ABSTRACT
The eating habits of adolescents are of concern for public health, as there is a direct association between inadequate diet during this phase and the occurrence of obesity. Adolescents are considered to be a nutritionally vulnerable segment of the population. Adolescents’ initial experiences with eating and food are strongly shaped by the parents. The link between parental involvement and influence on adolescents’ dietary practices have been the least explored area. The general objective of this study was to assess parental involvement, and factors associated with the dietary patterns of adolescents in the study area.
This research was a cross-sectional survey which was carried out among 411 respondents (parent-adolescent dyads) who resided in Alimosho Local Government of Lagos state. A semi-structured instrument (questionnaire) was used for data collection. They were selected through the use of the multistage random sampling technique which involved the selection of wards and houses which made it possible to get to the participants for the study. Associations between selected factors of adolescents’ dietary patterns (daily intake of candy and sweets, soft drinks, fruit and vegetables) and parental socio-economic position (occupation and income) was examined. Data collected were analyzed using Statistical Package for Social Science (SPSS) version 21 with levels of significance set at 0.05.
Findings revealed that there were 235 (57.3%) male adolescents and 176 (42.8%) female adolescents in this study with mean age of 16.09 ± 2.17 with however most adolescents (23.8%) of age 17 years old. Findings showed that these individual factors affecting dietary pattern varied across the demographic characteristics of both adolescents and parents; gender of respondents was found to have varied individual factors (df = 11; F = 11.72; P < 0,05), also was age of adolescents (df = 11; F = 10.26; P < 0,05), religion (df = 11; F = 11.20; P < 0,05). Dietary pattern of adolescents however was described as follows: consumption of red meat (beef), chicken and fish was low as just only 32 adolescents consumed these always as compared to 238 and 126 adolescents who never and rarely consumed these respectively. Result showed that adolescents’ parents involvement has a significant influence of their dietary pattern (F = 13.76; R Square = 0.033; P < 0.05) which can be deduced to be a 3.3% influence. However, this influence was determined to be negative (t = -3.71; β = -0.18) indicating the involvement of parent led to a low dietary pattern of adolescents in this study area.
In conclusion, parental involvement was poor, from playing role model and making healthy food available to eat at home, this in turn led to a poor dietary pattern by respondents. In light of this, health promotion intervention tailored towards improving dietary pattern of adolescents should not only be directed towards the adolescent but rather towards their parents and also, design of public health education program should be carried out which will aim at increasing the knowledge of parents on the needed classes of food that makes up a balanced diet.
Keywords:Parents, Involvement, Dietary patterns, Adolescents and Associated Factors.
Word Count: 498
TABLE OF CONTENTS
Content Page
Title Page i
Certification ii
Dedication iii
Acknowledgements iv
Abstract v
Table of Contents vi
List of Tables x
List of Figures xii
Abbreviations xiii
CHAPTER ONE: INTRODUCTION
- Background to the Study 1
1.2 Statement of the Problem 3
1.3 Objective of the Study 4
1.4 Research Questions 5
1.5 Significance of the Study 5
1.6 Justification for the Study 6
1.7 Operational Definition of Terms 7
CHAPTER TWO: REVIEW OF LITERATURE
2.0 Introduction 8
2.1 Parental Involvement in dietary patterns of adolescents 9
Content Page
2.2 Factors Associated with dietary patterns of adolescents 16
2.3 Dietary patterns of adolescents 23
2.4 Conceptual Model 29
2.4.1 Parental involvement 30
2.4.2 Accessibility and availability of food 30
2.4.3 Individual factors 30
2.4.4 Dietary patterns 30
CHAPTER THREE: METHODOLOGY
3.1 Research design 32
3.2 Population 32
3.3 Sample size and sampling Technique 33
3.4 Variables 35
3.5 Instrument 35
3.6 Validity and reliability of instrument 36
3.6.1 Validity of the instrument 36
