Journal of Nutrition Education and Behavior
Volume 42, Issue 3 , Pages 152-160, May 2010

Associations Between Parental Concern for Adolescent Weight and the Home Food Environment and Dietary Intake

  • Abbie MacFarlane, PhD

      Affiliations

    • Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
    • Corresponding Author InformationAddress for correspondence: Abbie MacFarlane, PhD, Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, 3125, Australia; Phone: 61-3-9251 7165; Fax: 61-3-9244 6017
    • ,
  • David Crawford, PhD

      Affiliations

    • Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
    • ,
  • Anthony Worsley, PhD

      Affiliations

    • School of Health Sciences, University of Wollongong, Wollongong, Australia

published online 25 January 2010.

Article Outline

Abstract 

Objective

Examine associations between parental concern about adolescent weight and adolescent perceptions of their dietary intake, home food availability, family mealtime environment, and parents' feeding practices.

Design

Cross-sectional study.

Setting

Adolescents, aged 12-15 years from 37 secondary schools in Victoria, Australia, and their parents completed surveys in 2004-2005.

Participants

1,448 adolescent–parent pairs.

Main Outcome Measures

Parental concern about adolescent weight; adolescent perceptions of their food intake and home food environment.

Analysis

Chi-square tests, exploratory factor analysis, independent t tests (P < .01).

Results

Although 12% of parents perceived their adolescent as overweight, 27% were concerned about their adolescent's weight (under- or overweight). Adolescents of concerned parents reported lower intakes of energy-dense snacks and less home availability of these food items, and they perceived that their parents less often listened to and considered their food preferences when shopping and cooking, than did adolescents of unconcerned parents. Concerned parents were no more likely to provide fruits and vegetables in the home or a positive family mealtime environment than unconcerned parents, at least as reported by their adolescents.

Conclusions and Implications

Parental concern about adolescent weight was associated with lower intakes of energy-dense snacks among adolescents, less home availability of these food items, and less supportive parental feeding practices. Parents should be encouraged to listen to and consider their adolescents' food preferences, and provide supportive family mealtime environments and healthful food in the home.

Key Words: adolescent, parents, home food environment, diet, parent feeding practice

 

Back to Article Outline

Introduction 

The rapid increase in the prevalence of childhood obesity in developed countries1 has led to increased concern about the diets of children and adolescents.2 Although a diverse range of factors has been found to be associated with children's and adolescents' eating habits,3 the home food environment, where eating habits are established and supported, is likely to be particularly influential. Parents influence their children's and adolescents' eating behaviors through the food they make available in the home, the structure and atmosphere of meals they provide, and their own beliefs and practices related the feeding of their children and adolescents.4, 5, 6

Studies examining parental influences on children's eating habits have tended to focus on younger children,7, 8 rather than on adolescents. Although this tendency may be owing to adolescents being more autonomous than younger children in their dietary choices,9 parents still have an important influence on their adolescents' dietary intake. However, the role of parental attitudes and practices related to the provision of food and the subsequent impact of these practices on the dietary behaviors and weight status of adolescents is unclear. For example, although parent modeling of healthful eating, parental provision of healthy food in the home, and eating meals as a family have been shown to positively influence dietary choices of adolescents,10, 11, 12, 13, 14, 15 other parenting practices—such as permissiveness, restriction, and monitoring of adolescent food intake—have been shown to negatively influence adolescents' food choices16 and weight status.17

Given that parents and the home food environment have a potentially powerful influence over the formation of adolescents' dietary habits, it is likely that parents can play an important role in preventing adolescent obesity.18, 19 However, relatively little is known about whether parents, particularly those who are concerned about their adolescents' weight, translate their concern into action and provide supportive home food environments for their adolescent children. A few studies have shown that parents who are concerned about their child's or adolescent's weight are more likely than unconcerned parents to use restrictive feeding practices.17, 20, 21 To the authors' knowledge, however, no studies have examined whether parental concern about adolescent weight influences other strategies parents employ to support adolescent healthful eating.

The current study fills a gap in the existing research by exploring associations between parental concern about adolescent weight and adolescent perceptions of their food intake and home food environment. This study aims to assess whether parental concern is associated with healthful eating behaviors by adolescents and the provision of a healthful home food environment.

Back to Article Outline

Methods 

Study Design and Procedures 

As part of a study investigating changes in dietary habits during adolescence, adolescents and their parents/caregivers were administered questionnaires between September 2004 and July 2005. This study was approved by the Deakin University Ethics Committee, the Victorian Department of Education and Training, and the Catholic Education Office.

All co-educational state (government-run) and Catholic secondary schools, located in the southern metropolitan region of Melbourne and the nonmetropolitan region of Gippsland to the east of Melbourne, Australia that included years 7 to 12 and had enrollments ≥200 were invited to participate. Of the 70 schools (47 metropolitan and 23 nonmetropolitan) that met these criteria, 37 schools (20 metropolitan and 17 nonmetropolitan) agreed to participate in the study.

