Associations between parenting styles and children's fruit and vegetable intake.

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Associations between Parenting Styles and Children’s Fruit and Vegetable Intake a

b

Naser A. Alsharairi & Shawn M. Somerset a

Griffith Health Institute, Griffith University, Southport, Queensland, Australia b

School of Allied Health, Australian Catholic University, Brisbane, Queensland, Australia Published online: 26 Nov 2014.

Click for updates To cite this article: Naser A. Alsharairi & Shawn M. Somerset (2015) Associations between Parenting Styles and Children’s Fruit and Vegetable Intake, Ecology of Food and Nutrition, 54:1, 93-113, DOI: 10.1080/03670244.2014.953248 To link to this article: http://dx.doi.org/10.1080/03670244.2014.953248

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Ecology of Food and Nutrition, 54:93–113, 2015 Copyright © Taylor & Francis Group, LLC ISSN: 0367-0244 print/1543-5237 online DOI: 10.1080/03670244.2014.953248

Associations between Parenting Styles and Children’s Fruit and Vegetable Intake NASER A. ALSHARAIRI


Griffith Health Institute, Griffith University, Southport, Queensland, Australia

SHAWN M. SOMERSET School of Allied Health, Australian Catholic University, Brisbane, Queensland, Australia

This study investigated associations between children’s fruit and vegetable intake and their parents’ parenting style (i.e., authoritative: high warmth-high control; authoritarian: low warmth-high control; permissive: high warmth-low control; and disengaged: low warmth-low control). Data from the Longitudinal Study of Australian Children K cohort, comprising approximately 5,000 children, were used for analyses in wave 1 (4–5 years), wave 2 (6–7 years), and wave 3 (8–9 years). Fruit and vegetable intake patterns were extracted through exploratory factor analysis. Boys with authoritarian mothers were found less likely to consume fruits and vegetables at 6–9 years. Children of both genders with authoritative and permissive fathers, and girls with authoritative mothers at 4–5 years were found most likely to consume fruits and vegetables two and four years later. Exploring possible mechanisms underlying such associations may lead to interventions aimed at increasing children’s consumption of fruits and vegetables. KEYWORDS children, cohort, cross-lagged correlation, crosssectional analysis, fruit and vegetable intake patterns, gender, parenting styles

Address correspondence to Naser A. Alsharairi, Griffith Health Institute, Griffith University, Box 4222, Southport, Queensland, Australia. E-mail: [email protected]

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N. A. Alsharairi and S. M. Somerset

There is robust evidence to suggest that the consumption of recommended levels of fruits and vegetables among Australian children and adolescents declines among both boys and girls. A report by Magarey, Daniels, and Smith (2001) showed that less than half of school children in the Australian States and Territories had an adequate intake of fruit, and less than one third had an adequate intake of vegetables. Results indicate that adolescents were less likely to consume vegetables, whereas children were less likely to consume fruits. Findings from a study conducted on 157 school children in Townsville, Australia, showed that on average Indigenous school children did not consume the daily requirements of vegetables. Baseline results demonstrated that Indigenous children, when compared with non-Indigenous children, were more likely to be overweight/obese, to suffer from health problems such as iron depletion and anaemia, and to have limited consumption of nutritious food options such as vegetables (Heath and Panaretto 2005). Parenting style establishes the emotional condition of the parent–child relationship, reflecting attitudes and begetting an emotional climate wherein parenting practices and behavior can be negotiated and managed (Talib, Mohamad, and Mamat 2011). Parenting styles have been divided into three major categories: permissive, authoritarian, and authoritative (Rosenkranz and Dzewaltowski 2008). Permissive parents give their children freedom in behavior and decision making, and they are less likely to control the food choices of their children (Dufour 1997). Authoritarian parents are firm, and they are likely to set strict limits for children and to use punitive and forceful actions of enforcement (Dufour 1997). Authoritative parents are described as warm, firm, and accepting of children’s need for autonomy (Steinberg 2001). Parenting styles play a significant role in determining children’s fruits and vegetables intake. In particular, authoritative parenting has been positively associated with enhanced fruit consumption (Kremers et al. 2003; Peters et al. 2013), and home availability of fruit and vegetables (Patrick et al. 2005). Although children’s fruit and vegetable consumption was found to be associated with an authoritative parenting style by De Bourdeaudhuij and colleagues (2009), that study also showed an association with an authoritarian parenting style. Conversely, Kremers and colleagues (2003) found that children’s fruit consumption was negatively associated with authoritarian and neglectful parenting styles. Also, Vereecken and Maes (2003) showed that a permissive parenting style employed by mothers of children aged 2.5–7 years was negatively associated with their children’s vegetable consumption; and Patrick and colleagues (2005) found that the availability of fruit and vegetables was negatively associated with an authoritarian feeding style. That study also found that children’s vegetable consumption was negatively associated with caregivers who exhibited an authoritarian feeding style. Hoerr and colleagues (2009) showed that children of parents who exhibited a permissive style were less likely to consume fruits, fruit juice, vegetables, and dairy products,


