Health Education Research Advance Access originally published online on August 14, 2006
Health Education Research 2007 22(2):295-304; doi:10.1093/her/cyl080
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Perceived parenting style and practices and the consumption of sugar-sweetened beverages by adolescents
1 Department of Public Health, Erasmus University Medical Center, PO Box 1738, NL-3000 DR Rotterdam, The Netherlands
2 Department of Health Education and Health Promotion, Maastricht University, Maastricht, The Netherlands
3 Department of Public and Occupational Health and Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands
* Correspondence to: K. van der Horst. E-mail: k.vanderhorst{at}erasmusmc.nl
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Abstract |
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The purpose of this study was to investigate whether perceived parenting practices and parenting style dimensions (strictness and involvement) are associated with adolescents' consumption of sugar-sweetened beverages. In this cross-sectional study, secondary school students (n = 383, mean age 13.5 years) completed a self-administered questionnaire on their consumption of sugar-sweetened beverages, attitude, social influences, self-efficacy, habit strength, food-related parenting practices and the general parenting style dimensions of ‘strictness’ and ‘involvement’. Data were analyzed using multiple linear regression analyses. More restrictive parenting practices were associated with lower consumption of sugar-sweetened beverages (ß = –38.0 ml; 95% CI = –48.1, –28.0). This association was highly mediated (
55%) by attitude, self-efficacy and modeling from parents. Nevertheless, a significant direct effect remained (ß = –17.1 ml; 95% CI = –27.2, –6.90). Interactions between perceived parenting style and parenting practices showed that the association between parenting practices and sugar-sweetened beverage consumption was stronger among adolescents who perceived their parents as being moderately strict and highly involved. Parents influence their children's sugar-sweetened beverage consumption and should therefore be involved in interventions aimed at changing dietary behaviors. Interventions aimed at the promotion of healthy parenting practices will improve when they are tailored to the general parenting style of the participants. |
Introduction |
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The prevalence of overweight among adolescents has increased rapidly over the last decades [1, 2]. Overweight is caused by an imbalance between energy intake and energy expenditure. Various behaviors, such as watching television [3–5], fast-food consumption [6, 7] and consumption of large serving portions [8, 9], have been identified as determinants of a positive energy balance. Additionally, consumption of sugar-sweetened soft drinks has been found to be positively associated with adolescent obesity [10–13]. Effective promotion of healthful eating requires a detailed understanding of the factors influencing dietary behavior. This is especially important for sugar-sweetened drinks, given the large increase in soft drink consumption in adolescents in recent years and the increase in soft drink consumption throughout adolescence [14]. Between 1977 and 1998, the consumption of carbonated soft drinks by school-aged children in the United States (aged 6–17 years) has increased from 5 fluid oz. (148 ml) to 12 fluid oz. (355 ml) day–1 [15], contributing 8% to the total daily energy intake of adolescents (10.3 and 8.6% in overweight males and females, respectively) [16, 17]. In Dutch adolescents (aged 13–18 years), similar trends have been reported between 1987 and 1998, with sugar-sweetened carbonated and non-carbonated soft drink consumption increasing by 50.2% (317–476 ml) and 32.5% (212–281 ml) day–1 for boys and girls, respectively [18].
