Table 4.

Social Family Influences on Youth Health Outcomes

Citation/Family level variable	Age range or mean ± SD/Sample size	Type of study/Sample	Outcome/Construct measurement/Finding	Alternatives: Follow-up, covariates, reverse causation
Suglia et al., 2009 Maternal intimate partner violence, supportive caregiving	Followed since birth N = 3116	Longitudinal Nationally representative sample of children from 20 large US cities	Maternal report of physician-diagnosed asthma at age 3 Children of mothers chronically exposed to intimate partner violence were more likely to be diagnosed with asthma	Followed for three years Relationship was moderated by level of mother-child activities Adjusted for child age, sex, ethnicity, low birth weight, maternal education, economic hardship, tobacco exposure
Wright et al., 2002 Caregiver stress (caregiver report every 2 months)	Followed since birth N = 499	Longitudinal Parents with a history of asthma/allergy were recruited within 48 hours of delivery	Bi-monthly parent-report of child wheezing Greater caregiver-reported stress at 2–3 months was associated with a greater risk of repeated child wheezing up to 14 months; dose-response relationship	Followed for 14 months Controlled for demographics, household income, birth weight, marital status, and maternal active asthma Same association also found cross-sectionally
Wright et al., 2004 Caregiver stress (caregiver report every 2 months for 2 years, then yearly)	Followed since birth N = 197	Longitudinal Parents with a history of asthma/allergy were recruited within 48 hours of delivery	Immune response outcomes in children – IgE expression, mitogen-induced and allergen-specific proliferative response, cytokine expression Higher caregiver stress in the first 6 months related to greater dust sensitivity among children; greater caregiver stress was associated with high total IgE levels and increased production of TNF-alpha	Followed for 1.5–2.5 years Controlled for demographics, household income, and maternal active asthma
Bartlett et al., 2001 Maternal depressive symptoms (parent report)	Kindergarten – grade 5 students N = 158	Longitudinal Children with physician-diagnosed asthma, and recent parent-reported asthma symptoms and emergency department visits, recruited through schools	Parent-reported emergency department use for asthma over the 6-month follow-up period Mothers with high levels of depressive symptoms were more likely to have taken their children to the emergency department over the follow-up period than mothers with low levels of depressive symptoms	6-month follow-up; prevalence ratios between groups were adjusted for age, asthma morbidity, depression, and family income
Klinnert et al., 2008 Caregiver mental health and family stress (parent report), home observation	9–24 months N = 98	Longitudinal Children from low SES families recruited from pediatric departments of local hospitals and clinics	Presence or absence of pediatric asthma at age 4 – caregiver-reported symptoms, evidence from medical records Children from families with greater family stress were more likely to be diagnosed with asthma at age 4	2–3 year follow-up (to age 4) Included maternal asthma, single parent status, prenatal smoke exposure, and ethnicity in model
Wolf et al., 2008 Parent stress and depression (parent report)	9–18 years n = 50 (asthma) n = 33 (control)	Longitudinal Youth with asthma and healthy youth recruited from the general population	Asthma inflammatory markers, stimulated interleukin-4 and eosinophil cationic protein concentrations Greater parental stress and depressive mood was associated with increases over time in ECP and IL-4 in children	Six months follow-up Controlled for asthma severity, medication use Relationship between parent psychological state and asthma outcomes not mediated by youth psychological state
Schreier & Chen, 2010 Family routines (parent-reported)	12.68 ± 2.55 N = 59	Longitudinal Community sample of youth with asthma	Mitogen-stimulated production of Interleukins 4, 5, and 13 Youth from more families with more routines decreased in IL-13 over the 2 year study period; when IL-13 was high, asthma symptoms were also high	Followed for two years Controlled for demographics and asthma severity Inclusion of medication use eliminated the relationship between routines and IL-13