3.6.2 Reliability of the instrument 37
3.7 Method of Data Collection 37
3.8 Ethical Consideration 38
3.8.1 Informed Consent 38
3.8.2 Confidentiality 38
3.8.3 Anonymity 39
Content Page
3.8.4 Right to withdraw 39
3.8.7 Post research benefits 39
3.9 Method of data analysis 39
3.10 Dissemination of Results 40
CHAPTER FOUR: DATA ANALYSIS, RESULTS AND
DISCUSSION OF FINDINGS
4.1 Demographic characteristics 41
4.2 Research questions 41
4.2.1 Is there any significant difference across demographic characteristics? 41
4.2.2 In what way would parental involvement influence dietary patterns? 44
4.2.3 Which of the associated factors influence adolescents’ dietary patterns? 52
4.2.4 What are the main dietary patterns among adolescents? 52
4.2.5 What is the relationship between accessibility and availability of food? 59
4.2.6 What is the difference between dietary patterns of adolescents? 59
4.2.7 What is the relationship between parents’ occupation to dietary patterns? 67
CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS
5.1 Summary 68
5.2 Conclusion 70
5.3 Recommendations 70
Content Page
5.4 Implication to Health Promotion and Education 70
5.5 Limitation of the Study 71
REFERENCES 72
APPENDICES 78
Appendix I 78
Appendix II 79
Appendix III 82
Appendix IV 84
LIST OF TABLES
Table Page
4.1 Respondents’ demographic characteristics 43
4.2 Respondents’ individual factors affecting dietary pattern 45
4.3 Mean score of individual factors 46
4.4 ANOVA of individual factors across demographics characteristics 47
4.5 Parents’ involvement in adolescents’ dietary pattern 49
4.6 Dietary pattern of adolescents 50
4.7.1 Regression analysis of Parental Involvement 53
4.7.2 ANOVA between parental involvement and dietary patterns 54
4.7.3 Mean scores for parental involvement and dietary patterns 55
4.8.1 Regression analysis for associated factors 56
4.8.2 ANOVA between associated factors and dietary patterns 57
4.8.3 Mean scores for associated factors influencing dietary patterns 58
4.9 Main dietary patterns among adolescents 60
4.10 Accessibility and availability of food by parents 61
4.11.1 Regression analysis between accessibility and availability of foods 62
4.11.2 ANOVA and regression analysis between accessibility and availability of foods 63
4.11.3 Mean scores between accessibility and availability of foods 64
4.12.1 Difference in dietary patterns between parents’ socioeconomic status 65
Table Page
4.12.2 ANOVA of dietary patterns between parents’ socioeconomic status 66
LIST OF FIGURES
Figure Page
- ASE (Attitude, Social influences and Self-efficacy)
and Socio-ecological Model for parental involvement and associated
factors affecting dietary patterns of adolescents 31
- Frequency distribution of respondents’ age 42
- Distribution of dietary pattern of respondents 51
ABBREVIATIONS
ANOVA: Analysis of Variance
ASE-model: Attitude, Social influences and Self-efficacy model
BUHREC: Babcock University Health Research Ethics Committee
DP: Dietary Patterns
KIDMED: Mediterranean Diet Quality Index
LCDA: Local Council Development Area.
LG: Local Government
NDHS: NigerianDemographic and Health Survey
PI: Parental Involvement
SPSS: Statistical Package for Social Science
WHO: World Health Organization
CHAPTER ONE
INTRODUCTION
- Background to the Study
Lifestyle of adolescents, especially their food pattern encounters dramatic changes, mainly due to their higher freedom in decision making, including selection and purchasing of foods (Daniel, 2002). The assessment of food consumption pattern of this highly vulnerable age group is important in enhancing health status of next generations. So, recognizing food consumption pattern and method of adolescents is one of the most important research priorities in designing appropriate programs and applying effective approaches toward improving the health status of future adults.There is a greater need to look into the dietary patterns of adolescents but unfortunately, precise estimates of their dietary intake, dietary practices have been the least explored area. The current direction in nutrition education reinforces the notion that parental involvement might be necessary for substantial dietary change in children and adolescents. However, research on family determinants of food patterns is limited.