Research indicates that parents play an important role in the eating behavior of adolescents [19]. Parents influence the availability of soft drinks at home, but can also exert their influence through food-related parenting practices [20–24]. Parenting practices are directly related to specific behaviors of their children, such as the consumption of soft drinks, and parents use different parenting practices for different behaviors. Studies on food-related parenting practices have reported contradictory results: on the one hand, the results of some studies indicate that strict parenting practices may increase children's preference for (and the intake of) the restricted foods [23, 25, 26], whereas an other study suggests that adolescents have a healthier diet and consume less soft drinks when they report more food-related rules in their family [27]. These mixed results suggest that additional factors play a role. For instance, Darling and Steinberg [28] postulated that parenting style modifies the association between parenting practices and adolescent behavior (Fig. 1). Parenting style refers to general patterns of parenting and the emotional climate in which the parents' behaviors are expressed. In contrast to parenting practices, parenting style refers to parent–child interactions in general, whereas parenting practices are related to specific behaviors, and are reflected in things like food rules [28]. Thus, parenting practices operate in the context of parenting style. Parenting styles are classified according to two dimensions of parental behavior: ‘strictness’ or parental control and ‘involvement’ or parental warmth and acceptance [29]. Food-related parenting practices might have a different effect on adolescents' behavior depending on the parenting style of their parents. Few studies have proposed this interaction effect between parenting style and parental child-feeding practices [19, 30]. Elaborating on the model of Darling and Steinberg, we aimed to examine the interactive nature of parenting style dimensions in more detail.
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Cognitive variables, such as attitude, social influence, self-efficacy (ASE) model or habit strength, may also be predictors of the consumption of sugar-sweetened beverages [21, 22]. Whether behavior-specific cognitions and habit strength can explain the link between parenting practices and adolescents' sugar-sweetened beverage consumption is not known, but most social cognitive theories assume that environmental influences are mediated by behavior-specific cognitions.
In this cross-sectional study, we investigated (i) whether behavior-specific cognitions from the ASE model and habit strength are associated with sugar-sweetened beverage consumption by adolescents; (ii) whether perceived parenting practices are associated with adolescent sugar-sweetened beverage consumption and whether cognitions and habit strength explain such an association and (iii) possible interactions between perceived parenting style dimensions and perceived parenting practices. We combined the contextual model of parenting style [28] with the ASE model [31] and habit strength [32] to investigate sugar-sweetened beverage consumption by adolescents.
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Methods |
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Study population and procedure
This study was part of the Dutch Obesity Intervention in Teenagers. The medical ethical committee of the VU University Medical Center granted ethical approval for this study.
Data were collected at Dutch secondary schools in May and June 2003. The subjects were 383 adolescents from 16 first and second grades of five secondary schools. The questionnaires were completed in the classroom. No refusals to complete the questionnaire were reported. The mean age (SD, range) of the respondents was 13.5 years (0.62, 12–17), 211 (55.1%) were females and 55 (14.4%) were of recent immigrant origin, defined as one or both parents born abroad.
Measurements
The questionnaire was based on other validated questionnaires that assessed dietary intakes and behavior-specific cognitions, habit strength and parenting variables in adolescent populations [30–34]. The self-administered questionnaire was pre-tested for clarity and length, by means of cognitive interviewing among four adolescents not participating in the study.
Outcome measure: sugar-sweetened beverage consumption
Sugar-sweetened beverages were defined as carbonated soft drinks, other non-carbonated sugar-sweetened drinks (water-based beverages that contain sugar) and so-called sport drinks. The consumption of sugar-sweetened beverages was assessed by two questions: ‘On how many days a week do you drink sugar-sweetened (not ‘light’ or ‘diet’) beverages?’, with answering categories ranging from 0 to 7 days week–1, and ‘On days that you drink sugar-sweetened beverages, how many glasses, cans, and/or bottles do you drink?’, with the amount to be filled in by hand. Total sugar-sweetened beverage consumption was expressed in milliliters per day and calculated from these two questions according to Dutch standard serving sizes (1 glass = 200 ml, 1 can = 330 ml, 1 bottle = 500 ml). Reported consumption of >4 l day–1 (n = 5) was recoded as 4 l.
Behavior-specific cognitions
Cognitions specific to sugar-sweetened beverage consumption, i.e. attitude, subjective norm, social modeling, social pressure and self-efficacy were assessed according to the ASE model [31]. All cognitions were assessed by two questions on a five-point bipolar scale. The internal consistency of the constructs was assessed using Cronbach's alpha (
). In the case of Cronbach's alpha > 0.6, the items were combined in one scale by calculating the mean item score [35].