All students (N = 9,842) from year 7 and year 9 were invited to participate. Teachers distributed parental consent forms to parents via students. In addition to requesting consent for their adolescent to participate in the study, parents were asked to report sociodemographic information including their sex, age, relationship to the adolescent, and highest level of schooling. They were also asked whether they would be willing to complete a questionnaire about their adolescent's eating habits. Parental consent was obtained for 4,502 (46%) of eligible students, but owing to absence from school on the day of testing, teachers administered surveys to 3,264 adolescents (73% of eligible students with parental consent and 33% of all eligible students who were invited to participate). This response rate is comparable to those reported in similar school-based research that requires active parental consent for student participation.22, 23 A parental survey was also mailed to 2,534 parents who indicated they would be willing to complete a questionnaire; of these, 1,622 (64%) returned a completed survey. In the present study, questions about parental perceptions of and concerns about their adolescent's weight, as well as questions about their own (and their partners') demographics, including highest level of education, were the only data used from the parental survey.

Teachers administered an on-line food habits survey to students during classes held in a computer room where each student had access to a computer. The on-line survey was pretested with a small group of adolescents for clarity and functionality. Teachers instructed the students to type in the URL of the Youth Eating Patterns (YEP) survey, which was provided to teachers with additional information covering answers to frequently asked questions. The YEP survey was 13 pages in length and took students approximately 20 minutes to complete. Almost all schools indicated that the major obstacle in obtaining parental consent would be owing to the apathy of adolescents in returning forms. To facilitate this process, the researchers provided small gifts (movie and music vouchers) to all adolescents returning consent forms, including forms denying consent. A detailed description of the YEP survey, participant recruitment, and study procedures have been provided in previous publications.24, 25

Measures 

Because this paper focuses on the home food environment, the authors drew on Birch and Davison's contextual model for childhood obesity,26 which is based on ecological systems theory,27 to inform the selection of measures. This theoretical model emphasizes the importance of focusing beyond the child to parenting styles and practices, and community, demographic, and societal characteristics.

Sociodemographics 

The YEP survey collected information on adolescent sex and current grade. Parents reported their sex, marital status, country of birth, and highest level of education in the parent consent form and/or questionnaire. Given the known associations between maternal education and childhood and adolescent diet,28, 29 maternal education was used as an indicator of socioeconomic position. Maternal education was collapsed to form 3 groups: “low” (completed Year 10 high school or less); “medium” (completed Year 12 high school, technical certificate, or apprenticeship); and “high” (university or tertiary qualification).

Parental concern about and perception of adolescent weight 

Parents were asked how concerned they were about their adolescent's weight at the time of the study. This item was based on a previously published measure.30 Responses were “not at all concerned,” “a little concerned,” “quite concerned,” and “very concerned.” Owing to small numbers, the latter 3 categories were combined. Height and weight of adolescents was not measured or reported in this study, thus whether parental concern about adolescent weight was warranted could not be assessed. Furthermore, parental concern about adolescent weight could be related to either underweight or overweight. However, since parents were also asked to classify their adolescent's weight at the time of the study, as either “very underweight,” “underweight,” “average,” “overweight,” or “very overweight,” and since the analyses were limited to adolescents in the latter 3 categories, the likelihood that parental concern was related to overweight, rather than underweight, was maximized.

Adolescent dietary intake 

Consistent with other large-scale studies,14, 31 adolescent dietary intake was assessed using a food frequency questionnaire (FFQ), which was included in the on-line survey. This FFQ, which was based on validated indices from the 2001 National Food and Nutrition Monitoring and Surveillance Project,32 asked adolescents how frequently they had consumed 37 food and beverage items during the previous month. The full list of food and beverage items is provided in a previous publication.24 Seven response categories were “never or not in the last month,” “several times a month,” “once a week,” “a few times a week,” “most days,” “once a day,” and “several times a day.”

Food and beverages from the FFQ were categorized into 6 food/beverage groups based on the Australian Guide to Healthy Eating33: fruit, vegetables, dairy, meat, bread, and extra food items (which included food items and beverages that did not fit into the other 5 groups). The frequency of consumption of each food item or beverage in the past month was converted into a daily equivalent, which is an established method34 that has been used in other dietary studies.31, 35, 36 Daily equivalent scores were calculated as follows: never or not in the last month (0.0 times/day), several times a month (0.1 times/day), once a week (0.2 times/day), a few times a week (0.4 times/day), most days (0.7 times/day), once a day (1.0 time/day), several times a day (2.5 times/day).

