Associations between Watching TV during Family Meals and Dietary Intake Among Adolescents

      Abstract

      Objective

      To examine associations between watching television during family meals and dietary intake among adolescents.

      Design

      Cross-sectional study using survey data from a diverse sample of adolescents.

      Setting

      Data were collected from a school-based survey during the 1998-1999 school year.

      Participants

      Middle and high school students (N = 4746) from 31 public schools in the Minneapolis-St. Paul area. Response rate was 81.5%.

      Variables Measured

      Intake of fruits, total vegetables, dark green/yellow vegetables, calcium-rich food, grains, soft drinks, fried food, snack food, calories, family meal frequency, and watching television during meals.

      Analysis

      General linear modeling comparing dietary intake across 3 groups.

      Results

      33.5% of boys and 30.9% of girls reported watching television during family meals. Adolescents watching television were found to have lower intakes of vegetables, dark green/yellow vegetables, calcium-rich food, and grains and higher intakes of soft drinks compared to adolescents not watching television during meals. However, watching television during family meals was associated with a more healthful diet than not eating regular family meals.

      Conclusions and Implications

      Watching television during family meals was associated with poorer dietary quality among adolescents. Health care providers should work with families and adolescents to promote family meals, emphasizing turning the TV off at meals.

      Key Words

      Introduction

      The importance of family meals in adolescents’ lives has received recent attention. More frequent family meals are associated with improved dietary intake among adolescents, including higher intakes of grains, fruit, vegetables, vitamins, and minerals including calcium, folate, fiber, iron, and vitamins A, C, E, B6, and B12, as well as a decreased intake of soft drinks.
      • Neumark-Sztainer D.
      • Hannan P.
      • Story M.
      • Croll J.
      • Perry C.
      Family meal patterns: associations with sociodemographic characteristics and improved dietary intake among adolescents.
      • Gillman M.
      • Rifas-Shiman S.
      • Frazier L.
      • et al.
      Family dinner and diet quality among older children and adolescents.
      • Videon T.
      • Manning C.
      Influences on adolescent eating patterns: the importance of family meals.
      The frequency of family meals has been found to decrease throughout adolescence.
      • Neumark-Sztainer D.
      • Hannan P.
      • Story M.
      • Croll J.
      • Perry C.
      Family meal patterns: associations with sociodemographic characteristics and improved dietary intake among adolescents.
      • Gillman M.
      • Rifas-Shiman S.
      • Frazier L.
      • et al.
      Family dinner and diet quality among older children and adolescents.
      • Neumark-Sztainer D.
      • Story M.
      • Ackard D.
      • Moe J.
      • Perry C.
      Family meals among adolescents: findings from a pilot study.
      • Taveras E.
      • Rifas-Shiman S.
      • Berkey C.
      • et al.
      Family dinner and adolescent overweight.
      Research indicates a steady decline as children age, with 51% of 9-year-olds and 35% of 14-year-olds reporting eating family dinner every day.
      • Gillman M.
      • Rifas-Shiman S.
      • Frazier L.
      • et al.
      Family dinner and diet quality among older children and adolescents.
      In addition to varying frequency of participation in family meals among adolescents, the context in which family meals occur varies as well.
      • Neumark-Sztainer D.
      • Hannan P.
      • Story M.
      • Croll J.
      • Perry C.
      Family meal patterns: associations with sociodemographic characteristics and improved dietary intake among adolescents.
      • Gillman M.
      • Rifas-Shiman S.
      • Frazier L.
      • et al.
      Family dinner and diet quality among older children and adolescents.
      • Videon T.
      • Manning C.
      Influences on adolescent eating patterns: the importance of family meals.
      • Neumark-Sztainer D.
      • Story M.
      • Ackard D.
      • Moe J.
      • Perry C.
      Family meals among adolescents: findings from a pilot study.
      • Neumark-Sztainer D.
      • Story M.
      • Ackard D.
      • Moe J.
      • Perry C.
      The “family meal”: views of adolescents.
      • Boutelle K.
      • Lytle L.
      • Murray D.
      • Birnbaum A.
      • Story M.
      Perceptions of family mealtime environment and adolescent mealtime behavior: do adults and adolescents agree?.
      • Boutelle K.
      • Birnbaum A.
      • Lytle L.
      • Murray D.
      • Story M.
      Associations between perceived family meal environment and parent intake of fruit, vegetables, and fat.
      • Coon K.
      • Goldberg J.
      • Rogers B.
      • Tucker K.
      Relationships between use of television during meals and children’s food consumption patterns.
      In some families, watching TV during meals is common practice, whereas in other families, watching TV during meals is rare.
      • Neumark-Sztainer D.
      • Hannan P.
      • Story M.
      • Croll J.
      • Perry C.
      Family meal patterns: associations with sociodemographic characteristics and improved dietary intake among adolescents.
      • Neumark-Sztainer D.
      • Story M.
      • Ackard D.
      • Moe J.
      • Perry C.
      Family meals among adolescents: findings from a pilot study.
      • Neumark-Sztainer D.
      • Story M.
      • Ackard D.
      • Moe J.
      • Perry C.
      The “family meal”: views of adolescents.
      • Boutelle K.
      • Birnbaum A.
      • Lytle L.
      • Murray D.
      • Story M.
      Associations between perceived family meal environment and parent intake of fruit, vegetables, and fat.
      • Coon K.
      • Goldberg J.
      • Rogers B.
      • Tucker K.
      Relationships between use of television during meals and children’s food consumption patterns.
      • Gentile D.A.
      • Walsh D.A.
      A normative study of family media habits.
      A national sample of adolescents indicated that 64% of 11- to 18-year-olds had the TV on during meals.

