Parental influence on the 24-hour behaviors of adolescents in Hong Kong

Ph.D.24-hour behaviors involve a wide range of human behaviors including Physical Activity (PA), Sedentary Behavior (SB), and sleep, all of which occur during the 24-hour cycle. The new paradigm of 24-hour behaviors changes the focus from individual behavior to the composition of behaviors across the whole day. In 2016, the 24-Hour Movement Guidelines for Children and Youth was launched, but the compliance of the guidelines and its association with health outcomes remain to be investigated. The aims of this thesis were to: firstly, examine the compliance and practical utility of an objective measurement (activPAL™) of 24-hour behaviors; secondly, assess the 24-hour movement behaviors in Hong Kong adolescents, examine the compliance with the 24-hour Movement Guidelines for Children and Youth and its associations with body mass index (BMI); finally, to investigate the cross-sectional and longitudinal associations between parenting styles and adolescents’ 24-hour movement behaviors.Chapters 1 comprised background and rational of this thesis, which introduced the pertinent issues related to 24-hour Movement Guidelines, 24-hour movement behaviors and their measurement activPAL™, emphasized the importance of parental influence and outlined areas of necessary future studies. Chapters 2 comprised of operational definitions and literature reviews, including the association of 24-hour behaviors and BMI, and association of 24-hour behaviors and parenting styles.Chapter 3 examined the compliance and practical utility of a continuous wear protocols for activPAL™, which was the main measurement for 24-hour behaviors in the thesis. 755 (11–18 yrs; 50.6% girls) students wore the waterproof activPAL™ for 7 consecutive days. The effects of factors such as weather and practical strategies on compliance were assessed. Students were asked to note reasons for removing in a log. After the 7-day period, students anonymously completed a practical utility questionnaire for their subjective feelings. 588 available data were analyzed. Rainfall was inversely associated with total wear time, whereas using alcohol pads and cartoon stickers during the application were positively associated with total wear time. Sweating (25.2%) and skin irritation (39.0%) were the most reasons for 290 removal episodes by 235 students. The 131 practical utility questionnaires showed that most students (80.1%) regarded the continuous wear period as too long and encountered problems; more than half students (55%) would rather not wear it again.Chapter 4 assessed the 24-hour behaviors including physical activity (PA), sedentary behavior (SB), sleep and screen time (ST) in Hong Kong adolescents, and examined their compliance with the 24-hour Movement Guidelines for adolescents and its associations with body mass index (BMI). A total of 1039 adolescents (11–18 yrs) wore the activPAL™ for 24 h for 7 consecutive days to assess PA, SB and sleep, of which 692 provided data (11-18 yrs; 53.4% girls) that were suitable for analysis. ST was measured using the Children’s Leisure Activities Study Survey (CLASS)-Chinese version. Results showed that only 1.0% of the