Association between Social Vulnerability and the Strengthening of the Parent-Child Relationship in a Childhood Obesity Prevention Program: Results from the Idefics Study

Introduction: A positive parent-child relationship is associated with a healthier weight, diet and higher levels of physical activity in children. IDEFICS study was a behavioral intervention to prevent obesity in children aged 2.0-9.9 years old from eight European countries. Objective: The objective of this study is to evaluate the association between social vulnerability and the strength of the parent-child relationship at follow-up. Methods: Data from 4,160 children was included in the analysis. We computed the vulnerability score (independent variable) by adding the number of social vulnerabilities a child/family experienced at baseline (minimal parental social network, non-traditional family structure, at least one nonnative parent, at least one parent unemployed, low parental educational level and low household income). Parents were asked “To what extent would the following items describe your family” with the items: “we often go on trips together”, and “I am often too busy to talk to my child” (reverse coded). Parents answered each item with a 4-point scale from 0-point (“not true”) to 3-points (“exactly true”). We added the points of both items to obtain a parent-child relationship strength score and classified families as "doing more together than average" if their score fell above the mean (≥5 points). Analysis was conducted separately by the relationship strength categorization at baseline. We used multilevel logistic regression mixed models to evaluate the association between social vulnerability score and the relationship strength at follow-up (outcome). Results: Families with relationship strength≥5 and with vulnerability score≥3 at baseline are less likely to do more things together at follow-up in comparison with families with vulnerability score=0 (OR=0.64; 95%CI: 0.44-0.95). Families with relationship strength<5 and with vulnerability score=2 at baseline are less likely to do more things together at follow-up when compared to families with vulnerability score=0 (OR=0.73; 95%CI: 0.54-0.98). Conclusions: Despite the parent-child relationship strength score at baseline, families with vulnerabilities are less likely to engage in behaviors than tend to strengthen their parent-child relationship (trips and communication). Results are consistent with the behavioral change theory that indicates that interventions favor subgroups without vulnerabilities as they have more resources to achieve behavioral change.