The reliability of the general functioning scale in Norwegian 13-15-year-old adolescents and association with family dinner frequency.

BACKGROUND: Family environment is crucial to the development of health behaviors into adolescence and adulthood. The aims of this study were (1) to explore the reliability of the General Functioning Scale (GFS) among Norwegian 13-15-year-olds, and (2) to assess whether family functioning reported by adolescents was associated with family dinner frequency. METHODS: In total 440 secondary-school students were invited to participate in this cross-sectional web-based questionnaire survey, with 54 participating in the test-retest study. Test-retest and internal consistency were assessed for the 12-item GFS-scale. Associations between family functioning and family dinner frequency were tested using multiple logistic regression. RESULTS: The GFS had high internal consistency (corrected item-total correlations ranging from 0.40 to 0.65, Cronbach's α = 0.85), and excellent test-retest reliability (intra-class correlation coefficient = 0.83). In the logistic regression model, a higher score on GFS (poorer family functioning) was associated with a reduced likelihood of having dinner together on a daily basis (i.e., 6-7 times per week, OR = 0.36, CI = 0.20-0-64) after adjusting for age, gender, ethnicity, living situation and parental education level. CONCLUSIONS: The GFS had high reliability. As poorer family functioning was associated with less frequent family dinners, the family environment may be an important (contextual) target to influence adolescent health behaviors. It would be of interest to further explore the role of family functioning in relation to adolescents' dietary habits, besides shared family meals, and to reveal the mechanisms underlying such relationships.

Perceived rules and accessibility: measurement and mediating role in the association between parental education and vegetable and soft drink intake.

BACKGROUND: The existence of socioeconomic differences in dietary behaviors is well documented. However, studies exploring the mechanisms behind these differences among adolescents using comprehensive and reliable measures of mediators are lacking. The aims of this study were (a) to assess the psychometric properties of new scales assessing the perceived rules and accessibility related to the consumption of vegetables and soft drinks and (b) to explore their mediating role in the association between parental education and the corresponding dietary behaviors. METHODS: A cross-sectional survey including 440 adolescents from three counties in Norway (mean age 14.3 years (SD = 0.6)) was conducted using a web-based questionnaire. Principal component analysis, test-retest and internal reliability analysis were conducted. The mediating role of perceived accessibility and perceived rules in the association between parental education and the dietary behaviors was explored using linear regression analyses. RESULTS: Factor analyses confirmed two separate subscales, named "accessibility" and "rules", both for vegetables and soft drinks (factor loadings >0.60). The scales had good internal consistency reliability (0.70-0.87). The test-retest reliability of the scales was moderate to good (0.44-0.62). Parental education was inversely related to the consumption of soft drinks and positively related to the consumption of vegetables. Perceived accessibility and perceived rules related to soft drink consumption were found to mediate the association between parental education and soft drink consumption (47.5 and 8.5 % of total effect mediated). Accessibility of vegetables was found to mediate the association between parental education and the consumption of vegetables (51 % of total effect mediated). CONCLUSION: The new scales developed in this study are comprehensive and have adequate validity and reliability; they are therefore considered appropriate for use among 13-15 year-olds. Parents, in particular those with a low educational background, should be encouraged to increase the accessibility of vegetables and to decrease the accessibility of soft drinks, in particular during dinner. Enforcing parental rules limiting soft drink intake in families with low parental education also appears relevant.

Adolescent impulsivity and soft drink consumption: The role of parental regulation.

The present study aimed to explore the process in which impulsivity might influence soft drink consumption in adolescents, addressing potential mediating effects of perceived parental regulation regarding unhealthy eating. A cross-sectional survey was performed among 440 13-15-year-olds in Eastern Norway. The survey questionnaire included measures of impulsivity, six types of maternal and paternal regulation (as perceived by the adolescents), and consumption of sugar-sweetened beverages (SSB). Parallel multiple-mediator analyses were performed to reveal potential mediating effects of perceived parental regulatory behaviors on the association between adolescent impulsivity and SSB consumption. Separate models were run for maternal and paternal regulation. Results from our model analyses (both maternal and paternal models) indicated that all the six measured parental regulatory behaviors jointly acted as mediators on the association between adolescent impulsivity and SSB consumption. However, only perceived maternal and paternal legitimacy of regulation showed a unique contribution to the mediated effect. This finding suggests that adolescents' perception of parental legitimate authority is of particular importance in explaining the relationship between impulsivity and unhealthy eating behaviors in adolescents. Future nutrition interventions targeting adolescents and their parents should take personal factors such as adolescents' level of impulsivity into account. Ultimately; what may be an appropriate approach to impulsive individuals and their parents may diverge from what may be an appropriate approach to less impulsive individuals and their parents.

