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Journal of Pediatric Nursing (2013) 28, 422429

Parenting Efficacy Related to Childhood Obesity:


Comparison of Parent and Child Perceptions1
Donna Marvicsin PhD , Cynthia A. Danford PhD
University of Michigan, School of Nursing, Ann Arbor, MI

Key words:
The aim of this study was to explore child and parent perceptions of parenting efficacy related to child
Parenting;
BMI. This descriptive, cross-sectional study recruited 27 parentchild dyads participating in a healthy
Child;
eating/activity intervention. Parent and child perceptions of parenting efficacy were measured using a
Obesity
version of the Tool to Measure Parenting Self-Efficacy (TOPSE). Paired sample t test and correlational
statistics were used. Parents and children had similar perception of parenting efficacy. Child report of
parenting efficacy and child BMI was significant. Exploring perceptions of parenting efficacy will help
individualize family-focused intervention programs to prevent obesity in children.
2013 Elsevier Inc. All rights reserved.

OBESITY IS NOW considered a global epidemic in 2012; Golan & Crow, 2004). There is a gap in the research
children (Lobstein & Jackson-Leach, 2007). If current related to the role of parenting efficacy in the prevention of
worldwide trends continue, it is estimated that 60 million childhood obesity. Parenting efficacy, specifically the ability
children will be either overweight or obese by the year 2020 to control, discipline and set boundaries is a key element in
(de Onis, Blossner, & Borghi, 2010). Prevalence of obesity, a managing healthy eating and activity in the home. Parenting
multidimensional phenomenon, is influenced by psychosocial efficacy becomes more complex when considering parent
factors such as socioeconomic level and family factors self-perception, perception of the other parent as well as the
including parenting. Parental influence on child eating and child's perception of the parenting in the home. The first aim
activity behavior is a particularly critical issue when of this pilot study was to compare parenting efficacy as
considering the rising prevalence of obesity in children at reported by both caregiver and child. The second aim was to
younger and younger ages (Birch & Davison, 2001). Young determine the relationship between parenting efficacy and
children are solely dependent on the actions of their parents or child BMI.
caregivers for providing adequate nutrition and regular activity
opportunities which emphasizes the importance of parenting
interventions to enhance child health and well-being.
Parenting and Prevention of Obesity
Parenting issues related to the treatment of childhood
obesity have been explored in the literature (Faith et al.,
Parents play an important role in obesity prevention.
Children rely on their parents to guide their eating and activity
1
Previous presentation: Marvicsin, D., Danford, C., & Schultz, C.
behaviors. Most obesity prevention studies to date have been
(2012). Parenting Efficacy Related to Childhood Obesity: Comparison of school-based interventions and few have included parents
Parent and Child Perceptions. Podium presentation at the NAPNAP Annual (Summerbell et al., 2005). Summerbell et al. found that school-
Conference, San Antonio, Texas. Marvicsin, D., Danford, CA., & Schultz, based interventions that focused only on the child did not
CM. (2011, June 2527). Parenting efficacy related to childhood obesity: significantly improve child BMI. Current evidence suggests
Comparison of parent and child perceptions. Paper presented at the 10th
International Family Nursing Conference, Kyoto, Japan. that interventions directed at parents during the child's early
Corresponding author: Donna Marvicsin, PhD. years may have an impact on the prevention of childhood
E-mail address: djmarvic@umich.edu. obesity (Brotman et al., 2012; Skouteris et al., 2011).

