Power point ( Kim Woods) only

228

E merging adulthood (EA; ages 18-25) is a unique period of growth, no longer under direct parental control.1 An important set of

behaviors developed during this time includes indi- vidual health behaviors.2,3 These health behaviors are linked closely to the infamous “freshman 15” weight gain.2 Although EA may be seen as an age of optimal health, research shows that unhealthy lifestyles are widespread and firmly established at this life stage;4,-6 possibly resulting in two-thirds of the population in the United States (US) being at risk for obesity or overweight.7

This study aims to examine how (un)healthful eating behaviors are shaped in EA, with a particu- lar interest in the role of childhood parental com- munication. Parents are one of the primary influ- ences on children’s health behaviors,8 including

eating.9 Parental influence does not immediately cease impacting the perception of healthful eating after leaving home.9,10 Many individuals continue past eating habits when adapting to the transition- al period of EA.11 This study examines the distal effects of and the paths through which perceived childhood parental communication is associated with EA eating, guided by the Integrative Model of Behavioral Prediction (IMBP).12,13

Eating Behaviors in Emerging Adulthood EA is characterized by the development of per-

sonal attitudes and beliefs and engaging in person- al growth away from constant overarching parental control.1 Individuals establish health behaviors that allow them to adapt to a new lifestyle full of novel and unfamiliar demands, decisions, and newfound release from persistent parental control.2,3 Unfortu- nately, however, unhealthy lifestyles are widespread at this life stage.4,6 Academic demands, organiza- tional affiliations, and other social functions become prioritized over developing and maintaining health- ful eating behaviors.14 Emerging adults may not be aware of the importance of nutrition as they form

Emily Scheinfeld, The University of Texas at Tyler, Depart- ment of Communication, Tyler, TX. Minsun Shim, Inha Univer- sity, Department of Communication and Information, Incheon, South Korea. Correspondence Dr Scheinfeld; [email protected] or Dr Shim; [email protected]

Understanding Eating Behaviors through Parental Communication and the Integrative Model of Behavioral Prediction

Emily Scheinfeld, PhD; Minsun Shim, PhD

Objective: Emerging adulthood (EA) is an important yet overlooked period for developing long-term health behaviors. During these years, emerging adults adopt health behaviors that persist throughout life. This study applies the Integrative Model of Behavioral Predic- tion (IMBP) to examine the role of child- hood parental communication in predict- ing engagement in healthful eating dur- ing EA. Methods: Participants included 239 college students, ages 18 to 25, from a large university in the southern United States. Participants were recruited and data collection occurred spring 2012. Participants responded to measures to assess perceived parental communica- tion, eating behaviors, attitudes, sub- jective norms, and behavioral control

over healthful eating. SEM and media- tion analyses were used to address the hypotheses posited. Results: Data dem- onstrated that perceived parent-child communication – specifically, its qual- ity and target-specific content – signifi- cantly predicted emerging adults’ eating behaviors, mediated through subjective norm and perceived behavioral control. Conclusion: This study sets the stage for further exploration and understanding of different ways parental communication influences emerging adults’ healthy be- havior enactment.

Key words: parent-child communica- tion; Integrative Model of Behavioral Pre- diction; healthful eating; emerging adults

Am J Health Behav. 2017;41(3):228-239 DOI: https://doi.org/10.5993/AJHB.41.3.2

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Am J Health Behav.™ 2017;41(3):228-239 229 DOI: https://doi.org/10.5993/AJHB.41.3.2

adaptation tactics,9 and develop unhealthy habits,15 which often precipitate weight gain.7 Unhealthful eating and weight gain often continue through and past college, giving rise to adults who are at risk for varying life-threatening diseases.16

The Integrative Model of Behavioral Prediction The IMBP, the most recent interpretation of the

theory of planned behavior,17 draws upon compo- nents from a variety of behavior prediction theo- ries (eg, theory of planned behavior (TPB),17 theory of reasoned action (TRA),18 and social cognitive theory19) to explain a range of volitional behaviors. Careful examination of these past behavior predic- tion theories suggests, “that there are only a lim- ited number of variables that must be considered in predicting and understanding any given behav- ior.”22 The theory of planned behavior17 brought together significant theoretical perspectives in an attempt to better predict behavior; the IMBP fur- ther extends the theory. The IMBP draws upon components from each of the above theories to ex- plain a wider range of behaviors, including those successful at predicting human behavior:17,18,20 at- titude, subjective norm, and perceived behavioral control.20 Each of these is a strong “psychosocial variable”12 that determines behavioral intention and enactment. In the domain of health behaviors, these components have been well supported for their ability to predict healthful eating in EA.21

