Appetite 63 (2013) 4858

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Appetite
journal homepage: www.elsevier.com/locate/appet

Research report

Self-efcacy for healthy eating and peer support for unhealthy eating
are associated with adolescents food intake patterns q
Amanda Fitzgerald a,, Caroline Heary b, Colette Kelly c, Elizabeth Nixon d, Mark Shevlin e
a
School of Psychology, University College Dublin, Dublin, Ireland
b
School of Psychology, National University of Ireland Galway, Ireland
c
Discipline of Health Promotion, School of Health Sciences, National University of Ireland Galway, Ireland
d
School of Psychology, Trinity College Dublin, Dublin, Ireland
e
School of Psychology and Psychology Research Institute, University of Ulster, Magee Campus, Londonderry, Ireland

a r t i c l e i n f o a b s t r a c t

Article history: Adolescence, with its change in dietary habits, is likely to be a vulnerable period in the onset of obesity. It
Received 26 January 2012 is considered that peers have an important role to play on adolescents diet, however, limited research
Received in revised form 1 December 2012 has examined the role of peers in this context. This study examined the relationship between self-efcacy
Accepted 12 December 2012
for healthy eating, parent and peer support for healthy and unhealthy eating and food intake patterns.
Available online 23 December 2012
Participants were 264 boys and 219 girls (N = 483), aged 1318 years, recruited from post-primary
schools in Ireland. Self-report measures assessed self-efcacy, parent and peer support for healthy eating,
Keywords:
and for unhealthy eating. Dietary pattern analysis, a popular alternative to traditional methods used in
Adolescents
Gender
nutritional research, was conducted on a FFQ to derive food intake patterns. Two patterns were identied
Self-Efcacy labelled healthy food intake and unhealthy food intake. Multi-group modelling was used to evaluate
Social support whether the hypothesized model of factors related to dietary patterns differed by gender. The multi-
Structural equation modelling group model t the data well, with only one path shown to differ by gender. Lower self-efcacy for
Dietary Pattern Analysis healthy eating and higher peer support for unhealthy eating were associated with unhealthy food intake.
Higher self-efcacy was associated with healthy food intake. Prevention programs that target self-ef-
cacy for eating and peer support for unhealthy eating may be benecial in improving dietary choices
among adolescents.
2012 Elsevier Ltd. All rights reserved.

Introduction inuence and mediators to address poor eating behaviours (Gentile

The quality of adolescents diets in the Western world is of
increasing concern (British Medical Association [BMA], 2003) with
obesity in adolescence now at epidemic proportions (Hedley et al.,
2004; Lobstein, James, & Cole, 2003). Research indicates that the
development of effective nutrition strategies requires an under-
standing of the multiple interacting factors that inuence adoles-
cents dietary behaviour (McClain, Chappuis, Nguyen-Rodriguez,
Yaroch, & Spruijt-Metz, 2009). There has been a recent move to de-
velop effective dietary interventions that target multiple levels of
q
Statement of research: Using Structural Equation Modelling, this research set out
to examine the relationship between perceived self-efcacy and social support for
eating with healthy (i.e., fruit, vegetables, brown bread, low-energy drinks) and
unhealthy (i.e., sweets, biscuits, desserts, snacks) food intake patterns among
adolescents.
Corresponding author.
E-mail addresses: amanda.tzgerald@ucd.ie (A. Fitzgerald), caroline.heary@
nuigalway.ie (C. Heary), colette.kelly@nuigalway.ie (C. Kelly), enixon@tcd.ie
(E. Nixon), m.shevlin@ulster.ac.uk (M. Shevlin).
et al., 2009; Gould, Jasik, Lustig, & Garber, 2009).
Despite greater nutrient needs during adolescence, there is evi-
dence that adolescents diet quality declines as a greater proportion
of meals and snacks are consumed away from the home (Lien, Lytle,
& Klepp, 2001; Neumark-Sztainer, Story, Hannan, & Croll, 2002).
Adolescents have been shown to consume high intakes of foods rich
in fat, sugar, and salt and low intakes of fruits, vegetables, whole-
grains, and calcium-rich foods (Institute of Medicine, 2007). Fur-
thermore, dietary behaviours established during adolescence tend
to persist into adulthood (Mikkila, Rasanen, Raitakari, Pietnen, &
Vikari, 2005) thus, targeting this age group offers an important
opportunity to inuence long-term dietary behaviours.
Socio-Cognitive Theory (SCT; Bandura, 1986) is the most
commonly used theory in interventions to promote healthy
eating among adolescents (Cerin, Barnett, & Baranowski, 2009;
Rinderknecht & Smith, 2004). SCT emphasises the importance of
personal, socio-environmental and behavioural factors and the
interaction between these factors in inuencing behaviour. This
interaction is referred to as reciprocal determinism as each factor
may affect or be affected by the others. Self-efcacy, dened as an

