Children’s executive functioning and health behaviors across pediatric life stages and ecological contexts

Kelly NR, Kosty D, Bodovski Y, Blackwell CK, Ganiban JM, Neiderhiser JM, Dabelea D, Gilbert-Diamond D, Aschner JL, Bastain TM, Breton CV, Bush NR, Calub CA, Camargo CA, Camerota M, Croen LA, Elliott AJ, Enlow MB, Ferrara A, Hartert T, Joseph RM, Karagas MR, Kelly RS, Lyall K, Magee KE, McEvoy CT, Merced-Nieves FM, O’Connor TG, Santarossa S, Schantz SL, Schmidt RJ, Stanford JB, Straughen JK, Stroustrup A, Talge NM, Wright RJ, Zhao Q, Leve LD, Smith PB, Newby KL, Adair L, Catellier D, Jacobson L, Cella D, Gershon R, Teitelbaum SL, Merhar S, Lampland A, Reynolds A, Hudak M, Pryhuber G, Moore P, Washburn L, Trasande L, Gatzke-Kopp L, Swingler M, Mansbach JM, Spergel JM, Samuels-Kalow ME, Stevenson MD, Bauer CS, Mitchell DK, Deoni S, D’Sa V, Duarte CS, Monk C, Posner J, Canino G, Gern J, Zoratti E, Johnson C, Farzan S, Habre R, Hertz-Picciotto I, Hipwell A, Keenan K, Karr C, Tylavsky F, Mason A, Sathyanarayana S, Lester B, Carter B, Pastyrnak S, Neal C, Smith L, Helderman J, Leve L, Weiss ST, Litonjua A, O’Connor G, Zeiger R, Bacharier L, Tepper R, Volk H, Landa R, Ozonoff S, Miller RK, Simhan H, Buss C, Wadhwa P, Huff K, O’Shea M, Vaidya R, Obeid R, Rollins C, Bear K, Lenski M, Singh R, Msall M, Frazier J, Gogcu S, Montgomery A, Kuban K, Douglass L, Jara H, Kerver JM, Barone C, Fussman C, Paneth N, Elliott M, Ruden D, Woodruff T, Porucznik C, Giardino A, Huddleston K, Nguyen R, Barrett E, LeWinn KZ, Swan S

Published April 2025 Journal of Behavioral Medicine, 48(2), 230-250
DOI 10.1007/s10865-024-00543-w PMC PMC12045159

Abstract

Executive functioning (EF) has been linked to chronic disease risk in children. Health behaviors are thought to partially explain this association. The current cross-sectional study evaluated specific domains of EF and varied health behaviors in three pediatric life stages. Pediatric participants (early childhood n = 2074, Mage = 6.4 ± 0.9 y; middle childhood n = 3230, Mage = 9.6 ± 1.2 y; adolescence n = 1416, Mage = 15.2 ± 1.7 y) were part of the Environmental influences on Child Health Outcomes (ECHO) Program. They completed neurocognitive tasks measuring cognitive flexibility, behavioral inhibition, and working memory. Parent- and/or child-report measures of dietary intake, physical activity, sleep duration and quality, income, and positive parenting were also collected. Neighborhood crime and greenspace were calculated from publicly available census-tract level indices. After adjusting for study site, child body mass index, and demographics, working memory was related in the hypothesized direction to several dietary behaviors within all pediatric life stages. Working memory and cognitive flexibility were positively related to physical activity in middle childhood and adolescence. In adolescence, behavioral inhibition was positively related to physical activity and inversely related to sugar-sweetened beverage and total caloric intake. Associations with sleep were all non-significant. All significant associations reflected small effect sizes. Income, positive parenting, greenspace, and crime did not significantly influence any of the EF-health behavior associations. Findings highlight the need to consider EF domains, specific health behaviors, and developmental stage in creating intervention strategies that target EF to improve health behaviors. The small effect sizes reinforce the need for multi-tiered interventions to maximize health.

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DOI 10.1007/s10865-024-00543-w 10.1007/s10865-024-00543-w Kelly et al. 2025, Kelly 2025