Subramanian et al., 2007 Domestic violence (self-report)	All ages N = 443249	Cross-sectional Nationally representative Indian sample	Self-reported asthma Among younger (5–15 and 15–24 years) groups of this sample, those from a household where women reported domestic violence were more likely to have asthma	Controlled for a variety of sociodemographics, environmental exposures, health behaviors
Cohen et al., 2008 Physical and sexual abuse (parent and child reports)	5–13 years N = 1213	Cross-sectional Population-based probability sample from Puerto Rico	Parent-reported physician-diagnosed asthma, Physical or sexual abuse in the previous year was associated with a greater likelihood of current asthma, health care use and medication use for asthma	Controlled for demographics, SES, parental history of asthma, and caregiver-perceived stress
Barreto do Carmo et al., 2009 Minor maternal psychiatric disorder (self report)	5–12 years N = 1087	Cross-sectional Randomized sampling from 24 regions in Salvador, Brazil	Presence of asthma, parent report; atopy according to skin prick test Mothers with minor psychiatric disorders were more likely to have children with asthma	Controlled for demographics, maternal education, history of maternal asthma, mold in the home, dog/cat contact Results independent of child atopy status
Shalowitz, 2001 Maternal depression (parent-report)	1.5–12 years N = 123	Cross-sectional Mothers of children with asthma recruited at subspecialty care	Asthma morbidity, combined index of health care utilization and recent symptoms Caregivers with more depressive symptoms were more likely to have children with high asthma morbidity	Controlled for demographics and SES
Chen et al., 2007 Family support (youth report)	9–18 years N = 78	Cross-sectional Youth with asthma recruited from the general population	Self-reported asthma symptoms and pulmonary functioning in the laboratory and at home; levels of IgE, IL-4, and eosinophils Less family support associated with greater symptoms and poorer pulmonary function	Controlled for demographics, asthma severity. Biological pathways (more IgE, IL-4, eosinophils) mediated the relationship between less family support and greater symptoms
Meijer et al., 1995 Parental child-rearing attitudes, parental relationship, family functioning (self-report)	9–15 years N = 70	Cross-sectional Youth with asthma who had been pediatric outpatients for at least 2 years	Controlled versus uncontrolled asthma, as determined by treating pediatrician Children with controlled asthma had parents who were better problem solvers, more rigid mothers, more cohesive families; more structured families better at correctly using medication	Controlled and uncontrolled cases matched for asthma severity
Brook & Tepper, 1997 Family interaction (youth report)	12.16 ± 2.56 n = 51 (asthma) 13.28 ± 1.4 n = 32 (control)	Cross-sectional Randomly chosen from youth treated for asthma; healthy children from nearby school	Asthma versus controls Youth with asthma were more likely to come from families who showed evidence of lower family interaction	Controls matched on demographics
Wamboldt et al., 1995 Parental criticism, based on five minute parental speech sample	11–18 years N = 19	Cross-sectional Adolescents admitted to the pediatric inpatient service for severe asthma	Treatment outcome measures: medication, history, current pulmonary function, physical exam, laboratory data; prednisone equivalents, treatment compliance, length of hospital stay Greater parental criticism associated with lower medication compliance at admission but also greater improvement in asthma severity, reduction in steroid medication dose, and short hospital stays	Findings independent of vocal cord dysfunction or youth allergy status
Taveras et al., 2005 Frequency of family dinner (youth-report)	9–14 years N = 14,431	Longitudinal National convenience sample; children of the Nurses’ Health Study II	Adolescent overweight (age- and sex-specific BMI > 85th percentile; self-reported height and weight) Cross-sectionally at baseline, eating family dinner on most days or every day was associated with lower odds of being overweight; no association with becoming overweight in longitudinal analyses	Controlled for sociodemographics, physical factors, and hours of physical activity/inactivity
Gable et al., 2007 Frequency of family meals (parent-reported)	Kindergarten children N = 8000	Longitudinal Nationally representative sample of children who entered kindergarten in 1998	Overweight (BMI > 95% percentile) Children who ate fewer family meals were more likely to be overweight for the first time at spring semester of third grade and to be persistently overweight	Followed for three years Controlled for demographics and family SES