Analysis of the Longitudinal Study of Australian Children

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but more likely to consume high levels of energy-dense food in the dinner meal, in three ethnic groups; African American, Hispanic, and White. Authoritarian parenting style, characterized by restricting access to particular foods, is more likely to lead to children consuming more energy-dense foods (Polfuss and Frenn 2012). Permissive parents practice low monitoring of their children’s food intake, thereby impeding their children’s ability to self-regulate their behavior, and therefore, potentially increasing their children’s risk of overeating unhealthy foods and BMI (Blissett and Haycraft 2008; Johnson et al. 2012). Permissive parents also allow their children to watch television, which may lead to increased intake of unhealthy foods (Harris and Bargh 2009). From the aforementioned studies, authoritative parenting was associated with determinants of better health outcomes for children, including a high intake of fruits and vegetables (De Bourdeaudhuij et al. 2009; Kremers et al. 2003; Patrick et al. 2005; Peters et al. 2013), low intake of unhealthy foods (Cullen et al. 2000; Gable and Lutz 2000), and less obesogenic environments (Johnson et al. 2012). The present study analyses involved data gathered from the national database of Growing up in Australia: The Longitudinal Study of Australian Children (LSAC). Its design covered developmental outcomes from early until late childhood, in two selected cohorts—B cohort (infant) and K cohort (child)—representative of Australian children and their families (citizens and permanent residents). The data were collected from multiple sources such as mothers and fathers, teachers and carers, and direct assessments and observations. Data were primarily collected to provide information regarding a child’s personality and behavior, family and relationship history, health and lifestyle, parenting practice, source of support, activities with children, education, paid work and physical measurements. This study extends and updates the literature concerned with the determinants of children’s fruit and vegetable intake, on a number of new levels including parental irritability and parental warmth and control over children’s behaviors. Previous evidence has revealed that the irritable behavior of parents can increase the incidence of overweight/obesity (Taylor et al. 2011), whereas no study to date has sought to discover if there is an association between parental irritable behavior and children’s fruit and vegetable intake. Few research findings have also investigated the association between parental warmth and children’s fruit and vegetable intake. Kremers and colleagues (2003) and Rhee (2008) indicate that parents practicing high warmth were more likely to have children who consume fruit and vegetables. There is no recent research which examines an association between parental control over children’s behaviors and children’s fruit and vegetable intake. Savage, Fisher, and Birch (2007) revealed that parental control of feeding practices is associated with overeating and poorer self-regulation of energy intake in school children. Forcible feeding practices may have

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an immediate and positive influence on diet, but in the longer term these will negatively influence the development of preferences for healthy foods (Bante et al. 2008; Galloway et al. 2006). This study also extends the previous cross-sectional findings to include cross-lagged associations between parenting styles and children’s fruits and vegetables intake. Therefore, the aim of the present study was to explore relationships between parenting style and fruit and vegetable intake in an Australian context using a large representative sample of Australian children.


METHODS Study Design This research was conducted through secondary analysis of data from Growing up in Australia: the Longitudinal Study of Australian Children. Briefly, the LSAC implemented a two-stage cluster sampling design. The purpose of a cluster sampling design was implemented to ensure that diverse observations could be gathered from within the community. Further, this strategy allows face-to-face interviews to be conducted cost-effectively. Stratification of postcodes was estimated by Australian Bureau of Statistics (ABS) in March 2004 to ensure proportionate geographic representation from states/territories and capital city statistical division (“met”)/rest of state (“exmet”) areas. Postal codes which included data for fewer than 20 children in non-remote regions and had 80 or fewer target-aged children in remote regions were excluded from the LSAC study. Around 20 children per cohort per postal code were considered to be acceptable in the final cluster size. Children born between March 1999 and February 2000 were selected by the Health Insurance Commission (HIC) from its Medicare Australia enrolment database. The Health Insurance Commission (HIC) mailed out an “invitation to participate” letter. This was supported by a letter from AIFS and a brochure entitled Growing Up in Australia (Soloff, Lawrence, and Johnstone 2005). Interviewers spent an average of 1.5 hours for collecting data for the B cohort and 2.5 hours for the K cohort, in the child’s home with the study child’s primary caregiver (e.g., biological mother, father). The latter were also requested to complete written questionnaires provided at the interview. The methods of data selection, collection, and analysis, as well as a detailed description of the LSAC dataset, are outlined elsewhere (Australian Institute of Family Studies 2009; Mission and Sipthorp 2007; Sipthorp and Misson 2009; Soloff et al. 2005; Soloff, Lawrence, Misson, and Johnston 2006).

Participants The study sample was nationally representative, comprising two selected cohorts (B and K cohorts). Data for K cohort children in wave 1 (at ages


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4–5 years), wave 2 (6–7 years), and wave 3 (8–9 years) were used for analyses. The purpose of choosing K cohort for analysis was to represent the dynamics of change as children develop, and how parenting style influences children’s food selection as they grow older. Of the 8,391 children resident within the selected postal code, 4,911 children (2,494 boys, 2,417 girls) took part at 4–5 years of age at wave 1 in 2004. The number of children in wave 2 and wave 3 were slightly lower, as a result of loss-to-follow-up, with 4,437 children (2,258 boys, 2,179 girls) retained at wave 2 and 4,310 children (2,200 boys, 2,110 girls) retained at wave 3.


Outcome Measure Fruit and vegetable intake when children were approximately 4–5, 6–7, and 8–9 years old was used as the outcome measure in the present study and emerged through exploratory factor analysis using ten food items in wave 1, and eleven food items in waves 2 and 3, based on the Kaiser criterion and the scree plot. A factor loading of 0.3 was used to test correlations between dietary factors derived from the original measurements using the varimax method. Through factor analysis, standardised food items within each factor were computed, and three dietary patterns emerged (fruits and vegetables, take-out meals, and high-fat snacks). Having only 11 questions related to diet is a major issue of the study. These questions were referred to the inception of LSAC, so there was no opportunity to expand these in the study. Limited numbers of food items in short dietary questions may represent challenges in providing reliable information on dietary intake, and therefore may affect on the validity of these questions (Rutishauser et al. 2001). This lack of dietary data prompted the beginning of LSAC. While it is necessary to classify the food items into a smaller number of food patterns so as to reduce the complexity of further statistical analyses, the study acknowledged lack of a comprehensive measure of food items. The LSAC collected data on consumption of various food items using a face to face interview (F2F) related to reported children’s food and drink consumption in the preceding 24 hours. Parents provided information on their child’s food intake. The response scale provided for each food item was (a) not at all, (b) once/day, and (c) more than once/day. These measures were coded into 0 = not at all; and 1 = once/day, more than once/day, so that a higher value represented children consuming fruits and vegetables ≥ 1 once/day.

