Appetite 81 (2014) 76–83

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Effects of children’s self-regulation of eating on parental feeding practices and child weight ☆ Matthew B. Cross a,*, Allen M. Hallett a, Tracey A. Ledoux a, Daniel P. O’Connor a, Sheryl O. Hughes b a Department of Health and Human Performance, Texas Obesity Research Center, University of Houston, 3855 Holman Street, Susanna Garrison Gym Room 104, Houston, TX 77204-6015, USA b Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children’s Nutrition Research Center, 1100 Bates Street, Houston, TX 77030-2600, USA

A R T I C L E

I N F O

Article history: Received 24 November 2013 Received in revised form 6 June 2014 Accepted 9 June 2014 Available online 12 June 2014 Keywords: Parent feeding Minorities Self-regulation

A B S T R A C T

The purpose of this study was to determine whether self-regulation of eating in minority preschoolaged children mediates the relationship between parent feeding practices and child weight. Participants were 299 low-income African American and Hispanic parents and their preschool-aged children who participated in Head Start. Parents completed questionnaires about controlling feeding practices (pressure to eat, restriction) and children’s appetitive characteristics (enjoyment of food, food responsiveness, satiety responsiveness). Path analyses were used to determine whether children’s self-regulation of eating mediated the relationship between feeding practices and child weight. Greater satiety responsiveness in African American preschool-age children partially mediated the inverse association between pressure to eat and children’s weight, B (SE) = −0.073 (0.036), P < .05. Enjoyment of food and food responsiveness did not mediate the relationship between pressure to eat and weight in the African American sample, ps > .05, nor did appetitive characteristics mediate the relationship between restriction and child weight, ps > .05. Appetitive characteristics did not mediate the relationship between controlling feeding practices and child weight in the Hispanic sample, ps > .05. Implications include the need for culturally sensitive self-report measures and for researchers to account for the possible effects of racial/ethnic differences when designing interventions. © 2014 Elsevier Ltd. All rights reserved.

Introduction Overweight and obesity is associated with increased risk of chronic diseases and premature death among minority children (Genovesi et al., 2012; Marcus et al., 2012; Popkin, 2010). The prevalence of overweight and obesity are markedly higher in Mexican American and non-Hispanic black preschool-aged (2–5 years) children relative to their non-Hispanic white counterparts (Ogden, Carroll, Kit, & Flegal, 2012). Health disparities by race/ethnicity are exacerbated by behaviors acquired in early life (Taveras, Gillman,

☆

Acknowledgements: This research was supported by funds from the United States Department of Agriculture, Grant No. 2006-55215-16696. This work is a publication of the United States Department of Agriculture (USDA/ARS) Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, and has been funded in part with federal funds from USDA/ARS under Cooperative Agreement No. 6250-51000-053. The contents of this publication do not necessarily reflect the views or policies of the USDA nor does mention of trade names, commercial products, or organizations imply endorsement from the U.S. government. * Corresponding author. E-mail address: [email protected] (M.B. Cross). http://dx.doi.org/10.1016/j.appet.2014.06.014 0195-6663/© 2014 Elsevier Ltd. All rights reserved.

Kleinman, Rich-Edwards, & Rifas-Shiman, 2010, 2013). Although the role of parents in determining their children’s health is wellknown (Lindsay, Sussner, Kim, & Gortmaker, 2006), evidence suggests that the mediating effect of child appetitive characteristics may predispose children to becoming obese and may differ by race/ ethnicity (Birch & Fisher, 2000; Joyce & Zimmer-Gembeck, 2009; Morrison, Power, Nicklas, & Hughes, 2013). Parenting behavior in the child-feeding context has been implicated in the maintenance of normal weight and prevention of childhood overweight and obesity. Parents typically determine the content, frequency, and quantity of food their children consume (Ventura & Birch, 2008). Thus, parent–child interactions around food have been associated with increasing rates of overweight and obesity in minority children (e.g., Hoerr et al., 2009; Hughes, Power, Fisher, Mueller, & Nicklas, 2005; Hughes et al., 2011). Two commonly assessed controlling feeding practices are restriction and pressure to eat. Restriction refers to parents making unhealthy foods (e.g., sweets, junk foods) less available, whereas pressure to eat describes the practice of encouraging a child to eat more food (e.g., spoon-feeding, verbally prompting the child to eat, and telling the child to eat a small amount of a particular food) despite the child indicating fullness (Birch et al., 2001). While some studies have found no

