Parental influences on children's diets

Parental influences on children's dairy products consumption: a narrative review

OBJECTIVE

To review research on the influence of parent-related factors on children's dairy products consumption.

DESIGN

A search of electronic databases and a narrative synthesis of the literature were conducted. English-language articles were included if they reported data relating to parental influences on children's consumption of dairy products and if statistical significance was reported.

SETTING

Studies were carried out in the USA (n 8) and in a range of countries across Europe (n 12) and Asia (n 5).

PARTICIPANTS

The subjects of this research were children aged between 2 and 12 years of age, from a range of geographical locations.

RESULTS

Twenty-five studies met the inclusion criteria. The studies examined children's dairy products consumption in relation to parental socio-economic status (education level and income) (n 12), home availability (n 2), home food environment (n 3), parental dairy products consumption (n 4), parent feeding practices (n 3), parents' beliefs and attitudes (n 3) and parental nutrition knowledge (n 3). Results on the association between socio-economic status and children's dairy products consumption varied; however, studies reporting a significant association generally observed a positive relationship. Fifteen studies reported children's total dairy products intake as an outcome measure, with the remaining studies reporting intake of milk or other dairy products as individual foods.

CONCLUSIONS

This review identified literature exploring a range of parental factors in relation to children's dairy products intake. However, there were limited numbers of studies published within each category of modifiable factors. Further research on the parent-related determinants of dairy products consumption in children is required in order to identify potential intervention targets in this age group.

Family and Cultural Perceptions About Meat Consumption among Hispanic/Latino and White Adults in the United States

The study examines the extent to which Hispanic/Latino Americans and non-Hispanic White Americans report that meat is an important aspect of their cultural beliefs and practices. An online national survey was completed using quota sampling to recruit approximately equal groups of U.S. Hispanic/Latino and non-Hispanic White Americans (n = 512). A path model predicting willingness to reduce meat consumption was estimated. Hispanic/Latino Americans viewed meat as a more integral aspect of their cultural food practices, and reported that meat dishes comprise a higher percentage of their culture's traditional foods. Cultural beliefs were associated with meat consumption and willingness to reduce meat consumption.

Implementing family-based behavioral treatment in the pediatric primary care setting: Design of the PLAN study

Family-based behavioral treatment (FBT) is an evidence-based treatment for pediatric obesity. FBT has primarily been implemented in specialty clinics, with highly trained interventionists. The goal of this study is to assess effectiveness of FBT implemented in pediatric primary care settings using newly trained interventionists who might implement FBT in pediatric practices. The goal is to randomize 528 families with a child with overweight/obesity (≥85th BMI percentile) and parent with overweight/obesity (BMI ≥ 25) across four sites (Buffalo and Rochester, New York; Columbus, Ohio; St. Louis, Missouri) to FBT or usual care and obtain assessments at 6-month intervals over 24 months of treatment. FBT is implemented using a mastery model, which provides quantity of treatment tailored to family progress and following the United States Preventive Services Task Force recommendations for effective dose and duration of treatment. The primary outcome of the trial is change in relative weight for children, and secondarily, for parents and siblings who are overweight/obese. Between group differences in the tendency to prefer small immediate rewards over larger, delayed rewards (delay discounting) and how this is related to treatment outcome is also evaluated. Challenges in translation of group-based interventions to individualized treatments in primary care settings, and in study implementation that arose due to the COVID-19 pandemic are discussed. It is hypothesized that the FBT intervention will be associated with better changes in relative weight for children, parents, and siblings than usual care. The results of this study can inform future dissemination and implementation of FBT into primary care settings.

Public Views of Dairy Calf Welfare and Dairy Consumption Habits of American Youth and Adults

The primary objective of this study was to explore views of dairy calf welfare and dairy product consumption habits among youth and adults. The secondary objective was to explore views of dairy calf welfare and dairy product consumption habits among a subset of parent-child pairs. Participants 5–17 years of age (n = 463) and 18 years old or greater (n = 1,310) completed an in-person survey at the Minnesota State Fair (St. Paul, MN, USA) in summer 2018. A subset of these data was comprised of parent-child pairs (n = 188). The survey was administered via Qualtrics using iPads and included multiple-choice questions about demographics and calf welfare, an open-ended question on “what dairy calves need to have a good life,” and multiple-choice questions about participants' consumption of dairy products and nondairy alternative products. Content analysis was used for responses to the open-ended question, and concepts to describe dairy calf welfare views were identified. Fisher's exact test and Cohen's Kappa were used to investigate the relationships between parent-child pair responses about dairy calf welfare. In addition to these methods, prevalence-adjusted and bias-adjusted kappa (PABAK) were used to investigate the relationships between parent-child pair responses about consumption habits. The median age of all youth participants was 11 years and 61% were female, 82% were urban residents, and 63% did not have prior experience handling agricultural animals but 83% had visited a farm in the past. Most youth participants (94.4%) indicated that they consumed dairy products, while 47.1% consumed nondairy alternatives products. Median age range of all adult participants was 45–54 years, 65% were female, 82% urban residents, and 81% did not have prior experience handling agricultural animals but 63% had visited a farm in the past. Most adult participants (94%) indicated that they consumed dairy products and 47% indicated that they consumed nondairy alternative products. In response to “what dairy calves need to have a good life,” youth and adults most commonly focused on issues related to biological functioning (82 and 70% of youth and adults mentioning this concept, respectively), followed by natural living (44 and 50%, respectively), humane care (30 and 20%, respectively), and affective states (5% of both youth and adults). For the natural living concept of animal welfare, parent and child responses were slightly associated (Kappa = 0.19; P = 0.01; overall agreement = 61%). Almost all participants reported consuming dairy products, therefore, the agreement is high between parents and children because in most households (90%), both parents and children consume dairy products. However, child consumption was observed to be lower (75%, 9/12) when parents do not consume dairy than when parents do consume dairy (95%, 167/176), leading to a Kappa of 0.20 (P = 0.006, PABAK = 0.81) and a slight association between parents and children. The results suggest that biological functioning is highly valued by the public and views of parents and their children related to natural living in dairy calves are slightly associated.