Primary Exposure Parenting style was assessed using a validated face-to-face interview in waves 1–3. Questionnaires provided information about parenting dimensions (i.e.,


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warmth, control, and irritability). All variables showed very good reliability and adequate internal consistency (r = 0.61–0.83). The warmth score was assessed by collating 12 items (6 for mothers, 6 for fathers) which measured warm affectionate behaviors towards their child. The latter was adopted from the Child Rearing Questionnaire (Paterson and Sanson 1999) (e.g., “In the last six months how often did you hug or hold this child for no particular reason?”). Items were computed and recoded into three new responses, 0 = medium (sometimes), 1= low (never/almost never, rarely), 2 = high (often, always/almost always). The control score was determined through the collation of ten items (five for mothers, five for fathers) which measured the frequency with which parents set and enforced clear expectations and limits for their children’s behavior (e.g., “When parents spend time with their children, sometimes things go well and sometimes they don’t. How often does the following happen . . . ?”; “When you give this child an instruction or request to do something, how often do you make sure that he/she does it?”). Items were computed and recoded into three new responses; 0 = medium (about half the time), 1 = low (never/almost never, less than half the time), 2 = high (more than half the time, all the time). The irritability score was assessed by 8 items (4 for mothers, 4 for fathers) which displayed the frequency with which parents’ interactions with the child entailed behaviors such as disapproval, lack of praise and anger (e.g., “When parents spend time with their children, sometimes things go well and sometimes they don’t. How often does the following happen . . . ?”; “How often do you feel you are having problems managing this child in general?”). Items were computed and recoded into three new responses; 0 = medium (about half the time), 1 = low (never/almost never, less than half the time), 2 = high (more than half the time, all the time). Both warmth and control scores were divided and combined to approximate the four categorical parenting styles (Wake et al. 2007): Authoritative parenting (the combination of high warmth and high control); Authoritarian parenting (the combination of low warmth and high control); Permissive parenting (the combination of high warmth and low control); and Disengaged parenting (the combination of low warmth and low control).

Data Analysis Statistical analyses were performed using Statistical Package for Social Science (SPSS) Version 20. The study measured the effect of parenting style on the outcome variable (fruit and vegetable intake) obtained from exploratory factor analysis. The proportion of children reported eating more than one fruit and vegetable were compared by gender using Pearson Chi-square tests. In crosssectional analysis, multivariate logistic regression analyses were performed separately for boys and girls. The analyses examined how parenting style



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influenced the odds of a high score for consuming fruits and vegetables. The outcome measure was transformed into binary variables (Reference category coded as 0). Analysis of cross-sectional data was adjusted for potential confounding factors (demographic variables: age in month, ethnicity, main language spoken at home, number of people in the household, number of siblings of the study child in the household and number of other people in the household of the study child). In longitudinal analysis, cross-lagged correlations were used separately for boys and girls to test whether parenting style can predict changes in fruits and vegetables consumption over time (e.g. in subsequent waves). The multivariate logistic regression analysis measured the association separately between wave 1 (4–5 years; parenting style) and wave 2 (6–7 years) and wave 3 (8–9 years) (fruits and vegetables), adjusting for demographic variables at wave 2 and wave 3, and fruits and vegetables at wave 1.

RESULTS Exploratory Factor Analysis Tables 1 shows exploratory factor analysis results of K cohort. The fruit and vegetable intake pattern represented food items associated with the consumption of fruits and vegetables. Fresh fruit had the highest factor loading in waves 1 and 3, whereas raw vegetables/salad had the highest factor loading in wave 2. Cooked vegetables consumption was also positively associated with fruits and vegetables in all cohort waves, since it showed high factor loading values.

TABLE 1 Factor-Loading Matrix for Fruits and Vegetable Consumption Pattern in the K Cohort Food Items (Variance explained)

Wave 1 15.07%

Wave 2 13.34%

Wave 3 12.66%

Fresh fruit Raw vegetables/salad Cooked vegetables Water Soft drink/cordial, not diet Fresh juice Hot chips/French fries Meat pie, hamburger, hot dog, sausage or sausage roll Potato chips/savory snacks Biscuits, doughnuts, cake, pie or chocolate Diet soft drink/cordial Eigenvalue

0.724 0.605 0.566 0.281 −0.112 0.148 0.015 0.086 0.012 0.082 NS∗ 1.50

0.665 0.683 0.621 0.126 −0.026 0.222 −0.019 0.073 0.066 −0.043 −0.033 1.46

0.696 0.637 0.562 0.206 −0.066 0.208 0.005 0.037 0.072 0.028 0.037 1.39

∗

Insufficient information about diet soft drinks/cordials available for this age group.

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TABLE 2 Frequency of Daily Reported Consumption of a Fruits and Vegetables Pattern Stratified by Gender in the K Cohort Age group

Frequency†

Boys n (%)

Girls n (%)

x 2∗

p∗

4–5 y

< 1 Once ≥ 1 Once < 1 Once ≥ 1 Once < 1 Once ≥ 1 Once

1, 636 858 1, 411 847 1, 411 789

1, 531 886 1, 277 902 1, 257 853

2.72

.099

7.00

.008∗

9.50

.002∗

6–7 y 8–9 y

(51.7) (49.2) (52.5) (48.4) (52.9) (48.1)

(48.3) (50.8) (47.5) (51.6) (47.1) (51.9)

∗ 2


x test, p < .05: Pearson’s chi-square analyses between boys and girls.

Frequency of Daily Reported Consumption of Fruits and Vegetables The frequency of daily reported consumption of a fruits and vegetables pattern stratified by gender in both cohorts is given in table 2. The frequency of reporting consumption of more than one fruits and vegetables pattern per day was significantly higher in girls than in boys in the 6–7 years age group (51.6% vs. 48.4%, x 2 = 7.00, p = .008) and also in the 8–9 years age group (51.9% vs. 48.1%, x 2 = 9.50, p = .002). The frequency of reporting consumption of more than one fruits and vegetables pattern per day was also observed as higher in girls than in boys at 4–5 years of age, but with no significant differences indicated.

Descriptive Statistics for Parenting Dimensions and Styles Maternal and parental dimensions and styles at all waves are summarized in table 3. Around 40% of mothers and 33% of fathers were classified as having a permissive parenting style at wave 1, and 43% and 31%, mothers and fathers, respectively, were classified as permissive at wave 2. At wave 3, around 28% of mothers and 30% of fathers were classified as having an authoritarian parenting style. Overall, mothers and fathers exhibited medium warmth toward their children’s behaviors at all waves.

