Assessing family influence on adolescent healthy eating: insights from knowledge, attitudes, and practices in a cross-sectional survey in Hong Kong

<h4>Background</h4>Poor dietary habits in adolescents contribute to the development of non-communicable diseases in adulthood. While family influence by parenting style, food parenting practice and household income on adolescent eating habits has been well-established, other family factors such as parental health conditions as well as the impact on dietary knowledge and attitudes in adolescents are underexplored. This study aimed to evaluate the relative importance of family factors on adolescent healthy eating using the knowledge, attitudes, and practices (KAP) model.<h4>Methods</h4>A cross-sectional online survey was conducted among parent-adolescent dyads recruited from a previous cohort study and secondary schools in Hong Kong. Adolescent healthy eating was assessed by a locally developed and validated KAP of Healthy Eating Questionnaire (KAP-HEQ). It evaluated knowledge on dietary recommendations, health outcomes and food choice; attitudes on outcome expectation, food preference, and self-efficacy; and practices on meal pattern and healthy/unhealthy food consumption. Parents reported on family factors including their KAP of healthy eating (KAP-HEQ), parenting style (Parenting Style and Dimensions Questionnaire), attitudes towards adolescent eating habit, food parenting practices, and family demographic characteristics such as employment status and household income. Multivariable linear regression was used to estimate the family influence on adolescent healthy eating.<h4>Results</h4>Two hundred seven dyads of parents (mean age = 46.14 years, 85.02% mothers, 80.19% married, 60.87% attained senior secondary education or above) and adolescents (mean age = 15.21 years, 48.31% female) completed the survey. Positive associations were found between dyad knowledge (β = 0.28, p < 0.001), dyad attitudes (β = 0.22, p < 0.001), and between adolescent practices and food parenting practices (β = 0.18, p < 0.001) and parental employment status (part-time vs unemployed: β = 4.08, p < 0.05). Negative associations were identified between adolescent attitudes and authoritative parenting style (β = -0.11, p < 0.05) and household size (β = -3.19, p < 0.05), and between adolescent practices and higher parental education levels (senior secondary or above vs primary or below: β = -2.86, p < 0.05).<h4>Discussion</h4>The study found positive effects of parental dietary knowledge, attitudes, and food parenting practices on adolescent KAP of healthy eating. Interventions to enhance these three family facilitators should be included in strategies for promoting KAP of healthy eating among adolescents.