Table 1 Characteristics and results table for included studies (n = 62)
From: The relationship between the home environment and child adiposity: a systematic review
Author, year | Study design | Country | Sample N (% male), age | HE Constructs assessed | HE measure (items, method of administration) | Adiposity Outcome | Key finding: Relationship with adiposity |
|---|---|---|---|---|---|---|---|
MEDIA ENVIRONMENT ONLY (STUDIES N = 23) | |||||||
Adachi-Mejia et al. 2007 [16] | Cross | USA | 2343 (50%), 9–12 y | Physical - TV in bedroom. TVs in household | 2 items; PR | BMI z-scoresa | TV in bedroom associated with OW (OR = 1.32). |
Anderson et al., 2010 [24] | Cross | USA | 8550 (51%), 4 y | Social - Caregiver limits around screen-time (< 2 h/day) | 1 item; PR. | BMI z-scoresa | Limits on screen-viewing duration associated with lower odds of OB (OR = 0.85, p = 0.002). |
Atkin et al. 2013 [25] | Prosp | UK | 2064, (T0) 9–10 y (45%); (T1) 10–11 y (41%) | Physical - Media equipment (TV, computer) in bedroom and household (assessed T0, T1y) | 2 items; PR | BMI, weight status (NW/OW)d | Children with OW more likely to have a TV in bedroom (T0 and T1) compared to children with NW. No effect of computer in bedroom. Higher total bedroom media score in children with OW compared to NW (T1y). |
Borghese et al. 2015 [26] | Cross | USA, Canada | 1201 (43%), 10 y. | Physical - TV in bedroom | ISCOLE HNEQ; 1 item; PR. | Body Fat % | Canadian sample: TV in bedroom associated with higher BF% compared to no TV (boys: 21.8% vs 18.1%; girls: 24.9% vs 21.3%). American sample: TV in bedroom associated with higher BF% compared to no TV in boys (21.4% vs 18.9%) only. |
Cameron et al. 2013 [27] | Cross | 7 European Countriesb | 7234 (48%), 10–12 y. | Physical - TV in bedroom | 1 item; PR. | BMI & WCd | TV in bedroom associated with higher BMI and waist circumference (in 4/7 European countries). |
Chahal et al. 2013 [28]. | Cross | Canada | 3398 (50%), 10–11 y | Physical - Media equipment in bedroom (TV, DVD player, computer, video game console, phone) | Project EAT-III questionnaire, (5 items), PR and CR | BMI and weight status (NW, OW, OB)d | Electronic media devices (3+) in bedroom associated with greater odds of OW (OR = 2.57) or OB (OR = 2.23, p < .05) compared to no devices. Increased odds of OB for children with TV in bedroom (OR = 1.64), or computer in bedroom (OR = 1.47). Increased odds of OW for children with phone in bedroom (OR = 1.42). |
Chaput et al. 2014 [29] | Cross | Canada | 502 (41%), 9–11 y | Physical – Media equipment in bedroom (TV, computer, video games) | ISCOLE HNEQ; 3 items; PR. | BMI z-scores, BMI centile, BF%e | 2–3 screens in bedroom associated with higher BF% compared to no screen. TV in bedroom associated with higher BF% compared to no TV. Computer in bedroom not associated with BF%. |
Dube et al. 2017 [30] | Cross | Canada | 2334 (47%), 10–11 y. | Physical - Media equipment in bedroom (TV, computer, video game, tablet, mobile phone) | Project EAT-III Q; 5 items; PR. | BMId | ≥1 device in bedroom associated with increased odds of OB (OR = 1.82). Increased odds of OB for those with mobile phone (OR = 1.56, 95% CI: 1.24, 1.98), TV (OR = 2.56), and/or computer (OR = 2.79) in bedroom. |
Farajian et al. 2014 [31] | Cross | Greece | 4552 (49%), 10–12 y | Physical - Media equipment in bedroom (TV, computer, video game) | 2 items; CR | BMId | Having both TV and PC/video game console in bedroom associated with increased odds of OW/OB (OR = 1.41). |
Ferrari et al. 2015 [32] | Cross | Brazil | 441 (49%), 9–11 y. | Physical - Media equipment in bedroom (TV, computer, video games) | ISCOLE HNEQ;3 items; PR. | BMIe | Video games in bedroom associated with higher BMI (β = 0.94). 2–3 electronic devices in bedroom associated with higher BMI (β = 0.51). No association with BMI for TV and computer. |