M.B. Cross et al./Appetite 81 (2014) 76–83

association between restrictive feeding practices and child weight (e.g., Baughcum et al., 2001; Carnell & Wardle, 2007a; Montgomery, Jackson, Kelly, & Reilly, 2006), other studies have found a positive relationship (e.g., Birch & Fisher, 2000; Faith, Dennison, Edmunds, & Stratton, 2006). Multiple studies have established a negative association between parents’ pressuring children to eat and childhood overweight and obesity (Carnell & Wardle, 2007a; Galloway, Fiorito, Francis, & Birch, 2006), and differences for controlling feeding practices have been identified among racial/ethnic groups (Hughes et al., 2011; Powers, Chamberlain, van Schaick, Sherman, & Whitaker, 2006). Furthermore, parenting behavior has been shown to differ between white and African American samples (Baumrind, 1972). Systematic reviews of controlling feeding practices and their relations with child weight have shown much of the research in this area has been conducted with predominantly or exclusively white samples (Faith, Scanlon, Birch, Francis, & Sherry, 2004; Hurley, Cross, & Hughes, 2011). More research is needed examining the role of controlling feeding practices on child weight status in African Americans and Hispanics. It is generally accepted that dietary habits track from childhood to adolescence (Feinstein et al., 2008; Ponza, Devaney, Ziegler, Reidy, & Squatrito, 2004; Singh, Mulder, Twisk, van Mechelen, & Chinapaw, 2008), so reducing maladaptive eating behaviors in preschool-age children and maladaptive feeding behaviors in their parents is paramount to preventing and managing overweight and obesity. Children’s self-regulation of energy intake has been identified as a mechanism governing weight loss or maintenance (Kristeller & Wolever, 2011). Child self-regulation of eating refers to the ability of the child to eat in response to their internal cues of hunger and fullness (Herman & Polivy, 2011). Children with greater fat mass and children whose parents controlled their children’s food intake exhibited impaired self-regulation of eating (Johnson & Birch, 1994). Parent-reported pressuring to eat predicted a greater tendency for girls to eat less and engage in disinhibited eating (Carper, Fisher, & Birch, 2000). In addition, mothers’ perceptions of their children’s overweight status were related to restrictive feeding practices that, consequently, were associated with children’s reduced ability to regulate their energy intake and with increased eating in the absence of hunger (Birch & Fisher, 2000). Using the Children’s Eating Behaviour Questionnaire (CEBQ; Wardle, Guthrie, Sanderson, & Rapoport, 2001), Carnell and Wardle (2007b, 2008) have found inverse associations between satiety responsiveness and eating in the absence of hunger and weight and positive associations between food responsiveness and energy intake and between enjoyment of food and eating in the absence of hunger and weight among predominantly white samples. To our knowledge, minority preschoolage children’s ability to regulate their energy intake has not been extensively examined. The mediating variable model posits that interventions should target known mediators acting as barriers to and facilitators of behavior change to induce adiposity change (Baranowski & Jago, 2005). The literature on controlling feeding practices and children’s weight has been inconsistent (see Faith et al., 2006; Hurley et al., 2011, for reviews). Two reasons may explain these inconsistencies. First, studies differ in whether they account for intervening variables. If children’s ability to regulate their energy intake is a mediator of the relationship between controlling feeding practices and child weight, then the relationship between controlling feeding practices and child weight will differ depending on whether self-regulation of energy intake is controlled. Second, it could be that the relationships between controlling feeding practices and child weight differ according to sample characteristics such that, for some racial/ethnic groups, controlling feeding practices may have negative effects on weight status whereas in others, they may not. The purpose of this study was to determine whether children’s ability to regulate their energy intake partially explains the relations between controlling