The daily intake for each of the 6 food/beverage groups was calculated by summing the daily equivalence for food and beverage items in each group. For example, the estimated daily intake of the dairy food group included the summed equivalence of 3 items: milk, yogurt, and cheese. The individual food and beverage items that were summed to give the daily intake of the other food groups are as follows: the bread group included bread, pasta/rice/noodles, and breakfast cereal; the fruit group included fresh, canned, or frozen fruit; the vegetable group included salad vegetables, potatoes (excluding hot chips, French fries, potato wedges, fried potato) and other cooked vegetables; the meat group included red meat, poultry, pork, fish, eggs, legumes, and nuts. The extra food items group included food items and beverages belonging to 3 additional groups: fast food, energy-dense snack food, and sugar-sweetened drinks. The fast-food group included fast-food items from fast-food chains (eg, McDonald's), as well as fish and chips, pizzas, and pastry goods like pies; the energy-dense snack food group included confectionary, cakes, cookies, and potato chips; the sugar-sweetened drinks group included regular soft drinks, sweetened drinks, energy drinks, and sports drinks.

The summed daily equivalence of each food/beverage group was then further collapsed into 4 categories (never/rarely, ≤0.4 times/day; a few times a week, 0.4 to 0.7 times/day; most days, 0.7 to 1.0 times/day; and daily, ≥1.0 times/day).24

Home food availability 

Adolescent perceptions of home food availability were assessed by asking adolescents, “How often are the following food items available in your home?” This question was followed by a list of 8 items, including fruit, vegetables, fruit juice, cakes, potato chips, chocolate, soft drinks, and sports drinks. Response options were “never”, “sometimes”, “usually” or “always” (Table 1). These items were adapted from Project EAT (Eating Among Teens).14

Table 1. Adolescent Perceptions of Home Availability of Energy-dense Snack Food According to Parental Concern about Adolescent Weight
Parental Concern about Adolescent Weight
Adolescent perceptions of home availability of energy-dense snack food% Concerned (n = 386)% Not Concerned (n = 1,025)P Value∗
I have cakes, cookies at home .003
Never53
Sometimes6256
Usually2429
Always912
I have potato chips, salty snacks at home .001
Never106
Sometimes5247
Usually2730
Always1117
I have chocolate, candy at home < .001
Never115
Sometimes6056
Usually2027
Always912

∗P value for chi-square test.

Family mealtime environment 

Adolescent perceptions of the family mealtime environment were assessed by asking how frequently the following 3 statements were true: “During meal times, I'm allowed to put on the television,” “The evening meal is an unpleasant time for my family,” and “The evening meal is a time when my family really talks and catches up.” Response options were “never,” “sometimes,” “usually,” or “always.” These items were adapted from Project EAT.14 To account for those who might have checked the “never” option because they infrequently ate dinner with their family, adolescents were also asked to report how frequently in the past month they had eaten dinner on their own. Response options were “not in the last month,” “1-2 times/month,” “1-2 times/week,” “most days,” and “every day.” Adolescents who reported that they ate dinner on their own on most days or every day (n = 125) were then excluded from analyses examining associations between parental concern and adolescent perceptions of the family mealtime environment.

Parental feeding practices 

Most studies examining parental feeding practices have focused on parental use of restriction and control of children's and adolescents' food intake37 and their association with negative child or adolescent eating3 and weight status.17, 38 However, more recent studies have recognized that other feeding practices, particularly those that may be associated with positive dietary outcomes in children, such as parental encouragement/modeling of healthful eating39 and allowing children and adolescents greater input and involvement in decisions related to food, may be important in the parent–child/adolescent feeding relationship.40 Thus, in this study, adolescent perceptions of parental feeding practices that might be associated with both positive and negative dietary outcomes were assessed using 25 items, which are provided in Table 2. Seven of these items were derived from Birch's Child Feeding Questionnaire41 and have previously been validated and evaluated among adolescents.17 The remaining 18 items were developed specifically for this study and are based on the literature.10, 14, 42, 43

