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Types of parenting styles and effects on children.

Terrence Sanvictores ; Magda D. Mendez .

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Last Update: September 18, 2022 .

Definition/Introduction

When it comes to parenting, there is a great deal of diversity among families. Cultural backgrounds have a major impact on how the family unit exists and how children are reared. In the last several years, the population of the United States of America has had a makeup. Changes driven by immigration (with different cultural, ethnic, and spiritual ideologies), socioeconomic status, and single-parent families are some of the factors that determine a variety of parenting styles among families. As per the 2014 U.S. Census Bureau data, ¼ of children lived in single-parent families, and three-fourths lived in households with two married parents. These patterns differ when race and ethnicity are considered. Although children can thrive in all types of family environments, data suggest that, on average, children living in single-parent families fare less well than their counterparts.

The definition of culture refers to a pattern of social norms, values, language, and behavior shared by individuals. As a result, parents are affected by their culture. When it comes to self-regulation, parenting approaches vary across cultures concerning promoting attention, compliance, delayed gratification, executive function, and effortful control.

Every parent has a different approach in how to interact and guide their children. A child’s morals, principles, and conduct are generally established through this bond. Different researchers have grouped parenting styles into three, four, five, or more psychological constructs. This article's content will only focus on four parenting categories: authoritarian, authoritative, permissive, and uninvolved. Every category employs a unique approach to how parents raise their children. Generally, each parent will fall into one of these categories and sometimes have some characteristics from another category. Parenting style can also be situation-dependent.

Issues of Concern

Authoritarian Parenting

Parents of this style tend to have a one-way mode of communication where the parent establishes strict rules that the child obeys. There is little to no room for negotiations from the child, and the rules are not usually explained. They expect their children to uphold these standards while making no errors. Mistakes usually lead to punishment. Authoritarian parents are normally less nurturing and have high expectations with limited flexibility.

Children that grow up with authoritarian parents will usually be the most well-behaved in the room because of the consequences of misbehaving. Additionally, they are better able to adhere to the precise instructions required to reach a goal. Furthermore, this parenting style can result in children who have higher levels of aggression but may also be shy, socially inept, and unable to make their own decisions. [1] This aggression can remain uncontrolled as they have difficulty managing anger as they were not provided with proper guidance. They have poor self-esteem, which further reinforces their inability to make decisions. [2] Strict parental rules and punishments often influence the child to rebel against authority figures as they grow older.

Authoritative Parenting

This type of parent normally develops a close, nurturing relationship with their children. They have clear guidelines for their expectations and explain their reasons associated with disciplinary actions. Disciplinary methods are used as a way of support instead of punishment. Not only can children have input into goals and expectations, but there are also frequent and appropriate levels of communication between the parent and their child. In general, this parenting style leads to the healthiest outcomes for children but requires a lot of patience and effort on both parties.

Authoritative parenting results in children who are confident, responsible, and able to self-regulate. [1] [3] They can manage their negative emotions more effectively, which leads to better social outcomes and emotional health. Since these parents also encourage independence, their children will learn that they are capable of accomplishing goals on their own. This results in children who grow up with higher self-esteem. Also, these children have a high level of academic achievement and school performance. [4]

Permissive Parenting

Permissive parents tend to be warm, nurturing and usually have minimal or no expectations. They impose limited rules on their children. Communication remains open, but parents allow their children to figure things out for themselves. These low levels of expectation usually result in rare uses of discipline. They act more like friends than parents.

Limited rules can lead to children with unhealthy eating habits, especially regarding snacks. [5] This can result in increased risks for obesity and other health problems later in the child’s life. The child also has a lot of freedom as they decide their bedtime, if or when to do homework, and screen time with the computer and television. [6] Freedom to this degree can lead to other negative habits as the parent does not provide much guidance on moderation. Overall, children of permissive parents usually have some self-esteem and decent social skills. However, they can be impulsive, demanding, selfish, and lack self-regulation. [7] [8]

Uninvolved Parenting

Children are given a lot of freedom as this type of parent normally stays out of the way. They fulfill the child’s basic needs while generally remaining detached from their child’s life. An uninvolved parent does not utilize a particular disciplining style and has a limited amount of communication with their child. They tend to offer a low amount of nurturing while having either few or no expectations of their children.

The children of uninvolved parents usually are resilient and may even be more self-sufficient than children with other types of upbringing. However, these skills are developed out of necessity. Additionally, they might have trouble controlling their emotions, less effective coping strategies, may have academic challenges, and difficulty with maintaining or nurturing social relationships. [9] [10]

Clinical Significance

Characteristics of a parent’s upbringing style may continue to be prevalent in the child’s behaviors and actions as they age. As a child grows older, they can be affected by other factors that further shape their conduct or possibly change it entirely (i.e., therapy, culture, job, and social circle). With regards to health outcomes, it is important to identify which areas of concern are related to the upbringing style of a patient’s parents (i.e., the habit of unmonitored snacking) and address the issues at that level. These issues become relatively more important when it comes to behavioral/ psychological intervention.

Becoming culturally competent whenever possible is a great asset for providers who take care of pediatric patients. Understanding the family background, how rules are set, and discipline styles will allow the clinician to understand the dynamics of the family unit. Once the provider is familiarized with the parental rearing techniques, identifying, managing, or referring families will be an easier task.

Nursing, Allied Health, and Interprofessional Team Interventions

Child interventions may require knowledge of their parent's upbringing style, especially if physical or verbal abuse is suspected. Understanding the child's home environment can lead to better patient outcomes as more personalized approaches can be taken towards the child's wellbeing.

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Disclosure: Terrence Sanvictores declares no relevant financial relationships with ineligible companies.

Disclosure: Magda Mendez declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

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Parenting styles and children's development: A review of the literature

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Parenting styles and academic achievement of young adolescents: A systematic literature review

Published: 30 October 2014
Volume 49 , pages 2411–2433, ( 2015 )

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Hamid Masud 1 ,
Ramayah Thurasamy 2 &
Muhammad Shakil Ahmad 1

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Literature accords the importance of parenting style and their impact on young adolescent’s behavior. There are many factors that affect the academic performance of children and parenting styles is one of the significant factors of academic performance. But there is lack of research that integrates and systemizes the relationship between parenting styles and academic performance especially in Pakistan. The unit of analysis of this research was studies that were previously conducted on parenting styles and academic performance of young children. Main focus of search was to availability of data that is most recent and relevant, so this research paper focuses on 39 studies. Articles from seven databases (Google Scholar, Science Direct, Taylor and Francis Journals, Web of Science, JSTOR, Springer link and SAGE Journals) were identified related to the topic using a pre-established set of terms that included both parenting styles and academic performance. All the studies highlighted that parenting styles affect the academic achievement of adolescents. It was analyzed that authoritative parenting style is the most effective parenting style in enhancing the academic performance of young children. More research is needed on parenting styles in different continents to have an understanding of the cultural effect of parenting styles on the academic performance of adolescents. Implications for parents and policy makers are discussed.