Involvement of the parents is a mixture of obligation and active contribution to the adolescent child. Adolescents’ initial experiences with eating and food are strongly shaped by the parents. Parental involvement talks about forces and conditions in the home which lure the child physically, intellectually and emotionally.
According to the World Health Organization (WHO) adolescence is a period between the ages of 10-19 years (WHO, 2016). Adolescents represent approximately 20 % of the world’s population and most (84 %) are living in developing or emerging countries (Ghai, Gupta & Paul, 2006).The prevalence of adolescents’ obesity is rapidly growing worldwide (WHO, 2013). This trend is of concern due to the negative health effects associated with increased body mass. Many studies reported that parents, particularly mothers, have a considerable influence on their children’s eating and dieting patterns, because of their presumed central role in acting out the nature and importance of thinness and the gender-stereotyped nature of dieting itself (Rafiroiu, Sargent, &Thompson, 2003).Community beliefs and family dietary practices have also been identified as important predisposing factor to malnutrition (Abubakar, Holding, Mwangome, & Maitland, 2011; Wong, 2014).
The eating habits of adolescents are of concern for public health, as there is a direct association between inadequate diet during this phase and the occurrence of obesity and other chronic diseases in adulthood (McNaughton, Ball, Mishra, & Crawford, 2008). Worsening this scenario, the prevalence of obesity and related diseases has significantly increased worldwide. (Gupta, Goel, Shah, &Misra, 2012; Robinson, Geier, Rizzolo, & Sedrak, 2011).
Adequate intake of foods and nutrients contribute significantly to the growth and development during the adolescence period particularly among the girls, who are the future mothers. A balanced diet during childhood and adolescence is crucial not only for the well-being and growth of the child, but also for the establishment of sound dietary habits that will persist in later life (Westenhoefer, 2002). An optimal diet during adolescence is important to support normal growth and development. (Vereecken, Inchley, & Subramanian, 2005). Dietary habits developed in adolescence may contribute to form adult dietary habits. Adolescent eating behaviour is a function of individual and environmental influences. Individual influences are psychological as well as biological, whereas, environmental influences include immediate social environments such as family, friend, and peer networks and other factors such as school meals and fast food outlets. In addition, another important factor is social system or macro system which includes mass media, marketing and advertising, social and cultural norms of the society (Story, Neumark-Sztainer, & French, 2002). Mishra, Ball, Arbuckle and Crawford, 2002 carried out a study in which education, occupation, income and employment were considered simultaneously, it was indicated that education and occupation are usually the strongest determinants of socio-economic status, however, education and the parent’s occupation have had more effects on food intake.
Mikkila, Rasanen, Raitakari, Pietinen and Viikari (2005) advanced that just limited researches have studied adolescents’ dietary patterns alongside environmental and social factors which could have effect on them through their life period. These studies on dietary patterns of young adults were grounded on small populations such as school classes.
Maria, June, Lily, Rachel, Judith, and Margaret (2011) established that the availability of foods in the home is likely to be related to consumption. We know of no studies that have reported this association in African-American participants, and few studies have examined home food availability using objective methods.
Arabshahi, Pourmoghim, Pouraram, Aminpour, Kalantari, Golestan, & Abtahi, 2003 addressed the relations of socioeconomic factors and the anthropometric indicators of adolescents. It was shown that it had more effects on factors like education and occupation of parents and the family size on food intake and anthropometric indicators of this age group. In spite of these findings, it is difficult to say how much of the seen differences is the result of each indicator.
Accordingly, knowledge about actual nutritional intake and diet behaviour among children and adolescents is essential. Information on dietary patterns reflect the overall nutritional behaviour better than information on single foods or nutrients (Hu, 2002). Therefore, the analysis of dietary patterns gives a more comprehensive impression of the food consumption habits within a population.It is common for adolescents to substitute main meals with high-calorie snacks or to skip important meals such as breakfast. In addition, they consume many foods with a high content of sugar, refined carbohydrates and saturated fats, and do not consume enough fruit and vegetables; they are also prone to adopting monotonous diets or food fads (Slattery, 2008).