Optimising Repeated Exposure: Determining Optimal Stimulus Shape for Introducing a Novel Vegetable among Children

Although it is well evident that a healthy diet rich in fruit and vegetables could prevent a number of major chronic diseases, national and international guidelines concerning their intake are not being reached by a large percentage of the population, including children. Thus, it is of interest to investigate how the consumption of this food group by children could be increased. The aim of this study was to examine the impact of serving style on the consumption of a raw snack vegetable (daikon) and the influence of its exposure on liking and intake of the vegetable. A group of 185 children 3–5 years old participated in the study. Two kindergartens served as intervention groups, while the third was assigned to be the control group of the study (n = 50). The intervention groups were repeatedly exposed to one of three different serving styles of daikon: sticks (n = 42), triangles (n = 46) or grated (n = 47), and they were all visited 7 times during the exposure period, on the same frequency (twice per week). Familiarity and liking of the target vegetable, daikon, and six other vegetables (cucumber, celery, celeriac, broccoli, cauliflower and beetroot) were measured at baseline, post-intervention and two follow up sessions (3- and 6-month) to investigate the likelihood of generalisation effects. Intake of daikon was measured at all control sessions and exposures. Moreover, children were asked to rank their favourite serving style of daikon and beetroot, among triangle, stick and grated, towards understanding the influence of shape on the efficacy of the exposure. The results revealed significant changes between liking and intake of daikon for the groups of triangles and sticks and the control group (p < 0.05). The group that received grated daikon did not show significant differences in liking and at intake levels during the exposures but performed well in the long-term. Throughout the exposure period, intake levels followed an overall increasing pattern, with all the groups to demonstrate a decrease of their intake at the last session, which was not found significant for the triangle group. Mere exposure was efficient towards increasing liking and intake of the novel vegetable with all the shapes to deliver positive results, but based on this study no particular serving style can be recommended.

Free Sugar Consumption and Obesity in European Adolescents: The HELENA Study

Few studies have evaluated the association between dietary free sugars intake (FSI) and obesity in adolescents. We examined the relation between FSI and their contributors from the main food groups and obesity in European adolescents. We included 843 adolescents (51.6% male) from the cross-sectional HELENA study with two completed 24 h recalls and anthropometric data. Linear mixed models were applied to investigate the relation between FSI and different anthropometric indices. Odds ratios for having a high body mass index (BMI) were also estimated by multilevel ordinal regression. Total FSI was higher in males than females (102.60 g and 87.58 g, respectively, p < 0.001). No effect was observed between free sugar from the main food groups and BMI. Consumers of FSI from "cakes, pies and biscuits" in males (odd ratio (OR) = 0.455; 95% Confidence interval (CI) 0.251, 0.824) and from "breakfast cereals" in females had a lower probability of having obesity (OR = 0.423; 95%CI 0.204, 0.878), whereas females consuming FSI from 'fruit and vegetables juices' had a higher probability of obesity (OR= 2.733; 95% CI 1.286, 5.810). This study provides no evidence that increased FSI is associated with obesity in adolescents. Further studies are needed to assess the longitudinal exposure to FSI and their effect on obesity development.

Improving Willingness to Try Fruits and Vegetables Among Low-Income Children Through Use of Characters

Purpose: Low-income children are disproportionately affected by high rates of food insecurity and obesity, placing them at risk for poor health outcomes. Diets that are rich in fruits and vegetables (FV) are associated with health benefits such as reducing the risk of obesity. Despite these benefits, American children do not consume nationally recommended amounts of fruits (63%) and vegetables (90%) per day. Data reveal that young children exhibit increased food neophobia toward vegetables. One way to decrease food neophobia is to introduce FV to young children via recipe tasting. The purpose of the study was to increase willingness to try FV among low-income children using live characters at Summer Food Service Program Sites.

Methods: The study design was a small-scale pilot study to conduct taste tests of recipes with 125 low-income children. Researchers created recipe-tasting stations at two different sites. At Site 1, characters promoting FV characters were present at the recipe-tasting station. At Site 2, researchers presented recipes without characters being present. Taste tests were conducted once per week for a period of 4 weeks using two previously validated instruments, Taste Test Tool and the Taste and Rate Questionnaire.

Results: Results demonstrated that introducing FV recipes with characters showed a trend toward increasing willingness to try FV among low-income children. Data also suggested that low-income children had limited exposure to specific FV before recipe tastings.

Conclusion: The use of characters is a promising approach to increase willingness to try FV among low-income children.

Association of parental guilt with harmful versus healthful eating and feeding from a virtual reality buffet

OBJECTIVE

Parents often report guilt about what they feed their child, but no studies have examined how this guilt might affect their child-feeding or own eating behavior. Some studies suggest that guilt motivates healthy behaviors, yet others show that guilt impairs the self-control needed to abstain from unhealthy behaviors.

METHOD

One hundred ninety parents reported how guilty they felt about their current child-feeding habits. Parents then chose food for their child in a virtual reality buffet and reported their intentions to improve child-feeding and own eating behavior in the future. Finally, parents were offered candy while they completed an unrelated survey.

RESULTS

Parents with greater guilt reported stronger intentions to improve both feeding (b = .27, p = .010) and eating (b = .21, p = .019) in the future. However, among parents with higher (but not lower) BMI, those who reported greater guilt served more unhealthy foods for their child in the buffet (b = .32, p = .010) and were more likely to eat candy at the end of the study (b = .92, p = .004). Further analyses revealed that guilt only predicted greater feeding intentions when parents had served relatively more unhealthy foods in the buffet (b = .43, p < .001).

CONCLUSIONS

Findings echo the mixed conceptualization of guilt shown in previous literature on health behavior. More research is necessary to understand the long-term influence of guilt on eating and feeding behavior and the circumstances under which guilt is associated with detrimental versus healthy behavior. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Food literacy predictors and associations with physical and emergent literacy in pre-schoolers: results from the Training-to-Health Project

OBJECTIVE

Food literacy (FL) is a crucial need encompassing basic literacy and fundamental movement skills. The present study aimed to investigate the FL level in pre-schoolers and to evaluate the effect of potential predictors and the associations with gross motor and emergent literacy skills.

DESIGN

Cross-sectional study conducted within the Training-to-Health Project.

SETTING

Kindergartens (n 21) in the Palermo City Council, Italy.