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Pontificating the relationship between parenting styles and academic performance of senior high school students in the Kumasi Metropolis, Ghana

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Masud, H., Thurasamy, R. & Ahmad, M.S. Parenting styles and academic achievement of young adolescents: A systematic literature review. Qual Quant 49 , 2411–2433 (2015). https://doi.org/10.1007/s11135-014-0120-x

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Published: 02 April 2024

Family systems approaches in pediatric obesity management: a scoping review

Natasha Wills-Ibarra 1 ,
Keryn Chemtob 1 ,
Heather Hart 1 ,
Francesca Frati 1 ,
Keeley J Pratt 2 , 3 ,
Geoff DC Ball 4 &
Andraea Van Hulst 1

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Family-based obesity management interventions targeting child, adolescent and parental lifestyle behaviour modifications have shown promising results. Further intervening on the family system may lead to greater improvements in obesity management outcomes due to the broader focus on family patterns and dynamics that shape behaviours and health. This review aimed to summarize the scope of pediatric obesity management interventions informed by family systems theory (FST). Medline, Embase, CINAHL and PsycInfo were searched for articles where FST was used to inform pediatric obesity management interventions published from January 1980 to October 2023. After removal of duplicates, 6053 records were screened to determine eligibility. Data were extracted from 50 articles which met inclusion criteria; these described 27 unique FST-informed interventions. Most interventions targeted adolescents (44%), were delivered in outpatient hospital settings (37%), and were delivered in person (81%) using group session modalities (44%). Professionals most often involved were dieticians and nutritionists (48%). We identified 11 FST-related concepts that guided intervention components, including parenting skills, family communication, and social/family support. Among included studies, 33 reported intervention effects on at least one outcome, including body mass index (BMI) ( n = 24), lifestyle behaviours (physical activity, diet, and sedentary behaviours) ( n = 18), mental health ( n = 12), FST-related outcomes ( n = 10), and other outcomes (e.g., adiposity, cardiometabolic health) ( n = 18). BMI generally improved following interventions, however studies relied on a variety of comparison groups to evaluate intervention effects. This scoping review synthesises the characteristics and breadth of existing FST-informed pediatric obesity management interventions and provides considerations for future practice and research.

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Obesity is a major public health concern affecting all age groups [ 1 ]. The high global prevalence of childhood overweight and obesity is concerning given known impacts on several body systems, including the cardiovascular, pulmonary, endocrine, gastrointestinal and musculoskeletal systems [ 2 ]. Obesity persists from childhood into adulthood [ 3 ] resulting in increased risk of morbidity and mortality [ 4 , 5 ]. In addition to its bearings on physical health, childhood overweight and obesity are associated with poor psychosocial outcomes [ 2 , 6 ]. Given its multiple immediate and long-term consequences, managing overweight and obesity in children and adolescents through effective interventions is a priority.

Most pediatric obesity management interventions fall within the umbrella of family-based approaches, targeting specific lifestyle behaviours (e.g., diet, physical activity) for obesity management and including at least one family member (e.g., a parent) in addition to the target child. Family-based behavioural interventions have shown improvements in lifestyle behaviours and in obesity-related outcomes [ 7 , 8 , 9 , 10 ]. However, these interventions may have limited effects if they fail to address the family patterns and dynamics that shape lifestyle behaviours [ 11 ].

Family Systems Theory (FST) has gained attention in pediatric obesity management [ 12 ]. Derived from general systems theory, FST focuses on understanding the interrelationships between elements within a system (e.g., the dynamics of a family unit, communication, and problem-solving). It views families as complex systems in which events or changes in one family member influence other interrelated parts of the system [ 11 ]. FST explicitly recognizes the key roles of family-level influences on children’s lifestyle behaviours and changes therein, with the goal of promoting health and managing obesity [ 13 ]. The integration of a family systems approach in pediatric obesity management interventions may increase their efficacy and sustainability by targeting core family dynamics that challenge lifestyle modifications required for obesity management [ 12 ]. A preliminary search of published systematic reviews on family-based obesity management interventions revealed a limited focus on family systems approaches with few reviews identifying specific intervention components consistent with FST [ 10 , 14 , 15 , 16 , 17 , 18 ]. Family systems concepts (e.g., interpersonal dynamics, family functioning, family problem-solving) were infrequently mentioned or only discussed narrowly [ 12 ]. Moreover, despite the potential benefits of using FST, clinicians have reported a lack of clarity regarding how to apply FST in the context of pediatric obesity management [ 13 ].

This scoping review addresses the following overarching question: How has FST been used in the context of pediatric obesity management interventions? Specifically, this review identifies 1) who is targeted by existing FST-informed interventions; 2) settings where they have been implemented (primary, specialty/tertiary, community); 3) delivery format (e.g., group vs. individual, parents-only vs. child-only vs. family) and professionals involved in the implementation of these interventions; 4) FST-related concepts that are integrated into interventions and tools used to measure these concepts; and 5) effects of FST-informed approaches on obesity outcomes and on FST-related concepts.

A scoping review of the literature was conducted following the Joanna Briggs Institute (JBI) methodology [ 19 ], and the PRISMA-ScR and PRISMA-S guidelines for searches [ 20 , 21 ].

