A healthy and balanced diet is critically important for the growth and development of young children. Dietary intake during the early years of life can have lasting impact on food preferences and eating habits [1]. Unfortunately, data from many developed parts of the world, including Australia [2], Europe [3], and North America [4, 5], consistently demonstrate that children’s dietary intakes fail to meet guidelines. In the U.S., many young children (2-3 years old) fail to consume recommended intakes of fruit (32%), vegetables (80%), whole grains (99%), and milk (41%), and most exceed recommended limits for solid fats (99%) and added sugars (98%) [6].

Children’s dietary intakes and eating behaviors are influenced by a multitude of interacting factors. Davison and colleagues [7], and more recently Harrison and colleagues [8], used Ecological Systems Theory to identify the variety of determinants of children’s weight-related behaviors, including diet. Their models recognize multiple levels of influence, including community and society, family and home, and child-specific characteristics. These models underscore the particularly important role that the home environment plays in shaping children’s habits, including eating behaviors.

Parents, as key gatekeepers of the home environment, strongly influence the home’s physical and social characteristics. Several food parenting practices have been shown to impact children’s dietary intake [9, 10]. Findings around the specific practices of parent role modeling and parent dietary intake have shown some inconsistencies. A 2009 systematic review of family correlates of children’s fruit and vegetable intake concluded that parent role modeling and parent dietary intake were positively associated with children’s dietary intake [11]. A 2011 meta-analysis examining similarities between parent and child dietary intakes concluded that associations were weak; however, authors of that review observed stronger associations in studies using recalls and food records (versus other diet assessment methods) and in studies involving younger children (versus older children) [12]. Conceptually these practices are somewhat related, but there are differences. Parent dietary intake refers to the parent’s actual consumption of food and beverages and may be assessed via food recall, food frequency questionnaire, or dietary screener [10]. Parent role modeling is often conceptualized as a parent’s purposeful or intentional effort to demonstrate healthy food choices and eating behaviors to encourage similar behaviors in the child; however, a parent may be less deliberate and unintentional in these behaviors and their demonstration of healthy or unhealthy eating in front of the child [10].

Because the practices of parent role modeling and parent dietary intake are somewhat related, these concepts have often been used interchangeably in studies. Rarely, however, have these practices been examined together to confirm how they may work in combination to influence children’s dietary intake. Additionally, relationships between parent role modeling and parent dietary intake with child dietary intake are often specific to fruit and vegetable consumption (e.g., how parents’ intake and modeling around fruits and vegetables influences child intake of fruits and vegetables). However, these practices may also impact children’s intake of unhealthy foods and their overall diet quality.

The purpose of this study was to examine the relationships between parent role modeling, parent dietary intake, and child dietary intake more closely. Specifically, this study will use cross-sectional data to examine whether there is evidence that parent role modeling and parent dietary intake are associated with child dietary intake. First, relationships between these parent practices will be examined to assess the possible overlap of constructs. Then, independent and additive relationships will be examined between these parent practices and child dietary intake to assess their relative level of association with parent role modeling and parent dietary intake.

This study used baseline data from a larger randomized control intervention trial evaluating a child obesity prevention intervention (My Parenting SOS) [13]. Participants in this larger trial included a convenience sample of 320 parent-child dyads recruited from central North Carolina. To be eligible for the larger trial, parents had to have one child 2-5 years old and at least one parent in the household had to be overweight (an effort to recruit children at higher risk for becoming overweight). Protocols have been described in detail elsewhere [13], but are reviewed in brief below. All study procedures were approved by the Institutional Review Board at the University of North Carolina at Chapel Hill (#08-0354).

Results from this study suggest that parent modeling of healthy eating and parent dietary intake may be distinct practices; however, only parent healthy modeling is associated with the quality of children’s diets when accounting for both parent modeling and parent diet (i.e., HEI). Specifically, children of parents with higher healthy modeling scores had higher HEI scores. In addition, children whose parents had high healthy modeling scores had higher diet quality, irrespective of their parent’s diet quality, which suggests that parent modeling is of more importance to child diet quality than parent’s own diet quality. However, data were cross-sectional; hence, caution must be taken when interpreting meaning behind these associations.