Compared to TPB and TRA, the IMBP puts a greater emphasis on background factors that may influence subsequent behavioral determinants.13 Recognizing individual, social, cultural, and popu- lation differences,22 the IMBP suggests that back- ground factors can impact behavioral intention and enactment, being mediated through attitude, subjective norm, and perceived behavioral con- trol.13 For example, an individual’s socioeconomic status may be correlated to his or her eating hab- its. Natural, organic, and fresh food options tend to be more expensive and those with a higher so- cioeconomic status can afford to eat these foods regularly, whereas an individual with lower socio- economic status may buy a 99¢ hamburger from a fast food chain because those are the funds avail- able. The importance of background factors is not lost on the IMBP. However, it may be difficult to understand which background factors should be considered when attempting to predict behaviors. Yet, the inclusion of them is an important facet that could lead to a more complete understanding of the overall process.13

Applying the IMBP to Parental Influences on Healthful Eating

This study applies the IMBP to examine how the association between perceived childhood parental communication and EA healthful eating is medi- ated through IMBP components. Parental commu- nication is an element of a person’s social environ- ment – an imperative background factor in IMBP.

Families, as well as peer groups and schools, make up the social environment impacting a child’s be- havior and social norms.23,24 Strong connections between children and their families can communi- cate prosocial norms and behaviors. Parents also can influence and control a child’s nutritional be- haviors in the school setting by allowing a child to purchase lunch or making a sack lunch. Addition- ally, when parents create the foundation for chil- dren to engage in healthy behaviors, children are likely to associate with others that share similar beliefs and engage in similar behaviors.

Extant research demonstrates that parent-child communication has an influential role in the devel- opment of childhood health behavior.11,25 Although the effects of parental influence have been exam- ined on children younger than 18 years under di- rect control of parental figures,8 childhood paren- tal communication continues to have an impact on individuals in EA as they are likely to hold existing health perceptions and eating habits in making a smooth transition into EA.8,11

In this research, parent-child communication is conceptualized following Miller-Day and Kam,26 who note limitations in past conceptualization of parent-child communication: for example, it is of- ten characterized simply as being open or closed,27 or assessed only with the amount of talk without discerning if the content of the talk is actually about healthy habits.28 Miller-Day and Kam’s26 ex- tended conceptualization of parent-child commu- nication encompasses its varying dimensions: the quantity of talk (ie, frequency), the quality of talk (ie, level of openness), and the content of talk (ie, the subject matter being discussed).

First, when it comes to encouraging healthy be- haviors in children, communication needs to be frequent between parents and children,26 so that it can establish a child’s perception of health behav- iors29 and set the standard for behaviors that are good to engage in or not. Second, when having good quality or open communication, parents and chil- dren feel comfortable talking to one another about healthy behaviors30 and receive acknowledgment and reaffirmation during interactions.31 Openness is often referred to as being synonymous with real or supportive communication, but it may be the perception of openness that impacts the relation- ship more profoundly than the actual openness.31 In the context of healthful eating, children’s per- ceived open communication with parents allows them to feel comfortable asking questions about eating and partake actively in conversations.11 Lastly, with respect to the content of talk, past research has supported the importance of having topic-based parental communication to encour- age child engagement in healthy behaviors, such as reducing alcohol consumption of one’s own26 or that of friends,32 and engaging in safe sexual be- haviors.33 Likewise, parent-child communication about specific topics of healthful eating may help children form healthful eating habits. In short,

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past research suggests that perception of effective parent-child communication has the potential to influence individuals’ behaviors. We term frequent, open, and topic-specific communication as “effec- tive communication” and posit the following hy- pothesis:

H 1 : The more effective perceived parent-child

communication in childhood, the healthier cur- rent eating behavior in EA. Specifically, college students’ perceived childhood parental communi- cation about eating, in terms of (1) frequency, (2) quality, and (3) target-specificity, will be positively associated with their current healthful eating.

Most empirical studies have examined the direct effect of parental influence8 and parent-child com- munication11 in relation to dietary tendencies of children. By contrast, this study implies the pres- ence of indirect parental influence, as suggested by the IMPB: parental influence mediated through in- dividuals’ attitude, subjective norm, and perceived behavioral control. Including these variables allow for a more thorough understanding of the pro- cess at hand. As the intent to eat healthy foods is a direct determinant of the actual behavior, the IMBP components on intention are valid research tools in this case.34 The success of IMBP and TPB in predicting eating behaviors may help clear ir- regularities and provide insight about child and EA dietary behavior development. Even as emerging adults make food-related decisions autonomously, their efficacy towards the behavior may continue to be influenced by parents.35 Accordingly, the role of past parental communication on current EA attitude, subjective norm, and perceived be- havioral control as it pertains to healthful eating also should be significant, suggesting the indirect pathways from childhood parental communication to EA eating, mediated through IMBP components:

H 2 : The associations between perceived child-

hood parental communication about eating and current EA eating will be mediated by current (1) attitude, (2) subjective norm, and (3) perceived be- havioral control.

