Abstract

This study developed and administered a questionnaire to identify feeding practices among low-income AfricanAmerican mothers and eating behaviors in their preschool children that are associated with childhood obesity. The

findings do not appear to implicate feeding practices to childhood obesity in this sample of preschoolers. However,

before concluding that feeding practices are not associated with childhood weight status, further research is needed

to ensure that the constructs used accurately assess feeding practices in specific populations.. Further research is also

needed using a larger sample of overweight children to compare the findings with those among children of normal

weight.

Parenting Practices and Obesity

in Low-Income African-American

Preschoolers

Contractor and Cooperator Report No. 3

January 2005

By Scott W. Powers, Cincinnati Children’s Hospital Medical Center,

University of Cincinnati College of Medicine

This study was conducted by the Cincinnati Children’s Hospital Medical

Center under a cooperative research contract with USDA’s Economic

Research Service (ERS) Food and Nutrition Assistance Research Program

(FANRP): contract number 43-3AEM-0-80078 (ERS project representative:

Elizabeth Frazão). The views expressed are those of the authors and not

necessarily those of ERS or USDA.
 

CONTENTS

Overview.........................................................................................................................................1 

Objective of the Study ...................................................................................................................2 

Methods...........................................................................................................................................2 

Semi Structured Qualitative Interviews......................................................................................2 

 Cognitive Interviews...................................................................................................................3 

Development of PFQ ..................................................................................................................4 

Administration of PFQ ...............................................................................................................6 

Results.............................................................................................................................................6 

 Sample Characteristics................................................................................................................6 

 Descriptive Statistics ..................................................................................................................7 

WHP Correlations for the 7 Constructs......................................................................................8 

Future Research.............................................................................................................................9 

 Factor Analysis...........................................................................................................................9 

Comparison to Prior Studies.....................................................................................................12 

Comparisons Based on WHP Using Variables From PFQ2 Listed in Table 3 ........................12 

Conclusion ....................................................................................................................................14 

References.....................................................................................................................................17

ii
 

Parenting Practices and Obesity in Low-Income 

African American Preschoolers 

Principal Investigator: 

Scott W. Powers, Ph.D., ABPP 

Associate Professor of Pediatrics 

Cincinnati Children’s Hospital Medical Center

University of Cincinnati College of Medicine 

OVERVIEW: Although there is a strong genetic contribution to obesity (1), alterations in our 

genes cannot explain the recent obesity epidemic in children. There is clearly a strong 

environmental or "nurture" component to obesity that could be targeted in obesity prevention 

efforts in young children. Feeding practices are established before school age (2-4) and in the 

preschool years, parents largely determine a child’s diet. Because a major nurturing role for 

parents is to provide food for their children, feeding and the shaping of eating behaviors in 

children cannot easily be separated from the overall task of parenting. Parents determine the 

social context for eating and may control the interaction by supplying emotional cues like verbal 

and non-verbal encouragement and discouragement to eat. 

Based on work with Caucasian children in middle and upper-middle class families, it has been 

suggested that a child's obesity risk may be increased when parents exert a high degree of control 

over the feeding interaction (5, 6). This “control” has been conceptualized in two forms − both 

“pushing” children to eat and “restricting” children from eating. When feeding young children, 

for example, mothers that have a more controlling parenting style deliver a greater number of 

cues or prompts for their children to eat (7). However, these prompts could either be a cause or 

an effect of the child's eating behavior or weight (7-9). Additional studies have focused on the 

impact of parent practices used to shape the food intake of Caucasian children ages 4-11 years 

(10-12). They have shown that using food as a reward (13) or restricting access to food (14) may 

lead to overeating. For example, restricting children’s access to palatable snack foods may 

increase consumption when restriction is removed. They have also shown that the relative 

weight of children is greater when parents report more restriction of children’s access to these 

snack foods (15). Despite these provocative findings, it is not clear whether restriction of 

children’s intake of certain foods leads to over consumption or if parents restrict foods in 

overweight children. There has been only one attempt to replicate any of these findings in 

African American families. Children in that study were ages 7-14 years (16). 

In the United States, African American families are at increased risk of obesity and its 

complications, relative to Caucasian families (17-19). Although infant feeding practices in lowincome African American mothers have been described (20-22), we are unaware of any research 

about how low-income African Americans feed their preschoolers or perceive the eating 

behaviors of their young children. This project sought to better understand maternal attitudes 

and practices around feeding of their preschool children (age 2 years 0 months to 5 years 11 

months) and examines the relation of these factors to child weight among African Americans. 