Table 2. Adolescent Perceptions of Parents' Feeding Practices (n = 1,411)
Adolescent perceptions of parents' feeding practicesFactor Loadings
Factor 1: Encouragement/modeling healthful eating
Eigenvalue: 3.5; Explained variance: 14.1%; Cronbach α: 0.74
My family encourages me to eat healthful food. ae0.82
My family eats healthful food with me. ae0.72
My family encourages me not to eat “junk” food when I feel like it. ae0.71
My family encourages me to try new food. ae0.61
My family makes me feel good about the way I eat. ae0.57
Factor 2: Negotiation
Eigenvalue: 2.9; Explained variance: 11.7%; Cronbach α: 0.67
I sometimes ask my parents to prepare something I want for dinner. be0.70
My parents take into account what I would like to eat or drink when preparing food for a meal. be0.69
I sometimes ask my parents to buy certain food when they go food shopping. be0.68
My parents take into account what I would like to eat or drink when buying food. be0.65
Factor 3: Pressure to eat disliked food
Eigenvalue: 2.3; Explained variance: 9.1%; Cronbach α: 0.66
I'm expected to eat all the food items served even if I don't like them. ce0.81
My parents make me eat everything on my plate even if I don't want it. bd0.80
My parents try to make me eat food that I don't like. be0.51
Factor 4: Pressure to eat when not hungry
Eigenvalue: 1.5; Explained variance: 5.9%; Cronbach α: 0.69
My family encourages me to eat even if I'm not hungry. ae0.80
My parents try to get me to eat if I say, “I'm not hungry.” bd0.77
My parents make me eat more than I want. be0.59
Factor 5: Monitoring
Eigenvalue: 1.3; Explained variance: 5.3%; Cronbach α: 0.87
My parents keep track of the snack food I eat (eg, potato chips, corn chips). cd0.89
My parents keep track of the sweets I eat (eg, candy, ice cream, cakes, cookies). cd0.88
Factor 6
Eigenvalue: 1.2; Explained variance: 4.7%; Cronbach α: 0.44
My family criticizes the way I eat. ae0.75
My parents would not approve of the food I choose to eat when I'm away from home. be0.60
My parents hide certain food items from me. bd0.47
Factor 7
Eigenvalue: 1.0; Explained variance: 4.1%; Cronbach α: 0.50
I can eat whatever I want at home. ce0.75
I'm always allowed to buy whatever I want from fast-food places. ce0.73
I have a lot of say in what I eat at home. be0.50
Items not loading on any factor
My parents try to make sure that I eat enough. bd
My parents offer to take me out for my favorite food (dinner, sweets, snacks) if I do something good. bd

Factor loadings > 0.4 are shown.

aResponse options were “never or rarely,” “sometimes,” and “often”

bResponse options were “disagree,” “not sure,” and “agree”

cResponse options were “never,” “sometimes,” “usually,” and “always”

dItems derived from Birch et al40

eItems developed for this study based on the literature.10, 14, 41, 42

Data Analysis 

Analyses were restricted to 1,484 adolescents (classified by parents as average, overweight, or very overweight) and their parents, which represent 91% of the total adolescent–parent sample. All analyses were conducted using SPSS (version 14.0, SPSS Inc., Chicago, IL, 2005). Statistical significance was set at P ≤ .01. Descriptive statistics were used to describe the sociodemographic characteristics of the parents and adolescents, as well as parents' perceptions of and concern about adolescent weight. Pearson's chi-square tests were used to examine bivariate associations between parental concern about adolescent weight and adolescent perceptions of their food intake, home food availability, and family mealtime environment.

Exploratory factor analysis using SPSS FACTOR was performed on the 25 parental feeding practices to identify underlying patterns of relationships among individual items and to reduce and simplify the items in order to facilitate subsequent analyses. This analysis was restricted to 1,411 adolescents who had nonmissing data for all the relevant variables. Principal components analysis with varimax rotation (since factors were not correlated) was used.44, 45, 46 Items that cross-loaded on several factors (ie, items that had a loading of > 0.4 on more than 1 factor), and items that had a loading of < 0.4 on all factors, were subsequently eliminated. Interitem reliability for each factor was assessed by Cronbach α coefficients and deemed acceptable if greater than 0.6.47 Standardized factor scores were computed for each factor, with a positive score representing a higher level of perceived parental use for items loading on that factor. Independent t tests were performed separately for each of the standardized factor scores to investigate differences in perceived parental use between adolescents of parents who were concerned about their weight and adolescents whose parents were not concerned.

Back to Article Outline

Results 

Sample Characteristics 

Of the 1,622 adolescents whose parents completed a parental survey, 138 were excluded because their parents classified their weight as “underweight,” leaving 1,484 parent–adolescent pairs in the final sample. The majority of adult respondents were mothers (87%), married or living as married (81%), and born in Australia (78%). Slightly more of the adolescent sample were female (53%) than male (47%), more were in Year 7 (63%) than in Year 9 (37%), more resided in the metropolitan (60%) than in the nonmetropolitan region of Melbourne (40%), and more had mothers with a low (45%) than with a medium (28%) or high (27%) level of education. The mean age was 13.3 years (± 1.7 years) for adolescents and 42.2 years (± 12.3 years) for adults. Although there were some statistically significant differences between those participants included in the final sample and those who were not, there were no significant differences in adolescent age or sex, or parent age. However, compared with those adolescents excluded, a higher proportion of those included were from nonmetropolitan Melbourne (40% vs 24%, P < .001), were in Year 7 (64% vs 60%, P = .02), came from 2-parent families (81% vs 77%, P = .003), and had mothers with a high level of education (27% vs 20%, P < .001).

