W4003: Parental practices supporting positive eating behaviors during independent eating occasions among early adolescent children
(Multistate Research Project)
Need as indicated by stakeholders
The prevalence of obesity among older children (9 - 11 years) and adolescents (12 - 15 years) in the U.S. was 18.5% and 20.6%, respectively, based on nationally representative data from the 2015-2016 National Health and Nutrition Examination Survey (NHANES) (Skinner et al., 2018). Obesity prevalence was higher among Hispanic (26.7%) and black (22.0%) adolescents compared to non-Hispanic white (16.3%) and Asian adolescents (9.1%) (Ogden, et al., 2018). Obesity prevalence was also higher among adolescents whose head of the household had ≤ high school diploma (22.3%) compared to some college (18.1%) or a college degree (11.6%). Obesity can cause serious consequences among children and adolescents including type 2 diabetes, dyslipidemia, hypertension, sleep-disordered breathing, nonalcoholic fatty liver disease, and polycystic ovarian syndrome (Gurnani, Birken, & Hamilton, 2015; Han, Lawlor, & Kimm, 2010). A review of existing longitudinal studies showed that children and adolescents who were obese were more likely to remain obese as adults leading to obesity-related complications in adulthood (Kelsey, Zaepfel, Bjornstad, & Nadeau, 2014).
Positive energy balance can result from obesogenic behaviors including excessive sedentary activity and overconsumption of palatable, highly available energy-dense foods. The frequency of these behaviors among children and adolescents is influenced by various personal, behavioral and environmental factors (Larson, Wall, Story & Neumark-Sztainer, 2013) including food-related practices of parents/caregivers. The Social Cognitive Theory (SCT) is an interpersonal theory that focuses on mutual interactions of personal, behavioral and environmental factors (Glanz, Rimer, & Viswanath, 2008). SCT has commonly been applied to eating behaviors of children and adolescents based on the reciprocal interaction between behaviors and the home social and physical environments shaped by food-related parenting practices. Obesogenic eating behaviors among early adolescents (11-14 years) may occur during eating occasions with parental supervision and during independent occasions when parents/caregivers are not present (Reicks et al. 2015). Early adolescents may have independent eating occasions at home, or in other environments away from home including friends’ homes, restaurants or convenience stores. The frequency of independent eating occasions among early adolescents is a concern because food choices during these occasions may be less healthful than when parents/caregivers are present, leading to potential development of overweight or obesity.
Several factors can influence the frequency of independent eating occasions among early adolescents (Pliner & Bell, 2009). Since the 1960s, the diversity in family structure has increased with more single-parent households and households with fewer children (Pew Research Center, 2015). The presence of one or more adults in the household may affect the availability of a parent to eat meals with children. The participation of mothers and fathers in the work force and work schedules may also affect the ability of families to eat meals together. In 2017, the labor force participation rate for mothers and fathers with children under age 18 was 71.1% and 92.8%, respectively (US Bureau of Labor Statistics, 2018). Of employed mothers, 79.0% of those with children 6 to 17 years old worked full time. NHANES data from 2007-2010 showed that the prevalence of having 0-2, 3-6, and ≥7 family meals per week was 18%, 32% and 50%, respectively among the US population with 2 or more individuals living in the household (Newman, Tumin, Andridge, & Anderson, 2015). A population-based study involving adolescents reported that the percentage consuming shared family meals was lower among lower socioeconomic status (SES) groups (Neumark-Sztainer et al., 2013). The share of US households’ food budgets spent on food away from home was greater than 50% in 2017 (Saksena et al., 2018). NHANES data from 2003-2006 showed that the contribution of snacking to total energy intake among 7-12 and 13-18 year olds was 26% and 27%, respectively (Piernas & Popkin, 2010). Collectively, these factors may contribute to a greater number of independent eating occasions for early adolescents and a greater likelihood of overweight and obesity.
