Volume 39, Issue 5 , Pages 248-256, September 2007
Associations between Maternal Concern for Healthful Eating and Maternal Eating Behaviors, Home Food Availability, and Adolescent Eating Behaviors
Article Outline
- Abstract
- Introduction
- Methods
- Measures
- Results
- Discussion
- Implications for Research and Practice
- Acknowledgments
- References
- Copyright
Abstract
Objective
Evaluate the relationship between maternal concern for healthful eating and maternal and adolescent dietary intake, eating behavior, and home food environment.
Design
Mothers of a subsample of adolescents who participated in a school-based survey (Project Eating Among Teens [EAT]) completed telephone interviews.
Participants
Seven hundred fourteen mother–adolescent pairs.
Variables Measured
Mothers responded to a question regarding how much they are personally concerned with eating healthfully, and adolescents responded to a question regarding perceptions of their mothers’ concern about eating healthfully. Dependent variables included adolescent and parent food intake and home food environment.
Analysis
Multinomial cumulative logistic regression models, adjusted for maternal race/ethnicity, socioeconomic status (SES), and adolescent grade level.
Results
A positive association was found between maternal concern for healthful eating and maternal fruit and vegetable intake, maternal breakfast and lunch consumption, and serving fruits and vegetables in the home. Maternal concern for healthful eating (as reported by mothers) was not associated with adolescent behavior. Adolescent perception of maternal concern for healthful eating was positively associated with adolescent fruit and vegetable intake.
Conclusions and Implications
Mother’s concern for healthful eating is associated with maternal eating behavior and the home food environment. Adolescent perceptions of maternal attitudes are a stronger predictor than actual maternal attitudes of adolescent behavior. Parents should be encouraged to share their beliefs regarding the importance of healthful eating with their adolescents.
Key Words: parent, child, food intake, home food availability
Introduction
Parents play a primary role in their child’s nutrition and health, through the creation of the home food environment and support and encouragement for making healthful food choices.1, 2, 3, 4, 5, 6, 7 Parental eating behaviors serve an important function in the development of children’s eating and health behaviors, directly through parental role modeling and indirectly through the transmission of attitudes and values.8, 9, 10, 11 To promote healthful eating behavior in children, a better understanding of the impact of parental influence and behaviors is needed.12, 13
The majority of studies that examine the relationship between parental and child eating behaviors have focused on the eating patterns of younger children.14, 15, 16, 17 In addition, several studies have examined parent-to-child/adolescent transmission of unhealthful eating attitudes and behaviors, including dieting attitudes and practices, disinhibited eating, and eating disordered behaviors.10, 18, 19, 20, 21, 22, 23 Fewer studies have evaluated parent-to-child transmission of healthful eating attitudes and behaviors,24 and even less is known about the influence of parental attitudes about nutrition on their adolescents’ behaviors.
Research is needed to investigate the relationship of healthful parental eating attitudes and behaviors on adolescent eating attitudes and behaviors. This need is particularly salient, given the importance of family involvement in the prevention and treatment of obesity. Parental attitude toward healthful eating may be an important factor in improving an adolescent’s diet. Parental attitudes regarding healthful eating may contribute to more healthful eating in their adolescents, particularly if their children are aware of their attitudes. Parental attitudes regarding healthful eating may also impact their own eating patterns and the home food environment, and thus may influence the adolescent’s eating patterns.
Thus, the current study aims to fill a gap in the existing research by exploring the association of maternal concern for eating healthfully on maternal eating behavior, adolescent eating behavior, and the home food environment. This study aims to assess whether maternal concern for eating healthfully is associated with healthful eating behaviors by mothers and the provision of a healthful home food environment. This study also assesses whether maternal concern for healthful eating is associated with adolescent concern for healthful eating and adolescent eating behaviors.
Methods
Sample Recruitment
Project Eating Among Teens (Project EAT) is a study of obesity, nutrition, and eating among 7th- through 12th-grade adolescents in the greater Minneapolis/St. Paul area.25, 26 A total of 4746 adolescents completed the school survey (82% participation rate). To identify families whose parent/guardian was to be surveyed for this study, the Project EAT sample was stratified by race/ethnicity and within each stratum, approximately one quarter (with some oversampling of Hmong) was randomly selected to ensure racial/ethnic diversity. Approximately one-fourth of the adolescents (n = 1182) who participated in Project EAT were selected to be included in the parent assessment, and 902 parent interviews were completed (76% participation rate). Because of the current study’s focus on maternal influence and the relatively small number of paternal interviews, fathers were excluded from this data analysis. A total of 714 mother–adolescent pairs were included in the analyses. Almost all (97%) were biological mothers, and 3% were stepmothers. Hereafter, all female mothers/guardians will be referred to as mothers.