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feeding practices and child BMIz and whether racial/ethnic differences existed on these variables. Understanding the mechanisms of the association between parent controlling feeding practices and child weight status and the characteristics of those for whom these associations exist will provide more accurate intervention targets in child obesity programs. In this study, we examined how controlling feeding practices predict children’s ability to regulate their food intake and consequently impact children’s weight status. Using a cross-sectional design, this study aimed to determine whether children’s ability to regulate their energy intake partially explains the relations between controlling feeding practices and child BMIz. We hypothesized that children’s ability to self-regulate energy intake would mediate the relations between controlling feeding practices and children’s weight status and differ by race/ethnicity. Method Participants Participants were part of a larger study aimed at gaining a better understanding of how low-income families interact during the dinner meal. The study consisted of three home visits in which parent– child interactions during the dinner meal were observed. Participants completed questionnaires and staff members obtained digital photographs of the foods placed on the dinner plates (parents and children). A subset of the participants was also observed during the dinner meals (to assess the emotional climate of the meal) (Hughes et al., 2011). A total of 299 low-income primary caregivers (referred to as mothers hereafter because the majority were mothers) and their preschool-age children were recruited for participation in the study. After a staff member explained the study to them, mothers provided informed consent for themselves and their children. Table 1 shows demographic characteristics of the sample stratified by race/ethnicity. Procedures Mothers received questionnaire packets at the end of the first home visit, and staff members picked up the packets at the subsequent home visit. Mothers completed questionnaires about demographics (i.e., age, sex, and race/ethnicity of the parent and child, mother’s education level), mothers’ child-feeding practices, and children’s appetitive characteristics. Because we were interested in mothers’ perceptions of their own and their child’s behavior and the constructs examined here differ from those in the observational data, this study examines only the questionnaire data relating to children’s self-regulation of energy intake and mothers’ child-feeding practices. The Institutional Review Board at Baylor College of Medicine reviewed and approved the procedures of the original study, and the Committee for the Protection of Human Subjects at University of Houston approved the secondary analysis of the data. Measures Child Feeding Questionnaire (CFQ) The Child Feeding Questionnaire (Birch et al., 2001) is a parentreport measure used to assess perceptions about their own weight and their children’s weight and controlling feeding practices used with their children. The CFQ consists of 28 items comprising seven subscales: perceived responsibility (3 items), perceived parent weight (4 items), perceived child weight (3 items), concern about child weight (3 items), restriction (8 items), pressure to eat (4 items), and monitoring (3 items). Internal consistencies for the subscales are α = .70 for pressure to eat and α = .73 for restriction (Birch et al., 2001). In this study, the internal consistencies for the entire sample were α = .53 for pressure to eat and α = .73 for restriction. Internal

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Table 1 Sample characteristics by race/ethnicity.

Demographic variables Parent gender (%) Education of parent (%)

Child gender (%) Employment of parent (%) Age, mean in years (SD) Relationship to child

Study variables (mean [SD])

N Male Female Less than high school diploma High school diploma Some college College graduate Post graduate Missing Male Female Employed Unemployed Parent Child Mother Father Grandmother Pressure to eat Restriction Enjoyment of food Food responsiveness Satiety Responsiveness

