title: Relationships among parent and youth healthful eating attitudes and youth dietary intake in a cross-sectional study of youth with type 1 diabetes.
abstract: BACKGROUND
  Constructs based on Social Cognitive Theory have shown utility in understanding dietary behavior; however, little research has examined these relations in youth and parents concurrently. Unique demands of dietary management among families of youth with type 1 diabetes (T1D) suggest the importance of investigation in this population. The purpose of this study was to develop and evaluate youth and parent measures of self-efficacy, outcome expectations, and barriers for healthful eating, and parent modeling of healthful eating, in a sample of youth with type 1 diabetes and their parents.
  
  
  METHODS
  Youth (n=252) ages 8-18 years with diabetes duration ≥1 year and parents completed self-report measures of healthful eating attitudes including self-efficacy, perceived barriers, positive and negative outcome expectations; youth reported parent modeling of healthful eating. Youth dietary intake from 3-day diet records was used to calculate the Healthy Eating Index 2005 and the Nutrient Rich Foods 9.3 index, measures of overall diet quality. The relations among parent and youth healthful eating attitudes, parent modeling, and youth diet quality were examined using structural equation modeling.
  
  
  RESULTS
  Internal consistency and test-retest reliability of the measures were acceptable. The structural equation model demonstrated acceptable fit (CFI/TLI=0.94/0.94; RMSEA=0.03), and items loaded the hypothesized factors. Parent modeling β^=.27,p=.02 and attitudes toward healthful eating (latent variable comprised of self-efficacy, barriers, outcome expectations) β^=.16,p=.04 had direct effects on youth diet quality. Parent modeling had a direct effect on youth attitudes β^=.49,p<.001; parent attitudes had an indirect effect on youth attitudes through parent modeling β^=.12,p,<.001. Youth attitudes were not associated with youth diet quality. Overall, the model accounted for 20% of the variance in child diet quality.
  
  
  CONCLUSIONS
  Parent diet-related behaviors demonstrated an impact on youth attitudes and diet quality, suggesting the importance of family-based clinical and public health efforts to improve diet.
authors.affiliation: Eunice Kennedy Shriver National Institute of Child Health and Human Development, Health Behavior Branch, Division of Intramural Population Health Research, NIH, DHHS, 6100 Executive Blvd,, Rm, 7B13, MSC 7510, Bethesda, MD 20892-7510, USA. nanselt@mail.nih.gov.
authors.forename: Tonja R
authors.initials: TR
authors.lastname: Nansel
authors.forename: Denise L
authors.initials: DL
authors.lastname: Haynie
authors.forename: Leah M
authors.initials: LM
authors.lastname: Lipsky
authors.forename: Jing
authors.initials: J
authors.lastname: Wang
authors.forename: Sanjeev N
authors.initials: SN
authors.lastname: Mehta
authors.forename: Lori M B
authors.initials: LM
authors.lastname: Laffel
mesh_terms: D000293:Adolescent; D002648:Child; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology* / Q000523:psychology; D004032:Diet / Q000523:psychology; D015930:Diet Records; D005247:Feeding Behavior / Q000523:psychology*; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010287:Parent-Child Relations; D010290:Parents; D015203:Reproducibility of Results; D020377:Self Efficacy; D012959:Socioeconomic Factors