0882-5963/$ see front matter 2013 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.pedn.2012.11.004
Parenting Efficacy and Obesity 423

Family-based interventions have been found to be not specifically targeted for healthy eating or activity.
effective in the treatment of pediatric obesity (Kitzmann & Specific program components such as increasing positive
Beech, 2006). A review of intervention studies treating parentchild interactions and emotional communication
obese children found evidence that including parents in skills, teaching parents to use time out and the importance
treatment resulted in more benefits than child-alone in- of parenting consistency, as well as requiring parents to
terventions (Summerbell et al., 2003). A prospective study practice new skills with their children during parent training
followed 150 children from birth to 9.5 years to determine sessions were consistently associated with more significant
risk factors for children becoming overweight (Agras, effects. Program components that had smaller effects
Hammer, McNicholas, & Kraemer, 2004). Results sup- included teaching parents problem solving; teaching parents
ported that child behaviors such as temper tantrums and to promote children's cognitive, academic, or social skills;
difficult behaviors, posed by a highly emotional child, may and providing other additional services.
lead to overfeeding. It was concluded that family in- Although parenting influences child behavior, research
terventions that specifically target parenting skills may be an focused on the specific influence of parenting on child eating
effective prevention strategy. A recent review supported the and activity is limited. Brotman et al. (2012) found that youth
premise that parents are receptive to some parenting beha- at risk for behavior problems who received a family inter-
vioral changes that may promote healthy weight in their vention based on improving parenting skills at age 4 had lower
young children (Campbell & Hesketh, 2007). Interventions BMIs as they approached adolescence. Previous studies have
focusing on parenting skills that influence modifiable child found that specific parental behaviors reflecting control and
behavior have been identified as important prevention discipline, such as parental monitoring and parental use of
strategies (Agras et al., 2004; Faith et al., 2012). appropriate reinforcement, have been associated with pre-
Furthermore, Birch and Davison (2001) suggested that school children's physical activity, sedentary behavior and
effective obesity prevention programs should focus on dietary patterns (Arredondo et al., 2006; Spurrier et al., 2008).
providing anticipatory guidance for parents on how to foster In addition, it has been speculated that providing children with
children's preferences for healthy foods. Golan and Crow healthy eating habits relates to parenting self-efficacy,
(2004) also concluded that parents should be included in specifically control and boundaries (Stenhammar, Sarkadi, &
weight related interventions due to their role in establishing Edlund, 2007). Control has been identified as a means for
an overall healthy environment that included healthy eating parents, as agents of change, to structure a healthier home
and activity patterns. Specific parental behaviors, such as environment for their children (Faith et al., 2012).
parental role-modeling, parental monitoring, and parental
use of appropriate reinforcement, have been found to be Purpose
associated with preschool children's physical activity,
sedentary behavior and dietary patterns (Arredondo et al., The purpose of this pilot study was to describe child and
2006; Spurrier, Magarey, Golley, Curnow, & Sawyer, 2008). parent perceptions of parenting efficacy in urban and
There is a need to develop family based interventions de- suburban families participating in the Gift of Health Through
signed to strengthen these parental behaviors to promote Nutrition and Exercise (GOH) intervention program. In
healthy eating and activity in families and children, and to addition, the relationship between perceptions of parenting
prevent childhood obesity. efficacy and child BMI was explored. This is the first known
study that explores the role of parenting efficacy (control and
Parenting Self-Efficacy discipline) as it relates to obesity in children.

Bandura's theory of self-efficacy has been used as a way


to understand and influence all types of behavior change
(Resnick, 2003). He first presented self-efficacy as a con-
Method
struct within his social cognitive theory. Bandura (1997)
defines self-efficacy as the self-belief or judgment of one's This was a descriptive cross-sectional study of parent/
ability to carry out a particular course of action. Parenting child dyads participating in the Gift of Health Through
could be broadly defined as a set of skills that occur in a Nutrition and Exercise (GOH) program, a healthy eating and
variety of situations, both public and private. Parenting self- activity intervention study. The data presented here regarding
efficacy refers to expectations caregivers hold about their parenting efficacy were obtained from the data collection
ability to parent successfully (Coleman & Karraker, 2000; packet and correlated with BMIs gathered from baseline data.
Jones & Prinz, 2005). Specific skills, such as consistently
setting limits, are used when parenting and can be translated Gift of Health Through Nutrition and Exercise
to guide child eating and activity behaviors. (GOH) program
Kaminski, Valle, Filene, and Boyle (2008) synthesized
the results of 77 evaluations of parent training programs The goal of the GOH program was to provide caregiver
specifically designed to improve general parenting skills, but school age child dyads with practical information to help
424 D. Marvicsin, C.A. Danford