This study provides a unique contribution to the literature in that it measured parent modeling and diet intake separately and assessed their independent and joint associations with child diet quality. We are aware of only one other study to date that has looked at these practices together. In the Harris and Ramsey study of fathers, children’s intakes of fruits and vegetables were associated with fathers’ intakes of these foods but not fathers’ use of modeling [25]. The inconsistent findings between that study and ours reiterate the need to repeat similar analyses in additional samples. One notable difference between the studies that may help explain the inconsistant findings is the use of a parent sample of fathers vs. predominantly mothers. The influence of specific food parenting practices may depend upon the parent’s role in the home; however, differential impacts between mothers’ and fathers’ behaviors have not been well explored in the food parenting practices literature. Our sample included a small number of fathers (n=17) and in sensitivity analyses excluding fathers, we did not find that inclusion of them impacted our results.

Results of the study also reiterate the importance of clear conceptualization of food parenting practice constructs. Recently, a content map with clear terminology and definitions of food parents practices has been published [10], which should facilitate improved conceptualization of these practices. Within the description of “modeling”, authors recognize the recent distinction between these two constructs of parent modeling and parent diet [26]. Given the small correlations (<0.30) observed between parent modeling of healthy eating and parent intake of healthy foods, findings would suggest that these are related but distinct constructs. Future research should evaluate the convergent and divergent validity of these constructs before deciding if terms can be used interchangeably. Authors of the content map also recognize limitations in current modeling scales, which focuses predominately on intentional modeling of healthy practices [10]. The modeling scale used in this study also had this narrow focus [14]. This limitation provided the rationale for our hypothesis that parent modeling would be associated with parent intake of healthy foods, but not less healthy foods. Results from this study seemed to confirm this hypothesis and suggest that just because parents model healthy eating does not mean that they are also avoid modeling less healthy eating (as parents may do both). However, the reliance on parent-report about what they may perceive as socially desirable behaviors (e.g., modeling, eating a healthy diet) may have also produced response bias [27]. The associations observed may have also resulted from parents over-reporting of what they perceived as positive practices. Moving forward, studies of parent modeling may benefit from instruments that assess modeling of both healthy and less healthy food habits. For example, Palfreyman and colleagues have suggested that there are three distinct types of modeling: verbal modeling, unintentional modeling, and behavioral consequences [28]. The unintentional modeling scale appears to capture parents’ modeling of unhealthy foods, as significant associations were observed between unintentional modeling and parent intake of savory snacks. The differential impact of modeling healthy vs. less healthy eating behaviors should be examined in future research.

This study had several strengths associated with its use of measures and its analytic approach. Not only were parent modeling and parent dietary intake measured separately, but both employed well-established methods. Parent and child dietary intakes were assessed using three randomly collected days of diet recalls using NDSR and multi-pass procedures. This recall protocol provides a rigorous method for diet assessment that is able to quantify intake while minimizing the potential for reactivity. Similarly, the modeling scale used in the the current study was selected based on its rigorous development and demonstration of good psychometric properties [14]. The analytic approach incorporated several steps to systematically explore the relationships between parent modeling, parent dietary intake, and child dietary intake. Hypotheses for each stage were developed a priori, which in turn assisted with the interpretation of the findings.

There are some study limitations that are important to note, including the cross-sectional nature of the data, the reliance on parent report, and characteristics of the study sample. While we were able to observe significant associations between parent modeling, parent dietary intake, and child dietary intake, cause and effect cannot be determined from cross-sectional data. In addition, all data were derived from parent report, and thus represent a single data source. Parents reported on their child’s dietary intake, which can be difficult given that parents may not be present for all meals and snacks that their child consumes (e.g., meals and snacks eaten at child care). This study, therefore, asked parents to report only those foods consumed while under their supervision, which resulted in a truncated day of intake given that many of the children in this sample where in child care. However, limiting children’s dietary intake data to foods eaten with the parent allowed us to better focus on the impact that parents have on their child’s dietary intake without the variance that may be caused by foods consumed elsewhere. Caution must also be taken when trying to generalize these findings as the sample included a large percentage of overweight and obese parents (higher than the general population in the US) and they were well educated and higher income.

Food-related parenting practices are thought to be important influences on the quality of their young child’s diet quality. In this study, parent modeling, a parent’s purposeful effort to demonstrate healthy food choices and eating behaviors, was positively associated with children’s diet quality as measured by the Healthy Eating Index. Although what a parent eats was also associated, parent modeling had a stronger association. Importantly, children of parents with higher healthy modeling scores had higher HEI scores, on average, than children of parents with lower healthy modeling scores. Future studies are needed to confirm these findings and to explore potential differences between mothers and fathers. If confirmed, parent modeling of healthy eating would be an important target to include in interventions promoting healthy eating habits in children.