Ferrari et al. 2017 [33] | Cross | Brazil | 328 (52%), 9–11 y | Physical - Media equipment in bedroom (TV) | ISCOLE HNEQ; 3 items; PR. | BMI, BF %, WCe | No associations with BMI. |
Hardy et al. 2012 [34] | Cross | Australia | 1141 (50%), 5–12 y | Physical – TV in bedroom. Social - Caregiver rules around screen-time duration. | ASAQ; 4 items; PR; validated. | BMI, weight status (HW, OW/OBd | Girls with OW more likely to have a TV in bedroom compared to girls with NW (OR = 2.00) (no association for boys). No association between caregiver media rules and weight status. |
Heilmann et al. 2017 [35] | Prosp | UK | 12,556 (51%), 7–11 y. | Physical - Media equipment in bedroom (TV) | 1 item; PR | BMI, body fat, weight statusd | TV in bedroom (at age 7) associated with greater RR of having OW at age 11 (RR for boys = 1.21; RR for girls = 1.31) compared to no TV. |
Gomes et al. 2015 [36] | Cross | Portugal | 580 (58.1%), 9–11 y. | Physical - Media equipment in bedroom (TV, computer, video games) | ISCOLE HNEQ; 3 items, PR. | BMIe | Media in bedroom associated with higher BMI (β = 0.26). |
Lane et al. 2014 [37] | Cross | Ireland | 8568 (48.7%), 9 y | Physical - Media equipment in bedroom (TV, computer, video games, phone) | 4 items; PR. | BMId | TV in bedroom (OR = 1.38) and owning a mobile phone (OR = 1.41) associated with increased odds for OW or OB. No association for computer and games console in bedroom. |
Li et al. 2014 [38] | Cross | China | 497 (51.7%), 8–10 y | Physical - Media equipment in home (games console, computer, DVD) | 3 items; PR. | BMI SDSb | No media equipment in home associated with lower risk of OB compared to 1–2 devices, specifically DVD players (OR = 0.68) and games consoles (OR = 0.60). No association for computer. |
Lehto et al. 2011 [39] | Cross | Finland | 604 (48.3%), 9–11 y. | Physical - Media equipment in bedroom (TV, computer, video games) | 2 items; CR. | BMI, WC, WHtRk | TV in bedroom associated with higher WC (β = 2.30). Computer/video games in bedroom associated with higher WC (β = 1.33) |
Sijtsma et al. 2015 [40] | Cross | Netherlands | 1670 (53%), 3–4 y | Physical – TV in bedroom. Number of TVs in home. | LRBQ; 2 items; PR. | BMI z-scorei | TV in bedroom associated with higher BMI. No association between number of televisions in home on and BMI. |
Tiberio et al. 2014 [41] | Prosp | USA | 213 (45%), 5–9 y | Social - Caregiver monitoring and limit setting around media use | 3 itemsn; PR | BMI z-scoresa | Less maternal monitoring associated with higher BMI z-scores at age 7 (β = −.23, p < 0.01) and steeper increases in BMI z-scores from ages 5 to 9 y (β = −.058, p < 0.01). |
Rutherford et al. 2015 [42] | Prosp | Australia | 4983 (51.4%) 4–9 y | Physical – TV in bedroom and computer in home. Social - Caregiver rules around TV viewing duration | 3 items; PR | BMId | No associations with BMI and weight status. |
Lin et al. 2019 [43] | Cross | Taiwan | 1031 (50%), 7–12 y | Media: Social – Caregiver modelling and limit setting around screen-viewing | 6 items; PR. | BMIq | No association with weight status. |
Paduano et al. 2020 [44] | Cross | Italy | 588 (53.2%), 6–7 y | Media: Physical – TV in bedroom | 1 item; PR. | BMI z-scored | TV in bedroom associated with higher odds of OW/OB (OR = 1.1) |
Park et al. 2019 [45] | Cross | USA | 129 (48.1%) 2-5y | Media: Physical - TV in bedroom | FNPAp; 20 items; PR; validated. | BMI z-scores, weight statusa | No association with weight status. |
FOOD ENVIRONMENT ONLY (n = 13) | |||||||
Cassimos et al. 2011 [46] | Cross | Greece | 335 (54.03%), 9–12 y. | Physical - Availability of and access to sweets and juice in the home. | 21 items; PR. | BMId | Availability of sweets associated with increased odds of OW/OB (OR = 0.357). |
