Eating Behaviors in Infants
Associations Between Working Hours and Parenting Stress in Parents and Eating Behaviors Among Their Infants in Amsterdam
Masterthesis Preventieve Jeugdhulp en Opvoeding Pedagogische Wetenschappen en Onderwijskunde Universiteit van Amsterdam M. Looijen, 12870366 Assessor: Peter Hoffenaar Second assessor: Jokelien van Houten Amsterdam, 26-06-2020
Abstract
Eating behaviors are formed at a young age in which parents play an important role as the main providers of food and guiders of feeding practices. Different factors influence the food choices parents make for their infants, including working hours and parenting stress, which were hypothesized as negative associated with eating behaviors in infants. The aim of the current study was to gain insight in associations between these variables and to show possible mediation effects. 424 parents of twelve-months-old infants took part in the Sarphati Cohort and filled in questionnaires regarding eating behaviors (Child Eating Behavior Questionnaire), parenting stress (Parenting Stress Index- short form) and employment in working hours. By using correlation analysis, analysis of variances and mediation analysis with PROCESS, associations between those variables were studied. Parenting stress was associated with eating behaviors in five out of six subscales, having very weak to weak associations. For working hours, only significant differences were found for the subscale satiety responsiveness in which no mediation was present with parenting stress. The role of parents seems thus small, but still present in the development of eating behavior in infants. Future research should specify employment characteristics and needs to investigate the long-term and causal effects.
“Eating patterns and behaviours in infants and young children are influenced by complex interrelated factors such as cultural beliefs, parental or child interactions and feeding styles, as well as the parent’s or primary caregiver’s education, experiences, attitudes and social and economic circumstances” (Abraham, Godwin, Sherriff, & Armstrong, 2012; p.1705).
Different factors determine the choice for nutrition and eating behaviors (see appendix A)(Rijksinstituut voor Volksgezondheid en Milieu, 2004). Primary caregivers/parents are responsible for the health and well-being of their own children and one of their main tasks is providing food and feeding (Hughes, Power, Liu, Sharp, & Nicklas, 2015). The food choices they make during infancy and the resulting eating pattern have important consequences in the long run (Savage, Fisher, & Birch, 2007), for example in the development of obesity
(Kuźbicka & Rachón, 2013).
Physiological processes (e.g., satiety, hunger) and psychosocial processes (e.g., learned food preferences, self-regulation) influence food choice and eating behaviors (LaCaille, 2013). The social environment also plays an important role, directly as well as indirectly via observing others and internalization of food rules. So, eating behaviors are a complex collection of diverse behaviors (WRR, 2017), in which infants are dependent on their parents’ choices. Parental food choices are likely to be affected by time constraints and available resources (e.g., income), but it is not yet apparent how. On the one hand, working full-time might reduce the time available for child care tasks in general and preparing healthy meals in particular (Heinrich, 2014), which could have undesirable consequences for
children’s health. But, on the other hand, some full-time working schedules may be more family friendly than working part-time and the extra income can be spent on higher-quality foods.
Although combining work and family life could potentially lead to conflict as well as enrichment, full-time working couples with children face the greatest challenges in balancing work and family life. Their solutions or quick fixes for the potentially stressful tasks of integrating their work and family roles are likely to impact the quality of their parenting and family experiences. When work affects parents’ personal family lives via stress, this could result in changes in eating behaviors (Bauer, Hearst, Escoto, Berge, & Neumark-Sztainer, 2012). It might be the case that this also affects eating behaviors in infants. The aim of this study is to gain more insight in how eating behaviors in infants are associated with parenting stress and working hours. For working hours, two groups have been distinguished: dual earner families (i.e., parents who work both >32 hours) and non dual earner families (i.e., parents who do not work both >32 hours). In addition, the aforementioned mediation model in which parenting stress mediates the association between dual earner families and eating behaviors in infants will be tested.
The first thousand days
The time between conception and the second year takes approximately thousand days and can be characterized as a crucial period for brain development, health and growth for infants (Cusick & Georgieff, z.d.). Already in utero, gustatory and olfactory systems emerge and provide early sensory learning for the fetus (Witt & Reuter, 1996). This indicates that prenatal influences on the development of food preferences are likely. What the mother eats during pregnancy provides a foundation for food preferences of the infant later in life (Anzman-Frasca, Ventura, Ehrenberg, & Myers, 2018). In utero exposure could lead to postnatal acceptance of flavors that would be otherwise non-preferred in animals, which possibly can be generalized to humans (Schaal & Orgeur, 1992). This has indeed been found (Mennella, Jagnow, & Beauchamp, 2001) and a more recent study confirmed this by showing increasing familiarity and acceptation of flavours in children over time (Cooke & Fildes, 2011).
