Association among Adolescents' Weight Status, Parents' Perception on Their Children's Weight, Parenting Behaviors and Parenting Style: A Cross Sectional Study in Southern China

Childhood obesity is becoming a challenging issue in China, and parents may playa key role in the development of adolescent obesity. However, the relationships between certain parent-related factors and the development of adolescent obesity are rarely reported in China. Therefore, this study aims to investigate the relationship among Chinese parents' perception of their children's weight, parenting behaviors, parenting style, and adolescents' weight status. Two studies were performed to achieve this purpose.;The first study (Chapter 3) examines the validity and reliability of the questionnaires for adolescents and parents; the questionnaires are intended to measure parenting behaviors, parents' perception of their children's weight, and parenting styles in the Chinese context. Several steps were performed. First, the questionnaires were selected based on their validity and reliability, as well as their applicability to the Chinese adolescent and parenting context. Second, the questionnaires were translated into Chinese using a cross-cultural translation technique. Third, five experts were invited to evaluate the content validity and feasibility of the questionnaires for application in the Chinese population. Fourth, 15 pairs of adolescents and their parents were invited to attend a short interview after completing the experimental version of the questionnaires. They were asked to share comments on the readability and cultural relevance of the questionnaire. The questionnaires were then revised according to their feedback. Fifth, 127 pairs of adolescents (10-15 years old) and their parents (Ganzhou: 62 pairs, Shantou: 65 pairs) were recruited to examine the retest reliability and internal consistency of the questionnaires. Sixth, the data collected in the main survey were used to examine construct validity. The result showed that 10 items were excluded because of poor content validity or low intraclass correlation coefficient (<0.7). The internal consistencies of the subscales (ranging from 0.61 to 0.81) were found to be acceptable (Cronbach's alpha >0.6). The goodness-of-fit statistics (RMSEA, CFI, and NNFI) also indicated acceptable fit for the theory models. The results suggest that the validity and reliability of the questionnaires are acceptable, and the questionnaires are applicable to Chinese adolescents and parents in Southern China.;The second study (Chapters 4,5,6) determines the relationships among parenting behaviors, parents' perception of their children's weight, parenting style, and adolescent weight status. A total of 2,143 adolescents and 1,869 parents were recruited from secondary schools in Ganzhou and Shantou in China. The adolescents' weights and heights were measured by trained testers. The dietary habits and physical activity level of the adolescents, as well as parenting behaviors, parenting styles, parents' perception of their children's weight, and demographic information were collected through questionnaires issued to the adolescents and parents validated in Study 1. Several parenting behaviors, including "pressure to eat" and "diet and PA monitoring," were found to be significantly related to adolescents' age and gender-specific BMI Z score (Z-BMI), although the correlation coefficients were low (r ranged from -0.23 to 0.09, p (r ranged from -0.23 to 0.09, p<0.01). The results of the hierarchical multiple regression revealed that "pressure to eat" and "diet and PA monitoring" were the predictors of adolescent Z-BMI. The results of Kappa statistics showed that only a slight agreement exists between parental perception of their children's weights and the adolescents' actual weights (Kappa=0.221, p<0.01). A significant difference in parenting behaviors was found between parents with correct and incorrect perceptions of their children's weight. Compared with the reference authoritative parenting style, the odds of acquiring unhealthy dietary habits were significantly higher for children with authoritarian (Father: OR=1.67, 95%CI: 1.29-2.16; Mother: OR=1.72, 95%CI: 1.31-2.26) and neglectful (Father: OR=2.17, 95%CI: 1.66-2.82; Mother: OR=2.29, 95%CI: 1.76-3.00) parents. The odds of being physically inactive for children with neglectful parents were almost twice than that for children with authoritative parents (Father: OR=2.05, 95%CI: 1.37-3.06; Mother: OR=1.77, 95%CI: 1.18-2.67). Significant differences were found in the parenting behaviors of parents with four different parenting styles. However, no association was found between parenting style and adolescent weight. The data of this study suggest that parenting behaviors are weakly but significantly associated with the development of adolescent obesity. Misclassifications of children's weight status were prevalent among Chinese parents. Parental perceptions of their children's weights were associated with some parenting behaviors related to children's weight development. The adolescents' dietary habits, physical activity, and some parenting behaviors were associated with parenting style. However, there was no direct association between parenting style and adolescent weight.;Key words: adolescent obesity, parenting behaviors, parenting styles...