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
children (Lobstein & Jackson-Leach, 2007). If current
worldwide trends continue, it is estimated that 60 million
children will be either overweight or obese by the year 2020
(de Onis, Blossner, & Borghi, 2010). Prevalence of obesity, a
multidimensional phenomenon, is influenced by psychosocial
factors such as socioeconomic level and family factors
including parenting. Parental influence on child eating and
activity behavior is a particularly critical issue when
considering the rising prevalence of obesity in children at
younger and younger ages (Birch & Davison, 2001). Young
children are solely dependent on the actions of their parents or
caregivers for providing adequate nutrition and regular activity
opportunities which emphasizes the importance of parenting
interventions to enhance child health and well-being.
Parenting issues related to the treatment of childhood
obesity have been explored in the literature (Faith et al.,
1
Previous presentation: Marvicsin, D., Danford, C., & Schultz, C.
(2012). Parenting Efficacy Related to Childhood Obesity: Comparison of
Parent and Child Perceptions. Podium presentation at the NAPNAP Annual
Conference, San Antonio, Texas. Marvicsin, D., Danford, CA., & Schultz,
CM. (2011, June 2527). Parenting efficacy related to childhood obesity:
Comparison of parent and child perceptions. Paper presented at the 10th
International Family Nursing Conference, Kyoto, Japan.
Corresponding author: Donna Marvicsin, PhD.
E-mail address: djmarvic@umich.edu.
2012; Golan & Crow, 2004). There is a gap in the research
related to the role of parenting efficacy in the prevention of
childhood obesity. Parenting efficacy, specifically the ability
to control, discipline and set boundaries is a key element in
managing healthy eating and activity in the home. Parenting
efficacy becomes more complex when considering parent
self-perception, perception of the other parent as well as the
child's perception of the parenting in the home. The first aim
of this pilot study was to compare parenting efficacy as
reported by both caregiver and child. The second aim was to
determine the relationship between parenting efficacy and
child BMI.
Parenting and Prevention of Obesity
Parents play an important role in obesity prevention.
Children rely on their parents to guide their eating and activity
behaviors. Most obesity prevention studies to date have been
school-based interventions and few have included parents
(Summerbell et al., 2005). Summerbell et al. found that school-
based interventions that focused only on the child did not
significantly improve child BMI. Current evidence suggests
that interventions directed at parents during the child's early
years may have an impact on the prevention of childhood
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
Family-based interventions have been found to be
effective in the treatment of pediatric obesity (Kitzmann &
Beech, 2006). A review of intervention studies treating
obese children found evidence that including parents in
treatment resulted in more benefits than child-alone in-
terventions (Summerbell et al., 2003). A prospective study
followed 150 children from birth to 9.5 years to determine
risk factors for children becoming overweight (Agras,
Hammer, McNicholas, & Kraemer, 2004). Results sup-
ported that child behaviors such as temper tantrums and
difficult behaviors, posed by a highly emotional child, may
lead to overfeeding. It was concluded that family in-
terventions that specifically target parenting skills may be an
effective prevention strategy. A recent review supported the
premise that parents are receptive to some parenting beha-
vioral changes that may promote healthy weight in their
young children (Campbell & Hesketh, 2007). Interventions
focusing on parenting skills that influence modifiable child
behavior have been identified as important prevention
strategies (Agras et al., 2004; Faith et al., 2012).
Furthermore, Birch and Davison (2001) suggested that
effective obesity prevention programs should focus on
providing anticipatory guidance for parents on how to foster
children's preferences for healthy foods. Golan and Crow
(2004) also concluded that parents should be included in
weight related interventions due to their role in establishing
an overall healthy environment that included healthy eating
and activity patterns. Specific parental behaviors, such as
parental role-modeling, parental monitoring, and parental
use of appropriate reinforcement, have been found to be
associated with preschool children's physical activity,
sedentary behavior and dietary patterns (Arredondo et al.,
2006; Spurrier, Magarey, Golley, Curnow, & Sawyer, 2008).