Procedure
During the 1998–1999 school year, trained research assistants administered a classroom-based, 221-item survey and measured heights and weights. Shortly thereafter, mothers of the selected adolescents completed a telephone interview administered by trained interviewers. The interviews consisted of a shortened version of the Project EAT survey. Interviewers were instructed to interview each adolescent’s mother or the primary caregiver. Multiple phone calls were made to each home to reach the mother or primary caregiver. Complete descriptions of participant recruitment and Project EAT study procedures are documented in other study-related publications.25, 26, 27
Study procedures were approved by the University of Minnesota Human Subjects committee and by the participating school districts’ research boards. Passive and active consent procedures were in accordance with the participating school board requirements.
Measures
Parent Telephone Interviews
Maternal concern for healthful eatingTo assess this variable, the following question was asked: “How much do you personally care about eating healthful food?” Responses included not at all, a little bit, somewhat, and very much. Responses were collapsed into (1) not at all/a little bit, (2) somewhat, and (3) very much.
Dietary intakeTo assess maternal intake of fruits, vegetables, and dairy, questions adapted from the 5 A Day Power Plus Program parent survey were used.28 Intake of fruit was assessed with the item: “Thinking back over the past week, how many servings of fruit did you usually eat on a typical day?” Similar items were used to measure maternal intake of vegetables and dairy products. Serving sizes were defined for mothers during the interviews as ½ cup or 1 medium piece for fruit, ½ cup cooked or 1 cup raw for vegetables, and 1 cup or 1 ounce for dairy food. Responses included 0, less than 1, 1, 2, 3, 4, and 5+ servings. The response options for fruits, vegetables, and dairy were collapsed into less than 1 serving a day, 1–2 servings, and 3+ servings.
Meal frequencyTo assess maternal frequency of breakfast, lunch, and dinner consumption, the following question was asked: “During the past week, how many days did you eat breakfast?” Similar items were used to determine lunch and dinner consumption. Responses included never, 1-2, 3-4, 5-6 days, and every day.
Fast-food consumptionTo assess maternal frequency of fast-food consumption, the following questions were used: “In the past week, how many times did you eat something from a fast-food restaurant, such as McDonald’s, Burger King, Domino’s or similar places?” and “In the past week, how many times was a family meal purchased from a fast-food restaurant and eaten at the restaurant or at home?” Responses included 0, 1-2, 3-4, 5-6, 7, and more than 7 times. The response options were collapsed into 0, 1-2, and 3 +.
Report of home food environmentTo assess the home food environment, mothers were asked 7 questions, such as “How often would you say fruits and vegetables are available in your home?” Similar questions were used to determine household availability of 100% fruit juice, soda pop, salty snacks, chocolate/candy, as well as how often vegetables are served at dinner, and how often milk is served at meals. Responses were scored as always, usually, sometimes, and never. The response options were collapsed into always, usually/sometimes, and never.
Weight statusTo assess maternal body size, maternal body mass index (BMI) was calculated based on self-reported height and weight measurements using the formula BMI = kilograms per square meter of surface area (kg/m2). Maternal weight status was included as a control variable, because data show that maternal eating behavior and attitudes vary by weight status.29, 30
Sociodemographic variablesMaternal self-reported sociodemographic variables included race/ethnicity, marital status, educational status, family income, and work status. Parental socioeconomic status (SES) was based on a factor analysis using parental education of the more highly educated parent, family income, and the higher employment status of father/mother. A single factor arose, with weights approximately equal. Five categories were chosen using cut-points at sparse regions of the distribution of the factor score. Of 810 mothers, 22 (2.7%) were missing SES data. Percentages from lowest to highest SES were 12%, 22%, 30%, 15%, and 20%. Socioeconomic status derived from parental data correlated 0.62 (p < .001), with SES derived from data reported by the student using a different method.31, 32
Student Survey
Adolescent concern for eating healthfullyTo assess adolescent concern for their own healthful eating, the following question was asked: “How much do you care about eating healthful food?” Responses included not at all, a little bit, somewhat, and very much. Responses were collapsed into (1) not at all/a little bit, (2) somewhat, and (3) very much.
Perception of maternal concern for eating healthfullyTo assess adolescents’ perceptions of their mothers’ concern for eating healthfully, the following question was asked: “My mother cares about eating healthful food.” Responses included not at all, a little bit, somewhat, and very much. Responses were collapsed into 3 categories, like the mothers’ responses.
Meal frequencyTo assess adolescent frequency of breakfast, lunch, and dinner consumption, the following question was asked: “During the past week, how many days did you eat breakfast?” Similar questions were asked for lunch and dinner. Responses included never, 1-2, 3-4, 5-6 days, and every day. The response options were collapsed into 0-2 days a week, 3-6 days a week, and every day.