It is important to bring the infant in touch with different foods at an early age, because otherwise non-varied eating patterns can arise. From the moment of birth, babies prefer sweet tastes and reject bitter/sour tastes (Steiner, 1979). In the period of 4 months to 3 years of age, food preferences are formed by the infant and new food is relatively easily accepted
(Cashdan, 1994). The infant will go through different phases: sensitive periods of taste (4-6 months), texture (6-12 months) and variety of food (before 20 months). In these windows of opportunity, repeated exposure to a variety of foods will lead to acceptation of new foods. Nevertheless, when a child is not exposed to a variety of food tastes, the risk of neophobia exists: reluctance to eat or the avoidance of new foods (Watson, Costantini, & Clegg, 2020). This is a universal reaction; however, the intensity differs among infants (Nicklaus &
Monnery-Patris, 2018).
Together, these studies emphasize the importance of a varied eating pattern, which is associated with the development of eating behavior of the infant: “a broad term that
encompasses food choice and motives, feeding practices, dieting, and eating-related problems such as obesity, eating disorders, and feeding disorders” (LaCaille, 2013; pp. 641). A varied eating pattern, however, is determined by parents/primary caregivers, who make decisions about food for their infants (Patrick & Nicklas, 2005).
The “how” of eating
Parents not only decide what their infant eats, but they also play a role in ‘how’ the family eats and the subsequent eating behaviors of the infant (Verhage, Gillebaart, Van der Veek, & Vereijken, 2018). Moments during the day when members of a family eat together, family meals (Martin-Biggers et al., 2014), were found to associate with health aspects such as diet quality, reducing obesity and eating behaviors (Hammons & Fiese, 2011; Verhage et al., 2018). However, parents report lack of time because of busy schedules as one of the primary barriers for not having frequent family meals (Rovner et al., 2010).
Those busy schedules may have to do with working hours; the number of two-income households seems to have been steadily increasing in recent years (OECD, 2017). When both parents work, work schedules were found to be the primary obstacle in nutritional habits (Devine, Farrell, Blake, Jastran, Wethington, & Bisogni, 2009). This can be a result of ‘time bind’, the experiencing time pressure and possible negative effects for the quality of family life (Hochschild, 1990), which increases because of work and technology creeps in home lives. This can possibly result in overscheduling for parents and their children.
Compared to part-time and unemployed mothers, full-time employed mothers reported several less healthful aspects of their family food environments (Bauer et al., 2012). This is in contrast with a study among parents in which the role of mothers’ employment has been studied, showing no evidence for an adverse impact of working full-time, part-time or not-working on diets of 11-year old children (Sweeting & West, 2005). Nonstandard not-working hours among parents (i.e. including either one or both weekend days) have been found associated with having more fast food (McIntosh et al., 2011), which was also the case when mother saw her work as more important than other roles. In conclusion, the findings with regard to the role of working hours in the association with eating behaviors are not consistent and research has mostly been restricted by distinguishing mothers from fathers.
The findings above regarding the association between time pressure and family meals indicate that lower levels of involvement and greater withdrawal from feeding situations might be likely in dual earner families, because of more limited time. In this study we test the hypothesis that infants of dual earner families have less favorable eating behaviors compared to infants of non dual earner families.
Parenting stress
Parental employment leads to income which can improve the development of children in many ways (Heinrich, 2014), but it can also have negative effects. It has been found that
when parents of adolescents experience high levels of work-life stress, it is likely that they will have less healthful family food environments (Bauer et al., 2012). In addition, different job characteristics such as high work demands and high levels of work-life stress are less likely to contribute to a healthful diet but more so to frequently skipping meals in parents (Devine, Connors, Sobal, & Bisogni, 2003). So, having a good balance between work and family life seems relevant for having healthy eating behaviors.
When not having a good work-family balance, the experience of work-family conflicts can be a predictor for higher levels of parenting stress (Vieira, Ávila, & Matos, 2012).
Parenting stress, the aversive psychological reaction to the demands of being a parent, differs among parents (Deater-Deckard, 1998). In the Netherlands, 84% of the parents does
experience low levels of parenting stress and 16% of the parents experience mild to very serious problems (Vermulst, Kroes, De Meyer, Nguyen, & Veerman, 2015). A correlational study (Park & Walton-Moss, 2012) found parenting stress negatively correlated with health-related behaviors, including nutrition among children.
The ecological systems theory (Davison & Birch, 2001), which is based on a bi-directional approach to understand eating behavior, states that feeding practices are a result of interactions between parent and child characteristics (Farrow, Galloway, & Fraser, 2009). However, when stressed, the ability of sensitive parenting and the subsequent proper
responding will decrease, which could lead to adjustments in eating behaviors. This has been confirmed by a study among mothers of 16-month old infants: when mothers experienced more parenting stress, less sensitive parenting was found (Pereira et al., 2012). Less ability to perceive and respond to behavioral cues from the infant has also been found among mother with higher levels of stress (Crnic, Greenberg, Ragozin, Robinson, & Basham, 1983).
In addition, the reciprocity between child and caregiver during feeding, defined as ‘responsive feeding’ is important (Black & Aboud, 2011). Conversely, a nonresponsive
feeding practice is characterized by lack of reciprocity, in which the caregiver does not respond properly on the signals of the infant for instance by a lack of involvement or due to being overcontrolling (Shi et al., 2017). Problems in eating behavior among children are associated with nonresponsive feeding at age 2 to 5 years, indicating the need for developing a positive eating behavior at young age (Savage et al., 2007). Summarizing, a likely
explanation might be that less favorable eating behaviors in infants are related to higher levels of parenting stress.
