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Graduate Teses and Dissertations Graduate College
2010
Parenting styles, child BMI, and ratings of
obesigenic environments in families of children age
5-11
Rachel Rae Johnson
Iowa State University, graygirl@iastate.edu
Follow this and additional works at: htp://lib.dr.iastate.edu/etd
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Recommended Citation
Johnson, Rachel Rae, "Parenting styles, child BMI, and ratings of obesigenic environments in families of children age 5-11" (2010).
Graduate Teses and Dissertations. Paper 11623.

Parenting styles, child BMI, and ratings of obesigenic environments in families
of children age 5-11


by


Rachel Rae J ohnson




A thesis submitted to the graduate faculty

in partial fulfillment of the requirements for the degree of

MASTER OF SCIENCE

Major: Kinesiology (Behavioral Basis of Physical Activity)
Program of Study Committee:
Gregory J . Welk, Major Professor
Douglas A. Gentile
Amy S. Welch







Iowa State University

Ames, Iowa

2010

Copyright Rachel Rae Johnson, 2010. All rights reserved.
ii


TABLE OF CONTENTS

ABSTRACT iii

INTRODUCTION 1

LITERATURE REVIEW 3

METHODS 18

RESULTS 28

DISCUSSION 37

CONCLUSION 42

APPENDIX A: ADDITIONAL RESULTS 43

APPENDIX B: FAMILY NUTRITION AND PHYSICAL
ACTIVITY ASSESSMENT ADULT VERSION 46

APPENDIX C: FAMILY NUTRITION AND PHYSICAL
ACTIVITY ASSESSMENT: 21 ITEM FORMAT 48

APPENDIX D: FAMILY NUTRITION AND PHYSICAL
ACTIVITY ASSESSMENT CHILD VERSION 49

APPENDIX E: PARENT STYLE AND DIMENSIONS
QUESTIONNAIRE (PSDQ) 51

REFERENCES 53
iii


ABSTRACT
Background: The epidemic of childhood obesity is a multi-factorial problem but the childs
home environment and parenting practices clearly play a role. This study evaluates the utility
of a behaviorally based screening tool for evaluating practices and home environments. This
study also seeks to determine if parenting styles influence parent and child environmental
ratings and child BMI. Methods: 313 elementary students and 75 of their parents completed
separate versions of the Family Nutrition and Physical Activity (FNPA) instrument. Parents
also completed the Parenting Styles and Dimension Questionnaire (PSDQ), a 58 item survey
that categorizes parenting practices into three styles: authoritative, authoritarian, and
permissive. Body Mass Index (BMI) data was obtained by trained staff. Cronbachs alpha
was run to check reliability of parent and child FNPA reports. Pearson product moment
correlations among the parent and child FNPA scores were used to determine overall
associations and parent-child agreement. Regression analyses were used to determine if
parenting styles were related to FNPA and child BMI. Cluster analysis was also used to
identify patterns in the PSDQ classifications that may be associated with particularly high or
low FNPA scores. Results: Correlations between childrens FNPA scores and parent scores
were low (r =.188). Correlations between the Parent FNPA score and child BMI-z score was
low (r =-.31) but statistically significant. Parents were more internally consistent in
evaluating home environments. Older children were more consistent reporters than younger
children. Cluster analysis revealed clear differences in associated FNPA scores. Less
authoritative parenting was associated with more obesigenic environments. Less obesigenic
environments were associated with authoritative parenting styles. Regression analysis shows
iv

that authoritative parenting was the best predictor of FNPA and no significant predictor was
determined for child BMI. Conclusion: Parents and children differ in perceptions of their
home environments and parenting style can alter parent ratings of the home environment.
1
INTRODUCTION
The epidemic of obesity is one of the most pressing public health problems facing our
country (NCHS, 2007). Obesity has become even more prevalent in Americas youth in
recent years (Ogden et al., 2006; Freedman et al., 2002). There are specific concerns about
the increasing prevalence in youth because overweight youth are more likely to become
overweight adolescents and adults (Dietz & Gortmaker, 2001; Ebbeling et al., 2002). Being
overweight can also increase risk for other negative and sometimes life threatening health
outcomes (Must & Strauss, 1999; Reilly et al., 2005).
Obesity is a multi-factorial condition that can be a result of many lifestyle habits and
environments. A number of behaviors influence risk for overweight in children including but
not limited to, television viewing time (Laurson et al., 2008; Deitz & Strasburger, 1991;
Gortmaker et al., 1990; Muller et al., 2002; Vanhala et al., 2009; Cheng, 2005), video game
play (Laurson et al, 2008; Skinner et al, 2004), physical inactivity (Harrison et al., 2006;
Stephens & Wentz 1998; Lazzar et al., 2007; Vanhala et al., 2009), energy intake (Gordana
& Levitsky, 2003; Rodriguez- Artalejo, 2002; Chang & Nayga, 2009), sleep deficiency
(Chen et al., 2008; Ozturk et al. 2009; Landhuis et al, 2008; Padez et al., 2009; Touchette et
al., 2008), sweetened drinks (Bowman, 2004; Must et al., 2009; Mrdjenovic & Levitsky,
2003) and parental influence (Barradas et al., 2007; Francis et al. 2003; Padez et al., 2009).
Parenting styles are also of importance. Baumrinds (1991) parenting typologies/
styles include authoritative, authoritarian, and permissive. Golan & Crow (2004) report that
authoritative parenting lead to healthier food choices and higher activity levels. Other studies
have found similar results (Patrick et al., 2004; Rutledge et al., 2007; Rhee et al., 2006).
2

Studies evaluating parent-child agreement of behaviors that increase child weight
suggest that parents and children do not often agree on child behaviors. Some of these
behaviors are fruit and vegetable consumption (Tak et al., 2006), eating styles (Braet et al.,
2007), television viewing time (Rossiter & Robertson, 1975), sleep time (Gruber et al.,
1997), and parental behaviors (Tein et al., 1994). In all behaviors children reports are not
similar to parent reports.
The factors above demonstrate the complex social, environmental, and behavioral
characteristics that influence a childs risk of becoming overweight. Genetics can play a role
as well but the recent obesity epidemic is more likely attributed to changes in environmental
interactions rather than inherited risk. Although studies have made connections with eating
habits, activity levels, and parenting styles, none to date have connected childrens home
environment and compared them with parenting styles and child BMI.
The purpose of this study is to examine factors that may explain variability in
childrens potential risk for obesity. The study will be conducted using a behaviorally based
screening tool called the Family Nutrition and Physical Activity (FNPA) Assessment (Ihmels
et al., 2009a). This tool consists of ten items that capture a diverse set of constructs that have
been empirically shown to predict risk of overweight. The tool is designed to evaluate the
obesigenic nature of home environments and practices and has potential utility for primary
prevention. Determining factors that influence FNPA scores will provide valuable
information for future research with the FNPA tool.
This study will address two specific research questions:
1. Do parents and children provide similar evaluations of the FNPA constructs?
2. Are parenting styles associated with FNPA scores and child BMI?
3

LITERATURE REVIEW
Obesity has been a growing epidemic in America for many years. Thirty-four percent
of Americas population is obese, compared to the twenty-three percent in 1994 (NCHS,
2007), the prevalence of class 3 obesity (Body Mass Index >40) has risen to 2.2% in 2000
(Freedman et al, 2002) compared to .78% in 1990. Considerable attention has focused on the
progression of obesity in Americas youth (YRBS, 2008, NCHS, 2007, Ogden et al, 2006).
Risk factors that have been recently researched include: unhealthy eating habits, low physical
activity, sleep time, parental influence, video game play and television viewing. Studies have
proven that these risks are directly related to overweight children. The rising obesity rates in
children highlight the continued need to develop prevention strategies that can be used in
family and school environments.
Childhood obesity rates have increased consistently each year since 1999 in the
United States (Ogden et al., 2006). The ongoing battle between policy makers and snack food
companies continue to leave the large amount of unhealthy foods and snacks available to
grade school students (Finkelstein et al., 2008). As grade level increases, more unhealthy
options are available in schools (Demory-Luse et al., 2004). Other countries report limited
healthy options for youth enrolled in grade school as well (Maddah, 2008; Drewnowski &
Popkin, 1997). There are many consequences of overweight including negative self-esteem
(McCullough et al, 2008), orthopedic problems (bowing of legs) (Must & Strauss, 1999),
hypertension (Lauer et al., 1975), and asthma (Velazquez et al., 2008 & Tai et al., 2009).
More severe health consequences occur over time if obesity persists. Childhood obesity
increases risk of type 2 diabetes (Shaw, 2007), cardiovascular disease (Maddah, 2008), and
persistence of obesity into adolescence and adulthood (Freedman et al., 1999).
4