There is a need to develop family based interventions de-
signed to strengthen these parental behaviors to promote
healthy eating and activity in families and children, and to
prevent childhood obesity.
Parenting Self-Efficacy
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-
struct within his social cognitive theory. Bandura (1997)
defines self-efficacy as the self-belief or judgment of one's
ability to carry out a particular course of action. Parenting
could be broadly defined as a set of skills that occur in a
variety of situations, both public and private. Parenting self-
efficacy refers to expectations caregivers hold about their
ability to parent successfully (Coleman & Karraker, 2000;
Jones & Prinz, 2005). Specific skills, such as consistently
setting limits, are used when parenting and can be translated
to guide child eating and activity behaviors.
Kaminski, Valle, Filene, and Boyle (2008) synthesized
the results of 77 evaluations of parent training programs
specifically designed to improve general parenting skills, but
423
not specifically targeted for healthy eating or activity.
Specific program components such as increasing positive
parentchild interactions and emotional communication
skills, teaching parents to use time out and the importance
of parenting consistency, as well as requiring parents to
practice new skills with their children during parent training
sessions were consistently associated with more significant
effects. Program components that had smaller effects
included teaching parents problem solving; teaching parents
to promote children's cognitive, academic, or social skills;
and providing other additional services.
Although parenting influences child behavior, research
focused on the specific influence of parenting on child eating
and activity is limited. Brotman et al. (2012) found that youth
at risk for behavior problems who received a family inter-
vention based on improving parenting skills at age 4 had lower
BMIs as they approached adolescence. Previous studies have
found that specific parental behaviors reflecting control and
discipline, such as parental monitoring and parental use of
appropriate reinforcement, have been associated with pre-
school children's physical activity, sedentary behavior and
dietary patterns (Arredondo et al., 2006; Spurrier et al., 2008).
In addition, it has been speculated that providing children with
healthy eating habits relates to parenting self-efficacy,
specifically control and boundaries (Stenhammar, Sarkadi, &
Edlund, 2007). Control has been identified as a means for
parents, as agents of change, to structure a healthier home
environment for their children (Faith et al., 2012).
Purpose
The purpose of this pilot study was to describe child and
parent perceptions of parenting efficacy in urban and
suburban families participating in the Gift of Health Through
Nutrition and Exercise (GOH) intervention program. In
addition, the relationship between perceptions of parenting
efficacy and child BMI was explored. This is the first known
study that explores the role of parenting efficacy (control and
discipline) as it relates to obesity in children.
Method
This was a descriptive cross-sectional study of parent/
child dyads participating in the Gift of Health Through
Nutrition and Exercise (GOH) program, a healthy eating and
activity intervention study. The data presented here regarding
parenting efficacy were obtained from the data collection
packet and correlated with BMIs gathered from baseline data.
Gift of Health Through Nutrition and Exercise
(GOH) program
The goal of the GOH program was to provide caregiver
school age child dyads with practical information to help
424
increase awareness of healthy eating and activity behaviors
so that more conscious healthy choices to maintain and
control weight may occur in the home environment. The
program was presented in four 1-hour sessions occurring
over 4 weeks. Two sessions focused on healthy eating and
were presented by a registered dietitian. Two sessions
focused on healthy activity and included chair aerobics led
by trained instructors. The nature of this program, which was
presented to caregiverchild dyads, allowed an effective
venue to gather data on parenting efficacy from caregivers
who were predominantly parents, and children collectively.
Procedures and Recruitment
A convenience sample of 27 caregiverchild dyads were
recruited from urban and suburban churches in a major
Midwest metropolitan area to participate in the GOH program.