Additionally, past behavior serves as an impor- tant factor to consider, as it is an “undisputed fact that the frequency with which a behavior has been performed in the past can be a good predic- tor of later action.”20 Therefore, past behavior may represent positive value on the behavior.37 As a background factor, past behavior impacts an in- dividual’s cognition and positively promotes be- having a particular way,13 and therefore, prompts engaging in that behavior in the future. For exam- ple, childhood eating behaviors recur throughout childhood, and therefore, are perceived positively. Following social cognitive theory38 past behavior would, in turn, shape a child’s way of thinking. In terms of the IMBP, past behavior is actually shap- ing an individual’s attitude, subjective norm, and perceived behavioral control. Therefore, we posited the following hypothesis about the mediating role of childhood eating behavior.

H 3 : Childhood eating behavior will mediate the

associations between perceived childhood parental communication about eating and current EA eat- ing.

Figure 1 depicts all our hypotheses.

METHODS Participants

Participants included 239 undergraduate stu- dents, ages 18 to 25 (M =19.37; SD = 1.22), from a large university in the southern US. To partic- ipate, students must have had a parental figure during childhood, and have had college marking the first time they lived outside of their parents’ home on a full-time basis. Participation fulfilled course requirements for basic communication studies courses. There were multiple opportunities for students to fulfill this requirement; therefore participation in this study was not mandatory by students in basic courses. Most participants were female (77.4%) and non-Hispanic white (73.8%).

Procedures The survey was conducted online, after filling out

an online consent form. First, we had participants recall their eating behaviors within the past 30 days, and indicate their intention to engage in sim- ilar behaviors the following week. Participants then responded to items pertaining to childhood eating behaviors, followed by a variety of items assessing current attitudes, subjective norm, and perceived behavioral control towards healthful eating. Next, they were prompted to recall their childhood, de- fined as the time before the age of 14, or before high school; they responded to items pertaining to parental communication about eating behaviors during that time. Participants were asked to think about the time before high school, as during this time parents are more easily influencing health behaviors through modeling, communication, and the idea that parents are providing meals more frequently during this time as compared to the high school years. Demographic information, body mass index (BMI), body satisfaction, peer subjec- tive norm, and other related information also was collected.

Measures Perceived childhood parental communica-

tion. We used 3 specific measures to assess per- ceived parent-child communication before the age of 14, on a 5-point scale. Although the measures of perceived parental communication were strong- ly inter-correlated (Table 1), confirmatory factor analyses (CFA) offered support for retaining them as 3 distinct measures: a 3-factor model (CFI = .98, RMSEA = .06, SRMR = .04) fit the data well, whereas alternative models, including a one-factor model (CFI = .65, RMSEA = .21, SRMR = .14) and a 2-factor model consisting of quality and frequen- cy/content (CFI = .92, RMSEA = .10, SRMR = .06), showed a poor fit. Perceived frequency of parental

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communication about eating was measured using 2 items adapted from Wills et al28 and Miller-Day and Kam,26 eg, “How often did you and your par- ents talk about the value of healthful eating?” (1 = never; 5 = extremely often; Cronbach’s α = .84; M = 3.26, SD = .96). One item (“How often did you and your parents talk about food rules?”) was removed based on low inter-total correlation and reliability during exploratory factor analysis (EFA) and CFA. Perceived quality of parental communication about eating was assessed with 4 items encompassing a degree of openness, ease, and comfort in parent- child communication. Items were developed based on several measures, including the Communica- tion with Parents measure,30 the closeness to par- ents measure, and other related measures,26,27 eg, “How openly did you talk with your parents about eating behaviors?” (1 = not at all; 5 = very often/ much; α = .83; M = 3.76, SD = .95). Third, the content-based measure of perceived target-specific parental communication about eating consisted of 6 items, developed based on the Targeted Parent- Child Communication About Alcohol26 to incorpo- rate varying domains found to be salient in parent- child communication about risky health behav- iors, eg, “My parents made comments about food decisions I would make” (1 = disagree a lot; 5 = agree a lot; α = .80; M = 3.10, SD = .84). One of the 7 items assessed was dropped (“My parents did not talk directly with me about healthful eating, but gave hints that I should do so”), based on inter- item correlations and EFA, consistent with past research.26 The full measure is in the Appendix.