consistencies for pressure to eat were α = .47 and α = .57 for the African American and Hispanic samples, respectively. For restriction, the internal consistencies were α = .77 and α = .67, respectively. In this study, we used only the restriction and pressure to eat subscales to measure mothers’ use of controlling feeding practices with their preschool-age children. Both of these subscales use a 5-point Likert scale ranging from disagree to agree. Children’s Eating Behaviour Questionnaire (CEBQ) The Children’s Eating Behaviour Questionnaire (Wardle et al., 2001) is a parent-report measure used to assess children’s eating behaviors. Child self-regulation of energy intake was measured using three subscales from the CEBQ. The measure consists of 35 items comprising seven subscales: satiety responsiveness (5 items), food responsiveness (5 items), emotional overeating (5 items), emotional undereating (3 items), enjoyment of food (4 items), desire to drink (3 items), slowness in eating (4 items), and food fussiness (6 items) (Wardle et al., 2001). In this study, we used the food responsiveness, satiety responsiveness, and enjoyment of food subscales to measure mothers’ perceptions of children’s ability to self-regulate their energy intake. All subscales use a 5-point Likert scale ranging from never to always. The enjoyment of food subscale assesses children’s desire to eat, and the food responsiveness subscale examines behaviors such as eating because of external cues, whereas the satiety responsiveness subscale measures how sensitive children are to internal hunger and satiety cues (Carnell & Wardle, 2007b). The internal consistencies were α = .82 for food responsiveness, α = .83 for satiety responsiveness, and α = .91 for enjoyment of food (Wardle et al., 2001). In this study, the internal consistencies for the entire sample were α = .74 for satiety responsiveness, α = .72 for food responsiveness, and α = .76 for enjoyment of food. For the African American sample, the internal consistencies were α = .70 for satiety responsiveness, α = .76 for food responsiveness, and α = .82 for enjoyment of food. In the Hispanic sample, the internal consistencies were α = .68 for satiety responsiveness, α = .58 for food responsiveness, and α = .69 for enjoyment of food. Anthropometrics Trained staff members obtained height and weight measurements for children and their mothers using the protocol described by Lohman, Roche, and Martorell (1988). Children and adults dressed

African American

Hispanic

140 2.1 97.8 7.2 29.7 47.1 9.4 1.4 5.1 47.1 52.2 52.8 47.2 31.83 (8.26) 4.4 (0.67) 95.0 2.1 2.8 3.32 (0.86) 3.67 (0.83) 3.94 (0.77) 2.44 (0.79) 2.82 (0.59)

159 1.9 98.1 46.8 21.8 23.7 4.5 1.9 1.3 51.3 48.7 45.4 54.6 31.81 (7.48) 4.5 (0.64) 96.9 1.9 1.2 3.53 (0.87) 3.72 (0.73) 3.74 (0.69) 2.19 (0.78) 2.85 (0.65)

in light clothing and removed their shoes. Staff measured in duplicate height to the nearest tenth of a centimeter and weight to the nearest tenth of a kilogram. Mothers’ heights and weights were converted to BMI. Using the revised 2000 growth charts from the Centers for Disease Control and Prevention (Kuczmarski et al., 2002), children’s heights and weights were converted to age- and genderspecific BMIz scores and percentiles, children were classified as normal weight ( .05. The direct effect of restriction on child weight was significant in the models including enjoyment of food, B (SE) = 0.204 (0.093), β = 0.154, P < .05, and satiety responsiveness, B (SE) = 0.998 (0.089), β = 0.224, P < .01, as the mediators. Mediating effect of child self-regulation of energy intake on the relationship between mothers’ feeding practices and child weight status in the Hispanic sample Results for all models in the Hispanic sample are reported in Table 3.

Indicators of model fit We examined four indexes to assess model fit: the unadjusted chi-square test, Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), and Root Mean Square Error of Approximation (RMSEA) based on recommendations in Byrne (2011). Model fit is indicated by the chisquare test such that small, nonsignificant chi-square values show a great degree of similarity between the data and the specified model. TLI and CFI indexes compare the model to the null model (all parameters = 0) with values greater than .90 indicating the model

Pressure to eat The models had or approached adequate fit (all nonsignificant χ2, CFI: 0.81 to 0.94; TLI: 0.68 to 0.89; RMSEA: 0.04 to 0.07). No mediating effects were significant in the hypothesized models, P > .05 (Table 3). The unconditional models were also nonsignificant, P > .05. None of the relationships between pressure to eat and the proposed mediating variables was significant, P > .05. The direct inverse effect of pressure to eat on child weight was significant in all three models, P < .01.