Weight statusTo assess adolescents’ weight status, measured height and weight was translated to gender- and age-adjusted BMI percentile using the Centers for Disease Control and Prevention Growth Charts.33 Adolescent weight status was included as a control variable, because data show that behaviors vary by weight status.31, 34, 35
Dietary intakeDaily servings of fruits, vegetables, and calcium-rich food were assessed using the Youth Adolescent Food Frequency Questionnaire (YAQ). The YAQ, a comprehensive dietary assessment instrument with 149 items, has been validated in adolescents,36 and the psychometric properties are reported in previous publications.37, 38 The YAQ has been used in other large-scale studies.36 Fruit servings were totaled from intakes of juices and 11 types of fruit. Total vegetable servings were summed from consumption of 16 vegetables, mixed vegetables, tomato sauce, and coleslaw. Because of their high fat content, french fries were excluded from the final calculations of vegetable servings. Dairy servings were totaled from intakes of calcium-rich food, including milk, yogurt, cheese, ice cream, and mixed dishes (eg, macaroni and cheese). Of note, the unit of measure for intake of dairy was frequency of dairy servings. The response options for fruits, vegetables, and dairy were collapsed into less than 1 serving, 1-2 servings, and 3+ servings per day.
Sociodemographic variablesSelf-reported adolescent sociodemographic variables included age, gender, grade level, and race/ethnicity.
Statistical analysisAll analyses were conducted using SAS/STAT (Version 8.2, SAS Institute, Cary, NC, 2001). Most of the variables used were categorical, except maternal and adolescent BMI. Frequency distributions of the various categorical outcomes were examined and in many cases trichotomized for simplicity of interpretation and to have sufficient numbers in each category. Because adolescents in Project EAT were in middle school (grades 7 and 8) or high school (mainly grade 10), grade level was dichotomized to middle and high school. Because of small numbers in the first 2 of 4 categories for maternal concern for her own health, responses were trichotomized into not at all/a little bit concerned, somewhat concerned, and very much concerned. The outcomes of maternal intake and eating habits, food availability in the home, as well as adolescent eating behavior and concern for health were also trichotomized.
For categorical outcomes, the multinomial cumulative logistic regression model was used to investigate associations of ordered outcomes with maternal concern for healthful eating, adjusted for maternal race/ethnicity, socioeconomic status, and grade level of the adolescent (middle or high school). The predicted prevalences of the outcome within each level of maternal concern are presented. A significant test directs attention to associations where mothers’ concern for healthful eating likely has an impact on the outcome, the direction of which can be judged from the profiles of prevalences within levels of maternal concern. For an ordered trichotomous outcome (eg, frequencies), 2 cumulative logits can be formed—the usual logit for lowest frequency versus any higher frequency, and a second logit of the 2 lowest frequencies versus the highest frequency. The 2 logits are compared across the different categories of the independent variable. A proportional odds assumption forces the model to pool the odds ratios (OR) over the 2 logits, giving a pooled OR for high versus low maternal concern, and a second OR for moderate versus low maternal concern for healthful eating. The hypothesis that both of these ORs equal 1 is tested by a 2-degree-of-freedom contrast based on the slope of the likelihood function (score test). In addition, a Spearman correlation analysis was performed to examine the relationship between adolescents’ perception of maternal concern for eating healthfully and maternal report of concern for eating healthfully.
Results
Characteristics of the Sample
MothersApproximately 48% of the mothers were white, 22% African American, 14% Asian, 9% Latino, 6% Native American, and 1% other/mixed. Roughly two thirds (64%) were married. Fourteen percent had less than a high school education, 28% had a high school education, and 58% had some post-secondary education. The majority (83%) of the mothers were employed, and half reported an annual household income above $40
000. The mean maternal BMI was 26.5 (SD = 5.9; range 15-58).
Fifty-three percent of the adolescent participants were female. The mean age of the adolescent sample was 14.5 (SD = 1.67), with 60% in high school and 40% in middle school. Approximately 33% of the adolescents were white, 24% African American, 17% Asian, 14% Latino, 9% Native American, and 3% other/mixed. Average age- and gender-adjusted BMI percentile was 67% (SD = 25%). This exceeds the value of 0.5 that would be expected if the sample matched the BMI of the CDC reference population.
Maternal Concern for Healthful Eating and Maternal Eating BehaviorsAs seen in Table 1, a quarter of the mothers reported eating 3 or more servings of fruits, vegetables, and dairy per day. Fewer than half (40%) of mothers ate breakfast on a daily basis; however, the majority reported eating lunch (58%) and dinner (75%) daily. About half of the mothers (52%) reported eating fast food 1 or 2 times a week and 16% more frequently.