Individual and contextual components in environments influence each other, as stated in the ecological systems theory (Davison & Birch, 2001). Influences of environments on food-choice coping strategies have been elaborated in a conceptual model, taking short-term and long-term adaptive strategies (see Appendix B)(Blake et al., 2009). In this model, affective experiences as well as work conditions can be seen as factors related to eating behaviors in parents respectively as short-term and long-term adaptive strategies. The eating behaviors of infants are not included in these models, which the current study wants to take into account.
The above-mentioned findings can also be indirectly linked to the Family Stress Model (see Appendix C)(Conger & Donellan, 2007). Economic hardship conditions (e.g., low income) are expected to affect family functioning in this model. When working less hours, having economic pressure is more likely and can result in increased risk for emotional
problems for parents. Subsequently, less involvement and affection in parenting are expected, which has the possibility of affecting the well-being of children. This is less likely among dual earner families, because of having two incomes. However, when having a good work-family balance as non dual earner families, it can be hypothesized that parenting stress will be lower and eating behaviors will be less affected in a negative way (Bauer et al., 2012).
Parenting stress can thus be seen in this case as a possible mediator in the association between working hours and eating behaviors.
The current study
Combining all studies, associations between working hours, parenting stress and eating behaviors in infants seem reasonable. Studies have been done among infants and children (e.g., Shi et al., 2017; Sweeting & West, 2005), but none of them focused solely on infants. Also, research has been focusing on the role of mothers and fathers; less is known about them as couple (e.g., Bauer et al., 2012). Furthermore, most research into eating behavior is done in the United States which makes it less generalizable to the Netherlands. Research in the Netherlands among infants is needed, because of the early formation of food preferences and the development of eating behaviors and the subsequent long-term
consequences (Cashdan, 1994; LaCaille, 2013; Watson et al., 2020).
In Amsterdam, a decrease in the number of people that are overweight has been found in 2015 compared to 2012. However, still 18.5% of children 2-18 years is overweight
(Steenkamer, Franssen, Stegeman, & Wachter, 2017). Given the importance of a healthy eating behavior for the development of children (Van de Weerdt, Mortier, & Chiaverini, 2014), it can be seen as societal relevant to start tracking eating pattern and behaviors at an early age. The Public Health Service Amsterdam therefore follows the development of children in Amsterdam, initiated by the Sarphati Cohort, making use of the regular care data as registered by Youth Health Care within the ‘Ouder en kind teams’.
Based on the significant role of caregivers in the first years of life, this study attempts to gain knowledge about eating behavior in infants. This study uses several aspects of eating behaviors in early life, which contributes to a deeper understanding of eating behavior. The current research has two research questions: (1) To what extent is eating behavior in infants
associated with working hours of parents and parenting stress? (2) And does parenting stress mediate the association between working hours and eating behaviors?
It is hypothesized that infants of dual earner families will have less favorable eating behaviors compared to infants of non dual earner families. ‘Time bind’ and busy schedules as a result of more working hours can lead to less healthy food choices and less involvement of parents (Verhage et al., 2018). Moreover, it can be hypothesized that parents with higher levels of parenting stress will show less sensitive parenting, resulting in less favorable eating behaviors for their infants. This hypothesis is supported by considering the ecological system theory, which states that interactions between parents and infants form the feeding practices.
Regarding the second research question, it can be hypothesized that parenting stress mediates the association between eating behaviors and working hours. Work schedules were found to be a primary obstacle in nutritional habits. Also, when having high levels of work-life stress, parenting is likely to be affected, which in turn affects family food environments. Based on the Family Stress Model (Conger & Donellan, 2007) it can be expected that non dual earner families receive less income and therefore might experience more parenting stress. This can affect nurturing and involved parenting, which could result in less favorable eating behaviors in infants.However, for dual earners, a good work-family balance might prevent heightened levels of parenting stress (Vieira, Ávila, & Matos, 2012) and thus contribute as mediator.
Method Design
This study used data collected by the Public Health Service of Amsterdam as part of the Sarphati Cohort. The Sarphati Cohort is a dynamic cohort study on the health and development of children aged 0-18 who receive healthcare within the Youth Health Care
(YHC) system in Amsterdam. Their development is tracked until they reach the age of 18 using standardized measurements, i.e., through consultations provided by YHC and questionnaires. The Sarphati Cohort is setup as part of Sarphati Amsterdam which is a collaboration between the City of Amsterdam and Amsterdam based knowledge institutions. Procedure
The digital records of the YHC contained information about all children aged 0-18 and their parents. These were systematically registered and used for the Sarphati Cohort. After giving consent to participate, additional questionnaires were sent per e-mail to be completed via limesurvey; all data were anonymized.
