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Objective The aim of the present study was to examine parents' reported and desired frequencies (practices vs. attitudes) of their 6-year-old children's meals, nutritional intake and lifestyle components, as well as possible obstacles and desired support with respect to higher or lower educational backgrounds.

Design Cross-sectional questionnaire study.

Setting Five elementary schools in Uppsala, Sweden.

Subjects Parents of 176 6-year-old pupils attending the first grade. The total response rate was 89.7%.

Results Parents with a college degree reported that their 6-year-olds had a higher frequency of milk, fruit and vegetable intake, more physical activity and fewer hours watching television compared with parents with a secondary school degree. Congruent to these differences in reported practices, more parents with a college degree desired a higher frequency of milk, fruit and vegetable intake, more physical exercise and less television viewing for their children. Regarding parents' desired meal frequencies during the week, no differences between the groups with higher and lower levels of education were found. Despite similar attitudes, however, parents with a college degree reported that their children ate mostly all meals significantly more often during the week. Both parent groups stated lack of time as the most common obstacle in providing their children with desired lifestyle practices, although parents with a secondary school education added lack of money as a contributing factor.

Conclusions As attitudes are not always reflected in reported practices, it seems a fruitful approach to assess both, as well as obstacles perceived by parents, before planning interventions to enhance healthy lifestyle habits in children.

Aim: The aim of this study was to investigate if family stress and parental attachment style are associated with body mass index (BMI) in young children, and identify possible explanations. Methods: A cross-sectional survey with a two-stage design was used. Parents of 873 children participated. They completed a demographic questionnaire, the Swedish Parenthood Stress Questionnaire (SPSQ), the Relationship Questionnaire (RQ) and reported their children's television-viewing habits (as a marker of physical activity). Children's height, weight and BMI were obtained from a general population-based register, BASTA. Associations with over- and underweight in children were assessed using multiple logistic regression analysis. Results: Family stress indicated by SPSQ-score was associated with suboptimal BMI. Maternal, but not paternal, SPSQ-stress score was statistically significantly associated with overweight and underweight, with adjusted odds ratios (and 95% confidence interval) of 4.61 (3.11-6.84; p < 0.001) and 3.08 (1.64-5.81; p < 0.001) respectively. Associations between childhood BMI and parental attachment style were identified, but were not independent of maternal SPSQ-score. Conclusion: Our findings support a role for family stress in development of both overweight and underweight among young children. This is likely to be attributed to behavioural mechanisms but a more direct metabolic influence of stress could also be involved.

Aim:  To explore parents' perspectives on providing their preschool child with a healthy lifestyle, including obstacles and resources.

Methods:  Five semi-structured focus group interviews were conducted, with 30 parents of 4-year-olds in Sweden. Interviews were transcribed verbatim and analysed using Systematic Text Condensation.

Results:  Four themes emerged from the qualitative analysis: Lifestyle -'The way you live is parents' responsibility', Challenges to promote children's healthy lifestyle, Support from professionals, and peers might facilitate, and Request for an overall responsibility from society. Parents felt that they were role models for their child's lifestyle, a concept including many factors. Attractive and tempting sedentary activities and unhealthy foods were perceived as obstacles, and parents were frustrated by the media's contradictory lifestyle messages. Child health services were expected to more actively invite parents to discuss their child's lifestyle issues. Parents desired some collective responsibility for children's lifestyles through agencies, services and media messages that support and promote healthy choices.

Conclusion:  Parents struggled to give their children a healthy lifestyle and the 'temptations' of daily unhealthy choices causing hassles and conflicts. Parents desired professional support from preschool, Child Health Care and a collective responsibility from society with uniform guidelines. Parents groups were mentioned as peer support.

Objective: To compare three different approaches for consent in postal questionnaire in terms of response rate, time consumption, and  cost-efficiency, and to collect a demographic questionnaire for dropout analyses.

Study Design and Setting: Population survey in Sweden. Mothers and fathers (n=600) of three hundred 3-year olds were divided into three groups. One group was asked to Actively Agree to participate in a cover letter and send consent back to receive the main questionnaire. The second group received the cover letter, the consent, and the main questionnaire in the initial mailings, Direct Delivery. The third group received the cover letter and consent form in which they were asked to Actively Decline  participation within 7 days if they did not want to participate. Otherwise, they were sent the main questionnaire. All parents were asked to fill in a demographic questionnaire regardless of whether they wanted to complete the main questionnaire.

Results: The highest response rate was in the Actively Decline mode. The cost-efficiency for this approach was 1.52 compared with Direct Delivery and 1.29 compared with Actively Agree.

Conclusion: Researchers can improve the response rate, time consumption, and cost-efficiency and obtain a demographic questionnaire for dropout analysis by using the Actively Decline approach for postal questionnaires.