Table 1. Maternal Eating Behaviors by Maternal Concern for Healthful Eating—Adjusted Prevalences and Score Test (Logistic Analysis of Covariance, Adjusted) (Entries are Column Percents)
| In the Past Week | Total | Low Concern n = 38 (%) | Moderate Concern n = 158 (%) | High Concern n = 518 (%) | p value⁎ |
|---|---|---|---|---|---|
| Serving of fruit/day | |||||
| <1 | 13.5 | 26.6 | 17.5 | 11.4 | <.001 |
| 1-2 | 61.9 | 61.7 | 64.0 | 61.4 | |
| > 3 | 24.5 | 11.7 | 18.5 | 27.3 | |
| Serving of vegetables/day | |||||
| < 1 | 7.6 | 22.6 | 7.8 | 6.5 | <.001 |
| 1-2 | 66.8 | 69.2 | 68.6 | 66.1 | |
| > 3 | 25.5 | 8.3 | 23.6 | 27.4 | |
| Serving of dairy/day | |||||
| < 1 | 15.9 | 17.4 | 11.7 | 17.1 | .05 |
| 1-2 | 60.7 | 61.4 | 58.3 | 61.4 | |
| 3+ | 23.4 | 21.1 | 30.0 | 21.6 | |
| Eat breakfast | |||||
| 0-2 | 32.8 | 48.0 | 40.8 | 29.3 | .01 |
| 3-6 | 26.6 | 25.8 | 27.0 | 26.6 | |
| Everyday | 40.5 | 26.1 | 32.2 | 44.1 | |
| Eat lunch | |||||
| 0-2 | 10.3 | 17.3 | 12.4 | 9.2 | .01 |
| 3-6 | 32.1 | 40.2 | 35.4 | 30.5 | |
| Everyday | 57.6 | 42.5 | 52.2 | 60.3 | |
| Eat dinner | |||||
| 0-2 | 3.1 | 5.0 | 2.7 | 3.1 | .28 |
| 3-6 | 22.0 | 30.6 | 20.1 | 21.9 | |
| Everyday | 74.9 | 64.4 | 77.2 | 75.0 | |
| Eat fast food | |||||
| 0 | 32.1 | 20.2 | 21.0 | 36.4 | <.001 |
| 1-2 | 51.7 | 54.5 | 54.6 | 50.6 | |
| 3+ | 16.2 | 25.2 | 24.4 | 13.0 |
⁎p value differences between categories (2 df) |
In general, maternal concern for healthful eating was positively associated with maternal eating behavior. As maternal concern for healthful eating increased, maternal consumption of fruits and vegetables increased. Likewise, as maternal concern for healthful eating increased, maternal report of eating breakfast and lunch increased and fast food decreased. Maternal concern for healthful eating was not associated with frequency of eating dinner.
Maternal Concern for Healthful Eating and Home Food EnvironmentAs shown in Table 2, almost three fourths (71%) of mothers reported always having fruits and vegetables at home, and more than half indicated that vegetables (59%) and milk (54%) are always served with meals. Half of the mothers reported always having 100% fruit juice available in the home. Roughly one fourth of mothers reported that salty snacks were always available in the home, and 43% reported that soft drinks were always available in their home. Fifty-four percent reported purchasing family meals from fast-food restaurants 1 or 2 times a week.
Table 2. Maternal Report of Home Food Environment by Maternal Concern for Healthful Eating—Adjusted Prevalences and Score Test (Logistic Analysis of Covariance, Adjusted) (Entries are Column Percents)
| Total | Low Concern n = 38 (%) | Moderate Concern n = 158 (%) | High Concern n = 518 (%) | p value⁎ | |
|---|---|---|---|---|---|
| Fruits/Vegetables available in home | |||||
| Never | 0.1 | 0.1 | 0.2 | 0.1 | <.01 |
| Usually/Sometimes | 29.1 | 31.9 | 39.9 | 25.6 | |
| Always | 70.8 | 68.0 | 60.0 | 74.3 | |
| Vegetables served at dinner | |||||
| Never | 0.8 | 1.7 | 1.1 | 0.7 | <.01 |
| Usually/Sometimes | 40.5 | 59.0 | 48.8 | 36.7 | |
| Always | 58.6 | 39.3 | 50.1 | 62.7 | |
| Milk served at meals | |||||
| Never | 7.0 | 7.5 | 9.4 | 6.3 | 0.06 |
| Usually/Sometimes | 39.2 | 40.9 | 45.1 | 37.3 | |
| Always | 53.8 | 51.6 | 45.4 | 56.5 | |
| 100% Juice available in home | |||||
| Never | 2.2 | 3.4 | 3.1 | 1.9 | 0.01 |
| Usually/Sometimes | 48.4 | 58.6 | 56.8 | 45.2 | |
| Always | 49.3 | 38.0 | 40.1 | 53.0 | |
| Salty snacks available in home | |||||
| Never | 3.8 | 2.9 | 2.2 | 4.4 | <.01 |
| Usually/Sometimes | 74.7 | 71.6 | 66.5 | 77.3 | |
| Always | 21.5 | 25.5 | 31.3 | 18.2 | |
| Chocolate/Candy available in home | |||||
| Never | 11.1 | 17.3 | 8.8 | 11.4 | 0.16 |
| Usually/Sometimes | 79.5 | 77.0 | 79.6 | 79.7 | |
| Always | 9.4 | 5.7 | 11.6 | 9.0 | |
| Soda pop available in home | |||||