0195-6663/$ - see front matter 2012 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.appet.2012.12.011
 A. Fitzgerald et al. / Appetite 63 (2013) 4858
individuals belief in their ability to perform a specic behaviour, is
considered to be a central determinant of behaviour in SCT. Dietary
self-efcacy refers to the perceived capability to make healthy food
choices, even when faced with potential barriers (Lubans et al.,
2012). Research with young people guided by SCT, has shown that
higher dietary self-efcacy is associated with higher intakes of
fruit and vegetables (Bere & Klepp, 2004), calcium-rich foods
(Ievers-Landis et al., 2003) and lower intakes of fat (Frenn, Malin,
& Bansal, 2003).
SCT also proposes that socio-environmental factors, such as so-
cial support, can inuence behaviour, both directly and indirectly
via personal factors such as self-efcacy.
Previous studies have shown that adolescents perceptions of
parent support for healthy eating was associated with fewer snacks
and more fruit, vegetables, bre- and calcium-rich foods (Ayala
et al., 2007; Stanton, Green, & Fries, 2007; Wind et al., 2006).
Dietary self-efcacy beliefs were also shown to partially mediate
the relationship between parent support and healthy food intake
among children and adolescents (Ievers-Landis et al., 2003; Young,
Fors, & Hayes, 2004), but did not mediate the relationship between
peer support and intake in adolescents (Ievers-Landis et al., 2003).
In relation to peer support for healthy eating, there is inconsis-
tency in the literature. Some studies found that self-reported peer
support for healthy eating was associated with adolescents
healthy food intake (Larson et al., 2009; Stanton et al., 2007),
whereas, other studies reported no associations (Finnerty, Reeves,
Dabinett, Jeanes, & Vgele, 2009; Ievers-Landis et al., 2003).
Interestingly, qualitative research suggests that peers may
encourage adolescents to consume unhealthy foods (e.g., Croll,
Neumark-Sztainer, & Story, 2001; Watt & Sheiham, 1997), how-
ever, little research has quantitatively examined how peer factors
may be related to adolescents unhealthy food intake.
In the social support literature, there is a tendency for peer sup-
port to increase during adolescence at the same time as a decrease
in support from parents (Cheng & Chan, 2004). However, there is
also evidence for gender differences in adolescent perceptions
and use of social support (Cheng & Chan, 2004; Colarossi, 2001;
Eschenbeck, Kohlmann, & Lohaus, 2007). Adolescent girls perceive
higher levels of peer support than boys, whereas, on the contrary,
adolescent boys perceive higher levels of parent support than girls
(Cheng & Chan, 2004; Colarossi, 2001). These studies highlight the
importance of perceived parental support for boys and perceived
peer support for girls. In the dietary behaviour literature, studies
have shown that parent support for healthy eating is associated
with healthy food intake among adolescent boys but not girls (Bau-
er, Larson, Nelson, Story, & Neumark-Sztainer, 2009; Larson, Story,
Wall, & Neumark-Sztainer, 2006).
Gender differences in adolescents dietary intake are widely
noted. Adolescent boys report consuming lower intakes of fruits
and vegetables and higher intakes of fast food and soft drinks than
girls (e.g., Lien, Jacobs, & Klepp, 2002). In recent years, research has
shown that hypothesized predictors of dietary intake may also
differ by gender (Bauer et al., 2009; Hanson, Neumark-Sztainer,
Eisenberg, Story, & Wall, 2005; Larson et al., 2006, 2008; Zabinski
et al., 2006). For example, Bauer et al. found that maternal and peer
healthy eating concerns and maternal support for healthy eating
were predictive of lower fast-food intake for boys but not girls.
Larson et al. (2006) found that self-efcacy was associated with
calcium intake for girls but not boys. Thus, the relationship
between hypothesized factors (such as self-efcacy and parent
support for eating) and dietary intake may differ by gender.
A common shortcoming of adolescent obesity programmes
across Europe is that they often look at adolescents as a homoge-
neous cohort and ignore the growing evidence that boys and girls
differ in their exposure and vulnerability to obesity and eating
problems (World Health Organization, 2011). They are affected
49
differently by the socioeconomic circumstances of their commu-
nity, their ethnicity, and by gender norms and values. In recent
years, it has been recommended that public health strategies to
prevent and reduce obesity should be gender specic (Groth, Fagt,
Stockmarr, Matthiessen, & Biltoft-Jensen, 2009).
Patterns of dietary intake
The majority of studies examining factors related to adoles-
cents dietary intake have traditionally focused on intake of indi-
vidual foods, food groups or nutrients (Cutler, Flood, Hannan,
Slavin, & Neumark-Sztainer, 2011). However, a limitation of this
approach is that people do not eat isolated foods or nutrients
and instead eat meals consisting of a variety of foods with complex
combinations of nutrients which are likely to be interactive (Hu,
2002; Tucker, 2010). The single food and nutrient approach may
be insufcient for taking into account complex interactions among
foods and nutrients in studies of people living in their everyday
context. Recently, dietary pattern analysis has emerged as an alter-
native and complementary approach to the single food and nutri-
ent approach. Dietary pattern analysis considers how multiple
foods, drinks and nutrients are consumed in combination and cre-
ates dietary variables that more realistically resemble actual die-
tary behaviour (Cutler et al., 2011). The collinerity of foods and
nutrients can be considered an advantage in dietary pattern anal-
ysis because patterns are created on the basis of usual food con-
sumption (Tucker, 2010).
Dietary patterns can be derived through data-driven methods
such as factor analysis using dietary data collected from a specic
study population. Factor analysis uses information reported on die-
tary tools such as food frequency questionnaires (FFQs) to identify
common underlying dimensions (patterns) of food consumption. It
aggregates specic food items (or groups) on the basis of the de-
gree to which food items in the dataset are correlated with one an-
other. A summary score for each pattern is then derived and the
individual obtains a score for each dietary pattern identied. Die-
tary pattern research has great potential for use in nutrition policy,
especially as it demonstrates the importance of total diet in health
promotion. Dietary pattern analysis has been used successfully in
adult populations to examine associations between socio-demo-
graphic and lifestyles factors and dietary patterns (Engeset, Alsak-
er, Ciampi, & Lund, 2005; Sanchez-Villegas, Delgado-Rodriguez,
Martinez-Gonzalez, Irala-Estevez, & J. for the SUN group, 2003),
and further exploration in adolescent populations is warranted
(Cutler et al., 2011).
The present study
Using self-reported variables, this study tested whether self-
efcacy mediates the relationship between social support variables
(i.e., peer support for healthy eating, peer support for unhealthy
eating, parent support for healthy eating, parent support for un-
healthy eating) and dietary intake patterns in adolescent boys
and girls. These predictions were derived from SCT. In addition,
multi-group analyses were conducted to test the hypothesis that
gender moderates the associations between self-efcacy and social
support variables and dietary intake patterns.
Method
Participants
Ethical approval to conduct the study was obtained from the
