A Mixed Methods Analysis of Beverage Choices in Adolescents and Their Parents Using the Theory of Planned Behavior

Background— Added sugar intake in the form of sugar-sweetened beverages (SSB) has been considered a contributor to weight gain and cardiometabolic dysfunction in adults and youth. Adolescents are some of the highest consumers of added sugars, taking in ~16% of their total calories from added sugars with ~40% of these calories coming from SSB. Youth’s food preferences and self-regulation of dietary intake can be influenced by parents. Objective— To evaluate the Theory of Planned Behavior’s (TPB) effectiveness in understanding and predicting adolescents' SSB consumption, identify which constructs are the most important when evaluating SSB consumption in adolescents, and determine if and how adolescents' beverage choices are influenced by parents' reactions to their beverage choices. Design— Measurements for this cross-sectional study included four record-assisted 24-hour dietary recalls and responses to a SSB-specific TPB questionnaire from 100 adolescents. Consenting parents completed a beverage intake questionnaire, a TPB questionnaire, and Parent Response to Beverage Choice Questionnaire. Results— The TPB explained 34% of the variance in adolescents' and parents' intention to limit SSB to less than one cup per day. Parents' perceived behavioral control ( b =1.35, p =0.002) and adolescents' subjective norms ( b =0.57, p =0.001) were the strongest predictors of intention, and intention was the strongest predictor of SSB consumption in both adolescents and parents ( b =−37, p =0.026, b =−49, p =0.003). The TPB explained more variance in parent SSB consumption ( R 2 =0.38) than adolescents ( R 2 =0.22). Parents did more discouraging of SSB and encouraging of non-SSB. Adolescents' intention to limit SSB moderated the relationship between parents' reactions encouraging SSB and adolescents' predicted SSB consumption ( p =0.021). Conclusions— The TPB explained a small, but significant amount of variance in adolescents' SSB consumption. When addressing adolescent SSB intake, people in addition to parents may influence their intentions and SSB consumption.

[1]  Andy P. Field,et al.  Discovering Statistics Using Ibm Spss Statistics , 2017 .

[2]  P. Estabrooks,et al.  A systematic literature review and meta-analysis: The Theory of Planned Behavior's application to understand and predict nutrition-related behaviors in youth. , 2015, Eating behaviors.

[3]  L. Mâsse,et al.  Parent-child associations in selected food group and nutrient intakes among overweight and obese adolescents. , 2014, Journal of the Academy of Nutrition and Dietetics.

[4]  J. Sallis,et al.  Home food environment in relation to children's diet quality and weight status. , 2014, Journal of the Academy of Nutrition and Dietetics.

[5]  B. Rosner,et al.  Association of sports drinks with weight gain among adolescents and young adults , 2014, Obesity.

[6]  W. Willett,et al.  Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis. , 2013, The American journal of clinical nutrition.

[7]  J. Müller-Nordhorn,et al.  Association between water consumption and body weight outcomes: a systematic review. , 2013, The American journal of clinical nutrition.

[8]  C. Ogden,et al.  Trends in sugar-sweetened beverage consumption among youth and adults in the United States: 1999-2010. , 2013, The American journal of clinical nutrition.

[9]  Kristine A. Madsen,et al.  Trends in sugar-sweetened beverage and 100% fruit juice consumption among California children. , 2013, Academic pediatrics.

[10]  L. Beilin,et al.  Prospective associations between sugar-sweetened beverage intakes and cardiometabolic risk factors in adolescents , 2013, The American journal of clinical nutrition.

[11]  A. Hayes.  Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach , 2013 .

[12]  E. Finkel,et al.  Buffering against weight gain following dieting setbacks: An implicit theory intervention , 2012 .

[13]  D. Drotar,et al.  The in vivo adherence intervention for at risk adolescents with asthma: report of a randomized pilot trial. , 2012, Journal of pediatric psychology.

[14]  P. Estabrooks,et al.  Exploring the theory of planned behavior to explain sugar-sweetened beverage consumption. , 2012, Journal of nutrition education and behavior.

[15]  C. Ogden,et al.  Consumption of added sugar among U.S. children and adolescents, 2005-2008. , 2012, NCHS data brief.

[16]  R. Carroll,et al.  Taking advantage of the strengths of 2 different dietary assessment instruments to improve intake estimates for nutritional epidemiology. , 2012, American journal of epidemiology.

[17]  K. Flegal,et al.  Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010. , 2012, JAMA.

[18]  P. Estabrooks,et al.  Beverage intake in low-income parent-child dyads. , 2011, Eating behaviors.

[19]  E. Trolle,et al.  Evaluation of 2 × 24-h dietary recalls combined with a food-recording booklet, against a 7-day food-record method among schoolchildren , 2011, European Journal of Clinical Nutrition.

[20]  M. Conner,et al.  Prospective prediction of health-related behaviours with the Theory of Planned Behaviour: a meta-analysis , 2011 .

[21]  Valisa E. Hedrick,et al.  Development of a brief questionnaire to assess habitual beverage intake (BEVQ-15): sugar-sweetened beverages and total beverage energy intake. , 2010, Journal of the Academy of Nutrition and Dietetics.

[22]  A. Mukhopadhyay,et al.  Building Character: Effects of Lay Theories of Self-Control on the Selection of Products for Children , 2010 .

[23]  D. Mozaffarian,et al.  Defining and Setting National Goals for Cardiovascular Health Promotion and Disease Reduction: The American Heart Association's Strategic Impact Goal Through 2020 and Beyond , 2010, Circulation.

[24]  K. Davy,et al.  Water Consumption Increases Weight Loss During a Hypocaloric Diet Intervention in Middle‐aged and Older Adults , 2010, Obesity.