increase awareness of healthy eating and activity behaviors chosen. The Tool to Measure Parenting Self-Efficacy
so that more conscious healthy choices to maintain and (TOPSE) is a multi-dimensional instrument of nine scales,
control weight may occur in the home environment. The each representing a distinct dimension of parenting (Kendall
program was presented in four 1-hour sessions occurring & Bloomfield, 2005). It has been previously used to measure
over 4 weeks. Two sessions focused on healthy eating and the effectiveness of parenting programs by pre and post
were presented by a registered dietitian. Two sessions testing. There are nine scales in the measure: emotion and
focused on healthy activity and included chair aerobics led affection, play and enjoyment, empathy and understanding,
by trained instructors. The nature of this program, which was routines, control, discipline, pressure, self-acceptance, and
presented to caregiverchild dyads, allowed an effective learning and knowledge. Internal reliability coefficients for
venue to gather data on parenting efficacy from caregivers the subscales range from 0.80 to 0.89, and the overall scale
who were predominantly parents, and children collectively. reliability is 0.94. This pilot study used only two scales from
the TOPSE, control and discipline.
Procedures and Recruitment Control and discipline were identified as key qualities of
parent efficacy, which can be easily translated to guide
A convenience sample of 27 caregiverchild dyads were healthy eating and activity behavior. Discipline reflects the
recruited from urban and suburban churches in a major action component of efficacy as evidenced by parent con-
Midwest metropolitan area to participate in the GOH program. sistency in implementing rewards or consequences based on
Inclusion criteria for caregivers consisted of their claim to be their child's behavior. Control has two components. One
the primary caregiver, reside in the home with the child, ability component reflects parental self-control as measured by
to read and speak English, and consent for participation for parent response to child behavior. The second component
themselves and their child. Children were included if they were reflects the child response to the rules. The original items of
between the ages of 7 and 14 years, had the ability to read and the parent self-efficacy tool were modified to measure the
speak English, had parental consent, and agreed to verbal other parent or caregiver in the home. These items were then
assent (less than 12 years) or written assent (12 years and adapted to capture the child's perspective of both parents'
older). If either parent or children did not meet the inclusion efficacy. The original 11 point Likert scale was modified to a
criteria the dyad was excluded. Data were collected from 6-point scale (05) for ease of completion.
January 2011 to June 2011. All study procedures including
letters of support from participating churches, protocols for
Child Perception of Parenting Self-Efficacy (C-TOPSE)
recruiting participants and obtaining inform consent and
The two scales described above, control and discipline,
assent, and program curriculum was reviewed and approved
were adapted to measure perceived parental efficacy from the
by the appropriate university institutional review board.
child's perspective. The items were modified to ask each
Participants were informed of the program through their
child to rate the parent/caregiver who was participating in the
churches in a variety of ways including explanations by the
GOH program. These scales also used a six-point Likert
pastor or another church official, flyers, and Web site
scale (05). The original items to measure control from the
announcements. The program was further explained and
TOPSE with the matching child perception items for the
questions were answered during the first session by the
participating parent are presented in Table 1. The original
principal investigators. At this time, caregiver and child
TOPSE discipline items with the matching child perception
participants signed the consent and assent forms and each
items are presented in Table 2.
received a self-administered questionnaire packet to com-
plete. The questionnaire packet contained several instru-
ments including demographic questions and the adapted Participating Parent Perception of Other
Tool to Measure Parenting Self-Efficacy (TOPSE). Height, ParentControl and Discipline(OP-TOPSE)
weights, and blood pressures were obtained by the co- In addition, the control and discipline items were modified
principal investigators and three trained data collectors. for each caregiver to rate the other parent/caregiver living in
the household who was not participating in the GOH program.
Measures Therefore, participating caregivers completed the TOPSE
reflecting not only their own self perception, but also their
Demographics perception of the other parent or caregiver in the home.
Caregivers provided information regarding age, gender,
race/ethnicity, marital status, employment status and level of
education. Children provided information regarding age, Child Perception of Other Parent Control and
gender, race/ethnicity, and year in school. Discipline(C/OP-TOPSE)
The child's perception of the parent/caregiver who was not
Tool to Measure Parenting Self-Efficacy (TOPSE) participating in the GOH program was also measured. There-
An instrument designed to measure specific levels of fore, the child rated both the participating parent/caregiver
parenting self-efficacy for an identified parenting task was on each item as well as the other adult in the household.
Parenting Efficacy and Obesity 425