Inclusion criteria for caregivers consisted of their claim to be
the primary caregiver, reside in the home with the child, ability
to read and speak English, and consent for participation for
themselves and their child. Children were included if they were
between the ages of 7 and 14 years, had the ability to read and
speak English, had parental consent, and agreed to verbal
assent (less than 12 years) or written assent (12 years and
older). If either parent or children did not meet the inclusion
criteria the dyad was excluded. Data were collected from
January 2011 to June 2011. All study procedures including
letters of support from participating churches, protocols for
recruiting participants and obtaining inform consent and
assent, and program curriculum was reviewed and approved
by the appropriate university institutional review board.
Participants were informed of the program through their
churches in a variety of ways including explanations by the
pastor or another church official, flyers, and Web site
announcements. The program was further explained and
questions were answered during the first session by the
principal investigators. At this time, caregiver and child
participants signed the consent and assent forms and each
received a self-administered questionnaire packet to com-
plete. The questionnaire packet contained several instru-
ments including demographic questions and the adapted
Tool to Measure Parenting Self-Efficacy (TOPSE). Height,
weights, and blood pressures were obtained by the co-
principal investigators and three trained data collectors.
Measures
Demographics
Caregivers provided information regarding age, gender,
race/ethnicity, marital status, employment status and level of
education. Children provided information regarding age,
gender, race/ethnicity, and year in school.
Tool to Measure Parenting Self-Efficacy (TOPSE)
An instrument designed to measure specific levels of
parenting self-efficacy for an identified parenting task was
D. Marvicsin, C.A. Danford
chosen. The Tool to Measure Parenting Self-Efficacy
(TOPSE) is a multi-dimensional instrument of nine scales,
each representing a distinct dimension of parenting (Kendall
& Bloomfield, 2005). It has been previously used to measure
the effectiveness of parenting programs by pre and post
testing. There are nine scales in the measure: emotion and
affection, play and enjoyment, empathy and understanding,
routines, control, discipline, pressure, self-acceptance, and
learning and knowledge. Internal reliability coefficients for
the subscales range from 0.80 to 0.89, and the overall scale
reliability is 0.94. This pilot study used only two scales from
the TOPSE, control and discipline.
Control and discipline were identified as key qualities of
parent efficacy, which can be easily translated to guide
healthy eating and activity behavior. Discipline reflects the
action component of efficacy as evidenced by parent con-
sistency in implementing rewards or consequences based on
their child's behavior. Control has two components. One
component reflects parental self-control as measured by
parent response to child behavior. The second component
reflects the child response to the rules. The original items of
the parent self-efficacy tool were modified to measure the
other parent or caregiver in the home. These items were then
adapted to capture the child's perspective of both parents'
efficacy. The original 11 point Likert scale was modified to a
6-point scale (05) for ease of completion.
Child Perception of Parenting Self-Efficacy (C-TOPSE)
The two scales described above, control and discipline,
were adapted to measure perceived parental efficacy from the
child's perspective. The items were modified to ask each
child to rate the parent/caregiver who was participating in the
GOH program. These scales also used a six-point Likert
scale (05). The original items to measure control from the
TOPSE with the matching child perception items for the
participating parent are presented in Table 1. The original
TOPSE discipline items with the matching child perception
items are presented in Table 2.
Participating Parent Perception of Other
ParentControl and Discipline(OP-TOPSE)
In addition, the control and discipline items were modified
for each caregiver to rate the other parent/caregiver living in
the household who was not participating in the GOH program.
Therefore, participating caregivers completed the TOPSE
reflecting not only their own self perception, but also their
perception of the other parent or caregiver in the home.
Child Perception of Other Parent Control and
Discipline(C/OP-TOPSE)
The child's perception of the parent/caregiver who was not
participating in the GOH program was also measured. There-
fore, the child rated both the participating parent/caregiver
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
and child BMI r(27) = 0.49, p = 0.01. No significant
correlations were found between parent self-report of con-
trol or discipline, and child BMI. Likewise, no significant
correlations were found for control or discipline, when the
parent rated the non-participating parent, and child BMI. A
moderate but non-significant relationship was seen for child
report of both participating parent discipline [r(27) = 0.26,
ns] and non-participating parent's discipline [r(23) = 0.31,
ns] and child BMI. Overall the control and discipline of the
non-participating parent as reported by the participating
parent and child were moderately correlated with child
BMI, yet non-significant [parent reported control r(24) =
0.29; parent reported discipline r(22) = 0.24; child
reported control r(23) = 0.29; and child reported disci-
pline r(23) = 0.31].