Parental Perception of and Concern about Adolescent Weight 

Although relatively few parents perceived their adolescent to be overweight (11%) or very overweight (1%) at the time of the study, a significant proportion expressed at least a little concern regarding their adolescent's current weight (27%). Parental concern about adolescent weight was not associated with adolescent sex or age or with maternal education. The authors therefore combined the data for subsequent analyses.

Parental Concern and Adolescents' Dietary Intake 

Parental concern about adolescent weight was associated with adolescent intake of extra food items (P < .001) and energy-dense snack food items (P < .001). Compared with adolescents of unconcerned parents, a greater proportion of adolescents of concerned parents reported eating extra food items and energy-dense snack food items on only a few days a week or less often. There was no difference between adolescents of concerned parents and unconcerned parents in their reported daily intake of fruit, vegetables, dairy, meat, bread, fast food, and sugar-sweetened drinks.

Parental Concern and Home Food Availability 

Compared with adolescents of unconcerned parents, a greater proportion of adolescents of concerned parents reported that cakes/sweet biscuits, potato chips/salty snacks, and chocolates/hard candies were never available at home (Table 1). There was no difference between adolescents of concerned and unconcerned parents in reported availability of fruit, vegetables, fruit juice, or other sugar-sweetened drinks such as soft drinks or sports drinks.

Parental Concern and Family Mealtime Environment 

None of the items used to measure the family mealtime environment were associated with parental concern about adolescent weight.

Factor Analysis of Parent Feeding Practices 

The factor analysis revealed 7 distinct, interpretable factors (shown in Table 2) with eigenvalues greater than 1. These factors together explained 55% of the total variance. Two items (parent tries to make sure you eat enough; parent offers favorite food when you do something good) were deleted as a result of low loading on all factors. Factor 6 and Factor 7 were dropped from further analysis because of low Cronbach α coefficients of 0.44 and 0.50, respectively. The Cronbach α coefficients for the first 5 factors ranged from 0.67 to 0.87, indicating acceptable internal reliability. Provisional names were assigned to these 5 factors: “encouragement/modeling healthful eating,” “negotiation,” “pressure to eat disliked food items,” “pressure to eat when not hungry,” and “monitoring.” The items included as “encouragement/modeling healthful eating” were related to parents modeling and promoting healthful food choices. “Negotiation” encompassed parents listening to and considering their adolescent's food preferences when shopping and cooking. “Pressure to eat disliked food items” and “pressure to eat when not hungry” related to parents pressuring their adolescent to consume more food at meals. “Monitoring” related to parents keeping track of their adolescent's intake of less healthful food items.

Mean standardized factor scores were computed for each factor and are presented in Table 3 (a higher score represents a higher level of parental use for items loading on that factor). T tests showed that mean scores differed significantly by parental concern for adolescent weight for 1 factor, negotiation (Table 3). Compared with adolescents of unconcerned parents, those with concerned parents perceived that their parents less often listened and took into consideration their food choices and preferences when shopping and cooking.

Table 3. Mean Standardized Parent Feeding Practice Scores by Parental Concern about Adolescent Weight
Parental Concern about Adolescent Weight
FactorConcerned (n = 386)Not Concerned (n = 1,025)P Value∗
F1: Encouragement/modeling healthful eating0.07−0.03.09
F2: Negotiation−0.170.06<.001
F3: Pressure to eat disliked food items−0.080.03.05
F4: Pressure to eat when not hungry−0.070.03.09
F5: Monitoring0.06−0.02.15

∗P value for t tests of significance of differences between parents who were concerned and not concerned about adolescent weight.

Back to Article Outline

Discussion 

This study examined associations between parental concern about adolescent weight and adolescent perceptions of their food intake, home food availability, family mealtime environment, and parents' feeding practices. Although only 12% of parents considered their adolescent to be overweight, slightly more than twice as many parents (27%) reported they were concerned about their adolescents' current weight. Adolescents of concerned parents reported lower intakes of extra food items, particularly energy-dense snacks, and less home availability of these food items, than did adolescents of unconcerned parents. However, according to adolescents, concerned parents were no more likely than unconcerned parents to make healthful food, such as fruits and vegetables, available in the home or provide a positive family mealtime environment. In terms of parents' feeding practices, adolescents of concerned parents perceived that their parents less often listened to and took into consideration their food choices and preferences when shopping and cooking than did adolescents of unconcerned parents.