Search strategy

A comprehensive search strategy was used. An academic health sciences librarian (FF) conducted a preliminary search that allowed us to analyse titles, abstracts, and index terms of isolated papers in order to refine our scoping review questions and define the final search strategy. Although we initially wanted to use a broad approach to the definition of FST, for feasibility reasons, we narrowed our review to articles that explicitly mention the use of FST to inform the development of obesity management interventions [ 12 ]. Similarly, although we initially wanted to include both prevention and management interventions, we narrowed our review to interventions focusing on obesity management (i.e., children and adolescents with overweight or obesity). Following these refinements, a final search strategy was developed by FF and a peer review of the search strategy was conducted by a second academic health sciences librarian using the PRESS (Peer Review of Electronic Search Strategies) guideline [ 22 ]. After minor revisions, the final search was run in Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Embase, and PsycInfo on April 4, 2020. Duplicates across databases were removed in EndNote using a simplified method described by Bramer et al. [ 23 ] and additional duplicates were identified in Rayyan [ 24 ]. Our search was based on three main concepts, namely family systems, pediatric obesity, and interventions. The full search strategies for all four databases are presented in Supplemental Table 1 . We also examined reference lists and citations of included studies for further pertinent studies that were not captured through our database searches. This overall search strategy was implemented for studies published between January 1980 and April 2020. No additional limits or search filters were used. In October 2023, we updated our review by conducting the same search in Medline to identify publications indexed between April 4, 2020 and October 27, 2023, the date of this search. We also searched for articles published in the last 3 years that cited previously identified research protocol articles of FST-informed obesity management interventions. This scoping review thus includes articles published between January 1980 and October 2023; this date range was selected to capture early family systems interventions following the increased recognition by the early 1990’s of the role of families in childhood obesity [ 25 ].

Inclusion and exclusion criteria

Details regarding inclusion and exclusion criteria are presented in Table 1 . Articles that used FST to inform the design of a pediatric obesity management intervention or program were included. Specifically, we included publications describing obesity management interventions that focus on children aged 2 to 18 years, with overweight or obesity, the direct involvement of at least one adult family member, and the explicit statement of a family systems-related theory, model, and/or framework [ 12 ]. Review papers, case studies, texts, opinion papers, letters and gray literature were excluded.

Study selection

EndNote (Thomson Reuters, New York, USA) was used to manage records identified from the literature search. Search results from all databases were combined, and duplicates were removed. Records were then imported into Rayyan [ 26 ] to manage decisions on inclusion/exclusion. For the updated search covering the period of April 2020 to October 2023, we used Covidence, a web-based collaboration software platform to manage the flow of records in review studies. Titles and abstracts were screened for inclusion by two out of four independent reviewers (NWI, KC and 2 research assistants), followed by screening of full-text by two of the same reviewers. Discordances at both stages were settled by the senior author (AVH).

Data extraction, analysis and synthesis

Data extraction, analysis and synthesis were conducted by two reviewers (NWI, KC) and verified by the senior author. An adaptation of the JBI data extraction instrument was used to import data into a table with the following fields based on the research questions: country and name of intervention; sample size (if applicable); study design; target population (e.g., age/sex of child, family members targeted, racial/ethnic groups, etc.); type of care setting (e.g., community, hospital); description and duration of the intervention; delivery format of the intervention (e.g., group vs. individual, parents-only vs. child/teen-only vs. family); professionals involved in the intervention; Family Systems related theory or framework and other theories used to inform the intervention; specific Family Systems concepts used (e.g., family dynamics, family functioning, parenting styles, etc.); and measurment of family concepts. The results of articles that reported intervention effects on outcomes were summarized in a separate table, including intervention effects on family systems concepts, mental health, lifestyle behaviours, body mass index (BMI) and other outcomes examined. The type of control group was classified as not applicable (no control group), waitlist control, usual care, or intervention control group, with descriptors provided when available. Intervention effects were summarised based on whether an improvement, a deterioration, or the absence of changes on outcomes were reported. No standardised metrics for outcomes were sought given the diversity of included studies.

All data extracted from articles were compiled using counts and proportions to answer our research questions. A conventional inductive content analysis was completed [ 27 ] in order to identify and summarize the FST-related concepts that were intervened upon in included studies. To do so, keywords and descriptive texts were extracted from the studies’ intervention descriptions and grouped into categories with similar content; once complete, these categories were individually labelled to represent different FST-related concepts.

Database and citation searches allowed us to identify 6053 records after the removal of duplicates, with a total of 50 articles that met inclusion criteria (Fig. 1 ). The most common reasons for exclusion were the absence of FST-related theory in the development of the intervention, and interventions not focusing specifically on children/adolescents with overweight/obesity. Among the included studies, all were published in English, 14 were descriptive articles (e.g., study protocols), 33 reported on at least one measured intervention outcome, 3 used qualitative post-intervention exploratory designs, and one included baseline data only. Supplemental Table 2 provides a summary of the 50 studies included in this review. Among included studies, we identified 27 unique FST-informed interventions which are presented in Table 2 .

PRISMA flow diagram

Who is targeted by existing FST-informed interventions?

Of the 27 unique interventions, 3 (11%) targeted preschool children exclusively, 7 (26%) targeted school-aged children exclusively, and 12 (44%) targeted adolescents exclusively. In addition, one intervention (4%) targeted both preschool and school-aged children, while 4 (15%) targeted both school-aged children and adolescents. Twenty-three interventions (85%) targeted the child/adolescent and at least one parent/guardian, and the remaining 4 interventions (15%) targeted a parent/guardian without the index child/adolescent. Five interventions (19%) were designed for families with low incomes or living in underserved areas. Some interventions targeted specific ethnic or population sub-groups, including 4 interventions (15%) for African American families, 3 (11%) for Latin American families, one for Hispanic and Black families, and one for female adolescents only.

In which settings are FST-informed approaches implemented?

All studies were conducted in Western countries, including the USA, Europe, and Canada. Four different intervention settings were identified: outpatient hospital (37%, n = 10), community-based (26%, n = 7), pediatric obesity management center (7%, n = 2), and home-based (7%, n = 2). An additional 6 interventions (22%) relied on a combination of settings, 4 of which included a home-based component (15%).

How are FST-informed interventions delivered, and which professionals are involved?

Intervention duration ranged from 1.5 to 24 months (median of 6 months). Most interventions were delivered entirely in person (81%, n = 22). Three interventions (11%) used a combination of in-person and virtual/online sessions, one intervention combined in-person and telephone delivery, and one intervention was delivered entirely over the phone. Twelve interventions (44%) were group-based, 6 (22%) were delivered individually, and 9 (33%) used a combination of group and individual sessions.

In terms of in-session participation, 12 interventions (44%) comprised sessions that included the child/adolescent together with at least one adult family member at all times, whereas another 11 (41%) had a mix of parent-only, child/adolescent-only, and parent–child/adolescent sessions. The remaining 4 interventions (15%) included only parents in their intervention, without the child/adolescent.