1
 

The long-term goal is to inform the development of obesity prevention interventions for this atrisk population. 

OBJECTIVE OF THE STUDY: The purpose of this study was to develop and administer a 

preschool feeding questionnaire (PFQ2) to identify feeding behaviors in low-income AfricanAmerican mothers and eating behaviors in their preschool children that are associated with the 

development of childhood obesity. 

In an earlier project (23) we developed and analyzed a Preschool Feeding Questionnaire (PFQ1) 

to explore possible factors that may lead to childhood obesity in children between the ages of 2 

to 5 years old. The PFQ1, designed as a self-administered questionnaire, was administered to 

634 mothers to assess maternal feeding practices and beliefs. The questionnaire, containing 29 

items, was factor analyzed and mean factors scores were calculated and linked to the children’s 

measured and mother’s self reported weight and height. Though we hypothesized that factors on 

PFQ1 would be related to obesity, results from this study did not suggest that there was a 

particular “feeding style” that was associated with overweight in young children. However, 

there were differences found in feeding behaviors between high and low income groups. 

 

METHODS: Through the use of qualitative research methods with low-income African 

American mothers with preschool children enrolled in the Special Supplemental Nutrition 

Program for Women, Infants, and Children (WIC) in Hamilton County, Ohio, and Chicago, 

Illinois, we set forth to determine which PFQ1 items to retain for PFQ2 and how to rephrase 

these items so that the intent of the question was clear to the mothers. Mothers recruited for the 

each type of qualitative interview described below were limited to biological mothers. Foster 

mothers and other nonbiological mother caregivers were excluded in an effort to obtain a 

consistent source of information on the child. We also conducted a current literature search and

examined scales (including parent feeding, parent concerns for child weight, and child eating) 

from other questionnaires that showed relations to child weight in Caucasian, higher income

samples (10-12). The following provides a chronological summary of the methodology used to 

develop PFQ2: 

Semi Structured Qualitative Interviews: 

1. Thirty semi-structured qualitative interviews to identify differences in parenting practices 

between two groups of African American mothers were conducted. Fifteen were 

caregivers of normal weight (weight-for-height 25th to 75th percentile) children 48 to 60 

months of age and 15 had overweight children (weight-for-height ≥ 95th percentile). All 

the study subjects were low-income African American families living in Chicago. The 

subjects were recruited from The Friend Family Health Center (FFHC) in Chicago. The 

FFHC is a Federally Qualified Health Center affiliated with the University of Chicago 

Hospital and Medical Center. Approximately 14,000 children are served by this clinic 

with about 40,000 visits annually. Over 80% of the patients are low-income and African 

American. Interviews were designed to gain understanding about the complex social, 

cultural, and psychological aspects of feeding through examining topics such as daily 

family routines; mealtime practices; child’s appetite, hunger cues, activity level, and 

television viewing; as well as disciplining, rewards, and mother’s perception of her 

child’s weight status. These interviews were audiotaped and transcribed. 

2
 

2. Seven additional audiotaped interviews with African American mothers of 24-59 month 

old children in Chicago enrolled in WIC were conducted. The weight status of the child 

was not considered when determining eligibility for the interviews. Using original PFQ1 

items, followed by probing questions, the interviews were designed to assess the mother’s 

interpretations of PFQ1 items. These interviews were audiotaped and transcribed. We

found the mothers consistently misunderstood PFQ1 items, interpreting items to mean 

something other than what was intended. In particular, the constructs “difficulty in child 

feeding”, “pushing the child to eat more”, and “using food to calm the child” were 

present among mothers but not captured by items on the questionnaire (24). 

3. In addition to the semi structured interviews conducted in Chicago, we recruited 6 

additional mothers in Cincinnati for semi-structured interviews that primarily focused on 

why mothers feed their children as they do and on the role feeding plays in the broader 

job of parenting. All mothers were African American and had a child enrolled in WIC 

between the ages of 48-60 months of age. Three of these mothers had normal weight 

(weight-for-height 25th to 75th percentile) children and 3 had overweight children 

(weight-for-height ≥ 95th percentile). These interviews were audiotaped and transcribed. 