Chen et al. 2018 [47] | Cross | China | 222 (51.5%), 3–6 y | Physical - Energy dense foods at home | FEAHQ; 29 items; PR, validated. | BMIe | Availability of energy dense foods associated with higher BMI (β coefficient = 0.30, p < .01) |
Couch et al. 2014 [13] | Cross | USA | 699 (50.2%), 6–11 y | Physical – Availability of energy dense foods and nutrient-dense foods Social – Caregiver modelling positive eating behaviours. Caregiver rules around child eating. | EMS (7 items); FEAHQ (3 items); AWQ (12 items); PR; validated | BMI z-scoresa | Encouragement/modelling of ‘healthy eating’ negatively associated with BMI z- scores (β coefficient = −0.17). No association between food availability and BMI z-scores. No association between caregiver rules around child eating and BMI z-scores. |
Downs et al. 2009 [48] | Cross | Canada | 225 (NP), 9–12 y | Physical - Food and beverages in the home. | FAQ; NP; CR interview. | BMId | No associations with BMI. |
Humenikova et al. 2008 [49] | Cross | Czech and USA | US: 45 (33%) Czech: 97 (43%), 10–11 y | Physical - ‘healthful’ foods (e.g. fruits, vegetables, low-fat dairy) in home | Shelf Inventory; 80 items; PR, validated. | BMI percentilesd | America: No association with BMI z-score. Czech: Greater availability of ‘healthful’ foods associated with lower BMI z-scores (r = −.203, p < .05). |
Gable et al. 2000 [50] | Cross | USA | 65 (43%), 6–10 y | Physical aspects - Food and beverages in the home. | FAQ; NP; PR. | BMIm | No associations with BMI. |
Lopez-Barron et al. 2015 [51] | Cross | Mexico | 684 (45.5%), 10–11 y | Physical - Food and beverages in the home. | Food inventory; 13 items; CR. | BMI z-scores, Height z-scores, WCb | OW/OB associated with increased odds of availability of fruits and vegetables (OR = 1.10, p = 0.035). OW/OB associated with lower availability of energy-dense foods at home (OR 0.56, p < .001) |
MacFarlane et al. 2009 [52] | Prosp | Australia | T0 = 161 (50%) 5–6 y T1 = 132 (50%) 10–12 | Physical - Energy-dense foods at home Social - Caregiver policies around energy-dense snacks and fast foods. | Family food environment; 7 items; PR. | BMI z-scoresa | No associations with BMI z-scores. |
Terry and Beck, 1985 [53] | Cross | USA | 16 (56%) 8–12 y | Physical - Foods in the home (foods traffic lighted based on caloric value; number of red, yellow and green foods visible in home) | In-home observation of food environment × 2. | BMIl | Observation 1: No difference between OB and NW in availability of energy-dense foods. Observation 2: No difference between OB and NW in availability of energy-dense foods. |
Palfreyman et al. 2014 [54] | Cross | UK | 484 (51%), 1–8 y | Social - Caregiver modelling of healthy eating behaviour | PARM; 18 items; PR. | BMI z-scoresj | No association with BMI. |
Van Lippevelde et al. 2013 [55] | Cross | 7 European Countries15 | 6374 (47%), 10–12-y. | Physical – Breakfast type foods (milk, cereal, breads) in home | 1 item; PR. | BMI z-scoreh | No association with BM. |
Vaughn et al. 2017 [56] | Cross | USA | 129 (51%), 3–12 y. | Physical - Food and drinks in the home. Social - Caregiver modelling of eating and limit setting around unhealthy food intake | CAFPP; 124 items; PR; validated | BMI centiles and z-scoresk | No associations between availability with BMI. No association between caregiver modelling or limit setting around unhealthy eating with BMI. |
Quah et al. 2018 [57] | Cross | Singapore | 511 (52.1%), 5y | Social – Caregiver modelling and support for healthy eating. | CFPQ; 8 items; PR; validated. | BMI z-scoreb | No association with BMI z-score. |
PHYSICAL ACTIVITY ENVIRONMENT ONLY (n = 5) | |||||||