Interventions were delivered by a wide range of health professionals, and commonly involved two or more professionals. These included dieticians/nutritionists (48%, n = 13), licensed counsellors/therapists (30%, n = 8), psychologists (30%, n = 8), sports trainers and exercise specialists (30%, n = 8), students in different health-related fields (22%, n = 6), nurses (19%, n = 5), pediatricians (15%, n = 4), occupational therapists (7%, n = 2), physiotherapists (7%, n = 2), social workers (7%, n = 2), health educators (4%, n = 1), and behaviouralists (4%, n = 1). Moreover, 7 of the interventions (26%) included other non-health-related professionals (e.g., local parks and recreation staff, prevention managers, and trained facilitators with unspecified backgrounds), or did not specify the professionals involved.

Which FST-related concepts are included in interventions and how are these concepts measured?

A detailed description of the 11 FST-related concepts identified across interventions, including definitions and examples of how they were integrated within interventions, is presented in Table 3 . The most common concepts related to parenting skills (59%, n = 16), family communication (52%, n = 14), and social/family support (48%, n = 13). Other concepts included family functioning (37%, n = 10), parental role modelling (30%, n = 8), autonomy support (22%, n = 6), shared decision-making (19%, n = 5), home environment (22%, n = 6), empowerment (11%, n = 3), family goal setting (26%, n = 7), and family problem solving (22%, n = 6). Some studies reported in-depth descriptions of how FST-related concepts were integrated while others did not. Few studies included pre- or post-intervention measurements of FST-related concepts as shown in Table 3 .

What are the effects of FST-informed interventions?

Of the 50 articles reviewed, 33 reported on at least one intervention outcome, including BMI or BMI z-scores ( n = 24), lifestyle behaviours (physical activity, diet, and sedentary behaviours) ( n = 18), mental health ( n = 12), FST-related outcomes ( n = 10), and other outcomes (e.g., waist circumference, heart rate, blood pressure, cardiovascular fitness) ( n = 18) (Table 4 ).

As shown in Table 4 , among studies that reported on BMI outcomes, virtually all studies with comparisons to baseline values or to waitlist control groups found post-intervention improvements in BMI. For studies that compared BMI to usual care or control interventions, 6 reported improvements, 4 reported no differences, and 1 reported worse outcomes in the FST intervention compared to the control group. For studies examining changes in physical activity, 4 out of 5 studies that used baseline or waitlist control groups reported improvements, whereas only 6 out of 11 studies with usual care or control intervention comparisons reported improvements in physical activity, and other studies reported no differences. For sedentary behaviour outcomes, 3 out of 4 studies using baseline or waitlist controls reported improvements, whereas no differences were found in the 2 studies with usual care or control interventions. Among studies that examined dietary outcomes, most found no difference, except for 2 studies with usual care or control intervention comparisons, and one relying on baseline comparisons. Most studies that reported improvements in mental health outcomes used baseline and waitlist control comparisons, with mixed findings for intervention effects compared to usual care and control interventions. Lastly, of the 10 studies that measured FST concepts (e.g., family communication, family functioning, family support), 5 reported improvements of which 3 were compared to usual care or control interventions, while the other studies reported no differences or mixed findings.

This scoping review sought to describe the use of FST in pediatric obesity management interventions over the past four decades to map current knowledge and identify research gaps and practice implications. Our review reveals that school-aged children and adolescents are more frequently targeted compared to preschoolers and that few interventions specifically target population sub-groups who are at increased risk of obesity and its complications due to systemic barriers to health (e.g., low socioeconomic status, racial/ethnic minority groups). Interventions were most commonly delivered in outpatient hospital settings by multidisciplinary teams using a variety of delivery modalities, and all studies were conducted in Western countries. We identified 11 FST-related concepts that informed intervention components, with parenting skills, family communication, and social/family support being the most common. However, many interventions did not elaborate on how FST was translated into specific intervention components, and few included measurements of FST-related concepts as part of the baseline and post-intervention assessments. Among studies reporting intervention outcomes, BMI was most frequently reported and generally improved following the intervention; however, there were a variety of comparison groups noted ranging from usual care obesity management to psychoeducation and other control interventions. This variety in comparison groups should be considered in the interpretation of intervention effects given differences between studies in intensity and dosage.

Preschool-aged children were infrequently included in the obesity management interventions we reviewed with inconsistent results for BMI, lifestyle behaviours, and/or family systems-related outcomes [ 51 , 53 , 54 , 55 , 58 , 59 ]. Considering their young age, it is possible that FST-informed obesity interventions targeting preschool-aged children are more likely to be preventative in nature. Inclusion in this review required children to have overweight/obesity at intervention baseline; exploring the use of FST in the prevention of obesity may shed light on the nature and overall usefulness of FST in preventing obesity among children under 5 years of age.

Moreover, given the higher rates of obesity in some ethnic minority groups [ 78 ], culturally adapted FST-informed interventions continue to be a priority. FST concepts integrated in interventions targeting ethnic minority groups did not differ from other interventions, but authors mentioned how cultural considerations and strategies were used to guide implementation. For example, the Supporting Health Interactively through Nutrition (SHINE) study enhanced intervention relevance for African American families through the recruitment of African American providers and community leaders, the usage of photos of African American families in intervention material, and the presentation of data related to African American youth specifically [ 70 ]. Other studies used qualitative methods to explore sociocultural values and barriers that could be integrated in the intervention’s final curriculum [ 35 ]. Of the 8 interventions that focused on ethnic minorities, 5 included measurements of pre- and post-intervention outcomes (e.g., BMI and lifestyle behaviours), and 4 of these resulted in improvements, lending support to the usefulness of culturally adapted FST-informed interventions.

Almost all studies included in this review reported the involvement of professionals from two or more disciplines. This is in line with the multidisciplinary approach recommended for pediatric obesity management [ 79 ]. However, few articles mentioned whether those delivering the interventions were trained in family systems approaches which is essential to ensure appropriate embodiment by involved professionals of core FST intervention components [ 80 , 81 ]. Interestingly, some interventions included staff outside of the traditional health fields (e.g., parks and recreation staff) which may provide a broader perspective of the different multi-sectoral and multi-systemic factors implicated in pediatric obesity and its solutions [ 79 , 82 ].