Consistent with the findings of the interviews conducted in Chicago, we found that while 

many of the mothers were able to provide answers to the PFQ1 question items, they did 

not clearly understand the meaning and intent of the items when follow up probes were 

utilized. 

Cognitive Interviews: Six cognitive interviews were conducted at Cincinnati Children’s Hospital 

Medical Center. Families that did not participate in the semi structured interviews discussed 

above were recruited. All mothers were African American and had a child enrolled in WIC 

between the ages of 48-60 months of age. Three of these mothers had normal weight (weight-forheight 25th to 75th percentile) children and 3 had overweight children (weight-for-height ≥ 95th

percentile). The cognitive interview is a method that was instituted in the early 1980’s to 

develop and test survey questions, and it has greatly improved the validity and reliability of

survey questionnaires (25, 26). Cognitive interviewing applies the theories and methods of 

cognitive psychology to questionnaire design. Respondents must comprehend the question, 

retrieve relevant information from memory, use the information retrieved, exercise problem

solving and judgment, arrive at an answer, and, finally, decide whether to “adjust” the answer 

(e.g., for self-presentation purposes) before providing an answer. Response error can be due to 

problems at any of these cognitive stages. The cognitive interviews tested items developed by 

our research team for a structured feeding construct, as well as the items which had been used in 

earlier feeding studies (11, 12, 27) since earlier qualitative interviews revealed the limitations of 

many of the PFQ1 items. A trained cognitive interviewer administered each question to the 

respondent and asked a series of probes to determine the cognitive processes used in arriving at 

the answer. Mothers were also asked to describe the meaning of the various response choices 

(answers) that were presented with the question items. This method was used to uncover 

problems with items that are often not identified by pretests and other traditional questionnaire 

design procedures. For example, ‘Does your child have a poor appetite?’ was followed by the 

following probes: 

 What were you thinking about when you answered the question I just asked you?

 Were you thinking about a specific event or experience?

 Were you thinking about the most recent time that this happened?

3
 

 What age was your child when this happened?

 Is it better if I change the question wording to________?

 Do you have any suggestions about changing the question wording?

 Is the question easy for you to answer?

 Do you think that you would give me the same answer to the question in a few days? A 

week from now? 

Mothers felt poor appetite mean that a child was sick or had an acute illness. Poor appetite was 

not a term used by mothers to reflect the child’s eating style. We learned these mothers did not 

feel ‘poor appetite’ was normal for any child, regardless of the amount of food they consumed. 

Mothers used the term ‘picky eater’ to describe what a child ate or how it was prepared. To 

these mothers ‘picky eater’ did not indicate the amount of food a child ate, nor was it considered 

a negative trait. Findings such as these supported the elimination of all the original PFQ1 items

since these items did not appear to be relevant among this population. Mothers were also asked 

the series of questions relating child’s emotional state to feeding (e. g. “My child eats less when 

he is upset/tired/happy”). Mothers were generally found to be unable to describe specific 

emotional states in their children. 

 

Development of PFQ2: At the completion of the qualitative methods described above, findings 

from each method were used to inform the development of PFQ2. In addition, members of the 

research team reviewed the published work of three validated feeding instruments; the Children’s 

Eating Behavior Questionnaire (27), the Parental Feeding Style Questionnaire (11), and the Child 

Feeding Questionnaire (12). Based on findings from the various interview methods used, the 

research team concluded using existing items from PFQ1 with low-income African American 

mothers would likely measure constructs that do not clearly exist among this population. 

Therefore, we eliminated the constructs from PFQ1. Scales from questionnaires validated in 

other populations that had shown differences between normal weight and overweight children 

were retained for PFQ2 (11, 12, 27). In addition, a construct developed through cognitive 

interviewing in our qualitative research was retained. The final version of PFQ2, therefore, 

contained 39 closed-ended items that yield scores for seven constructs (Table 1). Additional 

items were included on PFQ2 to gather demographic information, child’s height and weight and 

self reported maternal height and weight. 

