare, preschool-aged children spent approximately 4 hours per day playing, with 1 hour 45 minutes spent playing outdoors. Most outdoor play happened in gardens at home. Away from home, children most often played in playgrounds and green spaces. Levels of adventurous play were reported to be highest at indoor play centers, followed by playgrounds and green spaces. Total play differed significantly by location, with children in rural areas spending more time playing (vs urban areas). Child ethnicity was associated with play and outdoor play, with children belonging to minority ethnic groups (vs white) playing less. Child sex was also a significant predictor of outdoor play time: boys (vs girls) spent more time playing outdoors, driven primarily by time spent in green spaces. No associations were found for adventurous play. Conclusions: These results highlight how inequalities in access to outdoor space at home and good quality local play spaces may impact young children’s play opportunities and, in turn, exacerbate health inequalities.

Purpose: To explore how activity behaviors before/during pregnancy relate to those in later parenthood, we assessed associations between sitting and moderate-/strenuous exercise before/during pregnancy, and sedentary time (SED) and moderate to vigorous physical activity (MVPA) 4–7 years postpartum (“later parenthood”). Methods: Longitudinal data were from the Southampton Women’s Survey, United Kingdom. Women reported time spent sitting (in hours per day), in moderate-strenuous exercise (hours per week), and in strenuous exercise (hours per week) at 3 time points before/during pregnancy (ie, preconception, at ∼12-wk and ∼34-wk gestation). From this, we derived 3 behavior trajectories for each woman. In later parenthood, women wore an accelerometer for ≤7 days (mean: 5.4 [SD: 1.8] d), which we used to derive 2 outcomes: minutes per day SED and in MVPA. Multilevel linear regression was used to explore associations between trajectories before/during pregnancy and device-measured SED/MVPA in later parenthood. Results: A total of 780 women provided valid data before/during pregnancy and in later parenthood. Consistent high sitters (vs low) were more sedentary 4–7 years postpartum (β = 39.5 min/d [95% confidence interval, 23.26 to 55.82]), as were women in groups who sat more in later pregnancy. Consistently high moderate/-strenuous exercisers (vs low) were 22% (95% confidence interval, 2%–47%) more active in later parenthood; those engaging in strenuous activity preconception tended to have higher MVPA as parents. Conclusions: Trajectories of sitting and exercise before/during pregnancy are associated with SED and MVPA, respectively, in later parenthood. Interventions to reduce sitting in pregnancy and to encourage higher intensity activity preconception may benefit maternal and child health.

Background: Before pregnancy is recognized, ovulation, fertilization, and implantation must all occur. Physical activity and sedentary behavior may impact pregnancy success by altering each or all of these processes. The aim of this review was to review the association between physical activity and sedentary behavior with spontaneous female and male fertility. Method: PubMed/MEDLINE, Web of Science, CINAHL, SPORTDiscus, and Embase were searched from inception to August 9, 2021. Eligible studies included randomized controlled trials or observational studies, published in English, describing an association between physical activity or sedentary behavior (exposures) and spontaneous fertility (outcome) among women or men. Results: Thirty-four studies from 31 unique populations were included in this review (12 cross-sectional studies, 10 cohort studies, 6 case–control studies, 5 randomized controlled trials, and one case–cohort study). Of the 25 studies among women, the majority identified mixed results (n = 11) or no association (n = 9) between physical activity and female fertility. Seven studies reported on female fertility and sedentary behavior, and 2 found sedentary behavior was associated with decreased female fertility. Of the 11 studies among men, most of the studies (n = 6) found that physical activity was associated with increased male fertility. Two of the studies reported on male fertility and sedentary behavior, and neither identified an association. Conclusions: The association between spontaneous fertility and physical activity in both men and women remains unclear, and the association with sedentary behavior remains largely unexplored.