      Kaiser Family Foundation. Generation M: Media in the lives of 8-18 year-olds. March 2005. Available at: http://www.kff.org/entmedia/7251.cfm. Accessed May 25, 2006.

      An important question that has not been explored is whether watching TV during family meals diminishes the nutritional benefits of family meals.
      Increased TV viewing has been associated with increased caloric intake and decreased diet quality among children and adolescents, including consuming higher-fat food and lower intakes of fruits and vegetables.
      • Crespo C.
      • Smit E.
      • Troiano R.
      • Bartlett S.
      • Macera C.
      • Andersen R.
      Television watching, energy intake, and obesity in US children: results from the third National Health and Nutrition Examination Survey, 1988-1994.
      • Robinson T.N.
      • Killen J.D.
      Ethnic and gender differences in the relationships between television viewing and obesity, physical activity, and dietary fat intake.
      • Lowry R.
      • Wechsler H.
      • Galuska D.
      • Fulton J.
      • Kann L.
      Television viewing and its associations with overweight, sedentary lifestyle, and insufficient consumption of fruits and vegetables among US high school students: differences by race, ethnicity, and gender.
      Data from the Youth Risk Behavior Survey indicated adolescents who reported watching more than 2 hours of TV per day were more likely to consume inadequate servings of fruits and vegetables compared to adolescents who reported 2 or fewer hours of TV viewing per day.
      • Lowry R.
      • Wechsler H.
      • Galuska D.
      • Fulton J.
      • Kann L.
      Television viewing and its associations with overweight, sedentary lifestyle, and insufficient consumption of fruits and vegetables among US high school students: differences by race, ethnicity, and gender.
      Coon and colleagues looked at the relationship between watching TV at meals and dietary intake between fourth-, fifth-, and sixth-graders. The study found children from families with the TV on for 2 or more meals per day had lower intakes of nutrient-rich food and higher intakes of processed food and soft drinks compared to children whose families had the TV on less often during meals.
      • Coon K.
      • Goldberg J.
      • Rogers B.
      • Tucker K.
      Relationships between use of television during meals and children’s food consumption patterns.
      The present study expands on available research on TV viewing during family meals,
      • Patrick H.
      • Nicklas T.A.
      A review of family and social determinants of children’s eating patterns and diet quality.
      looking at adolescents. Specifically, the current study addresses the question: is watching TV during family meals associated with adolescents’ dietary intake? The hypothesis was that watching TV during family meals would be associated with a poorer quality diet compared to eating family meals but not watching TV. A secondary question examined whether watching TV during family meals was associated with better dietary intake compared to not eating regular family meals. The hypothesis was that eating family meals while watching TV would be associated with a higher quality diet than not eating regular family meals.