4
 

TABLE 1. CONSTRUCTS

CONSTRUCT NAME ITEMS

Parental Control 

(Wardle, 11) 

1. I allow my child to choose which foods to have for meals*

2. I decide how many snacks my child should have 

3. I allow my child to wander around during a meal* 

4. I decide when it is time for my child to have a snack 

5. I allow my child to decide when s/he has had enough snacks to eat* 

6. I decide the times when my child eats his/her meals 

7. I let my child decide when s/he would like to have his/her meal* 

8. I let my child eat between meals whenever s/he wants*

9. I insist my child eats meals at the table 

10. I decide what my child eats between meals 

Child’s Food

Responsiveness 

(Wardle, 27)

1. My child always asks for food 

2. If given the chance, my child would always have food in his/her mouth 

3. Given the choice, my child would eat most of the time

4. If allowed to, my child would eat too much 

5. Even if my child is full, s/he finds room to eat his/her food

Child’s Desire to

Drink (Wardle, 27) 

1. If given the chance, my child would always be having a drink 

2. If given the chance, my child would drink continuously throughout the 

day

Maternal 

Restriction 

(Birch, 12) 

1. I have to be sure that my child does not eat too many sweets (candy, ice 

cream, cake, pastries) 

2. I have to be sure that my child does not eat too many high fat foods 

3. I have to be sure that my child does not eat too much of her favorite

foods 

4. I intentionally keep some foods out of my child’s reach

5. I offer sweets (candy, ice cream, cake, pastries) to my child as a reward 

for good behavior* 

6. I offer my child her favorite foods in exchange for good behavior* 

7. If I did not guide or regulate my child’s eating, she would eat too many

junk foods 

8. If I did not guide or regulate my child’s eating, she would eat too much

of her favorite foods 

Maternal Pressure 

to Eat (Birch, 12) 

1. My child should always eat all of the food on her plate 

2. I have to be especially careful to make sure my child eats enough

3. If my child says “I’m not hungry”, I try to get her to eat anyway 

4. If I did not guide or regulate my child’s eating, she would eat much less

than she should

Maternal Concern 

for Child’s Weight 

(Birch, 12) 

1. How concerned are you about your child eating too much when you are

not around him/her?

2. How concerned are you about your child having to diet to maintain a 

desirable weight? 

3. How concerned are you about your child becoming overweight?

5
 

TABLE 1. (CONTINUED) 

CONSTRUCT NAME ITEMS

Structured Feeding 

(CCHMC) 

1. How often do you and your child sit down and eat together?

2. Over the past month, how often does your child eat outside your home at

some kind of restaurant (including a fast food restaurant)?* 

3. How often does your child eat in a bedroom?* 

4. How often do you sit down with your child while he/she is eating (even 

if you are not eating)? 

5. How often does your child pick out what you will prepare for him/her at 

mealtime?*

6. How often does your child eat and watch TV at the same time?* 

7. How often does your child get something to eat or drink him/herself 

without asking permission?*

* denotes items which were reverse coded for analysis

Administration of PFQ2: Between April 2003 and October 2003, the revised Preschool Feeding 

Questionnaire (PFQ2) was administered to 300 low-income mothers of African American 

children 24 to 59 months of age enrolled in the Hamilton County, Ohio Special Supplemental 

Nutrition Program for Women, Infants, and Children (WIC). For purposes of this study, the term 

‘mother’ referred to the primary caregiver of the child and included biological mothers, 

grandmothers, and legal guardians. Mothers had to be English speaking and at least 18 years of 

age. Participants were excluded if their child had a chronic medical condition affecting feeding 

and/or appetite. 

A member of the research team recruited mothers when they brought their child for a visit at one 

of seven WIC clinics in Hamilton County, Ohio. Selection of the seven WIC clinics was based 

on having a caseload of at least 500 African American children between the ages of 24-60 

months and at least 60% of the clinic population being African American. WIC is a federally 

funded program that provides supplemental food and nutrition counseling to low-income women 

and their children (up to 5 years of age). To be income-eligible for WIC, family income must be 

at or below 185% of the federal poverty level. At the time of the survey, 185% of the poverty 

level was $34,040 per year for a family of four. Written consent was procured from all the 

mothers prior to completing the self-administered questionnaire. Each mother who completed 

the questionnaire received $5 compensation. The Institutional Review Boards at Cincinnati 

Children’s Hospital Medical Center (CCHMC) and Ohio Department of Health (ODH) approved 

the study. 