Parental concern about adolescent weight was associated with less home availability of energy-dense snack food, like cakes, potato chips and sweets, and a lower intake of these food items among adolescents. Together these findings support previous studies that show home food availability to be strongly associated with adolescent dietary consumption12, 14 and suggest that by limiting availability of unhealthful food in the home, parents can have a positive impact on their adolescents' dietary intake.16 In addition, adolescents of concerned parents were no more likely than adolescents of unconcerned parents to report that fruit, vegetables, or sugar-sweetened drinks were available at home. This finding is consistent with a recent Australian study that found few parents promoted increased consumption of fruit and vegetables or reduced intake of high-energy drinks as strategies to prevent unhealthful weight gain in their children.30

Adolescents of concerned parents perceived that their parents less often listened to and took into consideration their food choices and preferences when shopping and cooking than did adolescents of unconcerned parents. To the authors' knowledge, no studies have directly examined whether parents' use of negotiation is linked to positive child and adolescent eating and weight outcomes. A few studies, however, have found that an authoritative parenting style, which is characterized by parents allowing their child or adolescent to make decisions about the types of food eaten and using clear, bidirectional communication in relation to food, is associated with more healthful childhood and adolescent diets.48, 49 Furthermore, pediatric obesity experts recommend negotiation as a strategy parents should use to prevent and treat childhood obesity.50 Thus, given that negotiation is likely to be associated with positive dietary outcomes, the finding that concerned parents were perceived to use this feeding practice less often than were unconcerned parents suggests that more could be done to raise parents' awareness of negotiation as a strategy to support adolescent healthful eating.

Strengths of the study include the large, regionally diverse sample and the assessment of important and relevant home environmental determinants of adolescents' eating behaviors. However, this study is not without its limitations. The response rate of 33% was low, and it is unknown how representative it is of the school population, as the authors could not collect data from those not consenting. The response rate and use of active consent procedures could potentially have biased the sample. For example, studies have shown that youth who are recruited by active versus passive consent procedures are more likely to be female, to live in 2-parent families, and to have parents with higher educational attainment, and less likely to engage in a variety of risky behaviors.51, 52 In this sample, however, only slightly more participants were female than male, and a higher proportion had mothers with low levels of education than had mothers with medium or high levels of education. The YEP survey items were based on validated, published items where possible. However, many items were developed specifically for this study, and although based on previously published measures, were not validated. The cross-sectional design of this study precludes drawing conclusions about the direction of causality of the reported associations. Further research is required to confirm these results longitudinally. Since the authors did not measure adolescent weight, they could not determine whether parental concern about adolescent weight was warranted, and since it is well known that parents tend to underestimate their adolescents' weight status,53 it is possible that the proportion of parents who were concerned about their adolescents' weight did not match the actual proportion of adolescents who were under- or overweight in this sample. The rate of parental weight concern, however, compares well with the current rates of overweight/obesity and underweight among this age group in Australia, which are estimated to be about 25% and 2% respectively.54, 55 For the purposes of this study, however, it was not necessary to measure adolescents' height and weight, since parental concern about adolescent weight is based on parents' perceptions of adolescent weight, not adolescent's actual weight.

Back to Article Outline

Implications for Research and Practice 

Findings from the current study are important, since little is known about whether parents, particularly those who are concerned about their adolescents' weight, provide supportive home food environments in response to their concerns. The findings showed that concerned parents limited home availability of energy-dense snack food, which may have contributed to the lower intake of these food items among adolescents of concerned parents. Concerned parents, however, could do more to support the healthful eating habits of their adolescents. Based on the findings of the present study and previous studies,11, 12, 14, 15, 40, 56 initiatives aimed at promoting healthful eating among adolescents might focus on increasing parental awareness of (1) the positive effects of feeding practices that emphasize negotiation and encouragement/modeling of healthful eating and (2) the importance of supportive family mealtimes and providing healthful food in the home.

Back to Article Outline

Acknowledgments 

This study was funded by the Australian Research Council and the William Buckland Foundation. The authors thank the staff, students, and parents who participated in the project. Abbie MacFarlane was supported by a National Health and Medical Research Council Capacity Building Grant. David Crawford was supported by a Victorian Health Promotion Foundation Public Health Research Fellowship.