Koch et al., 2008 Family stress (serious life events, parenting stress, lack of social support, parental worries)	Followed since birth N = 7443 (families)	Longitudinal General population cohort from an area in Sweden	Child obesity status (international age-adjusted standards) Children from families with stress in at least 2 of 4 areas were more likely to be obese, cross-sectionally and longitudinally	Five-year follow-up Adjusted for child sex, parental origin, parents’ age at birth, parents’ weight status, parents’ educational level, and marital status
Larson et al., 2007 Frequency of family meals (child-reported)	Grade 9–12 students N = 1710	Longitudinal Recruited from 31 public middle and high schools in the Minneapolis/St. Paul, Minn. area	Diet quality, meal frequency, social eating and meal structure during young adolescence More family meals during adolescence was associated with greater consumption of fruit, vegetables, and key nutrients and lower consumption of soft drinks during adulthood; also predicted more breakfast meals and higher priority for meal structure and social eating	Five-year follow-up Adjusted for demographics, energy consumption
Olvera & Power, 2010 Parenting style (parent-reported)	4–8 years N = 69	Longitudinal Community sample of Mexican Americans	Children’s overweight status (BMI > 85th percentile considered overweight, collected annually) Children of indulgent mothers were more likely to be overweight at follow-up than children of authoritarian or authoritative mothers	Three-year follow-up Controlled for initial weight status
Videon & Manning, 2003 Parental presence at dinner (adolescent report)	Grade 8–12 students N = 18177	Cross-sectional National stratified, systematic sample of high school students	Food consumption, fruit and vegetable consumption, breakfast skipping (adolescent report) If parents present for 3+ family meals/week, adolescents were less likely to skip breakfast and report poor consumption of fruits, vegetables, dairy; dose-response relationship	Controlled for sociodemographics and adolescent body weight perception
Gillman et al., 2000 Frequency of family meals (child-reported)	9–14 years N = 16,202	Cross-sectional National convenience sample; children of the Nurses’ Health Study II	Food and nutrient intake, self-reported Youth whose families ate more meals together consumed more fruits, vegetables, fiber, and micronutrients, less fried food, soda, and trans fat, and had a lower glycemic load	Adjusted for sex, BMI, physical activity, hours of television watched, smoking intention, smoking in the home, family structure, household income, frequency of child making his or her own dinner
Neumark-Sztainer et al., 2003 Frequency of family meals (child-reported)	11–18 years N = 4746	Cross-sectional Recruited from 31 public middle and high schools in the Minneapolis/St. Paul, Minn. area	Food and nutrient intake, self-reported Youth whose families ate more meals together consumed more fruits, vegetables, grains, calcium-rich foods, and micronutrients and fewer soft drinks	Adjusted for demographics, school level, mother’s employment status, SES, energy consumption and school
Toschke et al., 2005 Daily meal frequency (parent-reported)	5–6 years N = 4370	Cross-sectional German community sample	Child obesity (sex- and age-specific BMI cut-off points) Children who ate more daily meals were less likely to be obese	Controlled for a variety of sociodemographic, constitutional and lifestyle factors
Mamun et al., 2005 Maternal attitude towards family meals and frequency of family meals (parent-reported)	14 years N = 3795	Cross-sectional Data from a population-based Australian prospective birth cohort	Adolescent overweight (BMI > 22.62 for boys and > 23.34 for girls) Children of mothers who did not think eating together was important were more likely to be overweight; frequency of family meals did not impact overweight	Adjusted for child sex and age, maternal parity, family income, maternal education at birth, and race, child TV watching, child activity, child’s frequency of consumption of unhealthy foods