RESULTS:

Sample Characteristics: Of the 300 surveys administered, one did not meet inclusion criteria 

and was excluded from analysis. Table 2 summarizes the sample characteristics. Mothers 

ranged from 18 to 62 years of age (M= 27.9, SD = 7.64) and their children ranged in age from 24 

to 59 months old (M = 41.4, SD = 9.9) at the time the mothers completed PFQ2. Mother’s BMI 

ranged from 16.3 to 55.9 (M = 30.1, SD = 7.04) based on self-reported data. 

6
 

Weight for height percentiles for each child were calculated using the NutStat program within 

Epi InfoTM Version 3.01 Software based on both the 1978 & 2000 CDC growth references. Based 

on 1978 CDC growth data, 13% (38 children) had WHP > 95th for sex based on their most 

current WIC measurements. Using the 2000 CDC growth data, 9% (28 children) had WHP >

95th for sex based on their most current WIC measurements. All of the children were African 

American. Of the 307 eligible mothers approached, only 7 (2%) declined to participate in the 

project. 

Table 2. SAMPLE CHARACTERISTICS

% SUBJECTS

CHARACTERISTIC (N = 299)

MOTHERS

Low education level (high school diploma/GED or less) 68 

Currently enrolled in school 26

Currently employed 43 

Currently pregnant 15 

Current smoker 23 

Obese (body mass index > 30 kg/m2

) 43

CHILDREN

Attends childcare/daycare 52

 Average hours per week (M =29.5, SD= 16.9) 

Weight for Height Percentile (WHP) for Age 

1978* (N=298) 2000**(N=297)

WHP ≤ 5th %ile 12 (4%) 16 (5%)

WHP 6-84 %ile 218 (73%) 207 (70%) 

WHP 85-94th %ile 30 (2%) 46 (15%) 

WHP > 95th %ile 38 (13%) 28 (9%)

Normal weight 218 207 

Overweight/At risk 68 (23%) 74 (25%) 

* based on 1978 CDC growth data 

** based on 2000 CDC growth data 

Descriptive Statistics: Means and standard deviations for the complete sample (N=299) were 

calculated for each subscale of the PFQ2 (Table 3). Mean scores were derived by calculating the 

totals for each construct and dividing by the number of items in each construct. Additionally, 

reliability analyses were run and coefficient alphas were configured for each subscale. 

Coefficient alpha represents internal consistency reliability, which is the extent that items are 

highly intercorrelated suggesting that they measure the same thing (28). A coefficient alpha 

equal to or greater than .70 is generally considered acceptable and thus represents reliable 

factors. Therefore, it appears that some of the factors may not be as reliable for measuring what 

is intended (feeding behaviors) within this specific sample. 

7
 

TABLE 3. DESCRIPTIVE STATISTICS (N=299) 

Variables Mean SD Range Alpha

Parental Control 3.99 .489 1-5 .67 

Child’s Food Responsiveness 1.50 .81 0-4 .74 

Child’s Desire to Drink 2.62 1.08 0-4 .77 

Maternal Restriction 3.77 .82 1-5 .64 

Maternal Pressure to Eat 3.58 .89 1-5 .54 

Maternal Concern for Child’s Weight 2.44 1.37 1-5 .81 

Structured Feeding 2.86 .44 0-4 .47 

WHP Correlations for the 7 Constructs: Pearson correlation coefficients were calculated 

between each of the average construct scores and child’s weight for height percentile (WHP) and 

are described below in Table 4. 

TABLE 4. CORRELATIONS BY CONSTRUCT AND WHP

Construct 

Name WHP Parental

Control 

Child’s 

Food 

Responsiveness

Child’s 

Desire 

to Drink 

Maternal

Restriction

Maternal

Pressure 

to Eat 

Maternal

Concern

for Child’s 

Weight 

Parental

Control .102 -.049 -.167** .222** .056 .096

Child’s Food 

Responsiveness -.006 .363** .171** .147* .164**

Child’s Desire 

to Drink -.075 .123* .157** -.011

Maternal

Restriction .006 .307** .288**

Maternal

Pressure 

to Eat -.179** .190**

Maternal

Concern

for Child’s 

Weight 

.081

Structured

Feeding 

.077 .555** -.201** -.299** -.006 -.018 -.051

 *p<.05 

**p<.001 

Maternal pressure to eat significantly correlated with WHP in this sample (r = -.179, p<.001). 