adolescents met all three recommendations in the 24-hour Movement Guidelines. The proportion of adolescents that met the recommendation for PA, ST, and sleep was 9.1%, 31.2%, and 38.6%, respectively. Adolescent boys who did not meet the PA recommendation (b = 3.36; 95% CI, 1.04 to 5.68; p = 0.003) and those who did not meet the combination of PA and sleep recommendations (b = 2.10; 95% CI, 0.64 to 3.56; p = 0.005) had a higher BMI than those who met the respective recommendations.Chapter 5 investigated the cross-sectional and longitudinal associations between mother’s and father’s parenting styles and the 24-hour behaviors of their adolescents children. Baseline measurement was conducted from May 2016 to May 2017, 986 adolescents (11–18 yrs) wore an activPAL™ for 24 hours for 7 consecutive days to assess their light-intensity PA (LPA), moderateto- vigorous PA (MVPA), SB and sleep. Parenting styles from both parents were measured according to the reports of their children using Parenting Styles and Dimensions Questionnaire (PSDQ). A 2-year follow-up study was conducted between Sep 2018 and Mar 2019, 193 students (13–19 yrs) participated. The analytic sample consisted of 639 adolescents (53.7 % girls) at baseline and 117 adolescents (56.4 % girls) at follow-up. Cross-sectional associations were found between fathers’ permissive parenting style and boys’ daily LPA hours (b = 0.003; 95% CI, 0.002 to 0.063; p = 0.034), fathers’ authoritative parenting style and boys’ daily sleep hours (b = 0.020; 95% CI, 0.004 to 0.036; p = 0.015), and mothers’ permissive parenting style and girls’ daily ST hours (b = 0.180; 95% CI, 0.023 to 0.337; p = 0.024). Longitudinal associations were found between increases authoritarian parenting style and reduced girls’ PA participation in mother-daughter pairs of LPA (b = -0.018; 95% CI, -0.031 to -0.005; p = 0.006) and father-daughter pairs of MVPA (b = -0.010; 95% CI, -0.019 to -0.002; p = 0.017). Increases in mothers’ authoritarian parenting style were also associated with reduced girls’ daily ST hours (b = -0.211; 95% CI, -0.365 to -0.057; p = 0.008) and increased boys’ daily ST hours (b = 0.171; 95% CI, 0.018 to 0.325; p = 0.029). Increases in fathers’ authoritative parenting style were associated with reduced boys’ daily sleep hours (b = -0.040; 95% CI, -0.079 to -0.0004; p = 0.048) and increased girls’ daily ST hours (b = 0.106; 95% CI, 0.007 to 0.206; p = 0.037). Increases in fathers’ permissive parenting style were associated with significantly increased boys’ daily sleep hours (b = 0.123; 95% CI, 0.031 to 0.216; p = 0.010).The findings from this thesis demonstrated the compliance and practical utility of activPAL™. Rainy weather affected girls’ compliance with the continuous wear protocol for activPAL™. Skin irritation and sweat-induced inadvertent drops caused removal. Future studies should investigate more user-friendly protocols. Compliance with the 24-hour Movement Guidelines was alarmingly low among Hong Kong adolescents, especially PA recommendation. Meeting the PA recommendation or the combination of PA and sleep recommendations was associated with a healthier body weight in boys. Authoritarian parenting style has negative longitudinal