The contribution to energy intake and overall diet quality from foods and beverages consumed during independent eating occasions among early adolescents is not well established. In addition, the distribution of independent eating occasions between meal versus snack occasions is not known. In general, children in the US consumed food more frequently throughout the day and more at each occasion than 30 years ago (Popkin & Duffey, 2010); a rise that paralleled the rise in obesity and increases in portion sizes (Piernas & Popkin, 2011). More frequent eating occasions may be an indication of more frequent snacking occasions. Data from girls in the 10-year National Heart, Lung, and Blood Institute Growth and Health Study showed that snack eating frequency through adolescence was about 1-1.1 snacks per day. Snacking occasions likely include foods that have been shown to be high energy-dense including desserts, salty snacks (chips and crackers) and candy, based on NHANES 2003-2006 data from older children and adolescents (Piernas & Popkin, 2010).
The influence of particular parenting practices during independent eating occasions among early adolescents is not known. A review of studies examining associations between parenting practices and child snacking showed that restriction and home availability were associated with child snack intake, whereas studies involving pressure to eat, monitoring and modeling were limited and yielded inconsistent findings (Blaine, Kachurak, Davison, Klabunde, & Fisher, 2017). Parenting that fosters autonomous or intrinsic motivation in youth is of particular interest when considering early adolescent unsupervised eating behaviors. Autonomy-supportive parenting includes providing a clear rationale for the desired behavior, providing choice, and avoiding using pressured or coercive language (Ryan & Deci, 2000). Autonomy supportive parenting has been shown to lead to increased intrinsic motivation, greater receptivity to parent influence (Grolnick, 2003), increased perceived behavioral control, and increased frequency of FV intake (Dwyer et al., 2017; Girelli, Hagger, Mallia, & Lucidi, 2016; Parks et al., 2018) among adolescents.
Importance of the work and consequences if the proposed work is not done
Only a few studies have examined the frequency of independent eating occasions and eating behaviors of adolescents during these occasions. These studies have shown that more frequent independent eating occasions have a negative association with dietary intake and weight status among adolescents. For example, in a nationwide sample of U.S. adolescents (12-17 years) based on the Family Life, Activity, Sun, Health and Eating (FLASHE) Study data, eating alone was associated with greater intake of junk food and sugary beverages, lower home availability of fruits and vegetables, lower perceived parent support, and overweight/obesity (Reicks et al., 2019). A Japanese study reported that eating dinner alone was associated with overweight in adolescent girls but not boys (Shirasawa et al., 2018). In addition, little is known about how food-related parental practices influence early adolescent intake during independent eating occasions, especially among low-income, multiethnic early adolescents. A better understanding of the extent to which parenting practices influence food choice and eating behaviors of early adolescents during independent eating occasions is necessary to inform the development of interventions to promote positive parenting practices that may assist in obesity prevention.
An appropriate, validated instrument did not exist to identify associations between parenting practices and eating behaviors of early adolescents during independent eating occasions. Therefore, the W-3003 Multistate project conducted individual interviews with 51 early adolescents (10-13 years) and their parents to identify parenting practices and explore their influence on eating behaviors during independent eating occasions. The W-3003 project team used the interview results to develop survey items for parents and early adolescents, followed by cognitive testing to refine survey items and testing for reliability and validity using an online panel. In Objective 1 of the W-4003 project, these surveys will be administered to a larger online panel of parent/early adolescent (11-14 years) dyads to identify associations between parenting practices and food and beverage choices, eating behaviors, and weight with attention to intake during independent eating occasions.
Results from Objective 1 will provide a broad understanding of the influence of parenting practices on obesogenic behaviors of early adolescents during independent eating occasions. These findings will be used to develop digital communications for parents and early adolescents to enable healthy food choices during independent eating occasions among early adolescents (Objective 2). For Objective 3, the digital communications will be implemented and tested for effectiveness in a pilot intervention to promote positive parenting practices and improve early adolescent dietary intake during independent eating occasions. For Objective 4, a grant proposal will be developed to implement a full-scale intervention based on pilot test results. The intervention aim will be to determine how parents can influence early adolescents’ eating behaviors when the parent is not present to shape healthful food intake and prevent obesity. If the proposed work for W-4003 is not done, the goal of providing parents of early adolescent children with strategies that lead to positive parenting practices that promote healthier eating among early adolescents during independent eating occasions will not be achieved. In addition, the risk of adverse consequences of overweight and obesity will not be reduced with respect to health, psychosocial, and economical issues for early adolescents in the near future.