Discussion
This is one of the few studies to compare child and parent
perceptions of parenting efficacy. Since there is little known
research that addresses parenting efficacy as it relates to
eating and activity behaviors of children, the results of this
study provide unique insight into the phenomena of child-
hood obesity and parenting. Additionally, inclusion of the
child's perception of parenting efficacy provides further
perspective on parenting as it may relate to obesity. Infor-
mation on the participating parent or caregiver and the other
parent or caregiver in the home adds a broader family
perspective in that behavior patterns of family members
contribute to the health and well-being of the total family unit
(McDaniel, Campbell, Hepworth, & Lorenz, 2005).
The first aim of this study was to compare parent and
child perception of parenting efficacy, specifically control
and discipline. The scores for control and discipline sub-
scales were average to high for both parents and children.
Children's scores on the control scale were midrange.
Parents reported higher confidence in their parenting effi-
cacy, perceiving themselves as effective parents more often
than their children. This resulted in a significant difference in
perception between child and parent. The difference in
perception may be explained by the child's more realistic
view of parenting skills. Conversely, the parent's confidence
in their skills may be unrealistically inflated.
In terms of discipline, both parent and child reported higher
efficacy. This may reflect the concrete terminology of the
individual discipline items, such as rules. As stated earlier,
the majority of the participating parents were mothers.
Therefore, the other parent at home was usually the father.
Children tended to rate the other parent as high on the disci-
pline scale, which may reflect traditional societal stereotypes
that children may already be incorporating into their
perceptions of family and gender roles. Another explanation
might lie in the possibility that children may find it difficult to
be honest if their parent is present (Scott, 2008). Thus the
427
participating parent may have been rated more cautiously or
sympathetically than the non-participating parent.
Historically, the measurement of parenting efficacy has
its roots in the behavioral science literature (Coleman &
Karraker, 2000). Parents of children with behavioral concerns
were more likely to report a wider range of confidence in their
parenting skills than parents with children without behavioral
problems. It is possible that these tools are less helpful when
completed by parents in the community who are not
specifically seeking assistance for behavioral concerns with
their children. Parents of children with no behavioral concerns
may tend to report consistently higher confidence in their
parenting skills and a narrow range of scores. Similar to the
findings in this study, one other study of pediatric obesity also
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
connection between parental control and discipline as it
relates to healthy eating and activity patterns seems logical.
If a parent is able to set limits and boundaries easily with
their child then it seems they could also structure the eating
and activity environment in the home. However, no signi-
ficant relationship was found between parental report of
parenting efficacy and child BMI.
In this study, parents rated themselves high on the
control and discipline efficacy scales. This revealed a
ceiling effect in the data that contributed to the lack of a
significant relationship found between parenting efficacy
and child BMI. The cluster of scores at the higher end of
the parenting efficacy scale made data analysis difficult due
to the lack of variation in the data (Vogt, 2005). The lack of
variation could be explained by social desirability in that
parents were providing responses that they think were
expected or that they believe are true. Plus, it can be very
difficult for a parent to admit that they are not adequately
parenting their child (Stenhammar et al., 2007). Another
possible explanation regarding lack of significant correla-
tion between self-report of parenting efficacy and child
BMI may be attributed to the small sample size of this
study. However, although non-significant, the results did
reveal a moderate negative correlation in the relationship
between parenting efficacy and BMI. This suggests that
high parenting efficacy may contribute to lower child BMI.
