Characteristics of Western Dietary Pattern and its Association with Media Exposure in Two Generations of Hong Kong Chinese Women

Background: Studies on the characteristics associated with the Western dietary pattern (DP) in Asia are limited. Understanding the family DP resemblance in Asia is of public health importance because of the possible beneficial effects of intergenerational transfer of traditional plant-based Asian diet. Studies about media influence on dietary behaviours in Asia are few and none studied the effects on the overall DP.;Objective: This study aims to examine the dietary and individual characteristics associated with Western DP, investigate the association between the practice of Western DP and media exposure, and qualitatively assess how media and other factors influence the dietary practices in two generations of Chinese women.;Methods: This thesis composes two studies as follows: 1)a cross-sectional study on Western DP and media exposure; 2)a qualitative study on media influences on dietary practices.;The cross-sectional study recruited 207 (103 mothers, 104 daughters) community-based women from a longitudinal study. Dietary intake was quantified by an interviewer-administered diet history questionnaire. A self-reported questionnaire assessed the media (newspapers, magazines, radio, television, and leisure-time internet use) and other exposures (demographics, leisure-time physical activities, and lifestyles). Anthropometric data are measured. Two major DPs (Western and prudent) were identified using principal component analysis. Generation-specific factors associated with DPs were identified by multiple linear regression analyses adjusted for age and energy intake.;The qualitative study enrolled 22 mothers and 13 daughters from the same study population for semi-structured in-depth interviews. Themes were identified corresponding to the environmental levels described by the Ecological Model, with quotations supported. The final themes were evaluated by participant validation.;Results: 1)Cross-sectional study: Western DP was characterised by higher intakes of meat (red, processed, poultry), fast foods, seafood, energy-dense foods (e.g. high-fat dairy, cakes and snacks), eggs, energy, fat, and dietary cholesterol. Daughters had a higher Western DP score than their mother. Western DP score was positively associated with the time spent on total media exposure and years living in Hong Kong for mothers, and with the time spent on TV viewing, mother's Western DP score, and smoking status for daughters. Western DP score was positively associated with the prevalence odds of being overweight and negatively associated with the frequency of family meals for both mothers and daughters.;2)Qualitative study: Three areas were discussed: i) Generational differences in dietary practices were apparent and it was attributable to the discrepancies in the food environment during childhood, attitudes towards family meals, and practices of regular meal schedules between generations; ii) Mothers were influential but did not recognize their influences on their adult daughters' diet. Ignorance of the importance of diet-health relationship in young adulthood was observed; iii) Effects of media food promotions were apparent in the presence of Westernized food environment and reduced family size. Health and diet information in the media induced both positive and negative effects on the dietary behaviours of Chinese women.;Conclusion: There is an intergenerational association for practicing Western DP within family. Mothers were influential in adult daughters' dietary intakes, through modelling and family meals. A dose-response relationship exists between the practice of Western DP and media exposure in Chinese women. Public health strategies should consider promotion of family meals and empowerment of women on quick and healthy cooking skills as long-term approaches for family health promotion and obesity prevention. Policy evaluation of food or food-related advertising standards is necessary.;Keywords: mother, daughter, dietary pattern, media exposure, family meal, Western, TV viewing...