How Different Forms of Parent-Child Interactions Shape Healthy Aging: Evidence from over 100,000 Parent-Child Relationships on Lifestyle Behaviors Among Chinese Older Adults (2011–2020)

As family structures evolve in China, adult children's engagement with aging parents has become increasingly complex, yet little is known about how distinct forms of interaction shape older adults' health behaviors. This study examined how visitation, interaction frequency, co-residence, and financial support relate to four lifestyle behavior domains: total and leisure physical activity, smoking, alcohol use, and sleep. Data were drawn from 22,114 older adults and 138,243 parent-child dyads in the China Health and Retirement Longitudinal Study (2011 to 2020) and analyzed using multivariable mixed-effects models that accounted for repeated observations and clustering at both the respondent and child levels. Weekly interaction increased from 86.0% to 89.1%, while in-person visitation declined from 60.4% to 55.2%. Interaction was more common with healthier, more highly educated, and female children; male children were more likely to co-reside. Weekly interaction was associated with lower odds of low total physical activity, low leisure activity, and drinking. Co-residence reduced odds of drinking, and increased odds of low total activity, low leisure activity, and smoking. Financial support predicted lower odds of low total activity and low leisure activity, while weekly interaction was linked to lower odds of suboptimal sleep. Even as face-to-face contact declines, interaction continues to grow, likely through digital platforms, and distinctly shapes lifestyle behaviors. This study lays important groundwork for more intensive mixed methods research to explore mechanisms underlying how different engagement patterns influence health behaviors in aging populations.