      Methods

      Study Design

      Data for this study were drawn from Project Eating Among Teens (Project EAT), which was designed to assess socioenvironmental, personal, and behavioral factors related to adolescent nutrition. Trained research staff administered the Project EAT survey and the Youth/Adolescent Questionnaire (YAQ; a food frequency survey) during physical education, health, and science classes. Data were collected during the 1998-1999 school year. Study procedures were approved by the University of Minnesota Human Subjects Committee and by the research boards of the participating school districts. Consent procedures were followed according to school policy, with passive consent used in some schools, and other schools requiring active consent. The response rate for participation was 81.5%. The Project EAT survey was guided by Social Cognitive Theory as well as focus groups conducted with adolescents. The survey was pretested by seventh and tenth graders and then further pilot-tested by 161 seventh and tenth graders over a 2-week interval. Additional details of the Project EAT study have been described previously.
      • Neumark-Sztainer D.
      • Story M.
      • Hannan P.
      • Moe J.
      Overweight status and eating patterns among adolescents: where do youth stand in comparison to the Healthy People 2010 objectives?.
      • Neumark-Sztainer D.
      • Wall M.
      • Story M.
      • Perry C.
      Correlates of unhealthy weight control behaviors among adolescents: implications for prevention programs.

      Study Sample

      The study sample included 4746 ethnically and socioeconomically diverse adolescents from 31 public middle and high schools throughout primarily urban school districts in the Minneapolis-St. Paul metropolitan area. The sample was equally divided by gender (50.2% boys, 49.8% girls), and the mean age was 14.9 years (range 11 to 18), with 34.3% in middle school and 65.7% in high school. The ethnic/racial backgrounds of participants were as follows: 48.5% white, 19.0% African American, 19.2% Asian American, 5.8% Hispanic, 3.5% Native American, and 4.0% mixed/other. Of the total sample, 88.6% (n = 4206) completed the YAQ. The final analytic sample consisted of 4064 participants because of missing data on key independent variables and reported caloric intakes outside the plausible range.

      Measures

      Family meals

      The Project EAT survey assessed frequency of family meals with the question: “During the past seven days, how many times did all, or most, of your family living in your house eat a meal together?” (test-retest Spearman r = .74) Response categories were: never, 1-2 times, 3-4 times, 5-6 times, 7 times, or more than 7 times. Prior research has shown similar dietary intake for adolescents reporting no family meals or 1 or 2 family meals, but differences in intakes were seen for adolescents reporting more than 3 meals.
      • Neumark-Sztainer D.
      • Hannan P.
      • Story M.
      • Croll J.
      • Perry C.
      Family meal patterns: associations with sociodemographic characteristics and improved dietary intake among adolescents.
      Therefore, for the present analysis, frequency was dichotomized to 3 or more meals versus 2 or fewer meals eaten together per week.

      Television viewing

      Watching TV during meal times was assessed, using the Project EAT survey, with the question: “In my family, we often watch TV while eating dinner” (test-retest Spearman r = .65). Response categories were: strongly disagree, somewhat disagree, somewhat agree, or strongly agree. Responses were dichotomized for analysis (agree/disagree). Given that hours of TV viewing has been associated with dietary intake,
      • Robinson T.N.
      • Killen J.D.
      Ethnic and gender differences in the relationships between television viewing and obesity, physical activity, and dietary fat intake.
      • Lowry R.
      • Wechsler H.
      • Galuska D.
      • Fulton J.
      • Kann L.
      Television viewing and its associations with overweight, sedentary lifestyle, and insufficient consumption of fruits and vegetables among US high school students: differences by race, ethnicity, and gender.
      total TV viewing time was adjusted for in the analysis. Total TV time was assessed by asking how many hours per day adolescents watched TV and videos in their free time on weekdays and weekends. Response categories for each were 0, ½ hour, 1 hour, 2 hours, 3 hours, 4 hours, or 5+ hours, and responses were used to calculate weekly hours of TV.