Participants received the first questionnaire within one week after giving consent. Through this questionnaire, insight in background variables of the parents (e.g. sex, household composition, et cetera) has been gained, but also height, weight, ethnicity, occupation and educational level of both biological parents were recorded. Data derived from this
questionnaire has been used in the current study for background variables. When an infant reached the age of 6, 12, 18, 24, 36 and 45 months, other questionnaires were sent to monitor the development of children. However, the current study used only data from the 12 months questionnaire. This questionnaire consists of questions focused on child daycare services, sleep, nutrition and living environment.
After the participants received the questionnaire per mail, they had the possibility to complete it by using a website link. While answering the questions, parents were able to go back to show their answer or to correct their answer. The questionnaires were only open for a limited time to ensure completion around the specified age of the child, therefore only two reminders to fill in the questionnaire were sent: after seven and after fourteen days. Participants/sample characteristics and size
Parents living in Amsterdam who had completed the 12-month questionnaire between November 2019 and May 2020 were selected (n = 498). Participants who did not complete the questionnaires at 0 were excluded (n = 74), which decreased the total sample size to 424 parents. The questionnaires have been filled in by the biological mother (n = 331) or by the biological father (n = 93). Based on the guidelines of Centraal Bureau voor de Statistiek (CBS, 2016) most of the parents were highly educated, having a college degree or university degree (nperson who filled in questionnaire = 396, 93.4%; npartner = 345, 83.7%).
Materials
The current study used three questionnaires: the number of working hours was collected at baseline, parenting stress and eating behaviors were measured at 12 months. All questionnaires were available in five languages: Dutch, English, French, Spanish and Turkish.
Eating Behavior: CEBQ-T. The Children’s Eating Behaviour Questionnaire for Toddlers (CEBQ-T) is a modified version of the validated parent-report CEBQ (Carnell & Wardle, 2007; Wardle, Guthrie, Sanderson & Rapoport, 2001). The main goal of this questionnaire was to assess eating styles, which has been done by computing means for subscales. Prerequisite for these total scores on subscales is answering the majority of the items of the subscale, which means answering half of the questions of the corresponding subscale (Herle, Fildes, Van Jaarsveld, Rijsdijk, & Llewellyn, 2016).
Six subscales were distinguished in the CEBQ-T, which all needed to be interpreted individually. Food responsiveness consists of the desire to eat regardless how hungry the infant is and assessed appetite (Domoff, Miller, Kaciroti, & Lumeng, 2015; Sleddens,
Kremers, & Thijs, 2008). Enjoyment of food also reflects appetite, but also interest in eating. Satiety responsiveness consists of attending to internal cues of fullness, the ability to regulate intake of food. Slowness in eating assessed the speed of eating, taking a longer time to finish
or consume food. Food fussiness reflects being selective about foods eaten, such as picky eating.
Each subscale contains three to six items, in which parents were asked to rate the eating behavior of their infant on a five-point Likert scale from 1 (never) to 5 (always). The internal consistencies of the subscales can be seen as relatively high with food responsiveness (4 items, α = .77)(e.g., “My child is always asking for food”), emotional overeating (3 items, α = .80)(e.g., “My child eats more when worried”), enjoyment of food (4 items, α = .79)(e.g., “My child loves food”), satiety responsiveness (5 items, α = .77)(e.g., “My child has a big appetite”), slowness in eating (4 items, α = .71)(e.g., “My child eats slowly”) and food fussiness (6 items, α = .87)(e.g., “My child refuses new foods at first).
Dual earner status. Information about employment status for both parents is collected through the baseline questionnaire, in which they were asked to select their job status (see Table 1: Job status). Parents were able to select multiple options in this question. Parents were also asked to fill in how much hours each of them works per week. A distinction between working hours has been made, which includes 32 hours or more per week (1), between 20 and 32 hours per week (2), between 12 and 20 hours per week (3) less than 12 hours per week (4) and no job (99); which is presented in Table 2: Working hours per week. The current study distinguished two groups: dual earner families and non dual earner families. Dual earner families in this study were considered to be parents who both work 32 hours or more (full-time) and non dual families earners consisted of all other possible combination.
K. The Parenting Stress Index, short form (Opvoedingsbelasting Kort, OBVL-K) was used (Vermulst et al., 2015) to measure parenting stress. The OBVL-K consists of 10 questions, using a four-point Likert scale with answer possibilities from 1 (does not apply) to 4 (applies absolutely). The total score retrieved from the questionnaire must be calculated by summing up the scores and be converted into a t-score for the age group, indicating the level
of parenting stress (Vermulst et al., 2015). Consequently, a t-score below 60 can be seen as ‘not having any parenting stress-problems’, a t-score between 60 and 63 as ‘having mild problems’ and a t-score above 64 as ‘having serious difficulties’.
The OBVL-K was filled in by parents when the infant reached one year. Internal consistency of the OBVL-K (α = .86) varies over age groups, but in age group 0-3 years, the reliability found in the literature (α = .85)(Vermulst et al., 2015) and in the current study (α = .84) can be seen as high.