Attitude was assessed using the statements ‘I think it is good to drink a lot of sugar-sweetened beverages’ and ‘I think it is pleasant to drink a lot of sugar-sweetened beverages’. Answering categories ranged from ‘I completely agree’ (2) to ‘I completely disagree’ (–2) ( = 0.65). Social influences were assessed by three constructs: subjective norms, modeling and social pressure. Subjective norm was assessed by ‘My friends think that I should drink sugar-sweetened beverages’ and ‘My parents think that I should drink sugar-sweetened beverages’, with answering categories ranging from ‘Yes, definitely’ (+2) to ‘No, definitely not’ (–2) ( = 0.50). Modeling was assessed by ‘Do your friends drink sugar-sweetened beverages?’ and ‘Do your parents drink sugar-sweetened beverages?’, with answering categories ranging from ‘Yes, a lot’ (+2) to ‘No, very little’ (–2) ( = 0.34). Social pressure was assessed by two questions: ‘Do your parents encourage you to drink sugar-sweetened beverages?’ and ‘Do your friends encourage you to drink sugar-sweetened beverages?’, with answering categories ranging from ‘Yes, a lot’ (+2) to ‘No, very little’ (–2) ( = 0.73). Self-efficacy was assessed by asking ‘Do you think you are able to drink less sugar-sweetened beverages?’ and ‘Does drinking less sugar-sweetened beverages seem difficult to you?’, with answering categories ranging from ‘Yes, definitely’ (+2) to ‘No, definitely not’ (–2) ( = 0.72).
Habit strength
We assessed habit strength of sugar-sweetened beverage consumption by means of the Self Report Habit Index [32]. This questionnaire assesses three features of habitual behavior: (i) the extent to which a behavior is automatic, e.g. ‘drinking sugar-sweetened beverages is something I do without thinking’; (ii) the repeated character of the behavior, e.g. ‘drinking sugar-sweetened beverages is something I have been doing for a long time’ and (iii) the sense of identity the behavior reflects, e.g. ‘drinking sugar-sweetened beverages, that's typically "me"’. These three features were assessed by twelve questions on a five-point bipolar scale, ranging from ‘I completely agree’ (+2) to ‘I completely disagree’ (–2). An overall score for habit strength was constructed by summing the item scores ( = 0.88).
Perceived parenting practices and parenting style dimensions
Based on the parent–child food control questionnaire developed by Cullen et al. [33], we assessed perceived parenting practices using nine items. Four questions (identical for fathers and mothers) assessed specific practices regarding sugar-sweetened beverage consumption (e.g. ‘My father/mother tells me how much sugar-sweetened beverages I am allowed to consume’, ‘My father/mother tells me which sugar-sweetened beverages I am allowed to consume’). An additional item assessed the availability of soft drink in the home environment: ‘My mother always has my favorite sugar-sweetened beverage available at home’. All parenting items were measured on five-point bipolar scales ranging from completely agree (+2) to completely disagree (–2). A single score was computed by summing the scores on these items ( = 0.86), in such a way that a higher score reflects more restrictive parenting practices.
We assessed two parenting style dimensions, perceived strictness and perceived involvement, according to Steinberg et al. [34] and den Exter et al. [36]. Strictness was assessed by seven items, e.g. ‘My parents know exactly where I am most afternoons after school’ and ‘At what time do you have to be at home at night on weekdays?’. Involvement was assessed by ten items, e.g. ‘My parents make time to talk to me’ and ‘When I get a poor grade in school, my parents encourage me to do better’. Composite scores were computed for involvement ( = 0.83) and strictness ( = 0.77) by summing the scores on these items. Higher scores meant perceiving parents as more involved or stricter. The two dimensions of strictness and involvement can be used to define four parenting styles: authoritarian, authoritative, indulgent and neglectful, by dichotomizing the scores on both dimensions. In this study, however, we used the two continuous dimensions of strictness and involvement.