As the BMI of US children increase, so do the risks that were once considered adult
diseases. Lifestyle practices such as sedentary behavior, dietary patters, and even parental
obesity in early life can determine the risk for obesity later in life (Reilly et al., 2005). Other
risk factors contributing to child obesity will be discussed later in this review.
A new screening tool, the Family Nutrition and Physical Activity (FNPA) (Appendix
B) screening tool, works to assess family environmental and behavioral factors that predict
the future risk of childhood obesity (Ihmels et al., 2009b). The FNPA tool includes 21
questions about sedentary activities (video games, television viewing, etc.), eating behaviors,
physical activity, as well as family environments. The goal of the FNPA tool is to provide an
indicator of modifiable environments that may predispose youth to becoming overweight
using the FNPA tool in a new 10 question format. This tool may prove useful in advancing
public health efforts but additional research is needed to investigate the uses of the tool.
This literature review will review the development of the FNPA tool, factors that
have been shown to influence risk of obesity, and patterns of parent-child agreement on these
risk factors.
Development and Validation of the FNPA

The FNPA tool was developed from constructs in the American Dietetic Association
(ADA) Evidence Analyses shown to be predictive of childhood obesity
(http://www.adaevidencelibrary.com/category.cfm?cid=7&cat=0). This Evidence Analysis
reports the strength of association for various identifiable risks, using a grading system to
represent strengths of evidence (1: good, 2: fair, 3: limited, 4: expert opinion only, 5: studies
presently lacking). The ADA EA identified ten factors with grades of 2 or 3 and these were
used as the basis for the FNPA tool (see Appendix B). These ten factors are: breakfast
5

patterns, family eating, food choices, beverage choices, restriction and reward patterns,
screen time, television usage, family activity, child activity, and family bedtime routine. This
study provides new information about the utility of the FNPA tool for characterizing home
environments and behaviors related to risk of child overweight. The FNPA total score was
previously shown to predict risk of children becoming overweight even after controlling for
baseline BMI and parent BMI (Ihmels et al., 2009b). The original FNPA tool used a Likert
type scale but this is the first study to use a modified version of the FNPA with behaviorally
anchored rating (BAR) scales. The BAR items are designed to capture each of the 10 FNPA
constructs in 10 single items (See Appendix B) rather than 21 separate items (See Appendix
C). An advantage of the BAR format is that it is also more suitable for use in counseling
applications. The present study replicated some aspects of the original FNPA design but also
addressed several new questions. Other instruments have been developed to measure home
environments (Golan & Weizman, 1998, Bryant et al., 2008). The FNPA is unique in
capturing diverse aspects of the home environment that may predispose youth to become
overweight.
Responses from each item are summed to create a score for the participating family.
Higher FNPA scores suggest a less obesigenic environment. Lower scores suggest a more
obesigenic environment. A recent study (Ihmels et al., 2009a) evaluated the utility of the
FNPA for predicting a childs risk for becoming overweight. There were a total of 854
observed families residing in Midwestern U.S. and they were of various ethnicities (White,
Black, Latino, and Other), education levels, and income levels. The tool was made accessible
online and in paper versions in English and Spanish. Strong correlations between child BMI
and parent BMI were reported, showing that children and parents share similar weight status.
6

Of more interest was the association between child BMI and the overall FNPA score. This
supported the construct validity of the FNPA tool in assessing obesigenic environments when
completed by parents. A follow-up paper by Ihmels et al. (2009b) demonstrated that scores
on the FNPA tool predicted BMI change even after controlling for baseline BMI and parent
BMI.
The table below (Table 1) shows the risk factors addressed in this review, the ADA
EA grade, and current conclusions (evidence statements) drawn by the ADA EA. Additional
detail of these risk factors will be discussed.
7


Table 1. Derived from the ADA Evidence Analysis Library (except Sleep Deprivation)
(http://www.adaevidencelibrary.com/topic.cfm?cat=2792)
American Dietetics Association Evidence Analysis
Risk Factor & Grade Evidence Statement
Energy Intake
Grade 2
Total energy (caloric) intake measured using current dietary
assessment tools, which may not accurately assess total energy
intake does not appear to have a strong association with
overweight in children.
Sweetened Beverages
Grade 2
Intake of calorically-sweetened beverages is positively related to
adiposity in children.

Physical Inactivity
Grade 2
Participation in regular physical activity is associated with lower
adiposity in youth. This association is stronger in boys than in
girls.
Television Viewing
Grade 2
Excessive television viewing is associated with increased adiposity
in youth.
Video Gaming
Grade 3
Excessive use of video games may be associated with increased
adiposity in youth.
Sleep Deprivation
Grade 3
Lower levels of sleep have been associated with increased risk of
overweight in several studies.
Parental Influence
Grade 2
Using family-based counseling including parent training or
modeling as part of a clinical intervention treatment program
results in significant reductions in weight status/adiposity in
children 13 years and younger. The results of studies in older
children and adolescents are inconclusive.

8

Risk Factors for Childhood Obesity
Obesity is a multi-factorial condition that is influenced by many lifestyle factors.
Because genetic risk cannot be altered, it is important to better understand modifiable risks.
The following is a review of studies that have made connections between child BMI and
these lifestyle factors.
Energy Intake
Excess Energy intake has been consistently shown to increase risk for overweight.
Energy intake can be a choice (e.g., vending machines) or a reflection of a childs
environment. Fresh produce available to the child may be dependent upon the neighborhood
they reside in or family income (Dammann, 2009). Those communities that do offer healthy
options can be located too far from the childs place of residence. Factors such as culture,
race and socioeconomic status can play a role in the eating habits of the child (Caprio et al.,
2008). A study of four cities with very high child obesity rates assessed the energy intake of
fifty children from each school within the four cities, and found that these children had diets
that were high in saturated fats, sugar and cholesterol (Rodriguez-Artalejo et al., 2002).
Children with poor nutrition also had higher BMI. Foods high in sugar, fats, and oils, that are
often found in fast-food options, increases the total energy intake and lowers the nutrient
intake of children who eat them (Bowman et al., 2004; Chang & Nayga, 2009). Access to
healthier food options at home and in the school can promote consumption. Increased
consumption of fruits and vegetables is particularly important as these foods have a
protective effect on the body and are important in prepubescent stages (Rockett et al., 2001).
Sweetened Beverages
9

Increased consumption of high calorie beverages such as soda and other sweetened
beverages, instead of water and milk is thought to contribute to child weight gain. Some
studies have linked the intake of sugary drinks and weight gain in youth (Mrdjenovic &
Levitsky, 2003). Others have stated that the connection is near zero (Forshee et al., 2008).
Stronger evidence for the importance of sweetened beverages can be found from intervention
research that has demonstrated reductions in weight of children with high BMI by replacing
sugar-sweetened beverages with water or diet beverages (Ebbeling et al., 2006).
Physical Inactivity
Physical inactivity has been consistently shown to increase risk for overweight.
Children who have a sedentary lifestyle are more likely to gain weight (Laurson et al., 2008)
and children and adolescents have been consistently less active each year (Healthy People
2000; Powell et al. 2009). Of the nations adolescents, 65% did not meet recommended
activity levels and 46% of students did not participate in a physical education class (YRBS,
2007). In particular, the young female population has become less active each year,
particularly of Black ethnic background (Pate et al., 2005).
School is where children and adolescents spend most of their time; therefore this
setting has been commonly recommended as a promising target for intervention. Some
school-based interventions have been successful in their attempts to increase physical activity
levels of adolescent females (Pate et al., 2005; Flores, 1995) and grade school children
(Harrison et al., 2006; Stephens & Wentz 1998; Lazzar et al., 2007), lowering BMI in doing
so. Benefits go far beyond a reduction in weight when increased physical activity is achieved
as active children are at decreased risk for developing other health risks mentioned above
(Obarzanek et al., 1994; Rowlands et al., 1999).
10