National University of Galway Ethics Review Board. Criteria for
inclusion were adolescents aged between 13 and 18 years, parental
50 A. Fitzgerald et al. / Appetite 63 (2013) 4858
written consent and informed consent from participants. Criteria
for exclusion included participants with multiple or severe food
allergies (n = 2). Based on these criteria, 483 participants (264
boys) aged between 13 and 18 years (M = 15.06 years, SD = 1.40)
took part in the study. The sample was predominantly Irish
(89%). Based on International Obesity Taskforce criteria (Cole,
Bellizzi, Flegal, & Dietz, 2000), 4.4% of participants were under-
weight, 70.3% were a healthy weight, 21.0% were overweight and
4.2% were obese. The current study aimed to control for extraneous
sources of variance in the proposed model; therefore, demographic
variables including parent education, age and BMI were included
as covariates in the model testing.1 There were no missing data
for age or BMI, however, 5.6% (n = 27) of parental education data
was missing, therefore, only participants with completed data for
this variable were included in the nal sample (n = 456). Of this
sample, those who had more than 10% of missing FFQ data were ex-
cluded from analyses (n = 11). A nal sample of 445 participants was
retained for analyses.
Procedures
Participants were recruited from randomly selected post-pri-
mary schools from the Department of Education and Skills pub-
lished list of schools in the West of Ireland. Nineteen post-
primary schools were contacted in order to secure the consent of
13 schools; (overall school consent rate was 68.42%). Most schools
(97%) were designated as non-disadvantaged. During an initial vis-
it, students were provided with a study packet containing an intro-
duction letter, an information sheet and a parental consent form.
The individual-level consent rate was 57.92% (ranging from
43.68% to 77.27% depending on the school).
Data collection
After the researcher obtained written consent from the childs
parent and informed assent from students, self-reported measures
were administered during classtime in school. Data collection took
place from January to June 2009.
Measures
Basic demographic information. Parents provided demographic
information (e.g., childs age and gender, parent education) on
the parental consent form.
Dietary intake. Dietary intake over the past month was assessed
with a 98 item self-administered Food Frequency Questionnaire
(FFQ). The FFQ was selected to collect usual dietary intake as it
is cost-efcient, easy to administer to a large sample of adoles-
cents, has good response compliance, and has shown to be a valid
and reproducible dietary assessment method among adolescents
(Rankin, Hanekom, Wright, & MacIntyre, 2010). The FFQ was devel-
oped for the present study as no previously validated measures
were available for assessing usual dietary intake in Irish adoles-
cents. The FFQ food list was informed by national studies of Irish
childrens and adolescents diets (e.g., National Teens Food Survey,
2008), 24 h food diaries completed in a previous study (Fitzgerald,
Heary, Nixon & Kelly, 2010), input from nutrition experts and pilot
testing of the FFQ. The present study used factor analysis to derive
dietary patterns. Factor analysis (or principal component analysis
(PCA)) examines the correlation matrix of food variables and
searches for underlying dimensions (patterns or factors) that ex-
plain most of the variation in the data (Hu, 2002). Thus, a large
number of food variables are reduced to a smaller set of variables
1
Covariates serve to hold constant the inuences of variables not otherwise
explicitly modelled and they control for extraneous sources of variance in a proposed
model (Fletcher, Selgrade, & Germano, 2006).
that capture the major dietary patterns in the population. For each
factor, scores are obtained that dene the position of each person
along a gradient (Reedy et al., 2010). For the current PCA, 98 foods
items were reduced to 31 broader food groups by combining items
of similar nutrient composition and type. The food groups were
created based on a review of food group lists in previous Irish re-
search deriving dietary patterns among adults (Hearty & Gibney,
2008).
Measures of hypothesized predictors
Self-efcacy for healthy eating. Self-efcacy to make healthy food
choices was measured using a nine-item scale developed for use
with American adolescents (French, Story, Neumark-Sztainer, Fulk-
erson, & Hannan, 2001). The self-efcacy scale was used to assess
participants self-condence for making healthy food choices in so-
cial situations (e.g., with friends), in emotional situations (e.g.,
bored) and in normal situations (e.g., at family dinner). Responses
were rated on a ve-point scale ranging from not at all sure to
very sure and scores ranged from 9 to 45. Testretest reliability
for the summary scale score was found to be high (0.83) among
4746 adolescents (French et al., 2001). Adequate-to-high reliability
was also found for the social situation (SS) score (0.66), emotional
situation (ES) score (0.85), and normal situation (NS) score (0.66).
In the present study, alpha for the summary scale score was 0.73
(n = 445). Alpha reliabilities for the three subscales were low
(SS = 0.52, ES = 0.57, NS = 0.56). The reliability problem may be
addressed by employing SEM, where self-efcacy is used as a latent
variable, and latent variables are error free (Kline, 2005). The use of
latent variable models means that the relationships in the overall
model are not inuenced by measurement error (Bollen, 1989).
Social support measure for healthy eating. Social support for
healthy eating was measured by an eight-item scale adapted from
a measure of Diet-specic Social Support for Adolescents (DSSA;
Stanton et al., 2007). The specic items that were included in the
scale are indicated in Table 1. Participants rated on a ve-point Lik-
ert scale (never to very often) how often a parent or peer per-
formed a behaviour that was supportive of healthy eating. The
parent- and peer-support scales for healthy eating were scored
separately. Total scores for each scale ranged from 4 to 20. Alpha
values for the two scales in the current sample were acceptable:
0.73 (n = 445) for parent support for healthy eating and 0.78
(n = 445) for peer support for healthy eating.
Social support measure for unhealthy eating. A six-item measure
of social support for unhealthy eating was developed based on a
modication of the DSSA (Stanton et al., 2007). This measure was
used to assess how often a parent or peer performed a behaviour
that was supportive of unhealthy eating (see Table 1 for specic
items included in the measure). A denition and examples of com-
mon high-fat foods was provided in the instructions. Both the par-
ent and peer support scale for unhealthy eating were scored
separately, and scores ranged from 3 to 15. Alphas for the parent
and peer support scale for unhealthy eating were 0.60 and 0.64,
respectively (n = 445).
Body mass index. Height and weight were each assessed twice
using a Leicester height rod and a Seca Model 889 medical weight
scale. Anthropometric measurements were made according to
standard methods for body weight and height (Lohman, Roche, &
Martorell, 1998). BMI was calculated as kg/m2. To dene over-
weight and obesity, the IOTF sex- and age-specic BMI cut-offs
were used (Cole et al., 2000).
Analytic plan
Prior to analysis, data were screened for normality and outliers.
All survey items assessing hypothesized correlates of dietary
intake showed skewness and kurtosis within an acceptable range
 A. Fitzgerald et al. / Appetite 63 (2013) 4858 51