PARTICIPANTS

Pre-school children aged 3-6 years (n 921) followed education sessions on nutritional topics, practical activities and compiled prearranged sheets. FL was assessed by the five-domain toolkit 'preschool-FLAT'; gross motor and emergent literacy skills were assessed by the Italian version of the gross motor development test and the PRCR-2/2009, respectively. Correlation and regression analyses were performed to assess relationships between FL scores and gender, age, weight, height, BMI, gross motor and emergent literacy skills.

RESULTS

Independent predictors (β, se) of higher FL were female gender (1·06, 0·315, P < 0·01), older age (0·08, 0·019, P < 0·001) and greater height (0·13, 0·03, P < 0·001). The adjusted coefficients were significant for quotient of gross motor development and in particular for the locomotor component (0·03, 0·01, P < 0·01 and 0·16, 0·046, P < 0·001, respectively). Almost all associations with the emergent literacy skills were significant (β = -0·02 to 0·47).

CONCLUSIONS

The study suggests that children raised in an environment where both cognitive and motor skills are enhanced can have better chances of increasing FL and success at school. Thus, the need for monitoring FL and its predictors since early age is highlighted.

Determinants of a dietary pattern linked with greater metabolic risk and its tracking during adolescence

BACKGROUND

Although growing evidence suggests that dietary patterns associated with noncommunicable diseases in adulthood may develop early in life, when these are established, as well as their determinants, remains unclear.

METHODS

We examined determinants and tracking of a dietary pattern (DP) associated with metabolic risk and its key food groups among 860 adolescents in the Western Australian Pregnancy (Raine) Cohort study. Food intake was reported using a food frequency questionnaire (FFQ) at 14 and 17 years. Z-scores for an 'energy-dense, high-fat, low-fibre' DP were estimated by applying reduced rank regression at both ages. Tracking was based on the predictive value (PV) of remaining in the DPZ-score or food intake quartile at 14 and 17 years. Early-life exposures included: maternal age; maternal pre-pregnancy body mass index; parent smoking status during pregnancy; and parent socio-economic position (SEP) at 14 and 17 years. Associations between the DPZ-scores, early-life factors and SEP were analysed using regression analysis.

RESULTS

Dietary tracking was strongest among boys with high DPZ-scores, high intakes of processed meat, low-fibre bread, crisps and savoury snacks (PV > 1) and the lowest intakes of vegetables, fruit and legumes. Lower maternal education (β = 0.09, P = 0.002 at 14 years; β = 0.14, P < 0.001 at 17 years) and lower maternal age at birth (β = 0.09, P = 0.003 at 14 years; β = 0.11, P = 0.004 at 17 years) were positively associated with higher DPZ-scores.

CONCLUSIONS

An energy-dense, high-fat, low-fibre dietary pattern tracks more strongly among adolescent boys who have high scores for this pattern at 14 years of age. These findings highlight target foods and population subgroups for early interventions aiming to improve dietary behaviours.

Associations between selected dietary behaviours and academic achievement: A study of Australian school aged children

BACKGROUND

Research investigating the effects of dietary behaviours on children's academic achievement has predominately focused on breakfast consumption. The aim of this study was to conduct secondary analysis to examine associations between a range of dietary behaviours and children's academic achievement.

METHODOLOGY

Data on five dietary variables (fruit intake; vegetable intake; consumption of takeaway; sugar sweetened beverages; and breakfast) and scores in the five domains of a standardised academic achievement test known as NAPLAN (reading, writing, grammar/punctuation, spelling and numeracy) were obtained for Australian children aged 8-15 years in school grades three (n = 1185), five (n = 1147), seven (n = 1053) and nine (n = 860). Mixed linear models adjusted for socioeconomic status and gender were used to examine associations between dietary behaviours and academic scores.

RESULTS

Greater consumption of vegetables with the evening meal (7 nights/week) was associated with higher test scores in the domains of spelling and writing (p=<0.01), with the greatest effect observed for spelling with a mean score difference of 86 ± 26.5 NAPLAN points between the highest and lowest levels of consumption (95% CI: 34.0-138.1; p=<0.01). Increased consumption of sugar sweetened beverages was associated with significantly lower test scores in reading, writing, grammar/punctuation and numeracy (<0.01).

PRINCIPLE CONCLUSIONS

The findings of this study demonstrate dietary behaviours are associated with higher academic achievement. Future research should further explore relationships between a wide range of dietary behaviours and children's academic achievement.

A Parental Health Education Model of Children's Food Consumption: Influence on Children's Attitudes, Intention, and Consumption of Healthy and Unhealthy Foods

This study proposes that parental mediation of television advertising and parental guidance of food consumption differentially influence children's attitude, intention, and behavior toward the consumption of healthy and unhealthy foods. Structural equation modeling based on a survey of 1,119 children aged 9-12 supported our model, revealing that parental education strategies influence children's food consumption in a complex manner that is highly context-dependent. Parental guidance of food consumption enhanced children's healthy food attitude and intention to consume, while reducing the intention to consume unhealthy food. However, parental mediation of television advertising influenced unhealthy food attitude to a greater extent than healthy food attitude. Implications for health promotion and education, as well as parents and policy makers are discussed.

Motivational theater to increase consumption of vegetable dishes by preschool children

Background

By 3 years of age, many children have developed a dislike for certain foods, particularly vegetables. Seventy-five percent of young children consume less than the recommended levels for vegetables. The objective of this randomized feasibility intervention was to demonstrate the impact of an innovative approach to increase consumption of vegetable dishes by minority preschool children attending Head Start. The specific aims included the collection of data to assess feasibility and efficacy of the intervention.

Methods

Both qualitative and quantitative assessments were conducted. Qualitative data was used for development of the intervention and for program feedback at post assessments. Two hundred fifty-three preschool children (49% boys; 66% Hispanics and 34% African-Americans; mean age 4.4 years) were randomized either to the intervention (n = 128) or the control group (n = 125). The teacher/parent intervention group showed the children videotaped (DVD) puppet shows. Based on the theoretical framework “transportation into a narrative world”, three professionally developed characters, unique storylines and an engaging, repetitious song were incorporated in four 20-min DVD puppet shows. Prior to lunch each show was shown for five consecutive days in school and a minimum of once in the home. Digital photography was used in school to assess consumption of vegetable dishes at the lunch meal (quantitative assessment). At home parents were asked to complete the booklet questions corresponding to each DVD; questions could be answered correctly only if parents watched the DVD with their child. A multilevel mixed-effect model was used to analyze the data, adjusting for age, gender, and ethnicity.

