A parent-early adolescent intervention to reduce sweetened beverage consumption through home environment parenting practices.

Abstract

Overweight and obesity are national health problems and are associated with increased prevalence of chronic diseases, such as diabetes mellitus and cardiovascular disease. Patterns of excessive intake of sugar-sweetened beverages (SSBs) during early adolescence can replace beverages with nutrients needed for growth and maturation and increase risk of poor bone modeling. As SSB preferences become stronger, they can develop into poor beverage consumption habits, contribute excess calorie intakes and increase risks for adverse health conditions. Supportive parent actions can guide early adolescent (EA) (9-13 years) beverage choices at mealtimes and snacks at home. Parent management strategies to control beverage availability and accessibility at home include encouraging intakes of healthy beverages at mealtimes, setting rules and expectations for limiting SSBs, and role-modeling healthy beverage choices. The social cognitive theory framework describes how the home environment may be influenced by interactive parent-child communications. Building parent and EA personal self-efficacy to make healthier beverage choices with meals at home can also lead to healthier beverage choices in challenging settings away from home. Similarly, EA preferences for healthy beverages can influence parent purchases which determine home availability. Therefore, nutrition intervention programs regarding beverage intakes to improve nutrition and lessen health risks in all family members should address 1) self-efficacy, 2) personal beliefs and attitudes about healthy beverages at home, and 3) parenting practices such as encouraging parent-child interactive conversations at shared mealtimes. The Beverages 4 Health program is a 5-week parent-early adolescent nutrition education program designed to increase knowledge and behavioral skills at home and in unsupervised locations to reduce SSB consumption. The Beverages 4 Health program was developed and tested based on qualitative and quantitative research that required three Steps. In Step 1, six focus groups (n = 49) were conducted to understand how parents of 10-13 year-old children encourage and enable healthy beverage consumption (milk, water, 100% juice in moderation) by setting and enforcing expectations and rules. Parent expectations for EAs were based on health beliefs, EA preferences and cost. Another important finding was that most parents did not view water as convenient because water had to be cold and in some cases, portable to be well accepted by EAs. Parents usually managed SSB consumption by limiting home availability. Most parents managed beverage consumption at mealtimes and believed they could discourage SSB consumption but not directly control EA beverage choices away from home and when unsupervised. There were no consistent expectations for frequency of SSB intakes or perceptions of well-defined portion sizes. Parents requested that the ¡°goods and the bads¡± need to be taught to their child based on positive and negative aspects of healthy and unhealthy beverages. Thematic results from qualitative focus group interviews were incorporated into EA-only and parent-EA intervention sessions. Data from three, independent convenience samples of parent-child pairs (n = 146) were merged into a single dataset in Step 2 to create two valid and reliable evaluation instruments (one for parents and one for EAs). Each instrument was designed to assess self-efficacy, beliefs and expectations regarding intake of healthy beverages and perceptions regarding parenting practices. Principal components analysis with varimax rotation was used to group various statements into subscales. Parental self-efficacy subscales reflected parental sweetened beverage discipline and health conscious beliefs. One EA self-efficacy subscale described personal discipline regarding choices to select milk or healthy beverages. The parent evaluation tool addressed parenting practices of encouragement, SSB rules and expectations, role-modeling, and being permissive. Three EA subscales regarding beliefs and perceived rules and expectations at home were related to sweetened beverage rules, meal specific expectation and milk amount expectations. Parent and EA subscales had moderate to strong internal consistencies and test-retest reliability coefficients (.53 to .92). Parent and EA self-efficacy subscales were significantly associated with their own milk consumption (p ¡Ü .05). Parent health conscious self-efficacy was associated with EA water intake (p ¡Ü .05). Parenting practices of encouragement, role-modeling and setting SSB rules were associated with less sugar-sweetened soda pop and fruit drink availability at home. As expected, permissive parenting practices were associated with soda pop and fruit drink availability and inversely associated with EA water intake (p ¡Ü .05). EA self-efficacy and beliefs of mealtime beverage expectations were associated with EA milk and water consumption (p ¡Ü .03). EA reported frequency of eating dinner meals together was associated with soda pop consumption. Parent and EA questionnaires developed in Step 2 were intended for use in studies evaluating short term interventions targeting influences within the home environment. Specifically, parent and EA personal self-efficacy was associated with their own healthy beverage consumption. In contrast, parental permissiveness was associated with SSB availability. Eating mealtimes together was beneficial for parents in terms of the healthfulness of beverages consumed. In Step 3, a convenience sample of 29 mostly Native American and Hispanic parent-EA pairs participated in a 5-week intervention in community centers in the Minneapolis/St. Paul metropolitan area. Sessions one, three and five had EA and parent attendance, and sessions two and four had EA attendance only. The primary intervention outcome was to reduce SS soft drink and fruit drink consumption and promote adequate milk and water consumption. Joint parent and EA sessions focused on beverage label-reading, eating family meals together.