Table 1
Descriptive statistics and factor loadings for model variables.

Latent construct and indicators Final Sample (N = 445) Boys (n = 237) Girls (n = 208) Factor loadings for multi- T value (df)
M (SD) M (SD) M (SD) group Model
Age 15.13 (1.41) 15.02 (1.43) 15.24 (1.38) t(443) = 1.61,
p = .98
Parent education
n (%) n (%) n (%) v2 (6, 445) = .18,
p > .05,
No Schooling 1 (.2) 1 (.4) 0
Primary level or less 17 (3.8) 8 (3.4) 9 (4.3)
Second level 186 (41.8) 90 (38.0) 96 (46.2)
Third level 241 (54.2) 138 (58.2) 103 (49.6)
Parent support for healthy eating
given you ideas on how to eat healthier foods 3.54 (1.09) 3.60 (1.10) 3.48 (1.08) .72 t(443) = 1.14,
p = .80
offered you low-fat snacks 3.27 (1.23) 3.30 (1.21) 3.24 (1.25) .56 t(443) = .54,
p = .71
encouraged you to stay away from high-fat foods 3.37 (1.13) 3.37 (1.12) 3.37 (1.14) .62 t(443) = .06,
p = .80
talked with you about eating more healthy foods 2.86 (1.14) 2.97 (1.16) 2.74 (1.10) .62 t(443) = 2.21,
p < .81
Peer support for healthy eating
given you ideas on how to eat healthier foods 2.01 (1.09) 1.89 (1.08) 2.14 (1.11) .74 t(443) = 2.42,
p = .58
offered you low-fat snacks 2.01 (1.10) 1.87 (1.06) 2.18 (1.14) .57 t(443) = 3.04,
p = .18
encouraged you to stay away from high-fat foods 1.89 (1.03) 1.88 (1.11) 1.89 (.95) .78 t(443) = .21,
p = .001**
talked with you about eating more healthy foods 1.83 (1.03) 1.79 (1.02) 1.88 (1.04) .67 t(443) = .85,
p = .98
Parent support for unhealthy eating
offered you high-fat foods 2.42 (.92) 2.52 (.87) 2.32 (.96) .54 t(443) = 2.32,
p = .30
encouraged you to eat high-fat foods 1.61 (.78) 1.67 (.77) 1.55 (.78) .67 t(443) = 1.59,
p = .79
said nice things about the sweet or high-fat foods 1.89 (.95) 1.85 (.95) 1.95 (.96) .55 t(443) = 1.10,
you were eating p = .90
said nice things about the sweet or high-fat foods 2.94 (1.27) 2.68 (1.21) 2.80 (1.12) .58 t(443) = 1.09,
you were eating p = .08
Peer support for unhealthy eating
offered you high-fat foods 3.30 (1.14) 3.16 (1.09) 3.26 (1.09) .62 t(443) = .70,
p = .98
encouraged you to eat high-fat foods 2.29 (1.20) 2.20 (1.13) 2.28 (1.12) .62 t(443) = 1.10,
p = .08
said nice things about the sweet or high-fat foods 2.94 (1.27) 2.68 (1.21) 2.80 (1.12) .58 t(443) = 1.09,
you were eating p = .08
Self-efcacy (SE) for healthy eating
SE in social situations 7.71 (2.59) 7.28 (2.58) 8.20 (2.51) .63 t(440) = 3.75,
p = .78
SE in emotional situations 8.27 (2.86) 8.52 (2.86) 7.99 (2.84) .59 t(440) = 2.00,
p = .58
SE in normal situations 11.09 (2.57) 10.87 (2.54) 11.34 (2.60) .72 t(438) = 1.95,
p = .44
Unhealthy food intake
Food Group (FG) Confectionary 6.34 (5.99) 5.97 (5.32) 6.76 (6.66) .65 t(443) = 1.41,
p = .02*
FGBiscuits 4.42 (5.02) 4.44 (4.86) 4.39 (5.22) .70 t(443) = .12,
p = .30
FGDesserts 3.51 (4.58) 3.92 (5.60) 3.04 (2.98) .58 t(443) = 2.05,
p = .001**
FGSnacks 3.55 (3.66) 3.74 (3.77) 3.32 (3.54) .57 t(443) = 1.21,
p = 13
Healthy food intake
FGFruit 15.20 (14.54) 14.04 (14.06) 16.52 (14.99) .55 t(443) = 1.80,
p = .57
FGVegetables 19.12 (12.92) 18.07 (12.85) 20.32 (12.92) .62 t(443) = 1.84,
p = .25
FGBrown Bread 3.73 (3.58) 3.61 (3.68) 3.88 (3.48) .43 t(443) = .80,
p = .68
FGLow Energy Drinks 15.39 (7.82) 14.32 (7.47) 16.61 (8.04) .40 t(443) = 3.12,
p = .10
*
Signicance <.01.
**
Signicance <.001.
52 A. Fitzgerald et al. / Appetite 63 (2013) 4858
(Kline, 2005). The FFQ variables exhibited positive skewness and
high kurtosis, however, food intake variables are not expected to
be normally distributed in the population. If a variable is not ex-
pected to be normally distributed, an estimation method can be se-
lected that addresses the non-normality (Tabachnick & Fidell,
2001). Among the nal sample (n = 445), there were nominal
amounts of missing item-level data ranging from .2% to 2.6%. Miss-
ing data were imputed using the Expectation Maximization (EM)
algorithm, a statistical technique for imputing missing data that
employs an iterative estimation procedure to converge at a maxi-
mum-likelihood estimate that averages over the distribution of
missing values (Schafer, 1997).
In the hypothesized model, self-efcacy and parent and peer
support for healthy and unhealthy eating variables and dietary pat-
terns were tested as latent constructs in the structural model to
control for measurement error. Demographic covariates (age,
BMI, parent education) were tested as directly observed variables.
The hypothesized conceptual model was specied and estimated
using LISREL 8.8 (Jreskog & Srbom, 2006a). A covariance matrix
and an asymptotic weight matrix were computed using PRELIS
2.8 (Jreskog & Srbom, 2006b) and the model parameters esti-
mated using robust maximum likelihood (Satorra & Bentler, 2001).
Next, mediation analyses were conducted. According to Holm-
beck (1997), assuming there is a latent predictor variable (A), a la-
tent mediator variable (B), and a latent outcome variable (C), one
would rst assess the t of the direct effects model (A ? C). Assum-
ing an adequate t, the t of the overall model is then examined
(A ? B ? C). Assuming this model provides an adequate t, the
A ? B and B ? C path coefcients are then examined. The A ? C,
A ? B, and B ? C paths should all be signicant in the directions
predicted. If these paths are signicant, the nal step is to assess
the t of the A ? B ? C model under two conditions: (a) when
the A ? C path is constrained to zero, and (b) when the A ? C path
is not constrained.
Finally, multi-group analysis was conducted to examine whether
gender moderated the relationship between self-efcacy and parent
and peer support for healthy and unhealthy eating and dietary in-
take patterns. That is, separate models for boys and girls were spec-
ied simultaneously within the same overall model. Each model
was initially run with all paths xed to be invariant across genders
and tested for gender differences by freeing one path at a time in a
stepwise manner according to the modication indices, and
comparing the model with a fully constrained model (see Tildesley
& Andrews, 2008). If a structural path was signicant (p < .05) for
either gender, it was included in the nal multigroup model.
Based on Hoyle and Panters recommendations (1995), the ade-
quacy of model t was assessed using the SatorraBentler scaled
chi-square (v2), the Incremental Fit Index (IFI: Bollen, 1989), the
Comparative Fit Index (CFI: Bentler, 1990) and Root Mean Square
Error of Approximation (RMSEA; Steiger, 1990). As the v2 statistic
is sensitive to sample size and violations of normality (Kline, 2005),
it is reported for completeness, but it is not used to draw specic
conclusions about the model t (Hu & Bentler, 1999). Well tting
models should have values that are 60.05 for the RMSEA and val-
ues that are very close to 0.90 for the IFI and CFI (Hu & Bentler,
1999). A value less than or equal to .05 for the Standardized Root
Mean Square Residual is considered a good t (Kline, 2005).
Results
Dietary outcomes
A Principal Component Analysis (PCA) was conducted in order
to generate hypotheses about underlying dietary patterns
measured by the FFQ. In line with recommendations (e.g., Borland,
Robinson, Crozier, Inskip, and the SWS Study Group, 2008), the FFQ
food items were collapsed into a smaller number of food groups for
entry into the factor analysis. A PCA, using an orthogonal rotation
(varimax) was conducted on the reported frequencies of consump-
tion of 31 standardized food groups to identify a viable factor
structure based on a randomized split of the data in the sample
(n = 222). The number of factors to be retained was determined
by a convergence of criteria according to Gorsuch (1983), including
eigenvalues >1, the scree plot, parallel analysis and theoretical
interpretability of the resulting factor structure. PCA yielded a
two-factor solution which accounted for 47.99% of the total vari-
ance (factor 1 = 26.32% (2.11); factor 2 = 21.67% (1.73). The rst