Although most interventions were group-based and were delivered entirely in person, others were either partially or fully delivered virtually using web-based or telephone modalities. Virtual intervention delivery may facilitate reaching more family members, an important consideration from a family systems perspective. Moreover, overall attendance and retention may be improved for interventions delivered virtually [ 83 ]. Similarly, the use of home visits was reported in 2 interventions of which one (Multisystemic Therapy) reported effects on outcomes. The latter is one of the few interventions that reported improvements across all measured outcomes, including FST-related concepts, BMI, diet, and adiposity in comparison to a control intervention group [ 61 , 62 ]. Home visits may be an important modality to consider for the delivery of FST-informed interventions in pediatric obesity management. It has been shown that families support the use of home visits in the context of obesity management and perceive these as having benefits, namely in terms of convenience, tailored care, and family involvement [ 84 ]. While previous reviews have highlighted the importance of engaging multiple family members in pediatric obesity management [ 12 ], it has been noted that potentially influential family members, such as the other parent (often fathers), siblings, or grandparents, are often neglected in family-based pediatric obesity management interventions [ 85 ]. Home-based approaches may facilitate the involvement and engagement of multiple members within a family unit.

BMI outcomes were the most consistently measured to evaluate FST-informed interventions; they also showed the most consistent improvements, notably in comparison to baseline and waitlist control groups but also in comparison to usual care and to non-FST control interventions. These results are in line with previous reviews of family-based interventions that have reported weight-related improvements [ 10 , 14 , 86 ], and lend support to the use of FST-informed interventions in pediatric obesity management. Findings were generally similar with regard to improvements in physical activity but were largely inconsistent for other outcomes. This review highlights the need for more evidence on the benefits of FST-informed interventions in comparison to usual care and standard family-based obesity management interventions not based on FST. There is also a need for evidence on which families and children may benefit the most from FST-informed interventions in comparison to standard obesity management interventions.

Intervention effects on family systems measures (e.g., parenting skills, family communication, etc.) were either not reported or mixed in the few studies that evaluated these outcomes. This is an important knowledge gap given that one of the goals of FST-informed interventions is to improve dynamics and organisation within the family so as to create family environments and conditions that are supportive of improvements in health and lifestyle behaviour changes [ 11 , 12 , 87 ]. Inconsistency in results may be due to the relatively low number of studies that measured FST-related variables. Some studies used qualitative methods to assess participants’ perspectives on changes in the family system following the intervention, both of which reported perceived improvements [ 36 , 57 ]. Qualitative exploration may allow for a deeper understanding of family beliefs associated with family system concepts at baseline and how these evolve following an intervention. Exploring these perspectives can allow for a more tailored approach to obesity management and can provide a richer understanding of intervention effectiveness related to the family system.

This review highlights the importance of evaluating the family system before and after intervention delivery given its potential role as mediator of intervention effects. Intervening at the family systems level may lead to greater and more sustained changes due to improvements in underlying family dynamics that may hinder or challenge lifestyle modification [ 12 ]. In addition, the health of the family system may predict the response to FST-informed obesity management. For example, although Kitzmann et al. did not see improvements in examined family systems concepts following their intervention, baseline parental support for healthy eating habits and positive parenting styles were associated with greater reductions in BMI over the 6-week study [ 56 ]. Similarly, Spence et al. found that a healthier family system pre-intervention was associated with improved retention in their program [ 65 ].

In order to be included in this review study, studies had to explicitly mention how FST or related theories were used to guide the intervention development. Most studies used FST in combination with other health-related theories to inform certain components of their intervention, but fewer studies used FST as a broader lens through which to approach pediatric obesity at the family system level. Many studies briefly mentioned the use of FST or related theories but lacked a clear embodiment of FST and did not elaborate on the specifics of how these theories were integrated in their intervention delivery. One exception to this was the Families Improving Together (FIT) intervention which was described as deeply rooted in FST [ 35 ]. This intervention targeted a number of different FST-related concepts (e.g., parenting skills, family communication) and was centered on creating a positive social climate and promoting warm and supportive family interactions throughout all intervention sessions [ 35 ]. It further targeted positive parenting skills through parenting style, parental monitoring, shared decision making, and communication, while promoting family bonding and family support in weekly goal setting [ 35 ]. Other interventions that were more explicit on their family systems approaches were the Multisystemic Therapy, which included baseline assessment of the family’s strengths and weaknesses to target individual family needs related to FST concepts [ 62 , 63 , 88 ], the SHINE intervention, which provided detailed and specific descriptions of FST integration in their design [ 70 , 71 ], and ENTREN-F, which focused on behavioural parenting strategies, parental educational styles, feeding practices, communication skills and adaptive dynamics in the home environment [ 30 ].

Previous reviews have also pointed out that existing pediatric obesity interventions based on FST do not fully embody a family systems approach. In their literature review published in 2011, Kitzmann and Beech observed that the majority of pediatric obesity management interventions reviewed had a narrow family focus (e.g., parents were asked to modify health behaviours) while fewer were more broadly family-focused [ 86 ]. Additionally, as noted by Skelton et al. in their review of family theories in pediatric obesity management, FST was often used as a theme to discuss pediatric obesity but was rarely used to guide obesity management interventions [ 12 ]. Family perspectives and beliefs surrounding the family system were infrequently explored in the studies we reviewed. Exploring these beliefs would allow for a more tailored approach to intervention delivery and would promote an individualized, strengths-based design that builds on a family’s existing values and unique strengths to improve intervention outcomes [ 89 ].

Findings from this review provide insight for health care providers seeking to integrate FST into obesity management interventions. FST-informed approaches can be used across the pediatric age groups. Including a combination of in-person and virtual or home-based sessions can facilitate intervening with the family as a whole, and adaptations to increase relevance to specific sociodemographic backgrounds (e.g., socioeconomic status, ethnocultural backgrounds) are key. Training the intervention delivery team in FST and including the assessment of family systems concepts (e.g., baseline and follow-up measures of family communication and family functioning) are essential moving forward.