Cross-sectional Analysis Table 4 summarizes cross-sectional results identifying parenting styles associated with the intake of fruits and vegetables at 4–5, 6–7, and 8–9 years. Overall findings showed that parenting-style variables had negative associations with a fruit and vegetable intake patterns. Mothers’ authoritarian parenting style was significantly associated with a low fruits and vegetables intake in boys at 6–7 years (OR 0.43; 95% CI, 0.23 to 0.78) and at 8–9 years (OR 0.58; 95% CI, 0.35 to 0.98) more than once per day. Mothers

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TABLE 3 Parenting Dimensions and Parenting Styles of Maternal and Paternal Samples Maternal n (%) or mean ± SD

Paternal n (%) or mean ± SD

1.20 ± 0.91 0.79 ± 0.88 0.95 ± 0.88

1.15 ± 0.92 0.86 ± 0.88 0.98 ± 0.88

800 (22.6) 536 (15.2) 1405 (39.7) 798 (22.5)

774 (22.2) 964 (27.6) 1148 (33.0) 601 (17.2)

1.20 ± 0.92 0.69 ± 0.85 0.93 ± 0.88

1.18 ± 0.91 1.02 ± 0.86 1.06 ± 0.85

796 (25.9) 372 (12.1) 1328 (43.3) 573 (18.7)

643 (19.1) 831 (24.6) 1059 (31.4) 842 (24.9)

1.02 ± 0.95 1.00 ± 0.84 0.79 ± 0.87

1.08 ± 0.93 1.04 ± 0.85 0.72 ± 0.86

Wave 1 (4–5 y) Parenting dimensions Warmth Control Irritability Parenting style Disengaged Authoritarian Permissive Authoritative Wave 2 (6–7 y) Parenting dimensions Warmth Control Irritability Parenting style Disengaged Authoritarian Permissive Authoritative Wave 3 (8–9 y) Parenting dimensions Warmth Control Irritability Parenting style Disengaged Authoritarian Permissive Authoritative

670 929 925 855

(19.8) (27.5) (27.4) (25.3)

532 898 863 741

(17.6) (29.6) (28.4) (24.4)

Note. Parenting dimensions were recoded as 0 = low (never/almost never, rarely), 1 = medium (sometimes), 2 = high (often, always/almost always).

who reported high irritability at 8–9 years had lower odds of their sons consuming a fruits and vegetables option (OR 0.42; 95% CI, 0.34 to 1.39) more than once per day, and also high levels of maternal control over their children’s behaviors showed negative associations with a fruits and vegetables option intake in girls (OR 0.72; 95% CI, 0.53 to 0.99) more than once per day at the same age group. In construct, fathering factors displayed low warmth, which may lead to reduced consumption of a fruits and vegetables option among boys at 4–5 years (OR 0.68; 95% CI, 0.49 to 0.95) and at 8–9 years (OR 0.66; 95% CI, 0.45 to 0.95) more than once per day.

Cross-lag Correlation Analysis Table 5 shows the results identifying whether parenting style is associated with changes in a fruits and vegetables intake pattern over time.

102 OR

Informant

Father

Wave 3 (8–9 y)§

Warmth score Medium∗∗ Low High 1 0.66 0.71

1 0.43 0.83 1.05

Mother

Parenting style Disengaged∗∗ Authoritarian Permissive Authoritative

OR

1 0.68 0.82

Informant

Father

Warmth score Medium∗∗ Low High

OR

Wave 2 (6–7 y)§

Informant

Wave 1 (4–5 y)§

0.45–0.95 0.49–1.02

95% CI

≥ 1/day‡ Boys

0.23–0.78 0.55–1.24 0.65–1.71

95% CI

≥ 1/day‡ Boys

0.49–0.95 0.59–1.13

95% CI

≥ 1/day‡ Boys

.026∗ .068

p

.006∗ .378 .818

p

.027∗ .242

p

1 0.84 0.92

OR

1 0.64 0.93 0.90

OR

1 0.82 0.85

OR

0.58–1.23 0.64–1.32

95% CI

≥ 1/day‡ Girls

0.33–1.24 0.63–1.38 0.54–1.49

95% CI

≥ 1/day‡ Girls

0.58–1.15 0.62–1.17

95% CI

≥ 1/day‡ Girls

.387 .670

p

.192 .743 .685

p

.258 .338

p

TABLE 4 Cross-sectional Correlation between Parenting Dimensions, Parenting Style, and Fruits and Vegetables Intake Pattern Stratified by Gender at Ages 4–5, 6–7, and 8–9 Years


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Mother

Mother

Mother

1 0.58 0.87 1.16

1 1.14 0.42

1 0.97 0.94

0.35–0.98 0.51–1.49 0.67–2.00

0.97–1.86 0.34–1.39

0.72–1.30 0.69–1.27

.045∗ .624 .576

.076 .045∗

.840 .700

1 0.81 1.36 1.22

1 1.01 1.05

1 0.78 0.72

0.47–1.38 0.82–2.26 0.69–2.14

0.74–1.37 0.74–1.49

0.59–1.04 0.53–0.99

.442 .227 .484

.937 .757

.103 .043∗

§

The odds (OR) of consuming more than one fruit and vegetable option per day (High) Multivariate logistic regression analyses adjusted for age (month), ethnicity, language spoken, and number of people in the household, number of sibling in the household, number of other people in the household ∗ p < .05. ∗∗ Referent category.

‡

Control score Medium∗∗ Low High Irritability score Medium∗∗ Low High Parenting style Disengaged∗∗ Authoritarian Permissive Authoritative


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1 1.29 1.49 1.04

1 1.09 0.99 0.97

OR

0.92–2.41 0.83–1.99 0.64–1.68

0.64–1.85 0.67–1.47 0.61–1.54

95% CI

.103 .044∗ .860

.740 .997 .908

p

1 1.62 1.65 1.68

1 1.06 0.86 1.07

OR

0.97–2.70 1.06–2.55 1.03–2.75

0.63–1.79 0.57–1.30 0.65–1.75

95% CI

≥ 1/day‡ Girls

.064 .024∗ .037∗

.814 .495 .790

p

1 1.01 0.66 1.59

1 1.07 0.81 0.89

OR

0.61–1.66 0.42–1.04 0.36–3.98

0.61–1.86 0.53–1.23 0.53–1.49

95% CI

≥ 1/day‡ Boys

.955 .076 .045∗

.802 .336 .669

p

1 0.92 1.07 1.10

1 1.03 1.22 1.64

OR

Wave 3 (8–9 y)Œ

0.54–1.56 0.69–1.67 0.67–1.81

0.60–1.78 0.80–1.85 1.00–2.68

95% CI

≥ 1/day‡ Girls

.761 .734 .700

.900 .348 .047∗

p

§

The odds (OR) of consuming more than one fruits and vegetable option per day (High). Multivariate logistic regression analyses adjusted for age (month), ethnicity, language spoken, number of people in the household, number of sibling in the household, number of other people in the household at wave 2 (6–7 y), and fruits and vegetables options at wave 1 (4–5 y). Œ Multivariate logistic regression analyses adjusted for age (month), ethnicity, language spoken, number of people in the household, number of siblings in the household, number of other people in the household at wave 3 (8–9 y), and fruits and vegetables options at wave 1 (4–5 y). ∗ p < .05. ∗∗ Referent category.