Television viewing
Studies have been conducted that relate television watching to childrens unhealthy
eating or overweight (Cheng, 2005). Most studies have demonstrated positive associations
between television and BMI in youth (Laurson et al., 2008; Muller et al., 2002; He et al.,
2009). Intervention studies aimed at reducing TV viewing have demonstrated higher physical
activity rates and in some cases lower BMI and skinfold thickness (Berkey, 2000; Robinson,
1999).
Youth become targets for promotional ads on television, marketing products that are
high in sugar during programs intended for children (Byrd-Bredbenner, 1999). The greater
the TV time the greater the exposure to unhealthy food options. Television receives a
stronger relationship to food intake when the family begins to eat and snack in front of the
television (Francis et al., 2003). Macfarlane et al. (2009) conducted a longitudinal study and
found that children who ate dinner while watching television were more likely to have a
higher BMI than children who did not watch television during dinner. Not only does limiting
television lower the absorption of unhealthy ads in youth, it also increases available time to
be used for physical activity.
Video Games
Computer and video game play, like television viewing, is a sedentary activity that
has consistently increased in popularity among grade school children. Studies have shown
that there is a connection between video game play and weight gain in youth (Skinner et al,
2004). Some have shown that boys are more susceptible to the risk of weight gain, because
girls were less likely to play video games, or played for shorter times (Laurson et al, 2008).
11

The introduction of new interactive video games (ie: Dance Dance Revolution,
Nintendo Wii, Sony Eye Toy) may create a change in the aforementioned results (Maddison
et al., 2009), due to the player using physical activity to interact with screen images. Graf et
al. (2009) found that childrens energy expenditure, heart rate, and perceived exertion were
higher during walking, playing DDR, and playing Wii games than during television viewing.
Energy expenditure was highest during DDR-2 and Wii Boxing, when compared to walking
at 5.7 km/hour. McDougall & Duncan (2008) found that not only did children enjoy playing
the Sony Eye Toy interactive video games but understood and attained the positive health
results from the activity. Increases in physical activity were also identified with the Nintendo
Wii in adults and children, children having higher activity levels than adults (Lanningham-
Foster et al, 2009). Further research is needed to determine if there can be direct benefits of
using other varieties of interactive video games rather than non-interactive television
viewing. Activity gained through gaming is not meant to replace normal physical activity.
Sleep deprivation
Sleep recommendations for children ages 5-12 years are 9-11 hours each night (CDC:
http://www.cdc.gov/sleep/how_much_sleep.htm). A rise in the risk of obesity occurs when
children get less sleep. A longitudinal study by Landhuis et al. (2008) found that shorter
amounts of sleep during childhood are associated with higher BMI in childhood and into
adulthood. Other studies have found similar results and noted that at least ten hours of sleep
is needed for children (Chen et al., 2008, Ozturk et al. 2009, Landhuis et al, 2008, Padez et
al., 2009; Touchette et al., 2008). Padez et al. (2009) found that children of parents who have
low education levels sleep less. Further, children who are less physically active and watch
more television sleep less. The connection between shorter sleep time and increase in weight
12

is hypothesized to be due to lack of hormonal development time provided for the child in
relation to energy expenditure and eating habits prepared in the brain (Taheri, 2006; Sekine
et al., 2002). Even stronger relationships have been found for younger children; sleep
deprivation in early childhood creates a greater risk of obesity (Reilly et al., 2005; Sekine et
al., 2002).
Parental influence

Parenting involves a great responsibility in limiting and promoting behaviors in
children. Behaviors studied include activity habits, diet, sleep and television viewing time.
Parents not only can control these practices, but they are also role models. Most children
mimic or repeat the activities of their parents (Francis et al., 2003), making the parent a direct
influence on the childs adoption of lifestyle habits.
Parental influence over eating in children is complex. Although parents are the
gatekeepers to the meals provided to the child, there can be changes in the childs preference
for meals depending on the rigidity of the parents routines involving food (Costanzo, 1985).
Robinson et al. (2001) alternatively found that girls whose parents have greater control over
their childs eating regimen had daughters with lower weight. Parental feeding restriction has
been shown to be directly associated with child BMI (Joyce & Zimmer-Gembeck,
2009).This topic needs to be researched further to attain more recent and specific results in
relation to culture, race, and SES.
A longitudinal study associated parents BMI with their childs BMI, snacking habits,
and TV viewing (Francis et al., 2003; Whitaker et al., 1998). Both overweight parents and
their overweight children had an increase in BMI over the span of the study, along with
increases in snacking and television viewing time. This comparison between parent and child
13

weight in relation to television viewing time was looked at further by Barradas, et al. (2007)
showed that parental rules limiting childrens TV viewing time was more common in
children whose parents were not overweight. Parental sedentary levels are also a risk for a
childs TV viewing time, an inverse relationship when controlling for income level. A child
having a TV in the bedroom is at increased risk of being overweight (He et al., 2009). Other
characteristics such as parent education level, income level, and perceived neighborhood
safety are inversely related to child BMI, with television viewing identified as the primary
mediator (Cecil-Karb & Grogan-Kaylor, 2009; Morgenstern et al., 2009).
Parenting Style
Parenting styles are also of importance in the lifestyle factors and BMI of children.
Baumrind (1966) created three original parenting typologies: authoritative (provide clear
direction and warm discipline), authoritarian (have clear authority over the child and expects
unquestioning obedience), and permissive (allow child to make their own decisions and
provide minimal punishment). The introduction of the fourth typology was done by Maccoby
& Martin (1983). The fourth typology, uninvolved, characterized parents who had traits of
permissiveness and provided the child little warmth. Parents who were uninvolved did not
demand much from the child and had little control over the childs actions. Figure 1 exhibits
the two-by-two representation of the parenting styles and characteristics.




14

High expectations
for self-control
Low expectations for
self control
High Sensitivity Authoritative:
respectful of childs
opinions, but maintains
clear boundaries
Permissive: indulgent,
without discipline
Low Sensitivity Authoritarian: strict
disciplinarian

Neglectful/
Uninvolved:
emotionally uninvolved
and does not set rules
Figure1. Parenting Styles (Rhee et al., 2006)
Golan & Crow (2004) report that authoritative parenting lead to healthier food
choices and higher activity levels in children, whereas children of permissive parents had
poorer diets and less restriction to unhealthy food intake. Other studies have found matching
results (Patrick et al., 2004; Rutledge et al., 2007; Rhee et al., 2006).
Parenting styles have been compared to demographic information. Most studies, like
those mentioned above, comparing parenting style is on predominantly White, middle class
samples. Studies like these have results that show White parents have more authoritative
parenting styles and Latino have more authoritarian parenting styles (Chaundhuri et al.,
2009). Studies particularly studying parenting styles of low-income samples have found that
these parents have more authoritarian typologies, regardless of ethnicity (Pinderhughes et al.,
2000). This supports the strength of influence income has on parent stress, control, and
sensitivity. Other factors that are determined by income such as number of hours parents
worked (Morawska & Sanders, 2007) and low SES neighborhoods (Roche et al., 2007) are
related to parenting styles. Chaundhuri at al. (2009) explain further that parents of low SES
use authoritarian parenting styles to prepare their children for blue-collar or industrial work.
Parents of high SES use authoritative parenting styles to prepare their children for white-
collar positions where negotiation and creativity is needed.
15

The Parenting Styles and Dimensions Questionnaire (PSDQ) (Robinson et al., 1995)
utilize Baumrinds (1966) original three typologies, not including Maccoby & Martins
(1983) typology of uninvolved parenting style. Studies have used the PDSQ in various ways;
some include relating parenting style to childrens attachment, temperament, and school
adjustment (Coplan et al., 2008; Coplan et al., 2009; Karavasilis et al., 2003). Blissett &
Haycraft (2008) found no correlation between parenting styles and child BMI, using the
PSDQ, but did find relations between parental pressure to eat and parental drive for thinness
and lower child BMI. Permissive parenting and childs temperament increased the odds of
the child being obese (Zeller et al., 2008). Hubbs-Tait et al., (2008) conducted a similar study
and discovered that parental feeding practices can predict parenting styles.
Parent and Child Agreement
Studies have indicated that certain issues can lower parent-child agreement (Grills &
Ollendick, 2002) but few have studied agreements in factors that are related to child weight
gain. Tak et al. (2006) studied parent-child agreement on fruit and vegetable consumption.
Children in this study reported higher values than did parents at baseline and one year
follow-up. Low consumers of fruits and vegetables had higher parent-child agreement than
those who reported high consumption of fruits and vegetables. Tak et al. (2006) suggest that
child participants (elementary grade 4) may have overestimated their fruit and vegetable
intake.
Reported eating styles of overweight children and their parents are studied by Braet et
al. (2007), who finds that parents rated the emotional and external eating of their overweight
children higher than the child. Parents produced lower ratings of restrained eating than their
child counterpart. Agreement was lowest for children under the age of ten. The low parent-
16