| Never | 4.5 | 1.4 | 3.1 | 5.2 | <0.01 |
| Usually/Sometimes | 52.9 | 28.7 | 45.6 | 56.9 | |
| Always | 42.6 | 69.9 | 51.3 | 37.9 | |
| Purchase family meal from fast food restaurant | |||||
| 0 | 37.4 | 30.3 | 32.0 | 39.6 | .13 |
| 1-2 | 53.7 | 58.0 | 57.1 | 52.3 | |
| 3+ | 8.9 | 11.7 | 10.9 | 8.1 |
⁎p value for association of maternal concern on the outcome (2 df) |
Mothers with high concern for healthful eating were more likely to always have fruits and vegetables in the home, always serve vegetables at dinner, and always have 100% juice available in the home, and they were less likely to have salty snacks and soft drinks in the home, as compared to mothers who had low or moderate concern. Maternal concern for healthful eating was not associated with milk served at meals, chocolate/candy available at home, or the purchase of a family meal from a fast-food restaurant.
Maternal Concern for Healthful Eating and Adolescent Eating BehaviorsTable 3 presents the associations between adolescent eating behaviors and both the mother’s report (left half of the table) and adolescent report (right half of the table) of maternal concern for healthful eating.
Table 3. Adolescent Report of Eating Behaviors and Concern for Healthful Eating Related to Maternal Concern for Healthful Eating (Adjusted Prevalences and Score Test)
| Total | Mother Report | p Value† | Adolescent Report | p Value† | |||||
|---|---|---|---|---|---|---|---|---|---|
| Low n = 38 (%) | Moderate n = 158 (%) | High n = 518 (%) | Low n = 118 (%) | Moderate n = 262 (%) | High n = 268 (%) | ||||
| Serv of fruit/day | |||||||||
| < 1 | 23.5 | 20.6 | 23.7 | 23.6 | .88 | 25.9 | 28.4 | 17.6 | <.001 |
| 1-2 | 44.8 | 44.0 | 44.9 | 44.8 | 45.9 | 45.9 | 43.3 | ||
| > 3 | 31.8 | 35.4 | 31.5 | 31.6 | 28.2 | 25.7 | 39.2 | ||
| Serv of veg/day‡ | |||||||||
| < 1 | 26.0 | 27.8 | 31.1 | 24.3 | .19 | 33.5 | 28.8 | 19.5 | <.001 |
| 1-2 | 55.3 | 55.0 | 53.9 | 55.7 | 53.4 | 55.4 | 56.7 | ||
| > 3 | 18.8 | 17.2 | 15.1 | 20.0 | 13.1 | 15.8 | 23.8 | ||
| Serv of dairy/day | |||||||||
| < 1 | 7.2 | 6.8 | 5.9 | 7.6 | .38 | 8.7 | 6.5 | 7.1 | .36 |
| 1-2 | 42.0 | 41.0 | 38.2 | 43.3 | 46.4 | 40.8 | 42.5 | ||
| > 3 | 50.8 | 52.2 | 55.9 | 49.1 | 44.9 | 52.6 | 50.5 | ||
| Eat breakfast⁎ | |||||||||
| 0-2 | 41.8 | 43.6 | 42.3 | 41.5 | .96 | 48.2 | 40.3 | 40.6 | .25 |
| 3-6 | 29.0 | 28.7 | 28.9 | 29.1 | 27.9 | 29.5 | 29.4 | ||
| Every day | 29.2 | 27.7 | 28.8 | 29.4 | 23.9 | 30.2 | 29.9 | ||
| Eat lunch⁎ | |||||||||
| 0-2 | 9.8 | 10.2 | 11.3 | 9.3 | .50 | 12.0 | 9.2 | 8.8 | .24 |
| 3-6 | 33.6 | 34.4 | 36.1 | 32.8 | 38.0 | 33.5 | 32.5 | ||
| Every day | 56.6 | 55.4 | 52.6 | 58.0 | 50.0 | 57.3 | 58.7 | ||
| Eat dinner⁎ | |||||||||
| 0-2 | 4.0 | 3.5 | 4.0 | 4.1 | .89 | 3.8 | 4.4 | 4.0 | .74 |
| 3-6 | 28.5 | 25.7 | 28.1 | 28.8 | 26.8 | 29.7 | 27.8 | ||
| Every day | 67.5 | 70.8 | 67.9 | 67.1 | 69.4 | 65.9 | 68.3 | ||
| Fast food⁎ | |||||||||
| 0 | 21.8 | 13.8 | 19.1 | 23.2 | .08 | 29.5 | 23.6 | 19.9 | .05 |
| 1-2 | 54.7 | 51.7 | 54.5 | 54.9 | 53.9 | 55.2 | 55.0 | ||
| 3+ | 23.5 | 34.5 | 26.4 | 21.8 | 16.6 | 21.2 | 25.0 | ||
| Teen concern for healthful eating | |||||||||
| Not at all/A Little bit | 28.9 | 34.8 | 24.7 | 29.7 | .34 | 38.0 | 18.0 | 10.6 | <.001 |
| Somewhat | 69.0 | 63.6 | 72.8 | 68.3 | 50.7 | 55.7 | 49.7 | ||
| Very Much | 2.1 | 1.6 | 2.5 | 2.0 | 11.3 | 26.3 | 39.7 | ||
⁎In the past week |
†p value for association of self-report or adolescent perception of maternal concern on the outcome (2 df). |
‡French fried potatoes were excluded from servings of vegetables. |
