Improved Perceptions of Parental Support for Physical Activity and Healthy Eating among Young Adolescents During COVID 19 pandemic

How to Cite

Dou, N., Kowalski, A., Lane, H., Hatton, R., Black, M., & Hager, E. (2023). Improved Perceptions of Parental Support for Physical Activity and Healthy Eating among Young Adolescents During COVID 19 pandemic. Journal of Healthy Eating and Active Living, 3(2), 76–99.


Family routines play a key role in promoting child health behaviors. This study aims to 1) describe changes in children’s perceptions of physical activity (PA) and healthy eating family routines across three time points: pre-pandemic (2017-2020), early pandemic (2020), and mid-pandemic (2021); and 2) explore the role of pandemic-related economic stressors on these changes. Children’s perceptions of family routines were assessed using four scales adapted from the Comprehensive Home Environment Survey: PA-policies, Diet-policies, Diet-rules, and PA-Diet-role-model. Child age and sex were assessed at pre-pandemic, and household members’ employment loss and poverty levels were assessed during pandemic. Linear mixed models were used to assess changes and associated factors for each scale. Children (N=277) aged 8-13 y were enrolled pre-pandemic. Children’s perceptions of PA-policies and Diet-policies increased significantly from pre-pandemic to early-pandemic (b=0.9 and 2.4, respectively) and pre- to mid-pandemic (b=0.8 and 1.2, respectively). Diet-rules decreased significantly from pre- to early (b=-1.5) and pre- to mid-pandemic (b=-2.3), with no PA-Diet-role-model changes. Older children, compared to younger, had a faster decrease in Diet-policies from pre- to early pandemic. Females, compared to males, had a faster decrease in Diet-rules from pre- to mid-pandemic. Economic stressors were not associated with changes in perceived routines. Overall, children reported increased parental policies to support PA and healthy eating and decreased parental rules to regulate child eating behaviors during the pandemic. Future mixed methods research is needed to understand how changes in parental support on family routines relate to PA and healthy eating behaviors.


Adams, E. L., Caccavale, L. J., Smith, D., & Bean, M. K. (2020). Food insecurity, the home food environment, and parent feeding practices in the era of COVID‐19. Obesity, 28(11), 2056-2063.

Androutsos, O., Perperidi, M., Georgiou, C., & Chouliaras, G. (2021). Lifestyle Changes and Determinants of Children’s and Adolescents’ Body Weight Increase during the First COVID-19 Lockdown in Greece: The COV-EAT Study. Nutrients, 13(3), 930.

Azar, K. M. J., Halley, M., Lv, N., Wulfovich, S., Gillespie, K., Liang, L., & Goldman Rosas, L. (2020). Differing views regarding diet and physical activity: adolescents versus parents' perspectives. BMC Pediatr, 20(1), 137.

Bates, C. R., Nicholson, L. M., Rea, E. M., Hagy, H. A., & Bohnert, A. M. (2021). Life Interrupted: Family Routines Buffer Stress during the COVID-19 Pandemic. J Child Fam Stud, 30(11), 2641-2651.

Bayham, J., & Fenichel, E. P. (2020). Impact of school closures for COVID-19 on the US health-care workforce and net mortality: a modelling study. The Lancet Public Health.

CDC. (2019a). Building Structure. Retrieved August 2023 from

CDC. (2019b). Creating Rules. Retrieved June 2023 from

Cipolla, C., Curatola, A., Ferretti, S., Giugno, G., Condemi, C., Delogu, A. B., Birritella, L., & Lazzareschi, I. (2021). Eating habits and lifestyle in children with obesity during the COVID19 lockdown: a survey in an Italian center. Acta Biomedica Atenei Parmensis, 92(2), e2021196.

Cluver, L., Lachman, J. M., Sherr, L., Wessels, I., Krug, E., Rakotomalala, S., Blight, S., Hillis, S., Bachman, G., & Green, O. (2020). Parenting in a time of COVID-19. Lancet (London, England), 395(10231), e64.

Culbert, K. M., Sisk, C. L., & Klump, K. L. (2021). A Narrative Review of Sex Differences in Eating Disorders: Is There a Biological Basis? Clin Ther, 43(1), 95-111.