Table 1 TOPSE: Control (Note: 73% of the Caregivers Were Table 3 TOPSE: Control r/t Other Parent.
Female).
Parent Child
Parent Child My child's other parent is in My father or other caregiver is
As a parent I feel I am in My mother is in control of things. control of things. in control of things.
control. My child will respond to the I pay attention to the rules my
My child will respond to I pay attention to the rules my boundaries put in place by father or other caregiver sets
boundaries I put in place. mother sets and remember to the other parent. and remember to obey them.
obey them. My child's other parent can get I listen to and do what my
I can get my child to behave I listen to and do what my mother our child to behave well father or other caregiver tells
well without a battle. tells me to do without a battle without a battle. me to do without a battle.
I remain calm when facing My mother stays calm when My child's other parent My father or other caregiver
difficulties. things do not go as expected. remains calm when facing stays calm when things do not
I can't stop my child My mother cannot stop me when I difficulties. go as expected.
behaving badly. am behaving badly. My child's other parent can't My father or other caregiver
I am able to stay calm when My mother stays calm even when stop our child behaving cannot stop me when I am
my child is behaving I am not listening and behaving badly. behaving badly.
badly. badly. My child's other parent is able My father or other caregiver
to stay calm when our child stays calm when I am not
is behaving badly. listening and behaving badly.

Table 3 presents the adapted parent control items for the


other parent with the matching child items. Table 4 Description of Participants
presents the revised discipline items for the other parent
with the matching child perception items. The parent/caregivers reported a mean age of 42.8 years
(range = 2876). Eighty-nine percent of the caregivers were
parents and 7% were grandparents. Seventy-four percent of
Results the adult participants were female. The self-reported racial/
ethnic distribution was 70% white and 29% non-white.
Eighty-two percent reported being married to the child's
Descriptive statistics were used to capture the sample
parent. Approximately 52% reported having completed high
demographics. Paired t-test analysis was conducted to
school or some college education and 41% reported having a
compare child and parental perceptions of parenting efficacy.
college degree or higher. Sixty-three percent (63%) of the
Correlation analysis was conducted to determine a relation-
ship between parental efficacy and child BMI. Data were
analyzed using the software package Statistical Package for
Table 4 TOPSE: Discipline r/t Other Parent.
Social Sciences, Version 18, (SPSS, INC, 2010).
Parent Child
Setting limits and boundaries isMy father or other caregiver
easy for my child's other easily sets limits and
Table 2 TOPSE: Discipline. parent. boundaries for me to follow.
My child's other parent is able My father or other caregiver
Parent Child to stick to the rules set for our
sticks to the rules he/she sets
Setting limits and My mother easily sets limits and child. for me.
boundaries is easy for me.boundaries for me to follow. My child's other parent is able My father or other caregiver
I am able to stick to the rules
My mother sticks to the rules she to reason with our child. lets me know what is expected
I set for my child. sets for me. of me.
I am able to reason with my My mother lets me know what is My child's other parent can My father or other caregiver is
child. expected of me. find ways to avoid conflict. able to avoid fighting with me
I can find ways to avoid My mother is able to avoid when there is a disagreement.
conflict. fighting with me when there is My child's other parent is My father or other caregiver
disagreement. consistent in the way he/she disciplines me the same way
I am consistent in the way I My mother disciplines me the uses discipline. he/she disciplines others in the
use discipline. same way she disciplines others in house.
the house. My child's other parent is able My father or other caregiver
I am able to discipline my My mother does not feel bad when to discipline our child does not feel bad when he/she
child without feeling she enforces the rules (because she without feeling guilty. enforces the rules (because he/
guilty. is thinking the best for me). she is thinking the best for me).
426 D. Marvicsin, C.A. Danford

