title: Child behaviors associated with childhood obesity and parents' self-efficacy to handle them: confirmatory factor analysis of the Lifestyle Behavior Checklist.
abstract: BACKGROUND
  The development of family-based programs for child weight management requires an understanding of parents' difficulties in managing children's eating and physical activity behaviors; however, knowledge about the specific behaviors that parents find most difficult to address is still limited. The Lifestyle Behavior Checklist (LBC) is an Australian instrument that assesses parents' perceptions of children's obesity-related behaviors (the Problem scale), and parents' self-efficacy in dealing with these behaviors (the Confidence scale). Our aims were 1) to examine the psychometric properties (the factor structure, internal reliability, construct and discriminative validity) of the LBC in parents of preschoolers in Sweden, using the Child Feeding Questionnaire (CFQ) as a criterion measure, 2) to study associations between the LBC and socio-demographic factors.
  
  
  METHODS
  The LBC and the CFQ (measuring parental feeding practices) were distributed to parents from 25 schools/preschools and to parents starting a childhood obesity intervention. To test the fit of the original four-factor model (misbehavior in relation to food, overeating, emotional correlates of being overweight, physical activity (24 items)) to the data, confirmatory factor analysis (CFA) was performed. Structural equation modelling was used to examine associations between the LBC and the CFQ and socio-demographic factors.
  
  
  RESULTS
  In a sample of 478 parents, a five-factor structure proved best fit to data, after excluding 6 items and allowing two pairs of error terms to correlate (TLI = 0.899; CFI = 0.918; RMSEA = 0.042; SRMR = 0.055). The Confidence scale indicated unidimensionality, therefore a hierarchical CFA with 5 first order factors and one second order factor was tested showing good fit. The validity of the LBC was proven by relevant associations with the CFQ and child weight status; parental responses differed depending on child weight status. The Confidence scale was not associated with any child or parent variables.
  
  
  CONCLUSIONS
  In a large sample of Swedish parents of preschoolers, the LBC showed good psychometric properties, with relevant correlations to similar constructs. A five-factor structure showed best fit to data with moderate to high internal reliability. The LBC was shown to discriminate effectively between parents of normal weight children and parents of overweight/obese children.
authors.affiliation: Division of Pediatrics, B62, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 141 86, Stockholm, Sweden. anna.ek@ki.se.
authors.forename: Anna
authors.initials: A
authors.lastname: Ek
authors.affiliation: Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, 171 65, Solna, Sweden. kimmo.sorjonen@ki.se.
authors.forename: Kimmo
authors.initials: K
authors.lastname: Sorjonen
authors.affiliation: Division of Pediatrics, B62, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 141 86, Stockholm, Sweden. jonna.nyman@ki.se.
authors.forename: Jonna
authors.initials: J
authors.lastname: Nyman
authors.affiliation: Division of Pediatrics, B62, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 141 86, Stockholm, Sweden. claude.marcus@ki.se.
authors.forename: Claude
authors.initials: C
authors.lastname: Marcus
authors.affiliation: Division of Pediatrics, B62, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 141 86, Stockholm, Sweden. paulina.nowicka@ki.se.
authors.forename: Paulina
authors.initials: P
authors.lastname: Nowicka
mesh_terms: D000328:Adult; D001315:Australia; D057189:Checklist / Q000592:standards*; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D004435:Eating; D005163:Factor Analysis, Statistical; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D010287:Parent-Child Relations; D016487:Parenting; D010290:Parents; D063766:Pediatric Obesity / Q000209:etiology / Q000517:prevention & control; D011594:Psychometrics; D015203:Reproducibility of Results; D020377:Self Efficacy; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013548:Sweden