These results should be interpreted with caution but not
negated. In fact, two long term follow up studies of ran-
domized trials discovered that relative to control, youth at
risk for behavior problems who received a family inter-
vention based on improving parenting skills at age 4 had
lower BMIs as they approached adolescence (Brotman
et al., 2012). Additionally, an association between general
parenting at an early age and its influence on weight
outcomes and health-related behaviors later in life has been
revealed (Sleddens, Gerards, Thijs, DeVries & Kremers,
2011; Berge, Wall, Loth, Neumark, & Sztainer, 2010;
Lohaus, Vierhaus, & Ball, 2009).
428
The possibility that parenting efficacy impacts child BMI
is further supported when child report of parenting was
evaluated. Child report of the participating parent's control
related to child BMI was significant and negatively cor-
related. This suggests that children who rated the partici-
pating parent lower on the control scale (average efficacy
versus high efficacy) had higher BMI's. Previous studies
have found that specific parental behaviors reflecting control,
such as parental monitoring and parental use of appropriate
reinforcement, have been associated with preschool chil-
dren's physical activity, sedentary behavior and dietary
patterns (Arredondo et al., 2006; Spurrier et al., 2008). In
addition as previously stated, children may have a more
realistic view of parenting skills. Therefore, child perspec-
tives should be considered and included when developing
parenting interventions. However, due to lower reliability
scores on the child version of the instrument and small
sample size, this information needs to be interpreted judi-
ciously and requires further study.
Limitations
One limitation of this study was convenience sampling,
which contributed to the higher educated, higher income
level of the sample and was not reflective of the community
at large. This non-random selection procedure may influence
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-
vention is being developed that relies on parents reporting
confidence in their parenting skill, a ceiling effect in their
scores may be noted. Therefore the intervention may not
demonstrate an impact or change in behavior. Although the
child reports were statistically less reliable, the children's
lower overall scores did allow for a relationship between
parenting skill, as defined by control, and high child BMI to
be expressed.
Conclusion
It is well recognized that parenting generally benefits
child development and health (Eshel, Daelmans, de Mello, &
Matines, 2006). Yet, the specific connection between
parenting efficacy and obesity is less established. This
study provides important information related to parenting
and childhood obesity. It contributes to the knowledge of
parenting efficacy as it relates to the prevention of childhood
obesity. In addition the study raises questions on what factors
in the family environment need to be addressed when con-
sidering explanations for overweight and obese outcomes
amongst family members. Parenting self-efficacy skills, such
as use of control and discipline, are factors that need further
consideration in relation to parentchild interactions sur-
rounding eating and activity behaviors.
D. Marvicsin, C.A. Danford
This study not only addresses parenting self-efficacy,
but uniquely brings in a family perspective by presenting
information on efficacy related to the other parent in the
family and most importantly the child's perspective. It
reminds health care providers that data need to be gathered
from more than one family member to determine variations
in perspective that influence health outcome. This em-
phasizes the need to consider a family approach to deve-
loping interventions for research and practice related to
childhood obesity.
Tailoring a family-based intervention is needed to in-
fluence the relationship between parenting and obesity in
children. This is a critical need in the obesity research due to
the interdependent relationship between children and parents
for establishing healthy behaviors. The known risk of
associated health problems related to obesity, such as
diabetes and cardiovascular issues, beginning in childhood
and persisting into adulthood further emphasizes parenting
efficacy and parenting skills as important in the consider-
ation of intervention approaches for clinical practice. Over-
all, the youth of today may have a shorter life expectancy
than their parents unless effective interventions are devel-
oped to reduce obesity. Revisiting and enhancing the
contributions parents make to improve their child's health
may be lead to more effective and sustaining outcomes
related to healthy weight in children.
Acknowledgments
This pilot study was funded by AETNA Foundation. Co-
principal investigators, Cynthia Danford (University of
Pittsburgh) and Feleta Wilson (Wayne State University).
Thelma Phillips, doctoral candidate (Wayne State Univer-
sity), and Celeste Schutz, doctoral student (University of
Michigan) are acknowledged for their help with this study.
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