The technical feasibility of the work
Research team members for the W-4003 project have successfully collaborated on two or more Agricultural Experiment Station (AES) funded multistate projects (W-1003, W-2003 and W-3003) to study influences of parenting practices on parent and early adolescent dietary behaviors. The team has previously developed, tested and implemented survey instruments involving parent/early adolescent dyads across 10-12 states to identify calcium rich food and beverage (CRF/B) related parenting practices associated with CRF/B intake among early adolescents. The diversity of expertise has functioned well for this team in the past and is expected to contribute to the feasibility of developing and pilot testing digital communications for parent/early adolescent dyads regarding parenting practices that influence eating behavior of early adolescents during independent eating occasions. For example, within their own institutions team members have conducted interventions with parent/early adolescent dyads involving in-person cooking interventions (Overcash et al., 2018; Rogers et al., 2017), meal planning using meal calendar websites (Jones, 2018; Jones, Evich, & Gaskins, 2017), and experiential learning in a virtual world environment (Meng, Wong, Manore, & Patton-Lopez, 2018). This multistate team has completed previous studies and published results supporting successful collaborative projects in which all researchers were involved. These studies were based on interview, focus group, nominal group process and other qualitative approaches (Edlefsen et al., 2008; Cluskey et al., 2008; Richards et al., 2014), as well as quantitative approaches surveying large samples of parent/early adolescent dyads (Vyduna et al. 2016; Reicks et al. 2011; Reicks et al., 2012; Cluskey et al., 2015; Banna et al., 2019). The team includes nutrition researchers and Cooperative Extension Nutrition Specialists, as well as a marriage and family therapy researcher and a developmental/health psychologist, who all work together to provide expertise from a family social science perspective.
Advantages for doing the work as a multistate effort
This project has several advantages for being implemented as an AES multistate project. This particular research group has 12 participants in 9 states and the District of Columbia. Researchers have positions as faculty with research experience in community nutrition, eating behavior, and family dynamics including parent-child relationships. Several have appointments within Extension, which provides opportunities for broad access to potential participants. Researchers represent a cross-section of geographic areas within the U.S. with opportunities for reaching low-income, multiethnic groups from which the project can explore, focus and tailor behavior change strategies. Finally, this group has 13+ years of experience working together to conduct collaborative investigations reaching a large number of participants. Researchers understand how to successfully assure that all researchers follow an identical protocol and have been successful with this approach in previous multistate projects, W-1003, W-2003, and W-3003.
Likely impacts from successfully completing the work
Parenting practices influence early adolescent’s eating behaviors and therefore play an essential role in preventing obesity. Little information is available regarding how parenting practices influence early adolescents’ eating behaviors during independent eating occasions. The proposed W-4003 project is expected to result in the identification of food-related parenting practices associated with healthful dietary intake during independent eating occasions and healthy weight status among low-income, multiethnic early adolescents from both a parent and child perspective (Objective 1). Identifying associations between positive parenting practices and obesogenic behaviors will provide a rationale for the development of digital communications that encourage the use of those parenting practices (Objective 2). An intervention will be developed and pilot-tested to determine the effectiveness of the digital communications to impact obesogenic energy-dense and low-nutrient dense food choices and unhealthy eating behaviors of early adolescents during independent eating occasions (Objective 3). A grant proposal to take the intervention full-scale will be developed based on the results of the pilot test (Objective 4). The ability to build on findings from previous multistate projects (W-1003, W-2003, and W-3003) will allow the team to encourage parenting practices that result in early adolescents choosing healthy foods during independent eating occasions thereby addressing the need to improve diet quality and prevent obesity.