      Dietary intake

      Dietary intake was measured with the 149-item YAQ, which has been validated among adolescent populations.
      • Rockett H.
      • Berkey C.
      • Colditz G.
      Evaluation of dietary assessment instruments in adolescents.
      • Rockett H.
      • Breitenbach M.A.
      • Frazier A.L.
      • et al.
      Validation of a youth/adolescent food frequency questionnaire.
      • Rockett H.
      • Wolf A.
      • Colditz G.
      Development and reproducibility of a food frequency questionnaire to assess diets of older children and adolescents.
      In the present analysis, daily servings of fruit, total vegetables, dark green/yellow vegetables, calcium-rich food, grains, soft drinks, fried food, and snack food as well as daily caloric intake were assessed. Fruit servings were summed from reported intake of fruit and fruit juices. Vegetable servings were summed from consumption of individual vegetables, mixed vegetables, tomato sauce, and coleslaw. Intakes of fried vegetables including french fries and intakes of potatoes were excluded from total vegetable servings (analyses with and without fried food and potatoes revealed virtually identical results). Dark green or yellow vegetables were analyzed separately, as dietary recommendations indicate at least one third of vegetables consumed should include dark green, yellow, or orange vegetables.
      US Department of Health and Human Services
      Calcium-rich food included milk, chocolate milk, yogurt, cheese, cheeseburgers, pizza, macaroni and cheese, grilled cheese, ice cream, pudding, and milk shakes. Grains included cereals, breads, tortillas, pasta, rice, crackers, and pretzels. Soft drink servings included sweetened carbonated beverages, punch or lemonade, and fruit drinks (not 100% fruit juice). Participants with calorie intakes less than 400 kcal/day or greater than 7000 kcal/day were excluded from analysis, as these values are biologically implausible for habitual intake. Caloric exclusion criteria are similar to that used in other studies,
      • Rockett H.
      • Berkey C.
      • Colditz G.
      Evaluation of dietary assessment instruments in adolescents.
      with a slightly higher upper value, as it seemed possible that adolescents could be consuming over 5000 kcal/day.
      • Neumark-Sztainer D.
      • Hannan P.
      • Story M.
      • Croll J.
      • Perry C.
      Family meal patterns: associations with sociodemographic characteristics and improved dietary intake among adolescents.

      Sociodemographics

      Gender, school level, race/ethnicity, and socioeconomic status (SES) were based on self-report. Adolescents were classified as middle school (grades 7 and 8) or high school (grades 9-12) students. Race/ethnicity was assessed with the question: “Do you think of yourself as (a) white, (b) black or African American, (c) Hispanic or Latino, (d) Asian American, (e) Hawaiian or Pacific Islander, or (f) American Indian or Native American?” Adolescents reporting more than one response were coded as mixed/other. Variables used to assess SES included parental education level, eligibility for public assistance, eligibility for free or reduced cost school meals, and parents’ employment status.
      • Neumark-Sztainer D.
      • Story M.
      • Hannan P.
      • Moe J.
      Overweight status and eating patterns among adolescents: where do youth stand in comparison to the Healthy People 2010 objectives?.

      Statistical Analysis

      Three groups were created to describe family meals and TV watching: (1) adolescents eating regular family meals (3 or more family meals) who did not report watching television during meals; (2) adolescents eating regular family meals who reported watching television during meals; and (3) adolescents who did not report eating regular family meals (2 or fewer family meals). Continuous dependent variables (dietary intake) were adjusted for positive skewness using square root transformations.
      General linear modeling was used to test the independent effect of the family meal group (no TV, with TV, and no family meals) on daily servings from each individual food group. Previous research has documented differences in consumption patterns related to sociodemographic variables and TV viewing
      • Robinson T.N.
      • Killen J.D.
      Ethnic and gender differences in the relationships between television viewing and obesity, physical activity, and dietary fat intake.
      • Lowry R.
      • Wechsler H.
      • Galuska D.
      • Fulton J.
      • Kann L.
      Television viewing and its associations with overweight, sedentary lifestyle, and insufficient consumption of fruits and vegetables among US high school students: differences by race, ethnicity, and gender.
      • Neumark-Sztainer D.
      • Story M.
      • Hannan P.
      • Moe J.
      Overweight status and eating patterns among adolescents: where do youth stand in comparison to the Healthy People 2010 objectives?.
      • Krebs-Smith S.
      • Cook D.
      • Subar A.
      • Cleveland L.
      • Friday J.
      • Kahle L.
      Fruit and vegetable intake of children and adolescents in the United States.
      ; therefore analysis was run with and without adjustment for SES, school grade level, race/ethnicity, total weekly TV viewing (hours), and total daily caloric intake. Estimated mean intakes were squared to transform them back to original scale and are reported as median intakes.
      Analyses were conducted separately for boys and girls.