Data analyses
Missing data on the cognitions, habit strength and parenting variables were imputed using the median value of all respondents without missing values. The missing data on sugar-sweetened beverage consumption were replaced by the group mean. The highest frequency of missing values was 10 (2.6%), for a parenting practice item. Multicollinearity problems were not encountered; all inter-correlations between predictors were <0.5 [37].
In all conducted analyses, we used multiple linear regression analyses to examine whether the associations between the determinants of interest and sugar-sweetened beverage consumption differed with age, sex and ethnicity. Since no significant interactions were found (all P > 0.05), data are presented for the whole sample with adjustments for these variables as potential confounders.
The first set of multiple linear regression analyses examined whether cognitions and habit strength were associated with sugar-sweetened beverage consumption. A second set of multiple regression analyses investigated whether perceived parenting practices were associated with sugar-sweetened beverage consumption and the possible mediating effects of the behavior-specific cognitions. It used the following requirements for establishing mediation effects: (i) perceived parenting practices must be associated with sugar-sweetened beverage consumption, (ii) the potential mediators must be associated with sugar-sweetened beverage consumption and (iii) the mediators must cause a significant reduction in the association between perceived parenting practices and sugar-sweetened beverage consumption, after controlling for the mediator [38]. A P-value <0.05 was considered to be significant. A Sobel test was conducted [39] to examine whether the strength of the association between perceived parenting practices and sugar-sweetened beverage consumption (given by the regression coefficient) decreased significantly after a potential mediator was added to the model. Finally, we investigated the interaction between perceived strictness and perceived parenting practices and between perceived involvement and perceived parenting practices. To this end, interaction terms between parenting practices and the strictness and involvement dimensions were added to the regression model testing the association between parenting practices and sugar-sweetened beverage consumption. If the interactions had P-values <0.1, stratified analyses were conducted for the quartiles of strictness and involvement.
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Results |
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Table I shows the mean scores of the studied variables for boys and girls. A significant difference between boys and girls in perceived strictness, attitude and self-efficacy was found. Overall, respondents reported to perceive their parents using restrictive parenting practices regarding sugar-sweetened beverage consumption and they perceived the parenting style of their parents as low in strictness and high in involvement.
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Behavior-specific cognitions, habit strength and associations with sugar-sweetened beverage consumption
In the first set of regression analyses (adjusting for age, gender and ethnicity), all cognitions, except the social norm of friends, were significantly associated with sugar-sweetened beverage consumption (Table II). When all significant cognitions were included in the regression model, only attitude, self-efficacy and modeling from parents remained significantly associated with sugar-sweetened beverage consumption. Habit strength was also associated with sugar-sweetened beverage consumption (ß = 35.4, 95% CI = 28.8, 42.1).
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Mediation of the association between perceived parenting practices and sugar-sweetened beverage consumption
Perceiving more restrictive parenting practices was associated with less consumption of sugar-sweetened beverages (Table III, Model 1). Further adjustments for habit strength and cognitions significantly reduced the strength of this association, which nevertheless remained significant. Habit strength explained 44% of the association between perceived parenting practices and sugar-sweetened beverage consumption, as can be inferred from the reduction of the unstandardized regression coefficient from –38.0 to –21.3 ml day–1. Among the cognitions, attitude was the strongest mediator (22.7%, ß = –38.0 to –29.4), followed by modeling from parents (17.6%, ß = –38.0 to –31.3) and self-efficacy (9.9%, ß = –38.0 to –34.3) (Table III). The cognitions, age, gender, ethnicity and habit strength together (Model 6) explained 55.0% of the association between perceived parenting practices and sugar-sweetened beverage consumption (ß changed from –38.0 to –17.1 ml day–1).