Back to Article Outline

References 

  1. Lobstein T, Baur L, Uauy R. Obesity in children and young people: a crisis in public health. Obes Rev. 2004;5:4–85
  2. Nicklas TA, Yang S-J, Baranowski T, Zakeri I, Berenson G. Eating patterns and obesity in children: The Bogalusa Heart Study. Am J Prev Med. 2003;25:9–16
  3. Birch LL, Fisher JO. Development of eating behaviors among children and adolescents. Pediatrics. 1998;101:539–549
  4. Woodruff SJ, Hanning RM. A review of family meal influence on adolescents' dietary intake. Can J Diet Pract Res. 2008;69:14–22
  5. Savage J, Fisher J, Birch L. Parental influence on eating behavior: conception to adolescence. J Law Med Ethics. 2007;35:22–34
  6. Campbell K, Crawford D. Family food environments as determinants of preschool-aged children's eating behaviours: implications for obesity prevention policy. A review. Aust J Nutr Diet. 2001;58:19–25
  7. Wardle J. Parental influences on children's diets. Proc Nutr Soc. 1995;54:747–758
  8. Patrick H, Nicklas TA. A review of family and social determinants of children's eating patterns and diet quality. J Am Coll Nutr. 2005;24:83–92
  9. Hill AJ. Developmental issues in attitudes to food and diet. Proc Nutr Soc. 2002;61:259–266
  10. Feunekes GI, de Graaf C, Meyboom S, van Staveren WA. Food choice and fat intake of adolescents and adults: associations of intakes within social networks. Prev Med. 1998;27:645–656
  11. Fulkerson JA, Strauss J, Neumark-Sztainer D, Story M, Boutelle K. Correlates of psychosocial well-being among overweight adolescents: the role of the family. J Consult Clin Psychol. 2007;75:181–186
  12. Hanson NI, Neumark-Sztainer D, Eisenberg ME, Story M, Wall M. Associations between parental report of the home food environment and adolescent intakes of fruits, vegetables and dairy foods. Public Health Nutr. 2005;8:77–85
  13. Neumark-Sztainer D, Hannan PJ, Story M, Croll J, Perry C. Family meal patterns: associations with sociodemographic characteristics and improved dietary intake among adolescents. J Am Diet Assoc. 2003;103:317–322
  14. Neumark-Sztainer D, Wall M, Perry C, Story M. Correlates of fruit and vegetable intake among adolescents. Findings from Project EAT. Prev Med. 2003;37:198–208
  15. Young EM, Fors SW, Hayes DM. Associations between perceived parent behaviors and middle school student fruit and vegetable consumption. J Nutr Educ Behav. 2004;36:2–8
  16. De Bourdeaudhuij I. Family food rules and healthy eating in adolescents. J Health Psychol. 1997;2:45–56
  17. Kaur H, Li C, Nazir N, Choi WS, Resnicow K, Birch LL, et al. Confirmatory factor analysis of the child-feeding questionnaire among parents of adolescents. Appetite. 2006;47:36–45
  18. Ritchie LD, Welk G, Styne D, Gerstein DE, Crawford PB. Family environment and pediatric overweight: what is a parent to do?. J Am Diet Assoc. 2005;105(suppl 1):S70–S79
  19. Golan M, Crow S. Parents are key players in the prevention and treatment of weight-related problems. Nutr Rev. 2004;62:39–50
  20. May AL, Donohue M, Scanlon KS, Sherry B, Dalenius K, Faulkner P, et al. Child-feeding strategies are associated with maternal concern about children becoming overweight, but not children's weight status. J Am Diet Assoc. 2007;107:1167–1174
  21. Costanzo PR, Woody EZ. Domain-specific parenting styles and their impact on the child's development of particular deviance: the example of obesity proneness. J Soc Clin Psychol. 1985;3:425–445
  22. Tigges BB. Parental consent and adolescent risk behavior research. J Nurs Scholarsh. 2003;35:283–289
  23. Utter J, Scragg R, Ni Mhurchu C, Schaaf D. What effect do attempts to lose weight have on the observed relationship between nutrition behaviors and body mass index among adolescents?. Int J Behav Nutr Phys Act. 2007;4:40
  24. Savige GS, Ball K, Worsley A, Crawford D. Food intake patterns among Australian adolescents. Asia Pac J Clin Nutr. 2007;16:738–747
  25. MacFarlane A, Crawford D, Ball K, Savige G, Worsley A. Adolescent home food environments and socioeconomic position. Asia Pac J Clin Nutr. 2007;16:748–756
  26. Birch LL, Davison KK. Family environmental factors influencing the developing behavioral controls of food intake and childhood overweight. Pediatr Clin North Am. 2001;48:893–907
  27. In:  Bronfenbrenner U editors. The Ecology of Human Development: Experiments by Nature and Design. Cambridge, MA: Harvard University Press; 1979;
  28. Northstone K, Emmett P. Multivariate analysis of diet in children at four and seven years of age and associations with socio-demographic characteristics. Eur J Clin Nutr. 2005;59:751–760
  29. Johansen A, Rasmussen S, Madsen M. Health behaviour among adolescents in Denmark: influence of school class and individual risk factors. Scand J Public Health. 2006;34:32–40