Overall, roughly one third of adolescents reported eating 3 or more servings of fruit per day. Fewer adolescents (19%) ate 3 or more servings of vegetables per day. Moreover, almost a quarter of youth reported consuming less than one serving of fruits or vegetables per day over the past year. Approximately half of the adolescents in the study consumed milk products 3 or more times per day. Only 30% of adolescents reported eating breakfast on a daily basis, whereas the majority reported eating lunch (57%) and dinner (68%) on a daily basis. Almost a quarter of the adolescents reported consuming fast food 3 or more times per week. Only 2% of adolescents reported concern for healthful eating very much.
The Spearman correlational analysis showed a statistically significant, albeit modest, concordance between maternal and adolescent perception of level of maternal concern for personal healthful eating (r = .18, p < .001). Of note, the concern categories were not collapsed for the correlational analysis such that the analysis used all 4 response levels of concern (not at all, a little bit, somewhat, and very much concerned).
In the left half of Table 3, results show that reported maternal concern for healthful eating (as reported by the mothers) was not associated with adolescent meal frequency or adolescent personal concern for healthful eating. Adolescents with mothers who reported high concern for healthful eating did not report eating more fruits, vegetables, and dairy or consuming meals more regularly than adolescents whose mothers reported low or moderate levels of concern for healthful eating.
In the right half of Table 3, results show that adolescent perception of maternal concern for healthful eating was positively associated with adolescent fruit and vegetable intake. There were no significant differences found for servings of dairy per day or frequency of eating breakfast, lunch, or dinner per week. In addition, adolescents’ perception of mothers’ concern for healthful eating was positively associated with adolescents’ concern for healthful eating. Adolescent perception of maternal concern for healthful eating was not associated with number of servings of dairy consumed, or frequency of eating breakfast, lunch, or dinner among adolescents.
Discussion
This is the first study of which the investigators are aware that examines the transmission of parental eating attitudes to both parent and adolescent eating behavior and the home food environment. This study found that mothers who report higher levels of concern for healthful eating have greater intakes of fruits, vegetables, and dairy products. In addition, mothers who report higher levels of concern are more likely to have home food environments supportive of healthful eating. Interestingly, mothers’ report of their own concern for healthful eating was not associated with adolescent eating behavior in this study; however, adolescents’ perceptions of their mothers’ concern for healthful eating was associated with adolescent fruit and vegetable consumption.
As noted above, mothers’ report of attitudes regarding healthful eating was not associated with adolescent behavior. However, adolescents’ perception of mothers’ attitudes regarding healthful eating was associated with higher fruit and vegetable consumption in the adolescents, and adolescents’ concern for healthful eating. These results are consistent with research that suggests that parental modeling and dietary intake have a consistent impact on a child’s behavior.13 A number of studies on parental eating behaviors and adolescent eating behavior show positive relationships between healthful maternal intake and adolescent intake.19, 24, 39, 40, 41 In addition, adolescents in focus groups have also indicated that parental eating behavior influences their healthful food choices.42 This study expands on these findings, not by showing that parental behavior is associated with adolescent behavior, but that adolescents’ perception of mothers’ attitudes is associated with adolescent behavior and attitudes. These results highlight the importance of adolescents’ perceptions of their parents and the impact of these perceptions on adolescent attitudes and behavior.