This finding indicates that lower WHP is associated with higher scores on the maternal pressure 

to eat construct and suggests that parents of children with lower WHP report using more pressure 

to get their children to eat. This is consistent with the results of Birch et al., who, in a sample of 

394 parents of females aged 5-9 years, found a significant negative correlation between child 

8
 

weight status and maternal pressure to eat (12). Spruijt-Metz and colleagues revealed a 

significant negative correlation between total fat mass assessed by dual-energy X-ray 

absorptiometry (DEXA) and maternal pressure to eat after controlling for maternal concern for 

child’s weight (16). 

Additionally, in previous work, Birch and colleagues have found marginally significant 

correlations with child weight status and maternal restriction (r=.13, p=.06), with parents of 

heavier children reporting use of more restriction in their feeding practices. Restricting children’s 

access to “junk” food and snacks increased their intake of these foods when parental monitoring 

was removed (12, 29, 30, 31). The prevailing theory is that maternal food restriction may be a 

causal factor in childhood obesity because children become unable to develop appropriate 

internal cues for food intake regulation based on the imposition of external cues in their 

environment (i.e. maternal restriction). Similarly, in a sample of 120 mothers of both Caucasian 

(N=74) and African American (N=46) youth ranging in age from 7-14 years, maternal food 

restriction (r=.26, p<.001) and maternal concern for child weight (r=.53, p<.001) correlated 

significantly and positively with total fat mass (16). Our data obtained from a sample of 299 

African American caregivers of preschoolers age 2-5 years did not reveal a significant 

correlation between child weight status and maternal restriction nor a correlation between child 

weight status and maternal concern for child weight. 

FUTURE RESEARCH: 

Factor Analysis: Preliminary findings from a planned factor analysis with a varimax rotation 

resulted in an eight factor solution for 22 items retained with eigenvalues greater than 1. A 

planned factor analysis was chosen in an attempt to confirm previously specified factors or 

constructs identified in the literature within a sample of low income African American caregivers 

of preschool children. A varimax rotation was chosen because it is the most common orthogonal 

rotation method and maximizes the variance of the squared loadings (28). Items were retained if 

they loaded at or above .40 on a single factor and the difference was greater than .20 between 

that factor loading and any other loading on another factor. Two factors had 4 items, two factors 

had 3 items, and 4 factors had 2 items. Table 5 provides a summary of the factors with 

corresponding items. The final factor structure accounted for 66.5% of the variance in item

responses. Some of the factors were renamed to reflect the items retained within each construct. 

Child’s food responsiveness (Factor 1), maternal concern for child’s weight (Factor 2), maternal 

restriction (Factor 4), and child involvement in food preparation (Factor 5) all had coefficient 

alpha’s above .70 ranging from .74-.81. Maternal control (Factor 3), eating environment (Factor 

6), maternal presence during meal (Factor 7), and maternal pressure to eat (Factor 8) all had 

coefficient alpha’s above .50 but below .70. Seventeen PFQ2 items were eliminated as they 

failed to load onto a factor (Table 6). 

9
 

TABLE 5. ITEMS RETAINED BASED ON FACTOR ANALYSIS (N=22)

FACTOR

NEW 

CONSTRUCT

ITEMS ORIGINAL CONSTRUCT

1. If allowed to, my child would eat too much 

2. Even if my child is full, s/he finds room to eat his/her 

food 

3. Given the choice, my child would eat most of the time 1 Child Food

Responsiveness

4. If given the chance, my child would always have food

in his/her mouth 

Child’s Food

Responsiveness

(Wardle, 27)

1. How concerned are you about your child eating too

much when you are not around him/her?

2. How concerned are you about your child having to diet

to maintain a desirable weight? 2 

Maternal 

Concern for 

Child’s Weight 3. How concerned are you about your child becoming 

overweight? 

Maternal Concern for 

Child’s Weight

(Birch, 12) 

1. I decide how many snacks my child should have

2. I decide when it is time for my child to have a snack 

3. I decide the times when my child eats his/her meals 3 Maternal 

Control 

4. I decide what my child eats between meals 

Parental Control

(Wardle, 11)

1. If I did not guide or regulate my child’s eating, s/he 

would eat too many junk foods 4 Maternal 

Restriction 2. If I did not guide or regulate my child’s eating, s/he 

would eat too much of his/her favorite foods 

Maternal Restriction

(Birch, 12) 

1. I allow my child to choose which foods to have for 

meals 

Parental Control

(Wardle, 11) 5 

Child 

Involvement in 

Food 

Preparation 

2. How often does your child pick out what you will prepare for 

him/her at mealtime?