Results

Children in the intervention group significantly (p < 0.0001) increased consumption of vegetable dishes from baseline to follow-up compared to no change in the control group. At follow-up, the intervention group continued to have significantly (p = 0.022) higher intake of vegetable dishes compared to the control group. Sixty percent of the mothers completed the booklet’s questions with 76 to 98% correct responses.

Conclusion

Using theory-based motivational theater with multiple exposures may be an effective behavioral intervention to increase consumption of vegetable dishes by preschool children that can be easily disseminated to a large sample.

Trial Registration

ClinicalTrials.gov; Identifier: NCT02216968

Food group and micronutrient intake adequacy among children, adults and elderly women in Greece

The aim of the present study was to record the percentage of children, adults and elderly women in Greece meeting food and micronutrient intake recommendations. Additionally, the present study was aiming to identify the main food contributors of micronutrient intakes and assess the degree up to which meeting food intake recommendations also ensures micronutrient intake adequacy. Dietary intake data from three studies conducted in Greece (on 9-13-year-old children; 40-60-year-old adults; and 50-75-year-old women) were used to estimate mean intakes, the percentages of subjects meeting food and nutrient intake recommendations and the contribution of six core food groups to nutrient intake adequacy. The present study showed that more than 50% of children, adults and elderly women were failing to consume the recommended portions of vegetables, dairy and grains. Furthermore, children and adults consuming the recommended portions of individual core food groups had significantly lower percentages of inadequate micronutrient intakes compared to their counterparts not meeting food intake recommendations (p < 0.05). Nevertheless, even among those consuming the recommended portions from a specific core food group, the recommended intake of the corresponding micronutrient (for which this food group is the main contributor) was not always met. Indicatively, 18.2%-44.1% and 4.2%-7.0% of the populations under study were not meeting calcium and vitamin C intake recommendations, although they were consuming the recommended portions of dairy and fruits, respectively. In conclusion, these findings highlight the importance for public health policy makers to take all necessary initiatives to support the population in achieving the recommended intakes from all core food groups, but also emphasize on food variety to ensure adequate intake for all micronutrients.

Drivers of overweight mothers' food choice behaviors depend on child gender

BACKGROUND

National data suggest a higher prevalence of obesity among boys. One possible cause could be the food choices made by parents on behalf of their children.

OBJECTIVES

This study sought to determine whether and how mothers' food choices for their children differ by child gender and to understand the drivers of these differences.

DESIGN

Data were analyzed from a randomized controlled trial conducted using a virtual reality-based buffet restaurant. Overweight mothers filled out questionnaires and received an information module. They were then immersed in a virtual buffet restaurant to select a lunch for their 4- to 5-year-old child.

RESULTS

Of the 221 overweight mothers recruited, 55% identified their daughters as the child for whom they would be choosing the food. The caloric content of boys' meals was 43 calories higher than girls' (p = .015). This difference was due to extra calories from the less healthy food category (p = .04). Multivariate analyses identified more predictors of calorie choices for daughters' than sons' meals. Predictors of calories chosen for girls included: having both biological parents overweight (β = 0.26; p = .003), mother's weight (β = 0.17; p = .05), mother's education (β = -0.28; p = .001), her restriction of her child's food intake (β = -0.20; p = .02), and her beliefs about the importance of genetics in causing obesity (β = 0.19; p = .03). Mother's weight was the sole predictor of boys' meal calories (β = 0.20; p = .04).

CONCLUSIONS

Differences in dietary choices made for young girls and boys may contribute to lifelong gender differences in eating patterns. A better understanding of differences in feeding choices made for girls versus boys could improve the design of childhood obesity prevention interventions.

Hispanic Caregiver Perceptions of Water Intake Recommendations for Young Children and Their Current Beverage Feeding Practices

Hispanic children in the United States are at high risk of obesity. Sugar-sweetened beverage consumption (SSB) is a modifiable contributor to obesity. Hispanic children are more likely to drink SSB than non-Hispanic white children. The main goal of the study was to explore caregiver beverage feeding behaviors and evaluate reactions to water intake recommendations for children birth to five years old in a diverse U.S. Hispanic urban community. Findings will be used to develop community- and population-specific intervention messaging for obesity prevention for this population. The study used a qualitative focus group design using constant comparison coding methods. Participants included 35 Hispanic caregivers of children aged 0–5 years living in a low-income, predominantly Hispanic community in Chicago, Illinois. We found young children in this community drink a variety of SSBs and caregivers choose beverages based on cost, availability, health, and behavioral concerns. Participants report altering beverages for a variety of reasons, family member disagreement regarding beverage feeding practices, and older family members’ influence on children’s preferences. Puerto Rican and Mexican American participants differed in the range of beverages provided, concerns regarding water intake, and beverage alteration and feeding practices. Caregivers universally believe the recommended water intake amount of four six-ounce servings daily for children is too high. Findings will inform message development to reduce SSB intake and increase water consumption among young children in this community. Messaging should be ethnic group specific, target all family members, build on current beverage alteration practices, and include nutrition information specific to young children.

A narrative literature review of the development of obesity in infancy and childhood

This narrative review explains the development of excess weight gain in babies and children. It takes a life course approach which includes genetics, pre-conception, pregnancy, infancy and childhood. The paper focuses on feeding behaviours, physical activity, parental influences and the wider social and environmental context. Risk factors which can cumulatively lead to excess childhood weight gain include: under- or overweight during pregnancy; the presence of diabetes during pregnancy; low or high birth weight; having obese parents; early weaning; prolonged formula feeding; rapid weight gain in the first year; disinhibited eating patterns and the consistent availability of energy dense food at home; feeding practices which are not responsive to the child's cues; insufficient sleep among preschool children; sedentary parents; low parental education; living in poor socio-economic circumstances; absence, or perceived absence, of safe play areas; parents who lack time or confidence to authoritatively parent; environments where there is poor access to affordable lower energy dense foods; and parents who do not accept that excess weight is a health problem. Recommendations for health professionals are made.