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Table 2 Indicators of model fit for and results of mediation analysis in African American sample (n = 140). χ2

Independent variable: pressure to eat Mediators Enjoyment of food 8.299, df = 9, P = .50

CFI

TLI

RMSEA

1.000

1.000

0.000

Food responsiveness

7.82, df = 9, P = .55

1.000

1.000

0.000

Satiety responsiveness

11.49, df = 9, P = .24

0.90

0.83

0.04

Independent variable: restriction Mediators Enjoyment of food 8.297, df = 9, P = .50

1.000

1.000

0.000

Food responsiveness

8.155, df = 9, P = .52

1.000

1.000

0.000

Satiety responsiveness

10.02, df = 9, P = .35

0.96

0.94

0.03

a

b

c

Mediation effect

B (SE)

B (SE)

B (SE)

B (SE)

β

β

β

β

−0.139 (0.067)* −0.155 0.206 (0.072)** 0.225 0.145 (0.061)* 0.212

0.315 (0.113)** 0.221 0.305 (0.112)** 0.218 −0.505 (0.133)*** −0.271

−0.148 (0.108) −0.115 −0.249 (0.112)* −0.195 −0.117 (0.111) −0.092

−0.044 (0.027) −0.034 0.063 (0.055) 0.049 −0.073 (0.036)* −0.057

0.087 (0.064) 0.094 0.282 (0.084)** 0.299 0.119 (0.059)* 0.167

0.309 (0.115)** 0.216 0.181 (0.114) 0.130 −0.604 (0.131)*** −0.323

0.204 (0.093)* 0.154 0.184 (0.094) 0.139 0.998 (0.089)** 0.224

0.027 (0.022) 0.020 0.051 (0.037) 0.039 −0.072 (0.039) −0.054

Dependent variable: Child BMI z. a, path between independent variable and child self-regulation of energy intake (Enjoyment of Food, Food Responsiveness, Satiety Responsiveness); b, path between child self-regulation of energy intake and BMIz; c, path between independent variable and BMIz; Mediation effect = a × b, product of the coefficients of a and b; B, unstandardized beta coefficient estimate; SE, standard error of the unstandardized beta estimate; β, standardized beta coefficient estimate. CFI = Comparative Fit Index; TLI = Tucker-Lewis Index; RMSEA = Root Mean Square Error of Approximation. * P < .05; ** P < .01; *** P < .001.

Restriction The model including enjoyment of food as a mediator had the best fit for the hypothesized model (Table 3). No mediating effects were significant in the hypothesized models, P > .05 (Table 3). The unconditional models were also nonsignificant, P > .05. The direct effect of restriction on child weight was not significant, P > .05. Discussion The purpose of this study was to investigate the role of children’s self-regulation of energy intake on the relationship between mothers’ controlling feeding practices and children’s weight in lowincome families. The intent was to identify possible explanatory pro-

cesses predicting the relationships between controlling feeding practices and children’s weight status (e.g., Fisher & Birch, 1999; Galloway et al., 2006; Joyce & Zimmer-Gembeck, 2009; Powers et al., 2006). A second purpose of this study was to identify racial/ethnic differences in the independent effects of controlling feeding practices on children’s self-regulation of energy intake and selfregulation on child weight status. We found partial support for the hypotheses that appetitive characteristics mediate the relationships between mothers’ pressure to eat more food and child weight. Specifically, satiety responsiveness mediated the relationship between pressuring and children’s weight status among African American families. This finding indicates, in African American families, children with mothers who

Table 3 Indicators of model fit for and results of mediation analysis in Hispanic sample (n = 159). χ2

CFI

TLI

RMSEA

Independent variable: pressure to eat Mediators Enjoyment of food 11.327, df = 9, P = .25