families reported annual household incomes greater than Table 5 Aim 1: Explore Parent and Child Perceptions of
$50,000 per year. The mean body mass index (BMI) for Parenting Efficacy.
adult participants was 30 with 76% classified as overweight Efficacy:
or obese. Control Discipline
Participating
The child mean age was 10 years 5 months (range = 6 Parent (n = 26) Parent Child Parent Child
14 years). Fifty-six percent of the children were female. The
Low efficacy 0% 0% 0% 0%
racial/ethnic distribution was 59% white, 41% non-white. Average efficacy 52% 74% 41% 37%
The mean BMI for child participants was 20 with 15% clas- High efficacy 48% 26% 59% 63%
sified as overweight (BMI between 85th and 95th percentile)
and 26% classified as obese (BMI N 95th percentile). Grade
level in school ranged from first grade to eight grade, with a
mean of fifth grade. A paired sample t test was used to test the difference
between parent and child perception of control, revealing a
significant difference in perception, t = 3.12, df = 26,
Scale Statistics p b 0.05. More children rated their parent as having average
control. The paired sample t test did not find any significant
The items on all versions of the TOPSE were scored from difference between parent and child perception of discipline.
0 (completely disagree) to 5 (completely agree). Two items
required reverse scoring. Total scores were obtained on each Other Parent
subscale. The possible range of the total score was 030. Four percent of children rated the efficacy of the non-
Initially, inter-item correlation analysis was weak on the participating parent as low on control. Fifty-four percent
control scale for the same self-efficacy item for parent of the participating parents rated the other parent as aver-
report of self and other parent, and child report of partici- age on control and 46% as high on control. In com-
pating parent and other parent. The reverse scored item, parison, 61% of the children rated the other parent as
I can't stop my child behaving badly. was deleted and average on control and 35% as high. Parental report of
results were re-analyzed based on the remaining 11 items; the other parents' discipline was rated 41% as average and
5 items on the control scale and 6 items on the discipline 59% as high. However, only 26% of the children rated the
scale. Inter-item correlation improved and instrument reli- other parent as average on discipline, and 74% rated the
ability was strengthened. other parent as high on discipline. It is important to note
Resulting reliability scores for parent report of control for that most other parents were the father figures in the
self and other parent were 0.84 and 0.90 respectively. household (Table 6).
Reliability scores for parent report of discipline for self and A paired sample t test was also used to test the difference
other parent were 0.85 and 0.76 respectively. Child reli- between parent and child perception of the other parent's
ability scores on the control scale for parent and other parent control. No significant difference was revealed. However,
control were 0.55 and 0.71 respectively. Child reliability the paired sample t test did reveal a significant difference
scores on the discipline scale for parent and other parent were between parent and child perception of the other parent's
0.64 and 0.63 respectively. discipline, t = 2.57, df = 20, p b 0.05. On average, more
children rated their other parent as having high discipline.
Parent and Child Perception of Parenting Efficacy
Parenting Efficacy and Child BMI
Participating Parent
The five items on the control scale resulted in total scores Correlations between child BMI and parenting efficacy
ranging from 0 to 25. The six items on the discipline scale with the participating parent and non-participating parent
resulted in total scores ranging from 0 to 30. Efficacy was were reported by the participating parent and child. All were
defined as low for total scores falling in the lower one-third negatively correlated. The only significant correlation was
of the scale; average for scores ranging in the middle third, between the child's report of the participating parents control
and high for scores in the upper third. There were no total
scores in the lower third, for either parent report of self
Table 6 Aim 1: Explore Parent and Child Perceptions of
or child report of participating parent. Fifty-two percent of Parenting Efficacy.
the parents reported average control and 48% reported
high control. In comparison, 74% of the children reported Efficacy Control Discipline
average control for the participating parent and 26% Other Parent (n = 23) Parent Child Parent Child
reported that their participating parent had high control. Low efficacy 0% 4% 0% 0%
Parent self-report and child report of discipline were more Average efficacy 54% 61% 41% 26%
aligned, with average scores of 41 and 37% respectively High efficacy 46% 35% 59% 74%
and high scores of 59 and 63% (Table 5).
Parenting Efficacy and Obesity 427