‡

Father

Mother

Disengaged∗∗ Authoritarian Permissive Authoritative

Disengaged∗∗ Authoritarian Permissive Authoritative

Informant

Parenting style

≥ 1/day‡ Boys

Wave 2 (6–7 y)§

TABLE 5 Cross-lagged Correlation between Parenting Style at 4–5 years and Fruits and Vegetables Consumption Intake Pattern at 6–7 and 8–9 years Stratified by Gender (K Cohort)



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Cross-lag correlation analyses showed that permissive fathers at 4–5 years were more likely to have boys (OR 1.49; 95% CI, 0.83 to 1.99) and girls (OR 1.65; 95% CI, 1.06 to 2.55) who regularly consume fruit and vegetables pattern two years later at 6–7 years. Authoritative fathers at 4–5 years were associated with high intakes of a fruits and vegetables pattern more than once per day in girls two years later at 6–7 years (OR 1.68; 95% CI, 1.03 to 2.75) and in boys four years later at 8–9 years (OR 1.59; 95% CI, 0.36 to 3.98). Authoritative mothers at 4–5 years were associated with high intakes of a fruits and vegetables pattern more than once per day in girls four years later at 8–9 years (OR 1.64; 95% CI, 1.00 to 2.68).

DISCUSSION This study investigates the potential association between parenting style and fruits and vegetable intake pattern during the early years of life. Results showed gender differences in fruits and vegetables pattern intake, with girls at 6–7 and 8–9 years more likely than boys to report consuming a fruits and vegetables pattern daily. This gender difference has been observed consistently in previous studies (ABS 1998). The 1995 Australian National Nutrition Survey (NNS) indicated that girls at 2–11 years of age reported consuming daily fruits and vegetables more than boys (ABS 1997). An Australian study also indicated that greater proportions of girls than boys at 10–12 years of age reported consuming a fruit and vegetable option five or more times per day than boys (Pearson et al. 2009). This also accords with a Mexican study, where a higher proportion of girls compared with boys reported consuming fruit and vegetables three or more times per day (Perez-Lizaur, Kaufer-Horwitz, and Plazas 2008). Other research in the UK (Keyte et al. 2011), Norway (Bere, Brug, and Klepp 2008), and Canada (Sylvestre et al. 2007) has delivered similar findings, indicating that girls’ dietary perception of fruits and vegetables is more in line with what they should be eating, since findings confirmed that girls’ intake is likely to be higher than that of boys of the same age. One explanation may relate to girls at all ages having a greater liking for healthier food choices such as fruits and vegetables than do boys (Cooke and Wardle 2005). Another reason might be that girls demonstrated higher concern for weight control and were more health-conscious than boys (Sweeting and West 2002; Wardle et al. 2004). Findings suggest some opportunities to focus interventions regarding the importance of liking and preferences for healthy food choices as an effective way to promote the consumption of fruits and vegetables in boys. There are many strategies that might help boys to improve liking and preferences for fruit and vegetables. One strategy could be achieved by repeating exposure to different varieties of fruit and vegetable at early and later ages (Patrick and Nicklas 2005). Another possible strategy could be parental modelling of fruit and vegetable


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consumption where it has been found to be associated with increased liking and preferences for fruit and vegetables in children (Gregory, Paxton, and Brozovic 2011; Kristjansdottir et al. 2009; Wind et al. 2006). Parental monitoring of children’s intake of fruits and vegetables (Arredondo et al. 2006), and parental encouragement to eat fruit and vegetables (De Bourdeaudhuij et al. 2005; Jte Velde et al. 2006) have also been associated with increased liking and preferences of the same food intake. Of the parenting dimensions measured (i.e., warmth, control, irritability), all were found to be cross-sectionally associated with lower odds of consuming fruits and vegetables pattern in boys and girls. For example, mothers’ high levels of control over their children’s behavior were associated with reducing health behaviors (i.e., lower odds of consuming fruits and vegetables) in girls at 8–9 years. The underlying reason may relate to previous findings that high prenatal control over children’s behaviors may result in reduced food intake with more negative response to pressure (Keski-Rahkonen et al. 2003). Parents who practiced high control over their children’s behaviors may practice some pressure tactics such as ridicule and manipulation, which may result in children’s reduced consumption of fruits and vegetables (Lessard, Greenberger, and Chen 2010). The present study proposes that high levels of control over their children’s behavior by mothers may have negative effects on the quality of children’s diets by decreasing their preferences for fruits and vegetables. In the present study, fathers who practiced low warmth were less likely to have boys at 4–5 and 8–9 years who consumed fruits and vegetables. These findings are consistent with the finding that parents practicing high warmth were more likely to have children who consume fruit and vegetables (Kremers et al. 2003; Rhee 2008). Parents who practiced high warmth in regard to their children’s behaviors may provide more encouragement and take more responsibility over their children’s diet (Lessard et al. 2010), which may result in increased consumption of fruits and vegetables. The present findings also indicated that high irritability among mothers showed negative associations with health behaviors (i.e., lower odds of consuming fruits and vegetables) in boys at 8–9 years. The association might be related to previous findings that irritable mothers may use more restrictive feeding practices, which reduce their children’s healthy food consumption (Ventura and Birch 2008). One proposed explanation for this finding is that irritable mothers may find it difficult to prepare healthy food at home, and this may have a negative impact on the promotion of healthy food choices to their children. An authoritarian style of parenting among mothers was negatively associated with healthy behaviors (i.e., lower odds of consuming fruits and vegetables) in boys 6–7 and 8–9 years. One explanation for this finding may relate to previous findings that parents who exhibit an authoritarian parenting style tended to have children with less healthy eating habits (Patrick et al. 2005). Previous studies reported so far have demonstrated consistent