child agreements propose that parents and overweight children attribute their reasons to
eating differently.
Television viewing times reported by parents have shown to underestimate their
childrens reports (Rossiter & Robertson, 1975). In this study parents rating of household
rules, television co-viewing with child, parent-child interactions were all also higher than
their child counterparts. Parent and child report differences increased with socioeconomic
status. These results suggest a higher bias of social desirability for more affluent families.
Significant differences in parent and child reports were found in relation to estimated
child sleep time (Gruber et el., 1997). Children estimated sleep time more accurately than did
parents. Goodwin et al. (2007) compared parent reports of child sleep time to
polysomnography output to determine accuracy of parent reports. Parents were found to
overestimate the habitual total sleep time of their child. Hispanic parents significantly less
than Caucasian parents.
Parental behaviors (control, discipline, acceptance, and rejection) have presented low
parent-child agreement (Tein et al., 1994) and children rate parental behaviors of mothers
and father similarly. Suggesting that if either of the parents practices a behavior of warmth or
control, children perceive the behavior is directed from both parents. In this study children
older than age 10 disagree with mothers on degree of discipline.
The aforementioned studies all support that children and their parents differ on
reports of behaviors that have all been related to child weight gain. Grills and Ollendick
(2002) suggest possible issues with parent-child agreement including miscommunication
between parties, family conflict, child age, child and parent social desirability, etc.
17

Regardless of the reasons behind the difference in parent and child reports the consistent
result is that they do not usually correspond.

Conclusion


The risk factors for obesity in children include high energy intake, physical inactivity,
television viewing, sleep time, and parental influence and parenting style. Each of the risk
factors has their own influence on potential risk of weight gain. Parent-child agreement is
also very low in reporting of these risk factors. The FNPA tool is a potentially useful
screening instrument that can evaluate the likelihood of a child being overweight prior to
weight gain This project will advance research on the FNPA tool by evaluating whether child
ratings (scores) of the home environment are similar to parents ratings. If there is an
agreement between parent and child FNPA scores, it can help identify ways to promote
healthier environments in the home. Differences in FNPA scores can shed light on the
environmental and behavioral factors that could be perceived differently by parents and
children. Another objective of this study is to identify parenting styles that may be associated
with ratings of home environment, identified by the FNPA tool. Comparing these two factors
can help determine a childs risk for obesity increases according to their parents typology.
BMI is also of interest in relationship with parenting styles. This finding would support the
predicted risk determined by the FNPA tool. These questions will be examined in this
research study.
18

METHODS

Participants
The sample of this study includes a total of 313 elementary grade students (155
males, 158 females) and 77 of their parents (83%, Mothers) from a low socioeconomic status
Midwest elementary school in the state of Iowa. The surveys were administered to the
students during their physical education class. All students grades K-5 were welcome to
participate, 27% of students opted out of completing the survey.
BMI data were collected from all students (average age of the elementary students
was 8.56 +1.73 (5-11years). Descriptive statistics for BMI percentile are provided in Table 2
to characterize the prevalence of overweight in this sample. The mean BMI for students was
19 +4 kg/m
2
and this corresponded to an average BMI percentile of 68.3% +28.3. Based on
the standard CDC definitions, approximately 61% of participants were normal weight, 18%
were at risk for overweight (85
th
-95
th
percentile) and 21% were classified as overweight
(>95
th
percentile). The distributions for males (48%, 22%, 26%) were slightly different than
females (64%, 15%, 17%). The average BMI percentile for youth with parent FNPA data
was 65.4 % (males: 68.1%; females: 64.1%). Free and reduced lunches are provided to
80.1% of students.
Data on FNPA were obtained from 312 children involved in the project. The goal of
this study was to obtain corresponding FNPA scores from each parent but surveys were
returned from only 73 parents (25%). Most parents (48%) of students were between 30-40
years of age; 55% of the parent sample was White followed by 17% Hispanic, 10% Black,
8% Asian or Pacific Islander, and 9% Multi-racial. The majority of parents (50%) had
income levels below $25,000 per year, 35% had income between $25,000-50,000 per year,
19

7% had income between $51,000 75,000 per year, and 8% had income greater than $75,000
per year. The 85% of families with income below $50,000 per year and 80% of children on
free and reduced lunch support this sample being classified as a low SES. Parent education
level varied; 14.3% completed some high school, 26% completed high school, 37.7%
completed some college, 22% completed college.
Table 2. Descriptive data for children by gender and grade
Male Female
N Mean
BMI %
SD N Mean
BMI%
SD
All Grades 155 72.9 27.2 158 63.6 28.5
Grade 0 24 71.7 29.4 20 67.6 23.6
Grade 1 35 70.9 25.0 19 54.7 32.3
Grade 2 20 72.8 24.6 34 71.8 28.7
Grade 3 31 64.5 30.4 28 66.2 27.1
Grade 4 21 82.8 21.3 26 58.6 30.2
Grade 5 24 74.5 32.6 25 62.6 28.9

Procedures
The sensitive nature of the study necessitated the use of procedures to ensure
confidentiality of the participants. Specifically, the study required merging childrens self-
report data (and BMI) with parents self-report data in a confidential manner. To accomplish
this, student ID numbers from class lists were pre-printed on both a student survey and a
separate parent survey form (with informed consent form attached). Directions on how to
complete the FNPA survey were provided to the students and each question was read aloud
20

by trained testers to assure understanding for the elementary students. Students had their
height and weight measured by trained testers and then completed the FNPA assessment
during a separate class period. This took most students about thirty minutes to complete. A
TANITA BF-681W (Tokyo, Japan) scale was used to measure weight and a SECA Road Rod
stadiometer (Hanover, MD) was used to measure height. The height and weight data were
recorded on a form along with student ID to facilitate tracking and computation of BMI.
After students completed the testing they took parent packets home for parents to
complete and return to school. Two weeks after the first distribution of parent packets (parent
FNPA and PSDQ), there was a second distribution for those yet to return the first. This study
was approved by the Iowa State University Institutional Review Board.

Instruments
Family Nutrition and Physical Activity (FNPA) assessment - Adult Version
The FNPA was used to collect detailed information on home environments and
behavior related to overweight youth. The FNPA measures ten risk factors (constructs)
associated with overweight/obesity in children: (1) breakfast patterns, (2) family eating, (3)
food choices, (4)beverage choices, (5) parental restriction and reward, (6) TV/ video game/
computer screen time, (7) TV usage, (8) family activity, (9) child activity, and (10) family
bedtime routine. One question in a BAR format is assigned to each of the aforementioned
constructs, creating the 10 items. Each item is asked in terms of frequency (usually, often,
etc.). Responses have a minimum of 1 point (most obesigenic) and a maximum of 3 points
(least obesigenic). Responses to the 10 items are summed for a total score. The maximum
total score of 30 would be the healthiest home environment and the minimum score of 10
21

would be the home environment with a high risk for obesity. A Spanish version of the FNPA
Adult Version was created for the large proportion of parents whose first language was
Spanish.
The constructs are based on factors shown in a comprehensive evidence analyses to
be predictive of child overweight. The total score reflects the overall obesigenic nature of the
home environment; low scores indicate a more obesigenic (high risk) environment while high
scores are indicative of healthy (low risk) environments. Previous research has supported the
construct validity (Ihmels et al., 2009a) and predictive validity (Ihmels et al., 2009b) of the
FNPA tool.
FNPA - Child Version
The phrasing on the Adult Version of the FNPA tool was modified to fit an
elementary reading level. A pilot testing of the child version was conducted on children ages
5-14 from varying school districts. Students were able to understand each of the items when
read aloud to them. The same basic structure of the parent version was retained in the child
version. The FNPA Youth Version uses the same constructs as the aforementioned Adult
Version with the same scoring concept (Appendix D).
Parenting Styles and Dimensions Questionnaire (PSDQ)
The PSDQ is designed to characterize parenting styles of preschool and school-age
children (Robinson et al., 1995). The tool was designed around Baumrinds (1966, 1991)
three main typologies (authoritative, authoritarian, and permissive) but there is no specific
classification scheme available to determine a predominant style. The instrument includes 58
questions scored on a 1-5 scale and the items are clustered into different stylistic dimensions
which are then aggregated to create separate scores for each of the three typologies.
22