0.94

0.89

0.04

Food responsiveness

13.748, df = 9, P = .13

0.88

0.80

0.06

Satiety responsiveness

16.515, df = 9, P = .06

0.81

0.68

0.07

1.000

1.000

0.000

Independent variable: restriction Mediators Enjoyment of food 7.678, df = 9, P = .57 Food responsiveness

11.114, df = 9, P = .27

0.93

0.88

0.04

Satiety responsiveness

13.451, df = 9, P = .14

0.83

0.72

0.06

a

b

c

Mediation Effect

B (SE)

B (SE)

B (SE)

B (SE)

β

β

β

β

−0.070 (0.070) −0.088 0.030 (0.074) 0.034 −0.041 (0.055) −0.055

0.283 (0.128)* 0.159 0.292 (0.112)** 0.185 −0.276 (0.122)* −0.146

−0.341 (0.105)** −0.241 −0.370 (0.101)*** −0.262 −0.367 (0.105)*** −0.260

−0.020 (0.024) −0.014 0.009 (0.023) 0.006 0.011 (0.016) 0.008

−0.121 (0.081) −0.127 0.205 (0.086)* 0.192 0.127 (0.073) 0.143

0.322 (0.139)* 0.182 0.303 (0.123)* 0.193 −0.265 (0.132)* −0.141

−0.010 (0.116) −0.006 −0.112 (0.121) −0.067 −0.016 (0.117) −0.009

−0.039 (0.035) −0.023 0.062 (0.039) 0.037 −0.034 (0.028) −0.020

Dependent variable: Child BMI z. a, path between independent variable and child self-regulation of energy intake (Enjoyment of Food, Food Responsiveness, Satiety Responsiveness); b, path between child self-regulation of energy intake and BMIz; c, path between independent variable and BMIz; Mediation effect = a × b, product of the coefficients of a and b; B, unstandardized beta coefficient estimate; SE, standard error of the unstandardized beta estimate; β, standardized beta coefficient estimate. CFI = Comparative Fit Index; TLI = Tucker-Lewis Index; RMSEA = Root Mean Square Error of Approximation. * P < .05; ** P < .01; *** P < .001.

M.B. Cross et al./Appetite 81 (2014) 76–83

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Table 4 Correlations between study variables. Child BMI Z Child BMI Z Child sex Parent BMI Educ. SR FR EF Pressure Restrict

Child Sex .015

−.181* .252** −.215** −.178* .216** .203* −.233** −.069

−.007 −.034 .164* −.164* −.106 −.088 −.001

Parent BMI

Educ.

SR

FR

EF

Pressure

Restrict

.234** −.092

−.003 −.038 .188*

−.280** .118 −.067 −.079

.176* .001 −.001 −.056 −.254**

.221** −.010 −.043 −.078 −.531** .292**

−.134 −.092 .040 .020 .212* .225** −.155

.168* .075 −.055 .025 .167* .299** .094 .313**

−.134 .020 .049 .026 −.103 −.110

.134 .002 −.001 −.123 .088

−.294** −.454** −.056 .144

.284** .035 .193*

−.087 −.128

.362**

Correlations for African American sample are presented above the diagonal; correlations for the Hispanic sample are presented below the diagonal. Educ. = Parent Education Level; SR = Satiety Responsiveness (CEBQ); FR = Food Responsiveness (CEBQ); EF = Enjoyment of Food (CEBQ); Pressure = Pressure to Eat (CFQ); Restrict = Restriction (CFQ). * P < .05; ** P < .01.