This review was conducted by a multidisciplinary research team that included health professionals and researchers with expertise in FST and pediatric obesity management as well as a health sciences librarian. We used a broad search strategy to ensure all FST-informed interventions were captured. We included a variety of types of articles such as protocols, intervention descriptions, qualitative studies, randomized controlled trials and quasi-experimental studies. A rigorous approach was used to determine article inclusion/exclusion and to extract data from included studies. For example, a preliminary search guided our final inclusion/exclusion criteria, notably the explicit use of a family systems-related theory in the development of intervention and the focus on obesity management, which allowed us to synthesise evidence from more comparable interventions. In terms of limitations, our review does not include preventive interventions which may have excluded studies targeting preschool-aged children. Additionally, we did not assess the quality of included studies. Although this is not mandatory in scoping reviews, doing so strengthens the synthesised evidence. Lastly, we did not register or publish a protocol for this scoping review.

Conclusions

This review provides some support for FST as a useful theory to inform the development of pediatric obesity management intervention strategies targeting improvements in obesity-related outcomes, lifestyle behaviours (namely physical activity), and mental health. However, it remains unclear whether improvements at the family system level mediate favourable outcomes. This review further highlights the need for additional evidence on the benefits of FST-informed interventions in comparison to standard family-based obesity management interventions not based on FST. Future research should explore family perspectives and beliefs surrounding FST in pediatric obesity management. Assessing the family system prior to intervening, focusing on the family’s strengths, and exploring beliefs related to the family system may optimize the tailoring of pediatric obesity management interventions to the unique needs and context of each family.

Availability of data and materials

The dataset(s) supporting the conclusions of this article are available in the Medline, CINAHL, Embase, and PsycInfo repositories.

Abbreviations

Body Mass Index

Cognitive Behavioral Therapy

Control Intervention

Cumulative Index to Nursing and Allied Health Literature

Diastolic Blood Pressure

The Dyadic Communication Scale

The Family Adaptability and Cohesion Evaluation Scales IV

Multidisciplinary family-based behavioural therapy for obesity

Family Experiences Related to Food Questionnaire

Families Improving Together

Families Improving Together-Telehealth

Fit Kids / Fit Families

Families on the Move

Family Questionnaire

Family Systems Theory

United Families for Health and Wellness

Home Environment Survey-Physical Activity

Joanna Briggs Institute

Lighter Living program

Lund Overweight and Obesity Preschool Study

Motivational + Family Weight Loss Intervention

Mind, Exercise, Nutrition, Do it!

Physical Activity

Parents as Agents of Change

The Parenting Dimensions Inventory

The Parenting Strategies for Eating and Activity Scale

Peer Review of Electronic Search Strategies

Quality of Life

Systolic Blood Pressure

Standard Behavioural Treatment + Enhanced Parenting

Self-Report Family Inventory

Supporting Health Interactively through Nutrition and Exercise

Telephone-based Adiposity prevention for Families

United Kingdom

United States of America

The Weight Control Strategies Scale

Wait list control

The Youth Quality of Life Inventory

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Acknowledgements

Authors wish to thank Rosa-Elena Ponce Alcala and Rebecca Fox for their support towards this work.

Funding for this scoping review was obtained from the Cardiometabolic Health, Diabetes and Obesity (CMDO) Research Network and from the Fonds de la recherche du Québec – Santé (FRQ-S). N Wills-Ibarra and K Chemtob were supported by McGill University Ingram School of Nursing Summer Research Support Awards. A Van Hulst holds a Junior 1 research award from the FRQ-S.

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NWI and KC identified studies that met inclusion criteria and extracted data from included studies. NWI also drafted the initial version of the manuscript. FF contributed to the development and implementation of the search strategy and provided expertise on the knowledge synthesis review. HH, KJP and GDB provided expertise on family systems theory and childhood obesity in all steps of the knowledge synthesis and contributed to the interpretation of the results. AVH conceptualised the study, provided direct supervision to student authors, contributed to the interpretation of the results, and completed the writing of the manuscript. All authors critically reviewed the manuscript for important intellectual content and provided final approval for the work.

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Wills-Ibarra, N., Chemtob, K., Hart, H. et al. Family systems approaches in pediatric obesity management: a scoping review. BMC Pediatr 24 , 235 (2024). https://doi.org/10.1186/s12887-024-04646-w

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CENTERS & INSTITUTES

Research team examines role of parenting on LGBTQ mental health, substance use

Posted on April 2, 2024

by Matthew Smith

A paper published in Adolescent Research Review by a team featuring University of North Carolina at Chapel Hill School of Social Work faculty and students sheds light on parenting and its effect on LGBTQ youth.

Led by Associate Professor and Prudence and Peter Meehan Early Career Distinguished Scholar Melissa Lippold , Associate Professor and L. Richardson Preyer Early Career Scholar William Hall , graduate research assistants Denise Yookong Williams and Hayden Dawes were co-authors on the paper. UNC School of Social Work alum Melissa Jenkins and UNC School of Education Professor Roger Mills-Koonce also contributed to the study.

Lippold expanded on the study, its findings, and how she hopes its findings can help parents care for their children in the future.

Read the full paper online at Adolescent Research Review .

What was the overall purpose of the study?

Even though there is substantial research on parenting and its impacts on mental health and substance use in general, there has not been a lot of research on parenting LGBTQ youth. This is important because we know families are powerful influences on development, and interventions for parents and queer youth could potentially have large impacts. We decided to systematically review the literature on parenting and queer youth mental health and substance use. We also conducted a meta-analysis, which quantifies the effect of parenting across multiple studies.

Historically, why have queer youth faced higher rates of mental health and substance use challenges?

Queer youth face more stressors than heterosexual youth. For example, they face higher rates of harassment, rejection and discrimination. We know from minority stress theory and other research that these increases in stress can take a toll and can increase the risk of mental health challenges and substance use.

What research questions did you address as part of the systematic review?

We had three questions: What parenting factors are risk factors for mental health or substance use outcomes among queer youth? What parenting factors are protective factors for mental health or substance use outcomes among queer youth? And lastly, what is the magnitude and direction of parenting factors associated with mental health and substance use outcomes among queer youth?

What did the findings of the review show?

The findings showed a few things. First, we found that parenting matters for queer youth — that more parental support and less rejection were associated with less depression/anxiety and less substance use. Secondly, there was some evidence in the meta-analysis that parental rejection had stronger effects than parental support on queer youth mental health. Lastly, there is a need for a lot more research on parenting queer youth. Most of the studies were cross-sectional and they did not follow youth over time, making it harder to fully understand the long-term effects of parenting. Importantly, our measures of parenting, especially support, are very limited. Expanded conceptual models and new measures are needed that can capture how parents can affirm queer youth identity and promote queer youth well-being.