Reliability of the individual PSDQ scales ranged from .91-.75 (Robinson et al., 1995).
Questions such as I ignore our childs misbehaviors help to determine parents
permissiveness; other questions such as I demand for our child to do things help to
determine parents authoritarian styles.
Different stylistic dimensions are used to characterize the three parenting typologies.
Stylistic dimensions of permissiveness include lack of follow through, ignoring misbehavior,
and self-confidence. Authoritative stylistic dimensions include warmth and involvement,
reasoning/ induction, democratic participation, good natured/ easy going. Authoritarian
stylistic dimensions are verbal hostility, corporal punishment, non-reasoning/ punitive
strategies, and directiveness. The number of items in each stylistic dimension varied to mean
scores. These were first computed for each dimension. The total composite score for each
parenting typology was determined by computing an average of each of the associated
stylistic dimensions. This weights each stylistic dimension equally rather than basing the
overall typology on the mean of all associated items. Four questions were removed from the
original questionnaire to avoid reporting types of corporal punishment.
Data Analysis
The data analyses for the present study were conducted using SAS. The student BMI
and FNPA data were first merged with the parent FNPA data by school ID. Demographic
data obtained from the school district were then merged into the dataset (by school ID) to
create the final dataset. Student BMI, an outcome measure presents some challenges when
used to summarize data across different age groups of children. To provide a common
indicator it was necessary to convert the BMI data into standardized scores. Specialized SAS
programs available from the CDC were used to convert the student BMI data into BMI
23

percentiles (BMIpct) and BMI z-scores (BMIz). These were used to categorize students into
weight categories and for all subsequent analyses. Data analyses were conducted to answer
the two primary research questions in the study.

Research Question 1: (Agreement between parent and child FNPA scores)
One key research question was to determine whether a child version of the FNPA
scores yielded similar results. The revised format of the FNPA uses a different format
(behaviorally anchored rating scores) than the original (Likert). Therefore, it was important
to first evaluate the reliability of this new format (for both children and parents). Cronbachs
Alpha was calculated to measure internal consistency of the 10 item format of the parent and
child FNPA. Because age and gender may influence the childrens responses the alpha
reliability of child responses were examined separately by age group (younger: K-2; older: 3-
5).
Several analyses were conducted to evaluate agreement between parent and child
scores. Pearson product moment correlations were computed among the parent and child
FNPA scores to examine overall agreement between the two measures. Correlations were
examined separately by age and gender to test for any differential relationships. Differences
between the parent and child total FNPA scores were examined with a simple t-test.
Differences in individual items were also examined to determine whether there was
variability in parent and child perceptions of specific home environments or practices. These
relationships were also examined separately by age and gender. The primary determinant of
agreement was whether they possessed similar correlations with measured BMI. Comparing
the associations between the parent and child versions make it possible to see if associations
24

were similar for the parent and child version. These correlations were also examined
separately by age group and gender. Collectively, these analyses are designed to determine
whether parental and child evaluations of home obesigenic environments are similar and
whether they are equally effective at predicting risk of overweight.

Research Question 2: (Relationship between Parenting Style, FNPA scores, and child BMI)
The second goal of these analyses was to determine whether aspects of parenting
style (based on the PSDQ scales and Baumrinds typologies) were associated with child BMI
and parent FNPA scores. The computed scores for each typology provide an indicator of the
overall score for each person but the goal in this study was to determine if certain parenting
styles are associated with high or low scores on the FNPA. Therefore, it was important to try
to characterize typologies on a more relative basis. To accomplish this parenting typologies
were converted into Z-scores. This allowed the value for each typology to be interpretable
relative to others in the sample. Parents can then be classified as more or less authoritative,
more or less permissive, or more or less authoritarian.
It is possible for parents to score high on some typologies but low on others. Figure 2
shows a two-by-two representation of possible styles that Baumrinds typologies do not
include, represented by the shaded areas. Amounts of control and warmth can vary in a
parent and dimensions are not mutually exclusive. In other words, it is possible to score high
(or low) on each of the typologies. To examine this, a total of 8 distinct groups were created
based on whether parents scored above the mean (+z) or below the mean (- z) on the
individual scales. The 8 groups represent all possible combinations of these three variables.
The characterizations of the 8 groups are summarized in Table 3. Frequencies of
25

classification were computed to determine the relative distribution based on this
classification scheme. Mean FNPA scores and BMI percent scores for each group were then
compared using a simple ANOVA to examine possible differences in groupings.


Figure 2. Missing parenting style representations (Kim & Rohner, 2002)
26


Table 3. Statistical categorization of parenting styles (0- below the mean, 1- above the mean)
Group Authoritative Authoritarian Permissive
1 0 0 0
2 0 0 1
3 0 1 0
4 0 1 1
5 1 0 0
6 1 0 1
7 1 1 0
8 1 1 1

A limitation of this approach is that it forces categorization using arbitrary cutpoints.
Therefore, additional analyses were conducted to examine the patterns in more detail. Cluster
analysis was employed to determine if there were any natural distinctions or patterns in the
data. This empirically derived approach may be useful for identifying patterns in the PSDQ
classifications that may be associated with particularly high or low FNPA scores. The cluster
analysis used Wards method with squared Euclidian distance (maximize cases further apart
and therefore increasing the differences between clusters, viewed as the most popular
method), and the cluster solution was defined to identify the most appropriate number of
clusters based on the visual illustration of the resulting dendogram (see Appendix A: Figure
13).
27

Regression analysis was also used to determine if parenting styles were related to
FNPA and child BMI. The value of the regression approach is that it allows the relative
weight of each of the individual factors to be empirically determined. Separate regression
analyses were conducted for FNPA and BMI percent outcome measures.
28

RESULTS
Descriptive Results
To characterize the sample population, the outcome variables (BMI percent and
FNPA score) were stratified by demographic variables. Figure 3 shows the difference in
child BMI percent by Ethnicity Group, Figure 4 shows the difference in FNPA score by
Ethnicity Group, Figure 5 and 6 shows the same variables stratified by Income Level. Due to
inconsistent results, parents who classified as Multi-Racial werent included in this analysis.
The results show no significant relationship between child BMI percent and Ethnicity. White
parents reported the highest FNPA score. No association was found between parents income
level and the childs BMI percent. No association was found when parent FNPA scores were
stratified by income level. The sample sizes for income levels higher than $50,000 were very
small. This prevents generalizations about these patterns to higher income levels so results
are intended to be used only for descriptive purposes.
BMI percent by Ethni ci ty
30
40
50
60
70
80
90
100
110
1 2 3 4
Ethnicity Gr oup
B
M
I

-

p
e
r
c
e
n
t

(
m
e
a
n
)

Figure 3. Child BMI percent stratified by Ethnicity Group (1: Asian or Pacific Islander, 2: Black, 3:
White, 4: Hispanic)
29



Parent FNPA by Ethni ci ty
22
23
24
25
26
27
28
29
1 2 3 4
Et hnicit y Gr oup
P
a
r
e
n
t

F
N
P
A

S
c
o
r
e

(
m
e
a
n
)

Figure 4. Parent FNPA scores stratified by Ethnicity Group (1: Asian or Pacific Islander, 2: Black, 3:
White, 4: Hispanic)

BMI per cent by Income
50
60
70
80
90
100
110
1 2 3 4
Income Level
B
M
I

p
e
r
c
e
n
t

(
m
e
a
n
)

Figure 5. Child BMI percent stratified by Income Level (1) <$25,000, (2) $25,000- 50,000, (3) $51,000
75,000, (4) > $75,000

30

Parent FNPA by Income
20
21
22
23
24
25
26
27
28
1 2 3 4
Income Level
P
a
r
e
n
t

F
N
P
A

(
m
e
a
n
)

Figure 6. Parent FNPA scores according to income level: (1) <$25,000, (2) $25,000- 50,000, (3) $51,000
75,000, (4) > $75,000

Results for Research Question 1: Agreement between Parent and Child Versions.
Cronbachs alpha was first used to examine the internal consistency of the 10 parent
and child FNPA dimensions. The alpha reliability score for the parent FNPA was a =.68
while the value for the child FNPA was a =.71. According to Nunnaly (1978), values above
0.70 are indicative of acceptable internal consistency. While the values for parents were a bit
lower it is possible that this is due to the smaller sample. The results indicated that the
deletion of any single variable would not improve the alpha coefficient. This indicates that
the scale is most internally consistent with all items included. The reliability test was taken a
step further by stratifying child FNPA responses to age groups. Results showed low
reliability for the younger sample (a =.58) than for the older sample (a =.76). This suggests
that younger children may not be able to provide internally consistent responses on the
FNPA.
31