and child BMI r(27) = 0.49, p = 0.01. No significant participating parent may have been rated more cautiously or
correlations were found between parent self-report of con- sympathetically than the non-participating parent.
trol or discipline, and child BMI. Likewise, no significant Historically, the measurement of parenting efficacy has
correlations were found for control or discipline, when the its roots in the behavioral science literature (Coleman &
parent rated the non-participating parent, and child BMI. A Karraker, 2000). Parents of children with behavioral concerns
moderate but non-significant relationship was seen for child were more likely to report a wider range of confidence in their
report of both participating parent discipline [r(27) = 0.26, parenting skills than parents with children without behavioral
ns] and non-participating parent's discipline [r(23) = 0.31, problems. It is possible that these tools are less helpful when
ns] and child BMI. Overall the control and discipline of the completed by parents in the community who are not
non-participating parent as reported by the participating specifically seeking assistance for behavioral concerns with
parent and child were moderately correlated with child their children. Parents of children with no behavioral concerns
BMI, yet non-significant [parent reported control r(24) = may tend to report consistently higher confidence in their
0.29; parent reported discipline r(22) = 0.24; child parenting skills and a narrow range of scores. Similar to the
reported control r(23) = 0.29; and child reported disci- findings in this study, one other study of pediatric obesity also
pline r(23) = 0.31]. noted that parents rated themselves as very confident in their
parenting skills (Shelton et al., 2007).
The second aim of this study was to determine the
relationship between parenting efficacy and child BMI. The
Discussion connection between parental control and discipline as it
relates to healthy eating and activity patterns seems logical.
This is one of the few studies to compare child and parent If a parent is able to set limits and boundaries easily with
perceptions of parenting efficacy. Since there is little known their child then it seems they could also structure the eating
research that addresses parenting efficacy as it relates to and activity environment in the home. However, no signi-
eating and activity behaviors of children, the results of this ficant relationship was found between parental report of
study provide unique insight into the phenomena of child- parenting efficacy and child BMI.
hood obesity and parenting. Additionally, inclusion of the In this study, parents rated themselves high on the
child's perception of parenting efficacy provides further control and discipline efficacy scales. This revealed a
perspective on parenting as it may relate to obesity. Infor- ceiling effect in the data that contributed to the lack of a
mation on the participating parent or caregiver and the other significant relationship found between parenting efficacy
parent or caregiver in the home adds a broader family and child BMI. The cluster of scores at the higher end of
perspective in that behavior patterns of family members the parenting efficacy scale made data analysis difficult due
contribute to the health and well-being of the total family unit to the lack of variation in the data (Vogt, 2005). The lack of
(McDaniel, Campbell, Hepworth, & Lorenz, 2005). variation could be explained by social desirability in that
The first aim of this study was to compare parent and parents were providing responses that they think were
child perception of parenting efficacy, specifically control expected or that they believe are true. Plus, it can be very
and discipline. The scores for control and discipline sub- difficult for a parent to admit that they are not adequately
scales were average to high for both parents and children. parenting their child (Stenhammar et al., 2007). Another
Children's scores on the control scale were midrange. possible explanation regarding lack of significant correla-
Parents reported higher confidence in their parenting effi- tion between self-report of parenting efficacy and child
cacy, perceiving themselves as effective parents more often BMI may be attributed to the small sample size of this
than their children. This resulted in a significant difference in study. However, although non-significant, the results did
perception between child and parent. The difference in reveal a moderate negative correlation in the relationship
perception may be explained by the child's more realistic between parenting efficacy and BMI. This suggests that
view of parenting skills. Conversely, the parent's confidence high parenting efficacy may contribute to lower child BMI.
in their skills may be unrealistically inflated. These results should be interpreted with caution but not
In terms of discipline, both parent and child reported higher negated. In fact, two long term follow up studies of ran-
efficacy. This may reflect the concrete terminology of the domized trials discovered that relative to control, youth at
individual discipline items, such as rules. As stated earlier, risk for behavior problems who received a family inter-
the majority of the participating parents were mothers. vention based on improving parenting skills at age 4 had
Therefore, the other parent at home was usually the father. lower BMIs as they approached adolescence (Brotman
Children tended to rate the other parent as high on the disci- et al., 2012). Additionally, an association between general
pline scale, which may reflect traditional societal stereotypes parenting at an early age and its influence on weight
that children may already be incorporating into their outcomes and health-related behaviors later in life has been
perceptions of family and gender roles. Another explanation revealed (Sleddens, Gerards, Thijs, DeVries & Kremers,
might lie in the possibility that children may find it difficult to 2011; Berge, Wall, Loth, Neumark, & Sztainer, 2010;
be honest if their parent is present (Scott, 2008). Thus the Lohaus, Vierhaus, & Ball, 2009).
428 D. Marvicsin, C.A. Danford