These results show that higher maternal concern of healthful eating is associated with improved maternal eating behavior and home environment. There are very few studies that examine adult transmission of attitudes to eating behaviors. Two studies, one laboratory study and one clinical trial, found that intentions to eat healthfully were associated with a more healthful diet in adults.43, 44 However, the authors are not aware of any studies that have examined the range of eating behaviors that are included in this study (ie, fast-food consumption; breakfast, lunch, and dinner consumption). This study showed that maternal concern for eating healthfully not only was associated with servings of fruit, vegetable, and dairy, but was also associated with fast-food, breakfast, and lunch frequency among mothers.
Interestingly, adolescent perceptions of maternal concern for healthful eating and maternal report of concern for healthful eating are positively but weakly correlated. Studies examining parent and child perceptions of mealtime environment and behavior showed little concordance between parent self-reported perceptions and adolescent self-reported perceptions.45 These results highlight the need to evaluate outcomes in both parents and children when studying families and home environment, especially in light of the low correlation between parent and teen perceptions of parent behavior.
This study has a number of strengths and weaknesses that need to be noted. Strengths of this study include the large and diverse sample in terms of race/ethnicity and socioeconomic status, the collection of data from both adolescents and their parents, and the assessment of a broad array of dietary data. However, adolescent and parent data on behaviors are self-reported with relatively brief measures to assess parental eating behavior. In addition, this study is cross-sectional, and causal associations cannot be assumed.
Implications for Research and Practice
This study has implications for parents, nutrition educators, and research. Practitioners and educators are most likely aware that parental attitudes regarding healthful eating are not necessarily shared by their adolescents. However, this study serves as a reminder that youth perceptions need to be assessed when evaluating interventions for teens.
This study demonstrates that researchers need to better understand how adolescents’ perceptions are formed and how parental values are transmitted to youth. As in clinical practice, this study highlights that researchers need to assess youth perceptions of parent behavior and values, and not rely solely on parent report. Future research studies could focus efforts on identifying other factors that play a role in adolescent eating behavior, including home environment, school environment, and peer influence.
Parents need to know that their attitudes and behaviors regarding healthful eating have the potential to influence their adolescents’ behaviors, provided their children are aware of their attitudes and behaviors. Thus, parents should be encouraged to share their beliefs regarding the importance of healthful eating with their adolescents through verbal discussions and through their own behavior.
Acknowledgments
This manuscript was developed when Robyn W. Birkeland was a fellow at the University of Minnesota and is supported in part through funds from the Leadership Education in Adolescent Health (LEAH) Fellowship Training Program, University of Minnesota (grant 1-T71-MC00025-01, Maternal and Child Health Bureau, DHHS). This study was supported by grant MCJ-27034 (D. Neumark-Sztainer, principal investigator) from the Maternal and Child Health Program (Title V, Social Security Act), Health Resources and Services Administration, Department of Health and Human Services.
References
- Relationship of mothers’ food choice criteria to food intake of preschool children: identification of family subgroups. Health Educ Q. 1993;20:243–259
- Improving dietary behavior in African Americans: the Parents As Teachers High 5, Low Fat Program. Prev Med. 2003;36:684–691
- . Negative body image and disordered eating behavior in children and adolescents: what places youth at risk and how can these problems be prevented?. Clin Child Fam Psychol Rev. 2003;6:51–66
- . Unhealthy behaviors and psychosocial difficulties among overweight adolescents: the potential impact of familial factors. J Adolesc Health. 2002;31:145–153
- . Healthy Eating and Activity Together (HEAT): weapons against obesity. J Pediatr Health Care. 2003;17:210–215
- . Parent involvement in health concerns for youth: the issue of adolescent immunization. J Sch Health. 1997;67:292–293
- . Correlates of vigorous exercise in a predominantly low SES and minority high school population. Prev Med. 1994;23:314–321
- . Development of eating behaviors among children and adolescents. Pediatrics. 1998;101:539–549
- . Can mothers influence their child’s eating behavior?. J Dev Behav Pediatr. 1999;20:88–92
- . Parental eating attitudes and the development of obesity in children (The Framingham Children’s Study). Int J Obes Relat Metab Disord. 2000;24:1319–1325