Correlations were used to examine the relationships among the key main outcome
measures. The correlations between parent and child FNPA scores were low (r =.19) and not
significant (p =.13), indicating relatively poor agreement between these indicators. The
correlation between parent FNPA scores and the students BMIpct score was analyzed. The
correlations were variable but consistently negative for most grades (ranging from r =-.16 to
r =-.66), with the exception of a somewhat spurious finding for fourth grade youth (r =.14).
The data for this age group were examined in more detail and three outliers were detected
that may have caused the discrepant value. When these were removed from the group of
fourth graders being analyzed, the correlation for this age group increased (r =-.17), making
the composite correlation across all grades strengthen to statistical significance (r =-.31).
Correlations between the child FNPA score and child BMIpct scores were
considerably lower. The correlations ranged from r =.03 to r =-.26 across grades with the
composite correlation (based on all students) of r =-.08.
Correlations were also examined among the various items in the FNPA tool (See
Table 4). The correlations with BMIpct for individual items ranged from r =.03 to r =-.28.
Interestingly, the highest correlations with BMI were found for breakfast eating patterns and
sleep patterns items not typically thought to have a direct impact on overweight. The
correlations of the individual items with the parent FNPA total score ranged from r =.44 to r
=.57. In all cases, each item was more strongly correlated with the total parent FNPA score
than with any other item (see Table 4). Child FNPA correlations were mostly non-significant
r =-.06 to r =.19, other than TV usage (r =.26).
32


Table 4. Correlations between FNPA factors, parent, and child FNPA totals
*p<.05, **p<.01

Brkfst
Family
Eating
Food
Choice Beverage
Restr
&
Rewrd
Screen
Time
TV
Usage
Family
Act.
Child
Act.
Bed
time Pttl Cttl
BMIperct 0.28* -0.01 -0.10 -0.01 0.03 -0.10 -0.17 -0.06 -0.06 -0.26* -0.27* -0.08
Brkfst .28* 0.21 -0.01 .25* 0.12 .29* 0.08 0.06 -0.25* 0.47** 0.19
Family Eating .33** 0.19 0.22 .28* 0.21 0.09 0.06 0.23 0.56** 0.17
Food Choice 0.04 .35** 0.00 0.07 .288* 0.02 0.34** 0.51** 0.01
Beverage 0.12 0.14 0.22 .256* .26* 0.14 0.48** -0.06
Restr & Rewrd 0.22 .39** 0.08 .27* 0.18 0.57** 0.08
Screen Time .42** 0.04 0.04 0.21 0.49** 0.10
TV
Usage 0.16 .24* 0.03 0.59** 0.26*
Family Act. 0.20 0.21 0.51** 0.06
Child
Act. 0.12 0.44** 0.19
Bed time 0.51** 0.01
Pttl 0.19

Further investigation was conducted according to age group: 1 (K-2
nd
grade) and 2
(3
rd
-5
th
grade) and gender (male, female). Group 1 child FNPA correlations with BMI percent
were not significant (r =-.12). Group 1 parent FNPA had a significant correlation with BMI
percent (r =-.54). Group 2 child FNPA correlations with BMI percent were even lower than
group 1 (r =-.04), parent FNPA shows a similar trend (r =-.15). Parents of males (r =-.32)
and females (r =-.23) had correlations with BMI. Parents FNPA of group 1 females had a
significant correlation with BMI percent (r =-.55). Parents of group 2 females did not have a
significant correlation (r =-.07). Both groups 1 and 2 females had low correlations with BMI
percent (r =-.10, r =-.13). Parents FNPA of group 1 males had a significant correlation with
BMI percent (r =-.62), parents of group 2 males did not (r =-.22). Both groups 1 and 2
33

males had low correlation with BMIpct (r =-.17, r =-.07). Parent FNPA correlations were
stronger for male children, especially those in group 1.
Direct comparisons were also made to determine if the parent and child FNPA scores
were significantly different from each other. The overall score was not significantly different
(t =1.56 (64), p =.13). Additional tests were made for individual items and it was clear that
there were large disparities for individual items. Difference scores were computed for each
item (parent - child) so items with positive differentials reflect items that parents rated as
more healthy (less obesigenic) than children (see Figure 7). Significant positive differentials
were found for items 2 (t =2.82 (68), p =.006), 4 (t =2.12 (68), p =.038), 5 (t =2.28 (67), p
=.026), and 7 (t =6.2 (68), p <.001). A significant negative differential was found for item
10 (t =-3.07 (68), p =.003).

Figure 7. Difference scores for parent and child FNPA reports for each factor (parent score child score)
*p <.05, **p <.01, p<.001

Parent and Child FNPA Difference
Bed Time**
Child Act.
Family Act.
TV Usage
Screen Time
Rest. And Reward*
Brkfst Patterns
Family Eating**
Food Choices

Beverage Choices*
-0.4 -0.2 0 0.2 0.4 0.6
1
2
3
4
5
6
7
8
9
10
F
N
P
A

F
a
c
t
o
r
s

Difference Score
34

Stratifying differentials by age and gender produced more extreme differences on
several variables. The difference between parent and young child ratings of screen time was
significant (t =2.7 (23), p =.013), as was parent and females ratings of screen time (t =3.92
(11), p =.002). Older childrens television usage (t =5.38 (44), p <.0001) was also found to
be significant.
Results for Research Question 2: Parenting Style, FNPA scores, and child BMI
The PSDQ was used to characterize parents into 8 different groups. There was
considerable variability in responses to the PSDQ and this led to clear distinctions in the
parenting style groups (See Table 5).
Table 5. Description and Frequencies of Parenting Style Groups
Parenting Style Groups
Group Description n =
1 Parents with low responses to all parenting styles 12
2 Parents who are overall more permissive 7
3 Parent who are overall more authoritarian 5
4 Parents with stylistic dimensions in both authoritarian and permissive 14
5 Parents who are overall more authoritative 17
6 Parents with stylistic dimensions in both authoritative and permissive 3
7 Parents with stylistic dimensions in both authoritarian and authoritative 5
8 Parents with stylistic dimensions in all parenting styles 14

A cluster analysis was used to group parent FNPA z scores according to parenting
styles. Based on the dendogram (see Appendix A: Figure 13), three clusters were found to
35

categorize parent responses according to reported stylistic dimensions of authoritative,
authoritarian, or permissive parenting style (see Figures 9 & 10). One of the clusters (cluster
2) was not used because parents within it rated high in all three parenting styles; this report of
equal typologies is uncommon with both the PSDQ (Robinson et al. 2001, Coolahan et al.,
2002) and the adapted version of the PSDQ (PBQ: Hart et al., 1998).
The other two clusters were clearly interpretable so these were focused on in the
analyses. Authoritarian and permissive parenting styles are considered to be less effective
parenting styles than authoritative. Therefore a low amount of permissive or authoritarian
ratings would be expected to be associated with better home environments (higher FNPA
scores). High scores on these variables would be expected to have the opposite effect (lower
FNPA scores). Consistent with this expectation, cluster 1(Figure 9) shows that parents who
were less authoritative (and more permissive / authoritarian) had lower scores on the FNPA
(indicative of more obesigenic environments). In contrast, cluster 3 (Figure 10) shows that
parents who were more authoritative had higher FNPA scores (less obesigenic environment).
The clusters exhibit the expected relationship but it is not possible to determine if the
presence of a favorable trait (authoritative) is more important than the absence of a more
negative one (e.g. permissiveness or authoritarian)
36

Cluster 1- Low Parent FNPA
-1.2
-1
-0.8
-0.6
-0.4
-0.2
0
0.2
0.4
0.6
Authoritarian Authoritative Permissive
P
a
r
e
n
t
i
n
g

S
t
y
l
e

z
-
s
c
o
r
e

Figure 9. Parenting style trends of less obesigenic parent FNPA scores
Cluster 3- High Parent FNPA
-1.5
-1
-0.5
0
0.5
1
Authoritarian Authoritative Permissive
P
a
r
e
n
t
i
n
g

S
t
y
l
e

z
-
s
c
o
r
e


Figure 10. Parenting style trends of more obesigenic parent FNPA scores

Regression analyses were conducted to determine the relative importance of the three
parenting typologies on parent FNPA scores and child BMI percent. Regressions illustrated
that authoritative parenting (t =3.66 (30), p =.001) was the only significant predictor of
obesigenic environments. Authoritarian (t =-.02 (30), p =.985) and Permissive (t =-.20 (30),
p =.841) were not. Parenting styles were not significant predictors of child BMI percent.
37