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findings (Kremers et al. 2003; Patrick et al. 2005). Authoritarian parents are characterized as restrictive and punitive. They practice high pressure and restrict access to foods, and their children are expected to model their roles. In one study, children of authoritarian parents were more likely to be obese, compared with children whose parents employed a healthy parenting style (Rhee 2008). Overall findings suggest that exploring possible mechanisms underlying such associations may lead to the development of interventions aimed at increasing children’s consumption of fruits and vegetables. The finding that having a permissive father at 4–5 years was associated with higher odds of consuming fruits and vegetables options in boys and girls two years later, at 6–7 years, is consistent with a previous longitudinal study, which indicated a positive association between permissive parental style and fruit and vegetable intake among girls over a five-year period (Berge et al. 2010). Permissive parenting, characterized by high warmth and caring (Patrick and Nicklas 2005), may influence s fruit and vegetable consumption pattern. Permissive parents are emotionally close and supportive, but they don’t tend to set limits for their children’s behavior. The underlying reason may be that permissive fathers give their children requests to eat high amounts of fruits and vegetables. Authoritative fathers at 4–5 years were associated with high intakes of a fruits and vegetables—more than once per day—in girls two years later, at 6–7 years; and in boys four years later, at 8–9 years. Having an authoritative mother at 4–5 years was also associated with high intakes of a fruits and vegetables—more than once per day—in girls four years later, at 8–9 years. Children raised with an authoritative parenting style have previously been found to be more likely to make healthy food choices and to have a lower BMI (De Bourdeaudhuij et al. 2009; HubbsTait et al. 2008; Johnson et al. 2012; Kremers et al. 2003; Sleddens et al. 2012). Also, authoritative parenting is consistently related to a lower intake of unhealthy foods (Cullen et al. 2000; Gable and Lutz 2000). Authoritative parents are warm and supportive; they set limits on foods of the energydense variety but are responsive to their children’s need for them (Forthun 2012). This study proposed that an authoritative parenting style may be an important determinant in supporting children’s fruit and vegetable intake. This study did observe that not all parenting dimensions and style variables were significantly associated with fruit and vegetable intake. For example, only cross-sectional associations were found between mothers’ control over their children’s behaviors and fruit and vegetable intake in girls at 8–9 years. Additionally, fruit and vegetable intakes in boys and girls had a cross-lagged association with a permissive parenting style for mothers but not for fathers. This finding may be attributed to several possible limitations through analysis of the data. It is possible that implausible relationships between parenting style and children’s fruits and vegetable intake through cross-sectional and cross-lagged correlation analyses may produce positive or negative statistically significant associations simply by chance, and therefore,


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reflect reporting bias (Christenfeld et al. 2004). For example, cross-lagged correlation findings indicate that permissive mothers at 4–5 years were more likely to have boys and girls at 6–7 years who consume fruits and vegetables more than once per day. This finding may be due to a tendency for mothers reporting permissiveness to also report children’s high consumption of fruits and vegetables. The absence of an apparent plausible relationship to illustrate a putative cause (mother’s permissiveness) as a predictor along with confounding factors (demographic status) could emerge spuriously through a reporting bias for subjective outcomes like consumption of fruits and vegetables. Conflicting conclusions may thus be drawn from the results. The inclusion of demographic variables in the adjustment process may cause a key bias in identifying causal effects. The reliance on parents’ self-reported measures of factors may introduce some bias in over-reporting or underestimating of values. This could result in reducing the likelihood of finding significant differences when estimating the associations with fruit and vegetable intake. Limited number of response categories in short dietary questions may affect on the validity of these questions for detecting significant differences between population sub-groups (Rutishauser et al. 2001). In the present study, three responses categories are used for short dietary questions (not at all, once, more than once). Although cross-lagged correlation analysis is considered an appropriate test to determine a causal relationship between two time points, the relationship in some cases can cause bias when factors are unobserved from the modules, or other factors are invariant (McArdle 2009). In some cases even a causal relationship could provide a false interpretation of the results (Grimes and Schulz 2002). Items computed and recoded into new different response categories may affect the ability to detect cohort differences, and therefore, may decrease the likelihood of detecting significant differences. For example, the warmth score variable was coded using five responses categories ranging from 0 = never/almost, to 5 = almost always. Items were then computed and recoded into three new responses 0 = medium (sometimes), 1 = low (never/almost never, rarely), 2 = high (often, always/almost always). The missing data for parenting style in all waves were obvious. Maternal parenting style was missing for 27% of cases (n = 1,372) for wave 1, 26% of cases in wave 2 (n = 1,368) and 21% of cases in wave 3 (n = 931). Paternal parenting style was missing for 29% (n = 1,424) for wave 1, 24% of cases in wave 2 (n = 1,062) and 30% (n = 1,312) for wave 3. With more than 20% of maternal and paternal parenting style data missing, imputation is not recommended and was not included. Missing values in the present study were related to missing completely at random (MCAR). Reasons for missing data in the LSAC study includes families not interested/too busy, not capable/moving/overseas, refused, and were ill/died. The argument against imputation for missing data has been widely acknowledged. It argues that missing completely at random (MCAR) values were still give good results and



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not biased by the absence of data, however, this may lead to a substantial loss of statistical power (Heitjan and Basu 1996). This limitation can reduce the likelihood of finding significant differences, and therefore may have an impact on the validity of the findings. The present study found new interesting associations, but these need to be confirmed through other research approaches, and the specific mechanisms underlying such associations which would lead to possibilities for fruits and vegetables interventions to increase consumption. This study addresses an important step towards establishing the evidence base on which to develop interventions and policies in areas concerning children, particularly parenting and early childhood food choices. This study extends the previous cross-sectional findings and confirmed cross-lagged evidence for a positive association between parenting style and children’s fruit and vegetable intake among Australian children.