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Interaction between perceived parenting style dimensions and parenting practices
We further examined whether the perceived dimensions of parenting style (involvement and strictness) modified the associations between parenting practices and sugar-sweetened beverage consumption. P-values of interaction terms between perceived parenting practices and strictness (P = 0.065), and between perceived parenting practices and involvement (P = 0.069), were <0.1. Further stratified analyses revealed that the association between perceived parenting practices and sugar-sweetened beverage consumption varied by different quartiles of strictness and involvement (Table IV): parenting practices were most effective (i.e. associated with less sugar-sweetened beverage consumption) in the second and third quartiles of strictness and in the highest quartile of involvement.
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Discussion |
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TopAbstractIntroductionMethodsResultsDiscussionConflict of interest statementReferences |
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The present study investigated the association between perceived parenting practices and sugar-sweetened beverage consumption by adolescents on the one hand, and the influence of perceived parenting style dimensions on this association on the other. Perceiving more restrictive parenting practices was found to be associated with less soft drink consumption, which is in agreement with the findings of the study by De Bourdeaudhuij and Van Oost [27]. However, findings from studies among younger children suggest that strict parental practices can in fact increase children's preferences for, and intake of, the restricted foods [23, 25, 26]. These contrasting outcomes may have been caused by the difference between parenting practices that are used in childhood and in adolescence. For instance, parents might use pressure to get their young children to eat or may restrict access to foods. For adolescents, parents might use clearly defined rules about the times when a certain food can be eaten and how much of a certain food they can eat.
In our study, the model with age, gender, ethnicity, habit strength, modeling from parents, attitude and self-efficacy explained 55% of the relationship between perceived parenting practices and sugar-sweetened beverage consumption, the largest contribution being that by habit strength (44%). Nevertheless, perceived parenting practices had a direct association with sugar-sweetened beverage consumption unmediated by cognitions and habit strength. Sugar-sweetened beverage consumption may thus not always be reasoned behavior, and this finding has some theoretically important implications. Potential distal determinants of intakes in the social, cultural or physical environment may increase our understanding of sugar-sweetened beverage consumption in adolescents. In addition, since perceived parenting practices were still independently associated with the consumption of sugar-sweetened beverages, other factors may also be involved in the association between perceived parenting practices and sugar-sweetened beverage consumption by adolescents, for instance, the influence of taste preferences [20]. Parents shape their children's eating environment in different ways. Parental feeding practices in early childhood, for instance, using foods as a reward or to comfort [40], exposure to foods [41] and parental control of how much and what children eat [42] can influence a child's taste preferences which may persist into adolescence. In addition, the amount and diversity of sugar-sweetened beverages parents make available and accessible at home can influence the amount of such beverages adolescents consume [15, 20]. It has been suggested that the exposure to soft drink advertising may lead to a higher consumption of soft drinks during TV watching [20, 43], an activity which constitutes a considerable part of adolescents' leisure-time activity. Finally, the availability of soft drink vending machines in the adolescents' immediate environment (e.g. schools) could also contribute to a higher consumption of soft drinks [15, 20, 44].
We also explored whether the association between perceived parenting practices (specific rules about sugar-sweetened beverage consumption) and sugar-sweetened beverage consumption by adolescents was different depending on the perceived parenting style of their parents. We therefore examined if the dimensions of parenting style strictness (parental control) and involvement (parental warmth and acceptance) modified the association between parenting practices and the consumption of such beverages. The results indicated that the effect of parenting practices in this respect was most pronounced in those families with a highly involved or moderately strict parenting style. Kremers et al. [30] also found that adolescents raised in a family with authoritative parenting style (highly strict and highly involved) showed the most favorable consumption of fruits and vegetables. In the highest quartile of strictness, we found no significant association between perceived parenting practices and sugar-sweetened beverage consumption. This indicates that if parents use a very strict parenting style, parenting practices relating to sugar-sweetened beverage consumption may not have an additional direct limiting effect on their children's consumption of these beverages. The strongest association between perceived parenting practices and sugar-sweetened beverage consumption was found in the highest quartile of involvement indicating a stronger direct effect of parenting practices on adolescent behavior, in the case of involved parents. The results of our study and that by Kremers et al. [30] are not entirely comparable. We used the continuous measures of the two perceived parenting style dimensions instead of the four categories of parenting style. There were several reasons why we chose to use the two dimensions of strictness and involvement instead of the four parenting style categories. First, the skewed distribution on these dimensions would have caused misclassification when dichotomized into categories. Second, dichotomization itself is quite arbitrary since there are no ‘universal’ cut-off values for those dimensions and the cut-offs will therefore vary for different populations. Third, classification of two continuous variables into four categorical parenting styles means loss of information. Since we were interested in the role of various types and dimensions of parenting, we chose to include the two dimensions as continuous variables and investigate the existence of interactions.