Structured Feeding 

(CCHMC) 

1. How often does your child eat in a bedroom? Structured Feeding 

(CCHMC) 6 Eating

Environment 2. I allow my child to wander around during a meal Parental Control

(Wardle, 11)

1. How often do you and your child sit down and eat 

together? 7 

Maternal 

Presence 

During Meal 2. How often do you sit down with your child while 

he/she is eating (even if you are not eating)?

Structured Feeding 

(CCHMC) 

1. My child should always eat all of the food on his/her

plate 8 Maternal 

Pressure to Eat 2. If my child says “I’m not hungry”, I try to get him/her

to eat anyway 

Maternal Pressure to Eat 

(Birch, 12) 

10
 

TABLE 6. ITEMS ELIMINATED BASED ON FACTOR ANALYSIS (N=17)

CONSTRUCT NAME ITEMS

5. I allow my child to decide when s/he has had enough snacks to eat

6. I let my child decide when s/he would like to have his/her meal

7. I let my child eat between meals whenever s/he wants 

Parental Control 

(Wardle, 11) 

8. I insist my child eats meals at the table 

Child’s Food

Responsiveness 

(Wardle, 27) 

1. My child always asks for food

Child’s Desire to Drink 1. If given the chance, my child would always be having a drink 

(Wardle, 27) 2. If given the chance, my child would drink continuously throughout the day

1. I have to be sure that my child does not eat too many sweets (candy, ice 

cream, cake, pastries) 

2. I have to be sure that my child does not eat too many high fat foods 

3. I have to be sure that my child does not eat too much of her favorite foods

4. I intentionally keep some foods out of my child’s reach

5. I offer sweets (candy, ice cream, cake, pastries) to my child as a reward for 

good behavior

Maternal Restriction 

(Birch, 12) 

6. I offer my child her favorite foods in exchange for good behavior 

Maternal Pressure to Eat 

(Birch, 12) 

1. I have to be especially careful to make sure my child eats enough

2. If I did not guide or regulate my child’s eating, she would eat much less

than she should

Structured Feeding 

(CCHMC) 

1. Over the past month, how often does your child eat outside your home at

some kind of restaurant (including a fast food restaurant)?

2. How often does your child get something to eat or drink him/herself 

without asking permission?

11
 

There is some consistency between the factor structure of the PFQ2 and the constructs of the 

Child Feeding Questionnaire (12), the Parent Feeding Style Questionnaire (11), and the 

Children’s Eating Behaviour Questionnaire (27) when tested in our sample of African American 

caregivers of preschool aged children aged 2-5 years. Four out of 5 items loading on food 

responsiveness (Factor 1) are the same items that make up the construct food responsiveness on 

the CEBQ (27). The construct concern for child’s weight (Factor 2) is consistent with the CFQ 

(11). Two out of four items comprising the construct pressure to eat from the CFQ (12) load 

onto pressure to eat (Factor 8) of the PFQ2. Four out of ten items of the control construct (Factor 

3) are consistent with the control construct of the PFS (11). Two of eight items on the restriction 

construct (Factor 4) are consistent with the restriction construct of the CFQ (11). The construct 

desire to drink from the CEBQ (27) did not result in a stable factor. The items retained from the 

a priori construct named structured feeding loaded onto three different factors (5, 6, and 7) with 

items from Wardle’s control construct. This suggests that items thought to reflect specific 

feeding behaviors previously validated in predominately Caucasian populations by Birch and 

Wardle may reflect different aspects of feeding and the eating environment in this sample of low 

income African American caregivers of preschoolers. When data from our sample was factor 

analyzed, some of the items loaded on the same constructs that both Birch (12) and Wardle (11, 

27) developed. However, among our sample, several of the items were classified into new 

constructs (factors) as described in Table 6. In addition, some items were eliminated because a 

relationship could not be detected between those particular items and the other items. This 

suggests that the eliminated items, which had the greatest response variance, did not represent 

the latent construct very well in this sample. 

Comparison to Prior Studies: Based upon published literature regarding mother-child feeding 

relationships (11, 12, 27) we will be examining how the results from our population compare to 

their work. Table 7 shows some preliminary comparisons. 