Development of the Parental Modelling of Eating Behaviours Scale (PARM): links with food intake among children and their mothers

This study aimed to develop a self-report questionnaire to explore parental modelling of eating behaviours and then to use the newly developed measure to investigate associations between parental modelling with healthy and unhealthy food intake in both mothers and their children. Mothers (n = 484) with a child aged between 18 months and 8 years completed the Parental Modelling of Eating Behaviours Scale (PARM), a new, self-report measure of modelling, as well as a food frequency questionnaire. Principal components analysis of the PARM identified 15 items grouped into three subscales: verbal modelling (modelling through verbal communication); unintentional modelling (UM) (children adopting eating behaviours that parents had not actively modelled); and behavioural consequences (children's eating behaviours directly associated with parental modelling). The PARM subscales were found to be differentially related to food intake. Maternally perceived consequences of behavioural modelling were related to increased fruit and vegetable intake in both mothers and children. UM was related to higher levels of savoury snack intake in both mothers and their children. This study has highlighted three distinct aspects of parental modelling of eating behaviours. The findings suggest that mothers may intentionally model healthy food intake while unintentionally acting as role models for their children's less healthy, snack food intake.

Familial intergenerational and maternal aggregation patterns in nutrient intakes in the Lifeways Cross-Generation Cohort Study

OBJECTIVE

The current study prospectively examines the intra-uterine hypothesis by comparing maternal, paternal and grandparental lineage influences on children’s diet and also maternal–child aggregation patterns during pregnancy and early childhood.

DESIGN

Prenatal dietary information was available for expectant mothers, fathers and up to four grandparents through a detailed validated semi-quantitative FFQ. At 6-year follow-up, when children averaged 5 years of age, dietary information was re-collected for mothers and a subset of maternal grandmothers using the same FFQ. Child’s FFQ version was used for children. Anthropometric and sociodemographic variables were also collected.

SETTINGS

Three-generation familial cohort representative of the contemporary Irish national population.

SUBJECTS

Children aged 5 years (n 567) and their parents and grandparents.

RESULTS

Associations for energy, macronutrient and fibre intakes were compared using Pearson’s correlations, intra-class correlations (ICC) and linear regression models, adjusted for energy and potential confounders. Significant, moderatestrength positive correlations were observed for nutrient intakes in children’s nuclear families (ICC (range)50?22–0?28). The father–child associations (r (range)5 0?13–0?20) were weaker than the mother–child associations (r (range)50?14–0?33). In general, associations were stronger for maternal postnatal intake–child intake than for maternal prenatal intake–child intake, except for percentage of energy from fat (adjusted b50?16, 95% CI 0?05, 0?26; P50?004), which was stronger for maternal prenatal intake, specifically in non-breast-fed children (adjusted b50?28, 95% CI 0?12, 0?44; P50?001). Among all grandparents, correlations were significant only for maternal grandmother–mother pairs (r (range)50?10–0?36). Significant positive ICC were observed for nutrient intakes of maternal grandmother–mother–child triads (ICC (range)50?12–0?27), not found in paternal lines.

CONCLUSIONS

These findings suggest that maternal-environment programming influences dietary intake.

Development of eating behavior: biology and context

Eating is necessary for survival, gives great pleasure, and can be perturbed leading to undernutrition, overnutrition, and eating disorders. The development of feeding in humans relies on complex interplay between homeostatic mechanisms; neural reward systems; and child motor, sensory, and socioemotional capability. Furthermore, parenting, social influences, and the food environment influence the development of eating behavior. The rapid expansion of new knowledge in this field, from basic science to clinical and community-based research, is expected to lead to urgently needed research in support of effective, evidence-based prevention and treatment strategies for undernutrition, overnutrition, and eating disorders in early childhood. Using a biopsychosocial approach, this review covers current knowledge of the development of eating behavior from the brain to the individual child, taking into account important contextual influences.

Parental nutrition knowledge and attitudes as predictors of 5-6-year-old children's healthy food knowledge

OBJECTIVE

Young children's knowledge about healthy food may influence the formation of their eating behaviours, and parents have a major influence on the development of children's knowledge in the early years.

DESIGN

We investigated the extent to which parental nutrition knowledge and attitudes around food predicted young children's knowledge of healthy foods, controlling for other influences such as socio-economic status (SES) and parent education levels in a cross-sectional research design. Children were given a healthy food knowledge activity and parents completed questionnaires.

SETTING

Twenty primary schools in Adelaide, Australia, stratified by SES.

SUBJECTS

We recruited 192 children aged 5-6 years and their parents.

RESULTS

Structural equation modelling showed that parent nutrition knowledge predicted children's nutrition knowledge (r = 0·30, P < 0·001) independently of attitudes, SES and education level.

CONCLUSIONS

Nutrition education for parents, targeted at low-SES areas at higher risk for obesity, may contribute to the development of healthy food knowledge in young children.

Is maternal education level associated with diet in 10-year-old children?

OBJECTIVE

To examine the associations between maternal education level and diet in 10-year-old children.

DESIGN

Three-day diet diaries (child completed with parental help) were collected. Height and weight were measured in research clinics. Maternal education level was derived from a questionnaire completed during pregnancy and classified into low, medium or high. One-way ANOVA was undertaken to compare maternal education groups for nutrient intakes and the Kruskal-Wallis test used for food consumption.

SETTING

Avon Longitudinal Study of Parents and Children (ALSPAC), Bristol, UK.

SUBJECTS

Children (n 7474) who provided dietary data at age 10 years.

RESULTS

A large proportion (60 %) of the sample was classified as plausible reporters, with under-reporting accounting for 36 %. No clear differences were found for intakes of energy or macronutrients between maternal education groups for plausible reporters. However, there were marked differences in micronutrient intakes especially for vitamin C, retinol equivalents and folate, highlighting lower diet quality with lower maternal education level. Intakes of fruit and vegetables showed a positive gradient with increasing maternal education (57 % v. 79 % consumed fresh fruit in low and high educational groups, respectively). A trend towards higher intake in the lower educated group was shown for less healthy foods (meat pies P < 0·001; sausages, burgers and kebabs P < 0·001).

CONCLUSIONS

The quality of children's diet at 10 years was related to maternal education level. Lower maternal education was associated with less healthy food choices that could be detrimental to health. Further research is needed to establish if these associations can be explained by other socio-economic factors.