REFERENCES ABS. 1997. National Nutrition Survey selected highlights Australia 1995. Canberra, Australia: Australian Bureau of Statistics. ABS. 1998. National Nutrition Survey: Nutrient intakes and physical measurements Australia, 1995. Canberra, Australia: Australian Bureau of Statistics. Arredondo, E. M., J. P. Elder, G. X. Ayala, N. Campbell, B. Baquero, and S. Duerksen. 2006. Is parenting style related to children’s healthy eating and physical activity in Latino families? Health Education Research 21:862–871. Australian Institute of Family Studies. 2009. Data user guide. The Longitudinal Study of Australian Children: An Australian Government initiative, 1–65. Melbourne, Australia: Government of Australia. Bante, H., M. Elliott, A. Harrod, and D. Haire-Joshu. 2008. The use of inappropriate feeding practices by rural parents and their effect on pre-schoolers fruit and vegetable preferences and intake. Journal of Nutrition Education and Behavior 40:28–33. Bere, E., J. Brug, and K. I. Klepp. 2008. Why do boys eat less fruit and vegetables than girls? Public Health Nutrition 11:321–325. Berge, J. M., M. Wall, K. Loth, and D. Neumark-Sztainer. 2010. Parenting style as a predictor of adolescent weight and weight-related behaviors. Journal of Adolescent Health 46 (4): 331–338. Blissett, J., and E. Haycraft. 2008. Are parenting style and controlling feeding practices related? Appetite 50 (2): 477–485. Christenfeld, N. J. S., R. P. Sloan, D. Carroll, and S. Greenland. 2004. Risk factors, confounding, and the illusion of statistical control. Psychosomatic Medicine 66 (6): 868–875. Cooke, L. J., and J. Wardle. 2005. Age and gender differences in children’s food preferences. British Journal of Nutrition 93:741–746. Cullen, K. W., T. Baranowski, L. Rittenberry, C. Cosart, E. Owens, D. Hebert, and C. De Moor. 2000. Socio-environmental influences on children’s fruit, juice


110


and vegetable consumption as reported by parents: Reliability and validity of measures. Public Health Nutrition 3 (3): 345–356. De Bourdeaudhuij, I., K. Klepp, P. Due, C. P. Rodrigo, M. De Almeida, M. Wind, R. Krolner, C. Sandvik, and J. Brug. 2005. Reliability and validity of a questionnaire to measure personal, social and environmental correlates of fruit and vegetable intake in 10–11-year-old children in five European countries. Public Health Nutrition-Wallingford 8:189–200. De Bourdeaudhuij, I., S. J. Te Velde, L. Maes, C. Perez-Rodrigo, M. D. V. De Almeida, and J. Brug. 2009. General parenting styles are not strongly associated with fruit and vegetable intake and social-environmental correlates among 11-year-old children in four countries in Europe. Public Health Nutrition 12 (2): 259–266. Dufour, D. L. 1997. Nutrition, activity, and health in children. Annual Review of Anthropology 26:541–565. Forthun, L. 2012. Family nutrition: Parenting and family life. Gainesville: University of Florida Department of Family Youth and Community Sciences. http://edis. ifas.ufl.edu/pdffiles/FY/FY105900.pdf. Gable, S., and S. Lutz. 2000. Household, parent, and child contributions to childhood obesity. Family Relations 49 (3): 293–300. Galloway, A. T., L. M. Fiorito, L. A. Francis, and L. L. Birch. 2006. Finish your soup: Counterproductive effects of pressuring children to eat on intake and affect. Appetite 46:318–323. Gregory, J. E., S. J. Paxton, and A. M. Brozovic. 2011. Maternal feeding practices predict fruit and vegetable consumption in young children: Results of a 12month longitudinal study. Appetite 57:167–172. Grimes, D. A., and K. F. Schulz. 2002. Bias and causal associations in observational research. Lancet 359 (9302): 248–252. Harris, J. L., and J. A. Bargh. 2009. Television viewing and unhealthy diet: Implications for children and media interventions. Health Communication 24 (7): 660–673. Heath, D. L., and K. S. Panaretto. 2005. Nutrition status of primary school children in Townsville. Australian Journal of Rural Health 13:282–289. Heitjan, D. F., and S. Basu. 1996. Distinguishing missing at random and missing completely at random. The American Statistician 50 (3): 207–213. Hoerr, S. L., S. O. Hughes, J. O. Fisher, T. A. Nicklas, Y. Liu, and R. M. Shewchuk. 2009. Associations among parental feeding styles and children’s food intake in families with limited incomes. International Journal of Behavioral Nutrition and Physical Activity 6 (55). Hubbs-Tait, L., T. S. Kennedy, M. C. Page, G. L. Topham, and A. W. Harrist. 2008. Parental feeding practices predict authoritative, authoritarian, and permissive parenting styles. Journal of the American Dietetic Association 108 (7): 1154–1161. Johnson, R., G. Welk, P. F. Saint-Maurice, and M. Ihmels. 2012. Parenting styles and home obesogenic environments. International Journal of Environmental Research and Public Health 9 (4): 1411–1426. Jte Velde, S. J., M. Wind, F. J. Van Lenthe, K. I. Klepp, and J. Brug. 2006. Differences in fruit and vegetable intake and determinants of intakes between children of Dutch origin and non-Western ethnic minority children in the Netherlands:



111

A cross sectional study. International Journal of Behavioral Nutrition and Physical Activity 3:31. Keski-Rahkonen, A., J. Kaprio, A. Rissanen, M. Virkkunen, and R. J. Rose. 2003. Breakfast skipping and health-compromising behaviors in adolescents and adults. European Journal of Clinical Nutrition 57 (7): 842–853. Keyte, J., S. Harris, B. Margetts, S. Robinson, and J. Baird. 2011. Engagement with the National Healthy Schools Program is associated with higher fruit and vegetable consumption in primary school children. Journal of Human Nutrition and Dietetics 25:1–6. Kremers, S. P. J., J. Brug, H. De Vries, and R. C. M. E. Engels. 2003. Parenting style and adolescent fruit consumption. Appetite 41 (1): 43–50. Kristjansdottir, A. G., I. De Bourdeaudhuij, K. I. Klepp, and I. Thorsdottir. 2009. Children’s and parents’ perceptions of the determinants of children’s fruit and vegetable intake in a low-intake population. Public Health Nutrition 12:1224–1233. Lessard, J., E. Greenberger, and C. Chen. 2010. Adolescents’ response to parental efforts to influence eating habits: When parental warmth matters. Journal of Youth and Adolescence 39 (1): 73–83. Magarey, A., L. A. Daniels, and A. Smith. 2001. Fruit and vegetable intakes of Australians aged 2–18 years: An evaluation of the 1995 National Nutrition Survey data. Australian and New Zealand Journal of Public Health 25:155–161. McArdle, J. J. 2009. Latent variable modeling of differences and changes with longitudinal data. Annual Review of Psychology 60:577–605. Mission, S., and M. Sipthorp. 2007. LSAC Technical Paper No. 5: Wave 2 weighting and non-response. Discussion paper. Melbourne, Australia: Australian Institute of Family Studies. Paterson, G., and A. Sanson. 1999. The Association of behavioral adjustment to temperament, parenting and family characteristics among 5-years old children. Social Development 8 (3): 293–309. Patrick, H., and T. A. Nicklas. 2005. A review of family and social determinants of children’s eating patterns and diet quality. Journal of the American College of Nutrition 24 (2): 83–92. Patrick, H., T. A. Nicklas, S. O. Hughes, and M. Morales. 2005. The benefits of authoritative feeding style: Caregiver feeding styles and children’s food consumption patterns. Appetite 44 (2): 243–249. Pearson, N., A. Timperio, J. Salmon, D. Crawford, and S. G. H. Biddle. 2009. Family influences on children’s physical activity and fruit and vegetable consumption. International Journal of Behavioral Nutrition and Physical Activity 6:34. Perez-Lizaur, A., M. Kaufer-Horwitz, and M. Plazas. 2008. Environmental and personal correlates of fruit and vegetable consumption in low income, urban Mexican children. Journal of Human Nutrition and Dietetics 21:63–71. Peters, J., J. Dollman, J. Petkov, and N. Parletta. 2013. Associations between parenting styles and nutrition knowledge and 2–5 year old children’s fruit, vegetable and non-core food consumption. Public Health Nutrition 16 (11): 1979–1987. Polfuss, M. L., and M. Frenn. 2012. Parenting and feeding behaviors associated with school-aged African American and White children. Western Journal of Nursing Research 34 (5): 677–696.


112


Rhee, K. 2008. Childhood overweight and the relationship between parent behaviors, parenting style, and family functioning. The ANNALS of the American Academy of Political and Social Science 615 (1): 11–37. Rosenkranz, R. R., and D. A. Dzewaltowski. 2008. Model of the home food environment pertaining to childhood obesity. Nutrition Reviews 66 (3): 123–140. Rutishauser, I., K. Webb, B. Abraham, R. Allsopp, and Australian Food and Nutrition Monitoring Unit. 2001. Evaluation of short dietary questions from the 1995 National Nutrition Survey. Canberra, Australia: Government of Australia Department of Health. Savage, J. S., J. O. Fisher, and L. L. Birch. L. 2007. Parental influence on eating behavior: conception to adolescence. The Journal of Law, Medicine & Ethics 35:22–34. Sipthorp, M., and S. Misson. 2009. Wave 3 weighting and non-response: The Longitudinal Study of Australian Children, 1–25. LSAC Technical Paper No. 6. Melbourne, Australia: Australian Institute of Family Studies. Sleddens, E. F. C., S. M. P. L. Gerards, C. Thijs, N. K. Vries, and S. P. J. Kremers. 2012. General parenting, childhood overweight and obesity-inducing behaviors: A review. International Journal of Paediatric Obesity 6 (2-2): e12–e27. Soloff, C., D. Lawrence, and R. Johnstone. 2005. The Longitudinal Study of Australian Children, 1–30. LSAC Technical Paper No. 1. Melbourne, Australia: Australian Institute of Family Studies. Soloff, C., D. Lawrence, S. Misson, and R. Johnstone. 2006. Wave 1 weighting and non-response: The Longitudinal Study of Australian Children: An Australian Government initiative, 1–50. LSAC Technical Paper No. 3. Melbourne, Australia: Australian Institute of Family Studies. Steinberg, L. 2001. We know some things: Parents adolescent relationships in retrospect and prospect. Journal of Research on Adolescence 11 (1): 1–19. Sweeting, H., and P. West. 2002. Gender differences in weight related concerns in early to late adolescence. Journal of Epidemiology and Community Health 56:700–701. Sylvestre, M. P., J. O’Loughlin, K. Gray-Donald, J. Hanley, and G. Pardis. 2007. Association between fruit and vegetable consumption in mothers and children in low-income, urban neighborhoods. Health Education & Behavior 34:723. Talib, J., Z. Mohamad, and M. Mamat. 2011. Effects of parenting style on children development. World 1 (2): 14–35. Taylor, A., C. Wilson, A. Slater, and P. Mohr. 2011. Parenting and child body mass index: Longitudinal investigation of maternal and paternal influence. Australian Journal of Psychology 63:198–206. Ventura, A. K., and L. L. Birch. 2008. Does parenting affect children’s eating and weight status? International Journal of Behavioral Nutrition and Physical Activity 5 (1): 15. Vereecken, C. A., and L. Maes. 2003. A Belgian study on the reliability and relative validity of the health behavior in school-aged children food-frequency questionnaire. Public Health Nutrition 6 (6): 581–588. Wake, M., J. M. Nicholson, P. Hardy, and K. Smith. 2007. Pre-schooler obesity and parenting styles of mothers and fathers: Australian national population study. Paediatrics 120 (6): e1520–e1527.


113


Wardle, J., A. M. Haase, A. Steptoe, M. Nillapun, K. Jonwutiwes, and F. Bellisie. 2004. Gender differences in food choice: The contribution of health beliefs and dieting. Annals of Behavioral Medicine 27:107–116. Wind, M., I. De Bourdeaudhuij, S. J. Te Velde, C. Sandvik, P. Due, K. I. Klepp, and J. Brug. 2006. Correlates of fruit and vegetable consumption among 11-year-old Belgian-Flemish and Dutch schoolchildren. Journal of Nutrition Education and Behavior 38:211–221.

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