Chivers et al., 2012 [58] | Prosp | Australia | 2868 (NP%), 1–10 y. | Physical – PA equipment at home. Social - Caregiver support of PA by visiting park or playground with child. | NP; PR. | BMId | Cross-sectional: No associations with weight status. Prospective: No associations with weight status. |
Sijtsma et al. 2015 [59] | Cross | Netherlands | 1554 (50%), 3–4 y | Social - Caregiver modelling of PA behaviour | SQUASH; 11 items; PR. | BMI z-score and WCi | No association between caregiver modelling of PA and BMI or waist circumference. Caregiver modelling of PA commuting (e.g. walking) associated with lower BMI Z-score (r = −0.062). |
Liszewska et al. 2018 [60] | Prosp | Poland | 879 (48%), 6–11 y | Social - Caregiver modelling and support of PA | ARPQ (7 items); Modified CFPQ for PA (31 items); PR; validated | BMI z-scoresb | Caregiver modelling and support of PA associated with lower BMI z-scores (r = −.070, p < .05). |
Schalkwijk et al. 2018 [61] | Prosp | UK | 6467 (51%), 3–7 y | Physical - Access to garden at home | 1 item; PR. | BMId | No access to garden associated with increased odds for OW/OB (OR = 1.35). |
Umstattd Meyer et al. 2013 [62] | Cross | US/ Mexico | 94 (42%), 6–11 y | Physical - PA equipment at home | 16 items; interview PR. | BMI percentiles | No associations with BMI. |
STUDIES ASSESSING TWO DOMAINS OF THE HOME ENVIRONMENT (n = 16) | |||||||
Hales et al. 2013 [63] | Cross | USA | 129 (51%), 3–12 y | Media: Physical – Media equipment in home (TV, computer, video games) PA: Physical - Availability and access to PA equipment | HomeSTEAD; 1015 items; PR; validated. | BMI percentilesa | Media: No associations with BMI. PA: Greater PA equipment associated with lower BMI (‘adult exercise equipment’; r = − 0.26, and ‘child fixed play equipment’; r = − 0.25 and ‘child portable play equipment’; − 0.23). |
Jones, et al. 2009 [64] | Cross | Australia | 140 (51%), 2–6 y | Media: Physical- TV in bedroom. Social aspects - Caregiver rules around TV PA: Social - Caregiver rules around PA | Parenting Styles Q; 9 items; PR | BMId | Media: No associations with weight status. PA: No associations with weight status. |
Sleddens et al. 2017 [15] | Prosp | Netherlands | 1694 (51.2%), 5–7 y | Media: Social – Caregiver limit setting around screen-based activities PA: Social – Caregiver support of child PA | ARPQ; 7 items; PR; validated. | BMI z-scorei | Media: Caregiver policy ‘restriction of sedentary behaviour’ associated with greater increases in BMI z-scores from ages 5 to 7. PA: No association with BMI. |
Taylor et al. 2011 [65] | Cross | Australia | 175 (44%), 7–12 y | Media: Social– Caregiver modelling and limit setting around of media use. PA: Social - caregiver modelling of PA | Parent Physical Activity Practices Q; 11 items; PR. | BMI z-scored | Media: No association with BMI. PA: No association with BMI. |
Mathialagan et al. 2018 [66] | Cross | Malaysia | 802 (NP%), 10–12 y | Media: Social - Caregiver limit setting around electronic media equipment use. PA: Social - Caregiver PA levels | 42 items; CR; validated. | BMIb | PA: No association with weight status. Media: Caregiver limits on media use associated with lower child weight status. |
Rosenberg et al. 2010 [67] | Cross | USA | 116 (52.2%), 5–11 y | Media: Physical – Media equipment in bedroom and home (TV, computer, games console) PA: Physical - PA equipment at home | Home PA equipment scale (21 items); HEES (14 items); PR. | BMI z-scorea | Media: Electronics in bedroom associated with higher BMI z-score (β coefficient = .17, p < .05). TV in bedroom not associated with BMI. PA: No association with BMI. |