A tool for assessing healthy food knowledge in 5–6-year-old Australian children

Objective

In the early years of life, influential attributes are formed and may be difficult to change later in life. Early childhood is now recognised as a key target in the prevention of overweight and obesity, and the knowledge that children gain at this time about food and its health benefits may have an important influence on their dietary choices and preferences in later life. Therefore, an activity was designed using age-appropriate methods to assess nutrition knowledge of young children.

Design

The Healthy Food Knowledge Activity was developed using a list of thirty healthy and unhealthy foods and drinks generated from the Australian Guide to Healthy Eating.

Setting

The activity was conducted with individual children from reception classes of South Australian schools.

Subjects

Children aged 5–6 years undertook the activity in a pilot study (n 13) and in the main study (n 192).

Results

Pilot data indicated good test–retest reliability of the activity (r = 0·84, P < 0·01). In the main study, there was a good distribution of scores with acceptable skewness and kurtosis statistics. A breakdown of responses indicated good face validity, with more obvious foods being more correctly classified.

Conclusions

Children as young as 5–6 years of age can correctly identify healthy foods, and this can be measured objectively. This activity also provides interesting insights regarding misconceptions about foods that could be attributed to influences such as media advertising and that can be addressed by educators of this age group.

Individual and family environment correlates differ for consumption of core and non-core foods in children

Children's diets contain too few fruits and vegetables and too many foods high in saturated fat. Food intake is affected by multiple individual and family factors, which may differ for core foods (that are important to a healthy diet) and non-core foods (that are eaten more for pleasure than health). Data came from a sample of twins aged 11 years (n 342) and their parents from the Twins Early Development Study. Foods were categorised into two types: core (e.g. cereals, vegetables and dairy) and non-core (e.g. fats, crisps and biscuits). Parents' and children's intake was assessed by an FFQ. Mothers' and children's preference ratings and home availability were assessed for each food type. Parental feeding practices were assessed with the child feeding questionnaire and child television (TV) watching was maternally reported. Physical activity was measured using accelerometers. Correlates of the child's consumption of each food type were examined using a complex samples general linear model adjusted for potential confounders. Children's non-core food intake was associated with more TV watching, higher availability and greater maternal intake of non-core foods. Children's core food intake was associated with higher preferences for core foods and greater maternal intake of core foods. These results suggest that maternal intake influences both food types, while preferences affect intake of core foods but not of non-core foods, and availability and TV exposure were only important for non-core food intake. Cross-sectional studies cannot determine causality, but the present results suggest that different approaches may be needed to change the balance of core and non-core foods in children's diets.

"I'm the Momma": using photo-elicitation to understand matrilineal influence on family food choice

BACKGROUND

Many complex and subtle aspects relating to mothers and food choice are not well understood. Mothers play a primary role in their children's food choices, but research has not specifically examined how matrilineal family members who do not reside in the same household, such as a mother's mother, aunt, or grandmother, influence the current family's food choices.

METHODS

Seven participants were recruited from the Household Food Inventory (HFI) Study in the Bryan/College Station, Texas. All participants completed an in-depth interview, photographed food-related activities, and discussed photographs in a follow-up in-depth interview. Interviews were transcribed verbatim from audio recordings. Transcripts were analyzed using several qualitative approaches including grounded theory to identify themes and subthemes.

RESULTS

Participants discussed the following themes relating to the influence of their mother or other female relation (Mom) on their families' food choices: Relationship with Mom, Just like Mom, 'Kinda' like Mom, Different than Mom, and Mom's Influence on Children's Food Choices. Overall, participants used the photographs to illustrate how they were similar or different to their mothers, or other female family member, as well as how their mothers either supported or undermined control over their children's food choices. The "Mom effect" or matrilineal influence of mothers, aunts, and grandmothers on a mother's food choices was omnipresent, even though Mom was no longer living with the participants.

CONCLUSIONS

We found a matrilineal influence to have a residual and persistent influence on a family's food choices. This finding may be helpful for understanding the contextual elements of food choice and explaining why it is sometimes difficult to change mothers' food habits.

Persistent hyperphagia in acquired brain injury; an observational case study of patients receiving inpatient rehabilitation

BACKGROUND

Morbid hunger or persistent hyperphagia is a relatively rare but potentially life threatening complication of acquired brain injury (ABI).

METHOD

This paper presents findings from an observational case study of patients with hyperphagia receiving inpatient neurobehavioural rehabilitation following their acquired brain injury. The case study has utilized dietetic and medical records of identified patients to confirm the persistent and serious nature of this presentation in order to extract important management principles.

RESULTS

The findings confirmed that hyperphagia or morbid hunger posed potentially life-threatening health risks to the patient, primarily around weight control and fluid balance, and risks of aggression towards professional and family carers. Pharmacological or behaviour modification interventions were only partially successful in management of this presentation. The study identified a high need for environmental and cue exposure control in management of this condition.

Associations between parental concern for adolescent weight and the home food environment and dietary intake

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.

Sex differences among Swedish adolescents in mother–child relationships in the intake of different food groups

The present study has explored mother–child relationships in the intake of different food groups and the sex differences in these relationships. A population-based sample of 471 mother–child pairs from Stockholm completed a dietary questionnaire to assess habitual dietary intake. Girls showed overall stronger correlations with their mothers' diet than boys did. The strongest correlations found, in both girls and boys, were for the intakes of fruit juice and sweet bakery goods (r 0·30–0·37, P < 0·001). There was a wide range in correlation strength between food groups. Milk/yoghurt and desserts showed no mother–child relationship at all. Breakfast cereals was the only food group with a significant sex interaction (P = 0·01; mothers–girls, r 0·30, P < 0·001; mothers–boys, r0·05, NS). There were significant positive correlations between mothers and daughters in the intake of all macronutrients, whereas none between mothers and sons (sex interactions: protein, P = 0·001; fat, P = 0·004; carbohydrates, P = 0·001). Mothers and daughters (r 0·29, P < 0·001), but not mothers and sons, showed significant correlation in total energy intake, (P = 0·001 for sex interaction). There were generally more differences between mothers and children than between boys and girls in the relative intake (percentage of energy) of different food groups. Since teenaged children have a similar intake of especially snack foods as their mothers, it could be meaningful to educate mothers when aiming at improving the diet of teenaged children, both boys and girls.