factor termed unhealthy food intake was characterized by high in-
takes of snacks, sweets, biscuits, and desserts. The second factor
termed healthy food intake was characterized by high intakes of
fruit, vegetables, brown bread, and low-energy drinks.
The next step was to conduct a CFA with maximum likelihood
estimation procedures with the remaining sample (n = 223) to
cross-validate the two-factor structure obtained using PCA. The
two-factor model provided a good t to the data, v2
(df = 19) = 26.08, p = .13, RMSEA = .041 (90% condence interval
(CI): .00.076), IFI = .98, CFI = .98, and SRMR = .048 (see Appendix
A).
Model testing
Demographic and study variable means and standard devia-
tions for the overall sample and for boys and girls are presented
in Table 1. The standardized factor loadings for each of the mea-
sured variables are presented in Table 1. All factor loadings are po-
sitive and statistically signicant (p < .05). The correlations
between the variables were mostly signicant but some correla-
tions were modest. As multiple direct and indirect relationships
were tested, all theoretically meaningful variables were retained
for model building, even if they showed modest correlation.
Demographic covariates
Potential demographic covariates were determined by examin-
ing associations between age, BMI and parent education and die-
tary intake variables. There were signicant associations between
each of the covariates and dietary variables, therefore, all covari-
ates were included in subsequent analyses. To control for these
variables as possible confounding inuences, paths representing
their direct and indirect effects on all latent variables were incor-
porated into analyses.
Testing assumptions for mediation analysis
In line with Holmbecks (1997) recommendations, the direct ef-
fects model (A ? C) showed a good t to the data, v2
(df = 195) = 305.92, p < .001, RMSEA = .034 (90% condence inter-
val (CI): .026.039), CFI = .96, and SRMR = .046 (Model 1). The path
coefcients from peer support for unhealthy eating to unhealthy
food intake (b = .33, p < .01), parent support for unhealthy eating
to unhealthy food intake (b = .21, p < .05), and parent support for
healthy eating to healthy food intake (b = .15, p < .05) were signif-
icant. All other path coefcients were not signicant. Next, the t
of the overall A ? B ? C model was tested and provided a good
t to the data (v2 (df = 255) = 388.36, p < .001, RMSEA = .033 (90%
condence interval (CI): .026.039), CFI = .96 (Model 2). The path
coefcients for this model were examined: peer support for un-
healthy eating was signicantly related to unhealthy food intake
(b = .30, p < .01), parent support for unhealthy eating was signi-
cantly related to self-efcacy (b = .32, p < .01) and peer support
for healthy eating was signicantly related to self-efcacy
(b = .14, p < .05). Self efcacy was related to both unhealthy
(B = .27, p < .01) and healthy (b = .37, p < .01) dietary patterns.
 A. Fitzgerald et al. / Appetite 63 (2013) 4858
At this point, the A ? C, A ? B, and B ? C paths should all be signif-
icant in the directions predicted. However, none of the social sup-
port variables were found to be signicantly related to both the
mediator (self-efcacy) and the outcome variable (either healthy
or unhealthy dietary pattern) (see Fig. 1). Therefore, there was no
evidence to support the mediation hypothesis and no further anal-
yses to test the mediation hypothesis were conducted.
Testing model t by gender
Next, multi-group analyses were conducted to statistically eval-
uate the t of the hypothesized model of dietary intake and its
invariance for boys and girls. Six models were specied and tested.
The summary statistics for tested models in multigroup analyses
are shown in Table 2. Model 1.1 specied the measurement
model where factor loading, factor variances and covariances and
unique variances were allowed to vary across groups, v2 (561,
N = 445) = 723.88, p < .05, RMSEA = .036 (90% CI: .028; .044),
CFI = .95, IFI = .95. However, measurement invariance among
groups should be established prior to testing the difference in
the structural model across gender. Therefore Model 1.2 included
equality constraints on the factors loading, factor variances and
covariances and unique variances across groups. This model dem-
onstrated a good t to the data, v2 (579, N = 445) = 772.37, p < .05,
RMSEA = .039 (90% CI: .031; .046), CFI = .94, IFI = .94. Therefore, in
testing for the invariance of the structural model across gender, all
latent variable factor loadings in the measurement model were
constrained to be equal.
Next, multigroup analysis was conducted to test whether the
structural model differed by gender. For simplicity, all covariates
were removed from the multigroup analyses of the structural mod-
el until the nal multigroup model. The multiple group model with
no equality constraints across groups (Model 1.3) demonstrated a
good t for the data, v2 (566, N = 445) = 772.06, p < .05,
RMSEA = .041 (90% CI: .033; .048), CFI = .94, IFI = .94. With the
paths specied to be invariant (Model 1.4) the model t statistics
still indicated acceptable t, v2 (580, N = 445) = 787.07 p < .05,
RMSEA = .040 (90% CI: .033; .047), CFI = .94, IFI = .94. To determine
whether structural paths differed by gender, one path was freed at
a time in the model based on the modication indices (MI > 5), and
the model was compared with the fully constrained model. Based
Fig. 1. Partial mediation model of the relationship between hypothesized factors and dietary intake patterns for the overall sample (Model 2) p < .05;
53
on the modication indices for the multiple group model, the
equality constraint across groups for the path from peer support
for healthy eating to self-efcacy for healthy eating was removed
(Model 1.5) and the model provided a good t to the data, v2
(579, N = 445) = 780.05, p < .05, RMSEA = .040 (90% CI: .032; .047),
CFI = .94, IFI = .94. The standardized path coefcient between
self-reported peer support for healthy eating and self-efcacy
was signicant for boys (p < .01) but not for girls (p = ns). There
were no other MIs greater than 5. The nal multi-group model
with covariates included provided a satisfactory t to the data
(Model 1.6), v2 (714, N = 445) = 1129.80, p < .05, RMSEA = .051
(90% CI: .046; .057), CFI = .88, IFI = .88. As the demographic covar-
iates were signicantly associated with the dietary outcomes in
initial analyses, the nal model included these covariates so as to
control for their potential confounding effect on the relationship
between the latent constructs of social support and self-efcacy
and dietary outcomes. The nal multigroup model t the data
and no signicant covariances were needed to support the nal
model. For simplicity, the non-signicant paths were not shown
in the nal multigroup model in Fig. 2.
For the nal multi-group model, higher peer support for un-
healthy eating (b = .18, p < .05), and lower self-efcacy beliefs were
associated with unhealthy intake (b = .29, p < .01). Self-efcacy
was the only latent construct associated with healthy intake
(b = .33, p < .01). Parent support for healthy eating was associated
with self-efcacy (b = .10, p < .05). With regard to gender effects,
the path between peer support for healthy eating and self-efcacy
was signicant for boys (b = .18, p < .01) but not for girls
(b = .10). The latent construct of parent support for unhealthy
eating was not signicantly associated with any of the variables.
Figure 2 provides details on the signicant associations from the
multi-group analysis.
Discussion
The study ndings provide support for testing SCT predictions
in relation to adolescents dietary patterns. In line with previous
dietary studies using SCT (Bere & Klepp, 2004; Gallaway, Jago,
Baranowski, Baranowski, & Diamond, 2007), higher self-efcacy
beliefs were directly related to healthy food intake, and lower