TABLE 7. MEAN SCORES FROM PFQ2 COMPARED TO WARDLE (11, 27) AND BIRCH (12) 

Construct PFQ2 

Mean

Wardle 

Mean

Birch 

Mean

Mean 

Difference 

Possible 

Range 

Parental Control 3.99 4.0 -- -.01 1-5 

Child’s Food Responsiveness 1.50 2.35* -- -.85 0-4 

Child’s Desire to Drink 2.62 2.75* -- -.13 0-4 

Maternal Restriction 3.77 -- 4.0 -.23 1-5 

Maternal Pressure to Eat 3.58 -- 2.5 1.08 1-5 

Maternal Concern for Child’s Weight 2.44 -- 2.3 .14 1-5 

Structured Feeding 2.86 -- -- -- 0-4 

* average > 1 sample from prior reports 

Comparisons based on WHP using variables from PFQ2 listed in Table 3: Based on the 2000 

CDC growth data, 28 preschoolers were above the 95th percentile (BMI for age) in our sample. 

Therefore, we have limited power to detect differences between the weight categories described 

in Table 2. A One Way Analysis of Variance (ANOVA) was conducted to evaluate group 

differences on the factor scores. There were no significant differences between groups on any of 

the factor scores. In an attempt to increase our group sample size we aggregated the data of 

subjects with WHP between 85-94th and WHP > 95th percentiles (at risk/overweight) and 

12
 

compared them to the normal weight group (defined as WHP >5th and < 85th percentile). An 

independent samples t-test was conducted to detect difference between the normal weight 

preschoolers and the combined at risk/overweight group. A significant difference was detected 

for concern for child’s weight [t (118) = 2.29, p<.05]. Caregivers of at risk and overweight 

preschoolers reported more concern for child weight status (M=2.75, SD=1.46) than caregivers 

of normal weight preschoolers (M=2.30, SD = 1.31). No additional differences were revealed. 

 

Previous studies published by Wardle and colleagues and Birch and colleagues (11,12, 27) have 

employed the 1978 CDC/WHO growth charts for categorizing and comparing youth weight for 

height percentiles. Thus, to maintain consistency when comparing our findings with prior work, 

we also analyzed the data with the 1978 norms. These norms yielded a larger sample of children 

in the overweight and at-risk categories. A One Way Analysis of Variance (ANOVA) was 

conducted to evaluate group differences on the factor scores. One significant group difference 

was detected [F (3, 291) = 3.44, p<.05] for pressure to eat. Post hoc tests indicate that caregivers 

of underweight (WHP ≤ 5th percentile) preschoolers (M=4.13, SD= .86) report using more 

pressure to facilitate eating behavior than caregivers of overweight (WHP> 95th percentile) 

preschoolers (M= 3.28, SD=.83). An independent samples t-test was conducted to detect 

difference between the normal weight preschoolers and the combined at risk/overweight group. 

A significant difference was detected for concern for child’s weight [t (284) = 2.13, p<.05]. 

Caregivers of at risk and overweight preschoolers reported more concern for child weight status 

(M=2.73, SD=1.46) than caregivers of normal weight preschoolers (M=2.32, SD = 1.33). No 

other significant differences were indicated between caregivers of underweight preschoolers and 

either normal weight or at risk preschoolers. 

CONCLUSION: 

These findings offer additional information regarding the contribution of environmental factors 

in the etiology of childhood obesity. Interestingly, the findings do not appear to implicate feeding 

practices in relation to childhood obesity in this sample of African American preschoolers. 

However, since coefficient alpha's for the questionnaire were below 0.70 for 4 out of 7 factors, 

caution is advised when interpreting these results as it is possible that the constructs used to 

evaluate feeding practices may not be the most optimal for use with African American 

populations. It may be that mothers do not understand the questions and constructs in the way 

intended by the developers of the questionnaire. For instance, recent analysis of 7 interviews 

conducted as part of the development of the PFQ2 revealed that questions were interpreted by 

respondents to mean something other than what was intended (Jain et al., in press). Therefore, it 

is possible that although certain behaviors and feeding practices may be present, they are not 

being adequately captured by the survey questions. Further research needs to be conducted to 

ensure accurate assessment of feeding practices in multicultural populations before concluding 

that there is no association with child weight status. In addition, further research needs to be 

conducted using a larger sample of overweight children to compare the findings against those of 

normal weight. 

13
 

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