To our knowledge, this is the first study to indicate the role of parenting styles as an environmental context factor that can influence the effectiveness of food-related parenting practices in terms of adolescents' consumption of sugar-sweetened beverages. As such, it contributes to theory development of the influence of parents on adolescents' dietary behaviors. In contrast to assumptions that underlie theories such as the theory of planned behavior [45], the results indicate that sugar-sweetened beverage consumption may not always be reasoned or planned [46]. Additionally, contextual variables may moderate the associations between cognitive variables and intake levels. Notably, Bandura's social cognitive theory [47] does include the reciprocal interaction of person, environment and behavior. Such a theoretical approach may guide future research aimed at examining potential moderators of the environment—behavior relationship.
There are several limitations to the interpretation of the results of this study. Since the design of this study was cross-sectional, inferences regarding cause and effect must be made with caution and will not be conclusive. Parenting practices could determine, but also be a result of children's behavior regarding sugar-sweetened beverage consumption (and indeed that of other food items). Another limitation is that the schools and classes included in this study were not randomly selected. In addition, the study population included few children from the various ethnic minorities in the Netherlands, which made it impossible to examine the potential role ethnic background in sugar-sweetened beverage consumption. We used adolescents' reports of parenting practices and parenting style dimensions. Therefore, it could be that parental reports of practices and style would differ from their children's perceptions. In addition, what adolescents perceive as ‘strict’ and ‘involved’ may vary among individuals. Obtaining data from multiple sources (adolescents, parents and siblings) would probably result in data that are more valid. Finally, the assessment of sugar-sweetened beverage consumption relied on self-report and was not supported by any objective assessment. Assessment of validity and reliability data was not available for this measure. Although the measurement instrument used in this study was designed to be as clear as possible, it is not known whether adolescents under-reported or over-reported their sugar-sweetened beverage consumption. Validation studies on measures of sugar-sweetened beverage consumption are clearly needed, and might be undertaken as part of future research to improve the assessment of this behavior.
Despite these limitations, our findings emphasize the importance of parental rules and the interaction between these rules and parenting style dimensions for sugar-sweetened beverage consumption by adolescents. The central role parents can play on the primary prevention of obesity-related behaviors was clearly illustrated: a one-‘unit’ decrease on the parenting practice scale accounted for an increase of 38 ml day–1 in sugar-sweetened beverage consumption. Small increases in energy intake, not accompanied by concomitant increasing energy expenditure, will substantially contribute to weight gain.
Parents are thus important intermediates for changing dietary behaviors of adolescents and should therefore be involved in interventions aimed at changing dietary behaviors and reducing overweight. The present study showed that interventions aimed at the promotion of healthy parenting practices will improve when they are tailored to the general parenting style of the participants.
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Conflict of interest statement |
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None declared.
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References |
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Received on November 9, 2005; accepted on June 28, 2006
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  K. Rhee Childhood Overweight and the Relationship between Parent Behaviors, Parenting Style, and Family Functioning The ANNALS of the American Academy of Political and Social Science, January 1, 2008; 615(1): 11 - 37. [Abstract] [PDF]
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