Current eating behaviors in EA. Participants’ eating behaviors were assessed using the 13 items based on the Eating Habits in the Past 30 Days measure.40 These items encompass a variety of eat- ing habits occurring within the past 30 days, on a 7-point scale (1 = rarely; 7 = every day), eg, “I monitored the portions of my snacks and meals.” Responses were averaged to construct an index (α = .76; M = 4.64, SD = .84).

Current attitude toward healthful eating in EA. Participants rated their attitude using 2 sets of bipolar evaluative adjectives on a 7-point scale (1 = bad - 7 = good; 1 = harmful - 7 = beneficial), respec- tively for 3 specific eating behaviors (eg, “getting all the necessary nutrients regularly;” α = .73; M = 6.74, SD = .51).

Current subjective norm of parents about healthful eating in EA. Stemming from theoreti- cal measures,13 the Eating Habits in the Past 30 Days items were duplicated, changing the prompt from “In the past 30 days, I…” to “My parents be- lieve I…” Responses were assessed on a 7-point scale (1= should not; 7 = should): eg, “My parents believe I … monitor portions of my snacks and meals” (α = .84; M = 6.11, SD = .71).

Current perceived behavioral control over healthful eating in EA. Perceived behavioral control (PBC) was measured using 4 items to ex- plore an individual’s belief about ability to per- form a given behavior.13 Four items were developed based on Fishbein and Ajzen13 that specifically ask about healthful eating and the concept of PBC on a 7-point strongly agree to disagree scale (eg, “I can

Figure 1 Hypothesized Research Model

Attitude

Parent Subjective Norm

Perceived Behavioral Control

Past (childhood) Behavior

Behavioral Intention

Young Adulthood Eating Behaviors

Integrative Model of Behavioral PredictionProposed Hypotheses

Parent-Child Communication Frequency

Parent-Child Communication Content

Parent-Child Communication Quality

Understanding Eating Behaviors through Parental Communication and the Integrative Model...

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eat healthily if I really want to”; α = .82; M = 5.83, SD = 1.08).

Current intention to engage in healthful eat- ing behaviors in EA. Items from the Eating Hab- its in the Past 30 Days were replicated to measure intended eating behaviors, changing the prompt from “In the past 30 days, I…” to “In the next week, I plan to….” (eg, “In the next week, I plan to...only eat when I feel hungry”). Responses to the 13 items (1 = strongly disagree - 7 = strongly agree) were averaged to an index (α = .84; M = 5.39, SD = .85).

Past eating behaviors in childhood. Partici- pants responded to one question: “During child- hood, how often did you eat healthfully inside your parents’ home?” (1 = never - 5 = almost always; M = 4.18, SD = .77).

Control variables. Several variables were col- lected and controlled, including sex, age, BMI, body satisfaction, and peer subjective norm. Sex differences exist in daily calories consumed and in eating style,41 and it is reasonable that with age, individuals are able to adapt and learn from past unhealthy behaviors. We also assessed BMI (M = 23.16, SD = 3.85), based on self-reported height and weight, and body satisfaction (“At present, are you on a diet or doing something else to change your weight?” “No, my weight is fine / No, but I need to / Yes,”);30 BMI status frequently affects eating behaviors42 and body satisfaction has been associated with BMI and eating behaviors.43 Peer subjective norm was assessed asking peers’ ap- proval on the same set of behaviors measured for

parental subjective norm (α = .86; M = 6.12, SD = .80). Table 1 presents bivariate correlations be- tween all key variables in this study.

Analysis Scheme To test the hypothesized relationships, we car-

ried out structural equation modeling (SEM) using MPlus 6.0, with maximum likelihood estimation, in 2 steps. The first step involved confirmatory factor analysis (CFA) to obtain an adequate measurement model of latent variables in the model. Latent vari- ables included 3 variables on perceived childhood parental communication (frequency, quality, and target-specific content), as well as 3 variables from the IMBP (current EA attitude, subjective parental norms, and PBC). Past eating behavior in child- hood was excluded from the measurement model because it was assessed with one observed vari- able. Current eating behaviors and intention were considered to be an index encompassing varying aspects of healthful eating, instead of measuring one underlying latent construct. The full measure- ment model with all latent factors and their corre- sponding indicators (or parceled items) yielded an adequate fit, χ2(137) = 203.72, p < .001, CFI = .97, RMSEA = 0.05, 90% CI = [.03, .06], SRMR = .05. When the latent variables (eg, target-specific com- munication, attitude, subjective parental norm, and PBC) had more than 4 observed indicators, a parceling technique was employed with random assignment. A parceling technique is used com- monly in multivariate approaches to psychomet-