- Statement of the Problem
Adolescents eating patterns should be encouraged in adolescents and especially in females. This could assist in preventing the development of diseases associated with an inadequate intake of nutritious food (Ogunkunle & Oludele, 2013). It was established that understanding the overall dietary patterns of a population is an important and key step in initiating appropriate nutritional interventions and policies. Studies characterising the dietarypatterns of Nigerian mothers and children are lacking (Nwaru, Onyeka, Ndiokwelu, Esangbedo, Nguw & Okolo, 2015). Few studies have compared parent–child dietary intake among adolescents who are overweight or obese which is a nutritional problem. Helping parents improve their diet may promote improvements in their adolescent’s diet and is a potential target for interventions designed to increase healthy eating among adolescents (Allison, Louise, Susan, Chris & Rhona, 2014).
The diets of children and adolescents are of public health concern due to evidence relating poor nutrition in childhood to subsequent obesity and elevated risks for type 2 diabetes, the metabolic syndrome and CVD (Canete, Gil-Campos, Aguilera & Gil, 2007) all of which are increasing in prevalence (WHO, 2004). Research indicates that parents play an important rolein influencing the eating behaviors of adolescents (Rasmussen, Krolner & Klepp (2006), Pearson, Biddle & Gorely, 2008). However, relatively few healthy eating programs have utilized parents as potential avenues for intervening with adolescents. (Pearson, Atkin & Biddle, 2010). Parents influence the availability of food within the home but can also exert their influence through their attitudes and beliefs regarding eating, by exposing their adolescents to certain foods or by actively encouraging or controlling certain eating behaviors (Pearson, Biddle & Gorely, 2008; Brug, Tak & Velde, 2008). Less research has examined report of parenting practices and their associations with adolescent dietary intakes (Pearson, Biddle & Gorely, 2008).
However, parental report might be a more valid measure than adolescent report; for example, parents may be able to more accurately report their own attitudes, beliefs and behaviors and may have a better sense than adolescents of the home availability of specific foods, given that parents primarily control which foods are purchased for and served in the home (Hanson, Neumark-Sztainer, & Eisenberg, 2005). It is believed that almost one third of children in developing countries are malnourished (FAO, 2015). Identifying factors that influence the dietary patterns of adolescents may assist in targeting at risk groups and developing strategies to improve dietary intakes. Many studies have been done concerning involvement of parents in the dietary patterns of children most especially. However, there could be a dearth in research about the involvement of the parents in dietary patterns of adolescents or young adults especially in the proposed study of location.
- Objective of the Study
The general objective of this study is to assess parental influence, and factors associated with the dietary patterns of adolescents in the study area. The specific objectives are to:
- determine the relationship between socio demographic characteristics of parents’ and adolescents’ and individual beliefs to their dietary patterns;
- identify the main dietary patterns among adolescents;
- identify level of parental involvement influencing dietary patterns of adolescents;
- assess associated factors influencing adolescent’s dietary patterns;
- examine the relationship between accessibility and availability of food products and dietary patterns of adolescents at the household level;
- assess the difference between dietary patterns of adolescents across parents’ socioeconomic status and
- examine the relationship between parents’ education and socioeconomic status associated with dietary patterns of the adolescents.
- Research Questions
- Is there a relationship between socio demographic characteristics of parents’ and adolescents’ and individual beliefs to their dietary patterns?
- What are the main dietary patterns among adolescents?
- In what way would parental involvement influence dietary patterns of adolescents?
- Which of the associated factors influence adolescent’s dietary patterns?
- What is the relationship between accessibility and availability of food products and dietary patterns of adolescents at the household level?
- What is the difference between dietary patterns of adolescents across parents’ socioeconomic status?
- What is the relationship between parents’ education and socioeconomic status associated with dietary patterns of the adolescents?