Draxten, M., Fulkerson, J. A., Friend, S., Flattum, C. F., & Schow, R. (2014). Parental role modeling of fruits and vegetables at meals and snacks is associated with children's adequate consumption. Appetite, 78, 1-7.

Eyler, A. A., Schmidt, L., Beck, A., Gilbert, A., Kepper, M., & Mazzucca, S. (2021). Children's Physical Activity and Screen Time during COVID-19 Pandemic: A Qualitative Exploration of Parent Perceptions. Health Behav Policy Rev, 8(3), 236-246.

Fleary, S. A., & Ettienne, R. (2019). The relationship between food parenting practices, parental diet and their adolescents’ diet. Appetite, 135, 79-85.

Friel, C. P., Duran, A. T., Shechter, A., & Diaz, K. M. (2020). U.S. Children Meeting Physical Activity, Screen Time, and Sleep Guidelines. Am J Prev Med, 59(4), 513-521.

Fulkerson, J. A., Telke, S., Larson, N., Berge, J., Sherwood, N. E., & Neumark-Sztainer, D. (2019). A healthful home food environment: Is it possible amidst household chaos and parental stress? Appetite, 142, 104391.

Gao, M. M., & Cummings, E. M. (2019). Understanding parent-child relationship as a developmental process: Fluctuations across days and changes over years. Dev Psychol, 55(5), 1046-1058.

Gassman-Pines, A., Ananat, E. O., & Fitz-Henley, J., 2nd. (2020). COVID-19 and Parent-Child Psychological Well-being. Pediatrics, 146(4).

González, L. M., Lammert, A., Phelan, S., & Ventura, A. K. (2022). Associations between parenting stress, parent feeding practices, and perceptions of child eating behaviors during the COVID-19 pandemic. Appetite, 177, 106148.

Gustafson, S. L., & Rhodes, R. E. (2006). Parental correlates of physical activity in children and early adolescents. Sports medicine, 36, 79-97.

Haug, N., Geyrhofer, L., Londei, A., Dervic, E., Desvars-Larrive, A., Loreto, V., Pinior, B., Thurner, S., & Klimek, P. (2020). Ranking the effectiveness of worldwide COVID-19 government interventions. Nature human behaviour, 4(12), 1303-1312.

Jansen, E., Thapaliya, G., Aghababian, A., Sadler, J., Smith, K., & Carnell, S. (2021). Parental stress, food parenting practices and child snack intake during the COVID-19 pandemic. Appetite, 161, 105119.

Jia, P., Zhang, L., Yu, W., Yu, B., Liu, M., Zhang, D., & Yang, S. (2021). Impact of COVID-19 lockdown on activity patterns and weight status among youths in China: the COVID-19 Impact on Lifestyle Change Survey (COINLICS). International Journal of Obesity, 45(3), 695-699.

Kalil, A., Mayer, S., & Shah, R. (2020). Impact of the COVID-19 crisis on family dynamics in economically vulnerable households. University of Chicago, Becker Friedman Institute for Economics Working Paper(2020-143).

Katzmarzyk, P. T., Barlow, S., Bouchard, C., Catalano, P. M., Hsia, D. S., Inge, T. H., Lovelady, C., Raynor, H., Redman, L. M., Staiano, A. E., Spruijt-Metz, D., Symonds, M. E., Vickers, M., Wilfley, D., & Yanovski, J. A. (2014). An evolving scientific basis for the prevention and treatment of pediatric obesity. Int J Obes (Lond), 38(7), 887-905.

Kim, E. S., Kwon, Y., Choe, Y. H., & Kim, M. J. (2021). COVID-19-related school closing aggravate obesity and glucose intolerance in pediatric patients with obesity. Sci Rep, 11(1), 5494.

Kowalski, A. J., Kuhn, A. P., Lane, H. G., Trude, A. C. B., Selam, H., Hager, E. R., & Black, M. M. (2021). Pre-pandemic to early-pandemic changes in risk of household food insecurity among Maryland families with children. Public Health Nutr, 1-23.