Table 1 Bivariate Correlations between Key Variables

Variable 1 2 3 4 5 6 7 8

1. PCCFREQ -

2. PCCQUAL .34*** -

3. PCCCONT .64*** .18** -

4. Past Behavior .42*** .31*** .32*** -

5. Attitude .08 .04 .03 .03 -

6. Subjective Norm .33*** .18** .38*** .22*** .32*** -

7. PBC .18** .24*** .10 .17** .15* .22*** -

8. Intention .16* .06 .10 .08 .21*** .33*** .36*** -

9. Current Eating .19** .15* .12 .19** .16 .23*** .45*** .65***

p < .05,* p < .01,** p < .001***

Note. PCCFREQ = perceived frequency of parent-child communication, PCCQUAL = perceived quality of parent-child com- munication, PCCCONT = perceived target-specific content of parent-child communication, PBC = perceived behavioral control

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rics, by constructing a parcel as an aggregate-level indicator consisting of the sum (or average) of 2 or more items, especially when the research focus is placed on the relationships among latent variables (or constructs) rather than the exact relationships among the indicators.44 In the second step, we test- ed the full model with both the measurement and structural parts. Observed variables were added to the model, and the hypothesized structural re- lationships were specified. Control variables also were added and allowed to predict all key variables except for current intention and eating; all exog- enous variables on intention/behavior should be carried through their effects on attitude, norm, and PBC, according to the IMBP.13 On past eating behaviors, only age and sex were included as con- trol variables because logically the current BMI, body satisfaction, and peer subjective norm can- not influence past eating behaviors. We tested the full model to examine if it fit the data adequately, and requested hypothesized indirect pathways in the testing.

RESULTS The full model fit the data well, χ2(264) = 368.81,

p < .001, CFI = .96, RMSEA = .04, 90% CI = [.03, .05], SRMR = .04. The model, with the control vari- ables being taken into account, explained 22.8% of the variance in past eating, 7.5% of the variance in current attitude, 41.4% of the variance in current subjective norm of parents, 13.5% of the variance in current PBC, 23.5% of the variance in behav- ioral intention, and 48.3% of the variance in cur-

rent healthful eating. Parameter estimates for the model are presented in Figure 2. Figure 3 displays the same model with only the statistically signifi- cant pathways.

H 1 concerned the relationships between college

students’ perceived parent-child communication about eating in childhood and current eating be- haviors in EA. Furthermore, such relationships were thought to be mediated by current attitude, subjective norm of parents, PBC, and behavioral intention (H

2 ). As Figure 2 shows, perceived fre-

quency of parent-child communication in child- hood had no statistically significant relationships with any of the IMBP mediators (current attitude, subjective parental norm, and PBC). However, per- ceived quality of childhood communication had a positive association with current PBC (ß = .21, p = .013), but not with the other 2. Perceived target- specific content of childhood communication was positively associated only with current subjective parental norm (ß =.48, p < .001). With respect to the IMBP part in the model, the path from atti- tude to behavioral intention was not statistically significant, whereas the paths from subjective pa- rental norm to behavioral intention (ß =.25, p < .001), from PBC to behavioral intention (ß =.33, p < .001), and from behavioral intention to current eating (ß =.53, p < .001) were statistically signif- icant. Therefore, data lent partial support for H

1

and H 2 . Perceived childhood parental communica-

tion was associated with current eating behaviors in EA, possibly mediated through current subjec- tive parental norm and PBC; the specific domains

.02

Attitude

Parent Subjective Norm

Perceived Behavioral Control

Behavioral Intention

Young Adulthood Eating Behaviors

Parent-Child Communication Frequency

Parent-Child Communication Content

Parent-Child Communication Quality

.04

-.04

.02

-.11

.03

.48***

.09

.21*

-.01

.01

.11

.07

.28***

.07

.25***

.33***

.40**

-.01

.53***

.32***

.17**

.22**

.34***

.18*

.77***

(.17)

(.09)

(.16)

(.07)

(.15)

(.14)

(.17)

(.09)

(.16)

(.08)

(.07)

(.08)

(.14)

(.07)

(.13)

(.07)

(.07)

(.06)

(.05)

(.06)

(.07)

(.08)

(.17)

(.04)

(.08)

(.08)

(.08)

Past (childhood) Behavior

.18*

Figure 2 Model with Standarized Beta Valuesab

p < .05*

Note. a. The ß-values are presented through the path they represent. b. Standard errors are presented in parentheses.

Understanding Eating Behaviors through Parental Communication and the Integrative Model...

234

of communication (quality and content) worked through a different mediator.