- . Parents’ and children’s adiposity and eating style. Pediatrics. 1994;94:653–661
- . Predicting adolescent eating and activity behaviors: the role of social norms and personal agency. Health Psychol. 2003;22:189–198
- . Children’s eating attitudes and behaviour: a study of the modelling and control theories of parental influence. Health Educ Res. 2004;19:261–271
- . Development of food preferences. Annu Rev Nutr. 1999;19:41–62
- . Psychosocial correlates of dietary intake: advancing dietary intervention. Annu Rev Nutr. 1999;19:17–40
- . Family and child-care provider influences on preschool children’s fruit, juice, and vegetable consumption. Nutr Rev. 2001;59:224–235
- . The role of availability as a moderator of family fruit and vegetable consumption. Health Educ Behav. 2000;27:471–482
- . Five-year-old girls’ ideas about dieting are predicted by their mothers’ dieting. J Am Diet Assoc. 2000;100:1157–1163
- . Mothers, daughters and dieting: investigating the transmission of weight control. Br J Clin Psychol. 1998;37:3–13
- . Dieting concerns of 10-year-old girls and their mothers. Br J Clin Psychol. 1990;29:346–348
- . Parental input and weight concerns among elementary school children. Int J Eat Disord. 1999;25:263–271
- . Body image satisfaction, dieting beliefs, and weight loss behaviors in adolescent girls and boys. J Youth Adolesc. 1991;20:361–379
- . Mothers and daughters and disordered eating. J Abnorm Psychol. 1991;100:198–204
- . Associations between parental report of the home food environment and adolescent intakes of fruits, vegetables and dairy food. Public Health Nutr. 2005;8:77–85
- . Family meal patterns: associations with sociodemographic characteristics and improved dietary intake among adolescents. J Am Diet Assoc. 2003;103:317–322
- . Correlates of fruit and vegetable intake among adolescents: findings from Project EAT. Prev Med. 2003;37:198–208
- . Weight-related attitudes and behaviors of adolescent boys and girls who are encouraged to diet by their mothers. Int J Obes Relat Metab Disord. 2002;26:1579–1587
- Changing fruit and vegetable consumption among children: the 5-a-Day Power Plus program in St. Paul, Minnesota. Am J Public Health. 1998;88:603–609
- . Specific food intake, fat and fiber intake, and behavioral correlates of BMI among overweight and obese members of a managed care organization. Int J Behav Nutr Phys Act. 2006;3:42
- Fast-food habits, weight gain, and insulin resistance (the CARDIA study): 15-year prospective analysis. Lancet. 2005;365:36–42
- . Overweight status and eating patterns among adolescents: where do youths stand in comparison with the healthy people 2010 objectives?. Am J Public Health. 2002;92:844–851
- . Parental correlates of physical activity in a racially/ethnically diverse adolescent sample. J Adolesc Health. 2002;30:253–261
- CDC growth charts: United States. Adv Data. 2000;1–27
- . Weight control behaviors among obese, overweight, and nonoverweight adolescents. J Pediatr Psychol. 2002;27:531–540
- . Compensation for energy intake from fast food among overweight and lean adolescents. JAMA. 2004;291:2828–2833
- . Cross-sectional measurement of nutrient intake among adolescents in 1996. Prev Med. 2001;33:27–37
- Validation of a youth/adolescent food frequency questionnaire. Prev Med. 1997;26:808–816
- . Development and reproducibility of a food frequency questionnaire to assess diets of older children and adolescents. J Am Diet Assoc. 1995;95:336–340
- . Association between socioeconomic status, weight, age and gender, and the body image and weight control practices of 6- to 19-year-old children and adolescents. Health Educ Res. 2001;16:521–532
- . Development and change of young adults’ preventive health beliefs and behavior: influence from parents and peers. J Health Soc Behav. 1990;31:240–259
- . Influences on adolescent eating behavior. J Adolesc Health. 1996;18:27–34
- . Factors influencing food choices of adolescents: findings from focus-group discussions with adolescents. J Am Diet Assoc. 1999;99:929–937
- . Evidence that implementation intentions reduce dietary fat intake: a randomized trial. Health Psychol. 2004;23:319–323
- . Good intentions, bad habits, and effects of forming implementation intentions on healthy eating. Eur J Soc Psychol. 1999;29:591–604
- . Perceptions of the family mealtime environment and adolescent mealtime behavior: do adults and adolescents agree?. J Nutr Educ. 2001;33:128–133
This manuscript was developed when Robyn W. Birkeland was a fellow at the University of Minnesota and is supported in part through funds from the Leadership Education in Adolescent Health (LEAH) Fellowship Training Program, University of Minnesota (grant 1-T71-MC00025-01, Maternal and Child Health Bureau, DHHS). This study was supported by grant MCJ-27034 (D. Neumark-Sztainer, principal investigator) from the Maternal and Child Health Program (Title V, Social Security Act), Health Resources and Services Administration, Department of Health and Human Services.
PII: S1499-4046(07)00469-1
doi:10.1016/j.jneb.2007.04.179
Published by Elsevier Inc.
Volume 39, Issue 5 , Pages 248-256, September 2007
