The Intergenerational Transmission of Eating Behaviour

Author: Kate Rhodes

Rhodes, Kate, 2017 The Intergenerational Transmission of Eating Behaviour, Flinders University, School of Medicine

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Approximately two thirds of the Australian population are either overweight or obese (ABS, 2015). Diet and lifestyle factors independently contribute to the risks for obesity and a range of prevalent chronic diseases (NHMRC, 2013b; Stewart & Wild, 2014) therefore, the Health Belief Model (HBM) was used to predict health motivation and behaviour change in a series of four studies. According to the model, the benefits of engaging in health enhancing, or the disadvantages of engaging in health compromising, behaviours depend upon an individual weighing up the perceived risk and severity of a potential disease with the likely benefits and barriers of taking any relevant health action (Conner & Norman, 1995; Harrison, Mullen, & Green, 1992).

It is also important to understand the dietary behaviours that contribute to overall food consumption, and to explore the social context of the family for any influencing and modifiable factors. To date, there is little in the published literature beyond bi-directional food influences between parents and children, hence Study 1 presents a qualitative study that, through semi-structured family interviews, explored food purchasing, preparation, and consumption, and examined the bi-directional influences that occurred between family members within three generations (N = 57). Results were consistent with previous research indicating mothers were dominant in the provision of family meals (Beydoun & Wang, 2009; Green et al., 2009). Less is known regarding grandmother influences on diet (Wroten, O’Neil, Stuff, Liu, & Nicklas, 2012) and Study 1 suggested that the female role of grandmother also plays the most dominant role in the grandparent household. Fathers were found to be more likely to relax the family food rules. The grandparent-child dyad shared a bi-directional influence pathway that bypassed the parent generation: children influenced grandparents by introducing new foods to the diet, and grandparents provided grandchildren with indulgent treats.

Study 2 used a correlational design to examine resemblances in healthy and unhealthy food consumption between three generation family relationship dyads, and explored whether ‘Food Life behaviours and attitudes’ (Food Life Questionnaire Short-Form; Sharp, Hutchinson, Prichard, & Wilson, 2013) played a role in influencing healthy and unhealthy food consumption (N = 229). Results indicated both parents impacted upon the healthy food consumption of children. The mother’s importance was acknowledged by mother-daughter fruit consumption resemblances, and mother-child resemblances in vegetable consumption. A novel finding suggests fathers’ attitudes that diet can influence health and disease have positive influences on children’s healthy food consumption. Suggested by the correlation between his healthy food attitudes and fruit consumption in sons, and vegetable consumption in daughters. Food Life behaviours and attitude correlations supported directional hypotheses with the total sample for healthy and unhealthy food consumption. Grandparent marital-ties shared a lower incidence of fast food consumption when compared to parent and child generations, however, shared strong resemblances in snack consumption.

Study 3 was a cluster randomized control trial investigating tailored family health history feedback using the Families Sharing Health and Risk Evaluation (SHARE) workbook (Koehly, Morris, Skapinsky, Goergen, & Ludden, 2015) modified for Australians, to observe dietary and screening behaviour over time, and also examined the influence of Food Life behaviours and attitudes within three generation families (N = 178). Fruit consumption showed the most promising result in response to the Families SHARE intervention as demonstrated by stage of change progression from ‘precontemplation’ to ‘action’ (i.e., TTM, the Transtheoretical Model Stage of Change; Prochaska, DiClemente, & Norcross, 1992) in the experimental group for fruit consumption. Vegetable consumption, on the other hand, showed little change on any of the variables, and consumption remained well below the NHMRC recommendations (NHMRC, 2013a). Food Life behaviours and attitudes made significant contributions to food consumption when a family member or mother was at risk of chronic disease. Correlations in self-reported dietary behaviours (i.e., diet-health oriented behaviours, DHOB subscale of the FLQ SF) were shared between parents and grandparents at baseline. At follow up, correlations between parents and children achieved significance. Except for vegetable consumption, the grandparent generation showed greater dietary behaviour improvements than younger generations. Parent-child resemblance in attitudes that diet affects subsequent health or disease (i.e., diet-health/disease linked attitudes, DHLA subscale of the FLQ SF) observed at baseline differed at follow up with significant parent-grandparent correlations reported. This may suggest that the educational nature of the Families SHARE workbook motivated parents to talk with grandparents about the links between diet and disease and learn from this.

Finally, Study 4 used a mixed methods survey and family interview design to further evaluate the findings of Study 3 (N = 113). Results showed tentative support for the Families SHARE workbook as an effective family health history intervention tool that was particularly successful in engaging with families and promoting screening behaviours. Potential for dietary behaviour change was indicated by participant’s intentions to improve fruit and vegetable consumption. The dissemination of information beyond the nuclear family showed promise for intervening at the intergenerational family level in motivating health behaviour change.

Conclusions from this series of studies suggest that a combination of psychological variables influence the healthy and unhealthy food consumption of children. These include co-existing parental sex-role modeling (Bandura, 1977b; Bussey & Bandura, 1984), parenting and feeding styles (Baumrind, 1991; Blissett, 2011), and attitudes that diet affects subsequent health and disease (Rozin, Fischler, Imada, Sarubin, & Wrzesniewski, 1999; Sharp et al., 2013). Future research directions suggest investigating how gender differences that exist between mothers and fathers’ expression of co-existing parenting variables affect developing children’s dietary behaviours.

Keywords: dietary behaviour, eating behaviour, families, health behaviour, disease prevention, intergeneration, intergenerational transmission, generations, parents, grandparents, children, family health history, food, healthy lifestyle, randomised control trial, family interview,

Subject: Public Health thesis, Medicine thesis

Thesis type: Doctor of Philosophy
Completed: 2017
School: School of Medicine
Supervisor: Professor Carlene Wilson