Kuhn, A. P., Kowalski, A. J., Wang, Y., Deitch, R., Selam, H., Rahmaty, Z., Black, M. M., & Hager, E. R. (2021). On the Move or Barely Moving? Age-Related Changes in Physical Activity, Sedentary, and Sleep Behaviors by Weekday/Weekend Following Pandemic Control Policies. Int J Environ Res Public Health, 19(1).

Lane, H., Deitch, R., Wang, Y., Black, M., Dunton, G., Aldoory, L., Turner, L., Parker, E., Henley, S., Saksvig, B., Song, H.-J., & Hager, E. (2018). “Wellness Champions for Change,” a multi-level intervention to improve school-level implementation of local wellness policies: Study protocol for a cluster randomized trial. Contemporary Clinical Trials, 75.

Lane, H. G., Driessen, R., Campbell, K., Deitch, R., Turner, L., Parker, E. A., & Hager, E. R. (2018). Development of the PEA-PODS (Perceptions of the Environment and Patterns of Diet at School) Survey for Students. Prev Chronic Dis, 15, E88.

Liberali, R., Kupek, E., & Assis, M. A. A. d. (2020). Dietary patterns and childhood obesity risk: a systematic review. Childhood Obesity, 16(2), 70-85.

Linde, J. A., Horning Dehmer, M. L., Lee, J., Friend, S., Flattum, C., Arcan, C., & Fulkerson, J. A. (2022). Associations of parent dietary role modeling with children's diet quality in a rural setting: Baseline data from the NU-HOME study. Appetite, 174, 106007.

Liu, J., Rehm, C. D., Onopa, J., & Mozaffarian, D. (2020). Trends in Diet Quality Among Youth in the United States, 1999-2016. Jama, 323(12), 1161-1174.

Lopez, N. V., Lai, M. H., Yang, C. H., Dunton, G. F., & Belcher, B. R. (2022). Associations of Maternal and Paternal Parenting Practices With Children's Fruit and Vegetable Intake and Physical Activity: Preliminary Findings From an Ecological Momentary Study. JMIR Form Res, 6(8), e38326.

Loth, K. A., Ji, Z., Wolfson, J., Berge, J. M., Neumark-Sztainer, D., & Fisher, J. O. (2022). COVID-19 pandemic shifts in food-related parenting practices within an ethnically/racially and socioeconomically diverse sample of families of preschool-aged children. Appetite, 168, 105714.

Luo, W., Cai, Q., Zhou, Y., Cai, Y., Song, H., Zhang, Y., Chen, Y., & Liao, Y. (2022). Variation of parental feeding practices during the COVID-2019 pandemic: a systematic review. BMC Public Health, 22(1), 1600.

Maltoni, G., Zioutas, M., Deiana, G., Biserni, G. B., Pession, A., & Zucchini, S. (2021). Gender differences in weight gain during lockdown due to COVID-19 pandemic in adolescents with obesity. Nutrition, Metabolism and Cardiovascular Diseases, 31(7), 2181-2185.

Masarik, A. S., & Conger, R. D. (2017). Stress and child development: a review of the Family Stress Model. Current Opinion in Psychology, 13, 85-90.

Matos, R., Monteiro, D., Amaro, N., Antunes, R., Coelho, L., Mendes, D., & Arufe-Giráldez, V. (2021). Parents' and Children's (6-12 Years Old) Physical Activity Association: A Systematic Review from 2001 to 2020. Int J Environ Res Public Health, 18(23).

Nagata, J. M., Smith, N., Alsamman, S., Lee, C. M., Dooley, E. E., Kiss, O., Ganson, K. T., Wing, D., Baker, F. C., & Gabriel, K. P. (2023). Association of Physical Activity and Screen Time With Body Mass Index Among US Adolescents. JAMA Network Open, 6(2), e2255466-e2255466.

Ostermeier, E., Tucker, P., Tobin, D., Clark, A., & Gilliland, J. (2022). Parents’ perceptions of their children’s physical activity during the COVID-19 pandemic. BMC Public Health, 22(1), 1459.

Pinard, C. A., Yaroch, A. L., Hart, M. H., Serrano, E. L., McFerren, M. M., & Estabrooks, P. A. (2014). The validity and reliability of the Comprehensive Home Environment Survey (CHES). Health promotion practice, 15(1), 109-117.