  30. Crawford D, Timperio A, Telford A, Salmon J. Parental concerns about childhood obesity and the strategies employed to prevent unhealthy weight gain in children. Public Health Nutr. 2006;9:889–895
  31. Ball K, Mishra GD, Thane CW, Hodge A. How well do Australian women comply with dietary guidelines?. Public Health Nutr. 2004;7:443–452
  32. In:  Marks G,  Webb K,  Rutishauser I,  Riely M editor. Monitoring Food Habits in the Australian Population Using Short Questions. Canberra: Commonwealth of Australia; 2001;
  33. In:  Smith A,  Kellet E,  Schmerlaib Y editor. The Australian Guide to Healthy Eating. Canberra, Australia: Commonwealth Department of Health and Ageing; 1998;
  34. In:  Willett W editors. Nutritional Epidemiology. New York, NY: Oxford University Press; 1998;
  35. Mishra G, Ball K, Arbuckle J, Crawford D. Dietary patterns of Australian adults and their association with socioeconomic status: results from the 1995 National Nutrition Survey. Eur J Clin Nutr. 2002;56:687–693
  36. Hu FB, Rimm EB, Stampfer MJ, Ascherio A, Spiegelman D, Willett WC. Prospective study of major dietary patterns and risk of coronary heart disease in men. Am J Clin Nutr. 2000;72:912–921
  37. Faith MS, Scanlon KS, Birch LL, Francis LA, Sherry B. Parent-child feeding strategies and their relationships to child eating and weight status. Obes Res. 2004;12:1711–1722
  38. Birch L, Fisher J. Mothers' child-feeding practices influence daughters' eating and weight. Am J Clin Nutr. 2000;71:1054–1061
  39. Lee Y, Mitchell DC, Smiciklas-Wright H, Birch LL. Diet quality, nutrient intake, weight status, and feeding environments of girls meeting or exceeding recommendations for total dietary fat of the American Academy of Pediatrics. Pediatrics. 2001;107:E95
  40. Musher-Eizenman D, Holub S. Comprehensive Feeding Practices Questionnaire: validation of a new measure of parental feeding practices. J Paediatr Psychol. 2007;32:960–972
  41. Birch LL, Fisher JO, Grimm-Thomas K, Markey CN, Sawyer R, Johnson SL. Confirmatory factor analysis of the Child Feeding Questionnaire: a measure of parental attitudes, beliefs and practices about child feeding and obesity proneness. Appetite. 2001;36:201–210
  42. Sallis JF, Grossman RM, Pinski RB, Patterson TL, Nader PR. The development of scales to measure social support for diet and exercise behaviors. Prev Med. 1987;16:825–836
  43. Hill L, Casswell S, Maskill C, Jones S, Wyllie A. Fruits and vegetables as adolescent food choices in New Zealand. Health Promot Int. 1998;13:55–65
  44. In:  Hair J,  Anderson R,  Tatham L,  Grablowski B editor. Multivariate Data Analysis. New York, NY: McMillan; 1994;
  45. In:  Kline P editors. An Easy Guide to Factor Analysis. London, United Kingdom: Routledge; 1994;
  46. In:  Kim J,  Mueller C editor. Factor Analysis: Statistical Methods and Practical Issues. Thousand Oaks, CA: Sage Publications; 1978;
  47. In:  Sim J,  Wright C editor. Research in Health Care: Concepts, Designs and Methods. Cheltenham, United Kingdom: Stanley Thornes Ltd; 2000;
  48. Patrick H, Nicklas TA, Hughes SO, Morales M. The benefits of authoritative feeding style: caregiver feeding styles and children's food consumption patterns. Appetite. 2005;44:243–249
  49. Kremers SPJ, Brug J, de Vries H. Engels RCME. Parenting style and adolescent fruit consumption. Appetite. 2003;41:43–50
  50. Barlow SE, Dietz WH. Obesity evaluation and treatment: Expert Committee recommendations. The Maternal and Child Health Bureau, Health Resources and Services Administration and the Department of Health and Human Services. Pediatrics. 1998;102:E29
  51. Esbensen FA, Melde C, Taylor TJ, Peterson D. Active parental consent in school-based research: how much is enough and how do we get it?. Eval Rev. 2008;32:335–362
  52. Dent CW, Galaif J, Sussman S, Stacy A, Burton D, Flay BR. Demographic, psychosocial and behavioral differences in samples of actively and passively consented adolescents. Addict Behav. 1993;18:51–56
  53. Boutelle K, Fulkerson JA, Neumark-Sztainer D, Story M. Mothers' perceptions of their adolescents' weight status: are they accurate?. Obes Res. 2004;12:1754–1757
  54. National Nutrition Survey: Nutrient Intakes and Physical Measurements, Australia, 1995. Canberra: Australian Bureau of Statistics; 1998;Catalogue no. 4805.0
  55. Magarey AM, Daniels LA, Boulton TJ. Prevalence of overweight and obesity in Australian children and adolescents: reassessment of 1985 and 1995 data against new standard international definitions. Med J Aust. 2001;174:561–564
  56. Feldman S, Eisenberg ME, Neumark-Sztainer D, Story M. Associations between watching TV during family meals and dietary intake among adolescents. J Nutr Educ Behav. 2007;39:257–263

PII: S1499-4046(08)00848-8

doi:10.1016/j.jneb.2008.11.004

Journal of Nutrition Education and Behavior
Volume 42, Issue 3 , Pages 152-160, May 2010

Article Tools