Changing foodscapes 1980-2000, using the ASH30 Study

There has been a dramatic change in the UK 'foodscape', accompanied by increasing rates of overweight and obesity. This study explores dietary change and change in BMI recorded longitudinally (1980-2000) against the change in food availability recorded retrospectively. Over 20 years the foodscape changed dramatically, with the total number of food outlets increasing by 79.4%. Analysis did not find a relationship between the foodscape and food intake patterns in 1980 or 2000. However statistically significant associations were found between 1980 foodscape and percent change in BMI. Adding geographical elements to a dietary study adds an interesting dimension in exploring the change in eating and BMI from adolescence to adulthood.

Tracking of dietary intake and factors associated with dietary change from early adolescence to adulthood: the ASH30 study

OBJECTIVE

This paper describes the tracking of food intake from adolescence to adulthood according to location as an adult (at the time of the follow-up study) and gender. Additionally this paper explores factors associated with change in food intake.

METHOD

Two 3-day food diaries, demographic and socio-economic information were collected in 1980 and 2000 from the same 198 participants (81 male, 117 female). Foods consumed were assigned to the five categories in The Balance of Good Health (BGH) food model. The tracking of food intake was assessed using Pearson correlation analyses. In 2000 two questionnaires were completed. Demographic and key attributional factors, derived from closed and open-ended responses to the questionnaire, were compared with measured change using regression analysis.

RESULTS

There was significant tracking of intake by food group from adolescence to adulthood according to location as an adult and gender. Eight combinations of descriptive variables and questionnaire factors were associated with change in intake of four of the five BGH food groups.

CONCLUSION

Between adolescence and adulthood, dietary tracking is influenced by variables including gender and location. Attributions for change in food intake were associated with measured changes in food intake. In order to support healthier eating habits, it is important to be aware of factors contributing to changes in food intake, such as parental influences and perceived influences of time and work.

Determinantes do comportamento alimentar: uma revisão com enfoque na família

O comportamento alimentar ocupa atualmente um papel central na prevenção e no tratamento de doenças. A alimentação durante a infância, ao mesmo tempo em que é importante para o crescimento e desenvolvimento, pode também representar um dos principais fatores de prevenção de algumas doenças na fase adulta. Freqüentemente a família, os fatores sociais e os ambientais podem influenciar o padrão alimentar das crianças. O objetivo desta revisão foi abordar os diversos fatores ambientais envolvidos na aquisição de hábitos alimentares na infância. Os artigos selecionados foram pesquisados nas bases de dados Medline e SciELO considerando o período de 1978 a 2007. Foram utilizados os termos em ingles: children's eating patterns, children's dietary quality, determinants of children's eating patterns e em português. São apresentados os resultados de algumas investigações mais relevantes nesta área. Embora alguns desses fatores sejam inatos e, por isso, necessitem de um controle mais rigoroso, ressalta-se o papel determinante da família na formação dos hábitos alimentares saudáveis, pois a modificação de um hábito alimentar durante a fase adulta tem, em geral, alta taxa de insucesso. Além disso, outros fatores, como a escola, a rede social, as condições socioeconômicas e culturais, são potencialmente modificáveis e influenciam no processo de construção dos hábitos alimentares da criança e, conseqüentemente, do indivíduo adulto.

Gross for kids but good for parents: differing messages in advertisements for the same products

Objectives

There has been surprisingly little research into the effects of food advertising on parents’ perception of commonly consumed children’s food items, although the available research suggests that parents may find nutritional claims in these advertisements confusing. The purpose of the present study was to investigate parents’ perceptions of branded snack foods targeted at children, and the extent to which these perceptions are influenced by advertising messages.

Design

Using an intercept survey, participants were shown either adult-targeted or child-targeted advertisements for the same food products.

Setting

Central business district of a major Australian city.

Subjects

One hundred adults, mean age 40 years.

Results

The study results suggest that: (1) adults’ perceptions of advertised food products and, most importantly, purchase intentions for those products differ according to the version of the advertisement seen (for three of the products, 42–54% would buy the product after seeing the child version compared with 82–84% after seeing the adult version); and (2) adults clearly perceive distinctly different messages in advertisements for the same products which are targeting parents vs. those targeting children (e.g. for three of the products, 74–92% perceived that the adult version of the advertisement suggested the food was nutritionally beneficial compared with 2–14% perceiving this for the child version).

Conclusions

It is clear that the messages conveyed to children about specific foods are quite different to the messages conveyed to adults – and importantly parents – about the same foods.

A Review of Family Meal Influence On Adolescents’ Dietary Intake

Recent concerns about adolescent nutrition and unhealthy weights have prompted an examination of the myriad influences on dietary intake during adolescence. Included here are a summary of the literature on family influence on dietary intake, specifically during adolescence and within the family context, a summary of family meal patterns, and a systematic review of the known influences of family meals on dietary intake. Because of the complexity of families in today’s society, models were developed to depict the broad context of familial influences on adolescent nutritional behaviours and attitudes and to describe what is known and not known about family meal influences on adolescent dietary intake and quality. A systematic review of the literature revealed seven articles specifically related to adolescents, family meals, and dietary intake, which were analyzed for strength of evidence and plausibility. In spite of data collection methods relying on self-report, results suggested that family meals were associated with improved dietary intakes. Families in today’s societies are complex. Nevertheless, parents have the potential to influence positively, through family meals, what food is provided, where it is provided (e.g., home, restaurant), and within what type of atmosphere it is provided.

Perception versus reality: an exploration of children's measured body mass in relation to caregivers' estimates

This study investigated the relationship between parents' reports, as compared with our obtained measurements, of their children's body status. Separate body mass index (BMI) scores were calculated based on: (1) parents' report of their children's height and weight, and (2) children's measured height and weight. Results indicate that parents' perceptions of their children's body status reliably varied from the scores obtained from our measurements, such that parents whose children classified as overweight consistently underreported their children's BMI, while parents whose children fell into the underweight category did the opposite. Implications for the potential psychological mechanisms at play in addition to how these findings might relate to the larger childhood obesity crisis in the United States and internationally are discussed.