Garasky et al., 2009 Family stressors (disruption and conflict, mental and physical health problems, housing issues, health care struggles, financial strain, lack of cognitive stimulation/emotional support	5–11 years n = 1136 12–17 years n = 1001	Cross-sectional Second wave of a nationally representative US panel study of income dynamics and children	Weight status (healthy weight, overweight at BMI > 85th percentile, obese at BMI > 95th percentile) In younger children, lack of emotional support and cognitive stimulation was associated with greater likelihood of overweight and obesity In older children, financial stressors and mental and physical health stressors were associated with greater likelihood of overweight and obesity	Controlled for age of primary caregiver, whether primary caregiver was child’s mother, number of people in the household and family income
Hoerr et al., 2009 Parenting style (parent-reported)	Preschool children N = 715	Cross-sectional Children and parents selected from a study investigating Head Start families	Food intake (3 days of dietary recall with children) Compared to children authoritarian parents, those of indulgent or uninvolved parents consumed fewer fruits, vegetables, and juice
Moens et al., 2009 Parenting stress (parent-reported)	6–14 years N = 197 (families, 97 controls)	Cross-sectional case-control study Overweight children recruited from inpatient/outpatient/school intervention waiting list; control group from the community	Overweight status Children from families with greater parenting stress were more likely to be overweight	Controlled for parental education, employment status, family structure, and number of siblings
Coon et al., 2001 Presence of television during meals (parent-reported)	Grade 4–6 students N = 91	Cross-sectional Community sample	Food and nutrient intake (3 24-hour dietary recall interviews with children) Children from families with more television use during meals derived more of their total energy intake from meats, pizza, salty snacks, soda, and less from fruits, vegetables, and juices; they also consumed more caffeine	Controlled for demographics, SES, maternal education, maternal weekly working hours, 2-parent household, number of nights per week parents prepared quick suppers and parent’s knowledge and attitudes about nutrition
Johnson & Birch, 1994 Mothers’ degree of control over children’s food intake	3–5 years N = 77	Cross-sectional laboratory study Community sample from one university preschool	Manipulated caloric density of children’s meals; measured height, weight, skinfolds, ability to regulate energy intake Children who had more controlling mothers were less likely to regulate food intake and had greater body fat
Moens et al., 2007 Family Mealtime Interaction (coded videotapes of typical family mealtimes)	7–13 years N = 56 (families; 28 control)	Cross-sectional case-control study Overweight children recruited from inpatient/outpatient/school intervention waiting list; control group from the community	Overweight status Parents who were observed to display less support and use more maladaptive control strategies were more likely to have overweight children. Parents who self-reported being more controlling also were more likely to have overweight children.	Controlled for maternal BMI and family SES
Trost et al., 2003 Parent physical activity beliefs and support behaviors for children’s activity (parent-reported)	14.0 ± 1.6 years N = 380	Cross-sectional Participants recruited from junior and senior high schools in Amherst, MA	Youth physical activity (child-reported) Greater parental support resulted in greater youth physical activity, directly and through youth’s self-efficacy	Controlled for child’s age and gender
Davison et al., 2003 Parents’ activity-related parenting (parent-reported)	9 years N = 180	Cross-sectional Convenience sample from an ongoing longitudinal study	Physical activity (child-report) More modeling of physical activity behaviors and greater provision of logistic support of youth’s activity were associated with greater physical activity among children	Family income, parent education, parents’ work hours were unrelated to physical activity
Moore et al., 1991 Parental activity levels (assessed through accelerometer)	4–7 years N = 100	Cross-sectional Convenience sample from an ongoing longitudinal study	Child physical activity levels (accelerometer assessed) Children of active mothers and fathers were more active than those of inactive parents; having two active parents was related to much greater physical activity levels than having two inactive parents

Note: For the second part of this table concerning youth obesity we first list papers investigating family influences on BMI, followed by papers investigating family influences on physical activity behaviors.