For a more rigorous test of H 2 , Table 2 presents

the total and specific indirect effects from perceived childhood communication to current eating. The total indirect effect from communication frequency to eating was not statistically significant, and nor was any of the specific indirect paths. By contrast, the total indirect effect from communication qual- ity to eating was statistically significant (ß =.11, p = .015); specifically, there were 2 statistically sig- nificant indirect paths – one from communication quality to PBC to intention to eating (ß =.04, p = .028), and the other from communication quality to PBC to eating (ß = .06, p = .027). With respect to communication content, one statistically signifi- cant specific indirect effect was observed through subjective norm and intention (ß = .06, p = .016) although the total indirect effect was not statisti- cally significant. In short, findings suggest that PBC mediated communication quality and current eating whereas PSN mediated communication con- tent and current eating.

H 3

concerned the mediating role of past eating behaviors in relating perceived childhood parent- child communication with current eating. As Fig- ure 2 depicts, the paths from communication fre- quency to past behavior (ß = .40, p = .004) and from communication quality to past behavior (ß = .18, p = .012) were statistically significant; by contrast, the path from communication content to

past behavior was not. The paths from past be- havior to subjective norm, attitude, and subjective norm, respectively, were not statistically signifi- cant. Also, the specific indirect effects from per- ceived childhood communication to current eating passing through childhood eating were not statisti- cally significant (Table 2). H

3 was not supported.

DISCUSSION The purpose of this study was to examine how

perceptions of parental communication about eat- ing in childhood may be an important predictor of EA healthful eating behaviors. Results suggest childhood parental communication is positively as- sociated with EA eating. Targeted communication had a positive relation to EA parental subjective norm. Better quality talks were positively and sig- nificantly associated with EA perceived behavioral control. Both were significantly associated with EA intention to eat well, and in turn, eating behaviors. The frequency of communication was only signifi- cantly associated with past eating, which had no relationship with any of the IMBP variables, de- spite assumptions from past research.

Three Domains of Parent-child Communication in Healthful Eating

We extend the past research on EA health be- haviors by employing elaborated conceptualiza- tion of parent-child communication. Specifically, the content of childhood parent-child communica-

Parent Subjective Norm

Perceived Behavioral Control

Past (childhood) Behavior

Behavioral Intention

Young Adulthood Eating Behaviors

Parent-Child Communication Frequency

Parent-Child Communication Content

Parent-Child Communication Quality

.48***

.21* .28***

.25***

.33***

.40**

.18* .53***

(.14)

(.09)

(.14)

(.07) (.07)

(.06)

(.05)

(.06)

Figure 3 Model with Statistically Significant Pathwaysab

p < .05*

Note. a. The ß-values are presented through the path they represent. b. Standard errors are presented in parentheses.

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tion about nutrition was positively related to EA parental subjective norm. Emerging adults seem still to place importance on parental norms shaped from the subject of the conversations they remem- ber from childhood. These results are supported by similar research exploring parental injunctive norms of alcohol, drug, and marijuana use, and its impact on youth substance use.45 Therefore, the more parents focus their talk about healthful eating when their children are young, the more accessible these norms are to guide them in the processes of healthful eating later in life. The more accessible they are, the less likely individuals are to rely on other environmental or social cues.46

The quality of parent-child communication about healthful eating was based on the percep-

tion of openness, ease of conversation, and abil- ity to broach the topic of nutrition with parental figures. The knowledge of being able to talk about these types of topics with parents may give emerg- ing adults a sense of confidence as it pertains to nutrition. In turn, confidence introducing and freely discussing the topic also may give them con- fidence to engage in the relevant behaviors.

Frequency of conversations with parents about nutrition had no statistically significant associa- tions with any of the IMBP variables. It is plausible that each health behavior has different background factors to help explain behavior enactment.13 The frequency of conversations may be imperative to set social norms for children in certain health con- texts, eg, no use of substances,45,47 but not help

Table 2 Total and Specific Indirect Effects from Perceived Childhood

Communication to Current Eating Paths ß (SE) p

PCCFREQ → BEH (total indirect)    PCCFREQ → ATT → INTEN → BEH    PCCFREQ → PSN → INTEN → BEH    PCCFREQ → PBC → INTEN → BEH    PCCFREQ → PAST → ATT → INTEN → BEH     PCCFREQ → PAST → PSN → INTEN → BEH    PCCFREQ → PAST → PBC → INTEN → BEH    PCCFREQ → PBC → BEH    PCCFREQ → PAST → PBC → BEH

.05 (.08)

.00 (.01) -.01 (.02) .02 (.03) .00 (.00) .01 (.01) .01 (.01) .03 (.05) .01 (.01)