Prime, Wade, M., & Browne, D. T. (2020). Risk and resilience in family well-being during the COVID-19 pandemic. Am Psychol, 75(5), 631-643.

Rodgers, R., & Chabrol, H. (2009). Parental attitudes, body image disturbance and disordered eating amongst adolescents and young adults: a review. Eur Eat Disord Rev, 17(2), 137-151.

Rodgers, R. F., Lombardo, C., Cerolini, S., Franko, D. L., Omori, M., Fuller-Tyszkiewicz, M., Linardon, J., Courtet, P., & Guillaume, S. (2020). The impact of the COVID-19 pandemic on eating disorder risk and symptoms. International Journal of Eating Disorders, 53(7), 1166-1170.

Schneider, J., Pegram, G., Gibson, B., Talamonti, D., Tinoco, A., Craddock, N., Matheson, E., & Forshaw, M. (2023). A mixed-studies systematic review of the experiences of body image, disordered eating, and eating disorders during the COVID-19 pandemic. Int J Eat Disord, 56(1), 26-67.

Shonkoff, E. T., Dunton, G. F., Chou, C. P., Leventhal, A. M., Bluthenthal, R., & Pentz, M. A. (2017). Direct and indirect effects of parent stress on child obesity risk and added sugar intake in a sample of Southern California adolescents. Public Health Nutr, 20(18), 3285-3294.

Szpunar, M., Saravanamuttoo, K., Vanderloo, L. M., Bruijns, B. A., Truelove, S., Burke, S. M., Gilliland, J., Irwin, J. D., & Tucker, P. (2022). Children’s Physical Activity during COVID-19 in Ontario, Canada: Parents’ Perspectives. International Journal of Environmental Research and Public Health, 19(22), 15061.

United States Census Bureau. Poverty Thresholds.

Valenzise, M., D’Amico, F., Cucinotta, U., Lugarà, C., Zirilli, G., Zema, A., Wasniewska, M., & Pajno, G. B. (2021). The lockdown effects on a pediatric obese population in the COVID-19 era. Italian Journal of Pediatrics, 47(1), 209.

Vaughn, A. E., Martin, C. L., & Ward, D. S. (2018). What matters most - what parents model or what parents eat? Appetite, 126, 102-107.

Wang, S. D., Devjani, S., Chillakanti, M., Dunton, G. F., & Mason, T. B. (2021). The COMET study: Examining the effects of COVID-19-related perceived stress on Los Angeles Mothers' dysregulated eating behaviors, child feeding practices, and body mass index. Appetite, 163, 105209.

Wang, Y., Hager, E. R., Magder, L. S., Arbaiza, R., Wilkes, S., & Black, M. M. (2019). A Dyadic Analysis on Source Discrepancy and a Mediation Analysis via Self-Efficacy in the Parental Support and Physical Activity Relationship among Black Girls. Child Obes, 15(2), 123-130.

Wansink, B. (2006). Nutritional gatekeepers and the 72% solution. J Am Diet Assoc, 106(9), 1324-1327.

Ward, Z. J., Long, M. W., Resch, S. C., Giles, C. M., Cradock, A. L., & Gortmaker, S. L. (2017). Simulation of Growth Trajectories of Childhood Obesity into Adulthood. New England Journal of Medicine, 377(22), 2145-2153.

Yanovski, J. A. (2015). Pediatric obesity. An introduction. Appetite, 93, 3-12.

Zhang, X. (2022). Household Chaos and Caregivers’ and Young Children’s Mental Health during the COVID-19 Pandemic: A Mediation Model. Journal of Child and Family Studies, 31(6), 1547-1557.

Ziegler, A. M., Kasprzak, C. M., Mansouri, T. H., Gregory, A. M., 2nd, Barich, R. A., Hatzinger, L. A., Leone, L. A., & Temple, J. L. (2021). An Ecological Perspective of Food Choice and Eating Autonomy Among Adolescents. Front Psychol, 12, 654139.

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Copyright (c) 2023 Nan Dou, Alysse Kowalski, Hannah Lane, Ross Hatton, Maureen Black, Erin Hager