pressure their children to eat have better awareness of their satiety cues and thus, better weight outcomes. These results differed only slightly in magnitude from the model without covariates. However, these findings conflict with previous studies that have shown inverse associations between pressuring children to eat and responsiveness to satiety cues (e.g., Birch, McPhee, Shoba, Steinberg, & Krehbiel, 1987; Carnell & Wardle, 2008). Because these studies were conducted in predominantly Caucasian samples, the finding in this study may represent a pattern unique to African American families. It is also possible that mothers in this study used controlling feeding practices in response to their perceptions of their children’s satiety responsiveness. Conversely, among Hispanic families, appetitive characteristics did not mediate the relationship between pressure to eat and child weight. The direct effect between mothers’ restriction and child weight status was not significant in any of the analyses in either racial/ethnic group, so there was no effect to mediate. This nonsignificant relationship in these lowincome families contradicts some of the research on the role of mothers’ restriction on child weight status in predominantly white samples, which shows an inverse association (see Hurley et al., 2011, for a review). A number of potential explanations exist for these results. Previous research has indicated mediating effects concerning children’s weight. In a sample of 4- to 8-year-old children in Australia, Joyce and Zimmer-Gembeck (2009) found that disinhibited eating in children partially mediated the relationship between restrictive feeding practices and child weight. Contrary to our findings, Joyce and Zimmer-Gembeck found a significant direct effect between restriction and child weight. Similarly, Birch and Fisher (2000) found that maternal restriction predicted daughters’ dietary intake and weight and that higher levels of maternal restriction predicted poorer caloric compensation. These findings conflict with the results of our study, which found no mediating effect of any measure of children’s appetitive characteristics on the relationship between restriction and child weight and that greater maternal restriction predicted greater responsiveness to satiety cues. Conversely, in a longitudinal study with 2- to 4-year-olds, Gregory, Paxton, and Brozovic (2010) found neither controlling feeding practice predicted children’s weight a year later. Relationships between mothers’ controlling feeding practices and children’s appetitive characteristics differed by race/ethnicity. Although the relationship with pressure to eat was significant for all three hypothesized mediating variables (enjoyment of food, food responsiveness, and satiety responsiveness) in African American families, it was not related to any of the hypothesized mediators in Hispanic families. Restriction was related to food responsiveness in both racial/ethnic groups. When considering the relationship between the hypothesized mediating variables and child weight status, significant effects were found for all of the relationships in

both races/ethnicities except for food responsiveness in African American families. The direct effect of pressure to eat was significant in African American families with food responsiveness only compared with all of the models in Hispanic families. However, this finding concurs with Powers et al.’s (2006) study in African American preschool-age children. Restrictive feeding practices were significantly associated with enjoyment of food and satiety responsiveness in the African American families, but none of the associations between restriction and child weight status was significant in Hispanic families. In a study of white middle-income and Hispanic low-income mothers and their preschool-age children, Worobey, Borrelli, Espinosa, and Worobey (2013) found lowincome Hispanic mothers self-reported greater use of both restriction and pressure to eat compared with white middle-income mothers, but neither controlling feeding practice predicted children’s BMI percentiles. However, as in our study (Table 1), Worobey et al. reported intermediate levels of both controlling feeding practices. Differences between the two racial/ethnic groups relative to the effect of controlling feeding practices may be the result of differing interpretations of the questionnaire items between the African American and Hispanic families (Anderson, Hughes, Fisher, & Nicklas, 2005). For example, one of the items in the restriction subscale of the CFQ (“If I did not guide or regulate my child’s eating, she would eat too many junk foods”; Birch et al., 2001, p. 210) may be interpreted differently by African American and Hispanic mothers, and perhaps differently in both from white mothers, because the term “junk food” may have different meanings in each group (Anderson et al., 2005; Boles et al., 2010). Therefore, participants’ interpretations of the questionnaire items may have been associated with how they responded, resulting in nonsignificant findings. Furthermore, research has indicated both African American and Hispanic mothers perceive their preschool-aged children as thinner than they actually are and express a desire for their children to be heavier (Killion, Hughes, Wendt, Pease, & Nicklas, 2006). Therefore, African American and Hispanic mothers who use controlling feeding practices may not consider the behavior as maladaptive for having children with a healthy weight. The reason for contradictory results between the current study and previous research may be explained partly by differences in sample characteristics. The participants in the current study were recruited through Head Start from specific racial/ethnic minority groups. Conversely, previous studies investigating the mediating effects of children’s appetitive characteristics have consisted primarily of high-income, white families (Birch & Fisher, 2000; Joyce & Zimmer-Gembeck, 2009). Moreover, research into parent–child interactions in the feeding context has only recently begun to include socioeconomically and racially/ethnically diverse samples (Hurley et al., 2011).

