Physical Activity, Screen Time, and Dietary Intake in Families: A Cluster-Analysis With Mother-Father-Child Triads

Background: The co-occurrence of multiple health behaviors such as physical activity, diet, and sedentary behavior affects individuals' health. Co-occurence of different health behaviors has been shown in a large number of studies. This study extended this perspective by addressing the co-occurrence of multiple health behaviors in multiple persons. The objective was to examine familial health behavioral patterns by (1) identifying clusters of families with similar behavior patterns and (2) characterizing the clusters by analyzing their correlates. Methods: Cross-sectional data were collected from 198 families (mother, father, and child). Mothers, fathers, and children completed questionnaires assessing health related behaviors (physical activity, consumption of "healthy" and "unhealthy" foods, and screen time), the perception of Family Health Climate (regarding physical activity and nutrition) and demographics. Twelve variables (four health behaviors of three family members) were included in a cluster analysis conducted with Ward's Method and K-means analysis. Chi-square tests and analyses of variance were performed to characterize the family clusters regarding their demographics and their perception of Family Health Climate. Results: Three clusters of families with specific behavioral patterns were identified: "healthy behavior families" with levels of physical activity and consumption of healthful foods above average and levels of media use and consumption of sweets below average; "unhealthy behavior families" with low levels of consumption of healthful foods and high levels of screen time; "divergent behavior families" with unhealthier behavioral patterns in parents and healthier screen time and eating behaviors combined with low physical activity levels in children. Family Health Climate differed between family clusters with most positive ratings in "healthy behavior families" and least positive ratings in "unhealthy behavior families." "Divergent behavior families" rated the nutrition climate nearly as high as "healthy behavior families" while they rated the physical activity climate nearly as low as the "unhealthy behavior families." Conclusions: The study shows that co-occurrence of multiple health behaviors occurs on the family level. Therefore, focusing the family as a whole instead of individuals and targeting aspects related to the Family Health Climate in interventions could result in benefits for both children and adults and enhance effectivity of intervention programs.