      Results

      Family Meals and Television Watching

      Approximately two-thirds (66.9%) of adolescents reported eating regular family meals, characterized by 3 or more family meals during the past week. Among adolescents reporting eating regular family meals, roughly one half reported watching TV during the family meal. Family meal patterns and TV watching were similar among boys and girls, although a slightly higher percentage of girls than boys reported not eating regular family meals (36.0% vs. 31.4%, P < .01).
      Family meals and TV habits by sociodemographic characteristics are shown in Table 1. Middle school youth were most likely to report eating family meals without watching TV, whereas high school adolescents were most likely to report not eating regular family meals. Differences in family meals and TV watching were seen across race/ethnicity for boys and girls. White adolescents were the least likely to report eating regular family meals while watching TV, and African-American adolescents most often reported no regular family meals. In general, girls and boys from higher SES reported more family meals without TV, and adolescents from middle to low SES reported more family meals with TV.
      Table 1Family Meals and Television Watching By Sociodemographic Characteristics among Adolescents
      Boys (%)Girls (%)
      Family Meals, No TV (n = 724)Family Meals, with TV (n = 686)No Family Meals (n = 632)X2P ValueFamily Meals, No TV (n = 687)Family Meals, with TV (n = 624)No Family Meals (n = 711)X2P Value
      Total35.533.631.034.030.935.2
      School Level21.2< .00184.1< .001
       Middle School (658, 663)
      =n (boys, girls)
      39.836.024.242.536.121.4
       High School (1336, 1338)
      =n (boys, girls)
      33.232.734.129.728.342.1
      Race58.9< .00160.9< .001
       White (1106, 984)
      =n (boys, girls)
      39.929.430.737.225.637.2
       African American (304, 328)
      =n (boys, girls)
      22.037.240.821.736.342.1
       Hispanic (121, 98)
      =n (boys, girls)
      33.942.224.038.827.633.7
       Asian (372, 419)
      =n (boys, girls)
      37.137.125.837.238.424.3
       Native American (58, 84)
      =n (boys, girls)
      20.753.525.929.832.138.1
       Mixed (60, 84)
      =n (boys, girls)
      33.338.328.332.135.732.1
      Socioeconomic Status36.8< .00184.9< .001
       Low (275, 383)
      =n (boys, girls)
      29.540.430.229.238.632.1
       Low-Middle (367, 376)
      =n (boys, girls)
      29.436.833.826.130.943.1
       Middle (540, 513)
      =n (boys, girls)
      32.033.934.129.433.936.7
       Upper-Middle (524, 440)
      =n (boys, girls)
      40.730.528.837.724.637.7
       High (294, 270)
      =n (boys, girls)
      45.926.227.953.722.224.1
      low asterisk =n (boys, girls)