Mihrshahi et al. 2017 [68] | Cross | Australia | 3884 (49%), 6–10 y | Media: Physical - TV in bedroom. Social - Caregiver rules around screen-time Food: Physical – Sugar-sweetened beverages (SSB) at home. Social - Caregiver policies around sweet snacks | 5 items; PR. | BMI, WHtR - abdominal obesityk | Media: TV in bedroom associated with higher odds of OW/OB (OR = 1.74) and abdominal OB (OR = 1.96). No limits on screen-time associated with higher odds of abdominal OB (OR = 1.66). Food: Availability of SSB associated with higher risk of OW/OB (OR = 1.51) and higher abdominal OB (OR = 1.50) in unadjusted models. No association with adiposity in fully adjusted models. |
Keihner et al. 2009 [69] | Cross | USA | 299 (47.8%), 9–11 y | Media: Physical - TV in bedroom. Social – caregiver limit setting around screen-time Food: Social - Caregiver modelling of energy-dense foods | Food and activity diary, FMTS; 4 items; CR and PR. | BMI z-scores, BMI %tilesa | Media: No associations with BMI. Food: No associations with BMI. |
Huynh, et al. 2011 [70] | Prosp | Vietnam | 670 (49%), 4–5 y | Media: Physical - Media equipment in home (TV, computer, video games, portable devices) Food: Physical - Food and beverages in the home. | HOME-SF; validated. | BMI, skinfold thicknessg | Media: No associations with changes in BMI or skinfold thickness over 1 year. Food: Availability of ‘healthy foods’ negatively associated BMI (girls only) and skinfold thickness (boys and girls) over 1 year. |
Serene et al. 2011 [71] | Cross | Kuala Lumpur | 1430 (41.5%), 9–12 y | Food: Physical – Foods in home. Social - Caregiver encouragement of healthy eating. PA: Social - Caregiver support of PA | Q developed based on CFQ and DASH. | BMIe | Food: No associations with BMI. PA: No associations with BMI |
Serrano et al. 2014 [72] | Cross | Puerto Rico | 114 (42.1%), 12 y | Food: Social - Caregiver encouragement of healthy eating PA: Social - caregiver encouragement of PA | Team COOL Survey; 76 items; PR; validated. | BMIa | Food: No association with weight status. PA: No association with weight status. |
Moreno et al. 2011 [73] | Cross | USA | 233 (47%), 5–12 y | Food: Social - Caregiver modelling of healthy eating PA: Social - Caregiver modelling of PA | FHBS; 27 items; PR; validated. | BMI z-scorea | Composite score: No association between ‘Parent behaviour’ (caregiver modelling of healthy eating and PA) and child BMI z-scores. |
Sirikulchayanonta et al. 2011 [74] | Cross | Thailand | 280 children (50%), 8–12 y. | Food: Physical - Foods available in home PA: Physical – Access to PA equipment/garden | 11 items; CR. Composite score of ‘home environment’ | BMI age- and sex- specificf | Composite score: Higher risk ‘home environment’ associated with increased odds of OB (OR = 2.8). |
Torres et al. 2014 [75] | Cross | Puerto Rico | 114 (43%), 12 y | Food: Physical - Foods in home. PA: Physical - PA equipment at home | Home Physical Environment; 10 items; CR | BMI percentilesa | Food: Availability of ‘unhealthy’ foods associated with higher BMI (r = − 0.25). No association between availability of healthy foods with BMI. PA: Access to PA equipment associated with higher BMI (r = 0.25). |
Crawford et al. 2012 [76] | Cross | Australia | 491 (47%), 5–12 y | Media: Physical - TV in bedroom and home. Social - Caregiver limit setting around electronic media PA: Physical - PA equipment at home. Social - Caregiver support of PA | Home environment questionnaire; 46 items; PR; validated. | BMI z-scoresa | Media: TV in bedroom associated with higher BMI z-scores (B coefficient = 0.24). No association between caregiver limit setting and BMI. PA: No associations with BM |