Analysis plan
By performing a correlation analysis, the associations between eating behaviors and parenting stress were studied. Based on the hypotheses, one-tailed tests were performed with an alpha of α = .05, because of the expectation that associations are only in one direction. That is, higher levels of parenting stress are associated with less favorable eating behaviors and not with more favorable eating behaviors.With a sample size of 424 participants, a post-hoc power analysis for correlations in G*Power revealed insufficient power to detect small effect sizes of 0.10 (β = .66) but sufficient power to detect medium effect sizes of 0.30 (β = 1.00)(Field, 2009, p. 58).
To gain insight in the associations with eating behaviors for dual earner families and non dual earner families, Analyses of Variance (ANOVA) were performed in Statistical Package for the Social Sciences 23 (SPSS 23). Because of earlier inconsistent findings
regarding working hours, the current study used two-tailed tests to find any associations, both positive and negative.. A post-hoc power analysis with an alpha of α = .05, divided in two subgroups (ndual earner families = 231; nnon dual earner families = 191) revealed a power of β =.18 with effect size d = .1, which was insufficient to detect those small effect sizes. In contrast, with an effect size of d = .3, there was sufficient power to detect effects (β = .87).
Before running the ANOVA, the following assumptions were checked: (a) normality, (b) levels of the variables, (c) homogeneity of variance and (d) independency. The subsequent ANOVA was two-sided (α = .05) and the null hypothesis assumed no differences between eating behaviors and number of working hours.
To show possible mediation effects with parenting stress, a linear regression was executed. Prior to this analysis, six assumptions needed to be met: (a) having a random sample, (b) variance within the independent variable, (c) homoscedasticity, (d) having a normal distribution, (e) linearity and (f) multicollinearity. After the assumptions had been met, a regression analysis was executed by using the PROCESS-plugin, model 4 (Hayes, 2014). Figure 1 shows an overview of the expected mediation model with dual earner status (X), eating behaviors (Y) and parenting stress (M).
Results Descriptive statistics
The current study showed differences in the extent of parenting stress among parents. By converting raw scores to standardized t-scores for the normgroup 0-3 years, a scoring profile was drawn up for parents (Vermulst et al., 2015). It became clear that 79.7% (n = 338) did not have any parenting stress-problems by having a t-score below 60, 5.4% (n = 23) had mild problems with a t-score between 60-63 and 14.9% (n = 63) had serious difficulties with having a t-score above 63.The participants who filled in the questionnaires were dichotomized into dual earner families in which parents both >32 hours (n = 231) and non dual earner families in which parents did not both work >32 hours (n = 193). When comparing these two groups for parenting stress, no significant differences were found between dual earner
families (M = 51.68, SD = 8.14) and non dual earner families (M = 53.18, SD = 9.74) with (t(422) = -1.72, p = .086).
Association between eating behavior and parenting stress
The results showed that enjoyment of food was negatively correlated to parenting stress (r(422) = -.21, p < .001). This indicates that more stressed parents reported lower enjoyment of eating for their infant, suggesting that parenting stress hinders parents to some extent in stimulating a personal connection with food. Significant positive correlations with parenting stress were found for emotional overeating (r(422) = .11, p = .014), slowness in eating (r(422) = .12, p = .007), food fussiness (r(422) = .23, p < .001) and food
responsiveness (r(422) = .11, p = .015). The results revealed that parents with higher levels of stress reported thus more emotional overeating, slowness in eating, food fussiness and food responsiveness in their infant. These found associations were in line with the stated
hypothesis and suggested less favorable eating behaviors as reported by parents for infants when having higher levels of parenting stress. For satiety responsiveness, no association has been found with parenting stress (r(422) = .08, p = .116). For this subscale, the null
hypothesis stating parenting stress not as associated with parenting stress, was not rejected. With regard to all other subscales - enjoyment of food, emotional overeating, slowness in eating, food fussiness and food responsiveness- the null hypothesis was rejected because of finding less favorable eating behaviors when having higher levels of parenting stress. So, parenting stress associated with five out of six subscales of eating behaviors. Association between eating behavior and working hours
To compare eating behaviors, measured with the CEBQ-T, of the children of dual and non dual earner families, an ANOVA was performed. Being (non) dual earner family could be seen as the dependent variable (X) and the CEBQ-subscales as independent variable (Y)(for an overview of statistics, see Table 3). This ANOVA compared the means of the different eating behavior subscales. No significant differences were found for enjoyment of food (F(1, 422) = 3.60, p = .058, d = .18), emotional overeating (F(1, 422) = .27, p = .601, d = .05),
slowness in eating (F(1, 422) = 2.65, p = .104, d = .16), food fussiness (F(1, 422) = 1.34, p = .247, d = .11) and food responsiveness (F(1, 422) = .01, p = .932, d = .01) when comparing dual earner families with non dual earner families (Table 4). The reported enjoyment of food, emotional overeating, slowness in eating, food fussiness and food responsives of infants does therefore not differ between dual earner and non dual earner families. This means that it is not possible to reject the null hypothesis stating that there are differences in eating behaviors as reported by parents between dual earners and non dual earner families, as less favorable eating behaviors are not found the be associated with either of them.
