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The home environment and childhood obesity in low-income households: indirect effects via sleep duration and screen time
Preventive and Behavioral Medicine Publications and Presentations
  • Bradley M. Appelhans, Rush University Medical Center
  • Stephanie L. Fitzpatrick, Rush University Medical Center
  • Hong Li, Rush University Medical Center
  • Vernon Cail, Rush University Medical Center
  • Molly E. Waring, University of Massachusetts Medical School
  • Kristin L. Schneider, Rosalind Franklin University of Medicine and Science
  • Matthew C. Whited, East Carolina University
  • Andrew M. Busch, Brown University
  • Sherry L. Pagoto, University of Massachusetts Medical School
UMMS Affiliation
Department of Quantitative Health Sciences; Department of Medicine, Division of Preventive and Behavioral Medicine; UMass Worcester Prevention Research Center
Publication Date
Document Type
BACKGROUND: Childhood obesity disproportionally affects children from low-income households. With the aim of informing interventions, this study examined pathways through which the physical and social home environment may promote childhood overweight/obesity in low-income households. METHODS: Data on health behaviors and the home environment were collected at home visits in low-income, urban households with either only normal weight (n = 48) or predominantly overweight/obese (n = 55) children aged 6-13 years. Research staff conducted comprehensive, in-person audits of the foods, media, and sports equipment in each household. Anthropometric measurements were collected, and children's physical activity was assessed through accelerometry. Caregivers and children jointly reported on child sleep duration, screen time, and dietary intake of foods previously implicated in childhood obesity risk. Path analysis was used to test direct and indirect associations between the home environment and child weight status via the health behaviors assessed. RESULTS: Sleep duration was the only health behavior associated with child weight status (OR = 0.45, 95% CI: 0.27, 0.77), with normal weight children sleeping 33.3 minutes/day longer on average than overweight/obese children. The best-fitting path model explained 26% of variance in child weight status, and included paths linking chaos in the home environment, lower caregiver screen time monitoring, inconsistent implementation of bedtime routines, and the presence of a television in children's bedrooms to childhood overweight/obesity through effects on screen time and sleep duration. CONCLUSIONS: This study adds to the existing literature by identifying aspects of the home environment that influence childhood weight status via indirect effects on screen time and sleep duration in children from low-income households. Pediatric weight management interventions for low-income households may be improved by targeting aspects of the physical and social home environment associated with sleep.
  • Childhood obesity,
  • Socioeconomic status,
  • Home environment,
  • Sleep,
  • Socioecologic model
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© 2014 Appelhans et al.; licensee BioMed Central Ltd.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

DOI of Published Version
BMC Public Health. 2014 Nov 9;14:1160. doi: 10.1186/1471-2458-14-1160. Link to article on publisher's site
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Link to Article in PubMed
PubMed ID
Creative Commons License
Creative Commons Attribution 4.0
Citation Information
Bradley M. Appelhans, Stephanie L. Fitzpatrick, Hong Li, Vernon Cail, et al.. "The home environment and childhood obesity in low-income households: indirect effects via sleep duration and screen time" Vol. 14 (2014) ISSN: 1471-2458 (Linking)
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