DISCUSSION
This study provides new information about the use of the FNPA tool. One goal was to
determine whether parents and their children provide similar ratings of their home/obesigenic
environments as assessed by the FNPA. Both the child and parent versions were found to
have reasonable internal consistency but clear age related differences were noted for the child
version. Reliability was good for the older sample but not for younger samples. These results
show that older children are more reliable in rating their home environments than younger
children. The results support the utility of the FNPA for adults and older children but not
younger children. It may be that as children transition into preadolescence they are more
aware of their behaviors and have greater control in making some decisions about lifestyle
habits.
Correlations were low between the child and parent versions of the FNPA tool
suggesting poor agreement. The actual test of differences in mean FNPA values was not
statistically significant (suggesting parent-child agreement) but there is wide variability in
parent and child responses on individual items. The score differentials in evaluations between
parent and child were greatest when determining TV usage, family eating, and bedtime
routines. Parents underestimated the child in TV use and frequency of fast food consumption
in front of a television. This result confirms Rossiter & Robertsons (1975) study that
suggested parents reported significantly lower television viewing time than their children.
Social desirability is a determining factor in parent reports of their childs television viewing
time and this may explain the results. Parents provided lower reports of sleep time than the
child but this does not agree with findings from other studies. Goodwin et al., (2007)
compared child and parent reports of sleep time to actual sleep time and found that parents
38

reported longer sleep times than the child reported. A possible explanation to parents
underestimation of child sleep times could be that when completing the survey/questionnaire
the parent is considering just the bedtime of the child and assumed hours of rest. There may
also have been a misinterpretation of the recommended time span of sleep for children due to
the BAR format of the questionnaire. If parents are less aware of this, social desirability may
have influenced parents responses. Unlike other studies (Goodwin et al., 2007; Gruber et al.,
1997), there is no comparison of reports to actual measured sleep times in children to
determine who is a more reliable source on the subject.
Taken together, results suggest that children and parents do not provide similar
ratings of their home environment. Age and gender of the child was looked at as a possible
reason to the difference and what was found was that parents of males in K-2
nd
grade had the
highest correlation with BMI percent. Younger children were more predictive of BMI using
the child FNPA. These results could support the idea that older children have more autonomy
than younger children. Parents may not know all meals that the child intakes and television
that is watched. Parents of older children may also use the television as the babysitter and
assumes the childs behaviors. Regardless of the cause, the results here suggest that children
do not provide similar evaluations to parents.
Differences in the accuracy of FNPA reporting can be inferred by examining the
correlations with child BMI. The correlations between parent FNPA and BMI percentile
were considerably higher (r =-.31) than values between the child FNPA and BMI percentile
(r =.02). While the values are low in absolute terms, the values for the parent FNPA are
larger than the values reported by Ihmels et al. (2009a) using the original Likert scale (r =-
.173). The Ihmels study demonstrated predictive utility of the FNPA for detecting risk of
39

overweight so these relatively low correlations are still noteworthy. The correlations with the
BAR format suggests that this format may work as well or better for parents characterizing
home environments but the small sample makes it hard to draw too many conclusions.
A second goal of the study was to determine whether parenting styles relate to parent
and child FNPA scores. An interesting outcome from the study was the finding that FNPA
scores were related to parenting styles. Parents who were more authoritative rated their
homes as less obesigenic. Parents who were less authoritative rated their homes as more
obesigenic. Previous studies (Rhee et al., 2006; Rutledge et al., 2007) have reported that
permissive parenting was associated with an increased risk of overweight, relative to
authoritative parenting. Authoritative was the single parenting style predictive of parent
FNPA scores in the regression analyses. Several studies (Golan & Crow, 2004; Kremers et
al., 2003; Schmitz et al., 2002) have found that authoritative parenting styles are associated
with positive health behaviors such as child fruit and vegetable consumption and child
physical activity levels. The results from the cluster analyses confirmed that parenting styles
had an impact on the FNPA scores as clear in differences in cluster 1 and 3.
Interestingly, regression analyses revealed that none of the parenting styles were
significant predictors of child BMI. Other studies have found similar results (Blissett &
Haycraft, 2008; Hennessey et al., 2010, Hughes et al., 2008). A number of other variables
have shown to be significant predictors of child BMI. Parent BMI for example has been
found to be a strong predictor of child weight gain (Francis et al., 2003). This suggests a
genetic component may have a stronger (over-riding) impact on BMI than the environment
although this study cant determine this.
40

This study differs from previous research by using parenting styles and finding
relationships between them and obesigenic environments in children by using the FNPA tool.
Blissett & Haycraft (2008) has used the PSDQ and found no relationship between parenting
styles and child BMI. The null findings in the previous study may be due to the use of
individual items such as restricting feeding styles. An advantage of the FNPA tool is that it
captures multiple dimensions of the home environment. As previously described each item
exhibited the highest correlation with the parent FNPA total score findings comparable to
the results found by Ihmels et al. (2009a) see Table 4 and Appendix A: Table 6). This
similarity suggests that the parent responses to the FNPA collectively capture the overall
obesigenic nature of the home environment.
The associations with parenting style are interesting but further work is needed to
determine the best methodology to categorize parents into a single parenting style group. In
the validation literature, (Robinson et al., 1995) detail was not provided in how the stylistic
dimension responses translate into definitive parenting styles, resulting in eight categories
instead of three. The cluster analysis was essential in determining typologies of parenting
according to home environment ratings. The PSDQ has been used to measure parenting
styles in relation to attachment (Karavasilis et al., 2003), shyness (Coplan et al., 2008),
temperament (Coplan et al., 2009), and feeding practices (Hubbs-Tait et al., 2008). This
study is the first to compare 10 factors shown to be significant in child weight gain with
parenting styles, finding that parents who are less authoritative have children with a higher
risk of obesity.
Limitations to this study include a low response rate from parents of children who
participated. This may be due to the large percent of low income families; there may be less
41

time available or less perceived incentive to complete the survey. This low response rate
would limit the generalizability of the results. Further research would be needed to find if
these results are plausible across all SES levels and minority groups. Another limitation
would be the possible bias reporting from parents, some questions may seem probing or
personal and parents may answer falsely, if at all.
Future questions to be answered are whether parenting styles are correlated with
demographic information such as age, education level, etc. Another question may be whether
child FNPA factors such as consumption of sweetened drinks and physical activity level are
related to parenting styles. Longitudinal data would also be of value in extension to this
cross-sectional analysis; patterns of control may vary over time in parents of young children.
Answers to these questions would be beneficial to programs working to lower childhood
obesity rates by incorporating of the family and home environment.
42

CONCLUSION
This study provides information on the differences between parent and child
perceptions of obesigenic environments and can be helpful in a variety of intervention
settings. In this low-income sample parent-child agreement is low. Parents were better at
rating home environments for younger children. Older children were better at rating home
environments than younger children. Parents who are more authoritative rate their
environments as less obesigenic. Authoritative parenting was the best predictor of FNPA and
no significant predictor was determined for child BMI. Few studies incorporate the child,
parent, and home environment as all part of the transition into a healthy lifestyle; this study
may help promote change in those practices.
43


APPENDIX A: ADDITIONAL RESULTS
FNPA vs. BMIz
-2
-1
0
1
2
3
17 19 21 23 25 27 29 31
Parent FNPA Score
C
h
i
l
d

B
M
I

Z
-
s
c
o
r
e

Figure 11. Child BMI z-scores by parent FNPA scores



Figure 12. Bland Altman Plot- FNPA differences compared to mean FNPA difference


44


Table 6. Acquired from Ihmels et al., (2009a)