Dual earner families were found to differ in reported levels for satiety responsiveness in their infant (F(1, 422) = 4.57, p = .033, d = .21). A lower satiety responsiveness score was found for dual earner families (M = 12.41, SD = .19) compared to non dual earner families (M = 13.07, SD = .25). This indicated that dual earner families reported their infant as less good in regulating the intake of food in relation to satiety when compared to non dual earner families. Summarizing, no associations were found for all eating behavior subscales in dual earner families and non dual earner families, except for satiety responsiveness. This indicates that the number of working hours was in general barely associated with the eating behavior of the infant.
Mediation analysis
Because no significant associations have been found between (not) being a dual earner family and all eating behavior subscales except for satiety responsiveness, parenting stress could only serve as mediator in the association between satiety responsiveness and number of working hours (Figure 1). All assumptions are fulfilled for performing a regression analysis by using PROCESS model 4 with number of working hours (X), satiety responsiveness (Y) and parenting stress (M).
When dual earner families were compared to non dual earner families in parenting stress, no significant association has been found (F(1, 422) = 2.97, p = .086, R2 = .01, b = 1.50, t(1,422) = -1.72, CI [-0.21, 3.20]). This indicated no significant differences in parenting stress for dual earners and non dual earner families. Additionally, no significant association was found between parenting stress and satiety responsiveness (b = .02, t(1, 422) = 1,41, p = .160, CI [-0.01, 0.06]). So, parenting stress did not differ for dual earners and non dual earner families and the level of satiety responsiveness seems to not be associated with parenting stress.
By contrast, as could be seen in the ANOVA, the association between number of working hours and satiety responsiveness was significant (F(1, 422) = 4.57, p = .033, R2 = .01, b = .66, t(1, 422) = 2.14, CI[0.05, 1.27]). When taking parenting stress into consideration as possible mediator, the association remained significant (F(1, 422) = 2.01, p = .045, R2 = .02, b = .02, t(1, 422) = 1.41, CI[-0.01, .06])(Figure 2). This indicated a slightly stronger correlation when taking parenting stress into consideration (rparenting stress not as mediator = .10,
rparenting stress as mediator = .12), having more explained variance in the association between satiety
responsiveness when parenting stress was added as possible mediator. These results indicated that dual earner families were found to have an infant with a significantly lower satiety responsiveness score compared to non dual earner families, regardless of having parenting stress as mediator. Concluding, by not showing a decrease when adding parenting stress in the association between working hours and satiety responsiveness, no mediation effect was found.
Discussion
The aim of the current research was to gain insight in the associations between eating behaviors, parenting stress and working hours. This has been done by using data of parents living in Amsterdam and their infant aged 12 months. The current study showed more
beneficial outcomes for infants with parents with lower levels of parenting stress for five out of six subscales of eating behaviors (enjoyment of food, emotional overeating, slowness in eating, food fussiness and food responsiveness). However, parenting stress did not differ for dual earner families and non dual earner families. Satiety responsiveness in infants has been found lower for dual earner families, indicating that dual-earner families reported their infant as less good in regulating the intake of food in relation to satiety when compared to non dual earner families. Parenting stress did not contribute in this association; no mediation and thus no indirect effect was found.
The first research question was aimed at gaining insight in the associations between eating behaviors, parenting stress and dual earner status. Regarding the association between working hours and eating behaviors, it was hypothesized that infants of dual earner families would have less favorable eating behaviors compared to infants of non dual earner families. Busy schedules and the possibility of ‘time bind’ could lead to lower involvement because of more limited time (Hochschild, 1990; Verhage et al., 2018). However, the current study only found a negative association for satiety responsiveness: dual earner families had infants who scored significantly lower on satiety responsiveness compared to non dual earner families. A possible explanation for this result can be found in time spent with infants: it might be the case that non dual earner families have more interactions with their infants. When working less hours, parents could have made the decision to stay home to spend more time with their infant, which possibly made them better in recognizing cues of their infant (Crnic et al., 1983). In addition, non dual earner families were less likely to have busy schedules based on working hours, which possibly removes the barrier to have family meals (Rovner et al., 2010) and therefore leads to more positive eating behaviors (Verhage et al., 2018) such as satiety responsiveness.
The current study did not find associations for working hours with enjoyment of food, emotional overeating, slowness in eating, food fussiness and food responsiveness. Based on the power analysis, the current sample was able to detect medium effect sizes, but not small effect sizes. It might be possible that there were small effect sizes, but it required a sample of 5254 with the same allocation rate to detect those effect sizes. Another explanation for not finding associations in the current study could be found in the definitions of dual earner families and non dual earner families; within the current definition of non dual earner families, the families can consist of stay-at-home mothers/fathers and parents who are both unemployed for example. When distinguishing all possible combinations regarding working hours for the parents, differences could be found in eating behaviors among the different groups. However, it is also possible that there are no associations between those variables. Earlier research showed inconsistent findings regarding the working hours of the mother (Bauer et al., 2012; Sweeting & West, 2005). Less is known about the role of parents
together, which implies the possibility of not having any associations as found in the current study.