[25]  D. Spruijt-Metz,et al.  Psychosocial correlates of eating behavior in children and adolescents: a review , 2009, The international journal of behavioral nutrition and physical activity.

[26]  F. Gibbons,et al.  Reason and reaction: the utility of a dual-focus, dual-processing perspective on promotion and prevention of adolescent health risk behaviour. , 2009, British journal of health psychology.

[27]  I. Darnton-Hill,et al.  Food habits of adolescents. , 2009, Nutrition reviews.

[28]  Klaas Sijtsma,et al.  On the Use, the Misuse, and the Very Limited Usefulness of Cronbach’s Alpha , 2008, Psychometrika.

[29]  Kristopher J Preacher,et al.  Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models , 2008, Behavior research methods.

[30]  Karen Glanz,et al.  The Use of Theory in Health Behavior Research from 2000 to 2005: A Systematic Review , 2008, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[31]  S. Gortmaker,et al.  Increasing Caloric Contribution From Sugar-Sweetened Beverages and 100% Fruit Juices Among US Children and Adolescents, 1988–2004 , 2008, Pediatrics.

[32]  Neil H. White,et al.  Randomized, controlled trial of Behavioral Family Systems Therapy for Diabetes: maintenance and generalization of effects on parent-adolescent communication. , 2008, Behavior therapy.

[33]  S. Scaglioni,et al.  Influence of parental attitudes in the development of children eating behaviour , 2008, British Journal of Nutrition.

[34]  E. Bere,et al.  Determinants of adolescents’ soft drink consumption , 2008, Public Health Nutrition.

[35]  Kyung E. Rhee.  Childhood Overweight and the Relationship between Parent Behaviors, Parenting Style, and Family Functioning , 2008 .

[36]  D. Caulley.  Qualitative research for education: An introduction to theories and methods , 2007 .

[37]  J. Salmon,et al.  Associations Between the Home Food Environment and Obesity‐promoting Eating Behaviors in Adolescence , 2007, Obesity.

[38]  L. Birch,et al.  Parental Influence on Eating Behavior: Conception to Adolescence , 2007, The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics.

[39]  D. Baer,et al.  The USDA Automated Multiple-Pass Method accurately estimates group total energy and nutrient intake. , 2006, The Journal of nutrition.

[40]  J. Brug,et al.  Associations of social-environmental and individual-level factors with adolescent soft drink consumption: results from the SMILE study. , 2006, Health education research.

[41]  W. Willett,et al.  A new proposed guidance system for beverage consumption in the United States. , 2006, The American journal of clinical nutrition.

[42]  Deborah A Yurgelun-Todd,et al.  Developmental changes in the functional brain responses of adolescents to images of high and low-calorie foods. , 2005, Developmental psychobiology.

[43]  M B E Livingstone,et al.  Issues in dietary intake assessment of children and adolescents , 2004, British Journal of Nutrition.

[44]  M. Story,et al.  Factors associated with soft drink consumption in school-aged children. , 2004, Journal of the American Dietetic Association.

[45]  B. Lundman,et al.  Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. , 2004, Nurse education today.

[46]  Heather Y. Lovelace,et al.  Nutrition in the Prevention and Treatment of Disease , 2003 .

[47]  Richard A. Fabes,et al.  The Coping with Children's Negative Emotions scale (CCNES): Psychometric properties and relations with Children's emotional competence , 2002 .

[48]  Kim Fromme,et al.  Brief prevention for adolescent risk-taking behavior. , 2002, Addiction.

[49]  M. Conner,et al.  Efficacy of the Theory of Planned Behaviour: a meta-analytic review. , 2001, The British journal of social psychology.

[50]  Rob Horne,et al.  Statistical guidelines for studies of the theory of reasoned action and the theory of planned behaviour , 2000 .

[51]  R J Prineas,et al.  Relation of weight and rate of increase in weight during childhood and adolescence to body size, blood pressure, fasting insulin, and lipids in young adults. The Minneapolis Children's Blood Pressure Study. , 1999, Circulation.

[52]  M. Sullivan,et al.  Dietary intake in relation to restrained eating, disinhibition, and hunger in obese and nonobese Swedish women. , 1997, Obesity research.

[53]  G. Kok,et al.  The Theory of Planned Behavior: A Review of its Applications to Health-Related Behaviors , 1996, American journal of health promotion : AJHP.

[54]  S. S. St. Jeor,et al.  Dietary helplessness and disinhibition in weight cyclers and maintainers. , 1995, The International journal of eating disorders.

[55]  L A Lytle,et al.  Validation of 24-hour recalls assisted by food records in third-grade children. The CATCH Collaborative Group. , 1993, Journal of the American Dietetic Association.

[56]  N. Bull.  Dietary habits, food consumption, and nutrient intake during adolescence. , 1992, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[57]  I. Ajzen.  The theory of planned behavior , 1991 .

[58]  L. Cronbach.  Coefficient alpha and the internal structure of tests , 1951 .

[59]  David Eichelberger,et al.  Handbook Of Psychological Testing , 2016 .

[60]  Sophia Kluge,et al.  Development Through The Lifespan , 2016 .

[61]  Deborah D. Heisley,et al.  What are you dieting for? The role of lay theories in dieters' goal setting , 2014 .

[62]  K. Gray-donald,et al.  Consumption of added sugars from liquid but not solid sources predicts impaired glucose homeostasis and insulin resistance among youth at risk of obesity. , 2014, The Journal of nutrition.

[63]  Valisa E. Hedrick,et al.  A rapid beverage intake questionnaire can detect changes in beverage intake. , 2013, Eating behaviors.

[64]  A. Stunkard,et al.  The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger. , 1985, Journal of psychosomatic research.

[65]  Icek Ajzen,et al.  From Intentions to Actions: A Theory of Planned Behavior , 1985 .