Development of family and dietary habits questionnaires: the assessment of family processes, dietary habits and adolescents' impulsiveness in Norwegian adolescents and their parents.

BACKGROUND: There is a need for valid and comprehensive measures of parental influence on children's energy balance-related behaviours (EBRB). Such measures should be based on a theoretical framework, acknowledging the dynamic and complex nature of interactions occurring within a family. The aim of the Family & Dietary habits (F&D) project was to develop a conceptual framework identifying important and changeable family processes influencing dietary behaviours of 13-15 year olds. A second aim was to develop valid and reliable questionnaires for adolescents and their parents (both mothers and fathers) measuring these processes. METHODS: A stepwise approach was used; (1) preparation of scope and structure, (2) development of the F&D questionnaires, (3) the conducting of pilot studies and (4) the conducting of validation studies (assessing internal reliability, test-retest reliability and confirmatory factor analysis) using data from a cross-sectional study. RESULTS: The conceptual framework includes psychosocial concepts such as family functioning, cohesion, conflicts, communication, work-family stress, parental practices and parental style. The physical characteristics of the home environment include accessibility and availability of different food items, while family meals are the sociocultural setting included. Individual characteristics measured are dietary intake (vegetables and sugar-sweetened beverages) and adolescents' impulsivity. The F&D questionnaires developed were tested in a test-retest (54 adolescents and 44 of their parents) and in a cross-sectional survey including 440 adolescents (13-15 year olds), 242 mothers and 155 fathers. The samples appear to be relatively representative for Norwegian adolescents and parents. For adolescents, mothers and fathers, the test-retest reliability of the dietary intake, frequencies of (family) meals, work-family stress and communication variables was satisfactory (ICC: 0.53-0.99). Barratt Impulsiveness Scale-Brief (BIS-Brief) was included, assessing adolescent's impulsivity. The internal reliability (Cronbach's alphas: 0.77/0.82) and test-retest reliability values (ICC: 0.74/0.77) of BIS-Brief were good. CONCLUSIONS: The conceptual framework developed may be a useful tool in guiding measurement and assessment of the home food environment and family processes related to adolescents' dietary habits, in particular and for EBRBs more generally. The results support the use of the F&D questionnaires as psychometrically sound tools to assess family characteristics and adolescent's impulsivity.

Changes in adolescents' and parents' intakes of sugar-sweetened beverages, fruit and vegetables after 20 months: results from the HEIA study - a comprehensive, multi-component school-based randomized trial.

BACKGROUND: Interventions conducted in school-aged children often involve parents, but few studies have reported effects on parents' own behaviour as a result of these interventions. OBJECTIVE: To determine if a multi-component, cluster randomized controlled trial targeting 11-13 year olds influenced their consumption of fruit, vegetables, sugar-sweetened soft drinks and fruit drinks, and to explore whether the results varied by gender, adolescent weight status or parental educational level. A final aim was to assess whether the parents' intakes were affected by the intervention. DESIGN: Participants were 1,418 adolescents, 849 mothers and 680 fathers. Baseline and post-intervention data from the 20 months intervention study HEIA (HEalth In Adolescents) were included. Data were collected assessing frequency (and amounts; beverages only). RESULTS: No significant differences were found at baseline between the intervention and control groups, except for the parental groups (educational level and intakes). At post-intervention, the adolescents in the intervention group consumed fruit more frequently (P<0.001) and had a lower intake of sugar-sweetened fruit drinks compared to the control group (P=0.02). The parental educational level moderated the effect on intake of sugar-sweetened fruit drinks in adolescents. The intake was less frequent in the intervention groups compared to the control groups (P=0.02) for those who had parents with low and medium educational level. Furthermore, the intervention may have affected mothers' fruit intake and the vegetable intake in higher educated fathers. CONCLUSION: Favourable effects in favour of the intervention group were found for intake of fruit and sugar-sweetened fruit drinks among the adolescents in the HEIA study. Our results indicate that it is possible to reduce adolescents' intake of sugar-sweetened fruit drinks across parental education, and potentially affect sub-groups of parents.