p < .01.
54 A. Fitzgerald et al. / Appetite 63 (2013) 4858

Table 2
Summary statistics for tested models in multiple group analyses.

Model Parameter Satorra Bentler Chi square (df) MI Chi square RMSEA 90% CI CFI IFI
***
1.1 723.88 (561) 859.87 .036 .028; .044 .95 .95
1.2 772.37 (579) *** 955.86 .039 .031; .046 .94 .94
1.3 772.06 (566) *** 951.50 .041 .033; .048 .94 .94
1.4 787.07 (580) *** 968.37 .040 .033; .047 .94 .94
1.5 Peer support for healthy eating ? self-efcacy 780.05 (579) *** 5.91 961.96 .040 .032; .047 .94 .94
1.6 1129.80 (714) *** 1370.22 .051 .046; .057 .88 .88

MI, Modication Index.

1.1 All factor loadings in the measurement model were estimately freely for boys and girls.
1.2 All factor loadings in the measurement model were constrained to be equal for boys and girls.
1.3 All path coefcients in the structural model were estimated freely.
1.4 All path coefcients in the structural model were constrained to be equal.
1.5 Path coefcient from peer support for healthy eating to self-efcacy to make healthy food choices was estimated freely.
1.6 Final multi-group model with one parameter estimated freely across gender.
***
p < .001.