The possibility that parenting efficacy impacts child BMI This study not only addresses parenting self-efficacy,
is further supported when child report of parenting was but uniquely brings in a family perspective by presenting
evaluated. Child report of the participating parent's control information on efficacy related to the other parent in the
related to child BMI was significant and negatively cor- family and most importantly the child's perspective. It
related. This suggests that children who rated the partici- reminds health care providers that data need to be gathered
pating parent lower on the control scale (average efficacy from more than one family member to determine variations
versus high efficacy) had higher BMI's. Previous studies in perspective that influence health outcome. This em-
have found that specific parental behaviors reflecting control, phasizes the need to consider a family approach to deve-
such as parental monitoring and parental use of appropriate loping interventions for research and practice related to
reinforcement, have been associated with preschool chil- childhood obesity.
dren's physical activity, sedentary behavior and dietary Tailoring a family-based intervention is needed to in-
patterns (Arredondo et al., 2006; Spurrier et al., 2008). In fluence the relationship between parenting and obesity in
addition as previously stated, children may have a more children. This is a critical need in the obesity research due to
realistic view of parenting skills. Therefore, child perspec- the interdependent relationship between children and parents
tives should be considered and included when developing for establishing healthy behaviors. The known risk of
parenting interventions. However, due to lower reliability associated health problems related to obesity, such as
scores on the child version of the instrument and small diabetes and cardiovascular issues, beginning in childhood
sample size, this information needs to be interpreted judi- and persisting into adulthood further emphasizes parenting
ciously and requires further study. efficacy and parenting skills as important in the consider-
ation of intervention approaches for clinical practice. Over-
Limitations all, the youth of today may have a shorter life expectancy
than their parents unless effective interventions are devel-
One limitation of this study was convenience sampling, oped to reduce obesity. Revisiting and enhancing the
which contributed to the higher educated, higher income contributions parents make to improve their child's health
level of the sample and was not reflective of the community may be lead to more effective and sustaining outcomes
at large. This non-random selection procedure may influence related to healthy weight in children.
the findings through self-selection bias. Also, the small
sample size contributed to the low power of the study. In
addition, self-report measures are a limitation. If an inter- Acknowledgments
vention is being developed that relies on parents reporting
confidence in their parenting skill, a ceiling effect in their This pilot study was funded by AETNA Foundation. Co-
scores may be noted. Therefore the intervention may not principal investigators, Cynthia Danford (University of
demonstrate an impact or change in behavior. Although the Pittsburgh) and Feleta Wilson (Wayne State University).
child reports were statistically less reliable, the children's Thelma Phillips, doctoral candidate (Wayne State Univer-
lower overall scores did allow for a relationship between sity), and Celeste Schutz, doctoral student (University of
parenting skill, as defined by control, and high child BMI to Michigan) are acknowledged for their help with this study.
be expressed.

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