influence on adolescent girls’ PA. But more authoritarian mother might reduce the ST of daughter. Authoritative parenting style of father have negative influence on the reduction of their sons’ sleep and increase of their daughters’ ST. Permissive parenting style of father has positive impact on their sons’ LPA, SB and sleep. Further studies need to pay more attention on the decreasing healthy behaviors in boys and the influence from their fathers’ parenting.24 小時行為活動即為一個人24 小時內的行為活動，包括體力活動，靜態行為和睡眠。此概念的提出把對單一活動的研究注意力轉向了對整天的活動的集合。2016 年，“24 小時行為活動準則”公佈，但對於此準則的依從性以及其與個人健康指標的關係還需要更多的探究。因此，本論文的研究目的包括：首先探討一種24 小時行為活動監測儀器ActivPAL™ 佩戴的依從性和實用性。第二，監測香港青少年的24 小時行為活動，評估他們對“24 小時行為活動準則”的依從性及其與身體質量指數的相關性。最後，探究父母教養方式與青少年24 小時行為活動在橫向描述和縱向追蹤兩個方面的相關性。第一章包含了本論文的研究背景和基本邏輯原理， 當中介紹了“24 小時行為活動準則”，24 小時行為活動和測量儀器的議題，強調了父母影響的重要性并指出未來需要研究的方向。第二章包含了操作性定義以及文獻綜述，其中包括24 小時行為活動與身體質量指數的關係，24 小時行為活動與父母教養方式的關係。第三章調查了連續佩戴方式下加速度計activPAL™ 的依從性和實用性，此儀器也是貫穿整本論文的主要測量24 小時行為活動的儀器。755 位中學生（11–18 歲; 50.6% 女生）連續7 天佩戴activPAL™。研究探索了天氣以及不同實際佩戴策略與依從性的相關。參加者通過日記記錄佩戴過程中摘取儀器的原因。在7 天佩戴過後，參加者匿名填寫依從性問卷來匯報他們的主觀感受。結果中分析了588 個有效數據。結果發現降雨量與總佩戴時間呈負相關，使用酒精棉和卡通貼紙的實際佩戴策略與總佩戴時間呈正相關。235 位參加者共報告了290 條摘取原因，其中出汗（25.2%）和皮膚過敏（39.0%）是最主要的摘取原因。131 份依從性問卷結果顯示，大部分參加者（80.1%）認為連續佩戴方式時間過長并遇到困難，超過半數（55%）參加者不想再次佩戴。第四章首先監測了香港青少年的24 小時行為活動，包括體力活動，靜態行為和睡眠。然後評估他們對“24 小時行為活動準則”的依從性及其與身體質量指數的相關。1039 位11–18歲的青少年連續7 天，每天24 小時佩戴activPAL™ 以監測他們的體力活動，靜態行為和睡眠。其中692 位（53.4% 女生）參與者最終提供有效數據。研究使用中文版兒童休閒活動調查問卷來測量參與者的屏幕使用時間。結果顯示只有1.0%的參與者同時遵循“24 小時行為活動準則”中的三個準則。遵循體力活動，屏幕使用時間和睡眠準則的青少年比例分別為9.1%，31.2% 和38.6%。其中不能遵循體力活動準則（b = 3.36; 95% CI, 1.04 to 5.68; p= 0.003）和不能同時遵循體力活動和睡眠準則（b = 2.10; 95% CI, 0.64 to 3.56; p = 0.005）的男生比能遵循以上準則的男生有更高的身體質量指數。第五章探索了父親與母親的教養方式與青少年24 小時行為活動在橫向描述和縱向追蹤兩個方面的相關性。基線測量於2016 年5 月至2017 年5 月之間進行，986 位11–18 歲的青少年連續7 天，每天24 小時佩戴activPAL™ 以監測他們的輕度體力活動，中等及劇烈強度體力活動，靜態行為和睡眠。青少年通過父母教養方式問卷匯報他們父親和母親的教養方式。追蹤測量於2018 年9 月至2019 年3 月進行，193 位青少年（13–19 歲）參與調查。研究將基線測量中的639 人（53.7%女孩）以及追蹤測量中的117 人（56.4%女孩）作為有效數據，進行數據分析。橫向描述方面，父親的縱容型教養方式與男孩的輕度體力活動相關（b = 0.003; 95% CI, 0.002 to 0.063; p = 0.034），父親的民主型教養方式與男孩的睡眠相關（b = 0.020; 95% CI, 0.004 to 0.036; p = 0.015），母親的縱容型教養方式與女孩的屏幕使用時間相關（b = 0.180; 95% CI, 0.023 to 0.337; p = 0.024）。縱向追蹤方面，專制型教養方式會降低女孩的體力活動時間，母親的專制教養會降低女孩的輕度體力活動（b = -0.018;95% CI, -0.031 to -0.005; p = 0.006），父親的專制教養會降低女孩的中等及劇烈強度體力活動（b = -0.010; 95% CI, -0.019 to -0.002; p = 0.017）。但越專制教養的母親，她們的女兒會減少屏幕使用時間（b = -0.211; 95% CI, -0.365 to -0.057; p = 0.008），而她們的兒子會增加屏幕使用時間（b = 0.171; 95% CI, 0.018 to 0.325; p = 0.029）。父親民主型教養的增強會降低男孩的睡眠時間（b = -0.040; 95% CI, -0.079 to -0.0004; p = 0.048），增加女孩的屏幕使用時間（b = 0.106; 95% CI, 0.007 to 0.206; p = 0.037）。父親的縱容型教養方式的增強會增加男孩的睡眠時間（b = 0.123; 95% CI, 0.031 to 0.216; p = 0.010）。綜上所述，本論文的研究結果顯示了加速度計activPAL™ 的依從性和實用性。陰雨天氣會影響女孩對連續佩戴activPAL™ 的依從性。皮膚敏感和出汗所導致的儀器脫落是佩戴過程中取下儀器的主要原因。未來研究可探索對參與者更友好的佩戴方式。同時，香港青少年對“24小時行為活動準則”的遵從性非常低，尤其是最低的體力活動準則。男生的體重健康與遵循體力活動準則或同時遵循體力活動和睡眠準則相關。專制型教養方式在縱向追蹤方面對女孩的體力活動有消極影響。但專制型的母親可以顯著控制女兒的屏幕使用。父親的民主型教養方式會消極影響兒子的睡眠和女兒的屏幕使用時間。父親的縱容型教養方式對兒子的輕度體力活動，靜態行為和睡眠都有積極影響。未來研究需要更多關注男孩健康行為的減少現象，以及父親對他們的影響。Shi, Yan.Thesis Ph.D. Chinese University of Hong Kong 2019.Includes bibliographical references (leaves 76-92).Abstracts also in Chinese; appendixes in Chinese.Title from PDF title page (viewed on 26, March 2021)