In continuation of the first research question, it was also hypothesized that higher levels of parenting stress associated with less favorable eating behaviors in infants. This was found indeed for five out of six subscales: enjoyment of food, emotional overeating, slowness in eating, food fussiness and food responsiveness in infants were reported as less favorable when parents had a higher level of parenting stress. Earlier studies found higher levels of parenting stress associated with less sensitive parenting, less ability to perceive and respond to behavioral cues and nonresponsive feeding (Black & Aboud, 2011; Crnic et al., 1983; Pereira et al., 2012). The role of parenting stress in association with eating behaviors therefore seems reasonable based on earlier studies.
In contrast to the abovementioned five eating behaviors subscales,no association was found between satiety responsiveness and being a (non) dual earner family. Based on the power analysis, it might be the case that a small association could still be present, but this was not detected in the current study. Another possible explanation for this finding can be found in the design of the current study; eating behaviors and parenting stress were measured once. By doing so, moment specific influences could have affected the scores of eating behaviors and parenting stress. In order to obtain the true scores, multiple measuring moments should be used.
Based on classifications of interpreting correlation strengths (Evans, 1996), only enjoyment of food and food fussiness were weakly associated with parenting stress. All other subscales were found to correlate weakly. This indicates coherence, but suggests also the presence of other covariates in the associations. Possible covariates such as siblings (Park & Walton-Moss, 2012) and eating behaviors of parents (Bauer et al., 2012) could also have played a role in the association between parenting stress and eating behaviors, which needs to be studied in further research. Regarding the first research question, the results showed higher levels of parenting stress among parents has been found to be associated with less favorable eating behavior in terms of enjoyment of food, emotional overeating, slowness in eating, food fussiness and food responsiveness. For non dual earner families and dual earner families, only satiety responsiveness in the infant was associated, having higher levels of satiety
responsiveness for non dual earner families.
The second research question focused on the mediation effect of parenting stress in the assumed associations between eating behaviors and working hours. Mediation could only be present when having a significant association between (non) dual earner families (X) and eating behaviors, which was only true for satiety responsiveness (Y). However, when
for this could be found in the influences of the work situation on the family situation: work family spillover (Cho & Tay, 2016). This influence can be negative when parents experience negative feelings at work and express them in their home-setting, decreasing emotional and psychological availability to other family members (Davis, 2008). The influence can also be positive, defined as work-family enrichment (Vieira, Matias, Ferreira, Lopez, & Matos, 2016). Through work experiences parents could perform better in their parental role, which can either directly or indirectly positively influence eating behaviors in their infant
(Greenhaus & Powell, 2006). Because parenting stress has no mediating effect on the
association between being a (non) dual earner family and satiety responsiveness, work-family enrichment seems reasonable since dual earner families did not have heightened levels of parenting stress compared to non dual earners.
Non dual earner families were not having heightened levels of parenting stress, but were found to have infants with more favorable satiety responsiveness. This is not in line with the Family Stress Model (Conger & Donellan, 2007), since parenting stress was not present as mediator and infants were found better in regulating their food intake with regard to satiety. In addition, the findings did not support the food-choice coping model, since being (non) dual earner, eating behaviors and parenting stress were not all three associated. Regarding the research question, it can thus be stated that parenting stress does not mediate the associations between eating behaviors and (not) being a dual earner family.
In contrast to earlier studies, this study focused specifically on parents with an infant living in Amsterdam which gained knowledge about the Dutch situation. This can be seen as strength, because of having this sample, it may lead to generalization to all parents with infants in Amsterdam. The current sample represents the city by having levels of parenting stress almost equal to the population level (Vermulst et al., 2015). By making it possible to fill in the questionnaires in multiple languages, a more diverse population could have been
reached, but the dataset did not provide information about the language in which the
questionnaires were filled in. The current sample further consisted of parents with a relatively high educational level, which is the case for Amsterdam (CLO, 2020). However, the
educational level was higher in the sample than in the population, which indicates having less socio-economic diversity.
Despite the strengths of this study, it is important to bear in mind the limitations. With having a sample size of 424 participants, enough power was present to find medium effect sizes. For detecting small effect sizes, a larger sample was needed. Also, all parents living in Amsterdam could join the Sarphati Cohort. It might be the case that parents who signed up may be more motivated to share the development of their child and thus the sample might not be a (correct) reflection of all parents living in Amsterdam. This indicates the possibility of having a selection bias in the current sample. In addition, all questionnaires were self-reported, which made social desirability bias possible.
Regarding the questionnaires, the CEBQ-T had been used to gain insight in eating behaviors of infants. By using this questionnaire, eating styles in infants were measured as perceived by parents. When taking the definition of eating behaviors in consideration (LaCaille, 2013), not all aspects of eating behaviors were measured in the current study. For example, no insight was gained in healthy food patterns and eating habits. This indicates that an infant still can have favorable eating behaviors as indicated by the CEBQ-T subscales, but eat only high-calory foods.
Finally, by using parents as couples, the current study was limited to one informant who filled in the questionnaires for the family without distinguishing differences in paternal and maternal roles. It might be the case that parents had different views on parenting stress and eating behaviors of their infant, which is not included in the current study.