.553

.820

.480

.590

.918

.200

.383

.591

.385

PCCQUAL → BEH (total indirect)    PCCQUAL → ATT → INTEN → BEH    PCCQUAL → PSN → INTEN → BEH    PCCQUAL → PBC → INTEN → BEH    PCCQUAL → PAST → ATT → INTEN → BEH     PCCQUAL → PAST → PSN → INTEN → BEH    PCCQUAL → PAST → PBC → INTEN → BEH    PCCQUAL → PBC → BEH    PCCQUAL → PAST → PBC → BEH

.11 (.05)* -.00 (.00) .00 (.01) .04 (.02)* .00 (.00) .00 (.00) .00 (.00) .06 (.03)* .00 (.00)

.015

.702

.693

.028

.918

.189

.391

.027

.392

PCCCONT → BEH (total indirect)    PCCCONT → ATT → INTEN → BEH    PCCCONT → PSN → INTEN → BEH    PCCCONT → PBC → INTEN → BEH    PCCCONT → PAST → ATT → INTEN → BEH     PCCCONT → PAST → PSN → INTEN → BEH    PCCCONT → PAST → PBC → INTEN → BEH    PCCCONT → PBC → BEH    PCCCONT → PAST → PBC → BEH

.06 (.08)

.00 (.01) .06 (.03)* -.00 (.03) .00 (.00) .00 (.00) .00 (.00) -.00 (.05) .00 (.00)

.466

.894

.016

.966

.942

.919

.919

.966

.919

* p < .05

Note. PCCFREQ = perceived frequency of parent-child communication, PCCQUAL = perceived quality of parent-child communication, PCCCONT = perceived target-specific content of parent-child communication, ATT = attitude, PSN = parental subjective norm, PBC = per- ceived behavioral control, PAST = past eating behavior, INTED = intended eating, BEH = current eating behavior

Understanding Eating Behaviors through Parental Communication and the Integrative Model...

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with engaging in healthful eating later in life. This finding awaits further research.

Little Role of EA Attitude and Childhood Eating in EA Eating

Data showed no evidence for the role of EA at- titude in healthful eating, suggesting a measure- ment issue. The attitude variable had little to no variance. The mean was on the high end, experi- encing a ceiling effect, and the standard deviation was the smallest of all variables measured. More importantly, this issue can be discussed from a theoretical perspective. Fishbein and Cappella22 ar- gue that the success of IMBP components depends on the population being studied, as well as the be- havior. Sangperm48 also found that attitude did not affect intention to eat healthfully for a population of adolescents, and argues it may not be pertinent to adolescents who likely are not yet combating the development of weight-related diseases. One could make a similar argument for college students. Dur- ing EA, environmental and peer cues related to the social desirability of eating healthy and keeping a low weight (ie, physical attractiveness), rather than keeping good health, may be what pressures indi- viduals to eat healthfully. Also, not all of the IMB components are equally important.22 Depending on the behavior at hand, one of the variables used to predict eating may be more important than anoth- er. PBC, for example, may be a stronger indicator of actual behavior engagement during college.

Lack of support for the mediating role of past eat- ing suggests that childhood eating habits may not have long-term effects on EA eating. When emerg- ing adults are presented with other issues includ- ing financial difficulties, time crunches, and peer norms, the availability and inexpensiveness may outweigh the eating habits formed in childhood, developing more currently relevant norms shaped by the college setting and peer injunctive norms. These speculations need to be further studied with refined conceptualization and operationalization of past eating behavior. Also notable in our find- ings is that past eating behavior and current eat- ing behavior were related to different sub-domains of parent-child communication, inviting more re- search on the unique roles of the frequency, qual- ity, and content of communication about healthful eating.

Limitations and Future Research Directions This study utilized recall, which causes the data

to be subject to self-report and measurement bi- ases,51 possibly involving problems with accuracy in comparison to longitudinal research.10 However, lapsed time may be a strength of the study. The distal effect of childhood parental influence has not been examined before, and what individuals remember and perceive may be more important to current behavior enactment than what actually transpired. When it comes to medical records and health behaviors, people often successfully recall