      Dietary Intake By Family Meals and Television Watching

      In unadjusted analyses, boys reporting regular family meals without TV were found to have a higher quality diet than boys reporting watching TV during regular family meals (Table 2). After adjusting for sociodemographics, weekly hours spent watching TV, and caloric intake, boys eating family meals without TV were found to have more healthful diets with significantly greater intakes of total vegetables, dark green/yellow vegetables, grains, and lower intakes of soft drinks compared to boys eating family meals with TV. For example, boys eating family meals without TV reported an average of 1.4 daily servings of total vegetables compared to 1.2 daily servings among boys eating family meals while watching TV (P < .001). Differences in intakes of snack food, fried food, and total calories were not statistically significant between boys not watching TV and boys watching TV during family meals (Table 2).
      Table 2Median Daily Servings from Food Groups by Family Meal Habits (Boys)
      Median Daily ServingsUnadjusted AnalysisAdjusted Analysis
      adjusted for socioeconomic status, school level, race, weekly hours watching TV, caloric intake
      Family Meals, No TVFamily Meals, TVNo Family MealsP ValueFamily Meals, No TVFamily Meals, TVNo Family MealsP Value
      Fruit2.1
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      1.9
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      1.7
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      .0012.22.02.0.112
      Vegetables1.4
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      1.2
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      1.0
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      < .0011.4
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      1.2
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      1.1
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      < .001
      Dark green/yellow vegetables0.44
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      0.38
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      0.30
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      < .0010.45
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      0.40
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      0.33
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      < .001
      Calcium-rich food3.4
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      3.2
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      3.0
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      .0163.2
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      3.1
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      2.9
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      < .001
      Grains6.05.75.9.2075.9
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      5.6
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      5.8
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      .004
      Soft drinks1.1
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      1.2
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      1.3
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      < .0011.1
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      1.3
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      1.3
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      < .001
      Fried food0.49
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      0.57
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      0.55
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      < .0010.550.580.58.137
      Snack food2.42.62.5.4722.32.42.4.122
      Calories229322532232.599235722712208.057
      low asterisk adjusted for socioeconomic status, school level, race, weekly hours watching TV, caloric intake
      †‡§ superscripts indicate statistically significant differences when different from each other, P ≤ .05
      In unadjusted analyses, adolescent girls reporting family meals without TV had significantly higher intakes of dark green/yellow vegetables and lower intakes of soft drinks, fried food, and snack food compared to adolescent girls reporting family meals with TV. Significant differences remained for dark green/yellow vegetables and fried food after adjusting for sociodemographics, weekly hours of TV, and caloric intake. For instance, girls watching TV during family meals had an average of 0.49 daily serving of snack foods compared to 0.54 daily servings among girls not watching TV during family meals (P < .001). Caloric intake among girls not watching TV during meals was not statistically different compared to girls watching TV (Table 3).
      Table 3Median Daily Servings from Food Groups by Family Meal Habits (Girls)
      Median Daily ServingsUnadjusted AnalysisAdjusted Analysis
      adjusted for socioeconomic status (SES), school level, race, weekly hours watching TV, caloric intake
      Family Meals, No TVFamily Meals, TVNo Family MealsP ValueFamily Meals, No TVFamily Meals, TVNo Family MealsP Value
      Fruit2.2
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      2.2
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      1.7
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      < .0012.2
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      2.2
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      2.0
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      .002
      Vegetables1.6
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      1.5
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      1.1
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      < .0011.4
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      1.3
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      1.2
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      < .001
      Dark green/yellow vegetables0.54
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      0.47
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      0.36
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      < .0010.48
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      0.43
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      0.40
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      .003
      Calcium rich food2.9
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      2.7
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      2.2
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      < .0012.6
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      2.5
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      2.3
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      < .001
      Grains5.5
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      5.6
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      4.7
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      < .0015.4
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      5.3
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      5.1
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      .020
      Soft drinks0.87
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      1.1
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      1.2
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      < .0010.94
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      1.0
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      1.3
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      < .001
      Fried food0.44
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      0.56
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      0.50
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      < .0010.49
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      0.54
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      0.56
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      < .001
      Snack food2.3
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      2.6
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      2.2
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      .0142.2
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      2.2
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      2.4
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      .002
      Calories2030
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      2157
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      1860
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      < .0012139
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      2240
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      1969
      superscripts indicate statistically significant differences when different from each other, P ≤ .05
      < .001
      low asterisk adjusted for socioeconomic status (SES), school level, race, weekly hours watching TV, caloric intake
      †‡§ superscripts indicate statistically significant differences when different from each other, P ≤ .05
      Comparisons in dietary intake between adolescents who reported regular family meals with TV and adolescents not reporting regular family meals indicated that eating family meals with TV was associated with improved dietary quality. In adjusted analyses, adolescent boys and girls reporting family meals with TV were found to have higher intakes of total vegetables, calcium-rich food, and greater caloric intakes compared to boys and girls reporting no regular family meals. Girls reporting regular family meals with TV had higher intakes of fruit and grains and lower intakes of soft drinks and snack food than girls not reporting regular family meals (Table 3), but these differences were not seen among boys (Table 2).
      Family meals without TV were also found to be associated with more healthful intakes compared to not eating regular family meals. In adjusted analyses, higher intakes of fruit, total vegetables, dark green/yellow vegetables, calcium-rich food, and grains, and lower intakes of soft drinks, fried food, and snack food were found among adolescent boys and girls reporting family meals without TV compared to boys and girls reporting no family meals (Table 2, Table 3).

