Family and Home Environment Predictors of Children's 24-Hour Movement Guideline Adherence: A Mixed-Methods Study.

Background: During summer, children may meet fewer 24 hours Movement Guidelines (24 hr-MGs) [moderate-vigorous physical activity (PA): ≥60 minutes/day, screen time: ≤2 hours/day, sleep: 9-11 hours/day) compared with the school year. Structured environments within community settings (e.g., summer programs) support guideline adherence. Information about the relationship between structured home environments and 24 hr-MGs is needed. This mixed-methods study examined which features of the family, home, and community environment supported children in meeting 24 hr-MGs during the school year and summer. Methods: Children's PA and sleep data were estimated from wrist-worn accelerometry, and screen time was assessed via parent-reported nightly surveys (14 days) at two time points [school year: (March-April) and summer (July-August) of 2021]. Parents completed a survey at each time point with 13 measures of the family (e.g., screen time rules), home (e.g., bed sharing), and community (e.g., summer program enrollment) environment. Multilevel mixed effect logistic regression estimated the odds of meeting 24 hr-MGs at each time point. Parents (n = 20) completed a qualitative interview and thematic analysis revealed parents perceived facilitators and barriers to guideline adherence. Results: Summer program enrollment and bedtime rules were associated with greater odds of meeting the PA [odds ratios (ORs): 4.9, 95% confidence intervals (CIs): (1.4, 17.1)] and ≥two 24 hr-MGs [OR: 2.2, 95 CI: (1.2, 4.0)] during summer, respectively. Parents perceived family rules/routines supported guideline adherence and lack of access to summer programs was a barrier. Conclusions: Structured environments at home and in the community can support children in meeting 24 hr-MGs guidelines. Interventions that expand access to summer programming and encourage implementation of structured home routines may support meeting multiple 24 hr-MGs during summer.