- Significance of the Study
At the end of this study, the findings would provide a better understanding of parents’ involvement in the dietary patterns of adolescents and also the associated factors. The study would provide information on the need of parents to be more involved in adolescents’ dietary patterns. The findings may also provide useful information for parents to become more involved in their young adults’ food intake in order to enhance good health by taking the necessary measures. Also, this study would benefit the community, academic institution and the nation at large by making them informed and providing solutions to dietary issues of adolescents.
Dietary habits among adolescents represent an important public health issue because of the long-term effects on health and health behaviour. Knowledge of this age group and their dietary habits may provide a good basis for future health promotion initiatives and would also help public health workers to be able to tease out other areas where they can be involved in solving dietary issues.
- Justification forthe Study
The focus of the study is on the involvement of parent and associated factors in dietary patterns of adolescents’. Past research in this field points out that there is a weak relationship between parents and their adolescents’. Studies carried out in Ireland, suggest that it is necessary to include a parent component in which it may influence dietary patterns of adolescents’ (Amanda, Caroline, Elizabeth & Colette, 2010).
A study conducted by (Miller, Hering, Cothran, Croteau, and Dunlap, 2012), suggests that only a few studies have examined the effect of parental supervision on diet quality of older children and adolescents.Studies also revealed that parents do not usually get involved in dietary patterns of adolescents, unlike how they do with toddlers and children.Dietaryintakeduringadolescencecontributes to lifelong eating habits and the development of early risk factors for disease in adulthood. Few studies have examined the dietary patterns of adolescents and the social and environmental factors that may affect them during this life stage. (Gina, Wendy, Monique, Therese, Beth, Nick, Sven, Stephen, Garth, Fiona & Lawrence, 2008).Since there is very little information about dietary intakes and the relationship with parental influence of adolescent population an attempt would be made to find the relationship between dietary intakes and parental influence.
Research indicates that parents play an important role in influencing the eating behaviors of adolescents. (Rasmussen,Krolner& Klepp (2006), Pearson, Biddle&Gorely, 2008). However, relatively few healthy eating programs have utilized the home environment or parents as potential avenues for intervening with adolescents. (Pearson, Atkin & Biddle, 2010). Parents influence the availability of food within the home but can also exert their influence through their attitudes and beliefs regarding eating, by exposing their adolescents to certain foods or by actively encouraging or controlling certain eating behaviors. (Pearson, Biddle&Gorely, 2008; Brug,Tak& Velde, 2008). Most of the research examining parental influences on adolescent fruit consumption has examined adolescent perceptions (Pearson, Biddle&Gorely, 2008) less research has examined parent report of parenting practices and their associations with adolescent dietary intakes. However, parental report might be a more valid measure than adolescent report; for example, parents may be able to more accurately report their own attitudes, beliefs and behaviors and may have a better sense than adolescents of the home availability of specific foods, given that parents primarily control which foods are purchased for and served in the home (Hanson,Neumark-Sztainer,& Eisenberg, 2005).
Many of the studies that have been conducted are not conceptually and logically grounded in behavioral theories to identify some salient factors associated with parental involvement in the dietary patterns among adolescents. This study is therefore designed appropriately in such a way that, it is guided by an ecological model that will enable the salient factors associated with parental involvement of dietary patterns of adolescents in the area of study. Findings showed that no study was found conducted in Alimosho Local Government of Lagos state, Nigeria that addresses the involvement of parents in dietary patterns of adolescents. This study seeks to bridge this gap.
- Operational Definition of Terms
Parental involvement: This is a combination of commitment and active participation on the part of the parent to the adolescent.
Dietary patterns: This is referred to as quantities, proportions, variety or combination of different foods, drinks, and. nutrients in diets, and the frequency with which they are habitually consumed.
Adolescents: They are young people between the ages of 10 and 19 years who are often thought of as a healthy group. Nevertheless, many adolescents do die prematurely due to accidents, suicide, violence, pregnancy related complications and other illnesses that are either preventable or treatable. Many more suffer chronic ill-health and disability. In addition, many serious diseases in adulthood have their roots in adolescence.
Associated Factors: They are factors that needs to be recognised and they have a relationship with the dependent variable.
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