Fig. 2. Final multi-group model for boys and girls. Standardized parameter estimates in the nal SEM. The estimates for the girls were shown in the parentheses. For clarity,
non-signicant paths are not shown in the above diagram. All paths shown are statistically signicant p < .05; p < .01.

self-efcacy beliefs were directly related to unhealthy food intake.
This study tested the conditions necessary for a mediating effect of
self-efcacy in the relationship between social support variables
and dietary intake. There was no evidence that self-efcacy medi-
ated the relationship between social support variables and dietary
patterns. To date, previous research has provided inconsistent evi-
dence regarding the mediating role of self-efcacy between social
support variables and dietary intake. Some research has reported a
mediating effect for self-efcacy in the relationship between per-
ceived parent support and fruit and vegetable intake (Young
et al., 2004), while other research has reported mixed effects,
where self-efcacy mediated the relationship between parent sup-
port and calcium intake but did not mediate the relationship be-
tween peer support and intake (Ievers-Landis et al., 2003). In
another study, Reynolds et al. (1999) reported an indirect effect,
but no mediated effect, between social variables and intake via
self-efcacy. In the current study, the relationship between parent
support for unhealthy eating and peer support for healthy eating
were directly related to self-efcacy, and self-efcacy in turn was
related to the dietary outcomes. These ndings suggest that ado-
lescents whose peers support them to eat unhealthily reported a
lower level of self-efcacy, which in turn was associated with a
higher level of unhealthy eating. This nding suggests that it is
important for future research to examine the effect of peer support
for unhealthy eating and dietary intake.
The lack of a mediation effect could be attributed to measure-
ment of self-efcacy and social support, where the behaviours that
the self-efcacy measure was based on were distinct from the
behaviours that were utilized in the social support measure. Fur-
ther research is needed to clarify these ndings using measures
of self-efcacy and social support for eating that tap into the same
target dietary behaviours. Additionally, the use of more behaviour-
specic measures of predictor variables that relate to dietary out-
comes of interest in model testing are warranted and would likely
explain larger percentages of dietary intake (Neumark-Sztainer,
Wall, Perry, & Story, 2003).
Another important aim of this research was to examine the role
of gender as a moderator of the associations between hypothesized
factors and dietary patterns. The multigroup model was similar
for boys and girls, with one path found to differ across gender.
 A. Fitzgerald et al. / Appetite 63 (2013) 4858
Specically, the path between peer support for healthy eating and
self-efcacy was signicantly stronger for boys than girls.
The nding of a signicant relationship between peer support
for healthy eating and self-efcacy for boys but not girls may sug-
gest that boys perceptions of peer support for healthy eating is
more closely linked to their condence/ability to eat healthily than
it is for girls. It may be that boys whose peer group encourage and
support one another to consume healthy foods have greater con-
dence to make healthy foods choices, particularly in social settings,
such as when eating out with friends or in peer groups. As this
study was exploratory in nature, it is unclear why this gender dif-
ference was found. Observational studies on the peer eating envi-
ronment in schools would be worthwhile to tease out whether
gender variations in peers provision of support for eating in real-
life settings exist.
The current study extended research by showing that peer sup-
port for unhealthy eating was associated with an unhealthy dietary
pattern. This nding is supported by qualitative research where
adolescents related eating unhealthy/junk foods predominantly
with their friends (Watt & Sheiham, 1997) and peer-related social
pressures were cited as a barrier to healthy eating (Croll et al.,
2001). Experimental research also indicates that social facilitation
of eating occurs when children are familiar with each other (Salvy,
Vartanian, Coelho, Jarrin, & Pliner, 2008). There is also evidence
that the larger peer crowd with which adolescents afliate (e.g.,
Jocks, Populars) is related to their eating and weight control behav-
iours (MacKey & La Greca, 2007). These ndings suggest that
involving adolescents close friends and peers in dietary interven-
tions might help to offset the potentially competing inuences of
the peer group.
There are several potential explanations for the association be-
tween peer support for unhealthy eating and dietary intake. While
SCT emphasizes that individuals learn from other people, or mod-
els, through observational learning in their social environment,
other theories can be drawn upon to understand the role of peers
on health behaviours. A number of theories have specied pro-
cesses by which peers inuence each others behaviour (Brechwald
& Prinstein, 2011). These include selection processes where chil-
dren may choose friends that are similar in behaviour and beliefs.
Identity based theories suggest that during adolescence in particu-
lar, young people internalize and emulate idealized values and
behaviours of peers and adhere to social norms established within
their peer group (Brechwald & Prinstein, 2011). The extent to
which these processes operate in relation to adolescents food con-
sumption remains relatively underexplored.
There were no direct associations found between parent sup-
port for healthy eating and dietary intake variables, however, par-
ent support was associated with self-efcacy, which in turn was
related to an unhealthy food intake. This lack of a signicant direct
association may be attributed to adolescents increasing autonomy
in making food choice decisions away from the home (Story, Neu-
mark-Sztainer, & French, 2002). Longitudinal research has shown
that parental encouragement for healthy eating decreased from
early to mid adolescence (Bauer, Laska, Fulkerson, & Neumark-
Sztainer, 2011). There was also no association found between per-
ceived parent support for unhealthy eating and unhealthy dietary
pattern. In the current study, adolescents were asked to report
their parents support for eating, therefore, results may reect
changes in adolescents perceptions rather than changes in paren-
tal behaviour. As adolescents become older they may spend less
time with their parents, they may perceive less parent support
for eating than at previous points, regardless of actual changes in
parental behaviour. Despite the lack of an association between
parental support and dietary intake in this study, there is some evi-
dence that parents can promote and model unhealthy eating habits
to their children (Arredondo et al., 2006; Brown & Ogden, 2004;
55
Fisher & Birch, 2000). However, these studies have mainly focused
on parental controlling and monitoring styles among children. Fur-
ther research would be warranted to investigate the role that par-
ents play in supporting their adolescents to eat unhealthy foods
perhaps using multi-informant design and employing a combina-
tion of self-report and other-report measures (e.g., parents, peers).
Alternatively, capturing food intake objectively through the use of
weighed food methods would be valuable to explore adolescents
dietary intake combined with parental reports of food strategies
employed within the home.
Contrary to previous research, the current study found no gen-
der difference in the relationship between parent support for eat-
ing and dietary intake. Previous studies reporting an association
between parent support for healthy eating and boys dietary in-
take, but not girls, focused on specic dietary outcomes such as
fast-food intake (Bauer et al., 2009) or calcium-intake (Larson