Did any of the findings surprise you or make you reexamine existing ideas/norms related to how to parent queer youth?

I was surprised that there were not more studies on parenting queer youth, given how important we know parenting is during adolescence .

The findings suggest that parental rejection may have a bigger impact than parental acceptance. Why might this be the case?

There are a couple of reasons that the effects of rejection were stronger than support. First, negative experiences can elicit really strong emotions. We know that negative emotions and thoughts about experiences can linger and last longer than positive ones. This can be important as rumination about negative events — thinking about them often — can increase the risk for depression. Secondly, the field has really limited measures on positive aspects of parenting queer youth. A lot of studies use general support measures — things like if you feel loved by your parent. Such measures don’t capture the ways parents might affirm their child’s sexual orientation and support queer youth identity. In contrast, most studies on rejection do measure rejection due to sexual orientation. Because of this, our studies may be better at capturing the effects of rejection than support.

A major point of the review was comparing parental care between families with queer youth versus comparing queer youth families and heterosexual youth families. Why was this an important element of the review?

A lot of existing research focuses on comparing the experiences of queer youth to heterosexual youth. Such research can tell us important information. But in this study, we really wanted to center the queer youth experience. By identifying risk and protective factors within families of queer youth, rather than in comparison to heterosexual youth, we can gain an understanding of family processes among queer youth specifically.

After completing the review, what are some of the interventions that may work best for families with queer youth to ensure that their mental health needs are met?

Interventions that aim to reduce parental rejection may be really important. We know a lot of families that initially reject their children eventually become more accepting, but we don’t have a lot of interventions that help parents become more accepting. Interventions that can facilitate acceptance would be crucial. We need more interventions in this area.

How do you hope this review helps researchers and clinicians in the future?

I hope it highlights the important role that parents play in queer youth mental health and substance use and leads to the development of more parent-based interventions. Parents matter and developing programs that increase parent support and reduce rejection will improve queer youth well-being.

7 New Books We Recommend This Week

Suggested reading from critics and editors at The New York Times.

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Where are all the books about work? That question lands in our inbox from time to time, and no wonder: In terms of hours and paychecks and the sense of identity they impart, jobs are a consuming part of our lives that authors do indeed too often neglect. So this week we recommend three books that put the world of paid labor front and center: Adelle Waldman’s novel “Help Wanted” is set in a suburban box store, Hamilton Nolan’s “The Hammer” assesses the current state of union organizing, and Jane Kamensky’s “Candida Royalle and the Sexual Revolution” takes the measure of a proto-girlboss who went from starring in pornographic movies to launching her own production company with a feminist slant.

Also recommended this week: a look at Saddam Hussein’s state of mind as America and Iraq approached war in 2003, a study of African American literature as a reflection of Black history, a warning about the impacts of climate-fueled migration and, in fiction, Percival Everett’s sparkling riff on the story of Huck Finn, this time centering the character of Huck’s fellow runaway Jim. Happy reading. — Gregory Cowles

JAMES Percival Everett

In this reworking of the “Adventures of Huckleberry Finn,” Jim, the enslaved man who accompanies Huck down the Mississippi River, is the narrator, and he recounts the classic tale in a language that is his own and with surprising details that reveal a far more resourceful, cunning and powerful character than we knew.

“Luxuriates in language. Everett, like Twain, is a master of American argot. … This is Everett’s most thrilling novel, but also his most soulful.”

From Dwight Garner’s review

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In 1984, Candida Royalle changed the porn industry when she co-founded the female-targeted Femme Productions. As Kamensky convincingly argues in this scholarly and engaging tribute, the performer, producer and director was more than a feminist pioneer; her life mirrored that of the sexual revolution itself.

“Her rigor and thoroughness demand that the reader take seriously an underdog who made her name in a stigmatized industry. This book is a labor of empathy that refuses to simplify or valorize its subject.”

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HELP WANTED Adelle Waldman

Waldman’s long-anticipated follow-up to her 2013 debut, “The Love Affairs of Nathaniel P.,” applies her sharp sense of relational drama and dark comedy to the retail work space. The big-box store is Town Square, and the cast of characters who toil there are as surprising and varied as the merchandise they stock.

“Waldman is skilled at building momentum and tension through intricacies of plot. The book shines whenever the group is together, concocting plans … in search of a shared sense of hope.”

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THE HAMMER: Power, Inequality, and the Struggle for the Soul of Labor Hamilton Nolan

The longtime labor reporter and former Gawker journalist’s lively account of the current landscape of the American labor movement paints colorful portraits of union organizers from across the country alongside a pointed critique of the A.F.L.-C.I.O.

“Offers an impressive array of scenes from the front lines of the 21st-century economy. … As ‘The Hammer’ shows, the kind of solidarity that might naturally arise from shared frustrations on the conveyor belt doesn’t necessarily translate to the broader movement all on its own.”

From Willa Glickman’s review

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THE ACHILLES TRAP: Saddam Hussein, the C.I.A., and the Origins of America’s Invasion of Iraq Steve Coll

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“Most of the story is vivid and sometimes even funny. … Unlike his main character, Coll succeeds in part because he has an eye for dramatic irony.”

From Noreen Malone’s review

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“The author’s eloquent personal insights … are astonishing as well as gripping, presenting an intimate understanding of why poor agricultural workers, beset by droughts and calamitous economic circumstances, risk everything.”

From Jon Gertner’s review

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“The allure of this book, and the reason for its existence, are the narrative links he draws. … This is a literary history of Black America, but it is also an argument that African American history is inextricable from the history of African American literature.”