      Discussion

      This study explored associations between watching TV during family meals and dietary intake among adolescents. The data suggest adolescents watching TV during family meals are more likely to have a poorer quality diet compared to adolescents eating family meals without watching TV. Watching TV during family meals was associated with lower intakes of vegetables, grains, and dairy food, and higher intakes of soft drinks and fried food. Additionally, the results show that adolescents eating regular family meals while watching TV had better quality diets than adolescents not eating regular family meals.
      These findings are consistent with previous research on family meals and TV viewing.
      • Boutelle K.
      • Birnbaum A.
      • Lytle L.
      • Murray D.
      • Story M.
      Associations between perceived family meal environment and parent intake of fruit, vegetables, and fat.
      • Coon K.
      • Goldberg J.
      • Rogers B.
      • Tucker K.
      Relationships between use of television during meals and children’s food consumption patterns.
      Coon and colleagues found that younger children whose families ate 2 or more meals with the TV on consumed fewer servings of nutrient-rich food, including grains, fruit, green and yellow vegetables, beans, and nuts than children whose families ate meals with the TV on for one or fewer meals. Additionally, in agreement with these findings, children from families with the TV frequently on during meals consumed more soft drinks than other children.
      • Coon K.
      • Goldberg J.
      • Rogers B.
      • Tucker K.
      Relationships between use of television during meals and children’s food consumption patterns.
      A study by Boutelle et al focused on the family meal environment of middle and junior high school students and parental dietary intake and found parents reporting more frequent TV watching during family meals were more likely to report a greater intake of fat and lower intakes of fruits and vegetables.
      • Boutelle K.
      • Birnbaum A.
      • Lytle L.
      • Murray D.
      • Story M.
      Associations between perceived family meal environment and parent intake of fruit, vegetables, and fat.
      Associations between children’s intake and TV during family meals were not assessed in Boutelle’s study.
      Current findings provide additional insight into the relationship between watching TV and dietary intake. One potential mechanism explaining the association between watching TV during meals and dietary intake is through the influence of advertising. Commercials and advertisements shown on TV often focus on food and beverage products promoting unhealthful food, potentially influencing food choices and eating patterns of adolescents and families.
      • Harrison K.
      • Marsk A.
      Nutritional content of food advertised during the television programs children most watch.
      • Story M.
      • Faulkner P.
      The prime time diet: a content analysis of eating behavior and food messages in television program content and commercials.
      For instance, research has shown that among young children, food requests and recognition of products were correlated with advertisements seen on TV.
      • Taras H.
      • Sallis J.
      • Patterson T.
      • Nader P.
      • Nelson J.
      Television’s influence on children’s diet and physical activity.
      • Borzekowski D.
      • Robinson T.
      The 30-second effect: An experiment revealing the impact of television commercial on food preferences of preschoolers.
      Adolescents are not immune to advertisements or product placements in TV shows, and they have been found to be more likely to desire a particular item when favorite celebrities are depicted using the product.
      • Kennedy D.
      Coming of age in consumerdom.
      The finding that watching TV during family meals, even after controlling for overall hours spent watching TV, was associated with a lower quality diet compared to not watching TV provides evidence that exposure to TV during meals may have a role in eating habits of adolescents. Given this finding, health professionals, families, and adolescents should continue advocating for decreasing the number of TV commercials for low-nutrient food and increasing commercials for nutrient-dense food, including fruits and vegetables. Promoting and advertising healthful food on TV, while decreasing the number of ads for unhealthful food, has the potential to positively influence dietary intake among adolescents.
      Although watching TV during family meals was associated with a lower quality diet than not watching TV during meals, findings also revealed that boys and girls watching TV during regular family meals are more likely to report a more healthful diet than adolescents who do not eat regular family meals. In general, when families eat together, parents have the opportunity to influence what is served at meals. Families who choose to eat together may be more likely to try to prepare well-balanced, nutritious meals compared to adolescents eating on their own who may rely on prepackaged convenience food for meals, often lacking in fruits and vegetables. Additionally, when families eat together less frequently, parents may not have the opportunity to observe their adolescents’ eating behaviors and may be unaware of dietary inadequacies. When the family eats together more frequently, even if the TV is on, parents can observe what their adolescent is consuming. Adolescent girls not participating in family meals were found to have significantly lower calorie intakes than girls eating family meals with or without watching TV. There was a similar trend among adolescent boys. One possible explanation for these findings is that adolescents not frequently participating in family meals may be at increased risk for engaging in chronic dieting, binge eating, and unhealthful weight control behaviors,
      • Neumark-Sztainer D.
      • Wall M.
      • Story M.
      • Fulkerson J.
      Are family meal patterns associated with disordered eating behaviors among adolescents?.
      including restricting behaviors. Adolescents not participating in family meals may also be more likely to underreport caloric intake and have greater difficulty accurately remembering portion sizes and food consumed than adolescents participating in family meals. Overall, study findings provide clear evidence for the role of the family meal in enhancing dietary quality among adolescents.
      In some situations, it may be possible for TV to play a helpful role in increasing participation in family meals. Some adolescents cite a dissatisfaction with family relationships as a reason for not participating in family meals.
      • Neumark-Sztainer D.
      • Story M.
      • Ackard D.
      • Moe J.
      • Perry C.
      Family meals among adolescents: findings from a pilot study.
      Adolescents unhappy with family relationships may be more likely to participate in family meals if the TV is on and conversation isn’t the main focus. Therefore, it is possible that TV may be able to play the role of initially bringing families together for meals without causing additional strain on family relationships, but still allowing for nutritional benefits of family meals compared to not eating together.
      This study has several strengths that enhance the ability to draw conclusions from the findings. The large, socioeconomically and ethnically diverse study sample enhances the ability to make generalizations to diverse adolescent populations. The study was also strengthened by the use of a comprehensive survey instrument to assess dietary habits of adolescents, including measures to assess both family meal patterns and TV viewing during meal times. Study limitations should be taken into account when interpreting results. All variables were assessed via self-report; therefore, the possibility of social desirability, recall, or response bias was introduced. While the YAQ is a widely used, validated tool for assessing dietary intake among adolescents, it is not without limitations. Potential limitations may arise when using the YAQ in an ethnically diverse population, with one study showing lower validity among African-American adolescents,
      • Field A.
      • Peterson K.
      • Gortmaker S.L.
      • et al.
      Reproducibility and validity of a food frequency questionnaire among forth to seventh grade inner city school children: Implications of age and day to day variation in dietary intake.
      which compose 19% of the study population. Finally, because of the cross-sectional and observational nature of the study, a causal relationship between family meals and dietary intake cannot be established.