et al., 2006), whereas the current study focused on the intake of
combinations of foods. It may be that parents encourage their
son or daughter to eat specic foods depending on their son or
daughters eating patterns. For example, it may be that parents
encourage their sons, but not their daughters, to consume lower in-
takes of fast food and higher intakes of calcium if they are aware
that their son consumes high intakes of unhealthy foods and low
intakes of healthy foods. It is important for future research to fur-
ther examine whether the relationship between parent support for
eating and dietary intake differ by gender.
Strengths of this study include the use of food factor scores (die-
tary patterns) as dependent variables in model testing, the concep-
tualization of self-reported social support for eating and a primary
focus on the documented gender differences in factors associated
with dietary patterns. A main weakness of this study was the use
of self-report measures for the variables under investigation. Most
of the data were from adolescent self-report measures as opposed
to objective measures and thereby subject to possible attention,
comprehension, memory, and recording errors. Adolescents were
asked to report how frequently their parents and peers performed
certain supportive behaviours. Adolescents may however be vul-
nerable to all kinds of biases, for example, they may simply not no-
tice or remember how frequently they or others provide support
for eating. Adolescents perceptions of others supportive behav-
iours may also interact with their own desire for unhealthy foods
at a certain moment, or with their actual behaviour. Adolescents
may not accurately report their parents and peers behaviours be-
cause of a failure to recall important events, selective bias, or in
some cases, intentional distortions (Mash & Wolfe, 2008). Some
adolescents may try to make their parents/peers look better or
worse than they are. These cognitive biases might be a problem
particularly during puberty as adolescents begin to develop auton-
omy from parents and the role of peers becomes increasing impor-
tant and should be considered as a limitation of the current
research. Future research could use a multi-informant design as
data from parents or peers would serve as useful adjuncts to the
self-report methodology. The use of self-report measures of both
hypothesized factors and dietary patterns is another limitation in
that shared method variance could be inating the strength of
these associations. Longitudinal research is needed to determine
whether relationships between hypothesized variables and dietary
patterns are causal. Such studies are particularly important given
our focus on adolescents and their increasing autonomy and
changing social context.
The present study used a FFQ to assess habitual dietary intake.
Measurement errors inherent to the use of a FFQ for dietary assess-
ment are well documented (Livingstone & Robson, 2000). Despite
this, previous research has observed similar estimates for energy
intake with multiple 24-h recalls and a FFQ assessing diet over
the past year in adolescents (Rockett & Colditz, 1997). The use of
56 A. Fitzgerald et al. / Appetite 63 (2013) 4858
a non-validated FFQ is another limitation, however, the reading
and face validity of the FFQ was established in a pilot study (Fitz-
gerald, Heary, Nixon & Kelly, 2010) and the dimensionality of the
FFQ was explored. The cultural sensitivity of the self-efcacy mea-
sure should also be considered given that the reliabilities of the
subscales for the current sample were lower compared to an Amer-
ican sample. Low reliability may also raise questions about the
validity of the scale and it would be worthwhile to validate the
self-efcacy scale with an Irish population of adolescents. Finally,
the present study included a sample of Irish adolescents which
may limit generalizability of ndings to other cultural contexts.
Different social, cultural, economic, policy and regulatory food
environments might mean that results are not always transferable
from one country to the next.
Age was included as a covariate in the model, however it would
be worthwhile to look at whether age moderates the relationship
between hypothesized factors and adolescents dietary patterns.
Additionally, given that changes in food habits between early ado-
lescence and adulthood have been shown (Lake, Mathers, Rugg-
Gunn, & Adamson, 2006), it would be worthwhile to examine gen-
der as a moderator of the relationship between correlates and die-
tary intake for specc age groups of adolescents including younger
(1315 years) and older (1618 years) adolescents. There was no
relationship found between BMI and dietary patterns which may
be explained by the cross-sectional nature of the study. Alterna-
tively, it may be that BMI does not inuence dietary patterns, or
that if it does, a longer term prospective design is needed to inves-
tigate this.
In line with previous research (Bere & Klepp, 2004; Neumark-
Sztainer et al., 2003), the model accounted for less than a third of
the variance in dietary intake. The next step to theoretically ad-
vance the literature may be to incorporate other SCT constructs
that target the physical environment such as school food availabil-
ity or the neighbourhood food environment into models to explain
more of the variance in dietary patterns. In one of the rst studies
examining aspects of both the social (peer friendship groups) and
physical environment (school availability), both peer group snack
and soft drink consumption were associated with intake particu-
larly when availability in the school canteen and vending machine
was high (Wouters, Larsen, Kremers, Dagnelie, & Geenen, 2010).
The studys ndings suggest that interventions that address
self-efcacy for making healthy food choices in different situations
may be benecial for adolescents. Dietary strategies could help
students to make healthy food choices more readily in social situ-
ations with peers, when feeling bored/stressed or when at home.
Adolescents could also be taught skills to develop their personal
efcacy to resist peer encouragement to consume unhealthy foods.
Within the school context, adolescents could be taught self-advo-
cacy skills including assertiveness and effective communication
skills through role play scenarios with their peers around food.
These ndings support the recommendation of Wouters et al.
(2010), who argue for the need for interventions to focus on groups
of friends as well as on the individual.
In addition, in order to create healthy norms amongst adoles-
cent peer groups, the peer context needs to be facilitated and sup-
ported by the broader school, family and community context.
Eating is frequently a social occasion. Therefore, the availability
of healthy foods in schools and communities where adolescents
gather socially can enable young people to make healthy food
choices. At a broader population level, social norm interventions
could also be explored in an effort to change adolescents percep-
tions of the beliefs and behaviours of other young people regarding
food, particularly junk food. A recent social norm marketing cam-
paign had signicant effects on normative misperceptions and
drinking behaviour (Perkins, Linkenbach, Lewis, & Neighbors,
2011).
To conclude, these ndings offer evidence to suggest that
self-efcacy for healthy eating is associated with a healthy dietary
pattern, while perceived peer support for unhealthy eating is
associated with an unhealthy dietary pattern. Recognizing the
importance of peer support for unhealthy eating during adoles-
cence may be important to consider in dietary interventions.
Although the multigroup model was generally similar for boys
and girls, further research is warranted to draw rm conclusions
about the role of gender as a moderator of the associations.
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Appendix A

See Fig. A.

Fig. A. Conrmatory factor analysis model of the two-factor solution derived from PCA (n = 223).