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Because this study’s sample consisted of only one sociodemographic group (low-income minorities), the results may not generalize to other groups (e.g., preschoolers in families with higher socioeconomic status). Moreover, multiple studies (Anderson et al., 2005; Boles et al., 2010) have indicated concerns about the use of the CFQ (Birch et al., 2001) in minority samples. Anderson et al. (2005) found that the original model fit of the CFQ had a better model fit in a Hispanic sample compared with an African American sample, and it was necessary to delete some items to achieve measurement invariance between the two groups. Furthermore, Boles et al. (2010) determined internal consistency was poorer in a sample of caregivers of African American preschool-age children compared with the original study, and a poor model fit was identified for the factor structure of the concern about child’s weight, pressure to eat, and restriction subscales of the CFQ with some items cross-loading onto other factors. The internal consistency values for this study were generally lower than those reported in the original validation studies for the measures, particularly for pressure to eat (α = .53) and for the three subscales of the CEBQ (α = .72 to .76). Because the predictors and hypothesized mediators were measured using parent-report questionnaires, the possibility of shared method variance exists. The cross-sectional design of the study precludes any causal inferences. However, the use of a multiethnic (African American and Hispanic) sample strengthens the study’s findings because this area of research, until recently, has included predominantly white samples (Hurley et al., 2011). The use of subscales from validated and widely used questionnaires (restriction and pressure to eat subscales of the CFQ and food responsiveness, satiety responsiveness, and enjoyment of food subscales of the CEBQ) (Birch et al., 2001; Wardle et al., 2001) also strengthen the study. Because African American and Hispanic children have a higher prevalence of overweight and obesity (Flegal, Carroll, Kit, & Ogden, 2012) and are more susceptible to becoming overweight or obese (Taveras et al., 2010, 2013) compared with white children, future research should address the racial/ethnic differences both in controlling feeding practices and in children’s appetitive characteristics. Further qualitative research into different racial/ethnic groups’ conceptualizations of controlling feeding practices (e.g., Rodríguez-Oliveros et al., 2011) and further modification of existing self-report measures or development of culturally sensitive questionnaires (e.g., Tschann et al., 2013) may be necessary to account for racial/ethnic differences. This study indicates that although children’s ability to respond appropriately to satiety cues mediated the relationship between pressuring to eat more food by mothers and children’s weight status in an African American sample, children’s satiety responsiveness did not mediate this relationship in a Hispanic sample. Therefore, gaining a better understanding of racial/ethnic differences in feeding practices and using questionnaires developed specifically for minority groups may help better tailor interventions aimed at understanding the role of mothers in the development of self-regulation in eating and their associations with overweight and obesity in preschool-age children. References Agras, W. S., Hammer, L. D., McNicholas, F., & Kraemer, H. C. (2004). Risk factors for childhood overweight. A prospective study from birth to 9.5 years. The Journal of Pediatrics, 145, 20–25. Anderson, C. B., Hughes, S. O., Fisher, J. O., & Nicklas, T. A. (2005). Cross-cultural equivalence of feeding beliefs and practices. The psychometric properties of the Child Feeding Questionnaire among Blacks and Hispanics. Preventive Medicine, 41, 521–531. Baranowski, T., & Jago, R. (2005). Understanding the mechanisms of change in children’s physical activity programs. Exercise and Sport Sciences Reviews, 33, 163–168. Baughcum, A. E., Powers, S. W., Johnson, S. B., Chamberlain, L. A., Deeks, C. M., Jain, A., et al. (2001). Maternal feeding practices and beliefs and their relationships

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