From Tope Folarin’s review

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IMAGES

4 Types of Parenting Styles and Their Effects On The Child
(PDF) Parenting styles and their impacts on child problem behaviors
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(PDF) Literature Review of Parenting Style to Support the Development
Literature review on parenting styles. (PDF) Parenting styles and
Parenting Styles _ Education

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COMMENTS

Types of Parenting Styles and Effects On Children
When it comes to parenting, there is a great deal of diversity among families. Cultural backgrounds have a major impact on how the family unit exists and how children are reared. In the last several years, the population of the United States of America has had a makeup. Changes driven by immigration (with different cultural, ethnic, and spiritual ideologies), socioeconomic status, and single ...
Parenting Styles and Children's Development: A Review of the Literature
Methods: This study was a comprehensive literature review using the keywords of parenting styles, psychological factors, and parenting to search the databases of Google Scholar, PubMed, Scopus ...
How Parenting Style Influences Children: A Review of Controlling
This literature review examines three categories of parenting styles and their influence on children's behavior, risk-taking, mental health, and academic achievement. ... Parenting styles differentiated by level of demandingness and responsiveness. 34 Although permitting parents give considerable support to their children, the permitting
Parenting styles and children's academic performance: Evidence from
In accordance with the existing literature, we classify parenting style into four categories, namely, authoritative, authoritarian, ... Parenting styles and academic achievement of young adolescents: A systematic literature review. Quality & Quantity, 49 (6) (2015), pp. 2411-2433.
Influence of parental personality on parenting styles: A scoping review
Methods: This study was a comprehensive literature review using the keywords of parenting styles, psychological factors, and parenting to search the databases of Google Scholar, PubMed, Scopus ...
Psychological factors contributing to parenting styles: A systematic review
Methods: This study was a comprehensive literature review using the keywords of parenting styles, psychological factors, and parenting to search the databases of Google Scholar, PubMed, Scopus ...
Parenting styles and children's development: A review of the literature
(DOI: 10.1016/b978--12-818872-9.00082-0) Parenting behaviors and practices are widely acknowledged as playing a critical role in children's development. Parenting styles consist of parents' broad behavioral patterns that attempt to control and socialize children; and parental attitudes and practices that set an emotional context or climate for parent-child relationships and child ...
Review Parenting styles and Big Five personality traits among
Abstract. The present meta-analysis tested the associations between parenting styles and Big Five personality traits; N = 11,061 adolescents in 28 studies were included. The results provided evidence that authoritative parenting style was positively associated with openness to experience, conscientiousness, extraversion, and agreeableness and ...
Parenting styles and academic achievement of young adolescents: A
Literature accords the importance of parenting style and their impact on young adolescent's behavior. There are many factors that affect the academic performance of children and parenting styles is one of the significant factors of academic performance. But there is lack of research that integrates and systemizes the relationship between parenting styles and academic performance especially ...
Parenting Style And Children's Behavior: A Review Study
Abstract. Parenting is the general practise of child rearing that affects children's ph ysical, emotional, mental, and social. development in both the short- and long-term. Children's behaviour ...
Literature Review on Parenting Styles and ...
Parents play an essential role in a child's life, especially in childhood, till they become self-sufficient. Discipline and control imposed by parents help develop a healthy personality of a child. Research-based evidence supports that parenting style substantially affects children's development (Gupta, Mehtani 2017). Parenting styles have a more significant impact on children's ...
PDF The effects of parenting style on children's behavior: A systematic
The parenting style is the attitude that parents express to their kids. It can be affected by numerous factors, including: social, cultural, political, economic, etc. Parenting style is affected by both the parents' and children's temperaments, and is chiefly based on the impact of one's own parents and culture.
Parenting Styles and Internalizing Symptoms in Adolescence: A ...
A growing body of recent research has identified associations between various parenting practices and styles and internalizing problems among adolescents. However, the reported findings are inconsistent and the studies in question have been conducted from different theoretical backgrounds. The aim of this systematic review was to synthesize the literature on the association of parental ...
Parenting styles and academic achievement of young ...
Literature accords the importance of parenting style and their impact on young adolescent's behavior. There are many factors that affect the academic performance of children and parenting styles is one of the significant factors of academic performance. But there is lack of research that integrates and systemizes the relationship between parenting styles and academic performance especially ...
Family systems approaches in pediatric obesity management: a scoping review
In their literature review published in 2011, Kitzmann and Beech observed that the majority of pediatric obesity management interventions reviewed had a narrow family focus ... Appugliese DP, Kaciroti N, Bradley RH. Parenting styles and overweight status in first grade. Pediatrics. 2006;117(6):2047-54. Article PubMed Google Scholar ...
(PDF) A Review of the Relationship between Parenting Styles and
Abstract. This article reviews the literature on the relationship between parenting styles and adolescents' emotional intelligence. The review of the empirical research indicates that ...
UNC team examines role of parenting on LGBTQ mental health
Melissa Lippold, associate professor and Prudence and Peter Meehan Early Career Distinguished Scholar, was the lead investigator for a University of North Carolina at Chapel Hill research team that examine the effects of different parenting styles on the mental health of LGBTQ youth. The study included a systematic review and analysis of 24 ...
7 New Books We Recommend This Week
From Willa Glickman's review. Hachette | $30. THE ACHILLES TRAP: Saddam Hussein, the C.I.A., and the Origins of America's Invasion of Iraq. Steve Coll. Coll's book stretches from Hussein's ...
The Effect of Parenting Styles on Personality: a Review of Literature
Literature accords that based on Baumrinds model of Parenting Styles, authoritative parenting style is the most efficient in enhancing the academic achievement. ... The present literature review ...

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Family systems approaches in pediatric obesity management: a scoping review

Search strategy

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Who is targeted by existing FST-informed interventions?

In which settings are FST-informed approaches implemented?

How are FST-informed interventions delivered, and which professionals are involved?

Which FST-related concepts are included in interventions and how are these concepts measured?

What are the effects of FST-informed interventions?

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BMC Pediatrics

Research team examines role of parenting on LGBTQ mental health, substance use

What was the overall purpose of the study?

Historically, why have queer youth faced higher rates of mental health and substance use challenges?

What research questions did you address as part of the systematic review?

What did the findings of the review show?

Did any of the findings surprise you or make you reexamine existing ideas/norms related to how to parent queer youth?

The findings suggest that parental rejection may have a bigger impact than parental acceptance. Why might this be the case?

A major point of the review was comparing parental care between families with queer youth versus comparing queer youth families and heterosexual youth families. Why was this an important element of the review?

After completing the review, what are some of the interventions that may work best for families with queer youth to ensure that their mental health needs are met?

How do you hope this review helps researchers and clinicians in the future?

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THE HAMMER: Power, Inequality, and the Struggle for the Soul of Labor Hamilton Nolan

THE ACHILLES TRAP: Saddam Hussein, the C.I.A., and the Origins of America’s Invasion of Iraq Steve Coll

ON THE MOVE: The Overheating Earth and the Uprooting of America Abrahm Lustgarten

THE BLACK BOX: Writing the Race Henry Louis Gates Jr.

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