Based on these weaknesses, it is at first recommended to use both parents as informants to gain a better view of eating behaviors in infants. In addition, background variables such as single-parenthood (Nieuwenhuis & Maldonado, 2018) should be taken into consideration. Single parents might be limited in care, income, time and flexibility, but parental resources in alternative ways can still be provided. Additionally, characteristics of employment such as working nonstandard hours and flexibility in scheduling were not measured and thus not included in the current study, however, these may also be related to parenting stress and eating behaviors (Devine et al., 2003), as they lead for example to different work-family balance.
Also, more information about eating behaviors is required to associate other aspects of eating behavior with working hours and parenting stress. This can be done by gathering data about the frequency and amount of calories in food which is taken, as been done in other studies (e.g., Ten Cate, Huijts, & Kraaykamp, 2013). This, in combination with using a longitudinal design, makes it possible to state causal relations. When also measuring weight status, it might be possible to prevent overweight by tracking the development. It has been stated that the first thousand days are crucial for development (Cusick & Georgieff, z.d.), but recent research criticizes this by stating a too deterministic view about the early years of life (Macvarish, Lee, & Lowe, 2014). When performing longitudinal research, this view can also be tested.
Although further work is required to gain more knowledge about causal links, long term development and better understanding of eating behaviors, the findings of this study indicate an important role of parents in the association with eating behaviors of their infant. The found associations were very weak to weak, but still significant and thus indicating differences. A practical implication based on the findings of this study can be stimulating parents to start at an early age with offering new foods to minimize effects of neophobia at a
later age (Cashdan, 1994; Nicklaus & Monnery-Patris, 2018; Watson et al., 2020). By offering diversity in food, infants get in touch with different tastes, textures and varieties of food which can affect eating behaviors. This might result in having more enjoyment in eating and less food fussiness because of already being known with the foods.
Interventions to promote healthy eating behaviors should focus on decreasing
parenting stress, based on the findings of the current study. Reducing stress can possibly lead to more sensitive parenting (Pereira et al., 2012). This is in line with the ecological systems theory and as can be seen in Appendix B, it might influence other food-choice coping strategies.
Concluding, infants of dual earner families were not found having less favorable eating behaviors as a result of higher levels of parenting stress. Dual earner families were found to have infants with lower scores on satiety responsiveness, but this was not mediated by parenting stress. Based on the findings of the current study, it might be concluded that dual earner families do not have a conflicting work-family balance, which can be concluded from the similar levels of parenting stress among non dual earner families. Parenting stress thus occurs for non dual as well as dual earner families and seems associated with eating behaviors. It might be of popular belief that dual earner families would have less favorable eating behaviors for themselves and for their child. However, the current study shows no differences for dual and non dual earner families, except for satiety responsiveness, and suggest therefore no negative associations for working more hours.
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Tables Table 1 Job status Person completing the questionnaire Partner
Work situation n percentage n percentage
Paid job 385 90.8 386 91.0 No job 15 3.5 12 2.8 Disabled for work 6 1.4 1 0.2 Welfare payment 0 0 0 0 Houseman or -wife 28 6.6 18 4.2 Student 7 1.7 3 0.7
Note. Parents had the possibility to select more than one option, so different combinations are possible.
Table 2
Working hours per week Person completing the
questionnaire
Partner
Working hours n percentage n percentage
>32 279 65.8 346 81.6 20-32 88 20.8 31 7.3 12-20 12 2.8 4 0.9 <12 6 1.4 5 1.2 No job 39 9.2 38 9.0
Table 3
Means, standard deviations and variances Dual earner families (n = 231) Non dual earner families (n = 193) Power
Subscale M SD variance M SD variance β
Enjoyment of food 16.63 2.16 4.66 16.20 2.51 6.28 .47 Emotional overeating 4.94 1.83 3.34 4.85 1.86 3.45 .08 Satiety responsiveness 12.41 2.93 8.57 13.07 3.45 11.88 .56 Slowness in eating 9.85 2.61 6.82 10.29 2.98 8.85 .21 Food fussiness 11.93 3.84 14.77 12.38 4.18 17.48 .05 Food responsiveness 8.81 2.82 7.96 8.83 3.11 9.69
Table 4
Associations between eating behavior and working hours -ANOVA
df F p Enjoyment of food 1, 422 3.603 .058 Emotional overeating 1, 422 0.274 .601 Satiety responsiveness 1, 422 4.565 .033* Slowness in eating 1, 422 2.649 .104 Food fussiness 1, 422 1.341 .247 Food responsiveness 1, 422 .007 .932
Figures
Figure 1. Overview of mediation Number of working hours parent (X) Parenting stress (M) Eating Behaviour (Y)
Figure 2. Mediation model Number of working hours
(X) Parenting stress (M) Satiety responsiveness (Y) c = .66, SE = .31* c’ = .62, SE = .31* b = .02, SE = .02 a = 1.50, SE = .87
Appendices Appendix A: Conceptual model VTV
Appendix B
Appendix C