Food neophobia and 'picky/fussy' eating in children: a review

Two factors have been shown to contribute to rejection or acceptance of fruits and vegetables: food neophobia and 'picky/fussy' eating. Food neophobia is generally regarded as the reluctance to eat, or the avoidance of, new foods. In contrast, 'picky/fussy' eaters are usually defined as children who consume an inadequate variety of foods through rejection of a substantial amount of foods that are familiar (as well as unfamiliar) to them. Through understanding the variables which influence the development or expression of these factors (including age, personality, gender, social influences and willingness to try foods) we can further understand the similarities and differences between the two. Due to the inter-relationship between 'picky/fussy' eating and food neophobia, some factors, such as pressure to eat, personality factors, parental practices or feeding styles and social influences, will have similar effects on both magnitude and duration of expression of these behaviours. On the other hand, these constructs may be differentially affected by factors such as age, tactile defensiveness, environment and culture. The effects of these variables are discussed within this review. Behavioural interventions, focusing on early life exposure, could be developed to attenuate food neophobia and 'picky/fussy' eating in children, so promoting the ready acceptance and independent choice of fruits and vegetables.

What about the children? The experience of families involved in an adult-focused diabetes intervention

OBJECTIVE

Among adults with diabetes attempting to change their own diets, we explored how these adults approached providing food for their children and how their children reacted to dietary changes in the household.

DESIGN

The research design used semi-structured parallel individual interviews of adults and a child (aged 10-17 years) in their home. Interviews were audio-taped, transcribed, coded and analysed for themes.

SUBJECTS

Subjects included families in which one inner-city African American or Latino adult with diabetes had completed a diabetes intervention promoting healthy dietary behaviours.

RESULTS

We completed 29 interviews (14 adult-child pairs and one child). Adults approached making dietary changes for themselves and also providing food for their family in different ways, ranging from expecting everyone to eat the same thing to preparing two separate meals. Many children resisted dietary changes while fewer acquiesced. Among children who went along with changes, some reported resisting initially then adjusting, while others did not resist because the food still tasted good or they could obtain preferred foods outside the house. The intersection of adults' meal strategies and children's reactions to the changes can be used to categorise families into different patterns. These patterns highlight the tension between an adult who must make dietary changes to control diabetes and a child who is not necessarily motivated to change.

CONCLUSION

From this framework we suggest hypotheses about how these patterns might influence dietary behaviour in adults and children. Understanding these patterns could guide interventions to assist parents in successfully including children in their dietary changes.

The impact of child care providers' feeding on children's food consumption

BACKGROUND

In young children, the eating environment is an important social context within which eating behaviors develop. Among many low-income young children, the responsibility for feeding may have shifted from family members to child care providers because these children spend the majority of their day in child care settings.

METHODS

To examine the influence of feeding among low-income children in child care settings, feeding behaviors of child care providers in Head Start were observed and food consumption was assessed. Head Start, a comprehensive child development program that serves children from ages 3 to 5, was chosen because of the large percentage of minorities, the low-income status of the families, and the age of the children. Fifty child care providers (25 African-American; 25 Hispanic) randomly selected from Head Start centers in a large, urban southwestern city were observed on three mealtime occasions and self-reported feeding styles were assessed. Observed feeding behaviors were categorized into four feeding patterns based on their conceptual similarity to a general parenting typology (i.e., authoritarian, authoritative, indulgent, and uninvolved). Measures of food consumption were assessed on 549 children sitting with the child care providers during lunch at the Head Start centers.

RESULTS

Indulgent feeding behaviors were positively related to children's consumption of vegetables, dairy, entrée, and starch; authoritative feeding behaviors were positively related to dairy consumption.

CONCLUSION

This research highlights the important influence that child care providers have in the development of healthy and unhealthy eating behaviors in minority children. Implications for intervention training for child care providers to promote healthy eating among Head Start children are discussed.

Effecting dietary change

A world epidemic of diet-related chronic disease is currently being faced. In the UK incidence of obesity alone has tripled in the last 20 years and this trend is predicted to continue. Consensus exists for the urgent need for a change in diet and other lifestyle factors and for the direction and targets for this change. The evidence for how this change can be achieved is less certain. It has been established that disease processes begin in childhood. Recent evidence indicates that dietary habits too are established in childhood but that these habits are amenable to change. While establishing a healthy lifestyle in childhood is paramount, interventions have the potential to promote positive change throughout the life course. Success in reversing current trends in diet-related disease will depend on commitment from legislators, health professionals, industry and individuals, and this collaboration must seek to address not only the food choices of the individual but also the environment that influences such choices. Recent public health policy development in England, if fully supported and implemented, is a positive move towards this goal. Evidence for effective strategies to promote dietary change at the individual level is emerging and three reviews of this evidence are discussed. In addition, three recent dietary intervention studies, in three different settings and with different methods and aims, are presented to illustrate methods of effecting dietary change. Further work is required on what factors influence the eating behaviour and physical activity of individuals. There is a need for further theory-based research on which to develop more effective strategies to enable individuals to adopt healthier lifestyles.

Differences between parents' and adolescents' perceptions of family food rules and availability

OBJECTIVE

To test the hypotheses that adolescents have different perceptions of family-environmental factors than do their parents, and that dietary intake of adolescents is more highly associated with the adolescent's own perceptions than those of their parents.

DESIGN

Data from self-administered questionnaires were used.

PARTICIPANTS

Five-hundred two students aged 12 to 14 years, and one of each student's parents.

MAIN OUTCOME MEASURES

Two types of family-environmental factors (ie, family food rules and home availability and accessibility of food) for 3 self-reported dietary behaviors (ie, fruit, snack, and breakfast intake).

ANALYSIS

Unpaired t tests, chi-square tests, percentage (gross) disagreement, standardized regression coefficients, and linear regression analyses.

RESULTS

For most rules and most perceptions of availability and accessibility, considerable disagreement was found between parents and students. Self-reported intake of fruit and snacks was more highly associated with student measures, but breakfast intake was more highly associated with parent measures of rules and availability.

IMPLICATIONS FOR RESEARCH AND PRACTICE

The findings might explain mixed results on the associations between family-environmental factors and children's dietary intake that were found in earlier studies. Researchers need to be aware that in studies into family-environmental determinants of dietary habits using self-reports, the results are possibly influenced by whether the data were reported by parents or by children.