      Implications

      Findings from the current study support results of previous studies suggesting that regular family meals are associated with improved dietary quality among adolescents.
      • Neumark-Sztainer D.
      • Hannan P.
      • Story M.
      • Croll J.
      • Perry C.
      Family meal patterns: associations with sociodemographic characteristics and improved dietary intake among adolescents.
      • Gillman M.
      • Rifas-Shiman S.
      • Frazier L.
      • et al.
      Family dinner and diet quality among older children and adolescents.
      • Videon T.
      • Manning C.
      Influences on adolescent eating patterns: the importance of family meals.
      The findings revealed the most healthful diets, with highest intakes of fruits and vegetables and lowest intakes of soft drinks and fried food, were seen among adolescents eating family meals without watching TV. Yet, eating as a family, even with the TV on, appears to be beneficial, as adolescents reporting watching TV during regular family meals were found to have a more healthful diet compared to adolescents not eating regular family meals. Based on findings from the current study and previous studies,
      • Neumark-Sztainer D.
      • Hannan P.
      • Story M.
      • Croll J.
      • Perry C.
      Family meal patterns: associations with sociodemographic characteristics and improved dietary intake among adolescents.
      • Gillman M.
      • Rifas-Shiman S.
      • Frazier L.
      • et al.
      Family dinner and diet quality among older children and adolescents.
      • Videon T.
      • Manning C.
      Influences on adolescent eating patterns: the importance of family meals.
      • Coon K.
      • Goldberg J.
      • Rogers B.
      • Tucker K.
      Relationships between use of television during meals and children’s food consumption patterns.
      dietitians and other health care providers should make efforts to work with adolescents and families to increase the overall frequency of family meals. In working with families, practitioners should encourage turning the TV off as often as possible to maximize the benefits of the family meal.

      Acknowledgments

      Support for this project came from grant MCJ-270834 (Dianne Neumark-Sztainer, principal investigator) from the Bureau of Maternal and Child Health (Title V, Social Security Act), Health Resources and Services Administration, Department of Health and Human Services, US Public Health Service, 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), and from the General Mills Bell Institute of Health and Nutrition.

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