their behaviors despite some issues with preci- sion.52 Second, the data were cross-sectional and we cannot conclude causal relationships between the variables. The model has arrows pointing as though directionality is clear because the indepen- dent variables were perceptions of past communi- cation processes and also based on past work on IMBP. However, we acknowledge that the variables could be rearranged and the arrows reversed. Third, measures could have been validated further. Although we developed our measures based on the theoretical framework of IMBP and parental com- munication and related research, the exact mea- sures we used were not validated previously in a given context of healthful eating. Related, eating out has an important role on this generation and the eating behaviors developed both during child- hood and during EA. It would behoove future re- searchers to measure not only past eating behav- iors within the parents’ household, but also eating behaviors outside, including school lunches or eat- ing out with friends and/or family. We acknowl- edge that parental education and household in- come could impact communication, and therefore, the results of this study. We recommend that fu- ture researchers collect these data to examine the role they play in parental communication about healthful eating behaviors or as control variables in the tested model. We also acknowledge the role of parents in their child’s behavioral outcome and perceptions of communication. Therefore, future research should address parents’ perceptions of openness to improve understanding of these vari- ables. Lastly, there was the potential that normal weight individuals may perceive parent-child com- munication differently than their overweight or obese counterparts. Similarly, normal weight indi- viduals may have different subjective norms, atti- tudes, and perceived behavioral control than over- weight or obese individuals. Therefore, post hoc analyses were conducted and the results suggest that persons who are overweight or obese have dif- ferent perceived behavioral control towards health- ful eating and our findings should be interpreted with this fact in mind.

Implications for the IMBP Research The IMBP has been successful at predicting vari-

ous health behaviors, including physical activity.49 Due to the similarities between eating behaviors and physical activity (ie, they both share elements of consistency and repeated nature, and constitute overall well-being), similarities in the results were expected. In this study, however, the fit of the IMBP was not entirely satisfying. Possibly, there may be significant differences between the behaviors. Eating can occur both spontaneously and delib- erately, whereas physical activity is always calcu- lated. For example, individuals may think deliber- ately about what snack is healthiest in the vending machine, but at meal times, the decision is natu- ral, requiring little thought. This type of stability

Scheinfeld & Shim

Am J Health Behav.™ 2017;41(3):228-239 237 DOI: https://doi.org/10.5993/AJHB.41.3.2

in healthful eating may be determined by factors that influenced healthful eating in childhood and are exerting their influence without awareness,39 specifically PBC. Researchers also might consider other health models as complementing the IMBP to examine eating behaviors. For example, the Health Belief Model takes into consideration several fac- tors that may affect healthful eating, including social pressure, impact, the cue to action, or the use of media campaigns. The environmental fac- tors and societal norms pertaining to healthful eat- ing in EA may fit the function of the cue to action within the model.

Practical Implications The IMBP was extended to include background

factors to assist in effective message design and health interventions. Our findings provide an op- portunity to develop more persuasive health inter- ventions targeting eating behaviors of a younger population. This study also supports the role of parent-child communication in health campaigns, much like the Let’s Move! program encourages.50 Specifically, if campaigns decide to focus on PBC and subjective parental norms, incorporating par- ent-child communication from youth may be an advantageous approach.

Human Subjects Approval Statement This study was approved by the Internal Review

Board at The University of Georgia on November 23, 2011. The project case number is 2012-10375- 0.

Conflict of Interest Disclosure Statement This study was not funded by any source. There

are no conflicts of interest to declare financially or not.

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Appendix Perceived Childhood Parent Communication Scale

Perceived Target-specific This measure was based on Miller-Day and Kam’s26 targeted parent-child communication about alcohol measure.

Think about your childhood through middle school. Please choose how much you agree or disagree with the following state- ments.

disagree a lot 1  2  3  4  5  agree a lot 

My parents…

Did not directly talk with me about eating healthy, but gave hints that I should do so.

Lectured me or given me a speech about eating habits

Talked to me about the consequences and dangers of eating unhealthy foods.

Explicitly expressed food rules that I was to obey.

Made comments about bad food decisions represented in the media.

Made comments about food decisions I would make.

Talked to me about how to eat healthy, plan meals, and get the nutrients I needed from food.

Perceived Quality This measure was based on the Communication with Parents measure30

Please think about your childhood through middle school.

(1) Very Difficult (2) Difficult (3) Neither (4) Easy (5) Very Easy

     How easy was it for you to talk to your parent about your eating behaviors?

Please think about your childhood through middle school.

not at all 1  2  3  4  5  very often/much

How openly did you talk with your parents about eating habits?

How interested were your parents in talking to you when you wanted to talk about eating habits?

How comfortable did you feel about talking about eating habits?

Perceived Frequency This measure was based on Wills et al28 and Miller-Day and Kam26

Please think about your childhood through middle school.

never 1  2  3  4  5  extremely often

How often did you and your parents talk about nutrition (the number of servings you should eat, types of food to eat, etc.)?

How often did you and your parents talk about food rules (eg,  no soda in the house, you must clean your plate, no eating after  dinner)?

How often did you and your parents talk about the value of healthy eating?

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