Vaughn et al. 2019 [77] | Cross | USA | 129 (51%), 3–12 y | Media: Social – Caregiver modelling and limit setting around electronic media use. PA: Social - Caregiver modelling and support of PA | HomeSTEAD; 196 items; PR; validated. | BMI percentilea | Media: No association with BMI percentile. Caregiver modelling of video games and computer associated with higher BMI percentile (r = 0.15). PA: Caregiver encouragement of PA associated with lower BMI percentile (r = − 0.25). Lack of caregiver support for PA associated with higher BMI percentile (r = .17). No association for modelling of PA. |
STUDIES MEASURING ALL THREE DOMAINS OF HOME ENVIRONMENT (n = 5) | |||||||
Rodenburg, G., et al. 2013 [78] | Cross | Netherlands | 1480 (50.5%), 8–12 y | Food: Physical - Food and beverages in the home. Social - Caregiver modelling and support for healthy eating Media: Physical – Media equipment (TV, computer) in bedroom. Social – Caregiver modelling of TV viewing. Caregiver rules around screen viewing. PA: Physical - PA equipment at home. Social - Caregiver modelling of PA | Home Environment Survey (HES); 84 items; PR; validated. Five composite scores created. | BMI z-scorei | Composite score: ‘Diet- and activity-related positive modelling’ (caregiver modelling of healthy eating, modelling of sedentary behaviour, caregiver snack intake and access to PA equipment) was positively associated with child BMI z-scores (B coefficient = 0.08, p < 0.05). No association between ‘High visibility and accessibility to screens and unhealthy food’ and BMI z-scores. |
Ihmels et al. 2009 [79] | Cross | USA | 854 (51.3%), 6–7 y | Food: Social - Caregiver modelling of healthy eating behaviour Media: Physical - TV in bedroom. Social - Caregiver monitoring of TV PA: Social - Caregiver modelling and support of PA | FNPA; 21 items; PR; validated. | BMI, BMI percentilesa | Food: Caregiver modelling of healthy eating associated with lower BMI (r = −.132). PA: Caregiver modelling of PA associated with lower BMI (r = −.086, p < .01). Media: TV in bedroom associated with higher BMI (r = −.156, p < .001). No association between caregiver monitoring and child BMI. |
Kim et al. 2014 [80] | Cross | South Korea | 241 (47.7%), 2–5 y | Food: Social - Caregiver modelling of healthy eating Media: Social - Caregiver modelling of media use and limit setting PA: Social - Caregiver modelling and support for PA | ACTS; 7 items; PA and healthy eating barriers; 9 items; PR; validated. | BMIk | Food: Caregiver modelling of ‘healthy eating’ associated with higher odds of OB (OR = 1.11). PA: No associations with weight status. Media: Caregiver modelling of media use associated with higher odds for OB (OR = 1.01). Caregiver limit setting of media use associated with lower BMI (− 0.12, p < 0.05). |
Gubbels et al. 2011 [81] | Prosp | Netherlands | 2026 (51.2%), 5–7 y | Food: Social - Caregiver support for healthy eating Media: Social - Caregiver limit setting around electronic media use PA: Social - Caregiver support and encouragement of child PA | Modified CFQ for food (9 items); ARPQ (9 items); PR; validated. | BMI z-scoree | Food: Caregiver support/encouragement of ‘healthy eating’ at age 5 associated with lower BMI z-scores at age 7 (B coefficient = 0.07). PA: No association with BMI. Media: Caregiver limits of media use at age 5 associated with higher increases in BMI from age 5 to 7 (B coefficient = 0.06). |
Schrempft et al. 2015 [82] | Cross | UK | 1096 (49%), 4 y | Food: Physical – Food and beverages in the home. Social - Caregiver modelling of eating Media: Physical – Media equipment in home and bedroom. Social– Caregiver modelling and limit setting. PA: Physical – PA equipment at home. Social - Caregiver modelling/support of PA | HEI; 32 constructs; CATI PR; validated. | BMI z-scorec | Food: No association with BMI. Media: No association with BMI. PA: No association with BMI. Overall obesogenic risk: No association with BM. |