45








Figure 13. Dendogram grouped distribution by ID numbers

46

APPENDIX B: FAMILY NUTRITION AND PHYSICAL
ACTIVITY ASSESSMENT ADULT VERSION
Family Nutrition and Physical Activity Assessment (Adult Version)
Instructions: For each category, circle the description that best fits your child or your
family. It is important to indicate the most common or typical pattern and not what
you would like to happen.
1.
Breakfast
Patterns
My child rarely eats
breakfast and we dont
typically eat together as
a family.
My child does not
regularly eat breakfast
but we eat together as
a family on most days
of the week.
My child eats
breakfast on most
days but we dont
typically eat together
as a family.
My child eats
breakfast on most
days and we
typically eat
together as a family.
2.
Family
Eating
Our family regularly
eats fast food and we eat
while watching TV.
Our family regularly
eats fast food but we
rarely eat while
watching TV.
Our family rarely
eats fast food but we
eat while watching
TV.
Our family rarely
eats fast food and
we rarely eat while
watching TV.
3.
Food
Choices
Our family uses
prepackaged foods
frequently and we
usually do not eat fruits
and vegetables with
meals (or as snacks).
Our family uses
prepackaged foods
frequently but we
regularly consume
fruits and vegetables
with meals (or as
snacks).
Our family eats
mostly freshly
prepared meals but
we usually do not eat
fruits or vegetables
with meals (or as
snacks).
Our family eats
mostly freshly
prepared meals and
we regularly
consume fruits and
vegetables with
meals (or as snacks).
4.
Beverage
Choices
Our child frequently
drinks soda pop or other
sweetened drinks, and
rarely drinks low fat
milk with meals or at
snacks.
Our child frequently
drinks soda pop or
other sweetened
drinks but frequently
drinks low fat milk
with meals or at
snacks.
Our child rarely
drinks soda pop or
other sweetened
drinks, but rarely
drinks low fat milk
with meals or at
snacks.
Our child rarely
drinks soda pop or
other sweetened
drinks, and
frequently drinks
low fat milk with
meals or at snacks.
5.
Restriction
and
Reward
I dont monitor my
childs snack food
consumption and snack
foods such as candy are
frequently used as a
reward for good
behavior.
I dont monitor my
childs snack food
consumption but
snack foods such as
candy are not used as
a reward for good
behavior.
I monitor my childs
snack food
consumption but
snack foods such as
candy are used as a
reward for good
behavior.
I monitor my childs
snack food
consumption and
snack foods such as
candy are not used
as a reward for good
behavior.
6.
Screen
Time
My child watches
television or plays on
the computer (or with
video games) for more
than 4 hours each day.
My child watches
little television but
plays on the computer
or with video games
for 2-4 hours each
day.
My child doesnt
play on the computer
(or with video
games) but watches
television for 2-4
hours each day.
My child watches
television or plays
on the computer (or
with video games)
less than 2 hours
each day.
7.
Television
Usage
I rarely monitor the
amount of TV my child
watches and my child
has access to a TV in
I monitor the amount
of TV my child
watches but my child
has access to a TV in
I rarely monitor the
amount of TV my
child watches but
my child does not
I monitor the
amount of TV my
child watches and
my child does not
47















his/her bedroom. his/her bedroom. have access to a TV
in his/her bedroom.
have access to a TV
in his/her bedroom.



8.
Family
Activity
I rarely participate in
physical activity (e.g.
walking) and our family
does not play games
outside, ride bikes, or
walk together very
often.
I participate regularly
in physical activity
(e.g. walking) but our
family does not play
games outside, ride
bikes, or walk
together very often.
I rarely participate in
physical activity (e.g.
walking) but our
family plays games
outside, ride bikes, or
walks together fairly
frequently.
I participate
regularly in physical
activity (e.g.
walking) and our
family plays games
outside, ride bikes,
or walks together
fairly frequently.
9.
Child
Activity
My child participates in
almost no physical
activity during his/her
free time and is not
enrolled in any
organized sports or
activities with a coach or
leader.
My child participates
in some physical
activity a few days a
week (2-3 days) in
his/her free time but
does not typically
participate in any
organized sports or
activities with a coach
or leader.
My child does not
participate in
physical activity in
his/her free time but
does participate in
some organized
sports or activities
with a coach or
leader a few days a
week (2-3 days).
My child regularly
participates (i.e. on
most days) in
physical activity in
his/her free time
and also participates
in sports or activities
with a coach or
leader.
10.
Family
Routine
Our family does not
have a daily routine or
schedule for our childs
bedtime and our child
gets less than 12 hours
of sleep each night.
Our family does not
have a daily routine or
schedule for our
childs bedtime but
our child typically
gets at least 12 hours
of sleep.
Our family follows a
daily routine or
schedule for our
childs bedtime but
our child tends to get
less than 12 hours of
sleep a night.
Our family follows a
daily routine or
schedule for our
childs bedtime and
our child typically
gets at least 12
hours of sleep a
night.
48

APPENDIX C: FAMILY NUTRITION AND PHYSICAL
ACTIVITY ASSESSMENT: 21 ITEM FORMAT


49


PART 1
Instructions: Circle the square of each row thats most like you and your family.
1.
Family Meals
I dont eat breakfast
often and I dont
usually eat meals with
my family.
I dont eat breakfast
often but I eat meals
with my family on most
days of the week.
I eat breakfast most
days but I dont
usually eat meals with
my family.
I eat breakfast
most days
and I eat
meals with
my family on
most days of
the week.
2.
Eating with
Family
My family eats fast
food often and we eat
while watching TV.
My family eats fast food
often but we dont
usually eat while
watching TV.
My family does not
eat a lot of fast food
but we eat while
watching TV.
My family
does not eat a
lot of fast
food and we
dont eat
while
watching TV.
3.
Food
Choices
My family uses a lot of
packaged foods, like
TV dinners or frozen
pizzas, and we do not
eat many fruits and
vegetables.
My family uses a lot of
packaged foods, like TV
dinners or frozen pizzas
but we eat a lot fruits
and vegetables.
My family eats
freshly made meals
but we dont eat
many fruits and
vegetables.
My family
eats freshly
made meals
and we eat a
lot of fruits
and
vegetables.
4.
Drink Choices
I drink a lot of soda pop
or kool-aid and I dont
drink milk often.
I drink a lot of soda pop
or kool-aid but I drink a
lot of milk.
I dont drink soda pop
or kool-aid often but I
dont drink milk
often.
I dont drink
soda pop or
kool-aid often
and I drink a
lot of milk.
5.
Restriction
and Reward
My parents do not mind
how many snacks I eat
and I get candy for
being good.
My parents do not mind
how many snacks I eat
but I do not get candy
for being good.
My parents watch
how many snacks I
eat but I get candy for
being good.
My parents
watch how
many snacks
I eat and I do
not get candy
for being
good.
Family Nutrition and Physical Activity Screening Tool Child Version
APPENDIX D: FAMILY NUTRITION AND PHYSICAL
ACTIVITY ASSESSMENT CHILD VERSION
50


6.
Screen Time
I watch TV, play video
games, or play on the
computer for more than
4 hours each day.
I dont watch a lot of TV
but I play video games,
or play on the computer
for 2-4 hours each day.
I dont play video
games, or play on the
computer often but I
watch TV for 2-4
hours each day.
I watch TV,
play video
games, or
play on the
computer for
less than 2
hours each
day.
7.
T.V. Usage
My parents do not mind
how much TV I watch
and I have a TV in my
bedroom.
My parents limit my TV
time but I have a TV in
my bedroom.
My parents do not
mind how much TV I
watch but I do not
have a TV in my
bedroom.
My parents
limit my TV
time and I do
not have a
TV in my
bedroom.
8.
Family
Activity
My parents do not get
physical activity, like
walking, often and my
family does not play
games outside, ride
bikes, or walk together
often.
My parents get plenty of
physical activity, like
walking but my family
does not play games
outside, ride bikes, or
walk together often.
My parents do not get
physical activity, like
walking, often but my
family plays games
outside, ride bikes, or
walk together often.
My parents
get plenty of
physical
activity, like
walking and
my family
plays games
outside, ride
bikes, or walk
together
often.
9.
My Activity
I am not involved in
physical activities (like
tag, bike riding) in my
free time and I am not
in any sports or
activities with a coach
or leader.
I am involved in physical
activities (like tag, bike
riding) a few days a
week in my free time but
I am not in any sports or
activities with a coach or
leader.
I am not involved in
physical activities
(like tag, bike riding)
in my free time but I
am involved in sports
or activities with a
coach or leader a few
days a week.
I am involved
in physical
activities
(like tag, bike
riding) in my
free time and
I am involved
in sports or
activities with
a coach or
leader.
10.
Family
Routine
My family does not
have a routine or
bedtime for me and I
get less than 9 hours of
sleep each night.
My family does not have
a routine or bedtime for
me but I get at least 9
hours of sleep each
night.
My family follows a
routine for my
bedtime but I get less
than 9 hours of sleep
each night.
My family
follows a
routine for
my bedtime
and I get at
least 9 hours
of sleep each
night.
51

APPENDIX E: PARENT STYLE AND DIMENSIONS
QUESTIONNAIRE(PSDQ)

52


53

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